Calderdale and Huddersfield NHS Foundation Trust
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Calderdale and Huddersfield NHS Foundation Trust Evidence appendix The Royal Infirmary Date of inspection visit: Acre Street, Lindley 6 March to 5 April 2018 Huddersfield West Yorkshire Date of publication: HD3 3EA 20 June 2018 Tel: 01484342000 www.cht.nhs.uk This evidence appendix provides the supporting evidence that enabled us to come to our judgements of the quality of service provided by this trust. It is based on a combination of information provided to us by the trust, nationally available data, what we found when we inspected, and information given to us from patients, the public and other organisations. For a summary of our inspection findings, see the inspection report for this trust. Facts and data about this trust Acute hospital sites at the trust A list of the acute hospital and community sites at the trust is below. Name of acute Address Details of any Geographical area hospital site specialist services served provided at the site Calderdale Calderdale Royal Hospital, Surgery, Urgent and Calderdale & Royal Hospital Salterhebble , HX3 0PW emergency service, Huddersfield Services for children and young peoples, Gynaecology, Maternity, Medical care (including cardiology), Adults Community, Children, Young People and Families Huddersfield Huddersfield Royal Surgery, Urgent and Calderdale & Royal Infirmary Infirmary, Lindley, HD3 emergency service, Huddersfield 3EA Services for children and young peoples, Gynaecology, Maternity, Medical 20171116 900885 Post-inspection Evidence appendix template v3 Page 1 care (including older people's care), Adults Community, Children, Young People and Families Broad Street NHS at Broad Street Adults Community, Calderdale Plaza Plaza, Northgate, Halifax, Children, Community HX1 1UB sexual health St Johns Health Lightowler Road, Gibbet Adults Community, Calderdale Centre Street, Halifax, HX1 5NB Todmorden Lower George Street, Adults Community, Calderdale Group Practice Todmorden, OL14 5RN Community sexual health Acre Mills Acre Street Huddersfield Lindley Maternity Services, Huddersfield Outpatients HD3 3EA (Source: Routine Provider Information Request Calderdale and Huddersfield NHS Foundation Trust is an integrated trust. It provides acute and community health services. The trust serves two populations; Greater Huddersfield which has a population of 248,000 people and Calderdale with a population of 205,300 people. The trust operates acute services from two main hospitals; Calderdale Royal Hospital and Huddersfield Royal Infirmary. The trust has approximately 800 beds and 6,000 staff. Calderdale and Huddersfield NHS Foundation Trust provides the following acute core services: Urgent and emergency care, medical, surgical, maternity, gynaecology, critical care and children’s and young people’s services, end of life care and outpatient and diagnostic imaging services. The community health services for adults and end of life care are provided from the acute hospital sites and local health centres. These include St Johns Health Centre, Todmorden Health Centre and Broad Street Plaza. The community sexual health service is based at Broad Street Plaza in Halifax. There are two satellite clinics based in Todmorden and Brighouse. The trust saw over 102,000 inpatient admissions between January 2017 and December 2017. There were also over 601,310 outpatient attendances in the same period. There were over 150,000 accident and emergency attendances, 5,361 babies delivered and 1,632 patient deaths in the same period. We inspected the trust in March 2016 and visited Huddersfield Royal Infirmary, Calderdale Royal Hospital, Community services including adult community services, community services for children, young people and families and community end of life care. We rated the trust as requires improvement overall. We rated safe, effective, responsive and well led as requires improvement and caring was rated as good. We rated the Huddersfield Royal Infirmary and Calderdale Royal Hospital as requires improvement and community services as good. We found the trust was in breach of regulations and issued four notices which required the trust to develop an action plan for how they would comply with the regulations where breaches had been found. 20171116 900885 Post-inspection Evidence appendix template v3 Page 2 The trust has a financial turnover of £365m. The trust did not achieve its financial plan for 2017/18. The trust reported a deficit of £47.68m for 2017/18. This was £17.83m below the planned deficit of £29.84m. The Trust made savings in line with its cost improvement programme, however did not meet the stretch target set by the regulator of a further £2m. The Friends and Family Test was launched in April 2013. It asks people who use services whether they would recommend the services they have used, giving the opportunity to feedback on their experiences of care and treatment. The trust scored better than the England average for recommending the trust as a place to receive care for most of the time period from December 2016 to November 2017. Is this organisation well-led? Leadership Of the executive board members at the trust, 14.0% are Black and Minority Ethnic (BAME) and 37.5% are female. Of the non-executive board members there were no BAME members and 25.0% were female. Staff group BME % Female % Executive directors 14.0% 37.5% Non-executive directors 0.0% 25.0% All board members 6.3% 31.3% (Source: Routine Provider Information Request (RPIR) – Board Diversity) The trust board consisted of: The Chair (appointed in April 2018) Chief Executive Officer (appointed in May 2012) Director of Nursing / Deputy Chief Executive (appointed in June 2016) Medical Director (appointed in July 2014) Chief Operating Officer (appointed in January 2016) Director of Finance (appointed in November 2017) Director of Planning, Estates and Facilities (appointed in May 2006) Director of Workforce and Organisational Development (appointed in February 2018) Seven Non-executive Directors The trust board had the appropriate range of skills, knowledge and experience to perform its role. The board of directors’ portfolios covered all key areas. There had been a stable leadership team with most board members in place since the last inspection. The director of finance and director of workforce and organisational development had been appointed within the last six months. The new chair commenced employment in April 2018 and there was a handover process in place with the outgoing chair. The director of nursing was also the governance lead for the trust and was supported by the assistant director for quality and safety. The trust also had appointed a director of transformation and partnerships in 2013, who had overall responsibility for the trust’s reconfiguration plan but was not an executive voting member of the board. 20171116 900885 Post-inspection Evidence appendix template v3 Page 3 The non-executive directors were knowledgeable, competent and had the appropriate skills and experience relevant to their roles. They had worked in leadership and management positions in the NHS, education, voluntary and private sectors. They had a background in a range of areas including business planning, law and accountancy. The non-executive directors provided appropriate challenge and were positive about trust leadership. They demonstrated a clear awareness of the financial challenges faced by the trust and were clear that patient care and safety took priority over financial performance. Senior leaders demonstrated an understanding of the priorities and challenges facing the trust, such as financial performance, workforce and the realisation and delivery of the trust reconfiguration plan. These challenges were articulated in the strategy and operational plan and were also recognised in the corporate risk register and Board Assurance Framework. The leadership team were able to describe how they addressed patient safety and quality performance risks. However, we found that individual executive and non-executive directors did not have a collective view on addressing the key challenges the trust faced including financial performance and the delay to the trust reconfiguration plan. We carried out checks to determine whether appropriate steps had been taken to complete employment checks for executive and non-executive directors in line with the Fit and Proper Persons Requirement (FPPR) (Regulation 5 of the Health and Social Care Act (Regulated Activities) Regulations 2014). This regulation ensures that directors of NHS providers are fit and proper to carry out this important role. We looked at six executive and non-executive director employment files, which were completed in line with the FPPR regulations. The council of governors approved the appraisal process for the chair and non-executive directors. Performance appraisals for non-executive directors went to the nominations and remuneration committee, which held meetings on an annual basis. There was a structured competency based recruitment process for senior directors and the trust used an external recruitment organisation to produce detailed reports to help inform recruitment and selection. Newly appointed executive and non-executive directors underwent formal induction, which included mandatory training and a local induction plan specific to their role. The workforce strategy was launched in January 2017 and this identified leadership development and succession planning as a key activity. There were processes in place for leadership development and succession planning across