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Lewisham and Greenwich NHS Trust

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Lewisham and Greenwich NHS Trust Lewisham and Greenwich NHS Trust Evidence appendix High Street Date of inspection visit: Lewisham 25th to 26th September 2018 London SE13 6LH Date of publication: 11th January 2019 Tel: 0208 333 3000 www.lewishamandgreenwich.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 hospitals at the trust is below. Name of acute hospital site Address Geographical area served Royal Borough of Greenwich Queen Elizabeth Hospital in Stadium Rd, Woolwich, and the London Borough of Woolwich London SE18 4QH Bexley Lewisham High St, London London Borough of University Hospital Lewisham SE13 6LH Lewisham Some services at; Frognal Ave, Sidcup DA14 London Borough of Bexley Queen Mary’s Hospital in Sidcup 6LT 20171116 900885 Post-inspection Evidence appendix template v3 Page 1 The trust specialises in a range of services listed below: • Children's services • Clinical support services • Corporate services • Community services • Critical care • Elderly care • Emergency services • Maternity services • Medical conditions • Sexual health • Surgical services (Source: https://www.lewishamandgreenwich.nhs.uk/about-us) The trust provides a comprehensive range of services to approximately 526,000 people in the boroughs of Lewisham, Greenwich and Bexley. It runs a range of community services in Lewisham and has some services at Queen Mary’s Hospital in Sidcup. Community services in Greenwich are provided by Oxleas NHS Foundation Trust. The trust has 840 inpatient beds and 43 day care beds. There are 38 inpatient wards and the trust employs approximately 6,100 staff. In 2016/17 the trust had a deficit of £62.5m and the draft plan for 17/18 has a target deficit of £53.1m. The 2011 census found that a quarter of the population in Lewisham, Greenwich and Bexley were aged 19 or under. Bexley has the highest percentage of people aged 65 or over. In Lewisham, 46% of the overall population are from black, Asian and minority ethnic (BAME) groups, compared to 38% in Greenwich and 18% in Bexley. The last comprehensive inspection of the trust was in March 2017 and raised concerns in a number of services. As a result we took regulatory action, which included serving requirement notices. A focussed inspection in May 2018 found some improvements in the services we inspected (medicine at University Hospital Lewisham and Queen Elizabeth Hospital and surgery at University Hospital Lewisham) but, it was noted there was still much work to be done. The trust was subject to an investigation by NHSI into the trust’s financial situation September – October 2017. The investigation was triggered by a number of concerns including the trust’s compliance with NHSI financial and workforce policies, the trust boards’ understanding of the drivers of the trust’s deficit and whether it had a credible plan to address the drivers. The report was published in November 2017 and following the trust’s response in December 2017 NHSI closed the formal investigation in February 2018. Is this organisation well-led? Leadership Board Members Of the executive board members at the trust, 12.5% were British Minority Ethnic (BME) and 50.0% were female. 20171116 900885 Post-inspection Evidence appendix template v3 Page 2 Of the non-executive board members 37.5% were BME and 62.5% were female. Staff group BME % Female % 12.5% 50.0% Executive directors 37.5% 62.5% Non-executive directors 25.0% 56.3% All board members (Source: Routine Provider Information Request (RPIR) – Board Diversity tab) We carried out a comprehensive inspection in March 2017 and following that inspection a new chair was appointed (had previously been a non-executive director) followed by a new chief executive officer (CEO) and chief nurse (CN) in April 2018. An interim director of finance and recovery (DoFR) had recently been appointed. Although new to the trust, the CE, CN and interim DoFR had significant NHS experience. The medical director had been in post for several years and balanced the executive role with clinical responsibilities, which was a significant workload. There were plans to improve support for the medical director with the recruitment of deputy medical directors with dedicated time for responsibility for individual areas such as workforce and quality and safety. The CN was also the director for infection prevention and control (DIPC) and the executive lead for end of life care and shared responsibility for quality and safety with the medical director. The chief operation officer (COO) role had been dissolved and was in the process of being replaced by three roles who would all report to the CEO: Director of performance and recovery – interim post holder at time of inspection with plans to make a substantive appointment. Director of service delivery – interim post holder at time of inspection with plans to make a substantive appointment. Director of strategy - focusing on the Sustainable and Transformation Partnership (STP) for south east London, ‘Our Healthier South East London’. The director of strategy joined the trust in 2010 and had a joint remit for planning alongside the DoFR. The director of workforce and education (DWE) had been in post for several years. The non-executive director (NED) body had a similar turnover with the appointment of three new non-executives in 2018. Five of the non-executives had a background in finance. The chair of the trust’s audit committee was transitioning to one of the new NEDs who was a qualified accountant, and the chair of the finance and performance committee had an MBA in finance. At the time of the inspection the trust was made up of five clinical divisions which were: Acute and emergency medicine Children and young people Long term conditions and cancer Women and sexual health 20171116 900885 Post-inspection Evidence appendix template v3 Page 3 Surgery and critical care Community services were not a standalone division but were included in the appropriate divisions. It was proposing to review the size of the divisions to ensure more consistent size in terms of staffing numbers and budget.. There were also plans to establish a business support function for each division led by a business manager. The aim of the restructure was to create a flattened hierarchy and clarify roles and responsibility to allow for more devolved decision making and time for leadership development The proposed divisional structure is below: Lewisham medicine and community Queen Elizabeth medicine Surgery Women and children Diagnostics and therapies Leadership of the divisions were also changing to a structure headed up by a divisional director supported by a director of nursing and allied health professionals and a clinical director. Finance business partners sat alongside the divisional leadership teams. The divisional director would ultimately be responsible for the operational and financial performance of the division. As the structure was being implemented it was difficult to gauge the effectiveness of these changes. Although some medical staff had attended a senior leadership and a new consultants programme, the medical director was looking at a further senior leadership and aspiring leadership programme for consultants’. Medicines optimisation within this trust was well led. The leadership staff in the pharmacy department were visible and ensured that medicines optimisation strategy plans were discussed in team meetings The trust had leads for safeguarding children and vulnerable adults. Child and adolescent mental health was provided by the local mental health trust for each hospital. It was the same arrangement for adults who presented at the hospitals with mental health problems. Through various interviews, there was a consistent view of collective responsibility and of appropriate challenge between executives. However, as the new board formed, there was a question as to how the NEDs ensured their role of “critical friend” was balanced with the need to support the executive team. There was a clear enthusiasm for the changes being made by the new board. Senior managers, clinicians, executives and non-executives we spoke with were positive about the recent and proposed changes, even though some of them were still in progress, and how they would help the trust move forward. We found senior managers, nurses and medical staff were involved in decision making through attendance at the trust management executive (TME) meetings. This involvement had been strengthened since April 2018 and staff were positive about this change and welcomed the opportunity to be part of the discussions and engage with the executive team. We were told the new executive team had really ‘inspired people’ and staff ‘looked forward to the CEO’s social media interactions’. The CN was described as having ‘liberating nursing staff to take responsibility and be accountable and to find ways to balance quality and safety’. There was a programme of board visits to clinical areas and staff were positive about these visits and told us they found the executives and non-executives approachable. 20171116 900885 Post-inspection Evidence appendix template v3 Page 4 The trust’s leadership team were aware of the challenges facing them and the top risks for the trust. Along with finance, the recruitment and retention of staff and improvement to the estate was crucial to them being able to bringing about sustained improvement. At the inspection in March 2017 we found concerns with the trust’s was compliance with the Fit and Proper Persons Requirement (FPPR).
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