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Norfolk and Norwich University Hospitals NHS Foundation Trust A star Norfolk and Norwich University Hospitals NHS Foundation Trust Evidence appendix Colney Lane Date of inspection visit: Colney 22 January to 27 February 2019 Norwich Norfolk Date of publication: NR4 7UY 15 May 2019 Tel: 01603 286286 www.nnuh.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 The Norfolk and Norwich University Hospitals NHS Foundation trust consists of the Norfolk and Norwich University Hospital (NNUH) and Cromer and District Hospital, with some services available at other sites across Norwich. The status of foundation trust was achieved in May 2008. The trust is one of the largest teaching hospitals in the country and provides a full range of acute clinical services including more specialist services such as oncology and radiotherapy, neonatology, orthopaedics, plastic surgery, ophthalmology, rheumatology, paediatric medicine and surgery. The Norfolk and Norwich University Hospital (NNUH) is a 1,100-bed teaching hospital with state- of-the-art facilities for modern patient care. It has 998 adult and child inpatient beds across 31 inpatient wards, 154 day case beds, 90 maternity beds and 29 operating theatres (including one Vanguard theatre). The hospital was built in 2001 and is based on the Norwich Research Park. The NNUH provides care for a tertiary catchment area of approximately 1,016,000 people from Norfolk and neighbouring counties across the STP. The trust works closely with the University of East Anglia’s Faculty of Medicine and Health Sciences to train health professionals and undertake clinical research. Cromer and District Hospital is located on the north Norfolk coast and the hospital was redeveloped in a £15 million scheme, opening in March 2012. It has a Minor Injuries Unit and provides a range of outpatient and day-case services. 20190325 Norfolk and Norwich University Hospitals NHS Foundation Trust 1 The trust carries out nearly one million outpatient appointments, day case procedures and inpatient admissions annually. The population served is predominantly the people of Norfolk and north Suffolk, although some patients are referred from further afield in particular to access specialist services available at the trust. (Source: Trust Website/ Routine Provider Information Request- Context Acute) Acute hospital sites at the trust A list of the acute hospitals at Norfolk and Norwich University Hospitals NHS Foundation Trust is below. Details of any Name of acute Geographical area Address specialist services hospital site served provided at the site All CQC acute core services. There is also a dedicated children’s hospital (the Jenny Lind Children’s Hospital) within the hospital. The NNUH provides care for a tertiary Norfolk and Norwich Norfolk and The trust also provides a catchment area of University Hospital, Norwich range of more specialist approximately Colney Lane, University services such as cancer 1,016,000 people from Norwich, Hospital care and radiotherapy, Norfolk and NR4 7UY orthopaedics, plastic neighbouring counties surgery, ophthalmology, across the STP. rheumatology, children’s medicine and surgery, and specialist care for sick and premature babies. The hospital has a minor The hospital is based Cromer Hospital, injuries unit and also in Cromer on the North Cromer and Mill Road, provides a range of Norfolk coast and District Hospital Cromer, outpatient and day-case serves the North NR27 0BQ services. Norfolk population. (Source: Trust Website/ Routine Provider Information Request- Context Acute) Is this organisation well-led? Leadership There had been some significant changes in the executive leadership team. We found that there was a stronger clinical voice and a more cohesive approach from operational and clinical perspectives. However, there continued to be inconsistencies in leadership across the divisions. Not all managers at all levels in the trust had the right skills and abilities to run a service. 20190325 Norfolk and Norwich University Hospitals NHS Foundation Trust 2 At the time of inspection, in February 2019, a complete executive team remained in place. Five of the six executive directors were substantive posts. The chief operating officer (COO) post was interim with recruitment planned for the substantive appointment. The board of directors consisted of six executive directors and seven non-executive directors (NEDs). The Chief Executive Officer (CEO) had been appointed as interim CEO for the trust in August 2015 and had become substantive in November 2015. The chair had been in post since May 2013. There had been several changes in members of the executive team, in the twelve months prior to this inspection, with new appointments of the chief nurse, medical director, chief financial officer and chief operating officer. We found that the chief nurse and chief financial officer both had a wealth of previous experience which meant they had knowledge and skills required to undertake these positions. Both the medical director and the interim chief operating officer were internal appointments, having previously been deputy medical director and divisional operations director respectively. This meant they had previous knowledge of the trust and both were well known to staff. The medical director maintained their clinical commitments. At our previous inspection, published June 2018, we had reported a disparity in the leadership and line management processes for members of the executive team. The executive team was not functioning effectively or cohesively and there was an unproportionate operational focus. We issued three requirement notices (RN) and told the trust it must improve. The RN related to functionality of the board, support for directors, inconsistent processes in recruitment, including steps taken to ensure directors were fit and proper, line management at executive level and oversight and scrutiny by the chair and non-executive directors (NEDs). At this inspection, we found that actions had been taken in respect of these requirements. New appointments had positively impacted the dynamics of the team and the way in which the leaders at executive level functioned. The individual changes in members of the executive team had removed the previous perception of an inner circle and had improved communication amongst the executive directors. The chief nurse and medical director worked well together and had strengthened the clinical voice at board level and clinical concerns were now prominent. The triumvirate working between the chief nurse, medical director and interim chief operating officer appeared to be working well which was a significant improvement. There was a unified approach and we saw a level of healthy, constructive challenge that had improved the balance between operational and clinical leadership and focus. Whilst these changes in appointments had brought improvement and a stability to the board this remained in its early stages. There was a risk to the sustainability of this as further changes at executive board level were due to take place throughout 2019. We were informed that the chair would be retiring in the spring of 2019 when his tenure was complete. The CEO had also taken the decision to leave the trust in the autumn of 2019. The director of workforce had resigned and would be leaving the trust by the summer of 2019 alongside three NEDs, that had also reached the end of their tenure. Succession planning had commenced at the time of our inspection. The initial focus was on the recruitment for the chair and NEDs with chair interview dates scheduled. The director of workforce stated that the process had also meant the opportunity to reaffirm the governors’ responsibilities and status as they appoint the chair. The CEO explained that the early announcement of their intention to leave had been intended to allow the new chair, once appointed, to participate in the recruitment and appointment of the new CEO. 20190325 Norfolk and Norwich University Hospitals NHS Foundation Trust 3 Whilst there were no immediate concerns around technical capabilities of the executive board there was recognition that experience levels varied amongst individuals. For this reason, the board development programme that had started during the last inspection continued. The interviews that were undertaken with each of the executive team confirmed that they all recognised this as important, especially with future changes of the team to come. We reviewed the “board development and strategy development programme 2019/20” report to the trust board, dated 22 February 2019. We noted that this report referenced the risks and challenges associated with the significant turnover in the board membership. It was recorded that at a time of heightened operational, financial and regulatory pressure came an increased importance of giving adequate focus to nurturing the function of the board. Board development actions from the last reporting period and next month were included in this report to document progress and enable board oversight. We reviewed the board development plan itself, dated December 2018, that outlined actions taken following our previous report
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