Meeting of the Governing Body Agenda Item 11

Title of Paper Quality and Patient Safety Report for September 2015. What the Governing Body is being asked For information and discussion to decide or approve The report includes a review of quality performance by providers:

 James Paget University Hospitals NHS Foundation Trust (JPUH).  East Coast Community Healthcare (ECCH).  Norfolk and Norwich University Hospitals NHS Foundation Trust (NNUH). Executive Summary  Norfolk and Suffolk NHS Foundation Trust (NSFT).  Norfolk Community Health & Care (NCH&C).  Integrated Care 24 (IC24).  East of England Ambulance Service NHS Trust (EEAST).  An update on Infection Prevention & Control Performance.  GYW CCG Complaints.  Care Homes and CQC status of other registered providers.

Risks attached to this proposal/initiative: Not applicable Resource implications: None

Name Cath Gorman Job Title Director of Commissioning and Quality, Chief Nurse Date 15th September 2015

of 52 1.1 James Paget University Hospital (JPUH)

1.2 Friends and Family Test (FFT) for Inpatients, A&E and Maternity Services:

July 2015 Total Total Response % % Not Area Response Eligible Rate Recommended Recommended s A&E 818 5409 15.1% 91% 3%

Inpatients 980 6160 15.9% 97% 1% Maternity – Not 228 Not Available 98% 1% Antenatal Care Available Maternity – 77 151 51% 95% 3% Birth Maternity – Not 69 Not Available 97% 1% Postnatal Ward Available Maternity – Not Postnatal Community 108 Not Available 100% 0% Available Provision

June 2015 Total Total Response % % Not Area Response Eligible Rate Recommended Recommended s A&E 806 5029 16% 91% 4%

Inpatients 1164 5686 20.5% 96% 1% Maternity – Not 105 Not Available 95% 2% Antenatal Care Available Maternity – 78 155 50.3% 97% 3% Birth Maternity – Not 49 Not Available 94% 6% Postnatal Ward Available Maternity – Not Postnatal Community 107 Not Available 98% 2% Available Provision

For further information, the following link shows the full range of results for FFT by region, Trust, Site and Ward: http://www.england.nhs.uk/statistics/statistical-work-areas/friends-and- family-test/friends-and-family-test-data/

1.3 Care Quality Commission (CQC)

The CQC undertook a planned inspection at JPUH week commencing 10 August 2015. Publication of the inspection report is awaited.

1.4 Patient Safety Indicators Published on NHS Choices From June 2014, all NHS providers are expected to upload and publish data about their nurse staffing levels on their public website. In addition you can also see how hospitals perform on patient safety on NHS Choices. These include how hospitals recognise and report problems with safety, how well they are fulfilling their nurse staffing requirements or if the staff would recommend the hospital to their own family or friends. The August 2015 position for JPUH is below. The nurse staffing metrics continue to report that only 91% of planned nursing staff was in place; however this is an improved position and the Trust continues to actively recruit locally, nationally and internationally. It should be

of 52 noted that the Trust is reporting against their enhanced established levels which surpass NICE guidance.

1.5 Mixed Sex Accommodation (MSA)

There was one Mixed Sex Accommodation incident during June 2015 and two Mixed Sex Accommodation incidents during July 2015. All of the incidents occurred in acute cardiology ward.

For the incident in June, a patient who no longer required the higher level of care delivered in the acute cardiology ward, stayed stay in that ward as there was no suitable capacity in a more appropriate ward for the patient’s condition.

In each instance in July, a patient required a high acuity of care and the wards where this would normally be delivered were full to capacity with no other patients suitable to be transferred to another ward. They were therefore admitted to the acute cardiology ward which was a safe place for the specialist care to be delivered.

Serious Incidents (SIs) / Never Events

Serious Incidents reported:

Apr May Jun Jul Aug 2015 2015 2015 2015 2015 8 5 6 4 4

No new Never Events have been reported by the Trust since July ’14.

SIs that currently remain open (as at 01.09.15) pending investigation are noted within the following table:

SI number Category Current Status IGI/3074 Information Governance Currently under investigation 2015/17162 Delayed Diagnosis Currently under investigation 2015/23317 Grade 3 Pressure Ulcer Currently under investigation 2015/25262 Grade 3 Pressure Ulcer Currently under investigation 2015/26163 Grade 3 Pressure Ulcer Currently under investigation 2015/26771 Grade 3 Pressure Ulcer Currently under investigation

of 52 The GY&W CCG Patient Safety and Clinical Quality Committee continue to identify SIs to be reviewed in more detail. This focuses on completed RCAs and details behind any delays in submission.

1.6 World Health Organisation (WHO) Surgical Checklist

The Trust continues to audit compliance in operating theatre settings with the WHO Surgical Checklist on a monthly basis and results are received on a 6 monthly basis at the Quality Meetings. The April ‘15 results showed an overall figure of 99.6% compliance.

1.7 Quality Issue Reporting (QIR)

QIRs reported:

1.7.1 Open / Closed / Void

From 1st October 2014 to 1st September 2015, 13 QIR remain open pending investigation, 110 QIR have been closed, 7 QIR have been voided and 8 are pending closure.

1.7.2 Open QIR reported in 2014/15/16:

QIR Ref Date Source of QIR Description of Concern Status 17/12/201 Cutlers Hill Pending JPUH/251 Community bed capacity. 4 Surgery closure 14/01/201 Under JPUH/268 ECCH Poor care and support. 5 investigation 10/03/201 High Street Pending JPUH/298 Medication error. 5 Surgery closure Chet Valley 02/04/201 Pending JPUH/306 Medical Poor discharge summary. 5 closure Practice 20/04/201 Under JPUH/316 Park Surgery No discharge summary or instruction for care. 5 investigation Norfolk 29/04/201 Pending JPUH/319 Community Poor communication and handover. 5 closure Health & Care 14/05/201 Cutlers Hill Under JPUH/323 Incorrect discharge summary and record keeping. 5 Surgery investigation 02/06/201 Under JPUH/326 ECCH Locked box containing patient records found in a public area. 5 investigation 10/06/201 Pending JPUH/328 Park Surgery Medication issues. 5 closure 18/06/201 Under JPUH/330 IC24 Medication issues. 5 investigation 22/06/201 Norfolk County Pending JPUH/332 Poor discharge communication and planning. 5 Council closure 22/06/201 Beccles Pending JPUH/333 Delayed referral. 5 Medical Centre closure 15/07/201 Alexandra Road Under JPUH/336 Potential inappropriate discharge. 5 Surgery investigation 15/07/201 King Street Under JPUH/338 Information Governance. 5 Surgery investigation 14/07/201 Pending JPUH/339 IC24 Anti-coagulation issue. 5 closure

of 52 QIR Ref Date Source of QIR Description of Concern Status 29/07/201 Bridge Road Under JPUH/340 Medication error. 5 Surgery investigation 10/08/201 Bridge Road Under JPUH/343 Assessment and treatment delay. 5 Surgery investigation 20/08/201 High Street Under JPUH/344 Minor procedure delay. 5 Surgery investigation 03/08/201 Under JPUH/345 NCHC 5 Information governance and management. investigation 24/08/201 High Street Under JPUH/346 Anti-coagulation issue. 5 Surgery investigation 27/08/201 Under JPUH/347 Park Surgery 5 No patient identifiable information. investigation

The QIR reporting process between JPUH and ECCH has been adapted to ensure that issues are raised directly and immediately. This ensures that concerns are dealt with at the time of the incident and that timely feedback is provided more directly to those involved in an incident to reduce quality issues from occurring.

1.8 Infection Prevention & Control

The ceiling of maximum c-difficile cases within JPUH for 2015/16 has nationally been determined as no more than 17 avoidable cases.

The Trust reported 4 cases in July and 2 cases in August 2015. Of the 15 cases reported this year, in 12 of these cases it has yet to be determined if these were avoidable and where learning opportunities can be identified. An example of this for cases previously reviewed relates to antibiotic prescribing; as a result the Trust is investing in software to assist with improving compliance for antibiotic prescribing.

1.9 Stroke Performance (January 2015 – June 2015)

Standard Target Jan Feb ‘15 Mar ‘15 Apr ‘15 May ‘15 Jun ‘15 ‘15 4 hours direct to 90% 91.9 78.1 85.7 82.5 88.9 75.6 Stroke Unit 90% of time on 80% 92.3 78.1 83.7 76.2 92.6 87.8 the Stroke Unit 60 minutes to 50% 50.0 48.6 55.2 65.9 53.9 63.4 scan Thrombolysed 12% 16.2 13.8 3.1 10.0 8.3 within 3 hours Thrombolysed 12% 19.1 20.7 3.1 15.0 16.7 The CCG does not currently have access to more up to date performance information for stroke.

1.10 Cancer Target Performance (January 2015 – July 2015)

Preventing people from dying prematurely:

Breast symptoms urgent referral to first outpatient appointment (Target – 93%) Target is to achieve a 14 day maximum wait from GP referral to first outpatient appointment with patients with any breast symptoms except suspected cancer. Jan Feb Mar Apr May Jun Jul Aug Sep

of 52 100 96.77 100 95.8 96.8 100 93.3

Cancer urgent referral to first outpatient appointment (Target – 93%) Target is to maintain a 14 day maximum wait from urgent GP referral to first outpatient appointment for all urgent suspected cancer referrals. Jan Feb Mar Apr May Jun Jul Aug Sep 97.9 97.9 97.4 96.9 97.2 97.3 96.7

Cancer 2 week wait - Monitor combined Breast and urgent referral target (Target – 93%) Performance Target is to achieve a 14 day maximum wait from GP referral to first outpatient appointment for both patients with any breast symptoms and also urgent suspected cancer referrals Q4 (14/15) Q1 (15/16) Q2 (15/16) Q3 (15/16) Q4 (15/16) Met Met Cancer urgent referral to treatment 62 day target (Target – 85%) Performance Target is to achieve a maximum waiting time of 62 days from urgent referral to treatment for all cancers Jan Feb Mar Apr May Jun Jul Aug Sep 85.7 93.42 78.5 80 75 85.29 83.8

Cancer urgent referral to treatment from cancer screening services (Target – 90%) Target is to achieve a maximum time of 62 days from screening services referral to treatment. Jan Feb Mar Apr May Jun Jul Aug Sep 90 96.67 90.9 94.7 100 91.3 100

Cancer urgent referral to treatment – Consultant upgrade (Target – 85%) Target is to achieve a maximum waiting time of 62 days from Consultant upgrade to treatment. Jan Feb Mar Apr May Jun Jul Aug Sep 80 100 72.7 100 85.7 100 100

Cancer urgent referral to treatment all 62 day pathways - Monitor target (Target – 85%) Performance Target is to achieve a maximum waiting time of 62 days from urgent referral to treatment for all cancers across all 62 day pathways combined. Q4 (14/15) Q1 (15/16) Q2 (15/16) Q3 (15/16) Q4 (15/16) Met Failed Cancer diagnosis to treatment waiting times – 31 day target (Target – 96%) Target is to ensure a maximum waiting time of 31 days from diagnosis to treatment for all cancers. Jan Feb Mar Apr May Jun Jul Aug Sep 98.8 100 100 97.1 97.1 100 100

Cancer diagnosis to treatment waiting times – Surgery (Target – 94%) Target is to ensure a maximum waiting time of 31 days from diagnosis to subsequent treatment of surgery. Jan Feb Mar Apr May Jun Jul Aug Sep 100 100 100 100 100 100 100

Cancer diagnosis to treatment anti-cancer drug regimen (Target – 98%) Target is to ensure a maximum waiting time of 31 days from diagnosis to subsequent treatment or anti-cancer drug regimen. Jan Feb Mar Apr May Jun Jul Aug Sep 100 100 100 100 100 100 100

Cancer diagnosis to treatment all 31 day pathways - Monitor pathway (Target – 98%) Performance Target is to achieve a maximum waiting time of 31 days from diagnosis to treatment for cancer across all 31 day pathways combined. Q4 (14/15) Q1 (15/16) Q2 (15/16) Q3 (15/16) Q4 (15/16) Met Met

of 52 Cancer is a priority quality standard for the CCG and enhanced scrutiny is being placed on the acute providers to ensure delivery of these key safety standards.

1.11 Pressure Ulcers

Both JPUH and ECCH continue their local CQUIN Indicator in 2015/16 which requires both organisations to track patients with pressure ulcers within the Great Yarmouth and Waveney locality. Progress against these CQUIN local indicators is monitored by the CCG and at relevant monthly meetings with both organisations.

1.11 Slips, Trips and Falls (April 2014 to June 2015)

JPUH and ECCH continue to work collaboratively to identify and intervene where patients are at risk of falling.

1.12 Summary Hospital-level Mortality Indicator (SHMI)

JPUH have been identified, in recently published figures, as having a “higher than expected” SHMI for the period January 2014 to December 2014 with a SHMI of 1.13. The SHMI relates to patients who have died in hospital or within 30 days of discharge. The SHMI is the ratio between the actual number of patients who die following hospitalisation at the trust and the number that would be expected to die on the basis of average England figures, given the characteristics of the patients treated there.

Several actions are underway in the JPUH, led by the Medical Director, to review a large number of patient records to understand why deaths have occurred and the clinical pathways involved.

of 52 2.0 East Coast Community Healthcare (ECCH)

2.1 Serious Incidents (SIs)

SIs that currently remain open (as at 01.09.2015) are all being investigated within the contractual time-frame. These are noted within the following table:

SI number Category Current Status

2015/13287 Grade 3 Pressure Ulcer Currently under investigation 2015/15411 Fall Currently under investigation 2015/18273 Grade 3 Pressure Ulcer Currently under investigation 2015/25292 Information Governance Currently under investigation 2015/27305 Grade 3 Pressure Ulcer Currently under investigation 2015/27315 Grade 4 Pressure Ulcer Currently under investigation 2015/27582 Grade 3 Pressure Ulcer Currently under investigation 2015/28075 Grade 3 Pressure Ulcer Currently under investigation

QIRs reported against ECCH:

From 1st October 2014 to 1st September 2015, 1 QIR remains open, 1 QIR has been voided and 9 QIRs are pending closure.

The following QIR are open:

Source of QIR Ref Date Description of Concern Status QIR ECCH/02 Pending 20/01/15 JPUH Poor patient care and monitoring. 2 closure ECCH/02 Pending 20/01/15 JPUH Poor patient care and monitoring. 3 closure ECCH/02 Pending 06/02/15 JPUH Poor referral management and planning. 4 closure ECCH/02 High Street Poor clinical assessment relating to District Nursing Pending 11/05/15 8 Surgery care. closure Nelson ECCH/03 Under 04/06/15 Medical Poor communication relating to the ECCA service. 0 investigation Practice ECCH/03 Cutlers Hill Pending 06/08/15 Community bed capacity. 4 Surgery closure

of 52 Source of QIR Ref Date Description of Concern Status QIR ECCH/03 High Street Pending 20/08/15 Community nursing capacity. 5 Surgery closure ECCH/03 High Street Poor communication and community nursing Pending 20/08/15 6 Surgery capacity. closure ECCH/03 High Street Pending 20/08/15 Poor communication between services. 7 Surgery closure ECCH/03 High Street Pending 20/08/15 Clinical test delay. 8 Surgery closure

2.3 ECCH Quality Data

2.3.1 Pressure Ulcers

PU Grade Jan Feb Mar Apr May Jun July ONE 2 0 4 3 5 6 8 District Nurses 2 0 3 0 5 6 7 Inpatients 0 0 0 0 0 0 0 Admission 0 0 0 0 0 0 1 Prevention TWO 55 49 72 78 63 58 58 District Nurses 48 45 62 66 53 48 55 Inpatients 7 4 7 10 8 9 3 THREE 8 16 11 21 15 17 17 District Nurses 8 13 9 18 15 15 14 Inpatients 0 2 1 3 0 2 3 FOUR 2 3 3 4 0 0 4 District Nurses 2 2 2 2 0 0 3 Inpatients 0 1 1 2 0 0 0 Lowestoft Out of 0 0 0 0 0 0 1 Hospital Team

Not all of these pressure ulcers have developed whilst under the care of ECCH; however the Trust continues to report and investigate them. Safeguarding referrals are made to the local authorities, where appropriate. Two of the Grade 4 Pressure Ulcers reported in July 2015 developed out of ECCH’s care; one reported by the District Nursing Service and one reported by the Lowestoft Out of Hospital Team.

ECCH have implemented on-going staff training in relation to pressure ulcer management which is being developed within the new role of the Tissue Viability Nurse Specialist. ECCH has also offered training to staff in local Care Agencies. In addition ECCH continue to lead on the implementation of a pressure ulcer prevention plan across the health care system.

Note: August data was not available at the time the report was published.

2.3.2 Inpatient Falls

2.3.2 Recorded Patient Falls in Inpatient Areas

of 52 A number of initiatives continue underway in ECCH in the on-going prevention and management of falls. This includes:  Development of a falls training pack for use with staff  Exploring the potential benefit of additional assistive technology  Purchase of two new low-rise beds for Northgate Hospital

2.4 Care Quality Commission (CQC)

Beccles Hospital

The CQC inspected Beccles Hospital, on 15 August 2014 and judged the provider to be non- complaint with outcome 16 (assessing and monitoring the quality of service provision). The level of non-compliance was judged to have been at a ‘Moderate Impact’ and therefore action was needed.

The CQC have now re-inspected the hospital on 25th August 2014 and the outcome of this is awaited.

The ceiling of maximum c-difficile cases with ECCH for 2015/16 has been locally agreed as no more than 4 avoidable cases.

ECCH has reported 2 cases this year. Of these one has been agreed as unavoidable as it occurred even with best clinical practice being in place. In the other case it has yet to be determined whether it was avoidable.

3.0 Norfolk & Norwich University Hospital (NNUH) 3.1 Serious Incidents (SIs) for GYW patients

3.2 Never Events

One Never Event was reported by the Trust in June ’15 within the ophthalmology department but this was not a GYW patient.

3.3 Quality Issue Reporting (QIR) for GYW patients

Open / Closed / Void

of 52 From 1st October 2014 to 1st September 2015, 11 QIRs remain open pending investigation, 1and 1 QIR has been voided.

The following QIR are open and relate to GY&W patients:

QIR Ref Date Source of QIR Description of Concern Status High Street No notification of procedure NNUFT/378 18/11/14 Under investigation Surgery to GP.

NNUFT/379 20/11/14 ECCH Poor referral details. Under investigation

NNUFT/380 24/12/14 ECCH Poor discharge. Under investigation Failure to receive test NNUFT/381 24/12/14 ECCH Under investigation results.

NNUFT/382 06/01/15 ECCH Inappropriate discharge. Under investigation

Cutlers Hill NNUFT/383 12/02/15 Medication prescription delay. Under investigation Surgery

Inadequate issuing of disposal NNUFT/384 16/03/15 ECCH Under investigation equipment.

NNUFT/385 10/04/15 Park Surgery Medication issues. Under investigation

Cutlers Hill Incorrect advice given regarding GP NNUFT/386 06/05/15 Under investigation Surgery responsibilities.

Cutlers Hill NNUFT/387 22/05/15 No discharge summary. Under investigation Surgery

No drug chart was sent with NNUFT/388 11/08/15 ECCH Under investigation medication.

Delays in responding to QIRs by the Trust has been raised by the CCG Director of Commissioning and Quality within the NNUH CQRM.

3.4 Patient Safety Indicators published on NHS Choices

The August 2015 position for NNUH published on NHS Choices is below. To note, the CQC standards are not met as a result of previously reported non-compliance.

The nurse staffing metrics report that 97% of planned nursing staff were in place.

3.5 Friends and Family Test

of 52 July 2015 Total Total Response % % Not Area Responses Eligible Rate Recommended Recommended A&E 634 7781 8.1% 95% 3%

Inpatients 996 13679 7.1% 96% 2% Maternity – Not Not 17 94% 0% Antenatal Care Available Available Maternity – Birth 39 516 7.6% 100% 0% Maternity – Not Not 52 100% 0% Postnatal Ward Available Available Maternity – Postnatal Not Not 12 100% 0% Community Provision Available Available

June 2015 Total Total Response % % Not Area Responses Eligible Rate Recommended Recommended A&E 576 7290 7.9% 93% 3%

Inpatients 1279 13173 9.7% 96% 2% Maternity – Not Not 30 97% 0% Antenatal Care Available Available Maternity – Birth 44 464 9.5% 100% 0% Maternity – Not Not 56 98% 2% Postnatal Ward Available Available Maternity – Postnatal Not Not 30 100% 0% Community Provision Available Available

3.6 Stroke Performance

The Trust stroke performance remains below the required standard.

Standard Target Oct Nov Dec Jan Feb Mar Apr May Jun July Aug Sept ‘14 ‘14 ‘14 ‘15 ‘15 ‘15 ‘15 ‘15 ‘15 ‘15 ‘15 ‘15 4 hours direct 90% 71.4 84.5 72.4 71.4 67.7 69.9 76.9 80.9 71.4 to Stroke Unit 90% of time on 80% 74.7 86.2 84.7 66.7 76.6 83.7 79.1 69.8 75.9 the Stroke Unit 60 minutes to 90% 89.2 87.5 84.3 88.0 77.8 90.3 85.2 88.1 88.1 scan Door to needle time of 60 70% minutes for all 71.4 83.5 81.5 88.9 100 98.9 77.8 66.7 90.9 eligible thrombolysis

*The above data is included within the Trust’s Contractual and Key Performance Indicators reported to Trust Board on a monthly basis. No further data is provided by the Trust to the Lead Commissioning CCG.

3.7Cancer Target Performance

Maximum waiting time of 31 days for subsequent treatments for all cancers – Surgery (Target – 94%)

Q1 Q2 Q3 Q4

of 52 88.7%

Maximum waiting time of 31 days for subsequent treatments for all cancers – Anti-Cancer Drugs (Target – 98%) Q1 Q2 Q3 Q4 99.0%

Maximum waiting time of 31 days for subsequent treatments for all cancers – Radiotherapy (Target – 94%) Q1 Q2 Q3 Q4 98.5%

Maximum waiting time of 62 days for subsequent treatments for all cancers – GP Referral (Target – 85%) Q1 Q2 Q3 Q4

Maximum waiting time of 62 days for subsequent treatments for all cancers – Consultant Screening Service (Target – 90%) Q1 Q2 Q3 Q4 93.8% 2 week wait from referral to date first seen – All Cancers (Target – 93%) Q1 Q2 Q3 Q4 94% 2 week wait from referral to date first seen – Symptomatic Breast Cancers (Target – 93%) Q1 Q2 Q3 Q4 97.9%

The CCG has raised concerns about cancer performance and monitors GYW patient pathways on a weekly basis with intervention as required. The CCG now attends the Cancer PTL meetings and bi-weekly outcomes review meeting led by the lead commissioner. The CCG has been clear in our dissatisfaction with poor cancer performance.

3.8 Monitor Investigation

Monitor commenced a formal review of NNUH, with particular attention on breaches in C.Difficile, A&E 4 hour standard, Referral To Treatment and some cancer standards. The Trust has been found to be in Breach of their Licence.

Monitor published the outcomes of their investigation and particularly noted the need for improvements in A&E performance, cancer standards, RTT, leadership and governance. The formal notifications are published and can be found within the following hyperlinks:

Enforcement undertakings issued 24th April 2015 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/425078/Norfol k_and_Norwich_Enforcement_Undertakings.pdf

Additional Licence condition issued 29th April 2015

of 52 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/425073/Norfol k_and_Norwich_Additional_Licence_Condition.pdf

Monitor is continuing to work with the Trust in making sustainable improvements towards both performance and financial recovery.

3.9 CQC

The CQC undertook an unannounced responsive inspection in March ‘15.

Typically the CQC would publish their report to determine whether the Trust is considered Outstanding, Good, Requires Improvement or Inadequate across the five key elements of the inspection; that is whether the Trust is:  Safe  Effective  Caring  Responsive  Well Led

However the CQC published a partial report on 21st May with narrative information about their findings into the three services they reviewed, Urgent & Emergency Services, Medical Care and Surgery. This was followed by a further report on 11th June which determined that the hospital was not meeting its legal requirements, namely Regulation 17 HSCA (RA) Regulations 2014 Good governance. That is that “systems and processes were not established and operated effectively to enable the provider to assess, monitor and improve the quality and safety of the service provided or to mitigate the risks relating to the health safety and welfare of service users and other who may be at risk”.

Although there is no determination of the ratings for these services, the CQC are scheduled to undertake a full planned inspection in November 2015.

The initial report that is published can be found at the following hyperlink: http://www.cqc.org.uk/sites/default/files/new_reports/AAAC3296.pdf and the follow-up report at http://www.cqc.org.uk/sites/default/files/new_reports/AAAC3295.pdf

3.10 Referral To Treatment (RTT)

The CCG is concerned about Referral to Treatment (RTT) waiting times at the NNUH and continues to work closely with the lead commissioner, North Norfolk CCG, and the Trust to gain assurance regarding GY&W patients.

4.0 Norfolk and Suffolk NHS Foundation Trust (NSFT)

4.1 Care Quality Commission (CQC) and Monitor

The Care Quality Commission (CQC) has undertaken an inspection of the Trust using the CQC’s new methodology and overall has judged NSFT to be Inadequate.

CQC Inspection Area Ratings Safe Inadequate Effective Requires Improvement

of 52 Caring Good Responsive Requires Improvement Well-led Inadequate

This has resulted in the Trust being placed in Special Measures.

NSFT has developed a comprehensive improvement plan and is being managed by Monitor who has appointed an Improvement Director within the organisation. Monthly Stakeholder Meetings continue with the Trust, which the CCG attends, where the Trust is required to present an updated position against the agreed improvement plan. NSFT has placed the improvement plan within the Trust’s Project Management Office structure, mapped against the CQC’s five domains.

NSFT has also developed a dashboard cross referenced to the whole of the improvement plan which has been submitted for review to the lead commissioner, SNCCG.

4.2 Serious Incidents / Never Events for GYW patients

4.2.1 Current Open Serious Incidents (SIs) reported for GY&W CCG patients:

SIs that currently remain open (as at 01.09.2015) are all being investigated within the contractual time-frame. They are noted within the following table:

SI Number Category Current Status 2014/26274 Fall Currently under investigation 2014/33818 Unexpected Death of Inpatient (in receipt) Currently under investigation 2015/1398 Allegation against HC non-Professional Currently under investigation 2015/7458 Serious Incident by Outpatient (in receipt) Currently under investigation 2015/14996 Unexpected Death of Community Patient (in receipt) Currently under investigation 2015/18525 Accident whilst in Hospital Currently under investigation 2015/21371 Serious Self-Inflicted Injury (inpatient) Currently under investigation 2015/22206 Unexpected death of Inpatient (in receipt) Currently under investigation 2015/23487 Fall Currently under investigation 2015/24197 Medication Incident Currently under investigation

There are 2 QIR’s pending closure.

QIR Ref Date Source of QIR Description of Concern Status

NSFT/210 06/08/15 High Street Surgery Medication prescribing delay. Pending closure

NSFT/211 28/08/15 Park Surgery Clinical assessment delay. Pending closure

4.4 GYW Patients Placed Out of Area by NSFT

As at 10th September 2015, 12.00 there were 15 patients placed outside of the NSFT geographical area, 1 of these was a GYW patient.

NSFT have had 1 case of c-difficile this year which was unavoidable. At the review it was identified that previous learning from a prior case last year had been fully embedded and implemented.

5.0 Norfolk Community Health & Care (NCH&C)

5.1 Serious Incidents

5.2 Quality Issue Reporting (QIR) for GYW patients

NCH&C have reported 1 C-Diff case in 2015-16 for a GYW resident. This has been reviewed with the CCG and it has been agreed this is a non-trajectory case.

6.0 Integrated Care 24

6.1 Serious Incidents

There has been 1 SI reported by IC24 in 2015/16, reported in June ‘15.

From 1st October 2014 to 1st September 2015, 4 QIR remain open pending investigation, 11 QIRs have been closed and 1 is pending closure.

of 52 Source of QIR Ref Date Description of Concern Status QIR IC24/029 06/01/2015 ECCH On call doctor delay. Under investigation IC24/031 06/01/2015 ECCH On call doctor delay. Under investigation IC24/038 29/06/2015 EEAST Inappropriate call transferring. Under investigation Change in requirement for a procedure not IC24/039 30/06/2015 JPUH Pending closure communicated to patient. IC24/040 01/07/2015 ECCH Medication delay. Under investigation

6.3 Clinical Quality and Patient Safety Report

IC24 has been developing a dashboard and revising the format of the monthly Clinical Quality and Safety Report to ensure that sufficient assurance is provided regarding trends and theme analysis, lessons learned and shared, and to present an equitable approach between OOH and 111 issues.

6.4 Annual Quality Assessment

The Annual Quality Assessment is a Statutory Requirement for which IC24 provides an annual report. This report is conjoined with a Work / Audit Plan which is monitored at the monthly Quality Meetings.

In September a new process has been implemented between IC24 and the Microbiology laboratory to improve the management and treatment of C-diff and Glutamate dehydrogenase (GDH) positive cases identified out of hours. This is in place across the whole of the Norfolk and Great Yarmouth and Waveney Health systems.

7.0 East of England Ambulance Service NHS Trust (EEAST)

7.1 SIs for GY&W Patients There have been three SI’s for GY&W CCG in 2015/16 to 15th September 2015. The SI that currently remains open is as below:

SI Number Category Current Status 2015/26269 Non conveyance Currently under investigation There have been no Never Events from 1st April 2015 to 20th August 2015.

7.2 Performance

Indicator Name Item Apr-15 May -15 Jun-15 Jul 15 Actual 84.5% 83.3% 72.4% 73.2%

Plan 75.0% 75.0% 75.0% 75.0% Category A Red 1 responses ≤ 8 >8 min 11 10 16 22 minutes <8 min 60 50 42 60

Total 71 60 58 82

of 52 Actual 78.3% 75.7% 70.4% 70.2%

Plan 75.0% 75.0% 75.0% 75.0% Category A Red 2 responses ≤ 8 minutes >8 min 247 277 341 340 <8 min 892 861 810 802 Total 1139 1138 1151 1142 Actual 96.1% 96.7% 93.9% 93.5%

Plan 95% 95% 95% 95% Category A19 responses ≤ 19 minutes >19 min 46 39 73 79

<19 min 1161 1156 1129 1135

Total 1207 1195 1202 1214

Whilst EEAST steadily improved on performance in response times in GY&W CCG over the last year (2014-15), and in April and May 2015 achieved the plan for Category A Red 1 and 2, and Category A19 responses, over the last 2 months there has been a deterioration in performance.

On 14th September 2015, the consortium Co-ordinating Commissioner, Ipswich and East CCG, issued a contractual performance notice to EEAST on behalf of all 18 consortium CCG’s. This relates to the current and forecast performance on two key standards, Category Red 2 and Category Red 19. A remedial action plan for these is in discussion and has yet to be agreed. The actions for these should also have a positive impact on Category Red 1, which whilst being smaller numbers, is marginally not reaching standard in GYW CCG. Actions which are already in place with EEAST are a Hospital Liaison Officer is to be appointed for JPUH; there is a GP based in the Emergency Operations Centre who gives advice to crews on scene which is resulting in fewer conveyances; student paramedic recruitment continues and a number of staff are being up-skilled.

7.3 CQC position

EEAST were inspected by the CQC in December ‘13 and to date has had no further inspections. The outcomes of this inspection were:

 Non-Compliant for Outcome 4 – Care and welfare of people who use services (Moderate Impact).  Compliant for Outcome 11 – Safety, availability and suitability of equipment.  Compliant for Outcome 12 – Requirements relating to workers.  Non-Compliant for Outcome 13 – Staffing (Moderate Impact).  Compliant for Outcome 14 – Supporting staff.  Compliant for Outcome 16 – Assessing and monitoring the quality of service provision.  Compliant for Outcome 17 – Complaints.

7.4 Quality and Patient Safety

EEAST has developed a Quality and Patient Safety Strategy which was launched in July 2015. This is centred upon the five pledges set out in the Sign up to Safety Initiative.

8.0 Healthcare Associated Infections (HCAI)

of 52 In the event of C-diff cases being assessed following Root Cause Analysis that they are either unavoidable (with evidence of excellent practice) or a recurrence, cases can be reviewed and, if appropriate, can be considered to not count within the local trajectory. The case reviews that are successful will still be included in the national numbers, however not for the purposes of performance management.

Root cause analysis is undertaken on every single case and opportunities for learning are shared, reviewed within the local CDI case review team and learning incorporated within the local system wide CDI improvement plan. An up-date of this plan is due to be received at the Joint Infection Control Committee on 24th September. This provides an over-arching forum to ensure best practice is shared across the local GYW CCG health system.

8.1 Clostridium Difficile 2015/16

The GY&W CCG C. Difficile Infection (CDI) trajectory for 2015/16 is 70 cases.

From April to September 15th 2015, there have been 50 reported cases. Accountability for the cases is as follows:

 18 cases James Paget University Hospital (including 2 NNCCG cases) – 3 cases have been reviewed and are trajectory and 15 have still to be reviewed.

 27 cases GY&W Primary Care – 1 case is trajectory, 7 cases are non trajectory and remainder to be reviewed. Of the non-trajectory case learning has been noted with the out-of-hours service with antibiotic prescribing and communication between services.

 1 case Norfolk & Suffolk Foundation Trust – non-trajectory.

 2 cases East Coast Community Healthcare –1 case non trajectory and 1 case to be reviewed.

 1 case Cambridge University Hospitals Foundation Trust – non trajectory.

 1 case Norfolk and Norwich University Hospital – case to be reviewed.

of 52 8.2 MRSA

There has been 1 case of MRSA bacteraemia identified in the JPUH this year. On Post Infection Review (PIR) it was determined that this was most likely a ‘contaminant’ and not an MRSA bacteraemia.

9.0 GYW Complaints

The CCG has 3 Complaints outstanding from 2014-15 and has received 20 Complaints for the period 1 April to 31 August 2015. Details of these cases are as follows:

April ’15: Seven complaints received but only four investigations commenced as consent for three of the complaints was not received until May ‘15. All four complaints have been closed.

Receive Response Working Upheld / Not Upheld / Primary Complaint d Date Days Partially Upheld 01/04/15 24/04/15 15 CHC Assessment Upheld

09/04/15 24/04/15 11 CHC Assessment Upheld

13/04/15 22/06/15 49 CHC Care Upheld

21/04/15 26/05/15 23 IC24 (OOH) Not upheld

May ‘15 Three investigations commenced following receipt of the consent from the patient. One Complaint remains ongoing. The time taken in closing the Patient Transport complaint (EEAST) was due to our not receiving a signed response and having to chase for this. The IC24 (111) case was due to further questions being raised by the CCG on receipt of the response from IC24 and the delay in receiving the reply to the further questions.

Receive Response Working Upheld / Not Upheld / Primary Complaint d Date Days Partially Upheld 04/05/15 Ongoing James Paget Hospital Patient Transport Services 05/05/15 10/07/15 47 Not upheld (EEAST) 14/05/15 07/08/15 59 IC24 (111) Partially upheld

June ‘15 Six complaints were received in June, four have been closed and two are ongoing. One complaint was closed with no investigation as consent was not received. The time taken for

of 52 the closure of the James Paget response was due to us not receiving the response from the James Paget, the complainant was advised of the delay.

Receive Response Working Upheld / Not Upheld / Primary Complaint d Date Days Partially Upheld 04/06/15 Ongoing James Paget Hospital

08/06/15 04/09/15 62 James Paget Hospital Partially upheld

16/06/15 29/06/15 9 CHC Retrospective Claim Partially upheld

17/06/15 Ongoing Multi-agency

26/06/15 Closed n/a IC24 (111) Consent not received

30/06/15 27/07/15 18 CHC Retrospective Claim Partially upheld

July ‘15 Three complaints were received in July, one is ongoing and the other two have been closed, both were enquiries from Members of Parliament and responded to directly by the Chief Executive on an informal basis.

Receive Response Working Upheld / Not Upheld / Primary Complaint d Date Days Partially Upheld 21/07/15 Ongoing CHC Care

30/07/15 03/08/15 2 CHC Assessment n/a

17/07/15 23/07/15 4 CHC Care Not upheld

August’15 Four complaints were received in August, three are ongoing. One was an enquiry from a Member of Parliament and responded to directly by the Chief Executive on an informal basis.

Receive Response Working Upheld / Not Upheld / Primary Complaint d Date Days Partially Upheld James Paget Hospital and 10/08/15 Ongoing CHC Assessment 24/08/15 25/08/15 1 Commissioning n/a

24/08/15 Ongoing NNUH

27/08/15 Ongoing IC24 (OOH)

9.1 Common Themes

Complaints associated with Continuing Healthcare (CHC) continue to be the main theme in particular regarding the assessment process, care provided and retrospective claims. We have also seen an increase in the number of complaints made directly to the CCG regarding the James Paget University Hospital. We have also received complaints regarding IC24

of 52 who provide the 111 and Out of Hours service and EEAST regarding patient transport services.

The enquiries from Members of Parliament have been responded to directly by the Chief Executive on an informal basis but logged as complaints for monitoring.

 With regard to the CHC assessment process, the CHC Team are continuing their process of delivering an extensive training programme to hospital and community nurse colleague, this process is ongoing.

 Communication also remains an issue and the CHC Team has drafted a leaflet so patients and their representatives are given written information on how the NHS CHC process is delivered locally.

 Representative expectations remain a significant challenge to the team. The team are experiencing increasing episodes of conflict when discussing eligibility and care packages.

 Discussions are ongoing within the team to discuss ways in which it would be possible to check out the understanding of the process to be followed by patients and their representatives.

 The Retrospective claims also remain a source of complaint but due to the overall complexity of the continuing healthcare system, meticulous checking of all information at every stage of the process is required to ensure that a fair and reasoned decision is made for all claimants. Unfortunately, this does mean that claims can take a long time to process. The CCG has allocated an experienced nurse on a time limited basis within the CCG CHC team to quality check the work undertaken by the CSU to ensure process and outcome is correct.

 Complaints received regarding the James Paget Hospital relate to the care provided and discharge.

 Complaints regarding Integrated Care 24 (IC24) relate to the 111 service and in particular the lack of call back from the provider and the out of hours service at the James Paget Hospital.

All complaints associated with CHC are investigated and overseen by the Head of Quality in Care. The Director of Commissioning and Quality also reviews all complaints and responses to ensure optimal opportunities for learning and improvement.

10.0 Care Provider CQC Overview

The CQC publish the compliance status of all registered providers on their website; however this is not available in a dashboard in order to be able to review the position across all of the providers. The full table of all care homes and domiciliary care providers in Great Yarmouth and Waveney is presented.

of 52 The following provides explanation of the symbols used by the CQC found within the Appendix tables:

This means that the standard was being met in that the provider was compliant with the regulation. This means that the standard was not being met in that the provider was non-compliant with the regulation. People who use the service experienced poor care that had an impact on Min their health, safety or welfare or there was a risk of this happening. The impact was not significant and the matter could be managed of resolved quickly. This means that the standard was not being met in that the provider was non-compliant with the regulation. People who use the service experienced poor care that had a significant Mod effect on their health, safety or welfare or there was a risk of this happening. The matter may need to be managed of resolved quickly. This means that the standard was not being met in that the provider was non-compliant with the regulation. People who use the service experienced poor care that had a serious current Maj or long term impact on their health, safety or welfare or there was a risk of this happening. The matter needs to be resolved quickly. If the breach of the regulation was more serious, or there have been several or continual breaches, the CQC have a range of actions that they take using the criminal and/or civil procedures in the Health and Social Care Act (2008) and relevant regulations. These enforcement powers include issuing a warning notice; restricting or suspending the services En a provider can offer, or the number of people it can care for; issuing fines and formal cautions; in extreme cases, cancelling a provider or managers registration or prosecuting a manager of provider. These enforcement powers are set out in law and mean that they can take swift, targeted action where services are failing people.

The CQC has changed the methodology used when inspecting services. The CQC inspectors use professional judgement, supported by objective measures and evidence, to assess services against five key questions: Are they safe? You are protected from abuse and avoidable harm.

Your care, treatment and support achieves good outcomes, helps you to Are they effective? maintain quality of life and is based on the best available evidence. Staff involve and treat you with compassion, kindness, dignity and respect. Are they caring?

Services are organised so that they meet your needs. Are they responsive to people’s needs? The leadership, management and governance of the organisation make sure Are they well-led? it's providing high-quality care that's based around your individual needs, that it encourages learning and innovation, and that it promotes an open and fair culture.

The CQC also rate services. These ratings will help people to compare services and will highlight where care is outstanding, good, requires improvement or inadequate. This approach has been developed by the CQC over time and through consultation with providers, stakeholders, care professionals, the public, and people who use services.

of 52 The tables to display the results have been separated to distinguish between the services which have been inspected using the new methodology and the services which are yet to be inspected using the new methodology.

Care and Residential Homes (New Methodology) – Page 28 Care and Residential Homes (Pre-existing Methodology) – Pages 31

GP Practices, Acute Hospitals, Mental Health & Community Services (New Methodology) – Page 35 GP Practices, Acute Hospitals, Mental Health & Community Services (Pre-existing Methodology) – Page 37

O Outstanding G Good (No action required) R.I Requires Improvement I Inadequate Key:

10.1 Current Significant Concerns about Care Providers

The Dell, Oulton Broad, Lowestoft (run by Wellbeing Care Limited):

The CQC have undertaken a number of inspections this year which have resulted in a number of concerns. The most recent inspection has determined that the provider ‘requires improvement’.

Overall rating for this service Requires Improvement

Domains

Is the service safe? Requires Improvement

Is the service effective? Requires Improvement

Is the service caring? Good

Is the service responsive? Requires Improvement

Is the service well led? Inadequate

As a result of their inspections, the CQC raised seven Safeguarding alerts with Suffolk County Council.

Wellbeing Care Support Services, Oulton Broad, Lowestoft (run by Wellbeing Care Limited):

The service provides personal care and support to adults with a learning disability who live in flats owned by the provider. The provider was inspected on the 2nd April 2015 and the report

of 52 was published on the 12th June 2015 in which it stated that the provider was being placed into Special Measures. The CQC undertook a focused inspection of Wellbeing Support Services on 21 July 2015. This inspection was completed to check that people were safe after they had received information of concern. They also checked that improvement to meet legal requirements planned by the provider after the 2 April 2015 inspection had been made.

Overall rating for this service Inadequate

Domains

Is the service safe? Requires Improvement

Is the service effective? Inadequate

Is the service caring? Requires Improvement

Is the service responsive? Inadequate

Is the service well led? Inadequate

Salisbury Residential Home, Great Yarmouth (run by Dr Nagpal and Partners):

The CQC undertook an unannounced inspection using the new methodology on 26 November ’14 for which the final report was published on 26 January ’15.

The CQC deemed Salisbury Residential Home to be Inadequate overall and rated that the Residential Home needed to make improvements across all five domains as follows:

Overall rating for this service Inadequate

Domains

Is the service safe? Inadequate

Is the service effective? Requires Improvement

Is the service caring? Requires Improvement

Is the service responsive? Inadequate

Is the service well-led? Inadequate

10.2 Current Significant Concerns about GP Practices

Family Health Care Centre, Gorleston-on-Sea (Dr Keivan Malaki):

The CQC undertook an unannounced inspection using the new methodology on 28 October ’14 for which the final report was published on 5 March ’15.

The CQC deemed the Family Health Care Centre to be Inadequate overall and rated that the following improvements needed to be made across four out of the five domains:

of 52 Overall rating for this service Inadequate Domains Is the service safe? Inadequate Is the service effective? Inadequate Is the service caring? Good Is the service responsive? Requires Improvement Is the service well-led? Inadequate

Due to the ratings for each of the domains, the Practice was placed in Special Measures by the CQC. The practice has informed the CCG that the CQC has undertaken a full follow up inspection and the outcomes of this are awaited.

Oulton Medical Centre & Marine Parade Practices, Lowestoft (Dr Khauser Khan):

The CQC undertook an announced inspection in March 2015.

The CQC deemed that the Marine Parade practice to be Inadequate overall and rated that the following improvements needed to be made across four out of the five domains:

Overall rating for this service Inadequate Domains Is the service safe? Inadequate Is the service effective? Inadequate Is the service caring? Requires Improvement Is the service responsive? Inadequate Is the service well-led? Inadequate

Due to the ratings for each of the domains, the Practice has been placed in Special Measures by the CQC.

Practices that were previously rated as Requiring Improvement are:  Cutlers Hill, Halesworth – the follow up inspection has taken place and the publication of the report is awaited  Kirkley Mill, Lowestoft – however following re-inspection they are now rated as ‘good’  High Street, Lowestoft – the follow up inspection has taken place and the publication of the report is awaited

11.0 Recommendations

The Governing Body note the content of this report.

of 52 Care and Residential Homes (New Methodology)

D o m a i n s S Effective Caring Responsive Well-led Overall rating Date of report a f e Abbeville Residential Care Home, Great R Yarmouth . G G R.I G Requires Improvement 09 September 2015 I Avery Lodge, Great Yarmouth R . R.I G G G Requires Improvement 06 July 2015 I Beech House Residential Home, G G G G G Good 05 May 2015 Halesworth Blyford Residential Home, Lowestoft This service, provided by Eastern Healthcare Ltd, has not yet been inspected since it was registered by CQC on 23 February 2015. Britten Court, Lowestoft R . R.I G R.I R.I Requires Improvement 26 June 2015 I Burgh House, Burgh Castle, Great G R.I G G G Good 08 January 2015 Yarmouth Cherry Lodge, Lowestoft G G G G G Good 15 May 2015

Chevington Lodge, Bungay This service, provided by Cygnet Care Limited, has not yet been inspected since it was registered by CQC on 12 April 2014. Clarence Lodge, R Gorleston . R.I G R.I R.I Requires Improvement 19 August 2015 I Eastview, Lowestoft G G G G G Good 03 August 2015 Eversley Nursing Home, Great Yarmouth R G G G G Requires Improvement 30 July 2014

of 52 . I Holmwood Residential Home, Bungay This service, run by Holmwood Care Limited, has not yet been inspected since it was registered by CQC on 10 October 2014. Joseph House, Reedham, Norwich G G G G G Good 29 May 2015 Lydia Eva Court, Gorleston, Great This service, run by Norse Care Services (Limited), has not yet been inspected since it was registered by CQC on 12 June 2014. Yarmouth Manor Farm, Kessingland, Lowestoft G G G G G Good 10 February 2015

Marram Green, Kessingland, Lowestoft G G G G G Good 07 July 2015

Martham Lodge, Martham, Great Yarmouth This service, run by Hollyman Care Homes Limited, has not yet been inspected since it was registered by CQC on 01 January 2015. Ritson Lodge, Hopton, Great Yarmouth G G G G G Good 11 August 2015 Roseland Lodge, Great Yarmouth G G G G G Good 14 September 2015 Royal Avenue Residential Home, G R.I R.I R.I R.I Requires Improvement 07 July 2015 Lowestoft Salisbury, Great Yarmouth I I R.I R.I I Inadequate 26 January 2015 Seahorses, Gorleston, Great Yarmouth G G G G G Good 20 March 2015

Shaftesbury Court Residential Home, This service, run by Sanctuary Care Home Limited, has not yet been inspected since it was registered by CQC on 03 July 2014. Lowestoft St Barnabus, Southwold G G G G R.I Good 26 May 2015 St David’s Residential Home, Great G R.I G G R.I Requires Improvement 25 February 2015 Yarmouth St Edmunds, Great Yarmouth G G G G G Good 20 March 2015 St Georges Care Home, Beccles G R.I G G R.I R.I 30 July 2015 St Marys House, Bungay This service, run by Innomary Limited, has not yet been inspected since it was registered by CQC on 01 July 2015. Stradbroke Court, Lowestoft This service, run by Aps Care Limited, has not yet been inspected since it was registered by CQC on 04 September 2015. Squirrel Lodge, Lowestoft G G G G G Good 18 August 2015

of 52 The Coach House, Hemsby, Great R Yarmouth . R.I R.I G R.I Requires Improvement 30 July 2015 I The Dell – Residential Home, Oulton R Broad, Lowestoft . R.I G R.I I Requires Improvement 25 June 2015 I Wellbeing Care Support Services, Oulton R 12 June 2015 & 4th Broad, Lowestoft . I R.I I I Inadequate Sept 2015 I The Depperhaugh, Hoxne R . G G R.I G Requires Improvement 02 September 2015 I The Elms, Gorleston, Great Yarmouth G G G G G Good 29 April 2015

The Gables Residential Home, Gorleston, This service, run by Healthcare Homes Group Limited, has not yet been inspected since it was registered by CQC on 21 May 2014. Great Yarmouth The Grove, Lowestoft G G G G G Good 04 June 2015

The Moorings, Earsham, Bungay G G G G G Good 21 August 2015 The Old Rectory, Winterton-on-Sea, Great G G G G G Good 17 April 2015 Yarmouth Windmill Residential Home, Rollesby, G G G G G Good 09 July 2015 Great Yarmouth Woody Point, Brampton, Beccles G G G G G Good 04 June 2015

of 52 Care and Residential Homes (Pre-existing Methodology)

of 52 Respecting and Care M C S Cleanliness Safety and S S Asses and monitoring quality of involving people and e o a and suitability of t u service Welfare e o f infection premises a p t pe e control f p i ra g f o n ti u i rt g n a n i g r g n n wi d g u th i s t ot n t r he g a i r fr ff t pr o i ov m o id n er a a s b l u n s e e e d s 1 4 5 6 7 8 10 1 14 16 Comments 3 All Hallows Healthc are Trust, Last inspection report 27 Ditching March 2014 ham, Bungay – Nursing Beds Bungay Last inspection report 13 House, March 2014 Bungay Abbevil Last inspection report 11 le January 2014 Lodge,

of 52 Respecting and Care M C S Cleanliness Safety and S S Asses and monitoring quality of involving people and e o a and suitability of t u service Welfare e o f infection premises a p t pe e control f p i ra g f o n ti u i rt g n a n i g r g n n wi d g u th i s t ot n t r he g a i r fr ff t pr o i ov m o id n er a a s b l u n s e e e d s 1 4 5 6 7 8 10 1 14 16 Comments 3 Great Yarmout h Abbevil Last inspection report 21 le November 2013 Sands, The CQC are currently Great carrying out checks on this Yarmout provider using the new h methodology. Alexan dra House, Last inspection report 22 May Great 2014 Yarmout h All Last inspection report 08 Hallows January 2014

of 52 Respecting and Care M C S Cleanliness Safety and S S Asses and monitoring quality of involving people and e o a and suitability of t u service Welfare e o f infection premises a p t pe e control f p i ra g f o n ti u i rt g n a n i g r g n n wi d g u th i s t ot n t r he g a i r fr ff t pr o i ov m o id n er a a s b l u n s e e e d s 1 4 5 6 7 8 10 1 14 16 Comments 3 Nursing Home, Bungay Allied Healthc are Last inspection report 28 Lowest January 2015 oft, Beccles Amber House, Last inspection report 04 Gorlesto December 2013 n Amber Lodge, Last inspection report 01 Lowesto August 2013 ft

of 52 Respecting and Care M C S Cleanliness Safety and S S Asses and monitoring quality of involving people and e o a and suitability of t u service Welfare e o f infection premises a p t pe e control f p i ra g f o n ti u i rt g n a n i g r g n n wi d g u th i s t ot n t r he g a i r fr ff t pr o i ov m o id n er a a s b l u n s e e e d s 1 4 5 6 7 8 10 1 14 16 Comments 3 Ashurst Reside ntial Last inspection report 09 Home, November 2013 Lowesto ft Broadla nds, Oulton Last inspection report 02 May Broad, 2013 Lowesto ft Broadvi Last inspection report 14 ew February 2014 Reside ntial Home,

of 52 Respecting and Care M C S Cleanliness Safety and S S Asses and monitoring quality of involving people and e o a and suitability of t u service Welfare e o f infection premises a p t pe e control f p i ra g f o n ti u i rt g n a n i g r g n n wi d g u th i s t ot n t r he g a i r fr ff t pr o i ov m o id n er a a s b l u n s e e e d s 1 4 5 6 7 8 10 1 14 16 Comments 3 Great Yarmout h Brooke Last inspection report 29 July House, 2014 Norwich Carlton Hall Reside Last inspection report 30 ntial January 2014 Home, Lowesto ft Decoy Last inspection report 30 Farm, September 2014 Browsto n, Great

of 52 Respecting and Care M C S Cleanliness Safety and S S Asses and monitoring quality of involving people and e o a and suitability of t u service Welfare e o f infection premises a p t pe e control f p i ra g f o n ti u i rt g n a n i g r g n n wi d g u th i s t ot n t r he g a i r fr ff t pr o i ov m o id n er a a s b l u n s e e e d s 1 4 5 6 7 8 10 1 14 16 Comments 3 Yarmout h Ealing House, Martha Last inspection report 23 May m, 2014 Great Yarmout h Esthere ne Last inspection report 20 House, March 2015 Lowesto ft Florenc Last inspection report 30 e October 2013 House,

of 52 Respecting and Care M C S Cleanliness Safety and S S Asses and monitoring quality of involving people and e o a and suitability of t u service Welfare e o f infection premises a p t pe e control f p i ra g f o n ti u i rt g n a n i g r g n n wi d g u th i s t ot n t r he g a i r fr ff t pr o i ov m o id n er a a s b l u n s e e e d s 1 4 5 6 7 8 10 1 14 16 Comments 3 Great Yarmout h Genesi s Reside ntial Last inspection report 19 Home, February 2014 Great Yarmout h Georgi na House, Last inspection report 07 Great February 2014 Yarmout h

of 52 Respecting and Care M C S Cleanliness Safety and S S Asses and monitoring quality of involving people and e o a and suitability of t u service Welfare e o f infection premises a p t pe e control f p i ra g f o n ti u i rt g n a n i g r g n n wi d g u th i s t ot n t r he g a i r fr ff t pr o i ov m o id n er a a s b l u n s e e e d s 1 4 5 6 7 8 10 1 14 16 Comments 3 Gresha m Nursing Last inspection report 25 June Home, 2014 Gorlesto n Hales Lodge, Winterto n-On- Last inspection report 18 Sea, February 2014 Great Yarmout h Harlest Last inspection report 11 June on 2013 House,

of 52 Respecting and Care M C S Cleanliness Safety and S S Asses and monitoring quality of involving people and e o a and suitability of t u service Welfare e o f infection premises a p t pe e control f p i ra g f o n ti u i rt g n a n i g r g n n wi d g u th i s t ot n t r he g a i r fr ff t pr o i ov m o id n er a a s b l u n s e e e d s 1 4 5 6 7 8 10 1 14 16 Comments 3 Lowesto ft Highfiel d, Last inspection report 25 July Halesw 2014 orth

Imber House, Last inspection report 28 June Lowesto 2013 ft Ivydene Last inspection report 28 Reside January 2014 ntial Home, Ormesb y, Great

of 52 Respecting and Care M C S Cleanliness Safety and S S Asses and monitoring quality of involving people and e o a and suitability of t u service Welfare e o f infection premises a p t pe e control f p i ra g f o n ti u i rt g n a n i g r g n n wi d g u th i s t ot n t r he g a i r fr ff t pr o i ov m o id n er a a s b l u n s e e e d s 1 4 5 6 7 8 10 1 14 16 Comments 3 Yarmout h John Turner Last inspection report 24 House, January 2015 Lowesto ft Kirkley Manor, Last inspection report 11 July Lowesto 2014 ft Levingt on Last inspection report 08 Court, November 2013 Lowesto ft Lilac Last inspection report 30 May

of 52 Respecting and Care M C S Cleanliness Safety and S S Asses and monitoring quality of involving people and e o a and suitability of t u service Welfare e o f infection premises a p t pe e control f p i ra g f o n ti u i rt g n a n i g r g n n wi d g u th i s t ot n t r he g a i r fr ff t pr o i ov m o id n er a a s b l u n s e e e d s 1 4 5 6 7 8 10 1 14 16 Comments 3 Lodge & Lavend er 2013 Cottage , Lowesto ft Lound Hall Nursing Last inspection report 12 Home, September 2013 Lowesto ft Lynfiel Last inspection report 06 d, November 2013 Ditching

of 52 Respecting and Care M C S Cleanliness Safety and S S Asses and monitoring quality of involving people and e o a and suitability of t u service Welfare e o f infection premises a p t pe e control f p i ra g f o n ti u i rt g n a n i g r g n n wi d g u th i s t ot n t r he g a i r fr ff t pr o i ov m o id n er a a s b l u n s e e e d s 1 4 5 6 7 8 10 1 14 16 Comments 3 ham, Bungay Last inspection report 30 Marine October 2013 Court, The CQC are currently Great carrying out checks on this Yarmout provider using the new h methodology. Marlbor ough Last inspection report 25 June House, 2014 Lowesto ft Newnh Last inspection report 20 am September 2014 Green, Gorlesto

of 52 Respecting and Care M C S Cleanliness Safety and S S Asses and monitoring quality of involving people and e o a and suitability of t u service Welfare e o f infection premises a p t pe e control f p i ra g f o n ti u i rt g n a n i g r g n n wi d g u th i s t ot n t r he g a i r fr ff t pr o i ov m o id n er a a s b l u n s e e e d s 1 4 5 6 7 8 10 1 14 16 Comments 3 n North Bay Last inspection report 13 House, November 2013 Oulton Broad Oaklan ds Reside Last inspection report 08 ntial November 2013 Home, Reydon Oliver Last inspection report 05 Court December 2013 Great Yarmout

of 52 Respecting and Care M C S Cleanliness Safety and S S Asses and monitoring quality of involving people and e o a and suitability of t u service Welfare e o f infection premises a p t pe e control f p i ra g f o n ti u i rt g n a n i g r g n n wi d g u th i s t ot n t r he g a i r fr ff t pr o i ov m o id n er a a s b l u n s e e e d s 1 4 5 6 7 8 10 1 14 16 Comments 3 h Orchar ds Reside Last inspection report 28 ntial January 2014 Home, Bradwel l Oulton Park, Oulton Last inspection report 03 Broad, October 2013 Lowesto ft Park Last inspection report 16 May House, 2014 Great

of 52 Respecting and Care M C S Cleanliness Safety and S S Asses and monitoring quality of involving people and e o a and suitability of t u service Welfare e o f infection premises a p t pe e control f p i ra g f o n ti u i rt g n a n i g r g n n wi d g u th i s t ot n t r he g a i r fr ff t pr o i ov m o id n er a a s b l u n s e e e d s 1 4 5 6 7 8 10 1 14 16 Comments 3 Yarmout h Pine Lodge, Last inspection report 24 June Great 2014 Yarmout h Pitches View, Last inspection report 14 Reydon, September 2013 Southw old The Last inspection report 18 Clarem March 2014 ont, Caister- On-Sea,

of 52 Respecting and Care M C S Cleanliness Safety and S S Asses and monitoring quality of involving people and e o a and suitability of t u service Welfare e o f infection premises a p t pe e control f p i ra g f o n ti u i rt g n a n i g r g n n wi d g u th i s t ot n t r he g a i r fr ff t pr o i ov m o id n er a a s b l u n s e e e d s 1 4 5 6 7 8 10 1 14 16 Comments 3 Great Yarmout h The Heather s, Last inspection report 08 May Bradwel 2014 l, Great Yarmout h The Laurels Last inspection report 15 , February 2014 Lowesto ft The Old Last inspection report 02 Rectory September 2014

of 52 Respecting and Care M C S Cleanliness Safety and S S Asses and monitoring quality of involving people and e o a and suitability of t u service Welfare e o f infection premises a p t pe e control f p i ra g f o n ti u i rt g n a n i g r g n n wi d g u th i s t ot n t r he g a i r fr ff t pr o i ov m o id n er a a s b l u n s e e e d s 1 4 5 6 7 8 10 1 14 16 Comments 3 , Acle, Norwich The Vinerie s, Last inspection report 05 April Hemsby 2014 , Great Yarmout h Wainfor d Last inspection report 06 June House, 2014 Beccles White Last inspection report 27 April House 2013 Reside ntial

of 52 Respecting and Care M C S Cleanliness Safety and S S Asses and monitoring quality of involving people and e o a and suitability of t u service Welfare e o f infection premises a p t pe e control f p i ra g f o n ti u i rt g n a n i g r g n n wi d g u th i s t ot n t r he g a i r fr ff t pr o i ov m o id n er a a s b l u n s e e e d s 1 4 5 6 7 8 10 1 14 16 Comments 3 Home, Beccles Windso r Last inspection report 20 June House, 2014 Lowesto ft

GP Practices, Acute Hospitals and Community Hospitals (New Methodology)

of 52 a i n s S Effective Caring Responsive Well-led Overall rating Date of report a f e Andaman Surgery, Lowestoft This service has not yet been inspected since it was registered by CQC on 01 April 2013. Alexandra Road and Crestview Surgery, G G G G G Good 27 August 2015 Lowestoft Beccles Medical Centre, Beccles G G G G O Good 19 March 2015

Bridge Road Surgery, Oulton Broad, G G G G G Good 03 September 2015 Lowestoft Bungay Medical Centre, Bungay R . G G G G Good 30 April 2015 I Central Surgery, Gorleston Great Yarmouth G G G G G Good 31 March 2015 Coastal Villages Practice (Ormesby G G G G G Good 19 February 2015 Practice), Great Yarmouth Cutlers Hill Surgery, Halesworth R . G G G R.I Requires Improvement 22 January 2015 I Falkland Surgery, Bradwell, Great G G G G G Good 05 March 2015 Yarmouth Family Health Centre, Gorleston, Great I I G R.I I Inadequate 05 March 2015 Yarmouth Gorleston Medical Centre, Gorleston, G G G G G Good 22 January 2015 Great Yarmouth Greyfriars Health Centre, Great Yarmouth G G G G G Good 22 January 2015 High Street Surgery, Lowestoft R . G G G R.I Requires Improvement 16 April 2015 I James Paget University Hospital (JPUH), The CQC completed a planned inspection at the Trust during the week commencing 10 August 2014. The final inspection report is being awaited. The Gorleston, Great Yarmouth previous inspection report, published 07 October 2014, evidenced that the Trust was fully compliant with all CQC outcomes.

of 52 Kirkley Mill, Lowestoft G G R.I G G Good 20 August 2015

Lighthouse Medical Centre (King Street This service, part of Eastern Norfolk Medical Practice, has not yet been inspected by CQC. The service commenced on 24 August 2015. and South Quay Surgery), Great Yarmouth Longshore Surgeries, Kessingland, G G G G G Good 19 March 2015 Lowestoft Millwood Surgery, Bradwell, Great G G G G G Good 13 August 2015 Yarmouth Newtown Surgery, (Newtown and Caister G G G G O Good 05 February 2015 Medical Practice) Great Yarmouth Norfolk Community Health and Care, R G G G G Good 19 Dec 2014 (NCHC) Colman Hospital, Norwich I Norfolk and Norwich University Hospitals See NNUH section in main body of report for inspection details. NHS Foundation Trust (NNUH) Norfolk and Suffolk Foundation Trust NSFT is placed in Special I R.I G R.I I 03 February 2015 (NSFT) Measures. Oulton Medical Centre, Lowestoft I I R.I I I Inadequate 23 April 2015

Park Surgery, Great Yarmouth This service has not yet been inspected since it was registered by CQC on 01 April 2013. Rosedale Surgery, Carlton Colville, G G G G G Good 22 January 2015 Lowestoft Sole Bay Health Centre, Reydon, This service has not yet been inspected since it was registered by the CQC on 13 May 2015. Southwold Victoria Road Surgery, Oulton Broad, This service has not yet been inspected since it was registered by CQC on 01 April 2013. Lowestoft Westwood Surgery, Lowestoft This service has not yet been inspected since it was registered by CQC on 01 April 2013.

of 52 GP Practices, Acute Hospitals and Community Hospitals (Pre-existing Methodology)

Respecting and Care M C S Cleanliness Safety and S S Asses and monitoring quality of involving people and e o a and suitability of t u service Welfare e o f infection premises a p t pe e control f p i ra g f o n ti u i rt g n a n i g r g n n wi d g u th i s t ot n t r he g a i r fr ff t pr o i ov m o id n er a a s b l u n s e e e d s 1 4 5 6 7 8 10 1 14 16 Comments 3 Beccles Hospita Last inspection report 16 l, Mod September 2014 Beccles Patrick Last inspection report 01 May Stead 2013

of 52 Hospita l, Halesw orth Southw old Hospita Last inspection report 27 l, February 2014 Southw old Northg ate Hospita Last inspection report 09 l, Great January 2014 Yarmout h Beccles House- Last inspection report 21 Commu December 2013 nity Service Fleggb urgh Surgery Last inspection report 13 , Great March 2014 Yarmout h