CQC Evidence Appendix

North Bristol NHS Trust Evidence appendix North Bristol NHS Trust Date of inspection visit: Southmead Hospital 8 Nov to 29 Nov 2017 Southmead Road Bristol BS10 5NB Date of publication: 6 March 2018 Tel: 0117 950 5050 www.nbt.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 Details of sites and locations registered with CQC Three locations are registered with the Care Quality Commission. Southmead Hospital Cossham Hospital Frenchay Hospital We only inspected Southmead Hospital as part of this inspection. Background to the trust North Bristol NHS Trust is an acute trust located in Bristol that provides acute hospital and some community services to a population of about 900,000 people in Bristol, South Gloucestershire and North Somerset. The trust is not a foundation trust. It also provides specialist services such as neurosciences, renal, trauma and plastics/burns to people from across the South West and in some instances nationally or internationally. The new hospital at Southmead opened in May 2014 when the main hospital at Frenchay closed. Southmead Hospital provides a full range of acute clinical services. The trust also provides community healthcare for children and young people. Cossham Hospital provides maternity and outpatient services. Facts and data about the trust The trust provides a full range of acute clinical services. The trust employs 8141 staff. (Source: Provider Information Request 2017) 20171116 900885 Post-inspection Evidence appendix template v3 Page 1 There are 996 beds on the Southmead Hospital site. The population served is approximately 900,000. Financial position For the financial year 2016/2017, the trust’s income was £532 million. There was a deficit (shortfall) over costs incurred of £42.9 million. NHS improvement placed the trust in financial special measures with a recovery plan implemented in October 2016. The trust achieved its savings recovery plan and had special measures removed in June 2017. As of October 2017, the trust had a planned deficit of £18.7 million, which was in line with the agreed total with NHS improvement. What people who use the trust’s services say In September 2017, the trust scored lower that the national average in the NHS Friends and Family Test results (percentage of patients who would recommend the hospital) in the emergency department, maternity, inpatients and outpatients. The NHS inpatient survey 2016 had mixed results. The trust performed better than other trusts in one question (enough privacy when discussing treatment/ condition) and worse than other trusts in three questions (call button response time, waiting to be admitted and transition between services, information sharing). The trust performed about the same as other trusts for the remaining questions. Results from Patient Led Assessment of the Care Environment (PLACE) surveys showed results in line with the England average. The most recent data at the time of our inspection, published in August 2017, showed a cleanliness score of 95% against a national average for acute services of 98.4%. The trust improved its rating in the National Cancer Patient Experience Survey, published in June 2017, an overall rating of 8.7 out of 10, which is in line with the national average and six questions benchmarking above the expected range and two below, which also improved from the previous survey. Is this organisation well-led? Leadership To write this well-led report, and rate the organisation, we interviewed the members of the board, including the executive team, and a range of senior staff across the hospital. We spoke with the non-executive directors as part of a focus group. We met and talked with a wide range of staff to ask their views on the leadership and governance of the trust. We looked at a range of performance and quality reports, audits, action plans, meeting minutes, papers to the board, investigations, and feedback from patients, local people and stakeholders. The trust board largely had the appropriate range of skills, knowledge and experience to perform its role; we did identify some areas for development and we fed those back to the trust. The trust board members we met were a group of individuals with a wide range of experience, knowledge and skills and had mostly been in their positions for some time. The Chief Executive Officer had been in position since 2013. The Medical Director had been in position since 2009. The Director of Nursing had been in position since 2011. Other longstanding executives included; the Director of Operations who had been in position since 2014, the Director of Finance, Performance Planning and Information who had been in post since 2007, and the director of Estates, Facilities, and Capital Planning, who had been in position since 2000. 20171116 900885 Post-inspection Evidence appendix template v3 Page 2 The trust reviewed leadership capacity and capability on an ongoing basis. Executive directors at the trust underwent a formal induction process that comprehensively covered appropriate aspects of their role. Non-executive directors went through a modified induction process designed to meet the needs of their role. The board had their skills, knowledge, experience and integrity evaluated on an ongoing basis through an annual analysis of the skills and knowledge base. This was used to identify any gaps and inform development needs going forward. However, we found that many members of the non-executive team had not received safeguarding training for four years. Succession planning was being developed throughout the trust. Succession planning for board members included the appointment of deputies for all executive directors, together with a development programme for specialty leads. Fit and Proper Person checks were in place. The trust was satisfied that staff with director level responsibilities, including the non-executive directors, were fit and proper persons in accordance with Regulation 5 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We examined the files of two executive directors and three non-executive directors and found that they were all in order. The trust policy on the fit and proper person regulation had not changed since our inspection in December 2015 and was in line with the legislation. Records were kept of recruitment checks made for all executive directors. NHS Improvement (previously the Trust Development Authority) appointed non-executive directors. Disclosure and Barring Service checks were undertaken for all executive and non-executive directors at the trust. The trust had commissioned an external provider to undertake checks on the probity of information provided by executive directors. This included financial, educational and employment checks. Executive and non-executive directors submitted an annual declaration to confirm that there was nothing, which would affect his or her fitness as a director of the trust. The non-executive team were well informed and engaged with the senior team and formed an integral part of the effectiveness of leadership within the trust. We spoke with the non-executive directors as part of a focus group. There was a range of skills in the non-executive directors. From the focus group, we were assured of their significant skills and experience. Some of the non- executive directors described good working between the executive and non-executive teams. The trust was in the process of devolving leadership of divisions from a few individuals to divisional ‘service line management’. This process had started in June 2017 and was not fully embedded during the well-led inspection. However, the trust recognised that this change was work in progress and had identified a 12- month period of implementation. Some executives found there was a lack of engagement with speciality leads with a lack of clarity around their roles. As this had been identified, they were working with these staff to develop a programme of training. A triumvirate of managers consisting of a clinical director, manager, and lead nurse led each division. A gap analysis for the leadership triumvirate had been conducted and training developed using an external company. There were also plans to introduce additional bespoke training and human factors training. We found that one senior team member had a large portfolio of work, which meant that they were unable to give key areas of risk within those areas sufficient and consistent attention. This included managing a large number of complex services, specifically volunteering, the chaplaincy and bereavement service, patient experience, safeguarding, patient survey and complaints. Infection prevention and control fell under the leadership of the director of nursing and medical director at the trust. Consultants for both nursing and medicine infection prevention and control reported directly to these directors and this proved an effective method for communicating relevant issues at board level. Those holding leadership positions within infection prevention and control 20171116 900885 Post-inspection Evidence appendix template v3 Page 3 felt autonomous in their roles, with support available from the executive team. This enabled them to be visible and approachable at operational level, as well as using the structure around them to communicate to executive level. The infection prevention and control team produced an “Annual Infection Prevention and Control” report, which was presented with additional bi-monthly updates to the board. Vision and strategy There was a clear vision and set of values with quality, safety, and sustainability the top priorities. The values were: Working well together. Putting patients first.

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