Norfolk and Norwich University Hospitals NHS Foundation Trust
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Norfolk and Norwich University Hospitals NHS Foundation Trust Evidence appendix Colney Lane Date of inspection visit: Norwich 10 December 2019 to 15 January NR4 7UY 2020 Tel: 01603 286286 Date of publication: www. nnuh.nhs.uk 17 April 2020 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 Norfolk and Norwich University Hospitals NHS Foundation Trust operates primarily across two sites: • Norfolk and Norwich University Hospital (NNUH) – this was built in 2001 and is based on the Norwich Research Park. Care is provided for a tertiary catchment area from Norfolk and neighbouring counties across the sustainability and transformation partnership (STP) • Cromer and District Hospital – this was rebuilt by the Trust in 2013. It has a minor injuries unit and provides a range of outpatient and day-case services The trust has made significant investments in additional capacity, which includes additional inpatient facilities, four new interventional radiology laboratories and a fourth cardiac catheter laboratory which are due to open in Spring 2020. The Trust also recently opened a new positron emission tomography computed tomography (PET CT) scanner. At Cromer hospital, a new ambulatory cancer centre is planned to open in 2021 in partnership with Macmillan cancer. The trust opened the Quadram Institute in December 2018 in research partnership. This houses the largest endoscopy unit in Europe and research facilities, providing teaching and clinical training to a wide range of health professionals in partnership with the University of East Anglia and the Norwich Medical School. The trust also hosts the National Institute for Health Research (NIHR) clinical research network for the Eastern region. The trust is involved in partnership working across the healthcare system, including joint clinical appointments with neighbouring trusts, a shared electronic prescribing system, an STP wide urgent and emergency care delivery board and a referral to treatment (RTT) management board which works across the system to support delivery against key targets. 20190416 900885 Post-inspection Evidence appendix template v4 Page 1 The trust has also embarked upon an STP sponsored programme to redesign acute service provision across three acute hospital sites. This work will result in NNUH becoming the lead provider for a range of services across the county. (Source: Routine Provider Information Request (RPIR) – Acute context tab) Hospital sites at the trust A list of the hospitals at Norfolk and Norwich University Hospitals NHS Foundation Trust is below. Name of hospital Details of any specialist Geographical area Address site services provided at the site served Day procedure unit Dermatology ENT/Oral health General surgery Norfolk and Norwich Colney Lane, Ophthalmology Norfolk University Hospital Norwich, NR4 7UY Oral surgery Plastic surgery Urology Trauma and orthopaedics Vascular Day procedure unit Mill Road, Cromer, Cromer Hospital General surgery Norfolk NR27 0BQ Ophthalmology (Source: Routine Provider Information Request (RPIR) – Sites tab) Is this organisation well-led? Leadership Board Members Of the executive board members at the trust, none were Black and minority ethnic (BME) and 33.3% were female. Of the non-executive board members none were BME and 28.6% were female. Staff group BME % Female % Executive directors 0.0% 33.3% Non-executive directors 0.0% 28.6% All board members 0.0% 30.8% (Source: Routine Provider Information Request (RPIR) – Board Diversity tab) There had been significant changes in the executive leadership team in the preceding 18 months. There was a strong clinical voice and a more cohesive approach from operational and clinical perspectives. Leaders had the skills and abilities to run the service. They understood and managed the priorities and issues the service faced. However, the senior teams were still coalescing to become a highly productive team. They were visible and approachable in the service for patients and staff. They supported staff to develop their skills and take on more senior roles. 20190416 900885 Post-inspection Evidence appendix template v4 Page 2 The trust leadership were relatively new as a group of directors with almost all executive directors joining the trust in the last year, although all had executive experience. The Chief Nurse and the Medical Director had been in post since 2018. However, the Medical Director and the Chief Operating Officer had been at the trust in different posts for some time. The chief executive was appointed in October 2019 shortly before our inspection and was appointed initially on a fixed term contract with a planned review of performance after six months. It was anticipated that following a satisfactory assessment a permanent appointment would be made. The director of finance was shortly to retire leaving an important vacancy on the board. Since our last inspection there was also the appointment of a new chairperson of the trust who had significant experience as chair at another NHS trust. There were also four non-executive directors appointed since our previous inspection. Therefore, the board whilst being substantively appointed to were still in the early phases of becoming an established team. The trust had commissioned a board development programme in order to ensure that the board functioned to the best of its ability. Collectively, leaders demonstrated a complementary set of skills with which to address some long- standing issues at the trust. There was good insight into the ongoing development the board needed, and the board development programme continued throughout 2019. Each director spoke of a stronger sense of a unitary board; we found executives were clear about and understood the trust’s journey and direction of travel. Communication between board members as well as non- executive directors (NEDs), both formally and informally, was open, transparent and with constructive challenge. However, there remained some concerns that having a significant number of new NEDs in post could impact upon the challenge to the board. This risk was mitigated in part by the appointment of one NED who had NHS board level experience and a number of NEDs who had board level experience in other organisations. There had been a move to strengthen the clinical focus of the NEDs. Whilst these mitigations are in place the chair of the trust remains conscious that the new NEDs require extra support to fully develop into their roles. The chair of the trust felt that the tone of the board set the tone of the organisation and was clear of the importance on improving and developing relationships within the organisation and with other stakeholders. The board maintain a clear timetable of events to encourage cohesiveness as well as improve visibility, quality and operational management of the trust. Executive directors told us these initiatives had been positive for them as a group and also the wider trust. Staff we spoke told us of an increased visibility of executives and an ‘open door policy’ in the executive offices. Board to ward clinical and departmental visits had been introduced prior to board meetings that involved both executive directors and NEDs. This had increased visibility of senior leaders in the organisation as well. There was a board development plan in place. This was to support the relatively newly formed board work in a cohesive way, develop their skills and demonstrate accountability for the services. The development plan was being reviewed at the time of our inspection. All senior staff, as well as more junior staff, we spoke to on the core services inspection spoke positively about the senior leadership team including the increased clinical voice in the organisation. Whilst some staff continued to feel frustrated about the pressure the service was under, they told us that they felt listened to by the senior leaders which was an improvement on previous inspections. Regulation 5 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 states that providers must take proper steps to ensure that their directors, or equivalent, are fit and proper for the role (FPPR). It applies to a provider’s board directors, board members and equivalents, who are responsible and accountable for delivering care, including associate directors and any other individuals who are members of the board, irrespective of their voting rights. 20190416 900885 Post-inspection Evidence appendix template v4 Page 3 The trust had an FPPR policy in place to support the process of appointing senior managers. We reviewed four personnel files of executive directors, including those most recently appointed. We found that the improvements we had found before had been maintained in the management of FPPR, recruitment and line management of the executive team. Most files were complete with records of the recruitment process, interview notes and references though in one file there were no interview notes. The trust informed us that interview notes were kept separately to personal files. Disclosure and Baring Service (DBS) checks had been properly completed. There were annual ongoing checks including a search of disqualified directors and bankruptcy which were all completed in the files we reviewed. The divisional management structure had been introduced in April 2016 and at previous inspections we had found they were not always supported to make decisions about their services. We spoke with the divisional triumvirates of clinical leaders (a chief of division, divisional operations director and divisional nursing director) at our core services inspection as well as our well led inspection. We found that the divisional teams had matured. They were well sighted on their risks and had clear plans to address them and ensure mitigation.