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University Hospitals of Morecambe Bay University Hospitals of Morecambe Bay Evidence appendix Westmorland General Hospital, Date of inspection visit: Kendal 14 November to 14 December LA9 7RG 2019 Tel: 01539 732288 Date of publication: www.uhmb.nhs.uk 15 May 2019 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 Serving a population of around 365,000, the trust operates from three main hospital sites: Furness General Hospital in Barrow, Royal Lancaster Infirmary in Lancaster and Westmorland General Hospital in Kendal. Furness General Hospital and the Royal Lancaster Infirmary have a range of acute services, with full accident & emergency departments, critical/coronary care units and consultant led beds. Westmorland General Hospital provides a range of acute services, together with a primary care assessment service (PCAS). All three sites provide a range of planned care, including outpatients, diagnostics, therapies, day- case and inpatient surgery. In addition, a range of local outreach services and diagnostics are provided from a number of community facilities. (Source: Trust Website) Acute hospital sites at the trust A list of the acute hospitals at the trust is below. Details of any specialist Name of acute hospital site Address services provided at the site Furness General Hospital Dalton Lane, Barrow-in- Furness, LA14 4LF All CQC acute core services 20190508 RTX University Hospitals of Morecambe Bay NHS Foundation Trust Evidence Appendix Page 1 Ashton Road, Lancaster, All CQC acute core Royal Lancaster Infirmary LA1 4RP services Burton Road, Kendal, Medicine, surgery, outpatients, and maternity. Westmorland General Hospital LA9 7RG There is also an urgent care centre at WGH. Thornton Road, Queen Victoria Hospital Morecambe, Lancashire, Outpatients LA4 5NN Stanley Street, Ulverston, Outpatients and a number Ulverston Community Health Centre LA12 7BT of community-based clinics The trust also provides a number of community services, which are provided across a number of community locations. (Source: Routine Provider Information Return- Sites tab) Is this organisation well-led? Leadership University Hospitals of Morecambe Bay Service NHS Foundation Trust was governed by a board of directors. Records we reviewed confirmed that the board met formally ten times a year at trust headquarters. Trust board meetings were held in public six times per year. The senior leadership team at the trust consisted of the chief executive, chairman, five executive directors and six non-executive directors: • Chief executive • Chairman • Medical director • Chief nurse • Director of governance • Director of finance • Chief operating officer • Director of people & organisational development • Seven non-executive directors The chief executive officer and the chairman had commenced in post in April 2018. However, the chief executive officer had been in post at the trust since 2014 as the deputy chief executive officer and the director of finance. The chairman had extension experience to undertake his role, including a recent term as a chairman at a neighbouring trust. 20190508 RTX University Hospitals of Morecambe Bay NHS Foundation Trust Evidence Appendix Page 2 There was an experienced and committed executive team who engender a positive “can do” attitude to addressing the operational and strategic challenges faced by the trust. All the executive directors were substantive and of good tenure except for the director of finance who came into post in April 2018. Executive directors held responsibility for the day to day running of the trust whilst the non-executive directors brought external expertise to the organisation and provided advice and guidance to the senior management team. The trust has been held as an exemplar of governance by NHSI and in the last year and had provided peer support to the two other hospital trusts. The trust supported NHS England with a national review of complaints and the new system architecture. The governance framework was designed to support the ward to board escalation of risks and challenge performance. The trust had leadership structures and processes (WESEE) and the care group level. Executive oversight and challenge were through operational meetings including monthly performance reviews. Non-executive director challenge and oversight was through the board and the assurance committees. The structure enabled governors to observe non-executive directors in their roles as chair of the board assurance committees as well as receive regular reports at the council of governors. There was an extensive nurse management structure with the chief nurse being in post since December 2013. There were also two directors of nursing, one for acute and one for community, each having a deputy director of nursing. Each of the clinical care groups had a triumvirate management arrangement which included an associate director of nursing, clinical director, and an associate director of operations. There were five clinical care groups across the trust which included: • Core clinical services care group • Medicine care group • Surgery and critical care group • Women’s and children’s care group • Integrated community care group During the inspection we carried out checks to determine if the trust was compliant with the requirements of the Fit and Proper Persons Requirement (FPPR) (Regulation 5 of the Health and Social Care Act (Regulated Activities) Regulations 2014). This regulation ensures that directors of healthcare providers are fit and proper to carry out this important role. We reviewed six director’s files in total, of which two related to non-executive directors, two related to the newest appointments, including the chair and chief executive officer and one included the longest servicing director. We also reviewed the trust’s Fit and Proper Person Procedure (June 2016). We found that there was an error with the disclosure and barring service (DBS) check within one file where the person had commenced in post in April 2018, but the DBS check was only valid from October 2018. This had been due to an error within human resources (HR). The trust was working on two systems for their FPPR files, one being electronic and one being paper. We found some discrepancies within the files because of the two systems, including incorrect documentation of things such as number of references obtained and recruitment processes. The trust had developed an OD strategy, named ‘shaping the future’ which outlined the trust approach to systems leadership, compassionate inclusive leadership skills and talent 20190508 RTX University Hospitals of Morecambe Bay NHS Foundation Trust Evidence Appendix Page 3 management. The trust reported their approach sat within a wider context of development within local, regional and national leadership development programmes – supporting broad scale strategic development taking a cohesive approach across a number of strands to support development within the trust. This included year on year participation in National Leadership Academy trainings, Graduate Management Training Scheme, and leadership training at various levels. The trust informed us leadership development work focused on the executive team, board and integrated care partnership development programmes, developing system leadership (across the Integrated Care Partnership), inclusive leadership, innovative use of the apprentice levy to fund leadership development activity and Aspirant Clinical Leadership programmes. The approach sat within a wider context of development within local, regional and national leadership development programmes. The trust was utilising opportunities created through the Sustainability and Transformation Plan and Accountable Care System to ensure cross-organisational learning and true systems leadership. A ‘Transforming the Bay Together’ programme was launched in 2017/18 with 20 system leaders having participated at the time of our inspection. A leadership academy programme was launched in partnership with a local college in June 2018. To the time of our inspection, 13 members of staff had commenced level five apprenticeship in leadership with a further eight commencing a level three apprenticeship in leadership. The trust worked closely with the local university management school and local college and had in place leadership programmes at levels three, five and seven, as well as internal programmes bespoke to specific requirements. The trust was also due to launch an aspirant clinical leadership development programme ahead of the clinical leadership refresh scheduled to take place in April 2019. There had been good take-up of national programmes such as the Nye Bevan programme and seven of the 14 individuals to have completed the programme had secured promotion to senior posts both within the trust and across the wider health landscape. There was a succession plan in place for the executive team which was based upon the NHS north west leadership academy talent management framework and there were plans in place to develop this further and extend it formally to care group leadership teams in Autumn 2018. Development programmes were in place for the executive
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