Weston Area Health NHS Trust Evidence appendix Weston General Hospital Date of inspection visit: Grange Road 26 February to 28 March 2019 Uphill Weston-super-Mare Date of publication: Somerset 26 June 2019 BS23 4TQ Tel: 01934 636363 www.waht.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 Background Weston Area Health NHS Trust provides a wide range of acute and rehabilitation hospital services, as well as some community health services primarily to residents of the North Somerset area. It serves a resident population of around 212,000 people in North Somerset with over 70% of people living in the four main towns of Weston, Clevedon, Portishead and Nailsea. A further 3.3 million day-trippers and 375,000 staying visitors increase this base population each year. The trust provides clinical services from three sites. The main site, Weston General Hospital, is located close to the town of Weston-super-Mare. There are two children’s centres providing community children’s services located in Weston-super-Mare and Clevedon. The trust works closely with other hospitals in Bristol as part of ‘clinical networks’ including, for example, cancer, pathology and cardiology. At the time of our inspection the trust was involved in consultation surrounding an initiative called “Healthy Weston”. Healthy Weston is a programme led by the local clinical commissioning group aimed to join services for better care in Weston-super-Mare, Worle and surrounding areas. This includes the future for services at Weston General Hospital. The consultation period aimed to run until May 2019 at which point the trust would be involved in the review of, and plans for its part in the Healthy Weston programme. Additionally, to Healthy Weston, the trust has confirmed plans to join with a local NHS trust based in Bristol. The plan is for this piece of work to be completed by the Spring of 2020 with the aim of improving the effectiveness of services offered to the population of North Somerset. 1 Staff and services The trust’s workforce, of around 1,800 clinical and non-clinical staff, works primarily on the single hospital site, Weston General Hospital. The hospital has 261 beds, 11 inpatient wards, and 10 beds for day-case surgery. The trust provides full emergency department services for adults and children, and critical care for adults. This service operates under restricted times, currently seeing patients from 8am to 10pm. Patients are admitted for emergency and planned surgery, and a full range of medical care services. There are a range of outpatient services - including Child and Adolescent Mental Health Services (CAMHS), services for older people, acute stroke care, cancer services and a full pharmacy service. The trust provides maternity services, including a midwife-led maternity unit, community midwifery antenatal care and postnatal care. Diagnostic services include pathology, CT scanning, X-ray, MRI scanning, ultrasound and interventional radiology. What people who use the trust’s services say The NHS friends and family test was launched in April 2013. It asks people who use services whether they would recommend the services they have used, giving the opportunity to feedback on their experiences of care and treatment. Measuring from January 2018 to December 2018, the trust scored about the same as the England average for recommending the trust as a place to receive care. Financial position The financial position at the trust was challenging. In 2016/17, the trust saw a deficit of £8.9m against an income of £103.8m. In 2017/18, the trust returned a deficit of £14.6m and income that year fell to £101.2m. The trust plan for 2018/19 was to show a loss of £12.4m against a 2 slightly increased income of £102.6m. For the year 2019/20, the projected deficit has not been provided. Is this organisation well-led? To write this well-led report and rate the organisation, we interviewed the members of the trust board, both the executive and non-executive directors, and a range of senior staff across the trust. We met and talked with a wide range of all members of staff to ask their views on the leadership, performance and governance of the trust. We looked at a range of performance and quality reports, audits and action plans, board meeting minutes, and papers to the board. We reviewed investigations into serious incidents and deaths, and feedback from patients, local people and stakeholders. Leadership The trust’s leadership team had the integrity, and a range of experience and capability to manage the organisation. The executive team and the trust’s board members were a group of individuals with a wide and varied range of experience, knowledge and developmental need. We saw, through our conversations with the executive team, the non-executive directors and other leadership groups that there was evidence of a positive and productive working relationship within the team. The chief executive officer was appointed in the role to the trust in August 2015 having had a number of years of executive level experience prior to this. The chair was appointed to the post in April 2015 having previously served as a non-executive director at the trust. The medical director had been in post for almost two years at the time of our inspection, and the director of operations also for two years. The director of operations was also the deputy chief executive officer – appointed to this additional role in December 2018. The director of nursing had been at the trust since January 2018, having been appointed on a secondment initially, and made substantive in December 2018. The director of human resources was seconded from a local trust to the role and had been at Weston since January 2018. The finance director was also seconded into post and had been at the trust since April 2018. We were assured that the leadership team at the trust were fully sighted and conversant with the challenges of their roles. However, at the time of our inspection there were a number of competing priorities for the leadership team which meant that capacity to address all of them adequately was a concern. The chair and other executives were knowledgeable on the key drivers of the financial position and financial risks. The Chair indicated that most board members understood their role with respect to delivering the financial position. Finance was seen as an organisational issue to address, not just the responsibility of the finance director and the finance team. However, there was still further work to do to make sure this was understood by all staff. In pharmacy there was a senior leadership team that led and supported the department. However, the team was challenged by a pharmacy workforce that was 50% under resourced when compared with the staffing levels recommended by the Carter Report. The Carter Report was published in 2016 and addressed the issue of staffing and maximising its benefit in NHS organisations. According to these recommendations, the trust needed 44 whole time equivalent staff in its pharmacy team. Data provided to us by the trust stated that had 22.5 whole time equivalent staff. The department had high staff turnover and what was felt to be a lack of internal development. A business case, for additional resource to increase the team capacity to deliver 3 acceptable rates of medicines reconciliation, was submitted for discussion to the board in April 2019. This paper had the support of the medical director and the director of nursing, but it was not clear if the financial position of the trust allowed for additional recruitment There was a trust board of individuals with different strengths, experience and skills, providing collective leadership. James Rimmer, the chief executive officer had worked within the NHS for a number of years prior to joining Weston Area Health NHS Trust in 2015. Our conversations with James demonstrated his insight into the strengths and development needs of his board, and his resilience with regards to the challenges this brought. The non-executive directors, of which there were four in addition to the chair, had been appointed between 2013 and 2018. The trust’s chair, Grahame Paine joined the organisation in 2009 as a non-executive director, taking up his current chair role in 2015. Grahame held roles in a variety of banking institutions until 2005, since which he has held roles in central government, higher education and a number of financial service companies. The four non-executive directors have a variety of clinical and non-clinical backgrounds including finance, health service management, business and nursing. This brings with it the benefit of clinical and non-clinical insight into the challenges of the trust. Of the six executive roles at the trust, two were filled by seconded post holders. Of the remaining four executive post holders three of these were first time executive roles. This did provide a challenge to the trust in that these post holders were developing into these roles at a time when the trust was facing significant challenge and change. There was limited ethnic and gender diversity within the board. Of the six executive voting board members at the trust, none were black or minority ethnic (BME), and two were female.