Kettering General Hospital NHS Foundation Trust Evidence appendix Rothwell Road Date of inspection visit: Kettering 05 to 07 February 2019 and 12 to 14 Northamptonshire March 2019 NN16 8UZ Date of publication: Tel: 01536492000 22 May 2019 www.kgh.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 Acute hospital sites at the trust A list of the acute hospitals at Kettering General Hospital NHS Foundation Trust is below. Name of acute Details of any specialist services provided Address hospital site at the site • Assessment or medical treatment for persons detained under the 1983 Act • Diagnostic and screening procedures • Family planning services Kettering General Rothwell Road, • Maternity and midwifery services Hospital Kettering, NN16 8UZ • Services for everyone • Surgical procedures • Termination of pregnancies • Treatment of disease, disorder or injury Kettering General Hospital NHS Foundation Trust provides acute healthcare services to a population of around 275,280 in north Northamptonshire, South Leicestershire and Rutland. There are approximately 541 inpatient beds and over 3,400 whole time equivalent staff are employed. Kettering General Hospital is one of the largest employers in Northamptonshire. 20171116 900885 Post-inspection Evidence appendix template v3 Page 1 All acute services are provided at Kettering Hospital with outpatients’ services also being provided at Nene Park, Corby Diagnostic Centre, and Isebrook Hospital. The findings in this report do not reflect the site we did not inspect, Isebrook outpatients. The trust ended the financial year 2017/18 with a deficit of £34.7m (£33.6m after excluding the impact of non-performance technical adjustments – impairments, donated asset movements and loss on disposal of assets). The financial plan agreed with the regulator was a total deficit of £19.9m. This excluded sustainability and transformation funding as the trust rejected its control total. In 2017/8 the hospital had: • 87,497 patients per year, 240 patients per day in A&E; • 267,000 outpatients each year; • 741 outpatient clinics per week • 40,000 inpatients; • 41,500 day case patients; • 3,500 births. This was the fourth inspection of the trust which included ratings and the second inspection of the trust using a new methodology, whereby we inspected core services, and included an inspection of the well-led element of the trust overall and took place form 5 February 2019 to 14 March 2019. The first inspection took place in September 2014, when it was rated as requires improvement overall. The hospital was inspected again in October 2016. The overall rating for the trust was ‘inadequate’ with two of the five key questions we ask, safe and well-led, being ‘inadequate’. Effective and responsive were rated as ’requires improvement’. The trust, and every service level, was rated ‘good’ for care. The service was placed into special measures. The third inspection took place from 7 November to 1 December 2017, which was announced. Our rating of the trust improved. We rated it as requires improvement because: Caring was rated as good in all areas inspected. Safe, effective, responsive and well led were rated requires improvement, and leadership at the trust level overall was rated as requires improvement. However, the trust was not removed from special measures. Is this organisation well-led? Leadership The trust had managers at most levels with the right skills and abilities to run the service. There was a mix of experience within the executive directors with some new to the executive role and others with considerable experience. In order to assess if the organisation was well-led, we interviewed the members of the board, both the executive and non-executive directors, and held focus groups with a range of senior staff across the hospital. We met and talked with a wide range of staff to ask their views on the leadership and governance of the trust. Over the previous 12 months, we had observed board meetings and serious incident panel meetings. We looked at a range of performance and quality reports, audits and action plans, board meeting minutes and papers, annual reports, investigations, and received feedback from patients, staff, and stakeholders. 20171116 900885 Post-inspection Evidence appendix template v3 Page 2 The trust board had the appropriate range of skills, knowledge and experience to perform its role. Although some were new to the board and trust, they reported a high level of support, gave very positive messages with regards to improvements and future opportunities. The capacity of the executive team had increased and the leaders had the skills and experience required. Teamwork was much more apparent than at previous inspections. Additionally, all the board members told us that over the past year, since the substantive chief executive had been in post, there had been a period of stability; they had been able to stand back and assess their impact as board. They had all, through a series of board development sessions and subsequent reflection, realised that they had become too involved in operational issues within the trust. As a result of this, they had focussed on the work of the committees who reported to them, so that their work was more accurate, better presented, timely and succinct. Reports were presented to the board ‘by exception.’ This had allowed the board to leave operational issues to the divisional teams, so that they could be more strategic. Board Members Since our last comprehensive inspection, there had been some changes to the trust board. The board comprised a chief executive officer (CEO), who was appointed in April 2018.This was their first CEO post. There were seven other executive directors as detailed below: • Interim deputy chief executive, joined the trust in June 2018. • Chief operating officer, joined the trust September 2018. • Medical director, was appointed in June 2010. • Director of nursing and quality, appointed October 2014. • Director of human resources and organisation development, joined the trust in June 2014. • Director of finance and contracting, was appointed in June 2017. • Director of integrated governance, joined the trust in July 2018. The chair had been in post since August 2017 and was supported by six non-executives (NEDs) and one associate non-executive director. The NEDs had a range of experience and skills, including senior positions business and in health and social care. Of the executive board members at the trust, 0.0% were British Minority Ethnic (BME) and 50.0% were female. Of the non-executive board members 12.5% were BME and 37.5% were female. Staff group BME % Female % Executive directors 0.0% 50.0% Non-executive directors 12.5% 37.5% All board members 6.3% 43.8% (Source: Routine Provider Information Request (RPIR) – Board Diversity tab) There was a council of governors in place who spoke positively of the relationships since the arrival of the chair and chief executive officer. When senior leadership vacancies arose the recruitment team reviewed capacity and capability needs. Additionally, the trust reviewed leadership capacity and capability on an ongoing basis. 20171116 900885 Post-inspection Evidence appendix template v3 Page 3 Leadership development opportunities were available, including opportunities for staff below team manager level. We were assured there was an accountability framework in place which defined responsibility from ward to board through a clinical directorate and divisional structure. There was a programme of board visits to the wards, which was recorded. Staff reported leaders were visible and all were described as approachable, individual board members made visits to wards and departments on all the trust’s sites. In the 2018 staff survey 79.3% of respondents said they knew who the senior managers were, while this was below (worse) than the national average 83.4% it was an 4.3% improvement on 2017 response. 41.4% of staff said communication between senior management and staff was effective. This was above (better) than the national average (40.8%) and a 9% improvement from the previous year. 35.4% of responds said senior managers try to involve staff in important decisions, this was 1.6% above (better) than the national average and a trust improvement of 9.2% from the 2017 result. A formal leadership strategy, development programme, succession planning and talent management had been developed but not yet implemented or therefore embedded. The board recognised this needed further development throughout the trust. It was however, recognised that development had taken place with key individuals. The trust’s organisational structure comprised three clinical divisions; medical, surgical and family health. This organisational structure had been in place since late 2017. The medicine division included urgent and emergency care, nephrology, cardiology, diabetes rheumatology, adult medicine, respiratory, dermatology, neurology, radiology and stroke. The surgery division included gastroenterology theatres, trauma and orthopaedics, head and neck, general surgery, urology, colorectal and anaesthesia. The family health division included, obstetricians and gynaecology, midwifery, paediatrics, pathology, haematology, oncology, cancer services, outpatients and therapies. Each division had a chief of division role. The medicine division had a head of nursing for medicine and urgent care. Surgery also had a head of nursing in post. The trust leadership team had knowledge of current priorities and challenges and took action to address them. Staff at all levels were clear about their roles, responsibilities and what they were accountable. The organisational structure was embedded. All staff were clear on which division they worked within and who their divisional leaders were.