Kettering General Hospital NHS Foundation Trust Evidence appendix Rothwell Road Date of inspection visit: Kettering 7 November to 10 November 2017 Northamptonshire 24 November 2017 NN16 8UZ 29 November to 1 December 2017 Tel: 01536 492000 Date of publication: www.kgh.nhs.uk February 2018 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 Kettering General Hospital NHS Foundation Trust provides acute healthcare services to a population of around 275,000 in north Northamptonshire, South Leicestershire and Rutland. There are approximately 640 inpatient beds and over 3,400 whole time equivalent staff are employed. 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 three sites that we did not inspect: Nene Park, Corby diagnostic centre and Isebrook outpatients. In 2017/18, the trust has a budget of £218,465,000, with a projected deficit for the year of £19,539,000. In 2016/17 the hospital had: 87,509 A&E attendances (October 2016 to September 2017). 81,030 inpatient admissions (October 2016 to September 2017). o 5,062 of these were children and young people inpatient admissions (6.3%). 341,567 outpatient appointments (October 2016 to September 2017). 3,361 births June 2016 to June 2017). 1,210 in hospital deaths (October 2016 to September 2017). Number of beds: Acute - 590 (July 2017 to September 2017). 20180222 KGHNHSFT Evidence Appendix Page 1 Maternity – 49 (July 2017 to September 2017). Critical care – 16 (November 2017). Number of bed days - 250,363 (October 2016 to September 2017). Number of staff (in whole time equivalent posts): Medical - 424. Nursing – 884. Other - 2,098. Total - 3,406. Ethnicity of admissions (%) from October 2016 to September 2017: White - 93.4% Asian - 2.3% Not stated - 1.7% Black - 1.3% Mixed - 1.0% Other - 0.4%. (Source(s): Hospital Episode Statistics) Population served The trust provides hospital care for a population of 275,000. The local population from April 2016 to March 2017 was predominantly white (86%), with 3% Asian, 2.5% black and 1.2% mixed. Northamptonshire is a centrally situated county incorporating a mix of urban and rural areas. The population density is in the lowest 25% of upper tier authority areas within England. In spite of this, the county has seen one of the most significant levels of growth during the past 30 years, well in excess of national and regional growth trends. Whilst the population has grown across all broad age groups, this has been particularly high in those aged 65 and above. This is expected to continue in projections to 2021, with particular emphasis on the group aged 70 years and above. In spite of this growth at the top end of the age profile, the proportion of those aged 65 and above within Northamptonshire remains comparatively low against the national profile, with the child population (0 to 15 years) comparatively high. Deprivation Socio-economic deprivation is considered to represent an important health determinant. This is supported by the notable difference, which has been recorded between life expectancy in the most deprived and the most affluent areas of England. The extent of socio-economic deprivation in Northamptonshire is not as considerable as other parts of England, but specific pockets can be identified, particularly in the Corby and Northampton areas. Deprivation has a tendency to be concentrated in urban areas of the county. Health deprivation however has a higher occurrence at the most significant level in the county than overall deprivation. This is found within areas of Corby, Northampton, and to a lesser extent Kettering. The link between health deprivation and other forms of deprivation considered determinants is by no means explicit. Whilst 57% of those areas experiencing health deprivation amongst the top 30% in England also recorded similarly high levels of income deprivation, for environment deprivation, this was 22% and for barriers to services was just 8%. 20180222 KGHNHSFT Evidence Appendix Page 2 Is this organisation well-led? To write this well-led report, and rate the organisation, we interviewed the members of the board, both the executive and non-executive directors, and 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. We looked at a range of performance and quality reports, audits and action plans; board meeting minutes and papers to the board, investigations, and feedback from patients, local people and stakeholders. Leadership The leaders had most of the skills, knowledge, experience and integrity to lead the trust with some changes to personnel and roles taking place over the last year. Sustainability of improvements was to be an ongoing focus for the leadership team. The trust board now had the appropriate range of skills, knowledge and experience to perform its role. The trust now had a senior leadership team in place with the appropriate range of skills, knowledge and experience. The leadership team had the capacity to continue to drive improvements. Understanding and management of risks had improved. The trust board comprised of an interim chief executive officer (CEO) and five other executive directors and a chair of the board and six other non-executive directors (NEDs). Since our last inspection, there had been significant changes to the trust board. The acting CEO, who was in post in October 2016, had resigned to move to another trust and left in February 2017. The substantive CEO, who had been on sickness leave at the time of the October 2016 inspection, resigned in July 2017. An interim CEO was appointed and started at the end of February 2017 and was expected to stay until February 2018. In July 2017, the chair of the board resigned. A new substantive chair commenced in August 2018. A new substantive CEO had been appointed and was due to commence in post in March 2018. The finance director left in February 2017. A new director of finance and contracting was appointed in June 2017. The medical director had been in post seven years, the director of nursing three years, the chief operating officer since early 2016 (having taken on the role of deputy chief executive in late 2016) and the director of human resources for three years who was overseeing strategy supported by a director of strategy. Other than the medical director, the remaining executive directors had been in post three years or less, with the chief operating officer starting in early 2016. The board was therefore still relatively new. When senior leadership vacancies arose the recruitment team reviewed capacity and capability needs. The trust reviewed leadership capacity and capability on an ongoing basis. This was an improvement on the October 2016 inspection. There were three other director posts supporting the board: a director of digital services, director of estates and facilities and a director of integrated governance. This last post was a new post appointed to on an interim basis in August 2017. This new role of director integrated governance was responsible for embedding an effective strategy for governance and assurance across the trust, incorporating all aspects of corporate and clinical/quality governance. The trust leaders had recognised the lack of capacity within the executive team following the last inspection and this new role enabled more capacity to be available for each role. An improvement director from NHS Improvement had started in August 2017 to support the trust to drive the quality improvements required. There was better capacity in the executive team to recognise and respond proactively to new and emerging risks. The NEDs had a range of experience including business, public and private sector. The NEDs that we interviewed had a clear understanding of their roles and the remit and accountability, including addressing the challenges for the trust, of the governance or performance committees they chaired. Driving improvements throughout the trust was a clear focus. We attended a board meeting in October 2017 and found there was greater discussion and challenge from the NEDs compared to the previous inspection in 2016. This was confirmed by minutes of the board 20180222 KGHNHSFT Evidence Appendix Page 3 meetings that we reviewed as there were clear records of discussions and challenges about performance, accountability and confirmation of the actions agreed Executive directors spoke positively about the support they were receiving from the new chair and interim CEO. All were receiving regular one to one meetings with both the CEO and chair and had a mentor to support their development. In response to the findings of the previous inspection, the trust had, through NHS Improvement, commissioned a review of trust leadership and governance by an independent provider. A redacted summary of the report was made available on the trust’s website on 2 September 2017. The report looked in detail at the strengths and values of the executive team and made 37 recommendations in terms of governance, ownership, equal distribution of portfolio responsibility. Changes such as that made to separate quality from the director of nursing role and strategy from the director of human resources role aimed to provide extra capacity in the executive team.