Southend University Hospital NHS Foundation Trust Evidence appendix Prittlewell Chase Date of inspection visit: Southend-on-Sea 21 November to 14 December 2017 Essex SS0 0RY Date of publication: xxxx> 2018 Tel: 01702 435555 www.southend.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 Southend University Hospital NHS Foundation Trust (SUHFT) provides acute services from its main Southend Hospital site and outlying satellite clinics across Southend-on-Sea, Castle Point and Rochford. The trust employs over 4,500 staff, serves a population of over 350,000 and has a higher combined percentage population over 65 years of age (20.2%) than the England average (16.95%). The trust provides a comprehensive range of acute services including acute medical and surgical specialties, general medicine, general surgery, orthopaedics, ear, nose and throat, ophthalmology, cancer treatments, renal dialysis, obstetrics and gynaecology and children's services. It is the South Essex surgical centre for uro-oncology and gynae-oncology surgery and has a dedicated stroke unit. Also offered are breast screening, ophthalmology and orthodontic services to the wider South Essex population. The current hospital site opened in 1932 with additional extensions added throughout the existing site, the major extension of the tower block was opened in 1966. In 1997, the trust was officially designated cancer centre status and in 2006 opened the centre for clinical oncology. The trust has 544 acute inpatient beds, 31 maternity beds and 26 critical care beds. From July 2016 to June 2017 there were: 90,849 inpatient admissions 625,109 outpatient attendances 101,120 emergency department attendances. The trust is a part of the Essex Success Regime launched in 2015 with the aim of addressing the pressures on the local health and care system by tackling the gaps in clinical staffing, meeting the growing health demands of the population and enabling the system to achieve financial balance. In December 2016, the boards of the three acute trusts (SUHFT together with Basildon and Thurrock University Hospitals NHS Foundation Trust, and Mid Essex Hospital Services NHS Trust) decided to enter into a formal collaborative governance framework and contractual joint venture. This allows the organisations to plan services and make decisions together, whilst remaining three independent statutory organisations with their own boards and councils of governors (or equivalent). This followed a period of board-level collaboration as part of the Acute Joint Working Project Steering Group between April and December 2016. In November 2017, a public consultation started that included the option of the potential merger of all three acute trusts, this is due to end March 2018. The Essex Success Regime is one of three national initiatives designed to support the most challenged health and care systems across the country. It covers hospitals and NHS providers in the south of the county plus the CCGs that commission the services. The two to three year programme will see hospitals, GP surgeries and other NHS service providers work together to address deep-rooted pressures and secure high quality care. The overall aim is to improve health and care in areas managing financial deficits or issues of service quality or both. The Success Regime will bring managerial and financial support to the region. It will help facilitate the developments of local plans that will set out how partners will transform care in a sustainable way. Key elements of focus include a closer working relationship across the area and improvements of provision and access to urgent and emergency care. Is this organisation well-led? Leadership There were clear processes in place to ensure that the trust board and senior leadership team had the skills, knowledge, integrity and experience that they needed on appointment and throughout their employment. However, at the time of our recent inspection the trust was going through a period of transition that included an evolving leadership team to meet the needs of a changing organisation. The trust was part of the Essex success regime and in line with the Sustainability and Transformation Plan (STP) had formed a partnership with Basildon and Thurrock University Hospitals NHS Trust and Mid-Essex Hospital Services NHS Trust. This partnership was formalised as of 1 January 2017 and was overseen by the Joint Working Board (JWB), which was made up of nine executive members and six non-executive directors from all three trusts. Claire Panniker, Chief Executive Officer (CEO) for all three trusts, led the JWB. The chair of the JWB was also joint chair for all three trusts. There was also a Joint Executive Group (JEG), which worked with the JWB and consisted of nine executive directors with joint responsibility for oversight of specific areas across all three trusts. For example, the chief human resources director was responsible for the overall delivery of the organisational development strategy across all three trusts; they also sat on the JWB. Senior leaders acknowledged that the trust board was not representative of the workforce or the local population, they were working with the equality, inclusion and diversity advisor and HR and OD team to understand what was needed to address this. Board members1 Of the executive board members at the trust, 12% were BME and 67% were female. Of the non-executive board members, none were BME and 25% were female. BME % Female % 1 RPIR – Universal: Board tab Executive 12% 67% Non-executive 0% 25% Total 12% 92% At each trust in the Essex success regime there was a site level senior leadership management team (SLT) responsible for the day-to-day management team of the hospital and reporting to the relevant director at JEG level. The site level senior leadership team at the trusts were working on fixed term contracts until March 2018 when a decision will be made either to extend the JWB period or to disband the partnership working. A public consultation process started in November 2017 to consider these options and included the potential merger of all three trusts. The site level senior leadership team at SUHFT consisted of nine directors including a managing director who acted as overall site leadership and reported directly to the CEO. The managing director at SUHFT had been in this post since December 2016. Prior to this, they had been the chief nurse at SUHFT since October 2015. Other members of the SLT included the medical director who had been in post since 2012 after 16 years as surgical lead for the trust. The director of nursing had been in post since December 2016 and was previously associate director of nursing at the trust since October 2015. Our interviews with all of the directors at SUHFT confirmed that leaders understood the unique qualities and needs of their teams. There was a clear understanding of the challenges to developing and implementing a leadership team that would meet the needs of the changing organisation. Leaders that we spoke with acknowledged that the current leadership structure was complex and in a state of transition which was unsettling for all staff. The trust reviewed leadership capacity and capability on an on-going basis, however there was no formal succession plan or process in place at the time of our recent inspection. The CEO informed us that ensuring that the leadership team had the capability and capacity to deliver strategic objectives was an integral part of the organisation’s ‘journey’. A process had started in December 2016 to map the critical roles needed for the current and emerging organisational form. This would inform a long-term succession planning strategy across all three trusts. The process had enabled the trust to identify key roles within the current structure that would require emergency cover if individuals left or were absent for a period, however, this was still a work in progress. Our interviews with the HR team confirmed that the development and implementation of a robust succession planning and talent management programme was a priority of the ‘Human Resources and Organisational and development strategy, 2016-2019’. Our review of personnel files and policies demonstrated that the trust had a comprehensive Fit and Proper Persons Requirement (FPPR) process in place to ensure that directors were fit to carry out their responsible roles in accordance with Regulation 5 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The process included comprehensive pre- employment checks that included enhanced Disclosure and Barring Service (DBS) checks, insolvency and bankruptcy checks, disqualified director register checks and occupational health checks. There were further checks on appointment through self-declaration and on-going assurance through an annual declaration and an audit process conducted by the chair of the JWB. The leadership team had a comprehensive knowledge of current priorities and challenges and identified actions to address them. For example, one of the main risks identified to the board was the ability to meet key performance indicators (KPIs) such as ED four-hour performance target and referral to treatment (RTT) in all specialities including ophthalmology. The trust had been managing a backlog of follow-up appointments for this speciality since an improvement plan for this area was implemented in April 2016; (this is covered more fully in Outpatients report in ‘Safe’ and ‘Responsive’ sections). The trust had a comprehensive recovery action plan for RTT performance, which covered all specialities and was monitored by the trust’s dedicated improvement director.