To provide the Committee with a progress report on the Lancashire Care Foundation Trust Improvement Plan.
Minutes:
Dr Leon LeRoux, Clinical Director, Lancashire Care Foundation Trust (LCFT) provided an overview of the results of the recent Care Quality Commission (CQC) Inspection of LCFT services. He highlighted the key areas for improvement as Safe, Effective and Well Led and cited a shortage in staffing and poor IT system as areas of concern.
The Chairman expressed the Committee’s disappointment that Ms Jo Moore, Director of Operations and Mr Paul Lumsdon, Director of Nursing were not present at the meeting. He also advised that the report provided by LCFT was poor and did not provide any detail or assurance that the Trust would make the improvements required.
Members raised serious concerns regarding the leadership of the Trust and the citing of staffing issues as a reason for poor performance, highlighting that huge risks were being taking with patients in life or death situations. Concern was also raised that a number of the ‘must do’ actions from the CQC inspection were basics of care that should not fail to be undertaken.
The Committee referred to previous discussions with the Trust and Blackpool Clinical Commissioning Group (CCG) when the changes to mental health care provision including The Harbour were originally considered and the numerous meetings since. It was considered that despite repeated claims that the provision would work for Blackpool and Lancashire and improvements would be made, it had proved not to be the case and the level of service promised to residents had not materialised.
In response to questions, Dr LeRoux advised that the bed model had been based on population and patient numbers in 2006/2007 and had been ambitious in its assumption of performance in the top quartile. The model had also assumed that the money saved by the closure of acute mental health wards would have been reinvested in community service provision, which had not happened. There were therefore not enough beds available. He added that the Trust had struggled to attract staff and was in competition with big cities to do so.
The Chairman referred to the minutes of the meeting of the CCG’s Finance and Performance Committee, case studies provided by Blackpool Fulfilling Lives and the CQC inspection report and queried how the Blackpool Clinical Commissioning Group was ensuring that improvements would be made to service provision.
Mr Roy Fisher, Chairman, Blackpool CCG advised that the CCG was not happy with the level of service being provided by LCFT. He reported that concerns had been raised with the Trust and questions had been asked in order to challenge performance. The concerns had also been raised by the Integrated Care System and discussions were ongoing regarding how improvements could be made across Lancashire.
In response to questions, Mr David Bonson, Chief Operating Officer, Blackpool CCG advised that acute mental health provision was commissioned by eight CCGs as a Lancashire-wide service. He added that discussion would need to take place across all CCGs should LCFT not make the necessary improvements.
Members raised concerns that the response provided by the CCG did not give sufficient assurance that the situation would be monitored with steps taken, where required, to address failures. In response, Mr Bonson sought to assure Members that the CCG was taking the concerns seriously and wanting to work with partners across Lancashire to ensure improvements were made.
At the invitation of the Chairman, Dr Neil Hartley-Smith, GP, Bloomfield Medical Centre advised that more patients attended surgery for consultations regarding their mental health than any other complaint. He advised of the process that a GP would follow in order to make a referral and reported that GPs had recently met with LCFT to raise concerns regarding mental health services. He added that GPs were frustrated that patients were not receiving the treatment that one would like to see them have. Key concerns included the lack of a crisis team at Accident and Emergency to enable a quick decision on whether a patient needed admitting.
Following consideration of the concerns raised by Dr Hartley-Smith, the Chairman invited Mr Stuart Clayton, Fylde Family Support Group, Rethink to highlight the concerns of his service users. Mr Clayton reported that there were a number of very vulnerable people in Blackpool who required an immediate intervention and raised concerns that the only proposals being made were for long term solutions. He requested that the CCG and LCFT consider options to provide a ‘quick fix’ for those patients that needed immediate assistance and made a number of suggestions including use of Parkwood, a face to face crisis service and recruitment of more care assistants.
In response to the concerns raised, Dr LeRoux advised that LCFT had been exploring potential uses for the building Parkwood, which had been empty since the closure of the mental health unit previously based there. He advised that LCFT did have a high level of care assistants in comparison to similar trusts and noted that it was important to balance the number of care assistants with qualified nurses, acknowledging the benefit provided by the ‘human contact’ provided by care assistants.
Councillor Amy Cross, Cabinet Member for Adult Services and Health was invited to describe her experiences of mental health services in Blackpool and made a number of key points including that:
· Key officials from LCFT had not been attending meetings with partners despite confirming attendance.
· Emails sent requesting information and liaison from senior Council staff to LCFT representatives had not been answered.
· The issues relating to poor communication had been ongoing for over 12 months and were not one-offs.
· Discussion had been held at the Health and Wellbeing Board relating to the basic action plan that had been provided to address concerns with no detail of how improvements would be achieved or when.
· Anecdotal evidence had been received relating to poor patient management, including lack of communication with a suicidal patient regarding their discharge.
· The issues with staffing would not be rectified without addressing the culture of the organisation, accepting failures and improving staff morale.
The Committee raised further concerns including the speed in which LCFT was addressing the actions contained within the CQC report, noting that despite the judgement being received in May 2018, a discussion group had only just been established address some key actions. It was also considered that if the provision of mental health services was indicative of how the Integrated Care System would work across Lancashire and South Cumbria then the system was also a potential cause for concern.
At the invitation of the Chairman, Dr Arif Rajpura, Director of Public Health was invited to feed in his concerns. He highlighted that he was aware that GPs were unhappy with the current service provision and the access to services provided by LCFT. He added that there were a large number of residents who needed immediate help and were suffering. He wanted to work with LCFT, but was currently struggling to communicate with them due to a lack of response received.
Input from Ms Karen Smith, Director of Adult Services was also requested and she advised that she supported the comments and concerns previously raised. She highlighted the need to communicate and work together in order to achieve change.
The Chairman drew the item to a conclusion by requesting that a written response be provided within 21 days to the key concerns raised by the Committee and that a special meeting be established in January 2019 to consider the progress made by the Trust in addressing the 22 ‘must do’ and ‘should do’ actions contained within the CQC report.
Supporting documents: