Agenda item

To consider the Trust's response to its recently published Care Quality Commission (CQC) inspection reports and the independent review of the Trust commissioned by NHS England.

Senior representatives of the North East Ambulance Service NHS Foundation Trust (NEAS) were invited to provide the Committee with a response to recent Care Quality Commission (CQC) inspections of its services, as well as the findings of an independent review of the Trust.  Led by the NEAS Chief Executive Officer and supported by the NEAS Assistant Director – Communications and

Engagement, a presentation (circulated in advance) was given which drew attention to the following:

 Latest CQC Position

 Improvement Plan Overview

 Workstream Actions Progress

 Progress on Medicines Management

 Progress on Incident Reporting

 Progress on Governance

 Progress on Culture

 Response Time Benchmark Performance (June 2023)

 Draft June 2023 Position

 Independent Review – NEAS Assurance Statement

It was stressed from the outset that NEAS had worked hard with the CQC to fully understand the concerns raised following the regulator’s inspection of the Trust in July and September 2022 (published in February 2023).  The CQC had subsequently re-visited the Trust and the individual grading for its Emergency and Urgent Care (EUC) services had since improved from ‘inadequate’ to ‘requires improvement’ (with the Section 29A warning notice lifted).

As part of the Trust’s ongoing improvement plan, it was stated that two full cycles of audit over a timeframe of a year would be needed before there was sufficient confidence that actions undertaken as a result of the CQCs findings had become embedded into practice, and that independent auditing would be used to determine this.  It was acknowledged that organisational culture can take time to change and even longer to embed.

Progress against the four identified workstream actions was detailed.  Specific reference was made to developments around ‘medicines management’ and the ability for paramedics to collect required drugs from a location other than their base station, as well as the strengthening of ‘incident reporting’ which included the intended introduction of a new patient safety incident review framework by the end of 2023-2024 (NEAS being the first ambulance Trust to roll this out).  In terms of ‘culture’, progress around this would be monitored through staff surveys.

Despite the challenges identified by the CQC, comparative data indicated that, for June 2023, NEAS was the best performing ambulance Trust in the country in relation to category 1 (an immediate response to a life-threatening condition, such as cardiac or respiratory arrest) response times, an achievement which led to positive clinical outcomes for patients.  NEAS was working towards being the best for category 2 (a serious condition, such as stroke or chest pain, which may require rapid assessment and / or urgent transport) response times too, though this continued to be a struggle, with all Trusts above the national target (some others significantly so).

A brief background to events which culminated in a NHS England-commissioned independent review into patient safety concerns and governance processes related to NEAS was given.  Following issues raised by a whistle-blower back in 2018 regarding coronial processes, the Trust commissioned a review which culminated in significant change – however, despite the regulators being satisfied with these developments, the Trust was unable to agree with the whistle-blower that enough had been done.  NEAS acknowledged that it did not do the right thing by the families in question and had since publicly apologised.

Most of the recommendations emerging from the independent review were already being addressed (or had been completed) by NEAS prior to the publication of the report in July 2023.  There were some additional areas of focus identified, though, including the medical examiners model, the constitution of a committee (to be independently chaired) to allow families to see changes made (the Trust welcomed this and would be in contact with families in the future), and enhanced Board processes to ensure learning had been achieved.

The Committee drew attention to cases where independent services were being brought in to enhance the existing NEAS offer and queried whether Trust leaders had sufficient oversight of this.  In response, Members were informed that the only external / consultancy support being used was in relation to the ‘governance’ workstream and that this was on a short-term basis.

Continuing with the theme of governance, the Committee sought further details on the NEAS executive management team buddying programme with directors from Northumbria Healthcare NHS Foundation Trust.  Officers confirmed that support was being received for the benefit of the whole Trust, and that Northumbria had an excellent internal management programme which NEAS had been offered places on.  Critically, this arrangement provided challenge to the executive.

With reference to the independent review outcomes, the Committee asked if progress on implementation of the recommendations would go back to the report author, Dame Marianne Griffiths DBE.  Officers stated that ultimate responsibility sat with NHS England who commissioned the review, though a monthly quality improvement group that was co-chaired by NHS England and the North East and North Cumbria Integrated Care Board (NENC ICB) provided scrutiny of the Trust’s response to the recommendations.

AGREED that the North East Ambulance Service NHS Foundation Trust update regarding recent CQC inspection / independent review outcomes be noted.