Agenda item

Following the Committee’s request in February 2024 that the TEWV Lead Governor should be invited to a future meeting to respond to the latest Care Quality Commission (CQC) findings on the Trust from a Governor perspective, and further to Cabinet changes made at the subsequent Stockton-on-Tees Borough Council (SBC) Annual Meeting, the TEWV Chair (of both the Board of Directors and Council of Governors), as well as the TEWV Managing Director for Durham, Tees Valley and Forensics, were in attendance to provide a response to the latest CQC inspection of the Trust, progress of the Trust’s improvement plan, and the role / accountability of its Governors.

Prior to taking Members through a presentation, the TEWV Chair (in the role for around two years now) reminded the Committee of the Trust’s ‘Big Conversation’, a significant engagement initiative that was undertaken following difficult events at the former West Lane Hospital, Middlesbrough site.  The results of this consultation had defined a five-year strategic plan which TEWV was presently half-way through.  Whilst not yet the finished article, it was stressed that TEWV was not undertaking a process of ticking boxes, but instead sought to fundamentally change the organisation through involvement with patients and their families / carers.

The results of the latest CQC inspection (published in October 2023) were re-iterated, with TEWV recognising and accepting the description of it being a Trust which required improvement (though it was also noted that the Trust was rated ‘good’ in both the ‘effective’ and ‘caring’ domains).  Attention then turned to graphics which compared TEWVs CQC ratings from December 2021 with the current (October 2023) gradings across its 11 service areas.  Whilst progress had been made in general (particularly in improving upon the December 2021 ‘inadequate’ ratings for both wards for people with a learning disability or autism and forensic inpatient or secure wards), TEWV acknowledged that there was too much amber (‘requires improvement’) within the ‘safe’ domain and assurance was given that an Action Plan was in place to address this.

Further detail was provided in relation to the last CQC inspection of TEWV, with ‘positives’ and ‘areas for improvement’ listed.  For the former, recognition of the continued good engagement with stakeholders and partners was highlighted (an important factor given that the mental health agenda did not just sit with the Trust), as was evidence of innovative practice (co-creation initiatives, and embedding of the lived experience voice within governance structures which helped shape the delivery of services).  In terms of the latter, identified workforce issues had since been addressed through strengthened oversight of daily deployment of staff and successful international recruitment for doctors / nurses (TEWV was also now in the top 10 mental health Trusts nationally for employee retention), there was a new strategy in place for physical health monitoring, and the serious incident backlog (acknowledged as unacceptable) had been cleared following the introduction of the Patient Safety Incident Response Framework (PSIRF).  In summary, the CQC had recognised that significant improvements had been made since 2021, and a lot of further work had been done since the publication of the regulator’s report in October 2023.

The Committee began its response to the information provided by highlighting its historic concerns that the Trust’s Governors were not doing enough to hold the Non-Executive Directors to account, as well as past assurances provided by the now previous Lead Governor back in February 2022.  Members were very much aware of the five-year ‘journey of change’ (which some would say started in 2019, not two-and-a-half years ago), but the last CQC inspection once again raised numerous concerns, particularly in relation to a lack of learning from deaths, hence the request for a collective view from the TEWV Governors.  Ultimately, the positivity which was regularly translated by senior Trust personnel needed to filter into improved results on the ground, especially within the CQCs ‘safe’ domain.

Members continued to reflect on developments in the aftermath of events at West Lane Hospital and noted that TEWV performance was still declining post-2019 (resulting in the Trust being served a warning notice by the regulator in mid-2021).  TEWV had changed its Board and Chair in recent years, yet the CQC still rated it ‘requires improvement’, and the Committee felt a lingering sense of the Trust waiting for an issue to be highlighted before doing anything about it and, in essence, firefighting one problem before another emerged.  Other concerns were outlined, including reported historic criticism that Governors were not listened to, a lack of detail / data provided to back-up claims of improvement, and NHS staff survey results where many measures appeared to fall below the median for benchmarked Trusts.  A lot of people relied on TEWVs services, and assurance was needed around the effectiveness of the Governors and their collective ability to hold relevant parties, and themselves, to account.

The TEWV Chair stated that he did not agree with a number of the Member observations made and that the Trust was aiming to be balanced and reflect the positive change that the CQC had found when last inspecting services.  No mental health Trust in England had been rated above ‘requires improvement’ in the last two years, a situation which may indicate the nature of increasing numbers of people requiring help and greater acuity of those wanting to access it.  From a Council of Governors perspective, the group had come a long way and had played its part in improving the offer (e.g. highlighting the number of lost calls in relation to the crisis line).

TEWVs backlog of serious incidents requiring investigation was probed, with Members noting that this continued until it was highlighted by the regulator.  The Trust representatives reiterated that this was untenable, and that criticism of the Trust for not getting its act together 18 months-two years ago was valid.  Attempts to tackle this in partnership with other NHS colleagues had been made, though challenges around staffing and the demand for mental health support had inhibited progress.  However, the fact that the backlog had now been addressed (involving the dedication of a lot of professionals’ time) demonstrated the increased ‘grip’ of the Board.

The Committee expressed deep concern around the state of children’s mental health and sought confirmation that services for young people would be prioritised.  The TEWV Chair gave assurance that much was already being done to address the mental health needs of children and young people, and that such provision would certainly be central to the organisation’s focus of attention.  The Integrated Care Board (ICB) was also echoing concerns regarding waiting lists, something which TEWV had already started to reduce following its work on iThrive (model to support children and young people to access mental health services).

Looking ahead to the Trust’s next CQC inspection, Members asked what reassurance could be given that those areas requiring improvement would be upgraded to reflect provision that was deemed ‘good’.  The TEWV Chair stated that no guarantees could be provided since it was the regulator’s view that would determine the ratings, but did highlight the increased number of ‘good’ domains compared to the end of 2021.  That said, improving TEWVs ‘safe’ domain ratings was now a real focus, and the Trust would be happy to provide data to back-up evidence of progress where requested.

Members acknowledged that the TEWV Chair had come into the role during a time when the Trust was grappling with significant legacy issues, and expressed their hope that both he and the Governors were strong enough to hold the Board to account over its performance.  Decisions to call TEWV in to address the Committee were not taken lightly, but there was a strong desire to see improvement (in staff satisfaction as well as in the delivery of services).

SBCs recently appointed TEWV Governor (the new Cabinet Member for Adult Social Care) was also in attendance and gave assurance to the Committee that Trust-related information would be shared whenever it could be.  Emphasising the need to move on from the previous SBC representative, Members responded by urging the new TEWV Governor to make a positive impact in the role and commended the recent circulation of the Trust’s carers newsletter.  Clarity was also requested around the origins of the decision to appoint a Cabinet Member as a TEWV Governor and how that should be taken.

Concluding this item, the Committee Chair thanked the TEWV representatives for their attendance / information, and for responding to comments / questions.

AGREED that:

1)    the information submitted by Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV) be noted.

2)    confirmation be provided around the origins of the decision to appoint a Cabinet Member as a TEWV Governor and how that should be taken.