Thank you to everyone who attended the annual members' meeting and those who asked our leaders questions, whether it was in advance or on the day. You can find the recording of the event below along with all the pre-submitted questions and answers.
Watch it back
From Carole Woodman on behalf of the Governors and Members of the Foundation Trust
We have heard that Covid and continuing pressures are putting many healthcare professionals under considerable strain. Can the Trust please say what it is doing to help with the health and wellbeing of staff – and is a flexible working policy part of the approach?
We are very pleased to say that the comprehensive support we provide to our colleagues in these challenging times has been recognised through a prestigious Better Health at Work GOLD award. The award, backed by Public Health England and the Northern TUC, recognises the range of measures and support available to all our staff including:
- The additional wellbeing day we have given all permanent staff
- Our employee assistance programme
- Our employee benefits scheme provided by Vivup
- Wellbeing conversations which happen between managers and their team members
- Our positive approach to the Freedom to Speak Up role
- There are a lot of resources on our staff web dedicated wellbeing pages
- Specific workshops and webinars to deal with issues such as dealing with the menopause, sleep deprivation etc.
In relation to your question on flexible working - the Trust has recently updated its Flexible Working policy which covers many options to vary working arrangements. From joining the Trust all staff have the opportunity to request any changes and we are beginning to gather data centrally to track the progress of these applications which previously has been at a local management level.
There are always concerns and occasional rumours about the sustainability of services at the West Cumberland Hospital What reassurance can you give that services will remain there, that they are safe, and that clinical staff are seeing sufficient patients to maintain their professional skills?
We understand the strong feeling of our local community the difficult geography of North Cumbria. That is why we are committed to a two general hospital model in our area – supported by strong community service to provide appropriate care for patients close to home. Subject to Department of Health approval we will be investing a further £40m into WCH for phase two of the redevelopment. This is in addition to the £90m phase one investment. As well as creating an improved, modern environment, we will be keeping the bed capacity and services at the hospital. Many of our clinicians work across both CIC and WCH, providing clinics and carrying out surgery. Our plan is to continue to increase the number of operations we do at WCH.
Phase two of the redevelopment will include creating a new care of the elderly ward, new paediatrics area, a specialist palliative care ward a stroke and rehabilitation ward. We will also upgrade maternity and gynaecology facilities.
One of our concerns through COVID is that many people were putting off getting checked out for possible symptoms of cancer? Are you seeing an increase in cases and are you keeping up with the backlog of diagnostic tests?
Yes we are seeing an increase in cases. There does appear to have been an issue during the peak of the covid pandemic when we saw a drop in referrals. Referrals are now back to normal levels in most specialties and are above normal levels in some specialties. There is a lot of work going on with the CCG and Northern Cancer Alliance to ensure patients are appropriately referred.
We are keeping up with diagnostic tests for cancer. We have a backlog of diagnostics, but that is for routine patients. Cancer patients are always prioritised. The additional endoscopy activity delivered via the new mobile unit will be operational for 6 months from middle of November will help reduce these backlogs considerably.
From Liz Clegg West Cumbrians’ Voice for Healthcare
The members of West Cumbrians’ Voice for Healthcare would like to sincerely thank all the NHS staff in North Cumbria for their outstanding efforts over the past months of the pandemic to keep the Health Service in North Cumbria functioning and safe. We are well aware of the ‘backroom’ staff, cleaners, secretaries, IT staff, receptionists, accountants (and others that we are unaware of!) who are also vital to keep the frontline services operating. We thank them too.
However, we do have some questions:-
Will the questions, submitted by email and online at meeting, be incorporated, together with their answers, into the minutes of the meeting as if they were asked in person during the meeting?
A log of all questions submitted before or during the Annual Members meeting, and responses to them, are published on NCIC’s website. These remain available until the following year’s Annual members meeting. Minutes are not taken at Annual Members’ Meetings therefore minutes of the 2018 combined Annual Members Meeting / Annual General meeting for North Cumbria University Hospitals Trust and Cumbria Partnership Trust are not available. The AMM for 2019/20 was held ‘virtually’, the first time this approach had been taken and brought about due to Covid-19 restrictions preventing the meeting from being held in person. The recording of the 2019/20 AMM was available on the Trust’s website until October 2021. The recording of the 2020/21 AMM will be published on our website soon after the meeting and will be available until details of the 2021/22 AMM are published. Details of our Board of Directors meetings held in public and Governors Council meetings are available on the Trust website.
Contact Centre. The appointments system/contact centre has been a source of problems for a number of years, especially for patients in the West of the county.
a. Are the staff at the Trust, who are now responsible for resolving the issues, fully aware of all the problems, especially around travel and transport, encountered by service users?
b. Would a review/recap of the different issues reported by patients be helpful?
c. Those of us who have asked questions about this matter in the past are none the wiser as to:
- Which parts of the system are the source of the failings?
- What solutions are available?
- Have either of these been discovered yet?
Thank you for this helpful and timely question. We have become increasingly aware of some of the growing concerns about the current Contact Centre which we operate within the Trust and this has instigated a formal review which is being carried out. The aims of the review are to:
- Describe how the current Contact Centre operates at present and seek to understand how it interfaces with both our clinical services and patients;
- Understand the challenges and problems which the current Contact Centre staff and its users (patients), face at the minute and why these are occurring;
- Develop a view on what we require from the Centre and a range of proposals which could potentially help ensure that the centre fulfils this role; and
- Develop a view of a proposed operating model along with a timescale associated with implementing any necessary changes to support the delivery of this proposed improved service
We are aiming to complete this review by end of November and have included the issues raised with us from the Community Forum meetings which Dean Oliver, our Executive Director of Performance, Planning and Strategy regularly attends. Dean is our lead officer who is overseeing the review process
New Stroke Service:
a. How is the new stroke service performing?
The Sentinel Stroke National audit programme (SSNAP) has rated our stroke service very highly using key indicator ratings for a number of services including delivery of hyper acute stroke services, the performance of our stroke rehabilitation team and our discharge processes. Data taken from the audit shows that following the development of the Hyper Acute Stroke Unit or HASU there has been a reduction in time from admission to arrival on stroke unit and improvement in arrival time to stroke unit and thrombolysis treatment (that is a treatment to dissolve dangerous clots in blood vessels).
b. What are the problems?
The challenges we have within the service are:
- Recruitment to key positions including medical and nursing staff. Our experience in North Cumbria is reflective of the national picture
- Maintaining flow out of HASU to rehab ward due to demands for beds
- Pre hospital assessment
- Lack of Early Supported Stroke Discharge provision across some areas
c. What are the successes?
- Improved Quality of Care
- Providing a 7 day service for Hyper Acute Stroke
- Same care on arrival in hospital for all North Cumbria patients.
- Maintained/Improved thrombolysis rate
- Appointment of a Nurse Consultant
- International recruitment of nurses to support both CIC and WCH
- Able to maintain the delivery of community stroke rehab in innovate ways e.g. remote therapy in response to COVID
Legacy information within changing NHS organisations: Currently there is a lot of material preserved online from the Success Regime and the associated consultation. We understand that this site is maintained by the CCG. Given the high profile of the Consultation and the high input of both public money and NHS staff time involved, the information used to produce decisions, and the records of the actual decisions should continue to be preserved in an accessible form.
a. What are the plans for dealing with this in the successor organisations?
b. It is already unclear where records of other relevant meetings are now kept.
- Where, for instance, can one find the minutes of the 2018 combined NCUHT /Partnership Annual General Meeting?
All of the information from the Success Regime / Healthcare for the Future public consultation is still available on the standalone website http://www.wnecumbria.nhs.uk/ and has also been copied on to the CCG website here: https://northcumbriaccg.nhs.uk/get-involved/consultation-archive
The CCG is working with other CCGs and the developing Integrated Care Board to ensure legacy information is safely archived and stored.
Public and Community Engagement: The CCG will cease to exist in April of next year. This will remove large parts of the public and community engagement processes that had previously been in place. There is a real worry that North Cumbria, and in particular - West Cumbria, will be a smaller fish in a bigger pond. The members of the West Cumbrians’ Voice for Healthcare, together with others in the community, have reason to believe that they have a really useful breadth of experience in ways of operating engagement and expressing the wider community views. It will be frustrating if little regard is taken of that experience. With 6 months or less to go in which to get new public, community and patient engagement systems up and running, they are concerned that there is little time for any considered development of engagement and representation processes that will have lasting value.
a. How far has the planning and development of public, community and patient engagement systems got?
b. How can we help?
See question 9 response
Quality and Safety Assurance: Closely related to Q5 regarding issues of public and patient engagement are those regarding the oversight of safety and quality after the demise of the CCG. In the past the CPCT Standards and Quality committee, overseeing the work of the provider Trusts, enabled consultation to “take people’s views and/or experience into account” and was able to “secure lay participation“. The CCG maintained this with the Quality Review Group where both CCG staff and lay members could hold NCUHT to account. Reports went to the CCG GB meetings to ensure transparency and accountability.
a. After the CCG ceases to exist, how will quality and safety issues receive due oversight and independent assessment?
b. How will Quality and Assurance Reports be seen in the public domain?
The first thing to say is thank you for your recognition of the value of the engagement work we do and we don’t want that to stop or reduce.
The answer to both of the questions is that this design work for the new Integrated Care Board is underway and we are waiting for this to be clarified before we can share the details with you.
There’s certainly no intention to move things like those quality reports that are discussed at our CCG Governing Body out of the public domain – but equally we just don’t have the detail of what will happen just yet.
On the engagement front, there is work going on to develop the framework for the Integrated Care System which is starting from the position of valuing what already happens and making sure the mechanisms are in place for that feedback to be shared widely so it can influence the shaping of priorities and influence decision making.
It is also looking at what else this gives us the opportunity to do – making things more consistent across the region and looking at opportunities to develop what we do, for instance, with lived experience, behavioural insights, developing co-production. The guidance has 10 key points and we are working to ensure we address those expectations – (and that guidance includes some best practice from the work we have done in Cumbria)
What can you do to support that? We would like people to be able to test out the framework as it develops and of course hold us to account for doing that.
There is also something underlying in these questions about relationships - and I’d say that the people you work with now will be the people you continue to work with so we all need to keep talking and keep working together.
Recruitment: This last year has been extremely difficult for all of the Staff. Nationally and historically, there is a problem with staff recruitment to Cumbria, particularly West Cumbria.
a. What is the situation with recruitment of all types of medical staff?
The Trust has a vacancy rate of 6% for medical and dental staff with around 37 wte vacancies. During the pandemic the Trust had some difficulty recruiting overseas medical staff due to travel restrictions. However we have successfully been recruiting since restrictions were lifted and in the period April 2021 – September 2021 we have had 48 (46.56 wte) new starters 21 were recruited from overseas.
There are certainly challenges in primary care – we know that in north Cumbria the recruitment issues are worse in some areas than others
We are working hard to develop primary care teams so it is less about GPs but more about the right clinician and support at the right time (paramedics, nurses, pharmacists, healthcare assistants and social prescribers)
We are working hard to recruit GPs and are supporting the GP Fellowship programme which will wraparound support for newly qualified GPs and give them a range of rural and urban experience in Cumbria.
b. How well does the Trust perform on staff retention?
When the Trust was formed 6,466 employees were in post, by the end of September 2021, 5,185 remained (a retention rate of 80.19%). This figure excludes bank workers and please also bear in mind the exit figures includes doctors in training who hold temporary contracts as part of their training which requires rotation between various NHS organisations and so are expected to leave.
c. Are there any issues that come from ‘exit’ interviews that the North Cumbrian community can help with?
The Trust is working in collaboration with its partner organisations within the North Cumbria Integrated Care Partnership (ICP) to develop a retention strategy across the system. To inform the strategy we have carried out exit interviews via a telephone call with recent leavers of the organisation to collect additional information not collected through the usual exit questionnaire. In particular we have explored what the Trust could have done to encourage the leaver to stay in the Trust. We have also carried out a survey of our recent international nurse recruits to find out how successful our support has been during the onboarding process and to find out whether it is likely that they will stay with the Trust or in the UK in the longer term.
The Trust is also reviewing the exit interview process and systems used for collecting and reporting the data as there is a low response rate from leavers of the organisation.
Long Term conditions: The presentations said little about the out of hospital services. The pressures from the pandemic and the backlog of new and elective patients could cause a decline in care of patients with long term conditions, like Diabetes, glaucoma and COPD.
a. What are the plans for making sure that patients with long term conditions get the regular, consistent care and support that they need to prevent them from needing expensive treatment for an acute crisis, or life changing treatment?
Our community nursing and therapy teams, along with our specialist services, continue to support many patients with, or at risk of, long term conditions or ill health - in their own homes and in the community in partnership with primary care.
Over recent years, to manage the increasing demand with limited capacity plus the challenges caused by the pandemic, many positive changes and developments have taken place. Examples include:
- The introduction of virtual support such as mobility classes via Zoom, virtual diabetes education classes, and digital and telephone consultations
- Ongoing systematic review and triage of patients to enable appropriate prioritisation of caseloads and identification of escalating needs
- Clinical specialist reviews of patients to enable more manageable caseloads. For example, some diabetic patients have had changes to their insulin regime following a review with a Specialist Diabetes Nurse
- Weekly multi-disciplinary team meetings in each Integrated Care Community with representation from nurses, therapists, GPs, Mental Health, social care, third sector etc to enable appropriate support to patients who need a multi-agency approach.
- Daily ‘huddles’ to discuss and prioritise caseloads.
- Collaboration with third sector including the introduction of a third sector referral telephone line and dedicated third sector link workers. This service provides support, advice, guidance and signposting to patients to provide more holistic support enabling them to maintain independence and self-care
- Continued development and embedding of PCN roles within ICCs including Social Prescribers and Well-being activators
- Successful business case resulting in recurrent funding secured to deliver a Tier 3 Weight Management Service in North Cumbria
- Recruitment of a Public Health Consultant to the Community & ICC Care Group with a focus on developing a Population Health Clinical strategy and tackling health inequalities
- Ongoing delivery of Diabetes education course that has gained national recognition
- Additional funding secured by Sexual Health Services following a successful trial to deliver PrEP to people at high risk of contracting HIV
- Development of a community based Home Dialysis Education service
- Continued development of Day Unit services supporting a wide range of patients
A lot of care for people living with long term conditions is carried out in primary care. We know that people living with a long term condition have felt the impact of the pandemic more harshly than those in good health.
We have Health Pathways which was introduced in April 2020 and now has 200 pathways live. It provides a single source of information that can guide the GP through the right referral process, the most up to date treatments and NICE guidance and is pulled together by a team of clinical editors who curate ‘the way we do things here’ really valuable tool for improving consistency, avoids that time taken to find out how it works now etc and really helpful for locums
We have also invested in Sound Doctor, this is a collection of short films that are clinically developed and are specifically for people living with long term conditions and give detailed guidance about specific issues such as heart failure, ageing well, living with diabetes etc – details what it is, how to manage some of the symptoms, different treatments, and exercises to help people find ways to live with their condition. You can read more here: https://northcumbriaccg.nhs.uk/your-health/health-advice-resources-sound-doctor
From Jane Collins, Library and Learning Technologist at NCIC
What is the current provision for the charging of Electric Vehicles at CIC and WCH? What are the future plans for Charging Points for Electric Cars at CIC and WCH? Is this provision planned for staff and visitors? Will there be costs involved?
These issues are important especially in light of the climate emergency and the government’s announcement for low emission vehicles being eligible for a plug-in grant.
Thank you for raising this. This is an important issue and something which is raised with us more and more often, as our staff and patients make purchasing decisions in favour of new greener electric vehicles to help combat climate change.
We are currently trialling electric vehicle charging points at West Cumberland Hospital and once the trial is complete we will be looking at other locations, so bear with us and please watch this space.
From a county wide point of view the county council are leading on improving the electric vehicle charging infrastructure across Cumbria. They gave an update of their plans for community charging points earlier in the year. More information is available on the council’s website.
There is a further question to add from Leslie Blacklock, the response to this is to follow shortly.
There were questions raised on the event itself through the chat box function. With the exception of one, these were responded to during the live event and can be viewed on the recording.
One question that was asked and not responded related to the number of healthcare staff not vaccinated and our approach to that. This follows figures from NHS England which show that, of the 7,687 health care workers at North Cumbria Integrated Care NHS Foundation Trust, 7,278 (94.7%) had been given their first dose of the vaccine by the end of September (with 91.8% receiving both doses). Though this is above the average for NHS trusts across England, it means 409 workers are still unvaccinated.
North Cumbria Integrated Care NHS Foundation Trust was one of the first organisations in the world to deliver the vaccination to colleagues in December last year. Since then it has been offered to all staff and our vaccination rate is above the national average. Risk assessments are in place for all staff in relation to their deployment across the organisation in line with national guidance. The Trust regularly communicates the importance of the vaccination to its employees including through local discussions and question and answer sessions for all colleagues with senior clinicians.
It is over 2 years since CCG along with the then leaders of CPFT agreed the transfer of Mental Health services in North, East and West Cumbria to NTW (Northumberland Tyne and Wear). On the 1st October 2019 CNTW (Cumbria, Northumberland Tyne and Wear) was formed with the promise of Utopia, more money, better support for staff and better outcomes for our Cumbrian population and being part of a successful organisation. My question is where did all this go wrong, please don’t put all the blame on Covid, for instance:
a) Continued closure of beds at Carleton Clinic and ongoing concerns about the very future of Carleton Clinic
b) Staff Morale on the floor, Cumbrian population receiving inferior care in comparison with those in the North east.
c) Closure of offices to Save Money, when CNTW are cash rich and opening new facilities in the North East.
d) Is it not a fact that the Cumbrian population were sold a pup in 2019 with NCumbria CCG’s help, when will they receive an apology for this shambles.
As the commissioner of mental health services for our community in north Cumbria this was not a decision taken lightly, or in isolation. We worked with our partner NHS organisations to commission services from a long established specialist mental health and learning disability trust. Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (CNTW) has been able to bring some of its experience across the north, and some of the stability afforded by being a larger organisation.
While CNTW has announced the temporary closure of Rowanwood because of staffing challenges - which have been a long term challenge - there have been noticeable improvements in other areas including:
Much improved access to child and adolescent mental health services (CAMHS) where very long waits were a significant concern.
Opened an open access crisis line and developing improved access for all community services.
After an initial street triage pilot with Cumbria Police in Carlisle, the service is being rolled out more widely.
Worked with the Third Sector to establish, and provide ongoing support to, the Recovery College (initially funded through the CNTW Shine Fund).
Estate improvements at Carleton Clinic, including modernisation of Oakwood and the refurbishment of the Hadrian Unit.
Nobody promised utopia and there are still challenges, but this was the right decision and we are heading in the right direction.
Please see the NCIC AMM presentations below.
Lyn Simpson, Chief Executive Officer
Michael Smillie, Director of Finance, Digital and Estates
Please visit the CCG website to see their AGM presentations.