Eric Martlew, Public Governor Carlisle queried the total number of patients on the North Cumbria Integrated Care (NCIC) waiting list.
Answer: Dean Oliver, Executive Director of Performance and Planning reported the total number of patients on the waiting list currently sat at 38,000. The waiting list had stood at just over 30,000 as of April 2022. Planning for industrial action had resulted in a reduction in elective care in order to support and cover staff within Emergency Care; this had contributed to an 8000 increase in the waiting list.
Eric Martlew, Public Governor Carlisle queried the impact to NCIC on patients opting for Private Healthcare
Answer: Lyn Simpson, Chief Executive Officer reported the Trust currently did not capture data on patients choosing to opt for Private Healthcare. This was normally a decision made at General Practitioner (GP) level.
Lyn Simpson detailed the introduction of a new patient choice system. The system enabled patients to register electronically on a patient choice system that would identify waiting times for treatment/operation they required with other NHS providers nationally. NCIC would be expected to support and facilitate the transfer of care to another Trust.
Mahesh Dhebar queried the regional variation of access to emergency care.
Answer: Adrian Clements, Executive Medical Director discussed the importance of delivering high quality and safe patient care to the whole population of Cumbria. The Trust was aware of challenges faced in Cumbria due to the rurality and deprivation of certain parts of the county. In particular poor transport links often resulted in patients presenting late in their treatment for their emergency care.
Mahesh Dhebar queried the current financial challenges faced by the Trust and impact on services, in particular at West Cumberland Hospital.
Answer: Lyn Simpson, Chief Executive Officer emphasised that finances were not more important than the delivery of patient care. The Trust had a responsibility to manage the current deficit position ensuring that money was spent wisely. There would continue to be investment across all sites where the Trust delivered patient care including Cumberland Infirmary Carlisle, Community hospitals and West Cumberland Hospital. The Trust would continue to apply for national funding to help support continued investment in services.
David Hughes, Public Governor Copeland queried the current Private Financial Initiative (PFI) arrangements at Cumberland Infirmary Carlisle.
Answer: James Drury, Executive Director of Finance and Estates detailed the Trust are currently in a 30-year contract that was due to end in 2030. Due to the commercial and confidential nature of the contract, it was not possible to provide further detail.
David Hughes, Public Governor Copeland queried the how the Trust was able to have £48million capital investment plan in the face of a £50.7million deficit.
Answer: James Drury, Executive Director of Finance and Estates explained the £50.7million deficit is from the Trust’s income and expenditure account. The Capital investment plan was supported by funding from the national team called Public Dividend Capital. While there was an element of Trust funding, projects such as West Cumberland Phase 2, Community Development Centre and the Electronic Patient Record were primarily funded by Public Divided Capital.
Sheila Gregory, Appointed Governor for Community & Voluntary queried if the Trust’s deficit positon affected the delivery of services.
Answer: Steven Morgan, Trust Chair explained the Trust would continue deliver services despite the deficit position. At times, the deficit position limited the Trusts ability to make the investment and changes to services as much as would be liked. However, despite the deficit position the Trust would continue to drive improvement and deliver high quality patient care.
Martin Harris, Appointed Governor Cumberland Council queried the number of patients within the Trust who were awaiting treatment within another NHS Trust.
Answer: Johanna Reilly, Director of Operations (programmes) explained the Trust captured this data four times a day. At the current time, there was no patients in hospital awaiting treatment at another hospital. For any patient currently on a ward at NCIC awaiting treatment with another NHS Trust would not be transferred from NCIC until they were clinically stable to do so.
Brian Eaton, Public Governor Allerdale queried steps the Trust were taking to manage the high demand of patients going through Accident & Emergency (A&E) Departments.
Answer: Adrian Clements, Executive Medical Director reported on steps to expand pathways into the hospital to help alleviate pressures on Accident & Emergency. The Trust had increased provision of Same Day Emergency Care (SDEC). This service was now available 7 days a week at both CIC and WCH sites. The SDEC at CIC service also now had a direct pathway from patients coming to the hospital by ambulance; this ensured they bypassed the Accident and Emergency department if necessary. The Trust also operated two Urgent Treatment Centres (UTC) at Penrith and Keswick that would help to manage the demand and pressures on A & E.
Lyn Simpson, Chief Executive Officer discussed a Listening into Action (LIA) project called ‘Do you come here often’. This project aimed to understand and support frequent attenders to the accident and emergency department. This also included education on more appropriate avenues to attend to when requiring access to healthcare.
Mike Taylor, Public Governor Eden queried how the Trust were making savings on staffing vacancies despite recent investment in recruitment.
Answer: James Drury, Executive Director of Finance detailed the budgeted staffing base for the Trust was 7,100 members of staff. The current staffing base was around 6,800 members of staff; earlier in the calendar year the Trusts staffing position was around 6,500. The Trust was steadily moving towards its budgeted staffing position. The vacancies were helping to drive the underlying financial position.
Ajay Bangaragiri, Staff Governor Carlisle and Eden queried if there was plans to improve the current bed base position at CIC and WCH.
Answer: Lyn Simpson, Chief Executive Officer reported the Trust previously operated 693 beds across acute and community sites. The Trust had improved its bed base recently at West Cumberland hospital with 50 beds becoming part of substantial funding. The Trust were always looking at ways to improve its bed base position.
Rebecca Mullins, Public Governor Carlisle queried if the Trust had in place processes to ensure medical equipment was recycled.
Answer: Mr Park, Director of Communications provided assurance that the Trust did have a process in place to ensure any medical equipment was recycled where it can be appropriately done so.
Chris Findley, Staff Governor Allerdale and Copeland queried differences between how the Trust were paid per patient compared to other NHS Trusts.
Answer: James Drury, Executive Director of Finance and Estates detailed a funding formula used nationally to calculate how Trusts were paid per patient. The formula took into consideration a number of factors including levels of morbidity and deprivation. The funding received to the Trust would be reflective to Cumbria and parts of the rural deprivation experienced within the county.
Pre-submitted questions and responses:
Question from Philip Tuer: Having heard nothing I take it we were unsuccessful in obtaining money for Solar panels to go above the car parking spaces? Are there any other opportunities we can tap into?
Answer: James Drury, Executive Director of Finance and Estates said we will be applying for funding for a range of schemes to help towards our NHS net zero targets via the Public Sector Decarbonisation Scheme (PSDS) Grant funding when the process opens on the 7th November 2023.
Question from Philip Tuer: I do look forward to receiving the monthly electronic newsletter but on 27 October, the same day I received one, there was a report in the local press about the failings, as highlighted by a coroner, regarding communication, both within and between trusts that resulted in the death of a patient. Has management had a really good look at both this incident as well as looking across all other departments to ensure that there are going to be no other incidents like this one in the future?
Answer: Jill Foster, Chief Nurse responded in the meeting covering the process that the Trust must follow when we receive a 'regulation 28' from the coroner which includes making sure learning takes place. She also talked about our new process for learning from incidents that is being implemented called Patient Safety Incident Response Framework.
Philip Tuer: Unfortunately I've had to visit the A&E department at CIC twice in the last month with a 10 year old girl. Fortunately she is quite mature for her age and is not 'fazed' by having to walk past patients being treated in beds and chairs in the corridor. I do wonder if younger children may be affected by seeing some of the things I saw on my visits. Why are we still so overcrowded in A&E that it requires patients to be treated in the corridors? Has anybody thought about how it might be affecting children on their walk to/from the paediatric treatment area?
Answer: Johanna Reilly, Director of Operations:
With regard to the pressures on our A&E department, these remain are high across the country due to a number of factors. These include issues which patients sometimes experience in seeking to accessing GP services, and challenges in social care which impact on patients who are waiting to leave hospital who require social care support.
As a Trust, we are working closely with our health and local authority partners to address these issues, which will reduce pressures in our A&E. In the meantime, we will continue to work to ensure that patients are only looked after in this area when extremely high demand impacts on our A&E department.
Question: Dr Martin White, Medical Director Cumbria Medical Services NHS - I am aware from my role as medical director of Cumbria Medical Services NHS (CMS) of the significant backlogs of work certainly within Dermatology and Ophthalmology at NCIC. We as a CQC rated outstanding organisation have consistently directly and indirectly through the CCG/PCN offered help managing some of this work. We currently see over 8,000 new patients per annum referred by GPs who would otherwise be referred to the hospital. CMS delivers the service at approximately 60% of the cost of NHS tariffs.
To date NCIC have continued to use out of area insourcing companies. The costs to use these companies is expensive. Can the board maybe give some justification for these decisions especially in light of the financial constraints the organisation is working with.
Answer: Johanna Reilly, Director of Operations said we are currently reviewing our outsourcing companies to ensure that we get value for money, if there is a more competitive company then obviously we would look at this. Johanna offered to meet with Cumbria Medical Services to discuss this further.
The governors council have reported on their activity for the year of 2022 / 2023. Find the presentations below:
Has the Trust considered the possibility, along with professional bodies, of developing an alternative method of nurse training to professional qualification to avoid them, in these times of financial difficulty, having the expense of university fees?'
I am quite sure though that 'old nurses' would agree that a degree is not the be all and end all and a greater balance of grades of professionally qualified staff, and staff in training, on the wards, would assist in alleviating staffing difficulties, both employment and retention.
Health professional programmes are governed by the regulating bodies for example NMC, HCPC. All nursing, midwifery and AHP programmes are at Hons degree level or foundation degree level (for nursing associate and assistant practitioner programmes) and have been for many years.
We have a significant number of apprentices currently with several cohorts having qualified over the past 3 years as registered nurses, nursing associates, assistant practitioners, operating department practitioners, district nursing, and advanced clinical practitioners. This year we also have apprentices in midwifery, AHP professions and health care support workers with more apprentice opportunities becoming available each year. As an apprentice any course fees are paid via the apprenticeship levy, they are salaried during the programme and receive protected learning time.
Health professional programme requirements are updated by the governing bodies at regular intervals, approximately every 5-7 years. During this process the governing bodies consult the public and practitioners. When the new programme requirements are adopted by Higher Education institutions, registrants, students and service users have the opportunity to be involved in the development of the new programme.
Does the Trust see the need for trimming numbers of non-clinical staff in order to release funds for direct patient care?
Benchmarking through nationally recommended tools such as Model Hospital’ demonstrate that the cost of providing healthcare in North Cumbria is high compared to similar Trusts. The Trusts productivity in terms of the volume of healthcare delivered is also low in comparison to other similar Trusts. Some of this variation can be considered a justified consequence of providing health services across two District General Hospitals and multiple community sites in a rural setting. However there is more we can do to better manage costs and productivity. There is strong evidence that the Trust is a national outlier in the cost of some of its support services and as move towards becoming a stronger clinically led organisation with a clear focus on improving patient care we will need to robustly assess whether our investment in support service is appropriate or whether some of that investment should be redirected into frontline patient care.
What plans does the Trust have to set up step down/recovery facilities to which to discharge patients who no longer need acute care beds?
We know that the best place for the majority of patients after receiving care in an acute hospital is to recover at home (or where they reside) with their home comforts. We are focusing on ensuring that, where possible, we can put the right care in place in the patient’s home upon discharge
We have a number of initiatives in place, such as:
Discharge to Assess – patients can be discharged from one of the acute hospitals and the bed is held for two hours to allow our community teams to assess them at home to check they are safe. If it is not safe at home, the patient can be re-admitted into the acute hospital bed.
Home Care Practitioners – we are currently working to recruit additional Home Care Practitioners to help provide care to patients in their own homes, helping to promote independence and keep them safe at home. We are holding a recruitment assessment day for these roles this Saturday 12 November.
In addition, we are exploring opportunities to create more capacity in residential nursing homes alongside our partners in the County Council
I would firstly like to thank all staff for all their hard work and dedication during the past few years. It has been a very difficult time for us all and especially for those on the front line. Thank you.
My question is regarding bed capacity.
I understand from the last CQC report that, as per regulation 12, patient flow was not always as effective or timely as it could be. Understandably this must be partially, at least, because of a general shortage of bed capacity. I see that some steps have already been taken to address this but I am still concerned that it may be an ongoing issue.
I would like to know how many beds are currently available at each hospital and how many are being bought privately, if indeed beds are being outsourced.
Is staffing still a linked problem? Are private sources being used to provide beds and if so, how many, where are they and how much is it costing?
Something is very wrong if we are not able to provide enough beds from within the NHS, rather than outsourcing to private companies at greater cost.
Improving our patient flow is a key priority and as acknowledged, we have made a number of improvements but we know there is more work to do which is linked to improving discharges to ensure that patients can be discharged when they are medically fit.
Key improvements we have put in place:
Same Day Emergency Care units at both CIC and WCH – 7 day service where patients can be seen and treated urgently without the need for admission to hospital
Standardising our ward rounds and ward transfer processes – focus on clinical criteria at our ward rounds and making sure patients who need transferred to another ward are moved promptly
Virtual wards –allow patients to get the care they need at home safely and conveniently, rather than being in hospital. In a virtual ward, support can include remote monitoring using apps, technology platforms, wearables and medical devices such as pulse oximeters. Support may also involve face-to-face care from multi-disciplinary teams based in the community, which is sometimes called Hospital at Home. At NCIC virtual wards are being introduced using a phased approach throughout 2022, 2023 and 2024.
Additional beds – we have received funding to open additional beds over the winter period at West Cumberland Hospital and we have areas at CIC where we can open beds if needed. Of course opening additional beds is dependent on staffing availability.
We are always exploring options to expand bed capacity when needed including looking at arrangements with the County Council in residential care homes. We are not currently funding private beds.
Our bed numbers do fluctuate dependent on any additional beds open but currently we have approximately 397 adult beds open at the Cumberland Infirmary and 180 at West Cumberland Hospital.
It has been reported in the last week that 60% of nurses are considering leaving the NHS. What is the Trust doing to try and retain its staff and make NCIC a great place to work.
As you rightly point out this is an issue which is impacting across the NHS. In recognition of this we have been allocated funding to appoint our own NHS people Promise manager who is working hard to ensure we live up to the seven NHS People promise principles
- We are compassionate and inclusive
- We are recognised and rewarded
- We each have a voice that counts
- We are safe and healthy
- We are always learning
- We work flexibly
- We are a team
We are doing as much as possible to ensure our staff find NCIC a rewarding place to work. A key aspect of this is ensuring that colleagues feel supported by their colleagues and have strong stable teams around them. We have invested in increasing our acute nursing establishment, I am pleased to say that for the first time in many years we are going into the winter virtually fully staffed in this area. This will make a big difference to how it feels to work here. We are also ensuring that our colleagues have the support they need to develop and grow their careers within NCIC. We have developed a number of pathways for our staff to progress into nursing from more junior roles and for our senior nurses to develop advanced clinical skills. Working in the NHS can be stressful and supporting the health and wellbeing of our colleagues is crucial.
We have invested significantly in this area and I am pleased to say that we have reached the Gold standard Better Health at Work Award. Flexible working is increasingly important to our staff and in the last year we have introduced a new flexible working policy which creates greater opportunities for our colleagues to find a better balance between home and work. In Cumbria we have a relatively older workforce and we very much want to make the most of the skills and experience of our older colleagues and we have introduced a retire and return policy which makes this easier to achieve in Appropriate cases.
'Can you please out line the Trust's policy for supporting the specific needs of patients with learning disabilities and those who are autistic?'
We have a lead nurse for learning disabilities, autism and complex needs. Melanie is available for staff members or teams who require support and promotes our mandatory diamond standards training. This year we have also updated hospital passports for people with learning disabilities which was promoted by Melanie during learning disability week this June.
Key Corporate Objectives
1. What do you mean by 'Virtual Wards' and how will they benefit patients?
2. Cardiovascular - What is the current Europe figure for treatment?
3. Stroke - What is our current position compared to the rest of Europe?
- Virtual wards allow patients to get the care they need at home safely and conveniently, rather than being in hospital. Virtual wards are in place in many parts of the country, for example, supporting people with frailty or acute respiratory infections. The NHS is introducing more virtual wards to support people at the place they call home, including care homes. In a virtual ward, support can include remote monitoring using apps, technology platforms, wearables and medical devices such as pulse oximeters. Support may also involve face-to-face care from multi-disciplinary teams based in the community, which is sometimes called Hospital at Home. At NCIC virtual wards are being introduced using a phased approach throughout 2022, 2023 and 2024. The initial plan is to introduce 20 frailty and respiratory ‘beds’ with a surge capacity to 40 beds
- I am afraid we were not clear what is meant by this question – we could try to answer if you could clarify.
- The performance of stroke units is measures through the Sentinel Stroke National Audit Programme or SSNAP. The latest data shows that, despite the challenges of delivering urgent stroke care in a rural geography, our stroke services are amongst the 20% best performing services in the country. We do not have European comparisons. Thank you Mr Truer for your kind comments about the care you and your family received from or stroke service – such comments are appreciated.
When the Cumberland Infirmary was built it was stated that there was more than sufficient capacity for all those requiring 'inpatient' treatment. Almost from day one this has not been the case. Temporary bed space was built and has been reprocessed and appears to be still in use. We have seen wards closed and the number of beds reduced with management saying that we do not need the beds and by working differently we can see more patients!
This has never happened. We have a vast shortage of beds, primarily due to 'bed blocking' but if the wards had not been closed we would at least have had some additional capacity. I'm concerned that my first question above will see things get even worse.
The ongoing cost of living increases, especially fuel costs, is going to have a major impact on the NHS and its budget. What steps have been and are going to be taken, to try to live within our means?
Has the government indicated if they will provide any additional financial support towards the cost of providing services?
Steps that can be taken are limited from a fuel cost perspective. Although we do have a green plan to look overall at our environmental impact, including energy usage.
From a trust finance perspective we will look to secure inflation to our income to support our financial position and not divert funds from patient care. As we do every year, we will also develop an efficiency programme to better utilise the resources we have.
We will only get a view on this later in the financial year, likely in quarter 4. Logic would suggest that income allocations to the overall health system will need to increase, there will also be a drive though to improve efficiencies.
The Cumberland Infirmary has a large number of car parks that I believe can be better used. I have seen in other countries that they have Solar Panels mounted on a framework, above the height of cars and the average human, that generate large amounts of electricity. Can I suggest that the board looks into the viability of installing said panels to help reduce the amount of electricity they have to buy in. It will also go a long way towards the Green and Sustainability targets set as well?
A similar proposal is under active consideration and this concept was a recommendation of decarbonisation consultants who informed the Trusts Green Plan. As the Trust decarbonises by moving away from Gas heating to other more sustainable methods, it is likely to increase electricity consumption. This can be offset by the introduction of solar panels along the lines suggested. The Trust has made a bid to the Public Sector Decarbonisation Fund which if successful could lead to the introduction of solar panels along the lines suggested.
Unfortunately I and my family have had to make use of more than our fair share of NHS facilities. I would like to give praise to the Stroke unit for their rapid response and treatment. From a call to the GP surgery at 08.30, face to face assessment by GP at 11.40 then referral to the unit and a call from them at 3pm request I attend the following morning at 10am. Consultation and CT scan were carried out and a diagnosis and treatment plan sorted by 11.45. Follow up tests including heart scan and
24 hour monitoring were all done in less than two months. Very well done to everybody involved.
The Trust is faced with many challenges and progress is encouraging but the Trust still faces serious hospital congestion due to constraints on discharging well patients and recruiting sufficient staff to avoid burn out or even reductions in staff. What can the north Cumbria community do to help the Trust reduce the discharge constraints and what can we do to help recruit staff to move to Cumbria. Cumbrians want to help?
Thank you for your question, we always welcome the support of our community.
In terms of recruitment, we have had a lot of success in recruiting to our nursing teams in the acute hospitals this year. There are still some areas in our community teams and in our medical workforce where we are working hard to attract more staff. If we have staff moving here from out of area or from overseas, it is important to retain them and the community can help by giving them a warm welcome to our county.
Discharging medically fit patients is an ongoing challenge and it can be complex. We want to empower patients to retain as much independence as possible to help them with their recovery. We provide ‘helping to keep you safe in hospital’ information on our wards and a checklist for patients or their families/friends to help guide them with questions to ask our clinical teams which can help them to be discharged home when it is safe to do so.
From the Annual Report page 121 it states that the auditors cannot formally conclude the audit and issue an audit certificate in accordance with the requirements of Chapter 5 of Part 2 of the National Health Service Act 2006 and the Code of Audit Practice until they have completed their work on the Trust’s arrangements for securing economy, efficiency and effectiveness in its use of resources. What are the Trust's arrangements for ensuring this work is concluded?
Mr Diggles (interim Executive Director of Finance and Estates) explained:
"The auditors provided a 'qualified opinion' on the accounts as they had been unable to attend the Trust's formal stocktaking to establish a financial opening position for the accounts, due to Covid restrictions in place at the time. This is an issue which a number of Trusts faced for the financial year 2021/22 and is purely a technical matter from the auditor and the Trust perspective. It will not be a concern for the 2022/23 Annual Accounts as the auditors had been able to attend the stocktaking subsequently. With regard to the auditors' value for money recommendation the Trust did not have a financial model in place at the time of the audit but this has now been approved by the Board. The Trust's geography means that some services are necessarily provided based on clinical need rather than whether the service could be run more efficiently. For example the Trust provides two A&E departments where one would be adequate if the Trust was based in a large city. Mr Diggles assured the meeting that the accounts are now signed off.
Please explain the process that takes place when a GP refers a patient to hospital.
Johanna Reilly (Chief Operating Officer) commented:
"A GP electronic referral would be sent to the Contact Centre who would normally book the appointment into the appropriate speciality by date order. The exceptions would be a cancer referral which would be booked as a priority within 2 weeks of receipt, or alternatively where the GP has indicated that a referral is urgent."
Should copies of the Annual Report should have been sent prior to the meeting, and is it possible for copies to be provided on request.
Stephen Park (Director of Communication) clarified:
"There is a process in place for members of the public to request a copy of the Annual Report through the Corporate Governance team - email@example.com"
Is it possible to have 'meet and greet' staff available to receive patients coming in via taxi particularly those who might need a wheelchair. Patients coming via this route should also be given information regarding which department they are expected to attend. Volunteers helping patients are not currently provided with training in the use of wheelchairs, could this be put in place.
Johanna Reilly (Chief Operating Officer) responded:
"This is an area the Trust needs to build on and follow the example of other Trusts who have specific drop-off points for taxis where volunteers are stationed. She explained that Covid had impacted on the Trust's engagement of volunteers and this needed to be addressed. Jill Foster (Chief Nurse) added that wheelchair training for volunteers was something the Trust was already looking in to."
Recently in the press it was announced that the University of Cumbria will start training doctors. What involvement will the Trust have, and will this assist with recruitment?
Lyn Simpson (Chief Executive Officer) replied:
"This collaboration between the University of Cumbria and Imperial College London is a great opportunity for the Trust. It is a result of a shared vision to educate more medical professionals to serve their local communities, in regions with the greatest need. The school will be situated in an area of England where the recruitment and retention of medical staff remains a significant challenge. The Trust is currently exploring opportunities and synergies with colleagues in Newcastle who already have experience of such a system, and with the University of Cumbria. The Trust is delighted with the initiative which will hopefully encourage doctors to stay in the area once they have completed their training."
Has the Trust considered setting up suggestion boxes for staff?
Johanna Reilly (Chief Operating Officer) explained:
"The Trust is running a scheme whereby staff can contribute suggestions for improvements. This is the 'Learning into Action' (LIA) national programme designed to empower staff to implement changes quickly and easily. In addition there are 100 pioneers from 10 different teams in the Trust who are undertaking bigger projects for example in patient communication, community dentistry for children and another 100 pioneers will be recruited in the 2nd phase of the LIA. 'Small change, big difference'"
Noted the small numbers of people attending this Annual Members meeting. Is there an issue with engagement?
Stephen Park (Director of Communication) commented:
"There are over 10k individuals on the Trust's membership database and the Trust uses a number of different means to try and communicate with them. Newsletters are sent regularly, and there is information on the Trust's website about membership which includes an email address and phone number for individuals to get in touch with the Corporate Governance team with any queries."
The Trust often has medical equipment and / or goods returned, such as wheelchairs and blankets. Is there facility to ensure that these are cleaned and recycled rather than being wasted?
Stephen Park (Director of Communication) explained:
He holds the green portfolio for the Trust and this is an area that the Trust is actively engaged in. There are collection points for returned medical equipment, and the Trust has introduced a number of different initiatives to ensure that nothing is put to landfill. Everything is either recycled or appropriately disposed of.
In the absence of black bags in clinical areas there is a tendency for staff to put all rubbish in clinical waste bags which is not only costly but inappropriate.
Stephen Park (Director of Communications) replied:
"The Trust's Clinical Director is currently overseeing a project to reduce the amount of clinical waste."
Please see the presentations below:
Lyn Simpson, Chief Executive Officer
Peter Scott, Interim Chair
Stuart Diggles, Interim finance director
The governors council have reported on their activity for the year of 2021 / 2022. Find the presentation below:
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
Carole Woodman, Lead Governor