4 CM/02/18/04. Chief Executive s report to the Board David Behan, Chief Executive Kate Eisenstein, Special Policy Advisor to the Chief Executive

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1 Meeting PUBLIC BOARD MEETING Date 21 February 2018 Agenda item Paper Number 4 CM/02/18/04 Item title Sponsor Author Chief Executive s report to the Board David Behan, Chief Executive Kate Eisenstein, Special Policy Advisor to the Chief Executive PURPOSE OF PAPER: This is a paper for the Board to note. Introduction The report this month provides an update on the following matters: 1. Performance Report 2. Recent reviews into quality and safety at registered locations a. Mendip House b. Liverpool Community Health Trust 3. Forthcoming review of the Fit and Proper Person Regulations 4. Four Seasons Health Care 5. Recent publications 6. Forthcoming publications 1. Performance Report This is covered in the quarterly performance report as a separate item on the agenda. 2. Recent reviews into quality and safety at registered locations Mendip House On 8 February a Safeguarding Adults Review (SAR) was published following concerns about the mistreatment of residents at Mendip House, a care home with capacity for six people with autism and complex needs in Somerset, run by the National Autistic Society as a campus-based model of care. The review was commissioned by Somerset Safeguarding Adult Board following allegations of mistreatment and abuse of some residents by a number of staff. We welcomed the review and published a statement on our website. In May 2016, CQC had received safeguarding concerns raised by a member of staff. An urgent inspection found a chaotic management, and multiple breaches, leading to a rating of Inadequate in all five key questions. Shortly after the inspection the National Autistic Society decided to close Mendip House and registration was cancelled in November Page 1 of 5

2 The SAR makes clear that the primary accountability for the failure to address the abuse and intimidation of residents of Mendip House. It also highlights the failings of multiple commissioners in their assurance of the care provided at Mendip House. Media interest has focused on the failings of the National Autistic Society as the provider. The SAR acknowledges that the CQC would be unlikely to register this model of care now, as we made clear in Registering the right support. Our own internal review has identified that we should have done more when concerns were first raised with us. We referred those concerns to the local safeguarding authority but we were too ready to accept assurances from Somerset County Council and the National Autistic Society that they had been dealt with. Kirkup review of Liverpool Community Health Trust Also published on 8 February was an independent review of failings at Liverpool Community Health (LCH) NHS Trust, which was conducted by Dr Bill Kirkup CBE. The review, commissioned by NHS Improvement, looked into issues at the tryst from 2010 to 2014, as well as oversight of the trust by the Trust Development Authority (now part of NHS Improvement), NHS England, and local commissioners. The review found that LCH acted inappropriately in pursuit of foundation trust status, setting infeasible financial targets that damaged patient services. The leadership of LCH was inexperienced and inadequate. It highlights instances of staff bullying and significant unnecessary harm to people using LCH services. The review also highlights that bodies with oversight responsibilities including the strategic health authority, the TDA, and the CQC were slow to identify problems at LCH. It does however acknowledge that CQC s new approach to regulation means that we are in a much better position to find and challenge unsafe care and poor standards than we were at the time when concerns were first raised. Our inspection of LCH in November 2013 exposed an oppressive and bullying culture at the trust. The review recommends that the Department of Health and Social Care should review the working of the CQC fit and proper person s test, to ensure that concerns over the capability and conduct of NHS executive and non-executive Directors are definitively resolved and the outcome reflected in future appointments. We have welcomed this recommendation and are working closely with the Department of Health and Social Care to explore the scope of the review. 3. Forthcoming review of the Fit and Proper Person Regulations On 8 February, there was an oral statement in the House of Commons on Acute and Community Health, in response to the publication of Dr Bill Kirkup s independent review into Liverpool Community Health NHS Trust (LCH). The Minister of State for Health Stephen Barclay MP (Conservative, North East Cambridgeshire) apologised to the families and staff impacted by the service, and highlighted the work of Rosie Cooper MP (Labour, West Lancashire) on pursuing this issue. He outlined the findings of the report, which he said was a devastating account of failures at Liverpool Community trust by its management, its board and Page 2 of 5

3 its regulators. The Minister said that the review recognised that steps have been taken to introduce independent, clinically-led inspection by CQC. He noted that the Government had also introduced the special measures regime and the establishment of an independent Chief Inspector for Hospitals. The Minister outlined that the Government accepts the recommendations of Dr Kirkup in full, and that he would write to all relevant organisations asking them to outline what steps they will take in relation to the recommendations. He specifically addressed the recommendation of the report (recommendation 6.5) to review CQC s Fit and Proper Person test (also known as FPPR, or Regulation 5). In full, he stated that he intended to discuss the terms of the review with the Member for West Lancashire [Rosie Cooper MP] and will appoint someone to undertake that review within the coming days. That review will need to address the operation and purpose of the Fit and Proper Persons test, including but not limited to: where an individual moves from the NHS in England to another part of the United Kingdom; where they leave but they subsequently provide healthcare services to the NHS from another healthcare role such as with a charity or a healthcare company; where differing levels of professional regulation apply such as the Chief Executive who is a clinician compared to one who is a non-clinician; where there is a failure to cooperate with the review of this nature and what the consequences of that should be; and to review the effectiveness of such investigations themselves when they are conducted. And I will be pleased to hear the views of the Honourable Member for West Lancashire [Rosie Cooper MP] and those of the Health Select Committee on these issues. CQC has welcomed and accepted all the recommendations of the review that relate to CQC. These closely align with processes we have put in place since 2014 to ensure improved information sharing and closer working with partner organisations, so that we have a more complete picture of quality and performance which allows us to better identify and assess risk and to act more quickly to protect people if necessary. Having previously called for a review of the regulations in respect of Fit and Proper Persons we have also welcomed the Government s announcement review of the operation and purpose of the Fit and Proper Persons test and will be working to engage with the review as it progresses. It is important that the purpose of the Fit and Proper Person Regulations are central to this review. Sir Robert Francis QC in his report of the Mid Staffordshire NHS Foundation Trust Public Inquiry recommended: the establishment of a shared code of ethics which staff should comply with and employers enforce; the development of a list of qualities of a good and effective leader; and the enforcement of non-compliance with the code which should render directors and managers liable to be found not fit and proper persons with the effect of disqualifying them from holding such positions in the future. A further recommendation raised the potential to establish a regulatory body. The Fit and Proper Persons Regulations were the Government s response to Sir Robert s report and do not reflect the full range of his recommendations on leadership. A review which clarifies the policy ambition and purpose of these regulations is welcomed and the CQC will fully cooperate with the review. Page 3 of 5

4 NHS Improvement (NHSI) intends to respond in full to Dr Kirkup s review by the end of March Four Seasons Health Care There has been further speculation on Four Seasons Health Care. CQC s Market Oversight team has been closely involved with all parties to monitor the situation and ensure we can discharge our regulatory duties. Overnight on Thursday 8 February 2016, the company and H/2 (as the majority debt holder) signed a commitment letter and accompanying paperwork that intends to make available sufficient interim additional liquidity to allow the group to continue to trade whilst the ultimate debt restructure is agreed. The company has until 7 March 2018 to execute the interim facility documentation and the milestone dates contained in the original standstill agreement have been extended to 16 April 2018 (to mutually agree the restructuring terms) and 1 June 2018 (expiry of the standstill agreement) respectively. The Market Oversight team will continue to maintain a detailed monitoring brief and will provide further updates as and when any material developments arise. 5. Recent publications Local System Reviews Since the last Board meeting we have conducted local system reviews in Birmingham, Coventry and Bradford. We will be conducting review in Liverpool during the week commencing 19 February. We have also published reports for East Sussex, Plymouth and Oxford. 6. Forthcoming publications Review of children and young people s mental health services The Board is aware that CQC was asked by the Prime Minister to review the quality and accessibility of care and support for children and young people with mental health problems. The phase one report of this review, which was published in October 2017, summarised existing knowledge and understanding about quality and access across the system. Phase two of this work has involved fieldwork in ten local systems across England, looking at what helps and what makes it harder to ensure children and young people have timely access to appropriate care. This has culminated in a report, which the Board has reviewed, and which I have formally signed-off. This report will be published on 8 March. Mental Health Rehabilitation Units Page 4 of 5

5 In our report on the State of Mental Health Services 2014 to 2017, CQC expressed concern about the high number of beds in locked mental health rehabilitation wards that are situated a long way from the patient s home, meaning that people are isolated from their friends, families and from the NHS services that will provide care following discharge. To further explore the issue, CQC sent an information request to all providers of inpatient rehabilitation services both NHS and independent sector. We found that two-thirds of these patients are placed out of area, that those in independent sector beds have much longer lengths of stay and that there is very wide variation between clinical commissioning groups in the number of beds out of area that they fund. CQC has presented the finding to the Secretary of State; together with a set of recommendations for action to repatriate these patients and develop local services to better meet their needs. CQC will publish a report on this ( Mental health rehabilitation inpatient services: Ward types, bed numbers and use by clinical commissioning groups and NHS trusts ) shortly. Mental Health Act review We will be publishing our annual Mental Health Act review later this month. The Board is asked to note these items. Name: David Behan Title: Chief Executive Date: 13 Feb 2018 Page 5 of 5

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