PRESS RELEASE For immediate release: 01/05/2011 Monitor demands immediate action at Gloucestershire Hospitals to improve patient A&E waiting times Monitor has today instructed Gloucestershire Hospitals NHS Foundation Trust to take immediate action to improve A&E waiting times at the Trust. Monitor is using its regulatory powers of intervention to require the Trust to develop and implement an effective plan to improve its emergency care pathway with the support of the NHS Intensive Support Team. Monitor has decided to intervene to ensure that the Trust makes effective improvements to the delivery of emergency care and addresses all underlying issues that have caused the poor performance. It should be noted that the CQC has no outstanding concerns about the outcomes of patient care at the Trust. The Foundation Trust Regulator has also announced that it will be a joint addressee on an independent review of Board governance which the Trust is to commission immediately and will hold the Trust to account on delivering any actions it recommends. Pending this review, Monitor has asked the Trust to make improvements to its Board reporting processes so that all material performance failures and risks are promptly and appropriately reported to and managed by the Board. The Trust, which was found in significant breach of its terms of authorisation in September 2009 primarily for persistent failures in meeting A&E targets and weak financial performance, has failed to meet A&E targets consistently during the last two and a half years. In the second half of 2011 it showed a considerable deterioration in its performance against the target. Monitor has found that there are a number of reasons for the failures including poor systems to assess people arriving at A&E departments, poor coordination of inpatient care and the need to work more closely with primary and community services to address high demand for care. A recent review, carried out by the NHS Intensive Support Team, indicated that the Trust s plans would need to be improved significantly if they were to be successful in implementing the necessary long-term changes at the Trust. Speaking after Monitor s Board made its decision, Merav Dover, Compliance Director at Monitor, said:
We have decided to take action to ensure that the Trust makes immediate improvements to the way it delivers emergency care services to patients. Long waits are unacceptable for patients and the Trust has failed to rectify this issue sustainably during the last two and a half years. Monitor needs to be assured that the Board is able to identify and address issues at the Trust quickly and we are concerned that they have not been able to do this. The Trust is to commission an independent review of Board governance and we will expect the Trust to address any weaknesses identified in the report. We will keep under close review the Trust s progress in returning to compliance with the A&E target and will consider further action including intervening again if necessary. ENDS Notes for editors 1. For media enquiries please contact Isabella Sharp: 020 7340 2442 or Isabella.Sharp@monitornhsft.gov.uk 2. A copy of Monitor s decision to taken this action is available on our website here: http://www.monitor-nhsft.gov.uk/home/about-nhs-foundation-trusts/regulatory-action/nhsfoundation-trusts-significant-breach-their-au 3. More information about how Monitor regulates foundation trusts is available here: http://www.monitor-nhsft.gov.uk/home/about-monitor/how-we-do-it/how-monitor-regulatesnhs-foundation-trusts 4. Monitor was established in January 2004. It is independent of government and accountable to Parliament. Monitor s functions and powers are set out in the National Health Service Act 2006. 5. Monitor is now on Twitter - follow us @MonitorUpdate
Statement Monitor calls for Gloucestershire Hospitals NHS Foundation Trust to improve A&E waiting times Tuesday May 1 st 2012 Monitor, the independent regulator of NHS Foundation Trusts has today announced that it is using its regulatory powers of intervention to require Gloucestershire Hospitals NHS Foundation Trust (GHNHSFT) to improve A&E waiting times for the benefit of patients. Consistently meeting the A&E 4 hour waiting times is a high priority for the Trust and a detailed action plan has been produced and is already being implemented. More will be added to the plan following a countywide multi-agency review due to take place in May which will include community and social services. Monitor also announced that it will be joint addressee on an independent review of Board Governance which the Trust Chair, Professor Clair Chilvers had already decided to commission to take place this Autumn. This review will look at the effectiveness of our Board processes. Following discussions with Monitor it has now been agreed that this review will be brought forward. The review report will go to both Monitor and the Trust Board, with Monitor holding the Trust to account for delivering any recommended actions. In its communications today Monitor has clearly stated that the CQC has no outstanding concerns about the outcomes of patient care at the Trust. Chair, Professor Clair Chilvers said: As a Board we acknowledge that this is a very important area and that we have struggled to consistently see, treat and admit or discharge 95% of patients in our A&E departments within four hours. This is a cause of frustration to patients, to our frontline staff and a cause of great regret to the Board. We have stepped up our response to this problem with a detailed action plan and are confident and determined that we will be able to solve it for the benefit of patients. I would also like to reassure patients that although there have been delays in A&E, there is no suggestion that patients are receiving poor clinical care. Since March 30 th our Director of Nursing, Mrs Maggie Arnold, has taken on the role of Project Director for Emergency Care, leading a programme of work to improve the flow of emergency patients throughout our hospitals. This looks at all aspects of a patients journey from the time they arrive in A&E, going through diagnostics and inpatient treatment right through to making improvements to the way we discharge patients from hospital. 1
We are in the process of implementing our plan which we will be adding to and we have made this the highest priority for the Trust in the coming year. Actions currently being taken include: Building new consultation and treatment cubicles in the A&E Departments at both Gloucestershire Royal and Cheltenham General Hospitals Reviewing the distribution of staff and employing more A&E nursing staff Changes to the discharge process including earlier and more frequent ward rounds so that beds are available for emergency patients earlier in the day when they are needed Reducing unnecessarily long length of stay in our hospitals for patients who are ready to leave hospital Further development of Surgical Assessment Units to assist with patients who are referred to hospital by their GP and may remove the need for patients to be admitted to hospital Working with colleagues in the NHS community and social care Since starting work on this intensive programme, Mrs Arnold has reported excellent support and engagement from staff right across both hospitals who want to make a difference and initial results are encouraging. Mrs Arnold said: We have some way to go but I am encouraged by the response from staff and I am confident that in the forthcoming period we will begin to consistently deliver the four hour target. For the month of April 93.5% of A&E patients were seen, treated and discharged or admitted within 4 hours, against a target of 95%. Ends For more information, please contact: Yvonne Pirso, Head of Communications on 08454 224733 or email Yvonne.pirso@glos.nhs.uk Notes to Editors: 4 hour wait target The 4 hour wait target is that 95% of patients are seen, treated and discharged or admitted to hospital within 4 hours. During 2011/ 12 the Trust achieved the 4 hour wait target for 6 months (April September) but the position was unsustained during the 2 nd half of the year. For the month of April (2012) 93.5% of A&E patients were seen, treated and discharged or admitted within 4 hours, against a target of 95%. 2
Monitor Foundation Trusts are authorised by Monitor which is the independent regulator. GHNHSFT was authorised in July 2004. Monitor notifies Trusts that they are in breach of their authorisation if they do not achieve performance or financial targets or achieve the required level of governance. GHNHSFT was notified that it was in breach of its authorisation in September 2009. Read Monitor s News Release here 3
1 May 2012 Clair Chilvers Chair Gloucestershire Hospitals NHS Foundation Trust 1 College Lawn Cheltenham GL53 7AG 4 Matthew Parker Street London SW1H 9NP T: 020 7340 2400 F: 020 7340 2401 W: www.monitor-nhsft.gov.uk By email Dear Clair Gloucestershire Hospitals NHS Foundation Trust ( the Trust ) National Health Service Act 2006: section 52: failing NHS foundation trusts NOTIFICATION OF MONITOR BOARD DETERMINATION RE INTERVENTION 1. Further to our letter to you of 10 April 2012 indicating that further regulatory action in relation to the Trust was under consideration, I am writing to inform you of the decision of Monitor s Board, taken at its meeting on 27 April 2012. Monitor s Board decided to use its formal powers of intervention under section 52 of the National Health Service Act 2006 (the Act ), to address the concerns outstanding following its decision to find the Trust in significant breach of its Authorisation on 30 September 2009, primarily about the Trust s failure to achieve sustainable compliance with the Accident and Emergency target and related matters. 2. As indicated previously, this decision is the conclusion of a rapid decisionmaking process, involving timescales tailored to the need for swift regulatory consideration. 3. I should be grateful if you will ensure that this letter and its enclosures are shared with your Board of Directors and Council of Governors. 4. In accordance with its statutory obligations, Monitor will make this decision and the requisite section 52 notice (copy attached) public and a copy of this letter will be on Monitor s website today. 5. Monitor s Board Decision Regarding Intervention 5.1 Monitor s Board considered all relevant and available evidence, including all the Trust s responses to the concerns raised in our letter of 10 April 2012. The evidence upon which the Board s decision was based is summarised in Appendix 1 to this letter. Monitor s Board noted from this evidence that some of the specific areas of concern relating to the original Page 1 of 3
decision to find the Trust in significant breach in September 2009 remain unresolved. 5.2 As a result of the nature and extent of these continuing concerns and the manner and pace at which they have been addressed by the Trust and its Board, Monitor s Board considered whether to use its formal and discretionary powers of intervention under section 52 of the Act. In considering this, the Board assessed whether use of its formal powers was reasonable, proportionate and appropriate, and whether it was likely to result in a swifter and sustainable return by the Trust to compliance with its terms of Authorisation to safeguard prompt access to safe and quality care by the Trust s patients. 5.3 In making its decision on whether to intervene, the Board took full account of the nature and significance of the continued breaches of the two conditions of Authorisation (Condition 2 General Duty Economy, Efficiency and Effectiveness, and Condition 6, Healthcare Standards and Targets) represented by the continued failure to achieve sustainable compliance with the Accident and Emergency target and of the possible intervention options. 5.4 Monitor s Board agreed that in all these circumstances, including the length of time since its finding of significant breach in relation to these matters, its concerns about the effectiveness and pace of the Trust s actions to date and the need for particular control and oversight by Monitor of the Trust s actions to return to compliance with its terms of Authorisation, it should use its formal powers under section 52 of the Act. Further details are set out in the section 52 Notice at Appendix 2 of this letter. 6. Next Steps 6.1 As the Trust continues to be in significant breach of conditions 2 and 6 of its Authorisation, it will continue to be red rated for governance risk. 6.2 The Trust is required to report regularly on progress towards its return to compliance with its terms of Authorisation, including progress on the implementation of actions required by the section 52 notice and on addressing Monitor s residual concerns as set out in the Appendix to this letter. 6.3 In particular, as outlined in Appendix 1, Monitor has residual concerns relating to governance. We are aware that the Trust planned to commission a review of Board effectiveness. Monitor requires that the Board effectiveness review proceeds as proposed by the Trust, with the direct involvement of Monitor in agreeing the scope of the review and being a joint addressee of the report. Pending the Board effectiveness review report, we require the Trust to ensure that it has in place enhanced Board reporting arrangements, to ensure that all material performance Page 2 of 3
failures and risks are promptly and appropriately reported to and managed by the Board. 6.4 The Trust is required to continue to meet with Monitor on a regular basis until we are assured that the Trust is returning to full and sustainable compliance with its Authorisation. 6.5 Monitor s Compliance Director, Merav Dover, will be in urgent contact with you to agree milestones for the matters specified in the enclosed section 52 Notice and other steps detailed in this letter. If you have any questions in relation to this letter, please contact the Trust Portfolio Director Anne Fillis on 020 7340 2548 or by email Anne.Fillis@monitor-nhsft.gov.uk. Yours sincerely David Bennett Chairman and Interim Chief Executive Cc.: Frank Harsent Trust Chief Executive Jan Stubbings NHS Gloucestershire Chief Executive Mary Hutton NHS Gloucestershire Deputy Chief Executive Ian Biggs CQC Deputy Regional Director Sir Ian Carruthers - Chief Executive SHA Martin Horwood MP Cheltenham Richard Graham MP Gloucestershire Lawrence Robertson MP Tewksbury Neil Carmichael MP Stroud Geoffrey Clifton-Brown MP The Cotswolds Mark Harper MP The Forest of Dean Encs. Appendix1: Matrix of Evidence Appendix 2: s52 notice Page 3 of 3
National Health Service Act 2006 ( the Act ) NOTICE of exercise of intervention powers under section 52 of the Act To: The Board of Directors and The Council of Governors Gloucestershire Hospitals NHS Foundation Trust Trust Headquarters 1 College Lawn Cheltenham GL53 7AG 1. On the basis of information available to the Independent Regulator of NHS Foundation Trusts ( Monitor ) about Gloucestershire Hospitals NHS Foundation Trust ( the Foundation Trust ) and having taken into account representations made to Monitor by the Foundation Trust, Monitor is satisfied that: (a) the Foundation Trust has contravened, and is failing to comply with its terms of Authorisation, in particular: (i) (ii) Condition 2, which requires the Foundation Trust to exercise its functions effectively, efficiently and economically; and Condition 6, its healthcare targets and other standards duty. (b) the contravention and failure are significant under section 52(1) of the Act. 2. This Notice constitutes formal notification of the immediate exercise by Monitor of its statutory powers under section 52(3) of the Act. 3. Without prejudice to any further action which Monitor may take under the Act, Monitor requires the Foundation Trust to: 3.1 produce an overall plan for delivering sustainable achievement of compliance with the Accident and Emergency target and to implement it effectively; and 3.2 commission the NHS IMAS Intensive Support Team ( IST ) to approve the plan and to provide support to assist the Foundation Trust in the implementation of the plan. This will provide independent assurance to the Foundation Trust Board and Monitor on the effectiveness of the plan and on the effectiveness of the implementation of the plan. Dated 1 May 2012 David Bennett Chair
Annex to NOTICE dated 1 May 2012 of exercise of intervention powers under section 52 of the Act to: Gloucestershire Hospitals NHS Foundation Trust The aim of this formal intervention is to ensure that the Foundation Trust makes the necessary improvements to its Accident and Emergency service promptly and with sufficient regulatory oversight and control. This is intended to help ensure that all issues relevant to the Trust s breaches of its Authorisation can be properly and sustainably addressed at a suitable pace, thereby securing due assurance as to both the safety and quality of services for patients and the effective running of the Foundation Trust. In this context, it should be noted that the commissioning requirement at paragraph 3.2 will facilitate Monitor s intention to seek assurance from the IST on the effectiveness of the Foundation Trust s plan and on the effectiveness of the Foundation Trust s implementation of the plan, both of which remain the Foundation Trust s sole responsibility. Overall, intervention is a secure mechanism of ensuring that appropriate regulatory control is in place to help the Foundation Trust to strengthen its governance arrangements and to protect the services it provides to patients. In accordance with its Compliance Framework, Monitor will keep the Foundation Trust s situation under careful review.