Agenda item

To receive a briefing on the Northern Care Alliance.

The Chair provided an update on the current situation at the Northern Care Alliance, including covering what scrutiny that had been carried out at the local level.

The interim Chief Operating Officer provided an update to the committee, noting that NCA Hospital sites had different demand and capacity characteristics. Stakeholder communications were discussed, particularly around the need for better updates where possible and wanting to be in a position of ‘no surprises’. Work had been ongoing around safety, quality and governance with feedback coming from internal reviews, media coverage and patient and staff feedback. It was noted that it was key to have appropriate governance in place. It was highlighted that there were some issues around industrial action and the impact that was having.

Regulatory action was discussed, particularly the Section 29A notices and the System Improvement Board. It was noted that an integrated improvement plan was going through the internal governance mechanisms and that there were six strategic improvement themes – Safe and effective care; people and culture; governance; digital, data and information; operational delivery and performance; and financial sustainability and productivity.

Members queried the spinal services, particularly around how the new service would be different and what the timescales would be for the roll out. It was noted that the new spinal service had been established and, in relation to instrumental spinal services in particular, a multi-disciplinary team had been brought together. It was highlighted that the previous approach consisted of two teams (Neuro-spinal and Orthopedic), and these had now been brought together to reduce variances, and to ensure that they were to the same standard. It was noted that the spinal improvement plan had been programmed over a set amount of time with target dates for various elements.

Members queried when the Committee would see the integrated improvement plan, and it was noted that it was going through a private NCA Board next week, but that the evidence of assurances would start being seen from December onwards. It was highlighted that there was a legislative and regulatory hampering of this information being brought to the Committee, and it was questioned whether the Committee could communicate this to NHS England. Members also highlighted that a workflow would be helpful, and it was agreed that a workflow diagram would be created showing the workflow from the NCA to the Joint Health Overview and Scrutiny Board to local scrutiny boards.

Members noted issues that had been raised with them about the industrial action, particularly in regard to the overtime issue and the use of agency staff. It was noted that generally, agency staff are not used, instead staff come from a ‘bank’. It was highlighted that overtime had been reduced and vacancies were being permanently recruited to in order to reduce the reliance on overtime and bank staff.

Members also queried how treatment cancellations decided during industrial action, and it was noted that it would be primarily non emergency/trauma surgeries that would be impacted, with patients being risk rated and procedures being moved forward or to the following week. It was noted that it was the trade unions who make the offer on the surgery lists, not the NCA proposing them. It was noted that this was not the right level of cover that the NCA needed, but that it was part of the existing legislation and that it had been raised regionally and nationally.

The Chair sought clarity on this, and it was noted that the impact on surgeries was coming from a difference of opinion between the NCA and the trade union from an emergency point of view but what the trade union was doing was legally permissible. Members queried what was being done to reduce this gap in viewpoint and it was noted that talks were ongoing.

Members questioned what shortfalls were identified as part of the Section 29A notice, and it was highlighted that a key issue was the need to share wider learning beyond wards and services. It was noted that this had been improved since with the use of bulletins, safety huddles and creating an environment where this could routinely take place. A request was made by the Committee on reporting to the Committee on the different learnings.

Members queried what practical things were being done around staff concerns and enabling them to raise issues. It was noted that internally, there were a network of ‘freedom to speak up’ champions, and it was noted that the ‘people’ bit was key in all of the NCA’s work.

Members queried whether NDAs were used at the NCA. It was noted that this would be picked up as part of the Staff Experience item in the work programme.