32nd Meeting of the Council of Governors

20th March 2014

3pm – 5pm Applegarth Suite,

Marriot Hotel, Bexleyheath

Chair: Dave Mellish

Trust Secretary and Head of Governance: Ann Rozier

Public Governors / Service user/ carer Governors / Appointed Governors
Stephen Brooks / Jenny Kay / Maureen Falloon
Richard Diment / Chris Purnell / Carl Krauhaus
Jennifer Grant / Steve Seabrooke / Raymond Sheehy
Eimear Mallen / Fola Balogun / Malcolm Wood
Dalla Jenny / Katherine Copley
Raymond Pope / Baeti Mathobi
Judy Wolfram / Rob Hayles
John Woolgrave
Staff Governors
Marcos Da Silva / Kaye Jones / Barbara Cawdron
Maggie Grainger / Mary Titchener / Steve Francis

In attendance:

Non Executive Directors / Executive Directors /

Presenters and guests

Anne Taylor / Simon Hart / Estelle Frost Director of Older People’s Mental Health services
James Kellock / Ben Travis / Dorothy Tande (for Jane Wells)
Archie Herron
Seyi Clement
Steve James
Item /

Action

1. / Apologies
Stephen Firn, Helen Smith, Dr Okocha, Angela Sweeney, Folake Segun, Alan Cork,Steve Davies, Alan Downing, John Fahy, Amanda Finlay, Martyn Gaylard, Paul Harding, Eleanor Jones, Hugh Morgan, Jason Morgan, Judith Ellis, Ken Thomas, Leslie Smith / Noted
2. / Minutes of the last meeting of the Council of Governors
Rob Hayles was in attendance at the December meeting – subject to this amendment the minutes were agreed as an accurate record. / Agreed
3. / Matters arising
There were no matters arising not on the agenda. / Noted
4. / Dementia Strategy
Estelle Frost Director of Older People’s Mental Health services presented the Trust’s Dementia Strategy and gave an overview of the Trust’s award winning advanced dementia service. The Older People’s Mental Health Directorate has led a multi agency group in the development of an Oxleas Dementia Strategy. The Strategy explains how Oxleas will seek to shape service provision over the next 3 years. The Strategy was launched in December 2013. It sets out 9 promises:
  1. Early identification
  2. Specialist diagnostic assessment
  3. A joined up care pathway
  4. Help to live well in the preferred or appropriate place of care
  5. Appropriate use of anti-psychotics
  6. Good care towards the end of life
  7. Support to carers
  8. Excellent specialist services for people with dementia in the community and in hospital
  9. Supporting research in dementia
The advanced dementia service is being developed in Greenwich and Bexley. It is a service that is to deliver holistic care to people so that they may remain at home. It takes not only people’s mental health needs, but also their physical and social needsinto account and is met from a single source. The service takes on the responsibility for co-ordinating all elements of care.
JB – Is bed blocking a problem in the older person’s directorate?
EF – This is much more of a problem in acute care as people with dementia don’t respond as well to treatments. In Oxleas it is not a huge problem but it is true that sometimes it is difficult to find the resource for people with complex dementia needs.
JKa – Do we know why 50% of people are not diagnosed with dementia?
EF – Some of the reason is because some people don’t want to come forward and state that they are losing their memories and cognitive abilities. They are often frightened and there is still stigma around it. Some think it’s just a part of growing old. Some people find that even when they go to see their GPs, they also may say it is a natural part of ageing. This is not correct of course.
MF – In the action plan it talks about Bexley and Greenwich but not Bromley.
EF – In the last couple of weeks we have had a conversation with St Christopher’s Hospice in Bromley and we are thinking of some joint work. They are looking toward expanding their remit and some partnership work may be possible.
BC - Do we have enough resources to deliver this?
EF – We are working hard with Commissioners and keeping a close eye on our ability to meet demand. There is no more money. The way we have developed the advanced dementia service has been from our existing resources. It is a new way of working.
DJ – Can self-funders access the service?
EF – Yes
EM – Is pain and challenging behaviour linked? Do you teach this to staff in Care Homes?
EF – The list shown earlier shows the ‘bus’ route of what needs to be considered.
SB – Poor care has been publicised and it has been said there is a conspiracy of silence. What networks or arrangements are there to avoid this problem?
EF – The human interaction is miles more important than procedures. Some people are hard hearted. We get our staff to look behind the illness, to look at the person and their life histories. We have had some remarkable successes just by knowing and understanding this.
DM – This is a big issue coming out of the Francis report – how does the Board know that services are safe and compassionate. There has been much work undertaken to make sure the Board can gain assurance. One initiative is that the Non Executives and Executive members of the Board visit services (every unit) and we also have a programme of night visits.
SS – Happy to hear about the care coordination as this is fundamental. If this approach was taken in other care scenarios it would be a good thing. My concern is around the 50% diagnosis. There are a number of obstacles e.g. cultural. GPs not referring is a huge concern. A diagnostic tool would be of great advantage.
EF – Over the last year we have been to at least 15 GP practices to talk with them and have held 3 GP master-classes about dementia. We use every opportunity we can to talk to GPs and Commissioners. We are teaching how to screen using an easy screening tool.
JW – What is the waiting time for brain scans?
EF – 2-4 weeks for assessment and 4-6 weeks to be seen in clinic. The brain scan would be done in this time.
DM – Progress in delivering this important strategy is being monitored by the Board. / Noted
5. / Mental Health Crisis Care Concordat
The Mental Health Crisis Concordat was launched by Norman Lamb MP, Care Services Minister. It is a joint statement, written and agreed by its signatories, that describes what people experiencing a mental health crisis should be able to expect of the public services that respond to their needs. The Briefing provides a summary of the key principles and commitments in the Concordat and highlights how stronger local partnerships can work together to deliver improved crisis care. The Trust is preparing an action plan which will be presented to the Board in June and to the Council of Governors in June. The full document is available on request from AR. / Noted
DM
6. / Significant Transactions
The Health and Social Care Act 2012, requires the Trust to include its reporting obligations for the approval of significant transactions in its Constitution. For a significant transaction to be approved over half the Council of Governors in attendance and voting at a general meeting must agree that the application can be made. Following on from the work of the Health and Social Care Act group and the Governors’ Away Day regarding significant transactions, Governors were asked to give consideration to the criteria for approval to be adopted. It was proposed that the Council of Governors adopt the criteria used by Monitor for reporting material transactions. This would include all transactions over the value of 10% taken as a percentage of the Trust’s gross assets and/or income.
CP – A benchmark is necessary
SS – Is Monitor’s limit cumulative?
BT – Yes.
RS – I would support this proposal and would expect that any transaction that fell out of the direction of travel for the Trust would be discussed with the Council of Governors.
DJ – I would support the financial limits; does this also relate to whether the transaction affects over 10% or staff or patients?
BT – If there was a transaction that had such an affect it would come back to the Council of Governors for discussion.
SS – It would make sense for any transaction that NEDs deem significant should be brought to the Council of Governors.
The recommendation to define a significant transaction based on the criteria for reporting material transactions to the regulator Monitor was agreed. The Constitution will be amended accordingly. / Agreed
7. / Nominations Committee update
There has been a long period of little or no change in Board membership but there will be significant changes over the next couple of years. Over the next 20 months there will be vacancies for the Chair (October 2015) and 3 Non-Executive Directors.
The Nominations Committee met on 11 March to discuss how these changes will be managed. It was agreed to ask our internal auditors, KPMG, to undertake an audit of the skills of the Board and what will be needed in the future. Non-Executive Director applicants must be eligible for Trust membership (resident in Bexley, Bromley or Greenwich or have been a service user or carer). This has been quite restrictive and the Committee would like to explore extending the membership geographical area into any area where we deliver services. The recruitment process was discussed but the decision about who to recommend has not been decided. Also discussed the job description and remuneration of Non-Executives. We are comparing our rates with other FTs. We are also obtaining further guidance around the maximum terms of office.
DM – Recommendations will come back to the Council of Governors in June. / Noted
8. / Membership Committee update
RD gave the update. The February Membership Report was presented to governors. This includes a report on associate membership. The Committee has been struggling with two issues a) why should people want to become members of this Trust and b) what can we offer to members? Our membership numbers are not high compared to other FTs. At the moment the figures show we are where we expected to be but data cleansing has not been undertaken for a few years. This will mean we will lose 500-600 members. There is poor membership of younger people. We were concerned how we might use staff to approach potential members (e.g. community groups). Also can ask Stephen to promote membership at induction. There are also a significant number of volunteers – we can look at auto-enrolling these people. This can include Volunteer to Work. Changing the geographic area as mentioned in the Nomination Committee update may help.
CK – The CACT sees over 2000 young people each week and there are opportunities here.
BC – How do we sell this as a member of staff. What are the advantages we can talk about?
RD – Focus meetings, magazine, influence. We need to go further than this. If there are governors who would like to join the Committee please let us know.
AR – It has been some time since I have been involved with recruiting members but my view is that it is getting to a critical point. Our membership is our pool of people where our governors come from and they are the people who vote governors into office. If we were to look at election results we would see that turnout is quite low and that there are very low numbers voting governors into office. The lowest I have seen is 3 votes. Perhaps we could invest in getting some help with this important issue.
EM – I have been a Committee member. One of the decisions early on was that it was better for people to opt in to membership but we should reconsider this.
DM – The original decision was made in 2006 and it is timely to review that decision.
JW – Moorfields run occasional talks; perhaps we need to run something special for members.
RD – Some other Trusts do webinars etc.
CK – We can do more and we need to involve young people, education and them being given a task works well.
SS – My feeling is that we have recruited very few members from community services.
FB – We need leaflets and we can target membership through churches.
RD – There is new membership leaflet that is simpler.
DM – Good discussion. RD, SS, AR and SH to get together to prepare a paper for the Board, when Governors from the Membership committee can attend, probably June. / Noted
RD, SS, AR, SH
9. / Social Inclusion Operational Group
SB was the lone member on this group but other governors have joined since the appeal at the last meeting. Social inclusion is central to the Trust’s work and this group monitors progress. The Trust has a number of activities, one being the Volunteer to Work programme. 286 people have shown an interest in joining this. Individuals are supported for 18 months to volunteer and gain skills and interact socially. 118 placements have been found. Associate members have provided 14 placements. Now have a link with Canterbury University to take forward Peer Monitoring. And there is SEEK, employment support.
DM – Delighted more involvement from governors. This has been a key area of work with governor involvement since 2006. / Noted
10. / Annual Plan
The three-year Service Development Strategy has been in place since April 2013 and as we enter the second year it is timely to review the strategic priorities, in light of changing national and local requirements. Following work undertaken in workshops with the extended Board, a workshop with a subgroup of the Council of Governors and three borough focus groups (total of 150 attendees), the revised priorities for 14/15 – 15/16 were presented for approval by the Board.
As part of the Service Development Strategy process, the Trust identifies a smaller set of priorities each year, in line with the three-year priorities – these are called the annual plan priorities. The Council of Governors were asked to give a view on the forward plan presented in the enclosed papers.
The priorities are:
  1. As part of patient choice, extend opening hours for all community services
  2. Reduce waiting times in Allied Health Professionals and psychological therapies services, including children’s services, to less than 18 weeks. Publish on our website
  3. Agree an approach to estate rationalisation and development of estate strategy
  4. Publicise staffing levels on our inpatient units
  5. Introduce self-management/self-care approach in all Long Term Conditions services
  6. Meet the physical and mental health needs of all patients with Long Term Conditions
  7. To support quality, a review of best practice to be implemented in four ACS services and 2 services in the children’s directorate.
  8. Publish results of the Friends Family Test for patients and staff
  9. Implement the new performance management framework
  10. Improve procurement processes
  11. Undertake a programme of unannounced night visits to all wards and Board visits to all services
The 4 Must Dos will continue.
SB – Increasing productivity – apart from the use of technology, where will the other improvements be coming from? Will demand decrease productivity?
SH- It may be how teams are organised and streamline processes e.g. referral processes.
DM – There is rising demand across the board and at the same time resources are being reduced. We need to work smarter for example we have groups looking at improving procurement and estates rationalisation. The Annual Plan will now go to the Board for approval in April and then the Board will monitor progress. There will be a standing item at each CoG to give an update. / Approved
11. / Chief Executive Update
Simon Hart, Director of Human Resources and Organisational Development gave the update.
Recruitment
We have a large scale recruitment campaign starting on 24 March. Posters in shopping centres, bus stops and buses – are advertising for a large number of professional groups. Making the most of our excellent staff survey.
Bids
The Kent prisons MH service.
Bexley Mental Health Day Recovery Services. Defensive bid as subcontractor to Mind with Reinstate as partner. Replacement of Crayford Centre.
Bexley MSK.
Staff Survey
The National Staff Survey took place between September and November 2013. 850 staff were randomly selected from the total staff population. The staff survey results are based around the pledges in the NHS Constitution and are used by the CQC as a key indicator in its compliance regime. The CQC continues to measure Oxleas against other Mental Health & Learning Disability organisations.
Oxleas Scores
Oxleas was in the top 20% for the composite staff engagement score.
The two scores in the worst 20% were for incidents of physical violence from other staff and bullying and harassment from patients and public.
Two of the ‘average’ results were for training in Health and Safety and Equality and Diversity in the last 12 months. Since the Trust has been at c.90+% compliance for nearly all of this period there would have been no requirement for the majority of staff to complete the training this year.
The Trust received the best scores nationally for any Mental Health & Learning Disability trust for the following areas:
  • % of staff feeling satisfied with the quality of work and patient care they are able to deliver
  • % of staff agreeing that their role makes a difference to patients
  • Effective team working
  • % of staff having well structured appraisals in last 12 months
  • Fairness and effectiveness of incident reporting procedures
  • % of staff able to contribute towards improvements at work
  • Staff recommendation of the trust as a place to work or receive treatment
  • Staff motivation at work
/ Noted
12. / Advance Questions from Richard Diment Public Governor
  1. What response did Oxleas give to the FOI request from the BBC about the provision of CAMHS within the Trust?
  2. Has Oxleas, during the last year, needed to provide mental health treatment to any child or adolescent within facilities designed for adult service users?
  3. Has Oxleas, during the last year, needed to send any child or adolescent to facilities ‘out of area’ because of capacity within Oxleas CAMHS?
  4. Have the NEDS on the Trust Board had information provided to them on these issues over the last year, and what discussions have the NEDS had to reassure themselves that Oxleas is providing in patient CAMHS within appropriate age wards and locations?
The Trust does not provide inpatient CAMHS services. This is provided by South London and Maudsley. / Noted
13 / AOB - Serious Incident
DM reported that an Oxleas patient has been arrested and charged with the murder of his neighbour. The patient had been discharged from the Tarn on the Friday and the incident happened Sunday morning. Steve James is the NED and Chris Purnell, the Governor panel representative on the level 5 inquiry. The patient has been transferred to the Bracton. / Noted
Time and Date of the next meeting
3pm- 5pm19 June 2014
Applegarth Suite, Marriott Hotel
Bexleyheath
3.00 – 5.00pm

I confirm that the minutes of the Council of Governors meeting of 20th March 2014 are a true record