38thMeeting of the Board of Directors
Thursday, 1st October 2009
3.30pmBoardroom, Pinewood House
Board of Directors
Dave MellishChair
Archie HerronNon Executive Director
Anne TaylorNon-Executive Director
Bayo EmanuelNon-Executive Director
Donald Kirkham Non Executive Director
Paul WardNon Executive Director
Sally JacobsonNon Executive Director
Stephen FirnChief Executive
Richard Page Director of Finance
Ify OkochaMedical Director
Helen SmithDeputy Chief Executive and Director of Service Delivery
Simon HartDirector of HR and Organisational Development
Wilf Bardsley Director of Nursing and Governance
Directors
Keith Miller Director of Psychological Therapies
John EnserDirector of Bexley Mental Health and Forensic Services
Iain DimondDirector of Bromley Mental Health Services
Trevor EldridgeDirector of Greenwich Mental Health Services
Stephen WhitmoreDirector of Child & Adolescent Mental Health Services and Adult Learning Disability Services
Rachel EvansDirector of Estates and Facilities
In attendance
Ann Rozier Trust Secretary and Head of Governance
Item /Action
DM formally welcomed Dr Ify Ockocha to his first meeting of Oxleas Board of Directors as the new Medical Director.
1 /Apologies
Paul Ward. / Noted2 / Minutes of the Board of Directors meeting held on 3rd September 2009 and Away Day Minutes 3rd September 2009.
Board of Directors meeting
Page 7 –blanked out initials but on page 8 initials appear.
Away Day
Agreed item 7 charity funds should be consolidated into Trust accounts. / Agreed
3 / Matters arising
Board of Directors’ meeting
SF asked if arrangements and support had been put in place for non-executive ward visits.
AH, DK and AT have all conducted visits and other non executives are making arrangements.
DM – Item 16, Action plan for the inpatient survey. It was agreed at the last meeting that the action plan would come back to the Board on a regular basis for progress reports, given the concerns raisedby the inpatient survey. To come back to the Board every three months.
Item 20 – Annual Members Meeting. DM thanked everyone involved in the AMM, best we have had. Last year’s event was good, but this year’s was even better. 500 attended and the exhibitions and displays were wonderful. / Noted
WB
4 / Strategic Update
Community Health Services
Bexley - Adraft will be presented to the Board in November. Staff from Bexley CPU came to the AMM yesterday and were extremely positive. Theyreceived a good reception from Oxleas colleagues. SF has written to Bexley Care Trust Chief Executive about setting up a structure in order that Oxleas, South London Healthcare and the Care Trust can come together to start making the final decisions around the business case, the staff consultation, the paper that goes to the Cooperation and Competition Panel etc. Good progress is being made overall.
Croydon – Oxleas are now on a shortlist of two providers being considered. We have not been told who the other one is. It is likely that Mayday is the other provider. The tender deadline is 16thOctober and the presentations are on the 21st. Recommendations will then go to their Board. It is not entirely clear when the transfer will take place. We are trying to clarify all these things and we have got a meeting with their Directors on 12th October.
SF asked for approval to submit for tender and presented the risks and benefits. Croydon is a very big borough (350,000 population), a new geography and a new partner. Incorporating Croydon into the Trust will be a major undertaking.The benefits are that it extends our Trust base, both financially and in terms of the service; it:
- extends to a new host commissioner,
- complements Bexley Community Services
- provides a critical mass.
DM asked if the Trust has the capacity to go forward with this proposal.
SF – A significant Programme Board would need to be set up with a Director or somebody else leading. This will take up a significant amount of time and we may well need to buy in support not least with the due diligence.
DM asked forcomments or questions from Board members.
AT – If we did proceed with Croydon and, for example, another Borough approached us, could we manage all three?
SF – This would have to come back to the Board for a discussion. Where we previously thought about three boroughs, we felt it wasn’t possible and withdrew from Lewisham.
RP – We would need to use consultants for the financial due diligence. Bexley was easier because we do their accounts currently.
SJ – expressed concern about another organisation conducting the due diligence as Trust staff are better able to identify problems and benefits. It would be worthwhile to backfill posts. Bexley and Croydon are our priorities and any other community service that approaches the Trust should be made aware of the difficulties with timescales.
BE – asked about timeframe for Croydon to transfer.
SF – This is unclear. We have received documents that went to Croydon’s Board that state 1st April 2010 as the start date but we will check this when we meet with them on the 12th October.
The Board agreed to tender. / Noted
Agreed
5 / Kent Prisons and Belmarsh Update
JE gave an update on Kent and Belmarsh.
Kent Prisons: since the last Board we submitted a tender and were subsequently interviewed which went extremely well. We received a short telephone call from them today giving some feedback. On a very positive front we have been told that we have done well in all categories with the exception of finance which is yet to be assessed. The downside is that East Kent have a significant financial shortfall and are looking to reallocate funding. The original figure was £2.9m and is now £1.5 – 1.6m.
It was agreed, given the timescales involved, that the Project Board would decide on behalf of the Board how to proceed. A report is to come to the next Board meeting.
Belmarsh: The Project Team are meeting and the Primary Care element is now moving forward. A Question and Answer session has been held and was positive. The tender is due on the 13th November but need to be with the printer a week in advance of this. The paper for the Board will be a late submission therefore. AR to send the full paper and risk register to Board members when they become available. JE will do a presentation to the Board Away Day on the 5th November in the afternoon. / Noted
Agreed
JE
AR
JE
6 / Director of Service Delivery Report
Bromley Change Programme
The consultation has now finished. Implementation groups are being set up and work is being done with staff and service users/ carers. Communication with individual users of the services has begun.
Bromley CAMHS Tier 2
Options are being considered. There is agreement between Bromley and Oxleas for a single provider. We have met with Commissioners who are taking soundings. No issues have been raised by staff. A paper will be presented to the Board in December.
Inquiry
A meeting has been arranged with NHS London to discuss the report. The report from Sheffield has not yet been received. It is hoped that it will arrive before the meeting with NHS London.
SF asked the Board to note that NHS London has reviewed two previous homicide inquiry reports and that one of these will be subject to an independent inquiry. / Noted
HS
7 / Key Performance Indicators Exception Report August 2009
Monitor Targets
All Monitor targets were met in August. There has been a further decrease in delayed discharges to 4.31%. Only two areas are above 7.5%.
Carers
An error in reporting the carers figure in July means that both the July and August % clients with a carer on RiO is now 31%. The current RiO system is unable to identify when service users have reported that they have no carer. This will be achieved through manual audits in the future. It had been agreed that the % having carers should be around 60% but it is difficult to establish a baseline.
Incident Reporting.
The number of reported low level incidents (1-3) is still low.
Social Inclusion
We have previously monitored this target by reporting on all entries recorded in Rio for Employment Status. RiO version 5 will help resolve problems but in the meantime manual audits are being undertaken. Information has been sent out to staff.
Bed Occupancy
Pressure on beds in Bexley and Greenwich is high and work is underway to understand the reasons for increase. In Bexley older adults, bed occupancy has reduced and remains low in Greenwich
Psychological Therapies
There has been a small drop in figures from April. 16.3% of all Trust service users are currently receiving psychological therapies. The target is 18.8%.
DM expressed some concern around information/data and stated that key performance indicators were essential for Board assurance. It may be that the indicators need to be reviewed or alternative sources of assurance are found (audits for example). The Executive Team was asked to bring a paper/ proposal to the Board in December. / Noted
Executive Team
8 / Finance Report
On request, a Return has been sent to Monitor showing 3 downside scenarios on the assumption of a financial downturn. If we take no action to 2013 our risk rating will be 1.2; if take 29 actions outlined in the plan our risk rating will be 3.6; if we have a 6 month slippage against all plans our risk rating will be 3.2. It is critical to plan well for this and plans are being further refined. Monitor may request further detail. A Project Board is being established to take plans forward.
Income continues to rise above the plan level. And this, despite overspending on non-pay, non-achievement of CRE and UEA/CPC, results in EBITDA returning to a positive variance against plan by £32k. Interest receivable is below the plan by £65k, giving an overall shortfall in surplus of £32k. The risk rating has increased to 3.9. / Noted
9 / South East London Sector Meeting
The South East London PCT and Provider Chief Executives met on the 16 September 2009 to consider the financial challenges facing the sector and the development of a recovery programme. The most pertinent point is a ‘best case’ net funding gap of £260m by 2016/17. This represents the difference between projected PCT allocations and expenditure. This is after more than 3% annual savings following tariff reduction. NHS London has requested a strategy, by 18 December 2009, to address this deficit.
It was suggested that five cross sector work streams were set up, including mental health,to work on the strategy and asked SF and Stuart Bell from SLaM if they would lead on mental health. SF, supported by Stuart Bell, suggested that they undertook targeted work to support the overallsector strategy as this would yield more benefits. / Noted
10 / Workforce Report
The report shows a 5.01% absence rate for July and indicative data for August shows this has fallen to 4.64%. Flu features prominently in the reasons for absence.
Competency testing for occupational therapists has been agreed and will start in November. All existing OTs will have been tested by June 2010. SH asked the Board to note vacancy rates and that 2 induction session were being held this month.
DM asked if the indicative data was necessary. HS informed the Board that the workforce data is reported with a one month time lag and the position, therefore, is two months behind. / Noted
11 / National Patient Survey Report 08/09
The results were disappointing. In the 12 categories, 6 were as ‘expected’ and 6 were ‘worse than expected’. Nationally, there was a 28% response rate. In Oxleas the response rate was 24%.
Nationally results show that:
- only a third of respondents felt as involved in decisions about their care and treatment as much as they wanted to be.
- less than half (45%) ‘always’ felt safe on the ward, and 16% did not feel safe at all.
- 35% said there was a lack of activities available on weekdays, and over half the respondents (54%) felt this was the case for weekends and evenings.
- less than half of the 52% who wanted talking therapies (such as counselling, cognitive behavioural therapy and anxiety management) received any.
- 27% of patients detained under the Mental Health Act felt they did not have their rights clearly explained to them.
- 86% of respondents reported having physical health checks in hospital - but only 44% of those felt that these physical health problems were ‘definitely’ taken care of.
- almost half (48%) of patients said the potential side effects of medicines that were prescribed to them while in hospital were not clearly explained to them.
- About the ward (cleanliness of bedrooms, toilets and bathrooms as well as whether users were helped to keep in touch with family or friends).
- Nursing (whether the users felt listened to: given enough time to discuss treatments; confidence and trust in nurses; treated with respect and dignity).
- Medication (the purpose of medication explained and possible side effects).
- Care and treatment (given enough privacy when discussing treatments).
- Activities (lack of availability in the evenings and weekends).
- Leaving hospital (whether discharge delayed and time taken to contact after discharge).
- Greeting all new admissions within 2 working days
- Welcome pack for every new admission
- Improved ward information packs
- More rigorous and regular cleanliness checks
- Replacements of carpets and bathroom fittings
- Internet access on our wards
- Patient Experience Tracker and in-patient discharge survey introduced.
SF informed the Board that Louis Appleby had made strong representation not to judge organisations on results from such low numbers of respondents alone.
Progress against the Action Plan is to be reported to the next Board of Directors. / Noted
WB
12 / Monitor Governance Declaration October 2009
The Board quarterly Governance Self Certification to Monitoris due at the end of October. The Trust’s Governance Risk Rating is dependent on how many targets/ standards are not met. The weighting for each target not met is 1.0 and for each standard 0.4. Less than a total of 1.0 the Trust remains at Green, between 1.0 and 2.9 the rating goes to Amber and over 3.0 goes to Red. Monitor expects Boards to let them know of any areas of both certain and potential non compliance through the self certification process.
In the run up to Registration requirements under the Health and Social Care Act 2008, the CQC have asked for a mid year Core Standards Declaration. This is due in December 2009 and the Board will receive a full report on compliance prior to this. AR asked, given the results of the National Inpatient Survey, if the Board were in agreement to inform Monitor of possible non compliance issues around standards C16 (information) and C13a (respect and dignity). Further assurance around these particular areas of patient experience is being gathered (e.g. Patient Experience Tracker and Discharge Surveys among others) but full compliance cannot be assured until further analysis has been undertaken.
The Board agreed that part 2 of the Self Certification Form should be submitted outlining issues and plans for C16 and C13a and delegated responsibility for agreeing the detailedform to SF. / Agreed
SF
13 / Governance Report
Serious Untoward Incidents (SUIs)
There were 3 SUIs reported in August. Of the 18 reported to date this year, 8 investigations have been completed and 3 are overdue.
Incident trends level 1-3
Data has been adjusted for August. Reporting rates remain stable compared to July 09 and shows an increase on 08 figures.
Infection Control
There were no Infection control outbreaks or incidents in August. With the introduction of the new learning management system we are able to report that 73-74% of staff have undertaken training. The Director of Nursing has written to all Service Directors with the names of staff who have not completed training.
Safeguarding Children
There have been 54 referrals to date and 46 meet the threshold for a multi agency review. Work continues to improve awareness across all areas of the Trust.
Mental Health Act
We continue to experience delays in obtaining second opinion doctors (SOADS). The Mental Health Act Team is working with the Care Quality Commission (CQC) to arrange a series of SOAD days across the Trust to complete outstanding requests.