48Thmeeting of the Board of Directors

48thMeeting of the Board of Directors

Thursday 3rd June 2010

3.30pmBoardroom, Pinewood House

Board of Directors

Dave MellishChair

Archie HerronVice Chair & Non Executive Director

Anne TaylorNon-Executive Director

Sally JacobsonNon Executive Director

James KellockNon Executive Director

Stephen FirnChief Executive

Helen SmithDeputy Chief Executive & Director of Service Delivery

Ify OkochaMedical Director

Richard PageDirector of Finance

Simon HartDirector of HR and Organisational Development

Directors

Trevor EldridgeDirector of Greenwich Mental Health Services

Sian ThereseDirector Bexley Community Health Services

In attendance

Ann Rozier Trust Secretary and Head of Governance

John ForrestEstates Manager (in place of Rachel Evans)

David ShaerComplex Needs Service Manager, Bromley Mental Health Services (in place of Iain Dimond)

Item /

Action

1. /

Apologies for absence

Paul Ward, Non-executive Director; Stephen Whitmore, Director of CAMHS and ALD; Rachel Evans, Director of Estates and Facilities; Iain Dimond, Director of Bromley Mental Health Services; Wilf Bardsley, Director of Nursing and Governance; Keith Miller, Director of Psychological Therapies; John Enser, Director of Bexley Mental Health Service and Forensic and Prison Services. / Noted
2. / Minutes of the Board of Directors Meeting 6th May 2010
Page 5, item 9 - IAPT waiting list: TE is quoted as saying that ownership of the waiting list is unclear.
TE – The minutes should state that we are working with the PCT to resolve the waiting list.
Page 8, item 9 - Staff Survey: The response rate is 56, not 46.4%.
Subject to these alterations, the minutes were agreed as an accurate record.
Minutes of the Away Day 6th May 2010
Page 2 – 3 – National Patient Survey: The minutes state that we are 6% above the national average, but this should be that the for the overall quality of care, the number of respondents who rated Oxleas at “excellent” or “good” is 6% above the national average. We hope to receive the full report by the Council of Governors meeting.
Subject to these alterations, the minutes were agreed as an accurate record. / Agreed
3. / Matters arising
Minutes of the Board of Directors Meeting 6th May 2010
AH – The Bracton Silver Jubilee event was very well attended with approximately 70 people, including Governors and the Mayor of Greenwich. The speeches and the film presentations were excellent.
Minutes of the Away Day 6th May 2010
Pages 4 and 5 describe the group sessions on organising visits to gain feedback on the patient experience. DM had a one-off meeting with the User Carer Council at the beginning of last week. The comments from the Away Day were mirrored by the four groups at the User Carer Council. A paper will be taken to the Council of Governors next week and then to the formal meeting of the User Carer Council on 24th June to finalise the recommendations. A paper will be brought to the Board with proposals for the visits and the training and support necessary with a view to starting in Autumn 2010
AT –Will this cover all the various groups conducting the visits?
DM – Yes, inpatient, outpatient and provider services.
AT – Will there be a mix of people, including members of the Council of Governors?
SF – We have discussed moving towards functional care groups with the senior staff group, including senior clinicians and representatives from Bexley Community Provider Services, and this was very positively received. The timetable proposed was supported and a more detailed plan will be taken to the next senior staff group. / Noted
DM
HS
4. / Chief Executive Update
The new Coalition Government have given some indication as to what direction they will take with health and social care policy. Their website summarises the bullet points from their statement and the declaration provides some headlines which mirrors the manifesto and our awayday discussions. The White Papers is not now expected until July but the Government have given some clear messages. The Department of Health will be renamed the Department of Public Health and will focus on the health of the population and setting standards and actions around reducing alcohol intake, tackling obesity, smoking etc. It is intended to set up an independent NHS management board but there is some work to do to understand exactly what that will look like. It is likely this will be an Executive Board holding the commissioning budget and directing the key priorities, targets and standards for the NHS. This will mean the abolition of SHAs as we know them, but this will require legislative changes in the 2001/12 parliamentary term with the intention that the new arrangements are introduced from April 2012. The biggest change for us is the establishment of GP consortia and an absolute commitment that GPs should have responsibility for commissioning. This would mean that any service change has to have the backing of GPs and the local population and that PCTs won’t be responsible for commissioning. They will have a focus on public health and they may well undertake much of the transactional work and contract negotiations on behalf of GPs. They will be accountable to the GP consortia and their principle officers will be appointed by the NHS management board. They will want Monitor to become a single economic regulator and for all providers to be foundation trusts. This would see the biggest restructuring and top down change of the NHS for decades; as providers our actual structure won’t change because the FT model is seen as being the right one.
DM – Is there clarity about those who are not yet FTs? For example, would they become FTs by ‘lowering the standards’ or would be they be taken over by successful FTs?
SF – A turnaround specialist would be appointed who would get trusts toFT status although there are very specific issues in London. There will be a learning curve around how their aspirations will translate into reality.
AT – What about the commissioning groups that were set up?
SF –I met with Nicola Gardner yesterday and they are hoping to secure the PCTs agreement that there are some things they will work together on. The biggest impact is on reconfigurations and there will be no announcements until the White Paper comes out. They want a re-process which demonstrates that both GPs and local people approve any reconfigurations. Having said that she was very positive about community services integration with provider trusts and said she saw a lot of benefits from integrated care organisations.
AH – Will the PCTs continue to commission for a time until the GP consortia get together?
SF – I think so, yes. There may be some pilot projects but the working timetable is 1st April 2012.
AH – Does every GP have to be a member of the commissioning consortia?
SF – We don’t know and we don’t know how big the consortia will be. It really is a particular problem for London; this model may work better in a rural county, where there is single PCT and a single local authority. There are 31 PCTs in London with huge variances in the population so it is more difficult to see how it this could work.
JK – Is there a timetable for when the new structure will have been decided?
SF – No, obviously there will be civil servants working on the outline plan but although it should have a timetable, I don’t think all the details will be agreed by July, it will just give more indication about a process for setting all this up.
AT – The danger is of course that the current structure disintegrates because people will be looking for jobs if they know their structure’s going to go change and will not committed in the way they were.
SF – We can talk more as the plans develop. Organisations like Humana that have done commissioning in the USA will be very keen to be involved because GPs are going to need some expertiseeven if they make the final decision. / Noted
5. / New Service Developments
Bexley
The minor outstanding issues around the number of KPIs, contracts, SLAs and Leases have been addressed. There was a series of meetings with NHS London around the Right to Request including one with the staff from the Step Up Step Down unit and the Social Exclusion unit. The outcome of that was we appeared to reach full agreement and NHS London emailed us on 21st May to say they were now happy everything had been resolved. On that basis all the papers were prepared and the contracts made ready for 11.45 amsigning on Friday 28th May. That morning we were told that the Department of Health had a meeting the night before and there was nervousness about going ahead. Although the transfer was agreed in principle, the Department of Health did not get ministerial approval, so could not make announcements. SF wrote to Dave Nicholson (Chief Executive of the NHS)andRuth Carnellgiving context about costs and the impact on patients andstaff. We have not had a direct reply but the Department of Health acknowledge decisions need to be made as soon as possible. We are waiting for strategic direction from the Minister of Health. It is hoped to have a statement from the Minister by the end of June with a plan for transfer on 1st July.
DM –Sian, how has the Community Provider staff taken this further delay?
ST – It is affecting the staff based at Queen Mary’s more because they are picking up the general uncertainty across the whole of the hospital. Staff are getting on with their jobs and we are focusing on making sure that staff are delivering good services.
AH – Are patients aware?
ST – No, my greatest concern is, that if staff are unhappy, that will come out to patients and this will be a difficult message to handle.
AT – Is there anything supportive that we can do for staff at Queen Mary’s?
ST – The support that Stephen and his team are giving is really good and has a cascade affect so no special visiting or contact is needed at the moment, but I do think we need time to make sure the message is constantly going out to them.
AH – Would local MP support be helpful or not?
DM – We have written to the new ones.
SF – James Brokenshire, the new MP for Old Bexley and Sidcup is trying to reverse a Picture of Health because that was part of his election manifesto.
SF – What I want to ask Bob Ricketts is what more can we do to give them evidence that it is sensible to allow the transfer because the new process could take months
AH – It could be six months?
SF – Yes. So I will ask if we could meet, should we involve GPS, can we get Governors to write. These were the issues that I put in the letter as well.
DM – An integrated care model is what I would have thought politicians would be very interested in.
Greenwich
SF – There is not much more to report other that that we have met with key people from Greenwich PCT and Greenwich LA. We have had two or three meetings with Leslie Strong, Director of Provider Service and we are setting up the various structures. There is an uncertainty around exactly how we do this. At the first meeting I think we should start on the less contentious issues, but we will have to wait for the White Paper to see whether we need to do things in a different way.
AH – At least we have got enough time with this. We have to wait for the White Paper and then there is still going be several months.
ST – From an operational level we looked for potential for partnerships and streamlining our systems so that work has started too.
JK – Just picking up on the uncertainties that over the next 12 to 24 months in terms of not just our local picture but the whole issue of public sector finance. What as a Trust we are doing in terms of communicating to staff generally? Can we be as confident as we can be about the future to reassure people who might be worried about an uncertain picture?
SF – At the senior staff meeting we had quite a long discussion about what we thought the future held. As an organisation we need to be flexible and think how we develop our models of care and our philosophy as an integrated community provider. People were very receptive to that so there is a good understanding. This is something we need to think through as a Board.
SH – We have had a number of conversations with staff side over the last few months about the potential financial situation. We have not yet met to take into account the reorganisation, but there are certainly implications andthey are open to discussion about what that might entail.
DM – Other than what we have discussed already, is there anything that the Board can do to assist the progress, particularly around the Bexley situation?
SF –It will be helpful to speak to Bob Ricketts because I am trying to geta sense of whether a face-to-face meeting will help. We have at least a dialogue starting at the Department of Health.
TE - With regard to increased partnership working with local boroughs and making any statement to the staff, we need to be aware that a lot of our staff are employed by local boroughs. Following the publication of the White Paper and the Budget it might be the time consider any discussion we might have with the staff
SF – It may not be as big a change as it initially appears. The GP collaborativewas supportive around the Belmarsh bid and the decision around Greenwich Community Health Services and in Bexley we have GPs involved in setting the KPIs and the service reviews. Bromley is a different issue but we may just need to maintain a relationship with a relatively small number of key GPs rather than every single one. / Noted
6. / Director of Service Delivery Report
Health Festival
HS reportedthat the Health Festival at Charlton Athletic football ground was very successful. This was the second year that this event has been run. Over 250 people attended throughout the day. Feedback was very positive. There was a football tournament on the pitch and a number of stalls relating to physical and mental wellbeing. Thanks particularly to Catronia Toms and her colleagues who put a lot of work into making it such a successful day.
AT – It was very, very good. We got 19 new members and quite a few Governors attended. Members of the Membership Committee manned the membership stand.
HS – There was a steady stream of people visiting the stalls accessing information about physical and mental health wellbeing.
Belmarsh Bid
Unfortunately we had hoped that by this Board that we would have heard the outcome but it has been postponed until 8th June. In anticipation of the announcement, the Belmarsh Project Board has been working to immediately start implementation as we will have very little time if we are successful.
Kent PCT
On behalf of all the three PCTs, John Enser and HS had a meeting with Kent PCT to review the transfer of mental health prison services to Oxleas. This was very positive and the Director of Commissioning gave some helpful feedback on where improvements could be made but was clear that in the relatively short time that we have been running the service there have been a material improvement both in responsiveness and quality. On that basis, she indicated that she wants us to put in for a bid for a 20 bed low secure unit. She also alerted us to the fact that three of the Kent prisons will be putting their healthcare services out to tender and was very keen that we consider that. We are not sure about the timetable, but it will probably be over the next few months.
SUIs
There are two SUIs to report. The first is from Greenwich. It was reported in the local news that an 88 year old woman had been found dead in Charlton on 16th May. The man who has been arrested and charged with her murder had contact with our services. His most recent contact was in the beginning of December 2009 when he had asked for assistance in coming off crack cocaine. He was assessed and discharged back to his GP and the Beresford Project, a local drugs project. Prior to that he had very intermittent contact with us. He had contact in 2005, again around a substance misuse and alcohol consumption and then prior to that in 2001 when he had been assessed by the Bracton as to his suitability to care for his children. So his contact with us had been very sporadic and we will set up a Board level inquiry to investigate that. The secondSUI happened in Bromley on 26th May. The service was informed that a man who we believe had quite a lot of contact with our service had been found dead at his home following the Fire Brigade being called to a attend to a fire in his house and car. He had in fact been seen on the morning of his death by his care co-ordinator and his father. The police are treating it as a suspicious incident
DS –The Chief Fire Officer at Bromley had been in touch with London Borough of Bromley as there have been two other vulnerable people who died in fires over the previous month. He has asked to be part of any SUI process. The Care Co-ordinator has been supported.
SF – The Board has been informed about the Bromley incident as until we have more information we are not sure as to how it will be investigated.