51stMeeting of the Board of Directors
Thursday 7th October 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
Paul WardNon-Executive Director
Seyi ClementNon-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
Wilf BardsleyDirector of Nursing and Governance
Directors
Trevor EldridgeDirector of Greenwich Mental Health Services
Rachel EvansDirector of Estates and Facilities
Iain DimondDirector of Bromley Mental Health Services
Keith MillerDirector of Psychological Therapies
Stephen WhitmoreDirector of CAMHS and ALD
Sian ThereseDirector Bexley Community Health Services
In attendance
Ann RozierTrust Secretary & Head of Governance
Bryony RobertsonPatient Safety Lead
Action
1. / Apologies for AbsenceJohn Enser, Director of Forensic and Prison Services / Noted
2. / Minutes of the Board of Directors Meeting 2nd September 2010 and Board of Directors Away Day 2nd September 2010
Page 1 - We had 207 nominations which was a 90% increase on last year. Should read 50%.
Page 6 – item 10. …progress around SLR and PVR should read PbR.
Page 9 – item 15. …the satisfaction is high for information and low for safety. It should be clarified that ‘low’ is the lowest score. / Agreed
3. / Matters arising
Update of Right to Request
SF is attending the PCT Board in January.
Governance Report
Other organisations are not keen to share information for comparison. Lewisham is being approached.
Emergency Plan
No resubmission is required. The updated Plan will be presented to the Board in December.
NHS White Paper
Health Watch will be accountable to the Care Quality Commission. / Noted
4. / Chief Executive Update
All relevant items were covered in the Away Day. / Noted
5. / Greenwich Community Health Services
The Due Diligence Report was presented to the Integration Project Board in September. There were no significant barriers to integration but there are a number of items to be addressed.
It has been confirmed that Oxleas will retain its NHSLA Level 2 rating but we will need to be reassessed in the first quarter of 2012/13. This means that we will need to be collecting evidence of compliance with NHSLA standards 12 months prior to this date. The financial envelope is not yet known. There ahs been no final decisions made on which staff will be transferring until mid October. All other items are on track.
To move to the full Business Case, a significant amount of work is required to be completed by Christmas for submission to Monitor in January. Therefore, there will be an Extraordinary Board meeting the week before Christmas.
AH – will we use this instance of RiO for Bexley Community health Services?
WB – yes, that is our intention but as it is a different version to that used by Bexley some retraining will be needed.
PW – Will the current financial pressure on PCTs affect the transfer?
SF – Significant savings will be transferred.
RP – Some savings will be made in the transfer
SC – The Report is detailed but there is information missing. Will we be able to put together a detailed plan for December?
SF – Work streams have had good input and there is a willingness from Greenwich to make this happen. However, pulling together all the information is a risk. If it is not made available by December this may mean a delay.
RP – Also, we will not know about the Contract until very late in the process. / Noted
6. / Director of Service Delivery Report
Medway have issued invitation to tender for their PICU and we are in discussion with potential partners.
The ITT for Greenwich Urgent Care Centre has not been issued yet. Will keep the Board informed of progress.
The Bromley tender for community neuro-rehabilitation services is now at the next stage.
The Bromley SIT has reported. Good practice was noted and there was praise for services.
The first trust-wide social care conference was very successful. There were 90 attendees. An annual event is proposed. HS thanked non executives for their input.
AH – Can we ensure that any potential partner’s financial stability is checked?
HS – yes.
JK –Can you explain more about the Bexley CHS bullying and harassment survey?
ST - We are working with Human Resources, not just seeking advice, around bullying and harassment.
DM – Under the Greenwich MH report, it mentions moving out of Passey Place.
TE – Yes, but we have a presence in the IAPT in Eltham. / Noted
7. / Key Performance Indicators Exception Report August 2010
Information for Bexley Community health Services will be included in next month’s report.
Monitor Targets
7 Day follow up - There has been some difficulty with the 7 day follow up target. Following further guidance received, the Trust has discovered a small number of breaches. The majority of these are related to discharging people to residential care. Our performance is at 88.8%. Guidance has been issued to all units and we expect to be back on track very soon.
12 month reviews – there has been a data cleanse. The target is met
7.5% delayed transfers of care – The target is met
Admissions with access to CRHT – The target is met.
Contract caseload commitment for early intervention 95% - This target is to be met by year end. At the moment Bexley is at 90.9%, Bromley at 76.6%, Greenwich is at 63.0%.
SF – this has been discussed in the Executive Team meeting and we are trying to get confirmation from our commissioners that this meets their requirements.
ID – There is always an issue about whether there are enough cases and commissioners in Bromley are willing to provide assurance.
TE – We are doing everything to ensure this target will be met. The commissioners are members of the Early Intervention steering group.
Annual Plan Targets
Psychological Therapies caseload – A review is taking place as a manual count of caseloads has demonstrated a different figure.
CPA clients with employment status recorded – at 79.1%.
Reviews of clients on standard – please note this is a new target introduced.
New client reviews (6 monthly) – The gap identified in Forensic services is solely related to the William Morris Centre.
Acute Bed Usage
This is a positive position, particularly in Older Adults.
AH – Is the bed occupancy in Greenwich related to the disinvestment of 3 beds?
TE – there was an acute overspill on Millbrook ward.
SF – Occupancy remains stable but still needs to come down. / Noted
8. / Monitor Self Certification July – September 2010 (Targets & Standards)
The Board was asked to consider details from the last item in order to provide Monitor for the self certification of compliance with standards and targets. The quarter being reported is the 1st July 10 to 30th September. Data is available up to the 20th September. There is a breach of the 7 day follow up target although final figures are not available yet. An action plan to resolve the issues has already been implemented. Breach of this target carries a weighting of 0.5 so will not affect our Green rating.
SF – we will also be obtaining feedback from commissioners on the Early Intervention target.
The Board agreed to delegate authority to SF to complete and sign the appropriate declaration on behalf of the Board once all data for quarter 2 has been obtained. / Agreed
9. / Finance Report
The surplus is marginally below plan at £837k. This is an improvement on July. As with
previous months the income is ahead of plan and expenditure is as well. The Monitor financial risk rating is 3.4. This is the same as in July.
Income: Income is £151k above the plan. Bracton is £270k above, while other directorates are below. Some of these low figures are offset by equal spend reductions. There has been an accounting adjustment to show the effect of occupancy of Millbrook Ward, and this puts Bexley above the planned level. (This is a CRE item). The Greenwich PCT contract value has been agreed, and this will have a small effect on the overall figures included in the plan, as we had provided for most of the figures that were finally agreed.
The Greenwich LB envelope has also been agreed. This is at £300k lower than our plan.
It should not make a difference to the year end outcome as a savings plan has been agreed with the Council. Both these agreements were too late to be incorporated in the accounts for August. Interest receivable is increasing slowly as the invested balance and the interest rates are both increasing.
Expenditure: All the categories of expenditure are underspent and improving, except CRE’s.
Staff underspend increased to £132k (July £20k). The trends to date have continued with
both the underspending and overspending areas increasing. Medical, nursing and admin
are the main overspending areas with significant underspends in PAM’s, Psychology and
Social workers. Non pay is overall underspent by £70k (July £62k). The UEA/CPC continue to
underspend. This is now at £82k (July £62k). The CRE position shows a shortfall of £374k.
The nurse bank/agency was lower than July. Agency was considerably reduced from the
high figure in July. Bank spend was below the average spend for the year.Admin bank increased, while agency dropped to a new low.
Balance Sheet: Depreciation is still higher than capital expenditure, so fixed asset levels continue to fall.NHS debtors reduced, but non-NHS increased. The non-NHS is affected mainly byGreenwich Council who have not made any payments this year. This is rectified in
September.Greenwich PCT made a large payment in advance which affects the creditor position andthe cash flow.Cash balances increased by £6.8m to £52.5m
Efficiency Savings: The savings allocated have increased. There is now £1.087m to allocate.
The achievement to date is £1.2m. NB this does not include the savings achieved by the
Bexley Community Services as we have not yet set up the CRE accounting. We areundertaking a new forecast for CRE achievement at the year end and this will beavailable next month.The previous forecast was £3.4m compared to the plan of £4.6m.The forecast for the year end position of the Trust is that we will achieve, and probablyover achieve, the planned EBITDA and surplus.
SF informed the Board that he had received an email stating that the Greenwich contract will be signed on the 8th October 2010. / Noted
10. / Workforce Report
Sickness Absence – Sickness absence in August was 4.03%. The long term trend in absence continues to be downward. The rolling 12 month average level of absence now stands at 4.64%. At the same point in 2009 this was 5.18%.
Vacancy and turnover Rates - Vacancy rates have reduced to 10.98%. This is their lowest level for the last 12 months. Turnover also continues its downward trend and now stands at 8.39%. At the same point last year this figure was over 4% higher. The tightening of the health labour market will be a large factor in this reduction. On that basis alone it is likely that turnover will continue to be low going forwards.
PDR/appraisal uptake - The current level of recorded appraisals that have taken place in the last 12 months stands at 58.8%. This is an increase of 3% on the figures reported at the September Board. All directorates have plans for the completion of PDRs which are monitored locally. The target of 80% or more staff with a completed PDR should therefore be met.
Bank and Agency Usage - Bank and agency usage has reduced in August with significant reductions in the usage of both nurse and admin and clerical agency staff. Temporary staffing has now set up a Therapies bank to reduce agency expenditure in this area and this is now operational. Further work with business managers and ward managers is being done to improve existing controls within the directorates.
Quality Programme for Senior Managers & Clinicians - The initial plans for the programme were reviewed in the light of changed organisational circumstances and capacity by the Executive. A revised programme of master classes has been agreed which will be run on a bi-monthly basis from January.
SJ – The sickness absence improvement represents there being 5 more people at work everyday more than last year.
SC – Is there any succession planning?
SH – No, but this has been identified in the Human Resources Strategy.
SF –Executive and corporate departments performance in PDR is just as important as elsewhere.
SH – A report has been circulated to identify gaps.
DM – The completion of PDRs are important to the quality agenda.
SH – Processes to measure the quality of PDR is being put into place. / Noted
11. / Staff Performance Award
Staff Performance Awards have been made for the last 2 years. These Awards are based on external ratings thatdemonstrate high quality care. They are received very well and staff value the reason they are given. However, there are arguments for and against making the Awards, particularly when considering the broader health economy.
SJ – this is an award for performance. It has been a difficult year but staff have dealt with this seamlessly without effecting the quality of patient care. A thank you should be given to staff.
HS – The Bexley Directorate Management Team said that this Award is fantastic and understood it as a thank you. But, they did feel that it may be giving the wrong message. They suggested a compromise of writing to staff to acknowledge their achievements and only giving the Award to staff paid at grade 7 or below.
PW – I understand SJ point but it is difficult with the future financial challenges about to be faced and redundancies being made elsewhere.
JK – It does not feel comfortable.
SC – can we move this Award to next year?
DM – It may be better given in November rather than December.
AH – I agree that perhaps the higher paid should not receive it but I am happy for others to receive it.
AT – I support SJ in that we should not discriminate. We did extremely well in the National Patient Survey; was 4th best employer in the Country, it should be the same as last year.
WB – I have been talking to colleagues in other Trusts and they are envious that we are able to do this. It is very valued by staff.
RP – I cannot see a reason not to do it. We improved across nearly all indicators.
SH – The Award needs to be universal
SF – The Award should be consistent with the principles we established it for. We said, at the time, that everyone is responsible for quality. One flat rate for all, as last year. Last year I voted for the Award because of the Royal College Awards we received. This year, 2 independent surveys of staff and the Patient Survey were very positive – Top 5 in both. The best performance yet.
DM asked for a show of hands for/ against giving the Award.
It was unanimously agreed that the Awards should be given to all staff. / Agreed
12. / Governance Board Update
The Governance Board received the Annual Risk Management Report for 09/10 and this will be presented to the Board in November. The new Risk Management Strategy has been revised to reflect the new CQC Regulatory framework and changes to the Trust Governance arrangements. Further refinements are being made prior to it being presented to the Board for ratification in November.
Corporate Risk Register – Two risks were due for review and in each case it is proposed that the ratings are reduced:
COM2.2: Service users and carers feedback (based on their experience of receiving services) impacts on Trust reputation and performance.
Consequence remains at 4, likelihood reduced from 2 to 1; overall risk rating reduced from HIGH (8) to MOD (4)
OBJ1.1: That the Trust may not be successful in promoting social inclusion and tackling stigma and discrimination
Consequence remains at 3, likelihood reduced from 3 to 2; overall risk rating reduced from HIGH (9) to MOD (6)
JK commented that in 5 questions in the National Patient Survey, relating to social inclusion, the Trust was in the top 20%.
The Board approved the new risk ratings. / Approved
13. / Quality Report
Quality Board
The September Quality Board went through the Trust’s QSIP & CQUIN dashboard overview for August 2010. The highlights are as follows:
QSIP
- 7 out of 43 (16%) QSIP indicators have been highlighted as red (below target by 10%); an increase of 2% from the previous month
- 2 indicators are awaiting confirmation of August position
- 1 indicator (2%) has been highlighted as amber (1-9% below target)
- 19 quality indicators (44%) have been achieved (at target or higher)
- 14 indicators (33%) linked to the annual POMH UK audits and to ICD10 coding and reporting for clients on LD and autistic spectrum do not yet have a status
CQUIN
Specific focus was given to the draft CQUIN indicators circulated by NHS London on physical health monitoring. Following negotiations and agreement with the London wide LMC and other stakeholders, NHS London have proposed to change the physical health CQUIN indicators to the following