52ndMeeting of the Board of Directors
Thursday 4th November 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
John EnserDirector of Forensic and Prison Services
In attendance
Ann RozierTrust Secretary & Head of Governance
Action
1. / Apologies for AbsenceNone. / Noted
2. / Minutes of the Board of Directors Meeting7th October 2010
ST – Page 2, item 6: I am working with HR, not just seeking advice, around bullying and harassment.
SF – Page 8, ‘The Board thanked IO for an excellent report and commented on the potential to share this information with key partners such as GPs. JK asked if….Should be at the end of the Quality Report.
Subject to these amendments the minutes were agreed as an accurate record.
Minutes of the Board of Directors Away Day 7th October 2010
SF – Page 3: typo April 11th transfer, should be 1st April.
Subject to this amendment the minutes were agreed as an accurate record. / Agreed
3. / Matters arising
Minutes of the Board of Directors Meeting7th October 2010
SF – Page 4, first item ‘efficiency savings’, an email stating the Greenwich Contract will be signed on 8th October, it was signed.
Board of Directors Away Day 7th October 2010
There were no matters arising. / Noted
4. / Chief Executive Update
Telephone conference with Monitor. RP and SF had a teleconference yesterday with Oxleas new Relationship Manager at Monitor around Quarter 2 performance. Monitor confirmed that our financial risk rating moved back up to 3.7 and that our Governance rating was green.They noted that we had declared the breach around the seven day follow up. They were very interested in the Greenwich Community Health Services transaction. SF confirmed our intention to have the business case and all the other papersthat Monitor requireready by the end of December and that we intended to hold an Extraordinary Board Meeting before Christmas to sign off these papers.
GP Commissioning. Bexley PCT not formally confirmed as a pathfinder for GP commissioning. There will be one GP Consortia moving to devolving responsibility for commissioning decisions to the Clinical Cabinet.We mentioned the Right to Request; the PCT Board may consider the Clinical Cabinet’s recommendations in January.
A Picture of Health.These were the plans around the previous Government’s proposed changes in South East London. In relation to Queen Mary’s, the Coalition Government have said this now needs to meet the new test. GP leads in all three boroughs, Bexley, Bromley and Greenwich, have reviewed the original plans and have endorsed them, in particular the permanent closure of A&E.
AH –Right to Request. Is this the original request for the Step up Step down service?
SF – Yes, the Clinical Cabinet are going to take a view on 11th. / Noted
5. / Greenwich Community Health Services update
I am pleased to report that the Cooperation and Competition Panel have completed their fast track review and they have given approval. There is a reduction in PCT management costs. These reductions are across London; 53% in total. NHS London have directed PCTs to remove the same amount from the PCT provider arms’ management costs as well as from the PCT’s own management costs by March 2011. There havebeen a number of items closed on the Integration Project Board Risk Register. We identified very few significant risks to the transfer apart from finance which remains.There are ongoing risks potentially in the future but nothing that prevents the transfer. The risk about external approval has been reworded andrated as 12 because of the timescales we need to meet. There may be a delay to transfer if we are unablemeet Monitor’s and NHS London’s deadlines for documentation.
RP – Adecision about payroll arrangements post transfer needs to be made. My strong recommendation is that Payroll will be in-house.We have not conducted due diligence on the current payroll supplier to Greenwich PCTwhich sits within Lewisham PCT. Lewisham PCT will be disappearing(as other PCTs) and it will be more than doubling their payroll if we outsourced it to them. They do not handle more complicated payrolls such as dealing with shift patterns etc.
SF - I think it would be helpful to have a paper about Payroll at the next Integration Project Board so we can take an informed decision.
SC – Has the financial envelope been agreed?
RP – This has not been finalised. Further information and discussion is required.
SC – You are going away very shortly, what do we have in place to take this forward?
SF – A process has been established whereby RP’s deputy, Paul McAuliffe and Gwenda Cunnington, senior finance person,will continue to work on this and willkeep me informed so that I have the opportunity to negotiate and update the Board at the next meeting in December.
AH – Are we discounting any rationalisation opportunities?
RP – We have asked work stream leads to present their future staff structures on the basis of what is needed.
AH – So does this reduce potential savings in the future?
RP – No.
RP –We have looked at the position as we did with Bexley. We have taken the directorate cost as we defined it and added our average corporate costs which are 25.7%. This doesn’t include the £600,000 for property. There is no reason to assume that the estate is going to cost us more.
PW – In terms of financial risk, could we mitigate any gaps in funding by rationalising management and staff across both the community provider services for Bexley and Greenwich?
SF – The assurances that we gave to Bexley during the transfer and the assurances that we are giving so far to Greenwichis that we will retain those separate management teams because that is what both commissioners want. I think the reality was always that in the future we would see how things developed. When we are clear about any financial gap, if it is unbridgeableand the risk is too high, then we will have to look at other mitigations.
ST – Just briefly to say that the service level integration with Greenwich has already started. We have filled some of our senior posts with secondments from Greenwich.
The Board of Directors notedprogress and approved the changes to the Greenwich Community Services Risk Register. / Noted and approved
6. / Service Development Strategy Update
This is to reflect the outcomes of the work that we carried out at the last Board Away Day. The revised SDS will be presented at the December Away Day. The three new things that emerged with our refresh of the PEST and SWOT were:
- The need to establish the medium-term ambitions of the trust in relation to size and the nature of the services that we will offer. This may include specific branding as a NHS community organisation.
- The new directorate structure will be implemented by April 2011. The Board needs to continue to review the structure to meet emerging commissioning intentions and ensure we gain maximum benefit from the incorporation of community health services.
- We need to focus on relationships with GPs as:
Commissioners – discussions have included: positioning ourselves as leaders of OOH care; developing proposals to meet the treatment gap; providing good quality data on service use, cost and care pathways; meeting GP’s quality agenda.
Finally, in terms of our refresh, local authorities now have a completely new set of responsibilities that they didn’t have pre the White Paper. The Public Health White Paper will be published on 1st December.
- We need to focus on relationships with Local Authorities and seek to:
- Use our size and property portfolio to support the third sector, particularly deliverers of social care, wherever possible
- Join the new Health & Wellbeing Boards to promote social inclusion and support integrated commissioning
- Make good links with local HealthWatch bodies
HS – There is a meeting tomorrow with service directors and clinical directors to progress that.We need to formalise the mechanisms by which we are going to drive that work forward.
IO – Just to add that we have already had a meeting around the clinical website and how we can make that more accessible to GPs.Not just to learn about our services but to download referral forms and send them through to teams.
PW – Fully agree with what HS was saying in terms of Public Health White Paper.Would there be merit in us identifying how we mighttry and make sure that mental health is seen as an important area of public health.
HS - I think that is really critical because it is not been something that public health has paid much attention to. We do not yet know how the new Heath and Wellbeing Boards are going to work and whether there will be provider representation on them. We do have very well established mechanisms for talking directly to directors of adult services and that is working well in all three boroughs.
DM – As I understand it, there is a new national mental health strategy coming out at the end of the year which is being commissioned by the Secretary of State and that strategy is linked to the public health agenda. We will need to wait and see the content.
HS – Certainly the mental health strategy is around mental wellbeing, so it’s a mental wellbeing strategy rather than a mental health services strategy. I think the issue will be about how Health and Wellbeing Boards will work locally and how that is used as a driver for the public health perspective. It is also unclear how much resource public health will have.
DM – The timescales for the SDS are: to the December Away Day for agreement of the revised SWOT and PEST and priorities; to the Council of Governors’ meeting later in December ready for the borough based focus groups in January; back to the Board in February or March for signing off. / Noted
7. / Director of Service Delivery Report
Acute beds work programme
TE will be bringing a paper to the Board in January. We have begun talking with groups of staff around this.HS will be talking with TE and colleagues about getting a communications plan in place for stakeholders, particularly for the Overview and Scrutiny Committee.
SH - TE came along to our staff partnership forum to talk to staff side around this particular issue and staff side were absolutely on board with the proposals and totally supported the quality agenda underpinning the plans. They were confident around the staffing issues also.
HS – Yes,there is complete support for the rationale behind the work.
Discussion with LB Bexley
We are having some quite difficult discussions with the London Borough of Bexley in relation to the savings that they are requiring us to make within the Section 75 we have with them. They have asked us to make savings without having any direct impact on frontline care which is not possible to do;it is too large an amount. So discussions are at quite a difficult stage.
Engagement in winter planning
NHS London is co-ordinating the winter planning work for Bexley, Bromley and Greenwich and Lambeth, Southwark and Lewisham. This work incorporates the development of out of hospital care. NHS London is very pleased to have us on board and has invited HS to become a member of the planning group.
The implementation of functional directorates
The work around functional directorates is now progressing. SF is going to chair an internal project group that will drive that through.
PW – In terms of the winter planning, are you happy that we have sufficient risk mitigation in place? I am conscious that this is going to be the first year where we have been really exposed to winter planning. We are getting that exposure at exactly the same time as we can see there are challenges in the local acute sector.
HS – In terms of the day to day work around the operationalisation of winter planning, ST and colleagues are very closely involved in that as indeed they have been year on year. In terms of the wider strategic work around developing out of hospital care, that is now moving at a different pace than it was a year ago and I am not certain what the risks will be yet.
Forensic and Prison
JE – Jackie Craissati has been appointed clinical director. Jackie has been Head of Psychology at the Bracton since 1988; originally appointed as a psychologist. She is well linked nationally and is involved in a number of national bodies around psychological therapies.
The Forensic and prison services directorate is working with Cygnet health care on the submission of a joint tender to provide 20 low secure beds for Kent from April 2011. The timescale for submission is before the next Board meeting in December.
The Board agreed that the Chairman and Chief Executive sign off before the next Board meeting. / Noted
Agreed
8. / Key Performance Indicators Exception Report September 2010
Monitor targets
Delayed transfers of care – Target achieved 2.61%. Some areas are achieving better than others so work is underway to address that.
Early Intervention Psychosis caseload –on track to meet. Following discussions with Greenwich, the EIP target in the contract was significantly lower than we had been working towards so we are already over-performing.
All other targets achieved.
Bed Occupancy
Occupancy levels in working age adults in Bexley and Bromley are now consistently below 100%. Greenwich remains at 115% but this isn’t high for Greenwich given past rates. Figures have been consistent for the last six months.
PW – I was impressed by the Bexley Community performance around the 100% of referrals in terms of client contact within 48 hours.
AH – Very good to see these figures coming through now.
DM – We need to discuss potential bed blocking at the next Away Day, given cutbacks in LAs. / Noted
HS
9. / Urgent Care Centre Development and Winter Planning
The scale of change at South London Healthcare Trust is quite considerable. It is an extremely complicated plan and there are many tiers of project management. We have now had sight of the governance arrangement. To compliment that we have set a project process to ensure we strengthen the Urgent Care Centre so it is able to stand alone without the support of an A&E department next door. The paper outlines the work streams set up to support the project. They include our workforce, clinical pathways, IT, communications, estates and some issues around contracting. We are making good progress on our workforce changes. the clinical pathways are more complex to settle than perhaps we at first envisaged and we have commissioned an independent reviewer to look at that particular issue.We do think that the clinical protocols that we have in place to support what the UCC does are robust and we have had some good evidence over the last three weeks where we tracked cases into A&E and tested their appropriateness with a Consultant. The number we refer to A&E is very small. We have successfully appointed a clinical lead and management lead for the service and staff are feeling very comfortable about the development of the project.
In terms of winter planning, there is no doubt that this year will be similar to last year. QueenElizabethHospital struggled enormously to cope with its A&E four hour target. The patient flows will increase to QE, as it will for DarentValley for A&E attendances. We are moving our care navigation team to the QE site away from the Queen Mary’s site to ensure we have got maximum support there. I have put forward a proposal to extend the care navigation work and the central booking desk to a seven days a week service rather than five days. As yet I haven’t had a response. I do think that those small changes will make a big difference to some of the pressures. I have also tested whether there is any spot purchase bed capacity that we could have and make use of some of the Oxleas’ beds to support the Step up Step Down service and I will continue to pursue that. We expect to have a diarrhoea and vomiting outbreak, as previous years and that clearly will have a big impact on capacity.
AT – A comment, have we contacted the Beckenham Beacon, they are a stand alone urgent care centre, is there anything to learn from them or do they provide a different range of services?
ST – They do provide a different range of services. They are more a minor injuries unit than an urgent care, in fact they see less people. Out of all the urgent care centres locally we see more people, up to 30,000+attendances through Bexley.