57Thmeeting of the Board of Directors

57thMeeting of the Board of Directors

Thursday 7th April 2011

3.30pm Boardroom, Pinewood House

Board of Directors

Dave MellishChair

Archie HerronNon-Executive Director

Anne TaylorNon-Executive Director

Sally JacobsonNon Executive Director

James KellockNon Executive Director

Paul WardNon-Executive Director

Seyi ClementNon-Executive Director

Steve JamesBoard Advisor

Stephen FirnChief Executive

Helen SmithDeputy Chief Executive & Director of Service Delivery

Ify OkochaMedical Director

Richard PageDirector of Finance

Wilf BardsleyDirector of Nursing and Governance

Simon HartDirector of HR & Organisational Development

Directors

Trevor EldridgeDirector of Working Age Adult Acute and Crisis Care

Stephen WhitmoreDirector of CAMHS and ALD

Iain DimondDirector of Complex Needs and Recovery

Sian ThereseDirector of Bexley Community Health Service

Lesley StrongDirector of Greenwich Community Health Services

Estelle FrostDirector of Older Peoples Mental Health Services

John Enser Director of Forensic & Prison Services.

Rachel EvansDirector of Estates and Facilities

Keith MillerDirector of Psychological Therapies

Michael WitneyDirector of Therapies

In attendance

Ann RozierTrust Secretary & Head of Governance

Action

The Chair welcomed Michael Witney, Lesley Strong, Estelle Frost and Steve James.
1. / Apologies for Absence
None. / Noted
2. / Minutes of the Board of Directors Meeting held on the 3rd March 2011
Item 10; last sentence. These are clients with Learning Disabilities.
The minutes were approved as an accurate record.
Minutes of the Board of Directors Away Day held on the 3rdFebruary 2011
The minutes were approved as an accurate record. / Agreed
3. / Matters arising
Under Matters Arising page 1 – No further communication from SLHT has been received since 4th February 2011.
Under Matters Arising page 1 The submission of compliance with mixed sex accommodation was submitted as agreed at the last meeting.
Page 2 Suicides. It was reported last time that there had been a number of suicides in January and February. There have been no suicides in borough mental health services in March. However, there was one death in custody at Swale. The Prison is leading on the investigation with our input.
Item 13 Page 7 under-spend in psychological therapies. This continues to increase. KM and HR are looking into this situation. Maternity leave is a major factor in this. The under-spend will be used to recruit to a small bank of temporary staff to fill the gaps. / Noted
4. / Chief Executive Update
Feedback from the National Quality Board (NQB) visit on Tuesday 5th April
The morning was spent discussing National Mental Health Strategy and our quality initiatives to take this forward. In the afternoon the NQB held their Board meeting. Sir Bruce Keogh chaired the meeting. A number of people gave presentations on our quality initiatives. Feedback about the organisation of the meeting and catering (provided by patients and staff at the Bracton and Memorial low secure unit) was very positive. In terms of learning and outcomes; they were frank about needing to learn more about mental health. They were very interested in being involved in spreading good practice. They also talked about the National Commissioning Board. They welcomed our views about representation on that Board. They also said that there is nothing in the Bill that states that GP Consortia cannot have other types of representation as members. We will be following these points up. SF and DM are writing to the CEO and Chairs to provide a ‘joined up’ response.
PW – Welcome the move to influence
DM – On behalf of the Board, thanks all those who took part in the presentations and put the day together.
Queen Marys Sidcup site update
A proposal was submitted for the, now named, Bexley Health and Well Being Campus by the 31st March deadline. Three main health and social care needs were highlighted: a full range of older people’s services; long term conditions; the Urgent Care Centre (and associated services) to reduce emergency admission. The physical plans are quite radical but there will be some empty space and an opportunity for Oxleas to utilise some of this space. Simon Robbins, the Sector Chief Executive, has fully endorsed the plansbut has said the issue to be resolved is the ownership. It is a widely held opinion that the only way the plans can become a reality is if Oxleas own the site. Simon Robbins expects a costed Outline Business Case by September.
The Board agreed that a business case is to be developed and that opportunities, benefits and risks are explored.
Sector Cluster Arrangements
PCTs have delegated most of their functions to the Sector Clusters (6 in each Cluster). The governance arrangements are not yet clear. There is some level of risk to Oxleas as some contract negotiations are not complete.
GP Consortia Bromley
Have been declared a Pathfinder from the 1st April. They have written to Oxleas saying that they look forward to working with us. / Noted
and agreed
SF/RP
5. / Organisation Development Strategy
The proposed Organisational Development strategy required to support the Community Services transformation strategy was presented at the last Board meeting. Amendments have been made to incorporate comments received from that meeting around: clinical quality; demonstrating cultural change; and the annual assessment of Board effectiveness.
SJ – This is a well written document. How will we monitor this?
SH – The themes are reflected in the annual plan for HR and OD and there are set measures that can be presented to the Board.
DM – The date in the last paragraph needs to be changed given that final approval is being given today. A key element of each Board away day is organisational development; therefore it would be useful to see progress at every other away day. A copy of the HR and OD annual plan and measures to be presented in May.
The Board approved the amendments.
Carers Strategy
DM – I have been prompted by the Council of Governors about the Carers Strategy. This strategy came to the Board some time ago. There has been much progress so it is timely that this should come back to the Board with an update.
WB – This is being updated at the Family and Carers group and will be ready soon.
The Board agreed to receive an update in June. / Approved
SH
WB
6. / Annual Plan Priorities
Following the publication of the NHS White Paper in June 2010, the Board amended our three-year SDS (2010/11 – 2012/13) to take into account the very significant changes that are now being implemented in health and social care services. This included reviewing the PEST and SWOT and amending priorities for the Trust’s SDS. The amended SDS priorities were summarised and targets to achieve these priorities for the coming year were presented. These targets will form the Trust’s 2011/12 Annual Plan. The Must Dos are not specifically noted as the Quality Board are now overseeing these. The targets are a mix of quantitative and qualitative measures.
DM – The annual plan priorities were approved by Council of Governors in March.
JK – Under 6.1 and 6.2; what are the differences in these two items?
HS – There is some unpacking to do. 6.2 is about ease of referring into our services and 6.1 is about GPs having access to information e.g. criteria.
AH – If there are changes to the Bill this strategy will need to be refreshed. / Approved
7. / Greenwich Community Health Services Integration
Greenwich Community Health Services Transfer Agreement, and other associated documents (Community Services Contract, Estates FM SLA, Leases, Dental Contract) were signed on 31st March 2011. All staff transferred on 1st April. GCHS management team are based at Highpoint House. Some corporate staff are now based at Pinewood House and others will move in by June. Welcome packs have been sent to all GCHS staff transferring. All GCHS will attend a half day induction programme which will start in April and run through to July. A programme of visits to all GCHS bases by Oxleas Senior Managers will take place April – May 2011. The day 1 and 100 day integration plans are now in progress. Some relatively minor issues have been raised e.g. IT, badges. The 100 day plan is being monitored through the workstream leads meeting and the Integration Project Board. The challenge has now shifted to achieving all the benefits of integration. LS will be chairing the Transformation Board.
DM thanked all those involved for their hard work and cooperation. / Noted
8. / Key Performance Indicators Exception Report February 2011
All Monitor targets are on track to be met.
Self certification against compliance with the requirement for improving access to healthcare for people with a learning disability. Making sure all our services are as accessible as they need to be. Previously we were required to score ourselves against a number of criteria. Last year we submitted a self rating of 18 out of 24 based on those criteria. Monitor has changed the requirements. What they now require is the Board to certify that we are compliant (no score). This requirement has been discussed consistently at the Core Group and is being led by the Head of Nursing. We are confident that we are meeting all criteria and have documentary evidence of compliance. The Board agreed to self certify compliance on the 29th April.
SJames – If Borough Partnership Boards, who include people with learning disability, were asked – would they agree?
HS – This would be the acid test
IO – We need to be clear that we have in place an audit programme that can assure us that people with learning disabilities have been identified and that their care plans reflect their needs.
HS – The criteria was more process/protocol based e.g. do we have accessible information/ regular audits.
The Board agreed to self certify compliance. This will be followed up by more work around asking service users about the effectiveness of what has been put into place over the course of the year.
Occupancy levels
WAA – slight increase in Bexley and Bromley. Greenwich has good occupancy levels. Older adults are only 55% - 56% in Bromley. Consistently low. New information on waiting for psychological therapies – only in Greenwich at the moment. Currently 84.7% waited less than 18 weeks. If all referrals are taken into account (including those who have been discharged or seen) this would stand at 92.7% seen, waiting or discharged within 18 weeks.
In Greenwich WAA, 1.7% of those seen or currently waiting (for Psychological Therapies) waited over 6 months. Almost exclusively for long term psychotherapy.
MW – These are draft figures, we are not entirely certain this is entirely accurate and they need to be confirmed.
SC – When will we receive Bexley and Bromley figures?
HS - We can do this but it will take a little while as it is a difficult manual task.
KM – Reconfiguration of the directorates will help with that.
PW – What waiting time should we be aspiring to? 18 weeks is still a long time.
DM – Let us achieve 100% below 18 weeks and then discuss. Also the Board will need exception reporting (on the front sheet) around bed blocking and length of stay in the KPI. / Noted and approved
HS
9. / Director of Service Delivery Report
Contracts – Some are still outstanding. Bromley PCT MH & LD, Kent and Lewisham around prison and forensic have been signed off. There are complex negotiations taking place with Bexley and Greenwich PCTs (Bexley – all services, Greenwich – mental health and learning disabilities services). There are significant risks of having additional CREs above the 4% levied.
We have put in the bid for Bexley and Greenwich dental services. We are anticipating we will hear quickly. The GP Master Class was held last night. This went well and attendance was good. (25-26 GPs).
There was an article in the News Shopper on the suicides in Green Parks House and Ivy Willis. We were contacted by the News Shopper and gave our response. The reporting was inaccurate and very distressing for the families. We have been told that this was an individual’s viewpoint and not that of Bromley Mental Health Forum as a group. The individual does not know any of the circumstances around these cases.
SJ – In the Board brief paper - Diversion from Custody project with Greenwich Police Station;50 people arrested each week that are known to us.
DM – There will be a local conference with the Borough Commanders to seek support for commissioning the service in the future, as there appears to be clinical benefits / Noted
10. / Finance Report
Summary. The surplus is now £3,327k which is £870k above the plan; EBITDA is £763k above plan,and interest receivable £107k above plan. The favourable variance on income continues to increase, and the adverse variance onexpenditure is reducing.The Monitor Risk Rating has increased to 4.1 (January 3.9) due to an increase in theReturn on Assets.
Cash increased to £65m due mainly to payments in advance.
Income. Greenwich, Bracton, Bexley Community and miscellaneous income all increased in themonth.
Expenditure. The favourable variance on pay increased to £656k (January £577k). Medical andnursing costs continue to have a high overspend, but these are more than offset by PAM,
Therapies, Admin and management underspends.There was a large increase in social workers costs. This was due to very late invoicing bylocal authorities and under accrual by ourselves.
Non pay expenditure increased overspend to £448k (January £240k). Secondarycommissioning and clinical supplies contributed to most of this increase. Much of thiswas due to the GP costs at Bexley UCC (mainly doctors) and overspends on oxygen. UEA/CPC underspend increased to £593k (January £472k).
Balance Sheet - Debtors reduced in the month, and there was a significant increase in the advancepayments by GPCT (to £10.6m) which resulted in the increase in cash balances to
£65.1m (£54.7 in January).Capital expenditure rose to £330k, but is still below planned levels.
PW – In the current financial climate we need to be clear, and have a strong narrative, about our cash position.
SF – We need to be explicit in reports about essential future purchases/projects (e.g. Queen Marys, patient information systems etc.).
DM – Mention Greenwich before. Remarkable turnaround in Greenwich. Bromley – now a strong favourable position. / Noted
11. / Workforce Report
Sickness Absence - Sickness absence in February is recorded as 4.57%. There is a reduction from the January absence level of 4.98% and considerably lower than December. Bromley directorate has returned to its normal low levels and Greenwich and Bexley have also maintained low levels of absence. Forensics and Bexley Community services have also reduced although Bexley Community remains higher than normal. ALD continues to be the area of highest absence.
Vacancy and turnover Rates - Vacancy rates have dropped to 11.22% and remain at a low level when compared with the rest of the year. Turnover is slightly increased at 9.95% but remains at an overall low level
PDR/appraisal uptake - The overall uptake of PDRs across the trust in March was 73%, an increase of 0.5% on the previous month. The trust target of 80% completion by year end has not been met. Oxleas House are currently trialling a new system of reporting for PDR and supervision that is aimed to support managers in terms of planning and recording supervision and PDR for their staff. This will be rolled out across the Trust from April.
Bank and Agency Usage - A total of 5291 bank and agency shifts were booked in February, a decrease of 331 bookings from the previous month. The decrease included a reduction of 65 qualified agency shifts. Significant reductions were achieved in Bexley, Bexley community services, Bromley and forensics. ALD had a slight increase in usage as a result of its vacancies and sickness absence. The overall reductions in usage are principally related to the reductions in sickness absence in the majority of directorates.
UK Border Agency review - The Trust was visited by the UKBA at the end of March to review recruitment practices and controls around staff that require work permits. The UKBA met with a number of HR staff as well as the Trust Counter Fraud officer and reviewed policies and specific personnel files. They will inform us if there are any specific concerns in 2-3 months time. On the basis of initial limited feedback no particular areas of concern were identified and some minor improvements were suggested.
AH – Oxleas House is achieving 87% for PDR recording with the trial system.
SH – Oxleas House pilot system is easy to use.
AH - Can we increase the target of 80%?
SH – Happy for the rest of the Trust to reach 80% first. 100% will never be reached because the figures are for headcounts (people in post) and do not take account of leave, new starters.
SF – Perhaps we need to subtract these from the calculations. / Noted
12. / Staff Survey 2010
The Board received the published CQC NHS Staff survey 2010 as discussed at the last meeting. 800 Oxleas staff were surveyed of which 61% responded. The results demonstrate a further improvement on previous surveys and show Oxleas to have obtained some of the best results of any London Mental Health & Learning Disability trust. The results also include Bexley Community Health Services staff. On page 2, are the areas where we are significantly improved. The areas where we didn’t perform well are; working extra hours mitigated by job satisfaction and commitment to work life balance. The other area was staff experiencing discrimination (staff and public, service users and carers). A more detailed assessment was done. Greenwich older age and forensic services experience the largest amount of discrimination but very small numbers.