58thMeeting of the Board of Directors
Thursday 5th May 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
Michael WitneyDirector of Therapies
In attendance
Ann RozierTrust Secretary & Head of Governance
Action
1. / Apologies for Absence - None. / Noted2. / Minutes of the Board of Directors Meeting held on the 7th April 2011
The Board’s thanks were given to Keith Miller, Director of Psychological Therapies,at the last meeting for his contribution to the Board. Although this was Keith’s last Board meeting, he will continue to lead the Patient Experience work.
Remove final line on page 6 item 13 - DM comment. Not for noting. Replace with ‘to be followed up in 6 months’.
Subject to this additional note, the minutes were approved as an accurate record. / Agreed
3. / Matters arising
Page 2, National Quality Board. Nothing further has been heard at this time about the possibility of Oxleas working with the National Quality Board on a paper around mental health and the reform agenda. This has probably been superseded by events e.g. the Listening Exercise.
Queen Mary’s Sidcup. There have been no updates since the last meeting about the Bexley Health and Wellbeing Campus. Although it does seem likely that an outline business case will be funded.
Frognall Centre. The Bexley Business Support Unit is interested in purchasing the Frognall Centre from SLHT. / Noted
4. / Chief Executive Update
Invitation to Senior Staff Event – SF invited NEDS to the Senior Staff Away Day on the 19th May at the Marriot Hotel Bexleyheath. As part of the Senior Staff Development Programme Bill Moyes will be speaking in the afternoon session. Bill Moyes is now part of the Prime Minister’s new advisory group.
South London Healthcare Trust –Previous communications received by Oxleas have been reported to the Board; a letter has now been received from SLHT Board (tabled). The demand for £2m has not been withdrawn. Other issues around signed leases and service level agreements have been raised.
DM – The collective view of the Board is that it is difficult to negotiate given the threat of legal action. However it would be unreasonable not to enter into discussion with SLHT.
PW – The District Valuer could be a reference point for this dispute.
RE – Montague Evans has valued Oxleas House;we are paying above market rate.
DM – Negotiations should continue on all issues other than the £2m. Progress to be reported at the next Board meeting.
Listening Exercise
SF tabled slides about the Government Listening Exercise. The Bill was paused for the listening exercise and is due back in the Commons in June. A new NHS Future Forum has been established with 42 members to look at the details and listen to what stakeholders have to say. NHS Future Forum Member Dr Paul Lelliot (Consultant Psychiatrist) have asked for the Board’s comments/ general points of view. The Board fully discussed what points they would like to be fed back. SF to pass these comments on to Dr Paul Lelliot. / Noted
SF
SF
5. / Key Performance Indicators Exception Report March 2011
This is our year end position. All Monitor targets have been achieved this year. Item 8 - Self certification against compliance with the requirement for improving access to healthcare for people with a learning disability has been submitted as achieved. Monitor has gone out to consultation on community health service targets for next year. Most are focussed on data quality.
Annual Plan and QSIP targets
The staff list has been updated within the caseload review reporting for psychological therapies and this now demonstrates an increase in the PT caseload figures. These are now close to the position at start of 2010/11 again.
Allocation of service users to clusters - New referral clustering has risen slightly to 30.6%. Clustering of clients on CPA has increased from 79.2% at the end of February to 90.5% in March, which meets the 80% end of year CQUIN requirement.
CPA Caseload data. Not normally included in the Board papers. Bexley WAA with no CPA level has risen back to 568. This is being addressed by the Quality Manager. Bromley CAMHS has decreased again in February (previously being one of the highest) from 394 to 365. There are 204 clients in the Forensic community team showing with no CPA level. This is being addressed by their new Quality Manager.
Acute Bed Usage / Crisis Activity. All three Borough’s occupancy has dropped. Greenwich bed occupancy has dropped to 102.5%. Other than December 2010, where occupancy was 102.0%, this is the lowest in the last 12 months.
Psychological Therapies. The data has not changed since the last report. For Greenwich WAA, 84.7% of current waiters have waited less than 18 weeks. For Greenwich WAA – if all referrals are taken into account this would stand at 92.7% seen, waiting or discharged within 18 weeks. For Greenwich WAA, only 1.7% of those seen or currently waiting (for Psychological Therapies) waited over 6 months.
Community Health Services. The Board requested a change of indicators. This work is in development. There may be issues with data quality. We will be able to report bed occupancy for Step Up Step Down next month. / Noted
6. / Director of Service Delivery Report
There has been no change on the position with contracts since the last meeting. The Greenwichmental health and learning disability contract is the most worrying (over 13% savings taken over a two year period) and there is still work to do on the Bexley community health contract. There are risks around the contract for Urgent Care Centre and Oxygen.
Transfer of Greenwich Community Health Services. Visits for Corporate Directors to visit teams were set up and the feedback so far has been positive. The programme of induction days has been well attended.
A serious allegation at GCHS at Wensley Close respite service for children with complex needs came to light last week. Twenty-three families use the service. A small number of incidents of potential neglect have been made. Given the extreme vulnerability of these children we acted quickly to ensure the children’s safety. Parents have been written to and offered a meeting. Oxleas Head of Nursing and an external reviewer are now reviewing standards of care at Wensley Close. Thelocal authority has been informed and do not feel they need to instigate separate safeguarding procedures at this time. / Noted
7. / Inpatient Services Reconfiguration Board
The options for reconfiguring the Trust’s inpatient mental health services were discussed at the February 2011 Board Away Day. The Board asked for further work to be undertaken on the options and at the same time, approved the continuation of the work already underway to realign bed capacity, in line with changing demand. In addition to this work, the Executive has initiated: a review of the Trust’s inpatient mental health rehabilitation services; a review of the future demand for the inpatient treatment of people with a learning disability and mental illness/challenging behaviour and the consequences for the use of Atlas House; the estate for the provision of inpatient intermediate care through our community health services. To ensure that these plans are complimentary, to avoid unnecessary delays and to ensure capital expenditure is appropriately focussed, it was proposed that an Inpatient Services Reconfiguration Project Board be established.
AH – One of the members is a project manager – is this within the Trust or external?
HS – Internal.
AT – This is necessary but is it time to look at all the various boards and committees to rationalise.
DM – There is an issue about the number of committees. Clarity around the names of these groups is needed (use of the word ‘Board’). Should Forensic services be included in this work?
HS – Hazelwood and Greenwood are included.
PW – How does this link with other work related to the care pathway?
HS - One of the drivers of having this committee is to pull together service functions to make sure that it is complimentary to other objectives and does not negatively affect those. We can explicitly state this in the terms of reference.
DM – Is this committee time limited?
HS – Yes it is.
DM – Update to the Board in three months.
The Board approved the terms of reference for the Project Board. / Noted and approved
HS
8. / Transformation Strategy Implementation
Part of GCHS transfer is the Transformation work. There is an agreed transformation strategy. It is proposed that a two tier meeting structure is developed, one with accountability for delivery of the Transformation Strategy and one with responsibility for delivery of its component parts, making appropriate linkages across the organisation. One is the Transformation Executive Board to provide high level accountability to the Board and the other is the Transformation Strategy Working Group to progress and implement the GCHS Transformation Strategy bringing together, where useful to do so, synergies between Directorate programmes and projects and to develop the pathways of care across Directorates.
SC – Is it necessary to have two levels of meetings for this project? And the membership could be streamlined.
LS – It is important to have this level of membership given that NHS Greenwich and the Local Authority will hold the Trust to account. It is possible the working group will evolve into something different over time but in the early days we need to ensure that all the strands of work come together organisation wide.
DM – The model, including this wider membership, is timely. JK will chair and SMJ will be the advisor.
The Board approved the terms of reference. / Noted and approved
9. / Year End Accounts
We have prepared the first draft of the un-audited accounts. We made our return to Monitor at the end of April.
RP reported that the surplus for the year was £4.004m and the balance sheet had been strengthened by the increase in the I&E reserve and also the liquidity. The latter was shown by the increase in cash balances to £56.8m (2009/10 was £47.2m).
The I&E reserves were now £10.2m (2009/10 was £5.6m). In relation to the Board’s policy to achieve a sound financial position, the I&E reserves were still below the target figure as the turnover was increasing. The cash position was higher than the target but this would enable us to make a significant contribution to the changes needed in the local health economy by being available for capital developments.
RP noted that the figures are subject to change as the effects of merger accounting are reflected in the accounts. The merger accounting was required by the NHS following the integration of the Bexley CHS. The effect would be that the revenue accounts of April to June 2010 would be added to the Statement of Comprehensive Income. This would probably add about £5m to the turnover and the surplus would reduce by about £150k. The prior year accounts would have a full year effect of the Bexley Community Health Service income and expenditure incorporated. It is expected that this would add about £20m to the turnover but the surplus would not change.
The Statement of Financial Position (Balance Sheet) is expected to remain the same under merger accounting depending on the outcome of the audit.
PW – Surplus in public services is rare and will seem like quite a lot of money to most people. How do we explain this?
RP – This is less than last year and there are no great changes in other trusts.
JK – If we were asked what we are spending surplus on, how would we respond?
SF – We have an opportunity fund that allows us to invest in projects that is included in this surplus figure.
PW – We need to demonstrate more clearly to stakeholders how we are using this money to benefit patients and carers.
SC – Can we explain to the auditors what we intend to do with the surplus.
RP – Yes.
SMJ – There is a difference between how accounting practice deals with this and how it is perceived by the public and staff, say if it were to appear in the media. This is our opportunity to explain how we can/ intend to develop services more specifically.
AH – A lot of this money is made up of creditors. It is really £32m not £57m.
SF – In our annual plan next year we need to say what we are doing to develop services and improve local health economy more generally e.g. the Bexley Health and Wellbeing Campus. / Noted
10. / Workforce Report March 2011
Sickness Absence - Sickness absence in March is recorded as 4.44%. This is a reduction from the February absence level of 4.57%. Significant reductions in absence have been made by Bexley Community Services and Forensics and Prison services. Absence in ALD remains high but is reducing.
Vacancy and turnover Rates - Vacancy rates have dropped to 11.03% and remain at a low level when compared with the rest of the year. Turnover is again slightly increased at 10.09% but remains at an overall low level.
PDR/appraisal uptake - The report shows small increases (0.6%) in PDR uptake on the end of year data. 73.6% of PDRs have been completed. Slow progress towards the Trust target reflects the fact that directorates are now repeating PDRs completed this time last year when directorates were initially focusing on improving rates of PDRs. There are a small number of teams across the directorates where there is poor completion. These have been identified with HR managers and service directors.
Bank and Agency Usage - A total of 6320 bank and agency shifts were booked in March, an increase of 881 bookings from the previous month. Greenwich, Bromley, Forensics and Bexley Community Services all recorded large increases in bookings. Whilst there were a number of patients on the wards who required extra observations the reason given for the majority of extra bookings was ‘vacancy’. Service Directorates have reviewed their internal controls processes and are reviewing the data to fully analyse the reasons for the increases in bookings.
Employment Related Legal Costs - In 2010/11 the Trust spent a total of £35,300 on legal expenses and a further £32,500 on settling three cases. This compares with £23,500 on legal costs and £3,500 on settlements in 2009/10. The increase in costs relates to an increase in the number of tribunal applications in 2010/11 as well as costs incurred as a result of the Bexley and Greenwich Community Services transfers and the TUPE of Belmarsh services.
DM – Given the size of the organisation the legal costs are low.
SC – Three cases - are these Greenwich cases?
SH – Not Greenwich Community Health.
ST – Pleased with turnover improvements in Bexley. It shows that staff are developing their skills. / Noted
11. / HR and OD Annual Plan with performance measures
In response to the Board’s request to have assurance that the HR and OD Annual Plan was aligned with the HR and OD Strategy and that it will be a ‘live’ document, the paper set out the areas that will be addressed for 2011/12 and how these aligned with key themes.
DM asked that the Plan’s progress is reported to the Board every 6 months. / Noted
SH
14. / Compliance Report
A new Compliance Report is in development and will be presented to the Governance Board in May.
Serious incidents: Four serious incidents occurred in March 2011, all of which are being investigated at directorate level.
Incident trends level 1 to 3: A total of 332 incidents were reported in March 2011. In 2010/11, a total of 4245 incidents were reported, a 38% increase on last year (n=3075).
Infection control: There were no reportable outbreaks in March 2011.
Training: Trustwide, completion of infection control training as at 29 March 2011 is 84.46%
Safeguarding children: Nineteen referrals were made in March 2011 and of these, 11 were from Greenwich Mental Health. In 2010/11, there have been 113 referrals, compared to 162 for 2009/10
Training: As at 29 March 2011, trustwide completion of training is reported at: Level 1 = 85.79%: Level 2 = 84.94%: Level 3 = 74.60%:
Mental Health Act:
Consent to Treatment: Authorisation was available for 13 out of 14 patients who were detained beyond three months. The patient for whom appropriate authorisation was not available was on Shepherdleas Ward. Her Consent to Treatment was due on 8 March but although her progress notes record a capacity and consent discussion with the Responsible Clinician, the form has not been located. The patient was discharged from section on 22 March.