68thMeeting of the Board of Directors
Thursday 3rd May2012
2.30pm Boardroom, Pinewood House
Board of Directors
Dave MellishChair
Archie HerronVice Chair & Non-Executive Director
Anne TaylorNon-Executive Director
Sally JacobsonNon Executive Director
Paul Ward Non Executive Director
James KellockNon Executive Director
Seyi ClementNon-Executive Director
Stephen FirnChief Executive
Helen SmithDeputy Chief Executive & Director of Service Delivery
Ify OkochaMedical Director
Wilf BardsleyDirector of Nursing & Governance
Ben TravisDirector of Finance
Simon HartDirector of HR & Organisational Development
In attendance
Rachel Evans (For Items 8 & 9)Director of Estates and Facilities
Ann RozierTrust Secretary & Head of Governance
Keith SoperHead of Compliance
Action
1. / Apologies for AbsenceSteve James. / Noted
2. / Minutes of the Board of Directors Meeting held on the 1st March 2012
The Minutes were agreed as an accurate record.
Matters Arising
Item 6Transfer of Community Properties. SF advised that guidance has been issued confirming that transfer to the new provider will occur where occupancy exceeds 50%. Transfers must be completed before the end of March 2013. Any Primary Care Trust buildings that have not transferred will be retained and managed by a Department of Health company (PropCo).
Item 9NE Action Plan. WB stated that the action plan would be brought to the July meeting of the Board of Directors
Item 12 Compliance Report. SF updated colleagues on the serious incident discussed at the previous meeting. The main cause of death was recorded as a congenital heart condition, however the toxicology results indicated drug use, although not to a fatal level. In addition, investigations by the police found some evidence of drug activity at the inpatient unit. As a result, the investigation has been escalated to a Level 5 (Board Level) inquiry. WB added that immediate action has been taken in respect of additional room searches, including the use of police dogs. / Agreed
WB/AR
3. / Minutes of the Board of Directors Meeting held on the 5th April 2012
The Minutes were agreed as an accurate record.
Matters Arising
None. / Agreed
4. / Key Performance Indicator Report - March 2012
Monitor targets remain on track. There was a slight deterioration in waiting time at the Urgent Care Centre to 191 minutes, but this remained within the threshold of 240 minutes. This reflected the increased activity at local Accident and Emergency departments, which impacts on the number of patients and presenting conditions seen at the UCC. The service is aligning workforce to periods of anticipated high demand. Whilst not a specific target reported to Monitor, related to the increased demand performance against the median waiting time at the UCC has decreased to 59 minutes, 1 minute inside the 60 minute target.
IO - Patient Group Directions have been introduced following approval at the Medicines Management Board to enable nursing staff to prescribe and administer certain drugs, rather than relying on a doctor to prescribe, thereby causing delays.
AH - Can nurses not write prescriptions?
WB - Not routinely.
The trust has seen a deterioration in performance against the 18 week referral to treatment target for admitted consultant led services, as detailed in the compliance item. Occupancy in acute adult services rose substantially without a single identifiable reason. Colleagues in South London and the Maudsley NHS Foundation Trust reported similar peaks. Occupancy at the Bevan Unit reduced as a result of the additional work put in place following receipt of the winter pressures monies.
DM - Is it correct that many were first time attendees to acute adult mental health services?
HS - More detailed analysis is being undertaken. / Noted
5. / Director of Service Delivery Report
Training provided to the director of finance, director of service delivery, service and clinical directors on pitching for new business was warmly received and provided a number of tools to support future bids. This was considered important, particularly with competition from private providers. Commissioners have requested the trust work with South London Healthcare NHS Trust to develop pathways of care for frail elderly and cardiology services.
AT - Will the pathway development also include working with Bromley Healthcare?
HS - In future, yes.
DM - The paper suggests a significant increase in district nursing demand. Is this accurate?
HS - There have been a large number of tests, e.g. hearing tests, performed by district nursing staff.
IO - This added workload impacts on their ability to add and update care plans to RiO, as evidenced in QSIP and CQUIN attainment.
DM - The positive impact of and potential financial savings from the voluntary car service should be formally recognised from the Board.
SF - A recognition award was given to the lead member of staff some time ago but further thanks would be gratefully received.
SC - Has any feedback been received following the unsuccessful bid for Eastern and Coastal Kent prisons?
SF - Not formally, although I met with the successful bidder and it was clear they had a very good understanding of what commissioners were looking for, which is a strategy the trust will be utilising in future bids.
JK - Do we know how much is being saved through the use of video conferencing?
HS - It is already well used across the trust and is being piloted on Shrewsbury Ward.
WB - One example of a recent meeting held via teleconferencing saved at least £1k. / Noted
SF/DM
6. / Reconfiguration of Community Services
The consultation closed at the end of April. 65 responses were received, including from local authorities, which were supportive of the proposed structural changes. Some concerns have been raised and these will be considered as part of the outcomes paper to be produced. In addition, a formal six monthly review will take place, which will consider management capacity. Interviews for service director posts are scheduled for 17th May 2012.
HS - No changes to service delivery are proposed and therefore no public consultation was required. A further update paper will be presented to the next meeting of the Board of Directors.
The Board of Directors noted the progress and supported proceeding with the service director appointments. / Noted
7. / Olympic Planning Assurance
The trust has submitted a statement of Games readiness to NHS London, based on the results of completed local impact assessments and review of plans for services, particularly in areas where logistical difficulties are predicted. The main impact is anticipated in Greenwich, where travel and parking are expected to be problematic.
SF - GCHS undertakes around 500 home visits a day. Services have plans to ensure those patients requiring visits and support will receive it.
DM - The police has confirmed that all leave is cancelled over the Olympic period therefore the knock on affect is likely to result in leave being taken in September and October, resulting in reduced resources to deal with section 135/136. Assurance has been given that the significant number of officers on reserve during Games’ time will be allocated to section 135/136 if necessary.
JK - Will trust leave follow a similar pattern?
SH - No, services were required to complete rotas some weeks ago and minimum staffing levels will be maintained at all times on a service by service basis.
The Board of Directors noted the progress made. / Noted
8. / Annual Report on Sustainability
In 2010 the Board of Directors approved a sustainability development plan with targets set for carbon reduction from a baseline year of 2007. The plan was to achieve a 10% reduction in carbon emissions by 2012. Good progress has been made against reducing carbon usage in buildings as a result of a number of schemes, although further investment might be required. Reductions are more difficult to calculate for travel and procurement but there are plans in place to reduce travel emissions through the cycle to work and lease car schemes, which will also deliver financial savings. Of the required overall reduction 40% has already been achieved. Firm plans are in place to achieve a further 40%.
JK - Welcome report. LED lighting project appears critical. It would be useful to get further updates and to consider the overall benefits of all new projects, such as videoconferencing.
BT - What are the consequences of not achieving the target?
RE - Unknown at individual organisation level as NHS wide target.
The Board of Directors welcomed the progress and approved the report. / Approved
9. / Estates Capital Programme
The capital programme includes significant work in older people’s services and a focus on addressing ligature risks. The programme also details the potential purchase of the Market Street building, which would then require further investment prior to use as a multi-functional clinical space.
DM - If other opportunities arise is there room to flex the programme?
RE - Yes, the programme only includes committed to expenditure.
AH - Will the transfer of community properties impact on the programme?
RE - No.
The Board of Directors approved the programme. / Approved
10. / Quality Report - March 2012
An update was provided detailing key exceptions at the 2011/12 year end position (red and amber areas):
QSIP
Amber
- Carer details recorded on RiO (mental health)
- Section 132 compliance (mental health)
- CPA review within last 6 months (mental health)
- Follow up within 7 days of discharge (mental health)
- Care plans on RiO (community)
- Chlamydia screening (community)
- Pressure Ulcers (community)
Red
- Care plans on RiO (community)
- Pressure ulcers (community)
- Receipt of referral within four hours (community)
- Discharge summaries to GPs within two working days (community)
- Smoking cessation (community)
DM - How does performance compare to other NHS trusts?
IO - The information is not easily available.
AH - Good progress has been made by GCHS in respect of discharge summaries, however CQUINs in community health services have generally been difficult to achieve. Are the CQUINs for 2012/13 as challenging?
BT - Discussions with commissioners regarding targets for 2012/13 are on the basis that the CQUINs must be achievable.
SC - How is the gap between reported levels of Chlamydia screening and the audit results explained?
IO - A recent audit looked for specific written evidence of an offer of a test. Suspect in reality the offer was being made but not always recorded. Post audit performance has improved significantly.
SC - Is there further support that could be provided to district nurses?
WB - The new version of RiO is released in June. In addition, a trial of the use of digi-pens is underway. It is recognised there is a cultural shift required in some community services in respect of record keeping.
SF - Recent complaints investigations in community services have identified some gaps in record keeping standards. The trust has also had to declare a breach of a Monitor target for the first time, again relating to community health services. Appointments to service and clinical director roles in the new structure are important to ensure appropriate oversight and scrutiny.
SJ - It is important the organisation knows where problems are and that these are being addressed. / Noted
11. / Compliance Report - March 2012
The latest Care Quality Commission Quality and Risk Profile shows reduced risk ratings for Outcomes 11 (Safety, availability and suitability of equipment) and 16 (Assessing and monitoring the quality of service provision). Good progress has been made in respect of health and safety assessments, compliance with mandatory training requirements and PDRs. There has also been an improvement in the trust’s response to issued safety alerts. The overall increase in complaints was noted. It was agreed that fuller analysis be presented to the next meeting of the Board of Directors.
SC - Are complaints still concerning communications and attitude?
SF - Yes. Numbers are highest in the acute adult directorate and a number relate to Betts Ward. There is an initiative to promote care and compassion in the directorate, including the recording of patient experiences to share with staff and patients. The Executive Team has also agreed that every upheld complaint about staff attitude should result in a formal meeting with the member of staff.
A Coroner’s Rule 43 report was issued to the trust in respect of the death of TE. The issue raised was the safety and suitability of the transfer of TE and the trust, along with another NHS provider and private provider, were cited in the report. An open verdict was reached at the Inquest. The Rule 43 report did not concern the care and treatment provided to TE. The Director of Nursing and Governance and Director of Adult Acute Mental Health Services are conducting a supplementary investigation to review the circumstances surrounding the transfer of care to inform the trust’s response to the report. Initial findings suggest there was good dialogue and an appropriate exchange of clinical information prior to transfer. The Secretary of State for Health, to whom the report was submitted, is required to respond within 56 days. The trust will respond to HM Coroner within 28 days following liaison with the NHS and private provider.
JK - The letter from HM Coroner could be read as implying that there was a financial motivation to the transfer.
WB - This was not the case.
AH - The report suggests the level of observations reduced following TE’s transfer.
WB - The observation level was previously higher but at the time of transfer observations had already been reduced and this level was maintained after transfer.
The outcomes of two Independent Homicide Investigations (LJ and AA) have been received. Two recommendations for the trust were contained in the reports, namely i) the introduction of sub MAPPA or risk panel meetings and ii) auditing of the use of clinical assessments as part of monthly supervision sessions benchmarkedagainst practices in other trusts. Publication of the report into AA has been delayed because the other NHS Trust involved in the care of AA disputed the findings.
The report following the interim review of the Short Breaks Service in Wensley Close from Ofsted has been received and ‘good progress’ was deemed to be being made. This is the best possible rating for an interim inspection.
A briefing paper was circulated to members describing the impact of the inability of specialist foot surgery to meet the Monitor target of referral to treatment time within 23 weeks in Quarter 4. 16 patients waited longer than 23 weeks for podiatric surgery in February and March 2012 due to a lack of available theatre time. As a result, the trust’s governance rating has moved to Amber/Green. For 2012/13 the target has reduced to 18 weeks. The service has not met this target in April 2012 and therefore this will result in a further breach for Quarter 1. A robust plan is in place to bring the service in line with the new 18 week target by the beginning of Quarter 2.
Monitor has introduced an additional new referral to treatment target covering all consultant led services, requiring 92% of all patients on an 18 week pathway to have completed the pathway within 18 weeks. The services covered by this target include community paediatrics, specialist foot surgery, dental and contraception and sexual health. A review of data from community paediatrics indicates that, whilst the backlog is not as significant as first suspected, the target will not be met in Quarter 1. Additional management resources have been allocated to the service to review the data and ensure additional capacity is available for those children who need to be seen. The impact of non-compliance with two targets will result in the trust’s governance rating moving to Amber/Red.
SJ - Has private theatre provision been considered?
HS - Yes, although private theatre capacity is difficult to acquire. A locum community paediatrician has been recruited, although these are rare.
AH - Do the problems in community paediatrics suggest disciplinary procedures are required?
HS - Investigations are already underway to understand the reasons for the apparent lack of oversight of the waiting list data. / Noted
WB
12. / Governance Board update
Updated terms of reference for the Governance Board were presented. The Same Sex Declaration was approved at the Governance Board and has been published on the trust’s website. In addition, amendments to the Mental Health Act Scheme of Delegation were agreed. One new risk in respect of the possible misappropriation of patient monies has been added to the corporate risk register. This is rated as moderate.
JK - The corporate risk register only contains one high risk. Does this feel valid?
SF - That is a healthy challenge. Up until the recent Monitor declaration the trust had been rated as green for governance. In addition, the trust’s financial risk rating of 5, a low-risk Quality and Risk Profile and no major transactions on the horizon all provide further assurance, however further review of new and existing risks will take place at the next Governance Board.
The Board of Directors approved the changes to the terms of reference. / Approved