70thMeeting of the Board of Directors
Thursday 6thSeptember2012
3.00pm 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
Steve JamesBoard Advisor
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
Ann RozierTrust Secretary & Head of Governance
Keith SoperHead of Compliance
Action
1. / Apologies for AbsenceNone. / Noted
2. / Minutes of the Board of Directors Meeting held on the 5th July2012
The Minutes were agreed as an accurate record.
Matters Arising
Item 6 NE Action Plan. WB confirmed the disciplinary process was concluded and the dismissals had been upheld at a recent employment tribunal.
Item 7Olympics. DM wished to place on record the Board of Directors’ gratitude for the planning arrangements put in place by services and recognised the flexible options offered to staff and patients over the period. Because of sound planning disruption was minimal.
Item 8Audit Committee update. SH confirmed the internal disciplinary process in respect of the member of staff will commence in October. The delay was due to annual leave and late receipt of documentation from NHS Protect.
Item 11Compliance Report. WB stated the inquiry regarding the incident on Step Up Step Down was progressing and the outcome will be reported to the next meeting of the Board of Directors.
Item 19Chief Executive Strategic update. SF advised members that the full results from the national patient survey had now been published. Overall scores obtained were the same across all nine main category areas as in the previous survey. On two questions the trust performance had worsened, these related to goals being reflected in care plans and information provided regarding medication. Particularly good scores were received in respect of out of hours services and the crisis line.
Item 20Queen Mary’s Sidcup update. SF confirmed the memorandum of understanding with South London Healthcare NHS Trust had been signed.
Item 23 Any other business. SF reported the joint meeting with colleagues from Sussex Partnership NHS Foundation Trustwas positive. It is intended that the collaboration will offer opportunities to share best practice, along with some potential areas for joint working. / Approved
3. / Key Performance Indicator Report
Performance against referral to treatment targets improved in July 2012, with all three targets met with rates of 93.9% (admitted), 98.9% (non-admitted) and 97.3% (incomplete pathway). All other Monitor targets remain on track. Strong performance was seen in respect of median arrival to treatment time (30 minutes) at the UCC. Activity remains high in Acute Adult Mental Health Services, although occupancy at the Tarn reduced to 82%. A particular focus is being put on a number of specific indicators within Greenwich Community Health Services, although these are not Monitor targets. / Noted
4. / Director of Service Delivery Report
In response to recent complaints, allegations and incidents occurring on Acute Adult Mental Health inpatient wards at Green Parks House a working group has been established, chaired by the Deputy Chief Executive, to ensure the following:
- High standards of clinical practice
- Leadership across the unit
- Effective management and investigation of recent incidents
- Enhancement of the skills of nursing staff, particularly in relation to communication
HS - Immediate action has been taken with the model of the triage ward (Betts Ward) disestablished because of concerns regarding pressure on staff and the complex clinical composition of patients.
JK - What was the nature of the complaints?
HS - The most serious related to a patient who had video footage of a member of staff not responding in an appropriate manner.
SF - In addition allegations had been made of staff goading patients and there was an inadequate management response to the complaint. As a wider issue, consideration is being given as to how to strengthen reporting of patient experience indicators, such as complaints, to the Board of Directors.
SJac - Who is leading the investigation?
HS - It is being led by a senior manager from outside of the directorate. Six members of nursing staff are under investigation. Three have been suspended from duty, one has been moved to another ward and the remainder are under close supervision.
AH - Are staff routinely moved to work on other units / wards to prevent them from becoming stale and developing poor habits?
SH - This does happen at Oxleas House and in the Bracton Centre.
DM - Is there a leadership role in respect of supervision?
IO - The clinical director has increased consultant time to ensure effective role-modelling.
WB - Working with service directors to discuss the lead nurse role in inpatient areas.
HS - The Director of Finance is exploring options regarding the application of CRE targets for the Acute Adult Mental Health Directorate.
PW - Assured by prompt response to concerns.
The Board of Directors was advised of an inpatient suicide that occurred on Norman Ward. A Board Level Inquiry has been established.
The CQC and Ofsted safeguarding children inspection in Bexley has been completed. Health services were judged ‘good’ and in the verbal feedback CAMHS was described as ‘excellent’, although this has not featured in the draft report. The trust has made attempts to get the language of the report changed. / Noted
5. / Directorate Reconfiguration
The new directorate structure is on plan to go live from 1st October 2012. Positive feedback has been received from commissioners regarding the changes, in particular the focus on children’s services. / Noted
6. / Unsustainable Provider Regime - South London Healthcare NHS Trust (SLHT)
The trust continues to be an active participant on workstreams supporting the work of the Trust Special Administrator (TSA). The TSA will publish his draft report with recommendations on 29th October 2012. This will be informed by responses to the TSA following his invitation to NHS and independent sector providers requesting expressions of interest in providing any or all of SLHT services. The deadline for submissions of expressions of interests is14th September 2012. The trust will be making a submission.
Members discussed the financial implications of the administration process and the likely impact on the local health economy over the next five years. The expectation is that significant recurrent resources will need to be saved. Whilst the greatest impact will be on acute hospital services, commissioners will be required to reduce spending on other areas, including mental and community health services.
SJam - Need to demonstrate track record in providing community health services since these are likely to be at risk when retendered.
PW - Should take the opportunity to shape what sustainable mental health services could look like against a backdrop of reduced funding.
DM - This will continue to be the main item at future informal meetings of the Board of Directors. / Noted
7. / Memorial Strategic Outline Case
A summary of the outline strategic case (OSC) for the relocation of services from Oxleas House and Green Parks House to a new build facility at the MemorialHospital was provided. The enhanced environment will improve patient care and the number of beds in the OSC will enable the trust to continue to provide a safe service for current and predicted future demand. There will also be a reduction in revenue costs of circa £2m per year. The Board of Directors was requested to approve:
- Further development of the OSC
- An application for planning permission for a range of beds (between 90 – 150)on the Memorial site
- That the Inpatient Services Reconfiguration Committee continues to work on the most appropriate configuration of services, in light of the emergent changes in the local health economy
HS - The future of Queen Mary’s Sidcup will be critical to the reconfiguration options, however the case is predicated on the movement from three to two inpatient mental health units.
SF - The trust would be looking for long term contracts with this level of investment.
PW - Support recommendations and would suggest seeking to get commercial return on any investment.
The Board of Directors approved the recommendations. / Noted and Approved
8. / Proposal to Improve Informatics Capacity and Expertise
A review of skills and capacity undertaken by the executive board members identified as a key risk the ability to manage the IT and Informatics workstreams at a level and pace required to support delivery of the service development strategy and QIPP plans. It is proposed to increase capacity and expertise to lead the informatics agenda and also integrate the informatics function. Lead responsibility for all aspects of the informatics function, from the procurement of new systems to the quality and timeliness of information, will rest with the new Director of Informatics post. The new Director post will, in the first instance, be on a 3 year fixed term contract and the cost of this new post, and any associated posts, will be met within existing 2012/13 financial plans.
The Board of Directors approved the additional executive position and the formation of a dedicated informatics directorate. / Approved
9. / Quality Report
An update was provided detailing key exceptions (red and amber areas):
QSIP
There were no areas of red performance.
Amber
- Carer details recorded on RiO (mental health)
- Carers offered an assessment (mental health)
- Section 132 compliance (mental health)
- CPA review within last 6 months (mental health)
- Care plans recorded on RiO (community health)
The trust is on target for delivery of all CQUINS. Whilst the smoking cessation CQUIN trajectory was not met in quarter 1 the expectation is that the overall target will be met at year end with no financial penalty.
Details of the process for reporting and investigating pressure ulcers in community health services were shared. This has been an area of particular focus from commissioners since the integration of community health services. The review demonstrated there is good multidisciplinary working and evidence of robust care plans. Further work is required with nursing homes to ensure a timely referral to enable the best outcome. It is planned to share the learning with colleagues in mental health services.
Trust participation in the national audit of schizophrenia was shared. Performance was in the top 10% of participating organisations in respect of:
- Service users experience of care
- Monitoring of weight
- Advice about diet and exercise
- Service user involvement in the decision about antipsychotic drugs
- Offering psychological therapies to treatment resistant patients
10. / Monitor Annual Plan Review 2012/13 Executive Summary
Monitor has completed its review of Oxleas 2012/13 Annual Plan. The trust will remain on quarterly monitoring. Annual risk ratings for 2012/13 are:
- Financial Risk Rating - 3
- Governance Rating - Amber/Red (relating to missed referral to treatment targets)
SH - Professional leads will support services in the development of profession specific workforce plans. / Noted
11. / Serious Incident Inquiry (MO) Report
MO was a 22 year old man with a history of admissions to acute mental health services between November 2010 and his death on 16th January 2012, when he was found unresponsive in his bedroom on Millbrook Ward, Woodlands Unit. Despite the best efforts of staff and the attending ambulance crew, MO was pronounced dead at QueenElizabethHospital. The Coroner recorded a verdict of death by non-dependent abuse of drugs at the Inquest on 5th July 2012. The specialist toxicology report concluded that MO’s ingestion of Buprenorphine was the most likely cause of death. MO had not been prescribed Buprenorphine. The investigation could not confirm how MO acquired this drug.
The Panel made the following recommendations:
- The facility for scanning paper correspondence into RiO records to be available in all inpatient units
- All inpatient ward templates to include a section on physical health
- Consultant supervisors to be reminded of the importance of taking complete past medical history and how to obtain such details from RiO
- A review of security options to be undertaken to prevent the importation of contraband items
- Patients prescribed controlled drugs to have supervised administration
- Following a positive urine drug screen and/or after disclosure of drug use appropriate therapeutic interventions to be agreed with the patient, discussed with the multi-disciplinary team and described in the care plan
- Stronger monitoring of compliance with required essential skills training
SC - Was the panel able to discount the fact that the drug was passed to MO from another patient?
WB - No.
SJac - Was there not a previous similar recommendation relating to scanning to RiO?
WB - This recommendation relates specifically to third party correspondence, which was previously filed in the secondary (paper) record.
The Panel recommendations were approved by the Board of Directors. It was agreed that the action plan be presented to the next meeting of the Board of Directors. / Noted and Approved
WB
12. / Audit Committee update
The Audit Committee discussed the possibility of exploring insurance cover arrangements outside of the NHS Litigation Authority scheme. On balance the committee agreed that the existing cover was extensive and offered good levels of protection, which would be unlikely to be met by other insurers. Five internal audit reports were received covering clinical information systems in dental and sexual health services, recruitment, incident reporting, procurement and medical devices. It was noted that two of the three recent audit reports receiving ratings of ‘Limited Assurance’ related largely to systems and controls in place within community health services. This was despite thorough due diligence taking place prior to acquisition.
BT - Suggest a separate post acquisition review take place on day one of providing any new service. / Noted
13. / Governance Board update
Three changes to the risk register were proposed by the Governance Board, namely:
- Risk that the 18-week target for consultant led non-admitted services will not be met for successive quarters - proposed reduction from Significant (20) to Low (4)
- Accurate data is not always captured on all clinical systems impacting on ability to monitor progress against targets and priorities - proposed reduction from High (12) to Moderate (8)
- Trust is at risk of prosecution under the Bribery Act 2010 if it does not have adequate controls in place – proposed reduction from Low (4) to Low (2)
AH - Suggest risk be reviewed at Governance Board.
A new risk was proposed by the Governance Board:
- There is a risk that, should the Monitor target be disaggregated, Community Paediatrics would not meet the 18-week target for consultant led non-admitted services - proposed risk rating of Moderate (8)
SF
14. / Compliance Report
An update was provided in respect of referral to treatment performance in August. The Board of Directors was advised that all three targets were met in August, with performance broadly comparable to that reported for July. Some risk remains in the attainment of the admitted target due to the low number of overall treatments in any given month, meaning a small number of breaches can result in failure of the target. If all targets are met in September then the trust’s Monitor governance risk rating will revert to green from the current position of amber/red.
The Quality & Risk Profile shows an improving position with a large number of indicators moving into ‘better than expected’ performance. The overall position is one of low risk.
Reports following recent inspections at HMP Canterbury (CQC) and the Short Breaks Service (Ofsted) were received. The in-reach mental health service was found to be compliant with all essential standards reviewed at HMP Canterbury. The Short Breaks Service received an overall rating of ‘adequate’. This was largely due to there being no registered manager in the service at the time of the inspection. Action has been taken to address this.
The response to the Coroner’s Rule 43 Report was noted, confirming that the transfer was not financially motivated and was supported by a robust exchange of clinical information.
The Board of Directors was advised of the Care Quality Commission’s intention to inspect all registered trust locations before the end of the financial year. Plans have been put in place to prepare services, and these plans are being monitored by the Compliance Board.
DM - Request a further breakdown of complaints by area and type for next meeting. / Noted
WB
15. / Director of Infection, Prevention and Control Report 2011/12
The annual report of the Director of infection Prevention and Control was presented, demonstrating compliance with the Health and Social Care Act 2008. Specific highlights included:
- Successful integration of infection prevention and control policies into Greenwich Community Health Services
- Maintained low levels of infection in respect of alert organisms with no cases of MRSA, MSSA or E. Coli
- Consistently high training rates, above the trust standard of 80%
- Internal audit rating of substantial assurance
- Completion of unannounced audit programme
- Improvements in completion of and compliance with monthly hand hygiene and mattress audits across services