76thMeeting of the Board of Directors
Thursday 2 May 2013
2.30pmHoliday Inn, Bexley
Board of Directors
Dave MellishChair
Archie HerronVice Chair andNon-Executive Director
Anne TaylorNon-Executive Director
Paul Ward Non-Executive Director
James KellockNon-Executive Director
Seyi ClementNon-Executive Director
Steve JamesNon-Executive Director
Stephen FirnChief Executive
Helen SmithDeputy Chief Executive and Director of Service Delivery
Ify OkochaMedical Director
Wilf BardsleyDirector of Nursing and Governance
Ben TravisDirector of Finance
Simon HartDirector of HR and Organisational Development
In attendance
Iain DimondDirector Adult Mental Health and ALD Services
Anthony AkenzuaClinical Director, Adult Mental Health Services
Ann RozierTrust Secretary and Head of Governance
Susan OwenRisk Manager (Minutes)
Member of the Council of Governors in attendance
Chris PurnellService user/Carer Governor
Action
1 / Apologies for Absence – None / Noted2 / Minutes of the Board of Directors Meeting held on 7 March 2013
Item 18 – To be amended to read that the Trust will invest £30M in quality improvements and £10M in new technology.
Item 18 – To be amended to read that the Board will consider an option paper at the April Informal Meeting with theService Directors and Clinical Directors.
3 / Matters arising
Item 3 – Information relating to the Equality Delivery System (EDS) is being collected. The Trust is working towards an early re-validation.
Item 10 – The alleged perpetrator of the Memorial fraud has been charged and the matter has been referred to the Crown Court.
Item 14 – The Trust’s bid for the Bexley IAPT service was £1.7M more than the successful bid. There are no concerns about the quality of our bid, so the reasons for losing the bid appear to be financial.
Item 20 – Declaring private practice work will be added to contracts as an agreed variation.
Item 23 – SF and IO have met with Julian Hendy, the Chair of the “100 Families” charity to discuss how the learning from the NE incident was embedded. Mr Hendy has been invited to speak at one of the Trust Embedding Learning events. The Independent Inquiry into the NE homicide has commenced. The Coroner has asked for more information before deciding if there will be an inquest.
4 / KPI report
Monitor Targets
All Monitor targets are met. In March 2013, over 3500 people attended the Urgent Care Centre. This is a huge volume and the UCC performs strongly.
Monitor Shadow Targets
The Trust is currently achieving 94.4% for the shadow Allied Health Professional (AHP) 18 week referral to treatment indicator and 80.2% for AHP patients on an incomplete pathway. For the shadow 6 week referral to diagnostics indicator (Audiology), the Trust achieved 100% and for recovery following completion of psychological therapy the Trust achieved 41.7% against a target of 50%. Targets for waiting times for psychological therapies have yet to be set. Data cleansing and some further training is taking place.
Specific Indicators
There are some data quality concerns with the Adult Community Health Service Indicators. The implementation of remote access will help to address this. In quarter 4, the Bevan Unit performed poorly for clients with an estimated discharge date. It is important that improvements are made in this area.
JK – Can the UCC cope with the increased demand?
HS – Additional staff can be sourced if necessary.
PW – Is there a short term solution for improving waiting times for psychological therapies?
HS – We are looking at how these processes are managed.
AT – Have we been able to contain in-patient activity?
HS – There have been some private sector placements.
JK – Why is there such wide variation in the number of out-patient appointments cancelled by Oxleas?
HS – If a clinic is cancelled due to a clinician’s holiday, the policy is that the patient must be seen before the holiday.
It was agreed that ID would prepare a paper for a future Board of Directors relating to cancelled out-patient appointments and how this data is captured. / Noted
ID
5 / Director of Service Delivery Report
Step-up, Step-down
The Task Force has been disbanded as all actions have been implemented and are being monitored by the Clinical Director and the Quality Board.
Greenwich CCG
Greenwich CAMHS will be market tested over the next few months and a full tender process may follow. Greenwich Community Health Services will be re-tendered in March 2014. A working group will be established to prepare for this.
Adult Mental Health and ALD Directorate
The new directorate came into effect from 1 May 2013. Iain Dimond is the Service Director. The two new Assistant Directors will be in post by July or soon after.
Neuro-rehabilitation
This contract will generate income of £4.7M over three years, with the option to extend for a further two years.
Bexley Integrated Care System
A joint staff consultation is concluding.
SJ – Will the Greenwich Community Health Services tender be awarded in a single block?
BT – The CCG are looking to place with one provider. Some new services may also be included.
SC – Why is there a high number of staff in Older Persons services on paid overtime?
SF – There has been a rise in demand for memory services. We are investing in a new treatment model and increasing night staffing levels.
AT – How are we managing the different levels of funding across the boroughs?
HS – Expertise is being used across a wider area.
6 / Draft Annual Report
An extraordinary meeting of the Governance Board has been arranged for 20 May 2013 to sign off the Annual Report text and Quality Accounts. The financial elements and any final amendments to the Annual Report and Quality Accounts will be signed off by the Audit Committee on 28 May 2013. As the Chair will be away, the vice-chair will sign in his absence.
JK – The Report should include more patient stories.
AT – Mention how we encourage managers to comment.
PW – More emphasis on the public health aspect.
SF – A short summary of the report will also be produced.
The content of the report to date and the sign off process was approved. / Approved
7 / Board meetings in public
The Board of Directors approved the recommendation to the Council of Governors for changes to the Constitution and approved the arrangements for Board meetings held in public. / Approved
8 / Serious Incident Inquiry Action Plan
The Inquiry examined the care and treatment given to a patient who died at Green Parks House in August 2012. The Panelidentified three key issues relating to care and service delivery, plus some additional findings relating to the management of the incident and ward communication issues.
- Implement robust protocols for the management of unescorted leave.
- Ensure that there is early involvement with specialist services.
- Ensuring that referrals to safeguarding services are followed up.
- Every ward to be equipped with wireless handsets for the ward phone.
- All wards to have a prompt sheet of information to relay to the ambulance service. Staff to be reminded that LAS send two crews to an incident when cardiac arrest is suspected, so that staff must be ready to allow a second crew into the unit.
- Shift coordinators must be informed when any significant event occurs in the care of a nurse’s allocated patient.
- The MDT must ensure that a nursing report outlining the significant events or changes in presentation since the last review is made available at each ward round.
WB – We will have drills.
AH – How will these actions be audited?
ID – The Patient Safety Group will review all incidents on an on-going basis. Safeguarding practice is already the subject of an audit and there will be a focus on this in in-patient services.
WB – We will develop a scorecard to monitor the number of safeguarding referrals against those that meet the threshold for a multi-agency review. Ward managers must check that actions have been completed.
AA – We must embed a culture of seeking specialist help and we will audit how many professionals are involved.
The Board of Directors approved the action plan. The investigation report and the action plan will be presented to the next Council of Governors. / Noted
9 / Francis Report Action Plan
The report has been discussed extensively. To ensure patients are put first and that values of openness, transparency and candour are embedded, a Trust action plan has been developed with the following themes:
- Embedding values and behaviour.
- Using feedback from service users and carers.
- Strengthening performance management.
- Facilitating and ensuring increased patient focus and contact by managers.
- Implement nurse appraisal (and revalidation) that embeds the 6 C’s.
- Continue focus on Care and Compassion.
DM – At the next Informal Meeting with the Service Directors and Clinical Directors, there will be a focus on how these actions are taken forward.
It was agreed that Executive Directors and NEDS should visit sites on a monthly basis to observe how teams are responding to the Action Plan. A rota and a pro forma will be developed to support this. / Noted
AR
10 / Update on the Medical Profession (Responsible Officer) Regulations 2010 and Revalidation of Doctors
From 1 April 2013, re-validation will be open to the whole medical profession. All Oxleas doctors will be re-validated in the first year. The database we have developed (SARD) is being used by 95% of our doctors and is being marketed to other trusts. / Noted
11 / Governance Board update
The April meeting of the Governance Board reviewed the Corporate Risk Register. The following changes were made.
IG4: There are insufficient assurances that records in community services are being managed in line with trust policy. This means that clinicians may not be able to readily access clinical information from any one source, impacting on the delivery of care and treatment or the investigation of incidents, complaints and claims. Controls are in place and information can be accessed, so this is not a critical issue. Consequence remained at 3, likelihood reduced from 5 to 4, risk rating reduced from SIGNIFICANT (15) to HIGH (12). The Governance Board asked that the Patient Safety Group also reviews this risk.
PS4: The trust cannot provide assurance that medical devices are maintained, calibrated and that appropriate training is delivered in all directorates. If equipment is used incorrectly, this may impact on patient and staff safety. Following a re-audit by Deloitte in March 2013, an opinion of substantial assurance was given. Consequence to remain at 4 and likelihood reduced from 3 to 2, risk rating reduced from HIGH (12) to MODERATE (8). / Approved
12 / Quality Report
Mental Health QSIP update
70% of our goals were achieved in March 2013. There were no red indicators. The two amber indicators were registering carer details on RiO and Working Age and Older Adult patients on CPA allocated to a care cluster. Work continues to make improvements in these areas.
Community Health QSIP
The number of new cases of community acquired grade 2 pressure ulcers reported remains a red indicator. There has been an increased drive to report these as part of the Safety Thermometer. The prevention and management of foot problems in people with type 2 diabetes is also red; a recent audit identified that the risk of developing neurological and vascular problems was not always assessed. The third red indicator relates to whether a Doppler assessment was carried out to assess patients with a lower limb wound for blood flow problems. Amber indicators are care plans recorded on RiO for long term condition teams, care plans recorded on RiO for District Nursing and consenting girls immunised for HPV.
CQUINs
We are confident that we have met all CQUINs for 2012/13.
It was agreed that at future formal Boards, the chairs of the Quality Board sub-groups will attend on a rotational basis to report on progress against work-plans. / Noted
IO
13 / Compliance Report
There have been no breaches of regulatory standards. No significant concerns have been raised from MHA Commissioner visits, CQC compliance visits or Ofsted inspections. As at the end of March 2013, all Monitor targets, including Referral to Treatment Times were met.
Quality and Risk Profile
The overall position is one of low risk. The rating for Outcome 7 has reduced from High Yellow to Low Yellow. There is one additional “much worse than expected” item listed under Outcomes 4 and 6. This relates to the proportion of adults on Care Programme Approach confirmed to be in employment. The accuracy of this data is being validated.
Outcome 10 – Suitability and safety and availability of premises
Adult Learning Disability Services are showing a higher number of red indicators for completion of Health and Safety Risk Assessments compared to other directorates. As this analysis is based on five sites, expressing this as a percentage reduces the flexibility in achieving the target of 80%. The Health and Safety Team are working to ensure that outstanding risks assessments are completed.
Serious incidents
Two serious incidents were reported in March 2013. One relates to an attempted suicide and one relates to a fall resulting in a fractured pelvis.
Level 1 to 3 incidents
There has been a 40% increase in reporting Level 1 to 3 incidents compared to last year. The Trust is now in the middle 50% of reporters to the NPSA.
Complaints
18 complaints were received in March 2013, raising 52 issues. Of these, 14 were from acute adult mental health services and of those, nine related to SIT teams and five to in-patient teams. An early comparison of complaints received compared to contact with services has been made. This is the first attempt to describe the incidence of complaints by service. Further work will be taken to define a suitable comparable numerator.
JK – Will this comparison report include all directorates?
WB – This is in development.
IO – Michael Witney will include more detail in his report to the Board.
It was agreed that WB and IO will bring a more detailed report of MHA indicators to the next Board. / Noted
WB/ IO
14 / Council of Governors update
The Health and Social Care Act sub-committee has met. A form of words relating to significant transactions is being developed for approval at the June Council of Governors meeting.
QMH
All governors are to be invited to a visit to the Queen Mary’s site on 20 June 2013.
Re-appointment of NEDs
AT’s contract has been extended for a final term of three years.
External Auditors
Deloitte have been appointed as the Trust External Auditors from April 2013.
JK – What are we doing to encourage staff to nominate themselves for Staff Governor vacancies?
AR – This remains a challenge as staff often change their roles during their term of office and find they no longer have the time to commit to the governor role. / Noted
15 / Sealing of documents
The following documents require the affixing of the Trust Seal:
- Contracts relating to alterations to form open plan office at former Matron’s Flat, Memorial Hospital – DCB (Kent) Ltd. (£51,372.00)
- Contracts relating to mechanical services and combined heat and power installation at Goldie Leigh Children’s Therapy Unit – Enevis (£93,061.66).
16 / Finance report
The Trust has delivered a surplus of £8.1M, which is £4.9m higher than plan (£3.2m). The rent dispute with SLHT has been resolved and the provision of £5.3M has been released back into Income and Expenditure. At 31 March the Trust had £82.8M of cash, which is £16.4M higher than plan (£66.4M). The Monitor Financial Risk Rating is 5. All CREs have been delivered.
CREs for 2013/14 are being finalised. The Trust is looking to deliver a surplus of £2.8M. The CRE target is £6.8M. The CRE targets for Adult Mental Health and Older Persons Mental Health have been reduced on a non-recurrent basis to allow directorates time to implement changes. Non-recurrent expenditure included £400K on the Older Persons Day Treatment Team and £400K on Adult Home Treatment Team in order to reduce UEAs. The contract with the Specialist Commissioning Group has been agreed. There are no issues and the contract is deliverable. Five freehold and eight leasehold community health properties with an asset value of £10M transferred to the Trust on 1 April 2013.
DM – Are there any concerns about the Specialist Commissioning Group?
BT – We are not aware of any amalgamation plans. The Bracton business model is successful. Referrals will be priced by the Specialist Commissioning Group so we will lose the flexibility to set prices.
PW – What is the impact of Greenwich Community Health Service in light of the re-tender?
BT – We have the resources to target investment at this through the discretionary fund.
SJ – Can we extend the fund to our partners so that we can provide a better service and defend existing contracts?
HS – We are doing this in small ways, for example funding a member of staff to work on a specific project.
17 / Workforce report
Sickness absence has improved, particularly in the Adult Community and Older Persons directorates. We perform better than other trusts but we have not achieved our own targets. Vacancy rates have not changed. There are 177 recruitment campaigns in progress. Many of these relate to new services. Some vacancies are being held for re-organisation, but directorates are being encouraged to fill vacancies so as to reduce bank and agency usage. Turnover remains low. As at 30 April, PDR completion was 78%. Much effort is being made by directorates to improve compliance rates. The new performance management system will provide a more robust reminder system and link PDRs to quality.
Mandatory and Essential Skills training continues to be compliant, with food safety being the main outstanding area. Patient handling will be added to the dataset from next month.
Grievance, disciplinary and bullying and harassment cases have reduced by 16 compared to last year. A full equality impact and thematic analysis will be undertaken on these.
There are currently 12 live disciplinary cases, two staff on suspension and three employment tribunals.
SC – Is there a relationship between sickness absence and overtime in the older persons directorate?
SH – No, most of the absences are long term.
SC – Why is food safety training compliance lower?
SH – This is a taught course and is not currently available via e-learning.
WB – The frequency requirement of the training will also be reviewed.
JK – Care and Compassion has been linked to nurse recruitment. Will the same standard be applied to other groups?
SH – This is in development.
AH – Why is temporary staff use increasing?
SH – There have been some winter pressures and the need to source specialist staff. This is not a long term issue.
18 / Employee Assistance Programme
With effect from 1 April 2013 the Trust has put in place a new Employee Assistance Programme. The service, provided by Care First, replaces the previous provision. Care First will provide a 24 hour, 365 days a year, free telephone service. More complex cases can be referred to specialist services. The new service should remove the waiting list issues experienced with the Salomons provision whilst still providing access to high level psychological support for those staff who need it. Early feedback from staff has been positive. A full communications programme will be rolled out over the next couple of months. The contract for the service is for three years initially. Monitoring the performance of Care First will be take place through Workforce and Learning Development on a bi-monthly basis. / Noted
19 / Unsustainable Provider Regime
A new programme director has been appointed. The Secretary of State has been asked to approve a new target date of 1 October 2013for the dissolution of SLHT. The project plan and critical path have been adjusted accordingly. This is subject to the outcome of the judicial review. A site visit for the Council of Governors has been planned for 20 June 2013. The Business Case and Due Diligence will be submitted to the Board of Directors for approval on 4 July 2013. The Business Case will be submitted to Monitor in August. Papers must be laid before Parliament by 20 September 2013 to allow for dissolution on 1 October 2013.
JK – Will the Business Case look beyond the financial issues?
SH – It will also cover the strategic benefits. The Business Case will examine the risks of going ahead and not going ahead.
20 / Any other business
JK – Is there any update on ICT?
SF – These can be brought to a future Board meeting.
21 / Questions from the public
Question from Chris Purnell(Oxleas Governor) - What progress is being made in relation to Oxleas commissioning welfare rights provision in light of advocacy services cutting back on advice?
SF – This has been discussed at the Informal Executive and can also be brought to a future Council of Governors.
HS – Some training has been provided for staff. It would be unusual to use direct commissioning.
AT – Oxleas is investing in SEEC. This could be a vehicle for providing benefits advice.
Question from Chris Purnell(Oxleas Governor) – What do the three employment tribunals relate to?
SH – All relate to unfair dismissal.
Next meeting of the Board of Directors
4July 2013, Holiday Inn, Bexley
I confirm that the minutes of Board of Directors meeting of 2 May 2013are a true record