Central and North WestLondon

NHS Foundation Trust

Board of Directors Meeting- 7 December 2011

BOD1/2012

Minutes of a meeting of the Board of Directors held on 7 December 2011at 9.00am at Stephenson House, London, NW1 2PL.

Present:

Dame Ruth Runciman(Chairman)Chairman

Ms. Claire Murdoch(CM)Chief Executive

Prof Dot Griffiths(DG)Non-Executive Director

Ms Helen Edwards(HE)Non-Executive Director

Ian Holder (IH)Non-Executive Director

Ms Bhavana Desai(BD)Non-Executive Director

Mr Laks Khangura(LK)Non-Executive Director

Mr David Walker(DW)Non-Executive Director

Ms Mandie Campbell(MC)Non-Executive Director

Mr. Trevor Shipman(TS)Director of Finance

Dr. Alex Lewis(AL)Medical Director

Mr. John Vaughan(JV)Director of Strategic Development and Community Services

Mr Andy Mattin (AM)Director of Operations and Nursing

Mr. David Brettle(DB)Director of Human Resources

Mr Ian McIntyre (IM)Director of Commercial Development

In Attendance:

Ms Christine Baldwinson(CB)Trust Secretary

Ms. Robyn Doran(RD)Director Operations and Partnerships

Mr Richard Vergez (RV)Associate Director Corporate Governance

  1. Apologies for Absence

aThere were no absences.

  1. Financial environment

aTS updated the Board on the financial pressures within the health economy. He highlighted a number of forthcoming difficulties including a £20bn cost and pressure gap in the NHS, a proposed change in the funding formula which will adversely effect most London boroughs and continuing difficulties in PCTs balancing their accounts..

bThe Board also noted that, whilst the Trust operates at 4% below the national average cost, private sector providers operate with much greater EBITDA margins. This is largely due to their adoption of non-medical models of treatment but has the effect of making them more commercially attractive in a highly competitive market. The Board will review EBITDA in more detail at its workshop in February.

cIt was noted that the Annual Plan would document the Trust’s detailed plans for securing its financial and business position over the next three year period. The Board stressed the need for the Trust to be sufficiently resourced to pursue a proactive business development strategy.

  1. Minutes of Meetings- 9 November 2011

aThe Board noted the minutes of the meeting held on9 November2011which were confirmed asa true and accurate record.

  1. Matters Arising

aThe Board received and noted the Matters Arising Report and the Chairman invited comments on the report or any matters arising from the minutes.

bRR advised that the Mental Capacity Act training would take place in January.

cThe Board noted the IAPT data and asked that the service should be asked to also report by ethnicity as this information will be required by the Operating Framework. It was noted that psychological services will be integrated into care pathways and packages of care and therefore line managed though the service lines. It will be possible to look separately at the IAPT service as this is separately commissioned. A marketing plan is being developed for IAPT and further consideration will be given to how best to report to the Board on the service.

dIH advised that Internal Audit had now confirmed that there were no outstanding issues arising from work carried out by the previous Internal Audit supplier. It was noted that the delay in receiving this assurance had concerned the Audit Committee.

  1. Chief Executive’s Report

aCM advised that the reports of the CQC inspections at our learning disability services are expected by the end of next week.

bCM advised that the draft report of the CQC headquarters inspection undertaken as a result of an anonymous letter had reported no concerns. The Trust has in this instance decided to undertake an internal investigation looking at the issues raised in the letter. The Trust is working, through the Foundation Trust Network, to assist the CQC to develop a consistent approach to dealing with such anonymous complaints. It was agreed that the Trust should also review its own procedures for dealing with such letters.

cDB advised that only 120 staff went on strike and that all services had run normally. The Board recorded its thanks to staff who had worked normally to ensure continuity of patient care.

  1. Business and Finance Committee

aBD introduced the report of the Business and Finance Committee. In answer to questions it was confirmed that there are no pensions implications in the section 75 agreement with K&C as existing staff are not being transferred. Should the contract be lost any staff that CNWL have subsequently employed will be TUPEd to the new supplier. The Board gave formal approval to the section 75 agreement.

bBD drew attention to the importance of CQUINs going forward.

cIt was agreed that future reports would include a simple indicator of CIP performance showing % achieved to date and % achieved through non recurrent savings.

dTS advised that the Trust was on plan as at 31st November. It was noted that the issue of outstanding debt with the North Central Sector has now been escalated.

eThe Board recorded its thanks to all staff who contributed to the month on month successful delivery of financial performance.

fThe Board approved the Finance Report.

  1. Tender Activity in Addictions Service line

aThe Board noted the current tender activity and were advised that the service was receiving corporate support to pursue them. It was however noted that there is a sector-wide move towards non-NHS provision of addictions services with commissioners favouring cheaper non-medical models. The Board will give further consideration to potential service models in the new year.

  1. Quality Committee

aHE introduced the report and advised that the Committee was pleased that there was strong overall performance against the Trust quality objectives. The Committee had noted ongoing work to improve performance in some key areas notably care plans, crisis cards and AWOLs. With respect to crisis cards, the Committee had noted that, although this is a metric the Trust needs to perform against, they are not the only route by which service users access the crisis numbers and those using the service report that they receive a good response.

bIt was noted that work has started to merge the Quality and Performance Committees and this will include looking at the governance structures below the Committee including the role of the Care Quality Management Group.

cIn response the questions, HE advised that, whilst the Committee considered a specific issue relating to Jade, the wider issue of clinical systems including RIO is very much on the Committee’s radar. The failure of the JADE system will inform our business continuity planning.

dIt was noted that, while the Trust is focusing on attaining level 1 of the NHSLATrust- wide, we are still mindful of the aim of achieving level 2.

  1. Independent evaluation of the Accelerated Service Improvement Programme

aRD and LA introduced the report and advised that the Accelerated Service Improvement Programme is seen as helpful recognition that there are service delivery problems and provides a structured approach whereby they can be worked out.

bIt was noted that Verita had been asked to undertake the independent review as they had previously reviewed the Trust’s special measures programme. The Board welcomed their positive report and noted that the Quality Committee would review the recommendations in detail. The Board asked that consideration be given to whether the Trust could supply the programme on a consultancy basis to other healthcare providers.

  1. Service User Feedback in Camden Provider Services

aJV introduced the report which showed that clients were broadly positive about the services they received. It was noted that there is no national survey of community provider services and therefore no national benchmarks. Consideration is being given to adopting a consistent approach across Hillingdon and Camden provider services so that the Trust will generate internal benchmarking. The FTN Commissioning Group may also be able to provide some benchmarks. The Trust is also looking at the provision of patient experience trackers, trialling different models and identifying which settings generate a better response rate.

  1. Medicines Management Annual Report

aAnne Tyrell (AT),Chief Pharmacist, introduced the report. She outlined her statutory duties and confirmed that, whilst overallpatient satisfaction is good, more work is being done in informing patients about the side effects of medication. The medicines helpline has received very positive feedback from carer groups. Further work is also being undertaken on medicine storage.

bAT confirmed that there were very tight controls on prescription stationary and also on the list of medicines that may be prescribed to prevent fraud.

cThe Pharmacy team is providing support to clinicians, particularly in looking at the most appropriate medication for care pathways including discussing side effects and potential new medications

dIt was noted that there is a continuing underspend trend which is not associated with the move to generics. The service is also developing a business plan for acentralised pharmacy.

eStaff have been encouraged to report all medicines incidents and this is reflected in the high number of low or no harm incidents. This enables issues to be picked up and remedied at an early stage. RR noted that the number of incidents relating to patient safety are falling.

fAT advised that the acquisition of community services has required a different way of working with responsibility and accountability delegated to other senior staff.

gThe Board noted that there was limited benchmarking data available but the Trust performed well in terms of patient experience and in terms of the number of audits undertaken. It was also noted that no concerns relating to medicines management had been identified in any CQC visit to date. AT also advised that the Trust had been approached by other trusts to develop their pharmacy services.

hThe report assured the Board that there was good medicines management in the Trust and commended the pharmacy team for their work.

  1. Tanzanian Health Link Project

aJV introduced the report and advised that an ad hoc opportunity had arisen for the project to bid for funds to support volunteering for the project. The Board noted that it will continue to receive its regular 6 monthly updates on the project. It was noted that the trust already has a career break policy and that the same principles would be applied to anyone wanting to take up a volunteering opportunity. The Board welcomed this development opportunity for staff and noted that a selection process might be required. The Board formally supported the project’s bid to the Tropical Health Education Trust.

  1. SUI report

aThe Board noted theSUI’sreport.

  1. Performance Management Committee

aMC introduced the report and advised that the Committee had considered the requirement for creating an integrated performance management framework for service line reporting. The Executive Board is currently considering the resource requirements.

bThe Board noted that there had been some performance issues which on examination were as a result of late data entry in Westminster where major service reconfigurations were taking place. Steps have been taken to address the issues and the target will be hit.

  1. Performance Report

aRD introduced the report which was noted. It was agreed that in future reports the Trust’s quality priorities would be more clearly identified.

  1. Mandatory and Statutory Training

aDB introduced the report and advised that, whilst current compliance with statutory and mandatory training is high, it requires constant vigilance. Service Directors receive regular reports on attendance and training levels are considered as part of the services’ quarterly reviews. For individuals failure to attend training can lead to a refusal of incremental progression and other management action.

bIt was noted that the Trust is increasing its range of e-learning and provides half-day top-up sessions which allow for easier staff rostering.

cIn response to questions, DB confirmed that managers will ensure that essential specialist training is not delayed by the mandatory training requirements.

  1. Assurance framework

aRV introduced the report and advised that the Audit Committee considered the report at each of its meetings. Internal Audit would also review specific areas on a rolling programme and present their findings to the Audit Committee. They had undertaken one such review to date and had given substantial assurance. In the forthcoming year the Assurance Framework will be developed alongside the Annual Plan and will provide an update on progress against that plan.

bThe report was received.

  1. Investment Committee

aIH introduced the report and advised that the Committee had received substantial assurance on the acquisition process. Recommendations arising from the Internal Audit report and the internal review would be implemented.

bHe advised that the Committee was likely to consider the proposed asset transfer in April, a timetable dictated externally.

cBD noted that the Board had asked the Committee to take on a role in reviewing the progress of the Trust’s overall investment strategy.

  1. Change programme report

aCM introduced the report. She advised that theProgramme Board had met the previous day and that the programme was broadly on track. The Programme Board will receive a report back in January on the detail on the phased rollout including key ICT and other challenges relating to tracking patients, maintaining data collection and financial controls.

bThe Programme Board is reviewing the governance arrangements to ensure that they are fit for this next stage of the programme. In particular, it will define the scope of the project and reflect responsibilities and accountabilities going forward particularly in respect of interdependencies. The governance arrangements will be appended to the next report to the Board.

cIt was agreed to share the full risk register with the Board and it was noted there was a more detailed analysis of the control framework in the Assurance Framework.

  1. Top Risk Register

aThe Board noted the top risks and noted that the risk associated with the medium-term financial forecast has increased.

  1. Trust-wide Risk Register

aThe Board noted the Trust-wide risk register and were advised that services were being asked to give further consideration to their main clinical risks. The Board asked for consideration to be given to risks which had been present for a long period of time to identify whether further mitigating action was required or if they represented ever-present risks.

bIt was suggested that the mitigating action in place in respect of the move from block contract (HQ/FD8) should reduce the residual risk rating.

cTS advised that ICT risks would be included in the next iteration of the Trust–wide risk register.

  1. Any Other Business

aThere was no further business.

The meeting ended at 1.10pm