Minutes of the Barnet, Enfield and Haringey Mental Health NHS Trust

Annual General Meeting (AGM) held in public on Monday, 19 September 2016at

The Bernie Grant Arts Centre, Town Hall Approach Road, Tottenham Green, N15 4RX

The meeting commenced at 2.00 p.m. and closed at 4.30 pm

Present:
Board Members:
Michael Fox / Trust Chairman
Jonathan Bindman / Medical Director
Simon Goodwin / Chief Finance and Investment Officer
Andy Graham / Executive Director of Patient Services
Cathy Hamlyn / Non-Executive Director
Rebecca Harrington / Non-Executive Director
Christine Harvey / Non-Executive Director
Catherine Jervis / Non-Executive Director
Maria Kane / Chief Executive
Mary Sexton / Executive Director of Nursing, Quality and Governance
Mark Vaughan / Executive Director of Workforce
Charles Waddicor / Non-Executive Director
Staff:
Christine Bascoe / Communications Manager
Suchi Bhandari / Trust Lead of Psychology and Psychological Therapies
Rachel Clancy / Operational Manager, Eating Disorders Service
Phil Evans / Turnaround Director
Pardeep Grewal / Consultant Psychiatrist, Haringey Substance Misuse Service
Simon Harwin / Trustwide Enablement Lead
Karl Heidel / Associate Director of Communications
Amina Lahrichi / Team Leader, Haringey Substance Misuse Service
Marc Lester / Deputy Medical Director
John Mills / Director of Estates and Facilities
Jane Moiba / Medicines Optimisation Pharmacist
Barry Ray / Trust Board Secretary
Lorna Richards / Consultant Psychiatrist, Eating Disorders Service
Mandy Stevens / Improvement Director
Andrew Wright / Director of Strategic Development

Other members of staff and members of the public, including service users and carers, commissioners, regulators, local authority members and members of other partner organisations.

Item No. / Minute Item
1. / Chairman’s Welcome
Michael Fox welcomed Board Members, staff, members of the public and partner organisations to the Annual General Meeting of the Barnet, Enfield and Haringey Mental Health NHS Trust.
2. / Apologies for Absence
Apologies for absence were received from the following Board Members:
  • Paul Farrimond, Non-Executive Director

3. / Minutes of the Annual General Meeting held on 21 September 2015
The minutes of the Annual General Meeting held on 21 September 2015 were confirmed as a true record.
4. / Matters arising from the Minutes of the Annual General Meeting held on 21 September 2015
There were no matters arising.
5. / 2015 / 2016 Trust Annual Report
Maria Kane, Chief Executive, introduced the Annual Report for 2015/2016 and gave a presentation on the highlights, which included:
  • Continuing financial challenges– TheTrust ended 2015 / 2016 with a £7.3m deficit and was projecting a £12.6m deficit for 2016 /2017. Nationally, 55% of Trusts had declared a deficit at the end of 2015 / 2016.
  • North Central London (NCL) Sustainability and Transformation Plan (STP) – The Trust is one of a number of organisations across NCL developing a STP to improve health and wellbeing, quality of services, and financial sustainability and efficiency.
  • Successful Care Quality Commission (CQC) inspection – The CQC had given the Trust an overall rating of ‘Requires Improvement’, which was in line with the majority of all Trusts. Forensic Services were rated as ‘Outstanding’, the only such rating in London. Enfield Community Services were rated as ‘Good’.
  • Improved staff morale– The national Staff Survey indicated that the Trust had the highest level of staff morale of any Mental Health and Community Health provider in London.
  • Enablement – The Trust has continued to expand the Enablement Programme and marked the first anniversary with a stakeholder event held in May 2016. Arising out of the Enablement Programme the Trust has appointed a number of Peer Support Workers.
  • Health Service Journal (HSJ) Award – The Haringey Adolescent Outreach Team won the HSJ Award for Innovation in mental Health Services for the work undertaken in delivering Project Future.
  • New Services – The Trust has continued to develop and attract new business through the provision of mental health services in prisons, and the establishment of suicide prevention with the British Transport Police.
  • Panorama – The Trust participated in a Panorama documentary to highlight the pressures faced by NHS mental health services.
Maria Kane outlined the Trust’s priorities for 2016/2017, as follows:
  1. Improving our services – Deliveringthe CQC Action Plan as part of our Trust’s Improvement Programme in order to develop a Trust-wide continuous learning culture.
  1. Developing our model of care – ProgressingEnablement further, implementing a ‘stepped care’ model, with more care provided in community and primary care, transforming children’s and young people’s services, and developing ‘placed-based’ services, e.g. in Enfield.
  1. Workforce and organisational development – Developing new roles (such as Peer Support Workers and Primary Care Practitioners), further developing leadership and management across the Trust, strengthening the Trust’s commitment to equalities and diversity, and working with staff to embed the Trust’s refreshed Values of Compassion, Respect, Being Positive and Working Together.
  1. Improving our finances – Ensuringthat the Trust is financially stable, working with commissioners and other providers, as part of the NCL STP, and delivering internal cost improvements and efficiencies, particularly reducing temporary staff usage.
  1. Redeveloping St Ann’s Hospital – The Trust is working with NHS Improvement to obtain approval to move forward with the redevelopment of the St Ann’s Hospital site.
It was noted that copies of the 2015/2016 Annual Report were available on the Trust’s website and at the meeting.
6. / 2015 / 2016 Quality Account
Mary Sexton introduced the 2015 / 2016 Quality Account. She reported that the Trust produced a Quality Account each year which provided an opportunity to reflect and report on the quality of the services that the Trust delivers, demonstrates the Trust’s commitment to achieving high quality care for all, outlines the Trust’s performance taking into account the views of service users, carers, staff and the public, and outlines the key priorities for the year ahead against the three domains of quality of Patient Safety, Patient Experience and Effectiveness.
Mary Sexton explained that the Trust’s three quality priorities for 2015 / 2016, as agreed with service users and stakeholders, were:
  • Patient Safety
  • To improve discharge communication from inpatient settings with GPs - There had been a continued improvement from 62% in 2014 / 2015, rising to 89% in 2015 / 2016, due in part to the introduction of electronic mailing to GPs.
  • To improve individuals’ physical health and wellbeing through alcohol misuse screening - Successfully implemented the Fast Alcohol Screening Test (FAST) tool in all areas of our Trust. Achieved 100% screening across all services.
  • To improve provision of information of Smoking cessation services to service users - Targets set to ensure patients’ and service users’ smoking status and advice given on how to quit smoking was recorded in their records, and treatment to aid the person to quit smoking was prescribed. Achieved 94% in adults (target was 95%) and 56% in 14-18 year age group (target was 95%).
  • Patient Experience
  • To enable young individuals through coping and self-care skills training - The New Steps to Work Project, provides knowledge and support for students to identify any paid work, training, volunteering or meaningful activity that they would like to do.
  • To provide additional support to people dealing with long term conditions - The Recovery and Enablement Track (RET) provides support for clients to achieve their own goals and move from hospital to community care.
  • Effectiveness
  • To evaluate a sample of enablement pilots through patient reported outcome measures – The Trust successfully implemented a number of enablement pilot projects during 2015/16 including:
-Beacon Centre ‘My Star’ – which aims to engage with young people to reflect on their experiences, develop insight and consider future plans around eight parts of life that are important to children and young people.
-Forensic Sensory Project – development of a sensory room in order to create a safe space that promotes resilience, recovery and enable service users develop coping skills based on their sensory need.
Mary Sexton outlined the priorities for 2016 / 2017, which were determined through engagement with service users, patients, carers, staff, commissioners and other stakeholders, which are:
  1. To continue with the Enablement Strategy, achievingimproved outcomes for service users.
  1. To increase the use of Patient Reported Outcome Measures (PROMs).
  1. To improve the physical wellbeing of service users withmental health issues.
  1. To improve integrated care for patients with co-morbiditiessuch as diabetes, Chronic Obstructive Pulmonary Disease (COPD), and other long term conditions.
  1. To continue to improve our communications with our primarycare partners to ensure a continuity of care following changesin treatment and discharge.
  1. To increase the number of patients who feel safe when in ourhospital by reducing the violence against patients and staff.
  1. To improve response times to District Nurse referrals.
Copies of the 2015 / 2016 Quality Account were available on the Trust’s website. A summary of the 2015 / 2016 Quality Account was available at the meeting.
7. / 2015/2016 Annual Accounts
Simon Goodwin, Chief Finance and Investment Officer, presented the Annual Accounts for 2015/2016. He reported that the Trust had achieved two out of the three statutory duties:
  1. To achieve breakeven - Whilst the deficit was better than budgeted (delivering a deficit of £7.3m against a deficit budget of £7.5m) the Trust did not achieve breakeven.
  1. To operate within the Capital Resource Limit (CRL) - The Trust had a CRL of £5.7m with actual expenditure of £5.2m.
  1. To operate within the External Financial Limit - which was achieved.
Simon Goodwin advised that the Trust’s financial performance was achieved in a challenging environment, with commissioners continuing to manage financial difficulties within a difficult financial position for the NHS overall. The Trust had achieved 91% of its Cost Improvement Plans of £7.3m, which was equivalent to 3.2% of turnover.
Simon Goodwin set out the outlook for 2016/ 2017 as follows:
  • Financial challenges continue for the Trust’s commissioners, constraining the funding available for Mental Health Services.
  • Coupled with unfunded demand pressures, this means that the Trust requires a Cost Improvement Plan of £4.0m – 2.0% of our income.
  • The Trust’s forecast for 2016 / 2017 was a deficit of £12.6m.
  • Actions being taken include:
  • More rigorous controls around agency staffing
  • Reviewing how the delivery of our services is organised
  • Line by line review of non pay expenditure
  • Discussing with commissioners how best to manage services within the funding available – two of our three main commissioners spend significantly less on mental health that the London average - we need to get better alignment of expectations and funding
  • Creation of a Project Management Office to coordinate the implementation of CIP projects and maximise efficiency and effectiveness
Simon Goodwin advised that the funding situation would continue to be challenging and that in order to remain financially viable, the Trust would need to look at the following areas:
  • Significant service change.
  • Estates reductions.
  • Additional funding from commissioners.
A summary of the 2015 / 2016 Annual Accounts was included in the 2015 / 2016 Annual Report, copies of which were available on the Trust’s website and at the meeting.
8. / Introduction of Guest Speakers
Michael Fox introduced the following presentations which highlighted two of the Trust’s services.
8.1 / The Grove – Haringey Substance Misuse Service
Pardeep Grewal, Consultant Psychiatrist, and Amina Lahrichi, Team Leader, gave a presentation on the work of the Haringey Substance Misuse Service located at The Grove Drug Treatment Service in Haringey. The presentation included:
  • An outline of the clinical governance structure.
  • The number of clients (920 in treatment in a rolling year), and the number of new presentations in the last 12 months.
  • The services offered including harm reduction, prescribing of opiate substitutes, psychosocial treatment (such as motivational interviewing and Cognitive Behavioural Therapy), and abstinence-based interventions.
  • An outline of trends in substance misuse.
  • An outline of the benefits of the partnership approach to the delivery of services in Haringey.

8.2 / The Eating Disorders Service
Lorna Richards, Consultant Psychiatrist, and Rachel Clancy, Operational Manager, gave a presentation on the Eating Disorders Service located at St Ann’s Hospital.
Lorna Richards provided an introduction to Eating Disorders services and highlighted the following:
  • Eating disorders are severe mental illnesses with serious psychological, physical and social consequences.
  • Over 1.6 million people in the UK are estimated to be directly affected by eating disorders with health care costs of £80-100m.
  • Carer burden is high with psychological distress rated as highly as by carers of those who suffer with psychosis.
  • Stigma related to eating disorders affects patients, carers, health professionals and policy makers.
Lorna Richards informed that:
  • The Trust had a catchment area population of approx. 5 million across North East and North Central London.
  • The Trust had a 20 bed inpatient unit and Day Programme.
  • The main challenges included the increase in new referrals, supporting patients through the whole pathway from mild to severe, and delivering a community model within current resources.
  • The Trust was seeing 91% patients within 13 weeks.
  • The Trust was actively involved in research and training around Eating Disorders.
  • The Trust was developing a ‘hub and spoke’ model with satellite clinics offering specialist interventions more locally.

9. / Round Table Discussion and Feedback
A Round Table discussion was held enabling attendees an opportunity to provide feedback on the presentations directly with a member of the Trust Board.
10. / Close
Michael Fox thanked everyone for attending, especially the guest speakers.