Kent and Medway Nhs and Social Care Partnership Trust

Minutes of the Integrated Audit and Risk Committee Meeting

held on 3 June at 13.00 hours in Meeting Room 2, Magnitude, New Hythe Lane, ME20 6WT

Present: Integrated Audit Committee Members

Mr R Page Deputy Chairman/Non-Executive Director (Chair)

Professor M Andrews Non-Executive Director

In Attendance:

Grant Thornton

Ms L Robertson Manager, Assurance

Ms M Blanks Engagement In-Charge


Mrs R Goodall Audit Manager, from item IARC/15/81


Mr P Cave Executive Director of Finance and Resources

Mrs A Foreman Deputy Director of Finance

Ms M Brown Interim Company Secretary, from item IARC/15/80

Ms C Shaw Head of Communications and PR for item IARC/15/82

Dr C Kinane Executive Medical Director, for item IARC/15/83

via phone link

Miss A Bedford Assistant Trust Secretary, Minutes



The Chairman welcomed those present to the meeting.


Apologies for absence were received from Mr T Phillips, Non-Executive Director.


There were no declarations of interest.


There were no items notified for discussion not on the agenda.


The minutes of the Integrated Audit Committee and Risk Committee meeting held on 5 March 2015 were accepted and signed as a correct record.

The minutes of the Integrated Audit Committee and Risk Committee meeting held on 16 April 2015 were accepted and signed as a correct record, with one amendment – the date on the title page to be corrected.

IARC/15/80 Action Sheet

The Committee noted the updates to items on the action sheet and agreed the proposed closures of outstanding items. The following points were noted under specific items:

66a Head of Internal Audit Opinion – Mrs Foreman advised the Committee that it had been agreed that she would refer each limited assurance audit to the executive lead of the appropriate Board Committee to monitor progress against the recommendations. The Committee Clerk would ensure that this was progressed via the meeting schedule. Item closed.

66b Head of Internal Audit Opinion – Mrs Foreman advised that the audit recommendation relating to Self Employed Workers could not be completed until the Government Procurement Service Contract was awarded. In response to a question from Professor Andrews, Mrs Foreman said that the critical outstanding action was to finalise the agency contract to ensure that the necessary checks were completed.

69a & b Corporate risk register – it was noted that the HR Risk Register would be brought to the meeting on 29 June 2015.

44a Local Counter Fraud Specialist Report - Mr Cave noted that consideration had been given to changing the point at which documents for new starters were checked in the induction process and it had been decided to remain with the current arrangements. Item closed.


Mrs Foreman circulated a copy of the final Query/Change log raised by Grant Thornton in relation to the audit of the Trust’s Annual Accounts, for information. She noted that there were only 23 items listed and these were all minor amendments this was a reflection of the excellent work by Mrs Butcher, Head of Financial Accounting, and her team.

Mrs Foreman explained that the first part of the report provided a summary of the annual accounts and noted the following:

·  the Trust had performed well against the 2014/15 financial plan although it had been a challenging year;

·  table 1 showed the top level movements in relation to income and expenditure;

·  table 2 highlighted key areas of change in operating expenses – in response to a question from the Chairman, Mrs Foreman said that impairments were not as great as last year, a high proportion related to the loss of Stanley House following a fire which impacted on the level of assets;

·  table 2 – Mrs Foreman advised that the ‘other’ line would be removed in the coming year as it was no longer at a material level;

·  table 3 – it was noted that the change in ‘Other General Provisions’ related mainly to A Block dilapidations;

·  overseas patients – Mrs Foreman said that these had become more evident due to the need to re-coup charges by CCG area, she felt it unlikely that the recovery rate would be high;

·  it was suggested that this figure had been listed incorrectly as non-reciprocal income and Mrs Foreman agreed to check – Ms Robertson noted that this was not a material issue so would not affect the draft;

ACTION: Mrs Foreman

·  Mrs Foreman confirmed that monies were provided to the Trust direct from the CCGs in relation to liaison services;

·  Mrs Foreman said that she would confirm with Mrs Hunt, Head of Learning and Development, that the Trust was recovering all the student placement monies;

ACTION: Mrs Foreman

·  tables 6 and 7 includes the details of the material asset changes following the re-evaluation exercise;

·  the Chairman noted that the reverse side to this point was that depreciation had not increased, although it was noted that this would increase in the coming year, particularly in relation to IT equipment;

·  with respect to unpaid invoices with some CCGs, Mr Cave said that he was confident that the monies were due and the Trust would continue to chase for payment – Ms Robertson confirmed that the auditors were content that there was evidence to fully support the Trust’s position;

·  the Chairman noted the non-payment for the PTPS – Mrs Foreman advised that this was always paid a month in arrears;

·  table 8 – Mrs Foreman noted that the main reason for the changes in NHS payables capital was the Upnor Ward build, Mr Cave noted that the cost was around £6M but that the invoice had not yet been received;

·  Mrs Foreman confirmed that the Trust had met all four of the required financial targets – two of the targets had been undershot, which was allowed; and

·  Mrs Foreman said that the Trust’s performance against payment of Creditors within 30 days was not as good as she would have wished – the problem areas were mainly linked to payment of NHS invoices and she hoped that changes in the electronic management system would improve this in the coming year.

Mrs Foreman drew the Committee’s attention to the Letter of Representation which was a standard document, and would need to be recommended for signing at the Board meeting the following day.

The Chairman sought, and received, confirmation that the Trust had met point xi of the letter relating to financial statements from other trusts and that the auditors had tested this and had been satisfied.

The Committee considered the IAS compliance letter and agreed that it could be signed by Mr Page, as Vice-Chair of the Committee, on behalf of Mr Phillips, and Mr Cave, the Director of Finance.

The Committee:

1.  AGREED the draft Annual Accounts for recommendation to the Board for approval;

2.  AGREED to recommend to the Board that the Letter of Representation be duly signed; and

3.  AGREED to the signing of the IAS compliance letter.


Ms Shaw provided the Committee with a brief overview of the Annual Report noting that the structure was : executive summary, objectives, quality and performance, organisational structure and financial overview. She advised the Committee that changes had been made to the salary tables on pages 40 – 43 and on page 125. Ms Robertson advised that a narrative was needed to explain the median salary position on page 43.

The Committee noted the following:

·  Page 12 – it was agreed that Mr McFrederick would be asked to add some narrative to the reference to the PICU service to explain that this related to the out reach team;


·  Page 15 – Ms Shaw noted that the HR department was clarifying the data on sickness levels;

·  Page 21 – Ms Blanks confirmed that in the context of the statement reference to 121% was appropriate;

·  Page 40 – after some discussion it was agreed to add some narrative to the section on senior managers’ pay to put this into the national context;


·  Page 44 – Ms Shaw confirmed that the figure on carbon reduction was being checked; and

·  Page 100 – it was noted that the figure on sickness absence needed to be added to the report.

In response to a question from Professor Andrews, Ms Robertson explained that the Annual Report needed to be agreed at the Board meeting the following day and had to be published by 30 June. Presentational changes could be made to the report up to that point although the page numbering needed to remain unchanged as cross-references were made in the Audit Findings report, which had to be submitted formally at an earlier date.

The Committee:

1. DISCUSSED and AGREED to recommend the draft Annual Report to the Trust Board for approval, subject to the changes listed above.


Dr Kinane advised the Committee that the draft Quality Accounts followed the standard layout provided within the toolkit. Drafts had been presented to two meetings of the Quality Committee and changes made following discussions there. The recovery priority in the Clinical Effectiveness and Outcomes section had been a particular focus. The Chairman suggested that the Committee focus on the priorities set for the coming year and the following was noted:

Patient Safety

·  It had been decided that it was important to retain reduction in serious incidents as a priority and to use the similar measures to allow for comparisons to be made

·  There had been improvements against the safeguarding priorities set for the previous year so this had been retained for 2015/16 to ensure progress was sustained.

·  The choice of smoking cessation supported the work being done on implementing the Trust’s smoke free policy, with the focus on improving health.

Patient Experience

·  Dr Kinane noted that these priorities had been developed in conjunction with service users and carers through the Trustwide Patient Experience Committee.

·  The priority to produce a standard discharge letter had been strongly supported by carers. Professor Andrews commented that the most important aspect was to ensure that discharge letters were produced on every occassion. Dr Kinane explained that this was emphasised in the narrative on page 95; the wording of the priority itself had been strongly influenced by the carers involved in the drafting.

Clinical Effectiveness and Outcomes

·  Dr Kinane said that these had been the most challenging of the priorities to develop.

·  Dr Kinane explained that statistically people with mental health issues were likely to die prematurely, hence the focus on physical health, and the monitoring criteria linked to various aspects of physical health. This priority was supported by the patient experience priority on the Smoke Free Policy.

·  Dr Kinane noted that establishing the criteria and robust data collection for the recovery priority had proved difficult in the previous year and further work was needed to resolve this. The priority was important as the recovery model was at the centre of the Trust’s clinical strategy and was a key driver for change.

·  Dr Kinane advised the Committee that the Quality Committee now received quarterly reports on performance against the Quality Account priorities.

The Committee also considered performance against the 2014/15 priorities and noted the following:

Patient Safety

·  Falls - it was noted that this had been a stretch target for delivery over a couple of years. Performance against the priority had been good and there was a clear narrative set out on page 14 to explain why this had not been carried forward as a priority for 2015/16;

·  a reduction in frequency of serious incidents had been achieved;

·  Dr Kinane noted that there had been improvements in attendance at children’s’ case conferences and in recording the appropriate data relating to safeguarding in patient records - the priority had been rolled over to maintain the focus on these issues;

Patient Experience

·  Dr Kinane was pleased to note that complaints about staff attitude, an indicator for the better communication between staff and patients priority, had fallen in year;

·  Dr Kinane explained that using the effectiveness of patients’ CPA as a measure to monitor the patient experience had been identified from the results of the patient survey - improvements had been seen during the year;

·  Dr Kinane noted that work was still ongoing in the service lines to ensure that service users were informed when changes were made in care co-ordinators;

Clinical Effectiveness and Outcomes

·  the target for there to be evidence of service user involvement throughout all aspects of the care plan was set at 75% and this was exceeded;

·  Dr Kinane reminded the Committee that the physical health criteria were also Trust CQUINS with the CCGs; and

·  as noted previously, it had proved difficult to collect data for the measure set for the Recovery Star priority; a more realistic and measurable target had been set for the coming year.

Dr Kinane drew the Committee’s attention to the section on stakeholder comments, page 38. She noted that Hazel Carpenter, the accountable officer for the South East Coast and Thanet CCG had commented that there needed to be evidence of more robust learning; the Chief Executive had discussed this further with Ms Carpenter. Kent Healthwatch had made some positive comments, particularly in relation to partnership working. Medway Council were looking for more examples of partnership working in the document. In response to a question from the Chairman, Professor Andrews explained that the Trust did respond to the comments made by Stakeholders, although this was not detailed in the document itself. She recalled that there had been lengthy discussion with Medway Council in response to their comments on the 2014/15 Quality Accounts.