23rdMeeting of the Council of Governors
15th December 2011
3pm – 5pm Applegarth Suite, Marriott Hotel, Bexleyheath
Chair: Dave Mellish
Trust Secretary and Head of Governance: Ann Rozier
Public Governors / Service user/ carer Governors / Appointed GovernorsStephen Brooks / Julian Baker / Alan Downing
Amanda Finlay / Richard Comaish / Sandi Lowing
Paul Harding / Alan Cork / Liz Meerabeau
Jason Heward / Rob Hayles / Raymond Sheehy
Ann Lucas / Jenny Kay
Eimear Mallen / Chris Purnell
Raymond Pope / Stephen Seabrooke
John Woolgrove / Ken Thomas
Staff Governors
Scott Hunt / Kaye Jones / Shelley Ratcliffe
In attendance:
Non Executive Directors / Directors /Guests and Presenters
Anne Taylor / Stephen Firn / John Bell, Bexley LINkArchie Herron / Helen Smith
James Kellock / Dr Ify Okocha
Item /
Action
1. / ApologiesBeryl Day, Maggie Grainger, Rebecca Linton, Mary Stirling, Dave Stringer, Julian Thornington, Steven Turner, Anne Voce, Judy Wolfram / Noted
2. / Minutes of the last meeting of the Council of Governors 22nd September 2011
Agreed as an accurate record / Agreed
3. / Matters arising
Item 10 Chief Executive Update – LM assured Governors that “Listening Skills” are included in nurse training along with service user involvement and role play.
Crayford Centre – The Business Support Unit are reviewing the service to ensure that needs are met appropriately. This is being done jointly with the Local Authority. MIND has been asked to be involved in this review. Once the specification has been decided, a decision will be taken by the Trust on whether to bid for the service or if it may be more appropriate for the 3rd sector to deliver this service. / Noted
4. / New National MH Strategy Ministerial Committee
The Ministerial Advisory Group on the Mental Health Strategy has recently been established to lead the delivery of No Health Without Mental Health and is looking to recruit four persons who have used mental health services in England either currently or in the past, or a relative or friend who supports somebody who has used, or uses these services. There will be 4 meetings each year. The application deadline is the 5th January. Governors can contact DM or AR for further information and assistance in applying. / Discussed
5. / Feedback from the Constitution working group
A meeting of the Constitution Working Group was held on 26th October 2011. It was agreed that a meeting should take place with Service User Carer Governors to discuss options for implementing changes to the service user carer constituencies (agreed at the Annual Members Meeting). This meeting took place on the 8th December 2011. The enclosed flowchart showed the 3 options available to service user carer governors agreed at the meeting.
- Option 1 –Express a preference for a service user carer sub class
- Option 2 – Happy to represent any sub class
- Option 3 – Choose not to express a preference or represent any sub class
SS – The Membership Service User Carer constituency will not be divided into sub classes. / Agreed
6. / Serious Incident Inquiry feedback
This inquiry was commissioned by Oxleas NHS Foundation Trust following the death of a patient on 11 February 2011. JW, Governor representative on the panel, gave a summary of the outcome of the inquiry. On 11thFebruary, at approximately 14:30, the patient was not found in his room during hourly checks and the HCA undertaking the observations then checked the garden and communal area before checking his en suite bathroom. The patient was then found with a belt around his neck that was held securely in the en suite bathroom window. The panic alarm was activated and the emergency services were called. Three ambulances and an air ambulance arrived at the scene and CPR was taken over by the paramedics. CPR was continued until pronouncement of death at 15:30.
Whilst this incident could neither have been predicted nor prevented, and the care provided was generally of a high standard, the panel concluded that there were areas for improvement/ learningwhich are outlined in 6 recommendations. The action plan addressing each recommendation was enclosed in the meeting papers.
SS – Carers’ concerns should be taken note of; they can provide an ‘early warning’.
AF – This should also include GPs’ concerns.
JW – The order of the recommendations is not the order of priority.
EM – Ligature risks has come up in previous inquiries, why is this not dealt with?
SF – This was an older persons ward. There are regular ligature checks and all items on the prescribed list are removed. The belt used was jammed in the window and we have found no alternative/ solution to this risk.
SS – All doors should open outwards.
AD – Surely it was common sense to check the bathroom.
SF – Staff had concerns about infringing on patients’ privacy and dignity, so searched other areas first. A patient safety alert has been sent to all nursing staff about this so bathrooms will be checked in future.
Update on the 10th October serious incident in Bexleyheath
RS, the governor representative on this panel gave an update on progress. The process of investigation has been reassuring. Where improvements could be made immediately they were. No stone has been left unturned. Sometimes it can be difficult for families where investigations can take as long as a year but Oxleas has been able to give the victim’s family some information. SF met with them in November and there is another meeting arranged for tomorrow. The general conclusions are that care and treatment delivered by the Forensic team was of a high standard but there were some shortfalls at Oxleas House. The final report will be presented at the next meeting in March.
SH – In Bromley, they have started looking at pathways where the service user can go straight to a triage ward from A&E. There are resource issues for the Crisis teams.
SF – In this case resources were not an issue.
EM – What value/ priority is given for someone presenting at A&E with this type of psychiatric history?
SS – Do we have our assessment people in A&E?
HS – The panel looked at this. Part of the waiting time was not under Oxleas control. The patient waited for triage at A&E and then needed to wait for A&E to contact Oxleas. We need to ensure that the response is quicker.
SF – The IPPC is also investigating the matter. A series of 999 calls were made by the patient. The police took her to A&E instead of the Section 136 suite.
DM – The full report is being presented at the Board meeting in January and to the Council of Governors in March. / Noted
RS
7. / Patient Experience Update
The outcome of Patient experience Volunteer visits was tabled. Over 1000 questionnaires have been used and volunteers have been talking to service users. There are a further 4 reports in production. Issues have been raised by observation, service users and staff. The next step is to ensure those people who have been interviewed are informed of actions taken.
CP – I welcome and support this initiative. We need to appoint a person to progress/ chase actions arising from the visits – someone who can follow up at Patient Experience Groups in Directorates.
AF – It is essential to close loops. Follow up needs to be included in mainstream work via the Quality and Audit mechanisms rather than a special person.
DM – Well researched questions are used; delivered by well trained people. The volunteers are invited to Directorate Quality Boards but we need to do more on this. A meeting is arranged with Keith Miller in January about how to progress this. A report from Keith Miller will be presented to the March meeting.
IO – Agree that we need to embed this at team level and feed up to Directorate Quality Boards.
KJ – Are visits planned for Learning Disability Services?
AL – Presently there is only one person coordinating the visits. She has a plan.
RC – The comments re nurses spending time in offices – can anything be done about this?
SF – There is a scheme called ‘Productive Ward’ that measures how much time nurses spend with patients. / Noted
DM
8. / Psychological Therapies Board Update
Deferred to the next meeting. / Noted
9. / Feedback from the Membership Committee
A Strategy workshop has been held looking at a different approach as we have become a different type of Trust. We have done well so far but further effort is needed to focus on groups that are not well represented. A better balance is needed between staff, service users, carers and the public. The Strategy is due to be agreed by the Membership Committee on the 20th January 2012 and will come to the Council of Governors in March for final approval. / Noted
10. / Social Inclusion Update
SB gave the update from the Social Inclusion Operational Group. The Group’s remit is to monitor, encourage and initiate projects for social inclusion. There continues to be progress in the Volunteer to Work Scheme.
- 140 applications of interest completed
- 55 placements created in Oxleas
- 45 volunteers in placement
- 35 undergoing interviews
- 20 have left
- 15 are in paid employment
- 15 awaiting suitable placements
- 4 new placements under discussion
DM – The decision if this will be an Oxleas CIC or a partnership arrangement with the 3rd Sector will be made at the Board in January and reported back at the next Council of Governors meeting. / Noted
DM
11. / Carers Strategy Progress
The Carers Strategy is included in the Annual Plan and priorities for next year. There has been remarkable progress and this document is now in draft and will go to the Board of Directors early next year and to the Council of Governors in March. Work is being carried out on a more common sense approach to patient confidentiality. / Noted
DM
12. / 2012/13 Annual Plan
HS explained that the Service Development Strategy (SDS) is a 3 year plan. The Trust is now into the second year of its second 3 year plan. The SDS is not about capturing everything we do but it needs to look forward at what to pay particular attention to. Internally we need to: keep quality as our top priority; change our culture to become a new organisation; focus on data quality; explore new technology and remain financially strong and successful in new environment. Externally we need to:improve/ maintain our relationships with GPs: ‘get it right every time’; develop relationships with Clinical Commissioning Groups and support out of hospital care; support the third sector; influence Health & Wellbeing Boards and make good links with HealthWatch.
Borough Focus Groups will be held in January to consult with members about the proposed priorities for 2012/13 as described:
Quality Board is the highest priority: Meet Quality Board targets and review mental health, learning disability & intermediate care beds
Organisational change and development:Develop integrated care pathways and organisational development programme for senior staff
Improve data quality: Benefit from new business information system; support community health service teams to use RiO; implement national community information dataset; implement Mental health Payment by Results
Use of technology:Implement technology strategy: Develop a business case to expand tele-health; implement remote computer access; start replacement of RiO
Market development & financial stability: Develop a Marketing strategy; promote Oxleas services; implement Choose & Book
Develop new ways of delivering care:Redesign care pathways for long term conditions; plans for older people's services in Bexley
Support GPs & clinical commissioning groups (CCGs):Develop a work plan with GPs; inform GPs and CCGs about services & quality; seek GP views about our services
Enhance stakeholder engagement:Keep good links with LINKs; keep good links with third sector; keep working with Health & Wellbeing Boards
SH – How important is it to implement Payment by Results?
HS – This is a national initiative. By the end of December all Adults and Older Adults must be allocated to a cluster. Next year will be a shadow year for Payment by Results. The following year commissioners will set a local tariff. There is lots of work to do but the Trust has achieved around 70% clustering so far.
IO explained that the Quality Board priorities are around;
- Commissioning for Quality & Innovation (CQUIN)
- Quality and Safety Improvement Plan (QSIP)
•Patient Experience Group work plan (PEG)
•Patient Safety Group work plan (PSG)
Last year’s themes from the Borough Focus Groups were included in the work-plans of the CEG, PEG and PSG. The 4 Must Dos are the prime focus of these Groups and there is more work to do in these areas. The plans for the coming year around the 4 Must Dos are:
Support To Families and Carers
•Family inclusive practice training
•Carers strategy for 2012 - 2015
–Recognising carers
–Involving carers
–Informing carers
–Supporting carers
–Developing staff to work with carers
–Working in partnership with local agencies
Provision of Better Information
•Service user information packs
•Information handbooks and leaflets
•Availability of resources on the intranet
•Medication helpline
•Promotion of educational/information events/meetings
Enhancing Assessment and Care Planning
•Care planning and engagement – CEG agenda
•Evidence of service user involvement in care planning
•Trust-wide compliance visits
•CQC MHAC visit feedback
•Annual care planning audit
•Patient surveys (Local and National)
Improving The Way We Relate to Service Users and Carers
•Staff Attitude and Behaviour
•Dignity and Respect
•Patient Feedback
•Complaints
RP – Speaking as a carer, these words and expressions in the presentation are good news. The narrative so far is not supported by actions. Care assessments in learning disabilities are lacking. As a new Governor, I would ask for a focus on quality, of care plans and involving carers. A real focus on needs. This will give the Trust an automatic wave of support from carers.
SS – I agree with carer involvement and care coordination priorities. We still see polypharmacy – we need consistency. This needs to come into the quality agenda.
IO – We need to assure Governors that we are not over spending on expensive medication. Data is used to monitor this but not always on an individual basis. The Trust takes part in national audits and generally does well.
The proposals for next year’s priorities were approved and the plans will be presented to the Focus groups in January. / Approved
13. / Chief Executive Update
SF updated Governors on:
•Recent Awards and Inspection Reports
•Tender and Service Development Update
•Financial Outlook - What is the challenge and how can we meet it?
Awards - The Trust has been successful in a number of awards: Greenwich Community Services and Greenwich Council won the HSJ Awards for:Staff Engagement Award and the Secretary of State Award for Excellence. Bexley and Greenwich CAMHs has received an award from the London Safeguarding Boardfor the Non-Violent Resistance Project
CQC - CQC Review of Compliance has taken place atAtlas House – low secure unit people with learning disability and complex challenging behaviour. It was a thorough 2 day inspection that included talking to service users and carers. CQC found Atlas House compliant with all essential standards and no concerns were raised.
Tenders – The Trust has been successful in securing: West Kent Prison Healthcare; Greenwich Community Gynaecology and Bexley Specialist Stroke Rehabilitation.
Tenders in progress are:Kent CAMHs (with Sussex FT); Eastern Coastal Prison Healthcare; Greenwich Specialist Children’s service and Greenwich & Bexley Dental. We have been unsuccessful in securing Greenwich Urgent Care Centre and Greenwich & Bexley Wheelchair services.
RP – What services that Oxleas currently provide are coming up for tender and what is the value?
HS – Bexley Urgent Care Centre, District Nursing, muscular and skeletal across 3 boroughs and the Crayford Centre. The value of the District Nursing service would be sizable.
AF – What discussions at the Board take place about which tenders to go for; some look far away from our focus e.g. gynaecology?
SF – We have investment criteria. One of these is expertise and capacity. Bexley, Bromley and Greenwich are our key areas and we already deliver the sexual health services in Greenwich. It is a good challenge and does fit with us being an out of hospital community services provider.
AD – Who won the Greenwich Urgent Care Centre tender?
SF – The Hurley Group.
JK – How influential is patient experience data in the bidding process?
SF – This is a main criterion along with a good price.
Current financial position - Finances for the year are on track and surplus is forecast to be in line with plan (£3m). There is a shortfall on the CRE programme but non-recurrent savings are delivered. Nationally, £20bn efficiencies are required from NHS over next 3 years. This is due to rising demand, rising costs and rising expectations.
Monitor risk rating – For Q4 28% of FTs plan a rating of 4 or 5 and 64% plan a rating of 3. The Board has decided to plan for a 3 rating.
Commissioner intentions 12/13 and Total efficiency challenge 12/13
Contract cuts from Commissioners range from a best case of £2.4m, mid case £4.4m to worst case of £6.75m. The total efficiency challenge for 2012/13 will be in the region of 6% (mid case) taking into account other factors such as uplift, Agenda for Change increments and efficiencies. This equates to around £11m taking a mid case scenario. The Trust needs to be more efficient/ productive.
Cash position
Cash reserves are needed because FTs have limited access to central government funding hence require cash reserves to fund capital investment and as semi-autonomous organisationsa cash buffer is also needed in case commissioners do not pay on time or contracts are lost.
At the start of the year, FTs had £3.3bn of cash (average £24m per FT). Cash we hold above this level is potentially available for investment. There is no requirement to spend the cash but it is a potential resource to improve efficiency and effectiveness. This is non-recurrent so must be used wisely – we can only spend it once. Some ideas on how we could use the cash are: replacement of RiO; QMS campus; re-provision of acute beds; mobile working; pay-off PFI, tele-health.
Cash Releasing Efficiencies
The Trust is looking at the following areas.
•Extra focus on financial control
- As few bank & agency shifts as possible
- Careful eye on purchasing
- Performance & absence management
•Reducing bed numbers
•Reducing estate
•Re-designing community teams
•Reviewing care pathways
•Investing in tele-health and mobile working
•Increasing income
Longer term
Shifting sands make future difficult to predict but the expectation is that similar reductions required for 13/14 and 14/15. This could be 15%/ £30m over next 3 years.
SS – Is there a programme of investment that protects us from the current European situation?
AH – We have considered this and have a set of rules that requires us to only invest with UK Banks. We have a policy to spread the risk and this is looked at regularly.
RC – Has sustainability/ energy been looked at?
SF – One of our rising costs is utilities. This is a good point.
AH – External audits are looking a reducing energy costs.
AD – The % income of Community Health Services plus Mental Health plus Learning Disabilities; can one affect the others?
SF – The Trust has an income of £195m -£17m is BCHS, £36m GCHS (1/3 of staff) and Learning Disability is a small proportion of the income. Mental Health is the remainder and is inflated because of PFIs. One of the biggest pressures is Forensic MH.
SF – If we were planning the service from scratch, we would not be delivering services from 120 sites. We need to think about providing more services from fewer sites. This has been successful with Dementia services.
SH – Staff are worried that information about changes is not coming through.
SF – The challenge is to construct a business case that makes savings and improves quality. Any re-arrangement must be for the good.
JB- Do any dividends go to the Exchequer?
SF – We pay capital charges on buildings. / Noted
14. / Advance Questions from Governors – Item from Raymond Pope, Public Governor
The Department of Health (DoH) launched a three year pilot programme in 2009, which involved around half the primary care trusts in England to test out Personal Health Budgets (PHBs) in the NHS. Personal Health Budgets are seen as central to the new policy direction for health care in England. At the heart of a PHB is a care plan, the agreement between the primary care trust and the individual that sets out the person’s health needs, the amount of money available to meet these needs and how the money will be spent. On the 4th October, Andrew Lansley announced that, subject to the evaluation by April 2014, everyone who is eligible for NHS continuing healthcare will have the right to ask for a personal health budget.
Have Oxleas NHS Foundation Trust been requested to participate in the pilot, and if the reply is in the positive, what is the current thinking on such matters?
HS – Oxleas were not a part of the pilot scheme. Croydon, Lambeth and Southwark PCTs have signed up to this for a 2nd year. Andrew Lansley has said that from October 2012 people can request their plan of care under the scheme. This fits in well with how mental health trusts work. Community health services are also adopting a similar approach. We would support this. More detail can be obtained from the Department of Health website.
Time and Date of the next meeting
Thursday, 22nd March 2012
Applegarth Suite, Marriott Hotel
Bexleyheath
3.00 – 5.00pm
I confirm that the minutes of the Council of Governors meeting of15th December 2011are a true record