WEST LONDON MENTAL HEALTH NHS TRUST

FINANCE & PERFORMANCE COMMITTEE

Minutes

Tuesday 11th May 2010 (draft)

Present: Dame Sally Powell - Non-Executive Director (Chair)

Mr Geoff Rose - Non-Executive Director

Mrs Barbara Kerin - Non-Executive Director

Ms Lisa Harrington - Non-Executive Director

Mr Ian Kent - Deputy Chief Executive

Ms Ruth Lewis - Director of Organisation Development &

Workforce

Mrs Barbara Byrne - Director of Finance & Information

Mrs Jo Smith - Deputy Director of Finance

Mr Alex Dawson - Service User Representative

Mr Trevor Nelms - Director of IM&T

Attending: Mr McCorkell - Trust Chairman

Mr Cubbon - Chief Executive

Mr Steve Trenchard - Director of Nursing & Patient Experience

Ms Nicky Holdaway - Director, Hounslow SDU

Dr Alice Parshall - Clinical Director, Hounslow SDU

Miss Nina Griffith - Acting Head of Planning & Performance

Ms Babs Dhillon - Head of Information

Ms Lesley Day - Head of Service, Hounslow SDU, Cassel

Mr John Corlett - Director of Capital Development

Mr John Atkins - Head of Capital Projects (London)

Miss Abby Fadina - Board Secretary (minutes)

1.  APOLOGIES FOR ABSENCE

1.1 None. (All members of the Committee were present)

2. MINUTES OF THE PREVIOUS MEETING FOR APPROVAL

2.1 Subject to the following amendment, the minutes of the meeting held on the 9th March 2010 were agreed as a correct record:

Para 3.7 (matters arising) Minimum Dataset (MHMDS)

It was noted that the H&F Performance meeting had taken place the previous week and they did not believe gender should be part of the MHMDS. Advice was sought from the Information Centre - who recommended it should be included, as these patients were being seen by psychiatrists. This would be reviewed and H&F would talk to the Dept of Health and the Trust would possibly submit an extenuating circumstances form.

3. MATTERS ARISING

3.1 As detailed in the Committee’s Action Schedule.

3.2 PbR Update

3.2.1 The Committee received and noted the paper from Mr Nelms briefing the Committee on the Trust's current Payment by Results (PbR) compliance status. Discussion followed on the time line for theimplementation of PbR and in particular when Rio would be adapted tocapture the data. Mrs Dhillon explained that work on theupgrade of Rio could not start until the formalInformation Standards Notice (ISN)was released and that although this was now imminent the anticipated Rio release datefor PbR would not be until April 2011; however an interim, separate tool was under development for release to trusts ahead of this.

3.2.2  The Committeeexpressed their concern at the lateness of the Rio release and asked that pressure be put on LPfIT and BT to bring the date forward.Mr Nelms explained that the Trust had no direct contractual relationship with BT or LpfIT as part of the CfH implementation of Rio across London but that he would take the matter up with the London IM&T Directors Forum to see what pressure could be applied.

Action: Mr Nelms

3.3 Policy D9 – Data Quality Policy

3.3.1 This Policy was received and approved.

4. HOUNSLOW SDU FINANCIAL PERFORMANCE & SCORECARD

4.1 Dame Sally welcomed Ms Holdaway and Dr Parshall to the meeting to discuss the SDU’s financial performance and scorecard with the Committee.

The Committee commented on the many areas with significant improvements, e.g. physical healthcare. At the suggestion that the Houslow SDU show the other SDUs how they had met their targets in this area Dr Parscall explained about Physical health care modality on Rio and the process to inputting the data on Rio. She added that the SDU was arranging to audit the expected quality of the assessment and what it means to patient as well as dialogue with GPs.

In response to Mr Rose’s comments that improvements had been made under a climate of considerable financial pressures, and that £91K remained unidentified, he asked how managers and staff were coping with the pressures Dr Parshall said feedback was that” it feels like great fun working there, rewarding, things do go wrong, not comfortable but possible to focus and joint effort is worth it”. Ms Holdaway added that the Staff Survey results for the SDU were good compared to national and Trust average.

Mr Kent commented positively on the management of the SDUs financial position by the senior manager and with regards to the deficit and the Committee noted that their Local Authority had not taken out money and the team had a good relationship with its PCT.

There was discussion on whether the Cassel’s level of debt should be categorised as high or medium risk. Dame Sally expressed her concerns about debt management at the Cassel and she stressed the importance of the clinical team at the Cassel understanding that they had a responsibility to ensure they received appropriate funding before undertaking work and the impact on the rest of the Trust’s resources when this did not happen. In response, Ms Holdaway said that the Cassel had a new systems regarding debt recovery in place and that their occupancy was satisfactory at present, which is why they had rated the risk as medium. Mr Kent added that the new way the tariff had been revised now took into account bed recovery. The Committee discussed ideas to reconfigure the Cassel services.

Mr Cubbon informed the Committee that had asked for me the Business Case for the Cassel from PA Consulting as part of the workstream work. He highlighted that there were two issues to be considered; whether the Cassel received national funding through national specialist commissioning groups and secondly, if not, what would the Cassel’s business case and strategy be to remain viable. Mr Cubbon said that the Board would make a decision on the long term viability of the Cassel. Dr Parshall said that the SDU would welcome Board Level commitment re what level to put tariff and a decision on the future of the Cassel.

Mr Cubbon asked if there was any significance in the change of venue for the Cassel annual conference. Ms Holdaway agreed to find out and report back to Mr Cubbon.

Action: Ms Holdaway

Mr Dawson raised the issue of staff vacancy in older people’s services, Ms Holdaway explained that the latest figure was 22% vacancy and the figures for April are being computed. She added that the vacancy rate was not higher than the average.

Mr Rose commented on the SDUs summary regarding mandatory training; a positive statement but one which appeared to contradict the statistics showing the CAMHS only achieving 48% compliance against target. Ms Holdaway explained that the SDU had concentrated on hitting the 80% attendance training targets but this had been focused on teamwork, PMVA and safeguarding courses. Dr Parshall explained that the CAMHS PMVA training target was low because the SDU did not have any inpatient facilities for adolescents. Mrs Lewis informed the Committee that Statutory and Mandatory training was being reviewed Trustwide and the compliance across all required areas would be monitored.

Dr Parshall added that it was important that the Board were aware of other risks in Hounslow SDU such as adult and older people services and the Board should ensure the Cassel did not get a disproportionate focus.

Dame Sally thanked Hounslow SDU for their informative report.

(Mrs Holdaway and Dr Parshall left the meeting.)

5. 2009/10 CAPITAL OUTTURN

5.1 Dame Sally welcomed Mr Corlett and Mr Atkins to the meeting and offered to share other capital reports from other organisations, where she had worked, in order to assist with the re-design of future reports to the Committee.

5.1.1 Mr Corlett highlighted a number of typos in the report including; in (3.2) -should be 09 and not 10, outturn on Broadmoor redevelopment and PICU is not billion – (6.1.11) but million.

5.2 The Committee questioned why it was that the overspend position was known at such a late stage, February / March 2010, and asked whether there had been a rolling programme of works. In response Mr Corlett agreed that he too had been concerned and disappointed about the issues that had come to light so late in the process and it had been the first time in 8 years that the Trust had exceeded the Capital Resource Limit (CRL). Mr Corlett explained that the nature of work and programme size had changed in the last year and the amount of work on major projects was now small in comparison to smaller projects. Mr Corlett acknowledged that the situation had flagged up that the Capital Team’s procedures were not flexible and robust enough to pick up large amounts of small operational projects. Issues around effective communication with the Finance Team, concerning the information provided to the Capital Team, had all been contributory factors to the overspend position. Mr Corlett said that prior to February / March 2010 the financial reporting from Finance had indicated that they were in budget.

5.2.1  Responding to why the Capital Teams controls of the major projects had not been replicated when running the small projects, Mr Corlett explained how major projects were dealt with normally by one external consultant. He added that with the smaller projects his team were dealing with lots of small contractor, managing the overall spend and reacting to changes to scope of work and additional requirements which were requested after the project had started. Mr Corlett stressed that all the project works were tendered for appropriately and the budgets were always adhered to; it was what happened to the programme that was the problem.

5.2.2  Mr Atkins added that it had been a difficult year with the amount of demands from the SDUs on programme and as the Capital Team tried to remain flexible and start as many jobs as possible it had resulted in some projects escalating to larger schemes, due to client scope changes. Mr Atkins said that it had been the volume of smaller jobs that has led to failures in the system.

5.3 Looking forward to ensure that the same situation never recurred, the Committee noted that the Capital Team had devised an internal action plan and were putting in place a new financial tracking system. The Committee requested that a rigorous governance structure was also put in place to deal with requests, authorisation process and prioritisation of works.

5.3.1 Mrs Byrne informed the Committee that she had asked the Trust’s internal auditor, RSM Tenon, to conduct an advisory audit, commencing in mid May 2010, which would include reviewing the Capital Team’s Action plan – this will happen in mid May. Mr McCorkell requested that the outcome of the audit is presented to the Trust Board in July.

Action: Mr Corlett, Mr Kent

5.4 Mr McCorkell said that the position, 10% over budget, that the Trust had found itself was unacceptable position; he sad that because the Trust Board had responsibility on budget and expenditure it also had to accept overall responsibility. Mr McCorkell charged the Finance & Performance Committee, on behalf of the Board, with having overall control of the Capital outturn and to ensure appropriate systems were developed to control spend. Mr McCorkell added that there was also a need to develop a contingency plan against the budget.

6. 2010 / 11 CAPITAL PROGRAMME PROJECT PLANS

6.1 Mr Corlett presented the capital programme 2010/11 to the Committee; which raised concerns about the lack of clarity with regards to the priorities. Mr Kent said the proposed programme had been received by the Executive Director and the SDU Directors had been asked to prioritise within their SDUs; he acknowledged that the missing link was the ‘star chamber’ and the decision to be made regarding which programmes would not be categorised as a priority 2010/11. Mr Kent said that this decision could not be left to the Capital Projects Committee until its current membership was revised.

6.2 Mr Atkins agreed to present a paper to the Executive Directors detailing the capital programme commitments against 2010/11 so that they could approve expenditure on specific projects. The Executive Directors would look at the proposed programme and approve those schemes which either should not be delayed or were significantly committed and of suitable priority to proceed prior to the June 2010 Board meeting.

Action: Mr Atkins

6.2.1  Dame Sally asked for a revised paper to then be produce for the F&P Committee showing which schemes had been committed (to include graphs / pie charts). In addition a paper would be presented to the Trust Board in May 2010 detailing the schemes which would be progressed.

Action: Mr Kent, Mr Cubbon

6.3 The Committee agreed that the full Capital Programme would be presented for approval to the Trust Board at its meeting in June 2010.

Action: Mr Kent

(Mr Corlett and Mr Atkins left the meeting)

7. WORKFORCE AND OPERATIONAL DEVELOPMENT REPORT

7.1  The Committee discussed the workforce and information requirements for the Board and to the Committee.

7.1.1 The Committee agreed the following would be presented either at the Board, within the monthly Integrated Performance Report or at the F&P Committee meeting: