Minutes of the meeting of the Trust Board held in the Recovery College on 3 December 2015

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1 Minutes of the meeting of the Trust Board held in the Recovery College on 3 December 2015 TB(15-16) 8A Part A Present: Mr Peter Molyneux, Chairman Mr David Bradley, Chief Executive Ms Dawn Chamberlain, Chief Operating Officer Ms Jean Daintith, Non-Executive Director Ms Barbara Greenway, Non-Executive Director & Senior Independent Director Dr Ali Hasan, Non-Executive Director Mr Iain McCusker, Non-Executive Director & Vice Chair Ms Suzanne Marsello, Director of Strategy and Planning Mr Michael Parr, Director of Finance and Performance Ms Mandy Stevens, Interim Director of Nursing and Quality Standards Mr Jonathan Thompson, Non-Executive Director Dr Emma Whicher, Medical Director In attendance: Mrs Jane Paice, FT Programme Director Mr Paul Moore, Interim Head of Corporate Governance Mr Ranjeet Kaile, Head of Communications and Stakeholder Engagement /16 Apologies for absence Professor Andy Kent, Non-Executive Director Ms Jocelyn Fisher, Director of Workforce, Human Resources & Organisational Development /16 Declaration of interest There were no declarations made in respect of the agenda items /16 Minutes of the meeting held on 5 November 2015 TB (15-16) 7A The minutes of the meeting held on 5 th November 2015 were approved as a true and accurate record, subject to the recording of Ms Jean Daintith s attendance at the meeting /16 Action Tracker/Matters arising and Annual Planner TB (15-16) 7Ai The Board reviewed the action tracker. The Board welcomed progress to address outstanding actions and the improvement made to the action log. The following updates were received and noted by the Board: Action TB(15-16)139 - Dr Whicher confirmed that the action to pass on the Board s thanks to trainee medical staff is completed. Action Ms Chamberlain confirmed that the relocation of (Child & Adolescent Mental Health Services) CAMHS had recently taken place and was bedding in, she confirmed that efforts to ensure income received for the work undertaken by the Trust remains ongoing and that further discussions are required with Commissioners to secure income for referrals over and above plan. The Board agreed to Ms Chamberlain s request to report in more detail to the Board in SWLSTG minutes of the Trust Board 3 December 2015 (part A) Page 1

2 January Action Dr Whicher confirmed her intentions to submit a report to the Quality, Safety and Assurance Committee (QSAC) on how the Trust monitors the use of anti-psychotic medication for people who are learning disabled. Due to the absence of a colleague there had been a slight delay. Plans are in place to report to QSAC in January The Board expressed a need to bring forward the action and agreed, following discussion, to accommodate Dr Whicher s report to QSAC in December Action 77-15/16 Dr Whicher confirmed she had looked at the risk associated with service users who abscond, and confirmed her intentions to bring forward the review and update the Trust s policy to February Dr Whicher informed the Board she had initiated a more detailed piece of work involving Phoenix Ward, where the risk of absconding is greatest. The Board noted and agreed to extend the completion date to February /16 Report from the Chief Executive TB (15-16) Planned Junior Doctors Strike The Board were informed that the planned industrial action due to take place on the 1 st, 8 th and 16 th December 2016 had been postponed whilst talks between the government and the British Medical Association take place. He advised that the threat of industrial action remains, and expressed his confidence in the contingencies to ensure the continuity of services in the event of industrial action. The Board were informed that 69 service users had their scheduled appointments postponed as a consequence of the action planned for 1 st December Dr Whicher confirmed to the Board that a robust clinical risk assessment had been undertaken in each case, and that appointments are being rescheduled and prioritised accordingly to minimise any clinical impact of cancellation Comprehensive Spending Review The Board were informed that the government announced details of the comprehensive spending review and received an analysis of the implications for the NHS prepared by the NHS Confederation. Mr Bradley drew attention to the projected increase in NHS funding from 101bn to 120bn by 2020/21, and welcomed the allocation of 600m additional funds for supporting mental health, including access to talking therapies and crisis care. Given the current challenges regarding staffing, the Board reflected on the importance of keeping under review the potential impact on the future supply of nursing recruits following the government s decision to remove bursaries for student nurses and replace them with student loans NHS Trust Development Authority (NTDA) Self-Certification The Board received the monthly self-certification return to the NTDA. The declaration concerns the Board s compliance with Monitor s licence requirements for NHS trusts. The Board reviewed all licence conditions and approved the declaration. The Board authorised the Chief Executive to submit to the NTDA on behalf of the Board. SWLSTG minutes of the Trust Board 3 December 2015 (part A) Page 2

3 222.4 Royal College of Physicians Team of the Year 2015 Award The Board congratulated the Drugs & Therapeutics Committee (DTC) for winning the prestigious Psychiatric Team of the Year Award at a ceremony held in London on 10 th November The DTC had achieved the highest reduction in drugs spending of any London mental health provider, reducing by 75% expenditure on non-formulary medicines, and the Trust was recognised by the NTDA as one of the best performing mental health providers for medicines management and optimisation Healing Our Broken Village Conference Mr Bradley informed the Board he had presented at this well-attended conference along with Dr Whicher and other colleagues from the Trust. He outlined that the over-representation of BME communities in mental health services remains a concern and a priority for our local health community. The Executive are working to apply the learning from the event to the Trust s arrangements for meeting the needs of black and minority ethnic groups The Board received and noted the Chief Executive s report. The Board acknowledged there was no Employee of the Month for November, and were advised that two employees will be announced in December The Board confirmed the Chief Executive s report will be submitted to the shadow Council of Governors Meeting to be held on 8 th December /16 Report from the Chairman TB (15-16) The Board received and noted the Chair s report /16 Service User Story TB (15-16) The Board watched a video presented by a carer regarding his and his wife s experience of care on Crocus Ward following his wife s admission with early onset dementia. There were two episodes of care: an admission in 2013 which was described as not a happy experience as he felt he and his wife were not sufficiently informed or engaged; and a second admission in 2015 which was a much more positive experience where they felt treated as human beings, much more informed and aware, and feeling more in control. During the second admission, the use of talking books to engage his wife and better communications helped build a sense of partnership and supported preparations for discharge for his wife The Board reflected on the importance of carers, in particular the effective communication, point of contact and engagement of carers in the process of care. The Board previously had serious concerns about Crocus Ward and were encouraged by the improvements made since 2013 particularly with respect to leadership and standards of care. The Board explored continuity of leadership and discussed how the practice of redeploying staff during times of shortage has evolved to incorporate a more rigorous evaluation of risk, and how the Executive are exploring organisational development programmes to continue to grow and develop clinical leaders across the Trust. SWLSTG minutes of the Trust Board 3 December 2015 (part A) Page 3

4 The Board explored the extent to which a communications plan forms part of the service user s care plan, whether care plans are shared with carers, and how expectations of care are aligned between the clinical team, service user and carers. The Board asked Dr Whicher to pass on the their thanks to the carer for sharing his story and experience with the Board. The Board agreed to apply a focus on communication plans and care plans during their 15-Steps visits to clinical areas /16 Quality and Performance Report TB (15-16) The Board received the Performance Dashboard for October Ms Chamberlain guided Members through the primary risk areas as follows: CQC Requirement Notices In August 2015 the CQC reported on their assessment undertaken in May The CQC issued requirement notices for breaching four regulations relating to: (i) person centred care, in particular the use and effectiveness of care planning on Lilacs Ward; (ii) dignity and respect, in particular the layout of both wards for older people not complying with gender appropriate accommodation requirements; (iii) consent, in particular the need for greater understanding of the application of the Mental Capacity Act and Deprivation of Liberty safeguards on Lilacs Ward; and (iv) safe care and treatment, in particular the consistency of ligature risk assessment and subsequent management, ongoing administration of PRN medication and the recording of reasons, and placement of adult service users in older people s wards during periods of high demand for beds. The Board sought and received management assurance that appropriate project management arrangements are in place to address the concerns identified by the CQC. The Board acknowledged that more detailed examination and scrutiny of the progress to address the requirement notices shall be led, on the Board s behalf, by the QSAC at their meeting in December. The Board were satisfied that appropriate project management arrangements, led by the Interim Director of Nursing, are in place to restore compliance. A mock inspection is scheduled for January 2016 to test the organisation s readiness for the Chief Inspectors of Hospitals inspection later in the year. Ms Greenway confirmed QSAC have plans to review the progress to comply with the relevant requirement notices, and the output from the mock inspection, and confirmed intentions to report back to the Board and escalate any concerns as necessary Demand for Acute Adult Beds The Board acknowledged a heightened risk associated with increasing demand for care. Members agreed to discuss this issue as part of its consideration of the Board Assurance Framework Recruitment of Nurses The Board received an update on the progress of nursing recruitment. The Executive set out the arrangements to support colleagues through a range of SWLSTG minutes of the Trust Board 3 December 2015 (part A) Page 4

5 developmental strategies including preceptorship, alignment of national and local policy on preceptorship, development of supervision and support, and the introduction of a service rotational scheme to improve and develop knowledge and skills. Ms Stevens confirmed that the Trust had over-recruited to Healthcare Assistant roles to help mitigate the gap in registered nurse recruitment. The Board recognised that turnover rates remain high. The Board were advised that the top reasons cited as reasons for leaving include retirement, relocation and promotion. The Board discussed the impact of London weighting and recognised a need to mitigate the consequences in order to stabilise and further reduce colleague turnover rate. The Board acknowledged the need for experienced constructive human resource input into the development of proposals and plans to mitigate these risks. The Board sought and received management assurances that appropriate acting up arrangements have been put in place to cover the sickness of the Director of Workforce, Human Resources & Organisational Development. It was acknowledged that in some cases start dates had been delayed by employment screening processes. It was confirmed that additional support has been put in place to bolster and enhance recruitment practices with a view to reducing the time between offer and start date. The Board agreed the following action: To enhance the Board s assurance it would in future receive additional detail on the numbers of staff recruited and the size of the residual gap across the Trust. Ms Stevens agreed to develop the report accordingly Referral to Treatment Times - Incomplete Pathway (waiting community pathway) Ms Chamberlain informed the Board that although the Trust is achieving this target on aggregate, this target is not being met within the CAMHS Neurodevelopment Service. This service has experienced increased referrals placing it under considerable pressure, and there is currently insufficient capacity to meet current demand for the service. Members received management assurance that discussions with commissioners remain ongoing in an attempt to address the issue. The Board sought assurance that every patient waiting is captured in the measure of performance. Ms Chamberlain advised the Board of the work to expose and address hidden waits in Improved Access to Psychological Therapies (IAPT), and confirmed to the best of her knowledge there were no other concerns regarding hidden waits. The Board discussed the increase in people waiting over 18-weeks and explored with the Executive the projected outturn by the year end. The Board were advised that the surge in demand, and thus the deterioration in performance overall, is attributable in particular to two services: (i) Autistic Spectrum Disorder and Attention Deficit Hyperactivity Disorder solutions to this are under consideration by the Executive, and this remains unresolved at the time of report; SWLSTG minutes of the Trust Board 3 December 2015 (part A) Page 5

6 (ii) Neuropsychiatry the Trust has appointed an additional consultant that will increase capacity to handle the volume of referrals in accordance with relevant access standards week Breach The Board were informed that a 52-week breach occurred in October in the Richmond Memory Assessment service. The breach has been reported and classified as a serious incident. Initial investigation has shown that the breach was caused by human error. The service user has been contacted and treatment commenced on 18 th November The Board expressed concern at the breach, and sought and received management assurance that controls governing the Access Centre are being monitored closely to help mitigate the risk. Ms Chamberlain confirmed the intention is to move as quickly as possible to an electronic referral management system CQUIN: Physical Health Cardio-metabolic assessments (CMA) The Board noted an increased risk of under achievement in quarter 4 against the CMA requirement to ensure 90% of inpatients, and 80% for early intervention services receive CMA. The Board noted the concern /16 Finance Report TB (15-16) Mr Parr report to the Board that the Trust remains on track to achieve its original planned surplus of 1.6m. However, as previously report to the Board, the NTDA has applied a stretch target of an additional 1.05m surplus in 2015/16 making the Trust s revised financial target of 2.6m surplus for 2015/16. The Trust is 900k short of the revised 1.7m surplus for Month 7. The Trust continues to engage and work with commissioners to ensure the revised 2.6m surplus is achieved overall, but the effect of mitigating unplanned demand for services puts the full achievement of the revised surplus target at risk. The Board were informed that the Audit Committee reviewed debts that remained outstanding since 31 March 2015, and a number of actions were agreed to encourage early settlement. The Trust s is currently evaluating the implications of Monitor s price cap, which came into effect on 23 November 2015, on the Trust s temporary staff expenditure. The Board discussed the finance report. It sought and received management assurance that the Trust is actively engaged with commissioners to secure funding allocated to Mental Health in the Comprehensive Spending Review. Mr Parr informed the Board that he is awaiting clear guidance from NHS England on party of esteem and urged Members not to raise expectations until this had been clarified. The Board were encouraged by the progress made to recover debts. Mr Parr drew the Board s attention to the increased risk of a lower than planned surplus at year end, and the need for additional long-term SWLSTG minutes of the Trust Board 3 December 2015 (part A) Page 6

7 investment to address increasing demand for services. Mr Parr confirmed he did not believe any further inputs available across the system. The Board noted the report and acknowledged the increased risk of not meeting the stretch target and planned surpluses in year /16 Statement of Purpose TB (15-16) The Board reviewed the updated Statement of Purpose, a requirement of the Trust s Certificate of Registration with the CQC. The Board approved the Statement of Purpose /16 South West London & Surrey Downs Healthcare Partnership TB(15-16) The Board considered and approved the governance structure and the terms of reference for the South West London & Surrey Downs Healthcare Partnership. The Board welcomed the initiative to encourage greater integration and looked forward to engaging with the partnership /16 Patient and Public Involvement Progress Report TB(15-16) The Board received details of the establishment of a Patient Quality Forum. The Forum will encourage and promote service user engagement and representation in helping the Trust design, develop and continuously improve services to meet the needs of service users and carers. The Board welcomed the initiative and noted the update. The need to clarify issues associated with integration with other groups was noted, particularly the relationship with existing Borough groups and how new members of the group will be recruited. The Board agreed the following action: Dr Whicher will update the Board in February 2016 on the relationship between the Patient Quality Forum and existing Borough groups, and how new members of the group will be recruited /16 Board Assurance Framework TB (15-16) The Interim Director of Nursing introduced the Board Assurance Framework (BAF) and drew to the Board s attention the key changes since the last report. It was confirmed that the corporate risk register and BAF into which it feeds, are kept under constant review by the Executive and reassessed regularly. It was also confirmed that the Audit Committee had reviewed the BAF at their meeting held on 1 December The Board were informed that two potential risks were deemed by the Executive to be significant threats to the achievement of corporate objectives: Risk 564 Bed Pressures (rated 16); and Risk 246 potential risk associated with the tendering of CAMHS T4 and Forensic services (rated 15). SWLSTG minutes of the Trust Board 3 December 2015 (part A) Page 7

8 230.2 The Board reviewed the mitigation for bed pressures and recognised gaps in control (in respect of mitigating current levels of demand) and assurance (in respect of the Trust s capacity to absorb surges and the thresholds beyond which effective internal control would be put at risk. The Board planned to discuss and debate counter measures to address capacity and demand, alongside the financial implications of doing so, during Part B of the meeting. The Board challenged the Executive s evaluation of risk in respect of CQC compliance, in light of the recent notices served on the Trust. The Interim Director of Nursing outlined the changes that had been made to enhance control over CQC compliance, but agreed to re-evaluate the risk and report back. The Board also explored whether the risks associated with effective programme management capability, delivery of planned surplus and workforce are appropriately reflected in the BAF. It was confirmed that both the financial and workforce risks are reflected in the BAF, but pursuant to the Board s discussion to mitigate bed pressures, exposure to these risks may subsequently change and therefore require re-evaluation. It was confirmed that at the Audit Committee on 1 December 2015, the Director of Finance had agreed to assess and evaluate the risk relating to programme management capability and capacity and reflect this risk, along with the risk treatment, within the BAF in readiness for the next scheduled report. The Board agreed the following action: The Interim Director of Nursing agreed to re-evaluate the risk of CQC noncompliance and report back to the Board at the next scheduled review of the BAF /16 Proposed Trust Values TB(15-16) The Board received a proposal to update and refresh the values and behaviours which guide how colleagues work with patients and with each other The Board approved the values and behaviours and agreed to consider, at a future Board development event, how the Board needs to adapt in order to model the values and behaviours in its work /16 Roselands Clinic disposal TB(15-16) The Board reviewed the business case to dispose of Roselands Clinic in Kingston and associated land. The recommendation to the Board was to approve option 2 proceeding to the disposal of the property and associated land. The Board received assurance that issues relating to the legal title of the property have been resolved, and that legal advice received confirms that the Trust can now proceed the sale through to completion. The Board approved the declaration that Roselands Clinic and associated land be deemed surplus to the functional needs of the Trust, and approved the commencement of the disposal process /16 Minutes of the Quality and Safety Assurance Committee held 15 October 2015 and verbal report from meeting on 19 November 2015 Part SWLSTG minutes of the Trust Board 3 December 2015 (part A) Page 8

9 A TB (15-16) The minutes were noted. The Board were informed that the timing of the QSAC meetings will be changing from January 2016 to allow better synchronisation with the publication of the Trust s Quality Report /16 Minutes of the Finance and Investment committee held on 26 October 2015 Part A and verbal report of meeting held on 23 November 2015 Part A TB (15-16) The minutes were noted /16 Opportunities for Members of the Public to ask questions John Morrill, on behalf of Voicing Views, welcomed the establishment of a Patient Quality Forum. He expressed concern that the level of communication and engagement with all stakeholders gave rise to the impression of a closed-shop. Mr Morrill also invited the Board to reflect and consider the extent to which sufficient attention is given at the point of assessment to a service user s sexuality. He informed the Board of a Lesbian, Gay, Bisexual and Transgender project in Wandsworth, and suggested the Board may wish to develop links with the project to help meet the needs of the LGBT community going forward. The Board thanked Mr Morrill for his feedback and support for the Patient Quality Forum, and agreed to reflect on the approach to communication and engagement with stakeholders to the success of the Patient Quality Forum going forward. The Board welcomed the opportunity to talk about LGBT issues. Dr Whicher, on behalf of the Board, confirmed her intention to meet and discuss the issues Martin Haddon, representing Wandsworth Healthwatch, urged the Board to communicate the outcome of the Board s discussion on bed pressures. The Chairman confirmed this would be done /16 Verbal report on the Audit Committee meeting held on 1 December Mr McCusker, Audit Committee Chair, updated the Board on the meeting of the Audit Committee held on 1 December He drew the Board attention to the deep dive into programme management and highlighted the Committee s concern about the lack of skills and robust programme management. He confirmed he was satisfied with the assurance given to the Committee that the programme management methodology and auditable standards will be developed as a draft in January 2016 and audited later in the year. The Board noted the update /16 Any Other Business SWLSTG minutes of the Trust Board 3 December 2015 (part A) Page 9

10 237.1 There being no other business the meeting closed at 11:05am. Mr P Molyneux Chairman December 2015 SWLSTG minutes of the Trust Board 3 December 2015 (part A) Page 10

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