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Apologies
James Kellock, Non Executive Director
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Agreed Minutes of the Board of Directors meeting held on 3 rd December 2009
– AH It was agreed at the meeting that we were going increase the number of Governors in the short-listing part of the process to six but not at the interview stage.
The minutes were agreed as a true record subject to this amendment.
Matters arising
Page 2 – Monitor Board Programme on Quality. SF - At the last meeting the
Board agreed to participate in the Programme facilitated by McKinsey. The workshop is on 27 th January followed by a mirror workshop at Oxleas. They have asked about other ways in which they can help us deliver our strategy. This can be thought through at the workshop on the 27 th January.
Page 3 – Progress on greeters. WB has spoken to some members of the User
Carer Council. The proposal will be presented at the next meeting.
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Page 3 – Board level inquiry. SF – At the last meeting it was reported that South
London and Maudsley would be also be undertaking an Inquiry in relation to the incident involving a CAMHS service user. Following further discussion, there will be one Inquiry led by Oxleas. There will be an independent consultant psychiatrist and a Clinical Director from South London and Maudsley on the panel.
Page 5 – Belmarsh. JE – Oxleas was short listed and invited to attend an interview. This was cancelled two days before the date of the interview as there was a financial shortfall between all tenders and the funding available. We have been informally advised that Greenwich anticipate going back to the Pre Qualifying
Questionnaire (PQQ) stage. We expect to hear soon about the next steps.
Page 7 – Workforce recruitment. AT – There was discussion at the last meeting regarding the length of time it takes to recruit staff and the availability of information on this. Are there any ways this can be achieved?
SH – We are putting together the report but we have not been able to get the data in time for this Board meeting.
Page 9 – Mental Health Act Annual Statement. SF – The Commissioners were invited to this Board meeting but are not able to attend until March.
Page 10 –Helpline/Patient Promise letter. SF – This initiative went well. There was positive feedback from staff. We had 93 calls in the first 5 days plus a small number (about 6) emails and letters. We are now receiving one or two letters a week and some emails. Analysis will go to both the Patient Experience Group and then reported to the Governance Board. There was no overriding theme. There was a spread of concerns; no major single issue and no single directorate received more concerns than others. DM manned the helpline for the first hour and said that one common issue came from CAMHS. It was carers wondering why they got the letter. Once explained they were very pleased to have received it.
Page 11 – Quarter 2 Monitor Self Certification for Governance. SF Contacted
Monitor and explained the reasons why Oxleas had declared full compliance. They asked us to send the audit trail of the decision. AR sent the information on which the decision was based and there has been no further response from them. Monitor will be visiting the Trust on 5 th February, as part of their twice yearly visit programme, so we may have further discussions then.
General comment about the minutes of the meeting. AH - in the past
Auditors have said that the minutes have been too bland. I think these minutes particularly show the amount of challenge, the amount of answers to challenges and are a much better record of what actually goes on at the Board.
DM – Agreed, compliment to AR.
Chief Executive Update
The NHS Strategy 2010 – 2015,
was published on the 10 th
December. A full copy was distributed with the Board meeting papers. SF attended the launch and there is no radical change in direction. There is much more of a focus on early intervention and prevention, personalisation, an emphasis on patient experience and more productivity whilst also safeguarding quality. There will be a more detailed presentation at the Away Day in February.
PW – In terms of the Away Day, would there be merit in us having available the
Conservative’s health policy paper that came out last week for additional information?
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SF
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DM – Agreed this would be useful to the discussions/ decisions.
National Patient Survey.
The CQC are focusing on community patients this year. The questionnaires go out on the 15 th January to 850 Oxleas service users that have used community services between July and September. Just over 60% of the sample are on standard CPA.
Nearly 40% therefore are on enhanced CPA. This is an important point as there are many questions about CPA, care plans and care co-ordinators. The questions and areas are similar to last year. We are trying to increase the response rate. SF has written to every patient who will be receiving the survey attaching the Promise. Also a poster has been sent (one for each borough), giving local advocacy advice, and where people can get help and support. We have also doubled the amount we will pay from £5 to £10 to a local user group for every questionnaire that is returned.
We are sharing the names of the sample with care co-ordinators to that they can actually speak to people, not tell them how to respond to the questionnaire, but to encourage them to respond, reiterate the messages, tell them about advocacy etc.
The Operating Framework 2010/11
The Operating Framework has been published. The key messages coming out of the Framework are three-fold; none of them are a surprise. The NHS budget is under huge pressure as never before and the pace and scale of change required to deliver high quality services in this environment is exceptional. This is mentioned frequently within the plan. What is also very clear is that quality must continue to drive all that we do and there some helpful messages in the Operating Framework.
There is a strong emphasis on patient confidence and safety. The fourth priority around experience, satisfaction and engagement is very prominent.
In line with the patient confidence and safety driver within the framework, there are a number of structural changes that are taking place. There are legal rights enshrined in the NHS Constitution that will come into force this year, particularly in relation to waiting times and access to cancer services and the Government have asked a Parliamentary Committee to produce, what is called, the ‘
Report. All Trust Boards are asked to take account of this Group’s report. This requires Chairs to continue their leadership on the NHS Constitution. In the
Report it states that Boards should consider inviting patients and staff to share their stories at Board meetings. FT Boards need to describe how they have regard to the Constitution in their annual report. Boards should be encouraged to support frontline staff to ensure that care provided is around the Constitution rights.
There are other structural changes that are being put into place to support the emphasis on patient confidence and safety. The Board is already familiar with the new system of regulation that will come into force from 1 st April. We have not yet had a definitive view on the proposed National Care Service but consultation has now closed. This will put in place a national system for the provision of social care.
Also clearly stated in both the five year plan and Operating Framework is that all
Trusts will be Foundation Trusts by the end of 2013/14. By the end of this coming year Strategic Health Authorities will need to have received plans from all Trusts about how they are going to achieve this.
The DoH is also committed to putting in place a number of supporting programmes to enable the five national priorities to be met, detailed on page 2 of the enclosed report. A number are in the process of, or will be rolled out in the coming year.
There are a number of system levers and enablers which are going to be put in
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Item place. Three most important are: finance, workforce and commissioning. Finance – we have had a lot of discussion here about the pressures facing the NHS and we are developing our finance plans and our Cost Releasing Efficiency plans are developing in line with the Operating Plan reductions. In the Operating Plan it says there will be zero uplift on tariff, just inflation only, and the latest NHS London figures are saying that there will be a 0.5% reduction from 2011 onwards.
SF – The inflation uplift refers to the PCT allocation. This is the last year of the three year spending review where there was the commitment between 5.1% and
5.5% uplift. For the following two years this will be inflation only. There has never been two years in a row, since 1948, when the NHS has had inflation only in place.
HS – There will be additional challenges which are not mentioned in the Operating
Plan. For example, the pre-budget plan identified a 1% increase in National
Insurance costs in 2011 which will have an impact. As we know over the next three years the NHS as a whole is expected to achieve £10billion efficiencies and the
Operating Plan identifies a number of ways that can be achieved. Some of the savings will be made by cutting consultancy costs and there is also a commitment to reduce SHA and PCT management costs.
Mental Health Payment by Results (PbR) is specifically mentioned. It is stated that all health economies are expected to start using the currencies in shadow form this coming year and that local health economies should have local prices in place by
2011/12 based on clusters. We have talked with our Commissioners about this.
In terms of the workforce levers, a number of proposals are made around flexibility, mobility and sustained pay restraint. We know that there will be no pay increase for consultants and senior managers. Agenda for Change will be honoured but the review body has not put in for any further review of pay. GPs will not be expected to receive any increase in income this year and perhaps for the first time practices are expected to make a 1% efficiency.
There is also a clear expectation that Trusts, and Boards in particular, will pay attention to both staff satisfaction and engagement and those Boards will provide leadership around the management of sickness and absence.
The Plan wants bold and capable Commissioners and is putting in place a
Commissioner Performance Framework. The DoH is going to support Commissioners by extending the work they are currently doing on all standard contracts. By March
2010 PCTs must agree with SHAs what the future will be for provider services. The
Plan does not indicate a preferred option, it leaves all options around integration open. However, the White Paper does give a great emphasis to integration with existing acute or mental health trusts. What is clear is that Commissioners will need to commission their community and their acute services differently, there will be clear expectations about them shifting the balance to out of hospital care and it is said that the Department will put in place demanding national standards for reform in this area.
Our Service Development Strategy reflects virtually all the relevant priorities that came out both in the White Paper and the Operating Plan. Some amendments are being made. Our financial planning is well under way.
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HS asked the Board to note the planning timetable: National Contract for MH should be published this week; contracts will be agreed by 1 st March and to be signed by
15 th March; final SHA plans on 26 th March and the Department will sign off plans in
April. We also need to note that much of what is in the Operating Plan will need to be reflected in our Quality Accounts by June.
DM – Any comments, issues, concerns, implications?
AT – Management costs, reduction for PCTs at 30% seem huge.
SF – This may be solved by mergers.
AH – Page 7, the Vital Signs - are MH Trusts subject to MRSA and C Diff targets?
HS – The Vital Signs have remained virtually unchanged, and the ones that are in the Tier 1 vital signs are for all Trusts where they are relevant so certainly MRSA.
AH – The concern I have with that is when you are looking at percentages and we have such small numbers two cases of C Diff can put us up 50%.
WB –They do make some allowances if you have such a small number of cases; we have never had an incidence.
SF – We will double check.
DM – NHS Constitution will be on the Board Agenda for the February meeting. One question behalf of JK. Learning from the Inquiry - Sir Jonathon Michael Report
(Learning Disability). Have the implications been discussed?
SW – It has been discussed at the Executive Team and there has been some work.
It is actually about mainstream services. The report technically does not apply to
MH Trusts and LD Trusts. Primarily it is around care provided by acute hospitals. It is, however, being interpreted as applying to every NHS Trust and I will provide a report to the Board for February.
SJ – About all Trusts having plans to reach FT status, how many FTs are there at the moment?
RP – 125.
SJ – So doubling Monitor’s workload.
RP – 2013 was the next date and to do that they would have 50 applications per year, 62% are successful, currently Monitor are processing about 4/5 each year.
SF – Previously there had been a list of 20 challenged trusts. I think there is a question mark against some MH Trusts.
SJ – What are the implications for those?
SF – The Department needs to formally develop a failure regime.
WB – Add to comments about LD, we are also reviewing within our Equality &
Human Rights Framework, our progress around disability duties.
PW – Is there anything that suggests the Government are going to be implementing the Dementia Strategy?
HS – Only reference to dementia is in the priorities section of the Operating Plan. A range of different services are mentioned including dementia but it does not have a key focus.
SF - The SHA or PCTs have not discussed the Dementia Strategy with us.
DM – The Board is asked to note the briefing.
New Service Developments
Transfer of Bexley Community Services
The Board were asked to note the front sheet. SF gave further updates from the
Integration Project Board meeting held on Tuesday 12 th January. DM and SF met with the Chair and Chief Executive. Bexley PCT has made a revised offer which essentially halves the £350k budget gap that is identified in the paper. This leaves a shortfall of around £179,000 on the c£16m costing of what we estimated was needed to deliver the existing level of service. Given that finance was now agreed,
Action
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SW
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Item we will address the other challenges such as the Service Level Agreement arrangements around RiO. The draft SLA is expected by the 18 th and that will be checked by PWC to make sure that it gives assurances to the Board around information governance, confidentiality etc. Similarly, leases/licenses are being drawn up for estates. Staff consultation has already begun. In terms of
Governance, we have seen their CQC Quality and Risk profile and we will need to take account of this in terms of addressing governance. We are meeting with the
Cooperation and Competition Panel on the 28 th but Bexley Care Trust have already met with them and have been told verbally that the Panel will approve the transfer to Oxleas. Formal approval is expected by the 8 th February. The next steps will be agreeing and signing contracts. We are having some input into their Annual Plan which will be sent to the SHA. We are meeting with Monitor on 5 th February and we will brief them on where we are in the process. We will need to formally meet with
Monitor. This needs to be around March time if 1 st April transfer is to be achieved.
AT – When will there be final sign off at the Board?
DM – March Board is appropriate together with a short, medium or long term action plan or 100 day plan on how we will incorporate new staff.
AT – There will be further discussion at the Away Day in February?
SF – Yes there will need to be a final sign off where the Board needs to self certify.
The February Integration Project Board will be critical because at that point we should have both the SLAs around the IT and Estates with the external opinion on them. If there are major concerns these will need to be raised with the Board in the interim.
Greenwich Community Services
SF – As mentioned at the last meeting, the survey of staff in Greenwich community services demonstrated that the preferred option among staff was Oxleas. The PCT will want to speak to us in January about the process for tendering.
Director of Service Delivery Report
CAMHS Tier 2 Bromley
Work around integrating Bromley CAMHS Tier 2 service is progressing. SW met with the staff in Tier 2 as part of the formal consultation process and was very positive.
Today there was a formal consultation with our own staff in relation to integration.
There are still some issues to be resolved, particularly around the accommodation with the PCT, we are on track for a transfer date of 1 st April and anticipate bringing a paper to the March Board asking for the Board’s approval.
SW – The staff meeting was very positive on both sides.
Service Development Strategy (SDS)
Service Development Strategy work is continuing, updated in the light of the White
Paper and the Operating Plan. We will be speaking about the SDS with our senior staff group next week. The SDS will be brought to the Board Away Day in February for final sign off.
Security at the Bracton Centre
The planning application has been made and the local community will be invited to view the plans.
JE – There are 3 x 3 hour slots which have been identified. The appropriate response is to have an exhibition to give people time to talk to us and reassure them that there is no difference and no cause for concern.
Contracts
We are working with our three PCTs. The 1 st March is the deadline for the standard mental health contract. Progress has been held up as it is difficult to obtain director level involvement within the PCTs.
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Kent prisons.
This is progressing with a number of challenges. The number of staff being TUPED across is much greater than anticipated. Fiona Starkey Norman is going to be seconded for three days a week for the next six months to act as the operational manager. Discussions are taking place to return the scheme back to the model that was previously talked about.
AH – Increase in the staff being TUPED - is this within the financial envelope or is it agreed?
JE – Yes it is, all within financial envelope.
DM – Board to note update.
Key Performance Indicators Exception Report November 09
Continue to meet all of Monitor’s targets.
In relation to our own Plan targets:
 Carers. 40% of service users have carer details recorded and an additional
17.5% are recorded as having no carer. 60% will be met by the end of March.
 Clinical Quality: Continue to perform well on reporting incidents after a very slow start early in the year.
 Social inclusion: We are changing the way we are reporting information about employment. This is to meet the minimum data set requirements. Therefore, figures are not available this month and may not be available next month.
Currently we have 77%, this may change due to the reporting changes.
 Psychological Therapies: We have exceeded the target of percentage of Trust caseload who are receiving psychological therapies; this is now up to 18.6%.
One area of concern is the continuing number of people that we have across our three borough services where no CPA level is recorded. The Service Director group is very focussed on this.
DM – Are we more hopeful about the result as it has been an issue for a while?
HS – We are doing borough by borough breakdowns to identify who the people are.
Bed Occupancy
There is a relatively good picture in Bexley and Bromley. Bromley continues to perform extremely well and the high rates that we saw in Bexley have decreased.
Greenwich is showing 116% bed occupancy but that has been a relatively consistent picture for a number of months and in fact is a reduction. Older adults bed occupancy continues to show strong performance.
PW – At the Social Inclusion Steering Group yesterday we looked more broadly across the different indicators around Social Inclusion and it does feel as though we are making some good progress.
DM – At the last Performance Committee SH presented an initial paper on nonnursing agency spend and is doing further work and will be coming back to the
Performance Committee with proposals in February. This will be presented to the
Board in March.
The Board had discussed previously about reviewing KPIs and what needed to come to the Board in the light of all the changes. The Executive are looking at the KPIs.
IO is leading on quality indicators with the support of the Board and there will be support for that within the work we are doing with McKinseys. There will be noticeable changes in the Board agenda around April. There will be Board level
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Item performance indicators linked to each section around operation, HR, quality, finance and governance. There will be much more precise and concise critical success factors.
Finance Report
EBITDA
The EBITDA is still above plan but at lower favourable variance than last month, and with the adverse level of interest receivable, the surplus is marginally below plan.
The main change in the month relates to adjustments and changes in Greenwich income.
Income
Income is £723k above plan. There has been some adjustments to Greenwich income relating to West Park and CAPE as it is now expected that this income may not be achieved (NB since completing the accounts there has been some movement on the CAPE income.) There is also a reduction in the Tarn income. The effect of the income changes accounts for nearly all the movement against plan for EBITDA and surplus.
Expenditure
The expenditure overspend is marginally improved at £631k adverse.
Staff costs continue to show increasing underspending and are now £809k below plan. Conversely the non-staff costs are increasing with nearly all cost categories being overspent against plan except drugs and utilities. UEA/CPC shows a falling expenditure and is now only £158k above plan. Bank and agency nursing has reduced for the third consecutive month.
CRE savings have achieved 66% of the target.
Forecast
The year end forecast is for the EBITDA and surplus to be significantly above plan, and this could be further affected depending on outcome of discussions over provided income and costs.
Risk Rating
The risk rating is 3.7. The reduction is due to the reduced rate of the surplus.
Balance Sheet
Fixed asset spend continues at well above depreciation levels.
Cash increased to £47.5m.
AH – It looks like Bexley and Bromley are not going to achieve the CREs.
RP – Bromley, because of the Change Programme it may taking longer.
AH – Can any of the areas that have already achieved the CREs take a bit more.
RP – If an area, such as Bracton, is over-achieving on their income which they are doing, that is shown on the accounts as an over-achievement on income. It would not be shown as an over-achievement of CRE.
AH – Are there details of admin and clerical agency spend?
RP – Yes that can be provided.
SF – Bracton expenditure was raised at the Executive meeting because it had the biggest trend change in the month. It was achieving £100,000 favourable each month and this stopped. Given income is still the same; we wanted to look at why costs have increased.
DM – The Board tend to concentrate on those areas that are problematic but very rarely comment on those that are favourable. This year’s figures for Bracton and
CAMHS are remarkable and the turnaround in Greenwich compared to last year is also remarkable.
Workforce Report
Sickness absence up in October, largely reflecting the onset of colds and flu.
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However, all but two directorates managed to keep their sickness rate under the
Trust target. There is a spike in Forensics and this looks like it is going to continue into the following month.
DM – Is the sickness rate in Forensic due to flu or injuries?
JE – Not injuries. Colds/ flu and other general sickness.
SH – This is a spike rather than a trend.
SJ – When we review the KPIs whether we could get slightly more recent data?
Vacancy rates were slightly up in October. The principle increase being Greenwich and LD services. There has been a decrease in bank spend. Nursing agency spend has increased and we believe this is reflecting some difficulties in fill rates in certain areas. Bromley is traditionally a very difficult area to fill and sometimes have to resort to nurse agency.
Early indications for the results of the staff survey for 2009 show our response rate is up considerably. Early indicative results of the whole survey are looking very positive, of the 150 questions we scored significantly above average in around 70.
We scored significantly below in two and we were average or above average in all of the rest. The big caveats are it is only comparing us with the other 14 organisations who use the same survey providers.
DM – Question from JK: Highlights talk about staff response rate to NHS survey.
While showing improvement it is still low, do we need to do something to get a greater input?
SH – Our response rate is significantly above average.
Governance Report
Incidents – We have lower numbers of serious untoward incidents (SUIs) and we are maintaining an improvement in the reporting of lower level incidents. The Board were asked to note that the NPSA report shows there were no severe harm incidents and an increased number of no and low harm incidents.
Infection control: One Norovirus outbreak (winter vomiting) and two skin colonisations. 87% of people have completed infection control training.
Safeguarding children: Referrals are double where we were this time last year which is positive. More under item 12.
Mental Health Act: Less positive picture. We are still experiencing problems being able to demonstrate explanation of rights and full adherence to policies and requirements around consent to treatment. These are being looking at on a case by case basis. Lisa Moylan has been following these up with individual teams. We have done an analysis of the Mental Health Act Commission reports which was shared with Service Directors earlier this week.
DM – Those two areas have been raised year after year after year.
IO – Discussed this at the CEG. We have agreed for the March Trust-wide Medical
Advisory Committee that we would have someone from the Mental Health Act
Commission come and talk to us. This is a priority.
Complaints - No exceptions to say about complaints. 61 year to date, slightly less than the same period last year, raising 172 issues. It is worth noting that the issues around attitude for the second consecutive month are within the target we set of
20%. Discharge surveys and the Patient Experience Tracker shows good overall satisfaction around attitude of staff.
DM – Comments?
AH – Page 23 in the discharge survey shows quite a reduction in response rates.
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WB – There was a significant reduction in response in Greenwich and we are following that up.
TE – There may be reasons relating to the recent postal strike as numbers are dependent on people filling the forms in when they go home, they are not filled in on the ward.
TE – Prior to that Greenwich has had a good record.
WB – What we have also asked, and had some discussion both via nursing colleagues and through the Acute Care Forum, is to ensure that the results of the surveys and the Patient Experience Trackers are discussed at ward community meetings and actions agreed where there are particular concerns.
DM – Three questions from JK: SUI Inquiry overdue from 14 th October, are we satisfied that the delay in this case is justified?
WB – We understand why there has been a delay and we are following up. It will be finished by the end of January.
DM – Page 17 of the report - do we compare this data against population data to see if there are any particular ethnic groups that are being detained more than their proportion of the population would seem to justify?,
IO – I have received quite recently the London-wide summary which I wanted us to compare our rates against. I am keen that we look at that.
DM – Could we make sure if there is a variance it is highlighted? In London, and in particular in the 80s and 90s, the overuse by the Police of 136 for young Afro-
Caribbean men was a big issue, I don’t think it has ever been an issue here in
Oxleas but we do need to monitor this.
SF – I chair the Equality and Diversity Board and we don’t discuss these issues very often. It would be helpful to bring a summary.
Do we know who complains by ethnic group?
WB – We do not have a breakdown of complaints by ethnic group, but we should be able to develop this.
SF – If we bring a report looking at the representation of different ethnic groups for incidents, Mental Health Act, complaints and staff grievances, it may be a very helpful discussion to have.
Safeguarding Children Declaration
We published the enclosed declaration on 23 rd December. The target for training is
80% for level 1 and level 2 and 100% for level 3. We were able to demonstrate
93% compliance with level 3 training and just over 80% for level 1 and just under
80% for level 2. Figures taken from today show that we are over 80% for both level
1 and level 2 training which is really positive. We can now update the Declaration with the updated figures.
DM – Comments/questions. Good progress.
Monitor Governance Self Declaration for October to December 2009
Monitor requires Trusts to inform them of any plans to declare non compliance or insufficient assurance through the self declaration process. The Quarter 3
Governance declaration to Monitor is due at the end of January.
SF has checked with AR and Executive colleagues; we are not aware of any standards or targets that we are not meeting, we have seen the KPI report which is
Monitor’s compliance standards, we recently discussed Core Standard Compliance.
The Board agreed the recommendation that we declare full compliance.
Care Quality Commission Registration
We need to complete our application to be registered with the Care Quality
Commission at the end of the month for the different locations that we have identified. The Quality and Risk Profile received from the CQC is enclosed. AR has spoken to our assessor who has confirmed that it is a positive report but we do need
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Item to take account of the red areas and agree how we address those in our declaration.
The first one, and the main issue is, “no Local Security Management Specialist appointed”. We have identified a person, we intend to appoint on a six month contract before 1 st April to scope out the role and allow us to make a decision about a longer term solution.
DM – For the benefit of colleagues, could you just very briefly explain what a Local
Security Managements Specialist is responsible for?
WB – 2003 Directive by the Secretary of State requires every NHS organisation had to have a LSMS. This was largely aimed at Acute Trusts. We did map ourselves against the roles and how we were taking forward the responsibilities of the Security
Management Specialist. It is about improving security of the environment and safety for staff. We took a reasonable decision at the time but we now need to review that. We need have to have somebody who is accredited.
AH – There was a time we were told we had to have a fraud specialist in the Trust and we saved money by getting our internal auditors to provide that part time, we can’t do the same with this? One person for three or four Trusts?
SJ – Bexley also requires an LSMS.
WB – We have agreed that we will co-ordinate.
SF – I would like to understand more what the options are. A further discussion on what needs to be done will take place.
AR – Just to advise the Board that we do need to declare non-compliance on this even if we are going to have it resolved by 1 st April.
SF – Only other two red areas are to do with two aspects of the staff survey where we are in the bottom 20%. We are in the top 20% for work/life balance and staff feeling Oxleas is a good place to work. There is an amber rating for the underachievement of the CAMHS target. This was a self-assessment where we scored ourselves three out of four on all the items. Similarly with the Mental Health
Minimum data set, you might remember we had to hit 99% completeness and we were 0.2% short of this. There are two areas of criticism in the Mental Health Act
Annual Statement that need to be considered and we have broken that down by directorate and shared with Service Directors. Recommendations will be presented to the Governance Board on the 26 th January.
The Board were asked to agree a declaration of non-compliance against the LSMS requirement with a commitment to rectify the gap before April 2010, and that we move the Governance Board to the 26 th where a final decision on compliance in each of the 26 locations including consideration of the Mental Health Act can be taken.
Board members who do not normally attend the Governance Board are invited as the application needs to be approved by the Board.
DM – Comments.
DM – The recommendations are approved by the Board.
Quality Network Report for the Bracton Centre
The Bracton was recently rated as part of the Royal College of Psychiatrists Quality
Network reviews. The criteria used were developed in relation to the specification of
Medium Secure Services at the Department of Health. The Peer Review team visited in October and a very positive report was received. They were very impressed with the service, particularly with the staff’s commitment to work within an integrated multi-disciplinary team approach. They also noted there are very good levels of morale which is a credit to management and senior clinical colleagues within the service. A particular area of good practice was the provision of work opportunities
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Item for people. There is a very strong occupational therapy team within the Forensic directorate and it is good to see the hard work that they do reflected in the review.
DM – Comments or questions. Board to note. Well done everyone involved.
Psychological Therapy Benchmarking: Next Steps
KM reported on the National benchmarking exercise for psychological therapy. The period of data collection was between April and June and there was a conference in
November that we reported our results at. We participated in the exercise initially because we wanted to compare our performance with other Trusts but when we got to the conference we found that the other Trusts were unable to collect many aspects of the data required by the benchmarking exercise and it was impossible to make meaningful comparisons with our services with those of other Trusts except to say that our data set was by far the most complete of all the Mental Health Trusts that had participated. We have set our own commitments which are enclosed in the report.
In order to maximise our effectiveness in using the existing psychological therapists within our organisation we are: setting standards in relation to case loads, throughputs and activities. This is being incorporated in a job planning process where each psychological therapist will agree with their professional head and service manager very clearly what the main targets for their job are in patient contact, throughput, and some workforce training in a particular setting, running a supervision group on an inpatient ward.
DM – Comments or questions. The new commitments and plan, do they have a direct relationship to present and expected demand for psychological therapies, and similarly for existing and future waiting lists?
The action plan taken to the Board two years’ ago identified that to fulfil NICE compliant treatments for psychological therapy, 88 psychological therapists would be needed. If that were the case there would be no waiting lists. Over a five year period this works out at three new posts per directorate per year and in the first two years we have achieved that. There is a huge demand and we really need to keep focused on this area. We have a lot of work to do but with the support of Service
Directors we have achieved a lot in the last two years.
PW – Brilliant report. Do we have a sense of if and when it will be possible to do some prevention with some of the other organisations?
KM – We will participate again. I think there is some learning to do about how to measure this. Previous exercises have all been in acute medicine and the issues and data collection are quite different.
SF – Thanked KM for all the hard work put into this benchmarking and the leadership around the work. Just to note, for the discussion next time when we talk about the NHS Constitution, page 18 is – you have the right to drugs and treatment that have been recommend by NICE for use in the NHS. We have a five year plan but this needs to be addressed at the Away Day.
IO – We thought that the change that this would bring about not least with job planning would be efficiency, may be able to have 10% to 30% more psychological therapy time.
Audit Committee Update
Minutes of the last Audit Committee meeting are enclosed. After some years of trying to get a fraud expert time allocated to address staff inductions Audit
Committee are grateful to HR that this is now happening and this will help us move up from a level 2 to a level 3 in assessment of our fraud requirements.
Audit Committee also feel that more publicity should be given where there are
Action
Noted
Agreed
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18
Item resolved fraud cases in an attempt to deter staff from committing fraud. A section on the intranet may be useful. Debtors continue to be well controlled but we must continue to press for debts to be collected in the current economic climate to reduce the possibility of bad debt. There is action being taken to control contracts but feel that could be speeded up slightly. We are on track for conversion with our accounts to IRFS methods but there is an issue regarding segmental reporting, where nationally auditors feel that annual accounts should be segmented into various work streams. RP and Audit Committee are of the view that there is only one segment i.e. healthcare. The debate is national so we progress toward an outcome.
The Audit Committee are recommending to the Board two changes to the Capital
Expenditure Standing Orders:
 Reduce the required number of tenders from four to three;
 Increase from £100,000 to £250,000 Capital Expenditure reported to the Board where details have already been included in the Estates Annual Capital
Expenditure programme.
DM – The auditors are content with this?
AH – The auditors were present at Audit Committee and are content.
DM – Comments?
The Board agree the amendments to capital expenditure standing orders and note
Audit Committee report.
Council of Governors Update
The Council of Governors meeting was on 15 th December. The majority of discussion was around the SDS presented by HS, the Annual Plan and the Must do’s.
There was unanimous agreement on the way forward and some interesting and very positive suggestions about the actual wording of the Must do’s which was taken on board. The other main issue, mentioned last time, was around the Nominations
Committee process, not around the appointment of JK but around the process of the appointment. The concern was around the last stage; the presentation back to the
Council of Governors of the Nominations Committee recommendation. We made some amendments to the existing process which was universally agreed. In line with the Annual Planning process, the annual series of Borough Focus Group meetings, where members and Governors are invited along to have their say around our priorities for the forthcoming year, start next week. Bromley at Community
House on 18 th at 6pm, Bexley at the Marriott on 21 st at 6pm and Greenwich at
Charlton House on 27 th January. Everyone is welcome to attend.
Any other business
Next meeting
42 nd Meeting of the Board of Directors on 4 th February 2010
3.30pm Sundridge Park Golf Club
(following Board Away Day)
Action
Noted
th
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