65th Meeting of the Board of Directors
Thursday 12th January 2012
3.00pm Boardroom, Pinewood House
Board of Directors
Dave Mellish
Archie Herron
Anne Taylor
Sally Jacobson
Paul Ward
James Kellock
Seyi Clement
Steve James
Stephen Firn
Helen Smith
Ify Okocha
Wilf Bardsley
Ben Travis
Simon Hart
In attendance
Estelle Frost (For Item 15)
Ann Rozier
Keith Soper
1.
2.
Chair
Vice Chair & Non-Executive Director
Non-Executive Director
Non Executive Director
Non Executive Director
Non Executive Director
Non-Executive Director
Board Advisor
Chief Executive
Deputy Chief Executive & Director of Service Delivery
Medical Director
Director of Nursing & Governance
Director of Finance
Director of HR & Organisational Development
Director, Older People Mental Health Services
Trust Secretary & Head of Governance
Head of Compliance
Apologies for Absence
None.
Minutes of the Board of Directors Meeting held on the 1st December 2011
The action associated with DM and SF on page 1 should be regarding the Staff Performance
Award. The action relating to Crayford Day Centre should have HS’ initials alongside it.
Noting these amendments, the Minutes were agreed as an accurate record.
Matters Arising
Item 3 Staff Performance Award. The letter was sent to staff before Christmas. The
small number of responses supported and understood the decision. It was noted not all Non
Executive Directors had received a copy of the letter. This will be circulated again.
Item 3 Crayford Day Centre. Commissioners have confirmed the Trust is on one years’
notice (to September 2012) to vacate the centre and have also committed to review the
service alongside a similar service provided by MIND before deciding the future model of
provision. The Trust is making plans on the assumption the service will be closing.
Item 6 Tenders. SJ asked whether any additional feedback had been received following
the unsuccessful Greenwich UCC tender. Further detailed feedback had not been received.
The Hurley Group was the successful bidder.
Item 11 Hard Facilities Maintenance Contract. Further to the agreement to award the
tender to Norland at the previous meeting, SF detailed the two options available to the
Trust. Option 1 is for planned preventative maintenance only. The cost of this is £335k.
Option 2 includes planned preventative maintenance plus reactive works up to the value of
£500. Any works exceeding £500 will be chargeable to the Trust, minus the contribution of
the first £500. The total cost for Option 2 is £467k. The recommendation from the Director
of Estates and Facilities is the Trust takes up Option 2 since it provides a known cost ceiling
and significantly reduces invoicing. This includes an option to review at the end of year one.
The Board agreed with the recommendation to take up Option 2.
Action
Noted
Agreed
AR
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3.
Minutes of the Board of Directors Away Day held on the 24th November 2011
StJ and Sally Brydon had been omitted from the attendance list. Noting these amendments,
the Minutes were agreed as an accurate record.
Chief Executive Strategic update
Services coped well over the Christmas and New Year holiday period, demonstrating good
planning. Two serious incidents occurred; a suicide and an unexpected death. Planning for
the impact of the 2012 Olympics is continuing. The existing Olympic Planning Group is now
chaired by the Director of Estates and Facilities to provide senior scrutiny and oversight. The
Group is focusing on risks and required mitigation actions. There will be particular
challenges in respect of travel and transport. This has the potential to impact on community
teams. Plans are being developed to ensure our ability to deal with emergencies (s135 and
s136) is not affected. The Trust is in close liaison with the emergency services and has links
with the police planning group.
Action
Agreed
KS
Noted
AT - There will be significant road closures in Greenwich.
SF - GCHS undertake 500 home visits per day. We need to ensure services are maintained.
DM - Police leave has been cancelled over the period of the games therefore we also need to
consider the possible reduction in cover after the games have ended.
4.
The next Senior Staff Event is on 25th January 2012. Confirmed speakers are Sue Slipman,
Chief Executive, Foundation Trust Network and Chris Ham, Chief Executive, King’s Fund.
Actions from the Board away day
A draft marketing strategy has been produced. This takes account of the contents of the
SWOT analysis and Ansoff’s matrix completed at the away day. The key elements of the
draft marketing strategy are:
1. Action to strengthen marketing structure and capacity. This includes the
establishment of a Marketing Group, to be chaired by the Chief Executive. The
group will report to the Performance Committee. Also included is a dedicated team
to project manage tenders and enhance relationships with commissioners.
2. Action to improve our understanding of the market and our competitors, including
independent market research.
3. Action to improve our understanding of GP and commissioner views of Oxleas,
including research on GP and commissioner perspectives and how we need to adapt
our processes and practices.
4. Action to increase awareness of Oxleas and our broad range of services. This will
include branding and marketing campaigns.
Noted
The Trust Organisational Development Strategy has also been updated and expanded. The
revised document builds upon the human resources and workforce elements and links
closely with work streams including community services transformation; service development
strategy; IT strategy; budgetary framework; and the emerging marketing strategy.
PW - The marketing strategy needs to be based on the future service portfolio, both in terms
of breadth of services and geographical spread. The strategy also needs to consider the
organisation’s appetite for risk.
5.
The executive team will develop these strategies prior to further discussion at the Board
meeting on 2nd February 2012. SF invited PW to support the drafting of the document.
NHS Operating Framework
The NHS Operating Framework sets out the planning, performance and financial
requirements for NHS organisations and the basis on which they will be held to account.
Key themes - There are four key themes for NHS organisations in 2012/13:
1. Putting patients at the centre of decision-making
2. Completing the transition to the new system, building the capacity of emerging
Clinical Commissioning Groups (CCGs) and supporting Health and Wellbeing Boards
3. Increasing the pace of QIPP (the Framework requires cost improvement
Noted
2
Action
programmes to be agreed by Medical Directors and Directors of Nursing, involve
patients in their design and include in-built assurance of patient safety and quality)
4. Maintaining a strong grip on service and financial performance
Priority areas - The Framework notes the following areas will receive particular attention in
the coming year, all of which are relevant to the Trust:
 Dementia and care of older people
 Carers
 Military and veterans’ health
 Health visitors (the national programme to increase health visitors will provide an
additional 24 health visitor posts in Greenwich, but none in Bexley and Bromley)
An outcomes approach - The NHS Outcomes Framework has 5 domains and 60 indicators
and sets out the improvements against which the NHS Commissioning Board will be held to
account from 2013/14. The domains are:
 Preventing people from dying prematurely
 Enhancing the quality of life for people with Long Term Conditions
 Helping people to recover from episodes of ill health or injury
 Ensuring people have a positive experience of care
 Treating and caring for people in a safe environment and protecting them from
avoidable harm
BT - PCT allocations are up by 2.8% although they have been advised to hold back 2% for
organisational change and efficiency schemes, such as reducing hospital admissions. CQUIN
value has increased to 2.5% from the current 1.5%,
IO - CQUINs will be more closely linked to action rather than recording and counting. This is
likely to require some investment to be able to achieve agreed CQUINs.
PW - Useful to consider opportunities to capitalise on the integrated delivery of physical and
mental health care.
AT - Are we using information technology sufficiently to communicate with our patients and
provide access to their records?
WB - Text reminders are in use in some services.
IO - There is evidence such reminders reduce did not attend (DNA) rates. In addition,
technology could be used to remind people to take their medication.
6.
7.
The Chair commended HS on the summary document and the inclusion of carers needs in
the Framework.
Social Enterprise Company – Employment
Work on the project is continuing at a manageable pace. BT stated the proposal feels more
relevant than ever following the inclusion of two measures relating to employment in the
new NHS Outcomes Framework.
DM - We need to be mindful of our relationships with third sector colleagues.
IO - It is possible this could support the achievement of a relevant future CQUIN.
Key Performance Indicators Report – November 2011
The Trust remains on track with Monitor targets. The median arrival to treatment time at
the urgent care centre is above the target of 60 minutes at 72 minutes. The data is being
reviewed to determine whether there are particular times during the day / week when
waiting times increase. This is not a Monitor target but Monitor requires the Trust to report
the indicator to the Board.
Noted
Noted
IO - Currently the treating clinician does not know the length of time patients have been
waiting. A new form is being introduced, completed in triage, which will clearly state the
time by which the patient must be seen. This will be available to the treating clinician.
Occupancy rates at Step Up Step Down and the Bevan Unit have increased. Two income
generating patients were admitted to Atlas House.
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Action
StJ - The did not attend (DNA) rate for the LAC service in Greenwich is variable. 17% is high
for a vulnerable client group.
HS - Overall numbers are small hence the percentage changes. The Trust has appointed a
specialist nurse to support the service. Improvement is expected within three months.
AT - Do we always know the current address?
HS - A number of the children do not reside in the borough because of being placed with
foster families out of the area, however it remains our responsibility.
8.
9.
10.
The Board agreed to sign the Monitor declaration in relation to targets and indicators.
Director of Service Delivery Report
The Trust clustered 92% of the caseload by the December deadline. The target was 100%,
however there is no penalty associated with non-achievement. A ministerial visit from Paul
Bairstow MP reviewed the education and training programme provided to care homes on the
management of dementia and challenging behaviour. The project aims to reduce referrals
to secondary mental health services and admissions to hospital. It also aims to reduce
recourse to anti psychotic medication. A bid has been submitted to extend the work. The
Trust also received an award from NHS London for the best ‘tweet’ at Christmas.
SJ - Congratulations to CAMHS on receiving the first London Safeguarding Board award for
the Bexley and Greenwich Non Violent Resistance Programme.
JK - Congratulations to GCHS on progress against the UNICEF Baby Friendly Status.
AH – Are we confident we have the management capacity to deliver prison healthcare
services to Eastern and Coastal Kent?
SF - Management capacity and assignment of duties would need to be reviewed should the
bid be successful.
Finance Report
The Trust remains on track to exceed the Monitor financial plan. Up to the end of November
the surplus stood at £2.5m, with the underspend in Greenwich Community Health Services
(£2m) being the main reason. Cash levels are £5.5m above plan as a result of overall better
financial performance and a significant commissioner payment received in advance. The
Trust’s Monitor rating stands at 4.3 against a plan of 3. The Trust remains below target in
respect of CRE targets, with just under £1m of a total of £7.5m still to be identified.
AH - Bad debts are higher than plan due to a more aggressive process to write off debts.
JK - What are the plans for CREs for 2012/13?
BT - Expectation is the overall target will be similar to that in 2011/12. Services have known
about the requirement for CREs for some time and have been developing schemes. These
will be signed off by March 2012.
AT - Has there been any progress with the SLHT rent dispute?
BT - It is still unresolved therefore a provision remains in the accounts.
Fraud investigation
The Trust’s Local Counter Fraud Specialist (this service is sub-contracted to Deloitte)
conducted initial investigations into the alleged fraud. Deloitte have handed all aspects of
the investigation over to NHS Protect, the national organisation responsible for counter fraud
in the NHS. NHS Protect are conducting both a criminal and a financial investigation. The
Trust has advised Monitor. There has been no media interest. Before the police can take
the decision on whether to charge the individual, further evidence and paperwork is required
covering the whole period of the alleged fraud.
SJ - Recommend the language in the fraud update paper be revised to ensure the fraud is
described as alleged.
Agreed
Noted
Noted
Approved
BT
JK presented the KPMG independent review of the arrangements in relation to patients’
monies commissioned by the Trust. The KPMG review was received by a Board level panel
consisting of:
4
Action



Chair: JK, NED and member of the Audit Committee
Deputy CEO
Director of Finance
The panel recommends to the Board that all 21 recommendations set out in the KPMG report
and the 4 further recommendations made by the panel are accepted.
JK - Recommendation is that a project group approach is adopted to take the
recommendations and actions forward.
SC - The report highlights a lack of control and knowledge by the Finance department.
BT - The system was not designed correctly to detect the alleged fraud. Services generally
followed the established processes but there was an absence of proper oversight.
AH - It should be noted that it was the Trust that lost money, not patients.
BT - We will be required to include an explanation for the variance in the governance
statement within the annual accounts.
AH - The Trust met with internal auditors on 10th January 2012 to express dissatisfaction
with the level of scrutiny and negotiate recompense. A decision is expected shortly.
BT - Immediate action has already been taken in respect of the following issues:
 All cash ordering is now undertaken by the central Finance department.
 Spot checks are in place to check petty cash levels.
 Payments received from councils are now made direct to the Oxleas main account.
11.
The Board agreed the recommendations and the project group approach.
Workforce Report – November 2011
Sickness Absence - Sickness absence in November is recorded as 4.59%. This is a
marginal increase on the figures for October but remains low compared with previous years.
Older Age and Greenwich Community are reporting high levels of absence.
Vacancy & Turnover - Vacancy rates have reduced to 9.30%. The lowest vacancy rate is
in Acute and Crisis services (8.2%) and the highest is in ALD (14.6%). Vacancies are being
held prior to reconfigurations and CREs. Turnover remains at an overall low level.
PDR uptake - Overall Trust compliance is 72%. This represents a 1% improvement on the
position at the beginning of December. Bexley Community Services is the highest at 88%
compliant and Greenwich Community Services the lowest at 58%. Both Bexley Community
Services and Older Peoples directorates have met the 80% target. In order to achieve the
target of 80% an extra 260 PDRs are required to be completed.
National Staff Survey - The 2011 national staff survey closed in December. The Trust
response rate was 56%. Initial data is expected in February and the full CQC report
published in late March 2012.
Bank and Agency Usage - The data issues reported at the beginning of December in
relation to the new bank and agency system have not yet been resolved and so we are not
yet able to report with confidence on the overall numbers of bookings made in December.
AT - The number of staff listed as working at Banbury House appears very large.
SH - This is because all mental health complex needs community teams are associated with
this CQC registered location.
SJ - PDR uptake is still not improving at the required rate.
SF - Service Directors have been advised that further action is required to improve
performance.
SH - This is a performance management issue.
StJ - We need to target messages to those who have not undertaken a PDR.
AH - If it is not recorded on the system then it has to be assumed it has not happened.
WB - The new recording system does allow for retrospective entry.
PW - It appears there are particular issues in certain parts of the organisation and perhaps
more support is required to change the culture.
DM expressed the Board’s frustration at the lack of progress. SF proposed a stepped
approach which would include formal performance management action.
Agreed
Noted
SF/SH
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12.
Revalidation Software
The Trust has been working with Mango Swiss to develop software to support medical
revalidation in Oxleas. There has been significant interest in the product from other MH
Trusts in London. It is proposed that a Joint Venture company is set up between Oxleas and
Mango Swiss that would own, develop, and sell the software to other healthcare providers,
with a view to maximising the financial return to the Trust. Oxleas would be the majority
shareholder in the company and the Oxleas nominated director on the Board of the company
would report to the Trust Board of Directors via the Performance Committee. The company
would own the intellectual property. The proposed £40,000 loan to the company, to support
software development and market the product, would be repaid to the Trust once profitable.
Action
Approved
AR - Who will be the company secretary?
SC - Further work needs to be done on the structure of the company. In addition,
consideration needs to be given to dual directorships, directors and officers’ liability
insurance, the role of trustees and standard consultancy agreements.
StJ - We should not be put off by the work involved but do need to recognise any potential
conflict of interests.
SF - A concern is the potential reputational risk associated with a product that is delayed or
fails to deliver what is required.
IO - The software will not be showcased until it is fully operational.
13.
The Board agreed to establish the new joint venture company and invest £40,000 in the
development and marketing of the revalidation software.
Older Adults Serious Incident Report
This inquiry was commissioned by the Trust following the death of -- on 29th May 2011. -was a 64 year old married woman who had not used mental health services since 1992. On
26th April 2011 -- was brought to the Woodlands Unit for a mental health assessment and
was admitted. --’s husband found his wife on the morning of 29th May 2011. The post
mortem recorded the cause of death as:
1a Respiritaory failure
1b Citralopram, Propranolol and Alcohol poisoning
Approved
The panel was chaired by EF. Three main care and service delivery problems were found:
1. Incomplete understanding of mental state and associated risks
2. Planning of home leave not fully understood and well communicated
3. Management of medicines on the ward
An action plan has been developed, led by senior staff. EF has met with the family and
provided them with the general findings in advance of the approval of this report.
PW - Is there any support the Board could give in respect of ensuring adequate consultant
cover during periods of planned leave?
SF - This has been discussed with the clinical lead who has provided assurances adequate
arrangements are in place.
PW - There also needs to be more help for families in the reduction of risks relating to
suicide.
JK - Do junior staff regularly conduct ward rounds when consultants are away?
IO - It is variable but there is always cover and the ability to escalate. It is important to
define the role of the covering consultant.
DM - The two most senior clinicians would not be away at the same time?
IO - Correct.
StJ - How do we ensure progress against the actions from all Inquiries?
WB - The last Patient Safety Group reviewed serious incident recommendations and has
oversight of progress as well as producing a thematic analysis. Every inquiry is reviewed six
months following closure.
The Board approved the report and the recommendations.
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14.
Bexleyheath Serious Incident Inquiry Report
DM introduced the item explaining a significant amount of work had been involved in the
investigation and production of the report. Because the incident had been discussed in detail
at the previous meeting the chair of the panel, PW, focused on the investigation findings.
The panel investigated three main aspects of --’s treatment and care and found the
following:
1. The original conditional discharge decision under Section 41 of the Mental
Health Act in 2009.
The decision was properly supported and the correct procedure followed.
2. The multi-agency care and treatment of -- from 2009 to the incident.
There was much evidence to suggest the care provided was extremely good. -- was
compliant with the conditions of her discharge.
3. The events 72 hours prior to the incident on 10 October 2011.
There were some opportunities which may have reduced the likelihood of the
incident occurring.
Action
Approved
No single root cause was found but the following contributing factors were identified:
 The risk assessment, and consequent management plan did not adequately take into
account --’s risk to others in the context of her previous forensic history and her
evident relapse, nor was there adequate consideration given to the risk of her
absconding.
 Nursing staff did not prevent -- from leaving Oxleas House and did not follow her.
PW stated two meetings had been held with the family, which have been constructive.
15.
AH – Would the general public agree the conditional discharge decision was correct.
IO - It is more common for such decisions to be taken by a Tribunal. In this instance it was
based on the recommendation of the psychiatrist and agreed by the Ministry of Justice.
PW - There is evidence the decision was correct based on the improvements seen. The
process followed was legally compliant.
HS - The previous Tribunal hearing six months prior to the conditional discharge
acknowledged the progress made and was aware discharge was imminent.
DM - The point about the conditional discharge decision would carry more weight had there
not been a gap of over two years between the discharge and the incident.
SF - It is worth noting the reoffending rate from medium secure units is very low.
JK - The report does not specifically state this could have been prevented had we acted
differently and could appear defensive.
SF - Staff in Oxleas House did not know -- had been brought in by police and did not
consider her to be at risk of harming herself or others, or of absconding. It is the case that
staff did not consider her forensic history and recognise the potential risk.
JK - Can we check this detail in respect of police contact is in the report?
SC - Did staff have access to RiO?
PW - In Oxleas House, yes. The lack of availability in A&E was not a contributing factor.
JK - The patient called her CPN four times without success when she was in need of help.
PW - The patient had a clear crisis plan, which stated she should attend A&E when in crisis.
HS - We will check there is a divert in place to the Bracton Centre. There would be no
expectation the CPN would answer out of hours.
JK - Could we not have held -- in Oxleas House.
WB - -- had agreed to stay of her own volition.
SJ - Perhaps the report should include detail of all the interactions with services to
demonstrate the many contacts there were between conditional discharge and the incident.
The Board approved the report and the recommendations subject to any late revisions
agreed by the Chair.
Quality Report – November 2011
QSIP (mental Health) – There is one red rated item following the reduction in section 132
compliance.
QSIP (community health) – There are two red rated items, HPV immunisations and
WB
Noted
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Action
pressure ulcer reduction. This also threatens achievement of the related CQUIN.
CQUIN (mental health) – Good progress has been made in complex needs and recovery
services in ensuring GP discharge summaries are produced and sent.
CQUIN (community health) – The systems in place for identifying and investigating
pressure ulcers in community health services are sound, yet there is further work to ensure
lessons are learnt.
Potential mental health CQUINS for 2012/13 are to be mandated by NHS London, namely:
 Reduction in anti-psychotic prescribing in dementia
 Discharge of patients in cluster 11 to primary care
 Improvement of physical health in people with severe mental health problems
Community CQUINS look set to include management of urinary tract infections and the
reduction of pressure ulcers and falls.
16.
SC - Disappointed in the reduction of Section 132 compliance.
IO - Not due to increased activity and demonstrates the system is still not fully embedded.
WB - Need to mandate Mental Health Act administrators to escalate in a timely manner.
StJ - The 3% figure attributed to GCHS for the percentage of discharge letters sent by GCHS
does not look accurate. Can this be validated and the mechanism used checked?
Innovation with third sector partners should be considered as a potential CQUIN for 12/13.
DM - This will be picked up at the next Board meeting in February 2012.
Compliance Report – November 2011
The majority of indicators in the November Care Quality Commission Quality and Risk Profile
remain similar to expected. There has been an overall increase in the number of indicators,
both quantitative and qualitative, largely due to the inclusion of findings from Mental Health
Act and Compliance Review visits. Provider Compliance Assessments completed within
services cite infection control and cleanliness (Outcome 8) as the outcome where there is the
greatest identified risk of potential non-compliance. Five out of the six locations where
moderate action is considered to be required are within community services.
IO
Noted
There continues to be a positive increase in the number of reported incidents. The
introduction of Datix Web in two service directorates has been successful, with no reduction
in reporting seen. The independent homicide investigation for JJ has been commissioned by
NHS London. This will be a desktop review with selected interviews.
17.
18.
19.
The review of the short breaks service at Wensley Close by Ofsted resulted in a ‘satisfactory’
rating. Verbal feedback from the inspector recognised the improvements the service had
made. A follow up visit is expected in March 2012.
Atlas House – Care Quality Commission Compliance Review Report
Following the inspection by the CQC in October 2011 the service was deemed compliant with
all reviewed essential standards.
HMP Standford Hill – Care Quality Commission Compliance Review Report
Following the inspection by the CQC in December 2011 the service was deemed compliant
with all reviewed essential standards.
Council of Governors update
The meeting held prior to Christmas was positive, with support given to the proposed Annual
Plan priorities. These will now be taken to borough focus groups in Bexley, Bromley and
Greenwich prior to return to Board for formal sign off.
Noted
Noted
Noted
Next informal meeting of the Board of Directors
2nd February 2012, Bracton Conference Room
I confirm that the minutes of Board of Directors meeting of 12th January 2012 are a true record
Signed
Date:
Dave Mellish, Chair
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