64Thmeeting of the Board of Directors

64thMeeting of the Board of Directors

Thursday 1st December 2011

3.00pm Boardroom, Pinewood House

Board of Directors

Dave MellishChair

Archie HerronNon-Executive Director

Anne TaylorNon-Executive Director

Sally JacobsonNon Executive Director

Paul Ward Non Executive Director

James KellockNon Executive Director

Seyi ClementNon-Executive Director

Steve JamesBoard Advisor

Stephen FirnChief Executive

Helen SmithDeputy Chief Executive & Director of Service Delivery

Ify OkochaMedical Director

Wilf BardsleyDirector of Nursing & Governance

Ben TravisDirector of Finance

Simon HartDirector of HR & Organisational Development

In attendance

Ann RozierTrust Secretary & Head of Governance

Action

1. / Apologies for Absence
None. / Noted
2. / Minutes of the Board of Directors Meeting held on the 3rd November 2011
The Minutes were agreed as an accurate record.
Matters Arising
Item 3 Staff Performance Award. The letter to staff will be sent out before Christmas and copied to the Board.
Item 3 Crayford Day Centre. We will be speaking with Commissioners tomorrow but the position is still unclear.
Item 5 Inpatient activity (Bevan Unit). Oxleas staff and SLHT staff are meeting every day and referrals have increased.
Item 6 Dawn to Dusk Pilot. This was a pilot that Greenwich Business Support Unit asked Oxleas to pilot. It was around providing a night sitting service to the JET team. It has been decided to withdraw this pilot as the service was not used sufficiently and is not the best use of resource.
Item 9 Joint venture. There has been a meeting with the developers and another meeting has been arranged to look at the terms of the agreement. A progress update will be given to the Board in January.
Item 10 Industrial Action. An agreement was reached with Staffside that critical services would be covered. There is no indication that there were any problems and disruption was minimal.
Item 17 Oxleas House safety works. All the works were completed by Meridian within one week of them receiving the letter. A reply has not been received. / Agreed
DM/ SF
IO
3. / NHS Operating Framework 2012-13
The Operating Framework headlines are:

• Dementia and the care of older people. This will be measured through the Quality Accounts, NICE standards (prescribing of anti psychotics, mixed sex accommodation etc). In terms of the CQUIIN (increase of 2.5%), if this is adopted locally, one is diagnosis of Dementia in hospital. (The other is the implementation of the Safety Thermometer by December 2012.)
• Safe transition to the new system – setting up of Clinical Commissioning Groups and Health and Wellbeing Boards, National Commissioning Board. Although we do not lead on these matters we need to support partners, particularly for the authorisation process.
• QIPP and Finance -£20b reduction is being looked for over the next 3 years. For Oxleas this will be efficiencies of 4% and income will reduce by between 1.5% – 1.9%. This could be offset by an increase in CQUIN from 1.5% to 2.5%. The Operating Framework makes mention of introducing a tariff for mental health services next year and some other services that Oxleas provides.
• Performance – re-emphasising 18 week referral to treatment times which will be closely monitored and a strong recommitment to the A&E 4 hour wait target.

AH – Will there be a period where the Tariff will run in shadow form?
BT – For next year there will be block contracts but activity will be monitored using Payment by Results currency.
DM – Will there be a ‘reserve fund’ for mental health as there was for acute trusts?
HS – There is no possibility of there being any smoothing but the intention is for it to be cost neutral.
WB – Safety Thermometer, mentioned in the Framework, relates to work Oxleas has been taking forward through the National Nurse Sensitive Indicators work streams and Safety Express.
SJa – It would be worthwhile to look at how we respond more broadly to the priority of Dementia. We need to think about partnership working with the 3rd sector.
SC – Is there anything that we were not expecting?
SF – The Tariff deflator means that the best case we were considering at the Away Day is now the mid case. / Noted
4. / Bexleyheath Serious Incident - update
The Homicide Inquiry is progressing. A single root cause has not been found however 2 contributory factors have been identified. There were 4 care and service delivery problems that we can learn from. The draft report contains recommendations addressing these and some policy and practice issues that do not have a direct bearing on the incident. The final panel meeting is on Monday where the final report can be signed off. The Report will be presented to the Board in January 2012.
SF and PW have met with the victim’s family. SF has contacted Family Liaison to offer a further meeting to go through the findings with the family. SF has agreed to a request from Family Liaison to meet with the first victim who was attacked.
SMJ – Have any areas of good practice been found?
PW – There are some areas of notable practice also identified in the Report particularly within Forensic Services. / Noted
PW
5. / Key Performance Indicators Report – October 2011
Monitor target A&E and Referral to Treatment time.
SF - It was reported last time that we had met with Monitor about the UCC A&E targets. For the 4 hour A&E wait target we need to report how many (%) people are seen within 4 hours. Our performance is 99%. There are a further 5 indicators that the Board need to consider which are within the KPI Report on page 10. On page 10, we are breaching 2 of the 5. This does not affect our Monitor rating but the Board to note. More detail can be given at the next Board meeting.
Monitor target Referral to Treatment time.
The target for Greenwich CHS non admitted consultant led services and Greenwich CHS admitted consultant led dental services has been met.
Delivery of Early Intervention Psychosis Team service.
We are over performing in this area.
Inpatient Activity
The average occupancy rate in Adult Acute is 93% (excluding leave). The trend is established in this service. In the Older Persons service, taking account of the closed ward, we are at 70% occupancy (excluding leave). In the Step Up Step Down Service, the occupancy rate is 94.2%. All beds are fully open again.
AH – Over-performance in Early Intervention – when PbR comes in will we be paid for this?
HS – We will not benefit for over or underperformance in the first year. We will have a year to work with Commissioners on the pricing structure.
BT – In acute services only the A&E activity is capped.
SC – Although we are meeting the target the margin has increased by 30 minutes. Should we be concerned by this?
HS – We keep a close eye on what is happening in the UCC but there is a degree of volatility in this type of service. There is hour to hour variability in patient flows.
SC – The KPIs for BCHS and GCHS; can there be like for like indicators for comparable services?
HS – This is our aim. Currently there are different contractual requirements and that is reflected in the Report. The new Business Intelligence system will assist in gathering like for like data.
SJa – I have some concerns about GCHS ability to report on a variety of indicators. Some of these concerns lie in the culture of reporting what has been done in addition to the technological issues that need to be addressed e.g. mobile working.
IO – There is quite a lot of work to be done in order for CHS to demonstrate activity.
WB – We are hoping to bring the IT Strategy to the Board in January. Some of the components of this are what we are doing around RiO. There is a real opportunity to deal with cultural and competency issues as well as commence pilots for the use of devices such as digi-pens in patients’ homes. There will be efficiency and productivity gains in doing this as well as improving data quality. / Noted
6. / Director of Service Delivery Report
Tenders
We have received feedback from Integra on the unsuccessful Greenwich UCC bid but we have requested additional information. Oxleas has passed the PQQ stage of the Kent CAMHS bid and the Greenwich Specialist Children’s’ Services bid. We have been asked by Bexley Business Support Unit to develop a stroke service. More detail to follow.
Changes to the Older Adult Bed Services
All Dementia wards are now at the Woodlands with a Functional ward in Green Parks House and Oxleas House. The changes implemented 6 weeks ago are going very well with no complaints received.
The Kent Prisons Service
The Kent Prisons Service started today providing a full range of healthcare into 3 prisons including Maidstone.
DM – The GP Training Day with the Short Term Team; if this is successful will it be promulgated to other areas?
HS – It has been done in Bromley and we would like to do the same in Greenwich. / Noted
7. / Annual Plan priorities 2012/13 - update
Suggestions were made at the last meeting to be included in the priorities before presentation to the Council of Governors meeting on the 15th December. These have now been included. Following the approval of the Council of Governors, the priorities will be presented to the Trust membership at the Borough Focus Groups in January. / Noted and approved
8. / Finance Report
EBITDA. The Trust’s EBITDA for the seven months ending 31 October 2011 was £5.8m (5.1%). This is significantly higher (£1.3m) than the Monitor plan (£4.5m/ 3.9%), due to lower than planned expenditure. This is due to Greenwich Community Services being significantly (£1.6m) under-spent for year to date. The service has been aware of the future funding reductions and has taken early action in order to achieve financial balance in the longer term. Provisions have been made for a number of areas of financial risk, which broadly offset the lower than planned expenditure of corporate reserves
Surplus. The Trust has delivered a surplus of £1.9m, which is slightly higher (£0.2m) than plan (£1.7m). The Trust has written down the value of the Bracton fence (£1.3m). This is expected to be independently verified in quarter 3 when the Trust’s estate is re-valued. This is an accounting charge which is excluded from the Monitor risk rating and has a small positive cash impact on the Trust as it reduces the dividend payable to the HM Treasury. The forecast is £0.4m higher than plan, which is consistent with performance year to date. This assumes a consistent approach to provisions throughout the year.
Cash. Overall, the Trust had cash and short term investments of £62.2m at the end of October. This is £2.3m higher than plan (£59.9m) due to a combination of higher than planned EBITDA and the lower than planned expenditure of corporate reserves.The Trust continues to score a 5 for liquidity per Monitor’s financial risk rating.
Monitor rating. The Trust’s financial risk rating for the year to date is scored at 4, which is higher than the target of 3 set out in the annual plan. The actual score is 4.3 (against a plan of 3.5).
CRE and contract reductions delivery. The Trust has a savings target of £7.5m for 11/12, which includes savings required due to reductions in contract values, as well as internal efficiencies. CREs to the value of £6.8m full year effect have been identified and are being implemented, though £0.4m of these plans are considered to be high risk. The gap is being met by a combination of non-recurrent savings and the central CRE reserve.
Page 8, Appendix 1 shows operational performance. The GCHS underspend is significant. Working Age Adult Acute services are the most overspent, this is due to their CRE. The gap on the CRE is shown. Page 10 shows Provisions. We have added £3.5m.
SJa – There must be one off projects we could do with the Greenwich underspend.
HS – We are pursuing this with Commissioners. We are discussing extending the JET service over the winter period to help with A&E pressures. / Noted
9. / Fraud investigation – update
The Investigation progresses.The Report will be available for the next Board of Directors meeting. / Noted
BT
10. / Sealing of Documents
The Board approved affixing of the Trust Seal to:
Counterpart Underlease of The Source (65 Sibthorpe Road, London) between Greenwich Teaching PCT and Oxleas NHS FT
Licence to Underlet 65 Sibthorpe Road between The Mayor and Burgesses of the London Borough of Greenwich, Greenwich Teaching PCT and Oxleas NHS FT / Approved
11. / Hard Facilities Management Contract
Oxleas currently contracts with Rydon for the provision of planned preventative maintenance (PPM), reactive repairs and a small works service in Bromley and Greenwich. This service is currently facilitated by a miscellany of separate orders and contracts and has therefore been formally tendered. This process has been supported by the London Procurement Programme (LPP) an NHS sponsored agency, which has been tasked with creating approved frameworks to simplify and improve tendering for services and goods across the NHS in London. In addition, as the provider of Estates and Facilities Services to NHS SEL and Greenwich Business Support Unit, hard FM services for Greenwich BSU properties have also been tendered, most of which Oxleas occupy as service provider. With the exception of the contract period (5 years for Oxleas and 3 years for the Greenwich contract) the specification for these 2 service contracts are identical, but separate tender submissions were requested.
Tenders were sought from the 7 pre-qualified companies on the LPP hard FM framework.
5 companies returned tenders. Norland were found to have provided the best overall submission (on quality and cost evaluations) for both the Oxleas and Greenwich Community tenders and for the 2 separate variants, and represent a significant saving over current costs. A three month period is allowed prior to formal contract commencement to enable the preferred bidder to fully audit the premises and establish a comprehensive asset register.
The Board agreed to accept the Norland offer to enable the audit to take place, with the final contract variant to be agreed before contract commencement in April 2012. / Approved
12. / Workforce Report – October 2011
Sickness Absence - Sickness absence in October is recorded as 4.35%. This is a decrease from the September absence level of 4.82%.
Vacancy & Turnover - Vacancy rates have reduced to 9.64%. ALD and Bexley Community Services have the highest level of vacancy. Vacancies are being held prior to reconfigurations and CREs. Turnover remains at an overall low level.
PDR uptake–We are now reporting on a fortnightly basis. The overall Trust recording of PDRs is at 71%; the highest area is at 90%. In order to achieve the target of 80% an extra 292 PDRs are required. Staff are now becoming more familiar with the new recording system. A breakdown by CQC Location was provided to the Board.
Bank and Agency Usage - The new BSMS trinity bank system was installed in October. The new system directly links to the E roster system and payroll. When the E roster system is fully rolled out this will remove a number of manual administrative processes currently carried out by temporary staffing and payroll. As the system was implemented mid month the combined booking data for the previous system and the new system is not yet available.
Industrial Action 30th November–As noted under Matters Arising.
Staff Survey – This is closing on the 9th December.
JK – Are the reasons known for 6 PDRs in HR&LD not being completed?
SH – Maternity leave, long term sick and 2 planned in the next week.
AH – There are now figures for Corporate departments in the breakdown.
SH – These are CQC Locations which do not include Corporate services. These figures can be supplied by Corporate Directorate.
PW – This greater breakdown is good.
JK – As a Trust, is there a concept of who the star staff performers in the Trust are?
SH – This can be done through HR, Quality and Finance indicators.
DM – The PDR system is the starting point. / Noted
13. / Quality Report – October 2011
QSIP Mental Health - There have been no breaches of Section 132. Deloitte have completed an internal audit of the Mental Health Act system in Oxleas and have given a ‘substantial assurance’ rating. There are no reds for mental health for the QSIP indicators but there are some amber ratings in care planning. Training in care planning and engagement progresses. CAMHS and ALD training dates will be later but some focussed interim work will be done.
QSIP Community Health – Pressure ulcers remain an area of concern. Some more detailed work is being undertaken to understand the data and whether systems and processes are in place.
CQUIN Mental Health – We are ensuring that when a review takes place the care plan is sent to the GP within 2 weeks. Next year the timeframe is likely to be 7 days.
CQUIN Community Health – The work around pressure ulcers remains a priority. Also ensuing care plans are entered on RiO. Further work is being undertaken around ensuring discharge summaries are sent to GPs.
At the end of Quarter 2 we have been unable to achieve all of the CQUIN targets. This has an impact of just under £100k. We are hopeful this will improve in Quarter 3.