26th Meeting of the Council of Governors
20th September 2012
3pm – 5pm Applegarth Suite, Marriott Hotel, Bexleyheath
Chair: Dave Mellish
Trust Secretary and Head of Governance: Ann Rozier
Public Governors / Service user/ carer Governors / Appointed GovernorsStephen Brooks / Julian Baker / John Fahy
Amanda Finlay / Richard Comaish / Raymond Sheehy
Paul Harding / Alan Cork
Eimear Mallen / Rob Hayles
Judy Wolfram / Jenny Kaye
John Woolgrove / Chris Purnell
Stephen Seabrooke
Mary Stirling
Ken Thomas
Staff Governors
Maggie Grainger / Shelley Ratcliffe
In attendance:
Non Executive Directors / Executive Directors & Directors /Guests and Presenters
Anne Taylor / Stephen Firn / Anna Blackman PWCArchie Herron / Helen Smith / John Bell LINk
Ben Travis
Wilf Bardsley
Iain Dimond
Item /
Action
1. / Apologies GovernorsBob Bedwell, Beryl Day, Alan Downing, Scott Hunt,Kaye Jones, Rebecca Linton, Sue Mitchell, Raymond Pope, Julian Thornington, Michael Turner, Anne Voce, Malcolm Wood.
Apologies Directors
Dr Ify Okocha, James Kellock. Simon Hart, Michael Witney. / Noted
2. / Minutes of the last meeting of the Council of Governors
Agreed as an accurate record. / Agreed
3. / Matters arising
Page 1, Matters Arising – Bexleyheath serious incident. NE pleaded not guilty at the plea hearing and the court deferred the trial to January 2013.
Page 3, Community Interest Company. DM met with the manager of the Company, Iain Martin. Governors will have the opportunity to meet with Mr. Martin at the Annual Members Meeting.
Page 4, Patient Experience Update. The Trust internet pages will now include links to patient experience visits. This is currently being developed and will be presented to Governors in December. There is a pilot to interview service services by telephone is being undertaken in Bexley Community Health Services by trained interviewers. An update will be given at the December meeting.
Page 5, Care, Compassion and Engagement. This will be presented at the December meeting.
Page 8 – FTGA CQC Engagement Project. We applied to be one of eight Trusts to take part in the project. We thought we had not been chosen as we had not heard from FTGA. We received confirmation two days ago that we were included with 9 other Trusts. This is a 6 month project developing best practice in Governors engagement with CQC. A number of Governors to participate in setting out a short term plan for what Governors hope to achieve. / Noted
DM
DM
AR
4. / Nominations Committee
The Committee met on 9th July to discuss the reappointment of James Kellock and Paul Ward as Non Executive Directors. Non executive directors are appointed by the Council of Governors for a maximum of three terms. Their reappointment by the Chair at the end of each term is on the basis of satisfactory performance in the role as defined by the achievement of objectives which are discussed with the Chairman at the annual appraisal of each Non Executive Director.
James Kellock has completed one term of office. On the basis of his satisfactory performance and appraisal the Chairman approved his reappointment for a further term of three years. Paul Ward has completed two terms of office. On the basis of his satisfactory performance and appraisal the Chairman approved his reappointment for a third and final term of three years.
The Nominations Committee was satisfied that the Chairman had followed due process in his assessment of the performance of James Kellock and Paul Ward and was satisfied with the Chairman’s appraisal of their skills and contributions. The Nominations Committee endorsed the reappointment of Paul ward and James Kellock. The Nominations Committee did however note that it would wish to see an increased presence of Non Executive Directors at Council of Governor meetings and events. The Chairman agreed that this was desirable and noted the comments.
The term of Sally Jacobson, Non Executive Director, will end on the 31st December. Sally has made the decision to stand down at the end of December. The Nominations Committee met to agree the process. The Panel will short-list and interviews will take place at the end of November 12. The outcome of the interviews will be presented to the Council of Governors in December for approval. / Noted
DM
5. / Health and Social Care Act
Changes to the Trust Constitution from the 1st October 2012
All FTs are required to incorporate 2012 Act amendments which have/will come into force on or before 1 October 2012 as a result of the first and second commencement orders (Statutory Instruments 2012/1319 and 2012/1831).
Changes to be included are:
- The continuation of the body corporate known as Monitor;
- Change from the ‘Board of Governors’ to the ‘Council of Governors’;
- Requirement for the principal purpose (i.e. provision of goods and services for the health service in England) to be stated in the constitution;
- Introduction of the new legal duty to ensure that income of NHS funded goods and services is greater than income from other sources;
- Introduction of additional oversight and scrutiny by the Council of Governors over activities generating non-NHS income;
- Replacement of HM Treasury with Secretary of State as regards giving guidance over FT accounts.
- A Carers sub class is added to the Service User Carers Constituency (as per Monitors requirements)
- The CAMHS sub class is renamed Children’s sub class to align with the new Children’s Directorate
- The Bexley and Greenwich Community Health sub classes are renamed Adult Community Health to also align with the new Adult Directorate
6. / Serious Incident Board Inquiry Report
SS was the Council of Governor representative on the inquiry panel and presented the findings and recommendations. The Report concerns the unexpected death of a 22 year old man who between November 2010 and January 2012 had six inpatient admissions to acute adult mental health services, 4 of which were in the last 6 months. On 16 January 2012 at 09:30 the patient was found by staff in his bedroom slumped against his bed headboard. Emergency services were called and Cardio – pulmonary resuscitation (CPR) commenced but sadly he was pronounced dead at QueenElizabethHospital at 10:38. The initial post mortem report identified a cardiac abnormality and it was thought his death may be associated with that. However a later specialist toxicology report concluded death had most likely been caused by the ingestion of Bupernophine /Subutex which is a medication used in opiate drug detoxification. The patient was not prescribed Bupernophine either by his GP or during his inpatient stay. At the inquest on the 5 July 2012 the Coroner recorded a verdict of death by non dependent abuse of drugs. The panel met with the patient’s mother who spoke warmly about him. She recognised his problems and was supportive and realistic. She visited on the Saturday before his death and told the panel how optimistic he was about his future.
The Inquiry Panel’s Terms of Reference included risk of deliberate self harm, suicidal ideations, violence and safeguarding.
The inquiry identified 2 care and service delivery problems:-
1. Management of Hypertension
2. The patient was a known drug user who was able to access and ingest a controlled drug that was not prescribed to him.
Recommendations:
- That the facility for scanning paper correspondence and documents into RiO records is made available to all inpatient units.
- That all inpatient ward round templates include a section on physical health.
- Consultant supervisors are reminded of the importance of taking a complete past medical history and how to obtain information from RiO records to support that.
- There should be a review of security options, particularity regarding ingress and egress on adult acute inpatient wards to prevent the importation of contraband items.
- Patients who are prescribed controlled drugs are to have supervised administration.
- Following a positive urine drug screen and/or after disclosure of drug use from a patient appropriate therapeutic interventions should be agreed with the patient, discussed with the multidisciplinary team and these should be described in the care plan.
- There needs to be stronger monitoring of essential skills for training and monthly reports provided to service management teams.
RC – Was there a police investigation?
WB – The police were informed but there was no investigation.
RS – Recommendation 3 has arisen previously in other inquiry reports. This is basic and should be improved.
SS – Agree, but in this case it did not lead to the incident.
AF – It is important to ensure action plans are effective to prevent recurrence.
SF – The Trust continues to work on this. The Medical Director believes this could have been spotted by doctors regardless of RiO entry/ non entry.
DM – The Trust has taken action to prevent illicit drugs being brought into wards e.g. the use of drug-sniffer dogs. This is a difficult area, as can be demonstrated by the lack of success in keeping drugs out of prisons. It is likely there may be other incidents relating to drug use in the future. / Noted
7. / Membership Committee Update
SS introduced the Membership Report. The Committee has met three times since the last meeting. Following ratification of the Membership Strategy, new targets have been implemented and achievement is in line with the trajectory. Data cleansing will reduce the numbers and the conversion of ex staff members to the public constituency is underway. A new application form has been designed. Governors will have a stall at the Annual Members Meeting.
There has been success in recruiting new members from black communities but the gender split remains unchanged. 42 associate members have been recruited. Charlton Athletic Football Club Community Trust is meeting next month and will assist us in reaching out to the community.
CP – Trade Councils and Law Centres may be likely associate members.
JW – Mental Health Day – can governors get more involved? It would be good to receive information about what is going on that day. Are associate members potential partners?
SS- There may be volunteering opportunities arising from these. / Noted
8. / Social Inclusion Update - Peer Support initiative
By introducing intentional peer support workers (PSWs) into services, people with similar experiences can come together with the goal of changing their living patterns and take steps to move beyond the traditionally low expectations of them as service users to build positive, informative, respectful and reciprocal relationships that enhance quality of life, wellbeing and confidence. Peer support can deliver a number of roles, depending on the context. They include: - Research, Condition Management, Social Inclusion, Recovery, Personal Development and delivering Training. In Oxleas, peer support will be supported at Corporate level, with the direct involvement of HR and Learning & Development departments to create a successful context in which PSWs can reach their full potential. Managers and professional supervisors will be trained to support PSWs. The project will initially develop within the Complex Needs & Recovery Directorate in partnership with informed external agencies.
RC – Is there a side effect of Peer Support? Do people have to disclose their mental health?
ID – Disclosure is essential as part of their work. Not everyone will want to do this and we will continue to offer other options e.g. volunteering.
SB - When is the first pairing to be established?
ID – One Band 3 role is going through the Agenda for Change Process. More will follow.
EM – Did you look at AA or NA or other models?
ID – We conducted literature reviews on peer support nationally and internationally. We were in communication with other Trusts also.
DM – Progress on this project to come back to a future meeting. / Noted
9. / Annual External Audit Report
Anna Blackman form PriceWaterhouse Coopers presented the External Audit Report 2011/12 (ISA 260 and Quality Report).
Overall findings from 2011/12 audit
PWC issued an unqualified opinion on the Trust’s financial statements on 31stMay 2012, in linewith Monitor’s timetable. Findings were discussed with the Audit Committee on 25th May 2012.The finance team worked hard to produce a complete set of financial statements, with accompanying working papers. Auditing standards require two areas of risk are considered on every audit (i) Risk of fraud in recognition of revenue (and expenditure) (ii) Risk of fraud from management override of controls. We did not note any issues in relation to these two required risks.
Significant audit and accounting issues (1 of 4)
Transfer of Greenwich Community Health Services
On 1 April 2011, Greenwich Community Health Services transferred to the Trust. Under usual government accounting standards, this transfer would require accounting under merger accounting standards, which would require a prior period restatement. For 2011/12, a one year exemption from the application of merger accounting for the transfer of community services was granted. As a result, the Trust accounted for the transfer within 2011/12 and did not need to apply a prior period restatement. This differs to the treatment applied in 2010/11 for the Bexley Community Health Services transfer, where such an exemption was not granted and full merger accounting was required. This resulted in a prior period adjustment, and a qualification to the financial statements.
Valuation of the Trust’s estate
The Trust’s estate has been re-valued by Montagu Evans as at 31 December 2011. The valuation led to a fall in the value of the Trust’s estate of £5.1m, comprising reductions in land values of £2.8m and buildings of £2.3m. As part of PWC’s work on the valuation, the underlying records used by the Valuer to the records held by the Trust were compared in order to assess the accuracy and reliability of the records used by the Valuer. PWC noted the following: estimates were included in the valuation which was difficult to verify, for example in the estimate of surplus land under Modern Equivalent Asset (MEA) valuation methods. Cases where underlying records of assets (i.e. building size) differed between Trust records and those used as the basis for valuation. While PWC were satisfied that the effect of these was not material to the financial statements, PWC recommended that the Trust should review the estimates and underlying records used in the valuation to ensure accuracy and appropriateness.
Private Finance Initiative (PFI)
As part of PWC 2010/11 audit, some issues with the model used to calculate the accounting entries for the Trust’s PFI scheme were reported to management. In 2011/12, PWC introduced management to PWC PFI specialist, who assisted management in understanding this issues present in the model. Management then corrected their model, resulting in the favourable release of £1.6m to the Statement of Comprehensive Income. PWC reviewed the resulting adjustments and accounting transactions and agreed these were reasonable.
Provisions
The work focused on two key provisions:
- South London Healthcare Trust
- Restructuring provision
Quality Reports (1 of 3)
In 2011/12, FTs were required to:
• Include a brief description of the key controls in place to prepare and publish a Quality Report in the Annual Governance Statement in the 2011/12 published accounts;
• Sign a Statement of Directors’ Responsibilities in respect of the content of the Quality Report and mandated indicators for inclusion in the annual report;
• Sign a Statement of Directors’ Responsibilities in respect of all other indicators included within the Quality Report to provide to their auditors (this does not need to be published in the Quality Report);
• Include the signed limited assurance report provided by their auditors on the content of the Quality Report and the mandated indicators in the annual report; and