WEST LONDON MENTAL HEALTH NHS TRUST
OPERATIONS BOARD (the board) MEETING
Minutes Tuesday 2nd November 2010(draft)
Present:Mr Peter Cubbon, Chief Executive(Chair)
Dr Nick Broughton, Medical Director
Mrs Barbara Byrne, Director of Finance & Information
Miss Leeanne McGee, Director of High Secure Services
Mr Steve Trenchard, Director of Nursing and Patient Experience
Mr Nigel Leonard, Director of Planning & Corporate Affairs
Mrs Nicky Holdaway, Hounslow (incl CasselHospital) SDU Director
Dr Alice Parshall, Hounslow (incl CasselHospital) SDU Clinical Director
Dr Kevin Murray, High Secure Services SDU Clinical Director
Mr Andy Weir, West London Forensic SDU Director
Ms Helen Mangan, H&F (incl Gender Identity) SDU Director
Dr Michael Phelan, H&F (incl Gender Identity) SDU Clinical Director
Ms Bridget Ledbury, Ealing SDU Director
Dr Jonathan Scott, Ealing SDU Clinical Director
In attendance:Mr Trevor Nelms, Director of IM&T
MsBabs Dhillon,Head of Information
Mr Keith Ottley, Assistant DirectorEstates & FacilitiesBroadmoorHospital
Dr Kevin Healy, Clinical LeadConsultantCasselHospital, Hounslow SDU
Ms Lesley Day, Head of ServiceCasselHospital, Hounslow SDU
Ms Maria Harrington, Associate Director Clinical Governance
Also present:Dr Tim Bullock, Deputy Medical Director [item 2 and 3]
Ms Gemma Stanion, Programme Director [item 4]
MsPam Scott, Head of Programme Management Office [item 4]
Miss Abby Fadina, Board Secretary (minutes)
1APOLOGIES FOR ABSENCE
1.1Mrs Ruth Lewis, Director of Organisation Development & Workforce
2 KNOWLEDGE MANAGEMENT & BUSINESS INTELLIGENCE TOOL
2.1Mr Nelms and Ms Dhillon gave an overview of the Knowledge Management Vision for the Trust and demonstrated how a Business Intelligence Tool could be deployed to improve data quality and generate efficiencies through improved access to information at all levels of the organisation. Mr Nelms emphasised that a major element of the programme and a pre-requisite for the success of the business intelligence tool was reaching consensus in the definition of standards for the reported data items.Other benefits outlined included providing a consistent application to view data from multiple sources across the Trust, aiding the access and analysis of information to improve business decisions, improving governance arrangements by making data quality issues transparent and enhancing research and clinical audit and remote working solution for community nurses. Dr Scott asked that EalingSDU be considered as a pilot for remote working.
2.1.1Mr Nelms clarified the capital and revenue implications of the project. The Operations board were asked to support a 3 month “lights on” reporting service from IM&T so that internal staff can work on this development i.e. that only mandatory reporting needs and those authorised as priorities by the either ED’s or the Operations boardwould be produced and that all other ad hoc report production would cease so the team could concentrate on this strategic project. This approach was broadly accepted as a proposal although the detail would need to be agreed as would the identification of the revenue funding.
2.1.2In response to Dr Murray, Mr Nelms acknowledged that the use of the Tool would be limited at BroadmoorHospital to non-clinical information held in Rio following the recent decision not implement a full electronic record. .
2.1.3Mr Trenchard suggested that the project team involve clinicians and front line staff so that they are involved in the data resource, definitions and provide useful understanding as to the routine reports that would be required and therefore what data is needed to be collected.
2.2The Operations board approved the introduction of a Knowledge Management & Business Intelligence Tool subject to revenue funding being identified.
Mr Nelms and Ms Dhillonleft the meeting
3ASSURANCE & SAFE OPERATIONAL MANAGEMENT OF LEGIONELLA
3.1 On behalf of Ms Wood, Director of Estates & Facilities, Mr Ottleypresented her report which provided assurance to the Operations board on current safe management of legionella across the Trust’s estates by identifying the existing preventative processes, regimes and systems in place on external audit that had been undertaken to support this.
3.1.1In response to Mr Trenchard’s question about other assurance processes in addition to feedback from the Department of Health; Mr Ottley stated that there included the deep in-depth evaluation of the Trust’s processes and external review, which included visits, to ensure that the Trust’s action plan to address any risks was being progressed appropriately.
3.1.2Mr Ottley confirmed that the water was being run as part of a planned maintenance process in closed wards (e.g. on Blair ward) and those rooms which have changed their usage. He agreed to make further enquiries about the air conditioning units.
Action: Mr Ottley
3.1.3In response to Dr Murray’s question regarding how soon a decant ward could be brought back into use in an emergency, Mr Ottley said that it would take 2 / 4 hours to make sure that such a ward was safe to re-admit patients. He informed the board that he understood that there was a “sign-off” process to make sure that the ward is safe to come back in line.
3.2 The Operations board agreed that clinical services would report change of use of accommodation to the Estates & Facilities department to allow robust legionella practices to be adhered to.
7NEW ARRANGEMENTS FOR CAPITAL
7.1Mr Leonard’s presentation informed the board of the new assurance arrangements and governance structures that are being put into place to manage the Capital Programme. The presentation concentrated on 4 main areas:
(1)Approval of Capital Bids
(2)Reporting structure
(3)Capital Management
(4)Level of financial management
7.1.1Approval of Capital bids:The main change is to the management of the capital programme and the leadership of the capital team based in London. Mr John Atkins will now focus exclusively in the role of project manager for the St Bernard’s Redevlopment and Mr Keith Ottley, Assistant Director Estates and Facilities – Broadmoor will lead the capital team and assist in implementing new structures and processes at the London end of the Trust. Mr Ottley currently manages the Broadmoor capital team and will bestandardising the operating processes and controls across both departments.
In addition the Capital Projects Committee has ceased and has been replaced by Star Chamber through the weekly Executive Director meetings. Final decisions on all bids remain with the Star Chamber.The Star Chamber will also undertake responsibility for capital Planning.
7.1.2Capital Management: Mr Leonard updated the Operations board on the work currently taking place to increase controls within the management of the Trust’s Capital Programme. Mr Leonard explained that a number of changes have been made including additional controls around the allocation of capital codes for this year. A clear position in relation to the review of all capital projects will be available at the end of November 2010.
7.1.3Level of financial management: the board noted the level of financial authority:
Group / Financial AuthorityStar Chamber / In accordance with standing financial instructions
Capital Projects Board / Confirmation that authority limit for local Capital Groups and IM&T are within authorised limits.
£25k or 10% of the value of the individual projects whichever is the smaller.
SDU Senior Management Team / Up to Capital Resource Limit allocated under the Capital Approved Programme.
Operational Capital Groups including IM&T / To approved overall programme allocation within remit of individuals groups.
Project Managers / To approved Budget for individual projects.
7.1.3.1In response to a question regarding what would happen when a capital project starts to head into overspend, Mr Leonard said that only the Project Manager had the responsibility to approve the budget for individual projects.Mr Leonard said that project managers will now have a clear protocol outlining their responsibilities to escalate the issue of a likely project overspend. It will be the role of the Capital Project Board and the SDU senior management team to ensure that the programme overall remains within budget. The Capital Project Board will also retain the contingency sums agreed by the Board and make recommendations to the Star Chamber if there is a need to make changes to agreed programme of work.
7.2Mr Leonard informed the board that the Audit Committee has asked for an internal review of the Trust’s capital programme this year and that this was due to take place in January 2011.
4CASSEL BUSINESS CASE INITIATION DOCUMENT
4.1 The board noted that the Business Case Initiation Document for the CasselHospital, sponsored by the Chief Executive, had been written in collaboration with the Head of Service and Clinical Lead at the Cassel, relevant corporate leads for Finance, Estates and Capital, and the PMO. A non financial appraisal was carried out on the 14th October 2010. The document sought approval from the Operations board to take forward three preferred options for further development to a Summary Business Case stage, for services at the CasselHospital site.
4.1.1The board received and noted the seven Options which needed to be considered in terms of the future of the CasselHospital, and the services it provides. MsDay stressed that all the options were predicated on the fact that the Trust did not obtain national funding for inpatient family treatment services. The paper highlightedthree options that were considered worth pursuing to a Summary Business Case stage; if secure funding for the Families Service could not be secured or assured.
Option 3:Remain at the Cassel site, close Families Service, and expand ESPD Service to occupy space created.
Option 4: Partial site closure, close Families Service, remain at Cassel site, and provide existing ESPD service on site.
Option 6: Close the Cassel site, close Families Service, and relocate only ESPD Service to an alternative site.
4.1.2The board noted that these three options would involve full closure or part closure of some of the current clinical services provided by the Cassel. MsDay pointed out that clarification would need to be sought about the need for public consultation, consideration of an interim stage after the Trust Board in January 2011 has decided which option to proceed with, and the staff implications of this decision. Ms Day also sought clarification from the board as to whether any case could be made for continuing to provide some Families Service beds, but none was forthcoming from board members.
4.1.3Dr Healy highlighted a number of potential development opportunities within the Trust as areas for development that could make significant financial and clinical contributions to the Trust as a whole.
4.1.4The Operations board supported Dr Healy’s proposal to invite service users as part of future presentations to the Management Team.
4.2.1Mr Cubbon asked whether all existing staff at the Cassel were aware of the document presented to the board and its implications. In response, MsDay said that a non financial benefits option appraisal with some of the Cassel staff had been conducted and the result of this was also included in the document. It was noted that the staff had chosen 3 options which would necessitate the least change that is options 1, 2 and 5.
4.2.2Ms Stanion said that a decision regarding the estate had not been included in the document as this required a financial outlay. Ms Scott confirmed that estimatedstranded costs were included within the options.
4.2.3Dr Broughton asked whether it was worth pursuing links with the Tavistock and Portman NHS Foundation Trust. Dr Healy said that this organisation had less complex personality disorder patients in outpatient treatment than the Cassel and he did not think this would generate any income in the short term. He added that a more profitable link could be made with the independent sector and informed the board that he is liaising with some independent sector services regarding this.
4.2.4In response to Miss McGee’s question about how long it would take to close a service, Mrs Holdaway said it would take approximately 6 months to decommission a clinical service such as the families unit. Commissioners and referrerswould have to be notified.
4.2.5Miss McGee enquired as to how long it would take for the ESPD to be viable if option 3 was agreed, i.e. to increase the number of beds on the ESPD service. In response Ms Day said that this was dependent on a number of factors including whether or not the Tier 4 Regional funding of an inpatient PD service for London, South East, South Central and Eastern Regions went ahead and, if so, whether the Cassel was successful in its bid to provide this. Currently, the Cassel ESPD Service is the main Tier 4 provider for such an inpatient PD service and would need to promote its services actively with these commissioners as well as the other regions in England, as well as in Northern Ireland.
4.2.6The board discussed the functional suitability and condition of the current estate and the future use of the Cassel hospital site / grounds, if it were kept by the Trust; and whether the site would be an appropriate place for new business development ideas, including a Tier 4 adolescent inpatient service.
4.2.7In response to a question from Ms Mangan about staffing issues and possible redeployment, Ms Day confirmed that Linda Dyson, Deputy Director of HR, had provided some information on these issues, which were included in the document under each of the seven options. Detailed work would be undertaken when the three options had been chosen following today’s meeting.
4.2.8Mr Weir asked whether the proposed models were flexible enough and whether the Cassel services had spoken to commissioners regarding what they may want to buy. In this context, he referred to the possibility of a Tier 4 Adolescent Service being commissioned by the North West Sector, and agreed to send Ms Day the details of this proposal and any service specification.
4.2.9Mr Trenchard asked if the Cassel might provide a good Tier 4 residential clinical service for PD patients at and from another site, such as a site situated in an acute ward. Dr Healy responded that as former Chair of the Association of Therapeutic Communities he had visited lots of sites from which excellent local PD services were delivered. However he did not envisage that a National or Regional Specialist Service would easily attract clientele if delivered from such a setting. The Branding of the service is crucial in delivering a service known to referrers and commissioners as a centre of excellence that assists them in local service development for their patients.
4.3Dr Parshall soughtclarification as to who was being referred to with regard to the ‘Clinical Lead Hounslow’ detailed in the membership of theProgramme / Project Board. Ms Stanion thought that this referred to Dr. Healy, as the Clinical Lead for the Cassel, which is currently part of Hounslow SDU. The Board agreed that this would be clarified outside of the meeting.
4.4The board agreed that a Business Case for the Cassel would be presented to the January 2011 Trust Board with the three options (3,4 and 6) agreed by the Operations Board to be pursued to a Summary Business Case stage. In addition the Business Case would include the presentation of Option 1 as a base line option and Option 7 (closure of all clinical services).
Action: Dr Healy, Ms Day
4.5The Operations board agreed that formal wording to staff at the Cassel would be compiled by Mr Cubbon and Mr Trenchard.
Action: Mr Cubbon, Mr Trenchard
Dr Healy and Ms Day left the meeting
5 MINUTES OF THE LAST MEETING
5.1The minutes of the meeting held on the 5th October 2010 were agreed as a correct record.
6 MATTERS ARISING
As detailed in the Action Schedule.
8 OBJECTIVES FOR CONSULTANT PSYCHIATRISTS
8.1Dr Phelan presented suggested draft objectives for inpatient consultant psychiatrists and the proposed metrics for measuring performance; designed to produce a greater consistency of practice and help to ensure that senior medical staff are fully involved in delivering the Trust’s priorities. Dr Phelan added that an additional benefit would be the opportunity to link some of the objectives with the revalidation process.
8.2The board discussed the objectives and suggested areas that could also be added; including objectives relating to the frequency consultants see patients on the wards, inputting key dashboard data and clustering information as part of the performance culture of the Trust.
8.3The Operations board supported the draft objectives but were mindful of financial pressures and the overlap with existing job plans. It was agreed that the objectives would be refined so that they reflect the Trust’s expectations of its consultants.
Action: Dr Phelan, Dr Scott, Dr Parshall
Ms Harrington arrived
11CQC REGISTRATION UPDATE - October 2010
11.1The Operations board received the paper outlining the Trust’s progress against the CQC conditions of registration as at October 2010 and the Trust’s progress against self identified areas of non compliance at the time of registration. Ms Harrington tabled the Trust Board CQC Registration chart, colour coded because it was now linked with the Trust’s quality & risk profile, and which provided an overview regarding the Trust’s registration and any associated conditions.
11.2The board noted the following:
Regulation 11 - Safeguarding people who use services from abuse (CQC regulation declared non compliant but not registered with conditions): two key components of Mandatory Training which related to this regulation need to be met across all Locations; these are Safeguarding Children Training (Levels 1, 2 and 3) and the Prevention and Management of Violence and Aggression (PMVA) training, plus ‘Breakaway’. The Broadmoor location became compliant in September 2010 and it is anticipated that by the end of 2010 that the Cassel, the Limes, Hammersmith & Fulham, and Hounslow will also be compliant:
Concerns were raised about how to improve on the number of staff trained in Ealing SDU. Mr Trenchard agreed to develop an action plan for the areas such as safeguarding children, breakaway and PMVA teamwork.
The Operations board will re-consider the rating of non compliance based on its indictors for Regulation 11 at the end of Q3.