66thMeeting of the Board of Directors

Thursday 1st March2012

2.30pm Boardroom, Pinewood House

Board of Directors

Dave MellishChair

Archie HerronVice Chair & Non-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

Trevor Eldridge (For Item 9)Director, Acute Adults Mental Health Services

Rachel Evans (For Items 6 &10)Director of Estates and Facilities

Ann RozierTrust Secretary & Head of Governance

Keith SoperHead of Compliance


1. / Apologies for Absence
None. / Noted
2. / Minutes of the Board of Directors Meeting held on the 12th January2012
The last sentence of the fist paragraph under item 7 on page 3 should read ‘Failure to achieve the target does not impact on the trust’s Governance rating with Monitor, however Monitor requires the trust to report the indicator to the Board and escalate any issues with attainment of the target to them.’ Noting this amendment, the Minutes were agreed as an accurate record.
Matters Arising
Item 6Social Enterprise - Employment. SJ stated that good progress was being made and an update would be provided at the next meeting of the Board of Directors. / Agreed
3. / Minutes of the Board of Directors (Part 2) Meeting held on the 2nd February 2012
SC had been omitted from the attendance list. Noting this amendment, the Minutes were agreed as an accurate record.
Matters Arising
Item 1Service Delivery Strategy and Annual Plan Update. HS confirmed the revised priorities would be presented to the Council of Governors in March 2012. / Agreed
4. / Chief Executive Strategic update
A provider stakeholder event organised by NHS London is being held on 9th March 2012 to discuss South London Healthcare NHS Trust (SLHT). This is as a result of concerns regarding the future financial viability of the organisation and their ability to attain foundation trust status. A number of other local provider organisations have been invited.
DM stated that the Part 2 Meeting of the Board of Directors in April 2012 should include the outcomes of the stakeholder event. / Noted
5. / Marketing Group Terms of Reference
The first meeting of the group has been held and draft terms of reference shared. It is proposed that the Group reports to the Performance Committee. Additional resources have been committed with two new posts being created to undertake tender work and commission marketing research.
AH - Suggest a minor amendment to the third bullet point in the Terms of Reference to read ‘To plan for all future bids….’
PW - How do we ensure the approach is permissive rather than restrictive?
StJ - At times Chair’s action will need to be taken providing the new service or service development meets the agreed criteria.
DM -The Performance Committee, which is likely to be renamed the Business and Investment Committee, will meet monthly to enable timely decisions.
JK - Whilst understandable there is some concern in respect of senior management capacity. / Noted
6. / Transfer of Community Properties update
Progress on the purchase and transfer of community properties has been delayed until the passing of the new Health and Social Care Bill. Any transfers are currently on hold. An update will be brought to the Board of Directors as the situation changes. / Noted
7. / Key Performance Indicators Report - January 2012
Monitor targets remain on track. The mental health minimum data set submission in quarter 2 slipped marginally below 50%, but should not impact on the year end position. The reduction relates to difficulties obtaining the NHS number. Recent increased inpatient activity in Acute Adult services has been seen. An analysis of the additional activity is taking place to understand the reasons. Numbers have since settled to expected levels. There are currently 11 full beds at Atlas House, with 2 generating additional income.
The robustness of the RTT admitted (surgical) and non-admitted dataacross Greenwich Community Health Services iscurrently being reviewed. The admitted and non-admitted indicators are reported to Monitor as a combined figure across the applicable specialties. In the non-admitted bundle the overall figure is improved because of the large number of attendancesat our contraceptive and sexual health services. This has the potential to mask performance in other services. In addition, there are issues with the availability of theatre spacewhich impacts on the admitted bundle.
StJ - What is the position with the community dental contract?
BT - The contract has been extended until December 2012.
HS - From 2012/13 Monitor requires the trust to ensure that 92% of people on the waiting list must be waiting less than 18 weeks.
SF - The trust is not currently breaching Monitor requirements but Monitor will be provided with an update on the outcome of the review during the next quarterly update. / Noted
8. / Director of Service Delivery Report
The projects designed to assist with patient flow through A&E departments and facilitating discharge from hospital funded by the A&E access monies have had a positive impact and been welcomed by GPs. The possibility of extending the service is being explored with SLHT. The trust is registering relevant services to be linked to the new national 111 urgent telephone service.
Six bedrooms at the Bevan Intermediate Care Unit in Greenwich had to be closed last week due to the effects of building works. The building is owned and maintained by BUPA. Capacity was found in older adult services.
SJm - Need to declare a possible interest as through the access project a small number of patients were referred to the Avenues Trust. / Noted
9. / -- Action Plan
The action plan relating to the serious incident focuses on four main elements:
  • Safer assessment and monitoring
  • Smooth transfer from the place of assessment onto the ward
  • Infrastructure issues
  • Ensuring guidelines / policies are updated
Oxleas House and Green Parks House have rewritten their assessment protocols to ensure that when assessments are carried out for patients presenting in A&E departments, reference is made to care plans, relapse and contingency plans and risk assessment documentation on RiO. The protocols now include the necessity for the assessing clinician to contact the on-call consultant / specialist registrar for advice where the patient attends out of hours and has been known to have received a service from the Bracton Centre.
Although there is no longer an A&E department on site, patients still self-refer to the Woodlands Unit for assessment. The context and procedure for completing the assessment remain the same however some problems accessing the unit out of hours have been identified since reception is not accessible beyond 5pm. As a result the senior nurse on shift now carries a cordless phone and the telephone number for it is posted on the front door. A longer term solution is being sought, which will enable the bell to be heard across the wards.
The suitability of accommodation in both A&E departments is not appropriate. A brief for each department is being drawn up for discussion with SLHT, although achieving allocated accommodation for assessment teams will be difficult because of the demand on space.
The crisis line has been reviewed. Approximately 650 calls a year are received. The major problem is that staff responding to calls are not dedicated to this function and have limited time to provide advice. It is proposed that additional full-time staff be employed, subject to a successful cost pressure business case, to:
  • Ensure the quality of response
  • Ensure every action agreed with the service user is followed up
  • Complete other duties when not responding to calls
JK - It would be useful to have a periodic review of actions from serious incidents in the same way that the Audit Committee reviews audit recommendations.
WB - This task is routinely undertaken by the Patient Safety Group but a summary could be included in the Compliance Report.
SF - Whilst the actions provide greater levels of assurance in respect of safety there remains only a 24 hour crisis in Greenwich. A move to two sites across three boroughs might be necessary to further improve safety.
SJ - Is it not a reasonable assumption for all patients to be seen (assessed) by a doctor? The action plan suggests this is not currently happening.
IO - In many cases the liaison nurse may have more experience.
SF - The specific action requires an assessment by a doctor once the decision to admit has been made.
It was agreed the action plan should return to the Board of Directors in May 2012. / Noted
10. / Olympic Planning update
75% of Olympics Impact Risk Assessments have been completed. The majority of those outstanding are from sites in Bexley and Bromley where the impact of the Games is likely to be minimal. The next iteration of risk assessments and confirmation of service readiness is due at the end of March. Contractors and suppliers have been contacted to ensure they have robust plans to support business continuity during this period.
The Intranet will be the primary source of information for staff. An overarching plan has been drafted with links to the information services and individuals will require to make their plans, together with impact assessments and existing service plans. Guidance has been issued from Human Resources to staff and rotas are in the process of being finalised.
DM - Since Police leave is cancelled during the Olympics it would be worth checking whether the same applies to the London Ambulance Service as the trust might experience a reduced presence post Olympics when leave is taken. RE agreed to check. / Noted
11. / Quality Report - Quarter 3 position
QSIP(mental health) - There are five amber items;carer details recorded on RiO, CPA patients with a crisis plan, CPA review within last 6 months, Follow up within 7 days of discharge and Section 132 information.
QSIP (community health) - There are three red rated items;Timeframe for responding to complaints (Bexley) and Pressure ulcer reduction (grade 2 and grade 4) and one amber item; Care plans on RiO.
CQUIN (mental health)-There is one amber item; CPA summary review to GPs in 2 weeks.
CQUIN (community health) -There is one red item; Discharge summaries emailed to GPs within two working days and one amber item; Care plans on RiO. Performance in respect of pressure ulcer reduction is variable, with Bexley meeting the requirements in respect of grade 2 and 3 but not 4 and Greenwich meeting the requirements in respect of grade 4 but not 2 and 3.
The adverse financial variance as a result of non attainment stands at £185k. This comprises £87k mental health and £98k community health.
DM - Discharge summaries from community services to GPs remain low.
IO - Our ability to evidence this is through nhs.net email accounts only so it is likely the actual rate is much higher.
AH - Performance in respect of care plans on RiO in community requires improvement.
IO - This requires work on RiO roll out to staff with limited experience of using the system. In addition for many services the workforce is mobile and access is an issue. / Noted
12. / Compliance Report - January 2012
The majority of indicators in the Care Quality Commission Quality and Risk Profile remain similar to expected. There has been an overall decrease in the number of broadly negative indicators. Compliance with Section 132 requirements has improved for all sections excluding community treatment orders. A recent visit from the Mental Health Act Commissioner praised the consistent performance in respect of Section 132.
There were two recent outbreaks of diarrhoea and vomiting in Ivy Willis House and the Step Up Step Down Unit (SUSD). A full root cause analysis is being undertaken on the outbreak on SUSD. Two patients were transferred from SUSD as a result of the outbreak, with one requiring treatment in a High Dependency Unit, although they were already very unwell.
Compliance with health and safety risk assessments remains variable, with a number of assessments recently becoming out of date. An increased focus is required within services. Performance in respect of safety alerts has improved. Datix Web online incident reporting is now working in three service directorates and reporting continue to increase. Three serious incidents were reported in January 2012. One is an unexpected death where toxicology results are awaited.
PW - Is the serious incident where toxicology is awaited indicative of a wider problem?
WB - Drug misuse is a known issue. In Acute Services the use of sniffer dogs has been introduced in liaison with the Police. Forensic services are considering purchasing specialist equipment to detect drug presence.
SF - We are looking to hold a Board to Board event with Sussex Partnership NHS Foundation Trust. The event will include the opportunity to share learning. Sussex Partnership have a strong history of substance misuse provision.
DM - It would be useful to see a breakdown of complaints by locations and teams in light of the increase.
WB - Complaints numbers have risen by 60% in mental health services over the past year.
SF - The increase is largely attributed to Green Parks House and in particular Betts Ward, which is used to triage patients on admission to the unit. / Noted
13. / Governance Board update
The Board of Directors was requested to delegate authority to the Governance Board regarding the items below:
  • The annual Same Sex Accommodation Declaration must be published on the Trust website by 1stApril 2012. Further work is required to consider the impact of the transfer of the intermediate care facility (Bevan Unit) in Greenwich Community Health Services before the declaration can be finalised.
  • The Scheme of Delegation under the Mental Health Act sets out which members of staff are able to undertake functions of the Mental Health Act on behalf of the trust. Currently the Scheme of Delegation specifies the banding of the nurse who can receive section papers. It is recommended this be changed to allow the function to be performed by the most senior qualified nurse.
The Board of Directors agreed to delegate authority to the Governance Board to finalise the above items.
The Governance Board agreed with the recommendation of the NHSLA Steering Group that the trust undertake a Level 1 assessment in June 2012. The financial impact is approximately £50k per annum.
Two risks (IG4 and KP5.3.1) were reduced by the Governance Board. It was agreed to amend the wording on risk KP1.1.3 to: ‘This means that the trust may not always be able to consistently and accurately monitor progress against targets and Board priorities.’ The Board of Directors agreed that risks PS1 and KP1.2.3 be added to the Corporate Risk Register. / Noted
14. / Performance Committee update
The terms of reference will be reviewed in light of the introduction of the Marketing Group and changing responsibilities. The committee will now meet monthly. BT added that the Business Information System is now live and training of Business Managers has commenced. / Noted
15. / Audit Committee update
The Committee met on 21st February 2012 with the Trust Secretary in attendance. The Committee conducted a review of all outstanding audit recommendations and will be inviting lead directors to explain the reasons for non-completion of recommendations. New internal auditors have been assigned to the trust from Deloitte. A meeting with the Managing Director of Deloitte resulted in an offer of £60k with no admission of liability. The content of the confidentiality agreement will be reviewed prior to signature.
Fraud awareness and whistleblowing training have been added to the induction programme for new staff. Further training for all staff on risk management will be arranged. A working group has been established to implement the recommendations of the KPMG report. Visits have taken place to the main cash outlets in the trust.
The Committee received the internal audit report into data quality, which provided substantial assurance. The committee also agreed to increase the triviality level for adjustment from £20k to £50k, still well within the recommended limit, which is a percentage of overall turnover.
The Committee agreed a petty cash write off of £146,727.60. New limits of delegation will be taken to the Executive Team and then to the Board of Directors. The Committee agree a new risk FN14 in respect of the security of patient monies. The risk is currently rated at 9 (moderate) with a target rating of 6 (low).
BT - The trust has lodged an insurance claim with the NHSLA following the alleged fraud. The latest estimate of the fraud from NHS Protect is £299k.
DM - Board records gratitude for the amount of work undertaken in this area. / Noted
16. / Council of Governors update
The next meeting of the Council of Governors is scheduled for 22nd March 2012. The meeting will focus on the Annual Plan for 2012/13, feedback from Borough Focus Groups and the draft Carers’ Strategy. Monthly meetings between the Chair of the Board of Directors and the Lead Governor / Deputy Chair of the Council of Governors continue to take place. / Noted
17. / Sealing of Trust Documents
The following document requires the affixing of the Trust Seal: National Variation Deed 2011/12 in relation to the NHS Standard Mental Health and Learning Disabilities Services Contract - Bexley Primary Care Trust. The use of the Trust Seal was agreed. / Agreed
18. / Contract update and Financial Planning 2012/13
Agreement in principal has been reached with Bromley and Greenwich for mental health services for 2012/13. In Greenwich the proposal is to apply the national efficiency target plus the 2011/12 saving becoming recurrent. Bromley are looking to apply the national efficiency target with the possibility of additional investment in psychiatric liaison teams. The efficiency savings proposed for Greenwich Community Health Services exceed those outlined in the transfer agreement and therefore this remains under discussion. Negotiations with Bexley have not advanced as positively with savings of approximately £500k on each of the community and mental health contracts proposed on top of the national efficiency target. As a group Bexley, Bromley and Greenwich have requested the contracts be signed at the same time.
Budgets for services will be distributed in the next week.Services have been advised to plan for CREs of 4.5%, although there is a possibility the target will be lower.
PW - There is a risk that commissioners working together increases their leverage.
StJ - There is limited history of Bexley working with Greenwich and Bromley.
HS - Unfortunately negotiations are some way off being resolved with Bexley.
BT - The trust has been very open with commissioners and shared savings delivered in 2011/12 as evidence of the steps taken to reduce management costs. / Noted
19. / Finance Report - January 2012
The trust remains on track to deliver a surplus of £2.5m against a plan of £2.4m. The cash position stands at £69.7m, partly due to advance payments from Bexley and Greenwich. The trust’s current Monitor financial rating is at 5. The reason for the increased rating is because the recent impairment is excluded from the surplus. Progress against CREs continues to be a challenge although central funds are available to cover the gap.
SC - How advanced are plans to spend reserves?
SF - Resources have already been committed to support the IT strategy. Further investments will be in line with the organisational developmentstrategy. The impact of CREs on services will also need to be considered.
HS - There is the potential to continue access schemes into the new financial year. / Noted
20. / Workforce Report - January 2012
Sickness Absence - Sickness absence in January is recorded as 4.03%, which is low, particularly considering the time of year.
Vacancy & Turnover - Vacancy rates are at 9.73%. Vacancies continue to be held prior to reconfigurations and CREs. Turnover remains at an overall low level.
PDR uptake - Overall Trust compliance is at 80%. All bar two directorates have achieved the 80% target. The focus is now on ensuring all teams have met the target and scheduled dates for the next review. There are approximately 60 staff who have not had a PDR for 12 months or more. These are being actively followed up.
National Staff Survey - The initial data from the CQC report is extremely positive, with the trust in the top 20% in 28 out of the 38 criteria. In 7 of the criteria the trust achieved the best national score for mental health and community providers. The full report will be published in April 2012.
AH - Congratulations on achievement of the PDR target.
SJ -Board should write to two services that recently received awards to show appreciation. / Noted
21. / Reconfiguration of Community Health Services: Options Appraisal
The proposals seek to achieve greater integration of services to improve patient care, enhance productivity and increase efficiency. Three options for service directorate reconfiguration were presented:
  1. No change
  2. Merger of two community health services directorates
  3. Reconfiguration of community health services, CAMHS and ALD
StJ - Options do not integrate physical and mental health services, except in children. If this is part of a journey towards the ultimate destination we should be clear with staff.
HS - Teams will remain borough based and services will need to be provided based on what is commissioned, as currently happens in mental health.
SF - The level of savings are broadly similar for options 2 and 3 so the decision is about integration and quality.
WB - There are opportunities to align practice across community health services. We need to ensure we have the management and clinical leadership expertise across children’s services in particular
AH - The movement of ALD into Complex Needs and Recovery is a better fit.
SH - There will be management disruption.
PW - It is right that strategy is emergent rather than fixed.
SJ - Could the Board of Directors receive a copy of the consultation paper?
The Board of Directors agreed that option 3 should be pursued. An update on progress will be provided at the next meeting of the Board of Directors. / Agreed
Next meetingof the Board of Directors (Part 2)
5th April 2012, Bracton Conference Room

I confirm that the minutes of Board of Directors meeting of 1st March2012are a true record