COG 33/2013
COUNCIL OF GOVERNORS MEETING
20 March 2013
CHIEF EXECUTIVE’S REPORT
1. Potential Relocation of Northwood and Pinner Community Inpatient Unit
As reported at the December 2012 meeting, the Trust has been exploring the feasibility of relocating the Northwood and Pinner Community Inpatient unit, which is currently sited on the first floor of the Medical Block at Mount Vernon Hospital to the Woodlands site adjacent to Hillingdon Hospital. This is a 22-bedded in-patient unit providing nursing and rehabilitation services for patients who are registered with a Hillingdon GP. The current layout of the unit is configured in a typically old-style traditional arrangement with two main large bays; one 10-bedded male bay and one 10-bedded female bay. This configuration impacts on the degree of privacy and dignity that can be provided when curtains are all that separate individual bed areas. In 2009, work was undertaken on the unit to create 2 side rooms to support infection control requirements providing a total compliment of 22 beds.
The general fabric of the building where the ward is housed is poor and the structural limitations of the building limits opportunities to remodel the ward sufficiently in order to provide the required improvements that would deliver an affordable, modern ‘fit for purpose’ intermediate care facility. The proposal is to provide superior accommodation and services for the Northwood and Pinner in-patient unit by relocating it to the Woodlands site adjacent to Hillingdon Hospital. There will be no additional costs to the overall health economy as a result of this move. There will also not be any planned reduction in service provision or the number of beds as a result of this move. The new site has the potential to offer greatly improved accommodation and on-site facilities.
The proposal has been positively received by stakeholders including the CCG, and London Borough of Hillingdon. A business case has therefore been developed and will be presented to the Trust’s Business and Finance Committee on 22 March 2013. A schedule of visits for Governors and other interested stakeholders will be agreed over the coming weeks to enable interested parties to see first-hand the potential benefits of the move. Visits for Governors with a specific Hillingdon remit are being arranged if any other Governors are interested in joining these visits please contact Christine Baldwinson, Trust Secretary.
2. Acute Services Update
During 2012/13 the service undertook a key redesign programme within the boroughs of Kensington Chelsea and Westminster, this programme forms a vital part of the services 3 year efficiency plan to reduce the acute inpatient bedded provision.
Building Better Mental Health Care consultation ran from the 24 of August to the 16 of November. During the consultation period the trust undertook various stakeholder engagement events to ensure all affected parties were able to comment on the proposed service changes. Following on from an in-depth consultation both Westminster and Kensington and Chelsea Policy Committee held no objections to the service changes and have asked the trust to return to present further updates to services in the summer.
The Board are in favour of the reduction in inpatient bedded provision and have approved the redesign programme on the premise that some of the released monies are re-invested back into community services. At this stage negotiations are still underway with the Clinical Commissioning Group to establish the nature of this re-investment.
The service line is also looking to improve how Home Treatment Teams are currently operating, with the emphasis being put on better engagement with inpatient wards to ensure admissions are prevented and discharges facilitated in a timely manner. A project group has been set up to look at new ways of working within the Home Treatment Teams, improving the quality of care seen across the acute services care pathway and reducing the potential blockages within the system.
Sitting alongside and heavily integrated with the service redesign programme is the acute services care quality programme, which is looking at maintain and improving quality through the service. The main components of the programme are as follows:
- Development of Triage Wards
- The productive mental health ward framework
- The 15th Step Challenge
- Multidisciplinary Care Plan
- Reflective Practice
- Nursing Strategy and Development Programme
- Nursing Supervision
- Nursing Competency Framework
- Medicines Competency Framework
- Risk Assessment and Risk Management Training
- Handovers
- Communicating and Engaging with Patients
- Nurses Handbook
- Service User Involvement
- Support for Carers, Families and Friends
- Acute Service Audit Programme
- Acute Service Care Quality and Innovation Group
3. Safeguarding
The Board receives regular updates on the safeguarding of both vulnerable adults and children. The Board asked for specific focus to be given to how we ensure that a situation similar to the Jimmy Saville affair could not go undetected in the Trust. There are a small number of ‘celebrities’ who visit our services but they are all treated in the same way that we treat any other visitors ie by being escorted or having CRB checks. We are mindful that these checks alone do not identify all potential abusers therefore we are mapping the very many opportunities we provide for patients and their carers to feedback concerns in supportive environments.
4. Equality Act Compliance
We have just published the Trust’s second Equality Act Compliance report. It includes examples of the data included and actions that have been and are being taken which demonstrate that the Trust complies with the Public Sector Equality Duty of the Equality Act 2010 Act.
From the findings of the Report it is clear that there are a wealth of actions and initiatives taking place within the Trust to meet the public sector equality duty and that areas that continue to need addressing are largely being addressed via the 4-year Equality Objectives that the Trust put in place in April 2012:
- Improving staff understanding and sensitivity through training and community engagement
- Improving data collection for service user equality demographics
- Improving staff experience of the Trust through targeted staff development initiatives
- Tackling staff experience of violence and abuse
The full CNWL Equality Act Compliance Report 2013 is available from Richard Bryant-Jefferies, Head of Equalities and Diversity.
5. Monitor Licence
From 1 April 2013 the Trust will operate under a new licence from Monitor. The terms of this licence have just been published and the Trust is confident that it will be able to comply fully with these. Monitor will continue to demand regular performance and financial information from the Trust as well as receiving self certifications from the Board to ensure that it is meeting all the terms of the licence. If Governors would like more detailed information on the new regulatory framework in place from 1April we would be happy to host a Governor seminar.
6. CQC Activity
There was a routinereview of the Max Glatt Unit in Jan 2013. The CQC found that we were not compliant with onestandard in respect to staffing. They found that staff shortages, due to vacancies and absences, were having an impact on the consistency and continuity of care and the overall operation of the unit. However they found that there had been only minor impact on service users. We have an action plan in place to address this issue.
The CQC have alsocarried outan inspection at HMP Feltham. This was a joint inspection with HM Inspector of Prisons. We were found to be compliant with all standards.
A further inspection was held at HMP Rochester but we have yet to receive the final report
7. A New Name: Future Proofing the Organisation
The time has come where the name Central and North West London (CNWL) NHS Foundation Trust no longer reflects who we are and what we do. We now also provide services across Enfield, Surrey, Hampshire, Kent, and soon Milton Keynes. We are looking at opportunities beyond these areas and need to take steps now to ensure we are ready for future growth. Also, the name CNWL is largely associated with being a provider of only mental health care, whereas community health services now account for nearly 40% of our revenue.
There are a number of reasons why a growth strategy is the best course of action for the Trust. We are working in an increasingly competitive market and we need the economies of scale and efficiencies that only a large organisation can achieve, so we can invest more in front line care.
However, growth is not just about money. We want this Trust to be a national name and to be recognised as a symbol of quality healthcare. We want the policy makers to think of us so we can influence the direction of healthcare, just as large acute Trusts such as UCLH and Great Ormond Street do at present. We also need to be so good that we can hold onto our contracts and remain competitive.
We will not allow the name change to cause unnecessary distraction, as a name is a small part of the overall picture. We intend to come up with a list of potential names which we will consult with stakeholders. The re-launch will be supported by a communications campaign to ensure that key stakeholders, service users and carers are aware of any potential name change and the reasons for doing this.
We will be writing to members with more information about the name change. However, In the meantime, if you have any comments or suggestions please email .
8. Engaging with our Staff – The Conversation
Some of you were at our nursing conference where we launched ‘The Conversation’.
We know that nurses are central to the care we provide across CNWL and we want to engage them in a conversation about the valuesthat best embody a commitment to care. We have therefore asked all our nurses to tell us their top values that reflect high quality compassionate care.
We are already getting lots of feedback and weintend to use this todevelop a charterwhich will set out a consistent caring and compassionate approach across all of our services.
Some examples of comments received to date:
On Compassion
-“Compassionate, person-centred, mindful approach towards patients, carers and other staff members to build, facilitate and maintain a positive and enjoyable environment for all.”
-“Demonstrating care, compassion & understanding in practice.”
-“Instilling hope to those who others have often given up hope on.”
On Communication
-“To be open and honest about our own strengths and weaknesses and that of our colleagues.”
-“Breaking down barriers.”
-“Short term contracts and fear of losing their job make people less likely to speak out about problems.”
On Empathy / Respect
-“Treating people as you would expect to be treated yourself.”
-“Being understanding and respectful of patient’s needs and the concerns of friends, families and carers.”
-“Respectful, non judgmental, unconditional care. Providing care that I would wish my family and friends to receive.”
-“Providing support and guidance and empathy to people in distress.”
-“Respecting that every patient is an individual with their own history, special needs and goals which should be treated as such.”
On Professionalism
-“Having a patient centred approach to health care so that patients feel as if they are in control, having a positive experience to hopefully promote a faster rate of recovery.”
-“Always remaining up to date with modern clinical practice.”
-“Being educated and competent practitioners delivering care with sensitivity and respect.”
On Dedication
-“Making a difference by working outside of the box to meet individual needs.”
-“Providing support and supervision to all staff, challenging poor practice and acknowledging and celebrating good practice.”
-“Passionate belief in the NHS.”
On Empowerment /Knowledge
-“Empowerment of students, to encourage and harness fresh, new ideas directed towards making improvements to practice, care and procedures.”
- “Empowering patients to be involved in their own care and choices.”
Claire Murdoch
Chief Executive
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