Meeting of the Oxford Health NHS Foundation Trust

Public

Meeting of the Oxford Health NHS Foundation Trust

Board of Directors

Minutes of a meeting held on

26 October 2016 at 08:30

at Unipart Conference Centre, Garsington Road, Cowley, Oxford OX4 2PG

Present:

Lyn Williams / Non-Executive Director and Vice-Chair (the Chair)
Ros Alstead / Director of Nursing and Clinical Standards
Jonathan Asbridge / Non-Executive Director
Stuart Bell / Chief Executive
Mike Bellamy / Non-Executive Director
Alyson Coates / Non-Executive Director
Anne Grocock / Non-Executive Director
Mark Hancock / Medical Director
Mike McEnaney / Director of Finance
In attendance:
Mike Foster / Freedom to Speak Up Guardian – part meeting
Donna MacKenzie / Patient Experience and Involvement Manager – part meeting
Kerry Rogers / Director of Corporate Affairs and Company Secretary
Martyn Ward / Interim Director of Performance – attending for Dominic Hardisty, Chief Operating Officer
Hannah Smith / Assistant Trust Secretary (Minutes)
BOD
163/16
a
b / Welcome and Apologies for Absence
The Chair welcomed governors, staff and members of the public who had attended to observe the meeting.
Apologies for absence were received from: John Allison, Non-Executive Director; Sue Dopson, Non-Executive Director; Dominic Hardisty, Chief Operating Officer; and Martin Howell, Trust Chair.
BOD 164/16
a
b / Patient Story – Adult Directorate
Donna MacKenzie presented a recording of a service user from the Adult Directorate. The service user praised his care coordinator, especially for their support after a suicide attempt. The service user highlighted issues they had experienced in relation to: communication and missed opportunities and appointments being changed at short notice. The service user felt that they had had to make an effort to stay connected to services.
The Board noted that communication came up as a regular theme in patient feedback and discussed how communication issues could lead to patients not feeling cared for. The Director of Nursing and Clinical Standards noted that this recording would also be shared with staff in the Adult Directorate for their learning so that they were aware of the experiences of this individual. Anne Grocock added that the Patient Experience Group had recently met and also discussed the impact upon patients if their care coordinator or nurse unexpectedly went off sick and how the caseload could be picked up as seamlessly as possible.
Donna MacKenzie left the meeting.
BOD 165/16
a / Declarations of Interest
No declarations of interest were reported and none were declared pertinent to matters on the agenda.
BOD 166/16
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b
c
d
e
f / Minutes of the Meeting held on 28 September 2016
The Minutes of the meeting were approved as a true and accurate record.
Matters Arising
Item BOD 148/16 (c) Thames Valley Quality Surveillance Group (TVQSG)
The Chief Executive to inform (directly or through NHS Providers) the TVQSG of the outcome of the recent CQC inspection and to enquire about the cost/funding of the TVQSG’s process to review quality data in relation to the Trust. The Chief Executive noted that organisations which were members of the TVQSG were already aware of the outcome of the CQC inspection.
Item BOD 153/16(b) Joint Children and Adults Safeguarding Annual Report – actions to close gaps to achieve required training levels; and more information on audits, their outcomes and whether or not part of the Clinical Audit process
The Director of Nursing and Clinical Standards replied that the report author had now revised the annual report to include more of this detail.
Item BOD 152/16(c) Safer Staffing reporting
Future reporting to provide an overview of a longer period of time than a month as this would help to provide a more strategic outlook on safer staffing.
Item BOD 159/16(b) Strategic Partnerships Report
Future reporting to include more evaluation of whether progress achieved was as expected.
The Board confirmed that the remaining actions from the 28 September 2016 Summary of Actions had been completed, actioned/in progress or were on the agenda for the meeting: BOD 146/16(b); BOD 156/16(a); and 157/16(c). / SB
RA
DH
BOD 167/16
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b
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d
e
f
g
h
i
j
k / Chief Executive’s Report
The Chief Executive presented the report BOD 121/2016 which outlined recent national and local issues.
Buckinghamshire, Oxfordshire and Berkshire West Sustainability and Transformation Plan (BOB STP)
The Chief Executive updated the Board that since the report had been written, the most recent version of the STP had been submitted to NHS England last week. He highlighted the challenge in the BOB STP achieving a coherent view of what would be necessary to achieve various quality, service and financial targets when services were provided by a variety of local providers, rather than on a STP-wide basis as was the case in other STP areas. He noted the link of the STP process to the Sustainability and Transformation Fund for the NHS trust sector which depended upon NHS trusts delivering agreed financial control totals. Control totals had been offered to trusts on 30 September 2016. The Board would consider in private session the control totals which had been offered to the Trust for FY18-19 and the accompanying financial risks.
Care Quality Commission (CQC) inspection of GP Out Of Hours (OOH) services
The Chief Executive reported that the CQC would be inspecting GP OOH services on 07-09 November 2016. This inspection would not cover dentistry services.
Oxfordshire Contracting, Transformation and local collaboration/joint working
The Trust, Oxford University Hospitals NHS Foundation Trust (OUH) and OxFed (GP Federation) had submitted a joint proposal on developing an integrated partnership approach, particularly around the frail and elderly urgent care pathway, to Oxfordshire CCG. The contract for this may not be in place by December 2016 but should be by April 2017 when a united approach to new models of delivery and contracting was planned to be operational across much of Oxfordshire.
The Board discussed the challenges for local GP Federations and OUH in working under increased system pressure and demand. Mike Bellamy expressed concern that whilst local providers were resolving their own issues, they may be less focused upon progressing to a locality-based new model. The Chief Executive replied that a new locality model could offer a solution at scale to some current issues and unlock further resources but that the management of risk needed to be determined.
Mike Bellamy asked about Oxfordshire Healthcare Transformation and whether there was any update on when the public consultation on proposals for changes to health services, particularly in relation to community hospitals, would start. The Chief Executive replied that the public consultation led by Oxfordshire CCG was still subject to approval by NHS England of the pre-consultation business case from the CCG. At the previous meeting he had provided an update that the consultation had been delayed from the originally anticipated start date of October 2016 and was more likely to take place at the end of the calendar year or early in 2017. He noted that the delay was extending the period of uncertainty about the future of health services, including community hospitals.
Academic Health Science Centre (AHSC)
The Board in private session would consider the proposal to create a new legal entity in the form of a Charitable Incorporated Organisation to provide a delivery vehicle for the AHSC partnership. The proposal would also be considered by each of the AHSC partner Boards/governing bodies.
Learning Disability Services
The Chief Executive reported that the Trust had now been approached by NHS England to consider taking over provision of the Evenlode unit. Evenlode was commissioned by NHS specialist commissioning; Southern Health NHS Foundation Trust had given notice to the specialist commissioners of its intention to withdraw from providing services into the unit by the end of March 2017. The Trust had expressed concern that the unit was not fulfilling expectations of a forensic learning disability unit, especially as this was the only unit in the south which may be capable of providing this type of service. The Trust was considering what may be required to transition the unit to be able to provide a forensic learning disability service.
New Single Oversight Framework in effect from 01 October 2016
Under the new Single Oversight Framework and new segment rating system the Trust had an initial segment rating of “1” (no evident concerns/providers with maximum autonomy). The Board would consider the new Single Oversight Framework and segmentation further in private session.
Legal, Regulatory and Policy update
The Board considered the Legal, Regulatory and Policy update appended to the Chief Executive’s Report. Anne Grocock highlighted the report from the Public Accounts Committee, on Improving Access to Mental Health Services, which provided an insight into workforce challenges around achieving parity of esteem between mental and physical health services. The Director of Nursing and Clinical Standards noted that she would be attending a Health Education Committee meeting on mental health which would be considering workforce issues. The Medical Director added that the Royal College of Psychiatrists would also be holding a meeting on recruitment and retention in psychiatry.
The Board noted the report.
BOD 168/16
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b
c
d
e
f
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h
i
j
k / Chief Operating Officer’s Report
The Interim Director of Performance presented the report BOD 122/2016 which provided an update on areas of excellence and issues of potential concern against: quality (safe, effective and caring); finance/Cost Improvement Programmes (CIPs); workforce; and performance against key targets, for each of the Children & Young People’s Directorate, Adult Directorate and the Older People’s Directorate.
The Interim Director of Performance highlighted that the wider issues across directorates remained: workforce pressures; the high cost of agency and use of bank staff; and financial pressures to make Cost Improvement Programme savings. He noted that there had been improvement in collaboration with various partner agencies, a reduction in harm and a positive impact from improvement work.
In relation to the Older People’s Directorate, the Interim Director of Performance had tested areas of only partial compliance with NICE (National Institute for Health and Care Excellence) guidance. He confirmed that there were no areas of non-compliance but there were some areas where further continued improvement was required. The Chair added that the Older People’s Directorate Performance Review Meeting had also highlighted where new NICE guidance had come out and some areas of partial compliance related to where this new guidance needed to be fully implemented. The Interim Director of Performance added that Delayed Transfers of Care (DToCs) remained challenging, especially during the transition of the reablement service, but that patient flow coordinators had made good progress on standardising discharge planning.
In relation to the Children and Young People’s Directorate, there was pressure from the volume of tenders/re-procurement exercises for current business and the impact of managing this for the directorate. The Interim Director of Performance was assisting the directorate with this and arranging for external support. He noted that there were also challenges with maintaining training attendance and that the importance of attendance would be reinforced across services.
Alyson Coates asked about waiting times in Child and Adolescent Mental Health Services (CAMHS). The report set out that it was an area of potential concern that CAMHS waits were significantly below expected levels for Oxfordshire. The Interim Director of Performance replied that although waiting times were not yet where the directorate wanted them to be, these had significantly improved in recent months and this improvement trajectory had been discussed with the CCG.
Anne Grocock noted that pressure from the volume of tenders/re-procurement exercises was not unique to the Children & Young People’s Directorate and asked what work could be done to relieve this pressure across the Trust. The Interim Director of Performance replied that part of his role was to consider this for the Trust and that he was: looking at the various contracting resources available within each of the directorates and centrally; and developing a model to separate service delivery from the commercial operations which needed to take place with commissioners.
In relation to the Adult Directorate, the Interim Director of Performance highlighted that Out of Area Transfers (OATs) and increased length of stays were putting pressure on the directorate in terms of the impact upon funding and use of resources to resolve.
Anne Grocock asked whether new methods of allocating beds were being considered in order to resolve issues with OATs. The Director of Nursing and Clinical Standards replied that the Adult Directorate would be conducting a workshop next week to look at the multifactorial reasons behind current pressures on inpatient beds. The outcome of this should be reported in the next Chief Operating Officer’s update to the Board.
Jonathan Asbridge asked about the impact of the number of acting or interim staff in leadership roles on most of the acute Adult Directorate wards. He noted that although teams may be able to cope with this in the short term, the aim should be to make posts substantive. The Director of Finance replied that the HR team was working with the Service Director for the Adult Directorate to review management structures in the directorate.
The Director of Nursing and Clinical Standards expressed concern that more detail/data needed to be included in this report for it to provide sufficient assurance to the Board. She suggested that the report set out more clearly the impact of performance and evaluate progress made. If the intention was not for the Board to see this level of detail then it needed to be made clear which committees or meetings had considered the detail and how their work was providing assurance to the Board. She noted that the recent Performance Review Meetings had discussed the lack of progress on safer care work to reduce pressure ulcer incidents but that this was not referred to in the report. The Chief Executive noted that the timing of the very recent Performance Review Meetings may have meant that it had not been possible to include an update on that particular issue in this report.
The Board noted the report.
BOD 169/16
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b
c
d / Freedom to Speak Up Guardian report
The Freedom to Speak Up Guardian presented the report BOD 123/2016 on the first 6 months of activity since he took up his post. He noted that the report reflected what he had been approached about or made aware of but that he had not yet had approaches from some areas in the Trust, for example from community hospitals despite initial attempts he had made to engage. There were no whistleblowing cases of neglect or abuse to report but staff had reported workload pressure as a result of increasing demand upon services. Staff were very committed to patient care and therefore often went the extra mile to achieve that. No concerns had been raised by staff with the CQC about staff. Although 29 cases of concern had been raised with the Freedom to Speak Up Guardian, only one had become a formal whistleblowing investigation.