AGENDA FOR Council of Governors Meeting · 2018-05-09 · Page 1 . AGENDA FOR . Council of...

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Page 1 AGENDA FOR Council of Governors Meeting Date: Thursday 12 April 2018 Time: 4:00pm – 6:00pm Venue: Mersey Care NHS Foundation Trust HQ, V7 Building, Rooms 2 & 3, Kings Business Park, Prescot, L34 1PJ NOTE: There will be a pre-meet for Governors at 3.40pm No. Item Lead Details Timings PART 1 – FORMAL MEETING A Council Business A1 Welcome B Fraenkel Verbal to note 4:00pm A2 Apologies – Governors: Apologies – Attendees: B Fraenkel Verbal to note A3 Declarations of Interest B Fraenkel Verbal to note A4 Minutes of the Previous Meeting: a) 21 March 2018 b) 28 March 2018 c) Action Log B Fraenkel Paper for decision [ref COG18/19/001a] Paper for decision [ref COG18/19/001b] A5 Update from the Chairman B Fraenkel Verbal to note 4:05pm A6 Update from the Chief Executive (including update re Liverpool Community Health) J Rafferty Verbal to note 4:10pm C Our Services C1 Financial and Activity Performance Report N Smith Paper for assurance [ref COG18/19/072] 4.30pm C2 Specialist Learning Disabilities Division Retraction Plan Update L Taylor Paper for assurance [ref COG18/19/067] & presentation 4.45pm C3 Quality Account Priorities 2018/19 J Hurst Presentation 5.00pm C4 Kirkup Review Action Plan & Liverpool Community Health Update T Bennett Paper for assurance [ref COG18/19/072] 5.15pm D Governance D1 Appointment of New Non Executive Director [paper to be tabled] B Fraenkel / A Meadows Paper for assurance [ref COG18/19/069] 5.35pm D2 Outcomes of Chairman and NED Appraisals A Meadows Paper for assurance [ref COG18/19/070] D3 Council of Governors Annual Cycle of Business A Meadows Paper for approval [ref COG18/19/071] E Consent Items Note – these items are provided for consideration by the Council of Governors. Governors are asked to read the papers prior to the meeting and, unless the Chair / Trust Secretary receives notification before the meeting that a - -

Transcript of AGENDA FOR Council of Governors Meeting · 2018-05-09 · Page 1 . AGENDA FOR . Council of...

  • Page 1

    AGENDA FOR Council of Governors Meeting

    Date: Thursday 12 April 2018 Time: 4:00pm – 6:00pm

    Venue: Mersey Care NHS Foundation Trust HQ, V7 Building, Rooms 2 & 3, Kings Business Park, Prescot, L34 1PJ

    NOTE: There will be a pre-meet for Governors at 3.40pm

    No. Item Lead Details Timings

    PART 1 – FORMAL MEETING

    A Council Business

    A1 Welcome B Fraenkel Verbal to note 4:00pm

    A2 Apologies – Governors: Apologies – Attendees:

    B Fraenkel Verbal to note

    A3 Declarations of Interest B Fraenkel Verbal to note

    A4 Minutes of the Previous Meeting: a) 21 March 2018b) 28 March 2018c) Action Log

    B Fraenkel Paper for decision [ref COG18/19/001a] Paper for decision [ref COG18/19/001b]

    A5 Update from the Chairman B Fraenkel Verbal to note 4:05pm

    A6 Update from the Chief Executive (including update re Liverpool Community Health)

    J Rafferty Verbal to note 4:10pm

    C Our Services

    C1 Financial and Activity Performance Report N Smith Paper for assurance [ref COG18/19/072]

    4.30pm

    C2 Specialist Learning Disabilities Division Retraction Plan Update

    L Taylor Paper for assurance [ref COG18/19/067] & presentation

    4.45pm

    C3 Quality Account Priorities 2018/19 J Hurst Presentation 5.00pm

    C4 Kirkup Review Action Plan & Liverpool Community Health Update

    T Bennett Paper for assurance [ref COG18/19/072]

    5.15pm

    D Governance

    D1 Appointment of New Non Executive Director [paper to be tabled]

    B Fraenkel / A Meadows

    Paper for assurance [ref COG18/19/069]

    5.35pm

    D2 Outcomes of Chairman and NED Appraisals A Meadows Paper for assurance [ref COG18/19/070]

    D3 Council of Governors Annual Cycle of Business A Meadows Paper for approval [ref COG18/19/071]

    E Consent Items Note – these items are provided for consideration by the Council of Governors. Governors are asked to read the papers prior to the meeting and, unless the Chair / Trust Secretary receives notification before the meeting that a

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    member wishes to debate the item or seek clarification on an issue, the items and recommendations will be approved without debate at the meeting in line with the process for Consent Items. The recommendations will then be recorded in the minutes of the meeting.

    E1 Final Operational Plan 2018/19 L Edwards Paper for consent [ref COG18/19/066]

    5.45pm

    F Any Other Business

    F1 Any Other Business Governors Verbal .

    PART 2 – DEVELOPMENT SESSION

    Out of Hospital – Model of Care M Hindle PRESENTATION . 5.45pm

    Dates of future meetings: Wednesday 25 July 2018 4pm-6pm – (venue to be confirmed)

    Thursday 18 October 2018 4pm-6pm – (venue to be confirmed)

    Thursday 17 January 2019 4pm-6pm – (venue to be confirmed)

    Thursday 25 April 2019 4pm-6pm – (venue to be confirmed)

    Wednesday 31 July 2019 4pm-6pm – (venue to be confirmed)

    Thursday 17 October 2019 4pm-6pm – (venue to be confirmed)

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    C Status of these minutes (check one box):

    Paper No: COG18/19/001b

    Draft for Approval: ☒ Report to: Council of Governors

    Formally Approved: ☐ Meeting Date: 12 April 2018

    MINUTES OF THE MEETING OF THE

    Council of Governors Date: Wednesday 21 March 2018 Time: 4:00pm – 6:00pm

    Venue: Princes Royal Suite, Princess Royal Stand, Aintree Racecourse, Ormskirk Road, Aintree, Liverpool L9 5AS

    Name Job Title (Division/ Organisation*) *if not Mersey Care

    Present: Beatrice Fraenkel* Sayed Ahmed Paul Allen Clare Austin Johanna Birrell Tracey Cummins Debra Doherty Sarah Finlayson Mandi Gregory Mike Jones Mark McCarthy John Mousley Brian Murphy Scott Parker Garrick Prayogg Hilary Tetlow Paul Taylor Maria Tyson Veronica Webster

    Chairman (Meeting Chair); Staff, Medical (SLDD); Staff, Other Clinical/Therapeutic (SLDD); Appointed, Academic; Service User, Local (Liverpool, Sefton & Knowsley); Staff, Nursing (SLDD); Service User, Local (Liverpool, Sefton & Knowsley); Staff, Other Clinical, Scientific, Technical & Therapeutic Staff; Staff, Non Clinical; Staff, Non Clinical; Service User, Local (Liverpool, Sefton & Knowsley); Public, Sefton; Carer, Local (Liverpool, Sefton & Knowsley); Staff, Nursing; Public, Cheshire, St Helens, Wirral, West Midlands & Wales; Carer, Local (Liverpool, Sefton & Knowsley) & Lead Governor; Service User, Local (Liverpool, Sefton & Knowsley); Staff, Nursing Staff; Appointed, Local Authority (Sefton Council).

    In Attendance: Joe Rafferty* Neil Smith* Amanda Oates* Pam Williams* Elaine Darbyshire David Fearnley* Andy Meadows Sarah Jennings Paula Murphy Chris Lyons

    Chief Executive; Executive Director of Finance / Deputy Chief Executive Executive Director of Workforce; Non Executive Director; Executive Director of Communications and Corporate Governance; Medical Director; Trust Secretary; Deputy Trust Secretary; Corporate Governance Compliance Manager; Project Director.

    Apologies Received: George Allen Jane Lunt Jayne Moore Martin Murphy David Kitchen Vicky Keeley Matt Birch

    Carer, Local (Liverpool, Sefton & Knowsley); Appointed, Local CCG Public, Liverpool; Service User, Local (Liverpool, Sefton & Knowsley); Staff, Other Clinical/Therapeutic; Appointed, Local Voluntary Sector; Non Executive Director;

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    Cath Green Trish Bennett*

    Non Executive Director; Director of Integration;

    ISSUES CONSIDERED 2018 A1 WELCOME

    1. Mrs Fraenkel welcomed the Governors and attendees to the meeting.

    A2 APOLOGIES

    2. The apologies for absence received for the meeting were noted, as detailed above.

    A3 DECLARATIONS OF INTEREST

    3. Note – The report supporting Item C1 at the Board of Directors on 25 October 2017 noted that, in light of the Interim Management Agreement to provide support to Liverpool Community Health NHS Trust (LCH), the members of Mersey Care’s Board (highlighted with * in the list of those present on page 1 above) have a conflict of interest recognised by the Board of Directors in respect of items relating to LCH / the LCH transaction, as they are now also members of LCH’s Board.

    4. There were no further interests declared.

    A4 MINUTES OF THE PREVIOUS MEETING HELD ON:

    a) 27 January 2018 (including Action Log)

    5. The minutes of the meeting held on 27 January 2018, were accepted as an accurate record.

    6.

    Action Lead Timescale Status

    Recommendations approved by the Council of Governors, namely: • Approve minutes from 27 January 2018.

    Further actions required: • None identified.

    A5 UPDATE FROM THE CHAIRMAN

    7. Mrs Fraenkel informed Governors of the resignation of Non Executive Director, Dr Rob Beardall. Dr Beardall had a series of work commitments outside of the country and felt he could no longer dedicate sufficient time to the Trust and had therefore regretfully resigned. Agenda item D4 would address the process for sourcing a suitable replacement for Dr Beardall.

    8. Mrs Fraenkel highlighted her attendance at the following:

    a) continued visits to services, specifically Mrs Fraenkel had spent time at the dementia services at Mossley Hill and the maternity services at the Life Rooms;

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    b) attendance at the North West Company Secretaries Network where Mrs Fraenkel had been asked to speak regarding her perspective around governance. This had provided markers in relation to how the Trust compared with other organisations and had provided reassurance regarding the robust governance arrangements in Mersey Care;

    c) attendance at a NHS Academy training and development course for aspiring Chief Executives, subsequently hearing of experiences around their Boards and governance;

    d) attendance at the Mental Health Network where discussions took place regarding links between mental health and housing.

    A6 UPDATE FROM THE CHIEF EXECUTIVE

    9. Mr Rafferty stated that the transaction process had been an important focus for Executives and Non Executives over recent months, however Mr Rafferty highlighted other Mersey Care news: a) The Secure Services continued to perform well;

    b) The Treasury had approved the business case in relation to the new Medium

    Secure Unit to be built at the Maghull site. The existing Medium Secure Unit in Rainhill would then be closed as although the staff and services were excellent, the building was not fit for purpose. Whalley’s medium secure services would also transfer to the Maghull site. Mr Rafferty highlighted that this would become the only Medium Secure Unit in the country which was co-located with a High Secure Service and the potential synergies were highly beneficial and important. The new Medium Secure Unit would be a high quality service/building focused on recovery with relatively short stays (average 2 years);

    c) In Local Services, since November 2017, no patient in Liverpool or Sefton had been placed out of area for treatment and whilst achieving this had been challenging, the benefits for the patients were significant;

    d) The Trust would reach the end of the current financial year having achieved all its financial performance targets including a planned surplus. It was acknowledged that very few trusts were able to achieve this and Mr Rafferty took the opportunity to thank the entire executive team for all their hard work in such challenging times.

    10.

    Action Lead Timescale Status

    Recommendations approved by the Council of Governors, namely: • Note the verbal update.

    Further actions required: • None identified.

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    B1 LIVERPOOL COMMUNITY HEALTH (LCH) TRANSACTION (including information following the issue of the preliminary risk assessment from NHSi)

    11. Mr Rafferty provided a presentation to Governors to outline the background, process and benefits of proceeding with the acquisition of Liverpool Community Health NHS Trust (LCH).

    12. Mr Rafferty stated that it was important that Governors were satisfied that the Board of Directors had been thorough and comprehensive in reaching its proposal (undertaken proper due diligence); and had obtained and considered the interest of Trust members and the public as part of the decision making process.

    13. Mr Rafferty’s presentation highlighted:

    a) The Trust’s long-term strategic commitment to providing community services;

    b) How community mental health and physical health services might work together;

    c) Timescale for integration;

    d) Safeguards to ensure that mental health does not suffer in this integration;

    e) Kirkup Independent Review and organisational health.

    14. Following today’s Board of Director’s meeting, Mr Rafferty explained that the Board had agreed to conditionally approve the acquisition subject to the additional investment requested to address the Kirkup Review and associated action plan.

    15. Mrs Birrell queried the size of Mersey Care in comparison to Liverpool Community Health (LCH). In response, Mr Rafferty confirmed that Mersey Care’s turnover was £270m versus £90m for LCH. Mersey Care was approximately three times the size of LCH and the transaction would result in an additional 2000 employees of Mersey Care.

    16. Mr McCarthy queried the proposed contract with HMP Liverpool. Mr Rafferty confirmed that the Prisons contract was not part of this acquisition, although historically LCH had provided this service. Should Mersey Care’s proposed contract for the HMP Liverpool contract proceed, Mersey Care would provide mental health services for HMP Liverpool, not physical health. Mr McCarthy requested reassurance that executives would speak to prisoners regarding their experiences in relation to health provision. Mr Rafferty assured Mr McCarthy that working with prisons was not new to the Trust and mental health care was something the Trust specialised in and the Secure Division would be providing the service. Dr Fearnley added that prison health care had faced challenges as a result of the difficulties in attracting people to work in such an isolated environment.

    17. Mrs Birrell acknowledged the Trust’s expertise to take on the prisons contract in light of its work with services in secure settings. Mr Rafferty confirmed that the Trust had been approached to provide this service due to its reputation in this field and additional funds would be sought to ensure any risks were managed appropriately.

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    18. In response to Mr McCarthy’s question in relation to funding for the training of staff following the transaction (subject to approvals), Mrs Oates confirmed that the Trust would draw down funds from the apprenticeship levy and consideration would be given regarding the provision of nurse degree programmes. Mrs Oates highlighted the national challenge in relation to mental health nurses and those with speciality status who were eligible to retire at 55 years old, which was having a detrimental effect on the workforce. In order to mitigate this issue, work was on-going to create new roles for lower banded staff using the apprenticeship levy. There would also be an element of retraining current staff however a new career pathway would be developed.

    19. Mrs Finlayson requested the Trust considered integrating physical health care with mental health care in the prison service in order to provide the same benefits to prisoners as would be provided to the community following the acquisition of LCH. Mr Rafferty highlighted the complexity of this issue, noting there would be a lead contractor, Spectrum, with a small, bespoke additional provider and Mersey Care would be a sub contractor. The Trust were positive about the opportunities this would provide.

    20. In response to Mrs Doherty’s question relating to the ‘amber’ risk rating provided by NHS Improvement, Mr Rafferty noted that the majority of ratings in the report were green or amber/green. One particular rating was shown as amber/red for all issues associated with the Kirkup Review. The Trust had agreed that the way forward to manage this risk was to recognise that funding for 2 years was required to address the issues identified. NHS Improvement were keen for the transaction to proceed; however the Trust have stated that we would only proceed if the conditions specified were met to enable all amber/red issues to be addressed with appropriate investment.

    21. In reply to Mrs Doherty, Mr Lyons confirmed that the Trust must make a formal application following today’s Board of Directors and Council of Governors meetings, at which point NHS Improvement would then make their final deliberations.

    22. Mr Taylor noted that the Kirkup Review was damning and welcomed Mersey Care’s plans to address the issues identified. As a service user governor, Mr Taylor wholeheartedly supported Mersey Care’s application.

    23. Following Mr B Murphy’s question in relation to funding, Mr Rafferty stated that there was a strong likelihood that the additional funding would be forthcoming, however Governors were being requested to provide conditional approval for the Trust to formally make an application to acquire, subject to the requested additional funding being provided.

    24. In response to Mrs Doherty, Mr Rafferty clarified the process in relation to the ‘gateway to discuss year 3 funding’, confirming that as the business case was developed, it was apparent that most investment would be required in year 1, less in year 2, then a review in year 3 reserving the option to seek further funding in year 3 if required.

    25. Replying to Mrs Finlayson, Mr Rafferty confirmed that significant work was required and it was likely that further gaps would be identified. Reviews in relation to historic

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    serious untoward incidents would require funding and it was important that the Trust ensured a Just Culture philosophy when undertaking these reviews.

    26. Following Mr Prayogg’s question, Mr Rafferty confirmed that the Trust would be sighted on it’s liabilities as this historical review work was undertaken and it was likely that additional issues would be identified, confirming that these would be addressed also.

    27. In reply to Mrs Finlayson, Mr Rafferty confirmed that the Board were confident that the size of the enlarged organisation was manageable and the addition of LCH would make Mersey Care a medium sized NHS Trust.

    28. The Governors unanimously agreed the revised recommendations put forward as below.

    29.

    Action Lead Timescale Status

    Recommendations approved by the Council of Governors, namely: • The Council of Governors is satisfied that the Board

    of Directors of the Trust has been thorough and comprehensive (ie undertaken appropriate due diligence) in reaching its proposal to acquire Liverpool Community Healthcare NHS Trust and has obtained and considered the interests of trust members and the public as part of the decision-making process.

    • Therefore in accordance with section 56A(2) of the National Health Services Act 2006 and the Trust's constitution, the Council of Governors resolves to conditionally approve the Trust's and Liverpool Community Healthcare NHS Trust's joint application to Monitor (operating as NHS Improvement) in accordance with section 56A of the NHS Act subject to the Board of Directors of the Trust agreeing with NHS Improvement, no later than 12 noon on Tuesday 27 March 2018, post-transaction support funding of an amount no less than £4.5million in year one (2018/19), no less than £2.4million in year two (2019/20) and agreement for a gateway review to discuss year three (2020/21) funding.

    Further actions required: • None identified.

    C2 CORRESPONDENCE IN RELATION TO SPECIALIST LEARNING DISABILITIES DIVISION RETRACTION PLAN

    30. Mrs Fraenkel referred to the concerns raised at the January 2018 Council of Governors meeting in relation to the commissioner’s discharge plans at the specialist Learning disabilities Division (Whalley) and the subsequent effect such delays were having on patients and their families, together with delays in obtaining responses from external bodies. As agreed at the January 2018 meeting, Mrs Tetlow had formally written to the Chairman on behalf the Council of Governors to express their concerns

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    and the Trust’s formal response was subsequently shared with Governors for information.

    31. Mrs Tetlow confirmed she was content with the response and was keen to ensure this issue were progressed. Mr Meadows noted an update will be provided to April 2018’s meeting.

    32.

    Action Lead Timescale Status

    Recommendations approved by the Council of Governors, namely: • Note the letter from the Lead Governor on behalf of

    the Council of Governors and the subsequent response from the Chairman;

    Further actions required: • None identified.

    C3 KIRKUP REVIEW ACTION PLAN

    33. It was agreed to defer this item to the next meeting in April to ensure sufficient time to discuss the plan.

    34.

    Action Lead Timescale Status

    Further actions required: • Defer to the April 2018 CoGs agenda.

    T Bennett

    Apr-18

    On Apr-18 CoG Agenda

    D1 MEMBERSHIP & ENGAGEMENT COMMITTEE UPDATE

    35. Miss Jennings provided Governors with an update in relation to the Membership & Engagement Committee held on 9 February 2018.

    36.

    Action Lead Timescale Status

    Recommendations approved by the Council of Governors, namely: • Note the contents of the minutes and chair’s report.

    Further actions required: • None identified.

    D2 CHANGES TO THE TRUST’S CONSTITUTION

    37. Mr Meadows outlined the changes to the Trust’s Constitution as follows:

    • Should Mersey Care apply to acquire Liverpool Community Health NHS Trust (LCH) then we are required to review the Constitution to ensure the membership constituencies and Council of Governors reflects the wider members of the expanded Trust the membership of the trust;

    • The Council of Governors agreed to establish a Governance reference Group to work with the Trust Secretary to consider then recommend changes to the Trust’s Constitution;

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    38. Mrs Birrell queried whether geographical areas within the Constitution would be amended. Mr Meadows clarified that although some constituencies had had their geographical areas amended, this was influenced by that fact that some seats had had always experienced difficulty in being filled therefore the geographical boundaries had been amended to encourage local people to become Governors.

    39.

    Action Lead Timescale Status

    Recommendations approved by the Council of Governors, namely: • subject to the outcome of discussions around the

    proposal to acquire LCH, to consider the contents of this paper and approve the changes to the Trust’s Constitution outlined in paragraphs 5 to 13 of this paper;

    • to consider and approve the changes to the Trust’s Constitution outlined in paragraph 14 of this paper.

    Further actions required: • None identified.

    D3 MEMBERSHIP STRATEGY

    40. Mr Meadows provided Governors with a revised Membership Strategy which took account of the revised membership constituencies and Council of Governors reflected in the paper supporting agenda item D2 on today’s agenda.

    41. In response to Mr McCarthy, Mr Meadows confirmed that the Trust aimed to recruit the members from LCH as part of Mersey Care’s Membership, unless they wished to opt out. Mr McCarthy noted his concerns regarding maintaining a good representation from mental health service users on the Council of Governors as the Trust’s core business.

    42.

    Action Lead Timescale Status

    Recommendations approved by the Council of Governors, namely: • subject to the discussions re item D2, to consider and

    approve this revised Membership Strategy.

    Further actions required: • None identified.

    D4 NON EXECUTIVE DIRECTOR VACANCY

    43. Mrs Fraenkel stated that following the resignation of Dr Rob Beardall, Governors were being asked to approve the process to appoint a successor, as previously undertaken to appoint Ms Cath Green last year.

    44. In response to Mr McCarthy, Mr Meadows confirmed that as agreed by Governors previously, Non Executive Directors were paid £13k per year currently.

    45. Mr McCarthy raised some concerns in respect of the phrase ‘politically astute’ in the person specification. Mrs Fraenkel clarified that this referred to Non Executive’s sitting on the Board having an understanding of the complexities and changes of environment

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    and how the Board needed to set negotiations. Following discussion, it was agreed that the wording would be changed to, ‘an awareness and understanding of behaviours, situations, issues and climate both inside and outside the NHS’.

    46. Following a query from Mrs Doherty, Mr Meadows confirmed that the Nominations and Appointments Working Group was purely a change of title from the previous Nominations and Remuneration Committee which enabled a small group of Governors to make a recommendation to the full Council of Governors regarding appointments.

    47. In reply to Mr McCarthy, Mrs Fraenkel clarified that some of the Trust’s Non Executive Directors had a medical background and in replacing Dr Beardall it was important to ensure appointment of a Non Executive with a strong medical background to maintain balance and expertise on the Board.

    48. Mr Meadows agreed to circulate to Governors the link for the vacancy/advert as soon as it became live and asked Governors to share this link via social media to anyone they considered suitable to apply.

    49.

    Action Lead Timescale Status

    Recommendations approved by the Council of Governors, namely: • Consider the job description/person specification and

    approve the commencement of the recruitment process;

    • Agree to establish a Nominations & Appointments Working Group that will make the formal recommendation in respect of this vacancy to the next Governors meeting;

    Further actions required: • Circulate link to NED vacancy to Governors;

    A Meadows

    Mar-18

    Complete

    E1 ANY OTHER BUSINESS

    50. Mr Prayogg highlighted the Cite Region’s Health Summit and advised that the second summit related to mental health and was open for anyone to attend. Mr Meadows agreed to update Governors in relation to this.

    51.

    Action Lead Timescale Status

    Further actions required: • Provide update to Governors in relation to Liverpool

    Mayor’s Mental Health Summit;

    A Meadows

    Mar-18

    Completed

    52. No other business was raised.

    53. The meeting closed.

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    END OF DOCUMENT

  • Agenda Item No: TBC

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    Status of these minutes (check one box): Paper No: COG18/19/001b

    Draft for Approval: ☒ Report to: Council of Governors

    Formally Approved: ☐ Meeting Date: 12 April 2018

    MINUTES OF THE MEETING OF THE

    Extraordinary Council of Governors Date: Wednesday, 28 March 2018 Time: 12 noon

    Venue: Room 3, V7 Building, Prescot, Merseyside, L34 1PJ (and also by teleconference)

    Name Job Title (Division/ Organisation*) *if not Mersey Care

    Present (In the room): Beatrice Fraenkel* Sayed Ahmed Debra Doherty Mike Jones Jane Lunt Scott Parker Garrick Prayogg Maria Tyson

    Chairman (Meeting Chair) (Non-Voting member); Appointed, Academic; Service User, Local (Liverpool, Sefton & Knowsley); Staff, Non Clinical; Appointed, Local CCG Staff, Nursing; Public, Cheshire, St Helens, Wirral, West Midlands & Wales; Staff, Nursing Staff;

    Present (Via dial-in facility): Johanna Birrell Sarah Finlayson Mandi Gregory David Kitchen Mark McCarthy Jayne Moore John Mousley Hilary Tetlow Paul Taylor Veronica Webster

    Service User, Local (Liverpool, Sefton & Knowsley); Staff, Other Clinical, Scientific, Technical & Therapeutic Staff; Staff, Non Clinical; Staff, Other Clinical/Therapeutic; Service User, Local (Liverpool, Sefton & Knowsley); Public, Liverpool; Public, Sefton; Carer, Local (Liverpool, Sefton & Knowsley) & Lead Governor; Service User, Local (Liverpool, Sefton & Knowsley); Appointed, Local Authority (Sefton Council).

    In Attendance (Not members of the Council): Joe Rafferty* Neil Smith* Trish Bennett* Louise Edwards Amanda Oates* Andy Meadows Sarah Jennings Chris Lyons Alison Bacon Ashley Crossland

    Chief Executive; Executive Director of Finance / Deputy Chief Executive; Executive Director of Nursing; Director of Strategy Executive Director of Workforce; (Via dial-in facility) Trust Secretary; Deputy Trust Secretary; Project Director; Membership and Systems Manager Corporate Governance Assistant (Minutes Secretary)

    Apologies Received: Paul Allen Clair Austin Tracey Cummins Brian Murphy Martin Murphy

    Staff, Other Clinical/Therapeutic (SLDD); Appointed, Academic; Staff, Nursing (SLDD); Carer, Local (Liverpool, Sefton & Knowsley); Service User, Local (Liverpool, Sefton & Knowsley)

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    ISSUES CONSIDERED 2018 A1 WELCOME

    1. Mrs Fraenkel welcomed the Governors and attendees to the meeting.

    A2 APOLOGIES

    2. Given that some Governors were in attendance and some Governors joined the meeting by phone, Mr Meadows held a ‘roll call’ to confirm who was in attendance. This in attendance and apologies for absence received for the meeting were noted, as detailed on page 1.

    A3 DECLARATIONS OF INTEREST

    3. Note – the report supporting Item C1 at the Board of Directors on 25 October 2017 noted that, in light of the Interim Management Agreement to provide support to Liverpool Community Health NHS Trust (LCH), the members of Mersey Care’s Board (highlighted with * in the list of those present on page 1 above) have a conflict of interest recognised by the Board of Directors in respect of items relating to LCH / the LCH transaction, as they are now also members of LCH’s Board.

    4. There were no further interests declared.

    B1 LCH TRANSACTION

    5. Mr Rafferty referred to the discussions held at the last meeting of the Council of Governors, specifically the conditional approval given to the additional resources requested in respect of the acquisition of LCH.

    6. Mr Rafferty confirmed that NHS Improvement (NHSi) had formally responded to the Trust in order to detail a counter-proposal, consisting of £3.1million to be utilised during 2018/19. (A copy of this letter was attached to the paper supporting this item circulated to Governors). Mr Rafferty added that following this, NHSi would want to support us in an engagement processes in order to get a more accurate view of the risks to be faced during 2019/20, which would provide information of the finances required by the Trust in order to address these, adding that this was a demonstration of good risk management.

    7. Mr Rafferty confirmed that an extraordinary Board of Directors’ meeting had been held the previous day, 27 March 2018, at which it had been agreed that the acquisition should proceed with the additional funding identified in NHSi’s letter. Mr Rafferty assured that the proposed amount would allow the Trust to carry out the required recommendations arising from the Kirkup Review.

    8. Mr Taylor declared his support for the acquisition; however requested assurance that the quality of Trust services would not suffer as a result of the lower amount being accepted, which Mr Rafferty provided..

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    9. In response to Ms Birrell’s question in relation to 2019/20 funding, Mr Rafferty explained that further conversations would be held with both Liverpool and South Sefton Clinical Commissioning Groups (CCGs) and with other funding sources, such as the Sustainability and Transformational Programme (STP).

    10. Mrs Doherty referred to the 6-month review process noted within the paper, requesting detail of what this would entail and whether the Council of Governors would be included within this. Mr Rafferty explained that although there was still limited clarity in relation to the process, in respect of both the 6-month review proposed by the Trust and the 12-month review in line with the Kirkup recommendation, the Trust would be looking to co-produce this work with NHSi. The Trust would be monitoring against specific milestones and this information would be shared with Governors, NHSi and the CCGs.

    11. Ms Moore noted her approval of the due diligence process, which had taken place in relation to the acquisition and noted her confidence in the acquisition going ahead.

    12. Mr McCarthy requested rationale for the figure of £3.1million being proposed by NHSi. Mr Rafferty explained that NHSi had assessed the proposed uses of the funding by the Trust, identifying necessary tasks against those which could be considered as supplementary and on the basis of this made their funding proposal. In response to a supplementary question from Mr McCarthy, Mr Rafferty confirmed that the Trust was unlikely to be asked to take part in any further acquisitions in the foreseeable future.

    13. In response to Mrs Doherty, Mr Rafferty affirmed that the Trust was currently within the NHS contract rounds, with settlement for mental health and community services being good, concluding that quality and development would not suffer.

    14. Mrs Tetlow noted her concern in relation to the intention to halve the Patient Safety Team (referring to the table attached to NHSi’s letter). Mr Rafferty stressed his confidence in the capacity of a reduced team, adding that the core business of the team would continue to be adequately addressed. Mrs Edwards noted that the Trust would prioritise the use of these resources.

    15. Mr Rafferty read out the proposed recommendation. The voting members of the Council of Governors’ unanimously agreed to the acquire LCH in accordance with the recommendations below.

    16.

    Action Lead Timescale Status

    Recommendations approved by the Council of Governors, namely: • The Council of Governors is satisfied that the Board

    of Directors of the Trust has been thorough and comprehensive (i.e. undertaken appropriate due diligence) in reaching its proposal to acquire Liverpool Community Healthcare NHS Trust and has obtained and considered the interests of trust members and the public as part of the decision-making process.

    • Therefore in accordance with section 56A(2) of the National Health Services Act 2006 and the Trust's constitution, the Council of Governors resolves to

  • Agenda Item No: TBC

    Page 4 of 4

    approve the Trust's and Liverpool Community Healthcare NHS Trust's joint application to Monitor (operating as NHS Improvement) in accordance with section 56A of the NHS Act subject to the Board of Directors of the Trust agreeing with NHS Improvement and local commissioners post-transaction support funding of an amount no less than £3.1 million in year 1.

    Further actions required: • None identified.

    17. Mrs Fraenkel thanked all those Governors who had made themselves available to

    participate in this meeting at such short notice. Updates will be provided regularly to the Council.

    E1 ANY OTHER BUSINESS

    18. There were no further items of business.

    19. The meeting closed.

  • Council of Governors - Actions from meetingsPage Agenda Item Action Owner Status Due Date Comments

    Jan-18 A6-Update from the CEO

    Governors invited to meet Mr Sidney Dekker at the Life Room, Walton on 23 jan-18 at 5:30pm.

    All Jan-18 Jan-18

    Jan-18 A6-Update from the CEOData in relation to A&E/mental health waiting times to be shared with Governors J Rafferty Feb-18 Circulated via email (Paula) 3/4/18

    Jan-18 A6-Update from the CEO

    Out of Area transfers to be headlined at each meeting along with assurance of continued improvement / maintenance

    M Hindle On-going on-going

    Jan-18

    B2-Specialist Learning Disability Division - Retraction Plan Update

    Full report in relation to review/ follow up of discharges to be presented to Governors

    M Hindle Mar-18 On Mar-18 agenda (if finalised)

    Jan-18

    B2-Specialist Learning Disability Division - Retraction Plan Update

    Mr Meadows to liaise with HT, MMcC, DD & MH to facilitate a formal letter to the Chair/ Board regarding their concerns in relation to discharges

    A Meadows Feb-18 Completed

    Jan-18B3-Quality Account Priorities 2018/19 & Indicator Selection

    Email Governors regarding Quality Account Priorities/ Indicator Process A Meadows Jan-18 Completed

    Jan-18B3-Quality Account Priorities 2018/19 & Indicator Selection

    Governors to review indicators and forward any queries to Mr Meadows

    All Governors Jan-18 Completed

    Jan-18B3-Quality Account Priorities 2018/19 & Indicator Selection

    Mr Meadows to circulate responses to queries from Governors and request each governor identify an indicator. The indicator with the majority would be progressed

    A Meadows / All Governors

    Jan-18 Completed

    Meeting held on 17 January 2018

  • Jan-18B5-Staff Vacancies and Recruitment / Retention Update

    Feedback on report to be submitted directly to A Oates via email

    All Governors Feb-18 by Feb-18

    Jan-18 C1-Draft 2018/19 Operational PlanCirculate updated Operational Plan to Governors L Edwards Feb-18 Completed

    Jan-18 C1-Draft 2018/19 Operational PlanGovernors to provide feedback/ comments to Mrs Edwards directly via email

    All Governors End Feb-18 Completed

    Jan-18D1-Liverpool Community Health Update

    Governors to receive information following issue of the preliminary risk assessment from NHSi;

    C Lyons/ A Meadows Mar-18 Due 14 Mar-18

    Jan-18D1-Liverpool Community Health Update

    Governor Reference Group to advise if any further briefings/ information was required to allow Governors to make an informed decision

    A Meadows / All Governors

    Feb-18 Due Feb-18

    Mar-18 C3-Kirkup Review Action Plan Defer to April 2018 CoGs agenda T Bennett Apr-18 on Apr-18 COGS agenda

    Mar-18 D4-Non Executive Director VacancyCirculate link re NED vacancy to Governors A Meadows Mar-18 Completed

    Mar-18 E1-AOB Provide update to Governors in relation to Liverpool Mayor's Mental Health Summit A Meadows Mar-18 Completed

    KEYTO BE ACTIONED

    COMPLETEDONGOING

    Meeting held on 21 March 2018 (Extra Ordinary Meeting)

  • Agenda Item No: C1

    COUNCIL OF GOVERNORS Report provided (check necessary boxes): Paper No: COG17/18/072

    To Note: ☒ For Decision ☐ Meeting Date: 12 April 2018

    REPORT ON FINANCIAL AND ACTIVITY PERFORMANCE

    Report Author(s): Neil Smith, Executive Director of Finance Jennifer Billingsley, Performance and Business Intelligence Analyst

    Summary of Key Issues: • This report is based on data up to the 31 January 2018. February 2018 data was not available at the time of writing this report due to the reporting schedule.

    • The trust is performing well against the majority of keyperformance indicators for the three months ending 31 January2018.

    • Regulation – Care Quality Commission (CQC)

    Overall CQC Rating: Good Safe: Requires Improvement Effective: Good Caring: Good Responsive: Good Well-led: Good

    • NHS Improvement Single Oversight Framework (SOF)

    SOF Segment Score – 2 SOF Finance and Use of Resources Score – 2

    The metrics that are currently not being achieved are:

    Indicator Latest Perf

    Target Accountable Director

    % settled accommodation 60.00% 64% Trish Bennett

    % clients in employment 4% 9% Trish Bennett

    IAPT Recovery 35.07% 50% Trish Bennett

    Sickness 7.55% 4.46% Amanda Oates

    There are two metrics that support the delivery of the % clients in settled accommodation and % clients in employment and these are:

    Indicator Latest Perf

    Target Accountable Director

    Accommodation Status 80.63% 85% Trish Bennett

    Employment Status 83.06% 85% Trish Bennett

  • Agenda Item No: C1

    The Finance and Use of Resources Risks that are currently not being achieved are:

    Financial Risk Rating Rating Target

    Accountable Director

    Agency Spend 38% 0% Amanda Oates Capital Services Capacity 2 1 Neil Smith I&E Margin Variance -0.01% 0% Neil Smith

    Performance Improvement Plans have been requested from the Accountable Directors for the above metrics. These will be provided in the next report.

    Full details on the Single Oversight Framework can be found in Appendix A.

    • Out of Area Placements – STP Trajectory

    In line with the new NHSi single oversight framework reporting requirement to support the elimination of inappropriate out of area placements by 2021; the trajectory shared with executive committee in February 2018 had been revised to take into account internal out of area placements. The trajectory has been ratified by commissioners and the local division. Progress against the trajectory will be reported internally through the Executive Performance Report and monitored by NHSi through the single oversight framework. From April 2018 the data reported will be against the trajectory so progress can be monitored. On 2 March 2018, NHS England advised that the trajectory and baseline was to revert back to external out of area placements only. We are seeking guidance from NHS Improvement on whether they will look at the external out of area placements only when monitoring against the trajectory and considering potential implications for provider segmentation or whether they will look at external and internal. For data completeness external and internal has been provided for January 2018.

    Performance on Inappropriate Out of Area Placements split by External and Internal is provided below:

    Jan-18 External OAPs - OBDs 0 Internal OAPs - OBDs 136 Total OAPs - OBDs 136

    There was one external PICU OAP in January 2018, however the reason for the OAP was due to safeguarding rather than it being inappropriate and therefore it is not included in the numbers provided above.

  • Agenda Item No: C1

    • Strategic Priorities

    The below strategic priorities are currently underperforming as at 31 January 2018. Measures that form part of the NHSi SOF have not been repeated here. The strategic priorities for 2017-18 are currently under review for 2018-19, therefore performance improvement plans have not been requested.

    Strategic Priorities Rating Rating Target

    Accountable Director

    Physical Health for new admissions 17.64% 95%

    Trish Bennett

    Detention of BME 45.95% 18% Trish Bennett Substantive Leader in Place for 3 months or more 83.33% 90%

    Amanda Oates

    Core Statutory Training 82.62% 95% Amanda Oates

    Vacancy Rates 10.26% 5% Amanda Oates

    Turnover 13.34% 8%-12% Amanda Oates Actual & Potential Suicides (Rolling 12 month data) 32 25

    Trish Bennett

    No. of Restrictive Practice Incidents 255 208

    Trish Bennett

    An overview of the Strategic Priorities for 2017-18 can be found in Appendix B.

    Additional Reports

    Bed Management and Inappropriate OAP Report is provided in Appendix C. Integration Programme – Update Report is provided in Appendix D.

    Recommendation: The Council of Governors is asked to:

    Note the content of this report.

  • Agenda Item No: C1

    PURPOSE

    1. To provide the Council of Governors with an overview of trust performance for thethree months ending 31 January 2018.

    BACKGROUND

    2. The trust’s approach to performance reporting enables scrutiny of performance in thefollowing areas:

    a) Regulatory – this includes information relating to the trust’s compliance with CareQuality Commission requirements and performance against indicator in the NHSImprovement Single Oversight Framework.

    b) Our services – this looks at saving time and money and improving quality (safe,timely, effective, equitable, efficient and patient centred).

    c) Our people – this looks at whether we have great managers and teams, aproductive workforce with the right skills and the extent to which we are workingside by side with service users and carers.

    d) Our resources – this looks at our investment in technology to help us providebetter care and ensure that we have buildings that work for us.

    e) Our future – this includes measures that show the benefits of research andinnovation, our progress in growing our services and how we work effectively withprimary care and other organisations.

    3. The report also enables the four clinical divisions to highlight key operationalperformance issues.

    4. The format and the content of the Executive Performance Report continues to berefined to meet the needs of the Board of Directors and Board Committees.

    5. This paper is organised into the areas above for consistency of approach.

    Care Quality Commission (CQC)

    6. Remains unchanged since last report, overall the Trust remains with a rating of“Good”.

    NHS Improvement – Single Oversight Framework

    7. The trust remains in segment 2 based on the good CQC rating and our operationalperformance and is achieving the majority of metrics associated with the SOF. Theoverall ‘use of resources’ risk rating is currently at level 2, which is on plan. Full detailson the Single oversight Framework can be found in Appendix A.

    8. Exceptions are reported below. Performance Improvement Plans have beenrequested and will be provided in the next report.

    • MHSDS - % Clients in Settled Accommodation• MHSDS - % Clients in EmploymentData is being supplied to the divisions to enable breaches of these requirements to be addressed. The outstanding information can only be obtained from service users during planned reviews or when one of our staff has direct contact with the service user. It has been agreed that performance will continue to be monitored to ascertain if further improvement support is required.

  • Agenda Item No: C1

    • IAPT: % People completing treatment who moved to recoveryFor the percentage of people moving to recovery, a small improvement has been observed in Q3 2017-18 (35.07%) when compared with Q2 2017-18 (33.78%). Recovery is a key focus within the service and weekly meetings take place to review current and future levels. It is worthy of noting that although the service is below the 50% target overall, of all those patients who fully complete treatment with the service on average across the last year 65% achieved recovery.

    • Staff SicknessSickness absence rates continue to be above target and upward trend can be observed from May 2017 from 6.33% to 7.55% in January 2018. The target for staff sickness for the trust is 5.83%.

    • Agency SpendThe trust is currently 38% above national spending targets for agency staff as at 31 January 2018. The main areas of high agency usage continue to be in the local division and medical staff. Action plans have been requested from areas operating above the ceiling to reduce the forecast outturn.

    • Capital Services CapacityCapital services capacity measures how well the Trust can meet fixed payments associated with capital financing (e.g. lease interest payments, public dividend capital). The trust is able to cover the payments 2.3 times, which is rated as a 2. In order to achieve a 1 rating, the trust would need to be able to cover payments 2.5 times.

    • I&E Margin VarianceThe I&E margin distance from plan, compares the planned I&E metric to actual performance. This is currently rated at 2 as the trust is slightly ahead of its income plan by 0.01%.

    Strategic Priorities 2017-18

    9. The trust is achieving nine of the strategic priorities for 2017-18. An overview of theStrategic Priorities can be found in Appendix B.

    10. Exceptions are reported below. Strategic Priorities that form part of the SingleOversight Framework will not be replicated here.

    • Physical Health for New AdmissionsIn January 2018, the trust’s compliance with physical health screening of all new admissions slightly improved to 17.64%. Previously, this metric related only to the Local Division, however, from January 2018 reporting includes the Secure and SpLD Divisions. The position for the Local Division was 14.3%, this is inline with the trajectory following the deep dive into the under-performance.

    • Detention of BMEThe trust continues to see a disproportionate use of the Mental Health Act for people with a black or minority ethnic group.

    A member of staff is beginning a 4-6 month project to gain some narrative/qualitative information and we are meeting with members of community networks to set up the parameter for the work.

    We have also tentatively looked at having a member of staff do some work for a month to look at what other services have done alongside meeting with community teams and

  • Agenda Item No: C1

    managers to look at this from a staff perspective particularly re CTO’s as this has not been considered in detail by the Trust. This person will be able to look at some more specific data relating to particular ethnic groups, service areas etc. which may also support the development of positive action to improve the disproportionate experience.

    • Substantive Leader in Place for 3 months or moreSubstantive leader in place for 3 months has been under target since October 2017. Current position is 83.33%.

    • Core Statutory TrainingCore statutory training remains below the 95% target at 82.62% in January 2018. Significant work is on-going to improve and sustain statutory and mandatory training compliance across the divisions. Training compliance continues to be discussed at surveillance and all operational management groups. Staff road shows continue to reiterate importance of statutory and mandatory training to staff.

    • Vacancy RatesVacancy rates at the end of January 2018 are 10.26% with the highest rates (18.91%) in the specialist learning disability division. The trust are reviewing the recruitment events it holds to ensure we capture students from all universities and what packages we can offer to them to come and work for Mersey Care. The trusts new recruitment system – TRAC went live on 22 January and all vacancies are now processed through this system. The recruitment team have been training managers on the system. We will expect a good reporting suite from this system within 3 months to ensure enough data has been captured to give effective information. The collaborative bank project is still progressing across Cheshire & Merseyside with the 6 trusts in the pilot and are currently reviewing the pay rates to ensure a consistent approach. The go live date is now potentially going to be mid 2018.

    • TurnoverAs at 31 January 2018 turnover is at 13.34%. A downward trend can be observed from April 2017. The target is between 8% and 12%.

    • Community Actual & Potential Suicides (Rolling 12 months data)From 1 February 2017 to 31 January 2018 there have been 32 actual and potential suicides. There continues to be no observable links to any of the suicides, noted by the trust, with regards to social groups or specific locations. The suicides encountered by the trust continues to follow national trends with regards to age and gender, with males between 45 to 54 being the highest risk area. Similarly hanging as a means of completing suicide is the highest method nationally and as within trust suicides. The safe from Suicide team continues to monitor all suicides reported to the trust and action any areas of concern that are noted. Training with regards to risk assessment and safety plans continues to be rolled out to the clinical teams and this will be maintained through the coming months.

    • No. of Restrictive Practice IncidentsThe number of restrictive practice incidents in January 2018 continues to be above plan. The main contributor is the SpLD Division who has 180 incidents in January 2018 whereas Local Division had 44 and Secure Division has 31. The No Force First programme continues to be a key component of the trust’s perfect care aspirations and aims to eliminate physical restraint and medication led restraint within Mersey Care NHS Foundation Trust.

  • Agenda Item No: C1

    Bed Management & Inappropriate OAPs Report

    Bed Management Update – Local Division – January 2018

    11. The challenge surrounds the admission rates compared to discharges (flow andcapacity). This is being picked through a number of initiatives which are continuouslymonitored:

    a) The transformational programme around inpatients, community, crisis pathwaysand GP liaison. This is reviewed in Transformational work streams and in aTransformational Governance Steering Group each month within the Division.

    b) Recruitment to a flow/capacity/bed manager who is now in post.

    c) A number of different methods of addressing flow and capacity with daily bedmanager meetings, weekly summaries and spread sheets to highlight themes andtrends by service line and clinical areas. These continue and provide greater abilityto monitor and analyse peaks and troughs in flow.

    d) Monitoring of delayed discharges through Complex Case Triage Forums involvinglocal commissioners and local authorities, delayed discharge meetings andEnhanced RADAR meetings within clinical areas. We have also held MADE (Multiagency discharge events) as required in services that are struggling with delayeddischarges.

    e) Delayed discharges within Adult Mental Health have reduced significantly thismonth.

    12. There has been an improvement in flow over the last couple of months with a rise indischarges from an average of mid thirties to mid forties/fifties across thedivision. This has enabled us to reduce OAPs by 53% over a comparable period lastyear. OAPs continue to show a decline due to improved flow and capacity. We havehad no external OAPS in November and December 2017. There was one externalPICU OAP in January 2018, however this was due to safeguarding reasons ratherthan being an inappropriate OAP and is therefore not included in the occupied beddays reported above. We have started reporting on internal OAPs and for January2018 this was 136 occupied bed days.

    13. Winter plans have been developed and the division will be running a table top exercisevery shortly. This is still being planned.

    14. The division is in process of developing an escalation flow chart that draws togetherexpected actions when bed management is challenging. This is still being worked on.

    15. Further information is provided in the Bed Management and Inappropriate OAP Reportin Appendix C.

    Key operational issues for clinical divisions

    Local division

    Staffing 16. Staffing pressures fluctuate daily in the system and the infrastructure of Matrons

    reviewing and communicating with one another at least three times per week reviewing staffing across the division continues.

  • Agenda Item No: C1

    17. The e-rostering pilot continues to identify inefficiencies in the system (demandtemplates, errors in the roster set up, rostering practice) and work is being under takento identify standard operating procedures. Training groups of ward managers/matronsis planned for early March to provide assurances of consistency in roster practice andreinforcing accountability of budget holders.

    18. This will start to alleviate the pressure and provide enhanced monitoring from moremeaningful reporting frameworks which will be developed from the pilot.

    Winter Planning 19. Winter Pressures 2017/18 - Winter pressures have been managed within the

    parameters of the agreed protocol for 2017/18. There has been a number of level 3 weather alerts. The Local division did not have to initiate Level 3 on their plan and there was limited disruption to services. The Division participated in any CCG NHS England conference calls.

    20. Winter Schemes 2017/18 - Winter schemes are all on track and money has beenreceived accordingly in to finance. The COO is submitting the fortnightly returns asrequired for NHSE purposes

    21. Winter Planning 2018/19 - Workshops are being arranged to commence winterplanning for 2018/19. Donna Robinson has forwarded key areas that will requireaddressing for this period:

    • Workforce issues• Delivering effective admission avoidance• In hospital patient flow• Delivery of 7 day working• All work streams to have a mental health focus via a system wide

    thinking/review/implementation

    Good Practice - Liaison and Diversion Services 22. NHSe commissioner for Liaison and Diversion services Tracy Wilson has

    commissioned Claire Cairns Associates to undertake a desk top needs assessment and full service review of the Liaison & Diversion service operating in Merseyside.

    23. The objective of this work is to firstly ensure the service is meeting the demand in thearea, followed by clarifying adherence to the national specification and understandingthe areas of good practice which is being provided additionally by both Mersey Careand North West Boroughs.

    24. The review will ensure that these elements are reflected in future specifications whichwill inform the procurement process. Claire will be undertaking the review weekcommencing 26th February when she will be interviewing CJLT staff and partners fromcourt services and custody.

    Secure Division

    25. Delayed discharges have improved and currently there is only one delayed dischargeat Low Secure Unit.

    26. Active recruitment is ongoing, particularly for nursing and facilities roles. Open advertsremain in place for nursing posts and are being considered for facilities posts.

    27. Safe staffing fill rates for the division have been on average over 100% the last threemonths. Strategies are being developed to improve recruitment and retention of staff

  • Agenda Item No: C1

    across the division and Trust including proactive recruitment of students from our local HEI’s.

    28. The Division has achieved 2017/18 CIPs and is forecasting a breakeven positionunder spend for year end.

    29. Plans are continuing for the Wave 2 New Model of Care for Secure to go live in April2018. The clinical model is progressing well and issues relate to agreeing the financialmodel.

    Specialist Learning Disabilities Division

    30. The Specialist LD Division amalgamated the STAR Unit, Community LD Teams inLiverpool and Sefton and Wavertree Bungalow in recent months.

    31. Safe Contraction of Services/Implementation of new clinical models is a key issue forthe Division. This work is overseen by the Strategic Implementation Group heldmonthly. Work is progressing well for the new Specialist Support Teams.

    32. Discussions remain in progress about the location of LSU service with NHS England.There have been several meetings to discuss the future of the service and thisremains an ongoing issue.

    33. Regarding the workforce, the senior team continue to engage the workforce regardingretention and recruitment to the new clinical models.

    Update from Specialist Learning Disabilities Division re: Delayed Discharges

    34. There remain delays to discharge in the specialist learning disability division and thebed retraction plans shared with NHS Improvement have proven difficult to deliverbecause lack of appropriate placements in the community. The trust is working closelywith commissioners to ensure early resolution of these issues.

    35. There is currently an improving picture for actual discharges against the initial plan. Arevised contraction plan is in place that details how people (service users and staff),buildings and finances contract on the Whalley site with the emphasis on ensuring wekeep the service safe and make the best use of resources.

    36. The senior team are mitigating risks by having weekly contact with all commissioners(CCG’s and Spec Com) regarding discharges and tying commissioners in to firm andrealistic discharge plans.

    37. The implementation of the new clinical model is progressing. Recruitment to theSpecialist Support Teams (SST) across Lancashire and Greater Manchester isprogressing well and accommodation has been sought for the Manchester SST inEccles. Scott House is being used as an interim base.

    38. Partnership working across the STP is progressing well with a new joint admissionpanel hosted by Mersey Care agreed and a foundation group established for the LSUclinical model across the Specialised Commissioning footprint.

    39. The location of Low Secure Services remains under discussion with NHS England andNHSI. An options appraisal and business case is currently being progressed.

  • Agenda Item No: C1

    South Sefton Community Division

    40. Two Weeks Perfect Care The two weeks of perfect care took place between 2January 2018 and 12 January 2018 and was designed to ensure patients receivedoptimal care. The aim was to rapidly improve patient flow across the whole system toproduce a change in performance, safety and patient experience. The division workedhard with acute and social care partners to focus on improving patient pathways andflow during what was a very busy and difficult period for the NHS locally and nationally.The initiative was more than delivering improved patient flow; it was about reducingharm, improving patient outcomes and job satisfaction. Work is now progressing toanalyse the results of the two weeks and the difference it made to both patients andstaff, which will be published in due course.

    41. ICRAS Implementation As everyone will be aware, there is a huge demand forinpatient beds within the NHS which has been reported widely in the media recently.As a response to such challenges locally we have implemented the new ICRASsystem (Integrated Community Re-enablement Assessment Service), which is anintegrated health and local authority team that are co-located and work as one teamacross both community and bed base. Since the launch of ICRAS on 2 October 2017,the service has had a major impact on the average length of stay on the wards thathad stood at over 25 days, while there were also high levels of delayed transfers ofcare and an average occupancy level of 60%. By integrating the ICRAS team, the bedbase (based at ward 35) and community teams with our local authority partners, it hasprovided one pathway for patients, which have been enhanced with the introduction ofthe SAFER model. The team has supported with 23 step-up bed base patients andprevented 196 acute admissions. Within ward 35, there were no delayed transfers ofcare in December 33 discharges, an average occupancy of 90% and a length of stayof 17.7 days. As well as improving the patient’s journey, these changes have proveninvaluable to the health economy as a whole.

    42. Safer Staffing Reviews and quality review visits The division held a confirm andchallenge session where the Deputy Director of Nursing presented the themes fromthe safer staffing review were shared with team leaders at a divisional event on 16January. Staff welcomed the focus and challenge throughout the staffing reviews andthe workforce was presented as patient focused passionate, caring andcompassionate.

    43. The divisional Quality Review Visits started on 31 January 2018 with the aim ofpromoting safer patient care by, Improving quality, experience and safety, providing alevel of assurance about the quality of care and standards on wards, supportingclinical managers to understand how they deliver care; identify what works well, andwhere further improvements are needed. The QRV is designed as a cyclical andongoing process comprising of externally determined standards based upon: CQC’sKey Lines of Enquiry (KLOEs), review of team performance, team self-assessment.The overall aim is to answer the five key questions associated with Care QualityCommission’s (CQC) regulatory and compliance framework for the fundamentalstandards: Are our services; safe? effective? caring? responsive to people’s needs?And well-led?

    44. CQC Update The CQC action plans are in place for the division; these are monitoredand updated on a regular basis. The plans are scrutinised in the divisionalGovernance and Quality Committee and the Operational Management Board eachmonth. The inaugural Relationship and engagement meeting with CQCInspectors took place on 2 March 2018 and initial feedback following the visit has beenextremely positive.

  • Agenda Item No: C1

    45. Learning Through Transparency During January and February every member ofstaff has been given the opportunity to attend a workshop with Lockton an independentrisk management organisation that have been working with Mersey Care for the lastthree years. The workshops have been looking at how we learn from incidents andaddressing barriers to transparency and openness. Feedback to date from both thedivisional staff has been extremely positive and those who have already attended havefound the session so engaging they have encouraged colleagues to attend. A total of256 (62%) of staff have attended one of the workshops, Initial findings from thesessions are expected in March.

    46. Kirkup Report Dr Bill Kirkup published his report into historic issues at LiverpoolCommunity Health on 8 February 2018, the findings of which are currently beinganalysed by the trust board and any actions arising from the report will be developedinto a plan for the division.

    47. Visits To The Division The division welcomed visitors to the division on 31 Januaryfrom the Better Care Support Team, Local Government Association, Implementationunit – Cabinet office, Integration & Policy Improvement – Department of Health &Social care, NHSE; as part of a Regional visit arranged by Sefton CCG. The teamvisited both the community and bed base elements of ICRAS. Our Senior Leadershipteam also presented an update on ICRAS. The division received positive feedback; theteam found the visit very informative. The delegates stated only by going on thesevisits can they really understand what is being achieved on the ground and how theycan, support areas to better drive integration forward. They also want to highlight ourlearning and experiences and the work of the team to share it with other areas. Thealso commented on commitment and enthusiasm of everyone involved and the ICRASservice itself are a credit to Sefton.

    Integration Programme – Update Report

    48. Appendix D provides full details on the integration programme.

    Further Information

    49. The Executive Performance Report which provides further detail in relation to thetrust’s performance can be provided upon request.

    RECOMMENDATION

    50. The Council of Governors are asked to:

    a) Note the content of this report.

    JENNIFER BILLINGSLEY PERFORMANCE AND BUSINESS INTELLIGENCE ANALYST

    8 March 2018

  • Agenda Item No: C1

    Appendix A

    Rag RagG RG 71.13%

    100%86.03%

    G

    RagG KeyRR Rag

    Rag

    FinanceFinance & Use of Resources Score 2

    Operational Performance IAPT - Treated with 6 weeks

    Organisational Health Staff Survey R

    Operational Performance

    Cardio Metabolic Assessment and Treatment -

    Community MH ServicesR

    G

    Operational Performance IAPT - Treated with 18 weeks G

    ResponsivenessArea Indicator

    Early Intervention Treatment start within 2 weeks of

    referral

    Operational Performance

    Good

    Organisational Health G

    Organisational Health

    Staff Turnover

    GProportion of Temporary

    Staff

    Operational Performance DQMI - MHSDS % G

    Well LedArea Indicator

    Organisational Health Staff Sickness R

    Caring

    Operational Performance

    Cardio Metabolic Assessment and Treatment -

    EIP ServicesR

    Quick View - CQC Domains - Single Oversight FrameworkSafety CQC Domains Caring

    IndicatorArea Trust Rating

    Well LedSafe Requires Improvement

    GoodGood Quality of Care Staff FFT

    Quality of Care Community FFTQuality of Care

    Good Area IndicatorQuality of Care Written Complaints

    Responsive

    Quality of Care % in Employment

    Quality of Care Never EventsQuality of Care Patient Safety Alerts

    Under Reporting of Patient Safety Incidents G

    EffectivenessArea Indicator

    To be Reported on

    GoodQuality of Care

    Effective

    The metrics for FFT are currently not RAG rated within the Single Oversight Framework, however, NHSi have stated that if performance was to continually decline or low values are reported, this could indicate care quality issues.

    Mental Health FFT

    Quality of Care CPA 7 day Follow UpQuality of Care % in Settled Accom Not RAG Rated on SOF

    Quality of Care U16 AdmissionsQ1

    18/19Operational

    Performance Inappropriate OAPs

    Operational Performance

    Cardio Metabolic Assessment and Treatment -

    Inpatient WardR

    G

  • Agenda Item No: C1

    Appendix B

    RAG Kitemark RAG Kitemark

    RAG Kitemark RAG Kitemark

    Globlar Digital Exemplar - Delivery against milestone plan to attract the external funding

    Risks associated with Contracts from Board Assurance Framework

    No of Restrictive Practice Incidents

    Win Rate

    Self-harm incidents (Project wards Arnold, Dee, Harrington and Poplar)

    Completion of Core Statutory Training

    Involved in the development of your care plan

    Turnover Rate

    Strategic Priorities 2017/18 - Summary

    Metric Trend line Metric

    No of STEIS Incidents

    Trend lineSubstantive leader in place for 3 months or more (Self Assessment)

    Trend lineMetric

    Delayed Discharges

    Detention of BME under MHA

    Safe Staffing Levels

    Physical Health for new admissions

    Plan Surplus v Actual

    Patient Experience Friends and Family

    Plan Cashflow v Actual

    Estate Category B (Metric under review)

    Assaults on staff

    Trend line

    No of Actual and Potential Suicides

    Metric

    Sickness Absence

    Vacancies Vs Budgeted Establishment

  • Agenda Item No: C1

    Appendix C

    Bed Management and Out of Area Placement (OAPs) Exception Report – Jan 2018

    INTRODUCTION

    This is the second iteration of a report to provide the council of governors with an overview in relation to bed management and out of area placements (OAPs).

    The report will focus on the exceptions for the following areas by divisions and service lines (where applicable):

    • Bed Occupancy (excluding leave) %• Number of Delayed Discharges• Mean Length of Stay for Discharged Patients• % of admissions detained under the Mental Health Act• Unplanned Out of Area Placements

    In line with the new NHSi single oversight framework reporting requirement to support the elimination of inappropriate out of area placements by 2021. Progress against the trajectory will be reported internally through the Executive Performance Report and monitored by NHSi through the single oversight framework. From April 2018 the data reported will be against the trajectory so progress can be monitored.

    CURRENT POSITION – January 2018

    Local Division

    Adult Mental Health

    Bed Occupancy (excluding leave) %

    Number of Delayed

    Discharges

    Mean LOS for

    Discharged Patients (days)

    % of admissions

    detained under the

    MHA

    Internal/ External OAPs - OBDs

    Adult Mental Health 89.79% 14 38 46% 61

    In January 2018:

    Bed occupancy (excluding leave) was within the local threshold between 85% and 90% and was below the Adult Acute National 2015/16 mean average of 92.1%.

    There were 14 delayed discharges. This equated to 277 occupied bed days in the month of January 2018.

    The mean length of stay for discharged patients was above the Adult Acute National 2015/16 mean average of 33.4 days. The highest length of stay reported was 686 days for one patient.

    The % of admissions detained under the Mental Health Act is above the Adult Acute National 2015/16 mean average of 35.1%. Dee (58%) and Alt (47%) have the highest proportion of admissions detained under the Mental Health Act.

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    There were 61 occupied bed days for inappropriate out of area placements. This was for 6 service users. The shortest OAP was four nights to the longest OAP being 20 nights.

    Older Peoples Mental Health

    Bed Occupancy (excluding leave) %

    Number of Delayed

    Discharges

    Mean LOS for

    Discharged Patients (days)

    % of admissions

    detained under the

    MHA

    Internal/ External OAPs - OBDs

    Older Peoples Mental Health 90.73% 9 72 59% 75

    In January 2018:

    Bed occupancy (excluding leave) was above the Older Adult National 2015/16 mean average of 84.9% and just slightly above the local level of between 85% and 90%.

    There were nine delayed discharges. This equated to 157 occupied bed days in the month of January 2018.

    The mean length of stay for discharged patients was just below the national 2015/16 mean average of 75 days. There were 21 discharges in January 2018 and from these nine had a length of stay greater than 75 days with the highest being 204 days.

    The % of admissions detained under the Mental Health Act in January 2018 was 59%. Irwell (86%) and Acorn (76%) have the highest proportion of admissions detained under the Mental Health Act.

    There were 75 occupied bed days for inappropriate out of area placements. This was for 4 service users. All of these OAPs carried over to February 2018.

    Rathbone Rehab Centre

    Bed Occupancy (excluding leave) %

    Number of Delayed

    Discharges

    Mean LOS for

    Discharged Patients (days)

    % of admissions

    detained under the

    MHA

    Rathbone Rehab Centre 91.61% 0 293 72%

    In January 2018: Bed occupancy (excluding leave) is just above the local threshold of 85% - 90% and is above the High Dependency Rehabilitation National 2015/16 mean average of 86.2%.

    There were no delayed discharges in January 2018.

    The mean length of stay for discharged patients was below the High Dependency Rehabilitation National 2015/16 mean average of 499 days. There were two discharges within January 2018 with one of the lengths of stay being 473 days.

    The % of admissions detained under the Mental Health Act in January 2018 was 72%.

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    Brain Injury

    Bed Occupancy (excluding leave) %

    Number of Delayed

    Discharges

    Mean LOS for

    Discharged Patients (days)

    % of admissions

    detained under the

    MHA

    Brain Injury 50.54% 1 81 0%

    In January 2018:

    Bed occupancy (excluding leave) was below the local threshold of 85% - 90%.

    There was one delayed discharge. This equated to 31 occupied bed days in January 2018.

    The mean LOS for discharged patients was 81 days. There were two discharges within January 2018 with the highest length of stay being 141 days.

    PICU

    Bed Occupancy (excluding leave) %

    Number of Delayed

    Discharges

    Mean LOS for

    Discharged Patients (days)

    % of admissions

    detained under the

    MHA

    Brain Injury 58.33% 0 114 85%

    In January 2018:

    Bed occupancy (excluding leave) was below the local threshold of 85% - 90%.

    There were no delayed discharges in January 2018.

    The mean LOS for discharged patients was 114 days. There were seven discharges within January 2018 with the highest length of stay being 596 days.

    The % of admissions detained under the Mental Health Act in January 2018 was 85%.

    Secure Division

    Low Secure Unit - Rathbone

    Bed Occupancy (excluding leave) %

    Number of Delayed

    Discharges

    Mean LOS for

    Discharged Patients (days)

    Number of Out of Area Placements

    Rathbone LSU 93% 2 743 7

    In January 2018:

    Bed occupancy (excluding leave) is above the local threshold of 85% - 90%.

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    There were two delayed discharges. This equated to 31 occupied bed days in the month of January 2018.

    The mean length of stay for discharged patients was 743 days. There were two discharges in January 2018 with the longest length of stay being 771 days.

    There were 7 out of area placements. This equated to 217 OAP bed days in January 2017. The reason for the OAPs was due to no Mersey Care NHS Foundation Trust bed being available.

    Medium Secure Unit – Scott Clinic

    Bed Occupancy (excluding leave) %

    Number of Delayed

    Discharges

    Mean LOS for

    Discharged Patients (days)

    Number of Out of Area Placements

    Scott Clinic MSU 99.3% 2 182 46

    In January 2018:

    Bed occupancy (excluding leave) is above the local threshold of 85% - 90%.

    There were two delayed discharges. This equated to 62 occupied bed days within the month of January 2018.

    The mean length of stay for discharged patients was 182 days. There were three discharges in January 2018 with the longest length of stay being 521 days.

    There were 46 out of area placements. This equated to 1380 OAP bed days. The reason for the OAPs was due to no Mersey Care NHS Foundation Trust bed being available.

    High Secure Services – Ashworth Hospital

    Bed Occupancy (excluding leave) %

    Number of Delayed

    Discharges

    Ashworth Hospital HSS 91.33% 7

    In January 2018:

    Bed occupancy (excluding leave) is between the local threshold of 85% - 90% and is just above the High Secure National 2015/16 mean average of 88%.

    There were seven delayed discharges. This equated to 138 occupied bed days in the month.

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    Specialist Learning Disability Division

    Bed Occupancy (excluding leave) %

    Number of Delayed

    Discharges

    Mean LOS for Discharged

    Patients (days)

    SpLD 73.35% 8 2364

    In January 2018:

    Bed occupancy (excluding leave) is below the local threshold of 85% - 90%.

    There were 8 delayed discharges. This equated to 279 occupied bed days in the month.

    The mean length of stay for discharged patients was 2364 days. There were five discharges in January 2018 with the longest length of stay being 3593 days.

    South Sefton Community Division

    Ward 35

    Bed Occupancy %

    Number of Delayed

    Discharges

    Mean LOS for Discharged

    Patients (days)

    SSCD 87.5% 3 26

    In January 2018:

    Bed Occupancy was at 87.5%. This is between the local threshold of between 85% and 90%.

    There were three delayed discharges. This equated to 30 occupied bed days in the month.

    The mean length of stay for discharged patients was 25 days. There were 23 discharges in January 2018 with the longest length of stay being 69 days.

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    Report provided (check necessary boxes): Paper No:

    To Note: ☒ For Assurance: ☒ Report to: Council of Governors

    For Decision: ☐ For Consent: ☐ Meeting Date: March 2018

    Integration Programme - Update Report

    Accountable Director(s): Trish Bennett, Executive Director

    Report Author(s): Pat McGuinness, Deputy Director of Integration

    Alignment to the Trust’s Strategic Objectives: (listed by the 4 Strategic Aims)

    Our Services

    ☐ Save time and money ☐ Improve quality (STEEP)

    Our People ☐ Great managers and teams

    ☐ A productive, skilled workforce

    ☐ Side by side with service users and carers

    Our Resources

    ☐ Technology that helps us provide better care

    ☐ Buildings that work for us

    Our Future ☐ Effective Partnerships ☐ Research and innovation

    ☐ Grow our services

    Purpose of Report: The purpose of this report is to: Outline the work that has been undertaken thus far in

    relation to the effectiveness review of current virtualward/community care team arrangements in Liverpool andSefton.

    Summarise the work that is being undertaken in parallelwithin the South Sefton Community Division in terms ofreview of current services.

    Summarise key challenges, deliverables and outcomes inthe form of a plan on a page for the first year (2018/19) ofthe Integration Programme.

    Outline key next steps.

    Summary of Key Issues: Mersey Care will see the transfer into the organisation of community physical health services from Liverpool Community Health Trust on the 1st April 2018. Together with our community services in South Sefton, this now provides the organisation with a strengthened position within the wider health and social care system to ensure a collaborative approach is taken to redesigning out of hospital services.

    Our long term goal will be to ensure there is a higher proportion of care delivered at home or closer to home, reducing fragmentation in service delivery and improving overall population health.

    In the meantime work will begin to ensure the stabilisation, redesign and transformation of community services (physical, mental health and social care) via establishing an Integration Programme. The Programme will aim to bring together community and mental health services internally, but also support development and delivery of place based services in local neighbourhoods/localities working with our partners through the newly established Provider Alliance groups in Liverpool and Sefton and with all our stakeholders.

    Appendix D

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    Recommendations: The Council of Governors is asked to note the contents of this report.

    Next Steps: (Subject to recommendation being accepted)

    The following activities will be undertaken in the next reporting period to ensure a robust review is undertaken:

    a. Remaining interviews with individuals or groups to beconcluded.

    b. Synthesis Feedback Workshop to be undertaken on the 21st

    February.c. Ideation Workshop to be undertaken on the 2nd March.d. Patient/Service User Workshop to be undertaken on the 16th

    March (x2)e. Pilot areas to commence in April/May.f. Draft Programme Initiation Document (PID) and Programme

    Plan to be further developed.

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    MERSEY CARE NHS FOUNDATION TRUST

    Integration Programme - Update Report

    1. PURPOSE

    The purpose of this report is to:

    Outline the work that has been undertaken thus far in relation to the effectiveness

    review of current virtual ward/community care team arrangements in Liverpool and

    Sefton.

    Summarise the work that is being undertaken in parallel within the South Sefton

    Community Division in terms of review of current services.

    Summarise key challenges, deliverables and outcomes in the form of a plan on a

    page for the first year (2018/19) of the Integration Programme.

    Outline key next steps.

    2. BACKGROUND

    As a result of acquiring South Sefton community health services in June 2017 and the anticipated formal transfer of Liverpool Community Health services into the organisation from April 2018 Mersey Care now has a unique opportunity to ensure these services work effectively together with mental health, social care, acute, voluntary and specialist services using a locality place based approach. The aim will be to ensure our community model wraps around the patient, their families, GP and neighbourhood, extending the care and support that can be offered in the community thereby giving greater emphasis to prevention, self care and improved population health.

    We know from evidence nationally and internationally that integrated health and social care services in the community, which are wrapped around patients (adults and children) and their families/carers can have a significant impact on reducing demand for hospital care and improve health, social and wellbeing outcomes.

    This paper will outline some of the collaborative work that is under way to help develop a system wide shared vision and commitment to improving out of hospital care for the benefit of local communities. As a result we aim to ensure a robust Integration Programme is established which will support Mersey Care and the newly established Provider Alliance Groups in Liverpool and Sefton to enable us to move forward. It is acknowledged that this programme of work will be challenging and complex and has a likely 3-5 year timeframe for delivery.

    Since June 2017 the South Sefton Community Division has been undertaking a series of service reviews. During March and April 2018 confirm and challenge sessions will be held to review the findings from the review processes and a final report will then be presented to the Trust and commissioners in May 2018. Opportunities for integration that are identified as a consequence will be included within the Integration Programme Plan which is currently in development.

    Likewise the Local Services Division are taking forward their Transformation Programme and work has begun to link opportunities around integration together from a physical and mental health perspective in the South Sefton locality.

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    3. COMMUNITY CARE MODEL

    We know from evidence nationally and internationally that integrated health and social care services in the community, which are centred around patients (adults and children) and their families/carers can have a significant impact on reducing demand for hospital care and improve health, social and wellbeing outcomes.

    Our outline community care model is set out in the diagram below. We are currently engaging with a range of stakeholders to review the existing community care/virtual ward teams (MDT’s) and a new model will be finalised in April 2018.

    4. EFFECTIVENESS REVIEW PROCESS

    In order to review the effectiveness of the current community care team/virtual ward models in Liverpool and Sefton Mersey Care has adopted the use of ‘design thinking’ as an evidenced based methodology to inform future service planning. This approach puts real users at the forefront to solve important systemic challenges. The following diagram provides an overview.

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    We will undertake the review and develop a revised community care model centred on neighbourhoods/localities through engaging stakeholders from January – April 2018.

    The following table outlines phases, what will be undertaken during each phase and associated timelines for delivery.

    Design Thinking Phase Description Timescale

    Inspiration Phase (which

    includes both discovery and

    synthesis)

    This is where the fieldwork is undertaken to develop

    a deep empathic understanding of the end users’

    experiences. Information is collated and then

    synthesised into key themes.

    January

    2018

    Ideation Phase During the ideation phase the key themes are

    articulated in a series of How Might We…?

    statements which frame the design challenge. A

    broad range of potential solutions are generated

    before each is considered for its feasibility and likely

    impact. Typically a small number of potential

    solutions are then iterated through a series of

    increasingly sophisticated prototypes until the most

    promising ideas are ready to be piloted.

    March 2018

    Action Phase Selected interventions are piloted and feedback

    sought from end users at agreed junctures. Impact

    is carefully monitored and interventions refined

    accordingly. On conclusion of the pilot, where

    supported by the evidence, the most effective

    interventions are scaled across all relevant areas.

    April/May

    2018

    3a. Discovery Phase

    The Discovery Phase has been undertaken in January 2018. This involved a core team of

    clinical and managerial staff from both Local and Community Divisions undertaking a series

    of:

    Interviews with individual stakeholders including patients/service users

    Interviews with groups, including patient/service user groups

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    Focus sessions

    Observations of community care team/virtual ward MDT’s

    Visits to other organisations

    Desk top analysis

    Review of National and local best practice associated with community care models

    Workshop events

    The core interviewing team m