BOARD OF DIRECTORS · 6 Report from Integrated Governance Committee SBe Attached ... 12 Revenue...

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BOARD OF DIRECTORS

A Public meeting of theHertfordshire Partnership University NHS Foundation Trust Board

Will be held on Thursday 28 April 2016 – 11.00 – 13.30VENUE: The Colonnades, Beaconsfield Road, Hatfield AL10 8YE

A G E N D A

Presentation: A service user perspective from Broadlands Services Norfolk1 Apologies for Absence: Keith Loveman2 Declarations of Interest3 Minutes of Meetings held: January 2016 Attached4 Matters Arising Schedule Attached5 CEO Brief TC AttachedQUALITY AND SAFETY 6 Report from Integrated Governance Committee SBe Attached7 The University Partnership Report OS8 Patient Safety Report OS9 Safe Staffing Levels Report OS Attached10 Report from Audit Committee

Going concern StatementPBPR

AttachedAttached

QUESTIONS FROM THE PUBLICOPERATIONAL AND PERFORMANCE11 Mental Health Benefits Advice Project Gary

Vaux/Sue Darker

Presentation

12 Revenue Summary to 31 March 2016 Paul R Attached13 Q4 Annual Plan Report IE14 Q4 Operational Performance Report PL15 Workforce Reports:

Workforce Organisational Development KPI’s Q4 Staff survey report and action plan

JK

16 Strategy Update IE Presentation (not in pack)

17 Annual Plan 2016-17Quality Account Priorities IE/KM

18 Integrated Working:East & North Hertfordshire Integrating Care

JL Presentation

REGULATORY AND RISK

19Governance & Risk

Board Assurance Framework Corporate Risk Register

BSOS

20 Board of Directors Declarations of Interest BS21 Chairs Action

Appointment of MHA Manager CL22 Any Other Business

QUESTIONS FROM THE PUBLICDate and Time of Next Public Meeting26 May 11.00 – 13.30

Chris Lawrence - Chair

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Strictly Confidential / BS / CL / njp / Notes – Public Board of Directors – 28.10.15 - Page 1 of 12

PUBLIC MEETING OF THE BOARD OF DIRECTORS

Trust Head Office, The Colonnades, Hatfield, Hertfordshire

28 JANUARY 2016

ATTENDANCE

Present:

NON-EXECUTIVE DIRECTORSMr Chris Lawrence (Chair)Mr Peter BaynhamMr Robbie BurnsMs Sarah BetteleyMs Loyola WeeksMs Michelle MaynardEXECUTIVE DIRECTORSMr Tom Cahill Chief ExecutiveDr Oliver Shanley Deputy CEO / Executive Director Quality & SafetyMr Iain Eaves Executive Director Strategy & ImprovementMr Keith Loveman Executive Director of FinanceDr Kaushik Mukhopadhaya Executive Director Quality & Medical LeadershipIN ATTENDANCEMrs Jinjer Kandola Executive Director of Workforce & Organisational DevelopmentMr Jess Lievesley Executive Director Community Services & IntegrationMrs Barbara Suggitt Company Secretary & Head of Corporate AffairsMr Paul Lumsdon Interim Director Service Delivery & Customer ExperienceMEMBERS OF THE PUBLICMs Caroline Bowes-Lyons Public Governor HitchinMr Tap Bali Public Governor HatfieldChris Brearley Lead Governor ChorleywoodJohn WalmsleyOTHERTara Gouldthorpe Staff GovernorIsobel Gowen Representative from ForesightDr Ilona Szeredko Junior Doctor

Apologies:

NON-EXECUTIVE DIRECTORSMr Simon BarterMs Manjeet GillEXECUTIVE DIRECTORSMs Karen Taylor Executive Director, Community Services & IntegrationOTHERSue Darker Assistant Director, Herts County Council, Health Care Services

(Mental Health & Learning Disabilities)

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PUBLIC MEETING OF THE BOARD OF DIRECTORS

Trust Head Office, The Colonnades, Hatfield, Hertfordshire

28 JANUARY 2016

MINUTES

13/16 Apologies for AbsenceMr Simon Barter | Ms Manjeet Gill | Ms Karen Taylor | Ms Sue Darker

14/16 Declarations of InterestNone.

15/16 Minutes of Meeting Held 28 October 2015Approved.

16/16 Matters Arising ScheduleNo formal matters arising.

17/16 CEO Brief

Nationally there is significant movement within the NHS & a tightening of the grip of NHS England, Monitor & TDA. There is a financial commitment to mental health services & the settlement is slightly better than expected for our main Commissioners (E&NH CCG 5.61% & HVCCG 5.48%). The funding announcement will include £290m for perinatal care, £247m for liaison mental health services & over £400m to enable 24/7 treatment in communities.

West Essex CCG is still in the process of a recruitment exercise to appoint an Accountable Chief Officer.

West Herts Hospitals Trust is also in the process of a recruitment exercise to appoint to the Chief Executive post.

Locally financial pressures remain despite some improvement; the Trust now has to plan for 16/17 to bring the Trust back into balance whilst continuing to safely deliver services. TC formally acknowledged the sterling work of staff & thanked them for achieving fantastic results through careful management & use of agency staff whilst delivering new models of care. The System Transformation draft plans for all providers are due by 8 February for final submission June.




Operationally all services remain at full capacity & Community Teams remain busy. Pressures remain within IAPT.

The fundamental strategic platform moving forwards (for the next 4 to 5 years) will be building on “Good to Great”. During February / March the next phase of development will be to engage both staff & stakeholders to further develop this Strategy across the organisation including consultations & roadshows.Action : Agenda Item Next Board Meeting

Although Junior Doctor Strike Action is, at the current time, suspended, the Trust will continue to plan for future action planned for February.

Recruitment & Retention has been successful for many months although remains a challenge as a result of retirements & decisions re work / life balance.

Staff Survey complete & results will be available next month.

TC congratulated Dr Oliver Shanley on his OBE Award commenting that he was proud of his dedication to mental health & learning disabilities services.

18/16 Research Activity & Future Plans

Professors Tim Gale & Naomi Fineberg presented “Expanding Research Activity in HPFT”. Topics covered were :

o Why do Research ?o Research in HPFTo How to move forwardo Champion R&D Representation at a Senior Level in Trusts & CCGso Train the workforce in health research to build capacityo Strengthen local / regional networks in the Easto HPFT Mental Health & LD Research Groupo Generate, participate & sustain new portfolio worko Work closely with industry / SMEso The role of CRN & Contacts

Research is being undertaken within dementia, autism, epilepsy, OCD & Learning Disabilities.

Questions were taken & the Board asked to be kept updated with progress.Action : Agenda Item @ 6 months

19/16 Report from the Integrated Governance Committee

SB reported the highlights from the IGC meeting on 21 January 2016.

The committee had considered the process and possible subjects for its “deep dives” over the coming year. It was agreed that the suggested process was good and that the first deep dive to be undertaken should be around a Health & Safety issue – Fire Safety given the concerns raised within a recent audit. This deep dive would be used to “pilot” the process and help inform the scope and subjects of the programme for the rest of the year.

The committee had discussed the quarterly Patient Safety Report and noted the progress being made in reducing incidents in certain categories and the work being carried out within the Trust to review processes in the light of the report on Southern Health.




A verbal update was given on progress being made around recording and reportingSafeguarding incidents. There will be an audit undertaken in February to test whether the changes made have made a difference. The results of this audit will be reported to the Committee in May and a short update will be provided to the March meeting.

The Whistleblowing report was discussed by the committee and the recent appointment of a national guardian for the process was applauded. The committee also discussed theconcern about the fact that staff felt unable to raise bullying and harassment concernsthrough the policy process but had raised the issues, often anonymously, through thewhistleblowing process. This had also been discussed at JCNC and a champion was being sought from the Board. The Chair of the committee, as whistleblowing champion for the Board, was keen to see this taken forward.

The committee received the updated Board Assurance Framework and noted the changes that had been made in the levels of assurance against key objectives. A full report on the assurance around supervision within the organisation is due to come to the next meeting of the committee. There were no other issues of concern raised by members.

The committee received and discussed the Trust Risk Register, and in the light of earlier discussions agreed to recommend to the Board that the two new risks should be added to the register and that given the safeguarding update this could be downgraded for monitoring on the Corporate Safeguarding Risk Register & recommended these changes to the Board.

Terms of Reference

IGC have considered the TOR & recommended amendment to reflect the agreed changes to membership of the Committee & also to standardise the other elements in line with other Committees.

The Board approved the amended TOR.

20/16 Patient Safety Quarterly Report – Q3

OS presented the report on Patient Safety for the third quarter.

The HPFT predicted suicide rate per 1,000 Service Users for 2015/16 is marginally lower than the predicted suicide rate for 2014/15. However, the number of suspected service user suicides is higher for the first 3 quarters of the year compared with the same period in 2014/15 (18 suspected suicides in Quarters 1 to 3 of 2015/16, 15 suspected suicides in Quarters 1-3 of 2014/15). These numbers may be subject to change in future reports as Inquests are concluded. At the time of this report 13 deaths which occurred between October 2014 and December 2015 are still awaiting the conclusion of the Inquest. The Trust also uses the National Confidential Inquiry data to benchmark against. Currently our rate is below the NCI rate.

The Trust reported a total of 13 Serious Incidents in Quarter 3 of 2015/16, compared to 12 reported in the previous Quarter; these were seven unexpected deaths (suspected suicides), three serious self-harm incidents/para-suicides, an alleged homicide, and two serious incidents of violent & disruptive behaviour that met specialist commissioning reporting criteria.

Performance hotspots include North Essex where self harm & aggression remain prevalent. The MOSS Group is involved in examining this more closely & will ensure that any changes needed to improve this are taken.

In response to the findings of the Southern Health Report (Mazars Independent Review) a lot of work has been done to review the Trust’s governance processes around reporting & processes & continues to strengthen its position. The Trust has established




an internal group to review all deaths and report on findings from the review to the Clinical Risk and Learning Lessons Group. Outcomes of this work will be reported in the Quarterly Patient Safety Reports. The Trust is currently updating Datix to provide additional guidance to staff on reporting of deaths; this will also be reflected in the Incident Reporting Policy which is under review and due to be sent round for consultation in February 2016.

The Board noted and approved the work that had been undertaken as a result of the Mazars report.

21/16 Major Incident & Business Continuity Plan

In response to recent national terrorist activity, NHS England has asked all providers to provide a “Statement of Readiness” answering four specific questions (below). OS reported that The Major Incident & Business Continuity Plan has now been extended & reviewed.

(1) The Trust has reviewed & tested its cascade systems to ensure that they can activate support from all staff groups.

(2) The Trust has arrangements in place to ensure that staff can still gain access to sites in circumstances where there may be disruption to the transport infrastructure.

(3) The Trust has plans in place to significantly increase critical care capacity & capability.

(4) The Trust has given due consideration as to how it can gain specialist advice in relation to the management of a significant number of patients with traumatic blast & ballistic injuries.

The Board noted the action taken to respond to the questions & asked about the internal training undertaken to “test” the plan. OS responded that there will be annual training events & also local testing of the plans.

Board approved the responses.

22/16 Safe Staffing Levels Report

OS reported the overall picture is satisfactory in all areas.

Of particular interest the Board noted:

Although Norfolk remains a hotspot, there has been a vast improvement in fill rates; now over 90%. CL formally acknowledged staff for a job “well done”.

The Safe Staffing Group continues to scrutinise the agency cap target of 8%. The average performance of the Trust (since October 2015) has been 13%, 5% higher than the target.




23/16 Annul Plan Report – Q3

IE presented the report noting that across all areas there has been significant activity & good progress which is mapped by the RAG rating. However, despite significant progress, four of the five red & amber rated objectives remain the same as Q2.

The key areas to note are :

Agency Expenditure: Although this has reduced from £1.2m to £3/4m it is still higher than the target.

Workforce Vacancies / Recruitment:Good progress has been made but targets not yet met, including Norfolk (documented above).

Increase in Demand & Acuity Levels:There were pressures around workforce at the beginning of the year in response to rising acuity levels for both inpatient & community services which linked with agency usage spend.

Placements:Very good progress has been made on delivering safe & effective Acute Care Pathways but there has been a lot of acuity on the wards & the Trust is not where it wants to be yet although the external placements had reduced.

In summary, the Report reflects the amount of work undertaken during Q1 & Q2 to drive the Trust towards its targets.

The Board noted the ongoing work & accepted the report.

24/16 Performance Report – Q3

PL delivered Report highlights.

Monitor:As projected in previous reports, all Monitor Targets have been met for Q3 and with Board approval this will be reported in the quarterly monitoring return and declaration submitted to Monitor. Access to Healthcare for People with Learning Disabilities remains fully compliant with five out of the six indicators and partially compliant for the sixth indicator with plans in place to achieve full compliance by the end of Q4.

Trust Performance Framework:The Performance Framework focuses on the three broad areas: Access, Safety &Effectiveness, and Resources. There has been a positive shift in performance between Q2 and Q3. In Q3 49% of indicators were rated as fully compliant (green) against 39% in Q2. Red indicators had decreased to 35% of the total (45% in Q2).

Access to Services:There are 20 targets reportable in the period of which ten have been met or exceeded(reported green) and seven are reported as red. The key area of pressure remains access into IAPT services with the remainder of targets being missed due to waiting time breaches within services with relatively low service populations. Other areas below target; CAMHS 28 day waits and EMDASS 6 week waits are due to recognised problems with capacity that have agreed action plans for improvement.




Safety & Effectiveness of Services:There are 14 targets reported in the period of which seven are reported as green (6 lastquarter) and five are reported as red (8 last quarter). The red indicators are across several areas of measurement predominately within IAPT where recovery rates on each of the Essex services are below the 50% target and on clustering levels. The completion of risk assessments also remains below target.

Resources:This measures a series of workforce and financial metrics. The workforce indicators show an improvement over the previous quarter with a significant improvement on several measures within the period. In particular very strong increases have been recorded in the understanding of values and behaviours, workforce engagement and the staff Friends and Family Test score.

The financial performance should a continued improvement in the quarter with a surplusabove Plan. This is part due to cost reductions particularly through better control of agency spend. In addition there remains vacancies within several of the new Hertfordshire service developments funded mid-year. The YTD surplus is £113K compared to a Plan of £750K variance is now (£637K) compared to (£923K) at Q1. In September a surplus was reported for the first time this year.

In response to questions from the Board about safety on the Wards & ligature incidents, OS reported the Making Our Services Safer Group continues to work hard on the “Good to Great” Strategy. Feedback from Service Users “feeling safe” reveals slight decrease but this will vary from Ward to Ward, month on month; there is no definitive scale to quantify this. The H&S Committee are separately scrutinising ligature incidents in a context of identifying anchor points & training. Board was assured that staff are much more vigilant & respond incredibly swiftly & well to unexpected SU incidents. KM acknowledged the high level of GP vacancies currently in Essex.

IAPT National Targets / Contract Notice:Access targets remain very challenging to balance as not all people are suitable or will benefit from the service & the data captured does not reflect this. Discussions are continuing with Commissioners.

Board approved the 2 submissions of the Access to Healthcare Declaration for people with a learning disability.

Board also approved the submission of the performance declaration based on the Q3 Monitor indicators.

25/16 Workforce Report:Workforce Organisational Development KPIs Q3

Board noted the Q3 position & Report highlights delivered by JK.

A number of the key performance indicators for workforce have either improved orremained static in Q3.

Recruitment and retention remains a key activity for the Trust as turnover levels remainhigh at 14.8% and the current vacancy rate remains at 14%. We continue to see more staff start with the Trust than leave, however the number of leavers is still high. The focus on recruitment has continued this quarter and the ‘Golden Hello’ initiative has seen positive results with 58 candidates being eligible for the payment.

Retention also remains a key focus and a number of initiatives such as writing to staff who could retire within the next five years to understand when they may be likely to retire and to promote flexible retirement, and a retention workshop have been undertaken.




The desk based research for Collective leadership commenced in Q3 with ‘leadambassadors’ working under the guidance of the Kings Fund and using their evidencebased tools to undertake a cultural assessment of the organisation. This will inform thestrategy moving forward. The national staff survey was also undertaken in Q3 and theresults will be made available during Q4.

Q3 also saw the annual staff awards ceremony. 204 nominations were received, which isthe highest number ever and 16 awards were presented. The Trust also recognised andpresented 121 staff development awards.

Since October the Trust has been holding flu clinics at numerous sites to vaccinate staffagainst the flu virus. To date 27% of our frontline staff have been vaccinated which is a10% increase on last year.

26/16 Cultural Index – Q3

JK reported reduced returns from Q3 Pulse Survey, as expected, during the Festive period. However, feedback indicates a general improved position re staff experience & is encouraging overall. A greater response is anticipated following the next Pulse Survey in line with historic trends & the target for future returns remains 10%. There will be more listening events to try and address that.

Harassment & Bullying lowered to 14 % from 20% which is encouraging.

The OD work will be reviewed following results from the Staff Survey & the Collective Leadership Report which will be brought back to Board May / June.

Action: Board Agenda Item in due course

27/16 Report from Finance & Investment CommitteeTerms of Reference

KL delivered on behalf of SB.

A significant amount of time had been spent at the Committee on the recent planning guidance & its impact on the Trust financial plan for the remainder of the year & for 2016/ 17 which had also been discussed by the Board.

The Committee discussed the national proposals to develop new payment systems which Monitor consulted on last year. Two key options are being considered.

The Committee agreed that the internal “Service Line Reporting Board” shouldcontinue its work on developing an implementation plan and the trust would continue toexplore the transition to a revised payment approach within the current contract negotiations and into 2016/17 as part of the service development plan supporting the three year contract.

Final agreement is likely to take until end of March 2016.

The Committee discussed the updated Capital Plan which had been amended to reflectoverall affordability.

The Committee agreed that they wished to receive regular reports on the achievement of the plans timeline. The Committee discussed changes to the current Capital Plan and noted the renewed interest in the purchase of Shrodells Unit.




The Committee discussed its terms of reference which had been revised to reflect the Board review of its committees and reporting arrangements. They asked that consideration be given to ensuring standardisation across the terms of reference for all committees and asked the Company Secretary to revise as necessary concerning attendance at meetings and a section on escalation of risk. With these provisos the terms of reference were approved to be taken to the Board for final ratification.

Continued reliance on agency staff

Board ratified the Committee’s adapted TOR which had been revised to reflect the Board review of its Committees and reporting arrangements.

28/16 Revenue Summary to 31 December 2015

KL delivered headlines.

Overall there has been continued improvement although a small deficit for the year remains forecast as a result of acuity levels, bed placements & agency spend.

CCG investment will see benefits 16 / 17.

In addition, there has been a shift in the relationship between Monitor & TDA which, over time, will have a more direct impact on ourselves & a more detailed analysis will be brought to the Board on recent guidance from Monitor.

The overall Trust position is a surplus of £220k for the month, which is ahead of the Plan of £83k; and a surplus of £113k for the year to date, behind the Plan. This continues the improving trend over the last months; it is largely due to the continued reduction in Pay Costs, smaller reduction in Secondary Commissioning costs particularly private sector Acute placements, and non-recurrent benefit against income.

The Monitor Risk Rating, the FSRR, has increased to a 4 for the first time this year, the increase being due to the improvement in the I&E margin. The financial position for the remainder of the year will be dependent upon the level of recruitment and the level of additional non recurrent infrastructure investment planned in the final quarter which has been held back during the period to end of quarter 3. The forecast position remains a deficit of c. £200k, £1.2m below the Plan for the full year.

Board approved the Report for submission to Monitor.

QUESTIONS FROM THE PUBLIC

No questions were put to the Board.

29/16 Report from MHA Managers Committee

The Annual Report is brought to Board every year for information following the Annual Conference.

The Board was impressed with & acknowledged the amount of work undertaken by the MHA Administrators, Tina, Mary & Teams (in response to higher acuity levels) & all were formally commended on their huge commitment including the Training Programme currently being drawn up for the forthcoming year which was approved by the Board.

Board formally approved the request to revise the TOR following a review undertaken by the Committee.




Action : Future Board Agenda Item

30/16 Governance & Risk

Board Assurance Framework

BS reported that the Framework had been seen & discussed at the IGC.

The Board were asked to note the changes that had been made which IGC approved & would continue to follow up in the meetings.

Low / Medium Assurance against Strategic Objectives

Supervision- The assurance required is about supervision in general for all disciplines as well

as community and the need for assurance for all in a systematic way.- From a nursing perspective we are currently undertaking a qualitative and

quantitative audit of RN and HCA supervision across the Trust. The data collection was throughout November and has been extended to ensure full participation. The results will be analysed and a report available by the end of January 2016 with an action plan.

- Nursing supervision structure trees are available in each SBU.- The Heads of Nursing monitor the frequency of supervision for the services in

their SB.- E-rostering and ESR are two long term options but both require additional

resources. The results of the audit will be taken to the IGC for review.

The Trust Quality Account has been to the external quality review meeting and a Q2report was presented at the Integrated Governance Committee. Framework will beamended to reflect this.

The overarching 2015/2016 Corporate Communications and Engagement Strategy islinked to the Trusts Strategic Objective to develop a strong relationship withcommissioners, GPs, and key partners. The Communications and Engagement Strategyincludes guidance on the following:

- Public Engagement and Consultation- Media Relations- Stakeholder Roles and Framework- Membership Strategy (sign off is with Trust Governors)- Written Communication and Public Information (sign off is with the co-production

group)- Media Crisis Plan

The overarching strategy is now with the Executive Director for Workforce andOrganisational Development for review.

Corporate Risk Register

Board approved the recommendation of IGC re the addition of 2 Risks:

ID Risk 366 - Approved Mental Health Practitioner (AMHP) Staffing LevelsThere are not enough AMHPs to provide a robust service across Hertfordshire which means that the Trust is at risk of not delivering delegated duties under section 75 of the MHA, meet locally agreed timescales and with a potential patient safety risk for service users / carers. This risk was reviewed at the Safeguarding Strategy Group on 08.12.2015, the funding agreed for additional AMHPs is in place and interviews were taking place in December.




However HCC have recently said that these posts cannot solely be recruited to provide AMHP cover as this is a function of the local authority (AMHP cover is provide by HPFT staff who undertake it as a secondary role). This recent development might pose a barrier to recruitment.

ID Risk 488 - Timely Step up from PICU to Medium Secure ServicesThis risk covers a number of areas however the prime reason for escalation is the risk to staff which is a health and safety issue. Specifically Oak ward are holding a service user in long term segregation for months due to a resourcing issue of which the SBU have virtually no control but hold all the risks and will continue to do seemingly for a number of months to come. In addition it has/ is affecting the SBU’s ability to admit to PICU which has financial and quality implications on a number of levels.

Board also noted & approved the 1 Risk that has been downgraded:

ID Risk 430 - Gaps in the Safeguarding referral process leading to referrals not being completedThis risk was reviewed at the Safeguarding Strategy Group on 08.12.2015. A recent meeting hosted by the HPFT safeguarding team with HPFT patient safety teams has clarified the process and mandatory fields have been included on Datix to assist with the process. The risk has been downgraded to a score of 8. It will remain on the Corporate Safeguarding Risk Register.

Board understood the environmental issues at Kingfisher Court & assurances concerning the AWOLs & the work that was being undertaken to mitigate this risk.

AMHPS Recruitment Update

Action : Report to come back to Board

31/16 Well Led Framework: Board External Governance Review

BS welcomed Isobel Gowen from the Foresight Centre who was observing the meeting as part of the Review. The Centre had been awarded the contract, chosen by a small Panel following a tender process.

A Scoping Meeting was held with the Foresight Project Lead about the areas that the Board had highlighted during the initial assessment & the timetable of the review was agreed.

The review will be undertaken through a combination of interviews, focus groups and asurvey of key stakeholders as well as a document review. Board members will complete an individual survey as well as being interviewed. Focus groups are being convened forGovernors, Service Users and Carers and senior staff and external stakeholders, including commissioners, will be asked to respond to a survey. In addition to the document review representatives from the company will observe key meetings of the Board and its committees and the Council of Governors.

A final report will be presented to the Board at a workshop in March / April. The report will be shared with Monitor as required under the framework.

32/16 Any Other BusinessNil return.




QUESTIONS FROM THE PUBLIC

No questions were put to the Board.

33/16 DATE & TIME OF NEXT MEETING

Private Board Meeting25 February 2016

9.00 am to 1.00 pmDa Vinci B & C, The Colonnades, Hatfield, Hertfordshire



Hertfordshire Partnership University NHS Foundation Trust

Action Date not yet reached Action Not Completed

MATTERS ARISING FROM BOARD OF DIRECTORS PUBLIC MEETING HELD 28 October 2015 149/15 Think Local Act Personal (TLAP) Making it Real Kate Linhart Following discussion the Board agreed to

sign up to the programme and make a formal declaration to this effect. The work will be taken forward within the SBUs and the Board will be kept updated on progress. KL to report back to the Board in the future on progress

July 2016

MATTERS ARISING FROM BOARD OF DIRECTORS PUBLIC MEETING HELD 28 January 201617/16 CEO Brief: strategy development

Iain EavesFollowing brief update on the strategy and next stage in development. IE will feed back on the engagement with staff and other stakeholders at the next meeting.

Apr 2016

18/16 Research Activity & Future Plans Kaushik Mukhopadhaya

Following a presentation by Professors Tim Gale and Naomi Fineberg on the research being undertaken the Board asked for a further update in six months.

July 2016

26/16 Cultural Index Q3 JK Following discussion about the returns for Q3 Jinjer Kandola reported that she would be reviewing the OD strategy once the Staff Survey results and the Collective Leadership Report was available. This would then be brought to the Board.

July 2016

Agenda Item 4

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Hertfordshire Partnership University NHS Foundation Trust

Action Date not yet reached Action Not Completed

30/16 Corporate Risk Register OS The Board was concerned to hear more about the staffing levels for AMHP roles and asked to hear more about this at a future meeting. IGC were monitoring this closely.

April 2016

31/16 Well Led Framework BS Final report to be shared with the Board and then shared with Monitor together with action plan.

May 2016

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Brief for Board

Subject: Chief Executive Brief April 2016

External & Strategic

National Update

Junior Doctor Strike Action 26th to 28th April 2016

As you will be aware the British Medical Association has confirmed the intention of Junior Doctors to undertake industrial action. We are writing to advise you of the plans that have been put in place and the processes followed for the intended strike action on 26th and 27th April which include emergency cover 08.00hrs to 17.00hrs on both days. This is unprecedented in NHS History and will require even greater levels of planning and preparation than before.

We would like to acknowledge the help and co-operation of Clinicians and senior managers to ensure that patient safety is not compromised in any way. We have consulted with the LNC Chair, the Senior and Junior Trainee representatives, medical managers, service line leads, supported fully by the Managing Directors and Clinical Directors. Contingency plans are being put in place to ensure continuity of service.

A Control Room will be opened and staffed from 07.00hrs to 19.00hrs (longer in the event of a declared incident) with robust support from the Operational Services on both days of action.

NHS ImprovementFrom 1 April Monitor is now formally part of NHS Improvement, bringing together Monitor, NHS Trust Development Agency, Patient Safety, the National Reporting and Learning System, the Advancing Change Team and the Intensive Support Teams. For the present the framework for Monitor risk assessment will remain in place until the introduction of a single oversight framework during 2016/17 that is based on the principle of earned autonomy and that segments providers according to the extent to which they meet a single definition of success that incorporates: finance and use of resources; quality; operational performance; strategic change; and leadership and improvement capability. Views on proposals for this framework will be sought by NHSD Improvement during quarter 1 2016/17.

Agency Spend RulesFrom 1 April all Trusts are subject to an expenditure ceiling covering all locum and agency staff. This will form one of the targets to be monitored on a regular basis by NHS Improvement. For our organisation the target is £8,525,000 for 2016.17.

National Whistleblowing PolicyNHS England and NHS Improvement have published a national whistleblowing policy. The new policy will ensure:

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NHS organisations encourage staff to speak up and set out the steps they will take to get to the bottom of any concerns;

organisations will each appoint their own Whistleblowing Guardian, an independent and impartial source of advice to staff at any stage of raising a concern;

any concerns not resolved quickly through line managers are investigated; investigations will be evidence-based and led by someone suitably independent in

the organisation, producing a report which focuses on learning lessons and improving care;

whistleblowers will be kept informed of the investigation’s progress; and high level findings are provided to the organisation’s Board and the policy will be

annually reviewed and improved.We are ensuring that our current internal policy reflects the guidance in the national one.

National Pay IncreaseFollowing recommendations from the independent pay review bodies, the NHS Pay Review Body and the Doctors’ and Dentists’ Review Body, the government has accepted a 1% pay rise for doctors, dentists and all NHS staff on Agenda for Change contracts for 2016 to 2017.

CQC FeesThe CQC announced its new fees payable from 1 April following national consultation. The CQC is moving, over two years, to full cost recovery on its fees. This has resulted in a large increase for NHS organisations with fees increasing by up to 75% this year. Kings Fund PublicationThe Kings Fund released a new report in March - Bringing together physical and mental health - A new frontier for integrated care.

The report makes a case for this the integration of physical and mental health care, highlighting ten areas for possible improvement, from enhancing mental health provision in acute hospitals to increased support for GPs in managing people with complex conditions. It states that both physical and mental health should be embedded in routine care processes, which would also reduce the stigma around mental health, while a board-level champion for physical health should be named in mental health trusts and vice versa. The report goes on to warn that failure to address these issues increases the cost of providing services. The full report can be accessed at.http://www.kingsfund.org.uk/publications/physical-and-mental-health

Local Health Economy

HVCCG Accountable Officer

The CCG have appointed Cameron Ward as the Interim Accountable officer for the organisation until they can make a substantive appointment to this crucial role. Cameron has had a wealth of experience across the NHS including within Acute and Primary Care settings and has been a CEO.

East & North Hertfordshire Chair AppointmentEllen Schroder has been appointed as the chair of the East and North Hertfordshire NHS Trust. Ellen, who lives with her family in north London, will serve as the Trust’s chair for a four-year period from 1 April 2016 to 31 March 2020.

Ellen has been audit chair for the Camden Clinical Commissioning Group since its inception with responsibility for effective risk management and establishing good



https://www.gov.uk/government/publications/national-health-service-pay-review-body-29th-report-2016https://www.gov.uk/government/publications/national-health-service-pay-review-body-29th-report-2016https://www.gov.uk/government/publications/review-body-on-doctors-and-dentists-remuneration-forty-third-report-2016http://www.eshareuk.com

governance structures. As vice-chair, Ellen is part of a small group of clinical and executive leaders who have formed the CCG’s strategy and developed its business and organisational plan. In order to avoid any conflict of interest, she will be resigning from her role at the CCG on 31 March.

NHS Planning FootprintThe NHS Shared Planning Guidance has asked every health and care system to come together to create their own ambitious local plan to deliver the Five Year Forward View. Sustainability and Transformation Plans (STPs) will be place based five year plans based on the needs of local populations. East & North Herts CCG, Herts Valleys CCG were asked to form a STP footprint with West Essex CCG. After a lot of discussions with partners and their Governing Bodies this footprint has been agreed.

Beverley Flowers Chief Executive of East & North Herts CCG has agreed to take on the local lead role for our STP. Whilst the CCGs are leading the process, all local NHS providers, Herts County Council and the voluntary sector providers are key partners in the development of these plans.

There are layers of plans which sit above and below the STPs with shared links and dependencies. Hertfordshire has worked successful at a county level with the Health and Wellbeing Board, Overview and Scrutiny, work on mental health, learning disabilities, the JSNA, Crisis Care Concordat and with our voluntary sector partners. Your Care Your Future is the key transformation strategy in West Herts and this will continue. East & North Herts CCG will also be working with West Essex CCG on the services and sustainability of hospital provision in Harlow and Princess Alexandra Hospital (PAH).

These plans are important as future funding for investment from the national Sustainability and Transformation Fund as the STP will become the single application and approval process for transformation funding from 2017/18 onwards.

Ten big questions have been set to help shape and agree the local priorities and plans as detailed below:

1. How are you going to prevent ill health and moderate demand for healthcare? 2. How are you engaging patients, communities and NHS staff? 3. How will you support, invest in and improve general practice? 4. How will you implement new care models that address local challenges? 5. How will you achieve and maintain performance against core standards? 6. How will you achieve our 2020 ambitions on key clinical priorities? 7. How will you improve quality and safety? 8. How will you deploy technology to accelerate change? 9. How will you develop the workforce you need to deliver? 10. How will you achieve and maintain financial balance?

The timescales for delivering the initial plan are challenging as we have to submit this by 30th June 2016.

Internal & Reputation

End of Year UpdateAs we move into the new reporting year I wanted to reflect on the achievements of 2015-16. This was a challenging year for the organisation and I am proud to reflect on the results we achieved through the hard work and commitment of all the staff. We achieved a rating of




“Good” from our CQC Inspection which means we are in the top 25% of Trusts who have received ratings so far. We achieved 96% for our CQUIN targets which were stretching and improved the quality of services we provide. The results from our Staff Survey this year have reflected the end of the transformation period and the embedding of the new teams and new ways of working as well as the crucial work we have carried out on the values and culture. We have also seen in year a real improvement in our overall performance including finance as well as KPI’s and have continued to meet all our regulatory requirements. We have built a very solid base to support our ambition to move from “Good to Great” and have had strong support through all our engagement events with all our stakeholders in developing our strategy to support our vision.

Finance & Performance Finance The draft Annual Accounts for 2015/16 were presented to the Audit Committee on 20th April and subsequently submitted to NHS Improvement. The headline position is a deficit of £3.3m but this includes an impairment of property values which is a non-trading technical item and excluded from financial performance ratings by NHS Improvement.

The important figure to note is an underlying Trust deficit of £3k. This is behind the original plan of £1.0m surplus, but is in line with the recent forecasts reported. A deficit of £254k is reported for the month.

The Monitor Risk Rating, the FSRR, is a 3.

These figures reflect an increase in expenditure in Month 12, largely planned, including pay increases related to additional agency costs for CAMHS transformation and EMDASS, both being pushed by commissioners.

Whilst it remains disappointing that the planned surplus has not been achieved, this position reflects a significant improvement in relation to that forecast in the first quarter. This has resulted from agreement of commissioner funding part way through the year but also from strong focus on financial management throughout operational and support services.

Financial Plan for 2016/17Full details are contained in the agenda items .

Performance All monitor targets are met.

ContractsWe have had an extremely successful negotiating round with our major commissioners. The main contract with the Hertfordshire commissioners has been signed for the next three years and funding meets fully the parity of esteem requirements and uplift received by the CCGs. We have achieved a five year contract with Norfolk, which may be extended year on year for a further two years. We have also signed off our contract with the national commissioners and N Essex is progressing well and will be signed shortly. This has put us in a strong position moving forward to be able to develop and sustain our services.

Junior Doctors Contract




As part of the implementation of the contract there are a number of actions and processes we need to take. One of these is the appointment of an “independent guardian of safe working” for the Trust. This guardian has to be appointed jointly with the junior doctors. The post holder is accountable to the Trust Board, and has an independent role in relation to direct accountability to the Board. The job description is the standard one issued by NHS Employers and we are working on the appointment process to meet the specified deadlines. The guardian is responsible for protecting the safeguards outlined in the 2016 terms and conditions of service (TCS) for Doctors in Training. The guardian will ensure that issues of compliance with safe working hours are addressed, as they arise, with the trainee doctor/s and HPFT, as appropriate; and will provide assurance to the Trust Board that doctors' working hours are safe.

Quality & Safety

Quality Accounts & CQUIN Quality Accounts and CQUIN schedule for the year. We aim to include a number of areas that reflect physical health care, access to our services and learning disability services. There is a separate update on the agenda

Learning from Mistakes - National league table The league table has been drawn together by scoring providers based on the fairness and effectiveness of procedures for reporting errors; near misses and incidents; staff confidence and security in reporting unsafe clinical practice; and the percentage of staff who feel able to contribute towards improvements at their trust.

Well Led Framework Governance ReviewThe external review of governance and board performance has now been completed and final report has been shared with us. A workshop for the full Board was held on 22 April and the results will be shared with Governors in May. We are now developing our plans for improvement based on the findings in the report.

Operational Update

Acute ServicesWhilst there is still pressure on the beds this has improved and out of area placements are minimal. During the Easter bank holiday period we are aware this can be a testing time but the service has made sufficient beds available to date to manage demand.

The use of non-HPFT PICU/HDU beds has continued with on average the use of 6 beds reflecting the number of females admitted to services with a diagnosis of emotionally unstable personality disorder and the number of service users being transitioned from CAMHS requiring intensive care.

PerformanceAll 9 Monitor targets have been achieved. In addition to this focus has been given to;

Risk Assessments – The Trust has achieved its 95% target for year-end. Focus is now on sustained and consistent good practice for 2016/17.

Re-Clustering – Year-end achievement of above 99%. EMDASS – Year-end performance will be 189 short of assessment slots made available

and 155 short of diagnostic slots. In discussion with Commissioners about how we can




improve performance to help them obtain the overall dementia diagnosis target for the CCG.

Mid-Essex IAPT – End of year we achieved 13.9% access against a 15% target. Commissioners are aware focus is now on sustaining improved performance in Q4 into the new Financial Year.

Herts Valley IAPT – working with Commissioners together with Primary Care Counselling. 15% access was achieved for both Herts Valley and East & North CCG.

AMHP Provision – With the shortage of available AMHP’s TMG commissioned a working group to support immediate and medium term actions. This has resulted in a marked improvement in the reduction of the number of unskilled AMHP shifts. Instrumental in this has been the establishment of a bank AMHP hub which commenced on 1st March 2016 with 10 bank AMHP staff. This has been able to provide a more fully comprehensive and robust service that is benefitting patients and local teams. The Duty Desk practitioner allocates urgent work (136, police custody assessments, high risk community assessments) to the BANK AMHPs on duty and the quadrant AMHPs on their duty rotas are picking up more planned and anticipated work. Increased senior management oversight and a new process of escalation has also been of benefit. Moving forward there is continued emphasis on attracting staff to take up AMHP duty and this will include looking at Band 5 to 6 progression and review of the AMHP enhancement.

Staff We are currently out to advertisement for the permanent post of Director of Service Delivery and Service User Experience and interviews are being held at the beginning of May.Paul Lumsdon has been extended until the end of May 2016 whilst we recruit into the post.

Karen Taylor will be returning from maternity leave in mid-June to resume her role as Director of Integration and Community Services, to aid her return Karen will be joining us over the next few months at various key meetings.

The Company Secretary post Interviews for the Company Secretary post are being held on 22 April 2016. Barbara Suggitt will be with us until the end of June on a part-time basis.

Business Development - Buckinghamshire We have completed the due diligence process with regard to the delivery of Learning Disability Services in Buckinghamshire and business case was agreed last month. We are now looking to agree final contract details for agreement.

Awards The HomeFirst project, run by Hertfordshire County Council and supported by HPFT, has been named winner in the Health and Social Care category of the Local Government Chronicle (LGC) Awards 2016.HomeFirst provides a rapid response service which helps people stay well and independent. It supports older people and others with long term or complex conditions to remain at home rather than going into hospital or residential care.Commenting on the project, the judges’ said: “This project demonstrated true integration with shared belief. Judges were not only impressed that Hertfordshire delivered cross-commissioning support and integration but that it also developed outcomes for people supported by the whole system.”

Tom Cahill Chief Executive




BOARD OF DIRECTORS MEETING

Report of the Integrated Governance Committee

Agenda Item 6

Meeting Date28 April 2016

Presented By

Sarah BetteleyNon-executive Director

1. Purpose of the Report:

This paper provides a summary of the items discussed at the Integrated Governance Committee meeting on the 21 April 2016.

2. Items Discussed:

The following items were on the Agenda:

Reports from Sub Groups – Q&R Management, Workforce OD Group, Policy Panel AMHPs Report QIA Update Patient Safety Report Operational Update Homicide Updates Homicide Independent investigation CQC Report Board Assurance Framework Trust Risk Register Foresight Governance Review Staff Survey Update

The subgroups each reported on their most recent meetings. Quality & Risk Managementgave a report on the issues discussed regarding the area of physical health and its promotion for service users and the reduction by 90% of falls resulting in harm. The group had also reviewed the results of two audits and wished the IGC to be aware of these risk areas: CMAHS DNS and Pre-placement checks. The group recorded that the CAMHS DNA audits showed further work was needed to ensure risk management processes were being implemented following DNAs and this was being actioned and a further audit and report would be brought to QRM in June. The Pre-placement audit revealed a deterioration in compliance with the policy and action had been taken to improve this – a further audit will be carried out to ensure compliance. The group has also agreed that it will monitor the risk registers within SBU’s to ensure these are being updated and reviewed in a timely way providing more assurance in the risk escalation process overall.

The Workforce & OD group was now well attended and as part of their work programme had discussed Recruitment and Retention, noting the improvement in recruitment with 40

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nurses being offered appointments following a recent recruitment exercise in the Phillipines and offers of 35 appointments made to students at the end of their training. Retention of staff is now becoming the main issue and the new exit process is providing valuable analysis of the reasons for leaving. The top three reasons given are: retirement; Line Managers and; lack of career progression. The group would be looking at this in more detail together with the results of the staff survey and ensuring that actions needed to improve are reflected in the Annual Plan, building on the work already being carried out through the Managing Excellence training that is being given to Band 6 and 7 line managers, and which will become the standard training to support line managers in managing staff. Nurse revalidation had also been reviewed by the group. There were no issues for escalation to the committee.

The Policy Panel reported that 95% of policies were currently in date and there were no issues the panel wished to raise with the committee.

The committee received a report on the key issues relating to the AMHP service and its provision within the Trust, the key risks and controls in place and the progress being made to stabilise and improve the service provision. SD reported that the situation was improving and was now being addressed by all the stakeholders involved in the provision of the service. A review will be undertaken in respect of the current AMHP Allowance and whether this fully reflects the additional responsibilities and stresses of the role. Other organisations appear to be increasing the allowance for their AMHPs which could have a detrimental effect on recruitment and retention within Hertfordshire. The committee asked to be kept informed of developments as this was a corporate risk recorded on the risk register.

A report on the progress being made in relation to Quality Impact Assessments was presented to the committee. This report set out work that had been undertaken to address the shortfalls in the system which had been identified by the internal audit report. The audit had made clear that QIAs were not all signed off in a timely manner in relation to the 2015/16 CRES schemes. The QIAs are an essential part of the process as they support the Trust in ensuring that quality issues are taken on board fully when making efficiency savings. The new framework enables quality monitoring to take place systematically throughout the CRES process and will be signed off by a panel meeting which includes the Executive Leads for Quality as well as the Head of Financial Planning and the MDs and PACE Manager. Reports will be presented to IGC each quarter which will detail the new monitoring arrangements.

The Committee received a report on Patient Safety which detailed incidents in Q4 as well as reporting on related data for the year as a whole. The committee noted that the suicide rate, whilst lower than the national rates was higher that the predicted rate for the previous year – standing ar 25 as opposed to 22. There had been 9 Serious Incidents in the final quarter compared to 16 in the previous quarter. The action being taken by the Trust in relation to the MAZARs Report was also brought to the committees attention. The committee also noted that the Trust had been ranked as “good” in a National Learning from Mistakes League Table .

The Operational Update presented to the committee highlighted the key improvements that had been made in relation to performance standards and the reduction in use of non-HPFT beds for acute in-patient care. The report also gave detail about the action taken in respect of safeguarding services during the recent and forthcoming strike action by Junior Doctors. In particular the more intensive plans that have been made in relation to the strike that will take place on the 26 and 27 April which will include emergency cover. CAMHs services were still experiencing severe pressure and further support has been given to the senior management team. Other areas of performance had improved over the last quarter of the year although improvements were still needed within EMDASS and IAPT services to meet commissioner targets.



The committee received updates on two historic homicide cases to report that all actions had now been implemented and the cases were now closed. The committee also received a report on two current cases, on which the Board had been briefed, which will be subject to independent investigations and the committee will kept updated as these progress.

A formal update was given to the committee in respect of the implementation of the CCQ Action Plan and noted that an Internal Audit had been carried out which rated the process being followed as Amber/Green giving assurance to the committee. The committee asked about progress concerning the use of Lone Worker devices and heard that there had been a review of policy, reminders to all staff and strict monitoring of the use of the devices is now in place. There are still some minor issues to be worked through but good progress had been made.

The committee received the updated Board Assurance Framework and noted the changes that had been made in the levels of assurance against key objectives. A full report on the assurance around supervision within the organisation is due to come to the committee in three months and progress had been made in establishing the electronic system that could be used. There were no other issues of concern raised by members.

The committee received and discussed the Trust Risk Register, and noted the development of Corporate Risk Registers. The committee also heard that the CAMHS risk register was being reviewed to ensure that the cumulative effect of the number of risks identified had been fully recognised. This would be discussed by the Trust Management Group and may be reflected on the overall Trust Risk Register for presentation to the Board.JK also reported that the risk concerning recruitment and retention would be reviewed as recruitment is no longer high risk.

BS gave a brief verbal update concerning the Well-Led Governance Review, which has been undertaken by Foresight on behalf of the Board. The draft report has been shared with the Board and will be finalised shortly. The results overall were extremely positive with a few areas for development including the scope of the governance committees. Once the report had been finalised this, together with the action to be taken on the recommendations, would be brought back to the committee.

The committee were apprised of the Staff Survey results for this year and the recommended actions being undertaken to address key areas. The results of the 2015 National Staff Survey show a greatly improved position since 2014 with 14 of the key findings above average across Mental Health Trusts, 13 average and five below average. Against the 2014 survey, the Trust has achieved eight improvement areas, and fourteen areas that remain unchanged. There have been no areas of decline in the staff experience against any of the key findings since the last survey. The score for staff engagement has risen from 3.62 in 2014 to 3.86 this year, and is now above average. HPFT scores for staff motivation were the highest achieved in the country for mental health and learning disability trusts in 2015.

The key areas of focus for workforce which have also been aligned within the annual plan are:

Recruitment & Retention – reducing the reliance on temporary staff Engagement and Involvement Implementing collective leadership outcomes Reducing Harassment & Bullying



3. Matters Escalated to the Board:

There were no matters for formal escalation to the Board.

4. Board to Note:

No key items for the board to note as the BAF and Risk Register are to be considered in full by the Board.

5. Recommendation

Board members are asked to note the summary of items discussed at the meeting.



BOARD OF DIRECTORSMeeting Date: April 2016 Agenda Item:

Subject: Update report on The Trust University Status and Re-accreditation Author: Lindsey Holman Interim Associate Director OD and Learning

Presented by: Oliver Shanley Executive Director Quality & Safety

Purpose of the report:

The purpose of this report is to share with the Board an update on the status of the Trust University Partnership and the process for re-accreditation of the Trust’s ‘University Status’ which is due in July 2016 It outlines a high level summary of the benefits delivered through the Partnership in advance of the annual report, which is due to be tabled at the July Trust Board There were four key areas / workstreams in the original strategic university partnership strategic plan as follows:

Workforce Development – ensuring strength of academic and clinical expertise is shared and embedded across the organisations

Research and Development – utilise the uniqueness of the relationship to maximise the potential to obtain funding for research grants

Training and Development Programmes – co-create training programmes for staff utilising joint expertise

Partnerships and Developments – working with external agencies and Trusts nationally and internationally

The report recognises that the work has built upon the strong relationships between both organisations.

Action required:The Board are asked to discuss the report and identify areas of action to be considered in the re-submission for re-accreditation

Relationship with the Business Plan & Assurance Framework (Risks, Controls & Assurance):The attainment of University status was identified as a strategic goal of the Trust.

Summary of Financial, Staffing & Legal Implications:

Equality & Diversity and Public & Patient Involvement Implications:This relationship will further ensure that service users and carers can shape the provision of contemporary mental health and learning disability practice.

Evidence for CQC;; Information Governance Standards, other key targets/standards:

This report provides evidence of the Trusts further commitment to ensuring it has a workforce that provides the latest evidence based care.

Seen by the following committee(s) on date: Finance & Investment/Integrated Governance/Executive/Remuneration/Board/Audit

EC April 2016

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Update report on The Trust University Status and Re-accreditation

1. Background

In November 2012, following an extensive period of collaboration, Hertfordshire Partnership NHS Foundation Trust (HPFT) and the University of Hertfordshire (UH) attained University NHS Trust status being granted approval by The University Academic Board. At this time, HPFT was one of only a handful of Mental Health Trusts to formally attain this status. The relationship of the two organisations is strong. It is founded on over 23 years of collaborative working.

The panel commended the partnership and recognised it as an innovative development, with a high quality of partnership working at a range of academic levels and a strong commitment and enthusiasm from both organisations.

The initial validation period and current memorandum of understanding is due to expire and this report briefly summarises the process for re-validation, which will take place in July 2016.

The Partnership has delivered benefits to both organisations across the key elements of the strategic plan for the Partnership which were:

Workforce Development – ensuring strength of academic and clinical expertise is shared and embedded across the organisations

Research and Development – utilise the uniqueness of the relationship to maximise the potential to obtain funding for research grants

Training and Development Programmes – co-create training programmes for staff utilising joint expertise

Partnerships and Developments – working with external agencies and Trusts nationally and internationally

Moving forward, there are clear opportunities in further developing the University Partnership in the context of the Trust Strategy ‘Good to Great’ supporting the delivery of great care and great outcomes. This will be detailed as part of the re-submission and annual report documents which will be presented to the Academic Board and Trust Board in July.

2. Benefits of the University Partnership

All four workstreams within the strategic plan have seen progress to date. Examples of the activity delivered through this innovative partnership include:

The partnership has been used as a vehicle for research development, notably attaining a £450,000 award for patient safety from the Health Foundation in 2014 and over £970,000 in the current annual reporting period. Other research grants awarded include: Optimal treatments in OCD; WIELD Study for people living with learning disabilities; Herts and Minds Study researching the benefits od metallisation based therapy; Mortality and outcome of older age psychiatry acute ward inpatients.

Further bids are in progress including European funding. Collaboratively the partnership has also achieved £714,897 to date from the National

Institute for Health Research award category Research for Patient Benefit. Creation of a joint post of 1.0 FTE (0.5 FTE per institution) of a Senior Lecturer

Practitioner in Dementia Care was appointed in 2015. Other HPFT employees hold Agenda�Item�7�Board�Report�Uni



visiting lecturer and fellowship agreements with the University Accreditation by the Hertfordshire Business School of the Trust’s Leadership

Academy. An improvement by working in partnership to improved the percentage of nursing

students employed with the Trust at the end of their programme (95% of students from the November 2016 cohort were employed compared to 75% the previous cohort)

Collaborative conferences have been co-hosted including:o “learning disability action awareness” in partnership with DH to raise

awareness of health issues relating to this client groupo Physical health / mental health connection conferenceo Joint celebratory ‘Sharing Best Practice’ conference in December 2014

entitled ‘time to care’ for over 200 delegates and ‘HPFT Futures’ event in 2015

HPFT offer all foundation year doctors with a masters qualification and a member of the University is a standing member of the tutors committee

The OD Team worked with UH to undertake focus groups on understanding the perception of staff of bullying and harassment in the workplace informing the health and wellbeing activity and specific activity plans

Other collaborative working and supporting of delivering lectures and focus group participation for University feedback and programme developments

Significant provision of taught undergraduate and postgraduate programmes, short courses and continuing professional development programmes and those bespoke to HPFT facilitate learners success and attraction of HPFT as a place of work

The partnership has been instrumental in forming the NHS University Mental Health and Learning Disability Trusts South of England Partnership Networking Group following successful peer visits to other Trusts. This Group will meet with terms of reference to seek opportunities for collaboration.

Further detail on these benefits will be outlined in the Annual Report along with future opportunities for the next period of accreditation.

3. Re-validation Process

The revalidation will be awarded by ‘The University Academic Board’ and ‘Centre for Academic Quality Assurance’. It is the Panel’s responsibility to consider the strength of the existing partnership (and its governance arrangements) in terms of the organisational synergies, current collaborative activity, and a shared commitment to research and education. It will assess that it delivers an enhanced student learning experience across a range of health discipline areas at undergraduate, postgraduate and doctoral levels.

In particular, the re-validation criteria will seek evidence of the benefits of the University Partnership and the plans for further developments for the next period of validation.

The evidence will be submitted in advance for a private meeting of the Panel before representatives from HPFT and UH meet to respond to questions and present the submission for re-approval and our strategy for the future.

At the conclusion of the approval process, the panel will make recommendations to the University regarding:

1. The recognition of the partner organisation as a University Trust;2. The term for which approval is fixed;3. Any conditions of approval, which must be fulfilled before University Trust status can

be conferred 4. Any specific recommendations which the panel wish to make to the team.



4. Position Statement

The development of the re-submission documentation has commenced and as part of this the Strategic Management Group will work to identify further opportunities for the next period of validation in supporting the Trust Strategy Good to Great. Key members of the Trust Staff from Nursing, OD and Learning and Research and Development are contributing to the annual report and evidence preparation, which will include gathering feedback from our students and learners of their views on the benefits of the Partnership.

Some initial opportunities in working together over the next period have been identified as: Building a pool of mentors and coaches across the organisations Offering a wider range of work experience placements Working together to identify a skill set and programme development for the workforce

of the future (aligned to the five year forward view) To offer development programmes and work shadowing opportunities across the

organisations Tap into knowledge pools and expertise (for example view technological solutions

used by the University with a view to further develop in the Trust) Share a vision for nursing pathways (and other career pathways) of development for

the future workforce Linking with the wellbeing agenda at the University Clear alignment of the four components of the University Partnership Plan in

supporting the Trust strategy ‘Good to Great’ delivering ‘Great Care and Great Outcomes’.

The partnership recognises that to further develop the strategic plan additional resources will need to be allocated to project manage the implementation of the strategy. The University has agreed this in principle and a job description and person specification is being developed for the re-submission process.

The Board is asked to read the update report and outline for re-accreditation process and identify any additional comments for the re-submission document.

The University Annual Report will be tabled at the July Board.



Public Board

Purpose of the report

The purpose of this report is to provide an overview of patient safety related data including Serious Incidents and associated learning in Quarter 4 of 2015/16; the report also includes the patient safety related data from the year as a whole. It seeks to provide members with information on how the Trusts data compares nationally, in order to benchmark HPFT with performance of other Trusts.

Action requiredTo consider and discuss the content of this report and consider whether any additional actions may be required.

Summary and Recommendations to the Committee: Summary

The HPFT predicted suicide rate per 1,000 service users for 2015/16 (25) is higher than the predicted suicide rate for 2014/15 (22). However, the rate remains lower than the latest national rate for mental health service users provided by the National Confidential Inquiry. It should be noted that the number of predicted suicides for both years may be subject to change in future reports as Inquests are concluded and the rate may therefore improve. At the time of this report Inquests have not concluded for 19 deaths which occurred between October 2014 and March 2016 that were reported as serious incidents.

The Public Health suicide prevention profile for Hertfordshire shows that the suicide age-standardised mortality rate per 100,000 persons (3 year average) is 8.1 across the East of England region. The rate for Hertfordshire is 5.8.

The Trust reported a total of 9 Serious Incidents in Quarter 4 of 2015/16, compared to 16 reported in the previous Quarter; these were six unexpected deaths (suspected suicides), one serious self-harm incident/para-suicide, the admission of an under-18 year old to an adult ward and an incident related to Safeguarding Adults.

In 2014/15 the Trust reported a total of 56 serious incidents compared to a total of 54 serious incidents reported in 2015/16; the same number of unexpected deaths (28) was reported in both years. The Trust does not underestimate the effect the death of a loved one as a result of a sudden unexpected death or as a result of suicide has on families, friends, staff and the wider community and is committed to undertaking robust investigations and acting on areas of learning

1

Meeting Date: 28th April 2016 Agenda Item: 8

Subject: Patient Safety Q4 and Annual Report 2015/16

For Publication: Yes

Author: Bela Da Costa - Legal Services LeadNikki Willmott – Patient Safety Manager

Approved by: Oliver Shanley – Executive Director Quality & Safety, Deputy CEO

Presented by: Oliver Shanley – Executive Director Quality & Safety, Deputy CEO

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arising from serious incidents.

There has been a slight decrease (2) in the number of other serious incidents reported this year compared to 14/15; the Trust would expect there to be some variation. Other serious incidents include falls resulting in a long bone fracture, parasuicides (not completed), under 18 admissions to adult beds or infection control outbreaks leading to ward closure.

A national Learning from Mistakes league table has been drawn together by scoring providers based on the fairness and effectiveness of procedures for reporting errors; near misses and incidents; staff confidence and security in reporting unsafe clinical practice; and the percentage of staff who feel able to contribute towards improvements at their trust. Data is drawn from the 2015 NHS staff survey and from the National Reporting and Learning System. The Trust is currently ranked in the good category, with no red flags identified in relation to NRLS reporting.

Relationship with the Business Plan & Assurance Framework (Risks, Controls & Assurance):The Patient Safety Report links with the Risk Register and is central to the Trust’s systems of management of Patient Safety and Risk

Summary of Implications for: 1 Finance N/a2 IT N/a3 Staffing N/a4 NHS Constitution N/a5 Carbon Footprint N/a6 Legal N/a

Equality & Diversity (has an Equality Impact Assessment been completed?) and Public & Patient Involvement Implications:N/A

Evidence for Essential Standards of Quality and Safety; NHSLA Standards; Information Governance Standards, Social Care PAF:Patient Safety remains a high priority for the Trust.

Seen by the following committee(s) on date: Finance & Investment/Integrated Governance/Executive/Remuneration/Board/Audit This Patient Safety Q4 report has not yet been presented to any other Trust committees.

2Agenda�Item�8�use�April�BOD�Q4



HERTFORDSHIRE PARTNERSHIP NHS FOUNDATION TRUST (HPFT)

UPDATE ON PATIENT SAFETY AND SERIOUS INCIDENTS

QUARTER 4 2015/16 AND ANNUAL SUMMARY REPORT

1. PURPOSE OF THE REPORT

This report is intended to provide members with an overview of Serious Incidents which were reported by the Trust in Quarter 4 of 2015/16 with the use of safety metrics to provide the required assurance. Serious incidents are an important mechanism for monitoring and improving quality and safety. The report also provides an analysis of incident and serious incident data for 2015/16.

The report seeks to provide an element of forecasting in relation to unexpected deaths of service users as a result of suicide and nationally published incident data via the National Reporting & Learning System, as well as highlighting work being undertaken within the Trust to improve Patient Safety.

2. INCIDENT DATA ANALYSIS

Incidents

Table 1 below contains a summary of the top 5 incident trends reported on the Trust’s Datix incident reporting system in Quarter 4, 2015/16 with a comparison to data reported in the previous Quarters. This enables ongoing monitoring of potential trends, themes or actions required. The personal accident category includes incidents such as moving and handling, needle stick injury, or slip trip and fall. The practice category includes incidents such as staff shortages, pressure ulcers, communication and unexplained injury.

Table 1

Q4 14/15 Q1 15/16 Q2 15/16 Q3 15/16 Q4 15/16VIOLENCE & AGGRESSION 713 804 793 873 759PERSONAL ACCIDENT 314 337 317 316 297SELF HARM 199 199 234 299 356PRACTICE/CLINICAL CARE 314 246 240 249 224MEDICATION 98 120 129 111 104TOTALS: 1638 1706 1713 1848 1740

There has been a 6% increase in the overall number of incidents reported within the top 5 incident types in Quarter 4 when compared with the same Quarter in 2014/15, with 15% more incidents across all types being reported in 2015/16 than 2014/15; this demonstrates a good reporting culture amongst our staff.

The upward trend in the number of self-harm incidents reported since Quarter 3 of 2014/15 has continued, with the majority of incidents occurring in North Essex Inpatient services and CAMHS Inpatient Services. Both of these services are consistent reporters of incidents highlighting a positive reporting culture. A brief analysis of the incidents reported by North Essex shows that 88% of the incidents reported in 2015/16 relate to one individual with known self-harming behaviour (repetitively hitting self in face). It should be noted that the increase in reporting of self harm incidents is not seen across all services.

In contrast, the number of Practice/Clinical Care incidents reported over the last 15 month period has fallen by 29%. The largest reporting area within this type of incident relates to staff shortages, accounting for nearly one third of the incidents reported within Practice/Clinical Care since January 2015. There was a drop from 101 reported incidents of staff shortages in Quarter 4 of 2014/15 to 56 reported incidents in the same Quarter this year. These incidents are monitored by the Safer Staffing Committee who had noted a spike in Quarter 3 and a reduction in Quarter 4. Actions being taken in relation to safer staffing in each of the SBU’s and recruitment to posts is likely to have impacted on the reduction.




In addition to analysis and reporting at Operational level, detailed analysis of specific incident data is undertaken by Practice Governance Leads and specific groups such as the Trust Falls Group, the Making our Services Safer Group, and the Health Safety and Security Committee. Where felt to be required Task and Finish Groups are commissioned by the specific groups to look at specific patient safety related issues.

A review of Absent Without Leave incident data reported on Datix was undertaken in Quarter 4. The majority of AWOL incidents occur in Adult Acute services managed by West SBU. All staff including temporary staff have been reminded of the need to follow Trust policy and procedures to reduce the risk of AWOL. Patients at risk will be identified on the ward Patient Safety at a Glance board.

The key themes arising from AWOL incidents have been discussed and disseminated through the Clinical Risk and Learning Lessons Group.

Table 2

INCIDENTS BY TYPE (TOP 5) 1 4 15 – 31 3 16 2015/16VIOLENCE & AGGRESSION 3229PERSONAL ACCIDENT 1267PRACTICE/CLINICAL CARE 938SELF HARM 1089MEDICATION 464Total 6987

The table above shows that the top 5 incidents by type has remained consistent throughout the year; these incident types are consistent with the types being reported by other mental with trusts as seen in the Organisational Patient Safety Incident Report data for NHS organisations.

In addition to analysis and reporting at Operational level, detailed analysis of specific incident data is undertaken by groups including the Trust Falls Group, Safer Staffing Group, the Making our Services Safer Group, and the Health Safety and Security Committee. Where felt to be required Task and Finish Groups are commissioned by the specific groups to look at specific patient safety related issues.

An example of where incident data has been able to have a direct impact on patient safety is demonstrated in the reduction in harm from falls over the 2015/16 period. The graphs below show the number of falls resulting in a fracture some of which required surgical intervention reported between October 2014 and March 2016 and the level of harm from falls in 2015/16. It is of note that there have been no falls meeting criteria for reporting as serious incidents since October 2015.




Chart 3

The Trust introduced the use of a Falls Root Cause Analysis template and undertook targeted work to update the post falls protocol, review the Falls policy, raise awareness about medications which may have an impact on falls prevention. The graph below appears to indicate that this work has had an effect and that learning from the Falls RCA’s undertaken was implemented and shared with other inpatient units trust wide.

Nov-1

4

Dec-1

4Jan

-15

Feb-1

5

Mar-1

5

Apr-1

5

May-1

5Jun

-15Jul

-15

Aug-1

5

Sep-1

5Oc

t-15

Nov-1

5

Dec-1

5Jan

-16

Feb-1

6

Mar-1

60

1

2

3

4

5

FALLS SIs Nov 14-Mar 16




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