LANCASHIRE CARE NHS FOUNDATION TRUST BOARD Board/Trust Board... · 2014-08-27 · A Non-Executive...

LANCASHIRE CARE NHS FOUNDATION TRUST BOARD to be held in Training Room 2 at Preston Business Centre

03 October 2013, 9.30am

A G E N D A

Item Number

Item FOIA Exempt

Presenting

PART ONE

TB 106/13 Welcome and opening comments Chair

TB 107/13 Apologies for absence and Declaration of Interests Chair

TB 108/13 Minutes of the Trust Board meeting held on 02 July Chair

TB 109/13 Matters Arising Chair

TB 110/13 Feedback on Director Activity

Chairs Report

Chair

TB 111/13 This Agenda Chair

TB 112/13

TB 113/13

TB 114/13

TB 115/13

TB 116/13

TB 117/13

Formal Business of the Board

Chief Executive Briefing Pack

Disestablishment of CARE Committee

Use of Restraints Report

Workforce Reporting

Executive Risk Register

Board Assurance Framework

Chief Executive

Company Secretary

Director of Nursing

Director of Transformation and Innovation

Director of Nursing

Company Secretary

TB 118/13

TB 119/13

TB 120/13

Compliance Reports (information and assurance)

Finance Report

Performance Reporting

Sub-Committee Minutes

Director of Finance

Director of Finance

Company Secretary

PART TWO

TB 121/13 Action and Decision Tracker Chair

TB 122/13

TB 123/13

TB 124/13

TB 125/13

Formal Business of the Board

CIP Addendum

Charitable Trust Funds update

Inpatient Programme update

Detailed analysis of ‘new business’

Director of Finance

Director of Finance

Chief Executive

Director of Finance

TB 126/13 Any Other Business

Review of the meeting

Chair

TB 127/13 Date and Time of Next Meeting

Strategy and Policy Development Committee – 05

November 2013

Chair

BOARD OF DIRECTORS Minutes of the meeting of the Board of Directors (Part One) held on Tuesday 2nd July 2013 PRESENT: Derek Brown, Chair Peter Ballard, Non-Executive Director Jane Burtoft, Interim Director of Workforce and Organisational

Development Colin Dugdale, Acting Director of Nursing Gwynne Furlong, Non-Executive Director Chris Heginbotham, Non-Executive Director Mark Hindle, Chief Operating Officer Max Marshall, Medical Director Jim Taylor, Non-Executive Director Heather Tierney-Moore, Chief Executive Dave Tomlinson, Director of Finance Teresa Whittaker, Non-Executive Director

IN ATTENDANCE: Diane Halsey, Company Secretary Jo Alker, Executive Board Support Officer (Minutes)

Barbara Hummer, Staff Governor David Jackson, Public Governor TB 087.13 WELCOME AND OPENING COMMENTS

The Chair welcomed everyone to the meeting in particular Staff Governor Barbara Hummer and Public Governor, David Jackson. The Board noted that the previous Chair Steve Jones had resigned from the Trust and Derek Brown had been appointed by the Council of Governors to serve for the unexpired period of the previous Chairs term of office until 31st March 2016.

TB 088.13 APOLOGIES AND DECLARATION OF INTERESTS

No apologies for absence were received. No declarations of interest were received for part one of the agenda but it was noted that the Chair and Director of Finance would need to declare an interest in item TB101.13 under part two of the meeting.

TB 089.13 MINUTES OF THE TRUST BOARD MEETING HELD ON 02 MAY AND 29

MAY 2013 The minutes of the Trust Board meeting held on 2nd May and 29th May were confirmed as a true and accurate record.

TB 90.13 MATTERS ARISING

The Company Secretary reminded the Board of the process agreed at the last Board meeting to review the Board Assurance Framework. Agenda items relating to the assurance framework or emerging risks would be highlighted at each meeting to establish whether any further information was required. A full review of the Board Assurance Framework would be completed twice a year when the Executive Risk Register was also reviewed by the Board. These had been scheduled into the cycle of business.

TB 091.13 SUMMARY OF BOARD ACTIVITY A Non-Executive Director explained that he had recently attended a good practice visit with one of the Trust Governors which was very positive. There were a number of points raised around enhancing communication amongst similar working groups across the Trust and the Non-Executive Director asked what the next step was in terms of giving feedback. The Company Secretary explained that the feedback was reported to the Council of Governors Standard and Assurance Committee. The Chief Executive confirmed that she would clarify the internal process outside of the meeting. A discussion followed around the process of the good practice visits and how these inform the Board about service delivery issues. A Non-Executive Director explained that he had attended a Sustainability Development meeting and explained the progress being made. He had also attended a number of property roadshows which were fairly well attended however in some areas there was apparent lack of interest in attending. It was thought that it would be more appropriate to present to more senior staff and the Director of Finance added that the establishment of the Property Strategy Committee would embed this further. A Non-Executive Director explained that he had been asked to address an Adult Community Research clinic and was impressed with the number of staff interested in research and noted that it had been a very positive day. The Chief Operating Officer had been looking at other organisations and how they approach equality and diversity and it was very welcomed that senior people in the organisation had taken the time to attend. It was noted that the Chief Executive and Director of Finance had undertaken the first formal review with the new Monitor relationship management team and the highlights of the discussion were outlined.

TB 092.13 CHIEF EXECUTIVE BRIEFING PACK Governance Declaration The Chief Executive presented the briefing pack and highlighted the requirement to approve the quarterly governance declaration to Monitor. The information was reviewed and following discussion the Board approved the declaration. Tenders and contracts The Chief Executive gave an update on tenders. In response to a question relating to a recent unsuccessful bid she explained that feedback had been requested but not yet received on the reasons why the Trust had been unsuccessful. An internal review had been instigated to inform management in this area and this report was due soon. At the next Board the Chief Executive would bring back the internal review with or without the external outcome response. Long Term Conditions The Chief Executive advised that the Long Term Conditions programme is one of the key enablers to achieving the Trusts strategic aspirations. She noted that there was a further piece of work running alongside this in terms of national concerns around A&E. She explained how the systems that can be used more effectively and innovatively and pointed out that the Trust’s work around the neighbourhood teams is key to this area of work. The Chief Operating Officer added that Capita were also doing a similar piece of work in East Lancashire. Face Down Restraints A Non-Executive Director commented on the use of restraint in particular the issue around face down restraint. The Chief Executive expanded on the briefing in her report around the wider public concerns being raised in relation to the use of face down restraint. The Acting Director of Nursing explained that clear processes and procedures are in place at the Trust. The Trust works very closely with UClan to develop practice in the use of restraint including, face down restraint, which is always a last resort. An expert view around this and best practice governance arrangements were also being sought. The Medical Director explained that he had spoken to a Medical Director at another Trust who had decided not to use face down restraint. This had caused a number of other staff related problems including an increase in staff sickness rates. It was noted that an offer had been made to send some of our staff to this Trust to look at how the ban on face down restraint had worked for them. This offer would be taken up. A conversation followed around how the Trust could measure outcomes in this area at team level and learn from those who are doing well. A Non-Executive Director added that he had recently witnessed one of the Trust’s training session on face down restraint and noted that service users were present to give their views on the practice and experience as part of the learning process.

TB 093.13 TRUST BOARD TERMS OF REFERENCE

The Company Secretary presented the Trust Board terms of reference and explained that the Board is required to review them on an annual basis. The Board approved the revised terms of reference subject to some additional wording around the Trustee Committee.

TB 094.13 NOMINATION/REMUNERATION COMMITTEE The Company Secretary presented the Trust Board Nomination/Remuneration Committee terms of reference and highlighted that this paper was proposing combining the two Committees. The Board approved terms of reference and subsequent combining of Nomination and Remuneration Committee.

TB 095.13 AUDIT COMMITTEE ANNUAL REPORT

The Chair of Audit Committee presented the Audit Committee Annual Report and outlined the nature and content of the report in the context of the Committees discharge of statutory responsibilities. She asked Board members to comment on any areas where they would like to see more information included in future years. The Director of Finance added that it should be noted that this represented transparent reporting that goes beyond the minimum reporting requirements. The work of the Committee is very strong and acknowledgement that this is thanks to the Chair of Audit Committees’ significant guidance and input. The Chair of Audit Committee explained that the test would also be with the Council of Governors and whether they feel that they have the information they need to undertake their duties. Staff Governor, Barbara Hummer expressed her thanks to the Chair of Audit Committee for this comprehensive piece of work. Public Governor, David Jackson agreed with the comment and added how striving for excellence and continual learning had come across in the recent Audit presentation to the Council of Governors.

TB 096.13 COMPLAINTS REVIEW

The Acting Director of Nursing presented the complaints review that followed on from the report presented in January. He explained that the first complaints panel was scheduled for 4th July. This would be a learning exercise and practice and process would change as it evolved. He outlined the process involving a deep dive into a randomly chosen complaint and that Network Directors would be available at the meeting. The feedback from the panels would then be reported to Quality Committee.

A discussion followed around the information that would be provided to the panel showing trends and themes and the detail needed in the feedback report to Quality Committee. The Board was keen to note that the learning should not just be held with those that have had the experience but that it needed to be disseminated appropriately.

TB 097.13 QUALITY AND PERFORMANCE MONITORING AND REPORTING

The Chief Executive introduced the paper and explained that the standard quality report had still been provided as part of the pack to ensure the Board received an update. The development of the Balanced Score Card is also underway which is being led by the Company Secretary. The performance dashboard will be presented today and the quality SEEL will monitor quality across all the levels. The Director of Finance explained how the look and feel of the performance dashboard would also be evident in the Balanced Score Card and assurance received via the Board Assurance Framework and the Executive Risk Register would also link in. What was proposed in the Balanced Score Card was six domains that link to the organisations strategic aspirations. The Company Secretary explained the work undertaken to develop the straw man presented and outlined the work planned to further develop it. It was noted that this would continue to be a work in progress during this development phase. Comments on the content were noted. Non-Executive Directors commented on gaps around the commercial area and the Mental Health Act.

The straw man described the design and governance arrangements that aligned to each of the domains. The Director of Finance explained the need for ongoing input from the Non-Executive Directors to ensure that the understanding and reasoning behind it was aligned to their needs and requirements. It was inevitable that in developing a comprehensive map of this type gaps in either planning or data would emerge and the Board needed to commission work to address these. The Director of Finance added that there were a range of issues around the integration of ESR and financial systems. The difficulty was that both systems were designed to fulfil different needs. Current processes are being developed to ensure common structures and bring the two systems together. The Director of Finance presented the quality SEEL reporting map that showed each Networks response to their validated self-assessment. The Medical Director explained the process involved in the self-assessment, each team self-assesses and then an independent validator comes to check the outcomes. Variation in outcomes can change the score on an ongoing basis. The SEEL tool will be available to all Board members in electronic form. The Director of Finance explained the four domains held on the executive performance dashboard and demonstrated the system to the Board. He

highlighted the ability to drill down through information and explained that the level to which you can drill down to is still being worked through. Following a question from a Non-Executive Director, he explained that any areas of concern that emerge and need to be flagged up will be pulled through the Chief Executive’s Briefing Pack. The Director of Finance asked for feedback and comments on the performance dashboard and support from two Non-Executive Directors to further develop and enhance the system and the Balanced Score Card to ensure that Non-Executive Directors insight is designed in. It was agreed that Teresa Whittaker and Derek Brown would support this. The Board noted that the next report to the Board will be in this format.

TB 098.13 FINANCE REPORT

The Director of Finance presented his report and explained the costing process that supports the reference costs. The process is followed and signed off by the Director of Finance and assurance around this is presented to internal and external audit. The Board were content with the assurance received around reference costs.

TB 099.13 SUB-COMMITTEE MINUTES

The minutes of Audit Committee held on 30th April 2013 were circulated to the Board for information and assurance.

AGENDA NUMBER: TB 110/13

TRUST BOARD – 03 OCTOBER 2013 CHAIRS REPORT

FOIA STATUS: No Exemption Part exemption applies to page/s:

Not Applicable

PAPER TITLE: Chairs Report

PURPOSE: To purpose of this report is to provide Board members with an update on current activities

ACTION RECOMMENDED:

Noting

PAPER PREPARED BY: Derek Brown, Chair

1.0 Strategy and Policy Development Committee

Strategy and Policy Development Committee met in September and members of the Committee invited Network Directors and Clinical Directors to the session to review and refresh the Trust’s current Risk Appetite Statement. The group revisited the risk domains that they believed the Board need to state the extent of their risk comfort zone and then the boundaries and limits that the Board would want to set in relation to each of those domains. The Company Secretary is currently collating all feedback with a view to making a proposition for a draft statement for further discussion prior to formal approval in January.

2.0 Update on NEDs recruitment

On 31 July 2013 Jim Taylor resigned from the Trust as a Non-Executive Director and Monitor have been formally informed. This has caused two NED vacancies and recruitment is underway. Interviews are scheduled for 8 October 2013 and, at the time of writing there has been an encouraging response to our recruiters. Council of Governor Nomination/Remuneration Committee will take place on 29 October 2013 were we hope formal appointment to the vacancies will be made.

3.0 Governor Elections

On 05 March 2013 the Company Secretary presented a paper to Board members that outlined the proposals to reduce the number of Public Governors from 19 to 12 over a three year period. Due to resignations received in the constituencies proposed for reduction, we will achieve full reduction sooner than anticipated. The Governor Elections for 2013 are currently underway. Governor Awareness Session took place during September to educate and encourage members of the public to stand in West Lancashire, Central and Blackburn with Darwen. Nominations for the Elections have been opened early due to the high number of Staff Governor interest but this has no impact on the rest of the schedule.


TRUST BOARD – 03 OCTOBER 2013 CHAIRS REPORT

4.0 Annual Members Meeting

The Annual Members Meeting took place on 18 September 2013. 57 people attended in total, 35 of those people being members of the Trust.

5.0 Director Activity

In addition to the usual Board business, NEDs have been involved in their areas of special interest during September: Gwynne Furlong and Teresa Whittaker have separately met with the new Director of Transformation and Innovation, Craig Barratt. Teresa Whittaker also attended Quality Committee. Peter Ballard has undertaken a Good Practice Visit and attended a Healthwatch Event with myself. Chris Heginbotham has Chaired a Recovery Conference on behalf of Secure Services. I have sat on two consultancy interviews, met with the CQC and attended numerous sites across the Trust.


TRUST BOARD – 03 OCTOBER 2013

CHIEF EXECUTIVES BRIEFING PACK


Not Applicable

PAPER TITLE: Chief Executive’s Briefing Pack

PURPOSE: To purpose of this report is to provide an overall summary of the Trust position and highlight the areas for further discussion

ACTION RECOMMENDED:

Noting

PAPER PREPARED BY: Heather Tierney-Moore, Chief Executive




The following commentary is based on the development of the Balanced Score Card domains.

QUALITY

Quality Strategy update Electronic quality reporting The new Quality SEEL tool is now in place with an initial report showing the emerging organisational picture. This will be reported to Board in November. Team Information Boards The results of the survey monkey findings to support assurance of clinical teams across the organisation having the Team Information Boards (TIB) in place is summarised below. 181 out of 266 team in total have responded which give a 68% response. Further work to support the remaining teams and to extend the use of the TIB’s is underway.

Yes No

At present does this team have a Team Information Board (TIB)? 83% 17%

Is this TIB currently in use? 94% 6%

Friends and Family test A response to the initial first draft of the Friends and Family test guidance for community and Mental Health Services was submitted to NHS England. The Trust is consulting with Patient Experience Leads at NHS England, Lancashire Area Team and NHS England North Region to




explore the opportunity of becoming an early implementer. The collection of the friend and a family test responses is now underway across an initial group of District Nursing teams using an application on the hand held tablet devices. CQC Visit – Assessment and Detention Inspection A CQC assessment was conducted in September in East Lancashire. This was a multiagency inspection on the use of the Mental Health Act within Lancashire and inpatient services in Burnley. Informal feedback highlights some good developments specifically in older adults around patient and carer experience and engagement. The Trusts approach to developing practice and problem solving was commended. Formal feedback is expected in late October. In Patient Survey Results LCFT has participated in the 2013 Mental Health In-Patient Service Users Survey. The data collection period was June – August 2013 relating to inpatient stays earlier in the year. Quality Health was commissioned to conduct the survey which consists of 47 questions divided into 7 broad categories. The questionnaire was sent to 850 service users and there was a response rate of 24%. The Trust has received the initial data which indicates that from the 40 measurable questions LCFT scores have declined from last year in 52% of questions, have remained the same in 12% and are better in 5%. The decline is mainly attributable to 3 categories.

Introduction to the ward – such as feeling welcome and being introduced to the routine of the ward.

Hospital Staff – including being listened to and having enough time for discussion, and being treated with respect and dignity

Care and Treatment – including purpose and side effects of medications and being involved in decisions

The overall rating on the survey remains the same as 2012 and the remaining 3 categories relating to the ward environment, the rights of service users and leaving hospital also remain the same as 2012. When comparing LCFT results with those of other Trusts the responses were better for 27.5% of questions, similar for 37.5% of questions and worse for 35% of questions. Board will be updated in November following further analysis and planned actions. Wordsworth Centre Opening Wordsworth Centre (previously Coniston Ward) Older Adult inpatient unit opened on the 25 September. Representatives from CCGs, Lancashire Healthwatch and Council of Governors joined the Chief Executive in celebration of achievements covering an extensive improvement plan, staff development and environmental enhancement. Visitors enjoyed a tour of developments of the unit and ward environment designed to support those with acute dementia related difficulties. Board will be kept updated of progress and monitoring of this unit over the coming months.




FINANCIAL & BUSINESS HEALTH

The surplus for the five months to August is £1,599k against a plan of £1,784k, forecast to result in a full year outturn surplus of £3.1m against a plan of ££4.0m. This includes an under achievement of £311k YTD against the cost improvement programme. The under achievement is driven mainly by pressures in Adult Mental Health around inpatient services. While this is of concern, cash balances continue to hold up strongly and the risk rating YTD is in line with the plan of 3 and is projected to remain so for the year as a whole. At the end of August, Monitor confirmed that with effect from October the Risk Assessment Framework will replace the Compliance Framework, with CoSRR replacing FRR. Performance against CoSRR will be formally reported for the first time after Quarter 3, i.e. during January 2014. The precise implications of the new calculations are being considered (as there have been some minor changes following consultation), but it is currently expected that the Trust will be rated as a 4 (the lowest financial risk) on an ongoing basis. Fuller details are provided in the Finance Report which can be viewed here and the CIP report can be viewed here.

REPUTATION

Stakeholder Engagement Strategy Focus continues to be on political engagement to support bed reconfiguration and on GP Engagement to support the GP Charter via the Relationship Managers. Positive feedback from GPs in Lancaster has been reported about the increased interface between them and the Trust. Improved communication, dealing with enquiries promptly and the provision of simple tools such as contact lists for Mental Health teams have been well received and there is an opportunity to roll this out across the county, linking in with the work being carried out to support the One Stop Shop programme. Political Engagement MPs close to Burnley (Ward 19) have reacted positively to visits from the Engagement Director and Clinical Director for Adult Community Services. The numbers of families affected by dementia who will receive extra support in future years compared with the number who will need to travel further has been key to convincing stakeholders of the clinical case for change. A Trust delegation attended a meeting with the Labour group of Lancaster City Council to discuss the inpatient bed reconfiguration and the proposed closure of Altham Meadows. A wide variety of concerns were voiced by councillors and the team were able to rebut inaccuracies and reassure the councillors. This model of engagement was well received and will be rolled out as required. This will be followed up with Trust attendance at the Lancaster Overview and Scrutiny Committee on 9 October 2013 at Morecambe Town Hall. North Lancs CCG have been invited to give an




update on the work undertaken so far on the NHS Better Care Together consultation and the decision to close Altham Meadows in Morecambe. As Lancaster City Council are showing a keen interest in the closure of Altham Meadows Adult Community Network Director, will be in attendance. Primary Care Engagement GPs at the Chorley South Ribble and Greater Preston CCG joint clinical event, and practices in Lancaster have voiced concerns about a perceived limited access to Consultants. Work is on-going with the AMH network to ensure GPs have access to the right clinical advice when needed through improved communication of contacts and processes. The CCG have produced a draft report on the outcomes which the AMH Network are considering with a view to including in Action Plans. Healthwatch Engagement The Trust’s Chief Executive met the Chair and Vice Chair of Healthwatch Blackburn and Darwen to help the recently formed Healthwatch Board establish its vision as they begin to develop the business model for Healthwatch which will be implemented after April 2014. Specific updates on the Trusts’ plans for inpatient reconfiguration and on the progress of the North West Coast Academic Health Science Network were discussed. It was agreed that the Trust’s Chief Executive and Chair would meet the whole of the Healthwatch Blackburn with Darwen Board when the Board is fully constituted.

The Chair of Lancashire Healthwatch attended the official opening of Wordsworth Ward. She was impressed by the work undertaken and was keen to learn more about our approach to patient and carer involvement to share with other Trusts. The Trust has engaged with representatives from all three local Healthwatch organisations to explore the potential for volunteers from each organisation supporting the collection of responses from service users for the Friends and Family test across Trust sites and services. The Chair of the Trust led a delegation at a Healthwatch Blackpool open listening event on 20 September which included the formal launch of Healthwatch Blackpool. A question and answer session formed part of the event and LCFT was represented by our Interim Chief Operating Officer on the panel to answer questions from Healthwatch members. Most of the concerns related to Blackpool Victoria Hospital, and the removal of specific services, most notably a hydrotherapy pool and a falls clinic. These two issues prompted a variety of follow up questions from the audience. Questions addressed specifically to LCFT related to mental health and dementia patients placed in private care and out of area. The figures were provided and these satisfied the audience. There was no mention of the Harbour from the audience.

Third Sector Engagement The Trust will provide support at the Open Mind Festival which takes place between 30 September and 5 October in Preston. The Chief Executive is one of the guests of honour at the opening ceremony of the Festival which aims to challenge stigma and discrimination in mental health. The Chief Executive and the Clinical Director of the Adult Mental Health Network will lead a workshop based on video clips of the stories of patients of Trust services, at a Festival session on living with stigma. The Friday of the Festival is billed on the programme as ‘Lancashire Care NHS Foundation Trust Day’ and features relaxation technique workshops and music and poetry from both Trust professionals and service users.




Engagement with the Lancashire Third Sector Health and Well-being group continues to be proactive. As an example, the Director of the Insight Network and the recently appointed Chief Executive of Lancashire Mind have been invited to attend the November meeting of the informal Board of the Adult Mental Health Network. The most recent forum of the Insight Network was addressed by the Patient and Public Involvement Lead of the Central Lancashire long term conditions programme in which the Trust has a leading role. Public engagement on the programme will be supported by the Trust’s next public membership conference which is being held jointly with commissioners and providers involved in the programme. Public Membership Engagement Governor information sessions were held in Blackburn; West Lancashire and Central Lancashire constituencies in September aiming to encourage a diverse range of high quality candidates to stand for the forthcoming public governor elections. The sessions will include contributions from current public governors and UK Engage, the organisation which the Trust is working with on the electoral process. Media Coverage Positive media coverage during August remained reasonably high. The communications team has focused efforts managing the coverage in relation to homicides featured in the Lancashire Evening Post. This coverage caused an increase in the overall amount of negative coverage about the Trust for that period but was contained to that publication. Board members will be aware that a formal letter of complaint has been sent to the Press Complaints Commission in relation to the coverage. Clinical Director for Children and Families Network met with the Chief Executive of Rethink, who offered to support the Trust’s complaint. Several letters of support for the complaint have been received by the Chief Executive from commissioning partners. The proactive media plan in place for September included; world suicide prevention day, sexual health week, fit and quit squad promotion, the Annual Member’s Meeting, raising awareness of child sexual exploitation in partnership with Lancashire Constabulary, the opening of the Wordsworth Centre and the community mental health survey results. Plans are also in place to use world mental health day in October as a platform to send out positive messages about mental health to mitigate against the negativity of the Lancashire Evening Post coverage. Social media activity continues to grow with an extra 181 followers to the Trust’s Twitter feed. Topics that the Trust has been tweeting about include health promotion messages, updates about the development of The Harbour and affiliate membership promotion.

SERVICE DELIVERY

Review of delayed discharges and short stay admissions The review of delayed discharges and short stay admissions within adult and older adult wards has been completed. The review made the following key recommendations:




Development of a strategic, system-wide plan to impact on demand for LCFT inpatient beds. Development of alternatives to admission addressing effective rehabilitation and other

services including appropriate supported accommodation and community based alternatives to non-psychotic repeat admissions.

Continuation of a programme of marginal service improvements (Mind the Gap). The terms of reference of the Transformational Oversight Assurance Group have been reviewed primarily to provide an assurance mechanism for the transformation of mental health services across the following six work streams:-

i. Adult Functional System Service Redesign

ii. Accommodation issues (Functional)

iii. Review of the bed model iv. Older adults and Dementia v. Funding System vi. Marginal Improvements

The group is chaired by the lead CCG SRO on the mental health contract and includes representation from all Lancashire CCGs, LCC, Blackpool and Blackburn borough councils, CSU service redesign team and CSU contract management team as well as LCFT. CCS & Complex needs Discharge Team A small project team commenced its clinical review of service users in adult acute inpatient wards with lengths of stay of 50 day plus at the end of August. The external report suggests that focus on this cohort of service users would have the bigest impact on reducing acute inpatient bed use. This would require development of effective rehabilitation and other services.

The team is working closely with CCS (Clinical Commissioning Solutions) who can source alternative provision for these service users more cost effectively in the absence of local solutions. The work of the team will also provide further evidence of rehabilitation commissioning requirements lending support to the LCFT business cases and further inform service design at the interface between inpatient and community services.

Winter Planning and Health Resilience The Trust has provided a significant number of schemes to support winter pressures on acute trusts particularly in Central and East Lancashire as both are struggling to achieve their A&E targets increasing significantly anxiety for this winter. Our proposals for services across Lancashire build on the work of last year but present significant risk for LCFT. Many of our services currently divert people from hospital admission and we may be required to divert staff to deal with crises impacting on our transformation plans. Central Lancashire CCG has confirmed funding and we are confident that our other offers of support will be funded. We are currently awaiting response. The Trust will also collaborate with Lancashire partnership colleagues for winter preparedness by providing information regarding available mental health beds in the system on a daily basis to allow for a full picture of the whole system. There is a view that we should be aiming for 100% Flu vaccination uptake. Board should note the discussion that this may be linked to future contracts, further noting our historical challenge to reach 30% uptake. We have additional measures in place to support increased uptake of the vaccination this winter.




PEOPLE

Agenda for Change Flexibilities From 1 April 2013, Agenda for Change includes new provisions. Some of these have been implemented, whilst others will require the development of new procedures. The key changes that require development are:

Progression through all incremental pay points in all pay bands to be conditional on individuals demonstrating that they meet locally agreed performance requirements.

For staff in bands 8C, 8D and 9, pay progression into the last two points in a band will become annually earned, and only retained where the appropriate local level of performance is reached in a given year.

There is scope to put in place alternative, non-Agenda for Change, pay arrangements for Band 8C and above.

These changes give us an opportunity to link performance to pay. The Workforce team have set up a task and finish group including network and staffside colleagues to develop a proposal for implementation from April 2014. The intention is to deliver a relatively simple system from April 2014 with the option to develop further in years 2 and 3. People Strategy The Trust’s People Strategy is currently being developed. It will set out a framework for people management and development and will be aligned to the Trust’s strategic aspiration for the workforce. The document will be ready for consultation with networks between October and December 2013 for submission to the Board in January 2014. Workforce Reporting Following a review of the Workforce Board Report, the workforce team identified that whilst the current reporting provision includes a variety of data, it does not offer a full range of information with which to develop action plans to facilitate high quality service delivery. The new look Workforce Scorecard is submitted with the Board papers. The report is evidenced based focussing on measures of culture, engagement and leadership as well as well as compliance. Inspire As part of improvements to the PDR system we have volunteered to be part of the phase 2 pilot of a new electronic platform called ‘e-Inspire’ which builds on our existing process. The pilot launches on 1 October for six months ending on 31 March 2014. The pilot will run in a small number of corporate and clinical areas. The system is intuitive to use, has excellent reporting functionality and requires an assessment of values and behaviours as well as objectives. Throughout the pilot a cost-benefit analysis will be undertaken with recommendations put forward to the Trust in terms of future direction.




INNOVATION

Research Summary The total number of active portfolio studies to date this financial year is 98 with 38 actively recruiting. The 2013/14 Comprehensive Local Research Network (CLRN) participant recruitment target (850) has been 95% (810) achieved and the 30 day permission approval metric median 8 days, 86% (80% = good/ green). Three grants have been submitted during the month of September. NIHR Health Technology Assessment (two) Study Title: Assessing the clinical and cost effectiveness of a supported self-management intervention for relatives of people with recent onset psychosis: Relatives’ Education And Coping Toolkit (REACT ) (Host: Lancaster University) Study Title: COllaborative stepped care for New onset depressioN aftEr a cardiaC evenT: CONNECT University of Manchester(Host: LCFT) Research for Patient Benefit (two) Study Title - A Psychological Intervention for substance misuse in British South Asians (ASPIRE) (Host: LCFT) Study Title: Feasibility and Acceptability of a novel integrated intervention for families of parents with a diagnosis of schizophrenia. (Host: MMHSCT) Currently IT systems are being reviewed in order to more efficiently manage research governance and improve record keeping (related to research participation) in eCPA. The refurbishment of the first floor Hillview at Blackburn Royal Infirmary is being considered. This would facilitate a safe and ‘fit for purpose’ Clinical Trials Facility. Additionally, Network engagement programmes are been devised to continue to develop a research ready culture across the Trust. Innovation In line with the NHS’ initiatives and following on from the recent appointment of our, Innovation Programme Manager, LCFT is raising further the profile of innovation with the recent recruitment of our Director of Transformation and Innovation. A Trust wide innovation survey is being developed with TrusTech to create a baseline for Innovation activity. The Yammer Enterprise Networking tool is proving effective at disseminating Innovation information, eliciting ideas for improvements and promoting discussion. A wide range of possible Innovation projects have been proposed. They cover utilities, infrastructure, service improvement and the use of technology. Partnerships with supporting 3rd party organisations such as TrusTech, AQuA, UCLan and the newly formed Academic Health and Science Networks (AHSNs) are being actively pursued to help identify good practice, supporting data and funding opportunities.


TRUST BOARD – 03 OCTOBER 2013 DISESTABLISHMENT OF CARE COMMITTEE


Not Applicable

PAPER TITLE: Disestablishment of Cost and Resource Effectiveness Committee

PURPOSE: The purpose of this report is to present a proposal to the Board to disestablish the Cost and Resource Effectiveness Committee.

ACTION RECOMMENDED:

Decision

PAPER PREPARED BY: Jo Alker, Executive Board Support Officer

1. EXECUTIVE SUMMARY

As we move towards a new way of receiving performance information and review information flows to and from the Board it has become apparent that the requirement for the Cost and Resource Effectiveness Committee is no longer needed. The Chair and Company Secretary have reviewed the terms of reference and cycle of business and propose to disseminate future reporting as detailed in appendix one. All actions from the Committee have been closed off as detailed on the action tracker at appendix two.

2. FUTURE REQUIREMENTS

As we progress the development of the Board level balanced score card there may be a need for the Board to consider other reporting requirements needed through the various Committees.

3. BOARD ACTION

The Board of Directors is asked to approve the disestablishment of the Cost and Resource Effectiveness Committee with immediate effect and endorse the proposed future reporting as detailed in appendix one.


TRUST BOARD – 03 OCTOBER 2013 DISESTABLISHMENT OF CARE COMMITTEE

To formally close off the actions and the work already progressed by the Committee, the Board is asked to receive the minutes of the last meeting held on 03 April 2013 at appendix three.

APPENDIX ONE

Cost and Resource Effectiveness Committee Cycle of Business 2013/14

Pervious CARE Committee Business Proposed Execution

CIPs Programme - approve for recommendation on to board

Trust Board business – dealt with in the current CIP report

VfM - approve programme for systematic review of Network and Corporate processes to deliver VfM

- Performance benchmarking report (internal & external)

- Review Corporate system for VfM

Reported through EMT sub-committees

Annual report to Audit Committee for assurance

Approved CIPs

- Review of progress and sustainability - Test the rigour/quality and sustainability aspects of

provisional CIPs

Annual approval by the Board on recommendation of the Chief Executive and Director of Finance

Oversight through EMT sub-committees

Ongoing Board monitoring through the CIP report

Make recommendation to the Board on amendments to CIP plan

Trust Board business – dealt with in the current CIP report

Identify income growth opportunities To be included the Finance and Business Performance Committee cycle of business

Identify risks to achievement of CIP plans and approving corrective action

Executive Management Team business

Review impact of plans on Quality Executive Management Team business – the Director of Nursing and Medical Director review this annually

Review Network system for VfM Executive business – discharged via the quarterly Network reviews

Performance benchmarking report (internal & external) Being developed to be included in the performance dashboard

Review workforce productivity and effectiveness To be included in the Board cycle of business as part of the Workforce Strategy

APPENDIX TWO Cost and Resource Effectiveness Committee Action Tracker

DATE ORGIN OF ACTION

MINUTE REFERENCE

ACTION OWNER

ACTION KEY

DATES/FORECAST COMPLETION

STATUS IMPLEMENTATION

STATUS/CLOSE OUT ACTION

03 April 2013 CARE

Committee CARE 012/13 DLH

Demand Management: an informal discussion to be scheduled into the

Board plan August Closed

Discussed at the Board Away Day – 01 August

03 April 2013 CARE

Committee CARE 012/13 DLH

CIPs: potentially hindered by current contractual arrangements to be

discussed with the Board June Closed

Discussed at Board with

03 April 2013 CARE

Committee CARE 013/13 HTM

Value for Money: further evaluation to take place prior to reporting back

to Audit Committee August Closed

Agreed with Chair at Audit Committee that

an annual report will be produced

03 April 2013 CARE

Committee CARE 013/13 SJ

Reporting requirements: SJ to meet with TW to discuss the reporting requirements and mechanisms

ASAP Closed TW including the

discussion around the disestablishment

03 April 2013 CARE

Committee CARE 014/13 DMcK

Procurement and VfM: paper to be brought back to the CARE Ctte at the

next meeting August Closed

Information delayed from the national

supplies provider but note was circulated by

DoF

03 April 2013 CARE


CIP Report: progress against business plans and CIPs to be

reported back to the Ctte to consider a proposition

August Closed Included in CIP report

to Board in August

03 April 2013 CARE


CIP Report: clarity around reporting at Board level about the areas where we are investing to save or investing to support activity was requested and

would be included as part of future reports

August Closed Included in CIP report to Board in August

APPENDIX TWO

03 April 2013 CARE

Committee CARE 016/13 HTM

Date of the next meeting to be reviewed and possibly brought

forward N/A Closed No longer necessary

APPENDIX THREE

Cost and Resource Effectiveness Committee

Minutes of the meeting held on 3rd April 2013 at 10.00am

PRESENT: Steve Jones (Chair) Peter Ballard, Non-Executive Director Derek Brown, Non-Executive Director Chris Heginbotham, Non-Executive Director

Mark Hindle, Director of Service Delivery and Transformation Jim Taylor, Non-Executive Director Heather Tierney-Moore, Chief Executive

IN ATTENDANCE: Dominic McKenna, Financial Management Director Emma Foster, Transformation Director

Diane Halsey, Company Secretary Jo Alker, Executive Board Support Officer

CARE 010/13 APOLOGIES FOR ABSENCE

Apologies for absence were received from the Director of Nursing, Hazel Richards.

CARE 011/13 MINUTES OF THE MEETING ON 29 JANUARY 2013

The minutes of the meeting held on 29th January 2013 were confirmed as a true and accurate record.

CARE 012/13 ACTION TRACKER

Committee members noted that all items from the action tracker had been closed off. Two additional items were identified. The Director of Service Delivery and Transformation explained that demand management would be picked up in the work being done around service line management and described the work currently ongoing across the Trust. The Transformation Director added that this had been highlighted in the transformation programme capability and capacity review. This would inform the Chief Executives proposition to the Board regarding organisational development support. The Chief Executive agreed to schedule an informal Board session discussion regarding this. A second item relating to CIPs which were potentially hindered by current contractual arrangements was discussed. This would also be discussed at

Board and the overall intelligence regarding relationships with CCGs would be factored into the Board away day in June.

CARE 013/13 VALUE FOR MONEY The Chair introduced the subject of value for money in the context of the business planning process. The Financial Management Director introduced his paper by describing a maturity matrix approach to evaluating where Networks are in terms of value for money in order to highlight what support is needed to ensure that processes are in place that will drive value for money in the organisation. It was acknowledged that value for money should be embedded in everything that the Trust does. Some issues of clarity and understanding around what value for money means had been surfaced and it had been a helpful discussion. The exercise was intended to provide a baseline view. Discussions followed around the extent to which the exercise represents another initiative and whether this detracts from the main focus for value for money within business planning and effective execution. Aspiring to ensure we get value for money should be at the forefront of all managers’ agendas and the intention is not to create a burden of work but to create an understanding of the journey and a structure that facilitates the achievement of value for money. Ownership of the principle is the key message and this is part of what Excellence means in practice in the organisation. It was noted however that there remains a duty for the Trust via the Audit Committee to report on its approach and performance in relation to value for money agenda and the Cost and Resource Effectiveness Committee is charged with this responsibility on their behalf. In summary the Chair acknowledged the need for light touch oversight of this agenda and the need for appropriate tools and support for managers in achieving it but that this needed to be linked to the existing programmes around business planning which are the true drivers of value in the organisation. The balance between getting the best service in a cost effective manner is the ultimate aim and we need to ensure that communication is appropriately targeted to the right people. The control over resource utilisation at the front line because of the nature of the work and this is where value in its widest sense needs to be understood. It was agreed that there was a need to undertake some value for money evaluation in order to report back to the Audit Committee in line with the reporting requirements and the Chief Executive was to give some further thought about how this was achieved in practice. The Chair of Cost and Resource Effectiveness Committee would meet with the Chair of Audit Committee to agree the value for money reporting requirements to Audit Committee.

CARE 014/13 PROCUREMENT AND VALUE FOR MONEY

The Financial Management Director reminded the Committee that he had agreed to bring a paper back that followed up the move to an in-house procurement service and the realisable benefits achieved in terms of value for money. He highlighted the key messages noting that this was still an immature initiative and further work was being done to ensure organisational understanding about how procurement expertise can influence cost. A discussion followed on the robustness of contracts, the access to budgets and catalogues on line and the alignment of procurement to budgets on line. The longer term aims for procurement, how they link to other strategies and how this aligns to the IM&T investment strategy and is tracked through to the CIP performance were explored. Examples in Drugs and Therapeutic budgets where significant savings have already been achieved through attention to procurement were noted. Some of the risks inherent with the NHS contracts moving into the future were surfaced and discussed at high level. The majority of these were contained within the Estates and Facilities agenda and these would be discussed as part of the Estates Strategy that is due to come to the Board in April. The drive to save money from non-pay budgets was noted and a proposition requested on how savings can be achieved in this area through procurement and what investment is needed to achieve that position. The Chair commented on the number of areas where real savings had been achieved since the change in arrangement and these were to be commended. It was agreed that a paper would be brought to the committee at the next meeting having been considered by the Executive Team. This should include an analysis of the non-pay spend, a proposition around some of the savings that could be achieved and the investment needs to get there quickly together with a summary of key risks and opportunities associated with them.

CARE 015/13 CIP REPORT

The Financial Management Director introduced the CIP report which provided an update on the finalised position following the business planning process. The risk rating against schemes was noted and there was confidence around the outturn position. Differential CIPs was discussed in the context of the initial work that had been undertaken. The risks relating to achieving inpatient savings for Commissioners was noted in the context of the need to be able to close wards without impacting on safety. This £1.4m was therefore at risk but negotiations were ongoing to mitigate this on a non-recurrent basis. Future reporting arrangements were considered and it was proposed that a quarterly report is produced on progress to date on schemes including where necessary, a recovery action plan and that this would be produced by the Network Directors. It was noted that the network plans and progress would now be tracked in detail through the new governance structures at EMT level and Non-Executive Directors were aligned to these structures. Any issues

arising out of these meetings would be escalated to the Committee and or the Board as appropriate. The progress against business plans and CIPs would be reported back to the Cost and Resource Effectiveness Committee to consider a proposition. It was noted that this might impact the pattern of meetings moving forward. The differential CIPs plan was discussed and in response to a question it was noted that the outcomes had been aligned to the service line reporting plans. Further questions about the potential for double counting on CIPs plans in service re-design were raised and assurances provided about the extent to which these had been tested to ensure that this is not the case. Further information relating to targets and the extent to which these are stretch targets was also provided. Clarity in reporting at Board level about the areas where we are investing to save or investing to support activity was requested and would be included as part of future reports.

CARE 016/13 DATE AND TIME OF NEXT MEETING The next meeting was scheduled to take place on 14th August 2013 but the Chief Executive would review this and confirm to Committee members shortly.



USE OF RESTRAINT REPORT


Not Applicable

PAPER TITLE: Use of Restraint

PURPOSE: The purpose of this report is to provide the Board with an update on the use of restraint

ACTION

RECOMMENDED:

Decision

PAPER PREPARED BY: Colin Dugdale, Acting Director of Nursing

Section 6(4) of the Mental Capacity Act (2005) states that someone is using restraint if they: ‘use force – or threaten to use force – to make someone do something that they are resisting, or restrict a person’s freedom of movement, whether they are resisting or not’

1.0 BACKGROUND

In June 2013, MIND published a report ‘Mental Health Crisis Care; Physical Restraint in Crisis’ based on a survey of 54 Mental Health NHS Trusts in England. This report highlighted differences in recording of restraint within NHS providers, concern over the use of face down or prone position, and the lack of national guidelines. The report was based on information provided by NHS Trusts from a Freedom of Information request on the use of restraint. The report identified LCFT as one of the highest users of restraint nationally. However the report did not balance its findings by comparing trusts by size of population served, LCFT being one of the largest providers of Mental Health inpatient care responding to the survey, or by clearly defining the term restraint to allow for a consistent response from all trusts. There are occasions when physical restraint is required due to the danger posed by the violent presentations of a service user and the Trust has a duty of care to protect the general public, service users and staff from physical harm. As a result of the MIND report and negative publicity, the Director of Nursing commissioned an internal review of the practice of restraint and this report summarises the findings and work currently in progress in the following four areas:

Training

Recording of incidents

Governance arrangements; and

Reviewing and analysing information

2.0 CURRENT TRAINING ARRANGEMENTS

The Trust has a robust training programme in place and all Mental Health inpatient clinical staff are required to undertake annual training delivered by qualified instructors who are registered nurses.




The ethos of the training is based on the principles of violence prevention, non-physical intervention, de-escalation and use of minimal force. The training seeks to promote de-escalation techniques and respectful alternatives to physical restraint to help staff manage challenging situations and support the recovery of people in crisis. The Trust is using service users in delivering training within secure services and the plan is for this to be rolled out across the Trust. The target compliance rate for annual training is 80%, and compliance rates within Networks range from 73-82%. The delivery of restraint requires staff to also be trained in Basic Life Support (BLS). Compliance rates within networks range from 62-73% against the Trust target of 80%. On-going targeted work is taking place with networks to improve training compliance with and additional drop in sessions have been arranged.

3.0 RECORDING OF ‘USE OF RESTRAINT’ INCIDENTS DATIX is used to record all incidents of restraint across the Trust. During the period April 2012 to June 2013 there were 2,910 incidents where restraint was used. The quarterly total of use of restraint has fallen significantly during this period from 705 incidents in quarter one of 2012, to 307 in quarter two of 2013. To view the use of restraint across the Trust from September 2012 – August 2013 please click here.

The Adult Mental Health Network uses restraint most frequently and accounts for over 50% of all incidents. This network has seen the most significant fall in use of restraint particularly from May 2013 onwards. Both the Specialist Services Network and Adult Community Network have seen a sustained decline in incidents through the 12 month period. Some form of restraint was used in 34% of recorded incidents of violence and aggression across all networks. The Freedom of Information request highlighted that the Trust did not classify the use of face down restraint and was therefore unable to report on it. Due to the way the Trust has recorded incidents and the lack national data to benchmark against it is not possible to draw a solid conclusion from the data. As a result the Trust has set up reporting to enable recording of the specific restraint used and time periods when restraint is used.

4.0 GOVERNANCE ARRANGEMENTS

All incidents involving restraint are subject to review by managers and lead instructors via the DATIX system. There is no record of any significant injuries to service users as a result of the use of restraint during the reporting period. The Trust’s Violence and Aggression group is responsible for providing advice and support to clinical areas in relation to the prevention and management of violence and aggression and reports to the Health and Safety Committee. The group is integral to overseeing guidance and best practice in relation to training in restraint techniques and techniques deployed. The use of face down restraint is a last resort and is conducted in a way which seeks to minimise potential harm to all. The alternative to face down restraint is to lie the patient on their back, this form of restraint risk potential head, neck and back injury and exposes airways and eyes to further danger. The Trust’s Violence Reduction leads consider face down restraint the safer of these two as means of restraint. A visit has taken place to Mersey Care to review restraint practice and share ideas, which identified that overall the Trust content of training and governance




arrangements were similar. A visit is currently being arranged to Sheffield to review their experience of not using face down restraint. More detailed reporting of restraint is now possible and the reporting of violence and aggression will continue through the six monthly Serious Incident Advisory Group. The use of Restraint and Seclusion was audited in January 2013 as part of the audit into the management of violence and aggression. The findings of the audit indicated that the Trust was complying with the standards outlined in the Trust Policies and demonstrated a compliance rating of 95% which represented an improvement on the 2011/12 results. To view the full audit please click here.

5.0 REVIEWING AND ANALYSING AVAILABLE INFORMATION During the period from Quarter 1 2012/13 to Quarter 2 2013/14 one of the clinical area identified as a hotspot within the Trust for incidents of violence and aggression was the Acquired Brain Injury (ABI) service. During this period the network has made significant progress in reducing the incidents and reviewing the ABI model. Work on the Langden Ward has been particularly successful in reducing incident rates. The Board were updated in September on a specific concern within the ABI service that identified Bleasdale ward as a having higher use of restraint than other similar environments. A review of the care on the unit has taken place and bespoke training programme is being implemented with the staff group. Targeted work continues led by the violence reduction lead instructors to reduce violence and aggression and the use of restraint and this work is being reported to the Trust Violence Reduction group. Complaints involving restraint are reviewed by the lead violence reduction instructors to ensure a robust review of practice. During the period from Quarter 1 2012/13 to Quarter 2 2013/14, 5 complaints were received involving some form of restraint. These complaints relate to different units with no specific wards identified as a hotspot.

6.0 SUMMARY AND CONCLUSIONS

Overall, the review has found that the trend in use of restraint over the past 12 month period across the Trust is one of decline by up to 50%. This has resulted from a combination of actions within individual clinical areas and a wider refocusing of the management of violence and aggression to promote prevention and de-escalation. The practice of restraint within the Trust is supported by a robust training programme and a suite of policies and procedures which supports national guidance. The indication from current incident reporting is that practice is safe, with no reported serious injuries to service users during the reporting period. There are no national standards for the use of control and restraint, and in their absence the Trust is compliant with NICE guidance and NHSLA standards. Face down restraint is continuing to be used within the Trust as a last resort backed up by clear practice requirements.

Enhanced reporting at ward level, a continual focus on violence reduction and the adoption of the National Mental Health Safety Thermometer will further enhance the governance arrangements in place and ensure the reduction in the use of restraint remains a priority across Mental Health inpatient units.




7.0 RECOMMENDATIONS

Trust Board is asked to:

Note the Governance arrangements in place regarding the use of restraint within the Trust

Note the work taking place to improve reporting and the focus on individual service areas

Agree with the plan for the Trust to be an early adopter of the Mental Health Safety Thermometer

Colin Dugdale Acting Director of Nursing September 2013

Chart 12013

Chart 2

Use

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2; Incidents

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Lancashire

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1

Restraint and Seclusion Re-audit 2012/13

Version Three January 2013

Clinical Audit Facilitator Steve Hobin

2

Contents Introduction 3 Aims 3 Standards 4 - 5 Methodology 6 Executive Summary 7 Background information 8 Results Restraint 9 – 12 Seclusion 13 – 22 Compliance Opinion Framework 22 - 23 Discussion 23 - 26 Recommendations 28 Appendices Compliance Standards 29

Audit tool 30 - 37 Action plan 38 - 41

Restraint & Seclusion Audit Report 2012/13

Version: Three Author: Steve Hobin

Created on: 15/01/2013 Clinical Governance

Page 3 of 42

Introduction Restraint is defined by the CG25 NICE (2005) guidance as: “A skilled hands-on method of physical restraint involving trained designated healthcare professionals to prevent individuals from harming themselves, endangering others or seriously compromising the therapeutic environment. Its purpose is to safely immobilise the individual concerned”.

Seclusion is defined by the CG25 NICE (2005) guidance as: “The supervised confinement of a patient in a room, which may be locked to protect others from significant harm. Its sole aim is to contain severely disturbed/violent behaviour that is likely to cause harm to others. Seclusion should be used as a last resort, and for the shortest possible time. Seclusion should not be used as a punishment or threat; as part of a treatment programme; because of shortage of staff; where there is any risk of suicide or self-harm. Seclusion of an informal patient should be taken as an indicator of the need to consider formal detention”.

An initial audit was completed in January 2011. The report concluded that there were some areas of good practice within the Trust, as highlighted by the overall compliance opinion of significant compliance. However there were still some areas where practice could be improved and an action plan was developed to address these. One of these recommendations was to revise the seclusion policy. This was ratified in August 2011. Restraint and seclusion practise was subsequently re-audited in 2011/12 and areas further for further improvement were identified. In order to determine whether there have been changes in practice since the last audit, restraint & seclusion has been highlighted as a Trust-wide re-audit priority for 2012/2013 to provide assurances that Trust policies are being followed and to determine levels of practice regarding restraint and seclusion.

Aims To audit the use of restraint techniques and seclusion within Lancashire

Care NHS Foundation Trust (LCFT) compared to NICE guidance and Trust policy

To determine prevalence of use within the last 6 months




Page 4 of 42

Objectives To audit Trust performance against NICE violence guidance

To audit against the LCFT Seclusion policy

Standards

Policy for Teaching Effective Aggression Management – Including the

application of physical restraint CL009 (1)

Standard Essential/desirable Exception Compliance

1. Each member of staff to utilise only those skills and manoeuvres taught by a qualified Trust employed Instructor within the standardised Lancashire Care Foundation Trust training programme

Essential None 100%

The Procedure and Standards for the Application of Physical Restraint CL009 (3) Standard Essential/desirable Exception Compliance

1. Staff who employ physical intervention or seclusion should as a minimum be trained to Basic Life Support

Essential None 100%

2. Prior to involvement in the implementation of physical interventions, staff should have attended the Trust’s approved training programme and met the competencies expected of training outcomes

Essential None 100%

3. Staff trained in C&R manoeuvres should at all times adhere to the principles taught in the Trust’s training programme and avoid using non-approved modifications

Essential None 100%




Page 5 of 42

4. Restraint should only be used in those situations stated in the policy as appropriate

Essential None 100%

5. Each episode of restraint should take place with a minimum three person team of staff

Essential None 100%

6. Following any application of restraint, a Datix Incident Report / record of restraint form should be fully completed

Essential None 100%

LCFT Seclusion Procedure CL010A Standard Essential/desirable Exception Compliance

1. Were the appropriate people notified of the seclusion event? (RC/Consultant, ST on Call and Senior Nurse)?

Essential None 100%

2. Does the seclusion room meet the specification?

Essential None 100%

3. Was there a care plan in place throughout the seclusion event?

Essential None 100%

4. Were 2 hourly reviews conducted and the paper work completed?

Essential None 100%


Essential None 100%

6. Did a senior review take place within 8 hours?

Essential None 100%

7. Did a Multi-Disciplinary Team review take place within 24 hours?

Essential None 100%

8. Was the procedure for longer term segregation followed?

Essential None 100%

9. Did a post seclusion meeting take place?

Essential None 100%

10. Was the patient made aware of their rights?

Essential None 100%




Page 6 of 42

Compliance Project Leads set compliance levels at 100% for all standards with no

exceptions. All standards are considered essential.

Sample A query was run on Datix to identify the number of episodes of restraint and seclusion from 1st March – 31st August 2012. This provided the overall audit population. Approximately 10% of the episodes of restraint and seclusion occurring on each ward, during the audit period were selected at random and used as the audit sample. This methodology represented a change on the previous year when the last

five incidents occurring on a fewer number of wards were examined. In

addition a direct comparison, i.e. like month with like month the following year

was not completed.

As a result this year’s sample could be said to be more comprehensive rigorous and randomised than previously and not exactly directly comparable; this may go some way to explaining differences in compliance levels. (see recommendations below regarding sample sources in future years).

Data source Restraint and Seclusion records kept on the ward, eCPA, Datix

Audit type This is a Trust-wide standards based retrospective re-audit.

Methodology As this was a re-audit, an audit tool already existed. This audit tool was discussed by the Project Leads and clinical audit facilitator and amendments were made to both the standards and audit tool to reflect revised policy and procedure. The audit tool and project plan was sent to the Seclusion Policy Group and Effective Aggression Management Instructors Group for consultation and agreement. It was then sent to the SRO’s and the Head of Clinical Audit for sign off. The full data collection was completed by inpatient ward staff, utilising the agreed audit tool to provide detailed information on randomly selected episodes of seclusion and / or restraint, occurring during the audit period; the




Page 7 of 42

objective being to determine levels of current practice. A 10% spot check was completed by a Clinical Audit Facilitator during data collection. The circulation email of the audit tool included a two week deadline for completed questionnaires to be uploaded. A reminder was also sent to all recipients one week before the deadline. Again, a final email reminder was sent to all outstanding recipients on the next working day after the deadline for the outstanding questionnaires to be uploaded within the week. The appropriate Modern Matron / Ward Manager was copied into this email. Any responses received after this final date was not included.

Data analysis

The data quality check and data analysis by network was completed by the Clinical Audit Facilitator utilising MS Excel, and in order to validate the data a draft set of findings has been randomly checked by a second facilitator for

accuracy. Once data analysis and any further investigation was completed, the audit facilitator produced a draft report and met with the Project Leads for discussion. The final report was then quality checked by the audit team, reviewed by the SRO’s and Project leads who were responsible for the development of the recommendations contained herein. Once agreed by head of clinical audit the final report will be taken to Trust Board Governance and Audit Committee for the recommendations to be agreed before being disseminated across the Trust.

Executive summary Restraint

The audit appears to indicate that the Trust is complying with the standards

outlined in the Policies:

Teaching Effective Aggression Management Including the application of

Physical Restraint (CL009:1) and The Procedure and Standards for the

Application of Physical Restraint (CL009:3): as the audit demonstrates an

overall compliance rating of 95%. This represents an improvement on the

2011/12 results.

A total of seven standards were audited in relation to restraint, two standards

were found to be fully compliant whilst a further four standards achieved

compliance levels over 90%.

In relation to the final standard further investigation reveals that in relation to

standard 6 (Each episode of restraint should take place with a minimum three




Page 8 of 42

person team of staff) the results reflect the fact that often on initial

presentation the restraint incident is dealt with by the staff present (often less

than three) who are then supplemented by additional staff. In all cases on-

going restraint incidents were dealt with as per policy.

Seclusion

Conversely the audit appears to indicate that the Trust is failing to comply with

the standards set within its own Seclusion Procedure (CL010 A) only

achieving an overall compliance rating of 63%.

10 standards were audited in relation to seclusion. Three standards achieved

compliance levels over 90%; whereas compliance against the remaining

seven standards indicated that further work in the areas of revising

procedures and training will need to be undertaken, to ensure the Trust

meets the standards laid down in its’ Seclusion Procedure.

Background information The following information was provided by the risk department from entries made onto the Datix system, and details the total numbers of episodes of restraint and seclusion reported via Datix from 1st March 2012 – 31st August 2012 (6 months) in comparison with data from the last audit period 1st August 2011 – 30th January 2012 (6 months)

Control and Restraint 2011/12 Aug Sep Oct Nov Dec Jan Total

Adult Mental Health 126 88 110 125 147 89 685

Adult Community & Specialised Services

187 247 114 67 85 138 838

Total 313 335 224 192 232 227 1523

Control and Restraint 2012 /13 March April May June July Aug Total



74 48 79 83 66 37 387

Total 253 162 232 219 227 145 1238




Page 9 of 42

A significant increase in the use of restraint of 425 episodes was reported in the 2011/12 audit when compared with 2010/11 results; and this was attributed to a shifting of population across secure services during this period. When compared this current audit indicates a reduction of 285 episodes of restraint when compared with 2011/12. Taken together this would seem to indicate that figures are stabilising post the period of change and there is no emerging trend in the increased use of restraint. As noted in the 2011/12 audit the number of recorded episodes of seclusion

remains relatively stable. Further investigation with Adult Community and

Specialised Services indicates that the only significant change which may

account for the increase in the use of seclusion in that service during the audit

period; is the opening of three new wards for the treatment of Acquired Brain

Injury.

Results All percentages are rounded to the nearest whole number. When added together, the percentages for all answers to a particular question may not total 100% because of this rounding.

Restraint Standard 1: Each member of staff to utilise only those skills and manoeuvres taught by a qualified Trust employed Instructor within the standardised Lancashire Care Foundation Trust training programme (Compliance met 96%)

Placed in Seclusion 2012 March April May June July Aug Total



16 12 13 20 8 5 74

Total 52 38 33 58 47 47 275

Placed in Seclusion 2011 /12 Aug Sep Oct Nov Dec Jan Total



5 2 6 3 6 9 31

Total 43 21 42 38 55 44 243




Page 10 of 42

Have all staff involved in the restraint incident been trained in LCFT approved control and restraint (C&R) techniques?

2011/12 2012/13

Yes 23 (88%) 120 (96%)

No 3 (12%) 5 (4%)

NR - 16

TOTAL 26 141

If not, were non C&R trained staff relieved as soon as possible by staff trained in C&R?

Standard 2: Staff who employ physical intervention or seclusion should

as a minimum be trained to Basic Life Support. (Compliance met 95%)

Had all staff involved in the restraint incident been trained to Basic Life Support (BLS) as a minimum?

Standard 3: Prior to involvement in the implementation of physical

interventions, staff should have attended the Trust’s approved training

programme and met the competencies expected of training outcomes

(Compliance met 96%)

2011/12 2012/13

Yes 3 (100%) 5 (100%)

No - -

NR - -

TOTAL 3 5

2011/12 2012/13

Yes 23 (88%) 122 (95%)

No 2 (8%) 6 (5%)

NR 1 (4%) 13

TOTAL 26 141




Page 11 of 42

Have all staff involved in the restraint incident been trained in LCFT approved control and restraint (C&R) techniques?

Standard 4: Staff trained in C&R manoeuvres should at all times adhere to the principles taught in the Trust’s training programme and avoid using non-approved modifications. (Compliance met 98%) Were any skills and techniques utilised that used the deliberate application of pain?

Standard 5: Restraint should only be used in those situations stated in the policy as appropriate (Compliance met 100%)

Please state the reason for the application physical restraint:

Reason 2011/12 2012/13

The service user, as a result of their behaviour, presented a serious degree of danger such as risk of physical injury either by accident or intent, to themselves or others

23 (100%) 110 (100%)

The service user made significant threats or attempts specifically at self-injury with an intent to carry out such threats

2 (100%) 26 (100%)

Prolonged over activity by the service user promoted the risk of exhaustion

- 2 (100%)

Prolonged and serious verbal abuse and threats of serous ward disruption contributed to general social unrest

4 (100%) 47 (100%)

The service user attempted to abscond from hospital or escort

- 14 (100%)

The service user became seriously destructive of property

1 (100%) 16 (100%)

2011/12 2012/13

Yes 23 (88%) 120 (96%)

No 3 (12%) 5 (4%)

NR - 16

TOTAL 26 141

2011/12 2012/13

Yes - 2 (2%)

No 26 (100%) 126 (98%)

NR - 13

TOTAL 26 141




Page 12 of 42

Other 2 (100%) 13 (100%)

TOTAL 32 141

Standard 6: Each episode of restraint should take place with a minimum three person team of staff (Compliance met 79%) Please state the number of staff involved in the restraint incident

Number of staff: 2011/12 2012/13

Less than 3 6 (30%) 21 (24%)

3 or more 12 (60%) 70 (79%)

Other 2 (10%) 5 (6%)

Blank 6

52

TOTAL 26 141

Standard 7: Following any application of restraint, a Datix Incident Report / Record of Restraint Form should be fully completed (Compliance met 100%)

Question 2011/12 2012/13

Was a Record of Restraint Form or Datix incident report fully completed?

14 (54%) 93 (66%)

Record of Restraint Form NA in 2011 14 (10%)

Datix incident report

NA in 2011 141 (100%)

Was the Record of Restraint Form or Datix incident report cross referenced in the service user’s case notes?

12 (86%) 94 (67%)

Was a copy of the Record of Restraint Form or Datix incident report made available for the line manager?

13 (93%) 141 (100%)

Was a copy of the Record of Restraint form or Datix incident report made available for the attention of the service users doctor?

12 (86%) 78 (55%)

26 141




Page 13 of 42

Seclusion Standard 1: Were the appropriate people notified of the seclusion event? (RC / Consultant, ST on Call and Senior Nurse)? (Compliance met 95%) Was the seclusion notified immediately to the Responsible Clinician or Consultant/Senior Trainee on call?

Who was this done by?

Was the service user seen by a doctor (any grade) within one hour of the seclusion commencing? (18 of the 28 service users indicated in seclusion at one hour - 64% compliance) This is a new question introduced in this audit, so no comparison figures are available. Data regarding the names and grades of the Doctors attending is also available. Was the medical advice documented? This is a new question introduced in this audit, so no comparison figures are available

2011/12 2012/13

Yes 26 (96%) 28 (90%)

No 1 (4%) 3

NR - 5

TOTAL 27 36

2011/12 2012/13

Senior Nurse 23 (88%) 28 (100%)

Other 3 (12%) -

NR - -

TOTAL 26 28

Question 2012/13

On the seclusion record 20 (21%)

On eCPA 18 (64%)

Other 1 (3%)

TOTAL 28




Page 14 of 42

Standard 2: Does the seclusion room meet the specification? (Compliance met 95%)

Standard 3: Was there a care plan in place throughout the seclusion event? (Compliance met 69%) Was there a care plan in place from the commencement of seclusion?

2011/12 2012/13

Yes 27 (100%) 22 (69%)

No - 10 (31%)

NR 1 (4%) 4 ( in ECA)

TOTAL 27 36

Question 2011/12 2012/13

Provide privacy from other patients, but enable staff to observe the patient at all times

4 (80%) 27 (96%)

Be safe and secure and should not contain anything which could cause harm to the patient or others

5 (100%) 26 (93%)

Be adequately furnished, heated, lit and ventilated

5 (100%) 28 (100%)

Be quiet but not soundproofed and should have some means of calling for attention (operation of which should be explained to the patient)

4 (80%)

28 (100%)

The room will be furnished with a safe mattress and furniture

3 (60%) 20 (71%)

Normal bedding will be provided unless reinforced bedding is required

4 (80%) 28 (100%)

The patient will have access to toileting/washing facilities at all times (type dependent upon risk assessment of individual patient)

5 (100%) 27 (96%)

The patient will have access to fluids at all times (a fluid balance chart may be required) and food at normal dining times

5 (100%) 27 (96%)

The room will be of suitable temperature 5 (100%) 28 (100%)

Availability of a clock, means of orientation at all times

5 (100%) 28 (100%)

Mean Percentage 90% 95%




Page 15 of 42

Was the care plan reviewed?

If necessary, was the care plan updated?

Review of Care plans ends with seclusion, only 24 in seclusion at 2 hours

Standard 4: Were 2 hourly reviews conducted and the paper work completed? (Compliance met 65%) Was the service user reviewed every 2 hours?

If yes, was this done by 2 qualified nurses or other suitably skilled professionals? (i.e. Occupational Therapist, Psychologist, Social Worker)

If no, and reviews were missed, how many were missed?

2011/12 2012/13

Yes 22 (81%) 13 (48%)

No 4 (15%) 14 (52%)

NR - 4

TOTAL 27 36

2011/12 2012/13

Yes 11(92%) 9 (69%)

No - -

NR 11 -

TOTAL 22 13

2011/12 2012/13

Yes 21(81%) 13 (65%)

No 3 (12%) 7 (35%)

NA 3 4

TOTAL 27 24

2011/12 2012/13

Yes 20 (95%)

13 (100%)

TOTAL 21 13




Page 16 of 42

This is a new question introduced in this audit, so no comparison figures are available. One review was missed in Adult and Community Specialist Services for the following reason:

Four hour gap from implementation of seclusion and first medical review

Six reviews missed by Adult Mental health Services for the following reasons:

Not recorded on e-CPA whether patient reviewed 2 hourly or if any reviews were missed. Patient notes no longer available to check.

2 hourly reviews not documented on e-CPA or if any reviews were missed. Patient notes no longer available to check. e-CPA records patient sleeping overnight.

The patient was transferred to another inpatient unit within 85 mins

Marked not applicable?

Blank X 2 Did these reviews/ assessments/observations record the following?

Always Always Some times

Some times

Never Never

2011/12 2012/13 2011/12 2012/13 2011/12 2012/13

The time 30 (98%) 24 (100%)

1 (2%) - - -

Services users mood and behaviour

29 (94%) 23 (96%) 2 1(4%) - -

Conversation between the nurse and service user

24 (80%) 22 (92%) 5 (17%) 1 (4%) 1 (3%) 1 (4%)

Observed symptoms / Physical care given (including food and fluids)

25 (89%) 20 (83%) - 4 (17%) 3 (11%) -

Medication administered

27 (90%) 18 (75%) 2 (7%) - 1 (3%) 6 (25%)




Page 17 of 42

Standard 5: Were 4 hourly reviews conducted and the paperwork completed? (Compliance 79%) Was the patient reviewed every 4 hours by a doctor or suitably qualified Approved Clinician? Number Indicated in seclusion at four hours – 17

Did these assessments/observations record the following?

Always Always Some times

Some times

Never Never

2011/12 2012/13 2011/12 2012/13 2011/12 2012/13

Mental state of service user

16 (80%) 16 (94%) 2 (10%) - - -

The views of the service user

13 (65%) 12 (71%) 7 (35%) 4 (24%) - -

The service users physical state / concerns

14 (70%) 13 (76%) 4 (20%) 3 (18%) 1(5%) -

Observed symptoms

15 (75%) 16 (94%) 3 (15%) - - -

Food / fluid intake 13 (65%) 6 (35%) 5 (25%) 10 (59%)

1(5%) -

Review advice / management plan

15 (75%) 10 (59%) 5 (25%) - - 6 (35%)

2011/12 2012/13

Yes 19 (90%) 11 (79%)

No 1 (5%) 3 (21%)

Seclusion Less than 4 hours

- 15

NR - 3

TOTAL 27 17




Page 18 of 42

Was this in person between 8:00am and 10:00pm

Was this by telephone between 10:00pm and 8:00am?

This is a new question introduced in this audit, so no comparison figures are available. 15 indicated in seclusion overnight

9 Always reviewed by phone

2 in person

3 Sometimes reviewed by phone If there were any missed reviews, please state why?

No reviews were missed.

Standard 6: Did a senior review take place within 8 hours? (Compliance met 53%) Was the patient reviewed by a senior doctor (consultant or ST 4-6) face to face during the first eight hours of the seclusion episode?

Number indicated in seclusion for 8 hours plus -15

Data regarding the names and grades of the Doctors attending and the times attended is also available. If there was no review, please state why?

2011/12 2012/13

Yes 26 (96%) 6 (75%)

No - 2 (25%)

TOTAL 27 8

2011/12 2012/13

Yes 25 (93%)

8 (53%)

No - 7 (47%)

TOTAL 27 15




Page 19 of 42

The first 8hr were between 2200hr and 0600 - no senior doctor available during these hours

Is there documented evidence that the senior doctor put a plan in place to manage the patient until the MDT review was formulated?

Standard 7: Did a Multi-Disciplinary Team review take place within 24 hours? (Compliance met 63%) Did an MDT review take place within 24 hours after the commencement of seclusion? MDT to involve a senior doctor (consultant, associate specialist or senior trainee) or suitably qualified approved clinician, nurses and other professionals (ideally an occupational therapist, psychologist and social worker)

13 episodes of Seclusion recorded as receiving an MDT review

Only 4 episodes of seclusion extended beyond 24hrs, all four received an MDT review

Who was involved in the first MDT review? This is a new question introduced in this audit, so no comparison figures are available.

Was a management plan compiled at this review?

This is a new question introduced in this audit, so no comparison figures are available.

2011/12 2012/13

Yes 26 (96%) 5 (63%)

No - 3 (37%)

NR 1 -

TOTAL 27 8

Who was involved 2012

Consultant 10 (77%)

Senior nurse 12 (92%)

OT 7 (54%)

Psychologist 0

Social worker 0

TOTAL 13




Page 20 of 42

12 of the 13 MDT reviews conducted, resulted in a management plan (compliance met 92%)

Standard 8: Was the procedure for longer term segregation followed? (Compliance met 100%) Was the patient in longer term segregation (over 48 hours)?

Was the procedure for longer term segregation followed? This is a new question introduced in this audit, so no comparison figures are available.

Yes in all cases Were at least two medical reviews per day carried out in the first instance, one by a junior trainee (this could include a suitably qualified approved clinician) or Staff Grade doctor and one by a senior trainee or Consultant.

Yes in all cases. (100% compliance as in 2011/12)

From day eight were daily medical reviews carried out, and did these reviews include at least three reviews per week by a senior doctor.

Only one case of Seclusion extended beyond eight days, requirement

complied with. (100% compliance as in 2011/12)

Were weekly multi-disciplinary reviews undertaken?

Yes. (100% compliance as in 2011/12)

Did a review by an independent multi-disciplinary care team take place after seven days (i.e. on the next working day)?


2011/12 2012/13

Yes 5 (100%)

3 (100%)

No - -

NR - -

TOTAL 5 3




Page 21 of 42

Did the independent multi-disciplinary reviews continue every seven days i.e. at least weekly thereafter)?


Standard 9: Did a post seclusion meeting take place? (Compliance met 46%)

Is there a record of a post seclusion meeting taking place?

Standard 10: Was the patient made aware of their rights? (Compliance Met 38%) Is there evidence that the service user was made aware of their rights?

2011/12 2012/13

Yes 17 (63%) 6 (38%)

No 7 (26%) 10 (63%)

NR 3 16

TOTAL 27 32

Has the service user made use of the ECA area of the ward?

This is a new question introduced in this audit, so no comparison figures are available.

Four persons made use of ECA

How much time did the service user spend in ECA? This is a new question introduced in this audit, so no comparison figures are available.

15 mins

2011/12 2012/13

Yes 17 (63%) 6 (38%)

No 9 (33%) 10 (62%)

NR 1 16

TOTAL 27 32




Page 22 of 42

1hr 20min

12 hrs

3 days

Compliance opinion: Standard Overall

2011/12 Overall 2012/13

Restraint

1. Each member of staff to utilise only those skills and manoeuvres taught by a qualified Trust employed Instructor within the standardised Lancashire Care Foundation Trust training programme

88% 96%

2. Staff who employ physical intervention or seclusion should as a minimum be trained to Basic Life Support

88% 95%

3. Prior to involvement in the implementation of physical interventions, staff should have attended the Trust’s approved training programme and met the competencies expected of training outcomes

88% 96%

4. Staff trained in C&R manoeuvres should at all times adhere to the principles taught in the Trust’s training programme and avoid using non-approved modifications

100% 98%

5. Restraint should only be used in those situations stated in the policy as appropriate

100% 100%

6. Each episode of restraint should take place with a minimum three person team of staff

60% 79%

7. Following any application of restraint, a Datix Incident Report should be fully completed

- 100%

Overall Compliance

87%

95%




Page 23 of 42

Discussion

Restraint

In relation to standard six (Each episode of restraint should take place with a

minimum of a three person team of staff), compliance improved on the 2011

audit yet only achieved a level of 89%. Due to the spontaneous nature of the

incidents involved, the requisite number of staff initially involved in an

outbreak of violence and aggression, are not always immediately available or

formally trained in restraint techniques; however on all occasions audited

where three persons were not present initially, they were subsequently

replaced by a minimum of three trained staff. As these facts are well

documented compliance should not be considered an issue in relation to this

standard.

In relation to standard seven (Following any application of restraint, a Datix

Incident Report / record of restraint form should be fully completed).

All incidents reviewed were found to be fully recorded on Datix but not all

incidents were cross referenced with the related record of restraint form.

Seclusion Overall 2011/12

Overall 2012/13

1. Were the appropriate people notified of the seclusion event? (RC/Consultant, ST on Call and Senior Nurse)?

96% 95%

2. Does the seclusion room meet the specification? 100% 95%

3. Was there a care plan in place throughout the seclusion event?

100% 69%


81% 65%


90% 79%

6. Did a senior review take place within 8 hours?

93% 53%

7. Did a Multi-Disciplinary Team review take place within 24 hours?

78% 63%

8. Was the procedure for longer term segregation followed?

100% 100%

9. Did a post seclusion meeting take place? 63% 46%

10. Was the patient made aware of their rights? 63% 38%

Overall Compliance

86% 63%




Page 24 of 42

These forms taken together comprise a complete record of the incident and

ideally require storing together over the longer term.

Feedback from Networks

Adult Community and Specialised Services (secure Services specific

comments):

It is agreed that there should be simple document which allows a

detailed account of the restraint which took place. Including who was

involved, how long for, detail of restraint (holds etc) and the review

process following restraint physical and de brief.

There should be a greater emphasis for the current document

“Restraint Report Form” attached to the policy to be used through Ward

Manager audit tools and should be accessible electronically as well as

paper so it is ready for everyone to use. It can then be attached to the

Datix report and also can be uploaded to a single point of access on

the eCPA system rather than Windip therefore everyone can access

and use the information for reporting.

Following a restraint, a member of staff involved in the restraint should

fill out the restraint report form within 24 hours, upload it to the ecpa

system within 24 hours and therefore it can be transferred to the Datix

report within 72 hours. The Ward managers should audit this process

weekly and the Lead Nurses should review the standard of use of

restraint monthly ….. To be started in Jan 2013

Adult community and Specialist Service (Older people’s mental health in-

patients)

The need for storage of datix Incident report and record of restraint

should be stored together to give the full picture of the event is

supported.

The report acknowledges that the issue of ‘less than 3 staff’ being

available for a restraint team is reactive to circumstance and not to be

viewed as none compliance.

Adult community services acknowledge the level of compliance around

restraint acknowledged in this audit

Children and Families (Project Leads)

The restraint form being completed and then scanned into EDMS is a

good idea but would it not be better to have the restraint form as an




Page 25 of 42

integral component of the eCPA system and completed electronically,

with previous ones being stored (as we currently do with safety profiles)

Children and Families (SRO)

It is difficult to generalise from the findings of this audit as it is not clear

from the report how many cases are attributable to our inpatient units

and no comparison is made with the last audit for our inpatient sites.

This I assume is due to the the small numbers of incidents audited

(10% of incidents occurring from 1st March – 31st August 2012) that

are attributable to our Network.

Overall the incidence in use of restraint can vary greatly according to

when the audit is carried out. Generally in Tier 4 high incidences tend

to be around a particular young person at any given time and therefore

we would see high numbers for a relatively short period of time. If this

audit had been covering the last 6 months, the figures would have been

significantly higher, as there have been a number of restraints recently

both at The Junction and The Platform, as well as use of Extra Care

Area use (Which may be classed as seclusion – dependent upon

definition). However in the period from Jan to July 2012, there would

have been very few such incidents.

Given the understandable variation and overall small numbers of

incidents, it may be worth considering an alternative sampling strategy

for CAMHS Tier 4 in future audits. Perhaps an audit of the whole cohort

for a given period for Tier 4 would provide more meaningful data which

could be compared year on year. The relatively small numbers involved

would mean that this would not represent a disproportionate time

commitment by the audit department compared to the numbers audited

for the other networks.

More specifically, the restraint form being completed and then scanned

into EDMS is a good idea but it may be helpful to have the restraint

form as an integral component of the eCPA system and completed

electronically, with previous ones being stored (as we currently do with

safety profiles) so that patterns and triggers can be noted, considered

and approaches to managing individuals can be refined.

Adult Mental Health (SRO)

Signed off no comment.




Page 26 of 42

Seclusion

A review of the current Record of Seclusion form indicates that the form is

configured as an aid memoire to prompt the gathering of information to meet

the following non- compliant standards:

Standard 3 - Was there a care plan in place throughout the seclusion event?

Standard 4- Were 2 hourly reviews conducted and the paper work completed?

Standard 5 - Were 4 hourly reviews conducted and the paper work

completed?

Standard 6 - Did a senior review take place within 8 hours? Standard 7 - Did a Multi-Disciplinary Team review take place within 24 hours? Standard 9 – Did a post seclusion meeting take place?

Standard 10 - Was the patient made aware of their right’s

Often this information is then currently recorded elsewhere like on ECPA this

can make finding this information difficult and time consuming.

Further analysis indicates that the issue in relation to non- compliance is lack

of clarity about where information should be recorded and found, rather than a

failure to implement policy.

In relation to Standard 9 – Did a post seclusion meeting take place- at the

conclusion of the last audit the following observations were made:

Discussions with the audit lead, modern matron and ward staff, have

concluded that a specific post seclusion meeting is not normally routine in

practice. This discussion normally occurs as part of a review whilst the patient

is still in seclusion, with a view to the seclusion being terminated, rather than

as a specific meeting, post seclusion. In other instances this is discussed as

part of the next patient care team meeting (PCTM). In all cases where this

occurs, the notes / minutes from these meetings need to be transferred to or

referenced on the record of seclusion form so it is clear where and when this

discussion has taken place.

It would appear that the changes of practice recommended have not yet

worked through to effect the necessary improvement in compliance.




Page 27 of 42

Feedback from Networks

Adult Community and Specialised Services (secure services):

Already in the process of incorporating the uploading of completed

seclusion records to Windip / Oscar

New (last three months) in house database developed to assist the

network seclusion review group maintain an overview of seclusion

practise. Suggested that if this process was adopted by other networks,

the resulting databases would provide a good audit sample source.

It would appear that some figures in the previous audit were unusually

high given that the policy that was being measured against was new; in

this light it is considered that rather than reflecting a deterioration in

practice this larger more rigorous audit is more likely to be a more

accurate reflection of practise than that achieved previously.

The use of numerous different ward staff to undertake data collection

seems to have resulted in a degree of interpretive inconsistency; it is

suggested that the data collection for any subsequent re-audit should

be conducted by one Junior Doctor in an effort to improve consistency.

Adult community and specialist services (older peoples mental health in-

patients)

Seclusion does not occur in older peoples mental health in-patient

units.

Children and Families

On a general note it appears that there is a level of confusion about

whether the use of Extra care areas (ECA) constitutes seclusion and if

it does, is this every time it is used (as sometimes this is voluntarily

accessed when requested as a low stimulus area) or just on some

occasions and if this is the case, what differentiates seclusion from

Extra Care.

I think that staff who ‘escort’ people into extra care and then remain

with them, even though the door may be locked, do not necessarily

interpret this as seclusion (especially if the young person makes no

attempt to leave) and therefore do not utilise the seclusion standards or

paperwork but is this seclusion?




Page 28 of 42

.

It would be useful to define both terms and to articulate the differences

and the process involved in both at the start of the audit if repeated as

this lack of clarity may affect the responses provided by our staff.

Recommendations

Recommendation - The Paper Record of Restraint Form should be reviewed and amended to ensure that all necessary information is gathered in one place. Policy should then identify the Record of Restraint Form as the primary record, together with the direction that it should attached to the related Datix report within 48 hours of the Seclusion incident concluding. This would allow the widest possible access to a single point of reference, as well as facilitate the on-going audit process.

Recommendation - The Paper Record of Seclusion should be reviewed

and amended to ensure that a clear working definition of seclusion is

included and that all necessary information is gathered in one place.

Policy should then identify the Record of Seclusion as the primary

record, together with the direction that it should scanned and uploaded

to the Care planning section of Windip (Oscar) within 48 hours of the

Seclusion incident concluding. This would allow the widest possible

access to a single point of reference, as well as facilitate the on-going

audit process. Retaining a paper record element rather than direct input

to eCPA remains a more flexible / practical option for ward staff

engaged in practice “on the ground”

Additional training should then be provided in the new seclusion policy

and procedures particularly for nursing staff and consultants

Children and Families and Adult Mental Health to consider the adoption

of the best practise identified in Secure Services i.e. a network

seclusion review group that maintains an in house seclusion database

that assists the group in maintaining on on-going overview of seclusion

practise.

Should this practise be universally adopted it is suggested that the

seclusion database should provide the sample source for future audits.




Page 29 of 42

Appendices

Green: All standards have been met to appropriate grade (100%)

Green Amber: Most standards have been met to appropriate grade but some non-compliance (90% -99%)

Amber: There is evidence that the level of non-compliance with some of the standards may put the service at risk (70% - 89%)

Amber Red: The level of non-compliance puts the service at risk (50% - 69%

Red: significant non-compliance leaves the service open to error or abuse (<49%)




Page 30 of 42

Appendix 1

Restraint and Seclusion Audit Tool

Name (person Completing)_______________________________________

Network_____________________ Service ______________________

Ward ______________________ Locality: _________________________ Consultant__________________ Patient Pathway___________________

Restraint NHS number:__________________________________________________

1. Had all staff involved in the restraint incident been trained to Basic Life

Support (BLS) as a minimum?

Yes No

2. Had all staff involved in the restraint incident been trained in LCFT

approved control and restraint (C&R) techniques?

Yes No

3. If not, were non C&R trained staff relieved as soon as possible by staff trained in C&R?

Yes No

4. Were any skills and techniques utilised that used the deliberate application

of pain?

Yes No




Page 31 of 42

5. Please state the reason for the application physical restraint:

The service user, as a result of their behaviour, presented a serious degree of danger such as risk of physical injury either by accident or intent, to themselves or others The service user made significant threats or attempts specifically at self-injury with an intent to carry out such threats Prolonged over activity by the service user promoted the risk of exhaustion Prolonged and serious verbal abuse and threats of serous ward disruption contributed to general social unrest The service user attempted to abscond from hospital or escort The service user became seriously destructive of property Other (please state) __________________________________________________

6. Please state the number of staff directly involved in the application of

physical restraint _____________

7. Was a record of seculsion form or Datix incident report fully completed?

Yes No If yes please identify which

record of seclusion form Yes No

Datix incident report Yes No

8. Was the record of seclusion form or Datix incident report

cross referenced in the service user’s case notes? Yes No




Page 32 of 42

9. Was a copy of the record of seclusion form or Datix incident

report made available for the line manager? Yes No

10. Was a copy of the record of seclusion form or Datix incident

report made available for the attention of the

service users doctor? Yes No




Page 33 of 42

Seclusion audit tool

Ward _______________________ Locality: _____________________ NHS number:_________________ Date of Seclusion:______________ Day seclusion implemented: ___________________ Time seclusion implemented? _________________________________ Length of time seclusion lasted: ________________________________

1. Was the seclusion notified immediately to the Responsible Clinician or

Consultant/Senior Trainee on call?

Yes No

2. Who was this done by?

Senior Nurse Other (please state)

_____________________________

3. Was the service user seen by a doctor within one hour of the seclusion commencing

Yes No if not why not? _____________________________________

4. Was the medical advice documented?

On the seclusion record on eCPA other No

5. Was there a care plan in place from the commencement of seclusion?

Yes No

6. Was the care plan reviewed? Yes No

7. If necessary, was the care plan updated? Yes No NA

8. Was the patient reviewed every 2 hours? Yes No




Page 34 of 42

9. If yes, was this done by 2 nurses or other suitably skilled professionals?

Yes No NA seclusion less than 2 hours

10. If no, what proportion of reviews were missed? _____________ Is a reason given? ______________________________

11. Did these assessments/observations record the following?

The time Always Sometimes Never

Patient’s

behaviour and mood Always Sometimes Never Conversation between

the nurse and patient Always Sometimes Never

Observed symptoms Always Sometimes Never

Physical care given

(including food and fluids) Always Sometimes Never

Medication administered Always Sometimes Never

12. Was the patient reviewed every 4 hours by a doctor or suitably approved clinician?

Yes No NA as seclusion less than 4 hours

13. Did these assessments/observations record the following?

The mental state

of the patient Always Sometimes Never

The views of the patient Always Sometimes Never

Physical state/concerns Always Sometimes Never

Observed symptoms Always Sometimes Never

Food / Fluid intake Always Sometimes Never Review advice/

management plan Always Sometimes Never




Page 35 of 42

14. Was this in person between 8:00am and 10:00pm ______________

Always Sometimes Never

Was this by telephone between 10:00pm and 8:00am

_____________ Always Sometimes Never

15. If there were any missed reviews, please state why

________________________________________

16. Was the patient reviewed by a senior doctor (consultant or ST 4-6 ) face to face during the first eight hours of the seclusion episode?

Yes No What time did the review take place? __________________ What was the doctor’s name/grade _______________________

If there was no review, please state why ___________________

17. Is there documented evidence that the senior doctor put a plan in place to manage the patient until the MDT review was formulated?

Yes No

18. Did an MDT review take place within 24 hours after the commencement of seclusion?

(MDT to involve a senior doctor (consultant, associate specialist or senior trainee) or suitably qualified approved clinician, nurses and other professionals (ideally an occupational therapist, psychologist and social worker)

Yes No

19. Who was involved in the first MDT review:

Consultant Yes No Senior nurse Yes No

OT Yes No Psychologist Yes No Social worker Yes No




Page 36 of 42

20. Was a management plan compiled at this review?

Yes No

20 Was the patient in longer term segregation (over 48 hours)?

Yes No

21 Was the procedure for longer term segregation followed?

Yes No

21. At least two medical reviews per day in the first instance, one by the junior trainee (this could include a suitably qualified approved clinician) or Staff Grade doctor and one by a senior trainee or Consultant.

Yes No

22b) From day eight daily medical reviews including at least three reviews weekly by a senior doctor.

Yes No 22c) Weekly multi-disciplinary reviews

Yes No 22d) A review by an independent multi-disciplinary care team after seven days (the next working day)

Yes No

and then at least weekly) Yes No

22 Is there a record of a post seclusion meeting taking place?

Yes No 23 Is there evidence that the patient was made aware of their rights?

Yes No

25. Does the seclusion room meet the following specifications Provide privacy from other patients, but enable staff to observe the patient at all times.

Yes No




Page 37 of 42

Not contain anything which could cause harm to the patient or others.

Yes No

Is it adequately heated, lit and ventilated?

Yes No

Be quiet but not soundproofed and should have some means of calling for attention (operation of which should be explained to the patient).

Yes No

The room is furnished with a safe mattress and furniture.

Yes No

Normal bedding is provided unless reinforced bedding is required.

Yes No

The patient has access to toileting/washing facilities at all times (type dependent upon risk assessment of individual patient).

Yes No

The patient has access to fluids at all times and food at normal dining times.

Yes No

Availability of a clock, means of orientation at all times.

Yes No

26. Has a service user used ECA area of ward (separated from remaining service users and egress barred)

Yes No Time spent in ECA ___________ Was seclusion documentation used to document reviews and observations of service user in ECA

Yes No




Page 38 of 42




Page 39 of 42

Action plan for Restraint and Seclusion Audit Date: December 2012 Recommendation Status Action Person

responsible Start date & expected completion date

Evidence of completion

Datix ID Ref:

The Paper Record

of Restraint Form

should be reviewed

and amended to

ensure that a clear

working definition

of seclusion is

included and that

all necessary

information is

gathered in one

place, by ensuring

the document is

attached to the

related Datix report

Review of Restraint Form Circulation to staff of requirement to attach to Datix report for long term storage

Effective Aggression Management Instructors Group

Yet to be agreed Minutes of meeting Process in place

RSR12/1301




Page 40 of 42

for storage.

The Paper Record

of Seclusion should

be reviewed and

amended to ensure

that a clear working

definition of

seclusion is

included and that

all necessary

information is

gathered in one

place.

Review of Record of seclusion and addition of clear working definition

Secure Services Seclusion Review group

Yet to be agreed Meeting Minutes

RSR12/1302

Policy should be

amended to identify

the Record of

Seclusion as the

primary record,

together with the

direction that it

should scanned

and uploaded to

Policy Amendments Secure Services Seclusion Review group


RSR12/1303




Page 41 of 42

the Care planning

section of Windip

(Oscar) within 48

hours of the

Seclusion

Additional training

should then be

provided in the new

seclusion policy

and procedures

particularly for

nursing staff and

consultants

Develop and delivery appropriate training regarding policy amendments

Secure Services Seclusion Review group


RSR12/1304

Children and

Families and Adult

Mental Health to

consider the

adoption of the

best practise

identified in Secure

Services i.e. a

Consider the adoption of emerging best practise

SRO / Clinical Directors Children and Families and Adult Mental Health Networks


RSR12/1305




Page 42 of 42

network seclusion

review group that

maintains an in

house seclusion

database that

assists the group in

maintaining on on-

going overview of

seclusion practise.

Should this practise

be universally

adopted it is

suggested that the

seclusion database

should provide the

sample source for

future audits.

Consider at Commencement of planning for re-audit

Audit Team September 2013

Re –audit project plans

RSR12/1306


TRUST BOARD – 03 OCTOBER 2013 WORKFROCE REPORTING

FOIA STATUS: No Exemption Part exemption applies to page/s: N/A

Not Applicable

PAPER TITLE: Workforce Reporting

PURPOSE: To inform the Board of workforce metrics around capacity, leadership and quality, engagement and employee relations

ACTION RECOMMENDED:

Discussion

PAPER PREPARED BY: Leila Grieves, Associate Director of Workforce

1. Introduction

Following a review of the current Workforce Quarterly report to the Board, this paper outlines our plans to improve the format and content. This paper addresses Board level reporting. Network level reporting will mirror this format and where possible, information will be broken down to team level to allow for its close links with the Quality Strategy and use with the Quality SEEL and team information boards. It is acknowledged that further work will need to be undertaken in collaboration with Quality and Governance and Health Informatics to identify teams and how best to report at team level.

2. The Need for Change It has been identified that whilst the current reporting provision includes a variety of data, it does not offer its audience a full range of information with which to develop action plans to facilitate high quality service delivery. Although some of this information does exist it is shared through various channels which can make it challenging to draw accurate and useful conclusions. In addition, the Francis Report called for a change in NHS culture from one of bullying, fear and blame, in which people are afraid to raise concerns or in which staff, including doctors, “walked-by on the other side of the ward”, to a culture of openness, transparency and candour, in which targets never detract from compassion and care, where everyone sees quality and patient safety as their responsibility. Using workforce intelligence to support informed decision making, our organisation can increase effectiveness, without damaging morale, strengthen people’s resilience and ability to deal with change as well as their leadership capacity and capability, to embed a culture of high quality care and compassion which encourages innovation and collective learning.

3. The Research

Beverly Alimo-Metcalfe1 has undertaken many studies, most recently in the NHS on behalf of the Kings Fund, into the correlation between organisational performance, individual performance and leadership and engagement.


TRUST BOARD – 03 OCTOBER 2013 WORKFROCE REPORTING

Her research highlights that the key drivers for personal performance and high quality services, are leadership (at a local and organisational level) and engagement. There is also evidence that stress impacts directly on behaviours, reducing motivation, confidence, resilience and creativity, which in turn affects leadership style and ultimately, performance and we have therefore included specific information in relation to stress related absence. 1CPsychol. FBPsS, Professor of Leadership, University of Bradford School of Management and Emeritus Professor

of Leadership Studies, University of Leeds

The metric included in the revised report demonstrate our performance against these key drivers and limitation factors in addition to the “traditional” capacity figures, allowing us to identify opportunities for improvement, highlight risks and form the basis for robust action planning.

4. Conclusion

This is a new and innovative approach to workforce reporting. It is a developmental process and the attached report is designed to move towards offering Board intelligence rather than information and we acknowledge that it is not yet fully developed. To provide full insight the report will need to be developed from a ‘bottom up’ approach to allow for clear insight and interpretation of the figures. With this in mind we bring the concept and ideas and welcome comments and suggestions for improvement.

1

Workforce Scorecard Board Report

This document has been created to allow the Trust Board and senior management to make informed decisions on workforce needs in the future. The document is split into four sections, Workforce Capacity, Leadership & Quality, Engagement & Wellbeing and Employee Relations and will allow exploration of trends, highlighting risks and identifying opportunities for action.

Report of key workforce metrics to support Trust business objectives

Workforce at a Glance

(WAG)

Workforce Capacity

Leadership & Quality

Engagement & Wellbeing

Employee Relations

2

Contents

Workforce Capacity…………………………………………………………………………………………………………………………………………………………………………………………... Page 3-4

Capacity Sickness Absence

Headcount / Turnover Sickness Absence Costs

Redundancies & Redeployments

Bank and Agency

Leadership & Quality………………………………………………………………………………………………………………………………………………………………………………………….. Pages 5-7

Appreciative Leadership Safety

Aspiring Leaders Induction

Mandatory Training e-PDR

Staff Survey - Leadership

Engagement and Wellbeing………………………………………………………………………………………………………………………………………………………………………… Page 8-9

Sickness Absence (Top 3 Reasons)

PDR Engagement Scores

Overall Staff Engagement Questions/Score

Flu Vaccinations vs. Target

Employee Relations and Safety……………………………………………………………………………………………………………………………………………………………………………… Page 10-11

Formal Actions

Number of Live Suspensions by Network

Risk level of Current Employee Relations Cases Split by Type

Number of Formal Absence Cases (with Workforce Support) by Network

Employee Relations



Workforce Capacity

3

Capacity

Actual WTE (People in post) 5899.46

Bank/Agency Used WTE 282.83

Unavailable WTE (Mat. Leave,

career break, suspended, sickness etc.) -377.36 Capacity WTE 5804.93

Planned Budgeted WTE 6469.53

Headcount/Turnover

Redundancies & Redeployments

Bank and Agency

Workforce Capacity

4

Sickness Absence

2013 04 2013 05 2013 06

Absence 5.30% 4.80% 4.40%

Short Term (Quarterly)

Long Term (Quarterly)

Episodes 2,569 Episodes 466

FTE Lost 9290.01 FTE Lost 17890.24

Sickness Absence Costs

Workforce Capacity

Why have we included this data?

These figures relate to a traditional data set around workforce capacity. We

have moved away from cost of bank and agency usage to capacity and actual

usage as this give a better indicator of where and why bank is used to deliver

flexibility of the workforce.

What is this telling us?

Planned budgeted WTE was higher than actual available capacity by 664.6 WTE

across the Trust which suggests that vacant posts and sickness, maternity and

career break absences are not always being covered effectively.

Successful redeployment of ‘affected by change’ and ‘at risk’ staff meant

that redundancies and associated costs were minimised.

Throughout Q1, sickness absence and associated costs reduced month on

month.

There is no correlation between sickness absence rates and bank usage with

the highest reported reason for bank usage being acuity.

What should we do about it?

Further investigate reasons for gap in capacity e.g– holding vacancies for

CIPS, incorrect budget setting, inability to recruit.

Further investment in workforce planning capability to fully embed the Six

Step model.

Further roll out of e-rostering to support planning and staffing levels at ward

level.

5

Appreciative Leadership Percentage completed of B7 and above = 46.77%

Aspiring Leaders

Number of Attendees 21

Number Completed 12

Number Promoted within the Organisation During the Programme 10

Mandatory Training

Staff Survey - Leadership


6

Safety Patient Safety Incidents – 2747

Staff Related Incidents – 2113

Type of Incident Total Top Category Top Sub Category

Personal Accident 74 Sharps -18 Needle stick Injury -13

Staff Health

11 Staff unwell -11 Other -9

Physical Violence

513 Patient on staff -367 Assault -329

Non-physical violence

588 Patient on staff -378 Verbal -152

Vehicle 37 Collision -23 Contact with another vehicle -16

Patient Safety 890 Health Records – 542 Entry filled in wrong patient record – 248

Service Deficit - 348 Staff unable to take breaks - 252

1st April - 30th June 2013

Induction

Attendance % completed

Number of Attendees 182

% New Starters Within 1 Month of Start Date TBC

% New Starters Within 2 Months of Start Date TBC

% New Starters Within 3 Months of Start Date TBC

Data will be available for Q2 report

e-PDR


Not accessed 23%

Co-signed Objectives 60%

Not co-signed 30%

Accessed ePDR 77%


Multiple researchers have made clear the links between leadership, quality

and service user outcomes. This section is intended to link these together and

will in time utilise EAM, Datix and the Quality SEEL tool to identify risks and

analyse trends.

This will follow in Q2 report. In addition to reporting compliance, we are

considering mechanisms to regularly ask a cross section of employees

powerful questions relating to the quality and effectiveness of education,

learning and development interventions.

7



Continued investment in the Appreciative/Aspiring Leader programmes.

Employees to be released and encouraged to attend available mandatory

training sessions or complete online learning. Particular focus should be

given to Conflict Resolution training with the aim of reducing incidences of

abuse against staff.

Staff Survey results should be used to inform targeted action at Network

level. Reporting against network action plans will be monitored through

the Workforce Committee.

What is it telling us?

83% of those completing the Aspiring Leaders programme were promoted

within the Trust during the course.

Nearly half of our Band 7 and above employees have completed the Appreciative Leadership course, finding the workshops valuable and the learning relevant to achieving operational objectives and targets.

Attendance is higher at some mandatory training sessions than others. The

three courses which are least well attended are Basic Life Support, Infection

Control and Conflict Resolution. Infection control training has changed in

quarter 2 to e-learning so we would expect to see a rise in compliance.

The staff survey gives insight into our employees’ view of their leaders, with

the majority feeling they are encouraged and supported. Particular concerns

are around effective communication between senior managers and staff,

people not feeling involved in important decisions or that their feedback is

acted upon. In these questions respondents were more negative than

positive.

The greatest risk to our staff in terms of safety comes from physical and

verbal abuse.

Over two thirds of our employees have completed an online PDR which is

important as it links to them being clear about where they fit into the

organisation against our values and objectives.

8

Sickness Absence (Top 3 Reasons)

PDR Engagement Scores

Overall Staff Survey Engagement Questions/Score

Flu Vaccinations vs. Target 2012/13 National Target 50% front line staff. 2012/13 Uptake 39% all staff (of which 50% were front line).

The seasonal flu campaign, led by NHS Employers, will be delivered again in by the Trust during the Winter of 2013-14. 2013/14 Trust Target 50% front line staff.


1.24% 1.15%

1.21% 1.20%

0.40% 0.35% 0.33% 0.36% 0.38% 0.33% 0.33% 0.34%

0.00%

0.20%

0.40%

0.60%

0.80%

1.00%

1.20%

1.40%

2013 04 2013 05 2013 06 Quarter

S10 Anxiety/stress/depression/other psychiatric illnesses

S12 Other musculoskeletal problems

S25 Gastrointestinal problems

9



Evidence indicates that engagement and wellbeing sits alongside leadership as

a key contributor to high organisational performance. This section includes

sickness data but also shows more detailed information around reasons for

absence, such as stress. Alongside this we provide new information which

enables visibility of a wider picture of employee wellbeing. Trend analysis will

follow in Q2 report.


Sickness relating to Anxiety/Stress/Depression/Other psychiatric illness

remains more prevalent than absence for any other reason.

Both the e-PDR engagement scores and the overall engagement scores from

the staff survey demonstrate that LCFT employees are engaged.


Share best practice across Networks.

Monitor success of Wellbeing Strategy in relation to initiatives aimed at

reducing Anxiety/Stress/Depression/Other psychiatric illness and allocate

resources accordingly.

10

Formal Action

F

Number of Live Suspensions by Network

Risk Level of Current Employee Relations Cases Split by Type

Number of Formal Absence Cases (with Workforce Support) by Network

Employee Relations

11

Employee Relations


This section includes information relating to numbers and types of employee

relations cases to give an indication of the employee relations climate within

the Trust. There are plans to include staff related complaints and SUI’s in this

domain moving forward.


62% of current employee relations cases are rated as high risk in line

with the case risk model and therefore the resource impact on both

the Network and the Workforce Directorate is at a peak.

There are a higher number of suspensions (11) within Adult Mental

Health, in part due to an on-going investigation within PICU which

impacts on 5 employees. This case to due to be concluded in the

coming weeks.

The Trust currently has 3 employment tribunal cases which is low

when compared with the number of high risk cases typically on-going

with the Trust.

There is currently a very low level of employees subject to formal

performance procedures. Typically we would expect this to be around

5%.


Continue to closely manage high risk cases with a view to concluding

cases where an employee is suspended as soon as possible.

Develop Network level plans to reduce the number of employee

relations cases.

Provide coaching conversations and skills based training to support

employee performance management.


TRUST BOARD – 03 OCTOBER 2013 EXECUTIVE RISK REGISTER

FOIA STATUS: Part Document Exempt Part exemption applies to page/s: Page 1para 2

Appendix 1 & 2

Section 43: Commercial Interests

PAPER TITLE: Executive Risk Register

PURPOSE: To Provide Board with the Executive Risk Register and the detail of the controls and assurances against the key operational risks

ACTION RECOMMENDED:

Decision

PAPER PREPARED BY: Jane Burke, Head of Assurance

1. Background

In line with the Trust’s Risk Management Strategy the Executive Risk Register summarises the risks that have been identified as threats to the delivery of the Annual Plan and those significant risks that emerge from operational delivery. The Executive Risk Register forms part of the organisations Internal Control System and therefore the Board requires assurance that a clear process of risk identification and monitoring has been established, that all risks to the Annual Plan have effective controls in place to mitigate them and that the Executives have robust assurance systems around these. The Executive Risk Management Committee retains oversight of the Executive Risk Register and approves the associated controls whilst emerging risks may be identified across any of the Executive Committees and reported via Chairs reports to ensure that operational risks are not viewed in isolation within their area of origin but understood in the context of the whole organisation. There may be some overlap between the Board Assurance Framework and the Executive Risk Register as some of the strategic risks within the BAF have an operational origin. Examples of these are BAF002 and BAF017 however the Executive Risk Register details the operational controls that will mitigate these risks whilst the BAF identifies the assurances that are available to the Board around these areas of risk. 2.0 Risks for removal Since the meeting of the Executive Risk Management Committee in August 2013 the following items have been identified for removal



Risk Ref ERR35 Provision of medical care to patients with physical problems on elderly wards in Burnley does not meet CQC standards of care Improved controls are now in place including daily physical health checks by an RGN and fortnightly meetings with Junior Doctors. An option appraisal underway to provide appropriate physical health supervision and this is due to be implemented by 1st December. In addition to this is the planned closure of Ward 19 which will significantly reduce the physical health demands on site. The net risk score has therefore reduced to a 12 Risk Ref ERR37 Inability to ensure the storage of medicines meets legislative requirements due summer temperatures This was a national problem and advice was sort from Quality Control North West who stated that interpretation of the guidance suggests that the kinetic mean temperature of medicines should be considered across a 24 hour period and the relevant temperature devices will be considered in future plans. The net risk score has therefore reduced to an 8. Risk Ref ERR26 Lack of capability and capacity within the Networks to implement Service Line Management The ambition to implement Service Line Management was articulated within the Annual Plan however it was not without challenges and in some areas considerable work was required to understand the profitability of some services. A decision was taken by the Executive Team not to pursue this objective within 2013/14. Risk Ref ERR3 Lack of overarching Infection Prevention and Control Strategy The Strategy has been produced supported by the Infection Prevention and Control Annual Work Plan. Progress against this and areas of non-compliance are reported on a quarterly basis at the Network Governance meetings 2. Board action The Board is asked to:

Note the content of the Executive Risk Register Approve the removal of the risks identified



Consider whether any additional resource is required to support the management of any significant risks

Consider the escalation of any risks to the Board Assurance Framework to enable the Board to receive on-going assurances around the management of these risks


TRUST BOARD – 03 OCTOBER 2013 BOARD ASSURANCE FRAMEWORK

FOIA STATUS: Part Document Exempt Part exemption applies to page/s: Appendix 1

Section 43: Commercial Interests

PAPER TITLE: Board Assurance Framework (BAF) Update

PURPOSE: To Provide Board with an Update on Assurances Received Against Risks Identified on the BAF

ACTION RECOMMENDED:

Decision

PAPER PREPARED BY: Angela Wetton, Head of Company Secretary Service

The Board Assurance Framework (BAF) forms part of LCFT’s risk management strategy and policy and is the framework for identification and management of strategic risks, both risks internal to LCFT and those in the wider system in which LCFT has a role. Strategic risks are defined as significant risks that have the potential to impact across LCFT and are raised and monitored by the Executive team and the LCFT Board. The BAF will support one of the core roles of the Board which is to understand and manage risks, whether they are:

risks to delivery of our contractual commitments; or risks that the actions we are committed to (and are delivering) are not achieving the

successful outcomes we expect i.e. delivering our strategic priorities The format and content of the BAF 2013/14 was agreed by the Board at the meeting held on 2nd May 2013 (TB 076/13). The Executive Risk Management Committee, part of the recently implemented EMT Governance structure, provides a forum for identifying emerging risks requiring Board oversight and therefore elevation to the BAF. The Committee has met twice since the Board approved the BAF in May 2013; the most recent meeting was in August 2013. To date, no risks have been identified as requiring elevation. There is now a gap in control for BAF13 as the CARE Committee is to be disestablished, however, a proposal detailing how the critical elements of the business of this committee will be handled via other forums, will be discussed on this agenda at TB 114/13. Various pieces of assurance on the management of the identified risks have been received over the past 4 months and these have been logged against the relevant BAF item as can be seen on the attached appendix 1. Changes from the previous report are highlighted in red text. The Board is asked to:

Consider the risks identified and confirm they are still relevant


TRUST BOARD – 03 OCTOBER 2013 BOARD ASSURANCE FRAMEWORK

Consider whether any new strategic risks have emerged since May of which the Board require oversight and therefore should be elevated on to the BAF and used to inform the future Board Agendas

Confirm that the assurances received via the various reports, on the management of the identified risks, provide whole or partial assurance and whether anything further is required.


TRUST BOARD – 03 OCTOBER 2013 FINANCE REPORT AUGUST 2013


Not Applicable

PAPER TITLE: Finance Report August 2013

PURPOSE: To summarise and analyse actual and forecast financial performance and standing of the Trust, the implications and any proposed management action

ACTION RECOMMENDED:

Decision

PAPER PREPARED BY: Director of Finance

The Finance Report is a routine monthly report in a format agreed by the Board. The key element to be considered is the Financial Risk Rating (FRR) (to be replaced from 1 October by the Continuity of Service Risk Rating (CoSRR)), though the report provides insights into a range of other areas, including:

Income & Expenditure Balance Sheet Budgetary variances Cost improvements Balance sheet Cash flow Capital expenditure.

After five months, the Trust is under performing against Plan (£1,599k surplus v £1,784k Plan). This includes under achievement of £311k YTD against the cost improvement programme. Key drivers of the under performance are:

Pressures on bed numbers leading to costs being incurred for private sector placements, £866k, with £2m assumed for full year

Increased acuity on available beds demands additional use of bank and agency £683k YTD, £1.6m assumed for full year

Ward 18 in Burnley was planned to close, but this has been deferred, leading to £160k YTD and £720k outturn shortfall on CIPs

Executive Directors are planning corrective action to bring outturn back in line with Plan, though the current forecast is for a full year surplus of £3.1m v £4.0m Plan. Cash balances are holding up strongly (£36.2m v £23.0 Plan) and FRR for the year to date is 3 against a Plan of 3, with all modelled scenarios generating an overall FRR of 3 for the year as a whole.


TRUST BOARD – 03 OCTOBER 2013 FINANCE REPORT AUGUST 2013

At the end of August, Monitor confirmed that with effect from October the Risk Assessment Framework will replace the Compliance Framework, with CoSRR replacing FRR. Performance against CoSRR will be formally reported for the first time after Quarter 3, i.e. during January 2014. The precise implications of the new calculations are being considered (as there have been some minor changes following consultation), but it is currently expected that the Trust will be rated as a 4 (the lowest financial risk) on an ongoing basis. Further information and analysis of the implications of the introduction of CoSRR will be provided to the Board in future meetings. It is clear, however, from discussion with Monitor that, as previously reported, CoSRR will not be impacted by the availability or otherwise of the Working Capital Facility (£16m provided by Barclays). When this was rolled on recently, break clauses were built in to allow for this eventuality and the Board is asked to delegate authority to the Director of Finance to terminate the Working Capital Facility when it is considered appropriate and safe to do so.

Financial Report – August 2013

EXECUTIVE SUMMARY

Target To date Forecast for year Notes

EBITDA £’000 £5,531 v AP £5,806 £12,928 v AP £13,932 1

Surplus before exceptionals £’000

£1,599 v AP £1,784 £3,096 v AP £3,986 1

CIP £’000 £4,401 v AP £4,712 £10,011 v AP £11,033 2

Cash Balance £’000 £36,224 v AP £23,027 £17,495 v AP £19,746 3

Capital Expenditure £’000

£14,881 v AP £19,142 £39,366 v AP £41,800 4

Cumulative BPPC

Compliance %

NHS Volume 94

Value 98 v Target 95 Volume 95

Value 95 v Target 95 5

Non NHS

Volume 96 Value 97 v Target 95

Volume 95 Value 95 v Target 95

Financial risk rating 3 v AP 3 3 v AP 3 6

Key Significant risk of failure, additional action required

Medium risk of failure, performance needs to be monitored

Low risk of failure, no action required

AP Annual Plan Key Assumptions, Risks and Actions 1 Position includes under achievement of planned CIPs (£311k), resulting in an overall net

adverse variance in surplus of £185k, against a YTD Plan of £1,784k A surplus of £3.1m is forecast against the planned £4m without corrective action Key driver is unbudgeted costs of £866k in respect of mental health inpatient demand Executive Directors are considering corrective action to bring outturn into line with Plan

2 Figures shown are for planned schemes. Year-end position is £1.0m adverse. This is partially offset by under spends elsewhere

CIP achievement is below Plan, with a number of schemes delayed and mitigating schemes being developed

3 Cash balances remain high, some £13m better than Plan; key drivers are working balances (£9.4m) and under spending on Capital and Investment Activities (£4.1m), offset by I&E Performance (£0.3m).

4 Capital expenditure is below plan largely due to the reprofiling of The Harbour scheme 5 Minor issues with BPPC are not anticipated to impact on achievement of target. 6 Minor concerns over the impact of performance; some decreases in metrics, but overall

broadly in line with Plan. Risks align to performance.


1. INCOME AND EXPENDITURE PERFORMANCE

£0.0m

£0.5m

£1.0m

£1.5m

£2.0m

£2.5m

£3.0m

£3.5m

£4.0m

£4.5m

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

Cumulative Surplus £'m

Plan Actual Best Forecast Downside

Income and Expenditure

Actual Plan Variance Forecast Plan Variance£'m £'m £'m £'m £'m £'m

Income 133.013 129.388 3.625 320.235 310.525 9.710

Pay (101.889) (99.560) (2.329) (245.767) (238.944) (6.823)

Non Pay (25.593) (24.022) (1.571) (61.540) (57.649) (3.891)

Total Costs (127.482) (123.582) (3.900) (307.307) (296.593) (10.714)

EBITDA 5.531 5.806 (0.275) 12.928 13.932 (1.004)

P/L on Disposals 0.024 0.000 0.024 0.024 0.000 0.024

Capital Charges (3.739) (3.708) (0.031) (8.977) (8.977) 0.000

Interest Receivable 0.060 0.029 0.031 0.157 0.067 0.090

Interest Payable (0.277) (0.342) 0.065 (1.035) (1.035) 0.000

Net Surplus before Exceptional Items 1.599 1.784 (0.185) 3.096 3.986 (0.890)Exceptional items 0.000 0.000 0.000 0.000 0.000 0.000

Net surplus / (deficit) 1.599 1.784 (0.185) 3.096 3.986 (0.890)

EBITDA margin 4% 4% 0% 4% 4% 0%

Year To Date Annual

The surplus in August in isolation was £0.3m (July £0.3m).

Forecast outturn is £0.9m below Plan in the ‘Likely Scenario’ at month 5. This level of financial performance provisionally delivers a financial risk rating of 3 (against a Plan of 3).

Forecasts

All forecasts result in an overall risk rating of 3 against a plan of 3 ‘Likely’ produces a rating of 3 (2.7) based on a surplus of £3.1m

Financial Report – August 2013 ‘Best case’ produces a rating of 3 (3.4) based on a surplus of £4.1m

‘Worst case’ produces a rating of 3 (2.9) based on a surplus of £2.1m

Figures below are based on the ‘Likely’ scenario

The Best case assumes a falling off of OATs and more robust CIP delivery. Worst case assumes further deterioration of both these factors, along with redundancies. Executive Directors are considering corrective action to bring outturn performance in line with Plan

It should be noted that with the publication of the Risk assessment Framework effective from 1 October the Trust will in future be assessed using Continuity of Service Risk Ratings (see section 6)

Main variances against Plan

Planned income, pay and non pay are broadly in line with Plan with pay supporting the position presented by CIP slippage and non-pay overspends

The under achievement on CIPs (£311k) is not fully compensated for by underspends elsewhere, resulting in a net under achievement on EBITDA of £275k

Overspends have been identified in Adult Mental Health and Secure Services

CIP performance is being monitored against the raw Plan; the £1.0m forecast outturn under achievement was anticipated, based on risk assessment.

Key risks The primary financial risk concerns inpatient beds with three key drivers

Pressure on bed numbers leading to costs being incurred for private sector placements, £866k, with £2m assumed for full year

Increased acuity on available beds demands additional use of bank and agency £683k YTD, £1.6m assumed for full year

Ward 18 in Burnley was planned to close, but this has been deferred, leading to £160k YTD and £720k outturn shortfall on CIPs

Collectively, inpatient issues result in £1.7m of pressures to date and an expected £4.3m full year, compensated by, to a degree, risk assumptions around CIPs and £1.0m underspend on developments

CIP failure in other areas remains a possibility

Redundancies have not currently been allowed for within forecasts. Financial Impacts can be mitigated by appropriate workforce planning


2. ANALYSIS BY DIRECTOR (See Appendix VI for details)

Clinical Services Under spend of £550k, 0.6% (£415k, 0.6% July; Q1, £352k, 0.6%;) against net budget of £93m. £95k over spend on pay, £645k under on non-pay. Adult Mental Health is over spent by £533k, exclusively driven by Inpatient use of Bank and Agency due to acuity and the inability to proceed with ward closure. Adult Community returned a £663k underspend, dominated by Community Services. Secure is over spending by £282k, mainly driven by high use of bank and agency on wards and Escort and Bedwatch costs. Children & Families has favourable positions on pay from vacancies in Universal Services which helps deliver a £553k favourable position

Director of Nursing Under spend of £39k, 2.4% (£17k over, 1.4% July; Q1, £2k over, 0.2%) against budget of £1.6m. Under spend on pay relates to 13 staffing vacancies primarily relating to reduced hours, maternity leave and pending recruitment, offset by consultancy costs

Chief Executive Over spend of £76k (£61k July; Q1; £68k) against budgeted net income of £3.3m. Main variance relates to professional and consultancy costs

Director of Finance Under spend of £157k year to date, 1.1% (£127k, 1.1% July; Q1, £115k, 1.3%) against budget of £14.5m. Main variances due to pressures on security services and soft FM SLAs, offset by minor maintenance and Finance pay and non-pay savings

Director of Workforce and Organisational Development Over spend of £87k, 5.0% (£70k, 5.0% July; Q1, £29k, 2.8%) against budget of £1.8m. Main variance due to staffing £94k

Medical Director Under spend of £150k, 12.3% (£149k, 15.1% July; Q1, £66k, 9.5%) against budget of £1.2m. Main variances are drug under spends (£77k) following some drugs becoming generic

Chief Operating Officer Under spend of £94k, 15.4% (£79k, 12.8% July; Q1, £54k, 11.6%;) against budget of £0.6m. Main variances are due to vacancies in Lean Development (£53k) and Engagement (£29k)

Director of Innovation and Transformation Under spend of £34k, 14.6% (£25k, 13.6% July; Q1, £18k, 13.3%;) against budget of £0.2m. Main variances are almost exclusively driven by vacancies


3. COST IMPROVEMENT PROGRAMME (CIP) CIPs

Plan Actual Variance

£'000 £'000 £'000

Income &Expenditure CIP 4,711.7 4,401.1 ‐310.7

Year to Date

Overall under achievement against planned schemes to the end of August £311k, 6.6%. There is an under performance against planned schemes, but it is important to recognise that under spends are being generated against budgets which partly mitigate this position. Some shortfall has occurred in Adult Community (£132k year to date) where a number of schemes, particularly relating to service redesign, have been delayed and Adult Mental Health has seen the impact of deferring the closure of Ward 18 at Burnley (£160k year to date). Children and Families have recognised the remedial schemes they have implemented and are now returning a slight overachievement year to date (£5k). Adult Community have generated an overall year to date surplus of £663k implying some compensatory measures. There is concern around the year end position in Adult Mental Health, where the scheme to close Ward 18 is not expected to be implemented during 2013/14, causing a £720k shortfall. The figures as presented are solely against planned schemes. A number of additional schemes will be developed during the year and compensating measures identified to offset under performance. Executive Directors are actively considering corrective action to bring outturn performance into line with Plan. Senior management have reviewed CIPs and work is continuing on the most appropriate and effective way to monitor and review programmes. The need to robustly manage schemes and source compensatory schemes where there is any shortfall has been communicated to managers as a priority, and month 3 saw services report on their CIP performance together with an assessment of outturn and any remedial measures required.

The outturn position of £10.0m is better than the risk adjusted plan (£9.1m).


4. BALANCE SHEET Balance Sheet

Year To DateActual Plan Variance Forecast Plan Variance

£'m £'m £'m £'m £'m £'m

Fixed Assets 143.144 147.775 -4.631 162.777 165.554 -2.777

Stock 0.249 0.249 0.000 0.249 0.249 0.000

Trade Debtors 6.221 7.929 -1.708 9.115 9.115 0.000

Other Current Assets 2.768 3.388 -0.620 3.160 3.160 0.000

Cash 36.224 23.027 13.197 17.495 19.746 -2.251

Current Liabilities -34.557 -28.419 -6.138 -24.136 -24.136 0.000

Working Capital 10.905 6.174 4.731 5.883 8.134 -2.251

Long Term Assets 0.791 0.916 -0.125 0.916 0.916 0.000

Provisions and other Long Term Liabilities -1.758 -1.758 0.000 -1.700 -1.700 0.000

Loans -17.753 -17.405 -0.348 -32.738 -36.688 3.950

135.329 135.702 -0.373 135.138 136.216 -1.078

Taxpayers EquityPDC 100.889 100.889 0.000 99.201 99.201 0.000

I&E Reserve 14.973 15.070 -0.097 16.295 17.272 -0.977

Other Reserves 19.467 19.743 -0.276 19.642 19.743 -0.101

135.329 135.702 -0.373 135.138 136.216 -1.078

Annual

Fixed assets are £4.6m below plan, being attributable to timing differences on the capital programme. The transfer of £6.8m of community facilities has been confirmed and therefore is now included as having happened, formal paperwork is still awaited and the circular flow of funds has yet to take place (see section 6 for details on capital expenditure). The transfer also impacts on I&E Reserves as funding has been accrued to reserves to match the expenditure. Trade debt is now significantly ahead of plan (£1.7m). Good progress has been made against council debt and NHS debt remains better than plan. The Trust has now started drawing down loans for The Harbour construction highlighting the gains on current liabilities (£6.1m) enjoyed over recent months. Taking these factors together the cash balance is very strong despite the slight under performance in I&E terms.


5. CASH AND WORKING CAPITAL

£0.0m

£5.0m

£10.0m

£15.0m

£20.0m

£25.0m

£30.0m

£35.0m

£40.0m

£45.0m

Apr‐13 Jul‐13 Oct‐13 Jan‐14 Apr‐14 Jul‐14 Oct‐14 Jan‐15 Apr‐15 Jul‐15 Oct‐15 Jan‐16

Month End Cash £'m

Plan Actual/Forecast Best Downside Adjusted

Cashflow


Surplus/(deficit) after tax 1.599 1.784 (0.185) 3.096 3.986 (0.890)Non Cash Flows 3.932 4.021 (0.089) 9.832 9.946 (0.114)

Operating Cash Flows before WC 5.531 5.806 (0.275) 12.928 13.932 (1.004)

Changes to WC (0.866) (10.279) 9.413 (14.109) (13.924) (0.185)

CF from operations 4.665 (4.473) 9.138 (1.181) 0.008 (1.189)Capital and Investment Activities (7.773) (11.393) 3.620 (30.376) (33.174) 2.798

Financing and Other 6.047 5.609 0.438 15.768 19.628 (3.860)

Net cash inflow/outflow 2.939 (10.258) 13.197 (15.790) (13.539) (2.251)

Opening cash balance 33.285 33.285 0.000 33.285 33.285 0.000

Closing cash balance 36.224 23.027 13.197 17.495 19.746 (2.251)

Year To Date Annual

See Appendix IV for details Historic trends suggest a working capital ‘buffer’ in the system relating to the speed of settling liabilities (accruals, etc). An ‘adjusted’ forecast has been shown in the chart which allows for this ‘buffer’, estimated at around £3m, this is expected to reduce over time and will be reassessed after the NHS reorganisation has settled. The cash position is £13.2m higher than Plan: I&E performance is having a marginal negative impact (£0.3m) Changes to capital expenditure have boosted cash by £3.6m (note the delayed

transfers of community properties have not impacted on cash)

Financial Report – August 2013 Minor changes to Financing activity have had a marginal impact (note that Loan

drawdowns are now broadly in line plan and capital forecasts) Overall debtors are ahead of plan (£2.3m) with progress being made across both NHS

and Council Debt. Though similar to last month, current liability levels are significantly greater than Plan.

The timing of settlements with suppliers represents the bulk of the shift (generating gains of £5.2m) dominated by assessments and accruals (where invoices had not been presented, or in time to pay, before 31 August). The remainder is largely made up by £1.7m of additional deferred income.

Many of the shifts and variances are timing differences and do not change underlying long term liquidity. The reduction in forecast I&E performance will, however, reduce this (£1m) as will the increases to the Trust funded portion of the forecast capital programme and finance charges (£1m).

BPPC BPPC

Value Volume Target Value Volume Target

Cumulative Performance 98% 94% 95% 97% 96% 95%

NHS Non NHS

The Trust has made good progress against target and addressed most of the slippage on year to date NHS Volume (see last month). It is still expected that the annual target will be achieved.


6. CAPITAL PROGRAMME Capital Summary


Capex 14.881 19.142 (4.261) 39.366 41.800 (2.434)

Year To Date Annual

The Trust has spent £14.9m spend to date, some £4.3m below plan:

Spend is dominated by the Harbour (£6.3m). The Plan prudently allowed for an evenly spread cash flow with expenditure of £10m YTD. The Project Director is coordinating cash flows, but £2m of the apparent variance relates to phasing of the Plan (primarily the upfront phasing of contingencies) leaving £1.7m slippage against forecast (£0.9m in relation to the main contractors). Expenditure will be matched by loan finance so impact on cash outturn will be minimal

Oaklands and Moss View projects (£670k) are behind plan though they are expected to be substantially completed and will realise savings against plan in the order of £400k

Minor Improvements - an overspend of £0.3m against Plan; which is expected to continue

Note that a revised capital forecast has been developed for submission to Monitor. Though this differs significantly from plan, the bulk of the changes relate to the Harbour and will therefore also be reflected in funding. A net cash pressure in the order of £1m-£1.5m is considered likely. Transfers The transfer of £6.8m of community facilities has been confirmed and therefore is now included as having happened, but much of the paperwork and confirmation of the transfer mechanism is still awaited. The expenditure (not paid) has therefore been included as a technical adjustment and accrued against reserves (not received) as consistent with the plan submission - resulting in a nil impact on cash. This is expected to be resolved shortly Details of major expenditure and variance from Plan can be found in Appendix V


7. FINANCIAL RISK RATING

Weighted average is 3.3 against plan of 3.4 Overriding rules rating is 3 Small underperformance on plan has made no change to overall risk rating, though

weighted average has fallen in both year to date and forecast. Decreases in metrics have not reduced overall rating but an increase of £0.3m

would have been required to increase performance to planned weighted average. An increase of the order of £1.2m would be required to increase the overall rating to 4 (increase underlying performance - as limited by overriding rules)

A fall in the I&E surplus in the order of £1.5m would be required to decrease overall ratings to 2

It should be noted that with only 5 months’ results small variations can have a significant impact on risk rating, generally ratings become less sensitive as the year progresses.

Forecasts

All forecasts current deliver an overall risk rating of 3 against a plan of 3

‘Likely’ produces a rating of 3 (2.7) based on a surplus of £3.1m

‘Best case’ produces a rating of 3 (3.4) based on a surplus of £4.1m

‘Worst case’ produces a rating of 3 (2.9) based on a surplus of £2.1m

Figures below are based on the ‘Likely’ scenario

3 Months to June 2013

4 Months to July 2013

5 Months to August 2013

12 months to March

2014

EBITDA margin % 4.3% 4.2% 4.2% 4.0%

2 2 2 2

EBITDA % v Plan 97.0% 95.7% 95.3% 92.8%

4 4 4 4 Return on assets (Revised) %

2.9% 2.7% 2.7% 2.0% 4 4 4 4

I&E surplus % 1.3% 1.2% 1.2% 0.9%

3 3 3 2

Liquidity days inc WCF 26.2 25.0 31.4 25.3

4 4 4 4

Weighted average 3.3 3.3 3.3 3.1

Overriding rules rating 3 3 3 3

Key Rating = 3 Rating >3 Rating >3


0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

Apr‐11 Jul‐11 Oct‐11 Jan‐12 Apr‐12 Jul‐12 Oct‐12 Jan‐13 Apr‐13 Jul‐13

Overall Risk Rating

Average Overriding rules

Weighted average is 3.3 against plan of 3.4 Overriding rules rating is 3 Small underperformance on plan has made no change to overall risk rating, though

weighted average has fallen in both year to date and forecast. Decreases in metrics have not reduced overall rating but an increase of £0.3m

would have been required to increase performance to planned weighted average. An increase of the order of £1.2m would be required to increase the overall rating to 4 (increase underlying performance - as limited by overriding rules)

A fall in the I&E surplus in the order of £1.5m would be required to decrease overall ratings to 2

It should be noted that with only 5 months results small variations can have a significant impact on risk rating, generally ratings become less sensitive as the year progresses.

3 Months to June

2013


5 Months to August

2013

12 months to March

2014

Weighted average 3.3 3.3 3.3 3.1

Plan weighted average 3.4 3.4 3.4 3.4

Overriding rules rating 3 3 3 3

Plan overriding rules rating 3 3 3 3

Key Rating <3 Rating = 3 Rating >3


0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%


EBITDA Margin %

Actual 5 4 3 2

EBITDA margin 4.2% against plan of 4.5% Score of 2 against a plan of 2 Score of 3 would require increase of £1.1m (20%) Score of 1 would require a worsening of £4.2m (76%)

EBITDA margin % 3 Months to June

2013



12 months to March

2014 Actual/Forecast % 4.3% 4.2% 4.2% 4.0% Actual/Forecast Rating 2 2 2 2 Plan % 4.5% 4.5% 4.5% 4.5% Key Rating <3 Rating = 3 Rating >3


0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

120.0%

140.0%


Achievement Of Plan %

Actual 5 4 3 2

Achievement is 95.3% against a plan of 100% Score is 4 against a plan of 5 An increase of £269k (4.9%) in EBITDA would be required to meet plan A reduction of £596k (10.8%) in EBITDA would be required to reduce this score to

3

Achievement of Plan % 3 Months to June

2013



12 months to March

2014 Actual/Forecast % 97.0% 95.7% 95.3% 92.8% Actual/Forecast Rating 4 4 4 4 Plan % 100% 100% 100% 100% Key Rating <3 Rating = 3 Rating >3


‐6.0%

‐4.0%

‐2.0%

0.0%

2.0%

4.0%

6.0%

May‐12 Aug‐12 Nov‐12 Feb‐13 May‐13 Aug‐13

Return on Assets % (Revised)

Actual 5 4 3 2

Return of 2.7% against a plan of 3.0% Score of 4 against a plan of 4 Score of 5 would require an increase of £226k (14%) Score of 3 would require decrease of £382k (24%) Though sensitivity is largely based on revenue, large capital projects can impact

Return on Assets (Revised)% 3 Months to June

2013


5 Months to August

2013

12 months to March



‐3.0%

‐2.0%

‐1.0%

0.0%

1.0%

2.0%

3.0%

4.0%


I&E Surplus %

Actual 5 4 3 2

Surplus £1,599k Score of 3 against a plan of 3 Score of 4 would require increase of £852k (53%) Score of 2 would require a decrease of £293k (18%)

I&E Surplus % 3 Months to June

2013


5 Months to August

2013

12 months to March



0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0


Liquidity (Days)

Actual 5 4 3 2

Liquidity of 31.4 days against a plan of 26.6 days Score of 4 against a plan of 4 Score of 5 would require increase in liquidity in excess of £24.3m – 91% (assuming

no change in operating expenditure) Score of 3 would require a reduction in liquidity of around £5.4m – 20% (assuming

no change in operating expenditure) The score is dependant on the £16m working capital facility with Barclays which

has been rolled on.

Liquidity days inc WCF 3 Months to June

2013


5 Months to August

2013

12 months to March

2014 Actual/Forecast Days 26.2 25.0 31.4 25.3 Actual/Forecast Rating 4 4 4 4 Plan Days 31.3 29.0 26.6 29.0 Key Rating <3 Rating = 3 Rating >3


8. CONTINUITY OF SERVICE RISK RATINGS With the publication of the Risk assessment Framework (RAF), effective 1 October 2013 Financial Risk Ratings (FRR) will be replaced by Continuity of Service Risk Ratings (CoSRR). This has been factored into the Trust’s financial planning and forecasting but as the ratings are potentially still subject to change, the information and/or presentation may change.

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

Apr‐13 Jul‐13 Oct‐13 Jan‐14

CoSRR ‐ Overall

Actual/Forecast Plan

Overall forecast to be ongoing 4 against Plan of 4, though Debt Service cover forecast is 3 and could potentially dip to a 2 in Q3.

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5


CoSRR ‐ Debt Service Cover

Actual/Forecast 4 3 2

Year to date metrics show 3.1x against a Plan 3.1x, a rating 4 against a Plan of

4. A reduction of £1,063k would be required to force a 3


Based on likely performance the Trust will move toward 3 (against a Plan of 3) over the course of the year with a possible dip to 2 in Q3

This has been discussed with Monitor and it is not anticipated that this will give rise to any serious concerns around the Trust’s performance

‐30.0

‐25.0

‐20.0

‐15.0

‐10.0

‐5.0

0.0

5.0

10.0

15.0

20.0


CoSRR ‐ Liquidity

Actual/Forecast 4 3 2

Year to date metrics show 12.5 against a Plan 7.2, a rating 4 against a Plan of

4. A reduction of £10.7m would be required to force a 3 Based on likely performance the Trust will remain a 4 (against a Plan of 4)

throughout the year The finalised RAF changed the calculation of CoSRR Liquidity, but Trust

remains at rating of 4 The CoSRR Liquidity metric is not impacted by the availability or otherwise of

the Working Capital Facility


Appendices Appendix I Financial risk rating Appendix II Glossary, terminology and definitions Appendix III Detailed CIP performance Appendix IV Cashflow Appendix V Capital Appendix VI Budgetary performance


Appendix I Financial Risk Rating A financial risk-rating matrix is used to assess the financial health of Foundation Trusts. There are five possible risk ratings as follows:

Rating 5 - Lowest risk - no regulatory concerns Rating 4 - No regulatory concerns Rating 3 - Regulatory concerns in one or more components. Significant breach of

Terms of Authorisation unlikely Rating 2 - Risk of significant breach in the medium term, e.g. 12 to 18 months in

the absence of remedial action Rating 1 - Highest risk - high probability of significant breach in the short-term, e.g.

less than 12 months, unless remedial action is taken The 145 Foundation Trusts rated on Monitor’s website currently fall into the following categories:

Financial Risk Rating Governance Risk Rating Rating No Green Amber

Green Amber Red Red

5 10 9 1 4 33 21 7 2 3 3 82 44 13 15 10 2 10 2 3 5 1 11 11

Total 146 76 20 20 30 LCFT is rated in the boxes shaded Green, i.e. Top 74 FTs. 30 are rated lower risk and 72 rated higher risk Scoring Matrix Weight 5 4 3 2 1 Achievement of plan 10% 100% 85% 70% 50% <50% Underlying margin 25% 11% 9% 5% 1% <1% Return on assets 20% 6% 5% 3% -2% <-2% I&E surplus margin 20% 3% 2% 1% -2% <-2% Liquidity ratio (days) 25% 60 25 15 10 <10 The overall risk rating is produced by bringing together a weighted combination of the following four factors. Achievement of plan - EBITDA achieved as % of plan Underlying margin – EBITDA as % of total operating income Return on assets – EBITDA as % of average assets I&E surplus margin – Net surplus as % of total operating income Liquidity ratio – Days’ worth of operating expenses that are covered by current assets, i.e. how easy it is to cover costs by converting assets into cash. Overriding rules

Financial Report – August 2013 Whatever the score achieved, there are a number of overriding rules that will limit the overall risk rating. If the Trust has been an FT for 12 months or less, maximum rating = 4 If the lowest ranked metric is 1, maximum rating = 2 If one financial criterion is 1 or 2, maximum rating = 3 If two financial criteria are 1 or 2, maximum rating = 2 If two financial criteria are 1, maximum rating = 1 If Prudential Borrowing Code is breached, maximum rating = 2


Appendix II Glossary, Terminology and Definitions Accruals – An accounting concept. Accruals are used to charge expenditure to the period it relates to rather than when cash settlement is made. If the Trust has received a service costing £1,000 in May, but does not pay for it until June, an accrual for £1,000 will be raised in May to increase expenditure in that month. When the payment is made in June, the accrual is released to offset it. Amortisation – The process of charging the cost of an asset over its useful life as opposed to when payment is made for it. It has the same impact as depreciation, but normally relates to intangible assets. Assets – An item that has an ongoing value to an organisation, such as a debtor or a building. Breakeven duty – A financial target, requiring an NHS organisation to match income with expenditure, i.e. making neither a profit nor a loss. Usually taken to include a very small surplus or deficit. Brokerage – The transfer of repayable revenue, cash or capital from one organisation to another to support a financial need. Capital – Expenditure on fixed assets, cost must exceed £5,000 for an asset (or a group of assets) to be treated as capital expenditure. Such assets must have a useful life expectancy of more than one year. Capital charges – The cost of owning or using capital. A charge is made to expenditure on all fixed assets comprising depreciation and interest on the outstanding debt. Capital resource limit (CRL) – A limit determined by the Department of Health constraining the amount a Trust can spend on capital. Current assets – Debtors, stock, cash or similar, which can be readily converted into cash within the next twelve months. Depreciation – The process of charging the cost of an asset over its useful life as opposed to when payment is made for it. It normally relates to tangible assets. Direct cost – Costs that can be directly attributed to a particular activity, service or other output. For example, the cost of a nurse on an inpatient ward is a direct cost of the inpatient service, whereas the cost of a site is an indirect cost as it also covers other services and departments.

Financial Report – August 2013 Earnings before interest, tax, depreciation and amortisation (EBITDA) – Used as a more meaningful identifier of an organisation’s underlying profitability than raw surplus. It is calculated as follows: Net surplus

Add back depreciation Add back any interest paid Less any financial support received Less any interest received Add back any PDC dividends paid

Equals EBITDA External financing limit (EFL) – A limit on net external financing set by the Department of Health, determining how much more or less can be spent by a Trust than the money it generates from its operations in a year. Fixed assets – Land, buildings, equipment and other long-term assets that are expected to have a useful life of more than one year. Fixed asset impairments – When the estimated real value of an asset is less than that shown in the accounts, an impairment provision is created to represent that loss in value. Fixed cost – A cost that will not change despite fluctuations in the level of activity. Indirect cost – A cost that cannot be traced directly to a particular activity, service or other output. Intangible asset – Goodwill, brand value or some other right, which though invisible is likely to derive financial benefit for its owner and for which one might be willing to pay. Liability – Something which the Trust is liable to pay, such as an outstanding bill or loan. Liquidity ratio – Days’ worth of operating expenses that are covered by current assets, i.e. how easy it is to cover costs by converting assets into cash. Generally taken to be a measure of an organisation’s ability to cover its short-term liabilities. Marginal cost – The increase or decrease in cost caused by the increase or decrease in activity by a single unit. Net book value – The value of an asset as recorded in the balance sheet of an asset at a point in time. Normally the original cost less the accumulated depreciation relating to that asset (the extent to which the asset has been ‘consumed’ over its life). Net current assets/liabilities – The net asset or liability of an organisation after adding together current assets and current liabilities. Private finance initiative – A form of public/private partnership designed to fund major capital investments without immediate recourse to public funds. Generally a private sector

Financial Report – August 2013 organisation will fund the construction/procurement of an asset and a public sector organisation will pay a periodic charge for making use of the asset. Public dividend capital (PDC) – At the formation of a Trust, the purchase of assets from the Secretary of State was half funded by public dividend. It is changed by public sector capital received or paid back over a period. Dividends or interest are repaid to the Secretary of State. PDC dividend – An amount paid to the Secretary of State representing the ‘interest’ on PDC. Reference costs – Nationally collected schedule of the relevant costs per unit of activity for different services, allowing comparison between different providers. Revenue – Ongoing costs or funding associated with operations, as opposed to capital. Tangible asset – A sub-classification of fixed assets to exclude invisible or intangible assets. Total operating income – Overall funding less interest receivable Variable cost – An expense that varies proportionately with the level of activity undertaken.


APPENDIX III: Detailed CIP Performance

Annual Plan to Date Act to Date Variance

Expected

Outturn

Year End

Variance

Adult Community £3,415,622 £1,208,182 £1,076,134 ‐£132,048 £3,165,321 ‐£250,302

Secure Services £354,139 £147,565 £128,525 ‐£19,040 £314,039 ‐£40,100

Adult Mental Health £3,085,146 £1,708,852 £1,548,946 ‐£159,906 £2,365,546 ‐£719,600

Children & Family Services £2,430,517 £1,012,725 £1,018,142 £5,417 £2,430,517 ‐£0

LD Psychology £18,989 £7,910 £7,910 £0 £18,989 £0

Transformation £42,925 £17,885 £17,885 £0 £42,925 £0

Company Secretary £20,000 £8,335 £8,335 £0 £20,000 £0

Property Services £362,656 £57,369 £52,262 ‐£5,108 £350,398 ‐£12,258

Information Services £240,864 £100,360 £100,360 £0 £240,864 £0

Workforce £248,196 £103,420 £103,420 £0 £248,196 £0

Director of Nursing £176,452 £73,525 £73,525 £0 £176,452 £0

Pharmacy £506,000 £210,820 £210,820 £0 £506,000 £0

Finance £131,500 £54,795 £54,795 £0 £131,500 £0

Total £11,033,007 £4,711,743 £4,401,058 ‐£310,685 £10,010,747 ‐£1,022,260

% Variance ‐6.6% ‐9.3%

CIP Performance to Month 5 End August


APPENDIX IV: Detailed Cash Flow Reported Monthly Cash Flow Statement for LANCASHIRECARE

Plan YTD Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual

unitsYTD Ending 31 Aug 2013

YTD Ending 31 Aug 2013

Month Ending 30 Apr 2013

Month Ending 31 May 2013

Month Ending 30 Jun 2013

Month Ending 31 Jul 2013

Month Ending 31 Aug 2013

Month Ending 30 Sep 2013

Month Ending 31 Oct 2013

Month Ending 30 Nov 2013

Month Ending 31 Dec 2013

Month Ending 31 Jan 2014

Month Ending 28 Feb 2014

Month Ending 31 Mar 2014

Surplus/(deficit) after tax £m 1.784 1.599 0.310 0.281 0.433 0.282 0.294 0.068 0.189 0.189 0.189 0.309 0.309 0.246

Non-cash flows in operating surplus/(deficit), Total 4.021 3.932 0.786 0.785 0.786 0.785 0.790 0.843 0.843 0.843 0.843 0.843 0.843 0.843

Operating Cash flows before movements in working capital 5.806 5.531 1.096 1.066 1.219 1.067 1.084 0.911 1.031 1.031 1.031 1.151 1.151 1.089

Increase/(Decrease) in workling capital, Total £m (10.279) (0.866) (2.413) (2.413) 0.850 0.379 2.730 (6.521) (0.471) (0.425) (0.425) (0.471) (0.425) (4.504)

Net cash inflow/(outflow) from operating activities £m (4.473) 4.665 (1.317) (1.347) 2.069 1.446 3.814 (5.611) 0.560 0.606 0.606 0.680 0.726 (3.414)

Net cash inflow/(outflow() from investing activities, Total £m (11.393) (7.773) (2.787) 0.234 (2.204) (1.140) (1.877) (1.708) (1.682) (2.190) (0.502) (2.191) (5.415) (8.915)

Net cash inflow/(outflow) before financing £m (15.867) (3.108) (4.104) (1.113) (0.135) 0.306 1.937 (7.319) (1.122) (1.584) 0.104 (1.511) (4.689) (12.330)

Net cash inflow/(outflow) from financing activities, Total £m 5.609 6.047 (0.024) (0.084) (0.050) (0.072) 6.277 (0.017) (0.474) (0.019) 2.993 (0.019) (0.019) 7.274

Net increase/(decrease) in cash and cash equivalents £m (10.258) 2.939 (4.128) (1.197) (0.185) 0.234 8.214 (7.336) (1.596) (1.602) 3.098 (1.529) (4.707) (5.055)

Opening cash £m 33.285 33.285 33.285 29.157 27.961 27.776 28.010 36.224 28.888 27.292 25.690 28.787 27.258 22.551

Effect of exchange rates £m 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000

Closing cash £m 23.027 36.224 29.157 27.961 27.776 28.010 36.224 28.888 27.292 25.690 28.787 27.258 22.551 17.495

Financial Report – August 2013 Reported Monthly Cash Flow Statement for LANCASHIRECARE

Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual

units













Surplus/(deficit) after tax £m 0.332 0.332 0.332 0.332 0.332 0.332 0.332 0.332 0.332 0.332 0.332 0.332

Non-cash flows in operating surplus/(deficit), Total 0.957 0.957 0.957 0.957 0.957 0.957 0.957 0.957 0.957 0.957 0.957 0.957

Operating Cash flows before movements in working capital 1.289 1.289 1.289 1.289 1.289 1.289 1.289 1.289 1.289 1.289 1.289 1.289

Increase/(Decrease) in workling capital, Total £m 0.108 (0.011) (0.011) (0.011) (0.011) (0.011) (0.011) (0.011) (0.011) (0.011) (0.011) (0.711)

Net cash inflow/(outflow) from operating activities £m 1.396 1.277 1.277 1.277 1.277 1.277 1.277 1.277 1.277 1.277 1.277 0.578

Net cash inflow/(outflow() from investing activities, Total £m (1.898) (2.975) (2.975) (2.975) (2.975) (2.975) (2.975) (2.975) (2.975) (2.975) (2.975) (5.215)

Net cash inflow/(outflow) before financing £m (0.502) (1.698) (1.698) (1.698) (1.698) (1.698) (1.698) (1.698) (1.698) (1.698) (1.698) (4.638)

Net cash inflow/(outflow) from financing activities, Total £m (0.211) (0.035) 6.402 (0.035) (0.035) 4.310 (1.379) (0.035) 6.402 (0.035) (0.035) 4.646

Net increase/(decrease) in cash and cash equivalents £m (0.713) (1.733) 4.704 (1.733) (1.733) 2.612 (3.077) (1.733) 4.704 (1.733) (1.733) 0.008

Opening cash £m 18.588 17.874 16.141 20.845 19.112 17.379 19.991 16.913 15.180 19.884 18.151 16.418

Effect of exchange rates £m 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000

Closing cash £m 17.874 16.141 20.845 19.112 17.379 19.991 16.913 15.180 19.884 18.151 16.418 16.426

Financial Report – August 2013 Reported Monthly Cash Flow Statement for LANCASHIRECARE

Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual

units













Surplus/(deficit) after tax £m 0.333 0.333 0.333 0.333 0.333 0.333 0.333 0.333 0.333 0.333 0.333 0.333

Non-cash flows in operating surplus/(deficit), Total 1.110 1.110 1.110 1.110 1.110 1.110 1.110 1.110 1.110 1.110 1.110 1.110

Operating Cash flows before movements in working capital 1.443 1.443 1.443 1.443 1.443 1.443 1.443 1.443 1.443 1.443 1.443 1.443

Increase/(Decrease) in workling capital, Total £m 0.163 (0.011) (0.011) (0.011) (0.011) (0.011) (0.011) (0.011) (0.011) (0.011) (0.011) (0.694)

Net cash inflow/(outflow) from operating activities £m 1.605 1.431 1.431 1.431 1.431 1.431 1.431 1.431 1.431 1.431 1.431 0.749

Net cash inflow/(outflow() from investing activities, Total £m (0.735) (0.567) (0.567) (0.567) (0.567) (0.567) (0.567) (0.567) (0.567) (0.567) (0.567) 5.567

Net cash inflow/(outflow) before financing £m 0.870 0.864 0.864 0.864 0.864 0.864 0.864 0.864 0.864 0.864 0.864 6.315

Net cash inflow/(outflow) from financing activities, Total £m (1.331) (0.036) (0.036) (0.036) (0.036) (2.154) (2.843) (0.036) (0.036) (0.036) (0.036) (8.181)

Net increase/(decrease) in cash and cash equivalents £m (0.461) 0.829 0.829 0.829 0.829 (1.289) (1.979) 0.829 0.829 0.829 0.829 (1.866)

Opening cash £m 16.426 15.965 16.794 17.623 18.451 19.280 17.991 16.013 16.842 17.670 18.499 19.328

Effect of exchange rates £m 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000

Closing cash £m 15.965 16.794 17.623 18.451 19.280 17.991 16.013 16.842 17.670 18.499 19.328 17.463


APPENDIX V: Capital Capex

Actual Plan Variance Forecast Plan Variance£'000 £'000 £'000 £'000 £'000 £'000

CapexMajor

The Harbour 6.252 10.000 (3.748) 21.800 25.750 (3.950)

Oaklands 0.442 0.333 0.109 2.440 2.700 (0.260)

Moss View 0.024 0.800 (0.776) 1.571 1.700 (0.129)

Other 0.000 0.000 0.000 0.000 0.000 0.000

IT Schemes 0.037 0.133 (0.096) 1.700 1.700 0.000

6.755 11.267 (4.512) 27.511 31.850 (4.339)Minor

Minor Improvements 0.907 0.758 0.149 2.340 2.100 0.240

Backlog Maintenance 0.368 0.200 0.168 0.600 0.600 0.000

TCS Facilities 0.000 0.000 0.000 0.000 0.000 0.000

IT 0.000 0.000 0.000 0.300 0.000 0.300

Other 0.000 0.000 0.000 1.265 0.000 1.265

Contingency 0.001 0.067 (0.066) 0.000 0.400 (0.400)

1.276 1.025 0.251 4.505 3.100 1.405

Capital programme 8.031 12.292 (4.261) 32.016 34.950 (2.934)TCS Property Transfer 6.850 6.850 0.000 7.350 6.850 0.500

Total Capital 14.881 19.142 (4.261) 39.366 41.800 (2.434)

Year To Date Annual

Director of Innovation & Transformation

Chief Executive

Human Resources

Chief Operating Officer

Appendix VI Budgetary Performance

August 2013

Clinical Services

Finance and Business Operations

Medical Director

Nursing

Appendix VI Page 1

CORPORATE REPORT AUGUST 2013

CLINICAL SERVICES

FUNDED WTE BUDGET DETAIL BUDGET ACTUAL £ % ANNUAL PROJECTED £

EST. ACTUAL TO DATE TO DATE VARIANCE VARIANCE BUDGET ACTUAL VARIANCE

£'000 £'000 £'000 £'000 £'000 £'000

PAY

1,718.8 1,785.0 ADULT PAY 28,633.0 29,197.3 -564.3 -2.0 67,832.7 70,451.2 -2,618.4

NON PAY 1,500.6 1,469.6 31.1 2.1 3,543.4 3,509.9 33.5

PATIENT RELATED INCOME -254.7 -258.4 3.7 -1.5 -381.4 -397.5 16.1

NON PATIENT RELATED INCOME -627.3 -624.2 -3.1 -0.5 -1,467.8 -1,493.1 25.2

1,718.8 1,785.0 TOTAL 29,251.6 29,784.2 -532.6 -1.8 69,526.8 72,070.6 -2,543.7

1,930.4 1,860.9 ADULT COMMUNITY PAY 28,320.7 28,090.1 230.6 0.8 66,861.5 67,482.6 -621.0

NON PAY 5,283.0 4,932.9 350.1 6.6 12,695.6 12,102.6 593.0

PATIENT RELATED INCOME -3,745.4 -3,756.6 11.2 -0.3 -8,103.2 -8,076.0 -27.2

NON PATIENT RELATED INCOME -1,047.1 -1,117.8 70.7 6.8 -2,597.7 -2,779.4 181.7

1,930.4 1,860.9 TOTAL 28,811.2 28,148.6 662.7 2.3 68,856.2 68,729.7 126.5

1,323.7 1,265.4 CHILDREN AND FAMILY PAY 20,104.0 19,749.2 354.8 1.8 48,085.3 47,926.1 159.2

NON PAY 2,529.6 2,290.2 239.4 9.5 5,982.4 5,786.5 195.9

PATIENT RELATED INCOME -808.7 -803.2 -5.6 0.7 -1,561.8 -1,561.9 0.1

NON PATIENT RELATED INCOME -1,543.6 -1,507.7 -35.9 -2.3 -3,782.7 -3,850.9 68.1

1,323.7 1,265.4 TOTAL 20,281.2 19,728.5 552.7 2.7 48,723.2 48,299.9 423.3

95.4 91.1 PSYCHOLOGICAL THERAPY PAY 1,401.6 1,312.1 89.5 6.4 3,355.1 3,149.1 206.0

NON PAY 36.0 31.2 4.8 13.4 86.4 74.8 11.6

NON PATIENT RELATED INCOME -1,091.7 -1,036.3 -55.4 5.1 -2,611.3 -2,507.0 -104.3

95.4 91.1 TOTAL 300.7 265.4 35.3 11.7 721.7 617.0 104.6

40.4 37.5 PHARMACY PAY 835.9 751.7 84.2 10.1 2,010.0 1,889.1 120.8

NON PAY 248.7 215.3 33.3 13.4 596.8 541.8 55.0

NON PATIENT RELATED INCOME 0.0 -1.7 1.7 No Budget 0.0 -4.2 4.2

40.4 37.5 TOTAL 1,084.6 965.3 119.3 11.0 2,606.8 2,426.7 180.1

742.8 768.8 SECURE SERVICES PAY 11,415.4 11,682.7 -267.3 -2.3 27,421.3 28,008.5 -587.2

NON PAY 1,368.7 1,399.2 -30.6 2.2 3,284.7 3,493.2 -208.5

PATIENT RELATED INCOME -178.6 -156.1 -22.5 -12.6 -428.7 -384.6 -44.1

NON PATIENT RELATED INCOME -78.4 -116.9 38.5 49.1 -188.1 -287.4 99.3

742.8 768.8 TOTAL 12,527.1 12,809.0 -282.0 -2.3 30,089.2 30,829.7 -740.5

4.0 4.0 CLINICAL MANAGEMENT PAY 203.4 225.8 -22.4 -11.0 488.1 499.7 -11.5

NON PAY 367.9 351.1 16.7 4.5 867.6 861.1 6.5

4.0 4.0 TOTAL 571.2 576.9 -5.7 -1.0 1,355.8 1,360.8 -5.0

5,855.4 5,812.7 TOTAL 92,827.7 92,278.0 549.7 0.6 221,879.6 224,334.4 -2,454.8

Appendix VI Page 2


FINANCE & BUSINESS OPERATIONS



£'000 £'000 £'000 £'000 £'000 £'000

FINANCE

96.95 94.87 PAY 1,402.6 1,343.2 59.4 4.2 3,555.9 3,523.6 32.2

NON PAY 1,157.1 1,094.8 62.3 5.4 2,777.1 2,727.5 49.6

PATIENT RELATED INCOME 0.0 0.0 0.0 No Budget 0.0 0.0 0.0

NON PATIENT RELATED INCOME -438.0 -389.6 -48.3 -11.0 -1,348.3 -1,335.1 -13.2

TOTAL 2,121.7 2,048.4 73.4 3.5 4,984.7 4,916.1 68.6

IM&T

144.37 140.97 PAY 2,427.0 2,424.3 2.7 0.1 5,824.7 5,818.2 6.5

NON PAY 1,124.6 1,641.1 -516.5 -45.9 2,487.8 3,938.7 -1,450.9

PATIENT RELATED INCOME -271.7 -52.7 -219.0 80.6 -652.2 -126.6 -525.6

NON PATIENT RELATED INCOME -588.4 -1,321.2 732.8 -124.6 -1,200.9 -3,170.9 1,970.0

TOTAL 2,691.5 2,691.5 0.0 0.0 6,459.5 6,459.5 0.0

ESTATES & FACILITIES MANAGEMENT

52.90 40.30 PAY 859.2 697.8 161.4 18.8 2,062.2 1,674.8 387.3

NON PAY 8,940.5 9,084.8 -144.3 -1.6 21,232.2 21,707.4 -475.3

NON PATIENT RELATED INCOME -146.5 -213.3 66.8 45.6 -351.7 -512.0 160.3

TOTAL 9,653.2 9,569.3 83.9 0.9 22,942.6 22,870.3 72.3

294.2 276.1 TOTAL 14,466.3 14,309.1 157.2 1.1 34,386.8 34,245.8 141.0

Appendix VI Page 3


MEDICAL DIRECTOR



£'000 £'000 £'000 £'000 £'000 £'000

PAY

14.22 14.53 MEDICAL 450.1 390.8 59.4 13.2 1,078.1 1,017.8 60.3

33.21 31.92 RESEARCH 527.2 539.3 -12.2 -2.3 1,182.4 1,254.4 -72.0

5.51 5.31 CLINICAL AUDIT 82.8 83.4 -0.6 -0.7 198.7 200.1 -1.4

52.9 51.8 TOTAL 1,060.1 1,013.5 46.6 4.4 2,459.2 2,472.3 -13.1

NON PAY

MEDICAL 49.0 43.2 5.8 11.8 117.6 133.8 -16.2

RESEARCH 84.1 34.7 49.4 58.7 196.5 60.4 136.1

DRUGS 862.5 785.1 77.4 9.0 2,069.9 1,970.0 100.0

CLINICAL AUDIT 5.2 2.7 2.5 47.5 12.5 6.1 6.4

TOTAL 1,000.8 865.8 135.0 13.5 2,396.5 2,170.2 226.3

NON-PATIENT RELATED INCOME

MEDICAL -258.4 -256.6 -1.7 0.7 -620.0 -615.9 -4.1

RESEARCH -582.4 -552.7 -29.7 5.1 -1,380.5 -1,326.4 -54.1

TOTAL -840.7 -809.3 -31.4 3.7 -2,000.6 -1,942.3 -58.3

TOTAL 1,220.2 1,070.0 150.2 12.3 2,855.1 2,700.2 154.9

Appendix VI Page 4


DIRECTOR OF NURSING



£'000 £'000 £'000 £'000 £'000 £'000

PAY

11.99 9.34 DIRECTOR 368.1 362.6 5.5 1.5 883.4 880.2 3.2

26.06 22.40 CORPORATE RISK 474.7 448.6 26.1 5.5 1,139.4 1,110.3 29.1

19.27 16.11 CLINICAL GOVERNANCE 265.3 267.6 -2.3 -0.9 636.7 642.1 -5.5

21.42 17.77 CUSTOMER CARE 313.4 308.4 5.0 1.6 752.1 745.2 6.9

78.7 65.6 TOTAL 1,421.5 1,387.2 34.3 2.4 3,411.5 3,377.8 33.7

NON PAY

DIRECTOR 52.0 81.6 -29.6 -56.9 124.8 195.7 -71.0

CORPORATE RISK 39.9 35.8 4.1 10.2 95.8 86.0 9.8

CLINICAL GOVERNANCE 57.9 44.4 13.4 23.2 138.9 116.7 22.2

CUSTOMER CARE 35.5 33.5 2.0 5.6 85.3 80.5 4.8

TOTAL 185.3 195.3 -10.1 -5.4 444.7 478.8 -34.1


DIRECTOR -8.7 -20.9 12.2 -140.2 -20.9 -40.1 19.3

CLINICAL GOVERNANCE 0.0 -1.0 1.0 No Budget 0.0 -2.4 2.4

COMPLAINTS -1.5 1.5 No Budget 0.0 -3.6 3.6

TOTAL -8.7 -23.5 14.8 169.8 -20.9 -46.3 25.4

TOTAL 1,598.0 1,559.0 39.0 2.4 3,835.3 3,810.3 25.0

Appendix VI Page 5


HUMAN RESOURCES



£'000 £'000 £'000 £'000 £'000 £'000

PAY

115.33 124.83 HUMAN RESOURCES 1,408.5 1,502.8 -94.3 -6.7 3,363.3 3,377.3 -14.0

115.3 124.8 TOTAL 1,408.5 1,502.8 -94.3 -6.7 3,363.3 3,377.3 -14.0

NON PAY

HUMAN RESOURCES 671.9 683.4 -11.5 -1.7 1,585.3 1,610.1 -24.8

TOTAL 671.9 683.4 -11.5 -1.7 1,585.3 1,610.1 -24.8


HUMAN RESOURCES -320.2 -338.6 18.5 5.8 -724.1 -762.7 38.7

TOTAL -320.2 -338.6 18.5 5.8 -724.1 -762.7 38.7

TOTAL 1,760.2 1,847.5 -87.3 -5.0 4,224.6 4,224.6 0.0

Appendix VI Page 6


EXECUTIVE



£'000 £'000 £'000 £'000 £'000 £'000

PAY

9.73 11.27 EXECUTIVE 238.9 230.3 8.6 3.6 578.3 552.7 25.6

1.00 1.00 NON EXECUTIVE 51.8 55.6 -3.8 -7.4 124.3 133.5 -9.2

5.80 4.49 COMPANY SECRETARY 114.8 92.6 22.2 19.3 270.2 222.3 47.9

16.5 16.8 TOTAL 405.6 378.5 27.0 6.7 972.8 908.5 64.3

NON PAY

EXECUTIVE 90.2 293.6 -203.4 -225.6 217.4 611.9 -394.5

NON EXECUTIVE 4.8 8.9 -4.1 -85.6 11.5 21.3 -9.8

COMPANY SECRETARY 45.2 13.5 31.8 70.2 108.5 32.3 76.2

TOTAL 140.2 316.0 -175.8 -125.4 337.5 665.6 -328.1


EXECUTIVE -3,855.0 -3,927.4 72.4 1.9 -9,251.9 -9,425.8 173.9

TOTAL -3,855.0 -3,927.4 72.4 1.9 -9,251.9 -9,425.8 173.9

TOTAL -3,309.2 -3,232.9 -76.3 2.3 -7,941.6 -7,851.6 -90.0

Appendix VI Page 7


CHIEF OPERATING OFFICER



£'000 £'000 £'000 £'000 £'000 £'000

PAY

5.00 3.00 SERVICE IMPROVEMENT TEAM 85.5 64.6 20.9 24.5 205.3 175.1 30.2

17.82 18.73 CHIEF OPERATING OFFICER 450.1 352.0 98.2 21.8 1,066.1 938.4 127.7

22.8 21.7 TOTAL 535.7 416.6 119.1 22.2 1,271.4 1,113.5 157.9

NON PAY

SERVICE IMPROVEMENT TEAM 36.3 4.1 32.2 88.8 87.0 39.7 47.3

CHIEF OPERATING OFFICER 70.8 128.0 -57.2 -80.8 169.9 307.1 -137.2

TOTAL 107.1 132.0 -25.0 -23.3 257.0 346.9 -89.9

PATIENT RELATED INCOME

DIRECTOR STRATEGIC DEVELOPMENT -29.8 -29.7 0.0 0.0 -71.4 -71.4 0.0

TOTAL -29.8 -29.7 0.0 0.0 -71.4 -71.4 0.0

TOTAL 613.0 518.9 94.1 15.4 1,457.0 1,389.0 68.0


DIRECTOR OF INNOVATION & TRANSFORMATION



£'000 £'000 £'000 £'000 £'000 £'000

PAY

8.69 8.14 DIR INNOVATION & TRANFORMATION 223.9 191.5 32.4 14.5 585.6 494.6 91.0

8.7 8.1 TOTAL 223.9 191.5 32.4 14.5 585.6 494.6 91.0

NON PAY

DIR INNOVATION & TRANFORMATION 6.2 5.1 1.1 17.7 15.9 16.9 -1.0

TOTAL 6.2 5.1 1.1 17.7 15.9 16.9 -1.0

TOTAL 230.1 196.6 33.5 14.6 601.5 511.5 90.0


TRUST BOARD – 03 OCTOBER 2013 PERFORMANCE REPORT


Not Applicable

PAPER TITLE: Integrated Quality and Performance Report

PURPOSE: To purpose of this report is to provide Board members with performance data for the Trust

ACTION RECOMMENDED:

Noting

PAPER PREPARED BY: Damian Nelson, Head of Performance

PERFORMANCE DASHBOARD The attached report details the performance of the Trust for the latest data on each of the metrics. The latest data point will vary dependent on the relevant reporting period for that metric. The Performance Dashboard can be accessed through the link below

http://lct-yellowfin:8080/

The Board’s attention is drawn specifically to the following:

Workforce and Culture The metrics in the Workforce and Culture perspective are presently being revised by the Executive Director of Transformation and Innovation. They will be presented to the Executive Management Team and developed onto the Performance Dashboard.

Within this perspective, the point to note is the continuing fall in sickness absence levels which are below the threshold of 5% in the month.

Finance and Business The surplus for the five months to August is £1,599k against a plan of £1,784k, forecast to result in a full year outturn surplus of £3.1m against a plan of ££4.0m. This includes an under achievement of £311k YTD against the cost improvement programme. The under achievement is driven mainly by pressures in Adult Mental Health around inpatient services. While this is of concern, cash balances continue to hold up strongly and the risk rating YTD is in line with the plan of 3 and is projected to remain so for the year as a whole. Contracts and Performance The data for August shows the continuing pressures on beds within the Adult network. Overall occupancy, including out of area placements, equated to 104.3%. Average length of stay was 30.1 days for the Adult network in August. The occupancy for Older Adults was


TRUST BOARD – 03 OCTOBER 2013 PERFORMANCE REPORT

91.6% in August, which reflects higher demand in dementia beds combined with a reducing bed compliment. The average length of stay was at 60 days for the network, length of stay in advanced care wards was 54 days and on dementia wards was 68 days. Quality, Compliance and Innovation The Community Information Dataset targets have all been met in August. As the Trust standard systems continue to be rolled out to community teams, particular attention will be paid to these indicators.

The performance for the consultant led waiting times, applicable to Rheumatology only, continues to be excellent both they are at 100% for both the completed and incomplete pathways in August.

The 7 day follow up performance for August was under threshold at 94.7%. The Head of Performance was asked by the network to look at the interpretation of the Monitor guidance for this indicator with regards to readmissions within 7 days. The Head of Performance recommended a revision based on the exclusion of these patients and has made specific recommendations to the network which have been accepted.

Future Developments The Performance Team are working with the Chief Operating Officer and the networks to further develop the dashboard to Network level. The Performance Team have specified the mandatory metrics at this level.


TRUST BOARD – 03 OCTOBER 2013 COUNCIL OF GOVERNOR MINUTES


Not Applicable

PAPER TITLE: Council of Governor Minutes

PURPOSE: To ensure the Trust Board remain informed about the activity of the Council of Governors and any issues arising from their discussions.

ACTION RECOMMENDED:

Noting

PAPER PREPARED BY: Ashley Christian, Council of Governors Support Officer

EXECUTIVE SUMMARY The confirmed minutes from the Council of Governor meeting held on 26th June 2013 are provided to keep the Trust Board informed about the activity of the Council of Governors and any issues arising from their discussions. The Trust Board have received previous minutes detailing activity from Council of Governor meetings. Copies of CoG agendas and papers are available on the Trusts’ website, with papers exempted from publication under the Freedom of Information Act being available on request from the Company Secretary.

Council of Governors

CONFIRMED

COUNCIL OF GOVERNORS Minutes of the Part 1 meeting of the Council of Governors held on 26th June 2013 Present Derek Brown (Acting Chair) Public Governors Alan Ravenscroft Brian Spencer Brian Taylor Catherine Dobson David Jackson Linda Jones Hilary Whitworth Jane Kay John MacLeod Mike Marsden Mike Wedgeworth Tahir Khan Tom Lawman Appointed Governors Nigel Harrison Staff Governors Barbara Hummer Caroline Johnson Graham Ash Linda Ravenscroft Paul Morris

In Attendance Prof Heather Tierney-Moore, Chief Executive Peter Ballard, Non-Executive Director (SID) Gwynne Furlong, Non-Executive Director Jim Taylor, Non-Executive Director Diane Halsey, Company Secretary Dave Tomlinson, Director of Finance Steve Winterson, Engagement Director Bev Pickover, Head of Communications Angela Wetton, Head of Company Secretary Service

CG063.13 WELCOME AND OPENING COMMENTS The Chair welcomed everyone to the meeting and confirmed that the meeting was quorate.

CG064.13 APOLOGIES FOR ABSENCE AND DECLARATIONS OF INTEREST Apologies had been received from Andrea Walker, Selvizhi Subramanian, David Jones, Andrew Kirkby and Non-Executive Director, Chris Heginbotham. The Chair declared an interest in item CG069.13 and confirmed the Senior Independent Director would chair this item under Part 2 of the meeting. The Chair confirmed the arrangements for the rest of the meeting.

CG065.13 MINUTES OF COUNCIL OF GOVERNOR MEETING HELD ON 16th APRIL 2013 The minutes of the last meeting held on 16th April 2013 were confirmed as a true and accurate record.


CG066.13 MATTERS ARISING AND ACTION TRACKER UPDATES

The Council of Governors reviewed the action tracker and noted that all items are now closed.

CG067.13 THIS AGENDA Governors were given the opportunity to raise issues arising out of reports issued for information. There were no issues raised and the reports were taken as read.

CG068.13 TRANSFORMATION PROGRAMME/THE PLAN The Chief Executive gave a presentation on the progress of the

Transformation Programme ‘Engaging for Excellence’ which gave Governors context around the Trust’s strategic plan and the on-going period of major change within the organisation. She outlined the Trust’s Strategic Blueprint and explained the process behind achieving the aspirations set out within the plan and the importance of making progress against the clinical, business and quality aspects of the plan.

The Chief Executive highlighted the impact of recent changes in commissioners as well as the publication of the Francis II Report. She emphasised the importance of patient care and experience in measuring the Trust’s performance and discussed the challenges faced by the NHS in responding to the demands of an ageing population. The Chief Executive also commented on the move towards personalised care, ensuring that a different and much more flexible approach to care is realised in the future. The Chief Executive outlined the overall strategy of the Trust in responding to these changes and emphasised the importance of people, culture and systems at the core of delivering change. She illustrated Lancashire Care’s ambitions to achieve upper quartile performance in terms of quality of care and cost effectiveness.

The Chief Executive provided details on the progress to date of some of the ‘big ticket’ items within the Energising for Excellence programme, including Long Term Conditions, Electronic Prescribing, Inpatient Transformation and the Mind the Gap project. Updates were also given on the Agile Working and Space Utilisation projects. The Chief Executive gave an overview on the implementation of the Quality Strategy and the use of the Quality SEEL tool introduced during the previous year. She described the focus on achieving excellence in practice and also how the Board gain their assurance from the systems and the information flows. The Chief Executive advised that the Trust Board was pleased with progress to date and would continue to oversee the Engaging for Excellence plan.


The Council requested assurance around the confidence of the Board that there was sufficient leadership capacity and capability throughout the Trust to ensure delivery of the strategic aims and Engaging for Excellence projects. The Chief Executive explained how the Trust was investing in leadership programmes and gave detail around the complexities of clinical leadership. The Chief Executive summarised the challenges in ensuring people have the right skills and resource to deliver the business plans but assured the Council that there was a process in place to ensure teams have access to resource as appropriate. Changes to the Trust Board and senior network managers were highlighted and the process of managing this period of change was shared. Confirmation was given that a Director of Transformation had recently been appointed to fill the vacancy on the Trust Board and the robust procedures to fill the other vacancies at senior Network Director and Board level were outlined. The expected timescale of filling vacancies was discussed in line the need to ensure the correct skill mix amongst Board members.

CG069.13 REPORT FROM THE CHAIR OF REMUNERATION/NOMINATION

COMMITTEE It was agreed that this item would be taken later in the meeting, under Part 2.

CG070.13 REVISED GOVERNANCE HANDBOOK

The Company Secretary introduced the paper and reminded Governors how the Trust codifies the role and duties of Governors. She discussed how the Health and Social Care Act has impacted on the role of Governor and gave details of the revisions to the Governance Handbook to reflect the current statutory duties of Foundation Trust Governors. The Company Secretary noted that following the informal Governor discussion earlier on ‘Holding Non-Executives to Account’, part 2 of the Governors Handbook may be reviewed to reflect the outcomes of the informal discussion. She also drew the Councils attention to the revised terms of reference for the joint Nomination-Remuneration Committee within the Governance Handbook.

A Governor commented that the Governance Handbook was a helpful document for identifying the role of a Governor.

CG071.13 GOVERNOR TERMS OF OFFICE & ELECTION ACTIVITY The Head of Company Secretary Service asked the Council to note the

paper on Governor Terms of Office and highlighted the key points around the dates for elections later in the year. She outlined the process of aligning the member constituencies to the new CCG footprint and confirmed the current Governor vacancies. It was noted that Linda Ravenscroft’s term of office would be aligned with the rest of the Council and the Trust would hold a single election for vacancies in November 2013. The Head of Company Secretary Service reflected on the proposal for publicising the elections and confirmed UK Engage would be the Trust’s election partner.


The Head of Company Secretary Service moved on to discuss item CG075.13 and the links between appointed Governors and election activity planned for later this year. She updated the Council on the appointed governor vacancies and the possible move to introduce other key partners such as Public Health as agreed at the April Council of Governor meeting. Following a Governor query the Head of Company Secretary Service explained the rationale behind moving to another election partner. The Company Secretary emphasised that the Constitution’s Model Rules of Election are still applicable and remain unaffected by a change to the election partner.

CG072.13 PROPOSAL FOR THE 2013 ANNUAL MEMBERS MEETING

The Head of Company Secretary Service gave some background to the Annual Members Meeting (AMM) and explained the requirements as set out in the Constitution. She discussed the formal business to be undertaken at the AMM and noted the proposal had been recommended for approval by the Membership and Governance Committee. The rationale for holding the AMM separately to an engagement event was discussed and the Council were asked to approve the proposal.

A Governor emphasised to the Council the importance of a high Governor presence at the AMM to promote awareness of the Governors role and also encourage members to attend.

The Council approved the Annual Members Meeting proposal.

CG073.13 OUTCOME FROM GUIDED CONVERSATION The Head of Company Secretary Service introduced the paper and gave

apologies for some incorrect wording within the appendix. These items were reviewed and clarified and the Council were asked to note the paper.

A Governor raised some concerns around his personal experience of the

guided conversation process and suggested examples of flaws within the current process. A discussion followed around the value of guided conversation in the current format and it was generally felt that the process itself was beneficial but the paperwork was no longer fit for purpose. The Company Secretary reminded the Council of the origins of guided conversation as a tool designed by governors for governors and suggested a review be undertaken with a possible move to peer review instead.

CG074.13 CQC PROJECT ‘WORKING TOGETHER’ The Head of Company Secretary Service gave some background to the joint CQC/FTGA “Working Together” project and its progress so far. She explained that the previous Governor representative for the project had stepped down leaving an opportunity for another governor to become involved. She informed the Council of the current development changes taking place at the FTGA which have impacted on the progress of the project and as there is currently no clear indication of next steps it was agreed that


this be picked up again once the direction of the project is confirmed by the CQC/FTGA.

CG075.13 UPDATE ON APPOINTED GOVERNORS

This item was covered by the Head of Company Secretary Service under item CG071.13

CG079.13 ANY OTHER BUSINESS The Chief Executive referred to two queries received from Governors in the

past week and confirmed that the response around the CAHMS query had been tabled. The Chief Executive went on to clarify the concern raised around the recent release of nationwide restraint figures by the organisation MIND. The Chief Executive explained that the figures themselves had little context behind them and discussed some of the factors that contribute to the Trust’s score. The Acting Director of Nursing was currently leading a review on the use of face-down restraint in the Trust.

An in-depth discussion followed around previous research into use of

restraint and the progression of the Trusts own research in conjunction with UCLan. The Governors were mindful of the fact that media can use figures out of context. The Chief Executive advised that the detail from these discussions would be conveyed to the Acting Director of Nursing for absorption into his review.

The Chair asked that an update be brought back to the Council upon

completion of the report and this was expected in October. CG080.13 DATE AND TIME OF NEXT MEETING Formal Council of Governors, Wednesday 18th September, 4:00 – 6:00pm

LANCASHIRE CARE NHS FOUNDATION TRUST BOARD Board/Trust Board... · 2014-08-27 · A Non-Executive...

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