MINUTES OF A MEETING OF THE CAMDEN AND ISLINGTON NHS ... papers... · 17.01.143 Service User Story:...

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MINUTES OF A MEETING OF THE

CAMDEN AND ISLINGTON NHS FOUNDATION TRUST

BOARD OF DIRECTORS HELD IN PUBLIC

IN THE CONFERENCE HALL, ST PANCRAS HOSPITAL,

ST PANCRAS WAY, LONDON, NW1 0PE.

Tuesday 28 September 2017 at 2:00pm

Board Members Present:

Ms Leisha Fullick Chair

Ms Pippa Aitken Non-Executive Director

Prof Tom Burns Non-Executive Director

Ms Caroline Harris-Birtles Director of Nursing

Ms Angela Harvey Senior Independent Director

Dr Sue Goss Non-Executive Director

Dr Vincent Kirchner Medical Director

Ms Angela McNab Chief Executive

Mr Kieran Parmar Non-Executive Director (via Skype)

Ms Sally Quinn Director of Human Resources & Organisational Development

(Non-voting Member)

Mr Andy Rogers Chief Operating Officer

Mr Darren Summers Director of Strategy & Business Development

(Non-voting Member)

Mr David Wragg Director of Finance

Mr Patrick Vernon Non-Executive Director

In Attendance:

Ms Terri Burns Trust Company Secretary

Mr Martin Zielinski Board Secretary (minutes)

The following attended for the Service User Presentation (Item 17.01.143 only):

Hamid Rahmanian Consultant Psychiatrist

Accompanied by a service user

This meeting was open to the public

Minutes of the Public Board Meeting on 28 September 2017 Version: FINAL

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GENERAL BUSINESS

17.01.141 Welcome, Apologies & Quoracy

Ms Fullick welcomed those present. All Board members were present and the meeting was quorate.

17.01.142 Declarations of Interest

The register of declared interests had been issued as part of the meeting’s pack and no changes were requested.

17.01.143 Service User Story: Kingston Primary Care Mental Health and iCope

Dr Rahmanian thanked the Board for inviting him to attend. He explained the role of the Kingston Primary Care Mental Health Team and its work alongside GPs and practice nurses offering responsive mental health expertise within primary care providing an alternative to, and reducing the need for, secondary care. The team also worked jointly with Kingston CCG and local iCope Psychological Services. He gave further details on the services provided and referral sources, highlighting that the team had received 785 referrals during 2016/17. He advised that the service was currently offered across five of Kingston’s 22 GP surgeries and had received very favourable feedback via the ‘Friends and Family Test’.

The attending service user gave very positive feedback on how the service, and particularly Dr Rahmanian, had assisted her by correcting her prescribed medication to better match her requirements and continued to offer prompt and on-going support.

In response to Dr Kirchner, the service user considered that she would have been left on her previous anti-psychotic medication, which had been ineffective and had negative side effects, if this service had not been in place. In response to Dr Goss, Dr Rahmanian stated that miss-prescribing was rare and, in this instance, the service user had been diagnosed in another country and the specific medication originally prescribed was not the most effective for her individual needs.

Mr Rogers advised that the Kingston Primary Care Mental Health Team was highly respected by the commissioning CCG. Dr Rahmanian’s comment that, ideally, this service and related follow-up care would be more widely available was acknowledged. He added that discussions were underway with the South West London and St George’s Mental Health NHS Trust to explore the potential to increase service provision on a joint basis.

Ms Fullick thanked the team for travelling in from Kingston and providing an informative, engaging and positive presentation.


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17.10.144 Minutes from the previous meeting

The minutes of the previous meeting were reviewed and one amendment was requested by Ms Aitken. She advised that at the previous meeting she had stated, in relation to the Annual Research and Development Report, that the St Pancras Programme Development Board had agreed that there would be separate communications plan for research, distinct for the main St Pancras Redevelopment Programme communications plan. She was not required to undertake any further action.

The Board of Directors AGREED the minutes of its previous public Board meeting on 27 July to be a fair and accurate record of that meeting, subject to the requested amendment.

Matters Arising

17.01.145 The Board reviewed the matters arising from its previous public meeting on 28 September 2017. All of the required actions were considered as completed with the following exceptions and additional comments:

17.01.146 MA 5: Preparation for CQC Inspection Ms Harris-Birtles advised that the requested update was included in her CQC update, which would be provided in the subsequent private Board session.

17.01.147 MA 6: Annual Risk Management Report 2016/17 Mr Rogers advised that work on the analysis of incidents of violent, aggression and restrain was on-going. This matter was carried forward.

C/fwd

17.01.148 MAs 7 & 8: Updates on the effectiveness of introduced HR Roadshows and the staff ‘buddying’ scheme Ms Quinn advised that the requested updates would be provided in the next HR & Workforce Performance Report which was due to be presented at the next meeting. These matters were carried forward.

C/fwd

17.01.149 MA 9: Updating of the monthly finance report. Mr Wragg advised that the requested updates would be evident in the month 5, 2017/18 finance report that would be provided later in the meeting. (see item 17.01.161 below)

17.01.150 MA 10: Research & Development Annual Report. As recorded in section 17.01.144 above, the related minute had been captured incorrectly and no action should have been required.

17.01.151 No further matters arising were raised in addition to those listed on the presented schedule.


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17.01.152 Chief Executive’s Report

Ms McNab presented her regular update report to the Board. She highlighted the success of the programme of Executive service visits and how they were proving effective in informing management on the progress made against the Trust’s CQC action plan and on where issues blocking progress had yet to be addressed. She also drew attention to a recent psychiatric liaison CQC inspection advising that initial informal feedback had been positive and reflected the environmental improvements which had been made. She also highlighted that progress toward the opening of a new women’s PICU service at St Pancras was on track and that the appointment of staff had commenced. She also advised that a recent presentation of the Trust’s St Pancras Redevelopment Programme to a joint Camden and Islington Health Overview & Scrutiny Committee had been well received and supported. The Trust was invited to return and present its Final Business Case to the joint committee, once completed.

Dr Kirchner advised that a Women’s PICU Conference was being held on 16 November 2017 and that the Trust would attend and learn from the experiences of other providers of PICU service.

Ms Harvey queried the name that would be given to the Trust’s new women’s PICU service. Dr Kirchner advised that he expected the tradition of using the names of precious stones to be continued, adding that staff were being surveyed on possible options. He would happily discuss this further with Ms Harvey after the meeting if she would like further information.

There was no reported use of the Trust seal.

The Board of Directors RECEIVED, CONSIDERED and ACCEPTED the Chief Executive’s update report.

QUALITY IMPROVEMENT, SAFETY AND EXPERIENCE

17.01.153 Clinical Strategy 2016-2021 – Update September 2017

Dr Kirchner presented this update advising the Board on the progress made in implementing the Trust’s Clinical Strategy and the path forward to address those areas lacking progress. The paper also detailed some of the benefits obtained from service reconfigurations to date. Dr Kirchner was pleased with progress made to date but acknowledged that there remained issues to be addressed, highlighting demand for Camden’s recovery services and waiting list issues.

Ms Fullick praised the rich picture this report provided in highlighting where effective progress had been achieved and where difficulties remained. She highlighted the need for on-going work to further connect inpatient and community service and reduce the number of assessments faced by service users in the course of their care. Dr Goss similarly commended this paper. She found the positive/negative assessment of service reconfigurations useful and appreciated the presented staff view on how specialist services could be retained whilst


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making the referral and assessment process more streamlined, with priority focused on progressing an individual’s care.

Prof Burns supported the report, commenting that Community Mental Health Teams (CMHTs) work processes remained overly complex and over-stretched. He referred to his comments at an earlier meeting on how the removal of waiting lists would encourage clinicians to be more focussed on making difficult threshold decisions regarding the evaluation and provision of required care. Dr Kirchner acknowledged the pressures on CMHTs and advised that the Clinical Strategy supported increasing resources for these teams. He added that variations between the proportion of those with psychosis seen by CMHTs, rather than acute services, in Camden and Islington had to be understood and action taken to free up the CMHTs where appropriate.

Ms Harvey queried whether a noted issue regarding printing from CareNotes had been addressed. Dr Kirchner assured her that clinicians had been fully involved in the development of CareNotes and that work was underway to rectify the stated printing issues. Printing guidance was being rolled out to all CareNotes users and programmers were working on the

development of a single ‘print’ button and the generation of a

shorter care summary, as an alternative to the full 32 page report. Other software improvements were also in development.

In response to Dr Goss, Dr Kirchner assured the Board that CMHT services were fully engaged in work to improve waiting list management and that the level of unfunded demand was reported back to CCGs.

In response to Mr Parmar, Dr Kirchner confirmed that the risks to fully implementing the clinical strategy were fully reflected in

the Trust’s Board Assurance Framework (BAF) and lower level

risk registers. He also acknowledged the high level of interdependence between acute and primary care services; local authorities; and voluntary and other sectors. This was reflected on the BAF and he was hopeful that the activities of all parties would become increasing aligned as wider Strategic Transformation Plans were developed.

Mr Rogers stated that he could bring a report to the next Board on the significant work being undertaken on waiting lists. The Board agreed that this would be helpful and requested it include consideration of Prof Burns' suggestion on the removal of waiting lists. Mr Rogers added that the Clinical Strategy set out a sustainable model of care provision which should avoid the need for future waiting lists, once the existing waiting lists were cleared.

The Board RECEIVED, CONSIDERED and ACCEPTED the

provided update on the progress of the Trust’s Clinical

Strategy.

Mr Rogers


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17.01.154 Quality and Safety Overview

Ms Harris-Birtles presented this regular report taking the content as read. She highlighted the number of new NICE guidelines applicable to C&I and the current level of compliance. She added that the Trust could only state partial compliance where guidelines were only partially relevant to the Trust as it was not allowed to break down guidelines into relevant and irrelevant components.

In response to Ms Fullick, Ms Harris-Birtles advised that work was underway to increase compliance with relevant NICE guidance although 100% compliance was unachievable due to the regular release of new guidelines and the time taken to review these for relevance and then, where appropriate, distribute and embed them throughout the Trust.

In response to Ms Harvey, Ms Harris-Birtles advised that the CQC would consider the Trust’s compliance with NICE guidelines and would view verifiable efforts to improve compliance favourably. She added that NICE guidance compliance is monitored by the internal Quality Governance Group and is required to be reported to the Clinical Quality Review Group, which is CCG led.

The Board RECEIVED, CONSIDERED and ACCEPTED the provided Quality and Safety Overview.

17.01.155 Implementation of Triangle of Care

Ms Fullick noted that this paper had recently been discussed extensively by the Quality Committee and it was taken as read. Dr Goss, Quality Committee Chair, added that the main aspects to note were an acknowledged need to improve carer engagement and that any actions taken had to be effective and produce long-term improvements for service users. It was agreed that a pilot implementation of the ‘triangle of care’ would commence, ahead of a full scale programme of self-assessments being rolled out in January 2018.

The Board RECEIVED, CONSIDERED and ACCEPTED the provided paper on the implementation of the ‘Triangle of Care’.

17.01.156 Implementation of Service User Involvement Strategy

Dr Goss advised that the Quality Committee had considered this strategy in detail and it was taken as read. She was also pleased to advise that a ‘Service User Involvement Facilitator’ post had now been filled. She added that the Quality Committee was currently considering the appropriateness of incorporating a service user representative.

The Board were pleased to note the development of this strategy and were assured that service user and carer engagement within the Trust had improved, although there was more still to do. Ms Fullick highlighted her support for the


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strategy’s theme of ensuring a clear and robust process place covering the rewards available for service users in return for their involvement.

The Board RECEIVED, CONSIDERED and ACCEPTED the provided paper on the Implementation of the Service User Involvement Strategy.

OPERATIONAL PERFORMANCE

17.01.157 Board Performance Report (Month 5 2017/18 data)

Mr Rogers presented this report advising that its format continued to be developed to best support the Board’s information requirements. He highlighted the improvements made in aligning Trust internally reported data with that collected and published by NHS Digital. He also drew attention to the table of ‘additional performance indicators’ that now focussed attention on those areas that may need action, and broke down performance between services provided in Camden and Islington. The report also now included new ‘length of stay’ data, with waiting list data in development.

Ms Fullick queried whether the Trust would meet the stated re-admission rate targets. Mr Rogers advised that further work was required to improve admission and discharge management. Crisis teams and CMHTs were working as effectively as possible to best manage the need for inpatient admissions and the length of patient stays. Mr Summers added that the recent transfer of a number of service users from rehabilitation wards to a more appropriate community setting would ease the pressure on available beds.

Mr Parmar welcomed the improvements made to enhance the usefulness of this report. In relation to the ‘red’ rating in relation to ‘patients completing treatment moving into recovery’, he was advised by Mr Rogers that the Trust had been benchmarked against national data and that there were issues with variances over how different trusts coded and reported such data, although this was improving over time.

In response to Mr Parmar’s reference to the ‘admissions and discharge’ table, Dr Kirchner advised that not all received referrals resulted in an admission. Mr Rogers agreed to further review the data ahead of the next meeting as it was noted that the presented increase in admission was not off-set by a similar change in the number of discharges, which would effectively require additional beds. As the Trust’s bed base was constant, he would establish whether the presented data included outplacements.

The Board RECEIVED, CONSIDERED and ACCEPTED the provided Board Performance Report.

Mr Rogers


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17.01.158 HR / Workforce Performance Report Q1, 2017/18

Ms Quinn presented this report, advising that the Q2 report would be presented at the next meeting. She highlighted that there had been reductions in turnover, the sickness rate and in bank and agency spend since the end of the 2016/17.

The Board noted concern over the number of failures to meet core skills compliance targets. Ms Quinn updated them detailing compliance rates which had significantly improved since the production of this Q1 report. She was also confident that the target rate of 80% compliance for all core skills would be exceeded before the CQC visited the Trust in December 2017. She added that her team were also working to increase the reported Trust-wide staff appraisal rate of 48% with the aim of meeting the compliance target which was similarly set at 80%. It was acknowledged that recent changes in appraisal processes may have had an impact on compliance levels. Ms Aitken stressed the importance of measuring the value added by the appraisal process, in addition to gathering statistics on the number of appraisals completed. Ms Fullick agreed, stating that the appraisal process should add to staff’s sense of being valued and was a key to supporting cultural change. In response to Dr Kirchner, Ms Quinn advised that data on the appraisal of clinicians would be picked up from the existing doctor revalidation process.

Ms Quinn drew attention to the age banding of staff which highlighted the need for effective succession planning. HR had started a specific piece of work in relation to this issue.

Mr Parmar commented on the wide variance between the number of applicants for vacancies, compared to the number short-listed and ultimately appointed. Ms Quinn advised that the latter number reflected those staff who actually started in post during the reported period which may differ from the number of appointments in the same period. Many of those engaged may have an existing notice period delaying their start at C&I. She would consider how the reported data could be better reported to reflect activity within each quarter. Mr Rogers added that some staff groups had periodic intakes of new staff such as cohorts of qualifying students, that may impact on reported recruitment data.

The Board RECEIVED, CONSIDERED and ACCEPTED the provided Board Performance Report.

17.01.159 Learning and Organisational Development Update

Ms Quinn presented this update paper, taking the content as read. She highlighted that direct training funding from Health Education England (HEE) had reduced by 30% when compared to 2016/17. At the Board’s request she defined the difference between direct and indirect training funding. Whilst the Trust actually receiving some monies to fund ‘direct’ training, in the case of ‘indirect funding’ it was only able to allocate staff to places on externally funded courses.


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In relation to apprenticeships, Ms Quinn advised Ms Aitken that the Trust aimed to engage 50 apprentices per annum. She acknowledged that this target may not be achieved for 2017/18 and that this had not assisted by delays in the HEE giving approval for relevant courses. She added that HR’s Vacancy Review Panel considered all newly identified vacancies and whether they were an appropriate post to be offered as an apprenticeship. She confirmed to Ms Fullick that the Trust would lose apprenticeship funding if it did not meet its target of 50.

The Board RECEIVED, CONSIDERED and ACCEPTED the provided update on learning and organisational development.

17.01.160 Report on Safe Working Hours for Doctors in Training

Dr Kirchner advised the Board they were required to be assured on the safe working of junior doctors on a quarterly basis. This report would be expanded to include benchmarking once sufficient historic data was available. This was the second quarterly report produced. He added that the Trust had received six exception reports where planned working hours had been exceed during the quarter and all had been resolved locally. There were no material issues to bring to the Board’s attention and the report was taken as read.

The Board RECEIVED, CONSIDERED and ACCEPTED the provided report on safe working hours for doctors in training.

17.01.161 Month 5, 2017/18 – Financial Position

Mr Wragg advised that there Trust’s financial position had not changed significantly since the previous month. There had been some reduction in bank and agency staff costs but the number of required outplacements had increased, reflecting an unusual increase in demand for women’s PICU services. Looking ahead, the planned opening of women’s PICU within the Trust would allow such care to be provided in-house and also allow additional beds to be offered to neighbouring service providers producing additional income.

Ms Fullick sought assurance that C&I would not find itself in a situation where its new women’s PICU service was filled with other provider patients resulting in C&I patients having still to be outsourced. Ms Summers assured her that care of C&I patients was prioritised and that only a small proportion of the 12 beds would be available to other providers. The Trust was working with Barnet Enfield and Haringey Mental Health NHS Trust to jointly agree clinical admission standards and operational arrangement with a view to accommodating their regular demand for 4-5 women’s PICU beds. Funding arrangements would be agreed as a secondary matter. Mr Summers added that the introduction of an in-house service


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would improve the Trust’s ability to directly manage length of stay for women in PICU services. Ms Fullick welcomed this information, adding that the Board would be like to receive assurance that the actual patient mix was as expected once the service was operational. Any further additional need for women’s PICU would have to be raised with the North London Partnership, as overall it will benefit from the Trust opening this service. In response to Ms Fullick, Mr Rogers advised that the Trust had 9 outplaced patients on that day. The Board acknowledged the hard work of all those involved to bring the women’s PICU service on-line in budget and on time.

Mr Wragg also highlighted the additional costs being incurred to support preparatory work for the forthcoming CQC inspection in December 2017. He also highlighted a forecast section added to the report that set out how the Trust would aim to redress current overspending. The Board welcomed this new and informative section of the finance report.

Mr Wragg concluded by advising that the Trust’s cash position remained strong and was ahead of plan.

The Board RECEIVED, CONSIDERED and ACCEPTED the provided report on the Trust’s financial position.

GOVERNANCE / STRATEGIC DEVELOPMENT

17.01.162 Organisational Development Strategy

Ms Quinn introduced this draft strategy, inviting feedback from the Board. She set out how it summarised are earlier version making it more accessible and succinct, whilst remaining focused on key issues and being aligned to the Trust’s clinical objectives.

Dr Goss commented that the document was much improved but that further work was required to draw out its aims and further clarify how the Trust’s cultural pillar would actually become embedded. Prof Burns added that the links between ‘where we are’ and the solutions to how we get there could be clearer. He supported empowering staff by reducing bureaucracy. Ms Quinn would give further thought to this feedback but highlighted the difficulties of reducing bureaucracy, give that it was endemic throughout the larger and complex NHS.

Ms McNab commented that she had been pleased to note an increased understanding of the Trust’s cultural pillars among staff and highlighted the need for on-going work to further embed these across all levels of the organisation. She added that actions stated to embed each cultural pillar should be focused on a smaller number of key actions, those that would achieve the greatest result.

Mr Rogers stated that the presented document was a good summary of the strategy and reflected the improvements being made in organisational development. He added that the Board should retain a focus on this topic, as it was an area of potential interest to the CQC.

Ms Quinn

Ms Quinn

Ms Quinn


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The Board of Directors RECEIVED, CONSIDERED and APPROVED the presented Organisational Development Strategy, subject to the further work requested.

17.01.163 Mental Health Law Annual Report

Ms Fullick noted that this annual report had already been received by the Mental Health Law and Quality Committees. It was taken as read and questions were invited from Board members.

Mr Wragg noted that C&I had almost double the number of detentions under the mental health act when compared to the average against population size. Ms McNab acknowledged that C&I had a high level of such admissions and advised that the Board would be considering service demand in relation to the local population at a future seminar. She added that admission rates may be increased due to the higher than normal levels of homelessness and overseas visitors in the Trust’s host boroughs.

Prof Burns queried if there was any relationship between reduced bed numbers and an increase in detentions. Ms Fullick commented that the Trust bed base had been constant since 2012 and that it may be more useful to establish the breakdown between those referred and self-referring for secure care.

Ms Fullick noted the Board’s appreciation of the important work undertaken by the Mental Health Law Committee, under the Chair of Mr Vernon.

The Board RECEIVED, CONSIDERED and ACCEPTED the Mental Health Law Annual Report 2016/17.

17.01.164 Medicines Optimisation Annual Report

Dr Kirchner advised that this annual report had previously been fully considered by the Quality Committee and took it as read.

In response to her query, Ms Fullick was advised that the nationally set CQUIN target for providing patients with information about newly prescribed medication, whilst good practice, was unlikely to be achievable.

In response to Ms Harvey, Dr Kirchner advised that the medicine budget overspent annually by £300-400k. Mr Rogers added that management were fully aware of this cost pressure and confirmed that there was no sense of over-subscribing within the Trust. Ms Harvey commented that she had previously stated at Resources Committee that a more realistic budget should be allocated for medicines.

The Board RECEIVED, CONSIDERED and ACCEPTED the annual Medicines Optimisation Annual Report 2016/17.


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17.01.165 Information Governance Annual Report

Ms Harris-Birtles advised that this report demonstrated on-going progress in information governance. She highlighted that related policies and procedures were under review in preparation for forthcoming changes to the Data Protection Act. She was also pleased to advise that Umar Sabat had accepted the role of Information Governance Manager on a permanent basis, having covered the role on a temporary basis for some time.

Mr Parmar advised that this report was scrutinised at the last meeting of the Audit & Risk Committee and that there were no material matters requiring to be brought to the Board’s attention.

The Board RECEIVED, CONSIDERED and ACCEPTED the Information Governance Annual Report 2016/17.

SUB-COMMITTEES

17.01.166

Quality Committee

Verbal briefing from meeting on 19 September 2017

Dr Goss, the Committee’s Chair, advised that most of the key matters discussed by the Committee had already been considered earlier in this meeting, or were on the subsequent private session’s agenda. She added that the Committee continued to focus on producing more succinct and effective lessons learnt reports as a result of serious incidents.

17.01.167 Approved minutes from meeting on 18 July 2017

These were taken as read.

The Board of Directors RECEIVED and ACCEPTED the briefing and minutes submitted by its Quality Committee.

OTHER BUSINESS

17.01.168 Any Other Business that the Chair Considered Urgent

There were no other items of business.

17.01.169 New Risks Identified During the Meeting or Referred to/from Sub-Committees

No new risks were identified at this meeting.


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I certify that these are fair and accurate minutes of the stated meeting.

……………………………..…… …………………….

(Trust Board Chair) (Date)

Note: Board minutes are numbered sequentially throughout the calendar year.

17.01.170 Items for Communication to the Trust

The following items should be communicated throughout the Trust, or to the individuals concerned, as appropriate:

The Board was pleased to receive positive first hand service user feedback on the work of the Kingston Primary Care Mental Health Team;

The Board was pleased to note the progress made in implementing the Trust’s Clinical Strategy;

The Board was pleased to note the creation of, and appointment to, a Service User Involvement Facilitator post; and

The Board was pleased to note, and appreciated staff efforts, in keeping the forthcoming opening of women’s PICU services at St Pancras Hospital on track.

Mr Summers

17.01.171 Date of Next Meeting

26 October 2017.

17.01.172 CLOSE

The Chair declared the meeting closed at 4:25pm

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