SOMERSET PARTNERSHIP NHS FOUNDATION TRUST MINUTES … · The minutes of the Somerset Partnership...

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Minutes of the Public Board meeting held on 21 July 2015 September 2015 Public Board - 1 –

SOMERSET PARTNERSHIP NHS FOUNDATION TRUST

MINUTES OF THE PARTNERSHIP TRUST PUBLIC BOARD OF DIRECTORS’ MEETING HELD ON 21 JULY 2015

AT THE CANALSIDE, BRIDGWATER

PRESENT Stephen Ladyman Chairman David Wood Non-Executive Director Judith Newman Non-Executive Director Liz Simmons Non-Executive Director Barbara Clift Non-Executive Director Roger Powell Non-Executive Director Philip Dolan Non-Executive Director Edward Colgan Chief Executive Sue Balcombe Director of Nursing and Patient Safety Phil Brice Director of Governance and Corporate Development Andrew Dayani Medical Director Andy Heron Chief Operating Officer Pippa Moger Director of Finance and Business Development IN ATTENDANCE Lee Cornell Associate Director - Strategic Planning and Performance Sally Fox Interim Director of Human Resources and Workforce Development Julie Hutchings PA to the Chief Executive and

Chairman

1. APOLOGIES No apologies were received. The Chairman confirmed that the meeting was quorate.

2. QUESTIONS FROM MEMBERS OF THE PUBLIC The Chair requested members of the public to identify those items on the agenda where they would wish to comment or ask questions. No questions were received from members of the public.

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3. MINUTES OF THE PUBLIC BOARD MEETING HELD ON 26 MAY 2015

The minutes of the Somerset Partnership NHS Foundation Trust’s Public Board meeting held on 26 May 2015 were approved as a correct record with the following amendment: page 23, Item 25 – Any Other Business – Care Quality

Commission (CQC) Inspection - refers to a ‘Quality Site’ session and this should be a ‘Quality Summit’.

Judith Newman proposed, Roger Powell seconded and the Board approved the minutes of the Somerset Partnership NHS Foundation Trust’s Public Board meeting held on 26 May 2015.

4. MINUTES OF THE PUBLIC BOARD MEETING HELD ON 27 MAY 2015

The minutes of the Somerset Partnership NHS Foundation Trust’s Public Board meeting held on 27 May 2015 were approved as a correct record. Roger Powell proposed, Judith Newman seconded and the Board approved the minutes of the Somerset Partnership NHS Foundation Trust’s Public Board meeting held on 27 May 2015.

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MATTERS ARISING It was noted that all actions from the 26 May 2015 Board meeting had been completed. There were no matters arising. No actions were identified at the 27 May 2015 Public Board meeting as the purpose of this meeting was to approve the Annual Accounts. There were no matters arising.

6. REGISTER OF DIRECTORS’ INTERESTS The Board discussed the Register of the Board of Directors’ interests and the following changes to the Register were noted: David Wood – to replace “Interim Lay Member on NHS England

South West Pharmaceutical Services Regulations Committee” with “Lay Member on NHS England South West Pharmaceutical Services Regulations Committee”

No declarations of interests were declared in relation to the agenda items.

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7. CHAIRMAN’S UPDATE The Chairman presented the report which set out the Chairman’s visits to Trust premises/teams and external meetings since 26 May 2015 as well as future arrangements. The Board noted the report.

8. CHIEF EXECUTIVE’S REPORT The Chief Executive presented the report and highlighted the key areas covered in his report. The Chief Executive provided feedback on the meeting with the Monitor Relationship Team on 17 July 2015. Monitor met with the Chief Executive and Executive Directors in the morning and with the Chairman and Non-Executive Directors in the afternoon. Feedback from the meeting was very positive and the meeting provided an opportunity to explore details behind the operational plan and other issues impacting upon the organisation. It was anticipated that formal feedback will be received in writing in due course. The Board DISCUSSED and NOTED the report.

9. QUALITY REPORT The Director of Nursing and Patient Safety presented the quality report which set out the key issues and trends in relation to the Trust’s provision of high quality care and patient experience for the period ending 30 June 2015 and advised that the report showed that good and positive improvements had been made. The Director of Nursing and Patient Safety particularly highlighted: a reduction in the number of falls and the percentage of falls

resulting in harm during June 2015;

a reduction in the number of incidents of physical violence to patients by other patients;

a reduction in the use of restraint. The Board discussed the report and commented/noted that: figure 5a and 5b on page 22 indicated an increasing number

of incidents regarding ligatures. It was noted that these incidents related to Wessex House and a number of complex patients on Rydon ward;

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a focussed piece of work was being carried out on self-harm to ensure a consistent approach across the Trust;

with the re-opening of Wessex House and due to the fact that the client group varied from month to month, it was likely that the Trust will see more variation from now on in self harm incidents due to issues with children and young people and the way mental health problems were expressed;

page 38, Item 2.14 - Sign up to Safety - the Trust had signed up the Sign up to Safety Pledge and was committed to reducing avoidable harm by 50% over the next three years on falls, avoidable pressure ulcers, medicines management and restrictive practice (restraint).

The Director of Governance and Corporate Development advised that the Trust and its service provider have reviewed the Friends and Family response rates and for May 2015, the Trust was the 17th highest provider in the country in terms of responses. There had been approximately 15,000 responses between January and June 2015 with a 94% positive response figure. The provider of the online system had produced a ‘word cloud’ to identify the most frequently used words which indicated that ‘friendly’ was the most used word. There were also some negative responses, a small number of which were obviously significant for the individuals involved, however generally positive results. Barbara Clift advised that when inspecting Rydon Ward on a recent Patient Safety Walkround, feedback indicated that some patients would self harm multiple times a day and for them, this was symptomatic and a form of release. The Chairman agreed that this was difficult to report as there were occasions when allowing self harm was part of the recovery process. It was noted that Paul Watts was working closely with Rydon Ward managers and the Director of Nursing and Patient Safety agreed to provide an update in due course on this work. The Chairman referred to the benchmark figure and asked whether more sophistication could be introduced into the benchmarking. The Associate Director – Strategic Planning and Performance advised that the source of the benchmarking data was the NHS Benchmarking Network’s Hospital Project and was probably the best benchmarking data available for these type of services. Context had been included to show how well the Trust was performing, however, the Chairman stated that the average figure, which included all age groups, would not provide a true comparison as the Trust had a younger person’s ward.

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Liz Simmons welcomed the report and the fact that this reflected seclusion in inpatient wards and also highlighted the number of incidents of physical violence on page 28, as this information was not provided via PALs or Complaints. The Board discussed the position in relation to the Falls Champion as it was mentioned on a recent Patient Safety Walkround at Chard that the Falls Champion had moved and it was important to ensure that there was cover if staff move around. The Director of Nursing and Patient Safety advised of two schools of thought regarding the Falls Champion – where staff wanted to specialise, the Trust have kept and supported them and they were the single conduit but where people moved, it was important to ensure that there was a Falls Champion and it was the Ward Sister’s responsibility to ensure that someone took responsibility for falls. However, the prevention of falls was everybody’s responsibility. David Wood asked for an update on Wessex House. The Chief Operating Officer advised that Wessex House was currently operating at eight beds and was on track to increase the number of beds to ten beds on 27 July 2015. The aim, subject to successful recruitment, was to increase this further to twelve beds. The Medical Director will be interviewing for the Consultant Psychiatrist post in August 2015. Difficulties with recruitment were representative of issues across the medical society, in the past there would have been eight applicants, but there were only two applicants at the recent consultant interviews and one of those candidates subsequently withdrew. There was a similar picture across mental health elsewhere in the country. At a recent meeting with the Chairs and Chief Executives of the acute trusts, it was apparent that they were also experiencing similar difficulties. Judith Newman commented generally on the use of benchmarking data across the report without any explanation, although the details surrounding the data can be discussed in this forum, as this was a public meeting, it was felt that an explanation as to what the data meant was required. The Associate Director – Strategic Planning and Performance advised that he will look to review the data and explain where not wholly comparable with the Trust’s service configuration. The Board DISCUSSED the report.

10. “SAFER STAFFING” REPORT The Director of Nursing and Patient Safety presented the report which set out the progress made in relation to implementing the new Safer Staffing establishments for all inpatient wards in May 2015 and June 2015.

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The Board discussed the report and commented/noted that: there was a slight deterioration in performance when measured

against the fill fate of 80% and that by June 2015 this had reduced to 85.1% for day shifts and 93.5% for night shifts, the main issue being recruitment;

there was a slight improvement in Chard, which was now rated amber and a number of wards had successfully recruited newly qualified staff who will commence in September 2015;

whilst there still remained areas that were very challenging, the early warning trigger tool which indicated staff’s perception of the pressures, remained consistent and in some cases there was an improved position in feedback.

The Director of Nursing and Patient Safety advised that this was reflective of the national position and that Simon Stevens had advised that safer staffing will be taken forward by NHS England (NHS Improvement) and that there will be no compromise on safer staffing. Work had commenced on the new mental health and inpatient community standards and the Trust will be working with staff from August 2015 onwards to benchmark against the new standards. The Board DISCUSSED the report.

11. PERFORMANCE REPORT The Associate Director - Strategic Planning and Performance presented the performance report and scorecard for June 2015 and advised that the Trust had met all applicable standards within the Monitor Risk Assessment Framework and the Trust had also met the majority of its CQUIN and other compliance standards for measures contained on the Corporate Dashboard. The Associate Director – Strategic Planning and Performance highlighted those areas which had performed particularly well and these included: percentage of clients on CPA (level 2) seen within seven days of discharge; all recovery plans (level 2) to be reviewed at least annually; percentage of all adult inpatients who have had a venous thromboembolism risk assessment on admission to hospital; psychiatric emergency readmission rate within 30 days of discharge; carer’s assessments being offered/carried out for registered carers; percentage of Improving Access to Psychological Therapies (IAPT) treatment population entering treatment and moving to recovery; and referral to first treatment of patients accessing Psychological

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Therapies within six and 18 weeks (new national waiting times standards which Trusts are expected to achieve by April 2016). The Associate Director – Strategic Planning and Performance highlighted one performance exception relating to CQUIN measures which was in relation to a reduction in pressure ulcer incidence in community hospital inpatient. Although it was noted that actions had been implemented in respect of this measure, further actions were being planned. The Associate Director – Strategic Planning and Performance highlighted those indicators which had met the exception criteria for five corporate dashboard indicators: CAMHS clients referral to treatment waiting times within four

weeks;

identified carer who provides regular and substantial care registered for new mental health clients;

monthly percentage of community hospital bed days lost to delayed discharges, as a proportion of the total number of bed days – the rate for June 2015 decreased to 4.3% and patients awaiting residential or nursing home placements continued to account for the greatest number of bed days lost;

staff sickness – the rate for May 2015 was 4.3%. The Board discussed the report and commented/noted that: CAMHS waiting times - the Chief Operating Officer advised

that he was confident that there had been a genuine improvement in waiting times for CAMHS treatment. The Chief Operating Officer and the Associate Director – Strategic Planning and Performance were now members of the CAMHS Improvement Group, alongside the Head of Children’s and Young People’s Services. It was identified at the last meeting that urgent work was to be carried out with regards to producing a new policy with clear standards;

year-to-date position for CAMHS – currently 64.3% against a trajectory of 70%, which increased each quarter. The Associate Director – Strategic Planning and Performance advised that this target was discreet in each quarter and if not achieved in quarter one, the target for quarter two would increase to 82%. In terms of the degree of progress that was required, this was greater between the end of quarter one and quarter two, however performance was closely monitored and if needed followed up with the relevant teams. The Chief

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Operating Officer advised there were risks around performance of this service but whilst there was an intensive piece of work to improve this service, the focus will be on quality and effectiveness of practice across the county;

with regards to the reduction in the number of emergency

readmissions, the Chief Operating Officer explained that work had been undertaken by Neil Jackson and his team in mental health to exclude from the data those patients who had a note in their care plan for respite admission if required. The Chairman advised that as this was a different way of recording data, the thresholds for these figures may need to be reviewed as they may now be inappropriate – to remain under review;

triangle of care - very good performance in terms of giving

carers an assessment. The Chief Operating Officer advised that this was also due to the fact that staff had undertaken the new Care Act training;

psychiatric emergency readmission rate - the Director of

Finance and Business Development advised that this was a Monitor national target set at 10%;

delayed discharges – the Chief Operating Officer advised that

there had been a dramatic improvement in social care performance and that he had met with the Interim Director of Adult Social Care and the Head of Operations recently and whilst colleagues in social care were unsure of the precise reasons for this improvement, it was acknowledged that performance was capacity limited as there was a fixed amount of capacity in social care and in winter when beds were full and demand was very high, there was a ceiling on capacity which could not be stretched further whereas when below the threshold, processes were more timely;

the Chief Operating Officer and Associate Director – Strategic Planning and Performance were asked to include an explanation in the next report with regards to the new ways of recording readmissions.

The Board DISCUSSED and NOTED the report and the corporate dashboard.

12. FINANCE REPORT The Director of Finance and Business Development presented the report for June 2015 and advised that the position as at 30 June 2015 showed a deficit of £941,000 against a planned deficit of £813,000.

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The deficit was as a result of nursing agency costs and medical agency spend. The deficit arose as the impact of the cost improvement programmes was lower in the first quarter than later in the year and the projection was that deficits in the first four months will be recovered as the year progressed. It was noted that the Trust had a Monitor continuity of service rating of 3, which was in line with expectations and driven by the planned deficit in the early months of the year. It was anticipated that this will return to a rating of 4 by the second quarter. The Board discussed the report and commented/noted that: the £128K variance was due to high agency costs in the

month of June – £585K spend on agency;

there were high medical staffing costs relating to Wessex House and consultants;

agency costs in mental health units was proportionally higher than in community hospitals due to very challenging patients within units and some patients waiting for medium secure placements. The Trust were pursuing reimbursement of costs with NHS England however this was not included in the position;

the Trust will be pursuing costs from Surrey Clinical Commissioning Group once costs have been populated and have received confirmation from Surrey that they will reimburse the Trust for those costs;

there was a £127K variance against plan in month 3 on the Cost Improvement Programme, some of which was due to profiling on non-pay and medical savings. As profiling was on an equal basis across all months, and there were two large contracts which the Board approved several months ago and which will start from 1 July 2015, this position will improve in month 4;

IP2 – income element of cost improvement programme not yet started but plan progressing to increase specification of Willow Ward and to repatriate some of the out of county patients, to release pressure from the Out of Area budget;

the cash balance at 30 June 2015 was £2.3 million lower than forecast due to the high level of debtors and in respect of funding for the Public Dividend Capital on community hospitals which had still to be finalised and invoiced. The Director of Finance and Business Development will raise this matter with

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the CCG due to the impact on the Trust’s cash flow over the financial period;

capital expenditure for the year-to-date was £863,000. The capital plan for 2015/16 included schemes totalling £5.1 million and remained on target, with an £85,000 overspend against the monthly plan;

the Trust had resolved some disputes around rental arrears and payments with another organisation and had been able to release income into financial position.

The Director of Finance and Business Development advised that work had been carried out to look at controls around agency. The Chief Operating Officer and Director of Nursing and Patient Safety wrote to managers at the end of last week reiterating the controls in place. The Chief Operating Officer advised of work undertaken to look at agency expenditure in the first two weeks of July 2015, which showed a spend of £152,000 which, whilst not at the rate and level of June 2015, was higher than anticipated. To be able to reduce agency expenditure it was essential to have a good base of bank staff. The Trust was carrying vacancies and also in view of the national recruitment position, it was inevitable that agency staff was required. The Director of Nursing and Patient Safety and the Chief Operating Officer have reconfirmed to ward managers and ward sisters their responsibility for controls/flexibility with regards to agency usage. The Director of Nursing and Patient Safety advised that although discussions had taken place a few months ago regarding setting up a Trust run temporary staffing agency and a working group had been set up, this was currently not being pursued as it was felt that the priority for the time being was to concentrate on having a very good bank base. The Trust had just recruited a Nurse Bank Manager who will be looking at training issues. It was noted that the Trust had not broadened discussion regarding agency further with Taunton and Somerset NHS Foundation Trust in view of the message from NHS England that trusts should not be relying on agency. The Director of Nursing and Patient Safety advised that a lot of time had been spent empowering ward managers and also shift leaders to use their initiative and to use their professional judgement as to what was safe/unsafe, however there was very clear evidence relating to dropping below one nurse to eight patients. Staff can also call the manager if necessary. With regards to the overspend on CAMHS, the Director of Finance and Business Development advised that the majority of the overspend was

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particularly around Wessex house rather than general CAMHS and much of that related to recruitment at Wessex House. It was hoped that this position will improve with a consultant appointment in August 2015. It had been agreed that there will be some backfill of agency staff in the interim.

The Medical Director advised that with regards to the individual referred to in earlier discussions, this will impact significantly but on the Children and Young People’s budget rather than the medical budget as locum costs were approximately 50% more than a normal consultant. Currently the Trust had one of its own consultants acting in Wessex House with back-filling in the community. As soon as a consultant had been appointed for Wessex House, the backfilled person will be able to move back into community services.

The Board DISCUSSED and NOTED the report.

13. 2015/16 ASSURANCE FRAMEWORK AND CORPORATE RISK REGISTER The Director of Governance and Corporate Development presented the 2015/16 Assurance Framework which highlighted key risks to the Trust achieving its strategic objectives for 2015/16 which were as follows: achievement of safer staffing levels and the recruitment and

retention of staff;

the impact of future competition, tendering and commissioning decisions on Trust plans for further integration of services, which will be discussed further in the Confidential Board meeting;

the impact of the reductions in funding and service provision by the Local Authority;

delivery of a financial operating surplus;

management of length of stay and delayed discharges from community hospitals and mental health wards.

The Director of Governance and Corporate Development presented the Corporate Risk Register and highlighted the following: quarter one performance around immediate risks to assure the

assurance framework, mostly related to staffing. 60% of high level risks on the Corporate Risk Register were related to capacity and staffing in teams and services;

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further discussion will take place at the Confidential Trust Board

meeting. The Chairman invited questions from colleagues however no questions were raised. The Chairman also asked for views regarding the new format and feedback was that whilst the report was acceptable to review in hard copy format, it was not so easy to read electronically and more difficult to print due to the A3 rather than A4 format. The Director of Governance and Corporate Development agreed to keep this under review.

Barbara Clift proposed, Liz Simmons seconded and the Board approved the Assurance Framework and Corporate Risk Register.

14. 2015/16 BUSINESS ACTION PLAN AND 2015/2016 QUARTER ONE PROGRESS REPORT The Associate Director - Strategic Planning and Performance presented the 2015/16 Business Action Plan setting out the key priorities for the Trust, together with the actions to be undertaken and the timescales for their achievement. It was noted that the key priorities set out in the Plan were drawn predominantly from the Trust’s Monitor Annual Plan for 2015/16 but also from the Trust’s Monitor Strategic Plan, priorities identified by the Council of Governors during the annual business planning cycle and also suggestions put forward by staff and professional groups during the year. The strategic and annual objectives had been aligned with those set out in the Trust’s Assurance Framework and Action number 3.7 had been added in relation to talent management and succession planning. It was noted that this was a dynamic document which will evolve throughout the year. It was noted that milestones for the IP2 project will be brought in during the later quarters. The Associate Director - Strategic Planning and Performance presented the quarterly Business Action Plan progress report and advised that eight actions had been implemented, 51 actions were ongoing and one action was unlikely to be met. This action related to: action 1.3: Extend the use of the ‘Triangle of Care’ by

implementing the approach in all community mental health services: 70% of staff in identified services to have ‘Triangle of Care’ awareness training. Training had commenced but has recently been paused to help enable staff to be fully engaged in the Trust’s Phase II integration process. Training will recommence in full as the new models of care were embedded.

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It was proposed that the compliance rate associated with this action be revised to 50% for this year and then 90% by 31 March 2017 and the Board was asked to accept that recommendation.

The Board discussed the report and commented/noted that: with regards to Triangle of Care training, this was being

undertaken on a staged approach with the first phase for mental health, the second phase for mental health community services and the third phase for community services. The Chairman felt that as the Trust had informed people about the Triangle of Care training through the Carers’ Trust, this was a key priority for the Trust;

in relation to 3.6 on page 13 – ‘develop a cultural barometer to measure staff morale across the Trust’, it was queried whether a definition of culture should have been included and the Interim Director of Human Resources and Workforce Development advised that the specific text included was in relation to NHS England requirements and that discussions had taken place with the Joint Management Staff Consultative Committee as the Trust was required to demonstrate involvement of staff. The Interim Director of Human Resources and Workforce Development advised that this will need to be followed up as part of the organisational development strategy;

in relation to objective 4.9 on page 17 - ‘Work with partners to develop a sustainable health and social care system, delivering the Test and Learn project milestones by 31 March 2016’, it was noted that an active target had been set with regards to participating in test and learn initiatives and the Associate Director – Strategic Planning and Performance advised that this will be updated as new priorities emerge.

The Board DISCUSSED and NOTED the Business Action Plan quarter 1 progress report. The Board AGREED the proposal to revise the compliance standard to be achieved in relation to ‘Triangle of Care’ training. Roger Powell proposed, Judith Newman seconded and the Board approved the Business Action Plan for 2015/16.

15. MONITOR 2015/16 QUARTER ONE DECLARATION The Director of Finance and Business Development presented the update on the Monitor 2015/16 Quarter One Declaration. The 2015/16 Quarter 1 Monitor Self Declaration will need to be submitted by 31 July

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2015 and due to the early timing of the July 2015 Board meeting, the performance and financial information to be included in the self declaration will not be available until after the Board papers have been circulated. The Board was therefore asked to agree that Board members’ approval of the declaration can be sought be email after the July 2015 Board meeting. The Director of Finance and Business Development advised that it was likely that the Trust will have a risk rating of 3 and that the Trust will have achieved all of its performance targets. The report will be emailed to Board members later this week. The Board NOTED the report and AGREED that Board members’ approval of the 2015/16 Quarter 1 self declaration will be sought by email following the meeting.

16. 2014/15 CHARITABLE FUNDS ACCOUNTS The Director of Finance and Business Development presented the Charitable Fund Accounts for 2014/15 relating to mental health services. It was noted that the community services charitable funds were held under the umbrella charities of Taunton and Somerset NHS Foundation Trust and Yeovil District Hospital NHS Foundation Trust. The Trust was currently in the process of closing down the Trust’s mental health charity through the Charity Commission and incorporate the charitable funds into the funds held by Taunton and Somerset NHS Foundation Trust. The Board discussed the report and commented/noted that: the largest amount related to the dementia garden at Magnolia;

it was noted that Taunton and Somerset NHS Foundation Trust

will be featuring a picture of the dementia garden on the front page of a forthcoming report and the Trust will ensure that this was referenced appropriately for Frome;

the Chairman suggested that it would be helpful to list where the monies were being spent;

it was noted that a request had been received via the Lead Governor to fund additional people into the “Read to Learn” scheme;

when funds have been amalgamated, the Trust’s charitable funds will form part of Taunton and Somerset NHS Foundation Trust’s annual charitable funds which, in turn, will be amalgamated into their Trust accounts in line with new national guidance. Discussions will take place with Taunton and Somerset NHS Foundation Trust in relation to the production of

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Trust’s related expenditure reports. The Chairman asked for an annual report, listing where the Trust’s charitable funds were spent and in addition a more detailed report to be issued more frequently to the Trust’s stakeholders. The Director of Finance and Business Development agreed to take this action forward.

Liz Simmons proposed, Roger Powell seconded and the Board approved the Charitable Fund Accounts 2014/15.

17. 2014/15 ANNUAL MEDICAL APPRAISAL AND REVALIDATION REPORT The Medical Director presented the report which sets out statutory requirements and highlighted: that there had been a significant improvement during the year in

relation to the number of doctors completing their appraisals. In 2014 there had been a problem not with the completion of appraisals but the submission of completed documents by doctors within the timescales required and this requirement had been met for 2015. 97% of doctors with a connection to Somerset Partnership had a completed appraisal;

there were 27 recommendations made to the GMC, of which 23 recommended revalidation and four requested a deferral. There were no reports for non-engagement;

the Executive Team had approved the appointment of an Associate Medical Director for Community Health to improve the safeguarding function for community services. This post will provide a vital link to the doctors who provided services within Somerset Partnership but who were not directly employed by the Trust;

it was noted that a review of Medical Human Resources had been undertaken and that the Medical Director was liaising with the Interim Director of Human Resources and Workforce Development to take forward proposals for strengthening this function.

The Board discussed the report and commented/noted that: the Medical Director advised that issues related mainly to

timeliness of processes as ideally all checks would be completed prior to a doctor walking on to the ward, however some checks were currently completed within a day or two of a doctor commencing. There was a checklist of obtaining an RO (Responsible Officer) to RO report and making sure that before staff entered Trust premises they met the required standards;

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the Interim Director of Human Resources and Workforce

Development advised that the report covered the position as at the end of March 2015 and that employment checks were critical. Work had taken place to ensure that clinical checks were robust;

the Interim Director of Human Resources and Workforce Development also advised that a medical staffing expert from Devon had been commissioned to assist with medical staffing processes so that the Trust could be confident that processes were robust. The concerns did not relate to pre-employment checks but to ensuring that the RO to RO was in place. There were however some recording issues and an internal audit of all checks will be scheduled into the internal audit plan;

the Interim Director of Human Resources and Workforce Development advised that a checklist had been developed and agencies will be expected to complete the checklist to provide assurance that the required checks had been undertaken;

it was queried what additional resources would be required to assist the Medical Director in ensuring he was able to carry out his statutory responsibilities effectively. The Interim Director of Human Resources and Workforce Development advised that previously a HR business partner spend a small amount of time on medical staffing with locum cover carried out by a rotation of HR advisors, and this process was not felt to be satisfactory. It had been recommended having a dedicated medical staffing lead and instead of having four HR staff involved in rotas, to have two HR advisors with specialist knowledge but with the whole HR advisor team having a better knowledge of medical staffing issues. A senior medical staffing lead will need to be appointed.

The Board DISCUSSED the report. Phil Dolan proposed, Barbara Clift seconded and the Board approved the statement of compliance.

18. POSITIVE AND PROACTIVE CARE: REDUCING THE NEED FOR RESTRICTIVE INTERVENTION The Chief Operating Officer presented the report and particularly highlighted: in April 2014 the Government produced Positive and Proactive

Care, borne out of the Winterbourne incident and some of the

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focus on harm where there had been restraint and the report recommended a series of measures so that providers of care, particularly mental health care, moved to therapeutic environments rather than restrictive environments;

the Trust had been amongst the high performers for the last two to three years;

the Trust had been invited by the Department of Health to provide presentations at workshops on how interventions were delivered;

the headline was the end of face down prone restraint. The Board considered a report in November 2014 and the Chief Operating Officer chaired a monthly working group with input from senior clinicians and senior managers and others and there was a real commitment in the Trust to ensure that performance remained high in this area. The Trust’s target for 2015 was a 10% reduction in harm arising from restraint:

the action plan was a living document and was reviewed at each meeting with varying progress. The spirit of the report nationally was initially focused on mental health and learning disabilities and arguably CAMHS inpatient services. This was the main focus of the group since starting but the group was now moving on to look at community hospitals where there was an increase in the number of patients with dementia, an increase in incidents of violence and aggression experienced by staff and occasions when restrictive interventions were required. The emphasis was on early intervention and sometimes this was inevitable. All work was dedicated to predictive work and being able to take steps to diffuse situations;

a summary of other actions that had been achieved was contained in paragraph 3.6.

The Board discussed the report and commented/noted that: the Board felt that this was a very positive report and that the

format of the report was good, with the report being a credit to the Trust and something to be proud of. Furthermore, on visits to this team, the team’s performance had always been impressive. It was queried as to whether there was a way of rewarding this achievement. The Chief Operating Officer confirmed that Martin Chapman had played a key role with regards to the type of staff recruited and the Chief Operating Officer will relay the positive feedback received;

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discussion took place regarding paragraph 3.6, fourth bullet point and understanding of the way this was phrased. The Chief Operating Officer advised that historically pain techniques were taught and after considerable debate in relation to the Trust’s policy, there had been recognition that some holds caused pain for people and there was therefore no reference in the Trust’s new policy to the use of pain in any techniques. Pain was no longer taught as a technique.

The Board DISCUSSED the report. Barbara Clift proposed, Liz Simmons seconded and the Board approved the recommended actions.

19. RISK MANAGEMENT STRATEGY The Director of Governance and Corporate Development presented the report and particularly highlighted: that the Risk Management Policy was approved in May 2015

which set out the organisational approach to risk and the risk appetite;

the Trust had conducted an initial assessment against the Chartered Institute of Internal Auditors scheme and supported by internal audit, external review and self-assessment, the Trust considered itself as achieving ‘Risk Managed’ status across most criteria;

the Strategy set out how the maturity of Risk Management within the Trust will be developed over the next three years in order to demonstrate and assure the current ‘Risk Managed’ position and progress to a position of ‘Risk Enabled’. The Strategy focussed on embedding risk management processes across the Trust with a proactive approach and a positive risk appetite;

key actions included: - consistency of risk approach - the Trust has just submitted

local risk registers to the CQC and every team had a local register but it was important to ensure that these were consistent as there was currently a degree of inconsistency;

- being able to respond to internal changes – aligning them

to internal structures;

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- joint ventures and how the Trust managed risk management across organisations - awareness of staff;

- internal audit process – check initial assessments and

regular process over three years to check internal strategy;

- early part of next year – plan to commission external well

led governance review to provide level of assurance;

The Board DISCUSSED the strategy which was well received and provided clear direction and responsibility. Phil Dolan proposed, Roger Powell seconded and the Board ratified the Risk Management Strategy.

20. COMMUNICATIONS AND PATIENT AND PUBLIC INVOLVEMENT STRATEGY The Director of Governance and Corporate Development presented the report and particularly highlighted: updated, revised and consolidated communications strategy,

aligned with patient and public involvement work. Key initiatives around communications initiative were increased and extended use of social media, developing a new website, intranet and other platforms. Development of marketing approach – revisiting brand and how to manage that; .

patient and public involvement - commitment to Triangle of Care;

an annual action plan will be monitored through the Patient and

Public Group and considered at Executive Team meetings. The Board discussed the report and commented/noted that: as the Trust involved patients and the public in the Friends and

Family Test, it was queried whether that precluded the Trust from doing other similar things such as tokens in community hospitals as this was simpler and quicker than the Friends and Family Test;

it was noted that the Trust had good levels of feedback but that there had been a decrease in the response rate at MIUs. When looking at demographics more feedback was provided by older people than by younger people and this will be followed up with the development of social media;

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it was noted that a useful stakeholder event had been held and

that some people had comments rather than complaints and it was queried as to whether it was possible to have a card for people to write down their comments;

reference should also be made to families on pages 12 and 15 and section 8.3 will need to be strengthened to clarify the responsibility of Governors and to clarify that Governors were elected and were to represent their constituencies;

section 8.2 referred to Non-Executive Directors being advocates for the Trust in their communities, which was not the case;

The Chairman anticipated that the Governors will include something in his objectives about helping them to communicate with the public;

stakeholder engagement – description of stakeholder engagement process included and in the context of that, there was work that the Board will need to undertake in terms of stakeholder analysis and understanding who the Trust’s stakeholders were;

it was felt that whilst this included an exhaustive list of communication channels, the importance of this being embedded in culture was not highlighted and that every member of the organisation should be an advocate representing what the Trust stands for. The Director of Governance and Corporate Development advised that section 8 attempted to capture this but that he will strengthen this section accordingly. The Chairman suggested that it might be helpful to have a more strategic document behind this document detailing how those issues will be addressed.

The Director of Governance agreed to circulate the document with the agreed changes. The Board DISCUSSED the report. Liz Simmons proposed, Judith Newman seconded and the Board approved the Communications and Involvement Strategy 2015-2017 subject to the above changes being made.

21. SAFEGUARDING AT RISK POLICY The Director of Nursing and Patient Safety presented the report which had been updated to reflect Care Act changes. It was noted that this

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policy had been presented to the Safeguarding and Clinical Governance Group. The Board discussed the report and commented/noted that: section 8.3 - allegations against Trust staff – it was queried

whether or not this section stated that the Trust had an Allegations Against Staff policy, otherwise, this would need to be strengthened. The Director of Nursing and Patient Safety advised that this will be cross referenced to other policies.

The Board DISCUSSED the report. David Wood proposed, Roger Powell seconded and the Board unanimously approved the Safeguarding at Risk Policy subject to above change being made.

22. EQUALITY AND DIVERSITY POLICY The Director of Governance and Corporate Development presented the report and particularly highlighted: the policy sets out individual and Trustwide responsibilities and

a training programme to support that;

the policy had previously been approved by the Executive Team and was now presented to the Board for ratification;

the Non-Executive lead for Equality and Diversity was Liz Simmons.

The Board DISCUSSED the report. Roger Powell proposed, Liz Simmons seconded and the Board unanimously approved the Equality and Diversity Policy.

23. RATIFIED MINUTES OF THE INTEGRATED GOVERNANCE COMMITTEE MEETING HELD ON 25 FEBRUARY 2015 The ratified minutes of the Integrated Governance Committee meeting held on 25 February 2015 were noted.

24. RATIFIED MINUTES OF THE AUDIT COMMITTEE MEETING HELD ON 15 APRIL 2015 AND 27 MAY 2015 The ratified minutes of the Audit Committee meeting held on 15 April 2015 and 27 May 2015 were noted.

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The Board discussed the minutes of the meeting held on 15 April 2015 and commented/noted that: page 7, second paragraph - audit undertaken on Friends and

Family returns – on wards and patient areas, when a patient was unable to complete the form themselves, a member of staff will assist them – the auditors felt that this was inappropriate as members of staff could potentially influence the feedback provided but following discussion it was felt that this was unlikely and that there was sufficient data from other sources that would triangulate against it so it was felt beneficial to continue to offer that service;

it was noted that there were also language barriers and also elderly people who required assistance.

25. 2014/15 SAFEGUARDING CHILDREN ANNUAL REPORT AND

SAFEGUARDING CHILDREN SELF DECLARATION The Director of Nursing and Patient safety presented the report and particularly highlighted: pages 15 and 17 – it was noted that there had been a

significant increase in child protection activity in relation to child protection plans;

the impact of the Ofsted review of the Local Authority and the subsequent rating as inadequate was detailed on page 13;

that it was clear that the Trust had robust safeguarding arrangements – detailed policies, training and huge success of multi-agency safeguarding hub.

The Director of Nursing and Patient Safety advised that the Trust was required to produce and approve a safeguarding self- declaration. Sarah Ashe, Named Nurse, had reviewed the format of declaration used in other trusts. The Board discussed the report and commented/noted that: appendix 1 – with regard to child protection cases, it was noted

that the number of reports submitted against the number invited could be quite varied. The Director of Nursing and Patient Safety advised that this was a source of continuous debate with the Local Authority as these were very important events and one of the issues arising from the Ofsted report related to escalating concerns and a clearer way of escalating concerns

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and that these were brought to the attention of the Local Authority. Any requests received by the Trust were treated seriously – issues with some short notice requests – much better open dialogue with Local Authority and ways of escalating it. The Director of Nursing and Patient Safety advised that this was due to a variety of reasons - sometimes a resource issue, sometimes no notice or not informed and discussion as to the most suitable representative. It was felt positive that the Trust felt comfortable with escalating this matter;

David Wood advised that whilst he had a standing invitation to attend the Safeguarding Working Group, he did not receive invitations to meetings and the Director of Nursing and Patient Safety will action this matter. It was noted that David Wood had met with Richard Painter.

The Board DISCUSSED and NOTED the report. Judith Newman proposed, Barbara Clift seconded and the Board unanimously approved the Safeguarding Children 2014/15 Annual Report and Self-Declaration.

26. 2014/15 SAFEGUARDING ADULTS AT RISK ANNUAL REPORT The Director of Nursing and Patient Safety presented the report and particularly highlighted: that Safeguarding Adults was less well established nationally

but far more complex with MAPPA and MARAC – the Trust was focusing on having absolute clarity of roles for its teams and systems and processes for its staff; .

that The Care Act had a huge impact and led the Trust to be much clearer on roles, particularly on Local Authority roles which they were no longer able to delegate to others;

the positive feedback about the MASH.

The Board NOTED the report.

27. ANY OTHER BUSINESS Declaration of interests Barbara Clift advised that her daughter-in-law was part of the Transformation Team at Somerset County Council and was recently appointed Project Director to manage the whole new governance process in place for managing safeguarding of children and adults across the county.

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Inspection of Counter Fraud services The Director of Finance and Business Development advised that the Trust had been notified by NHS Protect that they will be carrying out an inspection on 2 and 3 September 2015 in relation to counter fraud services.

28. RISKS IDENTIFIED It was noted that the risk discussed earlier in the meeting had already been included on the Corporate Risk Register.

29. EVALUATION OF THE EFFECTIVENESS OF THE MEETING The Board agreed that the meeting had been effective with open and robust contributions.

30. ITEMS FOR DISCUSSION AT CONFIDENTIAL BOARD MEETING The Chairman highlighted the items for discussion at the Confidential Board meeting. There will also be a Remuneration Committee today attended by Non-Executive Directors only.

31. WITHDRAWAL OF PRESS AND PUBLIC The Board moved that representatives of the press and other members of the public be excluded from the remainder of the meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest.

32. DATE FOR NEXT MEETING The next meeting will take place on Tuesday 22 September 2015. Further meeting dates for 2015 Tuesday 24 November 2015 All meetings will start at 9.30am.

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Action Notes from the Public Board meeting held on 21 July 2015 September 2015 Public Board - 1 -

SOMERSET PARTNERSHIP NHS FOUNDATION TRUST

ACTION NOTES FROM THE PUBLIC BOARD MEETING

HELD ON 21 JULY 2015

AGENDA ITEM

ACTION BY WHOM DUE DATE PROGRESS

6. REGISTER OF DIRECTORS’ INTERESTS

To amend the Declaration of Interests. Ria Zandvliet September 2015 The Declaration of Interests has been amended to take account of changes.

9. QUALITY REPORT To provide an update on the work taking place at Rydon Ward on self harm. To review the benchmarking data referred to in the report and explain where not wholly comparable with the Trust’s service reconfiguration.

Paul Watts Lee Cornell

November 2015 September 2015

To be included on the agenda for the November 2015 Board meeting. The data has been reviewed and amended accordingly.

11. PERFORMANCE REPORT

To include an explanation in the next report with regards to the new way of recording readmissions.

Lee Cornell September 2015 An explanation has been included in the report.

13. 2015/16 ASSURANCE FRAMEWORK AND CORPORATE RISK REGISTER

To keep the format of the report under review. Phil Brice Ongoing The format will continue to be kept under review.

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Action Notes from the Public Board meeting held on 21 July 2015 September 2015 Public Board - 2 -

AGENDA ITEM

ACTION BY WHOM DUE DATE PROGRESS

16. 2014/15 CHARITABLE FUNDS ACCOUNTS

To present an annual report to the Board for information.

Pippa Moger July 2016 The annual report will be included on the agenda of the July 2016 Board meeting.

20. COMMUNICATIONS AND PATIENT AND PUBLIC INVOLVEMENT STRATEGY

To amend the strategy to take account of the Board’s comments and to circulate a revised document to all Board members.

Phil Brice July 2015 A revised strategy has been circulated.

25. 2014/15 SAFEGUARDING CHILDREN ANNUAL REPORT AND SAFEGUADRING CHILDREN SELF DECLARATION

To ensure that David Wood will receive invitations for the Safeguarding Working Group meetings.

Sue Balcombe July 2015 The distribution list for the meetings has been amended accordingly.

SOMERSET PARTNERSHIP NHS FOUNDATION TRUST MINUTES … · The minutes of the Somerset Partnership...

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