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Kent & Medway NHS Social Care Partnership Trust Board of Directors (Public) Minutes of the Meeting of the meeting held at 09:00-12:45, Thursday 29 November 2018 in Boardroom A&B, Farm Villa, Hermitage Lane, Maidstone, Kent, ME16 9PH Members: Andrew Ling AL Trust Chairman

Anne-Marie Dean AMD Non-Executive Director (Vice Chair/SID*)

Rod Ashurst RA Non-Executive Director

Venu Branch VB1 Non-Executive Director

Mark Bryant MB Non-Executive Director

Dr Jackie Craissati JC Non-Executive Director

Tom Phillips TP Non-Executive Director

Catherine Walker CW Non-Executive Director

Helen Greatorex HG Chief Executive Officer (CEO)

Vincent Badu VB2 Executive Director Partnerships & Strategy/Deputy CEO

Sandra Goatley SG Director of Workforce and Communications

Mary Mumvuri MM Executive Director of Nursing and Quality

Prof. Catherine Kinane CK Executive Medical Director

Jacquie Mowbray-Gould JMG Chief Operating Officer

Sheila Stenson SS Executive Director of Finance and Performance

Attendees: Tamara Croud TC Trust Secretary (Minutes)

Dr Andy Inett AI Consultant Forensics Psychologist (item 143 only)

Dr Sarah Cooper SC Forensics Psychologist in Training (item 143 only) Service User Item 143 only

Observers: Robert Nicholls Programme Director Clinical Workforce - Kent & Medway STP

Apologies *SID: Senior Independent Director Item Subject Action

TB/18-19/137 Welcome, Introductions & Apologies The Chairman welcomed everyone to the meeting.

TB/18-19/138 Declarations of Interest There were no conflicts of interest raised pertaining to the matters to be discussed on the agenda.

TB/18-19/139 Minutes of Previous Meeting The minutes of the meeting held on 25 October 2018 were approved as an accurate record of the meeting subject to the following changes and those provided by CW outside the meeting:

Page 1, attendees list: Remove ‘Dr’ from CW title;

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Page 3, item TB/18-19/122: Change to read Royal College of Psychiatrists (not Royal College of Psychologists);

Page 3, item TB/18-19/141, 1st bullet, 2nd paragraph, first sentence: revise to read “In relation to comments, from staff at Littlebrook, that therapeutic staffing and activities had ceased, it was noted that there is a clear multi-disciplinary team model which includes the provision of therapeutic activities”;

Page 3, item TB/18-19/141, 1st bullet, 3rd paragraph, last sentence: revise to read “The good work of Rosie Ward was also noted”.

Page 3, item TB/18-19/141, 3rd bullet, last sentence: revise to read “Also, as reported, the Trust will work with the Care Quality Commission’s National Patient Safety Director, as required”.

Page 9, item TB/18-19/146, 2nd bullet, 3rd paragraph: revise to read “There are 284 daily referrals. There is a disproportionate number from the Medway & Thanet area”.

TB/18-19/140 Action Log & Matters Arising

The Board received and noted the updated action log.

TB/18-19/141 Chair’s Report The Board received and discussed the Chairman’s report. The Chairman advised that he has decided to stand down after nearly eight years at the end of June. The recruitment process will be undertaken by NHS Improvement and the Trust has engaged Gatenby Sanderson to support the search.

The Sustainability Transformation Programme (STP) Non-Executive Director (NED) Oversight Group met and is progressing the recruitment of the new STP Chair. Glenn Douglas will remain as Chief Executive Officer for a further year to support the transition to the new Chair and provide an effective handover. The Vice Chair reported that the recent programme of 15 steps visits was positive and the nursing directorate team are to be congratulated. This programme of work will continue and the dates for 2019 shared with the Board, imminently.

The Vice Chair went on to highlight that the Disablement Service is an exemplar service for the Trust. It is, however, under financial pressure and needs new accommodation. The team has done impressive work around limbs and supported the Paralympics team. The new Veterans Covenant provides for new funding in this area and the Trust should consider how it can take advantage of the opportunity to work with Kent Community Hospital NHS Foundation Trust (KCHFT) and the Royal British Legion.

It was noted that HG and AL and VB2 have various meetings with key stakeholders to explore opportunities for the disablement services and supporting the Veterans Covenant.

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The Board noted the report and agreed that MM would share the 15 steps dates for 2019 with the Board via the Trust Secretariat.

MM

TB/18-19/142 Chief Executive’s Report

The Board received the Chief Executive’s report. The Trust has received its draft Care Quality Commission Well-Led report. It is currently carrying out the factual accuracy checks but it is noteworthy that there have been some significant improvements especially in relation to the Trust’s Community Mental Health Teams for Adults, now rated ‘Good’. The draft report outlines areas of sustained concentrated improvement. The Trust continues to work towards improving its financial performance and its aspiration to remain financially sustainable in the long term.

The Trust’s staff engagement is increasing and this is evidenced by the improved response rates to the staff survey. The Trust was 1% from the highest staff response rates when benchmarked against the other NHS organisations.

The Chief Executive confirmed that the Trust works with local schools to not only drive recruitment of future mental health workers but also to raise awareness of mental health issues. In addition through the Trust’s volunteer strategy it is taking the opportunity to engage with 16-18 year olds and currently has people from Mid-Kent College on its volunteer scheme. There is a programme of work in Barking and Dagenham which goes beyond mentoring which may be useful for the Trust.

The Trust continues to work with the Dementia Allies & Dementia Envoys. VB2 and MM are working on improving engagement with these key stakeholders and looking at other opportunities to increase its volunteer services. It was also noted that KCHFT is running dementia workshops on Saturdays and AMD would forward the details to VB2. The Board congratulated and commended HG on her graduation as a Florence Nightingale Scholar.

AMD/VB2

TB/18-19/143 Patient Story – Restorative Justice The Board welcomed Dr Andy Inett (AI), Consultant Forensics Psychologist and Dr Sarah Cooper (SC), Forensics Psychologist in Training along with a Service User who had used the restorative justice process. They provided an overview of the restorative justice initiative and the Board heard of its positive impact. By way of introduction, the Board noted that restorative practice is a process which brings people together, where harm has been caused. The individuals talk about the harm that has occurred, what happened, who was affected and look to find a way to repair that harm. It is a process of self-discovery and learning for the harmer and one of healing for the person harmed. Positive outcomes for both the harmed and the harmer are central to the intervention. The process supports people to talk through issues when they occur on wards and is used for staff and patients. This practice is used in the criminal justice

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system and is now being used in the mental health setting. The restorative justice team works closely with safeguarding teams. Twenty-one staff have been trained as Restorative Justice Champions. The Service User told the Board about his experience of using the restorative justice process. He reported that, following an altercation with another service user, which was reported to staff, he and the other individual were taken to different wards for a period of time. This allowed the situation to de-escalate. He and the other individual agreed to embark on the restorative justice process. A safe environment to meet was identified and they discussed what happened and how each other felt. They shook hands and apologised. Since the intervention there had been no further altercations between the he and the other individual. The process and the staging were very important and the wards felt safer. The initiative is being rolled out on acute wards and will be subject to evaluation. Discussions are also underway with the workforce team about how this can be used with staff. The Trust will also consider how it can be used as part of the complaints process. The Trust is looking at how it can make use of service users who are expert by experience to promote and support roll-out of the process. The time it takes for a case to be heard through this process depends on the complexity of the case and the service users involved. Some cases take 2-3 weeks whilst others can take 5-6 years depending on the restorative intervention required. The initiative is fairly new and take up has been gradually increasing. The team and the Service User were thanked for sharing their experience and the discussion with the Board.

TB/18-19/144 Board Assurance Framework The Board received and discussed the Board Assurance Framework (BAF) which had been refreshed since the last report in November 2018. The top five risks for the Trust are:

Financial Overspend

Recruitment

Retention of employees

Staff engagement action feedback and cultural change

Community Mental Health Team (CMHT) demand and capacity/KCC transformation.

New risks include:

The Kent County Council (KCC) transformation programme which resulted in repatriation back to KCC of the circa 250 social workers which were previously seconded to the Trust;

A ‘no deal’ European Union Withdrawal

The proposed remodelling of inpatient services in Canterbury

The due dates on the CMHT actions have been deferred until July 2019. The

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Board noted that there are robust plans in place to address the issues related to the KCC transformation but is recognised the importance of avoiding drift on actions to address key issues. The Trust continues to manage the risks and works closely with stakeholders to ensure that the transformation is managed effectively. The Workforce & Organisational Development Committee was assured by the confidence of the community team, which presented at its January 2019 meeting, that there was sufficient grip and control over the issues noting that the key challenges lay within smaller teams such as Swale, West Kent and Dover where there was a higher than average number of social workers who provided health assessments. The plans to address the CMHT/KCC risks are currently being put into action therefore it would be early for the Board to request a deep dive into the performance data at this stage. The Integrated Audit & Risk Committee, at its January 2019 meeting endorsed the process for developing a risk appetite management framework in the Trust.

The Board agreed that the executive would continue to implement the changes around KCC/KPMT and the Finance & Performance Committee would receive a report on performance in March. The Board would also receive a report in April as part of the Integrated Quality and Performance report (IQPR). It was also agreed that the Board would schedule an update from the CMHT at a Board seminar.

JMG

JMG/TC

TB/18-19/145 Quality Committee Report & Minutes The Board received and noted the report of the Quality Committee meeting which met on 15 January 2019 and the minutes of the meetings held on 20 November and 18 December 2018. The Committee was pleased that the recent reports from care groups on CLIQ Checks were much improved. The Committee was, however, concerned that there was still an over reliance on one person. It was noted that there are Quality Managers in each care group or an individual assigned to focus on quality management who provide additional support. It was also noted that the recruitment process for the Senior Quality Manager had been delayed but is now underway. HG noted that where there has been a delay in going to advert for key posts, she and the relevant Committee should be informed. The Board also received and noted the Annual Complaints Report. The Board noted and agreed that the list of individuals responsible for quality in the care groups would be provided to the Quality Committee and the CLIQ Checks data would be published in the next IQPR.

CK

TB/18-19/146 Integrated Quality & Performance Report (Month 09) The Board received and noted the Integrated Quality and Performance Report (IQPR) for month 09.

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The small decline in some of the Community Mental Health Team (CMHT) for Adults’ performance is an area of focus for the executive. Care Programme Approach (CPAs) package of care being completed, (moving from 94% to 92.9%), a reduction in the number of patients with valid care plans (moving to 92.5% from 93.1%) and Crisis Plans reducing to 93.6% from 93.8% were all subject to remedial action. It was noted that the number of patients waiting over 28 days to be assessed was at 58% however without team level data it is difficult for the Board to appropriately interpret this information. It is important that the Board has performance data at team level including data which distinguishes patients who have been screened versus being on active review as well as volumes and age of the backlog. This level of information used to be provided and was removed but should be included in the IQPR going forward. It was commented that this level of operational review was being undertaken by the executive team and senior leaders at various operational forums including the quality performance review meetings. It was agreed that the Board will conduct a deep dive on this performance data. The Board also agreed that a review of the data that is added and removed from the IQPR would be conducted and a protocol established for agreeing changes to the data set to be developed and shared with the Board. The average Length of Stay for patients in older adults had increased to 107.3 days. This is more than double the expected length of stay of 52 days. Key drivers include the Trust’s inability to discharge and/or repatriate patients and Delayed Transfers of Care (DToC) to other appropriate settings. The Trust’s quality improvement work on older adult bed modelling will support improvement in quality and timeliness of care. The Trust does not have any female Psychiatric Intensive Care Unit (PICU) beds only male PICU. Averages of 10 female patients are placed in out of area PICU beds. The Trust monitors these patients daily. The Trust continues to engage with commissioners about providing female PICU provision in the county. The Trust’s 2018-19 performance against its sickness absence trajectory is much improved against circa 5% in 2017/18. The year to data sickness rate is 4.26% against a year to date target of 4.3%.

The workforce team is currently reviewing the risk in relation to recruitment and retention. The plan is to split the risk into two risks, one for retention and one for recruitment. This will more accurately reflect the good work done on recruitment.

The Trust has 120 band five and six vacancies with 60 candidates in the pipeline. Similarly, of the 72 Health Care Assistants vacancies the Trust has appointed 42. Medical vacancies are down to 28.2%. The first interview round for the Certificate of Eligibility for Specialist Registration Fellowship (CSER) posts took place on 30 January 2019 and four people have been offered a post. The Trust is also embarking on recruitment campaigns in India and Australia for medics and nurses, respectively.

JMG

SS

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The turnover rate for doctors is 26% and work is underway to identify how best to retain these members of staff. The Board was pleased to note, in the draft CQC report, the commendation of the level of medical input across the Trust.

The staff survey response rate was very good. The Board should note that, due to an oversight, the sample size was not validated in time and leavers and absent members of staff were not removed. As a result the Trust response rate is recorded as 57.7% but had the sample size been validated it would have been 59.5%. 57.7% is much improved on the response rates in the previous year.

It was also agreed that an update on female PICU beds would be presented to the Board later in the year.

JMG

TB/18-19/147 y Workforce & Organisational Development Committee Report & Minutes The Board received and noted the report of Workforce & Organisational Development Committee meeting which met on 21 January 2019 and the minutes of the Committee’s meeting which was held on 20 November 2018. The Committee was pleased that the new supervision tool on iLearn is being piloted in the workforce, community and psychology teams before it will be rolled out across the Trust. In addition, the news that time to recruit is reducing was very positive. The Trust is also introducing centralised recruitment panels to streamline the recruitment process from start to finish. The Committee commended the work of Vicky Stephens and Paula Campbell in the Community Mental Health Care Group. It was noted that the Chambury Learning Solutions won the 2018 Totara Best Compliance project for the work they completed on behalf of the Trust in connection to iLearn. The team have been invited to a celebratory tea with the Chairman and Chief Executive.

TB/18-19/148 Strategy Steering Group The Board received the report from the Strategy Steering Group which was held on 17 January 2019 and the minutes of the meeting held on 19 September 2018. The Board also received the NHS 10 Year Plan – On Day Briefing from the NHS Confederation. The Trust’s strategic priorities are well aligned with the aspirations set out in the NHS 10 Year Plan. Opportunities include work around the Military Covenant. The Plan also refers to reducing the number of face to face contact in outpatient services and as such the Trust needs the right technology to respond to these proposed changes. It is important not to lose sight of the wider system plan and the Trust’s role. For example Kent and Medway Sustainability & Transformation Programme (STP) are looking at developing an Integrated Care System and four integrated care partnerships (ICPs) and the Trust will play a key role in these new structures. The Group also debated how best to ensure that the Trust retains its sovereignty over decision making. The Board has a fiduciary duty therefore due care should be taken to ensure the Trust is not devolving its powers to joint bodies without the proper due diligence and governance processes.

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It was noted that the challenge and process for engaging and working jointly with voluntary sector organisations should not be underestimated. The Board agreed the following: 1) The list of strategic priorities should include digital; 2) Glenn Douglas, STP Chief Executive would be invited to a Board

Seminar to provide an update on the financial context of the STP; 3) VB1 would share learning from recent voluntary and health sector joint

working.

VB2

VB2

VB1

TB/18-19/149 Nursing Strategy – One Year On The Board welcomed and noted the Nursing Strategy – On Year On report. Nurses represented the largest component of the Trust’s workforce and compared to 2016/17 (40%) the Trust now retains 80% of newly qualified nurses. As part of the Nursing Strategy there is now a Head of Nursing in each Care Group. Whilst the recent recruitment for Nurse Consultants was not successful, the Trust has created two trainee Advanced Clinical Practitioner (ACPs) roles. It is envisaged that the ACPs will develop into the role of Nurse Consultants. The posts will be evaluated in November 2019. The Board commended this level of innovation and congratulated the doctors on supporting this process. The physical health nurses are adding value and these roles are designed to complement the team not replace the responsibility of mental health nurses for physical health. The Trust will work with Maidstone & Tunbridge Hospital about technical supervision and training for the physical health nurses, in light of their plans to introduce a mental health nurse their wards. The Trust is supporting nine Health Care Assistants to train as Nursing Associates. The Board commended the work on the Nursing Strategy noting that it is given to all new nurses. The Board also thanked Teresa Barker for her hard work and wished her well in her new role with Oxleas NHS Foundation Trust.

TB/18-19/150 Finance & Performance Committee Report The Board received and noted the report of Finance & Performance Committee meeting which met on 29 January 2019 and raised the following salient points: Inpatient Services in Canterbury The Committee commended the work done to develop the full business case for inpatient services in Canterbury. The Committee Chair reported that the Committee received confirmation that:

Key enabler projects were in place and effective and that the Quality Committee signed off the clinical scope, approach and expected outcomes of each, based on the analysis presented. Further, that a clinical lead had been appointed and was in place for each project.

The expertise was in place, resources assigned for each key activity and

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deliverables from each main activity was clear.

The necessary engagement requirements were in place, internally and externally and that required approvals had been obtained.

Enhanced governance arrangements was in place, including oversight, detailed organisational structures, terms of reference for each group and risk registers, as requested by the Integrated Audit and Risk Committee (IARC).

The full business case approval from the Committee was subject to (the expected and imminent) written confirmation that the Programme Plan and scoping documents had been signed off by the Programme Management Office and that it had met the agreed sign-off criteria.

The expected financials (capital, revenue) and rationale for changes in costs/scope since the Outline Business case was presented.

A contingency plan was available in the event it is required, consistent with the approach established as part of the Outline Business Case discussions.

The Quality Committee endorsed the clinical cases recognising that additional work was required on Support and Signposting. It was noted that each of the clinical enabling projects is being led by an Assistant Medical Director and the Board reinforced the need for strong clinical leadership especially in relation to Support and Signposting. It was agreed that the governance structures would be updated to reflect that the Assistant Medical Directors were clinical leads for each of the enabling projects. The Board noted and agreed that the Integrated Audit & Risk Committee would monitor the governance process and risk registers for the project and TP and VB2 would meet and discuss any outstanding matters related to governance and risk. Financial Performance The Committee also considered the NHS Improvement letter which offered the Trust a 2019/20 control total to breakeven after receiving £4.5m financial recovery funding (non-recurrent) and £1.4m provider support funding. The Committee recommended that the Board considers and approve acceptance of the control total for 2019/20 and agree that the Trust can submit plans by 2 February 2019 deadline. This report is in the private meeting papers. The Board noted that the Trust has set a savings target of 8% in order to breakeven. The Board agreed that the Trust would accept the 2019/20 control total based on the recommendation given by the Finance & Performance Committee. The Committee also recommended that the Board considers and approve issuing a contract to the identified supplier for Finance and Accounting and Procurement Services. This report is in the private meeting papers. The Board considered and approved the proposal to award the contract for the provision of Finance and Accounting and Procurement service to the identified supplier. The contract value is £1.295m over five years.

TP/VB2

TB/18-19/151 Financial Report (Month 09)

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The Board received and discussed the month 09 financial report which was discussed in full detail at the Finance and Performance Committee on 29 January 2019. The Trust has reported a £0.3m surplus in month 09 which is a year to date (YTD) deficit of £2.6m. The Trust is still on track to deliver a year-end deficit of £1.8m. The Trust achieved YTD savings of £4.5m against a forecast of £6m. The use of resource rating is three which is line with plan and agency spend rating is two, down from three in the previous month. The key factors impacting on the deficit YTD include:

Agency spend which is now £200k above the cap. This is an improvement of £100k from last month;

The Trust wrote off £1.6m of assets under construction which is offset by other disposals and release of contingencies in line with plan;

A favourable cash position which in month 09 was £13.5m and reflected inclusion of the sale of ST Martins to Homes England; and

Capital programme is significantly underspent, with YTD, total being £3.9m as a result of slippage in IT schemes and timings for completion of business cases.

The Trust has been asked to reforecast its capital position to be £650k underspent at year-end. This has been through the relevant governance groups. The Trust is bringing forward any plans that it can reasonably achieve before year-end and is cognisant that once it reforecasts its capital position for 2018/19 it will not be able to recoup those monies. The Trust has provided NHSI with its draft capital programme budget for 2019/20 which includes the required contingencies.

The Trust’s run rate is on average a loss of £150k per month based on delivering the control total of £1.8m in 18/19. The underlying Trust deficit is closer to £6m per annum excluding contingencies, therefore on average a loss of £500k per month.

TB/18-19/152 Chief Operating Officer’s Report The Board received the report from the Chief Operating Officer which included a comprehensive report on the Single Point of Access. The Board noted the very positive movement on Single Point of Access (SPoA). It is now important to focus on embedding this good practice. The Single Operating Protocol (SOP) has been implemented for a pilot period and is currently being testing for operational robustness. This will be reviewed in March with GPs and through the Clinical Effectiveness Operational Group with the view of rolling out the final SOP in April. The NHS Long-term plan states that mental health patients should not be stigmatised by calling a special service. With the SPoA service the Trust has created a special service which is not in line with the national strategy to better support service users. The Trust will work with other providers and partners including 111 services to ensure that there is a provision for mental health patients that fit with the national mental health agenda. Once the detail of the 10 year plan is published the Trust will understand next steps for this service.

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The Board agreed that a report on SPoA would come back to the Board in six months. The report will include operational metrics for call volumes, call answer times, FTEs providing the service and associated costs. It would also include feedback from customers (patients and GPs).

JMG

TB/18-19/153 Integrated Audit & Risk Committee Report and Minutes The Board received and noted the report from the Integrated Audit & Risk Committee meeting which met on 10 January 2019 and the minutes of the Committee’s meeting which was held on 28 November 2018. The Board also received the NHS England Letter on Emergency Preparedness, Response and Responsiveness (EPRR) and the report on the Information Governance Incident. The Committee was pleased to note that plans for the year-end financial audit is on track and auditors are taking a risk based approach to audit matters. In relation to the information governance incident, it was noted that there are controls in place which manages who can access patient records. It was also noted that it may be useful to develop a mechanism for debriefing staff members in the midst of a high profile incident or case. The Board welcomed and commended the NHS England assurance on the Trust’s Emergency Preparedness, Response and Responsiveness.

TB/18-19/154 Mental Health Act Committee Report & Minutes The Board received and noted the report of Mental Health Act Committee meeting which met on 18 December 2018 and the minutes of the Committee’s meeting which was held on 06 September 2018. The Board agreed that it should be cognisant of the requirement for doctors to conduct assessments of individuals not necessarily under the care of the Trust by virtue of a court order. The Trust has processes in place to deal with such requests. This does, however, add additional pressure on section 12 doctors and already stretched clinical resources. The Committee Chair committed to the Associate Hospital Managers, that the non-executive members of the Committee would attend at least two AHM meetings, annually. It was noted that AHMs were invited to be part of the 15 steps visits. The Committee will conduct a deep dive into Section 136 in relation to Black Asian and Minority Ethnic (BAME) patients.

TB/18-19/155 Any Other Business There were no matters of any other business raised for discussion.

TB/18-19/156 Questions from the Public Inpatient Services in Canterbury The Board noted that the following written questions have been received from a stakeholder in relation to proposed changes to inpatient services in Canterbury. 1. Has St Martin’s old site been sold?

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2. What are the plans for Cranmer Ward (older people)?

3. What are the plans for Samphire Ward (which has 3 beds condemned by the

CQC) but remedial work not undertaken?

4. Further concerns with the old site are. a. What will the considerable Therapeutic Space be replaced by? b. What will the chapel (Religious and spiritual space) be replaced by? c. What will the Library be replaced by? d. What will the Lecture Hall be replaced by? e. What will the chill out/self-vending area be replaced by? f. If the old site is sold ...how will the boundaries be fenced off.

5. The Estates Strategy document was last written in 2015 with the narrative by

John Carey. It is clearly out of date although apparently for 5 years. 2015 -2020. It clearly needs updating.....sooner rather than later....to lock with the Operation Plan 2018 -2019 which indicates one disposal in 2019...presumably St Martins Old although not named.

The Board agreed that Helen Greatorex would respond to these questions on behalf of the Board taking into consideration the discussion at the Board meetings.

HG

TB/18-19/157 Date of Next Meeting The next meeting of the Board would be held on Thursday, 28 February 2019, 09:30 and will be held in Boardrooms A& B Farm Villa.