Birmingham and Solihull Mental Health NHS Foundation Trust

Transcription

1 Item 10 Birmingham and Solihull Mental Health NHS Foundation Trust Minutes of Trust Board Public Session Wednesday 26 March pm Uffculme Centre, Moseley, Birmingham Present Sue Davis John Short Sandra Betney David Boden Susan Fairlie Brendan Hayes Sukhbinder Singh Heer Barry Henley Peter Lewis Waheed Saleem Nerys Williams Joy Warmington Also In attendance Sue Hartley Gill Harrad Caroline Burgin Notes Governors Khalid Ali Maureen Johnson Peter Tinsley Steve Wordsworth Chair SD Chief Executive CEO Executive Director of Resources SB Non-Executive Director DB Interim Director of Nursing SF Executive Director of Operations/ Deputy CEO BGH Non-Executive Director SSH Non-Executive Director BSH Medical Director PL Associate Non-Executive Director WS Non-Executive Director NW Non-Executive Director JW Substantive Director of Nursing (from 01/04/14) SH Company Secretary and Head of Legal Services GH Board Support Officer CB Public Governor KA Carer Governor MJ Public Governor PT Stakeholder Governor SW Patient Story Bridget Bridget explained she has been an inpatient from September to December 2013 in Newbridge house, having previously been an inpatient on Lavender ward and Eden Unit. She was full of praise for Lavender, believing at the time that it was a private hospital. Bridget compared her experience at Newbridge House to the film One Flew Over the Cuckoos Nest. Bridget suffered loss of jewellery, was not given details of any possible sideaffects to medication, which resulted in her suffering hair loss, and was assaulted by another service user on two occasions. She was also not involved in the development of her care plan, and given no options on medication. Bridget saw her named nurse on one occasion in 10 weeks. Bridget stated the ward concentrated on medicating service users, and that was all. In addition, no nursing staff were visible on wards from 2.00pm onwards daily. She was put in contact with Mark Harvey after contacting the CEO and has been satisfied with the service she has received from the complaints service, but regrets that she has had to claim compensation for her jewellery, as she wished the loss had never taken place. Bridget has lost confidence in the system. Bridget has worked in the NHS for many years, and as someone familiar with NHS procedures she is concerned for any vulnerable service user in inpatient services.

2 Board members discussed the issues raised by Bridget, suggesting reports and the planning of additional unannounced visits to the Newbridge site. The CEO advised caution, as the Newbridge site is under close scrutiny at the moment, and must be allowed to operate without Board members being on site every week. BGH confirmed the action plan is being reviewed weekly at the Operations meetings and that staff on wards have responsibilities and will be held to account. The CEO stated his expectation is that the action plan is to be reported to IQC in April. ACTION Newbridge action plan to IQC April (BGH, April 14) Board members discussed that incidents and complaints are monitored to establish any potential new hot spots in inpatient areas. BGH noted that at IQC a reduction in incidents has since been noted at Newbridge. PL commented on the medication policies and procedures in inpatient areas, adding that medics had a major push to ensure service users are advised of side effects historically. He will repeat this process and added that service users on medication plans involves a lot more than just medication. 1. Apologies Apologies received from Sandra Betney who whilst present will be leaving the meeting at 4.00pm. 2. Review of Actions The Chair reviewed the action log, all actions were noted as complete or not yet due. 3. Declaration of Interests (as required) The Chair asked for any declarations of interest. No declaration of interests were declared. 4. Chair s Report 4.1 NHS Change Day The Chair reported on NHS Change Day, which was not discussed at last months Board meeting. The Non-Executives have had a discussion on what to pledge, and it was agreed that each would undertake to engage with a leader from another sector, either by giving to a charity or encouraging the sector staff to volunteer. SD asked the Executives to join the Chair and Non-Executives on the pledge over the next year. SD also confirmed that the Communications team are being asked to report this. 4.2 Council of Governors Update The Chair reported on the Council of Governors meeting that took place on 13/03/14, Governors had presentations on the business plans, the estates strategy and the work of the Integrated Quality Committee. The Chair will be consulting with Governors on the openness of future meetings after the attendance of some members of the public slightly hindered the Governors undertaking their work. Page 2 of 11

3 4.2.2 The Chair also reported that Sandra George, Public Governor for Solihull, has stepped down. An election is being arranged, with the election notice to be published next week. 5. Chief Executive s Report 5.1. The CEO reported on the commissioning of RAID, that the 4 local CCGs and 3 Acute Trust colleagues have agreed to the funding of the RAID service. Birmingham Cross City CCG & UHB have commissioned for 1 year, all the other Trusts and CCGs have commissioned for a further 3 years. The funding is worth 4.1 m. 5.2 The CEO reported that the CQC are proposing a full inspection as part of wave 2, starting on 12 May No further details are available at this point, although following discussions with other Trusts they received over 80 inspectors for their inspection. 5.3 The CEO reported that Rachel Mhaka is joining the CEOs office for the period of 1 year and 1 week on secondment as the lead for Listening into Action (LiA). The CEO formally thanked Coumarassamy Marimouttou for his work over the last 12 months on the LiA project. 5.4 The CEO reminded all that tomorrow Thursday 27 March is NHS Sustainability day, all NHS staff are encouraged not to use their car to travel to and from work. The CEO reported that the Trust pay expenses on more than 2 million miles per year and that 5% of traffic in Birmingham is for NHS purposes. 6. Quality of Clinical Services 6.1 Quality Report PL presented the Quality Report for thematic review of Serious Incidents (SI). PL reported on the incidents increase which is as a result of a major revision to RiO, designed to improve and streamline accurately and quicker report information. On CPA the result is 92% but it is felt that a deep dive on the data is needed to ensure this is accurate. PL reported on the CQC inspection on the prison, a very positive, and quite significant report SF reported on item 5a, the arrow should be orange, and the arrow should be going down, not up as shown in the report WS commented on the prison inspection, the feedback is extremely good, and the Trust should take credit for that. PL confirmed that visitors described it as gold standard Service WS asked on 4.4 Healthwatch what is their role, is this their first visit? The CEO stated last year he did write to the area director, to ask that they ensure coordination between Healthwatch/CQC/Commissioners when planning unannounced visits, he did receive assurance they would coordinate SF commented she has not seen a Healthwatch report but will check and chase a report back from them. DoN to chase. ACTION SF/ DoN chase Healthwatch report (SF/ DoN May 14) Page 3 of 11

4 6.2 Service User and Carer Experience Report SF presented the Service User and Carer Experience Report including complaints information and real time feedback reports. SF highlighted that they have a new associate director, Alison Simpson, for the complaints and service user experience. Her agenda is to review and highlight compliments as well as complaints. SF reported that Alison has her own ideas on how to report to Board and Committee. SD added it would be useful to discuss with SD & JW for IQC SF reported that there is a large shift in the number of complaints, and asked for more detail, which will be coming in the next report. There are also a significant number of ways to receive feedback at the Trust which is to be applauded. In addition, 12 new service user volunteers will be in place from next week to meet and greet GH asked in relation to complaints, are those complaint responses that are overdue suggesting that complaints are not given priority within the Trust? SF added that the process has been strengthened, and escalation of uncompleted responses is reported to BGH & SF NW asked how does best practice in CMHTs get shared, for example BGH confirmed that operational procedures, learning lessons is delivered to local integrated governance committees, the sharing between committees is next step SSH asked what is the definition of a formal complaint? SF confirmed it is formally writing to the Trust. SSH commented there may be other concerns outside of that. SF added that the PALS team focus on resolving issues prior to the use of the formal route. The CEO added that service users don t have to make formal complaint in writing some are accepted verbally, and recorded and it should be agreed and confirmed to them that we are taking it through the formal procedure SD commented the Board members find the feedback from Patient Story very grounding, but services do not get that same direct feedback, but it would be good if Newbridge House could get that feedback SB noted that the Healthwatch website have some of our services listed, but not all. SB also commented that she feels the Board need to adopt appropriate language when service users possessions go missing, some cases are clearly theft and some are fraud; SB feels Board should use that language. SB confirmed that she would follow up on the issues raised in the patient story. 6.3 Integrated Quality Committee JW presented the Integrated Quality Committee report and the minutes from the meeting on 19/03/14 which have been circulated to Board members JW reported that robust discussions took place on the Equality & Diversity paper, and Committee members were very clear on the outcomes that they wished to see. In addition, Committee received the HR staff survey results, and analysis of what those results really mean, including actions going forward such as to make mention in the CEO Blog. 6.4 Inpatient Nurse Staffing SF presented the Inpatient Nurse Staffing report which provides an update on actions being taken to review inpatient nurse staffing levels using professional judgement to drive Page 4 of 11

5 further improvement in clinical quality. At the February Board meeting the decision was reached to increase the nurse staffing level to 5/5/4 for 16 bedded wards, until this paper was received SF reported that there are some monies from the reduction in the deflator in region of 398k.The 16 bedded inpatient wards, with the exception Bruce Burns and Newbridge whose staffing levels will be 5/5/5 due to them being isolated units, are expected to be funded for 5/5/4 if Board members agree. The shortfall of funding will be an impact on the Trust s surplus, which will subsequently have an impact on the COS rating, with a reduction to 2 for , and back to a 3 for The options for funding the shortfall include disengaging from services and approaching commissioners to assist in funding SB commented that the local commissioners have expressed a wish to be involved in the discussions on nursing levels, or disengagement of services, as there would be an impact on capacity for commissioners SD noted complaints received from service users are on topics such as activities/ things to do, is there flexibility on what kind of staff this could fund? SF clarified this is our response to Francis, with the intension of driving up the quality, to deliver a reduction in incidents. BGH added that on George ward and Bruce Burns, the staffing increase has seen a dramatic reduction in absconsions and the feedback has been very positive with a reduction in incidents. SF added that the Trust are obliged to advertise staffing levels from next week, and a poster has been developed. The CEO suggested a photograph of the ward manager next to that poster at the entrance to every ward JW was pleased to hear about positive figures on incidents, but is cautious that staff measures do not mean that service users will get a better quality of service SSH expressed concern on the poster of the term non-essential activities SF added that we have to be clear it might impact on medical care Board members discussed the minimum staffing levels and possible unintended consequences which will need to be closely monitored WS asked where are those new staff going to come from and the Trust confident to be able to recruit. SD added that is a good point. WS asked if there is any financial payback or benefits for implementing this. SD commented that every Trust is going to be investing in this, without any obvious financial payback, although it is anticipated that we may see benefits in terms of patient experience and clinical effectiveness SF added other things to factor in are the use of12 hour shifts and compassion fatigue, SF hoped this staff would see the benefit of shorter shifts as well as alleviating pressure on wards SB discussed the risks to taking the funding from the Trust surplus, and the additional regulatory scrutiny this would create. The CEO stated this would be the Boards decision following the Francis report, it is a statement on the sort of decisions the Board have to make, that this is what it takes to deliver minimum standards of care. This is the cost identified and then the Trust would have to explain to Monitor why this is being carried out. Page 5 of 11

6 Board members debated the funding of the minimum staffing levels and commissioners/ regulatory impacts that may create. Board members decided to mitigate to approach the commissioners for additional funding and in the meantime the shortfall is taken from the surplus SD summarised, that if Board agree, that the shortfall to fund the additional nursing staffing would need to be found SD asked SB what the initial funding effect would be? SB stated that the capital programme will be unaffordable. The CEO suggests a dialogue with Monitor over what the impacts will be and commissioners be negotiated with SD asked Board members to approve the proposal of minimum level of staffing for acute wards. Board unanimously agreed. SD wishes the Executive team to negotiate as hard as they can with the commissioners and regulators. ACTION Inpatient Nurse Staffing levels approved. 7. Use of Resources 7.1 Finance Report Month SB presented the Month 11 report, the Trust forecast is a surplus of 3.165m and SSL s forecast is a deficit of 0.476m. The consolidated position is a forecast surplus of 2.689m compared to a budget of 1.507m surplus. This is an improvement of 0.252m from last month, due to income received from Health education. The COS rating is 3 at the end of this year. The savings are to be taken out of the budget at the start of next year. 7.2 Performance Report Month SB presented the Month 11 Performance Report, which was discussed at the Integrated Quality Committee, the highlights of which are as follows: Trust Board is asked to note that on 2013/14 definitions, performance for February 2014 shows 6 of the 7 Monitor indicators assessed on a monthly basis being met for month 11. The indicator exception relates to EIS new cases - compliance for the month of February (16 new cases taken on) is 3 cases below the monthly trajectory of 19 new cases. The Trust continues to meet and exceed both the quarterly and year to date trajectory agreed with Commissioners. The indicator is failing in month, but achieving year to date. Trust Board is asked to note the update provided in the report regarding the interim findings of the data quality review of the CPA 12 month review indicator and early findings of the CPA 7 day follow-up review indicator are also detailed within the report. Indications show small issues with the data quality, and the impact of those are being reviewed at the moment. This may have an impact on the Monitor indicator which is 95%. Trust Board is asked to note that the indicator on access to healthcare for people with a learning disability is assessed on a quarterly basis. Local Indicators on appraisals has reduced, this is due to a data issue, and sickness absence continues to fail to meet the objective. Page 6 of 11

7 7.2.3 The CEO asked BGH to review the sickness target and results. BGH reported that they have been reviewed, and the team have considered how we compare with other organisations, the target being 3.7%. This is believed to be unrealistic for mental health services, 4-4.5% feels like the right target which will still be a stretch to achieve SD commented that staffing levels or a shift review may also have an impact on absence levels SD asked for NWs opinion on the sickness results, NW commented that having asked DB, the sickness target has been in place at 4% for 8 years, and has never been met. The CEO commented that the target must be reviewed if it is never achieved SD suggests that at the May Board a report be presented on options to address the sickness absence and suggestions for sickness management. ACTION In depth sickness management report back to Board in May (BGH, May 14) 8. Items for Organisational Sign Off 8.1 Staff Engagement Strategy The CEO presented the Staff Engagement Strategy, highlighting that the previous staff engagement strategy, was signed off in 2012 by the Trust Board, and ran until June It was during the evaluation element of the previous strategy that a revision of the strategy was seen to be required. The CEO asked the Board to sign off this final version of the staff engagement strategy NW commented that she has witnessed a successful awards ceremony where colleagues had nominated colleagues SF suggested on the collaboration with a university, for mentor awards to be given by student nurses JW asked Board to consider the use of networks as a positive aspect within an organisation, or alternatively the Trust instigate the rewarding of the Trusts values. The CEO suggests the Executive team review. ACTION The Executive team to pick up the rewarding values suggestion (CEO, May 14) SD asked Board if they are satisfied with the Staff Engagement Strategy and they are happy to approve it. Board members approved the Staff Engagement Strategy. 9. Items for Information ACTION Staff Engagement Strategy approved. 9.1 Charitable Funds report and draft March minutes to be circulated Page 7 of 11

8 9.1.1 NW presented the Charitable Funds Committee report and the minutes from the meeting on 19/03/14 which have been circulated to Board members NW reported that key points include the resolution of the sum of 138k, which was owed to the Trust, and in addition the charity intends to ask SSH for his view on the investments. 9.2 Whistleblowing Report BGH presented the Whistleblowing report, highlighting that one Whistleblowing case is under investigation, which was received on 15/11/ Management & Leadership Strategy SB presented the Management & Leadership Strategy, which was developed from a Board Day last year. The specific aim of this strategy is to increase the capacity and capability of managers and leaders in the organisation by 31st March 2015 linking directly to the organisation s strategic ambitions and in keeping with the values. Measurements are also included within the report to demonstrate achieving the strategy JW commented this is a really very good paper, and asked how will we put it into practice, and how to demonstrate the behaviours we want to see. The paper is not explicit on how will we can achieve these goals WS commented equality and diversity is something for the Board to think about, and how we develop the management staff, perhaps by giving them experience in other organisations. SB stated the high impact changes were designed to address that SSH commented that he felt the report did address the issues, but perhaps the external aspects could be included. SSH added that he would like to see something more coordinated SD asked Board members if they were content to approve the strategy and high impact actions. Board members approved. Non-Executives and Executives are happy to participate in further development. SB left the meeting at this point. 9.4 Equality & Diversity ACTION Management and Leadership Strategy & High Impact Actions approved PL presented the Equality and Diversity Report, which was discussed at length at the Integrated Quality Committee on 19/03/14. PL reminded all that further work is being undertaken to develop a business case on the objectives WS commented on the number of Afro-Caribbean men sectioned, that good level of service should be delivered to these individuals. PL asked Board to exercise caution in assuming that, without any resources being input that changes can be made. Board members discussed. SD summarised that further research needs to be undertaken on this topic. Page 8 of 11

9 9.4.3 SSH commented that on workforce diversity, agreed during the Seminar session, the Executive team agreed to take that away and review. ACTION Executive team to review Workforce diversity (CEO, June 14) SD asked Board members to approve the Equality & Diversity report BSH commented on the reservations expressed in the IQC Committee, that further work is being undertaken on the objectives SD summarised that this will be presented back to IQC and Board will be assured of the objectives. 9.5 Research & Innovation Annual Report ACTION Equality & Diversity report to be updated and presented to IQC (PL, July 14) PL presented the Research and Innovation Annual Report, clarifying that in the progress of the Trust s performance in regards to the National Institute for Health Research (NIHR) higher level objectives compare favourably with other NHS member organisations, although our recruitment target of 800 remains a modest total relative to the size of the organisation. R&I exceeded the forecast with annual income exceeding 1.9 million and a Trust contribution of just over 100k. The team predict a modest rise in income for the coming year SSH commented surely this is a fundamental part of our business, which aligns with our values. Are we focussed enough on areas we want to be in, have we got too many projects? PL commented that there are only 6 areas we are currently involved in, and there could be a lot more that we could be doing WS this is an annual report, have we changed the research undertaken? PL commented that research has been informed by work that we are undertaking SD suggested the research teams be invited to present to Board on progress made yearly JW asked how is this communicated to the rest of the organisation? PL agreed that we should be better at communicating this to the wider Trust. The Board accepted the annual report as presented. 9.6 Staff Survey including Listening into Action Pulse Survey Results BGH reported that the 2013 NHS Staff Survey involved 265 NHS organisations in England, over 416,000 NHS staff were invited to participate using a self-completion postal questionnaire survey or electronically via . Birmingham and Solihull Mental Health NHS Foundation Trust randomly sampled 827 staff via postal questionnaire survey between Page 9 of 11

10 September and December staff responded from 827 survey questionnaires, an increase of 5% from last year s survey BGH reported that this report was discussed in depth at the Integrated Quality Committee. Two pieces of work were agreed at IQC, the HCA bullying and harassment by service users and public, be encouraged to come forward in the CEOs blog and a LiA event for HCAs, and a deeper dive on the areas of issues highlighted in the Staff Survey and Pulse Survey results. A report will be presented to IQC once complete. 9.7 Workforce Report BGH presented the Workforce Report, covering: Performance in relation to vacancy management, recruitment and TSS, given these are Board priorities Key risks and assurance BGH reported on a real strong focus on vacancy management at the front line, has highlighted an absence of managers being engaged in the recruitment process. In addition the recruitment team have instigated a weekly call to new appointees to keep appointees keen BGH reported on the review of TSS which was set up initially to cover for short term cover and sickness. It appears it is also being used to cover for annual leave. Also they are isolated from the HR team over at Ardenleigh. This service is under constant review. 9.8 Building a Culture of Candour in the NHS The CEO presented the report on Building a Culture of Candour in the NHS, reporting that following the Government's response to the Mid Staffordshire Public Inquiry, Professor Norman Williams, President of the College, and Sir David Dalton Chief Executive of Salford Royal Hospital, were asked by the Secretary of State for Health to lead a review on two proposals to enhance candour in the NHS. These include whether the threshold for the new statutory duty of candour should be set at the level of death and serious injury, or death, serious duty, and moderate harm and how the NHS Litigation Authority might incentivise candour by seeking reimbursements from trusts in cases where they had not been candid with a patient or family The CEO asks Board members to consider the report and submit any recommendations back to the CEO / GH by SF added that the report discusses the plethora ways of grading of SIs. SF suggests carrying on with the current process, until the regulator decides on the new format and grading of SIs. ACTION Board members to consider and recommend any improvements or suggestions to GH/ CEO by (All, May 14) 9.9 Monitor Quarter 3 Feedback Page 10 of 11

11 9.9.1 The Trust Board received the report on the Monitor Quarter 3 Feedback, presented by the CEO, commenting on the unexpected deaths, and the rate of suicides (the Trust are below average) which now needs identifying in the Quarter 4 report Birmingham Safeguarding Children s Annual Report & Action Plan SF presented the Birmingham Safeguarding Children s Annual Report & Action Plan for information. SF stated the key messages are that great strides have been made, however the Council are under a lot of scrutiny, adding that the recommendations made in the report have not been followed through. SF reported that the Trust will be writing to Birmingham City Council following receipt of this report to clarify the impacts on our services JW commented on the challenges now faced by the Trust in light of the Council s financial situation. 10. Minutes of the last Public Board meeting 26 February The minutes of the Public Trust Board meeting held on 26 February 2014 were reviewed for accuracy. With no amendments, the minutes of the last Public Board meeting on 26 February 2014 were agreed as a fair and accurate reflection of the meeting. 11. Matters Arising The Chair asked for any Matters Arising. No matters were raised. 12. Any Other Business No any other business raised. Next meeting Wednesday 30 April 2014, Uffculme Centre, 52 Queensbridge Road, Moseley, Birmingham. Page 11 of 11