Board Paper 10 th November Item 15/285. To improve health and provide excellent care

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1 Board Paper 10 th November 2015 Item 15/285 Title: Author: Responsible Director: Summary of Key Issues: To improve health and provide excellent care Review of the Governance Arrangements Relating to the Care of Patients on Tawel Fan Ward Prior to its Closure on the 19 th December 2013 and Current Governance Arrangements in Older People s Mental Health at BCUHB Mrs Grace Lewis-Parry, Board Secretary Mr Simon Dean, Interim Chief Executive The paper sets out the proposed terms of reference for an independent review into the governance arrangements relating to the care of patients on Tawel Fan ward prior to its closure on 19 th December 2013 and the current governance arrangements for inpatient mental health services for older people. In June 2015, the Health Board determined that Donna Ockenden would be commissioned to undertake this work. A single point of contact has been identified within the Health Board to work with Donna Ockenden so that access to information is managed in a timely and appropriate manner. The steps and stages that the review of governance arrangements will follow are being finalised with Donna Ockenden. This includes the quality standards, the project management of the conduct of this review as well as the methodology, specific review targets and presentation of the final report. It is expected that the work will have 5 key stages: Stage 1- finalising the terms of reference, governance processes, key documentation and reporting arrangements. Stage 2 documentary review and schedule of interviews with staff. Stage 3 analysis and interpretation of data. Stage 4 publication planning and preparation of recommendations. Stage 5 publication of report. The work will commence from the 16 th November The detail 1

2 Action Required By Board: Key Impacts: of the timeline for completion, which is part of the contracting process, is subject to ongoing discussion with Donna Ockenden. To: Note Endorse Ratify Approve (Please provide a short summary against all that apply) Corporate Good governance Objective Finance The contract for this review will be the subject of a single tender waiver. Costs will be confirmed once the number of days to complete the review and the membership of the review team have been finalised with Donna Ockenden. Quality Impact Assessment Health and Care Governance, leadership & accountability Standards Equalities, Diversity & Human Rights Risk & CRR20, governance risk Assurance Disclosure: Betsi Cadwaladr University Health Board is the operational name of Betsi Cadwaladr University Local Health Board 2

3 BETSI CADWALADR UNIVERSITY HEALTH BOARD REVIEW OF THE GOVERNANCE ARRANGEMENTS RELATING TO THE CARE OF PATIENTS ON TAWEL FAN WARD PRIOR TO IT S CLOSURE ON 19 th DECEMBER 2013 AND CURRENT GOVERNANCE ARRANGEMENTS IN OLDER PEOPLE S MENTAL HEALTH AT BCUHB PURPOSE TERMS OF REFERENCE To set out the Terms of Reference for an independent review into the governance arrangements relating to the care of patients on Tawel Fan ward prior to its closure on 19 December 2013, and the current governance arrangements for inpatient mental health services for older people. These draft Terms of Reference have been developed following the decision of the Health Board on 9 June 2015 that Donna Ockenden would be commissioned to undertake a review of governance arrangements. CONTEXT The Health and Social Care Advisory Service (HASCAS) has been commissioned to undertake a full investigation into the concerns raised by the families of patients on Tawel Fan ward. This investigation will consider evidence from a variety of sources including: The concerns raised by families prior to the original Ockenden review The original Ockenden report dated June 2015 Statements provided by the families to North Wales Police during the course of their investigation Further information provided to HASCAS by the families as part of the HASCAS investigation Concerns raised by members of the families of additional Tawel Fan patients which have been raised since the original Ockenden review and the police investigation. 3

4 The outputs from the HASCAS investigation will be: Full confidential reports for each family into the concerns they have raised in respect of their loved ones The preparation of specific employee reports that may be used for employment related purposes where appropriate, including disciplinary action where indicated A report to be placed into the public domain outlining their finding in terms which respect the confidentiality of the patients, their families and individual members of staff The work of HASCAS focusses on the concerns raised in respect of individual patients, and to their care and treatment on Tawel Fan ward. REVIEW OF GOVERNANCE ARRANGEMENTS The Health Board wishes to commission an independent review into the wider Ward to Board governance arrangements in place at the time to identify any matters which may have had a bearing on events on Tawel Fan ward. This Governance review will complement the HASCAS investigation into the individual concerns raised by the families. In order to ensure the integrity of both this Governance review and the HASCAS review, the Terms of Reference for both reviews aim to clearly define their individual scope and ensure that overlaps, gaps and duplication are avoided. The broad purpose of the Governance Review is to identify any failings in systems, structures and processes which contributed to the events on Tawel Fan ward, and identify lessons for learning and actions to be taken within a timely and specified time frame. The review will also consider current governance arrangements in place for inpatient mental health services for older people The review will be led by Donna Ockenden, an independent reviewer. The Terms of Reference will be kept under review by the Oversight Panel. MODUS OPERANDI It is essential that a clear distinction is maintained between both the HASCAS investigation and the Governance review. 4

5 The focus of the HASCAS investigation is events on Tawel Fan ward, including the treatment of individual patients and the actions of individual members of staff. The focus of the Governance review is on the historic and current systems, structures and processes of governance in older people s inpatient mental health services. Separate work is underway to develop the future service strategy for the care of older people with mental health care needs. The Governance Review will: Review the systems, structures and processes in place prior to the closure of Tawel Fan ward on 19 December 2013 Identify any failings in governance arrangements which may have contributed to the failings of care on Tawel Fan ward Review current governance arrangements for inpatient services for older people with mental health problems The Governance Review team will be provided with access to documentation relevant to their terms of reference. This will include among other things Board papers, management papers, minutes of meetings, governance reports, relevant correspondence and monitoring reports. The Governance Review team will not require access to patient records, clinical information related to individual patients or information related to individual members of staff unless it has a direct bearing on the terms of reference of the Governance Review and does not risk compromising the integrity of either the HASCAS investigation or the Governance review. Any necessary access will be agreed through discussion with the Oversight Panel (see below) and in accordance with protocols agreed to manage the links between the HASCAS investigation and the Ockenden review. The Governance Review team will interview members of staff and Board members as appropriate. CONDUCT OF THE REVIEW This section will be finalised in discussions with Donna Ockenden once the Terms of Reference has been agreed. 5

6 It will include: The composition of the review team Outline plan and timetable Agreement of costs Confidentiality, indemnity and other arrangements GOVERNANCE OF THE REVIEW A formal governance assurance process will be established for the review. This will ensure: Independent assurance and quality assurance for the BCU Board Alignment and co-ordination between the HASCAS investigation and the Ockenden Review A robust audit trail which may be required for any potential future investigations or inquiries A robust audit trail so that the investigation/review process can reasonably be expected to withstand any potential judicial review process Accountability, openness and transparency in the public interest Monitoring of value for money An Oversight Panel will be established as part of the governance arrangements to ensure the above. The Oversight Panel will provide assurance about the conduct of the investigation to the BCU Board and will meet on a monthly basis. The panel will comprise: The Executive Director of Workforce and Organisational Development An experienced member of the Regional Safeguarding Adult Board An external member. The senior lead for the Tawel Fan response team will be in attendance at all Oversight Panel meetings. Independent legal advice will be provided to the Oversight Panel. Where possible, meetings of the Oversight Panels for the HASCAS investigation and the Ockenden review will be held on the same day. This will allow the two panels to co-ordinate the governance assurance processes for both investigations/reviews. 6

7 The key roles and responsibilities of the Oversight Panel will be to: Ensure that a probity firewall is in place between the Ockenden review, the HASCAS investigation and BCUHB during the course of the active phases of the work Ensure all investigative/review processes adhere to best practice guidance Ensure that appropriate protocols are in place to manage the interface with the HASCAS investigation including on information sharing Provide support and assistance to the reviewer Ensure that all necessary clearances, confidentiality agreements, indemnity and similar governance requirements are in place Advise on any amendments to the Terms of Reference which may be required Ensure value for money and an avoidance of omission or duplication Ensure the public interest is upheld The Oversight Panel will not advise on or direct the content of the review. The reviewer will report progress against an agreed Assurance Proforma on a regular basis so that the BCU Board can be briefed appropriately on the progress of the review. 7