(Committee Chair) Chair) Interim Board Secretary (MHSA/16/25 onwards) Head of CAMHS and Childrens Learning Disability (MHSA/16/24 only)

Transcription

1 POWYS TEACHING HEALTH BOARD MENTAL HEALTH SERVICES ASSURANCE COMMITTEE CONFIRMED MINUTES OF THE MEETING HELD ON THURSDAY 03 MARCH 2016, AT 10.00AM, GROUND CONFERENCE ROOM, NEUADD BRYCHEINIOG, BRECON Present: Melanie Davies (MD) Matthew Dorrance (MJD) Roger Eagle (RE) In Attendance: Mandy Collins (MC) Kate Davies (KD) Stephen Edwards (SE) Andy Evans (AE) Jodene Fec Michelle Forkings (MF) Emily Groves (EG) Rhiannon Jones (RJ) Clare Lines (CL) Julie Richards (JR) Carol Shillabeer (CS) Powys Teaching Health Board Vice Chair (Committee Chair) Independent Member Independent Member (Committee Vice Chair) Interim Board Secretary (MHSA/16/25 onwards) Head of CAMHS and Childrens Learning Disability (MHSA/16/24 only) Interim Medical Director Deputy Director of Primary and Community Care Lead Pharmacist, (MHSA/16/26 only) Interim Operational Manager Corporate Governance Support Officer Director of Nursing Asst. Lead Director for Children & Strategic Lead for Women s and Childrens Service Manager (MHSA/16/24 only) Chief Executive Officer Observers Members of the Public: Liz Singer (LS) Independent Assurance Observer Apologies: Mark Baird (MB) Viv Harpwood (VH) Alan Lawrie Catherine Woodward (CW) Dr Wasi Mohamad Independent Member Powys Teaching Health Board Chair Director of Primary and Community Care Director of Public Health Clinical Director for Page 1 of 12 and Learning

2 Assurance/16/17 WELCOME AND APOLOGIES FOR ABSENCE MD welcomed Committee members and guests to the meeting. Apologies for absence were NOTED. Assurance/16/18 Assurance/16/19 DECLARATIONS OF INTEREST The Chair INVITED Members to declare any interests in relation to the items on the Committee agenda. None were declared. UNCONFIRMED MINUTES OF THE COMMITTEE MEETING HELD ON THURSDAY 07 JANUARY The minutes of the meeting held on the 07 January 2016 were RECEIVED and AGREED as being a true and accurate record, subject to the following amendments being made: Page 6, MHSA/16/06 paragraph 10 would need to be sought to be replaced by had been. Paragraph 14, omit not from third sentence Paragraph 15, compliancy to read compliant Page 7, MHSA/16/07 Risk Register Paragraph 3, psychology therapist driven to be inserted. Paragraph 5, 44 people to read 144 people Page 9, MHS/16/09 Funding of Indent 1, Omit the report. Assurance/16/20 MATTERS ARISING FROM THE PREVIOUS MEETING CL confirmed that since the last meeting the health board had made representations to Welsh Government (WG). CL confirmed that it had been agreed that the 30k slippage in relation to another WG funding Page 2 of 12 and Learning

3 stream could be used to cover the short-fall for 2015/16. CL advised that while this resolved the issue in the current financial year WG would not be stepping in to bridge the recurrent shortfall. It was confirmed that PTHB was the only health board having to top up its original allocation, which had been distributed based on population. It was confirmed that the re-tendering process had been initiated. However, it was noted that there were concerns that 70k would not be sufficient and it was suggested that the health board would have to cover a shortfall that was roughly equivalent to the cost of a psychiatrist. CL confirmed that WG had been advised that PTHB would continue with the tendering process based on the existing resources 70k ( 40k WG funding and 30k PTHB top up). If this did not result in a provider for PTHB there would need to be further discussion with WG about how this statutory requirement could be met in Powys. Assurance/16/21 It was confirmed that the next critical date was the 10 of March, when it would be known whether any compliant providers had come forward based on the existing level of funding. COMMITTEE ACTION LOG The Committee NOTED that a number of actions had been completed. It was AGREED that these could be removed from the live Action Log. The following updates were noted: MHSA/16/06 Performance Report It was AGREED that CL would re-circulate the information issued by WG in respect of Serious Incidents. MHSA/16/07 Risk Register It was AGREED that the detail of the letter received from Judith Paget, regarding psychology services would be circulated to Committee members outside of the meeting. Page 3 of 12 and Learning

4 It was AGREED that at the next meeting an exception report would be presented to the Committee in respect of psychology waiting times. MHSA/16/08 Estates and Environment of Care It was noted that the action plan would be further refined and prioritised on the basis of risk. It was NOTED that the Assistant Director of Estates and Property would provide an update in respect of this action in June. Assurance/16/22 MENTAL HEALTH PERFORMANCE REPORT (INCLUDING INCIDENTS) The Committee RECEIVED and CONSIDERED the performance report. CL provided a summary of Part 1 of the Measure and performance as at the end of December 2015 was reported: Assessments: Powys had narrowly missed the target 80% of assessments being undertaken in 28 days (79.4%) and a number of actions were provided with the paper to address the shortfalls in performance. Interventions: 72.5% of inventions are undertaken in 28 days against a target of 80%. The target for interventions moved from 90% in 56 days to 80% within 28 days in October It was noted that whilst this represented an improvement in performance, interventions for working age adults in the ABUHB area of South Powys remained a concern. In respect of Part 2 of the Measure (MHM) it was confirmed that the health board had been compliant with WG targets over the last 12- month period. However, it was noted that when moved back from Betsi Cadwaladr University Health Board, the information in relation to MHM service user validation (related to Part 2 of the MHM) was found to be inconsistent with the information that had previously been provided. The Committee was advised that the inputting of Page 4 of 12 and Learning

5 information by practitioners would be monitored to ensure that such action was carried out promptly. It was also noted that spot checks would be carried out. MF noted that a comprehensive list of Powys County Council s Care Co-ordinators was still to be received and confirmed that this would need to be escalated. As part of discussions in relation to Part 3 and Part 4 of the MHM it was noted that Psychology waiting times were still a significant concern, especially in North Powys where there had been recruitment difficulties. RE queries whether the waiting lists were based on time or need. In response, MF confirmed that the waiting lists were based on time. CS acknowledged that the health board needed further waiting list information from Aneurin Bevan University Health Board so that checks could be made to ensure that patients were being seen in order. She advised that it was important that the health board did all that it could to improve the psychology waiting times for patients. RJ advised that it was important to recognise that the number of people waiting for psychology were low and in the first instance a clinical review of the waiting list needed to be completed in order to fully understand the Powys position. It was noted that a benchmarking exercise would be undertaken in respect of the outpatient DNA rates and information on this would be included in the next report. It was NOTED that under the heading of other there needed to be greater detail in relation to suspected suicides. The Committee NOTED the update in respect of the performance of mental health services and that recovery plans that had been put in place to address areas of non compliance. Assurance/16/23 MENTAL HEALTH RISK REGISTER The Committee RECEIVED the Risk Register and as part of discussions the following issues Page 5 of 12 and Learning

6 were raised: MH 1 Performance Management of Service Provider North CL outlined the controls that had been put in place to ensure that the provider in North Powys met the minimum standards in terms of performance. MH 6 Commissioning Plans CL outlined the controls that had been put in place to address the lack of agreed NHS commissioning plans based on sound needs assessment and robust information. MH 9 Psychology Waiting Times It was noted that the current risk rating of 20 would possibly increase. It was highlighted that the risk tolerance rating of 6 needed to be reviewed to establish what actions had been taken to determine this score. RJ requested that the level of risk related to the staffing levels on Tawe Ward, Ystradgynlais Hospital be reassessed. Action: Assistant Director of Assurance/16/24 CHILD AND ADOLESCENT MENTAL HEALTH SERVICE REPORT KD introduced the paper. She advised the Committee that an additional investment of 33,693 made by WG had helped to significantly reduce waiting times. It was confirmed that waiting times for both assessment and intervention were expected to be no greater than 28 days by the end of March KD outlined the following in relation to Part 2 of the Measure: Compliance There was 100% compliance in relation to the completion of Care and Treatment Plans. Training Provided A rolling programme of training was provided by the Page 6 of 12 and Learning

7 CAMHS primary. Significant Incidents One significant incident had occurred in December 2015, with one child admitted to inappropriate adult bed at Hereford County Hospital. It was confirmed that this incident was subject to a serious incident review, which was linked to a joint partnership review with the Local Authority. Co-ordinated Intervention and Treatment Team (CITT) The name of the team had been changed in September 2015, prior to it becoming fully operational on the 28 September KD advised that all Children seen in the CITT team were subject to Part 2 of the MHM and have a carecoordinator within the Specialist CAMHS Service. The Service aims to provide an enhanced level of input for Children and Young People experiencing complex mental health difficulties. It was noted that the diagnosis of Eating Disorders (19%) had significantly increased. Additional Welsh Government Funding A summary of the new posts to be introduced was provided. RJ asked if KD was confident that they would recruit to posts outlined in the paper. In response, KD advised that they had received a lot of interest in the posts. It was noted that challenges remained in relation to recruitment of Consultant Child and Adolescent Psychiatrists. It was recognised that there was a national shortage of Child and Adolescent Psychiatrists and that options with neighbouring health boards had been explored. KD advised that there had been positive engagement with Wye Valley NHS Trust and that further discussions with Wye Valley NHS Trust were planned. Learning Disability It was noted that two recruitment drives had been Page 7 of 12 and Learning

8 attempted to fill a 0.4 WTE Learning disability Nurse post in the North of Powys. It was confirmed that there had been no appropriate interest and so the post would be advertised again. RJ raised concerns regarding the recruitment challenges and asked if this was a matter that should be looked at as part of the Workforce and Organisational Development agenda. RJ stated that staff skill mix also needed to be look at to help address this. JR advised that a Learning Disability Strategy for England had been published but there was no similar strategy for Wales. MD requested that an update report be presented to the Committee in June Action: Head of CAMHS and Childrens Learning Disability Key risk areas: The Committee NOTED the update regarding key risks and ACKNOWLEDGED that significant progress had been made in developing a new intensive team, introducing new ways of working and extending access to psychological therapies. Assurance/16/25 ADULT MENTAL HEALTH MANAGEMENT ARRANGEMENTS CL introduced the paper, and provided the Committee with a summary of progress in relation to the Adult NHS Management Arrangements. CL informed the Committee that key risks and issues were reviewed at the Project Team and Project Board and escalated accordingly. She confirmed that the overarching Project Board remained in place and would oversee an evaluation of Phase 2. It was noted that Aneurin Bevan University Health Board (ABUHB) risks had been transferred to a separate risk register and would be managed via the ABUHB Joint Transition Board (JTB), the first formal Page 8 of 12 and Learning

9 meeting of which had taken place on the 29 February It was confirmed that the JTB s Terms of Reference and the Phase 2 Risk Register had been discussed and agreed at that meeting. It was agreed that there needed to be greater clarity in relation to where responsibility sat for the professional leadership of nursing staff. Action: Assistant Director for. The Committee NOTED the progress made in relation to the Phase 2 and Phase 3 high level of the Adult NHS Management Arrangements Project. Assurance/16/26 INTERNAL AND EXTERNAL AUDIT AND REVIEW REPORTS: PROGRESS UPDATE (INCLUDING MEDICINES) The Committee RECEIVED a progress report relating to the implementation of the action plans relating to: Fan Gorau (Newtown Hospital) ward managed by Betsi Cadwalaldr University Health Board Clywedog (Llandrindod Hospital) ward managed by ABUHB Tawe (Ystradgynlais Hospital) ward managed by ABMUHB MF advised the Committee that all action plans had now been amalgamated into one action plan. It was also NOTED that: a review undertaken by the Delivery Unit as part of the assessment of Older Persons Inpatient across Wales commenced in November 2015 would be finalised by the end of July a number of Community Health Council (CHC) visits were planned and the findings from these would be reported to the Committee in due course. RE enquired as to whether the staffing levels on the Page 9 of 12 and Learning

10 Tawe Ward in Ystradgynlais hospital were adequate. In response, MF confirmed that staffing levels were adequate and strengthened arrangements to ensure a safe establishment for patients had been put in place. It was noted that following a review of pharmacy support to the mental health wards in Powys, and the appointment of Jodine Fec, as Lead Pharmacist for steps were being taken to strengthen the support provided to wards. Assurance/16/27 MENTAL HEALTH CAPACITY AND LEGISLATION COMMITTEE A report detailing the Act activity that took place during Quarter 3 (the period from 1 October to 31 December 2015) was RECEIVED. In discussing the report MD highlighted that during the last Power of Discharge Meeting, Committee members had raise some concerns regarding Advocacy services. She confirmed that a particular concern had been raised in relation to whether there was a conflict of interest as the Advocacy service was being hosted by the health board. MD asked if other health boards were seeing a decline in the take up of advocacy services. In response, CL advised that it may be possible to compare demand and provision on an All Wales basis. Action: Assistant Director for. Assurance/16/28 Assurance/16/30 ITEMS TO BE BROUGHT TO THE ATTENTION OF THE BOARD AND OTHER COMMITTEES It was NOTED there were no items to be brought to the attention of the Board and other Committees of the Board. REVIEW OF THE COMMITTEE S TERMS OF REFERENCE The Committee REVIEWED its Terms of Reference in line with the Standing Orders. Page 10 of 12 and Learning

11 The Committee AGREED that: - there should be stronger references made to Legislation. - it should cover all from CAMHS through to older age. - it should cover Learning Disability. - to ensure quoracy if regular members were unable to attend other independent members should be asked to cover in their absence. - meetings should be held at least quarterly. - meetings would be held in public with the option to hold discussions in private session where necessary i.e. when there was a need to protect the privacy of patients. It was NOTED that a Committee handbook would be developed and that this would set out guidance in relation to the administration, chairing and protocols for meetings. Assurance/16/31 REVIEW OF THE COMMITTEE S WORK PROGRAMME FOR The Committee AGREED that the following be incorporated into the 2016/17 work programme: - Heart and Minds - Power of Discharge Reporting - External Review of Advocacy - Capacity Act - Deprivation of Liberty Safeguards - (Estates) Assurance/16/32 SELF-ASSESSMENT OF THE COMMITTEE S EFFECTIVENESS As required by Standing Orders the Committee completed a self-assessment of its effectiveness. It was agreed that the findings arising from this assessment would be used to inform an improvement and development plan for the Committee. Page 11 of 12 and Learning

12 Action: Board Secretary in consultation with the Committee Chair Assurance/16/33 Assurance/16/34 ANY OTHER BUSINESS No items were raised NEXT MEETING This was scheduled for Tuesday. Page 12 of 12 and Learning