Item 9. Birmingham and Solihull Mental Health NHS Foundation Trust Minutes of Public Trust Board meeting Wednesday 29 July 2015 at 3.00pm Plymouth room, Uffculme Centre, Moseley, Birmingham Present Sue Davis Chair (SD) John Short CEO (CEO) Sandra Betney Executive Director of Resources (SD) Sue Hartley Executive Nursing Director (SH) Peter Lewis Medical Director (PL) (left the meeting after item 6) David Boden Non-Executive Director (DB) Sukhbinder Singh Heer Non-Executive Director (SSH) Nerys Williams Non-Executive Director (NW) Joy Warmington Non-Executive Director (JW) Barry Henley Non-Executive Director (BSH) (from item 13) Also in attendance Deborah Lawrenson Caroline Burgin Louise Butler Jane Reames Vinnett Lynch Diane Markham Julie Ramsdale-Owen Company Secretary (DL) Note taker / Board Support Officer (CB) Acting Head of Communications & Marketing (LB) (observing) Operational Development (JR) (observing) Lead for Proactive Partnership (VL) (observing) Lead for New Dawn (DM) (observing) Education Manager (JRO) (observing) Governors Patrick Cullen Maureen Johnson Lucy Okill Tony Brookes Phil Jones Apologies Waheed Saleem Clinical Non-Medical Staff Governor (PC) Carer Governor (MJ) Non-Clinical Staff Governor (LO) Carer Governor (AB) Public Governor (PJ) Non-Executive Director (WS) Questions from Members of the Public No questions were raised. 1. Apologies 1.1 Apologies were received from Waheed Saleem, Non-Executive Director, Barry Henley, Non-Executive Director, who would be arriving late and Peter Lewis, Medical Director who would need to leave the meeting early to attend the Strategic Partnership Board meeting on behalf of the Chief Executive. 2. Review of the Action Log 2.1 The action log was received and noted. 3. Declarations of Interests (as required) 3.1 None
4. Chair report 4.1 SD thanked DB, who was attending his last meeting as Vice Chair and Non Executive Director, for his support to her as Chair and for his long service to the organisation. 4.2 4.3 SD advised the Board she had appointed Barry Henley to take over as Vice Chair and had made the following changes to membership of the Board Sub Committees: WS to chair Planning & Development Committee (PDC). SSH to join Integrated Quality Committee (IQC). JW to join PDC. Confirmation as to which Committees the new Associate Non-Executive, when appointed, would take up will be confirmed after discussion with them The Chair reported that she would be meeting with the Chairs from Black Country Partnership and Coventry and Warwickshire Trusts within the next few days. 4.4 Executive support team to be informed of changes to Committee membership. (CB Aug 15) ACTION 5. Chief Executive report 5.1 The CEO provide an update on the following: 0-25 service concerns regarding the transition of services was discussed at length in the Private Board meeting Outcome of the inquest into the death of DE. It was confirmed the Trust had offered a full apology for its part in the circumstances leading up to her sad death and noted a separate report had been provided later in the agenda. Spaces had been offered to provider organisation representatives on the Health & Wellbeing Boards in Birmingham and Solihull and the organisations had agreed Tracey Taylor CEO at Birmingham Community Trust, would take up the place at Birmingham. The Chair will join HWBB. The Trust has been named as a partner in the Vitality Vanguard bid and the Solihull Vanguard emergency and urgent care bid. 9.4 Medical Revalidation report 9.4.1 PL presented the medical revalidation report reminding the Board that the Revalidation Oversight Committee (ROC) was initiated with a remit to provide assurance to the Board that BSMHFT was undertaking its statutory responsibilities to ensure that doctors in BSMHFT had been successfully revalidated, as well as supporting the decision making process for revalidation recommendations in complex cases. He noted that there had been issues with two clinicians who had failed to engage with the process, which he expected to be resolved shortly. 6. Quality of Clinical Services 6.1 Quality Report 6.1.1 SH presented the Quality report, noting that: Considerable improvements had taken place in relation to reducing the Page 2 of 11
use of restraint and in particular prone restraint. 307 cases of prone restraint were reported during the quarter, compared with 460 cases during quarter 4 of 2014/15 The vast majority of clinical areas have an up to date environmental risk assessment. Ligature risk assessments are up to date and in place. CPA improvements are being seen, led by PL, though there was still work to do to continue to drive improvements forward There had been a significant improvement in numbers of and speed of dealing with complaints Learning was taking place following the issuing of a national report on schizophrenia, 6.1.2 6.1.3 6.1.4 6.1.5 6.1.6 6.1.7 The drafting of the report was commended and felt to be much improved. NW expressed disappointment at the results indicated from the data on physical health and drew attention to a typo on page 3 of the report. Action SH JW asked that a timescale be provided for delivering the improvement plan. It was agreed this should be updated and provided through IQC. Note for IQC forward plan. SB expressed concern on the increased trajectory with regard to violence against staff and asked how assurance was being gained on actions taken to address this. SH suggested this be reported back though IQC. Note for IQC forward plan. SSH stated that although the report included the total number of incidents reported it was not clear what these related to. SH explained that the incidents reported came from a variety of sources but agreed to add a column for future reports to clarify this. Action SH SSH asked Board members to consider what the number of incidents reported says about the organisation. SH explained that the Trust encourages staff to report incidents and was seen to have a good reporting culture. She added that staff had a duty to do so and thanked them for continuing to submit incident reports. Actions SH to amend the typo on page 3 of the report and to be replaced on the website (SH, Aug 15) SH to add a column to the incidents section of the report providing further detail (SH, Aug 15) SH to take forward items advised for the IQC forward (SH, Sept 15) 6.2 SUCE Recovery & Inclusion 6.2.1 SH presented the SUCE Recovery & Inclusion report, noting: A reduction in the number of complaints registered has been seen compared to Q1 2014/15. 100% of all complaints were resolved in Q1 Improvements had taken place with regard to PALs but there remained an upward trend. More work would be undertaken to ensure the complainants are happy with their response first time The team were working closely with the Clinical Governance team to Page 3 of 11
ensure data is extracted correctly The Clinical Governance team are working with the complaints team on RCAs ensuring work is moving forward in the same direction. Recovery for All work is on track and gaining traction See Me workers are extremely busy, and the PALs work needs to be correctly resourced Carers have reflected back that they would prefer to be referred to as Family and Friends 6.2.2 6.2.3 BGH noted he and SH would be discussing taking forward a piece of work to triangulate information from the friends and family tests and other feedback from service users who had indicated they would be happy to return to the service or to recommend it to others. JW commended the drafting of the report which was much improved and also commended the achievement of the improvement in complaints response times which had risen to 100% of complaints being responded to within the target. 6.3 Integrated Quality Committee report & draft June & July minutes to be circulated 6.3.1 JW presented the Integrated Quality report which was noted and it was confirmed the draft June and July minutes would be circulated to Board members. 6.4 Whistleblowing report 6.4.1 BGH presented Board members with the Whistleblowing report, noting: There had been 6 cases are reported, which were RAG rated with timescales, 2 investigations had completed and the remainder were being managed within timescales There are some lessons on how we manage cases and consideration needs to be given to the time and complexity of some cases 6.4.2 6.4.3 6.4.4 BGH advised Board members that at the Workforce Committee which took place the previous day, a change was agreed to the investigation process which would impact on the following policies and should have a positive impact on the time taken to carry out investigations: Whistleblowing Disciplinary Bulling and Harassment Grievances JW asked that caveats be build in to ensure that staff feel they are appropriately supported given that with investigation hearings there could be negative perceptions around respective power. BGH confirmed this would be covered in the process and policy. Brendan to confirm this is already in track and therefore doesn t need to be an action NW noted similar work had been undertaken by the General Medical Council (GMC) in terms of its investigation process. She noted that there was evidence of damage not only to those bringing forward cases but also for those who have been accused and it was important all were appropriately supported through what can be very lengthy processes. Page 4 of 11
6.5. Nursing Validation 6.5.1 SH presented the Nursing Validation report, which was being piloted by the Nursing & Midwifery Council (NMC). She confirmed it was likely to come into force on 31 December 2015 for those renewing their registration in April 2016. 6.5.2 6.5.3 JW commented, with regard to requirements on training and development in the revalidation process, that it would be helpful if the Trust could direct this towards areas of need within the Trust. SH explained that if was individually focussed at the current time but had the potential to be developed in the future. SB asked if there was potential for the revalidation process to have a negative impact on an already difficult recruitment crisis for nursing. SH confirmed there was but that the Trust was offering support to neighbouring trusts with their implementation process. 6.6. Infection Prevention Control Committee Annual Report 6.6.1 SH presented the Infection Prevention Control Committee Annual Report, noting: The code sets out 10 criteria against which NHS Trusts are judged on how they comply with registration criteria for cleanliness and infection control. She confirmed the Trust was compliant with the standards. Work on the risk register is underway There remains an element of concern over community services, in that their work style is naturally far more fluid There is a robust infection control team in place, and SH extended thanks to them for the hard work they undertake TB monitoring is underway, the team are working very closely with the Birmingham Chest Clinic 6.6.2 SSH asked if the Trust had a large infection control team and SH explained it was small but very experienced with members of staff participating on regional and national bodies providing advice on policy development. 6.7. DE Inquest 6.7.1 SH presented the DE inquest report noting: On 21 July 2015, HM Coroner for Birmingham & Solihull returned a narrative conclusion that the death of service user Mrs E was contributed to by neglect following care received on Rosemary Suite, Juniper Centre from 20-30 July 2014 Mrs E was transferred to Queen Elizabeth Hospital on 30 July 2014 with a grade 3 sacral pressure sore and a suspected infection. The pressure sore developed into a grade 4 sacral pressure sore and Mrs E sadly passed away at the QE on 30 September 2014. The cause of death was recorded as 1a) bronchopneumonia 1b) infected grade 4 sacral pressure ulcer. 6.7.2 6.7.3 SH assured the Board that she had asked the SI review group to revisit the original root cause analysis (RCA) report in light of the findings from the inquest with a report to go back to IQC. JW asked for clarification on the work undertaken by the SI group. SH outlined the membership of the group which meets on a weekly basis to review incidents and RCAs. Page 5 of 11
6.7.4 6.7.5 6.7.6 ACTIONS NW noted that one aspect not referenced in the report to Board was the criticism that the Trust did not communicate sufficiently with the family and asked that this be reflected in the review of the RCA. Action SH DB commented that the report makes uncomfortable reading and it was disappointing to see that there were a number of missed opportunities where staff could have intervened and prevented the deterioration. SD asked that a review of internal processes takes place to improve the system for ensuring the Board is kept regularly briefed where the outcome of an incident becomes more serious after it is initially reported. Action. Updates to be made to the RCA review with regard to communication with the family (SH Sept) Internal review to take place to improve the system for ensuring the Board is kept regularly briefed where the outcome of an incident becomes more serious after it is initially reported. (SH Sept 15) 7. Use of Resources 7.1 Finance Report Month 3 7.1.1 The Month 3 finance report was received and noted. Detailed discussion had taken place in the private meeting following the Board Seminar on financial sustainability and progress with the savings programme. 8. Items for Organisational Sign Off 8.1 Safeguarding Annual Report 8.1.1 SH presented the Safeguarding Annual report noting: In 2014 an external review was commissioned by the Executive Director of Nursing in order to ascertain how to improve the teams function and an improvement plan was implemented. A new Head of Safeguarding was appointed and the Team structure was further enhanced to include a full time trainer, two safeguarding facilitators and an additional named nurse Detail on the operation of the Multi Agency Safeguarding Hub (MASH) A detailed discussion had taken place at IQC and a seminar was being planned for the Board to take place in September 2015 8.1.2 8.1.3 8.1.4 8.1.5 SD commented that the report was extremely lengthy. SSH asked for clarification on the position of the team. SH confirmed that the team was initially not well resourced or developed and a significant amount of investment and work has taken place to strengthen the team. SH stated that whilst considerable improvements had been made and she had an increased level of assurance, there was still more to be done to provide the Board with full assurance. BSH drew attention to a reference in the action plan around failures around use of RiO 6, and Eclipse and the CEO asked for clarification if this was due to staff reluctance or a failure of the systems. It was agreed SH would investigate and report back. Action. Page 6 of 11
ACTION Investigation to take place in respect of staff usage of Rio6 and Eclipse (as referenced in the action plan) and report back to the Board (SH, Sept ) 8.2. Health & Safety Annual Report 8.2.1 SH presented the Health & Safety annual report noting that the focus of the work during the previous 12 months had been to consolidate and strengthen the Trust s Health and Safety structure and this work included: The appointment of a Health, Safety and Fire Advisor to replace the Manual Handling Advisor. The portfolio for Business Continuity and Emergency Planning now sits with the Risk and Safety team, with this role being merged with the Local Security Management Specialist role and the Director of Nursing having the Executive Lead responsibility. Delivery of Risk Assessment (general, ligature, stress and pregnancy) training for Ward Managers. Uploading Trust risk assessments to Connect so that they are accessible to all staff Implementation of a new lone working solution which had increased usage in some areas Future plans include reviewing the ligature risks, improving fire safety and evacuation process Work underway with the HSE in relation to the stabbing of a member of staff on Zinnia. It was confirmed the outcome of the HSE report would be received shortly and shared with the Board. 8.2.2 8.2.3 8.2.4 8.2.5 8.2.6 NW asked if the manual handling trainer had left the Trust and SH confirmed she would check and report back to NW. Action The CEO raised concerns on the risks highlighted within the report which indicated that staff were not universally using the lone worker devices. SD asked why staff were not doing so. SH suggested some staff had indicated issues with receiving signals on the blackberries in some areas which BGH echoed. He suggestion it may be necessary to remind staff of the requirement to use the process. NW suggested it should be made clear there was an expectation the equipment should be used and that if not this should be picked up as a disciplinary issue. It was agreed a review would take place and a report provided back to the Board on use of lone worker devices. Action ACTION SH to check if manual handling trainer had left the Trust & report to NW (SH, Sept 15) Report back to the Board on use of lone worker devices (SH & BGH Sept) 8.3. MHLC Annual Report 8.3.1 BSH presented the Mental Health Legislation Committee annual report noting the report provided assurance to the Board on the arrangements and activities relating to the Mental Health Act (MHA), Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) and was received for approval at the Mental Health Legislation Committee (MHLC) on 22nd July 2015. 8.3.2 Issues for escalation to the Board were as follows: Page 7 of 11
Knowledge & Practice training days are no longer provided by Learning & Development BSH informed the Board that the committee had concerns about the number of staff who had failed MHL e learning 8.3.3 8.3.4 ACTION The CEO asked how many had failed the training and it was confirmed it was 153 who had failed the training twice. Those staff have been given two further opportunities to pass and it was noted that the failure number included a number of clinicians. It was agreed that PL should be informed of the names of clinicians which he would then follow up. It was agreed this issue should also be picked up through the revalidation and appraisal processes going forward. Action PL PL to contact the clinicians who have not completed the MHL training and to provide a verbal update to the next meeting. (PL Sept 15) 8.4. Launch of New Dawn consultation 8.4.1 BGH presented the New Dawn consultation. The model has been co-designed and co-produced with service users, carers, staff, partners and commissioners. There is an expectation of a reduction in inpatient beds, the aim being more service users to be treated at home HUB working - teams will be centrally located around a number of clinical HUBs Recommendations around single sex units Working in partnership with third sector providers delivering respite & housing services Project plan to be re-submitted to Board in September (note for forward plan) 8.4.2 8.4.3 8.4.4 8.4.5 8.4.6 BGH commented and expressed congratulations to Diane Markman for the report and work undertaken so far by all the project members. The project needs the development of a full project plan, but the work undertaken so far is impressive. SD commented what would be helpful for the Board to see the threats to implementation, in relation to the slipping timescale on the 0-25 tender. BGH confirmed that the report being prepared by Mental Health Strategies will form an essential part of this report to Board, and he will circulate that within the next 2 weeks. BGH to report on threats to implementation due to 0-25 timescales within 2 weeks (Action) JW asked when the communication briefing will be released? BGH confirmed that the briefing is within the report and will be released as soon as possible on the website. SSH asked in relation to the reconfiguration of the estate and sites, is this to be included in this report. BGH confirmed this is in development, including the access, booking and choice team that is planned. SSH asked if there could be a strengthening within the report, to the risk analysis in relation to the 0-25 risks discussed due to the slippage of the implementation dates. BGH confirmed it is included already, but will be developed further. Page 8 of 11
8.4.7 SB expressed concern on the actual delivery of the project, and the potential of additional costs. BGH confirmed that there is a potential risk to delivery, but it has to be delivered within the financial constraints. We are looking to work smarter, so this should reduce costs at the same time. 8.4.8 ACTION SD gave thanks to the team who have developed the vision and report. BGH to deliver report on threat to implementation in relation to the slippage of dates to the 0-25 tender, in association with the Mental Health Strategies report due within 2 weeks (BGH, August 15) 8.5 Proactive Partnership future plans 8.5.1 The CEO presented proposals for future provision of the Proactive Partnership work which included increased service user involvement, more direction to be provided by the team and structural changes to move the work under the Director of Resources via the Communications and Operational Development teams. The new approached was approved. 8.6 Transfer of Services 18-25 year olds 8.6.1 BGH presented an update on the transfer of services for 18-25 year olds noting that the reconfiguration of 0-25 Mental Health services was underway and highlighted key challenges and risks: Slippage on the timetable with the majority of services due to transfer between January and March 2016 The number of staff leaving their roles which put continued safe provision of the services at risk The new Host Forward Thinking Birmingham had confirmed their ICT system would not be in place until April 2016 8.6.2 A detailed discussion on the potential risks and next steps had been discussed in the private board meeting. 8.7 NHS England Core Standards for Emergency Preparedness, Resilience and Response 8.7.1 SH presented the NHS England Core Standards for Emergency Preparedness, Resilience and Response, noting this paper was presented to the Board prior to submission to NHS England (West Midlands) as part of the requirement for the 2015 self-assessment 8.7.2 The Board noted progress made over the previous nine months in meeting the requirements. SH confirmed the declaration demonstrated the Trust is currently partially compliant with work identified to deliver full compliance by July 2016. She confirmed any feedback from NHSE would be shared with the Board. 9. Items for Information 9.1 Charitable Funds Committee report & June minutes to be circulated 9.1.1 NW presented the Charitable Funds Committee report and it was noted the June minutes would be circulated to Board members. It was noted the committee discussed: Page 9 of 11
The fundraising update and plan Difficulties with recruiting to the fundraising post and next steps Fundraising income & expenditure to date general fund Fund balances and financial analysis to May 2015 Schroders (investment advisors) update to March & May 2015 9.2 Audit Committee report & June minutes to be circulated 9.2.1 SSH presented the Audit Committee report and it was noted the June minutes would be circulated to Board members. It was noted the committee discussed the following: Updating required to the Terms of Reference which had been provided for Board approval. The Committee self-assessment process it was agreed the Chair of the Committee and Company Secretary would agree the timing and factor this into the work plan Quarterly review of risk registers 9.2.2 9.2.3. SSH noted that he had decided the committee should meet b-monthly going forward and that the internal and external auditors would not be required to attend the additional meetings. The updated terms of reference were approved. 9.3 Mental Health Legislation Committee report & July minutes to be circulated 9.3.1 BSH presented the MHLC Committee report and it was noted the July minutes would be circulated to Board members. It was noted the committee discussed the following: The Work Plan for 2015 Policy Review a number of the Trust s MHA policies have been updated in line with the recent revision of the MHA Code of Practice. The updates were outlined to the committee and agreed. Annual reports from complaints, legal and incidents. Quarterly report from the Lay Managers. The annual report for MHLC prior to discussion at Board E-prescribing concerns were discussed, and drug error rates will be monitored going forward. 9.5 Use of the Trust Seal 9.5.1 DL presented the use of the Trust seal report for noting. 10. Minutes of the last Public Board meeting 27 May 2015 10.1 The minutes of the meeting held on the 27 May 2015 were reviewed and approved with the following amendment: Page 3, Item 6.4, line 2 should read.understand why some sessions remained unfilled. 11. Matters Arising 11.1 None 12. Board Forward Planner Page 10 of 11
12.1 The forward plan was noted and no changes were put forward 13. Any Other Business 13.1 SD gave thanks to David Boden for his long service, and the work he has undertaken during his tenure as a Non Executive Director and Vice Chair and wished him well in his future endeavours and retirement. David Boden gave thanks to the Board and wished them well for the future. Next meeting: Wednesday 26 August 2015 at 2.00pm, the Uffculme Centre, 52 Queensbridge Road, Moseley, Birmingham Page 11 of 11