WEST LONDON MENTAL HEALTH NHS TRUST OPERATIONS BOARD (the board) MEETING Minutes Tuesday 2 nd March 2010 (Draft) Present: Also present: Peter Cubbon, Chief Executive (Chair) Mr Ian Kent, Deputy Chief Executive Miss Leeanne McGee, Director of High Secure Services Mrs Ruth Lewis, Director of Workforce & Organisational Development Mrs Nicky Holdaway, Hounslow (incl Cassel Hospital) SDU Director Dr Alice Parshall, Hounslow (incl Cassel Hospital) SDU Clinical Director Dr Kevin Murray, High Secure Services SDU Clinical Director Mr Steve Trenchard, Director of Nursing and Patient Experience Dr Nick Broughton, West London Forensic SDU Clinical Director Mr Andy Weir, West London Forensic SDU Director Mrs Kate Lyons, High Secure Services SDU Director Mrs Barbara Byrne, Director of Finance & Information Dr Michael Phelan, H&F (incl Gender Identity) SDU Clinical Director Ms Helen Mangan, H&F (incl Gender Identity) SDU Director Dr Elizabeth Fellow-Smith, Medical Director Dr Jonathan Scott, Ealing SDU Clinical Director Ms Gail Miller, Associate Director Risk Reduction Ms Timandra Dyer, Patient Safety Incidents & Family Liaison Officer Ms Gemma Stanion, Programme Director for the CQC Action Plan Mrs Jo Smith, Deputy Director of Finance & Information Mrs Mandy Bassi, PA to Medical Director (minutes) In attendance: Mr John Lunn, PA Consulting - Programme Management Office Mr Richard Jones, PA Consulting - Programme Management Office Dr Tauseef Mehdi, ST2 CAFS - Shadowing Dr Fellow-Smith 1 APOLOGIES FOR ABSENCE 1.1 Ms Bridget Ledbury, Ealing SDU Director 2 MINUTES OF THE LAST MEETING 2.1 The minutes of the meeting held on the 2 nd February 2010 were agreed as a correct record subject to one amendment to Item 4.7 which should read Mrs Byrne said the codes of the 7 London MH Trusts would be circulated in due course. 3 MATTERS ARISING 3.1 (para 4.1.) Complaints Tracker (as at 21 st December 2009) Mr Trenchard and Anne Aiyegbusi, Head of Nursing WLFS SDU, were asked by Mr Cubbon to find out what neighbouring trusts do with regards to their corporate complaint governance structure. Mr Trenchard reported that a paper will be submitted to the Operations Board with regards to what neighbouring trusts do with their corporate complaint governance structure. Action: Mr Trenchard
3.2 (para 4.3) Matters Arising - Disciplinary Policy and Procedure Review The board noted that the issues of the policy not reflecting the SDU structures had been raised in a paper to the SMTs to review. Mr Cubbon said the policy was to be revised so that it no longer required Non Executive Directors to chair the appeal hearings. Mrs Lewis reported that the Disciplinary Policy and Procedure was under review and would be revised so that Non Executive Directors would only participate in appeal hearings if the case related to a Director. The policy will be amended to reflect this. 3.3. (para 4.4) Update on MORI Mr Kent said he had met with Lynne Read, Assistant Director Primary Care Developments, and discussed progress to feedback and communication of the 3 SDU Primary Care Interface Improvement Plans to the GPs, a paper will go out by the end of March 2010. Mr Kent informed members that correspondence will go out by the end of March 2010. 3.4 (para 4.5) Policy Review Group Mr Trenchard said that the new Policy Review Group was in the process of being established. The board agreed that the role of the new Policy Review Group would be to review all policies, identify issues from incidents for the Trust to address and recommend the new or revised policy to the Quality & Risk Committee for final sign off. Mr Trenchard informed members that the new Policy Review Group had their first meeting on Monday 1 st March 2010. 3.5 (para 4.7) Follow-up from 5 th Jan 10 CELF meeting Benchmarking Club Mrs Byrne said she had met with other Finance Directors and they had agreed to share the results of their respective organisations. Mrs Byrne said the results of the 7 major MH Trusts would be circulated in due course. Mrs Byrne said that this had been actioned. SDUs should review the mental health benchmarking to identify any lessons. Actions SDU Directors Dr Parshall informed members that Dr Bullock asked for a pilot on HONOS PBR, Mrs Byrne said any currency based SLAs will be based on HoNOS PBR. Dr Fellow-Smith informed members that Dr Bullock is a member of the London wide PBR steering group and is part of the WLMHT one too. 3.6. (para 4.8) Follow-up from 5 th Jan 10 CELF meeting data analysis The Board was informed that Dr Bullock is working on the data analysis with SDUs which will then be presented to the SDU's and to Executive Directors. Dr Bullock to be asked to work directly with SDU Directors and clinical directors to consider how they could use the information presented by Dr Bullock to support service improvement Action: Dr Bullock, SDU Directors 3.7 (para 4.11) Admissions of under 18s Mr Kent informed members that an operational policy for the 2 Wards will be drawn up. Action: Mr Kent
3.8 (para 9.1.1) Safeguarding Children s Training Dr Fellow-Smith reported on the figures achieved for the Safeguarding Children s Training, she said for Level 1 training the Trust have hit their 80% target, 54% for Level 2 and 90% for Level 3 Dr Fellow-Smith informed members who should be attending at what level:- Level 1 - All members of staff Level 2 - All staff who come in contact with parents and children Level 3 - All Staff who work directly with children Level 4 - Lead professionals 4 PROMISE PROJECT UPDATE This item was deferred 5 PORTFOLIO MANAGEMENT AT WLMHT PA CONSULTING Mr John Lunn & Mr Richard Jones from PA Consulting joined the meeting to give a presentation on Portfolio Management at West London Mental Health NHS Trust. Mr Lunn presented a summary of what has happened within the Trust over the past 4 weeks. He emphasised that the key thing was the collection of activity and the life cycle being consistent within the Trust. Mr Lunn felt with most projects it s not evident that risks have been identified and managed. Mr Lunn explained the Trust s main focus will be on 6 key programmes which are as follows:- o Meeting Regulatory Requirements o Improving Efficiency of Central & Business Services o Developing & motivating our people o Enhancing High Secure Services (Broadmoor) o Improving Service Delivery (London) o Improving Patient Experience & Safety Members of the Board received the presentation as being very well worked out and thanked Mr Lunn for the work already put together in such short time. Mr Cubbon said some projects are completed and completed well, but some require additional resources and therefore we need to ensure we consistently have the resources set in place to support people. If approved by the Operations Board then the 6 programmes will go for Board approval and identified to make sure resources are available. The Operations Board we need to monitor programmes to assure itself that programmes are on track. Mr Weir said some capital projects have good plans but the work is not always delivered on schedule. Mrs Lewis spoke of the communications strategy and said they have 5 key objectives in it. Dr Phelan informed members that H & F have a project manager who has brought discipline to the SDU and felt the SDU could not have managed without the project discipline in the redesign of its services.
Dr Parshall informed members that she had found it very encouraging particularly as so much had been done within a very short period. Dr Broughton asked if each SDU will be allocated a programme manager, Mr Lunn responded and said an Executive Director will be accountable to the programme and a programme manager will be allocated to each programme but these should come from within the Trust and we need to ensure enough people are skilled up to deliver this approach. Dr Fellow-Smith felt the Improving Patient Experience was a good project and Ms Stanion informed the Board that the SHA felt this was a very positive step forward for the Trust. It was agreed to take the 6 key programmes to the Board. Mr Lunn and Mr Jones left Action: Mr Cubbon 6 SOUTHALL NORWOOD COMMUNITY MENTAL HEALTH TEAM BASE REPROVISION - BUSINESS CASE This item was deferred 7 MANOR GATE CMHT BASE REPROVISION - BUSINESS CASE This item was deferred Ms Miller and Ms Dyer arrived 8. SDU BUDGET & CIP PLANS 10/11 8.1 WLFS SDU Mr Weir confirmed that to achieve a savings target of 5% and to cover an 878k loss of income, the West London Forensic Service is required to find 2.85 million. To date the SDU has found 2.6 million, leaving a gap of 251k yet to be identified. The savings already identified are all recurrent and deliverable 8.2 HIGH SECURE SDU Ms Lyons agreed to circulate an efficiency saving paper within a week, but reported that High Secure SDU s target is 2.4m, they are intending to reduce ward based staff, and the management team in the space of 6 months. Mr Weir asked if we need to inform the Commissioners of the Wells Unit & Women s Unit that we are reducing funding. Mr Cubbon agreed to clarify this first. Action: Mr Cubbon Mr Kent said this resource will be used to support work on reconfiguring services and modernisation to improve patient safety and the quality of care in the next 3 years. 8.3 EALING SDU Dr Scott reviewed the position in Ealing this year. There has been a significant overspend but this has currently been brought under control and the budget has balanced in the last 4 months. The major initiatives to bring in the CIPS for next year are disbanding of AOT as a separate team, the key staff moving back to the CMHTs. This will save approx 400k.
The wards are also being reconfigured, particularly to manage female admissions more efficiently as there have previously been empty female beds. This is anticipated to save 550k. There are also plans to reconfigure PICU across Ealing and H&F which should realise 4-500k. The remaining savings will come from small savings and staff reductions in teams. There is an ongoing problem with Ealing PCT in that they are asking for a further 1.8 to 2.1 million in the next financial year, which on top of the above would be very difficult to manage. Mrs Byrne informed the Board that a company called Green & Kassab are working with SDUs and Corporate leads to look at savings options across the Trust. There has been significant progress in identifying CiPs although there remained further work to be done. 8.4 HOUNSLOW SDU Ms Holdaway reported progress re the 5% efficiency savings for Hounslow which represent 1,021k. 196k is yet to be identified. The plans to achieve the 5% across Adults, OPS and CAMHS are essentially low risk. The Cassel has undertaken a comprehensive recosting exercise and a revised increased and simplified tariff will be in place for 1 st April 2010. The revised tariff will ensure achievement of the Cassels share of the 5% efficiency savings. Although it will be operational from 1 st April, it will apply to new clients only, so overall could be regarded as a moderate risk. The remaining 196k will be achieved through bringing forward a redesign of non bed based services. A meeting last week with the PCT took place re. the proposed 5% reduction in the SLA. Various proposals had been put forward by the PCT as alternatives to decommissioning. They included taking over work currently in a contract with SWL & St Georges. Dr Parshall spoke of the pressures in the SDU precipitated by non allocation of trainees to posts this rotation, compounding issues regarding new starters in Psychiatry tending to be allocated to the most acute jobs. Dr Parshall agreed to meet with Mr Trenchard to look at how the skills of experienced nurses could contribute to this eg. Nurse prescribing, nurse led discharge. Action: Dr Parshall & Mr Trenchard 8.5 H & F SDU Ms Mangan gave an overview of savings within the H & F SDU she explained that H & F have 1.1m redesign programme in place have increased gender income, and identified possible savings in the Ealing Blair PICU. 9 CORPORATE SERVICES BUDGETS & CIPS PLAN 2010 9.1. DIRECTOR OF FINANCE Mrs Byrne informed members that Corporate Services have had the opportunity to meet with Green & Kassab, all corporate service will feed into this. Mrs Byrne presented a paper which indicated a saving of up to 1.8m focussing on catering, energy workforce and restructuring in IM&T. IM&T s paperwork was circulated and Mrs Byrne commented that while year 1 was relatively sound further work was needed to risk assess year 2 and 3 Finance Dept have initially identified the year 1 10% by freezing vacancies. This is an interim position pending the outcome of the benchmarking work and the intention is to undertake a fundamental restructure in finance in the summer.
9.2 MEDICAL DIRECTOR Dr Fellow-Smith reported on savings within the Medical Directorate and said she was aiming to in addition remove the vacancy factor in the Clinical Governance and Risk Team. Other possible savings have been identified but will require further discussion. Agreed to review in 12 months. Will need to look at the impact of losing the 8A Post and look at what the expectations are. 9.3 DEPUTY CHIEF EXECUTIVE Mr Kent reported that he was making savings with freezing a Band 5 post and 8D post. He explained that most of his budget had shifted to the Director of Nursing & Patient Experience. He would meet with Mr Trenchard to discuss the budget in more detail. Action: Mr Kent & Mr Trenchard 9.4 DIRECTOR OF ORGANISATIONAL DEVELOPMENT AND WORKFORCE Mrs Lewis reported that work had starting on making a saving of 3.5% within her directorate before she joined the Trust. She said she is currently looking at other ways of saving i.e. having one Learning & Development Centre instead of two, and addition income from Occupational Health etc. Action: Mrs Lewis 9.5 DIRECTOR OF NURSING & PATIENT EXPERIENCE Mr Trenchard reported that he needs to make significant savings which he needs to discuss this with Directors in SDUs. He felt there was potential opportunity of merging departments for example Medical Records, he said there could be savings in pharmacy of up to 10%. 10 REVIEW OF INCIDENT POLICY Dr Fellow-Smith presented the I8 Incident Reporting and Management Policy and said it has been to the Operations Board previously and needs to go to the Board at the end of March for sign off. Ms Miller informed members the new analysis training had started this week with all courses being fully booked. Ms Dyer introduced herself to members of the Board. She explained that the policy had been reviewed after they had visited 3 other Trusts, Leeds, Cheshire & Wirral and the SLAM. Ms Dyer reported the new I8 Policy is different and is compliant with NHSLA standards and gives greater clarity on Level 1, 2 & 3 as how they are commissioned and who sits on the incident review panels. It gives clear direction to staff on what to do. Ms Dyer highlighted the appendices, guidance for giving evidence in court for staff and 72 hour report for Serious Untoward Incidents. She spoke of the Level 1 & 2 Action plan template and said the SHA can benchmark us against other Trusts. Members were informed that training has been arranged in Root Cause Analysis. Dr Murray emphasised the importance of communication with families and carers during process. Mr Cubbon spoke of a programme televised 1 st March, Why did you kill my dad and suggested people watch as it raised issues of information sharing with the victim s family. The Trust will try to get a copy of the documentary from the BBC. Action: Mr Cubbon
Members of the Board thought where an incident was of a verbal nature it is not always necessary to complete a 24/72 hour report. Ms Miller agreed to look at the wording of this. Action: Ms Miller It was agreed to take out Deputy Chief Executive on page 11 as the responsible person for notifications should be the Director of Nursing & Patient Experience. It was agreed that once any amendments were made to forward the policy to Dr Broughton & Ms Mangan to proof read before it goes to the Board Action Dr Broughton & Ms Mangan 11 SUSTAINABLE DEVELOPMENT STRATEGY The Sustainable Development Strategy was received and noted by the Board. The paper with any further comments wile b discussed at the Trust Board in March 2010. 12 WLMHT PERFORMANCE IMPROVEMENT FRAMEWORK The WLMHT Performance Improvement Framework was received and noted by the Board 13 NHS LONDON HOMICIDE LEGACY REVIEW Mr Weir & Dr Fellow-Smith presented a paper giving feedback from the LNHS London Homicide Legacy review event in January 2010. Mr Weir spoke to the paper and said it wasn t clear about how accurate the RCA reviews are, as so few of them actually demonstrate that a difference would have been made. He said it was not clear how the SHA would pick this up. Members were informed about a manual put together by Oxleas informing their staff of what to do if an incident occurred. Members were also informed that Glasgow Mental Health Trust have put together a clinical package and have introduced a handover sheet of risks. Dr Fellow-Smith spoke of a checklist by NPSA which has simple steps to receive a risk safely. It was agreed to get the Handover Sheet from Glasgow and look at introducing something similar for the Trust. Action: Dr Fellow-Smith Dr Fellow-Smith also presented a paper highlighted a framework for learning from incidents based on practice to date and discussions had at the Incident Review Group in February 2010. She explained that as a result the Trust are organising an annual conference, annual joint SDU Workshops, Alerts, Risky Business, SDU IM & RG standard items, Quarterly Powerpoint to feed article in Mental Health Matters, Actions to IRG from SDU Action Plans and the Exchange page to house learning and actions. 14 SAME SEX ACCOMMODATION Mr Trenchard informed members that he had received a letter from NHS London with regard to Privacy and Dignity fund Delivering Same Sex Accommodation and explained that Ms Scott will be putting an action plan together which will be presented to the next Trust Board. 16 SAFEGUARDING TRAINING BRIEFING The Safeguarding Training Briefing was received and noted by the Board
17 WLFS SDU CONSORTIUM REPORT The WLFS Consortium Report was received and noted by the Board 18 PETS UPDATE Mr Trenchard reported that although the PETs had been introduced the usage of them was highly variable and therefore the information is probably not as useful as it could be. Mr Trenchard requested that this item be discussed in more detail at the next meeting. 19 EALING SDU SMT MEETING The Ealing SDU SMT Meeting notes were received and noted by the Board 20 HSS SDU SMT MEETING 21.01.10 The HSS SDU SMT Meeting notes were received and noted by the Board 21 WLFS SDU SMT MEETING - 11.01.10 AND 25.01.10 The WLFS SDU SMT Meeting notes were received and noted by the Board 22 H & F SDU SMT MEETING - 26.01.10 CLINICAL & OPERATIONAL MINUTES The H & F SDU SMT Meeting notes were received and noted by the Board 23 HOUNSLOW SDU SMT MEETING 27.01.10 (DRAFT) The Hounslow SDU SMT meeting notes were received and noted by the Board 24 ANY OTHER BUSINESS There was no other Business The meeting closed at 1.35pm 25 DATE OF NEXT MEETING(S) Tuesday 6 th April 2010, 10.00am 1.00pm