POWYS TEACHING HEALTH BOARD MENTAL HEALTH SERVICES ASSURANCE COMMITTEE CONFIRMED MINUTES OF THE MEETING HELD ON THURSDAY 07 JANUARY 2016, AT 09.30AM, HAFREN TRAINING ROOM, HAFREN WARD, BRONLLYS HOSPITAL Present: Mark Baird (MB) Melanie Davies (MD) Matthew Dorrance (MJD) Roger Eagle (RE) Viv Harpwood (VH) In Attendance: Stephen Edwards (SE) Michelle Forkings (MF) Rhiannon Jones (RJ) Clare Lines (CL) Carol Shillabeer (CS) Liz Singer (LS) Mandy Collins (MC) Emily Groves (EG) Wayne Tannahill (WT) Catherine Woodward (CW) Public Attendance: Apologies: Alan Lawrie Dr Wasi Mohamad Independent Member Powys Teaching Health Board Vice Chair (Committee Chair) Independent Member Independent Member (Committee Vice Chair) Powys Teaching Health Board Chair Interim Medical Director Interim Operational Manager Director of Nursing (MHSA/16/07 onwards) Asst. Lead Director for Children & Strategic Lead for Mental Health Chief Executive Officer Independent Assurance Observer Interim Board Secretary Corporate Governance Support Officer Head of Estates and Property (MHSA/16/01-08 only) Director of Public Health There were no members of the public present Director of Primary and Community Care Clinical Director for Mental Health Services Page 1 of 12
MHSA/16/01 WELCOME AND APOLOGIES FOR ABSENCE MD welcomed everyone to the meeting and noted that there was a quorum present. Apologies for absence were received from Alan Lawrie, Director of Primary and Community Care and Dr Wasi Mohamed, Clinical Director for Mental Health Services. MHSA/16/02 DECLARATIONS OF INTEREST The Chair INVITED Members to declare any interests in relation to the items on the Committee agenda. None were declared. MHSA/16/03 UNCONFIRMED MINUTES OF THE COMMITTEE MEETING HELD ON THURSDAY 26 NOVEMBER 2015. The minutes of the previous meeting held on the 26 November 2015 were RECEIVED and AGREED as being a true and accurate record, subject to the following amendments being made: MHSA/15/35 Audit NHS Mental Health Management Arrangements (last paragraph, bullet point 3) should be acknowledged to be deleted. MHSA/15/39 Welsh Government spot checks and Healthcare Inspectorate Wales Inspection reports: progress update (paragraph two, bullet point 2) The words depravation to be replaced with deprivation. MHSA/16/04 MATTERS ARISING MHSA/15/36 MH Planning and Development Partnership CS advised the Committee that, since the last meeting of the Committee, the Mental Health Planning and Development partnership (MHPDP) had met early in December 2015 to consider the Hearts & Minds Annual Report. She confirmed that the report was on the agenda of the Board meeting scheduled for 24 February 2016. VH sought assurance from the Committee that part IV of the Mental Health (Wales) Measure 2010 was being progressed. In response, CL confirmed that a Page 2 of 12
requirement under Part IV of the Mental Health (Wales) Measure 2010 was that mental health in-patients (and those subject to Community Treatment Orders) were able to access Independent Mental Health Advocates (known as IMHAs). CL confirmed that Welsh Government had allocated recurrent funding to each health board, based on the population it served. PTHB received 40k. She advised that the current provider has agreed to keep covering Powys until July 2016 and that the services are being retendered. CL highlighted that there was a shortfall in funding from the Welsh Government that she felt the Welsh Government should meet. CL confirmed that Advocacy Cymru (the current provider of IMHAs) provide activity figures quarterly which are provided as part of the performance report. In terms of general advocacy, which covers other mental health patients in the community, it was confirmed that the Community Health Council gave notice to PTHB and the advocates transferred to the PTHB s Mental Health Department under TUPE. The Committee was advised that there is some unease about this as it could be perceived that they were not independent. CL advised that work is underway to base them within another Department of PTHB in order to provide as much independence as possible. CS stated that it was imperative that the problems encountered by PTHB in relation to the tendering process were reported to Welsh Government so that they fully understood the reasons behind the slow progress being made. It was agreed that information provided by CL in relation to Part IV of the Measure would be circulated to VH in preparation for her next briefing with the Deputy Minister. Action: Board Secretary MHSA/16/05 COMMITTEE ACTION LOG MC The Committee RECEIVED the Action Log. The Committee NOTED a number of actions had been completed and Page 3 of 12
agreed that these could be removed from the Action log. Action: Committee Secretariat EG MHSA/16/06 MENTAL HEALTH PERFORMANCE REPORT (INCLUDING INCIDENTS) The Committee RECEIVED and CONSIDERED the performance report. CL confirmed that the advice issued by Welsh Government in respect of the reporting of Serious Incidents would be circulated to committee members. Action: Asst. Lead Director for Children & Strategic Lead CL The Committee RECEIVED information in respect of assessments and interventions undertaken within 28 days. It was confirmed that the Executive Team Delivery and Performance meeting scheduled for 20 January 2016 would focus on areas of non-compliance to ensure that progress is made. CL advised the Committee that there were very small numbers in relation to CAMHS. RE stated that it was important to get a sense of how long individuals were waiting in respect of CAMHS. CS agreed with this, and stated that information should be provided to the Committee to provide members with a better understanding of the figures and the reasons behind them. CL noted that due to the reporting timeframes and the complex issues regarding the transfer of staff back to PTHB the narrative and she had not been able to prepare a full report for this meeting of the Committee. The Committee also RECEIVED information on the analysis of Mental Health Incidents recorded on Datix for the period April December 2015. The Committee discussed the level information available and the Committee s reporting requirements in relation to the following types of incident: Falls CL noted that obtaining the data and information from other providers remained an on going challenge. The positive work being undertaken in respect of falls Page 4 of 12
prevention in Ystradgynlais hospital was acknowledged. VH asked if falls figures were being benchmarked across provider health board was being undertaken and highlighted her concern that high levels of falls were not been captured. In response, CL stated that this was a huge challenge and to address it would require significant work with other health boards. CS suggested that further work be taken forward to look at general falls and trends to ascertain falls for certain types of patient could be undertaken. Action: Asst. Lead Director for Children & Strategic Lead MHA Absence (patient detained under the Mental Health Act absence without leave) CL advised the Committee that each health board had a different threshold for reporting and therefore clarification would had been sought from Welsh Government. Suicide CL outlined the proposals for suicide reporting and confirmed that the Suicide Review Group would report key messages and trends to the Mental Health Services. In response, VH stated that this would give the Committee an indication on whether or not part I of the mental health measure was working and it would also help the committee to understand if patients were seen in sufficient time. CW advised that it was important to note that many patients did not have the courage to visit their GP and therefore prevention work was fundamental and advised that this information should be provided on an annual basis. MJD asked for further clarification in relation to what type of incidents were included in under the heading of other. CL explained that until that Mental Health Services had been transferred back to PTHB further analysis of these incidents would be undertake and reported to the Committee. Page 5 of 12
The Committee NOTED: part one and part two target 80% for assessments and interventions within 28 days Compliance. the analysis of Mental Health Datix Incidents April December 2015 (Falls and MHA Absence) the proposals for suicide reporting. MHSA/16/07 MENTAL HEALTH RISK REGISTER The Committee RECEIVED the Mental Health Risk Register. In discussing the paper: - concerns were raised regarding psychology provision. CS stated that the biggest issue was in South Powys and following a conversation with Judith Paget, a letter had been received acknowledging that improvements need to be made. CS advised that the detail of the letter would be circulated to Committee members. Action: Chief Executive CEO RE asked if the situation was improving. In response, CS advised that improvements had been made as a result of the introduction of innovative ways of working. CS added that she got the sense that the problems were due to the service being psychology therapist driven and it shouldn t be. CL supported this viewpoint and explained that the service should be owned and delivered through a wide or broad section of professionals. - MJD queried the decision to reduce of the risk rating related to psychology services given that patients were still waiting for services. CL clarified that the rating had been reduced because a number of new resources had been made available such as new therapists, funding and it was planned to bring in additional therapists. MJD queried whether as a result of the input of new resources a reduction in waiting times had been noted? CL confirmed that initially 144 people had been waiting over three years and as a result of changes the number had been reduced to 90. MD suggested that this needed Page 6 of 12
to be made more explicit in future papers. MC advised that the Committee needed to think about whether the length of time taken to reduce the numbers was acceptable. CS agreed with this point and advised that a risk tolerance level needed to be set. LS stated that it was important for the committee to be mindful that patients were being seen and managed and having some therapy and oversight whilst on the waiting list. The Committee: NOTED the Mental Health Risk Register. AGREED that an exception report would be provided in respect of psychology waiting times. CL MHSA/16/08 ESTATES AND ENVIRONMENT OF CARE The Committee RECEIVED the action plan for the Mental Health estate. In discussing the report: - it was noted that further work was needed to further refine the action plan to ensure that it was prioritised on the basis of risk. Action: Head of Estates and Property WT - It was agreed that the organisation was in a much better place than it was nine months ago. - It was confirmed that the next step was to ascertain hotspot areas and that a workshop had been arranged for February 2016 to look at the standardisation of guidance in relation to anti-ligature approaches. - WT explained that a workshop was scheduled to take place in February 2016, to standardise guidance on anti-ligature points. MC noted that the Committee needed to satisfy itself that risks, such as risks related to ligature points, were being Page 7 of 12
managed appropriately while longer term approaches were being developed. In response, CS advised that whilst a number of steps had been put in place there remained a gap in respect of Executive Team ownership and Board scrutiny and agreed that this needed to change. The Committee: NOTED the Action Plan for Mental Health and Estates Department. ACKNOWLEDGED that further work was needed to further refine the report, to fully understand the risks in respect of outstanding work. MHSA/16/09 FUNDING OF MENTAL HEALTH SERVICES CL introduced the paper, advising the Committee that in 2015/16 Welsh Government had announced new investment of more than 15 million for mental health services in Wales. She provided an overview of the funding that had been made available to take forward improvements in mental health services for people of all ages. In discussing the paper the Committee: NOTED the report the schemes which had received approval to date AGREED to receive updates at future meetings NOTED that it was important to link funding to the mental health measures. AGREED that a veterans report would be built into the Committee work plan. MHSA/16/10 REPORT ON CAMHS The Committee AGREED to receive the paper at the next meeting. Action: Director of Primary and Community Care AL MHSA/16/11 ADULT MENTAL HEALTH ARRANGEMENTS CL, introduced the paper, in respect of Adult Mental Page 8 of 12
Health Arrangements. CL advised the Committee that: The transfer of management responsibility of North Powys (Betsi Cadwaladr University Health Board) and Ystradgynlais (Abertawe Bro Morgannwig University Health Board) was completed as planned on the 01 December 2015. The Overarching Project Board would remain in place and will ensure evaluation of Phase 2. It was entering Phase 3 for North Powys and the Ystradgynlais area. A Joint Transition Board had been established in order to complete Phase 2 the re-phased transfer of management responsibility for some mental health services currently provided by ABUHB in South Powys. Key risk and issues were reviewed at Project Team and Project Board and escalated accordingly. An audit was planned to commence in January 2016, this would provide the Health Board with assurance over the governance and delivery and management of key risks for example, transfer of staff. The review would be managed by the Transformation Programme and completed in line with the 2015/16 Internal Audit Plan. RE asked if out of hours remained a risk. In response, CL advised the committee that the north of Powys were using a rota of six doctors and weekly review meeting had been set up. CL confirmed that arrangements would be reviewed at the end of March and a mid-year review would be undertaken at the end of January 2016. VH enquired about the welfare of staff in North Powys. CL advised that staff were content. MF added that the transfer was a significant change for staff, albeit no change for service users and it was important not to lose sight of this. MF further added that new standards and expectations were being established and this would bring further changes for staff. RJ advised that it was important to note that during the early stages of staff transfer it was important to keep an Page 9 of 12
eye on staff absence in order to ensure sufficient back-up and cover arrangements. RJ acknowledged the enormous amount of work that had gone into the project and congratulated the whole team for all their efforts in making it happen. The Committee: NOTED the progress made against the Phase 2 of the Plan ACKNOWLEDGED the significant amount of work taken forward by the members of staff involved in the transfer of adult NHS mental health management arrangements back to PTHB. MHSA/16/12 INTERNAL AND EXTERNAL AUDIT AND REVIEW REPORTS: PROGRESS UPDATE The Committee RECEIVED a paper, which provided a progress update on the work taken forward in relation to the actions arising from Welsh Government Spot Checks. In discussing the paper: - MB enquired as to how best practice was disseminated across Powys. In response, CL advised that work was being shared but further work was required in relation to linking in new consultants and medical staff. -MF agreed that there was a need to consider different management arrangements however, from her viewpoint, the biggest challenge would be bringing about cultural change. LS felt that it was positive for staff to experience rotation within the workplace and in her experience, small units and static groups of staff produced poor standards. The Committee: NOTED the progress to date and further action required. NOTED the follow up checks and visits underway. MHSA/16/13 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 Page 10 of 12
attention of the Board and other Committees. MHSA/16/14 COMMITTEE WORKPLAN The Committee AGREED that the following items should be included: Veterans Report to be built into the workplan and report to the May 2016 Committee. Integration work Patient experience Annual Report and MH Partnership MHSA/16/15 ANY OTHER BUSINESS The Committee AGREED that at the next meeting Terms of Reference would need to be discussed and two hours should be allocated for this. The Committee AGREED that a pre-meet with LS and independent members should take place 30 minutes prior to each Committee meeting to allow opportunity for scrutiny. MHSA/16/16 NEXT MEETING This was scheduled for Thursday, 10:00am 12:30pm, Ground Floor, Conference Room, Neuadd Bryncheiniog, Brecon Offices MOTION TO EXCLUDE THE PRESS AND PUBLIC IN ACCORDANCE WITH SECTION 1(2) OF THE PUBLIC BODIES (ADMISSION TO MEETINGS) ACT 1960. Page 11 of 12