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GETHER NHS FOUNDATION TRUST

BOARD MEETING BUSINESS CONTINUITY ROOM, RIKENEL 28 JULY 2014 PRESENT

Ruth FitzJohn, Chair Shaun Clee, Chief Executive Martin Freeman, Non-Executive Director Charlotte Hitchings, Non-Executive Director John Trevains, Deputy Director of Nursing Stephen Andrews, Deputy Director of Finance Colin Merker, Director of Service Delivery John Saunders, Non-Executive Director Maggie Deacon, Non-Executive Director Carol Sparks, Director of Organisational Development Jonathan Vickers, Non-Executive Director Paul Winterbottom, Medical Director

IN ATTENDANCE

John McIlveen, Trust Secretary Dawn Lewis, Public Governor Jane Melton, Clinical Director of Social Inclusion June Hennell, Carer Ian Stead, HealthWatch Herefordshire Rod Whiteley, Public Governor Richard Castle, Public Governor Rob Blagden, Staff Governor Paul Grimer, Staff Governor Bren McInerney, Member of the Public Dr Philippa Moore, Joint Director of Infection prevention and Control (Item 7)

1.

WELCOMES AND APOLOGIES

1.1

Apologies were received from Trish Jay, Jo Newton and Andrew Lee.

2.

MONTPELLIER UNIT SERIOUS INCIDENT UPDATE

2.1

The Chief Executive read out to the Board a statement regarding the tragic death of Sharon Wall on the 9th July. The statement set out the facts of the incident as they were known at the time, and paid tribute to the dedication which Sharon had shown in providing care and compassion to patients during her life.

2.2

The Chair also read out a card which had been received from a member of staff who worked elsewhere in the Trust, thanking the Board for its efforts to support patients and to keep staff informed during this difficult time.

2.3

The Board observed a few moments of silent reflection in memory of Sharon.

3.

DECLARATIONS OF INTERESTS

3.1

Shaun Clee informed the Board that he had been asked by Sir Stephen Bubb to join a task and finish group set up following the Winterbourne View report to progress work at a national level regarding the placement of people with learning disabilities in more appropriate settings. The task and finish group would take up 4-6 weeks over a 12 month period.

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4.

MINUTES OF THE MEETING HELD ON 23 MAY 2014

4.1

Maggie Deacon’s attendance at the meeting had not been recorded. The minutes of the meeting held on 23 May were agreed as a correct record, subject to the attendance list being amended accordingly.

4.2

The revised minutes would be presented to the Trust Chair for sign off.

5.

MATTERS ARISING AND ACTION POINTS

5.1

The Board received an update on an action from the March 2014 meeting regarding more effective management of membership within current resources. The Board noted that the Communications Team was a small one, and its resources were spread thinly, making this a difficult task. The Chief Executive noted that the membership strategy agreed both by the Board and the Council of Governors sets out 4 types of involvement for members, and which will enable the Trust to develop a more targeted approach to members which will be more efficient and effective. The Trust is also considering the costs and benefits of using a customer relationship management system to manage member interaction. A proposed new survey of members would also help to identify how members which to be engaged, and enable the development of an annual plan of activities. A discussion would take place at the next Council of Governors meeting about how Governors might best help the Trust to engage with its members. ACTION: Gavin Davies to discuss membership engagement opportunities at the September Council of Governors meeting

5.2

The Board noted that further detail regarding complaints ‘not upheld’ would be provided in the Service Experience report to be presented to the September meeting of the Board.

6.

PATIENT STORIES

6.1

Jane Melton was in attendance to introduce June Hennell, who had been the carer to her late husband Brian following his diagnosis with dementia. June had contributed to the development of the Trust’s Service Experience strategy, and had written the foreword for that document. June is also a guest lecturer on a dementia issues at the University of Worcester, and speaks internationally on the subject.

6.2

June gave a thought-provoking presentation which highlighted the difficulties that can be faced by dementia sufferers and their families. June pointed out that there is no ‘user manual’ for dementia sufferers and their carers. Consequently, June and Brian had to find out about the disease for themselves to a great extent. However, this approach proved helpful in their own circumstances, and the expertise and lived experience which June developed following Brian’s diagnosis led to June becoming involved a number of local and national initiates such as the development of the NHS Gloucestershire Living Well Handbook. In memory of her late husband, June had launched the Hennell Award at the University of Worcester. The award is designed to recognize those students who identified good practice and spread it into their own organization. June had also produced a dementia survival guide, together with the University of Worcester, as a resource for dementia patients and carers.

6.3

June told the Board how difficult it was for carers and dementia sufferers when the patient receives a diagnosis of a second illness. June demonstrated this by introducing the Board to ‘Dementia mythbusting’ – 12 points which always come up in service user meetings. The

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first example concerned comorbidity, as often the experts seem to concentrate on their own specialism and overlook how the treatment for one illness might affect the treatment being received for the other. In Brian’s case, he and June were not told that the treatment Brian would receive for his cancer would lessen the impact of his treatment for dementia. 6.4

The second example highlighted to the Board June’s experience that healthcare professionals are not always taught about the basics of memory loss and how this affects the patient, and consequently the best way to communicate with the patient and the carer. By giving information to the carer and the patient at the same time, healthcare professionals can not only save time and trouble, but also contribute to the wellbeing of the patient helping to create what June referred to as a ‘crescendo of joy’ from the cumulative effect of several good experiences.

6.5

June’s final example also concerned communication, as she noted that sometimes NHS staff would give information to the carer but exclude the patient. June pointed out that the patient also has the right to be informed.

6.6

The Chief Executive thanked June for her presentation, and noted the difficulties in connecting the experts in instances of co-morbidity. However, work was ongoing in Gloucestershire to transform services for Long Term Conditions, and particular emphasis was being given to the management of co-morbidity. Within 2gether, every effort was made to spread good practice between Herefordshire and Gloucestershire, and vice versa.

6.7

The Board thanked June for coming to speak to them on such an important and emotive topic.

7.

INFECTION CONTROL ANNUAL REPORT

7.1

Dr Philippa Moore was in attendance to present the Annual Infection and Prevention Control Report 2013/14 which had been reviewed by the Governance Committee earlier in the month. The Trust remained compliant with the Health and Social Care Act: Code of Practice for Health and Adult Social Care on the prevention and control of infections and related guidance (The Hygiene Code). Risks for healthcare associated infection remained low in the Trust.

7.2

The Board was assured that the Trust was committed to providing high standards of infection control across all its services. Evidence of infection control related activity, monitoring and governance during 2013/14 was provided. Some of the highlights in the report included:  

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No exceptions had been reported during the year MRSA screening has been harmonised in Herefordshire and Gloucestershire in order to undertake screening only of those patients known to be MRSA positive previously. This represented a change in screening policy in Herefordshire in line with recent Department of Health guidance. There had been an increased uptake of Flu vaccinations from staff, and campaigns to promote further uptake in vaccinations would continue. There had been no influenza outbreaks during the year. Hand hygiene compliance had increased to 95% and would move to quarterly rather than monthly audits There had been 1 E. coli related bacteraemia relating to a patient transferred to the Stonebow Unit from Herefordshire County Hospital. A root cause analysis had shown that this was not a preventable incident.

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Infection Control training was now included as part of the e-Learning package. Some problems in accessing the e-learning in Herefordshire were being addressed

7.3

A total of 56 bed days had been lost due to norovirus. However, these outbreaks had each been successfully contained and were of a short duration. John Trevains noted that the fact that outbreaks had been successfully contained was a good indicator of the strong infection control culture on inpatient units. In response to a question from the Medical Director, Dr Moore confirmed the importance of staff suffering from norovirus remaining away from the workplace for 48 hours after symptoms had disappeared, in order to prevent the spread of infection. The receipt of sick pay for these absences was therefore important in encouraging appropriate absence. The Board felt that where staff were able to do so, this time could be used to complete their infection control e-learning.

7.4

The Board noted that antibiotic prescribing compliance had improved in Gloucestershire during the year, more so than in Herefordshire, but 2gether remains below the regional average for compliance. Different guidelines existed in Herefordshire Hospital.

7.5

The Board noted the audit results for inpatient units in Gloucestershire, and received assurance that action plans were in place for areas of poor performance. The audit tool had changed nationally since last year, and criteria were now more stringent. Jonathan Vickers queried the average audit score of 94% which seemed to have been calculated incorrectly. Dr Moore agreed to recheck the figures and report back to the Governance Committee. ACTION: Dr Philippa Moore to recheck the average inpatient audit score and provide an update to the Governance Committee

7.6

Dr Moore reported that the 2014/15 Infection Control Work plan was being finalised and the sign off of the In response to a question from Ian Stead, Dr Moore confirmed that the existing temporary arrangement with Wye Valley Trust was for reactive cover at the moment. A new Herefordshire infection control contract had been drawn up with Wye Valley NHS Trust and would shortly be completed once costs had been finalised.

7.7

The Board noted the positive assurance provided by the Infection Control Annual report and supported the ongoing infection prevention and control programme.

8.

MONITOR QUARTER 1 SUBMISSION REPORT

8.1

The Director of Service Delivery presented the quarterly Monitor report to the Board which provided an update on Monitor key developments and requirements, the latest published Monitor risk ratings for the Trust and the Quarter 1 compliance report in line with the Risk Assessment Framework. The Chair pointed out for the benefit of the members of the public present that in order to consider this report in open session, the Board had reviewed its detailed Finance report earlier in the morning.

8.2

The Board noted that a further case of Clostridium difficile at Charlton Lane in July had been reported to Monitor, as had the death of a member of staff following the serious incident at the Montpellier Unit. Both events were outside the reporting period, and would also be included in the next quarterly report to Monitor.

8.3

The Board noted some changes to data previously reported in the Trust’s Performance Dashboard, and which the Delivery Committee had been made aware of. These included

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Differences in the rounding up of figures between the Monitor report and the Trust’s Performance dashboard Care Programme Approach 7 day follow up, where the Gloucestershire position had been revised down due to an ongoing audit producing insufficient assurance around compliance with targets, while the Herefordshire position had improved as one follow up previously recorded as not having been made should in fact have been excluded as a non-contact. New psychosis early Intervention cases, where new reporting software had produced a different figure for May. The cause was being investigated, and the Board received assurance that this did not affect the Trust’s compliance against this indicator.

Following a review of the Monitor Quarter 1 report, the Board agreed the following recommendations:  Agreement of the financial compliance statement as recommended following consideration of the Board Finance report earlier in the morning.  Confirmation to Monitor that for Quarter 1 there is compliance with the governance requirements as outlined in the report and confirmation that: ‘The board is satisfied that plans in place are sufficient to ensure: ongoing compliance with all existing targets (after the application of thresholds) as set out in Appendix A of the Risk Assessment Framework; and a commitment to comply with all known targets going forwards’.  Note that the Executive Team have considered the exception report list of issues and there were no issues to escalate which have not already been raised with Monitor.  Note that the Quarter 1 reporting on suicides, homicides, absconsions and never events will be submitted to our Monitor Relationship Manager as outlined in this report.  Agreement that the document Well-led NHS Foundation Trusts: a framework for structuring governance reviews be reviewed by the November Audit Committee and a proposal for implementation agreed. The Board further agreed that prior to consideration by the Audit Committee, a report would be taken to the next Council of Governors meeting to enable the Audit Committee to take Governors’ views into account when determining its recommendation. The Trust Secretary would arrange meetings between the Chairs of Audit and Governance Committees, and the steering group established by the Council to consider this issue, should Governors consider this beneficial ACTION: Report on Well-led NHS Foundation Trusts to be presented to the September meeting of the Council of Governors. ACTION: Trust Secretary to arrange meetings between the Governor steering group and chairs of Audit and Governance Committees, if necessary

8.5

Ian Stead asked whether there was a more detailed report which the Trust considered in order to make these declarations. The Director of Service Delivery agreed to provide Herefordshire Healthwatch with assurance on how the Trust managed and reviewed its performance against contractual and other indicators. ACTION: Director of Service Delivery to provide assurance to Herefordshire Healthwatch on the Trust’s handling of performance against contractual and other indicators.

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9.

CHIEF EXECUTIVE’S REPORT

9.1

The Chief Executive presented his report to the Board. Nationally, a great deal of work had been taking place and the report outlined a number of key changes, guidance and policy updates.

9.2

Martin Freeman noted that the consultation on proposed changes to the Mental Health Act had been raised the Mental Health Act Scrutiny Committee last week. However, the deadline for responses to the consultation came before the next scheduled meeting of the Committee. The Chief Executive would invite expert practitioners to review the recommendations in the consultation and provide a draft response to the Executive Committee. This draft response would then be shared with the Mental Health Act Scrutiny Committee. ACTION: Chief Executive to share draft response on MHA consultation with the Mental Health Act Scrutiny Committee

9.3

The Board noted the Chief Executive’s report, including the local and regional Board engagement activities that had taken place during June.

10.

SUMMARY FINANCE REPORT

10.1

The Board received the Finance Report that provided information up to the end of June 2014. The month 3 position was a surplus of £237k compared to the planned deficit of £235k. While some budgets were currently underspent, it is expected that some of those budgets will be fully committed by the end of the year. The month 3 forecast outturn is therefore break even as per the plan.

10.2

The Board noted some slippage in savings plans, but also noted that alternatives have been identified. It is anticipated that the Trust will need to submit a reforecast of its capital plan to Monitor during the year. The Trust continues to have a Continuity of Service Risk Rating of 4. It was noted that the Trust submitted its four year Operational Plan to Monitor on the 30th June 2014.

11.

INFORMATION MANAGEMENT AND TECHNOLOGY STRATEGY

11.1

The Board received a draft Information Management and Technology (IM&T) Strategy which had previously been considered by the Development Committee.

11.2

The Board noted the strategy’s helpful structure for the future which outlined a number of potential direct and indirect benefits in terms of savings, efficiency, quality and outcomes. The Board welcomed two areas in particular: improved mobile working to deliver real time information and improve resource efficiency; and the use of social media technology to support service users and carers. These elements have assumed a greater prominence compared with previous versions of the strategy.

11.3

The overall investment required to deliver this Strategy will generate returns in a number of areas. All projects that will be set up under the Strategy umbrella will include full project documentation including a savings and benefit realisation component.

11.4

The Board noted the intended benefits of the strategy which will comprise:  Cash releasing savings benefits, e.g. Reduced travel costs due to increased mobile working.

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Efficiency benefits, e.g. “time released to care” due to more efficient data input processes for clinical and administrative staff , allowing more patient contact to be undertaken Quality benefits, e.g. patient safety enhancements due to better availability of “real time” clinical information leading to better clinical decision making. Outcome benefits e.g., increased successful treatment programmes due to the increased use of social media to support service users and carers.

Charlotte Hitchings asked whether a detailed statement of costs and benefits would be available to enable monitoring by the Delivery Committee. The Director of Service Delivery confirmed that these cost//benefit statements would be developed on a project by project basis as the strategy implementation progressed. The Director of Service Delivery would develop a high level milestone programme which would enable the Delivery Committee to provide some oversight to the implementation of the strategy. ACTION: Director of Service Delivery to develop a high level IM&T strategy milestone programme for the Delivery Committee.

11.6

Maggie Deacon asked whether the strategy included provision for technical support for NonExecutive Directors. The Chair confirmed that she had asked the Trust Secretary to review Board administration, and that this would include support to NEDs. The Board welcomed the strategy’s focus on interoperability of systems, and questioned whether the Trust was being sufficiently aspirational. John Saunders noted the Trust’s current capacity and capability constraints, and advised that the Trust should also be realistic in its aspirations. The Chief Executive noted that technology was a fast moving issue. The aim for the Trust would be to adopt and adapt available technologies, rather than to invent its own.

11.7

The Chair asked that spelling and grammar errors in the document be corrected before it was posted onto the Trust website. ACTION: IM&T Strategy to be checked for spelling and grammar errors prior to posting on the Trust website.

11.8

The Board approved the IM&T strategy as a framework for developments for the next 5 years.

12.

DELIVERY COMMITTEE ANNUAL REPORT

12.1

The Board received the Delivery Committee’s Annual Report and noted the activities undertaken by the Committee during 2013/14.

12.2

Considerable work had been undertaken during the year to reframe the work of the Committee to deliver its objectives in line with its Terms of Reference, including refreshing the agenda format and the structure and content of reports. The Committee’s primary contribution during the year to the achievement of the Trust’s strategic objectives had been to promote and oversee the sustainability of services, both financially and in terms of meeting contractual performance obligations. Overall the Trust’s performance in 2013/14 was very strong, with the achievement of the vast majority of performance measures. The Committee’s work during the year enabled it to promote and support this performance, improve data quality, recognise good work and achievement and provide robust assurance on all these matters to the Trust Board.

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12.3

The Chair welcomed the work done by the Delivery Committee, whose focus on detail provided assurance that enabled the Board to operate at a more strategic level.

13.

BOARD COMMITTEE SUMMARIES

13.1

Governance Committee The Board received and noted the Governance Committee summary report from the meeting held on 11 July 2014.

13.2

The Committee received an update report regarding the Homicide action plans into the Care and Treatment of Mr A (2008 incident) and Mr C (2010 incident). In summary, the Committee noted good progress on the action list with the completion of recommended audits and actions. In some areas however, the audit findings provided limited assurance of compliance with recommended audit standards and further work was required. Actions were in place to address this.

13.3

The Committee received a Serious Incident report which showed that Serious Incidents had increased to the levels of 2 years ago. Although these involved small numbers, the Committee would continue to monitor Serious Incidents in order to be assured that thorough investigations have taken place and appropriate lessons learned and shared throughout the Trust. The Committee had discussed the increase in incidents in the summer months and had recommended that clinicians once again be made aware of this.

13.4

The Committee received an update report on Safeguarding activity, and had received good assurance on 2gether’s role as a safeguarding partner. Some areas for improvement remained, which were being addressed; these included improved recording of safeguarding matters.

13.5

Other key areas to highlight from the Committee included an update on risk management, which would return to the Committee in due course.

13.6

Charitable Funds Committee The Board received and noted the Charitable Funds Committee summary report from the meeting held on 11 July 2014.

13.7

The Committee received the draft Annual Report and Accounts that stated that Charitable Fund balances stood at £367k at the end of March 2014. The Committee had considered a proposal to provide £160k in funding to support the development of a research centre, the initial focus of which would be dementia. The proposal was recommended to the Board of Trustees subject to confirmation of the receipt of match funding for the project, and agreement on how the Trust’s contribution would be apportioned between the various Charitable Funds accounts.

13.8

The Committee had agreed a marketing plan for Charitable Funds which endorsed the existing ‘care and maintenance’ approach set out in the Charitable Funds Strategy. The Committee agreed, however, that as leaflets were due to be produced in any case to raise awareness of Charitable Funds, some of these should be provided to lawyers and other bodies involved in charitable activity in order to raise awareness locally of the Trust’s Charitable Fund, and thus encourage donations. Maggie Deacon had agreed to take a pilot project forward.

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Delivery Committee The Board received and noted the Delivery Committee summary report from the meeting held on 26 June 2014. The Committee had considered early warnings in the Performance Dashboard regarding IAPT and dementia services in Herefordshire which are subject to ongoing discussion with commissioners, and also regarding waiting list issues in the Children and Young People’s Services level 3 in Gloucestershire. Again, these issues were the subject of ongoing discussion with commissioners.

13.10 The Committee had also considered the Community care budget. With the removal of age restrictions, this budget had been opened up to a much wider group of patients than originally envisaged and services were also being used for a longer time. The Committee also noted the work ongoing in Herefordshire to manage in-year financial pressures. The Committee had welcomed work associated with deliberate self harm presentations that provided assurance that this cohort was not influenced by young people waiting to access other Children and Young People’s services. Development Committee 13.11 The Board received a summary of the Development Committee meeting held on 11 June. The Committee had reviewed the five year plan for capital expenditure and disposals, and had also reviewed the Trust’s 5 year financial plan ahead of a strategic stock take conducted in preparation for submission of the Trust’s strategic plan to Monitor. 13.12 The Committee had also reviewed and endorsed the IM&T Strategy which had been approved at this Board meeting, and had received a report outlining business development opportunities for the Trust. 13.13 This was the first time that a Development Committee summary had been taken in an open session of the Board, and reports would continue to be presented in the public session of the Board to provide a summary of Committee business, other than that which was deemed to be commercially confidential.. 14.

INFORMATION SHARING REPORTS

14.1

The Board received the following reports for information:  Chair’s Report  Minutes from the Council of Governors meeting held on 14 May 2014

15.

ANY OTHER BUSINESS

15.1

There was no other business to be conducted by the Board.

16.

DATE OF THE NEXT MEETING

16.1

The next Board meeting would take place on Monday 29 September, at Trust HQ, Rikenel, Gloucester.

Signed: …………………………………………….. Ruth FitzJohn, Chair

Date: ………………………………….

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BOARD MEETING ACTION POINTS Date of Mtg 23 May

Item ref 7.5

28 July

5.1

28 July

7.5

28 July

8.4a

28 July

8.4b

28 July

8.5

28 July

9.2

28 July

11.5

28 July

11.7

Action Jane Melton to provide further detail regarding those complaints “not upheld” for Charlotte Hitchings Gavin Davies to discuss membership engagement opportunities at the September Council of Governors meeting Dr Philippa Moore to recheck the average inpatient audit score and provide an update to the Governance Committee Report on Well-led NHS Foundation Trusts to be presented to the September meeting of the Council of Governors. Trust Secretary to arrange meetings between the Governor steering group and chairs of Audit and Governance Committees, if necessary Director of Service Delivery to provide assurance to Herefordshire Healthwatch on the Trust’s handling of performance against contractual and other indicators. Chief Executive to share draft response on MHA consultation with the Mental health Act Scrutiny Committee Director of Service Delivery to develop a high level IM&T strategy milestone programme for the Delivery Committee IM&T Strategy to be checked for spelling and grammar errors prior to posting on the Trust website

Lead

Date due

Status/Progress

Jane Melton

September

Complete Section included in Qtr 1 SE Report

Gavin Davies

September

Complete

Dr Philippa Moore

August

Complete

Trust Secretary

September

Complete

Trust Secretary

September

Will be carried out if and when required

Colin Merker

September

Complete Meeting scheduled with Herefordshire Healthwatch to discuss further

Chief Executive

September

Complete

Colin Merker

October

Ryan Lewis

July

Complete