Council of Members

7 September 2015

Dorothy Griffiths

Chair

Dorothy Griffiths

Chair

Christine Baldwinson

Trust Secretary

Dorothy Griffiths

Chair

Annual Report and Accounts

Trevor Shipman, Director of Finance

Quality Account

Andy Mattin, Director of Nursing

Quality counts, it’s a film and a Quality Account is the trailer!CQC – ‘Requires improvement but the care was outstanding..’ million contacts!• 287,795 Patients treated in the community• 4,988 Patients treated in hospital

Quality Priorities 2014-15• Involvement• Carers• Compassionate and capable workforce

Effective care and treatment planning, measured by:• Patients report feeling definitely Involved as much

as they wanted to be in decisions about their care or treatment

• Patients report their care or treatment plan helped them achieve what matters to them

• Carers report they felt involved in the care or treatment planning for their loved one

Outstanding

Our staff

Teams

Peer support

Involvement

CQC progress

• Bed management and pathways

• Restrictive interventions

• Safer staffing

• Staff charter….

Tell us! Staff, patients, carers, Carers Council, Healthwatch

Our pledge – listen to you, hear what is saod and act on it.

Thanks to our staff and to you all

Council of Governors’ Review of the Year

Christine Baldwinson

Trust Secretary

Chief Executive’s Report and Forward View

Claire Murdoch, Chief Executive & Registered Nurse

Quality – central to everything we do

• Our Quality Account Priority – “Effective Care Planning and Treatment”

• Patient and family involvement in all we do• Achieving and sustaining full CQC compliance – actions

to be completed by December 15• Engaging, valuing and supporting our workforce• Better use of data – reduced bureaucracy

Operational Sustainability – our effectiveness depends on it

• Service Redesign – improving efficiency and productivity

• Reducing unnecessary hospital admissions• Single Point of Access – ‘SPA’• Bed rationalisation – with new models of home

treatment• Agile working – major programme of ICT investment• New models of integrated care and partnerships

Financial Viability – never been more challenging

• £26.4 million savings required this year - £28 million next year

• Driving down costs e.g. reducing agency spend• Better use of our buildings• Efficient ‘back-office’ functions• Viable contracts with commissioners – and tough

decisions when they are not

A focus on: Community, Sexual Health and Mental

Health Services

Robyn Doran, Chief Operating Officer

Frail and Elderly Integrated Practice Unit

Dr Pramod PrabhakaranDivisional Medical Director

Severely frail

Moderately frail

Mildly frail

Pre-frail

Camden Integrated Care Service (CICS)

• Systematic identification of frailty

• Care Planning and coordination of care

• Health and Social Care Multidisciplinary team

But.....

Building on success

Frailty IPU – current proposals• Value based – truly in partnership with patients/

families/carers• Increase identification of frailty through health and social

care staff• Single Point of Access• Risk Stratification• Holistic Care Planning based on CGA principles• Locality and borough based MDT’s• Case Management for those at highest need• Care Navigator service

CNWL Sexual Health and HIV Services

London’s most connected sexual health services

In Brent, Camden, Hillingdon, Islington and Westminster

Mortimer Market Centre off Tottenham Court Road

Archway Centre Archway

Margaret Pyke CentreKing’s Cross

Mortimer Market Centrey

GUMAppointments 48,425

• 42% female / 58% male• Females 97% straight, 2% bisexual, <1% lesbian• Males 49% straight, 47% gay, 4% bisexual• Q1 patient satisfaction (% would recommend) 94%

HIVAppointments 21,916, number of patients 4,500

• 16% female / 84% male• Females 98% straight, 0% bisexual, 2% lesbian• Males 12% straight, 87% gay, 1% bisexual• Q1 patient satisfaction 97%

Archway CentreGUM and SRHAppointments 35,900

• 70% female / 30% male• Females 98% straight, 1% bisexual, <1% lesbian• Males 75% straight, 22% gay, 3% bisexual• Q1 patient satisfaction 99%

Margaret Pyke Centre

SRH and GUMAppointments 21,680

• 96% female / 4% male• Females 99% straight, 1% bisexual, <1% lesbian• Males 78% straight, 17% gay, 6% bisexual• Q1 patient satisfaction 98%

Sexual and Reproductive Health

BrentAppointments 9,526

• 98% female / <2% male• Females 100% straight, very few males• Q1 patient satisfaction 100%

HillingdonAppointments 11,357

• 98% female / <2% male • Females 100% straight, very few males • Q1 patient satisfaction 98%

CommissioningGUM (income £12.8m)Local authorities, tariff (first/follow-up), Camden lead, total approx. 160 local authorities

Sexual and Reproductive Health (SRH) (income £3.9m)Local authorities, block, Camden and Islington, Brent and Hillingdon

HIV (income £31.4m)NHS England, fixed and variable funding

Health Promotion and Freedoms/Shop (income £2.4m)Local authorities, block, includes pan-London local authorities

Service highlights• Largest single site HIV Service in UK

• Bloomsbury Patient Representatives

• Links with UCL academic department

• National and international profile for SRH, GUM and HIV Services

• Clash

• Hepatitis C

• Psychosexual Therapy

• Freedoms Shop

Bloomsbury Patient Representatives

One to one peer support

• We can empathise and are role models

• We can offer hope for the future

• We take medication every day with no visible side effects

• We can offer practical support for a range of issues

• We have experience of psychological and psycho-social issues:

• the crisis of diagnosis • disclosure• fear of rejection • fear of stigma and discrimination

Education – Empowerment

We help patients develop self management and coping skills, build their self esteem and confidence - through courses, workshops, forums and social events.

• Motivational workshops• Educational forums • Women’s lunch club• Choir, summer picnic and fundraisers• Hepatitis C co-infection courses• Newly diagnosed courses

2,000 patients used Bloomsbury Patient Representative services in 2014

Bloomsbury Patient Representatives

Challenges

• Reduction in funding from local authorities

• Competition from other providers

• Pan-London Sexual Health Transformation

• Increasing rates of drug related sexual risk taking, ChemSex

• Infrastructure required to meet changing environment

CQC findings for sexual health services

Safe: GoodEffective: OutstandingCaring: OutstandingResponsive: OutstandingWell Lead: Good

Overall Rating: Outstanding

All the patients we spoke with told us they were very satisfied

with the care and treatment delivered to them, and felt

included and involved in their care. The services were easily

accessible and staff really focused on the individual needs

of each patient.

The services were a centre for national and international research and innovation. This meant that patients

were benefitting from this work and receiving

the latest treatment from staff who were

committed to improving care and treatment for

patients across the world.

Managers were dynamic,

inspiring and approachable

and gave support daily not just when

required.

Care and treatment provided to all patients were based on national

guidelines, directives and research. The care and

treatment was audited to monitor its quality and

effectiveness, and where needed action had been

taken to improve the service.

Patients were receiving safe care from appropriately trained, qualified

and skilled staff. An extensive

programme of training was in

place. Staff confirmed that this prepared them for

their roles and responsibility.

Brent Mental Health Services

Dr KishoreClinical Director

Natalie FoxBrent Borough Director

Brent Mental Health Services

• Two developments in response to CQC visit, service user feedback, carers feedback and partner organisations.

– Single sex ward pilot in Park Royal acute MH services.

– Redesign of the model of community provision.

Single sex wards pilot in Park Royal

Single sex wards pilot in Park Royal

• Single Sex Accommodation was provided @ PR prior to the Pilot. – Female and male zones within one ward environment.

• Pilot of Single Sex wards removed the zoning within the 2 treatment wards.– 1 female only ward and 1 male only ward.

Single sex wards pilot in Park Royal

• Pilot introduced due to the perception of service users safety & due to concern about safeguarding of both male and female patients.

• There had been positive evidence locally (Hillingdon) &

nationally for single sex wards.

• Pilot was introduced in February 2015.

Single sex ward pilotComparison data: August 2015

5 Months Prior to Single Sex

5 Months following Single Sex

Reduction %

Sexual Incidents

29 8 72%

Restraints 143 94 34%

Seclusions 71 59 17%

Rapid Tranquilization

128 101 21%

Close Observations

64 27 57%

Single sex wards pilot 1st quarter outcomes

• Patients and staff prefer single sex wards

• Significantly safer for patients at risk of sexual incident.

• Leads to reduction in physical restraints, rapid tranquilisation, seclusion and close observations.

• Gender Specific training & support is critical for staff.

Brent community services redesign

Brent community services redesign

Need for timely access to services.

Need to improve shared care with primary care.

Need to improve the experience for service users & carers.

Need to engage staff in the management of the demands on their roles.

Process we followedProject steering group – meeting every 2 weeks

Multi Organisational with Service User representation.

3 Wider Workshops

Service user involvement Staff engagement Commissioners & Partners

Co produced guiding principles for redesign

Focus on recovery.

Service throughput.

Streamlined pathways.

Easier to navigate for referrers and clients.

Reduction in the Length of stay.

To fit with the wider service developments of single point of access (SPA) & Home treatment rapid response team. (HTRRT)

Proposed pathway to recovery

Referrals in from

• GP• 3rd

sector• Self• Famil

y• Carer• Other

Single Point ofAccess(SPA)24/7

Urgent Care

In-patientHTRRT24/7

Recovery Service2 Teams (North & South)

• Full Core Assessment• Brief Treatment• Independent living skills development• Risk Management• Regular Reviews• Discharge preparation• Carer Support

Discharge to

• GP• 3rd

sector• Family• Carer• Primar

y Care Plus.

Next Steps

Single Sex Wards Pilot Community Redesign

Report on the 2nd quarter outcomes of the pilot and make recommendations, whether to sustain this position at Park Royal.

Co deliver the proposed pathway

Questions

Dorothy Griffiths, Chair

Any other business

Dorothy Griffiths, Chair