minutes of a meeting of the camden and … papers... · ms deborah wright head of social work &...

MINUTES OF A MEETING OF THE

CAMDEN AND ISLINGTON NHS FOUNDATION TRUST

BOARD OF DIRECTORS HELD IN PUBLIC

IN THE CONFERENCE HALL, ST PANCRAS HOSPITAL,

ST PANCRAS WAY, LONDON, NW1 0PE.

ON Tuesday 24 May 2016 AT 2:00PM

Board Members Present:

Ms Leisha Fullick Chair

Mr Paul Calaminus Deputy Chief Executive / Chief Operating Officer

Ms Claire Johnston Director of Nursing and People

Ms Pippa Aitken Non-Executive Director

Mr Richard Brooman Deputy Trust Chair (Left before item 16.01.101)

Ms Angela Harvey Senior Independent Director

Dr Sue Goss Non-Executive Director

Dr Vincent Kirchner Medical Director

Ms Angela McNab Chief Executive

Mr Darren Summers Director of Strategy & Business Development

(Non-Voting Member)

Mr David Wragg Director of Finance

Mr Patrick Vernon Non-Executive Director

In Attendance:

Mr Martin Zielinski Board Secretary

Ms Sarah Papworth-Heidel

Head of Quality and Patient Experience (item 16.01.084 only) (accompanied by a service user)

Ms Deborah Wright Head of Social Work & Social Care (item 16.01.098 only)

Mr Alwyn Davies Trust Safeguarding Manager (item 16.01.098 only)

This meeting was open to the public

Minutes of the Public Board Meeting on 24 May 2016 Version: FINAL

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16.01.081 Prior to this meeting Dr Goss undertook a service visit to the Rivers Crisis House.

GENERAL BUSINESS

16.01.082 Welcome, Apologies & Quoracy

Ms Fullick welcomed those present. All Board members were in attendance and the meeting was quorate.

Apologies were received on behalf of Mr Kevin Monteith, Trust Company Secretary.

Mr Brooman advised that he would have to leave before the scheduled end of the meeting.

16.01.083 Declarations of Interest

No changes were requested to the register of declared interests issued as part of this meeting’s pack.

The Board were satisfied that there was no conflict between any item on this meeting’s agenda and those interests declared.

16.01.084 Service User Presentation

Supported by Ms Papworth-Heidel, a service user attended Board to talk about her experience of the Islington Recovery and Rehabilitation Service. This individual explained that she had maintained a successful career prior to being diagnosed with bi-polar in 2008. She explained that she had initially been in denial and initially experienced some distressing contact with crisis teams where she had found herself having to regularly answer the same questions repeatedly. In 2014 she started group therapy and was totally surprised by the effectiveness of the care provided through the Recovery and Rehabilitation Service which allowed her to regain her sense of being a useful member of society. She now worked as a tutor at the Recovery College. In relation to that post, she stressed the need for service user tutors to be full supported and not overworked as there was a real risk that excessive duties could negatively impact on their recover and make them unwell again.

Ms Fullick asked what actions the Trust could undertake to protect the recovery of service users working with the Recovery College. The service user suggested that improved communication and peer worker support would help identify any issues and allow these to be addressed before they became a problem. She added that all staff fully engaging with the Trust’s values would enhance the working environment and service user support. She stated that working at the Recover College had been a great experience and she would like to ensure that other service user had the opportunity to have similar experiences and not fall into the pitfalls she had outlined.

Dr Goss commented that the Recovery College was evidently working well for service users but queried whether the aim to have staff attend to learn about recovery was equally successful. The service user stated that, as a tutor, she had seen a number of staff on Recovery College courses. She also suggested that managers could encourage more staff to attend,


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and allow them time to do so.

Mr Vernon asked what more the Board could do to identify, engage with, and respect the talents demonstrated by service users. The service user suggested that the Board should evidently demonstrate it was listening, and acting upon, the feedback it received from service users. Evident action communicated through newsletters, and other media, assured service users that their input was valued.

Ms Harvey queried how the situation could arise that a service user tutor was feeling overworked within the Recovery College. The service user did not feel such pressures were deliberately imposed but that sometimes there was a lack of awareness of the level of work each individual was allocated compared to what they felt able to undertake. A clearer mechanism to identify when individuals were struggling and more peer group support would assist in addressing this matter.

Ms Fullick thanked the service user for attending and sharing their interesting and thought provoking views with the Board.

16.01.085 Minutes of the Meeting of the Board of Directors held in Public on 28 April 2016

The Board considered the minutes from its previous meeting. One minor change was requested.

The Board of Directors AGREED the minutes of its previous publicly held meeting on 28 April 2016 as a fair and accurate record of that meeting, subject to the agreed amendment.

16.01.086 Matters Arising

The Board reviewed the matters arising from its previous public meeting on 28 April 2016. All of the required actions were considered to have been completed, with the exception of the following actions and comments:

16.01.087 MA1: Anti-Ligature Doors The Quality Improvement Planning Group was next due to meet on 7 June 2016. Ms Johnston assured the Board that a discussion on potential ligature free doors had been put on that meeting’s agenda. The action was considered completed in relation to the Board.

16.01.088 MA2: Homeless Discharge Group Mr Calaminus advised that he would bring a report on this group’s activities to the next Board meeting in July 2016.

Mr Calaminus

16.01.089 MA3: Analysis of 2016/17 Financial Budgets Mr Wragg advised that the requested analysis would form part of the M2, 2016/17 finance report that would be presented at July 2016’s Board meeting.

Mr Wragg


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16.01.090 MAs5&6: North Central London (NCL) Transformation Board Ms McNab would report back after the next meeting of the Transformation Board on how the most relevantly skilled NEDs would be engaged with; and on any improvement in the Sustainability and Transformation Plan’s incorporation of equality and diversity issues.

Ms McNab

16.01.091 MAs7, 8&9: Board Performance Report. The required actions in relation to the report were not due to be completed until July 2016 and they were carried forward to the next meeting.

C/fwd

16.01.092 No additional matters arising were raised that had not been listed on the presented schedule.

STATUTORY / REGULATORY

16.01.093 Preparation of the Annual Report & Accounts 2015/16

Mr Brooman advised the Board that they had seen an earlier version of the Annual Accounts; and the version presented here, along with the Annual Report, had been reviewed in detail by the Audit & Risk Committee the previous week. He advised that he was generally satisfied with the accounts although there were still a number of issues with grammar, punctuation and presentation in the Annual Report to be corrected. He requested that all Board members advise any required corrections to the Trust Company Secretary by the following morning to allow the report to be updated ahead of the required submission date. It was advised that the final published annual report would be reviewed by professional proof readers and type setters.

16.01.094 Trust Annual Report 2015/16 (including Summary Financial Statements and Quality Accounts 2015/16)

Ms McNab commented that the period covered by this annual report was prior to her appointment and that she would appreciate other Board members feedback on the proposed content.

Ms Johnston advised that significant work had been undertaken to improve the reported Quality Accounts and that she was satisfied that the correct quality priorities were reflected in that document. She considered the presented quality information to be true and accurate. Dr Goss, as Quality Committee Chair, acknowledged the amount of required data that had to be incorporated into the Quality Account but felt, in future, this could be presented more effectively with the use of enhanced narrative more clearly defining the quality focus of the Trust. Ms Johnston welcomed this feedback and agreed that all parties would meet early in the next year to discuss further improvements to the next annual Quality Accounts document.

Healthwatch from both the London Boroughs of Camden and

Islington had provided feedback for inclusion in the Trust’s

Quality Accounts 2015/16. Dr Goss was pleased to note this level of stakeholder engagement.


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The Board of Directors APPROVED the Annual Report 2015/16 for submission to NHS Improvement, subject to any timely minor correction submitted by Board members.

16.01.095 Trust Annual Accounts 2015/16

Mr Wragg presented the draft Annual Accounts 2015/16 and advised that this document had not changed significantly since the previous draft was seen by the Board. He added that the Audit & Risk Committee were satisfied with the year’s draft final accounts, which they reviewed the previous week and that the feedback from the external auditors had been positive. Mr Brooman, as Audit & Risk Committee Chair, concurred. He gave thanks to the Finance Team for the prompt completion of an accurate and well-presented set of annual accounts.

Mr Wragg added that the Resources Committee had also had the opportunity to review an earlier draft of these accounts and he recommended their approval to the Board so that they could be summited to NHS Improvement, and subsequently laid before Parliament.

The Board of Directors APPROVED the Annual Accounts 2015/16.

16.01.096 NHS Improvement Annual Certifications and Corporate Governance Statement

Mr Wragg introduced the declarations required of the Board in support of the Trust’s annual submissions to NHS Improvement.

Mr Brooman sought further assurance that the Trust had provided appropriate training for its Governors. At the Chair’s request, Mr Zielinski expanded on the provided response, advising that the Trust, in conjunction with University College London Hospitals NHS Foundation Trust, had engaged NHS Providers to offer their full range of ‘Governwell’ courses in-house since the last intake of new Governors.

Mr Brooman challenged the Board as to whether they were satisfied they were ‘fit and proper’ persons and had done all that was possible to improve their knowledge and learning on an annual basis. Ms Fullick commented that there was always the possibility of further improvement and she would have on-going discussions with the Trust Company Secretary on potential options for further Board development. She was fully satisfied that the Board were in a position to respond positively to the ‘fit and proper’ person declaration.

The Board of Directors AGREED the proposed NHS Improvement Annual Certifications and Corporate Governance Statement and APPROVED their submission to NHS Improvement.


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STRATEGIC / GOVERNANCE

16.01.097 Haringey and Islington Wellbeing Partnership

Ms McNab presented this item advising that the London Boroughs of Islington and Haringey were keen to establish what cost effective changes they could implement to improve integrated care for their local populations. She advised that the paper was being shared with the Boards of all the listed organisations to obtain joint agreement to progress the proposed Wellbeing Partnership. She highlighted that the paper set out four key themes that were similar to the aims of the NCL Strategic Transformation Plan, but were focused on a more local level. The challenge would be running both schemes in parallel without duplication. The NCL Transformation Board was aware of this sub-work stream but it was yet to be formally agreed how this would feed into the wider transformation plan.

Ms McNab advised that she had received agreement to re-word part of the presented document to enhance the references to mental health as a cross-cutting theme. She also acknowledged that some resources would be required to ensure that C&I was a key player in the partnership although the level of resource required would not be clear until the relevant work streams were developed. She acknowledged that senior staff were already extremely busy and the Board should remain mindful of any additional demands on their time.

Dr Kirchner stated a concern that, if social services and NHS funding was to be pooled, there was a risk mental health services may be overlooked. He suggested that it may be wise to trial this proposal on a population, as the Trust had done with the Psychosis Integrated Practice Unit.

Dr Goss commented that the Board needed a clear sense of where this work stream was leading and the level of integration proposed. Ms McNab advised that this remained to be clarified but she expected the final formation of services to follow function and support the most positive outcomes for service users. It was clarified that there had been no consideration of any estate requirement as part of work stream to date.

Mr Brooman queried why the London Borough of Camden, a key Trust partner, was not included in this partnership. Ms McNab advised that Islington and Haringey considered their populations to be quite similar and had been key in driving this partnership forward. Camden had not been interested in taking part.

Mr Vernon asked what opportunities there were for Non-Executive Director involvement in the partnership. Ms McNab acknowledged this was an important point and stated she would raise it, and seek clarity, at the next partnership meeting. Mr Vernon also advised that equality should be clearly incorporated into the work of this partnership, which covered a large and highly diverse population. Mr Calaminus advised that equality, and service user involvement, had been clearly incorporated into the mental health work stream that would be included in the next re-iteration of this paper.


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Ms Harvey stated that she has previous experience of such multi-borough schemes and suggested that each trust may wish to consider independently providing services that could be jointly drawn on by partner organisations. She had found such arrangements to be effective in the past, and a more efficient use of public resources. She suggested that the Board should be advised of any resource requirement from C&I as soon as such demands were known. Ms McNab responded that the Board would be regularly updated on progress, possibly via a quarterly report.

The Board of Directors ENDORSED, in principal, the Trust’s on-going participation in the Wellbeing Partnership.

16.01.098 Safeguarding Annual Report 2015/16

Ms Johnston presented this annual report which provided assurance that the Trust had adequate resources, management and reporting structures in place to support safeguarding. She added that the report also included a forward plan for the forthcoming year and sought the Board’s endorsement.

Ms Johnston highlighted that 2015/16 had been a busy year, in terms of safeguarding, having an increased focus on the safety of vulnerable adults following the introduction of the Social Care Act. She went on to draw the Board’s attention to key sections of the report.

Ms McNab focused on the forward looking priorities and advised that the Quality Committee had requested that these be re-worded to more clearly define the goal, impact and expectations. She added it would be useful to have a small number of key expected outcomes, ideally in relation to safeguarding, against which progress could be effectively measured.

Dr Goss was pleased to advise that Mr Alwyn Davies had commenced in post as the Trust’s new Safeguarding Manager from the start of that week. She welcomed this appointment and was hopeful Mr Davies would improve the Trust’s safeguarding performance going forward. She suggested that the Board should maintain a more effective overview of safeguarding, which would continue to be closely scrutinised by the Quality Committee. She agreed with Ms McNab that more definable goals had to be established in relation to safeguarding, rather than having a focus on planning and process measures.

Dr Kirchner stated that he was confident that safeguarding, on a clinical basis, was well managed.

Ms Fullick supported the proposal to focus on several key goals and suggested that the forthcoming CQC inspection report may direct where that focus should be. She emphasised the need to have managers at all levels engaged with, and focused on, safeguarding. Staff should be shown that safeguarding was valued and not just a topic for policies and training. She would welcome feedback from managers on any challenges and/or issues that may be negatively impacting on safeguarding.

Ms Fullick fully supported the Trust’s ‘safeguarding statement’


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within the report. She suggested that the last line of this should reflect the Trust’s commitment to support staff on safeguarding issues. She proposed that the updated statement should be widely circulated in Trust communications.

The Board discussed safeguarding training and acknowledged that online training, whilst not as good as face to face training, was a useful tool in reaching a larger number of staff within the Trust. Ms Wright addressed the Board advising that each Division had a social work lead that dedicated one day of their working week to safeguarding issues. She added that a key focus should be on domestic problems and ensuring that those treated in the community felt safe within their own homes and did not suffer in silence from domestic violence or their own self-neglect. She also referred to the need to safeguard service users against current day risks such as radicalisation, people trafficking and modern slavery. Mr Vernon highlighted the importance of ensuring staff knew where to obtain guidance and support on these issues. He added that there were a number of external stakeholders working to address such concern which the Trust may be able to engage with.

Ms Fullick concluded discussion of this item and advised that the Quality Committee would take this work forward and develop future priorities with obtainable and measurable outcomes. The Board would be kept informed via the regular updates it received from the Quality Committee.

The Board RECEIVED and ACCEPTED the presented Annual Safeguarding Report 2015/16 and AGREED that objective and priorities for 2016/17 would be refined and taken forward by the Quality Committee.

Ms Johnston

OPERATIONAL

16.01.099 Chief Executive’s Report

Ms McNab took the majority of her report as read and highlighted a small number of key points to the Board. She drew the Board’s attention to the update on the NCL Strategic Transformation Plan adding that significant additional work had been undertaken in the last ten days to identify and agree key aspects of the mental health work stream. The future structure of mental health liaison services may become more complex with the potential to integrate such services throughout the acute sector. Ms McNab added that the Transformation Board had acknowledged a need to improve its understanding of the needs of its local population and may require external assistance with that task. It had to be demonstrated that all bodies within NCL were working together and communicating effectively. She advised that a ‘headlines’ report on this matter was required to be submitted to NHS England by 30 June 2016. Ms Aitken queried the level of input from involved organisations’ Boards prior to this submission as she was concerned that Non-Executive Directors had not been adequately engaged with on this important matter. Ms McNab advised that she had already raised this concern with NCL but that the due submission date did not allow time for wider consultation on the ‘headlines’. She


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assured the Board that they would have adequate time to fully consider, and sign off, on the next more detailed document that was due for submission in October 2016. In response to Dr Goss, Ms McNab stated that she expected to be able to bring more information on this matter to the next Board. Ms Fullick added that the Board would discuss this matter further at their June 2016 away day as it would only be able to fully evaluate this matter once it had developed a clear organisational strategy. She added that the Board was continually clarifying its expectations for the future of mental health service provision. It was also noted that a number of devolution projects were under consideration under the auspices of the Mayor of London, although these tended to have a more estates based focus. That focus could not however be dismissed as it had the potential to challenge the availability and use of public sector land within London.

Ms McNab highlighted the excellent reaction of staff to the recent fire on Sapphire Ward which had ensured the safety of service users at that location. She had recently visited that site to acknowledge the prompt work being taken to re-open the beds on Sapphire Ward and passed on the Board positive feedback on how well this incident had been handled. The formal report on this fire was yet to be received.

Ms McNab Highlighted the energy and enthusiasm evident at the recent launch of the Trust’s BME Network.

Mr Brooman asked what impact the reported 10% rise in basic pay for junior doctors would have on the Trust. Mr Wragg advised that this increase, resulting from changes to junior doctor contracts, was not expected to have a material impact on the Trust’s finances. The junior doctor working rotas would need to be reviewed and re-worked where necessary but no major cost impact were expected within the next 3 years. Ms McNab added that she had asked for a paper to be prepared on this for the next meeting of the Resources Committee.

The Board of Directors RECEIVED and ACCEPTED the Chief Executive’s Report.

Mr Wragg

16.01.100 Month 12, 2015/16 – Financial Position

(Included with item 16.01.062 above)

16.01.101 Human Resources & Workforce Performance Report, Q4, 2015/16

Mr Johnston presented this report which covered the last quarter of 2015/16. She highlighted that continuing concerns were higher than expected bank and agency costs and above target turnover, with the average employment period of only two years in many staff groups. She also drew attention to work underway to develop career pathways to help staff progress and improve retention, and highlighted that action was being taken to improve working condition based on feedback from the staff survey.

It was particularly noted that vacancy and sickness rates


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remained high within the Acute Division and, with the addition of the new Emerald Ward, recruitment in that area was a priority. Mr Brooman queried the material increase in staff costs compared to the previous quarter. Mr Calaminus explained that the report could have been clearer and that the comparative figures provide related to the quarterly positions during the previous year and not the previous quarter. The quarterly change was less material.

Ms Johnston advised that the Trust was working on a range of measures to improve control over bank and agency staff usage, and restrict this to instances of clinical need. This was being assisted by the availability of increased staffing data from the new roistering system. Mr Wragg added that progress had been made in recruiting permanent staff but that this had not resulted in an expected decrease in bank and agency usage. Overall, more staff had been engaged. Ms Fullick commented that the Board needed a clear trajectory setting out planned bank and agency staff usage for the rest of the year, with actual usage also reported, on a monthly basis. It was acknowledged that NHS Improvement had set a ceiling on agency usage for 2016/17 which required the Trust to reduce its usage. The Board would require regular assurance that the Trust was on target to achieve required levels and avoid any penalties. Ms Johnston added that the same level of Board scrutiny given to bed usage and external placements should now be given to bank and agency staff usage. Ms Harvey added that the Resources Committee would be also be monitoring this matter in some detail. Dr Kirchner stated that any focus on bank and agency usage should focus on all staff groups, and not just nursing.

It was noted that the average recruitment time had increased from 51 to 61 days, after a period whereby this had been substantially reduced. This was being kept under review.

Ms Johnston concluded by advising that a revised exit interview process had been launched earlier that year and that the Equality & Diversity Committee would be reviewing the progress on the recent successfully launch of the BME Staff Network. She also asked the Board to endorse the work plan for 2016/17 which was contained within the report.

Ms Harvey commended the establishment of the BME Staff Network and stated her interest is seeing what progress this achieved.

Dr Goss stressed the importance of improving staff retention, adding that management, human resources processes and cultural issues may need to be changed to facilitate this. With specific reference to staffing issues within the Acute Division, she suggested that a ‘deep dive’ be undertaken to understand the issue leading to the reported increasing vacancy rate. Ms Johnston responded that a specific piece of work was already underway to monitor the progress and views of a cohort of nurses recruited in the previous year which would hopefully indicate what issues were impacting on retention and what action needed to be taken. Mr Summers added that the Trust may have to accept high turnover rates within some work groups purely because of the transient nature of the local population and the cost of living issues within the local area,


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especially for those lower banded posts. Dr Goss added that turnover had to be managed, even if unavoidably high. Mr Brooman added that constant turnover had the potential to impact negatively impact on progress and future planning. Mr Vernon added that a recent RCN survey had highlighted that the high cost of living within London was negatively impacting on the size of the local recruitment market. Ms Aitken commented that this may be an issue when considering how the St Pancras site would be developed.

Ms McNab referred to the future plan in the paper and proposed that this be re-cast for the next report to prioritise the aims and adding relevant workforce numbers to allow progress against each trajectory to be measured. She stressed the need to have the right number of staff, with the requisite skills, to provide the required services in each area of the Trust.

Mr Vernon stated that, in light of the recent BME Staff Network event, temporary staffing usage needed further analysis to ensure equality. He added that people from BME backgrounds often chose to work via an external agency. He had also noted feedback that BME staff were concerned about the lack of opportunities to progress within the Trust. Addressing these concerns may be key to encouraging people to opt for more permanent roles. Ms Aitken agreed, stating that a large number of leavers left the Trust for promotion. This was indicative of the lack of clear progression pathways within the Trust.

The Board of Director RECEIVED and ACCEPTED Q4, 2015/16 report on Human Resources & Workforce Performance.

SUB-COMMITTEES

16.01.102 Quality Committee

Dr Goss provided a verbal update on the Quality Committee’s meeting on 17 May 2016. She advised that the meeting had covered several topics which had already been discussed at this meeting. She advised that other issued discussed were equality and diversity; service users being absent without leave (AWOL); and the need for more work on the Service User Involvement Strategy had been discussed.

The Board Of Directors RECIEVED and ACCEPTED the verbal updated provided by Dr Goss on the activities of the Quality Committee at their meeting on 17 May 2016.

OTHER BUSINESS

16.01.103 Any Other Business that the Chair Considered Urgent

No other urgent items of business were raised.

16.01.104 New Risks Identified During the Meeting or Referred to/from Sub-Committees


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I certify that these are fair and accurate minutes of the stated meeting.

……………………………..…… …………………….

(Trust Board Chair) (Date)

Note: Board minutes are numbered sequentially throughout the calendar year.

No specific new risks were identified at this meeting.

16.01.105 Items for Communication to the Trust

The following items should be communicated throughout the Trust or to the individuals concerned as appropriate:

That the Board were pleased to note the successful launch of the BME Staff Network and were fully supportive of its aims.

The Board’s thanks to the Finance Team for preparing a prompt and accurate set of annual accounts.

The Board’s thanks to all staff that assisted with the fire incident on Sapphire Ward for their prompt and professional action which ensured all service users were safely evacuated.

Mr Vernon suggested that in future the Board may wish to give some consideration to sharing some of the learning from provided service user presentation with the rest of the Trust. Ms Fullick agreed that this would be considered as it was an important point that could demonstrate back to the Trust that the Board actively listened to the concerns raised by service users and staff.

Mr Monteith

16.01.106 Date of Next Meeting

28 July 2016.

16.01.107 CLOSE

The Chair declared the meeting closed at 4:35pm






ON THURSDAY 28 APRIL 2016 AT 2:00PM



Mr Paul Calaminus Deputy Chief Executive / Chief Operating Officer

Ms Claire Johnston Director of Nursing and People


Mr Richard Brooman Deputy Trust Chair

Ms Angela Harvey Senior Independent Director



Ms Angela McNab Chief Executive


(Non-Voting Member)



In Attendance:

Mr Kevin Monteith Trust Company Secretary


Dr Zoe Fyffe Head of Patient Experience (item 16.01.052 and 16.01.66 only)

Ms Helen Flynn Head of Facilities Management, Estates & Facilities -

accompanied by a service user (item 16.01.052 only)

Ms Taffy Gatawa Associate Director, Clinical Governance (items 16.01.64 and 16.01.70 only)


Minutes of the Public Board Meeting on 28 April 2016 Version: FINAL

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16.01.049 The meeting was preceded by a Board lunch which took the form of a tasting of the Trust’s updated service user food menu.

GENERAL BUSINESS


Ms Fullick welcomed those present, especially Ms McNab who was attending her first Board meeting since being appointed as the Trust’s new Chief Executive.

All Board members were present and the meeting was quorate.


It was noted that Ms Charles should be removed from the presented register of Board members interests as her term of office had expired.

The Board were satisfied that there was no conflict between those interests declared and any item on this meeting’s agenda.


Ms Flynn introduced a Trust service user who had taken part in the Trust’s annual Patient Led Assessments of the Care Environment (PLACE) inspections over the last few years. These service user led inspections considered issues such as patent food, patient environment, privacy, dignity, and compliance with dementia standards. The service user felt fully supported, but not influenced, by staff in undertaking inspections and was satisfied that their feedback had been accepted verbatim and was acted upon. It was noted that the assessments were conducted against a range of pre-set criteria and the service user highlighted that some of the more minor concerns identified, such as cleaning and gardening issues, were often rectified soon after being reported. This year the service user had taken part in inspections at the Aberdeen Park and Highview sites and stated that the kitchen at Aberdeen Park, while not materially dirty, was not up to her exacting standards of cleanliness.

The service user highlighted the wide range of staff that provided input into the patient environment and that success in achieving and maintaining a favourable environment was a team effort. They did suggest it would be more satisfying to attend the same site in subsequent years to establish for themselves if issues raised from their first visit had been addressed.

Ms Fullick asked whether sites were aware of forthcoming PLACE inspections. Ms Flynn advised that no site was notified ahead of an inspection, although actions taken such as a request for extra catering to be available may alert management that an inspection was likely.

Dr Kirchner sought assurance on the validity of PLACE assessment results. The service user advised that they were satisfied their findings were accurately recorded. Ms Flynn added that all feedback was entered onto a national matrix that required a ‘pass/fail’ input against each inspection criteria and


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generated the Trust’s overall PLACE scores.

Ms Fullick reminded the Board that in the previous year the Trust’s score of ‘respect and dignity’ had reduced as a number of wardrobes in patient rooms had their doors removed to reduce the potential ligature risk. She asked whether this issue had been resolved. Mr Calaminus advised that this was still an issue as replacing the door would re-introduce the risk of ligature. Ms McNab stated that she understood that anti-ligature risk doors were available on the market and Ms Johnston advised that this would be followed up by the Anti-ligature and Safe Environment Working Group.

Ms Fullick thanked those that presented for attending.

Ms Johnston

16.01.053 Minutes of the Meeting of the Board of Directors held in Public on 31 March 2016

The Board considered the minutes from its previous meeting and one minor typing correction was requested.

The Board of Directors AGREED the minutes of its previous publicly held meeting on 31 March 2016 as a fair and accurate record of that meeting, subject to the agreed amendment.


The Board reviewed the matters arising from its previous public meeting on 31 March 2016. All of the required actions were considered to have been completed with the exception of the following actions and comments:

16.01.055 MA4: Discharge and Homelessness. Mr Calaminus advised that a homeless discharge group had been established and had met twice to date. Updates from this group would be fed back at future Board meetings and to the Council of Governors, who had initiated a motion over their concern for the homeless being discharged from hospital care.

C/fwd

16.01.056 MA6: Workforce Strategy It was noted that work was on-going to develop more detailed shorter term action plans in line with the approved Workforce Strategy. The finalisation of action plans and their implementation would be overseen by the Trust’s Workforce Committee. The required action was considered completed in relation to required action from the Board.

16.01.057 MA8: Workforce Strategy Ms Fullick noted the proposed action to engage with service users as potential employees and commented that the Board may wish to re-visit this topic in the future.

16.01.058 MA11: Financial Position It was noted that the more detailed analysis of the 2016/17 financial budgets was due to be undertaken during May 2016, not April 2016 as detailed in the schedule. Work was underway and there would be report at May’s Board.

Mr Wragg


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16.01.059 MA 12: New Contracts for Junior Doctors It was noted that the requested action had been undertaken. Mr Brooman asked if that week’s strike action, which had included the withdrawal of emergency cover, had impacted on the Trust and whether any further Board or management action was required on this matter. Ms McNab advised that she had requested a report detailing the number of cancelled service user appointments the time taken for these to be re-booked. She had also asked for details on how the contractual changes would actually affect junior doctors working at C&I. Ms Johnston added that the number of junior doctors taking part in that week’s industrial action, whilst larger than on previous strike days, remained relatively low. Dr Kirchner added that no future strike action had been advised.

16.01.060 No additional matters arising were raised that had not been listed on the presented schedule.

STATUTORY / REGULATORY

16.01.061 Draft Board Assurance Framework (BAF) 2016/17

Ms Johnston introduced the draft BAF updated for 2016/17. She advised the Board that the strategic risks that they had identified during an earlier seminar were now fully reflected in the document. She added that this document would be presented to the Board on a quarterly basis in future, rather than only being considered annually.

Ms Johnston highlighted the proposed principal Trust objectives for 2016/17, which remained aligned to the Trust’s on-going priorities.

Mr Brooman advised that the Audit & Risk Committee had considered this document in detail and that it had subsequently been updated in line with that Committee’s recommendations. He added that, in light of the recent e-mail outage, the Board may wish to add a more specific ICT related risk. It was agreed that this risk was covered under objective four, but to clarify this point it was agree to amend this objective to read ‘we will develop the Trust’s estate and infrastructure to deliver our clinical strategy in a safe, fit for purpose environment’.

Ms Aitken queried the risk score of 15 allocated to the redevelopment of the Trust’s estate at St Pancras. It was agreed that this risk score would be retained, as it mainly related to the initial stage of achieving consensus on redevelopment works, and that the allocated risk score would remain under review by the Audit & Risk Committee.

The Board of Directors APPROVED the Trust’s Board Assurance Framework for 2016/17.

Mr Monteith


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16.01.062 Monitor Finance Declaration – Quarter 4, 2015/16 (1 January – 31 March 2016)

(Declaration included the Financial Position Report – item 16.01.069 below)

Mr Wragg apologised for the late release of this paper, which had been necessary to allow year-end accounts work to be completed. He thanked his Finance Team for their excellent work in completing a clear and well prepared set of accounts within an ever decreasing timetable. He added that external audit had concluded their interim work and that no material concerns had been raised to date.

Mr Wragg advised that the Trust had a achieved a normalised surplus of £720k, which although below the originally planned surplus of £2m, was better than the more recently expected year end position of £500k. He added that the Trust’s unaudited balance sheet showed a £1,678k deficit but that fixed asset impairments of £2,398k had turned this around into the normalised surplus reported. This reflected the current modern valuation methodology that if a property had to be replaced it would be re-built in a less expensive location, thereby reducing the asset value. The reduction in fixed asset value also had the unplanned benefit of reducing capital charges payable by the Trust. If this additional benefit was to be excluded this would have left an underlying normalised surplus of £459k, a truer picture of the year-end financial position. Mr Wragg expected NHS Improvement to accept the reported surplus of £720k but advised that the Trust would work on the basis of the £459k figure going forward.

Mr Wragg advised that income had reduced by approximately £3m. This had decreased at a quicker rate than the Trust’s expenditure; which had reduced by £2m once the fixed asset impairment had been taken into account. It was noted that this variance had to be addressed as the Trust would be unable to retain its slim surplus going forward if expenditure did not reduce in line with reductions in income. He highlighted that pay costs had increased due to an increase in the Trust’s establishment but that this had failed to be off-set by an expected relative reduction in temporary staff costs.

Mr Wragg advised that NHS Improvement were introducing caps on trusts’ agency staff expenditure. To comply with the agency costs cap for the full year, C&I would need to reduce related expenditure by approximately one third. The Trust had already advised NHS Improvements that it would proportionally exceed this cap during the first three months of 2016/17 as measures were put into place to come within the capped limit by year-end.

Mr Wragg advised that the Trust had retained a year-end cash balance of £41m and concluded by recommending that the Board approve the 2015/16 Q4 declaration confirming that the Trust would retain a financial sustainability rating of a least 3 over the next 12 months.

Ms Harvey commended the Finance Team on their excellent work in producing a prompt and professional set of accounts.


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She commented that the inability to achieve the planned surplus was disappointing, but not unexpected. As Chair of the Resources Committee, Ms Harvey had been kept informed during the year of the additional financial pressures incurred by the Trust due to need for external bed placements and to engage temporary staff.

Dr Goss queried why the increase in permanent staff had not been reflected in a reduction in the need for temporary staff. Ms Harvey advised that the increased need for patient observations had been a key factor in driving up the staffing need. Mr Calaminus advised that planned and actual staffing on each ward was reviewed weekly and that the current budget setting processes allowed for sufficient staff to safely operate required services. He added that work was underway to further analyse staff usage, sickness and absence rates, rostering patterns and the potential to share staff between wards to flex cover during periods of high demand. He referred the Board to the safer staffing paper later on the agenda.

Mr Brooman suggested that the budgeting assumptions made may be fundamentally wrong if additional temporary staff were consistently required on top of the staffing establishments currently set for each ward. Ms Fullick acknowledged this concern. She referred to the previous bed pressures faced by the Trust whereby the Board had understood the problem and ensured that a reactive plan was put into place to bring costs back under control. She suggested similar oversight and action be taken to improve the management of staffing costs. Dr Goss concurred, commenting that effective leadership and management were effective tools to be used in addressing staffing level issues.

The Board of Directors RECEIVED and ACCEPTED the headline financial position as at year-end 2015/16 and APPROVED the submission of the presented finance declaration for Q4, 2015/16 to NHS Improvements.

16.01.063 Monitor Governance Declaration - Quarter 4, 2015/16

(1 January – 31 March 2016)

Mr Monteith presented the proposed governance declaration for Q4, 2015/16’ advising that all of the quarterly service performance targets had been achieved. He directed the Board to the ‘exception report’ and the one issue reported on the disappointing and continuing need to improve the CQC rating for the nursing home services provided at Stacey Street.

Mr Brooman challenged whether the recent e-mail outage incident should have been declared in the ‘exception report’. Mr Wragg advised that he had verbally reported the matter to NHS Improvements and that there had been no sense of any expectation it should be formally declared in the quarterly return. He added that the need to develop the Trust’s business continuity plans to cover such events had been taken on board. The Board agreed there was no need to amend the Trust’s declaration.


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The Board of Directors APPROVED the submission of the presented governance declaration for Q4, 2015/16 to NHS Improvements.

16.01.064 Quality Accounts Preparation 2015/16, (Presentation on the Quality Priorities)

Ms Johnston invited Mr Gatawa to address the Board. Ms Gatawa provided a short slide-based presentation to update the Board on the preparations of the Trust’s 2015/16 Quality Accounts. She outlined the context of the Quality Accounts and new requirements for 2015/16’s submission. She also took the Board through the 12 quality priorities identified for the Trust in 2016/17, included one priority indicator chosen by the Trust’s Council of Governors. She concluded by advising on the in-depth consultation process undertaken in producing the quality accounts and how they would be presented to NHS Improvements, prior to be laid before Parliament in June 2016.

Dr Goss highlighted that some of the presented priorities reflected what the Trust was already doing and were basic steps in providing a quality patient environment. She added that previous attempts to undertake wider public consultation on the Trust’s quality indicators had proved ineffective. She also queried how, with 12 priorities established, it would be ensure that each was given adequate attention. Ms Gatawa assured her that each priority had a lead officer and a Board sponsor and progress against all priorities was monitored by a quarterly workshop.

Dr Goss also stated that the priorities were not dissimilar to the actions listed in the Trust’s CQC action plan. Ms Fullick stressed the need to ensure that all such documents shared the same aims and retained a consistent focus on achievement of the Trust’s goals.

Dr Kirchner commented that some activities stated among the priorities were already underway and that it was important that management understood whether the actions underway or the identified priorities were the drivers for progress.

The Board of Directors RECEIVED and ACCEPTED the provided presentation on preparation of the Trust’s 2015/16 Quality Accounts.

16.01.064 Infection Prevention and Control Annual Report

Ms Johnston presented this report advising the Board that it demonstrated a successful year where significant work had been undertaken to ensure that service users were treated in a safe and clean environment. She drew attention to key findings in the report and advised that a new lead Infection Control Nurse was due to start with the Trust the following week. It was also highlighted that the ‘champion’ model had worked well in the Trust to promote infection prevention, with ‘champion’ training provided jointly with Central North West London NHS Foundation Trust. Ms Johnston commended the hard work of the Trust’s infection control team which was demonstrated in


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this report.

Ms Fullick noted the reference to equality in relation to infection control. It was added that the ‘single equalities impact assessment’ element on report coversheets was being reviewed by Mr Monteith to ensure that issues of equality and diversity were more clearly established for reports submitted to the Board and its committees. Ms Johnston advised that equality issues related to infection control would be considered further at the next meeting of the Equality and Diversity Committee, which would be attended by the Trust’s new lead for equality and diversity.

The Board of Directors RECEIVED and ACCEPTED the presented annual report on infection prevention and control.


16.0165 North Central London (NCL) Sustainability and Transformation Plan – Draft Submission

Mr Calaminus presented this item advising that the slides in pack for the meeting summarised the Draft North Central London Sector Transformation Plan for submission to NHS England. He drew attention to list of organisations within the NCL footprint; the challenges faced in developing this area; and the four key themes being used to shape developmental plans. The financial challenges expected to face NCL in 2020/21 were also highlighted. It was advised that a programme management office had been established to support the process and to ensure that all participating bodies were fully engaged in the developmental work.

Ms McNab advised that this draft, due for submission in June 2016, was more a ‘plan for a plan’. She proposed that the time was right for C&I to think about which aspects of NCL services it would wish to influence and what services it would like to see provided on the St Pancras site as part of a wider NCL Estates Strategy. She added that the local authority/social care aspects of the plan require further development; as did the focus on engaging with primary care. She added that the Chief Executives within the NCL footprint would be meeting within the next few weeks to discuss this plan further.

Ms Aitken stressed the need to engage with primary care on transformation plans; which was also a key element of the Trust’s Clinical Strategy. Mr Summers advised that work was underway to model standard processes on engaging with GPs across NCL. It was also noted that the plan referenced strong Non-Executive Director (NED) involvement and Ms Aitken queried how this was being achieved. Ms McNab responded that details of NED involvement were yet to be agreed but that, as part of the Board, they would be engaged in the sign-off on any transformation plans. She added that it should be ensured that clear communication processes were in place to keep NEDs updated on progress. Ms Aitken commented that the NEDs on various partner organisations Board may have quite different skill sets and that it would be productive to establish


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these now to ensure the most beneficial NED input was obtained. Ms McNab stated she would feed back this suggestion to the NCL Transformation Board.

Mr Vernon was disappointed that the transformation plan made no reference to equality and diversity issues, an inappropriate oversight given the demographic and population size affected. Ms McNab expected that this would be an overarching theme for all transformation activity but she would feed back his concern to the Transformation Board. Mr Summers added that equality and diversity had featured strongly in discussions on the mental health strand of the transformation plan. He acknowledged that this could be stated more explicitly in related documentation.

Ms Fullick concluded this item by advising that the NEDs had noted the additional work pressures placed on Executive Directors to develop the NCL Transformation Plan and that this should be kept under review to ensure they were still able to undertake their regular duties effectively during these developments.

The Board of Directors RECEIVED and ACCEPTED the provided briefing on the draft submission of the North Central London (NCL) Sustainability and Transformation Plan

Ms McNab

Ms McNab

16.01.066 Patient Experience Strategy 2016/17

Ms Johnston invited Dr Zoe Fyffe to address the Board to present the Trust’s Patient Experience Strategy. Dr Fyffe advised that this strategy set out how the Trust listened to and understood its service user; and worked to improve their experience whilst under C&I’s care. She outlined how the strategy had been consulted upon and that it had already been reviewed by the Trust’s Quality Committee. She drew attention to the five key principals undelaying the strategy and the ten milestones it aimed to achieve over the next three years. The Board were invited to ask questions.

Dr Goss commended the strategy as a clear and exemplary document. Mr Vernon concurred, asking how it would be ensured all Divisions were adequately supported in achieving the aims of the strategy. Dr Fyffe assured him that 2 clinical audit facilitators were in post that had clearly defined links with Trust Divisions and who would ensure that expected progress was achieved. In addition, the Quality Committee would be overseeing related activity.

In response to Ms McNab, Dr Fyffe advised that the Trust’s Lead for Equality and Diversity was fully engaged in supporting this strategy and would ensure that no staff group was marginalised or not engaged when taking the strategy forward.

Ms Johnston, noting that Dr Fyffe would soon be leaving the Trust and thanked her for all the work she had undertaken while in post.

The Board of Directors APPROVED the Patient Experience Strategy 2016/17


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16.01.067 Use of the Trust Seal

Mr Monteith advised the Board on the use of the Trust’s seal since it had last met. It was noted that such usage would normally be included in the Chief Executive’s report.

The Board of Directors RATIFED the reported use of the Trust seal.

OPERATIONAL


Ms McNab stated how pleased she was to have joined the Trust and that she had already held several open sessions to meet with staff and had visited a number of services. She had been pleased to note how open, energetic and engaged staff had been, adding that she had a wide variety of future meetings planned to engage with more staff. She was also engaging with a number of CCG and local authority leads through a variety of meetings and had 1-1 meetings planned with other local Chief Executive colleagues.


16.01.069 Month 12, 2015/16 – Financial Position

(Included with item 16.01.062 above)

16.01.070 Board Performance Report Q4, 2015/16

Ms Johnston introduced the integrated performance report and invited Ms Gatawa to take the Board though its key messages and content.

Ms Gatawa highlighted the immediate concerns raised by the CQC as a result of their recent inspection of the Trust; the continuing work to improve data reporting within the new Carenotes system; and the continuing staffing pressures facing a number of Divisions. Ms Fullick then lead the Board through the report section by section, inviting questions.

Dr Goss referred to the performance dashboard stating that this could be improved by the addition of some clear narrative to highlight any new issues, or issues of concern, to the Board. Ms Fullick added that on-going concerns that had stalled or increased in severity should also be highlighted. Ms Johnston agreed to take these comments on board for the next report. Within the performance dashboard, Mr Brooman noted three outcomes under the ‘minimum data set’ shared one result that far exceeded the expected target. He queried why this was the case and whether the target itself was reasonable. Mr Calaminus explained that the result demonstrated that all three expected data fields, within one form, had been fully captured for the majority of patients and that the target had been set externally by NHS Improvements. Mr Brooman also queried the reported number of home treatment episodes carried out as 504

Ms Johnston


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were reported against a year-end target of 750, although the result was rated ‘green’. Mr Calaminus advised that the reported result was for the quarter and that the annual target of 750 episodes had been exceeded. Mr Brooman stated that the differing time periods should be clearly stated in the report.

Ms Fullick commented that she was pleased to note that comparative data from NHS Choices had been included within the report. Mr Brooman noted that the Trust had one of the highest bed occupancy rates at 99.2% and asked if all Trusts shared the same target. Mr Calaminus advised that the considered target was 85% although this was unlikely to be achievable. He acknowledged that the inclusion of an expected target or threshold within the table would assist in analysing the data provided.

Dr Goss noted the Trust’s poor performance in ‘communication with GPs – quality’ and queried why this had not been addressed. Dr Kirchner advised that this was complex issue as GP correspondence was impacted on by both staffing and the ICT systems in place. He added that he expected to see improvement over the next year as integrated digital medical records began to come on-line. The Board considered GP feedback on the Trust services, with Ms Fullick querying how C&I could best understand GPs’ views on the Trust’s services. Mr Summers suggested that it would be best practice to have a focussed customer/stakeholder process to engage with, and gather feedback from the Trust’s strategic partners. It was agreed that this should be considered further by the Trust’s Strategic Development Committee.

Ms Harvey was disappointed to note the reported increase in the number of non-clinical bed moves. Dr Goss advised that the Quality Committee had retained a keen focus on minimising such moves and that, whilst bed usage was closely monitored, high demand often necessitated that inpatients be moved between beds. The Board’s concern over such moves, and the implications for patient safety, was noted.

In relation to the recent CQC inspection of the Trust, Ms Johnston advised that the standard post-inspection letter issued by the CQC had been received and responded to by the Trust. This had focused on a small number of patient safety concerns that had already been advised to the Chief Executive at the end of the inspection visit. A required action plan had already been put into place to address the issues identified. It was noted that the Trust would be meeting with the CQC in May 2016, at which point it was expected to receive the draft inspection report to allow it to be checked for factual accuracy. It was noted that a key concern raised by the CQC had been the poor environmental conditions of the ‘places of safety’ within local A&E departments staffed by the Trust. The Executive assured Ms Fullick that they had already been aware of such concerns and had raised it with the relevant acute sector colleagues over a significant time period but the Trust could not directly make improvements to another trust’s infrastructure. Ms McNab was authorised to progress this matter with her acute sector Chief Executive colleagues, if required.

Ms Johnston

Ms Johnston

Ms Fullick


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The Board of Directors RECEIVED and ACCEPTED the Board Performance Report for Q4, 2015/16.

16.01.071 Six Monthly Nursing Establishment Review

Ms Johnston presented this paper reminding the Board that they had a duty to periodically, at least every six months, receive safe staffing data and assure themselves that the Trust’s services were safely staffed. She added that NHS Improvement had increased the safe staffing monitoring requirements for 2016/17.

It was highlighted that a planned pilot implementation of a ‘Safecare’ application on three Trust wards would allow management to receive daily updates on staff actually in post on a shift by shift basis. Using available data this application should clearly demonstrate how safe each ward/unit was during each staffing shift and allow staff to be re-deployed to where they were most needed on a real time basis. It is also expected that such information would assist with work underway to review the Trust’s current staffing establishment and staff work patterns. It was acknowledged that appropriate levels of staffing were key to staff morale and in allowing the best level of service user care to be provided.

Ms McNab commented that, with the increased focus on recovery as an aim, the Trust should also consider the need for therapeutic staff and not assume all issues could be resolved by amending the number of nurses on duty. A dynamic approach was required to establish which staff groups combined to constitute the most effective and economic workforce.

Dr Goss noted the range of issues raised by this review and would have liked to see more details on how management actually planned to improve staffing.

Ms Harvey advised that the Resources Committee, which she chaired, retained an overview on the raised staffing issues and discussed workforce concerns as a regular item.

The Board of Directors RECEIVED and ACCEPTED the reported progress made in relation to safe staffing and supported on going work in this area, as outlined in the recommendation contained in the presented paper.

16.01.072 Emergency Preparedness, Resilience and Response Annual Report

Mr Calaminus introduced this report which updated the Board on the Trust’s activities in relation to emergency preparedness, resilience and response over the last year. The report covered topics which included planning, training, exercises and actual events. He highlighted the main public risks outlined in the report as pertinent to the boroughs of Camden and Islington. The range of relevant Trust policies in place was noted; as was the fact that the Trust’s Pandemic Influenza Policy had been updated during the year; and that this policy could be easily adapted to cover any pandemic contagion. He added that other policy revisions had been made to ensure that the current sites


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could be promptly evacuated and/or locked-down, should such action be required.

Ms Fullick thanked Mr Calaminus for this report and was pleased to note the improvements made and that the Trust’s rating had improved in this area. Mr Calaminus confirmed that this was the case and that the Trust was now mainly rated as ‘green’. He added that he would circulate scoring details to Board members after the meeting.

Mr Brooman, noting the Trust’s central London location, commented that terrorism did not feature in the risk register. Mr Calaminus assured him that the Trust had taken part in relevant pan-London exercises and was prepared for such incidents as part of a multi-agency team. Ms Fullick queried the role of the Board in such an incident. Mr Calaminus advised that the Chief Executive would be immediately informed of any serious incident affecting the Trust and then decisions would be made on the need to inform the Chair and Non-Executive Directors. Ms Harvey asked whether C&I’s doctors would be called upon to support triage at a major incident. Mr Calaminus advised that the Trust’s doctors would normally be called upon to support those services offered by the Trust and required by its local residents but this could change under the direction of NHS London who would oversee any major incident in the capital. Ms Harvey asked how our service users would be advised on any changes to their appointments or risks related to coming on site during a major incident. Ms McNab acknowledged the importance of the comment and highlighted the importance of having an appropriate communications strategy in place to advise our service users where necessary and to keep them as safe as possible should a major incident occur.

The Board of Directors RECEIVED and ACCEPTED the presented Emergency Preparedness, Resilience and Response Annual Report.

Mr Calaminus

SUB-COMMITTEES

16.01.073 Quality Committee

(No items)

OTHER BUSINESS




No specific new risks were identified at this meeting.


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……………………………..…… …………………….





New Chief Executive welcomed by the Board;

Patient Experience Strategy 2016-19 received, approved and supported by the Board;

Board approval of the Annual Infection Prevention and Control report for 2015/16 and their thanks to all staff in maintaining and improving performance in this area; and

The Board sampled the updated patient food menu ahead of their meeting and were pleased to note that the food offered to patients was much improved and that they had enjoyed the menu items available.

Mr Monteith


24 May 2016.

16.01.080 CLOSE







ON THURSDAY 31 MARCH 2016 AT 2:00PM



Ms Claire Johnston Acting Chief Executive / Director of Nursing and People


Mr Richard Brooman Deputy Trust Chair

Ms Angela Harvey Non-Executive Director




(Non-Voting Member)



In Attendance:

Mr Andy Stopher Acting Chief Operating Officer

Mr Kevin Monteith Trust Company Secretary



Minutes of the Public Board Meeting on 31 March 2016 Version: FINAL

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GENERAL BUSINESS


Ms Fullick welcomed all those present. Apologies had been received from Ms Wendy Wallace (Chief Executive) and Mr Paul Calaminus (Deputy Chief Executive/Chief Operating Officer). Ms Fullick noted that Ms Johnston was acting as Chief Executive and welcomed Mr Stopher who was acting as Chief Operating Officer. She also welcomed Mr Summers who was attending his first Board meeting.

To acknowledge Ms Charles’ last meeting; her significant contribution to the Board over the last seven years and material input into the Trust were recorded. Her excellent work in championing service users and supporting Governors was also highlighted as she was presented with a bouquet of flowers and received a round of applause.

The meeting was quorate.


No changes were requested to the presented declarations and the Board were satisfied that there was no conflict between those interests declared and any item on this meeting’s agenda.


The Board were advised that there would not be a service user presentation as the service user was unable to attend.

16.01.028 Minutes of the Meeting of the Board of Directors held in Public on 28 January 2016

The Board considered the minutes from its previous meeting. One minor amendment was requested to add Ms Charles to the list of those Board members who were in attendance.

The Board of Directors AGREED the minutes of its previous publicly held meeting on 28 January 2016 as a fair and accurate record of that meeting, subject to the agreed amendment.


The Board reviewed the matters arising from its previous public meeting on 28 January 2016. All of the required actions were considered to have been completed; with the exception of the following actions and comments:

16.01.030 MA3: Organisation Development Strategy Progress Report It was noted that this report remained due to be received in December 2016.

c/fwd


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16.01.031 MA4: Briefing Note on Lessons Learnt from Serious Incidents The Board noted that this action was stated as ‘complete’ but several members did not recall seeing the stated briefing. Ms Johnston assured Board members that the requested briefing had been provided to them ahead of the recent CQC inspection of the Trust. She added that the Q4 2015/16 Serious Incidents, Inquests & Claims Summary Report, presented at private Board, would include further details on the serious incident process. No further action was required.

Ms Johnston.

16.01.032 MA5: Smoking Cessation Reports

Ms Johnston advised that a report evaluating the first year of smoking cessation had been produced for the Quality Committee and that a further evaluation would be prepared in six months’ time. Those Board members not on the Quality Committee were welcome to request a copy of the report. The required action was considered completed.

16.01.033 MA6: Further Details on Non-Clinical Transfers

The requested chart providing further detail on the 62 non-clinical transfers reported in the Q3 Board Performance Report was deferred until the next meeting.

Ms Johnston

16.01.034 MA7: Paper on Discharge & Homelessness It was noted that the required action had been completed with a requisite working group and reporting processes having been established. A further update would be provided at the next meeting.

Mr Calaminus

No additional matters arising were raised that had not been listed on the presented schedule.

16.01.035 STATUTORY / REGULATORY

(No items)


16.01.036 NHS Improvement One Year Operational Plan

Mr Monteith presented this plan advising that it had already been fully considered by the Foundation Trust Executive and at the Strategic Development Committee. Following submission of a draft version to NHS Improvement (Monitor) in February 2016; this final version was due for submission by 11 April 2016. No template was issued for 2016/17 plan; although clear section headings were provided. It was noted that feedback from NHS Improvement on the Trust’s draft plan had been positive with no material concerns highlighted. Mr Monteith invited the Board to satisfy themselves that the presented plan was appropriately focused on delivering operational and financial stability; whist evidently demonstrating a commitment to the development of the Sustainability and Transformation Plan in collaboration with CCGs and other stakeholders to develop service provision within the North Central London footprint over the next five years.


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Mr Brooman queried the deliverability of the presented financial plan. Mr Wragg responded that he was confident that this was the case, with Trust management fully committed to the financial and cost improvement plans proposed for 2016/17. He acknowledged that there would still be challenges to face with Divisions and Human Resources being required to work hard to further improve recruitment and retention and meet NHS Improvement’s new agency cap target. He added that the Trust was moving into 2016/17 with a strong balance sheet and appropriate contingency fund arrangements in place.

Mr Wragg confirmed to Ms Fullick that 2015/16 had been a challenging year that had not been assisted by the need to contract external beds to allow refurbishment and anti-ligature works to be undertaken. These costs had negatively impacted on the Trust’s finances in-year but were non-recurring.

Ms Fullick directed attention to the statement on ‘parity of esteem’ and queried the likelihood of C&I being given a full share of the addition mental health monies allocated to CCGs given the current focus on funding perinatal and adolescent services. Mr Wragg responded that Camden CCG was passing on their full 1.4% uplift to the Trust, whilst Islington CCG was passing on 1.8% of their 2.2% additional allocation. He added that expenditure plans would be adjusted in line with these funding decisions.

Ms Fullick made a general comment that she was dismayed that the Trust was meant to improve and grow whilst income reduced annually. A view supported by Dr Goss, who added that this was against a background of ever increasing service demand. Mr Wragg acknowledged these comments adding that, whilst income had reduced, so had related service costs which maintained a rough equilibrium. Mr Brooman added that, regardless of financial balance, the size of the Trust continued to reduce and this may impact on its ability to influence wider ranging healthcare decisions and its sustainability; especially important when trying to ensure that NCL transformation plans include appropriate levels of mental health services. Mr Summers added that 2016/17’s income could improve substantially as the Trust had the opportunity to submit a number of business cases to its CCGs that could attract additional funding.

Dr Kirchner supported the view that mental health funding was not keeping pace with the demand for services. He also noted the planned rationalisation of corporate teams, incongruently reducing management funding at a time when the Trust was aiming to develop its services and the St Pancras site.

Mr Vernon noted the Trust’s ownership of the freehold for the St Pancras site. He queried the status of the Hanley Gardens and Tottenham Mews sites. Mr Wragg responded that the Board had yet to finalise its overall estates strategy and would be seeking advice from specialist property advisors, which were yet to be appointed.

Ms Charles requested the inclusion of the refreshed Service User Strategy as an action in the patient experience quality priority section of the plan.

Mr Monteith


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The Board of Directors APPROVED the NHS Improvement One Year Operational Plan, subject to the proposed amendment.

16.01.036 Five Year Forward View for Mental Health – Mental Health Taskforce Strategy

Mr Summers presented this strategy which made a strong argument for growth, and investment in, mental health services. He highlighted how this was in line with the Trust’s own recently approved Clinical Strategy. He drew attention to the service areas emphasised for growth and additional funding, whilst acknowledging that the source and allocation of any such monies remained to be clarified. He added that the NCL Sustainability and Transformation Plan, which had to be submitted by the end of June 2016, had to demonstrate how the recommendation in this document would be delivered.

Ms Fullick highlighted how this strategy, and the previous one year plan, suggested it may be time to review the Trust’s strategic aims and priorities; although this should be done to take account of the views of the incoming new Chief Executive.

Mr Vernon reflected on those recommendations supporting the provision of housing on NHS land and the need to ensure equality and diversity issues were clearly embedded in future plans.

Ms Aitken noted that the Strategic Development Committee’s consideration of efficiencies and step down housing were not fully reflected in this paper. Ms Fullick added that the new Chief Executive had contacted her advising the need to consider employment, housing and the care of 16-25 year olds as set out in the strategy.

Dr Goss questioned how satisfied the Board were that NCL plans had an appropriate focus on the inclusion of mental health services and whether they needed to act to ensure that mental health services were given an appropriate level of attention. She also asked if the move to seven day service provision would impact on strategies and plans. Mr Summers responded that a significant number of services provided by the Trust were already available seven days per week so any proposed changes to work patterns were less material for C&I. He added that the Executive had a strong and evident focus on ensuring mental health services were adequately taken into account by the NCL Transformation Board.

Mr Stopher advised that work had already been undertaken with Islington and Haringey CCGs over the last six months to ensure that NCL retained a focus on mental health. He also advised the Board on the need to be mindful that NHS changes were taking place on several different levels: locally; London-wide and nationally. The Board should be aware of all influencing factors and changes. Ms Fullick stated that the majority of the Trust’s Executive already had some involvement in ensuring mental health needs were reflected in NCL plans. She added that that all Trust Chairs, within NCL, had raised concerns that neither they nor their Non-Executive Directors had been involved in any of NCL’s Strategic planning to date. She stated that she would like to see this position change going forward.


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She thanked Mr Summers for a useful and informative report.

The Board of Directors RECEIVED and ACCEPTED the presented summarisation of the ‘Five Year Forward View for Mental Health – Mental Health Taskforce Strategy’.

16.01.0037 Membership Strategy

Mr Monteith presented this item advising that it was a requirement for foundation trusts to have a membership strategy and that the Trust currently had approximately 5,000 members. This version of the strategy had been reviewed and refreshed with input from the Council of Governors’ Membership Working Group and covered the future period 2016 – 2019. He requested that the Board agree the content of this document and to it being taken to May’s Council of Governors meeting for final approval.

Dr Goss found some sections of the strategy to be overly elaborate and suggested that it may be more effective to identify a small number of key actions to focus upon. Mr Vernon stated that it should be ensured that the service user constituency were fully engaged with as part of this strategy. Mr Monteith acknowledged that cross-referencing with the Service User Involvement Strategy could be improved. Ms Charles added that service users may choose to join the Trust as public members as they may not necessarily want to be publicly identified as service users. She also highlighted the need to offer any additional support required by service user members.

Ms Fullick commented that the Trust had a reasonably sized membership but engagement and membership activity had significant scope for improvement. She referred to the ‘tools for informing members’ in the strategy and advised that she would work with Ms McNab to improving communication and engagement with members. It was noted that there was no longer a ‘membership manager’ post at the Trust.

Ms Johnston advised that a work stream had recently been undertaken with schools within Islington and that the Trust should be mindful to use such external engagements as an opportunity to grow its membership.

The Board of Directors AGREED the updated Membership Strategy and that it should be forwarded to the Council of Governors for approval.

Ms Fullick

16.01.038 Workforce Strategy

Ms Johnston presented the Workforce Strategy for the Trust covering the next 5 year period. She stressed that the Trust could not provide excellent services without an excellent workforce. She highlighted the Trust’s recent recruitment successes and the need to kept this momentum going; along with work to improve staff retention. Recent successes in staff transitioning into new roles to support new services were also highlighted.


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It was noted that key aims were to develop more peer support arrangements; increase recruitment from the local area; and improve support for staff wellbeing, given the pressures on staff from on-going and rapid change within the NHS. It was also noted that a new provider would be taking over the provision of occupational health services in the near future. Ms Johnston concluded by commending this ambitious, but deliverable, strategy to the Board.

Dr Kirchner full supported this strategy and appreciated its strong links with the Trust’s Clinical Strategy.

Dr Goss supported the strategy but considered that it was more of a statement of intent, rather than a clear plan setting out clear and measurable management actions. Ms Johnston acknowledged this comment and advised that a more detailed action plan, perhaps for the next six months, would be drawn up in support of the strategy. Ms Aitken reinforced the need for all required actions to be measurable, which was not the case with the wording currently used.

It was noted that the CQC had shown material interest in workforce issues; especially in relation to staff morale.

Mr Brooman noted that the pie chart depicting ‘headcount by profession group’ had eight sections but only seven headings in the legend. This should be corrected.

Mr Vernon queried what arrangements were in place to engage service users as employees, in support of their recovery, and suggested such intentions should be reflected in the strategy. Mr Stopher advised that the Trust was working with a nurse consultant in Islington this year to consider opportunities to introduce peer support roles.

Ms Fullick drew the discussion to an end, noting that this strategy, like all others, would be revisited in the future. She added that she had completed the necessary foreword that would be added to the document.

The Board of Directors APPROVED the Workforce Strategy 2016 – 2021 for the Trust, subject to the addition of a ‘forward’ by the Chair and the other amendments highlighted.

Ms Johnston

Ms Johnston

Ms Johnston

OPERATIONAL


Ms Johnston presented this report in Ms Wallace’s absence. She noted that the report set out Ms Wallace’s reflections on her time in office and highlighted a number of key items for information that were set out in the report.

Ms Charles noted the difficulties faced by the Highgate Day Centre and commended Mr Stopher and the centre’s staff for their professional handling of these matters.

There had been no use of the Trust seal since the last meeting.



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16.01.040 Month 11 2015/16 - Financial Position

Mr Wragg presented this report. He advised that his main concern was the on-going issue of temporary staffing costs, which were significantly above their planned trajectory. He added that NHS Improvement would be reducing the cap on agency staff expenditure from 11% to 8% next year. To meet this new target the Trust would have to reduce its current agency expenditure and manage staff recruitment and retention more effectively.

Mr Brooman highlighted the need to react to the lower cap and improve staff management very quickly, given that the new financial year would start the following day. Mr Wragg responded that there may be some variance form the 8% limit in the early months of 2016/17 but that budgets had been set to phase in reduced agency usage and meet the new targets. He also confirmed to Ms Fullick that the 2016/17 financial plan would be presented at the May Board meeting. Mr Brooman requested that full details on the agency staff usage caps, and their potential impact on the Trust, be reported at the next meeting of the Audit & Risk Committee.

Mr Wragg advised that the Trust would end the year with a Continuity of Service rating of ‘3’, and, with the achievable expenditure and capital plans for 2016/17, this may rise to the highest rating of ‘4’ next year.

Mr Wragg concluded by advising that capital expenditure was below budget, but within required tolerance limits, and that cash position remained strong although below plan.

Ms Harvey, as Resource Committee Chair, advised that the Committee discussed the on-going financial positon, and particularly temporary staffing costs, on a regular and detailed basis. She added that the on-going need for additional temporary staff may indicate the need to increase the Trust’s staffing establishment and recruit accordingly. Dr Goss commented that there was a lack of knowledge of the current workforce market and it was unclear whether there were sufficient potential workers to fill an increased establishment. She added that a proportion of people deliberately choose to work on a temporary basis or via an agency. Mr Stopher noted this point, adding that the Trust had been unable to fill all its vacancies below band 5 for some time. He added that the Trust was working to understanding staff demand and that the new staff rostering system allowed management to examine staffing requirements in much more detail. Ms Johnston added that a safer staffing paper was due at the April 2016 Board. She advised that the additional temporary staff had been engaged for valid clinical reasons and acknowledged that it may be more cost effective to increase the workforce than continuing to operate with the current usage of bank and agency staff. She added that an increased establishment may require efficiency saving to be made elsewhere. Ms Harvey stated that, for any such actions, there should be a clear explanation of what was termed an ‘efficiency saving’; and whether there was any actual reduction in service provision. Mr Brooman added that if the Trust’s establishment was wrong then corrective action was

Mr Wragg


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required but cautioned against potential cost increases as the Trust’s current surplus was fragile and could easily become a deficit.

Dr Kirchner stated that the Trust’s Clinical Strategy aimed to develop community services and reduce the need for inpatient beds. He highlighted that this conflicted with the proposals from the Mental Health Taskforce which seem to be aiming to increase inpatient care. He advised that the Board should be mindful of these conflicting aims and their potential impact on staffing and other costs. Dr Goss added that if funding moved from preventative care to inpatient care it would lead to a loop of ever increasing demand and costs as mental health care would less likely to be provided until an individual was in crisis.

Mr Wragg advised the Board that the annual accounts process had commenced and was adequately resourced to allow the required submission of a first draft to External Audit and NHS England by the required date of 22 April 2016.

He advised that the Board had approved next year’s budget as part of the Trust’s 2016/17 operational plan. However, due to the issues highlighted above, he would bring a more detailed analysis to the May Board meeting when the contract negotiations are concluded. This would include the effect funding agreed for 2016/17 would have on staffing levels and service capacity. He confirmed to Ms Fullick that contracts should have been agreed with all commissioners by that point.

Ms Fullick recorded the Board’s thanks to Trust staff for their hard work and efforts to manage their budgets during 2015/16.

The Board of Directors RECEIVED and ACCEPTED the M11, 2015/16 financial position statement and the update on financial planning.

Mr Wragg

16.01.041 New Contract for Junior Doctors

Dr Kirchner updated the Board on the introduction of new contracts for junior doctors. He advised that this would affect a significant portion of the Trust’s workforce as currently there were 83 junior doctor posts. He added that junior doctors in psychiatry would be the first to transfer to the new contracts in August 2016.

It was highlighted that the new contracts introduced significant changes to junior doctors’ terms and conditions and that staff rotas would need to be reviewed to comply with the proposed changes. Any financial effect may not be evident for another three years due to initial pay protection. It was also noted that junior doctors had further strike action planned in response to these changes. Dr Kirchner added that past strike action had only minimal effect on C&I’s services but that such action did require consultants to cancel some clinics to cover junior doctors’ duties.

In response to a question from Mr Brooman, Dr Kirchner advised that the Trust currently had 66 consultant posts. He also advised that the number of junior doctor posts was set externally and that approximately 10 posts were vacant. He also advise that he did not foresee any reduction in the quality


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of service provided as a result of the introduction of the new contracts. Mr Brooman requested that details of changes, and potential impacts, from the new junior doctors’ contract should be advised to the Audit & Risk Committee for consideration and identification of any associated risks.

The Board acknowledged that junior doctors were on national contracts and that it would not be feasible for foundation trusts to unpick these arrangements and establish their own local contracts.

Ms Harvey queried as to how junior doctors were feeling about the new contracts. Dr Kirchner advised that, whilst they were initially quite distressed, their responses to the new proposals were now more informed and measured. The intense media focus may have added pressure to the situation but that overall junior doctors felt well supported.

The Board of Directors RECEIVED and ACCEPTED the update on junior doctors’ contracts.

Dr Kirchner

Mr Wragg

SUB-COMMITTEES

16.01.042

Quality Committee

Briefing note from meeting on 15 March 2016

Dr Goss, as the Quality Committee’s Chair, highlighted that the Committee had received a well written updated version of the Trust’s Patient Experience Strategy covering 2016 – 2019. It was noted that a Service User Involvement Strategy was also in the process of being updated and would clearly link to the Trust’s Clinical Strategy. The Committee had also received a report for Camden Healthwatch and was pleased to note improved relations with that organisation.

16.01.043 Approved minutes from meeting on 19 January 2015

These minutes were taken as read.

The Board of Directors RECEVED and ACCEPTED the presented briefing and approved minutes from the Quality Committee.

OTHER BUSINESS




No specific new risks were identified but the Audit & Risk Committee would consider the potential of the new junior doctors’ contract and the NHS Improvements caps on agency expenditure at its next meeting to give further thought as to whether either issue presented any new risks for the Trust.


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……………………………..…… …………………….





Convey the Board’s thanks to all Trust staff for their hard work over the last financial year in providing quality services and managing their financial budgets.

The Board’s acknowledgement of the March increase in demand for beds and the additional pressure that this had placed on staff.

The Board’s receipt and approval of an updated Workforce Strategy and its commitment to improving the experience of all staff engaged at the Trust.

The Board’s agreement, and support for, the received updated Membership Strategy.

Mr Monteith


28 April 2016.

16.01.048 CLOSE


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