trust board monday, 28 november 2016 at 1 us/board papers... · monday, 28 november 2016 at 1.00pm...

Trust Board

Monday, 28 November 2016 at 1.00pm

Lecture Theatre, St Ann’s Hospital, St Ann’s Road, London, N15 3TH

A G E N D A

(Meeting of the Trust Board held in public)

Time Item Number

Agenda Item Page Number

Lead

1.

General Business

1.00 1.1 Chairman’s welcome

Verbal Michael

Fox

1.02 1.2

Apologies for Absence Verbal Michael Fox

1.04 1.3 Declarations of Interest and of any Conflicts of Interest

To review the attached Summary of Board Members’ declarations of interest and to declare at the meeting any conflicts.

Verbal Michael Fox

1.05 1.4 Minutes of the Board Meeting held on 26 September 2016 To confirm the minutes of the last meeting as a true record.

Michael Fox

1.08 1.5 Matters arising from the Minutes To review progress set out in the attached written report and to discuss any other matters raised by Board Members.

Page 15

Michael Fox

1.10

1.6 Patient Focus – “Establishing A ‘Pets As Therapy Group’ - The Impact on a Service User’s Experience in The Magnolia Unit”

Verbal Mary Sexton

1.40 1.7 Chairman’s Report To receive the Chairman’s verbal report.

Verbal Michael Fox

1.45 1.8 Chief Executive’s Report To receive an update on Trust matters.

Page 19

Maria Kane

Time Item Number


Lead

2.00 1.9 Chief Operating Officer / Executive Director of Patient

Services’ Report To receive an update on Operational matters.

7

Andy Graham

2.

Risk and Performance

2.10 2.1 Board Assurance Framework

To consider the Board Assurance Framework.

To Follow

Barry Ray

2.20 2.2 Integrated Quality and Performance Report To review the Integrated Quality and Performance.

Page 35

Andy Graham

2.30 2.3 Financial Performance: Month 7 (October 2016) To receive an update on recent financial performance.

Page 43

Simon Goodwin

3. Quality and Safety

2.40 3.1 Clinical, Quality and Safety Report

To receive an update on Clinical, Quality and Safety matters.

Page 59

Mary Sexton

2.50 3.2 Safe Staffing Levels To note the Safe Staffing Levels report and the actions being taken.

Page 73

Mary Sexton

4. Governance and Assurance

3.00 4.1 North Central London (NCL) Sustainability and

Transformation Plan (STP) To note an update on the North Central London Sustainability and Transformation Plan.

Page 95

Maria Kane

3.10 4.2

Medical Director’s Report To receive an update on Medical matters.

Page 111

Jonathan Bindman

3.15 4.3

Annual Review of Standing Orders, Standing Financial Instructions and Scheme of Delegation To approve revisions to the Trust’s Standing Orders, Reservation of Powers to the Board and Delegation of Powers, and Standing Financial Instructions.

Page 115

Barry Ray

Time Item Number


Lead

5.

Annual Reports

3.20 5.1

Annual Workforce Report To note the annual report providing details of key workforce indicators and performance.

Page 125

Mark Vaughan

3.30 6. Other Items

6.1

Any Other Urgent Business

The Chairman will be asked to consider any other urgent business which he has been previously notified of in advance of the meeting, but which has not been provided for on the agenda.

6.2

Date and Time of Next Meeting

Monday, 30 January 2016 at 1.00 pm Lecture Theatre, St Ann's Hospital Reports scheduled for consideration at the next meeting, include: • Chairman’s Report • Chief Executive’s Report • Chief Operating Officer’s Report • Board Assurance Framework • Integrated Performance Dashboard • Financial Performance • Clinical, Quality and Safety Report • Safe Staffing Report • Medical Director’s Report • Equality and Diversity Annual Report

7.

Exclusion of the Press and the Public

To resolve that representatives of the press and other members of the public be excluded from the remainder of the meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest (Section 1(2) Public Bodies (Admission to Meetings) Act 1960).

Michael Fox Trust Chairman

BOARD OF DIRECTORS’ REGISTER OF INTERESTS

Board Member:

Interest Declared:

Michael Fox Trust Chairman

• None.

Jonathan Bindman Medical Director

• Married to a GP currently working in Newham Community Services, managed by East London Foundation Trust and undertaking locum work in Tower Hamlets.

• Unpaid adviser to Raphael, a Jewish counselling service based in Barnet.

Frank Devoy Non Executive Director

• Director and shareholder of Building Change Ltd, a strategic real estate consultancy (no previous or expected work with the NHS).

• Director and shareholder of Waverley Investments Ltd, a property developer.

• Wife is a Community Pharmacist.

Paul Farrimond Non-Executive Director

• Director of P.F. Consultancy Ltd. • Trustee of Together (a mental health charity). • Specialist Advisor on Mental Health for NHS Providers • Member of the Care Quality Commission’s (CQC) Mental Health Act

External Advisory Group. • Member of the CQC’s Deprivation of Liberty Safeguards Advisory Group. • Member of the CQC’s review of how NHS Trusts investigate and learn

from deaths expert advisory group.

Simon Goodwin Chief Finance and Investment Officer

• Married to a senior manager at East London NHS Foundation Trust.

Andy Graham Executive Director of Patient Services

• Partner is a Director at InHealth, which provides diagnostic services to the NHS.

Cathy Hamlyn Non-Executive Director

• Executive Associate Director in Nudge Associates (provision of consultancy services to the NHS and local authorities in relation to sexual health; HIV and in addressing sexual violence).

• Chair of MEDFASH (Medical Foundation for AIDS and Sexual Health). • Member of the Labour Party.

Rebecca Harrington Non-Executive Director

• Sole owner of Rebecca Harrington Ltd (intended provision of services to the NHS – none at present).

• Chair at The Maya Centre, providing free psychological support for women.

• Chair of the NICE Guideline Development Group for Transitions between Inpatient Mental Health Care and Residential and Community Placements.

• Partner is Consultant Psychiatrist at Camden & Islington NHS Foundation Trust and Professor at University College London.

• Partner appointed to the Care Quality Commission as National Adviser on Rehabilitation Psychiatry.

Board Member:

Interest Declared:

Dr Christine Harvey Non-Executive Director

• None.

Catherine Jervis Non-Executive Director

• Non Executive Director for First Community Health and Care, a not for profit company providing community health services (primarily to the NHS) in East Surrey.

• Trustee and Treasurer for First Community Trust (supporting the provision of health and social care in Surrey).

• Advisor to CEO for Achievement for All, a national education charity providing services to schools and other educational settings in collaboration with partners from the health field (e.g. Place2Be and Young Minds).

Maria Kane Chief Executive

• Trustee (unremunerated) of Young Minds (a small national charity supporting better mental wellbeing for children and young people).

• Member of Information Committee of Lullaby Trust. • Stake Holder Member (unremunerated) to the Health Education England

London and South East Local Education and Training Board

Mary Sexton Executive Director of Nursing, Quality and Governance

• Honorary Clinical Professor, Middlesex University. • Clinical and Professional Advisor, CQC.

Mark Vaughan Executive Director of Workforce

• None.

Charles Waddicor Non-Executive Director

• Director / Owner of SAMRO health and social care solutions • Trustee of The Primary Care Respiratory Society UK. • Mental Health Clinical Advisor to the care Quality Commission. • Small shareholding in Ventura Group. • Chair of a Board, operated by Social Finance, overseeing projects running

in Haringey, Tower Hamlets, and Staffordshire, supporting people with mental health problems into employment.

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BEH-MHT – Trust Board – 28.11.2016 1.4 – Minutes of the Board Meeting – 26 September 2016

Minutes of the Board Meeting held on Monday, 26 September 2016 in the Lecture Theatre, St Ann’s Hospital, St Ann’s Road, London, N15 3TH

The meeting commenced at 1.00 pm and closed at 3.19 pm

Present: Michael Fox Trust Chairman Maria Kane Chief Executive Jonathan Bindman Medical Director Frank Devoy Non-Executive Director Paul Farrimond Non-Executive Director Simon Goodwin Chief Finance and Investment Officer Andy Graham Executive Director of Patient Services Cathy Hamlyn Non-Executive Director Rebecca Harrington Non-Executive Director Christine Harvey Non-Executive Director Catherine Jervis Non-Executive Director Mary Sexton Executive Director of Nursing, Quality and Governance Mark Vaughan Executive Director of Workforce Charles Waddicor Non-Executive Director In attendance:

Barry Ray Trust Board Secretary Suchi Bhandari Consultant Clinical Psychologist (For Minute Item 1.6 only) Fatima Bibi Clinical Psychologist / Project Lead, MAC-UK (For Minute Item 1.6 only) Derek Service User (For Minute Item 1.6 only) Ken Service User (For Minute Item 1.6 only) Mandy Stevens Improvement Director (Observing) Phil Evans Turnaround Director (Observing) Item No.

Minute Item Actions

1.

General Business

1.1 Chairman’s Welcome Michael Fox welcomed everyone to the meeting, including Mandy Stevens and Phil Evans who were attending their first Trust Board meeting.

1.2 Apologies for Absence Apologies for absence were received from: Paul Farrimond, Non Executive Director

1.3 Declarations of Interest and Declarations of any Conflicts of Interest The Trust Board agreed to note that there were no conflicts of interest declared in relation to items on the agenda.

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1.4 Minutes of the Meeting held on 18 July 2016 The Board confirmed the minutes of the last meeting as a true record.

1.5

Matters Arising from the Minutes of the Meeting held on 18 July 2016 The Board noted the written report on matters arising and accepted the updates.

1.6

Patient Focus – Project Future Suchi Bhandari introduced a presentation which outlined the work of Project Future. Project Future is a Tottenham based integrated mental health and well-being service working with young men that are often labelled as “socially excluded”, “offenders” and “gang affiliated”. Project Future is partnership between the Trust, Haringey Council, MAC-UK (a mental health charity), and is supported by other partners such as the police and probation service at a strategic level. Suchi Bhandari advised that Project Future started in 2012 when the Trust and MAC-UK made a joint bid to the Big Lottery Fund, and won funding of £1.6 million for three years (2014 to 2017). The aims of the project are to increase access into education, employment or training, improve physical and emotional wellbeing, increase access to services, improve stability, and to reduce offending. Suchi Bhandari informed that Project Future was based on MAC-UK’s INTEGRATE model, and was youth led and co-produced with the young people it serves. Mental health is placed at the heart of the project ensuring that a psychologically informed approach is used in all activities. Project Future employs Community Consultants; these roles are intended to enable young people to share their expertise, whilst developing their employability skills in a nurturing environment. Project Future operates on a peer referral system, with Community Consultants encouraging their friends and peers to attend. The Trust Board was advised that the Centre for Mental Health were part way through an evaluation of the impact that Project Future has had. The key findings from an interim report produced in June 2016 highlighted: Engagement and Help-Seeking – through peer referral, 124 young people

have been in contact with the project since starting in March 2015. Approximately 40 young people engage meaningfully with the project each month.

Mental and Emotional Well-Being – a clinician-rated measure, that assesses severity of need relating to mental well-being, has seen a statistically significant reduction, with the biggest change relating to psychological, social and survival needs.

Education, Employment and Training (EET) – 29 out of the 124 young people were now access accessing EET.

Offending – Project Future will be seeking consent to access offending data, although there was a perception amongst young people and several community stakeholders that the severity and frequency of offending has reduced.

Suchi Bhandari highlighted that the original funding for Project Future was in the final year, and that work was being undertaken to sustain the work of the project through seeking funding from a range of sources, including the Big Lottery Fund.

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Derrick and Ken, two service users, addressed the Trust Board and outlined the help and support that Project Future had given to them. Ken advised that he had successfully obtained a Building apprenticeship as a result of engagement with Project Future. In response to a question from Charles Waddicor, Fatima Bibi highlighted that young people with mental health issues may lose trust in officials through poor experiences. Instead, they turn to their peers for support. Project Future aims to utilise Community Champions for peer referrals to the project. In response to a question from Mark Vaughan, Suchi Bhandari advised that staff were acutely aware of the need to seek additional funding to sustain Project Future and that independent evaluation of the project would help in this regard. The London School of Economics has been asked to assist in evaluating the economic value of the project, such as reduction in the need for engagement with the police, probation service, etc. Michael Fox noted that staff and service users from Project Future provided a display at the Trust’s Annual General Meeting on 19 September. He commented that he was impressed with the way in which Project Future has had a positive impact on the young people’s lives. The Trust Board agreed to note the Patient Focus on Project Future.

1.7

Chairman’s Report Michael Fox advised that he had recently attended a NHS Providers event for Trust Chairman, at which the main topic of discussion was the financial position of the NHS as a whole, which was expected to be a deficit in the region of £0.6bn by the end of the financial year. Those attending the event expected this figure was likely to get worse. Discussion also included the work being undertaken by NHS Improvement to support Trusts and issues affecting those Trusts that have not signed up to their Control Totals. Simon Goodwin clarified that the figure of £0.6bn for the NHS as a whole follows a recent injection of £1.8bn towards transformation funding. Michael Fox stated that he undertakes regular visits to services and was pleased to note that staff continue to look at ways to innovate in order to improve services despite the financial constraints. The Trust Board agreed to note the Chairman’s verbal report.

1.8 Chief Executive’s Report Maria Kane presented her report on Trust Matters and highlighted the following: The Trust held its Annual General Meeting (AGM) on 19 September. The

meeting was attended by around 70 service users, carers, staff and representatives from a number of stakeholders.

Mehdi Veisi has been appointed as the new Clinical Director for Specialist Services.

The North Central London (NCL) sector submitted its Sustainability and

Transformation Plan (STP) to NHS England on 30 June 2016. The STP

Page 3


summarised the high level plans developed jointly across Barnet, Camden, Enfield, Haringey and Islington to improve the health and wellbeing of local residents and the care that they receive.

The Trust has appointed Phil Evans as Turnaround Director from 1 August

2016. Phil Evans will be assisting the Trust to focus on financial improvement activity, alongside work to improve the quality of Trust services being led by Mandy Stevens.

The Trust has appointed Salford Royal NHS Foundation Trust as the Trust’s

Improvement Partner, to teach Trust staff how to use their world renowned continuous improvement methodology called ‘Haelo’. The partnership will see the launch of improvement programmes across the Trust to not only improve the quality of healthcare, but also build momentum, resilience and capability among staff to help them continue and embed a culture of improvement.

The Trust has three services shortlisted for four awards at the HSJ Awards,

which celebrates excellence in UK healthcare. The shortlisted projects are: o Enablement – Helping people have a life beyond diagnosis. o Care Homes Assessment Team (CHAT) - Improving the lives, and

deaths, of residents in Care Homes through Learning and Development.

o Project Future - a community based, youth led mental health project that works with socially excluded young men aged 16-25 involved in gangs, offending and serious youth violence.

The Trust was hosting the 11th International Conference on Terrorism,

Extremism and Mental Health Services at Queens’ College, Cambridge on Monday, 26 September and Tuesday, 27 September. The conference was aimed at mental health professionals, counter-terrorism practitioners and academics in terrorism studies.

The North and North East London Liaison and Diversion Trial Site, a major service jointly delivered by the Trust, Together for Mental Wellbeing, East London NHS Foundation Trust, and North East London NHS Foundation Trust, has won the ‘Liaison and Diversion’ category at the Howard League Community Awards, which recognise the country’s most successful community projects encouraging desistance from crime.

Over the summer, the following staff were recognised as employees of the

month: o June - Faye Bailey, a Health Visitor Assistant working at Moorfield

Health Centre in Enfield. o July - Adrienn Hanko, a Health Care Assistant on Devon Ward,

Chase Farm Hospital. o August - Bronwyn Roane, an Occupational Therapist for Enfield

Community Services, and Bina Kanabar a Receptionist and Administrator for Enfield Adult Acute Services.

Maria Kane also informed the Board about the following matters: The Trust featured in a Panorama programme entitled ‘Britain’s Mental

Health Crisis’ which has been shortlisted in the Mind Media Awards in the ‘Documentary’ category.

Page 4


The Staff Survey has been launched. The Trust will be looking at a range of methods to ensure as many staff as possible submit a response.

All Trusts were due to receive Planning Guidance, in respect of the 2017 /

2018 contract round, by the end of September. There was an expectation that Trusts would be given a Control Total and that the NCL sector would also be given a Control Total.

In response to a question from Frank Devoy, Michael Fox stated that there was currently no clear legal framework and accountability for the STP process. Simon Goodwin advised that the purpose of a sector wide Control Totals would enable Trust’s to reallocate Control Totals within the sector as long as the overall Control Total was achieved. The Trust Board agreed to note the Chief Executive’s report.

1.9 Executive Director of Patient Services’ Report Andy Graham presented the Executive Director of Patient Services’ report and highlighted the following: Adult Mental Health Pathway Review – each Borough has been asked to

consider plans to redesign the adult care pathway, supported by the Project Management Office and quality improvement work that the Trust has commissioned.

Increasing Activity – a Trust wide group has been working on ways to

increase recorded activity including making changes to RiO to make recording easier, intensively working to support local staff groups and a programme of communications titled ‘be recognised for what you do’. As at August the Trust was seeing a 30% increase in activity being recorded. Initial indications for September indicated a 20% increase in activity compared to the same month in 2015, despite recent IT outages.

Catherine Jervis expressed her concern about the Adult Mental Health Pathway Review resulting in different models in each Borough. Andy Graham advised that whilst a single solution would be preferable there was a need to ensure ownership in the delivery of the revised pathways in each Borough. A Peer Review process was being used to allow each Borough to learn from and challenge each other’s plans. Maria Kane referred to the work being undertaken to record activity and highlighted that increased activity recording would be a key factor in the contract round discussions with commissioners. The Trust Board agreed to note the Executive Director of Patient Services’ report.

2. Risk and Performance

2.1

Board Assurance Framework Barry Ray introduced a report which presented the Board Assurance Framework (BAF), which identifies the risks faced by the Trust in meeting the Trust’s objectives for 2016 / 2017.

Page 5


Barry Ray highlighted that the BAF incudes 12 identified risks, of which two have increased in score (1.1.1 and 1.1.2) and one risk had decreased in score (3.1.11). The BAF therefore had four risks that are rated as ‘high’ with eight risks rated as ‘moderate’. Three risks have achieved their respective tolerable risk score. Christine Harvey highlighted that the ‘Rationale for current score’ for several risks did not provide enough information, especially for those risks which had increased in score. Board members requested that the ‘Rationale for current score’ for each risk be more clearly articulated in future iterations. In response to a query from Charles Waddicor, Simon Goodwin agreed to amend Risk 3.1.8 – ‘If the Trust fails to deliver the Trust’s Budget for 2016 / 2017 the Trust will not be able to meet its Control Total or be financially sustainable going forward, in order to provide clarification regarding the risk. Charles Waddicor reported that the Trust was still on target to achieving the Trust’s agreed budget position of a deficit of £12.6m. Simon Goodwin confirmed that the Trust Board would be informed if there were any material risk to achieving the budget position. Catherine Jervis requested an update in respect of Risk 3.1.9 – ‘If the Trust does not manage its Liquidity position then the Trust will not be able to pay its creditors and staff’. Simon Goodwin advised that the Trust had obtained a loan which had delayed the need to secure financial support from NHS Improvement. NHS Improvement has also indicated that the Trust could access financial support despite the Trust’s current position in respect of the Control Total. The Trust Board agreed: 1. To note the content of the Board Assurance Framework for 2016 / 2017. 2. That the ‘Rationale for current score’ for each risk is more clearly

articulated. 3. That Risk 3.1.8 – ‘If the Trust fails to deliver the Trust’s Budget for 2016

/ 2017’ be reviewed.

Executive Leads Simon Goodwin

2.2

Integrated Quality and Performance Report Andy Graham presented the Integrated Quality and Performance Report for 2016 / 2017. The report shows performance against targets set by NHS Improvement and other quality and performance targets. Andy Graham highlighted that as a result of improvements to pathways for referrals to the Early Intervention in Psychosis (EIP) service there had been a cumulative increase in caseloads. He highlighted that there had also been an increase in the number of patients that had not engaged with the service, which had the potential to affect the time to treatment indicator. Andy Graham informed that the Child and Adolescent Mental Health Service (CAMHS) waiting list remains high in Enfield, following reductions in funding from Enfield Council. Did Not Attend (DNA) rates are also high in CAMHS, although the spike compares favourably to last August when It peaked at 14%. Recording appointments further in advance, which will allow more time for reminder text messages to be sent, is expected to improve the position moving forwards.

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Christine Harvey queried the ‘Agency as a % of Employees’ and Bank as a % of Employees’ targets. Mark Vaughan agreed to review and amend the targets. The Trust Board agreed to note the Integrated Quality and Performance Reports for the year-to-date performance for 2016 / 2017, subject to the targets for ‘Agency as a % of Employees’ and Bank as a % of Employees’ being reviewed and amended as necessary.

Mark Vaughan

2.3

Financial Performance: Month 5 (August) 2016 Simon Goodwin presented a report providing an update on the year to date financial performance. The report highlighted the current position in respect of the Trust’s Income and Expenditure, Cost Improvement Programme (CIP), Balance Sheet, Cash Flow, Capital Expenditure, and the Financial Risk Rating. Simon Goodwin highlighted the following: At the end of Month 5, the Trust’s financial performance was a deficit of

£5,634k against a planned deficit of £5,081k, an adverse variance of £553k.

The key areas of risk to the achievement of the forecast deficit are the continued use of private beds, continuing high expenditure on agency staff, additional costs associated with addressing issues identified in the CQC inspection report, increased costs from the implementation of the new Junior Doctors contract and slippage on existing Cost Improvement Plans.

Charles Waddicor highlighted discussions at the recent meeting of the Finance and Investment Committee. He stated that the Committee had considered the various risks to achieving the Trust’s budget, and that the biggest risk was the increased use of private sector beds over and above the monthly planned figure. The Trust Board agreed to note the year-to-date financial performance for 2016 / 2017.

3. Quality and Safety

3.1

Clinical, Quality and Safety Report Mary Sexton presented a report which provided an indication of the Quality and Safety of the Trust’s services. Mary Sexton highlighted the following issues: There has been a Care Quality Commission (CQC) Mental Health Act

(MHA) visit to the Ken Porter Ward on 30 August 2016. Initial feedback was positive. The formal report has yet to be received by the Trust.

Work continues across all Trust services to deliver the agreed actions set out in the Quality Improvement Plan to address the ‘Must Do’ and ‘Should Do’ actions following the CQC Comprehensive Inspection in November 2016. As at 12 August, there were 45 ‘Must Do’ actions of which 6 were rated as red, 20 as amber and 19 as green. There were 108 ‘Should Do’ actions of which 34 were rated as red, 37 as amber and 37 as green. There was limited assurance that the Trust would be able to achieve delivery of the actions set out in the Quality Improvement Plan.

The CQC and NHS England have been kept informed of progress in discussions with the three local Clinical Commissioning Groups to secure

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funding to address four of the key actions in the Quality Improvement Plan. The Flu Vaccination Campaign for 2016 / 2017 has commenced. The Trust

has put in place arrangements to achieve the target of vaccinating 75% of staff.

The Patient Led Assessment of the Care Environment (PLACE) scores have

been published. The overall Trust scores in each category assessed were above the overall national average scores. The lowest scores were for services located at St Ann’s Hospital and in the main related to the accommodation.

The Integrated Safeguarding Committee (ISC) is now established and

provides strategic leadership to ensure safeguarding children, young people and adults remains a high priority across the Trust. The ISC endeavours to ensure there is a whole organisational approach to safeguarding and promoting the welfare of children, young people and adults and that this is embedded across all Boroughs and services provided by the Trust, and in every aspect of the Trust’s work. The ISC will hold services to account to ensure effective and robust safeguarding practice.

The Trust’s Preceptorship and Mentorship Lead and Preceptorship and

Mentorship Co-ordinator have brought about significant improvements including revisions to the Perceptorship Policy, simplification of the Triennial Review process, and revisions to the Trust’s ‘live’ Mentor Register.

In response to a question from Maria Kane, Mary Sexton advised that there was very little evidence that the flu vaccination programme reduces sicknesses absence levels in staff over the winter period. Charles Waddicor noted that the Trust had attracted a number of newly qualified nurses to the Trust and asked how this would impact on the Trust’s reliance on agency staff. Mark Vaughan commented that agency staff were employed on a shift basis and therefore it was not possible to articulate the number of agency shifts that would be reduced through the appointment of new staff. Mary Sexton highlighted that there would be a delay between when the newly qualified staff would start to be employed at the Trust and when they would receive their professional registration numbers, although there would be a reduction in the number of agency staff employed as Health Care Assistants in September and October. The Trust Board agreed to note the Clinical, Quality and Safety report.

3.2

Safe Staffing Levels Mary Sexton presented a report which provided an overview of nurse staffing for the Trust’s inpatient wards for July and August 2016. The data demonstrates both the planned and actual level of staffing achieved for each ward as well as a range of Quality, Safety and Patient Experience indicators across wards where the Trust is reporting Safe Staffing data, in order to give assurance of staffing impact against patient safety indicators. Mary Sexton highlighted the following: Overall, the wards have met their planned number of hours worked for

registered and care support staff; they continue to address the challenge of securing staff at times with the use of temporary staff, at times of an

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opposite grade. In Barnet, Avon, Thames and Trent wards have significantly high vacancy

rates that have remained unchanged across July and August 2016. Ken Porter ward’s vacancy rate has reduced but remains high at 18.5% for August 2016.

In Enfield, there continues to be high levels of sickness rates in the inpatient

wards, although there was some improvement from July to August 2016 in all wards except Dorset ward, The Oaks and Silver Birches, which have increased over the same period.

In Haringey, Haringey ward has maintained improvement in respect to

vacancies, although significant vacancies remain for Finsbury and Haringey wards for the period July to August 2016. Sickness rates have increased for Haringey and Fairland wards from July to August 2016. Finsbury ward has the highest sickness rate within Haringey at 13.6% in both July and August 2016.

Vacancy rates continue to maintain and/or improve across the wards within

the Specialist Services, with the exception of Fennel ward where they have increased from July to August 2016. There is an unsettled position in Specialist Services wards which has resulted in increased use of 1-2-1 monitoring. The Beacon Unit vacancies are significant at 23.2%.

Mark Vaughan highlighted that the overall vacancy rate has come down from 13% to 9%. In response to a question from Catherine Jervis, Mark Vaughan confirmed that the Trust was undertaking recruitment activity to address vacancies in community services. Mary Sexton advised that the roll out of the SafeCare module of the e-rostering software package would assist the Trust in having real time data in relation to staffing levels across the Trust. The Trust Board agreed to note the information combined in the report and the actions being taken to ensure all in-patient wards are safely staffed.

4.

Governance and Assurance

4.1

Freedom to Speak Up – Changes to Arrangements in Raising and Handling Staff Concerns Mark Vaughan presented a report which outlined changes required to the way in which staff are able to raise concerns. The report set out proposals for appointing a Freedom to Speak Up (FTSU) Guardian and the proposed approach to raising awareness of the revised process within the Trust. Mark Vaughan highlighted that the Trust’s Whistleblowing Policy was updated in 2015 and renamed as “Raising Concerns at Work Policy”. This reflected the emerging role of the FTSU Guardian, required in every Trust in England. Over the past year, Mary Sexton, Executive Director of Nursing, Quality and Governance, has fulfilled the role of the FTSU Guardian. The current arrangements are neither sufficient nor compliant with national guidance requiring an independent person to be appointed as the FTSU Guardian by the deadline of 1 October 2016.

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Mark Vaughan advised that there had been discussions about the Trust’s approach to appointing a FTSU Guardian which have been inconclusive. The report was therefore recommending that the Executive Director of Nursing, Quality and Governance continues to fulfil the role of FTSU Guardian until 31 December by which time the Trust will need to fill the role on a permanent basis. Board members noted a proposal to appoint a Non Executive Director as the independent FTSU Guardian and expressed concerns regarding the amount of time required to undertake the role. Mary Sexton advised that it was envisaged that the appointed FTSU Guardian would be supported to undertake their role. Frank Devoy requested a breakdown of the number and types of concerns that have been raised by staff in order to get a better understanding of the time impact. The Trust Board agreed: 1. That the Executive Director of Nursing, Quality and Governance

continues to fulfil the role of Freedom to Speak Up Guardian until 31 December in order to allow the Trust further time to review options to fill the role on a permanent basis.

2. To receive a further report providing at the next Trust Board meeting

providing a breakdown of the concerns raised by staff.

Mark Vaughan / Mary Sexton

Mark Vaughan / Mary Sexton

4.2

Medical Director’s Report Jonathan Bindman presented a report providing an update on the work of the Medical Director and his direct reports. He highlighted the following: Planned strike action by junior doctors in October, November and December

have been suspended. The Trust has plans in place, based on previous strikes, to manage services should the strikes go ahead.

As a result of the claimed rota breaches in the Senior Trainee (ST) rotas the

Trust has moved to a new form of rota for ST doctors - a ‘24 hour partial shift rota’, based on a template also in use in Camden and Islington Foundation Trust (where trainees also work on rotation).

Since the last meeting, visits have been undertaken to the Estates

Department (to discuss clinical input into plans for the redevelopment of the St Ann’s Hospital site and to gain Estates input to the Smokefree plans), Enfield Community Services operating at St Michael’s (to discuss opportunities for further links between perinatal mental health and health visitors in Enfield), to the Psychiatric Intensive Care Unit (PICU) on Avon Ward, as well as Thames Ward, Trent Ward and the Barnet Assessment and Crisis Resolution Teams.

The Trust wide Smokefree Implementation Group continues to make

progress toward the Trust going smoke free on 17 January 2017. The Trust Board agreed to note the Medical Director’s report.

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4.3 Medical Revalidation Annual Report Jonathan Bindman presented a report providing the Board with assurance in relation to its role as a ‘designated body’ for the purpose of medical revalidation. The report outlined the processes for ensuring appraisal and revalidation of doctors, the associated processes for managing concerns in relation to medical practice, and sought approval for the Chairman to sign the ‘Statement of Compliance’ confirming that the Trust, as a designated body, is in compliance with ‘The Medical Profession (Responsible Officers) Regulations 2010 (as amended in 2013)’. In response to a question from Mark Vaughan, Jonathan Bindman advised that the Medical Revalidation process has ensured that all doctors go through the appraisal process. Catherine Jervis asked for an update on Nursing Revalidation. Mary Sexton advised that, of the recent cohort to go through the revalidation process, all but one nurse had been successfully revalidated, and that the nurse in question did not require revalidation for their current role. The Trust Board agreed: 1. To note the Medical Revalidation Annual Report. 2. To note the Medical Revalidation Annual Report will be shared with Dr.

Mitchell, the Higher Level Responsible Officer (HRLO) for the London Region, and the NHS Revalidation Team.

3. To note the HRLO Visit report (external quality assurance) and the

subsequent action plan. 4. That the Chairman sign the ‘Statement of Compliance’ (Appendix D to

the report) confirming that the Trust, as a designated body, is in compliance with ‘The Medical Profession (Responsible Officers) Regulations 2010 (as amended in 2013)’.

Jonathan Bindman Michael Fox

4.4 Pharmacy Annual Report Jonathan Bindman presented a report providing an update on the progress made on the Pharmacy Strategy 2015 / 2020, and actions for the coming years. The report advised that a number of objectives have been achieved and some are in the process of being progressed further or being embedded into practice. Jonathan Bindman highlighted the following main points: The need to undertake a comprehensive review of the Service Level

Agreement of pharmacy services provided by the Royal Free London Hospital Trust.

Progress with the pharmacy service redesign which has allowed more pharmacy technicians and assistants to take on roles traditionally provided by pharmacists.

The Trust’s experience in trialling the electronic prescribing and administration system attached to “Open Rio” and the current planned way forward.

Current engagement and further opportunities for collaborative work with other pharmacy services across the North Central London sector.

Page 11


In response to a question from Michael Fox, Jonathan Bindman confirmed that GPs were the main prescribers of medication and that there were shared care protocols in place to facilitate close working with GPs. In response to a question from Rebecca Harrington, Jonathan Bindman confirmed that the Trust’s website was part of a package being developed to help patients to enable them to better understand the medication they were being prescribed. Andy Graham commented that the he had undertaken a number of visits to wards and on each occasion ward staff had highlighted the improvements as a result of positive engagement from pharmacy staff. The Trust Board agreed to note the update on progress in achieving the Pharmacy Strategy 2015-2010, and the Pharmacy Strategy Action Plan.

4.5 Freedom of Information Annual Report Barry Ray presented a report which provided an update in relation to the Trust’s Freedom of Information (FOI) Act activity during the 2015 / 2016 financial year. The report informed that the total number of information requests received under FOI between 1 April and 2015 and 31 March 2016 was 280 and that 97% of requests were dealt with within the statutory timeframe of 20 working days, compared to 263 requests and 95% in 2014 / 2015. Board members requested that future reports include benchmarking data in order to compare year on year performance as well as performance against neighbouring Trusts. Mary Sexton requested details of gaps in the Trust’s publication scheme against the Information Commissioner’s Office’s model publication scheme. The Trust Board agreed: 1. To note the work being carried out in order to comply with the Freedom

of information Act 2000. 2. That details of gaps in compliance with the Information

Commissioner’s Office Publication Scheme be provided to Mary Sexton.

3. That future reports incorporate benchmarking data, in order to

compare year on year performance as well as performance against neighbouring Trusts where available.

Katia Louka Katia Louka

4.6 Information Governance Mid-Year Toolkit Review Barry Ray presented a report which provided an update in relation to information governance processes and procedures within the Trust, and highlighted areas of concern. The report highlighted the work being undertaken in respect of the Information Governance Toolkit, that there have been no level two (significant) incidents reported to date in the current financial year, and that compliance with Information Governance training was at 72.85% against a target of 95%. Mark Vaughan highlighted that the Trust was looking at ways to improve compliance with Information Governance training, through making training more user friendly.

Page 12


Board members requested that future reports include benchmarking data in order to compare year on year performance as well as performance against neighbouring Trusts. The Trust Board agreed: 1. To note the Information Governance Mid-Year Toolkit Review report. 2. The Action Management Plans set out in the report.

3. That future reports incorporate benchmarking data, in order to compare year on year performance as well as performance against neighbouring Trusts where available.

Doreen Todd Doreen Todd

5. Other Items

5.1

Any Other Urgent Business None.

5.2 Date and Time of Next Meeting The Board agreed to note the schedule of reports for consideration at the next meeting.

6.

Exclusion of the Press and the Public

The Board resolved that representatives of the press and other Members of the public be excluded from the remainder of the meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest (Section 1(2) Public Bodies (Admission to Meetings) Act 1960).

Page 13


Page 14

BEH-MHT – Trust Board – 28.11.2016 1.5 – Matters Arising from the Minutes 26.09.2016

Matters Arising from the Minutes of the Trust Board Meeting held on 26 September 2016 Minute no.

Action Action by Current Status

2.

Risk and Performance

2.1

Board Assurance Framework 1. That the ‘Rationale for current score’ for each risk is more

clearly articulated. 2. That Risk 3.1.8 – ‘If the Trust fails to deliver the Trust’s Budget

for 2016 / 2017’ be reviewed.

All Executive Leads Simon Goodwin

} } Report scheduled for consideration on 28 } November 2016. }

2.2

Integrated Quality and Performance Report To amend the targets for ‘Agency as a % of Employees’ and Bank as a % of Employees’ as necessary.

Mark Vaughan Completed.

4.

Governance and Assurance

4.1

Freedom to Speak Up – Changes to Arrangements in Raising and Handling Staff Concerns 1. That the Executive Director of Nursing, Quality and

Governance continues to fulfil the role of Freedom to Speak Up Guardian until 31 December in order to allow the Trust further time to review options to fill the role on a permanent basis.

2. To receive a further report providing at the next Trust Board

meeting providing a breakdown of the concerns raised by staff.

Mark Vaughan / Mary Sexton Mark Vaughan / Mary Sexton

} } } Report scheduled for consideration on 28 } November (Part 2). } } } }

Page 15


Minute no.


4.3 Medical Revalidation Annual Report 1. To note the Medical Revalidation Annual Report will be shared

with Dr. Mitchell, the Higher Level Responsible Officer (HRLO) for the London Region, and the NHS Revalidation Team.

2. That the Chairman sign the ‘Statement of Compliance’

(Appendix D to the report) confirming that the Trust, as a designated body, is in compliance with ‘The Medical Profession (Responsible Officers) Regulations 2010 (as amended in 2013)’.

Jonathan Bindman Michael Fox

Completed. Completed.

4.5

Freedom of Information Annual Report 1. That details of gaps in compliance with the Information

Commissioner’s Office Publication Scheme be provided to Mary Sexton.

2. That future reports incorporate benchmarking data, in order to


Katia Louka Katia Louka

Completed. A comparison of performance for 2015 / 2016 and 2014/ 2015 was included in the report: During 2015 / 2016 the Trust received 280 requests with 97% dealt with within 20 working days. During 2014 / 2015 the Trust received 263 requests with 95% dealt with within 20 working days. Benchmarking information between Trusts is not currently available.

Page 16


Minute no.


4.6

Information Governance Mid-Year Toolkit Review 1. The Action Management Plans set out in the report. 2. That future reports incorporate benchmarking data, in order to


Doreen Todd Doreen Todd

In progress. Benchmarking data to be included in future reports where available.

Page 17


Page 18

BEH-MHT – Trust Board – 28.11.2016 1.8 – Chief Executive’s Report

Title:

Chief Executive’s Report

Report to:

Trust Board

Date:

28 November 2016

Security Classification:

Public Board Meeting

Purpose of Report: This is a regular report to the Board, intended to provide an update on recent Trust matters, since the last meeting held on 26 September, which include the following matters: Sustainability and Transformation Plan Strategy and Leadership Away Day Celebrating Excellence Awards Night Health Service Journal Awards (HSJ) 2016 World mental Health Day

Recommendations: The Trust Board is asked to note the update on recent Trust matters since the last Trust Board meeting. Sponsor:

Maria Kane, Chief Executive

Report Author:

Name: Maria Kane Title: Chief Executive Tel Number: 020 8702 3026 E-mail: [email protected]

Report History:

Regular Report

Budgetary, Financial / Resource Implications:

No particular matters to highlight

Equality and Diversity Implications:


Links to the Trust’s Objectives, Board Assurance Framework and / or Corporate Risk Register

The associated risks are managed through the Risk Register and Board Assurance Framework (see an item on this agenda)

List of Appendices:

None

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Report 1. Introduction 1.1 This report reflects Trust matters since the last Trust Board meeting held on 26 September. 2. Sustainability and Transformation Plan 2.1 The draft North Central London (NCL) Sustainability and Transformation Plan (STP), which

sets out plans for the future of health and social care across the five boroughs of Camden, Islington, Haringey, Barnet and Enfield, was published on 14 November 2016.

2.2 A summary of this document, designed to support public engagement and feedback, has also been published. Copies of the full submission and the summary document are available on the Trust’s website: http://www.beh-mht.nhs.uk/news-and-events/North-Central-London-Sustainability-and-Transformation-Plan.htm. A further report on the STP is attached as Agenda Item 4.1.

2.3 The Trust has been closely involved in the development of the STP, particularly the Mental Health Workstream. The STP Mental Health Workstream has made significant progress over recent months and has developed a clear and consistent plan for the development of mental health services across the NCL sector. This has involved input from NHS providers and commissioners, local authorities, and, importantly, service users, carers and the public. The Workstream has held three engagement events over the last nine months to seek views and input, including most recently on 14 October. Further engagement events are planned over the coming months, including greater engagement of staff.

2.4 The strength of the plans for mental health services in NCL and the degree of collaboration in developing them has been recognised by NHS England. The NCL mental health proposals within the October NCL STP submission were rated as the joint highest rated in England along with South East London and Cheshire & Merseyside as “Outstanding” by NHS England, reflecting the collaborative nature of the STP development and the fact that it is costed, which most mental health elements in STPs are not. The Trust has had significant input in developing the NCL mental health element of the STP and this gives a strong foundation to continue to develop local mental health services.

3. Strategy and Leadership Away Day 3.1 The Trust held a Strategy and Leadership Away Day for senior clinical and managerial

leaders across the Trust on 16 November 2016. The purpose of the Away Day was to review the Trust’s priorities for the year ahead in the context of the bigger picture across the wider NHS and the North Central London (NCL) health sector.

3.2 Guest speakers included: Steve Russell, NHS Improvement Executive Regional Managing Director (London), who

outlined the big issues across London and the wider NHS and what these mean for the Trust.

Maxine Power, Chief Executive of Haelo, Salford Royal Foundation Trust’s Innovation and Improvement Science Centre, who provided an outline of the Haelo Quality Improvement Programme

Claire Murdoch, Chief Executive of Central and North West London NHS Foundation

Trust, and NHS England Director for mental Health, who outlined current key policies affecting mental health.

Page 20

http://www.beh-mht.nhs.uk/news-and-events/North-Central-London-Sustainability-and-Transformation-Plan.htm



4. Financial Turnaround and Programme Management Office (PMO) 4.1 The Trust’s Enablement, Quality Improvement, and Financial Turnaround programmes are

working together seamlessly, with fortnightly meetings of the Improvement and Delivery Board providing oversight. This three pronged approach will help the Trust deliver better quality care to the people who use the Trust’s services and their families, and to do it more efficiently, whilst assisting the Trust’s financial position.

4.2 The PMO and Financial Turnaround team have been identifying, and ensuring sustainable plans are in place to deliver savings over the next three years, and wherever possible, making sure the necessary changes happen quickly. These include plans to reduce sickness absence, reducing the time it takes to hire new staff, and minimising agency usage, particularly for positions lasting more than three months.

4.3 The Trust has set better pay controls, developed a plan to improve finances in the long term, and is recruiting Trust staff to an organisation-wide PMO, which will ensure projects are effectively planned, implemented, tracked and evaluated.

5. Celebrating Excellence Awards Night 5.1 The Trust will be holding its annual Celebrating Excellence Awards Night on 1 December

2016. A record number of 329 nominations were received for 185 teams and individuals. The top three nominations in each of the eleven categories have been shortlisted. This year’s Awards Night will also feature the finals of the ‘BEH has got Talent’ competition.

6. Health Service Journal Awards (HSJ) 2016 6.1 As reported at the last Trust Board meeting, the Trust has three services shortlisted for four

awards at the HSJ Awards. The shortlisted projects are: Enablement - Helping people have a life beyond diagnosis.

Care Homes Assessment Team (CHAT) - Improving the lives, and deaths, of residents

in Care Homes through Learning and Development.

Project Future - a community based, youth led mental health project that works with socially excluded young men aged 16-25 involved in gangs, offending and serious youth violence. It is a partnership project with Haringey Council, MAC-UK and Metropolitan Police. This project has been shortlisted for two categories.

7. Her Majesty's Young Offenders Institute (HMYOI) Feltham 7.1 The Royal College of Speech and Language Therapists’ Sternberg Clinical Innovation

Award has been awarded to HMYOI Feltham. The award is shared jointly between the project’s partners the National Autistic Society (NAS), HMYOI Feltham and the Trust. The project involved developing and implementing standards across the prison to improve the identification and support of autistic people at Feltham.

7.2 The on-going project made changes across the prison to help autistic young offenders, who can be among the most vulnerable of the offender population. These changes included familiarising staff with autism, allowing autistic prisoners to use communal areas at quieter times and making reasonable adjustments to the building, such as creating areas with less clutter. Visual stimuli was reduced by removing posters and notices.

7.3 HMYOI Feltham recently became the first prison in the world to be awarded Autism Accreditation by NAS, after working with the charity to adapt its national accreditation programme to the prison environment. The charity is now hoping to roll the programme out

Page 21


more widely, by working with other prisons and young offender institutions to improve autism practice and ultimately lower reoffending rates.

7.4 The winners of the HSJ Awardswere announced at a ceremony on 23 November 2016 at the InterContinental O2. A verbal update will be provided at the meeting.

8. Dragon’s Den Update

8.1 Finsbury Ward Mosaic - Service users on Finsbury Ward have been working on a mosaic as part of their therapy. The project, funded through the Dragon’s Den, was carried out in partnership with the Hackney Mosaic Project and is now on display in the Finsbury Ward garden.

8.2 Outdoor Gym – The Trust has established an Outdoor Gym at the St Ann’s Hospital site, as part of the Trust’s commitment to improve staff wellbeing. Eight machines were purchased through the Dragon’s Den to provide staff with an opportunity ti undertake light exercise.

8.3 Back in the Game Football Club – received funding through the Dragon’s Den to continue to provide an opportunity for a football team made up of service users to compete in the Tottenham Powerleague. The Football Club is founded on the principles of self-help and independence, to help service users build their resilience and confidence through physical activity.

9. World Mental Health Day 2016 9.1 The Trust hosted a series of events as part of its contribution to World Mental Health Day

on Monday 10th October 2016). Stalls were held across the three boroughs to mark the day, with staff on hand at the Meritage Centre in Barnet, outside Wood Green library in Haringey at an event hosted by Haringey Association for Independent Living (HAIL), and at Chase Farm Hospital, Avesbury House and the Dugdale Centre in Enfield.

9.2 The theme this year was Psychological First Aid (PFA) and the support people can provide

to those in distress. PFA aims to reduce stress symptoms and assist in a healthy recovery following a traumatic event.

9.3 Enfield’s Child and Adolescent Mental Health Services took part in Young Minds’

#HelloYellow campaign to mark World Mental Health Day 2016. Teams at Charles Babbage House, Cedar House and Riverside House raised awareness and collected £60 for the children and young people’s mental health charity by wearing yellow.

10. Outsider Gallery 10.1 David Lammy MP opened the Outsider Gallery London, a collaboration between the Trust,

Clarendon Recovery College and other partners including Public Health England and the Teenage Cancer Trust, providing London’s first art and music gallery for mental health.

10.2 More than 250 people turned up to see the opening show called ‘Untitled’, an exhibition of works by NHS patients and therapists – artists and contributors who through ill health, injury, social exclusion or circumstances have not shared their creative ideas and perspectives before. The exhibition featured paintings, digital media, music, sound, poetry and spoken word items. The aim of the exhibition is to provide a platform to promote the creative works of people greatly affected by challenges and promote conversations around mental health issues. Launched on 7 October, the exhibition will be on display until the end of the year.

Page 22


11. CHOICES 11.1 The Trust held a launch event for CHOICES, a new service for children, young people and

their families in Haringey, who may need emotional support. The event was held on 10 November at Park View School, West Green Road, Haringey.

11.2 CHOICES is a free and confidential service. The team provide an initial one-to-one appointment to establish appropriate support to help children and young people with their emotional wellbeing. The CHOICES website address is www.haringeychoices.org.

12. Allied Health Professions (AHPs) Conference 12.1 The Trust held its second Annual AHP Conference on Wednesday, 2 November. The

event provided an opportunity for AHPs to hear about the Trust’s priorities and how AHPs can contribute to change. Presentations included an update on the AHP Mandate and how using AHPs is key to transforming health, care and wellbeing, the Support Workers Project carried out with the engagement of the Trust and other North Central London sector organisations, and the AHP Leadership Programme funded by Health Education England North Central East London.

13. Workforce Update 13.1 Employee of the Month

September’s employee of the month award went to Keith Foster, a social worker on Mint Ward, Chase Farm Hospital. He was nominated for excellent communication, friendliness, patience and acting to transform care.

Valda Ozolina was awarded the October employee of the month. Valda works in the domestic service department and was described by colleagues as being passionate about her job, being very effective and efficient and being very kind.

13.2 Retirements

The Trust would like to place on record it’s thanks to the following members of staff who have or are due to retire in the near future:

Dora Bobadilla-Jones, 39 years, Assistant Director of Hotel Support Services Sukhdev Singh, 35 years, 1 months, Nurse Pushpawathy Naveenan, 29 years, 7 months, Associate Specialist Dayanand Casseeram, 22 years, 10 months, Nurse Megnath Rakatoo, 22 years, 9 months, Team Leader Barnet Memory Services Mary Doherty, 21 years, 8 months, Health Care Assistant Pearl Amoah, 20 years, 7 months, Nurse Theresa Asaolu, 17 years, 0 months, Nurse Chandyrachegaren Maruthan, 16 years, 9 months, Nurse Shaharazad Maraj, 14 years, 10 months, Administrator Josefina Cupido, 14 years, 9 months, Arts Therapist Patricia Feltham, 12 years, 7 months, Administrator Olushola Lawal, 11 years, 11 months, CRHT Senior Practitioner

Page 23

http://www.haringeychoices.org/


14. Communications Update (1 September – 31 October 2016) 14.1 The Communications Team achieved the following outcomes for the specified dates:

Total News Items – 111 (the number of news impressions across the media) Total Reach – 7.97m (the numbers of people who are likely to have seen PR initiatives) Total Value - £158,007 (The cost of PR if we had paid for placing our news items in

the press) Total Social Items – 677 (the number of social media tweets and retweets) Total Twitter Reach – 661,170 Total Twitter Impressions – 1,340,000 Engagement Rate – 87.93% Total Items - 788

14.2 During September and October, the Communications Team issued the following news

releases to the local press and partners: Mental Health Trust awarded for its pioneering work with court defendants BEH shortlisted for four HSJ Awards New service for young people in Haringey Untitled: New exhibition with artwork by NHS patients and therapists BEH marks World Mental Health Day 2016 Project to support autistic prisoners wins prestigious award

14.3 The following stories, developed by the Communications Team, appeared in the press: 1. BEH marks World Mental Health Day 2. Counter Terror Police Team Up With Mental Health Professionals to Tackle

Radicalisation 3. Project to support autistic prisoners wins prestigious award 4. Fewer mentally ill people being locked up in London police cells, figures show 5. Management of prisoners with autism is not perfect but is improving

14.4 The following Trust staff have featured in national articles / blogs:

Katherine Delargy, Deputy Chief Pharmacist, provided a comment on a study of ex-prisoners in Sweden in The Pharmaceutical Journal. The research found that three types of psychotropic drugs were associated with a reduction in violent reoffending.

15. Chief Executive Officers’ Forum 15.1 The Chief Executive held another successful CEO’s Forum meeting on 15 November 2016

which was attended by nine members of staff, held at the Dennis Scott Unit, Edgware Community Hospital in Barnet, as part of the ongoing series of CEO Forums.

16. Visits 16.1 Since the last meeting of the Trust Board on 26 September, the Chief Executive has

undertaken visits to the following services:

Springwell Centre, Barnet Beacon Centre, Barnet Finsbury Ward, Haringey

Page 24

http://www.beh-mht.nhs.uk/news-and-events/Mental-Health-Trust-awarded-for-its-pioneering-work-with-court-defendants.htm

http://www.beh-mht.nhs.uk/news-and-events/BEH-shortlisted-for-four-HSJ-Awards

http://www.beh-mht.nhs.uk/news-and-events/New-service-for-young-people-in-Haringey.htm

http://www.beh-mht.nhs.uk/news-and-events/Untitled-New-exhibition-with-artwork-by-NHS-patients.htm

http://www.beh-mht.nhs.uk/news-and-events/World-Mental-Health-Day-2016.htm

http://www.beh-mht.nhs.uk/news-and-events/Project-to-support-autistic-prisoners-wins-prestigious-award.htm

http://www.thetottenhamindependent.co.uk/news/14795055.North_London_NHS_trust_marks_World_Mental_Health_Day/?ref=mrb&lp=5

http://www.towerfm.co.uk/news/local/counter-terror-police-team-up-with-mental-health-professionals-to-tackle-radicalisation/

http://www.towerfm.co.uk/news/local/counter-terror-police-team-up-with-mental-health-professionals-to-tackle-radicalisation/

http://www.buildingbetterhealthcare.co.uk/news/article_page/Project_to_support_autistic_prisoners_wins_prestigious_award/122462

http://www.thisislocallondon.co.uk/news/14824989.Fewer_mentally_ill_people_being_locked_up_in_London_police_cells__figures_show/

http://www.bmj.com/content/354/bmj.i4881


17. Trust Seal 17.1 Since the last report, the Trust seal has been affixed to the following documents.

Seal no.

Description of the document Date sealed

Names of those attesting Seal

215

License to underlet with Forest Vale Fundco, Community Health Partnerships Ltd for Forest Road Primary Care Clinic

21.10.16 Simon Goodwin, Chief Finance and Investment Officer Mary Sexton, Executive Director of Nursing, Quality and Governance

216

Lease with Whittington Health re buildings at St Ann’s Hospital

24.10.16 Simon Goodwin, Chief Finance and Investment Officer

217

Service Level Agreement with Whittington Health for estates and facilities services at St Ann’s Hospital.

24.10.16 Simon Goodwin, Chief Finance and Investment Officer Mark Vaughan, Executive Director of Workforce

218

Service Level Agreement with Whittington Health for estates and facilities services at St Ann’s Hospital.

24.10.16 Simon Goodwin, Chief Finance and Investment Officer Mark Vaughan, Executive Director of Workforce

219

Deed of Indemnity re S.106 Agreement with Royal Free London NHS Foundation Trust.

27.10.16 Maria Kane, Chief Executive Simon Goodwin, Chief Finance and Investment Officer

220

Unilateral undertaking with London Borough of Enfield re land at Chase Farm Hospital owned by the Royal Free London NHS Foundation Trust.


221

Unilateral undertaking with London Borough of Enfield re land at Chase Farm Hospital owned by the Royal Free London NHS Foundation Trust.


Ends.

Page 25


Page 26

BEH-MHT – Trust Board – 28.11.2016 1.9 - Executive Director of Patient Services’ Report

Title:

Executive Chief Operating Officer / Director of Patient Services’ Report

Report to:

Trust Board

Date:

28 November 2016



Purpose of Report: This is a regular report to update the Board on Trust operational matters. The report is to inform and update the Board on the progress of key operational issues across the Borough and Specialist Services.

Recommendations: The Trust Board is asked to note progress made since the last report to the Trust Board on 26 September 2016. Report Sponsor:

Andy Graham, Chief Operating Officer / Executive Director of Patient Services

Comments / views of the Report Sponsor:

This section is to be completed by the above named Report Sponsor only. Report Sponsors are requested to set out their views in relation to the proposals within the report.

Report Author:

Name: Andy Graham Title: Chief Operating Officer / Executive Director of

Patient Services Tel Number: 020 8702 6010 E-mail: [email protected]

Report History:

Regular Report


Some cost reductions set out in this report.


None.


Links to the Board Assurance Framework summary (Trust Board agenda item).

List of Appendices:

None

Page 27


Report 1. Introduction 1.1. As introduction to this report, I will cover the top 4 areas agreed with my operational team.

Our priority areas are: 1.2. Adult pathway review and reducing dependency on in-patient beds 1.2.1 The adult pathway review is progressing well in each borough, the most advanced being

Barnet who have started formal consultation on a new primary care based style of service. Consultations in Enfield and Haringey will be launched early in the New Year following a further staff engagement.

1.2.2 External bed places continue to be an issue. Focused peer review of all patients in

placements outside of the Trust have been implemented and 6 additional adult beds are planned to be opened on the Chase Farm Hospital site.

1.3. Activity 1.3.1 Our staff have recorded 13% more activity this year to date than last year. This is above the

level of planned activity agreed with our Clinical Commissioning Groups (CCGs) and a reflection of the intensive work that teams undertake.

1.4. Responding to the recommendation made by the Care Quality Commission (CQC) 1.4.1 Negotiation continues with our commissioners on recurrent funding to address adult mental

health pathway and Child and Adolescent Mental Health (CAMH) waiting times issues. It is therefore unlikely that any recurrent funding will take effect in 2016/17. Additional income has been secured for psychological therapies and the Psychiatric Intensive care Unit (PICU).

1.4.2 Clinical teams continue to work to secure evidence that demonstrates compliance with the

recommendations made by CQC. 1.5. Achieving Cost Improvement Plans (CIPs) and improving financial run rate 1.5.1 This is set out in detail in the Financial Performance report and improvements in these

areas are evident. External bed placements remain a financial risk. 1.6. I can also report that the Section 136 Suite at St Ann’s Hospital will be closing from 9

January 2017. This follows significant clinical safety and CQC concerns. Extensive discussions have been undertaken with our CCGs, Local Authority and Police partners. All Trust Section 136 activity will now take place at the Chase Farm Hospital site.

1.7. The remainder of this report reflects local borough and specialist service issues. 2. Barnet Borough Services 2.1 Barnet Acute and Liaison Services 2.1.1 Progress has been made against the revised Avon Ward improvement plan, supported by

the Executive Director of Nursing, Quality and Governance. The ward manager post has been appointed to which is a significant step and will support the sustainability of the progress made to date. The ward has also been receiving support from colleagues in the North London Forensic Service to unblock barriers to service users moving on from the PICU environment.

Page 28


2.2 Barnet Community Services – Adults 2.2.1 The first quarter performance report for the Link working service in Barnet has been completed

and is showing very positive early signs of adding value across key measures. Customer satisfaction is very high from service users and GPs. Responses to referrals and contacts is very prompt and there are early indicators that the approach may be impacting on presentations in the acute pathway. Negotiations are being taken forwards with Barnet CCG to consider extending the availability of transformation funding into this scheme across 2017-18. We are now active in the South and the West localities and rolling out to the North locality from January.

2.2.2 Related to this, the Adult Pathway consultation process is under way with the formal

consultation period ending on 19 November. There has been excellent engagement in the process to date from team members and colleagues following the consultation and consideration of the issues raised. A shared implementation plan has been developed in partnership with the London Borough of Barnet to ensure that there is safe and careful implementation of the changes pending and to maximise the links with the voluntary sector.

2.3 Barnet Child and Adolescent Mental Health Services (CAMHS) 2.3.1 Barnet CCG and the London Borough of Barnet have confirmed that their intention, now

ratified by the Health and Wellbeing Board, is to pool budgets, form a Section 75 agreement and re-commission CAMHS services following a local transformation review. This generates continued uncertainty and difficulties with regards to planning the Trust’s changes and re-organisation with CAMHS. Associated barriers to recruiting substantively to key clinical roles presents risks to continuity of care and service delivery.

2.3.2 On a positive note, the CCG and the Trust have applied for waiting times income from NHS

England and are hoping to achieve the full allocation of £168,000 for Barnet. Whilst the funding is non-recurrent, this will treat more children this year.

2.4 Barnet Older Adults 2.4.1 The Royal College of Psychiatrists Memory Service National Accreditation Programme

(MSNAP) assessment has been completed and the service has now received accreditation – this is an achievement that the team in Barnet are rightly proud of and reflects the high quality of the service and the hard work of all those involved.

3. Enfield Borough Services 3.1. The borough is focused on improving its finances, with plans to bring adult mental health bed

management into borough and new targets for bed use bringing clarity, and initiatives around one to one care in Older People’s inpatients. Meetings have been held between the Clinical Director, Governance lead for the borough and the Nursing Directorate to establish shared understanding of the detail on actions to be delivered to meet the CQC targets, which will lead to improvements. The Community Services benchmarking report will be published early in December.

3.2. Child and Adolescent Mental Health Services (CAMHS) and Children and Young People

(CYP) 3.2.1 Natalija Lytrides has taken up her role as the new Interim Enfield CAMHS Service Manager. 3.2.2 Financial re-positioning to clarify funding streams and budgetary lines continues in light of the

London Borough of Enfield’s (LBE) planned savings. Enfield CCG to invest Future in Mind funding in accordance with local Transformation priorities and in line with demand for services.

Page 29


3.3. Health Visiting 3.3.1 Recruitment continues in line with commissioner agreement to reach 73 whole time

equivalent (wte) posts. This currently stands at 66.06 wte.

3.3.2 The Healthy Child Programme (0-5), 5 mandated contacts is now being delivered across all teams. The service is working more closely with the local authority’s Children’s Centre colleagues, who have adopted the Health Visiting First Time Parents Sessions to include IAPT, Pre-school Speech and Language. The six High Impact Areas, Transition to Parenthood, Maternal Mental Health, Breastfeeding, Healthy Weight, Managing Minor Illness and School Readiness is the focus of ‘making every contact count’.

3.4. School Nursing 3.4.1 School Nurses are working towards fulfilling their new service specification. This will be

incrementally delivered across the academic year. It includes an offer of ‘Health Needs Assessment’ to all 4-5 year olds, 10-11 year olds, and any new entrant during the academic year. There continues to be a high level of safeguarding work undertaken. The named School Nurse for each school is accompanying the new Immunisation Team to deliver national Immunisation Programme.

3.5. Family Nurse Partnership (FNP) 3.5.1 The Team continues to enroll vulnerable young parents onto the Programme. The highly

complex client group are benefitting from the intense work undertaken by the nurses. The 3rd Department of Health Annual Review takes place on 15 November where local Councilor’s will be present to hear of the hard work of both nurses and clients.

3.6. School Aged Immunisation Team 3.6.1 The National Immunisation Programme has begun with this seasons Flu vaccination, via

nasal spray of all children in all 75 primary schools’ Year 1, 2, and 3. The uptake has already improved on last year’s uptake. Tight deadlines for delivery of both doses of Human Papilloma Virus (HPV) vaccination before the end of the academic year is planned for. Catch up sessions for those children unwell during school based immunisation is also planned.

3.7. Child Health Information System (CHIS) 3.7.1 NHS England (NHSE) announced the tender winner for the North East London CHIS Hub

on 8 November. The Trust’s CHIS will be hosted by the North East London Foundation Trust, who have a good knowledge of the current CHIS processes, and are hopeful that a smooth transition will take place for staff to be transferred across. During this transition, the CHIS team continue to ensure robust data is dealt with in a timely and safe way ensuring children’s’ services receive information required to carry out necessary care and client contacts are maintained. There will be four main ‘mobilisation’ meetings with NHSE between now and March 2017.

3.8. CYP Specialist Children Services 3.8.1 The Speech and Language service for school age children has been operating with a

reduced budget reduction of £52k full year effect due to LBE funding reductions across all provider services. The new service model since September 2016 operates at a specialist tier only with new levels of allocated sessions to maximise efficient use of valuable resources. The new referral criteria means only children and young people undergoing statutory assessment or who have an Education, Health and Care plan with specified

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speech and language interventions will access support. Children with specialist Health needs such as Voice Disorders, Dysphagia, Phonological Disorders and Dysfluency are also included in the new service criteria.

3.8.2 The LBE has opened a new 30 place nursery for children with complex physical health

needs cared for at home. This meant a redesign of our specialist nursing and therapies provision to manage increases in referrals for children with complex long term conditions.

3.8.3 Referrals for Autism Diagnostics at the Child Development Service have consistently

increased requiring weekly clinics to be doubled to meet demand within existing capacity. Services are working closely with The Royal Free London Foundation Trust and LBE to ensure all referrals are seen within agreed waiting times. The Trust is working closely with colleagues across Camden and Barnet to develop a sustainable model across the sector which will be launched in 2017.

3.9. Non-demographic Growth Income 3.9.1 The £301k income has now been allocated to Adult Speech and Language Therapy (SLT)

and Community and Outpatient Physiotherapy. Recruitment is under way but there has been significant difficulties in recruiting to SLT and Physiotherapy positions within the Trust, and nationally.

3.10. District Nurse Recruitment Update 3.10.1 Recruitment and retention of staff within the District Nursing service continues to be

difficult. There are 27 vacancies, which equates to a quarter of the establishment. This is only partly covered by bank and agency staff.

3.10.2 The service is part of the Trust’s Recruitment steering group and has attended several job

recruitment fairs in London, Dublin and Glasgow with limited success. The Trust is currently considering a number of initiatives to support recruitment including international recruitment. From January ‘Enfield Health’ will become the new generic name for all Trust services in Enfield, and this should help improve visibility for recruitment.

3.11. Bay Tree House 3.11.1 Services provided at Bay Tree House moved from their previous location in Enfield Town

on 25 October 2016 to the old Somerset Villa on the Chase Farm Hospital Site. The new service is now known as Somerset Villa (formerly Bay Tree House, Older Adults).

4 Haringey Borough Services 4.1 Haringey In Patient Therapies Team 4.1.1 This team/service is currently under review. Consultation meetings have been well attended

by staff to discuss and to structure up the review process. 4.1.2 The Therapies team organised an event to celebrate Black History Month on 31 October

2016, which was well attended by service users. There was food and music, and the participants were shown videos to celebrate the achievements of Black history over the last 50 years.

4.2 The Hub 4.2.1 The team has recently trialled the Storm ® portal phone system. This has allowed staff to

keep track of how many calls are in the queue waiting to be answered and also highlights the team functionality levels per day, individually displaying staff names with how many calls

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have been received/missed and displaying overall team performance statistics. 4.2.2 The Hub has also introduced a clinical handover each day. This is used for clinicians to

openly discuss any difficult cases they encountered in the last 24 hours and enable them to receive feedback and recommendations going forward.

4.3 Haringey Crisis Resolution Home Treatment Team (HCRHT) 4.3.1 A member of staff from the Team recently qualified as a nurse prescriber. 4.3.2 The Team are now holding a weekly quality improvement meeting, where the Team is

stream lining improvement tasks to staff. 4.4 Haringey Assessment Ward 4.4.1 Discharge leaflets are routinely being given to patients on discharge. These contain useful

information as well as telephone numbers of relevant professionals. 4.5 Finsbury Ward 4.5.1 A quality improvement programme has commenced. Finsbury Ward and the Home

Treatment Team (HTT) are working in conjunction to review patients on a weekly basis. The idea is to identify any patients that could be discharged directly to the HTT. This will reduce the length of stay on the ward. The next stage is for the Ward Manager to meet with the clinical team and HTT to work on the final details.

4.6 Fairlands Ward 4.6.1 There is now a weekly physical health day on the ward. 4.6.2 The ward manager is leading on the weekly smoking cessation group. 5 Specialist Services 5.1 North London Forensic Service (NLFS) 5.1.1 The Service has welcomed two new consultant Forensic Psychiatrists – Dr Shyamal

Mashru and Dr Carolyn Stanley. Both consultants will be working within the medium secure wards. Dr Mashru has already commenced in post and Dr Stanley will take up post as of 1 February 2017.

5.1.2 The Service has recruited an Imam to lead Friday prayers and offer spiritual guidance

to Muslim patients. 5.1.3 A key Commissioning for Quality and Innovation (CQUIN) target for the in-patients forensic

service is the engagement with the reducing restrictive interventions programme which requires each service to demonstrate innovative developments in this respect. The NLFS has received positive feedback in this area from commissioners, peer review and CQC visits; however there is a drive to ensure that the service continues to be seen as innovative in this respect. The Service has recently established a working group of staff and service users and has begun to develop a model/framework that draws on all of the historical and present good practices in this area whilst identifying and benchmarking areas of excellence beyond the service.

5.1.4 The current key management system will be replaced on 25 November. This will enable

staff to access keys using a biometric approach/fingerprint technique. This is to make it more efficient and secure to access keys.

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5.1.5 Work has now taken place to address the on-going flooring dampness situation on

Derwent ward which involved patients decanting to the Kingswood Centre (KWC) on a daily basis to enable contractors to enter the ward and remove sections of flooring, diagnose issues and take action. At this point it is believed that the action taken has been successful; however the extent at this point cannot be confirmed.

5.1.6 ‘Dog as Therapy’ is starting this week. The Service will have a dog coming to the KWC for

therapeutic engagement with patients. 5.1.7 The NLFS has worked in partnership with Matchlight and Key Changes (which provide

music sessions to patients) to complete a short pilot that has been presented to the BBC for consideration for future commissioning. The pilot is about the benefits that hip hop music has for individuals experiencing mental health challenges.

5.2 Substance Misuse Service 5.2.1 The Service submitted a bid to provide the Substance Misuse Services in Enfield and was

invited to attend a clarification interview on 2 November. The outcome of the bid is expected on 4 January 2017.

5.3 Beacon Centre 5.3.1 A locum has been successfully recruited to replace one of the two substantive consultants

who is leaving the Beacon Centre at the end of November. The service has substantively recruited a Band 7 Occupational Therapist. Priority areas at this point are retention of new band 5 staff, preparation for the Quality Network for Inpatient CAMHS accreditation, and delivering a Dragons’ Den initiative.

Implications 6. Budgetary / Financial Implications 6.1 There are no budgetary / financial implications as a direct result of this report. 7. Risk Management 7.1 There are no risk management implications as a direct result of this report. 8. Equality and Diversity Implications 8.1 None.

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Page 34

BEH-MHT – Trust Board – 28.11.2016 2.2 - Integrated Quality and Performance

Title: Integrated Quality and Performance Report

Report to: Trust Board

Date: 28 November 2016

Security Classification: Public Board Meeting

Purpose of Report: Attached is the integrated report on quality and performance against key targets and milestones. This Trust Dashboard shows performance against national and locally agreed targets up to the month of October 2016. Exceptions and Highlights for October: The waiting lists for Enfield CAMHS remain high. The IST Demand and Capacity model was completed for all three CAMHS services and indicated a shortfall in the capacity required to maintain appropriate waiting times. This has been shared with the CCGs and we are working closely with Enfield CCG and LBE on a recovery plan. Activity recorded by community teams is now 3% above the contracted plan and more than 12% higher than the same point last year, strengthening our position for the 17/18 contract negotiations. We continue to see consistent delivery of CPA follow-up and review standards; continued delivery of PbR Cluster Reviews and low emergency re-admission rates. Lengths of inpatient stay and delayed transfers were both down in October. The EIP and IAPT waiting times standards and IAPT coverage targets were all met. The IAPT recovery rate fell further from target and we are working with Enfield CCG on a plan to improve this. Every board level performance standard for Children’s Services continues to be met.

Recommendations: The Trust Board is asked to: 1. Receive and comment on the content of the report;

2. Receive assurance on the areas of quality and performance which require performance

improvement action and note those areas of improvement during the last month;

3. Confirm where additional investigation and assurance is required on the basis of the data contained in the report (for report back at the next Board meeting)

Page 35

BEH-MHT – Trust Board – 28.11.2016 2.2 - Integrated Quality and Performance

Sponsor: Andy Graham, Executive Chief Operating Officer

Report Author: Name: Alex Manya Title: AD Information and Performance Tel Number: 020 8702 3999 E-mail: [email protected]

Report History: Regular Report KPIs and format revised April 2016 Formatting revisions July 2016


Improved performance in some of the target areas will have financial implications, particularly the variance from contracted activity.


None highlighted.


Links are described in the attached report.

List of Appendices: Trust Performance Report – October 2016

Page 36

mailto:[email protected]

Trust Quality and Performance Report - Oct 2016

Trust Performance Scorecard

1 Apr May Jun Jul Aug Sep Oct

Safe

3 CPA Acute & PICU % of patients followed-up 7 Days after discharge 99.2% 99.1% 100.0% 99.2% 97.5% 99.3% 99.1% 95%One breach in Enfield. Several unsuccessful attempts to make contact with client discharged from

Suffolk ward.

6 Care Programme Approach: % of patients reviewed in the last 12 months 95.8% 96.5% 96.7% 95.2% 96.9% 96.0% 95.2% 95%

15 Admissions to adult facilities of patients who are under 16 years of age. 0 0 0 0 0 0 0 0

16 Number of SI incidents reported 3 7 4 8 4 7 5

Five serious incidents were recorded in October - one in Barnet, three in Enfield, and one in

Haringey. Details will be reported in the Medical Director's Serious Incident Update.

17 Number of Never Events 0 0 0 0 0 0 0 0

18 136 Suite – inappropriate use 0 0 1 0 1 0 0 0

19 Seclusion Room – inappropriate use 0 0 0 0 0 0 0 0

20 Number of Mixed Sex Accommodation occurrences 0 0 0 0 0 0 0 0

21 Adult Acute Inpatient Risk Assessments - % Current (From sample) 96% 92% 95% 96% 97% 96% 98% 90%

24 Crisis Team Caseloads (for information) 0%

25 Barnet 95 102 92 96 112 76 71 ###

26 Enfield 114 125 119 123 152 154 114 ###

27 Haringey 87 99 71 87 107 79 75 ###

28

CAMHS Waiting Lists - Percentage of GP referrals waiting over 13 weeks (snapshot

taken on last working day) 10.1% 9.8% 5.9% 5.3% 8.5% 14.0% 12.1% 3%

Barnet and Haringey have remained within target whilst Enfield experience a significant increase in

the Waiting list. The Trust is working with Enfield CCG and LBE to agree a plan to address CAMH

waiting times sustainably.

Effective

37 Infection Control: number of MRSA cases 0 0 0 0 0 0 0 0

38 Infection Control: Number of Clostridium Difficile cases 0 0 0 0 0 0 0 0

39 % PbR Cluster Reviews completed on time 88.4% 87.8% 90.2% 88.3% 88.2% 89.1% 89.8% 85%

51 % Patients gate kept by the Crisis Resolution and Home Treatment Team 100.0% 98.9% 100.0% 98.2% 99.2% 100.0% 95.8% 95%

48 % Admissions that are emergency readmissions within 28 days of previous

discharge 1.7% 1.0% 2.8% 0.9% 0.8% 1.8% 1.0% 5%

54 Falls resulting in severe injury or death 0 1 1 1 0 2 0 0 Two falls were reported on Cornwall Villa

55 Grade 3 or 4 pressure ulcers 0 1 2 1 2 3 1 1 One reported by Forest Road District Nursing team.

56 Formal Complaints received 18 9 21 22 14 18 12 -

57Complaints: Response in time 72.0% 100.0% 95.0% 90.0% 64.0% 94.0% tbc ### 90%

This is the percentage of complaints received in the reporting month that received responses within

the 25 day target or within a timescale agreed with the complainant. As such, the measure is

reported a month in arrears.

Qtr 1 Qtr 2 Qtr 3 Trend

Target Comments

2016/17

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Target Comments

2016/17

Caring

61 Patient Survey - Information provided 86% 84% 86% 87% 87% 88% 88% 80%

64 Patient Survey - involved in decisions 87% 85% 86% 87% 88% 88% 87% 80%

67 Patient Survey - treated with dignity 93% 91% 93% 94% 95% 94% 94% 80%

70 Overall Patient Satisfaction 87% 85% 87% 88% 88% 89% 89% 80%

73Number of patients completing surveys 716 884 730 797 810 727 695 700

The patient/carer survey has been redesigned with service users and the new survey available on

meridian from January 1st. 2017. Work is being done by the patient experience team to engage all

services to improve uptake.

74 Overall Carer Satisfaction 94% 87% 87.0% 89% 91% 95% 90% 80%

77Number of carers completing surveys 122 96 162 119 146 83 133 130 Response rate and strategies to increase engagement, including review of survey questions, are

being discussed and monitored via Deep Dive/local governance meetings.

78 Patient FFT - Mental Health Response Rate 7.0% 10% 8% 7% 9% 7% 7.3% 7%

81 Patient FFT - ECS Response Rate 2% 2% 2% 3% 3% 2% 2.3% 3%

84Patient FFT - Mental Health Overall Score 84% 81% 84% 82% 81% 81% 83% 80%

The patient experience team have started work with the services in ECS to review the FFT / surveys

used and assurance will be managed through local Governanace meetings and the Deep Dives.

87 Patient FFT - ECS Overall Score 95% 97% 98% 98% 99% 89% 97% 90%

Responsive

91 DToC - % All Occupied Bed Days (OBDs) due to delayed transfers 9.1% 10.7% 9.5% 8.65% 8.21% 7.70% 5.55% 7.5%

94 DToC - % Adult OBDs due to delayed transfer of care 9.4% 10.8% 9.2% 8.12% 8.77% 7.42% 5.21% 5%

97 DToC - % Older People's OBDs due to delayed transfer of care 8.7% 10.4% 10.1% 9.6% 7.3% 8.2% 6.2% 20%

## DToC - Number of Patients delayed in the month 34 38 31 26 32 22 18 30

The actual number of people delayed fell in all three boroughs. Regular DToCs meetings and close

monitoring of discharges practices continue to remain a high priority.

## Let's Talk (Enfield IAPT) % of people treated within 18 weeks of referral 99.6% 98.0% 100.0% 98.9% 98.9% 99.6% 99.0% 95%

## Let's Talk (Enfield IAPT) % of people treated within 6 weeks of referral 91.9% 92.0% 90.0% 89.4% 94.4% 93.4% 91.0% 75%

## Let's Talk (Enfield IAPT) number entering treatment each month. 452 473 535 461 444 384 463 441

The access target of 441 was exceeded by 22 patients. In the year to date, the coverage continues to

exceed target by 4.27% (132 clients). December is a traditionally slow month and is expected to

deplete this margin.

##

Let's Talk (Enfield IAPT) Recovery Rate 46.4% 46.9% 47.5% 50.6% 47.2% 49.3% 46.2% 50%

The recovery rate dropped to 46.2%. The main reason was a reducedsample size this month, partly

due to rotation of trainees, thus fewer clients ending therapy. In addition, recovery rates are highly

volatile when sample size drops - to illustrate this, if only 7 more patients moved to recovery in

October, the 50% target woiuld have been met. There has been a trend over the past 3 years of

lower recovery rates in Q3, across both the Enfield and Haringey Services, which may support the

hypothesis that at least part of this may be due to the large staff changeover in Sept/Oct.

##

EIP % of people treated within 2 weeks 44.4% 62.5% 64.3% 58.8% 63.6% 69.2% 66.7% 50%

18 cases met the Access Standard criteria in October, of which 12 were taken onto the caseload

within 14 days. 6 breaches were reported in the month: 1 in Barnet, 2 in Enfield and 3 in Haringey.

Delays are less the result of late referral and more the effect of increased demand on the three

teams, with at least 60 referrals being the average received each month.

## CRHT GP Response Times - 4 hours 100.0% 100.0% 100.0% 100.0% 97.5% 96.3% 100.0% 95%

##Liaison Service - N. Mid 1-hour response time for A&E referrals 82.0% 80.0% 71% 81% 86% 82.5% 84.2% 95%

Limited staffing resources to work out of hours and multiple referral continues to impact on the

ability to assess all referrals within the 1 hour target. Work is being undertaken to build a recent

profile of admission times

## Liaison Service - Barnet 1-hour response time for A&E referrals 77.0% 85.0% 91% 88% 86% 95% 94.0% 95%

The service saw a slight increase in referrals in October. Performance was just below the 95% target

for the month. The team continue to face challenges in its ability to manage demand.

Response rates are based on the number of people accessing services in the month. The target is an

indicative value, based on the values over the past year.

The number of people delayed, the number of days lost to delay and the days lost as a proportion of

all OBDs. Significant improvement in October as all three boroughs reduced the number of DToCs ,

Barnet & Haringey 50% and Enfield 40% in the month. A high proportion of DToCs continue to be

predominantly due to delays around funding agreements and accommodation issues.

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Target Comments

2016/17

Well Led

##

Proportion of staff compliant with individual mandatory training requirements 85% 84% 83% 84% 82% 81.8% 82% 90%

Due to legislative changes affecting mandatory training, a revised training matrix was approved by

the Quality and Safety committee in July, increasing the requirements for this measure. Additional

courses, workbooks and e-learning are in place to meet demand. 77% of staff are currently compliant

with the new requirements.

##Sickness/absence rate % 3.3% 3.1% 2.6% 3.1% 3.3% 3.1% 3.6% 3.5%

Despite the increased sickness in October, the rate is lower than it was in October last year or the

year before. Actions are in place with boroughs to ensure that absence is being managed robustly.

## Agency as a % of Employee Spend (Financial - agency spend as a percentage of

staffing spend) 8.4% 7.7% 7.9% 8.0% 7.3% 9.6% 6.6% 10%

## Bank as a % of Employee Spend (Financial - bank spend as a percentage of staffing

spend) 10.6% 8.7% 8.9% 9.0% 10.3% 7.8% 8.6% 7%

## Agency as a % of Employee Time (Workforce - Agency WTE as a percentage of

budgeted establishment) 4.6% 4.3% 4.6% 4.8% 3.1% 3.3% 3.1% 4%

## Bank as a % of Employee (Workforce - Agency WTE as a percentage of budgeted

establishment) 8.9% 9.0% 9.4% 9.9% 10.0% 9.1% 9.4% 10%

## Total vacancy rate (% established posts without staff members in place) 12.0% 11.0% 13.4% 12.7% 13.5% 12.7% 12.4% 10%Despite an increase to the budgeted establishment in October, the vacancy rate has decreased by

0.3% due to the increased fte number of staff in post.

##

Nursing Vacancy Rate 17.7% 17.8% 18.2% 18.0% 19.9% 17.9% 16.3% 10%

An anomaly was identified in the coding of nursing roles on ESR. This has been reconciled and the

nursing vacancies have been reviewed for the year since April 2016. The overall levels of nursing

vacancies are higher than previously reported, however the declining trend since June is still noted,

despite the increase in establishment in August.

## Medical vacancy rate 11.2% 12.9% 10.0% 16.2% 14.4% 12.5% 14.9% 10%

##

Time to hire (mean number of days from advert start to provisional start date) 104 102 95 104 106 105 104 -

An SLA has now been drawn up for the recruitment function which is also intended to highlight the

need for pace in relation to recruitment. This is now in place. The team are working towards a

challenging target of 77 days, to be achieved by March 2017. A session is being organised with

support from the PMO in November to review recruitment processes and streamline them.

##

Nursing time to hire (mean number of days from advert start to provisional

start date) ###

## Staff Turnover (Total) 14.4% 14.5% 14.3% 14.1% 14.0% 13.3% 13.2% 15%

## - Staff turnover (Unplanned) 10.3% 10.5% 10.3% 10.3% 10.3% 9.5% 9.6% 11%

## - Staff turnover (Planned) 4.1% 4.0% 4.0% 3.8% 3.7% 3.8% 3.6% 5%

Percentage of exit interviews where the trust was described as a good place to

work 58.8% 58.8% 59.7% 60.1% 60.0% 60.3% 60.3% -

Staff FFT - Response rate 10%

Staff FFT - Overall score: % would recommend as a place to work 50%

Staff FFT - Overall score: % would recommend as a place for care 55%

## Estates Maintenance - proportion of jobs that are unplanned 52% 45% 55% 47% 42% 50% 48% 55%

Enablement

## Percentage of people in receipt of Community Mental Health services who are in

settled accommodation 75.2% 75.1% 75.9% 76.4% 76.2% 77% 76% 70%

##

Percentage of people in receipt of Community Mental Health services who are

engaged in structured occupations, including actively seeking work, parenting and

running a home

22.0% 22.0% 22.9% 23.1% 22.8% 22.6% 23% 20%

##

Assessment Services DNA Rate 23.0% 17% 18.7% 16.8% 14.7% 13.5% 17.0% 15%DNA rates increased in all three Assessment Services but remain lower than they were at the start of

the year. Analysis of DNAs by referring GP continues to inform work with primary care.

70.44% 54.00%

67.98% 60.00%

16.50%

Agency bookings have shown a declining trend since July, and this has been reflected in both volumes

of bookings and spend. Further actions are in place to review all long term bookings (medical and non-

medical), continue with controls through the vacancy control panel and ensure that required roles

are converted to substantive at pace. Managers are being encouraged to replace agency with bank

whilst substantive appointments are sought. This has resulted in an increase in bank.

The poll ran from 4 August to Friday 30 September. 159 staff out of 965 contacted responded.

Indicator reported quarterly.

21.67%

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Target Comments

2016/17

Activity and Efficiency

Activity Recording - Percentage variance from contracted activity plan (CCG

Contracted Activity) 2.5% 1.5% 1.2% -3.7% 15.3% 8.3% 3.8% 3%

Continued management focus and local accountability for activity recording saw October's MH

activity at 3.8% above CCG contract targets and ECS activity 9.90% above. Year to date, the Trust is

now 3% above contracted activity plan and more than 12% 2015/16 YTD activity.

Activity Recording - Percentage variance from contracted activity plan (NHSE

Contracted Activity) 3.0% -6.0% 3.0% 2.0% -1.0% 0.0% 0.0% 3% Activity recorded against our Specialist Services contracts is 0.04% below target in October and in the

year to date.

##

Adults - Mean length of acute inpatient stay on discharge (Trimmed to exclude <3

and >90 days) 29 26 27 25 20 27 29 25

##

Adults - Mean length of acute inpatient stay on discharge (Untrimmed) 35 36 46 44 34 35 34 35

##

Adults - Median length of acute inpatient stay on discharge (Untrimmed) 28 26 25 28 22.5 28 23.5 28

##

Adults - percentage people on the acute inpatient caseloads that have had stays of

over 100 days 16.2% 13.7% 16.2% 15.7% 12.5% 13.1% 13.4% 25%

##

Older People - Mean length of acute inpatient stay (Untrimmed) 31 50 40 45 167 51 39 40

##

Older People - Median length of acute inpatient stay (Untrimmed) 36 45 25 28.5 15 28 23 40

##Mental Health DNA Rates (Excluding CRHTs) 8.7% 8.5% 8.4% 8.6% 6.9% 7.8% 6.9% 10%

##- Mental Health DNA Rates - Adults 9.4% 9.2% 9.0% 9.6% 7.4% 9.2% 8.1% 11%

## - Mental Health DNA Rates - Older Adults 4.1% 4.2% 3.5% 2.9% 2.6% 2.8% 2.6% 4%

## - Mental Health DNA Rates - CAMHS 10.4% 10.5% 11.3% 10.3% 11.6% 9.3% 8.0% 10%

## Memory Clinic Number of Referrals 151 148 176 146 174 135 150

## Memory Clinic: Average No of weeks from Referral to Assessment 8.30 8.17 6.97 5.50 5.60 6.67 5.18

## Memory Clinic :Average No of weeks between Assessment Appointment &

Dementia Start Date 5.97 4.03 4.43 4.87 4.03 4.53 4.11

Management continues to address lengths of stay over 100 days. Total number of discharges were

lower than the previous month, the decrease in both the median and mean untrimmed values

relates to patients over 100 days having lower lengths of stay on discharge.

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Target Comments

2016/17

Enfield Community Services

District Nursing

% of urgent referrals responded to within 4 hours 100% 100% 100% 100% 100% 100% 100% 90%

% of referrals responded to within 48 hours 100% 100% 100% 100% 100% 100% 100% 90%

% of urgent referrals to OOH nursing responded to within 4 hours 100% 100% 100% 100% 100% 100% 100% 90%

Community Physio

% of urgent referrals seen within 5 working days 100% 83% 100% 100% 100% 100% 100% 90%

% of routine referral seen within 8 weeks 75% 72% 79% 81% 77% 73% 82% 90%

While performance has improved, the service is still working with 5.5 WTE vacancies. Several

recruitment drives yielded one new band 6 in Neurology. With no other band 6 candidates, a band 7

post will be advertised in November, although a further band 4 vacancy is also anticipated in

November.

Service delivery is routinely reviewed in clinical supervision, prioritising more acute patients. The

service aims to develop more senior physio’s through internal development, but this will take time.

Physio MSK

% of urgent referral seen within 5 days None None None None None None 100.0% ### 90%

% of patients whose first appointment is within 13 weeks 75% 74% 74% 70% 69% 72% 65% 80%The service still has 4 vacancies in a team of 17.5 WTE. The last two recruitment drives have been unsuccessful.

Podiatry

% of non-urgent referrals assessed within 13 weeks 59.7% 82% 93% 89% 91% 90% 90% 90% The service is now fully established having successfully recruited 3 new staff.

% of urgent referrals responded to within 48 hours 100.0% 100% None 100.0% 100.0% 100.0% None ### 90%

Safeguarding Children and Young People

% up to date with required Level 1 & 2 safeguarding Training 92.6% 94% 94% 97% 97% 95% 94% 80%

% up to date with required Level 3 Safeguarding training 92.0% 92% 91% 92% 91% 92% 86% 80%

% of Health Visitor child protection supervision sessions completed within 3 months timescale 100.0% 94% 92% 100% 94% 100% 100% 90%

% of School Nurse child protection supervision sessions completed within the previous term 100%

Children Looked After

% health assessments carried out by the specialist nurses within timescale 100% 100% 100% 100% 100% 100% 100% 95%

New-born Health Visiting

% of new birth assessments carried out between 10-14 days 96.4% 96% 96% 98% 96% 95% 97% 95%

SaLT - Early Years Drop-In % Referrals (following drop-in assessments) for specialist interventions, that are seen within 13 weeks 99.0% 100% 100% 100% 100% 100% 94% 75%

Children's Physio (MSK)

% Routine referrals for initial Physio assessment seen by 13 weeks 98.0% 98% 100% 98% 99% 96% 100% 85%

Children's Occupational Therapy

% Complex referrals for initial OT assessment seen by 13 weeks 100.0% 100% 100% 100% 100% 100% 100% 95%

100%

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f

Early Intervention in Psychosis (EIP) Access Standard

The EIP Access Standard requires that 50% of first episodes of psychosis are taken onto an EIP caseload, allocated a care coordinator and have commenced a NICE concordant care package within two weeks of psychosis suspicion. The clock continues to run regardless of clients failing to attend appointments. BEH EIP teams removed their age limit in November 2015. Alongside trustwide awareness raising, this prompted a spike in referral numbers . Delays in referring to EIP teams were largely addressed through regular meetings with EIP , CRHT, Assessment Service and Liaison Service managers. This has substantially reduced waits over 6 weeks that tended to result from late referral to the teams while people were treated in other areas. While referrals are still occasionally delayed, the current challenges relate more to the volume of referrals to the teams themselves. The quality of information offered in referrals is being addressed through new guidance and checklists to 'feeder' teams. There are three separate groups - one led by CCG colleagues - aiming to address the remaining challenges. The worked example in this flow diagram illustrates the four points of concern that we are seeking to fix: ① - The sheer number of referrals is overburdening the team - the guidance and pre-referral checking aims to reduce this and we have started to see improvement in May. ② - The number of assessments is expected to remain fairly static, but more resource will be available and joint assessments will be prioritised by other teams, such as CRHTs ③ - Promoting closer working between Assessment Services, CRHTs and EIP Teams is expected to reduce (albeit slightly) the proportion of cases that are reasonably suspected to be FEP, but are ultimately better served by other teams so excluded from the standard.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Ap

r-1

5

May

-15

Jun

-15

Jul-

15

Au

g-1

5

Sep

-15

Oct

-15

No

v-1

5

De

c-1

5

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

Pe

rce

nta

ge o

f ca

ses

me

eti

ng

14

day

tar

get

Trustwide percentage compliance with 2-week access standard

Actual

Target

B E H B E H B E H B E H B E H B E H B E H B E H B E H B E H B E H B E H B E H B E H B E H B E H B E H B E H B E H

Apr-15 May Jun Jul Aug Sep Oct Nov Dec Jan-16 Feb Mar Apr May Jun Jul Aug Sep Oct

12+ 1 1 1 2 1 1 0 1 1

9-11 1 1 1 1 1 1 0 0 1 1 1 0 0 1

6-8 1 1 1 4 1 1 1 1 1 1 1 1 1 0 3 2 1 0 0 0 1 1

3-5 1 5 3 2 2 1 1 2 3 1 1 2 3 1 4 3 1 0 2 5 4 3 2 6 3 5 5 2 3 5 1 4 2 4 4 2 1 2 1 5 2 3 1 2 2 1 1 1

0-2 7 11 2 3 7 3 8 4 5 7 5 3 4 2 4 4 3 4 7 1 5 8 11 7 4 3 11 6 1 7 6 2 5 2 2 0 2 4 2 3 4 3 3 1 5 2 3 5 2 5 2 3 4 3 7 2

0

2

4

6

8

10

12

14

16

18

20

Nu

mb

er

of

case

s

All EIP Patients - Weeks waited by team and by month

12+

9-11

6-8

3-5

0-2

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct

Barnet 100% 43% 67% 64% 80% 67% 64% 73% 50% 58% 75% 33% 33% 75% 60% 100% 0% 100% 75%

Enfield 100% 70% 67% 63% 40% 43% 50% 65% 60% 14% 40% 33% 50% 67% 50% 43% 50% 60% 78%

Haringey 50% 60% 60% 80% 40% 60% 83% 55% 61% 50% 50% 0% 50% 50% 71% 63% 83% 67% 40%

Target 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50%

0%

20%

40%

60%

80%

100%

% W

ith

in 2

We

eks

EIP % RTT within 2 weeks - by borough

0

10

20

30

40

50

60

70

80

90

Ap

r

May Jun

Jul

Au

g

Sep

Oct

No

v

De

c

Jan

Feb

Mar

Ap

r

May Jun

Jul

Au

g

Sep

Oct

Re

ferr

als

to E

IP t

eam

s

Referrals to EIP teams by month

Haringey

Enfield

Barnet

① 50 people referred

②

23 people assessed ③

15 people taken on

18 People eligible

27% inappropriate 35% not FEP post-

assessment Some excluded from the

standard

④ DNA rate ≈30%

4-5 breaches

Page 42

BEH-MHT – Trust Board – 28.11.2016 2.3 – Financial Performance Report

Title:

Financial Performance Report (Month 7 / October 2016)

Report to:

Trust Board

Date:

28 November 2016



Purpose of Report: This is a regular report to the Board, intended to provide an update on the year to date Financial Performance. The report provides details about the Trust’s Income & Expenditure, Cost Improvement Programme (CIP), Cash Flow, Capital Expenditure, and the Financial Risk Rating. This report was considered at the Finance and Investment Committee at their meeting on 21 November 2016. Any updates as a result of discussion at that meeting will be verbally reported. Recommendations: The Trust Board is asked to note the year to date financial performance. Sponsor:

Simon Goodwin, Chief Finance and Investment Officer


This is the regular report to the Trust Board which provides an update on the current financial position of the Trust.

Report Author:

Name: Simon Goodwin Title: Chief Finance and Investment Officer Tel Number: 020 8702 3028 E-mail: [email protected]

Report History:

Regular Report


The report sets out the year to date financial performance.


None.


Achievement of the Trust’s financial and business plan targets is fundamental to the achievement of objective 1.3 – Meeting all our quality and performance targets, and 3.1 – Developing a long term clinical and financial sustainability plan with our commissioners.

List of Appendices:

Financial Performance Report (Month 7 / October 2016)

Page 43

BEH-MHT – Trust Board – 28.11.2016 2.3 – Financial Performance Report


Page 44

1

Trust Board

Finance Report to 31st

October 2016

Contents Page

1. Financial Performance Overview 2

2. Financial Summary – Income and Expenditure 4

3. Cost Improvement Monitoring 6

4. Balance Sheet 8

5. Monthly Actual and Rolling 12 Month Cash Flow Forecast

9

6. Capital Expenditure 11

7. Single Oversight Risk Rating 13

Page 45

2

1. Financial Performance Overview

Achievement of Forecast

Budget Actual Variance

Month 7 (962) (894) 68Year to Date (7,056) (7,287) (231)Forecast (12,589) (12,589) 0

£'000s

Financial performance at the end of month 7 is a deficit of £7,287k against a planned deficit of £7,056k.

The forecast outturn remains a deficit of £12.6m.

Budget/Actual - Surplus/(Deficit) Variance to Budget - Favourable/(Adverse)

Actual deficit better than plan by £67k in month. Continued pressure from expenditure on private beds of £318k in month (£1,998k YTD). However this is offset

by reserves; The forecast outturn remains a deficit of £12.6m. The continued use of private beds is the most significant risk to the achievement of the forecast outturn.

Cost Improvement Programme (CIP)

CIP performance is worse than planned by £36k in month and is worse than planned YTD by £68k. The risk adjusted forecast is that the target of £4.1m will be exceeded by £94k. Service Lines are continuing to work on their CIP proposals for 2017/18 and 2018/19. These will be presented

to the Integrated Performance meetings during November for discussion. Key Areas of Risk

Increased use of private beds, however the forecast assumes that the current level of usage continues, which is an average of 7 private beds per night in addition to the 10 block purchased beds from ELFT;

Costs arising from the action plan following the CQC inspection (up to £1m in year); Decorating and furniture costs that are not able to be capitalised (estimated at up to £0.5m); Increased costs from the implementation of the new Junior Doctors contract (up to £0.1m in year); Slippage on identified CIPs (up to £0.3m worse than the risk adjusted forecast).

Actions to achieve the Forecast Outturn

Bed management continues to be closely monitored at the fortnightly Improvement and Delivery Board. Discharge Intervention has transferred to borough responsibility. Plans are being drawn up to also transfer responsibility for bed management to borough teams;

Improvement and Delivery Board held every 2 weeks, chaired by the Chief Executive, focussed on review of the financial position, progress on CIP development, external placements,CQC actions, implementation of improvement methodology and workforce;

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3

PMO focus on briging forward “quick wins” for savings such as stationery, printing and hospitality . This includes a review of stationery stocks with a potential to ban stationery ordering until the end of the financial year, and communications advising staff to think about the need to print in colour or even at all ;

Next Haelo Improvement Collaborative workshop to be held on 21 November. Cash

The graph below shows the actual and forecast cash position. The favourable YTD variance of £6.5m is mainly due to debt recovery performing at better levels than planned (£1.0m), provisons being utilised later than planned in the year (£1.0m) and creditors continuing at higher than planned levels (£4.5m) due to specific creditors remaining unpaid whilst disputes are resolved (NHS Property Services and Royal Free Hospital) and accrued inocme being higher than planned. For further details see section 5.

Single Oversight Risk Rating

The Trust scores 3 against the new NHS Improvement Single Oversight Risk Assessment Framework for both year to date and forecast outturn. This is detailed in section 7 of this report.

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4

2. Financial Summary Year to Date - Income and Expenditure

The table below shows the values for planned and actual performance against the budgeted deficit of £12.6m submitted to NHS Improvement in April. NHS Improvement informed us of a Control Total of £9.1m, £3.5m less than the budgeted deficit for the year. Year to date performance continues to suggest that the Control Total remains unachievable. Annual Forecast

Budget Budget Actual Variance Budget Actual Variance Outturn

£000's £000's £000's £000's £000's £000's £000's £000's

186,497 Patient Care Income 15,647 15,638 (9) 108,688 108,793 105 186,4977,911 Non Patient Care Income 701 634 (67) 4,629 4,833 204 7,911

(149,593) Pay (12,516) (12,636) (121) (86,828) (88,883) (2,055) (149,593)(44,388) Non Pay (3,710) (3,464) 246 (25,952) (24,419) 1,534 (44,388)

426 EBITDA 123 172 50 536 324 (212) 426

0% EBITDA % -1% -1% 0% 0% 0%

- Profit/(loss) on asset disposal - - - - - - - - fixed asset impairment - - - - - - -

(6,350) Depreciation and Amortisation (529) (536) (7) (3,704) (3,802) (98) (6,350)(6,282) PDC Dividend (524) (502) 22 (3,665) (3,602) 63 (6,282)

(383) Interest payable (32) (30) 2 (223) (216) 7 (383)- Interest Receivable - 1 1 - 9 9 -

(12,589) Surplus / Deficit (962) (894) 68 (7,056) (7,287) (231) (12,589)

- Fixed Asset Impairments - - - - - - 0(12,589) Surplus / Deficit including impairments (962) (894) 68 (7,056) (7,287) (231) (12,589)

Mth 7 YTD Mth 7

Summary: The Trust's financial performance at the end of month 7 is a deficit of £7,287k against a budgeted deficit of £,7,056k, giving an adverse YTD variance of £231k. The in-month position is £68k better than budget. Income

Total income is worse than plan by £76k in month (£309k better than budget year to date); Patient care income is in line with budget in month, £105k better than budget YTD; Additional income of £38k in month is matched by expenditure on pay in relation to t he Community Crisis

Response Service and the continuation of A&E Liaison Winter Pressures funding; Non patient care income is worse than plan by £67k in month, £204k better than plan year to date; There is £137k of unbudgeted commercial income YTD, which are mainly small amounts across a number of

areas but includes £29k for the use of St Ann’s for filming; Education and training income is also better than plan by £92k YTD.

Pay

The monthly pay bill was £121k over spent in month, £2,055k YTD. Of the over spend on pay, £17k relates to the additional income for the Community Crisis Response Service

and A&E Liaison mentioned above; Enfield are over spent by £29k in month, but this improvement is due to budget being allocated for unfunded

post in the Discharge Intervention Team and in Complex Services. Actual expenditure has only reduced by £40k;

Haringey have returned to an over spent position in month of £88k, compared to being on budget in September. Adjustments were made to junior medical budgets last month which benefited Haringey’s in month position. The main movement is within CAMHs which is now £50k over spent in month;

The Specialist Services financial position has improved substantially from September, and is now better than budget for pay by £26k;

Barnet is £132k better than budget in month. This is due to vacancies across the Community Teams; Corporate is £202k worse than budget in month, however this is due to the allocations of funding from

Reserves.

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5

Non Pay

Non Pay is under spent by £246k in month and £1,534k year to date; This includes over spends of £318k in month (£1,998k YTD) relating to private bed usage and £602k YTD

relating to unidentified CIP and CIPs that are shown as achieved but for which budgets have not been adjusted. Reserves have been released to manage this pressure.

Other Expenditure

Relates to the PDC dividend, depreciation and interest payable; £17k better than budget in month and £20k over spent year to date.

Other Emerging Issues

NHS England have not yet adjusted the contract to reflect the level of QIPP that the Trust has identified as achievable. A meeting is being held on 15 November with NHSE to discuss this;

There has been no further progress on the issues reported last month relating to: o NHS Property Services rental charges; and o CAMHs Future in Mind funding.

The above issues have all been included in the Trust’s response to Commissioning Intentions; The Trust has been successful in a joint funding bid with Camden and Islington NHS Trust for perinatal mental

health funding, for which mobilisation will commence immediately; Winter pressures funding has been allocated for a Crisis Lounge at North Middlesex Hospital and an extended

Intermediate Care provision in Enfield Community Service.

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6

3. Cost Improvement Programme Monitoring 2016/17

The table below shows the performance against the CIP target at month 7.

Month

Plan

Month

Achieved Variance Plan YTD

Achieved

YTD Variance

Full Year

Plan

Forecast

Outturn Variance

Full Year

Effect

£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000

Barnet 28 32 4 100 142 42 334 300 (34) 401Enfield 74 90 16 319 440 121 746 890 144 660Haringey 23 22 (1) 147 147 0 270 270 0 377Specialist Services 42 39 (3) 192 302 110 507 507 0 311Corporate 83 62 (21) 446 331 (115) 864 642 (222) 864Estates 111 84 (27) 787 590 (197) 1,333 1,411 78 1,334Trust wide 4 0 (4) 29 0 (29) 50 178 128 278Total 365 329 (36) 2,020 1,952 (68) 4,105 4,198 94 4,225

Barnet

Ahead of target year to date by £42k Ahead of target by £4k in month. No further schemes confirmed for this year, however it is proposed that this is covered by cost per case

income on Ken Porter ward. Enfield

Ahead of target in month and year to date, and are forecast to exceed their CIP target for the year by £144k. Haringey

On target in month and year to date. On track to achieve CIP target for the year.

Specialist Services

Behind target by £3k in month and ahead of target by £110k year to date. On track to achieve CIP target for the year. £90k of identified CIPs for the year are non-recurrent.

Estates

Behind plan by £27k in month and £197k year to date. Forecast outturn is full achievement of the CIP target for the year. £118k has been agreed by Estates so far

and discussions are ongoing for the remainder.

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7

2017/18 onwards Progress

There is an overall drive to bring forward the implementation of schemes so that savings are starting to be realised in 2016-17. Initiatives around printing and taxis have already been launched, such as in Specialist Services.They are forecasting a reduction in taxi usage of between 50% and 75%. This equates to a saving of approx. 6k within the 2016-17 financial year if continued;

The Psychology Workforce review has commenced with a review of the workforce establishment and finance data. Once any anomalies have been addressed, the project will move to the evaluation of the current structure against case mix and activity;

A meeting has been held with Chief Pharmacist to look at savings from medicines management and an action plan has been started to reduce paliperidone prescriptions to deliver additional in-year savings, and to renegotiate supply and distribution of medicines across Trust;

The Project Management Office (PMO) team are now supporting the Enfield senior team in delivery of their recovery plan;

The PMO supported the development of a Translation Proposal for submission into EMT; A meeting has been held with Estates to look at possible schemes which are being developed into proposals

to be considered by the Exec team; A new substantive PMO Project Manager and Head of PMO have been appointed.

Next Steps

Both Haringey and Barnet will have further workshops focussing on the 2017-19 CIPs; Push forward the implementation of schemes around hospitality and procurement. For example, savings

made by reducing spend on white goods, stationery and gloves; The new protocol and criteria for the use of taxis, developed and deployed in Specialist Services is to be

rolled out across other boroughs; The PMO are working with the Head of Contracts to progress the set up of new Translation Contact; The PMO are working with Finance to confirm the exact savings generated from schemes and when it will

actually impact budgets; The PMO are supporting Clinical Directors in forthcoming presentations of their CIP proposals to the

Integrated Performance meetings during November. Risks / Issues

There are not yet schemes identified for 2017/18 that mean the Trust will achieve its minimum CIP target of 4%;

A full set of Schemes for 2018/19 within boroughs are yet to be scoped out even at an ideas stage; Maintaining ownership and leadership with the Borough teams to deliver schemes and to keep the pace in

terms of engagement between the PMO team and Borough teams in progressing work.

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8

4. Balance Sheet

Annual

plan

Opening

B/Sheet YTD plan

YTD

Actual

YTD

Variance

Year end

forecast

Forecast

variance

207,419 Total Non-Current Assets 207,374 205,681 204,920 (761) 204,998 (2,421)

Current Assets

92 Inventories 92 92 115 23 92 012,107 Receivables 14,492 11,810 10,795 (1,015) 12,107 01,174 Cash at Bank & in Hand 3,727 1,076 7,599 6,523 1,174 0

13,373 Total Current Assets 18,311 12,978 18,509 5,531 13,373 0

Current Liabilities

(24,441) Payables (25,257) (23,416) (30,370) (6,954) (24,562) (121)(10,700) Borrowings 0 (2,500) 0 2,500 (9,100) 1,600

(498) Loan, Current portion (498) (498) (496) 2 (498) 0(398) Other current liabilities (2,124) (1,068) (2,030) (962) (398) 0

(36,037) Total Current Liabilities (27,879) (27,482) (32,896) (5,414) (34,558) 1,479

184,755 Non-Current Assets/Liabilities 197,806 191,177 190,533 (644) 183,813 (942)

(9,754) Creditors > 1 Year (10,307) (10,029) (10,224) (195) (9,752) 2(9,754) Total Non-current (10,307) (10,029) (10,224) (195) (9,752) 2

0175,001 Total Assets Employed 187,499 181,148 180,309 (839) 174,061 (940)

Taxpayers and Others Equity

147,814 Public dividend capital 147,814 147,814 147,815 1 147,814 0

(53,370) Retained Earnings (39,720) (47,223) (46,910) 313 (52,939) 431

80,557 Revaluation Reserve 79,405 80,557 79,405 (1,152) 79,186 (1,371)175,001 TOTAL 187,499 181,148 180,309 (839) 174,061 (940)

Non-Current Assets: The variance arises from a combination of factors. The first of these is the impact of the year end revaluation of land & buildings only being finalised after the plan figures were produced, which impact s both opening position and in year depreciation charges. The second factor is the impairment of the wheelchairs transferred to London Borough of Enfield with a third factor being a slippage in the capital programme YTD. The final factor which affects only the FOT variance is that it is now forecast that Baytree House will be disposed of in quarter 4 of 2016/17, which was not included in the original plan. Cash: The favourable variance of £6.5m in cash is mainly due to debt recovery performing at better levels than planned (£1.0m) and creditors continuing at higher than planned levels (£7.0m) due to deferred income and specific creditors remaining unpaid whilst disputes are resolved (NHS Property Services and Royal Free Hospital) . Current Assets: Current receivables are £10.8m at 31 October, £1.0m above plan. This is due to successful debt recovery efforts.

Total Current Liabilities: Current liabilities (authorised invoices, accruals and deferred income) are £5.4m higher than planned. This is mainly due to the £5.0m adavcne payment of SLA icome by local CCGs and and some specific cases where payment is being withheld whilst disputed amounts are investigated and resolved whilst provisions are £1.0m higher due to the utilisation occurring later than planned. Reserves: The variance against plan arises from the impact of the year end revaluation of land & buildings only being finalised after the plan figures were produced and both the impairment of the wheelchairs transferred to London Borough of Enfield and the forecast disposal of Baytree House which were not included in the plan.

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5. Monthly Actual and Rolling 12 month Cash Flow Forecast at 31st October 2016

Actual Actual Actual Actual Actual Actual Actual Actual Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast

M12

15/16

M01

16/17

M02

16/17

M03

16/17

M04

16/17

M05

16/17

M06

16/17

M07

16/17

M08

16/17

M09

16/17

M10

16/17

M11

16/17

M12

16/17

M01

17/18

M02

17/18

M03

17/18

M04

17/18

M05

17/18

M06

17/18

M07

17/18

Receipts from Operations

NHS SLA Income Receipts 12,238 11,763 11,763 14,565 13,638 13,484 13,639 13,467 13,763 13,763 13,763 13,763 8,763 13,588 13,588 13,588 13,588 13,588 13,588 13,588Other Clinical Income 579 579 579 345 1,374 1,401 583 1,605 579 579 579 579 579 567 567 567 567 567 567 567Receipts from Local Authorities 1,117 1,117 1,117 529 801 634 645 640 1,117 1,117 1,117 1,117 1,117 1,095 1,095 1,095 1,095 1,095 1,095 1,095Research, Education and Training 373 373 373 378 399 376 388 381 373 373 373 373 373 366 366 366 366 366 366 366Other Non Clinical Income 529 758 758 301 248 248 273 254 758 758 758 758 758 743 743 743 743 743 743 743VAT 400 395 457 227 141 106 369 617 240 240 240 240 240 235 235 235 235 235 235 235Total Receipts from Operations 15,236 14,985 15,047 16,345 16,601 16,249 15,897 16,964 16,830 16,830 16,830 16,830 11,830 16,594 16,594 16,594 16,594 16,594 16,594 16,594

Operating Payments

Monthly Payroll ( Net pay) (6,250) (6,360) (6,432) (6,558) (6,465) (6,573) (6,519) (6,664) (6,400) (6,400) (6,400) (6,400) (6,400) (6,400) (6,400) (6,400) (6,400) (6,400) (6,400) (6,400)Statutory & Other Deductions from payroll (4,500) (4,455) (5,214) (5,113) (5,108) (5,159) (5,192) (5,112) (5,200) (5,200) (5,200) (5,200) (5,200) (5,200) (5,200) (5,200) (5,200) (5,200) (5,200) (5,200)Non Pay (4,433) (4,269) (3,297) (5,587) (5,945) (5,689) (5,538) (5,368) (5,771) (5,768) (5,769) (5,769) (5,766) (5,430) (5,430) (5,430) (5,430) (5,430) (5,430) (5,430)Total Payments on Operations (15,183) (15,084) (14,943) (17,258) (17,518) (17,421) (17,249) (17,144) (17,371) (17,368) (17,369) (17,369) (17,366) (17,030) (17,030) (17,030) (17,030) (17,030) (17,030) (17,030)

Net Cashflow from Operations 53 (99) 104 (913) (917) (1,172) (1,352) (180) (541) (538) (539) (539) (5,536) (436) (436) (436) (436) (436) (436) (436)

Other:

PDC dividend (2,714) (3,432) (3,141) (3,141)Loan repayment (246) (249) (248) (248)Interest Paid (187) (186) (179) (179)Capital Expenditure (1,619) (54) (162) (196) (182) (311) (154) (255) (458) (696) (855) (983) (1,344) (600) (500) (500) (500) (500) (500) (500)Capital slippage Non recurrent income 3,100Interim Support received 2,200 2,200 8,000 2,000 1,000 900 600Interest Received 0 1 1 1 1 2 1 1Movement in Creditors 2,216 (253) (3,354) 1,375 1,032 6,967 (2,227) (1,918) (4,293) (550) (600) (3,900) 2,966 (100) (100) (100) (100) (100) (100) (100)Movement in Debtors 980 (1,288) 3,889 2,236 (3,107) (5,877) 8,529 5,464 500 600 150 0 (509) (1,000) 100 100 100 100 100 100Other Movements (2,296) (4) 19 590 231 515 254 502 (5) (598) (5) (5) (79) (4) (4) (4) (4) (4) (4) (4)Net Movements in Other items (3,866) (1,598) 393 4,006 (2,025) 1,296 2,536 3,794 (4,256) (1,244) 890 412 5,466 296 496 396 96 (504) (4,072) (504)

Net Cash flow Movement in Month (3,813) (1,697) 497 3,093 (2,942) 124 1,184 3,614 (4,797) (1,782) 351 (127) (70) (140) 60 (40) (340) (940) (4,508) (940)

Bal b/fwd 8,324 3,727 2,030 2,527 5,620 2,678 2,802 3,986 7,599 2,802 1,020 1,371 1,244 1,174 1,034 1,094 1,054 714 (226) (4,734)Bal C/fwd 4,511 2,030 2,527 5,620 2,678 2,802 3,986 7,599 2,802 1,020 1,371 1,244 1,174 1,034 1,094 1,054 714 (226) (4,734) (5,674)

Original plan bal c/fwd 2,867 2,386 4,169 2,911 1,654 1,077 1,075 1,025 1,060 1,014 963 1,174Actual/Forecast Variance against plan (837) 141 1,451 (233) 1,148 2,909 6,524 1,777 (40) 357 281 0

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10

Monthly Actual and Rolling 12 Month Cash Flow Forecast (cont.) The cash flow forecast and forecast cash balances are based on the 2016/17 financial plan submitted to the NHSI on 15 April 2016. The cash position at 31 October 2016 was £7.6m, £6.5m above the 2016/17 plan. This is largely due to creditors being greater than planned due to deferred income arising from advance SLA payments by the local CCGs and payment being withheld in a couple of specific cases whilst disputes are resolved. Due to the Trust continuing to operate at a deficit position the Trust will require cash support from NHSI in 2016/17. It has previously been forecast that the initial cash support would be required in September 2016 when it would be needed to meet the PDC and loan repayment requirements. However the Trust has successfully negotiated an advance payment of £5.0m in month 6, from the 3 main commissioners, this now means cash support is not forecast to be required until quarter 4. The total cash support available from NHSI in 2016/17 has now been confirmed at £12.6m and it is forecast that £12.4 will be required. The cash support is forecast to begin in the final quarter of 2016/17. This plan reflects anticipated movements in debtors and creditors based on historical performance. This cash position will continue to be closely monitored with potential variances being identified as soon as possible and appropriate actions implemented. The underlying position of cash support being required due to the I&E deficit position impacting on cash reserves remains the same in the longer term.

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11

6. Capital Expenditure

Plan DescriptionMonth

Actual

Month

VarianceYTD Actual

YTD

Variance

Year end

forecast

Forecast

variance

£000 Projects £000 £000 £000 £000 £000 £000

157 Statutory Compliance Projects 1 (4) 12 (126) 102 (55)990 Risk Management Projects 19 9 124 (226) 673 (317)820 Backlog Maintenance Projects 12 (34) 59 (20) 187 (633)

3,720 Information Technology Projects 154 (303) 908 (761) 2,887 (833)100 St Ann's redevelopment 0 0 23 16 800 700577 Other Projects 69 39 196 (195) 1,001 424

(714) Contingency 0 0 0 0 0 7145,650 Total 255 (294) 1,322 (1,313) 5,650 0

Funding

6,350 Depreciation (non cash) 536 (7) 3,802 98 6,350 00 Borrowings 0 0 0 0 0 00 Asset sales 0 0 0 0 3,100 3,100

(700) Working capital (281) (287) (2,480) (1,411) (3,800) (3,100)5,650 Total 255 (294) 1,322 (1,313) 5,650 0

The capital programme approved by the Board in March 2016 was for a total expenditure of £5,650k, although individual projects identified in the paper totalled £6,364k, leaving unidentified reductions of £714k required. A capital prioritisation meeting in June identifed net reductions of £606k which left a remaining risk of £108k of programme reductions still to be identified

A further capital prioritisation meeting took place in September to further review and prioritise the projects. This identified an additional £1,410k of savings to the programme resulting in a net £1,302k underspend on the programme/available for new projects. The main savings identified were:

IT projects 700

Anti Ligature (windows) 310

Cyclical Refurbishment Programme (TW) 100

Furniture Budget 70

Design team fees 50

Clinic room cooling 45

Provision for the installation of Trust Wide CCTV 31

Misc others 104

1,410

The Trust’s Capital Resource Limit )(“CRL”) will remain unchanged at £5,650k for 2016/17 but any underspend against this will result in an improved cash position/ reduced borrowings at 31 March 2017 compared with plan. However, the year end foreacts remains at £5,650k due to anticipated increases in the capital programme in 2016/17 on the St Ann's redevelopment and refurbishment costs for the Seacole building at Chase Farm.

The capital programme will continue to be reviewed on a regular basis in light of the Trust’s cash position and the changing capital priorities.

At the end of October capital expenditure is £1,313k under plan for the year to date. This underspend is due to the changes to the components and phasing of the capital programme compared with the original plan and is forecast to be fully recovered in 2016/17.

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12

Cumulative capital spend and forecast v plan

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13

7. Single Oversight Risk Rating

As reported in the September 2016 board report, NHSI have issued a new Single Oversight framework with effect from 1 October 2016. This includes a Use of Resources (“UoR”) rating to replace the current Financial Sustainability Risk Rating. The new UoR contains the existing 4 metrics but also has an additional metric relating to agency spend. All 5 metrics have equal weighting and the new ratings are still on a 1-4 range but with 1 now representing the best outcome and 4 the worst. Currently the Trust’s FOT position results in a rating of 3. If the final deficit were to be worse than plan this rating would change to a 4. NHSI have stated that the new UoR ratings calculated in 2016/17 will not be used to identify any concerns or consequent support needs at providers in 2016/17. Instead they will be reviewed and used to consider how best to introduce them formally, with detailed definitions and thresholds if appropriate, in 2017/18 On this basis a FOT rating of 3 would potentially raise comment but not automatically lead to further measures.

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Page 58

BEH-MHT – Trust Board – 28.11.2016 3.1 - Clinical, Quality and Safety Report

Title:

Clinical, Quality and Safety Report

Report to:

Trust Board

Date:

28 November 2016



Purpose of Report: The purpose of the Clinical, Quality and Safety report is to provide an indication of the Quality and Safety of our services. It will outline key quality developments which are occurring and areas which may require further work to address variation in standards of practice. This report should be read in conjunction with the Integrated Performance and Quality Dashboard.

Recommendations: The Trust Board is asked to consider the report and discuss any further actions or assurance they require in respect of the Clinical Quality and Safety of Trust services. Report Sponsor:

Mary Sexton, Executive Director of Nursing, Quality and Governance


This report highlights the key work undertaken across all Trust services and demonstrates that supporting patients and carers and ensuring they have a positive experience/outcome remains a priority.

Report Author:

Name: Mary Sexton Title: Executive Director of Nursing, Quality and

Governance Tel Number: 020 8702 3032 E-mail: [email protected] Name: Gillian Kelly Title: Deputy Director of Nursing and Governance Tel Number: 020 8702 6051 E-mail: [email protected]

Report History: Regular Report


None


None


Action taken will assist in delivering our objective of ‘Providing excellent services for patients’.

List of Appendices: None

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Report

1. Introduction and Background 1.1 The Clinical, Quality and Safety Report supplements the Integrated Performance and

Quality Dashboard by outlining the key clinical, quality and safety areas which the Executive Director of Nursing, Quality and Governance would like to bring to the attention of the Board.

2. CQC MHA monitoring visits and actions 2.1 Ken Porter Ward – 30/08/16

The visit feedback was positive, the only concerns raised by the visiting commissioner were in relation to staffing; it was noted that no Occupational Therapist (OT) or Psychologist was currently in post, and ward staff indicated to the commissioner that they would like the nursing staff establishment to be increased. The response noted that a substantive OT for the ward had already been recruited and was due shortly to start, and detailed the service’s plans to recruit to the ward’s nursing vacancies and review the ward activities programme with consideration given to psychological therapies.

2.2 Tamarind Ward – 07/10/16

We are yet to receive written feedback from this visit. 2.3 Fennel Ward – 18/10/16

We are yet to receive written feedback from this visit. 2.4 Severn Ward – 19/10/16

We are yet to receive written feedback from this visit. 2.5 Thames Ward – 25/10/16

We are yet to receive written feedback from this visit. 3. Infection Control Update: September and October 2016

Good infection prevention and control including cleanliness is essential to ensure service users receive safe and effective care. The trust has implemented a number of measures such as regular infection control training for all staff, have updated infection control policies in place, and undertake regular of audits of the clinical environment to reduce the risks of infections. All this information is fed back to the relevant service, and discussed at the quarterly Deep Dive meetings and Infection Control Committee. Below is a summary of infection control activities for September and October 2016.

3.1 Infection Control Training 3.1.1 The trust offers infection control training to all staff on their induction and this followed by a

three yearly update delivered either face to face or the infection control E-learning module. There are two modules; one for clinical and one for non-clinical staff. The Trust induction includes hand washing training for all staff. The Infection Control Team delivers hand washing training to services and teams where requested and where they are concerns.

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3.1.2 The trust internal training target is 85% although this will be changing to 90%. To deliver the

new target extra training has been provided from September 2016. 3.1.3 Training uptake was at 86% in September and 85% in October. The slight drop reflects a

small increase in the total workforce. 3.2 Hand washing audit results and discussions 3.2.1 The hand washing audit monitors compliance with the hand washing policy. Standards

within the audit tool include; whether staff are washing their hands before and after delivering an episode of care, whether staff are the wearing any nail varnish, wrist watches and rings (except for a plain band ring) and hand washing technique.

3.2.2 Audits are carried out monthly in inpatient areas and quarterly in outpatient services. The

trust internal compliance target is 90% and above. A score below 90% is an indicator of potential concerns and these areas are supported to improve their score.

3.2.3 During September and October, a total of 97 audits hand washing audits were completed in

inpatients and outpatients services compared to 83 in the previous two months. 60 audits were from the inpatients services and 37 were from community clinics. Compliance with hand washing remains good in both inpatients and outpatients services. However compliance with the dress code policy and the bare below the elbows policy is not fully achieved in all areas audited.

3.2.4 A score of 90% and above is seen as compliant however the size of the sample audited

can significantly affect the percentage scores. Blue Nile scored 80% in September and 75% in October 2016. This was due to a different member of staff on each occasion not complying with the bare below the elbow policy. Fairland’s scored 75% in September 2016, and this was due one of the four staff members audited not being compliant with the bare below the elbow policy. Compliance has improved to 100% in October 2016.

3.2.5 There was no return from the Halliwick complex care team in September 2016 however

they completed the audit in October 2016. Compliance was 100%. 3.2.6 Juniper scored 75% in September 2016. Four out of the 16 staff audited did not comply with

bare below their elbow. Compliance had improved to 95% in October 2016. 3.2.7 Sussex ward scored 83% in September 2016 where one out of the six staff audited was not

fully compliant. Compliance improved to 100% in October 2016. 3.2.8 Trent ward score 100% in September 2016 but dropped to 83% in October 2016 with one

out of the six staff audited not complying with the bare below the elbows policy. 3.2.9 There were no returns from 13 community teams in quarter 2 however seven of those

teams have completed the audit in quarter 3. Any failure in submitting returns was addressed with the team managers.

3.2.10 Of the 37 community audits three teams scored below 90% because of poor compliance

with the dress code policy. Dress code standards have been re-iterated. 3.3 Inpatient Hygiene Assurance Audit 3.3.1 The Hygiene Assurance Audit assesses compliance with The Health and Social Care Act

2008: Code of Practice on the prevention and control of infections and related guidance (2015). The tool assesses the following areas for compliance: Bathroom/showers,

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Bedrooms, Clinical room, Domestic room, Kitchen, Laundry room, Sluice room, Store room, Toilets, and Common areas.

3.3.2 Audits are carried out monthly in inpatient areas and quarterly in outpatient services. The

trust internal compliance target is 90% and above. A score below 90% is an indicator of potential concerns and these areas are supported to improve their score.

3.3.3 For September 2016 and October 2016, 75 hygiene assurance audits were completed. Of

those 63 were carried out by infection control link nurses/ward nursing staff and 12 spot checks by the infection control team.

3.3.4 Fairland’s scored 85% on average during the three inspections carried out in September

2016. This had improved to 87% in October 2016 but still below the 90% threshold. Maintaining cleanliness of the clinical environment and the fabric of the building were the main concerns. The wards at St Ann’s remain challenged due to the fabric of the building.

3.3.5 Ken Porter scored 88% in September 2016 after a spot check and this was due to general

tidiness of the cleaner’s room and dust found under some of the bed frames. These were rectified straight way. The score had improved to 99% in October 2016.

3.3.6 The Oaks dropped from 91% in September 2016 to 88% in October 2016 due to variable

cleanliness on the ward at the time of the audits. All of which have been addressed. 3.4 Healthcare Associated Infections 3.4.1 There were no cases of MRSA, MSSA, & E. Coli in September and October. 3.4.2 There were no outbreaks of infection. 3.5 Flu Vaccination Campaign Update 3.5.1 The flu clinics started on the 3rd October and will run until end of February 2017. Clinics are

running daily alternating between all the trust main sites. Additional clinics have been offered at the larger community clinics. Occupational Health are attending large trust meeting for example the Deep Dive meetings, and trust inductions to make it easier for staff to be vaccinated.

3.5.2 The trust has 2261 eligible front line staff and as of week ending 11th November 2016 have

vaccinated 668 eligible members staff (uptake rate 29.5%). This is a significant increase in comparison to last year’s flu campaign.

3.6 Patient-Led Assessment of the Care Environment (PLACE) 3.6.1 Overall the Trust performance was strong when considered in the national context. The

borough based Environment Operational Action Group (EOAG) continues to review local PLACE action plans on a monthly basis ensuring that the identified shortfalls are rectified and any serious concerns are addressed through the Infection Control Committee (ICC).

3.6.2 The PLACE Lead oversees the operational management of the PLACE process and has

responsibility for the Dementia and Disability Lead requirements. Following the 2016 PLACE assessments, the PLACE lead has convened two meetings with key stakeholders to discuss prioritisation of PLACE work / domain improvements for 2016. Outcomes and/or recommendations from these meetings will be provided to the ICC.

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4. Safeguarding Children and Young People and Adults at risk 4.1 The Trust recognises its statutory duties and responsibilities to safeguard children, young

people and adults at risk. The Trust continues to build on existing effective partnership working and remains a key player at the safeguarding Boards for children and adults across the three boroughs of Enfield, Barnet and Haringey. The Trust has contributed to ‘Safeguarding Month’ facilitated by Barnet Safeguarding Children and Adult Boards, for example our Barnet CAMHS staff are conducting workshops for professionals who encounter children and young people who self- harm. It is anticipated that the Trust will contribute in similar ways to the other Borough safeguarding events when they host their respective ‘Safeguarding Months’.

4.2 The Trust continues to be involved in a range of Serious Case Reviews, Safeguarding Adult

Reviews and Domestic Homicide Reviews currently underway across the three boroughs. Reviews at this level take considerable time to complete and the Trust remains responsive to the need for effective partnership working to ensure high level reviews are completed to a satisfactory standard.

4.3 The Trust has recognised the need to improve our response to service users who disclose

domestic violence and abuse (DVA). In order to achieve this we are delighted to report that we have been successful in a business case to secure funding from NHS England to pilot an innovative DVA project. This is an exciting opportunity to demonstrate the difference a dedicated DV worker could make for service users and their families. We have worked closely with Solace Women’s Aid and Safelifes to secure funding to pilot a model based on the current Independent Domestic Violence Advocate (IDVA) model and the model known as IRIS (Identification and Referral to Improve Safety). The two models are different in the way they approach identification of DVA. We believe a combination of both models may be better suited to service users with mental health needs. The project will run over twelve months across Barnet and a working group has been established. It is anticipated that the DVA worker will commence in January 2017. NHS England has indicated their on-going interest in the project.

4.4 Safeguarding activity is monitored by the ISC in the form of a dashboard. The dashboard

has been populated for quarter one and two (2016) and helps the ISC and our partner agencies to have an informed overview of our activity. It is anticipated that as we go forward we will be able to establish baseline trend data. Data gathered so far indicates that Trust staff understand their safeguarding responsibilities; and make appropriate referrals including contributing to the various Channel Panels if there are concerns regarding service users who may be at risk of radicalisation.

4.5 The Trust’s Integrated Safeguarding Committee has agreed the need to deliver level three

safeguarding children training in line with the recommendations of the Intercollegiate document 2014 and the UK Core Skills Training Framework (March 2016).

4.6 This has considerably increased the numbers of adult-focused mental health staff requiring

training. This in turn has had a direct impact on level 3 compliance resulting in a drop from 82 % compliance to 45% compliance (chart 1). The change reflects the national and local recognition of the significant role that our staff have in preventative and responsive safeguarding children. There is no change for adult mental health consultants, team managers, safeguarding children champions, substance misuse teams or for child focused ECS or CAMHS staff who have all been required to undertake level three training for a number of years. The Trust’s training matrix has been updated to reflect the new requirements is and is outlined in the table below.

4.7 We hope to achieve a compliance level of 85% by 31 March 2017. To enable this to

happen and reduce the impact on clinical services, a new model of training has to be established. The model will include a blended approach of face-to face training, team

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discussion, case discussion, and on-line training but should always include some face-to face learning such as the Trust induction day safeguarding programme. Staff will fall into three groups of need depending on the amount, level and timing of prior safeguarding children training they have completed.

4.8 Many staff will have already completed level three safeguarding children learning despite it

not being mandatory for them as individual practitioners specified on the training matrix. The Intercollegiate document is clear that a blend of face-to face, e-learning and team activity and personal reflection may be used to meet the hours required.

4.9 An outline of the staff now required to undertake safeguarding children training at level 3 is

given below

Clinical staff working with children and young people (No change)

12-16 hours education and learning over 3 years All qualified nurses and doctors (in clinical roles); allied health professionals; staff in band 4 working with children or young people and all clinical managers.

Clinical staff working with parents/carers

6 hours education and learning over 3 years All qualified nurses and doctors (in clinical roles); allied health professionals; and all clinical managers in mental health or substance misuse services. Applies to community and acute services (Does not apply to ECS adult physical health teams who require level 2).

Clinical staff working predominantly with older people or in ECS physical health services predominantly with younger or older adults (No change)

6 hours education and learning over 3 years Team manager and safeguarding champion (if not the manager).

4.10 As from January 2017 the Trust will require identified groups of staff to complete level 3

safeguarding adult training. A training needs analysis and training delivery plan is under development. The majority of the safeguarding adult training we currently offer at corporate induction meets the level three requirements such as Mental Capacity Act/Deprivation of Liberty Safeguards training, PREVENT training and domestic violence and abuse training.

4.11 The need for level 3 safeguarding adult training has been specified in the Intercollegiate

Document for Safeguarding Adult training 2016. Although the final version of this document has not yet been agreed we do not anticipate major changes.

Chart 1: Mandatory Safeguarding Training Compliance as of 30th October 2016

86.5% 46% 100% 84%

Safeguarding childrentraining Level 1 and 2

Safeguarding childrentraining Level 3

Safeguarding childrentraining Level 4

Safeguarding AdultTraining Level 1 and 2

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5. Patient and Carer Experience 5.1 Friends and Family Test (FFT) 5.1.1 Table 1 shows a summary of the FFT results from October 2015 to October 2016 with

specific figures for the last seven complete months. For September 2016 and October 2016 the percentage of service users/carers that would recommend our services to friends and family was 83% and 87% respectively. The overall figure from October 2015 to October 2016 is 86%.

Table 1: FFT Results: April 2016 to October 2016 and Rolling Year: October 2015 to October 2016

5.1.2 Managers are being encouraged to increase return rates for the FFT and Patient and Carer

surveys. Managers are being encouraged to check the FFT feedback on at least a weekly basis and act upon any feedback as quickly as possible using the “You Said We Did” poster or equivalent to inform patients of what is being done to address the feedback received.

5.2 Patient and Carer Experience Survey 5.2.1 Tables 2 and 3 below provide the Patient and Carer Experience survey responses and

satisfaction rates. Overall response rates have reduced over the last 12 months. Satisfaction rates demonstrate minimal fluctuation across the same period.

5.2.2 People and their family/carers using services are taking the time to complete surveys and

this is generally supported well by staff. The deep dive meetings identify areas and agree actions with borough teams and the Patient Experience Team are working with services to strengthen this feedback process.

Date Recommend

Not

Recommend

Total

Responses

Extremely

Likely Likely

Neither

Likely or

Unlikely Unlikely

Extremely

Unlikely

Don't

Know Oct '16 87% 4% 865 464 288 48 21 11 33

Sep '16 83% 4% 827 455 230 43 18 12 69

Aug '16 86% 4% 975 518 321 54 26 11 45

Jul '16 87% 3% 923 500 302 55 11 18 37

Jun '16 88% 3% 953 490 346 47 15 10 45

May '16 85% 4% 1047 504 383 80 27 20 33

Apr '16 87% 4% 884 435 338 50 21 14 26

Oct '15 - Oct '16 86% 3% 12219 6364 4201 747 260 167 480

0

200

400

600

800

1000

1200

1400

Table 2: Patient and Carer Experience Survey Response Totals

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Table 3: Patient and Carer Experience Survey satisfaction Rates October 2015 - 2016

5.3 Complaints 5.3.1 Table 4 gives an overview of the Trust overall complaints activity from the 1st April 2016 to

31st October 2016. Our Trust compliance target is 95% for 3 day acknowledgement and 90% for 25 day response.

*Suspended cases are included in the 3 day acknowledgement compliance but not the reply within 25 working day compliance. Suspended cases closed to date were all responded to within timescales agreed with the complainant.

5.3.2 Comments and complaints about services are taken very seriously. All complaints are

treated in confidence and we aim to respond within 25 working days of receiving a complaint.

5.3.3 The 25 day response rate to formal complaints is an area for improvement with on-going

work. The Patient Experience Team continue to work and support all Clinical and Assistant Directors to process and manage complaints in a timely way and with person centred principles guiding the process.

6. Nursing Developments 6.1 Mentorship and Preceptorship 6.1.2 The newly qualified nurses who have started during September and October 2016 have all

commenced our new trust Preceptorship Programme. The Preceptorship and Mentorship Lead is working with clinical areas/teams where additional support may be required due to the high level of newly qualified nurses starting in those areas. To date the 3 cohorts of preceptees have all completed the first day of the Preceptorship Programme. Attendance has been good. The feedback received has been positive with preceptees reporting finding the programme sessions supportive, helpful and integrating. The Preceptorship and

78

80

82

84

86

88

90

92

Patient and Carer Survey Overall Satisfaction Rate

Table 4: Formal

ComplaintsApr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16

Formal Complaints 18 9 21 22 14 18 12

Acknowledged in Time (3day) 94% 100% 100% 100% 100% 100% 100%

Responded in Time (25 day) 72% 100%* 95%* 90%* 64% 94%* tbc

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Mentorship Lead has made contact with the communications teams to develop an article on Preceptorship for inclusion in a future edition of Trust Matters.

6.2 Nursing Associates 6.2.1 In December 2015, the Government announced a plan to create a new nursing support

role. Following this announcement, Health Education England (HEE) launched a public consultation on the proposal for introducing a new “Nursing Associate” role to support the Registered Nurse workforce in providing high quality person centred care across health and social care settings. This new role, and the opportunity it offers for those who want to progress to a registered nurse, is expected to open up a career in nursing for thousands of people from all backgrounds.

6.2.2 HEE invited a consortium of Trusts and Higher Education Institutions to bid to become a

test site to pilot the training and development of the new role within their organisations with effect from January 2017. Positively, BEH-MHT as part of organisations in the North Central and East London (NCEL) consortium have been successful in the bid to become a test site.

6.2.3 The “Nursing Associates” programme will comprise of being employed by a host NHS

organisation and receiving a first class education from experienced and knowledgeable Lecturers at Middlesex University. It is a 24 month programme which will commence on 9th January 2017.

6.2.4 Our trust has committed to taking on up to five trainee Nursing Associates and these

positions are open to both existing members of staff and new recruits.

Nursing Associate - Key Dates:

Event Date

Open events x 4 31st October, 1st November, 4th November and 10th November 2016

Closing date for completed applications for the nursing associate role

15th November 2016

Potential Candidates : Testing (Numeracy/Literacy)

23rd November 2016

Interviews for successful candidates

12th – 16th December 2016

Course commencement 9th January 2017

6.2.5 Open events are scheduled at Middlesex University for all who wish to know more about

the new Nursing Associate Trainee Programme. Information about the role and the open events has been communicated to our staff via take 2 and internal email.

6.3 Student Nurses: 6.3.1 Trust induction has been arranged for year one nursing students allocated to our Trust.

This is taking place on 10th November 2016 and 12th January 2017. 6.4 Trainee Graduate Mental Health Worker (TGMHW) Update 6.4.1 The Trainee Graduate Mental Health Worker programme is a 12 month programme

designed for individuals with a degree, 2:2 or above who are passionate about mental

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health and wish to develop a career in this field. The programme comprises of successful candidates working three days per week in the Trust and the remaining two days shall be spent at Middlesex University.

6.4.2 Recruitment for cohort 8 of the TGMHW programme, due to start in January 2017, has

recently taken place. A total of 30 trainees have been appointed for our Trust and are currently undergoing employment checks.

7. Allied Health Professions working in the Trust 7.1 Allied Health Professions (AHPs) Conference 7.1.1 On Wednesday, 2 November the 2nd Annual AHP Conference was held. The event

provided an opportunity for AHPs to hear about our Trusts priorities and how AHPs can contribute to change from Marie Kane.

7.1.2 Suzanne Rastrick Chief Allied Health Professions Officer at NHS England gave an update

on the AHP Mandate and how using AHPs is key to transforming health, care and wellbeing.

7.1.3 Professor Mary Lovegrove gave a presentation on the Support Workers Project carried out

with the engagement of our Trust and other North Central Sector organisations. NHS England is interested in the report findings and recommendations.

7.1.4 June Davis one of the programme directors and AHP participants from the first and second

cohort of the AHP Leadership Programme funded by Health Education England North Central East London(HEENCEL) spoke about the programme and the impact it has had on them.

7.1.5 A presentation on the impact of AHPs on delivering continuous improvement was given by

Mary Sexton along with reiterating Maria Kane’s message that AHPs have permission to initiate change within the organisation.

7.1.6 There were presentations from the following Trust AHPs:

Occupational Therapy in Liaison Psychiatry Lindsay Truran and Rachel Yona Developing a Peer Support Programme: The Journey So far Camilla Cox Pain Assessment and Management MSK Physiotherapists Amanda Gill, Nicky Gritten

and Claudia Treasure Supporting teenagers with autism: Do transitions have to be terrifying? Helen Cooke

and Andrew J Wright 7.2 AHP Leadership Development Programme 7.2.1 The second cohort of this programme sponsored by HEENCEL concluded on the 3rd

November 2016. A third cohort is planned and Band 7 and Band 8 AHP’s can apply to attend. There is definite interest, one of the key objectives of the programme is to develop a service improvement initiative.

7.2.2 Funding from Health Education England North Central East London (HEENCEL)

Funding has been agreed for an AHP transformation and development programme across the sector. Trust AHPs will be able to attend the programmes which are funded via HEENCEL.

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7.3 Band 5 Occupational Therapy Peer Support Development Network 7.3.1 The first meeting of the Trust wide Band 5 network met on the 17th October 2016. A

programme of identified learning requirements has been created by the group which will meet on a six weekly basis.

8. Psychological Therapies 8.1 CPD Programme for Psychological Therapists 2017 8.1.1 This is an exciting new venture aimed at Psychological Therapists within the Trust to

support their CPD requirements. This programme has been shaped through an audit of responses provided in a Therapist Questionnaire administered earlier in the year. This audit captured the Psychological Therapists supervision requirements, their areas of expertise for presentations, knowledge and interests, topics and their training competencies.

8.1.2 The line-up of speakers showcases the vast amount of talent and expertise within the Trust.

This is a quality initiative that demonstrates a cost effective way of delivering partial requirements for CPD within the Psychological workforce.

8.1.3 We have sourced a highly acclaimed external speaker for Acceptance Commitment

Therapy; this approach is part of the third wave therapies and has good trans-diagnostic applicability.

Date & Time Presentation Title Presenter/s Room

25th January 09.30 – 13.00

A Brief Introduction to Cognitive Analytic Therapy

Dr Alison Macdonald – Counselling Psychologist, Course Director North London CAT Practitioner Training Course

Maple Unit, SAH

15th Feb 09.30 – 13.00

Substance misuse in Specialist Services

Sara Boulter – Consultant Clinical Psychologist, Specialist Services Nicola Piek – Forensic Psychologist, Specialist Services

Lincoln Room, CFH

14th March 09.30 – 13.00

FUTURE – Mental health and wellbeing model of psychological delivery for gang members and excluded young offenders – a social justice approach

Dr Fatima Bibi – Clinical Psychologist, Project Lead, Future, Dr Suchitra Bhandari – Consultant Clinical Psychologist, Trust Head of Psychological Therapies

Conference Room, CFH

13th April 13.30 – 17.00

Complex Trauma and PTSD - Concepts and Assessment

Dr Ed Freeman – Clinical Psychologist, PTSD Lead, CCT Dr Daniel Skehan – Clinical Psychologist, Haringey Acute Care Services

Large Halliwick 43, SAH

17th May 09.30 – 13.00

Containing or Treating: ‘specialist’ services for people with PD in a generic treatment world

Tracey James - Trust wide Personality Disorder Lead across Barnet, Enfield and Haringey

Lincoln Room, CFH

21st June 09.30 – 13:00

Positive behaviour support for inpatient and community services

Dr Rupa Gone – Lead Clinical Psychologist, Enfield Integrated Learning Disabilities Service Dr Sophie Doswell – Lead Clinical Psychologist, Barnet Learning Disability Service

Lincoln Room, CFH

19th July 09:30 – 13.00

Understanding and Working with Complex PTSD - From Cognitive to Psychodynamic approaches

Dr Ed Freeman – Clinical Psychologist, PTSD Lead, CCT Dr Steven Livingstone – Principal Clinical Psychologist, Haringey Early Intervention Service Dr Daniel Skehan – Clinical Psychologist, Haringey Acute Care Services

Lincoln Room, CFH

27th September 09:30 – 17:00 28th September 09:30 – 17:00

Acceptance and Commitment Therapy (2 days training)

Dr David Gillanders - Clinical Psychologist, HCPC; BABCP regd.

Holtwhites Sports & Social Club

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18th Oct 9:30 – 13:00

Working with Problem Behaviours: Stalking and Harassment

Sara Henley - Consultant Clinical and Forensic Psychologist, Specialist Services

Lincoln Room, CFH

22nd Nov 09.30 – 13.00

Phased Trauma Treatment - Keys to Successful Therapy

Dr Ed Freeman – Clinical Psychologist, PTSD Lead, CCT Dr Steven Livingstone – Principal Clinical Psychologist, Haringey Early Intervention Service Dr Daniel Skehan – Clinical Psychologist, Haringey Acute Care Services

Lincoln Room, CFH

8.1.4 The programme will be communicated via Trust Matters and the Organisational

Development and Learning Department. 8.2 Research Focus Group 8.2.1 The Research Focus Group will be having its 4th meeting on 22nd November 2016 at Chase

Farm Hospital. Confirmed to present are Dr Alan Underwood, Clinical Psychologist, who will be presenting on The North London Forensic Service Research Groups and Dr Ayo Sodeke-Gregson, Clinical Psychologist, who will be presenting on the Bulimia Recovery Group.

8.2.2 The Research Focus Group aims to facilitate research within the Trust. This Group shares

research ideas and supports on-going funded studies; to develop service related research; to facilitate student research i.e. doctoral and other publications. It is also a forum to scope links with universities and ensure learning amongst staff.

8.3 London Division Clinical Psychology (DCP) Conference – 10TH November 2016 8.3.1 Our Trust Lead, Dr Suchi Bhandari was invited by the Division of Clinical Psychology –

London to present at the DCP Conference. Dr Bhandari presented with three other Clinical Psychologists are on Social Justice, Community Psychology and Restorative Justice. Learning from Project Future and the other Integrate sites shared these findings. This will showcase BEH as a Lead partner in this innovative project.

8.3.2 The presentation and workshop used a community psychology approach and focus on the

learning from Future. The presenters included a perspective that goes beyond an individual focus by integrating systems and services that surround young people; impacting social, cultural, economic, and environmental influences with the aim of promoting positive change and empowerment at an individual and system level. Narrative Therapy is one of the main approaches used at Future in which we take a social justice approach to therapeutic conversations, challenging dominant discourses and constructs of young people by multiple systems (e.g. police, prisons, social care) as ‘violent’, ‘dangerous’, ‘criminals’ and ‘gang members’.

8.4 Barnet Psychological Therapies Update 8.4.1 Psychological Therapies Leadership 8.4.2 The Psychological Therapies lead role in Barnet has been reconciled with one individual

now in role covering Adult and CAMHS Services. It is anticipated that the discontinuity between CAMHS psychological therapies lead role and other Barnet BEH provision and management will now be minimised. Building stronger links between services will be vital in developing services which provide more effective pathways of care across whole lifespan of Barnet Service users especially at points of developmental transition. The consolidation of the Psychological Therapies Lead role has resulted in the launch of the Barnet Clinical Governance Forum and the continuation of the Barnet Unmanaged Risk Forum, both chaired by Patricia McHugh Psychological Therapies Lead.

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8.5 Outcome Data for Psychological Therapies – “Patient Owned Data” POD 8.5.1 The need for systematic collection of outcome data for psychological therapies using the

POD system has begun in the Barnet Complex Care Team. POD is a system that allows service users to log in from where ever they are to complete their outcome data including their levels of satisfaction with the service they have received. Service users can also view their scores over time and in line with evidence of effective practice review of progress in treatment will become part of every psychological therapies intervention – evidence suggests that this level of shared ownership, review and tracking of psychological progress in therapy ensures that therapy remains focussed and that if, it is not effective can be reviewed at the earliest appropriate point. Establishing the use of POD in Barnet Complex Care Team is a priority and is now led by the consultant psychologist. The plan would be to roll the POD system of evaluation out to all adult psychological therapies services that are within secondary care. This will also translate easily into the proposed service model that is now out to consultation.

Ends.

Page 71


Page 72

BEH-MHT – Trust Board – 28.11.2016 3.2 - Safe Staffing Levels

Title:

Safe Staffing Levels

Report to:

Trust Board

Date:

28 November 2016



Purpose of Report: This report provides an overview of nurse staffing for BEHMHT inpatient wards for September 2016 to October 2016 across all Boroughs/Specialist Services. The data demonstrates both the planned level of staff and the actual level achieved. Borough teams continue to flex their approach in respects to staffing across wards and the use of temporary staff to support acuity/dependency and special observations has ensured that staffing levels have remained safe throughout the reporting period. A range of quality, safety and patient experience indicators are included alongside the safe staffing data to give assurance of staffing impact against patient safety and experience indicators. In addition, the report outlines key actions being taken to support staff and ensure safety across inpatient wards. Recommendations: The Trust Board is asked to note this nurse staffing report and the actions being taken to ensure all inpatient wards are safely staffed Report Sponsor:

Mary Sexton, Executive Director of Nursing, Quality and Governance


Vacancy levels remain variable across all wards even with the recent initiatives in respects to recruitment; there has been some improvement in substantive staffing levels I remain concerned regarding substantive vacancy levels. Recruitment and retention of skilled staff is essential and a robust whole system approach is required. Further assurance is required with respect to recruitment activity and outcomes regarding the Trust’s active recruitment into vacancies to continue the momentum and address innovatively long standing vacancies in hard to fill areas. Overall, the wards have met their planned number of hours worked for registered and care support staff; they continue to address the challenge of securing staff at times with the use of temporary staff, at times of an opposite grade.

Page 73


Agency spend continues to be addressed and only named agency’s that have been approved are utilised. A mandate has been given to reduce agency staff this financial year. To address this new Bank has been established to ensure that we are able to address short term staffing issues and an investment in the training of bank staff to address the quality of temporary staff with compliance in mandatory training. Sickness continues to require robust management to ensure a consistent workforce to meet all quality and patient experience indicators. Occupational Health support actively being sought by managers in respect of staff sickness.

Report Authors:

Name: Mary Sexton Title: Executive Director of Nursing, Quality and

Governance Tel Number: 020 8702 3032 E-mail: [email protected] Name: Gillian Kelly Title: Deputy Director of Nursing and Governance Tel Number: 020 8702 6051 E-mail: [email protected]

Report History:

Regular Report.


Numerous financial implications associated with safe staffing including;

- costs associated with purchasing of electronic IT solution to record and track staff usage

- costs associated with use of temporary staffing or savings from reduced usage

- costs associated with use of agency staff or savings from reduced usage


The planning of staff is taken into account across all Trust services and is compliant within our Equality and Diversity duty.


Links to all Trust objectives and regulatory standards

List of Appendices:

Appendix 1 and 2 – Barnet, Enfield, Haringey and Specialist Service Indicator Data Sets

Page 74




Report 1. Introduction and Background 1.1 This report provides the Trust position in relation to safe staffing indicators for all of the

Trust’s inpatient wards. 1.2 This work has included the daily monitoring and robust management of planned and actual

staffing of both registered and unregistered staff across all in-patient areas. The analysis allows for the emerging challenges to be addressed in a timely manner to ensure the delivery of planned staffing levels, to support the provision of safe and high quality care to service users and improved patient experience.

1.3 It is acknowledged that staffing indicators and fill rate analysis alone do not give adequate

assurance of patient safety, high quality care and positive patient experience. It is the triangulation of key patient safety, quality and experience measures, alongside staffing data that informs the Board that staffing data is being considered, measured and analysed in relation to key patient safety, quality and experience indicators. Borough service lines continue to identify areas of concern, which are addressed in robust ways to enable clinicians and service management teams to have greater integrated intelligence to drive improvements in patient care.

1.4 It is acknowledged that this triangulated and integrated intelligence alone cannot provide

definitive indicators, but it can give a steer and indication on possible areas of risk and allows wards and teams to share best practice in respects to how they may have achieved more positive outcomes.

1.5 The key indicators currently being measured alongside staffing fill rates are:

Patient Experience : Family and Friend Test ( FFT) and Patient Experience Survey

Complaints and Concerns of Service Users: formal and informal complaints

Clinical incidents: Overall Datix Incidents, Moderate Incidents and Serious Incidents

Overall vacancy rates of each ward

Overall sickness rates of each ward 2. Indicators 2.1 Patient Experience: The Trust continues to carry out local real time patient experience

feedback, using an online survey system. Data is collected using various methods which include electronic tablets and paper surveys. The frequency of service user surveys varies across wards and teams, and is dependent upon the speciality of the ward/department and the length of stay of the service user group, and can vary from weekly to three monthly. In addition, the Family and Friends Test (FFT) give an indication of service user experience.

2.2 Complaints and Concerns: Complaints of both a formal and informal nature give an

indication of patient satisfaction, and continue to be both monitored and reported through local governance structures and Trust wide Deep Dive meetings. All formal complaints are evidenced using actions plans to ensure that lessons learnt can be tracked and appropriate assurance given that areas of concern have been addressed. It is recognised that we need to capture, replicate and celebrate with staff the positive comments and compliments. The patient experience team is now providing details of open text comments received via The Patient Experience Survey as well as compliments data at the Deep Dive Meetings.

2.3 Clinical Incidents: It is acknowledged that improved reporting of incidents is viewed as

positive. It is understood that a richness of data/intelligence in respect of incidents, trends and patterns allows organisations to develop approaches to address emerging themes ensuring that we respond in a timely manner. This learning from incidents assists in the development of improved services specifically informed by patient information with an

Page 75


aspiration to ensure there is co-design and development of services with patients, including internal and external user and carer groups

2.4 Vacancy Rates: We have previously acknowledged that in some clinical areas/wards there

are vacancy levels that exceed the Trust target. The teams are committed to ensuring that this is addressed and that vacancy levels are reduced through active recruitment. We understand that the use of temporary staff can have a negative impact on patient and staff experience with regards to lack of continuity and consistency of staff. A bank recruitment drive commenced to improve continuity and consistency within the temporary workforce and includes; encouraging current agency staff to opt into the bank with competitive rates, additional funds for holidays and mandatory training. This drive to develop the bank of temporary staff addresses the decrease in agency usage.

2.5 We are developing a robust recruitment and retention plan as part of a whole systems

approach through rigorous interviewing processes to obtain the right people with the right skills who demonstrate BEHMHT values and behaviours. We are reviewing and developing our preceptorship programme to better support newly trained staff into the clinical area and ensure staff are enabled to be the best that they can be.

3. Fill Rate 3.1 Table 1 gives an indication of overall fill rate between January 2015 and October 2016

across all inpatient wards, which shows little variance between both Registered and Care staff during this period. Wards continue to use temporary staff resources where needed due to clinical demands and to address the staff vacancies. Temporary staff who are identified as being familiar with the clinical setting are sort to ensure continuity and more positive patient experience and risk management.

3.2 Some wards continue to meet their fill rate compliance with the use of temporary staffing;

both bank staff and agency staff. As described above, the focus now is to strengthen bank arrangements and reduce the use of agency.

Table 1

Registered

Nurses Average

Fill Rates - DAY

(%)

Registered

Nurses Average

Fill Rates -

NIGHT (%)

Care Staff

Average Fill

Rates - DAY (%)

Care Staff

Average Fill

Rates - NIGHT

(%)

January 101 102 98 99

February 102 103 98 98

March 102 102 98 99

April 103 102 97 99

May 100 102 98 99

June 102 102 97 99

July 100 98 98 100

August 99 101 99 98

September 100 100 98 99

October 99 101 100 99

November 100 100 101 101

December 101 100 101 100

January 101 100 100 100

February 101 100 100 102

March 101 103 101 102

April 100 101 101 101

May 102 101 99 100

June 102 101 99 100

July 100 101 100 101

August 100 102 101 100

September 101 101 102 103

October 103 101 101 103

2015

2016

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4. Vacancy Factor 4.1 For October 2016, the overall vacancy rate for our inpatient wards is 7.4% (Table 2).

Table 2

4.2 The focus on recruitment and retention needs to continue to ensure that vacancies across

in-patient wards are minimised and trajectories are considered for each of the wards as part of the retention of staff and the proactive management of the number of staff who have expressed their intention to retire.

5. Sickness Rate 5.1 Overall sickness rates across in-patient wards continue to improve, albeit with some

variations, following a peak of 8% in September 2015 (see Table 3 below). The overall sickness rate for October 2016 is 4.6%. Whilst some areas appear to have proactive approaches to the management of sickness, this needs to be seen across all clinical areas and reiterated in managerial supervision of staff. A robust process in addressing sickness and absence indicates to staff our duty of care to them and to the patients who use our services. Where sickness is addressed robustly this can be learnt best practice across the trust.

Table 3

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

Vacancy Rates (%)

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

Sickness (%)

Page 77


6. Barnet Borough 6.1 Barnet Borough has presented a mixed picture in respect to vacancies across inpatient

services. Formal vacancy and recruitment groups have been established and continue to look at ways to address the challenge that vacancies pose the service. Avon, Thames and Ken Porter wards have significantly high and increasing vacancy rates that have remained unchanged across September 2016 to October 2016. Thames ward’s vacancy rate has reduced significantly and is -3.3%.

6.2 All Barnet Borough wards have seen decreasing sick rates across September 2016 to

October 2016. 6.3 Fill rates indicate that the staffing deficiencies have been met through temporary staffing

which we continue to carefully monitor from a continuity, quality and safety perspective. 6.4 The Patient Experience Survey and FFT data within the Barnet inpatient wards shows

considerable variation in relation to both; engagement with the surveys and the feedback received. For both September 2016 and October 2016; Avon, Trent and Thames wards Patient Experience Survey and FFT feedback is generally very positive. Ken Porter ward Patient Experience Survey scores are below the 80% benchmark and the FFT shows reduced satisfaction at 56% in September 2016 and 65% in October 2016.

6.5 Seven complaints (two formal and five informal) were received within the Barnet Borough

inpatient wards between September 2016 and October 2016. 7. Enfield Borough 7.1 Across a number of Enfield Borough inpatient wards there continues to be concerns in

relation to vacancy rates, notably; Bay Tree House, The Oaks, Silver Birches, Dorset Ward and Magnolia Unit. During the period from September 2016 to October 2016 vacancy rates have improved for Suffolk Ward, Cornwall Villa and Dorset Ward.

7.2 There continues to be high levels of sickness rates in the Enfield Borough inpatient wards.

There were some improvement in sickness rates from September 2016 to October 2016 in Dorset ward, Cornwall Villa and Somerset Villa (formerly Bay Tree House). Silver Birches have remained same whereas Magnolia Unit, the Oaks, Sussex and Suffolk wards have seen an increase in the same period.

7.2 All of the wards in Enfield Borough have seen a good improvement in filling care staff shifts

in September 2016 to October 2016 in comparison to July 2016 to August 2016 period. Fill rates indicate that the staffing deficiencies have been met through temporary staffing which we continue to carefully monitor from a continuity, quality and safety perspective.

7.3 The Patient Experience Survey and FFT data within the Enfield Borough inpatient wards

shows considerable variation in relation to both; engagement with the surveys and the feedback received. A number of the wards Patient Experience Survey percentages do not meet the Trust 80% benchmark and FFT data suggest satisfaction rates could be improved significantly. Areas of potential concern include: The Oaks, Suffolk and Sussex wards. It is noted that, Silver Birches and Cornwall Villa have not submitted Patient Experience Survey data during September 2016 to October 2016 limiting assurance. The Deep Dive meetings will continue to discuss patient experience indicators and agree actions to address. The senior managers are aware and are addressing within the respective teams.

7.4 One formal and one informal complaint were received within the Enfield Borough inpatient

wards between September 2016 to October 2016.

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8. Haringey Borough 8.1 Haringey and Finsbury wards have made improvement in respect to vacancies, whereas

Fairland’s ward vacancies have risen to 8% for the period of September 2016 to October 2016.

8.2 Sickness rates have increased in all the Haringey borough wards from September 2016 to

October 2016. Fairlands ward has the highest sickness rate within the borough ending at 14.0% for the September 2016 to October 2016 period.

8.3 Fill rates remain strong across all three wards. 8.4 The Patient Experience Survey and FFT data within the Haringey Borough inpatient wards

shows considerable variation in relation to both; engagement with the surveys and the feedback received. Fairland’s ward Patient Experience Survey percentages showed improvement for both September 2016 (98%) and October 2016 (90%). FFT data for Haringey ward 0% in September and 33% in October 2016 suggest that satisfaction rates could be improved significantly. Actions taken to improve in light of patient and carer feedback continue to be discussed at borough Deep Dive meetings.

8.5 Six formal and four informal complaints were received within the Haringey Borough

inpatient wards between the periods of September 2016 to October 2016. 9. Specialist Services 9.1 Across a number of wards within the Specialist Services, vacancy rates continue to improve

and/or be maintained. Sage ward’s vacancy rate has significantly increased from September 2016 to October 2016 whilst Beacon Unit’s vacancies improved slightly but remains significant at 18.2%.

9.2 Sickness rates have decreased across many of the wards, with the exception of

Cardamom, Paprika, Severn and Sage wards which have seen some increase from September 2016 to October 2016.

9.3 The Patient Experience Survey and FFT data within the Specialist Services inpatient wards

shows considerable variation in relation to both; engagement with the surveys and the feedback received. The Beacon Unit and Phoenix Patient Experience Survey percentages do not meet the Trust 80% benchmark. FFT scores for a number of the wards suggest satisfaction rates could be improved significantly. It is of note that there is no patient experience survey or FFT data for Severn, Fennel and Devon wards during September 2016 and Mint ward in October 2016, limiting assurance. The Deep Dive meetings will continue to discuss patient experience indicators and agree actions to address. The senior managers are aware and are addressing within the respective teams.

9.4 Four formal and two informal complaints for the Specialist Services were received during

the period September 2016 to October 2016. 9.5 Fill rates across all thirteen Specialist Services inpatient wards remains strong. 10. Recruitment and Resourcing 10.1 Recruitment Surgeries

The Trusts recruitment team hold a succession of recruitment surgeries across all boroughs on a 4 – 6 weekly basis. The purpose of the surgeries is to meet with borough managers to identify hard to fill recruitment ‘hot spots’ and any associated recruitment issues.

Page 79


10.2 Health Visitor recruitment update A programme of recruitment is on-going.

10.3 In-patient Staffing Recruitment The Trust aims to recruit to all inpatient staff vacancies and reduce the reliance on temporary staffing. There are several recruitment initiatives in place to fill vacancies across the Trust.

11. Summary 11.1 Safe staffing reports continue to be incorporated into existing governance structures,

namely Borough Deep Dive meetings, and will be incorporated into future borough based governance structures. This has allowed greater discussion and understanding of the data presented and analysed to ensure that the safe staffing agenda and associated quality and safety indicators are understood and acted upon to enhance safety in the clinical areas.

11.2 Safe staffing reports are made available to commissioners; promoting transparency and

providing assurance in relation to the Trust monitoring of safe staffing in the context of a range of workforce, quality and patient experience indicators.

11.3 There is a need to ensure that the focus on recruitment is maintained to respond to the

persistent staffing challenges that we face. The agency cap on spend can only be achieved and sustained if we accelerate substantive recruitment to all vacant posts. As well as recruit more external candidates for our Nurse Bank. Further work is also required in relation to the management of vacancies and sickness, with any lessons learnt and successful innovations shared within and across the service lines.

12. Outcomes, Service Delivery and Performance Issues 12.1 To improve the understanding of workforce, their deployment and reduction in the reliance

upon temporary staffing. 12.2 To improve understanding at a borough service line level of the areas of risk in respects to

safe staffing, including interrelated and contributory factors. 12.3 To improve management of the workforce to maximise stability and consistency and

enhance patient experience, quality and safety. 12.4 To consider and scope the requirements of the service areas and match this to current and

future capacity. 12.5 To consider the investment in staff at all levels to assist in recruitment and retention activity.

Implications 13. Budgetary / Financial Implications 13.1 Financial costs associated with the procurement of electronic IT solutions to record and

track staff usage. 13.2 A reduction in the reliance on temporary staff, and associated savings.

Page 80


14. Risk Management 14.1 Consistency in high calibre, well trained and competent staff will contribute to risk reduction

and improved quality of care and patient experience. Investment in staff development will also assist in retaining high quality staff and assist in the recruitment of staff in the future.

15. Equality and Diversity Implications 15.1 None Ends.

Page 81


APPENDIX 1

Hospital site name Ward name Speciality

Average

Fill Rate -

registered

nurses

Average

Fill Rate -

care staff

Average

Fill Rate -

registered

nurses

Average

Fill Rate -

care staff

Patient

Experience

Survey

Patient

Friends &

Family (FFT)

Formal

Complaints

Informal

Complaints

Datix

Incidents

Serious

Incidents

Moderate

Incidents

Vacancy

Rate Sickness

Edgware Community

Hospital Avon

Psychiatric Intensive

Care Unit 99.0% 100.8% 100.0% 100.0% - - 0 0 10 0 0 33.0% 2.6%Edgware Community

Hospital Thames Ward Adult Mental Il lness 100.0% 100.0% 100.0% 100.0% 82% 92% 1 0 25 0 0 0.7% 2.2%

Edgware Community

Hospital Trent Ward Adult Mental Il lness 97.6% 100.0% 100.0% 100.0% 100% 100% 0 2 25 0 0 20.0% 4.2%

Barnet General

Hospital Ken Porter

Adult Mental Il lness,

Old Age Psychiatry 132.0% 148.3% 100.0% 151.7% 66% 56% 0 0 22 0 1 15.4% 8.5%

Barnet - September 2016Staffing Day Staffing Night Experience Complaints Incidents Workforce


Average

Fil l Rate -

registered

nurses

Average

Fil l Rate -

care staff

Average

Fil l Rate -

registered

nurses

Average

Fil l Rate -

care staff

Patient

Experience

Survey

Patient

Friends &

Family (FFT)

Formal

Complaints

Informal

Complaints

Datix

Incidents

Serious

Incidents

Moderate

Incidents

Vacancy

Rate Sickness

St Michael's

Hospital Magnolia Ward

General Medicine,

Rehabilitation 95.6% 100.0% 90.0% 111.1% 100% 43% 0 0 26 0 1 8.9% 4.9%

Chase Farm Hospital Dorset Adult Mental Il lness 99.9% 106.3% 100.5% 101.6% 81% 94% 0 0 22 0 0 8.0% 8.4%

Chase Farm Hospital Suffolk Ward Adult Mental Il lness 96.0% 98.7% 103.1% 102.6% 67% 67% 1 0 22 0 0 3.4% 8.8%

Chase Farm Hospital Sussex Ward Adult Mental Il lness 100.0% 98.9% 100.0% 100.0% 66% 56% 1 1 17 0 0 -2.4% 0.1%

Chase Farm Hospital

Somerset Villa

(formerly Bay

Tree House) Old Age Psychiatry 99.2% 99.2% 100.0% 100.0% 87% 100% 0 0 4 0 0 26.8% 5.2%

Chase Farm Hospital The Oaks Old Age Psychiatry 96.9% 99.6% 100.0% 100.0% 73% 100% 0 0 19 1 0 5.9% 0.0%

Chase Farm Hospital Cornwall Vil la Old Age Psychiatry 125.7% 83.8% 155.0% 80.0% - - 0 0 9 1 0 1.4% 0.6%

Chase Farm Hospital Silver Birches Old Age Psychiatry 105.8% 97.1% 100.0% 100.0% - - 0 0 20 0 0 24.9% 3.9%

Workforce

Enfield - September 2016IncidentsStaffing Day Staffing Night ComplaintsExperience

Page 82



Average

Fill Rate -

registered

nurses

Average

Fill Rate -

care staff

Average

Fill Rate -

registered

nurses

Average

Fill Rate -

care staff

Patient

Experience

Survey

Patient

Friends &

Family (FFT)

Formal

Complaints

Informal

Complaints

Datix

Incidents

Serious

Incidents

Moderate

Incidents

Vacancy

Rate Sickness

St Ann's Hospital Fairlands Adult Mental Il lness 106.7% 131.3% 100.0% 126.2% 98% 96% 1 0 29 0 1 0.0% 11.3%

St Ann's Hospital Finsbury Adult Mental Il lness 97.8% 102.9% 97.0% 110.0% - - 2 0 28 0 0 1.6% 2.5%

St Ann's Hospital Haringey Ward Adult Mental Il lness 114.7% 100.0% 126.1% 100.0% 96% 0% 0 2 10 0 0 -9.2% 6.3%

Workforce

Haringey - September 2016IncidentsStaffing Day Staffing Night ComplaintsExperience


Average

Fil l Rate -

registered

nurses

Average

Fil l Rate -

care staff

Average

Fil l Rate -

registered

nurses

Average

Fil l Rate -

care staff

Patient

Experience

Survey

Patient

Friends &

Family (FFT)

Formal

Complaints

Informal

Complaints

Datix

Incidents

Serious

Incidents

Moderate

Incidents

Vacancy

Rate Sickness

Chase Farm Hospital Cardamom Forensic Psychiatry 93.3% 100.4% 98.3% 95.5% 100% 100% 0 0 14 0 0 2.4% 1.3%

Chase Farm Hospital Blue Nile House Forensic Psychiatry 98.4% 100.0% 100.0% 100.0% 98% 100% 0 0 3 0 0 -12.9% 8.5%

Chase Farm Hospital Fennel Forensic Psychiatry 99.2% 99.2% 100.0% 98.3% - - 0 0 11 0 0 8.8% 4.0%

Chase Farm Hospital Juniper Forensic Psychiatry 95.2% 100.5% 96.7% 106.7% 94% 67% 0 0 2 0 0 10.6% 5.6%

Chase Farm Hospital Mint

Forensic Psychiatry,

Learning Disability 100.0% 99.5% 100.0% 100.0% 85% 93% 0 0 9 0 0 8.3% 0.7%

Chase Farm Hospital Paprika Forensic Psychiatry 96.7% 101.0% 100.0% 100.0% 85% 50% 1 0 17 0 0 -2.4% 1.3%

Chase Farm Hospital Sage Ward Forensic Psychiatry 100.0% 100.0% 100.0% 104.5% 80% 71% 0 0 15 0 0 8.6% 3.3%

Chase Farm Hospital Devon Ward Forensic Psychiatry 100.0% 100.0% 100.0% 97.0% - - 1 0 12 0 0 14.1% 0.9%

Chase Farm Hospital Tamarind Ward Forensic Psychiatry 97.9% 99.6% 91.7% 108.3% 99% 100% 0 0 14 0 0 4.0% 4.7%

Chase Farm Hospital Severn Forensic Psychiatry 96.9% 113.0% 83.3% 119.4% - - 0 1 11 0 0 4.0% 0.5%

Chase Farm Hospital Derwent Forensic Psychiatry 90.8% 111.4% 100.0% 98.3% 94% 58% 1 0 1 0 0 -10.0% 10.1%

Edgware Community

Hospital Beacon Centre

Child and Adolescent

Psychiatry 97.4% 105.2% 100.0% 116.9% 76% 100% 0 0 14 0 0 21.5% 12.9%

St Ann's Hospital Phoenix Adult Mental Il lness 98.5% 100.0% 100.0% 100.0% 62% 50% 0 1 28 0 0 6.5% 1.3%

Workforce

Specialist - September 2016IncidentsStaffing Day Staffing Night ComplaintsExperience

Page 83



Average

Fill Rate -

registered

nurses

Average

Fill Rate -

care staff

Average

Fill Rate -

registered

nurses

Average

Fill Rate -

care staff

Patient

Experience

Survey

Patient

Friends &

Family (FFT)

Formal

Complaints

Informal

Complaints

Datix

Incidents

Serious

Incidents

Moderate

Incidents

Vacancy

Rate Sickness

Edgware Community

Hospital Avon

Psychiatric Intensive

Care Unit 100.0% 96.5% 96.9% 101.9% - - 0 1 31 0 0 34.8% 0.8%Edgware Community

Hospital Thames Ward Adult Mental Il lness 100.0% 100.0% 100.0% 100.0% 87% 100% 1 0 54 0 0 -3.3% 1.1%

Edgware Community

Hospital Trent Ward Adult Mental Il lness 100.0% 100.0% 100.0% 100.0% 83% 80% 0 0 38 0 0 24.0% 1.9%

Barnet General

Hospital Ken Porter

Adult Mental Il lness,

Old Age Psychiatry 120.1% 134.4% 98.4% 151.6% 74% 65% 0 2 35 0 0 23.1% 0.0%

Barnet - October 2016Staffing Day Staffing Night Experience Complaints Incidents Workforce


Average

Fil l Rate -

registered

nurses

Average

Fil l Rate -

care staff

Average

Fil l Rate -

registered

nurses

Average

Fil l Rate -

care staff

Patient

Experience

Survey

Patient

Friends &

Family (FFT)

Formal

Complaints

Informal

Complaints

Datix

Incidents

Serious

Incidents

Moderate

Incidents

Vacancy

Rate Sickness

St Michael's

Hospital Magnolia Ward

General Medicine,

Rehabilitation 98.4% 99.6% 96.8% 101.6% 100% 90% 0 0 23 0 0 10.1% 5.2%

Chase Farm Hospital Dorset Adult Mental Il lness 102.1% 105.5% 99.0% 101.5% 79% 88% 0 0 16 0 0 6.8% 5.1%

Chase Farm Hospital Suffolk Ward Adult Mental Il lness 100.0% 100.0% 100.0% 100.0% - - 0 0 12 0 0 -3.4% 20.5%

Chase Farm Hospital Sussex Ward Adult Mental Il lness 99.1% 98.8% 100.0% 100.0% 81% 100% 0 0 17 0 0 0.3% 3.0%

Chase Farm Hospital

Somerset Villa

(Formerly Bay

Tree House) Old Age Psychiatry 99.2% 97.2% 100.0% 100.0% 86% 50% 0 0 2 0 0 22.7% 0.0%

Chase Farm Hospital The Oaks Old Age Psychiatry 104.7% 97.9% 100.0% 97.9% 55% 70% 0 0 22 2 0 5.9% 2.5%

Chase Farm Hospital Cornwall Vil la Old Age Psychiatry 121.2% 90.6% 111.3% 95.9% - - 0 0 17 0 0 -5.5% 0.2%

Chase Farm Hospital Silver Birches Old Age Psychiatry 118.5% 92.7% 100.0% 99.0% - - 0 0 17 0 0 24.9% 3.9%

Workforce

Enfield - October 2016IncidentsStaffing Day Staffing Night ComplaintsExperience

Page 84



Average

Fill Rate -

registered

nurses

Average

Fill Rate -

care staff

Average

Fill Rate -

registered

nurses

Average

Fill Rate -

care staff

Patient

Experience

Survey

Patient

Friends &

Family (FFT)

Formal

Complaints

Informal

Complaints

Datix

Incidents

Serious

Incidents

Moderate

Incidents

Vacancy

Rate Sickness

St Ann's Hospital Fairlands Adult Mental Il lness 102.2% 151.6% 100.0% 138.7% 90% 100% 0 0 54 0 0 8.0% 14.0%

St Ann's Hospital Finsbury Adult Mental Il lness 100.0% 100.0% 100.0% 100.0% 95% 89% 2 0 38 0 0 -6.4% 5.5.%

St Ann's Hospital Haringey Ward Adult Mental Il lness 115.1% 100.0% 131.0% 100.0% 83% 33% 1 2 30 0 0 -23.7% 10.2%

Workforce

Haringey - October 2016IncidentsStaffing Day Staffing Night ComplaintsExperience


Average

Fil l Rate -

registered

nurses

Average

Fil l Rate -

care staff

Average

Fil l Rate -

registered

nurses

Average

Fil l Rate -

care staff

Patient

Experience

Survey

Patient

Friends &

Family (FFT)

Formal

Complaints

Informal

Complaints

Datix

Incidents

Serious

Incidents

Moderate

Incidents

Vacancy

Rate Sickness

Chase Farm Hospital Cardamom Forensic Psychiatry 99.4% 99.6% 100.0% 100.0% 98% 100% 0 0 8 0 0 3.6% 4.1%

Chase Farm Hospital Blue Nile House Forensic Psychiatry 99.3% 100.8% 100.0% 100.0% 98% 100% 0 0 2 0 0 -8.4% 8.3%

Chase Farm Hospital Fennel Forensic Psychiatry 99.2% 102.4% 100.0% 100.0% 80% 64% 0 0 22 0 0 4.4% 0.6%

Chase Farm Hospital Juniper Forensic Psychiatry 97.6% 99.0% 100.0% 100.0% 87% 83% 1 0 3 0 0 10.6% 4.9%

Chase Farm Hospital Mint

Forensic Psychiatry,

Learning Disability 98.5% 99.1% 100.0% 100.0% - - 0 0 11 0 0 14.9% 0.0%

Chase Farm Hospital Paprika Forensic Psychiatry 99.2% 100.3% 103.3% 100.0% 88% 80% 0 0 7 0 0 -10.4% 2.8%

Chase Farm Hospital Sage Ward Forensic Psychiatry 99.0% 100.0% 97.2% 100.0% 76% 57% 0 0 14 0 0 17.3% 3.9%

Chase Farm Hospital Devon Ward Forensic Psychiatry 100.0% 98.6% 100.0% 100.0% 93% 88% 0 0 7 0 0 8.1% 0.8%

Chase Farm Hospital Tamarind Ward Forensic Psychiatry 105.2% 101.8% 100.0% 100.0% 87% 71% 0 0 16 0 0 4.0% 3.7%

Chase Farm Hospital Severn Forensic Psychiatry 97.1% 114.2% 86.5% 118.5% 87% 63% 0 0 7 0 0 8.4% 5.9%

Chase Farm Hospital Derwent Forensic Psychiatry 99.2% 125.6% 100.0% 100.0% 90% 100% 0 0 13 0 0 -22.0% 4.8%

Edgware Community

Hospital Beacon Centre

Child and Adolescent

Psychiatry 99.3% 100.0% 100.0% 101.0% 73% 100% 0 0 32 0 1 18.2% 10.7%

St Ann's Hospital Phoenix Adult Mental Il lness 97.7% 102.7% 100.0% 102.3% 74% 64% 0 0 37 0 0 10.3% 0.8%

Workforce

Specialist - October 2016IncidentsStaffing Day Staffing Night ComplaintsExperience

Page 85


APPENDIX 2

BARNET

-40

-30

-20

-10

0

10

20

30

40

No

v-1

5

De

c-1

5

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

Avon

Vacancy (%)

Sickness (%)

-40

-30

-20

-10

0

10

20

30

40

No

v-1

5

De

c-1

5

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

Thames

Vacancy (%)

Sickness (%)

-40

-30

-20

-10

0

10

20

30

40

No

v-1

5

De

c-1

5

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

Trent

Vacancy (%)

Sickness (%)

-40

-30

-20

-10

0

10

20

30

40

No

v-1

5

De

c-1

5

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

Ken Porter

Vacancy (%)

Sickness (%)

Page 86


ENFIELD

-40

-30

-20

-10

0

10

20

30

40

No

v-1

5

De

c-1

5

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

Magnolia

Vacancy (%)

Sickness (%)

-40

-30

-20

-10

0

10

20

30

40

No

v-1

5

De

c-1

5

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

Sussex

Vacancy (%)

Sickness (%)

-40

-30

-20

-10

0

10

20

30

40

No

v-1

5

De

c-1

5

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

Somerset Villa (Prev. Bay Tree House)

Vacancy (%)

Sickness (%)

-40

-30

-20

-10

0

10

20

30

40

No

v-1

5

De

c-1

5

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

Suffolk

Vacancy (%)

Sickness (%)

Page 87


-40

-30

-20

-10

0

10

20

30

40N

ov-

15

De

c-1

5

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

Cornwall Villa

Vacancy (%)

Sickness (%)

-40

-30

-20

-10

0

10

20

30

40

No

v-1

5

De

c-1

5

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

Silver Birches

Vacancy (%)

Sickness (%)

-40

-30

-20

-10

0

10

20

30

40

No

v-1

5

De

c-1

5

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

The Oaks

Vacancy (%)

Sickness (%)

-40

-30

-20

-10

0

10

20

30

40

No

v-1

5

De

c-1

5

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

Dorset

Vacancy (%)

Sickness (%)

Page 88


HARINGEY

-40

-30

-20

-10

0

10

20

30

40

No

v-1

5

De

c-1

5

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

Fairlands

Vacancy (%)

Sickness (%)

-40

-30

-20

-10

0

10

20

30

40

No

v-1

5

De

c-1

5

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

Finsbury

Vacancy (%)

Sickness (%)

-40

-30

-20

-10

0

10

20

30

40

No

v-1

5

De

c-1

5

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

Haringey

Vacancy (%)

Sickness (%)

Page 89


SPECIALIST SERVICES

-40

-30

-20

-10

0

10

20

30

40

No

v-1

5

De

c-1

5

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

Blue Nile

Vacancy (%)

Sickness (%)

-40

-30

-20

-10

0

10

20

30

40

No

v-1

5

De

c-1

5

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

Cardamom

Vacancy (%)

Sickness (%)

-40

-30

-20

-10

0

10

20

30

40

No

v-1

5

De

c-1

5

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

Fennel

Vacancy (%)

Sickness (%)

-40

-30

-20

-10

0

10

20

30

40

No

v-1

5

De

c-1

5

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

Juniper

Vacancy (%)

Sickness (%)

Page 90


-40

-30

-20

-10

0

10

20

30

40

No

v-1

5

De

c-1

5

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

Mint

Vacancy (%)

Sickness (%)

-40

-30

-20

-10

0

10

20

30

40

No

v-1

5

De

c-1

5

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

Paprika

Vacancy (%)

Sickness (%)

-40

-30

-20

-10

0

10

20

30

40

No

v-1

5

De

c-1

5

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

Sage

Vacancy (%)

Sickness (%)

-40

-30

-20

-10

0

10

20

30

40

No

v-1

5

De

c-1

5

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

Devon

Vacancy (%)

Sickness (%)

Page 91


-40

-30

-20

-10

0

10

20

30

40N

ov-

15

De

c-1

5

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

Severn

Vacancy (%)

Sickness (%)

-40

-30

-20

-10

0

10

20

30

40

No

v-1

5

De

c-1

5

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

Tamarind

Vacancy (%)

Sickness (%)

-40

-30

-20

-10

0

10

20

30

40

No

v-1

5

De

c-1

5

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

Derwent

Vacancy (%)

Sickness (%)

-40

-30

-20

-10

0

10

20

30

40

No

v-1

5

De

c-1

5

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

Beacon Centre

Vacancy (%)

Sickness (%)

Page 92


-40

-30

-20

-10

0

10

20

30

40N

ov-

15

De

c-1

5

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

Phoenix

Vacancy (%)

Sickness (%)

Page 93


Page 94

BEH-MHT – Trust Board – 28.11.2016 4.1 - North Central London Sustainability and Transformation Plan

Title:

North Central London Sustainability and Transformation Plan

Report to:

Trust Board

Date:

28 November 2016



Purpose of Report: This report provides an overview of the published North Central London (NCL) Sustainability and Transformation Plan (STP). Recommendations: The Trust Board is asked to: 1. Note the North Central London Sustainability and Transformation Plan 2. Support the direction of travel and priorities for improving services and outcomes set out in

the STP. 3. Comment on the next steps. Sponsor:


Report Author:

Name: Maria Kane Title: Chief Executive Tel Number: 020 8702 3026 E-mail: [email protected]

Report History:

Regular Report






List of Appendices:

NCL STP summary document.

Page 95


Report 1. Introduction 1.1 This report provides an overview of the published North Central London (NCL) Sustainability

and Transformation Plan (STP). 1.2 Attached to this covering report is a summary of the NCL STP. A copy of the draft NCL STP

strategic narrative as submitted to NHS England on 21 October 2016 can be found on the Trust’s website at: http://www.beh-mht.nhs.uk/news-and-events/North-Central-London-Sustainability-and-Transformation-Plan.htm.

2. Sustainability and Transformation Plan 2.1 The draft Sustainability and Transformation Plan (STP) has been produced by all the main

healthcare organisations and local authorities within North Central London. It sets out plans to meet the challenges faced locally and to deliver high quality and sustainable services in the years to come.

2.2 The vision for the STP is for North Central London to be a place with the best possible health

and wellbeing, where no one gets left behind. 2.3 The clinical case for change within the STP describes the changing health and care needs of

local people and the key issues facing health and care services in North Central London. It will be used to guide the transformation of local services over the next five years.

2.4 The clinical case for change in the STP is aligned to address the gaps identified in the Five

Year Forward Plan for health and wellbeing, care and quality, and finance. 2.5 To support delivery of the vision for the STP and address the clinical case for change a

programme of transformation has been designed with four fundamental aspects:

Prevention: We will increase our efforts on prevention and early intervention to improve health and wellbeing outcomes for our whole population;

Service transformation: To meet the changing needs of our population we will transform the way that we deliver services;

Productivity: We will focus on identifying areas to drive down unit costs, remove unnecessary costs and achieve efficiencies, including working together across organisations to identify opportunities to deliver better productivity at scale;

Enablers: We will build capacity in digital, workforce, estates and new commissioning and delivery models to enable transformation.

2.6 Delivering these plans will result in improved outcomes and experience for the local

population, increased quality of services and significant savings. 2.7 The STP is still work in progress. Despite the development of the plans for prevention, service

transformation, productivity and enablers the draft STP submitted on 21 October 2016 showed an overall £75m deficit in 2020/21 across NHS organisations. A number of areas for further work have been identified between now and Christmas where additional savings can be found to address this residual gap.

2.8 To ensure overall delivery as a system, a robust governance structure is being developed to

enable NHS and local government partners to work together in new ways to drive implementation.

Page 96




2.9 It is crucial that the whole system is aligned around delivery of the STP and work is underway to ensure that the development of the two-year health contracts that are being put in place for 2017/18 - 2018/19 are consistent with the STP strategic framework.

2.10 There is more work to do to finalise the granular detail of our delivery plans and address the

residual challenge forecast. Development of plans in more detail will involve full engagement of people who use services and the public to ensure those plans are reflective of their needs. There is a commitment to being radical in approach, to focusing on improving population health and delivering the best care in London. Our population deserves this, and we are confident that we can deliver it.

2.11 The draft North Central London Sustainability and Transformation Plan therefore articulates:

The health and social care landscape, and its complexity; The collective understanding of the challenges faced through the clinical case for change; The vision for health and care in NCL in 2020/21; The plans to deliver the vision and address the challenges, and the delivery framework that

will enable implementation of those plans; The impact expect to be achieved through the delivery of the plans; Supporting governance arrangements; Plans for securing broader public support and engagement with the STP proposals; Next steps for further developing proposals and responding to our residual financial gap.

3. Workstream delivery plans 3.1 Submission of the draft NCL Sustainability and Transformation Plan is supported by the

development of workstream delivery plans. 3.2 The workstreams focus on identified priorities for joint working across North Central London

and focus on:

1. Prevention: We will increase our efforts on prevention and early intervention to improve health and wellbeing outcomes for our whole population: This includes a focus on population health, particularly in areas that will support

improved outcomes and reduced costs within the five-year period of the STP – smoking, alcohol ,obesity, falls and sexual health (use of long-term contraception and earlier diagnosis of HIV);

A focus on a workforce for prevention including mental health first aid, dementia awareness, and the making every contact count programme;

A focus on healthier environments including workplace wellbeing and an environment to help reduce childhood obesity.

2. Service transformation: To meet the changing needs of our population we will transform

the way that we deliver services: A focus on developing out of hospital services and providing health and care closer to

home. This includes the development of urgent care and primary care services; Development of mental health services for adults and children; Urgent and emergency care including an integrated urgent care system; Optimising elective care pathways including outpatient activity; Consolidation and/or networking of services following the previous template in London

for stroke and trauma services; Cancer pathways including earlier diagnosis and improving patient experience.

Page 97


3. Productivity: We will focus on identifying areas to drive down unit costs, remove unnecessary costs and achieve efficiencies, including working together across organisations to identify opportunities to deliver better productivity at scale through a focus on:

Workforce (skill-mix; shared recruitment and bank functions, increase retention); Reducing operational and clinical variation including a response to recommendations in

the Carter Report; Procurement efficiencies by acting at scale; Sharing back office functions; Reducing contract and transaction costs including new commissioning and contract

models; Cost improvement schemes including theatre productivity.

4. Enablers: We will build capacity in digital, workforce, estates and new commissioning and

delivery models to enable transformation. This will be dome through workstreams for:

Workforce including the use of integrated employment models, developing new roles to support new models of care, and enabling productivity opportunities;

Digital maturity including interoperability across providers as envisaged with the “Care My Way” programme in Islington;

Estates including developing an overarching estates strategy, optimising the use and quality of estate across health and care services, supporting delivery of new models of care by delivering linked improvements to the health and care estate, and creating partnership working between commissioners and providers to align incentives for estate release and support delivery of devolved estates powers for the NHS and partners.

5. Patient and public engagement: We have a commitment to work in an open and

transparent way. The STP summary has been produced to support further engagement, in recognition that the full STP is a technical planning document. All organisations involved in the STP are asked to publish the full strategic narrative and summary on their websites to stimulate feedback and engagement with patients, the public, staff and other stakeholders. We recognise that engagement on the overall STP to date has been limited to the stakeholder meetings held in each borough in September, although individual STP workstreams such as mental health have also engaged users of service in the development of their plans. We will now develop an STP workstream on communications and engagement to ensure we build active and effective engagement into the further development and delivery of the STP.

Ends.

Page 98

North Central London

Sustainability and Transformation Plan

A summary

North Central London

N C LPage 99

2NCL | Sustainability and Transformation plan – a summary

N C LNorth Central London

IntroductionHospitals, local authorities, GPs, commissioners, and mental health trusts across north central London have all come together to transform the care we deliver to our patients.

On a scale never seen before, health and social care services in the region are working on the ‘North and Central London (NCL) Sustainability and Transformation Plan (STP)’.

Our work covers the five boroughs of Camden, Islington, Haringey, Barnet and Enfield – an area that is home to nearly 1.5 million people.

We know that the health and social care needs of our local people are changing, and that there are serious issues facing health and care services in NCL. People receive different standards of care depending on where they live: waiting times for services and health outcomes vary, and the quality of care and people’s experience of health and social services is sometimes not as good as it should be.

We must improve and we can only do this if we all work closely together – with each other and with our local residents.

It does not mean doing less for patients or reducing the quality of care provided. It means more preventative care - finding new ways to meet people’s needs, and identifying ways to do things more efficiently. We want to ensure that everybody we care for has greater control of their health and wellbeing and receives the support they need to live longer, healthier lives. Many of these ambitions are not new, but are based on what local people have told us they want.

The plan is currently work in progress. We are looking to engage with as many people as possible over the next few months to develop our ideas further.

John, age 62 is a lifetime smoker who was recently diagnosed with chronic bronchitis. His GP ad-vised him to stop smoking but John said he could not cope without his cigarettes and refused the offer of nicotine replacement therapy (NRT). John contracted a chest infection, went to A&E and was admitted. He stayed for several days, was given some NRT on the ward to cope with his cravings for cigarettes. In future, when John is admitted to hospital his respiratory physician will discuss the importance of stopping smoking as a treatment for his bronchitis. He will be prescribed NRT to relieve his cravings and on discharge he will be offered a referral to specialist stop smoking support for heavily addict-ed smokers. John will then get a call the next day from the specialist stop smoking advisor who will arrange a home visit for the following day. John will be supported by the specialist advisor in weekly visits to help him to reduce or stop smoking altogether.

Page 100



What is the Sustainability and Transformation Plan (STP)?To make sure everybody receives the care they need when they need it, we have to change the way we do things.

Our draft plan sets out how we will work together to deliver high quality, sustainable services in the years to come and how we can meet the financial challenges and increasing pressures on our services over the next five years.

The North Central London area has a growing population and people are also living longer, often with long term health problems.

The growth in our funding over the next five years will not match the expected increases in population and the resulting growth in demand for health services. NHS services already have deficits and, if nothing changes, it is anticipated that the combined deficit of health services alone will be nearly £900million by 2020/21. Local authorities are also facing significant financial pressures on their social care budgets. We need to change how we provide services, reduce the amount of time and treatment spent in hospitals, boost prevention and offer more local people the care they need closer to home.

Page 101



Enfield CCG / Enfield Council~320,000 GP registered pop~324,000 resident pop49 GP practices

Barnet CCG / Barnet Council~396,000 GP registered pop~375,000 resident pop62 GP practices

Haringey CCG / Haringey Council~296,000 GP registered pop ~267,000 resident pop45 GP practices

Islington CCG / Islington Council~233,000 GP registered pop~221,000 resident pop34 GP practices

Camden CCG / Camden Council~260,000 GP registered pop~235,000 resident pop35 GP practices

London Ambulance Service East of England Ambulance Service

Total health spend £2.5bn

Total care spend £800m

Primary care spend

£~180m

Specialist commissioning

spend £~730m

NHS England

Note: registered pop data shows 2014 figures. Source: ONS

Barnet Enfield and Haringey Mental Health NHS Trust (main sites, incl Enfield community)

Camden and Islington NHS Foundation Trust (and main sites)

North Middlesex University Hospital NHS Trust The Royal Free London NHS Foundation Trust University College London Hospitals NHS

Foundation Trust Whittington Health NHS Trust

(incl Islington and Haringey Community) Central and North West London NHS Foundation

Trust (Camden Community) Central London Community Healthcare NHS

Trust (Barnet Community) Specialist providers

Other specialist providers out of scope: Great Ormond Street Hospital, Moorfields Eye Hospital, Tavistock and Portman Foundation Trust, Royal National Orthopaedic Hospital

North Central London overview

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What are we going to do to?There are a wide range of health problems in the region including high rates of childhood obesity and mental illness. Too many people are treated in hospital for long term conditions when they could be better cared for in the community. Waiting times to see a specialist and for diagnostic tests are long. Attendance levels at A&E departments are high and it’s difficult to recruit staff. We want to create a health and social care system which delivers positive outcomes in all of these areas, no matter where you live.

To help us achieve this, over the next five years we aim to:

Invest more in prevention to stop people getting ill

Work with people to help them remain independent and manage their own health

Give children the best possible start in life

Provide care closer to home so that people will only need to go to hospital when it is clinically necessary

Give mental health services equal priority to physical health services

Improve cancer services

Make the best standards available to all and reduce variation

Make north central London an attractive place to work so that we have the right workforce to deliver high quality services

Modernise our buildings and make greater use of digital technology

Ensure value for tax payers’ money through increasing efficiency and productivity, and consolidating and specialising where appropriate

PreventionWe aim to do more to promote and empower people to live healthy lives so we can stop the onset of disease, and keep people out of hospital. We want to increase investment in prevention and ensure that the places where people live and work promote good health.

We want to support residents, families and communities to look after their own health. We will work to diagnose residents with clinical risk factors and long term conditions much earlier to increase life expectancy.

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Care closer to homeWe aim to deliver more health and care closer to home, so that people are treated in the best possible environment and do not have to go to hospital unless they really need to.

This would be achieved through local networks which bring different services together and improving access to GPs or other primary care professionals.

We aim to provide 24/7 access to specialist opinion in primary care, ranging from an advice only service to admission to an acute assessment unit. We will also review the existing provision across NCL of GP presence in emergency departments.

We will look to develop special falls emergency response services to help support older people to remain at home after a fall, as well as helping to educate them about the risks.

What will be different for patients

GP servicesMs Sahni is 87 and has four chronic health problems. She currently has to book separate appointments with different doctors to have all of the relevant check-ups and appointments that she needs.

In future, Ms Sahni will be in a special “stream” of patients who will have all of their care co-ordinated by a very experienced GP. This will allow her to see the specialist heart or diabetic nurses at the integrated care centre at her GPs surgery. There will also be a care navigator in the team who can help sort things out for her at home including community support.

What will be different for patientsPrevention and care closer to home John, age 62 is a lifetime smoker who was recently diagnosed with chronic bronchitis. His GP advised him to stop smoking but John said he could not cope without his cigarettes and refused the offer of nicotine replacement therapy (NRT). John contracted a chest infection, went to A&E and was admitted. He stayed for several days and was given some NRT on the ward to cope with his cravings for cigarettes.

In future, when John is admitted to hospital his respiratory physician will discuss the importance of stopping smoking as a treatment for his bronchitis. He will be prescribed NRT to relieve his cravings and on discharge he will be offered a referral to specialist stop smoking support for heavily addicted smokers. John will then get a call the next day from the specialist stop smoking advisor who will arrange a home visit for the following day. John will be supported by the specialist advisor in weekly visits to help him to reduce or stop smoking altogether.

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Achieving the best start in lifeBetter education for children is crucial to our plan. We need to put health and wellbeing on the map at the earliest opportunity. We need to create healthy environments, promote active travel, sport and play in schools.

We have identified areas of focus – from prevention to acute care – which will improve health and outcomes for children and young people

This will include a focus on maternal health which evidence strongly suggests has an impact on child and adult health – for example obesity, diabetes and cardiovascular disease.

We want to address mental health in children as early as possible, supporting mothers with mental health problems both before and after birth. We also want to provide services for parenting support and health visiting which focus on vulnerable, high risk families.

Mental healthWe will give equal priority to physical and mental illness and aim to reduce demand on hospital care and mental health inpatient beds.

Our plans include increasing access to primary care mental health services and improving how we manage acute mental health problems, building community capacity to enable people to stay well; and investing in mental health liaison services – for example ensuring that more people in hospitals have their mental health needs supported. We will also look to strengthen perinatal and child and adolescent mental health services (CAMHS).

What will be different for patients

Mental health liaison Maisie suffers from dementia, and is cared for by her husband Albert. Previously, after falling at home Maisie was admitted to hospital. Due to the accident and change of surroundings, Maisie was agitated and more confused than normal.

In future, as the hospital will have Core 24 liaison psychiatry, the liaison team will be able to help the hospital support both Maisie’s physical and mental health needs. As Maisie will receive holistic care it will mean that she is ready to be discharged sooner than if only her physical health needs were supported. Maisie’s husband Albert will also be supported by the dementia service, allowing him to continue to care for Maisie at home.

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Urgent and emergency careOver the next five years, we aim to provide a consistent urgent and emergency care service. Patients should be seen by the most appropriate professional for their needs, which may include directing them to an alternative emergency or urgent care service. There is strong evidence that getting patients to the right specialist service, even if that might not be their local hospital, improves outcomes.

We want to develop high quality ambulatory care services across NCL – so patients can be assessed, diagnosed, treated and able to go home on the same day without needing a hospital admission.

For those patients who do need emergency treatment, we aim to have services in place that help them to leave hospital as quickly as possible and rehabilitate closer to their home if appropriate

Planned careWe want to reduce variation in the way that we deliver planned care across north central London. This includes some key areas for improvement, such as making sure patients can access the right expertise locally and that their experience of surgery is seamless, smooth and efficient.

We aim to have clear ‘pathways’ for patients across the region, with consistent approaches, so that we become more efficient and there is less variation in outcomes and experience.

We want to improve patients’ access to information and help people manage conditions without surgical intervention where possible. We will ensure patients spend as little time as possible in hospital.

CancerOur aim is to save lives and improve patient experience for people who have cancer. The priority areas we have identified for improvement are getting earlier diagnosis and better provision of radiotherapy and chemotherapy.

Targeting colorectal and lung cancers are a particular focus given the high percentage of patients receiving late stage diagnosis, often in emergency departments.

We are also developing a case for a single provider model for radiotherapy in NCL.

We want to improve palliative care so that patients have a better quality of life in their final weeks.

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Social careSocial care is a crucial part of many elements of our plan, in particular in delivering care closer to home and improving mental health services. We want to ensure that health and social care services work well together to deliver well-coordinated care for local people. We will improve collaboration between local authorities and hospitals – for example, focusing on earlier discharge of hospital patients where safe and appropriate. We will build on the experience and expertise of social care and public health in the development of new models of care.

We recognise that many social care providers of services such as residential, nursing home and home care services are under great pressure. We aim to focus on strengthening the supply of the workforce for these services to address risks around their staffing capacity.

The role of social workers will also be essential to delivering our model for health and care closer to home, in addition to the role of home care workers, personal assistants and the blended role between district nurses and care workers. We will focus on recruiting to these posts and developing career opportunities in these areas.

Bringing services togetherWe will work out where it makes sense to bring services together or create networks across organisations to improve the experience of our patients. We are already collaborating across the region with positive results in cardiac/cancer; pathology; neurosurgery; stroke; and many other services.

We can learn from our experience in these areas and more work is planned to identify areas where some form of consolidation may be worth considering.

What will be different for patientsCancerPreviously Margaret, aged 60, went to see her GP with persistent gastric pain for several weeks. She was otherwise well, and did not have reflux, diarrhoea, vomiting or weight loss. Over the course of the next three weeks, Margaret's GP organised tests and ruled out any inflammation, heart problem, or gallstones that could cause the pain. He gave Margaret tablets to try to reduce inflammation from acid on her stomach lining. However, Margaret's pain was more persistent this time and she was still worried.

In the new system, Margaret’s GP will be able to refer her to a Multidisciplinary Diagnostic Centre at UCLH despite the fact that her symptoms are not considered “red flag”. Here, Margaret will be assessed for vague abdominal symptoms. A clinical nurse specialist will see her four days after referral. The team will identify that Margaret has early stage pancreatic cancer and because it was picked up early she can access potentially curative keyhole surgery.

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WorkforceWe want to attract the highest quality staff to deliver the best possible care we can for local people. Therefore as well as creating the most positive environment for our patients, we want NCL to be a place where we offer the best opportunities for people to develop their careers.

Our aim is to attract, develop and retain people who work in and support health and social care in north central London. We want to create attractive careers with a workforce fit for purpose in the changing healthcare landscape – so we have the right skills in the right place for patients.

Digital and estatesWe want to use the power of digital communications and IT systems to share information and support the provision of better care and treatment for patients. We aim to promote changes so that patients can use technology to receive and share information, get treatment and prescriptions through e-referrals and e-consultations. Sharing high quality data between health and care professionals will mean people don’t have to retell their stories. Digital technologies will help ensure care is delivered in the right place at the right time by the right person.

We also want to modernise the buildings we work from and our equipment to make sure they are fit for purpose. We already have major investments planned at University College Hospital and Chase Farm Hospital and would look to develop plans for investment to improve facilities so we can deliver more care closer to home and improve mental health services.

Reducing costsWe think the changes we have set out will help us reduce waste in the health and care system. For example we can reduce cost of care by:

– treating people right first time and improving the co-ordination of services.

– avoiding unnecessary admissions to hospital .

– speeding up discharge when people are ready to go home.

– being less reliant on agency and temporary staff.

– avoiding unnecessary duplication of services between organisations.

However our plans at the moment do not achieve financial balance over the next five years, so we will continue to look for other opportunities to improve our efficiency.

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EngagementWe are committed to being open and transparent about our plan as it develops. We need engagement from all of our partners, patients and local residents if we are to succeed

This means:

Early engagement on the issues before any decisions are made

Stakeholders and the public help to devise the solution

Ensuring decision-making is transparent and people know what to expect when

Each stage of the process is informed by ongoing dialogue.

As we add more detail to our plans, we will ensure that we undertake formal public consultation where appropriate. We will work with the North Central London Joint Health Overview and Scrutiny Committee to agree when we need to do this and how we best do this.

Next stepsThe draft Sustainability and Transformation Plan sets out our proposed approach to achieve sustainable health and care services in north central London. It is still work in progress. There is much more to do before we finalise the detail of these plans.

We want to fully engage patients and the public in our thinking to make sure we get this right. The various NHS organisations and local authorities will be looking at this draft plan over the next few months and they will arrange events to raise awareness of the proposals and get people’s feedback.

In the meantime if you want to feed in ideas or comments please contact the NCL STP office at [email protected]

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Page 110

BEH-MHT – Trust Board – 28.11.16

4.2 – Medical Director’s Report

Title:

Medical Director’s Report

Report to:

Trust Board

Date:

28 November 2016



Purpose of Report: This is the fifth Medical Directors Board Report. It includes:

Smokefree Quality Improvement New contract and rota issues Visits and clinical engagement External engagement and activities Clinical Work

Recommendations: The Trust Board is asked to note the report Sponsor:


Report Author:

Name: Jonathan Bindman Title: Medical Director Tel Number: 020 8702 4888 E-mail: [email protected]

Report History:

Regular Report






The associated risks are managed through the Risk Register and Board Assurance Framework.

List of Appendices:

None

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Report 1. Introduction 1.1 This report describes the work of the Medical Director, principally since the last Board

Meeting on 26 September 2016. 2. Smokefree 2.1 The Trust continues to make good progress towards implementation of the Trust’s

Smokefree Policy on 17 January 2017. As the date approaches, the Smokefree Implementation Committee has been meeting fortnightly and has been well attended, and now has good representation from all boroughs.

2.2 The Implementation Committee has engaged with staff in all boroughs, has developed

communication materials (banners, posters, and leaflets), and has developed the new Trust Smokefree Policy together with an inpatient protocol and a Pharmacotherapy Protocol describing how Nicotine Replacement Therapy (NRT) is to be provided on inpatient units within 30 minutes when needed. Open meetings have taken place in each borough (with varying success). Training (both e-learning- level 1, and face to face- level 2) have been launched.

2.3 While concerns persist about the effective support to be provided to smokers newly

admitted to wards, the Trust is also focussing on the community teams. These need both to advise and support service users at risk of admission, and also those discharged from wards on NRT who need advice and help if they are not to resume smoking immediately. There is an ongoing need for engagement of ward staff, who will be offered practical training in the delivery of NRT, in addition to the more theoretical training available on-line.

3. Quality Improvement 3.1 Together with other members of the Executive Management Team, I am getting involved in

the development of Quality Improvement in the Trust. I attended the two Haelo collaborative sessions, on 31 October and 21 November, and am sponsoring three collaborative groups at Wormwood Scrubs, the Phoenix Unit and in the Haringey Acute wards. I also attended the ‘Haelo Hosts’ conference in Salford on 11 and 12 November. The conference was fascinating and well delivered, and demonstrated the importance of inspirational personal narratives in motivating staff to participate in quality improvement. I continue to progress work with Haelo to develop Quality Improvement Fellows as part of changes to the current role of Deputy Medical Director.

4. New contract and medical rota issues 4.1 I am meeting regularly with Mark Vaughan, Executive Director of Workforce, colleagues

from Medical HR, Gareth Jarvis, the Guardian of Safe Working, and doctors in training to plan the implementation of the new contract from 1 April 2017. This is progressing well, and new rotas have been drawn up and costed. The BMA have formally ended the dispute, and it seems probable that the contract can be implemented without difficulty.

4.2 On 4 November I met with Steve Powis, Medical Director RFH, Mark Berelowitz, CAMHs

lead RFH, Mike Greenberg, Paediatrics lead RFH, Ruth Ouzia, Senior Ops Manager Children’s Servcie’s RFH, and Eamann Devlin and Neil Snee (from Barnet CCG) to discuss the future of the interim protocol for CAMHs cover to Barnet A&E, which has now been in place for over a year but remains a source of concern to our consultants. We were again assured of Barnet CCGs commitment to additional investment in CAMHs liaison services and their intention to develop a new service model which will support our consultants. While

Page 112



it is encouraging that the CCG appear committed to improving the service, the new investment has been delayed previously and I and RFH colleagues emphasised the importance of making progress before the end of the current protocol on 9 January 2017.

4.3 While problems with CAMHs cover in Barnet remain unresolved, a problem is now

developing in Haringey and Enfield, where the Deanery have advised the Trust that we may not ask STs in adult psychiatry to see anyone under the age of 18. CAMHs consultants in these areas have up to now been taking part in an on-call rota on the basis that the cover they provide is ‘telephone only’ (though on my advice they have not in practice declined to attend in emergency). In my view this is now unsustainable as it is a requirement of the Mental Health Act, and indeed safe clinical practice, that a child presenting out of hours should have access to CAMHs expertise, and at present the pathway for obtaining this is unclear and dependent on consultant goodwill. I will be meeting with the CAMHs medical staff on 30th November to seek a resolution.

5. Visits and clinical engagement 5.1 On 2 November I attended the excellent BEH Mental Health Law Conference; the teaching

on mental capacity was of immediate value in my clinical work as I conducted a capacity assessment using the new material the following week.

5.2 On 7 November I led a Berwick learning event at the Chestnuts Community Centre on the

subject of ‘Leaving Hospital Safely’. An audience of 70 (our largest to date excepting the Patient Safety Conference in January) heard a powerful and moving account form a bereaved carer. Rebecca Harrington, Non Executive Director of the Trust then presented the NICE guidelines on Transition between Mental Health Inpatient Settings and the Community (https://www.nice.org.uk/guidance/ng53), based on her experiences of chairing the development group, and I summarised lessons learned from a series of relevant SI investigations.

5.3 On 8 November I chaired the Clinical Cabinet. There was a lively debate about the role of

the Cabinet in bringing together services of similar types across our borough Directorates. In addition to the Clinical Networks (8 of which are now functioning well across the organisation and reporting to the Cabinet), it was felt that the Cabinet had a role in bringing a clinical perspective to changes within the organisation. Some concern was expressed that the current plans to develop the Adult Pathway, while positive and creative, might also lead to an unhelpful divergence in service models across the organisation. It was suggested that there is now a need for a process of sharing local plans for the pathway across the organisation, and making sure that any significant differences in proposed service models across the organisation are fully understood and justified. This has been agreed by the Clinical Directors.

6. External engagement and activities 6.1 The new National Medical Director for Mental Heath, Professor Tim Kendall, has

established a national network for mental health MDs, which has held two telephone conferences; at the first on 5 October we heard from Stephen Firn on new care models for tertiary services, and at the second on 2 November we heard from Paul Farmer about ‘holding NHS England to account for the delivery of the mental health transformation’. I also attend the London Medical Directors meeting, most recently on 12 November.

6.2 From 11-14 October I attended the first residential session of the ‘NHS Leadership

Academy Director Programme’ in Leeds. I am one of 21 participants on the programme, none of whom are psychiatrists, and the majority are in leadership roles in acute Trusts or CCGs. While exposure to the wider NHS was initially daunting, the group bonded quickly. I look forward to developing my leadership skills and capabilities in a very different setting

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https://www.nice.org.uk/guidance/ng53



from anything I have been used to. The course continues for a further year, and I am grateful to the Trust for the opportunity.

6.3 I have continued to attend the STP Clinical Cabinet approximately fortnightly throughout the

period, and also meetings of the NCL Mental Health Steering Group. It appears that the quality of the mental health element of our STP has been acknowledged by a national assurance review, but it will remain a challenge to ensure it is given sufficient time at the Clinical Cabinet.

6.4 On 3 November I met with Professor Glyn Lewis at UCL to discuss the possibility of

developing further clinical academic roles within the Trust. This is challenging at present as UCL is not encouraging expansion in the numbers of academic staff, and post become available only as others vacate them. In addition it might be necessary for the Trust to fund some academic time in addition to the clinical part of the job. This will only be possible if an appointment would result in the delivery of recruitment to studies for which we receive funding from the CRN, but this is an option we will be exploring.

6.5 On 18 November I attended the Strategic Clinical Network for London. Having focused on

standards for Early Intervention, Health Based Places of safety and perinatal services (for which BEH has recently obtained funding together with C&I and Tavistock and Portman) we are now considering our priorities for the next year, and I am advocating strongly for a clear focus on the future development of community mental health teams, particularly the sort of models of working across the primary secondary care boundary we are developing in BEH through our adult pathway.

7. Clinical Work 7.1 Since my last report I have done 20 sessions (10 days) of clinical work, seeing

approximately 70 patients in clinic in addition to home visits (and a rare Mental Health Act assessment in the community), providing supervision for the clinical team, liaising with GPs and visiting the inpatient wards.

7.2 I continue to develop my interest in patients with autistic spectrum disorders who do not

have learning disability (‘Asperger’s syndrome’), who are presenting with increasing frequency to services. I am now seeing about 12 people regularly in the clinic, and will describe their presentations and needs, and plans for service development, in more detail in future reports.

Ends.

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BEH-MHT – Trust Board – 28.11.2016 4.3 - Annual Review of Standing Orders, Standing Financial Instructions and Scheme of Delegation

Title:

Annual Review of Standing Orders, Standing Financial Instructions and Scheme of Delegation

Report to:

Trust Board

Date:

14 November 2016



Purpose of Report: This report presents revisions to the Standing Orders, Reservation of Powers to the Board and Delegation of Powers, and Standing Financial Instructions for approval. These documents are required to be published in accordance with the National Health Services Act 1977 and Community Care Act 1990, as amended by the Health authorities Act 1995 and Health Act 1999 Code of Accountability and have been to ensure that these documents are accurate and up-to-date. Appendix 1 sets out the full list of revisions made to the above documents and the reasons for these. The key revision to note is the updating of the relevant OJEU limit from £111,676 to £106,047 (SFI para 8.5.3) with other amendments being the removal of obsolete paragraphs, correction of job titles and clarifications of contents. This report was considered by the Audit Committee at their meeting on 14 November which has recommended that the Trust Board ratify the proposed changes.

Recommendations: The Trust Board is asked to: 1. Ratify the amendments to the Trust’s Standing Orders (as attached as Appendix 2); 2. Ratify the amendments to the Trust’s Reservation of Powers to the Board and Delegation of

Powers (as attached as Appendix 3); and 3. Ratify the amendments to the Trust’s Standing Financial Instructions (as attached as Appendix

4). 4. Agree the further changes identified to Section 11.1.2 and 14.1.1 in the Trust’s Standing

Financial Instructions and subsequent changes required in the Trust’s Reservation of Powers to the Board and Delegation of Powers, as set out in paragraph 5 of this report.

Report Sponsor:



The revisions in this report have been proposed in line with decisions taken through the year, to reflect legislative changes or have been made in line with best practice to ensure that these documents are accurate and up to date.

Page 115


Report Author:

Name: Barry Ray Title: Trust Board Secretary Tel Number: 020 8702 4060 E-mail: [email protected] Name: Martin Davies Title: Head of Financial Control Tel Number: 020 8702 3703 E-mail: [email protected]

Report History:

Annual Report


None.


None.


The Trust has a legal/mandatory requirement to publish Standing Orders, Reservation of Powers to the Board and Delegation of Powers, and Standing Financial Instructions in accordance with the National Health Services Act 1977 and Community Care Act 1990 as amended by the Health authorities Act 1995 and Health Act 1999 Code of Accountability.

List of Appendices:

Appendix 1 – Schedule of Revisions Appendix 2 – Standing Orders Appendix 3 - Reservation of Powers to the Board and Delegation of Powers Appendix 4 – Standing Financial Instructions Appendices 2-4 are available on the Internet, and will be circulated to Board members under separate cover.

Page 116


Report 1. Introduction and Background 1.1 The Trust has a legal/mandatory requirement to publish Standing Orders, Reservation of

Powers to the Board and Delegation of Powers, and Standing Financial Instructions in accordance with the National Health Services Act 1977 and Community Care Act 1990 as amended by the Health authorities Act 1995 and Health Act 1999 Code of Accountability.

1.2 These documents are reviewed on an annual basis to ensure that these documents are

accurate and up-to-date, reflecting decisions taken throughout the year, legislative changes and best practice in order to ensure that the Trust is operating lawfully.

1.4 Attached as Appendix 1 is a schedule of the revisions proposed. 2. Standing Orders 2.1 The NHS Code of Accountability requires all Trusts to adopt Standing Orders for the

regulation of its proceedings and business. The Standing Orders detail the composition of the Trust Board, arrangements for Trust Board meetings, the appointment of Committees, arrangements for the exercise of functions, and the duties and obligations of members and officers.

2.2 The revised Standing Orders, with the changes highlighted, are attached as Appendix 2. 3. Reservation of Powers to the Board and Delegation of Powers 3.1 Section 15 of Schedule 7 of the National Health Service Act 2006 requires that all Trusts

demonstrate the existence of comprehensive governance arrangements which may be delegated in accordance. The Reservation of Powers to the Board and Delegation of Powers sets out those decisions which are reserved for the Trust Board and those which may be delegated to a committee, sub-committee, or a Director or Officer of the Trust.

3.2 The revised Reservation of Powers to the Board and Delegation of Powers, with the

changes highlighted, are attached as Appendix 3. 4. Standing Financial Instructions 4.1 The Trust (Functions) Directions 2000 require that each Trust shall agree Standing

Financial Instructions for the regulation of the conduct of its members and officers in relation to all financial matters with which they are concerned. The Standing Financial Instructions detail the financial responsibilities, policies and procedures adopted by the Trust.

4.2 The revised Standing Financial Instructions, with the changes highlighted, are attached as

Appendix 4. 5. Additional amendments 5.1 Following consideration of proposed changes to the Standing Orders, Reservation of

Powers to the Board and Delegation of Powers, and Standing Financial Instructions by the Audit Committee a further two minor amendments have been identified.

5.2 Standing Financial Instructions section ‘11.1 – Delegation of Authority’ states:

Page 117


“11.1.1 The Board will approve the level of non-pay expenditure on an annual basis and the Chief Executive will determine the level of delegation to budget managers.

11.1.2 The Chief Executive will set out:

(a) the list of managers who are authorised to place requisitions for the supply of goods and services;

(b) the maximum level of each requisition and the system for authorisation

above that level. 11.1.3 The Chief Executive shall set out procedures on the seeking of professional advice

regarding the supply of goods and services.” 5.3 Standing Financial Instructions section ‘14.1.1 (under 14.1 – Capital Investment’), states:

“14.1.1 The Chief Executive:

(a) shall ensure that there is an adequate appraisal and approval process in place for determining capital expenditure priorities and the effect of each proposal upon business plans;

(b) is responsible for the management of all stages of capital schemes and for

ensuring that schemes are delivered on time and to cost; (c) shall ensure that the capital investment is not undertaken without

confirmation of purchaser(s) support and the availability of resources to finance all revenue consequences, including capital charges.”

5.4 It is proposed that reference to ‘The Chief Executive’ in 11.1 and 14.1.1 be amended to

read ‘The Chief Finance and Investment Officer’. These changes will require subsequent minor amendments to be made to the Reservation of Powers to the Board and Delegation of Powers.

Implications

6. Budgetary / Financial Implications 6.1 There are no budgetary implications as a result of this report. The report seeks to make

revisions to the Standing Financial Instructions which will help to ensure that the Trust’s financial transactions are carried out in accordance with the law and with Government policy in order to achieve probity, accuracy, economy, efficiency and effectiveness.

7. Risk Management 7.1 Revisions to the Standing Orders, Reservation of Powers to the Board and Delegation of

Powers, and Standing Financial Instructions have been made to ensure that these documents are accurate and up-to-date, and in so doing provide a framework for the Trust to operate within.

8. Equality and Diversity Implications 8.1 None. Ends.

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Appendix 1 Schedule of Revisions

Page Paragraph

Original Text Revision Required Reason for Amendment

Standing Orders Page 6 Para 1.2.8

1.2.8 “Clinical Governance Committee" means a committee whose functions are concerned with the arrangements for the purpose of monitoring and improving the quality of healthcare for which the Barnet, Enfield and Haringey Mental Health NHS Trust has responsibility.

1.2.8 “Clinical Governance Committee" means a committee whose functions are concerned with the arrangements for the purpose of monitoring and improving the quality of healthcare for which the Barnet, Enfield and Haringey Mental Health NHS Trust has responsibility.

No longer relevant.

Page 9 Para 1.4

1.4 Integrated Governance 1.4.1 Trust Boards are now encouraged to

move away from silo governance and develop integrated governance that will lead to good governance and to ensure that decision-making is informed by intelligent information covering the full range of corporate, financial, clinical, information and research governance. Guidance from the Department of Health on the move toward and implementation of integrated governance has been issued and will be incorporated in the Trust’s Governance Strategy (see Integrated Governance Handbook 2006). Integrated governance will better enable the

1.4 Integrated Governance 1.4.1 Trust Boards are now encouraged to

move away from silo governance and develop integrated governance that will lead to good governance and to ensure that decision-making is informed by intelligent information covering the full range of corporate, financial, clinical, information and research governance. Guidance from the Department of Health on the move toward and implementation of integrated governance has been issued and will be incorporated in the Trust’s Governance Strategy (see Integrated Governance Handbook 2006). Integrated governance will better enable the

No longer relevant.

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Page Paragraph


Board to take a holistic view of the organisation and its capacity to meet its legal and statutory requirements and clinical, quality and financial objectives.

Board to take a holistic view of the organisation and its capacity to meet its legal and statutory requirements and clinical, quality and financial objectives.

Page 23 Para 5.3.2

5.3.2 When the Board is not meeting as the Trust in public session it shall operate as a committee and may only exercise such powers as may have been delegated to it by the Trust in public session.

5.3.2 When the Board is not meeting as the Trust in public session it shall operate as a committee and may only exercise such powers as may have been delegated to it by the Trust in public session.

Section 5.3 should only refer to the delegation of executive powers to Committees.

Reservation of Powers to the Board and Delegation of Powers Page 8 Para 3.2

3.2 Delegation to Officers

Data Protection Act - Chief Executive has overall accountability, however day to day responsibility is delegated to the Medical Director.

3.2 Delegation to Officers

Data Protection Act - Chief Executive has overall accountability, however day to day responsibility is delegated to the Medical Director Chief Information Officer.

Amendment reflects that the Chief Information Officer is the Trust’s Senior Information Risk Owner responsible for implementing the Data Protection Act.

Page 11 Para 5.4

Designate an officer responsible for receipt and custody of tenders before opening.

Designate an officer responsible for receipt and custody of electronic and postal tenders before opening.

Amendment made to clarify that both electronic and postal tenders will be accepted.

Page 13 Para 2.2.1 (c)

Investigate any suspected cases of fraud or other irregularity.

Investigate any suspected cases of fraud or other irregularity. Decide at what stage to involve the police in cases of misappropriation and other irregularities not involving fraud or corruption.

Amendment made to reflect the wording in the Standing Financial Instructions.

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Page Paragraph


Page 19 Para 5

5. Non Pay Revenue and Capital Expenditure

a) Approving a Requisition

All requisitions up to £999

5. Non Pay Revenue and Capital Expenditure

a) Approving a Requisition

All requisitions up to £999 £499

Amendment made to reflect the decision taken by the Trust Board on 18 July 2016.

Page 20 Para 5

b) Authorising an Invoice for Payment for Goods & Services acquired without purchase order or prior agreement of charges in writing in accordance with limits above.

* up to £999

* £1,000 to £4,999

b) Authorising an Invoice for Payment for Goods & Services acquired without purchase order or prior agreement of charges in writing in accordance with limits above.

* up to £999 £499

* £1,000 £500 to £4,999

Amendments made to reflect the decision taken by the Trust Board on 18 July 2016.

Page 21 Para 6

- All amounts refer to total contract values, not annual values.

Inclusion of text for clarification.

Page 22 Para 7



Page 23 Para 8



Page 24 Para 10

- Any engagement must be compliant with employment and tax law and best practice.


Page 27 Para 16

Doctor/ward manager. Doctor/ward manager and Head of Financial Control or nominated deputy

Doctor/ward manager. Appropriate clinician. Doctor/ward manager. Appropriate clinician and Head of Financial Control or nominated

Amendment made to reflect the wording in the Patient Monies policy.

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Page Paragraph


deputy.

Standing Financial Instructions Page 11 Para 2.4

- 2.4.2 From 2017/18 onwards the external auditor will be appointed directly by the Trust, with the Audit Committee acting as the Trust’s Auditor Panel to oversee the appointment and management of the External Auditor.

Amendments made to reflect the decision taken by the Trust Board on 16 November 2016.

Page 20 Para 8.5.3

Formal tendering procedures and alternative procurement processes for contract values below £75,000 may be waived in the following circumstances but cannot be waived for contracts which exceed the OJEU threshold (£111,676 at October 20152016): (f) where Framework agreements are in place and have been approved by the Board;

Formal tendering procedures and alternative procurement processes for contract values below £75,000 may be waived in the following circumstances but cannot be waived for contracts which exceed the OJEU threshold (£111,676 £106,047 at October 20152016): (f) where Framework agreements are in place and their use have has been approved by the Board;

Amendment reflects change to the OJEU threshold. Minor amendment.

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Page Paragraph


Page 21 Para 8.6.1 (iii)(a)

(a) submitted in a manner stipulated by the tender documentation and the latest date and time for the receipt of such tender addressed to the Chief Executive or nominated Manager. The manner of submission of a tender shall either be through electronic submission or by post. The tender document shall stipulate which of the modes of submission should be use. For electronic tenders, the submission request shall request for copies of submissions to be sent to the email address of the Chief Finance and Investment Officer.

(a) submitted in a manner stipulated by the tender documentation and the latest date and time for the receipt of such tender addressed to the Chief Executive or nominated Manager. The manner of submission of a tender shall either be through electronic submission or by post. The tender document shall stipulate which of the modes of submission should be use. For electronic tenders, the submission request shall request for copies of submissions to be sent to the email address of the Chief Finance and Investment Officer.

Amendment to reflect correct process

Page 25 Para 8.6.8 (b)

(i) Invitations to tender shall be made only to firms included on the approved list of tenderers compiled in accordance with this Instruction or on the separate maintenance lists compiled in accordance with Estmancode guidance (Health Notice HN(78)147).

(ii) Firms included on the approved list of

Tenderers shall ensure that when engaging, training, promoting or dismissing employees or in any conditions of employment, shall not discriminate against any person because of colour, race, ethnic or

(i) Invitations to tender shall be made only to firms included on the approved list of tenderers compiled in accordance with this Instruction or on the separate maintenance lists compiled in accordance with Estmancode guidance (Health Notice HN(78)147).

(ii) Firms included on the approved list of Tenderers shall ensure that when engaging, training, promoting or dismissing employees or in any conditions of employment, shall not discriminate against any person because of colour, race, ethnic or

This Health Notice is now not in force and reference must be removed.

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Page Paragraph


national origins, religion or sex, and will comply with the provisions of the Equal Pay Act 1970, the Sex Discrimination Act 1975, the Race Relations Act 1976, and the Disabled Persons (Employment) Act 1944 and any amending and/or related legislation.

national origins, religion or sex, and will comply with the provisions of the Equal Pay Act 1970, the Sex Discrimination Act 1975, the Race Relations Act 1976, and the Disabled Persons (Employment) Act 1944 and any amending and/or related legislation.

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BEH-MHT – Trust Board – 28.11.2016 5.1 - Workforce Annual Report 2016

Title:

Workforce Annual Report 2016

Report to:

Trust Board

Date:

28 November 2016



Purpose of Report: This report provides an overview of the activities of the Workforce Directorate during 2016. It also provides information about progress against our directorate priorities for 2016/17. Recommendations: The Trust Board is asked to note the report.

Report Sponsor:

Mark Vaughan, Executive Director of Workforce

Comments/views of the Report Sponsor:

The Workforce Directorate aims to provide for the Board an annual report that offers an up-to-date overview of key workforce indicators and performance. Whilst focussing on our agreed priorities, we have also endeavoured to forge strong working relationships with operational and clinical managers to help progress the workforce agenda. To this end, the team has taken on board feedback from those managers and made improvements and changes to processes throughout the year to facilitate both management and development of the workforce. It is clear that there remain challenges to achieving our targets for 2016/17 but the workforce leadership team is confident about continuing to make progress across all aspects of our work. Whilst this is a retrospective view of our work and it is important to assess our progress, the work described in this report underpins our proposed focus in the coming year on:

improving recruitment and retention embedding our values and positive behaviours enhancing staff engagement

In addition to organisational priorities, our plans will include our contribution to the wider STP/sector-wide priorities which reflect many of our own.

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Report Author:

Name: Jackie Stephen/Meera Nair Title: Deputy Director of OD & Learning/Deputy Director

of Workforce Tel Number: 020 8702 25332 / 25331 E-mail: [email protected] [email protected]

Report History:

Annual Report


None.


None.

Links to the Trust’s Objectives, Board Assurance Framework and/or Corporate Risk Register

The contents of this report relate to the Trust objectives of delivering excellent services for our patients and developing our staff.

List of Appendices: None

Page 126

mailto:[email protected]@beh-mht.nhs.uk

mailto:[email protected]@beh-mht.nhs.uk


Report 1. Introduction and Background 1.1 This report provides an overview of the activities led by the Workforce Directorate during

2016. It includes commentary on the directorate’s priorities for 2016/17 including progress towards our targets for 2016/17.

1.2 Throughout the year, the workforce team has supported Trust-wide initiatives and is

collaborating closely with the turnaround, enablement and quality improvement work which is underway.

2. Directorate priorities for 2016/17 2.1 Our priorities for 2016/17 have included: getting the basics right, promoting staff wellbeing,

increasing staff engagement and developing management capacity and capability. Our activities, as reported below, have all served to support and progress these priorities.

2.2. As a directorate, we developed a series of key performance indicators for 2016/17. The table

below provides progress towards the year-end targets:

Measure 2015-16 outturn

Target for 2016-17

Progress to date

Turnover 14.3% 12% 13.2%

Staff survey response rate 38% 45% 43%

Sickness absence 4.7% 3.5% 4.2%

Mandatory training compliance 85% 90% 77%*

Vacancy rate 11.4% <10% 12.4%**

Vacancy rate - nursing 17.7% <10% 16.3%

Time to hire 15 weeks 11 weeks 14.8 weeks***

Clearances 99% 99% 99%

Nominations for staff awards 79 100 329

Staff engagement 3.83 3.85 Not available until Feb 2017

Appraisals 85% 90% 72%

* reduction because of recent changes in mandatory training requirements ** there were increases in establishment at the start of the year and again in August 2016 *** time to hire measured in calendar weeks from the time a vacancy is advertised to employee’s start date

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3. Overview of Workforce Directorate activity in 2016 3.1 Recruitment

The recruitment service has been an area of significant focus over the last year, particularly in light of the need to make a significant impact on vacancy levels across the Trust. Implemented TRAC recruitment system in late 2015

Set up recruitment project team, with borough and corporate representation - has led to streamlined recruitment process for nursing roles

Project team and nurse managers attended five recruitment fairs and held open recruitment days at Trust sites, offering on-the-day interviews and conditional offers of employment – achieved near 0 healthcare assistant vacancies

Developed better links with local universities – attended events with recently qualified/soon-to-graduate nurses and mental health workers and attracted our largest cohort of newly qualified nurses

Recruited 30 candidates to the Trainee Graduate Mental Health Scheme with the expectation that they will be placed in substantive roles on completion of training

Piloted a social media recruitment campaign

Launched a “recruit a friend” scheme (targeting nurses) to recognise the effort staff make in directing their friends and contacts to suitable roles within the Trust

Sustained reduction in vacancies requires systems and process improvement. Now reporting on “time to hire” and implemented a service level agreement with recruiting managers. Receiving support through quality improvement experts to make marked improvements in process and system design

3.2 Retention

An improved exit survey process has resulted in a higher response rate from less than 10

in 2015 to over 200 so far in 2016. The most commonly quoted reason for staff leaving was “better career opportunities”.

Launched a nursing career development framework for Band 5 nurses to address retention and provide progression opportunities within the Trust. Provides opportunity to move laterally to other nursing roles within the Trust with a simpler HR process to support this transition and get priority consideration for promotional opportunities

Career progression

17%

Better benefits/pay

17%

Proximity to home 13%

Improved work life balance

12%

Retirement 8%

Conflict 8%

Family and/or personal

reasons 7%

Career change 7%

Other 11%

Reasons for leaving employment

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3.3 Mandatory training Reviewed and refreshed the Trust’s mandatory training matrix in line with the UK Core

Skills Training Framework (developed by Skills for Health), the intercollegiate document affecting safeguarding children and legislative changes affecting mandatory training provision. Approved by the Quality and Safety Committee in July

Matrix changes have resulted in recent fall in compliance to 77%. We are confident that this fall is temporary, given the measures put in place to increase compliance. Continuing to find alternative ways to improve compliance and reinforcing personal and managerial responsibility for maintaining training compliance

Supported the delivery of nearly 15,000 training sessions in the past 18 months, ranging from management development (39) to resuscitation training (529) and induction (26) with increased frequency of induction because of the success of recruiting new staff

3.4 Leadership and management development

Strengthened leadership and management development offer to support middle leaders.

Introduced two new programmes so far this year - the new and aspiring managers and experienced middle leaders programmes

Sponsored another cohort of 14 delegates on the Middlesex University postgraduate certificate in leadership and management as well as some senior managers on national NHS Leadership Academy programmes

3.5 Appraisals

Streamlined the performance development framework (appraisal process and paper work)

in response to feedback from managers. Current appraisal return rate is 72% though likely to be under-reported

3.6 Staff development

Continued focus on streamlining mandatory training but also introduced new programmes

e.g. Supporting Excellent Care to enhance customer service skills and develop service standards

Facilitated away days for departments and delivered other department-level activities Used the national Learning at Work Week as a vehicle to raise awareness of training and

development that is available to staff – three LAW days held across the Trust Undertook Trust-wide training needs analysis – requests for wide range of professional

development programmes, Fully utilised indirect funding to commission courses with universities including Middlesex, City, London Southbank, Hertfordshire, BPP

Changed central training panel process for applying for funding – reduced delays for approvals and ensured equitable use of the funds

Embarked on embedding the Care Certificate for healthcare support workers (Cavendish Review recommendation)

3.7 Engaging with external stakeholders

This year we have increased our engagement with external stakeholders including: Health Education England, North Central and East London (apprenticeships and Talent for

Care – development for staff in bands 1-4), Healthcare People Management Association Community Education Provider Networks, including membership of steering groups,

contributing to strategies and designing their network events Haringey Adult Learning Service – invited onto their advisory group to provide support and

challenge to the work of the service through providing stakeholder input to the strategic leadership and management of the service

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Middlesex University and Camden and Islington Mental Health NHS Foundation Trust – membership of the Board for My Care Academy (chaired by our Director of Nursing)

Strategic and operational involvement in the work of the North Central London Sustainability and Transformation Plan

3.8 Work experience

Introduced a work experience programme for school students.14 students completed a week

in a range of work areas. Intending to increase the selection of opportunities for the coming year by encouraging more managers to participate

3.9 Focusing on making our Trust the Place to BEH

We have mapped activities into a set of OD workstreams to help improve the effectiveness of interventions that support excellent service delivery, promote improvements, equalities and staff engagement.

BEHeard: staff engagement and empowerment

BEHWell: staff wellbeing initiatives – health, welfare, social

BEHExcellent: staff recognition awards and innovation initiatives

BEHFair: staff equality and diversity work

BEHKind: specific staff to staff anti- bullying, harassment and abuse work

Staff Friends and Family Test

National Staff Survey

Employee Assistance Scheme

Occupational Health service

Staff wellbeing forum (cultural and social activities)

Staff benefits initiatives

Staff Awards: annual, monthly, local (service line and team-based)

Dragons’ Den

Staff equalities groups for disabilities, LGBT and race

Coordinating Trust-wide equalities performance monitoring

Online fora

Dignity at work advisors

Anti-bullying,

harassment and abuse team interventions

2015 staff survey revealed growth in number of staff feeling more engaged with the Trust.

Results very positive in the areas of flexible working, staff satisfaction in being able to provide quality patient care and effective use of service user feedback. Need improvement in other areas e.g. reversing the trend of rising numbers of staff reporting a recent experience of harassment, bullying or abuse

Staff survey action plan highlights five areas of focus: a) Promoting staff health and wellbeing b) Tackling discrimination c) Lowering incidence of physical violence and harassment/bullying/abuse from other staff d) Improving perceived fairness with regard to career progression/promotion e) Improving staff perception of the Trust as a high quality employer/service provider so

more staff would recommend the Trust as a place to work or care for a friend/family member

Quarter 2 of Staff Friends and Family Test shows a fall in recommending the Trust for

care (60% from 70%) and as a place to work (68% to 54%) as well as a reduced response rate (16.5%). Propose to wait for national staff survey results before drawing conclusions or inferences

Undertook major engagement exercise to seek views from staff and stakeholders on crafting a new set of values. The resulting values - Compassion, Respect, Working

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Together, Being Positive - are supported through a further Trust-wide direct engagement programme to identify the behaviours which best illustrate the values and can then be used to bring them to life

Participated in joint procurement exercise for a new Employee Assistance Programme (EAP). New provider is Care First which provides more features, including online provision of wellbeing advice and information, at a lower unit cost

Achieved “commitment” status for the London Healthy Workplace Charter, an initiative backed by the Mayor of London. Applying for ‘Achieving’ status in April 2017 which requires grassroots-level staff engagement in driving the wellbeing agenda so we are refreshing our Staff Wellbeing Forum to provide improved engagement and governance

Supported successful Dragons’ Den bid for an outdoor gym for staff - installed at St Ann’s Supported the 2016 Dragons’ Den programme - generated 11 major bids (over £5,000)

and 25 minor bids (under £5,000), a significant increase on last year Embedded employee of the month programme - aiming to retain corporate, Trust-wide

scheme and supplement it with local schemes in each clinical division Coordinating the 2016 Celebrating Excellence Awards which have generated a record

number of nominations (over 300) Supported the formation of a staff-led race equality network - ‘Better Together’ - and its

programme of activities Supported the launch of an online disabilities staff equality forum Provided robust data for the Workforce Race Equality Standard (WRES) - leadership of

the workforce directorate, executive directors and managers across the Trust are working with staff side and the Better Together Network to develop practical interventions to address the gaps. Analysis of the WRES will be included in the annual equality report in January 2017

Recruited and trained a cohort of 25 volunteer dignity at work advisors (DAWAs) whose role is to be available to staff who feel they are victims of bullying, harassment and abuse

3.10 Workforce information

Improved level of granularity and analysis for a range of meetings including divisional

integrated performance management meetings and Deep Dives Support for quality improvement initiative with Haelo Comprehensive reports which inform a range of initiatives including equality (WRES) and

recruitment 3.11 Temporary Staffing

Temporary staffing bank went live in November 2015 providing a comprehensive temporary staff booking service - has provided the Trust and managers with transparent and accessible data on bookings

Established a preferred supplier framework for nursing agencies in October 2015 - has been effective in controlling rates and improving booking processes. Implementing new framework for AHP roles to allow us to achieve further efficiencies and financial savings

Introduced vacancy control panels to review requests for substantive and temporary recruitment – has provided a higher level of scrutiny of all requests and scrutiny of all long term agency bookings

Adhered to agency rate caps with few exceptions since introduction in November 2015 3.12 E-rostering

Implemented e-rostering upgrade, allowing cloud-based access to full-system functionality for managers and staff

Delivered e-rostering training for managers, focussing on the importance of finalising rosters, logging sickness and annual leave correctly and embedding good practice

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Introduced ‘Good Rostering Practice’ meetings to review performance against defined key performance indicators. Marked improvement in the quality of rosters over the last six months

3.13 Safe Care

Implemented SafeCare to provide a dynamic view of wards and patient acuity, allowing us to have the right staff with the right skills in the right place at the right time. 150 nurses trained on the system over a period of three weeks. Provides information on staffing levels and patient acuity which impacts on discussions regarding skill mix and rostering

3.14 Medical Workforce

Job planning principles agreed by the Local Negotiating Committee – 82% of our consultant workforce have job plans in place, aiming for 100% in 2016/17

Rolled out a direct engagement model for booking temporary staff, supported by a cloud-based portal (TempRe) – has led to improved reporting and data accuracy on bookings and weekly financial savings since August. Considering rolling out for other staff groups

Reviewed out of hours working patterns of trainee doctors to bring in standardised systems for on-call and cover arrangements whilst ensuring adherence to the Working Time Regulations - led to improved rota cover, decline in locum bookings and related spend

Led on developing an implementation plan for introducing new junior doctors’ contract. The Trust was amongst the first to appoint to the role of Guardian of Safe Working. New contract coming into effect in February 2017. Focussing on maximising the level of involvement in the design of new rotas in line with new safety principles

3.15 HR Business Partnering

Supported enablement programme by recruiting eight Community Engagement Workers

(Peer Support Workers) with lived experience of mental health. Review underway of the measures of success and the impact their work is having

Four claims taken to tribunal in 2016 all defended successfully Focus on resolve matters quickly and informally, so promoting resolution of grievances via

informal resolution routes such as mediation or facilitated meetings Established sickness absence boards, chaired by borough Assistant Directors and

supported by the business partnering team, aiming to ensure active management plans in place for each member of staff. Sickness reduced from 4.7% to 4.2% this year

Implications 4. Budgetary/Financial Implications 4.1 There are no budgetary/financial implications beyond what has been agreed during the

priority setting process. 5. Risk Management 5.1 None 6. Equality and Diversity Implications 6.1 None.

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