Minutes of the Board Meeting held at 2.00pm on Monday 19 September 2011 in the Common Room, Block 6, St Ann s Hospital, St Ann s Road, London N15 3TH

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1 Minutes of the Board Meeting held at 2.00pm on Monday 19 September 2011 in the Common Room, Block 6, St Ann s Hospital, St Ann s Road, London N15 3TH Present: Michael Fox Richard Fass Paul Cinnamon Cathy Hamlyn Christine Harvey Maria Kane Lee Bojtor Simon Goodwin David Robinson Chairman Non-Executive Director Non-Executive Director Non-Executive Director Designate Non-Executive Director Chief Executive Chief Operating Officer Chief Finance and Investment Officer Director of Nursing, Quality and Safety In attendance: Stephen Guile Head of Corporate Affairs & Trust Secretary Andrew Wright Director of Strategy and Performance (for items 1-3.3) Kate Holmes Enfield Mental Health Users (EMU) (for items 1 to 1.7; 3.1 & 3.2 Elsie Lyons Barnet Voice for Mental Health (for items 1 to 1.7; 3.1 & 3.2 Michael Fox welcomed Cathy Hamlyn to her first Board meeting. He welcomed representatives of service user groups, attending in order to present the report on Service User and Carer involvement. The meeting was also attended by members of the public. 1 GENERAL BUSINESS Actions 1.1 Chairman s Welcome Michael Fox welcomed staff and members of the public to the meeting. 1.2 Apologies for Absence David Griffiths, Non-Executive Director; Pete Sudbury, Medical Director and Bronwen Tumani, Non-Executive Director 1.3 Declarations of Interest and of any Conflicts of interest The Board noted and accepted the declarations of Board Members interests. Paul Cinnamon amended his declaration in that he was now remunerated by Barnet Education Business Partnership Ltd. There were no other declarations of interest and there were no conflicts of interest declared at the meeting. 1.4 Minutes of the meeting held on 25 July 2011 The minutes of the meeting held on 25 July 2011 were confirmed as a true record, subject to an amendment to Minute to read: In response to a question from Paul Cinnamon, Simon Goodwin said that he would provide more detail on the phasing of the annual budget by month and outturn by month. 1.5 Matters Arising from Minutes of the Meeting held on 25 July 2011 The Board noted the written report on matters arising and accepted the updates. The following matters were noted:

2 1.5.1 Chief Operating Officer s Report (Minute 1.5.1) Lee Bojtor would be providing an analysis across locations to show service changes, with the Estates Strategy for review at a Board Workshop in October or November Section 75 Health and Social Care Agreements (Minute 1.5.2) Lee Bojtor will advise the Board of the date of the meeting when the reviews of the three boroughs agreements will be brought to the Board together. Lee advised that the Agreement with the London Borough of Barnet would come to the 28 November Board meeting for renewal Clinical Governance (Minute 1.5.3) The Board will be provided with further updates on clinical governance methodology Medical Director s Report (Minute 1.5.4) Michael Fox said that, in general, updates must state when actions are planned to be carried out. Dr Pete Sudbury would be amending the Clinical Strategy to reflect the activities of ECS. Dr Pete Sudbury would be reviewing the need for a workshop session for Board Members on the Clinical IT Strategy Dr George Ikkos would be attending the 28 November Meeting to present the next six-monthly update on Medical Education Clinical Governance Update: May Data (Minute 2.1) CQC Compliance visits had begun across the Trust. Feedback reports were awaited External Auditors Report on the Trust s Quality Account 2010/11 (Minute 3.2) The 2011/12 Quality Account will include more benchmarking information on quality (wherever it is available). A Stakeholder event will be held on 22 November to update partners on progress with the identified quality priorities for 2011/12. LB LB LB DR All PS PS PS DR DR Did Not Attend results (Minute 5.2.2) Lee Bojtor advised that an IT system aimed at reducing Did not Attend rates was now being procured Rethink Mental Health Contract for Recovery Houses (Minute 5.2.3) The Board noted the Supplementary Note in which listed the performance measures for the contract with Rethink Mental Health. This would be monitored at Board level though the Performance Report. 1.6 Chairman s Report Michael Fox highlighted the following matters: He had re-opened the Town Clinic on 2 September, following its move from Wenlock House to The Villa on the St Michael s site. He had recently met Councillor Doug Taylor, the Leader of Enfield 2

3 Council. Together with Maria Kane, he had recently met the Chair and Vice Chair of Enfield Health Overview and Scrutiny Committee On 13 September he had met Paula Kahn, the NHS North Central London Sector Chair. The discussion had included the low comparative rates of PCT spending on mental health for Barnet, Enfield and Haringey compared with the higher rates for Camden and Islington. 1.7 Chief Executive s Report Maria Kane presented her report. She highlighted a number of matters, including the following: The Trust s Foundation Trust (FT) application was progressing. NHS London was carrying out a Quality gateway review. The Trust s Annual General Meeting had taken place immediately before the Board meeting. The AGM had been very well attended. There had been keen interest in and questioning on the presentations, including that of Alison Mohammed, of Rethink Mental Health, the Trust s Recovery House partner. Full consultation was due to take place on the future of St Ann s Hospital. The Trust was committed to retaining and attracting as much health services provision as possible on the site. A Consultation on the restructuring of the Nursing, Quality and Safety Directorate was under way. The outcomes of the two latest NED service visits were noted. Maria Kane and colleagues had attended a Joint Overview and Scrutiny Committees meeting. The meeting had reviewed the commissioners proposals to change the service provision for young people at Northgate House, Edgware. The OSCs had postponed a decision pending further clarification from commissioners. A senior Leadership Day was due to take place on 7 October. Service, Cost and Quality Improvement plans would be discussed The Board noted the Chief Executive s update report. 1.8 Chief Operating Officer s Report (This item was taken after items 3.1 and 3.2) Lee Bojtor presented the report and highlighted the following matters: CIP delivery Productivity and quality initiatives: following on from the Productive Ward, the Trust was developing the Productive Team approach. Advice on productivity activity recording had been sought from the Trust s auditors Progress on introducing Recovery Houses and the new care pathway. The Board noted that an oral appeal was due be heard on 23 September against the Court s rejection of an application for judicial review of the move of Holly Oak Ward patients from Colindale to the Springwell Centre, Barnet. Two new Enfield Community Services: Community Stroke Rehabilitation and Community Rehabilitation Action being taken to recover over-payments to staff The Board noted progress made on operational services activities. 1.9 Medical Director s Report: Maria Kane presented the report on behalf of Dr Pete Sudbury. The Board 3

4 noted the report. 2 PATIENT QUALITY AND SAFETY 2.1 Clinical Governance Update: July Data David Robinson presented the report. The purpose of this report was to update the Board on the following clinical governance areas: Quality assurance: the START Team in Haringey had achieved improved performance Patient Experience: there was increased correlation between Meridian Patient Experience Tracker scores and survey results. ECS surveyed service users extensively with twice yearly; postal surveys that ached responses reporting high level of satisfaction. Analysis of patient experience broken down by service would be proved for the 28 November Board meeting. CQC Compliance: CQC visits to the Trust were under way Complaints: in addition to the percentages of complaints resoled in time, an indication of numbers by Service Line would indicate scale. Serious Untoward Incidents Infection Control: low rates maintained Suicide data: DR The Board noted the report, including the trend analyses and noted that the Governance and Risk Management Committee keeps under regular review the adequacy and appropriateness of clinical governance indicators and that it received greater detail on performance by team. 3 STRATEGY 3.1 Service User and Carer Involvement Report (This item was taken after item 1.7) David Robinson, Kate Holmes and Elsie Lyons presented the update report. The background was that the Trust-wide Service User Involvement Strategy Group had developed a Service User Involvement Strategy in August 2005 and a Service User Involvement Action Plan in The Strategy and Action Plan had been reviewed and updated in June In October 2010, the Group widened its remit to include carer involvement and to open membership to carers representatives. The Group was renamed the Service User and Carer Involvement Strategy Group (SUCISG) and new terms of reference were agreed in January David Robinson said that he had found working with the Group very positive and productive. The report set out progress to date. The Action Plan would improve involvement further Elsie Lyons explained that Haringey Users group had been unable to attend the Board meeting. She too felt that there had been successes in working together and in particular service user involvement in training Trust staff and in the protocol for service user involvement in job interviews. The Group met bi-monthly, with the chairmanship alternating between David Robinson and Kate Holmes. She queried whether information for patents and the Trust s Wellbeing Pack is explained properly at the stage that a very ill serve user is more able to be receptive Else Lyons said that service user and carer representation on the right Trust groups and panels was not always sufficient in itself to achieve meaningful involvement, for example in significant service changes. The pace of change seemed sometimes to militate against involvement. She hoped that in developing the Trust s application to become a Foundation Trust it would achieve the commitment to involve FT members in the 4

5 development of services Elsie Lyons said that the Group welcomed the Trust s review, later in the meeting, of the smoking ban Kate Holmes confirmed that relationships with senior staff had improved. She commended the adoption of the Mindful Employer scheme. She agreed that earlier consultation on service changes was necessary. Kate invited the Board to appoint a Non-Executive Director to join the Service User and Carer Involvement Strategy Group and the each Service Line to appoint a lead for service user and carer involvement who would coordinate consultation on service developments. MF/DR LB/DR Michael Fox acknowledged the need to ensure appropriate involvement especially given the pace of change. He acknowledged that the Board would be reviewing, in the run up to becoming an FT, how best to involve FT members and the Council of Members in particular. The Trust would learn from other trusts experience Maria Kane said that the need for effective consultation and involvement about services was increasing with the pace and extent of change. Commissioners intentions would be discussed with service user and carer groups wherever possible. Short timeframes were sometimes imposed on the Trust. The suggestions made by the Group would be reviewed at the Senior Leadership day on 7 October. The proposal that the Trust becomes a Mindful Employer was due to be discussed by the Executive Team the following week. The Trust s FT plans were likely to include focus groups and Council of Members task groups David Robinson acknowledged that there was still room for improvement in the Trust s processes for involving service users and carers, especially given the rapidity of change and reductions in resources. He acknowledged that there had been consistent views expressed against the smoking ban, which was about to be reviewed by the Board later in the meeting Lee Bojtor acknowledged that there was a need for more qualitative feedback on care planning. LB/DR Michael Fox thanked Elsie Lyons and Kate Holmes for attending the meeting and though them the service user and carer groups and individuals who have contributed to the Service User Involvement Strategy and Action Plan. The Board would consider the suggestions made and respond. 3.2 Review of the Trust Smoking Ban David Robinson introduced the report. The July 2006 Health Act had required all enclosed work and public places to be smoke free. The government extended that requirement in July 2008 to all mental health facilities. Over and above that legal requirement, the Trust commenced a rolling programme to implement a total ban on smoking on all Trust premises from March The ban prohibited service users from smoking in outside areas as well as within inpatient units. Ward staff received training in smoking cessation The Board had previously lifted the ban on patients at the North London Forensic Unit, to allow controlled smoking outdoors. The report set out the difficulties in maintaining the ban throughout the remainder of the Trust s 5

6 facilities, including personal and buildings safety issues. The Board noted that a number of other mental health trusts had rescinded their bans, notably West London and South Essex Partnership The Board approved the recommendations that: As the majority of inpatient areas have some access to outdoor areas suitable for the situation of smoking shelters, supervised outdoor smoking is reintroduced to all inpatient areas which have not already done so. As part of this general re-introduction, ward teams will be required to ensure that outdoor smoking remains controlled and monitored. There will continue to be an emphasis on providing advice and encouragement to service users to make connection with the stop smoking services available. 3.3 Summary of Responses to Foundation Trust Public Consultation Andrew Wright introduced the report which summarised the key outcomes of the recent public and staff consultation on the Trust s plans to become an FT and set out the Trust s proposed responses. This second consultation had become necessary because of the lapse of time since the original consultation on 2007/08 and the changes within the Trust since The Board was invited to review and to agree the proposed Trust responses to the consultation as set out in the report and to endorse the formal consultation response document attached The Board was pleased at the range of responses received. The proposed change of name to North London Foundation Trust had been supported by 54% of respondents. 23% of respondents had opposed it and the remainder didn t express a view. However NHS London had received a query about the name change from other NHS organisations and was currently considering the matter. The Board : Noted the key findings from the consultation as set out in the report. Endorsed the formal consultation response document attached. 4 BOARD ASSURANCE 4.1 Board Assurance Framework & Corporate Risk Register Lee Bojtor presented the report. The BAF and CRR had been updated, with changes shown in red to reflect changes since the Performance and risk Sub-Committee meeting on 15 August. The Governance and Risk Management Committee (GRMC) meeting that had been due to take place on 1 September had been postponed until 27 September. SMART (Specific, Measurable, Achievable, Realistic and Time related) plans and controls and assurance had been further developed following the July Board review The Board noted that the three risks rated as red on the CRR were: The achievement of Cost Improvement targets Potential reductions in income Workforce productivity The Board noted that the Historic Due Diligence review report by PricewaterhouseCoopers had recommended that the Trust continue to develop the BAF as a live document driving the business of the organisation. Michael Fox said that considerable progress had been made in developing and using the BAF. He asked that we should identify good 6

7 practice from elsewhere and assure ourselves we are following best practice. LB/AJ The Board approved the updated Board Assurance Framework & Corporate Risk Register and actions set out in the report. 5 PERFORMANCE 5.1 Financial Performance Report 2011/12 : Month 4 (July) and oral update for Month 5 (August) Simon Goodwin presented the report on the Trust s financial performance for July 2011 and gave an oral update to 31 August For the period 1 April to 31 July 2011 the Trust made a deficit of 1,585k compared with a planned deficit of 1,359k, an adverse variance against plan of 191k. In the month of July a surplus of 420k had been achieved against a planned deficit of 192k. This was due mainly to a one-off upside in ECS income and a reversal of prior year expenditre provisions For the period 1 April to 31 August 2011 the Trust made a deficit of 1,503k compared with a planned deficit of 1,225k, an adverse variance against plan of 278k. In the month of August a surplus of 83k had been achieved against a planned surplus of 170k. This was due mainly to a under performance in cost and volume income in ECS GUM, Northgate House and Forensic Services. There had been reduced bank and agency staff spending, and improvements in the financial performance of the Dementia and Cognitive Impairment Service Line and the Crisis and Emergency Service Line Simon Goodwin confirmed that the Executive Management Team continued to take firm action to achieve the budgeted year end surplus and to deliver on the Cost Improvement Programme (CIP) whilst providing safe services The Board noted the financial performance report for Months 4 and the oral update for Month 5 and noted that measures were being taken to address the income and CIP shortfalls in the financial year to date. 5.2 Performance Report Lee Bojtor presented the Performance report. The report highlighted the following matters: In patient efficiency Productivity of CR&HTT and CMHTs New Birth Visits Simon Goodwin asked about plans to achieve forecast green ratings from current red ratings on the dashboard in the BAF or CRR. Further information on the action plans to achieve an improved rating would be incorporated into the report to the 28 November meeting Performance measures would be applied to the Rethink contract and reported to the Board in the Performance Report. LB/DR LB The Board considered the contents of the report and agreed the actions being taken to improve performance in the areas which were highlighted as of concern. 5.3 Trust and Charitable Funds Annual Report 2010/11 7

8 5.3.1 Simon Goodwin presented the report. The Board s Trust and Charitable Funds Committee had reviewed the Annual Report, the Annual Accounts, the Letter of Representation to be signed on behalf of the Trust Board as sole corporate trustee and the Auditors Report to Those Charged With Governance (known ISA 260).The TCFC had approved all four documents subject to amendments to the letter of representation paragraph xi to read to the best of our knowledge and belief The Board approved the following, for signing on its behalf as set out in the report: the 2010/11 Annual Report, the 2010/11 Annual Accounts and the 2010/11 Letter of Representation and accepted the Auditors Report to Those Charged With Governance 2010/11 SJG 6 OTHER BUSINESS 6.1 Review of the Board s Business at this Meeting The Board noted that all of the items discussed had been necessary. The meeting had been scheduled to start at 2 pm instead of 1 pm because of the preceding AGM. The meeting finished to time, at 4 pm. Board members found the attendance of service users to present the update report very helpful. 6.2 Any other business None 7 DATE AND TIME OF NEXT MEETING Monday, 28 November 2011 at 1pm - in the Lecture Theatre; Block 6, St Ann s Hospital, St Ann s Road, London N15 3TH. 8 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). 8