Meeting of the Board of Directors in Public (Part 1)
24 November 2010 from 09.30am for a 09.30am start Stapleford House, Stapleford Close, Chelmsford, Essex CM2 0QX
Document header here
Meeting of the Board of Directors to be held in Public on Wednesday 24 November 2010 from 09.15 for a 09.30 start at Trust Headquarters, Stapleford House, Stapleford Close, Chelmsford, Essex CM2 0QX
AGENDA
1. Welcome, Introductions & Questions from the Public MSA 09.30
2. Apologies for Absence [Receive] DMc 09.35
3. Declarations of Interest [Receive] DMc 09.35
Minutes
4. a) Minutes of the Meeting held on 25 August 2010 [Approve] MSA 09.55
b) Matters Arising [Discussion] MSA 09.55
Setting Strategy
5. Chief Executive’s Report [Information] AG 10.00
6. Draft Strategy for Service User and Carer Engagement and Involvement MF 10.20 [Decision]
7. Carers’ Strategy (2010-13) [Decision] GS 10.35
8. Health and Wellbeing Strategy [Decision] LA 10.50
Quality
9. Quality Accounts Progress on five key quality priorities from Trust Quality MF 11.00 Report (Account) 2009/10 and patient safety dashboard [Information]
10. Care Quality Commission Monitoring of Essential Standards of Quality MF 11.10 and Safety [Information]
11. Compliments and Complaints Annual Report 2009/10 [Information] MF 11.20
Monitoring
12. Performance Report to 31 October 2010, Month 7 [Information] RT/PK 11.30
13. Finance Report for the period ending 31 October 2010, Month 7 RT 11.40 [Approval]
Governance
14. Treasury Management Strategy [Approve] RT 11.50
15. Audit Committee RCx 12.00 a) Audit Committee Chairman’s Report for the Year to Date [Information] b) Terms of Reference [Decision]
16. Nominations Committee Chairman’s Report for the Year to Date MSA 12.15 [Information]
17. Risk & Governance Executive Report for Year to Date [Information] MF 12.20
18. Council of Governors – Draft Minutes of the Meeting held on 05 October MSA 12.25 2010 and Feedback [Information]
Assurance
-
Policies
-
Items for Noting
19. Review of Mental Health Employment Strategy (2008-11) [Information] GS 12.30
20. Summary of Board Decisions [Information] DMc 12.30
21. Execution of Deeds [Information] DMc 12.35
Other Items
22. Any Other Notified Business [Discussion] MSA 12.40
23. Questions from members of the public relating to items on the agenda MSA 12.45 only [Discussion]
Meeting Closes
Date of Next Meeting in Public: 02 March 2011 at the St Helena Hospice, Myland Hall, Barncroft Close, Highwoods, Colchester, Essex, CO4 9JU
Dermot McCarthy, Trust Secretary, North Essex Partnership NHS Foundation Trust, 103 Stapleford Close, Chelmsford, Essex CM2 OQX
Meeting of the Board of Directors to be held in Public on Wednesday 24 November 2010 from 09.15 for a 09.30 start at Trust Headquarters, Stapleford House, Stapleford Close, Chelmsford, Essex CM2 0QX
AGENDA
1. Welcome, Introductions & Questions from the Public MSA 09.30
2. Apologies for Absence [Receive] DMc 09.35
3. Declarations of Interest [Receive] DMc 09.35
Minutes
4. a) Minutes of the Meeting held on 25 August 2010 [Approve] MSA 09.55
b) Matters Arising [Discussion] MSA 09.55
Setting Strategy
5. Chief Executive’s Report [Information] AG 10.00
6. Draft Strategy for Service User and Carer Engagement and Involvement MF 10.20 [Decision]
7. Carers’ Strategy (2010-13) [Decision] GS 10.35
8. Health and Wellbeing Strategy [Decision] LA 10.50
Quality
9. Quality Accounts Progress on five key quality priorities from Trust Quality MF 11.00 Report (Account) 2009/10 and patient safety dashboard [Information]
10. Care Quality Commission Monitoring of Essential Standards of Quality MF 11.10 and Safety [Information]
11. Compliments and Complaints Annual Report 2009/10 [Information] MF 11.20
Monitoring
12. Performance Report to 31 October 2010, Month 7 [Information] RT/PK 11.30
13. Finance Report for the period ending 31 October 2010, Month 7 RT 11.40 [Approval]
Governance
14. Treasury Management Strategy [Approve] RT 11.50
15. Audit Committee RCx 12.00 a) Audit Committee Chairman’s Report for the Year to Date [Information] b) Terms of Reference [Decision]
16. Nominations Committee Chairman’s Report for the Year to Date MSA 12.15 [Information]
17. Risk & Governance Executive Report for Year to Date [Information] MF 12.20
18. Council of Governors – Draft Minutes of the Meeting held on 05 October MSA 12.25 2010 and Feedback [Information]
Assurance
-
Policies
-
Items for Noting
19. Review of Mental Health Employment Strategy (2008-11) [Information] GS 12.30
20. Summary of Board Decisions [Information] DMc 12.30
21. Execution of Deeds [Information] DMc 12.35
Other Items
22. Any Other Notified Business [Discussion] MSA 12.40
23. Questions from members of the public relating to items on the agenda MSA 12.45 only [Discussion]
Meeting Closes
Date of Next Meeting in Public: 02 March 2011 at the St Helena Hospice, Myland Hall, Barncroft Close, Highwoods, Colchester, Essex, CO4 9JU
Dermot McCarthy, Trust Secretary, North Essex Partnership NHS Foundation Trust, 103 Stapleford Close, Chelmsford, Essex CM2 OQX
Agenda item No: 1
Name of Meeting: Meeting of the Board of Directors in Public
Date: 24 November 2010
Title of Report: Welcome, Introductions & Questions from the Public
Presented By: Mary St Aubyn, Chairman
Subject, Purpose and Recommendation: Those present will be welcomed, and there will be the opportunity for those attending to ask questions about matters not included upon the agenda.
Finance Implications: N/A
Clinical Implications: N/A
HR Implications: N/A
Legal Implications: N/A
Equality Implications: N/A
Risks: N/A
Agenda item No: 2
Name of Meeting: Meeting of the Board of Directors in Public
Date: 24 November 2010
Title of Report: Apologies for Absence
Presented By: Dermot McCarthy, Trust Secretary
Subject, Purpose and Recommendation: The Board is asked to receive apologies for absence.
Finance Implications: N/A
Clinical Implications: N/A
HR Implications: N/A
Legal Implications: N/A
Equality Implications: N/A
Risks: N/A
Agenda item No: 3
Name of Meeting: Meeting of the Board of Directors in Public
Date: 24 November 2010
Title of Report: Declarations of Interest
Presented By: Dermot McCarthy, Trust Secretary
Subject, Purpose and Recommendation: In accordance with Standing Orders the Board of Directors is asked to receive any declarations of interest from members relating to items on the agenda.
Finance Implications: N/A
Clinical Implications: N/A
HR Implications: N/A
Legal Implications: Declarations of interest are required to comply with Standing Order 7 (“Declarations of Interest and Register of Interests”).
Equality Implications: N/A
Risks: N/A
Colchester Northern Approaches Road phase 3 (NAR3) Construction Timetable
1 1 1 1 2 2 2 2 10 10 1 1 1 1 11 11 1 1 1 1 12 12 - - - - r- y-11 - - - - - r- y-12 - - - ep-10 ct-10 ov ec an eb pr-11 un ul-11 ug-11 ep-11 ct-11 ov ec an eb pr-12 un ul-12 ug-12 ep-12 ct-12 ov ec S O N D J F Ma A Ma J J A S O N D J F Ma A Ma J J A S O N D
Survey work, Audits, Detailed Design, Final Contract documentation, Enabling Approvals works (e.g. Stats Diversions)
Procurement - Tender Process
Implementation Mobilisation
H:\PCP\Major Schemes Mgmt\Schemes\ZA.43.245 Northern Approach Road Phase 3\30 Key Document File\Finance and Costs and Timetables\NAR3 Construction Timetable - 2010.10.13 - for MHT HCA meeting 2010.10.14 s\NAR3 Construction Timetable - 2010.10.13 for MHT HCA meeting 2010.10.14
H:\PCP\Major Schemes Mgmt\Schemes\ZA.43.245 Northern Approach Road Phase 3\30 Key Document File\Finance and Costs Timetable 2
Agenda item No: 4a
Name of Meeting: Meeting of the Board of Directors in Public
Date: 24 November 2010
Title of Report: Minutes of the Meeting held on 25 August 2010
Presented By: Mary St Aubyn, Chairman
Subject, Purpose and Recommendation: The Board is asked to receive and approve the minutes of the meeting held on 25 August 2010.
Any issues of a non-material nature e.g. minor typographical errors, should be communicated to the Trust Secretary in advance of the meeting.
Finance Implications: N/A
Clinical Implications: N/A
HR Implications: N/A
Legal Implications: N/A
Equality Implications: N/A
Risks: N/A
NORTH ESSEX PARTNERSHIP NHS FOUNDATION TRUST MINUTES OF THE MEETING OF THE BOARD OF DIRECTORS IN PUBLIC HELD ON WEDNESDAY 25 AUGUST 2010 IN THE SEMINAR ROOM AT TRUST HEADQUARTERS, STAPLEFORD HOUSE, STAPLEFORD CLOSE, CHELMSFORD, ESSEX CM2 0QX
PRESENT: Mary St. Aubyn Chairman Ray Cox Non-Executive Director Dr. Malte Flechtner Medical Director Paul Keedwell Director of Operations & Nursing Sarah Phillips Non-Executive Director Geoff Scott Director of Strategy Mark Simpson Non-Executive Director Charles Abel Smith Non-Executive Director Rick Tazzini Director of Resources
IN ATTENDANCE: Lisa Anastasiou Director of Workforce & Development, NEPFT Annette Bright Public Governor (Colchester) Mike Chapman Director of Commercial & Service Development, NEPFT Nicola Colston NHS Mid Essex Pippa Ecclestone Public Governor (Uttlesford) Sheila Jackman Public Governor (Epping Forest) Elizabeth Mabbutt Executive Assistant to Chief Executive, NEPFT (Minutes) Jayne Marshall Public Governor (Colchester) Dermot McCarthy Trust Secretary, NEPFT Linda Pearson Clinical Systems Manager, NEPFT & Governor (Non Clinical Staff) Mary Power Public Governor (Chelmsford) Betty Perry Action for Sick Children Steven Pruner Public Governor (Chelmsford) James Purves Legal Adviser, NEPFT Brian Spinks Elected Governor (Epping Forest) & Deputy Lead Governor Harry Young Elected Governor (Colchester)
2010/46 OPENING, INTRODUCTIONS AND QUESTIONS FROM THE PUBLIC Mary St. Aubyn welcomed everyone and congratulated Mike Chapman on his substantive appointment as Director of Commercial & Service Development. Mary invited questions from the public relating to matters not covered on the agenda. Any questions concerning agenda items would be addressed at the end of the meeting. a) Personalised Budgets – Geoff Scott confirmed to Jayne Marshall that the mental health pilot had commenced in January 2010 and 10 people were going through the resource assessment process. A full evaluation of the feedback, Page 1 of 13
L:\Board Meetings in Public\2010\24 Nov 2010\Part 1\agenda item 4a.2 - minutes August 2010 Board.doc lessons learned and future implications for the Trust would be undertaken in December 2010. Geoff agreed to provide the Board with a brief update in October/November 2010. Action: Geoff Scott
2010/47 APOLOGIES FOR ABSENCE Apologies were received from Andrew Geldard, Chief Executive and John Gilbert, Non-Executive Director.
2010/48 DECLARATIONS OF INTEREST There were no declarations of interest.
2010/49 MINUTES OF THE MEETING HELD ON 26 MAY 2010. There being no factual corrections, the Board of Directors approved the Minutes of the meeting held in public on 26 May 2010 and these were signed by the Chairman.
2010/50 MATTERS ARISING There were no matters arising.
2010/51 CHIEF EXECUTIVE'S REPORT On behalf of Andrew Geldard, Geoff Scott highlighted: Anticipated ratings from Monitor for Quarter 1 20010/11 are ‘Green’ for Governance and ‘4’ for Finance. The rating system has changed and Mandatory Services are now included within Governance. Monitor’s Compliance Framework now covers 8 key targets rather than 4. The Trust is performing well against these, although there are some areas for improvement. Local community engagement activity was high, with extensive Governor involvement. Building good media relationships was important and positive coverage had increased. 150 new members have been recruited, but cleansing the database had highlighted the need for recruitment. This will be a key item at the next Governors’ Membership Marketing & Public Relations (MMPR) Workstream meeting. Publication of “Equity and Excellence: Liberating the NHS” included a major reorganisation of the NHS with a key impact being that commissioning will be led by GPs. Staff Governors are leading a staff consultation event on 10 September 2010 looking at the types of outcomes that the NHS will be measured by in the future. Monitor had formally confirmed that they were satisfied with our Annual Plan. The Trust is developing a broader statement of strategic direction which will include significant Governor input.
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L:\Board Meetings in Public\2010\24 Nov 2010\Part 1\agenda item 4a.2 - minutes August 2010 Board.doc The Trust is continuing its efforts to be the ‘preferred bidder’ for West Essex PCT’s Community services All 45 Governor positions are now filled, which is excellent. A half day Governors’ Development Session had been held the day before.
Mary St Aubyn commented the development day had been very well received. Mike Waddington, Associate Director of Communications was championing the use of plain English and had introduced a ‘Cabbage Card’ to be held up at meetings when technical language or acronyms were used. She was delighted by this initiative.
The Board of Directors received the Chief Executive’s report.
2010/52 STRATEGIC CAPITAL PRIORITIES 2010/11 Rick Tazzini reminded the Board that it had already approved the full business cases for Low Secure Unit (LSU), Child and Adolescent Mental Health Services (CAMHS) and a Psychiatric Intensive Care Unit (PICU). Work was also on-going to develop a business case for the refurbishment of the Derwent Centre following the purchase by the Trust in April 2010.
The Trust has secured £8.5m. Public Dividend Capital funding (i.e. a grant) from the Department of Health, which underlined the importance of these developments. The Trust can afford to commence work on one scheme this financial year and must therefore make a choice. Any decision on the PICU scheme would need to await the outcome of discussions with commissioners around the possible reconfiguration of this service. A detailed business case for refurbishment and the services provided at the Derwent Centre (ranging from circa. £5m-£16m) needed to be completed.
Both the CAMHs and LSU schemes would replace ageing accommodation and include the development of some new services. The associated business risks had been assessed, taking into account issues including: patient experience, quality, how quickly the investment would be repaid, the impact on the Trust’s financial risk and performance ratings (i.e. from Monitor and the CQC), liquidity, income streams, initial cost, construction times/project management, local commissioning needs, market conditions, and opportunities for developing new services.
Rick confirmed that the LSU scheme (c.£5.3m.) will be brought back to the Board in the autumn 2010, when a range of options for funding could be considered. Action: Rick Tazzini
Following a discussion the CAMHS development was confirmed as the best strategic ‘fit’. The scheme would start on site by February 2011. The forthcoming increase in VAT would add approx. £200k. to the cost. Charles Abel Smith added that this could be mitigated as the construction market was currently highly competitive. Ray Cox commented that the Board had properly assessed all the implications of its capital programme, and was satisfied that it could provide efficient, economic and quality services.
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The Board of Directors unanimously confirmed the decision made on 30 June 2010 to commence work on the CAMHS strategic capital scheme in 2010/11.
2010/53 CARERS' SURVEY Geoff Scott explained that this bespoke survey had been carried out by Quality Health (using similar methodology to the Patient Survey) between March and July 2010, with 500 questionnaires sent to the carers of adult service users. Quality Health’s Chief Executive had advised that NEPFT was the only Trust which had commissioned a study of this type, and therefore the responses cannot be benchmarked. The questions had been agreed with carers/families and the response rate at 29% was comparable to that of the Annual Patient Survey.
The main themes of the survey included carer involvement in the Care Plan Approach and Reviews, decision making, accessibility of care-coordinators, knowledge of mental health issues and the type of advice/support carers need.
Key outcomes included: Two thirds of respondents had been offered the opportunity to discuss their caring role and needs o 70% had accepted the opportunity o 88% said this was in the last 12 months Over 80% understood the term “carer’s assessment”
Points of learning included the need to: Continue the focus on offering carer assessment and support, looking at how to increase take up Improve the involvement of carers in care and support plans, and the provision of appropriate information.
Further analysis of the many ‘free text’ comments would be carried out. Action: Geoff Scott
Demographic and service markers had not been included and these, along with rephrasing of some of the questions, will be developed for the winter 2010 Survey. The Trust’s Carer’s Strategy is due for review in 2011 and feedback from this initiative will be included in the Action Plan. Overall, the responses were very positive and will allow the Trust to focus on the areas that are most important to carers.
Sarah Phillips commented that the percentages related to a sample of 190 respondents and this was therefore a small sample. Sarah advocated the use of a more inclusive word than ‘carer’ since a wide range and number of family, friends, neighbours, colleagues, employers and others are affected by mental health issues. Ray Cox commented that the needs and challenges for carers of in-patient and community service users were probably very different. Geoff agreed that a marker for this should be included in the next survey, alongside the demographic information. Action: Geoff Scott Page 4 of 13
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Mike Chapman commented on the substantial amount of work done around offering Carer’s Assessments and asked that front-line staff be congratulated on the 88% positive response. Action: Geoff Scott
Geoff Scott added that as part of the CAMHS Commissioning Contract a Young Person’s Survey will be carried out later in the year. He underlined that the Trust takes the views and needs of carers very seriously.
The Board of Directors received the Carer’s Survey report for information.
2010/54 PATIENT ENVIRONMENT ACTION TEAM (PEAT) INSPECTION REPORT 2010
Rick Tazzini advised that the annual PEAT (Patient Environment Action Team) inspection was carried out between January and April 2010 across all inpatient properties with more than 10 beds. These were stringent high quality self- assessment inspections carried out in accordance with the National Patient Safety Agency’s guidelines. The areas covered include safety, privacy and dignity, catering, laundry, cleanliness, infection control and environmental and clinical standards. The Trust’s inspection team, which included executive directors, carried out these inspections as if they were external assessors in order to achieve and maintain the high standards which patients and staff deserve. Each visit is detailed, taking 2-3 hours, and the team includes an Infection Control Specialist.
Overall the results were good with all units scoring “good” or “excellent” for each aspect of the survey; Environment, Food, Privacy and Dignity. 3 scores have improved from ‘good’ to ‘excellent’, whilst 4 have fallen from ‘excellent’ to ‘good’. Areas for improvement included Ipswich Road for outside maintenance and laundry and The Derwent Centre for laundry. Appropriate remedial action had been taken. A capital allocation of £90k for furniture and £50k for redecoration had been set aside for next year, which should support improvement for 2010/11 PEAT.
Paul Keedwell advised Sarah Phillips that pre-inspection visits are undertaken to highlight any areas of concern, and he confirmed that a monthly cleaning audit is also carried out. Ward Staff take patient environment issues extremely seriously and could alert him personally if they are concerned.
Mary St. Aubyn commented that out-patient areas should also be considered and Paul Keedwell advised that although PEAT only applies to in-patient areas, a redecoration schedule was in place for these areas. Mary asked that all cleaning and support services staff be congratulated and thanked for their efforts. Action: Rick Tazzini
The Board of Directors received the PEAT report 2010.
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2010/55 SUMMARY OF GUIDANCE FROM MONITOR ON THE BOARD'S ROLE IN IMPROVING PATIENT SAFETY
Dr. Malte Flechtner advised that in June 2010 Monitor had published “The role of Boards in improving patient safety” to offer guidance in bringing about safety improvements. The paper emphasised the responsibility of Boards in improving patient safety. The document gave good examples of the 6 key elements of leadership, staff engagement, guideline/training, safety metrics/information, learning and resourcing.
Dr. Flechtner commented that learning from unforeseen incidents and improving systems to avoid recurrences is a robust part of the Trust’s culture which is monitored via the Patient Safety Dashboard and the Risk & Governance Executive. In addition, a new ‘Hotspots’ report alerts Ward Managers to any trends so that action plans can be developed and implemented promptly.
Lisa Anastasiou commented that the recommendation to ‘increase visibility of Directors amongst front-line staff’ had prompted a “Back to the Floor” initiative which she was preparing for consideration by the Executive Management Team. Paul Keedwell added that the development of the Patient Safety Dashboard over recent years demonstrated the high priority which the organisation attached to this issue. Dr. Flechtner agreed with Charles Abel Smith that all frontline ward staff need to be fully engaged and he anticipated that dissemination of the ‘Hotspots’ report would support this. Sarah Phillips stressed the need for the Board to be reassured that ward staff were able to assess their own areas of risk and share this learning across the Trust. Mary St. Aubyn suggested that 2 or 3 ward managers be invited to a Board meeting to give examples of how day-to-day patient safety has been improved. Action: Paul Keedwell
The Board of Directors received the report on Monitor’s Guidance on the Board’s role in improving patient safety, for information.
2010/56 PERFORMANCE REPORT TO 31 JULY 2010, MONTH 4 Rick Tazzini reminded the Board that the focus of this paper was the exception report and that the majority of the Trust’s performance against targets was rated as ‘green’. Monitor had increased the number of its key mental health indicators from 4 to 8.
Monitor now also required the Trust to record 8 core pieces of personal data about every service user. The Trust was currently achieving 98.5% for data completeness against a target of 99%.
Key points of the report included: Receiving an Assessment or Review in 12 months (Target 95%; YTD Performance 61.5%) – The Trust’s own target is 6 monthly review, this is being monitored monthly.
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L:\Board Meetings in Public\2010\24 Nov 2010\Part 1\agenda item 4a.2 - minutes August 2010 Board.doc Health of the Nation Outcome Scales (HoNOS) (Year End Target 95%; YTD Performance 2.0%). Training is scheduled for circa. 600-700 care coordinators. Employment Status (Year End Target 95%; Performance 47.2%). Settled Accommodation Status (Year End Target 95%; YTD Performance 48.2%). Although the employment and accommodation status of service users is outside our direct control, this information is being recorded. The target for Drug Misusers in Effective Treatment is a year-on-year improvement in retention. NEPFT Performance is at 89.2% against a national benchmark of 85%.
Paul Keedwell confirmed that Area Directors understand the above issues and have action plans in place. The recording of out-patient information by some staff is an issue and training has been arranged.
Rick Tazzini commented that activity levels showed some significant year on year increases including day care (+17%), outpatients (+3.3%), community face-to-face contacts (+6.7%), community non face-to-face (+13.1%) and specialist teams (+6.1%). Lisa Anastasiou added that staff turnover was at an appropriate level.
In answer to a question from Charles Abel Smith regarding HoNOS and reviews, Rick explained that these were cumulative targets for the year, i.e. 25% for the 1st quarter, 50% for the 2nd quarter, and 95% for the year end. Rick’s team would reformat the report to clarify this. Action: Rick Tazzini
The Board of Directors received the Performance Report to 31 July 2010, Month 4 for information.
2010/57 FINANCE REPORT FOR THE PERIOD ENDING 31 JULY 2010 – MONTH 4 Rick Tazzini reported a month 4 surplus of £986,000 which was £167,000 better than plan. The Trust had a financial risk rating of ‘4’ which was also better than plan. An element of the commissioning contract is subject to delivery of a number of quality and innovation targets equalling £1.2m; if these targets are not achieved the funding will not be forthcoming.
The Trust was planning for a year end surplus of £1.4m and a financial risk rating of 3.
There were cost pressures in Specialist Services, mainly around staff and terminal cleans and also within Corporate budgets. Cash Releasing Efficiency Savings (CRES) had been identified, secured and delivered, and the Trust held £15m in cash. Other issues included that the new Mother & Baby Unit will cost £90,000 more than planned. The Trust was performing very well in terms of the efficient payment of creditors, with 90% paid within 90 days and 50% within 10 days.
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L:\Board Meetings in Public\2010\24 Nov 2010\Part 1\agenda item 4a.2 - minutes August 2010 Board.doc Rick Tazzini advised Charles Abel Smith that income from ‘spot’ activity was largely generated from providing CAMHs and Adult services for Suffolk PCT. Ray Cox commented that without this additional income the Trust would be behind plan and this therefore represented a risk.
Dr. Malte Flechtner explained that the £250,000 overspend on the medical staffing budget was being addressed via the Associate Medical Directors. This pressure was largely due to the cost of covering vacancies for training/middle grade doctors. There was a national shortage at this level and Lisa Anastasiou added that international recruitment was being considered as one possible solution. Action: Lisa Anastasiou
Sarah Phillips commented that the previous experience demonstrated that a significant overspend in medical staffing could be a complex, lengthy and costly issue to resolve. Dr. Flechtner agreed, adding that the current recruitment market now posed different but significant challenges.
The Board of Directors approved the Finance Report for the period ending 31 July 2010, Month 4.
2010/58 PRUDENTIAL BORROWING - WORKING CAPITAL FACILITY Rick Tazzini explained that the current (£7.5m.) Working Capital Facility with Barclays Bank was put in place to aid cashflow and business continuity. The guidance from Monitor was that this facility should equate to 30 days expenditure which in 2008 was assessed on £7.5m. Given the increase in income, this was no longer sufficient and an increase to £8.0m. was proposed. The costs would be a one-off arrangement fee of £3,000 plus £2,000 p.a.
The Board of Directors: a) Authorised the Director of Resources to apply to Monitor to increase the Trust’s Working Capital Facility (WCF) from £7 million to £8 million; and b) Subject to receipt from Monitor of a revised Schedule 5 (Prudential Borrowing Requirement), authorised the Director of Resources to arrange the £500,000 increase in the Revolving Credit Facility with Barclays Bank PLC.
2010/59 DIRECTORS' REGISTER OF INTERESTS - UPDATE Dermot McCarthy advised that in accordance with the Standing Orders of the Board of Directors, the Board was asked to receive the updated register of interests and confirmed that no material conflicts had been identified.
The Board of Directors received the Register of Interests.
2010/60 INFECTION CONTROL ANNUAL REPORT AND INTENSIVE SUPPORT TEAM (IST) PROCESS AND REPORT Paul Keedwell advised that when the East of England IST visited the Trust in July 2010 they found that overall standards of infection control and cleanliness Page 8 of 13
L:\Board Meetings in Public\2010\24 Nov 2010\Part 1\agenda item 4a.2 - minutes August 2010 Board.doc were very good. The IST had recommended that the 2009/10 Infection Prevention and Control Annual Report be brought to the Board for approval, having already been approved by the Risk & Governance Executive in May 2010.
Paul highlighted the time and resources used in preparing to meet the challenges of a Pandemic Flu outbreak. Infection Control was a serious issue for the nurses, medical, estates and facilities staff in every health organisation. Every inpatient ward had a designated Infection Control lead, as do some community teams. The details of the report on Infection Control and Enhanced Cleaning Audits were shown within the Infection Control Annual Report with areas including equipment, ward environment and laundry. A close inspection of foam mattresses had been conducted, and a programme of replacement had been implemented. Paul was delighted to advise that almost all the ‘reds’ shown in the report had been improved to ’green’ following an enhanced audit in April 2010, i.e. since the report had been written.
With regard to the report detail, Paul Keedwell advised that an infection ‘outbreak’ was designated as affecting more than 2 people and most of those within the Trust related to D&V incidents (16). All service users were now tested for MRSA which had led directly to a rise in reported cases. Four patients developed a C.Difficile infection whilst in the Trust’s care and were treated successfully and an outbreak of scabies affecting 5 patients and 8 staff was also contained and treated.
Many areas were highlighted as demonstrating good practice by the East of England Intensive Support Team and they commended the high level of staff awareness at ward level.
The Board of Directors approved the Infection Control Annual Report and the Intensive Support Team (IST) Process and Report.
2010/61 AUDIT COMMITTEE REPORT Ray Cox explained that this was the first edition of a regular report to the Board. It included the main areas of work and demonstrated that the Audit Committee was working effectively. The report included the background to the committee and described its core functions. It focussed on the key strands of work undertaken so far this financial year including:
Annual report and accounts 2009/10 – significant work undertaken to enable the committee to unanimously recommend to the Board that it adopt the accounts and that the Chairman and Chief Executive sign the letter of representation.
Internal audit – planned audits including detailed discussion of 2 final reports and a focus upon the implementation of the recommendations.
Local counter fraud service including supporting a 3 year strategy.
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L:\Board Meetings in Public\2010\24 Nov 2010\Part 1\agenda item 4a.2 - minutes August 2010 Board.doc Whistle blowing policy supported and recommendations made re implementation.
The report also set out the work schedule for the rest of the year and future reports will demonstrate the extent to which this has been achieved. Ray welcomed any comments from Board Members on the format or content of the report.
Mary St. Aubyn thanked all Members of the Audit Committee for their diligence and the assurance which their work gives to the Board.
The Board of Directors received the Audit Committee Report (year to date) for information.
2010/62 NOMINATIONS COMMITTEE REPORT Mary St. Aubyn confirmed that the Committee had met to consider the Job Description and Person Specification and agreed Terms & Conditions in relation to the reappointment of Charles Abel Smith as Non-Executive Director. The Committee unanimously supported his reappointment for a further 3 years and this was also supported by the Remuneration & Appointments Committee of the Council of Governors on 7 July 2010. A final decision will be made at the Council of Governors meeting on 5 October 2010.
The Board of Directors received the Nominations Committee Report (year to date) for information.
2010/63 RISK & GOVERNANCE EXECUTIVE (R&GE) REPORT Dr. Malte Flechtner presented this report. The work of the R&GE was extensive and wide ranging, covering the Trust’s Risk Register, Assurance Framework, Internal Audit and National Patient Safety Agency Reports, Serious Incidents, Professional Registrations, Quality & Audit Group Reports, Safety Alerts, Quality Strategy, Final Year Audit Plan, Infection Control, Complaints and Safeguarding issues. In addition, it had approved 18 Trust Policies.
Dr. Flechtner reassured Sarah Phillips that the forthcoming abolition of the National Patient Safety Agency would not change the Trust’s safety priorities.
The Board of Directors received the report (year to date) of the Risk and Governance Executive.
2010/64 COUNCIL OF GOVERNORS – DRAFT MINUTES OF THE MEETING HELD ON 01 JUNE 2010 AND FEEDBACK Mary St. Aubyn was delighted that she had been formally reappointed Chairman of the Trust for a further 2 years from 01 December 2010. Mary commented that the commitment of Governors, as evidenced by their attendance and excellent contribution at meetings, was clear and greatly appreciated by Board members. Dermot McCarthy added that it was a good meeting with much business concluded. Page 10 of 13
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The Board of Directors received the Draft Minutes of the Council of Governors Meeting held on 01 June 2010 and feedback for information.
2010/65 SUMMARY OF BOARD DECISIONS The Board of Directors received the Summary of Board Decisions for information.
2007/66 EXECUTION OF DEEDS Dermot McCarthy advised that since the last report to the Board the following deeds have been executed: a) 02 June 2010 Broomfield site, updated plans re perimeter road (no. 74) b) 04 August 2010 25 West Avenue, Clacton-on-Sea Land, sub lease to Colchester Mind (no 75)
Two further deeds had been executed subsequently, relating to the updating of a plan of one building and the lease for Oyster Court. These will be formally reported in due course.
The Board of Directors received the report regarding the Execution of Deeds for information.
2010/67 WAIVERS OF STANDING ORDERS Rick Tazzini corrected a typographical error on Page 1, i.e. “There have been eight (not forty) Waivers of Standing Orders since the last report….” He explained that the process was robust, with purchases having to be sanctioned by the local Area Director, Head of Procurement and himself.
The Board of Directors received the report for information.
2010/68 ANY OTHER BUSINESS (NOTIFIED IN ADVANCE) There was no further business.
2010/69 QUESTIONS FROM THE PUBLIC a) Agenda Item 6 – Strategic Capital Priorities: Sheila Jackman commented that, as an Associate Hospital Manager, she was concerned about ensuring a good care pathway for those requiring accommodation at the Low Secure Unit. Mary St. Aubyn responded that the Trust is anxious to progress the LSU scheme. Nicola Colston commented that she was delighted with the development of the Capital Programme. Commissioners are talking to the PCTs about the possibility of reorganising PICU services in Essex and working together to take this forward. NHS North East Essex had just announced that they want to review rehabilitation service provision and she looked forward to working with the Trust on this.
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L:\Board Meetings in Public\2010\24 Nov 2010\Part 1\agenda item 4a.2 - minutes August 2010 Board.doc Pippa Ecclestone requested an update on the status of Sydenham House and Paul Keedwell confirmed that there were no plans for the Trust to vacate this unit. b) Agenda Item 7 – Carers’ Survey: Geoff Scott advised Mary Power that the Trust’s discharge plan for service users in the community included carers' involvement in the decision making process and a professional support package; however, the carers’ survey indicates that this can be improved upon. In response to a query from Annette Bright, Geoff Scott advised that where a carer is designated, details are included on a service user’s records. For the survey the sample of 500 carers was taken at random. Jane Marshall commented that Point of Change works closely with the PCTs and is able to help service users with a range of issues including benefits and accommodation. Carers often need respite for just a few hours and this can be included within personalised budgets. Mary Power advised that mid Essex GPs are issuing generic Carer’s Cards giving contact details. Geoff commented that he had just been made aware of this and would investigate the background with Heather Harris, the Trust’s Carers’ Manager. Action: Geoff Scott c) Agenda Item 8 – PEAT In response to a query from Annette Bright, Paul Keedwell confirmed that the new catering contractor was able to meet patients’ dietary needs. d) Agenda Item 9 – Monitor Guidance on Patient Safety Paul Keedwell advised Annette Bright that any death in the community was fully investigated by the Trust. e) Agenda Item 10 – Performance Report Nicola Colston advised that Commissioners were providing funds to improve quality in a variety of areas and will be looking at Trustwide variances in the average length of stay. It would therefore be helpful to include the time between 1st and 2nd appointments in the Performance Report. Rick Tazzini responded that this is not included in Monitor’s Compliance Framework, but the Trust was aware of the issue. f) Agenda Item 11a – Finance Report Jayne Marshall congratulated Rick Tazzini on the Trust’s prompt payment record. g) Agenda Item 13 – Infection Control Annual Report Paul Keedwell reassured Sheila Jackman that all the mattresses which required replacement had been replaced. h) Agenda Item 17 – Council of Governors Meeting on 01 June 2010 Sheila Jackman spoke in support of inviting Governors to ask questions unrelated to the main agenda at the beginning of the Council of Governors’ meetings. Mary St. Aubyn advised that Executive Directors would be available
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L:\Board Meetings in Public\2010\24 Nov 2010\Part 1\agenda item 4a.2 - minutes August 2010 Board.doc 30 minutes in advance of the next meeting to answer individual’s questions. This approach would then be evaluated. i) Patient Experience Dr. Flechtner advised Harry Young that the Service User Involvement Strategy would be progressed as soon as possible.
Mary St. Aubyn thanked everyone for their time and commented that she hoped for a high attendance at the Governors’ Annual Public Meeting at Latton Bush on 08 September, 2010.
2010/79 DATE OF NEXT MEETING The next Board meeting in public will be held on Wednesday, 24 November 2010 at Trust Headquarters, Stapleford Close, 103 Stapleford Close, Chelmsford CM2 0QX.
The Chairman formally declared this part of the meeting ended and requested the public to be excluded to affect business in accordance with the Public (Admissions to Meetings) Act.
Signed: ……………………………………
Name: Mary St. Aubyn
Position: Chairman
Date: 24 November 2010
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L:\Board Meetings in Public\2010\24 Nov 2010\Part 1\agenda item 4a.2 - minutes August 2010 Board.doc
Agenda item No: 4b
Name of Meeting: Meeting of the Board of Directors in Public
Date: 24 November 2010
Title of Report: Matters arising from the minutes of the meeting held on 25 August 2010
Presented By: Mary St Aubyn, Chairman
Subject, Purpose and Recommendation: The Board is invited to address matters arising from the previous discussions and actions of the Board. An update on action points raised by the public at the previous meeting is attached.
Finance Implications: N/A
Clinical Implications: N/A
HR Implications: N/A
Legal Implications: N/A
Equality Implications: N/A
Risks: N/A
Agenda item No: 5
Name of Meeting: Meeting of the Board of Directors in Public
Date: 24 November 2010
Title of Report: Chief Executive’s Report
Presented By: Andrew Geldard, Chief Executive
Subject, Purpose and Recommendation: The Board is asked to receive the attached update from Andrew Geldard, Chief Executive.
Finance Implications: N/A
Clinical Implications: N/A
HR Implications: N/A
Legal Implications: N/A
Equality Implications: N/A
Risks: N/A
Chief Executive’s Report - Board Update 24 November 2010
1. Introduction
This brief report sets out progress in relation to some of the main activities of the Trust during the last month. It is presented as a ‘current state of play’, but also as a backdrop to the main Agenda items presented at the Board.
2. Performance
The Trust has reached the end of the 2nd quarter with encouraging performance in relation to the financial position and compliance with Monitor's standards.
The Trust has made its "Quarter 2" compliance return to Monitor with the following risk ratings being anticipated:
Mandatory Services Green Governance Green Finance Risk Rating ‘3’
The reduction in the financial risk rating to '3' is in line with the 2010/11 Annual Plan.
At the end of October the financial result is that the Trust earned £4,449,000 more from providing health services than it spent on its cost of operations. After accounting for depreciation, public dividend capital and non-operational costs, the Trust achieved a net Income and Expenditure surplus of £1,178,000 which is £311,000 better than plan. The current forecast year end surplus is £1,848,000 against the plan of £1,400,000. Whilst there remain a number of financial risks for CQUIN and decommissioning, this is a reasonably prudent estimate at this stage.
The Finance Report within the main Board Agenda gives more detail in relation to this position.
The Trust continues to perform well against the traditional Monitor Compliance Framework items, namely CPA 7-day Follow-up, CRHT Gatekeeping and Delayed Transfers of Care. Significant emphasis is now being placed on the recording of CPA period reviews and HoNoS scores.
For CPA Reviews, we are now achieving 73% of all service users receiving a Recorded Annual Review with an internal trajectory aimed at achieving 95% by the end of Quarter 3. HoNoS training is now being rolled out with an anticipated improvement in data collection by the end of the calendar year.
3. Community Engagement & Communication i) Community Engagement a) Schools – Since September we have met a further 600 school students. New bookings include schools in Ipswich and Lowestoft.
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b) World Mental Health Day – On 7 October, as part of World Mental Health day, 250 people took part in the 'Go the Extra Mile' event which the Trust organised with Rethink, MIND, Virgin Active and LINKs. A DVD has been made of the event with a soundtrack of my speech to the participants that day. We also had a ‘living book’ event on 6 October – this was where service users and carers were available in Chelmsford library to talk about post natal depression and bipolar disorder to the public.
c) 5QP – This is a project from the Youth Matters Workstream and is a young person's involvement project (five questions to be asked of CAMHS staff about services and facilities, to be taken to me and Mary). It is hoped that this will help encourage some groups to be involved more in youth activity. One school and three service users have come forward so far. A young service user also made a cartoon about psychosis which is on YouTube which also received some newspaper publicity. Work with the Scouts and Guides is planned and meetings are taking place.
d) GPs – Three engagement events held. Dr Brian Balmer, who runs the BMA locally, is coming to the Trust to do ‘An audience with …” in January 2011. ii) Patient Experience 159 PALS enquiries (5 were referred for further investigation) Translation and Interpreting Policy consultation period now concluded and is awaiting ratification. Plain English group of service users/carers set up. DVDs on Dementia care and Carers Training being made by Communications. iii) Media Coverage Positive press and radio coverage as follows:
Colchester Gazette published an article about the opening of the new Mother & Baby Unit in Chelmsford. The Extra Mile Walk was featured in the Colchester Gazette and Chelmsford Weekly News. The Colchester Gazette published a full page article about a mother’s concern about her son’s ADHD. Colchester Gazette published some of our press release about our consultation with young people about CAMHS. Colchester Gazette - fire at Willow House - statement published in full. Heart Radio also interviewed the manager at the Mother & Baby unit. Mary Kennedy and Susan Worsfold were interviewed on BBC Essex radio on 12 November about new initiatives that to help people with dementia.
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4. Membership
We have recruited 90 new members since the last meeting and the overall public membership is at 6,101. We recruited at Maldon MIND AGM, 23 at the Extra Mile event and a few at Chelmsford Library. Although this is good progress it is still someway from our target of 7,200 members by the end of March 2011. We have launched a membership drive and invited Governors and members to participate in public events in town centres/libraries. We are writing to outpatients and also, at Brian Spinks suggestion, have written to 100+ tennis clubs.
5. Regulator Issues i) Care Quality Commission Overall, there is a very low level of activity within our regulators. The Care Quality Commission (CQC) have released to us a draft of our "Quality and Risk Profile" which will ultimately be published in summary form as a public document. The 250 page document rates the Trust on a Red-Amber-Green spectrum across a range of issues. An overview of this process is contained in the main Board Agenda. ii) Monitor There has been no notable activity from Monitor in the last quarter. i) Department of Health The Government's consultation process in relation to the new White Paper "Equality and Excellence: Liberating the NHS" concluded during October. The legislative process is expected to commence before Christmas with implementation taking place from April 2012. During October, two additional consultation papers were released, the first dealing with 'Patient Choice' and the second focussing upon 'Access to Information'. In relation to mental health services, the 'Choice' document describes a system where service users have more control over how they access services and which professionals they see. It re-emphasises the importance of care plans and the involvement of patients in their construction. It does however recognise that choice may be restricted for those detained under the Mental Health Act.
6. Commissioning Issues
In-year contract monitoring processes continue with particular attention being paid to the delivery of key performance issues and CQUIN targets.
NHS Mid Essex have now issued their commissioning intentions for 2011/12. There are no major surprises within the document with a number of areas raised in the last six months now finding their way into the document. The programme of work includes:-
Targets for out-patient follow-up attendances and in-patient lengths of stay. A review of Community Services. A focus on Recovery and Re-ablement Services.
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A review of the services currently provided on Lucas Ward. A focus on Personality Disorder Services. A focus on Eating Disorder Service. A pan-Essex review of Psychiatric Intensive Care services
7. Business Development
The Trust is disappointed to report that it was unsuccessful in its recent bid to acquire the West Essex Community Services. Whilst the Trust put forward a credible option to the PCT, NHS West Essex have chosen to move forward with South Essex Partnership. NHS West Essex have been keen to keep the Trust's bid active and we currently occupy a 'reserve position' in the process.
On other fronts, the Trust has been successful or is still in contention to gain additional income in the following:-
CAMHS Learning Disability Services CAMHS Tier 2 services - "through to the next stage" Eating Disorder Services - in principle agreement with a detailed proposal to be agreed with Commissioners North East Essex - Older Adults Liaison Service North East Essex - Memory Assessment Service North East Essex - Intermediate Mental Healthcare in Primary Care Suffolk Sexual Health Services shortlisted to final three from six Additional Deprivation of Liberty Services Mother & Baby income now coming in from the new unit Brian Royroft Unit additional income
8. Strategy Development
At a recent "Awaytime", the Trust Board reconfirmed its commitment to the existing strategic direction of developing good quality mental health and associated services, primarily in the North Essex area, but also in closely adjacent areas. We will continue to develop specialist services with an eye to a wider East of England market. The Trust remains keen to bring 'on-board' some community services with a focus now being placed on the roll-out of 'any willing provider'.
9. Other Issues a) CAMHS Tier 4 Planning permission for the specialist CAMHS unit is expected to be granted towards the end of November 2010. In anticipation of a positive outcome, the procurement process has commenced with a plan for a start on site in the new calendar year.
Page 4 of 5 b) Severalls Hospital Work has been continuing in recent months to secure the existing planning consent whilst at the same time facilitating the development of road and education infrastructure in North Colchester.
Good progress has been made and a more formal joint announcement will be made to coincide with opening of the A12 junction in early December 2010. c) Service User & Carer Engagement and Involvement Strategy Work has now concluded on this document and it forms an item on the main Board Agenda. Following approval, the document will provide the framework for the Trust over the coming period. The document will be shared with the Council of Governors at its December meeting. d) Personalised Budgets Ten people are currently involved in the personalisation pilot that was commenced in January 2010. A full evaluation of the feedback, lessons learned and future implications for the Trust will be undertaken in December 2010.
Andrew Geldard Chief Executive
24 November 2010
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Agenda item No: 6
Name of Meeting: Meeting of the Board of Directors in Public
Date: 24 November 2010
Title of Report: Draft ‘Strategy for Service User and Carer Engagement and Involvement’
Presented By: Malte Flechtner, Medical Director Presentation and draft strategy prepared by Susannah Howard, Enable East
Subject, Purpose and Recommendation: The Board is asked to review and comment on the draft Strategy and approve its’ release for consultation with service users and carers and Trust staff.
Finance Implications: Some initial investment is required in 2010/11 to develop some of the tools and capability for the Trust to implement the strategy (up to £30,000). From April 2011 there will then be an ongoing revenue costs including the post of an ‘Involvement Co-ordinator’ (band 5/6). Out of pocket expenses for involved individuals will be reimbursed from local budgets.
Clinical Implications: There are opportunities for clinical staff to improve service delivery and further enhance relationships and opportunities for service users through a broader range of involvement opportunities e.g. stories project.
HR Implications: Employment of an ‘Involvement Co-ordinator’ as part of the Trust communications team. The strategy does not suggest payments to involved service users and carers although ‘out of pocket’ expenses will need to be reimbursed. If payment for involvement is deemed to be necessary then a temporary contract for services should be issued.
Legal Implications: A range of issues will need to be considered to establish the involvement register including information governance. Need to ensure that relevant Trust policies and procedures dovetail with the strategy.
Equality Implications: A section of the strategy considers the issues that need to be considered to ensure involvement from a range of specific groups.
Risks: It is important that the Trust demonstrates that the views of service users and carers put forward earlier this year have been listened to and acted upon. It is difficult at this time to estimate the potential number of involvement opportunities that may be identified within the trust and how many individual service users and carers may be willing to join the register.
Service User and Carer
Engagement and
Involvement Strategy
Contents
1. Introduction 1.1 Overview 1.2 The Trust 1.3 Why Involve?
2. Underpinning Principles 2.1 Trust Vision and Values 2.2 Let’s Work Together 2.3 Further Principles 2.4 Definitions 2.5 Scope
3. Involving Service Users and Carers Across the Trust 3.1 A Spectrum of Involvement Opportunities 3.2 An Involvement Register 3.3 Stories Database
4. Supporting Involvement Across the Trust 4.1 Involvement Co‐ordinator 4.2 Wider Responsibilities for Involvement 4.3 Finance
5. Specific Areas for Consideration 5.1 Overall issues 5.2 Children and adolescents 5.3 Older people 5.4 Those in secure settings 5.5 BME Communities 5.6 Substance misuse 5.7 Learning Diabilities 5.8 Lesbian, gay, bisexual and transgender
6. Development, consultation and implementation 6.1 Development of the strategy 6.2 Relevant trust policies and procedures 6.3 Implementation support
7. References
Appendix 1 – Examples of Current Good Practice
2 North Essex Partnership NHS Foundation Trust | Service User and Carer Engagement and Involvement Strategy DRAFT November 2010
1. Introduction
1.1 Overview
1.1.1 North Essex Partnership NHS Foundation Trust is committed to involving service users and carers in all that we do. We believe that service users and carers not only have the right to be involved in decisions that directly affect their lives, but that it is also essential that the users of our services be involved in shaping and influencing our organisation. We want to make sure that the people who use the services that we provide are always at the heart of everything that we do.
1.1.2 The Trust has an established track record of promoting and supporting service user and carer engagement and involvement. A list of examples of existing positive practice in service user and carer engagement and involvement from across the Trust is included in appendix 1 of this document. This strategy aims to build on this existing positive practice to ensure that the Trust has an explicit, consistent approach that ensures that a wide range of service users and carers become genuinely involved in the everyday business of the Trust.
1.1.3 This strategy for service user and carer engagement and involvement replaces the previous Trust ‘Service User and Public Involvement Strategy’ originally dated 2003 to 2006 and updated again in 2007.
1.2 The Trust
1.2.1 The Trust currently provides services to a population of one million people in north Essex, treating around 17,000 people each year. Our mental health services (inpatient, day, community and outpatient) include home treatment, memory assessment, dementia care and child and adolescent services. The Trust also provides a range of substance misuse services and some services, including specialist inpatient care, to people living in Suffolk, east Hertfordshire and south Essex. Our services are for people of all ages and include a very wide range of community, day and inpatient care, as well as services within the criminal justice system.
1.2.2 The overall aim of this strategy for service user and carer engagement and involvement is to underpin delivery of the trust’s strategic vision, purpose and values. The Trust aims to achieve inclusive involvement and excellent partnerships and believes that it can best achieve its plans by working closely with colleagues, governors, members, service users, carers, families and partner organisations. “Listening, learning and continuously improving to deliver quality and value” is also one of the Trust’s core values.
1.3 Why Involve?
1.3.1 Effective service user and carer involvement is essential to ensuring that the Trust develops high quality, accessible services that are inclusive and meet the needs of those who use them and their carers and/or families. We positively value the knowledge, skills and
North Essex Partnership NHS Foundation Trust | Service User and Carer Engagement and Involvement Strategy 3 DRAFT November 2010
experience of those using its services and the wealth of expertise that they can bring to the organisation. We also want to ensure that by actively engaging people in our work we counteract any potential feelings of disempowerment or passivity that receiving services might engender and align all aspects of Trust business with recovery‐based approaches, inclusion and citizenship agendas.
1.3.2 Nationally, there is a developing culture, enshrined in law and supported by national policy directives, that requires the active involvement of local communities in the planning and development of services. The Trust is therefore also increasingly required to demonstrate externally that it has robust and effective mechanisms for involvement in place. For example, the Care Quality Commission (CQC) who are responsible for reviewing the quality of care that the Trust provides monitors these arrangements as part of their regular ‘provider compliance assessments’ (CQC, 2009).
1.3.3 Involvement of service users and carers is also increasingly promoted by the individual professional organisations of professional staff working within the Trust. These include The Royal College of Psychiatrists, Royal College of Nursing (RCN), various professional social care organisations (General Social Care Council, Commission for Social Care inspection, Skills for Care & Social Care Institute for Excellence) and the British Psychological Society who in May 2010 published ‘Good Practice Guidelines to support the involvement of Service Users & Carers in Clinical Psychology Services’ (BPS, 2010).
1.3.4 Also local NHS commissioners in Essex expect the Trust to “offer the opportunity and appropriate support to service users and carers to become involved in strategic planning and development within the organisation and to become involved in service monitoring’. It is suggested that each individual service (e.g. community team, inpatient unit, etc.) should involve service users and carers in the ‘planning, development, delivery, review and overall quality of the services they provide’. ‘Each provider organisation should have a clear written policy and procedure for involving service users and carers in reviewing and monitoring all parts of services provided by them’. The Trust is expected to provide documentary evidence of service user and carer involvement including evidence that the opportunity to access involvement opportunities is offered to every individual who uses their service.
1.3.5 More effective and consistent involvement of service users and carers is also important to ensuring that the organisation is well positioned to respond to the challenges of the future. The recent government white paper, ‘Liberating the NHS’ (DH, 2010) states that in the future service users and carers “will have far more clout and choice in the system; and as a result, the NHS will become more responsive to their needs and wishes”. This will be achieved through greater shared decision making (‘no decision about me without me’), ensuring that patients have choices about their care, increased control over their own care records, choice of provider, consultant led team and treatment, offering the opportunity to patients to rate the quality of care that they receive, an increasingly personalised care that reflects individuals’ health and care needs and supports carers and a powerful new consumer champion, HealthWatch England, located in the CQC. The New NHS Commissioning Board will champion patient and carer involvement and there will be an increasing use of information technology to support the use of tools like ‘Patient Reported
4 North Essex Partnership NHS Foundation Trust | Service User and Carer Engagement and Involvement Strategy DRAFT November 2010
Outcome Measures’ (PROMS) and ‘Carer reported Outcome Measures’ (CROMS), patient experience data and real‐time feedback.
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2. Underpinning Principles
2.1 Trust Vision and Values
2.1.1 This strategy is an integral to delivery of the Trusts’ core vision and values. Our vision is to provide care that is outstanding in its quality, transforming the lives of individuals and families every day. Our communities will have total confidence in our services, our staff feel a strong sense of belonging and satisfaction, and our partners are proud to work purposefully with us.
2.1.2 The Trust purpose is: For individuals and families – to work together, building on strengths to improve mental health and wellbeing; For our staff – to value everyone individually, promote wellbeing, support involvement and encourage personal development and leadership; For our teams – to support their role in the delivery of best value, innovation and excellence in local and trust wide services.
2.1.3 The Trust values underpin everything we do: Promoting dignity, respect and compassion Demonstrating openness, honesty and integrity Building on individual strengths Tackling stigma, promoting inclusion and valuing diversity Listening, learning and continuously improving to deliver quality and value.
2.1.4 Through implementation of this strategy we aim to build effective and dynamic relationships with the individuals who use our services and their families and other carers that: put service users and carers at the heart of the organisation recognises the value of their knowledge, experience and skills improves the quality of the services that the Trust delivers ensures that the organisation is well positioned for the future.
2.2 ‘Let’s Work Together’
2.2.1 On 16 June 2010, the Trust held a workshop ‘Let’s work together’ attended by more than 100 people the majority of whom were services users, carers and representatives from the third sector and service used led groups. Trust staff from all levels of the organisation also participated in the event. The views of participants were sought through a series of workshop groups which considered existing practice, key principles of effective involvement and how the Trust and service users and carers could work more effectively together.
2.2.2 Key issues arising from this workshop were the need to:
change the way that staff value service user and carer involvement support service users to participate in involvement opportunities
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link with a wide range of partner organisations: Essex County Council, third sector, organisations and others that engage with service users ensure that there is open access to opportunities for advising the Trust sustain service user and carer involvement ‘past an initial flurry of activity’ make connections between patient experience and service user engagement whilst retaining the separation required avoid duplication of effort and public sector resources make connections between service user and carer involvement and CPA, complaints and compliments and serious and untoward incidents make involvement work locally whilst maintaining corporate ‘clout’ be cost effective and acknowledge public sector funding constraints.
2.2.3 Further discussion on key principles for user and carer involvement has taken place more recently at a workshop as part of a Trust conference for our senior clinical staff held in October 2010. Additional points raised there included the need to:
communicate in plain English ensure that contributions are genuinely listened, acted on and that resulting actions are fed back pay out of pocket expenses develop clear and explicit processes for involvement to be shared by service users, carers and staff promote involvement opportunities widely and actively work with BOTH service users and carers provide appropriate resources and time to involvement offer a wide variety of ways to be involved in a range of different settings and environments make involvement local and use local knowledge develop a database of people willing to be involved enable people to move on provide appropriate training for people to be involved provide contracts for volunteers ensure effective management of involvement resources involve a wide range of individuals – “not just the usual suspects” make involvement the business of everyone in the Trust not just those the role of key individuals recognise that the involvement process can sometimes be just as valuable as the outcome to the individual
2.3 Further Principles
2.3.1 In developing this strategy the Trust has also adopted the ‘Eight principles for involving service users and carers’ published by a collaboration between The General Social Care Council, The Commission for Social Care inspection, Skills for Care and The Social Care Institute for Excellence. They are:
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1. To be clear about the purpose of involving service users or carers 2. To work with people who use services to agree the way they are involved 3. To let service users and carers choose the way they become involved 4. To exchange feedback about the outcome of service users’ and carers’ involvement in appropriate ways 5. To recognise and overcome barriers to involvement (including physical and environmental barriers, procedures and practice and attitudes) 6. To make every effort to include the widest possible range of people in our work 7. To value the contribution, expertise and time of service users and carers 8. To use what we have learned from working with service users and carers to influence changes in our ways of working, to achieve better outcomes.
2.3.2 Other principles considered in developing this strategy were:
FREDA – fairness, respect, equality, dignity, autonomy (Merseycare NHS Trust, 2010)
Principles of Reciprocity and Co‐production ‘a partnership between citizens and public services to achieve a valued outcome’ (Cabinet Office, 2009). There is overwhelming evidence that people want to be more involved when public services relate directly to them and their family and that we often underestimate people’s willingness to help others. Through co‐production it is argued that effective partnerships are based on four clear values: a) everyone has something to contribute, b) reciprocity is important c) social relationships matter d) social contributions (rather than financial contributions) are encouraged
Development of this strategy has also been mindful of the common obstacles to involvement that are often raised when approaches to involvement are discussed (BPS, 2010). These include: o Representativeness – the recognition that one service user cannot represent all service users’ views o Tokenism – concerns that involvement is not meaningful or genuine. o Over dependence on one of two people – an apparent lack of interest in initiatives from wider service users and carers can lead to a reliance on a small number of highly involved individuals. The incentives for those involved should be to engage and garner interest from a wider group of individuals. o Matching supply and demand – this may be concerns about whether enough people will wish to be involved with the range of opportunities on offer or concerns about whether the organisation can genuinely respond to all the issues raised through involvement.
The Trust also believes that the full benefits of involvement will be realised through development of an ongoing relationship that is build up over time, and undertaken in a systematic way, alongside specific initiatives as needed.
2.4 Definitions 8 North Essex Partnership NHS Foundation Trust | Service User and Carer Engagement and Involvement Strategy DRAFT November 2010
2.4.1 For the purposes of this strategy a service user is defined as anyone who is currently using or has recent experience of using any service provided by North Essex Partnership NHS Foundation Trust.
2.4.2 A carer is defined as anyone (family member or close friend) who has recent experience of services provided by North Essex Partnership NHS Foundation Trust
2.5 Scope
2.5.1 This strategy underpins service user and carer involvement across the whole Trust and as such has implications for all Trust staff and the full range of Trust business and activity. The focus of the strategy is therefore on providing an overarching organisational strategy to facilitate service user and carer involvement in local service delivery and other corporate activities. The strategy overlaps with Trust policy and strategy in a wide range of other areas of Trust life. However it does not seek to replace and should be complementary to, and should therefore dovetail with, Trust strategy in relation to:
Trust governance arrangements including arrangements for Foundation Trust Membership and Governors Delivery of frontline services to individuals, clinical and professional practice and use of the Care Programme Approach (CPA) Trust partnership working with external agencies including emerging local HealthWatch groups (previously known as LINks) and local user led organisations (ULOs) Operational Trust policies in relation to finance, employment practice, risk management, health and safety, information governance and confidentiality, communications etc.
Figure 1 – Overlapping Areas of Trust Life
3. Involving Service Users and Carers Across the Trust
North Essex Partnership NHS Foundation Trust | Service User and Carer Engagement and Involvement Strategy 9 DRAFT November 2010
3.1 A Spectrum of Opportunities for Involvement
3.1.1 The Trust believes that service users and carers can and should be involved in all aspects of Trust life. The Trust is a large and complex organisation within which there are a broad range of opportunities for individuals to be involved with varying levels of intensity, in a range of different environments and requiring a wide range of basic competencies and skills.
3.1.2 This provides the potential for a spectrum of involvement opportunities ranging from very low intensity involvement for large numbers of people in activities such as responding to surveys through to very high intensity involvement opportunities for far smaller numbers of people for example, in delivering training to staff or as Trust Governors.
Figure 2 – Spectrum of Trust Involvement Opportunities
Informal feedback processes
Trust Membership
Facilitated Individual feedback e.g. share story
Facilitated group participation
Infrequent supported participation e.g. recruitment panel
Regular committed supported participation e.g. committee or working group member
Specific technical contribution e.g. delivery of training, research
Formal role as Trust Board member, Governor
10 North Essex Partnership NHS Foundation Trust | Service User and Carer Engagement and Involvement Strategy DRAFT November 2010
3.1.3 Opportunities for involvement at each of these levels could include the following:
Potential Involvement Examples of relevant existing Opportunities Trust practice Informal Respond to surveys Feedback questionnaires on discharge feedback Add comments to online discussion from inpatient services processes groups Community Services feedback questionnaire Big Carers Survey
Facilitated Contribute story to Trust stories Quality Accounts – individual individual database interviews contribution Complaints, compliments, SUIs Facilitated Participate in focus group or local ‘Let’s work Together’ workshop group service feedback group Landermere community meetings participation Lucas Ward listening events Infrequent Involvement in recruitment panels Involvement in major capital schemes supported Professional accreditation Involvement in reviews of services participation Investigation of SUIs SUI investigations Investigation of complaints Practice development accreditation Service review Involvement in recruitment panels Judging positive practice awards Developing patient reported outcome measures Redesign of estates Commenting on draft trust policy and strategy documents Regular Member of working group Involvement in clinical boards for committed Member of committee each of the five operational areas supported Involvement in clinical boards Service user and carer representatives Delivery of services e.g. befriending, on Quality Implementation Steering participation advocacy, support workers Group, Clinical Audit & Effectiveness Peer support, mentors, buddies group and Medical Revalidation Special interest groups e.g. arts, Steering Group drama etc. Representation in locality acute care forum, mother and baby steering group, PDU steering group, carers support group
Specific Delivery of staff training Commission to develop strategy technical Research document contributions Service development Carers involved in design of Audit bereavement packs Communications Volunteers after discharge at Trust user or carer spokesperson Greenwood Day Service Performance monitoring e.g. user focused monitoring Formal roles Trust Member Board of Governors Trust Governor Trust membership
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3.1.4 Each individual involvement opportunity in the Trust differs in terms of the: purpose of the involvement nature and context of the involvement location, frequency and intensity of involvement commitment required from the involved individual remit in terms of influence and authority specific type of service experience required for the role any knowledge, skills, experience or competencies that the individual may require potential benefits of involvement including any training /development opportunities support offered to the involved individual e.g. buddying, debriefing other specific requirements for an individual to be involved e.g. CRB checks, confidentiality agreements, etc. process of selection for the role
3.1.5 Every involvement opportunity must therefore need to be fully specified so that individuals are absolutely clear about the purpose of their involvement can make a fully informed decision to become involved. Local team leaders, service managers and other staff are responsible for completing an involvement specification checklist and producing a role description and person specification for each involvement opportunity.
3.1.6 Involvement opportunities will then be advertised on the Trust website and/or other means. Individuals on an involvement register (see below) with relevant profiles may then either be invited to apply or openly apply to be involved as appropriate. In the event that more than one individual expresses an interest in an individual involvement opportunity a selection process will be undertaken commensurate with the nature and intensity of the involvement required.
3.2 An Involvement Register
3.2.1 A broad range of opportunities within the Trust should enable involvement by a large number of individual service users and carers. The Trust currently delivers services annually to around 17,000 service users across five operational areas. Involving up to 5% of service users locally and up to 1% corporately each year means that we could involve around 1,000 service users each year (approximately 170 in each locality) in our work.
3.2.2 Such a large number of individuals will have a broad range of knowledge and skills to offer to the Trust. Individuals will also vary in the type and intensity of involvement that they are willing or able to offer to the Trust. An up‐to‐date register of individuals interested in being involved will therefore need to be developed and maintained. This register will be established using an appropriate bespoke database system with appropriate safeguards for information governance and data protection.
3.2.3 Individuals joining the register will be asked to indicate; the types of involvement activity they may be interested in the areas of Trust services (locality / speciality) that they have experience of
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their key relevant knowledge, skills, competencies and experience relevant practical information e.g. willingness to travel, availability at different times of the day, any special needs etc. (in line with DDA requirements) an outline of the types of Trust services that they have experience of and when.
Regular information / induction sessions offering informal briefing for individuals interested in joining the register will be offered quarterly in each locality.
3.2.4 When joining the involvement register individuals will also be asked sign up to a simple involvement contract with the Trust. This will confirm: the reciprocal, voluntary nature of involvement the Trust policy on reimbursement of reasonable expenses the responsibilities of involved individuals to observe relevant Trust policies for health and safety, confidentiality etc. arrangements to provide support to involved individuals.
3.2.5 Further information about these and other issues will be provided by providing individuals with a copy of a Trust involvement handbook. This would include information about: management of the involvement register the Trust involvement procedure policies on managing practical issues (including difficulties concentrating, early starts, smoking, transport, communications etc.) overview of relevant Trust policies including reimbursement of expenses, confidentiality, CRB checks, health and safety, etc. support mechanisms including briefing and debriefing, buddy support etc. advice on supporting individual well‐being and not compromising individual health through involvement a communications jargon buster information about how to raise concerns and complaints an explicit protocol on managing and resolving any issues that may arise e.g. any potential conflicts of interest.
3.2.6 Further benefits of being on the Trust involvement register will include: regularly receiving the Trust newsletter and other relevant communications an invitation to an annual Trust involvement conference regular circulation of Trust involvement opportunities regular invitations to contribute to ideas for involvement targeted communications from the Trust when specific involvement opportunities arise that match individual experience and competencies
3.2.7 In the event that it seems appropriate to offer payment to individuals for specific involvement activities this would be deemed to be employment rather than involvement. Under these circumstances it would not be possible for the individual to be involved through the involvement register alone and so following appropriate selection processes the individual would instead need to be offered a temporary contract for services. North Essex Partnership NHS Foundation Trust | Service User and Carer Engagement and Involvement Strategy 13 DRAFT November 2010
3.3 Stories Database
3.3.1 Life stories can be very powerful and offering people the opportunity to tell their story can be both liberating for them, and helpful to others. Inviting service users and carers to tell their story offers a further way to involve people as part of the spectrum of Trust involvement opportunities.
3.3.2 Either whole stories or extracts can be used in a wide variety of ways. Even short quotations can be very effective. Stories could also be written or recorded (audio or video).
3.3.3 Stories offer a useful contribution to the following Trust communications activities: Trust website Trust newsletter posters, leaflets and other Trust communications Trust annual report events e.g. in delegate packs or videos during the event other publicity opportunities
3.3.3 Stories also offer opportunities to enrich further areas of Trust life: as a mechanism to offer feedback and a unique insight to the Trust Board and Governors as material to be used in staff training or other quality or service improvement activities as material to demonstrate the quality of Trust services to prospective commissioners as a way of providing data for performance management purposes as an alternative to the Trust complaints system by offering an alternative mechanism through which service users and carers can share their experiences both positive and negative
3.3.4 The Trust will therefore establish a Trust stories database including the following features: the database would be a bespoke database that can be easily managed service uses and carers will be invited to share their story via a leaflet, newsletter, the Trust website and, most importantly, by staff asking people personally. individuals will be invited to share the story of their journey, steps in their recovery, and the people or things that have made a real difference to them receipt of all stories will be acknowledged. Contributors will then be asked their consent for the Trust to use their story indicating the format(s) that they would be most happy with, whether they agree to be identified or not. Data protection guidelines must be followed) the story would be entered on database with contact details and outline details of content – i.e. type of service, area, etc. the database would be managed by the Trust Communications, but its existence needs to be widely publicised within the Trust
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4. Supporting Involvement Across the Trust
4.1 Involvement Co‐ordinator
4.1.1 Implementation of this strategy will require delivery of some specific new Trust systems and processes. This will required dedicated capacity to support the following functions:
management of the Trust involvement register including dissemination of handbooks and contracts to involved individuals central recording of involvement opportunities advertising of involvement opportunities on the Trust website circulation of Trust communications to those on the Involvement register providing a central point of contact for involvement practice including advising Trust staff on the use of the Trust involvement procedure providing quarterly induction meetings in each Trust locality organising an annual Trust involvement conference management of the Trust stories database
4.1.2 Since these functions are closely related to the broader functions of the existing Trust communications team a new post of ‘Trust Involvement Co‐ordinator’ (agenda for change band 5 or 6) will be created as part of the Trust communications team under the management of the Associate Director of Communications.
4.2 Wider Responsibilities for Involvement
4.2.1 A fundamental principle of this strategy is that involving service users and carers is an integral part of Trust life. It is therefore expected that involvement is the responsibility of all Trust staff.
4.2.2 Responsibilities for specific tasks and activities will be determined for individual local operational service areas by area directors or service managers as appropriate ‐ in the same way that local responsibilities for practice development or clinical governance are identified.
4.2.3 Involvement practice in each locality will then be overseen and monitored by the clinical boards.
4.2.4 The Trust Executive Management Team will set targets for involvement practice for individual services or localities. These may include: the number on individuals on the Trust involvement register the number of opportunities for involvement identified numbers of stories collected through the Trust stories project
4.2.5 Responsibilities for involvement will be interwoven through the Trust so that appropriate mechanisms for leadership and governance are established as follows: North Essex Partnership NHS Foundation Trust | Service User and Carer Engagement and Involvement Strategy 15 DRAFT November 2010
Level Explicit Lead Roles Responsibilities Trust Board Chair Oversight of Trust involvement NED Lead for Involvement strategy Executive Chief Executive Sets targets for organisation Management for involvement Team Director with lead Reports on Trust performance responsibility for Involvement on involvement Patient Chair Chairs and convenes meetings Experience of the patient experience Board Members board Facilitate communication between the Patient Experience Board and the rest of the organisation Trust Associate Director for Manages capacity and Communications Communications capability for Trust Team involvement process Involvement Co‐ordinator Co‐ordinates and promotes the Trust involvement process and opportunities Clinical Boards Area Director Oversees the use of the Trust involvement process within their business area and ensures that involvement targets are met Area Medical Director Ensures that involvement practice is integral to the work of the clinical boards Professional Professional leads Advises individual professional Groups groups on the integration of involvement practice within their professional discipline Frontline Service Managers Identify opportunities for Services involvement in service planning and operational management. Ensure that opportunities are specified and promoted through the Trust involvement procedure Team Leaders Promote and encourage involvement practice and use the Trust involvement procedure by the staff that they manage Individual Staff Clinical staff Promote the Trust Administrative staff involvement programme to Admin & Support staff individual service users and Managers carers Identify new local opportunities for involvement
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North Essex Partnership NHS Foundation Trust | Service User and Carer Engagement and Involvement Strategy 17 DRAFT November 2010
4.3 Finances
4.3.1 Involvement will be on an entirely voluntary basis. However, involved individuals will be reimbursed for reasonable out‐of‐pocket expenses incurred. Expenses will be reimbursed, in line with relevant Trust reimbursement procedures and guidance: Guidance on reimbursement of travel expenses and necessary, reasonable subsistence costs to mental health service users and carers (requires updating) A guide to claiming your travel and subsistence expenses (needs car mileage rate updating) Travel and subsistence expenses for service users and carers: information for Trust staff (needs car mileage rate updating)
4.3.2 Reimbursement will be paid from relevant locality or corporate budgets depending on the process or activity that individuals are involved in. It is expected that the majority of travel costs will be incurred within the locality. However, there may be occasions when service users and carers with particular expertise are recruited from outside the locality and are willing to travel, in which case the cost will be greater. Overall costs for travel are not expected to be significant for any locality. If 20 people are involved each week in each locality with average travel being between £5‐£7 then this could be around £6,000 a year.
4.3.3 In 2010/11 expected costs for implementation of the strategy are likely to include: support for development of the strategy and implementation – already commissioned internally by the Trust from ‘Enable East’ Trust event to consult with service users and carers on this draft strategy development of the involvement register system development of the stories database system printing of materials to promote Trust involvement opportunities printing of involvement handbook
4.3.4 From 2011/12 onwards there will then be the following annual corporate revenue costs to the Trust to support involvement: annual salary and travel for grade 5/6 ‘Involvement Co‐ordinator’ post circulation of some materials through communications team (postage etc.) annual Trust involvement event for service users and carers any re‐printing of involvement handbook and promotional materials
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5. Specific Areas for Consideration
5.1 Overall issues
5.1.1 The aim of this strategy is to encourage involvement of all service users and carers, without excluding those in any particular group or setting. In fact, it may sometimes be helpful to promote specific involvement opportunities to a particular group, who can bring their background of experience. Issues relevant to ensuring effective involvement of service users and carers in specific groups and settings are outlined below:
5.2 Children and adolescents
5.2.1 Research has shown that in order to encourage children and young people’s involvement, the following premises should apply:
Clear explanations about the purpose, mechanisms and hoped‐for outcomes should be given. Participation should be meaningful, possibly achievable through sensitivity to participants’ developmental stages and offer appropriately limited (rather than endless) choices made possible by providing sufficient information. Children and young people should have their own voice rather than be used to give legitimacy to others’ decisions. Senior support should be garnered. The impact of initiatives should be assessed.
5.3 Older People
5.3.1 Older service users and carers may be excluded from decision‐making because of assumptions that they are incapable. However, if people can communicate in some way, however difficult it may be, they should be encouraged to do so. Factors to increase communication with older individuals and carers include:
Viewing involvement as an ongoing not a one‐off process. Training everyone in communication skills. Providing service users and carers with appropriate support, advice and encouragement. Ensure appropriate mechanisms for users and carers to genuinely voice their views. Train staff in involvement skills. Allow enough time for effective involvement. Provide feedback on the outcomes of involvement initiatives.
5.4 Those in secure settings
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5.4.1 Areas highlighted as difficulties in involving service users in secure settings include security and confidentiality. One national initiative which has worked well involved service users in secure settings working mostly, but not exclusively, ‘remotely’ by post, e‐mail and telephone.
5.4.2 A Trust version of this could be to offer involvement via the stories database, which would enable a voice to be heard, without the person being physically present.
5.5 BME Communities
5.5.1 Recommendations designed to increase the effectiveness of involvement initiatives for black and minority ethnic groups include:
Linking involvement work to wider race and rights focused initiatives (e.g. education, forensic services, employment). Focusing on building relationships between communities, service users and professionals. Encouraging black and minority ethnic mental health professionals to consider race related issues in their own work. Supporting local agencies to work independently and to access sustainable funding. Refocusing attention to the individual’s social role rather than on their mental health. Increasing networking. Providing opportunities for service users to be mentor and be mentored by other service user involvees. Evaluating initiatives based on outcome rather than content and process and disseminate lessons learned.
5.6 Substance misuse
5.6.1 As with other service users, the level of involvement opportunity offered will vary according to people’s stage of recovery. Where confidentiality is a concern, involvement via the stories database could be appropriate. This would enable someone’s voice to be heard, without the person being physically present
5.7 Learning Disabilities
5.7.1 Studies have shown that types of involvement can slot into one of five levels – ‘giving information’, ‘consulting’, ‘deciding together’, ‘acting together’ or ‘supporting independent community interests’. These five levels may be viewed either as ways people develop their own power and responsibilities or as the appropriate level of participation that the initiative is operating at. Giving information is described as vital to help people making choices but it casts the giver as ‘expert’ though users and carers could also be the information givers. Consultation allows choice between limited options. Deciding together suggests that people negotiate decisions from positions of equal weighting. 20 North Essex Partnership NHS Foundation Trust | Service User and Carer Engagement and Involvement Strategy DRAFT November 2010
Acting together helps people identify solutions and implement them, with key ingredients being trust and equality in power and resources on all sides.
5.7.2 These dimensions are consistent with suggestions that having a limited number of choices may, for some decisions, be optimal.
5.7.3 ‘Valuing People’ the Government’s strategy for improving the lives of people with learning disabilities, that describes the importance of individuals’ recognition as citizens, consumers and voters. However, there is a need for broad yet specific policy and guidance concerning involving people with learning disabilities on a level.
5.8 Lesbian, gay, bisexual and transgender (LGBT)
5.8.1 Inclusion of the views of LGBT service users and the ‘empowerment’ of this often ignored sector of the service‐using community is important. Advocacy and ‘speaking up’ are essential to involvement – providing an appropriate environment may enable LGBT voices to be heard. Areas highlighted in research as being specific to success for LGBT service users and carers included:
Positive role modelling Providing a safe space Removing barriers Honesty Eliciting trust and confidence
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6. Development, consultation and implementation
6.1 Development of the strategy
6.1.1 The following table summarises the timeline for development of this strategy to date and timescales for consultation and implementation.
Date Activity 2007 Service User & Public Involvement Strategy developed but was never fully implemented March 2010 Patient & Public Involvement Strategy developed but not taken forward
16 Jun 2010 ‘Let’s Work Together’ Service user and carer involvement workshop held with speaker from Mersey Care August 2010 Patient Experience Board considered next steps
Sep 2010 Enable East commissioned to develop strategy and support implementation
8 Oct 2010 Service user and carer involvement workshop at Trust Senior Clinical Staff Conference 18 Oct 2010 Enable East Presentation to Performance EMT Meeting
24 Nov 2010 Consideration of Strategy Document by Trust Board
Dec 2010 Period of engagement/consultation with staff and service users and carers ‐ Feb 2011 Feb 2011 Facilitated consultation event (February is possibly the earliest possible time for optimum service user and carer engagement). March 2011 Implementation begins
6.2 Relevant Trust Policies and Procedures
6.2.1 This strategy cannot be considered in isolation, but the following aspects overlap and complement the relevant Trust policies:
‐ Involvement in personal care (covered by CPA policy) ‐ The first aim of the CPA is to; Ensure service users and their carers are involved in the planning to meet their health and social care, parenting, leisure, educational and vocational needs and in planning services which support increased social inclusion and recovery
‐ Equal opportunities (covered by Single Equality Scheme 2009) ‐ Covers equal opportunities, disability equality, race equality etc.
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‐ Employment of current and past service users (covered by Mindful Employer) ‐ Promoting the employment of people who have mental health needs
‐ Confidentiality issues (included within Disciplinary policy & procedure) ‐ “All information, including manual or computerised records, relating to service users, employees, salaries, tenders or other potentially sensitive information, is to be regarded as confidential at all times.”
‐ Voluntary work (included within Guidance for the placement of volunteers) ‐ Sets out a clear framework for Managers regarding the recruitment of people undertaking work experience, placements and voluntary work within the Trust.
‐ Complaints (covered by Comments, Compliments and Complaints policy and guidance “Making Experiences Count”)
‐ Foundation Trust membership (covered by recruitment process for members)
‐ Carers Strategy – also recently revised
6.2.2 This strategy also complements and dovetails with the following existing Trust policies & procedures regarding user and carer involvement
‐ Reciprocal Code of Conduct for formal service user/carer/public involvement Covers recruitment and training
‐ Guidance on Reimbursement of travel expenses and necessary, reasonable subsistence costs to mental health service users and carers. Produced in 2004 & needs updating to remove references to payment and update car mileage rate
‐ A guide to claiming your travel and subsistence expenses ‐ Clear explanation of the procedure for claiming. Needs car mileage rate updating
‐ Travel and subsistence expenses for service users and carers: information for Trust staff ‐ Explains procedure for staff. Needs car mileage rate updating
6.3 Implementation Support
6.3.1 Implementation of this strategy will require development of the following tools and capabilities. Programme management and technical support for the implementation of the strategy has already been secured through Enable East. However additional technical (MS Excel VBA programming) support will be required to develop the involvement and stories database products. ‐ Recruitment to the post of involvement co‐ordinator ‐ Development of Involvement Register ‐ Development of checklist of involvement opportunity specification ‐ Development of materials to promote involvement programme North Essex Partnership NHS Foundation Trust | Service User and Carer Engagement and Involvement Strategy 23 DRAFT November 2010
‐ Development of Trust Involvement Handbook ‐ Development of Stories Database 7. References
Arnstein, Sherry (1969) A ladder of citizen participation
Care Quality Commission (2010) Essential standards of quality and safety
Care Services Involvement Partnership (2005) Everybody’s business: Integrated mental health services for older adults: A service development guide. (Funded by the Department of Health)
Day, C. (2008) Children’s and young peoples involvement and participation in mental health care. Child and Adolescent Mental Health, 13(1) 2–8
Department of Health (2010) Equity & excellence: Liberating the NHS. The Stationery Office
Department of Health (2009) Valuing people now: a new three‐year strategy for learning disabilities. Department of Health
Department of Health (2008) High quality care for all: NHS Next Stage Review final report
Department of Health (2008) Real involvement: working with people to improve health services
Department of Health (2006) A stronger local voice: A framework for creating a stronger local voice in the development of health and social care services.
Department of Health (2006) Reward and recognition: the principles and practice of service user payment and reimbursement in health and social care (second edition)
Department of Health (2004) Patient and public involvement in health: The evidence for policy implementation. Department of Health
Department of Health (2002) Women’s mental health: into the mainstream. Department of Health
Department of Health (2001) Involving patients and the public in healthcare: A discussion document. London: Department of Health.
Department of Health (1999a) National Service Framework for Mental Health: Modern standards and service models. London: Department of Health.
Dorr, H. (2000). Involving people with learning disabilities in developing service in Lincolnshire. The Bridge, 2.
General Social Care Council, The Commission for Social Care Inspection, Skills for Care and The Social Care Institute for Excellence (2006) Eight principles for involving service users and carers. General Social Care Council
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Horne, Matthew & Shirley, Tom (2009) Co‐production in public services: a new partnership with citizens. Cabinet Office Strategy Unit
Kalathil, J. (2008) Dancing to our own tunes: Reassessing black and minority ethnic mental health service user involvement. National Survivor User Network.
King’s Fund (2008) Project evaluation: ‘Mental Health Advocacy’ Project for advice counselling and education. HM Government (2008
Mersey Care NHS Trust (2010) A human rights based approach to involving people who use Trust services and their carers 2009‐2010. Mersey Care NHS Trust
Mersey Care NHS Trust (2008) Involving service users and carers – Information pack. Mersey Care NHS Trust
Mersey Care NHS Trust (2007) Involving service users and carers – The Mersey Care Way. Mersey Care NHS Trust
Making Involvement Matter in Essex (MIME) (2010) Standards
New Economics Foundation (2008): The new wealth of time: how time banking helps people build better public services
NIMHE/CSIP (2007) Valuing involvement: Making a real difference: Strengthening service user and carer involvement in NIMHE and CSIP
Royal College of Nursing (2007) User involvement in research by nurses: RCN guidance
Royal College of Psychiatrists (2008) Fair deal for mental health. Royal College of Psychiatrists
Sheldon, K & Harding, E (2010) Good practice guidelines to support the involvement of service users and carers in clinical psychology services. British Psychological Society.
Social Care Institute for Excellence (2007) Developing social care: service users driving cultural change
Time Banks UK (2007) Co‐production, time banking and mental health. Time Banks UK
Time Banks UK (2007) Getting real: co‐production, time banking and mental health. A report of the conference held at London Art House 2007
World Health Organisation (2010) User empowerment in mental health ‐ a statement by the WHO Regional Office for Europe. WHO
North Essex Partnership NHS Foundation Trust | Service User and Carer Engagement and Involvement Strategy 25 DRAFT November 2010
Appendix 1 – Examples of Current Good Practice
A ‐ Summary of NEPFT Service User Involvement collated by Paul Keedwell (May 2010)
1. Active involvement at Board of Governors. A significant proportion of our elected governors are also service users. They play an active part in the development of the Trust’s strategic plan and overall governance of the organisation.
2. We have recently formed locality Clinical Boards as part of our drive towards service line reporting. Each of the five operational areas now has, or is in the process of seeking, service user representation at these meetings.
3. Our Quality Implementation Steering Group has active service user and carer representation.
4. Our Clinical Audit and Effectiveness Group has service user representation.
5. The Medical Revalidation Steering Group has service user representation.
6. Each of our major capital schemes, CAMHS, Low Secure, PICU and the Derwent Centre have active service user participation in the design process.
7. We actively involve service users in reviews of service. Major service changes as a result of SUIs have involved affected carers. This includes the Cedar and Maple improvement review.
8. We actively seek service user opinion of our inpatient services upon discharge. Each is asked a series of questions and the feedback is collated, reported upon and used to inform improvements.
9. We are actively involved in a number of quality improvement and accreditation schemes including practice development accreditation. These schemes demand the active involvement of service users.
10. Our most recent international recruit from New Zealand was interviewed via web link at Essex University with full service user involvement in both the interview and decision making process.
12. Service User representation at the following meetings in Central: Acute Care Forum Mother & Baby Unit Steering Group PDU Steering Group
13. East are drafting a community services service user feedback questionnaire which they will be proposing is completed at each CPA review. This is part of the
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Community Service User survey work. A meeting was held recently at Trust HQ with several staff reps across the Trust and Mike Waddington, Associate Director of Communications, from which a questionnaire has been drafted and which will be presented at the next Trustwide Community Survey Improving Service User Experience Group.
14. Service user representation at the following meetings in East: East Acute Forum Carers Support Group Clinical Board
15. In the West examples of service user involvement include: Involvement in the clinical board and each workstream PDU Steering Group Day services review Acute Care Forum Derwent Centre Review Older adult carers group – Roding Ward Carers Support group – Loughton & Harlow CMHTs Service user volunteers in day services
B – Further Examples of Good Practice put forward at NEPFT Senior Staff Conference held in Chelmsford on 8 October 2010
Examples of involvement:‐ Work done around surveys Big carers’ survey carried out, which will be an annual event Quality Accounts has a sub group re service users and cares input and output measures, big picture/high level. Have first interviews and follow up interviews Complaints, compliments, SUIs Landermere (older adults) twice weekly community meeting ‐ minuted & responded to Lucas Ward older adults – listening events Communications Board involvement – pre‐briefs and debriefs for meetings Guidelines/toolkits – empowerment – how to develop therapy in itself Involvement in recruitment Carers in interviews Service users in interviews for AMPs Green light project Carers involved in design of bereavement packs CAMHS – service users involved in design and operational policy Service users in AMP training course for Trust Service users coming back as volunteers when discharged at Greenwood Day Service, Epping
North Essex Partnership NHS Foundation Trust | Service User and Carer Engagement and Involvement Strategy 27 DRAFT November 2010
Agenda item No: 7
Name of Meeting: Meeting of the Board of Directors in Public
Date: 24 November 2010
Title of Report: Carers’ Strategy 2010 - 2013
Presented By: Geoff Scott, Director of Strategy
Subject, Purpose and Recommendation:
The Board is recommended to approve the attached draft Carers’ Strategy 2010 - 2013
The Carers’ Strategy was introduced in 2006 covering a three year period through to 2009. Last year the board reviewed the strategy and agreed to extend it for one year, with an updated action plan, pending the outcome of our carer survey to inform future priorities. The outcome of the carer survey was presented to the last meeting of the board in public in August and the strategy has been fully reviewed and updated to reflect learning from the survey which will be repeated in 2011.
The strategy and its detailed action plans are founded on achieving the outcomes carers and families have identified as important: Access to information to make informed decisions Knowing someone will respond Knowing support is available should a crisis occur Contact with other people Being listened to, recognising the value of carers and their knowledge and experiences
Many people in North Essex are caring for someone with mental health needs and this caring role can affect the whole family and not just the main carer. Often people do not identify themselves as carers and are often unaware of the support services available, often coping and sometimes struggling with the pressures of caring in isolation. This can of course have an adverse impact on the carers own health and well-being. Actions which have been progressed over the previous strategy period include: Improved performance on carers’ assessments and provision of information, advice and support Substantial staff training Greater opportunity to hear the experience of carers – survey, development of outcome measures with carers, governor with focus on carer needs Improved networking / partnership with other generic carer support services
Finance Implications: Funding to access direct support services and Direct Payments for carers is through budgets for which Essex County Council has retained management and accountability.
Carers Strategy 2009 Clinical Implications: The Care Programme Approach includes the provision of assessment and support for carers as an integral element. Those who take on the role of carer sometimes find they have to make considerable life changes and the demands can affect the physical and emotional well-being of the carer, which then impacts on the caring role and capacity.
HR Implications: The trust employs a senior Carers Support post and two and a half carer support workers are funded by Essex County Council.
Legal Implications: Compliance with the Carers (Recognition & Services) Act 1995 – those people who provide “substantial care on a regular basis” have the right to request an assessment of their needs from Social Services”. Through the Partnership Agreement the Trust delivers such assessments in respect of carers of adults of working age known to Trust services. The requirements are extended by the Carer’s & Disabled Children’s Act 2000 which allows provision of social care services direct to carers including Direct Payments, and the Carers (Equal Opportunities) Act 2004 which specifies that access to work, lifelong learning and leisure are to be considered when assessing the needs of a carer.
Equality Implications: Training and information packs developed with carers for staff include access to both mental health specific and generic carer support groups and links to information for carers seeking support within a faith or cultural community.
Risks: Failure to provide an appropriate response to assessing carer needs and facilitating the provision of appropriate information, advice and support may impact on the wellbeing of both carers and those they care for and fail to comply with statutory requirements. Mitigation and controls include ensuring feedback of views from carers, active engagement of carers in the CPA process, and regular monitoring of performance.
Carers Strategy 2009
Carers’ Strategy 2010 - 2013
November 2010
Carers’ Strategy 2010 - 2013 1
Foreword
We value carers and the enormous support they give and in our earlier strategy for the period 2006 – 2009 we made a firm commitment to work with carers and families, listen to their views and move forward in partnership.
A great deal of progress has been made in developing our links with carers in many parts of North Essex and we are delighted that we have been able to continually expand the number of carers we have heard from about the issues, concerns and ideas they want to raise. Our first carers strategy was launched in 2006, reviewed in 2009 and then extended for a one year period to enable the findings from our first extensive carers survey to inform the development of a new strategy. Carer views are also reflected back to us through an appointed Governor who is able to specifically provide a focus for the Council of Governors from a carer perspective.
Our new strategy now reflects the findings of the carers survey undertaken between March – August 2010 by Quality Health Limited. We sought the views of over five hundred carers. Work is also underway in the Trust to develop a new service user and carer involvement strategy. This will facilitate further carer involvement opportunities which will in turn assist the review process associated with this strategy.
The findings from our survey underpin the overall direction and many of the specific actions set out in this strategy. Here we set out how the Trust aims to support carers and promote services which help carers fulfil that role, based on what we have heard from carers through this process. Carers and their concerns and hopes were placed rightly at the centre of the consultation and this is now fully reflected in our new strategy.
Mary St Aubyn Andrew Geldard
Chairman Chief Executive
Carers’ Strategy 2010 - 2013 2
Contents
Foreword
1. Introduction
2. Legislative and Policy Framework
3. Carer Developments to Date
4. Themes and issues raised by carers
5. Performance
6. Actions for 2010 - 2013
Carers’ Strategy 2010 - 2013 3
1. Introduction
1.1 This strategy sets out what the Trust has done to date in improving support for carers and how we aim to build on this, responding to a range of issues raised by carers in the carers survey commissioned earlier this year. The action plan then sets out required actions in detail for the three year period of this strategy and this plan will be reviewed and updated annually. Carers have shown that the caring role can be stressful and can affect the whole family, not just the main carer. It has also been recognised that terms used are not universal or always helpful to those concerned. Often people do not identify themselves as carers, instead simply seeing themselves as parents, partners, family or friends. We have seen through the survey comments illustrating often selfless and devoted support which is never referred to as care by those providing it. Some questioned why they had been sent the survey questionnaire but nonetheless provided ample evidence of such caring roles as part of these responses.
1.2 Caring for someone with mental health needs can often have a detrimental impact on the carer’s own health and emotional well-being and may cause social and financial disruption and restrict educational, employment and leisure opportunities for both the carer and the person supported and worsen social exclusion. Those who take on the role of carer sometimes find they have to make considerable changes to their lives and the demands of caring can also affect the physical and emotional health of the carer. The survey indicates very clearly that most carers have measured and limited requirements to enable them to continue in their caring role and these are often about timely access to good quality information and advice.
1.3 The carers survey has highlighted the progress we have already made and gives very useful feedback to assist with the programme for further improvement. It was helpful to find that two thirds of respondents were offered the opportunity to discuss their caring role and needs and that 70% of these accepted the opportunity. We welcome also the better than expected level of understanding of the term carers assessment – 80% of those surveyed said they understood it. Two thirds also felt involved in the decision making process for the person they supported and 82% who attended a Care Programme Approach (CPA) Review (just under 60% had been to one) felt they were able to have their say. There were mixed views about the ease of contact with care co-ordinators with 72% finding it very or fairly easy and most carers (80%) said that if they phoned the Trust they were responded to quickly.
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1.4 The responses also helped focus on further developments needed. 44% of carers said they did not know enough about the mental illness or needs of the person they care for and 42% mentioned a range of other advice as being key including areas such as benefits and respite care. Issues around contact with the clinicians providing support for the person they care for and concerns around boundaries, confidentiality and understanding the service user’s needs and how to best respond are at the centre of many of the issues raised. Some carers find themselves adversely affected when services change without adequate contact and explanation which then heightens the impact on both service users and carers. The strategy sets out actions which will specifically address the issues raised. Our overall aim is to continue offering carer assessments along with the associated advice and support and to better focus this and further increase uptake. We recognise the need to improve the involvement of carers in care and support plans and provide better information and advice. Future surveys will also enable improved identification of variations in specific parts of North Essex, to better enable comparisons and improvements to be made where indicated.
2. Legislative and Policy Framework
2.1 This strategy takes account of national guidance and legislation for carers and our ongoing consultation with carers. The strategy promotes the fundamental rights of all carers to be recognised and to have an assessment of their needs.under the Carers Recognition & Services Act,1995. We are committed to providing such assessments in a helpful, timely and non-intrusive way. We also wish to ensure that we recognise in all the work we do the key role of carers in line with Caring about Carers: a National Strategy for Carers (1999) which identified the vital role of carers providing a focus for policies of local and national government which impact on carers. To promote carers’ assessments in accordance with guidance set out in the National Service Framework for Mental Health: Department of Health 2000, Standard Six, Caring for Carers which contains a specific section on carers as one of its seven standards, stating that all individuals who provide regular and substantial care for a person under the Care Programme Approach (CPA) should have an assessment of their caring, physical and mental health needs leading to provision of their own care plan. The assessment should be repeated on at least an annual basis.
2.2 In line with the Government’s New Deal for Carers, announced in February 2007, carer assessments should also offer the carer an opportunity to discuss contingency plans setting out what would happen to the cared for person if the carer were to become ill or incapacitated. Recording of any contingency plans/family contact details etc should be recorded electronically as part of the carer assessment care plan. We
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continue to raise awareness of the Carers (Equal Opportunities) Act, 2004, among carers and staff supporting them, to help ensure that carers are informed of their rights and that access to work, lifelong learning and leisure are considered when a carer is assessed. There is a growing recognition across all agencies of the substantial contribution made by informal carers in our community. There is a desire that this should continue with a parallel commitment to work in partnership with carers. We need to ensure that carers receive the appropriate quality services they need to continue caring and the support they need when their caring role ceases.
2.3 The Equality Act (2010) gives people the right not to be treated less favourably by public authorities because of their age, religion, or belief, sexual orientation, or trans-gender status as well as their disability, gender or race, which were previously covered by equality laws. The Act provides new protection for people who care for a disabled person. The legislation obliges Local Authorities and housing associations to consider carer’s housing needs as well as those of the cared-for person. Carers generally become expert in identifying their own needs and recognising how services can best meet these and at recognising shortfalls in service provision. In policy and service developments, the Trust strives to recognise the expertise of carers and welcomes their involvement. This involvement will also be available to carers of people with a learning disability who access our services and the Trust will ensure that information regarding any additional needs is made available to carers. Carers should be treated with the level of respect which we would expect for or from our family and friends.
3. Carer Developments to date
3.1 Our work so far on carers support directly promotes practical and measurable services for carers. It aims to diminish the sense of isolation, frustration and carer stress burden, whilst aiding self-management, empowerment and assertiveness skills. It helps to lessen discord between mental health staff and those carers who feel disenfranchised and neglected by the ‘system’. A full time carer support manager working to the associate director, social care, is responsible for the coordination of our improvements to carer support across the Trust and this post is supported by a full time carer support worker on a 12 month secondment and these two posts constitute the carer support development team. 1.5 time-limited carer support worker posts are funded by commissioners to provide additional support to teams in the Colchester and Tendring areas.
3.2 In our community teams, in addition to care co-ordinators, support time and recovery workers are also increasingly providing assistance to carers.
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3.3 The carer support development team have directly provided a range of training to Trust staff including workshops and team based learning events. In addition they provide ongoing advice and guidance, proactively visit carer support groups across north Essex and improve communication links. Carer information packs for staff and carers/carer groups have been improved along with the availability of national, regional and local information on carer’s issues and services. This has also increased awareness of carer assessment requirements, helping to substantially increase numbers of carer assessments and carer support plans completed. Carer views are reflected back to the Trust Council of Governors through a carer-specific governor, enabling carers to have a voice on the Council of Governors.
3.4 A training and information pack has been developed in conjunction with carers and delivered to all community mental health teams in team based workshops. The information pack aims to provide a training resource and guidance on carer assessment recording in order to increase the number of carer assessments offered and recorded and to encourage uptake of assessments by carers. These events have been able to reinforce the Trust’s commitment to the importance of carer assessments, advice and support.
3.5 Existing training has also focused on performance monitoring, legal issues regarding carers, CPA and professional requirements, direct payments for carers, respite provision, benefits information for carers and information on access to both mental health specific and generic carer support groups and services along with links to support for carers of people with learning disability and young carers and also for those carers seeking support within a faith or cultural community. Guidance has been provided on local and national carer resources, enabling staff to provide appropriate sign- posting and support for carers. Direct payments and self-directed support for carers are being actively promoted, highlighting the opportunity this payment provides to meet carers’ needs in a flexible and creative way.
3.6 A number of joint working initiatives with generic carer support colleagues from Essex County Council and the third sector have been possible, enabling carers of people with both a severe and enduring mental health need and with additional needs such as a learning disability, sensory impairment, or physical disability, or where there is a health need in the carer themselves, to receive appropriate assessment and support. A new Trust carer information leaflet has been introduced to good effect, raising awareness of carers rights and sign-posting carers and staff to appropriate mental health specific, geographic and generic carer resources. Support, time and recovery workers and community support workers have increasingly been deployed to assist with carer assessment and support in community mental health teams, enabling a greater quantity and quality of
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carer assessments and carer support plans to be put in place.
3.7 Carers have been given a greater opportunity for their voice to be heard and increased awareness of carer issues to be raised. These have included Trust-facilitated carer support and education groups, carer information sessions, a carer and service user involvement workshop, a carer survey and the development and piloting of Carer Reported Outcome Measures (CROMS), described below. The opportunity for carers to become foundation trust members and the appointment of a Trust governor with a carer lead are all ways in which dialogue with carers is being improved and together this has meant that the value of the contribution carers make is better recognised across the Trust.
3.8 Progress has been made on the production of an innovative training DVD which will be used as part of a joint training initiative with carers. Carers and Trust staff are involved in its production, providing feedback on the benefits of an effective carer assessment to the carer (family members and/or friends), and to the service user. Carers and staff will also be discussing concerns regarding issues such as confidentiality and communication and where to go for information. Profile raising events across the Trust this year have provided an opportunity for carers to attend. These have provided carers with information and advice, enabled signposting to other relevant services where appropriate and provided a chance for carers voices to again be heard.
3.9 The Trust has also recognised the Quality Accounts process set up as part of the Darzi High Quality Care for All initiative as another excellent opportunity to engage with carers and service users and achieve valuable participation. We see this as a key vehicle for ongoing carer participation in the development and review of outcome measures to improve service quality. The work to date has resulted in the following initial carer reported outcome measures which we are currently testing through a set of structured interviews with a cohort of carers and which will then be developed further.
3.9.1 Access to information to make informed decisions – Carer’s should expect information that enables them to make informed decisions.
3.9.2 Knowing someone will respond – Carer’s can expect Trust staff to communicate with them to help inform and enable choices to be made.
3.9.3 Knowing support is available should a crisis occur – Carer’s can expect the service to provide them with support in coping with their caring role.
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3.9.4 Contact with other people – Carer’s can expect Trust staff to offer appropriate opportunities for them to make contact with other carers in the same or similar circumstances.
3.9.5 Being listened to – Carers can expect the service to respond and learn from issues or concerns raised.
4. Themes and Issues Raised by Carers
A survey of the views of carers of adult service users age 18-65 years was undertaken between March and July 2010 which involved a questionnaire being sent to 520 carers. Response rate was 26%. The survey was conducted and the results analysed by an independent organisation (Quality Health Limited), and these results highlighted a wide range of issues which have provided valuable indicators for strategic development. Carers also made many comments in the free text areas of the survey and we have considered all of these as they add both depth and detail to the overall findings. We have included a sample of these to illustrate this.
4.1 Assessments offered and accepted
Of the 133 carers who responded to the survey, over two-thirds stated that they had been offered their assessment in the last year. Of those who confirmed that they had been offered an assessment, 70% stated that they had accepted this offer. 80% of those who responded stated that they understood the term ‘carers assessment’. We were pleased to note this level of understanding but recognise that more work is now required to ensure this is understood by more carers. We are in the light of the survey aiming to ensure carers are offered an assessment in a way that they are more likely to accept. We are also working to ensure that assessments cover the information most likely to be sought by carers such as respite care availability, benefits and money, support in the caring role, support in a crisis and improving access to care co-ordinators and other support staff.
4.2 Awareness of service user’s needs and involvement in their care planning
Two thirds of respondents felt involved in the decision making process in relation to the person they supported and we recognise the vital importance of such involvement. However, a significant minority of carers say they are not aware of he needs of their service users and are not involved in the decision making process. We therefore want to improve on this. Of those who had attended CPA (Care Programme Approach) review meetings, 82% stated that ‘they had been able to have their say’. There
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is therefore a clear need to improve the quality and quantity of focused information given to carers and ensure they are offered an opportunity to attend a review and produce clear written information which is targeted to the carer’s needs.
4.3 Access issues
Contact made by Trust staff with carers by telephone was rated to be good and prompt by 82% of carers surveyed. However, access to care co- ordinators and other key staff was reported to be more difficult for carers to achieve. Accordingly actions will be required in future to ensure that all carers have the contact details (i.e. work base address and telephone number) of care co-ordinators and other key staff. We will also ensure we obtain feedback from carers on their views on this in future surveys to track the progress.
4.4 Quality of information given
Most information given at the time of the assessment included reference to three basic areas: Carers support groups Crisis contact arrangements & advice about the person cared for Support for the carer
57% of all carers given advice rated this as ‘excellent or very good’. Many other comments were made by carers in the survey referred to the need for additional information regarding financial benefits, respite care, and telephone support. This is very helpful feedback and indicates that the content of all assessments needs to be more comprehensive in order to address all relevant needs. This will be reflected in ongoing training and our work on Carer Reported Outcome Measures (CROMS) will help to ensure that improvement in this area.
4.5 Themed Comments from the survey responses
In addition to answering specific questions, carers were offered the opportunity to make comments regarding future service improvements in the form of responses to several ‘free-text questions’ (ie ‘What are the 3 things that would best help you to support the person you care for?’ and ‘How can the Trust improve the services for the person cared for?’). The comments from carers in response to these questions provide a rich source of feedback – identifying both positive practice as well as areas for improvement. A summary against a number of key themes is included at Appendix A.
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5. Performance
5.1 Performance indicators are performance managed through the Trust Board, Executive Management Team and reported to Essex County Council as part of the Partnership Agreement by which the Trust delivers integrated health and social care.
5.2 The social care performance indicators for the Trust include the number of assessments and reviews of informal carers (of clients aged 18+) as a % of all assessments and reviews (including carers) and the number of carers receiving a specific carers service or advice as a % of those receiving a service. The latter is now the key indicator, shifting the focus onto the service or advice provided following a carer assessment.
6. Action Plan 2010 – 2013
The following action plan incorporates actions brought forward from the Trust’s previous carers’ strategy and actions arising from the 2010 Carers Survey. The latter are identified by an asterisk*
Action Lead Completion Date a. Listen, learn and respond* -To Heather Harris Survey 2010- learn more about carers needs, Graham Field completed concerns and issues via carer Survey Jan 2011- surveys and ensure these inform March 2011 improvement plans.. Annual survey thereafter b. Improved recording of carer Carol Larcombe, April 2011 details* - To ensure through staff CPA Coordinator training that recorded carer details Area Directors are regularly monitored and updated.
c. Maintain effective carer support Heather Harris March 2011 service* – To continue to develop Area Directors the Trust carer support service and Review annually maintain links with existing and developing carers groups across North Essex.
d. Maintain Performance – we will Area Directors April 2011 maintain our performance in relation Graham Field to ECC key indicators in respect of Heather Harris provision of carer services/ information and advice
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e. Reducing the number of declined Graham Field Review November carer’s assessments – we will take Heather Harris 2011 account of survey feedback to make Area Directors the process as accessible, acceptable and comfortable as possible . f. Develop and implement joint Graham Field March 2011 training programme - we will plan Heather Harris Review December and deliver a training programme for Mike Waddington 2011 staff incorporating the use of a specially commissioned DVD involving staff and carers to enhance understanding of carer issues. g. Improve support available in rural Heather Harris March 2012 areas – we will explore the need for Area Directors outreach services, informed by 2011 carer survey. h. Improve understanding of needs Heather Harris March 2012 of carers of service users with Young Onset Dementia - we will working with Essex County Council and third sector partners. . i. Improve information and Heather Harris March 2012 engagement with carers of people Nicola Armstrong with additional needs (e.g. learning Lynda Hampel disability, physical disability or sensory impairment) j. Improve carers’ information* - we Heather Harris March 2011 will continue to provide and develop Graham Field our range of carer information in a Mike Waddington range of formats and media e.g. leaflet, website, newsletter etc. and to be available from different locations. k. Promote direct payments - We will Christine Holland Review annually continue to promote Carer Direct Area Directors Payments and personal budgets and including further training development.
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l. Access to advice & support* - To Graham Field Review outcome of map carer service provision, Heather Harris 2011 survey signposting carers to appropriate statutory and voluntary sector mental health specific and generic carer support services, recognising diversity of need. m. Carers recorded Outcome Graham Field March 2011 then Measures- data will be collected on annually an annual basis in order to assess Trust achievement levels. n. Increase appropriate involvement Graham Field Review annually re in care planning/ decision making/ Heather Harris accuracy of carer CPA* reviews - responding to theme Area Directors information from recent carer survey Team Managers . Carol Larcombe o. Support carers in maintaining Heather Harris Review progress employment - we will work with our Raza Ahmed March 2012 Vocational Service Manager to consider how we can better support carers to continue in employment. p. Monitoring & ongoing review of Graham Field Review May 2011 strategy - To monitor and review and then annually progress of the strategy . q. Recognition of the carer role* Heather Harris Review April 2011 To further support trust staff and carers to identify sometimes unrecognised caring responsibilities within the family at the point of service user assessment/review. r. Provision of crisis support* Heather Harris, Review December To ensure carers are given Trust Carebase Trainers 2011 Crisis Information leaflet/card and Care Co-ordinators that contingency planning forms an Carer Support integral part of a carer assessment Workers s. Advice & Management of Heather Harris Review annually medication issues* AD Pharmacy Information to be made available to carers to support them in the administering and monitoring of
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service user medication. t. Continuity of professional staff* Area Directors Review annually To explore ways of ensuring Associate Medical improved continuity/consistency of Directors care coordinator and other key staff Team Managers roles in support of both the service Care Co-ordinators user and carer in order to reduce carer stress. u. Provision of more rapid and Graham Field Review annually responsive services* Heather Harris To explore ways of understanding carer need for rapid and responsive support, mapping national, regional and local mental health specific and generic carer services. v. Access to specialist staff* Team Managers Review annually To ensure carers are aware of which Care Co-ordinators key specialist staff to contact if Carer Support required. Workers w. Benefits advice* Team Managers Review annually As part of ongoing carer awareness Care Co-ordinators and assessment staff training, to Carer Support ensure carers are appropriately sign Workers posted for benefit/finance related information. x. Respite care* Team Managers Review annually To provide information regarding Care Co-ordinators home based and residential respite Carer Support and funding sources to carers and Workers staff supporting them. y. Carers support meetings* Heather Harris Review 6 monthly To provide current carer support Care Co-ordinators group information to carers and staff Carer Support supporting them, also identifying Workers gaps in service provision.
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Appendix A
Summary of free-text responses from Carer Survey under key themes
Recognition of the carer role
Carers often make an enormous contribution towards the support of service users. These carers can include family members, or friends who are unpaid and who provide ‘ongoing and substantial’ care. However, their role is often unrecognised, either because they have not been named by the service user to professional staff, or because the carers themselves feel that they have an over- riding moral responsibility to provide care without any recognition or support in their own right. Work on the survey has shown our need to improve the accuracy of information held about carers. There were a mixture of views around how well carers are listened to and their key role recognised:
“..professionals should accept that I am the ‘expert’ in my husband’s condition. When I say particular help is needed, this should be acted upon.”
“The standard of care for patients is very good. A greater level of understanding of the patient’s personal circumstances would be obtained by listening to carers more”
“You did everything you could but her illness caused me so much emotional stress as I felt I was dealing with a complete stranger, not my wife”
Communication and Involvement in care planning
In order to obtain a full picture of the service user’s needs and to ensure that a fully ‘joined up’ approach is undertaken together with their carers, it is essential that effective communication arrangements are in place with carers who will know the service user’s needs better than anyone else. Therefore, it is important that carers are offered the opportunity to contribute to care planning arrangements and that any potential difficulties with confidentiality and information sharing are addressed. The following demonstrate the range of comments:
”It would be helpful to be part of the reviews of the person we care for. As carers we are fully aware of their current health. We hold a lot of information that would be useful to review panels. I realise there are confidentiality issues but I am sure that information can be shared in such a way that will be helpful to all parties”
“The Trust has been there for me whenever I needed help. The care co-ordinators
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always listen, are helpful, and also support us whenever we have needed to see them”
“I know that I am too far away to get involved as I would like to be, but I could be telephoned or written to. I speak to (the service user) every day”
“I am very grateful for all the ongoing support I have. My son’s support is of most importance to me and my family. He has always received an outstanding and excellent service. If I needed to discuss anything I have always been listened to and have received excellent feedback”
Crisis support
Management of mental health needs can be a ‘roller-coaster’ experience for both the service user and their carer, and therefore it is essential that both carers and service users have suitable contingency plans in place if a crisis occurs and that they have immediate access to help and advice if required. The following needs were highlighted by carers :
“I would like to see a support telephone contact available. As carers, if something goes wrong, we need information & support there and then”
“Better out-of-hours cover, especially at weekends”
“Speedy hospitalisation when we cannot cope any longer as the (service user’s) condition escalates very fast”
“More communication involving the person being cared for and the carer with staff involved in the patient’s care. More regular follow-ups to avert crisis rather than dealing with it when it happens”
Medication
Provision of appropriate medication will often be one of the key elements of any treatment plan for people with mental health needs. Carers will often take a role in either monitoring or administering medication and therefore should be advised of their benefits and side-effects. The following needs were identified by carers from the survey:
“Someone to administer medication, not me”
“...we need to be kept up to date on changes in medication. Why it differs etc.”
“To have a regular medication review”
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Continuity of professional staff
Therapeutic engagement between the service user and their professional staff is crucial in ensuring that the service user’s treatment plan will work. This applies equally to carers in terms of their trust and confidence in the help provided by professional staff. Frequent changes in staff can have an adverse impact on effective working arrangements, and continuity of staff is therefore important in helping to sustain and promote effective engagement. Carer’s comments on this issue included the following:
“We have recently moved from one mental health team to another and have lost the fortnightly personal contact between our son and the mental health team. This was an important contact not only for our son but also for us – his parents and will be greatly missed”
“Continuity of care – a regular psychiatrist not a locum”
Provision of more rapid/responsive services
Service users and carers need to be offered care and support in a timely and responsive manner in order to avoid unhelpful delays and potential disengagement with services. Carer’s comments from the survey included:
“I had to make my own arrangements to see a counsellor at my surgery. When my son was first admitted to hospital, I didn’t understand what happened and was in shock.
“Quicker appointment times”
“All the people I have spoken to have been very helpful and understanding. Quicker decisions and regular phone checks will help”
Information and advice
Provision of information regarding mental disorder and relevant sources of support are fundamental to improving the understanding of mental illness and its treatment. This information can be provided in various formats, e.g. via leaflets, websites and through one-to- one verbal discussion with professional staff. Carers comments on information and advice included:
“More financial advice on benefits as entitlements”
“I have attended the ‘Caring with Confidence’ course which was excellent”
“An information pack given to the carer with all relevant details which they can use when needed”
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Access to specialist staff
Service users may receive support from a variety of different professional staff (e.g. doctors, nurses, psychologists, social workers, OTs etc) and carers have also emphasised the need to identify and contact any relevant staff for advice or support. Carers identified the following needs:
“More regular contact with the care co-ordinator”
“Access to alternative therapies”
“I am fortunate to be able to speak to the bipolar nurse regarding the person I care for. She is extremely helpful to me and is a great listener”
Benefits Advice
Carers who provide ‘substantial and continuing care’ to service users on an informal unpaid basis are entitled to claim for a Carer’s Allowance. They may also be eligible to claim for a Carers Direct Payment for specific services which they provide. Carers raised a number of issues about finance and benefits suggesting more focused signposting to advice services :
“As a carer, it would be nice to have a point of contact to help at times when the benefit office decides to suddenly stop their income support and DLA. This stretches my role as a carer to an accountant and financial advisor! People who cannot work due to disabilities really do not need the extra stress or worrying about paying bills when their bank account goes into the red.”
““....communication that is clear, concise, and prompt is vital...”
Carers support meetings
Many carers find it helpful to have access to local support groups where they meet with peers to share their experiences and learn from others who are in the same position as themselves. In addition, professional staff who attend these meetings also have the opportunity to obtain feedback on their services and to make appropriate improvements where required. Therefore it is important that opportunities are available for carers to attend such meetings if they wish to do so. Many carers already attend these but access can sometimes be a problem and they are not available in all areas. The benefits and also the limitations are highlighted here:
“Carers support meetings are at times and locations which are difficult to attend”
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“The Trust holds parent/carer support sessions (within the Early Intervention in Psychosis service). This is excellent and very helpful to families, although personally I have support from family and friends”
“Transport can be a problem – we have to take time off work and have a 60 mile round journey”
Respite Care
Provision of ongoing care for some people may be a very emotionally and physically demanding role, and it is recognised that many carers need to have access to periodic respite breaks to enable them to sustain their support role on a long term basis. The following comments illustrate the importance to carers of limited and occasional additional support :
“I would like to have 3 hours per week to mentally rest from everything to be able to just get my bearings”
“Someone to sit with him if I wanted an evening out”
“Somewhere for the person I care for to go for breaks a couple of times per year”
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Agenda item No: 8
Name of Meeting: Meeting of the Board of Directors in Public
Date: 24 November 2010
Title of Report: Health and Wellbeing Strategy
Presented By: Lisa Anastasiou, Director of Workforce and Development
Subject, Purpose and Recommendation: In 2009 Dr Steve Boorman undertook a review of staff health and well-being in the NHS and found that 10.3 million days are lost to sickness per year, at a cost to the NHS of £1.7 billion. The review supported the case for a greater focus on the health and well- being of staff and clearly identified a link between an effective strategy and improved patient care.
The strategy attached identifies specific actions for the roll out of a health and well being programme designed to further improve staff engagement; improve the health and well- being of our staff and reduce sickness absence rates.
The Board is asked to: 1. Support the introduction of a health and well-being strategy 2. Support the schedule of actions designed to support the implementation of the strategy.
Finance Implications: There will be costs associated with branding and some health and well-being activities. These may be offset if plans to secure sponsorship are successful.
Clinical Implications: N/A
HR Implications: The implementation of the strategy is designed to engage all Trust employees.
Legal Implications: N/A
Equality Implications: Health and well-being activities will be delivered in a manner that embraces all employees irrespective of “protected characteristics”.
Risks: N/A
Staff Health and Well-Being Strategy 2010 - 2013
1. Background
In 2009 Dr Steve Boorman undertook a review of NHS staff health and well-being. He gathered a wealth of evidence of the state of health and well-being in the NHS, its impact on quality of care, and cases of good practice. His interim report, published in August 2009, made the case for taking action on health and well-being in the NHS workforce - currently 10.3 million days are lost to sickness per year, at a cost of £1.7 billion.
The majority of absence was due to musculoskeletal and mental health issues, yet the Boorman review could not find evidence of clear treatment pathways to quickly support staff with these problems back to work.
Amongst the findings of the review there appeared to be inconsistency of occupational health provision across the NHS. He made recommendations for local reviews of occupational health provision, to ensure that occupational health teams are able to focus on preventative activity to support staff in healthy life choices as well as providing a gateway to early treatment of musculoskeletal and mental health problems, which is not reliant on manager referral. Occupational Health team staffing should be reviewed to ensure that staff are able to deploy their expertise effectively.
A number of case studies have been presented where trusts have put in place preventative activity and early access to treatment of common conditions. These case studies demonstrate, as a result, reductions in direct costs of sickness absence and improvements in staff satisfaction, amongst other benefits to the organisation. [email protected])
Studies show that work is good for your health. As well as a financial reward it gives many of us self-esteem, companionship- and status. The Macleod Review on employee engagement, published in July 2009, has revealed how this ‘feel good’ factor is strongly influenced by:
Leaders who help employees see where they fit into the bigger organisational picture Effective line managers who respect, develop and reward their staff Consultation that values the voice of employees and listens to their views and concerns Relationships based on trust and shared values.
Whilst the benefits of work greatly outweigh any disadvantages, work can also be detrimental to health.
Page 1 of 13 NEPFT Staff Health & Well-being Strategy Sept 2010
According to Government figures, two million people suffer an illness they believe has been caused or made worse by their work [‘Choosing Health’ White Paper]. This can take the form of stress, anxiety, back pain depression and increased risk of coronary heart disease.
People in high status jobs are often thought to be more at risk of heart disease due to stress. Research by the Cabinet Office dispels this myth. The Whitehall II study of public sector workers, published in 2004, found that men in the lowest paid employment grades were more likely to die prematurely than men in the highest grades. In contrast, higher rates of absence – and illness – were associated with low levels of work demand, control and support.
According to research by the Confederation of British Industry, non-work related mental ill health is the most significant cause of long-term absence in the UK and musculoskeletal problems are the second most significant cause.
The Trust has embraced the national Health and Well being Strategy and is committed to ensure that the health and well-being of all staff are considered. It will be important to begin by measuring where we are now and that any initiatives launched are fit for purpose. The data collection will give a clearer view on whether: Employees feel valued and involved in the organisation What health and well-being promotion they feel would be helpful for them in the workplace. Managers are confident and trained in people skills Managers use appropriate support services such as Occupational Health and Human Resources to tackle absence and helping staff get back to work Managers promote an attendance culture Jobs are flexible and well-designed Managers know how to manage common health problems such as mental ill health and musculoskeletal disorders.
2. Current Organisational Health and Well-being Status
The Trust will review a number of workforce indicators to assist in identifying its current health and well being status. The success of this strategy will be determined by an improvement in the following indicators:
Sickness absence rate Sickness absence rate WTE Sickness absence (direct costs) Agency expenditure Staff turnover Current Injury Benefits Scheme costs to organisation No. staff off sick for more than [20] days with musculoskeletal problems Cost of staff off sick for more than [20] days with musculoskeletal problems No. staff off sick with mental health problems for more than [10] days
3. Current Health and well-being activity in the Trust
Occupational Health Initiatives
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Lifestyle Assessments
The Occupational Health Service offers all staff the opportunity to have a health and lifestyles assessment on an annual basis. This includes:
BMI measurements with an assessment of 10 years risk factors of Stroke and heart disease. Dietary advise on optimising healthy living Blood pressure measurements and advice Exercise advice and information on local initiatives, e.g. referral to leap program [North East Essex]. Access to local gyms. Smoke cessation advice Alcohol consumption and advice on acceptable limits Well women advice Well men advice.
The Specialist Practitioner in Occupational Health or OH Adviser for each geographical area carries out these assessments.
Personal Stress Management
Staff also have the opportunity to self refer for personal stress management. This gives employees the space and privacy to explore individual stressors and the ways in which they can look at the coping strategies they use currently. From this they are encouraged to make a personal plan to make changes to more appropriate and affective strategy for coping with personal and work related stress. This includes: Initial stress assessment Looking at coping strategies Embracing the positive and changing the negative coping behaviours Measuring their degree of assertiveness skills Decision making Time management Personal space and relaxation How to cope with pressure How to work in a competitive or aggressive working environment.
Currently, this service is carried out by the lead Specialist Practitioner in Occupational Health.
Employee Assistance Program [EAP]
The Head of Occupational Health manages the contract for the EAP service. This service is currently provided by Work-life Options, originally established in 2002, has continued to be well utilised by staff throughout the trust.
The EAP provided by Work-life Options, is completely independent from any other support offered by the Trust. Anyone contacting them are only asked the name of the organisation.
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Workplace Options provide practical information, resources and counselling to help balance employees work, family and personal life. Topics included, but are not limited to the following: Work-life Balance Relationships Childcare Health and well – being Debt Disability and illness Careers Bereavement and loss Stress Elder care Life events Immigration Anxiety and depression Family issues Bullying and harassment Education Consumer rights
Available 24 hours a day, 7 days a week, to employees and their significant others. The service is well established and current annual report revealed an 18.9 % usage across the Trust.
Information is available on the OH webpage of the Trust's Intranet.
Eliminating Bullying and Harassment in the workplace
It is recognised that bullying behaviours can have a detrimental effect on the health and well being of staff. The Trust wants an environment where staff feel valued, well treated and respected by those around them.
The Trust’s Harassment and Bullying Policy sets out staff’s right to respect and dignity and defines what behaviour is unacceptable.
Our “Respect” campaign encourages those who feel they have not been treated with respect and dignity to come forward and seek help. There are a number of ways that staff can do this including the use of a “Respect” telephone hotline where staff can call in confidence and report concerns about bullying behaviours.
There are also plans to recruit 10 Respect & Dignity at Work Advisors. An advisor will be a listening ear for staff across the organisation who need help because they feel their dignity at work has been compromised. They will listen, offer support and encouragement and advise individuals on the course of action required to ensure their concerns are addressed.
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Supporting staff who experience mental ill health
The Occupational health service has continued to work with the commissioners at the Primary Care Trust (PCT) and now have a clear pathway for staff to access when they choose to receive their mental health services outside the Trust. This includes: IAPT Community support Crisis support Emergency inpatient services
The current referral process is through the OH service during "office hours", with on call managers having access for emergency crisis intervention "out of hours". Arrangements have been made for staff to see a Psychiatrist at the Occupational health Department.
Exemplar Employer well-being initiatives
The Trust has an established Exemplar Employer Group, chaired by the Vocational Services Manager. This group is primarily concerned with developing and maintaining ‘mentally healthy workplaces; it works to promote and encourage the employment of people who experience mental health in the workplace; also contributes to the review of HR/recruitment policies and procedures.
The group also oversee the Trust’s status as a Mindful Employer, ensuring the Trust promotes staff health and well being; also encouraging and supporting other local employers to be Mindful Employers.
Work-life Group well-being initiatives
The Work -life Group (formerly Improving Working Lives) is dedicated to creating and championing initiatives that support our staff at work. The core membership is made up of clinical management representation, Occupational Health Specialist, trade union reps, communication and workforce development. It is also a unique open forum where any staff member can attend, should they wish to. The group fully recognises the correlation between healthy happy staff and patient satisfaction and strives to support staff through a range of relevant policies and guidelines for managers. Also a significant amount of health and well being initiatives are agreed and supported by this group, for example:
Cycle to work scheme Childcare vouchers Staff discounts Moat Hansey (key worker housing support) Local gym membership
4. Strategic Approach
The Health and Well-being Strategy aim is to encourage, empower and provide an environment within North Essex Partnership NHS Foundation Trust which helps all staff to live healthier, happier and longer lives. In turn staff will work well, feel positive about their role within the trust. Attendance will be increased and absence reduced.
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The trust will be committed to ensuring that work adjustments are made to accommodate staff with a health deficit, the opportunity to be at work whilst recovering from illness or injury. The strategic approach can be divided into three different sections:
Reactive activity - this will help support staff with ill-health return to work as soon as possible;
Preventative activity - to reduce ill-health and poor well- being, split into " fit for work" activity [lifestyle improvement] and "Healthy Work" [to improve well-being through quality work and management practice; and
REACTION PREVENTION
Activities which will be put in FIT FOR WORK HEALTHY WORK place to quickly support staff with Activities to Activities to ensure well-being is not ill-health and support prompt promote and return to work. threatened by support negative working
healthy environments – lifestyles giving staff satisfying roles, with good management practice and support, and leadership.
MONITORING & EVALUATION •Recording sickness absence at all levels consistently and effectively. •Staff satisfaction [survey, turnover, vacancies] •Patient satisfaction •Board reporting
Leadership
The HR Director has accepted the board lead to ensure that the Health and well-being Strategy is delivered and meets the needs of the trust.
Staff Engagement
It will be necessary to carry out a survey of all staff within the trust to ensure that the well - being strategy is fit for purpose. Using the a staff questionnaire initially, followed by focus groups across the trust will enable the strategy to deliver what staff view as priority well being initiatives which are sustainable and fit for purpose.
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Management Practice
Review management practice Introduce 360 degree feedback Ensure that all staff who have an appraisal will have realistic objectives and Personal Development plans. Ensure that all staff returning from sick leave complete a return to work interview Ensure that all managers have training in :
1. Managing sickness absence 2. Performance management 3. Mental health issues for staff and where the DDA links to the care of staff with a disability. 4. Stress awareness
Clear action pathways in place for managers whose staff are :
1. At risk of mental health problems 2. Experiencing recurring short-term sickness absence 3. Experiencing chronic health problems or illness. 4. Experiencing age related health issues which can be supported to ensure that staff remain at work
Occupational Health
A full review of the OH service will need to be undertaken and advice given on ways the service can "work smarter". A strategy for supporting the HR service to reduce the sickness absence rate significantly will be a priority for the service, in particular, an approach to reduce intermittent sickness absence. A review of the management referral process will be undertaken. The Occupational Health Service will sign up to being accredited by the Faculty of Occupational health Medicine [FOM]. The Occupational Health service will organise Health promotion initiatives as indicated on the health and well-being calendar; ensuring that all staff have the opportunity to attend. Provide opportunities for staff to complete a healthy lifestyle session where they can have measurements taken and receive the appropriate advice. Audit areas where high levels of stress are reported in the staff survey and work with staff in finding ways to control stress and the affects on staff.
Exemplar Employer Approach
The Trust has an established Exemplar Employer Group, chaired by the Vocational Services Manager. This group is primarily concerned with developing and maintaining ‘mentally healthy workplaces’; it works to promote and encourage the employment of people who experience mental health problems; to tackle stigma and discrimination that negatively affects mental health in the work place; also to contribute to the review of HR / recruitment policies and procedures.
The Trust has signed up to the Mindful Employer charter (www.mindfulemployer.net) demonstrating a positive and enabling attitude to employees and job applicants with mental health issues. The Vocational Services Manager is a member of the regional Mindful Employer network and the Trust has a partnership agreement with Work Ways (who Page 7 of 13 NEPFT Staff Health & Well-being Strategy Sept 2010
facilitate mindful employer), to support local employers to develop and maintain mentally healthy work places and become Mindful Employers. The Exemplar Employer group are linked to this network.
The group, via the Vocational Services Manager also has a role in monitoring and reviewing the provision of evidence based supported employment services across the Trust area, to service users experiencing severe and enduring mental ill health.
The Exemplar Employer Group is closely linked with the Work-life group and the Equality and Diversity Group and will play an integral part in the delivery of the health and well being strategy.
Workforce Development
Effective leadership is crucial to the smooth running and good working environments that staff warrant. Development programmes designed for individuals and teams will continue to enable managers to support staff in relation to managing their stresses and developing excellent leadership skills. There are a number of initiatives currently in place that impact favourably upon staffs’ feeling of well being at work. These include:
Diversity training for new starters and managers Modules within the managing performance for success; such as appropriate and effective leadership styles. Managing conflict Negotiation skills Using emotional intelligence in appraisal The Workforce Development Team will continue to develop programmes that support creating a learning environment that understands the importance of health and well being at work.
Work life group
The work-life group will continue to oversee health and well being initiatives emerging from the health and well being action plan.
One important initiative is the development of an action plan to actively support staff through the ongoing financial crisis and the impact on the public sector and in particular NHS roles in the future
5. Monitoring and Evaluation
It will be important to monitor the progress of the Strategy at key stages. A full evaluation of progress to date will be undertaken in September 2011.
6. Partnership Working
Partnership working is taking place via the Exemplar Employer Group/Mindful Employer network (including representation from a range of statutory and voluntary organisations) where good practice is shared. Also, we collectively work to support local employers to become Mindful Employers.
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We will continue to work closely with the East of England’s Staying healthy at work Network Manager and work towards incorporating the Staying healthy at work information on the intranet, www.stayinghealthyatwork.co.uk.
7. Action Plan
Set out below is a summary of the Trust’s intentions for the Health and Well-being strategy in the coming twelve months and beyond.
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HEALTH AND WELL BEING STRATEGY 2010-2013 ACTION PLAN
Priority Summary of Key Actions Timescale Leadership The Director of Workforce & Development has accepted the Board lead to ensure that Ongoing the Health and Well Being Strategy is delivered and meets the needs of the Trust. Branding In conjunction with the communications teams develop a recognised “brand” to support December 2010 the implementation of the Strategy. Staff Conduct a needs assessment Trust wide. February 2011 Engagement Develop a Strategy Group underpinned by Health and Well Being Champions across November 2010 the Trust. Seek nominations from managers for Health Champions across the Trust. Train Health Champions to undertake the co-ordination of the Health and Well Being Strategies across the Trust. September 2010 Develop Staff Champion initiatives.
October 2010 – January 2011
March 2011 Sponsorship As a means of supporting the roll out of this Strategy the Trust will explore opportunities January 2011 for sponsorship. Health at Physical activity discounted gyms. Ongoing Work Healthy eating initiatives. Smoke cessation. Health promotion event. Occupational Review current OH service for both NEPFT and ECC staff. January 2011 Health Re-band the OH service. Service Update intranet site. December 2010 Health promotion initiatives. Ongoing Occupational Health o Specialist to undertake Royal Society for Public Health Award Training Level 2. October 2010 – January 2011
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Continue to offer lifestyle assessments including the delivery of health initiatives across the Trust. Carry out an HSE audit within the Psychological Services following the results of the Ongoing latest Staff Survey. Consider conducting focus groups on how we can work in collaboration to reduce of control the affects of stress.
Completion date end of December
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Mental Well Promote the reduction of stress in the workplace. Ongoing Being Initiatives Occupational Health co-ordinate the service level agreement with Suffolk which gives staff working within the Trust who require mental health services the choice to be seen Ongoing ‘outside their place of work’. Exemplar Partnership Working via the Exemplar Employer Group/Mindful Employer Network (South Ongoing Employer Essex Partnership Trust, Colchester Mind, Shaw Trust, RF, Mid Essex PCT, Essex County Council and Interact, where good practice is shared. Also we collectively work to support local employers to become Mindful Employers. Workforce Staff will be supported to develop skills that will enable confidence building and create a Ongoing Development learning environment that understands the importance of health and well being at work. Training Developing negotiation skills. Ongoing Effectively managing conflict situations. Ongoing Using emotional intelligence skills when appraising staff timescale. Ongoing Equality and Diversity training. Stress Awareness training. Ongoing Managing Performance for Success.
February 2011 Ongoing
Ongoing Develop a Work towards a Health and Well Being at Work web page which incorporates the East of January 2011 Health & Well England directives from the Department of Health. Being at Work web page Work Life The Work Life Group will continue to oversee Health and Well Being initiatives emerging Ongoing Group from the Health and Well Being Action Plan. Initiatives Staying Seek recognition by IIP for the Trust’s Health and Well Being practices. November 2010 Healthy at Ongoing Work (IIP) Accreditation
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Elimination of Launch of RESPECT campaign October 2010 bullying and harassment in Appointment of Respect and Dignity Advisors December 2010 the workplace ongoing
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Agenda item No: 9
Name of Meeting: Trust Board of Directors in public
Date: 24th November 2010
Title of Report: Progress on five key quality priorities from Trust Quality Report (Account) 2009/10 and patient safety dashboard
Presented By: Dr. Malte Flechtner, Medical Director
Subject, Purpose and Recommendation: Subject: Progress on the five key quality priorities from the Trust Quality Report 2009/10 Purpose: The purpose of the report is outline progress made in the first six months of the year and to initiate dialogue on the continuation of these in the new Quality Report or the inclusion of new priorities. Also included is the up-to-date version of the patient safety dashboard. Recommendation: The Trust Board of Directors is asked to note progress on the key quality priorities. The Board to note that recommendations will be made to the Board in due course on the proposed key quality priorities for 2010/11 and the Council of Governors will be engaged in this process
Finance Implications: N/A
Clinical Implications: N/A
HR Implications: N/A
Legal Implications: The Trust has a legal obligation to produce a Quality Report (Account) as part of its annual reporting process
Equality Implications: N/A
Risks: N/A
NORTH ESSEX PARTNERSHIP NHS FOUNDATION TRUST
SUMMARY OF PROGRESS AGAINST KEY QUALITY PRIORITIES
1. Introduction The Trust Quality Report (Quality Account) for 2009/10 was published as part of the Annual Report 2009/10. Included in that report were the five key quality priorities for 2010/11. This paper summarises progress against those quality priorities for the six months to end September 2010.
2. Key Quality Priorities
2.1 Developing systems and processes around quality accounts
Quality Accounts Implementation Steering Group is now Trust Quality Steering Group chaired by the Medical Director Sub-Group set up to deal with implementation of NICE guidance and Terms of Reference are being written Service user and carer group continues to oversee the pilot of PROMs and CROMs (patient reported outcome measures and carer reported outcome measures) We have developed a matrix of local Trust quality metrics including the rationale, standard and target for each one Close working between IM&T and Quality and Audit Team is improving understanding and data quality of the metrics The matrix is presented as a hot spots dashboard currently encompassing all inpatient areas There is top level commitment to the hot spots dashboard enabling dialogue and challenge on data quality and format The hotspots dashboard provides one element of an ’early warning system’ for areas and for RGE A set of locally developed PROMs and CROMs are being piloted with 30 service users and 30 carers and is linked to the Trust CQUIN programme The complex development and implementation of PROMs and CROMs will require a full evaluation prior to any agreed roll out Several Datix database modules have been procedure, initial training carried out, and a programme of roll-out is now in progress. Communication is maintained in a number of ways, through the hotspots dashboard direct to senior managers, a Questions and Answers about Quality and Audit newsletter, and regular slot in staff publications. A QDOCS pilot is underway and expected to finish in December when an evaluation of this will be taken as a method of ‘individual’ quality improvement Work is underway to produce a three-year Quality and Audit Strategy
2.2 Developing Outcome Measures
The development of outcome measures has been superseded by HoNOS There is a HoNOS project team currently working on implementation including communication and training 2.3 Implementation of PROMs
The service user and carer work stream has made great strides in developing a set of patient reported outcome measures that are currently being piloted with 30 service users and 30 carers
2.4 The Promotion of Mental Health
The Trust has a membership strategy and a membership, marketing and public relations group chaired by a Governor Monthly reports are produced on recruitment and analysis of representation Support from Virgin Active and Dorset Cereals for our public events Community networks and events very successful Organised a Living Book event with Essex Libraries and regular use of libraries for engagement work Member ‘listening’ meetings are held regularly Members newsletter and Governors update published regularly Successful anti-stigma work around mental health awareness in schools ‘No health without mental health’ event and live interviews on BBC Essex 250 people involved in World Mental Health Day and Go the Extra Mile event Friends of the Landermere Unit and Friends of the Mother and Baby Unit set up 5QP young person’s involvement project
Audit to review key aspects of a range of standards assessing compliance with a number of policies relating to physical healthcare carried out with an action plan drawn up Continuous support of mental and physical healthcare needs for those people who use our services long-term
2.5 Medicines Management
Ongoing action plan for updating medicines procedures reported quarterly to EMT and the Board Multi-disciplinary meetings held regularly Good progress on medicines reconciliation procedures and revised admissions and discharge policy incorporates the reconciliation form and 24 hour discharge form Notice given to terminate pharmacy contracts early 2011 Error reporting group set up and working on Terms of Reference Errors procedure now in place and competency framework in use Annual report accepted by RGE and summary reporting in place
3. Next Steps
Involve the Council of Governors and the Board in discussions about continuation of these key quality priorities or a process for agreeing new ones for 2011/2012.
Safety measures reported
The charts that follow are an extract from our Patient Safety Dashboard, which we monitor throughout the year. We benchmark the figures over a rolling two year period. We have developed clear targets for the reports within the dashboard. We also use National Patient Safety Agency’s national reporting and learning reports for benchmarking.
The Patient Safety Dashboard is part of a broader Quality Dashboard, which will encompass the three Quality headings of Patient Safety, Patient Experience and Clinical Effectiveness.
Chart 1 – Total Number of Incidents An incident in the Trust is any adverse event that has the potential to cause harm to an individual. There is proactive reporting of incidents in the Trust. It is imperative that incidents are reported if we are to continue to learn from events. (High level of reporting is actively encouraged nationally). There is currently no significant change to the level of reporting from the previous year.
Chart 3 – Total Number of Reported Serious Incidents (SIs) The number is a reduction on the same period last year.
Chart 4 – Falls This year our priority is to reduce the level of falls occurring to patients. This is both observed and unobserved falls reported by staff. The previous year saw a significant reduction in falls. Therefore we are working on action plans and individual care plans for patients who are deemed high risk in order to make further reductions in this area. The Trust wide action plan covers, all patients being risk assessed for falls on admission, monitoring of medication and the environment.
Chart 5 – Patient to Patient Violent Incidents Patient to Patient Violence incorporates aggression, harassment, actual assault and inappropriate behaviour towards another patient. Violence towards people and property is closely monitored and shows the level of patient to patient violence/aggression that is being reported. It must be stressed that due to proactive reporting many of these incidents are verbal aggression rather than physical.
Chart 6 – Total Number of Violent Incidents This chart relates to violence towards property or verbal aggression towards staff.
Chart 6 – Patient Deaths This graph records the deaths patient deaths known to the Trust, where patients have a known serious physical or life-threatening illnesses these are separated from where the death is sudden and there are no known physical issues prior to the event. All these latter deaths are subject to rigorous investigation through the serious incident procedure.
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Chart 7 – Rapid Tranquillisation Incidents Rapid Tranquillisation incidents are when medication is administered in line with the protocol to control behaviour usually precipitated by violence/ impulsivity, where other attempts at de-escalation have not been successful. This chart looks at the number of rapid tranquillisations that have taken place. This level is low in the wider context of the number of violent incidents that have been reported in the Trust to date, as Rapid Tranquillisation is reduced to a minimum.
Chart 8 and 9 – Drug Errors and Pharmacy Interventions We are continuously exploring new ways to improve drug error reporting in conjunction with the Trust pharmacist, we have an open reporting culture to ensure the safety of patients is paramount. All drug errors are fully investigated and subject to a competency framework. The pharmacy interventions are monitored to ensure that correct prescribing practices are being followed and a high level in this area should be viewed as proactive monitoring and is part of the wider medicines management framework of the Trust.
Agenda item No: 10
Name of Meeting: Board of Directors meeting in public
Date: 24 November 2010
Title of Report: Care Quality Commission Monitoring of Essential Standards of Quality and Safety
Presented By: Dr. Malte Flechtner, Medical Director
Subject, Purpose and Recommendation: Subject: Care Quality Commission (CQC) Monitoring of Essential Standards of Quality and Safety and Trust Quality and Risk Profile
Purpose: The purpose of this report is to summarise how the CQC monitor compliance with their Essential Standards of Quality and Safety through its registration scheme and to show how this is intrinsically linked to the Trust’s Quality and Risk Profile published on a monthly basis by the CQC.
Recommendation: The Trust Board of Directors to note the requirements for monitoring compliance and the purpose of the Quality and Risk Profile.
Finance Implications: Registration with the CQC has a financial cost in relation to fees set down by the Care Quality Commission. Any changes made by the Trust in relation to its registration are also subject to fees.
Clinical Implications: All clinical staff have a part to play in evidencing compliance with the essential standards.
HR Implications: There are resource implications for the ongoing collation of evidence against the essential standards
Legal Implications: The Trust has a legal requirement to be registered with the Care Quality Commission
Equality Implications: N/A
Risks: Compliance with Essential Standards of Safety and Quality impacts on the Trust’s registration with the Care Quality Commission
Compliance22nd April 2009with Care Quality Commission Essential Standards of Quality and Safety Essential Standards of Quality and Safety Care Quality Commission Expectations Initial Greater initial emphasis on evidence from policies, procedures and systems – always in relation to the impact they have on people who use the service As system is embedded Evidence should directly demonstrate outcomes or comes directly from people who use the service Providers should Think about how to collect this evidence and monitor their own compliance with the outcomes routinely CQC: Monitoring Compliance
Information capture The Quality and Risk Profile is used to assess risk and act as a prompt for regulatory action Supports CQC judgement (registration)
Examples Information from service users, Local involvement networks, Overview and Scrutiny Committees Information from Health and Safety Executive, NHS Litigation Authority, National Institute for Health and Clinical Excellence, Monitor, Mental Health Minimum Data Set, Royal College Data, Parliamentary and Health Service Ombudsman (not exhaustive) Quality and Risk Profile: Summary
Judgement on risk
Use of the CQC judgement framework Based on impact on people using the services and likelihood the impact will happen – minor, moderate or major concerns CQC: Monitoring Compliance
Statutory Notifications Changes to Statement of Purpose Certain changes to and other events concerning the service Certain deaths of people who use the service (through NPSA) Deaths and unauthorised absences of people detained or liable to be detained under the Mental Health Act 1983 Certain serious injuries (through National Patient Safety Authority) Applications to deprive a person of their liberty under the Mental Capacity Act 2005 Allegations of abuse (through NPSA) Events that prevent or threaten to prevent the registered person from carrying on the service to the essential standards of quality and safety (through NPSA) Absence of registered managers Changes such as a new provider taking over the service, changes of address, changes to services provided CQC: Monitoring Compliance
Information analysis Reviews of compliance e.g. planned (between 3 months and 2 years of registration); high risk (more frequent); responsive (gaps in information or concerns about compliance) Outcome evidence – detailed in essential standards of quality and safety For people who use services providers should consider how evidence relates to or has an impact on a range of outcomes; Quantitative and qualitative measures e.g. clinical data Policies, Procedures and Systems Implementation and monitoring of policies; Specifically relating to staffing, learning and development; Systems for reporting and learning from incidents; Safeguarding procedures Outcomes direct from people (as system for monitoring compliance is embedded) Demonstrates outcomes for people directly or indirectly Regulatory response
Compliance with essential standards – no action Less than full compliance – use of a ‘setting the bar’ framework High confidence in capability minor – informal regulatory action moderate – formal regulatory action major – compliance / enforcement action (warning/conditions etc) Low confidence in capability minor – formal regulatory action moderate – formal regulatory action below the bar – compliance / enforcement action (warning/conditions) major – compliance / enforcement action (penalty/suspend/prosecute)
Agenda item No: 11
Name of Meeting: Meeting of the Board of Directors in Public
Date: 24 November 2010
Title of Report: Compliments and Complaints Annual Report 2009/10
Presented By: Dr Malte Flechtner, Medical Director
Subject, Purpose and Recommendation: To provide an overview to the Trust Board of the compliments and complaints performance for the performance year 2009/10.
Comparative data for the year performance 2008/09 is also included.
The Board of Directors is asked to receive and approve the Compliments and Complaints Annual Report 2009/10.
Finance Implications: N/A
Clinical Implications: N/A
HR Implications: N/A
Legal Implications: N/A
Equality Implications: N/A
Risks: N/A
From: Kay Boyle, Making Experiences Count Manager
Subject: Compliments & Complaints Annual Report, April 2009 – March 2010
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Purpose: To provide the Trust Board with an overview of the compliments and complaints received in the year 2009/10. Comparative data for the year 2008/09 is also included.
1. Compliments In the year 2009/10 221 written compliments were received by the Making Experiences Count Team compared with 213 in the previous year. The top 5 units receiving compliments were as follows:
2008/09 2009/10 Rank Unit Number Unit Number 1 Henneage 37 Peter Bruff Unit 14 Ward, Clacton Hospital Kingswood Centre 2 Redwoods 21 Redwoods Day 13 Day Hospital Hospital, Ward J9 St Johns Hospital 3 Ward J6, St 17 The Lakes MH 13 Johns Unit Hospital 4 CMHT Older 12 CMHT (Adult) 12 People, Oyster Court St Clacton Helen's Lane 5 CRHT 10 Gosfield Ward 9 Central The Lakes MH Unit
This table demonstrates a consistent positive feedback for a number of the older people’s in-patient wards, adult in-patient wards and day units over the past two years.
1
2. Complaints analysis: The Department of Health issued new complaint regulations which came into effect on 1 April 2009. It is now a two stage process: complaints should be addressed and resolved at local level and if the complainant is not satisfied it can then be referred to the Parliamentary Ombudsman for review. The process also encompasses joint working with local authorities, PCTs and other Trusts to produce a single response.
The complaints on receipt are now risk scored into Low, Moderate, High or Extreme and must be acknowledged within 3 days of receipt. The regulations also state that each Trust has up to 12 months to respond.
The new process of complaint handling is to meet with the complainant, if appropriate, and try to agree a way forward to resolve the issues that they have raised.
The tables below show an outline for the performance year, which has been split into two categories, Low risk and Moderate/High/ Extreme.
The Trust has agreed for the Patient Advice and Liaison Service (PALS) to manage and record the Low risk concerns which are resolved at local level.
The Department of Health are expecting numbers of complaints to increase as the low risk concerns were not previously recorded under the previous DoH Complaint regulations process.
Concerns/Complaints risk scored at Low level Fig. 2
Quarter Quarter Quarter Quarter TOTAL One Two Three Four 94 65 61 124 344
Complaints risk scored at Moderate/High/Extreme level Fig. 3
Quarter Quarter Quarter Quarter TOTAL One Two Three Four 12 12 18 14 56
The Trust has been fully compliant on achieving acknowledgement of complaints within 3 days as per the regulations.
The new regulations state that the Trust has to achieve responses within an agreed time with the complainant. There are no Moderate/High/Extreme complaints outstanding. All complaints have been responded to and have been closed subject to completion of action plan implementation.
2
Evaluation forms filled in by complainants and informal feedback suggest that the new process is working well and that the service users feel that they are being listened to and their issues resolved satisfactorily.
The following analysis of complaints received during the period April 2009 to 31 March 2010 are set out and compared with the equivalent preceding annual figures for 2008/09:
(i) Outcome of Moderate/High and Extreme complaints
Complaint findings are classified according to three categories following the completion of investigations i.e.: Fully upheld, partially upheld, not upheld.
The findings are as follows:
Decision 2008/09 2009/10 Not Upheld 35 (43%) 10 (19%) Partially Upheld 27 (33%) 21 (41%) Fully Upheld 19 (24%) 19 (37%) Not able to investigate 1 (0.5%) Total 81 51
The above table illustrates the number of those which were fully upheld has remained the same. The number of complaints that were not upheld has reduced considerably.
(ii) Type of Complaint
Low risk concerns
Key issues raised with the PALS Team
Information, communication and choice Improvement in care Improvement in process Access to treatment Staff attitude Continuity of care
3
Moderate/High and Extreme risk Complaints Complaints are classified by subject matter or ‘issue’ according to national standard definitions (KO41a). The top five issues arising against these definitions in 2009/10 were as follows:
Type 2008/09 2009/10 Clinical Issues 10 (12%) 19 (34%) Staff Attitude 13 (16%) 11 (20%) Communication 25 (31%) 8 (14%) Access to Service 20 (25%) 6 (11%) Privacy and Dignity 8 (10%) 5 (9%) Others 5 (6%) 6 (11%)
Total 81 56
The total number of complaints has gone down substantially in 2009/10 compared to 2008/09. “Clinical issues” are now causing the highest number of complaints These complaints comprise of some of the following examples:
Failure to expedite a referral for specialist assessment Failure to expedite a referral for continuing care Disagree with diagnosis Consultant not reviewing medication quickly enough Withholding diagnosis Failure to diagnose as a child Consultants disagreeing on diagnosis
‘Communication’ has reduced considerably from 25 to 8, which clearly indicates that staff are handling the complaints at local level.
(iii) Main units involved
This table shows the 5 units receiving the highest number of complaints::
2008/09 2009/10 Rank Unit No of Unit No of Complaints Complaints 1 Tower Ward, 4 (5%) The Lakes 4 (7%) Landermere based Centre Consultant 2 CRHT 4 (5%) Peter Bruff 4 (7%) Derwent Unit Clacton Centre Hospital 3 Finchingfield 4 (5%) CMHT The 3 (5%) Ward, Gables Linden Centre 4
2008/09 2009/10 4 Longview 3 (4%) The Linden 3 (5%) Adolescent Centre, Unit 216 Consultants Turner Road only 5 CBT C&E 3 (4%) CMHT (Adult) 3 (5%) Centre Oyster Court St Helen's Lane CMHT 3 (4%) Chelmer Ward 3 (5%) Samphire, St St Margarets Peters Hospital Hospital CMHT The 3 (4%) Gables CRHT New 3 (4%) Ivy Chimneys
There are two units that have jointly received the most Complaints this year, The Lakes and Peter Bruff. These two units have not previously featured in the top five for a number of performance years.
The ‘CRHT, Derwent Centre’ and Longview Adolescent Unit do not appear in the top 5 units for the year 2009/10. This has been due to their significant improvement in local complaints resolution.
This year inpatient units received more complaints than community teams
These data have been shared with the teams involved.
(iv) Involvement of Parliamentary Ombudsman
In relation to the 56 complaints received in 09/10, NEPFT were contacted by the Parliamentary Ombudsman with regard to 2 cases. The Ombudsman have made preliminary enquires and decisions will be made in due course on whether or not there will be any further investigation.
(v) Risk rating
Complaints are graded in accordance with 5 levels of potential organisational risk. The relevant numbers for each risk level in 2009/10 are as follows:
2006/07 2007/08 2008/09 2009/10 Extreme = 0 0 0 0 Major = 0 0 0 0 Serious = 28 23 18 11 Minor = 80 58 51 40 Negligible = 14 25 12 5
The numbers have reduced on all levels of risk.
5
(vi) Learning arising from complaints
Examples of learning arising from 2009/10 complaint investigations
Emphasis on the involvement of family and carers to ensure that they have a better understanding of the roles, systems and processes around referrals and appointments The waiting room facilities are reviewed and changed as required for separate service entrance for NEEDAS and Psychology at Herrick House, Colchester Further training for staff on the process of safe keeping of personal possessions, to include documentation and audit. Review the safety storage facility. Agree advance directives with service users where appropriate Provide access to a confidential mental health service for staff who are also service users
All learning is shared across the Trust via regular meetings with the Area Directors for dissemination to their Teams. There are sample case scenarios which are published in the bi monthly Trust magazine, Connections.
(vii) Future requirements
By listening to people about their experiences of health and social care services, managers can resolve mistakes faster, learn new ways to improve and prevent the same problems from happening in the future. By dealing with complaints more effectively, services can get better, which will improve the services for the people who use them as well as for the staff working in them. The first year of the new DoH Complaint regulations and process has been time intensive and continual training is necessary for all Trust staff to embrace this new way of working.
The reporting of Low risk concerns requires all Trust staff to be reminded that they need to forward all details to the PALS Team at Trust Headquarters.
NEPFT continue to host the joint Essex Health and Social Care Complaints VIAN Forum, which forms part of the East of England and National Voices in Action (VIAN) network for sharing and learning.
3. Conclusion
Since the introduction of the new DoH Complaint regulations and the new ways of working with the PALS Team, it has become clear that the complainants responded positively about these changes. The new process
6
can be quite time consuming but the quality of investigations is excellent providing full remedy and an apology if appropriate with an agreed outcome.
The Trust continues to demonstrate learning from the findings of complaint investigations through improved training and the revision of relevant policies, services, patient information and clinical practice.
Evidencing the implementation of action plans that arise from complaint investigations is a standard Trust procedure, it continues to form part of the Trusts performance management framework.
All complainants will receive an evaluation form to complete once the investigation has been completed to enable the Trust to gain an understanding of whether the new process is working satisfactorily as part of the patient experience.
Prepared by Kay Boyle, Making Experiences Count Manager with input from Marilyn Williams, PALS Facilitator 13 September 2010
End of Report
7
Agenda item No: 12
Name of Meeting: Meeting of the Board of Directors in Public
Date: 24 November 2010
Title of Report: Performance Report to 31 October 2010, Month 7
Presented By: Rick Tazzini, Director of Resources
Subject, Purpose and Recommendation:
The Board is invited to receive and note the summary key performance indicators (operational to 31-10-10 and workforce to 30-09-10) and operational activity schedule. The Director’s commentary is provided below.
Operational Performance In overall terms, the Trust is exceeding the (Care Quality Commission) CQC targets and Monitor thresholds in all but one indicator. The traffic light rating reports “G” (Green) for the majority of targets.
Care Programme Approach (CPA) review Only one indicator currently falls below the external CQC/Monitor targets; being the CPA review in 12 months. Year to date performance has increased from 60% in June to 73%, with a stretching target to reach the 95% threshold by 31 December 2010. Work is on-going to ensure the CPA data is being correctly recorded in CareBase as well as retrospective checks on closed cases. Area Directors have produced detailed plans with their teams to address both the recording and on-going performance issues. This will be a significant challenge particularly for Outpatient services, because of the sheer volume of activity. All 20,000 service users (except substance misuse) in NEPFT are on CPA. The trust is checking with Monitor and other MH Trusts to enquire whether they have a similar approach to having all clients on CPA or whether they have a smaller “CPA population”. There remains a risk that the Trust may not reach the 95% threshold by 31 December, but will do so soon afterwards. All efforts to achieve the target by December are in place. Under the Monitor compliance framework, a failure to reach 95% in CPA at Qtr3 will not jeopardise the Trust’s “Green G Governance rating, so long as all other thresholds are met.
The regulator, Monitor has confirmed that the data completeness threshold for the three outcome measures (accommodation, employment and HoNOS) is 50%, in aggregate for Qtr3 and Qtr4. The Trust’s has already achieved 69.5% by month 07. The metric for (Health of the Nation Outcome Scales) HoNOS has doubled this month to 13.8% and is on a trajectory to exceed 90% by 31.3.11, following the rollout of Trust-wide training which started in November and will continue through into January for some 500+ staff.
The target for retaining problematic drug users in effective treatment has stabilised at around 89% and whilst this is lower than last year’s performance of 92%, the Trust’s performance is considerably above the national average of 85%.
Other internal targets such as HoNOS, 5 week waits and in-patient diagnosis are not meeting the targets and are being addressed.
Activity Compared to the same period in 2009/10, overall activity has increased 7.7%. Day care has increased 17.7%; inpatient activity is broadly stable; outpatients +3.9%; face to face community +6.9%; community phone contact +24.1% and specialist team face to face +6.3%. As the trust has a “block” contract with the commissioners, it receives no payment for the extra activity.
Workforce Sickness absence data to 30 September shows absence rate of 4.1%, which is better than the 4.5 days target. Rolling turnover at 10.9% is just a shade above the target of 10%. Excluding retirements the figure is 8.6%. (48 retirements in rolling 12 months).
Finance Implications: Financial plan – ensure costs contained despite rising activity. Potential loss of Commissioners’ reward monies if Commissioning for Quality and Innovation (CQUIN) quality / innovation targets not met.
Clinical Implications: Actions are being taken to achieve improved standards; this should deliver positive change to patient experience and access to services.
HR Implications: Workforce data re. sickness, turnover etc.
Legal Implications: None
Equality Implications: None
Risks: A key risk for the Trust is that under performance will negatively impact upon the Trust’s compliance with Monitor’s Quarterly Monitoring Score and the Trust’s CQC ratings for ‘Achievement of National Priorities’ and ‘Quality of Financial Management’. Poor performance also carries a risk to reputation and demand for services from referral.
HR Performance Report as at 30th September 2010
Summary of Performance
In month Rolling YTD Targets position Position Position Trust NHS
Vacancies No Target 423.6
Sickness Absence 4.5% 4.5% G 4.1% G
Long Term Sickness No Target 3.0%
Turnover 10% 0.9% G 10.9% R 5.3% G Turnover Excluding Retirements 10% 0.7% G 8.6% 4.1% G
Leavers No Target 16 233 114 Leavers Excluding Retirements 13 185 91 Trust Performance Report as at 31st October 2010 Summary of Performance
Monitor / Care Quality Commission Compliance Trust Performance Monitor / CQC Target In Month YTD
CPA 7 Day Follow-up 95% 100.0% G 98.9% G
Crisis Resolution (Gatekeeping) 90% 95% 99.3% G 99.9% G
Delayed Transfers of Care - Monitor <=7.5% 2.7% G 0.7% G
Delayed Transfers of Care - CQC 0.29% G 0.08% G
MHMDS Data Completeness 99% 99.17% G
Data Completeness on Ethnicity 85% 99.6% G
Under 16 Admissions to Adult ward 0% 0 G 0 G
Detained Patients AWOL no target 0.03 0.13 Outcome Indicators Received an Assessment or Review in 12 months 95% 74.3% G 73.0% A Received an Assessment or Review 6 months internal 61.4% G 59.3% R
Monitor Data Completeness (aggregrated score) 50% - Dec 10 69.5% G Accommodation 96.4% G Employment 98.4% G HoNOS 13.8% R
Inpatient Discharges with a Diagnosis n/a (Int target 100%) 66.2% 90.2% A
18wk Referral To Treatment - Consultant Lead Services 95% 99.5% G 99.9% G New Cases Served by EIP G Problematic Drug Users in Effective Treatment >92.0% 89.2% A
Other Primary Indicators Trust Performance Target In Month YTD
5 wk wait for 1st Appointment - Consultant Lead Services 100% 88.5% A 84.3% A
18 wk Referral To Treatment - Non Consultant Lead 100% 45.7% 84.6%
Carers Assessments 111 777 119 G 1043 G
Under 18 Admissions to an Adult Ward 1 3
Assertive Outreach Caseloads 277 288 G
Inpatient Re-admissions within 28 days of previous discharge tbc 7.6% 5.1% G North Essex Partnership Foundation NHS Trust Service Line Activity Analysis (Base Year activity figures corrected) 2010/11 Base Line Services Activity M07 M07 2009/10 Baseline Actual Difference Variance Comment
Day Care (Attendance) Mental Health Patients: Adult 30,969 18,065 21,238 3,173 17.6% Mental Health Patients: Elderly 22,606 13,187 15,365 2,178 16.5% 53,575 31,252 36,603 5,351 17.1% Inpatients (Occupied Bed Days) Adult : Acute Care 46,019 26,844 27,353 509 1.9% Adult : Rehabilitation 15,533 9,061 8,557 -504 -5.6% Reduction of 1 bed on Severalls House Children 2,617 1,527 1,929 402 26.4% Variation Increased from 23.7% reported in Mth 6 Elderly 53,302 31,093 31,490 397 1.3% Reduction of 2 beds on Lucas wef 01/04/10 Mother & Baby 107 62 134 72 114.7% Rainbow Unit Opened Oct 10 Local Psychiatric Intensive Care Units 6,102 3,560 2,737 -823 -23.1% Temporary Closure of Maple Unit Low Level Secure Services 4,009 2,339 2,442 103 4.4% 127,689 74,485 74,642 157 0.2% Outpatients (Attendance) Adult :Drug & Alcohol Services First Attendance 1,319 769 612 -157 -20.5% Adult :Drug & Alcohol Services Follow Up Attendance 17,427 10,166 11,262 1,096 10.8% Adult :Other Services First Attendance 4,595 2,680 3,019 339 12.6% Adult :Other Services Follow Up Attendance 21,476 12,528 11,724 -804 -6.4% Child :Other Services First Attendance 1,671 975 1,013 38 3.9% Child :Other Services Follow Up Attendance 18,202 10,618 11,752 1,134 10.7% Variance increased from 8.3% reported in Mth 6 Elderly First Attendance 2,675 1,560 1,827 267 17.1% Variance increased from 14% reported in Mth 6 Elderly Follow Up Attendance 5,699 3,324 3,083 -241 -7.3% 73,064 42,621 44,292 1,671 3.9% Community (Face to Face Contact) Adult Eating Disorder First Contact 82 48 28 -20 -41.5% Variance reduced from -48.8 reported in mth 6 Adult Eating Disorder Follow Up Contact 2,597 1,515 1,246 -269 -17.8% Community Mental Health Teams Adult 59,736 34,846 37,278 2,432 7.0% Community Mental Health Teams Elderly 16,782 9,790 10,821 1,032 10.5% Variance increased from 7.9% reported in Mth 6 79,197 46,198 49,373 3,175 6.9% Community (Non Face to Face) Adult Non Face to Face 50,451 29,430 36,103 6,673 22.7% Variance increased from 13.8% reported in Mth 6 Elderly Non Face to Face 3,090 1,803 2,130 328 18.2% Children Non Face to Face 1,532 894 1,639 745 83.4% 55,073 32,126 39,872 7,746 24.1% Mental Health Specialist Teams (Face to Face Contact) Other Mental Health Specialist Teams: Adult 29,686 17,317 21,167 3,850 22.2% Other Mental Health Specialist Teams: Elderly 9,157 5,342 3,675 -1,667 -31.2% Early Intervention in Psychosis Services 8,413 4,908 5,920 1,012 20.6% Variance increased from 18.7% reported in Mth 6 Adult Crisis Resolution Home Treatment 23,960 13,977 13,133 -844 -6.0% Children Crisis Outreach 1,885 1,100 1,457 357 32.5% Assertive Outreach Teams 13,253 7,731 8,173 442 5.7% 86,354 50,373 53,525 3,152 6.3%
Trustwide Total 474,952 277,055 298,307 21,252 7.7% Overall increase in activity reported in Mth 6 by 1.6%
Agenda Item No. 13
Name of Meeting: Meeting of the Board of Directors in Public
Date: 24 November 2010
Title of Report: Finance Report for the period ending 31st October 2010 - Month 7
Presented By: Rick Tazzini, Director of Resources
Subject, Purpose and Recommendation:
The report shows that, to 31st October 2010, the Trust has earned £4,449,000 [£3,257,000] more from providing health services than it spent on its cost of operations.
After accounting for non operating costs, the Trust has achieved a net Income and Expenditure surplus of £1,178,000 [£907,000] which is £311,000 [£109,000] better than plan.
The Trust has an overall year to date level 4 Monitor financial risk rating (FRR), which is better than plan. The FRR has improved due to the accounting treatment of the hosted Eastern Development Centre (EoE SHA) redundancy costs £476,000 as an exceptional item. These costs have been funded by the SHA.
The Forecast EBITDA at year end is £7,269,000 with a forecast retained surplus of £1,848,000 [£1,793,000] against the plan of £1,400,000. Whilst there remain a number of financial risks for CQUIN and decommissioning, this is a prudent estimate and the retained “surplus for a purpose” will be reinvested in the capital programme.
The Board is asked to approve the Month seven Financial Report.
Finance Implications: After consideration of identified risks the Trust is considered to be a going concern able to implement its approved strategic plans.
Clinical Implications: The financial performance of the Trust should not, of itself, constrain planned clinical performance.
HR Implications: The Trust’s reward strategy is affordable and within budget.
Legal Implications: The Trust has not been advised of legal action, or the risk of legal action, which may materially impact upon the Trust’s financial performance.
Equality Implications: None.
Risks: In year financial risks are being managed.
22nd April 2009 Financial Position Month 7: 31st October 2010 Index
Page Page
Glossary 3 Balance Sheet 21
Financial Report 4 Working Capital 22
Performance Overview 6 Treasury Management 23
Financial overview 7 Capital Expenditure 24
Income and Expenditure 8 Cash Flow 25
Service Lines 9 Schematic Cash Flow 26
Subjective Analysis -Pay 12 Forecast Cash Flow 27
Medical 13 Financial Risk Rating 28
Nursing 14 EBITDA Margin/Achieved 29
Subjective Analysis –Non- 16 Return on Assets 30 Pay Prescribing 17 I&E Surplus/Margin 31
Efficiency Programme 18 Liquidity 32
Reserves 19 Prudential Borrowing 33 Limit Year-end Forecast (I&E) 20
2 Glossary
CRES Cash Releasing Efficiency Saving
EBITDA Earnings Before Interest, Taxation, Depreciation, and Amortisation
I&E Income and Expenditure
KPI Key Performance Indicators
LCFS Local Counter Fraud Specialist
MDCR Maximum Debt to Capital Ratio
PBL Prudential Borrowing Limit
PbR Payment by Results
PDC Public Dividend Capital
PSPP Public Sector Payments Policy
SLA Service Level Agreement
TM This Month
WTE Whole Time Equivalent
YTD Year to Date
3 Financial Report (1)
NORTH ESSEX PARTNERSHIP NHS FOUNDATION TRUST Impairments SUMMARY FINANCE REPORT FOR THE PERIOD ENDING 31st October 2010 Month 7 The Trust has appointed Montagu Evans to conduct its five yearly valuation of the estate. An scoping meeting has been arranged for 1. Introduction November with the objective of providing draft figures be the end of This report presents the financial performance for the month ending December. October 2010, focusing on key indicators within the Monitor financial The expectation is that the valuations will result in impairments on the regime. Derwent Centre and the Land held at Severalls.
2. Financial Overview 3. Financial Risk Rating This report shows that, to 31st October 2010, the Trust has earned The Trust has planned for a weighted average financial risk rating £4,449,000 [£3,257,000] more from providing health services than it (FRR) of ‘3’. At the end of October, the cumulative average FRR is 3.9 spent on its cost of operations. This figure, called EBITDA, excludes equating to a risk rating of 4. interest, tax, depreciation and amortisation, and dividends. 4. Service Lines After accounting for non operating costs, referred to above, the Trust The service line summary on page 9 shows that overall services have achieved year to date net I&E surplus of £1,178,000 [ £907,000] , which been delivered within budget. However, some service lines are is £311,000 [£109,000] better than plan. exceeding their budget limits: Specialist Services overspent £91,000 [£207,000] Corporate overspent £5,000 [£86,000], Director of The Trust has an overall year to date Financial Risk Rating 4, which Operations & Nursing overspent £163,000 [£135,000] and better than plan. North East Essex is overspent £67,000 [ £98,000]. The FRR has improved due to the treatment of EDC redundancy costs (£476,000) as an exceptional item. This is under International Financial Actions have been taken to fund non-recurring expenditure in Specialist reporting standard 5 on the treatment of discontinued operations. The Services and Corporate Services. Further actions are expected in final closure costs of the centre will be subject to External Audit November to reduce the number of external placements within the approval at year end. These costs are met by the EoE SHA. Director of Operations budget. Also we are actively pursuing the recovery of a debt from PAH (£37,000) that is affecting the Director of The Forecast EBITDA at year end is £7,269,000 with a retained Operations & Nursing financial position. surplus of £1,848,000 [£1,793,000] against the plan of £1,400,000. Whilst there remain a number of financial risks for CQUIN and decommissioning, this is a prudent estimate.
4 Financial Report (2)
5. Subjective Analysis In Month 7, managers have spent less than their pay budgets by 10. Positive Change Agenda – Achievements £126,000 [£119,000] after the applications of Reserves.( see page 12). All budgets have been loaded onto the financial systems in line with the Spending on Goods and Services (Non-pay) is more than budget by 2010/11 revenue budget, as approved by the Board in March 2010. £550,000 [£509,000] ( see page 16). -The Annual Plan and Accounts for 2009/10 have been sent to Monitor. Expenditure on pay and non pay is being offset by under spends on -The Trust has received confirmation that it has not been selected for income and Overheads. stage 2 review of its 2010/11 – 2012/13 plans. -FRR 3 has been reported to Monitor at Quarter 2. 6. Efficiency Programme – See page 18 The value of the Trust’s efficiency programme is £2,518,000. £2,495,000 11. Next most important things has been deducted from budgets at month seven in line with plans - Budget building for 2011/12
agreed with managers.
This leaves the CRES target almost achieved in year, with £23,000 still 12. Financial Risks
to be found The following ‘in-year’ financial risks are under review and active
management. -
-Low interest rates for short term investments 7. Balance Sheet The Trust’s balance sheet, on page 21, presents level 4 liquidity (47 -Managing agency spend and sickness days) with net assets of £89,913,000 [£89,641,000]. -Ensuring CQUIN Income is secured. ( Provision included £150,000) -Demand for refund 2010/11 contract income associated with 8. Capital decommissioning of PICU services by Mid Essex PCT. (Provision At Month 7 the Trust has incurred capital expenditure of £5,295,000 included £200,000) [£5,102,000]. The principle item of expenditure was the purchase of the Derwent Centre at £3,600,000. 13. Assurance Statement Performance to date is consistent with the Trust being a going concern. 9. Cash-flow During October the Trust had a net cash outflow of £486,000 decreasing 14. Recommendation cash balances to £12,715,000. The Board is asked to approve the Financial Report, noting the achievement of the year to date level 4 financial risk rating.
5 Performance Overview
Income and Expenditure M7 Annual YTD YTD Budge t Budge t Actual YTD Var YTD Variance & (Surplus)/Deficit £'000s £'000s £'000s £'000s 0 0 Income (105,491) (62,382) (62,992) (610) (250) (250) Expenditure 98,595 58,119 58,543 424 EBITDA (6,896) (4,263) (4,449) (187) (500) (500) Other Costs 5,020 2,920 2,795 (125) (750) (750) Net (surplus)/deficit before (1,876) (1,343) (1,654) (311) (1,000) (1,000)
impairments Variance £'000s (1,250) (1,250) Impairments & Restructuring Costs 476 476 476 0 (Surplus)/Deficit £'000s Net (surplus)/deficit (1,400) (867) (1,178) (311) (1,500) (1,500) Jul Jun Oct Jan Feb Mar Apr Sep Nov Dec Financial Risk Rating M7 May Aug Actual Actual YTD (Surplus)/Deficit YTD Var Score Rating Metric EBITDA Mar gin 7.1% 3 EBITDA % Achieved 122.9% 5 Return on Assets 5.7% 4 Current and Projected Cash I&E Surplus Margin 2.6% 4 30,000 Liquid Ratio 47 4 25,000 Weighted Average 3.9 Rating 4.0 20,000 15,000
Efficiency Programme M7 £'000s 10,000 Original YTD Balance Balance 5,000 Plan £'000s £'000s £'000s % 0
CRES Programme (2,518) (2,495) (23) 0.9% Jul-10 Jun-10 Oct-10 Jan-11 Mar-10 Apr-10 Feb-11 Mar-11 Sep-10 Nov-10 Dec-10 May-10 Aug-10
Orig Plan Actual Capital Programme M7 This Forecast Last Forecast Alloc- YTD Re m ain- Y-End YTD ation Spend ing Forecast £'000s £'000s % £'000s £'000s
Capital Expenditure 8,655 5,295 61.2% 3,323 8,361 6 Financial Overview
Income and Expenditure M7 Annual YTD YTD Income and Expenditure YTD Var Budge t Budget Actual The income and expenditure £'000s £'000s £'000s £'000s account presents the trading Income Net (surplus)/deficit at Month 7 is position of the Trust. Clinical income (96,072) (56,113) (56,473) (360) Other income (9,419) (6,270) (6,519) (250) £(1,178,000) [£(907,000)], which is This is shown at EBITDA level £(311,000) [£(109,000)] better than and also net surplus/deficit. Total income (105,491) (62,382) (62,992) (610) Costs plan. EBITDA is earnings from Pay costs 80,134 47,097 46,971 (126) The improvement in Month in mainly trading activity less operating Non Pay Costs 18,460 11,022 11,572 550 and indirect costs excluding due to income benefits as detailed on interest, tax, depreciation and Total Costs 98,595 58,119 58,543 424 page 8. amortisation. EBITDA (6,896) (4,263) (4,449) (187) Profit/loss on asset disposals 0000 Total depreciation and amortisation 2,210 1,289 1,242 (47) Interest receivable (139) (81) (40) 41 Interest payable 216 126 121 (5) Unw inding discount 32 19 19 0 Cash-flow Total int. payable on loans & leases 0000 PDC Dividend 2,702 1,567 1,455 (113) The cash-flow statement Taxation payable 0000 gives an overview of how Net (surplus)/deficit before impairments (1,876) (1,343) (1,654) (311) funds are generated and Impairments & Restructuring Costs 476 476 476 0 used. Net (surplus)/deficit (1,400) (867) (1,178) (311) It identifies those funds Cash Flow Statement M7 generated from the operation M6 YTD TM YTD Annual of the organisation and those Net cash has decreased by £486,000 brought in via financing Actual Actual Actual Plan M12 mechanisms. It also shows £'000s £'000s £'000s £'000s in month. This is mainly due to EDC funds re-invested in the EBITDA 3,257 1,193 4,449 6,655 redundancy payments. organisation (capital Movement in w orking capital: (939) (518) (1,457) 359 This represents a decrease of expenditure) and those Cash flow from operations 2,317 675 2,993 7,014 £5,578,000 year-to-date. This is due returned to share holders Net capital expenditure (5,872) (196) (6,067) (7,988) (Dept of Health) mainly to the purchase of the Other Items 0 (476) (476) 0 Derwent Centre in April £3,600,000. Cash flow before financing (3,554) 4 (3,551) (974) Financing LT Debtors/Creditor 0 (506) (506) 0 Net Interest (68) (13) (80) (204) Loans (223) 0 (223) 3,333 Net PDC 0000 Dividends Paid (1,247) 28 (1,219) (2,822) Other 0 0 0 0 Net cash (outflow )/inflow (5,092) (486) (5,578) (667) Closing Cash at bank & in hand 13,199 12,715 12,715 17,622 7 Summary Income and Expenditure Income and Expenditure M7 Annual YTD YTD YTD Var The summary Income and Budget Budge t Actual Income is £610,000 better than plan. Expenditure Account gives £'000s £'000s £'000s £'000s This is mainly due to positive an overview of the variances on cost and volume performance of the Trust by Income main income and expenditure Other - Cost and Volume Contract Inc. (620) (409) (749) (341) contracts. NCA income now has a headings. Block Contract - 1 Host (86,011) (50,165) (50,065) 101 positive variance of £189,000 due to Block Contract - 2: Herts Part.NHSFT (107) (62) (62) (0) Quarter two invoicing, Perinatal Block Contract - 3: Suffolk (920) (537) (537) (0) income £77,000 with four beds being Block Contract - Other (560) (287) (289) (1) Income is subdivided by main invoiced on Rainbow Ward. Further income streams separating Clinical Partnerships (7,013) (4,140) (4,157) (17) clinical income from other Other clinical income from mand serv. 0 0 0 0 income was received in month for income. Private patient income 0 0 0 0 Longview beds £18,000 and Brian Other non-protected clinical income (841) (512) (614) (102) Roycroft beds £12,000. Clinical income (96,072) (56,113) (56,473) (360) Costs are analysed by main Research and Development (75) (68) (68) (0) The positive variance on Education budget headings. Further Education and Training (2,013) (1,177) (1,374) (197) and training is due mainly to EoE analysis of these is contained Other income (7,332) (5,024) (5,077) (53) Psychology trainees £107.000. within subsequent tables in Other income (9,419) (6,270) (6,519) (250) this report (see pages 10 to Total income (105,491) (62,382) (62,992) (610) 16) Costs Pay Costs 80,134 47,097 46,971 (126) Expenditure is £424,000 more than Drug costs 1,687 984 978 (7) The table contains the current plan due to Pay under spends of annual budget which may be Clinical supplies and services 279 163 192 29 £126,000 and Non Pay over spends adjusted in year and vary Secondary Commissioning costs 180 119 120 0 of £550,000, from the original plan. In Other Costs (excl. depreciation) 16,315 9,755 10,283 527 addition to EBITDA and Non-pay costs 18,460 11,022 11,572 550 net/surplus deficit, the table Total costs 98,595 58,119 58,543 424 Depreciation is under spending due to also shows the year-to-date EBITDA (6,896) (4,263) (4,449) (187) the lower than forecast capital spend variance against the phased Profit/loss on asset disposals 0 0 0 0 to date. annual budget. Depreciation & amortisation 2,210 1,289 1,242 (47) PDC dividend is lower than budgeted Interest receivable (139) (81) (40) 41 due to impairments last year and Interest payable 216 126 121 (5) lower than forecast capital EBITDA and net Unw inding discount 32 19 19 0 expenditure. surplus/deficit demonstrate Total interest payable Loans & leases 0 0 0 0 the current trading position PDC Dividend 2,702 1,567 1,455 (113) of the trust whereas the variance gives an indication Taxation payable 0 0 0 0 of performance against plan. Net (surplus)/deficit before impairments (1,876) (1,343) (1,654) (311) Impairments & Restructuring Costs 476 476 476 0 Net (surplus)/deficit (1,400) (867) (1,178) (311)
8 Service Line Summary
The graph shows the track of the net YTD Variance & (Surplus)/Deficit (surplus)/deficit and variance. 0 0 Corporate (250) (250) Corporate position has improved due (500) (500) to the funding from reserves of non recurring expenditure identified in (750) (750) ealier months. (1,000) (1,000) . (1,250) (1,250) Variance £'000s Director of Operations & Nursing (Surplus)/Deficit £'000s (1,500) (1,500) Incremental pressures on Associate Jul Jun Oct Jan Feb Mar Apr Sep Nov Dec May Aug Director posts £53k, West Essex SLA YTD (Surplus)/Deficit YTD Var £11k for Specialist services at the Derwent, the cost of mandatory The service line summary Service Lines M7 training for bank staff £31,000 and gives an overview of the Annual YTD YTD PAH bad debt provision of £37,000. financial performance of YTD Var service lines by reference to Budge t Budge t Actual variance against the phased £'000s £'000s £'000s £'000s Specialist Services annual budget Income (95,846) (55,925) (55,908) 17 Overspend is predominantly due to CAMHS 6,335 3,640 3,476 (165) Corporate 16,745 9,651 9,655 5 the earlier staff over-establishments In the summary contractual on Cedar. Also staffing issues on income is excluded from the Dir of Operations & Nursing 1,659 991 1,154 163 Area financial position and Mid Essex 14,361 8,566 8,550 (16) Severalls which have now been displayed separately. The North East Essex 19,633 11,447 11,514 67 resolved and additional Medical costs current report will evolve into a Psychological Services 3,250 1,904 1,822 (82) due to re-grading. full trading position for each Specialist Services 10,252 6,014 6,106 91 component when the shift to West Essex 16,454 9,524 9,424 (100) North East Essex service line reporting is Sub total (7,156) (4,188) (4,208) (20) completed. Reserves 1,113 659 473 (186) The pressure is due mainly to Overheads (176) (164) (144) 20 overspends on medical staff due to Trust total (6,220) (3,693) (3,878) (185) This will enable assessment of the use of agency staff to cover contribution of each service Enable East (676) (570) (571) (1) vacancies. Also catering costs on line to the cumulative EBITDA EBITDA (6,896) (4,263) (4,449) (187) position. older Adult services.
9 Service Lines - Year to Date and Forecast (1)
CAMHS CA MHS Y TD V ariance Corporate YTD Variance 400 400 The favourable position is due mainly to 200 200 surplus spot income and under spends 0 0 on medical and AHP staff due to vacancies £'000s £'000s (200) (200)
(400) (400) Corporate
(600) (600) Forecast assumes Incremental M1 M2 M3 M4 M5 M6 M7 M8 M9 M1 M2 M3 M4 M5 M6 M7 M8 M9 M10 M11 M12 M10 M11 M12 pressures within HR, Social Care and IM&T will continue until corrected as part of 2011/12 budget building.
Dir of Operations & Nursing Dir of Operations & Nursing YTD Variance Mid Essex YTD Variance 400 400 Forecast assumes that two of the three 200 200 service users on external placements will be brought back to Severalls House 0 0 during November and that Incremental £'000s £'000s (200) (200) pressures will continue (400) (400) Mid Essex (600) (600) The variance assumes the Associate M1 M2 M3 M4 M5 M6 M7 M8 M9 M1 M2 M3 M4 M5 M6 M7 M8 M9 Specialist on sick leave will not return to M10 M11 M12 M10 M11 M12 work and the post will be covered by a Locum. Also a reduction in CMHT vacancies that have been frozen due to reorganisation and an occupancy of 60% on Rainbow ward.
10 Service Lines - Year to Date and Forecast (2)
North East Essex North East Essex YTD Variance Psychological Services YTD Variance 400 400 The forecast to year end assumes 200 200 further vacancies in community and day 0 0 services will occur during the remaining months of the financial year. £'000s £'000s (200) (200)
(400) (400) Psychological Services (600) (600) M1 M2 M3 M4 M5 M6 M7 M8 M9 M1 M2 M3 M4 M5 M6 M7 M8 M9 Forecast assumes that Psychology M10 M11 M12 M10 M11 M12 trainees income will not continue to over-achieve the income at the same level and vacancies in East and Mid will West Essex YTD Variance be filled. Specialist Services YTD Variance 400 400 200 Specialist Services 200 0 0 Forecast assumes that expenditure
£'000s (200) remains at consistent level with recent
£'000s (200) trends and that staff termination costs (400) (400) at Ipswich road do not exceed £25,000. (600) (600) West Essex M1 M2 M3 M4 M5 M6 M7 M8 M9 M10 M11 M12 M1 M2 M3 M4 M5 M6 M7 M8 M9 M10 M11 M12 Assumes the 2 beds commissioned by West Essex PCT are occupied until year end and that vacancies in community nursing posts are filled as planned.
11 Subjective Analysis - Pay
Pay budgets represent approximately 75% of the Pay-Subjective M7 The under spend on pay budgets Annual YTD YTD Trust’s total costs. The YTD Var £126,000 [£119,000] is primarily due management of pay costs is Budge t Budge t Actual to vacancies in Allied Health fundamental to the financial £'000s £'000s £'000s £'000s success of the organisation. Management 6,433 3,967 4,033 66 professionals and reserves. Medical -NHS 12,715 7,434 7,100 (334) Medical staff is overspent by a net Medical Agency 54 32 726 694 £360,000 [£347,000], Nursing is On the whole, pay costs tend Nursing - NHS 35,224 20,686 20,352 (334) under spent by a net £96,000 to be a “fixed” cost within the Nursing Agency 12 12 250 238 [£78,000] and Admin and Clerical is Trust with most staff being AHPs 13,815 8,032 7,682 (350) paid via fixed salaries. In ward over spent by a net £62,000 Admin and Clerical 8,696 5,020 4,931 (88) areas and other 24/7 services [£53,000]. enhancements are paid to Admin Agency 56 57 207 150 recognise un-social hours, but Ancillary 2,017 1,200 1,217 18 again these areas tend to have Other Pay 0 0 0 0 Details of the current overspends on relatively fixed establishments Reserves 1,113 659 473 (186) Medical pay have been sent to the and pay costs 80,134 47,097 46,971 (126) medical Director for review.
Pay-Service Line M7 For reserves, please see page 19 When pay costs vary, this Annual YTD YTD tends to be a consequence of YTD Var Budge t Budge t Actual Director of operations and Nursing is vacancies and the use of £'000s £'000s £'000s £'000s supplementary hours to cover overspending due to the NE Temp staffing shortages. CAMHS 6,559 3,791 3,680 (111) Corporate 7,524 4,415 4,389 (26) staff solutions cost centre ((NETSS), Dir of Operations & Nursing 1,422 845 920 76 not containing costs within the Mid Essex 13,305 7,904 7,927 23 commission charged to Wards. North East Essex 18,320 10,672 10,614 (58) Psychological Services 4,472 2,627 2,657 29 Specialist Services 9,421 5,532 5,656 124 The overspend in Specialist Services West Essex 15,091 8,785 8,788 3 Reserves 1,113 659 473 (186) is predominantly due to over Overheads 0 0 (0) (0) establishments on Cedar due to staff Enable East 2,906 1,868 1,867 (0) redeployed from Maple 80,134 47,097 46,971 (126)
12 Subjective Analysis – Medical Pay
Medical Monthly Actual Medical YTD Variance 500 1,200
1,000 400
800 300 600 200 £'000s £'000s 400 100 200
0 0 Jul Jul Oct Jan Jun Feb Mar Apr Oct Jan Jun Sep Nov Dec Feb Mar Apr Aug May Sep Nov Dec Aug May 0809 0910 1011 0809 0910 1011
Medical M7 Annual YTD YTD Medical spending in Mid is over spent due to Locum cover for sick leave of an YTD Var Budge t Budge t Actual Associate Specialists £65,000 ( Due back December) and the covering of gaps £'000s £'000s £'000s £'000s in Junior Doctors rota £80,000 that ended in August. Medical NHS 12,715 7,434 7,100 (334) Medical Agency 54 32 726 694 In Specialist services Medical pay is over spent due mainly to an unfunded 12,769 7,465 7,826 361 medical trainee post.. CAMHS 1,446 843 795 (48) Corporate 233 136 137 1 In the West Medical costs are overspending by £135,000 due to an unfunded Mid Essex 3,446 2,019 2,161 142 staff grade post until September 2010, locum cover of vacancies and two re- North East Essex 3,914 2,283 2,364 81 Psychological Services 180 105 105 0 grading back dated to April 2008. Specialist Services 828 491 540 49 West Essex 2,722 1,588 1,723 135 North East Essex is overspent by £81,000, due mainly to the use of agency 12,769 7,465 7,826 361 staff to cover vacancies (3 posts in October).
13 Subjective Analysis – Nursing Pay (1)
Nursing Monthly Actual Nursing YTD Variance 4,000 400
3,000 200 0 2,000 (200) £'000s
£'000s (400) 1,000 (600)
0 (800) Jul Jul Oct Jan Jun Feb Mar Apr Sep Nov Dec Oct Jan Jun Aug May Feb Mar Apr Sep Nov Dec Aug May
0809 0910 1011 0809 0910 1011
Nur s ing M7 Annual YTD YTD Specialist services are over spending due to over establishments on Cedar ward YTD Var Budge t Budge t Actual and sickness levels on inpatient wards. £'000s £'000s £'000s £'000s NHS 35,224 20,686 20,352 (334) The overspend on Nursing is due to the underachievement of income on the Agency 12 12 250 238 NETSS profit Centre. This is due to the commission charged to budgets (6%) not 35,236 20,698 20,602 (96) covering costs. In Month 6 the commission was increased to 7.5%.. CAMHS 2,129 1,246 1,272 26 Corporate 392 229 271 42 The corporate overspends relate to incremental costs within Occupational Health. Dir of Operations & Nursing 212 152 223 72 Mid Essex 6,753 4,052 3,906 (146) CAMHS is overspending due to high levels of patient activity on Longview. North East Essex 10,203 5,928 5,840 (88) Psychological Services 405 236 219 (17) Specialist Services 6,958 4,084 4,157 73 West Essex 8,184 4,771 4,715 (57) 35,236 20,698 20,602 (96)
14 Subjective Analysis – Nursing Pay (2)
The graph shows that the year to date Bank & Agency YTD Variance variance for nursing bank is running in line with those levels experienced in 2009/10. 500
400 Nursing agency is showing similar trends to last year. 300
200
£'000s 100
0
(100) Jul Jun Oct Jan Apr Feb Mar Sep Nov Dec May Aug
Bank 0910 Agency 0910 Agency 1011 Bank 1011
The table shows the main overspending Nursing Hotspots units in relation to overall nursing costs. M1 M2 M3 M4 M5 M6 M7 Ward/Unit YTD Var YTD Var YTD Var YTD Var YTD Var YTD Var YTD Var £'000s £'000s £'000s £'000s £'000s £'000s £'000s Cedar – as previously reported due to over Cedar Unit 20 48 52 61 69 78 63 establishment. Galleyw ood Ward (1) 11 15 27 37 45 59 Severalls House 7 14 25 35 43 51 52 Severalls –Staffing issues due to Interim Chelmer Ward 6 14 22 27 37 42 45 suspension. Longview Adolescent Unit 7 21 12 18 21 26 45 Eaglehurst Rehabilitation Unit 5 17 23 29 33 33 36 Galleywood - is due to staff suspensions Lucas Ward 11 11 21 18 33 33 35 Finchingfield Ward 5 10 11 5 15 16 24 and sickness. 439 Ipsw ich Road (3) 2 2 4 6 8 14 Roding Ward (2) (1) 2 2 1 2 13
15 Subjective Analysis – Non-Pay
Non-Pay M7 Non-pay budgets are £550,000 Non-pay budgets account for Annual YTD YTD overspent [£509,000 ] after 7 Months. YTD Var approximately 20% of the Trust’s Budge t Budge t Actual expenditure. £'000s £'000s £'000s £'000s Cleaning the overspend has reduced Drugs 1,687 984 978 (7) due to the central funding of Terminal Med and Surg Supplies 279 163 192 29 cleans. A new contract for Domestic These budgets tend to be more Contractual Beds 180 119 120 0 volatile in their nature reflecting services was approved on the 29th pressures in the wider economy. Rents Rates Utilities 2,476 1,407 1,391 (16) Cleaning 1,110 665 711 46 September 2010 and the cost Telephones 538 265 286 21 pressure will need to be funded in 2011/12.. For 2008/09, only limited funds Catering 946 558 636 78 were invested in enhancing non- Computing 299 169 231 62 Catering is over spending due to pay budgets with individual areas Training 390 213 227 14 additional costs from the new contract being requested to continue Repair and Maintenance 367 217 187 (30) in November 2009. These are due to downward pressure in this area. Travel 2,275 1,313 1,329 17 product mix and additional items. Services From Other NHS Bodies 4,072 2,381 2,450 69 Bad Debts - Provision (201) (188) 55 243 Computing is over spending on Increasing fuel costs and overall Miscellaneous 4,044 2,755 2,779 24 IM&T Hardware and maintenance inflationary pressures within the 18,460 11,022 11,572 550 costs. Work is ongoing to see if some Trust’s supply chain will likely of these costs need to be charged to mean that non-pay budgets Non-Pay M7 capital. become pressured during the Annual YTD YTD current financial year. YTD Var Services from other NHS Bodies Budge t Budge t Actual comprise patient transport £14,000, £'000s £'000s £'000s £'000s IM&T £36,000 Pharmacy £20,000, Income 0 0 150 150 and Derwent recharges for utilities CAMHS 418 230 261 32 Corporate 9,728 5,592 5,640 48 costs £23,000. Dir of Operations & Nursing 559 347 427 80 The Bad debt provision covers all Mid Essex 1,346 841 916 75 invoices over 90 days that have not North East Essex 1,611 940 1,064 123 agreed payment terms, and NCA Psychological Services 189 110 150 40 invoices that are outstanding. Specialist Services 928 548 637 89 Overspends are being managed by West Essex 1,685 951 845 (106) utilising under spends on vacancies Overheads (176) (164) (143) 21 Enable East 2,174 1,627 1,626 (1) and restricting spend on other budget 18,460 11,022 11,572 550 lines, without impacting on service quality.
16 Subjective Analysis – Prescribing
Drugs Monthly Actual Dr ugs YTD V ar 250 150
200 100 150 50 100 £'000s
50 £'000s 0
0 (50) Jul Jun Oct Jan Jul Apr Feb Mar Sep Nov Dec May Aug Jun Oct Jan Apr Feb Mar Sep Nov Dec May Aug
0809 0910 1011 0809 0910 '1011
Dr ugs M7 Annual YTD YTD YTD Var Budge t Budge t Actual Specialist services has an over spend of £32,000, due to increased drug charges £'000s £'000s £'000s £'000s on Substance Misuse, Ipswich Road and Severalls House. This is a volume issue and has been raised with the commissioners. CA MHS 28 16 22 6 Corporate 5 3 0 (3) Mid Essex 494 288 308 20 Mid pressure is due to the additional costs for running the Memory Assessment North East Essex 449 262 254 (8) and Support Service. This has also been raised with commissioners. Psychological Service 0 0 1 1 Specialist Services 357 208 240 32 West Essex 354 207 152 (55)
1,687 984 978 (7)
17 Efficiency Programme
The Trust’s longer term financial model plans for significant year-on- Efficiency Programme year savings generated Actnd Original Actnd Out- by an internal efficiency YTD programme. Plan at M7 standing Total £'000s £'000s £'000s £'000s Status These savings allow the "Margin" on new developments (165) (2) (15) (150) Trust to respond to Capital Charges (Crystal Centre & Lakes) (323) (323) 0 inflationary pressure Lease cost savings on Derw ent Centre (339) (466) 127 and also to steadily Reduction in PAH SLA overheads (106) (106) 0 improve its financial Unidentified CRES (323) (323) 0 performance. 0 Area Targets - 0 CAMHS (157) (157) 0 Corporate (100) (100) 0 Mid Essex (267) (267) 0 North East Essex (382) (382) 0 Specialist Services (76) (76) 0 West Essex (280) (280) 0 (2,518) (2) (2,495) (23)
The delivery of the CRES programme has almost been achieved with a surplus of £127,000 on the Lease costs of the Derwent offsetting the yet to be delivered Margin on new developments.
The margin on new developments is dependent on the appointment of new CAMHS posts and the commissioning of Mother and Baby beds.
18 Reserves
Funds are set aside within the Cost Pressure Trust’s financial plan for a number of issues. These funds Re s e r ve s The surplus Cost Pressure funding are generically known as Original Remaining Forecast (Surplus) YTD relates mainly to IM&T and Pharmacy reserves. Plan at Month 7 Spend Deficit Var funding being held until expenditure is £'000s £'000s £'000s £'000s £'000s incurred. Pay Inflation 1,610 (2) 0 2 2 Reserves tend to fall into two Non-Pay Inflation 100 (38) 0 38 38 categories:- Agenda For Change 50 50 0 (50) (29) Developments Clinical Excellence 0 0 150 150 150 Forecast spend includes estimate future costs on Memory Assessment Funds set aside for inflationary Cost Pressures 728 424 0 (424) (250) pressures anticipated during Developments 816 351 392 (126) (74) service until agreement is reached the year; and IDTS Reserves 317 100 0 (100) (93) and slippage on CAMHS covering Revenue of Capital 200 181 0 (181) (105) income shortfall. Other Reserves 300 70 200 130 158 CRES at Risk 0 0 23 23 17 Funds set aside for specific Capital /Revenue developmental issues 4,121 1,136 765 (538) (186) This reserve is to cover revenue consequences of capital programme in year.
Other Reserves This is a provision against potential The year to date variance on Reserves, is reported under Pay contractual risks for Maple. on page 9. IDTS The Forecast surplus in included on page 20 in the forecast summary for the Trust. This is slippage on recuritment this year.
Clinical Excellence A provision has been included for the for CQUIN repayment.
19 Year End Forecast
Forecast Month 7 In examining the income and Year-End Forecast Variance expenditure position, M3 M4 M5 M6 M7 Income –. The income surplus is mainly due significant emphasis is placed £'000s £'000s £'000s £'000s £'000s to Non Contracted Income £284,000. Also on describing the features of SIFT( Service Increment for Teaching) the year-to-date position. Income (54) (168) (232) (242) (75) Income and higher than anticipated Deanery CAMHS (100) (213) (223) (192) (160) Corporate 254 219 241 243 30 funding. In this section of the report, Dir of Operations & Nursing 172 199 182 175 191 the emphasis is to look Mid Essex 184 159 135 127 107 Corporate – The forecast for Corporate forward, initially to year-end, to North East Essex (50) 0 40 40 15 assumes that cost pressures in HR for check the predicted track of Psychological Services (113) (110) (118) (113) (104) the I&E position. incremental pay costs will continue. Specialist Services 270 269 330 330 213 Also Incremental pressures within the West Essex (69) (76) (51) (32) (52) Information and Medical records departments Forecasts are prepared on a Sub total 494 279 304 336 165 Reserves (739) (506) (408) (403) (538) will continue. Work is in progress to look at monthly basis by service line how increments can be funded as part of management. They form a Trust total (245) (227) (104) (67) (373) significant part of basis of the Enable East (200) (200) (200) (200) 0 base budget preparation. internal performance EBITDA (445) (427) (304) (267) (373) management system. Overheads etc 51 42 (19) (126) (75) Dir of Operations &Nursing The forecast Net (surplus)/deficit (394) (385) (323) (393) (448) assumes that one external placement will continue along with the incremental pressure In due course, year-end forecasts will be supplemented on Area Directors posts by year-end targets as the Trust focuses upon a desired Specialist Services The forecast assumes out-turn position that expenditure will remain at a consistent level with Severalls now resolved. The forecast EBITDA incorporating the £373,000 variance is £7,269,000, with a forecast surplus of £1,793,000 against the Enable East The forecast assumes that plan of £1,848,000. Enable East will be able to deliver Planned surplus of £200,000 in year. The business case assumed income generation of £334,000 to year end. Since June £427,000 of services has been commissioned.
20 Balance Sheet
Detailed Balance Sheet Fixed assets have increased by The balance sheet is a 31/03/2010 30/09/2010 31/10/2010 31/03/2011 £3,600,000 due to the purchase of snapshot of the trust’s £'000s £'000s £'000s £'000s the Derwent Centre, with a Fixe d As s e ts financial health at a point corresponding reduction in cash. in time. Tangible and Intangible Assets 84,893 88,975 88,943 90,264 Total Fixed Assets 84,893 88,975 88,943 90,264 Current Assets The target for Trade Debtors over 90 It identifies;- Stock & Work in Progress 0 0 0 0 days is 5% of total debtors. The NHS Trade Debtor 691 1,078 1,631 691 •Fixed assets current position net of provisions is Non NHS Trade Debtor 0 0 0 0 3%. •Liquid assets Other Debtors 673 75 110 673 Accrued Income 568 546 597 568 •Liabilities Prepayments 324 666 529 324 •Shareholder Equity Cash at Bank and in Hand 18,289 13,199 12,715 17,621 Total Current Assets 20,545 15,564 15,582 19,877 Current Liabilities The percentage of invoices paid The Trust’s financial risk Trade Creditors (695) (568) (396) (1,195) within 30 days for month ended rating uses the I&E Invoice Accruals (3,151) (1,921) (1,586) (3,960) October 2010 is 93% [September position as the reference Other Creditors (2,777) (2,496) (2,766) (1,468) 2010 88%] point but relates this to PDC dividend creditor 0 0 (236) 0 the strength of the Capital Creditors (941) (172) (169) (941) balance sheet for a Bank Loan Less then one year (445) (445) (445) (445) Capital creditors are those number of key indicators. Provisions (302) (303) (303) (302) remaining from 31 March 2010. Accruals (1,400) (2,204) (2,300) (1,400) Deferred Income (1,767) (1,858) (2,043) (2,273) Enable East Deferred income has Total Current Liabilities (11,478) (9,965) (10,244) (11,984) decreased from £1,600,000 at year Net Current Assets/(Liabilities) 9,067 5,598 5,338 7,893 end to £1,300,000. This is mostly Long Term debtors 610 610 610 610 Total Assets Less Current Liabilities 94,570 95,183 94,891 98,767 due to the funding of redundancy Creditors: amount falling due after more than one year (506) (506) 0 0 costs £476,000. Finance Leases 0 0 0 0 Provisions for Liabilities and Charges (1,997) (1,925) (1,867) (1,997) Loans (3,333) (3,110) (3,110) (6,888) Total Assets Employed 88,734 89,641 89,913 89,882 Tax Payers Equity Public Dividend Capital (29,087) (29,087) (29,087) (29,087) Income and Expenditure Reserve (27,551) (28,467) (28,738) (28,699) Revaluation Reserve (32,096) (32,088) (32,088) (32,096) Donated asset reserve 0 0 0 0 Other Reserves (Government grant reserve etc) 0 0 0 0 Total Taxpayers Equity (88,734) (89,641) (89,913) (89,882)
21 Working Capital
The working capital position Working Capital shows the balance between 15,000 net current liabilities and 10,000 current assets excluding 5,000 cash. 0 (5,000) £'000s (10,000) (15,000) Jul-10 Jun-10 Oct-10 Jan-11 Apr-10 Feb-11 Mar-11 Sep-10 Nov-10 Dec-10 May-10 Aug-10 Y-End Forecast
Debtors Creditors Net Working Capital Cash
Working Capital Y-End Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Forecast £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s The table and graph show a De btor s high level of net working NHS Trade Debtor 708 1,832 634 1,598 1,006 1,078 1,631 691 capital since the start of the Non NHS Trade Debtors0000000 0year. Other Debtors 366 61 186 49 131 75 110 673 The in-month cash position Accrued Income 6,679 264 152 298 323 546 597 568 more than balances the Prepayments 404 306 540 577 581 666 529 324 liability in the net working Total Debtors 8,156 2,462 1,512 2,522 2,041 2,364 2,867 0 0 0 0 0 2,256 Creditors capital position. Trade Creditors (3,044) (2,233) (2,217) (2,207) (2,112) (2,489) (1,983) (5,155) Other Creditors (2,451) (2,568) (2,509) (2,547) (2,732) (2,496) (2,766) (1,468) PDC Dividend Creditor (263) (528) (708) (944) (1,180) 0 (236) 0 Capital Creditors (307) (225) (209) (208) (189) (172) (169) (941) Bank Loan less then one year 0 (445) (445) (445) (445) (445) (445) (445) Provisions 0 (303) (303) (303) (303) (303) (303) (302) Accruals (2,390) (1,594) (1,911) (2,575) (2,659) (2,204) (2,300) (1,400) Deferred Income (308) (2,873) (2,384) (2,363) (2,175) (1,858) (2,043) (2,273) Total Creditors (8,763) (10,768) (10,685) (11,592) (11,795) (9,965) (10,244) 0 0 0 0 0 (11,984) Working Capital Net w orking capital (607) (8,306) (9,173) (9,070) (9,754) (7,601) (7,377) (9,728) Cash 7,036 14,355 15,214 15,269 15,684 13,199 12,715 17,621 Working capital facility 7,500 7,500 7,500 7,500 7,500 7,500 7,500 7,500 22 Treasury Management
Management of the Trust’s liquid position is generically known as treasury management. Short-Term Investments Cash Average Interest The Trust has a £7.5million working Invested at Interest Re ce ive d capital facility with Barclays Bank. This remains unutilised. This term encompasses both the Month End Rate In Month borrowing of funds, but also the £'000s % £'000s investment of funds immediately The Trust has an £8million loan facility surplus to requirements. April 6,900 0.45 4 as a source of finance for the Crystal May 21,100 0.46 3 Centre capital scheme. £4million was June 36,200 0.47 7 July 51,200 0.48 6 drawn down in 2009/10, with the August 66,500 0.47 6 balance expected to be drawn down September 13,000 0.47 6 this year. The final repayment date is October 12,400 0.48 5 18th September 2018 and interest rate November is 5.33 percent per annum. December January February Mar c h The trust makes short term deposits Total 37 with the National Loans Fund.
Interest is earned on current account balances.
Total interest earned year to date is £37,000.
The Trust has made no long term investments of cash.
A new Treasury management policy was approved by Audit Committee on the 14th October.
23 Capital Expenditure
Capital Expenditure M7 A brief overview of capital Allocation YTD Spend Remaining Y-End expenditure only is included in The bulk of the programme details this report. Periodic, more Forecast have been agreed and expenditure detailed reports on the £'000s £'000s £'000s £'000s will be incurred in the coming months. progress of the capital programme will be made to the Maintenance 1,059 494 565 1,067 The year to date expenditure of Board. Non-Maintenance 7,596 4,801 2,758 7,294 £5,295,000 has been spent mainly on TOTAL 8,655 5,328 3,323 8,361 the purchase of the Derwent Centre The Board approved a capital (£3,600,000). programme of £15,005 million 1. Strategic Schemes at the beginning of the financial year. Adult Unit Harlow - Prof Fees 100 85 15 130 The allocation for other strategic CAMHS - Works 700 0 700 279 schemes £1,000,000 has been allocated to schemes. For 2009/10 the source of CAMHS - Prof Fees 200 111 89 221 funds for the capital CAMHS - Client Risk 0 0 0 31 programme are internally The Strategic Capital Group agreed to generated funds (EBITDA), Low Secure Col - Works 0 2 (2) 2 review forecast capital spend in order accumulated cash balances Low Secure Col - Prof Fees 0 87 (87) 110 to profile budget allocation to cover and long term loans. PICU Colchester - Prof Fees 0 2 (2) 5 overspends on Low Secure and other areas. PICU Colchester - Land 0 0 0 0 The year to date and forecast This has now been agreed and the spend was confirmed with Derw ent Centre Purchase 3,600 3,623 (23) 3,623 year end forecast amended to show capital project directors and 1. Strategic Schemes Total 4,600 3,910 690 4,402 expenditure restricted to within budget holders at the Strategic available funding. Capital Group chaired by the 2. Replacement & Refurbishment 1,059 494 565 1,067 Director of Resources. 3. Infrastructure, H&S, PEAT 1,070 383 684 1,069 4. Devolved AD Capital 250 29 220 262
5. Capital Development 650 306 344 747 6. Old Year Schemes 0910 100 173 (106) 146 7. Loan Repayment 668 0 668 668 8. Contingency 258 0 258 0 Grand Total 8,655 5,295 3,323 8,361
24 Detailed Cash Flow
Detailed Cashflow (1) M7 Annual M6 YTD TM YTD M7 YTD The detailed Cash-flow Plan Actual Actual Actual Actual statement shows how liquid 31/03/10 resources are generated £'000s £'000s £'000s £'000s £'000s The EBITDA position (£4,449,000), within the organisation, and EBIT DA how they are used Non-Cash Operational I&E Items 3,257 1,193 4,449 4,449 6,655 contributes to the strong cash position Movement in Working Capital during the year. Stocks & Work in Progress 0 0 0 0 0 Funds are generated from NHS Trade Debtors (387) (553) (940) (940) 0 operations combining Non NHS Trade Debtors 0 0 0 0 0 EBITDA with movements in Other Debtors 598 (35) 563 563 0 working capital. Accrued Income 23 (51) (28) (28) 0 Funds are expended on Prepayments (343) 137 (206) (206) 0 capital expenditure or Trade Creditors (627) (172) (799) (799) 0 exceptional items Invoice Accruals (2,039) (334) (2,374) (2,374) 359 Other Creditors 1,028 270 1,298 1,298 0 Payments on Account 1 0 1 1 0 The majority of capital expenditure The net cash flow is Accruals 804 96 900 900 0 relates to the purchase of the determined when loans, Deferred Income 91 185 276 276 0 Derwent Centre. interest , dividends and Provisions & Liabilities (88) (60) (148) (148) 0 changes in shareholders CF from Operations 2,317 675 2,993 2,993 7,014 equity are taken into account. Capital Expenditure Maintenance Capex (5,872) (196) (6,067) (6,067) (7,988) Non Maintenance Capex 0 0 0 0 0 Othe r Item s During October, the cash balances Cash exceptional items 0 (476) (476) (476) 0 Cash receipt from Asset Sale 0 0 0 0 0 decreased by £486,000. This is Taxation Paid 0 0 0 0 0 mainly due to EDC redundancy costs CF before Financing (3,554) 4 (3,551) (3,551) (974) £476,000. Movement in LT Debtors 1 0 1 1 0 Movement in LT Creditors (0) (506) (506) (506) 0 Interest The trust’s cash balance stands at st Interest (Paid) on Loans and Leases 0 0 0 0 (324) £12,715,000 at 31 October 2010 Interest (Paid)/Received (68) (13) (81) (81) 120 Loans Draw dow n of Loans and Leases (223) 0 (223) (223) 4,000 Repayment of Loans and Leases 0 0 0 0 (667) Othe r Public Dividend Capital Received 0 0 0 0 0 Public Dividend Capital Repaid 0 0 0 0 0 Movement in other Grants/Capital Received 0 0 0 0 0 Dividends Paid (1,247) 28 (1,219) (1,219) (2,822) Net Cash (Outflow )/Inflow (5,092) (486) (5,578) (5,578) (667) Opening Cash Balance 18,289 13,199 18,289 18,289 18,289 Net Cash(Outflow )/Inflow (5,092) (486) (5,578) (5,578) (667) Closing Cash Balance 13,199 12,715 12,715 12,715 17,622 25 Schematic Cash Flow
Cash Flow Analysis (2) YTD This schematic version of the cash flow statement shows, in a more May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Total simplified way, the generation and £'000s £'000s £'000s £'000s £'000s £'000s £'000s use of resources. Protected Clinical Income (8,159) (7,828) (8,269) (8,005) (8,015) (8,154) (56,416) Inc ome Other Income (666) (882) (1,123) (741) (791) (1,548) (6,659)
Pay 6,692 6,784 6,767 6,812 6,713 6,744 46,971 Expenditure Non-pay (excluding depreciation) 1,427 1,546 1,766 1,554 1,688 1,766 11,452
(Increase)/Decrease in Debtors 5,694 950 (1,010) 481 (323) (503) (611) Working Capital Increase/(Decrease) in Creditors 559 (251) 607 (17) (635) (15) (846)
Capital Expenditure (212) (210) (390) (297) (377) (196) (6,067) Capital Disposal Proceeds 0 0 0 0 0 0 0
Cash Exceptional Items 0 0 0 0 0 (476) (476) Taxation Paid 0 0 0 0 0 0 0 Other Movement in LT Debtors 81 0 0 0 0 0 1 Movement in LT Creditors 506 0 0 0 0 (506) (506)
Interest Payable (0) 0 0 0 0 0 0 Interes t Interest Receivable (14) (11) (12) (11) (6) (13) (81)
Loans (Repaid/Received) 0 0 0 1 (223) 0 (223)
PDC/Loans PDC net (Repaid/Received) 0 0 0 0 (0) 0 0 Dividends Paid 0 0 0 0 (1,245) 28 (1,219)
Total cashflow 7,319 859 55 537 (2,406) (486) (5,376)
26 Forecast Cash Flow
Current and Projected Cash 30,000 25,000 20,000 15,000
£'000s 10,000 5,000 0 Jul-10 Jun-10 Oct-10 Jan-11 Mar-10 Apr-10 Feb-11 Mar-11 Sep-10 Nov-10 Dec-10 May-10 Aug-10
Orig Plan Actual This Forecast Last Forecast
The Trust has a longer term financial model which was refreshed as part of the annual plan process. This model projects cash on a monthly basis for one year from 1st April 2010.
Periodically, these projections are reviewed for known changes to assumptions.
The forecast takes into account the new profile for the draw down of the £4million loan in 2010/11.
27 Financial Risk Rating - Overview
Financial Risk Ratings The target weighted average Financial Risk Rating (FRR) of 3.45 is rounded to 3 for purposes Criteria Weight Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar of Monitor performance Planned Weighted Average 100% 3.3 3.3 3.3 3.3 3.3 3.3 3.3 3.3 3.3 3.5 3.5 3.5 assessment. Rating (rounded) 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0 Actual Rating EBITDA margin Underlying Performance 25% 3 3 3 3 3 3 3 At the end of October the Trust’s EBITDA, % achieve Achievement of Plan 10% 5 5 5 5 5 5 5 weighted average financial risk ROA Financial Efficiency 20% 5 5 4 5 4 3 4 rating (FRR) is 3.9, rounded to I&E surplus margin Financial Efficiency 20% 5 4 4 4 3 3 4 FRR4. Liquid ratio Liquidity 25% 4 4 4 4 4 4 4 Weighted Average 100% 4.3 4.1 3.9 4.1 3.7 3.5 3.9 The weighted average Rating Score 4.0 4.0 4.0 4.0 4.0 3.0 4.0 performance is now in line with plan. Financial Risk Indicators The Financial Risk Indicators are Potential financial risk indicators Yes/No/NA the position reported to Monitor at Unplanned decrease in EBITDA margin in tw o consecutive quarters NO Quarter 2. Quarterly self-certification by trust that the financial risk rating (FRR) may be less than 3 in the next 12 NO FRR 2 for any one quarter NO Working capital facility (WCF) agreement includes default clause NO Debtors >90 days past due account for more than 5% of total debtor balances NO Creditors >90 days past due account for more that 5% of total creditor balances NO Tw o or more changes in Finance Director in a tw elve month period NO Interim Finance Director in place over more that none quarter end NO Quarter end cash balance <10 days of operating expenses NO Capital expenditure <75% of plan for the year to date NO
28 Financial Risk Metric (1) – EBITDA Margin/Achieved
The EBITDA rating is focussed upon two metrics, EBITDA margin and 14 EBITDA margin achieved. 12 10 The EBITDA margin is measured by 8 comparing the EBITDA achieved and 6 total income for the period expressed 4 as a percentage. Metric scores are 2 awarded on the following basis. 0 Risk Rating Value Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 1<1% Planned EBITDA Actual EBITDA M argin 21% 35% 49% 511% The EBITDA margin is 7.1%.
EBITDA Margin Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar The EBITDA margin achieved is Planned Metric measured by comparing the planned EBITDA Margin(%) 5.9% 5.9% 5.9% 5.9% 5.9% 5.9% 5.9% 5.9% 5.9% 6.1% 6.2% 6.3% Metric Rating 333333333333and actual EBITDA expressed as a Actual Metric percentage. Metric scores are EBITDA (729) (1,434) (1,815) (2,674) (2,934) (3,257) (4,449) 0 0 0 0 0 awarded on the following basis. Total Income (8,893) (17,718) (26,428) (35,820) (44,566) (53,290) (62,992) 0 0 0 0 0 Risk Rating Value EBITDA Margin (%) 8.2% 8.1% 6.9% 7.5% 6.6% 6.1% 7.1% 1<50% Metric Rating 3333333 250.0% Achievement of Plan 370.0% EBITDA Planned (517) (1,034) (1,552) (2,069) (2,586) (3,103) (3,621) 485.0% EBITDA Achieved (729) (1,434) (1,815) (2,674) (2,934) (3,257) (4,449) 5100.0% EBITDA Achieved (%) 141% 139% 117% 129% 113% 105% 123% Risk Rating5555555 The EBITDA margin achieved is 123%
29 Financial Risk Metric (2) – Return on Assets
8 The Return on Assets is measured by 6 comparing the I&E Surplus (adjusted for 4 dividends) achieved and average assets employed over the period expressed as 2 a percentage. Metric scores are 0 awarded on the following basis.
(2) Risk Rating Value (4) 1< -2% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 2-2% 33% Planned ROA Actual ROA 45% 56%
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar The Trust’s performance on this metric Planned Return on Assets 4.3% 4.2% 4.2% 4.2% 4.2% 4.2% 4.2% 4.2% 4.2% 4.3% 4.4% 4.5% is 5.7%. The corresponding score on Planned Metric Rating3333333 33 33 3this metric is 4. Net Surplus (448) (529) (547) (986) (828) (907) (1,178) 0 0 0 0 0 Add Back Exceptional Items00000047600 00 0 PDC dividends 265 530 710 946 1,182 1,247 1,455 0 0 0 0 0 Net Return (713) (1,059) (1,256) (1,932) (2,009) (2,154) (3,109) 0 0 0 0 0
Average Assets Employed 93,281 93,322 93,331 93,551 93,471 93,400 93,535
Annual Days 360 360 360 360 360 360 360 Days in Period 30 60 90 120 150 180 210 Actual Return on Assets 9.2% 6.8% 5.4% 6.2% 5.2% 4.6% 5.7% Metric Rating5545434
30 Financial Risk Metric (3) – I&E Surplus Margin
The I&E Surplus Margin is measured by comparing the I&E 5 Surplus achieved and total income over the period expressed as a 3 percentage. Metric scores are awarded on the following basis. 1
(1) Risk Rating Value 1< -2% (3) 2 -2.0% 31.0% (5) 42.0% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 53.0%
Actual Surplus Planned Surplus
The current calculation for the metric is a “4” rating based on the Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar I&E surplus margin at the end of Planned I&E Surplus Margin 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.1% 1.2% 1.3%September of 2.6% . Planned Metric Rating22222222233 3 Net Surplus(448)(529)(547)(986)(828)(907)(1,178)0000 0 Add Back Exceptional Items0000004760000 0 Net Return(448)(529)(547)(986)(828)(907)(1,654)0000 0
Total Income (8,893) (17,718) (26,428) (35,820) (44,566) (53,290) (62,992) I&E Surplus Margin 5.0% 3.0% 2.1% 2.8% 1.9% 1.7% 2.6% Actual Metric Rating 5 4 4 4 3 3 4
31 Financial Risk Metric (4) – Liquidity
The Liquidity metric compares the 90.0 current assets and liabilities and costs 80.0 incurred. The result, expressed as 70.0 days, gives an indication of the length 60.0 of time the organisation could survive 50.0 on current liquid resources. 40.0 Weeks 30.0 The Liquidity metric is; 20.0 Cash plus Debtors plus Creditors 10.0 divided by total costs multiplied by 0.0 number of relevant days to date. Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Relevant days are 30 days per month. Planned Liquidity Actual Liquidity The calculation also includes provision for the working capital Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar facility for £7.5million procured by the Planned Liquid Ratio 54.3 50.1 45.8 50.7 50.5 45.4 44.9 44.4 43.9 53.0 57.0 56.1 Trust. Planned Metric Rating 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 Metric scores are awarded on the following basis. Cash at bank and in hand 7,036 14,355 15,214 15,269 15,684 13,199 12,71500000 Committed Financing Facility 7,500 7,500 7,500 7,500 7,500 7,500 7,500 7,500 7,500 7,500 7,500 7,500 Draw dow n Committed Facility 0 0 0000000000 Risk Rating Value Remaining Facility Available 7,500 7,500 7,500 7,500 7,500 7,500 7,500 7,500 7,500 7,500 7,500 7,500 1.0 <10 Cash Available 14,536 21,855 22,714 22,769 23,184 20,699 20,215 7,500 7,500 7,500 7,500 7,500 2.0 10.0 Add 3.0 15.0 Current Receivables 8,156 2,462 1,512 2,522 2,041 2,364 2,867 Total Debtors 8,156 2,462 1,512 2,522 2,041 2,364 2,867 4.0 25.0 Less The Trust’s5.0 liquidity 60.0is now 46.9 days. Current Payables (8,500) (10,241) (9,977) (10,649) (10,616) (9,965) (10,008) This is in accordance with plan as Total Creditors (8,500) (10,241) (9,977) (10,649) (10,616) (9,965) (10,008) cash is drawn down to fund capital Relevant Days 30 60 90 120 150 180 210 spend. Total Liquidity 14,192 14,077 14,249 14,642 14,610 13,098 13,074 Total Costs 8,165 16,284 24,613 33,146 41,632 50,033 58,543 Liquid Ratio 52.1 51.9 52.1 53.0 52.6 47.1 46.9 Actual Metric Rating 4.0 4.0 4.0 4.0 4.0 4.0 4.0
32 Prudential Borrowing Limit
PBL and Covenants Ris k Rating Current The Trust has drawn down £4million in The Trust’s projected Financial 5 4 3 Values 2009/10. Risk Rating, as assessed by Ratio Limit MONITOR in the Annual Planning Minimum Dividend Cover >1x >1x >1x 1.15 Process, determines the limits to The PBL is £20,200,000 cumulative long-term borrowing placed on the Revenue available for debt services borrowing following Monitor’s assessment of Annual dividend payable organisation. the Trust’s Annual Plan. This is in addition to The risk rating determines the Minimum Inter es t Cov er >3x >3x >3x 8.92 the £8million working capital facility, which maximum “Debt to Capital Ratio” Revenue available for debt services (MDCR). Monitor increased during September from Interest payable £7.5million. Minimum Debt service Cover >2x >2x >2x 2.91 The MDCR is then translated to a Revenue available for debt services Prudential Borrowing Limit (PBL) Debt Service Maximum Debt Service to Revenue <3x <3x <3x 0.01 The Trust must operate within its Debt Service PBL and satisfy a number of ratios associated with the PBL. Revenue Borrowing Limit £'000s
PBL Line Graph Max long Term Borrow ing 20,200 30.0 25.0 Working Capital Facility 8,000 20.0 15.0 Draw Dow n (4,000) £M 10.0 5.0 Repaid 443 0.0
Jul PBL Available 24,643 Oct Jan Jun Feb Mar Apr Sep Nov Dec Aug May Months Working Capital Loan Utlilisation Long Term Loan
33
Agenda item No: 14
Name of Meeting: Meeting of the Board of Directors in Public
Date: 24 November 2010
Title of Report: Treasury Management Policy
Presented By: Rick Tazzini
Subject, Purpose and Recommendation:
The Board of Directors is asked to approve the Treasury Management Policy.
The Policy has been produced in accordance with guidance published by Monitor and was presented to the Audit Committee on 14th October 2010 and their comments have been incorporated into the attached final version.
Finance Implications: The Policy should enable the Trust to increase its return on investments.
Clinical Implications: N/A
HR Implications: N/A
Legal Implications: N/A
Equality Implications: N/A
Risks: Investing with commercial organisations carries a higher risk than the current arrangements of investing with the Post Office General.
NORTH ESSEX PARTNERSHIP NHS FOUNDATION TRUST
POLICY DOCUMENT
Document Title Treasury Management POLICY
Reference Number Policy Type Finance Policy
Electronic File Location Intranet / Finance / Procedures
Intranet Location Home Page Finance Trust Policies, Procedures and Guidelines Finance Policy & Procedures
Status Draft
Version Number/Date Version 2 – September 2010
Author(s) Responsible for Writing and Associate Director Finance Monitoring
Approved By Audit Committee
Approval Date 14th October 2010
Implementation Date October 2010
Review Date October 2012
D10164 1
NORTH ESSEX PARTNERSHIP NHS FOUNDATION TRUST
1. Introduction
NHS Foundation Trusts (FTs) are public benefit corporations, with the principal role of providing healthcare services for the NHS in England. As such, boards of NHS FT’s need to ensure that surplus operating cash is invested in accordance with their duty to safeguard and properly account for the use of public money.
This Policy aims to promote fiscal responsibility and prudent investments that do not compromise effective, efficient, and economic delivery of services. It applies to all funds owned by North Essex Partnership NHS Foundation Trust, and must be adhered to by staff responsible for managing and administering this function.
2. Objectives
The overall treasury objectives are to support the Trust’s development and are influenced and informed by :
Investment - ensuring a competitive return on surplus cash balances, within an acceptable risk profile;
Funding - ensuring the availability of flexible competitively priced funding for working capital at all times;
Risks - identifying and managing the financial risks, including security of funds, accessibility, interest rate and foreign currency [transaction and translation] risks, arising from operational activities.
Banking – ensuring strong relationships with banks and compliance with all banking covenants.
Regulation – ensuring compliance with Monitor’s Prudential Borrowing Code, and any additional internal regulations applying to this Policy.
The Trust’s treasury activities will be undertaken in a manner that achieves the following key objectives:
Surplus cash: To obtain the most competitive deposit rates using institutions permitted under the Safe Harbour definitions stated in the guidance issued by Monitor “Managing Operating Cash in NHS Foundation
D10164 2 Trusts and in line with deposit guidelines ratified by the Director of Resources, subject to the over-riding objective of ensuring cash is available to the Trust as and when it is required for the efficient operation of its services.
Funding: Ensure the availability of flexible and competitively priced funding from a number of sources to meet the Trust’s current and future requirements.
Interest rate management: Maintain an interest rate structure which minimises out the impact on its income and expenditure of volatility in interest rates.
Foreign currency management: Reduce the Trust’s exposure to exchange rate movement risk by covering known foreign exchange exposures.
Bank relationships: Develop and maintain strong, long-term relationships with a core group of quality banks that can meet current and future funding requirements.
Monitor Compliance: To ensure that the Trust complies with all mandatory regulations issued by the Independent Regulator.
3. Investment Monitoring
Monitor strongly recommends that each Trust set up an Investment Committee.
The Audit Committee will monitor the Trust's performance against investments which will be managed under this policy on behalf of the Board.
4. Attitude to risk and risk management strategy in key treasury activities
4.1 Funding
The principal role of the treasury function is to ensure liquidity, to mitigate and manage risk, to ensure a competitive return on cash balances and to manage total costs of funds, including interest paid on funds borrowed.
D10164 3 The Trust will maintain a risk-averse approach to funding, recognising the on- going requirement to have committed funds in place to cover both existing business cash flows and reasonable headroom for missed payments by major debtors (e.g. Commissioners) seasonal debt fluctuations, capital expenditure programmes and acquisition financing. The Trust will not allow its authorised assets to be used for secured lines of credit.
It is not appropriate to arrange long-term specific debt without a specific need, i.e. the Trust should not pre-finance in anticipation of potential future acquisitions.
Under no circumstances should money be borrowed for speculative investment.
4.2 Investments
The Trust maintains a risk-averse stance to investing surplus cash balances and forbids speculative trading/investment. In line with Monitor guidance all investments will be made within safe harbour provisions, within defined limits and with certain ‘permitted institutions’ considered low risk.
Essentially all cash balances will remain in a comparatively liquid form and generally cash balances (and investments resulting from them) directly under the control of Trust will be realisable and have maturity not exceeding three months.
4.3 Foreign Exchange
The Trust’s primary operating currency is sterling and it is the policy of the trust not incurs significant exposures to foreign currency fluctuations. However, The Trust‘s current approach is not to cover any foreign exchange risk. This is due to the low value and volume of the Trust’s foreign exchange exposure. This approach will be re-evaluated if foreign trading becomes more significant.
4.4 Interest Rate Exposure
The Trust maintains a risk-averse stance to interest rate exposure and will maintain an interest rate structure that minimises its exposure to volatility in interest movements and optimizes the use of interest rates within the risk framework.
4.5 Banking
The Trust will reduce Funding Risks to a minimum by observing and monitoring adherence to any covenants and through the development and maintenance of sound long term relationships with banking partners. This should drive a high degree of confidence and commitment between the parties so that banks would be prepared to enter into arrangements to meet funding requirements at crucial times and at short notice.
D10164 4 5. Risk Management
To ensure that the Trust undertakes treasury activities in a controlled and properly reported manner defined within this document, there are a number of overall high-level controls that will be established and maintained. These include: the documentation of treasury management policies and processes the documentation of clearly defined roles and responsibilities in treasury management activities for the Board of Directors, the Director of Resources, the Treasury function and the Finance Department the documentation of strict limits on the types of investments used and the circumstances in which they can be used the documentation of restricted procedures used to authorise long-term borrowing.
Additionally the following high-level controls have been established: segregation of duties between those who handle, those who initiate payment and those who account for treasury activities inclusion of treasury management activities within the scope of review by internal audit and external audit regular reporting of treasury activities. Monitoring and review of the Policy by Audit Committee.
6. Cash Holding and Investment of Surplus operating Cash
General principles: Investments will only be made with surplus funds; Investments will be used to maximise returns; Investments will be at minimal risk.
6.1 Current Accounts
The Trust will manage cash through a central current account. Use of local facilities will be minimised. Again this account will be managed to maximise interest received subject to the over-riding objective of minimising credit risk and minimise charges and interest paid. Current Accounts will be tested to ensure best value. Currently the Trust operates this facility through the OPG (Office of the Paymaster General).
6.2 Investment Accounts
The use of investment accounts will be made to optimise returns in accordance with the activities outlined:
6.2.1 Identification of Surplus Funds
D10164 5 The Finance Department will identify surplus cash balances by monitoring the following: cash reports prepared daily showing receipts and payments on that day. short-term in month cash flow reports prepared by the Finance Department; and longer term month by month cash flow reports for the year ahead prepared by the Finance department.
The Finance department prepares the longer term cash flows using a system that, with appropriate precision: predicts longer term receipts and payments in accordance with the Trust’s plans; captures short-term receipt and payment data periodically but without significant delay; and keeps the forecast constantly updated.
6.2.2 Investment of Surplus Funds
The Treasury function must obtain due authorisation of any proposed investment (or proposal to roll over an investment) in accordance with the following limits
Investment Value Less than £1m £1m to £5m Over £5m Investment Period Overnight Head of Financial Head of Financial Associate Director Accounts Accounts of Finance
2 days to 1 week Head of Financial Head of Financial Associate Director Accounts Accounts of Finance
1 week to 1 month Head of Financial Associate Director Associate Director Accounts of Finance of Finance
1 month to 3 months Head of Financial Associate Director Director of Accounts of Finance Resources
The Treasury function will also obtain such authorisation as is required by the relevant bank mandate or authorised signatory schedule. The Treasury function will also maintain records of all transactions and bank mandates.
6.2.3 Permitted Institutions
The Trust should adopt the following institutions and accounts that meet monitors ‘safe harbour’ criteria. Safe harbour means that the Trust board does not need to undertake an individual investment review for these investments.
Permitted Institution as adopted by NEPFT Key Use / Purpose Current Account – Office of the Paymaster General Direct credit and receipts from all OPG bodies and specific payments re NHS
D10164 6 transaction. The majority of day to day payments. National Loans Fund Sterling Investment Account ) Shorter and longer term deposits [Bank**] Sterling Investment account Shorter and longer term deposits OPG Euro account Receipt and Payment of significant items denominated in euros
6.2.4 Safe Harbour Criteria
• Institutions that have been granted permission, or any European institution that has been granted a passport, by the Financial Services Authority to do business with UK institutions, provided it has an investment grade credit short -term rating of p-1 (Moody rating) and long-term rating A1(Moody rating). In accordance with Monitor guidance.
• The UK government, or an executive agency of the UK government, that is legally and constitutionally part of any department of the UK Government, including the UK Debt Management Agency Deposit Facility.
Investments that do not fulfil the criteria for safe harbour are higher risk investments and include bonds, equities, commodities and derivative products such as futures.
The Trust will obtain credit ratings from two agencies- Standard and Poors, Moody’s or Fitch. The ratings used are based on Moody’s rating system.
6.2.5 Banks
A list of permitted banks will be maintained by the Head of Financial Accounts. Additions and removals can only be authorised by the Audit Committee
The proposed Initial List: (October 2010) comprises the main high street banks and will be expanded as Treasury Management experience is developed within the Finance Department.
Barclays Bank PLC HSBC Bank PLC RBS / National Westminster Bank PLC Lloyds TSB PLC
Clearing banks have a limit of £15 million.
Limits based on Moody’s Ratings are as follows; Banks rated Aaa have a limit of £10 million. Banks rated Aa1 have a limit of £5 million. Banks rated Aa2 and Aa3 have a limit of £3 million. Banks rated A1 have a limit of £2 million. Banks rated A2 and A3 have a limit of £1 million.
D10164 7 Banks rated below this have NIL limits
The Associate Director of Finance will manage all necessary relationships with banks and other financial institutions and ensure all covenants are kept.
6.2.6 Concentration Limits
Cash deposits will only be placed with permitted institutions, in line with the deposit limits agreed by the Trust Board, as recommended by Audit Committee and based on Moody’s credit ratings. Surpluses above £500,000 will be spread across a number of institutions as detailed below, in order to spread the investment risk :
Minimum £ Maximum £ Number of Institutions
£ 500,001 £10,000,000 At least 2
£10,000,001 £15,000,000 At least 3
£15,000,001 £20,000,000 At least 4
For amounts in excess of £20million, one additional institution is required for every additional £5million of investment.
6.3 Borrowing
The Trust recognises in principle the ongoing need for committed funds in place to cover existing business cash flows and to provide reasonable headroom for seasonal cash flow fluctuations, capital expenditure programmes and acquisition financing; General principles: Borrowings must only be used to manage liquidity and never to fund cash investments for returns. Borrowings should minimise costs and risks. Borrowings and their maturity profiles must be affordable. All borrowing facilities will be agreed by Audit Committee. The Trust will not allow its authorised assets to be used for secured loans.
Borrowing is divided into short-term and long-term All long-term borrowing must be consistent with the plans outlined in the current annual plan and in line with the Prudential Borrowing Limit. All short-term borrowings should be kept to the minimum period of time possible, consistent with the overall cash flow position. Any short-term borrowing requirement in excess of one month must be authorised by the Director of Resources.
The use of funding will be made to optimise funding costs and minimise liquidity, security and credit risks. The following borrowing principles apply:
D10164 8 As far as possible, the Trust will make use of existing business cash-flows to provide the headroom required. Short-term funding will be by way of the established Working Capital Facility. The Trust will annually review its requirement for a working capital facility and any application for an overdraft facility. Any short term borrowing may only be made with the authority of two of those Officers approved under standing financial instructions, one of whom must be the Chief Executive of the Director of Resources. Long-term funding will require the specific approval from the Board of Directors.
Any application for an overdraft facility or for additional borrowing will be made by the Director of Resources subject to the Trust’s policies and procedures that comply with the instructions issued by the independent regulator.
The Board must be advised of any financial and non financial covenants or actual or potential lien on Trust assets, arising from Borrowings. Any such covenants being reported to the Board as part of the Monthly Finance Report.
D10164 9
Agenda item No: 15a
Name of Meeting: Meeting of the Board of Directors in Public
Date: 24 November 2010
Title of Report: Audit Committee Chairman’s Report to the Board
Presented By: Ray Cox, Non Executive Director
Subject, Purpose and Recommendation:
The Board of Directors is asked to receive and note the Audit Committee Chairman’s Report to the Board.
Finance Implications: N/A
Clinical Implications: N/A
HR Implications: N/A
Legal Implications: N/A
Equality Implications: N/A
Risks: N/A
North Essex Partnership HHS Foundation Trust
Audit Committee Chairman’s Report to the Board ‐ Review of Activity for the year 2010/11
1. Introduction
This is the second report I have presented to the board. The first report was considered and approved by the board their meeting dated 25 August, and I have included in paragraph 2, a brief summary of its content. Since the 25 August there has been one meeting of the committee and I have included in paragraph 3, a summary of the main issues dealt with.
2. Summary of First report.
2.1 The introduction included details of the core functions of the committee and an outline of the main skills of the non executive members of the committee.
2.2 Paragraph 2 of the report contained details of the work carried out by the committee up until the 8 July. This included:
The Annual Report and Accounts 2009/10, which received an unqualified audit report, and was adopted by the board on the 26th May.
Internal Audit Planned Audits progress report, which was proceeding well, although it was reported that there was some concern by the committee over the number of recommendations that had passed their deadline for implementation.
Local Counter Fraud Service progress report, which included a three year strategy 2010/11 to 2012/13. The information included in the report represented a significant improvement in the quality of counter fraud activity.
Whistle‐Blowing Policy, which was agreed, with periodic update reports to the committee.
Other matters included, reappointment of external auditors, Trust Assurance Framework, self assessment.
2.3 Paragraph 3 of the report set out details of the matters to be dealt with during the remainder of the year.
3. Summary of matters dealt with since the first report.
3.1 External Audit
The main item discussed related to the external assurance on the Quality Report 2009/10. The year in question was a ‘dry run’ in preparation of the formal introduction of Quality Accounts. The review by the auditors centred around the following criteria: Governance and Leadership; Policies; Systems and Processes; People and Skills; and Data Use and Reporting.
Recommendations were included and an action plan agreed for their implementation. It was clear to the committee that if the Quality Report is to be externally reported for 2010/11 (rather than a dry run again), then along with many Trusts, and because of the timing of the recommendations and the action plan (particularly around data quality issues), individual indicators will not be in place for the major part of 2010/11, and therefore it is possible the Trust may receive a qualified report from the auditors. In view of the urgency around this matter, steps would be taken by management to raise the priority of data quality by all concerned. In addition the committee would be drawing the attention of the board to this matter, when presenting the minutes.
The Annual Audit letter for 2009/10 was received by the committee, which represented a very positive outcome to what has been a very encouraging audit.
3.2 Internal Audit
Reports were received on:
Progress on 2010/11 audits; good progress was being made.
Quality Plan 2010/11, which set out internal audit standards of service. This was discussed in some detail and suggested changes were agreed.
Follow up of previous audit recommendations. This was the subject of a lengthy discussion regarding lack of progress in completing the implementation of recommendations, and the residual risk particularly for priority 1 recommendations. The Director of Resources agreed a series of very firm actions that would be taken immediately, including the involvement of EMT and R&GE, which he was confident would achieve and sustain a significant improvement in the situation. Audit Committee will of course be monitoring the situation carefully.
Four new Internal Audit reports.
Charitable Funds – substantial assurance.
Care Programme Approach – limited assurance, including 2 priority 1 recommendations.
Business Continuity Planning – substantial assurance.
IT PC Controls – limited assurance, including 1 priority 1 recommendation.
All recommendations will be followed up by the committee.
3.3 Local Counter Fraud Service
Reports were received on:
Progress Report 2010/11. Very good progress was reported, which continued the excellent improvement in the impact of counter fraud activity.
Review of Tender Processes. This report included a number of recommendations and an agreed action plan, but importantly confirmed that no evidence had been found that tenders had been inappropriately contracted. The committee will be monitoring the implementation of the recommendations.
3.4 Draft Treasury Management Policy. This draft policy was discussed in detail and the following changes were agreed with the Director of Resources and the auditors:
The Audit Committee to monitor performance rather than an Investment Committee. One set of rating agency criteria was insufficient, so two or three should be included.
It was agreed to recommend the Policy for approval, and Audit Committee Terms of Reference to be amended accordingly.
3.5 Other Matters
Update on Risk & Governance Executive, including the minutes of July and August 2010, and preparations for a joint meeting of Audit and R&GE.
Update on Poppie computer system. This is a national product and therefore some of the outstanding control recommendations could not be implemented. Therefore management should consider the extent to which the system could be accepted, and a progress report back to the committee was requested.
Charitable Funds Accounts 2009/10. The committee reviewed the accounts and supporting statements , and subject to some minor changes they were recommended for approval.
It was agreed that the final draft of the Policy for the Safeguarding of Patients’ Belongings would be circulated to the committee for approval.
4. Looking forward to the rest of the year
The final meeting of the year is scheduled for the 13 January 2011, and the following important matters are still to be dealt with.
Joint meeting with R&GE
Internal Audit plan 2011/14
Internal Audit current year reports
Counter Fraud current year reports
Whistle Blowing Review
The board is asked to receive and note the report.
Ray Cox, Audit Committee Chairman.
6 November 2010.
Agenda item No: 15b
Name of Meeting: Meeting of the Board of Directors in Public
Date: 24 November 2010
Title of Report: Audit Committee Terms of Reference
Presented By: Ray Cox, Non Executive Director
Subject, Purpose and Recommendation:
The Board of Directors is asked to approve the revised terms of reference for the Audit Committee.
Finance Implications: N/A
Clinical Implications: N/A
HR Implications: N/A
Legal Implications: N/A
Equality Implications: N/A
Risks: N/A
NORTH ESSEX PARTNERSHIP NHS FOUNDATION TRUST
AUDIT COMMITTEE OF THE BOARD OF DIRECTORS
TERMS OF REFERENCE
1. CONSTITUTION
The Board of Directors of the Trust (‘the Board’) has resolved to establish a committee of the Board to be known as the Audit Committee ( ‘the Committee’) which shall have the following terms of reference but no executive powers save as specifically delegated to it by these terms of reference.
2. MEMBERSHIP
The Committee shall be appointed by the Board from amongst the non-executive directors of the Trust. Its membership shall consist of not less than three independent non-executive directors and one of the members shall have recent and relevant financial experience. A quorum shall be two members. The Board will appoint one of the members Chair of the Committee. The Chairman of the Trust shall not be a member of the Committee.
3. ATTENDANCE
The following persons shall attend meetings of the Committee:
The Director of Resources or his or her deputy, and
appropriate Internal Audit, the Local Counter Fraud Specialist (LCFS) and External Audit representatives
any executive director or officer of the Trust asked by the Committee to attend, particularly when the Committee is discussing areas of risk or operation that are the responsibility of that director or officer
the Chief Executive when requested, to discuss the internal audit plan, the process for assurance that supports the Statement of Internal Control and the annual Financial Statements when presented
the Trust Secretary to provide appropriate support to the Committee.
4. FREQUENCY OF MEETINGS
Meetings shall be held not less than four times a year. The External Auditor or Head of Internal Audit may request the Chair of the Committee to call a meeting if they consider that one is necessary. The Chair of the Committee or any two members of the Committee may also call a meeting at any time. Committee members shall also meet once a year with no other person present.
ToRs – October 2010 (D10163)
5. AUTHORITY
The Committee is authorised by the Board to investigate any activity within its terms of reference. It is authorised to seek any information it requires from any employee of the Trust or from any provider of goods or services to the Trust and all employees of the Trust are directed to co-operate with any request made by the Committee. The Committee is authorised by the Board to obtain outside legal or other independent professional advice and to secure the attendance of outsiders with relevant experience and expertise if it considers this necessary.
6. DUTIES OF THE COMMITTEE
6.1 Governance, risk management and internal control
The Committee shall ensure that the Trust establishes and maintains effective systems of integrated governance, risk management and internal control, across the whole of the organisation’s activities (both clinical and non-clinical) that support the achievement of the organisation’s objectives, and shall bring to the attention of the Chief Executive any concern which it may have regarding those systems.
In particular, the Committee will satisfy itself as to:
the adequacy and efficiency of the Trust’s internal financial controls
the appropriateness of all risk and control related disclosure statements and declarations of compliance (in particular the Statement on Internal Control), together with any accompanying Head of Internal Audit statement, External Audit opinion or other appropriate independent assurances, prior to endorsement by the Board
the adequacy and efficiency of the underlying assurance processes that indicate the degree of the achievement of corporate objectives, the effectiveness of the management of principal risks and the appropriateness of the above disclosure statements
the adequacy and efficiency of the underlying assurance processes supporting the preparation and issue of the Trust’s Quality Accounts
the adequacy and efficiency of the policies for ensuring compliance with relevant regulatory, legal and code of conduct requirements
the adequacy and efficiency of the policies and procedures for all work related to fraud and corruption as set out in Secretary of State Directions and as required by the Local Counter Fraud Service
the arrangements by which staff of the Trust may, in confidence, raise concerns about possible improprieties in matters of financial reporting and control, clinical quality, patient safety or other matters, the objective being to ensure that arrangements are in place for the proportionate and independent investigation of such matters and for appropriate follow-up action
D10163 (October 2010) 2 In carrying out this work the Committee will:
ensure that an effective Assurance Framework has been established to guide its work and that of the audit and assurance functions that report to it.
utilise the work of Internal Audit, External Audit and other assurance functions, but will not be limited to these audit functions
seek reports and assurances from directors and managers as appropriate, concentrating on the over-arching systems of integrated governance, internal financial control, risk management and other internal controls, together with indicators of their effectiveness.
6.2 Internal Audit
The Committee shall ensure that there is an effective internal audit function established by management that meets the requirements of the DoH Internal Audit Standards for the NHS and provides appropriate independent assurance to the Committee, the Chief Executive and the Board. This will be achieved by:
considering the effectiveness of the internal audit service, and the cost of the audit, including any question of resignation or dismissal;
considering and approving the internal audit strategy, operational plan and more detailed program of work, ensuring that this is consistent with the audit needs of the organization as identified in the Assurance Framework
considering the major findings of internal audit work and management’s responses
ensuring co-ordination between the Internal and External Auditors to optimise audit resources
ensuring that the Internal Audit function is adequately resourced and has appropriate standing within the organisation
undertaking a market-testing exercise for the appointment of an Internal Auditor at least once every five years
the holding of a private meeting with the Head of Internal Audit at least once a year.
6.3 External Audit
The Committee shall:
discuss and agree with the External Auditor, before the audit commences, the nature and scope of the audit as set out in the proposed Annual Plan, and ensure coordination, as appropriate, with other external auditors in the local health economy;
D10163 (October 2010) 3 discuss with the External Auditors their local evaluation of audit risks and assessment of the Trust and the associated impact on the audit fee
review all External Audit reports, the Annual Governance report and the Auditor’s report on the Financial Statements before submission to the Board and any work outside the annual audit plan, together with the appropriateness of management responses
assess the External Auditor’s work and fees on an annual basis to ensure that the work is of sufficiently high standard and that the fees are reasonable
make recommendations to the Council of Governors, in relation to the appointment, re-appointment or removal of the External Auditor, and approve the remuneration and terms of engagement of the External Auditor
review and monitor the External Auditor’s independence and objectivity and the effectiveness of the audit process, taking into consideration relevant UK professional and regulatory requirements
in considering the engagement of the External Auditor to supply non-audit services, take into account relevant ethical guidance regarding the provision of non-audit services by the external audit firm in accordance with the Monitor’s Audit Code for NHS Foundation Trusts which requires the prior approval of the Council of Governors
hold a private meeting with the External Auditor at least once a year
6.4 Other Assurance Functions
The Committee shall review the findings of other significant assurance functions, both internal and external to the organisation, and consider the implications to the governance of the organisation.
These will include, but will not be limited to:
any reviews by Department of Health arms length bodies regulators inspectors or professional bodies with responsibility for performance
the work of other groups teams or committees within the organisation, whose work can provide relevant assurance to the Committee’s own scope of work, particularly in the fields of clinical governance (including clinical audit) and risk management.
the Committee shall be responsible for the monitoring compliance with the Trust’s Treasury Management Policy and the performance of the Trust’s treasury management activities. The Committee will approve the Treasury Management Policy and any subsequent changes to the Treasury Management Policy.
D10163 (October 2010) 4 6.5 Financial Reporting
The Committee shall satisfy itself as to the integrity of the financial statements of the Trust and any formal announcement relating to the Trust’s financial performance including any significant financial reporting judgments contained in them.
The Committee shall also ensure that the systems for financial reporting to the Board, including those of budgetary control, are sound and effective and provide appropriate and accurate information to the Board.
The Committee shall review the Annual Report and Financial Statements before submission to the Board, focusing particularly on:
the wording in the Statement on Internal Control and other disclosures relevant to the Terms of Reference of the Committee changes in, and compliance with, accounting policies and practices unadjusted mis-statements in the financial statements major judgemental areas, and significant adjustments resulting from the audit.
the Letter of Representation.
7. REPORTING
The minutes of Committee meetings shall be formally recorded by the Trust Secretary and submitted to the Board. The Chair of the Committee shall draw the Board’s attention to issues that the Committee feel require disclosure to the full Board, or executive action.
The Committee will report to the Board annually on its work in support of the Statement on Internal Control, specifically commenting on the fitness for purpose of the Assurance Framework, the completeness and embeddedness of risk management in the organisation, the integration of governance arrangements and the appropriateness of all declarations of compliance.
The Committee will, when appropriate issues arise, make a report to the Council of Governors, identifying any matters in respect of which it considers that action or improvement is needed and making recommendations as to the steps to be taken.
The Committee shall also report to the Council of Governors in relation to the performance of the External Auditor including detail of the quality and value of their work, the timeliness of reporting and their fees, to enable the Council to consider whether or not to reappoint them.
The Terms of Reference of the Committee, including its role and the authority delegated to it by the Board and by the Council of Governors, shall be publicly available and a separate section of the annual report shall describe the work of the Committee in discharging these responsibilities.
D10163 (October 2010) 5 8. ANNUAL REVIEW AND SELF ASSESSMENT
These Terms of Reference shall be reviewed annually by the Committee and the Board. The Audit Committee will also conduct an annual self assessment of its own performance and effectiveness.1
1 These Terms of Reference are based on the recommendations contained in the NHS Audit Committee Handbook published by the Healthcare Financial Management Association (HFMA) for the Department of Health, and the NHS Foundation Trust Code of Governance published by the Independent Regulator.
D10163 (October 2010) 6
Agenda item No: 16
Name of Meeting: Meeting of the Board of Directors in Public
Date: 24 November 2010
Title of Report: Nominations Committee Report for the Year to Date
Presented By: Mary St Aubyn Chairman
Subject, Purpose and Recommendation: The Board of Directors is asked to receive the report for information.
Finance Implications: N/A
Clinical Implications: N/A
HR Implications: The Nominations Committee of the Board of Directors has a range of duties in relation to the Board of Directors including keeping the size structure and composition of the Board of Directors under regular review, and preparing role descriptions and person specifications for each of the executive and non executive directors to reflect the balance of skills, knowledge and experience required by the Board.
Legal Implications: The Committee has regard for the Code of Governance for NHS Foundation Trusts issued by Monitor.
Equality Implications: The Committee is advised by the Director of Workforce and Development regarding current best practice.
Risks: The key risk is of the Committee failing to make appropriate recommendations to the Chairman of the Trust regarding executive director position and to the Remuneration and Appointments Committee of the Council of Governors in respect of the Non executive Directors
1) Background The Nominations Committee consists of: Mary St Aubyn, Chairman John Gilbert, Non Executive Director Sarah Phillips, Non Executive Director Ray Cox, Non Executive Director Mark Simpson, Non Executive Director.
2) Meeting As reported to the meeting of the Board of Directors in public on 25 August 2010, The Nominations Committee has met on one occasion to date in 2010/11, on 07 July 2010, with a second meeting planned for 24 November 2010.
The meeting was convened to consider the appointment of a non-executive director in view of the expiry of the term of office of Charles Abel Smith on the 6 October 2010.
The Nominations Committee unanimously supported the appointment of Charles Abel Smith for a further 3 year term commencing on 06 October 2010. This issue was subsequently considered by the Remuneration and Appointments Committee of the Council of Governors (RAC) at their meeting held on 07 July 2010. The recommendation received unanimous support and was taken to the meeting of the Council of Governors held on 05 October 2010 where Charles Abel Smith’s reappointment was made with strong support.
The Nominations Committee considered the end dates of the current terms of office of a number of non executive directors and asked the Trust’s legal adviser to formulate a timetable of key milestones in relation to these. This has been drafted and shared with the Remuneration and Appointments Committee (RAC) of the Council of Governors at their meeting held on 28 October 2010. The next non executive director appointment to expire is that of John Gilbert, on 31 May 2011. John Gilbert has written to the Trust Chairman confirming that he would like to be reappointed to the role of non executive director for a further period of 3 years. The members of the RAC have been invited to make suggestions with regard to the job description for this role, and their views will be considered by the Nominations Committee at its next meeting on 24 November 2010. The timetable for the associated process is being conducted so that a decision regarding this appointment can be brought to the meeting of the Council of Governors to be held on 15 March 2011.
North Essex Partnership NHS Foundation Trust
Risk and Governance Executive Report (August – October 2010)
The group has met four times in this period, twice in October The group divides its agenda into three parts:
Assurance and Feedback Quality and Audit Policy approval
Assurance and Feedback
The group now regularly receive exception reports on professional registration for all disciplines to an agreed template. This was a recommendation of an internal audit and is now routine agenda item for the group.
The group has reviewed and rescored and ranked the Trust wide risk register and this has already been submitted to the Board.
The group receives quarterly analysis and learning for complaints and Serious incidents as well as a monthly monitoring. These reports examine compliance with the process as well as themes and potential clusters. The group will be receiving the aggregated action plan to monitor implementation not just in the team area but to ensure that Trust wide initiatives can be taken.
The group have received the following annual reports
Claims Risk Management Health and Safety Physical Healthcare CPA steering group Medicines Management NICE guidance Local Security Management service Mandatory and Statutory Training report
These reports were accepted and action plans to address any limited assurance issues. CPA was also audited through internal audit and this report was also examined by RGE – there had been good progress on the recommendation from this report in this financial year but only limited assurance was agreed for the preceding year but the progress was acknowledged.
Claims management was also subject to an internal audit where substantial assurance was achieved. The increased activity in this area is being closely monitored.
Page 1 of 3
Physical Healthcare report highlighted some good initiatives however the training activity was limited due to available resources. The issue of training in this area was taken forward in the wider debate around mandatory training in the Trust.
The mandatory and statutory training was discussed a new prospectus was now in place and the training needs analysis and action plans were accepted by RGE however there was an action plan to address deficits around standardised recording and analysis of training across the Trust due to the activity being co-ordinated by different department. A separate workstream was commissioned to review training in the organisation and from January all training to be recorded through Organisation learning module (part of the Electronic staff record system).
Medicines Management annual report and the Deloitte audit were discussed in detail and significant progress was acknowledged in this area in relation to the development of the in house pharmacy. Training in medicines management was also separated out to be part of the training workstream mentioned above.
Quality and Audit
The group also received the audit results of the care audit which covered a number of clinical policies relevant to inpatient care. There is an agreed action plan as a result of the audit and plans to initiate more specific audits in this area such as Rapid Tranquillisation and observations.
Patient safety dashboard is received on a monthly basis and this is integrated into the quality accounts report at the end of the year. Falls prevention and level of violence continue to the closely monitored. This will be covered in more detail as part of the Quality accounts progress report.
The group have also received the action plans for the Essex safeguarding children board – serious case review action plan.
The group received and analysed the Quality and risk profile issued by the CQC and identified information sources and an appropriate action plan to address issues raised. The group continue to monitor the CQC evidence for registration and they will have a formal presentation on this in January.
Regular monitoring has now been established for Corporate induction, local induction and induction of temporary workers. This will be quarterly and there will be a requirement of the reports to include assurance around the follow up for non attendance/ non compliance mechanisms in this area.
Page 2 of 3 Policy approval
The group receive a monthly monitoring of policy review to ensure appropriate reviews take place. All policies are required to be approved by RGE/EMT in line with Trust policy. The group has approved 16 policies during this period. This includes the first initial version of the new mother and baby unit operational policy.
The framework for information governance which is a key requirement for the information governance toolkit compliance was also approved.
A new policy was approved for audit.
Page 3 of 3
Agenda item No: 18
Name of Meeting: Meeting of the Board of Directors in Public
Date: 24 November 2010
Title of Report: Council of Governors - Draft Minutes of the Meeting held on 05 October 2010 and Feedback
Presented By: Mary St Aubyn, Chairman
Subject, Purpose and Recommendation: The Board is asked to receive the draft minutes of the Council of Governors meeting held on 05 October 2010 and give feedback.
Finance Implications: N/A
Clinical Implications: N/A
HR Implications: N/A
Legal Implications: N/A
Equality Implications: N/A
Risks: N/A
Agenda item No: 19
Name of Meeting: Meeting of the Board of Directors in Public
Date: 24 November 2010
Title of Report: Review of Mental Health Employment Strategy (2008 – 2011)
Presented By: Geoff Scott, Director of Strategy
Subject, Purpose and Recommendation:
The board is recommended to receive and note the report on progress being made on implementation of the trust Employment Strategy including the current action plan.
The trust introduced its employment strategy in May 2008 and appointed its current Vocational Services manager in July 2009. The strategy has three key objectives: Enabling and increasing the number of people using secondary mental health services (subject to CPA) who move into paid employment, education and voluntary work by ensuring the implementation of the evidence based Individual Placement and Support (IPS) model of supported employment Maintaining exemplary practice as a Trust, promoting the employment of people with mental health problems within NEPFT and our partner public sector organisations and across the full range of local employers Supporting social enterprise initiatives, through partnership working with third sector organisations and other enterprise and development agencies.
Progress has included the following: Excellent progress being made on employment, education, and voluntary work outcomes for individual service users on CPA The trust leading by example by signing up as a ‘Mindful Employer’ and being a key player in local and regional networks The Trust aspiring to being an ‘Exemplar Employer’ and in positively promoting and encouraging the employment of people who have a history of mental health problems, reviewing its support for staff Achievement with Essex partners of accreditation by the Centre for Mental Health as one of only four national Centres of Excellence for vocational support Strong partnerships with social enterprises being developed across north Essex and engagement with the Essex Mental Health, Work and Wellbeing Network’, which is facilitated by PCT and ECC commissioners
Finance Implications: The trust employs a full time vocational service manager. Vocational advisers in community teams are funded by commissioners through separate contracts with a range of providers. The provision of effective support to staff experiencing mental ill health is important both in terms of personal wellbeing but also in reducing sickness absence.
Clinical Implications: Meaningful occupation/ work are good for physical and mental health and can provide a sense of purpose, identity and structure that promotes wellbeing. Identifying vocational aspirations is an important part of the assessment/ care planning process as part of the Care Programme Approach (CPA) and vocational advisers are located within community teams
HR Implications: The trust aspires to be an exemplar employer. The trust employs a Vocational Services Manager to provide leadership to the employment strategy. Vocational advisers are employed by partner organisations.
Legal Implications: Implementation supports compliance with the Health & Safety at Work Act 1974, the Disability and Discrimination Act 2005 and the Work & Families Act 2006
Equality Implications: The employment strategy seeks to improve equality of access to meaningful occupation/ employment for people who have experienced serious mental ill-health, and to help tackle discrimination.
Risks: The provision of vocational advisers into community mental health teams follows an employment services review by commissioners and the award in 2008 of contracts for three years. In the absence of continuation of these contracts there would be insufficient skills and capacity within teams to successfully achieve vocational outcomes. The trust maintains regular dialogue with commissioners, maintaining profile and ensuring strong performance management against expectations and targets
Page 2 of 2
Review of Mental Health Employment Strategy (2008 – 2011)
September 2010
Mental Health Employment Strategy Review Sept 2010 1 North Essex Partnership NHS Foundation Trust
Review of Mental Health Employment Strategy (2008-2011)
1. Introduction
1.1 The Social Exclusion Unit report from 20041 highlighted that people with mental health conditions are one of the most excluded groups in society. It is recognised that people with mental health problems experience stigma and discrimination to either secure or retain employment2. Only 24% of people with mental health problems are in employment compared with 65% of people with physical health problems; 90% of those with continuing mental health problems (not in employment) wish to return to work3.
1.2 It is widely acknowledged that support to access or retain employment can be part of the recovery process from mental ill health4. In light of the aforementioned research findings and in order to ensure consistent, evidence based employment support is available across North Essex for people experiencing severe and enduring mental health problems, North Essex Partnership NHS Foundation Trust (NEPFT) introduced its Mental Health Employment Strategy, in May 2008. An update on the strategy was provided at the Meeting of the Board of Directors in Public in November 2009 and there was a further update in April 2010.
This full review will offer:
A brief summary of the strategy Achievements – against key actions Service outcomes 2009/10 and additional achievements Key actions for the future
2. A brief summary of the strategy
A number of key principles underpinned the strategy, including:
Social inclusion Wider community participation User involvement Responsibility Equity of service Multi Agency partnership
Mental Health Employment Strategy Review Sept 2010 2
2.1 The strategy reviewed government policies, guidance and reports which indicated that there were a lot of positive initiatives that have been undertaken to help people experiencing mental health conditions to find and sustain work. The strategy was informed by the recommendations from the following reports, guidance and policies: National Service Framework for Mental Health, Vocational Services for people with mental health problems, Mental Health and Employment5; Social Exclusion Unit Report1 and Pathways to Work6.
2.2 The strategy also considered up to date and local evidence, namely that employment is a realistic, obtainable goal for many people who experience mental health problems. Secker et al3 carried out a survey in North Essex which indicated 65 to 90% of service users on enhanced CPA want to work, providing the barriers they face are addressed and their support needs are met.
There was strong evidence in favour of implementing the evidence based Individual Placement Support (IPS) model of service delivery4.
2.3 The strategy acknowledged the role of public services as ‘exemplar employers’ of people with mental health problems, which was considered to be specifically important with regard to the fact that the Trust was a provider of mental health services.
2.4 The vision within the strategy was stated as ‘to develop evidence based, comprehensive, effective employment support services for people with mental health problems across North Essex’.
The aims and objectives of the strategy were detailed in depth. The overall aim was summarised as ‘to promote recovery, social inclusion and wellbeing’. Trust level, service level and practitioner level objectives were also outlined.
Page 4 (below) outlines the service pathway and key relationships.
2.5 It was proposed within the strategy a number of ‘outcomes’ to be monitored including:
number of people being supported into open / paid employment number of people being supported into mainstream education / training number of people being supported into ‘supported employment’ number of people being supported to volunteer
Outcomes are monitored on a monthly basis and relevant information is provided to the Mental Health Joint Commissioning Team.
Monitoring outcomes in this way allows for difficulties and challenges to be addressed as they arise.
Mental Health Employment Strategy Review Sept 2010 3 Client
Vocational CMHT Mental Health Services Manager Joint Commissioning Team Service Providers Employment Specialists Social Enterprise
Short term (6-10 Weeks) Mainstream Social Enterprise/firms Voluntary work Open (paid) Programmes education/ Work experience Employment. training Time limited work Confidence/self esteem experience placements/ Work with On-going support building Colleges Permitted work. Employers Links to mainstream Training On-going opportunities for Job Retention education/training providers those not able to go into open employment. Maximising external funding Work with Income generation opportunities Employers Training (NVQ) placements Links to CMP Links to Day Services Links with local employers Training for local employers
Mental Health Employment Strategy Review Sept 2010 4 3. Achievements - against key actions
Supported employment services have been embedded well into existing structures and there has been excellent progress to date.
All key actions from the action plan of the strategy have been completed. This review will now address specific major points from the sections of the action plan.
Exemplar Employer
3.1 Relevant legislation, government guidance and commissioning guidance continue to inform service developments7.
3.2 HR and Occupational Health Departments work together via the Trust Exemplar Employer group, ensuring employment opportunities for people who have experienced mental health problems are available and that the process of recruitment is fair and supportive.
A ‘charter / statement’ (re employing people with mental health needs) is included in all job advertisements.
3.3 A network of ‘health and well being champions’ is being developed as part of the ‘staff health and well being strategy’.
3.4 Ongoing work as part of the ‘Mindful Employer’ initiative demonstrates the Trust has a positive attitude to employing people who have mental health needs.
Develop Employment Services across North Essex
3.5 Supported employment services, with Individual Placement Support model of service delivery as the preferred option, are fully operational across North Essex.
3.6 Service providers have been fully supported to establish employment support services across North Essex with Employment Specialists accommodated across all CMHTs.
3.7 There is ongoing work with local employers to support and promote the employment of people with mental health needs; directly by Employment Specialists and via the Mindful Employer Network.
Mental Health Employment Strategy Review Sept 2010 5 4. Service outcomes 2009 / 10 and additional achievements
4.1 Following CPA assessment, care planning and referral to Employment Specialists in CMHTs, the Employment, Education and Voluntary work outcomes for the year 2009 / 10 are detailed in the table below, against LAA total targets. There are 2 sets of targets that service providers aspire to meet. The targets in this table are previous Local Area Agreement (LAA) targets; there are also commissioning strategy targets which are for there to be a minimum of 50 outcomes in each area, i.e., for there to be at least 50 people in each area to have been supported into employment, education and / or voluntary work. The targets for the west and north east of the county are higher than mid as there are additional ‘supported volunteering’ opportunities in those areas – west (20) and north east (40).
Area 09/10 1st 2nd 3rd 4th Total Target Quarter Quarter Quarter Quarter N East 76 21 20 14 21 76 Mid 40 22 28 11 9 70 West 55 26 44 16 17 103 Total 171 69 92 41 47 249
The year end figures highlight both commissioning strategy and LAA targets have been met / exceeded.
4.2 It is noted that the 3rd and 4th quarter outcomes are significantly low which is likely to have been due to the time of year; October, November and December not being good months to support people into education or employment. Also, the recession had a negative impact with the availability and competition for jobs.
4.3 Mid Essex had a particularly difficult 3rd and 4th quarter due to long term staff sickness and a vacancy which has now been addressed.
4.4 West Essex had a very good 2nd quarter, outcomes are significantly higher than other quarters as a much higher proportion of clients were supported into education (September).
Centre of Excellence in the provision of supported employment services
4.5 During 2009 / 10, the Trust with partners were successful in the application for Essex to have the status of ‘Centre of Excellence’ in the provision of supported employment services – a (Sainsbury) Centre for Mental Health initiative.
There is ongoing work to improve data collection mechanisms, demonstrating fidelity to the IPS model of service provision, developing a centre of excellence network and supporting the development of services in other areas.
In 2010, a fidelity review of the service in Uttlesford was carried out by Professor Geoff Shepherd. The service was considered to demonstrate ‘good’ fidelity’ and progress is being made against the minor recommendations for improvement.
Mental Health Employment Strategy Review Sept 2010 6 Social Enterprise
4.6 During 2009 / 10, social enterprises operated by the third sector organisation MCCH became fully operational across north Essex. The Trust continues to work with MCCH and mental health commissioners to ensure the social enterprises are innovative and inclusive, supporting service users who are not ready for the competitive employment market.
The three social enterprises have been commissioned to provide up to 31, 37 and 28 places respectively for Colchester, Braintree and Harlow for time limited work experience / placements. Collectively, 88 places are currently being utilised (representing 91% utilisation – Sept 2010). There has been a steady increase of referrals to the social enterprises.
Partnerships including contact with employers
4.7 The Trust maintains a number of important partnerships including within the Mindful Employer Network (statutory and third sector organisations) and the Essex Mental Health Work and Well being Forum (primary and secondary care). These partnerships are essential to ensuring service pathways are transparent, effective and equitable; also ensuring the interface between different levels of service and organisations are able to meet differing and diverse needs without repetition or duplication.
The Trust acknowledges that contact with employers is essential in order to challenge the stigma associated with mental ill health and to create employment opportunities for service users. As a member of the Mindful Employer Network Steering Group, the Vocational Services Manager is active in engaging local employers and has also engaged with the governor Social Inclusion Workstream in respect of this work. A number of different mechanisms are used to engage employers including direct one to one contact, via the Chamber of Commerce and attending breakfast / evening meetings of specific business forums.
4.8 Employment Specialists are also required to make direct face to face contact with employers. As of April 2010, Employment Specialists will report the number of face to face contacts they make with employers on a monthly basis; 149 face to face contacts with employers were made in the first quarter of 2010 / 11. It is recognised as an important aspect of evidence based supported employment services that direct contact with employers can lead to opportunities for services users. This approach is advocated in the UK by the Sainsbury Centre for Mental Health8; it is also internationally recognised, for example, by the Dartmouth IPS Supported Employment Centre in the USA9.
Mental Health Employment Strategy Review Sept 2010 7 5. Key actions for the future
Key actions for the future will build on progress to date of the employment strategy. The key actions must be viewed and understood in the current social, political and economic context.
The Institute for Public Policy Research (ippr)10 highlight that the Coalition government seeks big savings to the incapacity benefits bill, partly through personalised support for those furthest from the labour market. They go on to suggest ‘as well as more personalised support, a citizen – centred welfare system should guarantee minimum standards’. Evidence suggests that certain entitlements to support are needed for provision to be effective for those with complex barriers to work including:
An accurate and realistic assessment of barriers to employment To be given regular support from advisers with sufficient expertise
Key Key Action details Date Action Point
Access to Employment, Education and Voluntary work
5.1 Maintain high level fidelity to the evidence based Sept 10 Individual Placement Support (IPS) model of supported Mar 11 employment services. Continue working with the Centre for Mental Health, service providers & other relevant stakeholders. Facilitate a minimum of 2 fidelity reviews. 5.2 Promote and publicise service to staff and service users, Jan 11 via publicity material and also via direct dialogue. 5.3 Continue monitoring service performance data on a Monthly monthly basis against previous Public Sector Agreement (PSA) targets as well as local commissioning targets. Produce update reports as required. 5.4 Encourage and monitor contact with employers as Monthly evidence suggests dialogue with employers can break down some of the barriers to employment & create opportunities for service users.
5.5 Respond to the opportunity to bid to provide Jun 11 Employment / Vocational services when the service is re- tendered by the Joint Mental Health Commissioning Team.
Mental Health Employment Strategy Review Sept 2010 8 Leading by example
5.6 Complete and deliver the staff health & well being Mar 11 strategy, closely working with different departments within Ongoing the Trust; introducing staff health & well being ‘champions’. Establish a Staff Health and Well being Strategy Group (incorporating existing groups). 5.7 Maintain & further progress the Trust’s status as a Ongoing Mindful Employer, liaising with WorkWays. Continue working with Mindful Employer Network Steering Group to engage local employers; produce quarterly newsletter for employers. 5.8 Investors in People – Staying Healthy at Work (SHaW) Dec 10 award – Vocational Services Manager to train to become a licensed Internal Reviewer.
Carry out internal review for SHaW award. 10 /11 5.9 Continue to contribute to the training and development Ongoing of first line managers in managing mental health difficulties in the work place.
Partnerships and Social Enterprise
5.10 Maintain internal partnerships (Occupational Health, HR, Ongoing Communications, Clinical Staff) to ensure the areas of employment, recovery and inclusion are integrated & at the forefront of service delivery.
Maintain external partnerships (ECC, service providers, Ongoing employers & other relevant stakeholders) to raise the profile of supported employment services, promote the employment of people with mental health needs, and assist the trust’s carer support service to consider how best to support carers to maintain their employment. 5.11 Continue working with the Joint Mental Health Ongoing Commissioning Team and service providers to ensure social enterprises are innovative and dynamic with the ability to meet service user needs. 5.12 Support other organisations and Trusts to develop and Ongoing deliver supported employment services; via the Mindful Employer Network, Centre for Mental Health partnership and local contact.
Mental Health Employment Strategy Review Sept 2010 9 References
1. Social Exclusion Unit Report (2004) Mental Illness and Social Exclusion. London. ODPM.
2. Warner R, (1994) Recovery from Schizophrenia: Psychiatry and Political Economy. Oxford. OUP.
3. Secker et al (2002) Challenging barriers to employment, training and education fro mental health service users. King’s College
4. Sainsbury Centre (2009a) Briefing 37: Doing What Works, Individual Placement and Support into employment. London. SCMH.
5. DH, National Service Framework for Mental Health (1999); Vocational Services for people with mental health problems: commissioning guidance, empowering people to work (2006); Mental Health and Employment (2004).
6. DWP (2003) Pathways to Work
7. TSO (2009) Working our way to better mental health: a framework for action, www.workingforhealth.gov.uk
8. http://www.centreformentalhealth.org.uk/
9. http://www.dartmouth.edu/~prc/page1/page1.html
10. Institute for Public Policy Research (2010) Now It’s Personal? The new landscape of welfare to work; www.ippr.org.uk
Mental Health Employment Strategy Review Sept 2010 10
Agenda item No: 20
Name of Meeting: Meeting of the Board of Directors in Public
Date: 24 November 2010
Title of Report: Summary of Board Decisions
Presented By: Dermot McCarthy, Trust Secretary
Subject, Purpose and Recommendation: Attached for information is a summary table showing a ‘rolling year’ of Board decisions.
Finance Implications: N/A
Clinical Implications: N/A
HR Implications: N/A
Legal Implications: N/A
Equality Implications: N/A
Risks: N/A
Summary of Board Decisions
Date of Type of Minute Decision Item Received/Noted etc Meeting Meeting Reference 21/10/09 Private P2009/132 Care Quality Commission Ratings 2008/09 The Board noted the Care Quality Commission Ratings 2008/09 P2009/133 Child and Adolescent Mental Health Services (CAMHS) Tier 4 Full Business Case The Board of Directors: 1. Received the presentation outlining the full business case (FBC), including a walkthrough video of the proposed new building and the service user’s perspective from the young people of Longview.
2. Received the full business case document and companion paper exploring the additional issues of concern
3. Approved the CAMHS FBC in principle and authorised a controlled progression of the scheme to its next logical stage (detailed design and planning application) in the context of the forthcoming low secure and psychiatric intensive care unit full business cases (to be presented to the Board of Directors in December 2009). During this phase a marketing and risk mitigation plan would be constructed in conjunction with Commissioners to explore mutual benefit realisation. This would be brought back to the Board of Directors at an appropriate time with a view to seeking Board approval to progress with the build.
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Date of Type of Minute Decision Item Received/Noted etc Meeting Meeting Reference P2009/134 Learning Disability: The Board of Directors then approved the submission of the Tender document and notification to Monitor in respect of the North East Essex Specialist Adult Learning Disability Service.
P2009/135 Transfer of IT Shared Services: The Board of Directors agreed to support the transfer of hosting arrangements from Essex Shared Service Agency managed by the East of England Ambulance NHS Trust to NHS West Essex in respect of hosting arrangements for IM&T Services.
P2009/141 Proposed Changes to the Constitution and Standing Orders of the Trust - The Board of Directors approved the Trust Constitution and the Standing Orders of the Council of Governors and Standing Orders of the Board of Directors in their revised form so that they could now be placed before Monitor and receive final approval.
P2009/144 Core Standards 2009/10 – Progress Report The Board of Directors received the progress report on Core Standards 2009/10. P2009/145 Audited IFRS Re-statement of 2008/09 Accounts The Board of Directors agreed the wording with regard to the IFRS statement for signature by Andrew Geldard, Chief Executive, dated 21 October 2009.
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Date of Type of Minute Decision Item Received/Noted etc Meeting Meeting Reference
P2009/146 Risk Register - Subject to the approval of the Audit Committee, the Board of Directors accepted the recommendations of the Risk & Governance Executive and approved the amendments to the Risk Register. P2009/151 Any Other Urgent Business Working Capital Facility The Board: (a) Confirmed its approval of the working capital facility on the terms and conditions set out in the Credit Agreement (defined below) supplied by Barclays; and
(b) Approved the Chief Executive and Director of Resources signing the Credit Agreement and Schedule 4 (Directors’ Certificate) to reflect the Board’s acceptance of the terms and conditions of the Credit Agreement
(c) Agreed that the Chief Executive take all actions necessary to settle the Credit Agreement; and
(d) Adopted the suggested Board Resolution as a record of the decision.
25/11/09 Public 2009/84 Piloting self-directed support & Personal social care budgets in mental Health services - The Board of Directors
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Date of Type of Minute Decision Item Received/Noted etc Meeting Meeting Reference approved the involvement of the Trust in a 12 month pilot in partnership with Essex County Council, testing development of self directed support and personal social care budgets, to be reviewed on a quarterly basis.
2009/85 Progress update on trust employment strategy – the Board of Directors received the progress report and reconfirmed the trust's three key employment strategy objectives.
2009/87 Carers' Strategy Review 2009 - The Board of Directors noted the review of the Carers' Strategy and to extend it for a further year (to 2010), with an updated plan, pending the outcome of a Carers’ Survey to be undertaken in 2009/10 to inform future priorities.
2009/88 Care Quality Commission (CQC) core standards 2009/10 declaration of compliance - the Board of Directors received the assurance of the Risk & Governance Executive and agreed that the trust should declare full compliance with CQC’s core standards 2009/10 for the period April to October 2009, by 7 December 2009.
2009/89 Care Quality Commission Registration 2010 - The Board of Directors noted the components of CQC registration, the timescales for registration and agreed the actions to be taken 2009/90 Privacy & Dignity update (including the elimination
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Date of Type of Minute Decision Item Received/Noted etc Meeting Meeting Reference of mixed sex accommodation action plan) - The Board of Directors noted the Privacy and Dignity Update (including the elimination of mixed sex accommodation action plan).
2009/93 Constitution Update - In order to correct the references to the NHS Act 2006, the Board of Directors approved the following resolution: “That the references to sections 224 and 225 of the National Health Service Act 2006 appearing in Annex 5 of the revised Constitution and in Schedule C of the revised Standing Orders for the Council of Governors, were approved by the Board at its meeting on the 21 October 2009, be corrected to references to sections 244 and 245 of that Act”
2009/95 Annual planning (2010/11) event for Elected governors on 12 November 2009 - The Board of Directors agreed that a summary of the annual plan workshop for Elected Governors be submitted to the meeting of the Council of Governors on 8 December 2009.
25/11/09 Private 3. Outcome of Board Review of Strategic Direction - The Board of Directors: Confirmed that the paper represented an accurate summary of the development of the Board’s strategic thinking on 09/10 November 2009
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Date of Type of Minute Decision Item Received/Noted etc Meeting Meeting Reference Agreed to receive a more detailed paper refreshing the strategic workstreams and outlining next steps to formulate, implement and monitor strategy at the December 2009 meeting.
4. Patient Safety Dashboard - The Board of Directors noted the Patient Safety Dashboard for Quarter 2, 2009/10.
7. Any Other Notified Business
a) Delegation of Powers under the Mental Health Act 1983 (as amended) (for inclusion in the Trust Scheme of Delegation)
The Board of Directors approved the four proposed resolutions:
1. That the Powers Reserved to the Board are varied by the addition of the following paragraph I; “Approval of the arrangements to exercise the powers of the Trust, and to comply with the responsibilities of the Trust, as Hospital Managers under the Mental Health Act 1983 (as amended); 2. That save as mentioned in paragraph 3 below, the Board affirms that its powers under the Mental Health Act 1983 (as
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Date of Type of Minute Decision Item Received/Noted etc Meeting Meeting Reference amended) are delegated in the manner set out in the attached Appendix; 3. That the powers of the Trust under section 23 of the Mental Health Act 1983 (as amended) are delegated to Associate Hospital Managers to be exercised by three or more persons who shall be neither an Executive Director of the Trust nor an employee of the Trust, and who shall be appointed and administered by the Mental Health Forum of the Trust; 4. That a copy of these resolutions and the attached Appendix are added to and become part of the Powers Reserved to the Board and Scheme of Delegation
16/12/09 Private 7 Refreshing our Strategic Workstreams - The Board of Directors agreed the seven workstreams outlined in the paper “Refreshing our Strategic Workstreams”, and the next steps as described.
8. Resource Management Strategy - The Board of Directors agreed the approach of a Quality Innovation Productivity Prevention (QIPP) driven resource management strategy and supported the development of QIPP initiatives to be included within the annual plan.
9. Update Regarding Recent Tender Activity - The Board noted:
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Date of Type of Minute Decision Item Received/Noted etc Meeting Meeting Reference The outcome of the North Essex Learning Disability Tender The position regarding the Trust not proceeding with a bid to provide the Essex Criminal Justice Interventions Service (substance misuse) 10. CAMHS Full Business Case Progress Update - The Board of Directors received the CAMHS Full Business Case Progress Update, and noted the progress to date.
11. New Low Secure Unit, Broomfield Hospital Site – Full Business Case The Board of Directors approved commencement of the scheme as outlined in the full business case document having given consideration to the additional papers prepared by Rob Yeomans (Interim Project Director) concerning strategic capital investment.
13. IM&T Strategy The Board of Directors: received the presentation from Rob Yeomans regarding IM&T management noted recent progress in IM&T agreed to the strategic direction of development agreed to the development of the IM&T programme.
14. Carbon Management Plan - The Board of Directors
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Date of Type of Minute Decision Item Received/Noted etc Meeting Meeting Reference agreed the carbon reduction target (30% by 2015) and supported the development by carbon management workstreams of robust and detailed plans to be incorporated within the Trust’s annual plan noted that Charles Abel Smith had agreed to be Board champion for sustainability recorded their thanks to Paul Fenton and Daniel Yeomans for their work on his project.
17. Nominations Committee Terms of Reference The Board of Directors: approved the revised Terms of Reference of the Nominations Committee appointed Ray Cox and Mark Simpson to the Nominations Committee.
19. Section 75 Partnership Arrangements in respect of Child and Adolescent Mental Health Services (CAMHS) – 3 Year Agreement - The Board of Directors confirmed agreement to a 3-year Section 75 Arrangement for CAMHS from 01 April 2009 by further extending the existing partnership agreements in place for CAMHS (including staffing and financial arrangements) for up to 3 months from 01 January 2010 enabling completion of a new fit for purpose agreement, terms and conditions of which would be mutually agreed and acceptable to both parties.
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Date of Type of Minute Decision Item Received/Noted etc Meeting Meeting Reference 21. Charitable Fund Accounts and Annual Report - The Board of Directors: Agreed the annual report and accounts for the charitable funds for the year ending 31 March 2009 and approved the signing of those accounts Agreed the contents of the letter of representation and approved the signing of the letter.
24. Any Other Urgent Business (Notified in Advance) 24.1 Council of Governors Code of Conduct The Board of Directors adopted the Code of Conduct for Governors with immediate effect.
28/01/10 Private P2010/6 Outline Financial Plan – Revenue 2010/11The Board of Directors received the Outline Financial Plan – Revenue 2010/11
P2010/7 Medicines Management Strategic Plan - The Board of Directors approved the Medicines Management Strategic Plan
P2010/8 2010/11 Operating Framework and Commissioning Update - The Board of Directors noted the NHS Operating Framework 2010/11 and the local progress with commissioning for 2010/11 contracts.
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Date of Type of Minute Decision Item Received/Noted etc Meeting Meeting Reference P2010/9 Mother & Baby Unit Business Case – January 2010, The Board of Directors approved the Mother & Baby Business Case (January 2010)
2010/10 Update on Service User Experience & Preparation for the Community Mental Health Service User Survey 2010 - The Board of Directors received the update on Service User experience and preparation for the Community Mental Health Service User Survey 2010.
P2010/13a Monitor Compliance – Governance Report for Quarter 3, 2009/10 - The Board of Directors then approved the positive Governance Return to Monitor for Quarter 3, 2009/10, including the Exception Report.
P2010/13b Monitor Compliance – Consultation re Compliance Framework 2010/11, The Board of Directors then received the report regarding Monitor’s Consultation re the Compliance Framework 2010/11.
P2010/14 CQC Registration - The Board of Directors then approved the Declaration of Compliance against CQC Registration Standards and agreed to immediate submission of the registration application prior to the deadline date of 29 January 2010.
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Date of Type of Minute Decision Item Received/Noted etc Meeting Meeting Reference P2010/15 Amendment to the Constitution – Inclusion of Additional Appointed Governor, The Board of Directors passed the resolutions.
P2010/22.1 Staff Survey 2009 - The Board of Directors received the presentation from Colin Moore re the Staff Survey 2009.
24/02/10 Public 2010/07 Equality & Diversity – The Board of Directors approved the recommendations regarding Board leadership for Equality & Diversity and re the Single Equality Scheme. 2010/08 The NHS Constitution - The Board received the report for information
2010/09 Care Quality Commission Mental Health Act Annual Statement 2009 - The Board of Directors received the Care Quality Commission Mental Health Act Annual Statement 2009 for information.
2010/10 Patient Safety Report on the Successful Reduction in the incidence of falls - The Board of Directors received the report and noted the significant reduction in the number of falls.
2010/13 Update on Service User Experience, Patient & Public Involvement & Progress on the Current Mental Health Service Users Survey 2010
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Date of Type of Minute Decision Item Received/Noted etc Meeting Meeting Reference The Board of Directors noted the update on service user experience, patient and public involvement and progress on the current mental health service users survey 2010. 2010/14 Appointment of Deputy Chairman, The Board unanimously that Ray Cox be recommended to the Council of Governors for the post of Deputy Chairman of the Trust with effect from 01 April 2010.
2010/15 Board Self Assessment - The Board of Directors agreed to undertake self assessment for 2009/10 March 2010 and that the Chairman and Senior Independent Director commission an external Board 360° for 2010/11.
24/02/10 Part 2 2010/26 Summary business case – purchase of the Derwent Centre, The Board of Directors granted authority Chairman’s urgent action to purchase the Derwent and associated land.
2010/27 Psychiatric Intensive Care Unit Business Case - The Board of Directors approved the full business case (but not commencement of the scheme)
2010/28 Mental Health Contracts 2010/11 - The Board of Directors granted authority to the Chairman to take Chairman’s action on variations to the contracts prior to them being signed for and on behalf of the Trust by the Chief Executive by 15 March 2010.
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Date of Type of Minute Decision Item Received/Noted etc Meeting Meeting Reference 2010/32 Patient Safety Dashboard - The Board of Directors noted the Patient Safety Dashboard.
2010/33 Strategic Audit Plan 2010-2013 - The Board of Directors noted the Strategic Audit Plan 2010-2013.
31/03/10 Private P2010/30 Derwent Centre Freehold - There was a unanimous favour of the proposal i.e. approval of the purchase of the Derwent Centre
P2010/31 Financial Plan – Revenue 2010/11- The Board of Directors approved the 2010/11 revenue plan.
P2010/32 Financial Plan – Operational Capital Programme 2010/11 - The Board of Directors approved the financial plan for operational capital for 2010/11
P2010/33 CAMHs Tier 4 – Update - The Board of Directors received the report on the CAMHs Tier 4 – update P2010/35 Preparing the Annual Plan 2010/11- The Board of Directors agreed the recommendations including the process for drafting the 2010/11 Annual Plan.
P2010/36 Section 75 Partnership Agreements - The Board of Directors: Noted the successful conclusion of outstanding negotiations in respect of Section 13 (insurance, liabilities and indemnities section) of the S75 Adult services agreement and approved a S75
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Date of Type of Minute Decision Item Received/Noted etc Meeting Meeting Reference Child and Adolescent Mental Health services (CAMHs) 3-year agreement.
P2010/37 Severalls Hospital: Planning Issues Update Report - The Board noted the Severalls hospital planning issues update report
P2010/38 Care Quality Commission – 2009 Staff Survey - The Board received the report on the Care Quality Commission 2009 Staff Survey.
P2010/43 Board Self-Assessment - The Board of Directors approved the report on Board Self-Assessment and approved the recommendations.
P2010/44 Trust Assurance Framework 2009/10 - The Board received the Revised Assurance Framework
P2010/45 Risk Register Report – Quarterly Review - The Board of Directors accepted the recommendation of the Risk & Governance Executive and approved the amendments to the Risk Register
P2010/46 Verita Investigations - The Board of Directors noted the content of the 7 reports
P2010/47 Insurance - The Board of Directors received and noted the report on insurance
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Date of Type of Minute Decision Item Received/Noted etc Meeting Meeting Reference P2010/48 Privacy & Dignity Report - The Board accepted the Privacy and Dignity Audit Report and acknowledged the completed action plan.
P2010/49 Single Sex Accommodation Declaration - The Board of Directors agreed to the Single Sex Accommodation declaration and statement for publication on the Trust’s website. 28.04.10 Private P2010/58 a) Draft Annual Plan 2010/11 – The Board of Directors received the report and agreed to the recommendations including to receive and adopt the final plan at the meeting of the Board in Public on 26 May P2010/58 b) 3 Year Financial Plan – Overview - The Board supported the draft plan with the exception of the issue of the financial risk rating which would be discussed further P2010/59 b) Draft Statement of Accounts for the year ending 31 March 2010 - The Board of Directors noted the draft statement of accounts for the year ended 31 March 2010. P2010/62 Serious Case Review – Longview The Board of Directors received the Longview SUI Steering Group minutes and approved the action plan P2010/63 Trust Organisational Openness (Whistleblowing) Policy - The Board of Directors received and endorsed the Trust’s Organisational Openness (Whistle blowing) Policy.
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Date of Type of Minute Decision Item Received/Noted etc Meeting Meeting Reference P2010/64 Alterations to the Scheme of Delegation – Quotation, Tendering and Contract Procedures - The Board of Directors approved the increase in limits as set out in the report
P2010/65 Execution of Deeds - resolution of the Board of Directors - The Board of Directors approved the resolutions in respect of granting a general authority for the Execution of Deeds
30.06.10 Private P2010/63 Severalls Update - The Board agreed the recommendations of the report
P2010/64 Strategic Capital Priorities 2010/11 - The Board agreed the recommendations of the report
P2010/65 Enable East Draft Business Case - The Board of Directors then unanimously approved the Business Case for the continuation of Enable East
P2010/70 Performance Management Framework 2010 - The Board of Directors approved the Performance Management Framework 2010.
P2010/71 Risk & Governance Executive (RGE) Annual Report - The Board of Directors received the Risk & Governance Executive Annual Report 2009/10.
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Date of Type of Minute Decision Item Received/Noted etc Meeting Meeting Reference 21.07.10 Private 2010/75 Outstanding Care, Transforming Lives - developing our strategy together
The Board received the presentation from Geoff Scott, Director of Strategy regarding Outstanding Care, Transforming Lives - developing our strategy together.
2010/76 Service User and Carer Engagement - The Board of Directors received the presentation from Paul Keedwell, Director of Operations and Nursing with regard to Service User and Carer Engagement.
2010/77 Government White Paper ‘Equity and Excellence: Liberating the NHS’ The Board of Directors received the presentation from Andrew Geldard, Chief Executive regarding the Government White Paper ‘Equity and Excellence: Liberating the NHS’
2010/78 West Essex Community Provider Services – Business Case requesting approval to proceed - The Board of Directors received the report from Mike Chapman, Director of Business Development, supporting the continuation of the managed dialogue process with regard to the acquisition of West Essex Community Health Services.
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Date of Type of Minute Decision Item Received/Noted etc Meeting Meeting Reference 2010/79 Engagement with GPs as Commissioners The Board of Directors received the presentation from Mike Chapman, Director of Business Development with regard to Engagement with GPs as Commissioners.
2010/80 Monitor Compliance - Finance and Governance Return for Q1 2010/11 The Board of Directors approved the governance return to Monitor for quarter 1 2010/2011
2010/81 Finance Report for Period ending 30 June 2010 - Month 3 The Board of Directors approved the finance report for the period ending 30 June 2010 - Month 3.
2010/82 3-year financial plan-Update July 2010 - The Board of Directors received the report.
2010/84 Trust Sickness Absence Target - The Board of Directors agreed to the revised Trust performance target of sickness absence at 4.5% for 2010/11 with an annual review of the target in the context of changing benchmark data. 2010/85 Board Operating - The Board of Directors approved the recommendations of the report including the 3 Board objectives for the period ending 31 March 2011.
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Date of Type of Minute Decision Item Received/Noted etc Meeting Meeting Reference 25.08.10 Public 2010/52 Strategic Capital Priorities 2010/11 The Board of Directors unanimously reconfirmed the decision made on 30 June 2010 to commence work on the CAMHS strategic capital scheme in 2010/11.
2010/53 Carers' Survey - The Board of Directors received the Carer’s Survey report for information.
2010/54 Patient Environment Action Team (PEAT) Inspection Report 2010 - The Board of Directors received the PEAT report 2010 for information.
2010/55 Summary Of Guidance By Monitor On the Board's Role In Improving Patient Safety - The Board of Directors received the report on Monitor’s Guidance on the Board’s role in improving patient safety, for information.
2010/58 Prudential Borrowing - Working Capital Facility The Board of Directors: a) Authorised the Director of Resources to apply to Monitor to increase the Trust’s Working Capital Facility (WCF) from £7 million to £8 million; and b) Subject to receipt from Monitor of a revised Schedule 5 (Prudential Borrowing Requirement), authorised the Director of Resources to arrange the £500,000 increase in the Revolving Credit Facility with Barclays Bank PLC.
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Date of Type of Minute Decision Item Received/Noted etc Meeting Meeting Reference 2010/59 Directors' Register Of Interests - Update The Board of Directors received the Register of Interests for information.
2010/60 Infection Control Annual Report and Intensive Support Team (IST) Process and Report The Board of Directors approved the Infection Control Annual Report and Intensive Support Team Process and Report
2010/61 Audit Committee Report For Quarter 1 2010/11 The Board of Directors received the Audit Committee Report (Quarter 1) for information.
2010/62 Nominations Committee Report For Quarter 1 2010/11
2010/63 Risk & Governance Executive (R&GE) Report For Quarter 1 - The Board of Directors received the report for information.
2010/64 Council of Governors - Draft Minutes of the Meeting held on 01 June 2010 and feedback - The Board of Directors received the Draft Minutes of the Council of Governors Meeting held on 01 June 2010 and feedback for information.
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Date of Type of Minute Decision Item Received/Noted etc Meeting Meeting Reference 29.09.10 Private P2010/96 Approval for Debt Write-off (Decision) - The Board agreed that advice would be sought from Bevan Brittan, legal advisors, regarding the options for action regarding the bad debts as listed.
P2010/98 Update on Working Time Directives - The Board of Directors received the report from Dr Malte Flechtner giving an update on Working Time Directives.
P2010/99 Derwent Centre Business Case and Wrap Around Document - The Board of Directors agreed that the document be regarded as a business case (not a full business case) and on that basis approved it. The Board of Directors asked for further work to continue to look at how the business case integrated with other business cases and asked for a report to be bought back to the Board of Directors in November 2010.
P2010/100 Domestic Services - Award of Contract - The Board of Directors approved the award of the contract for Domestic Services to Healthcare Initial on a 3 year basis commencing on 1 January 2011 (with the option to extend for a further 1 or 2 years).
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Date of Type of Minute Decision Item Received/Noted etc Meeting Meeting Reference P2010/101 White paper ‘Equity & Excellence: Liberating the NHS’ – Presentation The Board of Directors received the presentation from Andrew Geldard,’ Chief Executive regarding ‘Equity & Excellence: Liberating the NHS’.
2010/103 GP Engagement – Presentation on Next Steps The Board of Directors received the GP Engagement update and approved the GP Engagement framework.
2010/104 Legal Services - The Board of Directors agreed that the Trust remain with Bevan Brittan as its main external legal advisors with a rolling 3 month notice perios.
2010/105 Notice of Meeting of ECC/NEPFT MH Partnership Board - The Board received the agenda and Terms of Reference of the North Essex Mental Health Partnership Board.
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Agenda item No: 23
Name of Meeting: Meeting of the Board of Directors in Public
Date: 24 November 2010
Title of Report: Execution of Deeds
Presented By: Dermot McCarthy, Trust Secretary
Subject, Purpose and Recommendation:
The Board of Directors is asked to note the report.
At its meeting held on 28 April 2010 the Board of Directors gave general authority for the execution of Deeds on the following terms:
“Pursuant to paragraph 37 of the Constitution which came into effect on the 1 April 2010 the Board of Directors gives authority for the execution of Deeds by or on behalf of the Trust in the circumstances and in the manner specified below:
In the case of Deed for the sale lease or purchase of land or a building at a price or value of £250,000 or less, and in the case of a lease, also at an annual rent of £100,000 or less, or for building works or capital expenditure of £100,000 or less, it shall be sealed in the presence of, or executed for the Trust by two Officers, one of whom must be the Chief Executive, or the Finance Director, and the other of whom must be an Executive Director, or the Trust Secretary.
In the case of any other Deed, it shall be accompanied by a certificate signed by the Finance Director confirming his approval to the transaction to which the Deed relates, and to the execution of the Deed, and the Deed shall be sealed in the presence of, or executed for the Trust by two Directors of the Trust, one of whom must be the Chairman or the Chief Executive, excluding for this purpose their authorised representatives”.
Since the last report to the Board the following deeds have been executed: a) 23.12.10; Variation agreement (annulment of the tripartite agreement) between Colchester Borough Council, NEPFT and the Homes and Communities Agency (No 82)
b) 23.12.10; Agreement of Education Funding for land to the south of the A12 at Cuckoo Farm, Mile End between NEPFT and the Homes and Communities Agency and Essex County Council. (No 83) c) 23.12.10; Agreement of Land to the south of the A12 at Cuckoo Farm Mile End Colchester (the NAR3 Agreement) between NEPFT and the Homes and Communities Agency and Colchester Borough Council and Essex County Council (No 84) d) 23.12.10; Agreement under Section 106 Town and Country Planning Act 1990 in relation to land north east of Colchester known as the former Severalls Hospital and Cuckoo Farm between Colchester Borough Council the Homes and Communities Agency and NEPFT (No 85) e) 20.01.11; Additional copy of the Variation agreement (annulment of the tripartite agreement) between Colchester Borough Council, NEPFT and the Homes and Communities Agency (No 86) f) 20.01.11; Additional Copy of the Agreement of Education Funding for Land to the south of the A12 at Cuckoo Farm, Mile End between NEPFT and the Homes and Communities Agency and Essex County Council (No 87) g) 20.01.11; Additional Copy of the Agreement of Land to the south of the A12 at Cuckoo Farm Mile End Colchester (the NAR 3 agreement) between NEPFT and the Homes and Communities Agency and Colchester Borough Council and Essex County Council (No 88) h) 20.01.11; Additional Copy of the Agreement under Section 106 Town and Country Planning Act 1990 in relation to the land north east of Colchester known as the former Severalls Hospital and Cuckoo Farm between Colchester Borough Council, Essex County Council, the Homes and Communities Agency and NEPFT. (No 89).
Finance Implications: N/A
Clinical Implications: N/A
HR Implications: N/A
Legal Implications: N/A
Equality Implications: N/A
Risks: N/A
Agenda item No: 22
Name of Meeting: Meeting of the Board of Directors in Public
Date: 24 November 2010
Title of Report: Any Other Notified Business
Presented By: Mary St Aubyn, Chairman
Subject, Purpose and Recommendation: The Board is invited to consider any items of urgent business notified in advance to Mary St Aubyn Chairman or Dermot McCarthy, Trust Secretary.
Finance Implications: N/A
Clinical Implications: N/A
HR Implications: N/A
Legal Implications: N/A
Equality Implications: N/A
Risks: N/A
Agenda item No: 23
Name of Meeting: Meeting of the Board of Directors in Public
Date: 24 November 2010
Title of Report: Questions from members of the public relating to items on the agenda only
Presented By: Mary St Aubyn, Chairman
Subject, Purpose and Recommendation: The Board is invited to reply to any questions from members of the public relating to items on the agenda only.
Finance Implications: N/A
Clinical Implications: N/A
HR Implications: N/A
Legal Implications: N/A
Equality Implications: N/A
Risks: N/A
Meeting of the Board of Directors in Public (Part 2)
24 November 2010 Stapleford House, Stapleford Close, Chelmsford, Essex CM2 0QX
Document header here
Meeting of the Board of Directors to be held in Private (part 2) on Wednesday 24 November 2010 at Trust Headquarters, Stapleford House, Stapleford Close, Chelmsford, Essex CM2 0QX
AGENDA
Declarations & Minutes
1. Declarations of Interest DMc 1.15
Strategy
2. Update on NEPFT Expression of Interest to Essex County MC 1.15 Council provide CAMHS Tier 2 Services [Information]
3. Severalls - Heads of Terms of Agreements [Decision] AG 1.30
4. Board Awaytime [Information] AG 1.40
Quality
-
Governance
5. NHSLA Assessment Feedback MF 1.50
6. Revolving Credit Facility Agreement [Decision] RT 2.00
7. Prudential Borrowing - Application for loan finance RT 2.05
Assurance
-
Items for Noting
8. Audit Committee Minutes - Draft (14 October 2010) RCx 2.10
Other Items
9. Any Other Notified Business MSA 2.10
10. Review of Today’s Meeting MSA 2.15
Meeting Closes
Dermot McCarthy Trust Secretary, North Essex Partnership NHS Foundation Trust, 103 Stapleford Close, Chelmsford, Essex CM2 0QX
Agenda item No: 1
Name of Meeting: Meeting of the Board of Directors - Part 2 Confidential
Date: 24 November 2010
Title of Report: Declarations of Interest
Presented By: Dermot McCarthy, Trust Secretary
Subject, Purpose and Recommendation: In accordance with Standing Orders the Board of Directors is asked to receive any declarations of interest from members relating to items on the agenda.
Finance Implications: N/A
Clinical Implications: N/A
HR Implications: N/A
Legal Implications: Declarations of interest are required to comply with Standing Order 7 (“Declarations of Interest and Register of Interests”).
Equality Implications: N/A
Risks: N/A
L:\Board Meetings in Public\2010\24 Nov 2010\Part 2\agenda item 1 - declarations.doc
Agenda item No: 2
Name of Meeting: Meeting of the Board of Directors – Part 2 Confidential
Date: 24 November 2010
Title of Report: Update on NEPFT Expression of Interest to Essex County Council provide CAMHS Tier 2 Services
Presented By: Mike Chapman, Director of Commercial and Service Development
Subject, Purpose and Recommendation: The Board is asked to note the progress of this bid.
ECC Commissioning Intention Essex Joint Commissioning Unit is seeking to commission provision of a targeted tier 2 CAMH service in order to meet the needs of children across Essex. This provision is for a 2 year contract, with commencement in April 2011.
Tier 2 is defined as: CAMHs specialists working in community and primary care settings offering consultation to children, families and other professionals, outreach to identify severe or complex needs, assessment and training and support for other professionals.
Specifically, the service should provide interventions which lead to improved emotional health and wellbeing for some 7,500 children and young people per year across Essex who have emerging emotional health issues. complete high quality psychological assessments for courts resulting in appropriate decisions and placements. Provide single door access to all tiers of CAMHS using the Brief Child and Family Phone Interview (BCFPI).
Commissioners have invited both Essex Mental Health Trusts and the five Community Provider Services across Essex to express interest and make a proposal to them to provide this service. Although not asking for formal tender, a formal tendering type process has been used with a bid process through Bravo Solutions and formal interview. The intention is to second staff into the successful organisation using a Section 75 arrangement. However, ECC will not clarify the amount of staff to be transferred until after Jan/Feb 2011 when they believe that the implications of savings across ECC on CAMHS will be clearer. The current process is being used to identify a preferred provider with whom further negotiations can continue.
The NEPFT Proposal Our proposal, written by Toni Scales, Area Director, has indicated to ECC that we wish to be considered to provide: A Tier 2 targeted CAMH service across North Essex and the geographical area which is co-terminus with our Tier 3 Specialist CAMHS teams with a minimum core team of 39wte plus 3 wte managers.
A County Wide Lionmede Service for Looked After Children and Adopted Children with 5.2wte ECC staff plus the 4.8wte seconded from NEPFT (including 2wte vacancies) plus 1wte manager.
A Comprehensive County wide Service for Court work with the 4wte clinical psychologists for single professional assessments supported by a multidisciplinary team for complex assessments
Our proposal indicates a desire to provide Tier 2 services for North Essex in order to fully integrate Tier 2 and tier 3 services which we know is ECC’s intention. At bidder interview we explained that position and also confirmed that we would be interested in providing Tier 2 services in South Essex if that was the model preferred by commissioners.
The proposal was submitted on 14th October 2010 and bidder interviews were held on 2nd November.
Bid Presentation and Next steps The Trust’s bid was presented on 2nd November 2011 by Mike Chapman, Toni Scales and Dr Julet Butler in the form of questions from a panel of nine commissioners. In our view, the session went very well.
We expect to be informed of the result within two weeks of the bidder interview. If we are successful we expect to enter into a further period of discussion and negotiation regarding the way this service is taken forward.
Finance Implications: These will be dependent upon future negotiation, but in essence, as staff will be seconded and premises costs are borne by ECC, the financial implications relate mainly to negotiating full recovery of overheads and margin. In the current climate any margin is likely to be small. We estimate the start up costs to be £183,000 and non-staff costs to be in the region of £448k, but these figures are dependent upon actual staff numbers to transfer. There may be further opportunity for income from the Court report element of this service.
Clinical Implications: This service could be successfully integrated with existing Tier 3 services and provide a coherent service for the population, and for GPs who are unhappy with the current Tier 2 service. There is much crossover between the tiers and a single management structure and integration makes sense clinically.
HR Implications: There will need to be consultation with staff prior to secondment into our organisation, and a clear understanding with ECC regarding recruitment processes and security of funding during the two year contract.
Legal Implications: These relate mainly to the use of a Section 75 Agreement which will need to be changed to take account of this new service.
Equality Implications: The Trusts obligation with regard to equality would apply equally to this service
Risks: Financial risks depend upon future negotiation but would appear minimal. If unsuccessful, risk is with regard to a competitor having a strategic foothold in children’s MH services in our home market. Clinical and risks to reputation are not dissimilar to those in services currently provided. However, the reputation of the Tier 2 existing service is poor and could reflect upon NEPFT if not improved.
Agenda item No: 3
Name of Meeting: Meeting of the Board of Directors - Part 2 Confidential
Date: 24 November 2010
Title of Report: Severalls - Heads of Terms of Agreements
Presented By: Andrew Geldard, Chief Executive
Subject, Purpose and Recommendation: During recent months the Board has been updated in respect of the progress being made in relation to the preservation of the existing planning consent for residential development on the Severalls Hospital Site.
The 'Outline Consent' was timed to lapse in March 2010. It has been 'kept alive' by the submission of a detailed planning consent for a proportion of the site owned by the Homes and Communities Agency (HCA). The current strands of work have been focussed upon ensuring workable variations to the existing planning agreements (i.e. Section 106 and others) which will allow the planning to be implemented. In addition to this, the Trust and HCA have also sought other concessions from Essex County Council (ECC) and Colchester Borough Council (CBC) that will allow both development to commence and additional value to be generated by the site. This activity will also allow the Trust to test the market for a sale in the New Year.
Recommendations The Board is ask to: i) Agree the 'Heads of Terms' for the NAR3 forward funding arrangement. ii) Agree the 'Heads of Terms' for the Education forward funding agreement. iii) Note the progress on the ECC purchase option. iv) Approve the £35,000 expenditure in relation to the Masterplanning exercise. v) Note the overall progress in relation to the site.
Finance Implications: The Trust has been invited to submit a revised 'Masterplan' for the overall site and this will then be considered by the Borough's Planning Committee early in 2011. The estimated cost of this masterplanning exercise is £35,000.
Clinical Implications: N/A
HR Implications: N/A
Legal Implications: It is anticipated that final legal agreements will come to the Board on 15th December 2010 for final approval.
Equality Implications: N/A
Risks: There are two significant risks:- i) The ongoing cost and burden of continued ownership of the site weighed against the price attracted by an early sale. ii) If we are unable to secure an agreement with ECC for the forward funding of the NAR3, then HCA will withdraw their offer of a £4m. contribution. This will severely jeopardise the ability of CBC's Planning Department to grant full planning permission.
Severalls Hospital Heads of Terms of Agreements
1. Introduction and Background
During recent months the Board has been updated in respect of the progress being made in relation to the preservation of the existing planning consent for residential development on the Severalls Hospital Site.
The 'Outline Consent' was timed to lapse in March 2010. It has been 'kept alive' by the submission of a detailed planning consent for a proportion of the site owned by the Homes and Communities Agency (HCA). The current strands of work have been focussed upon ensuring workable variations to the existing planning agreements (i.e. Section 106 and others) which will allow the planning to be implemented. In addition to this, the Trust and HCA have also sought other concessions from Essex County Council (ECC) and Colchester Borough Council (CBC) that will allow both development to commence and additional value to be generated by the site.
2. Trust Board Meeting on 20th October, 2010
At this meeting, the Chief Executive sought the advice and support of the Board to pursue a forward funding arrangement with ECC, whereby they would provide the outstanding funding and undertake the construction of the NAR3. This course of action was supported by the Board, which also asked for a purchase option, also offered by ECC, to be 'kept alive'.
3. Heads of Terms - For Approval
Following the 20th October Board meeting, significant activity has taken place to crystallise the agreements between the various bodies. Following approval of 'Heads of Terms', these will then be translated into full legal agreements. a) 278 Funding Agreement for the Northern Approach Road Phase (Annex 1) The agreement reached with ECC is that they will provide the forward funding of the residual sum with the following conditions:
Interest rate will be the Public Works Loans Board rate. Interest accrues only after completion of the 375th unit. There is no 'long-stop' date for repayment to ECC. A legal charge will be placed on the land to ensure reimbursement to ECC when the Trust sells its holding.
The Board is asked to agree to these 'Heads of Terms'.
Page 1 of 10 b) Education Forward Funding Agreement (Annex 2) The current planning agreement envisages that the landowners fund a Primary School and make a capital contribution to Secondary Education totalling c.£5.0 million. The Primary School contribution was initially due prior to commencement of the development. Both sums have been determined by a prescriptive formula, with the sums linked to a detailed index.
The current agreement with ECC is that they will provide forward funding for these two elements with the following conditions:
Repayments commence from the completion of the 300th unit. There is no 'long-stop' date for repayment to ECC. A legal charge will be placed on the land to ensure reimbursement to ECC when the Trust/HCA sell their holding.
The Board is asked to agree these 'Heads of Terms'. c) Option to Sell Severalls to ECC (Annex 3) Further discussions have taken place with ECC to hold open the 'option' to sell the site to the County. Unfortunately County are unlikely to enter into a legal option and are more likely to be willing to give a letter of comfort and signal intent.
The Board is asked to note the progress on the purchase option.
4. Legal Agreements
Subject to the Board's agreement to the 'Heads of Terms', legal agreements will now be constructed that will allow the detailed planning application to progress. The legal work will focus on a number of areas: a) Deeds of Variation to the Existing Planning Conditions. These are being prepared based on the 'Heads of Terms' for the forward funding arrangement. b) Annulment of the Tri-Partite Agreement CBC have fulfilled their requirements within the Tri-Partite Landowners Agreement and to ease the overall legal burden, have suggested that the current agreement be 'annulled'.
This appears to be a sensible and helpful course of action but the Trust is seeking legal advice to confirm that this is indeed the case. c) Bi-Partite Agreement The original agreement envisaged a single sale by NEPFT and HCA to a single developer. The site development is not now progressing via this mechanism and the Bi-Partite Agreement needs amending accordingly.
Again, legal advice is being sought in relation to this issue.
Page 2 of 10
5. Other Planning Issues
CBC continue (at officer level) to confirm that the value of retained buildings on the Severalls Hospital Site can be reduced. This has the impact of significantly enhancing the value of the site. To this end, the Trust has been invited to submit a revised 'Masterplan' for the overall site and this will then be considered by the Borough's Planning Committee early in 2011. The estimated cost of this masterplanning exercise is £35,000.
The Board are asked to approve this expenditure.
6. Looking Forward
The impact of the actions described above is as follows: i) They will allow detailed planning to be approved, hence preserving the existing value in the site. ii) Road infrastructure will commence in 2011 and plans for the construction of the Primary School will progress. Both of these make the site more attractive to householders and hence developers. iii) The revised 'Masterplan' will crystallise the direction of travel for further planning applications, both in terms of housing units and the percentage of retained/converted units. This has a positive impact on value.
Combined, the above will allow the Trust a better opportunity to test the market for an early sale and/or pursue the purchase option with ECC with more certainty on risks to the scheme.
7. Public Relations
The A12 'grade separated junction' is due for official opening on 6th December 2010. The local press have previously led with the headlines 'The Road to Nowhere', with criticism directed at all the public bodies involved. The progress described above will allow a positive collective response to any repeat.
8. Conclusions and Recommendations
The current strands of activity in relation to Severalls Hospital will have the effect of preserving the existing planning consent and will also allow the Trust to test the market for a sale in the New Year.
The Board is asked to: i) Agree the 'Heads of Terms' for the NAR3 forward funding arrangement. ii) Agree the 'Heads of Terms' for the Education forward funding agreement. iii) Note the progress on the ECC purchase option.
Page 3 of 10 iv) Approve the £35,000 expenditure in relation to the Masterplanning exercise. v) Note the overall progress in relation to the site.
It is anticipated that final legal agreements will come to the Board on 15th December 2010 for final approval.
Andrew Geldard Chief Executive 24th November 2010
Page 4 of 10 ANNEX 1
Heads of Terms Subject to Contract & Without Prejudice
Severalls Hospital Site, Colchester 278 Funding Agreement for the Northern Approach Road Phase 3 (NAR3)
Party (1) Name: Essex County Council (ECC)
Address: County Hall Market Road Chelmsford CM1 1QH
Contact: Paul Bird, Keith Lawson
Solicitor: John Chambers
Party (2) Name: North Essex Partnership Foundation Trust (NEPFT)
Address: Stapleford House 103 Stapleford Close Chelmsford CM2 0QX
Contact: Andrew Geldard
Solicitor: Paul Silcocks, Bevan Brittan
Party (3) Name: Homes and Communities Agency (HCA)
Address: Block 2 Suite 3 Westbrook Centre Milton Road Cambridge CB4 1YG
Contact: Mike Goulding
Solicitor: Catherine Ochiltree, Beechcrofts
Page 5 of 10 Principle ECC have agreed to forward fund NEPFT’s portion of the design and construction cost of the NAR3, estimated at £4,745,200. HCA have deposited £4m with ECC in lieu of their share of the costs under a separate funding agreement. For the avoidance of doubt, HCA will not be required or liable to meet any further costs in this respect. Below sets out the criteria of the funding and repayment mechanism.
Repayment (a) There will be no long stop date for NEPFT to repay the forward funding to ECC.
(b) From completion of the 375th unit, capital and interest repayments are to be made in 100 unit tranches for NAR3 contributions.
Interest (c) No interest will be charged or accrued on any outstanding balance of the forward funding of the NAR3 until the completion of the 375th unit and thereafter until the completion of the site.
(d) The rate of interest will be charged at PWLB prevailing rate.
Land Charge (e) A legal charge will be placed upon the NEPFT land only or “other contractual comfort” will be given to ECC to ensure that upon sale of the land by NEPFT the purchaser will be obliged to reimburse ECC.
Primary School (f) There will be a separation of the NAR3 and Primary School forward funding elements.
VAT (g) Recoverable by ECC in full.
Condition (h) Completion of this agreement will be conditional upon satisfaction of the other owner’s condition in the HCA’s NAR 3 Funding Agreement.
(i) Completion will need to be simultaneous with completion of the education forward funding agreement, S106 Deed of Variation and Tri-partite annulment. (j) The landowners agree to provide sufficient land for the construction of the NAR3 (k) The landowners will be free to connect into the utility services within the NAR3 on an unencumbered basis.
Timescale (l) ECC will use best endeavours to adhere to the construction timetable attached hereto.
Page 6 of 10
Page 7 of 10 ANNEX 2
Heads of Terms Subject to Contract & Without Prejudice
Severalls Hospital Site, Colchester Education Forward Funding Agreement
Party (1) Name: Essex County Council (ECC)
Address: County Hall Market Road Chelmsford CM1 1QH
Contact: Paul Bird
Solicitor: John Chambers
Party (2) Name: North Essex Partnership Foundation Trust (NEPFT)
Address: Stapleford House 103 Stapleford Close Chemsford CM2 0QX
Contact: Andrew Geldard
Solicitor: Paul Silcocks, Bevan Brittan
Party (3) Name: Homes and Communities Agency (HCA)
Address: Block 2 Suite 3 Westbrook Centre Milton Road Cambridge CB4 1YG
Contact: Mike Goulding
Solicitor: Catherine Ochiltree, Beechcrofts
Page 8 of 10 Principle ECC have agreed to forward fund the design and construction of the 420 place primary school at the Severalls Hospital site and commence construction of the primary school using best endeavours in accordance with the attached construction timetable, subject to statutory processes in parallel with the construction of the NAR3. It has been agreed to revise the timing of the PSCC1 and SSCC1 payments as set out in the extant S106 agreement. All other triggers in respect of primary and secondary education payments will remain as set out in the S106.
Below sets out the criteria of the funding and repayment mechanism:
Repayment (a) There will be no long stop date for NEPFT/ HCA to repay the forward funding to ECC.
(b) From completion of the 300th unit, capital repayments for the PSCC1 and the SSCC1 are to be made in equal amounts in 100 unit tranches such amounts being index linked to the PUBSEC index. ( For the avoidance of doubt at current costs12 payments of £418,207.09) (c ) No distinction will be made between the repayment of and allocation of PSCC1 and SSCC1 monies to allow greater flexibility.
Land Charge (d) A legal charge will be placed upon the whole Severalls site to ensure that upon sale of the land by NEPFT/ HCA the purchaser will be obliged to reimburse ECC.
NAR3 (e) There will be a separation of the NAR3 and Education Infrastructure forward funding elements.
VAT (f) Recoverable by ECC in full.
Transfer of land (g) All parties agree to transfer sufficient land for the school in accordance with the extant S106 at Nil cost.
Condition (h) Completion will need to be simultaneous with completion of the NAR3 forward funding agreement, S106 deed of variation and the Tri- partite annulment agreement.
Page 9 of 10 ANNEX 3
Heads of Terms Subject to Contract & Without Prejudice
Option for the Sale of the Severalls Hospital Site, Colchester
Party (1) Name: Essex County Council (ECC)
Address: County Hall Market Road Chelmsford CM1 1QH
Contact: Paul Bird
Solicitor: John Chambers
Party (2) Name: North Essex Partnership Foundation Trust (NEPFT)
Address: Stapleford House 103 Stapleford Close Chemsford CM2 0QX
Contact: Andrew Geldard
Solicitor: Paul Silcocks, Bevan Brittan
Principle a) The parties hereby agree that the option to purchase the NEPFT land remains open subject to the criteria below
b) The purchase price will be in accordance with the agreed joint valuation process and taking into consideration the effect of any risk mitigation issues and impact of any concessions made with regards to the original or the revised Master Plan for the site.
Condition Exercising the option to purchase will be dependant on sufficient funding being available to the County Council at that time.
The Construction of NAR3 will proceed in accordance with the works programme using best endeavours.
Page 10 of 10
Agenda item No: 4
Name of Meeting: Meeting of the Board of Directors in Public
Date: 24 November 2010
Title of Report: Board 'Awaytime' - 11 November 2010
Presented By: Andrew Geldard, Chief Executive
Subject, Purpose and Recommendation: The Board is asked to receive the initial feedback report from Andrew Geldard, Chief Executive, and confirm the key forward looking points from the 'Awaytime' session on 11 November, 2010.
Finance Implications: N/A
Clinical Implications: N/A
HR Implications: N/A
Legal Implications: N/A
Equality Implications: N/A
Risks: N/A
Board Awaytime - 11 November 2010 Initial Feedback
1. Introduction
The Board met on 11 November 2010 at an 'Awaytime' event held within Maple Ward, Colchester. The day was sub-divided into three main sessions: i) The consideration of the outcome of the recent West Essex Community Health Services (WECHS) bid and revisiting the options for the future business strategy. ii) Developing and shaping the Trust's strategy. iii) Early consideration of the financial plan for 2011/12-2012/13.
This brief paper gives early feedback on the themes that were developed during the day.
2. Major Themes a) Business Strategy - was reconfirmed in line with the discussion held at the May 2010 'Awaytime', i.e. a focus on organic growth based on mental health/substance misuse and associated services in North Essex and adjacent geographic areas. The Trust needs to increase its pace and appetite in relation to this activity. b) Community Services - whilst the prime opportunity for this form of expansion has probably passed, we need to be more active in selling the Trust as a fall back position. The onset of 'any willing provider' may provide a future way into this market. c) There was no significant appetite for pursuing a merger route with South Essex Partnership NHS Foundation Trust (SEPT). The merger route elsewhere was not ruled out, but would need to be based on a more holistic analysis rather than a knee-jerk reaction. d) The stated business strategy provides a clear position for articulation to partner/purchaser organisations and further description in the forthcoming public strategy. e) The existing 'Vision and Values' work was reconfirmed, possibly with an additional section describing the Trust's approach to our commissioners/ tenders. f) The strong "family" feel of the organisation was encouraged. g) External relations require further work and more emphasis.
Page 1 of 2 h) We need to focus on our "products". Good quality services is a given. How do we layer other goods on top of this? i) The Financial Plan for 2011/12 is a critical piece of work, as is the negotiated content for next year. j) The Executive Directors need to consider how they make better/more effective use of the skills afforded by the Trust's Non-Executive Directors.
3. Recommendation
The Board is asked to confirm the above as the key forward looking points from the 'Awaytime' session on 11 November 2010.
Andrew Geldard Chief Executive
24 November 2010
Page 2 of 2
Agenda item No: 5
Name of Meeting: Meeting of the Board of Directors - Part 2 Confidential
Date: 24 November 2010
Title of Report: NHSLA Assessment Feedback
Presented By: Dr Malte Flechtner, Medical Director
Subject, Purpose and Recommendation; The Trust was unsuccessful in achieving NHSLA level 3 and was downgraded to level 0. We are awaiting the full, detailed assessment report. The focus will now me to achieve level 1 again at the next assessment.
Finance Implications: Increased NLSA premium.
Clinical Implications: N/A
HR Implications: N/A
Legal Implications: N/A
Equality Implications: N/A
Risks: The Trust will be perceived to run higher risks. This could damage our reputation with Commissioners, and alert CQC and Monitor.
North Essex Partnership NHS Foundation Trust
NHSLA Assessment Feedback - initial report 11 November 2010
This report is based upon the feedback from the assessors over the two assessment days as we are still awaiting the full report and this will not be received before 20 days from the assessment.
The Trust was unsuccessful in achieving level 3 compliance and this is around the area of monitoring. North Essex Partnership is the only mental health Trust to date to be assessed at any level in this financial year. If we had been successful then we would have been the only mental health Trust to be level 3.
Level 3 is gold standard and extremely difficult to achieve. NHSLA is meant to be mainstream not a separate part of the Trust activity. It is crucial that the preparation for any future assessment must cover each document in detail as this level of assessment requires absolute adherence to detail.
The NHSLA rules and the risk of going for Level 3 is that if we do not meet level 3 sufficiently then we fall back to 0. At the Board meeting where it was agreed to go for Level 3 it was explained that this was significantly different evidence from Level II and that the evidence required was for the preceding 12 months.
We have extended the period to the full three years to allow for policy revision and embedding of monitoring processes. At the time of the assessment we had no choice but to be assessed. The only choice was the level of assessment. It is extremely difficult, due to the difference in the evidence to change levels so close to the assessment.
The only choice open would have been to go for level 1 and in hindsight based on the feedback during the assessment some of the documents would not have met the level 1 compliance. This is due to the requirement to spell out literally every aspect of the monitoring including the format of the reports.
It is due to their exacting standards that our monitoring was commended by the assessors, however, it was not possible to give compliance as the original document – policy etc did not state this particular monitoring mechanism.
Below are some examples of the assessment.
Standard 1 Governance
We complied with 5 of the 10 standards in this category at Level 3 and we needed to have 7.
The Risk management strategy did not explicitly state how they would monitor quarterly the risk assessment processes in the Trust that is done through the administrative mechanism of the RGE calendar to ensure that groups dealing with this are reporting progress and the need for action.
Policy and procedure writing monitoring did not monitor the archiving arrangements and this was also not part of the Deloitte audit in sufficient detail for the assessors. This is all Trust policies not just clinical policies.
Standard 2 Competent and capable workforce
The major error in the assessment is the lack of monitoring of the follow up on training when staff fail to attend and this affected 13 elements out of 50. Whilst the Mandatory and statutory training process did not state explicitly in the monitoring section that follow up on non attendance would be included, this was also not physically present in most of the training monitoring evidence and therefore Level 3 compliance would still not have been achieved. It should be noted that this affected 8 criteria in this standard and 5 criteria in other standards. Training monitoring must be sorted before we can achieve level 2.
Temporary staff induction did not have 12 months of monitoring and this was requested in January when the policies came through RGE- the eventual report was submitted in October.
Induction monitoring – corporate and local was also not explicitly stating follow up and the monitoring of follow up was not in the reports explicitly either. We would not have achieved level 1 compliance as we did not state in the monitoring section that follow up on non attendance was being monitored and how this was done.
There is also a requirement to have training in record keeping, supervision and dual diagnosis. Therefore they only granted compliance against one of the 10 criteria.
Standard 3 Safe environment
The Trust achieved 7 out of 10 for this standard. They wished to see more action plans as a result of risk assessments for manual handling, inoculation incidents and absent without leave data. It was not deemed sufficient to be just monitoring the level of occurrence.
Standard 4 – Clinical care
This area was seriously affected by the capacity to conduct in house audit. They wanted to see more robust action plans and evidence of actions taken. It was unfortunate that we had tried to undertake one large audit to cover a number of the elements in this area, however, this was not undertaken until the summer and the actions were not sufficiently underway for them to grant compliance in these elements. Therefore they only granted compliance against one of the 10 criteria.
Standard 5 – Learning from Experience
This area achieved 7 out of 10 criteria. The elements that required further work was a separate policy on national confidential enquiries and national enquiries. Monitoring our policy on being open requires further work and this was a difficult one to gain compliance as NHSLA were unclear as to the nature of the evidence they would expect. Finally they wanted the monitoring section on the incident reporting policy to be redrafted to make it more explicit. We are awaiting further detail in the report.
The following are the baseline documents required before any assessment can commence.
1. Risk Management Strategy 2. Policy and procedure writing 3. Terms of reference of RGE and Audit Committee 4. Risk Management Process 5. Health and Social care Records 6. Record keeping standards 7. Mandatory and statutory Training policy and Annual report* 8. Induction policy 9. NETSS induction 10. Employment check policy 11. Registration Policy 12. Rapid Tranquillisation 13. Safeguarding adults 14. Dual Diagnosis 15. Needlestick 16. Infection control 17. Discharge /CPA 18. Transfer of service users 19. Sickness absence 20. Physical Healthcare 21. Missing persons procedure 22. Staff support 23. Incident reporting 24. Claims management 25. Complaints 26. Audit 27. Being open 28. Manual Handling 29. Harassment and Bullying 30. Stress Management 31. Nice guidance 32. National Confidential enquiries 33. External visits Policy 34. Security 35. Falls Prevention 36. Health and safety 37. Medicines Management 38. Violence and aggression 39. Resuscitation 40. Service user information 41. Training Needs Analysis 42. Clinical Risk Protocol 43. Inpatient Observation Policy
We also need to be tighter on version control and track changes on documents as these are not tolerated by the assessors.
Archiving of documents needs to be demonstrable both Policies/ procedures and service users information leaflets.
Appeal Process
This is the appeal process from the handbook however we would need to be specific about the 9 areas we wished to challenge in order to retain level 2 compliance.
If the organisation has any concerns about the assessment or report it should raise these with their assessor or the DNV Operations Manager as soon as possible and no later than 20 working days after receipt of the report. If the concerns are not resolved to the organisation’s satisfaction and it feels that the assessment outcome is unjust, it may refer the matter to the NHSLA. An email or letter should be sent to the Risk Management Director as soon as possible, and no later than 40 working days following receipt of the assessment report. It should be noted that the assessment level and full report will be available on the NHSLA website. This will also feed into the CQC planned collaborative review – next one is scheduled for January.
Next Steps
We need to be proactive and keep the momentum from this disappointment to achieve level 1 compliance early in the next financial year. We cannot be assessed for more than one level in one financial year but the next 12 months need to provide evidence for level 2 assessment in 2012/13. Minor alterations to the above mentioned documents need to be project managed over the next 3 months. An independent mechanism to check against the NHSLA requirements would offer further assurance in this process. Key deficit to be addressed is the co-ordination, recording and reporting of all mandatory training in the organization. A work stream is already taking this forward with a target date of January 2011.
Meeting of the Board of Directors – Part 2 Confidential 24 November 2010
Agenda item 6 – Revolving Credit Facility Agreement Appendix 3
Changes to the Constitution since 02 November 2010
25/11/09 – Reference to NHS Act Constitution Update - In order to correct the references to the NHS Act 2006, the Board of Directors approved the following resolution: “That the references to sections 224 and 225 of the National Health Service Act 2006 appearing in Annex 5 of the revised Constitution and in Schedule C of the revised Standing Orders for the Council of Governors, which were approved by the Board at its meeting on the 21October 2009, be corrected to references to sections 244 and 245 of that Act”
28/01/10 - Inclusion of Additional Appointed Governor (Tendring & Colchester Ethnic Minority Partnership) The Board of Directors approved the associated resolutions.
26 May 2010 – Variation to Standing Orders The Board of Directors unanimously passed a resolution to amend standing order 9.3.2.1* of the Standing Orders of the Board of Directors by substituting the figure of £30,000 for the figure of £50,000, subject to and with effect from the date of Monitor’s approval being given to that change.
*Standing Order 9.3.2 read:
Agenda Item No. 7
Name of Meeting: Meeting of the Board of Directors – Part 2 Confidential
Date: 24 November 2010
Title of Report: Prudential Borrowing – Application for loan finance
Presented By: Rick Tazzini, Director of Resources
Subject, Purpose and Recommendation:
The Trust seeks to progress its strategic capital programme, to retain existing business in high quality and safe settings and also to pursue new business lines for regional/national services to generate additional margin.
During 2009 and 2010, the Board approved a number of business cases for CAMHS, LSU, Derwent Centre and PICU. Approval was granted by the Board in June 2010 to commence the CAMHS scheme, due for completion in mid-2012. The Board unanimously agreed that the LSU scheme should proceed as soon as possible. Other strategic schemes will require funding in due course. However funding remains an obstacle to getting the strategic schemes off the ground. The Board requested that the Director of Resources investigate further the opportunities to achieve the strategic capital intentions.
Whilst the CAMHS unit has already commenced, the funding required for the unit is £9.4m, of which £2.25m has been obtained from the DoH as PDC, leaving a unfunded balance of £7.15m.
Recent discussions with the DoH Trust Financing Unit has indicated potential availability in the current year of loan finance for Trust’s capital schemes. The Trust has been invited, if approved by the Board, to submit the CAMHS business case to apply for loan finance of up to £7million. There is no guarantee of available funding, but the Trust is encouraged to seek such an opportunity. At the time of writing, the current DoH loan finance interest rates of 3% are favourable and a new loan will produce a saving of 3.5% on the PDC dividend calculation. In effect, the loan places no strain on the revenue budget. DoH loan rates vary each day according to market conditions.
The Trust’s Prudential Borrowing Limit (PBL) is £28.2m (includes £8m working capital facility). The forecast PBL balance at year-end is £20.643m. The Trust can apply for further borrowing of £7m and remain within the PBL for long term loans.
The Financial Risk Rating (FRR) will see a slight dilution on the Return on Assets criteria but an increase in Liquidity criteria. These can be managed to ensure no dilution in the overall FRR for 2011/12.
Page 1 of 7
Recommendation: The Board of Directors is asked to give the Director of Resources authority to apply for a loan finance facility up to a maximum value of £7million to part-fund the CAMHS capital development, over a period of not less than 10 years at the current DoH Trust Finance rates. If DoH loan finance is forthcoming the Director of Resources will return to the Board with the detail of the loan agreement, a suggested Board minute authorising the specific loan and the appropriate Directors Certificate for approval.
Finance Implications: A loan finance facility of £7million is affordable and within the Trust authorised PBL for cumulative long term borrowing. A Loan will not dilute overall FRR. The Trust is considered to be a going concern able to implement its approved strategic plans and enter into such agreements.
Clinical Implications: The enhancement of Trust mandatory services from existing settings into purpose built, first class, modern environs with additional services for extra margin.
HR Implications: n/a
Legal Implications: The Trust will seek legal advice on the loan, which is likely to be similar to the existing Crystal Centre loan.
Equality Implications: None.
Risks: Key risk is securing sufficient revenue surplus/margin and cash to finance the loan repayment and retaining contracts for mandatory services.
Page 2 of 7
North Essex Partnership NHS Foundation Trust
Prudential Borrowing – Application for loan finance
Introduction
The Trust seeks to progress its strategic capital programme, to retain existing business in high quality and safe settings and also to generate additional margin by developing new specialist business lines for regional/national contracts.
This paper seeks approval from the Board of Directors to authorize the Director of Resources to apply for a loan finance facility with the DoH Trust Financing Unit up to a value of £7million to part-fund the CAMHS development. If such an offer is forthcoming, then the detail of any such loan facility agreement will be brought before the Board of Directors for approval.
Background
During 2009 and 2010, the Board of Directors approved a number of business cases for CAMHS, LSU, Derwent Centre and PICU (latter two were conditional). Approval was granted by the Board of Directors at its meeting in June 2010 to commence the CAMHS scheme, due for completion in mid-2012. The Board unanimously agreed that the LSU scheme should proceed as soon as possible, given the need to relocate from the Severalls site, meet national LSU standards, tender requirements and seek extra margin from new “step down” services. However, funding of the overall strategic capital programme remains an obstacle.
The potential sources of finance for strategic capital schemes are: I&E surplus Borrowing - new loans PDC from the DoH Asset disposals Government / PCT / 3rd party contributions (grants)
The first call on the I&E surplus is the principal repayment of the existing 10-year loan, at £444k/pa, rising to £890k/pa once the full loan is drawn down.
Depreciation is the main source for operational capital, i.e. replacement, refurbishments and infrastructure and the demands (c£2.5m/pa) are broadly in balance with depreciation charges.
The total strategic capital expenditure for the building and IT schemes ranges from £25m to £36m. The variability arises in potential range of schemes for the Derwent Centre. The Trust has already received £8.5m of specific PDC funding from the DoH. This money sits within the Trust’s current cash balances. The Trust will draw down n Q4 of 2010/11, the £4m balance of the Crystal Centre loan. The Trust could also generate potential receipts of up to £2.5m from property disposals, excluding Severalls in the next 2-3 years. This leaves an unfunded balance if all schemes were to proceed of between £10m-£21m.
A main case scenario for the next three years is exemplified in the table below.
Page 3 of 7
High level Capital Requirements - 2010/11 to 2012/13 (3 years)
£m
Operational capital- 7.500 Funded from Depreciation 7.500
Strategic Schemes Low Secure - 5.320 CAMHS - 9.400 PICU - 4.700 Derwent Centre say - 5.500 Carebase / IT - 3.000 - 27.920 Strategic Funding Cash New PDC - existing cash balances 8.500 Further internal cash / WC ? I&E surplus 6.400 Loan repayment- 4.100 Existing loan draw down 4.000 Asset sales 2.500 Severalls ? Grants / Contributions ? New Loans ? 8.500 8.800 17.300
The table shows a main case shortfall in funding of at least £10million. Securing existing business and developing new services in CAMHS and LSU are a critical element of the Trust’s Business Strategy for organic growth.
Whilst the CAMHS unit has already commenced, the funding required for the unit is £9.4m, of which £2.25m has been obtained from the DoH as PDC, leaving an unfunded balance of £7.15m.
The LSU approved business case cost is currently £5.3m, based upon the former P21 procurement route. At the Board of Directors meeting in October 2010, approval was given to move to the traditional competitive tender route in readiness for approval to commence the scheme at some later date. PDC funding form the DoH of £4.09m has been received by the Trust for LSU.
Availability of loan finance
Recent discussions with the DoH Trust Financing Unit have indicated potential availability in the current year of loan finance. The Trust has been invited to submit the CAMHS business case to secure loan finance of up to £7million. There is no guarantee of available DoH funding, but the Trust has been encouraged to seek such an opportunity. At the time of writing, the DoH Trust Financing Unit is offering such loan finance at a relatively favourable interest rate of 3%. The DoH rates vary each day, according to market conditions.
The Trust already has a loan of £8million from the DoH Trust Financing Unit for the Crystal Centre, £4m of which was drawn down in 2009/10 with the balance being drawn down in Quarter 4 of 2010/11.This loan finance agreement was negotiated in 2008 at an interest rate of 5.56%.
Page 4 of 7
Prudential Borrowing Limit (PBL)
The PBL is the sum of the cumulative long term borrowing limit and working capital facility. The PBL is based on Monitor’s assessment of the Trust’s Annual Plan. The Trust’s authorised Prudential Borrowing Limit 2010/11 for cumulative long term borrowing is £20.2million. Adding the working capital facility of £8million, brings the maximum PBL to £28.2m. As at 1 November the Trust’s available borrowing limit is £24.643m, as shown below;
Borrowing Limit £'000s
Max long Term Borrow ing 20,200
Working Capital Facility 8,000
Draw Dow n (4,000)
Repaid 443
PBL Available 24,643
The Trust has drawn down £4million against the £8m loan for the Crystal Centre in 2009/10 and plans to draw down the balance of £4milllion in quarter 4 of 2010/11. This will reduce the available PBL to £20.643m.
The Trust could borrow a £7million for CAMHS and would retain a balance on the total PBL of £13.6million; comprising £8m working capital facility and £5.6m long term borrowing. As loan repayments of principal are made the available PBL for long term borrowing increases up to the maximum PBL.
Financial implications
A loan rate 3% is a very attractive proposition in terms of revenue affordability, since the loan will reduce net assets in the calculation of the 3.5% dividend charge. The loan has the effect of reducing the Trust’s net assets, as long as the cash is held on the 31 March in non- commercial deposits i.e. the PGO account. Therefore, the cost of a loan at 3.5% or lower will not bear a burden on the I&E revenue account. A loan at 3% is modeled in the table below.
Page 5 of 7
Exemplification of £7million loan at 3% over 10 years
Loan repayment PDC Dividends calculation Year Principal Interest Balance Increase Capital Net Cost 3.0% Creditors Charge saving (saving) 3.5% (£7,000,000) (£7,000,000) (£7,000,000) Yr1 £350,000 £102,375 £452,375 £350,000 £97,125 £447,125 (£6,300,000) (£232,750) (£33,250) Yr2 £350,000 £91,875 £441,875 £350,000 £86,625 £436,625 (£5,600,000) (£208,250) (£29,750) Yr3 £350,000 £81,375 £431,375 £350,000 £76,125 £426,125 (£4,900,000) (£183,750) (£26,250) Yr4 £350,000 £70,875 £420,875 £350,000 £65,625 £415,625 (£4,200,000) (£159,250) (£22,750) Yr5 £350,000 £60,375 £410,375 £350,000 £55,125 £405,125 (£3,500,000) (£134,750) (£19,250) Yr 6 £350,000 £49,875 £399,875 £350,000 £44,625 £394,625 (£2,800,000) (£110,250) (£15,750) Yr7 £350,000 £39,375 £389,375 £350,000 £34,125 £384,125 (£2,100,000) (£85,750) (£12,250) Yr8 £350,000 £28,875 £378,875 £350,000 £23,625 £373,625 (£1,400,000) (£61,250) (£8,750) Yr9 £350,000 £18,375 £368,375 £350,000 £13,125 £363,125 (£700,000) (£36,750) (£5,250) Yr10 £350,000 £7,875 £357,875 £350,000 £2,625 £352,625 ‐ Totals ‐ £1,050,000 £1,050,000 (£1,212,750) (£173,250)
Financial Risk Rating – 2011/12
Return on Assets (RoA) Whilst the impact on the I&E surplus is negligible, a loan has the effect of increasing the value of assets in the calculation for RoA. All other things being equal, the new loan will reduce return on assets from 5.5% to 4.9%. To avoid the dilution of this criteria’s rating the Trust will need to increase the I&E surplus to meet or exceed 5% to maintain RoA rating 4.
Liquidity The receipt of the loan will initially increase liquidity by £7million, adding some 21 days and reaching 60 days. This will improve liquidity from a rating 4 to 5 on the liquidity criteria.
Conclusion
The Trust seeks to progress its strategic business objectives and develop strategic capital schemes to retain existing business in high quality and safe settings and also to generate additional margin by developing new specialist business lines for regional/national contracts.
The potential opportunity to borrow from the DoH at favourable interest rates, that does not dilute I&E surplus/ margin or FRR is particularly attractive value for money solution to achieve the Trusts business development intentions. Securing such funding for CAMHS will enable the Board to approve the commencement of the LSU scheme.
Page 6 of 7
Recommendation
The Board of Directors is asked to give the Director of Resources authority to apply for loan finance for the CAMHS unit up to a maximum value of £7million over a period of not less than 10 years. If DoH loan finance facility is forthcoming, the Director of Resources will return to the Board of Directors with the detail of the loan agreement, a suggested Board minute authorising the specific loan and the appropriate Directors Certificate for approval.
Director of Resources 12 November 2010
Page 7 of 7
Agenda item No: 8
Name of Meeting: Meeting of the Board of Directors - Part 2 Confidential
Date: 24 November 2010
Title of Report: Audit Committee Minutes - Draft (14 October 2010)
Presented By: Ray Cox, Non Executive Director
Subject, Purpose and Recommendation: In accordance with Terms of Reference of the Audit Committee the minutes of the meeting held on 14 October 2010 (draft) are attached; for information.
Finance Implications: N/A
Clinical Implications: N/A
HR Implications: N/A
Legal Implications: Declarations of interest are required to comply with Standing Order 7 (“Declarations of Interest and Register of Interests”).
Equality Implications: N/A
Risks: N/A
L:\Board Meetings in Public\2010\24 Nov 2010\Part 2\agenda item 8.1 - Audit Cttee Cover.doc D R A F T NORTH ESSEX PARTNERSHIP NHS FOUNDATION TRUST AUDIT COMMITTEE Minutes of meeting held at 8.00 am on 14th October 2010 in the Seminar Room at Stapleford Close
Present: Ray Cox, Audit Committee Chairman (RC) Charles Abel Smith, Non-Executive Director (CAS) John Gilbert, Non-Executive Director (JG)
In attendance: Rick Tazzini, Director of Resources (RT) Dermot McCarthy, Trust Secretary (DMC) Mark Hodgson, Audit Commission (MH) Carl Pettitt, Audit Commission (CP) Mike Clarkson, Deloitte (MC) Dan Bonner, Deloitte (DB) Priti Amin, Local Counter Fraud Officer (PA) Carol Edwards, PA to Director of Resources (Minutes) (CE)
RC asked if the agenda items could be re-arranged, as CAS needed to leave at 9.45 am, i.e. Items 1-6 and Items 9(b) and (d) be reviewed before his departure. This was agreed.
1. APOLOGIES None.
2. ADVICE OF URGENT OTHER BUSINESS None advised.
3. AGREE MINUTES OF MEETING HELD ON 8TH JULY 2010 The minutes were confirmed as accurate.
4. MATTERS ARISING Page 1. Matters Arising. Internal Audit Reports. Patient Monies & Property. RT apologised for the Report not being included on the agenda, noting that it was 80% complete but again due to pressure of work on the 2009/10 Accounts, it had not been possible to finalise it. To be brought back to the Committee in October. Action: RT On current agenda.
Page 1. Matters Arising – Item 7e. Internal Audit Reports Treasury Management & Property. Draft would be taken to EMT and the Trust Board. However, it was agreed that the draft would be circulated to the Audit Committee before being taken to EMT/ Trust Board. RT reported this would need to be deferred to a later date due to contract negotiations and annual accounts commitments, although he had already held some discussion on the matter with David Lambert. Action: RT On current agenda.
Page 3. Item 9b. Proposed Guide for Governors on NHS Finance & Financial Accounts. RT reported that the Guide was in progress, and DMC advised that it would be presented in one of the workshops at a Development Day for Governors planned for 24th Aug. Action: RT RT reported he had run two sessions for the Governors on 24th August, which had generally received positive feedback.
Page 4. Item 7a. Internal Audit. Progress Report 2010/11 – July 2010. RT to provide a progress report on responses received within the allocated 15-day period. He would also contact the manager responsible if it appeared that it was unlikely a response would be produced within that period, to ensure some action was taken. Action: RT RT noted an improvement to 50% had taken place, with further improvement expected during the year.
Page 4. Item 7b. Follow Up of Previous Recommendations – July 2010. DH to investigate whether a D10150 1 D R A F T further column might be added to the graph for Recommendations which had not passed verification. Action: Dan Hellary. DB said he was not clear on this request. It was agreed this would be reviewed later in the meeting.
Page 5. Item 7b. Follow Up of Previous Recommendations – July 2010. RT to bring an update on Poppie to the next meeting of the Committee in October. Action: RT On current agenda.
Page 5. Item 7c. Internal Audit Reports. JG suggested a summary might be included on the front page of each report for easy reference. Action: DH / DB DB confirmed a section on Key Recommendations had been added. JG asked that a box be added to the front cover of Reports with rating information. Action: DB
Page 5. Item 8a. LCFS Strategy 2010/11 – 2012/13. RT advised that the Strategy had been circulated to EMT by email, and it was agreed that he would retrospectively formally present a hard copy to the next EMT meeting. RT to let RC know when this had been actioned, and RC would then advise the Committee. Action: RT / RC RT confirmed this had been actioned.
Page 5. Item 8b. LCFS Work Plan 2010/11. National Exercises. RC said if a national exercise did take place, he would like some follow up to be reported by RT, i.e. what implications it might have for the Trust and what actions had been taken, in order to demonstrate that the Committee was using this resource in an effective way. Action: RT PA confirmed this had been covered in the LCFS Work Plan.
Page 6. Item 8c. LCFS Progress Report 2010/11 – June 2010. RT said it might be helpful if a Corporate DVD, which was presented at Induction Course and which included a section on Counter Fraud, be presented to the Trust Board. Action: RT RT confirmed this had been circulated to all Non Executive Directors at a Trust Board in the summer.
Page 6. Item 8c. LCFS Progress Report 2010/11 – June 2010. A draft report on the tender process requested last year had been completed which would be presented at the next Audit Committee. Action: PA. On current agenda.
Page 6. Item 9a. Annual Report to the Chief Executive (April 2009 – March 2010). Clinical Audits – it was suggested that JG raise the issue of audits which had to be done and those audits which staff would like to do. Action: JG JG confirmed that there were ongoing discussions at R&GE about progress on clinical audits. RC asked that JG make a note of issues in this regard for discussion at the joint meeting of R&GE and the Audit Committee which was to be arranged. Action: JG
Page 7. Item 10a. Monitor’s Code of Governance. CAS asked if there was anything which could be done to draw together how the internal audit reports have helped the Trust bring about changes and improvements in the way in which it operated. DH said he would attempt to obtain the report which addressed this. Action: DH DB noted he had misunderstood the request and after some discussion, it was clarified that the request had been to identify what value Internal Audit had added to the way the Trust conducted its business and evidence produced to this effect. It might also be something Internal Audit could include in its Opinion at the end of the year. It would also highlight to EMT, the Governors, and individuals in the Trust the importance of Internal Audit. Action: MC / DB
Page 7. Item 10b. Review of Audit Committee’s Terms of Reference. On a suggestion from DMC, a few further additions to the ToR under sections 6.3 and 7 were suggested. RT and DMC would agree these and thereafter forward to RC for review. Action: DMC / RT. On current agenda
D10150 2 D R A F T Page 7. Item 10d. Approach to Costing. CP advised that he was part of a Mental Health costing group which had been set up primarily recognising that Payment by Results was beneficial. From this, a sub group had been formed, comprising of Trusts which were trying to establish how much services were costing internally, and to possibly move beyond PbR to a system whereby individual patient level costings could be established. It was agreed that CP would periodically update the Committee on the progress of the group. Action: CP CP confirmed he would keep the Committee updated but the M H Costing Group had not met since the last Audit Committee.
Page 8. Item 11a. Audit Committee Forward Planning Calendar 2010/11. It was agreed that a special brief meeting be included to take place before the May Trust Board to approve the Accounts. DMC would amend the list, which would be circulated to the Committee. Action: DMC / CE DMC said that a special 8.00 am meeting in May to approve the Accounts had now been scheduled into the meetings’ calendar for next year.
5. EXTERNAL AUDIT a) Progress report against Audit Plan 2009/10 – October 2010 MH introduced the Plan, briefly noting a few main issues, including: All issues compliant with ISA and Monitor’s Code The production of a national report on Quality Accounts.
RC thanked MH for the informative report which had been produced.
RC drew attention to Paragraph 37 concerning ISA260. RT advised that he would bring a report on the progress of the Recommendations back to the next meeting in January 2011. Action: RT
RT gave an update on progress with the Key Considerations.
The Director of HR & Workforce Development had been supplied with the NAO report for managing staff costs. Information Governance was planned for this year. The Toolkit had changed markedly from the previous year. DB would check which Version on the current version, i.e. 7 or 8. Action: DB Annual Governance Report would be reported on at the next meeting. Monitor’s Guide on Transforming Community Services was included in the current agenda. The Trust’s Annual Plan had been reviewed by Monitor and awarded a green light. The Governors had been made aware of the new quarterly newsletter for Governors. Care Quality Commission’s assessment methodology for 2010/11 – RT would check with the Director of Nursing & Operations and the Medical Director in this regard. Action: RT RT confirmed the Trust was aware of the Quality & Risk Profile recently issued by the Care Quality Commission.
On a query from RC, JG confirmed he felt confident the latter two items mentioned under the above bullet points would be brought to the R&GE at some point. Action: RT
b) External Assurance on the Quality Report – July 2010 CP gave a brief summary of the findings of the ‘dry run’ which had taken place in July in preparation for the publishing of the Quality Report. The review of arrangements had included various criteria and some recommendations had been made. Criteria included: Governance & Leadership Policies Systems and Processes People & Skills Data Use and Reporting.
On a query from RC regarding the Action Plan in Appendix 3, CP confirmed this included all the actions which were required from the Trust. He confirmed he was satisfied with responses from management, and reported on issues surrounding the latest information on timescales. There had
D10150 3 D R A F T been some discussion around whether the 2010/11 Quality Report would be externally reported or whether again, it would be a dry run just reported to the Board. CP awaiting Monitor decision.
RC queried whether in the case of Monitor not providing for flexibility on the timescale as set out in the Action Plan, would the Trust be likely to have a qualified report? CP responded that it was possible but they were limited by when the controls actually came into place, an issue which would affect many Trusts. RC felt the Board should be made aware of this, and asked CP whether there was anything which could be done by the Trust to make Monitor aware of the issue. This was discussed, and CP noted it was a matter to watch, and one on which careful consideration was being given by Monitor. CP agreed to update the Committee when further information was available. Action: CP
After some lengthy discussion around the collection of data and its quality, MH confirmed the overall system was satisfactory, but because of the Action Plan’s timing, individual indicators could not be guaranteed to be in place for the major part of 2010/11. RC noted a lot would depend upon Monitor’s attitude, i.e. if another dry run was decided upon, then some of the urgency around the issue would be dissipated. However, the general urgency around the matter remained and reinforcement of this to the teams inputting data was critical.
CAS suggested that the Board might need to be made aware of the above to raise the importance of the matter. RT said the Data Quality Policy could be presented to the Board when it had completed the process of going through the internal mechanisms. RC commented that the Audit Committee minutes would be taken to the Board, and this would present an opportunity to highlight the issue. Action: RC
c) Annual Audit Letter 2009/10 – September 2010 MH gave a brief summary of the Letter. RC said it was a positive report, and the comments on Data Quality were consistent with what had been included in the other two Reports.
RC thanked MH/CP for all their Reports.
6. INTERNAL AUDIT a) Progress Report 2010/11 – October 2010 MC briefly reviewed the Report, noting: Six final and five draft Reports had been delivered, with five audits having been booked. Approximately 50% year to date had therefore been achieved. Fifteen Terms of Reference 2010/11 had been issued to management. Performance Indicators had been developed and reported on.
MC noted from Internal Audit’s perspective, good progress had been made in the delivery of the above, and asked the Committee for comments. Performance against the key indicators was discussed and noted.
b) Quality Plan 2010/11 DB advised that the report had recently been introduced and would be brought to the Committee on an annual basis at the beginning of each year. The report set out Internal Audit’s standard of service and how Recommendations had been categorised. It also noted agreement on how information of a sensitive nature was obtained in accordance with the Caldicot principles. DB then briefly reviewed the report.
RC raised the issue of delays in the verification of reports, and asked if a standard could be set for this to draw staff’s attention to completion within a timeframe. MC said a discussion should be held with RT, as there were various ways of approaching the matter. RT said he would again send out a clear message to remind staff of their obligation to respond in a timely way to the Auditors.
JG asked whether trigger points had been set up in regard to Priorities 1 – 3 as they were in the Risk Matrix. DB would confirm this with Sue Barry. Action: DB
D10150 4 D R A F T JG queried the performance target of 40% for qualified staff when in fact double that was consistently achieved. MC said that it was a requirement to quote in the proposal a minimum percentage coverage level of FTE staff fully or partly qualified, so this was the target set.
c) Follow Up of Previous Recommendations – July 2010 DB reviewed the Recommendations, noting that: 19 had been removed from the schedule, with a further 12 being added in. The graph indicated an improvement, with the slight increase in the overdue Recommendations predominantly caused around delays in progressing Poppie, the Internet and IT Strategy.
A lengthy discussion ensued regarding lack of progress in implementing Recommendations. The following suggestions were noted:
JG felt that the Trust should have a clear statement of policy about the management of risk and the management of audit findings.
RT said Priority 1 Recommendations would be non-negotiable and the managers involved would need to attend EMT to give an explanation if the matter remained outstanding.
DB to speak to a few key teams within the Trust to explain the audit process, which would help in drawing attention to the importance of this. Action: DB
RC asked DB to advise him if he considered that managers requested extra time for implementing recommendations in order to keep themselves on the safe side of the timeframe. Action: DB
MH said Recommendations could be fed into an External Audit tracker to enable a clear picture to be available to the Committee. This was agreed. MH/MC to liaise. Action: MH/MC
JG suggested once the Recommendations had been dealt with by Internal Audit, R&GE could be advised of all the outstanding Recommendations.
RC noted that if the responsible officer wished to revise a recommendation made by internal audit, some discussion should be held with their line manager to obtain a second view, otherwise it would be less than best practice. After some lengthy discussion on this issue, as well as setting realistic deadlines, RC suggested JG raise the process of managing risks at R&GE. RT follow up with MA. Action: RT / JG
d) Internal Audit Reports DB reviewed the four reports: Charitable Funds – Substantial Assurance - (No.1: Priority 2). Procedural Guidance. On a query from RC regarding the policy on the “Guidance on Spending of Charitable Funds”, RT confirmed this would be brought to the Audit Committee in January 2011 after approval by the Charitable Funds Forum. Action: RT - (No. 3: Priority 2). Gift Aid Reclamation of Tax. Gift Aid forms to be held on the units. RT to check with Clare Povah for further details. JG noted that there was an opportunity to obtain donors’ signatures to gift aid 6 years past donations under the millennium scheme. Action: RT
Care Programme Approach – Limited Assurance - (No. 2: Priority 1). Retention of Signed Care Plans/CPA Review Forms. RT advised that the CMHT teams at Latton Bush had gone paperless on a six months’ trial, so this might be something for consideration in the future. MC noted part of the problem was that both paper and computer records were held which could result in missing documentation. The problem might be solved if only one or the other was maintained - as was being attempted at Latton Bush.
Business Continuity Planning – Substantial Assurance - It was agreed that Internal Audit would add an explanatory comment to management responses - D10150 5 D R A F T if appropriate - to clarify issues. Action: DB
IT PC Controls – Limited Assurance After some discussion around accepting the risks contained within a few of the recommendations, RC noted that as a Limited Assurance report, it would be presented to EMT for their consideration of the risks involved, and this could be followed up at the next meeting.
7. LOCAL COUNTER FRAUD SERVICES a) PROGRESS REPORT 2010/11 – OCTOBER 2010 PA briefly reviewed the Report, highlighting the main issues: Publicity. A number of activities had been undertaken to help further raise awareness of fraud. Fraud Awareness & Training. Individual teams were being contacted to remind them of the availability of fraud awareness sessions. A number of Trust Policies had been reviewed. Five fraud alert notices had been issued. Protocols had been agreed and signed with Internal Audit. There had been no requests from CFSMS for National Proactive or Risk Measurement Exercises. The Trust will, however, take part in the Audit Commission’s National Fraud Initiative as far as is required. Local Proactive work has included a final report on tendering arrangements (included in the current agenda). One new referral had been received since the last Audit Committee, with the continuation of a previously opened investigation.
RT also confirmed that work had been completed on Quality Assessment, which had replaced the previously named Compound Indicators. PA said the issue of ratings for the Quality Assessments had commenced the previous week for Trusts which had received a rating of One last year.
PA then took questions from the Committee.
Appendix 2 – Other Referrals. RT to follow up a referral on the potential fraudulent cashing of a petty cash cheque. Action: RT
MC queried, when making reclaims on salaries, whether tax and national insurance were reclaimed as well. RT would check and report back. Action: RT
b) REVIEW OF TENDER PROCESSES – OCTOBER 2010 PA said that this was the final report on the review of the Trust’s tender processes which had been requested by the Chair of the Audit Committee. A number of findings and recommendations had been made and the report had been discussed and agreed with management. On a query from RC, PA confirmed that she was happy with the response from management. The recommendations would be followed up through Internal Audit, and PA confirmed that no evidence had been found that tenders had been inappropriately contracted but a few weaknesses in the system had been identified.
RC thanked PA for both the above reports, which were noted.
8. ASSURANCE: RISK & GOVERNANCE EXECUTIVE a) Update on Risk & Governance Executive JG gave a verbal update on a few issues, including: MA was presently ensuring that all appropriate documentation had been signed for presentation to the NHS SLA assessors. “Hot Spot” Reporting had been introduced this year, which was still work in progress. This listed statistics, which were presently in-patient focused, and enabled a quick assessment of how different units were performing. Monthly changes in the process of reporting of SIs continued but would be firmed up in due course.
D10150 6 D R A F T A large number of policy approvals were being dealt with. There was some concern that R&GE was concentrating on the sorting out of internal risk related matters at the expense of other important issues.
RC raised the subject of the Assurance Framework, and asked whether this was refreshed on a regular basis at R&GE. JG confirmed this was done in line with the Annual Plan process and was actioned more than once a year but not at every R&GE meeting. RC suggested this could be a topic raised at a joint meeting of the Audit and R&GE committees, together with other topics which Committee members could start to give some thought to. To be noted
b) R&GE Minutes of July and August 2010 The minutes were noted by the Committee.
9. MANAGEMENT ISSUES a) Updated Audit Committee Terms of Reference The Terms of Reference were reviewed and the following amendments agreed:
The insertion of two items under 6.4 – Other Assurance Functions: Review of Treasury Management Performance and Local Counter Fraud Services.
MC to draft a sentence re LCFS assurance and advise RT. Action: MC RC/RT would agree a form of words on the Review of Treasury Management. Action: RC/RT
Once the above had been actioned and approved by RC, the ToR would be re-issued and circulated.
b) Update on Poppie System RT gave a brief update on Poppie, noting that Linda Pearson, Clinical Systems Manager, had sent him a detailed report on the Poppie system, addressing all the Recommendations. He noted that as the Poppie system was a national product, some of the controls required may never be introduced by Blithe, the software company, and the risks would need to be accepted and dealt with controls. There was no replacement for the system at present but it was currently being reviewed as part of CareBase.
DB said that as long as management could accept or manage some of the risks presently stated within the report, the appropriate recommendations would be removed from the follow up report which would be brought back to the next meeting in January 2011. Action: DB
RC asked MC/DB to alert him if what was planned would make a different to Internal Audit’s opinion. MC suggested a short note in this regard be presented to the next meeting. Action: DB
c) Amendment to Scheme of Delegation The amendments on page 14 under 3.2, item 2i, ii, iii and ix were reviewed and agreed. RT would check on a few points and the amendments would be actioned. Action: RT
d) Bid for WECHS – Financial Due Diligence Arrangements RT introduced the Report, noting that NEPFT was currently bidding for the acquisition of the West Essex Community Health Services. The report set out an intended plan if the Trust was successful in being awarded the bid. RT noted the details had been presented to EMT and the Board both through informal workshops and reports and presentations by the Director of Commercial & Service Development and the Chief Executive. However, greater detail on the offer for WECHS would be available as the process of due diligence was completed.
RC raised the issue of the Audit Committee’s role in the process. RT suggested an exceptional R&GE and Audit Committee joint meeting might be considered for this purpose and the Chief Executive could be approached for his approval in this regard. Action: RT
MC said an Audit Committee’s role was to confirm that the process involved in the acquisition was
D10150 7 D R A F T acceptable, as the detail of the matter was a Trust Board issue.
RC said that the Non Executives would need to be updated on the details of the bid. DMC advised that a session was planned for the November Board meeting when a partner from Bevan Brittan would be speaking to the Board.
CAS queried details around the financial aspect of the bid. RT said that the detailed due diligence processes were to be dealt with at the Board Away Day on 11th November.
Some concern was expressed on the low rate of return on the turnover of approximately £34M, and it was felt that insufficient discussion had been held at the Trust Board as to the details of the transaction.
MC and RT would speak to the Chief Executive about the Audit Committee and R&GE involvement in assurance of the process. Action: RT / MC
e) Draft Charitable Funds Accounts 2009/10 RT reviewed the Accounts, noting that there were no fundamental changes in lay out or format, but pointed out that the Charity Commission would be provided with a legal deed to change the name of the registered charity from NEMHPT to NEPFT.
JG pointed out a minor error on Page 4 which RT would ask Clare Povah to correct, i.e. to remove the apostrophe from “This report was approved by the Trustee on ….. and signed on its behalf by…” Action: RT
RC drew attention to Page 4, fourth bullet point. A statement re “going concern” should also be mentioned in the narrative.
The Accounts were recommended for approval after the above amendments had been made. Action: RT f) Debt Write-offs: East of England Ambulance NHS Trust RT said the Write-off had been taken to the Trust Board in September 2010 and it was agreed it would be turned around very quickly in order to present it to the Audit Committee. However, in doing so, final advice was still awaited from Bevan Brittan. RT asked that as soon as this advice had been received, he share it with RC and/or all of the NEDs, on the basis that this could then be approved or not. It was agreed that this would be dealt with outside of the Committee. Action: RT/RC
g) Policy & Procedure for the Safekeeping of Patients’ Belongings RT briefly reviewed the Policy, which had been prepared in consultation with Area Directors and service users in order to make it relevant. PA noted that she had made some recommendations for the policy but was not sure whether these had been included. PA would follow this up and when confirmed, would send to RT. The revised policy (with track changes highlighted) would then be circulated to the Committee. Action: PA/RT
h) (Draft) Treasury Management Policy RT said a Treasury Management Policy had been identified as a Priority 1 issue from an internal audit last year. The draft policy submitted included a proposal to establish an Investment Committee for treasury management. This was discussed and the following noted: The Audit Committee would monitor Treasury Management Performance and therefore an Investment Committee would not be required. The draft Policy would be circulated to the Non Executives One set of rating agency criteria was insufficient, so two or three should be inserted. The Audit Committee ToR would need amendment to take into account its monitoring role.
RT, MC and DB agreed that the above comments were appropriate and acceptable, and therefore the amended draft was agreed and recommended for approval.
D10150 8 D R A F T
i) ASP Update RT said, for information, that ASP had the previous week put an OJEU (Official Journal of the European Union) notice out to seek a potential joint venture partner to take the business forward. It was currently hosted by Cambridgeshire and Peterborough NHS FT and they were seeking to find partners in a shared business service. ASP staff had been informed the previous week.
After discussion on resulting changes in legal arrangements, it was agreed that RT would check on the timescales involved and let MC know. He would also circulate ASP’s email to the Committee. Action: RT
10. OTHER MATTERS a) Audit Committee Forward Planning Calendar 2010/11 The Forward Plan was reviewed. The following items were agreed for 13th January 2011 –
Audit Plan 2011/12. MC said that the Internal Audit Plan 2011/12 would normally be included at this time but with the possible addition of WECHS, the Plan might need to be revised.
b) Standing Orders i) Notification of Waivers/Breaches The nine entries were reviewed. It was agreed that RT would check on whether 51/10 should have been included. Action: RT
ii) Losses & Compensation Register 2010/11 RT briefly reviewed the Report updated since the last meeting, which was discussed and noted by the Committee. RT would check on a couple of compensation issues with the Director of HR and Workforce Development Action: RT
c) Legal Issues None reported.
d) Urgent Other Business None had previously been advised.
e) Date of next meeting – 9.00 am on 13th January 2011.
11. PRIVATE MEETING WITH NON EXECUTIVES AND AUDITORS The Committee and CP met for a brief private meeting.
D10150 9
Agenda item No: 9
Name of Meeting: Meeting of the Board of Directors - Part 2 Confidential
Date: 24 November 2010
Title of Report: Any Other Notified Business
Presented By: Mary St Aubyn, Chairman
Subject, Purpose and Recommendation: The Board is invited to consider any items of urgent business notified in advance to Mary St Aubyn Chairman or Dermot McCarthy, Trust Secretary.
Finance Implications: N/A
Clinical Implications: N/A
HR Implications: N/A
Legal Implications: N/A
Equality Implications: N/A
Risks: N/A
Agenda item No: 10
Name of Meeting: Meeting of the Board of Directors - Part 2 Confidential
Date: 24 November 2010
Title of Report: Review of Today’s Meeting
Presented By: Mary St Aubyn, Chairman
Subject, Purpose and Recommendation: The Board is invited to review today’s meeting.
Finance Implications: N/A
Clinical Implications: N/A
HR Implications: N/A
Legal Implications: N/A
Equality Implications: N/A
Risks: N/A