Council of Governors 19th February 2018 Public
COUNCIL OF GOVERNORS MEETING IN PUBLIC
To be held on Monday 19 February 2018 at 11.00 The Red Room, City Coast Centre, North Street, Portslade, Brighton BN41 1DG AGENDA INTRODUCTION ACTION
11.00 CG 01/18 Introductions and apologies for absence
For A 11.01 CG 02/18 Council Group Agreement approval
11.05 CG 03/18 To receive any declaration of interests
11.07 CG 04/18 Questions from members of the public
Minutes of the meeting held on 16 October 2017 and For 11.10 CG 05/18 Matters Arising B approval (Richard Bayley, Interim Chair)
Spirituality Strategy For 11.15 CG 06/18 C (Simon Hobbs, Spirituality Team Leader) information
CG 07/18 CURRENT PRIORITIES
Chief Executive’s Report For CG 07.1/18 D 11.30 (Sam Allen, Chief Executive) information
Lead Governor Report (Amy Herring, Lead Governor) For 11.40 CG 07.2/18 E Supporting Individuals in Governance Roles information (Amy Herring, Lead Governor)
Annual Plan 2018/19 For (Sally Flint, Chief Financial Officer & Richard Bayley, F 11.50 CG 07.3/18 information Interim Chair)
CG 08/18 ASSURANCE
Strategic Review of Sussex Partnerships NHS Foundation Trust’s Older People’s Mental Health For G 12.00 CG 08.1/18 and Dementia Services (Presentation) discussion Oral (John Child, Service Director- Brighton & Hove & East Sussex CDS)
Quality Report Indicators – External Audit For 12.10 CG 08.2/18 H (Paul Cuttle, External Auditor KPMG) decision
Quality Improvement Project For I 12.20 CG 08.3/18 Steven Yarold, Associate Director of Quality discussion Oral Improvement
12.30 BREAK
CG 09/18 REPRESENTING MEMBERS AND THE PUBLIC
Governors’ Twitter Account For 12.40 CG 09.1/18 J (Amy Herring, Lead Governor) approval
CG 10/18 HOLDING TO ACCOUNT
For 12.45 CG 10.1/18 Issues from the Council of Governors discussion K
Quality Committee Summary (Gordon Ferns, Non-Executive Director) For 12.50 CG 10.2/18 L Feedback from Governor Observers discussion (Mark Hughes, Carer Governor, Shannon Guglietti, Staff Governor)
Finance & Investment Committee Summary (Finance Report) (Richard Bayley, Non-Executive Director) For 12.55 CG 10.3/18 M Feedback from Governor Observers discussion (Michael Decker, SU Governor, Scott Hunt, Public Governor)
Audit Committee Summary (Lewis Doyle, Non-Executive Director) For 13.00 CG 10.4/18 Feedback from Governor Observers discussion N (Shannon Guglietti, Staff Governor, Glen Woolgar, Staff Governor)
GOVERNANCE CG 11/18 Governor Committees and Working Groups
To receive an update from the Constitutional Review For O 13.05 CG 11.1/18 Working Group information (Dom Ford, Director of Corporate Affairs)
To receive an update from the Membership For P 13.10 CG 11.2/18 Committee information (Mark Hughes, Carer Governor)
To receive an update from the Training and For Q 13.15 CG 11.3/18 Development Committee information (Amy Herring, Interim Lead Governor)
To receive an update from the Joint Board and For Council Review Session information 13.20 CG 11.4/18 Oral (Richard Bayley, Interim Chair & Amy Herring, Interim Lead Governor)
To receive the minutes of the Annual Members For R 13.25 CG 11.5/18 Meeting information (Richard Bayley, Interim Chair)
13.30 CG 12/18 ANY OTHER BUSINESS
Date and Venue of the next Council of Governors Meeting 19 March 2018, 09:00-15:00 Training Centre, Swandean (Extraordinary)
Sussex Partnership NHS Foundation Trust Council of Governors: 19 February 2018 - Public Agenda Item CG 05/18 Attachment: A For: Decision By: Rebecca Huth, Corporate Governance Administrator SUSSEX PARTNERSHIP NHS FOUNDATION TRUST
Minutes of the Council of Governors held in public on Monday 16 October 2017 at 11:00 in the Roebuck Suite, Hellingly, East Sussex
Present Richard Bayley, Interim Chair (RB) Sam Allen, Chief Executive (SA) Alex Garner, Staff Governor (AG) Amy Herring, Lead Governor (AH) Anne Beales, Non-Executive Director (AB) (from item CG 30.1/17) Bryan Goodenough, Carer Governor (BG) Cllr David Simmons, Appointed Governor (DS) Diana Marsland, Non-Executive Director (DM) Dr Natasha Sigala, Appointed Governor (NS) Fiona Mclay, Service User Governor (FM) Gary Beecheno, Public Governor (GB) Giles Adams, Appointed Governor (GA Glen Woolgar, Staff Governor (GW) John Holmstrom, Appointed Governor (JH) Karen Braysher, Service User Governor (KB) Katie Glover, Appointed Governor (KG) Lewis Doyle, Non-Executive Director (LD) Mark Hughes, Carer Governor (MH) Martin Richards, Non-Executive Director (MR) Mel Smith, Service User Governor (MS) Michael Decker, Service User Governor (MD) Peter Thompson, Public Governor (PT) Phyllida De Salis, Public Governor (PDS) Scott Hunt, Public Governor (SH)
Not Present Angie Culham, Service User Governor (AC) Brian Doughty, Appointed Governor (BD) Gillian Brown, Public Governor (GB) Jayne Bruce, Staff Governor (JB) Rachel Brett, Appointed Governor (RB) Terry Dorset, Service User Governor (TD)
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In Attendance Adam Churcher, Head of Corporate Governance (AC) Dominic Ford, Director of Corporate Affairs (DF) Justine Rosser, Deputy Chief Nurse (JR) Natalie Hennings, Corporate Governance Manager (NH) Rebecca Huth, Corporate Governance Administrator (RH) Sally Flint, Chief Finance Officer (SF)
Observers Louise Phillips, CQC
ITEM NO ITEM
INTRODUCTION
CG 26/17 Introductions and Apologies for absence
RB welcomed all present to the meeting and began introductions. RB noted apologies from: Amy Dickinson, Service User Governor (AD) James Domanic, Service User Governor (JD) Gabrielle Gardner, Service User Governor (GG) Gordon Ferns, Non-Executive Director (GF) Shannon Guglietti, Staff Governor (SG) Simon Street, Staff Governor (SS) Sarah Gates, Appointed Governor (SG)
RB read out the Trust values, advising he would like to run the meeting to these values. Because of the full agenda, RB advised if he wishes to summarise an item he will raise his hand.
CG 27/17 To receive any declarations of interest
There were no additional declarations of interest.
CG 28/17 Questions from members of the public
No questions were submitted in advance of the meeting and no questions were given at the start of the meeting.
CG 29/17 Minutes of the meeting held on 17th July 2017 and Matters Arising
Minutes of the Council of Governors held on 17th July 2017 in public were approved as an accurate record. Matters Arising AC advised that a number of these actions have been shared and completed in the Governors weekly message. Some updates were provided; JR advised that Diane Hull is looking into the buddy system and will be talking to
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services about appropriate safeguards in November. RB advised that there are two recruitment and retention actions outstanding which will be picked up outside of the meeting. All other actions are complete.
CG 30/17 CURRENT PRIORITIES
CG 30.1/17 Chief Executive’s Report
SA wished to firstly welcome our new and returning Governors. SA advised that last week a Chief Executive briefing was held and a really helpful presentation was made by Amy and Mark which reminded them of the role of the Council. SA’s main highlights included; Our services continue to work under pressure, particularly as winter draws closer and all of our partners are experiencing a surge in demand for services. Maintaining our standards is a challenge due to these system pressures, however we are working closely with our partners to ensure we have things flowing well across all of our care pathways. We continue to escalate and address delayed transfer of care (DToC) and we currently have 28 patients still in hospital who are clinically fit for discharge, however are unable to leave for many reasons, mostly due to awaiting accommodation. We routinely meet with our Health Overview and Scrutiny Committee (HOSC) and partners to highlight these issues and seek support. We’ve been working with Sussex Police in reinstating Operation Cavell, as our highest reported incident is violence and aggression towards our staff. With regards to our Thematic Review, which was published in full last year, we’re actively implementing our triangle of care which is about ensuring there’s a good partnership between our patients, carers and local services. PDS queried what is being done to ensure as many staff as possible receive the winter flu vaccination. SA advised that we’re actively promoting this and we’re using it as a safety campaign, however some staff just don’t want the jab due to personal reasons. SA added that our nurse recruitment campaign is on national TV. PDS requested a report on the percentage of staff that get the flu jab from the Trust. SH noted that SA has visited a lot of MPs, however he feels that they lack a lot of understanding about the services in their area. SH asked if Governors can be assured that SA had ensured MPs are aware of how hard our staff are working. SA advised that Governors can be assured and the Chair has joined her on one meeting with an MP. SA added that MPs need to retain a huge amount of knowledge and feels that we can make things easier for them, explaining that we’re holding an informative session at Westminster for support staff to MPs, as they’re usually the first point of contact. PT asked how the impact of the recruitment campaign can be measured. SA advised that our Communications Team have a whole raft of measures, including looking at how many people come back to the team following the video, and we do track the activity of this. PT queried whether there’s a cost benefit for these campaigns. SA advised that we recruited around 40 nurses from our last campaign. MD felt that we still need to spend a lot less on recruitment, however work like to
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commend Diane Hull’s work at Langley Green Hospital. AH followed on from PT’s point, querying whether we’ll come to a point where we can stop recruiting and just focus on retaining staff. SA advised that the number of people going into nursing has dropped and we’re going to face an on-going challenge to recruit to these roles, however we’re looking at alternative and new types of roles to help attract more people. RB reiterated SA’s point that we’re trying new things to recruit and retain, and we can’t afford not to, however it is tricky. RB assured Governors that we’re really keeping a focus on this on-going issue. KB asked for an update on the study for paying graduates tuition. SF advised that the bursary for nurses has been removed and we’re talking to nurses about offering them a role with us in their last year of study, however this is a whole project that Diane Hull is working on. KB asked for a specific update regarding the possibility of paying for graduate’s tuition fees. SA wished to note that we do sponsor some of our health care assistants in their Open University study to become nurses. DS queried whether we’re engaging with local authorities and if so what response are you getting. RB advised that we need to do more with local authorities and would appreciate his help with this. SA advised that she met with West and East Sussex Local Authorities and we’re raising this issue in the South East, which is attracting and retaining people into the area. GB queried what we’re doing to retain our current nurses. SA advised that we have clear pathways so our health care assistants can move to nurses and we’re looking at post graduate workers who are not clinically qualified, and our Secure and Forensic teams are piloting their training. We’re also really focusing on people returning to work and we have attracted some people back into nursing through this route. AG thanked SA for the really helpful report, however mentioned that he felt the general public don’t understand how complicated the system is. SA agreed, adding that we have to really promote mental health as a good place to work and a great place to be. GA asked SA when she’s in Westminster to discuss the high cost of living in this area as it’s impossible to attract people here. RB advised that he’s going to write to MPs, our STP and Local Authorities regarding housing and cost of living.
Action(s) Governors to receive a report on the number of staff who get the flu jab from the Trust. To present a paper on recent nurse recruitment campaigns, including a cost benefit analysis and their effectiveness on future retention of staff. Paper to include explanation on graduation tuition fees (raised by Karen Braysher). The Chair to write a letter to MPs, STP and Local Authorities regarding housing and cost of living.
Decision(s) None.
CG 30.2/17 Lead Governor Report
AH discussed the Chief Executive briefing held last week with staff, advising that it was great to raise the role of the Governors and MH touched on the Heads On Page 4 of 13
charity pub quiz, which is a great way to meet more people and get to know each other. AH encouraged Governors to attend opportunities to meet Council members for social development. AH mentioned KB’s joint quality review visit to Lewes Prison with MR and FM and asked her to share her feedback. KB advised that she’s been assured of the improvements, cleanliness and refurbishment of cells, however some cells were still unclean and there are no skirting boards whilst they await a floor refurbishment. In summary, although KB had some reassurances, she couldn’t see that a full refurbishment had taken place. She felt it was really helpful to attend a site visit with a Non-Executive Director and wished she’d done it sooner. MR advised that the building mitigates against health care and the staff are working with what they can, however the 600 inmates in the prison receive all sorts of different levels of care. FM advised that she was incredibly impressed with the staff and how they’re still working on forming a good relationship with the prison workers and system. FM was however concerned that there are only 2 disabled cells in the prison and there are many people with disabled needs. Richard Bayley advised that he and Adam will arrange more joint quality review visits with Governors and NEDs. SA felt it would be helpful to share KB’s full report with Governors, adding that she has escalated general concern about the prison with the healthcare lead in England. SA advised that we’re keeping our work in the prison under review to assess whether we can provide a high quality service. LD advised that he has previously visited Ford prison and found it to be very clean and in good repair, and the feedback from the prisoners within the service was very positive. LD added that it would be interesting to do some food testing within prisons to assess the quality of patient’s food. AB advised that it’s really important to look at prisoners’ discharges with medication, as some patients have to wait 3-4 days after discharge for their medication, after being on very high doses of drugs in prison.
Action(s) To co-ordinate governor site visits with Quality Safety reviews and site visits taken alongside Non-Executive Directors. Karen Braysher to share her feedback on a recent visit to Lewes Prison with Governors on Alfresco
Decision(s) None.
CG 30.3/17 Sustainability and Transformation Plan
SA advised that throughout the summer she’s been leading a piece of work to develop a strategic framework for mental health through the STP, which includes children’s services and it’s being shared with the STP programme board at the end of the month. The framework has identified 12 opportunities and three priorities for mental health. These are 24/7 crisis pathway, recovery and discovery colleges and suicide prevention. SA explained that our STP has a large deficit for NHS services and whilst the STP structure has attracted some challenges, we’ve really created a strong case for change for mental health. RB added that we have been working really hard over the summer on the STP work to ensure mental health services are featured as a priority in the STP.
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KG queried how, in regards to the leadership within the STP, solutions will not only lie with Sussex Partnership and how the overall leadership will execute. SA advised that she’s been leading the work as a leader of the STP rather than the Chief Executive of a Trust, however we do need to have a clearer conversation about the delivery of the STP and how to use the skills, experience and expertise of the other organisations. SA reiterated that we need to really push on the 24/7 crisis service as it’s really not good enough. AB states that alignment across the STP is a priority. AG felt that it sounds very complicated to have everyone in the STP working together. SA advised that Adrian Whittington is applying for a £50,000 leadership grant to use for training and support within the leadership of the STP. RB advised from a leadership perspective, that we’re up for the challenges. MR requested some clarity on the clinical strategy. SA advised that the strategy was published in draft in the summer with engagement events throughout September, and the final vision with a delivery plan will be received at the next Board, adding DS advised that he would like to see the funding and partnerships more joined up and we need to be much more open to the voluntary sector. GB noted that we have 28 DToC patients and queried how this is anticipated to change within the STP with multiple providers involved. SA advised that we’re commissioned by multiple CCGs and the numbers of these are being reduced to become more strategic, adding that the more we can put our staff in charge of our funding, the better. SA added that the more we can reduce the number and locality of our commissioners, the better.
Action(s) Sustainability and Transformation (STP) Plan Draft Framework to be shared with Governors once approved by the STP Group. Clinical Strategy update to come to February 2018 Council of Governors.
Decision(s) None.
CG 31/17 ASSURANCE
CG 31.1/17 CQC Compliance and Strategic Assurance
JR advised that we’re completing community team reviews. Inpatient wards have all received reviews and local and strategic initiatives are coming out of those. Adult and Older People’s services have been visited in the last two weeks by the CQC. AG advised that Governors are very welcome to join these visits. DM advised that teams are trying really hard to make improvements and she has always made a point of asking members of staff on visits what they do well, which often results in shock, and DM encouraged members to ask this question as it provides good balance and is really good to know what they do feel they’re doing well. GA advised that the preparation work teams are doing for the CQC needs to become business as usual, rather than driven by the CQC. JR advised that we have a lot more involvement with teams now, and we’re assessing what we’re doing and how we can improve what we do. The aim is to not talk about the CQC at all and agreed with GA, that our aim is to work like this in a
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business as usual manner. AH advised that a few days ago we won two awards at the National Positive Practice Awards, for Time for Dementia and i-Rock Youth Service.
Action(s) None.
Decision(s) None.
CG 31.2/17 To receive a report on Serious Incidents
SH queried whether there’s a reason for the large difference between July 2016 and July 2017 statistics in terms of the numbers of Serious Incidents. JR agreed that this was the case but it wasn’t clear what the reasons for this were. GA queried why, if incident reports are decreasing, why we’re not seeing an increase in completed reports within their timeframes. JR advised that we’re focusing on the quality of the reports more than the deadline of them, adding that we are working with the families involved, and sometimes this delays the process. KB queried the prevention of future death notice received in Brighton and Hove. SA advised that we were unsuccessful in the substance misuse community tender, and therefore we closed the substance misuse inpatient unit, previously Promenade Ward at Mill View Hospital, because we felt unable to provide only one part of the substance misuse service. This has resulted in patients having to travel to Islington for this service, which was the decision of Brighton and Hove council who were successful in the community contract. KB advised as a Governor of Brighton and Hove, she agrees with the coroner that this is unacceptable. PDS queried whether staff are spoken too after an incident takes place about how learning can be carried forward. JR advised that if it’s a very serious incident, we obtain learning immediately and carry out lengthy reviews. We have a Patient Safety Matters process which is the main learning across the Trust, and we try to engage members of staff in all areas about learning. LD felt that looking at the papers, he is not always convinced that we learn as much as we should do, however being on the wards and having conversations with staff, he feels much more assured than what’s reported in the papers. RB felt that our learning is maybe not as evident in the paper as it should be. PT queried with regards to Duty of Candour, who takes up the responsibility. JR advised that the services do, adding that the family contact was being done, we just had to put a formal process in place to show this. GA was concerned that 78% of actions are outstanding, querying whether the learning is happening. JR advised that we’ve got 400 outstanding action plans down to 99, and we’re working on changing our timelines to ensure our learning can be learnt and embedded and quickly as possible.
Action(s) Governors to be invited to the Learning Event on 01 November 2018.
Decision(s) None.
CG 32/17 HOLDING TO ACCOUNT
CG 32.1/17 Issues from the Council of Governors
AH queried whether there’s been any progression with the Youth Council. AC
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advised that since Elizabeth Hall’s departure we haven’t progressed much so we need to sit down and discuss a delivery plan. KB queried the development of the funding for a Choir at Mill View Hospital. AB advised that the last she knows about this is that we’re going to put forward a bid to the Rotary Club, however we’ve had a member of staff from the Charity team who’s on long term sick, and is unable to confirm at this point if the bid has been submitted. KB felt unhappy that she’s not been kept informed with this. PDS felt that the Council should receive a regular report from the Charity Committee. SA advised that the Charity do some absolutely fantastic work and the Annual Report will be shared with Governors when it’s available. SH wished to go back to PT’s previous question about Duty of Candour, advising that we used to receive fines for missing this and our compliance is much better now. With regards to the substance misuse service, SH advised that this issue was brought to the Council about two years ago and it’s a shame it’s taken this long for us to realise the direct impact of the loss of this service. SF confirmed that we have not received any Duty of Candour fines since the first year of implementation and our services are very good at contacting families. RB advised that he remembers the Finance and Investment Committee meeting where the substance misuse service was discussed, and the feeling was that we couldn’t continue with the inpatient service when we had no control over the community service. AH advised that when she and Elizabeth Hall were researching the Youth Council we received some really good advice about how to get it started, adding that she already knows some people with interest in joining a youth council. AC advised there has been a concern raised about whether non-clinical staff in mental health settings around the Trust, should receive mental health training. AC will speak to Adrian Whittington about this and bring an update back to the Council.
Action(s) Adam and Amy to discuss the delivery of the Youth Council. Governors to be advised of progress with the funding bid for the Mill View choir Governors to receive a regular report from the Charity Committee. Heads On Annual Report to be shared with Governors when available. Adam to speak with Adrian Whittington and bring an update back to the Council about non-clinical staff receiving mental health training (question raised by a previous staff governor).
Decision(s) None.
CG 32.2/17 Quality Committee Summary
DM advised that the Quality Committee has been reshaped to ensure the correct information and committees are feeding into the meeting. At the previous meeting there was a lot of conversation around SIs, safer staffing and recruitment. The report attached states that although we have vacancies, we are staffing our wards at a safe level.
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AH queried when looking at the KLOE’s (key lines of enquiry) which are shared over more than one committee, would one take responsibility or would they be jointly led. AH also noted that staff aren’t feeling valued and appreciated, and wondered what it means for them to feel valued and appreciated. DM advised that she can’t answer in specifics about staff feeling valued and appreciated, however this should be covered in appraisals and supervision. DM advised she’d come back to the next meeting with a more detailed answer. DM advised in terms of the KLOE’s, we’re trying to avoid duplication so we’ll see how this works. SA mentioned on the point of staff appreciation, we do an exit survey for all staff and Diane Hull has been calling each nurse which has left. Feedback we’ve received is staff are questioning whether they feel part of their team, whether they have regular supervision and whether they have access to training and development.
Action(s) Diana to bring back to the Council what it means for staff to feel appreciated.
Decision(s) None.
CG 32.2/17 Feedback from Governor Observers
None.
CG 32.3/17 Finance & Investment Committee Summary
RB advised that the report covers the meeting at the end of August, at which there was a deficit of £961k, within this there are three particular areas which are not as good as we’d like them to be. These are: 1. Adult Services, which have some areas of improvement, and some areas of worsening. 2. Non-pay, particularly drug spend, is still an on-going issue and requires a budget re-set going forward. 3. ECRs (out of area bed placements) are also suffering, mainly due to DToC issues of bed blocking. RB wished to make a final point of agency, recruitment and retention being a continuing focus of the Board and there has been quite a lot of work going on to get ourselves in a better place. Our aim is to spend no more than £850/900k on agency in the year. We’re forecasting a breakeven point as a best-case scenario. The Executives have also been talking to the CCGs about additional funding that was agreed in our contract settlement, about £1.4m to support us in breaking even. RB advised that this time last year we were about £5m in deficit, so we’re definitely making improvements.
Action(s) None.
Decision(s) None.
CG 32.3/17 Feedback from Governor Observers
KB advised that she went to visit MSK (a joint venture service between Sussex Partnership and on 06 October 2017 and found it a very informative and productive visit. KB feels that they’re on a road to facilitating successful pathways and patient
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choice is very important to them. They also signpost to over services very well, and they ensure that every call to them counts. MD felt that compared to last year our situation is so much better, and there’s far better reporting and forecasting coming into the committee. MD added that we can make a third of our deficit from the CCGs off our financial recovery plan and from the award in ensuring most staff receive the flu jab. PT queried the consequences of not breaking even. SF advised that NHSI take a keen interest into Trust’s who appear to be slipping off track. At first, SF advised she’d have monthly, robust calls with NHSI with quarterly reviews, and then it could reach being placed in special measures, which is a place we really want to avoid being in. SA advised that one of the biggest consequences is the time and effort taken away from service improvement. RB provided members with some assurance by advising that we’ve gone through the control tracker and we’re doing pretty much everything we should be doing. PDS queried whether CDSs are getting the right support in order to identify areas in need of improvement. RB advised we’re on an upwards trajectory with the CDSs and they’re getting positive support in order to achieve their next steps.
CG 32.4/17 Audit Committee Summary
LD wished to welcome the new Governors, advising that the Audit Committee is made up of three NEDs, meeting 6 times a year, and for 30 minutes each meeting the NEDs meet with the auditors privately. One of these 6 meetings is solely to discuss the annual report and to look deeply at the numbers. We are due to complete another self-assessment in January 2018, and will receive the results around March/April. LD had two areas of concern to highlight: Drug spend – the audit report was fairly positive in how we purchase and dispense drugs, the concern seems to be around the budget set which is not close to a true reflection of drug spend. Counter Fraud – looked at Langley Green Hospital and temporary staff there as there was a concern raised that there was fraudulent activity. Although there were poor practices highlighted, no fraudulent activity from temporary staff was found. LD wished to note that we haven’t had a governor observer attend the committee for the last three meetings. AC advised that governor commitment to committees is being discussed in the private meeting. AB wished to inform members that the auditors have congratulated us on our transparency on highlighting issues to be investigated.
Action(s) None.
Decision(s) None.
CG 32.4/17 Feedback from Governor Observers
None.
CG 32.5/17 Mental Health Act Committee Summary
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MR advised that the committee saw clear guidelines for community teams on ligatures, and two officers have been recruited to the Mental Health Act Team which will allow an important Mental Health Act training function to be done. MR raised the concern of the use of police custody for patients detained under section 136, in spite of the great progress the Trust has made, it’s experienced a bit of a dip. SH queried the increase of cost for transport for detained patients. SA advised they are the one provider for secure transport and there has been an increase in usage. SF advised that we’re looking at this cost in our financial recovery plan.
Action(s) None.
Decision(s) None.
CG 32.5/17 Feedback from Governor Observers
None.
CG 33/17 GOVERNANCE
CG 33.1/17 Governor Committees and Working Groups
To receive an update from the Membership Committee MH advised that the membership report has not reported whether members have been removed due to not having provided us with a contact email address, or whether they have moved address, unsubscribed, died etc. To receive an update from the Nomination and Remuneration Committee SH advised that a very thorough and open conversation took place about how to move forward with the Chair and Non-Executive Director recruitment. AH advised that we took everything apart and really re-worked the information in this committee. AB wished to make a declaration; she know one candidate involved in the Chief Digital Officer role and wished to confirm that she had no involvement in the process or recruitment. PDS felt that the Lead Governor should always be a member of this committee, and we should nominate back-up members for each constituency for when members can’t attend and there are quorate decisions to be made. To review and approve the Council Committee’s Terms of Reference AC advised that it’s good practice to take these through the Council each year, and other than PDS’s comment about the Lead Governor attending each Nomination and Remuneration Committee, there have been no further amendments received. To receive an update from the Governors Development Day (6th October 2017) AH advised that the Governors Development Day was split into a few different areas, including a discussion around the role of the Lead Governor, engaging with our constituencies and how we do this effectively. A recommendation for a one page guide on how to engage effectively was requested. A mission statement for the
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Council was also discussed, including what are we doing and what our aim is. The day was very calm and the feedback was very good in terms of being able to network and making conversations. There was a request to have a positive forward action plan and timelines for when our 5 actions will be completed. As a final point, AH felt that the day was much better and was not only lecture based. MS agreed, adding that learning and having a conversation about it and creating ideas was a really good plan for the day. AC advised that we’ll write these actions up in a plan with some timelines, adding that the Organisational Development supporters at the day are really keen to work with the Council on a 12/18 month development. AH noted that we had 2 members attend, which is really positive. RB advised that the Board Development Day was held on the same day and was also really positive. RB added that hopefully they’ll be in a similar position where the Board and Council can come together for a joint day next year.
Action(s) The Terms of Reference’s for the Council of Governors’ Committees were approved, subject to the amendment of including a requirement
Decision(s) for the Lead Governor to always be member of the Nomination and Remuneration Committee.
CG 33.2/17 To receive the Council of Governors Declaration of Interest Register
RB asked for any updates to be sent to NH and AC. AC advised that this is published in the annual report and felt it would be good practice to bring it through the Council each year as it’s good to have sight on this.
Action(s) None.
Decision(s) Council of Governors Declaration of Interest Register to be received at a Council of Governors meeting annually.
CG 33.3/17 To agree the Frequency and Council of Governors Meetings dates for 2018
RB advised that this sets out the meeting for the next year and the recent streamline of meetings between the Council of Governors and its committees. AC advised that the Council is required to meet formally a minimum of three times a year, and there has in the past been a requirement to hold an extraordinary meeting at least yearly, therefore a recommendation is included to schedule only three, rather than the usual four formal meetings for 2018, allowing some flexibility for extraordinary meetings. AC advised that the paper also requests any different thoughts on venues and timings for the meetings. A vote was taken on whether to hold three or four formal meetings in 2018; the majority of the Council requested four meetings. SA advised that we have no members of the public observing today, and therefore it may be worth doing an equality impact assessment on suggested venues to ensure it’s not limiting people’s attendance. Other suggested venues included the Amex stadium, Sussex Uni, Brighton Racecourse and Hove Cricket Club. Page 12 of 13
AC advised that once the fourth meeting for 2018 has been scheduled, some dates may change. Members were asked to hold the date of the first scheduled Council meeting in February 2018, with all other dates to be confirmed.
Action(s) A fourth formal Council of Governors meeting to be scheduled for 2018.
Decision(s) The dates for 2018/19 were approved, subject to a fourth formal meeting being scheduled.
CG 34/17 Any Other Business
There was no further business.
Date and Venue of the next Council of Governors Monday XXXXXXX 2018, time TBC Venue TBC
Signed………………………………………………………. Date………………….. Richard Bayley, Interim Chair Sussex Partnership NHS Foundation Trust
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Sussex Partnership NHS Foundation Trust Council of Governors: 19 February 2018 – Public Agenda Item: CG 05/17 Attachment: A For: Approval By: Rebecca Huth, Corporate Governance Administrator
MATTERS ARISING: ACTION POINTS FROM THE COUNCIL OF GOVERNORS HELD IN PUBLIC ON 16th OCTOBER 2017
Action Minute Action Points Lead Action Required Date Reference 16/10/2017 CG 30.1/17 Governors to receive a report on the number of staff who Diane Hull Scheduled: Council get the flu jab from the Trust. will be advised once programme complete and CQUIN results available.
16/10/2017 CG 30.1/17 To present a paper on recent nurse recruitment Diane Hull / Sally Scheduled: Paper to campaigns, including a cost benefit analysis and their Flint come to the next CoG effectiveness on future retention of staff. Paper to include meeting in February explanation on graduation tuition fees (raised by Karen 2018 Braysher).
16/10/2017 CG 30.1/17 The Chair to write a letter to MPs, STP and Local Richard Bayley
Authorities regarding housing and cost of living.
16/10/2017 CG 30.2/17 To co-ordinate governor site visits with Quality Safety Richard Bayley / Completed: Safety reviews and site visits taken alongside Non-Executive Adam Churcher and Quality Review Directors. training being planned for 2018. For discussion at Training and Development Committee on 4th
Page 1 of 3 Action Minute Action Points Lead Action Required Date Reference December
16/10/2017 CG 30.2/17 Karen Braysher to share her feedback on a recent visit to Karen Braysher/ Complete: Uploaded Lewes Prison with Governors on Alfresco Rebecca Huth to Alfresco.
16/10/2017 CG 30.3/17 Sustainability and Transformation (STP) Plan Draft Sam Allen Scheduled: Plan will Framework to be shared with Governors once approved by be shared with the STP Group. available
16/10/2017 CG 30.3/17 Clinical Strategy update to come to February 2018 Council Rick Fraser Complete: agenda
of Governors. item February
16/10/2017 CG 31.2/17 Governors to be invited to the Learning Event on 01 Justine Rosser Complete: invitation November 2018. circulated to governors in their weekly message dated 20/10/2017
16/10/2017 CG 32.1/17 Adam and Amy to discuss the delivery of the Youth Adam Churcher Complete: Council. and Amy Herring Discussion held with Amy about the
Working Together groups across CAMHS services.
16/10/2017 CG 32.1/17 Governors to receive a regular report from the Charity Dom Ford Scheduled: Paper to Committee. come to the next CoG
meeting in February 2018
16/10/2017 CG 32.1/17 Heads On Annual Report to be shared with Governors Sam Allen/Adam Scheduled: To be Churcher completed after Page 2 of 3 Action Minute Action Points Lead Action Required Date Reference when available. November Board meeting
16/10/2017 CG 32.1/17 Adam to speak with Adrian Whittington and bring an Adam Churcher Scheduled: Paper to update back to the Council about non-clinical staff come to the next CoG
receiving mental health training (question raised by a meeting in February previous staff governor). 2018
16/10/2017 CG 33.1/17 Include in the Nomination and Remuneration Committee’s Adam Churcher Complete: ToR and Terms of Reference the requirement for the Lead Governor Lead governor role to always be a member of the committee. description updated
16/10/2017 CG 33.3/17 A fourth formal Council of Governors meeting to be Adam Churcher Complete; Dates scheduled for 2018. circulated to Governors.
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Report to Council of Governors Agenda item CG 06/18 Attachment C EHRIA N/A code Date of meeting 19 February 2018 Format of Paper Title of paper Spirituality Strategy Written Author Oral ☐ Simon Hobbs, Chaplain Presenter Presentation ☐ Committees/meetings where this item has been N/A considered Purpose of report (tick all that apply) To provide assurance ☐ For decision ☐ Regulatory requirement ☐ To highlight an emerging risk or issue ☐ To canvas opinion ☐ For information To highlight patient, carer or staff experience ☐ Strategic Goals (tick all that relate) 1. Safe, effective, quality patient care ☐ 2. Local, joined up care ☐ 3. Put research, innovation and learning into practice ☐ 4. Be the provider, employer and partner of choice ☐ 5. Living within our means ☐ Summary of Report We are currently rewriting our Spirituality Strategy. The following is a discussion paper to stimulate ideas, feedback and thoughts on the future direction of the spirituality service both in terms of its purpose and its delivery. We aim to complete this by the end of 2018.
Recommendation To note the content of the report.
1. INTRODUCTION
We are currently rewriting our Spirituality Strategy. The following is a discussion paper to stimulate ideas, feedback and thoughts on the future direction of the spirituality service both in terms of its purpose and its delivery. We aim to complete this by the end of 2018.
2. REPORT
1. Some Principles At a recent meeting of the Religion and Belief Steering Group we considered what spirituality is. The answers that we came up with were ideas like: Wholeness – acceptance – peace - joy. These are all concerned with our quality of life and common to all of us as human beings. Jon Kabat Zinn once said that spirituality was what makes us more deeply human. In our new spirituality strategy for Sussex Partnership Trust we wish therefore to reflect this search for a deeper and more joyful humanity and seek ways in which this can contribute to our common human healing and flourishing in the context of mental healthcare. Spirituality is, therefore, about the personal search for meaning, purpose, connection, transcendence (either religious or philosophical) joy and peace in life. It is that part of us which explores the nature of consciousness and engages with life beyond ourselves (transcendence;connection). It encompasses both the search for wisdom (contemplation ; being) and the pursuit of virtue through the engagement with an ethic for life (action ; doing) which springs out of that. According to Plato, virtues are the skills we require to achieve wellbeing. It is therefore a fundamental part of the human journey and one which is fundamental to our wellbeing, health and wholeness as individuals and as a society. Spirituality therefore reflects these complementary aspects of living: contemplation/action ; being/doing; self/others. 2. The necessary difficulty of definition “Mainstream scientific thought, which has been dominated by Newtonian and Cartesian paradigm, is characterised by its reductionistic and materialistic worldview. In this paradigm, a complex whole (be it an ecological system or a living organism) is viewed as reducible and can be explicable only by objectively examining and measuring its components. In other words, the whole is understood in this paradigm by the properties of its parts. Spirituality as an aspect of life belongs to a differing paradigm of thought with entirely different ontological and epistemological assumptions. Spirituality is an emergent property of a complex living system and exists only when such a system is examined in a holistic manner. Contrary to the maxim “I think, therefore I am,” understanding spiritual life is achievable not by thinking or cognitive contemplation on the definition. Instead, it is “realised” through practices and its embodied form of knowledge often resists objectification and verbalisation. Komatra Chuengsatiansup (for WHO paper) The search, for some, will take the form of religious faith and adherence, others will take inspiration from philosophical and humanist traditions, others again will pursue a personal path of wisdom, unique to them, often drawn from many spiritual, ethical and philosophical traditions. Spirituality seeks to engage with the great questions of suffering and struggle in the quest for wisdom and virtue with honesty and courage, it also seeks to offer insight, from human reflection, into what constitutes the good life in the fullest sense of the word. It seeks to enlighten the journey of each of us along life's way by offering a framework for the person to understand their own personal narrative and experiences. Spirituality draws on thousands of years of tradition throughout the world as human beings from all cultures and faiths have sought to understand the world and creation they live in, their place within it, the nature of the human mind and condition and the various paths to tread which have been signposted by the great spiritual and philosophical teachers of the ages. “The capacious term ‘spirituality’ lacks clarity because it is not so much a unitary concept as a signpost for a range of touchstones; our search for meaning, our sense of the sacred, the value of compassion, the experience of transcendence, the hunger for transformation.” Andrew Powell 3. Religion or Wellbeing? Within spirituality there are two seemingly contradictory paradigms : religion and wellbeing. This can lead to a conceptual tension. It is tempting in the context of healthcare provision to come down on the side of wellbeing. Yet this could ignore the communal element of wellbeing provided by religion. If our minds are “social, unconscious and embodied” (Jonathan Rowson) then the communal is an essential aspect of wellbeing. Nearly all spiritual traditions are lived out communally and spiritual practice is essentially communal in character. 4. Spirituality as Space, Stillness, Slowness Spirituality seeks to foster healing, connection and wholeness through slow attention to the moment; creating space for reflection and encouraging stillness to give the body and soul time to heal and connect. “You’ve been doing lots of good things for lots of good reasons for a long time now,” he said, “for your physical health, your psychological health, your emotional health, for your family life, for your future success, for your economic life, for your community, for your world. But a spiritual practice is useless. It doesn’t address any of those concerns. It’s a practice that we do to touch our lives beyond all concerns – to reach beyond our lives to their source.” (Zen priest Norman Fischer) Spirituality is a way of being and living pursued not as an end in itself, therefore, but as a way from out of which our wholeness and happiness are forthcoming. It is not an intervention in that sense. Tao Te Ching Chapter 11 “Thirty spokes unite around one hub to make a wheel. It is the presence of the empty space that gives the function of a vehicle.” Focussing our strategy 1. Spirituality is the pursuit of wisdom and virtue as defined above (para 1) Spirituality is the cultivation of wholeness, acceptance, peace and joy Spirituality is about seratonin, not dopamine - a long term way of living not a quick fix Spirituality is about our experience of transcendence and our connection with life beyond ourselves 2. How are these done? Blaise Pascal: “All men’s miseries derive from not being able to sit in a quiet room alone” a) Spirituality is about helping people “sit in a quiet room alone”, so that they think and act from a state of peacefulness, not fear; (Contemplation) b) It is about helping people face their inner emptiness and not get distracted from reality; (Being) c) It is about fostering skills for long term peace and contentment by focusing on causes not symptoms, and providing life skills not quick fixes. (Virtue) d) It is about giving people a framework to understand their lives and experiences which can help them move forward positively. (Meaning) e) It is about connecting people to communities of support (Connection) It is therefore about longterm health and well-being, about slow medicine for life. It is about helping people discover for themselves the building blocks of steadfast happiness and wellbeing. Our service delivery and focus of our work should be directed towards this end. What service delivery can look like in practice, given the right resources and commitment. Resources Current provision of 2.17 WTE staff enhanced on temporary basis (January to March 2018) by 1 day a week extra at and funded by Langley Green and 1 day a week extra funded by Forensic Services at Hellingly to backfill post at DoP/Amberstone/Woodlands in order to free up more time at Hellingly . NHS guidelines suggest a WTE of 5.5 for our Trust. We are currently looking at our funding level with the SDB. Current Projects Hellingly 1. Weekly music Group - building a community group/choir for residents and staff 2. Weekly meditation for residents 3. Weekly meditation for staff 4. Weekly ward Communion services 5. Weekly Happiness Course for residents –(and starting for staff in April) a. out of which: eg we are adopting a local charity to be involved in. 6. Festivals programme - starting with Passover 7. Tai Chi for residents and staff in process of being set up. 8. Spiritual support lead can now attend weekly OT meetings This gives time to get alongside people, both staff and residents, pay them full attention and be a part of the team, to build trust and relationships. Langley Green 1. Meditation classes on all four wards 2. Happiness course on three wards (Positive Psychology) 3. Support during times of crisis/serious incidents on the wards 4. Induction training 5. Attendance at community meetings on the wards 6. Attendance at management level meetings representing patients spiritual and religious needs but also patients views 7. Greater input into patients care by being able to talk to doctors and staff about concerns and needs 8. More visibility has enabled me to become a trusted member of the team by staff and has resulted in me diffusing two incidents last week and this is becoming higher 9. More visibility and regular visits has also earnt more trust for the patients so I am seeing a greater increase in SU’s asking to talk to me 10. I am just beginning to experience staff asking for time to talk/listen 11. I have been able to work with local faith-based charities to provide presents for all our patients at Christmas, support at our Christmas party and a place of safety in emergency. DoP-Amberstone-Woodlands Offered as spirituality drop-in by bank Buddhist Chaplain. This has not raised any difficulties or issues because he is not a Christian priest. Staff spirituality training in Woodlands on 06/02/2018 Chichester 1. Regular attendance at the morning meetings on the Forensic Units, and talking to patient groups via the OT’s about our work (alongside the normal referrals and giving communion. 2. Discussions with local parish priest who wants to offer space in his vast church hall as a mental health drop-in on a week day. This is in conjunction with the CMHT in Chichester. 3. Link to Rev Simon Holland in regards to mental health advice for Deliverance Team. 4. Working with OT’s on Dementia Assessment enabling them to have a spiritual component to their activities. 5. In discussion with a Curate in the Witterings part of W Sussex to provide a befriending service to patients on their own who are under the memory assessment team. 6. Weekly visiting on all units responding to referrals and home visiting by request from MAS, CMHT and crisis team. 7. Plans to make contact with Clergy in the North of the Trust (isolated, rural Midhurst) to provide them with resources and contact. Mill View 1. 1:1’s and referrals 2. Community visits 3. Community training with B&H Faith in Action; Peace of Mind, Diocese of Chichester 4. Choir project partnering with Choir With No Name Worthing 1. Weekly spirituality drop-in; weekly communion service 2. Monthly drop in at Selden and Burrowes 3. Occasional drop in at Shepherd House Iris ward Monthly drop-in We have at present no capacity for visits to Horsham, Beechwood, community work and visits in Crawley, Hastings or Eastbourne or rural Sussex. Who delivers the service? Service Delivery lead Spirituality is a service which we want to be available to all staff, patients and carers, on the basis of para 1 and which therefore must be framed in such a way so that it is available to all. Therefore there is also a distinction between spiritual support which is for everyone and religious care which is for those who wish for it. Both are an important part of the delivery of a spirituality service. Service Delivery should be led by professionally trained spiritual support leads but involve all staff wherever possible. Religious care can also be offered by the spiritual support leads, but emphasis should be on linking patients to their faith community for them to support them. We know a supportive faith community can be protective of mental wellbeing, offer social support and enhance meaning of life. (see Theos academic study Religion and Wellbeing) The role of spiritual support leads should be to encourage the faith community to support their members who are experiencing mental ill-health both in inpatient care and in the community. Staff The current system of spirituality advocates is not working. Supervision and communication are difficult, and there are issues of governance.. Better to have spiritual support leads working with staff where they are, as staff can be engaged with and team work can be built up. Spiritual support can however be delivered by all staff in varying ways. Training can be and is offered in basic spirituality training and assessment to all staff. Referrals are often made by community teams when requested by service users or on the suggestion of staff members.
3. NEXT STEPS
Survey Monkey Please go to https://www.surveymonkey.co.uk/r/TYGN62R to complete the survey! Some results from talking to stakeholders in the Trust and in the Community and from the survey: a) Welcome the move from ‘chaplaincy’ to spiritual support b) Feel religious care is a part of spiritual care but not the only focus c) Believe we should concentrate our time in inpatient units and staff support mostly. d) The most important aspect of spirituality a sense of connection to the world outside e) One of main goals of spiritual care a greater sense of peace of mind f) Spirituality brings a sense of comfort and is a source of guidance for one’s life
Report to Council of Governors Agenda item CG 07.1/18 Attachment D EHRIA N/A code Date of meeting 19 February 2018 Format of Paper Title of paper Chief Executive Report Written Author Sam Allen, Chief Executive Oral ☐ Presenter Sam Allen, Chief Executive Presentation ☐ Committees/meetings where this item has been N/A considered Purpose of report (tick all that apply) To provide assurance ☐ For decision ☐ Regulatory requirement ☐ To highlight an emerging risk or issue ☐ To canvas opinion ☐ For information To highlight patient, carer or staff experience ☐ Strategic Goals (tick all that relate) 1. Safe, effective, quality patient care 2. Local, joined up care 3. Put research, innovation and learning into practice 4. Be the provider, employer and partner of choice 5. Living within our means Summary of Report
In this report the Chief Executive will update the Council of Governors on a number of areas relating to local, regional and national issues.
Recommendation For the Council of Governors is asked to note the report and ask any questions of the Chief Executive.
1. INTRODUCTION The purpose of this report is to provide a summary from the Chief Executive of information relating to Sussex Partnership colleagues and clinical services along with an overview of relevant regional and national items of interest. 2. REPORT 2.1 Sussex Partnership Colleagues 2.1.1 The Care Quality Commission have published the outcome of their most recent inspection of the Trust. The inspection took place between October and December and involved comprehensive, unannounced, inspections of four core services and concluded with a well-led review. The CQC spoke to 134 patients, 65 carers, held 121 staff focus groups (involving 192 staff) and spoke with 280 staff during the inspections. I am delighted to report the CQC have rated Sussex Partnership as Good overall. We are holding a Quality Summit on the 15th March and members of the Council will be represented to contribute to our ongoing quality improvement work.
2.1.2 I want to share and acknowledge the significant work colleagues put in to supporting people over the Christmas holiday period. I have been so impressed with the celebrations and little touches like hearing about one of our Crisis Teams bringing in a client to one of our wards on Christmas Day for lunch and company as they were on their own. This is one of many acts of kindness shown and I thank all for making such a difference to the people we provide care and support to. My thanks also to our Governors for attending various events in the lead up to Christmas and for your support to the Heads On Chirstmas Quiz. This raised funds to support the celebrations and the winning quiz team were most impressive! Below is a picture from our Hellingly Medium Secure Centre.
2.1.3 Our flu jab campaign across the Trust has been a great success with over 70% of frontline staff taking up the vaccination. This is a 50% improvement on last year and this is down to the leadership of our physical health team and our peer vaccinators. Given the increase in reported flu we have also been offering the vaccination to people in our dementia inpatient wards and participating with partner organisations on infection control procedures to ensure we mitigate the risk of likelihood of outbreaks in our hospitals
2.1.4 Our Chief Nurse and Chief Medical Officer were invited to present at the National Learning from Deaths conference on 14th December, with the parents of Bethan Smith (David and Aldyth). The focus of the presentation was sharing our learning and the changes we have made working with families following a death of someone under our care.
2.2 Sussex Partnership Clinical Teams & Networks 2.2.1 The Trust continues to experience a sustained period of pressure on our adult acute services. Levels of demand are high as are levels of acuity; which reflects the picture nationally in the NHS. Teams are working tirelessly to support the pressures and to ensure we can enable people to be admitted to hospital close to their home.
2.2.2 Our i-Rock Youth Service attended the first ever Children and Young Peoples National Awards earlier this month and won the national award for Partnership and Co-Production.
2.3 Regional and National Highlights
2.3.1 Section 136 In my last report to the Trust Board I highlighted the changes to s.136 of the Mental Health Act that took effect from December 11th along with how we were preparing operationally for the changes. I am pleased to report all partners (Police, Acute, Local Authority, Clinical Commissioning Group) are working in partnership and the system is working well. The changes have been a contributory factor to the pressure on acute services as the assessment period has reduced from 72 to 24 hours.
2.3.2 Visit to Westminster On the 29th January Dr Rick Fraser, Simon Street and I visited Westminster to meet with a number of Sussex and Hampshire MPs. At this meeting we provided an update on the work of the Trust. It also provided the opportunity to share both the challenges and opportunities we have. It was well received and very helpful. My thanks to Sir Nicholas Soames MP for organising the meeting for us.
2.4 Sussex and East Surrey Sustainability and Transformation Partnership (STP) 2.5.1 The focus of partners in the STP is on moving the strategic framework for mental health developed by the STP, with stakeholders in to a delivery plan. A governance structure has been developed and this includes establishing a ‘single point of ‘ leadership’ group for mental health, which I will chair. The strategic commissioning for mental health has now moved to the recently formed Central Sussex Alliance. This new alliance brings together 5 Clinical Commissioning Groups. This is a positive step forward.
3. Recommendation For the Council of Governors to note the report and ask any questions of the Chief Executive.
Report to Council of Governors Agenda item CG 07.2/18 Attachment E EHRIA N/A code Date of meeting 19 February 2018 Format of Paper Title of paper Lead Governor Report Written Author Amy Herring, Interim Lead Oral ☐ Governor Presenter Amy Herring, Interim Lead Presentation ☐ Governor Committees/meetings where this item has been N/A considered Purpose of report (tick all that apply) To provide assurance For decision ☐ Regulatory requirement ☐ To highlight an emerging risk or issue ☐ To canvas opinion ☐ For information To highlight patient, carer or staff experience ☐ Strategic Goals (tick all that relate) 1. Safe, effective, quality patient care 2. Local, joined up care 3. Put research, innovation and learning into practice 4. Be the provider, employer and partner of choice 5. Living within our means Summary of Report The Interim Lead Governor gives an update of the last three months of governor activities.
Recommendation The Council is asked to note the report and ask any questions of Amy Herring, Interim Lead Governor.
1. INTRODUCTION Welcome to the first Council of Governors of 2018 and I can say it has definitely been a ‘good’ few months. Sussex Partnership has moved from ‘Requires Improvement’ to now overall ‘Good’ with ‘Outstanding’ in the caring domain. But I would like to thank Governors for participating in the CQC Governors Focus Group which was done by a survey. CQC had 18 responses from the Council (which is the most they have had from Governors at Sussex Partnership)! 2. REPORT I am very grateful and proud of the ongoing dedication of our Governors as I have seen that there has been an increase in Governor activity. On 1st December we had a team of Governors for the Heads On Christmas quiz named the ‘Gallant Governors’ and with a massive difference of coming last place in 2016, we ended up in first place in 2017. We had 19 Governors attend our Joint Development Day with the Board (which is also the most turnout we have had for a joint development day)! There was a really positive and energetic atmosphere in the room with our Council of Governors working together with our Board of Directors on the annual plan and also developing our knowledge on accountability. We received a lot of verbal feedback that it was a beneficial and enjoyable session. Some of our Governors also attended a NHS Providers GovernWell training day which I heard was really useful and Governors came away feeling they had learned something new. A lot of the Governors have also been busy visiting services, that I hope have been insightful experiences. It is also great to see that Governors have sent out letters to their MPs asking about funding for mental health services. Quite a few Governors have been successful in regards to their MP agreeing to meet for a discussion. I hope these goes well. Jeremy Hunt even visited Sussex Partnership on 1st February, as a Council of Governors you would be pleased to know I asked him about funding for mental health services. I have been busy myself meeting with Lead Governors of other NHS Foundation Trusts and have managed to join Sussex Partnership to the National Lead Governor Network where there is a lot of learning and sharing to be done. We have a lot of exciting developments in 2018 for the Council of Governors. You will have seen that we have introduced peer support calls and group agreements as a way of enabling Governors and the Council to become more effective in the ways of working. Hopefully Governors will have had the opportunity to read the feedback from the workshop on ‘Supporting individuals in Governance roles’ which was part of a conference organised by Anne Beales. A lot of interesting feedback came out of the discussions which I hope we can use for the Council of Governors. Some new developments in regards to engaging Governors has been around asking Governors to choose an area of service to visit which will then be organised by our Corporate Governance Office to then visit, also the new idea of asking Governors to identify a Quality Improvement project they would like to collectively work on for the year. The People Participation Team are also busy in developing the Quality and Safety Visits to services, in which there is also a specifically designed Quality and Safety Visit for Governors and Non-Executive Directors that should be ready to happen at some point this year. There is also an even more exciting development lined up that I have been working on with the support of NHS Providers which I hope will begin in April. I am still aware there is much more we need to do in regards to developing, particularly around engaging with our constituents and more clarity on the role of a Governor, but I am hopeful we can improve on this throughout the year. My final message I would like to say for this report is that I am extremely proud of each of our Governors who have all worked together as a team and contributed in their own unique way to helping the Council progress. With the progress of the Council of Governors so far I am positive that we are on the path to improving our effectiveness and making a difference to the mental health community.
Photo taken at the Joint Board and Council Development Session
3. RECOMMENDATION & NEXT STEPS The Council is asked to note the report and ask any questions of Amy Herring, Interim Lead Governor.
SPFT Governor Feedback from Checkbox Exercise – 22 November 2017
20 Respondents
1. Do you think there is a positive culture within the Trust? 19 said Yes / 1 said No Summary of comments: Governors generally reported a positive culture at executive level and among frontline staff which was actively support. There is a desire to improve services.
2. Do you feel able to freely question the Trust executive team on the following: Quality report - 19 said Yes / 1 said No CQC judgements on the quality of care provided -18 said Yes / 2 said No Performance of the Trust against goals - 18 said Yes / 2 said No
Summary of comments: A willingness to engage, however communications could be more in-depth.
3. Do you feel able to engage with the non-executive directors to share concerns, e.g. such as by way of joint meetings? 19 said Yes / 1 said No Summary of comments: Overall good working relationships with NEDs exist, however a formal annual meeting for NEDs may be useful.
4. Do you receive timely information on proposed significant mergers, acquisitions, separations or dissolutions and feel able to question the non- executives on the board’s decision-making processes, and then, if satisfied, approve the proposal?
13 said Yes / 1 said Yes and No / 2 did not respond / 4 said No Summary of comments: while information is shared, improvements could be made regarding the increase in regularity of delivery and scope of information shared.
14. Can you tell us about how you seek the views of members and the public on material issues or changes being discussed by the trust.
Summary of comments: Through use of social media and meetings with the public using local voluntary and health services, and with members of the trust. A guide is being developed on how to carry out this consultation activity.
15. Can you tell us about how you feedback to members and the public information about the trust, its vision, performance and material strategic proposals made by the trust board.
Summary of comments: Governors reported they fed back verbally to members and the public, via the Trust’s quarterly Partnership Matters Newsletter, through the Trust’s social media and their website, at the annual Members' meeting, informally during the year, to management teams in meetings, individually produced newsletters. However, it was reported that there is no structured approach to this activity.
16. How do you ensure that when you are communicating with directors of the trust that you represent the interests of members and the public rather than just your own personal views?
Summary of comments: Governors gather views from wide range of individuals and groups and communicate these onwards using recorded experiences and notes to ensure accuracy.
17. Do you feel you are able to contribute to any changes to the trust constitution? 15 said Yes / 2 did not respond / 3 said No.
Summary of comments: Generally governors felt able to do this, however it can be a challenge to contribute to constitutional changes.
18. Were you able to contribute to the appointment of the Chief Executive and other members of the trust board?
11 said Yes / 3 did not respond / 6 said No.
Summary of comments: Governors generally felt they were able to contribute, however 6 were not in post or available at the time.
19. Please summarise the trust’s ability to provide services which are safe, effective, caring, responsive & well-led.
Summary of comments: Governors generally felt the trust learned from incidents and thematic reviews, had strong research resources, caring staff, responded well, offered high quality services despite financial constraints. Two respondents reported that services needed to be improved.
Report to Council of Governors Agenda item CG 07.2/18 Attachment E EHRIA N/A code Date of meeting 19 February 2018 Format of Paper Title of paper Supporting Individuals in Written Governance Roles Author Amy Herring, Interim Lead Oral ☐ Governor Presenter Amy Herring, Interim Lead Presentation ☐ Governor & Anne Beales, Non-Executive Director Committees/meetings where this item has been N/A considered Purpose of report (tick all that apply) To provide assurance For decision ☐ Regulatory requirement ☐ To highlight an emerging risk or issue ☐ To canvas opinion ☐ For information To highlight patient, carer or staff experience ☐ Strategic Goals (tick all that relate) 1. Safe, effective, quality patient care 2. Local, joined up care 3. Put research, innovation and learning into practice 4. Be the provider, employer and partner of choice 5. Living within our means Summary of Report Amy Herring, Interim Lead Governor and Anne Beales, Non-Executive Director attended the Principled Ways of Working Conference held on 30th November 2017. This report gives a summary of topics discussed at the conference and how the learning has been incorporated into the Governors Development Programme for 2018.
Recommendation The Council is note the report and ask any questions of Amy Herring, Lead Governor and Anne Beales, Non-Executive Director.
1. INTRODUCTION Amy Herring, Interim Lead Governor and Anne Beales, Non-Executive Director attended the Principled Ways of Working Conference held on 30th November 2017 which was Chaired by Sarah Yiannoullou, Managing Director of the National Survivor User Network/NSUN. This report provides a summary what was discussed at the conference and what methods are being introduced at the Trust to help support individuals in governance roles. 2. REPORT Supporting Individuals In Governance Roles – Workshop Feedback At the conference, Amy Herring, Interim Lead Governor and Kate Gedney, Peer Support Worker facilitated the workshop looking at ‘supporting individuals who are in governance roles’. The reason for this workshop was to recognise that some individuals in governance roles may struggle in the role, but when offered either practical or emotional support, they could become quite effective in their role. This workshop applied to service users in governance roles, but it can also be applied carers, members of the public or staff who are also in governance roles. One half of the workshop focussed on ways to practically support individuals in governance roles. Whereas the other half of the workshop focussed on ways to emotionally support individuals in governance roles. The learning and how particular methods will be adopted at the Trust are listed below: Practical Support The first area and suggestion raised by participants on practical support was to ask individuals in governance roles as early as possible whether there was anything needed in terms of physical and/or mental and/or emotional support. For example: if someone identified as having difficult hearing, would it be best to sit the individual nearer the front, or if someone identified as having difficulties in processing information, would it be best to think of alternatives to offer information like agendas. The overall idea was for individuals to come up with their own checklist of requirements that they think would help them in being able to carry out their governance role. A second area on practical support that was raised by participants was being able to participate effectively in meetings. Some suggestions were for agendas to be sent in advance so that there was enough time to ask questions in case someone did not understand something on the agenda. There was also mention of agendas or information being available in different formats that suited the individual. A third area on practical support that was identified by participants related to appropriate training. Types of training that were referred to by participants were: how to prepare for a meeting, how to hold to account, how to represent broad interests and getting to know the people they would likely interact with in their role. The fourth area on practical support that was referred to by participants was on meetings. Participants thought engagement in a governance role was most effective when meetings were well structured and the Chair/Facilitator of the meeting appropriately managed the meeting and had an understanding of when something was out of context or a boundary/rule had been crossed. Relative to this, participants also felt that a meeting was effective when the group were aware of the rules and boundaries of the meeting (group agreement between individuals). Also in terms of meetings participants felt practically supported when there was the availability of remote meetings (via skype/telephone), however participants also realised that some meetings which required a large numberPage 2 of of 4 people or a large amount of time were best to attend in person rather than other methods. Participants also felt it beneficial when action or learning plans came out of points in meetings as it was a way of individuals knowing what is going on and whether something is happening about a particular issue. The last point participants raised about meetings was for a reduction in the use of acronyms and for language barriers to be broken down. One suggestion from a participant was for individuals in meetings to be aware of others present in the meeting. For example, if a clinician was in a meeting that also involved service users, then it would be useful if the clinician was aware that service users may not understand what is considered as professional language. Emotional Support The first area and suggestion raised by participants on emotional support was about the culture of behaviours within a meeting. Possibly the most important aspect of culture within a meeting is that everyone feels they are in a safe space and do not have to worry about being caused emotional distress. A few other points participants thought emotionally supported them in their role was when they felt equally valued and respected by others. Some participants said when they felt valued and respected, they also felt confident to have a voice and ask questions without feeling it may have been a silly question or an invaluable point. A second area on emotional support that was raised by participants related back to a previous item on meeting agendas. Some participants thought that when they attend meetings, the agenda items were very complex, not engaging and were inappropriate for the meeting attended. It was discussed by participants that they were able to engage in agenda items when there was a clear relation between the item and their role. Also some agenda items were written or presented in a professional language manner, as also mentioned within practical support. Participants had said that when agenda items were written or presented in a professional language, it caused confusion and disengagement. Participants also raised the idea of having a briefing session and a debriefing session before and after a meeting. The briefing session was to ensure everyone was okay and had an understanding of the meeting that was occurring, this is done so individuals do not feel stressed about the meeting, can have a chance to adapt to their surroundings and to also feel comfortable about going into the meeting. The debriefing session was to enable a reflection of the meeting of what maybe went well or what maybe did not go so well that can be improved upon for next time. This debriefing session is to also ensure individuals feel emotionally safe before departing to travel or go to another meeting. A third area that was discussed by participants was about how a meeting is conducted. Participants thought that an example of a good meeting was a safe meeting. By safe meeting, the participants meant a meeting where they knew they were emotionally safe from harm or distress. A further point is the idea of ‘group agreements’. Group agreements are considered as a set of rules of behaviour and values that are created by the group to ensure the best interests of the group’s member’s physical and emotional safety. Generally it is the role of the chair/facilitator to keep the group to the group agreements and to also sustain a safe space. There is also an additional aspect that was raised by participants which is that professionals within a meeting should be aware that an individual might be nervous, struggling slightly or may have even been triggered by a sensitive topic. Participants thought it had been beneficial when it was recognised that they may have been struggling and support was offered for them to still be able to carry out their role. A final area that was raised by participants was around the idea of having someone they could trust or speak to. There was an idea of having a critical friend/buddy. A critical friend or buddy was someone an individual could trust and talk to if they had a problem or wanted Page 3 of 4 feedback on how they did in a meeting. Participants found it really useful and supportive to have someone as a buddy they could check in with if they did not feel okay or if they were not sure of how they performed within a meeting they could seek honest feedback from a critical friend. In response to the above learning, the Trust is implementing a support and reasonable adjustment process for both new and existing governors. This was discussed by the Training and Development Committee at their last meeting and forms part of their summary report to the Council of Governors meeting, item CG11.4/18. Support through this process includes: Governor induction session - the Company Secretary running Equality, Diversity and Human Rights session, covering the definition of disability and the Trusts obligation to provide support and reasonable adjustments. Mentor/Buddy - All new governors will be offered the opportunity to have a buddy and these arrangements will be made through the Corporate Governance Office Occupational Health Referral - Following the completion of the Equality Monitoring Form and any discussions with new governors on support and reasonable adjustments an occupational health referral will be offered Peer Support Conference Calls - Briefing and debriefing call are available before and after every CoG meeting and are available to all governors. These are led by the Lead Governor Council Agreement - This Group Agreement has been developed not replace the Code of Conduct, but act alongside it. Code of Conduct addresses Governors overall conduct of behaviour, whereas Group Agreements are designed to address the behaviour demonstrated within a meeting. As a mental health trust, we will have individuals who have different mental health difficulties and the Group Agreement is in place to support and protect an individual’s mental health as well as ensuring a meeting is effective. Group Agreements are present in other areas (e.g. National Survivor User Network) and have proven to work really well. 3. RECOMMENDATION & NEXT STEPS The Council is note the report and ask any questions of Amy Herring, Lead Governor and Anne Beales, Non-Executive Director.
Page 4 of 4
Report to Council of Governors Agenda item CG 07.3/18 Attachment F EHRIA N/A code Date of meeting 19 February 2018 Format of Paper Title of paper Annual Plan 2018/19 Written Author Tony Sharp, Head of Oral ☐ Strategic Planning Presenter Sally Flint, Chief Finance Presentation ☐ Officer Committees/meetings where this item has been N/A considered Purpose of report (tick all that apply) To provide assurance ☐ For decision ☐ Regulatory requirement ☐ To highlight an emerging risk or issue ☐ To canvas opinion ☐ For information To highlight patient, carer or staff experience ☐ Strategic Goals (tick all that relate) 1. Safe, effective, quality patient care 2. Local, joined up care 3. Put research, innovation and learning into practice 4. Be the provider, employer and partner of choice 5. Living within our means Summary of Report On 30 January 2018 Sussex Partnership held a joint planning day with the Council of Governors and Board of Directors. The purpose of this session was to help develop our annual plan for 2018/19. In order to achieve this aim we briefed people on the current situation in relation to our agreed strategy; national and local requirements; feedback from patients, staff, partners and regulators; and to hear an analysis from senior leaders including the chief executive and chair. Recommendation To note the content of the report.
1. INTRODUCTION On 30 January 2018 Sussex Partnership held a joint planning day with the Council of Governors and Board of Directors. The purpose of this session was to help develop our annual plan for 2018/19. In order to achieve this aim we briefed people on the current situation in relation to our agreed strategy; national and local requirements; feedback from patients, staff, partners and regulators; and to hear an analysis from senior leaders including the chief executive and chair. 2. REPORT We organised into break-out table discussions and fed back to the wider group. The outputs of these sessions are set out in section 3. Clinical strategy sessions
Priority area Lead
Suicide prevention Dr Rick Fraser, Chief Medical Officer
Crisis and urgent care Peter Ley, Project Lead – Urgent and Crisis Care
Access Jonathan Beder, Programme Director
New roles Andrew Vickers, Director of Human Resources
Teams Simone Button, Chief Operating Officer
Recovery colleges Lucy Locks, Deputy Director of Occupational Therapy and Louise Patmore, Patient Lead to the Clinical Strategy
Enabling sessions
Priority area Lead
Workforce Andrew Vickers, Director of Human Resources
Digital Beth Lawton, Chief Digital and Information Officer
Estates Nigel Burchett, Director of Estates
Research & Mark Hayward, Director of Research development
Finance Paul Green, Director of Finance
1. Strategic context We have some very clear guiding strategies within the trust and externally. The annual plan is about setting how we deliver on these for the year ahead. Our guiding strategies: • 2020 Vision (2015) • 5 year forward view for mental health (2016) • Clinical Strategy (2017) • NHS planning across Sussex and East Surrey (ongoing) • Enabling strategies and plans (including estates, digital, workforce, health and wellbeing, equality and diversity, finance) The Trust’s overarching strategy ‘Our 2020Vision’ sets out how we will provide outstanding care and treatment you can be confident in. Our clinical strategy aims to help us achieve this vision. It outlines the type and range of clinical services we want to offer by 2020 to deliver the best care we can for service users, carers and their families within the resources we have available. It also describes the type of partnerships we want to form, the key changes in services and clinical practice we want to see, and the support we will put in place to make these changes happen. The clinical strategy has been developed in partnership with patients, carers, staff, commissioners and other key stakeholders. It aims to directly address the concerns and ambitions of each stakeholder group. Set out below are the components of our Clinical Strategy
Our Offer: The New Service Model New Partnerships Enabling High and New Ways of Quality Care Working
Working with communities Suicide Caring for our 24/7 Crisis care Prevention staff Access to care Integrated Improving Primary care mental health and tier 2 physical & mental teams pathfinder services health services Secondary care community and youth Measuring services People outcomes participation Wellbeing recovery & discovery college Pathways of Acute inpatient services Workforce and care Rehabilitation new roles Using data and Children and young people: CAHMS, technology to EIP and Perinatal Mental Health Services improve care Specialist services for people with learning disabilities and autistic spectrum conditions Digital by Services for older people and people with design dementia Medicines Forensic healthcare services Optimisation Care-home plus Dual Diagnosis
The table below sets out NHS England’s Five year Forward View priorities
FIVE YEAR FORWARD VIEW PRIORITIES
Crisis All areas will provide crisis resolution and home treatment teams (CRHTTs) delivering a 24/7 service
Acute All acute hospitals will have all-age mental health liaison teams in place, and at least 50% of these will meet the ‘Core 24’ service standard as a minimum
Improving Access 75% of people are able to access treatment within 6 weeks, 95% within to Psychological 18 weeks; and at least 50% achieve recovery across the adult age Therapies (IAPT) group, with a focus on people living with long-term physical health conditions 25% of people with common mental health conditions are able to access psychological therapies Early Intervention At least 60% of people with first episode psychosis starting treatment in Psychosis (EIP) with a NICE-recommended package of care with a specialist early intervention in psychosis (EIP) service within 2 weeks of referral
Primary Care New mental health therapists will be co-located in primary care
Integration More people with a severe mental illness receiving a full annual physical health check and people with long term conditions will receive mental health support
Individual A doubling in access to individual placement and support (IPS), Placement & (IPS) enabling SMI patients to find and retain employment
Out of Area Out of area placements will be eliminated for acute mental health care Placements
Suicide prevention Reduced suicidal rate by 10% supported by local multi-agency
2. Output of sessions
Suicide prevention Dr Rick Fraser, Chief Medical Officer
Training – risk factors and dual diagnosis include: Staff Community GPs / A&E Use the grass Roots App Cover risk factors such as social media Prevention Resilience building Distress tolerance Specifics around medication and post discharge support Connecting with others Aiming for ‘perfect depression care Awareness raising How best to reach people – look at a range of options and take a market research approach Co-production is very important – involving service users, family and friends, other organisations Communities- take a whole system approach Local / regional / national – networks and learning Use of digital and social media – catch phrase like RUOK? Communications – data sharing and risk management Access and engagement Mental health line, perhaps develop a ‘suicide hotline’ so people can access help Follow up active 24/7 crisis care Support should be meaningful and consistent
Crisis and urgent Peter Ley, Project Lead – Urgent and Crisis Care care We need to Understand the profiles of people presenting in crisis o Who they are o What matters to them This will inform decisions about skills mix, training and staffing. Understand what we have in place already o Where does SPFT resource fit in against the wider system including the voluntary sector? o Where does Urgent care fit in with other community teams? This will allow us to identify where there are gaps in the provision of urgent and crisis care and link in with partner agencies and other stakeholders Our model for Crisis care includes: A standard model based around o 24/7 Response o Prevent hospital admission o Easily accessible (via a single point of access) Deciding on the model allows us to focus on the gaps and to provide patients and other stakeholders with a consistent experience which is evidence based. The response is provided across a range of resources including: Crisis Cafes/ Urgent Care Lounges to provide a space for de-escalation Peer Support Workers for telephone reassurance and support We will map our current provision, working with Service Users, Commissioners, CDS staff, and other partners to understand the current levels of service provision and the relationships between them. We will identify the gaps and areas for development and produce proposals to inform commissioning intentions.
Access Jonathan Beder, Programme Director
Communicating to people where to go for initial contact. Issues are that it can be a 4 week wait for a GP and some people would rather not go to their GP. Ensuring well publicised with schools, colleges, GPs, sports clubs, social groups- having good information Do more work with partners especially SECAmb, but also organisations like St Johns Promotion also addresses stigma Link to primary care staff e.g. MHLPs Link to 111 - need a good entry in the Directory of Services (DoS) Interfaces with other access points need to work well e.g. CAMHS, councils, Citizens Advice Bureaus. Improving links with the Samaritans. There are risks around seeking unmet demand, but it is the right thing to do. Also need to consider how people physically access services, especially for people living in remote areas. New roles Andrew Vickers, Director of Human Resources
Need to ensure clarity of purpose before clarity of roles Need to address the ‘doubters’ in terms of value and benefits of the change Need to be clear about professional boundaries and contribution of experts by experience and role in becoming lead practitioner or delivering interventions? Need for jointly shared goals in clinical teams and clarity of who does what around coordination, integration, leadership Need to establish roles on basis of trust across teams Need understanding of clinical pathway drivers and required outcomes Need to be clear about the evidence to support implementation of new roles including views of service users Need to scale up in controlled and structured way taking into account evaluation, measurement, governance, care model Different type of leadership required
Teams Simone Button, Chief Operating Officer
1. To work in effective supportive teams - importance of being able to pull data across teams (e.g. Electronic Self-Record, My Learning, appraisal/supervision rates) - improvements needed in the interface between teams (e.g., community, inpatient/wards)
2. Supporting teams to improve - making sure that there are people to actually do the work (e.g., checking teams are having 2 development days a year) and if they aren’t how can they best be supported to do so - how are we/should we be measuring team effectiveness - using Quality Improvement (QI) methodology (e.g. Organisational Development (OD) practitioners) to improve team working, especially when team members are regularly working together
3. To make leadership more effective - developing leadership at all levels (e.g., NHS Leadership Academy) and funding for more senior leadership programmes - moving from hierarchical leadership to “collaborative leadership” - lack of communication in large organisation; staff do not know how different things/teams/etc work together; where do things link; communication with other teams requires improvement (Care Delivery Services) - roles and responsibilities, especially leadership; for example, “leader leader” and “service leader” model at Langley Green (based on the wealth of useful knowledge both staff and service users/patients and carers bring) - reminders of vision, purpose, meaning to develop team cohesion and building a community - developing a collective ownership for everyone’s wellbeing, e.g., being supportive of staff who are having an off day, looking out for your own and colleague’s wellbeing (making sure this is not a detriment to your own wellbeing) - moving from a culture of being afraid of making mistakes to one of continuous quality improvement, comments around the table regarding experienced staff who remember the old culture which might impact on their ability to try something new without fear of consequences for mistakes - moving from RAG (Red, Amber, Green) ratings (which miss out on key information) to quality improvement - making better use of team meetings/bite-size training sessions in teams/Langley Green development sessions for lower banded staff (bands 2/3) - importance of equality and diversity within leadership (beyond bullying and Black, Minority, Ethnic (BME) programmes) in order to help facilitate better communication and create better therapeutic and working relationships. For example, a Social Graces training workshop is being delivered on 20th February to the People Participation Team and OD Practitioners, etc. by Kamala Persaud (Systemic Psychotherapist), Alex Garner (People Participation Lead – Brighton and Hove) and Shannon R. Guglietti (Senior Assistant Psychologist). Aim is to give tools to staff members so they can use this model/exercise within other teams throughout the Trust. Essentially, it is a model drawn out of family psychotherapy used to increase one’s reflectiveness around the similarities and differences between people, understanding how these develop, resulting in greater understanding, awareness and empathy towards others. The experience of doing the task involved is not to be underestimated; it’s very powerful. (There are resources available to learn more, please email [email protected]).
Recovery colleges Lucy Locks, Deputy Director of Occupational Therapy and Louise Patmore, Patient Lead to the Clinical Strategy
Volunteering opportunities
Recovery wellbeing Specialist College approach to courses courses involvement
Person experiencing difficulties
Current Innovations Discovery College – Stakeholder events in E/W Sussex • Forensic college - Recruiting new peer trainers • Acute Recovery College - Increasing acute ward courses • Increasing co-produced staff training – PMVA co-design – Risk management co-design / delivery – Care planning co-design / delivery • Delivering MHA courses to public sector- Employing MH practitioners in new roles. • Develop IT infrastructure for increasing capacity Wellbeing Approach to Involvement Service users know what works o Engaging with their knowledge and expectations to boost the Recovery Colleges ability to deliver an expanded set of courses. o Coproduction makes the difference o Solidarity in a constructive way Recovery College gives students the experience of solidarity with others in a community setting. Funding Working closer with Heads On – Charity on bids for funding. o This could help to facilitate smaller providers to engage with the college and help with extra costs. o Develop multi agency forum for Discovery College. o Recovery College could be a champion for smaller third sector providers. o Christs Hospital has funding to engage with deprived communities and there might be scope for new partnerships. o Scope adult education funding streams. Working with CCG Finalise Recovery College Business Model and share with CCG. Co-production with the CCG- Commissioners - need to be involved with the development process. Creating alliance funding Scope for anti-radicalisation funding.
Enabling sessions
Workforce Andrew Vickers, Director of Human Resources
How do we help people make the decision to stay? Long service re generation X&Y who want different things from life Need to have less generic roles; specialist roles are more attractive Low cost changes will help e.g. team and individual recognition Career coaching surgeries Space and time to do interesting things around QI, innovation, CPD (bite sized) Reduce admin and increase clinical content Must be able to structure roles to vary patient intensity Induction important Good supervision; culture of support Need independent exit interview process Communication key
Digital Beth Lawton, Chief Digital and Information Officer
This is a fantastic opportunity to get alongside people. Key discussion points: The way we work needs to model what realities are. For some this will mean taking them on a digital journey. Support and help people to engage with and use digital. All to be ‘digital ambassadors’. Need clinical systems / environments to support systems Can we go paperless? Can we use mixed systems? Why are we still sending letters? Cultural shift – still required to realise benefits, it should not be discretionary, keep an open mind-set We need to be aware of how we work with service users – sort the basics and embed behavioural change Priorities: Focus on cultural change and getting support from staff Single information All new services designed with digital in mind
Estates Nigel Burchett, Director of Estates
Recognition that good environments creating positive first impressions are important. Thoughts included: Creating a recognisable brand image across the estate Ensuring reception areas are welcoming Good signage and wayfinding is important The right type of property in the right location is essential Thoughts around whether it may be possible to create mobile services to go out to rural communities rather than relying on physical buildings Also it is important to be aware and pre-empt the role of technology and how this may affect not only building design but how and where services users are engaged. Staff may be less reliant on fixed buildings in the future. Recognition that whilst funding may be tight investment in creating compliant and modern premises is required if we are to move to outstanding. Thus sharing and collaboration with other NHS stakeholders will be important in sharing risk and cost.
Research & Mark Hayward, Director of Research development
There is a mismatch between how the research department is funded (to generate new knowledge) and the need to use existing knowledge. At the moment 20-30% of resources go into the design of research 50-60% in the delivery of research projects and 10% in the translation of research evidence into services through clinics and by using existing evidence We need to make more use of existing evidence and knowledge in collaboration with library services and Clinical Academic Groups (CAGs).
Finance Paul Green, Director of Finance
Key ideas and areas to focus on for 2018/19 Improving retention rates and reducing the use of agency Staff are the solution There was a feeling that targets can be too difficult Renegotiate aspects of our contract where we do not get paid enough to deliver the expectations placed upon us Look at longer term investment to return to break even Five year forward view money – this has not been passed on to local mental health services by local commissioners. Governors have decided to lobby CCGs and politicians about this scandal. Working with partner organisations – how can we deliver services more efficiently working with local community organisations and charities.
3. Emerging priorities for 2018/19 EARLY DRAFT FOR INFORMATION
Priority area Objective / Measure When Lead
Access Introduce a Single Point of 31/12/18 Jonathan Beder Access for routine and crisis referrals across Sussex
Introduce Agree funding with Peter Ley comprehensive 24/7 commissioners; crisis care Develop a clinical network
Ensure smooth Delayed Transfers of Care Simone Button acute and target community interface Bid for comprehensive recovery/discovery colleges
Physical and mental Physical health screenings Diane Hull health for people with mental health needs Mental health support for people with long term physical health conditions
Move towards zero Ensure all staff have Rick Fraser suicides accessed the 20 min e learning module and have the staying alive app on phone/laptop Engage staff/partners/public health/communities through local towards zero suicide chapters, the launch event in May 2018 and implementation of the towards zero suicide consensus statement
Digital technology TBC Beth Lawton Quality Meet the objectives agreed Rick Fraser and improvement and at our quality summit Diane Hull training
Workforce and Turnover % reduction; Andrew Vickers teams agency % reduction; 2 team development days per team
3. RECOMMENDATION To note the content of the report.
External Audit Presentation to Council of Governors
Sussex Partnership NHS Foundation Trust
19 February 2018 Your KPMG external audit team
Neil Hewitson Paul Cuttle Director Senior Manager KPMG KPMG 15 Canada Square 15 Canada Square London, E14 5GL London, E14 5GL Tel: +44 (0)20 7311 1791 Tel: +44 (0)20 7311 2302 Mob: +44 (0)7909 991 009 Mob: +44 (0)7917 307 842
Josh Rolls Assistant Manager KPMG 15 Canada Square London, E14 5GL Tel: +44 (0)20 7311 2271 Mob: +44 (0)7468 768 912
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Document Classification: KPMG Confidential
Key elements of our financial statements audit approach
Our external audit opinion is addressed to the Trust’s Council of Governors. Below we explain the key elements PFI valuation of our audit approach: and disclosures Valuation of land Correct recording and building of remuneration assets £163m • Audit risk identification – areas of the Trust’s activities policies Valuation of which are considered unusual or higher risk Intangible assets £4.3m • Materiality – we’re particularly focussed in issues and Audit fee accounts items of approx. £4.8m or higher Annual report preparation Valuation for provision of debtors Leases £0.6m • Significant audit risks – those areas of the accounts Related parties we pay particularly close attention to. Currently we Recognition of NHS & have identified the following: non-NHS income £250m - Valuation of land and buildings Going concern Cash controls and application of cut Rationale for - NHS and non NHS income off £21m pay in excess of Management override of - Management override of controls prime minister controls
Completeness, existence Completeness and and accuracy of payroll valuation of costs £199m provisions £1.4m
Completeness, existence and accuracy of accrued expenditure £9m
Audit risk key: Significant audit opinion risk Figures shown taken from 2016/17 published financial statements
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Document Classification: KPMG Confidential Value for Money
For 2017/18 our value for money (VFM) work will follow the NAO’s guidance. It is risk based and targets audit effort on the areas of greatest audit risk. Our methodology is summarised below.
OOverallverall ccriterion:riterion: InIn allall ssignificantignificant rerespects,spects, thethe auditedaudited bodybody hadhad properproper arrange arrangementsments to to en ensuresure it it took took properly properly infor informedmed de decisionscisions and and deplo deployedyed re ressourcesources to to a achievechieve
planned and sustainable outcomes forplanned taxpa yanders sustainableand local people. outcomes for taxpayers and local people.
InformInformeded decis iondecision making making Sustainable resourSustainablece deploym resourceent deploymentWorking with partner and thirdWorking parties with partner and third parties
The full guidance is available from the NAO website at: https://www.nao.org.uk/code-audit-practice/guidance-and-information-for- auditors/. Our approach to the value for money is recorded below:
VFM audit risk No further work required
assessment V
Identification of FM Assessment of work by other
significant VFM
review agencies Conclude on c
risks (if any) arrangements to on c
secure VFM lu s
Specific local risk based work ion
Financial statements and Continually re-assess potential VFM risks other audit work
We have identified one significant risk relating to financial resilience. The Trust is facing ongoing funding pressures and is currently forecasting a best case scenario of a breakeven position with worst case of £3.4m deficit.
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Document Classification: KPMG Confidential External Audit responsibilities regarding your Quality Report 2017/18
Public limited assurance opinion issued on Content and Content and consistency consistency • Quality report is prepared in line with the criteria set out in NHS Improvement guidance and is not inconsistent with other information available. Two mandated indicators • Two indicators selected from mandated NHSI indicators.
Two mandated • Assessed against the six components of data quality. indicators Private limited assurance opinion issued on
Locally selected third indicator
• Governor selected indicator which we are not required to issue an opinion on.
• Assessed against the six components of data quality. Locally selected third indicator Six components of data quality 1. Completeness 3. Reliability 5. Timeliness 2. Accuracy 4. Relevance 6. Validity
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Document Classification: KPMG Confidential Mandated indicator testing
2017/18 testing Guidance on quality report content. Two mandated indicators. From the following list of four in the following order of preference:
• Early intervention in psychosis (EIP): people experiencing a first episode of psychosis treated with a NICE-approved care package within two weeks of referral. • Inappropriate out-of-area placements for adult mental health services. • Improving access to psychological therapies (IAPT): waiting time to begin treatment (from IAPT minimum dataset): within 6 weeks of referral. • 100% enhanced Care Programme Approach patients receiving follow-up contact within seven days of discharge from hospital. 2016/17 conclusion Our work on the two mandated indicators concluded that there is sufficient evidence to provide a limited assurance opinion in respect of CRHT gatekeeping and the 7 day follow up indicator.
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Document Classification: KPMG Confidential Selection of the local indicator 2017/18
The Governors are required to select an indicator that meets the following criteria: • Must be written definition. • The indicator must be one based on data that has been collected throughout 2017/18. • This is a historical data review and hence the indicator chosen must be retrospective, rather than forward looking, i.e. for the year ending 31 March 2018. • National indicators tend to be easier to audit; local indicators link in more directly to what you’re concerned about.
National indicator Local indicator
National rules suite available. Allows the Trust to select a bespoke indicator targeting specific risk areas.
Comparability to other Trusts. Opportunity for assurance assessment over internal
processes for the local indicators where there may not be national guidance available.
Possible pre-planning for future quality account Allows assessment of the viability of new indicators audits. introduced by the Trust.
2016/17 local indicator In 2016/17 the local indicator selected by governors was ‘statutory and mandatory training’. We concluded that if required we would not be in a position to provide a limited assurance opinion due to an issue with gaining assurance in relation to the completeness of the data driving the indicator.
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Document Classification: KPMG Confidential Selection of the local indicator 2017/18
The following are examples of indicators which other Trusts have chosen as the local indicator last year:
Indicator Description Mental health The trust’s ‘Patient experience of community mental health services’ indicator score with regard to a patient experience patient’s experience of contact with a health or social care worker during the reporting period. Percentage first Number of formal complaints (those complaints received by letter, email or phone) that have response received received a first response within the agreed time as negotiated between the client and the Patient by the complainant Experience Team at the start of the complaint (30 days per Complaints policy unless otherwise within agreed time agreed). Re-admittance The percentage of patients readmitted to a hospital which forms part of the trust within 28 days of being discharged from a hospital which forms part of the trust during the reporting period. Patient safety The number and, where available, rate of patient safety incidents reported within the trust during the reporting period, and the number and percentage of such patient safety incidents that resulted in severe harm or death. Reducing staff To reduce the number of incidents of abuse (including discriminatory abuse) experienced by staff abuse in the work place.
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Document Classification: KPMG Confidential Recommendations arising from our 2016/17 quality accounts audit
Below we detail the recommendations arising as a result of our 2016/17 audit:
# Risk Recommendation Management Response / Officer / Due Date 1 CPA 7 day follow up data cleanse Agreed
Our review of exclusions identified 2 errors in our initial This will be completed on a quarterly basis going sample of 25. In our additional sample of 15 we identified forward.
a further 5 errors where cases were incorrectly excluded. Officer Responsible: Performance Director As a result the Trust undertook an exercise in May 2017 to review all exclusions to ensure that any which should be Due Date: 30 August 2017 included in the calculation of the indicator had been. Management should consider regularising this exclusion review process throughout the year. 2 Completeness of statutory and mandatory training Agreed As part of our audit we were unable to get assurance over The alignment between the two systems is currently the completeness of data used in this indicator. The Trust being completed. could not provide a listing from MyLearning that agreed to Officer Responsible: Clare Marr ESR. Work is underway to align these systems. As part of this alignment Management should consider reconciling Due Date: 30 August 2017 the data held on ESR to MyLearning to ensure completeness of the records held on MyLearning.
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Document Classification: KPMG Confidential
Report to Council of Governors Agenda item CG 09.1/18 Attachment J EHRIA N/A code Date of meeting 19 February 2018 Format of Paper Title of paper Council of Governors Twitter Written Account Author Dominic Ford, Director of Oral ☐ Corporate Affairs Presenter Dominic Ford, Director of Presentation ☐ Corporate Affairs & Amy Herring, Lead Governor Committees/meetings where this item has been N/A considered Purpose of report (tick all that apply) To provide assurance For decision ☐ Regulatory requirement To highlight an emerging risk or issue ☐ To canvas opinion ☐ For information ☐ To highlight patient, carer or staff experience ☐ Strategic Goals (tick all that relate) 1. Safe, effective, quality patient care 2. Local, joined up care 3. Put research, innovation and learning into practice 4. Be the provider, employer and partner of choice 5. Living within our means Summary of Report The Training and Development Committee discussed how Governors engage with members, in line with their statutory duty to represent the interests of members and the public. One way to engage more widely is through social media, and it was agreed that a framework would be developed for a Governors’ Twitter account to raise the profile of Governors and connect with the wider membership of Sussex Partnership NHS Foundation Trust
Recommendation The Council is asked to consider the proposed framework and nominate members of a social media group to oversee the account
1. INTRODUCTION The Training and Development Committee discussed how Governors engage with members, in line with their statutory duty to represent the interests of members and the public. One way to engage more widely is through social media, and it was agreed that a framework would be developed for a Governors’ Twitter account to raise the profile of Governors and connect with the wider membership of Sussex Partnership NHS Foundation Trust. 2. REPORT The aim and governance of the Governors’ Twitter account is set out below. Aim To use social media (specifically, Twitter) to raise the profile of Governors and connect with the wider membership of Sussex Partnership NHS Foundation Trust Governance The Twitter account will be managed by a social media group of Governors agreed by the Council The Council will delegate freedom and responsibility for posting messages via the account to the social media group (as long as the conditions below are adhered to) Members of the social media sub group agree not to post messages which: - could damage the reputation of the Council of Governors or Sussex Partnership NHS Foundation Trust - reflect their personal views on issues such as NHS policy or funding - reveal confidential / sensitive information discussed by the Council - criticise individual Governors or others associated with the work of Sussex Partnership NHS Foundation Trust More broadly, the account will be managed in line with the principles regarding the use of social media set out in the Trust’s media policy The Twitter account will carry a brief disclaimer making it clear that the messages posted via the account do not represent the formal views of the Council of Governors, but those of individual members e.g. Views from Governors @withoutstigma. 3. RECOMMENDATION & NEXT STEPS The Council is asked to consider the proposed framework and nominate members of a social media group to oversee the account
Report to Council of Governors Agenda item CG 10.2/18 Attachment L EHRIA N/A code Date of meeting 19 February 2018 Format of Paper Title of paper Quality Committee Summary Written Author Justine Rosser, Deputy Chief Oral ☐ Nurse Presenter Professor Gordon Ferns, Presentation ☐ Non-Executive Director Committees/meetings where this item has been N/A considered Purpose of report (tick all that apply) To provide assurance For decision ☐ Regulatory requirement ☐ To highlight an emerging risk or issue ☐ To canvas opinion ☐ For information To highlight patient, carer or staff experience ☐ Strategic Goals (tick all that relate) 1. Safe, effective, quality patient care 2. Local, joined up care 3. Put research, innovation and learning into practice ☐ 4. Be the provider, employer and partner of choice ☐ 5. Living within our means ☐ Summary of Report The Quality Committee last met on 15 November 2017, chaired by Professor Gordon Ferns, Non-Executive Director. This summary was submitted to the Trust Board on 29 November 2017. In summary, the meeting considered reports from sub committees: Effective Care & Treatment Committee Positive Experience Committee Safety Committee Well Led Committee, Workforce The committee also considered the Quality Improvement Programme update, the Quality Assurance Report and agreed the Quality Committee Annual Cycle of Business. Recommendation The Council of Governors is asked to note the content of this report and raise any issues for clarification.
1. INTRODUCTION The purpose of the Quality Committee is to enable the board to obtain assurance that high standards of care are provided by the trust and in particular, that adequate and appropriate governance structures, processes and controls are in place: promote safety and excellence in patient care identify, prioritise and manage risk arising from clinical care ensure the effective and efficient use of resources through evidence-based clinical practice protect the health and safety of trust employees ensure compliance with legal, regulatory and other obligations 2. REPORT
Below is a summary of the Quality Committee held on the 15 November 2017.
Effective Care & Treatment Committee The purpose of this committee is to make services more effective: providing evidence- based, recovery oriented care and treatment, supported by research and education activity.
The committee stated that they would report to the Quality Committee on work plan developments in addition to giving assurance. They are reviewing all the CQC KloEs to ensure that each are aligned to the appropriate Quality Sub Committee. It was agreed where there are areas of uncertainty/overlap; this would be reported to the Quality Committee. Each of the subcommittee chairs will review the KloEs in detail to agree which falls under their remit and present to the next Quality Committee.
Positive Experience Committee The purpose of the PEC is to provide assurance to the Quality Committee that appropriate systems are in place to ensure that people who use services, their families and carers, have a voice in the organisation providing their care.
The 3 key ways which comprise the PEC work plan are: Introduction of Involvement Standards which will complement the work being undertaken through the Triangle of Care scheme Triangulation of feedback and identification of themes from internal and external sources of service user and carer experience, and to prioritise and commission action arising from these Introduction of Experts by Experience to PEC and other Quality Committee functions
A People Participation progress report was presented which informed the Quality Committee of the progress of priority participation work streams which consist of: Working together groups (WTG) Developing access to peer support throughout services Increasing the numbers of service users and carers actively involved in the trust (EBE, Experts by experience)
The developments in 2017 for the Friends and Family Test were highlighted. This year the People Participation and IT Solutions teams, which went live in October 2017, worked to develop an in-house survey, the Sussex Experience Survey, incorporating the Friends and Family Test. This was in response to staff/service user and carer feedback on the previous delivery system. The Sussex Experience Survey gives us the structure to collect near real
time, team level information about patient and carer experience.
Safety Committee The last Safety Committee focused on: Quarterly Quality Report Learning from Deaths & Mazars Report Least Restrictive Practice SI Assurance Report Homicide update Learning Lessons from incidents
The Quarterly Quality Report was presented and agreed that the report will identify, going forward, the top ten hotspots by triangulating incidents, SI’s, complaints and risks. It was also agreed that this report should be submitted to the trust board as an attachment for information.
Well Led Committee Workforce Report The Well Led Committee is revising the Terms of Reference as the committee is addressing well led elements of the clinical strategy in addition to workforce issues.
It was raised that there was a gap in assurance for training and supervision not being recorded on My Learning. It was confirmed that an online appraisal form will be introduced that will ensure all appraisal documents are uploaded onto the system.
Quality Improvement Update Exploratory work is being carried out in order to create a work programme and action plan Next steps are to engage with a strategic partner and this will be going out to tender within the next couple of weeks, and to define the metrics to be used.
Quality and Assurance Report The Trust Quality and Assurance report has been reframed to describe the performance of each Care Delivery Service in relation to the CQC domains (Safety, Effective, Response, Caring and Well Led).
Each CDS prepares monthly individual quality assurance reports which are submitted each month to the review group which include the Chief Operating Officer, Performance Director and representatives from Finance and HR.
It was highlighted that key features of change in the law regarding the use of s136 suites, come into effect nationally on the 11 December 2017, which reduces the time of detention and therefore increases the need to have people assessed more quickly.
Rapid Tranquilisation The Quality Committee was provided with an update on actions taken as a consequence of concerns raised by the CQC, specifically the taken of non-touch observations where a patient refuses intervention.
PMVA/Least Restrictive Interventions The Quality Committee was provided with a report which outlined a workplan to ensure the reduction of least restrictive interventions. This incorporated 6 key areas highlighted as stipulated by the two guidance documents published by the Department of Health and are
entitled: Positive and Proactive Care Positive and Proactive Workforce
The 6 key areas are: - Leadership and Governance - Performance Management - Learning and development - Providing Personalised Support - Communication and Service User focus - Continuous Improvement
The Quality Committee Annual Cycle of Business The annual cycle was introduced and it was noted that the cycle runs from January 2017. From January 2018, the trust is moving to bi monthly board meetings and the Quality Committee will meet on alternative months.
Recommendation The Council of Governors is asked to note the content of this report and raise any issues for clarification.
Report to Council of Governors Agenda item CG 10.3/18 Attachment M EHRIA N/A code Date of meeting 19 February 2018 Format of Paper Title of paper Finance & Investment Written Committee Report Summary Author Sally Flint, Chief Finance Oral ☐ Officer Presenter Richard Bayley, Interim Chair Presentation ☐ and Chair of the Finance & Investment Committee Committees/meetings where this item has been Finance & Investment Committee considered Purpose of report (tick all that apply) To provide assurance For decision ☐ Regulatory requirement To highlight an emerging risk or issue To canvas opinion ☐ For information To highlight patient, carer or staff experience ☐ Strategic Goals (tick all that relate) 1. Safe, effective, quality patient care 2. Local, joined up care ☐ 3. Put research, innovation and learning into practice ☐ 4. Be the provider, employer and partner of choice 5. Living within our means Summary of Report This paper provides a summary of the informal Finance & Investment Committee meeting held on the 22nd December 2017 and the details of the formal meeting to be held on the 24th January 2018. The agenda for the informal meeting on the 22nd December was focused on delivery of the Trust’s financial plan for 2017/18 and the progress being made to develop the Annual Plan for 2018/19.
The main areas of the agenda for the meeting on the 24th January were:- delivery of the Trust’s financial plan for 2017/18 financial planning for 2018/19 the Global Digital Exemplar Funding Opportunity The Committee also received its regular Contracts Update and report on Commercial activities. Recommendation The Council of Governors is asked to note this report.
1. INTRODUCTION The purpose of the Finance & Investment Committee is to drive excellent financial performance and ensure that the Trust has an investment strategy that supports the business and is financially deliverable. The Committee is responsible for ensuring that robust scrutiny is in place, taking action to commission further work as required in the achievement of this objective.
This paper provides a summary of the informal Finance & Investment Committee meeting held on the 22nd December 2017 and the details of the agenda for the formal meeting held on the 24th January 2018.
It should be noted that a summary of the Finance and Investment Committee is reported to the Board on a regular basis and the paper is public part of the Board and therefore the paper is available on the Trust’s website. It should also be noted that the full minutes of the meeting are circulated to all members of the Board for information. 2. REPORT Informal Meeting Held on the 22nd December 2017 The agenda for the informal meeting on the 22nd December was focused on delivery of the Trust’s financial plan for 2017/18 and the progress being made to develop the Annual Plan for 2018/19. The Committee were updated on the Trust’s financial position for Month 8 with the Trust reporting a year to date deficit of £2.3m, with the main drivers of the overspend being the use of external placements due to system pressures (£1.1m) and overspend on the Adult in-patient wards due to the acuity of patients and high occupancy levels (£1.6m). It was noted that discussions are on-going with commissioners to support these pressures and to address the underfunding of Mental Health services across Sussex. It was also noted that there is a significant planning gap for 2018/19 that will either need to be addressed by additional funding or reduction in service provision. The Committee requested more information and assurance on a number of areas to be included on the agenda for the January meeting.
Formal Meeting Held on the 24th January 2018 The agenda for the formal Committee meeting on the 24th January was structure around a number of key areas, as set out below.
Month 9 Financial Report and Delivery of the Service Improvement Plan and Financial Recovery Plan for 2017/18 The Committee received the financial report for Month 9 noting that the Trust is report a deficit for of £0.1m for Month 9, taking the year to date deficit to £2.4m. However, this position was only achieved due to the release of £0.6m of one off accruals relating to the settlement of a number of long standing disputes and therefore the underlying position in the month was a deficit of £0.7m.
The Committee held a detailed discussed on the main issues contributing to the deficit, namely the continued high use of external placements, the overspend on the Adult in-patient wards, including high use of agency staff and the slippage on the delivery of service improvement schemes, including the joint financial recovery plans with commissioners. It was noted that based on the Month 9 position and progress being made on the financial recovery plan the Trust’s best case forecast is breakeven (which will require financial support from commissioners to address the system pressures and gaps in funding) with a mid and worst case position of a deficit of £2.4m and £3.7m respectively.
The Committee also discussed the delivery of the Service improvement Plan and Rapid Quality Improvement Plan and the work that needed to be undertaken to deliver the Trust’s best case position. The Committee also discussed the funding expectations from commissioners in order breakeven this financial year.
Agency Reduction Programme The Committee received a report setting out the work that was being undertaken on roster planning on the Trust’s in-patient wards in order to reduce the reliance on temporary staffing, particularly agency staff. The report provided a summary the progress each ward is making in the creation of rosters six weeks in advance taking into account, sickness levels, planning for annual leave, study leave and any other absences. The Committee noted that good progress is being made in reducing the use of both qualified and unqualified nursing agency staff, but raised their concerns regarding the increasing number of medical agency staff being used across the Trust. The Committee requested an update on this at the next meeting.
Financial Planning 2018/19, including format of the Annual Plan and update on progress being made to develop the financial plan for 2018/19 The Committee received an update on the progress that is being made to develop the Annual Plan and financial plan for 2018/19. It was agreed that the context of the plan would be aligned to the delivery of the Trust’s 2020 vision, also taking account of the 5 Year Forward View for Mental Health, the Trust’s Clinical Strategy and the Strategic Review of Mental Health commissioned by the Sussex and East Surrey Sustainability & Transformation Partnership (STP). The Committee also received a paper setting out the financial challenge for 2018/19. It was noted that the savings plan to deliver the Trust’s control total set by NHS Improvement of a surplus of £4m, will require the Trust to deliver savings of between £18m to £24m, depending upon the Trust’s year end position. This equates to savings of between 7.5% and 10%. The Committee are recommending to the Board that the level of savings are capped at £12m (5%), as anything higher than this will have a detrimental effect on service delivery and quality of care. There is therefore an expectation that commissioners will close the gap on savings required with additional funding for 2018/19. It was noted that to date no national Planning Guidance had been issued, although it is expected by the end of January.
The Global Digital Exemplar Funding Opportunity The Committee received a draft proposal to make a submission to NHS Digital to engage in the Global Digital Exemplar (GDE) Fast Follower programme, being a fast follower of Oxford Health, an exemplar site. If successful the Trust could attract up to £3m of match funded capital investment to accelerate the Trust’s digital agenda and underpin delivery of the Clinical Transformation Programme. The Committee discussed the proposal and agreed to submit the proposal and in the meantime to develop the business case for the match funding investment.
Contracts Update The Committee received an update on the Trust’s contracting position, which particularly focused on the delivery of the Trust’s Commissioning for Quality and Innovation (CQUIN) programmes, that includes the following schemes:-
Improvement of Staff Health & Wellbeing Healthy Food for NHS staff, visitors and patients Improving uptake of flu vaccinations for frontline staff Improving the Physical Health or people with Serious Mental Illness Improving services for people with mental health who present at A&E Transition out of Children & Young People’s Mental Health Services Preventing ill health by risky behaviours – alcohol and tobacco screening
Of the £3.1m available for full delivery of CQUIN schemes, the Trust is currently forecasting a £0.4m shortfall. However, the Committee acknowledged the excellent work that had been undertaken this year to ensure that the CQUIN associated with flu vaccinations had been fully achieved. A similar approach is also being adopted for the other schemes. The Committee requested regular updates on the performance against the CQUIN schemes and requested that Sussex commissioners are approached to pay CQUIN schemes in full given the shortfall in funding of their overall contract.
The Committee also noted that discussions with commissioners were underway to negotiate the contract for 2018/19.
Commercial Report The Committee received the Commercial Report that provided an update on current tenders and business development opportunities. The Committee noted that the Trust has been successful in its bids for Winter Pressure funding (£284k) and to deliver forensic services for Children & Young People’s across Kent, Surrey & Sussex. The Trust has also recently submitted a bid for funding to develop our Places of Safety and has submitted its tender for West Sussex Learning Disability Services.
3. RECOMMENDATION The Council of Governors is asked to note this report. 4. NEXT STEPS The next formal Finance & Investment Committee is due to be held on the 23rd March, with an informal meeting scheduled for 23rd February 2018.
Report to Council of Governors Agenda item CG 10.4/18 Attachment N EHRIA N/A code Date of meeting 19 February 2018 Format of Paper Title of paper Audit Committee Report Written Summary Author Sally Flint, Chief Finance Oral ☐ Officer Presenter Lewis Doyle, Non-Executive Presentation ☐ Director Committees/meetings where this item has been Audit Committee considered Purpose of report (tick all that apply) To provide assurance For decision ☐ Regulatory requirement To highlight an emerging risk or issue To canvas opinion ☐ For information To provide assurance To highlight patient, carer or staff experience ☐ Strategic Goals (tick all that relate) 1. Safe, effective, quality patient care 2. Local, joined up care 3. Put research, innovation and learning into practice 4. Be the provider, employer and partner of choice 5. Living within our means Summary of Report This report provides a summary of the papers and discussions from the Audit Committee meeting held on the 17th January 2018. The agenda for the meeting in January included a number of reports that provided the Committee with assurance and reported on the good progress being made across a number of areas of governance including:- An audit report on Management of Employee Relations Cases, that provided a number of useful recommendations The good progress made by the Procurement Team to reduce the use of Single Tender Waivers The significant work that had been undertaken to re-write the Trust’s Risk Management Policy to strengthen the governance from Ward to Board. Development of a framework to review the quality of data used to populate the Trust’s key performance indicators The Committee also received the regular updates from the internal auditors and local counter fraud service (LCFS) and the External Audit Plan for 2017/18.
Recommendation The Council of Governors is asked to note this report.
1. INTRODUCTION
The Audit Committee is responsible for monitoring and reviewing matters such as the integrity of financial statements, internal controls and overseeing the internal audit function. It is also focused on providing assurance to the Board that the systems and processes are functioning effectively (so that the Board is discharging its duty) and that those committees that are reviewing quality information in more detail are doing so effectively. The Audit Committee’s annual work plan is designed to cover these responsibilities and sets the agenda for each meeting, which is built around the following areas:- • Internal Audit and Counter Fraud • Financial Controls and External Audit • Internal Controls and Risk Management • Corporate Governance • Accountability and Other Matters The January meeting was attended by Glen Woolgar, Staff Governor, Shannon Guglietti, the other Governor Observer for the Committee sent her apologies. Minutes of the meeting are also circulated to all Board members.
2. REPORT
The agenda for the meeting in January covered a number of areas across internal controls and risk management (including both operational and financial risks), accountability and assurance and included discussion of the following reports. Internal Audit Update Report on progress being made to deliver the internal audit plan – the Trust’s Internal Auditors presented an update on the progress being made to deliver the Internal Audit Plan for 2017/18. The report highlighted 59% of the audit plan had been completed, 18% is in progress and 23% of assignments were planned across the remainder of the financial year. The Committee was asked to consider the audit report on the Management of Employee Relations which had been requested by Trust management as they recognised that improvement was needed in this area. The auditors issued an audit opinion of partial assurance and provided a number of helpful actions, including reducing the timescales taken to conclude cases, to take the opportunity to digitalise the cases management process, to consider the use of suspensions to be used as a last resort and to ensure managers are properly trained to have difficult conversations with staff where there are concerns before issues are escalated to employee relation cases. It was noted that management have asked internal audit to undertake a similar review of Serious Incidents, including the follow up of actions and how learning from incidents is being embedded. The Committee supported this review, which is now included in this year’s Internal Audit plan. Since the last meeting the Internal Auditors have also been invited to take part in the Trust’s Principled Ways of Working Conference. The overarching theme of the conference was around user involvement and the benefits this brings. The auditors were able to offer support to the governance workshops. The Committee also reviewed the progress being made on the implementation of the recommendations arising from previous audit reports, noting the good progress made. The Internal Auditors also shared a number of information briefings that they have recently released, including briefings on the Autumn Budget, Quality Improvement, Data Security, the NHS Counter Fraud Authority that has replaced NHS Protect, Trusts’ use of resources assessment process, Managing Conflicts of interest, Procurement Fraud, Gender Pay Gap Reporting and Consideration of how People Risks are included within Risk Management. Local Counter Fraud Service (LCFS) – The Committee received an update from the Trust’s LCFS manager that set out the progress being made to deliver the annual LCFS plan for 2017/18 including the following areas. The proactive work that has been undertaken since the last Audit Committee meeting included:- conclusion of the review into the Trust’s procedures and measures in place to prevent bribery and corruption. The review found that the Trust had good processes in place, but could make further improvements in the recording of declarations of business and conflict of interests commencement of a fraud risk assessment to identify the Trust’s exposure to risk conducted a fraud awareness activity month to raise the profile of the Counter Fraud The Committee also received an update on current reactive cases, noting that there have been 8 referrals year to date, with one case still on-going. Financial Statements, Annual Report and External Audit - the Committee received two papers under this heading as follows:- External Audit Update – the Committee received the External Audit Plan for 2017/18 from KMPG. The plan set out their approach to auditing the financial statements, reaching a conclusion on the value for money opinion and providing assurance on the Quality Report. The auditors highlighted that the two main areas of focus in auditing the financial statements would be the valuation of the Trust’s estate and recognition of income. It was noted that these are two generic risks that are reviewed by all external auditors and are not specific areas of concern for the Trust. The auditors also highlighted that there were expected to be some changes to the quality indicators to be assessed for the data quality audit and were awaiting further guidance in this area. The Committee approved the External Audit Plan and noted the forward work plan including the completion of the interim audit and compliance review of the Trust’s constitution. Annual Accounts Timetable & Review of Property Valuation Exercise – the Committee received a paper setting out the timetable for the 2017/18 annual accounts. The paper also provided an assessment of the approach to be taken for the valuation of the Trust’s estate. The recommendation was not to undertake a full or desktop valuation of the estate for 2017/18, as current property indices are indicating that a valuation would only provide a small movement in the valuation that is deemed immaterial. However, this approach is subject to no material change to the indices between now and the year end. The Committee supported this approach. The paper also included details of the professional qualifications of the finance team (which was a recommendation arising from last year’s Audit Committee Self-Assessment). It was noted that there are 6 qualified accountants in the team, with two other members of staff studying for an accountancy qualification. Review of Losses and Special Payments and Schedule of Aged Debtors & Creditors over 6 months old – the Committee noted this report and were assured that the outstanding debtors and creditors are discussed on a regular basis at the monthly Finance meeting. The Committee also noted the good progress that had been made to resolve a number of longstanding disputes. Internal Controls and Risk Management – the Committee received a number of papers under this heading, as follows:- Risk Management Policy Review – the Committee were asked to review the updated Risk Management and Strategy Policy, noting that the policy had gone through a significant re-write to strengthen the governance from ward to board and accountability and responsibility. The Committee particular commended the inclusion of a risk appetite statement of each of the Trust’s objectives and a process diagram setting out the key levels of accountability from the ward to board. The auditors also commented that it was a sound policy document, but the key to this would be how the policy is applied across the organisation. The Committee agreed to recommend the strategy to the Board for approval. Accountability and Other Matters – the Committee received a number of papers under this heading including:- Preparation for Self-Assessment of Committee’s Effectiveness – the Committee discussed the approach to its annual review of effectiveness and agreed to adopt the same approach as last year. It was agreed that the survey would be circulated to members and attendees of the Committee and that the results of the survey would be reviewed at the next Committee meeting and used to influence the Committees work plan for 2018/19. . Procurement & Single Tender Waiver Update – the Committee received paper on procurement setting out the progress made on addressing the use of single tender waivers (STW). It was note that during 2017 the number and value of STWs had reduced by 62% and 82% respectively. The paper also highlighted the work that is being undertaken to establish the Procurement Team across the Trust and Surrey & Borders Partnership NHS Foundation and the engagement work with Carter Procurement Savings Collaborative and the use the Purchase Price index and Benchmarking Tool. The Committee was asked to agree to increase the threshold to procure goods and services from £5,000 to £10,000. The Committee was not able to support this recommendation. Although the Committee acknowledged that good progress is being made, they felt that governance and compliance with procurement procedures needed to be strengthened further and requested an update in the new year when they would revisit this recommendation. Data Quality Update / Framework – at the Committee’s request they received a paper describing the framework to assess the level of assurance that can be taken from the information presented to the Board in relation to the quality of the data used to populate the various key performance indicators. The report was well received by the Committee and it was agreed to share assessment of data quality with the Trust’s Care Delivery Services (CDSs) and the internal auditors were asked to include the review of data quality in their work plan for 2018/19. Intellectual Property Review – the Committee reviewed the Trust’s Intellectual Property Policy. It was agreed that there needed to be clarity on the ownership of this area within the Executive Team and a full review of the overall policy. Action Log and Forward Look – the Committee reviewed the action log and noted the good progress made in closing a number of the actions. 4. RECOMMENDATION The Council of Governors is asked to note this report. 5. NEXT STEPS The next meeting of the Audit Committee is due to be held on 22nd March 2018.
Report to Council of Governors Agenda item CG 11.1/18 Attachment O EHRIA N/A code Date of meeting 19 February 2018 Format of Paper Title of paper Constitutional Review Written Working Group Author Natalie Hennings, Corporate Oral ☐ Governance Manager Presenter Dom Ford, Director of Presentation ☐ Corporate Affairs Committees/meetings where this item has been N/A considered Purpose of report (tick all that apply) To provide assurance ☐ For decision Regulatory requirement To highlight an emerging risk or issue ☐ To canvas opinion ☐ For information ☐ To highlight patient, carer or staff experience ☐ Strategic Goals (tick all that relate) 1. Safe, effective, quality patient care 2. Local, joined up care 3. Put research, innovation and learning into practice 4. Be the provider, employer and partner of choice 5. Living within our means Summary of Report The Constitution Review Working Group was established by the Council of Governors as a time-limited group in accordance with Annex 7 of the Constitution. The Working Group is responsible for reviewing and making recommendations to the Board of Directors and Council of Governors relating to any changes to the Constitution. The Working Group met on 05 January 2018 and 09 February 2018 when they discussed proposed changes to the Constitution. A further meeting will be scheduled in March and following this recommendation for changes will be presented to both the Council of Governors and Board of Directors in March. Recommendation The Council of Governors is asked to note the report.
Report to Council of Governors Agenda item CG 11.2/18 Attachment P EHRIA N/A code Date of meeting 19 February 2018 Format of Paper Title of paper Membership Committee Written Update Author Membership & Voluntary Oral ☐ Services Coordinator Presenter Mark Hughes, Membership Presentation ☐ Committee Chair/ Carer Governor Committees/meetings where this item has been N/A considered Purpose of report (tick all that apply) To provide assurance ☐ For decision ☐ Regulatory requirement ☐ To highlight an emerging risk or issue ☐ To canvas opinion ☐ For information To highlight patient, carer or staff experience ☐ Strategic Goals (tick all that relate) 1. Safe, effective, quality patient care ☐ 2. Local, joined up care ☐ 3. Put research, innovation and learning into practice ☐ 4. Be the provider, employer and partner of choice 5. Living within our means ☐ Summary of Report This paper is to summarise the proceedings of the most recent Membership Committee held on 7 December 2017 and highlights the main points from the 4 primary agenda items.
Recommendation The Council is asked to note this paper for information and ask any question of Mark Hughes, Chair of the Membership Committee.
1. INTRODUCTION The Membership Committee last met on 7th December 2017. Its purpose is to oversee all membership related areas of the Trust and to look at ways of promoting greater involvement members. The following report highlights some of the topics considered at this latest meeting. 2. REPORT The Committee discussed: Membership Report: It was highlighted to the Committee that the drop in final numbers within the Service User category was due to a discrepancy in previous reports where member numbers in the Service Users and Carer category were not reported separately but as one under ‘Service User’. The Committee discussed feedback received from staff that they were unaware of Trust membership and the meaning of being a Foundation Trust. Though it was highlighted that all employees are sent information relating to Trust membership, it was agreed that more awareness was needed. The Committee suggested that the Communications team should be approached to discuss including articles about the subject in Partnership Matters The committee viewed the report as being a true reflection in the membership numbers and involvement. Membership Development Strategy The Committee agreed that the 3 priorities within the strategy should remain the same but that actions should be set to achieve then and monitor progress. The Committee agreed that the strategy should be extended 2020. Membership involvement in the 70th Birthday of the NHS In the absence of Harriet Shelley, Deputy Director of Communications from the meeting, the Committee decided that this agenda item should be taken forward via the weekly ‘Governor Message’ with a focus on how Governors can be involved. Partnership Matters Magazine: The Committee agreed that they would like a schedule of work for Partnership Matters and for a member of the Committee to sit on the editorial team so that they can feed back ideas and suggestion generated at Committee meetings. 3. NEXT STEPS Any comments and agreed suggestions will be taken forward by the Committee.
Report to Council of Governors Agenda item CG 11.3/18 Attachment Q EHRIA N/A code Date of meeting 19 February 2018 Format of Paper Title of paper Update from the Training and Written Development Committee Author Natalie Hennings, Corporate Oral ☐ Governance Manager Presenter Amy Herring, Lead Governor Presentation ☐ and Chair of the Committee Committees/meetings where this item has been N/A considered Purpose of report (tick all that apply) To provide assurance For decision Regulatory requirement ☐ To highlight an emerging risk or issue ☐ To canvas opinion ☐ For information To highlight patient, carer or staff experience ☐ Strategic Goals (tick all that relate) 1. Safe, effective, quality patient care 2. Local, joined up care 3. Put research, innovation and learning into practice 4. Be the provider, employer and partner of choice 5. Living within our means Summary of Report This report summarises the meetings of the Training and Development Committee since the Council meeting in October 2017.
Recommendation The Council of Governors is asked to receive this report and approve: The appointment of Elizabeth Hall, Mark Hughes and Sarah Gates as members of the Training and Development Committee. The Governors Development Programme for 2018
1. INTRODUCTION The Training and Development Committee met on 04th December 2017 and 08th February 2018. 2. REPORT Meeting on 04th December 2017 The Committee discussed: Letters to MP’s The Committee together with the Director of Corporate Affairs produced a letter that governors were provided with to send direct to the MP in their constituent area. The letter set out the particular challenges in Sussex, noted the funding gap and asked MP’s for their help. Governors have received multiple responses and these are available to read on Alfresco. Governors Annual Questionnaire The Committee received the results of the annual questionnaire and a number of actions were drawn up following the results, many of these formed parts of the Governors Development Plan for 2018 which was discussed at the February 2018 meeting. 2018 Governor Development Sessions Thinking about the responses to the annual questionnaire the Committee discussed a potential plan of development for 2018. The topics considered and discussed were taken away and arrangement put in place to bring the plan back to the next meeting. The Committee were pleased to invite Diana Marsland; Non-Executive Director to help with the planning of the governors’ development programme alongside the help Diana has been giving to the board development programme. Council of Governor Reflections Diana explained to the Committee that she had been leading a reflections session after the Board meetings. This dedicated time directly after the formal meeting has closed allowed members to feel able to reflect on the meeting and how they felt. Diana advised that the Trust would be implementing this at the next Council of Governors meeting.
Meeting on 08th February 2018 Governor Election Campaign 2018 The Committee were informed the Trust is seeking the appointment of an external provider through a tender exercise and working with their internal Procurement Department the contract will be awarded by the end of March. The Corporate Governance Office will enable those governors who do not have a conflict of interest to be involved in this process. There are nine positions in the election campaign this year and these are in the following constituencies: Service User, Brighton and Hove – 1 position Service User, East Sussex – 1 positions Service User, West Sussex – 2 positions Service User, Outside of Sussex – 1 position Public, Brighton and Hove – 1 position Public, Outside of Sussex – 1 position Carer – 1 position Staff – 1 positions
The Committee reviewed an extensive engagement plan to help achieve contested elections in all of the above constituencies. Pending the appointment of the external provider the Trust aims to commence the process and open nominations week commencing 16 April 2018. Governor Induction Programme The Committee received and discussed the proposed induction programme for new governors. The timetable is set to ensure an induction session is held first, followed by an informal development session and then a formal Council of Governors meeting. The Committee has also introduced a support and reasonable adjustment process for new and existing governors, this ensures all governors are supported throughout their tenure; a copy of this process is attached as appendix 1. Governors Annual Questionnaire Using the feedback provided by the Committee at their last meeting they received and discussed an updated questionnaire. Whilst there was a delay in the Committee receiving the results of the last survey, members understand the importance of continuing to circulate the annual questionnaire, especially given there are a number of new governors on the Council. The Committee asked for an additional three questions to be added in relation to practical, emotional and aware of Freedom to Speak up. The Corporate Governance Manager will circulate this year’s questionnaire to governors at the end of February. Governor Development Programme The Committee received the development plan for 2018; (attached as appendix 2) and recommend the approval of this programme by the Council of Governors. Due to apologies received, the Committee was not quorate at either of the above meetings and therefore it was suggested further members were sought through the weekly message and taken forward for agreement at the next Council of Governors meeting. Governors that have put themselves forward to become members of the Committee are: Elizabeth Hall, Public Governor Mark Hughes, Carer Governor Sarah Gates, Appointed Governor The Council of Governors is asked to agree the appointment of the above governors to the Training and Development Committee. 3. NEXT STEPS The Council of Governors is asked to receive this report and approve: The appointment of Elizabeth Hall, Mark Hughes and Sarah Gates as members of the Training and Development Committee. The Governors Development Programme for 2018
Appendix 1
Process and Checklist of Support for Governors
New Governors Induction Date Completed Induction Session Within the first 2 weeks of election (Induction booklet and This will cover a range of topics including the Company Secretary running forms) Equality, Diversity and Human Rights session, covering the definition of disability and the Trusts obligation to provide support and reasonable adjustments.
Individual Meeting If governors are unable to attend the induction session they will be offered (Induction booklet and an individual meeting with the Company Secretary. forms)
Equality Monitoring This form will be part of their induction pack and asks ‘do you consider Form yourself to have a disability’
Mentor/Buddy All new governors will be offered the opportunity to have a buddy and these arrangements will be made through the Corporate Governance Office
Occupational Health Following the completion of the Equality Monitoring Form and any discussions with new governors on support and reasonable adjustments an occupational health referral will be offered
Agree Adjustments Within the first 6 weeks of election The Company Secretary will meet with the governors following an Occupational Health Assessment and agree what reasonable adjustments need to be put into place.
3 Month Review After 3 Months The Company Secretary will ensure all new governors feel well supported and have the necessary adjustments to fulfil their role
Annual Review After 1 year The Corporate Governance Office will proactively communicate annually to ensure current support offered to individual governors is appropriate
Ongoing Support Date Completed Annual Review The Corporate Governance Office will proactively communicate annually to ensure current support offered to individual governors is appropriate
Peer Support Briefing and debriefing call are available before and after every CoG Ongoing meeting and are available to all governors. These are led by the Lead Governor
Development and GovernWell courses are continuously on offer to all governors and the Training Governors Training and Development Committee set a dedicated training and development programme each year.
Appendix 2
Governor Development Programme 2018
Items Details Joint Board and Council Development Session Date: 30 January 2018 (after extraordinary CoG – 09.30am) Annual Plan – Clinical Strategy, focus groups and discussion (10.45- 12.15) Time: 10.45 – 13.00 Venue: Training Centre, Swandean Holding to Account (12.15-13.00) – Amy has invited a Lead Governor from another trust to give a national perspective on others Trusts.
Joint Board and Council Development Session Date: 23 March 2018 Time: 13.00-16.00 This session is being led by Anne Beales, Non-Executive Director and Venue: Training Centre, Swandean will be focused on the importance of peer support and co- production.
Governor Development Session Date: 12 July 2018 (after Governor Induction Session) How to engage constituents (invite a Lead Governor from another Time: 13.00-16.00 mental health trust) Venue: Conference Room, Langley Green Facilitator: Freedom to Speak Up – Lynn Richardson FTSU Guardian (action for RB following Audit Committee)
Bribery Training – Led by Matt Wilson from RSM (action for LD following Audit Committee)
Alfresco Training – refresher session
Governor Development Session Date: 09 November 2018 Time: 10.00-13.00 History of Mental Health in Sussex Venue: Roebuck Suite, Hellingly Mental Health Act Training (also on Gov Induction agenda) Facilitator:
Additionally: Council Group Agreements Peer Support Conference calls - in preparation for Council meetings and debriefs afterwards. Led by the Lead Governor.
Other development identified and where is has been included: Buddy/Mentor – covered in support and reasonable adjustment process undertaken as part of the governor induction process and included and annually thereafter. Clarifying Governor Roles – to be included in the Joint Board and Council session in March.
Report to Council of Governors Agenda item CG 11.5/18 Attachment R EHRIA N/A code Date of meeting 19 February 2018 Format of Paper Title of paper Minutes of the Annual Written Members Meeting Author Natalie Hennings, Corporate Oral ☐ Governance Manager Presenter Dominic Ford, Director of Presentation ☐ Corporate Affairs Committees/meetings where this item has been N/A considered Purpose of report (tick all that apply) To provide assurance For decision ☐ Regulatory requirement ☐ To highlight an emerging risk or issue ☐ To canvas opinion ☐ For information To highlight patient, carer or staff experience ☐ Strategic Goals (tick all that relate) 1. Safe, effective, quality patient care 2. Local, joined up care 3. Put research, innovation and learning into practice 4. Be the provider, employer and partner of choice 5. Living within our means Summary of Report The Trust’s Annual Members Meeting was held on 16 October 2017 at the CityCoast Centre in Portslade. The meeting was held in two parts with the formal section at the beginning when the Annual Report Accounts and Quality Report were presented to members by the Chief Finance Officer. The second part of the meeting gave attendees the chance to learn more about the Trust as well as how mindfulness, spirituality, working together groups and art can help in the management of mental health. Only the formal section of the meeting was minuted and these are attached for information. These minutes will be formally approved at the next Annual Members Meeting. The full video recording of the Annual Members Meeting is available on the Sussex Partnership website here: https://www.sussexpartnership.nhs.uk/membership
Recommendation The Council is asked to note the minutes of the Annual Members Meeting.
Sussex Partnership NHS Foundation Trust Annual Members Meeting – 19 October 2017 Agenda Item: TBC Attachment: X For: Decision By: Natalie Hennings, Corporate Governance Manager SUSSEX PARTNERSHIP NHS FOUNDATION TRUST
Minutes of the Annual Members Meeting held in Public on 19 October 2017 at 10.00am in the CityCoast Centre, Portslade, BN41 1DG
Present Richard Bayley, Interim Chair (RB) Sam Allen, Chief Executive Sally Flint, Chief Finance Officer and Deputy Chief Executive Rick Fraser, Chief Medical Officer
In Attendance Trust Governors, Staff and Members of the Public
ITEM NO ITEM
AMM 01/17 WELCOME & INTRODUCTIONS
Richard Bayley (RB) welcomed members, governors and partners to the meeting. At the outset RB advised he and the Board felt very privileged to be working with such a strong and committed set of members and governors. The work undertaken is simply life changing; equally RB felt very privileged to be working in an organisation that has very hard working and strong staff. RB took the opportunity on behalf of foundation trust members and board members to thank staff for all their hard work. RB explained that the Board are committed to work as hard as they can to secure additional resources that are needed to ensure services and care are delivered in the best possible way. RB recognised that the Board want to hear from members and staff to get their feedback so they are able to take this into account when making decisions about the future of the organisation. RB finished by explained the formalities that must be undertaken as part of the Annual Members Meeting.
AMM 02/17 ANNUAL REPORT AND ACCOUNTS
Sally Flint (SF) presented the Annual Accounts and Quality Account to members and gave a summary of how the Trust has managed the financial position through 2016- 17. SF advised it had continued to be another challenging year, not just for the Trust but also for the NHS; working in times when there are so many demands on public sector funding. The Trust has continued to experience high demand for services and therefore it has been important that monies were used in the best way possible to ensure quality services for the people the Trust serve.
SF referred to a power point presentation slide which displayed a diagram of the funding for 2016-17 and a breakdown of the total income and expenditure.
SF advised that the Trust is able to continue making significant investment in their services through capital developments and highlighted last year the Trust spent £6.7m of capital investment to improve services for both patients and staff. The big scheme for last year was finalising the secure service development in Hellingly.
IT investment has remained a focus for the Trust and they have continued to invest in the IT infrastructure and Clinical Information System which will be key in helping staffs operate over the Trusts large geographical area. The Clinical Information System will also give the Trust a clinical record that can be shared with partners to improve joined up care.
The Trust also continued to improve their planned maintenance, and complete the developments highlighted by CQC in their inspection visits.
SF echoed RB’s comments and confirmed that the Trust continues to work with Commissioners to secure additional funding for mental health. A recent piece of work through the Sustainability and Transformation Partnership showed that some areas of Sussex are well below the national average for investment in mental health, and the Trust will continue to challenge this. The Trust is really pleased to see that mental health is on the political agenda and that the Five Year Forward View for mental health has brought some more investment that the Board hope will continue.
SF moved on to the external audit and explained to members that every year the Trust has to have an external audit of the Annual Accounts and Quality Report, this was undertaken by KPMG the Trust External Auditors. SF confirmed the Trust was really pleased to receive a clean bill of health this year, both in terms of the financial accounts with a true and fair view and the recognition that they were properly prepared in accordance with national guidance. The Trust also had a clean bill of health on its Quality Report.
SF turned to the Quality Report and the four priorities of work the Trust focused on last year, these included:
Care Planning – in particular the quality of care plans ensuring they are developed with patients to enhance the care provided. Suicide Prevention – working towards a zero suicide approach. Sussex has one of the highest rates of suicide in the country so it is really important that we focus on this area. 24 hour crisis care and street triage will help to take this priority forward. Physical Health – work has been undertaken to ensure this sits hand in hand with mental health and the Trust have employed a physical health team and development a strategy. These developments were recognised by our recent CQC inspection. Staff Health and Wellbeing – We had a much more positive result from our staff survey last year and hope to see further improvement this year. The Trust is doing work around team development and staff also took part in an international imitative run by Virgin called the Global Challenge. The Trust had 900 staff sign up in teams of seven where you try to do 10,000 steps a day in a virtual tour of the world. The benefits of it are that’s staff walked over 315,000 kilometres, improved their exercise, sleep and wellbeing and managed to lose a considerable amount of combined weight. Initiatives such as these bring staff together and make them feel energised; we all know that positive staff really aids and helps great patient care.
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SF invited all presenters up onto the stage and welcomed questions.
Question 1: It was mentioned how £249m of the £252m was spent. What happened to the remaining £3m?
Response: In the year there are other costs over and above the operating costs and therefore in the year we made a loss. That means that the Trust expenditure exceeded its income. The plan this year it to break even and then progress from that.
Question 2: How does the trust help bring guidance to those who have no prior understanding of the services or systems that are available to them?
Response: The Clinical Strategy describes the way the system will be changing and this means the Trust will strive to have 24 hour crisis care, integrating community crisis and acute services and also working more productively with other organisations. The question is so relevant for someone with a psychosis who may not believe they have any difficulties, so the Trust has an Early Intervention in Psychosis Teams who working with people that may not recognise they have any particular difficulties with mental health. Housing is a very important issue that the Trust needs to improve on and work more closely with partner organisations that can provide support and also making sure communication with families is better. For people who are really unwell there is the mental health act which can be used as a safety net, but we would also prefer to work with people on a voluntary basis. In summary, there is a system in place, we are improving it and we can absolutely do better by working with families and our partner organisations.
Question 3: Can you explain more about the Improving Access to Psychological Therapies (IAPT) and staff wellbeing?
Response: The Trust provides two IAPT services, one in East Sussex called Health in Mind and the other called the Brighton and Wellbeing Service working in partnership with another couple of organisations in Brighton and Hove. There is also an IAPT service in West Sussex called Time to Talk, provided by Sussex Community Trust. The Trust’s talking therapies are accessible to everybody, people can self-refer to those services and there is also a Mindfulness Centre in East Sussex, this delivers mindfulness based therapies but also most importantly developing the evidence base and governance that sits around it. The centre provides a number of mindfulness services to other NHS organisations working in Sussex and courses are also available to staff. Each of these services has websites available.
Question 4: Is the trust not concerned that such a big proportion of the budget is spent on salaries? Does this leave enough money to cover other essential services?
Response: As a mental health trust we deliver our services through people and face to face intervention, not high cost equipment and theatres which are needed by acute trusts. The Trust therefore feels it has the right balance and staff salaries are all within the NHS salary scale.
Some costs that can be reduced within our staffing are agency workers. As a Trust we currently spend several million pounds a year on agency staff that are helping to address workforce shortages and gaps and the Board are focused on reducing these costs going forward.
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Question 5: I noticed that some information literature available to the public at services is out of date and not relevant to the area. Can this be reviewed and updated?
Response: The Interim Chair made a commitment that the Trust would update literature around the Clinical Strategy as soon as possible.
Question 6: How will the trust help ensure that the new strategy can fit into the lives of those who are unfamiliar with the changes and new systems?
Response: The strategy must work for everyone, if the Trust finds there are people that it isn’t working it will be flexible. The overall drive behind the strategy is that it needs to be acceptable, accessible and available for people with an assertiveness in following up and building networks. If the Trust can get that right then improvements can be made.
Question 7: How is the trust looking into improving staff satisfaction? How can it minimise the impact upon staff retention?
Response: The staff survey results last year indicated that 50% of our staff would recommend the Trust as a place to work. This was an increase on the previous year by about 30%. The Trust is improving but there is some way to go. The turnover rate is about 16%, which is average for NHS Trusts, but still too high. The Trust recognises the impact of turnover and vacancies on continuity of care and that is why the Board are focusing on the importance of staff wellbeing as a key priority. The Trust monitors in real time, the friends and family test and can see this improve alongside the percentage of staff recommending the Trust as a place to work.
Question 8: Are mental health services working enough with the Department for Work and Pensions (DWP) in order to be effective?
Response: The Trust recognises that physical health, employment factors, housing, relationships all impact on a person’s mental health. The Trust is seeing Universal Credits starting to be implemented more across our area, there is more that can be achieved through the voices the Trust has, i.e. membership, NHS Confederation and NHS Providers in speaking up and sharing the impact on services. Also working with our Local Authorities on how we need to be responsive to these needs. The pressure on services is for a variety of reasons not least the constrained resources across the sector. The Trust knows improvements can be made to use resources more wisely, but we need to ensure we share our ideas for solutions through the forums we have available. The Recovery College is getting outstanding outcomes, we need to make sure we are in a position to prevent rather than just respond when people are in crisis.
Question 9: Do you think the Department for Work and Pensions (DWP) are assessing properly?
Response: The Trust doesn’t do any direct work with the DWP, but from listening to peoples experience these assessments perhaps could be better, and this is widely reported in the press.
Question 10: Can you give more clarity of where the strategy mentions the relationship between mental and physical health services?
Response: Physical health runs through the centre of the strategy. There is an
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association between mental health, physical health, and mortality which is partly around lifestyle factors. The Trust needs to get better at working with their partners in acute and primary care to make sure we work holistically and not in silo. The Sustainability Transformation Partnership is bringing together trusts, local authorities, and third parties within the local area to make sure there is a more joined up system. With limited resources it is important that organisations are able to combine their expertise to avoid duplication, this will ensure that services are created around people.
Question 11: Based on current issues with agency staff, what strategies are in place to recruit, gain and retain equipment and staff?
Response: The Trust is fighting hard to get additional resources to make sure our primary focus is on the quality of care. For the Trust to be able to make sure mental health gets its place within the system we have in the last six months completed a piece of work that states we are underfunded and that the system itself isn’t helping the people who need mental health support. Within the Sustainability Transformation Partnership making sure we can rectify a lot of issues at a strategic level, that’s the Trust’s primary focus when speaking to our partners.
One of the Trusts values is to put People First, and if staffs are not experiencing this then Sam Allen, Chief Executive encouraged them to speak out about their experience. Recent feedback from the Care Quality Commission have recently undertaking visits to some wards and have feedback that staff morale is really good. It was highlighted that there were challenges in one hospital but equally the Trust has to make changes to the way we work; inpatient beds are running at 100% occupancy and staffs continually have to deal with this this level of high demand and pressure. The Trust is proud of the way in which staffs cope with the pressure and are confident in the knowledge that they always try to do the right thing first time, and that they are working to the best of their ability.
The Trust launched a National Nurse Recruitment Campaign this week, led by Diane Hull, Chief Nurse in line with their commitment to recruit 150 nurses. We have recruited nearly 50 nurses and are currently engaging with Universities and student nurses in their final year of placement to make them aware of the support and opportunities within the Trust.
Action(s) The Interim Chair made a commitment that the Trust would update literature around the Clinical Strategy as soon as possible.
Decision(s)
REF Any Other Business
None
These minutes represent the formal section of the Annual Members Meeting, the full video recording of the Annual Members Meeting is available on the Sussex Partnership NHS Foundation Trust website here: https://www.sussexpartnership.nhs.uk/membership
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Date and Venue for Next Meeting: 17 September 2018 Time and Venue - TBC
Signed………………………………………………………. Date………………….. Richard Bayley, Interim Chair
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