Leeds Community Healthcare NHS Trust Public Board Meeting

233 Pages·2016·3.83 MB·English

by  Health Informatics Service

Leeds Community Healthcare NHS Trust
Public Board Meeting
Friday 5 August 2016, 9.00am –12 noon
Trust Headquarters, Stockdale House, Victoria Road, Leeds LS6 1PF

AGENDA

Time Item no. Item Lead Paper
Preliminary business
9.00 2016-17 Welcome, introductions and apologies
Neil Franklin N
(16)
9.00 2016-17 Declarations of interest
Neil Franklin N
(17)
9.05 2016-17 Questions from members of the public
Neil Franklin N
(18)
9.10 2016-17 Patient’s story: end of life care
Marcia Perry N
(19)
9.25 2016-17 Minutes of previous meetings and matters arising:
(20) a. Minutes of the meeting held on 2 June 2016 Neil Franklin Y
b. Actions’ log Neil Franklin Y
c. Committees’ assurance reports:
i. Nominations and Remuneration Committee: 24 June 2016 Neil Franklin Y
ii. Charitable Funds Committee: 21 July 2016 Brodie Clark N
iii. Audit Committee: 22 July 2016 Richard Gladman Y
iv. Quality Committee: 25 July 2016 Elaine Taylor-Whilde Y
v. Business Committee: 27 July 2016 Brodie Clark Y
Quality and delivery
9.45 2016-17 Chief Executive’s report
Bryan Machin Y
(21)
10.00 2016-17 Performance brief and domain reports Y
Bryan Machin
(22)
10.20 2016-17 Safe staffing
Marcia Perry Y
(23)
10.30 2016-17 Changes to service locations
Sam Prince Y
(24)
10.45 2016-17 Child and adolescent mental health services: quality actions
Marcia Perry Y
(25)
Strategy
10.55 2016-17 Research and development strategy: implementation
Amanda Thomas Y
(26)
11.05 2016-17 Security strategy
Bryan Machin Y
(27)
Governance
11.15 2016-17 Executive Medical Director’s report: medical revalidation
Amanda Thomas Y
(28)
11.25 2016-17 Nursing revalidation
Marcia Perry Y
(29)
11.35 2016-17 Significant risks report
Bryan Machin Y
(30)
11.45 2016-17 Corporate governance update
Bryan Machin Y
(31)
11.55 2016-17 Board workplan
Bryan Machin
(32) Y
Reports
11.55 2016-17 Approved minutes of Board committees: Neil Franklin Y
(33) a. Audit Committee: 22 April and 27 May 2016
b. Quality Committee: 25 April and 23 May 2016
c. Business Committee: 27 April and 25 May 2016
12.00 2016-17 Close of the public section of the Board
Neil Franklin N
(34)
Date of next public meeting
Friday 7 October 2016, 9.00am – 12 noon
Trust Headquarters, Stockdale House, Leeds LS6 1PF
Leeds Community Healthcare NHS Trust

Trust Board Public meeting AGENDA ITEM
2016-17
Boardroom, Stockdale House, Victoria Road, Leeds (20a)

Thursday 2 June 2016, 9.00am – 11.30am

Present: Neil Franklin Trust Chair
Thea Stein Chief Executive
Brodie Clark Non-Executive Director
Dr Tony Dearden Non-Executive Director
Jane Madeley Non-Executive Director
Richard Gladman Non-Executive Director
Elaine Taylor-Whilde Non-Executive Director
Sue Ellis D irector of Workforce
Bryan Machin Executive Director of Finance and Resources
Marcia Perry Executive Director of Nursing
Sam Prince Executive Director of Operations
Dr Amanda Thomas Executive Medical Director
Emma Fraser Director of Strategy and Planning

Apologies: None

In attendance: Vanessa Manning Company Secretary
Lisa Ferguson Senior Clinical Practitioner (for item 4 only)
A patient and family member

Minute taker: Vanessa Manning Company Secretary

Observers: Cherrine Hawkins Interim Deputy Director of Finance
Stephanie Lawrence Deputy Director of Nursing
Victoria Douglas Head of Business Intelligence
Rebecca Le-Hair Clinical Governance Manager

Members of the None
public:

Item Discussion points Action

2016-17 Welcome and introductions
(1) The Trust Chair welcomed Trust Board members, particularly two newly appointed
non-executive directors, Richard Gladman and Elaine Taylor-Whilde who took up
their posts on 1 April 2016. The Chair also extended a welcome to observers
attending the meeting.

Apologies
There were no apologies.

1
Chair’s opening remarks
The Chair said he wished to make some remarks in order to provide a strategic
context for the Board’s deliberations during the course of the meeting, he set out a
number of key strategic issues for the Trust, these being:

• Meeting the requirements of the Trust’s regulators, particularly the
Care Quality Commission (CQC): ensuring and evidencing that the Trust’s
services are safe, caring, effective, responsive and well-led for patients, for
staff and for the organisation as a whole
• Financial performance: meeting the challenges in the short
term (returning the Trust to financial balance after recording overspending
against budget in the first month of the new financial year) and in the longer
term (maintaining a viable and sustainable organisation)
• Leadership: meeting the need to grow and retain good leaders to build on
achievements in 2015/16 and to continue to address the quality, financial
and workforce challenges in the coming year
• Working within the wider Leeds health and social care economy:
working with partners to achieve change (strategically and operationally)

2016-17 Declarations of interest
(2) No declarations of interest were received.

2016-17 A patient’s story
(3) The Executive Director of Nursing welcomed a young person who is a patient of
the Trust’s child and adolescent mental health services (CAMHS) to the meeting.
The patient was accompanied by a family member and Lisa Ferguson, Senior
Clinical Practitioner.

The patient explained her background. She said that she had been an inpatient
initially in Sheffield for a period of eight months prior to being transferred to Leeds.
Following a spell of inpatient care, the patient had been supported by the CAMHS
outreach team.

The patient’s step-mother said that the initial engagement with the service had
been very good. The team had adopted a highly collaborative approach and the
family had been very involved in care and treatment planning whilst at all stages
respecting the confidentiality of the young person in the context of the family and
formal services. The level of ‘joined up’ help and support was described as ‘very
refreshing’.

The patient described how the amount of clinical contacts and frequency of
appointments had reduced over time but that at all times she had been
empowered to make or alter appointments. The therapy support available had
proved very helpful and had been offered on a flexible basis.

The patient reflected positively on her journey to recovery and that, thanks to the
help of the clinical team she was now more independent and was looking forward
to starting a course in September 2016.

A Non-executive Director (TD) said that it was very good to hear of such positive
outcomes for the patient and asked whether the inpatient stay in Sheffield had
been as a result of clinical need or bed availability. The Senior Clinical Practitioner
said that the inpatient stay in the Sheffield unit had been to sustain a period of
intensive therapy; she noted that Leeds had no young person’s psychiatric
intensive care beds.
2
In reply to a Non-executive Director (BC), the Executive Director of Operations
outlined the inpatient, outreach and community services available to young people
with mental health problems; she referred to presentations made to two recent
Quality Committees and suggested that the presentations be circulated to Board
members.

Action: Presentations on CAMHS services to be circulated to Board members. Company
Secretary
The Chair concluded this item by thanking the patient and her family for sharing
their story with the Trust’s Board; he remarked on how the support from the
Trust’s dedicated staff had helped to bring about a much brighter outlook for the
patient and her family.

2016-17 Minutes of the previous meeting held on Thursday 31 March 2016 and
(5) matters arising

(5a) Minutes of the previous meeting held on Thursday 31 March 2016
The minutes were reviewed for accuracy and agreed to be a correct record.

(5b) Items from the actions’ log
Item 2015-16 (86) Equality and diversity strategy: The Executive Director of
Nursing reported that the identification of indicators would be agreed by the Senior
Management Team (SMT). This action was therefore closed.

Item 2015-16 (103) Quality strategy: The Executive Director of Nursing reported
that the ‘mapping’ of actions related to the implementation of the quality strategy
was to be concluded for noting by the Quality Committee. An update on the action
would be reported to the Board on 5 August 2016.

Item 2015-16 (104) Safeguarding strategy: The Executive Director of Nursing
reported that a framework for recording and monitoring safeguarding training,
including identification of a compliance target was to be concluded by the end of
June 2016.

(5c) Assurance reports from sub-committees
Item 5c(i) – Quality Committee held 23 May 2016
The report was presented by the Committee Chair and Non-executive Director
(TD) who drew the Board’s attention to a number of significant topics, namely:

• The need to maintain timely investigation of incidents and the number of
overdue actions from serious incidents; the latter had shown an improvement
• Considerable progress with addressing waiting time for CAMHS services
• Environmental improvement actions at the CAMHS inpatient facility
• Continued incidences of pressure ulcers; a six month improvement plan was
being enacted and a full progress report was to be considered by the Quality
Committee on 25 July 2016

The Chair reflected that, in relation to addressing the pressure ulcers’ issue, he
was keen to see progress commensurate with the robust processes now in place.

The Chair also referred to actions to support the duty of candour initiative. He said
that he felt assured that there was an appropriate culture in place but that the
processes for recording and demonstrating compliance needed to be robustly
applied.

3
The Chair reported on his recent service visit which had reinforced to him that,
through the demonstration of good practice, effective leadership at all levels was
essential to the delivery of quality services.

Item 5c(ii) – Business Committee held 25 May 2016
The report was presented by the Committee Chair and Non-executive Director
(BC) who drew main items to the Board’s attention, namely:

• The need to improve and maintain levels of activity and activity reporting in
neighbourhood teams; performance had been at variance from target and
failure to achieve activity levels within 5% of target could result in lost
income to the Trust
• A significant improvement in waiting times had been welcomed
• Scrutiny of sickness absence levels continued with in depth examination of
levels within specific staff groups
• Financial performance during April 2016
• Development of a strategic direction for estates management; the Trust’s
approach being aligned to city-wide considerations

The Committee Chair and Non-executive Director (BC) also reflected on the pace
and volume of service and business change planned for 2016/17 and the need to
prioritise in order to maintain effective delivery.

A Non-executive Director (RG) referred to the adverse financial position for April
2016 and enquired about the inter-connectivity between staff turnover, sickness
absence rates, agency staff deployment and staffing costs.

The Director of Workforce said that the staff turnover figure for March 2016 had
been 20%, the 2015/16 year-end figure had been below 15% and April 2016 had
been 10%. She added that it was important to look at the overall trend rather than
a single month. She further explained that recruitment and retention was much
improved on the same time in the previous year.

The Executive Director of Finance and Resources underlined the need to balance
supply and demand. He indicated that some areas were not experiencing the
levels of vacancies that might be expected whilst other areas were needing to rely
more heavily on agency staff to cover absences.

Item 5c(iii) – Audit Committee held 27 May 2016
A verbal update from the meeting was provided by the Committee Chair and Non-
executive Director (JM). She indicated that the Committee had considered the
draft annual report and annual accounts for 2015/16; both items had been
recommended for adoption by the Board. The Chief Executive had made a
presentation on achievements and challenges in 2015/16.

Outcome: The Board noted the committees’ reports and the matters highlighted.

2015-16 Chief Executive’s report
(6) The Chief Executive presented her report and invited questions on specific issues
of note.

Staff survey results
The significant update on staff engagement initiatives was welcomed. The Chief
Executive reinforced the importance of the current series of open meetings for
staff.
4
In response to a Non-executive Director (BC), the Chief Executive explained about
the network established to co-ordinate sustainability, improvement and
transformation initiatives. The network brought together experts in business
change, service improvement and organisational development to support the
delivery of outcomes, for example the aim to achieve high-performing
neighbourhood teams.

A Non-executive Director (RG) referred to discussions begun in the Business
Committee about the management of change. He noted that the Trust was
engaged with a portfolio of projects in 2016/17 and advocated a structured
approach to their management whereby projects had agreed project plans with
clear outcomes, identified resources and governance arrangements. It was
suggested that the Business Committee membership should meet to consider
project prioritisation and resourcing.

Action: A meeting of Business Committee members to be convened to discuss Executive
project prioritisation. Director of
Finance
Inpatient facilities and
A Non-executive Director (JM) asked about the transfer back to the Trust of the Resources
management of the community intermediate care unit. The Executive Director of
Nursing said that following a period of management by Leeds Teaching Hospitals
NHS Trust, the management was reverting back to the Trust on Monday 6 June
2016; the unit would return to the originally commissioned model of service
comprising 24 beds. Whilst under the management of the acute trust the ward had
been inspected by the CQC.

A Non-executive Director (TD) referred to the discussions throughout 2015/16
relating to the model of care provided by the South Leeds Independence Centre
and said he would be keen to see the development of a commissioner-led
intermediate care and community beds strategy.

The Chief Executive reported that the Trust had undertaken a review of
environmental issues at inpatient facilities following the publication of the report
into Bootham Park. She said that she was confident that the Trust had satisfactory
processes for managing environmental issues and she cited actions taken to
address issues at the CAMHS inpatient facility. Safeguarding patient safety being
of paramount importance at all times. It was noted that the Business Committee
was examining issues in some detail and an update would be provided at the next
Board meeting.

Action: An update on environmental issues at the CAMHS inpatient facility to be Executive
made to the Board meeting on 5 August 2016. Director of
Finance
Estates developments and
The Executive Director of Finance and Resources added that the intention was to Resources
ensure optimal use of all the Trust’s estates. Work was underway with other NHS
providers and the City Council to ensure appropriate and better utilisation of
buildings. Benefits would both be in terms of providing services from those
buildings best suited for clinical purpose and to ensure efficiency in the use of
estate and estate related budgets.

Outcome: The Board noted the Chief Executive’s report and the matters
highlighted.

5
2016-17 Annual report and accounts 2015/16
(7a) Annual report
The Executive Director of Finance and Resources introduced this item and began
by referring to the Audit Committee meeting on Friday 27 May 2016 at which the
Chief Executive had made a presentation setting out the achievements and
challenges in 2015/16. He added that the welcome letter had been adjusted since
the meeting and the revised version had been made available to Board members.

A Non-executive Director (JM), in her capacity as Chair of the Audit Committee,
said that the Committee had very much welcomed the Chief Executive’s
presentation and the opportunity to comment and contribute to the draft annual
report. She added that the Trust’s external auditors had confirmed that the annual
report’s content was in line with the requirements stipulated by the Department of
Health.

The Audit Committee had recommended the draft annual report for adoption by
the Board.

Annual accounts, letter of representation and external auditors’ opinion
The Executive Director of Finance and Resources stated that the Audit Committee
had given full and proper scrutiny to the Trust’s accounts for 2015/16. At the Audit
Committee meeting on Friday 27 May 2016, the Committee had also reviewed the
letter of representation and the audit memorandum on the Trust’s financial
statements issued by the external auditors, KPMG.

The Executive Director of Finance and Resources confirmed that, as noted in the
letter of representation, directors had provided confirmation that, to the best of
their knowledge, all information relevant to the financial statements had been
disclosed. The external auditors had confirmed their confidence that this had been
the case.

Referring to the external auditors’ opinion on the accounts, the Executive Director
of Finance and Resources said he could report that the auditors would issue an
unqualified opinion on the Trust’s accounts; there had been some minor
presentational changes and one recommendation as a result of KPMG’s audit.

A Non-executive Director (JM), as Chair of the Audit Committee, reported that she
was very satisfied with the opportunity the Committee had had to review the
accounts and she extended her thanks to the finance team for their efforts in
maintaining a robust process both throughout the year and for the year end
processes. This conclusion had been supported by the external auditors’ opinion
of the accuracy of the financial statements.

The Chair also expressed his gratitude to the finance department for the
production of quality work.

Outcome: The Board accepted the recommendations of the Audit Committee
and:
• adopted the draft annual report, including the annual governance
statement
• adopted the annual accounts, having noted the external auditors’
opinion
• approved the letter of representation

6
2016-17 Quality account 2015/16
(8) The Executive Director of Nursing introduced the Trust’s quality account for
2015/16. She advised the Board that the account, in its draft format, had been
scrutinised by the Quality Committee. She also explained that, since the Quality
Committee had viewed the document, a new section had been added which
contained the feedback from stakeholders. Stakeholders, including clinical
commissioning groups and Healthwatch, had provided positive comments and
constructive suggestions.

A Non-executive Director (TD), in his capacity as Chair of the Quality Committee,
reported that the Quality Committee had reviewed progress against quality
indicators set for 2015/16 and had set a number of priorities for the coming year.
Achievement of priorities would be monitored by the Quality Committee
throughout the year. He added that he felt that stakeholders had provided a good
and well-balanced response. He noted his thanks to the team responsible for
compilation of the document.

The Chair stated that he felt that the document was comprehensive and struck a
correct balance between realistic expectations and aspirations.

Outcome: The Board approved the Quality account for 2015/16.

2016-17 Complaints and incidents report
(9) The Executive Director of Nursing introduced the six monthly complaints and
incidents report. She said that there were robust processes to capture and report
data but that she wished to further develop thematic analysis; she was also keen
to further evidence consideration of learning and the impact that the application of
learning had on clinical practice.

Between 1 October 2015 and 31 March 2016 the Trust had received 204
complaints and 120 concerns. In the same period, there had been 66 serious
incidents. Category 3 pressure ulcers having accounted for 72.7% of all reported
serious incidents.

A Non-executive Director (BC) noted that a third of complaints related to clinical
judgement and he asked for more information on any particular themes. The
Executive Director of Nursing answered that the majority of these related to prison
healthcare and prescribed and available medication. A smaller number (four) were
about podiatry treatment.

The Chair referred to the complaints in the adults’ business unit related to
cancelled appointments. He was assured that cancellations were only considered
when this could be supported by an assessment of clinical need. He then
suggested that, on these grounds, initial assessments needed further
consideration to ensure appointments were made when and where appropriate
and to reflect patient need and choice. He asked that further analysis of cancelled
appointments feature in future reports.

Action: The Executive Director of Nursing to include analysis of cancelled Executive
appointments and the effectiveness of initial assessments in the report to Quality Director of
Committee. Nursing

7
2016-17 Performance brief and domain reports
(10) The report was presented by the Executive Director of Finance and Resources;
he indicated that the report was in two parts:
• year end report of performance in 2015/16
• performance brief and domain reports for April 2016

Year end performance report 2015/16
The Director of Workforce noted the significant monthly variation in staff turnover
throughout the year but added that the overall figure was 14.6% against a target of
9-13%.

The Chair said that, despite focused activity throughout the year, a number of
safety indicators had remained short of target for example, the number of patient
safety incidents and the incidences of pressure ulcers.

The Executive Director of Operations referred to the recovery rate indicator for
psychological therapies. She explained that the greatest impact on improving the
recovery rate would come about as a consequence of achieving the 15% access
rate and more effective management of internal waiting times. She said that there
was a wide range of referrals and recovery rates reflected the case mix. In reply to
a Non-Executive Director (ET-W), the Chief Executive added that the matter was
being discussed with commissioners with the aim of reporting performance on a
more case sensitive basis.

A Non-executive Director (RG) noted the significant improvement in waiting times
for CAMHS services and asked whether the demand and capacity management
actions were being applied to other areas ensuring that the approach was
prioritised to areas where the intervention would contribute the greatest benefit.
The Executive Director of Operations said that this was the case; adding that the
combination of data analysis and clinician involvement had been particularly
effective in adjusting practice in CAMHS.

Performance brief and domain reports April 2016
The Executive Director of Finance and Resources described the new report, which
comprised:
• High Level performance summary
Summary of performance against high level indicators
o
Statutory breaches
o
Heat map (quarterly)
o
• Contract related issues
• Detailed narrative on specific areas of interest

Neighbourhood teams’ activity
o

Sickness absence
o
• Domain reports: safe, caring, effective, responsive, well-led and finance

He reported that the Quality Committee had examined in detail the safe, effective

and caring domains. The Business Committee had examined the responsive and

well led domains whilst maintaining an overview of performance across all key

performance indicators; the Business Committee was considering the inclusion of

improvement trajectory targets. The Senior Management Team viewed a more

granular level of detail.

8
A Non-executive Director (TD) commented that the domain report relating to
effectiveness was under-developed. The Executive Medical Director said she had
met with the Head of Business Intelligence to identify additional matters for
inclusion such as compliance with clinical guidelines and mortality surveillance
measures.

Action: Effectiveness measures to be developed and included in domain reports Executive
for 5 August 2016 meeting Medical
Director
Neighbourhood teams’ activity
The Executive Director of Finance and Resources explained that, as part of the
agreement of the contract for 2016/17, the Trust’s commissioners had instigated a
risk mechanism in respect of neighbourhood teams’ activity levels. Failure by the
Trust to report activity not within 5% of target could lead to financial sanctions to a
maximum of £1m. He reported that the activity target was not finalised and the
requirement to work to target would commence from August 2016; a number of
initiatives to improve performance and ensure accurate recording had been put in
place and there was confidence that activity within 5% of target could be delivered.

Action: The agreed activity target along with performance against target to be Executive
reported to Board meeting on 5 August 2016. Director of
Finance
The Chair referred to the ongoing discussions with commissioners and the need to and
understand the tension between increasing the volume of activity and maintaining Resources
high standards of quality and safety. He reflected on his recent visit to a
neighbourhood team which had raised the matter of whether resourcing was
sufficiently sensitive to respond to the complexities of the patient population.

A Non-executive Director (BC) added that neighbourhood teams needed to
carefully prioritise a number of change initiatives such as the electronic patient
record implementation and e-rostering.

The Chief Executive said that it was important that the Trust clearly understood
the demand for services. A Non-executive Director (JM) agreed and reinforced the
importance of delivering the volume and nature of services as commissioned.

Sickness absence
The Director of Workforce reported that sickness absence had been at 5.69% in
April 2016 against a target of 4.21%. The highest rate being within the adults’
business unit. She further explained that an in-depth review had been undertaken
at the absence profile amongst health care support workers but that no consistent
pattern had emerged; the most common reasons for absence being stress-related
absence, back problems and other musculo-skeletal problems.

A Non-executive Director (JM) referred to the graph illustrating absence patterns
and said that she did not feel that the narrative indicated that actions were
satisfactorily addressing areas of poorer performance.

The Executive Director of Operations said that absence levels, along with other
workforce indictors were examined closely at the business units’ performance
panels; she added that actions needed to be applied differentially taking account
of approaches to tackle short and long term absences.

A Non-executive Director (BC) commented on the considerable effort being
applied to address absence issues but added that it was important that procedures
were rigorously applied and that improvements were evidenced.
9