agenda - dchs home · 2015. 1. 19. · gavin sykes gs staff governor – facilities and estates 78...

Top

Derbyshire�Community�Health�Services

Council�of�Governors

Council�of�Governors�-�December�2014

11�December�2014�-�14:00

Alfreton�Hall,�Church�Street,�Alfreton,�Derbyshire,�DE55�7AH

AGENDA

75 Chairman’s�Welcome�and�Introduction�of�GovernorsOwner:�Chair

Verbal

76 Apologies:�Owner:�Chair

Tabitha�Crapper,�Tim�Broadley,�Jackie�Pendleton,�Karen�Ritchie

77 Declarations�of�InterestOwner:�Chair

Verbal

78 Draft�Minutes�of�the�meeting�held�on�9�September�2014Owner:�Chair

Paper�for�Decision

78�Minutes�September�2014 8

79 Matters�ArisingOwner:�Chair

Verbal

http://www.eshareuk.com

Top

80 Actions�MatrixOwner:�Chair

Paper�for�Information

80�Actions�Matrix 16

81 Patient�StoryOwner:�Carolyn�White


81�Patient�Story 17

82 Quality�and�Governance

83 Patient�Experience�Report�including�Complaints�Process�and�NationalStandardsOwner:�Carolyn�White


83�Patient�Experience�Update 2084 Care�Quality�Commission�Update

Owner:�Carolyn�White


84�CQC�Update�Report 52

85 Council�of�Governors�Terms�of�ReferenceOwner:�Kirsteen�Farrar


85�Council�of�Governors�Terms�of�Reference 54

86 Foundation�Trust�AuthorisationOwner:�Kirsteen�Farrar


86�Foundation�Trust�Authorisation 58

87 Nominations�and�RemunerationOwner:�Brenda�Greaves

Paper�for�Decision�

87�Nominations�and�Remuneration�Group�Summary�Repo 6087�Nominations�and�Remuneration�Group�Summary�Repo 6287�Draft�Nominations�and�Remuneration�Committee�Te 64


Top

88 Appointment�of�External�AuditorOwner:�Chris�Sands


88�Appointment�of��External�Auditor 67

89 Policy�for�Additional�Services�by�the�External�AuditorOwner:�Chris�Sands


89�Policy�for�Additional�Services�by�the�External� 71

90 Quality�Business�CommitteeOwner:�Barry�Steans

Presentation

90�QBC�Presentation 83

91 Trust�Secretary’s�ReportOwner:�Kirsteen�Farrar

Paper�for�Information�and�Decision�

91�Trust�Secretary�Report 95

92 Role�of�the�Senior�Independent�DirectorOwner:�Barbara-Anne�Walker

Verbal

93 Performance

94 Quality�and�Performance�ReportOwner:�Chris�Sands


94�Quality�and�Performance�Report 104

95 Strategy�and�Planning

96 Chief�Executive’s�ReportOwner:�Tracy�Allen


96�Chief�Execs�Report 115


Top

97 2015/16�-�16/17�Operational�PlanOwner:�Chris�Sands

Paper�for�Information�and�Decision

97�2015.16�-�16.17�Operational�Plan 126

98 Membership�Recruitment�and�Engagement�UpdateOwner:�Amanda�Rawlings


98�Membership�Recruitment�and�Engagement�Update 131

99 Concluding�Items

100 Any�Other�BusinessOwner:�Chair

Verbal

101 Council�of�Governors�-�Review�of�MeetingOwner:�Chair

Verbal

102 Date�and�Time�of�Next�Meeting:�Owner:�Chair

4�March�2015,�2.00pm-5.00pm,�Alfreton�Hall,�Church�Street,�Alfreton,�Derbyshire,�DE55�7AH

103 Key�Dates�and�Future�EventsOwner:�Kirsteen�Farrar


103�Key�Dates�and�Future�Events 137

AttendeesPrem�Singh�(PS) UnconfirmedChairRay�Asher�(RA) UnconfirmedPublic�Governor�-�Amber�Valley,�Erewash�&�South�DerbyshirePeter�Ashworth�(PAs) UnconfirmedPublic�Governor�-�Amber�Valley,�Erewash�&�South�DerbyshireValerie�Broom�(VBr) UnconfirmedPublic�Governor�-�Amber�Valley,�Erewash�&�South�DerbyshireRoz�Coldicott�(RC) UnconfirmedPublic�Governor�-�Amber�Valley,�Erewash�&�South�Derbyshire


Top

Bridget�Leech�(BL) UnconfirmedPublic�Governor�-�Amber�Valley,�Erewash�&�South�DerbyshireMichael�John�Perry�(MP) UnconfirmedPublic�Governor�-�Amber�Valley,�Erewash�&�South�DerbyshireLinda�Barker�(LB) UnconfirmedPublic�Governor�-�Bolsover,�Chesterfield�&�NE�DerbyshireLorraine�Culpin�(LC) UnconfirmedPublic�Governor�-�Bolsover,�Chesterfield�&�NE�DerbyshireBarry�Jex�(BJ) UnconfirmedPublic�Governor�-�Bolsover,�Chesterfield�&�NE�DerbyshireSandra�Moody�(SM) UnconfirmedPublic�Governor�-�Bolsover,�Chesterfield�&�NE�DerbyshireMaureen�Strelley�(MS) UnconfirmedPublic�Governor�-�Bolsover,�Chesterfield�&�NE�DerbyshireAndrea�Cooke�(AC) UnconfirmedPublic�Governor�-�Derbyshire�Dales�&�High�PeakRoger�Green�(RG) UnconfirmedPublic�Governor�-�Derbyshire�Dales�&�High�PeakBrenda�Greaves�(BG) UnconfirmedPublic�Governor�-�Derbyshire�Dales�&�High�PeakPaul�Kirtley�(PK) UnconfirmedPublic�Governor�-�Derbyshire�Dales�&�High�PeakBernard�Thorpe�(BT) UnconfirmedPublic�Governor�–�City�of�DerbyDiana�Wood�(DW) UnconfirmedPublic�Governor�–�Rest�of�EnglandSally-ann�Coope�(SC) UnconfirmedStaff�Governor�-�NursingRuth�M.�Francis�(RF) UnconfirmedStaff�Governor�-�NursingDenise�Sanderson�(DS) UnconfirmedStaff�Governor�-�NursingSara�Nash�(SN) UnconfirmedStaff�Governor�-�Other�Registered�ProfessionalsEmma�Meakin�(EM) UnconfirmedStaff�Governor�-�Other�Registered�ProfessionalsTabitha�Jane�Crapper�(TC) UnconfirmedStaff�Governor�-�Healthcare�Support�StaffVacancy UnconfirmedStaff�Governor�-�Healthcare�Support�StaffAmanda�Smith�(ASm) UnconfirmedStaff�Governor�-�Medical�&�DentalGavin�Sykes�(GS) UnconfirmedStaff�Governor�–�Facilities�and�EstatesAdam�Short�(ASh) UnconfirmedStaff�Governor�–�A�and�C�and�ManagersPaul�Jones�(PJ) UnconfirmedAppointed�Governor�-�Derbyshire�County�CouncilKaren�Ritchie�(KR) UnconfirmedAppointed�Governor�-�HealthwatchJackie�Pendleton�(JP) UnconfirmedAppointed�Governor�-�North�Derbyshire�Clinical�Commissioning�Group


Top

In�Attendance UnconfirmedTracy�Allen�(TA) UnconfirmedChief�ExecutiveChris�Bentley�(CB) UnconfirmedNon-Executive�DirectorSarah�Banks�(SB) UnconfirmedHead�of�Quality�GovernanceLisa�Barrett�(LB) UnconfirmedClinical�Effectiveness�and�Audit�LeadTim�Broadley�(TB) UnconfirmedDeputy�Director�of�StrategyMelanie�Curd�(MC) UnconfirmedDeputy�Trust�SecretaryKirsteen�Farrar�(KF) UnconfirmedTrust�SecretaryWilliam�Jones�(WJ) UnconfirmedDirector�of�OperationsTony�Okotie�(TO) UnconfirmedNon-Executive�DirectorClair�Sanders�(CSa) UnconfirmedOrganisational�Health�LeadChris�Sands�(CS) UnconfirmedDirector�of�Finance,�Performance�and�InformationNigel�Smith�(NS) UnconfirmedNon-Executive�DirectorBarry�Steans�(BS) UnconfirmedNon-Executive�DirectorRob�Steel�(RS) UnconfirmedHead�of�CommunicationsBarbara-Ann�Walker�(BAW) UnconfirmedNon-Executive�DirectorCarolyn�White�(CW) UnconfirmedChief�Nurse�&�Director�of�QualityDavid�Boddy�(DB) UnconfirmedCorporate�Governance�Manager�(minute�taker)


Top

Index78�Minutes�September�2014.doc..............................................................................................8

80�Actions�Matrix.docx............................................................................................................16

81�Patient�Story.docx..............................................................................................................17

83�Patient�Experience�Update.pdf.......................................................................................... 20

84�CQC�Update�Report.docx..................................................................................................52

85�Council�of�Governors�Terms�of�Reference.pdf.................................................................. 54

86�Foundation�Trust�Authorisation.docx................................................................................. 58

87�Nominations�and�Remuneration�Group�Summary�Report�-�13�No.................................... 60

87�Nominations�and�Remuneration�Group�Summary�Report�-�25�No.................................... 62

87�Draft�Nominations�and�Remuneration�Committee�Terms�of�Ref....................................... 64

88�Appointment�of��External�Auditor.docx...............................................................................67

89�Policy�for�Additional�Services�by�the�External�Auditor.do.................................................. 71

90�QBC�Presentation.pdf........................................................................................................83

91�Trust�Secretary�Report.pdf.................................................................................................95

94�Quality�and�Performance�Report.docx.............................................................................104

96�Chief�Execs�Report.pdf....................................................................................................115

97�2015.16�-�16.17�Operational�Plan.docx........................................................................... 126

98�Membership�Recruitment�and�Engagement�Update.docx............................................... 131

103�Key�Dates�and�Future�Events.docx............................................................................... 137


Shadow Council of Governors

Minutes of the Meeting held on 9 September 2014 Belper Football Club, Bridge St, Belper DE56 1BA

Present

Name Job title

Prem Singh PS Chair - Non-Executive Director

Peter Ashworth PAs Public Governor - Amber Valley, Erewash & South Derbyshire

Ray Asher RA Public Governor - Amber Valley, Erewash & South Derbyshire

Roz Coldicott RC Public Governor - Amber Valley, Erewash & South Derbyshire

Andrea Cooke AC Public Governor - Derbyshire Dales & High Peak

Bridget Leech BLe Public Governor - Amber Valley, Erewash & South Derbyshire

Michael John Perry MP Public Governor - Amber Valley, Erewash & South Derbyshire

Linda Barker LB Public Governor - Bolsover, Chesterfield & NE Derbyshire

Lorraine Culpin LC Public Governor - Bolsover, Chesterfield & NE Derbyshire

Barry Jex BJ Public Governor - Bolsover, Chesterfield & NE Derbyshire

Sandra Moody SM Public Governor - Bolsover, Chesterfield & NE Derbyshire

Brenda Greaves BG Public Governor - Derbyshire Dales & High Peak

Paul Jones PJ Appointed Governor – Derbyshire County Council

Paul Kirtley PK Public Governor - Derbyshire Dales & High Peak

Margaret Slater MSi Public Governor - Derbyshire Dales & High Peak

Maureen Strelley MS Public Governor - Bolsover, Chesterfield & NE Derbyshire

Diana Wood DW Public Governor – Rest of England

Bernard James Thorpe

BT Public Governor – City of Derby

Sally-ann Coope SC Staff Governor - Nursing

Sara Nash SN Staff Governor - Other Registered Professionals

Emma Meakin EM Staff Governor - Other Registered Professionals

Ruth M. Francis RF Staff Governor - Nursing

Hazel Lowe HL Staff Governor - Healthcare Support Staff

Denise Sanderson DS Staff Governor - Nursing

Adam Short ASh Staff Governor – A and C and Managers

Gavin Sykes GS Staff Governor – Facilities and Estates

78�Minutes�September�2014.doc

Top

Overall�Page�8�of�137Page�1�of�8


Apologies

Name Job title

Tabitha Jane Crapper

TC Staff Governor - Healthcare Support Staff

Valerie Broom VBr Public Governor - Amber Valley, Erewash & South Derbyshire

Jackie Pendleton JP Appointed Governor - North Derbyshire Clinical Commissioning Group

Karen Ritchie KR Appointed Governor – Healthwatch

Amanda Smith ASm Staff Governor - Medical & Dental

In Attendance

Tracy Allen TA Chief Executive

Sally Edwards SE Head of Equality, Diversity & Inclusion

Kirsteen Farrar KF Trust Secretary

Mary Heritage MH Assistant Director of Quality and Professional Lead for AHPs

William Jones WJ Director of Operations

Rick Meredith RM Acting Medical Director

Rebecca Oakley RO Head of Organisational Effectiveness

Tony Okotie TO Non-Executive Director

Nigel Smith NS Non-Executive Director

John Cornett JC Director, KMPG

Melanie Curd MC Deputy Trust Secretary (minute taker)

Item Description Action

48/14 Chairman’s Welcome and Introduction of Governors PS welcomed the Governors.

49/14 Apologies for Absence Noted as above.

50/14 Declarations of Interest None.

51/14 Draft Minutes of the meeting held on 11 June 2014 The minutes were approved as a true reflection of the meeting.

52/14 Matters Arising There were no matters arising.

53/14 Actions Matrix The Actions Matrix was reviewed. PS confirmed the Governor’s Meeting with Monitor had taken place on 18 August 2014.

54/14 Patient Story MH presented the Patient Story which involved a Health Visitor supporting a family who had learning difficulties. Initially the family were reluctant to engage with services but they were offered and accepted an enhanced package of care. There were many positives to the story including the fact that both parents


Top




now work, have moved their family into larger accommodation and the mother would like to become a peer support volunteer with Breastmates. MH confirmed the learning outcomes are shared within the Patient Experience and Engagement Group and across Children’s Services. The story was received for information.

55/14 Quality and Governance

56/14 Equality & Diversity SE started her presentation by discussing the DCHS vision and values and our specific vision for equality within DCHS. She explained that equality is about fair treatment and not about treating everybody the same. Diversity is about recognising that everyone is different and that we are all individuals. SE explained inclusion is about a sense of belonging and feeling respected and valued. SE discussed with the group why these things were important to DCHS, in terms of staff and service users. SE asked the group to identify the nine protected characteristic within the Equality Act 2010 and explained what we were doing as an organisation to promote Equality, Diversity and Inclusion, including the 360 Assurance Report. SE discussed the Governors responsibilities; to have an understanding of the Trust’s equality, diversity and inclusion priorities and support their achievement and to be a positive and visible role model. SE finished her presentation by asking all the Governors to make an Equalities Pledge and explained her pledge was not to book any meeting rooms that were inaccessible. The Governors asked how many complaints we receive as a Trust regarding Equality, Diversity and Inclusion and TA explained that we have had two significant complaints where we have not provided the best service for people with physical disabilities. The presentation was received for information.

57/14 Patient Experience Report MH presented the report for quarter 1 and highlighted:

Complaints – MH explained the numbers of complaints had increased in the quarter

Friends and Family Test – we are receiving a high number of comment cards from all services and a high number of people using our services say they are extremely likely to recommend us

MH confirmed she had no further update on the complaint that had been referred to the Ombudsman. The Governors discussed complaints and highlighted the high number


Top




received within outpatients departments. MH explained that these services tend to have a higher footfall of service users. The Governors requested a breakdown is included in the report where we have a high number of complaints. The Governors requested that information on waiting times was included within the Quality and Performance Report. The report was received for information.

MH CS

58/14 Service Issues Update WJ provided an update on the service development and change issues across the Trust and highlighted:

Heanor – the consultation has now commenced and capital planning has now started

Belper – staff and public meetings have been delayed. Negotiations for the site continue and any developments will be subject to public consultation

North and Hardwick Clinical Commissioning Group (CCG) – they have a five year plan and are proposing eight hubs and Integrated Community Teams. This is subject to public consultation

Clay Cross Hospital – staff and public meeting held on 18 July 2014. No decision about the site have been made

Ilkeston Minor Injury Unit (MIU) – following Royal College of Paediatrics review Buxton, Ripley and Whitworth MIU’s opening hours were reduced. Erewash CCG wished to complete its own review and has now agreed to close Ilkeston MIU overnight

WJ stated there are now five community care centres being developed across the county and also gave an overview on the services which are currently out to tender. PS stressed the importance of these changes and asked that we all use our leadership endeavours to support our work in engaging communities and staff in a positive way, seizing the opportunities to improve service quality and patient safety. The presentation was received for information.

59/14 Audit & Assurance Committee (AAC) NS gave an overview of the role of the Audit and Assurance Committee and highlighted:

It’s a statutory, sub-committee of the Board whose members are Non-Executive Directors

It is the central means for the Board to ensure an effective system of internal control is in place

AAC reviews compliance, governance arrangements, self-certifications and the Board Assurance Framework

AAC approves and receives updates on the Internal Audit plan and received the Head of Internal Audit Opinion which informs the Annual Governance Statement


Top




AAC approves the External Audit Plan and the audit fee and received the report from the auditors on the financial accounts

AAC approves the Counter Fraud work plan and received regular updates

The role of AAC will change once we become a Foundation Trust (FT) and the responsibility for some of its functions will transfer to Governors

The presentation was received for information.

60/14 Role of External Audit & Council of Governors – Governance Statement JC from KPMG gave a presentation on the role of External Audit and highlighted:

Currently governed by Audit Commission Code of Audit Practice; as an FT will be Audit Code for NHS Foundation Trusts

External Audit will audit the Financial Statements and give an opinion on these and ensure that proper arrangements have been made for securing economy, efficiency and effectiveness in the use of resources. This is often referred to as the Value for Money (VfM) conclusion

Key audit documents; Audit Plan, Audit Highlights Memorandum, Audit Opinion, Annual Audit Letter. The requirements and timescales for these change once we become an FT

For 2013/14, DCHS received an unqualified opinion on the financial statements and an unqualified VfM Conclusion

As an NHS Trust the External Auditor is allocated to us by the Audit Commission, as a FT the Governors will appoint the external auditor

The presentation was received for information.

61/14 Trust Secretary’s Report KF presented her report and highlighted the work the Governors have been doing with David Boddy regarding developing a questionnaire. KF suggested that the questionnaire is completed first and then we review the Terms of Reference. The Council of Governors agreed. KF explained the role of the Nominations Committee and suggested that we start to put arrangements in place. KF will work with BG and bring a proposal back to the December meeting. The paper was received for information.

KF

62/14 Derbyshire Community Health Services NHS Foundation Trust Constitution MC presented the Constitution and explained earlier in the year had asked our Solicitors to undertake a review to ensure it was still compliant with Schedule 7 of the NHS Act. The solicitors suggested a number of amendments which MC worked through with a small working group of Governors. MC stated a significant transaction would be 25% of our assets or income.


Top




MC confirmed that Monitor have now seen the final draft and are happy with the suggested changes. The Council of Governors approved the Constitution.

63/14 The NHS Foundation Trust Code of Governance

Engagement Policy

Statement on the Role and Responsibilities of the Council of Governors

MC presented the two documents and explained these are new documents which have been produced to strengthen our compliance with Monitor’s Code of Governance. The Council of Governors approved the Engagement Policy and Statement on the Role and Responsibilities of the Council of Governors.

64/14 Attendance and Involvement of Governors KF explained that once we are a Foundation Trust it is a requirement to publish the attendance at the Council of Governor meetings within the Annual Report. In addition, it is good practice to review the meetings and ensure we have been quorate. KF confirmed that all of the meetings have been quorate and highlighted all the activities which Governors have been involved in. The paper was received for information.

65/14 Performance

66/14 Quality and Performance Report CW presented an overview of the Trust’s quality, regulatory and financial performance up to month 4 of 2014/15. CW explained Harm Free Care and explained the challenges we were having reducing the numbers of pressure ulcers. CW went through the actions we are taking including working with Chesterfield Royal Hospital to look at pressure ulcers across the patient pathway. CW explained the increase in the target from 93% to 95% had been set for us externally by the Trust Development Authority. BL asked whether all of the pressure ulcers developed in our care and CW explained that we analyse the data and know whether a pressure ulcer developed or deteriorated in our care or was inherited from another organisation. CW stated for DCHS this is about 50/50 split between developed and inherited. CW stated we are performing really well on the Patient Safety agenda. We have signed up to a national campaign on safety and the five pledges from the campaign have been incorporated into our Quality Always. SN provided an update on Hello My Name Is and explained it had been


Top




discussed at the Frontline Care Council in August 2014 and they agreed it fitted well with the DCHS Way and Quality Always. There has been a pilot of staff using name badges to support this and the Frontline Care Council would like to roll this out – the costs of this will be going to Board for them to agree. CW highlighted section 3 of the report and thanked all the Governors for their attendance at the Quality Visits training. CW said they will shortly be reviewing this and so if the Governors have any feedback to forward it to CW or KF. With regard to the CQC Action Plan, a further review of progress will be undertaken at the beginning of October which will help to inform the Board on when we should invite the CQC back in. CW discussed the financial performance and that we were meeting our four main duties for 2014/15. CW highlighted we were behind plan on our planned surplus and BT asked whether this was because of an unexpected budgetary pressure. TA explained it was because we have had an increase in demand in community nursing and an increase in the acuity of patients. We have a number of different reserves and we have utilised some of this to increase the resources in this area. We expect to meet our year-end targets. The paper was received for information.

67/14 Strategy and Planning

68/14 Chief Executive’s Report TA stated that many of the items within her report had been discussed already in the meeting; however she wanted to highlight the work we have been doing with Monitor regarding our Foundation Trust application. TA explained we have developed a five year plan which is then tested by Monitor. Monitor provided us with their “downside scenarios” on 8 September 2014 and we have three days to review these and explain to Monitor what mitigation we would put in place to ensure the Trust remains a going concern. BJ congratulated the Trust in becoming one of the Top 100 places to work. He asked, with regard to the Staff Survey, what was happening with the results of this, particularly in response to staff saying they did not feel they could make improvements. RO explained she is working across the Trust and with the Frontline Care Council and the Staff Forum to look at ways to incentivise staff to suggest improvements and also to support managers to release staff to look at improvements within their area of work. The report was received for information.

69/14 Membership Recruitment and Engagement Update RO provided the membership update and highlighted:

Our current membership numbers are 17,183

Undertaken targeted recruitment within Physiotherapy and Podiatry


Top




outpatient clinics

Received guidance from the Information Commissioner that we can change our current process for staff leavers and opt them into the public constituency

Held the first meeting of the Communication Sub-group with Governors and developed a number of actions on membership engagement. A DVD is being filmed which can be used at events to explain what Governors do

The paper was received for information.

70/14 Concluding Items

71/14 Any Other Business MS asked whether we could consider the order of the items on the agenda and consider moving the quality items to the top. It was agreed the order would be considered for the next meeting. MP asked for an update on the staff awards. PS confirmed this has not been cancelled but has been postponed until March 2015.

KF

72/14 Council of Governors - Review of Meeting Consider using a different venue as it was very difficult for the people at the back to hear. The Governors confirmed they liked the tables set out in cabaret style.

73/14 Time and Date of Next Meeting: 11 December 2014, 2.00pm -5.00pm. Venue to be confirmed.

74/14 Key Dates and Future Events The key dates and future events were discussed.


Top



COUNCIL OF GOVERNORS - ACTIONS MATRIX

DATE: December 2014

Date/Item No:

Item/subject: Decision taken and/or Action required:

Progress: Responsible Person:

Deadline:

Outcome:

Sep 57/14 Patient Experience Report

The Council requested a breakdown of issues is included in the report where we have a high number of complaints in a particular area

Mary Heritage Dec 2014 Patient Experience Report is an Agenda Item at December meeting

Completed:

Date/Item No:

Item/subject: Decision taken and/or Action required:

Progress:

Responsible Person:

Deadline:

Outcome:

Sep 57/14 Patient Experience Report

The Council requested that information on waiting times was included within the Quality and Performance Report

Chris Sands Dec 2014 Complete

Sep 61/14 Trust Secretary’s Report

To start arrangements for a Nominations Committee Kirsteen Farrar will work with Brenda Greaves and bring a proposal back to the December meeting

Kirsteen Farrar Dec 2014 Complete

Sep 71/14 Agenda Change the order of the agenda items by moving the quality items to the top

Kirsteen Farrar Dec 2014 Complete

80�Actions�Matrix.docx

Top



COUNCIL OF GOVERNORS

Title of Paper: Patient Story

Paper for: Information

Presenter: Carolyn White, Chief Nurse and Director of Quality

Author: Kim Ashall, General Manager

Date of Meeting: 11 December 2014 Agenda Item No: 81/14

No of pages incl this one: 3

Appendices:

Purpose of Paper

To share how a community team supported a gentleman at home.

Summary

TK was a 66 year old gentleman who lived in a deprived part of North East Derbyshire & Bolsover. He was a widower and was grossly obese (32 stone). He had multiple pressure sores and wounds across his body. He was unkempt and did not maintain his own hygiene needs as well as some would consider necessary. As a consequence during a visit to his GP a number of years ago, the medic had commented that the patient ‘did not smell good’. This was followed up by letter to TK telling him not to attend surgery. This was the second time a GP had asked him not to attend the surgery due to his appearance. This was deeply distressing to the patient and so he chose to remain in his own home without any input from medics to help manage his problems. He was mobile around his home but chose to spend much of his time in bed. His wife had died in their bed at home and in his mind that was what he was going to do. It was very obvious that he was grieving for his wife terribly. His home and personal hygiene suffered even more as a consequence. The GP made a referral to the district nursing (DN) team due to self-neglect and leaking oedematous legs. The DN’s tried to visit whilst he was still mobile but he refused treatment from the nurses. In order to ensure he had a regular review the DN’s made a referral to social services for direct care which Mr K accepted. The district nursing team also referred to community Occupational Therapist (OT) at Bolsover hospital in July 2013. At this point TK, whilst reluctant to accept any help from nursing

81�Patient�Story.docx

Top



colleagues, through time and patience accepted the OT’s help and built up a relationship with the OT’s that allowed them to start to put services and equipment in place that he desperately needed i.e. a care package and major adaptions to his home. They undertook regular visits to support TK. The community OT’s arranged for a deep clean of his property and provided appropriate showering facilities with social care colleagues. In July 2014 TK became unwell and took to his bed. His health quickly deteriorated and he became unable to stand or walk. As a result of the deterioration of his personal care and his home, social care carers refused to go in to care for him because they found it very distressing. The DN team revisited with the community matron to assess what could be done to support this gentleman. They requested a review by a GP. The GP recommended admission to hospital but TK refused and as he was considered to have ‘capacity’ there was little the team could do but put together a package of care delivered in his own home. He would be frequently found by our community nurses and OTs smeared with his own faeces and lying in pools of urine. Our community nursing and OTs team had to act as carers during every visit but they too found it a very distressing situation. Pharmacy also refused to deliver medications and dressings as they felt his house was an unsafe environment. A referral was made to the continence service. Because of his worsening skin condition it was considered necessary to admit the patient to hospital but he absolutely refused to be taken out of his bed. However he did agree to a nursing home admission but there were problems with financing the bed and so he was not able to be moved. It was clear the gentleman needed a new bariatric bed to better meet his needs. The gentleman agreed to have a new bed. This was the next challenge. How to get a new bed into a small, very cluttered, dirty house. The Falls Partnership Service and Intermediate Care Teams were approached as were our colleagues from the Manual Handling Specialist team. On the 22nd August 2014 community OT’s, community physios, manual handling specialists and community nurses managed to move the gentleman from his bed to the new bariatric bed. This meant he was able to be cared for more easily by 2 members of staff. He had specialist continence wear. He was clean and, as a consequence, his wounds started to heal. On the 4th September Mr K telephoned the OT department and said he had decided he would accept admission to a hospital bed because he was feeling really unwell. He stated he would go into hospital if he had support throughout the process of moving from his house to the hospital and onto admission. Admission was arranged for the 5 September 2014 and involved joint working between community OT’s, Community PT’s and the Ambulance Service who worked through until midnight to safely get TK out of the house which included sawing and knocking out door frames. The Community OT Manager worked until 10pm and remained on call to support the service. Other work colleagues were available for support throughout the evening and night by telephone. This for us is an example of what our community staff regularly have to deal with, especially in the more socially deprived parts of our County and how, with goodwill and lots of people going lots of ‘extra miles’, we can maintain a patient in their own environment instead of admitting them


Top



to hospital often for years at a time. I am hugely proud of every single one of my staff who helped to care for this gentleman and have thanked them on behalf of the organisation.

Recommendations

For information only


Top




Title of Paper: Patient Experience Update


Presenter: Carolyn White, Chief Nurse and Director of Quality

Author: David Brewin – Head of Patient and Family Centred Care



Appendices: Appendix 1 DCHS Quarter Two Patient Experience Report

Purpose of Paper

To summarise our performance and activity in relation to patient experience during quarter two of 2014/15. To outline the work underway with regard to our Complaints Management.

Summary

The DCHS Quarter Two Patient Experience Report is attached as an appendix. The Introduction serves as an Executive Summary, with full detail of all data collected during the quarter presented in the remaining sections. Complaints Management One of the CQUINs for 2014/15 is about improving how we manage complaints through adopting the ‘Patient’s Association Good Practice Standards’ in complaint handling. It is intended to be a three year CQUIN. This should lead to an improved complaints management process and a better experience for people who make complaints about our services. The Clwyd/Hart complaints report which was published in October 2013. This followed the Francis Reports about Mid-Staffordshire NHS Trust and gave indications for how Trusts should improve their practice in relation to complaints management. It contains 18 recommendations which are aimed at Trusts In DCHS we have made some changes to the way we handle complaints. To meet the CQUIN and receive the funding in 2014/15 we have three actions:

To participate in two peer review panels. These will be two day panels. The first will be held in late November 2014 with the second in February 2015. The panels include: A clinician, complaint manager, public governor and a magistrate (provided by the Patients Association).

To start to use the standard complainant satisfaction survey.

To identify improvements and commit to an action plan.

83�Patient�Experience�Update.p

Top



The report from the November panel is due by mid-January. We anticipate that this process will highlight significant areas identified for improvement. In preparation for the amount of work that we expect to need to undertake we have established a Project Board – chaired by Tracy Allen which reports through Patient Experience and Engagement Group to Quality Services Committee and Board.

Recommendations

For information only


Top



Chief Executive Tracy Allen Chair: Prem Singh

Patient Experience Report

Quarter 2: 1 July 2014 – 30 September 2014


Top



Contents

Overview Page

Introduction 3

Compliments and Complaints

Compliments 5

You Said We Did 6

Complaints 7

Complaints by Service April to June 2014 9

Complaints by Trends and Theme April to June 2014 10

Complaints Level 2,3,4 by Subject April to June 2014 11

Equality monitoring feedback 12

Complainant Satisfaction Survey 13

Parliamentary and Health Service Ombudsman (PHSO) 14

MP Letters 14

Themed Feedback

Friends and Family Test Results 15

Healthwatch 21

Patient Stories 22

Patient Opinion and NHS Choices 24

Twitter 27

Derbyshire Dignity Campaign 28

Caring Always 29

Patient Experience and Engagement Strategy 30


Top



Introduction The purpose of this report is to summarise our activity and performance during quarter two of 2014/15. This introduction gives the headlines and significant developments. The sections that follow are a more detailed analysis and the data we have used to reach our conclusions. There are some identifiable trends in formal complaints. The overall ‘activity figure’ is broadly consistent and shows little variation across the whole of 2013/14 and the first two quarters of 2014/15. The number of complaints showed some reduction in the first two months of this quarter. This may be because of the summer holiday period. There was an increase in September to around the average figure. The detail reveals that there is still a notable trend of resolving a higher proportion of complaints at level one. This means that more complaints are resolved quickly and informally. Consequently, we need to undertake less lengthy and expensive investigations. This quarter we have added a column to the table at page 8 showing the number of cases that are investigated a second time because the complainant remains dissatisfied. We describe these as ‘2nd Bites’. This shows a significant increase. In the first three quarters of 2013/14, there were four in total. In the last three quarters there have been 19. These complaints tend to be lengthy and complex and need considerable resources to resolve them. Of the 12 cases resolved during quarter two only three were not upheld. The 2013/14 Complaints Annual Report tells us that around 40% were not upheld during the year. This could indicate a trend and we will monitor this in future. We sent out 32 complainant satisfaction surveys in the quarter of which 11 provided us with demographic information. There was a dramatic reduction in the numbers who answered the additional questions about their satisfaction with only one satisfaction questionnaire being returned. We will also continue to monitor this. Friends and Family Test results remain broadly positive. There had been a slow but steady decrease in scores in the four months to August. Broadly, this was because services that generally and consistently receive a lower score had sent a higher proportion of the returns. It was also possible to identify some ‘hot spots’ where services had scored comparatively poorly and action is being taken to address this. By some margin, the highest number of negative themes identified was ‘long waiting times.’ The score across the Trust for September recovered considerably and was higher than the full year average for last year. Our score still compares exceptionally well with all other NHS providers. NHS England have issued new national guidance about the Friends and Family Test. This will have a considerable impact on how we conduct the test and how we calculate and report a score. In particular, we will score it as a percentage of patients who are positive or negative about their care and will stop using the ‘net promoter’ approach. In quarter’s three and four we will report using both the old and the new score but will exclusively adopt the new national approach from the beginning of 2015/16. We have included the feedback we receive from ‘Healthwatch’ as a separate section for the first time. There is an example of the format of the comments and our responses. We received 36 comments during this quarter which is an increase from previous quarters and they are giving us a useful insight. Each month the Patient Experience Team meets with a Healthwatch representative to work through the responses and identify any themes, trends and areas of concern. This information provides a valuable and independent mechanism for capturing the views of our patients. Comments are not consistent with those gathered in other ways. There are generally more negative comments that make them valuable insight. In addition, some services such as the incontinence services are disproportionately represented.


Top



We receive posting on the two national websites - NHS Choices and Patient Opinion – about our services. We monitor these sites are monitored and responses submitted promptly. Some examples are at pages 24-26. They still account for a small proportion of overall patient feedback about our services. We also receive a small but growing number of comments through social media. We work with our colleagues in communications to ensure we pick up and respond to any comments about the care we provide. An illustration of a situation that we recently dealt with on Twitter can be found at page 27. We anticipate this will become more frequent in future. The Dignity in Care campaign continues to progress toward the goal of all services achieving their bronze award by 31 March 2015. In this quarter we refreshed the internal group the membership of the group that leads this work and have focused our attention on achieving the target this year. Progress is good with around 18 services across DCHS still to submit an application. Further concerted efforts will be made during Quarter Three including holding a workshop to promote the scheme and encourage applications. The Patient Experience and Engagement Group had a more detailed look at our action plan for 2014 with a particular focus on any actions that were red or amber. We now have a realistic assessment of what we will achieve by the end of the year. We will carry a small number forward into 2015. Overall, there has been considerable progress against an ambitious and stretching plan. David Brewin Head of Patient and Family Centred Care


Top



Compliments

……..They were always caring and attentive to his needs, and were

always open and helpful in explaining his situation and progress to us. In our particular case, we cannot praise this establishment and its staff too highly.

Okeover Ward, St Oswald’s Hospital

To the kind and efficient staff who saw us within five minutes of arriving in the hospital and who ‘put back’ our grand-

daughter’s elbow. We were very concerned but your reassurance and

‘miracle’ cure put our minds completely to rest. She’s fine this

morning!! Many many thanks.

MIU, Whitworth Hospital

Compliments

My daughter saw a podiatrist today. I was very impressed with her, she made my

daughter feel at ease and made the appointment fun. She was a lovely lady and very professional. She also kept me up-to-date with what she was doing afterwards

regarding a referral.

Podiatrist, Alfreton Primary Care Centre

Thank you to all the DN team for the help and support given over the last 18 months. It would have been a lot harder if it was not for all the

support given which played a part in making our lives a little easier. The collective treatment at

home was always done with care and consideration and even though we both knew staff were often pressed for time; they never ever rushed the process making my wife feel

the centre of your attention

District Nursing Team, Chapel Health Centre

Thank you to all the staff involved in making my sister’s home much safer since she has experienced several falls.

The Occupational Therapist worked professionally and treated my sister with dignity and respect. The equipment fitted is now assisting her and was fitted and installed to a

high standard causing no disruption within the home. Please accept our sincere thanks

Falls Prevention Service, Erewash


Top



You Said We Did

Parents report that changes to the Core Programme within Health

Visiting have resulted in not receiving weaning advice. This

was previously offered at the 3-4 month contact

Health Visitors/Community Nursery Nurses have introduced weekly or monthly weaning

groups in partnership with the Children Centre Staff to specifically address this issue

Children's Services

The disabled bays were not clearly

defined

Contacted estates requested the disable bays to be re-lined / painted. This has now

been completed.

New Mills Clinic

Long waiting time within clinics

Introduction of an under 25’s walk in clinic at Long Eaton Health Centre every Friday afternoon which is reported to have improved waiting times in this area

Sexual Health Services


Top



Complaints

DCHS Complaints (Levels 2, 3 and 4) in

Quarter 2 = 32

Statutory Reporting

Upheld 5

Partially Upheld 4

Not Upheld 3

Ongoing 20

TOTAL 32

Complaints (Levels 2, 3 & 4)

Status in Quarter 2


Top



Complaints Key

Level 1Resolved by end of next

work ing day

Level 2 None or minimal impact to the

provision of healthcare

Level 3 Potential to impact on service

provision/ delivery

Level 4 Significant issues of standards

causing lasting detriment

Statutory Reporting

2013/2014 Complaints Level 1 Level 2 Level 3 Level 4 2nd

Bites

Enquiries

& Other

Activity

Total

Activity

Total

Activity

Per

Quarter

Apr-13 11 13 4 0 0 26 43

May-13 18 10 4 0 0 22 36

Jun-13 10 5 5 0 0 12 22

Jul-13 18 8 5 0 0 16 29

Aug-13 11 9 3 0 0 22 34

Sep-13 11 14 10 0 2 24 50

Oct-13 10 11 6 0 0 26 43

Nov-13 12 11 8 0 0 38 57

Dec-13 6 13 3 0 2 20 38

Jan-14 10 12 6 0 3 21 42

Feb-14 20 11 4 0 2 26 43

Mar-14 21 15 2 0 3 25 45

158 132 60 0 12 278

Apr-13 26 3 2 0 1 31 37

May-13 13 5 3 0 1 21 30

Jun-13 28 9 6 0 1 24 40

Jul-13 10 6 3 0 4 31 44

Aug-13 10 5 4 0 2 25 36

Sep-13 16 10 4 0 2 18 50

103 38 22 0 11 150

Quarter 1

Quarter 2

Quarter 3

Quarter 4

TOTALS 2013/2014 482

101

113

138

130

107

130

237TOTALS 2014/2015

2014/2015

Quarter 1

Quarter 2


Top



Complaints Received by Service 2014/2015

Complaints Overview

Level 1 Level 2 Level 3 Level 4 TOTAL

Community Podiatry 7 1 1 0 9

Outpatient Department 3 5 0 0 8

Community Nursing 1 3 2 0 6

Hospital Nursing (Rehab) 4 2 0 0 6

Minor Injury Unit 3 2 1 0 6

Service Top Complaints Quarter 2


Top



Complaints Trends and Themes 2014/2015

Complaints Overview


Top



Complaints Overview

Complaints Overview


Top



Equality Monitoring

During Quarter 2 were 32 surveys sent out to all Level 2, 3, 4 Complainants to which 11 chose to respond. The results for this period are below, not all questions apply to each complainant so we have omitted them from the results.

Complainant Feedback


Top



Complainants’ Satisfaction

We sent out 32 surveys and received 1 back during July to September 2014. The graphs below show the result of the 1 returned surveys. Please note that not all questions were applicable to each complainant so we have omitted them from the results.



Complainant Feedback Complainant Feedback


Top



Complaints to the Parliamentary and Health Service Ombudsman (PHSO) and MP

When we have exhausted our internal complaints process, we give everyone the option to contact the Ombudsman and ask them to review their complaint, if they remain unhappy with our response and findings. In Quarter Two the Ombudsman requested information on a case about a patient’s outpatient consultations at Ilkeston Hospital. The complaint was received by DCHS in September 2013. Based on the information from the complainant the Ombudsman’s office informed us that they will be investigating the complaint unless they find good reason not to. The complainant specifically mentions two consultants in the complaint and both consultants responded directly to the Ombudsman. Patient Experience Team sent the patient’s outpatient medical record and the complaints case file to the Ombudsman.

MP Enquiries We received no MP enquiry in Quarter Two.

MP Complaints

There was no MP complaint received in Quarter Two.

Statutory Reporting


Top



The Friends and Family Test The Friends and Family test is part of an initiative known as “The Patient Revolution” designed to improve patient experience. It is a comparable test, which can identify both good and bad performance. It encourages us to make improvements where services do not live up to patients expectations. We ask the question: “How likely are you to recommend our services to friends and family if they needed similar care or treatment?” and there is a scale from 1-6 on which to rate the service they received (1 is the most likely to recommend and 5 is the least likely to recommend, 6 is don’t know). We then calculate a score from this. The higher the score, the more likely patients are to recommend DCHS’ services. An example of the card that we introduced in April 2013 that we use to ask the question is below:

Friends and Family Test


Top



Quarter One and Quarter Two

Friends and Family Test (FFT) Results and Return April 2013 - September 2014



Top



This graph shows the total number of returned FFT cards for Quarter 1 & Quarter 2 on how likely patients were to recommend our services.



Top



This graph show the positive themes which have been received for Quarter 2, a total of 16380 themes identified. The services which received the most Improvement Themes were: Minor Injury Services Received 4279 of which 877 stated ‘Service – quality’ Physiotherapy (out-patients) received 2547 of which 569 stated ‘Service – quality’ Sexual Health Services received 2394 of which 438 stated ‘Staff – friendly’



Top



The graph below show the comparison between the top number of Negative Themes against the top number of Positive Themes for Quarter 2



Top



This graph shows the suggested improvement themes for Quarter 2, which a total of 355 were identified. The services which received the most Improvement Themes were: Health Promotion – Healthy Lifestyles received 50 of which 43 stated ‘Service – more clinics’ Minor Injury Units received 47 ‘Service – improve waiting times’ and 15 ‘Staff – employ more staff’ Sexual Health Services received 62 of which 48 stated ‘Service – improve waiting times



Top



Healthwatch

Sentiment Commentator

Type

Provider

Branch

(If

relevant)

Topic Specific

Service

Specific

Location

of Service

(eg Ward

Number)

Comments Provider Commissioner Reponse

Mixed Service User Ash Green Access to a

Service;Doctors

;Suitability of

Staff

Learning

Disabilities and

Autism

I have a learning disability. I really like going to see the Doctor at

Ash Green (named), I can talk to him and he is patient. He

explains w hat tablets he gives me, I understand that I have

sleeping tablets and I know w hen to take them. I haven't seen

the Doctor for a long time, it has been over a year and I should

see him once a year.

During the last year have had 2 Doctors on long terms sickness

,1 of w hich has returned this w eek, the other post is being

covered by a locum and therefore back up to full capacity.

Clinics are very busy, but no obvious back log and appointment

are offered if clients ring in. If the commentator w ould like to ring

Ash Green directly for an appointment or contact the Patient

Experience Team this matter can be looked into on behalf of the

commentator.

Positive Carer Walton

Hospital

Suitability of

Provider

(Organisation)

Care of the

Elderly;Inpatient

Care

Linacre Commentator reported, "The Community Hospital w as

w onderful, my next of kin didn't w ant to leave as he w as so

used to everyone. The care w as second to none. My next of

kin w as in there for 9 w eeks as there w as delay after delay

w ith the Continuing Healthcare Team, it didn't get sorted out

quickly but that didn't bother him. The food w as good and the

w ard w as very clean."

Negative Service User Long Eaton

Health

Centre

Access for

people w ith a

disabiity;Waiting

Times

Primary

Care/GPs

Commentator received a letter from the health centre to confirm

a chiropody appointment. It has been 20 w eeks since last

appointment. Commentator said this is unacceptable; if

appointment dates and times cannot be met by the provider,

perhaps it may be an idea for the provider to contribute

tow ards the cost of private treatment for patients in order for

treatment to be done at a more frequent and regular time OR go

back to the old system of allow ing patients to make their

appointment before leaving the clinic. Commentator said, had

he not been able to make this appointment and time

(appointment is 1 w eek aw ay) the chances are, the next

appointment offered w ould be a later one rather than an earlier

one. This w ould cause further delay.

Due to increase in high risk patients referred throughout the

county has increased by approx. 10%. Available appointments

prioritised for high risk patients, resulting in delays in treatment

intervals. None high risk patients informed how to self-care

during intervals. Unfortunately funding of Private Treatment is

not an option due to f inancial restrictions. When there is a time

that f inances are improved the service w ill ook at employing more

podiatrists. If the commentator w ould like to discuss this further

please ask them to contact the Patient Experience Team.


Top



Patient Stories

All DCHS Board and Quality Services Committee meetings start with a patient story. Other meetings also use these stories to ensure the patient is at the centre of everything we do. During Quarter Two the following stories were told:

Patient Story Actions/Lessons Learned

July 2014

Board – Tony’s Video Following transfer from another provider, the medication regime was found to be a significant causative factor in the episodes of psychosis. Staff began working closely with the neurology / epilepsy team to gain better control of his epilepsy.

Tony was successfully discharged to independent supported living in July 2014 after being hospitalised for seven years. He told his story on film and talked about his hopes for the future. This story was also shared at the Trust’s AGM.

QSC – Antenatal Story The Health Visiting Service in the High Peak and Dales received an antenatal referral for a family where both parents had learning difficulties.

One of the successes of the story was that the mother overcame various obstacles and succeeded in breastfeeding both of her babies and was keen to become a breastfeeding volunteer. The outcomes for both children are positive. They are currently developmentally progressing well.

August 2014

No Board Meeting

QSC – Mrs M’s Story Patient with severe mental health issues. After discharge the CPN informed the ward that she was neglecting herself and was refusing to leave the house. Her medications had been reduced since discharge and she had subsequently stopped taking them.

One reason for failed discharge had been the change in her dose of medication soon after discharge. If we had a discussion regarding the Consultant’s plans formulated and an in-depth back up plan for an increase in services from the community mental health team if she was showing signs of relapse, the initial outcome could have been more positive. Following this discharge she and her son will be receiving support from a social worker, community mental health team, day centre and befriending service.

Patient Opinion


Top



Patient Story Actions/Lessons Learned

September 2014

Board – M’s Story M was diagnosed with Chronic Obstructive Pulmonary Disease and was referred me to Pulmonary Rehab. ‘The education provided was priceless. It was what had been missing for me up til then. There were 10 of us. The companionship was remarkable. Anil (respiratory physiotherapist) course at Clay Cross hospital ran twice a week for two hours and for six weeks’. Patient has since lost weight and attends a gym and now walks every day.

Pulmonary Rehab are starting to use ‘graduates’ of the programme like M to support new service users. M attended Board meeting to tell her story.

QCS – Jo’s Story Jo is a 28 year new client in wheelchair service who has cerebral palsy. She is unable to mobilise and unable to self-propel and needs her wheelchair to perform all activities of independent daily living. She has never had an NHS wheelchair, having had charitable funding as a child. The patient is in the process of making an appeal to the Commissioners for additional funding in order to get the wheelchair that will fully help her. The Committee considered that if extra Commissioner funding was made available for a more expensive but more appropriate wheelchair then this might provide social and healthcare cost savings in the long term.

It was recommended that the patient should be supported In her discussions with the Commissioners in terms of thinking through a business case to present at the meeting to support her case.


Top



Patient Opinion and NHS Choices

Patient Opinion is a not for profit social enterprise which uses the web to carry the voices of users and carers into the heart of the health services. The aim is to make it quick, easy and safe for patients and carers to give feedback about their health care, and for health service providers and commissioners to respond and use the feedback for service improvements. NHS Choices is part of the Department of Health. The comments and responses posted on NHS Choices are transferred automatically on the Patient Opinion website. All comments from both these sites are sent directly to DCHS as soon as they are received. The graph below shows all the activity of both websites between July 2014 and September 2014.

Patient Opinion


Top



This is an example of a NHS Choices positive posting:

Patient Opinion

NHS Choices


Top



This is an example of a Patient Opinion negative posting:

Patient Opinion


Top



An example of how DCHS has had feedback through social media regarding patient experience this quarter. We expect this route to be an important one in the future.

Patient Opinion

DCHS Twitter


Top



The Derbyshire Dignity Campaign

Dignity in Care

Dignity and respect is the foundation for all health and social care services and needs to be the business of everyone involved at every level.

The purpose of the Derbyshire Dignity campaign is to encourage practical changes, which improve the experiences of people who use health

and social care services.

Bronze and Silver Standard Awards

The Derbyshire Dignity Campaign has been running since 2011 there have already been a considerable number of establishments and

organisations who have achieved this award. We launched the Silver Award was launched in March 2013. We now have an internal group that

coordinates Dignity in Care in DCHS. We now have around 18 remaining services that we will support through the application process before

the end of March 2015.

Quarter 2 – Bronze Award Gained Quarter 2 – Silver Award Gained

Health Visiting Community Services – Amber Valley Minor Injury Units – Ripley & Ilkeston

Working Towards Working Towards

Rockely Core Unit Day Services - Babington Occupational Therapy Inpatient – Ilkeston Hospital

Single Point of Access Team Health Visiting – Bolsover & Nth East Alton Ward

DN, OT & Physio - Erewash Health Visiting - Chesterfield Outpatient Dept – Ilkeston Hospital

Rowsley Ward Health Visiting - Erewash Physio/OT/MSK/Outpatient – County wide

Integrated Care Team - South Salaried Dental & Out of Hours (all) Valley view

Okeover Ward Oker Ward Occupational Therapy – Newholme Hospital

MIU - Whitworth Leicestershire Dental

Wheelchair Services

Please note that 11 Bronze Awards awarded to Leicestershire Services have been deducted from the original 56 as no longer DCHS 31 March

2014

45 4


Top




Top



Patient Experience and Involvement Strategy

The Trust agreed a Patient Experience and Involvement Strategy in 2013 that we will deliver through an ambitious action plan to guide our work during this year. The Patient Experience and Engagement Group receive an update each month. At the meeting in October, we had a detailed look at what we will achieve by the end of this year. There has been some excellent progress during 2014 despite other competing pressures. We will carry a small number of actions into 2015. Notable progress this quarter includes

Significant headway towards ensuring all services have a bronze Dignity in Care award by the end of March 2015 and a clear plan for supporting the final service through the application process.

We have identified some resources to deliver the equalities actions in the report. This will be through establishing a discrete project.

Compiled by

Lisa Hallam Patient Support Officer

Compiled by

David Brewin Head of Patient and Family

Centred Care

Patient Experience Strategy


Top




Title of Paper: Care Quality Commission (CQC) Update Report


Presenter: Carolyn White, Director of Quality/Chief Nurse

Author: Carolyn White, Director of Quality/Chief Nurse



Appendices:

Purpose of Paper

To provide the council of Governors with an update related to the CQC inspection.

Summary

Background During March 2014 the CQC undertook one of the first of the new style community trust inspections using the new CQC inspection framework developed under the guidance of Sir Mike Richards. DCHS had volunteered as a pilot site for this inspection and as such did not receive a rating at the end of the inspection process, however was assessed as good enough to progress through the Monitor foundation trust assessment pipeline. At the Trust quality summit the CQC identified a number of areas of non-compliance with essential standards 1. Safe management of medical equipment 2. Safe management of medicines 3. Patient centred care planning in OPMH 4. Assessment of capacity in patients needing to give consent In addition the CQC made a wide range of recommendations for improvements across the services inspected which DCHS embraced in full. The trust has been working hard to implement the agreed changes. During week commencing the 10th November the CQC undertook an unannounced visit to the trust. The CQC visited all areas where non-compliance with essential standards had been found including Cavendish, Whitworth and Walton hospitals. The primary focus was in OPMH and included experts by experience, clinical advisors and CQC inspectors.

84�CQC�Update�Report.docx

Top



Informal feedback following three days of inspection confirmed that:

Compliance issues related to safe medicines management and safe equipment management had been addressed

That patients within OPMN were well cared for and that relatives were complimentary about care

Staff in OPMH were enthusiastic and committed and had good interaction with patients

Good progress had been made and was obvious to the team regarding care planning and policy development

There were good behaviour management plans

Evidence of patient involvement and improved process for assessing capacity for consent The CQC highlighted a number of new areas for improvement related to:

Rapid tranquilisation and recording of the same

Recording of episodes of restraint

Training in regard to MHA

Patients not aware of their care plans

Mental health hospital managers audit tool

MHA committee administrative support

Care of a younger patient The last two issues were clarified at the feedback session and during the following day. The CQC advised that they would need to review their findings before advising on the outcome of the visit and that the trust would receive a draft report within three weeks for accuracy checking. At the time of writing the report the trust had not received the draft report. Looking Forward The issues raised by the inspectors have now been incorporated within the OPMH teams actions and work has commenced. The trust will continue to focus on strengthening its compliance assurance through the Quality Always initiative.

Recommendations

The Council of Governors are asked to note progress with regard to CQC inspection and associated action plan and to take assurance that good progress was noted and two of the compliance actions were lifted at the visit.

84�CQC�Update�Report.docx

Top




Title of Paper: Council of Governors Terms of Reference

Paper for: Approval

Presenter: Kirsteen Farrar, Trust Secretary

Author: Kirsteen Farrar, Trust Secretary



Appendices: Appendix 1 Council of Governors Terms of Reference

Purpose of Paper

Governors are asked to review the attached Terms of Reference for the Council of Governors and to consider approval of them.

Summary

The Terms of Reference were approved by the Council of Governors in June 2013 with a view to adoption once DCHS became authorised by Monitor to become a Foundation Trust. As DCHS were authorised on 1 November 2014, the Terms of Reference are presented again to the Council for review and approval. The Terms of Reference explain the purpose of the Council of Governors. They reflect the duties, roles and responsibilities of the Council of Governors as well as setting out the membership of the Council. They also support the good working relationship between the Council of Governors and the Board of Directors because that will be critical for the welfare of the organisation. The Terms of Reference for the Council are shaped from the DCHS Constitution.

Recommendations

The Council of Governors are asked to discuss and approve the Terms of Reference in Appendix 1.

85�Council�of�Governors�Terms�

Top



DCHS Council of Governors

Terms of Reference December 2014

Introduction In accordance with its Constitution (‘the Constitution’), the Trust has a Council of Governors elected by public and staff members of the Trust and appointed by partner organisations. These Terms of Reference are intended to reflect the duties, roles and responsibilities of the Council of Governors as contained in the Trust’s Constitution and Monitor’s Code of Governance for Foundation Trusts (2010) (the ’Code’).

What The Council of Governors represents the interests of and is accountable to the membership of the Foundation Trust. The Council of Governors also has a broader duty to represent the interests of the general public in the areas served by the Foundation Trust. The full meeting of the Council of Governors, the Nominations and Remuneration Committee are the bodies in which governors have official standing. All other forums are advisory.

Who Membership of the Council is determined in accordance with Annex 3 of the Constitution. There will be 30 members of the Council of Governors as follows:

17 governors elected by members of the public constituency

10 governors elected by members of the staff constituency

3 governors appointed by partner organisations The Chair of the Board of Directors is the Chair of the Council of Governors and presides over the meetings of the Council of Governors. In the absence of the Chair, the Vice Chairman, one of the Non-Executive Directors, appointed by the Council of Governors, will preside at a meeting of the Council of Governors.

Quoracy No business shall be transacted at a meeting of the Council of Governors unless at least one third of the total number of Governors are present with a majority of those present being Public Governors.

When The Council of Governors will meet in public at least four times a year including an Annual General Meeting. The meetings will take place on a quarterly basis.


Top



Where Council meetings will be held at pre-arranged premises throughout Derbyshire to ensure accessibility by all Stakeholders.

Why In summary, the purpose of the Council of Governors is to hold the Non-Executive Directors, individually and collectively, to account for the performance of the Board of Directors and to represent the interests of the members of the Trust as a whole, and the interests of the public. Governors are responsible for regularly feeding back information about the Trust, its vision and its performance, to the constituencies and the stakeholder organisations that either elected, or appointed, them. The good working relationship between the Council of Governors and the Board of Directors is critical for the welfare of the organisation. The Council of Governors and the Board of Directors will meet regularly and with sufficient frequency to establish appropriate channels of communication and constructive challenge. The respective roles need to be clear, to avoid confusion and creating tension that might disrupt the working of the governance arrangements.

How The Council of Governors will carry out: Statutory Duties

Appointing/removing our Chair and Non-Executive Directors

Determining the pay and terms of office of our Chair and Non-Executive Directors

Approving the appointment of our Chief Executive by the Non-Executive Directors

Being consulted on forward planning by the Board of Directors

Receiving the annual report and accounts, and the report of the auditor

Receive and comment on the annual report of the audit committee on the work, fees and performance of the external auditor

Appointing/removing our Auditor

Holding the Non-Executive Directors to account for the performance of the Board

Acting as a critical partner to the Board of Directors in the development of the Annual Plan, including reviewing progress reports

Decide whether the Trust’s private patient work would significantly interfere with the Trust delivering health service or other functions

Consider approval of: o mergers and acquisitions o significant transactions o proposed increases of non-NHS income of more than 5% of total

income o constitutional changes jointly with the Board

Requiring one or more directors to attend a meeting to answer questions

Ensuring we operate in accordance with our legal framework


Top



Other Areas Receive and review reports:

Presented on behalf of the Board of Directors on the performance of the Trust against agreed key financial, operational, quality and regulatory compliance indicators and stated objectives

Patient experience in areas such as accessibility, cleanliness and the environment, and overall ‘customer care’

Staff experience such as Staff Surveys including quarterly “Pulse Checks”

Campaigns such as smoking, alcohol, nutrition, drug abuse and accident prevention

Regular summary reports from sub-committees of the Council of Governors

Working groups formed by Governors with selected Non-Executive Directors , each led by an Executive Director and targeted at the key areas of the Trust’s activity and strategic planning.

Membership strategy and the development of plans for growing and developing the membership

Other areas of activity of interest to Governors

Hold Annual Members’ Meeting to present and receive feedback on the overall strategic aims of the Trust

Commission an annual review of its effectiveness and efficiency in the discharge of its responsibilities and achievement of objectives

Sub Committees The Council of Governors will establish the following committees:

Nominations and Remuneration Committee

Such other groups as required from time to time

Task and finish working groups as necessary.

Communication Links

Council of Governors sub-committees Board of Directors Monitor All stakeholders Chair

Reporting To Membership and partner organisations

Key Performance Indicators

The Council of Governors will participate to develop a series of perfomance indicators.

Review Date The Council of Governors will review these terms of reference annually. The review date will be December 2015.


Top




Title of Paper: Foundation Trust Authorisation



Author: Kirsteen Farrar, Trust Secretary



Appendices:

Purpose of Paper

The purpose of this paper is for the Council of Governors to receive the Foundation Trust’s key authorisation documentation.

Summary

DCHS was formally authorised by Monitor on 1 November 2014. The Council is asked to note the following key documents listed below. The documents can be read in full via the DCHS website (go to the homepage and click on Publications). If any governor would like to receive a hard copy then we will bring a copy to the meeting on request. Authorisation Letter – letter of authorisation from Monitor. The Constitution – the Constitution is the document that sets out the purpose and the powers of the NHS Foundation Trust and its governance arrangements. Any subsequent changes to the Constitution must be approved by both the Board of Directors and the Council of Governors (CoG). If the changes relate to the powers and duties of the CoG, the changes must be ratified by the members at the next Annual Members Meeting. The Trust must remain compliant with the Constitution otherwise there is a risk that it could be in breach of legislation and the conditions as set out in Monitor’s NHS Provider Licence. NHS Provider Licence – the Provider Licence sets out the conditions issued by Monitor for the Trust to operate as an NHS Foundation Trust from 1 November 2014. The Trust must comply with the conditions.

86�Foundation�Trust�Authorisat

Top



Recommendations

The Council is asked to note the documents listed above, which can be viewed by going to the following http://www.dchs.nhs.uk/home/dchs_publications.

86�Foundation�Trust�Authorisat

Top


http://www.dchs.nhs.uk/home/dchs_publications


Summary Report

Report To: Council of Governors

Date: 11 December 2014

Name of Reporting Committee / Group: Nominations and Remuneration Group

Date of Meeting: 13 November 2014

Presenter: Brenda Greaves, Lead Governor

Author: David Boddy, Corporate Governance Manager

Key Issues

3/14 Draft Terms of Reference The Governors discussed the process for setting up the Nominations Committee. PS described the timeline challenges following DCHS becoming a Foundation Trust (FT). Although the Council only meets quarterly and the next meeting is not until December, DCHS have to formally approve the Chair and Non-Executive Directors (NEDs) along with their terms and conditions. BG said that the September Shadow Council of Governors had tasked her with gathering a group of Governors together to discuss the Terms of Reference (ToR) for the committee and to make recommendations to the December Council meeting. The group agreed to ask the Council to approve this body, including membership by the Governors who attended the meeting today. The Governors discussed the draft Terms of Reference in detail and agreed to recommend to the Council that they adopt the ToR, subject to a number of amendments including:

Inclusion of the review of Governors with respect to individual and overall performance, contribution, attendance and conduct

Include reference to the regular and systematic monitoring of the performance of the Chair and the NEDs

Increase the Quorum to the Chair or Vice Chair and 3 Governors

The annual review of the structure, size and composition of the Board of Directors to be done in conjunction with the Chair

The Chief Executive, as Accountable Officer, may attend the meeting from time to time, as appropriate.

Correction of some minor typo errors 4/14 Appointment Ratification of the Chairman and Non-Executive Directors AR reported that one of the first requirements of the Council of Governors is to formally appoint the Chair and Non-Executive Directors. KF asked the Governors to consider that Monitor had already assessed the Board and considered it of good quality for leading DCHS. It was agreed to propose to the Council of Governors that they:

Approve the appointment of the Chair and Non-Executive Directors for a term of tenure that is compliant with the NHS Foundation Trust Code of Governance and referenced in the DCHS Constitution

87�Nominations�and�Remuneratio

Top



Agree to an extension of tenure for two NEDs (Barbara-Ann Walker and Tony Okotie) whose tenure comes to an end in March 2015. To encourage continuity it was agreed to recommend that their tenure be extended until November 2015

5/14 Governor Issues for Discussion The group discussed the current level of remuneration received by the Chair and the NEDs and, reflecting on the average market rates of remuneration, the risks to continuity of the governance structure. The Governors asked, now that we are an FT, what would be the appropriate remuneration for the Chair and NEDs reflecting it is different from a NHS Trust. The group asked AR to provide a benchmark data report, including local and national comparators and a recommendation regarding levels of remuneration. 6/14 Reporting to Council of Governors It was recommended that a Summary Report for each Nominations Committee meeting should be presented to the Council of Governors.

Attendees Initial Title





Adam Short AS Staff Governor – A and C and Managers

Bernard Thorpe BT Public Governor – City of Derby


Amanda Rawlings AR Director of People and Organisational Effectiveness

David Boddy DB Corporate Governance Manager (minute taker)


Top



Summary Report

Report To: Council of Governors

Date: 11 December 2014

Name of Reporting Committee / Group: Nominations and Remuneration Group

Date of Meeting: 25 November 2014

Presenter: Brenda Greaves, Lead Governor

Author: David Boddy, Corporate Governance Manager

Key Issues

13/14 Nominations and Remuneration Committee Terms of Reference The group reviewed the updated Terms of Reference and agreed to recommend them to the Council subject to the following amendments:

Quoracy to be: “The Chair or Vice Chair and three governors including the Staff Governor. In the absence of the member who is the Staff Governor then a named, deputising Staff Governor should receive papers and attend the meeting”. (BG, AS and KF will meet to identify a named deputy Staff Governor)

In Attendance section to include “The Chief Executive, as Accountable Officer, may attend the meeting from time to time, as appropriate”.

14/14 Succession Planning The group discussed the process for succession planning for the Chair and Non-Executive Directors in the new Foundation Trust setting. The group were informed that Non-Executive Director (NED) Barry Steans had recently resigned and there was an immediate priority to replace him on the Board. The group considered the estimated costs for using a recruitment agency and agreed that :

For the current vacancy we should employ a recruitment agency to provide the best chance of procuring a good list of candidates

Take experience from the exercise of using a third party with a view to managing the recruitment process ourselves in the future

To achieve against tight timescales for the current vacancy it was agreed that in December:

BG will present a paper to the pre-meeting on the 11 December 2014 to explain the process for recruitment.

The full Council meeting will then be asked approve the process

The Nominations Group will review and develop the person specification

The Nominations Group will receive presentations from recruitment agencies and then choose who to employ for the process of filling the current vacancy

The timescale for all of the above will be before Christmas to facilitate an efficient recruitment process in the new year

The group also agreed that in 2015 meetings will be arranged to develop an open dialogue between NEDs and Governors so that the Council have a better understanding of the role and skill set requirements for NEDs.


Top



15/14 Remuneration of the Chair and Non-Executive Directors in DCHS NHS Foundation Trust (The Chair and TO left the meeting for this agenda item). AR presented analysis of a wide range of information that has been considered in order to make a recommendation to the Council regarding an appropriate salary level for the Chair and NEDs. AR recommended an average market rate for the salaries. The group considered equity, fairness and value for money issues around recommending an increase in salary levels. They took into account:

The commitment expected from the Chair and NEDS in a Foundation Trust.

The benefits for DCHS in keeping a stable and loyal Board

That proposed salary increases have been budgeted and will not have a negative impact on services

AR will discuss with the Chair and the Committee the minimum time commitment. The group agreed it was important to be open and transparent with the staff about the increase. The group agreed to recommend that the Council approves salaries of £45,000 for the Chair and £12,000 for the NEDs.

Attendees Initial Title


Tony Okotie TO Non-Executive Director




Adam Short AS Staff Governor – A and C and Managers

Bernard Thorpe BT Public Governor – City of Derby

Tracy Allen TA Chief Executive


Amanda Rawlings AR Director of People and Organisational Effectiveness

David Boddy DB Corporate Governance Manager (minute taker)


Top



Appendix One

Nominations and Remuneration Committee

Draft Terms of Reference November 2014

What To consider and make recommendations regarding issues relating to the appointment and remuneration and other relevant issues relating to the Chair and Non-Executive Directors

Who

DCHS Chairman (Chair of Nominations Committee) Vice Chairman (Chair of Committee when considering issues relating to the Chair) 5 Governors in total to be constituted of: Lead Governor 3 Public Governors 1 Staff Governor (or agreed named deputy) In attendance: Trust Secretary Director of People and Organisational Effectiveness The Chief Executive, as Accountable Officer, may attend the meeting from time to time, as appropriate.

Quoracy The Chair or Vice Chair and 3 governors including the Staff Governor. In the absence of the member who is the Staff Governor then a named, deputising Staff Governor should receive papers and attend the meeting.

When As required and no less that twice a year

Where To be confirmed

Why

The Nominations Committee is established in accordance with the Constitution for Derbyshire Community Health Services NHS Foundation Trust. The purpose is to identify appropriate candidates for the office of Chairman and Non-Executive Directors and to make recommendations to the full Council of Governors. The Committee will act in accordance with Annex 5 of the Foundation Trust’s Constitution for the appointment and removal of the Chairman and other Non-Executive Directors.

87�Draft�Nominations�and�Remun

Top



How

The committee is responsible to the Council of Governors for the following:

Considering and making recommendations to the Council of Governors on the appointment of the Chairman and Non-Executive Directors. The Committee is to satisfy itself that its recommendations fulfil DCHS needs in terms of skills and experience.

Agree the process for recruitment of the Chairman and Non-Executive Directors taking into account the views of the Board of Directors on the process in general and the qualifications, skills and experience required for the position. For NED appointments the Chairman will be asked to Chair the appointments panel. For appointments to the Trust Chair position, the panel will be chaired by the Vice Chair (or in the event of the Vice Chair submitting an application the SID or other suitable NED).

The Committee will ensure appointments are based on merit and objective criteria as well as meeting the ‘fit and proper’ persons test described in the Provider Licence and CQC Regulations.

To make recommendations to the Council of Governors on the re-appointment of the Chair and/or Non-Executive Directors where it is sought and is constitutionally permissible. The Committee will look at the existing candidate/s against the required role description.

To consider and make recommendations to the Council of Governors as to the remuneration and allowances and other terms and conditions of office of the Chairman and other Non-Executive Directors.

In conjunction with the Chairman, to contribute to an annual review of the structure, size and composition of the Board of Directors and to make recommendations for changes to the NED element of the Board of Directors to the Council of Governors where appropriate. When undertaking this review, the Committee will consider the balance of skills, knowledge and experience of the Non-Executive Directors.

The Committee will also consider succession planning to include the balance of appropriate skills and experience for Non-Executive Directors which will complement the full Trust Board.

To consider issues relating to the performance and attendance of the Council of Governors (individually and collectively).

Sub Committees/

Groups

Not applicable

Communication Links

Board of Directors

Reporting To The Committee will report formally to the Council of Governors through the Lead Governor or other nominated Governor is they are not present at the COG.


Top



Key Performance

Indicators

Review Date November 2015


Top




Title of Paper: Appointment of External Auditor

Paper for: Approval

Presenter: Chris Sands, Director of Finance, Performance and Information

Author: Chris Sands, Director of Finance, Performance and Information


No of pages

Inc. this one: 5

Appendices:

Purpose of Paper

As an NHS Trust, the Organisation has no say in the appointment of the external auditor as this decision is made by the Audit Commission. As a Foundation Trust, the Council of Governors is responsible for appointing auditors. The Audit and Assurance Committee is responsible for making a recommendation to the Council of Governors. This paper sets out the recommendation of the Audit and Assurance Committee for the appointment of the NHS foundation trust external auditor.

Summary

Background Each NHS Trust and foundation trust must have an external auditor in place. The Audit Code for NHS Foundation Trusts (the code) prescribes the way in which auditors of NHS foundation trusts are to carry out their functions. The auditors of NHS foundation trusts must comply with the principles set out in this code in all instances. The criteria for the selection of auditors for foundation trusts is included in Appendix 1. It is the auditors’ decision to determine who are ‘those charged with governance’ at an NHS foundation trust. It is expected however that this will be the Audit Committee in the first instance and the Council of Governors if the auditors feel that the issue is significant.

88�Appointment�of��External�Au

Top



Appointment of Auditors On establishment as an NHS foundation trust, the auditors appointed by the Audit Commission to the predecessor NHS trust (the incumbent auditors) will continue to be appointed until the Council of Governors has had an opportunity to discuss the matter. An engagement letter must therefore be agreed between the NHS foundation trust and the incumbent auditors for that interim period so that there is not a period during which the NHS foundation trust has no auditor in place. The Council of Governors must discuss at their first meeting after establishment whether they wish to extend the appointment of the incumbent auditors or whether they wish to undertake a competitive tender exercise to appoint their auditors. Transition – 2 sets of accounts For the financial year 2014/15, the Trust will have to produce two sets of financial accounts. One will cover the period as an NHS Trust (1 April 2014 to 31 October 2014), the second will cover the period of the NHS foundation trust accounts (1 November 2014 to 31st March 2015). Our current external auditors, KPMG, were appointed from 1 September 2012 by the Audit Commission. They will be responsible for auditing the part year NHS Trust accounts to the period end 31st October 2014. It is proposed that the term of office be extended to cover the 2014/15 part year foundation trust accounts. This is a practical, and most efficient way forward given that under their Audit Commission appointment, the auditors will be reviewing the part year NHS trust accounts. Following this work the auditors will have been in the role for 3 years. Financial Year 2015/16 onwards Monitor recommends that NHS foundation trusts should undertake a market testing exercise of their external auditors at least every 5 years. It is recognised that there is value in an appointment of up to 5 years as this allows the external auditor to understand the business and risks of the Trust, which allows them to provide an efficient audit. The appointment of the external auditor is a key function of the Council of Governors. It is suggested that the Council of Governors should be given the opportunity to exercise this function by appointing the External Auditor at the earliest practical opportunity. It is therefore recommended that the Trust External Audit be put out to tender for audit year 2015/16. In practice, the new auditor would need to be in place for October 2015. The intention would be to evaluate submissions through a panel of the Audit Committee Chair, Governor representative and Director of Finance, Performance and Information. Financial Implications The Audit Fee for the NHS accounts is set by the Audit Commission. The audit fee for the foundation trust accounts is agreed between the auditor and Trust.


Top



The fees for 2014/15 are £70,200 plus VAT. Due to the Trust being authorised in mid year, the Audit Commission will set a part year fee for the NHS Trust period, and the Trust will need to agree a fee with its auditors for the foundation trust period.

Recommendations

The Council of Governors is asked to approve:

An extension to the appointment of KPMG as External Auditors to complete the Foundation Trust part year accounts 2014/15

The market testing of the External Audit contract for audit year 2015/16 and beyond.

A Nomination of a Governor to work with the Audit Committee Chair and Director of Finance, Performance and Information to progress the tender


Top



APPENDIX 1 Criteria for the selection of auditors of NHS foundation trusts and rotation of auditors (Taken from the Audit Code) Appointment of auditors The board of governors of the NHS foundation trust is responsible for appointing an auditor. The NHS foundation trust must ensure that the auditor appointed by the board of governors meets the following criteria, at the date of appointment and on an on-going basis throughout the term of their appointment:

the auditor must satisfy the criteria for appointment as an auditor of an NHS foundation trust, as set out in paragraph 23(4) of Schedule 7 of the 2006 Act;

the auditor must have an established and demonstrable standing within the healthcare sector and be able to show a high level of experience and expertise. The work is of a specialised nature, and so general audit experience is not sufficient;

the auditor must comply with the Audit Code for NHS Foundation Trusts; and

the auditor must subject the audit to internal quality control procedures which are sufficiently robust to monitor the compliance of the audit work with the Audit Code for NHS Foundation Trusts.

Rotation of auditors The audit committee of the NHS foundation trust established in accordance with paragraph 23(6) of Schedule 7 must assess the auditor’s work and fees on an annual basis to ensure that the work is of a sufficiently high standard and that the fees are reasonable. Performance measures may be used as part of the assessment. The audit committee shall then make a recommendation to the board of governors with respect to the reappointment of the auditor. If the auditor’s work has been satisfactory and the charges reasonable; the board of governors may reappoint the auditor for the following year without the need for a formal selection process. However, Monitor recommends that the NHS foundation trust should undertake a market-testing exercise for the appointment of an auditor at least once every five years. Auditors must comply with the relevant ethical standards in relation to rotation of key individuals within the audit team. When an auditor’s appointment ends, the Chair of the Board of Governors must write to Monitor informing it of the reasons behind the decision.


Top




Title of Paper: Policy for Additional Services by the External Auditor

Paper for: Approval


Author: Chris Sands, Director of Finance, Performance and Information


Time required on agenda:

Appendices: Policy For Additional Services By The External Auditor

Purpose of Paper

This paper sets out a draft policy for the procuring of additional services from the external auditor. Under the new governance arrangements of operating as a foundation trust, this policy should be approved by the Council of Governors.

Summary

The Audit Code for NHS Foundation Trusts (FTs) (The Code) was revised and re-issued by Monitor and became applicable to FTs from 1 December 2007. The Code prescribes the way in which auditors of NHS Foundation Trusts are to carry out their functions, as set out in the National Health Service Act 2006 (the 2006 Act). The Code also allows the auditor, with the approval of the Council of Governors, to provide the Trust with services which are outside of the scope of the audit as defined in the Code (additional services). The Code requires the Trust to adopt and implement a policy for considering and approving any additional services to be provided by the auditors. Appendix 1 sets out the proposed policy for additional services from the external auditor.

Recommendations

The Council of Governors is asked to approve this policy.

89�Policy�for�Additional�Servi

Top




Top



POLICY FOR ADDITIONAL SERVICES BY THE EXTERNAL AUDITOR

Document History

Version Date: 10th November 2014

Version Number: 2

Status: For Approval

Next Revision Due:

October 2016

Developed by: Chris Sands, Director of Finance, Performance and Information

Policy Sponsor: Chris Sands, Director of Finance, Performance and Information

EQIA completed: ( including reference number

Yes

Approved by: Council of Governors

Date approved: To be arranged

Revision History

Version Revision date

Summary of Changes

1 October 14

Policy Information Leaflet (delete if not applicable) To help ensure that this policy is as accessible as possible, it has been left-aligned and is available in alternative formats and languages. To obtain a copy of the policy in large print, audio, Braille (or other format) or in a different language, please contact The Communications Team, by Tel: 01773 525099 or email [email protected]


Top


mailto:[email protected]


TABLE OF CONTENTS

1. Background ................................................................................................................. 3

2. Aim /Purpose .............................................................................................................. 3

3. Definitions and an Explanation of Terms Used........................................................ 3

4. Intended Users ............................................................................................................ 4

Table of Intended Users: .............................................................................................. 4

5. Full Details of the Policy ............................................................................................ 4

6. Support and Additional Contacts .............................................................................. 5

7. References and Associated Documentsnts ............................................................. 5

8. Trust Accountability / Responsibilities ..................................................................... 5

9. Monitoring & Performace management of the Policy ......................................... 7

10. Equality Impact Statement ..................................................................................... 8

11. Equality Impact Assessment.................................................................................. 8

Equality & Diversity Impact Assessment : Level I Screening .................................... 9


Top



Additional services by the external auditor

Version 2 Page 3 of 12 10th

November 2014

1. BACKGROUND This policy has been developed to provide a process for procuring of additional services from the external auditor. This is a requirement of the Audit Code for NHS Foundation Trusts.

2. AIM /PURPOSE The Audit Code for NHS Foundation Trusts (FTs) (The Code) was revised and re-issued by Monitor and became applicable to FTs from 1 December 2007. The Code prescribes the way in which auditors of NHS Foundation Trusts are to carry out their functions, as set out in the National Health Service Act 2006 (the 2006 Act). The Code also allows the auditor, with the approval of the Council of Governors, to provide the Trust with services which are outside of the scope of the audit as defined in the Code (additional services). The Code requires the Trust to adopt and implement a policy for considering and approving any additional services to be provided by the auditors. Section 2.14 of the code states that it is the auditors’ decision to determine who are “those charged with governance” at an NHS foundation trust. It is expected, however, that this will be the Audit Committee (Audit and Assurance Committee for DCHS) in the first instance and the Council of Governors, if the auditors feel that the issue is significant. The Council of Governors at one of their early meetings will need to confirm their approval for the external auditors to provide additional services which are outside of the scope of the audit. The code, in section 2.12, states that “the auditor may, with the approval of the board of governors, provide the NHS foundation trust with services which are outside of the scope of the audit as defined in this code (additional services). The trust shall adopt and implement a policy for considering and approving any additional services to be provided by the auditor”. The additional services are to be determined by the Audit and Assurance Committee.

3. DEFINITIONS AND AN EXPLANATION OF TERMS USED Monitor is the Independent Regulator of Foundation trusts. The auditor is the external auditor to the Trust as appointed by the Council of Governors. Additional Services are services provided by the auditor which are outside the scope of the statutory audit as defined in The Code.


Top





November 2014

4. INTENDED USERS

Table of Intended Users:

DCHS

Chief Executive’s Department YES

Finance Performance & Information YES

Quality YES

Strategy YES

Operations YES

People & Organisational Effectiveness YES

Medical Directorate YES

Leicester Employees YES

Governors YES

Within this policy where it states “all employees”, please note, that it relates to all the employees who are highlighted in the table above.

5. FULL DETAILS OF THE POLICY The Director of Finance, Performance and Information with the external auditors will agree a plan of additional services to be commissioned for consideration by the Audit and Assurance Committee. The Audit and Assurance Committee will consider the plan, taking account of any potential threats to the objectivity and independence, of the auditors, and will determine whether it is satisfied that the auditors’ independence is not jeopardised, taking into account the scope of the audit work to be carried out. The Audit and Assurance Committee will include within their Annual Report all additional audit work performed by the Trust’s external auditors. This should also include assurances that in authorising additional audit work the auditor’s independence has not been compromised. The external auditors would also be required as a matter of course, to summarise in their external auditors Annual Governance Report any work undertaken as part of additional audit services for the Trust. This policy is to be reviewed every two years and will be monitored by the Audit and Assurance Committee. The policy will be approved by the Council of Governors.


Top





November 2014

6. SUPPORT AND ADDITIONAL CONTACTS The policy has been developed by the Director of Finance, Performance and Information. Additional support and advice to implement this document can be obtained from either the Trust Secretary or Director of Finance, Performance and Information.

7. REFERENCES AND ASSOCIATED DOCUMENTS This policy is consistent with the Trust’s Terms of Authorisation as a Foundation Trust and Standing Orders for the Council of Governors and Board of Directors.

8. TRUST ACCOUNTABILITY / RESPONSIBILITIES 8.1 The DCHS Way Expectations: What we can all expect from DCHS:

Share and support us in understanding our vision, values and priorities

Be clear as to what is expected of us and what our part is to play in the organisation

Support us to deliver our job in the best way

Manage and support us to maximize our performance

Communicate with us in a timely, open and honest way

Listen to us and involve us in decision making

Respect and value diversity What DCHS can expect from all of us:

Put patients at the heart of what we are doing, promoting their health at every opportunity

Go to the extra mile for patients, carers, colleagues and the good of the organisation

Continuously improve our performance and our services

Eliminate waste and ensure we work as efficiently and flexibly as possible

Live the DCHS values and behaviours

Fulfil the requirements of our professional standards

Take responsibility for promoting the reputation and image of DCHS at every opportunity

8.2 Individuals: 8.2.1 Chief Executive The Chief Executive has responsibility from the DCHS Board for ensuring that there are safe and effective systems in place to deliver high quality services. 8.2.2 Director of Operations The Director of Operations is responsible for the high quality, efficient and effective community services provided by the four operational divisions within the Trust, ensuring that they meet and exceed performance standards.


Top





November 2014

8.2.3 Director of Quality / Chief Nurse The Director of Quality / Chief Nurse is responsible for the professional leadership of non medical clinicians across the Trust and for ensuring the highest possible quality of care for patients and service users. The Director of Quality is also responsible for the development and implementation of effective strategies and systems to improve patient safety and patient experience across the Trust. 8.2.4 Director of Strategy The Director of Strategy is responsible for developing and leading the Trust’s business development function, ensuring business opportunities and challenges are proactively identified and effectively managed to support delivery of the Trust’s strategy. 8.2.5 Director of People and Organisational Effectiveness The Director of People and Organisational Effectiveness is responsible for providing visible, credible and effective leadership to the Trust in the development and delivery of a HR, workforce and organisational development strategy to support the delivery of both Trust strategies and objectives. 8.2.6 Director of Finance, Performance & Information The Director of Finance, Performance & Information is responsible for providing leadership and management to the finance, information and performance functions and takes responsibility for the financial stewardship, probity and governance of the Trust’s resources. 8.2.7 Medical Director The Medical Director is responsible for providing medical leadership and direction to the Trust Board to ensure that clinical issues are understood and appropriately drive the Trust’s strategic and operational plans. 8.2.9 Head of Service / Operational Managers The Heads of Service and Operational Managers have a responsibility to ensure that the policy is implemented within their area and that their teams are aware of the policy and have received the appropriate training. 8.2.10 Employees Professionally registered employees; all employees are accountable for their professional practice and hold individual responsibility to maintain their knowledge and skills. All employees have a responsibility to be aware of and read policies appropriate to their roles and others where necessary. They should be aware of, and comply with, their responsibilities within the individual policies of the Trust. 8.2.11 Policy Sponsor The policy sponsor is responsible for ensuring that:

the policy is developed in line with this framework

the policy is disseminated to its target audience;

appropriate training is given in the use of the policy;

the policy is properly implemented.

its implementation is monitored and reviewed on a regular basis.


Top





November 2014

The policy sponsor for this policy is the Director of Finance, Performance and Information 8.3 Committees: 8.3.1 DCHS Board The DCHS Board has ultimate responsibility for DCHS. The Board’s prime duty is to ensure good governance throughout the Trust and act in the best interests of the public for the services DCHS provides. 8.3.2 The Quality Business Committee (QBC) QBC will be responsible for the Governance aspects of the Quality Business domain of the DCHS Way, on behalf of the Board and will shape, influence and provide overall assurance regardring the delivery of the Performance Framework, Financial strategy and investment, IM&T Strategy, Business Development Framework and Integrated Business Plan (IBP). 8.3.3 The Quality People Committee (QPC) QPC will be responsible for overseeing the development of the People and Organisational Development Strategy, providing assurance to the Board that DCHS has the right staff, in the right place, doing the right things. This will include ensuring that staff are recruited, trained and qualified to do the roles required, monitor DCHS’ Quality People performance targets, ensure that effective workforce plans and development are in place and ensure DCHS has effective staff involvement and engagement. The Quality People Committee will have joint responsibility with the Quality Service Committee for developing and assuring equality and diversity activity. 8.3.4 The Quality Service Committee (QSC) QSC will be responsible for shaping, influencing and providing overall assurance in relation to the quality of DCHS services. This will incorporate the three elements of quality governance i.e. – patient safety, the patient experience and the effectiveness of care in relation to patient outcomes. This will be achieved by working on the delivery of DCHS Quality Strategy and compliance against regulatory requirements and external scrutiny. 8.3.5 Audit and Assurance Committee The Audit and Assurance Committee is responsible for providing assurance to the Trust Board, through the oversight, assessment, review and scrutiny of functions, process and systems within the Trust to maintain a sound system of internal control.

9. MONITORING & PERFORMANCE MANAGEMENT OF THE POLICY

Minimum Requirement Monitoring Who Frequency Review

Process including any flow charts

Review of policy

Policy Sponsor

Bi annually Audit and Assurance Committee / Council of


Top





November 2014

Governors

Monitoring Use of additional services included in AAC Annual Report and auditors Annual Governance Report

Audit and Assurance Committee

Annually Council of Governors

Equality Impact Assessment (EIA)

Review of policy

Policy Sponsor

Bi annually Audit and Assurance Committee / Council of Governors

10. EQUALITY IMPACT STATEMENT We welcome feedback on this policy and the way it operates. We are interested to know of any possible or actual adverse impact that this policy may have on any groups in respect of age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex and sexual orientation. The person responsible for equality impact assessment of this policy is the Director of Finance, Performance and Information This policy has been screened to determine equality relevance for the following equality groups: age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex and sexual orientation. The equality relevance is considered to have low equality relevance. A full impact assessment has been conducted and the report is attached to this policy.

11. EQUALITY IMPACT ASSESSMENT


Top



EQUALITY & DIVERSITY IMPACT ASSESSMENT : LEVEL I SCREENING Which of the following diversity profiles could suffer detriment as a result of this policy / procedure /process?

Race Gender Disability Age Sexual Orientation

Religion/Belief

Transgender/ Transsexual

What is the purpose of the policy under assessment?

To have an agreed process for the procuring of additional services from the external auditor

What is the background to the policy? (e.g. in response to a statutory requirement, development of good practice, organisational review etc..)

This policy is a requirement of the Audit Code for NHS foundation trusts

Who is intended to benefit from the proposed policy?

The policy brings clarity to the process for procuring additional services. This clarity will benefit Trust officers, the Audit and Assurance Committee, and the Council of Governors.

Is there any potential for impact on non-beneficiaries?

No

Is there up to date data on the groups/individuals on whom there may be impact?

N/A

Have there been changes to the equalities profile of the above groups/individuals since the collection of the data?

No

Does the policy influence in a positive way relations between different groups of people?

N/A

Does it promote equality of opportunity?

Although the Trust has developed a policy for additional services with the external auditor, the Trust will still need to comply with Standing Financial Instructions which does require work to be tendered unless there are special circumstances.

Does the function either eliminate or contribute to the elimination of unlawful; discrimination across all equalities themes?

The policy is neutral

Are there any concerns expressed about the policy having the potential for adverse impact on any group/s of people?

No


Top



Assessment Outcomes

No further action √ Revisions required / not required (please indicate)

Level 1 assessment – signing off date: 10th November 2014

Assessment carried out by: Chris Sands, Director of Finance, Performance and Information


Top



Quality Business Committee

Council of Governors 11 December 2014

Barry Steans

Non-Executive Director

90�QBC�Presentation.pdf

Top



Q Committees

• We have 3 Board sub-committees, known as the ‘Q committees’, which reflect the DCHS Way – Quality Service, Quality People and Quality Business

• Directly accountable to the Board


Top




Top



Q Committees

• Have delegated Board authority to approve relevant policies and to make decisions in their areas

• Ensure high standards of governance are maintained

• Monitor relevant controls, review performance and agree actions, to provide assurance to the Board

• Operate in line with DCHS’s vision and values


Top



Quality Business Committee (QBC) QBC meets not less than bi-monthly, with additional meetings held as required. Membership includes: • 2 Non-Executive Directors (one of whom is the Chair) • Director of Finance, Performance and Information and Deputy Director of Finance

and Performance • Director of Operations • Director of Strategy • Chief Nurse/Director of Quality or Medical Director • Director of People and Operational Effectiveness • Trust Secretary Chief Executive attends the Q committees on a rotational basis The DCHS Chair also attends on an occasional basis


Top



QBC has a number of working groups which report into each meeting:

• Emergency, Preparedness, Response and Resilience Group

(quarterly) • Information, Management and Technology (IM&T) Group • Capital and Estates Programme Group • Strategic Programme Group

• Tender Oversight Group


Top



What does QBC do? • It shapes, influences and takes major

decisions regarding the Quality Business element of the DCHS Way

• It makes sure that DCHS is effective, efficient

and economically sound and provides good value to our communities and commissioners


Top



What does QBC do? It shapes, influences and assures regarding delivery of the: • Integrated Business Plan (IBP) • Performance Framework • Financial Strategy and Investment


Top



What does QBC do? It shapes, influences and assures regarding delivery of the: • Estates Strategy

• IM&T Strategy

• Emergency planning and business continuity


Top



What does QBC do?

It shapes, influences and provides assurance on delivery of: • Business Development (progress of tenders,

SWOT (Strengths, Weaknesses, Opportunities and Threats) analysis and horizon scanning)

• Relationships with commissioners and other providers


Top



In recent months QBC have discussed: • Monthly reporting of performance (financial and CIPs (Cost

Improvement Plans) in particular)

• LTFM (Long Term Financial Management) and, in particular, mitigation plans

• Agreement of income assumptions with commissioners and validation by Finnamores

• IM&T strategy implementation, in particular progress regarding mobile working

• Commissioning strategy and business development, including our performance in recent tenders


Top



Quality Business Committee Strategy, financial and operational performance and business development


Top




Title of Paper: Trust Secretary Report

Paper for: Information and Decision


Author: Kirsteen Farrar, Trust Secretary David Boddy, Corporate Governance Manager



Appendices: Appendix 1 Council of Governors Meeting Self-Assessment

Purpose of Paper

The purpose of this paper is to provide information to the Governors about matters affecting the Council over the last quarter.

Summary

Governor News We are pleased to announce that in November 2014 Roger Green joined the Council as the new Public Governor for Derbyshire Dales. Roger replaced Margaret Slater who resigned in November 2014. In October, Hazel Lowe resigned as Staff Governor for the Healthcare Assistant constituency. We thank Margaret and Hazel for their involvement with the Council of Governors and wish them well in the future. Election Update We have started the election process in order to fill the vacancy left in the Healthcare Assistant constituency following Hazel’s resignation. This is because when Hazel was elected, it was on an uncontested basis. Unlike the Derbyshire Dales vacancy (see above) we have therefore been unable to offer the seat to the next candidate from the 2013 elections. It is planned for the election to commence in January 2015 and the result will be announced on 9 April 2015. The Electoral Reform Services will act as our election agents in managing the process. Lead Governor We are pleased to announce that Brenda Greaves and Ray Asher have been elected as Lead Governor and Deputy Lead Governor respectively. Brenda and Ray’s nominations were both uncontested.

91�Trust�Secretary�Report.pdf

Top



Brenda and Ray are elected to serve as Lead Governor and Deputy Lead Governor from 11 December 2014 until the annual meeting in 2015. Council of Governors Meeting Self-Assessment The June Council of Governors meeting agreed to evaluate the effectiveness of Council of Governors meetings. This was to give us the opportunity to consider how we can make improvements to the meetings and help Governors to contribute further. We are grateful to the large majority of Governors who completed the assessment and also provided very useful comments. The responses to the survey were received in October and have been collated. The results, including comments, are attached in Appendix 1. We would like to ask for a small group of Governors to volunteer to help identify, from the results and comments, what improvements might be made to improve our Council of Governors meetings. An action plan will then be put in place. A number of Governors fed back that the Council of Governors meetings often have large agendas which lead to very long meetings. One of the reasons for this is that the Council only meet on a quarterly basis. To alleviate some of the workload of the four meetings the Council are asked to consider increasing the number of meetings each year to six. The benefits would be that the agendas for each meeting would be smaller and there would be more time to discuss the papers that are presented.

Recommendations

Governors are asked to:

Review the Self-Assessment and, those interested in joining a group to recommend improvements, to make themselves known to David Boddy

Decide whether to increase the number of Council of Governors meetings from four to six


Top



Appendix 1 Shadow Council of Governors Meeting - Self-Assessment Questionnaire No. Statement Strongly

Agree Agree Disagree Strongly

disagree Don’t

know

Meetings 1 The Shadow Council of Governors meet at appropriate and

regular intervals 5 20 2

Comments:

Would prefer all daytime meetings.

Don’t like late evening meetings in winter months

I feel this is working well

I believe that we will need to meet more frequently once we become a Foundation Trust. At present we try to squeeze too much into each CoG meeting. I would like to see each meeting have only one main presentation to allow much more time to focus on questioning the authors of the regular reports we receive.

2 I receive written agendas, which contain relevant items, with supporting documentation

11 16

Comments:

Wonder if powerpoint presentations could be thumbnail ie 6-8 a page to reduce paperwork

Would like more re Non-Exec's

I have suggested that as this is an expensive exercise (sending what has recently been a large document by post), that some may wish to download it on to their own PC, or alternatively may wish to collect it from their local hospital, office, etc.. Postage on my copy was £2.50 - multiplied by the number of governors makes it very costly.

A large amount of information is provided

3 All papers for the Council meetings are provided in a timely manner

9 16 2

Comments:

This is much better now

If possible would like earlier but understand this may be difficult.

Papers are now received earlier as requested

Improvement at last meeting. Earlier papers were a little late to be sent out prior to meetings.


Top



No. Statement Strongly Agree

Agree Disagree Strongly disagree

Don’t know

4 I receive sufficient information to understand the required standards of the Trust’s performance

5 21 1

Comments:

Think this needs looking at

Sometimes a little too much info provided in paperwork

5 The Council meetings are sufficiently involved in the Trust’s business and strategic plans

5 19 2 1

Comments:

Usually but would like more info on constituency plans at an early stage on occasion

Generally agree but I have some reservations which may be answered given a little more time.

Such a lengthy agenda that it is difficult to discuss detail for sufficient understanding and debate

Informed but I do not feel really involved.

6 Council meetings focus on relevant issues 4 22 1

Comments:

I think so but don’t always know what might be relevant

I feel that we are not quite there with this but improving with every meeting

7 There is sufficient time at meetings for the presentation and full discussion of issues

21 5 1

Comments:

The meetings do not need to be any longer.

I believe that we will need to meet more frequently once we become a Foundation Trust. At present we try to squeeze too much into each CoG meeting. I would like to see each meeting have only one main presentation to allow much more time to focus on questioning the authors of the regular reports we receive.


Maybe could do with a full day

This has improved with the implementation of a pre meet and a mechanism for feeding into the chairman

The agenda is always very full


Top





Don’t know

8 I consider the Council meetings to be effective and that the meeting outcomes are valued and followed up by the Trust

5 16 2 4

Comments:

I feel that this is improving at each meeting and will continue to do so


I think most decisions have already been made before it is discussed

I do feel that meetings are effective - due to the amount to get through. I am not sure the follow-up is reported as well as it could be

9 The meetings have open and constructive discussions 6 20 1

Comments:

Answer relevant to Q9 and Q10: Again, generally agree but feel that those of us who are public governors are occasionally expected to know more than we do. I understand how easy this could happen but I am aware of some governors who are reluctant to speak for varying associated reasons. Recently I have felt I was in a difficult situation and will think twice before saying something that, due to my lack of knowledge of a procedure, policy, etc. I should keep quiet.

10 I get opportunity to speak if desired and am made to feel comfortable for doing so

8 19

Comments:

11 I have received sufficient training to fulfil my role at meetings 9 12 3 2 (+ 1 N/A)

Comments:

Firstly, familiarisation of processes and roles is such a massive task that on-going training is vital. I feel we should within our separate roles (public/staff) identify and request more information as time progresses. It is easy for ex-NHS public governors to fulfil their role but non-NHS public governors who may have valuable contributions to make may, as I have recently experienced, feel discouraged.

Having been very recently appointed to the Council, I do feel as though I have been thrown in at the deep end, with very little knowledge of what to expect.

Already trained - so have not required much from DCHS.


Top





Don’t know

12 The Council meetings are well chaired 14 11 2

Comments:

Answer relevant to Q12 and Q16 I do feel that the Chair(man) should not be 'ex-NHS' and be someone who will be willing to stand his/her ground and who should not appear to be in the 'pockets' of the Board.

13 At Council meetings Governors have sufficient opportunity for contact with the Non-Executive Directors

2 18 4 3

Comments:

Don’t fully know all their functions yet

Much better recently now that they are doing presentations

14 At Council meetings Governors have sufficient opportunity for contact with the Executive Directors

5 16 4 2

Comments:

There is usually so much to discuss, it might be difficult for 30 Public Governors to do this. I think if it was important to do so it probably would be possible

15 The level of participation in Council meetings by the Trust management is appropriate

4 22 1

Comments:

I think so but would have to ask them!

Too much time is spent giving reports - I would like to have more time for questions and assume that the reports have been read by the governors!

16 I understand the role of the Lead Governor 7 19 1

Comments:

17 Sufficient time is given for Governors to discuss matters at the pre-meeting

2 17 6 2


Top





Don’t know

Comments:

I feel that there should be time for public and staff governors to meet separately before the joint meeting. Further I suggest that electoral area meetings of staff/.public governors should be arranged.

This currently is a little hit and miss

I would expect our Chairman to be present at pre-meets. I envisage this to be a forum he could use to help keep us informed, as well as a forum for governors to contribute to.

The pre-meet needs to be tightly controlled to get the most benefit from it.

One hour only is not long enough

Usually only one matter is discussed, and there are few opportunities to discuss items from the agenda.

This needs strengthening - an agenda circulated for matters to discuss at the pre-meet would aid this

18 The venues provided are adequate for the Council meetings 2 16 8 1

Comments:

Some of the venues are more difficult to reach than others.

Mostly not always

Perhaps other venues could be identified??

Although venues are good facilities such as microphones etc and set up of rooms is not always as good

The Belper Town FC venue is not appropriate - acoustics are poor and vehicular access is not good.

Football club in Belper is a poor venue.

Of the venues used to date I prefer the Postmill. A sound system would help those of us who struggle to hear all the contributors.

The acoustics in Belper Town FC are poor and difficult to hear

The Ashbourne venue was appalling for disturbance

The trust has listened to feedback from council members

They are sometimes cramped and with poor acoustics

Due to the acoustics in some venues, cannot always hear what speakers are saying. Perhaps more use of microphones.

Roles and Responsibilities 19 I am clear about my role and responsibilities as a Governor 7 18 2


Top





Don’t know

Comments:

I hope I represent the members/public views to DCHS and vice versa

I thought I was but recently have had cause to re-consider. There should be an opportunity to discuss this further

I was impressed how DCHS have tried to involve the public but not sure if there is enough information and education to engage 'hearts and minds' at an early stage about necessary changes. I think people should have the opportunity to have their say, even if I personally don’t agree with it. I think it is a steep learning curve on both sides

20 I am aware of the differences between an NHS Trust and an NHS Foundation Trust

8 16 2 1

Comments:

21 I am clear about the differences between the roles of the Governors and the Board of Directors

8 16 2 1

Comments:

Requires some more discussions and practical exercises.

22 I fully understand the role of the commissioners 6 8 11 1 1

Comments:

Realising that this is a national consideration, as a public governor representing the public who do not understand the various departments/roles of those in the NHS (and do not really care in the case of the vast majority) more must be done to clarify matters. In addition, there appears to be a lack of understanding in the top echelons of the NHS of the strength of feeling amongst the public as to their 'own' local hospital.

I would like to have a greater understanding of their role, responsibility, funding and accountability

I think I understand their roles however their qualifications for the role and how they make decisions are a mystery to me

Staff Governor Feedback 23 I feel able to fulfil my role fully even where there may be

conflicting interests 2 5 2

Comments:

24 I feel I am able to give enough time to fulfil my role as a governor 2 3 3 1


Top





Don’t know

Comments:

Unable to commit the time I would like to as I work full time

If I had more time I would like to be involved in one of the working groups, but this is not possible given my clinical commitments.

25 I feel supported by my manager to fulfil my role as a governor 3 6

Comments:

26 Please provide any other relevant comments that you wish to make in the space below, including the number of the statement your comment refers to.

I feel the role of the governors will develop and strengthen as Foundation Trust Status is achieved

I have been made acutely aware of NHS staff, having understandable concerns, when referred to staff governors, being totally dismissive. They preferred either to dismiss any offers of assistance as 'waste of time' or asked for their concerns to be raised in other guises. One example was staff who had expressed grievances (on the face of it, understandably) being referred to their staff governor who happened to be a senior staff member and in their eyes, most unlikely to represent their interests. Even worse were their fears of reprisals if they chose that route. The staff asked me to express their concerns in governors' meetings but in a generalised manner where individuals could not be identified. As an 'outsider' with experience of representations within large organisations about sensitive matters, I did feel the staff had grounds for their concerns. I did spend some time with them but now feel they are wary of speaking to me too! I am willing to discuss issues with officers if genuine consideration and attention is given to concerns. As I am not the person to keep quiet if I feel it inappropriate and, vitally, was actively encouraged to apply for the role, by a community anxious about their 'local' hospital and NHS generally, I feel I must express public views and perceptions even if it does not fit in with policies and attitudes of officials.

I am happy with way the CoG has developed and anticipate that it will develop still further over the coming months.

As an extra statement I feel the number of governors make for an unwieldy group and not cohesive enough to ascertain whether we agree or disagree with what is happening. A longer meeting is unhelpful as we already attend for 3 hours plus a pre-meet. The pre-meet needs to be tightly controlled to get the most benefit from it.

I like being a governor but am unable to commit to the role as I would like due to other pressures. I now feel under more pressure since our performance is documented regarding how much we have achieved in between meetings.

Although I have ticked "Disagree" columns, I am not unhappy generally with DCHS, so maybe an extra column between "Agree" and "Disagree" ie "Slightly Disagree"


Top




Title of Paper: Quality and Performance Report



Author: Carolyn White, Chief Nurse / Director of Quality and Chris Sands, Director of Finance, Performance and Information



Appendices:

Appendix 1, Quality Report Appendix 2, Regulatory Framework Appendix 3, Referral To Treatment Waiting Times Appendix 4, Finance Report Appendix 5, Big 9

Purpose of Paper

The purpose of this paper is to provide the Council of Governors with an overview of the Trust’s performance against our quality objectives, and regulatory performance targets.

Summary

1. Quality Report

The Trust has set itself a number of quality objectives to support the delivery of its Quality Strategy. The objectives are:

Keep patients safe

Put patients (and family) at the centre of care

Get the basics right The quality section of this report provides Governors with an overview of the Trust’s performance against key performance indicators in each of these three areas for the month.

2. Regulatory Performance Report The second part of the report provides an update on the Trust’s performance against the regulatory performance indicators included within the Provider License by the regulator of foundation trusts, Monitor, for the first seven months of 2014/15. The Trust is monitoring performance against these indicators in shadow format in preparation for achieving foundation trust status. The position for month 7 shows that the Trust is reporting one area of risk resulting in a

94�Quality�and�Performance�Rep

Top



red rating. This relates to the percentage of OPMH Delayed Transfer of Care at 10.6% against a target of 7.5%. There is continued focus on discharge planning and escalation of issues.

3. Referral to Treatment Waiting Times RTT Waiting Times information is now enclosed at Appendix 3, following this request at the last Council of Governors meeting.

4. Finance Report The Trust is forecasting at month 7 that it will achieve all its statutory financial duties. The Trust is currently behind plan by £0.28 million, driven by budgetary pressures within the Integrated Care Based Services division, and some shortfall on delivery of cost improvements. However, it is forecast that this shortfall will be addressed through additional mitigations agreed with the divisions, and through the use of reserves.

5. Big 9 The Quality and Performance report provides an update of Trust progress against the “Big 9” key performance indicators which were agreed as part of the Annual Planning process.

Recommendations

The Council of Governors is asked to receive this report for information. The Council of Governors are asked to nominate a representative for the Quality Always steering group.


Top



APPENDIX 1 - QUALITY REPORT

1. Safe Care The NHS Safety Thermometer is a national tool designed to be used locally for measuring, monitoring and analysing patient harms and ‘harm free’ care. Prevalence data is collected once monthly on a set day to provide the data for the national system. The tool measure 4 aspects of patient safety Falls, Venous Thromboembolism (VTE). Catheter Acquired Urinary Tract Infections (CAUTI) and Pressure Ulceration. Patient safety is a top priority for DCHS and the results from this toolkit continue to be used to improve practice across the organisation. The Harm Free Care graph below illustrates DCHS’s position compared with the National District Nursing HFC benchmark and demonstrates that for DCHS Harm Free Care for quarter 2 was 90.96% July, 93.25% Aug and 91.59% in Sept an average for the quarter of 91.93% which falls below the target set by DCHS. This performance is driven by the number of pressure ulcers being managed by the trust.

Prevalence rates Q2

Overall Harm free

score (Target 93%)

Falls Pressure ulcers(total

Pressure ulcers (New)

Catheter related

infections

Venous thromboembolism

July 90.96% 0.67% 8.25% 1.21% 0.12% 0.18%

August 93.25% 0.4% 5.96% 0.86% 0.46% 0.13%

September 91.59% 0.87% 7.42% 1.6% 0.37% 0.12%

Average 91.93% 0.65% 7.21% 1.22% 0.32% 0.14%

Work continues to reduce pressure ulcers with initiatives including:

Equipment review

Patient compliance linked to patient understanding

Practice reviews and training

Review of root cause analysis

Joint work with Chesterfield Royal Hospital

Health community wide workshop with NHS England Nurse Lead to look at best practice

Focus on accountability and personal performance

89

90

91

92

93

94

95

96

% o

f p

atie

nts

re

ceiv

ing

Har

m F

ree

ca

re

Harm Free Care DCHS Harm FreeCare Score (HFC)

DCHS Target (HFC)

DCHS DistrictNursing (HFC)

National DistrictNursing (HFC)


Top



Falls initiatives include:

Introduction of coloured wrist bands based upon risk assessment of patients

Introduction of new post to focus on falls management with quality team

Review of root cause analysis

Development of falls strategy 1.1 Medicines Management The trust has continued its previous good performance with regard to medicines incidents resulting in serious harm to patients with no incidents being reported during the second quarter. The trajectory was based on last years outturn of 14 incidents applying a 50% reduction target resulting in a ceiling of no more than 7 incidents. Serious Incidents as a result of poor medicines management

Q1 Q2 Q3 Q4 Total Reduction trajectory

2 2 2 1 7

Actual incidence 0 0

2. Compliance

During quarter 2 the trust has continued to focus on implementing the actions agreed as a result of the CQC visit during March 2014. An internal triangulation exercise was conducted during October which demonstrated that good progress had been made a cross the wide range of actions agreed, however there were still some areas of concern which may have resulted in non compliance if the CQC had inspected. These included issues related to equipment and medicines management. Actions to address these have been implemented and arrangements to discuss concerns with relevant general managers made. OPMH services have seen marked improvements in record leeping and underpinning policies and whilst there is still more work to do to embed these changes it was pleasing to note the progress. The CQC undertook and unannounced visit during November as anticipated, the initial feedback from this visit is the subject of a separate report on the agenda.

3. Staffing for Quality (Safer Staffing) In line with the national requirements to report on nurse staffing levels the trust has continued to report monthly on ward based staffing levels and is seeing an increased compliance with the required thresholds as more Registered Nurses are recruited to our clinical teams. A detailed piece of work has been undertaken during Q2 focusing on community nurse staffing assessing the workload and dependence of patients for each of our community nursing teams. Analysis of the data has demonstrated that in many areas there are inadequate numbers of staff to deal with the increasing workload. The data also illustrates the differences between nursing teams in terms of practice, patient workload and training. Early discussion with our Commissioners have been positive with regard to funding additional posts to support the increasing workload. Work is underway within the planned care services to assess workload within our clinics and operating theatres. This will be reported during Q3.


Top



4. Quality Always Quality Always is an overarching process for systematic review of clinical standards underpinned by a clinical leadership development model. The initiative is based on the work from Salford Royal Hospitals NHS trust and their work on patient safety. Currently the Quality Always team are conducting baseline assessments of our inpatient wards and developing tools to do the same across our planned care and community services. In tandem the organisational development team are working with us to deliver a development centre for our clinical leaders which will help to identify their strengths and development needs with regard to clinical leadership. The first cohort of staff will undertake their development centre in January 2015.

4.1 Quality and Safety Visits The management of the Quality Visits transferred from The Patient Safety Team to the team managed by the Head of Quality Governance on October 1st 2014. The format for the visits changed from 1st June 2014 and the meeting to review both format and processes was held in mid-October 2014 chaired by the Director of Quality. In preparation for the review those who have taken part were asked to provide feedback, a summary of the responses are in the table below:

You said Improvements and comments

The wards and teams don’t know we are visiting

All ward managers / team leaders, Matron’s ICMs and General Managers are informed of the visits and asked to inform their teams. Some have chosen not to in the past but all have been asked to ensure that they do inform as these are announced and planned visits.

Please can Hospital visits be planned for the afternoon and Community visits in the morning

This is now scheduled into the forward plan. Hospitals between 1.30 – 4pm and Community between 09.30 and 12.00

Consider adding question ‘when was the last time you or a member of your team was injured at work?’

This will be added to the staff questions

Simplify the language used in the patient questionnaire

A prompt card is being developed in conjunction with the Patient experience team to support discussion with patients and carers

Pre-format the information provided to visitors so that it prints on a page

The way information is presented is being reviewed ,however this will be superceded by the quality dashboard and therefore a limited amount of time will be sent on this exercise.

Answer boxes need to be enlarged to allow easy completion

The forms are designed to be completed on a computer. Where they need to be printed off the visitor should speak to the organising team who will facilitate this

Reduce the number of staff questions The questions are designed to guide the conversation they do not need to be asked verbatim.

Governors would like feedback on areas of concern and actions taken

The local manager on the visit is responsible for ensuring any actions are taken and concerns resolved. Arrangements are being made to provide summary reports on key findings going forward

We have a significant amount of rich information from a variety of sources can this not be pulled into a summary for each visit

The plan is that the visitors have access to the Quality Dashboard and will use this to provide a live feed of data for the visit. Unfortunately there is not the capacity within the organising team to provide a detailed summary report for each visit.


Top



It is proposed that the visits continue to be planned on a weekly basis and aim to cover areas of higher risk, as advised by the intelligence monitoring group and analysis of the Quality Dashboard, in the first instance, with a rolling rota of all areas continuing throughout the year when no areas of higher risk are identified. It will not be possible to visit every team / service within a 12 months period as this would require 3 to 4 visits every week. However if the current programme of Hospital visits continues and Board members each undertake 3 Community visits per year each Team / Service will be visited within a rolling 3 years. The visiting team will continue to be made up of a Board Director, senior manager for the area under review and one or two governors. The availability of individuals does impact significantly on the ability to arrange these visits and has contributed to some of the confusion related to cancellations. The rationale for the team selected is to ensure that senior managers responsible for the area are involved with visits and witness first hand challenges staff are facing in their day to day work and are then in the best position to support change post visit. Visits will continue to be announced to clinical staff so that they can arrange to have time to meet with the clinical team.


Top



APPENDIX 2 – REGULATORY PERFORMANCE

Monitor Risk Assurance

Framework Indicators

Measure Measure-Sub GroupRAF Appendix

A Area

RAF Target

2013/14Q1 14/15 Q2 14/15 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Narrative

RTT Waits - admitted patients 90th percentile

(weeks)See note 1 1 90% 93.3% 94.7% 94.0% 95.0% 93.3% 93.1% 94.7% 94.7% 95.2%

Quarterly scores are quarter

ending scores

RTT Waits - non admitted patients 95th

percentile (weeks)2 95% 99.0% 98.5% 99.0% 99.0% 99.2% 98.6% 100.0% 98.5% 97.5%


ending scores

RTT Waits - incomplete pathway 92nd

percentile (weeks)3 92% 100.0% 98.0% 98.0% 99.0% 100.0% 98.9% 99.4% 98.0% 98.0%


ending scores

A&E 4 Hour Wait for A&E Attendances (%) 4 >95% 100.0% 100.0% 99.5% 99.8% 100.0% 100.0% 99.9% 100.0% 100.0%Quarterly scores are quarter

ending scores

Healthcare Care Associated Infections -

Clostridium difficile (no.)14 12 (year) 4 7 1 1 2 2 0 1 0

Quarterly figures are just for the

quarter

Delayed Transfer of Care for OPMH - Monitor

compliance framework calculation (%)16 <7.5% 6.6% 4.4% 7.1% 5.1% 6.6% 4.3% 4.9% 4.4% 10.6% Monitor quarterly calculation.

Mental health data completeness: identifiers 17 97% 100% 100% 100% 100% 100% 100% 100% 100% 100%

Certification against compliance with

requirements regarding access to healthcare

for people with a learning disability

19 Yes Yes Yes Yes Yes Yes Yes Yes Yes YesTo be reported to EDS &

quarterly to QSC

Data completeness: community services ,

comprising:

referral to treatment

information20 50% 82.5% 82.5% 82.5% 82.5% 82.5% 82.5% 82.5% 82.5% 83.1%


ending scores


comprising:referral information 20 50% 74.7% 74.7% 74.7% 74.7% 74.7% 74.7% 74.7% 74.7% 75.4%


ending scores


comprising:

treatment activity

information20 50% 74.7% 74.7% 74.7% 74.7% 74.7% 74.7% 74.7% 74.7% 75.4%


ending scores

Governance Score Rating 1 0 0 0 1 1 2 0 1


Top



APPENDIX 3 – REFERRAL TO TREATMENT WAITING TIMES

AHP-Led Referral to Treatment Schedule in Weeks (October 14) - Clocks ended in October

Service Line 0-6 7 - 12 13 - 17 18+

Total

Waiters

Max

Waiter

>6 week

waiter

total

%

Waiting

over 6w

>13

week

waiter

total

%

Waiting

over 13w

Planned Care

AV&E MSK, Physio, OT, Podiatry 2473 386 24 25 2908 20 435 15.0% 49 1.7%

CHE MSK, Physio, OT, Podiatry 1758 155 8 11 1932 52+ 174 9.0% 19 1.0%

HPD MSK, Physio, OT, Podiatry 1317 96 0 1 1414 19 97 6.9% 1 0.1%

Speech and Language Therapy 502 96 2 5 605 52+ 103 17.0% 7 1.2%

ICBS

AMBER VALLEY 337 71 15 18 441 47 104 23.6% 33 7.5%

EREWASH 389 51 18 21 479 52+ 90 18.8% 39 8.1%

S DERBYS & S DALES 218 23 0 0 241 12 23 9.5% 0 0.0%

CHESTERFIELD 235 97 8 11 351 33 116 33.0% 19 5.4%

Traumatic Brain Injury Service 12 1 0 0 13 11 1 7.7% 0 0.0%

Respiratory Services 68 42 29 65 204 52+ 136 66.7% 94 46.1%

All Services 7309 1018 104 157 8588 52+ 1279 14.9% 261 3.0%

Consultant-Led Referral to Treatment Schedule in Weeks (October 14) - Clocks ended in October - Admitted Patient Care

Specialty 0-6 7 - 12 13 - 17 18+

Total

Waiters

Max

Waiter

>6 week

waiter

total

%

Waiting

over 6w

>18

week

waiter

total

%

Waiting

over 18w

Planned Care

General Surgery 4 17 25 2 48 23 44 92% 2 4%

Urology 24 32 5 0 61 16 37 61% 0 0%

Trauma & Orthopaedics 15 21 15 6 57 24 42 74% 6 11%

Ear, Nose & Throat (ENT) 2 2 2 0 6 16 4 67% 0 0%

Ophthalmology 18 48 16 2 84 20 66 79% 2 2%

Oral Surgery 0 0 0 0 0 0 0 0% 0 0%

Neurosurgery 0 0 0 0 0 0 0 0% 0 0%

Plastic Surgery 0 0 0 0 0 0 0 0% 0 0%

Cardiothoracic Surgery 0 0 0 0 0 0 0 0% 0 0%

General Medicine 0 0 0 0 0 0 0 0% 0 0%

Gastroenterology 0 1 4 0 5 15 5 100% 0 0%

Cardiology 0 0 0 0 0 0 0 0% 0 0%

Dermatology 7 13 15 3 38 25 31 82% 3 8%

Thoracic Medicine 0 0 0 0 0 0 0 0% 0 0%

Neurology 0 0 0 0 0 0 0 0% 0 0%

Rheumatology 0 0 0 0 0 0 0 0% 0 0%

Geriatric Medicine 0 0 0 0 0 0 0 0% 0 0%

Gynaecology 1 2 1 0 4 14 3 75% 0 0%

Other

Dental 32 34 43 7 116 84 72% 7 6%

All Services 103 170 126 20 419 38 316 75.4% 20 4.8%

Consultant-Led Referral to Treatment Schedule in Weeks (October 14) - Clocks ended in October - Non-Admitted Patient Care

Specialty 0-6 7 - 12 13 - 17 18+

Total

Waiters

Max

Waiter

>6 week

waiter

total

%

Waiting

over 6w

>18

week

waiter

total

%

Waiting

over 18w

Planned Care

General Surgery 5 7 1 0 13 16 8 62% 0 0%

Urology 9 1 2 1 13 20 4 31% 1 8%

Trauma & Orthopaedics 39 17 19 4 79 19 40 51% 4 5%

Ear, Nose & Throat (ENT) 33 20 13 2 68 19 35 51% 2 3%

Ophthalmology 60 11 17 1 89 18 29 33% 1 1%

Oral Surgery 0 0 0 0 0 0 0 0% 0 0%

Neurosurgery 0 0 0 0 0 0 0 0% 0 0%

Plastic Surgery 0 0 0 0 0 0 0 0% 0 0%

Cardiothoracic Surgery 0 0 0 0 0 0 0 0% 0 0%

General Medicine 0 0 0 0 0 0 0 0% 0 0%

Gastroenterology 1 0 0 0 1 1 0 0% 0 0%

Cardiology 1 1 1 0 3 17 2 67% 0 0%

Dermatology 4 10 6 0 20 17 16 80% 0 0%

Thoracic Medicine 0 0 0 0 0 0 0 0% 0 0%

Neurology 0 0 0 0 0 0 0 0% 0 0%

Rheumatology 0 6 0 0 6 12 6 100% 0 0%

Geriatric Medicine 5 0 0 0 5 5 0 0% 0 0%

Gynaecology 11 3 0 0 14 9 3 21% 0 0%

Other

Dental 2 5 1 0 8 14 6 75% 0 0%

All Services 170 81 60 8 319 149 46.7% 8 2.5%


Top



APPENDIX 4 – FINANCE REPORT

1. Financial Duties The Trust is required to achieve a number of statutory financial duties as an NHS Trust. Under the new Provider License, foundation trusts report against a Continuity of Services (CoS) risk rating. The Trust is reporting against this measure on a shadow basis:

1.1 NHS Trust Duties NHS trusts have a number of financial duties. Trusts must make a surplus of income over expenditure, provide services with a cash limit, known as an External Financing Limit, spend resources on major refurbishment schemes within a Capital Resource Limit, and pay our suppliers within 30 days of receipt of invoices. The month 7 position is summarised below: Duty Year to Date Forecast Performance

Break Even Duty Surplus £1.130m Surplus £2.0m √

Maintain within External Financing Limit

£3.711m £2.192m √

Maintain within Capital Resource Limit

£1.710m £4.925m √

Comply with Better Payment Practice Code

Compliance with all 4 measures

Forecast to meet all 4 measures

√

The Trust is forecasting that it will meet all of these duties for 2014/15.

1.2 Foundation Trust The new Provider license that was effective from October 2013 introduced a new Continuity of Services metric for assessing financial risk in foundation trusts. This is based upon the amount of cash an organisation has to pay its staff and suppliers, and the amount of revenue available to service debts.

Measure Indicator Weight Year to Date

Forecast

Liquidity

Number of days operating expenditure covered by current working capital balances

50% 4 4

Capital Servicing Capacity

Revenue cover available to service debt repayments

50% 4 4

The calculations give a score from 1 to 4, with 1 being most risky and 4 less risky. The Trust is currently achieving a Continuity of Service score of 4, and forecasting a score of 4 at the year end.


Top



2. Month 7 Financial Position The Trust is reporting a surplus position of £1.13m at month 7, which represents a £0.28m adverse variance against the planned surplus of £1.41m. A year end forecast surplus of £2m is reported which will exceed the planned surplus of £1.6m by £0.4m. This forecast position assumes that the Trust will recover the position through a combination of additional mitigations, and the use of the general mitigation reserve. The cash position at the end of month 7 was ahead of plan with a balance of £15.4 million, against a plan of £11.4 million.

3. Forecast Outturn Financial Position A year end forecast surplus of £2m is reported which will exceed the planned surplus of £1.6m by £0.4m. This forecast position assumes that the Trust will recover the month 7 adverse variance through a combination of additional mitigations, and the use of the general mitigation reserve. The general mitigation reserve remains uncommitted and unallocated at month 7. The Trust is forecasting a year end cash position of £13.9 million will is consistent with the financial plan.


Top



APPENDIX 5 – “BIG 9”

Objective Priorities 2014/15What are we aiming

for this year

Plan to end

of October

- Keeping patients safe whilst in

our care

- Putting patients at the centre

of care delivery (patient

experience)

- Enhance the healing

environment and improve

outcomes for patients with

dementia

- 95% of patients with Diabetes

to have appropriate care plans86.0% 94.6% (GREEN) 95.0% (GREEN)

- To get the basics right

(clinical effectiveness)

- 10 patient engagement groups

active in the year, starting June

2014

5 4 (RED) 10 (GREEN)


for this year

Plan to end

of October

- Engaged and supported staff - Increase staff engagement 76.4 76.0 (AMBER) 76.8 (GREEN)

- Everyone has a quality

appraisal- 100% appraisal completion 100% 81.0% (RED) 95.0% (AMBER)

- Everyone maintains a high

level of attendance

- Minimum 97% staff

attendance97% 96.0% (AMBER) 95.5% (AMBER)


for this year

Plan to end

of October

- To deliver our £7.5m cost

improvement programme

- £7.5m cost improvement

programme£3.590m £3.127m (RED) £6.663m (AMBER)

- To end the year with and

income and expenditure

surplus of £1.60m

- Income and expenditure

surplus £1.60m-£1.535m -£1.059m (RED) -£1.940m (GREEN)

- To reduce our carbon usage- 200,000 miles saved on

business travel50,000 -6,800 (RED) 0 (RED)

Forecast

Quality

Business

Achieved to

end of

To ensure effective, efficient

and economical organisation

that promotes productive

working and which offers good

value to it's community and

commissioners

Quality

People

Achieved to

end of

To build a high performance

work environment that engages,

involves, and supports staff to

reach their full potential

Big 9 - October 2014

7 (100%)

Forecast

(GREEN)

Forecast

Achieved to

end of

Quality

ServiceTo deliver high quality and

sustainable services that echo

the values and aspirations of

the community we serve

- Reduce the number of serious

medication errors to 7 in the

year (100%)

6 (86%) 1 (14%) (GREEN)


Top




Title of Paper: Chief Executive’s report


Presenter: Tracy Allen, Chief Executive

Author: Tracy Allen, Chief Executive



Appendices: Appendix 1: 21st Century Joined up Care Work Programme Appendix 2: ‘Big 9’ Performance for Month 7

Purpose of Paper

The Chief Executive's report provides the Council of Governors with information about key national and local strategic issues affecting Derbyshire Community Health Services NHS Trust.

Summary

The paper includes:

A brief summary of the recently published NHS Five Year Forward View

Information on national NHS priorities for the next 6 months

Progress with implementing our strategy including: o An update on system integration plans o Recent tender successes o A decision on the provision of health services in Heanor o Winter resilience planning

Developments in our approach to support raising concerns

Performance against the ‘Big 9’ organisational priorities for month 7

Recommendations

The Council is recommended to note the paper.

96�Chief�Execs�Report.pdf

Top



Chief Executive's Report December 2014 1. Purpose of the paper This paper is to provide the Council of Governors with information about key national and local strategic issues affecting the Trust. 2. National NHS developments

2.1 The NHS Five Year Forward View

The NHS Five Year Forward View was published on 23 October 2014 and sets out a vision for the future of the NHS. It has been developed by the partner organisations that deliver and oversee health and care services including NHS England (NHSE), Public Health England, Monitor, Health Education England, the Care Quality Commission (CQC) and the NHS Trust Development Authority (TDA).

Key elements of the plan include1:

New models that build on our excellent hospital, community, mental health and ambulance services. The View avoids a ‘national blueprint’ approach, instead committing to work with local areas to work out what is right for them, and to be more flexible about how national rules are applied. These service delivery models – in advance of the Dalton Review – suggest an appetite for change and improvement (though there is no mention of how the FT pipeline will be resolved). However, the contribution of significant parts of the service needed to be clearer:

o The document says little about the future and role of mental health, community and ambulance providers in leading change.

o The independent sector is absent from most of the vision, and private providers are not mentioned once.

It sets out clearly that the £30bn funding gap cannot be closed without more funding, alongside further action on both demand and efficiency. There is a commitment to design a model to ‘pump prime’ new models of care and a commitment not to expand the Better Care Fund (BCF) before evaluating the impact of the shift of funding in 15/16.

It stresses we must avoid a nationally imposed reorganisation. There is also a helpful commitment to improve the alignment of NHSE, Monitor and TDA assurance and intervention processes – though this omits alignment with CQC.

There is also a strong emphasis on other vitally important areas including: o Parity of esteem for mental health (though no new commitments here). o More influence for CCGs over wider NHS budget. o Developing our workforce to meet current and future needs, including working across

boundaries and more often in community settings. This, and pay and terms and conditions, will be one of the biggest issues over the next five years.

o Faster adoption of innovations that add value, though more detail is needed on how this can be achieved.

o Commitment to support more patients to self-manage.

1 As summarised by the NHS Confederation


Top



o Raising prevention up the agenda, while also emphasising empowering patients and engaging communities

The clinical service models outlined in the document are very consistent with our clinical strategy and the contribution we want to develop to improving health across our local communities. The Forward View will be a key reference document for our organisational and local health and social care system planning over the next few months. 2.2 Key messages from recent Tripartite briefings from Monitor, NHS England

(NHSE) and the Trust Development Authority (TDA) on system priorities

Along with other provider chief executives and commissioning accountable officers, I recently attended a regional 'tripartite' briefing about system priorities over the coming months. David Bennett (Monitor), David Flory (TDA) and Simon Stevens (NHSE) shared the platform and there was an emphasis on an increasingly joined up approach to managing the system across the three organisations.

Following shortly after the publication of the Five Year Forward View for the NHS there was a focus on preparing for the radical service transformation that is required in the next couple of years, with local systems encouraged to begin to explore how the different care delivery models outlined in the View would best fit local needs. This will be a key part of the joint integration programmes in Derbyshire.

There was a parallel focus on the critical service pressures being experienced currently and the need for organisations to demonstrate the excellent operational grip required to ensure robust and consistent delivery of the national NHS performance standards relating to A&E, referral to treatment and cancer waiting times. Referral to treatment standards for elective care is the key standard that directly relates to our service provision and we will continue to focus on ensuring that the Trust has strong plans in place to manage continued delivery.

We also have an important role to play in supporting the A&E standard, which acts as a barometer of overall system performance, through our winter resilience planning which is progressing well, as highlighted in section 3 below.

3. Progressing our strategy

3.1 Update on Derbyshire integration programmes

Work is continuing across the North and South Derbyshire Units of Planning on our strategic transformation programmes.

In southern Derbyshire the system is working with KPMG on the development of a 5 year plan which should be completed before Christmas. The initial stages of benchmarking have been completed and confirmed a number of key characteristics of our current system including:

Comparatively low levels of GPs and practice nurses in primary care.

A comparatively high level of beds (acute, community and mental health) and longer than average lengths of stay.

An unusually fragmented pattern of service provision across different providers.


Top



Significant differences in Local Authority (LA) service provision and outcomes between the city and county councils (both positive and negative).

Work is now focusing on a number of clinical workshops to confirm priorities for improvement and transformation, supported by a series of leadership sessions to confirm the overarching vision and framework for implementation and delivery.

In the north Unit of Planning the 21st Century Joined Up Care Programme work is continuing on a series of projects to deliver much more integrated care in the community provided by joint health and social care teams. A Community Hubs workstream has begun work on developing options for how we use our health and social care facilities across North Derbyshire to support the new models of care, working towards a public consultation next summer. A programme briefing on the work and the initial service priorities is attached for information at Appendix 1.

The whole programme is being supported by extensive public engagement and it has also been agreed to organise a joint Board and Council of Governors workshop for the organisations involved in the programme in March to support the development of shared understanding and common priorities for 2015/16.

3.2 Recent service procurement success As the Council of Governors will be aware a wide range of services provided by the Trust are now commissioned by Derbyshire County Council who are managing a series of competitive procurements for them during 2014/15. I am delighted to announce that the Trust has been successful in the procurement for an integrated healthy Lifestyles service, and for an integrated community sexual health service across the county, which we will be providing in partnership with Chesterield Royal Hospital. In both instances this secures current business and also represent a small expansion in services to include Glossopdale. Provision in this new geography is being built into the service offer through a range of partnership sub-contracting arrangements. Work is now focused on responding to the tender for universal children’s community services (health visiting and school nursing) across the County. 3.3 Health services in Heanor Following the conclusion of the public consultation led by Southern Derbyshire CCG on the future of local health service provision in Heanor the CCG Governing Body has agreed to proceed with the preferred option identified in the consultation. This is to ‘ demolish the existing Heanor Memorial Hospital facility and rebuild on that site, but with a new suite of services based on health needs analysis and to incorporate services traditionally provded from the Wilmot Street Health Centre site’. DCHS officers have been fully involved in this process, prior to and during consultation, and have already made a provision in our long term financial plan for the capital costs of a new build.


Top



We are now working jointly with the CCG on the development of a full business case for the new development which will be considered by our Board in due course. The anticipated completion of the new facility would be the first half of 2017. 3.4 Winter resilience planning The Trust has worked closely with partners across the health and care system to develop operational resilience plans for the winter, recognising the increasing pressure on services and the very high national expectations about NHS performance in the coming months. We have:

Developed a joint winter plan with Derbyshire County Council’s Adult Care Department to manage different levels of escalation and ensure clarity about respective roles and responsibilities

Taken forward and implemented a number of service changes following the successful Peak Flow One exercise in the north of the county in September to increase patient flow through the system.

Successfully bid for resilience funding from the local CCGs to enhance community service provision over the winter including increased community nursing capacity and 7 day community services in some areas

Initiated an internal flu vaccination campaign to ensure as many staff as possible minimise the risk of transmitting the disease to vulnerable patients, colleagues and members of the public.

The trust is part of operational resilience groups working across North and South Derbyshire which will oversee the system’s response during the coming months.

4. Raising concerns the DCHS Way Governors may have seen the release last month of our new ‘app’ to support colleagues, patients and members of the public to raise concerns about our services in a quick and accessible way. Downloadable onto smart phones the app enables concerns to be directed in a number of different directions in line with our Whistleblowing and Raising Concerns frameworks and is a key development in our strategy to enhance openness and transparency across the Trust.

5. Headline organisational performance – ‘the Big 9’ Month 7 performance against the big 9 priorities for 2014/15 is attached.


Top



Five‐year plan – Board update

Purpose of this paper:

To provide an update ‐ informing the various Commissioner and Provider ‘boards’ of the status and progress of ‘21C #JoinedUpCare: Five‐Year Plan’.

To set consistent expectations ‐ in terms of the need for co‐ordinated cross system actions and communication.

Boards are asked to:

1. Support the messages that will now start to be shared with stakeholders to explain the 21C ‘story’.

2. Recognise the current position in terms of responses to key questions ‐ to build confidence in the system’s readiness to change.

Background and context:

In September, ‘boards’ received a summary setting out the direction of the Five‐Year Plan and the status of work to deliver that plan.

In summary it stated that:

• Commissioners and providers are committed to the aims and principles within the Five‐Year Plan.

• Significant progress has been made to identify priorities, establish leadership and determine the overall approach to developing and delivering integrated care.

• The approach provides significant challenges to existing organisation and role boundaries.

• All organisations recognise that changes need to be co‐ordinated and implemented cross system. And, that all organisations must be prepared to actively manage the uncertainty it presents.

• There are a number of questions that need to be addressed, to have confidence and assurance that the system is sufficiently ready to manage the changes.

Engaging others in the 21C #JoinedUpCare Programme

The focus for the next six months is a blanket communications campaign that tells the story of 21C #JoinedUpCare in a way that makes it real for patients, staff, local people, partners and the many other stakeholders interested in our programme of change. Phase 1 (October‐April) aims to share key messages about 21C in many different ways, to as many audiences as possible. In that way, when we are ready and able to reveal our future plans and proposals for health and social care, our stakeholders will have had an opportunity to: influence our thinking; contribute to the debate and discussion; and will be able to participate in any consultation fully understanding the story and how we’ve reached our conclusions.

The 21C #JoinedUpCare Story

‘Tell me your story’ (page 4) was developed to provide all partner organisations with a short, but consistent explanation of what the programme is about. This simple two page summary will provide a foundation for all communications and engagement materials and messages. The Communications and Engagement Work Stream are now working on the programme outlined above to reach as many stakeholders as possible.

Join in the 21C story on Twitter.

Use the hashtag #JoinedUpCare in your conversations about partnership working,

service change and new developments.


Top



Are we ready for change?

The previous update to boards identified a number of questions that needed a response, to build confidence and provide assurance that we are sufficiently ready (as a health and social care system) to manage change. As well as the messages in ‘Tell Me Your Story’ these responses begin to address some of the other specifics organisations have asked:

For existing organisations

What does this (programme) mean/what is the impact on individual organisations and their statutory responsibilities?

#JoinedUpCare puts individual service user needs before those of any particular organisation. This provides significant challenges to existing and traditional organisation and role boundaries. Consequently, in due course, changes to existing governance, contracting and funding arrangements will be required.

System leaders recognise that managing this transition will be a complex and often ambiguous challenge.

A cross‐system programme, directed by the Chiefs of each of the partner organisations, has been set‐up to manage the delivery of #JoinedUpCare alongside (and linked to) existing governance arrangements.

Current individual organisations’ statutory responsibilities will be unaffected. This may need to change in future, but any changes will only be carried out through due process.

How will we manage with existing contracting, funding, procurement and competition processes, policies and rules?

• A cross system Finance and Contracting work‐stream made up of of senior Finance Directors from Commissioners and Providers has been set up to address these issues.

• National policy and guidance related to procurement and competition recognises the importance of facilitating integrated working for the benefit of service users.

• Specific arrangements to ensure effective compliance and transparency and to enable appropriate collaboration will be addressed by the Finance and Contracting work stream.

How will #JoinedUpCare change the clinical/professional governance responsibilities?

We have set up a work steam as part of the overall programme to address issues related to clinical/professional governance. The overarching principle is to establish a framework that allows for safe and effective delivery of care, whilst supporting professionals to exercise their professional judgment.

Do we have the capacity to manage this scale of change?

• We do not underestimate the scale of change, but nor do we yet know all of what it will take to deliver. Hence, one of the underlying principles is ‘learning by doing’.

• A cross system programme, directed by the Chiefs of each of the organisations, has been established to manage the delivery of #JoinedUpCare.

• As part of this, we are looking to align and rationalise existing structures, projects and meetings.

How are we engaging with people to help shape the plans and services? The experiences and views of local citizens and patients are vital to our programme and we are collaborating across partner organisations to ensure that they are fully involved. We are already working with a number of patient and public groups. The Communications and Engagement work stream, is responsible for telling the 21C #JoinedUpCare ‘story’ and for ensuring effective engagement contributes directly to service change and development.


Top



When will it be necessary to formally consult? As we develop our plans in more detail, we will have a better idea if and what formal consultation work is required. We will work to best practice standards and communicate and engage with the patients and citizens that may be affected by any proposed changes to services.

For staff: How will this help me to do my job? Or help me to improve how I do my job?

#JoinedUpCare aims to:

Provide the basis for teams and individuals to provide compassionate, empathetic care with fewer ‘hand offs’ between organisations, improved responsiveness leading to an improved overall experience and outcomes;

Establish more sustainable integrated teams, focused on the needs of local communities, able to develop existing roles and develop new ones where appropriate;

Build on a number of changes which have already been implemented in Derbyshire or elsewhere in the country so we are not starting from scratch. We need staffs’ expertise to advise us how we best develop integrated care in North Derbyshire.

Who will I be working with? Where will I be based?

We do not know yet ‐ and will work with you to understand the best way of providing this #JoinedUpCare model. We understand that this will be different in each community based on specific needs, geography and existing service provision. And we are committed to ‘learning by doing’ which will require us to adapt as we begin to understand what works best.

Does this change my Terms and Conditions?

At this stage, no. But again, we will be working with you to develop #JoinedUpCare. In future this may require changes to terms and conditions, but these would only be made by always following agreed organisational change procedures.

What’s the plan? When are we going to make the changes?

• We have already made a number of changes to care across North Derbyshire. The aim now is to learn from these and implement change at a scale and pace which enables us to address the changing needs of our population.

• Priority work streams to deliver #JoinedUpCare have been identified.

How will we go about it?

• We have a cross system programme, led by Chief Officers, which is overseeing the development of JoinedUpCare and the detailed implementation plan which underpins this.

• Individual Boards, staff and all stakeholders will be routinely kept informed of the plan and its progress through a dedicated communications and engagement group.

Is it the same plan for each community?

We will work to a consistent strategic and governance framework across North Derbyshire. However, because of the differing needs of each community and the different availability of services and facilities, the way services are provided in each geographical community will vary to reflect local needs, demography and current service provision.

Future updates will be provided to all Boards to provide a consistent picture and messages and enable shared understanding and alignment

ENDS

STS/AG/SROctober152014

North Derbyshire Clinical Commissioning Group Hardwick Clinical Commissioning Group

Chesterfield Royal Hospital NHS Foundation Trust Derbyshire Community Healthcare Service NHS Trust

Derbyshire Health Care NHS Foundation Trust East Midlands Ambulance Service NHS Trust

Derbyshire Health United Derbyshire County Council


Top



Communications Workstream

We’ll treat you with dignity and respect

Our services will be person-centred

We’ll be flexible and adaptable to meet your needs

We’ll challenge what we do now and find better ways of working

We’ll work with you to plan and deliver services

We’ll promote healthy lifestyles and support you to make a change

TELL ME YOUR STORY…

What are you doing? The organisations in North Derbyshire that spend public money (known as commissioners) to buy health and social care on your behalf; and those that provide these services (including hospitals, GPs, community and mental health services and social care) have worked together to create a five-year plan for how care will be provided to you in future. We have called this plan 21st Century Healthcare – or 21C for short. And we’re using the phrase #JoinedUpCare to describe what we we’re trying to achieve.

Everyone involved has signed up to six important principles (shown above) and at this stage we’re starting to work out what the five-year plan will mean for people in North Derbyshire; and how it will impact on all our organisations.

Who is involved? Our 21C #JoinedUpCare partnership is made up of:

North Derbyshire Clinical Commissioning Group Hardwick Clinical Commissioning Group Chesterfield Royal Hospital NHS Foundation Trust Derbyshire Community Healthcare Service NHS Trust Derbyshire Health Care NHS Foundation Trust (mental health services) East Midlands Ambulance Service NHS Trust Derbyshire Health United (out of hours GP service) Derbyshire County Council


Top



Why are you doing it? What people need from health and social care is changing. In North Derbyshire we have a growing elderly population and more of our residents have long-term, complex illnesses and perhaps a multiple number of conditions. It means the demand for the services we all provide continues to increase.

Some health and social care services are organised in outdated, complicated ways – and we have a shortage of skills and expertise in some areas, so we can’t always give our patients and communities the right care in the right place. This is frustrating as we want everyone using our services to receive high-quality care and an exceptional experience.

The public sector is also receiving little or no investment, so if we don’t change how we run our services, by the time the year 2020 arrives between us we will be £150 million short of funds – and that would have an unthinkable impact on the 380,000 North Derbyshire people we are all responsible for.

What’s going to change for me - the patient? Your experiences as a patient will improve and the quality of care you receive will be to agreed joint standards. In future we will be looking to provide you with #JoinedUpCare (often known as integrated care). It means all our organisations need to work together to find the solutions - to meet the on-going health and care needs for people in North Derbyshire. Care will be organised around you and your individual requirements, and not limited by the roles and boundaries of several different organisations.

For you, the patient, your care should be well-planned, organised and smooth. For example, if you’ve been in hospital and your consultant says you are fit to go home, you should be able to leave that day – with all the back-up services and support you need at home already planned for and in place. You shouldn’t have to stay in hospital for longer than necessary because your requirements have not been organised in advance.

What’s going to change for me - the health or social care worker? You and the teams you are already a part of will work with greater integration – organising what you do around the ‘person’ and the ‘community’. There are already some great illustrations of how this works in practice. For example, in the Falls Partnership, where appropriate, patients who have suffered a fall at home will be checked over by a specialist who has travelled out to them. They assess the patient’s individual needs in their own environment, instead of the first response being an admission to hospital. It may mean that in future staff from all our organisations will work in a variety of different environments – from hospitals to people’s homes.

What’s going to change in the health and social care ‘system’? Across North Derbyshire there’s likely to be a number of ‘community hubs’. These will be the bases that local health and social care services will work from. We don’t know yet what they will include, or where they will be – but they will represent communities across the North Derbyshire area and focus on their specific needs. We will also work beyond our traditional boundaries to link in with other networks. This will make sure people in our communities not only have access to local services, but to the specialist expertise they may need that’s elsewhere (for example specialist cancer care).

There are some good examples of changes already working well in practice. For example, if a GP is concerned about the welfare of a child, but doesn’t feel they need to be admitted to hospital, they can call on the services of the specialist consultants at Chesterfield Royal. All GPs can now access a rapid access clinic, which ensures their young patient is reviewed within 48 hours or so. In the future, GPs may be able to access this sort of service through their community hub.

How will you involve me? Over the next few months we will be telling our story in lots of different ways, to reach lots of different audiences who are interested in health and social care - including our communities, our patients and our staff. And we’ll be asking for views and opinions – for example looking at the services local people might expect to find in a community hub. That way, when we are ready to explain exactly how we’d like to change our services, everyone will be able to contribute to the debate knowing the background to 21C - #JoinedUpCare.


Top



Objective Priorities 2014/15What are we aiming for

this yearPlan to end of October

- Keeping patients safe whilst in our care

- Putting patients at the centre of care delivery (patient experience)

- Enhance the healing environment and improve outcomes for patients with

dementia

- 95% of patients with Diabetes to have appropriate care plans

86.0% 94.6% (GREEN) 95.0% (GREEN)

- To get the basics right (clinical effectiveness)

- 10 patient engagement groups active in the year, starting June

20145 4 (RED) 10 (GREEN)



- Engaged and supported staff - Increase staff engagement 76.4 76.0 (AMBER) 76.8 (GREEN)

- Everyone has a quality appraisal - 100% appraisal completion 100% 81.0% (RED) 95.0% (AMBER)

- Everyone maintains a high level of attendance

- Minimum 97% staff attendance 97% 96.0% (AMBER) 95.5% (AMBER)



- To deliver our £7.5m cost improvement programme

- £7.5m cost improvement programme

£3.590m £3.127m (RED) £6.663m (AMBER)

- To end the year with and income and expenditure surplus of

£1.60m

- Income and expenditure surplus £1.60m

-£1.535m -£1.059m (RED) -£1.940m (GREEN)

- To reduce our carbon usage- 200,000 miles saved on business

travel50,000 -6,800 (RED) 0 (RED)

Forecast

Quality Business

Achieved to end of October

To ensure effective, efficient and economical organisation that

promotes productive working and which offers good value to it's community and commissioners

Quality People


To build a high performance work environment that engages,

involves, and supports staff to reach their full potential

Big 9 - October 2014

7 (100%)

Forecast

(GREEN)

Forecast


Quality Service

To deliver high quality and sustainable services that echo the

values and aspirations of the community we serve

- Reduce the number of serious medication errors to 7 in the year

(100%)6 (86%) 1 (14%) (GREEN)


Top




Title of Paper: 2015/16 - 16/17 Operational Plan

Paper for: Information and Decision


Author: Tim Broadley, Acting Director of Strategy



Appendices:

Purpose of Paper

The purpose of this paper is to update the Council of Governors with regards to the work in hand to develop the 2015/16 and 16/17 Operational Plan and the proposed further engagement with staff, governors and the Board which will be undertaken to achieve this. This includes details of the timeline for the planning submissions required and it takes account of recently published guidance from Monitor in relation to strategic planning. It is also written in the context of the emerging national and local strategic and commissioning priorities a summary of which will be available separately to Council members as a briefing paper.

Summary

A. Update on Progress to Date

1. The Board has agreed a revised Commercial Strategy at its September Meeting

2. Work has been undertaken in September and October with the services to review progress regarding the implementation of this year’s plans and performance against our agreed targets and objectives.

3. Where available commissioner’s plans have been reviewed and consideration has been

given to the changing economic, commercial and policy context within which DCHS will be operating. This has also taken into account the role DCHS is taking within the emerging collaborative framework across the north and south units of planning as well as the risks and opportunities related to the competitive tendering of a number of our existing services. A briefing paper to support the forthcoming development Board sessions in relation to the Operational and Commercial Plans will be available separately for Council members which covers:

A summary of the CCG Commissioning Intentions

A wider review of background information including the 5 year forward view and the

97�2015.16�-�16.17�Operational

Top



emerging views of the main political parties

4. This work has enabled us to begin to identify the key priorities that DCHS will either need to carry forward into, or to develop within, the next two years. Further work is now planned to engage with staff, Governors and the Board around the key themes to ensure that the Operational plan is developed in a way that is first and foremost of value to DCHS after which we will consider the “fit” with national planning guidelines when these become available in December.

5. Guidance in relation to Strategic Planning has been received from Monitor and this

comprises a 374 page strategy development toolkit and other supporting resources together with a shorter guidance document for Board members. The main guidance has been reviewed and the overarching methodology is being applied to the DCHS planning process. This methodology is outlined below:

97�2015.16�-�16.17�Operational

Top



6. A timeline has been issued together with overarching planning requirements from Monitor and the TDA and these are outlined below. Relating this timeline back to the planning methodology above the following planning phases can be identified

Frame and Diagnose – Nov/Dec 2014

Forecast and Generate Options – Jan 2015

Prioritise – Feb 2015

Deliver – Mar/Apr 2015 B. Planning Timeline (Subject to Review)

C. Planning Requirements

2014/15 saw a move away from incremental annual planning to longer term strategic plans.

In the 2015/16 planning round we are expected to refresh both the second and third years of our strategic plans (i.e. two-year operational plan).

Our plans should be created in the context of our ongoing five-year strategy, which should remain bold, transformational and the result of robust engagement with Local Health Economy partners

We must address opportunities/ challenges to the sector: Better Care Fund, Five Year Forward View; and demonstrate how we will maintain the balance between quality, access and cost to ensure the delivery of high quality, sustainable services

We must describe a realistic timeframe for delivery and agreement on how risk will be

97�2015.16�-�16.17�Operational

Top



shared and non-recurrent costs of change managed

The timing for further five year plan submissions will be confirmed in due course

Monitor will publish Risk Assessment Framework consultation in November. D. Work in Hand

1. Work to complete the Clinical Quality Strategy and revisions to the People, IM&T and Estates strategies is in hand.

2. A Board development session was held on the 1st December to review the planning and

financial context and emerging operational priorities

3. A Commercial Plan is currently being finalised and this will be the subject of the 18th December Board development session.

4. Work continues through the North and South units of planning to ensure we are fully

engaged and can reflect the agreed joint priorities within our plans

5. Contract priorities for 15/16 are also being assessed and these will also be aligned with the planning priorities to ensure there is consistency through ours and the health and social care communities plans

E. Proposed Engagement

1. Staff engagement events are taking place across November and December and the development of the Operational Plan will be a key element of these sessions

2. A planning session with the Governors is to be arranged in December to review the

planning context and the emerging plans.

3. This planning report will also be given to the full governors meeting in December and further planning meetings will be arranged for Governors in January/February before the final plan is presented at the March Governors meeting

4. There will be a further Board development session on the 18th December focusing on the

commercial plan which in turn will inform the final Operational Plan development and the key contract negotiation priorities for 15/16. The December Board will then be presented with a final version of the Commercial plan for approval.

5. Briefing papers will then follow to the January and February boards regarding further development of the plans including the impact of the planning guidance expected in December 6. A further Board development session will follow in March with final plan sign off at the March Board 7. Monthly planning sessions are in hand with the services to firm up the CIP and to

97�2015.16�-�16.17�Operational

Top



challenge and confirm the emerging plans and finalise plans in February in relation to the contract negotiations and agreed financial envelope.

Recommendations

The Council are asked to support the proposed arrangements for further engagement specifically with respect to the proposed Plan development sessions in December 2014 and January 2015.

97�2015.16�-�16.17�Operational

Top




Title of Paper: Membership Recruitment and Engagement Update


Presenter: Amanda Rawlings, Director of People and Organisational Effectiveness

Author: Jo Chick, Membership Officer



Appendices:

Purpose of Paper

To provide information and assurance to the Council of Governors that we have a representative membership with a range of opportunities for our members to get involved with the work of the Trust.

Summary

Public Membership Update DCHS currently has a total of 17,082 members; comprising of 12,503 public members and 4,579 staff members (accurate as of 21 November 2014). Membership Recruitment We recently achieved our public membership target of 12,500. Our new target in line with our Membership Strategy until March 2015 is to grow and maintain our public membership population between 12,500 and 13,000. Membership and Governor Engagement Activity We have summarised our recent membership and governor engagement activity from August - November 2014 below:

The redesigned membership flyer capturing extra demographic information such as disability, sexual orientation and religion is now in use. We have also designed a new membership poster which has been sent out to all hospitals to display near the flyers to encourage people to find out more about membership and sign up if they’re interested.

Trialled the use of social media adverts to promote and recruit people to our public membership scheme. Our targeted advert on Facebook over four weeks cost £102. It generated 17 new members but also advertised the Trust and the membership to the wider public. In total, the advert received 278 website clicks through to our Become a Member page and the advert reached a total of 3,521 people.

98�Membership�Recruitment�and�

Top



Undertook an in-house patient mailout to a small sample of patients who have recently attended a podiatry or physiotherapy clinic. We wrote out to 500 patients to tell them about our membership scheme, encouraging them to sign up as a member. We weighted the mailout more heavily in the High Peak and Derbyshire Dales area to increase our membership index in this area. We anticipated a return of more than 20 flyers which we achieved.

We are aware that a number of other Trusts opt in staff leavers to their public membership schemes. On seeking advice from the Information Commissioners Office, they confirmed that we were able to do this with our staff leavers as long as we provide a clear way for staff to opt out of the public membership scheme if they wished. We wrote to staff leavers from June onwards to inform them that we will opt them in to our public membership scheme three weeks from the date of the letter unless they tell us otherwise. A small number of staff opted out of the scheme but the majority of staff leavers were transferred to public members.

1. Events

Held our first annual member’s meeting in September. Members and the general public were invited to come and hear first-hand accounts from patients who have received care from DCHS in recent months, as well as learn more from our Chief Executive about our organisation’s major highlights and achievements in the past year, and specific developments in community healthcare. The session concluded with a short talk from our Lead Governor, Brenda Greaves on the role and her experiences over the year.

The annual member’s meeting ended with a health education session on falls prevention. The invitation to the health education session was included within our invitation to the annual member’s meeting via:

o Email to those members with an email address o Issued a press release to local media o Promoted the event via our website, Twitter and Facebook pages.

Despite a number of members booking on to the session and our best efforts in promoting the falls prevention session, it unfortunately received a very low turnout. There are lessons to be learned for the future as to whether the health education session was best placed after the annual member’s meeting.

Attended Wheatbridge Health Village with public Governors, Sandra Moody and Linda Barker. We spent two hours in the waiting room speaking to patients who were attending appointments in the outpatient clinics. We signed up four members on the day and some patients took the flyer home to have a read through. It was also a good opportunity for Sandra and Linda to talk to patients who were attending the clinics, one of which who was already a member and very complimentary about the service he has received!

Invited to talk to the Staveley Seniors on 28 August. Kim Ashall, General Manager, spoke to the fifteen attendees about the services that DCHS provide in the area and also what services we don’t provide. Prior to the meeting, all attendees were given a membership flyer and a copy of The Community to take away with them. Jo Chick, Membership Officer, ended Kim’s talk with a membership plug to encourage them to sign up as a member and the benefits of joining. They thanked us for an interesting talk with a couple signing up as members and a number promising to return the form via the freepost address.


Top



Members who took part in our Patient Led Assessments of the Care Environment (PLACE) attended a feedback session on 29 August. Graham Smith informed them of our hospital results in the PLACE assessments and took feedback from the group on how the assessments had gone.

Had a membership presence at the Cavendish Hospital with the Buxton League of Friends (LOF) on 7 September. The LOF spoke to patients and relatives regarding the LOFs future plans and fundraising, and also took the chance to talk about our public membership scheme.

Attended the Working Together to Improve Quality Care (Care Home Advisory Service events) market place at these events in October. Limited interest in attendees as the majority of attendees were DCHS staff.

The Marketing and Communications team took on the challenge of each visiting a hospital or health centre to recruit some new public members towards our 12,500 target.

Six members of the team visited Ilkeston Community Hospital, Wheatbridge Health Village, Alfreton Primary Care Centre, Ripley Hospital, Chapel-en-le-Frith Health Centre and recruited 38 new public members between them.

2. Email Updates

Consulted members on out new draft Equality Strategy. We asked members for their views on our equalities priorities and objectives and sent them a questionnaire to complete regarding their feedback. A number of the members have replied and one said “Thank you for giving me the opportunity to comment.”

All public members with email addresses were invited to participate in a survey as part of the Dalton Review. This review is being led by Sir David Dalton on request of the Department of Health. The survey allowed members to provide their views around how providers of NHS care can remain accountable to the local populations, and how patients can be involved in improving the quality of services that are provided. Invitation to September’s AGM and Annual Member’s meeting including invitation to the health education session on falls prevention.

Stand-alone invitation to the health education session on falls prevention asking members to book on to the session.

Announcement to our members of our approval as one of the first community NHS Foundation Trust’s in the country.

Want to volunteer? We need you! – informed the membership of the funding we have been awarded from Nesta (an innovations charity) and the Cabinet Office to develop a new volunteering programme across DCHS. The ‘Home from Hospitals’ scheme is to be delivered by volunteers, which is set to offer a wide range of practical support to patients being discharged from hospital back into their home environment. Members were invited to attend the launch event on Monday 10 November at Charnos Hall, Ilkeston Hospital. A small


Top



number of voluntary sector/DCHS staff attended the evening and we gained two potential volunteers (a member of staff and an ex GP).

Invited public nominations for the outstanding care and compassion award at Extra Mile Awards to recognise the unsung heroes of DCHS. The outstanding care and compassion award is open for votes from patients, members of the public, carers and families who have a special person or team in mind from DCHS who has helped when they needed it most.

3. Governors

We would firstly like to thank the several Governors who played such an active role in the public and staff engagement process around the future of health services in Heanor.

Issued a number of Governor newsletters. The newsletters featured: o Invited Governors to attend Staveley Seniors with Kim Ashall to talk about the role of a

Governor. o Informed Governors of some involvement opportunities with our Patient Experience

Group and patient/service shadowing activity in order to evaluate leadership practice in that area and to help formulate recommendations for improvement.

o We have successfully bid for some external funding by NESTA to develop our approach to volunteering and Governors were invited to join a project group to guide this piece of work.

o Invitation to take part in the Recruitment Day for the Medical Director to take part in a discussion group with the applicants and attend the presentations by each of the applicants

o Governor support in collecting patient experience information from people using our learning disability services

o The chance to feedback on the newly designed DCHS website o Taking part in the End of Life Care group o DCHS Operational Planning Meeting – invited to attend a meeting with Tim Broadley,

Acting Director of Strategy, to discuss the work taking place towards the DCHS Operational Plan.

o The Shadow Council of Governors Meeting Self-Assessment Questionnaire to assess how well the Council of Governors meetings have been working or give us the opportunity to consider how we can make improvements to the meetings and help Governors to contribute further.

Announced our authorisation as an NHS Foundation Trust to all Governors.

Filmed a short video with a small number of staff and public Governors to explain what the role of a Governor is. Following our authorisation as an NHS Foundation Trust, amendments will need to be made to the video before release to the public.

Staff Governors have continued to feature in each month’s editions of Our Voice talking about how they have been finding their roles as Governors and what they have been doing in their role. Staff Governors who have featured in the last three months are:

o Sara Nash – Other Registered Professionals o Amanda Smith – Medical and Dental.


Top



The October edition of Our Voice also featured a two-page spread on September’s Council of Governors meeting, informing staff on the discussions and outcomes of the meeting.

Future Activities

Membership Workshop in the morning of Thursday 11 December 10.00am – 12.00 noon. This session will be run by our Marketing and Communications team to support Governor engagement opportunities with our members.

Rolling programme of events to be held at each of our main hospitals and health centres, this would include larger ‘open days’ at the hospitals as well as some smaller sessions, all of which Governors can have the opportunity to get involved

Photos of local public Governors to be displayed along with the executive team photos at the main sites

List of local events e.g. Christmas bazaars, summer fayres to be made available to governors who can attend if they wish as an opportunity to raise their profile at their local sites

Pull up banners to be developed that can be put up when a Governor is on site to explain who they are and what they do

Look at producing some suggestion boxes and comment cards to have on site to enable those members who don’t want to speak directly to a Governor to leave their comments

Script to be prepared for Governors who wish to be involved in the events – this would cover DCHS – who we are, what we do Governors role Membership.

Membership Representation As the population is ever-changing our membership database supplier MES who work with over 100 other NHS organisations nationally states that an index between 80 – 120 is seen as representative. We have endeavoured to achieve an in-house target of maintaining indexes of between 90 – 110. Following the in-house patient mailout, we have brought the Derbyshire Dales and High Peak constituency back in line with the remaining Derbyshire constituencies.

The table below displays how our total membership is split between each constituency and how the membership population currently aligns with the local base population in that area. We have removed the base population and percentage of membership for the Rest of England constituency, as these figures would skew the overall report significantly.

Public

% of Membership Base

% of Area Index

Amber Valley, Erewash & South Derbyshire 3,335 33.75 334,932 32.41 104

Bolsover, Chesterfield & North East Derbyshire 2,766 27.99 280,450 27.14 103

City of Derby 2,360 23.88 254,563 24.63 97

Derbyshire Dales & High Peak 1,420 14.37 163,511 15.82 91

Rest of England 0 0.01 0 0.00 0

Out of Trust Area 0 0.01 0 0.00 0

Total 9,881 100.02 1,033,456 100.00


Top



* Out of Trust area: Our membership database is populated by Royal Mail’s Postcode Address Files (PAF). New addresses (or where commercial properties have been converted to residential properties) can take a period of time to get updated by Royal Mail, thus defaulting these addresses to Out of Trust area. This figure could also include members who live outside of our constituencies and appropriate action will be undertaken if members are found to live outside of England. Please find the total membership breakdown for all of our membership constituencies including the number of members within our Rest of England and Out of Trust area constituencies.

Public % of Membership Base

% of Area Index

Amber Valley, Erewash & South Derbyshire 3,335 26.67 334,932 32.41 82

Bolsover, Chesterfield & North East Derbyshire 2,766 22.12 280,450 27.14 82

City of Derby 2,360 18.88 254,563 24.63 77

Derbyshire Dales & High Peak 1,420 11.36 163,511 15.82 72

Rest of England 2,581 20.64 0 0.00 0

Out of Trust Area 41 0.33 0 0.00 0

Total 12,503 100.00 1,033,456 100.00

Recommendations

We would like the Council of Governors to receive this paper for information and the assurance it provides.


Top



Key Dates and Future Events 2014-2015

Date Event Time Venue

Wed 4 March 2015 Council of Governors Meeting

2.00pm - 5.00pm

Alfreton Hall Church Street Alfreton Derbyshire DE55 7AH Tel: 01773 838200

Thurs 11 June 2015 Council of Governors Meeting

6.00pm – 9.00pm

Postmill Centre Market Close South Normanton Alfreton DE55 2EJ Tel: 01773 860296

Wed 9 September 2015 Council of Governors Meeting

2.00pm - 5.00pm

Alfreton Hall Church Street Alfreton Derbyshire DE55 7AH Tel: 01773 838200

Thurs 3 December 2015 Council of Governors Meeting

2.00pm - 5.00pm

Postmill Centre Market Close South Normanton Alfreton DE55 2EJ Tel: 01773 860296

103�Key�Dates�and�Future�Event

Top

