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Board of Directors’ Report September 2015 Council of Governors - 1 -

SOMERSET PARTNERSHIP NHS FOUNDATION TRUST

BOARD OF DIRECTORS PERFORMANCE REPORT 1. OVERVIEW OF ISSUES COVERED

1.1 This report covers the following issues:

quality report; financial position;

performance; “Safer Staffing”; escalation beds; “Breaking the Cycle” exercise; Monitor Quarter 3/Annual Plan Review Telephone Call and

2014/15 Feedback; NHS South West Leadership Academy; appointments and senior staff changes;

Chief Executive’s reports.

2. QUALITY REPORT 2.1 The Board receives a detailed patient safety and quality report on a

monthly basis which sets out the key issues and trends in relation to the Trust’s provision of high quality care and patient experience.

2.2 The report is structured around the five key questions which the Care Quality Commission will consider when reviewing and inspecting services of: are they safe?

are they effective? are they caring? are they well-led?

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are they responsive to people’s needs? and the areas covered in the report are:

slips, trips and falls; medication incidents; prescribing and administration errors; pressure ulcers; incidents involving ligatures and ligature points; incidents involving actual physical violence to patients; incidents relating to clients being absent without leave whilst

under the Mental Health Act; unexpected deaths; use of seclusion; use of restraint; infection control; complaints and PALS; the Friends and Family Test; Patient and Public Involvement; patient safety walkrounds.

2.3 The Board also receives significant assurance through its programme of

Patient Safety Walkrounds and detailed feedback from the visits is provided to the Board.

2.4 The Trust has sought, where possible, to incorporate comparative benchmarking data or improvement standards into the patient safety and quality report, but robust and directly comparable national data appears to be scarce for the majority of indicators.

2.5 The Trust has proposed successfully, to the NHS Benchmarking

Network, that a national data collection and benchmarking exercise be launched, to provide a source against which its own quality standards can be compared, and better informed targets for quality improvement

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can be set. The Trust has shared its Quality report with the NHS Benchmarking Network, as an illustrative guide to the areas for inclusion in the national data collection exercise.

2.6 The Trust has also sought to set improvement targets to quality and

patient safety standards, via the process to agree measures for the 2014/15 framework for Commissioning for Quality and Innovation (CQUIN).

2.7 The full Quality Report is available on the Trust’s website. 3. FINANCIAL POSITION 3.1 The result for the Trust to 31 July 2015 shows an operational cumulative

deficit of £1,200,000 (against a planned deficit of £1,023,000) and a planned outturn of a surplus of £252,000 for the year 2015/16.

3.2 The Trust is required to generate a surplus to meet Monitor’s requirement in relation to their continuity of services rating. In addition, the surplus generates funds for reinvestment through the Trust’s capital programme. The largest areas of capital expenditure to date have been IT, refurbishment of the Rowan S136 Suite, Wessex House refurbishment, Dorset dental services, and backlog maintenance. Additional equipment brought into use has been largely funded from donations.

The Trust is required to achieve a significant level of cost improvements, in order to meet the efficiency savings requirement and to manage local cost pressures in 2015/16. A cost improvement programme totalling £7.4m was drawn up in conjunction with operational directors and managers and has been approved by the Director of Nursing and Patient Safety and the Medical Director

The cost improvement programme has been increased to £7.6m in

order to fund the revisions to staffing establishments following the review of in-patient establishments approved by the Board in May 2015.

3.3 As at 31 July 2015, the cost improvement programme plan shows a £87,000 variance against the revised plan to date of £1,342,000.

3.4 There is an established process within the Trust to ensure that all Cost improvement Programme (CIP) proposals are risk assessed for impact on patient safety, patient and staff experience. The impact and risks are reviewed by the Executive Team before submission to ensure that the impact of any CIP has been fully assessed and agreed before negotiations with the Clinical Commissioning Group take place.

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3.5 The full finance report and appendices are available on the Trust’s website.

4. PERFORMANCE

4.1 The Trust met all applicable standards contained with the Monitor Risk Assessment Framework. The Trust also met the majority of its CQUIN and other compliance standards for measures contained on the Corporate Dashboard.

4.2 Areas in which the Trust is performing well include:

M4: Percentage of Minor Injury Unit patients waiting under four hours from arrival to admission, transfer or discharge. During July 2015, 99.8% of clients attending a Minor Injury Unit were seen admitted, transferred or discharged within four hours of arrival;

M9b: All recovery care plans (level 2) to be reviewed at least

annually. During July 2015, a rate of 95.6% was achieved against a required compliance standard of 95%;

2: Percentage of all adult inpatients who have had a venous

thromboembolism (VTE) risk assessment on admission to hospital. During July 2015, 97.6% of all patients admitted had a VTE assessment within the required standard;

5a: For new mental health clients, an identified carer who

provides regular and substantial care must be registered. The rate achieved during July 2015 was 97.0%, against a 90% compliance standard;

5b: Where there is a registered carer, a carer's assessment has

been offered and, if not declined, this has been carried out. A rate of 98.8% was recorded during July 2015, against a compliance rate of 95% or more;

6a. Percentage of IAPT treatment population entering treatment. During July 2015, a total of 882 people entered treatment against a required standard of 679 or more;

6b: Percentage of IAPT treatment population moving to recovery.

For July 2015, 56.6% of clients entering treatment moved to recovery against a required standard of 50% or more;

6ci and 6cii: Referral to First Treatment of patients accessing

Psychological Therapies (IAPT). In July 2015, 93.9% of patients had their first treatment within six weeks of referral against a required standard of 75%, and 100% of patients had their first

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treatment within 18 weeks against a required standard of 95%. These are new national waiting times standards, which Trusts are expected to achieve by April 2016.

4.3 The Trust had one performance exception relating to CQUIN measures:

C4i: Reduction in pressure ulcer incidence for community district nursing: 16 cases were reported for the period 1 April to 31 July 2015. This is higher than the trajectory set to achieve this particular CQUIN.

4.4 Other corporate dashboard indicators meeting the Trust’s exception

reporting criteria during July 2015 were:

1b: CAMHS clients referral to treatment waiting times within four weeks. The rate recorded July 2015 was 78.5% against a required performance trajectory of 85%;

3. Psychiatric emergency readmission rate within 30 days of

discharge. During July 2015 the rate increased to 13.3%, compared to rate recorded for June 2015 of 3.9%;

10: Monthly percentage of community hospital bed days lost due to delayed discharges, as a proportion of the total number of occupied bed days. The actual rate for July 2015 increased to 5.7%. Patients awaiting residential or nursing home placements continued to account for the greatest numbers of bed days lost;

11. Mandatory Training. As at 31 July 2015, the Trust had an

overall compliance rate for mandatory training of 88.8%, against an required compliance standard of 90%;

12: Staff Sickness Absence Rate. The staff sickness absence

rate for July 2015, was 4.4%.

4.5 The detailed performance reports considered in the public part of the regular Board meetings are available on the Trust’s website.

5. SAFER STAFFING

5.1 On 27 May 2014 the Board approved new staffing establishments for

each ward in line with national guidance. Additional investment in staffing was agreed to support the recruitment of additional registered nurses and health care assistants. On 9 June 2014, each ward moved to staff the wards in line with the new recommended staffing levels recognising that the additional recruitment of staff would take time, and there would be an increased reliance on temporary staffing in the interim.

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5.2 In July 2015 the average “fill rate” for registered nurses for the day shifts

was 87.5% and for the night shift 91.57%.

5.3 The main reason why wards failed to meet the recommended levels was recruitment to vacancies and sickness levels. The number of wards using block contracts with agencies has increased as accessing temporary staff remains challenging. The Trust continues to implement a comprehensive recruitment and retention plan which includes facilitating return to practice, preceptorship programmes and overseas recruitment.

6. MONITOR

6.1 The Chief Executive and Executive Directors participated in a meeting

with Monitor - Steve Atkins (Regional Manager), Justin Collings (Senior Regional Manager) and Jane Knox (Regional Support Officer) - on 17 July 2015 at Bridgwater Community Hospital. The meeting with Executive Directors focused on the 2015/16 operational plan, 2015/16 contracts, service developments, progress on the 2015/16 cost improvement programme, capital expenditure and plans, workforce recruitment and retention, and the wider local health economy strategy. The Monitor team subsequently met with the Chairman and Senior Independent Director. The Director of Nursing and Patient Safety accompanied them on a visit to the Bridgwater Community Hospital after the review meeting.

6.2 The Chief Executive, Director of Finance and Business Development,

Director of Nursing and Patient Safety, Chief Operating Officer, Associate Director - Strategic Planning and Performance and the Secretary to the Trust participated in a telephone conference call with Monitor on 19 August 2015 to review Q1 progress. The agenda included: operational performance (Q1 position, current performance and risks for the remainder of Q2); finance (discussion around the David Bennett letter dated 3 August 2015, overall position at Q1, 2015/16 contracting, cost improvement programme, capital) and an update on the IP2 integration programme. In discussion the following additional issues were raised: monthly reporting by NHS foundation trusts, the appointment of the new Director of Workforce and Organisation Development, and recruitment arrangements for the new Chief Executive.

6.3 The Chairman and the Chief Executive formally responded to David

Bennett’s, Monitor, letter of 3 August 2015, requesting the Trust to review its 2015/16 Annual Plan to determine whether additional savings could be made, on 21 August 2015 stating that the Trust was not proposing to revise its financial plans as previously submitted in the light

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of the particularly demanding financial targets included in the Trust’s Operational plan for 2015/16.

6.4 The Chief Executive received a letter from Monitor on 4 August 2015 following the quarter four performance review, advising that the Trust’s ratings for quarter four were as follows: Continuity of Services risk rating – 4;

Governance risk rating – Green,

7. INDEPENDENT LIVING TEAMS POSITION 7.1 The Independent Living Teams (ILT) have been through a period of

change and uncertainty since September 2014 when Adult Social Care (ASC) announced proposals to withdraw all qualified Social Workers and most of the local authority employed Occupational Therapy staff from the teams. These proposals were implemented in November/December of last year as part of an initiative to enhance social care capacity in acute services and in the social care local area teams. The remaining social care staff within these teams are currently awaiting the outcome of ASCs current transformation programme to clarify the local authority’s future approach to delivering community reablement services. In the meantime, the Trust remains fully committed to continuing to deliver ILT services across the county as one of the core components of the new integrated teams as proposed under the IP2 modernisation programme. Staff and managers from the ILT service are currently participating in finalising these proposals to bring together the service with District Nursing and older people’s mental health teams to create fully integrated services. Further consultation commenced on these plans in June 2015 and the Trust continues to work closely with its partners in the local authority to share plans as they develop.

8. MAKING THE MOST OF COMMUNITY SERVICES REVIEW

8.1 The Chief Executive, Chief Operating Officer and Director of Nursing

and Patient Safety met with David Slack, Managing Director and Ann Anderson, Director of Clinical and Collaborative Commissioning, Somerset Clinical Commissioning Group, on 7 July 2015, to review progress on the ‘Making the Most of Community Health Services’ review and arrangements for the publishing of the Third Stage Report. The Council of Governors and League of Friends have been advised of the publication of the Third Stage Report.

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9. CONSULTANT CONTRACTS AND WORKING TIMES

9.1 Contract negotiations are currently taking place between NHS

Employers and the BMA with regard to medical contracts. The Secretary of State for Health, Jeremy Hunt has indicated the wish to move to seven day working.

9.2 The move towards seven day working is being driven by a desire to

improve quality of services, accommodate service redesign and reconfiguration, and improve access and convenience.

9.3 The Trust already provides seven day services, particularly in relation to

inpatient and Community services. We do not currently operate seven day outpatient services. Much of the discussion has focussed on acute medical services and access to diagnostic services.

9.4 Our Community Hospital inpatient services are nurse-led with medical

support available throughout the week. There is no formal Consultant medical input and medical advice in the out of hours period, including weekends is provided by the GP Out of Hours provider as a separately commissioned contract.

9.5 For mental health services, there is Consultant and Junior doctor cover throughout the week, although this is on an on-call basis at night and at weekends. The Trust has to provide 24 hour Responsible Clinician availability under the Terms of the Mental Health Act. Current provision ensures that medical input to the inpatient wards is available through junior doctors with senior support from Consultants. Consultant Psychiatrist input is concentrated upon supporting Mental Health Act assessments, out of hours.

9.6 There is little evidence that our current arrangements affect clinical outcomes adversely. Improvements would be expected from changes to seven day working for Consultants by ensuring that review and discharge could occur across the full week and that service responsiveness and resilience was enhanced. Secondary benefits arise from providing earlier patient reassurance and from earlier return to their home environment. From a service perspective it potentially allows earlier diagnosis and the most appropriate treatment option to be offered at the earliest opportunity.

10. INTEGRATION PHASE 2 (IP2) PROGRESS REPORT 10.1 Integration Phase 2 (IP2) is the Trust’s transformational change project

for community services. A period of engagement with staff, patients and carers took place over the summer of 2014 and led to proposals for a significant re-structure of community services. The aims of IP2 were to

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maximise the benefits of integration, modernise working practices and provide more patient centred care, particularly for those with multiple and long term conditions.

10.2 The first stage of the project involved revising the management and leadership structures to make sure that they are proportionate, affordable and able to support the new clinical structures. The second stage has been to further refine the proposals for new, improved services and to seek feedback on how we can best deliver the IP2 aims.

10.3 Following the recent consultation period with staff a number of new models have been agreed and will begin implementation over the autumn/winter:

10.4 Integrated Teams – Older People’s Mental Health, District Nursing and the Independent Living Teams will combine under a single manager. They will be co-located and will be organised around new complex care hubs to manage the most vulnerable and complex patients.

10.5 Mental Health – There will be a new 24 hour countywide crisis team with a unified management structure and improved bed management system. The assessment and recovery functions in mental health will combine to become Community Mental Health Teams (CMHTs) allowing increased flexibility as staff can work across all team functions. The Trust will also be bringing mental health support workers into the teams so that they can be more responsive and targeted to those with the greatest need.

10.6 0-25 Pathway – the pathway and transitions experience for young people with mental health difficulties will be improved. The Trust will create dedicated transitions workers and staff from the adult mental health service will be asked to become part of a new service designed to better meet the needs of young people.

10.7 All of the clinical models have been underpinned by the Estates and Time to Care Task and Finish Groups. Their work has been to support the changes to services by looking at smarter use of our buildings, more agile working and a strong commitment to reduce duplication and streamline our recording and reporting practices, freeing up the time of frontline staff.

10.8 Teams will also be looking closely at the skill mix of operational staff to ensure that they will be able to deliver the current and future demands. This means new roles for non-registered staff and focussing the activities of professionals where they are most needed.

10.9 The feedback from the recent consultation process has been positive and many staff have submitted suggestions and ideas about how to

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make the new clinical service models as effective as possible in delivering care and treatment.

11. WATCH PROJECT 11.1 The Chief Executive visited the WATCH project, Chard, on 2 July 2015,

where he received a cheque on behalf of the project for £1000 from the family of the late Barry Doble, a member of the WATCH project who painted the two portraits of the Chief Executive which are on display in Mallard Court. The Chief Executive also presented a retirement certificate and gift to Gaynor Trafford, Treasurer and Book Keeper.

12. APPOINTMENTS AND SENIOR STAFF CHANGES 12.1 The Chief Executive announced on 1 July 2015 that he will be taking

early retirement as from 1 January 2016 and that his last working day as Chief Executive of Somerset Partnership NHS Foundation Trust will be 31 December 2015.

12.2 The Trust has appointed Nick Macklin, currently Director of Human

Resources and Organisational Development at Royal Cornwall Hospitals NHS Trust, following an interview process on 26 and 27 July 2015. Nick Macklin will be taking up his positon as Director of Workforce and Organisation Development on 5 October 2015.

13. SOMERSET CLINICAL COMMISSIONING GROUP MEETING 13.1 The Chief Executive, Director of Finance and Business Development,

Director of Nursing and Patient Safety met with David Slack, Managing Director of Somerset Clinical Commissioning Group and Debbie Hillier, Interim Deputy Chief Finance Officer, on 11 August 2015 at Wynford House, Yeovil as part of their regular 1:1 meetings. Issues discussed at the meeting included: the distribution of winter escalation funds, progress in relation to “Making the Most of Community Health Services”, and Outcome Based Commissioning. In relation to Outcome Based Commissioning, the Chief Executive restated the position that a single county model for the provision of services was the preferred arrangement for the Trust rather than the East/West proposal that is being considered by the Clinical Commissioning Group.

13.2 Colleagues from the Trust also raised issues regarding the proposed

£500,000 reduction of spend in mental health services by Somerset County Council and their concerns this reduction would have for patient services in the context of the national move for parity of esteem and the delivery of integrated care.

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14. DORSET AND ISLE OF WIGHT DENTAL SERVICES 14.1 The Chief Executive and Sara Harding, Head of Operations/Deputy

Chief Operating Officer – Community Services, visited community dental services between 24 and 25 August 2015 in Dorset and the Isle of Wight including the Special Care Dentistry Unit; based in Dorset County Hospital, Dorchester; Canford Health Paediatric Dental Clinic, Poole; The Browning Centre, Bournemouth; the Brookside Health Centre, Freshwater, Isle of Wight; Carisbrooke Health Centre, Newport, Isle of Wight; the Arthur Webster Clinic, Shanklin, Isle of Wight; and the West Cowes Medical Centre, Cowes, Isle of Wight, to review progress and arrangements following the winning of the Dorset and Isle of Wight community dental services contract earlier in the year.

15. CHIEF EXECUTIVE REPORTS 15.1 The detailed Chief Executive report presented to the Board on a

monthly basis is available on the Trust’s internet – http://www.sompar.nhs.uk/about_us/board_papers

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