Board of Directors Thursday 09 January 2020

09:30am

Boardroom, Trust HQ, Sceptre Point, Sceptre Way, Walton Summit, Preston, PR5 6AW

Board of Directors

People & Quality

Committee

Finance & Performance Committee

Nomination Remuneration

Committee

Audit Committee

Board of Directors

Meeting Board of Directors Meeting Location Boardroom, Trust HQ, Sceptre Point, Sceptre Way, Walton Summit, Preston, PR5 6AW Date Thursday 09 January 2020 Time 09:30am

Reference Item Lead Action Enc.

PART ONE (PUBLIC MEETING)

TB 001/20 Welcome and opening comments Chair Verbal

TB 002/20 Apologies for absence and confirmation of quoracy Chair Verbal

TB 003/20 Declarations of Interest Chair Verbal

TB 004/20 Minutes of the previous meeting Chair Decision Paper

TB 005/20 Action Tracker Chair Decision Paper SCRUTINY & ASSURANCE (PUBLIC MEETING)

TB 006/20 Trust Chair’s Report Chair Noting Paper

TB 007/20 Chief Executive’s Report Chief Executive Noting Paper

TB 008/20 South Cumbria Assurance Committee Chair’s Report Committee Chair Assurance Paper

TB 009/20 Quality and Performance Report (QPR) Director of Operations Noting Paper

TB 010/20 Mental Health Improvement Plan Director of Operations Noting Paper

TB 011/20 Finance Report Chief Finance Officer Noting Paper

TB 012/20 Nurse Safe Staffing Report Director of Nursing and

Quality Assurance Paper

TB 013/20 Board Assurance Framework (BAF)

Director of Compliance and Improvement Noting Paper

TB 014/20 CQC Update Director of Compliance

and Improvement Noting Paper

TB 015/20 Mental Health Benchmarking Report 2019 Acting Medical Director Noting Paper

TB 016/20 Any Other Business Chair Verbal

PART TWO (PRIVATE MEETING) TB 017/20 Welcome and opening comments Chair Verbal

TB 018/20 Apologies for absence and confirmation of quoracy Chair Verbal

TB 019/20 Declarations of Interest Chair Verbal

TB 020/20 Minutes of the previous meeting Chair Decision Paper

TB 021/20 Action Tracker Chair Decision Paper

TB 022/20 Chief Executive’s Report Chief Executive Discussion Verbal

TB 023/20 Provider Trusts Collective Decision Making Proposal Chief Executive Noting Paper

TB 024/20 Locality Model Re-design Progress Report Director of Operations Noting Presentation

TB 025/20 Control Total Chief Finance Officer Discussion Verbal

TB 026/20 Pennine Diagnostic Outputs Director of Operations Noting Paper

TB 027/20 Adult ADHD Service Director of Operations Noting Paper

TB 028/20 Contract Approval for Avondale Rehabilitation Ward Remodelling Chief Finance Officer Approval Paper

TB 029/20 Any Other Business Chair Verbal

TB 030/20 Date & Time of the Next Meeting Chair Verbal

Declarations of Interest – Board of Directors

Name Role Description Date Inputted Comments

David Eva Chairman

1. Employed by Union Learn as National Manager2. Trustee of national Association of Racing Staff3. Non-Executive Director Liverpool Media Academy4. Independent Chair of the Wirral Integrated Care Partner

20/02/2019

Louise Dickinson Non-Executive Director

1. Director at Talegar Limited2. Consultancy Services at Talegar Limited3. Foundation Governor and Finance Chair at St. Vincent’s primary School

20/02/2019

Isla Wilson Non-Executive Director

1. NED - Progress Housing Group2. Shareholder - FSquared Ltd3. Shareholder - Ruby Star Associates Ltd4. Consultancy/Advisory Work Ruby Star Associates5. NED - Healthier Lancashire & South Cumbria ICP6. Chair - Borough Care7. Director - Life In Colour Ltd8. Innovation Agency

24/09/2019

David Curtis Non-Executive Director Director at Clinical and Corporate Governance Limited 29/04/2019

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Name Role Description Date Inputted Comments

Bill Gregory Chief Finance Officer

1. Trustee of Healthcare Financial Management Association2. Co-opted member of Lancaster University Financial and GeneralPurpose Committee3. Director of HSIS4. Director and shareholder of Healthcare Business Partnerships Limited(HBP).

09/09/2019

HBP will not be providing any services to the Trust

Julia Possener Non-Executive Director

1. Lay member of the Lancaster University Management School andFaculty of Arts and Social Science Ethics Committee2. My partner's sister is the owner Bluebird Lancaster & South Lakeland3. Director of HSIS4. Director of Zephyr Musical Ventures Ltd

29/04/2019

No business with the Trust or other NHS organisation or organisations providing services to NHS No unrelated faculties or formal or informal business.

Shazad Sarwar Non-Executive Director

1. Director Msingi Research Ltd2. Lay Member Lord Chancellors Advisory Committee for Cumbria &Lancashire3. Independent Member Joseph Rowntree Foundation Audit & RiskManagement Committee4. Community Representative Pendle Community Safety Partnership

30/08/2019

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Name Role Description Date Inputted Comments

Debbie Francis Non-Executive Director Managing Director at Direct Rail Services 01/09/2019

Richard Morgan Acting Medical Director Nil Declaration 02/04/2019

Caroline Donovan Chief Executive Nil Declaration 29/04/2019

Russell Patton Director of Operations Nil Declaration 28/06/2019

Maria Nelligan Director of Nursing and Quality

1. CQC Executive Reviewer 2. Honorary Senior Lecturer – Chester University 3. Company Secretary at National Mental Health & Learning Disability Director of Nursing Forum

10/10/2019

Nicky Ingham Interim Director of HR 1. Chief Executive – Nicky Ingham and Associates Ltd 2. Executive Director – Healthcare People Management Association (HPMA)

25/09/2019

Ursula Martin Director of Compliance and Improvement Nil Declaration 01/10/2019

Paul Farrimond Non-Executive Director

1. Managing Director of P.F. Consultancy Ltd 2. Facilitate meetings and conferences for the CEOs of the nine mental health Trusts in North East and Yorkshire and Humber 3. Specialist mental health advisor to NHS Providers

24/12/2019 No conflict with LSCFT

Peter Williams Non-Executive Director 1. Secondary care doctor Manchester health and care board 2. Non executive director NHS transformation unit.

Declaration of Interest Presented to the Board of Directors on 09 January 2020

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BOARD OF DIRECTORS

Minutes of the Part One Board of Directors meeting held on 05 December 2019 Boardroom, Sceptre Point

PRESENT: David Eva, Trust Chair (Chair)

Caroline Donovan, Chief Executive Maria Nelligan, Director of Nursing and Quality Ursula Martin, Director of Compliance and Improvement Jo Moore, Director of Partnerships and Strategy Russell Patton, Interim Director of Operations Richard Morgan, Acting Medical Director Nicky Ingham, Interim Director of HR David Curtis, Senior Independent Director Louise Dickinson, Non-Executive Director Debbie Francis, Non-Executive Director Shazad Sarwar, Non-Executive Director Julia Possener, Non-Executive Director Isla Wilson, Non-Executive Director

IN ATTENDANCE: Fiona Ritchie, Company Secretary Viv Prentice, Deputy Company Secretary (minutes) Dominic McKenna, Director of Operational Finance Bev Howard, Head of Communications Dr Gareth Thomas, LIA Lead (TB 320/19) Tom Swan, Quality Improvement Lead (TB 321/19) Susan Barber, Specialist Speech & Language Therapist (TB 321/19) Alison McCarthy, Team Co-Ordinator, Children’s Therapies (TB 321/19) Mother of Service User (TB 321/19)

OBSERVERS: Vicky Shepherd, Nominated Governor

Shelley Wright, Director of Communications Paul Farrimond, Non-Executive Director

Peter Williams, Non-Executive Director

TB 313/19 WELCOME AND OPENING COMMENTS

The Chair welcomed everyone to the meeting and introduced the newly appointed Director of Communications, Shelley Wright and Non-Executive Directors, Paul Farrimond and Peter Williams who were observing the meeting prior to commencing with the Trust in January 2020.

TB 314/19 APOLOGIES FOR ABSENCE AND CONFIRMATION OF QUORACY Apologies for absence were noted from Bill Gregory, Chief Finance Officer (Dominic McKenna, Director of Operational Finance deputising).

Confirmation of quoracy was provided.

TB 315/19 DECLARATIONS OF INTEREST There were no declarations of interest declared.

UNCONFIRMED

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TB 316/19 MINUTES OF THE PREVIOUS MEETINGS The minutes of the previous meeting held on the 07 November 2019 were agreed as a true and accurate record.

TB 317/19 ACTION TRACKER The Board reviewed the action tracker and received updates in respect of the three open actions. The Board also noted the closed actions and the actions scheduled for future meetings.

There were no further matters arising.

TB 318/19 TRUST CHAIRS REPORT The Chair presented his monthly report which included an overview of the activity of Non-Executive Directors and Governors.

The report was noted by the Board.

TB 319/19 CHIEF EXECUTIVE’S REPORT The Chief Executive presented her report and was pleased to announce that the Trust was the first trust to achieve a City of Sanctuary Award for the work it had undertaken to ensure that staff have access to resources and information to help those seeking asylum or refuge.

Further key highlights included the annual staff survey which had closed on the 29 November. A lot of effort had been put into encouraging people and teams to complete the survey with the final report due to be received in February/March 2020.

The Chief Executive confirmed that the Mental Health Improvement Plan was continuing to gather pace and it had been pleasing to note the enthusiasm from staff at the closing workshop of Access (Urgent and Non-Urgent, Adults and Older People’s Mental Health). The Executive Team had also recently visited a number of sites in South Cumbria and had met lots of enthusiastic members of staff. The Chief Executive took the opportunity to voice particular thanks to Gary O’Hare, Director of Mental Health and Learning Disability (South Cumbria) for his leadership in progressing the Out of Area Placements (OAP) in South Cumbria.

The Chief Executive confirmed that achievement of the Trust’s control total remained a key challenge for the Trust. It was also noted that whilst PriceWaterhouseCoopers were undertaking a review of the commissioning of mental health services, the Trust had highlighted the importance of working in partnership when developing a strategy for mental health.

An update was provided in respect of the development of the Clinical Strategy. It was noted that there was still further work to be undertaken on the delivery and shaping of future services but that there had been a lot of engagement with service users and carers which had been really positive.

The Chief Executive provided an update regarding executive appointments and welcomed Shelley Wright, the newly appointed Director of Communications who

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will join the Trust on the 6 January 2020. Advertisements had also been out for substantive posts on the Executive Team including Chief Operating Officer, Director of Digital and Director of People & Organisational Development.

In respect of flu, the Trust’s Infection and Prevention Control Team had continued to work hard to vaccinate teams against the flu virus with the current uptake noted as 54% for frontline staff and 43% for all staff. However, there was still work to do to further support uptake.

The Chief Executive drew the Board’s attention to a number of recent awards which included an accolade for a volunteer within the Trust’s Community Pain Service in recognition of the difference made to people in Southport and Formby. The Trust’s Medical Education Team had also been named the second ‘Best Teaching Placement’ by medical students from Manchester University’s Medical School whilst the Children’s Learning Disabilities and Behaviour Support Service based in Cumbria had won the Learning Disabilities Nursing Award.

The Chief Executive highlighted the recent Home Office data that indicated a 20% increase in the number of people being detained by the police under the Mental Health Act in England and Wales over the past two years.

TB 320/19 LISTENING INTO ACTION (LiA) The Chief Executive welcomed Dr Gareth Thomas, the Trust’s Listening into Action (LiA) Medical Lead who was in attendance to provide an update on the Trust’s LiA journey.

An overview of LiA was provided together with examples of quick wins which included 50 new laptops for junior doctors and new physical health equipment for inpatient wards.

The Medical Lead confirmed that the findings from a recent Pulse Check had indicated that more communication from Senior Management was required. A number of communications had therefore been introduced including a live fortnightly podcast with the Chief Executive and a weekly LiA newsletter.

The Medical Lead referred to ‘LiA Simple Things’ which was about empowering teams to make easy changes that matter to them and worked on four basic principles: don’t do any harm, don’t spend money we haven’t got, don’t compromise our reputation and do it in a joined up way. Examples of the simple things that had been introduced was provided which was beginning to increase as staff were becoming empowered to make changes within their teams.

An overview of the work of the Trust-wide teams, clinical teams and enabling teams was provided. The Medical Lead also referred to the weekly newsletter which had been well received with data showing that on average the newsletter was opened 6000 times per edition reflecting staff engagement.

LiA champions had been introduced with staff invited from all disciples to become involved. Several service user and carer events had also been held and a number

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of service users/carers had attended the big conversations and were getting involved in sponsor groups.

An LiA Twitter account had been set up and a campaign for Christmas introduced with the hashtag #LSCFTElfSquad.

The Chief Executive thanked the Medical Lead for his update and personally thanked the clinical and medical leads for the work that had been undertaken to date.

TB 321/19 PATIENT STORY The Chair welcomed everyone to the meeting and introductions were made.

The Quality Improvement Lead introduced the Specialist Speech & Language Therapist (SLT), Team Co-Ordinator for Children’s Therapies and the mother of a service user who were in attendance to outline the journey of a little boy and his family and the difficulties they experienced in obtaining a diagnosis of Autistic Spectrum Disorder (ASD) due to the child’s young age.

The Speech and Language Therapist provided an overview of the Children’s Therapy Service which is one of six teams across Lancashire and South Cumbria NHS Foundation Trust. The service works closely with paediatricians from Lancashire Teaching Hospitals and with colleagues from SEND services and Early Years. Families are also key partners in their work with children.

The referral criteria and SLT assessment was outlined and whilst other clinicians had initially rejected the referral due to the child’s age (11 months old), the team had agreed to accept the referral due to concerns about the possibility of social communication difficulties.

During the initial assessment in May 2018, the mother of the child explained that she had previously voiced concerns about ASD to her health visitor only to be told that it was her maternal mental health which was affecting the interaction with her child. However, following the assessment, flags for ASD were identified and an SLT involvement plan put in place.

The Speech and Language Therapist provided an overview of the therapy and support provided from the initial assessment in May 2018 to the final diagnosis of ASD in August 2019. Following diagnosis and as a result of the therapy provided, the child had made excellent progress with his communication and his mum was now positive about the future. Intervention from SLT would continue, with the team supporting the child’s transition into school to ensure that the appropriate strategies were in place to support his communication needs. SLT would work towards discharge to self-management but that re-referral was always an option should the child’s needs change. To summarise, the Speech and Language Therapist stated that mum had recognised the difficulties in her child when he was just ten months old but had been told by her health visitor not to worry. The key message was therefore that health professionals should listen and take notice of parent’s concerns.

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Following a question from the Chief Executive regarding how closely the Trust worked with Health Visitors, the Chair explained that whilst the Trust had previously provided the service this had recently been contracted out to Virgin Care.

The Chief Executive queried if there was anything the Trust could do to support the learning with GPs. The Specialist Speech & Language Therapist confirmed that a full report would have been forwarded to the GP.

Following a comment from a Non-Executive regarding the importance of ensuring that learning was disseminated, the Director of Operations highlighted the difficulty in speaking collectively to GPs.

The Director of Nursing informed the Board that going forward patient stories would be videoed providing the Trust with a collection of clips that would be easier to share across organisational boundaries. The Chair highlighted the importance of targeted communications and using real examples to highlight the differences that had been made. A Non-Executive Director also stressed the importance of building resilience in parents to enable them to go back to their GPs if they had continuing concerns.

The Chair thanked the team for attending and sharing their story.

TB 322/19 PEOPLE AND QUALITY COMMITTEE CHAIR’S REPORT The Committee Chair presented the Chair’s Report following the meeting held on 08 November 2019. Key highlights included the quality story update on end of life care and the positive feedback that had been received on the responses to the end of life care questionnaire. The second quality story had looked at transforming the response to domestic abuse. 23 workshops had been facilitated around routine enquiry, increasing communication skills together with accessible advice/information which staff had found really useful.

There had been some challenges around reporting of the NRLS data and therefore NICHE had been appointed to undertake a review of this.

The Committee had discussed safer staffing and the risks associated with these vacancies.

The quarterly safeguarding report had been presented which highlighted some issues around child deaths. The Committee would therefore receive an additional report around unexpected child deaths at the next meeting.

The Committee Chair confirmed that the Board of Directors had previously ratified the CQC action plan and that an exception report would be presented to the People and Quality Committee.

The Committee received the apprenticeship update with discussions focusing on how the Trust uses the levy for clinical posts and for people in communities that haven’t been targeted before.

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There was a lengthy discussion around complaints and the complaints process, particularly around the high level of MP complaints. An external review of the complaints procedure had therefore been commissioned.

The Committee Chair highlighted that following the appointment of the Director of Nursing and the Director of Improvement and Compliance there was further work to be undertaken around scheduling of reports to the Committee and the future workplan.

Following a question from the Chair in respect of the review of the complaints process, the Director of Improvement and Compliance confirmed that the review had now commenced and that the findings would be presented to Board in January/February 2020.

Following a query from the Chief Executive regarding the Workforce Race Equality Standards (WRES) and the discrepancy between ESR and the survey in relation to the percentage of workforce that are disabled, the interim Director of HR confirmed that some staff may have acquired a disability since completing the survey. Following a further comment in respect of duty of candour and the delays involving families, the Director of Nursing confirmed that a practice note had been circulated to staff and training undertaken. An audit will also be undertaken after Christmas to ensure practice was embedded.

The Board noted the content of the Chair’s Report for assurance.

TB 323/19 SOUTH CUMBRIA ASSURANCE COMMITTEE CHAIR’S REPORT The Committee Chair presented the Chair’s Report following the meeting held on 27 November 2019 which focused on themes and risk. Staffing levels had been flagged as the most significant risk post-transfer and environment risks also remained high. An update would therefore be provided to the next meeting.

The Committee Chair referred to the changes around the Kentmere inpatient ward and confirmed that these would be addressed as part of the Mental Health Improvement Plan. In relation to the strategic plan for Kentmere, the Chief Executive confirmed that Gary O’Hare, Director of Mental Health and Learning Disability (South Cumbria) would be leading on this with a view to bringing it to a conclusion by the end of March 2020. The Committee Chair highlighted that prioritisation of the capital programme was key and that following discussions during the meeting regarding whether there was sufficient budget, the Committee Chair had assured colleagues that the budget would not be constrained if there were safety issues.

The Committee were informed that the Trust had been notified by the CQC (via a whistleblower) of issues related to inpatient units (Ramsay and Dova) in South Cumbria relating to staffing and other concerns received.

In terms of information flowing to the Committee, the focus would be on the strategic plan around improvement of services, moving us away from tactical action planning. A discussion had ensued about what that would look like in assurance papers going forward.

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It had been agreed a standing agenda item would be added to future Committee agendas to discuss any escalation required to the NHSI/E South Cumbria Mobilisation Board to support engagement around any system-wide issues.

The Chief Executive took the opportunity to highlight the positive feedback from staff in South Cumbria in relation to IT which was a credit to the teams that had supported South Cumbria staff.

The Board noted the content of the Chair’s Report for assurance.

TB 324/19 QUALITY PERFORMANCE REPORT The Director of Partnerships and Strategy presented the report for month 7 and confirmed that the Trust was compliant with 8 of the 11 current NHSI metrics.

Inappropriate OAPs continued to exceed the current trajectory (which was agreed at the start of 18/19). The number of OAPs occupied bed days had increased in month 7 coinciding with increased demand for inpatient admissions and following the trend started last month. Indications from weekly monitoring suggest that the increase seen in month 6 was being maintained into November. Actions to improve the OAPs position were being progressed as part of the system-wide action plan developed to respond to the NTW review.

IAPT Recovery fell just below the target of 50%, achieving 49.8% for the first time in the past 3 years. The dip in performance was due to a change in the numerator and denominator as a result of patients being removed from the waiting list who were at recovery stage being transferred to St Helens as part of the contract transfer.

The latest position available (July 2019) of the Data Quality Maturity Index (DQMI), reported by NHS Digital, showed the Trust was non-compliant against the 95% standard (and the 90% - 95% for the CQUIN achievement). The DQMI measures the Trust’s performance against data submission to 36 fields. The Director of Partnerships and Strategy confirmed that the newly appointed Head of Business Intelligence was looking into this.

It was noted that there had been some changes to the structure of the report with changes to the HR and workforce dashboard but that there was still further work to do.

The Director of Partnerships and Strategy highlighted that the key South Cumbria metrics were presented in a dashboard under the Summary Dashboard section and that the combined performance for Lancashire and South Cumbria was presented in a separate dashboard. One issue that was particularly challenging for South Cumbria was around 7 day follow ups. Further work was therefore being undertaken with the Director of Mental Health and Learning Disability (South Cumbria).

The Director of Operations referred to previous conversations in respect of the Mental Health Improvement Plan being a joint improvement plan. This had recently been discussed at the ICS Board together with the identification of key metrics

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which had been viewed positively. The number of 12 hour breaches was noted as 37 during the month of October which was a culmination of the closure of the MHDUs. In respect of super stranded patients, a census had been undertaken of all inpatients and their particular needs and the requirement to provide them with a more appropriate programme.

Following a question from a Non-Executive Director about the number of beds at The Cove, the Director of Operations confirmed that there had been an agreement with NHSE about reducing the number of beds and this had been effective with better utilisation of staff.

The Director of Nursing highlighted that the number of incidents of only one registered nurse on duty had nearly halved since the previous month. There was also further work to be undertaken with the Director of Compliance in respect of Mental Health Act KPIs.

The interim Director of HR provided an update in respect of workforce and confirmed that there continued to be high levels of agency use in South Cumbria. Further work would therefore be undertaken to review how bank availability could be improved. In addition, a recent recruitment event had been held in Barrow which had been successful and whilst sickness had reduced it was still higher than the previous year.

In respect of the Staff Friends and Family Test, there was a worryingly decline in the engagement score which was currently 6.8 which meant the Trust was in the bottom 20%. The Listening into Action work would, however, help to improve this engagement score.

Following a question from a Non-Executive Director regarding the poor uptake with mandatory training, the Director of Nursing confirmed that targeted training was being undertaken, particularly at the Harbour. However, whilst there was a programme of training there continued to be issues with staff being released to attend. The team were therefore holding additional sessions and undertaking sessions in between planned sessions.

The Director of Operations responded to a question from the Chief Executive regarding team trajectories for improvement and confirmed that each of the networks would have a trajectory and on each ward you would be able to clearly identify how many staff had not undertaken training. Moving away from a composite picture was also a positive start.

Following a question from a Non-Executive Director around ADHD data, the Director of Operations confirmed that a number of conversations had taken place around ADHD commissioned activity and it had been agreed that a paper would be presented to the January Board.

The Board noted the content of the report and the actions from the System Assurance meetings.

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TB 325/19 MENTAL HEALTH IMPROVEMENT PLAN The Director of Operations presented the report which provided an update on the work undertaken to date in improving key aspects of the mental health urgent care pathway as highlighted in the ICS Mental Health Improvement Plan.

In terms of frequent attenders, there was general recognition that there was a small group of individuals within each health and social care system that made disproportionate and inappropriate use of the available services. With this in mind, the Trust had committed to develop a small number of Frequent Attender Care Teams to manage these individuals. Standard operating procedures had been developed with teams consisting of nurses, psychological service workers, the police and addictions staff. The Trust had successfully recruited to the Pennine Lancs service with plans to roll out the concept to other ICPs in December and January.

In terms of rehabilitation capacity, the Trust was considering medium to long term sustainable options within the NICHE review. A visit was also planned to Cumbria, Northumberland Tyne & Wear’s (CNTW) Sunderland services in December 2019 to meet with key clinicians and to look at their clinical model.

An update was provided in respect of the Home Treatment Teams with investment at both a local and national level enabling the Trust to move away from 9am – 5pm provision to a 24/7 service.

The Director of Operations confirmed that the Trust had a strong working relationship with the Richmond Fellowship who currently provided two crisis houses within Burnley and Chorley. Following further negotiations, it had been agreed they would provide a third property in Blackpool which should be ready early 2020. It had been agreed that the Trust would work with the Richmond Fellowship over the coming months to review and enhance the current working relations to ensure that optimum provision was available.

Following the recent Kiazan event in relation to transforming the Trust’s bed management service, a number of areas were identified for improvement. One such area was that the Trust did not currently have a switchboard and therefore one of the outcomes of this work would be the submission of a business case for a switchboard. Another area would be ensuring more clinical staff worked in bed management services as currently admin staff covered out of hours. From a clinical perspective, a decision had been taken to immediately enhance the Trust’s OATs review team which had been really positive.

The Pennine Lancs pathway review had commenced which would undertake a diagnostic review of the ‘current state’ with the expectation that this would be rolled out in other ICP areas.

An update was provided on the progress against the key metrics that were deemed to be the most critical from an urgent care pathway perspective. In terms of the Home Treatment Team, 160 staff were in post providing 24 hour care. Face to face activity appeared to have increased only modestly despite the increased funding. Further work was therefore being undertaken to look at the recording

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process. Work would also be undertaken to review recording of mental health liaison activity as there was clearly inconsistency between teams and between months in terms of face to face activity.

The Director of Operations referred to 12 hour breaches, in particular the month of October, which was the first month without access to the Mental Health Decision Units (MHDUs). Data highlighted that the total number of 12 hours breaches linked to Lancashire and South Cumbria had fell slightly in October 2019 compared to September 2019.

The Board’s attention was drawn to bed utilisation and the graph outlining total daily acute demand which highlighted people waiting for admission, demand for beds and actual usage. The Director of Operations confirmed that both he and the Medical Director were meeting with key representatives of the consultant workforce to undertake some work around flow.

In respect of the monthly average for OAPs and following discussions with colleagues at the ICS, it had been agreed that key events and triggers would be added in order to provide a fuller picture. Following a question from the Director of Nursing in respect of including data for stranded patients, the interim Medical Director referred to the graph detailing stranded and super stranded cases with 180+ day lengths of stay and confirmed that a census of patients in inpatient beds had been undertaken which identified that there were a number of people in intensive care that should be in high dependency units therefore this work in terms of stranded and super stranded would be included from next month.

An update was provided regarding the access line and 136 usage. Following the previous lack of confidence in this service, the Trust had undertaken a lot of work with the police and now had two members of staff and a more robust crisis service which had seen an increase in calls and a reduction in the application of s136 detentions.

The Director of Operations confirmed that there had been a decrease in the number of detentions under s136 and s135 in October 2019 and a slight increase in the number of s136 and s136 breaches.

The Board noted the contents of the report.

TB 326/19 FINANCE REPORT The Director of Operational Finance presented the finance report for October and confirmed that the Trust had received clarity around accounting for assets for Cumbria. The overall adjustment means effectively that the Trust will receive an £8.2m gain next year. Excluding that, the year to date position was behind plan by £0.6m at month 07. Whilst the Trust was maintaining a forecast for delivery of the control total, the reality was that a significant year end deficit of c£4.3m was building.

The Director of Operational Finance confirmed that there was £1.2m movement on outturn this month driven by change in OAPs forecast with upsides of £1.7m which may not all be delivered. Equally there were downsides around re-charges

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for stranded patients. Two big areas of overspend were highlighted as OAPs and ward staffing. At this stage we would expect recovery measures to bridge the gap and to have seen improvements in the position but at the moment do not have either of these manifesting.

The Chief Executive highlighting the importance of continuing to challenge commissioners in respect of stranded patients.

Following a discussion in respect of the achievability of the control total, the Chief Executive confirmed that an OAP team had now been established and that bed days needed to be tracked. The Trust also needed to work with the consultant body to help get stranded flow and thirdly the need to address agency through having a non-tolerance in agency for health care support workers.

In relation to capital, the Director of Operational Finance confirmed that a £1m overspend was predicted. The Chief Executive confirmed that there was lobbying nationally and that if Avondale was opened in February/March 2020 the Trust would receive a further £1m capital which would address the gap.

TB 327/19 NURSE SAFE STAFFING REPORT The Director of Nursing and Quality presented the report which provided Board with an update on LSCFT nurse staffing and assurance of actions being taken to improve safety and quality in the delivery of care to people who use our services.

It was noted that during October 2019, across 43 inpatient settings, the Trust had achieved an average day fill rate for registered nurses of 77% and 129.7% for health care support workers. For night shifts, the average fill rate had increased to 95.9% for registered nurses and 154.1% for health care support workers. Registered Nurse Associates had also been included this month providing 986.6 hours of care on days and 161 hours on nights.

The Director of Nursing drew the Board’s attention to Appendix 2 which showed a breakdown of care hours and referred to the further narrative within the report which detailed when there had been an increase in care hours.

In terms of safety, a total of seven (a reduction of six) Datix incidents were recorded in October 2019 for inpatient wards in relation to staff, all of which resulted in ‘no harm’ with patient care unaffected.

Following previous conversations at Board regarding incidents of only one registered nurse on duty, the Director of Nursing confirmed that this had decreased significantly and had nearly halved during the month of October 2019.

An update on recruitment was provided with recruitment of registered practitioners continuing to be a priority for the Trust. A recruitment event had recently been held in South Cumbria which had been successful with four registered nurses recruited together with a number of health care support workers. The Trust was also recruiting for registered nurse apprenticeships.

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The Director of Nursing confirmed that a staffing for safety and quality action plan had been developed which detailed the improvement actions required in relation to staffing, recruitment and retention. This is monitored via the Staffing for Safety and Quality meeting which meets on a monthly basis. Safer staffing reviews had commenced and would be completed by December 2019 with South Cumbria commencing after Christmas.

The Board noted the challenges in delivery of safer staffing together with the mitigations and action plans in place.

TB 328/19 CQC UPDATE The Director of Compliance and Improvement presented the report which provided the Board with an update in relation to the Trust’s response to the CQC S29A enforcement notices, exception reporting against the CQC action plan and an update relating to the governance arrangements in place.

In terms of the CQC action plan, there were 181 actions broken down by core service with support available to help staff address the actions, a lot of which were quick wins.

The Director of Compliance and Improvement confirmed that the monthly CQC Steering Group had been reconvened and would monitor both the action plan and oversee the quality assurance outcomes once actions had been reviewed. In addition, to provide a third line independent assurance review of the organisation’s response to the enforcement requirements, the Trust’s Internal Auditors had been requested to undertake a review which would be completed before 20 December 2019. The Trust had also signed up to the NHS Improvement ‘Moving to Good’ programme.

A Well Led Framework Review had recently been undertaken and this was due to be presented at the Board Development Session on the 17 December 2019 which would discuss how the recommendations from the review would be taken forward.

A Non-Executive Director referred to the discussions at the recent South Cumbria Assurance Committee and the lack of confidence regarding completion of actions in accordance with the timeframes. The Director of Compliance and Improvement confirmed that following discussions at the meeting additional support had been put in place to progress these actions. In addition, the CQC action plan was completed alongside the Mental Health Improvement Plan and Listening into Action to avoid silo working. The Director of Operations also referred to the Mental Health Act inspections that provided a further level of assurance that previous concerns had been addressed.

Following a question from the Chair regarding the issues with smoking, the Director of Compliance and Improvement confirmed that the Medical Director had reviewed the policy and implementation plan and had changed from ‘stop smoking’ to a ‘moving towards stop’ programme. A Nicotine Management Conference was also being held in January 2020 which the Trust’s Medical Director was opening. Some of the ward managers had also met as a group to look at the attitude to smoking. Following a comment from the Chair highlighting the importance of

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utilising peer support workers, the Director of Nursing confirmed that there would be an opportunity for service users to talk about their experience at the January 2020 conference.

The Board noted the update provided in relation to the CQC processes in place and the associated governance arrangements.

TB 329/19 STATE OF HEALTH CARE AND ADULT SOCIAL CARE IN ENGLAND 2018/19 The Director of Compliance and Improvement presented the report which provided Board with an overview of the CQC 2018/19 State of Health Care and Adult Social Care in England. It summarised the key issues across all sectors, including workforce challenges, and outlined what the Trust was doing to take forward the agenda.

The Chair highlighted that the issues around learning disability services would be a key priority for the Trust.

The Board noted the briefing and the actions currently being taken/planned in response.

TB 330/19 NHS ENGLAND LEAD PROVIDER COLLABORATIVE The Director of Partnerships and Strategy presented the report which provided the Board with an update regarding the development of the two Lead Provider Collaboratives (LPCs) for CAMHS Tier 4 and Adult Secure Services.

A summary of the Trust’s position following outline submissions was provided. It was noted that the recommendation for the provider collaborative for CAMHS was to be on the ‘development track’. The recommendation for Adult Secure Services was to be on the ‘further development track’ with the next assurance gateway identified by NHSE to remain on track highlighted as October 2020 when a more detailed business case would need to be submitted.

The Director of Partnerships and Strategy confirmed that across the North West of England lead providers had applied to lead a number of provider collaborative partnerships, with NHSE being clear that the proposed ‘live’ date for CAMHS would be October 2020. In respect of Adult Secure Services, it was noted that Merseycare NHS Foundation Trust were on ‘fast track’ with a proposed go live date of April 2020.

The learning to date was highlighted which included key messages around data validation and having dedicated resources.

An overview of the proposed governance structure was provided. The Director of Partnerships and Strategy confirmed that an Operational Delivery Group would be established on an interim basis to oversee the initial developments and partnership arrangements in advance of the establishment of the formal Partnership Board.

The Director of Partnerships and Strategy referred to resources and confirmed that Executive Directors had been kept up-to-date with developments and the commitment to recruit a Programme Director/Lead post. In addition, it was noted

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that there was the potential for two further collaboratives in the near future: Acute Brain Injury (ABI) and Perinatal services, which the Trust would be bidding for. It was therefore important not to underestimate the amount of work involved and that this may be an opportunity for additional funding.

A summary of the activity and milestone start dates to mobilise the Provider Collaborative Partnerships was provided. Establishing the Shadow Partnership Board and submitting the business cases was highlighted as key.

The Director of Partnerships and Strategy confirmed that there were some significant challenges in relation to CAMHS that could impact on the development of the Lancashire and South Cumbria LPC, in particular there was still no decision about the very specialist CAMHS beds which was necessary to ensure full development of the model.

The Director of Partnerships and Strategy referred to the summary of the emerging risks and mitigating actions and confirmed that a detailed risk register was being developed to support the Provider Collaborative.

Following a question from the Chair regarding capacity to undertake the work, the Chief Executive highlighted the importance of the Trust’s involvement and confirmed that discussions would take place with NHSI/E for appropriate resources.

The Director of Partnerships and Strategy responded to a question from the Chair regarding timescales and confirmed that the Trust had been working in partnership with the Priory Group and that Memorandums of Understanding were already in place.

The Board noted the outcome of the outline business cases submitted to NHSI/E, the associated timescales for delivery and the anticipated infrastructure costs. The Board also noted the risks and mitigating actions identified to date and the expectation that further work is planned to define the impact of the risks on LSCFT.

TB 331/19 ANY OTHER BUSINESS There was no other business to discuss.

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Board of Directors Agenda Item TB 006/20 Date: 09/01/2020 Report Title Trust Chair’s Report Prepared By Umme Batan, PA to Chair & Non-Executive Directors Presented By David Eva, Trust Chair Action Required Noting Supporting Executive Director Chief Executive

PURPOSE OF THE REPORT: Report Purpose The purpose of the report is to provide the Board with an

overview of the activity undertaken by the Board and Non-Executive Directors in addition to the Board of Director meetings and Council of Governor meetings.

Strategic Objective(s) this work supports

To become recognised for excellence

Board Assurance Framework Risk 1.0 The Trust does not protect the people who use its services from avoidable harm and fails to comply with the CQCs standards for the quality and safety of services

CQC Domain Well-led 1.0 NON-EXECUTIVE DIRECTOR ACTIVITY

The Non-Executive Directors have been attending the Board Committee meetings of which they are a member (including the Financial Recovery Group) and apologies have been given where they were unable to attend. In addition to the usual Board business, Non-Executive Directors (NEDs) have been involved in their areas of special interest during the period 02 December 2019 – 02 January 2020:

Louise Dickinson

Attended the Board of Directors Meeting Attended the NEDs quarterly meeting Attended the Committee Chairs Meeting Attended the Board Development Session Attended the Council of Governors to the Board of Directors Meeting Attended the South Cumbria Assurance Committee Meeting

Julia Possener

Attended the Board of Directors Meeting Attended the NEDs quarterly meeting Attended the Charitable Trustee Funds Committee

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Attended the South Cumbria Assurance Committee Meeting David Curtis

Attended the Board of Directors Meeting Attended the NEDs quarterly meeting Attended the Committee Chairs Meeting Met with the Director of Nursing and Director of Compliance and Improvement Attended the Board Development Session Attended the Council of Governors to the Board of Directors Meeting

Isla Wilson Attended the Board of Directors Meeting Attended the ICS Board Meeting Attended the NEDs quarterly meeting Attended the Committee Chairs Meeting Attended the Associate Managers Hearing Met with the Deputy Medical Director/Chief Clinical Information Officer Attended the Board Development Session Attended the Council of Governors to the Board of Directors Meeting

Shazad Sarwar

Attended the Board of Directors Meeting Attended the NEDs quarterly meeting Attended a NHS Providers Board development programme: Risk Management Attended the Charitable Trustee Funds Committee Attended the Board Development Session Attended the Council of Governors to the Board of Directors Meeting

Debbie Francis

Attended the Board of Directors Meeting Attended the NEDs quarterly meeting Attended the Committee Chairs Meeting

2.0 CHAIR’S ACTIVITY

Had the weekly catch ups with the Chief Executive Had the monthly catch up with the Deputy Chair Chaired the Board of Directors Meeting Chaired the AAC Panel interviews Attended the NEDs quarterly meeting Attended the Committee Chairs Meeting Attended the shortlisting for the Chief Operating Officer Interviews Met with the Chair of Blackpool Attended the Board Development Session

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3.0 COUNCIL OF GOVERNORS UPDATE This section has been added to the Chair’s Report in order to keep the Board updated on Council of Governor activity, recognising that since 01 April 2017, Board members have been attending meetings on an invitation basis. Since the last Chair’s Report, the Council of Governors to the Board of Directors meeting took place.

4.0 USE OF THE COMMON SEAL

To inform the Board that the Common Seal has not been applied since the Board of Directors meeting on 05 December 2019.

5.0 BOARD ACTION

The Board of Directors is asked to note the content of the Trust Chair’s Report.

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Board of Directors Agenda Item TB 007/20 Date: 09/01/2020 Report Title Chief Executive’s Report Prepared By Caroline Donovan, Chief Executive Presented By Caroline Donovan, Chief Executive Action Required Noting Supporting Executive Director Chief Executive

PURPOSE OF THE REPORT: Report Purpose The purpose of this report is to provide Board members with

an overall summary of the Trust position and highlight areas for further discussion and celebration.

Strategic Objective(s) this work supports

To provide high quality services

Board Assurance Framework Risk 2.0 The Trust does not deliver safe, appropriate and therapeutic environments to deliver high quality services

CQC Domain Well-led INTRODUCTION

This report updates the Board on activities undertaken since the last meeting and draws the Board’s attention to any other issues of significance or interest.

Local Updates BOARD ACTION: Noting

1. CQC UPDATE

The Trust continues to prioritise delivery against the CQC actions from the inspection earlier this year. The CQC Steering Group is meeting monthly to ensure that assurance is gained in terms of delivery against these actions. This is supported by the quality review process that has been put in place by the Director of Improvement and Compliance. The CQC Action Plan report on the Board agenda provides more information in terms of the current position of delivery against the plan.

2. MENTAL HEALTH IMPROVEMENT PLAN Board members may be aware that we have a contractual relationship with Burnley Football Club in relation to community wellbeing. We have met with their Commercial Director and he has confirmed that our continued input and support of their services has led to them receiving substantial funds from the football premier league’s charitable arm. The proposed work will see

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LSCFT working with families and young people from the Burnley area in relation to health and well-being. With regards to rehabilitation services, senior members of the Trust had a visit to Hopewood Hospital in Sunderland on 9 December to meet with senior clinical staff to discuss our emerging rehabilitation strategy/model. This proved to be a very useful visit, which confirmed and clarified our thinking to a 3 tiered approach to rehabilitation care. The initial learning set between LSCFT and CNTW took place in early December. This initiative will see key clinical senior staff from both organisations meeting to discuss issues of mutual benefit. The initial conversation focussed on our emerging locality model and supportive medical management arrangements. We intend to develop a full programme of events for the coming months.

3. SOUTH CUMBRIA UPDATE

Work continues to implement the Post Transaction Implementation Plan (PTIP). Where new actions are required these are being added, so the PTIP is becoming a Service Development plan also. The CQC actions continue to be delivered, and all actions cross referenced with the Risk Register which has been reviewed and now contains all the identified risks from the various Risk Registers inherited. A successful recruitment event was held at the end of November and the following posts were secured:

Three students who will qualify in September (one for each South Cumbria Ward) One Registered Mental Nurse Nineteen Health Care Assistants Seven bank staff (HCAs)

Following the success of this event, another recruitment event is to be held in Kendal. The operational team also continues to recruit to posts via the usual process to meet the safe staffing requirements on the wards. 4. STAFF SURVEY RESULTS Picker have confirmed that our final response rate was 48.3% (47% including our South Cumbria locality which was dealt with as part of Cumbria Partnerships survey) meaning that 2,867 of our staff shared their views. Whilst this is an improvement from last year’s response rate of 43%, it is lower than the national average of 51% for Mental Health/Learning Disability and Community Trusts. This was the first time that the Trust has had a full census survey – open to all our employees. It was carried out via a mixture of electronic and paper surveys – the latter for inpatient areas which

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were visited by the OD & LiA teams to deliver surveys and encourage responses. Survey completion was incentivised with prize draws providing the chance for respondents to win a team wellbeing activity and an additional day of annual leave. An ambitious response rate target of 55% had been set, which unfortunately despite our communication and engagement efforts, was not achieved. We will be sharing the results Trust wide with all staff in February 2020 once the national survey figures have been collated and published by NHS England. We aim to have action plans in place by May 2020, setting out precisely how we intend to respond to the findings. Key highlights include: HR and OD achieved the highest response rate amongst our Network and Corporate functions

with 78.9% Administrative and Clerical staff achieved the highest response rate amongst our Staff Groups

of 66.8% Children’s and Young People’s Network achieved the highest response rate of the Clinical

Networks, of 58.8%. There is learning about how we encourage and enable clinically facing staff, particularly our nursing workforce to participate in the future. A lessons learned is being coordinated by the OD team to include communications, LiA and workforce information colleagues with additional feedback from key stakeholders. The purpose of this is to review the survey implementation plan and consider opportunities to strengthen this for next year.

5. LISTENING INTO ACTION The LiA advent calendar campaign ran through December following a #Hottopic that asked LSCFT teams to request clinical or team equipment that they needed. Staff submitted their requests via the LiA crowd fixing app, which were then reviewed and discussed with operational leads. A one off budget was set aside to purchase the items which were then delivered to teams. Equipment allocated includes: Musical instruments to the Chorley inpatient unit for therapy sessions New physical health equipment to North EiS, Adult ADHD, Community Falls Team and East

Lancs RiTT An extra breast pump for the Ribblemere mother and baby unit to help support mothers with

their decision to breast feed their babies Games and resources for the CAMHS team at Shawbrook House to increase engagement

during therapy sessions Funding to create a 1950s memory pod at The Harbour to evoke memories from the past for

our dementia patients. Festive selfies were taken of the teams receiving their ‘gifts’ from the ‘LiA Elf Squad’ and this fed into the overarching advent communications campaign on social media, Sharepoint and the LiA

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newsletter. This also served to remind teams about the procurement process and how to use local budgets appropriately to purchase essential equipment. The 15 LiA teams continue to progress with addressing their 3 priority actions with triumvirate leads providing strong leadership and unblocking any barriers. Triumvirate leads will come together on 15 January, which marks the half way point of the 20 week programme, to share progress. Awareness of the programme continues to be spread via the LiA newsletter and ‘Change Champions’ continue to support clinical leads to embed staff led change and share good practice with the next ‘Change Champions’ event planned for 28 January. 6. ICS UPDATE

The Trust has submitted its final plans to the ICS as part of developing a 5-year system-wide strategy. As advised previously, our plans are consistent with national guidance in relation to both the Mental Health Investment Standard, as well as national funding that is to be distributed to each ICS for mental health as part of the Long Term Plan. 7. CLINICAL STRATEGY UPDATE

Work continues to refresh the Trust’s strategy and central to this is the development of a Clinical Services Strategy. Following two successful workshops with our clinical staff, a set of principles have been developed, which describe the basis upon which all are services should be delivered. Staff from across the Trust have been invited to continue to shape these principles via discussion on an online platform. An update to the Trust Board was provided during December 2019. To supplement this work, the Trust is also engaging external support to assist in articulating clear intent and vision for our six major service lines (adult mental health, older adult mental health, children, learning disability and autism, community services including dental, specialist secure services). External engagement with service users and wider partners and stakeholders is continuing.

8. FUTURE NURSING STRATEGY

2020 is the year of the nurse and LSCFT will also be launching its nursing strategy. It will outline the priorities for the nursing workforce over the next three years including the development of a nursing career framework from apprentice to consultant nurse. The strategy will be underpinned by nursing values and compassionate leadership. A programme of monthly celebratory events is being developed and this will include a nursing conference to recognise the Year of the Nurse.

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9. FLU UPDATE

The Trust’s Infection and Prevention Control team continues to work hard to vaccinate our teams against the flu virus so that we can ensure staff wellbeing and patient safety over the cold winter months. Over the past few weeks there has been a significant increase in cases of flu with a number of outbreaks affecting schools, care homes and hospitals. Within the Trust, a small number of patients have been diagnosed with the virus with three wards being temporary closed. Whilst the vaccine is being offered to all colleagues, it is vitally important that as many frontline employees as possible are vaccinated as a means of preventing infection in our services and ensuring that we are keeping the most vulnerable members of the population safe. Every effort has been made to ensure that employees can get their vaccination flexibly around their schedules at various locations and these have been well advertised. In addition to this, peer to peer vaccination is also in place and flu vouchers have been issued so that staff can get vaccinated in their own time if they prefer. The current uptake is 67% for frontline staff and 57% for all staff. The vaccination rate of employees in South Cumbria has been recorded separately and the denominator of frontline staff is being calculated so that the percentage uptake rate for this locality can be identified. In total, 80% of employees need to be vaccinated to achieve the CQUIN that has been agreed with commissioners.

10. SECLUSION CONTINUOUS IMPROVEMENT GROUP WINS NHS ELECT AWARD The Trust’s Seclusion Continuous Improvement Group which brings together patients, carers and clinicians to help improve services has won the ‘Co-created Service Award’ in the national NHS Elect Patient Experience and Quality Improvement Awards 2019/2020. The ceremony is a celebration of projects that achieve great strides in increasing patient experience and care while improving efficiency. It also recognises and highlights good practice amongst NHS organisations. Two other services run by the Trust were also shortlisted for the finals of the awards. The Central Lancashire Moving Well Service was shortlisted in the ‘Excellent Teamwork Award’ category and the Blackburn & Darwen Pulmonary Rehabilitation Team in the ‘Patient Experience and Communications Award’ category. The Seclusion Continuous Improvement Group was formed following feedback from people with experiences of seclusion. The group, which has developed the programme, comprises current and former service users, their families and clinicians and has done some sterling work in listening to people we provide care to and their families, to improve the quality of care delivered. The Co-created Service Award recognises services that have been created together with patients, carers and clinicians.

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11. PHARMACY TECHNICIAN OF THE YEAR AWARDS One of the Trust’s Chief Pharmacy Technicians has been recognised as Pharmacy Technician of the Year by the Association of Pharmacy Technicians UK (APTUK). Sarah Green has received the award which acknowledges outstanding Pharmacy Technicians who have made a significant contribution to the profession by going above and beyond their day to day duties. Her work is also known nationally; Sarah has produced up to date guidance on the safe and secure handling of medicines. Michelle Walker, Rheumatology Pharmacy Technician for the Trust’s Moving Well Service, also received recognition, coming second in the Excellence in Pharmacy Practice award category for developing a new pharmacy technician role within a community based rheumatology service. 12. MOST INCLUSIVE EMPLOYER

Once again, LSCFT has reached a high place amongst other NHS Trusts that are demonstrating a diverse and inclusive workplace, being ranked 3rd in the UK’s Top 50 Employers. This is the fourth year in a row that the Trust has been listed, this time moving up another place and ranking 19 out of 50 organisations in the UK for outstanding efforts and commitment to attracting and retaining a truly diverse workforce. Compiled by a dedicated panel of judges, the list is collated based on organisations’ performance in a range of areas within the diversity arena including recruitment procedures, training and other diversity related initiatives. Our presence on the list is a really positive reflection of the hard work we’ve been doing to make our organisation as inclusive and accessible as possible for a wide range of people. There is always more that can be done to be even better and the work that we are progressing under LiA is supportive of this.

National Updates BOARD ACTION: Noting

13. POST ELECTION UPDATE

The Conservative Party secured an 80 seat majority in the General Election, returning 365 MPs. There are five new MPs across the Lancashire & South Cumbria area: Barrow in Furness, Simon Fell – Conservative (Outgoing John Woodcock IND) Blackpool South, Scott Benton – Conservative (Outgoing Gordon Marsden Lab) Hyndburn, Sara Britcliffe – Conservative (Outgoing Graham Jones Lab) Burnley, Antony Higginbotham – Conservative (Outgoing Julie Cooper Labour, and member of

the shadow health team)

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South Ribble, Catherine Fletcher – Conservative (Outgoing Seema Kennedy Con, former Public Health and Primary Care Minister.)

14. PERINATAL MENTAL HEALTH OUTCOMES MANUAL

NHS England/NHS Improvement have published a perinatal mental health outcomes implementation manual, as part of the ongoing work to improve access and outcomes for specialist perinatal mental health services.

NHSE/I commissioned the manual from The Child Outcome Research Consortium which co-produced the guidance with experts by experience, commissioners, service managers and trust data leads. It focuses on examples of good practice, tools, tips and information to help services embed appropriate routine outcome measuring, using measures which are already part of the Mental Health Services Dataset.

The Trust’s specialist perinatal service is now well established providing both inpatient services and community support across Lancashire and South Cumbria. Having this service locally has improved access and outcomes for mothers in Lancashire who previously would have had to travel outside of the area for this type of specialist care.

15. UK DEMENTIA DIAGNOSES RISE IN FIVE YEARS

Analysis of NHS data indicates that some parts of the UK have seen the number of people diagnosed with dementia more than double in five years due to a drive to increase diagnosis rates and an ageing population. NHS England have set the priority to diagnose dementia earlier so people could receive correct treatment. Across England, Wales and Northern Ireland, the number of people on the register has risen by 40% to around 508,000. James Hughes, Head of Alzheimer's UK has warned that Britain is facing an Alzheimer's "humanitarian crisis" because the care system is failing dementia sufferers and their families. Figures compiled by the charity have estimated that a million more people will be caring for someone with dementia in England by 2035. Currently, around 1.8 million carers in England are looking after someone with Alzheimer’s, with family members having sacrificed some three billion hours for dementia care in the UK since 2017, the charity estimated. In Lancashire and South Cumbria the percentage of the population aged over 65 is 19.9%, slightly higher than the national average for England which is 18.2%. Clearly, the work that we do with partners to implement the long term plan locally will need to ensure that support is in place for our ageing population and their carers.

16. 2020 IS THE YEAR OF THE NURSE AND MIDWIFE NHS England and NHS Improvement have earmarked 2020 as the ‘Year of the Nurse and Midwife’ to celebrate and renew perceptions of the professions.

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https://www.england.nhs.uk/wp-content/uploads/2019/12/Implementing-routine-outcome-monitoring-in-specialist-mental-health-services.pdfhttps://www.england.nhs.uk/wp-content/uploads/2019/12/Implementing-routine-outcome-monitoring-in-specialist-mental-health-services.pdf

The aim of the campaign is to encourage new people to join and existing staff to stay. To do this they will be using real stories to provide a snapshot and share good practice of the professions, throughout the year. These will be hosted on the NHS England and NHS Improvement website, and they may also be used as a starting point for media stories and interviews. LSCFT will contribute to the campaign by gathering stories and case studies from its nursing workforce.

17. FLU CASES HIGHER THAN LAST YEAR Reports from Public Health England indicate that the rate of hospital admissions for flu is ten times higher than this time last year (December.) Figures show that the flu hospitalisation rate is at "moderate intensity", with 5.06 cases per 100,000 people. The rate last winter did not rise above five cases per 100,000 people until the penultimate week of January, suggesting that this year, the flu season has arrived more than a month early. Here at The Trust we continue to promote the availability of flu clinics as per the update provided earlier in the paper with the aim of making it as easy as possible for employees to get protected. There has been some occurrences of the flu virus within services, however these have been well managed and contained. A full update about the Trust’s position in the context of the 80% target agreed with commissioners was provided earlier in the pack. 18. NHS DIGITAL DATA: MENTAL HEALTH BULLETIN 2018/19

The Mental Health Bulletin 2018-19 Annual Report published by NHS Digital indicated that 2,726,721 people in England were known to be in contact with secondary mental health, learning disabilities and autism services at some point in the year, 632,261 of these were under 18 years of age. This equates to 4.9% of people in England known to be in contact with secondary mental health, learning disabilities and autism services during this period. Within this, 3.8% (104,035) of people known to be in contact with secondary mental health, learning disabilities and autism services were admitted to hospital. Within Lancashire & South Cumbria, 110,350 people (of all ages) had contact with secondary services, with 1,710 admitted (2%). In terms of people under the age of 18, 22,335 had contact with services, 60 of whom were admitted. The full report and data can be accessed here.

19. NATIONAL TASKFORCE FOR MENTAL HEALTH, LD & AUTISM John Lawlor, Chief Executive of Cumbria, Northumberland, Tyne and Wear Foundation Trust, has been asked by NHS England to lead a national taskforce group charged with improving inpatient mental health, learning disability and autism services for young people. The NHS Long Term Plan sets out an ambitious programme to transform mental health services, autism and learning disability; with a particular focus on boosting community services and reducing the over reliance on inpatient care, with these more intensive services significantly improved and more effectively joined up with schools and councils.

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https://digital.nhs.uk/data-and-information/publications/statistical/mental-health-bulletin/2018-19-annual-report

The taskforce will seek to make a rapid set of improvements in care and agree a set of recommendations for next steps. The NTW review of the mental health pathway in Lancashire highlighted gaps in provision for these groups of patients. Therefore developments to these services are welcome and LSCFT will contribute to work locally to implement the requirements of the long term plan. 20. NHS PEOPLE PLAN

NHS England and Improvement have appointed a ‘Head of Flexible Working, Jane Galloway in support of the NHS People Plan, working within the “best place to work” programme. This serves to encourage more part-time work in the health service and is part of broader plans to ensure employees have more flexible careers and a better work/life balance. The appointment comes at a time when the Government is encouraging NHS leaders to introduce a new staff morale tracker which could potentially report every month as a means of regularly surveying staff morale. Concern has been expressed amongst NHS about how feasible this would be if it is to be carried out monthly. Here at LSCFT, LiA continues to be the vehicle used to deliver staff led change and achieve the associated culture shift. There continues to be good engagement at all levels of the organisation in the programme and the team also supported the promotion of the national staff survey to encourage uptake. The results of the survey are due next month and will serve to inform the next phase of the LiA journey.

21. NATIONAL VACANCIES Universities have warned the Government about nurse training shortfalls, citing the loss of the bursary. There are now 44,000 nursing vacancies and, separately, reports of a fall in health visitors and future reliance on nurse associates. LSCFT continues to be proactive in developing its future workforce; there are 65 Trainee Nursing Associates in training, with the next cohort of 23 due to qualify in June 2020 and two more cohorts in progress, liaison with the University of Cumbria to develop a Registered Nurse Apprenticeship (Mental Health and Learning Disability), appointment of Advanced Clinical Practitioner roles in the crisis care pathway, return to practice opportunities, participation in the National Global Learners Programme and the NHSI Retention Programme, and a new preceptorship programme. In addition to this, the Trust is exploring additional options for overseas recruitment of registered nurses in partnership with CNTW. Increasingly there will be a requirement for whole systems to work together to find innovative solutions to address workforce challenges.

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22. SYSTEM WORKING TO OVERCOME WORKFORCE CHALLENGES A place to work: system approaches to workforce challenges in the NHS shares case studies of how NHS Trusts and Foundation Trusts have worked with partners across the wider system to develop joined-up workforce solutions, support the workforce with system transformation, tackle challenges in recruitment and retention, and address skills gaps. Some of the innovative approaches highlighted include:

addressing broader workforce challenges by attracting people into the system and offering varied and flexible careers

making it easier for staff to move between organisations through rotation agreements, aligning terms and conditions, and 'passporting'

connecting staff banks to make better use of workforce capacity in a system and reduce agency spending

enabling staff to develop a sense of belonging to a place or system, helping to break down organisational siloes

utilising apprenticeships to join up staff training opportunities and develop skills for a 'place-based' approach to care.

In the Lancashire and South Cumbria health economy nurse recruitment is being developed through the Global Health Exchange Programme – all Trusts have taken part in an initial recruitment exercise with more than 200 offers of employment being made. Additionally, a programme called EPIC has been established to share and adopt best practice; celebrate the achievements of staff; and connect individuals and teams across the partners of Lancashire and South Cumbria Integrated Care System.

23. NHS OVERSPEND

The first half of 2019 has seen a £130 million overspend in the NHS. However, combined figures for providers and commissioners were £160m better than at the same point last year, according to NHS England and Improvement. 15% of PSF funding is contingent on the Lancashire and South Cumbria health system achieving its control total. There is uncertainty about the delivery of this given issues currently being flagged in the health economy.

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https://news.nhsproviders.org/52PX-4FLQ-13C7J6-2KXRC-1/c.aspx

Board of Directors Agenda Item TB 008/20 Date: 09/01/2020 Report Title South Cumbria Assurance Committee Chairs Report Prepared By Shannon Higginbotham, Quality and Assurance Manager Presented By Louise Dickinson, Chair of South Cumbria Assurance

Committee

Action Required Assurance Supporting Executive Director Chief Executive

PURPOSE OF THE REPORT: Report Purpose To provide an outline of the activity undertaken by the South

Cumbria Assurance Committee on the 20 December 2019

Strategic Objective(s) this work supports

To provide high quality services

Board Assurance Framework Risk 4.0 The Trust does not ensure safe and effective transfer of mental health, CAMHS and learning disability services into the Trust

CQC Domain Well-led 1.0 INTRODUCTION

This Chair’s Report outlines the activity undertaken by the Board South Cumbria Assurance Committee held on the 20 December 2019.

2.0 BOARD ACTION The Board of Directors is asked to note the content of the Chair’s Report for assurance

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MEETING: South Cumbria Assurance Committee DATE: 20 December 2019

RISKS: RISK

SCORE 4.0 The Trust does not ensure safe and effective transfer of mental health, CAMHS and learning disability services into the Trust 16

AGENDA ITEM COMMITTEE ACTION IMPACT ON

BAF RISK 4.0 (if applicable)

Action Tracker & Matters Arising To achieve the South Cumbria flu CQUIN target of 80%, only 21 additional staff were required to receive the vaccine. The current achievement was 76%. The 72-hour follow-up CQUIN was on trajectory for achievement. An options appraisal was due to be reported to the Executive Group and Trust Board in respect of the action to take on the Kentmere site. The two options were; to close the facility (because it is not fit for purpose) or to transform the unit into an acute 6 bedded facility to support step-down into the Community.

The Trust Board and Committee would receive an update in February 2020 on the decision around the use of the Kentmere unit.

4.0

Workforce Report There had been significant data challenges in respect of workforce data, in particular around staffing establishments versus vacancies and a specific challenge on ESR around mandatory training which had resulted in 5010 missing training entries, equating to approximately 510 attendances at training. Work was underway as part of an assurance activity to address these discrepancies.

The Committee flagged the significant data issues and need for accurate data to support assurance into the Committee. The Committee would receive an up to date workforce report with accurate data in January 2020.

4.0

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AGENDA ITEM COMMITTEE ACTION IMPACT ON BAF RISK 4.0 (if applicable)

Post Transfer Implementation Plan (Including CQC and CQUIN updates) Recruitment in medicines management was underway. The Trust’s Executive Group would be required to make a decision in respect of the mandatory training data discrepancies, to accept the due diligence training records as a baseline position. There was currently 8 overdue CQC actions in respect of the CPFT CQC report. 6 of these were on track for completion. 2 of these related to mandatory training trajectories and were linked to the mandatory training data discrepancies on ESR. The completion dates for these actions would be reviewed as part of a robust governance process. The CQC had notified the Trust of a historical case on Dova unit and the response to the CQC was due to be issued on the 20 December 2019. Previous investigations had been undertaken and no material evidence had been identified. The family remained unsatisfied and in response the Trust had commissioned Capsticks to undertake a review of the investigations which would be paid for by CPFT. The family had not yet responded to this proposal.

The Committee would receive an update on the Executive Group’s decision to accept the due diligence training records, in January 2020.

4.0

Performance Report The performance report had been presented to the Executive Group via the monthly performance meeting. An updated data pack would be provided to the Executive Group due to gaps and challenges with data in reflection of previous discussions. The Committee reiterated concerns around the data challenges. There was currently 6 incidents categorised as ‘catastrophic’ as the Trust currently reports death by physical illness within this categorisation. The outcome of the Niche review would support the Trust in redesigning its processes to accurately capture mortality and incidents data.

The Committee would receive an update on the action taken to address quality of information in January 2020. The Committee would receive an update on the plans and progress to improve quality of services at the February 2020 Committee.

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AGENDA ITEM COMMITTEE ACTION IMPACT ON BAF RISK 4.0 (if applicable)

There had been a significant reduction in OAPs. The Committee was concerned around the progress to improve quality of services in South Cumbria due to a lack of monitoring of these improvements. An integration Board was due to be implemented to support the establishment of the locality model. Commitments within the BTA Escalation to the Chief Executive and Chief Finance Officer in respect of the delays with NCIC signing the property transfer document had been actioned. This was now partially complete and minor delays remained. There was no associated risk.

The Committee would receive an updated table of progression against the commitments with the BTA in January 2020.

4.0

Capital Spend Update Good progress had been made since the last Committee and a safety prioritisation plan been developed and agreed with the Trust’s Safety team. This was reflective of the safety issues following the Trust’s internal risk assessments and was overseen by the Director of Nursing and Quality and Director of Improvement and Compliance. Work will commence on Dova and Ramsey units in January 2020 to address ligature concerns. Quick wins will commence on Kentmere in January 2020. There was some challenge in understanding how the full works will be delivered on inpatient units due to challenges with working in the live environment. A discussion would take place outside of the Committee to consider how access to units could be provided earlier. The Committee requested additional assurance that the safety prioritisation plans had been appropriately signed off and developed in line with the Trust’s internal risk assessments.

The Committee would receive an update at the January 2020 committee on any changes with the timescales of work. The Committee would receive the internal risk assessments that had been undertaken and approved to ensure the Committee was assured on the process.

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Integration into the Bay Locality model An integration Board was due to be implemented in the early New Year to support progression with integration into the locality model.

The Committee would receive a comprehensive update on the integration into the locality model in February 2020.

4.0

Outcome of the Lessons Learnt review As part of the findings of the lessons learned review, it had been agreed that the current mobilisation SOP would be completely refreshed and enhanced, to support future transactions. This would include key areas such as the governance structure, planning time, dedicated resource, and information on assessing the quality of due diligence. CNTW had also undertaken a review of lessons learned and the findings of this would be built into the Trust’s findings to support integration. To ensure that all recommendations were implemented, an action plan would be developed and monitored by the Committee.

The Committee would receive an update on any additional recommendations following the outcome of the CNTW lessons learned review. The Committee would receive an update on the action plan developed to support delivery of the recommendations.

4.0

South Cumbria Mobilisation Board Update The Director of Improvement and Compliance had attended the South Cumbria Mobilisation Board and provided assurance on the work undertaken by the Trust via the South Cumbria Assurance Committee chairs report to the Board. The Mobilisation Board had requested additional assurance on the CQC action plan and workforce risks.

The Committee noted the update.

4.0

Board Assurance Framework The Board Assurance Framework risk 4.0 would be updated to reflect the workforce data risks and concerns around the monitoring of improvement in the quality of services.

The Committee would receive an update at the February 2020 Committee if there had been no

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The Committee requested assurance on the risks within the remit of medicines management. The Head of Operations for South Cumbria advised the Committee that improvements in this area was underway.

improvement in medicines management risks.

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Board of Directors Agenda Item TB 009/20 Date: 09/01/2020 Report Title Quality and Performance Report (QPR) Prepared By Joanne Moore, Director of Partnerships and Strategy Presented By Russell Patton, Director of Operations Action Required Noting Supporting Executive Director Director of Operations

PURPOSE OF THE REPORT: Report Purpose To appraise the Board of Directors of key elements and

themes from the Month 8 QPR

Strategic Objective(s) this work supports

To provide high quality services

Board Assurance Framework Risk 2.0 The Trust does not deliver safe, appropriate and therapeutic environments to deliver high quality services

CQC Domain Well-led 1.0 INTRODUCTION The Board of Directors are asked to note the QPR for month 8 with the following comments below:

The Trust is compliant with 8 of the 11 current NHSI metrics in month 8: o Inappropriate OAPs continues to exceed the current trajectory (which was agreed at the

start of 18/19). The number of OAPs occupied bed days increased in month 8 coinciding with increased demand for inpatient admissions and following the trend started the previous month. Indications from weekly monitoring suggest that the increase in demand seen in month 6 is being maintained into November. Actions to improve the OAPs position are being progressed as part of the system-wide action plan developed to respond to the NTW review. The Mental Health Improvement Plan Update paper, presented by the Executive Director of Operations, provides the detailed update on the action plan

o IAPT Recovery returned to above the target of 50%, Whilst IAPT Recovery is reported here on a monthly basis it is a quarterly target so there is opportunity to achieve the Quarter and early indications for December suggest that this will be achieved.

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o The latest position available (August 2019) of the Data Quality Maturity Index (DQMI), reported by NHS Digital, shows the Trust is non-compliant against the 95% standard (and the 90% - 95% for the CQUIN achievement). The DQMI measures our performance against data submission to 36 fields. Due to lack of overall alignment with our systems to the national dataset, and the partial roll out of RiO (RiO PAS rolled out only) this is proving to be a complex, challenging piece of work. Currently there are 20 fields at 90% or above. Actions are in place to address each area, and based on the current assumptions of the impact of our interventions, it is expected that the minimum CQUIN standard may be achieved from Q3 onwards, however payment mechanisms are such that there is a risk to financial achievement for the year.

As agreed with the regulator and Trust Board, South Cumbria metrics are presented separately in

a dashboard under the Summary Dashboard section (page 10) and the combined performance for Lancashire and South Cumbria is presented in dashboards on page 12. It should be noted that due to the small numbers involved that S Cumbria failed the 7 Day Follow Up target for the 3rd consecutive month, but this performance did not impact on the Trust’s overall pass.

In line with the planned introduction of SPC methodology into the HR section of the QPR, SPC icons are now available on the Sickness and Training run charts. Alongside the introduction of SPC, a review of the content has been undertaken with positive feedback received. In response to feedback, references have been added at the side of the summary dashboards as to where additional narrative can be found. Further work will be undertaken with the new