BOD 54/2019

Meeting of the Oxford Health NHS Foundation TrustBoard of Directors

Minutes of a meeting held on 25 April 2019 at 09:30

Unipart Conference CentreUnipart House, Garsington Road, Cowley, Oxford OX4

2PG

Present:1

David Walker Trust Chair (the Chair) (DW)John Allison Non-Executive Director (JA)Jonathan Asbridge Non-Executive Director (JAsb)Stuart Bell Chief Executive (SB)Tim Boylin Director of HR (TB)*2

Sue Dopson Non-Executive Director (SD)Mark Hancock Medical Director (MHa)Dominic Hardisty Chief Operating Officer (DH)Chris Hurst Non-Executive Director (CMH)Mike McEnaney Director of Finance (MME)Aroop Mozumder Non-Executive Director (AM)Kate Riddle Acting Director of Nursing & Clinical Standards (KRi)Kerry Rogers Director of Corporate Affairs & Company Secretary

(KR)*Lucy Weston Non-Executive Director (LW)

In attendance3:Donna Mackenzie-Brown

Patient Experience & Involvement Manager - part meeting

Stephen Moore Practice Manager – Luther Street Surgery – part meeting

Julie Pink Community Involvement ManagerHannah Smith Assistant Trust Secretary (Minutes)

1 Quorum is 2/3 of the whole number of members of the Board (including at least 1 NED and 1 Executive) i.e. where voting members of the Board are 13 (from March 2019), quorum of 2/3 with a vote is 9 2 * = non-voting3

Public

BOD56/19a

b

c

Welcome and Apologies for Absence

The Chair welcomed members of the Board present, staff and members of the public observing and the governor (Davina Logan) who had attended to observe the meeting.

Apologies for absence were received from: Bernard Galton, Non-Executive Director; and Martyn Ward, Director of Strategy & Chief Information Officer.

The Chair congratulated the Chief Operating Officer on his promotion to Chief Executive at Avon & Wiltshire Mental Health Partnership NHS Trust.

BOD 57/19a

b

Patient Story

The Patient Experience & Involvement Manager, the Luther Street Practice Manager and a Luther Street service user joined the meeting. The service user set out her experiences of using the Luther Street surgery after she had experienced homelessness and subsequently been housed in supported accommodation. She expressed appreciation for how well the Luther Street surgery worked with other organisations in the Oxfordshire Mental Health Partnership. She explained how the Luther Street surgery had been a foundation point of her recovery which had: understood her specific needs, including physical and mental health care (and had provided access to services such as dentistry and podiatry); and provided a safe and consistent environment. She noted that the staff were compassionate but had also held to professional boundaries; she explained that this had been useful for her when she was going through a recovery process and had needed to step away from old habits whilst also accessing appropriate support. She had been held to be responsible for her actions but had not felt blamed for her situation; she felt that the balance of responsibility without blame which the staff had maintained meant for good care for service users who could be in chaotic situations. She had also become the chair of the Luther Street Patient Participation Group in recent years and she described the experiences of other service users who chose to return to the Luther Street surgery, noting that they felt that the GPs there genuinely cared about them and they were not just another number in the system.The Board discussed the service user’s current situation and living arrangements with her, noting that she also engaged

2

Public

c

d

with the Complex Needs Service and had joined STARS (Support, Training and Recovery Systems) to deliver training alongside clinicians. Within six months of leaving supported housing, she would need to leave the Luther Street surgery. Stephen Moore noted that Luther Street would support her to integrate with another GP surgery. The meeting discussed: healthcare for the homeless (and the importance of partnership working with the police and other agencies); access to GPs for the homeless; and contact between various GP surgery participation groups. Whilst the service user had not yet had the chance to attend a national Patient Participation Group meeting, Stephen Moore noted that there was the opportunity to do so.

John Allison referred to his visit to the Luther Street surgery, noting that his visit had been consistent with the experiences described by the service user and that he had been impressed by staff morale; he recommended that other colleagues also visit the service.

The Board thanked the service user for her story and Luther Street staff, including Stephen Moore.

The Patient Experience & Involvement Manager, the Luther Street Practice Manager and the service user left the meeting.

BOD58/19a

b

Declarations of Interest

The Chair presented the report BOD 40/2019 which set out the Register of Directors’ Interests and summarised recent changes.

The Board received the report.

3

Public

BOD 59/19a

b

c

d

e

Minutes of the Meeting held on 27 March 2019

The Minutes of the meeting were approved as a true and accurate record.

Matters Arising

Item BOD 43/19 Performance reporting – impact of waiting times

The Medical Director confirmed that he had received a draft report on waiting times from the Deputy Chief Operating Officer and this would be reviewed before presentation.

Item BOD 45/19 Inpatient Safer Staffing targets

The Acting Director of Nursing & Clinical Standards reported that the Trust’s targets were based on national targets originally set by the national quality board. Although the targets for weekly day and night fill rates were 85%, the Trust aspired to achieve more.

The Board noted that the following actions were to be progressed: BOD 05/19(c) – Performance Report data being checked prior to submission for publication; BOD 44/19(f) – Whistleblowing cases to be presented to a future Board meeting in private; and R&D focus at a future Board Seminar (after July 2019).

The Board confirmed that the following actions had been progressed: BOD 41/19(d) Winter Director scheduled to present at the May Board Seminar.

MHa/KRi

BOD 60/19a

b

Chief Executive’s Report

The Chief Executive added his congratulations to the Chief Operating Officer on his promotion.

The Chief Executive presented the report BOD 42/2019 which provided updates on: recent national and local issues; and legal, regulatory, compliance and policy matters.

Mental Health Funding

4

Public

c

d

e

f

The Chief Executive referred to his report and noted that progress was being made to address the issue of historic underfunding of mental health services in Oxfordshire, sufficient to allow the Trust to accept its Control Total for 2019/20. However, the challenge was to achieve a recurring solution so as to balance demand with capacity and establish a sustainable service portfolio. The Trust’s ability to fund Crisis Resolution/Home Treatment teams was dependent upon achieving a stable and sustainable funding situation; funding for this had been agreed in Buckinghamshire and the Trust aimed to bring a similar service to Oxfordshire if the underlying financial position could be secured. In both counties however, he noted the need to develop an improved response to the needs of people with ADHD, Autism and mental health comorbidities.

New Care Models

He referred to his report and added that although the Forensic New Care Model had achieved significant success in its pilot phase, there had also been increased pressure on services which had not been fully anticipated. However, the Trust had coped well and was moving towards taking on more delegated commissioning responsibilities; the Trust was participating in three other New Care Models, including specialist dentistry.

‘Winter’ model of collaboration for community and urgent care

He referred to his report and highlighted that the improved management of ‘Winter’ in Oxfordshire supported the case for developing the ‘Winter’ model of collaboration into a more lasting urgent care approach for the future. He noted that the work which had been taking place on developing the Oxfordshire Care Alliance would be adapted into the development of Primary Care Networks, as described in the NHS Long Term Plan.

Workforce – Gender Pay Gap data

He referred to his report and the publication of the Trust’s Gender Pay Gap data for 2017/18. He explained that in order to comply with IR35 tax legislation, the Trust had needed to bring high cost roles such as Out of Hours GPs and specialist

5

Public

g

h

i

j

consultants onto its payroll. This had contributed to the Trust’s Gender Pay Gap figure increasing significantly from the previous figure, although the Trust was still broadly in line with other local NHS trusts. The Trust was also working on ethnicity pay gap data.He referred to EU exit planning and noted that the potential long term impact upon staffing should not be forgotten despite the extension of the Article 50 period.

Healthcare providers’ strategic direction

He reported that he had attended the Oxford University Hospitals NHS FT (OUH) strategy planning day and noted the degree of convergence between the strategies of both organisations and emphasis upon team working and understanding patient experiences. He noted that it may be beneficial to discuss further how the organisations’ strategies could align and to achieve a mutual understanding of both organisations’ objectives and that this strategic collaborative thinking could be extended to Buckinghamshire also.

System integration

He referred to his report and the focus of the Buckinghamshire, Oxfordshire and Berkshire West Sustainability and Transformation Partnership (the BOB STP) on the development of plans to enable Oxfordshire to reach Integrated Care System and Primary Care Network maturity. The Chair asked about BOB STP progress to appoint an independent chair. The Chief Executive confirmed that this post was being advertised and that the debate as to whether the post should be held by someone with no local connections had been resolved such that it could be open to a local candidate or a local Non-Executive Director. He added that the STP stakeholder group was seeking Non-Executive Director participation. The Chair supported one of the Trust’s Non-Executive Directors attending.

The Chair asked about a strategic response to the creation of Primary Care Networks, noting the opportunities for the Trust to help to shape that process. The Chief Executive replied that he had been designated as Chief Executive lead in the Oxfordshire system for the development of Primary Care Networks and, as referred to at item BOD 60/19(e) above, the Trust’s work on developing the Oxfordshire Care Alliance had been a useful precursor and would be adapted into the

6

Public

k

l

m

development of Primary Care Networks. He noted potential challenges for the Primary Care Networks in dealing with: (i) funding flows, and the high level of scrutiny which could come with these; and (ii) local differences between various neighbourhoods, for example the variation in attendance rates at Accident & Emergency between different neighbourhoods, and the impact this could have upon the wider system. He suggested that at a strategic level, it may be necessary to take some risk in developing more effective pathways of care in order to unlock resource but that individual GP practices may not be most securely placed to do this.

The Chair asked about the risk of demand/volume of business increasing further and whether a more structured risk response would be put in place. The Chief Executive agreed that this should be done once the leadership of Primary Care Networks across Oxfordshire was known. He noted the direction of travel towards working in partnership especially with OUH and GP federations. The Chief Operating Officer added that Oxfordshire CCG had convened several workshops which had been attended by the Winter Director/Service Director and which had started to discuss how responses at practice and neighbourhood levels may develop.

Aroop Mozumder asked whether formal changes were anticipated to the way in which services, such as Out of Hours GP services, were commissioned. The Chief Executive replied that funding flows may change and involve Primary Care Networks directly; he recommended establishing a partnership model of working at the outset, similar to that which had been established with the Mental Health Partnership.

The Board noted the report.

BOD 61/19a

b

Performance Report and Operational Perspective

The Chief Operating Officer thanked the Board for their congratulations and expressed that it was a privilege to work at the Trust and to have been mentored by the Chief Executive.

The Chief Operating Officer informed the Board of a fire incident on a ward in the forensic service during the week;

7

Public

c

d

e

this had been started by a patient but the Fire Service had been on site quickly. The ward had been evacuated overnight but was now operational with local repairs required to one room. He praised the Head of Nursing for Forensic Services for her management of the situation.The Chief Operating Officer presented the report BOD 43/2019 and highlighted:

the risk rating columns which had been included in the main body of the report against the various Key Performance Indicators (KPIs). He explained that the Board was invited to comment upon whether this was useful to understand the impact and likelihood; and

an overall picture of ongoing significant pressures in Adult Mental Health services, especially in Oxfordshire and Children’s services. The underlying causes were lack of funding and staffing gaps; plans were in place to mitigate these but whilst the risks could be managed, the situation could not necessarily be remedied.

Form and content of reporting

The Board discussed the report and whether it highlighted strategically vital indicators or movement in indicators. John Allison commended the covering report for succinctly highlighting key points but noted that there was too much detail in the main body of the report and that rating the KPIs by significance may be more useful than including risk ratings. The Chief Operating Officer cautioned that the detail should be available to Board members and if not at a Board meeting in public then the Board would need to take assurance via delegation to one of its Board sub-committees. The Chair noted that the Board needed to be assured that there was a process by which this information was assessed. The Board discussed the timing of reporting against the current scheduling of committee meetings and the amount of business which currently needed to be fitted into committees. Chris Hurst reminded the Board of the balance to be struck between a Board which could become too tied down by detail and the risks posed by a Board which did not know what was going on. He noted that moves towards more electronic working and development of systems which could drill down into the detail of data, if it was required, may put the Board into a stronger position to achieve this

8

Public

f

g

h

balance.

The Board discussed the volume of indicators which still needed to be included in reporting. The Chair suggested reporting on an exception basis and focusing on the amber or red rated; however, he also acknowledged that regulators may require Board processes to include and evidence review. The Chief Executive recommended that the Trust should continue working with commissioners to further reduce the overall volume of indicators against which the Trust was required to report as this added a bureaucratic burden. He noted the difference between information and indictors used to improve care and those required to report against contractual performance. The Director of Finance cautioned that reducing the amount of information available may not be feasible in the world within which the Trust operated; year on year more information may inevitably become available but if this was recognised then the next step would be to put in place systems to collect, manage and prioritise this data so that it could be processed as efficiently as possible.

The Director of Corporate Affairs & Company Secretary reminded the Board that it needed to bring together its thinking and reporting from Performance, Quality & Safety, Workforce and Finance especially in order to achieve a comprehensive picture of the impact upon patients; otherwise, the Board would continue to debate the volume/type of information included in Performance reporting. She noted that integrated reporting had been an ambition for the Board, including through the Well Led development plan, and that work was taking place to start to triangulate some of this.

Delayed Transfers of Care (DToCs)

Jonathan Asbridge referred to the covering report and the number of bed days which had been lost this year due to DToCs, noting that this had equated to 7 mental health beds and 42 community beds. He asked whether the position had deteriorated. The Chief Operating Officer replied that the position had been worse as formerly there had been periods when this had equated to up to 60-70 beds. Although previously at best up to 25-30 beds had been impacted, he emphasised that even 25-30 beds were too many. Issues remained with sourcing sufficient domiciliary care to provide step-down pathways for patients through OUH’s HART (Home

9

Public

i

j

Assessment Reablement Team) service, despite efforts to resolve these, but he noted that there had been material system changes which may ultimately lead to resolution.Out of Area Treatments/Placements (OATs/OAPs)

Jonathan Asbridge referred to national focus on substandard care from sub-contracted providers and asked whether the Trust conducted due diligence into those providers to whom it transferred patients on OATs/OAPs. The Chief Operating Officer confirmed that the Trust did and that Care Quality Commission (CQC) ratings were also considered carefully; a care coordinator would also liaise with the third party provider with a view to repatriating the patient as soon as possible. The Acting Director of Nursing & Clinical Standards added that the Trust also worked closed with NHS England if there were any concerns around safeguarding incidents. The Medical Director noted that the Trust also had a list of preferred placements although it was sometimes not possible to secure these places at times of urgency. Jonathan Asbridge asked if the views of repatriated patients were sought. The Chief Operating Officer replied that an information governance issue had been identified with obtaining patient feedback if they were classified as under another organisation’s care, however the Patient Experience & Involvement Manager had been working on seeking consent to sharing care information. The Chief Executive noted the further complications when placements were funded through specialist commissioning arrangements or local authority placements when the Trust would have less agency or decision-making authority over where a patient may be sent; however, New Care Models would afford the Trust more agency and decision-making authority.

The Chair summarised the discussion on the likelihood of the volume of performance data continuing to increase and the need to develop intelligence systems to handle it; the importance of systemic data on the provider health economy; the (system) position on DToCs; and the quality of placements for OATs/OAPs.

The Board noted the report.

BOD 62/19a

Human Resources (Workforce Performance) Report

The Director of HR presented the report BOD 44/2019 which set out workforce performance indicators and updates on:

10

Public

b

c

d

e

f

the position on the NHS 3-year pay deal; temporary staffing spend and the Healthcare Assistant (HCA) agency reduction project; Nurse Associates; recruitment and retention (including the go-live of the TRAC recruitment system); management of concerns (whistleblowing); health and wellbeing; sickness; turnover (leavers’ data not internal moves); and Workforce Race Equality Standards (WRES).

He highlighted that the TRAC recruitment and candidate management system was already in use in other NHS organisations, would take an element of risk away from the existing database process and provide an opportunity to improve the Trust’s website-offering for candidates and remove reliance upon NHS Jobs (although the system would link with NHS Jobs).

He reported significant recruitment to the staff bank which now included over 2,000 people of which 1,400 were substantive staff available for extra work through the bank. However, although the staff bank continued to grow it had not yet resulted in a reduction in overall agency spend. Agency reduction was therefore part of the Cost Improvement Programme plan for 2019/20, as set out in the covering report on p.3.

Further to the reference to Gender Pay Gap reporting at item BOD 60/19(f) above, he added that although a Gender Pay Gap had not been found at individual levels/pay bands, when the overall workforce was considered, there was a mean average gap of 20%. The ethnicity pay gap work which had taken place had highlighted no pay gap at an overall level but within categories of staff groups, ethnicity pay gaps had been identified. Further work was taking place to analyse whether these were reflective of society but benchmarking was difficult as few organisations yet published ethnicity pay gap data.

Lucy Weston noted that although it was reassuring that a Gender Pay Gap had not been identified within pay bands, the Trust should not be complacent about the gap across bands.

Lucy Weston referred to the main body of the report and the slide on the HCA agency reduction project which referred to the increase in temporary staffing hours used in inpatient units not being reflected in the number of additional shifts

11

Public

g

h

i

recorded (with the steep rise possibly being due to substantive employees working flexible shifts whilst taking annual leave from their substantive posts). She expressed concern that staff may be working bank shifts whilst on annual leave and not taking appropriate rest/annual leave. The Director of HR replied that safeguards were built into the system to ensure that staff received a minimum level of annual leave and around their ability to book shifts. He added that where some staff were entitled to more than the minimum and wanted to, or were determined to, work then it was preferable that they worked for the Trust than elsewhere. John Allison supported staff being able to make informed judgements about preferring to work, subject to due legal compliance.

The Director of Corporate Affairs & Company Secretary noted that Bernard Galton had submitted a comment on the draft Annual Report that it was useful that the draft Annual Report had presented sickness absence data in days rather than percentages; he had suggested that the same approach be applied to the monthly workforce report to the Board. John Allison added that whilst it was possible to cost days lost, this was less feasible with percentages. The Director of HR replied that it was easier to measure sickness absence for part time workers in percentages rather than days lost.

The Chair referred to the April Board Seminar on Equality, Diversity & Inclusion, including review of the Staff Survey, and thanked the Director of HR for this and noted that the Trust was committed to organising an event involving colleagues with disabilities, especially hearing impairments.

The Board noted the report.

BOD 63/19a

Inpatient Safer Staffing Report – 25 February to 24 March 2019

The Acting Director of Nursing & Clinical Standards presented the report BOD 45/2019 which provided an exception report and assurance that sufficient staffing levels were in place to deliver safe, effective and high quality care. The report also included an update on Community Hospitals’ registered nursing vacancies and provided assurance that action was being taken in response to the action from the CQC Well Led inspection that efforts should be made to reduce the level of vacancies, particularly of qualified nurses.

12

Public

b

c

d

e

f

Average weekly daytime fill rates for registered and unregistered staff remained above the national target of 85% at 95% for registered staff and 91% (marginally up from 90%) for unregistered staff. Average weekly night time fill rates had also remained above the Trust target of 85%. However, 4 wards had been below the 85% target for average daytime fill rates for registered nurses (an increase from 2 in the previous reporting period) but all wards remained safe to deliver care. She highlighted particular challenges for:

City ward in relation to: unregistered staff as City ward had only an average weekly fill rate of 69% for unregistered staff; and vacancies at Band 5 level (pressures were being managed through reducing bed capacity); and

forensic wards which, as per p.7 in the report, were below the average 50% skill mix in registered nursing. A Recruitment and Retention premium had been introduced from April 2019 to incentivise new staff and enhance retention of existing staff.

Agency usage had increased slightly to 11.5% (from 11.3%). There had been a decrease in sickness absence for ward staff to 5.2% (from 5.8%).

She referred to the focus in the report on Community Hospitals’ registered nursing vacancies at p.5 and noted the static position of vacancies on the Stroke Rehabilitation Unit in Abingdon; she explained that there had been some workforce issues following the change period and the unit was therefore running at 16 beds rather than the full potential of 20 beds.

In relation to recruitment activity, she referred to pp.6-8 in the report and noted that international recruitment beyond the EU was being considered and that a further recruitment event had been undertaken at Oxford Brookes University. However, despite this activity, availability was not sufficient to meet the need for staff arising from vacancies and demand.

Aroop Mozumder reported that the Audit Committee meeting on 23 April 2019 had received the Internal Audit review on the Buckinghamshire Directorate and raised concerns about

13

Public

g

findings in relation to: lack of capacity planning; and missing census data which hindered safer staffing processes. The Director of Finance added that the Executive had not yet had the opportunity to discuss this more fully. The Acting Director of Nursing & Clinical Standards added that she would discuss in more detail with Aroop Mozumder outside of the meeting. The Chief Operating Officer added that he had finalised the review together with the Buckinghamshire Service Director and the Clinical Director; the demand and capacity findings were correct and this was a known issue which was getting closer to resolution but was not there yet. He confirmed that the Internal Audit review of the Buckinghamshire Directorate would be discussed with the Executive.

The Board noted that the report and that the Internal Audit review of the Buckinghamshire Directorate would be discussed with the Executive.

DH/MME

BOD 64/19

a

b

c

Complaints and Patient Advice & Liaison Service (PALS) annual report 2018/19

The Acting Director of Nursing & Clinical Standards presented the report BOD 46/2019 which set out the annual report on Complaints and PALS activity, including over 3,000 compliments received. Despite the significant number of contacts received by the team, she highlighted that there had been a 7% decrease in complaints and a 39% decrease in PALS contacts. She referred to p.6 of the report for a sample of actions taken arising from complaints’ investigations. She noted that there continued to be a high number of requests from directorates to extend timeframes on complaints investigations; this was symptomatic of unavailability of staff to undertake investigations due to annual leave, sickness or current work pressures. When extensions were requested, she confirmed that these were negotiated with complainants to ensure that they understood the reasons and agreed the extensions.

Chris Hurst expressed concern at the average of 70 days taken to respond to a complaint and noted that although he recognised that staff were under pressure, this could represent 70 days before relevant learning in relation to clinical processes was picked up. The Medical Director replied that all new complaints were reviewed weekly and any that indicated a clinical concern could be escalated for a

14

Public

d

e

clinician to review the actual care.John Allison noted his particular interest in this area and commented that despite issues with availability of staff to undertake investigations, the process was working well; that 52% of complaints had elements which were upheld indicated objectivity.

Lucy Weston referred to the most common categories of complaints and expressed surprise that 179 cases had related to staff attitude/behaviour; she noted the importance of staff attitude, especially further to the Patient Story from the Luther Street service user at item BOD 57/19 above. She asked whether these cases related to isolated individual incidents or were a wider issue. The Acting Director of Nursing & Clinical Standards replied that if they related to a specific staff member then they would be considered further to identify whether this could be an issue with an individual or a team; complaints review panels were also available to undertake deep dives into particular cases. She added that staff who were under pressure may also not respond ideally in some situations. The Chair noted that it could be meaningful to distinguish between complaints which arose from inadequate resources from those which arose from failures of service delivery or quality which could apply regardless of resources.

The Board noted the report.

The meeting took a short break at 11:00 and resumed at 11:15.

BOD 65/19a

Quality and Safety Report: Incident, Mortality and Patient Safety

The Acting Director of Nursing & Clinical Standards presented the report BOD 47/2019 and highlighted:

the increase in the number of medication administration incidents reported by Adult mental health wards;

themes for learning identified from reviews of unexpected deaths including physical health care for mental health patients, involvement with families, communication at points of transition and awareness of sepsis for learning disability patients; and

the need to ensure timely completion of actions from

15

Public

b

c

d

e

Serious Incidents. Further to action taken by the Patient Safety Service Manager, outstanding actions had reduced in recent weeks.

She referred to the report and highlighted areas of good practice summarised on the coversheet, in particular that: incident reporting levels continued to be positive which suggested a learning culture in the Trust; and most incidents resulted in no harm (62%) or minor harm (27%) which was in line with the national picture.

Lucy Weston referred to p.8 of the report and the high number of incidents reported by Ruby ward. She noted that the Board and the Council of Governors had received presentations this year on the improvements being undertaken on the ward and asked whether the incidents reported indicated that challenges were returning. The Acting Director of Nursing & Clinical Standards replied that there were still challenges with the particular patient group and the reporting presented did not extract detail in relation to whether incidents were linked to individual patients who might be particularly challenging.

The Chair referred to the control chart at figure and asked about the significance of the increase in incidents reported. The Acting Director of Nursing & Clinical Standards noted that an upwards trajectory of reporting of incidents was positive and that she would be more concerned if people had not felt able to report incidents.

Jonathan Asbridge noted that the Stroke Rehabilitation Unit in Abingdon had featured in a number of reports to this meeting, including this report and the Safer Staffing report at paper BOD 45/2019. He suggested that the Quality Committee consider the Stroke Rehabilitation Unit at Abingdon in more detail. The Acting Director of Nursing supported this as the unit had undergone recent change and some issues had been reported.

Aroop Mozumder referred to the incidents of violence and aggression against staff and asked if there was more which could be done from a HR or Trust-wide perspective; he noted the challenge that such behaviours could cause to staff retention especially on wards such as Ruby. The Chief Executive agreed that there may be more which could done and noted that the Trust had been in contact with East

DH

16

Public

f

London NHS FT following their improvement work to tackle racial abuse of staff; he emphasised that the message to staff was that this was not acceptable behaviour and that staff would be supported. He noted that work was taking place on Ruby ward to look at staff and patients working in partnership. He added that adolescent units also tended to have the highest instances of incidents of aggression and this was common across the NHS. Whilst this was not acceptable, persistent work was required in order to shift the culture. The Director of Corporate Affairs & Company Secretary noted that there was also significant national focus upon violence reduction from the Department of Health and from the CQC. The Director of Corporate Affairs & Company Secretary asked if the Board could in the future receive a staff experience story from a member of staff who had been impacted by an incident relating to violence or aggression; the Acting Director of Nursing & Clinical Standards confirmed that could be scheduled.

The Board noted the report and that a future Staff Experience Story would come from a member of staff who had been impacted by an incident relating to violence or aggression.

KRi

BOD 66/19a

b

Finance Report

The Director of Finance presented the report BOD 48/2019 which summarised the financial performance of the Trust for March 2019 (Month 12, FY19). The Month 12 position was an Income & Expenditure (I&E) deficit of £6.8 million which, after adjustments, was an underlying performance deficit of £8.4 million and £7.5 million adverse to the Trust’s Control Total and plan. The position was still, however, an improvement on the reforecast position. He reported that last week NHS England had also confirmed that the Trust would receive a share of unallocated Provider Sustainability Funding of just over £1 million and this would improve the deficit position to closer to £5.7 million.

EBITDA (Earnings Before Interest, Taxation, Depreciation and Amortisation) was £4.8 million which was £10.8 million adverse to plan. The Trust continued to be under severe operational pressures in mental health services in particular. Overspend continued in relation to OATs/OAPs and residential care in Adult services as well as in Oxfordshire Child & Adolescent Mental Health Services (CAMHS).

17

Public

c

d

e

However, he highlighted: good work in Oxfordshire to bring OATs/OAPs almost back to budgeted level; Community services had delivered within the original plan (not just the reforecast plan); and savings from the Forensic New Model of Care which had contributed towards the Cost Improvement Programme (CIP). In relation to CIP, cost improvements of £8.5 million had been delivered, of which £7.4 million were non-recurring, against a year-end target of £6 million.

The cash balance had improved to £20 million which was £6.4 million ahead of plan. He highlighted that this was a positive position, especially given the I&E deficit, and that the reasons for the improved cash position were: the reduced capital plan (capital expenditure was £6.7 million); decreased spend; improved working capital management; and a high level of year-end creditors. The Use of Resources risk rating however remained an overall ‘4’ (where ‘1’ was the best rating/low risk and ‘4’ the worst/high risk) with individual ‘4’ ratings against the metrics for agency spend, I&E margin and capital service cover.

The Chair referred to national reporting on the Treasury having refused to meet on-costs for Trust with local authority contracts and asked if this would impact the Trust. The Director of Finance replied that this was relevant for up to £0.7 million which had been allowed for in costs.

The Board noted the report.

BOD 67/19a

b

c

Operational Plan 2018/19 – Q4 report

The Chief Executive presented the report BOD 49/2019 which provided an update on delivery against the Operational Plan. He noted that it reinforced the issue with increasing numbers of referrals and high demand.

Lucy Weston referred to achievement against Quality Priority 3.1 (to reduce patient violence and aggression) and noted that this was marked as close to target which did not correspond with the Incident, Mortality & Safety report at paper BOD 47/2019 and the discussion at item BOD 65/19(e) above. The Chief Executive replied that the Quality Priority was specifically focused upon Adult acute mental health wards.

Aroop Mozumder noted the increasing referrals especially for

18

Public

d

CAMHS in Oxfordshire and asked why Buckinghamshire was different, whether there had been a change in GP referral behaviour or other factors. The Chief Executive replied that further to investment in new services for CAMHS, some increase in referrals was anticipated but the Oxfordshire figure was still strikingly large and ahead of funded capacity. The Director of Finance noted the importance of reduction in activity levels being a key goal and objective for 2019/20. The Medical Director noted that clinical teams were reporting increased levels of morbidity in the patient group. Lucy Weston added that there could be issues with the referral process relating to duplication of effort, misinformation and complexity. The Chief Executive agreed that there could be unnecessary complexity in the way different services were commissioned in Oxfordshire and that the development of an Integrated Care Sub-system focused upon children and young people may be helpful in resolving this.

The Board noted the report.

BOD 68/19a

b

Community Involvement update report

The Director of Corporate Affairs & Company Secretary introduced the Community Involvement Manager and the report BOD 50/2019 on progress and developments with volunteering, the Oxford Health Charity and community engagement. The Director of Corporate Affairs & Company Secretary highlighted the contribution of Corporate Affairs to care and delivery of care for staff and patients, noting the impact that this had had upon issues discussed at Board such as workforce capacity, time to spend with service users, quality of environment and patient space. She noted the achievements of the Community Involvement Manager who had only recently had the support of a Band 3 administrator.

The Community Involvement Manager highlighted achievements:

the doubling in numbers of volunteers (currently 100-140 people, with some still in recruitment processes) since she had arrived;

the work of 15 volunteers in urgent care units to support patients coming in with high levels of stress;

the significant work to lead the Charity to achieve a new brand and a new website, noting that the Charity was doing very well in terms of fundraising (including

19

Public

c

d

e

sponsorship for the annual ROSY/Respite for Oxfordshire’s Sick Youngsters walk which Board members would be participating in and teams participating in the Oxford half marathon and the Blenheim 7K run);

the key development of Healthfest as part of community engagement, which would next be held on 14 September 2019 and for which 39 organisations and teams had already registered their support. The Board and governors were warmly invited to attend and provide their support; and

further to what was in the report, she had represented the health care sector at an event yesterday on volunteer sector co-production work with Oxfordshire County Council. She highlighted the importance of the Trust supporting and engaging with the volunteer sector.

The Acting Director of Nursing & Clinical Standards acknowledged and endorsed the significant work of the Community Involvement Manager to develop volunteering, especially around safeguarding and governance. The Director of HR added his thanks for being able to access charitable funds to support staff wellbeing.

The Chair asked about the costs associated with preparing volunteers and ensuring they were appropriately supervised when with patients. The Community Involvement Manager replied that she planned to undertake a cost benefit analysis.

The Board noted the report.

BOD 69/19a

Trust partnerships update report

The Chief Executive presented the report BOD 51/2019 noting progress which had been made to chart the extent of the Trust’s partnerships. Partnerships ranged from the informal ones with no income transaction through to those governed through contractual agreements. Further to the Board’s most recent Development Day in February 2019, he noted the value of creating more opportunities for informal discussions between partners (and their Boards) and the Board. Chris Hurst suggested that partnerships may work

20

Public

b

c

most effectively when there was clarity around future direction of travel and noted that an annual focused event with key partners may be helpful and could potentially highlight new opportunities. The Chief Executive noted that this may require more thought given the differences between the various partners and the risk of some not being as engaged in others’ activity. The Director of Corporate Affairs & Company Secretary added that a number of the Trust’s partners had participated in the first ever Healthfest last year and would be part of it again this year and that events such as this offered other opportunities to have discussions about working together.

Jonathan Asbridge declared an interest in the Paterson panel/the Independent Inquiry into the issues raised by Paterson.

The Board noted the report.

BOD 70/19a

b

c

d

Updates from Committees

John Allison presented the minutes of the Audit Committee meeting on 19 February 2019 at BOD 52/2019 and provided an oral update of the meeting on 23 April 2019 which he had chaired. He noted that the Audit Committee had recommended that the Finance & Investment Committee review in more detail the Trust’s status as either a going concern without any qualifications or a going concern with some qualifications. Chris Hurst provided further explanation of the distinction in going concern status, noting that there could be an impact from increasing demand for services upon adequacy of resources and that controlling this was difficult, not least because staff may not want to turn patients away. He also reminded the Board of the heavy cost gearing attached to spend upon agency staff.

John Allison and Aroop Mozumder added that the Trust should also be aware of the clinical implications of activity management, especially if this was a key part of FY20. The Chief Executive noted that this would not be a decision for the Trust to take on its own but in collaboration and consultation with commissioners and ideally with their support to reduce activity levels.The Director of Corporate Affairs & Company Secretary presented the minutes of the Charity Committee meeting on 19 February 2019 at BOD 53/2019.

21

Public

The Board received the minutes.

BOD 71/19a

Any Other Business and Strategic Risks

The Chief Executive recommended that the Strategic Risks be amended/developed to highlight demand and capacity as a recurring theme/key risk especially as this was becoming an open-ended driver of cost and time.

HS

BOD 72/19a

Questions from Observers

Davina Logan, Governor (Age UK) recommended that the Council of Governors also review the new TRAC recruitment system.

BOD 73/19a

In accordance with Schedule 7 of the NHS Act 2006, the Board resolved to exclude members of the public from Part 2 of the board meeting having regard to commercial sensitivity and/or confidentiality; personal information; and legal professional privilege in relation to the business to be discussed.

The meeting was closed at 12:20.

Date of next meeting: 24 May 2019

22