trust board meeting agenda documents/trust... · agenda trust board part 1, 27 july 2020 page . 2....

Agenda Trust Board Part 1, 27 July 2020 of 2

Timing Number Item Enclosure Item Presenter

Action of the Board

Public and Patient Focus 9.30

5 mins 20/1848

Open Forum Opportunity for the public to ask questions of the Board

Verbal Public Respond to questions

9:35 15 mins

20/1849 Patient Story This month’s patient story tells of a service user who has received care in one of our in-patient wards during the COVID-19 pandemic. The story describes the patient’s experience of his stay and the impact that this has had on him.

Video presentation

Joanne Hiley Discuss and note

9:50 15 mins

20/1850 Safety Walkabout Feedback • Kingsley Ward, Memory Inpatient

Services, Warrington, visited on 10 July 2020

• Intensive Community Support Team for adults with a learning disability, St Helens and Knowsley, visited on 14 July 2020

Verbal John Heritage John Heritage

Note

Assurance (reports from) 10:05 1 min

20/1851 Apologies for absence

Verbal Helen Bellairs Receive apologies

10:06 1 min

20/1852 Declarations of Interest Verbal Helen Bellairs Identify and avoid conflicts of interest

10:07 2 mins

20/1853 Minutes of the Board Meeting held on 29 June 2020

Helen Bellairs Confirm as accurate and approve

10:09 2 min

20/1854 Matters arising and action points

Helen Bellairs Note progress

10:11 5 mins

20/1855 Chairman’s Report

Helen Bellairs Note and approval of any actions from the Board Development Day

10:16 5 mins

20/1856 Chief Executive’s Business Report/COVID-19 Update

Simon Barber Discuss and receive assurances

10:21 10 mins

20/1857 Report from Executive Leadership Group Meeting held on 9 July 2020

Simon Barber Receive assurances, note and endorse decisions made and discuss

10:31 2 mins

20/1858 Report from Quality Committee Meeting held on 8 July 2020

Tricia Kalloo Receive assurances and note decisions made

10:33 2 mins

20/1859 Digital Transformation Group Quarterly Update

Simon Barber Note and receive assurances

10:35 10 mins

20/1860 Finance Report – Month Three

John McLuckie

Discuss and receive assurances

Trust Board Meeting Agenda Meeting not held in public 27 July 2020

Meeting via MS Teams from Chief Executive’s Office Hollins Park, Winwick, WA2 8WA

Agenda Trust Board Part 1, 27 July 2020 of 2

Timing Number Item Enclosure Item Presenter

Action of the Board

Governance (approvals and decisions required of the Board) 10:45 2 mins

20/1861 Fit and Proper Persons’ Annual Update

Simon Barber Note and receive assurances

10:47 Break – 5 mins

Performance and Quality 10:52

20 mins 20/1862 Quality and Performance Report

John

McLuckie Discuss and note

Safety and Risk 11:12 2 mins

20/1863 Serious Incident Report Joanne McDonnell

Information and receive assurance

Strategy and Future Focused 11:14

15 mins 20/1864 High Level Objectives 2020/21

Quarterly Update Tracy Hill Information,

assurance and discussion

11:29 10 mins

20/1865 Transaction Update

Tracy Hill Information and discussion

11:39 Close

Date of next meeting: Monday 28 September 2020 at 9.30am, meeting via MS Teams from Chief Executive’s Office, Hollins Park, Winwick, WA2 8WA Exclusion of the Public: The Chairman will propose a Part 2 meeting on the basis: “That publicity would be prejudiced to the public interest by reason of the confidential nature of the business to be transacted, and that the public be excluded”

We will always do our very best to make the right decisions for the health and well-being of our patients and staff.

Agenda Item No NWBH (20/1853)

20/1853 Approved Minutes Trust Board Meeting 29 June 2020 Page 1 of 16

MEETING OF THE TRUST BOARD Part One

Approved Minutes of a meeting held on 29 June 2020 in Chief Executive’s Office, Hollins Park, Winwick, Warrington WA2 8WA and via SKYPE

Commencing at 9.30am

Present: Mrs H Bellairs Chairman Mr S Barber Chief Executive Mrs T Hill Director of Strategy and Organisational Effectiveness

*Professor S Ranote Medical Director *Mr J McLuckie Chief Finance Officer Mr J Heritage Chief Operating Officer and Deputy Chief

Executive *Ms J Hiley Executive Director of Nursing and Quality *Ms J McDonnell Executive Director of Nursing and

Governance *Ms A Tumilty Non-Executive Director *Ms T Kalloo Non-Executive Director *Dr J Berry Non-Executive Director *Mr S McAndrew Non-Executive Director *Mr M Tate Non-Executive Director *Mr I Arnold Non-Executive Director

Apologies: None

In Attendance: *Mrs J Hughes Company Secretary *Ms J Upjohn Corporate Governance Coordinator

*Ms L Prescott Chief Pharmacist *Ms S Waterworth Deputy Director of Finance

Item 20/1824: *Dr R Madgula Associate Medical Director *Ms M Peake Nurse Practitioner *Ms L Tyms Ward Manager

* Attended via SKYPE

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20/1823 Open Forum Governors were not present and there were no questions raised.

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20/1824 Staff Story Ms J Hiley, Executive Director of Nursing and Quality, introduced Dr R Madgula, Associate Medical Director and Ms M Peake, Nurse



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Practitioner, who described their experiences working for the Trust during the coronavirus crisis. Dr Raj Madgula, a consultant in our inpatient services in St Helens, Melody Peake, Nurse Practitioner on Parsonage Unit in Wigan, and Louise Tyms, Melody’s ward manager, shared their stories. Raj gave a moving example of treating a Covid-positive patient in an emergency situation while awaiting an ambulance responding to the ward’s 999 call. He said: “The Covid pandemic has made us revaluate a lot of how we not only deliver care, but also our own vulnerabilities and our strengths. “The experience has made me reflect on how we provide care and compassion when we need the courage to overcome our fears in unprecedented times, alongside the importance of good communication.” He praised the ongoing communication from the Trust’s Communications Team throughout the response to the pandemic. Melody’s presentation had communication at the heart of it. Melody has been shielding at home, but has been supported to remain in touch with her colleagues and has been able to be a source of support to them throughout. This meant she remained a key part of the team looking after very poorly patients in what Louise described as very tough times. Melody spoke of “the emotional impact of needing to shield” and how she was able to support her colleagues by offering supervision to the ward team. She reflected that: “The team was willing, excited, extremely motivated and looking forward to the challenge.” The Board heard about the upheaval staff experienced in their personal lives and that some had suffered family bereavement due to Covid-19. Melody’s feedback was: • Nurses felt supported at a team level by their line manager • Line manager felt valued by their team • New team members commented on the positive culture of care

Staff were offered sessions with the ward clinical psychologist which they found helpful

Staff off sick with Covid-19 were contacted regularly and felt their team cared

• Shielded staff felt they had lots of contact from their team



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• The Trust decision to shield vulnerable staff left them feeling protected and safe

Melody has written a poem about her experiences and the experiences of her colleagues which the Board wants to be shared. The Board thanked Raj, Melody and Louise for their moving contributions to the meeting and for their service during the pandemic and wanted to extend that thanks to our entire Trust workforce.

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20/1825 Apologies for absence As above.

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20/1826 Declarations of Interest Dr Berry informed the Board that he is a Reflection Supervisor to three Extended Primary Health teams of the Trust, under COVID-19 arrangements.

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20/1827 Minutes of the Board Meeting held on 26 May 2020 The minutes of Part One formal Board Meeting held on 26 May 2020 were accepted as a true and accurate record subject to minor amendments.

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20/1828 Matters arising and action points All items with a due date of 29 June 2020 were included as agenda items.

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20/1829 Chairman’s Report The report provides an update on activities undertaken by the Chairman and Non-Executive Directors and any actions taken on behalf of the Trust Board since the last meeting held on 26 May 2020. A summary of business carried out by the Governors is included. Areas covered in Part Two of the Trust Board Meeting are reported. Mrs H Bellairs, Chairman, brought to the attention of the Board information regarding Black, Asian and Minority Ethnic (BAME) people being involved in decision making following a letter from NHS Improvement about the disproportionate impact of COVID-19 on this specific group of people. The Trust’s review of involvement in decision making was noted and is ongoing. The Board noted the report.



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20/1830 Chief Executive’s Business Report Mr S Barber, Chief Executive, introduced the Chief Executive’s report to provide a résumé of key issues of Trust business and items that impact on the Trust and its services. Mr Barber highlighted the system architecture and response under the NHS England national level four emergency for COVID-19. A financial governance assurance checklist issued by Mersey International Audit Agency has been completed to benchmark Trust governance arrangements. There have been 257 pieces of COVID-19 guidance received into the Trust, 196 being relevant to the Trust. The compliance position is not rated red for any guidance. Amber rated guidance is not a cause for concern and items are mostly in progress. The Trust has justifiable reasons for non-compliance in some cases; Trust measures are stronger than the guidance would achieve. Mr Barber commented on the importance of diversity and inclusion: the Trust is one of five diversity and inclusion partner organisations in the North West. The report describes the role of the partner organisation. Ms S Hunt, Professional Lead for People Services Transformation, is an expert in this field supporting the Trust to drive progress towards becoming a truly diverse and inclusive employer. Ms Tumilty commented on system capacity and demand following COVID-19 and asked if the amount of demand has been assessed. Mr Barber confirmed that although the amount of demand is unknown a variety of demand scenarios have been considered and modelled against. The Board noted the report.

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20/1831 Report from Executive Leadership Group Meeting held on 11 June 2020 Mr Barber introduced the report to provide the Trust Board with a summary of activity from the meeting of the Executive Leadership Group held on 11 June 2020, and to provide assurance of decisions aligned to the Terms of Reference. Questions were raised regarding the following areas of the report. Operations Group: Ms Tumilty asked if all funding avenues had been considered to meet the funding gap in 2020/2021 created by implementing the Crisis



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Resolution Home Treatment team model earlier than originally planned. Mr Barber responded that where the Trust has been asked to incur additional or earlier than planned expenditure it is anticipated that the ongoing cost will be met direct from the out-of-hospital cell. Mr J Heritage, Chief Operating Officer and Deputy Chief Executive, explained that a 24/7 Mental Health Crisis Helpline was put in place in April 2020 ahead of schedule due to COVID-19. This was the first part of the Crisis Resolution Home Treatment team model and the decision was made to also advance the other elements of the model. Confirmation of the costs of these services will be made with the mental health out-of-hospital sub-cell. Workforce Strategy Group: Mrs Bellairs wanted to know if there is a timeline for the new People Strategy being developed. It was confirmed that the 2019-2020 People Strategy would be presented to the Board in September 2020. Clinical Leadership Group: Mrs Bellairs enquired about Clinical Innovations being removed from the Clinical Leadership Group. Professor Ranote clarified that this only relates to a Trust high level objective to develop a ‘Dragon’s Den’ for clinical innovations, however, review of Trust high level objectives resulted in the decision not to progress the objective as part of a ‘doing less better’ approach. Quality, Safety and Safeguarding Group: Dr Berry asked about the verification of deaths by the Trust during COVID-19. Ms Hiley confirmed that deaths are verified by the Trust in person by District Nurses. COVID-19 guidance offered an option for virtual verification of death with remote guidance from a GP, however, the nurses, based on a set of competencies, took the decision not to take up the option. The Board: • Reviewed the update provided by the Executive Leadership

Group for the meetings held on 11 June 2020, Chaired by the Chief Operating Officer/Deputy Chief Executive.

• Received assurance that the Executive Leadership Group is fulfilling its purpose and Terms of Reference.

• Endorsed the decision relating to remote verification of death.



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20/1832 Report from Quality Committee Meeting held on 10 June 2020 The report is to provide the Board with a summary of activity from the meeting of the Quality Committee held on 10 June 2020, and to provide assurance of decisions aligned to the Terms of Reference. The Board noted that pressure ulcer monitoring will be continued by the Quality Committee on a quarterly basis. The Board: • Reviewed the update provided by the Quality Committee for

the meeting held on 10 June 2020, and confirmed agreement for the ‘ask’ of the Board for all activity undertaken.

• Received assurance that the Quality Committee is fulfilling its purpose and Terms of Reference.

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20/1833 Report from Audit Committee Meeting held on 10 June 2020 The report is to provide the Board with a summary of activity from the meeting of the Audit Committee held on 10 June 2020, and to provide assurance of decisions aligned to the Terms of Reference. The Board: • Reviewed the update provided by the Audit Committee for

the meeting held on 10 June 2020, and confirmed agreement for the ‘ask’ of the Board for all activity undertaken and the requirement for all future Audit Committee reports to provide the appropriate level of assurance.

• Received assurance that the Audit Committee is fulfilling its purpose and Terms of Reference.

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20/1834 Report from the Extra-Ordinary Audit Committee Meeting held on 22 June 2020 The report is to provide the Board with a summary of activity from the meeting of the Extra-Ordinary Audit Committee held on 22 June 2020, and to provide assurance of decisions aligned to the Terms of Reference. The Board: • Reviewed the update provided by the Audit Committee for

the Extra-Ordinary meeting held on 22 June 2020, and confirmed agreement for the ‘ask’ of the Board for all activity undertaken and the requirement for all future Audit Committee reports to provide the appropriate level of assurance.

• Received assurance that the Audit Committee is fulfilling its purpose and Terms of Reference.



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20/1835 Finance Report - Month Two Mr J McLuckie, Chief Finance Officer, introduced the report to inform the Board of the month two financial performance and the level of financial support provided by NHS England/Improvement. The following areas were highlighted from the report: Measures to return the financial position to breakeven point continue, and include reimbursement of COVID-19 costs. There has been £60k capital spend which is lower than planned with a set figure that is required to be utilised. The cash value for month two is £19.2m. A long awaited VAT reclaim from the Atherleigh Park build has now been paid to the building contractors by Her Majesty’s Revenue and Customs and is being transferred to the Trust; The Board: • Received the month two financial performance. • Received assurance that the month two performance

presents a true and fair picture of the Trusts expenditure, including that related to the COVID-19 response.

• Noted the improved cash position and explanation thereof.

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20/1836 Summary Capital Business Case Mr Barber presented Summary Capital Business Cases for IT equipment for video consultation and general supply and Digital Programmes Implementation Team. Mr McAndrew asked how much of the proposed spend for video consultation is attributed to COVID-19 contingency and could this be claimed back from central funding, Mr McLuckie confirmed that the expenditure is as a result of decisions made by the Trust on how to deliver services during COVID-19. Cheshire and Merseyside Health and Care Partnership are not refunding IT spend, however, Greater Manchester Health and Care Partnership take a different view and approved approximately £1.5m for IT expenditure; this has been highlighted to Cheshire and Merseyside Health Care Partnership and their response is being sought. The Board: • Noted that given the Trust’s capital plan fits within an

overarching Cheshire and Merseyside capital control limit, the need for the Trust Board to monitor the spend to ensure it is fully utilised.



• Considered the content for the summary capital business cases and approved the capital expenditure for IT equipment for video consultation and general supply at a costs of £200,000 and the digital programmes implementation team at a cost of £260,000.

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20/1837 COVID-19 Update Mr Barber presented the paper to provide the Trust Board with a progress update on the Trust response and plans to manage the COVID-19 pandemic. The challenges to communication with regard to social distancing and face mask guidance across the Trust and externally were discussed. The Board was confident that Trust communication is effective. Professor Ranote informed the Board that a Trust response had been prepared against a series of ‘asks’ of organisations with regard to the Black, Asian and Minority Ethnic workforce; outlined in a letter received 20 June 2020 from the regional Chief People Officer. The Trust response includes; Black, Asian and Minority Ethnic people are well represented in senior leadership and decision making groups managing the COVID-19 incident. There is a Black, Asian and Minority Ethnic network and advice has been provided by personal letter to every Black, Asian and Minority Ethnic employee. Professor Ranote explained the Safety, Assessment and Decision (SAAD) risk assessment tool has been approved to support the Black, Asian and Minority Ethnic workforce because of their significantly higher morbidity and mortality rate from COVID-19. The tool is also suited to all ‘at risk’ groups and will be rolled out for everyone in these groups in the workplace. Professor Ranote expressed thanks to Ms S Hunt, Professional Lead for People Services Transformation, who has led the development of a system to capture, monitor and track data from Black, Asian and Minority Ethnic risk assessments; data will be evaluated through the data dashboard. The Occupational Health department offers baseline vitamin D level blood tests for Black, Asian and Minority Ethnic staff unable to access the test through their GP. Mrs Bellairs commented that Professor Ranote’s update was comprehensive and that the Trust is doing more than asked to support the Black, Asian and Minority Ethnic workforce. The Trust Board received assurance that the Trust is responding to the COVID-19 pandemic and taking actions as required to maintain staff and patient safety.



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20/1838 Quality and Performance Report Mr McLuckie introduced the Quality and Performance Board Report to allow the Trust Board to monitor their defined Key Performance Indicators at a Trust-wide level. Mr McLuckie highlighted key areas in each of the domains relating to May 2020. Safe Patient incidents rated amber have risen to 3.6 percent against the target of 2.9 percent and activity has been reviewed for incidents and restraints and seclusions and these do not correlate to the performance. Ms Hiley added that meetings to look at least restrictive planning and support are being trialled with regard to complex patients and challenges. The aim being to review care plans and address issues in a planned proactive way instead of reactively. Ms Tumilty commented that March 2020 clinical supervision performance had declined and suggested consideration of less formal forms of supervision for the next quarter report; informal supervision has been taking place throughout the COVID-19 crisis. Mrs Hiley explained that compliance rates are communicated across the Trust and work continues towards the clinical supervision target, however, COVID-19 has impacted. The Management Supervision element of ‘MySupervision’ is being launched within the next month and will capture other forms of supervision. Effective Mr McLuckie drew attention to Improving Access to Psychological Therapies and challenges faced as a result of COVID-19 affecting recovery rates. Mr Heritage added that prevalence is the target number of people that the Trust is expected to deliver Improving Access to Psychological Therapies provision to, on a monthly basis. Approximately a 70 percent reduction of people being referred has been seen during the pandemic and this is now starting to increase; significant pressure on the service is anticipated as the country comes out of lockdown. Plans are being made to manage the pressures with investment in St Helens Think Wellbeing services and a move to the iaptus system in August for improved data management. An improvement in prevalence will be seen next month. Professor Ranote commented that there is potential for a super surge



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for mental health services due to COVID-19 and Improving Access to Psychological Therapies services will have to respond, however, skills needed to deal the specific trauma related problems may be lacking nationally; a matter for national recovery planning. Ms Kalloo asked how the absence of face-to-face service delivery has affected the number of patients accessing services; did patients withdraw as a result of the transition to IT solutions or because of personal reasons related to COVID-19? Mr Heritage reported that feedback from patients accessing video and telephone consultations was positive and he was unaware that patients had withdrawn due to the transition to digital provision; this is something that he is looking into. Ms Tumilty noted that the target for percentage of re-admission in 30 days had reduced then increased again. Mr Heritage confirmed that the changed target was accurate. The target has been re-baselined and is expected to remain at the higher percentage for the year. Responsive Mr Heritage highlighted out of area placements; female bed capacity has been a challenge. Out of area placements were significant from May to June 2020; improvements have been made since with one patient placed out of area currently. Admissions are being looked into and an increase in admissions under the Mental Health Act is noted. All providers in the region are at 100 percent capacity. Well Led Mr McLuckie reported positive performance for attendance at 94.6 percent. Turnover is at 12.49 percent and ‘stay’ interviews are being introduced. Caring No issues. The Board noted and discussed the content of the Quality and Performance Report.

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20/1839 Bi-Annual Safer Staffing Report Ms J McDonnell, Executive Director of Nursing and Governance, presented the report to provide the Trust Board with progress and compliance against national requirements for safer staffing. Supplementary information to support the May Safe Staffing report by way of an update on staffing level fill rates covering the period from 1 October 2019 to 30 April 2020 was reported.



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Ms McDonnell highlighted that the Trust is on track to meet the requirement for submissions of staffing Level fill rates to the national system by 15 July 2020; information is also available on the Trust website. As rotas are completed six weeks in advance there may be variance against actual fill rates. The average overall fill rate is above 100 percent. The Trust Board: • Discussed the report and by its publication evidenced that

the Board is discussing safe staffing levels.

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20/1840 Medical Appraisal and Revalidation Report Professor Ranote presented the report to advise the Board of the systems in place for, and delivery of, appraisal and revalidation during 2019/20. The Annual report is mandated by the General Medical Council. Professor Ranote highlighted that revalidation and appraisal has been paused during COVID-19, however, the annual organisation audit has been completed; the Trust has robust systems in place with a good e-appraisal system, Allocate. Professor Ranote commented on positive progress; the completion rate for appraisals is above the national average at 98 percent. Professor Ranote reported that an internal audit was completed this year and an appraisal lead has been appointed. The Trust has 25 appraisers each completing an average of three appraisals within their supporting professional activity time. Feedback is good, however, the audit recommends further improvement through appraiser training and peer review. An external independent audit in 2015/16 and participation in a peer review with Mersey Care NHS Foundation Trust in 2019 have provided significant assurance. The Trust is commended on patient and public engagement and for good governance processes. Professor Ranote added that 26 doctors have been recommended for revalidation and accepted this year. There have been two disciplinaries; one closed and one is ongoing. Dr Berry commented on the cost implications to train the appraisers. The Trust Board accepted the report and approved the ‘statement of compliance’ confirming that the organisation is in compliance with the regulations.



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20/1841 Workforce Race Equality Standard and Workforce Disability Equality Standard Update The report provides the Board with an update on the NHS Workforce Race Equality Standard and Workforce Disability Equality Standard following the publication of the Workforce Race Equality Standard and Workforce Disability Equality Standard annual reports. Publication of the reports was delayed due to COVID-19. The annual reports enable benchmarking against comparator groups in addition to tracking year on year changes. NHS England has requested Boards are fully sighted on issues relating to equality and inclusion in light of the disparities that COVID-19 has demonstrated. Mr McAndrew commented that an increase in bullying and harassment may be attributed to heightened awareness as a consequence of Freedom to Speak Up which could be a positive development. Mr Barber added that the National Director of People Services has requested data for workforce ‘at risk’ groups. Definition of ‘at risk’ groups and methods of contacting individuals to offer risk assessments, which are already being offered to Black, Asian and Minority Ethnic colleagues, is being considered. The Board noted the current position in relation to Workforce Race Equality Standard and Workforce Disability Equality Standard and received assurance of the steps in place to improve the experience of Black, Asian and Minority Ethnic staff and disabled staff across the Trust.

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20/1842 Freedom to Speak Up Quarter Four Report The report provides the Trust Board with the summary of activity from the Freedom to Speak Up Meeting held on 10 June 2020, which reviewed activity for quarter four 2019/20 and provides assurance that cases are processed in accordance with national guidance. The Trust Board: • Reviewed the update provided by the Freedom to Speak up

meeting held on 10 June 2020, and received assurance that the cases are processed in accordance with national guidance.

• Authorised the new Terms of Reference.

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20/1843 Serious Incident Report The report informs the Board of serious incident reviews commissioned in May 2020, recent and planned Coroners Inquests



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and all deaths reported in May 2020. The Trust Board: • Received the latest position regarding serious incidents,

deaths reported and inquests. • Noted that the Quality Committee is undertaking their

delegated activity for the scrutiny and oversight of serious complex incidents, complaints and claims.

• Received assurance that serious incidents are being managed effectively in the organisation.

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20/1844 Board Assurance Framework

The Board Assurance Framework contains all risks rated 15 or above and the risks mapped across from the Trust Risk and Opportunities Universe 2019/20 which may impact on the delivery of the Trust strategy. Ms McDonnell reported significant progress, highlighting key points; risk owners are now Executive Leads, the rating system has been revised, gaps in control on the framework have been transferred to the action plan, the annual objective is aligned to the Board Assurance Framework strategic priorities and cause and effect information is being provided in an extra column on the document. Ms McDonnell recommended the proposal for quarterly review of the Risk Universe against the Board Assurance Framework to create a more dynamic document. Ongoing improvements to risk management can be seen through the Executive Leadership Group report. Mr McAndrew was involved in the development of the new risk rating system and commented that the ambition was to support decision making to remove, accept or replace risk. Mr Heritage commented that the approach is incredibly helpful and articulates the point at which a different course of action is required for a risk and supports confident decision making. The viewpoint of the Board was positive. The Board: • Received assurance that the development of the 2020/21

Board Assurance Framework has been completed and is aligned with the 2020-23 strategic priorities.

• Received assurance that the strategic risks on the 2020/21 Board Assurance Framework are being effectively managed with actions identified to mitigate these risks.

• Approved the proposal for quarterly reporting to Trust Board



providing an opportunity to review and refresh the Risk Universe.

• Noted that the Audit Committee provides oversight of compliance on reviewing the systems of internal control to effectively identify and manage risks.

• Noted the Audit Committee activity report is provided separately.

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20/1845 Proposal for the future configuration of services between Mersey Care NHS Foundation Trust and North West Boroughs Healthcare NHS Foundation Trust: Strategic Case The report was presented to the Trust Board to seek approval of the revised strategic case for the acquisition of North West Boroughs NHS Foundation Trust by Mersey Care NHS Foundation Trust. The Board reviewed the revised Strategic Case and was content with the revisions made. The Board approved the revised Strategic Case for submission to NHS England and NHS Improvement.

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20/1846 Focus On..Approach to Restoration and Recovery Mr Heritage gave a presentation on the Trust’s approach to restoration and recovery from the COVID-19 pandemic. Mr Heritage reiterated that keeping staff and patients safe is the primary focus; staff continue to be supported to work from home, two metre distancing is implemented in the workplace and appropriate personal protective equipment is in use. A three stage approach to restore community services is planned. Operation leadership is being initiated to promote consistency of services across the boroughs. Plans are scheduled until the end of July 2020 supported by Bronze level of the current command structure, which will become a Restore and Recovery group. The Trust is anticipating where the greatest demand for services will be and is aware of national requirements around restarting services. By the end of September 2020 services that have been reduced or suspended will return to providing face-to-face activities. The future will not be the same as the past; digital initiatives have been embraced and will be incorporated in future operating. Approximately 80 percent of pre-pandemic demand is being experienced in Improving Access to Psychological Therapies and Mental Health services and the trend is set to continue. Inpatient demand has returned to previous levels.



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A dashboard is produced weekly to give a snapshot of Attend Anywhere consultation activity. There have been 4855 virtual consultations delivered in response to COVID-19 and a significant amount of telecommunications support. Mr Heritage reported that system capacity and demand is based on activity in the Cheshire and Merseyside Health and Care Partnership footprint; a capacity and demand plan has been developed based on previous activity and anticipated increase in demand. Looking forward digital first will be further developed, staff will be recruited to any vacant posts remaining following redeployment during the pandemic and systems to capture non-face-to-face activity data will be established; waiting times will continue to be monitored. Mr M Tate, Non-Executive Director, asked about the clinicians’ attitude to virtual consulting. Professor Ranote confirmed that clinicians are wholeheartedly embracing the digital enablers from assessments through to therapeutic interventions where they appropriately meet patient care; offering wider choice to staff and patients and greater efficiency. Mr Heritage agreed that feedback from patients and staff was positive and patient feedback will be used to help shape digital development. The Trust Board noted the contents of the presentation and was assured that the Trust continues to plan for restoration and recovery of clinical services.

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20/1847 Remuneration Committee Update Mrs Bellairs informed the Board that a virtual meeting of the Remuneration Committee took place between 22 and 25 June. There were two items of business. The Board • Reviewed the summary of decisions made at the virtual

meeting of the Remuneration Committee held between 22 and 25 June 2020.

• Ratified the extension of the secondment for the Chief Finance Officer until 31 March 2021, at which it will then be reviewed in relation to the timescales for completion of the transaction.

• Received assurance that the Trust met the requirements of the Terms and Conditions – Consultants (England) 2003 in relation to Clinical Excellence Awards for 2019/20.

• Was assured that the Remuneration Committee is fulfilling its purpose and Terms of Reference.



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Date of next meeting: Monday 27 July 2020 at 9.30am Via Skype from Chief Executive’s Office Hollins Park House Winwick Warrington WA2 8WA Exclusion of the Public: The Chairman would propose a Part 2 meeting on the basis “That publicity would be prejudiced to the public interest by reason of the confidential nature of the business to be transacted, and that the public be excluded”.

Signed………………………………………………………….. Date:………………………… Chairman

Agenda Item No NWBH 20/1854

Page 1 of 9 20/1854 Matters Arising Matrix (Part 1)

TRUST BOARD MATTERS ARISING – Board Meeting 27 July 2020

FOLLOW-UP ACTIONS MATRIX – Part One DATE: 29 June 2020 Date / Agenda

Reference Item/subject: Decision taken

and/or Action required:

Format:

Responsible Person:

Deadline:

Outcome:

25 March 2019 19/1581

Benefits Realisation

Report – Information

Management Platform

The Board thanked Mr McLuckie for the report which provided the right amount of detail and requested that a further update be provided twelve months after the clinical elements had been implemented, expected in October or November.

Benefits Realisation Report – Information

Management Platform JM November

2020

27 January 2020 20/1736

Quality and Performance Report – Well

Led

Dr Berry highlighted that dysphagia is not core curriculum for speech and language therapy and asked if it can be taken up with universities.

Professor Ranote agreed to discuss this with Salford University.

24 February 2020 Update Agenda Item 20/1748 Professor Ranote has not met formally with Salford University to discuss dysphagia training and will advise the Board when a meeting has taken place.

27 April 2020 Update Agenda Item 20/1788 The action for Professor Ranote to speak with Salford University about dysphagia and speech and language training has been deferred; focus for the Trust is currently on managing COVID-19. Revised action date of July 2020 agreed.

Matters Arising SR July 2020 Verbal



Date / Agenda Reference Item/subject:

Decision taken and/or

Action required: Format:

Responsible

Person: Deadline:

Outcome:

24 February 2020 20/1744

Safety Walkabout –

Westleigh Unit

Weekend groups have been developed for patients on the female unit. A substance misuse group provides good additional intervention. It was suggested that weekend groups would be beneficial to male patients. Professor Ranote will feed back the suggestion.

27 April 2020 Update Agenda Item 20/1788 Professor Ranote reported that activity has ceased while focus is on managing COVID-19. Revised action date of July 2020 agreed.

Matters Arising SR July 2020 Verbal

26 May 2020 20/1810

Report from Quality

Committee Meeting

Progress on the development of a process to close down matters delegated and under review by Board Committees will be provided to the Board for agreement and adoption.

Report from Quality Committee / Audit

Committee Meeting

TK AT

July 2020

Agenda Item 20/1858



DELEGATED ACTIONS MATRIX - Part One DATE: 26 May 2020

Date Item/subject:



Responsible

Person: Deadline:

Outcome:

29 October 2018 18/1511

Focus on… Care Quality Commission

Well Led Inspection

DELEGATED TO THE QUALITY COMMITTEE The Board discussed the current various reporting mechanisms through the Quality Committee and it was established that the Quality Committee will oversee the action plan and provide a detailed report and assurances to the Board via the delegated action updates. Updates were received on the following dates and have been removed as they are over 6 months old: 26 November 2018 Update Agenda item 18/1520 28 January 2018 Update Agenda Item 19/1536 25 February 2019 Update Agenda Item 19/1556 25 March 2019 Update Agenda Item 19/1572 29 April 2019 Update Agenda Item 19/1593 28 May 2019 Update Agenda Item 19/1614 24 June 2019 Update Agenda Item 19/1634 29 July 2019 Update Agenda Item 19/1652 30 September 2019 Update Agenda item 19/1675 28 October 2019 Update Agenda Item 19/1694 27 November 2019 Update Agenda Item 19/1713 27 January 2020 Update Agenda Item 20/1733 24 February 2020 Update Agenda Item 20/1754 The Care Quality Commission position is a delegated item from the Trust Board and the Quality Committee will continue to have oversight of any action plan that comes out from the inspection report. 30 March 2020 Update Agenda Item 20/1776 Care Quality Commission Six Monthly Update Report provided to the Board. Focus is on the COVID-19 pandemic and the report was not prioritised for

Quality Committee Update T Kalloo

Monthly – until

completion

Next update due July 2020

Agenda Item 20/1858



Date Item/subject:



Responsible

Person: Deadline:

Outcome:

discussion during the meeting; comments were instead invited via email to the Company Secretary. 27 April 2020 – Update Agenda Item 20/1792 The Care Quality Commission accepted the return that was submitted in relation to “Must Do” actions and the proposed timescales; it is acknowledged that given the current COVID-19 response some timescales may slip. It has been agreed that actions related to patient safety will be actioned. The Quality Committee were assured by the update, the Action Plan in place and the process which will be taken forward to monitor the delivery. 26 May 2020 – Update Agenda Item 20/1810 The Quality Committee continue to be assured by regular updates. The Executive Director of Nursing and Quality continues to have monthly relationship meetings with the Care Quality Commission. 29 June 2020 – Update Agenda Item 20/1832 The Quality Committee continue to be assured by regular updates. Amber rated actions and planned remedial actions were discussed by the Quality Committee and it was noted that there are currently no red rated actions in the action plan. Assurance was received on the process for the delivery of the action plan and senior leadership assigned to the delivery of the action plan. The Quality Committee agreed to accept the recommendations of the report. The Board is assured that effective processes are in place and will continue to be monitored.



TRUST BOARD MATTERS ARISING - FOLLOW-UP MATRIX – ARCHIVE (6 months) PART ONE

Item/subject:



Responsible

Person: Deadline:

Outcome:

27 November 2019 19/1721

Strategy Update – Estates Strategy

Mr Arnold asked about informal agreements in place and where we co-locate as opposed to formal lease. Mr McLuckie mentioned use of space in other establishments.

Mr Heritage to confirm the responsibilities around compliance in informal agreements for use of accommodation.

Matters Arising JHer March 2020

Completed Agenda Item

20/1766

27 January 2020 20/1731

Report from Executive

Leadership Group – Quality, Safety,

Safeguarding and

Governance

The Trust is meeting the Service as commissioned for Knowsley and St Helens Multi-agency Safeguarding Hubs, however, this falls below national requirements; the Clinical Commissioning group is aware that the Trust will not be providing staffing and resources in excess of what has been commissioned. Discussions continue as to how this service can be adequately funded and resourced.

The Board agreed to receive further updates regarding the commissioners intentions for Knowsley and St Helens Multi-agency Safeguarding Hubs.

Report from ELG Jo Hiley or

Joanne McDonnell

March 2020

Completed Updates are reported to Trust Board by exception in the Report

from ELG

27 January 2020 20/1732

Report from Audit

Committee – Risk and

Assurance

The Board considered the report and discussed risk appetite tolerance.

It was agreed to look at including risk as an item for a forthcoming Trust Board Away Day.

Matters Arising SB/HB February 2020


20/1748



Item/subject:



Responsible

Person: Deadline:

Outcome:

24 February 2020 20/1751


Leadership Group – Clinical

Leadership

Mr McAndrew questioned the assurance level for clinical impact assessment shown in the report, it was established that the Board was assured that actions are taking place towards the planned outcome. Mr Barber confirmed that the process is effective, and agreed an action should remain open until assurance is received that the clinical impact assessment has been updated.

Clinical Assurance of Cost Improvement

Plans SR March

2020


20/1781

27 January 2020 20/1731


Leadership Group –

Workforce Strategy

The Board discussed and noted progress with strategy pillars; the Trust may consider it helpful to understand how other organisations are supporting neurodiversity employee recruitment.

Mr McAndrew agreed to discuss further with Mr Brannan, Deputy Director of Human Resources and Organisational Development.

Update February 2020 – 20/1748 Other organisations have been contacted to establish how they are supporting neurodiversity employee recruitment and response is awaited. Further update to be provided to March 2020 Trust Board.

Matters Arising SMcA April 2020 Completed

Agenda Item 20/1788

27 January 2020 20/1736

Quality and Performance

Report - Effective

Mr Tate commented on the relationship between did not attend rate and text messaging facility, asking for significant steps to be recorded in order to review the impact.

Mr McLuckie agreed to look at making information available for future reporting.

Update February 2020 – 20/1748 Mr McLuckie requested that the action for additional information for reporting to be provided is deferred to March.

Quality and Performance Report JMcL April

2020


20/1788



Item/subject:



Responsible

Person: Deadline:

Outcome:

27 January 2020 20/1736


Report - Responsive

Achievement of the waiting time for IAPT is below target. It was confirmed to be under target for Halton services, although an improvement has been made and also over target is the St Helens services that moved to the Trust in November 2019. The Trust has only been commissioned to provide a service in St Helens that is below the national level of compliance; the basis of delivering the service has been clearly advised to NHS Improvement.

The Board agreed to receive a separate performance chart for St Helens due to the commissioned compliance level not being the national target.

Update February 2020 – 20/1748 Mr McLuckie requested that the action for additional information for reporting to be provided is deferred to March.

Quality and Performance Report JMcL April

2020


20/1788

24 February 2020 20/1751


Leadership Group – Quality, Safety,

Safeguarding and

Governance

Mr Arnold requested that the Board receive an update of the risk rating for the risk of out of borough diabetic patients not being able to access appropriate treatment and equipment in a timely way.

Matters Arising JMcD April 2020


20/1788

24 February 2020 20/1758


Report – Retention of

the Workforce

Mrs Bellairs asked if internal transfers of staff within the Trust are included in the report analysis of employees leaving the Trust. This was not clear and will be established from the Electronic Staff Record system. Mr Heritage to determine if internal transfers and external leavers are included in leaver information recorded.

Matters Arising JHer April 2020


20/1788



Item/subject:



Responsible

Person: Deadline:

Outcome:

30 March 2020 20/1783

Trust Annual Objectives

Mrs Hill and Mr Heritage agreed to revise the objective prior to publication with regard to retention of staff; for a more balanced view of the reasons for staying with the organisation as well as reasons for staff leaving.

Trust Annual Objectives 2020-21 TH / JHer April

2020

Completed The revised version has been made available to

staff via Communications

27 January 2020 20/1738

Learning from Deaths Report

Mr Tate made a request for table two in the report to depict expected and unexpected deaths separately for comparison.

Professor Ranote agreed to add expected deaths assessment of care data to the report tables.

Learning from Deaths Report SR May

2020


20/1819

24 February 2020 20/1753

Report from Audit

Committee Meeting

Ms Tumilty agreed to provide assurances received by the Audit Committee in future reporting to the Board. Report from Audit

Committee AT May 2020


20/1811

27 April 2020 20/1800

Trust Annual Internal

Operating Plan

Report to be amended prior to publication to ensure it captures the Board’s discussion regarding Wigan services and that timeframes were ‘COVID-19 permitting’

Trust Annual Internal Operating Plan THil May

2020

Completed. Paper

amended. Published on website April

2020

27 April 2020 20/1798


Report

Mr McLuckie agreed to look at reporting numbers of cases and not percentages which was suggested by Dr Berry while COVID-19 is impacting on overall incidents. 26 May 2020 Update Agenda Item 20/1816 Mr McLuckie apologised that actions to update the report format have not yet been completed; these will be incorporated in the next report.

Quality and Performance Report JMcL June

2020


20/1838



Item/subject:



Responsible

Person: Deadline:

Outcome:

26 May 2020 20/1802

Open Forum – Staff

Statement of COVID-19

Experience

Patient and staff stories are a regular item on the agenda, however, during the Coivd-19 pandemic the presentation of patient stories has been suspended. A suggestion came from the Governor for Knowsley Borough for staff statements of their feelings and views during the COVID-19 pandemic to be presented as an alternative and this was agreed as an action for the Executive Directors for the next meeting.

Staff Story Executive Directors

June 2020


20/1824

26 May 2020 20/1808

Chief Executive’s Business

Report

The Board agreed to receive assurance for guidance received rated as red and the number of those rated as amber.

Chief Executive’s Business Report SB June

2020


20/1830

26 May 2020 20/1817

Bi-Annual Safer Staffing

Report

Statistics to indicate safe staffing levels and the actual position to be provided in a table and included as an appendix to the report. Report to be resubmitted to the Board in June 2020 for review and approval.

Bi-Annual Safer Staffing Report JMcD June

2020


20/1839

DELEGATED ACTIONS – PART ONE – ARCHIVE (6 months)

Date Item/subject:



Responsible

Person: Deadline:

Outcome:

No items archived within last 6 months


Page 1 of 5


DATE OF MEETING 27 July 2020

Item

N

o.

20/1

855

TITLE OF REPORT Chairman’s Report PRESENTED BY Helen Bellairs, Chairman AUTHOR(S) Helen Bellairs, Chairman

REPORT PURPOSE

Information X Assurance X Approval/ Decision X

To provide a summary of Part Two of the Board meeting held on 29 June 2020 To provide an update of activities undertaken by the Chairman and Non-Executive Directors and any actions taken on behalf of the Board since its last meeting. To provide a summary of business carried out by the Governors.

ALIGNMENT TO THE TRUST’S STRATEGIC OBJECTIVES (x) We will deliver quality, safe and efficient services with a highly skilled and motivated workforce X We will engage with our communities and staff to deliver

services differently X We will deliver whole person care through targeted growth We will play an active role in place-based care systems to

maintain a whole person care focus X We will retain our values and culture X We will grow and develop the Trust at scale, being seen

as an equal partner in any system-wide collaboration X

SUBJECT MATTER/CONTENT CONSIDERED AT THE FOLLOWING COMMITTEES / GROUPS Committee / Group Date Audit Committee Quality Committee Remuneration Committee Executive Leadership Group Sub Group Name (if applicable):

Other Group Name: Trust Board Private Meeting Verbal update will be given on any outcome/decision from the Trust Board Development Day

29 June 2020 22 July 2020

This content has not been considered elsewhere

THIS REPORT RELATES TO A RISK ON THE BOARD ASSURANCE FRAMEWORK (Y/N) No Risk Reference Strategic Objective Description (as per BAF)

RECOMMENDATIONS (what is the ‘ask’ of the Board)

The Board is asked to note the report and approve any recommendations following the Trust Board Development Day.

Trust Board Meeting


Page 2 of 5


Report to Trust Board

27 July 2020

Chairman’s Report

1. INTRODUCTION This is my fourth report being written during these unprecedented times for the NHS and the country as a whole. Although restrictions are still easing I am still keeping in line with the Trust’s policies and guidelines and continue to limit contact wherever possible and hold meetings using digital media. The face to face business conducted by myself and the Non-Executive Directors and Governors continues to be curtailed. Meetings continue to be held virtually by email or via Skype/Microsoft Teams and other digital media. I want to record my thanks to the staff throughout the organisation who are continuing to provide the best care possible for our patients, including caring for those on our wards who have or have had COVID-19 virus. All our staff whether they are frontline or working from home continue to go the extra mile we have come to expect from such a great group of people. Everyone is contributing the best they can. We had a great example of out of the box thinking from a colleague who despite having to shield herself at home was providing support and supervision for her colleagues remotely. I would also like to place on record my personal thanks to the Executive Team who have all worked tirelessly during this period, many with very little downtime for themselves. We also have a lot to thank our IT colleagues for, working as they are to support our new digital lives. We continue to learn a tremendous amount about how we can do things differently and I know that the Executive Directors are keen to capture that learning for when we return to a more normal scenario. We do not intend to lose the gains we have made through innovation nor slow the momentum for change where change is for the better. I am also pleased to note the wearing of face coverings in communal areas and the use of Personal Protective Equipment in patient facing situations. It is so important we all do the right thing to help control this virus. We continue to have support and best wishes from our Governors who continue to be incredibly proud of the way the teams are working. It is good that some Governors are able to join our Board meeting.

2. UPDATE FROM PART TWO OF THE BOARD MEETING HELD ON THE 29 JUNE 2020 This section of my report provides an update on the matters discussed in the private Board Meeting on 29 June 2020.


Page 3 of 5


Medicines Supply Contract Update Professor S Ranote, Medical Director, presented a report to request that the Trust Board approved the extension to the Medicines Supply Contract. An extension is permitted under the current contract arrangements provided that the contractor is meeting all of the requirements of the contract. Professor Ranote confirmed that this was the case and the Board formally approved the extension to the Medicines Supply Contract. Finance Report – Month Two The Finance Report in Part Two covers areas of finance that for commercial or other reasons are not shared in the Public Meeting. Mr J McLuckie, Chief Finance Officer, informed the Trust Board of the details of the COVID-19 expenditure and financial forecast to month four as requested by NHS England/Improvement. The Board noted the expenditure to date and noted the forecast position. Serious Incident Update – Part Two The Quality Committee continues to have delegated responsibility to track and monitor serious incidents. The Committee provides the Board with assurance that the incidents are being managed appropriately. The Chair of the Quality Committee updated the Board on four incidents that are being scrutinised, the details of which contain identifiable patient information and therefore cannot be public. Transaction with Mersey Care NHS Foundation Trust – Draft Outline Strategic Case Mrs T Hill, Director of Strategy and Organisational Effectiveness, informed the Trust Board of the business conducted at the Transaction Board meeting on 19 June 2020. She also explained that the Outline Strategic Case that members had received had been revised following the Board’s decision last month not to approve the initial Outline Case. The Board considered the revised document and were content with the more clearly defined financial assumptions, and discussed risks and requirements for due diligence. Acknowledging the work which had been undertaken since the last Board meeting the Board approved the amended Outline Strategic Case for submission to NHS England/NHS Improvement. The Board was also informed that NHS Improvement Transaction Teams are being stepped back up. They are hopeful that the Transaction will complete as expected.

3. MEETINGS AND ACTIVITIES UNDERTAKEN BY THE CHAIRMAN AND NON-EXECUTIVE DIRECTORS All Meetings are being held via Skype including the Quality Committee and Audit Committees. In addition to the Board meeting I have continued to join (via Skype) the Ethics part of the Clinical and Ethical Reference Group each week where there are ethical issues for discussion. Staff can use the Committee to help them with unusual or particularly


Page 4 of 5


challenging scenarios. This use has lessened as teams become more familiar with the Ethical Decision Making Tool and are able to work through the issues themselves and feel empowered to take decisions without the need for a formal reference to the committee. The Regional Director continues to hold a fortnightly briefing for Chairs via Tele-conference. I am pleased to say that the information gained from this continues to feature in other information cascades and via the Executive Team, confirming to me that we are receiving relevant information as Board Members. I have also participated in a North West Chairs meeting with NHS Providers and the national meeting where a wide ranging discussion about the current operating conditions in the NHS; the move towards a new normal in respect of the business carried out; and a look forward to the longer, post COVID-19 scenarios took place. The Greater Manchester Provider Chairs’ Group also met virtually on two occasions to discuss current governance arrangements and arrangements going forward. This group will continue to meet quarterly. I also participated in a meeting established through the Good Governance Institute and the University of Chester looking at Governance in the new COVID-19 world and looking beyond. It was agreed this group of interested Chairs would meet quarterly to learn from each other. The Non-Executive Directors have attended scheduled Committee meetings and other meetings relevant to their role (Mental Health Act Strategy Group) and Board meetings. We have also held a Non-Executive Director meeting via Skype. I have also held virtual 1-1 meetings with other Chairs.

4. BOARD DEVELOPMENT DAY At the time of writing this report we are planning a Board Development Day facilitated by Pip Gaskell, Head of People and Organisational Development. The day will explore promoting greater discussion and debate in Board meetings. Any decisions made by the Board during this session that need to be formally recorded will be verbally reported by me at the Board meeting.

5. ACTIONS TAKEN ON BEHALF OF THE BOARD There have been no actions taken by me on behalf of the Board.

6. CHAIRS AND NON EXECUTIVE APPRAISALS I have completed all of the Personal Development Reviews for the Non-Executive Directors.


Page 5 of 5


7. SUMMARY OF THE BUSINESS CONDUCTED BY THE COUNCIL OF

GOVERNORS There has been no formal business transacted by the Governors since my last report.

8. RECOMMENDATION The Board is asked to note the report and approve any recommendations following the Trust Board Development Day.

Helen Bellairs Chairman

of 7



Item

No

.

20/1

856

TITLE OF REPORT Chief Executive’s Business Report/COVID-19 Update

PRESENTED BY Simon Barber, Chief Executive

AUTHOR(S) Simon Barber, Chief Executive

REPORT PURPOSE

Information X Assurance X Approval/ Decision

X

To provide the Trust Board with an update on any business items and a progress update on the Trust response and plans to manage the COVID-19 pandemic.

ALIGNMENT TO THE TRUST’S STRATEGIC OBJECTIVES (x) We will deliver quality, safe and efficient services with

a highly skilled and motivated workforce X

We will engage with our communities and staff to deliver services differently

X

We will deliver whole person care through targeted

growth

We will play an active role in place-based care systems to

maintain a whole person care focus

We will retain our values and culture X

We will grow and develop the Trust at scale, being seen

as an equal partner in any system-wide collaboration

SUBJECT MATTER / CONTENT CONSIDERED AT THE FOLLOWING COMMITTEES / GROUPS

Committee / Group Date

Audit Committee

Quality Committee

Remuneration Committee

Executive Leadership Group Sub Group Name (if applicable):

Other Group Name: Gold Command

This content has not been considered elsewhere (x)

THIS REPORT RELATES TO A RISK ON THE BOARD ASSURANCE FRAMEWORK (Y/N)

Risk Reference Strategic Objective Description (as per BAF)

Risk 2629- COVID-19

We will deliver quality, safe and efficient services with a highly skilled and motivated workforce. We will engage with our communities and staff to deliver services differently.

There is a Trust wide risk to all staff and patients due to the coronavirus (COVID-19) outbreak in China with international spread, leading to an inability to maintain safe and effective service delivery and the need for the Trust to invoke Business Continuity.


The Trust Board is asked to: Receive an update on any business items and to receive assurance that the Trust is responding effectively to the COVID-19 Pandemic and taking actions as required to maintain staff and patient safety.

Trust Board Meeting

of 7



27 July 2020

Chief Executive’s Business Report/COVID-19 Update 1. BACKGROUND There are no new business items not covered elsewhere on the agenda, so the focus of this report is to provide the Trust Board with an update on any business items and on the Trust response to the current coronavirus pandemic. This novel virus is a new strain of coronavirus referred to as 2019-nCOV (COVID-19). 2. TIMELINE AND CURRENT POSITION On 2 March 2020 the UK Chief Medical Officer raised the risk to the public from moderate to high. On 11 March 2020 the World Health Organisation declared COVID-19 a pandemic. The Prime Minister briefed the nation on the 23 March 2020 announcing measures to delay and limit the spread of COVID-19 and protect the NHS. In line with the NHS Emergency Preparedness, Resilience and Response Framework, the Trust has maintained its command and control structure implemented in March 2020. The Clinical and Ethical Reference Group that supports clinical and ethical decision making during the COVID-19 response also remains in place. An analysis of the risk register related to COVID-19 has been completed to ensure identified COVID-19 risks are analysed, mitigated and escalated accordingly. Timely and responsive work to ensure an effective Trust response to COVID-19 is ongoing. This report will focus on key areas of progress and the Trust response since the previous update. 3. ACTIONS UNDERTAKEN BY THE TRUST SINCE THE LAST BOARD All discussions and decisions made by the Clinical and Ethical Reference Group are formally recorded. All recommendations they make to Gold Command are contained in a report to Gold Command three times a week. All actions taken by Gold Command are logged by an independent loggist and are reported weekly to the Chairman and the Non-Executive Directors. To communicate some key messages from decisions taken previously:

of 7


• Support to staff who are shielding

• Availability of risk assessments for BAME staff but also staff in “at risk” groups

• To reopen wards for visiting To receive assurance from Local Authority partners about our inclusion in their local outbreak plans. To approve a recommendation from CERG approving the resuscitation Standard Operating Procedure. To approve a recommendation from CERG to stand down the out of hours rota for the ethical “three wise men” and to deal with ethical issues on Wednesdays at CERG. The chairman of CERG would remain available in an urgent situation out of hours and could convene the necessary multidisciplinary support, but the volume of issues raised doesn’t warrant a rota. To receive assurance from CERG that we are compliant with the requirements of a letter received from the NW COVID-19 Clinical Ethics advisory committee in respect of visiting restrictions. To approve a recommendation from CERG to swab all in-patients every seven days. To approve a recommendation from CERG to isolate and swab any patient returning from off-site leave who reports being in a high risk situation AND to routinely swab all patients who have off-site leave every seven days. To reiterate the need for clinical staff, especially ward staff, to wear PPE. The first “audit” by the PPE monitors showed inconsistent adherence. To approve a recommendation from CERG that face masks with clear panels can only be used as face coverings as they are not compliant with the required standards. Also that full face visors be provided to clinical staff for the circumstances where it is advantageous for the full face to be seen by the patient. To approve a recommendation from CERG that whilst we can be compliant with national IPC guidance that requires staff to maintain a 2m distance from patients or wear appropriate PPE when on the ward, we should issue each member of ward staff with a pack containing goggles in the event of an incident that requires enhanced PPE. The review of compliance against all items in the national & regional guidance continues to happen in a timely way. From 18/03/2020 to 04/07/2020, 323 pieces of guidance have been received by the Trust. All have been logged on the Document Management System. Of the 323 received, 242 were assessed as relevant to the Trust. None is rated as red and five are rated as Amber. These are detailed in the appendix to this report. The Care Quality Commission carried out a desktop review of our compliance with the Infection Prevention & Control checklist that has been reported to Board previously. Our previous report to Board stated that we were compliant or had introduced measures which we felt offered a greater level of protection to staff and

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patients. I am pleased to report that the Care Quality Commission‘s feedback confirms this and states “The trust was assessed as compliant and we were given a real insight into all the hard work undertaken in response to COVID19”. At the end of the antibody testing period the Trust had tested 77% of the workforce and results show that 14% have tested positive for antibodies. A sub analysis of the data shows that 76% of our BAME workforce was tested and this returned a marginally higher positive result at 19%. 4. CONCLUSION

The Trust continues to work at pace and there is an assurance process in place to ensure compliance with guidance or instructions from multiple sources, this includes the Emergency Preparedness, Resilience and Response national function. 5. RECOMMENDATIONS

The Trust Board is asked to:

Receive the report and assurance that the Trust is responding effectively to the COVID-19 Pandemic and taking actions as required to maintain staff and patient safety.

Simon Barber Chief Executive Appendix 1 Areas where we have assessed our compliance with guidance to be “Amber”

of 7


Appendix 1

Amber ratings following quality assurance review up to and including 04/07/20

Ref Name and Summary Source &

date

received

into Trust

Proposed

Monitoring

Group/

Accountable

person

Rationale for Amber rating Remedial Actions planned By When?

1 PHE statement regarding

NERVTAG (New and

Emerging Respiratory

Virus Threat Advisory

Group) review and

consensus on

cardiopulmonary

resuscitation as an aerosol

generating procedure

(AGP)

PHE

26/04/20

CERG Public Health England Infection Prevention and

Control guidance will not be adding chest

compressions to the list of Aerosol Generated

Procedures. As a result, only level two personal

protective equipment is required.

CERG has approved that the Trust do not follow

the Public Health England Infection Prevention

and Control guidance and instead follow the

Resuscitation Council guidelines which state

that cardio-pulmonary resuscitation is an

aerosol generating procedure, and as such staff

are advise to wear an enhanced level of

personal protective equipment for a resuscitation

attempt.

Current mitigations agreed at

CERG, as a result the Trust will

remain non-compliant with Public

Health England guidelines.

This will

remain amber

2 Supporting patients who

are unwell with COVID-19

Guidance refers to the

direction to establish

inpatient cohort wards.

NHSE/I

01/05/20

CERG

It is recommended that inpatient settings should

‘cohort’ patients into those: – with confirmed

COVID-19, without confirmed COVID-19 and

where an individual is admitted who meets

government criteria for ‘shielding’, they should

be prioritised for an en-suite facility.

‘Shielding’ patients are prioritised

for en-suite facilities. Inpatient

settings are considering the

vulnerabilities of all patients and

making reasonable adjustments

where required.

This will

remain amber.

of 7



date

received

into Trust

Proposed

Monitoring

Group/

Accountable

person


CERG has agreed to alternative mitigations and

will remain non-compliant with some of the

cohort ward requirement. As such this will

remain amber rated.

3 Option for planned

placements - England only

Undergraduate nursing

and midwifery student

numbers for the 2020/21

September intake

Areas where students can

carry out placements will be

significantly reduced due to

business continuity and the

stepping down of community

services across the trust.

NMC/HEE/

HCPC/NHS

Employers/

Council of

Deans for

Health

12/05/20

NHSE/I

18/05/20

Operational

Group

Assistant

Director of

Nursing

Student progression should be a high priority for

all placement providers and universities. Trusts

are asked to identify as many placement

opportunities as possible to help make up for

placement hours that have already been lost to

COVID-19.

The Trust is continuing to assess the impact of

the step down in services on the number of

available student placements and further work is

required to increase placement capacity.

Work is ongoing to identify areas

for student placements and

ensure this is equitable across

boroughs.

Trust Operational Leads have

agreed that senior leadership

teams will oversee and manage

situations where teams feel

unable to support students.

This will be driven by operations

and overseen by the Assistant

Director of Nursing.

31/07/20

of 7



date

received

into Trust

Proposed

Monitoring

Group/

Accountable

person


4 Funding for employing

students for the COVID-19

response

A small number of 3rd

year

students (approximately 14)

will need to have their

contracts reviewed prior to

the 31st July to determine

whether they are still

required in the area they are

placed.

NHSE/I

HEE

19/05/20

Operational

Group.

Assistant

Director of

Nursing.

Funding for supernumerary placements for

students ceases on July 31st.

The Trust is rated amber because the 14

contracts have not yet been reviewed.

The 14 contracts are under review

and are being updated.

This will be overseen by the

Assistant Director of Nursing.

31/07/20

5 COVID-19: management of

staff and exposed patients

and residents in health and

social care settings.

This guidance provides

advice on the management

of staff and patients or

residents in health and social

care settings according to

exposures, symptoms and

test results.

GOV.UK

08/06/20

PHE

update

02/06/20

GOV.UK

08/06/20

PHE update

02/06/20

The guidance recommends that symptomatic

staff who have tested positive can return to work

after seven days if their clinical symptoms have

improved and they have had no fever for 48

hours.

The Trust will not be compliant with this element

of the guidance because the decision had

already been taken at CERG on 28 April that all

staff who have tested positive need to have had

no fever for 72 hours AND have a negative test

before returning to work.

.

The action agreed at CERG offers

additional safety measures above

and beyond those recommended

in the guidance. As a result the

Trust will remain non-compliant

with Public Health England

guidelines.

This will

remain amber.


Page 1 of 16



Item

No

.

20/1

857

TITLE OF REPORT Report from Executive Leadership Group Meeting held on 9 July 2020


AUTHOR(S) John Heritage, Chief Operating Officer/Deputy Chief Executive

REPORT PURPOSE

Information Assurance X Approval/ Decision

To provide the Trust Board with summary of activity from the meeting of the Executive Leadership Group held on 9 July 2020, and to provide assurance of decisions aligned to the Terms of Reference.




X


growth X






SUBJECT MATTER/CONTENT CONSIDERED AT THE FOLLOWING COMMITTEES / GROUPS


Audit Committee

Quality Committee


Executive Leadership Group – sub-groups that report in and assurance provided for:

Operations Group

Workforce Strategy Group

Clinical Leadership Group

JCNC

Quality, Safety, Safeguarding & Governance Group

Transformation & Efficiency Strategy Group

9 July 2020

Other Group Name:

This content has not been considered elsewhere

THIS REPORT RELATES TO A RISK ON THE BOARD ASSURANCE FRAMEWORK (Y/N) No



The Trust Board is asked to review the update provided by the Executive Leadership Group for the meeting held on 9 July 2020, chaired by the Chief Operating Officer/Deputy Chief Executive and receive assurance that the Executive Leadership Group is fulfilling its purpose and Terms of Reference.

Trust Board Meeting Meeting held in public

Trust Board Meeting


Page 2 of 16



27 July 2020

Report from Executive Leadership Group held on 9 July 2020

1. PURPOSE AND AUTHORITY

The Executive Leadership Group is established and constituted to provide the Trust Board with an update on the activities of and the decisions taken by the operational groups that report to it. Appendix one details those groups. 2. ACTIVITY OF THE Executive Leadership Group AT THE MEETINGS HELD ON 9 JULY 2020

The Activity of the Executive Leadership Group is set out against the specific terms of reference, detailing the items discussed, assurances received, decisions made and the ‘ask’ of the Board against each item.


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2.1 Governance The group will carry out the following functions:

The group shall review and approve the terms of reference for all groups that report to it on an annual basis and shall, where appropriate review and agree those groups’ work plans.

The group shall have regard to the strategic objectives of the Trust when reviewing the work plans of the groups

What was discussed Assurance Received / Issues noted

Decisions made Ask of the Board

The Group fits in to the governance structure as shown in Appendix one.

To note the amendment made to the reporting

group structure.

Quoracy of our group meetings. It was decided that following national guidance on the need to be flexible, we would relax the quoracy for some of our group meetings, so long as the meeting Chair felt that proceeding would be meaningful.

To be assured that meetings of our groups will be meaningful if at times not in accordance with the quorum.


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2.2 Management & Assurance The Executive Leadership Group shall manage effectively the groups that report to it.

The Executive Leadership Group shall request and review reports from the groups that report to it in order to gain assurances that the business of each group is being conducted effectively.

A report from the Operations Group held on 7 July 2020 was received and discussed.



Management & Assurance: The group noted that the Chief Operating Officer/Deputy Chief Executive had updated members of the Operations Group on the key items of discussion from the Executive Leadership Group and Trust Board and the approach to Restoration and Recovery work

The Executive Leadership Group was assured of the information flow from the Executive Leadership Group to Operations Group and up through to the Board.

None. To be assured that there is a feedback mechanism to the Trust Operations Group from the Executive Leadership Group and Trust Board on key issues discussed.

The group heard that the Operations Group had received an update from the Patient Journey meeting with a specific focus on progress made towards developing the Crisis Resolution Home Treatment Team Model for Mid-Mersey and the interdependencies with Mersey Care. The Staffing model will be based on call handlers, the lead is speaking to Mersey Care and we are waiting confirmation from them that they are comfortable with the model.

The Executive Leadership Group was assured that there is positive progress being made in these key areas of focus for the Patient Journey work-stream.

To support the proposal for the model to be received by the Transaction Board in August and to formalise the approach

To be assured that work is on-going with appropriate Executive oversight on the agreed priorities for the Patient Journey work-stream.


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Trust-wide consultation on the new model will commence following noting at the Transaction Board in August. The group also heard that there had been good progress made with pathways and IT for the re-based plan for the community nursing review in Knowsley following the departure of the Community Nursing Team in St Helens.

The group heard that a discussion had taken

place regarding the continued pressures within

the Wigan Urgent Care Pathway. A number of

rapid reviews have been commissioned to

consider the impact on services and the actions

that can be taken by the Trust and the wider

Wigan system. A meeting has been arranged

on 13 July 2020 to discuss the issues.

The Executive Leadership Group was assured that there is continued focus on addressing the challenges in the system in Wigan.

None To be assured that there is appropriate Executive support to the Wigan Team and wider Operations Leadership Team about the continued challenges in the Wigan mental health system.

Operation Management On Call The group heard that the Assistant Director of Ops for St Helens had provided a quarterly update on the work that is underway with Operational and Clinical Managers for the Manager on-call rota to review current arrangements and to ensure that logs are being completed. It was agreed a lesson learned session would take place with the Operational Managers on the rota.

The Executive Leadership Group was assured that there is a process in place to receive feedback and opportunities to improve the manager on-call rota.

None To be assured that there is a process in place to receive feedback and opportunities to improve the manager on call rota.


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Covid:19 Assurance – Restoration and Recovery Following the decision to stand down Silver Command, Bronze Command has been re-named to become the Restoration and Recovery Planning Group and will report into the Operations Group. TheTerms of Reference will be updated to reflect this change. A report will be provided monthly detailing those services that have had a signed off Restoration and Recovery plan and any issues that need addressing would be raised through the Operations Group.

The Executive Leadership Group was assured of the positive progress being made with the Restoration and Recovery plans within services and the approach being led by the Director of Operations.

To check there is the appropriate level of representation on the groups with involvement from Service Users & Carers from both physical health as well as mental health.

To be assured that there is a process to manage the restoration and recovery of Trust services and to be assured that those national requirements that are under the remit of the Operations Group are receiving appropriate scrutiny.

The group heard that a discussion had taken place with the Deputy Director who is leading a cross Trust project on maximising our opportunity to capitalise on agile work and how this project will be informed by and will inform operational services restart and recovery plans.

The Executive Leadership Group was assured that this piece of work will connect with the restart and recover of Trust services led by the Director of Operations.

To ensure that the Deputy Director links in with Operations group and the work completed by Directors & Deputies on lesson learned.

To be assured that this piece of work will connect with the restart and recover of Trust services and link with other pieces of ongoing work across the Trust.

Business Development The group heard that the Assistant Director of Business Development provided an update on the business development pipeline and informed the group that the Trust will receive funding to roll out the Mental Health in School’s service in two Boroughs. Further details are provided in the Commercial report.

The Executive Leadership Group was assured that the Business Development pipeline and potential opportunities are discussed and well understood by the Operations Group.

Need to consider how we maximise the use of technology if schools have not returned by September.

To be assured that the Business Development pipeline and potential opportunities are discussed and well understood by the Operations Group.


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A report from the Workforce Strategy Group on the 19 June 2020 was received and discussed



As the meeting was not quorate, there was a discussion whether it was ok to proceed.

The Executive Leadership Group was assured that the meeting had been conducted effectively.

The Director of Operations to speak to the relevant people from Operations about attendance at this group.

To be assured that time is being used wisely during these challenging times.

People Strategy 2019-2022 As previously heard the National People Plan is still awaiting publication and not likely until Autumn 2020. There have been five key themes identified and there is strong correlation with the five priorities for the Trust people plan.

The Executive Leadership Group was assured that the National People Plan and the Trust People plan are aligned.

To receive the plan at the Trust Board meeting in September for full discussion.

To be assured that performance against the People Plan is being measured.

Talent and Succession Student nurse recruitment pipeline - An update was provided on the number of students we have and those currently in paid placements.

24 nurses due to qualify in August / September already have job offers with the Trust

21 – Third year students qualify early in 2021

24 – Second year students are currently working for us on paid placements.

The Executive Leadership Group was assured of the process and accepted that with the current short fall of nurses nationally, all opportunities should be explored to secure available resources into the Trust.

As a Trust we need to explore all opportunities to recruit qualified nurses and consider posts within any new services. Sue Hunt, Professional Lead for People Services Transformation, to develop a proposal.

To be assured that all opportunities will be explored to secure available resources into the Trust.

A discussion took place regarding the second year students we have had working as paid Band 3’s during COVID-19 and if we should interview them now and give them a provisional


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offer providing they qualify. If they get the practice hours in they can qualify earlier.



The group heard about the challenges with student placement capacity and the significant pressures on teams due to the changing services models as a result of COVID-19 – particularly in community services. There is an expectation that post COVID-19, changes will be made nationally to make the use of the apprenticeship levy easier There was a verbal update on the apprenticeship levy, which we continue to fail to utilise due to the challenges of the lack of backfill funding.

The Executive Leadership Group was assured that we are working to agree consistent and ambitious student numbers across all our services and boroughs.

The Deputy Director Nursing & Governance should be taking the lead on this piece of work as the professional lead, supported by Mr L McMenamy, Director of Operations and Integration. To consider looking at higher level apprenticeships and how we can use the funding differently

To be assured that we are working to agree consistent and ambitious student numbers across all our services and boroughs.

Diversity & Inclusion The group heard that a detailed discussion took place on the Workforce Race Equality Standard and Workforce Disability Equality Standard reports and how we use the data to inform our strategic approach to inclusion in 2020/21.

The Executive Leadership Team was assured that the data will be used from these reports and the employee networks to

None.

To be assured of the sharing of the reports and that there is executive level visibility of the issues facing Black and Minority Ethnic females and disabled staff in our

The 2018/19 Gender pay gap report that was originally due to be submitted in March 2020 was presented - this was deferred due to Covid-19. It was noted that there has been a closure in the gender pay gap compared to the previous year.

identify five high impact actions that will improve the experience of work for Black and Minority Ethnic females and Disabled staff.

workplace and actions are being taken to support the networks.


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Learning & Development The Trust has access to over £500k in Continued Professional Development Monies for registered healthcare staff in 2020/21. A proposal on the application and prioritisation process to be developed with Assistant Clinical Directors over the next 4-6 weeks.

The Executive Leadership Group was assured of the direction of travel for the use of significant Continued Professional Development monies to support the trust ambition.

Workforce Strategy group to ensure they follow the scheme of delegation even though the funding comes in externally and ensure it is signed off by the correct people.

To be assured of the direction of travel for the use of significant Continued Professional Development monies to support the trust ambition.

Workforce Risks The risks were reviewed and an update was provided regarding the new workforce risks on the Board Assurance Framework.

The Executive Leadership Group was assured that the risks are being reviewed and monitored.

None. To be assured that the risks are being reviewed & monitored.


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A report from the Quality, Safety & Safeguarding Group held on 9 June 2020 was received and discussed

Responsive



MH Law Strategy Update – Work plan: The group heard that the Mental Health Law Strategy work plan will be provided for discussion at the July Quality, Safety, Safeguarding and Governance Group, following the Mental Health Law Strategy Group on 25 June 2020.

The Executive Leadership Group was assured of the changes made to the governance of this group and the progress being made.

None. To be assured of the changes made to the governance of this group and the progress being made.

The group heard that the following reports were submitted to Quality, Safety, Safeguarding and Governance Group. Q4 Medicines Management/Incidents Reports: A report was provided regarding medication incidents for Quarter 4. The report was reviewed and approved for external release to the Clinical Commissioning Group.

The Executive Leadership was assured that the content of the reports have been reviewed and noted the release of the report to the Clinical Commissioning Group.

None.

To be assured of the process and actions taken.

Q4 Infection Prevention Control Report: IPC team activity report during Q4 focused on response to COVID-19. Agreed to share COVID-19 board reports and/or Infection Prevention and Control assurance template with Clinical Commissioning Groups.

The Executive Leadership Team was assured of the decision made to report COVID-19 activity during this period.

None.

Note the approval of reports for external release.


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Q4 Health & Safety Report: Health & Safety Annual Report and Health & Safety Q4 Report data, statistics and activity was approved following minor amendments at Quality, Safety, Safeguarding and Governance Group with no significant concerns.

Agreed that this report does not need to go to Audit Committee.

Borough Assurance Templates and Minutes of local Quality, Safety, Safeguarding and Governance Group meetings: The group heard that the Borough’s Quality, Safety, Safeguarding and Governance Group papers were discussed to provide evidence of effective governance locally and proposed approval of assurance templates for release to Clinical Commissioning Groups. Some assurance templates required additional data input following the meeting, to be approved virtually with Assistant Clinical Directors.

The Executive Leadership Group was not assured of the process and requested a process is brought to Executive Leadership Group for approval.

None. To be assured of the process for external release of assurance information, following final approved accountability checks.

Care Quality Commission Current Position/ Compliance Report: A summary of external inspections and quality assurance visits and an update on progress/ status of ‘must do’ and ‘should do’ action plans from the recent Care Quality Commission meeting was provided to Quality, Safety, Safeguarding and Governance Group. The Deputy Clinical Director of Operations to scrutinise the evidence with every owner.

The Executive Leadership Group was assured of the continued progress and actions taken with the evidence repository on progress with must do/should do action plans.

None

To be assured of the continued progress and actions taken with the evidence repository on progress with must do/should do action plans.


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Complaints Improvement Action Plan (Phase 2): The group heard that an update was provided against the complaints improvement action plan. Quality, Safety, Safeguarding and Governance Group required further assurance of delivery against the action plan and this will be provided to the next Quality, Safety, Safeguarding and Governance Group. The next phase action plan will focus on training, data, quality of complaint responses, timeliness and delivery of existing action plan.

The Executive Leadership Group was not assured that the action plan is looking at the right aspects for improvement and further work is required.

Note further work required through Trust Quality, Safety, Safeguarding and Governance Group on a next phase complaints improvement plan with demonstrable achievement milestones.

Q4 Patient Experience Report activities during Q4 2019/20: The group heard that Quality, Safety, Safeguarding and Governance Group had received an update on feedback from Service Users and Carers, emerging themes from complaints, concerns and compliments and learning lessons/changing practice following feedback. Quality, Safety, Safeguarding and Governance Group recommended that options are considered for revising the current format of the current report with more focus on changes received from carers and patients and lessons learned.

The Executive Leadership Group was not assured that this process will work.

To note further work is required.


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Least Restrictive Practice Update: The group heard that the Positive Behavior Support plans are being rolled out with a Standard Operating Procedure in development, 1:1 action plan sessions to be held with ward managers in June/July. External training secured for September. Quality assurance framework in development to be presented at July. To ensure there is a clear reporting line and oversite from Quality, Safety, Safeguarding and Governance Group. The new observation policy will be circulated to the group for comments before final approval at next month’s Quality, Safety, Safeguarding and Governance Group.

The Executive Leadership Group was assured of the progress being made around Least Restrictive Practice.

None.

To be assured of the progress being made around Least Restrictive Practice.

Risk Management Group: The group heard that the new borough risk reports were presented with a particular focus and scrutiny on each areas top 3 risks. The need to strengthen controls and mitigating actions for some risks and inconsistencies in risk scores was noted. Peer discussion and review of risks was beneficial. Insufficient time in the meeting to retrospectively scrutinise all open risks, plan agreed for focused sessions outside of Risk Management Group, to ensure all risks are thoroughly reviewed.

The Executive Leadership Group was assured that there is evidence of a process in place to scrutinise and challenge risks but also to support boroughs with risk management.

None. To be assured that progress has been made to ensure there is an effective risk management process in place with plans to strengthen further.


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Quality, Safety, Safeguarding and Governance Group requested the Audit Committee delegate monthly analysis, scrutiny/assurance monitoring to the Risk Management Group and Quality, Safety, Safeguarding and Governance Group by exception.

Policies/Procedures/SOPs for Approval

Non-Medical Prescribing Policy and Procedure approved with Minor amendments.

Policy for the Prevention and Management of Pressure Ulcers was approved.

The Executive Leadership Group was assured of the actions taken.

None. To note the changes to Policies and Procedures.


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A report from the Transformation & Efficiency Strategy Group held on 6 July 2020 was received and discussed

What was discussed Assurance Received/ Issues noted

Decisions Made Ask of the Executive Leadership Group

2020/21 plans The group heard that the corporate CIPs had been reviewed and the progress to date with embedding the paused schemes into the rest of the plans for those services. The plans to bridge the gap on Human Resources and Organisational Development plans was not available. The high-level plan to assure the Group

The Executive Leadership Group was assured that The schemes that were unaffected by COVID-19 are on track and progress is being made with schemes that were paused as a result of COVID-19.

Meeting with the Chief Executive and the Director of Human Resources and Operational Development arranged to discuss an update for Human Resources and

To be assured that all schemes are being monitored.

What was discussed Assurance Received/ Issues noted

Decisions Made Ask of the Executive Leadership Group

that operational schemes paused are embedded in the Restoration and Recovery plans was presented. Progress has been made with regard to District Nursing and Walk In Centres. Detailed plans to be brought to the next meeting.

Operational Development which will be available at the next meeting

3. RECOMMENDATIONS The Trust Board is asked to: Review the update provided by the Executive Leadership Group for the meeting held on 9 July 2020 and receive assurance that the Executive Leadership Group is fulfilling its purpose and Terms of Reference. Simon Barber Chief Executive


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APPENDIX ONE

Agenda Item 20/1858

Page 1 of 14


Item

No

.

20/1

858

TITLE OF REPORT Report from Quality Committee Meeting held on 8 July 2020

PRESENTED BY Tricia Kalloo, Non-Executive Director

AUTHOR(S) Tricia Kalloo, Non-Executive Director

REPORT PURPOSE


To provide the Trust Board with summary of activity from the meeting of the Quality Committee held on 8 July 2020, and to provide assurance of decisions aligned to the Terms of Reference.




X


growth


maintain a whole person care focus X






Audit Committee

Quality Committee 8 July 2020



Other Group Name:

This content has not been considered elsewhere (x)




The Trust Board is asked to: Review the update provided by the Quality Committee for the meeting held on 8 July 2020, and confirm agreement for the ‘ask’ of the Board for all activity undertaken. Receive assurance that the Quality Committee is fulfilling its purpose and Terms of Reference.

Trust Board Meeting

20/1858 Report from the Quality Committee 8 July 2020

Agenda Item 20/1858

Page 2 of 14



27 July 2020

Report from Quality Committee Meeting held on 8 July 2020 1. PURPOSE AND AUTHORITY The purpose of the Quality Committee is to provide leadership and assurance to the Trust Board on the effectiveness of Trust arrangements for quality, safety and risk ensuring there is a consistent approach throughout the Trust, specifically in the areas of: The Quality Committee is authorised by the Trust Board to investigate any activity within its Terms of Reference. The Quality Committee is authorised by Trust Board to obtain outside legal or other independent professional advice and to secure the attendance of non-Board members, including non- Trust staff, with relevant experience and expertise if it considers this necessary. 2. ACTIVITY OF THE QUALITY COMMITTEE AT THE MEETING HELD ON 8 JULY 2020

The Activity of the Quality Committee is set out against the specific Terms of Reference, detailing the items discussed, assurances received, decisions made and the ‘ask’ of the Board.

Agenda Item 20/1858

Page 3 of 14


2.1 ACTIVITY The Committee ensures that there is good quality governance in place around the quality of care within the Trust through the following eight principles: 1) Ensuring that the fundamental standards of quality and safety (as determined by CQC’s registration requirements) are at a min imum being met by every service that the organisation delivers 2) Ensuring that the organisation is striving for continuous quality improvement and outcomes in every service 3) Ensuring that every member of staff that has contact with patients, or whose actions directly impact on patient care, is motivated and

enabled to deliver effective, safe and person‐centred care 4) Ensuring required standards are achieved

5) Investigating and taking action on sub‐standard performance 6) Planning and driving continuous improvement

7) Identifying, sharing and ensuring delivery of best‐practice 8) Identifying and managing risks to quality of care To achieve its purpose, the Committee agenda is divided into six sections enabling quality to be considered, with a focus every meeting on an element of each area, based on a rolling programme. Each of the six areas will have the eight principles above applied to them when being considered by the Committee in order to provide assurance to the Trust Board on their delivery.

Agenda Item 20/1858

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Trust Board Delegated Actions The Quality Committee will provide updates on progress against delegated tasks from the Board:

Care Quality Commission Current Position and Compliance Update

Delegated by the Trust Board on 29 October 2018, agenda item 18/1511: The Board discussed the current various reporting mechanisms through the Quality Committee and it was established that the Quality Committee will oversee the action plan and provide a detailed report to the Board via the delegated action updates monthly until completion. ** Please note that the meeting was held virtually and it was agreed in advance which papers would not be formally presented. All Committee members were invited to propose any questions in advance of the meeting **


Decisions made by the Committee

Ask of the Board

20/77 Care Quality Commission Action Plan Rebekah Roshan, Deputy Director of Governance, provided the Committee with an update on the current position and status of the ‘must do’ and ‘should do’ actions highlighted by the Care Quality Commission following inspection of the Trust in 2019. Further points discussed included the amber rated actions and those actions which had changed status since the previous Committee. The Committee received an update from Joanne Hiley, Executive Director of Nursing and Quality, in relation to the CQC relationship meeting. It was also noted that the progress made in relation to development of the information dashboard which has been developed re the

The Committee noted the contents of this report and the current position in relation to the status of the ‘must do’ and ‘should do’ actions highlighted in the final inspection report published by the Care Quality Commission in February 2020. Noted the rationale in relation to actions reported as ‘amber’ or ‘red’ and that movement of the grading has changed in both directions Received assurance that the Trust has an effective process in place to

No decision made by the Quality Committee

The Board is asked to note that the Quality Committee received assurance that effective processes are in place and will continue to be monitored.

Agenda Item 20/1858

Page 5 of 14


S136 places of safety and also training compliance position. The dashboards have been developed from the information management platform and allow scrutiny to a patient level if required. It was recognised that further focus on improvement of recording within Rio to ensure the dashboards fully reflected accurate activity. The work was recognised as a priority for improvement. Mrs Hiley stated that current practise was not compromising patient safety.

monitor progress and assurance on completion of actions.

Report from Quality Committee Meeting

Delegated by the Trust Board on 26 May 2020, agenda item 20/1810: Progress on the development of a process to close down matters delegated and under review by Board Committees will be provided to the Board for agreement and adoption.



Ask of the Board

20/85 Committee Review of Update Report to the Trust Board The Committee discussed the process for closing down delegated items from the Trust Board, and agreed that the processes in place are sufficient. A decision will be made as to whether sufficient assurances have been received, and if so a request will be made to the Trust Board to close the delegated item. Where sufficient assurances have not been received the Committee will continue to receive updates and the Trust Board will be notified via this report.

The Committee is assured that the process for delegated actions from the Trust Board is sufficient.

The Committee agreed that the current processes in place are sufficient and will continue to inform the Trust Board of updates received, and will request for items to be closed upon satisfaction that assurances have been received.

To be assured that a process is in place and is working effectively.

Agenda Item 20/1858

Page 6 of 14


Borough/Cross Organisational Assurance The Committee will receive a borough/cross organisational update on a rolling programme that gives assurances that all the elements within the agreed agenda are being delivered in all services in the Trust. This enables the Committee to receive assurance and challenge the leadership teams on their implementation of quality improvements.

See below

Quality Strategy The Committee approve and direct the quality strategy, and will then receive assurance on the delivery and effectiveness of the strategy throughout the year.

See below

Care Group Collaboratives There are six care group Collaboratives (and their sub-groups) within the Trust that the Committee will be responsible for assuring the Trust Board on their effectiveness and delivery of quality improvements.

See below



Ask of the Board

20/78 Knowsley Borough Presentation Rebecca McCarren, Assistant Clinical Director for Knowsley Provided a strategic overview regarding the quality improvement activity taking place across Knowsley borough. A combination of both quantitative and qualitative evidence was provided.

The presentation included data relating to a range of patient safety measures, clinical supervision compliance, Knowsley borough risks and the steps being taken to mitigate and improve any areas out of tolerance. The presentation included examples of how we are embedding practice to improve learning.

The key information highlights included: Patient Safety Measures • Knowsley Patient Safety Data is not displaying any

trends that are out of tolerance for seclusion and rapid tranquilisation.

The Committee noted the benefit in the information being presented in the format it was, particularly in relation to the borough data being compared to Trust Wide data. The Committee noted that the pressure ulcer improvement work and that a further update is scheduled for September 2020 Committee. Assurance was received by the Committee that Knowsley borough is working effectively to sustain and deliver quality.


The Board is asked to note that the Quality Committee received assurance that that Knowsley borough is working effectively to sustain and deliver quality.

Agenda Item 20/1858

Page 7 of 14


• The numbers of falls in Knowsley resulting in patient harm remains low and below the mean.

• The percentage of patient incidents that has result in moderate or above harm has increased in Knowsley. This is largely attributable to pressure ulcers first observed in the current episode of care and is currently an area out of tolerance but a borough priority for quality improvement.

• The percentage of staff incidents in Knowsley resulting in moderate or above harm is 0%.

Clinical Supervision Compliance • Clinical supervision uptake in Knowsley is below target

for Q1 48.77% Knowsley Borough Risk • Adult SLT is the most significant Borough Risk – Score

12 Limited Control. Embedding Practice to Improve Learning • Learning from pressure ulcer incidents has informed a

review of the action plan resulting in a number of practice changes to improve scheduling, provide clinical training and to develop Quality Standards.

• The MDT process has been improved within our Male Acute Mental Health Ward following the learning from a serious incident and in response to family feedback.

Agenda Item 20/1858

Page 8 of 14


Quality Governance The Committee will receive a rolling report relating to Patient Safety, Effectiveness, and Patient Experience. This will contain plans for the previous quarter in delivering quality improvements for each area, assurance regarding the work of the previous quarter, and plans for the following quarter. The detailed work will be carried out within Trust groups however the Committee will receive assurance regarding the quality and safety improvements in these areas, coordinated by the Integrated Governance Team.

See below



Ask of the Board

20/79 Quality Committee Work Schedule Mrs Hiley shared the proposed work plan for 2020-2021 for review. The key points highlighted included that; • Integrated Governance reporting removed following

agreement in June 2020 • Quarterly complaints reporting added and scheduled for

the year • Borough Presentations scheduled for the year • Exception reporting from Audit Committee added and

scheduled for the year

The frequency of borough presentations was considered

and the need to review how clinical audit would be

presented to Committee.

It was noted that further work

was required to confirm the

frequency of borough

presentations and the

requirement to review how

clinical audit would be presented

to Committee. The statutory

reports required by the

Committee requires further

review.

The Committee agreed that further work was required and a new proposal would be presented in August 2020.

The Board is asked to note the decision made

Agenda Item 20/1858

Page 9 of 14




Ask of the Board

20/84 Quality Accounts Report 2019-20

Lorna Griffiths, Assistant Clinical Director provided a

summary of the draft Quality Accounts Report in line with

the mandated detailed guidance for 2019-20.

It was noted that

• relevant leads for subject areas have contributed to this report and the subject matter has been considered in-year at the relevant stakeholder events, internal meetings and via the Trust’s monthly Quality and Performance Report.

• The executive sections have yet to be approved by the respective person(s).

• The requirement for external auditing was removed and the revised method of internal assurance was agreed including: the use of the auditor’s checklist for the quality and consistency of the report; a senior leadership reader group; Council of Governors and review of the content by the Quality Committee prior to Board level approval.

• Final scrutiny of the checklist will be undertaken by the Company Secretary for assurance purposes.

• The draft report will be shared with lead commissioners and stakeholders by 15 October 2020 for scrutiny and feedback and their letters will be inserted into this report.

• The report will be signed and dated by the Chairman and Chief Executive following final approval by the

The Committee noted that this draft report has been produced in line with the amended national guidance and the Quality Committee’s agreed method for monitoring the quality and consistency of the content. The Committee noted that Quality Accounts Report 2019-20 will be added to the agenda again for final approval. The Committee noted the actions required for overview and scrutiny by lead commissioners and stakeholders. The Committee noted that the

Trust is on target for completion

within the national timescales

and that a review of the

timescales for sharing with

CCG’s would be reviewed.

The Committee noted that there

was a requirement to include

appropriate narrative in relation

The Committee endorsed the report however requested any changes annotated for Committee consideration at August Committee


Agenda Item 20/1858

Page 10 of 14


Quality Committee. • The Trust is on target for completion and submission in

line with the national timescale of 15 December 2020.

to COVID 19 given that its

impact did influence during the

reporting period for this report

Required reporting The Committee will be delegated areas of quality and safety to review and provide further assurances to the Trust Board as required by the Trust Board.

See below



Ask of the Board

20/80 Patient Experience Annual Report Rebekah Roshan, Deputy Director of Governance provided

Committee with the key points of the report which included;

• The Trust has a range of processes and structures in place to capture patient and carers feedback.

• Elements of the Trust strategic priorities and quality priorities have been supported by patient experience/feedback.

• There has been a reduction in complaints referred to the Parliamentary and Health Service Ombudsman.

• There has been a reduction in the number of complaints that were upheld.

• Improvements have been identified and will continue throughout the next reporting period.

• There are further opportunities to embed continuous quality improvement from lessons learned.

• The Trust Quality Strategy will drive the learning from concerns, compliments and complaints.

• The introduction of the Peer Support Role is having a positive impact for carers.

The Committee received assurance that patient experience and feedback processes are in place. The Committee noted the developments throughout 2019/20. The Committee noted that the Lessons Learned process will be further developed via the Quality Strategy with embedded processes to share learning at borough and Trust Wide Level. The Committee noted that for future reporting the report could be strengthened in relation to the data and its explanation of how the Trust ranked in relation to other Trusts in the National patient survey.


The Board is asked to note that the Quality Committee received assurance that patient

experience and feedback processes are in place

Agenda Item 20/1858

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Ask of the Board

20/81 Medicines Optimisation Strategy Annual Report Lorraine Prescott, Chief Pharmacist, provided the Committee with a report highlighting the key actions that have been undertaken to implement Year 2 of the Medicines Optimisation Strategy 2018-2021 The report demonstrated the outcomes and actions which have been achieved in order to successfully deliver year two of the Medicines Optimisation Strategy. A number of key projects which have been implemented during 19/20 are highlighted. A number of year one and two priorities will be continued into 20/21 to further develop and embed service delivery. A review of year three priorities has been undertaken with a number of additional priorities being identified which will support the delivery of the Medicines Optimisation agenda through 20/21. Noted the patient engagement and how it influences the delivery

The Committee reviewed and noted the actions and key projects that have been implemented to deliver the year two priorities within the Medicines Optimisation Strategy. The Committee noted the value of the clinical contribution to effective collective clinical leadership by pharmacy on the work of delivering the strategy.

No decision made No specific ask of the Board

Agenda Item 20/1858

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Ask of the Board

20/82 Director of Medical Education Annual Report Dr Ashley Baldwin, Director of Medical Education shared the Director of Medical Education Annual Report. The key points included: • The Trust is fulfilling its requirements as per the Terms

and Conditions of Service for Doctors in Training (2016), including the amendments introduced in 2019.

• There are no significant issues which lead to any cause for concern regarding overall safe working hours for Junior Doctors in the Trust and/or their impact on training.

The Committee noted the

content of the report.

The Committee acknowledged and compliment the work undertaken.

No decision made No specific ask of the Board

Patient Safety In line with Trust policy and procedure, the Committee will receive a Patient Safety Report every meeting, detailing serious incidents, deaths, inquests, coroner’s activity, claims and legal activity taking place within the Trust to ensure there is Board level understanding and challenge around that activity.

See below



Ask of the Board

20/83 Confidential Patient Safety Report Rebekah Roshan, Deputy Director of Governance provided the Committee with a verbal overview of the papers purpose:

• To provide information and detail of serious incidents reported to StEIS in May 2020.

• To provide information and detail on the management of incidents in line with the NHS Serious Incident Framework (2015).

• To inform the Committee of high profile serious incidents,

The Committee noted the request to approve the recommendation for the Corporate Patient Safety Panel reports directly to the Trust Quality Committee. The Committee received assurance that patient safety incidents are being managed effectively within the organisation and that further

The Committee approved the recommendation that Corporate Patient Safety Panel reporting is directly to the Trust Quality Committee

The Board is asked to note the decision made and the assurance received.

Agenda Item 20/1858

Page 13 of 14


complaints and inquests. • To inform the Committee of the governance

arrangements in place for the monitoring of high profile cases.

• For the Committee to be assured that patient safety incidents are being managed effectively within the organisation and that further work continues to strengthen lessons learned.

work continues to strengthen lessons learned. The Committee requested that themes in the data are further analysed and presented with a focus on data and its statistical significance in conjunction with the narrative provided.

2.2 Audit Committee Delegated Actions The Quality Committee will provide updates on progress against delegated tasks from the Audit Committee:

The Committee will receive delegated actions from the Audit Committee where quality assurance is required by the Trust Board.



Ask of the Board

No actions at this time

2.3 Other Business conducted



Ask of the Board

20/75 Exception Reporting Item The Committee considered and accepted the request to review the circumstances relating to the admission of a patient under a Section 2. A review will be undertaken collaboratively using an after action review model across multiple agencies and review pathways of care.

Note the request Agreed to receive the review report


Agenda Item 20/1858

Page 14 of 14


3. RECOMMENDATIONS The Trust Board is asked to: Review the update provided by the Quality Committee for the meeting held on 8 July 2020, and confirm agreement for the ‘ask’ of the Board for all activity undertaken. Receive assurance that the Quality Committee is fulfilling its purpose and Terms of Reference. Tricia Kalloo Non-Executive Director

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20/1859 Digital Transformation Group – Quarterly Update


Item

No

.

20/1

859

TITLE OF REPORT Digital Transformation Group – Quarterly Update

PRESENTED BY Simon Barber, Chief Executive Officer

AUTHOR(S) Asim Patel, Chief Information Officer

REPORT PURPOSE


To provide an update on the key digital developments and projects aligned to the global digital exemplar fast follower programme. In addition, there is a particular emphasis on the digital response to the COVID-19 pandemic in this quarterly report.

ALIGNMENT TO THE TRUST’S STRATEGIC OBJECTIVES We will deliver quality, safe and efficient services with



X


growth X



We will retain our values and culture





Audit Committee

Quality Committee


Executive Leadership Group Sub Group Name (if applicable): Digital Transformation Group

15 June 2020

Other Group Name:

This has not been considered elsewhere (x)

THIS REPORT RELATES TO A RISK ON THE BOARD ASSURANCE FRAMEWORK (Y/N) Yes


2510

We will play an active role in place-based care systems to maintain a whole person care focus

There is a risk of being unable to provide safe and effective care due to a lack of interoperability and integration of digital systems and services across clinical boundaries leading to a detrimental impact on patient care, clinical safety and the Trust’s reputation.


The Trust Board is asked to note the quarterly update on the delivery of the Trust’s digital programmes and the digital response to support the COVID-19 pandemic.

Trust Board Meeting

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Report to Trust Board 27 July 2020

Digital Transformation Group – Quarterly Update

1. INTRODUCTION The paper provides an update to the Trust Board on developments and progress made relating to the global digital exemplar fast follower programme overseen by the digital transformation group. The Trust’s Digital Transformation Group meets on a monthly basis and is chaired by the Chief Information Officer and attended by the Chief Clinical Information Officer, Executive Director of Nursing and Quality, Director of Operations and Integration, Deputy Director of Finance and representatives from the Informatics team. 2. GLOBAL DIGITAL EXEMPLAR AND FAST FOLLOWER PROGRAMME

The global digital exemplar and fast follower funding agreement was formally submitted to NHS Digital in July 2018 and the Trust received confirmation of approval in September 2018. The programme has the following vision: Through digital maturity of our systems and our workforce, we will improve access and outcomes for people with mental and physical health conditions, supporting them to take more control over their recovery and live life well. The vision will be delivered through five working differently programmes:

1. Being paper free at the point of care 2. Creating an efficient and agile workforce 3. Crossing boundaries through interoperability and shared records 4. Digital channels (engagement, choice and access) 5. Being driven by intelligence

The following section provides an update on the working differently programmes that are part of the global digital exemplar and fast follower funding agreement. In addition, there is a particular emphasis on the digital response to the COVID-19 pandemic in this quarterly report.

3. GLOBAL DIGITAL EXEMPLAR FAST FOLLOWER PROGRAMME UPDATE On 7 November 2019 the Trust held its final external assurance meeting with colleagues from NHS Digital. The session was opened by the Trust’s Chief Information Officer and there were presentations from a number of clinicians and operational colleagues who described the benefits that their services have realised through the implementation of specific digital schemes.

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Feedback on the day from NHS Digital was very positive. Formal reporting followed and in early January NHS Digital confirmed that the final tranche of capital programme funds can be drawn-down from the centre. 3.1 Working differently series one: being paper free at the point of care

This working differently series will deliver an integrated patient administration system and a comprehensive electronic clinical care record that can be accessed from anywhere at any time and allows for the capture of data at the point of care. The schemes in this programme will deliver the foundations to reduce variation of practice across services and enable service re-design. Updates for three of the active schemes are provided below; Electronic Prescribing and Medicines Administration, Rio optimisation and text messaging.

Electronic prescribing and medicines administration As reported in the previous quarter, the final wards for the electronic prescribing and medicines administration system rollout were concluded in March. Since then the system has been invaluable as it enables the remote review and prescription of medications by pharmacists and prescribers, thereby reducing footfall on wards and allowing colleagues to work safely throughout the COVID-19 pandemic. An interim solution is in place between the electronic prescribing and medicines administration system and Rio to support processes around discharge medications. Development work is underway to enhance this and to automate the flow of information and subsequent production of electronic discharge summaries. This is made possible using the recently procured ‘Conexes’ integration capability. Work in the coming months will also focus on ensuring that use of the system is fully optimised by conducting a project evaluation. The informatics and pharmacy teams are also working together to scope and plan: developments around pharmacy stock control; the potential rollout of the electronic prescribing and medicines administration system to community mental health teams; and an upgrade which will bring a number of enhancements. Any emerging business cases and financial requirements will be presented at the relevant groups and committees.

Rio Optimisation The informatics team is working with Trust’s care collaborative leads, ensuring process redesign and Rio development time is focussed on the areas that add the most value to improving quality. A more structured route for raising Rio optimisation requests is being established to ensure care collaborative leads have oversight of requests coming in and can prioritise accordingly with the informatics clinical change leads. A new request for engagement process is currently being introduced to support this process and in line with support from other clinical oversight groups. In the last quarter, Rio optimisation for mental health has supported the update to the assessment pathway, including changes to 24/7 crisis line processes and a series of forms for biopsychosocial assessment, emergency referrals and external referrals. This has also improved the process of re-prioritising referral urgencies, giving staff the ability to step-up or step-down clients during the assessment process.

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In addition, a review is underway of the process for recording Multi Agency Public Protection Arrangements (MAPPA), and Mental Health Act sections 132 and 117. Rio optimisation within the community physical health services continues. There has been further development of the community nursing assessment and wound forms to improve the reporting for pressure ulcer quality standards. This has involved work with multiple teams across physical health to rationalise and consolidate different forms from different services, in particular podiatry and district nursing staff, all of which now record and track wounds on the same form. This has significantly improved access to clinically pertinent information, reducing clinical risk and duplication of information capture. Work has been undertaken to implement National Early Warning Score (NEWS2) recording in community nursing services, improving identification of the deteriorating clients and the subsequent escalation of care where necessary. NEWS2 processes, developments and documentation in the Trust have been shared with Mersey Care, aligning the operational practices across both trusts in readiness for the deployment of Rio eObservations later in the year. The Wigan Building Attachment and Bonds Service has recently mobilised and is using Rio for the recording of clinical activity.

Text Message Appointment Reminders

The rollout of text message appointment reminders is currently paused, but will resume in the next quarter. During the last quarter and to support the Trust’s COVID-19 response, the informatics team was required to make changes to the text messaging platform in order to reflect the different ways in which appointments can take place, for example, telephone and video consultation. This has presented a number of technical challenges, but these have been overcome and will allow more targeted text messages to be sent out in future. Between April and June, the text message reminder service for all teams generated approximately 69,000 messages, averaging 22,889 messages a month and over 750 messages per day.

3.2 Working differently series two: creating an efficient and agile workforce

This working differently series will enable a more efficient and dynamic clinical and clerical workforce that will maximise the use of digital solutions to become more agile that will be manifested by the better utilisation of our estate. There will also be noticeable reduction in letter production turnaround times and physical paper transfers.

Updates for four of the active schemes are provided below; Skype for Business, IT Kit Replacement Programme and the Digital Staff Platform. There is also an additional section regarding other schemes to digitally support the Trust through COVID-19 with items not mentioned elsewhere in this update report.

SKYPE for Business

Whilst the deployment of Skype for Business was completed some time ago, uptake in usage has significantly increased since many staff have been required to work from home during the COVID-19 pandemic.

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Skype for Business has proven to be an extremely effective communication tool. Over the last quarter, 35,487 Skype calls have taken place, including 11,523 Skype meetings/conferences, as well as 26,258 instant message conversations. The informatics team is continuing to review and release guidance in the correct use of Skype for Business, including hints and tips, general etiquette and advice on troubleshooting any technical issues. The informatics team is currently piloting Microsoft Teams, a successor to Skype for Business, before it is deployed further across the Trust on completion of the Windows 10 rollout programme. Microsoft Teams introduces a significant number of new features to support collaborative working, sharing, discussion and engagement, as well as offering enhanced messaging and call functionality.

Windows 10 Upgrade Programme and Kit Replacement

The informatics team has continued to support the St Helens and Knowsley Health Informatics Service (HIS) with the deployment of the Windows 10 operating system and IT equipment refresh programme. The Trust had committed £1m of capital investment for IT equipment replacement programme, which will see the replacement of computers that do not have the required specification to operate Windows 10. In the last quarter, technical teams have mainly focussed on priorities in response to the COVID-19 pandemic. The Windows 10 rollout programme was officially paused, however despite this, the teams were able to facilitate a number of borough-based drop-in sessions, allowing the staff who were due receive a new laptop the opportunity to attend site and collect it. The sessions were very successful, with over 200 new laptops deployed and a good number of staff able to work more effectively. To date and with additional effort made to safely rollout new computers during the pandemic, 2475 computers have been replaced or upgraded to Windows 10 (58% of the total estate). A re-baseline exercise following a full review of remaining assets is currently being undertaken. The project is scheduled to complete in quarter 3 2020.

Additional COVID-19 IT and Training Support It was described in the last report that the informatics team had been working to support the Trust with the introduction of a number of technologies / solutions as part of COVID-19 response. These solutions have remained in place and continue to make a significant difference in the way staff adopt a new way of working. In summary, the informatics team has been:

Working with the St Helens and Knowsley Health Informatics Service (HIS) to support the rollout of ‘Always-on’ VPN technology supporting staff to seamlessly access the network when working from home.

Deploying over 300 laptops (part of Windows 10 and temporary loan computers) to support staff to be able to work from home.

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Redesigning clinical systems training in order for training to be delivered via Skype for Business and eAssessments to be completed to assess Rio and electronic prescribing and medicines administration users’ capabilities

Developing a new training booking system to support staff to easily enrol on clinical systems training

Distributing iPads to inpatient wards to allow patients to video call their family and friends

Supporting development of virtual desktop infrastructure (VDI) technology, allowing staff to use their own, personal computers to access their work files, folders, systems and desktops securely from home

3.3 Working differently series three: crossing boundaries through interoperability and shared records This working differently series will enable clinicians to seamlessly view relevant records from other providers in the health and social care economy.

Greater Manchester Care Record (formally Wigan Share2Care Record) The Wigan Share to Care Record is now formally known as the Greater Manchester Care Record. In response to a letter received by the Greater Manchester Combined Authority (GMCA), the informatics team has accelerated data sharing development work as part of the Wigan Share to Care programme. In the last quarter, the informatics team has been working to support the sharing of additional clinical information with the Greater Manchester Care Record (and the other organisations in Greater Manchester that use it). In line with agreed data sharing principles, the Trust is now sharing more clinically relevant information, such as care plans, care coordinator details, risk assessments and mental health act activity in order to support delivery of cross-boundary patient care. Conversely, the Greater Manchester Care Record is available for staff to review information shared by other organisations and can be accessed at the click of a button via a link in the patient’s Rio record. 3.4 Working differently series four: digital channels (engagement, choice and access)

This working differently series focuses on connecting our service users and patients with clinicians using digital technologies as well as providing tools to support self-care and maintaining independence.

Video Consultation In the last quarterly update, it was reported the Trust has accessed sub-licenses for a nationally procured video consultation solution “Attend Anywhere” and a joint video consultation deployment team across the Trust and Mersey Care had been established.

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During the last quarter significant progress has been made in the deployment of Video Consultation and over 7000 virtual consultations have taken place since April 2020 across a range of services in the Trust.

In June 2020 the team introduced the ability to provide feedback following their virtual consultation and provisional data to date shows that 454 patients have provided feedback with 43% stating the experience was as good as a face to face session with 39% stating it was better or much better.

A number of patients have also provided comments on their experience and in the main, these comments have been positive. A sample of the patient comments is provided below:

“The video call is an excellent and a great way of embracing new modern technology. Personally, I would prefer the psychology appointments to be done by video in the future because the website was very simple and successful”

“It is really cost effective for me as I rely on taxis to get me to/from appointments. I have a limited income so I have found video calls a great help. I am still able to get the one-to-one contact that I need but without the associated normal travel costs. I really hope that this option can continue, even when the current lockdown has ended.”

“It's a really useful medium to have this therapy and still feels like face to face session. Please continue providing! Thanks”

“This is allowing my therapy to continue when otherwise I would be without any support. Absolutely brilliant.”

“It's much easier for my child and less stressful than having to travel and wait in a waiting room full of people”.

Along with the positive comments there has also been feedback that will support the Trust in developing and improving the service. Some patients have provided feedback about their concerns with privacy and confidentiality, technical capabilities and connectivity issues. The feedback from our patients and clinicians will be used to improve the video consultation offering and further embed this digital channel as an option for our patients and service users. 3.5 Working differently series five: being driven by intelligence This working differently series will deliver a new data warehouse making use of the latest infrastructure and business intelligence tools to provide insights. All relevant information both clinical and corporate will be made available at the point of need to support decision making. Automation of information reporting, continued development of the Trust’s information management platform and management and supervision tool (MaST) are the current active schemes in this programme.

Combined Intelligence for Population health Action (CIPHA)

This regional programme, sponsored by the out of hospital and acute response COVID-19 cells has now received funding from NHSX and has a deployment timeline of five weeks beginning 13 July 2020. It will support:

Intelligence to support COVID-19 response

Shared COVID-19 data facility including Test Track Trace and Contain

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Continued resilience; smart-release from lock-down including identifying hotspots

Support for long-term recovery – identifying regional capacity and mutual aid linking NHS, Social Care and Care Homes

The initial use cases are for epidemiology; capacity and demand planning; population stratification (identifying the vulnerable); and to augment the data feeds to local COVID-19 intelligence teams. The integrated data sources are:

Acute, Mental Health and Community Trust

Secondary Use Services national data sets

GP

111, 999

Out of Hours

Social Care (Adult and Children)

Care home capacity

Laboratories (testing and other pathology)

Track and trace

SITREPs The Trust data is on track to be included in the data platform and the data sharing agreement are in the process of being signed-off.

Management and Supervision Tool (MaST)

The Management and Supervision Tool (MaST) has been deployed to the St Helens and Warrington Recovery teams. The tool can be used to support daily operations and assist with caseload allocation and capacity management through the use of easy to understand team level and individual patient level dashboards, which detail risk and complexity profiles. The Trust’s Digital Transformation Group recently received a presentation from the system supplier (Otsuka Health Solutions) detailing how the MaST platform has been adapted by Mersey Care to provide support services during the COVID-19 pandemic. A similar approach will now be taken forward within the Trust and will enable risk stratification and pathway allocation to be applied across all services by integrating datasets from multiple sources (including mental health, physical health, and social care.)

COVID-19 Web Form

In order to support the requirements for the COVID-19 local and national daily sitrep returns, the informatics team has developed a web-form to capture required information. The web-form presents a list of employees for a chosen team, and allows the user to select a status (daily) against each employee. This not only allows the aggregation of data for all staff and teams to produce the necessary figures, it also offers benefit by being able to track individual employees’ working and/or absence days, which can be followed-up with additional support as needed. This web-form is now live across all boroughs. In addition, the Trust is now working closely with Mersey Care NHS Foundation Trust to automate the requirements for the national COVID-19 inpatient sitrep. The intention for this is to utilise a

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number of forms within the Rio system to capture this information, and provide this in report format for use by the Incident Management Team when submitting local and national returns.

COVID-19 Automated Reporting and Dashboards

All data captured via the COVID-19 web-form is imported into the Trust’s data warehouse several times per day, and is available to view through the Information Management Platform reporting platform. There are now two COVID-19 reports available in the Information Management Platform:

COVID-19 Daily Sitrep report – This report shows the aggregated web-form data against each question required for the local and national returns. The data can be drilled-down from borough level down to team / employee level as necessary.

COVID-19 key performance indicator report. Both reports are updated on a daily basis, and available on a self-service reporting basis through the Information Management Platform.

4. RECOMMENDATIONS

The Trust Board is asked to note the quarterly update on the delivery of the Trust’s digital programmes and the digital response to support the COVID-19 pandemic.

Simon Barber Chief Executive

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20/1860 Finance Report Month Three


Item

No

.

20/1

860

TITLE OF REPORT Finance Report – Month Three

PRESENTED BY John McLuckie, Chief Finance Officer

AUTHOR(S) Sarah Waterworth, Deputy Director of Finance

REPORT PURPOSE


This report is to inform the Board of the revised contracting and payment arrangements currently in place and the month three financial performance.





growth

We will plan an active role in place-based care systems to







Audit Committee

Quality Committee



Other Group Name:

This content has not been considered elsewhere X





Receive the month three financial performance.

Be assured that the month three performance presents a true and fair picture of the Trusts expenditure, including that related to the COVID-19 response.

Note the improved cash position and explanation thereof.

Trust Board Meeting

of 5 Page 2 of 5


Report to Trust Board – Public Meeting 27 July 2020

Finance Report– Month Three

1. INCOME AND EXPENDITURE The month three performance against the underlying budget is shown in table 1 below. Table 1 – Income and Expenditure Performance against underlying Budget

Year to date position We report a breakeven position in the year to date. The income balance includes £38.2m block payments, £2.182m top up payments and £8.2m of other income invoiced or received. It also includes an accrual of £2.410m in relation to the COVID-19 reimbursement. An additional retrospective top up payment of £279k has been required in order to report a break even position in the period to date. The retrospective top up is the mechanism by which the Trust can receive funding for developments progressed late in 2019/20 or this year and as such were not included in the block calculations. This is expected to be reimbursed by NHS Expenditure/Improvement. The retrospective top up that we have required in relation to such developments has been significantly reduced, due to lower expenditure levels on our underlying business. Excluding the COVID-19 reimbursement, the income reported is £1.938m more than our underlying budget. This is due to the top up payments received and accrued, which mitigate the underlying deficit of £1.927m in the year to date allowing a break even position to be achieved. Expenditure, excluding COVID-19 costs is reasonably in line with the underlying budget, showing a £125k favourable variance. Within the balance is a favourable variance due to reduced demand for some services and a corresponding reduction in bank and agency expenditure as well as significant savings through vacant posts. Recruitment is progressing in several key areas now that management have the capacity to focus on this. This underspend to budget however is offset by expenditure in relation to new services that were not included in budgets.

Period ending 30 June 2020Budget

£'000s

Actual Incl

Covid

£'000s

Variance

Actual

Excluding

Covid

£'000s

Variance COVID-19

£'000s

Budget

£'000s

Actual Incl

Covid

£'000s

Variance

Actual

Excluding

Covid

£'000s

Variance COVID-19

£'000s

Total Income 15,645 17,133 1,488 16,256 611 877 46,936 51,284 4,348 48,874 1,938 2,410

Pay Expenditure (13,180) (13,552) (372) (12,995) 185 (557) (39,525) (40,728) (1,203) (39,116) 409 (1,612)

Non Pay Expenditure (2,771) (3,258) (532) (2,938) (167) (320) (8,313) (9,394) (1,082) (8,596) (284) (798)

Total Operating Expenditure (15,951) (16,810) (904) (15,933) 19 (877) (47,837) (50,122) (2,285) (47,712) 125 (2,410)

Net (306) 323 584 323 629 - (902) 1,162 2,064 1,162 2,064 -

Capital Financing (342) (272) 70 (272) 70 (1,026) (1,010) 16 (1,010) 16

Interest Payable (52) (46) 6 (46) 6 (157) (151) 6 (151) 6

Interest Receivable - (4) (4) (4) (4) - (1) (1) (1) (1)

Surplus/(Deficit) for period (648) - 648 - 648 - (1,927) - 1,927 - 1,927 -

In month Year To Date

of 5 Page 3 of 5


2. CAPITAL

Table 2 – Year to date capital expenditure vs plan

As expected under the current circumstances, capital expenditure for the first quarter was minimal at £135k. Business cases for IT kit £200k, Marlowe taps £77k and Brooker heating £143k have been approved. The reforecast capital plan for 2020/21 was submitted to NHS Improvement at the end of May as requested. Given the pressures on capital resources nationally, it will be important that the Trust utilises the resources fully.

Scheme

Annual

Plan

2020/21

Plan Actual Variance

£'000 £'000 £'000 £'000

INFORMATICS SCHEMES

2019/20 schemes b/f

IMP 168 6 20 (14)

EPMA 201 43 24 19

2020/21 schemes

Flow * 207 21 21

EPMA (Community MH) * 251

Patient Held Record * 119

Agile working (virtual smart cards and ipads) * 290

Voice recognition / digital dictation * 119

Online consultation * 126

Infrastructure upgrade * 170

IT Kit - Phase 1 200

IT Kit - Phase 2 100

TOTAL INFORMATICS SCHEMES 1,951 70 44 26

ESTATES SCHEMES

2019/20 schemes b/f 16 16 14 2

2020/21 schemes

Fees 60 15 14 1

Marlowe taps 77

Brooker heating 143 9 (9)

St Helens relocation 559

St Helens relocation enabling works 15

Backlog maintenance 130 55 54 1

TOTAL ESTATES SCHEMES 1,000 86 91 (5)

GRAND TOTAL 2,951 156 135 21

* NB - The cost of the implementation team at £260k has been allocated to each of these schemes

Year to Date

of 5 Page 4 of 5


3. CASH

The table below shows the Trust’s planned cash position (as per the budget paper

submitted to the Trust Board in April) and the actual cash position as at 30 June

2020.

Table 3 – Cash Flow Movements

The closing cash balance at the end of June was £19.1m, which is a significantly higher balance than planned. The main reasons are summarised below:

A number of payments were received from commissioners towards the end of March, which were not anticipated. This accounts for the £2m variance in the opening cash balance.

The Trust planned a deficit position however, due to the top-up payment system introduced as part of the new financial arrangements, the Trust’s revenue position was brought back to break-even in April, May and June.

Also as part of the new financial arrangements, the Trust is receiving payments from NHS commissioners in advance. In accordance with standard accounting practice, the income received in advance has been deferred to the period to which it relates. This accounts for the majority of the movement in working balances.

The Trust will not now require borrowing as planned by July in order to maintain its liquidity position. However, once guidance becomes clear on how the financial framework will operate for the remainder of the year, we will need to revise our cash forecast and re-assess any future borrowing requirement.

Plan Actual Variance

£000 £000 £000

Opening Cash 2,416 4,428 2,012

Surplus/(Defecit) (1,927) 0 1,927

Non Cash - Depreciation 603 602 (1)

Q4 2019/20 PSF Receipt 604 604 0

Atherleigh Park VAT Receipt 1,400 0 (1,400)

Loan Drawdown 565 0 (565)

Repayment of Loan Principal (427) (427) 0

Capital Expenditure (156) (135) 21

Movement in Working Balances 115 14,345 14,230

Movement in Inventories 0 (293) (293)

Closing Balance 3,193 19,124 15,931

Year to Date

of 5 Page 5 of 5


4. RECOMMENDATIONS


Receive the month three financial performance.

Be assured that the month three performance presents a true and fair picture of the Trusts total expenditure, inclusive of the COVID-19 response expenditure.

Note the improved cash position and explanation thereof. John McLuckie Chief Finance Officer

of 7



Item

No

.

20/1

861

TITLE OF REPORT Fit and Proper Persons’ Annual Update


AUTHOR(S) Jacqueline Hughes, Company Secretary

REPORT PURPOSE


To provide assurance to the Board that the Trust is compliant with Regulation 5 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014; Fit and Proper Persons’ requirement for Directors.





growth








Audit Committee

Quality Committee



Other Group Name:

This content has not been considered elsewhere (x) x




The Board is asked to note the assurances, evidence and update provided that confirms the Trust is compliant with Regulation 5 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014; Fit and Proper Persons’ Requirement for Directors.

Trust Board Meeting

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Fit and Proper Person Annual Update

1. INTRODUCTION

The Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 introduced two new regulations which came into force for NHS bodies from 27 November 2014. These were Duty of Candour and the Fit & Proper Persons’ requirement for Directors.

2. BACKGROUND

The Trust Board received the first report in July 2015; providing information about the Regulation and outlined the Trust process for ensuring compliance both on appointment of a new Director and for existing Directors. The Regulation states (amongst other things) that the Trust has to:

Provide evidence that appropriate systems and processes are in place to ensure that all new directors and existing directors are, and continue to be, fit, and that no appointments meet any of the unfitness criteria set out in Schedule 4 of the regulation.

This means that board directors should be of good character, have the required skills, experience and knowledge and that their health enables them to fulfill the management function. None of the criteria of unfitness should apply, which include bankruptcy, sequestration and insolvency, appearing on barred lists and being prohibited from holding directorships under other laws. Directors should not have been involved or complicit in any serious misconduct, mismanagement or failure of care in carrying on a regulated activity.

Make every reasonable effort to assure itself about an individual by all means available.

The Trust Board has received annual update reports each year since 2016 providing assurance and evidence of compliance to the requirements. This is the fifth annual update the Trust Board will receive and provides assurance and evidence of continued compliance to the requirements.

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3. ANNUAL CHECKS

The Trust has a rigorous process in place for new appointments and annual reviews which meet the requirements of the regulation; details are included within appendix one of this report. In July 2018 (agenda item 18/1470) the Board agreed the frequency of Disclosure and Barring Service Checks to be undertaken; during recruitment and subsequently on a three yearly basis for Executive Directors, and on the commencement of each term of office for Non-Executive Directors. Appendix three of this report sets out the current status of Disclosure and Barring Service checks for all Trust Board Members, the type of check undertaken, the agreed frequency, and the next time it is due to be undertaken. All other requirements of the annual checks have been completed, no issues were identified during any of the checks undertaken which would result in a Director meeting the unfit criteria of Regulation 5 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to Fit and Proper Persons.

Appendix two of this report provides evidence to support the Trust in meeting the requirements of the regulation. Due to the the current focus on responding to the coronavirus pandemic, a decision has been taken to extend the deadline for completion of performance development reviews (PDRs) to the end of September 2020.

The Care Quality Commission reviews this regulation as part of the Well-Led review. The Trust holds Fit and Proper Persons’ folders for all Trust Board members and this report as evidence of compliance to this regulation.

4. RECOMMENDATIONS

The Board is asked to note the assurances, evidence and update provided that confirms the Trust is compliant with Regulation 5 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014; Fit and Proper Persons’ Requirement for Directors. Simon Barber Chief Executive


Fit and Proper Persons' Test for New Appointments

Checks carried out by Recruitment Services and Company Secretary Team; evidence is filed in the Fit and Proper

Persons' folders

Two references, one of which must be most

recent employer and must cover at a minumum the

last three years of employment

Qualification Checks (pre employment)

Professional Registration (pre

employment)

Right to work

checks

Occupational Health Clearance

Fit and Proper Persons' Test

checks (where appropriate) with a requirement for the individual to join the

DBS

Professional Registration checks (where appropriate)

Search of the Insolvency, Bankruptcy

and Disqualifed Directors' Register


Self Declaration

Proof of Identity Checks

Fail

Do not appoint unless exception

permitted

Pass

Appoint and add to existing documents

Job description

Contract

Application form/CV

Appendix 1

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Fit and Proper Persons' Annual Check

Inform Chair/Lead Governor of outcome of Fit and Proper

Persons' Test

Issues

Consider continuing

appointment taking account of issues and regulations

Confirm Fit and Proper Persons'

Test

pass, noting exception made (if

permitted)

Undertake steps to remove

Appeal Process

No issues

Confirm Fit and Proper Persons'

Test

pass on file

Search of Insolvency

and Bankruptcy

Register

Professional

Registration (where

appropriate)

Performance and

Development Review

Disclosure and Barring

Service Update

Search of Disqualified

Director Register


Self Declaration

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Appendix 2

Name

Professional Registration (date check undertaken)

Performance and Development

Review (date review completed

Disclosure and Barring Service

Update (date update completed)

Search of Insolvency and

Bankruptcy Register (date

check undertaken)

Search of Disqualified

Director Register (date check undertaken)

Self Declaration (date

declaration made)

Mr I Arnold N/A 6 July 2020 27 August 2019 7 July 2020 7 July 2020 22 May 2020

Mr S Barber N/A *28 July 2020 15 November 2018 7 July 2020 7 July 2020 27 May 2020

Mrs H Bellairs N/A 12 June 2020 14 April 2020 7 July 2020 7 July 2020 22 May 2020

Dr J Berry N/A 6 July 2020 10 November 2017 7 July 2020 7 July 2020 22 May 2020

Mrs J Hiley 7 July 2020 *7 September 2020 27 May 2020 7 July 2020 7 July 2020 22 May 2020

Mrs T Hill N/A *26 August 2020 11 July 2018 7 July 2020 7 July 2020 22 May 2020

Mr J Heritage N/A *7 September 2020 4 July 2018 7 July 2020 7 July 2020 27 May 2020

Ms T Kalloo N/A 8 July 2020 18 June 2020 7 July 2020 7 July 2020 7 June 2020

Mr S McAndrew N/A 8 June 2020 12 July 2018 7 July 2020 7 July 2020 18 May 2020

Ms J McDonnell 7 July 2020 *25 August 2020 23 June 2020 7 July 2020 7 July 2020 27 May 2020

Mr J McLuckie 9 July 2020 *14 September

2020 6 July 2018 7 July 2020 7 July 2020 27 May 2020

Dr S Ranote 9 July 2020 *27 August 2020 5 March 2018 7 July 2020 7 July 2020 22 May 2020

Mr M Tate N/A 12 June 2020 14 August 2018 7 July 2020 7 July 2020 28 May 2020

Ms A Tumilty 9 July 2020 6 July 2020 13 October 2018 7 July 2020 7 July 2020 26 ay 2020

*In light of the current focus on responding to the coronavirus pandemic, a decision has been taken to extend the deadline for completion of performance development reviews (PDRs) to the end of September 2020.

of 7


Appendix 3

Director

Type Of Disclosure And Barring Service

Check

Date Current Disclosure And Barring Service Check

Undertaken

Proposed Frequency Of Disclosure And Barring

Service Checks

Year For Renewal Of Disclosure And Barring Service

Renewal

Mr I Arnold Basic 27 August 2019 3 Years 2022

Mr S Barber Basic 15 November 2018 3 Years 2021

Mrs H Bellairs Basic 14 April 2020 Next term of office 2023

Dr J Berry Basic 10 November 2017 Next term of office 2020

Mrs T Hill Basic 11 July 2018 3 Years 2021

Mrs J Hiley Enhanced 27 May 2020 3 Years 2023

Mr J Heritage Basic 4 July 2018 3 Years 2021

Ms T Kalloo Basic 18 June 2020 Next term of office 2023

Mr S McAndrew Basic 12 July 2018 Next term of office 2021

Ms J McDonnell Enhanced 23 June 2020 3 Years 2023

Mr J McLuckie Basic 6 July 2018 3 Years 2021

Dr S Ranote Enhanced 5 March 2018 3 Years 2021

Mr M Tate Basic 14 August 2018 Next term of office 2021

Ms A Tumilty Basic 13 October 2018 Next term of office 2021

End.

of 1

20/1862 Quality and Performance Report


Item

N

o.

20/1

862

TITLE OF REPORT Quality and Performance Report PRESENTED BY John McLuckie, Chief Finance Officer AUTHOR(S) John McLuckie, Chief Finance Officer

REPORT PURPOSE

Information X Assurance Approval/ Decision

The Quality and Performance Board Report is designed to allow the Trust Board to monitor their defined Key Performance Indicators at a Trust-wide Level. These Key Performance Indicators include national measures and locally-agreed priorities. For each applicable measure a target has been set based on either the national target, or a locally agreed target, which will drive the required standard of performance. If performance is below the required standard, an improvement trajectory will be set and performance will be monitored against this trajectory on a month by month basis. Whilst a small number of indicators are service specific, this report focuses on KPIs at a trust wide, mental health and community level. This report utilises Statistical Process Control (SPC) techniques where applicable. SPC techniques can be used to understand variation in a process and highlight areas that would benefit from further investigation.

ALIGNMENT TO THE TRUST’S STRATEGIC OBJECTIVES (x) We will deliver quality, safe and efficient services with a highly skilled and motivated workforce X We will engage with our communities and staff to deliver

services differently X We will deliver whole person care through targeted growth X We will play an active role in place-based care systems to

maintain a whole person care focus X We will retain our values and culture X We will grow and develop the Trust at scale, being seen


SUBJECT MATTER / CONTENT CONSIDERED AT THE FOLLOWING COMMITTEES / GROUPS Committee / Group Date Audit Committee Quality Committee Remuneration Committee Executive Leadership Group Sub Group Name (if applicable):

Other Group Name: Executive performance Meeting 16 July 2020 This content has not been considered elsewhere (x)

THIS REPORT RELATES TO A RISK ON THE BOARD ASSURANCE FRAMEWORK (Y/N) No Risk Reference Strategic Objective Description (as per BAF)


The Trust Board is asked to: • Note and discuss the content of the Quality and Performance Report

Trust Board Meeting

June 2020 Quality and Performance Board Report

Context

The Quality and Performance Board Report is designed to allow the Trust Board to monitor their defined Key Performance Indicators at a Trust-wide Level. These Key Performance Indicators include national measures and locally-agreed priorities. For each applicable measure a target has been set based on either the national target, or a locally agreed target, which will drive the required standard of performance. If performance is below the required standard, an improvement trajectory will be set and performance will be monitored against this trajectory on a month by month basis.

Each measure falls within one of the following five domains which correlate to those used by the Care Quality Commission. They are as follows:

The detail behind these measures and a significant number of others are scrutinised by the Operational Performance Group and the Executive Performance Group on a monthly basis.

Whilst a small number of indicators are service specific, this report focuses on Key Performance Indicators at a Trust wide, Mental Health and Community level.

This report utilises Statistical Process Control (SPC) techniques where applicable. Statistical Process Control techniques can be used to understand variation in a process and highlight areas that would benefit from further investigation.

Safe Effective Responsive Well led Caring

Regulatory & External view

Outstanding Good Requires Improvement Inadequate

CQC - Good(Link to CQC report)

NHS Improvement - Segment 1

Key

Current Month / (Last Month) Use of Statistical Process Control Charts

G Green - Achieving Target

R

A

Gr

Summary DashboardJune 2020

Grey - No defined target/target being developed*

SPC rules are used to identify unusual patterns in the data which are unlikely to have occurred due to chance. Special cause variation is the term used when a rule is triggered. The four most common rules are:

A single data point outside the process limitsTwo of three data points close to a process limitShift of points above/below mean lineRun of data points in ascending/descending order

Red - Not achieving target and outside the process control limits

Amber - Not achieving target and within the process control limits

1 2 3 4

Outstanding

Outstanding

The service is performing exceptionally well.Good

GoodThe service is performing well and meeting our expectations.

Requires improvement

Requires improvementThe service is not performing as well as it should and we have told the service how it must improve.

InadequateInadequateThe service is performing badly and we've taken action against the person or organisation that runs it.

Segment Description

1 Providers with maximum autonomy: no potential support needs identified. Lowest level of oversight; segmentation decisions taken quarterly in the absence of any significant deterioration in performance.

2Providers offered targeted support: there are concerns in relation to one or more of the themes. We've identified targeted support that the provider can access to address these concerns, but which they are not obliged to take up. For some providers in segment 2, more evidence may need to be gathered to identify appropriate support.

3Providers receiving mandated support for significant concerns: there is actual or suspected breach of licence, and a Regional Support Group has agreed to seek formal undertakings from the provider or the Provider Regulation Committee has agreed to impose regulatory requirements.

4 Providers in special measures: there is actual or suspected breach of licence with very serious and/or complex issues. The Provider Regulation Committee has agreed it meets the criteria to go into special measures.

Gr 1 R 1

A 1

G 5

(1)

(4)

(2)

(1)

GrRAG

Gr 0R 0

A 4

G 7

(0) (2)

(2)

(7)

GrRAG

Gr 0R 0A 1

G 5

(0)(0)

(1)

(5)

GrRAG

Gr 1

R 1

A 1

G 4

(1)

(4)

(1)

(1)

GrRAG

Gr 1

R 0

A 0G 2

(1)

(0)(2)

GrRAG

(0)

Safe Effective

Responsive Well led

Caring

Page 2 of 23

https://www.cqc.org.uk/news/releases/north-west-boroughs-healthcare-nhs-foundation-trust-rated-good-cqc

Indicator Executive Lead Units National (N) or Local (L) Target

Improvement Trajectory set Timescale Target Current Month

TargetCurrent Month

Actual R A G SPC Applicable

Percentage of staff incidents that result in moderate or above harm JHI Percentage L - Apr-20 1.0% 1.0% 0.0% ✔ Y

Percentage of patient incidents that result in moderate or above harm JHI Percentage L - Apr-20 2.9% 2.9% 3.3% ✔ Y

Clinical supervision - percentage of clinical staff who have at least one supervision in the quarter JHI Percentage L - Apr-20 0.0% 80.0% 61.6% ✔

Number of restraints at level 3 or above JHI Number L - Apr-20 149 149 126 ✔ Y

Number of seclusions JHI Number L - Apr-20 30 30 18 ✔ Y

Percentage of inpatient falls that result in harm JHI Percentage L - Apr-20 0.0% 34.2% 25.6% ✔ Y

Bed days in adult facilities of patients who are under 18 years old JH Days L - Apr-20 0 0 0 ✔

Mental Health

Trust wide

June 2020

Level

Safe Domain scorecard

Page 3 of 23

Safe June 2020

R A G R A G

✔ ✔

Improvement Trajectory Set Y N Improvement Trajectory Set Y N

✔ ✔

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

20/21 Target/Trajectory 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 20/21 Target/Trajectory 2.9% 2.9% 2.9% 2.9% 2.9% 2.9% 2.9% 2.9% 2.9% 2.9% 2.9% 2.9%

Comments / Performance Improvement Actions and Timescales Comments / Performance Improvement Actions and Timescales

Indicator progress sheet

Not required Incidents resulting in harm are closely monitored in each borough. Each incident will be tracked both at a borough and Trust-wide level and remedial action taken if necessary.

Current performance is better than the planned target and does not trigger a process control rule. The Trust takes seriously any incident that results in harm to staff.

Current performance is worse than the planned target but does not trigger a process control rule. The Trust takes seriously any incident that results in harm to patients.

Percentage of staff incidents that result in moderate or above harm

Percentage of patient incidents that result in moderate or above harm

Issue Issue

Page 4 of 23

Safe

R A G

✔

Out

Improvement Trajectory Set Y N

✔

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

2 20/21 Target/Trajectory 80.0% 80.0% 8.0% 80.0%

Issue

Comments / Performance Improvement Actions and Timescales

June 2020Trustwide - Clinical supervision - percentage of clinical staff who have at least one supervision in the quarter

Targeted interventions across teams are in place with plans to increase activity. It is pleasing to note that despite not achieving the Trust target there has been increased activity quarter on quarter with individual supervision sessions, in quarter one there were 6,000 occasions of supervision, this is almost 900 more that in the previous quarter.

Current performance is worse than target.


Page 5 of 23

Safe June 2020

R A G R A G

✔ ✔


✔ ✔Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

20/21 Target/Trajectory 149 149 149 149 149 149 149 149 149 149 149 149 20/21 Target/Trajectory 30 30 30 30 30 30 30 30 30 30 30 30

Issue Issue



Not required Not required

Current performance is better than the planned improvement trajectory and does not trigger a process control rule.


Mental Health - Number of restraints at level 3 or above Mental Health - Number of seclusions

Page 6 of 23

Safe

R A G R A G

✔ ✔


✔ ✔


20/21 Target/Trajectory 34.2% 34.2% 34.2% 34.2% 34.2% 34.2% 34.2% 34.2% 34.2% 34.2% 34.2% 34.2% 20/21 Target/Trajectory 0 0 0 0 0 0 0 0 0 0 0 0

Issue Issue


June 2020


There were no bed days in adult facilities for patients who are under 18 years old



Bed days in adult facilities of patients who are under 18 years oldPercentage of inpatient falls that result in harm

Page 7 of 23

Indicator Executive Lead Units

National (N) or Local (L)

Target

Improvement Trajectory set Timescale Target Current

Month TargetCurrent

Month Actual R A G SPC Applicable

Improving Access to Psychological Therapies - Proportion of people completing treatment who move to recovery JH Percentage N - Apr-19 50.0% 50.0% 47.9% ✔ Y

The number of people who have entered (i.e. received) psychological therapies during the reporting period JH Number N - Apr-20 1,432 1,432 1,091 ✔ Y

Care programme approach follow up - proportion of discharges from hospital followed up within 72 hours JH Percentage N - Apr-19 80.0% 80.0% 86.1% ✔ Y

Percentage of readmissions within 30 days of discharge JH Percentage L Y Mar-21 9.0% 12.0% 12.6% ✔ Y

Percentage Inpatient Occupancy

Adult Mental Health JH Percentage L Y Jun-21 85.0% 95.0% 83.6% ✔ Y

Later life and memory services JH Percentage L Y Apr-19 85.0% 85.0% 79.8% ✔ Y

Secure services JH Percentage L - Apr-19 85.0% 85.0% 68.5% ✔ Y

Percentage of delayed transfers of care JH Percentage L Y Feb-20 6.0% 6.0% 2.8% ✔ Y

Patients requiring acute care who received a gatekeeping assessment by a crisis resolution and home treatment team in line with best practice standards JH Percentage N - Apr-19 95.0% 95.0% 98.2% ✔ Y

Percentage of open patients on Care programme approach having a Health of the Nation Outcome Score assessment in the past 12 months JH Percentage L - Apr-19 90.0% 90.0% 88.4% ✔ Y

Community Percentage of new birth visits completed within 14 days of birth JH Percentage N Y Mar-20 90.0% 90.0% 90.2% ✔ Y

Mental Health

Effective June 2020

Level

Domain scorecard

Page 8 of 23

June 2020T

R A G R A G

✔ ✔


✔ ✔


20/21 Target/Trajectory 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 20/21 Target/Trajectory 1432 1432 1432 1432 1432 1432 1432 1432 1432 1432 1432 1432

Issue Issue


IAPT - Proportion of people completing treatment who move to recovery (from IAPT minimum dataset)

The number of people who have entered (i.e. received) psychological therapies during the reporting period

As stated last month, following the Trust's take over of the St Helens service the borough leadership team in conjunction with the Trust wide clinical lead have developed an action plan to improve the service offer to patients across St Helens. Both the operational and clinical model of care are being reviewed and changed to match the models in the other three boroughs.

In order to achieve this an action plan of changes has been drawn up and is now being implemented. The service changes include:1. Commissioned an external provider to support the treatment of the patients in the backlog, it is anticipated that the company will start to support seeing patients in July and will conclude in December.2. Recruitment of two senior practitioners whose role is going to work with patients who potentially want to cease treatment before they have recovered. It is anticipated that these practitioners will be in role by August. 3. The migration of the patient data system over to the Trust is to commence in August. This will aid managers to have live data reports which will help the Trusts responsiveness to changes and issues.

The borough leadership team have worked closely with St Helens Clinical Commissioning Group to formulate the action plan and the timeframes.

It is anticipated that all the above actions will aid in the improvement of the clinical quality of the service and the operational delivery. It is anticipated that the recovery rate will continue to improve and achieve 50% compliance by the end of October.

Current performance is worse than target, but its not triggering a process control rule.Performance within our Halton, Knowsley & Wigan services is better than targert.

St Helens boroughs recovery rates have improved from 39% in May to 40% in June

Effective

Current performance is worse than target but does not trigger a process control rule.

Referral rates continue to increase each month since the outset of COVID-19. Borough leadership teams continue to work with primary care colleagues and the wider community in relation to improving access.

Patients self referring into the service continues to be lower than pre-COVID-19 levels. Borough leadership teams are developing strategies that can be implemented to improve this.

Based on the current trajectories it is estimated that the Trust will achieve its overall prevalence rate by the end of August with all boroughs achieving target in October.

Referral rates will continued to be monitored on a weekly basis at Trust, team and individual practitioner level.


Page 9 of 23

June 2020

R A G R A G R A G

✔ ✔ ✔

Improvement Trajectory Set Y N Improvement Trajectory Set Y N Improvement Trajectory Set Y N

✔ ✔ ✔

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

20/21 Target/Trajectory 80.0% 80.0% 80.0% 80.0% 80.0% 80.0% 80.0% 80.0% 80.0% 80.0% 80.0% 80.0% 2 20/21 Target/Trajectory 12.0% 12.0% 12.0% 12.0% 12.0% 12.0% 12.0% 12.0% 12.0% 11.0% 10.0% 9.0% 20/21 Target/Trajectory 6.0% 6.0% 6.0% 6.0% 6.0% 6.0% 6.0% 6.0% 6.0% 6.0% 6.0% 6.0%

Issue Issue Issue

Comments / Performance Improvement Actions and Timescales Comments / Performance Improvement Actions and Timescales Comments / Performance Improvement Actions and Timescales

Effective

Care programme approach (CPA) follow up - proportion of discharges from hospital followed up within 72 hours Percentage of readmissions within 30 days of discharge Mental Health - Percentage of delayed transfers of care


Current performance is worse than the planned target but does not trigger a process control rule. Current performance is better than the planned improvement trajectory and does not trigger a process control rule. There are no current Trust-wide issues to report.

Not required.Following the increase in the number of patients readmitted, a review has been conducted of all patients who were readmitted and the reason for this admission. In total 15 of the 22 patients reviewed were readmitted as they required crisis support. Wigan borough were the highest borough with eight of the ten patients readmitted for crisis support.

A review of Wigan boroughs urgent care pathways was conducted throughout June. The review highlighted a number of issues with the crisis response and home treatment pathway, following the redesign earlier this year, coupled with a significant increase in patient referrals to the urgent care pathway. Action plans are being formulated with immediate actions to increase staffing to help support the increase in referrals.

The executive and borough leadership teams continue to work closely with the Clinical Commissioning Group and system partners to identify the reasons for increase in referrals and in turn putting increasing pressure on the resources.

The new crisis pathways for mid Mersey boroughs continues with an aim to have the full service offer up an running by January,which is three months ahead of schedule.

Current performance is better than the planned target and does not trigger a process control rule. There are no current Trust-wide issues to report.

Not Required

Page 10 of 23

June 2020

R A G R A G

✔ ✔


✔ ✔



Issue Issue

Comments / Performance Improvement Actions and Timescales Comments / Performance Improvement Actions and TimescalesThe improvement trajectory set last month, aimed for Trust compliance by the end on July 2020. Based on the current trajectory it is anticipated that Trust achievement remains on track for delivery of the Target by the end of July.

All boroughs with the excption of Wigan achieved target. Wigan compliance deteriorated from 80.1% in May to 78.5% in June.

The DIrector of Operations has instructed the Wigan Management Team to report on a weekly basis to him on their performance improvement plan. It is expected they will achieve the 90% target by August.

Effective

Mental Health - Percentage of open patients on Care programme approach having a Health of the Nation Outcome Score assessment in the past 12 months

Mental Health - Patients requiring acute care who received a gatekeeping assessment by a crisis resolution and home treatment team in line with best practice standards

Current performance is worse than target, however is above the lower process control limit for the first time since December.


Not Required

Current performance is better than the planned target and does not trigger a process control rule. There are no current Trust-wide issues to report.

Page 11 of 23

June 2020

R A G R A G R A G

✔ ✔ ✔


✔ ✔ ✔


20/21 Target/Trajectory 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 94.0% 92.0% 90.0% 20/21 Target/Trajectory 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 20/21 Target/Trajectory 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0%

Issue Issue


Issue

Effective

Percentage Inpatient Occupancy - Adult Mental Health Percentage Inpatient Occupancy - Later life and memory services

Mental Health - Percentage Inpatient Occupancy - Secure services


The Trust was able to maintain a lower bed occupancy. Temporary bed closures were continued during June with an aim of reducing each inpatient unit to less than 80% occupancy. This continues to be kept under review.

Not required

Current performance is better than the planned target and does not trigger a process control rule. Current performance is better than target but is below the lower process control limit. Current performance is better than target but is below the lower process control limit.

Despite the increase in female patient admissions throughout June, the Trust was able to maintaining patient occupancy below 85% due to the temporary reduction of male beds across the Trust.

The aim wherever possible was to reduce a set number of beds on each unit which in turn would aid a more efficient patient flow. The Trust was able to do this across the male inpatient units, due to an overall reduction in male patient admissions and a reduction in length of stay. However despite best efforts this was unable to be conducted on the female units as the Trust had seen an increase of 24% in female admissions compared to the monthly average.

Page 12 of 23

June 2020

R A G

✔


✔Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

20/21 Target/Trajectory 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0%

sIssue


Current performance is better than the target and does not trigger a process control rule.

Not required.

Effective

Community - Percentage of new birth visits completed within 14 days of birth


Page 13 of 23



Target

Improvement Trajectory set Timescale Target

Current Month Target

Current Month Actual

R A G SPC Applicable

People with a first episode of psychosis begin treatment with a NICE-recommended package of care within 2 weeks of referral JH Percentage N - Apr-20 53.0% 53.0% 70.0% ✔ Y

Waiting time to begin treatment (from IAPT minimum data set) within 6 weeks JH Percentage L - Apr-20 95.0% 95.0% 97.6% ✔ Y

Number of routine Children and Young Person's Eating Disorder Services care pathways completed within 4 weeks JH Percentage N Y Apr-20 95.0% 95.0% 100.0% ✔ Y

Number of urgent Children and Young Person's Eating Disorder Services care pathways completed within 1 week JH Percentage N - Apr-20 95.0% 95.0% 100.0% ✔ Y

Out of area placements JH Number L - Apr-20 19 19 152 ✔ Y

Walk in Centre maximum waiting time of 4 hours from arrival to admission/transfer/discharge JH Percentage N - Apr-20 95.0% 95.0% 100.0% ✔ Y

June 2020Responsive

Level

Domain scorecard

Mental Health

Community

Page 14 of 23

Responsive June 2020

R A G R A G R A G

✔ ✔ ✔


✔ ✔ ✔


20/21 Target/Trajectory 53.0% 53.0% 53.0% 53.0% 53.0% 53.0% 53.0% 53.0% 53.0% 53.0% 53.0% 53.0% 20/21 Target/Trajectory 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 20/21 Target/Trajectory 19 19 19 19 19 19 19 19 19 19 19 19

sIssue Issue Issue


Mental Health - Out of area placementsMental Health - Waiting time to begin treatment (from IAPT minimum data set) within 6 weeks

Mental Health - People with a first episode of psychosis begin treatment with a NICE-recommended package of care within 2 weeks of referral (UNIFY2 and MHSDS)


Not required Due to the lower referral rates into the service, the overall waiting list for new treatments commencing has reduced by 20%. This in turn has reduced the overall waiting times and improved the percentage of patients who have commenced within 6 weeks.

Current performance is better than target and is not triggering a process control rule. Current performance is better than target and is not triggering a process control rule. Current performance is worse than target, but its not triggering a process control rule.

Overall 17 patients utilised 152 out of area bed days during June. Five patients remained in beds from May and 12 further patients placed in June. Following an initial increase in female admissions at the end of May, the Trust continued with these pressures during the first week of June, with another 10 female patients being placed in an out of area bed in the first week of June. 10 of the 12 new patient placed out of area were placed under the mental health act.All Mental Health providers across the North West Region experienced increased demand for adult inpatient beds during the same period, and pressure continues across all providers.

A number of actions have been put in place to support the on-going management of inpatient flow:

- Daily (and if required twice daily) multi-disciplinary bed calls take place across seven days per week to support safe flow jointly chaired by an Operational Assistant Director (or on-call manager at weekends). The role of the on-call Consultant in these calls and other senior clinicians continues to be strengthened;- A continued strong focus on managing delayed transfers of care (resulting in a sustained positive position) to ensure maximum inpatient flow;- A rapid review of admissions in May and into June to understand opportunities for further management or clinical action to improve flow and safe patient management; - A rapid review of the approach to Home Treatment within the Borough of Wigan where we continue to experience bed pressures to understand the short-term and longer term actions to improve the Crisis Resolution Home Treatment Team offer.- A continued strong focus on proactive but safe repatriation of all those placed out of area back into Trust beds.

Since the first week in June only one patient has been placed in an out of area.

Page 15 of 23

Responsive June 2020

R A G R A G R A G

✔ ✔ ✔


✔ ✔ ✔


20/21 Target/Trajectory 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 20/21 Target/Trajectory 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 20/21 Target/Trajectory 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0%

Issue Issue Issue



Current performance is better than target and is not triggering a process control rule. There are no current Trust-wide issues to report.

Current performance is better than target and is not triggering a process control rule. There are no current Trust-wide issues to report.


Current performance is better than target and is a special cause improvement, we have maintained 100% for the last 10 months. There are no current Trust-wide issues to report.

Not Required

Walk in Centre maximum waiting time of 4 hours from arrival to admission/transfer/discharge

Number of urgent Children and Young Person's Eating Disorder Services care pathways completed within 1 week

Number of routine Children and Young Person's Eating Disorder Services care pathways completed within 4 weeks

Page 16 of 23



Target





Staff Attendance JH Percentage L Sep-20 95.0% 93.5% 95.3% ✔ Y

Voluntary staff turnover JH Percentage L Apr-20 11.0% 11.0% 12.1% ✔ Y

Consultant and SAS doctor job plan completion SR Percentage L Apr-20 90.0% 90.0% 97.0% ✔

Statutory Training Compliance JH Percentage L Apr-20 90.0% 90.0% 88.6% ✔ Y

Core Training Compliance JH Percentage L Apr-20 90.0% 90.0% 93.6% ✔ Y

Specialist Training Compliance JH Percentage L Apr-20 90.0% 90.0% 90.5% ✔ Y

Trust

June 2020Well-led

Level

Domain scorecard

Page 17 of 23

Well-led Indicator progress sheet

R A G R A G

✔ ✔


✔ ✔



Issue Issue


June 2020

Trustwide - Voluntary TurnoverTrustwide - Staff Attendance

Current performance is better than the improvement trajectory and does not trigger a process control rule. Current performance is worse than target and is a special cause concern.

All boroughs with the exception of Knowsley are above the improvement trajectory of 93.5%.

Though it is likely that sickness has reduced in part due to a number of staff in self isolation, there is informal feedback that the move to more flexible working, due to a large number of staff working from home, has led to increased work life balance satisfaction and that this has positively impacted the overall wellness of our staff.

To ensure all staff are supported to return to work, data relating to covid-19 absence is shared with both Occupational Health and People and Organisational Development Business partners, who contact managers and staff to offer support and advice on ensuring staff are able to return to work. The Trust has also developed a clear protocol as to when and how staff can return to work in the safest way.The Trust developed 'staff well being hub', specifically designed to support the impact of Covid-19, continues to be a popular and useful resource for our staff. The Hub has four key areas: physical health, family life and staying connected, psychological wellbeing and leaders, teams and Line manager support. It is accessible via the Trust intranet site. Staff are also supported by a national health and wellbeing service, that provides telephone counselling, apps to reduce stress and anxiety and access to financial wellbeing.

The achievement of reducing voluntary turnover is a Trust-wide strategic objective. Work has been undertaken in this area specifically to look at why staff leave and work in the second quarter of 2020/21 will focus on why staff choose to stay. The development of "stay" interviews will be led by colleagues in People Services.

An action plan to help reduce the number of staff who voluntary choose to leave the organisation will also be developed by the end of September.

This plan will include a review and development of a refreshed and robust preceptorship programme for our nursing staff. By reviewing how we support those newly qualified staff who are often new into post, it is expected this will provide a more stable and fulfilling early stage of careers and support staff staying with the Trust for a longer period.

Page 18 of 23

June 2020

R A G R A G

✔ ✔





Current performance is better than the planned target. Current performance is better than the planned target.

Not required. Not required.

Well-led Indicator progress sheet

Trustwide - Consultant and SAS doctor job plan completion

Trustwide - Consultant and SAS doctor job plan completion

Issue Issue

Page 19 of 23

Well-led June 2020

R A G R A G R A G

✔ ✔ ✔


✔ ✔ ✔


20/21 Target/Trajectory 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 20/21 Target/Trajectory 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 20/21 Target/Trajectory 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90%

Issue



Current performance is better than target but below the lower process control and a low point. Current performance is better than target but below the lower process control and a low point.

Although above target, compliance is at a low point due to the unavailability of staff to undertake training as well as the need for the training team to stand down training whilst members of that team were redeployed.

Now that the Trust is looking to move into a recovery and restore stage, a number of actions need to be considered to support a move back to increasing the Trust training position and a detailed paper outlining the steps required and possible options has been developed by the Trust Learning and Development Manager and shared with Executive colleagues within the Trust.

The paper proposes a number of changes to Face to Face training that will enable this to be replaced where possible with other alternatives, and to be made as safe as possible where it is not. Adopting these changes will mean that the necessary volume of courses can be maintained and the quality and safety of services assured from a training perspective.

Although above target, compliance is at a low point due to the unavailability of staff to undertake training as well as the need for the training team to stand down training whilst members of that team were redeployed.



There has been a slight increase in the compliance of all the courses that make up the statutory training portfolio

Compliance is below target is due to both the general unavailability of staff, be they off sick or isolating, as well as the need for the training team to stand down training whilst members of that team were redeployed into other areas.



IssueIssue

Trustwide - Statutory Training Compliance Trustwide - Core Training Compliance Trustwide - Specialist Training Compliance

Current performance is worse than target, below the lower process control and a low point.

Page 20 of 23

Caring



Target





Number of ombudsman complaints upheld JMcD Number L - Apr-20 0 0 0 ✔

Number of compliments JMcD Number L - Apr-20 n/a n/a 109 X

Breaches of same-sex accommodation (Unjustified) JMcD Number N - Apr-20 0.0% 0.0% 0.0% ✔

June 2020Domain scorecard

Level

Trust

Mental Health

Page 21 of 23

Caring

R A G R A G

✔



20/21 Target/Trajectory 20/21 Target/Trajectory 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0%

Issue Issue


June 2020

A target has not been set for the number of compliments, and therefore the measure has not been classified as red, amber, or green.

Not required.


Number of compliments Number of ombudsman complaints upheld

There are no Trust-wide issues to report

Not required

Page 22 of 23

Caring June 2020

R G

✔


✔

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

20/21 Target/Trajectory 0 0 0 0 0 0 0 0 0 0 0 0

Issue



Unjustified breaches of same-sex accommodation

There are currently no breaches of same sex accommodation.

Not required

Page 23 of 23

of 9

20/1863 Serious Incident Report

` DATE: 27 July 2020

Item

No

.

20/1

863

TITLE OF REPORT Serious Incident Report

PRESENTED BY Joanne McDonnell, Executive Director of Nursing and Governance

AUTHOR(S) Nicola Jones, Head of Patient Safety

REPORT PURPOSE


To inform the Trust Board of:

Serious Incident reviews that have been commissioned in June 2020.

Information on recent and planned Coroners Inquests.

All deaths reported in June 2020.

ALIGNMENT TO THE TRUST’S STRATEGIC OBJECTIVES (X) We will deliver quality, safe and efficient services with




growth

We will plan an active role in place-based care systems to







Audit Committee

Quality Committee



Other Group Name:

This report has not been considered elsewhere (x) x



No No Not applicable



Receive the latest position regarding serious incidents, deaths reported and inquests.

Note that the Quality Committee is undertaking their delegated activity for the scrutiny and oversight of serious complex incidents, complaints and claims.

Receive assurance that serious incidents are being managed effectively in the organisation.

Trust Board Meeting

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27 July 2020

Serious Incident Report

1. INTRODUCTION / EXECUTIVE SUMMARY This paper has been developed to provide the Board with information on the Strategic Executive Information System (StEIS) reportable activity during June 2020. It also details coronial activity for the same period. The Board are requested to note recent activity on serious incident reviews and the assurance processes in place. 2. BACKGROUND

This paper is produced as a standing agenda item for the attention of the Board. 3. NEW INCIDENTS COMMISSIONED FOR REVIEW In June 2020, a total of 14 serious incidents were reported through the Strategic Executive Information System (StEIS). The number of incidents reported to StEIS in June 2020 remains within normal variation based on the last twelve months data. This can be seen in graph one below. 72 hour reviews have been commissioned for all of the incidents reported to StEIS during June 2020. All final root cause analysis investigations submitted during June 2020 were submitted within the agreed timeframes. Further details of serious incidents and relevant updates on high profile cases are provided to the Trust’s Quality Committee. Graph One overleaf shows the total number of incidents reported to StEIS in the last 12 months:

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Graph one

Fourteen serious incidents were reported to StEIS during June 2020. Twenty 72 hour reviews were received by the Corporate Patient Safety Panel in June 2020. 3.1. Strategic Executive Information System Reportable Reviews Strategic Executive Information System reportable incidents can include:

Sudden, unexpected death of a community patient in receipt of services or who has been involved with our services within the last six months

Inpatient suicides

Unexpected death of an inpatient

Suspected suicides of community patients

Serious safeguarding allegations

A never event

Absconds from secure units

Serious self-harm

Any other incident where there is significant learning potential 4. ASSURANCE PROCESSES IN PLACE FOR SERIOUS INCIDENT REVIEWS High level information is provided to the Trust Board at each of its meetings which allows the Trust Board to gain assurance that serious incidents are being managed effectively and that agreed processes remain in place. The weekly corporate patient safety panel continues, chaired by the Executive Director of Nursing and Quality and attended by the Associate Medical Director for Quality and Safety, Pharmacy Safety Lead, Professional Lead for Psychology and the Assistant Clinical Directors for each borough. The panel continues to review all 72 hour reviews following a suspected serious incident, commission further

0

5

10

15

20

25

Jul2019

Aug2019

Sep2019

Oct2019

Nov2019

Dec2019

Jan2020

Feb2020

Mar2020

Apr2020

May2020

Jun2020

Data

Mean

UCL

LCL

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investigations as required, and review and approve completed serious incident investigations and learning prior to submission to the commissioners. The corporate patient safety panel now reports directly to the Trust quality committee on all matters arising from serious incidents and patient safety concerns. A proposal to further strengthen the current patient safety report received by the quality committee was also agreed during the July 2020 committee meeting. Borough patient safety panel meetings are well established and continue to take place on a weekly basis. Borough patient safety panels’ review all 72 hour reviews reported within borough in order to inform next steps and post review learning. The local patient safety panels work to ensure continued delivery of outcome focused actions plans in response to lessons learned. Both corporate and borough patient safety panels have continued to operate through virtual meeting processes during the current COVID-19 pandemic. 5. LESSONS LEARNED To support the NHS England Serious Incident Framework (March 2015) and to implement learning from serious incident investigations, inquests and other sources of learning such as themes from complaints, the Trust has an agreed process for lessons learned. Methods to promote and embed lessons learned across the organisation would typically include:

Local learning via after action reflection and sessions delivered by Matrons, Heads of Quality and Assistant Clinical Directors.

Communications via managers briefing notes, patient safety alerts and lessons learned events.

Peer Reviews.

Local Patient Safety Panels.

Corporate Patient Safety Panels.

Care Collaboratives.

Thematic Reviews of Serious Incidents.

Lessons learned continue to be driven through established borough and corporate

patient safety panels. Reflective discussions within each borough patient safety

panel promote local learning with shared oversight via the corporate patient safety

panel.

Work to strengthen the lessons learned agenda under the quality strategy pillars

"value added care" and "quality assurance frameworks" continues with progress

updates reported to the quality committee. Continued improvements to the Trust’s

incident reporting system are being considered in collaboration with Merseycare

NHS Foundation Trust as part of these work streams; a joint meeting is scheduled to

take place 22 July 2020.

Since the last report to the Trust Board, the following methods of shared learning and communications have taken place as identified within table one below:

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Table one:

Communication Brief Description

Patient Safety Alerts: Alerts requiring immediate and on-going actions generated from learning following a serious incident. Audience: Issued to all managers

There were three Patient Safety Alerts issued in June 2020. 1. Ligature Point Anchor Risk

A national alert was issued identifying there has been a small number of isolated ligature incidents whereby a patient has managed to secure a ligature using the waste hole on an en-suite bathroom sink. All clinical staff were made aware of the potential risk when formulating service user risk assessment for all patients. The risk has been raised in line with the Trust risk management procedure with plans in place to consider effective control and mitigation. All managers have been asked to review environmental and ligature risk assessments in response to the identified ligature point. Assurance has been delivered to the health and safety team confirming that all ligature risk assessments and environmental risk assessments have been reviewed to consider and reflect the potential risk. 2. Nasogastric Tube Safety for all Covid-19

Patients. Professional bodies for nutrition, anaesthetics and intensive care produced an aide-memoire to help prevent nasogastric tube Never Events. It also included special considerations for the safety of patients with COVID-19 when in critical care. The document was disseminated through a safety alert via the datix system for consideration wherever appropriate. 3. Ligature Risk with Personal Protective

Equipment. The Trust identified a ligature risk from the personal protective equipment surgical masks being used to control the spread of COVID-19. The risk was related to the elasticated banding used to secure the mask. The metal wiring embedded within the mask was also highlighted as a potential risk as it could be used by a patient to self-harm by cutting.

of 9



All staff were made aware of the issue and ward managers were requested to update their environmental risk assessments and ligature risk assessments in accordance with this. The health and safety team continue to monitor assurance to ensure appropriate actions to mitigate the risk have been taken and are in place.


Briefing Note: Email communication sent to all staff members

The Communications team continue to provide daily updates to all staff regarding the ongoing COVID-19 public health crisis. Information is circulated Trust wide to keep staff informed of developments and actions being taken in response to concerns relating to the ongoing major incident. Live Question and Answer sessions continue to be provided via Skype on a weekly basis.


Locally Driven Lessons Learned: Post incident review and After Action Reflection is routinely driven through discussion within borough patient safety panels.

Throughout June, local patient safety panel meetings have taken place weekly within all boroughs. Corporate patient safety panel also continues to operate on a weekly basis to provide an opportunity for shared learning and reflection upon identified themes.

6. INQUEST UPDATE There were two inquests heard in June 2020. Due to the ongoing situation concerning COVID-19 and the social distancing measures in place, both inquests were heard as documentary hearings, with no witnesses being called to attend the hearing in person. The outcomes of these hearings are detailed in the tables below.

Ref/ID: 19/926

Inquest details: 1a) Fatty Liver Disease 2) Effects of synthetic cannabinoids (spice)

Borough: Wigan, Bolton and Greater Manchester

Inquest date: 09/06/2020

Investigation type: 72 Hour Review

Summary: No witnesses were called to attend the inquest in person. The coroner gave a narrative conclusion that the death was a consequence of naturally occurring disease exacerbated by the use and effects of synthetic cannabinoids. No concerns were raised about the care provided by the Trust.

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Ref/ID: 20/946

Inquest details: Drug Toxicity

Borough: Wigan, Bolton and Greater Manchester

Inquest date: 12/06/2020

Investigation type: 72 Hour Review

Summary: No staff were called to give evidence in person at the hearing. The coroner concluded that the death was ‘drug related’ and raised no concerns about the care that had been provided by the Trust.

There are no inquests currently scheduled to be heard in July 2020. 7. LEARNING FROM DEATHS Table two below identifies the deaths reported during June 2020, to show the level of investigation undertaken. Eighty two deaths were reported through Datix during June 2020. Table two

Total Investigation Type

Datix

review

72 hour

review

Concise

Investigation

Comprehensive

Investigation

Structured

judgement

review

June 82 67 12 1 2 0

For the purpose of this report expected and unexpected deaths are defined as below: Unexpected death: Any unexpected or unintended event which has caused

the death of a person.

12 of the 82 deaths were unexpected deaths. Six of the unexpected deaths are due to causes which are currently under review and six are due to incidents of suspected suicide; two of which relate to interface incidents outside of the care of the Trust. Four of the incidents of suspected suicide have been reported to the Strategic Executive Information System (STEIS).

Expected death: Where a death has occurred which was an expected or inevitable consequence of the patient’s medical condition or healthcare.

70 of the 82 deaths were considered an inevitable consequence of the patient’s medical condition. Of these deaths, four were related to COVID-19.

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All of the Trust reported incidents of unexpected death received a 72 hour review.

Table three below shows the number of deaths reported in the last twelve months and the level of investigation undertaken. Table three

Month Total Investigation Type

Datix

review

only

72 hour

review

Concise

Investigatio

n

Comprehensive

Investigation

Structured

judgement

review

Jul 74 57 11 5 1 0

Aug 57 37 19 1 0 0

Sep 58 44 11 3 0 0

Oct 54 41 11 1 1 0

Nov 84 63 13 8 0 0

Dec 66 54 11 1 0 0

Jan 91 69 18 4 0 0

Feb 68 45 20 3 0 0

Mar 69 58 10 1 0 0

Apr 159 140 17 1 1 0

May 126 110 13 3 0 0

June 82 67 12 1 2 0

Work is continuing to adopt the Mazar’s classification of death scale; further updates will be reported within the learning from deaths quarterly report to the September 2020 Trust Board. 8. SUMMARY

Fourteen serious incidents were reported through the StEIS system in June 2020.

Two inquests were heard in June 2020.

No inquests are listed to be heard in July 2020.

Eighty two deaths were reported during June 2020.

Twelve deaths were unexpected.

Seventy deaths were expected deaths or considered an inevitable consequence of a medical condition; four of which related to COVID-19

Four deaths reported during June 2020 were identified to meet the StEIS reporting criteria as a serious incident.

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9. RECOMMENDATIONS


Receive the latest position regarding serious incidents, deaths reported and inquests.

Note that the Quality Committee is undertaking their delegated activity for the scrutiny and oversight of serious complex incidents, complaints and claims.

Receive assurance that serious incidents are being managed effectively in the organisation.

Joanne McDonnell Executive Director of Nursing and Governance

of 15

20/1864 High Level Objectives 2020-2021 Quarterly Update


Item

No

.

20/1

864

TITLE OF REPORT High Level Objectives 2020/2021 – Quarterly Update

PRESENTED BY Tracy Hill, Director of Strategy & Organisational Effectiveness

AUTHOR(S) Tracy Hill, Director of Strategy & Organisational Effectiveness

REPORT PURPOSE


To provide a position relating to the High Level Objectives 2020/2021, at the end of quarter one.




X


growth X








Audit Committee

Quality Committee


Executive Leadership Group Sub Group Name (if applicable): <add name of sub group here if applicable>

Other Group Name:

This content has not been considered elsewhere (x) X

THIS REPORT RELATES TO A RISK ON THE BOARD ASSURANCE FRAMEWORK (Y/N) Risk

Reference Strategic Objective Description (as per BAF)

2615

1. Throughout 2020/21 we will contribute to the production of a full business case supporting the acquisition of the Trust, in such a way that the quality of our services is not adversely impacted.

There is a risk that the transaction with Mersey care diverts management attention to such an extent that the quality of care to patients declines and that goes unnoticed.

2656 2. By June 2020, we will have completed an analysis of the reasons why staff stay in employment with and leave the employment of our organisation and by September 2020, we will have developed a plan to positively impact on our voluntary staff turnover. 3. By September 2020, we will have agreed a plan to maximise the opportunities that new workforce roles and new ways of working provide to enhance

There is a risk that the clinical workforce is not developing in-line with the NHS People Plan, due to delays adopting and creating new roles and ways of working. This may lead to a widening gap between the needs of the population and our models of care.

Trust Board Meeting

of 15


health and care delivery within our Trust.

2657 1. Throughout 2020/21 we will contribute to the production of a full business case supporting the acquisition of the Trust, in such a way that the quality of our services is not adversely impacted.

There is a risk that the Transaction to acquire Trust services leads to a higher than expected number of senior managers leaving the Trust to such an extent that it impacts on the ability to complete Trust business to provide quality and safe patient services.

2658 4. During 2020/21, will deliver the first phase of our Patient Access transformation programme which will ensure:

All services have a target time for a new patient appointment.

92% of patients on the waiting list for a new patient appointment will have waited less than the agreed target time.

Patients will have access to the most up-to-date waiting times.

Patients will not have their appointments cancelled more than once by the Trust.

Text message reminders will be in place for all community appointments.

Administration hubs will be in place for all boroughs and services, offering streamlined access for patients to simplify referral into our services.

There is a risk of increase waiting times to our patients.

2659 4. During 2020/21, will deliver the first phase of our Patient Access transformation programme which will ensure:






Administration hubs will be in place for all boroughs and services, offering streamlined access for patients to simplify referral into our services.

5. During 2020/21, we will deliver the first phase of our Patient Journey Transformation programme which will focus on adult mental health and community nursing improvements which will:

Deliver access to 24/7 crisis resolution and home treatment services.

Enhance our adult mental health crisis across all our boroughs, with the addition of more services, including crisis houses.

Deliver and embed our inpatient model changes, including our approach to least

There is a risk that the Trust will be unable to respond to growing service demand.

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restrictive practice, positive behaviour support and creating more time to care.

Deliver on the recommendations from our externally commissioned review into community nursing. This includes improved pathways, improving our pressure ulcer care and agreeing a specification with commissioners which more closely reflects the needs of the community.

2660 5. During 2020/21, we will deliver the first phase of our Patient Journey Transformation programme which will focus on adult mental health and community nursing improvements which will:



Deliver and embed our inpatient model changes, including our approach to least restrictive practice, positive behaviour support and creating more time to care.

Deliver on the recommendations from our externally commissioned review into community nursing. This includes improved pathways, improving our pressure ulcer care and agreeing a specification with commissioners which more closely reflects the needs of the community.

There is a risk we will not transform and improve our services in line with phase 1 of our Patient Journey.

2662 2. By June 2020, we will have completed an analysis of the reasons why staff stay in employment with and leave the employment of the organisation, and by September 2020, we will have developed a plan to positively impact on our voluntary staff turnover.

There is risk that we will not have the appropriate availability to staff our services safely due to the deteriorating health and wellbeing of our staff.

2663 2. By June 2020, we will have completed an analysis of the reasons why staff stay in employment with and leave the employment of the organisation, and by September 2020, we will have developed a plan to positively impact on our voluntary staff turnover. 3. By September 2020, we will have agreed a plan to maximise the opportunities that new workforce roles and new ways of working provide to enhance health and care delivery within our Trust.

There is a risk that we won’t have the necessary capacity across our workforce to deliver 21st century care.

2664 6. During 2020/21, we will improve digital access and choice for our patients on how they can interact with our services, including the opportunity to receive psychological therapy via video consultation and for patient correspondence to be delivered electronically.

There is a risk of the Trust’s critical information systems suffering some sort of failure due to a cyber-attack leading to possible financial loss, disruption to services and patient care and/or damage to the reputation of the Trust.

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2665 6. During 2020/21, we will improve digital access and choice for our patients on how they can interact with our services, including the opportunity to receive psychological therapy via video consultation and for patient correspondence to be delivered electronically.

There is a risk of regression in the use of digital solutions due to new working practices being insufficiently embedded within services leading to reduced digital access and choice for patients.


The Trust Board is asked to: Note the information and assurances within this paper and direct any action relating to its content.


Page 5 of 15



High Level Objectives 2020/2021 – Quarterly Update

1. INTRODUCTION

This paper is presented to Trust Board following the agreement in March 2020 of the High Level Objectives for 2020/2021. It should be noted that this is the first update to the Trust Board on performance against the 2020/2021 objectives. Additionally, information is provided through regular updates as part of the normal course of Trust Board business. This includes the Commercial report, reports received from Trust Board sub committees, reports received from the Executive Leadership Group and progress papers and presentations with a specific spotlight, for example, the People and Quality Strategies. This update presents the status and position of each objective following Trust Board, and senior management discussions relating to the priority areas for delivery in 2020/2021. It provides the following information;

Progress with each objective, and the position as at 30 June 2020 (Q1)

If progress is not on track, recovery actions to be taken

The assurance offered to the Trust Board by the Accountable Officer of the expected successful, timely delivery of this objective.

2. PROGRESS WITH OUR 2020/2021 HIGH LEVEL OBJECTIVES Appendix 1 provides details of the position of each objective at the end of Quarter one. 3. RECOMMENDATIONS The Trust Board is asked to:

Note the information and assurances within this paper and direct any action in relation to its content.

Tracy Hill Director of Strategy and Organisational Effectiveness


Page 6 of 15


Appendix 1

Trust objectives 2020/2021

Update at the end of Quarter One


Page 7 of 15


Trust objectives 2020/21 – Update at the end of Quarter One

Owner

Quarter 1 update

If progress is not on

track, further actions to be taken

Assurance offered

Director of Strategy & Organisational Effectiveness

1. Throughout 2020/21 we will contribute to the production of a full business case supporting the acquisition of the Trust, in such a way that the quality of our services is not adversely impacted.

The Strategic Case was submitted to NHSI on 1st July 2020. Feedback is expected by early September. Resources are committed to contribute to the production of the full business case in line with processes and timelines agreed between all parties.

N/A I can assure the Board that this objective is currently on track and at this stage cannot foresee any reason why the objective will not be fully achieved.


Page 8 of 15


Owner

Quarter 1 update



Assurance offered

Director of HR & OD

2. By June 2020, we will have completed an analysis of the reasons why staff stay in employment with and leave the employment of our organisation, and by September 2020, we will have developed a plan to positively impact on our voluntary staff turnover.

Analysis of turnover, including destination themes presented to Trust Board. People services currently developing a plan which will be agreed with operational colleagues, to ensure joint ownership of reducing voluntary turnover. Turnover rate in Q1 denotes marginal improvement in voluntary turnover.



Page 9 of 15


Owner

Quarter 1 update



Assurance offered

Medical Director/Deputy Director of Nursing & Governance

3. By September 2020, we will have agreed a plan to maximise the opportunities that new workforce roles and new ways of working provide to enhance health and care delivery within our Trust.

Progression has been slightly impacted due to COVID-19 however delivery remains on track. A monthly Workforce Strategy Transformation Group has been established to provide a multi-professional forum to address our workforce challenges, with a plan for the implementation of new roles and ways of working in the organisation. A detailed plan with timeframes for delivery against each action will be finalised by the Workforce Transformation Group for September 2020. A number of work streams have been identified with a focus on the following roles:

Advanced Clinical/Nurse Practitioners

Non-Medical Prescribers

Physician Associates

Nursing Associates

Psychology posts specifically to grow the IAPT workforce

Student Nurses

N/A We can assure the Board that this objective is currently on track and at this stage cannot foresee any reason why the objective will not be fully achieved.


Page 10 of 15


Owner

Quarter 1 update



Assurance offered

Director of Operations & Integration

4. During 2020/21, will deliver the first phase of our Patient Access transformation programme which will ensure:






Administration hubs will

At the end of quarter one 98.6% of services have a target wait time allocated and these target wait times are now on display on the Trust web site.

At the end of quarter one 54.3% of patients waiting for their first appointment are below the target wait time, with 37% of services achieving the 82% standard. The deterioration in the waiting list position is due to reduced service delivery for routine services during the COVID-19 outbreak. All services are now working on recovery and restoration plans and it is anticipated that the 92% target will be achieved by the end of quarter 4 2020, pending no further disruptions in service delivery.

There have been delays in rolling out the patient access policy and procedure trust wide

Due to the COVID-19 outbreak a separate working group has been developed to recover and restore services. This group meets twice weekly and it is anticipated that all services will be reviewed by August 2020. All services are expected to have recovery plans in place to ensure all patients will be treated according to the new pathways implemented. All services that have a backlog of patients to see are expected to have plans in place to ensure this backlog can be reduced.

I can assure the Board that whilst

progress with this objective has

been challenged due to the

additional pressures of managing

the Covid-19 pandemic, plans

are in place such that I cannot

foresee the objective not being

fully achieved by year end.


Page 11 of 15


Owner

Quarter 1 update



Assurance offered

be in place for all boroughs and services, offering streamlined access for patients to simplify referral into our services.

and therefore the implementation of the cancellation procedure. It is anticipated that the rollout will occur by then end of quarter two.

The Text messenger reminder service has been rolled out to over 50% of community services, but roll out was paused due to the COVID-19 outbreak. It is anticipated that this will recommence during quarter two and will be completed by quarter three.

Plans for the remaining administration hubs continue to progress with an aim to be fully rolled out by the end of quarter three.


Page 12 of 15


Owner

Quarter 1 update



Assurance offered

Chief Operating Officer / Deputy Chief Executive

5. During 2020/21, we will deliver the first phase of our Patient Journey Transformation programme which will focus on adult mental health and community nursing improvements which will:



During Q1 we have:

Implemented the 24/7 all age crisis mental health Freephone line which is the first part of the 24/7 Mental Health Crisis Resolution Home Treatment Team model;

Developed a plan to implement the full 24/7 Crisis Resolution Home Treatment Team model during Q4 (January – March 2021) in line with the Cheshire and Merseyside system plan

Agreed a pilot in two of our Boroughs to work with a third sector provider to deliver ‘wrap around’ social support to those who are discharged from our inpatient services to provide an enhanced offer to patients in the community as well as their clinical needs;



Page 13 of 15


Owner

Quarter 1 update



Assurance offered

Deliver and embed our inpatient model changes, including our approach to least restrictive practice, positive behaviour support and creating more time to care.

Deliver on the recommendations from our externally commissioned review into community nursing. This includes improved pathways, improving our

The plan for inpatient positive behaviour support and roll out has been developed;

The Community Nursing review plan has been re-base to focus on the Knowsley Community Nursing service (as a result of the St Helens service transferring to St Helens and Knowsley Teaching Hospitals NHS Trust). A key number of operational improvements have been implemented including clinical record updates, pathway developments and implementation etc.


Page 14 of 15


Owner

Quarter 1 update



Assurance offered

pressure ulcer care and agreeing a specification with commissioners which more closely reflects the needs of the community.


Page 15 of 15


Owner

Quarter 1 update



Assurance offered

Chief Operating Officer / Deputy Chief Executive & Chief Information Officer

6. During 2020/21, we will improve digital access and choice for our patients on how they can interact with our services, including the opportunity to receive psychological therapy via video consultation and for patient correspondence to be delivered electronically.

Progress in relation to video consultation has progressed at pace in response to the COVID-19 pandemic and this digital choice for our patients covers a number of services across the Trusts beyond psychological therapies that was initially planned for delivery in 2020/21. A digital first approach is being built into the Trust Recovery and Restoration Plans going forward. Approximately 5000 patient virtual consultations took place in the first quarter. The delivery of patient correspondence to delivered electronically remains on track to be delivered by March 2021.

N/A We can assure the Board that this

objective is currently on track and at

this stage cannot foresee any reason

why the objective will not be fully

achieved.

of 3



Item

No

.

20/1

865

TITLE OF REPORT Transaction Update

PRESENTED BY Tracy Hill, Director of Strategy & Organisational Effectiveness

AUTHOR(S) Tracy Hill, Director of Strategy & Organisational Effectiveness

REPORT PURPOSE


To update the Trust Board on the business completed since the last Trust Board meeting on matters relating to the acquisition of Trust services.




X


growth X








Audit Committee

Quality Committee



Other Group Name:

This content has not been considered elsewhere (x) X



2615 2657

Throughout 2020/2021 we will contribute to the production of a full business case supporting the acquisition of the Trust, in such a way that the quality of our services is not adversely impacted.

There is a risk that the Transaction with Mersey Care NHS Foundation Trust diverts management attention to such an extent that the quality of care to patient’s declines and that goes unnoticed. There is a risk that the Transaction to acquire Trust services leads to a higher than expected number of senior managers leaving the Trust, to such an extent that it impacts on the ability to complete Trust business to provide quality and safe services.


The Trust Board is asked to: Note the content of this paper and direct any action relating to its content.

Trust Board Meeting

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Transaction Update

1. INTRODUCTION This paper will provide an update on business completed since the last Trust Board meeting on matters relating to the future acquisition of Trust services. 2. STRATEGIC CASE Following the submission to NHS Improvement of the Strategic Case relating to Mersey Care NHS Foundation Trust acquiring our Cheshire and Merseyside services, it has been confirmed the National Provider Development Team are planning to begin reviewing the case on 20 July, with an aim of the North West Regional Support Group considering the findings of the review on 24 August. In line with our commitment to keep stakeholders fully informed, this information has been shared with staff, governors and members. A letter has also been sent to the Commissioners of our Cheshire and Merseyside services updating on the current position and advising the first meeting of the Commissioner Stakeholder Forum will be arranged for September 2020. This was originally planned for April but was stood down due to the COVID-19 pandemic.

3. THE FUTURE OF WIGAN MENTAL HEALTH SERVICES

Following notification of the intention for Mersey Care NHS Foundation Trust to acquire the services delivered by North West Boroughs Healthcare NHS Foundation Trust, Wigan Clinical Commissioning Group has considered the options available for the future delivery of Wigan Mental Health Services. An options appraisal relating to the future delivery of mental health services was completed by Wigan Clinical Commissioning Group, with the recommendation presented to their Integrated Commissioning Committee on 15 July 2020. The recommendation was for a direct award of contract, for Wigan’s mental health services, be made to Greater Manchester Mental Health NHS Foundation Trust, and with a Memorandum of Understanding to work in partnership with Wrightington, Wigan and Leigh NHS Foundation Trust, to enable the further integration of physical and mental health across the Borough and as set out in the Wigan Locality Plan. Following consideration, the Integrated Commissioning Committee approved this recommendation and advised the Trust of their intention for services to transfer from 1 April 2021. The indication from the Greater Manchester Commissioners is other Greater Manchester Services will transfer to Greater Manchester Mental Health NHS Foundation Trust as part of the same process.

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4. NEXT STEPS Discussions have commenced with all organisations involved in the transfer and future delivery of services currently delivered by the Trust. Furthermore we are engaging with NHS Improvement to determine the formal governance arrangements surrounding the whole Transaction. A regular update will continue to be provided to the Trust Board.

5. RECOMMENDATIONS The Trust Board is asked to:

Note the information within this paper and direct any action relating to its content.

Tracy Hill Director of Strategy & Organisational Effectiveness

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