2gether NHS Foundation Trust
                                                                Council of Governors Meeting
                                                                                13 July 2011

                        GETHER NHS FOUNDATION TRUST
                           13 OCTOBER 2011

PRESENT:           Rennie Fritchie (Chair)    Joan Tranter         Julie Garnham
                   David Maynard              Gill Pyatt           Mark Elliott
                   Tim Stokes                 Ros Taylor           Richard Butt-Evans
                   Francesca Tolond           John Gillett         Rod Whiteley
                   Duncan Smith               Jan Furniaux
                   Pat Ayres                  Amjad Uppal

IN ATTENDANCE: Nick Baker, Deputy LD Governor
               Mike Brereton, 2gether (Supporter for LD Governors)
               Matthew Page, Director, Children & Young People’s Services (Item 4)
               Richard Szadziewski, Non Executive Director
               Shaun Clee, Chief Executive
               Frank Powell, Non Executive Director
               Thomas Dunleavy, Deputy LD Governor
               John McIlveen, Trust Secretary
               Roger Brimblecombe, Senior Independent Director
               Felicity Longshaw, Chair, Avon & Wiltshire Partnership
               Ted Quinn, Locality Director North


1.1   Apologies for the meeting were received from, Jo Smith, Nigel Hayward, Sam
      Tolley, Kristoff Fraszczak, Phil Hennessey, Marion Winship, Faye Henry and
      Peter Braidwood. Jill Crook did not attend the meeting.

1.2   Rennie Fritchie welcomed Rod Whiteley, Pat Ayres and Amjad Uppal to their
      first Council of Governors meeting following their election.


2.1   Julie Garnham advised that she had taken up a role with the Shape charity, to
      help with their Help for Africa project.


3.1   The following change to the minutes was agreed:

      12.2 ‘Shaun Clee informed the Governors that 2gether had helped
      commissioners identify the needs of residents’. Subject to this change, the
      minutes of the last meeting held on 13 July were agreed as a correct record.


4.1   There were no matters arising from the last meeting.
                                                                2gether NHS Foundation Trust
                                                                 Council of Governors Meeting
                                                                             13 October 2011


5.1   The Governors received a presentation from Matthew Page on the work of the
      Children and Young People’s Service. A copy of the presentation is attached to
      these minutes.

5.2   Matthew explained how the service was changing from the previous Child and
      Adolescent Mental Health Service (CAMHS) to its current model. Rod Whiteley
      asked about the risks involved in changing the service model. Shaun Clee
      explained that there would be some risks associated with every service change,
      but 2gether has a project management team in place to make sure that the
      change is properly managed.

5.3   Duncan Smith asked about the process for service users moving into adult care.
      Matthew Page explained that this was not a straightforward process, but 2gether
      has an organisational policy in place to manage it. Work had also been
      commissioned to find out service users’ experiences on moving into adult care,
      and on leaving children’s services altogether, without moving into adult services.
      Matthew agreed to update the Council of Governors about the results of this
      work in six months time.

5.4   Tim Stokes asked about out of hours care within the new service model.
      Matthew explained that this had improved, with 24 hour consultant cover being
      available via the usual referral routes, for young people in crisis.

      ACTION: Matthew Page to report back to the Council in the summer on the
      results of the review of the transition from children’s services to adult


6.1   Rennie Fritchie had attended two Strategic Forum meetings with Chairs and
      Chief Executives of the PCT, Acute Trust and County Council. These meetings
      enabled organisations in the health economy to work together in order to save
      money and solve mutual problems.

6.2   Rennie Fritchie had attended 2 meetings with local government, concerning the
      new Health & Wellbeing Board which would plan and commission healthcare for
      Gloucestershire. The meeting was also attended by Mary Wilcox and Andrew
      Gravells. The meeting discussed the issue of mental health representation on
      the Health and Wellbeing Board, but did not agree that the Board should include
      a mental health representative.

6.3   Rennie Fritchie had attended two events for members of staff who were leaving
      the Trust. These were for Sheila Molesworth who was the Medical Director’s
      Secretary, and Mervyn Dawe, who was the Trade Union’s Staffside
      representative. Both had been with 2gether for many years. Rennie had also
      signed 104 long service certificates in the last 2 weeks.

6.4   Rennie Fritchie had also visited Gloucester Prison, where 2gether had recently
      taken on responsibility for prison healthcare, to meet with the Governor, Mike
      Bolton. Rennie explained that the head of the Prison healthcare service,
                                                                 2gether NHS Foundation Trust
                                                                  Council of Governors Meeting
                                                                              13 October 2011

      Marieanne Bubb-McGhee was due to give a presentation to the October Board
      about the work of the Prison healthcare service. Marieanne is one of only 2
      Queen’s Nurses in prison healthcare, both of whom work for 2gether.

6.5   Rennie had also attended a meeting of the Role of the Governors working
      group, and papers from that meeting were on the agenda for the Council of
      Governors this evening. Rennie had also attended the Trust’s Annual General
      Meeting on 21 September. There had been good attendance both from
      Gloucestershire and Herefordshire.

6.6   Rennie Fritchie pointed out that this would be Frank Powell’s last Council of
      Governors meeting, as Frank’s term of office as a Non-executive Director ended
      on 31 December 2011. The Council of Governors thanked Frank for his hard
      work during his time with 2gether.


7.1   John McIlveen presented a report to Governors which confirmed that Martin
      Davis had been reappointed as a Non-executive Director for a period of 2 years.

7.2   John reminded Governors that earlier in the year, the Nomination and
      Remuneration Committee had recommended that Martin be reappointed.
      Because there was no Council of Governors meeting due, Governors were
      asked to vote by post or email. Everyone who voted had agreed that Martin
      Davis should be reappointed, and Rennie Fritchie had sent Martin a letter to
      congratulate him on his reappointment.


8.1   John McIlveen gave Governors an update on the results of recent elections for
      Governor positions.

8.2   An election had been held for two vacant Public Governor positions in the
      Cotswolds. Three candidates had put their names forward. Rod Whiteley and
      Pat Ayres were elected.

8.3   An election was held for the vacant Medical Staff Governor. Amjad Uppal was
      elected unopposed.

8.4   An election was held to replace Tim Coupland, who was stepping down as
      Nursing Staff Governor. Phil Hennessey was elected unopposed. Rennie
      Fritchie had written to Tim Coupland to thank him for his hard work as a

8.5   Governors asked whether elections for a Herefordshire Governor would take
      place. John McIlveen explained that there were still some vacant Governor
      positions. There was no separate Herefordshire constituency, but members
      living in Herefordshire would be free to stand for election in the Greater England
      constituency. John agreed to report back to the next meeting about membership
      in the Greater England constituency, and also to tell Governors whether there
      was a minimum number of members that the Trust needed to recruit before
      elections could be held for that constituency.
                                                                  2gether NHS Foundation Trust
                                                                   Council of Governors Meeting
                                                                               13 October 2011

       ACTION: John McIlveen to report back on the minimum number of
       members needed to hold an election for Governor in the Greater England


9.1    The Governors received a report from the Role of the Governor Working Group
       which set out a role description for the Lead Governor.

9.2    John McIlveen explained that the Lead Governor had a formal role in enabling
       the Council of Governors to communicate with Monitor, or with the Chief
       Executive, if the Council felt that communication via the Chair would be

9.3    The Role of the Governor Working Group had therefore approved a role
       description for the Lead Governor which set out the statutory and other
       responsibilities of the Lead Governor role, and also set out some of the abilities
       which a good Lead Governor would need to have. The report which Julie
       Garnham had written for the July Council of Governors meeting had been very
       helpful in putting this role description together.

9.4    Ros Taylor noted that the role description would be very useful for future Lead
       Governors, as they would now have a clearer understanding of what the role

9.5    Frank Powell asked whether the Lead Governor was also the Chair of the
       Nomination & Remuneration Committee. Rennie Fritchie explained that although
       Julie Garnham had held both positions last year, they were not linked. Julie
       would continue to chair the Nomination & Remuneration Committee, with Ros
       Taylor as Lead Governor

9.5    The Council of Governors approved the Lead Governor role description.


10.1   John McIlveen presented the Council with a report from the Role of the Governor
       Working Group concerning Governor attendance at key Board committees.

10.2   The Working Group had been looking at ways to improve the way that
       Governors could hold the Board to account. A number of systems had been
       tried in recent years, such as having all business going to the Council of
       Governors. This had proved unwieldy, and the current system of Governor
       Committees had been set up. However, this system did not provide Governors
       with the opportunity to see Board members in action, and also incurred extra
       administration costs.

10.3   The Working Group had therefore recommended that a trial be set up which
       would enable Governors to attend key Board Committees. At the end of the trial
       period, there would be a review and a report to the Council of Governors. If the
       trial was felt to be successful, the Council of Governors could agree to retain the
       new system and formally disband some Governor Committees.
                                                                   2gether NHS Foundation Trust
                                                                    Council of Governors Meeting
                                                                                13 October 2011

10.4   The Working Group proposed that the trial should cover three meetings each of
       the Governance and Delivery Committees, and that two Governors should be in
       attendance at each Committee. Ideally, the same two Governors should attend
       all three meetings of the Committee. A maximum of four Governors would
       therefore be needed for this trial.

10.5   Mark Elliott said that this was a good option, and that having a review of the trial
       at a Council of Governors meeting would be useful. Francesca Tolond supported
       the trial, as it demonstrated open governance. Duncan Smith also supported the
       trial, but expressed some concern that Governors may find it difficult to attend
       Board Committees as these were held during office hours. David Maynard
       agreed with this point, and suggested that an alternative might be to have the
       Committee Chairs report to Governor Committees.

10.6   Shaun Clee said that the timing of meetings was a difficult issue. It would be
       difficult to change the timings of Board Committees, but many employers do give
       employees time off to attend such meetings.

10.7   Shaun Clee said that any Governor wishing to take part in the trial would need to
       work with John McIlveen to understand the role and purpose of the Board
       Committee, and what Governors would need to look for when attending those
       Committees. Governors would also need to think about their own skills and
       interests and whether these would equip Governors to attend a Board

10.8   Governors would be asked to nominate themselves if they wished to take part in
       the trial. John McIlveen agreed to circulate to all Governors some information
       about the Committees in order to help Governors make a decision about taking

10.9   The Council of Governors agreed to a trial of the proposal, with a formal review
       at a future Council of Governors meeting.

       ACTION: John McIlveen to circulate information about Committee timings
       and purpose, and skills/interests required by Governors in attendance at
       these Committees.

       ACTION: Governors to nominate themselves to John McIlveen if they wish
       to take part in the trial.


11.1   Shaun Clee gave the Governors a useful verbal update on the national and local
       context of the NHS.

11.2   This was a busy and confusing time for the public sector. The Health Bill was
       going through the House of Lords, and although some amendments had been
       made, the infrastructure continues to be implemented, with appointments being
       made to Public Health England. The final picture was still unclear, so it was
       important that any actions we take are sensible ones. However, the biggest
       challenge for the NHS would be the £25 billion savings requirement.
                                                                  2gether NHS Foundation Trust
                                                                   Council of Governors Meeting
                                                                               13 October 2011

11.3   Public sector unions were currently balloting for strike action in defence of
       pensions. Shaun pointed out that at 2gether, both sides were in agreement
       about the right of employees to strike, and the importance of maintaining patient
       safety and service continuity. The Board has put in place a group chaired by the
       Chief Executive to put contingency measures in place in the event of a vote for
       strike action. This will ensure that patient safety and service continuity are not

11.4   The Mental Health Strategy had been published in February this year. The
       Mental Health Network will be writing to the Minister to ask what has been
       achieved so far.

11.5   There had been an unannounced inspection yesterday at Westridge by the Care
       Quality Commission. This had come about following the revelations about
       Winterbourne View, after which the CQC had announced that inspections of all
       Learning Disability facilities would take place. 2gether had done its own mock
       inspection in preparation for the visit. The CQC report would be sent to the Trust
       within 28 days. Westridge had also been the subject of an unannounced visit by
       the Mental Health Act Commissioner. The results of this visit had been very

11.6   The Trust had submitted a tender to acquire Oxford learning Disability Trust. The
       tender document and a presentation had been submitted, and we were waiting
       to hear whether we have been selected to go forward as one of the final three
       bidders. While the tender process was going on, the Board was undertaking its
       own due diligence to decide whether we would want to proceed with the
       acquisition if we were successful in the tender process. If we were successful,
       Monitor would deem this a ‘significant transaction’ and a Board-to-Board with
       Monitor would be required. Following this, Monitor would express a view as to
       whether it would be appropriate to proceed, although the final decision would be
       for 2gether’s Board.


12.1   Richard Butt-Evans, Chair of the Governance and Performance Committee
       presented the Council with the Committee summary from the meeting held on
       17th August 2011.

12.2   The Committee received three key reports at the meeting; Sickness Absence,
       Serious Incidents, and the Performance Dashboard.

12.3   The sickness absence report showed that while the Trust was currently missing
       its target of 4%, the current level of 4.8% was better than the average
       performance of other mental health trusts. 21gether was the only mental health
       trust in the South West region to have achieved sickness absence levels below
       5% between April 2008 and March 2011.

12.4   The Committee received a report that provided assurance on the way serious
       incidents were managed. There was a clear process for reporting, investigating
       and learning from serious incidents. Serious incidents were reported monthly to
       the Board. The numbers of serious incidents reported had risen of late due to
       new business being taken on in Herefordshire and the Prison.
                                                                 2gether NHS Foundation Trust
                                                                  Council of Governors Meeting
                                                                              13 October 2011

12.5   The next meeting of the Governance and Performance Committee would take
       place on 16th November 2011.


13.1   Ros Taylor presented the summary report from the Quality Review Committee
       held on 6th September 2011.

13.2   The Committee had received the results of the National Patient Survey for
       community patients in Herefordshire and Gloucestershire. For both areas,
       results were at or above the national average, although Gloucestershire’s results
       had declined slightly since last year. The Committee noted that action plans
       were in place for both areas, and that next year a single survey would cover both

13.3   The Committee received the Quarter 1 Service Experience report. Complaints
       had increased during the period, but this could be attributed to new business in
       Herefordshire and the Prison. The increase in complaints was consistent with
       the larger population which the Trust now serves. The Committee noted that the
       Trust now offers complainants a face to face meeting to discuss their complaint.
       While this has meant that some complaints aren’t dealt with as quickly as before,
       satisfaction levels with the way complaints are dealt with have gone up.

13.4   The Committee received a report updating them on progress with the Quality
       Account. Good progress had been made in the five major Quality Account
       categories. We had not met our target for accurately recording ethnic origin, and
       violent assaults on staff had increased. Work was underway to understand and
       address both these issues.

13.5   The Committee received an update on the patient safety works at Wotton Lawn.
       These would address some safety concerns raised by the clinical team, and
       would result in a reconfiguration of bed numbers across the hospital, to bring
       those numbers into line with best practice. Work would be done on a rolling
       basis, beginning with the reception area, where work had already commenced.

13.6   The Committee also received a presentation on AIMS accreditation for inpatient
       wards. This accreditation is given to individual wards, following an application
       process led by the ward staff. The accreditation covers several quality
       standards, and several wards already hold the accreditation.

13.7   Paul Winterbottom, Medical Director had also attended the meeting to give the
       Committee a presentation on the work being carried out within the Trust to
       develop services for people with a personality disorder.

13.8   The next Quality Review Committee would take place on Tuesday 6th December.


14.1   Ros Taylor presented the summary report from the Membership Committee held
       on 22th September 2011, and gave the Council an update on the latest
       membership statistics.
                                                                 2gether NHS Foundation Trust
                                                                  Council of Governors Meeting
                                                                              13 October 2011

14.2   The Committee had discussed a draft Membership Strategy, which covered a
       three year period and which aimed to recruit and retain members, communicate
       effectively with members, and encourage meaningful membership.

14.3   The Committee agreed that given the current resources available to the Trust, it
       would not be possible to achieve everything in the draft strategy, and some
       prioritisation would therefore be required.

14.4   The Committee asked that further work be done on the strategy, and agreed to
       consider an amended version at the next meeting of the Committee.

14.5   The next meeting of the Membership Committee is 15th December 2011.


15.1   Julie Garnham gave the Council an update on the Nomination and
       Remuneration Committee meeting of 22 September 2011.

15.2   The Committee had met to discuss the process for appointing a replacement for
       Frank Powell. The Committee had agreed to use an executive search agency,
       and had agreed the role and person specification for the position.

15.3   The recruitment process would comprise discussion groups involving Board
       members and members of the Committee, with a separate discussion group
       involving service users. A formal interview panel would then be convened,
       comprising the Trust Chair, members of the Committee, and a Non-Executive

15.4   The Committee intended to make a recommendation to the Council of
       Governors in January.


16.1   John Gillett had taken part in a protest against the proposed move to a Social
       Enterprise Trust for Gloucestershire community health services.

16.2   Thomas Dunleavy had taken on a new role as a Quality Checker for
       Gloucestershire Voices.

16.3   Nick Baker informed the Governors that he was on the Board of Gloucestershire

16.4   Rod Whiteley had attended a meeting of the South West Governors Exchange
       Network in Taunton. This had been a useful opportunity to meet with other
       Governors and exchange information. Together with Pat Ayres, Rod had also
       attended a very good conference organised by 2gether and SOBS (Survivors of
       Bereavement by Suicide).
                                                                  2gether NHS Foundation Trust
                                                                   Council of Governors Meeting
                                                                               13 October 2011


17.1   David Maynard had submitted a question asking about the reasons for the
       recent shortage of inpatient beds in Gloucestershire, and the actions the Board
       was taking to address this.

17.2   Shaun Clee replied that the problem had applied to the whole of the South West
       region, and not just Gloucestershire, for the past ten days. Historically there has
       been a rise in admissions each year around late September/early October. The
       reasons were unclear, but all South West inpatient units, including those in the
       private sector, had been full.

17.3   The Trust had agreed with Commissioners to put additional beds into our
       inpatient units, to provide 69 beds instead of the usual 66. Clinicians and
       colleagues in Crisis Home Treatment Teams had worked closely with the new
       Countywide Clinical Director to treat patients in the community where possible,
       and to manage inpatient admissions.

17.4   Governors expressed their thanks to the staff involved in managing this
       challenging situation.


18.1   Julie Garnham informed Governors that she had attended a meeting of the
       FTGA in Taunton. This had been a good opportunity to meet and exchange
       ideas with other Governors.


19.1   There was no other business.


20.1   The next meeting would take place on Thursday 19th January 2012 at 5.00pm in
       the Business Continuity Room, Rikenel
                                                                     2gether NHS Foundation Trust
                                                                      Council of Governors Meeting
                                                                                      13 July 2011

                                     Council of Governors
                                       13 October 2011

                                         Action Points
Item                           Action                               Lead               Progress
5.4    Report back to the Council in the summer on the           Matthew Page         Scheduled for
       results of the review of the transition from children’s                      July 2012 meeting
       services to adult services

8.5    Report back on the minimum number of members              John McIlveen       A minimum of 50
       needed to hold an election for Governor in the                                  members are
       Greater England constituency                                                   Membership in
                                                                                     this constituency
                                                                                       exceeds this
10.9   Circulate information about Committee timings and         John McIlveen           Complete
       purpose, and skills/interests required by Governors
       interested in attendance at these Committees.

10.9   Governors to nominate themselves to John                   Governors              Complete
       McIlveen if they wish to take part in the trial of
       attendance at Board Committees.

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