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					                                                                                   COM /2008
                              Central and North West London
                                  NHS Foundation Trust

                   Annual General Meeting / Council of Members Meeting
                                   23 September 2008

                                        Draft Minutes

Minutes of a meeting of the Council of Members, combined with the Trust’s Annual General
Meeting, held at 5pm in public on 23 September 2008 at Congress House, Great Russell Street,
London WC1B 3LS.

The Chair welcomed Governors to the meeting, and paid tribute to them for their work during
the year gone by.

Members Present:

      Dame Ruth Runciman (Chair)              Mr. Sean Bell-Briggs
      Dr. Mike Crawford                       Mr. Paul Byrne
      Ms. Jo Andrews                          Ms. Jenny Trite
      Ms. Charlotte Green                     Mr. Roger Warren
      Mr. Marek Stepniak                      Ms. Janet Seale
      Ms. Monique Klang-Voves                 Cllr Barry Macleod-Cullinane
      Dr. Alicia Etchegoyen                   Dr. Kostas Agath
      Ms. Andrea Rayner                       Mr. Robin Walker
      Ms. Shalinie Tewarie                    Ms. Zrinka Bralo
      Mr. Timothy Seale                       Mr. Christopher Keeffe


In Attendance:

      Mr. Chris Bumstead         Head of Patient & Public Involvement
      Mr David Brettle           Director of Human Resources
      Mr. Ian Holder             Non-Executive Director
      Ms Bhavana Desai           Non-Executive Director
      Prof. Dorothy Griffiths    Non-Executive Director
      Dr. Alex Lewis             Director of Clinical Governance and Medical Director
      Ms. Claire Murdoch         Chief Executive
      Ms Christine Baldwinson    Trust Secretary
      Mr Nick Bell               Deputy Trust Secretary
      Mr. John Vaughan           Director of Partnerships
      Mr. Richard Vergez         Associate Director, Corporate Governance
      Ms Robyn Doran             Director of Operations
      Mr Trevor Shipman          Director of Finance
      Mr. Ian McIntyre           Director of Business and Estates




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1. Apologies

a Apologies for absence were received from Cllr John Detre, Jill Patel, Russell Healy, Andy
  Lale, Rami Jumnoodoo, Edward Matt, Cllr Alexander Nicholl, Hiroo Chothia, Cllr Robert
  Freeman, and Tony Ogofere.


2. Governor Election, Appointments, Resignations and Terminations Update

a The Chairman welcomed new User Governor Timothy Seale to his first Council of
  Members meeting.


3. Minutes of the Last Meeting- 23 July 2008

a The Council received and noted the minutes of the last meeting, COM 19/2008, which
  were confirmed as a true and accurate record.


4. Matters Arising

a Item 5b, Governor Workshops: the Chair noted that there had been two workshops held
  since the last Council of Members meeting, on the NHS Constitution, and CPA.

b Item 5c, Mental Health Day: the Chair confirmed that the date is the 10th October 2008,
  and flyers were available to take away.

c   Item 6c, Harrow Vocational Strategy: the Chair advised that there would be an item on
    social inclusion on the agenda for the next Council of Members meeting in January.

d Item 8c, Appointments Committee: the Chair advised that the Committee had met on the
  16th September 2008 and considered the process for appointing Non-Executive
  Directors, and following presentations from the applicants it had been unanimously
  agreed to use the Appointments Commission.

e Item 10d, Board to Board meeting: the Chair asked that all Governors respond to the
  Trust Secretary’s email requesting availability on a selection of dates, as not all
  responses had yet been received.

f   Item 11, Review of Council of Members’ Performance: the Chair asked that appraisal
    forms be returned as soon as possible, as they would be used as a basis for discussion
    during the away day.


5. Annual Report and accounts for the 1 month period 1 April 2007 to 30 April 2007
and
6. Annual Report and accounts for the 11 month period 1 May 2007 to 31 March 2008

a The Director of Finance explained that two sets of accounts had been produced because
  CNWL was authorised as a Foundation Trust part way through the year 2007/8, and
  statute required that two separate sets of accounts be produced to govern the periods
  pre- and post-authorisation.

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b The Director of Finance advised that in both sets of accounts the Trust had finished in
  surplus and had made a £5.2m surplus over the whole year 2007/8. The Director of
  Finance noted that he further anticipated a surplus in the region of £7.8m for the year
  2008/9. He then invited questions from the public. The Trust’s External Auditor, Mr.
  Henry Arthurs from Baker Tilly, was also available at the meeting to respond to any
  queries.

c   In response to a question regarding the Trust’s improved financial position, the Director
    of Finance explained that this was due to its authorisation as a Foundation Trust, which
    gave CNWL scope to negotiate its own contracts and manage its own resources. As an
    NHS mental health trust in previous years, the NHS took any surplus to offset deficits of
    other trusts.

d Following a question about the projected surplus for 2009/10, the Director of Finance
  advised that that it was hard to be specific, as there were a number of factors which
  could affect targets, but he was anticipating steady growth. It was queried whether a
  large surplus could have any detrimental effect. In response, the Director of Finance
  advised that PCTs would want to see they are getting value for money on their contracts,
  and that the Trust was using its surplus both to secure its position and to invest back into
  the services it provides. An excessive surplus could therefore lead to PCTs questioning
  the cost of the service provided.

e The Council of Members received the accounts.


7. Activity and Innovation in Child and Adolescent Mental Health Services – A CNWL
   perspective

a The Chairman introduced a series of presentations by CNWL CAMHS staff, noting that
  there was an increasing national emphasis on helping children, families and the
  community, and that this item was to celebrate some of the work currently being carried
  out by the CNWL CAMHS directorate.

b Marie Crofts, Deputy Service Director of the CAMHS directorate, provided an overview of
  the service, and explained that the presentations would focus on the work of two teams,
  Collingham Gardens and the Marlborough Family Service.

c   Paul Byrne, Manager of Collingham Gardens and also a Staff Governor on the Council of
    Members, presented a description of the service Collingham Gardens provides, the work
    ethos of the team and the range of initiatives it had implemented in London and the
    awards the team and these initiatives had received.

d Dr. Eia Asen and Jane Dutton, Consultant Psychiatrist and Head of Social Work
  respectively at the Marlborough Family Service, presented an overview of the
  Marlborough Family Service and the specialist projects it currently provides, and the
  take-up of some of their initiatives within the country and across Europe.

e Following a question about preventative work done in schools. Dr. Asen explained that
  there was a devolved service within schools to identify problem children early.
  Furthermore a series of training sessions are provided to the Headmaster, and then to


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    Year Heads and other identified personnel. These sessions coach how to identify
    children with more complex needs early, and are free of charge.

f   A question was raised about the service’s response if the child’s problems stem from the
    parents, for example abuse. Mr. Byrne responded that Risk Assessments are always
    carried out to gauge the suitability of the child staying at home, but noted that most cases
    involve a range of complex factors and cannot be pinned down to simple bad parenting.
    The projects run within the CAMHS service are aimed at helping parents manage the
    problems a child presents with.

g A question was asked about the development of further specialist services in Asperger
  Syndrome. Mr. Byrne advised that there was a gap nationwide for children with learning
  disabilities, and that there was a need to address this. He added that, in comparison to
  other parts of the UK, London was well served in these areas.

h Following a question about whether treatment was ever enforced, Mr. Byrne responded
  that they look to the parent to make the decision for pre-adolescents. In the case of
  adolescents, there can be the possible use of the Mental Health Act, but again largely it
  is a decision-making process on the part of the family. There were also semi-voluntary
  cases whereby a family has been referred by court order to the service.

i   Following a question about the referral process, Mr. Byrne explained that all referrals
    come from outpatient CAMHS services. As the service has to operate on a low volume
    basis, cases are ‘filtered’ through the other CAMHS services so only the most needy are
    taken on.

j   Following a question about the recording of information, Mr. Byrne acknowledged that it
    was a difficulty faced by the team, to balance the need to document the relevant
    information against the desire not to label the child for life.

k   Ms. Crofts, Mr. Byrne, Dr. Asen and Ms. Dutton were thanked for their informative and
    enlightening presentations and answers.


8. Chief Executive’s Report – Perspective on the year and a view to the future

a The Council received and noted a verbal presentation from the Chief Executive that
  provided a look back at the highlights of the previous year and a summary of
  expectations for the forthcoming year.

b The Chief Executive started by congratulating the CAMHS directorate on their work and
  noting that this was one example of the range of services that CNWL provided to its
  community.

c   The Chief Executive noted that two booklets had been provided to the Council of
    Members that they could review at their leisure – a green booklet which provided the
    annual review for 2007/8, and a blue booklet which provided a summary of the annual
    plan for 2008/9, which Governors had helped develop.

d The Chief Executive thanked the Trust’s many partners – the Local Authorities, the
  PCTs, the private and voluntary sector bodies, and also the Governors, service users,


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    carers, and staff – for their contribution in the delivery of the high quality services CNWL
    provides.

e The Chief Executive went on to identify some key highlights of the year gone by for the
  Trust: Quentin Blake-led arts projects at various hospitals within the Trust; the
  development of a bespoke Onset of Young Dementia service in Kensington, Chelsea and
  Westminster; the reinvigoration of the Learning Disabilities services at Kingsbury since
  the Trust’s takeover; the success of the bid to provide SMS services in Feltham prison;
  the expansion of the Court Diversion work, including working with the Old Bailey; the
  medication helpline; the sale of Collingham Gardens and deployment of a new
  Collingham Gardens service at another site, the profits from which had also helped fund
  developments at Northwick Park Inpatient Services and the Horton Haven; and the move
  of Westminster SMS services to Latimer House.

f   Looking to the year ahead, the Chief Executive acknowledged that it would be another
    hard year’s work for CNWL, and that the Trust needed to be innovative and develop new
    services, but also to improve on the core functions it already provided. To this end, the
    Trust would continue to review its service provision and ensure that it responded to
    changes in the health service, including the probable introduction of poly-clinics. The
    Trust would also be looking to develop proposals for an autism and aspergers service,
    and would be opening the UK’s first gambling addiction clinic. The Chief Executive also
    noted that the new Mental Health Act and CPA frameworks would need to be integrated
    into the Trust’s service provision.

g Following a query about the Northwick Park redevelopment, the Director of Business and
  Estates advised that, as there was currently a spare ward on the site, service users
  would be accommodated by rotating them into the spare ward whilst work was
  undertaken on their wards. It was further noted that work needed to be carried out on
  Park Royal to bring it up to the same standard, and in the meantime the Trust was
  examining ways to improve the overcrowding situation there, such as looking for
  alternatives to admission and ensuring there are no delayed discharges.

h Following a query about minority communities within the Trust catchment area, it was
  noted that a range of innovations had been introduced to provide a better service,
  captured within the Delivering Race Equality scheme and carried out largely through the
  Focussed Implementation Site Project. A report on the work of the FIS project over the
  last three years would be forthcoming and will be presented to the Council at a future
  meeting.


9. Council of Members’ Review of the Year

a The Council received the paper entitled ‘Council of Members Review of the Year
  2007/08’, presented by the Director of Partnerships.

b The Director of Partnerships advised that it had been informed by the contribution of the
  Governors that had been provided to the Trust Secretary, and summarised the roles and
  responsibilities of the Council, and what they had done over the last year. The Director of
  Partnerships advised that their responses would inform a larger debate at the Board-to-
  Board Away Day.



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10. Questions from Members of the Public

a The Chairman invited questions from the floor.

b Following a query about providing mental health services to the Armed Services, the
  Chief Executive advised that the Ministry of Defence had advertised for provision of
  services, however the Trust had decided not to bid for it because it required an inpatient
  facility for the service, which the Trust did not have available.

c   The Director of Partnerships undertook to look into why a member of the Trust had not
    received information back from the Trust as to possible projects he could become
    involved in.
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d The Director of Clinical Governance and Medical Director undertook to meet with a
  member of the public to discuss her individual concerns about a gap in information
  provided around medication, and more generally the provision of services she had
  encountered.
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e Following a further concern raised that not enough information is provided at medication
  meetings, the Chief Executive noted that in the last two user surveys over 90% of
  patients had indicated that they felt they were treated with dignity and respect. Evidence
  was there that the Trust’s approach did work, but the Chief Executive fully acknowledged
  that further work needed to be done to improve contact for those who responded
  negatively in this respect.


11. Any Other Business

a There was no further business.


12. Date of Next Meeting

a The Chairman thanked the attendees for coming and advised that the next meeting
  would be held at 5pm on 20th January 2009 at Westminster Council House.


The meeting was declared closed at 7.10 p.m.



Chair




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