The next meeting of the Trust Board will be held on Thursday 31

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The next meeting of the Trust Board will be held on Thursday 31 Powered By Docstoc
					                                                                                         PAPER   F
                           MENTAL HEALTH NHS FOUNDATION TRUST

                            COUNCIL OF GOVERNORS MEETING

Meeting Date:          11 February 2010

Title and Author of Paper: Chief Executive Report – Christine Boswell

Paper for Debate, Decision or Information:       For information

Key Points to Note:

The Chief Executive’s Report to the Council of Governors provides details of key news, events,
policy documents, reports and general pertinent information for Governors in order that Governors
are well informed at all times on key issues both within the Trust and in the wider NHS.


1a       Leading the Way with Quality

The responses, comments and suggestions captured in the four staff group meetings, the meeting
with the Clinicians and from the Governors at their meeting on 11 November 2009, have now been
collated. All the events were very interactive and generated great enthusiasm and input. The key
themes emerging are:

        Quality at the heart of all clinical practice
        Creating a ‘quality culture’ which challenges current practice and drives improvement
        Encouraging extensive staff engagement
        Pro-active means of gleaning feedback from service users, carers and families.
        Recognising that good quality doesn’t necessarily cost more
        Link between the quality agenda and the Trust’s Vision and Values
        Embracing innovation and creating an energy for change
        ‘Customer Care’ as a dimension of ‘quality care’
        Research, benchmarking and audit
        Small changes can lead to big benefits

These themes will be shared and developed with staff in a further set of workshops arranged for
Spring 2010.

In terms of the key five components of the LWQ Programme, a brief update is provided in the table

         Component                                            Update

 Trust Quality Council        TQC has met monthly since the last COG meeting. Copies of minutes
                              are available on request.
 Trust Business Divisions     The Board of Directors received a substantive update in September.
                              The Operations Team are currently preparing to make applications for
                              Trust Business Division status by 8 February 2010.
 Getting Ready for PbR        A further update on this component was presented to the Board of
                              Directors and work continues on implementation.
        Component                                           Update

 Leadership for Quality      The Leadership Framework was presented to and approved by the
                             Board of Directors in October 2009. A detailed action plan was
                             presented to the Board of Directors in January 2010.
 QIPP                        The QIPP programme was discussed and approved by the Board of
                             Directors in October 2009. The work streams have commenced as per
                             the paper presented to the Board of Directors and the first meeting of
                             the QIPP Programme Board took place on 26 November 2009.
                             A detailed paper on QIPP is attached at Paper I.

Lead: Christine Boswell, Chief Executive

1b   Annual Awards/Volunteers’ Luncheon

It was with great pleasure that I attended two Trust events during December. The Annual Awards
Ceremony celebrated the Trust’s and individual staff members successes and helped to recognise
and reward good practice and personal achievements. As well as over a hundred educational
awards and 30 long service awards, the Trust Award winners each received a certificate and a prize,
with the LWQ Award winner being supported to undertake a travel scholarship in order to investigate
best practice elsewhere in the country. The Award winners were:

  Award                              Winner
  Leading the Way with Quality       Productive mental Health Ward Team – Rehab and
  Award                              Recovery Services for the launch and implementation of the
                                     Productive Mental health Ward initiative,
  Clinical Team                      ‘Know the Score’ Rotherham for their work with Police and
                                     other authorities delivering outreach work across
                                     Rotherham in relation to young people’s excessive drinking.
  Clinical Member of Staff           Louise Metali, Learning Disability Service for her
                                     supervisory role and improved working practices in North
  Non Clinical Team                  Rotherham Modernisation Project Team for the work in
                                     providing new and refurbished buildings and the re-
                                     provision of community services.
  Non Clinical Member of Staff       Ann Bowers, Support Worker for the support, guidance and
                                     motivation provided to a person with mental health issues
                                     who successfully completed the Duke of Edinburgh Gold

On 11 December 2009, I attended the Volunteers’ Festive Luncheon. This was another opportunity
to say thank you to a range of individuals that volunteer to help the Trust. Invitees included
Governors, Associate Hospital Managers and Trust Volunteers.

Lead: Christine Boswell, Chief Executive

1c   NHS Forest

The NHS Forest is an exciting new national project coordinated by the Campaign for Greener
Healthcare. The idea is based around the knowledge that looking through hospital windows at trees
and green space rather than concrete significantly reduces recovery times. The added benefits
      A healthier environment for staff visitors and patients/service users and the local community.
      Reduced carbon emissions through offsetting – helping us to meet our carbon reduction
      Improved access to nature and green space, and increased biodiversity.
      Community involvement helping to overcome stigma associated with mental health
The main aim of the project is to plant a tree for every employee within the NHS a total of 1.3 million
trees. Working with partner organisations such as Natural England, the Forestry Commission, the
Woodland Trust, British Trust for Conservation Volunteers and the Small Woods Association, who
will engage with local community groups and schools to assist with the planting and maintenance of
the woodlands, it is envisaged that the local community will have a sense of ownership of the
woodland which will inevitably ensure its survival.

A pilot study “Planting the Seed” undertaken by the Yorkshire and Humber Strategic Health
Authority, has identified a small number of Trusts to take the project forward in a pilot phase during
the current planting season, Nov 2009 to Feb 2010; RDaSH is one of those identified with a
proposal for planting prepared by the Woodland Trust.

The Campaign for Greener Healthcare have secured several sponsors to provide the core funds for
the setting up of the scheme, offering significant subsidies for Trusts who enrol. The development of
a tree sponsorship scheme held centrally by the Campaign for Greener Healthcare will ensure
financial sustainability of the project; people will be able to sponsor a tree to commemorate a
specific event or occasion.

The proposal for RDaSH is to include planting schemes at St Catherine’s and Swallownest Court in
the first phase, with the possibility of further planting at both the Bentley and Great Oaks sites. The
project will be further enhanced by the inclusion of service users within the Walled Garden in
harvesting seeds and propagating trees for further phases of the scheme, service users would also
be included in the final planting alongside members of the community and school children alike, so
helping to reduce the stigma associated with mental health. Ian Higgins, the Trusts Environmental
Project Manager, would also like to see the existing woodland at St Catherine’s have improved
access suitable for wheelchairs, the woodland on this site is a fantastic resource we have available
to us that is currently greatly under utilised. For further information visit:

Lead : Allan Makeman

2a     World Class Commissioning

The second year of world class commissioning (WCC) assurance was launched by the Department
of Health in September 2009. WCC assurance is the national system that holds PCTs to account,
whilst providing support for them as they start to become world class commissioners.
We have been asked to contribute as a stakeholder to assessments for NHS Doncaster, NHS
Rotherham, NHS Barnsley and NHS North Lincolnshire. The results of the assessments will be
published in Summer 2010.

2b    Local Authority Ratings

On 9 December 2009 the outcomes of the most recent organisational assessments for Councils and
the Children’s Services annual ratings were published. The table below presents the outcome for our
main three Local Authority Councils:

                                Organisational Assessment
        Area                                                                Children’s Services
                          Use of         Managing            Overall
                        Resources       Performance

 Doncaster             Performing       Performing       Performing        Performs poorly
                       adequately       poorly           poorly
 Rotherham             Performing       Performing       Performing        Performs poorly
                       well             adequately       adequately
 North Lincolnshire    Performing       Performing       Performing        Performs well
                       adequately       adequately       adequately

Full details of the assessments can be found on the Governments website One Place

3a     High Impact Actions For Nursing And Midwifery

The Chief Nursing Officer, Christine Beasley, has announced eight high impact actions for nursing
and midwifery which, if implemented in every NHS organisation across the country, will hugely
improve the quality of care and make significant reductions in cost. Nurses and midwives posted
600 submissions on the High Impact Actions web site. These actions have now been translated into
the above publication and have the potential to not only transform the care patients receive, but
importantly, to also reduce costs. The High Impact Actions are as follows:

1. Your Skin Matters - No avoidable pressure ulcers in NHS provided care.
2. Staying Safe – Preventing Falls - Demonstrate a year on year reduction in the number of falls
   sustained by older people in HNS provided care.
3. Keeping nourished – getting better - Stop inappropriate weight loss and dehydration in NHS
   provided care.
4. Promoting Normal Birth - Increase the normal birth rate and eliminate unnecessary caesarean
   sections through midwives taking the lead role in the care of normal pregnancy and labour,
   focusing on informing, educating and providing skilled support to first-time mothers and women
   who have had one previous Caesarean section.
5. Important Choices – where to die when the time comes- Avoid inappropriate admission to
   hospital and increase the numbers of people who are able to die in the place of their choice.
6. Fit and Well to Care- Reduce sickness absence in the nursing and midwifery workforce to no
   more than 3%.
7. Ready to go – no delays - Increase the number of patients in NHS provided care who have their
   discharge managed and led by a nurse or midwife where appropriate.
8. Protection from Infection - Demonstrate A dramatic reduction in the rate of Urinary Tract
   Infections (UTIs) for patients in NHS provided care.

A paper was presented at the December 2009 Board of Directors meeting detailing actions the Trust
is taking on the eight high impact actions.

Lead: Helen Dabbs, Deputy Chief Executive

3b     Anti-psychotic drugs and dementia

A new action plan to tackle the over-prescribing of anti-psychotic drugs to people with dementia has
been announced by Care Services Minister Phil Hope. The action plan responds to an independent
review by Professor Sube Banerjee, commissioned by the Department of Health. Professor
Banerjee’s review shows that too many people with dementia are routinely prescribed anti-psychotic
drugs to treat aggression and agitation, contrary to National Institute of Health and Clinical
Excellence (NICE) guidance.

The implications will be discussed at the Medicines Management Committee and debated at TQC to
identify any specific actions required within the Trust to address the action plan and recommended

Lead: Dr Riadh Abed, Medical Director

3c     Promoting mental wellbeing at work: NICE Guidance for employers on promoting
       mental wellbeing through productive and healthy working conditions

The guidance is for all employers and their representatives who are responsible for, promoting
mental wellbeing at work. It focuses on interventions to promote mental wellbeing through
productive and healthy working conditions.

Mental wellbeing at work is determined by the interaction between the working environment, the
nature of the work and the individual. The five recommendations cover: strategy, assessing
opportunities for promoting mental wellbeing and managing risk, flexible working, the role of line
managers, and supporting micro, small and medium-sized businesses.
They include:

        Promoting a culture of participation, equality and fairness that is based on open
         communication and inclusion.
        Using frameworks such as Health and Safety Executive management standards for work-
         related stress to promote and protect employee mental wellbeing.
        Consider particular models of flexible working that recognise the distinct characteristics of
         micro, small and medium-sized businesses and organisations.

This guidance will be responded to both in relation to RDASH employed staff and what actions the
Trust needs to take to support them, and also in respect of any commercial development
opportunities it may present for future business development.

Lead: Rosie Johnson, Director of Workforce, Organisational Development and Corporate Affairs /
      Helen Dabbs, Deputy Chief Executive

3d        National Consultations

a.        NHS Constitution

A consultation on proposals to include new rights into the NHS Constitution was launched on 10
November. The rights proposed are a right to access services within maximum waiting times or for
the NHS to take all reasonable steps to offer a range of alternative providers, and a right to an NHS
Health Check every five years for those aged 40-74. The introduction of a number of other potential
future rights and the role of ‘Constitution Champion’ are also explored.

b.        Care Quality Commission - Interim NHS registration fees consultation

From April 2010, NHS providers must pay fees for their registration with CQC under the Health and
Social Care Act 2008. The consultation, launched on 2 November 2009, sets out proposals for an
interim scheme of fees for NHS providers, while the registration system is being phased in during
2010-2011. This will be followed by a further consultation in late 2010 on a single long term fee
proposal for all health and social care effective from April 2011.

This current consultation is asking for feedback specifically on the overall approach to regulatory
fees, the fee model - how fees are calculated to take account of the different sizes and types of
providers and the amounts of each fee.

Lead: Richard Banks, Director of Performance and Assurance

c.        Monitor – Consultation on additional annual reporting requirements 2009/10

Monitor launched its latest consultation on 2 November 2009 and set out its proposals for additional
annual reporting requirements for NHS foundation trusts for 2009/10. The proposals in the
consultation cover five main categories of reporting:
       1. Quality
       2. Sustainability;
       3. Valuing people
               a. Equality and diversity
               b. Staff feedback;
       4. NHS Constitution; and
       5. Regulatory findings.

The consultation document includes examples of the proposed format of reporting in each of the
above five categories, and indications as to how reporting requirements in each of these, and the
related assurance, may be likely to develop. The purpose of the consultation is to enable Monitor to
finalise guidance for the 2009/10 quality accounts include reporting requirements against the NHS

Lead: Richard Banks, Director of Performance and Assurance/Philip Gowland, Board Secretary
3e    New Horizons

Following a consultation exercise that ended in October 2009, the Department of Health has now
published New Horizons. It is a cross-government programme of action to help improve everyone's
mental well-being and the services that provide mental health care.

New Horizons covers a lifetime - from laying down the foundations of good mental health in
childhood, through to maintaining mental well-being into older age. It also emphasizes the
importance of prevention through to effective treatment and recovery and outlines the benefits of
reducing the burden of mental illness and unlocking the benefits of well-being in terms of physical
health, educational attainment, employment and reduced crime.

The document has been launched along side two plans to support people with mental health
problems back into employment - Work, Recovery and Inclusion and Working Our Way to Better
Mental Health.

Lead: Helen Dabbs, Deputy Chief Executive

3f    NHS 2010-2015: From good to great, preventative, people-centred, productive

On 10 December 2009, Health Secretary Andy Burnham set out his strategy for the NHS to put
patients first and improve the quality of care as it enters an unprecedented era of reform. The
strategy, which replaces the NHS Plan and is entitled ‘NHS 2010-2015: from good to great.
Preventative, people-centred, productive,’ explains the need to accelerate the pace of NHS reform
to make the system more productive and hasten improvements in quality of care – protecting
patients, supporting staff, shifting resources to the frontline and slashing back office waste and

The strategy paper is available on the Department of Health website, or in hard copy from the Board

Lead: Christine Boswell, Chief Executive

3g     Operating Framework

Also on 10 December 2009, NHS Chief Executive David Nicholson outlined details of the NHS
Operating Framework for 2010/11, due to be published in the week commencing 14 December
2009, which will set out NHS priorities for the next year. The Operating Framework will help the NHS
make the changes necessary to embed quality and for it to drive all that the NHS does. The
Framework will allow the NHS to focus on ensuring care is safe, compassionate and personal to
patients and will provide real opportunity for radical and innovative approaches to improve the quality
of services, whilst at the same time reducing costs. The four key headline areas are:
    1. Focus on quality: strong clinical engagement, patient experience; linking quality to the
        payments system.
    2. Risk management: Managing financial and clinical risk
    3. Characteristics of the future system: collaboration on a local level with providers and
        commissioners sharing common objectives.
    4. Importance of Integration: Vertically with respect to the care pathways and horizontally
        between health and social care.

A summary of the key issues in the Operating Framework is as follows:

     1. Priorities
        The top five priorities for the NHS in the Operating Framework remain unchanged and are:

           improving standards of cleanliness and tackling healthcare associated infections:
           improving access to care through the achievement of the 18-week referral to treatment
            pledge and improving access to GP services, including at evenings and at weekends;
           improving the health of adults and children and reducing health inequalities, by focusing
            on improving care for cancer and stroke, and paying particular attention to children's
            health, particularly in the most deprived areas of the country;

           improving patient experience, staff satisfaction and engagement; and
             preparing to respond in a state of emergency, such as an outbreak of pandemic

     2. Finance
         5.5% growth in 2010/11
         2% of growth in 2010/11 is non-recurrent.
         Flat real growth in 2011/12 and 2012/13
         In 2010/11, 0% uplift in tariff and 3.5% CRES

     3. Quality
         CQUIN in 2010/11 up to 1.5%
         Penalties for non delivery of key quality targets

     4. Management costs
         30% savings in management costs by PCT/SHA over 4 years
         15% savings in management costs in year one (2010/11)

     5. Community Services
         All PCTs to agree their forward model by March 2010 and to implement it by March 2011.

     6. Commissioning Development
         All PCTs to achieve at least Level 3 scores in seven of the eleven World Class
          Commissioning competencies by March 2011

Lead: Christine Boswell

3h       Patient Safety Alert - Being Open

Being open is a set of principles that healthcare staff should use when communicating with patients,
their families and carers following a patient safety incident in which the patient was harmed. Being
open supports a culture of openness, honesty and transparency, and includes apologising and
explaining what happened. In 2005, the National Patient Safety Agency (NPSA) issued a Safer
Practice Notice advising the NHS to develop a local Being open policy and to raise awareness of
this policy with all healthcare staff. The guidance has now been revised in response to changes in
the healthcare environment and in order to strengthen Being open throughout the NHS.

The six actions required of NHS organisations are:

     1. Local policy: Review and strengthen local policies to ensure they are aligned with the Being
        open framework and embedded with your risk management and clinical governance
     2. Leadership: Make a board-level public commitment to implementing the principles of Being
     3. Responsibilities: Nominate executive and non-executive leads responsible for leading your
        local policy. These can be leads with existing responsibilities for clinical governance.
     4. Training and support: Identify senior clinical counsellors who will mentor and support fellow
        clinicians. Develop and implement a strategy for training these staff and provide ongoing
     5. Visibility: Raise awareness and understanding of the Being open principles and your local
        policy among staff, patients and the public, making information visible to all.
     6. Supporting patients: Ensure Patient Advice and Liaison Services (PALS), and other staff
        have the information, skills and processes in place to support patients through the Being
        open process.
The patient safety alert that was used to re-launch this matter was discussed at PAG on 10
December 2009 and at Board of Directors in January 2010. NHS organisations are expected to have
actions underway by 22 February 2010 and actions completed by 23 November 2010.

Lead: Richard Banks, Director of Performance and Assurance

3i    Regulators

Baroness Young has announced that she will be leaving her post as Chair of the Care Quality
Commission (CQC) and she will be replaced on an interim basis by Dame Jo Williams, who will start
work in January 2010. The two are expected to work jointly until Baroness Young steps down on
1 February 2010.

It has also been reported that the attempts to find a successor for William Moyes, the out going
Executive Chairman of Monitor have recently stalled.

Further updates on the appointments to two important posts will be provided in due course.

Christine Boswell
Chief Executive
February 2010

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