Agenda Item 4a Minutes December 2012 - North Essex Partnership by huangyuarong


           HELD AT 9.30 AM ON WEDNESDAY 21 DECEMBER 2011 AT

Mary St. Aubyn             Chairman
Ray Cox                    Non-Executive Director
Andrew Geldard             Chief Executive
Sarah Phillips             Non-Executive Director
John Gilbert               Non-Executive Director
Charles Abel Smith         Non-Executive Director
Geoff Scott                Director of Strategy
Dr Malte Flechtner         Medical Director

Vince McCabe               Director of Community Services
Lisa Anastasiou            Director of Workforce & Development
Mike Waddington            Associate Director, Communications
David Lambert              Associate Director of Finance
Harriet Carr West          Area Director West
Lorraine Bush              Area Director Mid & Specialist Services
Naushad Nojeeb             Operational Services Manager
Ian Carr                   Operational Services Manager
John Gardner               Clinical Manager/Modern Matron
Jackie Feltwell            Operational Manager OT & AHP
David Wheatland            NEPFT Member
Julie Harkus               Advocacy (Essex) Services Limited
Paul Rogers                NHS North East Essex
B. Simon                   Member of the public
P. Davies                  Member of the public
Danny Scott                NACRO, Trinity House
David Bamber               NEPFT Governor (Harlow)
Keith Biggar               Essex and Southend LINk

Mary St. Aubyn welcomed everyone to the meeting and expressed her formal thanks
to the Board of Directors and the Council of Governors for their support during the past
year. She then read a statement from Dan Kessler, Lead Governor and Public
Governor (Tendring) who was unable to attend the meeting due to illness. He
expressed his support for the Board holding meetings in the Trust’s localities,
commenting on the benefits of seeing members and the public talking about the work
of the Trust in supporting those experiencing and recovering from mental ill health. As
Lead Governor, he recorded his congratulations to the Board on a job well done this
past year. Under the Board’s leadership he was confident that the Trust was
delivering a high quality of service to its patients, and demonstrating its ability to
provide additional services to its commissioners across the East of England. He
added that, although our Trust faces challenging months ahead during which many
important decisions will be made, he was optimistic about the future.
Mary St Aubyn then invited questions from members of the public. One member of
the public commented on the experiences of her son at the Lakes (Colchester) in
2010, and in particular around pressures in relation to bed occupancy. Andrew
Geldard commented on the context of NHS funding nationally, advising that the Trust
had no plans to expand its general adult capacity, however, plans were in place to
expand low secure provision in Chelmsford, which it was hoped would relieve overall
bed pressure. He offered to discuss this particular case in more detail outside of the

Apologies were received from Paul Keedwell, Director of Nursing and Operations, Rick
Tazzini, Director of Resources and James Purves, Legal Advisor. Mary St Aubyn welcomed
David Lambert and Harriet Carr West, who were representing Rick Tazzini and Paul
Keedwell respectively.

There were no Declarations of Interest.

The minutes of the meeting held on 31 August 2011 were agreed as a correct
record and signed by the Chairman.

There were no matters arising.

Andrew Geldard presented his report and highlighted the following:

a)    Performance: The Trust had received confirmation from Monitor of its Quarter
      2 ratings, Governance at Green and the a Financial Risk Rating (FRR) of 3. He
      commented on the benefits for the Trust as an FT re-investing its surplus in its
      services, including the Remedy Project which focussed on the replacement of
      the Trust’s clinical system. The Remedy Project Board would bring a
      recommendation to the Board within the next two months.

b)    Strategy: There had been a successful annual Governors’ Plan event on 28
      November 2011 which had been very well attended.

c)    Contracts: Contract negotiations for the new year had commenced within a
      harsh financial climate. A key element of this was the 4% efficiency target for
      2012/13 which equated to a cash reduction of 1.8%, in addition to savings
      already achieved.

d)    Expanding the business - Current bids included:
         Suffolk Community Health Services
         Suffolk Wellbeing
         Marginalised and Vulnerable Adults in Suffolk
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             Prison Health Care in Chelmsford with partners
             Drug and Alcohol Services in Norfolk with a partner.

e)     CAMHS Unit: Andrew Geldard was delighted to report on the recent topping
       out of the CAMHS unit, named the Mary St Aubyn Centre in recognition of
       Mary’s outstanding service to the Trust.

Mary St Aubyn commented that she and Andrew had almost completed their annual
round of Christmas visits to all of the teams within the Trust and the level of morale
was very high, with a strong level of commitment from staff. Mary St Aubyn requested
that her thanks to staff for their outstanding work during the year be formally minuted.
She was also pleased to comment on successful recruitment to positions to deliver
new service for veterans.

Sarah Phillips recorded her thanks to Mary and Andrew for the time and effort taken to
visit all of the Trust’s teams which was an excellent example.

The Board of Directors received the Chief Executive’s report.

Mary St Aubyn commented that, for this particular item, questions from the public
would be permitted. Towards the end of the meeting, there would be a separate
section where members of the public would be able to ask questions about any other
items on the agenda.

This item was introduced by Lorraine Bush, Area Director for Mid and Secure
Services. The report focussed on the key elements of the plan for the current year,
whilst also referring to 2012/13. Lorraine commented on the Trust’s response to
service user and carer feedback regarding the Crisis Line which had led to the
development of proposals to our NHS commissioners to improve the service, initially
by a six month pilot. The service would be triaged by NERIL. In answer to a question
from David Wheatland, Lorraine Bush advised that NERIL staff would have the
appropriate training in order to triage the callers to the pilot service. The pilot would be
thoroughly evaluated.

Ian Carr, Operational Services Manager for Secure Services, then reported on
developments in his area. Key areas during the year which had demonstrated
improvement had included the Patient Environment Action team (PEAT) reports e.g.
around cleanliness, improvements regarding infection control, and a positive staff
survey. Other key issues included:
    Psychiatric Intensive Care Unit (PICU) accreditation by the Royal College of
    Improvements in the Secure Services budgetary position during 2011/12
    Developments in how information is shared with police during times of crises.
    Development of a new Low Secure Unit in the Chelmsford area (20 beds) - due
      to complete in 2012.

Ian also reported on the work of the Criminal Justice Mental Health Teams serving
courts in Essex, supporting them as they undertook new ways of working in new
locations. He then commented on work within prison including the in reach service.
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In answer to a question from Pippa Ecclestone, Ian Carr commented that the protocol
to share information with police was operating Trust-wide. In answer to a point made
by Ray Cox, Ian Carr commented on the Trust’s active engagement with the Probation

Naushad Nojeeb (Operational Service Manager) then reported on a new service within
the Linden Centre; the specialist five-bed Mother and Baby Unit which was available
across the NHS Eastern Region. Jackie Feltwell (Operational Manager OT & AHP)
added that the unit had capacity for partners to stay, with a focus on working with the
family as a whole. Naushad Nojeeb then commented on the Linden Centre review
which had been instigated in response to feedback. There were a 11 workstreams in
place including:
    Patient and Carer experience
    The working environment
    Introducing the concept of the therapeutic day
    Length of stay and outcome of treatment.

In answer to a question from Ray Cox, Naushad Nojeeb stated that the each
workstream had specific areas to take forward and progress would be monitored
closely. The success of the programme would also be evaluated by patient and carer
feedback and via the staff survey.

Naushad Nojeeb then reported on Older Adult services, including the excellent
services at the new Crystal Centre, including the Mid Essex Memory Assessment and
Support Service (MASS), recognised by the Department of Health as an example of
good practice. He also reported on future developments, including Admiral Nurses,
whose focus was supporting carers and families of people with dementia and the
delirium pathway.

In answer to a question from Charles Abel Smith about resources, Jackie Feltwell
commented that areas which would benefit from increased resources included:
     Physiotherapists in Older Adult Services
     Speech and Language Therapists in Mid
     Dietetics.

The Board of Directors received the presentation on the Central Area Business

Lisa Anastasiou explained the background and said the purpose of the report was to
provide the Board with an update on the implementation of the Equality Delivery
System and to seek agreement and support for the Trust’s equality objectives for the
period 2012-2016. A comprehensive paper on the background to the Equality Delivery
System within the NHS had been presented to the Board of Directors in August 2011.
Engagement of key stakeholders was at the heart of EDS. As part of the
implementation process the Trust had participated in five community engagement
events throughout Essex during September and October 2011, attended by over 150
people. The aim was to engage and seek the views and experience of NHS services
from people representing the nine “protected characteristics” as defined by the
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Equality Act 2010. To ensure that the views of all stakeholders were considered, the
Trust also undertook a postal survey which included patients, carers, partner
organisations, governors and staff who were asked to rate the Trust on a number of
EDS outcomes.

There were over 400 responses which were then used to grade a number of equality
statements. The Trust’s Equality and Diversity Group undertook an overall self
assessment and grading process, using the national guidance in terms of evidence
and sources, including the questionnaire. The Board was asked to note that the Trust
was required to publicise its rating against each of the 18 outcomes and EDS
objectives by 06 April 2011. Out of 18 rated statements, the Trust was rated:
     11 Green
     6 Amber
     1 Red.

The red rated item (competency framework) had just been introduced and therefore
there had not been the opportunity to comply with its requirements. Priorities for
2012/13 included developing community engagement by working with the Tendring
and Colchester Minority Ethnic Partnership (TACMEP) and:
    Improving the experience of those who were deaf or had hearing impairments
    Developing services around translation and interpretation
    Address barriers to flexible working.

In answer to a question from Sarah Phillips, Lisa Anastasiou described the support in
place for staff who made a declaration around disability. Geoff Scott commented that
the work on the EDS reflected some of the outcomes from the governors’ Annual Plan
Event, for example the theme around improving access to services for marginalised

The Board of Directors received the update on the implementation of the
Equality and Delivery System that supported the Trust’s equality objectives for
the period 2012-16.

Geoff Scott explained that the report updated the Board on progress and implementation
of the three-year Carers’ Strategy 2011-2013, approved at the March 2011 meeting of the
Board of Directors in Public. The report included a high level summary of progress
against the range of actions. A further survey had been commissioned from the provider
(Quality Health) and this had been extended to include carers of adults in later life. Carers
and families had identified a number of issues as important, including:
     Access to information to make informed decisions
     Knowing someone will respond
     Knowing support is available should a crisis occur.

Geoff Scott also commented on the importance of the contribution of the Carers’ Support
team. Key developments included the increase in uptake of carers’ assessments and a
focus on training within teams on carer involvement in care planning.

The Board of Directors received the report from a Carers’ Strategy Update and
noted good progress on the implementation of the three-year Carers’ Strategy
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Dr Malte Flechtner explained that the next patient survey, (focusing on community
patients) had been delayed nationally. A considerable amount of work had been
undertaken within the Trust to improve the patient experience, including the areas of
benefits advice and support into employment. Posters would be placed in all patient
areas, notifying patients that benefits advice was available. A letter would be sent to
patients advising them of the Trust’s commitment to supporting them regarding
benefits and employment. A letter would be sent to all care co-ordinators from the
Director of Nursing and Operations, the Director of Strategy and the Medical Director,
reminding them of the importance of offering support and sign-posting re benefits and
supporting people into employment. A concise and easy to use information pack
would be made available to all relevant staff which would include local telephone
numbers and web links. Staff would be encouraged to undertake relevant training. In
addition, work would be undertaken to enhance and develop local partnerships in
respect of benefits advice, for example with third sector organisations such as the
Citizens Advice Bureau and Mind.

Dr Flechtner then commented further on the Crisis Line discussed earlier in the
meeting, and the recommendation to establish a six month pilot with NERIL, subject to
funding from commissioners. This would include the drafting of a service specification,
implementation plan and evaluation criteria. In answer to a question from Sarah
Phillips, Andrew Geldard stated that the start date for the new service depended on
funding from commissioners; their response to the proposal was awaited.

Ray Cox commented on the potential to work with Essex County Council and district
Councils in terms of their existing provision to provide advice around benefits. Harriet
Carr-West advised that this type of initiative was already in place in Harlow, noting
however that local authority funding for this type of service was being reduced.

The Board of Directors received the presentation Service Users’ Survey 2011 –

Dr Malte Flechtner gave an overview of the outcomes of the 2011 GMC Survey of
Trainees. The results compared the Trust regionally rating it against under number of
topics including:
    Overall satisfaction
    Clinical supervision
    Work load
    Handover
    Compliance with European Working Time Directive
    Education supervision
    Induction
    Work intensity
    Access to educational resources
    Local teaching
    Study leave.

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He was pleased with the overall results for the Trust.; areas of particularly good
performance included:
    Clinical supervision
    Compliance with the European Working Time Directive
    Local teaching
    Study leave.

In answer to a question from Charles Abel Smith, Dr Malte Flechtner stated that good
experience in training was likely to impact on the preferences expressed by trainees in
their future careers. Andrew Geldard commented on the importance of monitoring the
satisfaction of trainees and of encouraging speciality trainees to seek career
opportunities within the Trust.

The Board of Directors received the presentation on the GMC Junior Doctors’
Survey 2011.

Geoff Scott commented that progress with the local business plans, which underpin
the Trust’s Annual Plan, was managed by Clinical Boards and Area Directors and
were brought to the Executive Team panel as part of their validation. In addition,
presentations in respect of area business plans were now part of the cycle of the
meetings of the Board of Directors in Public. Governors had been engaged in a round
of meetings with Area Directors to discuss progress re the 2011/12 plans and priorities
going forward. They were also closely involved in locality meetings and events with
members during the year to inform their views. Governors had recently held their
annual planning meeting event for the 2012/13 plan and received a brief presentation
at the Council of Governors meeting on 13 December 2011 re feedback on key
themes and priorities. Overall, the report presented a very positive position with all but
two areas rated Green, the remaining two being Amber. These related to ensuring
that all staff take up mandatory training and achieving a membership of 6,800 people
by 31 March 2012. Key achievements included:
     Agreement in place to manage Suffolk Community Services
     CAMHS new building due to complete during 2012
     LSU under construction
     Derwent Centre garden bridge completed
     Accreditation of the PICU
     Practice development unit status achieved at St Margaret’s
     Development of community Eating Disorder service
     Community engagement including schools.

The Board of Directors received the update on the Annual Plan Review of
Progress 2011/12, noting progress.

(a) NEPFT Performance Report to 30 November 2011, Month 8.
This item was presented by Harriet Carr West who stated that overall the Trust
continued to meet or exceed all CQC targets and Monitor thresholds; however, service
users on CPA receiving a review in the last 12 months was just 0.1% ahead of the
Monitor threshold of 95%.
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Lisa Anastasiou reported on the position regarding Sickness Absence and Turnover.
The sickness absence position was 4.5% in month; turnover at 4.8% was very low.
The number of appraisals recorded as completed was now 66.4% which represented
a significant improvement. In answer to a question from Sarah Phillips, Andrew
Geldard stated that the target was 100% and that a system was in place to ensure that
the appraisals were logged. John Gilbert requested that the report be amended so
that where items were not ranked as Green, there was an explanation and an account
of the actions being taken to correct the position.
                                                                Action: Rick Tazzini

There was a decrease in the amount of overall activity. Mike Chapman clarified that
this still in excess of the amount within the Trust’s funded contract.

The Board of Directors received and noted the NEPFT Performance Report to 30
November 2011, Month 8.

b) Suffolk Community Healthcare (SCH) Interim Management Agreement
Performance Report to 31 October 2011, Month 7.
This report was presented by Vince McCabe who commented that overall
performance was excellent. The CQC had recently visited Felixstowe Hospital and
found no matters of concern. Overall CQC registration had been maintained without
any concerns. NEPFT was providing additional capacity as required to support the
SCH quality/governance team. The SCH Patient Safety and Quality Dashboard
demonstrated compliance within contracted thresholds in all areas. There was an
increased focus on preventing pressure ulcers with actions included commissioning a
local tissue viability service.

In terms of financial performance, Vince McCabe provided a verbal report advising
that as at the end of Month 8 there was a £240K surplus and the CRES of £1.8M had
been achieved. He anticipated that the year end position would be a small

Suffolk Community Services was maintaining an position in relation to the Strategic
Health Authority’s performance management regime achieving, at Month 7, a Green
governance/operational risk rating, i.e. full compliance.

The Board of Directors received and noted the SCH Summary Performance
Report to 31 October 2011 – Month 7.

              ENDING 30 NOVEMBER 2011, MONTH 8.
This report was presented by David Lambert, Associate Director of Finance. As at 30
November 2011, the Trust had earned £2.251M more from providing health services
than it had spent on its cost of operations. After accounting for non-operating costs,
the Trust had achieved a net Income and Expenditure surplus of £1.39M which was
£6.6K better than planned. The forecast EBITDA at year end was £6.309M with a
retained surplus of £1.607M. The Trust had an overall weighted financial risk rating of
3.55, rounded to a 4, ahead of the plan submitted to Monitor of 3. Areas of variance
included an overspend in Mid due to one to one observations, maternity leave and
sickness. The capital forecast spend for year end had reduced due to a beneficial
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VAT settlement in respect of new buildings. The Trust was also benefiting from the
performance of the new Eating Disorders service which was likely to generate circa
£100K in 2011/12 (contractual maximum for the year).

Charles Abel Smith commented that as the Trust moved forward and had an
increasing number of components to its risk portfolio, there was a need to consider
how this was addressed within the reporting framework. Sarah Phillips commented on
the underspend for Allied Health Professionals and the need to consider the
appropriate budgeting for this area in 2012/13.

Mary St Aubyn commented that overall she was encouraged by the strong financial
position reported.

The Board of Directors approved the Finance Report – Financial Position for the
period ending 30 November 2011, Month 8.

Geoff Scott explained that the Board of Directors approved the existing three-year
partnership agreement renewal in February 2009 for the period 01 April 2009 to 31
March 2012. The renewal in 2009 involved the separation of previous arrangements
into two agreements, one with ECC Schools, Children and Families service for
CAMHS, and one for ECC Adults Health and Community Wellbeing Service for Adult
Mental Health and Substance Misuse. The agreements included the option to
extend for a further year beyond March 2012. Older Adult MH Services had
remained outside of these arrangements, however singly managed joint Older Adult
MH Community teams were in place. In answer to a question from Mike Chapman,
Geoff Scott explained that he and Andrew Geldard met regularly with seconded staff
to explain the emerging direction. The Trust was working with ECC on an outcomes
accountability framework which was intended to form the basis of their future social
care commissioning intentions beyond March 2013. In order for this substantial work
to be completed and its future implications to be considered and planned for, ECC
had asked for an extension to the existing Section 75 partnership agreements for a
further twelve months from 01 April 2012.

The Board of Directors ratified the Chief Executive’s decision to proceed with
the extension of the existing partnership agreements in both Child and
Adolescent and Adult Mental Health and Substance Misuse services for a
further year until 31 March 2013.

Ray Cox advised that there had been one meeting of the Audit Committee since the
last meeting of the Board of Directors in Public. This had been held on the 13 October
2011. Key areas discussed included:
     The External Audit (Audit Commission)
     Update regarding appointment of External Auditors
     Internal Audit Report (Deloitte & Touche)
     Counter Fraud Report (Deloitte & Touche)
     Audit Committee Self Assessment 2011.

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In respect of the appointment of the External Auditors, Ray Cox commented on the
excellent joint approach of the Audit Committee and the Governors’ Working Group for
the Appointment of External Auditors. A presentation would be received from the
bidding companies on 12 January 2012 and a recommendation brought to the Council
of Governors on 25 January 2012. Mary St Aubyn then thanked the Audit Committee
for their work during the year.

The Board of Directors received and noted the Audit Committee Report.

Ray Cox commented on the meeting of the Nominations Committee held on 12
October 2011. Key elements of the meeting had been the update in respect of the
process to recruit a non-executive director and a recommendation made to the
Remuneration and Appointments Committee of the Council of Governors in respect of
the use of an external recruitment agency for future appointments.

The Board of Directors received the report of the Nominations Committee.

This report covered the period July to December 2011 and updated the Board in
respect of the five key elements of the RGE agenda.
    Assurance Overview
    Business and Reports
    Action Plans/Monitoring
    Quality and Audit
    Policy and Approval.

John Gilbert commented on the effectiveness of the cycle of reports from Trust-wide
groups into RGE and on the nomination of the Hot Spots report for an award by the
Healthcare Financial Management Association (HFMA).

The Board of Directors received the report from the Risk and Governance
Executive (RGE)

             MEETING HELD ON 13 DECEMBER 2011.

The Board of Directors received the minutes of the meeting of the Council of
Governors on 12 October 2011.

Ray Cox commented in particular on the effectiveness of the meeting of the Council of
Governors held on 13 December 2011, in particular in relation to the large number of
governor-led items.

The Board of Directors received the verbal feedback on the meeting held on 13
December 2011.
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The Board of Directors agreed the Annual Report and Accounts for the Year
ending 31 March 2011 and approved the signing of the Accounts, and agreed
the contents of the Letter of Representation and approved the signing of the


The Board of Directors noted the Execution of Deeds.


The Board of Directors noted the rolling year of Board decisions.

There was no other notified business.


a)   Agenda Item 12(a) – Performance Report. David Bamber commented on the
     performance report and expressed a view that the CPNs were effective in
     carrying out the CPA review every six months. However, in his opinion, the
     performance of consultant psychiatrists was less effective.

b)   Agenda Item 9 – Service Users Survey. David Bamber commented on the
     concern of service users in respect of government’s benefit reforms. Harriet Car
     West commented on the complexity of benefits and the importance of staff
     understanding where information and advice can be best gained.
     Danny Scott commented on the work undertaken by NACRO in providing a
     “surgery” regarding housing issues at Tillingham Day Hospital. He was happy to
     work with the Trust on this type of initiative. He also commented on the context
     in that some local authorities were outsourcing benefits advice.

     David Pickles declared an interest in respect of his roles with Maldon MIND and
     the Citizens Advice Bureau and asked how Trust staff were trained, for example,
     in relation to benefits. Harriet Carr West advised that training sessions were
     available, for example, through Essex County Council. Other training took place
     on the job, for example, with external agencies attending team meetings. She
     also commented on the role of Raza Ahmed and the team of employment

     In answer to a question from David Pickles, Andrew Geldard stated that it was
     not known at this stage when a decision would be made by the PCT in relation to
     the funding for the Crisis Line pilot.

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     In answer to a suggestion from Pippa Ecclestone, it was suggested that a report
     be brought forward to the Council of Governors in respect of Charitable Funds
     and the ways in which Governors could support this process.

Mary St. Aubyn then thanked everyone for attending and wished them a happy New

The next Board meeting in public will be held on Wednesday 29 February 2012 at the
Ramada Hotel, Colchester CO7 7QY.

The Chairman formally declared this part of the meeting ended and requested the
public to be excluded to affect business in accordance with the Public (Admissions to
Meetings) Act.

Signed:      ……………………………………


Date: 29 February 2012

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