Item 3 - June 09 minutes

                       HELD ON 29TH JUNE 2009

PRESENT           Madeliene Long                   Chair
                  Dr Martin Baggaley               Medical Director
                  Stuart Bell                      Chief Executive
                  Prof Chris Clare                 Non Executive Director
                  Dr Patricia Connell-Julien       Non Executive Director
                  Robert Coomber                   Non Executive Director
                  Kumar Jacob                      Non Executive Director
                  Prof Hilary McCallion            Director of Nursing and Education
                  Zoë Reed                         Director of Strategy & Business Development
                  Prof Eric Taylor                 Non Executive Director

IN ATTENDANCE Alison Baker                         PA to Chair & Non Executive Directors
              Jonathan Beder                       Deputy Service Director, Lewisham
              Patrick Halloran                     Trust Emergency Planning Liaison Officer
              Patrick Gillespie                    Service Director, Lambeth
              Tim Greenwood                        Deputy Finance Director
              Jill Lockett                         Service Director National Division & Neurodevelopment
              Paul Mitchell                        Trust Board Secretary
              Ricky Mackennon                      Head of IT
              Louise Norris                        Director of Human Resources
              Prof Graham Thornicroft              R&D Director
              Anthony Schnaar                      IT Analyst
              Karen Taylor                         Assistant Director of Nursing – Infection Control
              Noel Urwin                           Members’ Council

APOLOGIES         Clive Baker                      Head of Capital Planning & Projects
                  Steve Davidson                   Service Director, Croydon
                  Harriet Hall                     Non Executive Director
                  Gus Heafield                     Director of Finance and Corporate Governance
                  Tracey Power                     Service Director, Lewisham

Madeliene Long declared an interest as a Lewisham Councillor. Patricia Connell-
Julien declared an interest as an employee of Kings College London. Prof. Eric
Taylor declared an interest as a former employee of Kings College London. Hilary
McCallion declared an interest as Visiting Professor to South Bank University and
Kings College Hospital. Robert Coomber declared an interest as the former Chief
Executive of the London Borough of Southwark. Stuart Bell declared an interest as a
Board member of the Picker Institute Europe.

The minutes of the meeting held on the 19th May 2009 were agreed as an accurate
record of the meeting.

The minutes of the Trustwide MHA Committee meetings of December 2008 and
March 2009 were noted.

The Draft minutes of the Patient Safety & Service Improvement May meeting were
noted. Dr Martin Baggaley explained that regarding managing prescribing risks it
had been agreed to remove the prescribing screen from EPJS pending the
implementation of e-prescribing.

   1. Privacy & Dignity Standards Update – BOD 65/09
    Stuart Bell explained that listings of Trust beds – whether they were in mixed
    sex wards, in single rooms and en-suite - had been prepared and was being
    returned to the DoH imminently. It was agreed to collate the information and
    publish in the Privacy and Dignity update at the September Board meeting.
    Action: Hilary McCallion.

    Louise Norris explained that this was the eighth report to the Board of
    Directors, which provided feedback on the Trust results, the aim of the survey
    was to gather information that helped Trusts provide better care for patients
    and improve working lives for those who provide the care. A full copy of the
    Trust’s results could be found on the SLaM Intranet and website.

     As in previous years only a random sample of the Trust’s workforce had been
     asked to complete the survey. The response rate to the survey was 49% which
     was lower than previous years, however it did show a relatively stable response
     rate over the past 5 years. The highest response rates were in Corporate and
     CAMHS, with the lowest in Croydon and Lambeth. In terms of gender profile
     34% of respondents were male, with 66% female. The number of disabled
     respondents remained the same at 13%. The ethnicity of respondents showed
     a greater proportion of white than black and minority ethnic groups.

     Louise Norris explained that the Trust had no means of changing the core
     questions asked, however there were some local questions the Trust had
     added. The survey would be due again in October 2009 and it was agreed that
     questions regarding patient care and quality areas would be added to the local

     Local action plans for each service identifying specific issues were to be
     monitored through the Chief Executive Performance Review meetings.

     Board of Directors noted the presentation.

    Dr Martin Baggaley explained that this report updated the Board of Directors on
    progress in meeting the recommendations of the DH report “Healthcare for All”
    2008. The report had been received at the Board meeting in October 2008
    included ten recommendations. The Trust had focussed on improving patients’
    physical health care.

     It was agreed that it would be useful to benchmark the Trust’s progress against
     other Trusts. Dr Martin Baggaley agreed to raise this with colleagues across
     London. It was agreed to bring the report back to the Board on a regular basis.
     Action: Martin Baggaley.

     The Board of Directors noted the update.

    Patrick Gillespie explained that during 2008 Lord Keith Bradley undertook an
    extensive review regarding people with mental health problems and people with
    learning disabilities within the criminal justice system. The report proposed a
    new way of partnership working with the development of criminal justice mental
    health teams. It also highlighted the need to invest more resources at the point
    of entry into the criminal justice system. There was currently the highest
    recorded number of people with mental health problems in prison.
     Out of the 82 recommendations, the Government agreed 78 fully or in principle
     with 3 recommendations being under review.

     One of the targets recommended the development of a new minimum target for
     the NHS of 14 days to transfer a prisoner with acute, severe mental illness to
     an appropriate healthcare setting. This had been currently undertaken with
     Brixton prison, and had proved to reduce prison transfers. However, it was
     dependent on effective liaison between NHS Trusts and the courts, along with
     improved pathways for transferring offenders back from health services to

     Patrick Gillespie report that onset service screening of people in reception over
     a six week period saw 150 people screened with a result of 39 people being
     picked up as showing signs of mental illness, with 9 acutely unwell.

     Whilst the report recommendations did not specify a given date for
     implementation many stated implementation should be delivered as a matter of
     urgency and immediately. Commissioners in local Boroughs and PCTs were
     arranging Borough-wide, multi-agency workshops to scope out the implications
     for the respective Boroughs.

     The Board of Directors noted the report.

    Tim Greenwood explained that the Trust was reporting a net surplus of £1.8m
    which was £0.6m above current Plan. However the variance was largely due to
    the phasing in of budgets that would be expected to be utilised later within the
    year, this included the Carbon Trust Plan.

     There were three Directorates currently exceeding their budget by more than
     5%. Southwark Adults overspend was due to overspill into the private sector,
     particularly within female PICU, along with other cost pressures. Specialist
     Services were reporting a shortfall against planned income targets and
     overspends on Addictions inpatients. ICT overspend was overstated as a
     number of internal recharges are to be put through. Expenditure had taken
     place on EPJS4 developments for which funding was still to be confirmed.

     Ward Nursing expenditure had continued at a similar level, with wards
     cumulatively overspent by £0.5m at month 2. Directorates were implementing
     measures to either bear down on expenditure or improve income. It was felt
     the Board required a fuller explanation and understanding regarding this
     overspend. It was agreed to provide an analysis of the top ten overspending
     wards over the past three years and report back at the next Board meeting.
     Action: Tim Greenwood.

     It was noted that there had been a peak in admissions within the Trust which
     was also the case across London. Discussions were taking place with local

     The Trust was currently preparing a report for Monitor on consideration of the
     potential implications of a slow down in growth of health funding from 2011/12.
     Monitor had extended the deadline to September 2009.

     The Board of Directors noted the report.

    Anthony Schnaar explained that this report gave a high level summary of the
    Key Performance Indicators for the financial year 2009/09. The paper had
    been divided into sections:-

        •   Care Quality Commission Indicators
        •   Monitor Targets
        •   Overall Data Quality
        •   Patient Experience
        •   Outcome Analysis

     It was noted that the data presented showed the Trust having the third highest
     readmission rates amongst London Mental Health Trusts, whereas other data
     suggested that readmission rates were low. It was agreed that further analysis
     of this should be carried out and linked to the analysis of the top ten
     overspending wards. Graham Thornicroft explained that there was minimal
     research regarding the optimum length of stay for acute patients. It was agreed
     that he would pursue this further with Hilary McCallion. Action: Graham
     Thornicroft / Hilary McCallion

     The Board of Directors noted the report.

    Patrick Halloran explained that all public services including NHS Trusts were
    required to demonstrate preparedness such that in the event of a major
    incident or other emergency they were able to respond effectively. The Trust
    completed a comprehensive review of its Emergency & Major Incident Plan,
    and introduced Emergency Preparedness networks, with progress being made
    across all three areas.

     The Trust undertook various training and exercising initiatives relating to
     Emergency Preparedness and participated in exercises run by partner
     organisations and those run nationally. The Chief Executive was responsible
     for ensuring that the Trust had a Major Incident Plan, in line with DH guidance
     and Gus Heafield, Director of Finance and Corporate Governance had been
     designated to take responsibility for Emergency Preparedness. The guidance
     also indicated good practice to appoint an officer to act as Emergency Planning
     Liaison Officer, this was currently Patrick Halloran. Further guidance from the
     DH on preparing for Pandemic Flu advised a planning lead officer at a Director
     level who should have a clinical background, therefore the flu planning was
     transferred in June 2008 from Gus Heafield to Martin Baggaley, the Trust’s
     Medical Director.

     The Trust’s Emergency & Major Incident Plan was recently updated taking into
     account of numerous guidance documents from the DH, along with lessons
     learned from the December 2007 Emergency Planning exercise. The Trust
     had two Emergency Control Rooms located at the Maudsley and the Bethlem.

     The Trust had undertaken initial work on Business Continuity Planning, much of
     this work presented major challenges and significant management attention
     would be required on an ongoing basis for continued progress and
     improvements across all services to be both made and maintained. A template
     for prioritising services had been circulated and directorates were making
     progress on developing robust plans.

     The Board of Directors noted the report.

    Stuart Bell introduced his report which informed the Board of significant issues
    arising from Trust Executive Meetings, Performance Management Meetings,
    the local health economy and nationally in the NHS and Social Care.

     Stuart Bell explained that there was a vacancy on the governing body of the
     Bethlem and Maudsley Hospital School for a community governor, following the
     retirement of Patrick Byrne. Dr Sean Maskey, Consultant Child and Adolescent
     Psychiatrist and Lead Clinical, National and Specialist CAMHS had kindly
     offered to fill this post.

     Stuart Bell explained that from next month the Denis Hill Unit would house a 28
     bedded substance misuse services. Given the change in the clinical function of
     the unit it would be more appropriate to commemorate Sir Denis Hill in River
     House which maintained his association with forensic psychiatry. An extensive
     consultation process had been carried out regarding the name for the new unit,
     with the new recommended name of “Bethlem Addiction Service”.

     The Board of Directors noted the report, and approved the appointment of
     Sean Maskey as Community Governor.

     The Board of Directors approved the naming of the Bethlem Addiction

    Noel Urwin reported that the Members’ Council had accepted the
    recommendation from the Nominations Committee to appoint Charles Bland to
    the vacant Non Executive Director position. His career combined over twenty
    years senior management roles within the Civil Service with more recent
    experience in the private sector, and was a long term resident of Lambeth. It
    was hoped Charles would take up his position in September 2009.

     The Nominations Committee had also recommended to the Members’ Council
     the reappointment of Kumar Jacob for a further three years term as Non
     Executive Director. This was agreed.

     The selection panel for the appointment of the Trust’s external auditors met on
     the 14th May 2009 to interview five short-listed candidate organisations. It was
     the panel’s unanimous recommendation that the Audit Commission be
     reappointed as the External Auditors to the Trust for a further three years. The
     Audit Commission had expressed a wish to work closely with the Members’
     Council within the terms of their contract.

     New starters to the Trust were now being automatically opted into membership
     of the Foundation Trust unless they specifically request to opt out. This would
     require an amendment to the Trust Constitution to remove paragraph 7.1.2.

     The Board of Directors noted the report, and agreed to seek approval
     from Monitor the removal of paragraph 7.1.2 of the Trust’s Constitution.

    Karen Taylor explained that this report covered the period from June 2008 to
    June 2009. The overall IC policy and core clinical guidelines for hand hygiene
    and needle stock injury were ratified by the Governance Executive in June
    2008, with the remaining guidelines being ratified at the ICC on the 20th
    October 2008. Following the NHSLA assessment in December 2008 changes
     had been made to the overall IC policy, these had been uploaded onto the IC
     website which was updated on a regular basis.

     Hand hygiene sessions had been carried out in non clinical areas including
     catering, domestic and portering staff.

     4,000 influenza vaccines had been ordered for staff and patients for the
     influenza season in late 2009.

     There had been one new case of c.difficile in a patient on a ward at the
     Maudsley, on the day of notification the patient was transferred to Kings
     College Hospital. There had also been another case on a different ward, in
     both cases appropriate measures were carried out, in the latter case
     appropriate antibiotic treatment was prescribed.

     The Board of Directors noted the report.

    Zoe Reed explained that the report updated the Board of Directors on the
    recent appointments and changes to the Transitional Executive. Professor
    Robert Lechler had been appointed as the permanent Executive Director, this
    would be followed by the appointment of an independent Chair in the summer
    and the appointment of a permanent Executive. Following the appointment of
    Roland Sinker as Director of Operations at KCH FT, Lynn Carlisle, Interim Chief
    of Staff would also take on the role of Programme Director. Steve Wilkerson
    had been appointed as the Implementation Programme Office Manager and
    Zoe Reed, formerly Joint Interim Director of Strategy, would take on the role of
    Interim Strategy Lead.

     A second half day workshop had been held in May 2009 to progress the
     development of the mental health Clinical Academic Groups. Future plans
     were to bring stakeholders together in facilitated workshops to progress the
     development of all the mental health CAG’s.

     The Board of Directors noted the update.

    Bob Coomber explained that this report focused on matters relating to the year

     The Audit Committee had carried out a 360o assessment, reviewed assurances
     requested from the Trust and reviewed assurance reports from auditors and
     counter fraud specialists.

     The Board of Directors noted the report.


        •   Patricia Connell-Julien – reported that the Associate Hospital
            Managers’ (AHMs) biannual event had taken place on Friday 26th June,
            at which they received an update on the AHSC from Stuart Bell, as well
            as presentations on deprivation of liberty safeguards and independent
            mental health advocates. A revised ward visiting system for AHMs was
            also launched to bring this process into line with statutory requirements.
            AHMs were also provided with an updated version of the declaration
            form which included an additional section on potential conflicts of
            interest to facilitate improved governance.
         •   Madeliene Long – reported that she along with Kumar Jacob and Zoe
             Reed had attended the NHS Confederation Conference, where the key
             emphasis had been on quality, innovation, productivity and prevention in
             the speech made my the new Health Secretary, Andy Burnham.

    The Forward planner was noted.

    No other business was considered.

    The Board of Directors agreed that representatives of the press and other
    members of the public be excluded from the remainder of the meeting having
    regard to the confidential nature of the business to be transacted, publicity on
    which would be prejudicial to the public interest (Section 1(2) Public bodies
    (Admission to Meetings) Act 1960.

The date of the next meeting will be: Tuesday 28th July 2009 3:00pm – Boardroom,
Maudsley Hospital



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