Board of Directors Meeting - SLaM · Page 2 of 3 Ref Issue/Board Paper Action By When Status RAG April 2017 meeting 4 Staff Engagement and Survey Action Plans Chairman to Investigate

Please note that minutes from this meeting are a public document and will be published on the Internet and may be requested under the Freedom of Information Act (2000). Any attendee that would like their name omitted from the minutes should discuss this with the minute taker. Note that it may not always be possible to oblige as this is dependent on the persons role and the business being discussed.

web site: www.slam.nhs.uk

Board of Directors Meeting

To be held 27th June 2017 3:00pm Learning Centre, Maudsley Hospital

AGENDA: Part 1

Opening Matters 1. Welcome and apologies for absence 2. Minutes, Action log review & Declarations of Interest 3:00pm 3. Patient Story Kathryn 3:05pm Page 20 4. Chief Executives Report Rachel 3.15pm Page 22 Presentation 5. KHP Update Q&A discussion (no paper) Robert 3:20pm Strategy 6. Estates Strategy Altaf 3:50pm Page 25 Quality & Safety 7. CQC Mental Health Older Adults Vanessa 4:00pm Page 68 8 Quality Improvement Update Michael 4:10pm Page 74 9. Revalidation Annual Report Michael 4:25pm Page 81 10. Fire Safety Kris / Beverley Page 96 Governance 11. Council of Governors Update Rachel Page 98 12. Quality Committee Update May Amanda Page 100 13. Finance & Performance Committee Update June Steven Page 102 14. Business Development & Investment Committee Update - June Altaf Page 104 15. Audit Committee update May Special Accounts Meeting & 2016/2017 Annual

Report. Steven Page 105

Performance 16. Performance Report Kris 4:45pm Page 115 17. Finance Report Gus Page 147 18. Wrap-up and Next Meeting The next Board of Directors Meeting will be held on 25th July 2017, at

3:00pm in the Learning Centre, Maudsley Hospital

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Board meeting 27 June Action points

Ref Issue/Board Paper Action By When Status RAG

September 2016 meeting

1 Revalidation Annual Report Initially intended that brief paper to be brought to the Board on the progress toward delivery of the organisational action plan.

Update: Given new recruitment, now proposed to role this into the Annual Revalidation Report in June.

MH June 17

On Agenda

February 2017 meeting

2 Safer Staffing A paper received at the QSC 20th June 2017. The paper sets out a proposal for future reporting

NB / BM

June 17

Completed

3 Performance Report Chair to write to Croydon CCG expressing concern over access to CAMHS in that Borough.

RP June 17

Awaiting confirmation of Croydon CCG CEO appointment and clarification of Lambeth CCG role in commissioning decisions in Croydon

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April 2017 meeting

4 Staff Engagement and Survey Action Plans

Chairman to Investigate establishment of a Committee Resource overseeing Workforce issues

RP June 2017

Proposal being considered.

5 Finance Report Review of Place of Safety and PICU costs to the Board

GH/KD July 2017

6 Board Assurance Framework

Review of BAF for 2017/18 June Board Workshop

BM/GH June 2017

Review Undertaken

May 2017 Meeting

7 Chief Executives Report The CEP documentation to be sent to NEDs for information Governors to be informed of CEP

RE June 2017

Completed

8 Chief Executives Report OL lessons learned Board to reflect on process

RE July 2017

9 Scheme of Delegation. Clarification (Consultant Appointments Reporting)

GH June 2017

Part of CEO Report

10 Workforce Race Equality Standard Metrics for 2016-2017

Implementation plan to come to the Board in September 2017

LH Sept 2017

11 Combined Performance and Trajectory of Overspill bed use per borough

KD June 2017

Within Agenda

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Finance Report

12 Combined Performance and Finance Report

Governors to be informed of Trust challenge to Croydon proposals for Acute and CAMHS cost per case

KD June 2017

Reported at June Council of Governors

13 Combined Performance and Finance Report

NEDs to receive detail of extra central government funding to Local Authorities to support social care.

KD June 2017

Completed

Code:

Green completed

Amber on schedule

Red not on schedule

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MINUTES OF THE HUNDRED AND SEVENTH MEETING OF THE BOARD OF DIRECTORS OF

THE SOUTH LONDON AND MAUDSLEY NHS FOUNDATION TRUST HELD ON 23 MAY 2017

PRESENT

Roger Paffard Chair Kristin Dominy Chief Operating Officer Alan Downey Non-Executive Director Rachel Evans Director of Corporate Affairs Mike Franklin Non-Executive Director Louise Hall Director of Human Resources Duncan Hames Non-Executive Director Gus Heafield Chief Financial Officer Dr Michael Holland Medical Director Dr Julie Hollyman Non-Executive Director Professor Matthew Hotopf Non-Executive Director Altaf Kara Director of Strategy and Commercial June Mulroy Non-Executive Director Beverley Murphy Director of Nursing Dr Matthew Patrick Chief Executive

IN ATTENDANCE

David James Business Manager Trust Secretariat (Minutes) Jenny Cobley Lead Governor

APOLOGIES

Anna Walker Non-Executive Director

DECLARATIONS OF INTEREST

None

MINUTES

Section BOD 056/17 should have read Matthew Patrick mentioned the Mayor of Londons Thrive project. The minutes of the Board held on the 26 April 2017 were then agreed, as an accurate record of the meeting

BOD 69/17 MATTERS ARISING/ACTION POINTS REVIEW

Progress made on action points was noted.

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Action: Roger Paffard/Rachel Evans

BOD 70/17 PATIENT STORY

The presentation was introduced by Roslyn Walcott-Cumberbatch Professional Head of Occupational Therapy and Yhanthy Lee a Lewisham Linkworker and they referred to the improvements in Occupational Therapy services at the Ladywell Unit in Lewisham. Over many years, patients had informed the Trust they would have liked more activities available on the wards at the Ladywell Unit. Lack of resources and complicated management structures made this difficult, but there had been attempts to improve things with Linkworkers and volunteers running activities such as art and poetry groups, but activities were patchy and not regular in their delivery. The new Acute CAG has brought together the wards under one management system and they agreed it was essential that Occupational Therapists were available on all the Trust major sites. As this is being implemented, systematic improvements are beginning to be made and Yhanthy Lee stated this is far better for patients as the level of activity offered increased patient engagement and reduced boredom. Mike Franklin asked why the provision of Occupational Therapy (OT) had not been in place previously. Roslyn Walcott-Cumberbatch responded that there had been borough OT leads and this led to variation of service across the areas served by the Trust. Now with the Acute CAG in place there had been a move to standardisation across the Trust and hence the enhancement of the Ladywell service. Roger Paffard asked what further could be done to improve the experience of patients in the Ladywell Unit. Yhanthy Lee stated access to the garden, which was restricted due to staffing issues, would be beneficial. Beverley Murphy responded that work was in process to address this matter so access to the garden for patients could be enhanced. Roger Paffard gave his and the Boards thanks to Roslyn Walcott-Cumberbatch and Yhanthy Lee for their presentation

BOD 071/17 CHIEF EXECUTIVES REPORT

Matthew Patrick took his paper as read. Matthew Patrick highlighted the findings of the Inquest into the death of Mr Olaseni Lewis (OL) where it was noted that there were a number of areas where the Trust could have done better and there were also issues for the Police to address. It was accepted that more work was required to ensure such a tragedy did not occur again. The Trust has learnt a great deal and made changes to how it works such as introducing new processes to improve training and how it supports staff. Also improvements have been made on how the Trust works with the Metropolitan Police in high-risk situations. The Trust has also committed itself to working ever more

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closely with local communities such as Black Thrive in Lambeth to ensure that the services provided by the Trust are high-quality. The Board were informed that Paula Swann had stepped down as Chief Officer of NHS Croydon Clinical Commissioning Group and Andrew Eyres Chief Officer of NHS Lambeth CCG will now have a joint Chief Officer role for both organisations. This action reflects the on-going consolidation of CCGs in London. Matthew Patrick also informed the Board of his concern over the Capped Expenditure Process (CEP) which is part of a south east London Sustainability and Transformation Plan (STP) submission to NHS England which focussed on what would be required within the south east London STP area for it to be in financial balance The south east London STP presently has deficit problems within its boundaries. The submission, made without consultation with the Trust refers to potential hard choices including possible disinvestment in Mental Health. The STP leadership have received robust comment from Gus Heafield and Matthew Patrick regarding the CEP. It was also noted by the Board that no extra monies have been allocated to Mental Health within the STP, so to withdraw extra funding would not be possible. However, there was concern that any potential action to address the STP deficit might lead to disinvestment in Mental Health. It was agreed that the Boards concern over the proposals should be escalated to the south east London STP executives and also Governors should be informed of the situation at the next Council of Governors. Action: The CEP documentation to be sent to NEDs for information Governors to be informed of CEP Matthew Hotopf asked if there had been any response at a national level to these proposals such as from Royal Colleges. Matthew Patrick responded he was unaware of such a response, but he recognised that the STP response had been template driven, but the concern was that such conceptual options may eventually become real. Mike Franklin asked in relation to the OL Inquest would it be beneficial to get a Board level view of the narrative verdict. It was concerning that the verdict was given 7 years after the death of OL. Both Matthew Patrick and Beverley Murphy were in agreement, but the delay was due to several investigations taking place in a sequential manner. Mike Franklin noted the causes of the delay, but felt one lesson for the future was to consider approaching the Coroner during a process of investigation and requesting support to speed up processes and overcome blockages. Roger Paffard agreed that a Board discussion of the narrative verdict was required and time should be made available to discuss the matter. Action: OL Narrative verdict to be discussed at July Board

The Board noted the Report.

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BOD 072/17 CQC RE-INSPECTION REPORT ADULT ACUTE PATHWAY

Beverley Murphy presented the paper. It was taken as read but a brief summary was given to the Board. The Trust was subject to a comprehensive Care Quality Inspection (CQC) during the week commencing 21st September 2015. The overall Trust rating was good but the adult acute pathway was rated as 'requires improvement and the rating for the safety domain in the acute and psychiatric intensive care units (PICU) was inadequate. An improvement plan was agreed, implemented and monitored. The Acute and PICU care pathway was re-inspected by the CQC in January 2017. The key findings were that the service continues to be rated as requires improvement but there have been improvements meaning that there is no longer an inadequate rating for safety. The team identified various improvements and these were set out within the report. The key areas that require further work included elements on staffing, safeguarding, ligatures, restraint, fire drills, supervision and governance. There is already trust-wide quality improvement work underway on both staffing and restraint, which was detailed in the paper. Clinical and Service Directors have met with Beverley Murphy to consider the must and the should do actions. The Clinical and Service Directors will lead the process of developing an action plan at CAG level which will be scrutinised by the Beverley Murphy and Kris Dominy. Once approved it will be sent to the CQC and be implemented across the CAG. The deadline is 22nd May 2017. The Trust is still awaiting the formal CQC report on Mental Health Older Adults although a draft has been seen by the Trust. Louise Hall mentioned that the original report had caused staff morale to fall but they had worked hard to address the issues raised by the CQC and this was to be commended. Roger Paffard agreed and requested that the Boards congratulations should be passed on to the staff involved.

The Board noted the report.

BOD 073/17 PHYSICAL HEALTH THEMATIC REVIEW - HIGHLIGHT REPORT

Beverley Murphy introduced the paper and it was taken as read although a brief background was given to the Board. The Quality sub-committee receives assurance reports about the delivery of physical health care within the Trust and the challenges in maintaining good physical health for people with mental health problems. On receiving a report in February 2017, the Quality sub-committee requested the Board be sighted on progress and challenges against the 2016 quality priorities. The paper presented set out the background and importance of why the Trust is focussed on improving the physical health care provided within its services. It also set out the priorities for 201617 and the achievements in that year, as well as the challenges

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being considered. The financial, regulatory and sustainability risks were broadly outlined as well as the potential risks to the safety of people who use services. Beverley Murphy informed the Board that she will now Chair the Physical Health Committee to drive forward the change required. Alan Downey thought the paper set out very clearly why there is a problem with the physical health of the seriously mentally ill, but then listed a number of priorities that did not seem to address the issues. He was not convinced or assured that progress had been made. Beverley Murphy responded that the process had to be correct before there could be effective action. Alan Downey noted the need for process, but felt that the issues were clear cut and not enough was being done to address these head on. Beverley Murphy responded that The Trust has acknowledged physical health as a quality priority since 2016, continuing into 2017-18 and the Trust has a CQUIN scheme to improve physical health assessment intervention and communication through to 2019. Michael Holland noted that there was extensive mortality data available regarding these issues and it would be beneficial if the focus of the Trust was expanded beyond the remit of the CQUIN. Julie Hollyman informed the Board that the Trust did operate an effective no smoking policy which was to be commended and the Quality subcommittee did not have Beverley Murphy present, as she was still to take up her post, when the report came to them for discussion in February 2017, when there had been difficulty seeing the way forward. Matthew Patrick observed that the work in the community needed to be recognised as for the majority of people time in any acute medical setting is limited. Therefore overall physical health needed to be properly addressed by developing links with primary care and GP services. Beverley Murphy was in agreement with this approach, but added that research had shown that preventative work within an acute setting was effective in terms of improving health. The view of the Board was the paper presented was not fit for purpose and an update would be required in six months. This was agreed The Board noted the report

BOD 074/17 WORKFORCE RACE EQUALITY STANDARD METRICS for 2016-2017

Louise Hall introduced the paper and it was taken as read. The Trust Board and senior management team, led by the Chair and Chief Executive, have established that improving the experiences of Black and Minority Ethnic (BME) staff within the workforce as a key organisational priority. The purpose of the report was to set the foundations for change for equality and inclusion within the Trust especially BME staff where their reported experience is less favourable than their white counterparts. The report also incorporated the Trust Workforce Race Equality Standard metrics for 2016-17 in accordance with the national contract under NHS England requirements.

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The report identified the difference in experience between white and BME staff through nine different standards including Board composition and the proportional ethnicity of staff across the different pay scales and bandings. Mike Franklin asked if the focus on the Agenda for Change band 8c was appropriate as in his view the blockage point was obtaining posts at band 7 that would allow for access to band 8 posts. Roger Paffard noted that the distinct difference in recruitment seemed to occur above band 6. Louise Hall responded it was less of a particular band being a barrier, but more a need to develop career pathways across the organisation. Roger Paffard noted the observation, but felt a mark in the sand had to put somewhere. He thought it implicit that to improve the achievement of 8c posts and above for BME staff meant improvement would have to be throughout all the pay scales. Matthew Patrick asked why there was no trend data in report, which Louise Hall explained was due to changes in the way the data had been collected and collated over time. Duncan Hames commented his perception of the recent recruitment of the Director of Finance was that BME candidates did apply but did not get through the early stages of selection. He assumed an external agency was used to assist with recruitment and asked what signals or requests did the Trust make to the agency to enhance BME involvement. Louise Hall responded that the Trust encourages diversity and is supportive of BME applications. The internal process of recruitment is anonymous to avoid bias but that is not the case if external head-hunters are used. Gus Heafield stated that head hunters used to assist with the recruitment to this role had been requested to seek a good gender and BME mix in terms of applicants. Mike Franklin noted the support that the Trust gave to BME applicants but thought it worth considering agencies with a strong track record of BME employment rather than candidate mix. Louise Hall responded that the reason certain agencies were used by the Trust was there success with attracting BME candidates with the abilities to fill the roles advertised. The Board agreed that the implementation plan to: Achieve representation of BME staff at pay bands 8c and above; eliminate the over-representation of BME staff involved in disciplinary proceedings and improve the career opportunities offer for BME staff should come back to the Board. Action: Implementation plan to come to the Board in September 2017 The Board Approved actions and targets outlined in the report. Noted and approved the publication of the WRES metrics and submission to NHS England in July 2017.

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BOD 075/17 UPDATE FROM THE COUNCIL OF GOVERNORS Jenny Cobley introduced the paper. Governors were pleased to see the 'safe' domain has improved from inadequate to requires improvement in the recent CQC re-inspection of Acute Adult and PICU services, but were concerned that the CQC did not think the Trust has robust enough governance structures in place to identify where improvements may be needed. Governors looked forward to receiving the Trust's action plans in due course. Congratulations were forthcoming in regard to the IT systems within the Trust which had not been affected by the recent ransom attack on other NHS organisations. This clearly reflected on necessary investment being made by the Trust into IT security. Mention was made over staff welfare and safe staffing levels in community services, as concerns had been made by Lambeth Healthwatch. It was also reported that a number of Governors had visited St Thomass and Kings acute A&E departments to see the facilities made available to patients with mental health conditions when they presented to those departments. It was noted efforts were being made to improve the environment but more could be done. On the issue of the Trusts Quality Account a response had been sent by the Quality Group but a further meeting with Beverley Murphy was planned for later in the week. Thanks was given to Rachel Evans for her support for Governors in the relation to their input into the appointment of the external auditors for the Trust and to Amanda Pithouse for the recent invite to service user and carer Governors to join the Involvement Oversight Group. The Board noted the Report

BOD 076/17 SCHEME OF DELEGATION

The paper was taken as read and presented by Gus Heafield The Trusts Scheme of Delegation was reviewed and an updated scheme was approved at the Board in November 2016. When it was approved, the Board requested an update in April 2017. The paper set out the work that has been undertaken since November 2017 and the on-going workstreams. The Trust Board was asked to note the amendments and the on-going work including that with the Trusts partners in the south London Partnership. The Trust will keep the Scheme of Delegation under review as the workstreams progress, but unless appropriate it was proposed there would be no further update until a further update March 2018. Julie Hollyman asked how the Board fulfilled item 1.4.6 of the scheme of delegation which stated the Board is responsible for ratifying the appointment of Consultant Medical Staff, based on the recommendation of an Appointment Committee.

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It was agreed the matter would be looked at and an explanation and/or clarification about that element of the scheme of delegation would come to the June Board. Action: Clarification of item 1.4.6 to come to the June Board The Board noted the report.

BOD 077/17 SOUTH LONDON PARTNERSHIP Roger Paffard reported that the Trust was committed to being open and transparent and in light of this the draft Terms of Reference and Draft Memorandum of Understanding for the South London Partnership were being placed in the public domain. The Board noted the report.

BOD 078/17 HAEMATOLOGY INSTITUTE STRATEGIC OUTLINE CASE, FINAL VERSION

The report was taken as read. The briefing paper summarised the key points of the Haematology Institute Strategic Outline Case (SOC) Final Version. It detailed what has changed from the first version and sets out the conclusions and recommended next steps. Matthew Patrick advised the Board that although the paper referred to approval the Board was being asked to endorse the paper as there was no financial commitment required by the Trust. The Board endorsed the Report

BOD 079/17 COMBINED PERFORMANCE and FINANCE REPORT

Kris Dominy introduced the paper and it was taken as read, but a number of issues were highlighted. Gus Heafield presented the finance elements of the report. Kris Dominy reported that the Trust continues to meet the majority of the performance-related NHS Improvement Single Oversight Framework indicators but a number of risks and associated actions were noted. The Improving Access to Psychological Therapies (IAPT) recovery rate performance continues to be an area of focus. The pressure in the acute inpatient pathway has not resolved and the existing actions have been escalated across the system and the plan is being refined to deliver improvements to the full system working across all boroughs.

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The recovery rate performance for the Trust overall was 49% in April compared to 50% in the previous two months. Lewisham and Lambeth performance continued to deliver over 50% but Southwarks performance fell in April after significant improvements in previous months. Croydon IAPT performance is beneath target following its under commissioning as part of the implementation of the affordability bridge in June 2016. Croydon CCG planned not to renew the contract at the end of September 2017 and the Trust needed to consider if it should bid for the new contract. Discussions have taken place and due to time pressure it had been agreed to extend the present contractual arrangements with Croydon CCG until the end of the 2017/18 financial year. Roger Paffard asked if the Trust were going to bid for the new Croydon CCG contract. Kris Dominy replied that it would be considered and discussions are to take place at the Business Development and Investment (BDIC) subcommittee. The view established by the BDIC will then come back to the Board for discussion. Kris Dominy advised the Board that the situation with private patient overspill levels is a growing concern. In response the Trust has initiated a number of actions one of which was daily bed state reporting to the senior management team. Whilst the rate of growth has been arrested, there has been limited impact in delivering the necessary reduction in overspill. The Trust actions are being reviewed and escalated beyond Croydon across the whole system. Alan Downey enquired that the reasoning behind the South London Partnership bid for the Forensics contract was the ability to reduce overspill and yet the Trust was faced with a serious issue in this area. Matthew Patrick responded that in relation to that particular contract 16 patients will have been repatriated by the end of May 2017. The issue with overspill was to do with the pressures elsewhere in the Trust. Duncan Hames asked about the progress with the Fitzmary beds which had been reported as delayed last month. Kris Dominy responded that problems with the alarm system in that facility had now been addressed and 8 beds were now open and 6 more would open in the next week. Roger Paffard asked what the trajectory of overspill beds use was for the Trust, Kris Dominy responded that trajectories per borough were being developed and that detail would come to the next Board. Action: Trajectory of Overspill bed use per borough for the June Board Matthew Patrick advised the Board he had formally declared a bed crisis due the situation. There were large financial and quality issues when the numbers of overspill numbers were so high. He also advised the Board of potential reductions in the cost per case funding paid by Croydon in the area of Acute Adult and CAMHS care. A challenge to these proposals is being developed and once that is completed it was agreed that the detail be shared with Governors. Action: Governors to be informed of Trust challenge to Croydon proposals for

Acute and CAMHS cost per case funding when completed Kris Dominy gave an update on the extra monies for social care that had been made available by central government to local authorities. This issue had been initially raised by Roger Paffard at the April 2017 Board. It was reported to the Board that

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there seemed to be a lack of awareness within local authorities as to if the monies had been allocated by central government. Roger Paffard commented there seemed to be a conscious lack of commitment and awareness regarding this matter within local authorities so preventing the use of the monies allocated in the areas for which it was intended. Roger Paffard requested that any detail that the Trust had, in terms of funding being allocated to local authorities by central government for social care, should be shared with NEDs. This was agreed. Action: NEDs to receive detail of extra central government funding to Local Authorities to support social care.

FINANCE REPORT

Gus Heafield reported on this part of the paper He advised the Board that the accounts for 2016/17 were in the process of sign off and presently that procedure was on track to sign off and submit to NHSI by 31 May in accordance with their timetable.

As raised earlier in the report the use of overspill beds by the Trust is a concern and presently the level of use is 41 beds above plan. The expectation is that this level of overspill bed use in May (month 2 of 2017/18) will create an additional cumulative pressure on the Trust finances of 2m in 17/18. The Trust would need to identify a further 2m surplus this year to mitigate the unexpected additional costs in April and May. Continuing at this rate of overspend for too long would destabilise the finances of the Trust.

In order to deliver the control total for 2017/18, the Trust has set itself a savings target of 27m. Schemes with an estimated value of 21.7m have been identified, leaving an unidentified savings gap of 5.3m plus the value of identified schemes does also include 3.9m that has been assessed as high risk. The pressures on overspill would increase the value of schemes to be delivered and those rated as high risk by 2m.

Complex placements, particularly in Southwark continue to over-perform. The Local Authority did not increase their share of the budget but continue to operate under a 100% risk share arrangement. The CCG by contrast did increase their budget based on the outturn position but then applied a QIPP that has resulted in a net decrease in funding for the year. The CCG are also undertaking a review with the Local Authority and the Trust to improve processes and quality of information. This will lead to improvements later in the year but at month 1 the position is a 240k overspent

Use of agency staff has fallen compared to month 12 of 2016/17 and is closer to the NHSI ceiling set for the year to spend no more than 17.4m on all agency staff. A considerable challenge is still faced by the Trust in regard to reducing agency spend on clinical and nursing roles

Roger Paffard asked if the present financial challenges would affect the Trusts risk rating with the NHSI. Gus Heafield responded that the extra costs would impact on the financial element but he did not expect that the overall rating would be adjusted immediately, but continuing issues with overspill bed use and cost, if not addressed, might have an effect on our overall rating.

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Julie Hollyman asked for clarification on the planned disposal of Woodlands/Masters House. Altaf Kara answered that a valuation had been received for the property, but it is expected the real value will not be known until it is on the market. Discussions with potential buyers of the site are on-going.

The Board also asked for an update on the squatters occupying Douglas Bennett House. Altaf Kara responded that an interim possession order had not been achieved due to legal advice that was now thought to have been questionable. A possession order is being sought for completion by 22nd June 2017. Utilities of power and water were available in the property and discussions were on-going as to if these should be cut off.

The Board Approved the Report

BOD 080/17 WRAP UP

No other business was discussed.

BOD 081/17 FORWARD PLANNERS & DRAFT AGENDA

This was noted by the Board.

The date of the next meeting will be: Tuesday 27 June 2017 3:00pm

Learning Centre, Maudsley Hospital, Denmark Hill, London, SE5 8AZ

Representatives of the press and members of the public were asked to withdraw 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)

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REPORT TO THE TRUST BOARD: PUBLIC

27th June 2017

Title

Declarations of Interest

Author David James, Business Manager, Corporate Affairs

Accountable Director Rachel Evans, Director of Corporate Affairs

Purpose of the paper

Attached is the Boards updated Declaration of Interest for June 2017. Interests previously listed and

reported that ceased during the financial year 2016/17 have been deleted and new declarations received

since April 2017 have been included.

The Board is asked to note the present Declarations of Interests Register.

To note that in February 2017, NHS England issued new guidance on managing conflicts of interest in

the NHS. This guidance proposed common principles and rules for managing conflicts of interest and the

intention was to provide advice to staff and organisations in May 2017. The advice was delayed due to

General Election purdah restrictions. Once released the guides will help organisations understand what

they need to do to update their policies and procedures.

Managing Conflicts of Interest in the NHS will be circulated to the Board for information shortly. It is

proposed that the necessary alterations to Trust policy, guidance and practice relating to the collection

and publication of staff interests; if they have decision-making authority, will return to the Board for

approval in September 2017. There will also be a need to reconsider the criteria for reporting gifts

received by staff and how that information is made publicly available. These issues will be addressed at

the September 2017 Board.

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Declaration of Interests register ( 2017 - 2018)

Name Postion held Nature of interest Self

Immediatefamilymember

Date of Declaration

Roger Paffard ChairmanChair of Trustees for Sue Ryder Charity providing end of life and complex neurological care X Nil 04/03/2017Trustee of Ajahma- a small charity funding projects in the 3rd World and in London X 04/03/2017Vice Chair Kings Health Partners Academic Health Science Centre 04/03/2017

Kristin Dominy Chief Operating Officer Nil Nil Nil 17/02/2017

Alan Downey Non Executive DirectorCharity Commission: Co-opted member of Audit and Risk Committee X 24/02/2017

Rachel Evans Director of Corporate Affairs Nil Nil Nil 09/03/2017

Mike Franklin Non Executive Director External Adviser - Solicitors Regulation Authority (SRA) Nil 21/04/2017

Louise Hall Director of Human Resources Nil Nil Nil 08/03/2017

Duncan Hames Non Executive DirectorEmployment at Transparency International UK (from 30th August 2016). X 09/03/2017Owner and Director of Human Dances Limited. X 09/03/2017Owner and Director of Equal Power Consulting Limited. X 09/03/2017Chair of Maternity Action. X 09/03/2017

Gus Heafield Chief Financial Officer

Wife works for a PR Consultancy providing stategic PR advice to pharmaceutical industry for drugs in various specialities X 28/02/2017Deputy Chair London Procurement Partnership Steering Board X 28/02/2017

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Michael Holland Medical Director

Richmond Fellowship/Recovery Focus Non Executive Board Member (Trust receives payment for time) X Nil 03/03/2017Senior Fellow at London School of Economics Teaching and marking on courses XOccasional advisory work for Management Consultants re. digital health X

Dr Julie Hollyman Non Executive Director Nil Nil Nil 16/02/2017

Prof Matthew Hotopf Non Executive Director

Academic leader (principal investigator) of the RADAR-CNS consortium, a precompetitive public private partnership in which 5 pharmaceutical companies and 2 digital companies contribute research funding to benefit the consortium. Some of my research is therefore supported by this activity. X Nil 02/03/2017Iindependent expert witness in a group lititagation where claimants have alleged injuries by a pharmaceutical company.Instructed by the claimants solicitors X 02/03/2017

Altaf KaraDirector of Strategy &Commercial Nil Nil Nil 13/03/2017

June Mulroy Non Executive DirectorGovernor/Non Executive Director, St Marys University College, Strawberry Hill, Twickenham X Nil 08/05/2017

Trustee/Director, The Peel Institute, registered charity. 3 Corners Centre, Northampton Road, London EC1R 0HU XManaging Director, EFKM Ltd, Consultancy, principally in charity/NFP sector XDirector, MAK Business Services Ltd, consultancy, principally in Financial Management X

Beverley Murphy Director of Nursing Nil Nil Nil 09/05/2017

Dr Matthew Patrick Chief Executive Nil Nil Nil 16/02/2017

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Anna Walker Non Executive Director Non Executive Director of Welsh Water X 09/03/2017Council Member: Which X 09/03/2017Chair: St George's Hospital Charity X 09/03/2017Trustee: Women in Rail X 09/03/2017Trustee: Drinkaware X 09/03/2017Member: Competition Appeal Tribunal X 27/03/2017Daughter Employee of QCG (Company has Contract with Trust) X 27/03/2017

Board Memberswho left in 2017/18

Dr Neil Brimblecombe Director of Nursing Honorary Professor of Nursing, Kings College London X 30/03/2017

Part time Employment at London South Bank UniversityProfessor of Mental Health X

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KM; Laura Troughton; Jane Lyons | Carer; Team Leader; Involvement Lead | June 2017

1

Patient / Carer Story To the Board 27th June 2017

Psychosis CAG

The Carer Story

I have been a carer for my mum since the age of 7. My mum suffered from severe depression

resulting in a diagnosis of Psychosis. My mum has been sectioned 3 times so far. During this time my

mum has fallen off the radar with the community care team which has resulted in her not being

compliant with medication, self-neglect and her illness getting worse to the extent where she nearly

died due to Hyperthermia. This led to my mum being sectioned again in May 2015. I did not want

history to repeat itself again with my mum receiving treatment whilst in hospital and then having a

relapse so I pushed for my mum to be placed under a compulsory treatment order (CTO). Although

she was not happy about this it was the only way I could ensure that she would be compliant with her

medication and not be forgotten. At first my mums doctor was not willing to do this as she didnt feel it

was necessary; however when I drew her attention to my mums history the doctor changed her mind.

When my mum was released from hospital the aftercare was very good. My mum built a good

relationship with her care coordinator and started to understand her illness. However knowing my

mum so well I could see that her medication wasnt working as effectively and that it may need to be

reviewed or changed. I bought this to the care coordinators attention and after a long battle she

agreed to have my mum seen by a psychiatrist. This made a big difference as the psychiatrist

prescribed additional medication which my mum agreed to take. This stopped my mum having

suicidal thoughts.

Shortly after this the care coordinator was changed to another person. My mum was very distressed

by this as she had learnt to trust the previous one. Since then my mums care coordinator has

changed numerous times, there have been occasions when she hasnt known when she will be

receiving her depot, when someone will be visiting and who it will be. She has also been forced to

visit the office a few times at short notice to receive her medication. The lack of communication was

also poor and every time I tried to call the care coordinator I couldnt get hold of her, she didnt return

any of my calls which led to a complaint being filed. During this period I discovered that my mum had

been assigned a new coordinator who was off sick.

The lack of communication between staff and my mum and I was really poor. If my mum hadnt been

on a CTO she would have not bothered chasing her medication which would have resulted in her

being ill and sectioned again. I believe that Tamworth need to communicate better with patients and

their families and take ownership of their caseloads. Tamworth also need to listen to carers more as

they often know and see things which may benefit the patient.

My complaint was resolved by speaking to the team leader and discussing the lack of communication

and how this could be improved. Although it did take some time for someone to contact me about my

complaint I was happy with the resolution and treatment.

KM, Scotland

20 of 159

KM; Laura Troughton; Jane Lyons | Carer; Team Leader; Involvement Lead | June 2017

2

What we didnt do well

We did not communicate clearly with the family member that there had been a change in care

coordinator

We did not acknowledge the importance of the role of the carer, or of her own experience, and did

not therefore prioritise keeping her informed

We allowed ourselves to become overwhelmed by all the changes going on in the team. We

werent properly prepared for the likely impact of a large number of staff leaving with little notice

and had no contingency plans

What we did well

We responded swiftly to the complaint as soon as was escalated to a permanent member of staff

We were able to resolve the complaint by speaking openly and respectfully with the family member

We apologised unreservedly without making excuses

No.

What we will do now

Owner Date due

INITIALS DD/MM/YY

1 As a team we will check in with clients when there is a new care coordinator and, with permission, share this information with the carer

LT With immediate effect

2

As a team we will discuss how to improve our inclusive practice and better value the role and needs of carers and we will actively support carers with their needs via the newly implemented carers support and engagement plan (new form on ePJS) Communicate to team at next business meeting Support implementation via supervision and clinical review systems

LT

13/6/17 Review in 6 months

3

The Promoting Recovery service will develop a protocol to guide good

practice around change of care coordinator HW 25/08/17

4

The Promoting Recovery service will co-develop an information leaflet with and for service users and carers to clarify what people can expect when care coordinators change

HW 31/10/17

21 of 159


JUNE 2017

Title

CHIEF EXECUTIVES REPORT

Author

Dr. Matthew Patrick


To inform the Board about significant issues affecting the Trust.

A - London Bridge incident London NHS Mental Health response

The horrific attack that took place on the evening of Saturday June 3rd, resulting in the death of eight

people and the injury of at least 48 people, has shaken our local communities. It has also demanded a

huge amount of the dedicated NHS staff who were only very recently grappling with the tragic events on

Westminster Bridge and are now involved in supporting the victims of the Grenfell Tower disaster and the

recent attack at Finsbury Park mosque. Our thoughts are particularly with our friends and colleagues in

Guys and St Thomas Foundation Trust (GSTT) who are devastated that one of their colleagues, Kirsty

Boden a staff nurse who worked in Theatres Recovery at Guys tragically died during the attack. At

SLaM, we have done everything we can to provide our support and I want to extend my particular thanks to

our Director of Nursing, Beverley Murphy, who went out of her way to provide extensive help to our

colleagues at GSTT during the days following the attack.

Following the incident, I have been the NHS lead for work on a cross-London basis to develop London

Incident Support Pathways for adults and children affected by the incident. Building on the excellent work

undertaken by mental health colleagues in Greater Manchester, we have developed a comprehensive

package of guidance and information sheets to provide the best support for those dealing with horrific

incidents. We are also working to ensure that those in the fire, ambulance, police and other services are

properly supported.

B Capped Expenditure Process

An issue of significant current concern for the Trust is the Capped Expenditure Process (CEP) that is

currently being applied to a number of STPs. The CEP is a process that has been devised by the national

bodies to try and bridge the significant financial gap for 2017 / 18 in these areas. Typically this gap is

associated with one or two organisations within the geography. The national bodies are targeting 13

Sustainability and Transformation partnerships (STPs) one of which is the South-East London STP to

identify further savings.

22 of 159

Of particular concern to Trusts, as reported in the press, is that the type of savings that STPs are being

asked to contemplate include failing to meet national commitments or targets, potentially including those

around mental health. In our two-year contracts with Lambeth, Southwark, Lewisham CCGs we received

a net reduction in commissioned services in total of 1.2m for 2017/18 and a further 5m proposed

reduction in 2018/19. There is also a potential risk that the process will transfer risk from commissioners to

providers within the financial year.

Within South East London the STP has been working together to mitigate these risks and to ensure that we

support those organisations that are in financial distress in ways that are sustainable and that continue to

improve both value and quality.

C New Care Models

Last year, the Trust was successful with South London partners in its bid to host a new care model focused

on forensic services. This has entailed effective delegation of the forensic specialist commissioning budget

from NHS England, including the budget for out of area placements. Since April, the programme has

successfully repatriated 16 patients to local beds.

Three weeks ago, a team from Oxleas, South West London and St Georges and SLaM, led by me, were

interviewed in relation to the delegation of a second budgetary area, namely Tier 4 CAMHS. We were

delighted to hear that this bid was successful, with the result that our South London Mental Health and

Community Partnership (SLMHCP) now as delegated responsibility for approximately 80% of the South

London specialist mental health commissioning budget. The next step is the preparation of a more detailed

business case for submission in July.

D - Scheme of Delegation update

The Board approved the updated Scheme of Delegation in May, subject to clarification about the

requirements for the appointment of consultants (as described in paragraph 1.4.6). Gus Heafield and

Michael Holland have confirmed that the Board of a Foundation Trust are not required to approve all

medical consultant appointments and the delegations are left to the discretion of the Trust. On this basis,

Gus and Michael have agreed that paragraph 1.4.6 should be removed from the Board Reservation of

Powers Document and that the Scheme of Delegation should be updated to reflect that the appointment of

medical consultants is delegated to Clinical Directors in the Trust in line with the authority to appoint locum

doctors. The Scheme of Delegation will be revised on this basis and circulated appropriately within the

Trust.

E Smoke-free policy leading to a drop in violence

New research into the impact of SLaMs smoke-free policy has revealed a 39% drop in physical assaults,

both between patients and towards staff. The research was led by Kings College London and was

published on the 15th June in The Lancet Psychiatry. The reduction was noted after accounting for

general and seasonal trends and a range of other factors what could also have influenced the rates of

violence. Smoking within psychiatric hospital has long been the cultural norm and is thought to be a major

reason why people with mental health problems die 15 20 years earlier than the general population. The

study has important implications for the introduction and smoke-free policies, not only in psychiatric

hospitals but also in other institutions, such as prisons.

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F - Birthday Honours

I am absolutely delighted to announce that Graham Thornicroft, now Sir Graham Thornicroft, was knighted

in the 2017 Birthday Honours. Graham is a consultant psychiatrist at the Trust and Professor of

Community Psychiatry at the Centre for Global Mental Health and Centre for Implementation Science at the

Institute of Psychiatry, Psychology and Neuroscience as well as performing a range of other important

mental health roles. He has contributed a huge amount to the Trust and to tackling mental health stigma

and I am so pleased that his outstanding contribution has been recognised.

Dr Matthew Patrick

Chief Executive

24 of 159

1

REPORT TO THE TRUST BOARD: PART 1

27 June 2017

Title

Estates Strategy

Author Altaf Kara

Accountable Director Matthew Patrick, Chief Executive


The purpose of this paper is to:

Summarise the 5-year Trust estates strategy and outline implementation plan

Seek support for the strategic direction and for developing a full implementation plan

Seek support for moving forward with the new build scheme for Douglas Bennett House

Executive summary

Over the last 6 months, with the help of external support, the Trust has developed a 5-year estates strategy which is now moving towards implementation. The recommended strategic direction is to:

Commit to a 175m programme of modernisation to leading national and international levels that is aligned with clinical priorities starting with areas of the estate where need is greatest.

In the community, alongside modernisation, our strategic direction is also to consolidate estate that is not fit for purpose and to align with local community network hubs.

For inpatients, alongside modernisation, our strategic direction is also to build new, adult inpatient decant space and a new building to integrate our children and young peoples services and research activities on the Maudsley Hospital site. We will also move forward with commercial development of excess capacity on the Maudsley Hospital site.

Our current, on-going programme of major refurbishment and service moves will be adjusted to reflect this timetable.

Trust senior management feels that, whilst a challenge, the net 4.2m annual cost increase in capital charges (PDC/Debt and depreciation) is bridgeable by means of estate cost reduction, staffing efficiencies and commercial development of excess land.

A high level implementation plan for the strategy is under development and plans for the key next steps, set out below, are being developed:

Complete modelling of the financial impact of the strategy

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2

Engage with NHS Improvement on the strategic direction

Explore options for strengthening our capacity to deliver this programme

Complete our internal and external stakeholder engagement and handling plan

Move forward with the Douglas Bennett House rebuild scheme.

Committees where this item has been considered

Date Committee / Meeting

16/3/17 Finance and Performance Committee Meeting

Background

Dealing with the significant issues in our estate has been a strategic priority for SLaM for some time and for that

reason we decided to develop an estates strategy in December 2016.

Approach and progress update

The approach used was to develop the strategy through a combination of fact-finding, benchmarking, canvassing of

views and testing of assumptions and holding workshops with members of SMT, the executive and the full Board.

The workshops covered the following areas:

Production of a fact base

Setting out benchmarks and development scenarios

Scrutiny of assumptions, assessment of scenarios and programme review

Scenario assumptions, assessment and programme

Review of the emerging strategic direction

In addition, we set up a steering group comprising members of the Trust executive and 3 non-executive directors to

review, scrutinise and challenge progress.

At the time of writing this paper we have:

Agreed a fact base

Agreed a 5-year strategic direction which aligns with our clinical and operational strategy

Performed high-level financial evaluation

Set out an initial timetable for delivery

Started work on a high-level implementation plan

Fact base

We have an estate that for the most part is beyond its useful life of 30 years (c 60%) and falls short on a number of

metrics paramount of which being size and usability of community buildings, in-patient rooms with en-suites and

access to external space. It also falls significantly short of those of our peers who have modernised their estate such

as Oxleas and Northumberland Tyne and Wear and standard setters in the UK and internationally. This is detailed on

slides 12-18 of the accompanying slide deck.

Recommended 5-year strategic direction

The key features of the recommended strategic direction are shown in pages 7-11 and pages 19-27 of the

accompanying power point.

The estates strategy is an enabler of the Clinical Strategy. This is set out on pages 19-21 of the accompanying power-point. The aim of the Clinical Strategy is to deliver the right care in the right place at the right time and at the right value. Key elements of the strategy include:

o Improving population health including crisis care

26 of 159

3

o Focus on increasing out of hospital care providing care closer to home for patients, increasingly using integrated models of care and primary care integration

o Reducing the stigma of mental health o Maintaining clinical excellence and our leading research focus o Developing a culture of quality improvement (including as delivered through our key-note QI

programme)

The community estate is consolidated into larger, more modern buildings within our estate that are aligned with locations selected as local community network (LCN) hubs. The proposals involve rental of further space near local hubs where required and disposal of surplus estate. This is set out on pages 23-25 and pages 35-39 of the accompanying document.

The inpatient strategic direction is to o build new, adult inpatient decant space and a new building to integrate our children and young

peoples services and research activities on the Maudsley Hospital site and moving forward with commercial development of excess capacity on the Maudsley Hospital site, and to

o build a new unit for specialist, CAMHS services at the current site of the Dennis Hill Unit on the site of the Royal Bethlem Hospital.

Our current, on-going programme of major refurbishment and service moves will be adjusted to reflect this timetable.

Financial evaluation of end state

Full financial evaluation is still underway and we have not yet fully modelled the impact of the strategy on our

financial ratios but current work suggests that the investment is affordable.

The capital expenditure associated with the 5-year estates strategy is 175m and is driven by build and

refurbishment costs. Against this are disposals and capital contributions of approximately 120m (as shown on slide

31). We could fund the remaining programme through cash reserves, but would almost certainly prefer to take on a

debt facility to ensure sufficient liquidity.

If we make the reasonable assumption that debt is as costly as capital charges, the programmes impact on our I&E is

the same whether we fund by cash or debt. We estimate that to be an annual increase in costs of 4.2m, as shown

on slide 32.

Slide 32 also suggests that we can bridge this impact by a combination of staffing and estate efficiencies driven by

consolidation, better layout and reduction of length of stay.

Timetable

A timetable for development is set out and shown on slide 29 of the accompanying document:

Proceed with planned community disposals Immediately

Complete work on Douglas Bennett House upon approval of the strategy as the first key, in-patient development Within 2.5 years

Complete work on CAMHS consolidation and childrens development building Within 4 years

Complete work at Bethlem Year 5

Adjust major refurbishments programme year 1 and monitor thereafter.

High level Implementation plan

We have started to work on developing a high level implementation plan for the strategy. Key planks that require

completion and execution are:

Deepen understanding of the financial impact of the estates strategy o Further modelling of the proposed strategy is required particularly the impact on our financial

ratios

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4

o Some of the financial questions that face us are specialised and are beyond our current experience. We will consult with external advisors after we have exhausted NHS and KHP/STP sources of expertise.

Engage with NHS Improvement on the strategy o Our view is that upon Board endorsement of the strategic direction we should share our thinking

with NHS Improvement to secure support, expertise that may be on offer and surface any concerns early on.

Strengthen operational processes around space allocation and service moves o Recognising that we need more robust processes around space allocation and service moves going

forward, we have explicitly nominated the COO to chair decision making around operational moves in the operational executive.

o This will also enable CAGs to remain clearly sighted on disposals of surplus to requirement estate in the community.

Develop an internal and external stakeholder engagement and communication plan o Internally, considerable effort has already been made to engage with the Trust executive and with

non-executive directors on the steering group o Initial governor engagement has taken place through the Planning and Strategy Working Group o We have been having initial discussions with our CCGs, local borough stakeholders and provider

partners within the STPs and KHP about the emerging direction of the estates strategy o A comprehensive plan of engagement and communication and for involving service users and carers

is under development.

Explore options for strengthening our capacity to deliver this programme o We are in the process of exploring options to strengthen our capital project team to deliver such a

significant programme.

Move forward with the Douglas Bennett House scheme o The estates strategy confirms that the Douglas Bennett House recommendation to rebuild on the

existing site is aligned with the overall strategic direction. If the Board supports the strategic direction and the high level implementation plan, we recommend moving this forward.

Recommendations and next steps

We seek Board support for the following recommendations and next steps:

Endorse the strategic direction as described

Approve moving forward with the proposed implementation plan

Approve the recommended proposal for the rebuild of Douglas Bennett House.

28 of 159

1

SLaM estatesstrategy

29 of 159

2

Contents

1. Factbase2. 5-yearstrategicdirectionwhichalignswithourclinicaland

operationalstrategy3. Timetablefordelivery4. High-levelfinancialevaluation5. High-levelimplementationplan

30 of 159

3

Factbase

31 of 159

4

Contents

1. Snapshot2. Bestpracticevision3. Communitygap4. In-patientgap5. Bysitefunctionalgap

32 of 159

5

FactBase:SnapshotofKeyFacts

SLaMcomprisesof4hospitalsitesand90communitysites

165,000sqmGIAacrossallsites

Communitysitesaccountfor37%ofestatebyarea

49%Freehold,49%Leasehold,1%LIFT,1%SLA/Licencebyareaacrossallsites

58%oftheestatebyareaisover30yearsold

DistrictValuation292M

798beds,524+clinicroomsacrosssites

100%singlerooms,26%withensuites

LetsfilltheInformationgapsbeforegoingforward(PlacesandSpaces)

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6

FactBase:Snapshot:Whathavewegot?

Bethlem27%

Maudsley22%

Lambeth9%

Lewisham5%

Community37%

Clinical53%

Non-clinical47%

HospitalSites

Clinical54%Non-

clinical20%

Vacant13%

LeasedOut13%

CommunitySites

165,275sqmofproperty

34 of 159

7

BestPracticeVision:Worldclassestatetomatchthereputationofservicedelivery

Principles

Improveaccessforall:integrationofcommunity

Leastrestrictiveenvironment:consistentwithsafety

Integrationoftechnology:transformcareprogrammeapproach

Accesstotherapeuticoutdoorspaceforall

Calmenvironmentswithchoiceofspaceforpatients

Personalisedspace:highqualityensuite accommodation

Providingforfamilies

Outofhospitalcare closerto

homeConsolidationtosupport

betterclinicaloutcomes

Therapeutichealing

environments

Flexible andresponsiveestate

StandardiseWorkforceandculture

Sustainable;social

environmenteconomic

35 of 159

8

Lutherwood Childrens MentalHealthCentre, Canada

BestPracticeVision:Providinggoodqualityoutpatientclinicalenvironmentsincommunitysettings

WaldronHealth Centre, Lewisham

Parkwood InstituteMentalHealthcare Building,Canada

Parkwood InstituteMentalHealthcareBuilding,Canada

OldSeeHouse MentalHealthFacility,BelfastHeartofHounslow, London

36 of 159

9

BestPracticeVision:Singlebedroomswithensuiteaccommodation GlensideHealthCampus

GAPSPsykiatrisygehus

HelixForensicPsychiatryClinic

Trelleborg RightPsychiatricCentre

GAPSPsykiatrisygehus 37 of 159

10

BestPracticeVision:Leastrestrictiveenvironmentalignedtopatientneedsandsitepermeabilitytoenablecommunityintegration

Forensisch psychiatrisch centrumGent

Centre forAddiction andMentalHealth, TorontoGlenside Health Campus

OttoGerhardHeldring FoundationZetten

IrishNational Forensic Hospital

Roseberry Park Campus

38 of 159

11

BestPracticeVision:Terracedoutsidespace

CAMHS,TorontoCAMHS,Toronto39 of 159

12

Gapanalysis:Communityproperties

Whichpropertiesare>30years? 30propertieshavebeenbuilt

inthelast30years

60propertiesare>30yearsold

35arepre1948

Whichpropertiesaretherightsize? Neighbourhub- 6rooms

wouldneedroughly250-300sqm

Networkbase- 6consultroomsplusworkspacefor20workstations 500sqm

Largerboroughhub- egJeanetteWallaceHousewith300workstations

0

5

10

15

20

25

30

35

40

2005to2014

1995to2004

1985to1994

1975to1984

1965to1974

1955to1964

1948to1954

pre1948

AgeofCommunity Properties

-

500

1,000

1,500

2,000

2,500

3,000

3,500

GIA(sqm

)

Areas ofCommunity Properties

Propertiesforconsideration40 of 159

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Gapanalysis:recapcurrentestateperformance

Performance measureCurrentPerformance Target

Now NewDBHandvacateLadywell 2022 2027+

%beds in single rooms with ensuiteaccommodation 26% 42% 60% 100%

%bedroom of anareain linewithrecommended guidelines 36% 51% 60% 100%

%inpatient unitswith direct accesstosafetherapeutic outdoor space 50% 66% 75% 100%

%ofestatebyareadedicated tonon-clinical use 36% 36% Cartertargettbc

RiskAdjusted backlog /m2 18/m2 - 13/m2 2/m2

%ofhospital estatebyarearankedasCondition Borhigher 35% 43% 80% 100%

Consulting roomutilisation: patientcontacts perroom ~955

- 2,300 2,300

Agileworking: %reduction ofworkstations

2,700 staffoccupy2,600 desks - 20% 40%

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14

Benchmarkperformance:SomeMentalHealthhospitals

MentalHealthTrust

%Area %SingleBedroomsRiskAdjustedBacklog

/sqmClinical Non- clinical with ensuite withoutensuite

South London andMaudsley NHSFT 66% 34% 25% 75% 18/sqm

Oxleas NHSFT 66% 34% 67% 33% 0/sqm

South West Londonand StGeorge'sMentalHealthNHS T

55% 45% 22% 78% 141/sqm

Northumberland,Tyne andWearNHSFT

60% 40% 80% 20% 3/sqm

ERICreturns data2015/16, combined Trusts hospital sites

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FactBaseAnalysis:Howfunctionallysuitableisit?

Maudsley site 73%ofbuildingsonMaudsley site>30yearsold

71%builtpre1948 Buildingsdatebackto1700sand1800s

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16


Bethlemsite

62%buildings>30yearsold

50%builtpre1948

24%builtsince2005;

Newestbuildings: RiverHouse2008 MonksOrchard2002

Chelsham 1999

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Lambethsite

7%buildings>30yearsold Majorityofthesitebuilt1994 BridgeHousenewest2006

45 of 159

18


Lewishamsite Built1927 5storeysplusbasement

100%singlerooms Limitedensuites inHayworthandTriagewards

46 of 159

19

Clinicalstrategy

47 of 159

20

Keyclinicaldriversoftheestatesstrategy

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CurrentCAGclinicalprioritiesCAG KeyStrategicDrivers

AcuteCare Acutecarepathwayprogramme Concentrateclinicalinpatientactivityintocorrect

clinicalsetting ReduceOBDstoagreedcontractlevels

Psychosis ConsolidatebedsacrosssitesonBethlemsite

PsychologicalMedicineandIntegratedCare

Maintainspecialistserviceprovision Relocateeatingdisordersandneuro-psychiatry

servicestotheMaudsleysite

BehaviouralandDevelopmental

Consolidateforensicinpatientservices,potentialopportunitythroughSouthLondonForensicAlliance

Maintainandimprovequalityoflearningdisabilitiesserviceprovision

MentalHealthofOlderAdults&Dementia

Maintaincurrentacuteinpatientcapacitybutorganiseonfunctionalandorganicmentalhealthlines

Rationaliseandre-providecontinuingcareserviceasseriousmentalillness/challengingorganicservicelocatedontheMaudsleysite

ChildandAdolescentMentalHealthServices

EstablishCAMHSInstitute;integratingclinical,educationandresearchontheMaudsleysite

PotentialgrowththroughCAMHSlearningdisabilitiescontract

Addictions Developservicetoberesponsivetocommissionerstrategies

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5-yearstrategicdirection

50 of 159

23

CommunityEstate: currentproperties

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BaseCase:Community Properties

Thegapincommunity space

Gapidentified of2,960sqm Gapmaybereduced whereaccommodation occupied byCAMHS canbesharedwithother services Retainedworkspace accommodation issufficient toaccommodate staffinthecommunity whereagileworking applied Lambethwith thegreatestgap

Workinprogress: Includes onlyproperties

utilised forworkspaceandoutpatientaccommodation.

Leasedoutpropertieshavebeenexcluded.

Activity dataiscurrentlygoing through validationwitheachCAG.

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25

CommunityEstate: proposedretainedproperties(seeappendix)

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StrategicDirection:Maudsley HospitalSite Landvalue

c.19M+overageproceeds

Phase1ADouglasBennettHouseRedevelopment

Relocation ofLewisham plus twowardsfromBethlem

Completed: Q12020-21

Area:7,500 sqm

Content: 8wards,144beds

Capital cost:52M

Phase1BCAMHS InstituteMaudsley

Relocation ofMapother andMichael Rutter


Area:5,000 sqm

Capital cost:43M

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Phase1CCAMHS development


Area:2,500 sqmNB

Capital cost:22M

StrategicDirection:BethlemHospital

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Deliverytimetable

56 of 159

29

Programmetimeline

Bethlemsite Maudsleysite

Alongside capital build will be are-prioritised schedule ofmajorrefurbishments

57 of 159

30

Highlevelfinancialevaluation

58 of 159

31

Assumptions:Capital;55mtobefundedbyTrust

20m175m58m

2m40m

55m

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Assumptions:Anet4.2mincreasethatcanbebridgedthroughefficiency

6.54.2m

Netincreaseincapitalcharges

Netincreaseincapitalcharges

4.2m

Efficiencyfromestate,workforceand lengthofstay

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Implementation

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Deepenunderstandingofthefinancialimpactoftheestatesstrategy

EngagewithNHSImprovementonthestrategy Developaninternalandexternalstakeholderengagement

andcommunicationplan Exploreoptionsforstrengtheningourcapacitytodeliverthis

programme MoveforwardwiththeDouglasBennettHousescheme

Keyimplementationsteps

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35

Appendix

63 of 159

36

Lambeth

Identifiedlocationgap

64 of 159

37

Southw

ark

Identifiedlocationgap

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38

Lewisham

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39

Croydo

n

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1


27th June 2017

Title

CQC re-inspection report Mental Health Older Adults inpatient wards

Author Mary ODonovan, Head of Quality

Accountable Director Beverley Murphy, Director of Nursing and Quality


1. To report the findings and outcome of the re-inspection by the CQC in March 2017 of the Mental

Health Older Adults inpatient wards.

2. To note the key issues raised and the highlighted risks.

Executive summary

As a part of the Chief Inspector of Hospitals inspection regime the Trust was subject to a comprehensive

Care Quality Inspection (CQC) during the week commencing 21st September 2015. The overall Trust

rating was good. The rating for Mental Health Older Adults inpatient wards was requires improvement.

An improvement plan was agreed, implemented and monitored.

The Mental Health Older Adults inpatient wards were re inspected as a focussed review March 2017. As

a result, the rating for these wards has significantly improved to good overall and improved to good in

the domains of effective, caring and responsive.

The paper will highlight the improvements and good practice that the CQC could see since the 2015

inspection it will also offer the detail on the improvement actions the CQC state the Trust 'MUST' and

'SHOULD' respond to. The paper will set out the revised ratings for each of the five quality domains, the

overall rating for Mental Health Older Adults inpatient wards and the overall rating for the Trust. The

paper will also show the overall rating grid by domain and service line for the Trust.

The excellent work of the clinical staff in making the improvements is acknowledged.

The paper sets out the approach to the development of the improvement plan being led by the Clinical

and Service Director of the Clinical Academic Group (CAG) and notes the date for submission to the

CQC. The internal governance process to ensure the delivery of improvements actions is monitored and

evidenced is described.

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CQC re-inspection report Mental Health Older Adults inpatient wards

1.0 Introduction

As a part of the Chief Inspector of Hospitals (CIH) inspection regime the Trust was subject to a

comprehensive Care Quality Inspection (CQC) during the week commencing 21st September 2015. The

overall Trust rating was 'good, however the rating for Mental Health Older Adults inpatient wards was

requires improvement, with the individual domain ratings outlined below in table one.

Table one: CQC MHOA Inpatient Rating; Jan 2016

The MHOA Adults Inpatient pathway was re-inspected in March 2017. The paper sets out why the re-

inspection took place, the findings and the subsequent quality rating.

2.0 Re- Inspection Ratings

Following the initial round of CIH inspections all Trusts that were rated required improvement overall or for

a specific service line would be subject to further inspection. Therefore, the inspection of the Mental Health

Older Adults inpatient wards was anticipated.

The September 2015 CQC inspection findings outlined eight MUST and seven SHOULD improvement

actions. The re-inspection in March 2017 assessed if the Mental Health Older Adults inpatient wards had

made the required improvements, following the previous comprehensive inspection of the trust in

September 2015.

Following the re-inspection the overall rating for the Trust remains at Good. The overall rating for the

Mental Health Older Adults inpatient wards has significantly improved to good overall and improved to

good in the domains of effective, caring and responsive. The table below outlines the revised quality rating

for the pathway.

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Table two: CQC MHOA Inpatient Rating; June 2017

3.0 Improvements and good practice

The CAG developed an improvement plan and we are indebted to the ward and corporate teams for

delivery of the plan.

3.1 Improvements since 2015

The CQC highlighted the improvements made in each of the five domains; Safety, Effective, Caring,

Responsive and Well led since 2015. These improvements are highlighted below.

Domain CQC Identified Improvements

Safe An improvement in the standard of cleanliness, with

no lasting odours.

An improvement in the level of detail recorded in risk

assessments.

All wheelchairs were intact and well maintained and appropriate

hoisting equipment was available for staff.

Improved medicines management at these units, including

dedicated trust pharmacy provision.

An improved recording to ensure patients food and fluid intake

was monitored accurately.

Effective Dementia training was being provided both by distance learning

and at ward level. Staff displayed a good understanding of

meeting the needs of patients with dementia. The trust had also

taken steps to recruit to vacancies across the wards, and

improved staff cover of shifts.

Staff kept records of when detained patients rights were read to

them and these were audited. We also found that staff offered

patients copies of their leave forms.

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Caring An improvement in the recording of patients and carers involvement in care

planning and assessments.

Responsive Observed that the vast majority of staff supported patients in a

caring way, including at mealtimes. The meal experience had

improved, and some patients were involved in setting tables.

Care was provided within gender specific areas. Staff closed

observation windows when not in use, and further protected

patient privacy by closing curtains fitted around them

The trust provided a service user and carer advisory group, which

involved patients and carers with experience of the trusts older

adults services.

Well Led Staff were implementing a number of quality improvement initiatives,

including Four Steps to Safety, a this is me booklet that they prepared with

patients to go with them when they left the ward and the electronic

observations for health monitoring, EoBs.

Table three: CQC MHOA Inpatient CQC Identified Improvements; June 2017

3.2 Good practice

The CQC highlighted in their report particular areas outlined below as good practice:

4.0 Areas for Improvement The MHOA Inpatient pathway received one MUST do and eleven SHOULD do actions to improve

on.

4.1 MUST

Number Must Action

1 Training The provider must ensure that all relevant staff complete training in mandatory areas

including intermediate life support, basic life support, and fire safety.

Table four: CQC MHOA Must Dos; June 2017

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4.2 SHOULD

Number Should Action

1 PH

Monitoring-

Rapid Tranq

The provider should ensure that accurate records are maintained of post dose vital

sign monitoring after patients receive rapid tranquilisation.

2 Sight line-

Blind Spot

The provider should ensure that records are maintained of blind spots on each ward,

to ensure that new staff are aware of these risk areas.

3 Supervision The provider should ensure that all staff receive regular supervision sessions in line

with the trust policy and that this is monitored effectively.

4 Privacy and

Dignity

The provider should ensure that staff provide patients with the option of having clinical

observations carried out in a private area such as the

ward clinic room or their bedroom.

5 Informal

Patients

The provider should review the policy regarding ensuring that informal patients are

given clear information about their right to leave each ward.

6 Privacy and

Dignity

The provider should ensure that staff and patients are aware of how to ensure their

privacy in the identified bathroom on Aubrey Lewis 1 ward, by

closing the frosted windows.

7 Accessibility-

Bathroom

The provider should consider the addition of an accessible bathroom within the female

patients area on Aubrey Lewis 1 ward.

8 Living Skills The provider should ensure that patients have access to the laundry rooms on the

wards, following a risk assessment, to ensure and they are supported

to maintain their independent living skills.

9 Food The provider should ensure that accessible menus are available to patients with

dementia, and improve consistency in ensuring that patients have a choice of meals.

10 Risk Register The provider should ensure that ward managers are made aware of the issues

recorded on the clinical academic group risk register and further develop links

between senior management and ward level.

11 Informal

Patients

The provider should ensure that informal patients on Hayworth ward are given clear

information about their right to leave the ward in the posters on display.

Table five: CQC MHOA Inpatient SHOULD Dos; June 2017

The MHOA Inpatient CAG alongside the Trust Quality Team are currently developing an action plan which

will be submitted to the CQC by the 29th June 2017.

4.3 IMPROVEMENTS UNDERWAY

Mandatory training

All Wards within the CAG are implementing a training action plan to facilitate an improvement in this area.

This included optimising the management use of the LEAP system to ensure training was not reliant on

individual bookings. This will be monitored daily by the Service Manager and monthly by the Operational

Managers via the monthly Operations Management meeting.

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Post rapid tranqulisation care

Both the CAG and Trustwide Pharmacist has provided training to all MHOA Inpatient Ward staff in ensuring

that accurate records are maintained demonstrating the management of post dose vital sign monitoring

after patients receive rapid tranquilisation.

Food

It has been agreed with the new food providers will ensure that accessible menus are available to patients

with dementia by November 2017.

Bathroom windows privacy and dignity

The CAG held a stakeholder event with patients, staff, carers and Window suppliers to look at different

window dressing options available to ensure the balance of ensuring privacy and dignity whilst not

impacting on ventilation and light. In addition staff have been reminded to ask the patients for their

preference regarding the window being open or closed whilst using the bathroom or acting in their best

interests if patient lacks capacity.

Informal patients rights to leave the ward

Hayworth Ward now have the correct poster on display regarding the rights of Informal patients.

5.0 Governance and Assurance

The Director of nursing has met with the Interim Service Director and Interim Deputy Director of Nursing to

consider the MUST and SHOULD do actions, they will lead the process of developing an action plan at

CAG level.

The Director of nursing and Chief operating officer will jointly scrutinise the plan and once approved it will

be provided to the CQC and be implemented across the CAG. The deadline is 29th June 2017.

The CAG leaders will take operational responsibility for the delivery of the improvement plan, the

governance of the plan is via the Quality Delivery Committee (QDC) and the progress or issues for

escalation reported to the Senior Management Team meeting or the Quality Sub Committee accordingly.

The QDC will also consider the utility of the learning from the report across the CAGs trust wide.

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1


27th June 2017

Title

QI Workplan Update

Author Barbara Grey Accountable Director Michael Holland


To provide the board with an update on the QI work plan and note the recommendations for action

Executive summary

The paper provides an overview of progress against the QI workplan and the board is asked to note:

1. Recruitment to the QI team 2. The review of the PDSA cycle for the Senior management team leadership quality and safety

walk arounds

3. The communication plan and driver diagram to increase awareness and engagement in QI 4. The learning from the first Collaborative event for the Large-scale initiative (LSI) for adult

mental health

5. An update of the QI dashboard that was presented at the QSC in March 2017 and next steps 6. The revised training and development plan for QI 7. The contribution of the QI work plan to progress the delivery of the Trusts objectives for this

year set out in the Trust driver diagram for QI

Recommendations 8. There is one system for leadership walk arounds that includes Board members, SMT/CAG

executive/governors/service users/carers

9. The board test the QI dashboard in the July board meeting and provide feedback 10. The board agree a QI slot every two months, to start in Sept and to move to monthly

presentations in 2018. A team involved in a QI initiative will present their work to the board

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Progress against QI work plan

1.Recruitment to the QI team: The assessment centre and interviews took place on 12th and 13th June 2017 for the Communications/ events manager and unfortunately, we were unable to appoint to the post. The QI team are working with Communications to review next steps for the post. The assessment centre and interviews for the QI Lead posts areon 16th and 21st June. The senior data analyst post is being shared with contracts and performance and the post holder has a key role in heling to generate data for QI work and for the QI dashboard development.

2.Senior Leadership quality and safety walk arounds

PDSA (Plan Do Study Act) cycle One: completed over three months February April 2017

Nine leadership walkarounds were completed (1-2 per week) by all but two members of the senior management team (SMT). Although visits by the SMT were open to all staff, they were mainly attended by nursing staff with a small number of medical and OT staff and no psychology or other therapies. Some patient involvement was also generated from visits to clinical environments. The Pareto chart below illustrates that most concerns noted by teams were concerned with the environment and staffing, followed closely by technology.

SMT members agreed with each team the actions they would take to address problems raised by teams. In this PDSA cycle, it is not possible to provide data on outcomes as teams have not provided feedback. Teams identified effective team work as an area of good practice. Recruitment of teams for the PDSA SMT walk arounds was more challenging than expected. Some clinical teams did not want to engage in this as they had other visits arranged with board, CAGs or nursing directorate. There was a perception that the visits could be repetitive and busy clinical teams did not want to duplicate work. The administration and coordination of visits was more complex than expected and achieved through the good will of personal assistants to the SMT. At a review with the SMT on 22nd May, a decision was made to develop one clear

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Documents

Board of Directors Meeting - SLaM · Page 2 of 3 Ref Issue/Board Paper Action By When Status RAG April 2017 meeting 4 Staff Engagement and Survey Action Plans Chairman to Investigate