agenda for council of governors meetingagenda item no: a4a private council of governors minutes –...

AGENDA FOR Council of Governors Meeting

Date: Thursday 27 April 2017 Time: 4.00 p.m. – 6.00 p.m.

Venue: Box 10, Merryman Suite, Aintree Racecourse, Ormskirk Road, Liverpool L9 5AS NOTE – 2.30pm – 3.30pm - Focus Group with Governors & Care Quality Commission

No. Item Lead Details Timings

PART 1 – FORMAL MEETING

A Council Business

A1 Welcome B Fraenkel Verbal 4.00 p.m.

A2 Apologies – Governors: Apologies – Attendees:

B Fraenkel Verbal to note

A3 Declarations of Interest B Fraenkel Verbal to note

A4 Minutes of the Previous Meeting(s) held on: a) 12 January 2017 – Private meeting b) 12 January 2017 – Public Meeting

B Fraenkel Paper for decision [ref COG17/18/025]

A5 Update from the Chief Executive J Rafferty Verbal to note 4.05 p.m.

A6 Update from the Chairman B Fraenkel Verbal to note 4.10 p.m.

B Our Services

B1 Report on Financial and Activity Performance W Copeland-Blair / G O’Keeffe

Paper for assurance [ref COG17/18/026]

4.15 p.m.

B2 Quality Account 16/17 & Indicator Testing R Walker / H McCourt

Paper for decision [ref COG17/18/027]

4.25 p.m.

C Our Future

C1 Liverpool Community Health – South Sefton Transaction

T Bennett Paper for decision [ref COG17/18/028]

4.35 p.m.

D Governance

D1 Non-Executive Director Appointment A Meadows Paper for decision [ref COG17/18/029]

4.50 p.m.

D2 Amended Constitution A Meadows Paper for decision [ref COG17/18/030]

4.55 p.m.

D3 Membership and Engagement Committee Update S Jennings Paper to note [ref COG17/18/031]

5.00 p.m.

D4 Council of Governors Governance Annual Cycle of Business 2017/18

S Jennings Paper for decision [ref COG17/18/032]

5.05 p.m.

E For Information

E1 Final Operational Plan 2017-2019 --- --- ---

F Any Other Business

F1 Any Other Business Governors Verbal 5.10 p.m.

PART 2 – DEVELOPMENT & INFORMATION SHARING

G1 CQC Inspection – Initial Feedback / Actions R Walker Presentation 5.15 p.m.

PART 3 – OPPORTUNITY FOR Q&A WITH BOARD MEMBERS

H1 Governor & Board Member Q&A All - 5.30 p.m.

Close 6.00 p.m.

Agenda Item No: A4a

PRIVATE Council of Governors Minutes – 12 January 2017 Page 1 of 4

Status of these minutes (check one box): Paper No: COG17/18/025

Draft for Approval: ☒ Report to: Council of Governors

Formally Approved: ☐ Meeting Date: 27 April 2017

MINUTES OF THE MEETING OF THE

Council of Governors - PART 2 – HELD IN PRIVATE Date: Thursday 12 January 2017 Time: 4:15pm – 6pm

Venue: Merriman Suite, Aintree Racecourse, Ormskirk Road, Liverpool L9 5AS

Name Job Title (Division/ Organisation*) *if not Mersey Care

Present:

Beatrice Fraenkel Johanna Birrell Debra Doherty Sara Finlayson Neil Frackelton Mandi Gregory Mike Jones David Kitchen Jane Lunt Mark McCarthy Teresa McDonnell Jayne Moore John Mousley Martin Murphy Brian Murphy Scott Parker Hilary Tetlow Maria Tyson Veronica Webster

Chairman Service User, Local (Liverpool, Sefton & Knowsley); Service user, Local (Liverpool, Sefton & Knowsley); Staff – Other Clinical, Scientific, Technical & Therapeutic Staff; Appointed, Voluntary Sector; Staff, Non Clinical Staff; Staff, Non Clinical Staff; Appointed, NHS England; Staff, Other Clinical, Scientific, Technical & Therapeutic Staff; Service User, Local (Liverpool, Sefton & Knowsley); Service user, Local (Liverpool, Sefton & Knowsley); Public, Liverpool; Public, Sefton; Service user, Local (Liverpool, Sefton & Knowsley); Carer, Local (Liverpool, Sefton & Knowsley); Staff, Nursing Staff; Carer, Local (Liverpool, Sefton & Knowsley) & Lead Governor Staff, Nursing Staff; Appointed, Sefton, Local Authority;

In Attendance:

Joe Rafferty Louise Edwards Wendy Copeland-Blair Trish Bennett Elaine Darbyshire Amanda Oates Gerry O’Keeffe Pam Williams Ian Lythgoe Joanne Bull Ray Walker Andy Meadows Sarah Jennings Paula Murphy

Chief Executive Director of Strategy Head of Performance Improvement Director of Integration Head of Corporate Governance and Communications Executive Director of Workforce Non Executive Director Non Executive Director Deputy Director of Finance Head of Governance Executive Director of Nursing Trust Secretary Deputy Trust Secretary Corporate Governance Compliance Manager/Minute Secretary

Agenda Item No: A4a


Apologies Received:

George Allen Sandra Wright-Perkins Hetalkumar Mehta Matt Birch

Carer, Local (Liverpool, Sefton & Knowsley); Public, Liverpool; Staff, Medical; Non Executive Director;

ISSUES CONSIDERED 2017

D3 APPOINTMENT OF EXTERNAL AUDITOR

1. Mr Jones declared an interest in this agenda item as a Financial Accountant within the Trust and direct involvement in External Appointment process.

2. Mrs Williams outlined the procurement process followed and the evaluation undertaken to appoint a new External Auditor from 1 April 2017, led by the Audit Appointment Working Group.

3. Mrs Williams advised that the current External Audit contract was with Grant Thornton LLP and the Council of Governors and Audit Committee agreed in October 2016 to extend the contract to 31st March 2017 to enable the provider to complete the current year.

4. An Audit Appointment Working Group was created to lead the tender process on behalf of the Council of Governors and consisted of: a) Hilary Tetlow, Lead Governor (service user and carer constituency) b) Debra Doherty, Governor (service user and carer constituency) c) Tracy Smith, Head of Procurement d) Ian Lythgoe, Associate Director of Finance e) Pam Williams, Non-Executive Director/ Audit Chair

5. Mrs Williams confirmed that there were 8 potential bidders for the contract and 3

official bids were received, all of which were invited for formal interview. The scores achieved were set out in the report provided along with the subsequent outcomes and recommendations for the consideration of the Council of Governors.

6. Mrs Williams confirmed that through the appointment process, the Audit Appointment Working Group had recommended that the contract was awarded to Grant Thornton LLP.

Action

Lead Timescale Status

Recommendations approved by the Council of Governors, namely: • Approve the awarding of the External Audit Services

contract to Grant Thornton LLP.

Further actions required: • None identified

Agenda Item No: A4a


D4 APPOINTMENT AND RE-APPOINTMENT OF NON-EXECUTIVE DIRECTORS

7. This item had previously been discussed in the Nominations Committee; therefore Non Executive Directors were permitted to remain in the room.

8. Mr Meadows noted that the Council of Governors had a key role in ensuring the succession planning of the Non Executive Directors (NEDs), seeking advice from the Chairman/ Senior Independent Director (as appropriate) and the rest of the Board of Directors in order to determine the skills necessary for NEDs on the Board of Directors (informed by independent Board Skills Reviews).

9. Mr Meadows highlighted that as a result of the expiration of Professor Chris Dowrick’s term of office as a Board Advisory Member on 30 November 2016, the Council of Governors approved at it’s meeting in September 2016, the recruitment for a new NED post. Following a recruitment process which culminated in an interview before an interview panel comprising of the Chairman (Beatrice Fraenkel), the Lead Governor (Hilary Tetlow), a Service User/Carer Governor (Brian Murphy) and an appointed Governor (Veronica Webster), it was now recommended that Cath Green be appointed for a 3 year term of office. Mrs Green’s CV was provided in appendix A.

10. Mr Meadows informed the Governors of the requirement to fill an additional NED

vacancy due to Professor Roe stepping down in May 2017 and authority was sought from the Council of Governors to commence the appointment process. Subject to approval of the Council of Governors, the intention was that the recruitment process would be completed with the Governors approving the appointment at their next meeting in April 2017. A job description and person specification for this post was provided in appendix B.

11. Mr Meadows asked that Governors note two typographical errors in the report, namely,

Pam Williams proposed term of office to be extended to 3 years (not 2 years) and in paragraph 4b, Veronica Cuthbert should read, Veronica Webster.

12. Taking into account the decision of the interview panel, and the recommendation of the

Nominations Committee, the Governors approved the new terms of office proposed for existing NEDs, approved the appointment of Cath Green as a NED and approved commencement of the recruitment process for the soon to be vacant NED post.

Action


Recommendations approved by the Council of Governors, namely: • consider and approve the proposed terms of office

for the NEDs listed in this paper; • consider and approve the appointment of Cath

Green as a NED; • consider and approve the commencement of the

recruitment for the soon to be vacant NED post.


Agenda Item No: A4a


D5 RE-APPOINTMENT OF THE CHAIRMAN

13. This item had previously been discussed in the Nominations Committee; therefore the Chairman was permitted to remain in the room.

14. Mr Meadows informed Governors that the Chairman was subject to the same appraisal process as NEDs and as such, Mrs Fraenkel had been interviewed by the Non-Executive Senior Independent Director (Gerry O’Keeffe) and the Lead Governor (Hilary Tetlow). Mr O’Keeffe and Miss Tetlow, utilising the process approved by Governors, recommended to the Nominations Committee that the Chairman’s term of office, which expired on 3 November 2017, be extended by 2 years to 3 November 2019.

15. Following the guidance and advice provided, the Governors approved the re-

appointment of the Chairman for a 2 year extension of the term of office to expire on 3 November 2019.

Action


Recommendations approved by the Council of Governors, namely: • consider and approve the proposed term of office for

the Chairman, namely a 2-year extension.


E1 ANY OTHER BUSINESS

16. Mrs Birrell raised a concern in relation to support groups for service users in Southport where unsubstantiated information had been obtained that carers would be withdrawn from these groups and they would attended service users only. Mrs Birrell emphasised the need to permit carers participation in these groups and raised concerns regarding where ownership sat in making this decision.

17. Mr Rafferty acknowledged Mrs Birrell’s concerns, stating that it was unclear from the information provided as to whether these were services led by Mersey Care. Mr Rafferty agreed to ensure Mrs Birrell was contacted outside of the meeting to discuss this issue further.

Action


Further actions required: • Appropriate member of staff to contact Mrs Birrell in

relation to the potential issues for service users in Southport and clarify where ownership lay.

A Meadows

Jan-17

Due Jan-17

18. No further items of business were discussed.

19. The meeting closed.

Agenda Item No: A4b

Council of Governors Minutes – 12 January 2017 Page 1 of 14

Status of these minutes (check one box): Paper No: COG17/18/025

Draft for Approval: ☒ Report to: Council of Governors

Formally Approved: ☐ Meeting Date: 27 April 2017


Council of Governors Date: Thursday 12 January 2017 Time: 4:15pm – 6pm

Venue: Merriman Suite, Aintree Racecourse, Ormskirk Road, Liverpool L9 5AS


Present:

Beatrice Fraenkel Johanna Birrell Debra Doherty Sara Finlayson Neil Frackelton Mandi Gregory Mike Jones David Kitchen Jane Lunt Mark McCarthy Teresa McDonnell Jayne Moore John Mousley Martin Murphy Brian Murphy Scott Parker Hilary Tetlow Maria Tyson Veronica Webster

Chairman Service User, Local (Liverpool, Sefton & Knowsley); Service user, Local (Liverpool, Sefton & Knowsley); Staff – Other Clinical, Scientific, Technical & Therapeutic Staff; Appointed, Voluntary Sector; Staff, Non Clinical Staff; Staff, Non Clinical Staff; Appointed, NHS England; Staff, Other Clinical, Scientific, Technical & Therapeutic Staff; Service User, Local (Liverpool, Sefton & Knowsley); Service user, Local (Liverpool, Sefton & Knowsley); Public, Liverpool; Public, Sefton; Service user, Local (Liverpool, Sefton & Knowsley); Carer, Local (Liverpool, Sefton & Knowsley); Staff, Nursing Staff; Carer, Local (Liverpool, Sefton & Knowsley) & Lead Governor Staff, Nursing Staff; Appointed, Sefton, Local Authority;

In Attendance:

Joe Rafferty Louise Edwards Wendy Copeland-Blair Trish Bennett Elaine Darbyshire Amanda Oates Gerry O’Keeffe Pam Williams Ian Lythgoe Joanne Bull Ray Walker Andy Meadows Sarah Jennings Paula Murphy

Chief Executive Director of Strategy Head of Performance Improvement Director of Integration Head of Corporate Governance and Communications Executive Director of Workforce Non Executive Director Non Executive Director Deputy Director of Finance Head of Governance Executive Director of Nursing Trust Secretary Deputy Trust Secretary Corporate Governance Compliance Manager/Minute Secretary

Agenda Item No: A4b


Apologies Received:

George Allen Sandra Wright-Perkins Hetalkumar Mehta Matt Birch David Fearnley Nick Williams Brenda Roe Neil Smith Mark Hindle

Carer, Local (Liverpool, Sefton & Knowsley); Public, Liverpool; Staff, Medical; Non Executive Director; Medical Director; Non Executive Director; Non Executive Director; Executive Director of Finance (Deputy CEO); Executive Director of Operations;


A1 WELCOME AND INTRODUCTIONS

1. Mrs Fraenkel (Chairman) welcomed all members to the meeting and introductions were made around the room.

A2 APOLOGIES 2. The apologies for absence received for this meeting are detailed on page above.

A3 DECLARATIONS OF INTEREST 3. Mr Jones declared an interest in relation to agenda item D3 (External Audit

Appointment).

A4 MINUTES OF THE PREVIOUS MEETING: 28 SEPTEMBER 2016 4. The minutes of the meeting held on 28 September 2016 were accepted as an accurate

record.

A5 UPDATE FROM THE CHIEF EXECUTIVE

5. Mr Rafferty updated Governors on the successful bid to provide South Sefton Community Health Services in partnership with 5 Boroughs Partnership NHS Foundation Trust. The Trust’s plan was to deliver a coordinated programme of integrated healthcare with the aim of producing better outcomes and ensuring that patient care remained central. This was in line with the Trust’s commitment to integrate physical and mental health care, which was consistent with South Sefton’s CCG ‘Shaping Sefton’ programme for community centred health and care.

6. Mr Rafferty stated that unlike the process for the acquisition of Calderstones last year, this transaction was not considered by NHS Improvement to be a significant transaction. For the Council of Governors, this meant that Governors would not be

Agenda Item No: A4b


required to approve the transaction, but Mr Rafferty assured Governors that they would be kept updated on progress as the Trust progressed through the usual checks and due diligence.

7. Mr Rafferty confirmed that the Trust had also made a successful bid to provide better mental health services for pregnant women and new mothers in Cheshire and Merseyside. The perinatal mental health contract had been won in conjunction with Cheshire and Wirral Partnership NHS Foundation Trust and 5 Boroughs Partnership.

8. Mr Rafferty also highlighted that in November 2016, the findings of the 2016 National Community Mental Health Survey were published by the Care Quality Commission (CQC). The overall experience score had shown a small improvement in satisfaction from 73.30% in 2015 to 73.50% in 2016. There were however, two categories that demonstrated a statistically significant reduction from 2015, namely, Crisis Care (knowing who to contact out of hours if in crisis); and Support and Well-Being (guidance or help provided by NHS Mental Health Services with finding support for physical health needs and support in taking part in local activity). The high level findings of the survey were discussed by the Board of Directors in November 2016 and by the Quality Assurance Committee in January 2017 who had requested a detailed action plan to address the areas to be improved.

9. Mr Rafferty advised that the long-awaited NHS England consultation into Learning

Disability Services had commenced with regard to where and how services would be delivered at the Whalley site. Mr Rafferty acknowledged that the consultation added to the existing concerns of service users, carers and staff regarding the future of the site and the outcome of the consultation were unlikely to be available for a number of months. The Trust were committed however, to continue delivering the very best Learning Disability services with the best clinical, therapeutic and expert staff. The Trust (as a provider) were not permitted to make public comment on the consultation, but an organisational response would be provided and the outcomes of the consultation would be reported back to Governors in due course.

10. Following discussion, it was agreed that NHS England consultation documentation

would be circulated to Governors for those who wished to provide a response as a private citizen.

A6 UPDATE FROM THE CHAIRMAN

11. Mrs Fraenkel referred to the Trust’s Positive Achievement Awards, which were held on 24 November 2016 and had been an evening of celebration for outstanding staff and volunteers. Mrs Fraenkel highlighted for those Governors who had been unable to attend, that the Chairman’s Award had been presented to Governors, Brian and Martin Murphy who had become key members of Mersey Care’s volunteering programme.

12. Mrs Fraenkel referred to the Trust’s Big Brew Campaign, stating that the Trust were at the forefront of promoting the importance of getting people to talk about their problems to enable them to access services early and thus stand a better chance of recovery.

Agenda Item No: A4b


With the so-called ‘Blue Monday’ approaching on 16 January, (which had been calculated by experts as the most depressing day of the year), the Trust were renaming this as ‘Brew Monday’ to encourage people to talk to each other. Details of a series of events and activities taking place on Monday 16th January had been circulated to Governors via email and the Chairman encouraged Governors to be involved in the planned events wherever possible.

A7 UPDATE FROM THE LEAD GOVERNOR

13. Miss Tetlow updated the Governors on her activities since the previous meeting, summarising as follows: a) Involvement in Quality Review Visits - Governors participating in Quality Review

Visits had requested more guidance before attending a visit to enable Governors to understand what was required and how to purposefully engage;

b) Involvement in the process undertaken to interview and appoint the new Non Executive Director (subject to HR checks);

c) Participation in the process (along with Governors Debra Doherty, David Kitchen and Sarah Finlayson) agreed by the Council of Governors to appoint a new External Auditor from 1 April 2017;

d) Attendance at the membership and engagement meeting with Governors held on 28 November 2016 to discuss communication and engagement mechanisms;

e) Attendance at a series of events including the Remembrance Service at Whalley site with Brian Murphy and Johanna Birrell, the award ceremonies for Whalley and Mersey Care and the Whalley Carol Service;

B1 REPORT ON FINANCIAL AND ACTIVITY PERFORMANCE

14. Mr O’Keeffe introduced himself to Governors, noting that as part of his role of Non

Executive Director, he was also Vice Chair and Senior Independent Director.

15. Mr O’Keeffe stated that the Trust had established a new approach to reporting performance to the Board and its Committees following a Board Development Session held in August 2016. This new approach enabled scrutiny of performance in the following areas: a) Regulatory; b) Our Services; c) Our People; d) Our Resources; e) Our Future;

16. The report presented to Governors reflected a summary of performance over the

previous quarter against the areas outlined above.

Regulatory

17. Mr O’Keeffe referred to paragraph 6 of the report (Regulatory), and confirmed that the CQC inspection was scheduled to take place in March 2017. Two years previously,

Agenda Item No: A4b


the Trust had achieved a rating of ‘good’ following the comprehensive CQC inspection and confirmed that whilst the Trust was in a position to achieve a good rating in 2017, there was no complacency and preparations would continue to ensure a successful outcome.

18. Mr O’Keeffe referred to the Single Oversight Framework and advised that this had

been introduced by NHS Improvement on 1 October 2016 as new approach to monitoring the performance of NHS Trusts and NHS Foundation Trusts. The Single Oversight Framework included 5 themes:

a) quality of care b) finance and use of resources c) operational performance d) strategic change e) leadership and improvement capability

19. Trusts had been placed into performance segments by NHS Improvement based upon

performance against the measures in use. The segments range from 1 to 4 with segment 1 enabling Trusts to operate with maximum autonomy and segment 4 aimed at providers who were considered to be in special measures (where there had been an actual or suspected breach of the provider’s licence conditions).

20. Mr O’Keeffe advised that Mersey Care has been allocated to segment 2 based on the good CQC rating and operational performance but moderated by the Trusts performance against the agency spend cap. Actions were in place to address this issue, but it would take time to achieve the target successfully and safely.

Our Services

21. Mr O’Keeffe referred to concerns identified in relation to Duty of Candour in which the Trust had not achieved 100% compliance. Significant work had been undertaken to address this at the request of the Quality Assurance Committee and on 11 January 2017, the Committee had received a report which demonstrated the Trust were now 100% complaint in this area.

22. Mr O’Keeffe informed Governors that the Trust was achieving the trajectory for

delayed discharges agreed with NHS Improvement; however there remained challenges in the local division in relation to out of area treatments associated with high levels of bed occupancy in acute wards. There continued to be concerns regarding the potential for further delays to discharges in the specialist learning disability division and trust was working closely with commissioners to ensure early escalation of these issues.

Our People

23. Mr O’Keeffe noted that sickness absence rates continued to be reporting significantly above target and had increased to 7.1% in the recent period. This was higher than the relative position reported in 2015 and a number of actions were being undertaken

Agenda Item No: A4b


including analysis of the causes of staff sickness within each of the clinical divisions and identification of any themes within staff groups or teams.

24. Mr O’Keeffe advised that vacancy rates had risen to just over 10% in the last three

months (latest data was for October 2016) particularly within the Specialist Learning Disabilities Division. The Trust also had a number of medical vacancies at consultant level and were experiencing recruitment difficulties with junior doctors.

Our Resources

25. Mr O’Keeffe advised Governors of the Trusts’ robust financial management over the years and confirmed that the Trust remained on track to achieve all financial duties including a surplus to be reinvested by the Board of Directors.

26. The Trust was on plan to meet its key financial targets of: a) Breakeven £6.903m surplus b) Capital £21.853m c) Cash £12.018m d) BPPC 95%

Our Future

27. Key priorities for the Trust included reducing inpatient ligatures and restraint and good progress had been made in these areas. These issues continued to be part of the Trusts key priorities and work continued to improve and sustain these reductions.

Key Operational Issues for Clinical Divisions

Local Division 28. Mr O’Keeffe stated that the IAPT service continued to underperform against targets

and the Trust had received notification from Liverpool CCG advising that contract penalties would be imposed in 2016/17 as a result of this underperformance. Penalties were capped at 2.5% of the quarterly contract value; thus the penalty for quarter 1 was £0.03m. Despite this, there had been a significant improvement in waiting times following implementation of the new clinical model for the service. Mr O’Keeffe advised Governors that the Trust had inherited a series of performance issues when taking over the service and these issues were more significant than those identified through the due diligence process. Lessons had been learned from this experience and would be utilised going forward. Secure Division

29. The Quality Assurance Committee had been informed at their meeting in January 2017 that Mersey Care had been identified as the best performing mental health trust in respect of achievement of the flu vaccination target (75%).

Specialist Learning Disabilities Division

30. Mr O’Keeffe highlighted the 3 main performance issues as following: a) Safe contraction of services; b) Workforce retention and sickness levels;

Agenda Item No: A4b


c) Use of agency staff.

31. Mr McCarthy raised concerns in relation to plans to reduce the use of agency staff, stating that it was vital to ensure reductions were carried out in a safe manner and quality of service remained. Mr O’Keeffe concurred and confirmed the Board were aware of these issues and were considering this carefully to ensure any reduction in agency use was undertaken safely.

32. Mr Kitchen queried how the Trust were addressing staff sickness absence issues. Mrs Oates confirmed that whilst significant work had been undertaken to address the levels of staff sickness, other incentives were being considered and managers were supporting staff effectively through periods of ill health. In addition, Staff Side were involved in discussions relating to the provision of improved support for staff with a disability. Mrs Oates stated that the approach managers took was critical to address sickness absence in addition to an effective Occupational Health team. Staff side were working closely with HR managers to arrange and run joint training sessions for managers in order to provide a consistent message with regards to the management of sickness absence and the appropriate process for conducting return to work interviews following a period of sickness absence. Mrs Gregory noted the importance of staff feeling that they had an advocate during ‘return to work interviews’.

33. Mrs Oates advised Governors of the work undertaken by the Trust in relation to staff

health and wellbeing by offering discounts for exercise classes, Health and Wellbeing checks, rapid access to healthcare, health checks for the over 40’s and slimming world passes for a 12 week course which were free to eligible staff.

34. Mrs Doherty sought further clarification regarding the percentage of temporary staff, which was currently above the set target. Mr O’Keeffe confirmed that there were a number of factors which impacted upon temporary staffing levels including the need to ensure levels remained safe at Whalley following the resignation of staff pending the outcomes of the consultation. In addition, there were a number of temporary staff in place to manage the LCH bid process and those temporary contracts would cease in due course.

35. Mrs Birrell queried whether any long term investment in staff had been made. In

response, Mrs Oates confirmed that £2.4m had been invested in front line staff in 2016. The Trust had its own internal staff on a bank system which worked effectively and advised that the use of temporary staff was largely attributed to unplanned care, i.e., leave of absence for special reasons, hospital visit escorts and increased patient observations. Mrs Oates advised that funding had been secured from Health Education England to enable a student fast track programme for 20 individuals. These students would be available for employment in 2 years time.

36. In response to clarification sought by Mrs Doherty, Mrs Oates confirmed that in some cases, staff on long term sick leave who were unlikely to return to work, were dismissed.

Agenda Item No: A4b


37. With regard financial performance, Mrs Finlayson queried whether the cost

improvement plans (CIPs) were aggressively implemented. Mr O’Keeffe confirmed that the Board were comfortable that CIP’s were deliverable and where a team identified significant issues in delivery of a cost efficiency this was escalated and an alternative plan required.

38. Mrs Fraenkel thanked Mr O’Keeffe for his presentation and Governors for their

questions, noting that Governors were invited to contact Andy Meadows or the Corporate Governance team with questions at any time should any further questions arise regarding performance.

Action


Recommendations approved by the Council of Governors, namely: • Note the content of the report;


B2 QUALITY REVIEW VISITS

39. Mrs Bull provided an oversight of the Trust’s internal process to monitor quality, safety and compliance, known as Quality Review Visits (QRVs).

40. Mrs Bull advised Governors that the QRVs had been in place since 2012 which enabled a small team of staff and experts by experience to review the ward environment. The visits allowed for a review of systems and processes in addition to the general condition of the services, activities on the wards and feedback of staff, service users and carers.

41. Mrs Bull confirmed that Governors were invited to participate in the visits and a

number Governors had already attended these providing a valuable perspective. Mrs Bull stated that whilst Governors could be involved any aspect of the visit, a main priority would be gaining Governors views through observing and talking to service users, carers and staff.

42. Mrs Birrell requested that training be provided to Governors attending the visits to

outline their role, what to look for and how to complete any relevant pro-forma. Mrs Doherty concurred, stating that although she had participated in the visits and completed the pro-forma, it would have been helpful to have some background information and advice in advance. Mrs McDonnell agreed and emphasised the need for training to ensure Governors were able to confidently participate in visits.

Action


Recommendations approved by the Council of Governors, namely: • Note contents of the report;

Agenda Item No: A4b


• Review scope of their roles for involvement in QRV Process;

Further actions required: • Schedule ½ day Training session to offer guidance

to Governors attending QRVs.

J Bull

Apr-17

Due Apr-17

B3 CARE QUALITY COMMISSION INSPECTION – MARCH 2017 43. Mr Walker outlined to Governors the process and requirements for the Care Quality

Commission (CQC) inspection due to take place in March 2017.

44. Mr Walker advised that the CQC were changing the approach taken to inspect providers and would be returning to the Trust to undertake targeted reviews and examining specific areas following the acquisition of Calderstones. The focus of the inspection in March 2017 would largely be on inpatient areas in high secure services and Calderstones. A draft programme of events prepared by the CQC was anticipated w/c 16 January 2017 and it was expected that Inspectors would wish to meet with Governors.

45. Mr Walker advised that all core services would be reviewed against the 5 domains which were as follows: a) Safe; b) Effective; c) Responsive; d) Caring; e) Well Led; f) Fundamental Standards.

46. In addition, there were a series of proposed new key lines of enquiry (KLOE) for the

Well Led domain and these would replace the previous iterations. Whilst the new KLOE’s would not be implemented until 1 April 2017, the CQC had confirmed that the Trust would be reviewed against these in March. Mr Walker agreed to circulate information to Governors in relation to the Well-led domain for information.

47. Mr Walker advised Governors that the CQC Inspector link for the Trust had delivered a session to Board members on 14 December 2016 to present and discuss the new process of the Well Led Review and there were 5 CQC/MCT engagement meetings planned between December 2016 and March 2017. The Trust had been open and transparent with the CQC in relation to areas which needed addressing and were confident that all aspects had been considered.

48. Mr Walker informed Governors of the current issues and focus of the Trust in

preparing for inspection, which were: a) Delivery of the previous Action Plan; b) QRVs/Self Assessments; c) CQC MHA Review Visits; d) National Focus, e.g. Crisis Services / High Secure Services;

Agenda Item No: A4b


e) Staffing; f) Risks; g) Local Issues e.g. Irwell Ward; Closure of LD Whalley.

Action


Recommendations approved by the Council of Governors, namely: • Note the verbal update and PowerPoint

presentation;

Further actions required: • Circulate information in relation to Well Led domain

to Governors;

R Walker

Jan-17

Due Jan-17

C1 REVIEW OF THE TRUST’S STRATEGY AND OPERATIONAL PLAN (INCLUDING PRESENTATION) 49. Mrs Edwards and Mr O’Keeffe provided an update and presentation to Governors

regarding the annual review of the Trust’s strategy and the planning process for 2017/18 and 2018/19.

50. Mrs Edwards stated that the Trust were entering the 4th year of delivery against its strategy wheel, which captured the issues that were most important to the Trust and highlighted its priorities in respect of the four key areas; a) Our Services; b) Our People; c) Our Resources; d) Our Future.

51. Mrs Edwards confirmed that the Strategy was reviewed and turned into a plan on an annual basis and outlined the changes made since the previous year due to the changing landscape, i.e., the acquisition of Calderstones, becoming a Foundation Trust and being awards preferred providers status for South Sefton Community Health Services, as examples.

52. Mrs Edwards highlighted the recent focus of the Prime Minister on mental health, but noted that no additional resources would be made available regardless of new targets to be introduced including access targets.

53. Mr O’Keeffe highlighted that improving quality, reducing costs and managing

increasing demand was the Trust’s key challenge going forward and it was important to ensure robust planning to achieve this. Mrs Edwards concurred and confirmed that delivery of transformation programmes would continue to be the focus of the Trust.

54. In relation to resources, Mrs Edwards noted that the Trust would face increasing

financial pressures over the next year but had a good track record of financial management.

Agenda Item No: A4b


55. Mr McCarthy referred to non-attendance at appointments [DNA’s] and suggested that the Trust could eliminate the vast majority of DNAs at clinics by adopting the systems utilised by other NHS providers, specifically, sending text message reminders for clinical appointments. Mrs Copeland-Blair confirmed that some work had commenced in relation to this approach and a digital strategy was place which included how to support service users to attend appointments. Mrs Copeland-Blair agreed to provide an update to Governors in due course.

56. Mrs McDonnell raised a concern in relation to the limited opportunities to provide input

as Governors regarding key issues. Mrs Edwards stressed the importance of listening to people and confirmed that input from Governors would be welcomed, but noted that a suitable format to do this had yet to be implemented. Mr O’Keeffe concurred, stating that the Council of Governors was still in its infancy and the environment was new both Governors and Board members. Mrs Fraenkel noted Mrs McDonnell’s concerns and highlighted the next report on the agenda in relation to engagement and communication, which would enable this concern to be taken forward.

57. Mrs Moore noted Mrs McDonnell’s concerns and highlighted that attendance at

previous Governor meetings had provided confidence to speak up and question issues.

58. Mr Meadows acknowledged the issues raised and referred to an engagement initiative

utilised with staff entitled ‘You said… we did…’ which demonstrated actions taken to address issues raised by staff and provided assurance that staff were heard, noting that consideration could be given to adopting a similar scheme for Governors. Mrs Fraenkel concurred, adding that the Council of Governors was a new arrangement and lessons were being learned as they progressed.

Action


Recommendations approved by the Council of Governors, namely: • Note the update regarding the planning process for

2017/19; • Comment on the emerging priorities and the

proposal to prioritise the development of ‘firm foundations, but doing the basics consistently well.’

Further actions required: • Update to be circulated to Governors in relation to

the Digital Strategy/ supporting service users to attend appointments;

• Corporate Governance Team to consider Your Voice Your Change approach;

W Copeland-Blair A Meadows

Mar-17 Feb-17

Due Mar-17 Due Feb-17

D1 MEMBERSHIP AND ENGAGEMENT 59. Mr Meadows noted that all Governors had been invited to attend an informal meeting

to commence discussions regarding how they wished to communicate and engage with the wider membership going forward and as such, a number of Governors had

Agenda Item No: A4b


attended a meeting on 28 November 2016 at Quaker Meeting House, Liverpool. The outcomes of these discussions were reflected in the report provided and included a series of recommendations for consideration and approval by Governors.

60. Mr Meadows advised that all Governors present at the November 2016 meeting had supported the need to establish a Membership and Engagement Committee of the Council of Governors in order to: a) support the Trust in developing and engaging the membership; b) review and oversee implementation of the Membership Strategy; c) develop a mechanism to facilitate the communication between Governors,

members and the local community. 61. There was consensus that membership of this proposed committee should not be

limited to allow all interested Governors to participate. The proposed Terms of Reference for the Committee had been prepared reflecting the discussions and were attached in appendix A for approval.

62. In light of earlier discussions, Mrs Fraenkel asked Governors if they were in a position to support this paper and develop it further, or whether they wished to revise the proposals. Mrs Moore stated that Governors needed to take ownership of the communication and engagement mechanisms, therefore should agree the recommendation of the report to allow progress. Mrs McDonnell declined to support the paper, stating that lack of a limit on committee membership would lead to a large committee in which progress would be hindered. Mrs Birrell added that on occasions, Governors were outnumbered by Trust staff at meetings and this should be considered when determining the membership of committees. Mrs Fraenkel proposed that the recommendations be agreed to allow establishment of the Membership and Engagement Committee and confirmed that following its initial meeting, there would be opportunity to revise the terms of reference should membership be inappropriate.

Action


Recommendations approved by the Council of Governors, namely: • Consider and agree the implementation the

proposed mechanisms for communication and engagement outlined in paragraphs 8-15 above;

• Approve the proposed establishment of the Membership and Engagement Committee;

• Approve the Membership and Engagement Committee Terms of Reference outlined in Appendix A;

• Note that the Membership Strategy will be reviewed by the Membership and Engagement Committee in spring 2017 and presented to the Council of Governors for approval.


Agenda Item No: A4b


D2 APPRAISAL OF THE CHAIRMAN AND NON-EXECUTIVE DIRECTORS 63. Mr Meadows provided a summary of the outcomes of the Chairman’s and Non-

Executive Directors’ annual appraisals and confirmed areas for their further development.

64. Mr Meadows advised that the appraisals were conducted in line with the process agreed at the previous Council of Governors meeting in September 2016 and no significant performance issues had been identified through this process.

Action


Recommendations approved by the Council of Governors, namely: • Note the outcomes of the process for the appraisal

of the Chairman; • Note the outcomes of the process for the appraisal

of the Non-Executive Directors; • Note the completion of the annual Fit and Proper

Persons Test self-Declaration by all Non-Executive Directors;

• Note that the appraisal process will be reviewed for 2017/18 by the Nomination and Remuneration Committee.


65. The remainder of the agenda was held in private.

66. The meeting closed.

Agenda Item No: A4b


PAGE INTENTIONALL BLANK

Agenda Item No: B1

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COUNCIL OF GOVERNORS

Report provided (check necessary boxes): Paper No: COG16/17/026

To Note: ☒ For Decision ☐ Meeting Date: 27 April 2017

REPORT ON FINANCIAL AND ACTIVITY PERFORMANCE

Report Author(s): Wendy Copeland-Blair, Head of Performance Improvement and Customer Relationship Management

Summary of Key Issues:

• The trust is performing well against the majority of key performance indicators for the three months ending 28 February 2017.

• The Care Quality Commission undertook an inspection of all core services and completed a “Well-Led” review during week commencing 20 March 2017.

• The trust has been allocated by NHS Improvement to segment 2 in the single oversight framework and has been allocated a finance and use of resources score of 3.

• Key areas for performance improvement include: o NHS Improvement Single Oversight Framework

Agency spend Data completeness: priority metrics Improving Access to Psychological Therapies

(IAPT): Recovery Staff sickness Aggressive cost reduction plans 7 day follow up for people on the Care

Programme Approach (CPA) Written complaints rate per 1000 staff

o Serious Incidents (StEIS) incidents (Our Services) o Physical health – physical health screening for new

admissions and annual physical health checks for community service users on CPA (Our services)

o Patient Experience (Our Services) o Bed Management - Unplanned out of area placements

(Our Services) o Detention under MHA for BME service users (Our

Services) o Leadership and Management Continuity (Our People) o Statutory Training (Our People) o Sickness Absence (Our People) o Vacancies v Budgeted Establishment (Our People) o Spend on information management and technology (Our

Resources) o Commissioning for Quality and Innovation (CQUIN) –

Physical health (Our Resources) o NHS Improvement Finance and Use of Resources

Score (Our Resources) o Inpatient Ligature Incidents (Our Future) o Restrictive Practice Incidents (Our Future)

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o Contract Risks - Talk Liverpool (Our Future) Recommendation:

The Council of Governors are asked to: 1) Note the content of this report.

PURPOSE

1. To provide the Council of Governors with an overview of trust performance for the three months ending 28 February 2017.

BACKGROUND

2. The trust’s approach to performance reporting enables scrutiny of performance in the following areas:

a) Regulatory – this includes information relating to the trust’s compliance with Care Quality Commission requirements and performance against indicator in the NHS Improvement Single Oversight Framework.

b) Our services – this looks at whether services are safe, timely, effective, equitable, efficient and patient centred.

c) Our people – this looks at whether we have supported managers and effective teams, a productive workforce with the right skills and the extent to which we working side by side with service users and carers.

d) Our resources – this looks at our investment in technology to help us provide better care, buildings that work for us, how we can save time and money to ensure the most efficient use of the funding we get and our NHS Improvement finance and use of resources score.

e) Our future – this includes measures that show the benefits of research and innovation, our progress in growing our services and how we work effectively with primary care and other organisations.

3. The new report also enables the three clinical divisions to highlight key operational performance issues.

4. This paper is organised into the areas above for consistency of approach.

ISSUES

Regulatory

Care Quality Commission (CQC)

5. The CQC inspection commenced on 20 March 2017 and the final interview took place on 6 April 2017. Item F1 on the agenda will provide information on initial feedback and actions resulting from the inspection process.

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NHS Improvement – Single Oversight Framework

6. On 1 October 2016, NHS Improvement implemented the Single Oversight Framework (SOF) as the mechanism by which performance of NHS trusts and NHS foundations trusts is monitored. The SOF includes five themes:

a) quality of care b) finance and use of resources c) operational performance d) strategic change e) leadership and improvement capability

7. Trusts have been segmented by NHS Improvement based upon their performance against the measures in use. The segments range from 1 to 4 with 1 confirming that trust can operate with maximum autonomy and segment 4 being aimed at providers who would be considered to be in special measures (where there has been an actual or suspected breach of the provider’s licence conditions).

8. The trust remains in segment 2 based on the good CQC rating and our operational performance and is achieving the majority of metrics associated with the SOF. Exceptions are reported below.

9. The trust is currently 77% above national spending targets for agency staff and this has led to the trust receiving a finance and use of resources score of 3. Analysis of the reasons for this identified high levels of medical locums within the local division; the trust’s hosting of iMerseyside (which provides information technology support to a number of other organisations); agency nursing costs in the specialist learning disability division to fill vacancies following the decision by NHS England to announce the closure of the Whalley site services; and short-term posts within the corporate division for people with specialist expertise to support the work on the acquisition and integration of Calderstones Partnerships NHS Foundation Trust; the bids for community physical health services in Liverpool and Sefton and the subsequent transaction for Sefton. The most recent report to the executive committee anticipated a rise in the use of agency staff within the local division due to requirements in the supported living service to ensure roster compliance.

10. Actions to address this area of underperformance include:

a) An approach to NHS Improvement to ask for a review of the agency cap value to acknowledge the particular circumstances for the trust; particularly in relation to the acquisition of Calderstones and the hosting of iMerseyside.

b) Any override of price and wage cap rules has to be approved by an executive director.

c) Development of a plan by the associate medical director of the local division to address medical locum spend. The most recent report to the executive committee suggested that spend on locum consultants has started to reduce.

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d) The use of the centralised agency booking service has been strengthened and approval levels amended with only director level roles now able to approve.

e) Roll out of the bank module of the roster system across the trust from 1 April 2017.

f) A review of all agency staff in post for more than six months with any future planned spend on these roles to be approved by the executive team.

g) Monthly reporting continues to the executive team via the Agency Expenditure Ceilings Report.

11. Based on our internal analysis, we continue to have a number of operational performance and quality indicators currently underperforming:

a) Data completeness - priority metrics (ethnicity, settled accommodation status, employment status). Data is being supplied to the divisions to enable breaches of these requirements to be addressed. The outstanding information can only be obtained from service users during planned reviews or when one of our staff has direct contact with the service user. It has been agreed that performance will continue to be monitored over M12 2016/17 and M1 2017/18 to ascertain if further improvement support is required.

b) Talk Liverpool (IAPT) – For the percentage of people moving to recovery, a small improvement has been observed in the last month but there is still a significant distance between the current level of performance and the target. This was an expected consequence of the work agreed with NHS England and commissioners to reduce waiting times for the service.

c) Sickness absence – further information is provided in the “Our people” section.

d) Aggressive cost improvement plans – the trust’s cost improvement plans were equivalent to 5.82% of budget to the end of February 2017. NHS Improvement consider plans of above 5% of budget to be “aggressive”. All cost improvement plans are subject to a quality impact assessment by the medical director and executive director of nursing prior to submission to the performance, investment and finance committee and the trust board for approval.

e) 7 day follow up for people on the Care Programme Approach (CPA) – in February 2017 there were 10 breaches of the seven day follow up standard. The local division has investigated each case and has identified opportunities to improve processes. Performance will continue to be closely scrutinised.

f) Written complaints rate - In Q1 2016/17 (as reported for November to January 2017 in the Care at a Glance report) the data was based on the number of complaints per 10,000 open mental health referrals and the trust compared positively with this benchmark. In Q2 2016/17 a change in methodology was implemented by NHS Digital and the rate is now based on the number of new written complaints per 1000 staff. This data is classified as experimental by NHS Digital. The upper decile for Q2 2016/17 is 37. A further analysis to look at complaints rates by each division based on this approach is in train to identify where opportunities for improvement might lie.

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Our services

12. The number of serious incidents (reported through the Strategic Executive Information System, StEIS) remains fairly consistent. All StEIS incidents are subject to a 72 hour safety review and, where, appropriate a full serious incident review will be undertaken. The Quality Assurance Committee provides oversight of incident management processes. The percentage of all incidents that result in harm continues to be below target.

13. The trust has now started to report on a new indicator relating to screening of all new admissions in line with the seven standards detailed in the national audit of schizophrenia:

a) body mass index, or waist circumference; b) blood pressure; c) use of tobacco; d) use of alcohol; e) substance misuse; f) blood levels of glucose and lipids (total cholesterol and HDL cholesterol); g) history of cardiovascular disease, diabetes, hypertension or dyslipidaemia in

members of the service user’s family.

14. The initial data for this new indicator shows very low levels of compliance with these standards and an investigation is underway to understand what actions to improve performance are required.

15. In Q3 2016/17, the percentage of services users on CPA for whom an annual physical health check has been completed was reported as 51.09%. The trust’s physical health strategy group are reviewing the community physical health pathway with a view to clarifying the roles and responsibilities in relation to physical health checks for people on CPA. In the meantime, the local division operational management team has asked all care co-ordinators to ensure that they ascertain the physical health check status for people on their caseload and work with GPs to ensure health checks are completed. Staff have also been reminded to ensure completion of the field within the community physical health form on ePEX. Interim data for Q4 2016/17 suggests that the position has improved but work is still required to hit the target of 95%.

16. Patient experience continues to report about 90% but is still below the 95% quality target set for 2016/17. The scores for community services have dropped below 90 on five occasions since April 2016. The patient experience results continue to be monitored at a local level and scrutinised through divisional surveillance meetings alongside other quality indicators.

17. The trust continues to achieve the trajectory for delayed discharges agreed with NHS Improvement. There has been a pleasing reduction in the number of unplanned out of area placements within the local division over the last three months (from 23 in December 2016 to 6 in February 2017) but this continues to be a focus both from a patient experience perspective and to support NHS England’s aspiration to eliminate “inappropriate out of area placements by 2020/21”. Concerns also exist relating to the potential for delays to discharge in the specialist learning disability division and the bed

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retraction plans shared with NHS Improvement have proven difficult to deliver because lack of appropriate placements in the community. The trust is working closely with commissioners to ensure early resolution of these issues.

18. The trust continues to see a disproportionate use of the Mental Health Act for people with a black or minority ethnic group. A programme of work is in train in response to this. This includes engagement with UCLAN to support a more comprehensive analysis of the data to support the identification of key areas, with the aim of developing a 5 year plan to support a long term change. A community engagement session was planned for 16 March 2017 to support a co-production with the communities we serve.

Our people

19. An improvement in the number of teams reporting that there has been a substantive consultant, team manager and deputy manager in post for three months or more has been observed since December 2016 with 80.88% of teams now reporting positively for this question in the trust’s team self-assessment process. Continued work is in train by all clinical divisions to drive further improvements.

20. In February 2017 all managers were given access to reports showing the statutory and mandatory training information for their teams. This has enabled managers to focus on releasing non compliant staff to complete their training. Organisational effectiveness and learning staff are continuing to target “hot spots” as identified within our new organisational reports. This work has resulted in a 16% increase in performance since November 2016.

21. Sickness absence rates continue to be above target and spiked in January 2017 to 8.22% but have subsequently reduced to 7.16%. A deep dive session took place with the Trust Board on 22 February 2017 from which a draft action plan has been developed.

22. The trust has seen vacancy rates reduce to 7.21% at the end of February 2017 with the highest rates (9.17%) in the specialist learning disability division. A strategic recruitment and retention map has been agreed and a task and finish group established to address vacancies. Currently, there is an issue regarding vacancies for junior medical and staff grade, specialty and associate specialist (SAS) doctors; a medical staffing recruitment paper has been agreed.

23. Pleasing performance continues to be observed for the measure relating to working side by side with service users and carers with over 95% of people completing the trust’s patient experience questionnaires reporting that they have been involved in the development of their care plan.

Our resources

24. The trust is on plan to meet its key financial targets of: a) Breakeven £6.903m surplus b) Capital £13.437m c) Cash £20.248m

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d) BPPC 95%

25. In December the Trust received notification from HM Treasury of a 1% change to the discount rate. This will impact upon the trusts provisions for Early Retirements and Permanent Injury Benefit. Mersey Care has an unusually high level of provisions (circa £22.183m) and when applied creates a technical cost pressure to the trust of £2.740m. Whilst this is a non-cash adjustment it would reduce the Trust surplus in 2016/17.

26. The spend on Information Management and Technology (IM&T) is currently above plan. This is primarily due to information technology support, maintenance costs and agency costs. Actions are being implemented to resolve overspends.

27. There is a small risk of not receiving all of the income attached to the Commissioning

of Quality and Innovation (CQUIN) schemes. This relates to targets linked to physical health and the financial risk amounts to £0.080m.

28. As mentioned previously, the trust’s finance and use of resources score is 3 as a result

of agency expenditure in excess of the value set by NHS Improvement.

Our future

29. Through the investment in research and innovation, the trust anticipates sustained reductions in the number of inpatient ligatures and restrictive practice:

a) Inpatient ligatures: The trust monitors this data on an in quarter basis and has observed an increase in the number of inpatient ligature incidents within the local division in Q3 2016/17 (from 19 in Q2 2016/17 to 26 in Q3 2016/17). A design thinking project is underway and the last update (reported in February 2017) indicated that this was at the stage of identifying remedial actions.

b) Restrictive practice incidents: A small increase in the number of restrictive practice incidents in the last twelve months has been observed in the local and secure divisions in the period November 2016 to January 2017. Work is in train to ensure accurate reporting for the specialist learning disability division and the target will be reviewed upon receipt of the new baseline information from the patient safety team. The No Force First programme continues to be a key component of the trust’s perfect care aspirations and aims to eliminate physical restraint and medication led restraint within Mersey Care NHS Foundation Trust.

30. The trust awaits tender outcomes for Liverpool Mutual Homes, Bury Council.

31. The trust was successful in its bid to become a Global Digital Exemplar1. A global digital exemplar will be an internationally recognised NHS care provider delivering exceptional care, efficiently, through the world-class use of digital technology and information flows, both within and beyond their organisation boundary. It will also be a reference site to other care providers.

32. The trust has identified a small number of risks associated with contracts:

1 https://www.england.nhs.uk/digitaltechnology/info-revolution/exemplars/

https://www.england.nhs.uk/digitaltechnology/info-revolution/exemplars/

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a) Increased demand due to block contract – there is a national directive to move away from block contract arrangements from 2017/18.

b) Investment in liaison services – non-recurrent funding has been provided in the 2017/19 contract offer and the trust is working on a bid to secure further funding for a Core 24 service.

c) Underperformance against the early intervention in psychosis referral to treatment target – the trust has received a 1% uplift on the local clinical commissioning groups’ (CCGs’) contract offer. This is to fund ‘must dos’ in the five year forward view for mental health and will be used to provide additional funding to the Early Intervention in Psychosis services.

d) Talk Liverpool performance and delivery of the agreed recommendations following the NHS England Intensive Support Team review – the trust continues to work closely with NHS England and the NHS Liverpool CCG to redesign the service and put a revised improvement plan in place. There is a potential financial risk of £0.120m for non-delivery of key performance indicators.

Key operational issues for clinical divisions

Local division

33. The division continue to proactively monitor the use of out of area placements which has decreased during the month of February. The chief operating officer has also attended the first meeting of the NHS England led Out of Areas Placements (OAPs) meeting to look at reducing OAPs across the Cheshire and North Mersey footprint.

34. The is currently reviewing all inpatients who have had a stay in excess of 90 days to identify any blockages that are delaying timely discharge. A formal report will be presented to the Operational Management Board in April.

35. The division have agreed all CQUIN requirements for 17/18. An action planning meeting has taken place and recruitment commenced in March to support delivery of key performance metrics.

36. Staffing continues to be a pressure however successful recruitment events have taken place for support staff and vacancies continue to be proactively managed. A dedicated recruitment event for Southport is being planned due to the difficulties recruiting in this area.

37. The division have been successful in securing significant Sustainability and Transformation Plan (STP) funding to develop liaison services to achieve Core 24 model fidelity. Formal notification is yet to be received; however the division have held an internal workshop resulting in a number of task and finish groups to enable rapid development of the model post April. This will involve external partners.

Secure Division

38. Delayed discharges remain an issue in low secure and they continue to be escalated with Commissioners.

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39. Recruitment is ongoing; since January 13 staff nurses and 20 nursing assistants have been appointed. This has resulted in 3.2 WTE staff nurse vacancies and 24 WTE nursing assistant vacancies at the end of February 2017. The next round of recruitment of the nursing assistants has commenced. In addition to this, 17 apprenticeship posts were appointed in February 2017.

40. Safe staffing levels have improved slightly across the Division, however fill rates on some of the medium dependency wards in high secure are running below 90% due to low patient occupancy.

41. Patient experience scores continue to report well for the Division, any dips in performance are considered at Surveillance.

42. The Division has achieved 2016/17 CIPs and is forecasting a £300k under spend for year end.

43. All Secure CQUIN schemes are on target to be achieved.

Specialist Learning Disabilities Division

44. Safe Contraction of Services/Implementation of new clinical models is a key issue for the Division. This work is now overseen by the Strategic Implementation Group held monthly and is now chaired by the Executive Director of Operations.

45. The NHS England consultation on the future of the Whalley site closed on 23rd February. Joint meetings with NHS England were held on 13 March 2017 to understand the feedback from the consultation and next steps. The Chief Operating Officer has completed the Road shows with the Divisional teams. Staff have reported positively about ‘knowing as much as we do’.

46. The Division has developed a financial recovery plan and the Division is working hard to keep the additional costs to a minimum. The main issue remains in covering vacancies with higher cost agency staffing due to the inability to recruit.

RECOMMENDATION

47. The Council of Governors are asked to:

a) Note the content of this report.

WENDY COPELAND-BLAIR HEAD OF PERFORMANCE IMPROVEMENT

13 April 2017

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END OF DOCUMENT

Agenda Item No: B2

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Report provided (check necessary boxes): Item No: COG17/18/027

To Note: ☐ For Decision ☒ Meeting Date: 27 April 2017

2016/17 Quality Account – Indicator Testing

Report Author(s): Helena McCourt Deputy Director of Nursing


• The 2016/17 Quality Account will be published on the 31st May 2017.

• The Quality Account will describe the quality improvement priorities for 2017/18. Appendix A provides details.

• In line with the most recent guidance on Quality Accounts issued by NHS Improvement in early February, as a Foundation Trust we are now required to ask the Council of Governors to choose an indicator from those included in our Quality Account which they would like the Trust’s auditors to look into further by undertaking some testing.

• Due to timing, members of the Membership and Engagement committee were asked to consider which indicator they would prefer to be tested from those outlined in section 5.

• At the meeting on 24 February 2017 the indicator chosen as a preference was: (1) Early intervention in psychosis (EIP): people experiencing a

first episode of psychosis treated with a NICE-approved care package within two weeks of referral;

Recommendation:

The Council of Governors is asked to: 1) Formally approve the indicator to be tested. Subject to the

feedback received, external auditors can then complete testing. 2) Consider and comment on the priority areas for 2017/18.

PURPOSE

1. All NHS foundation trusts trust must publish quality account each year. These quality accounts help trusts to improve public accountability for the quality of care they provide and support service users and carers to know that they are receiving the very best quality of care. They include our performance against the quality priorities we set for the previous year, in addition to our quality priorities for the following 12 months.

2. The following four priorities for 2017/18 are detailed in appendix A: 1) No Force First 2) Towards Zero Suicide 3) Physical Health Pathways

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4) A Just and Learning Culture

3. Trusts are also required to obtain external assurance on their quality account. Subjecting them to independent scrutiny improves the quality of data on which performance reporting depends. This is undertaken by our external auditors.

BACKGROUND

4. In line with the most recent guidance on Quality Accounts issued by NHS Improvement in early February 2017, as a Foundation Trust we are now required to ask the Council of Governors to choose an indicator from those included in our Quality Account which they would like the Trust’s auditors to look into further by undertaking some testing

5. Auditors will test a total of three indicators – two are selected from a list of three provided by NHS Improvement and based on our previous discussions they will be looking to test the Care Programme Approach indicator and Access to Crisis Resolution and Home Treatment indicator. The third will be that indicator chosen by the Council of Governors.

6. The relevant indicators from which we would like to seek the Council of Governors views on their preference for testing by external auditors are as follows:

a) Early intervention in psychosis (EIP): people experiencing a first episode of psychosis treated with a NICE-approved care package within two weeks of referral;

b) Improving access to psychological therapies (IAPT) - people with common

mental health conditions referred to the IAPT programme treated within 6 weeks of referral

c) Improving access to psychological therapies (IAPT) - people with common


d) The number and, where available, rate of patient safety incidents reported within

the trust during the reporting period, and the number and percentage of such patient safety incidents that resulted in severe harm or death.

PROCESS

7. The indicator testing by our external auditors must be completed before our Board approve our Quality Account on 24 May 2017.

8. Given the short period of time between seeking the Council of Governors selection if an indicator and circulation of the final Quality Account to the Board of Directors for approval, we requested that the Membership and Engagement Committee consider and discuss whether there is an indicator of preference.

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9. Whilst the Committee could not formally make this decision at the meeting on 24 February 2017 the indicators chosen as a preference were, for recommendation to the full Council of Governors was as follows:

a) Early intervention in psychosis (EIP): people experiencing a first episode of psychosis treated with a NICE-approved care package within two weeks of referral;

b) Meeting commitment to serve new psychosis cases by early intervention teams; (Note: following the meeting we were informed that NHSi have now removed this indicator.)

RECOMMENDATIONS

10. The Council of Governors is asked to: a) Formally approve the indicator to be tested. Subject to the feedback received,

external auditors can then complete testing. b) Consider and comment on the priority areas for 2017/18.

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APPENDIX A – Quality Account Priorities for 2017/18 Priority 1: No Force First a) By September 2017 all wards will implement a debriefing protocol after incidents for

both service-users and staff to ensure individual and organisational learning takes place following incidents.

b) By March 2018 the core strategies from the Reducing Restrictive Practice Guide will

be implemented on all wards. The wards will produce evidence of these strategies and the impact on the ward. This will be reported into the Reducing Restrictive Practice Monitoring Group.

c) By March 2018 all ward managers will demonstrate a reduction of a minimum of three

restrictive practices in local protocols (not related to security requirements in secure services).

d) By March 2018 planned prone restraint (face down floor based restraint) will be

reduced by 20% as part of our longer term strategy to eliminate completely. e) By March 2018 a Research Evaluation of the programme will be completed by

Liverpool University. Priority 2: Towards Zero Suicide a) By September 2017 a Suicide prevention dashboard will be in place to track and

monitor progress on the 10 key parameters for safer mental health services. By March 2018 a report will be produced on the effectiveness of the dashboard as a performance improvement tool, to support clinical decisions.

b) By March 2018, the safety planning intervention will be integrated to the Level 2

Suicide Prevention training and will be made available at high risk points and there will be a core staff group able to implement the plan.

c) By March 2018 in-patient wards will be implementing a design based solution to

reduce self-harm, with an evaluation completed. d) By March 2018 a proof of concept study on the zero suicide app in conjunction with

Stanford University will have been completed. e) The Safe from Suicide team will continue to monitor and measure suicide and near-

fatal self-harm data and respond with enhanced support and interventions, including training, supervision, psychologically informed risk formulations and safety planning. Specific team based interventions will result from the suicide data, where problems are identified.

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Priority 3: Improvements In Physical Health Pathways

a) By September 2017, the physical health pathway for community service users on care programme approach will be fully implemented.

b) By March 2018, there will be a 90% uptake of the Annual Health Check (AHC) for all

long stay inpatients across all clinical divisions. c) By March 2018 65% of community service users on CPA will have a completed

physical health pathway. d) By March 2018, 100% of inpatients screened as smokers will have prescribed nicotine

replacement therapy on admission. Priority 4: A Just And Learning Culture By March 2018:

a) Build opportunities for rapid, accessible learning by:-

Transforming QPA into a valued alerts (ie colour code red, amber, green) Monthly learning publication (ie good practice stories Standardised MDT meetings

b) Implementation of simplified policies and processes that support and enable a Just

and Learning Culture A review of key policies raised:- managing attendance, disciplinary, incident

reporting and investigations Operationalise a Just Culture incident decision tree

c) Establish a culture that values and embeds learning and creates an open, safe and

supported environment to report, share and learn. revolutionising RCA investigations/72 hour reports into compassionate, dynamic

learning reports and processes Supporting staff if things go wrong

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END OF DOCUMENT

Agenda Item No: C1

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COUNCIL OF GOVERNORS Report provided (check necessary boxes): Paper No: COG/17/18/028


Acquisition of South Sefton Transaction

Report Author(s): Trish Bennett, Director of Integration Chris Lyons, Acquisition Programme Director


This paper outlines the background, process and benefits of the proposed transfer of South Sefton Community Services from Liverpool Community Health NHS Trust to Mersey Care NHS Foundation Trust and asks the Council of Governors to note and be assured that proper processes (for example due diligence) have been undertaken in line with guidance issued by NHS Improvement for the management of such transactions. Although this transaction has not been classified as a ‘significant transaction’ – as was the case when Mersey Care acquired Calderstones Partnership NHS Foundation Trust – it is still appropriate we notify and seek the approval of Governors. The Board of Directors will be considering this transaction at its meeting on 26 April 2017.

Recommendation:

The Council of Governors is asked to: 1) approve the trust submitted its application to NHS Improvement

to seek approval of the proposed transfer of South Sefton Community Services (currently provided by Liverpool Community Health NHS Trust); and

2) in making such approval, the Council of Governors are satisfied that the Board of Directors has been thorough and comprehensive in reaching its proposal (that is, has undertaken proper due diligence).

PURPOSE

1 This paper outlines the background, process and benefits of the transfer of South Sefton Community Services (currently provided by Liverpool Community Health) to Mersey Care and asks the Council of Governors to agree to progress an application to NHS Improvement for the transaction to be approved.

2 Governors are responsible for satisfying themselves that the Board of Directors has been thorough and comprehensive in reaching its proposal (that it has undertaken proper due diligence). Provided appropriate assurance is obtained – which this paper seeks to provide - Governors should not unreasonably withhold their consent for the proposal to go ahead.

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BACKGROUND – CONSIDERING THE PROPOSAL

3 It is a decision of the Board of Directors as to whether the proposed transaction should proceed but this decision is conditional on the majority of Governors in post being assured the Board of Directors has undertaken the correct process. The Board of Directors will themselves be considering this application at their meeting on 26 April 2017, and a verbal update on the outcome of that meeting will be provided to the Council of Governors meeting on 27 April 2017

4 In considering their decision, the Board of Directors will consider

a) why they believe the transaction is necessary;

b) the full range of risks involved;

c) the assurance provided that these risks are manageable; and that

d) the transaction has been manage in accordance with national guidance..

BACKGROUND TO THE PROPOSAL

5 A decision was taken that Liverpool Community Health (LCH) would no longer be viable as a standalone healthcare provider and as such NHS Improvement and the local CCGs decided to split LCH into 13 different ‘bundles’ of services. The two major ‘bundles’ – community services in Liverpool and community services in South Sefton – were put out to tender. Mersey Care bid for both these ‘bundles’ in consortium with its partner, North West Boroughs Healthcare NHS Foundation Trust (formerly 5 Boroughs Partnership, who changed their name on 1 April 2017)

6 Mersey Care (with North West Boroughs) has been identified as the preferred provider to provide community services for the South Sefton ‘bundle’, with the intention that we seek to transfer services on 1 June 20171. As part of this process we are required to submit a Full Business Case, complete a due diligence process and submit a number of self-certificates to NHS Improvement for the regulator to approve Mersey Care taking over the community physical healthcare services for South Sefton. Again the Board will be considering these at its meeting on 26 April 2017.

7 Our bid price is £22.5m per annum plus £2.6m transaction costs and is based upon creating a ‘bio-psycho-social’ clinical model whereby we will bring the physical community healthcare services in South Sefton (currently provided by Liverpool Community Health) together with the mental health / learning disability / addiction community services in South Sefton (currently provided by Mersey Care) under a single set of clinical and management arrangements.

8 Approximately 410 staff will transfer in total to both Mersey Care and North West Boroughs Healthcare, with the majority transferring to Mersey Care.

1 Mersey Care was unsuccessful in its bid for the Liverpool ‘bundle’, although no successful

bidder has been identified for Liverpool

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9 We believe this is a unique opportunity for Mersey Care to successfully implement truly integrated community physical and mental health services which we believe will provide a better service to the people of South Sefton.

SERVICES TO BE PROVIDED

10 Mersey Care will be the main provider contracted by NHS South Sefton Clinical Commissioning Group (CCG) to provide community physical health services to South Sefton. However as part of our consortium arrangements, we will sub-contract elements of the community services in South Sefton to North West Boroughs Healthcare. A list of these services we will be providing directly and through the sub-contract are outlined in the table below:

Mersey Care providing care • Adult Occupational Therapy • Adult Physiotherapy • Community Matrons • District Nursing • Total Wound Purchasing • Virtual Ward • Adult Dietetics • Adults Speech and Language Therapy • Adults Diabetes • Community Respiratory • IV Therapy • Palliative Care • Podiatry • Heart Failure • Respiratory • X-Ray • Treatment Rooms • Psycho-sexual Service • Adult Safeguarding • Discharge Planning • Integrated Care Sefton Direct • Intermediate Care (bed-based and community) • Vaccination and Immunisation

Subcontracted to North West Boroughs Healthcare:

• Phlebotomy • Community Equipment • Walk-in Centre • Child Safeguarding • Specialist Children's Services

Hosted by Liverpool Community Health pending confirmation of acquiring organisation for the Liverpool Bundle:

• Single Point of Access • Child Health Information • Health Records

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PHASES FOR THE TRANSACTION

11 There are two key phases in relation to this transaction:

a) ‘Pre Transaction Phase’ (Phase 1) runs from the 1 December 2016 to date of Transaction on the 1 June 2017. This phase involves: • the development of a Full Business Case (FBC), detailed Integration Plan and

self-certificates for approval by the Board of Directors and NHS Improvement (as well as to provide assurance on the completion of the proper processes to the Council of Governors),

• the completion of a comprehensive due diligence exercises in order to identify the financial implications, quality considerations and all risks associated with the transaction, which in turn will inform the development of the FBC, Integration Plan and self-certificates considered by the Board of Directors and NHS Improvement,

• completion of the new clinical model with its ‘bio-psycho-social’ vision for services,

• identifying and implementing of all the tasks necessary to allow for the both the safe transfer and legal transfer of services to Mersey Care (e.g., to identify which staff, equipment and building need to be transferred) so that services may continue to be provided as usual from 1 June 2017

b) ‘Post Transaction Phase’ (Phase 2) runs from date of transfer, i.e., from 1 June 2017 over a 5 year period. This phase will be divided into sub-phases by year. .

12 Programme management arrangements have been established to manage all aspects of this transaction. Overseen by a Transaction Steering Group which meets every fortnight, eight workstreams have been established to allow focused work to take place and ensure the smooth transfer of services. These workstreams are:

• Clinical Services • Clinical Governance • Corporate Governance • Workforce • Informatics and Performance • Estates • Finance • Communications

13 The Transaction Steering Group is accountable to a Joint Oversight Group, a coordinating group made up of senior Mersey Care and North West Boroughs staff, chaired by Joe Rafferty.

14 In addition a Strategic Partnership Board has been established to oversee the strategic development of physical community and mental health services in South Sefton, in partnership with other key stakeholders, including South Sefton CCG, Sefton Council, and local GPs

15 It is expected that the delivery and the integration of community services in South Sefton will take place over a 5-year timeframe, as set out overleaf:

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Year One

• Safe transfer of staff and infrastructure to new organisation • Quality assurance and risk management processes operational from

day one. • Separate division within Mersey Care.

Year Two

• Key aspects of clinical model activated • First year efficiencies made through natural efficiencies • Separate division within Mersey Care, although looking at close links

with the Local Services Division

Years 3-5

• Integration of mental health and physical health community services • One community services division for South Sefton within Mersey Care

TIMETABLE FOR THIS TRANSACTION

16 Outlined below is the proposed indicative timelines suggested by NHS Improvement

Key Activity Approval Target Date Due Diligence - Full Composite Review Paper (Final Draft)

Mersey Care’s Board of Directors 26 April 2017 Full Business Case (Draft review only)

Mersey Care Self-Certification for NHS Improvement (Draft review)

Council of Governors Consideration Mersey Care’s Council of Governors 27 April 2017

Submission of Drafts to NHS Improvement (for comment

NHS Improvement’s Assessment Team 28 April 2017

Full Business Case (Final Approval) TBC Mersey Care’s

Board of Directors 17 May 2017 Mersey Care Self-Certification for NHS Improvement (Final Approval) TBC

NHS Improvement’s approval NHS Improvement’s Assessment Team 31 May 2017

BENEFITS AND OPPORTUNITIES

17 There is a clear strategic rationale for Mersey Care to provide community physical health services in South Sefton. By providing community services through our ‘bio-psycho-social’ clinical model, there is a distinct opportunity for Mersey Care to improve patient care both for our current service users (whose physical health is currently under-served by community physical health services) and for people with long term conditions and co-morbid mental health conditions.

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18 This synergy between mental health services and community services is the reason why the vast majority of mental health trusts already provide some level of physical health community services.

19 Community services are also critically important in the development of Sustainability and Transformation Plans (STPs) and the associated development of an Accountable Care System in North Mersey (Liverpool, Sefton and Knowsley). Local NHS organisations are all now part of a Sustainability and Transformation Plan, which describe how services will be changed strategically over the next five years to improve quality, improve population health outcomes and reduce cost.

20 As part of the STP programme, NHS England are encouraging local NHS organisations to develop Accountable Care Systems, whereby providers and commissioners work together to

a) decide how the STPs will be implemented in practice, and

b) decide how resources and activity will shift between providers over the next five years.

21 With the development of the Accountable Care System being led in Liverpool by Alder Hey Children’s NHS Foundation Trust, the Royal Liverpool & Broadgreen University Hospitals NHS Trust and Aintree University Hospital NHS Foundation Trust, it is strategically important that Mersey Care’s perspective on accountable care, community services and the allocation of resources and activity is reflected in the Sefton health economy through community services

FINANCIAL ANALYSIS AND DUE DILIGENCE

22 In determining whether or not to proceed with the Transaction, Mersey Care commissioned Deloitte (a management consultancy), Hempsons (solicitors) and Peter Hadley Consulting Limited (building and estates) to undertake detailed Due Diligence. This is to ensure that the proposed South Sefton Community Services transaction meets all the checks and requirements set out in Supporting NHS Provides: guidance on transactions for NHS foundations trusts published by Monitor (now NHS Improvement, the regulator for NHS Foundation Trusts).

23 The table below outlines the areas where Due Diligence was carried out, as well as showing the external and internal leads for ensuring its completion:

Due Diligence (as per Monitor’s Guidance)

External Completion by:

Internal Oversight by:

Clinical Quality Due Diligence Deloitte Ray Walker / Trish Bennett IT Due Diligence Deloitte Sarah Barr

Estates due diligence Peter Hadley Consulting Limited

Neil Smith / Alison Jordan

Legal due diligence (to include property ownership issues and HR/employment issues)

Hempsons Andy Meadows / Amanda Oates

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Due Diligence (as per Monitor’s Guidance)

External Completion by:

Internal Oversight by:

Financial due diligence Deloitte Neil Smith / Wesam Baker

Contract due diligence

Hempsons (Part of Legal Due Diligence)

Neil Smith / Andy Meadows

Taxation due diligence – not applicable

This was deemed not applicable to this transfer

Not applicable

Environmental / Health & Safety due diligence

Hempsons (Legal aspects) (Note: prior to transaction completion and in the immediate days following transaction our own H&S teams will inspect all buildings from a procedural H&S perspective.

Neil Smith / Alison Jordan

Carve out specific due diligence – not applicable

This was deemed not applicable to this transfer Not applicable

24 It is important to note that whilst many issues have been identified within the Due Diligence reports which need to be addressed both prior to and post transaction; it is the view of all the responsible Executives that there are no issues which are unmanageable and would prevent the Transaction from proceeding. The Due Diligence reports provide a useful and an essential check list of issues to be addressed pre and post transaction. There are funding requirements in relation to a number of issues identified, but discussions about these are ongoing with South Sefton CCG and a mutually agreeable solution is expected.

25 At its meeting on 26 April 2017 the Board of Directors will be provided with a full and detailed financial analysis which cannot be shared in the public domain due to the commercially sensitive nature of the information. Discussions have been ongoing with South Sefton to agree the transitional and recurrent funding requirements. These discussions are on going at the time of completion of this paper. Again it is expected these discussions will meet a mutually agreeable solution.

ENGAGEMENT

26 As part of the rules governing the bidding process for this Liverpool and South Sefton ‘bundles’, initially Mersey Care only had limited opportunity to engage with staff and local stakeholders. Since being identified as the preferred bidder Mersey Care has held several meetings with staff and has met with senior managers from LCH, as well as individually with officers from South Sefton CCG and the local Council. In addition we have also established the South Sefton Community Services Strategic Partnership Board to advice both Mersey Care and North West Boroughs as to how it should best develop services both during the transition and into the future

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KEY ISSUES AND RISKS

27 It is expected that the transfer of services from LCH to Mersey Care will take place on 1 June 2017. However, this date of transfer could be affected by the following issues / risks:

a) a refusal of by South Sefton CCG to fund outcome of Due Diligence process and transaction costs. This is a risk which is being addressed by the ongoing conversations with the South Sefton CCG and, as has been indicated above, it is expected that a mutually agreeable solution will be arrived at. Verbal updates will be provided to both the Board of Directors meeting on the 26 April 2017 and the Council of Governors meeting on 27 April 2017;

b) a delay in completing negotiations with LCH regarding those services still to be hosted by LCH. This risk has occurred because although the Liverpool ‘bundle’ was awarded to Bridgewater Community Healthcare NHS Foundation Trust, Bridgewater has not been allowed to complete the Liverpool transaction. Under the arrangements to replace LCH it was intended that winner of the Liverpool ‘bundle’ would continue to host some common support services across both the Liverpool and South Sefton areas. This has created some uncertainty and delay in negotiations in respect of hosted services, but these negotiations are now expected to be completed no later than the end of April 2017;

c) a delay in completing the sub-contract agreement between Mersey Care and North West Boroughs. Although this is a possible risk, negotiations are underway and will be based on the main contract agreed with the main commissioner – South Sefton CCG – which is currently awaited.

NEXT STEPS

28 As can be seen in the timetable in paragraph 16 above, Mersey Care is in the process of preparing the papers about this transaction for the consideration and approval of NHS Improvement’s assessment team. Although the transfer of South Sefton Community Services to Mersey Care is a ‘material’ transaction, we have deployed many of the systems and processes we used to consider the acquisition of Calderstones which was judged to be a ‘significant’ transaction. The Executive Team is therefore confident in giving assurance to both the Board of Directors and particularly the Council of Governors that will allow Governors to satisfying themselves that the Board of Directors has been thorough and comprehensive in reaching its proposal (that it has undertaken proper due diligence).

RECOMMENDATION

29 The Council of Governors is asked to

a) approve the trust submitted its application to NHS Improvement to seek approval of the proposed transfer of South Sefton Community Services (currently provided by Liverpool Community Health NHS Trust); and

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b) in making such approval, the Council of Governors are satisfied that the Board of Directors has been thorough and comprehensive in reaching its proposal (that is, has undertaken proper due diligence).

TRISH BENNETT DIRECTOR OF INTERGRATION

April 2017

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Appointment of a Non-Executive Director

Accountable Director(s) Beatrice Fraenkel, Chairman Report Author(s): Andy Meadows, Trust Secretary


To seek Governors approval in respect of appointing Gaynor Hales and a Non Executive Director (NED)

Recommendation:

The Council of Governors is asked to: 1) consider and approve the appointment of Gaynor Hales as a

NED, subject to completion of the necessary Fit and Proper Person Test.

PURPOSE

1. One of the key roles of the Council of Governors is the appointment of Non-Executive Directors (NEDs) to the Board of Directors. Based on the recommendation of the Nominations Committee, the Council of Governors is asked to approve the appointment of Gaynor Hales as a NED.

BACKGROUND

2. As outlined in Paper D4 to January’s Council of Governors meeting, one of our existing NEDs – Professor Brenda Roe - has indicated her attention to step down in May 2017. At January’s meeting the Council of Governors approved the trust embarking on a recruitment process to replace Professor Roe.

RECRUIRTMENT PROCESS

3. In line with the Constitution and policies, the trust embarked on a recruitment process for this NED post which culminated in a interview before a Nomination Committee consisting of Beatrice Fraenkel, the Lead Governor (Hilary Tetlow), an Appointed Governor (Veronica Cuthbert) and a Staff Governor (Maria Tyson).

4. This Nomination Committee has recommended the appointment of Gaynor Hales for a 3-year term; however this is subject to the approval of the Council of Governors and completion of the necessary Fit and Proper Person Test. It is hoped that Gaynor’s term of office will start on 1 June 2017. Gaynor’s CV can be seen at Appendix A.

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5. The person specification for this new NED post was as follows • Senior nursing background with current or very recent Board Level experience

in the NHS or Health Education sectors • Demonstrate an understanding of mental health • Experience of working at a regional and/or national level • Highly developed interpersonal and communication skills • The ability to understand complex strategic issues, analyse and resolve

difficult problems • Have a clear understanding and acceptance of the legal duties, liabilities

and responsibilities of non-executive directors • Be politically astute.

RECOMMENDATIONS

6. The Council of Governors is asked to: a) consider and approve the appointment of Gaynor Hales as a NED, subject to

completion of the necessary Fit and Proper Person Test

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Appendix A

Gaynor Hales’ CV

April 2016 – Present NHS Improvement - Regional Director of Nursing (North)

Trust Development Authority and Monitor aligned to work under the umbrella of NHS Improvement increasing the number of organisations I support from 21 to 74. The support offer is to work with the Executive team within Trusts to deliver quality improvement.

• Review of Quality Impact Assessments for FiP programmes and CIPs within the Trusts • Clinical Workforce Lead for re-design of workforce, taking into account new NQB

guidance • Migration levy and apprentice offer • Lead for implementation of agency cap resulting in reduction in cost whilst maintaining

quality • Clinical and Quality Lead in Exec to Exec meetings with challenged Trusts • Clinical Lead on Improvement Boards

October 2014 – 31 March 2016 Trust Development Authority - Nurse Director – North

Working directly to the Executive Director of Nursing, provide expert professional leadership to Trust Board Nurses, Chief Executives, Chairs and to the Regional Delivery and Development Team, ensuring high quality care is delivered in the most efficient way. Influencing strategic change through personal actions and senior leadership whilst shaping and developing a culture of continuous improvement.

Key Achievements

Established positive working relationships with key national bodies including NHS England, NMC, HEE, CQC, AHSNs, Social Services, Monitor and nursing and midwifery Royal Colleges

Working with and supporting Trusts in difficulty and those in special measures to • Deliver CIPs ensuring there isn't a negative impact on patient safety • Redesign of the workforce to deliver safe patient care • Prepare papers for Board that give the Executive Team assurance

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February 2013 – October 2014 NHS England – Merseyside Area Team – Director of Nursing and Quality

Providing strategic clinical and professional leadership across the commissioning landscape of Merseyside supporting Clinical Commissioning Groups and healthcare providers to thrive within the health and social care context, whilst holding them to account for the quality of care commissioned. Worked collaboratively across the Health and Social Care sectors to redesign services to deliver excellent patient care in the most appropriate setting.

Secondment as Portfolio Director for Specialised Commissioning

Providing strategic leadership across the North West on the reconfiguration of Vascular and Neonatal Intensive Care Units Services. • Established and chaired an Implementation Board which assessed the Trusts proposals,

resulting in agreed care pathways between local providers and the dedicated vascular centre

• Held 1-2-1 meetings with CEOs and Medical Directors to ensure Board level ownership embedding the agreed actions and identification of clinical champions

April 2002 – January 2013 Countess of Chester Hospital NHS Foundation Trust • Interim Chief Executive • Deputy Chief Executive, Director of Nursing & Quality • Director of Nursing Quality and Environment • Executive lead for Diagnostic & Therapies Division • Executive lead for the Urgent Care Division • Acting Director of Nursing, Midwifery and Therapies

The Countess of Chester NHS Foundation Trust, one of the first 10 Foundation Trusts, is a 600 bed Acute Trust providing services to over 260,000 people across South Cheshire and North Wales, with a turnover of £190m.

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To Note: ☐ For Decision ☐ Meeting Date: 27 April 2017

Proposal to Amend the Constitution

Report Author(s): Andy Meadows, Trust Secretary


To seek the Council of Governors approval to proposed changes to the trust’s Constitution in respect of: • reducing the Council of Governors by one Appointed Governor,

and • amending the description of what is meant by West Midlands

when referring to constituencies

Recommendation:

The Council of Governors is asked to: 1) consider and approve the changes proposed to the Trust’s

Constitution

PURPOSE

1. In line with section 47 of the Constitution, amendments need the approval of:

a) at least half the members of the Board of Governors; and

b) at least half the members of the Council of Governors;

with amendments coming into effect when both bodies have given their approval. .

2. The Board of Directors considered and approved the matters outlined in this paper at their meeting on 29 March 2017, and have recommended that the Council of Governors also approves these changes to the Trust’s Constitution.

PROPOSED CHANGES

3. Two changes to the trust’s Constitution are proposed.

a) Annex 4 - Composition of the Council of Governors

Proposal - to remove paragraph 2.4.5 which refers to the NHS Commissioning Board (known as NHS England) having the right to appoint an Appointed Governor.

Impact – this will effectively reduce the size of the Council of Governors from 36 to 35 governors. At present as well as the public, staff and service user / carer governors, the Constitution allows five types of organisations (i.e., local authority,

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clinical commissioning group, university, voluntary sector and NHS England) to appoint a governor. Although NHS England did initially nominate an officer they have been unable to attend and NHS England has taken the decision not to appoint another representative. As such it is proposed to remove NHS England as one of the organisations with an Appointed Governor. It is not a statutory requirement to have NHS England as a member of the Council of Governors.

b) Annex 1 – The Public Constituencies

Proposal – to amend the description of the area covered for the Cheshire, St Helens, Wirral, West Midlands and Wales constituency so that it properly reflects the West Midlands.

Impact – an error was made in the Constitution which effectively means that we defined the West Midlands area for the above constituency by referring to the local authorities in the county of West Midlands rather than the region of the West Midlands. Appendix A is an updated section of Annex 1 of the Constitution which shows in red all the changes necessary to ensure the description of the Cheshire, St Helens, Wirral, West Midlands and Wales constituency covers the whole of the region of the West Midlands. The number of Governor appointments for this redefined constituency remains unchanged at 1 Public Governor.

NEXT STEPS

4. Subject to the Council’s decision, it is proposed that these changes come into effect from 1 May 2017. As is required, NHS Improvement will also be provided with an updated copy of the Constitution.

5. If approved the updated Constitution will be referred to a Version 3.

RECOMMENDATIONS

6. The Council of Governors is asked to: a) consider and approve the changes proposed to the Trust’s Constitution

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Appendix A

Annex 1 – The Public Constituencies Extract re Cheshire, St Helens, Wirral, West Midlands and Wales Constituency

Proposed Amendments to Description relating to West Midlands Changes highlighted in red

Name of the Public

Constituency

Area of the Public Constituency (comprising all of the Electoral Wards within the

following Local Authority areas and / or Countries)

Minimum Number of Members

Number of Governors

Cheshire, St Helens, Wirral, West Midlands and Wales

Within the county of Cheshire, the following local authorities: • Cheshire West and Chester Borough Council • Cheshire East Borough Council • Halton Borough Council • Warrington Borough Council

10 1

Within the county of Merseyside (excluding Liverpool, Sefton and Knowsley), the following local authorities: • St Helens Metropolitan Borough Council • Wirral Metropolitan Borough Council

Within the ‘region’ of the West Midlands, the following local authorities within the following counties: • within the county of Herefordshire, the

following local authority: • Herefordshire Council

• within the county of Shropshire, the following local authorities: • Shropshire Council • Telford and Wrekin Borough Council

• within the county of Staffordshire, the following local authorities: • Cannock Chase District Council • East Staffordshire Borough Council • Lichfield District Council • Newcastle-under-Lyme Borough Council • South Staffordshire District Council • Stafford Borough Council • Staffordshire Moorlands District Council • City of Stoke-on-Trent • Tamworth Borough Council

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Name of the Public

Constituency

Area of the Public Constituency (comprising all of the Electoral Wards within the

following Local Authority areas and / or Countries)

Minimum Number of Members

Number of Governors

• within the county of Warwickshire, the following local authorities: • North Warwickshire Borough Council • Nuneaton and Bedworth Borough Council • Rugby Borough Council • Stratford-on-Avon District Council • Warwick District Council

• within the county of the West Midlands, the following local authorities: • City of Birmingham • City of Coventry • Dudley Metropolitan Borough Council • Sandwell Metropolitan Borough Council • Solihull Metropolitan Borough Council • Walsall Metropolitan Borough Council • City of Wolverhampton

• within the county of Worcestershire, the following local authorities: • Bromsgrove District Council • Malvern Hills District Council • Redditch Borough Council • City of Worcester • Wychavon District Council • Wyre Forest District Council

• The country of Wales

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To Note: ☒ For Decision ☐ Meeting Date: 27 April 2017

Membership & Engagement Committee (including Chairs’ Reports) Report compiled by: Sarah Jennings, Deputy Trust Secretary, April 2017

Page Name of Committee/ Group Meeting (Chair) Date of the Board Committee Meeting

Approved

Yes No

2 Membership & Engagement Committee (Mr A Meadows) 24/2/17 ☐ ☒

Key Issues Emerging From Meeting

The Membership and Engagement Committee:

• discussed and agreed the Terms of Reference and agreed a process for identification of a Committee chair;

• considered a proposed new format for Council of Governors meeting in order to address the concerns raised by a number of Governors regarding the opportunity to raise issues and insights with Board members;

• considered and discussed the Membership and Engagement Plan which detailed the actions agreed by the Council of Governors with regard improving membership, communication and engagement;

• received and noted the Engagement/ Events Schedule which will be regularly updated and circulated to all Governors;

• discussed and agreed the focus of the Governor feature to be included in the Trust Magazine;

• received an update on the current profile of the Trust membership in which it was confirmed that there were a total of 12.144 members with some areas of under-representation;

• considered and recommended to the Council of the Governors, the quality indictor to be tested by External Auditors as part of their review of the Trust’s annual Quality Account.

Recommendation: The Council of Governors is asked to note the contents of these Committee minutes and the accompanying reports from the Chair

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APPENDIX A


Council of Governors Membership and Engagement Committee Date: Friday 24 February 2017 Time: 2.00pm

Venue: Institute Room, The Quaker Meeting House, 22 School Lane, Liverpool, L1 3BT


Present: Andy Meadows George Allen Sara Finlayson Teresa McDonnell Brian Murphy Martin Murphy Hilary Tetlow Maria Tyson Veronica Webster

Trust Secretary (Meeting Chair) Governor Governor Governor Governor Governor Governor Governor Governor

In Attendance: Alison Bacon Michael Crilly Joanne Cunningham Sarah Jennings Mike Jones Paula Murphy Ashley Crossland

Systems & Membership Manager Director of Social Inclusion & Partnership Communications Manager Deputy Trust Secretary Financial Accountant (Assurance) Corporate Governance Compliance Manager Corporate Governance Assistant (Minutes Secretary)

Apologies Received: Debra Doherty Dave Kitchen

Governor Governor


A1 WELCOME AND INTRODUCTION

1. Mr Meadows welcomed all those present and introductions were made.

A2 APOLOGIES

2. The apologies for absence received for the meeting were as detailed above.

B1 MEMBERSHIP AND ENGAGEMENT COMMITTEE GOVERNANCE

3. Mr Meadows highlighted the need to determine the future chairing arrangements for the Membership and Engagement Committee, adding that the Corporate Governance Team would provide full support to the Governor wishing to carry out this role. Following discussion, Miss Jennings proposed to circulate a request for expressions of interest in chairing the Committee and agreed to provide an indication of the

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associated time-commitment required. This would ensure that all members, including those absent from the meeting, were provided with opportunity to consider this.

4. In response to a suggestion from Mr Allen that Governors serving a three year term would be better suited to fulfil the role of Committee Chair, Mr Meadows stated that all Governors on the Membership and Engagement Committee would be eligible to chair the meetings.

5. Ms McDonnell questioned whether a ‘co-chairing’ approach may be useful in order to assist with any concerns regarding time commitment required and expressed an interest in fulfilling the role of co-chair. The Committee welcomed this approach and Miss Jennings agreed to include the option of co-chairing when seeking expressions of interest from Committee members.

6. Mr Meadows concluded that the role of chair of the Membership and Engagement Committee would be made available to all members of the Committee and it was agreed that subject to the number of responses received, expressions of interest would be considered at the next meeting of the committee and a decision be made. In the interim, Mr Meadows agreed to chair the meeting.

7. Mr Meadows led a discussion to determine a suitable quorum for future meetings of the Committee and it was agreed that a majority attendance (6) would be the accepted level, with Mersey Care staff members being classed as in attendance, rather than Committee members.

8.

Action Lead Timescale Status

Recommendations approved by the Board, namely: • Consider and agree the wording regarding Section 4

[Membership] of the presented terms of reference. • Consider and agree the wording regarding Section 6

[Quorum] of the presented terms of reference. • Discuss and agree the chairing arrangements.

Further actions required: • Return any expressions of interest in relation to the

chairing of the Committee (specifying interest as Chair or as Co-Chair) to Sarah Jennings.

• Update on expressions of interest to Chair the Committee to be presented to the next Committee meeting.

• Update the terms of reference with the agreed information.

All Governors S Jennings S Jennings

Apr 2017 May 2017 May 2017

In progress On M&E Agenda for May-17 Completed.

B2 FORMAT OF COUNCIL OF GOVERNORS MEETING

9. Mr Meadows referred to concerns raised by Governors regarding the need for opportunity to raise issues / questions and input into the Trust’s business and the need a forum through which Governors can provide general insight as a representative of their constituency. As such, Mr Meadows provided a suggested new format of the Committee meetings, explaining that the format would allow for the necessary statutory items to continue to be discussed.

10. Miss Jennings highlighted that in addition to provision of a Governor-only pre-meeting, the second part of the formal Council of Governors meetings would enable the sharing

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of information and development opportunities. Finally, an informal ‘issues and insight session’ to be held following formal Council of Governors meeting would act as a forum through which Governors can provided insight and direct questions and put questions to Board members.

11. Members of the Committee welcomed this new format for meetings and agreed that this should be utilised for the next Council of Governors meeting in April 2017.

12. Mr Allen requested the views of the committee in relation to the structure of ‘any other business’ brought to the Council of Governors meetings. It was the agreed that in order to promote efficiency and allow for preparation, any such items should be submitted to the Corporate Governance Team in advance of Council meetings where possible. It was acknowledged however, that a degree of flexibility would be applied and items of pressing importance could be raised as ‘any other business’ without prior submission.

13. Following a request from a number of Governors, it was agreed that meetings of the Membership and Engagement Committee would be held following the Council of Governor meetings. As such, the existing dates of the Committee meetings would be revised and re-circulated accordingly.

14.


Recommendations approved by the Board, namely: • Note the contents of the paper. • Provide any feedback on the proposed new format for

the Council of Governors meetings.

Further actions required: • Amend meeting dates to ensure that future meetings

of this Committee are held after the main Council of Governors meetings.

• New format for Council of Governors meetings to be circulate to all Governors.

• New format for Council of Governors meeting to be adopted from April 2017.

P Murphy S Jennings A Meadows/ S Jennings

Mar-17 Mar-17 Apr-17

Completed Due Mar-17 From Apr 17

C1 MEMBERSHIP AND ENGAGEMENT PLAN

15. Miss Jennings referred to the Council of Governors agreement of a series of proposed mechanisms regarding membership, communication and engagement in January 2017 and advised that a Membership and Engagement Plan had been developed which reflected this mechanisms and included leads and timescales to enable monitoring.

16. Miss Jennings confirmed that the Plan would be added to, updated and monitored via the Membership and Engagement Committee and provided an update on the actions outlined in the Plan.

17. Mrs Webster referred to her participation in a recent Quality Review Visit (QRV) and

confirmed that although this had been a valuable experience, it had proved to be an extremely intense process. Miss Jennings confirmed that QRV training sessions had been arranged for April 2017 and a practical guide, based on the ‘15 Steps Challenge’ would also be made available to accompany this training.

Agenda Item No: D3

Page 5 of 8

18. Ms McDonnell requested a schedule of planned Quality Review Visits to enable Governors to register their interest in taking part. Miss Jennings agreed that this could be provided, however due to the responsive nature of these visits, the actual locations could be subject to change at short notice and this needed to be considered.

19. In response to clarification sought by Mr Allen, Mrs Tyson confirmed that Quality Review Visits took place within all services across the Trust including Community Services.

20.


Recommendations approved by the Board, namely: • Note the contents of the paper. • Consider and comment on the Membership and

Engagement Plan. • Agree to receive an update against the Membership

and Engagement Plan at each meeting of the Committee.

Further actions required: • Circulate schedule of QRVs on a 6-8 weekly basis to

Governors.

S Jennings/ J Bull

April 2017

Due Apr-17

C2 ENGAGEMENT / EVENTS SCHEDULE 21. Miss Jennings explained the purpose of the events schedule to assist Governors in

increasing their visibility and engaging with the membership and confirmed that this would be subject to regular update.

22. It was noted that the Disability Access Event was taking place on 12 March 2017 and not 11 March and Miss Jennings agreed that the schedule would be amended to reflect this.

23. Miss Jennings informed Governors of the intention to develop a Governor-only section of the Trust website specifically for the Governors and Ms Crossland offered assistance to Miss Jennings in setting this up.

24. With regard Governor’s Surgeries, it was agreed that the some thought would be given to this approach and this would be discussed explore at the next meeting.

25.


Recommendations approved by the Board, namely: • Note the contents of the paper. • Agree to discuss the Governor’s Surgeries at the next

meeting of the Committee • Note that there will be an opportunity for Governors to

feedback regarding any engagement as a verbal standing item at the Council of Governors meetings

Further actions required: • Add Governor’s Surgeries to the agenda of the next

meeting. • Update / amend the schedule as appropriate.

S Jennings S Jennings

May 2017 On-going

On M&E May-17 agenda On-going

C3 MAGAZINE – GOVERNOR FEATURES 17/18

Agenda Item No: D3

Page 6 of 8

26. Miss Jennings explained the intention to utilise the Trust’s seasonal magazine in order to promote the role of the Governors and encourage membership involvement.

27. Mrs Cunningham confirmed that the submission deadline for the next issue of the magazine was early March 2017. It light of the restricted time available, it was greed that a short feature would be drafted for inclusion in the Magazine and that this would focus on the role of the Council of Governors and how to make contact with Governors.

28. Miss Cunningham queried whether a photographer should attend the next meeting of the Council of Governors and this was agreed.

29.


Recommendations approved by the Board, namely: • Discuss and agree how the Trust magazine should

be used in order to promote the role of the Governors.

• Agree a topic for the first magazine entry.

Further actions required: • Magazine article to be drafted and submitted to the

Communications Team for approval and inclusion. • Communications photographer to attend next

meeting of the Council of Governors.

S Jennings J Cunningham

1 March 2017 Apr-17

Due Mar-17 Apr-17

D1 MEMBERSHIP UPDATE

30. Miss Jennings provided to the Committee an update on the current profile of the Trust membership and noted that it was intended that this would be provided at each meeting of the Committee going forward.

31. Miss Jennings outlined the following membership breakdown as at 31 January 2017: a) There were 12144 members in total; b) There was under-representation with regards members aged 74+; c) There was under-representation with regards members aged males; d) There was significant under-representation in a number of ethnic groups.

32. Whist it was acknowledged that a number of areas were under-represented, it was

noted that the profile of the membership would change once members of the former Calderstones Partnership NHS FT were invited to join as a member of Mersey Care. It was agreed that no further members would be actively recruited; however focus would be given to proactively engage with the current members.

33. Miss Jennings noted that it had been recognised that the current membership levels (informed, involved and active) may require amendment given that members tended to fall into one of two categories - those wanting minimal contact and those wishing to be actively involved. It was therefore proposed that it would be beneficial for our membership levels to reflect this.

34. In response to Ms Tyson, Miss Jennings and Ms Bacon explained the differences

between the membership levels.

Agenda Item No: D3

Page 7 of 8

35. Miss Jennings agreed to seek the approval of the Council of Governors in April 2017 to

amend the current membership levels in line with the report.

36.


Recommendations approved by the Board, namely: • Note the content of the paper. • Note the areas of membership which are under-

represented and suggest ways to engage and recruit in these hard to reach areas.

• Consider the proposed shift to a two-tier membership • Note that an update will be provided to the

Committee at every meeting.

Further actions required: • Membership levels to be discussed and agreed at the

Council of Governors meeting.

S Jennings

27 Apr-17

On CoGs Apr-17 agenda

D2 QUALITY ACCOUNT – INDICATOR TESTING

37. Miss Jennings introduced Ms McCourt (Deputy Director of Nursing) to the Committee.

38. Ms McCourt advised Committee members that all NHS foundation trusts must publish

a Quality Account each year and in line with the most recent guidance on Quality Accounts issued by NHS Improvement in early February, the Trust was now required to ask the Council of Governors to choose an indicator from those included in our Quality Account for testing by the Trust’s auditors.

39. Ms McCourt confirmed that due to timing, members of the Committee were asked to

consider which indicator they would prefer to be tested from those outlined above in the report and advised that this preference, along with an accompanying report would be circulated to the full Council of Governors and views sought. A formal report would then be submitted to the Council of Governors on 27 April 2017 and Governors would be asked to formally approve the indicator to be tested.

40. Indicators available to testing were highlighted as follows:

(1) Meeting commitment to serve new psychosis cases by early intervention teams; (2) Early intervention in psychosis (EIP): people experiencing a first episode of

psychosis treated with a NICE-approved care package within two weeks of referral;

(3) Improving access to psychological therapies (IAPT) - people with common


(4) Improving access to psychological therapies (IAPT) - people with common


Agenda Item No: D3

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(5) The number and, where available, rate of patient safety incidents reported within the trust during the reporting period, and the number and percentage of such patient safety incidents that resulted in severe harm or death.

41. Mr Meadows highlighted that it was acknowledged that the full Council of Governors

may choose a different indicator for testing at their meeting in April 2017.

42. After a full and detailed discussion, the Committee expressed their wish for to test indicator 1 [Meeting commitment to serve new psychosis cases by early intervention teams] and indicator 2 [Early intervention in psychosis (EIP): people experiencing a first episode of psychosis treated with a NICE-approved care package within two weeks of referral] and these would be recommended to the Council of Governors in April 2017.

43. Note – Following the meeting, it was confirmed that indicator 1 [[Meeting commitment

to serve new psychosis cases by early intervention teams] had been excluded by NHS Improvement and therefore indicator 2 would be recommended to the Council of Governors.

44.


Recommendations approved by the Board, namely: • Consider which indicator they would prefer to be

tested from those outlined within the paper

Further actions required: • Indicator 2 - [Early intervention in psychosis (EIP):

people experiencing a first episode of psychosis treated with a NICE-approved care package within two weeks of referral] to be recommended to the full CoGs meeting for approval of external auditors to test

S Jennings

Apr-17

On Apr-17 CoGs agenda

E1 REFELCTION & ESCALATIONS TO COUNCIL OF GOVERNORS

45. Mr Meadows and Miss Jennings confirmed that this section of future meetings would be used to reflect, ask questions and agreed any issues which may require escalation to the Council of Governors.

E2 FORMAT, ARRANGEMENTS & ITEMS FOR THE NEXT MEETING

46. Following a request for feedback, Governors confirmed that the format and venue of the meeting was appropriate.

47. Miss Jennings confirmed that Committee members would be contacted prior to the next meeting, in order to seek any items for the agenda.

E3 ANY OTHER BUSINESS

48. There was no other business raised.

49. The meeting was brought to a close.

Agenda Item No: D4

Page 1 of 6




Council of Governors – Annual Cycle of Business

Report Author(s): Sarah Jennings, Deputy Trust Secretary


• It is good practice to ensure that agendas for Council of Governors meetings are set based on a work programme agreed at the start of the year. The attached Annual Cycle of Business is therefore presented for the Council of Governors’ approval which seeks to guide the agendas for the quarterly meetings of the Council of Governors, and ensure that the Council of Governors is able to undertake their statutory functions.

• Subject to the Committee’s approval of the Council of Governors Annual Cycle of Business, the cycle will be used as the basis for agenda’s.

Recommendation:

The Council of Governors is asked to: 1) Agree the Council of Governors Annual Cycle of Business; 2) Note that the Cycle will be subject to change in light of issues

that arise during the year.

PURPOSE

1. To seek the Council of Governor’s approval of its Annual Cycle of Business for 2017/18.

BACKGROUND

2. It is good practice to ensure that agendas for Council of Governors meetings are set based on a work programme agreed at the start of the year. The attached Annual Cycle of Business is therefore presented for the Council of Governors’ approval which seeks to guide the agendas for the quarterly meetings of the Council of Governors, and ensure that the Council of Governors is able to undertake their statutory functions.

3. The Annual Cycle of Business sets out those matters to be considered by the Council of Governors over the next 12 months and is intended to capture those items which the Council of Governors can expect to receive over the course of the year in order to fulfil its purpose.

4. The cycle is aligned the Trusts strategy and as such, items of business are mapped against the areas of: a) our services;

Agenda Item No: D4

Page 2 of 6

b) our future; c) our people; d) our resources.

5. In addition, the new format for Council of Governors meeting allows for a minimum of

30 minutes for development and information sharing at each meeting and where possible, the topics to be discussed have been scheduled. These will be subject to change to reflect the key issues and developments facing the Trust over the coming year.

6. The Council of Governors Annual Cycle of Business has been developed to ensure it meets the duties outlined in Your Duties: a brief guide for NHS foundation trust governors.

NEXT STEPS

7. Subject to the Committee’s approval of the Council of Governors Annual Cycle of Business, the cycle will be used as the basis for agenda’s. Delivery against the Annual Cycle of Business will be monitored throughout 2017/18 and reported to each meeting of the Council of Governors as an addendum to the agenda.

RECOMMENDATIONS

8. The Council of Governors is asked to: a) Agree the Council of Governors Annual Cycle of Business;

b) Note that the Cycle will be subject to change in light of issues that arise during the year.

Agenda Item No: D4

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APPENDIX A: Council of Governors Annual Cycle of Business 17/18

July 2017

Council Business Our Services Our Future Our Resources/ Our People

Governance / Governor Issues

Development / Info Sharing Topics

Declarations of interest

Performance & Financial Activity Report

Membership & election update

Annual Accounts

Membership Strategy

South Sefton- Update

Minutes & Action Long

Final Quality Account 16/17

External Audit Opinions

Update from Membership & Engagement Committee

Care Quality Commission Inspection Update

Matters arising Annual Report Council of Governors Annual Report

Member meetings proposal

Chief Executive Update

Update on Delivery of Strategic Priorities

Council of Governors Development Plan

Chairman Update Review of Governor Handbook and Governors Interests

October 2017






Update on Annual Planning Process 18/19

Election Outcomes 2018/19 draft strategic priorities



Update from Membership & Engagement Committee

Transformational update

Matters arising

Agenda Item No: D4

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Chairman Update

January 2017






Draft 18/19 Operational Plan

Update from the Membership & Engagement Committee


Quality Account Priorities 18/19 & Indicator Selection

Chairman & NED Appraisal Process

Matters arising



Chairman Update

April 2018






Update from the Membership & Engagement Committee


Quality Account 17/18

Outcomes of Chairman & NED Appraisals

Matters arising Update on Delivery of Strategic Priorities

Council of Governors Annual Cycle of Business

Agenda Item No: D4

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Chairman Update

Agenda Item No: D4

Page 6 of 6

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Agenda Item: E1

Page 1 of 47

Mersey Care NHS Foundation Trust Operational Plan 2017-19

1. Summary

Mersey Care is operating in a challenging context. In the face of public sector

organisations cutting back, and increased demand for services driven by demographic

change and complex social issues that affect people’s use of public services, demand for

Mersey Care’s services is increasing. People’s needs are becoming more complex, people

are often more acutely unwell by the time they present to secondary NHS services, and

discharges from secondary NHS services can be delayed as other agencies attempt to

resolve relating social issues such as long-term care or housing.

Nationally, suicides are rising, and there has been a 10% national increase in the number

of people sectioned under the Mental Health Act over the past year, suggesting their

needs are not being met early enough. Referrals to Mersey Care increased by 14%

between 2014/15 and 2015/16, with over 1000 more GP referrals. Across the three

hospital sites that Mersey Care provides A&E liaison, there has been a significant

increase in face to face contacts; from 6,800 in 2015/16 to an expected 13,000 in

2016/17.

Like all other mental health trusts, Mersey Care has to continually improve care within a

constrained financial envelope, whilst simultaneously addressing people’s increasingly

acute and complex needs. Although £1.8bn of sustainability funding has been earmarked

for conditions that include mental health and learning disabilities, ensuring this funding

is actually channeled into NHS mental health and learning disabilities services through

the Sustainability and Transformation Plans (STPs) will require concerted effort by

providers.

But Mersey Care is well placed to deal with such a challenging environment. Our

organisation is three years through a five-year programme of genuine service

transformation – i.e. change to our service and workforce models in order to deliver

improvements in quality and cost – which is essential if we are to continue to meet

Agenda Item: E1

Page 2 of 47

demand within the resources available to our organisation. We call this striving for

perfect care for the people we serve.

Through delivery of our strategy over the last three years with estate improvements (e.g.

Clock View), strengthening our recovery pathways (Life Rooms, the recovery college and

peer support working) and changing the way that we work in both local and secure

services (for example, investing in psychological approaches in local services and

changing our rehabilitation services in high secure services) we go into 2017-19 with firm

foundations and experience of successfully delivering major change. With the successful

acquisition of Calderstones NHS Foundation Trust, Mersey Care has the opportunity to

implement an exciting new care model for people with forensic learning disabilities and

complex needs. Through our Centre for Perfect Care and considerable investment in

supporting organisational development, we are helping our frontline clinical teams to

transform our service and workforce models from the ground up. We recognise it is

important to grow and innovate from firm foundations of supporting our frontline

clinical teams to get the basics of care right.

Our plan for the next two years prioritises getting the basics of care right, along with our

transformation programmes in local, secure and specialist learning disabilities services.

• We will focus on developing a standard operating platform across all three clinical

divisions, standardising our core care pathways to ensure that the basics of care are

always undertaken consistently.

• In local services we will be improving our crisis services, clarifying the core business

and pathways of our community mental health services and improving flow through

our inpatient services. We will also improve access to IAPT and Early Intervention in

Psychosis in line with national policy requirements.

• In secure services we will be changing the focus and skill-mix on some of our wards,

reducing long-term segregation, implementing changes to workforce planning and

focusing on our low secure and community forensic services.

• In specialist learning disabilities services, we will be implementing a major

programme of retraction of inpatient services whilst supporting service users in

alternative community-based care.

Agenda Item: E1

Page 3 of 47

• Life Rooms and our recovery college will be strengthened in order to provide

support to people outside the traditional models of service delivery and enable

people to take more control over their health and recovery.

• As preferred provider of community physical health services for the people of

South Sefton, we will progress the acquisition of services from Liverpool Community

Health and maximise opportunities to provide high quality integrated physical and

mental health services.

• These changes to our service and workforce models will be enabled by investment

in our estate and IM&T infrastructure, and more effective corporate services.

• These changes can only be implemented by our people, and in recognition of the

considerable challenges our frontline clinical teams face, we will renew our focus on

supporting our people to change their service and workforce models whilst ensuring

a just and learning culture.

Agenda Item: E1

Page 4 of 47

Our People

AIMS OBJECTIVES PROGRAMMES MEASURES Our Services Improve quality (STEEP)

Save time and money

Getting the basics right

Pursuing Perfect Care

Transformation programmes in our clinical and corporate divisions

Five Year Forward View ‘must dos’

Quality dashboard Service users on clusters 1-3 CMHT caseloads Out patient DNAs Average length of stay Unplanned OATs Bed occupancy rates Delayed discharges

Support managers and effective teams

A productive, skilled workforce

Working side by side with service users and carers

Supporting managers

Recruitment and retention

Health and wellbeing of our people

Recovery College and Life Rooms Southport

Peer support

Sickness absence Attrition rate National staff survey People supported into meaningful activity

Our Resources Technology that helps us provide better care

Buildings that work for us

Future digital capability

IM&T infrastructure

Estates programme

Estate at category B Digital maturity CQUIN Data quality

Our Future Effective partnerships

Research and innovation

Grow our service

Collaborative care with primary care

Strategic alliances with housing providers

Centre for Perfect Care

Standardised improvement model

Pursuit of key business development opportunities

Discharge of service users in clusters 1-3 Targeted services retention rate Externally funded research

2017/19 PLAN ON A PAGE

SLD retraction plan Long term segregation Patient experience score Suicides within our care Use of restraint Physical health checks (CPA) Staff disciplinaries Access targets (FVFV)

Agenda Item: E1

5

2. Highlights from 2016-17 CQC ‘Good’ rating

Mersey Care became a Foundation Trust on 1 May 2016. We remain part of the NHS,

but being a Foundation Trust gives us greater freedoms and flexibilities than NHS trusts

regarding the use of resources and more power and a greater voice to local

communities and front line staff about the delivery and development of health care. We

have members drawn from patients, the public and staff and are governed by an elected

Council of Governors.

In 2016, we also acquired Calderstones NHS Foundation Trust and created our Specialist

Learning Disability Division. Our vision for these services is that as much as possible,

care in the future will be provided in community care settings. Bed-based services will

be reduced and the Calderstones site will close within three years, subject to and NHS

England consultation. The majority of service users will be cared for in community

settings in future, and where people need short-stay inpatient care, it will be provided in

“state of the art” units and services and services will offer equal opportunities for men

and women.

In the last year, we have invested in psychological therapies in our local services, with 19

new psychologists appointed. This has resulted in a 30% increase in psychological

clinical activity (November to January 2016/17), when compared to the same period last

year. We have reviewed our community mental health team caseload and begun to

work collaboratively with primary care colleagues. Additional support is now being

provided to primary care colleagues to provide good quality mental health support to

those whose mental health condition is stable.

In secure services, we have developed an approved a full business case for a new

medium secure unit at Maghull to replace Scott Clinic and have implemented a standard

assessment and discharge arrangements. We have redesigned rehabilitation services in

high secure, making them more responsive to the needs and interests of service users.

Since this new model was introduced service users have had access to 30 extra sessions

per week for activities which were previously only available in centralised workshops. In

reach activities are now core business for the Rehabilitation Service which reaches out to

Agenda Item: E1

6

those patients who would not normally come to the workshops due to illness or any

other reasons.

May 2016, saw the opening of our Life Rooms in the former Walton Library which has

been transformed into a new centre for learning, recovery, health and wellbeing. In the

last year, over 1400 people enrolled in Recovery College courses and since opening, over

8000 people have accessed the Life Rooms for advice, support and college activity.

No Force First, which aims to eliminate physical and medical-led restraint in our services

was a winner at National Patient Safety Awards 2015 (Changing Culture Award). We

have seen a 15% decrease in the use of restraint since the initial baseline period (April –

March 2012/13) across wards implementing No Force First, with some wards achieving

well over 50% reductions.

Mersey Care is committed to reducing the number of deaths by suicide of people in our

care to zero by 2020. 74% of our staff have now participated in our Mersey Care-

designed suicide awareness training.

We are delighted that our progress has been recognised by others. In 2016, amongst

other recognition, Mersey Care won Positive Practice Awards for innovation in older

people’s mental health and dementia care and for integration of physical and mental

health. Clock View Hospital was recognised by the Design in Mental Health Awards and

our secure services won a National Service User Award for Health and Wellbeing.

Mersey Care was highly commended in the Health Service Journal Provider Trust of the

Year award.

Agenda Item: E1

7

3. Our changing environment

Each year we review our strategy and how it will be delivered so that we can respond to

the changing environment in which we operate. Doing this allows us to focus our

resources to achieve the best outcomes for Mersey Care and our service users and

carers. Whilst the profile of mental health has grown in national policy since the

publication of the Five Year Forward View (2016), levels of investment in mental health

do not match levels of need and wider NHS pressures impact on investment in our

services, and in particular in the availability of capital funding. Delivery of Sustainability

and Transformation Plans (STPs) require greater collaboration within local health

economies with exploration of new models of care emerging nationally. We foresee

even greater focus on efficiency of delivery within the NHS. We anticipate challenges

associated with an ageing workforce and, potentially, with the impact of ‘Brexit’.

Opportunities are presented by new workforce models and the role of the peer worker in

our services. Technological developments will provide new opportunities for the delivery

of services and must be maximised to support our workforce. However, in exploiting the

benefits of technology, we must take account of those service users and carers who may

become disempowered without access to these new tools.

The table below summarises some of the key factors in our environment which will

impact on the delivery of our strategy over the next 2-3 years.

Political

•5 Year Forward View for Mental Health

•Physical and mental health integration

•Parity of esteem •Development of

accountable care organisations

•Sustainability and transformation planning across Cheshire and Merseyside

•Brexit and potential staff loss

•Commissioning reorganisation

Economic

•Social care budget cuts •Historic

underinvestment in mental health

•Mental health investment standard

•Lack of capital monies •Wider NHS financial

pressures •Increasing service

tendering – dynamic market place

•Implementation of Carter review

Social

•Ageing workforce •Growing demand and

acuity •Introduction of new

workforce roles •Sickness absence •Recruitment challenges •Increased roles for peer

workers

Technological

•New clinical information systems •Growth in telehealth •Handheld technology •Social media and app

development •Impact of digital

deprivation •New systems for

corporate services

Agenda Item: E1

8

3.1 Sustainability and Transformation Plan

The national planning guidance for 2017/19 is clear that the planning and contracting

round will be built upon each local sustainability and transformation plan (STP). Mersey

Care must deliver its financial control totals, with our finance, activity and workforce

plans being consistent with the STP. Mersey Care is part of the Cheshire and Merseyside

STP footprint and, within this, the North Mersey Local Delivery System. The Cheshire and

Merseyside STP is still at a developmental stage and is in the design phase of a

programme that will help to create healthier NHS services across Cheshire and

Merseyside for future generations.

The illustration below provides key facts regarding Cheshire and Merseyside STP.

The three mental health trusts in the STP have developed a mental health work-plan to

support delivery of the Five Year Forward View for Mental Health. Additional funding to

support the transformation of mental health services will include centrally-held

transformation funding and allocations via CCGs. It is assumed that an appropriate share

of national monies will be made available and that this investment will rise to at least

£57.9m in Cheshire and Merseyside by 2020/21. The plan is only deliverable if mental

health services receive the identified additional investment set out in the Five Year

Forward View implementation plan. Evidence provided within the Centre for Mental

Agenda Item: E1

9

Health Economic Report indicates that significant savings across the health and care

system will outweigh the investment needed to deliver services.

Three priorities have been identified for early implementation across Cheshire and

Merseyside:

• Eliminate out-of-area placements

• Develop integrated clinical pathways for those with a personality disorder

• Enhance Psychiatric Liaison provision across the footprint and establish a Medically

Unexplained Symptoms (MUS) service

The STP priorities regarding mental health will be taken forward through a Chief

Executive-led programme group. Mersey Care will be a member of this group, working

in collaboration with Cheshire and Wirral Partnership NHS Trust and 5 Boroughs

Partnership NHS Trust and at local level, a Mental Health Transformation Board has been

established to take forward implementation of the Five Year Forward View for Mental

Health in North Mersey.

3.2. Five Year Forward View for Mental Health and local commissioner expectations

Local areas are required to plan to deliver in full the implementation plan for the Five

Year Forward View for Mental Health, including commitments to improve access to and

availability of mental health services across the age range, develop community services,

taking pressure off inpatient settings, and provide people with holistic care, recognising

their mental and physical health needs.

The 2017/19 NHS Operational Planning and Contracting Guidance, sets out a series of

‘must dos’. These requirements are reflected in Mersey Care’s contractual agreement with

Liverpool and Sefton CCGs.

Urgent and Emergency Care

• Implement the Urgent and Emergency Care Review, ensuring a 24/7 integrated care

service for physical and mental health is implemented by March 2020 in each STP

footprint, including a clinical hub that supports NHS 111, 999 and out-of-hours calls.

• Initiate cross-system approach to prepare for forthcoming waiting time standard for

urgent care for those in a mental health crisis.

Agenda Item: E1

10

Mental Health

• Deliver in full the implementation plan for the Mental Health Five Year Forward View

for all ages, including:

o Additional psychological therapies so that at least 19% of people with anxiety and

depression access treatment, with the majority of the increase from the baseline

of 15% to be integrated with primary care;

o Expand capacity so that more than 53% of people experiencing a first episode of

psychosis begin treatment with a NICE-recommended package of care within two

weeks of referral;

o Increase access to individual placement support for people with severe mental

illness in secondary care services by 25% by April 2019 against 2017/18 baseline;

o Reduce suicide rates by 10% against the 2016/17 baseline.

• Ensure delivery of the mental health access and quality standards including 24/7

access to community crisis resolution teams and home treatment teams and mental

health liaison services in acute hospitals.

• Maintain a dementia diagnosis rate of at least two thirds of estimated local

prevalence, and have due regard to the forthcoming NHS implementation guidance

on dementia focusing on post-diagnostic care and support.

• Eliminate out of area placements for non-specialist acute care by 2020/21.

People with learning disabilities

• Deliver Transforming Care Partnership plans with local government partners,

• Reduce inpatient bed capacity by March 2019 to 10-15 in CCG-commissioned beds

per million population, and 20-25 in NHS England-commissioned beds per million

population.

• Improve access to healthcare for people with learning disability so that by 2020, 75%

of people on a GP register are receiving an annual health check.

• Reduce premature mortality by improving access to health services, education and

training of staff.

3.3. Specialised commissioning and our secure and specialist Learning Disabilities

services

NHS England have committed to a comprehensive programme of work to increase high

quality care that prevents avoidable admissions and supports recovery in the least

Agenda Item: E1

11

restrictive setting as close to home as possible. This is intended to address the existing

fragmented pathways in secure care, increase the provision of community-based services

and trial new co-commissioning funding and service models. A consultation process has

been completed for low and medium secure services and this could lead the way for a

re-procurement process nationally. The core components of the secure care programme

include identifying an optimal secure care pathway, including community-based

interventions, informed by the experience of people in secure services and carers, and

the appropriate use of evidence-based interventions and promoting the implementation

of personalised recovery-focussed care planning in secure in-patient services.

NHS England is consulting on how low and medium secure services for people with a

learning disability and/or autistic spectrum disorders (ASD) should be provided across

the North West. The consultation builds on the commitment made to reduce reliance on

inpatient care by developing community services for people with a learning disability/and

or ASD. The outcome of the consultation will impact on the approach we take to

transform the secure care pathway over the next 3 years to deliver the best possible care

in facilities fit for the future.

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4. Strategic Direction

4.1 Transforming our Trust

The Trust is striving to provide perfect care for the people we serve and make a positive

difference to the lives of service users and carers. In order to pursue perfect care, we

believe that change must happen across four domains of our services, our people, our

resources and our future. Three years ago, we recognised the scale of the challenge for

us in continuing to improve services and their quality in the context of a more

competitive, financially constrained environment. As a result, we embarked on a co-

ordinated programme of strategic change to our service and workforce models in order

to continue to meet people’s increasingly complex needs within the resources available

to us. Our strategy is set within a long term financial framework which entails savings of

£6.2 million in 2017/18 and £5.4 million in 2018/19 from service and workforce model

redesign in local and secure services, to invest in our major estate schemes (Southport,

Liverpool 2 and Medium Secure Unit in Maghull) of £109.7m over coming years.

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Our services – we will improve the quality of our services, and strive to provide safe,

timely, effective, equitable and person-centred care every time, for every service user. As

we strive for continuous improvements in quality, we will also strive for find ways to save

time and money.

Our people – we will have a productive and high performing workforce that work in

great teams, and we will work side by side with service users and carers.

Our resources – we will make full use of our resources, ensuring our buildings work for

us, and using technology to help improve our care.

Our future – we will create opportunities for improvement and grow in the future, by

working more closely with primary care and other organisations, delivering the benefits

of research, development and innovation, and by growing our services.

4.2 Why we must transform our services

We have described the challenging environment in which Mersey Care operates, with

increased demand for services driven by demographic change and complex social issues

and more complex needs in the people we serve. This is coupled with the need to

continually improve care within a constrained financial envelope.

Key benchmarking and quality data allows us to assess where we must place greatest

emphasis in transforming our services in order that we can improve quality whilst safely

reducing costs. In inpatient mental health services, Mersey Care has higher occupancy

levels and length of stay compared to other mental health trusts. Community caseloads

are higher when compared with other trusts and level of complexity in these caseloads is

lower. In secure services, we see high occupancy levels in low and medium secure

services, with the efficiency demonstrated in our high secure service length of stay, not

replicated in low and medium secure services. Across our services, we have higher levels

of staff sickness and greater use of bank and agency staff than we would wish.

We can see that the impact of increasing demand and acuity on services which are yet

to transform to deliver new models of care is starting to impact upon the quality of our

services and our staff. Unless we are able to deliver our planned service and workforce

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transformation, our ability to deliver the standards of the Five Year Forward View for

Mental Health and the Transforming Care agenda will be limited.

Therefore, we must renew our efforts in the delivery of our co-ordinated programme of

strategic change to service and workforce models. In doing this, we must:

• Increase flow through our inpatient services to give staff more headroom and to

make these environments safer

• Redefine the core business of our community mental health teams, which greater

focus on more complex patients and managing the flow into and out of our services,

in partnership with primary care.

• Create a simpler and more effective crisis pathway.

• Implement a major change programme in specialist learning disabilities services,

whilst looking after our staff and creating new opportunities for them.

• Make the whole secure pathway more effective, with a particular focus on low secure

and community forensic services

• Maximise the return on our investment in the Life Rooms and Recovery College to

provider greater support options for service users and carers

• Address the workforce issues that are affecting all our services.

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5. Our services

5.1 Improving quality (STEEP)

Providing high quality services in safe environments is our core purpose. As such, we

start from a strong underlying position on quality. This is reflected in our CQC ‘Good’

rating in 2015. We await the report from a further inspection of our services in March

2017.

We plan to improve quality through Perfect Care in 2017-19 by developing a standard

operating platform; continuing with our perfect care programme and implementing

transformation plans in our clinical and corporate services.

5.1.1 Getting the basics right – developing a standard operating platform

Improving quality and outcomes for those we serve will require us to get the basics of

care consistently right. This means ensuring that basic clinical processes and pathways

are well functioning and having the right staff in the right place at the right time.

This focus is summarized below:

Standard operating procedures (SOPs) are written instructions intended to document

how to perform a routine activity. Many companies rely on standard operating

procedures to help ensure consistency and quality in their products. Many workplace

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processes require strict adherence to a set of instructions to ensure the intended

outcome occurs. Even the best employees don't have perfect memories, so having a set

of written instructions they can refer to when performing the steps of the process

ensures everything is done correctly. The stability and clarity of standard operating

procedures becomes increasingly important if the organisation is growing or looking to

acquire other organisations. Through the introduction of a new clinical information

system and the implementation of standardised care pathways in all three clinical

divisions, we will Improve quality and reduce clinical variation and we expect this

standardization to improve productivity (and also reduce waste).

5.1.2 Pursuing Perfect Care

We have set ambitious goals in pursuit of perfect care:

• Adopt a 'No Force First' approach (avoid physical restraint, including medication-led

restraint)

• Zero suicide for those in our care

• Physical health for service users

• A just and learning culture – promoting accountability within a blame-free

environment

Perfect Care means getting the basics of care right every time, whilst setting our own

stretching goals for improvement and relentlessly pursuing safer care through a learning

culture. In practice this means that we try to make every episode of care safe, timely,

effective, equitable and positively experienced (STEEP).

Priorities for safe care will be the roll out of suicide prevention training across all

Divisions and fully embedding No Force First on all wards with individual ward action

plans that are clinically specific. We will adopt the new National Safe Sustainable

Staffing improvement resource and review all inpatient and community teams at regular

intervals and continue to report staffing levels on a monthly basis. We will also continue

to implement the Partnership for Patient Protection programme (P4P2) via the violence

reduction project in the Specialist Learning Disability Division and the self-harm project

across Local and Secure Divisions.

Timely care priorities will be to address access issues for our Talk Liverpool IAPT service

and improve access to tier 3 and 4 psychological therapies and psychotherapy. We will

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also focus on meeting new targets for access to treatment for first episode psychosis and

access to CBT and psychology in our secure services. As a partner in the local health

economy, will work to deliver 24 hour mental health crisis care, including the new liaison

response times of 1 hour in A&E and 24 hours on acute wards. Delivery of these new

access and waiting time standards is dependent upon funding from our commissioners.

Priorities for the delivery of effective care will be to improve the ‘flow’ of service users

in local services through developing alternatives to inpatient admission, reducing length

of stay through bed management, and supporting discharge through developing step

down services and addressing delays in discharge caused by social factors. We will

implement a new structure for community mental health teams and ensure a greater

focus on people with complex needs on care programme Approach (CPA) in order to

reduce their caseload. In secure services we will focus on discharge from low secure

services and the community forensic team. We will also target our improvements efforts

on physical health, to ensure that metabolic screening is undertaken comprehensively

using the Lester tool and that physical health risk factors are addressed.

Equitable care priorities will be the development of a sensitive and comprehensive

understanding of the needs of service users at service level and to address the priorities

identified.

To deliver person-centred care we will work closely with the clinical teams that have

seen an increase in complaints to address any root causes. As we implement other

aspects of our transformation plan in local services (e.g. a new crisis pathway, a new

structure for community mental health teams) we expect patient experience scores to

improve. We will also focus on achieving 90% compliance with the Triangle of Care and

establish peer-run carer support groups throughout the Trust.

Our pursuit of perfect care in our services depends on a ‘just and learning

organisational culture’. People make errors, and errors cause accidents. In healthcare,

errors and accidents result in morbidity and adverse outcomes, and sometimes

mortality. The trust has been progressing plans to develop a just and learning culture at

Mersey Care. This has been informed by the significant input from the wide range of

engagement events throughout the trust over recent months. The engagement has

enabled the Trust to draft a high level goal aimed at addressing the issues that inhibit

reporting and learning and ultimately stop us from delivering Perfect Care. We are

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planning incremental yet significant changes to fundamental aspects of organisational

and procedural management to create a just and learning culture for all.

To achieve our perfect care goals we will us the same improvement methodology

across the organisation. This will be the Institute for Health Improvement’s ‘Model for

Improvement’ supplemented, where appropriate, by teams of experts using Design

Thinking methodology. This will ensure an empathic approach to problem solving and

improving quality which is standardised and easily utilised by clinicians in the clinical

divisions.

5.1.3 Transformation programmes

As we have described, in 2017-19 we will prioritise the delivery of the transformational

programmes in our clinical services (local, specialist learning disabilities and secure

services) and in our corporate services.

Considerable changes will be made to our care and workforce models in the coming

year in order to fulfil our strategic objectives, making key quality improvements and

releasing efficiency savings. Transformation priorities for 2017/19 are set out in the

diagram below and further detail is provided regarding the key challenges and

deliverables for each project in following section.

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Local Services Transformation

Currently, people are accessing our community services with no clear pathway and are

often on our caseloads for a long time with little improvement in their health outcomes.

With the implementation of clearer care pathways for community services and a new

structure and purpose for community mental health teams, people will know what to

expect from their care with Mersey Care, and clinicians and staff will know what we can

offer to the people in our care. The pathways will be reflected in our new clinical

information system, which will be much faster to use for our frontline staff but it will also

guide what we can and should offer service users at different steps in their care journey.

We will create alternatives to outpatient clinic appointments to reduce DNAs and to

make better use of specialist and service user time. Where people’s mental health needs

are stable we will work with GPs to provide support for people closer to home in primary

care rather than treatment in a mental health setting.

In our local services inpatient services, there are currently too many access points to our

services and as a result, some inconsistency in how people’s needs are assessed. Once

people are admitted, the purpose of wards is not clear and people’s expected length of

stay and package of care is not always agreed. It is increasingly difficult to discharge

Specialist LD DivisionRetraction plan

Low secure - new build/ transition to community (subject to consultation)

ESS - discharge of service usersSpecialist support teams in community

Local DivisionClear core business for CMHTs

Improved crisis pathwayEarly intervention and IAPT

accessIncrease patient flow

Collaboration with primary careImplement community services

in South Sefton

Secure DivisionIntelligence staffing allocationIncrease flow through secure pathway - medium and low secure LOS and discharge

Changes to high dependency wards

Medium secure unit at Maghull Reduce long term segregation

Respond to Transforming Care

Enablers of change for all divisions

1. Standard operating plat form

2. Staff support and culture change

3. Corporate services transformation

4. Digital technology to support transformation

5. Estates improvements

Transformation Programme

2017-19

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people because of social factors such as social care packages, housing and benefits. Our

transformation programme will create standards for access and admission, introduce a

bed management system that all staff use through our clinical information system, and

will support discharge and recovery by focusing on people’s social circumstances. We are

also developing a clear crisis pathway and alternatives to inpatient care, by creating ‘step

up’ and ‘step down’ beds with the voluntary sector so that service users and frontline

practitioners have choices at times of distress.

Key challenges

Key Deliverables

PROJECT: COMMUNITY SERVICE REDESIGN

• Increase in demand

• Managing complex patients effectively for

their needs e.g. personality disorder, older

adults

• Increase in incidents

• Caseload management variable

• Low productivity levels

• Inconsistency in pathways, thresholds and

operating procedures

• Variable relationships with primary care

• Poor IM&T and estate infrastructure

• Redefine purpose of CMHT’s including

focus on CPA

• Caseload review, managed transition of

caseload in clusters 1-3 back to primary

care

• Integrated working with primary care

• Implement standard care pathways for

community services

• Move away from outpatient model

• Implement workforce modelling

recommendations – ensuring correct

current and future staffing levels and skills

to meet need as well as use of new or

enhanced roles

• Ensure delivery of all IAPT and EIS

standards

• Introduce standard operating platform to

get the basics right

• Implement Psychological Skills Strategy

PROJECT: INPATIENT AND ACUTE SERVICES REDESIGN

• Increase in demand and acuity

• Managing complex patients effectively for

their needs, e.g. personality disorder

• Continued use of OAT’s

• Longer than benchmark lengths of stay in

acute adult wards

• Implement workforce modelling

recommendations – ensuring correct

current and future staffing levels and skills

to meet need as well as use of new or

enhanced roles

• Develop alternatives to inpatient admission,

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• Increase in delayed discharges

• High levels of occupancy

• Increase in incidents

• Unwarranted variation in pathways of care

i.e., crisis, step down solutions

• Enhance AED liaison services across the

patch

• Implement the findings from the acute care

pathway review

• Implement bed management system

• Progress new inpatient builds in Liverpool

and Southport

• Implement nurse led discharge across the

patch

• Introduce standard operating platform to

get the basics right

Secure Services Transformation

In secure services we will continue to build upon and strengthen the quality of our core

clinical specialisms. Improving effectiveness and timely access to services through the

development of 'Care bundles' will allow us to standardise and formalise clinical

expectations, reduce variation in care both within and across services, and improve

quality and patient experience. Clinical oversight of the care pathway will improve access

to treatments and through-flow, minimise therapeutic drift, and improve discharge

planning and efficiency.

We will be changing the focus and function on some of our wards in response to

changing clinical priorities, reducing restrictive practices including long-term segregation

and blanket restrictions, improving the effectiveness of how we utilise our staff resources,

and focusing on our low secure and community forensic services.

Changing the way in which we manage and monitor the administration of our staff

rostering will give us the ability to ensure staffing across the division remains more

responsive to clinical need and patient complexity. Allowing for greater mobility of staff

at the point of care delivery will serve to maintain safety and improve both quality and

consistency of care.

As the planning for, and building of the new medium secure service progresses we will

be working closely with our colleagues from the Specialist Learning Disability Division to

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align models of care, governance arrangements, workforce planning, recruitment and

training to ensure that plans for the eventual transfer of care for both the mental health

and learning disability patient groups are effective and robust.

A further priority for the division will be the development of a medium and long term

estates strategy that supports the aspirations of the trust, whilst also ensuring long term

sustainability of the secure services with modern, safe and therapeutic clinical

environments that enhance patient care and recovery.

Key challenges

Key Deliverables

PROJECT: Improved flow through the secure pathway

• Efficiency of high secure pathway not

replicated across division

• Longer lengths of stay in low and medium

secure than benchmark

• Clinical variation that does not add value

for patients

• Step down part of pathway not working

optimally

• Implement standardised pathway for

assessment, bed management and

discharge, utilising a care bundle approach.

• Consistent management of pathway from

secure to local services as host provider of

pathway.

PROJECT: Intelligent staffing allocation

• Staff rostering does not offer flexibility to

reflect need and higher periods of demand

in services.

• Lack of staff mobility across the division.

• Flexible rostering system, which meets

service need.

• Positive employee relations to support

flexible deployment of staff.

PROJECT: Reduced use of long term segregation

• Greater use of long term segregation than

desirable

• Segregation does not enhance recovery

through provision of therapeutic

environment.

• Will require staff cultural change to

implement reduced long term segregation.

• Reduce in number of service users in long

term segregation and in average length of

segregation.

• Support to staff to work in environment

with reduced segregation.

PROJECT: Changes to high dependency wards

• Clinical practice for managing high

dependency patients has moved on since

• Fit for purpose environments

• PIPs staff would be ward based

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current wards were built.

• Building design not suitable for current

observation practices, seclusion and

segregation

• Lack of space for works with PIPs teams

• Links to reduced seclusion, segregation and

time spent in both of these.

• Reduction in restraint and incidents.

• Reduction in overall length of stay

• More meaningful activities for patients

PROJECT: Development of a medium secure unit at Maghull

• Medium secure services at Scott Clinic are

not fit for purpose.

• Physical separation of medium and high

secure services limits divisional knowledge

transfer and flexible staffing approaches.

• Alignment of development plan for medium

secure unit with that for Specialist Learning

Disabilities.

• Build and open new unit.

Specialist Learning Disabilities Transformation

The national Transforming Care programme aims to reduce reliance on inpatient beds

and to treat individuals with learning disabilities in the least restrictive environment,

ensuring a seamless and efficient pathway that allows people to quickly move back to

their local communities with appropriate levels of support. We will co-design a new

clinical model with service users, staff, families and commissioners with a strong

emphasis upon personalised care and support and co-design of new state-of-the-art

facilities.

As the number of existing inpatient beds are reduced, we will establish and recruit

specialist support teams to support care outside of hospital. They will provide active

intervention to enhance the discharge process, reducing delayed discharges by providing

expertise care and wrap around support on discharge from secure facilities. They will

also work with community providers and agencies to ensure the correct training and

support is accessible. In addition, the team will provide Early Intervention support to

prevent crisis.

New and existing state-of-the-art medium and low secure facilities will transform the

secure care pathway over the next 3 years and allows us to deliver the best possible care

in facilities fit for the future. They will utilise the most up-to-date technology to improve

patient experience, enhance engagement, increase autonomy and potentially reduce the

intrusion of physical observations. This ambitious improvement to secure services is

currently subject to a Regional Consultation, with an outcome due in March 2017.

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We will invest in our staff, building skills, establishing new roles and growing the

workforce for the future to implement this new model of care.

Key challenges

Key Deliverables

PROJECT: Retraction plan

• Subject to NHS England consultation

regarding future of the Whalley site.

• Need to reduce reliance on inpatient care.

• Availability of alternative care settings in

the community.

• Retraction of specialist LD services from the

Whalley site in line with outcome of NHS

England consultation.

• Ensure alignment with medium secure

development on Maghull site.

PROJECT: Low secure transition to new build/ community based service (subject to

consultation)

• Subject to NHS England consultation



• Availability of alternative care settings in

the community.

• Contraction of low secure bed numbers to

60.

• Ensure alignment with medium secure

development on Maghull site.

PROJECT: Specialist community support teams

• Current lack of specialist community

support teams limits ability to care for

people with complex and challenging

behaviour in the community.

• Upfront investment in the new model of

care is required.

• Support to Community LD Teams with

Forensic and complex challenging

behaviour patients.

• New model of care to prevent admission

and support successful discharge into the

community.

• Development of community beds in line

with commissioner plans.

PROJECT: Discharge of Enhanced Support Service service users

• Provide specialised support to service users

with highly complex needs.

• Discharge of service users and contraction

of the current estate.

• Provision for these service users within

specialist community services.

• Provision for a small number of service

users who required continued package of

care in ESS setting.

PROJECT: Development of a medium secure unit at Maghull

• Subject to NHS England consultation • Alignment of development plan for medium

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• Opportunities to align medium secure

specialist LD and mental health services are

not maximised.

secure unit with that for secure services.

• Build and open new unit.

5.1.4 Providing community physical health services

Mersey Care has been announced as the preferred provider of community physical

health services for the South Sefton population, with the opportunity to acquire services

currently provided by Liverpool Community Health NHS Trust. Provision of community

physical health services allows the pursuit of our vision for perfect care for people with

mental health problems, learning disabilities and addictions problems and offers the

opportunity to lever our skills and expertise in the management of long term conditions

apply our recovery-focussed approach to a wider population. Parity of esteem between

mental and physical health will be boosted our expert understanding of the relationship

between physical and mental health.

The skills of Mersey Care staff in risk management, assessment, integrated working with

other agencies and taking a recovery-oriented approach will support the provision of

effective care from community services service users and carers. Being the integrated

provider of physical and mental health community services will also enhance the care

that we are able to provide for existing Mersey Care service users.

In 2017/19, we will progress the acquisition of community services for the population of

South Sefton from Liverpool Community Health and maximise opportunities to provide

high quality integrated services as we deliver our transformation programme.

5.1.5 Corporate Services Transformation

We will commence a Corporate Service transformation programme to ensure that our

back-office services are as efficient and effective as possible, in line with the

recommendations of the Carter Review. The review will ensure that our corporate

services are fit for purpose and meet the strategic needs of Mersey Care, whilst

supporting delivery of corporate CIPs of £0.7m in 2017/18 and £4.7m in 2018/19.

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5.2 Save time and money

The NHS is expected to deliver efficiencies of 2-3% per year, effectively setting a 10-15%

real terms cost reduction target for achievement by April 2021. The 2016 Carter Review

considered productivity and efficiency and concluded that there is significant

unwarranted variation across the NHS estimated this unwarranted variation is worth £5bn

in terms of efficiency opportunity nationally.

The Carter Review recommends a target of 6% of turnover for back office functions and

this would equate to c£15m for Mersey Care. There is considerable opportunity for back

office and corporate services efficiency which will be reviewed and achieved in 2017-19.

Further work by Lord Carter regarding efficiency specifically in mental health trusts is

currently being undertaken and the Trust is an active participant in this.

5.2.1 Cost improvement programmes

Mersey Care has a long-term financial model which will ensure our ambitious service

plans are delivered within a challenging economic climate that requires significant

efficiency savings to 2020/21, with higher efficiency savings in the earlier years of our

plans as we redesign our care and workforce models.

We have reviewed our Cost Improvement Scheme in light of the changing environment,

including increasing demand and acuity facing our clinical services, and particularly

difficulties in access to enabling funding, such as capital monies and resources from

commissioners. We have also taken account of the recommendations of the Carter

review regarding corporate/ back office costs. As a result, the efficiency savings planned

for 2017/18 and 2018/19 have been re-profiled, and the revised efficiency savings

required are set out below:

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Cost efficiency savings

required

2017/18

£m

2018/19

£m

Secure division 2.2 0.7

Local division 3.3 -

Corporate division 0.7 4.7

Total 6.2 5.4

The Specialist Learning Disabilities Division is engaged in a contraction programme and a

three year transformation plan under the ‘Transforming Care’ agenda. Cost

improvements are integrated within the contraction plans and in the reduction of

beds/contract value for the inpatient element whilst developing new community services.

There is a cost saving to the health economy of approximately £12 million at the end of

the three year transformation.

For 2017/18 this translates into a cost improvement plan (CIP) of 2.6% (£6.2m). Through

the clinical division transformation programme and a programme of transformation

within corporate services, Mersey Care will deliver the service and workforce change

necessary to release these efficiency savings. We have an excellent track record of CIP

delivery without reducing service quality or performance, so we are confident that

delivery of CIPS for the coming year is achievable. The majority of our CIPS are delivered

from our pay bill.

5.2.2 Activity and demand management

In the years ahead we will continue our efforts to manage demand, in particular working

closely with primary care colleagues. Our transformation programme in local services,

whereby we will standardise access, bed management and discharge arrangements to

increase the flow of patients through our services is key to demand management. We

also manage mental health demand in A&E, in primary care and in the criminal justice

system, and we are looking to build on our pioneering liaison work in these settings

through additional CCG investment.

The Directors of Finance/Chief Finance Officers within the North Mersey Local Delivery

System (LDS) agreed a set of principles to enable an innovative approach to contracting

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to be established for the financial years 2017/18 and 2018/19. The aim of this

arrangement is to bring financial stability to the North Mersey system and enable a focus

on pathway redesign, cost containment and delivery of Must Dos. The four broad tenets

of the agreement are;

• Forecast Outturn

• +1% growth for each of the next 2 years

• Shared plan for delivery of ‘Must Dos’ (as set out in the 5 Year Forward View for

Mental Health)

• Delivery of North Mersey Local Delivery System transformation milestones

We have agreed with commissioners to link prices to locally agreed quality and outcome

measures from 2017/18 and to adopt the option of an episode of care/year of care

model. This will be developed during 2017/18 with a full payment model implemented in

2019/20. The guidance suggests linking between 2% to 4% of the total financial contract

value to outcome measures. The percentage linked to outcomes measures and the

weightings assigned to each needs to be agreed with commissioners during 2017/18.

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6. Our People

Ensuring we get the basics right first time every time, providing quality care and the

effective implementation of our new models of care all depend upon the calibre of our

leaders and managers and effective teamwork across all services. 30% of our workforce

is over the age of 50 years and so our approach to supporting our people must ensure

that we plan for our future workforce needs.

6.1. Great managers and teams

Our organizational effectiveness plans take account of the need to distinguish leadership

attributes from management capability. To support managers, will be clearer about the

core expectations we have for managers and their teams, such as having shared team

objectives, regular team meetings and appropriate levels of clinical supervision. We will

embed these requirements through our PACE appraisal process and in turn place greater

emphasis on the good management of this appraisal process. Enabling consistently

good people management and development within our services is a priority. Our Thrive

programme, which is delivered to team and ward managers, amongst others, will support

the development of management capability to ensure high performing teams.

We will continue to embed and integrate the 'Leading Perfect Care' and 'Leading Teams

to Perfect Care' plans in 2017/19 to support the development of effective leaders and

will embed the next stage of our leadership plan, talent and succession planning,

‘Maximizing Potential’, which will be piloted in 2017/18 and inform broader rollout

2018/19.

6.2. A productive and skilled workforce

Recruiting and retaining high performing staff is essential to delivery of our strategy for

perfect care. Our analysis of highlights areas of specific challenge, notably, the

recruitment and retention of inpatient consultants in our local division, learning disability

nurses in our specialist learning disabilities division (related to uncertainty about the

future of services on the Whalley site) and in services where posts are fixed term due to

commissioner funding restrictions, for example in our Criminal Justice Liaison service.

We will establish a recruitment and retention task and finish group to address these and

other difficulties, including innovative approaches to nurse training, development of new

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roles, review of fixed term posts and risk assessed transfer to permanent contracts,

targeted advertising and use of social media, financial incentives and forward planning

and recruitment to future vacancies.

Our work on improving the health and wellbeing of our staff will include a focus on

reducing sickness absence. Mersey Care’s sickness absence rate is higher than all other

North West mental health trusts. Particular attention will be placed on sickness in

inpatient settings across both secure and local services, where our analysis identifies

higher sickness absence rates than in our community services. To address these issues,

amongst other things, we will introduce over 40s and over 50s health checks to act as a

preventative and support measure to staff and a programme of support for staff living

with a long term condition or chronic pain. We will focus attention on the impact of

assault in our services on sickness absence and develop our support systems for staff

following a traumatic incident. We will also review our sickness absence practices,

processes and performance management approach to ensure they align with emerging

evidence of best practice, working closely with our clinical divisions.

Staff engagement remains a significant priority as we continue to go through our

programme of large scale change. Staff engagement will be included within divisional transformational delivery plans. We will continue to deliver our robust annual

programme of communication and engagement which will underpin our ‘just and

learning culture’ goal. In particular, we will focus on clinical engagement and the

leadership of change.

6.3 Side by side with service users and carers

Working side by side with service users and carers and taking a human rights

approach to providing services is embedded in our Trust values of continuous

improvement, accountability, respect and enthusiasm and is of critical importance if we

are to deliver large-scale transformation. Our People Participation Programme is based

on the principles of volunteerism, recovery and social inclusion which enable

transformation in clinical services through the development of our 'Life Rooms' model

which incorporates recovery college, social inclusion, peer support and volunteering

programmes.

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In early 2017, we will open a second ‘Life Rooms’ in Southport and our primary focus

will be to embed Recovery College and social inclusion programmes into care pathways

and discharge planning across both local and secure services. We will also expand the

physical health offer from the Life Rooms and rollout the model to our new South Sefton

Community services.

We will build upon the pilot peer support worker programme by formally incorporating

the peer support workers within the Life Rooms structures so as to support the

embedding of the Life Rooms in care pathways.

We will continue to increase service user and carer participation in all aspects of the

Trust. We are a member of the Triangle of Care scheme (good practice in carer

involvement and support in mental health services). We will continue to embed this

across all services and extend to both Specialist Learning Disabilities and South Sefton

services. Additional service user and carer support groups will be established in services

across the Trust building upon the first 14 launched in the previous year. In the past 12

months, we have updated service user and carer information packs for Specialist

Learning Disability and Secure Divisions and service user packs for Local Division. In

2017/19 we will develop carer information packs for Local Division services and use our

standard operating procedures to set down expectations about the way in which these

packs are used and the way in which information about their care is communicated with

service users and carers.

Key deliverables:

• Clarity about the core expectations of managers and teams.

• PACE process incorporating objectives focussed on ‘getting the basics right’.

• Implementation of strategic recruitment mapping and approaches to increase

recruitment and retention.

• Preventative and supportive measures to improve staff health and wellbeing.

• Reviewed sickness absence processes and practice to align with the ethos of a just

and learning culture and national best practice.

• Opening Life Rooms Southport

• Embedding Recovery College into care pathways across services

• Additional service user and carer support groups across the Trust

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• Implementing standard practices for the provision of service user and carer

information and points of contact in services.

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7. Our resources

7.1 Buildings that work for us

High quality buildings are critical to the delivery of our transformation plans and to our

goal of striving for perfect care for the people we serve. In 2017/18, Our Design

Champions Board will review our estates needs to support the delivery of perfect care

and the transformation programmes in our clinical divisions.

Specific capital schemes for 2017/19 include those below. Figures provided refer to

2017/19 investment only.

Inpatient builds in Liverpool and Southport (Investment of £28.4m for Liverpool and

£17.2m for Southport in 2017/19)

• The Liverpool inpatient facility will deliver a purpose-built inpatient facility on the

trust’s Mossley Hill site. The Southport inpatient facility will deliver a purpose-built

facility on the site currently occupied by the trust’s Boothroyd Unit, allowing for the

closure of the existing buildings and the closure and sale of the Hesketh Centre site.

• In addition, enabling capital development to support these schemes will be

undertaken, such as the relocation of pharmacy services from the Mossley Hill site.

Redeveloped medium secure provision in a secure campus at Maghull (Investment of

£40.8m in 2017/19)

• We hope to relocate the trust’s medium secure unit to our Maghull site, allowing the

trust to close our facility at Scott Clinic and dispose of the site. The project also

allows the trust to provide secure learning disability services, subject to consultation

regarding the future of such services on the Whalley site.

• Pending the outcome of the NHS England consultation, we will develop a plan for

the future of the Whalley site. We also plan to develop a centre of excellence at

Maghull to support the Centre for Perfect Care and our research and development

capability.

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Key deliverables:

• Implementation of plans for inpatient builds in Liverpool and Southport

• Enabling works to support these inpatient builds

• Development of medium secure provision in Maghull, integrating requirements of

secure and specialist learning disabilities services.

7.2 Technology that helps us provide better care

Mersey Care has begun to transform the end-to-end patient experience in mental health

through use of digital technology. Against a backdrop of serving the most vulnerable

and excluded people in society and in a place with very high levels of digital exclusion,

we will use digital technology in all aspects of mental health care. Through the use

of digital technology, we will transform outcomes for people with mental health

problems, helping people get quicker access to services, enabling them to take more

control over their own health, reducing premature mortality and death by self harm, and

enabling them to experience sustainable recovery. Because digitisation is about people

and not just technology, we will co-produce our programme with service users and

frontline clinicians to ensure that technology is useful and fully adopted. We aim to

make mental health services a receptive culture for digital technology by focusing on the

people who use and provide services at the frontline.

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Our priority continues to be on establishing firm foundations on which to build future

digital capabilities and in 2017/19 we will continue to deliver our digital strategy, which

was refreshed and extended for a further five years in November 2016. In the future we

will make use of ‘big data’ to drive intelligence-led improvement.

During 2016/17, the trust has identified that a re-focus on improving data quality and

health records management is critical if we are to have a robust basis upon which new

payment systems can be based and to provide assurance of the quality of care being

delivered. A detailed, overarching, action plan to support sustainable improvements in

data quality and record keeping has been developed and will be implemented during

2017-19 under the leadership of the Chief Clinical Information Officer. The action plan

includes a review of the governance arrangements around data quality and health

records management across the trust.

Key deliverables:

• New data centre with our third sector partner following capital investment.

Partner organisations

• We have well-established partnerships locally, nationally and globally to maximise our digital capability and deliver our objectives

• We will establish further partnerships in our pursuit of Perfect Care

Deliverables

• 1a. Implement new clinical information system, automated pathways and inter-operable systems

• 1b. Develop information-based management tools to support clinical decision making

• 1c. Use technology to make care safer

• 1d. Use technology and the internet to extend the reach of our service to those who need it

Vision Mersey care and the Centre for Perfect Care will use digital technology to transform all aspects of mental health care, encouraging learning from local

and global health systems about the future potential of digital technology to transform outcomes in mental health.

Through the use of digital technology, we will transform outcomes for people with mental health problems, helping people get quicker access to services, enabling them to take more control over their own health, and enabling them to experience sustainable recovery

Objective 1

We will revolutionise technology

systems and infrastructure to use technology in all aspects of the services we

provide

Deliverables

• 2a. Co-produce digital technology solutions with experts by experience

• 2b. Co-produce digital technology solutions with clinicians

• 2c. Change the culture in mental health services and improve workforce skills and learning, enabled through a ‘just’ culture

Objective 2

We will design the programme around insight, co-production

and digital skills development with frontline clinicians and service users,

enabled through a ‘just’ culture

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• Roll out Rio, our new clinical system to the Local division in 2017/18 and 18/19.

• Electronic Prescribing and Medicine Administration (EPMA) is now live in High secure

and a roll out plan across the remaining divisions has been agreed.

• Focus on interoperability and sharing information.

• Ensure wi-fi networks are opened up to ensure staff can work at any site even if its

not part of Mersey care’s estate infrastructure

• Investigate closer collaboration across the health economy through the Sustainability

and Transformation plan.

• Continued development of quality dashboards from our data warehouse and

continues development self service reporting.

• Integration of informatics services from Whalley to ensure we align processes across

the Trust.

• Planning for the integration of South Sefton community physical health services

acquired from Liverpool Community Health NHS Trust.

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8. Our future

8.1 Effective partnerships

8.1.1 A collaborative care model with primary care

Mental health and primary care services are typically delivered by different providers in

separate settings with little co-ordination and integration. This fragmented delivery of

care can be problematic for people with mental health problems but also those with co-

morbid long-term physical conditions.

There is now a strong body of evidence from both the United States and from other

parts of the UK that shows that the integration of mental health in primary care settings

can significantly improve outcomes for people with both mild to moderate and severe

and enduring mental health problems, can be cost effective, and can reduce emergency

admissions and use of A&E.

We have evidence that a significant number of referrals to secondary care could and

should be managed in primary care. It is in our interest to ensure that our valuable

resources are not directed in the wrong places making us less clinically and cost

effective. Current relationships and approaches at the interface with primary care are

highly variable across the area we serve. There is some good practice and a more

integrated approach is being championed by GPs, but integrated care in Liverpool and

Sefton is currently focussed on co-morbid physical conditions. It is imperative that we

ensure mental health is part of this transformation.

We will build on the work already in place relating to increased communication and

support to GPs and their teams in mental health. The capacity of our specialist

services is often stretched by people with stable mental health conditions because there

is limited capacity in primary care to deal even with people whose mental health

condition is relatively stable. Supporting shared care and learning in primary care to

enhance GPs ability to manage stable patients will ensure that referrals to Mersey Care

are more consistent and proportionate to need. Building on the relationships developed

through our primary care mental health liaison workers and consultant to GP

relationships, we believe there is an opportunity to develop further collaborative working

between GPs and Mersey Care to improve mental health support in primary care

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generally, and enhance GP capability to manage patients with stable mental health

conditions themselves through training and development.

We will organise focussed training for members of the primary care teams so that they

can better support people with mental health problems without the need for referral to

secondary care. GPs have existing skills upon which to build specialist mental health

education and training, and we are identifying local GP champions for mental health to

help drive forward implementation of integration of mental health in primary care over

time. Along with recruiting GP champions for mental health, we will look to deliver

mental health work-based learning packages for primary care practice teams.

8.1.2 Building strategic alliances with housing providers

Having somewhere safe and warm to live is fundamental to our mental health and

wellbeing. Housing should provide not only shelter but also a secure and positive

environment that supports people in their recovery and as their lives progress. Mersey

Care has found that lack of suitable housing with the right support is often a barrier to

being discharged from hospital across the mental health and learning disabilities care

spectrum, from secure mental health care through to discharge from acute mental health

hospitals and from inpatient settings for people with learning disabilities. Despite this

fundamental connection between housing and health, strategic alliances between NHS

providers and housing providers are not commonplace.

In recognition that housing support is an essential element of looking after someone’s

mental wellbeing, Mersey Care will be seeking to build strategic alliances with the

housing sector in 2017-19, in order to develop innovative ways to give people more

choice and independence in their lives and avoid acute admissions. This is a theme that

applies to a number of our services, including step down from adult acute care, specialist

learning disability care and low secure and forensic community services.

8.2 Research and innovation

8.2.1 Centre for Perfect Care

The Centre for Perfect Care was established in January 2014. It brought together the

areas of: quality improvement, innovation, research and development, knowledge and

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learning services. This promoted sharing of resources and an opportunity to engage

clinicians in delivering perfect care across the six quality domains: safe, timely, effective,

efficient care, equitable care and positively experienced. It was agreed that better

coordination and planning would help improve quality, along with sufficient investment.

The Centre has stimulated new ways of thinking about the quality of care and enabled

non-recurrent resources (£2 million) to pump prime novel and ambitious quality and

innovation programmes. In 2017/19, we plan to build on and accelerate the research and

innovation work of the Centre, focusing on achieving critical mass with programmes such

as zero suicide, zero restraint and improving physical healthcare, whilst continuing to

innovate in models of care for the future through our partnership with The Risk Authority

at Stanford and through our Innovate Depression programme.

Key deliverables:

• The development of an R&D ‘Centre of excellence’ as part of the secure campus in

Maghull (£10minvestment)

• No Force First - embed No Force First approach on all in-patient wards

• Zero suicide - fully implement zero suicide policy and strategy

• Physical health - increase Trust-wide compliance with Lester tool and help services

meet physical health targets

• Lockton, Mills-Reeve partnership – continue to work with external experts to

implement a world class incident/claims management function

• P4P2 Patient Safety Partnership – Continue to work with The Risk Authority at

Stanford to implement a modern clinical enterprise risk management and safety

system in the UK and US. Using Innovence Pulse determine what interventions a

health care entity should take to reduce risk, improve safety, as well as create or

expand on the value of risk management initiatives.

• Suicide Prevention App – in partnership with The Risk Authority at Stanford, and

LeanTaas, develop the Innovence AIMS suicide prevention app

• Design Thinking – work with in-patient and community teams using design thinking

to deliver user focused solutions to service delivery issues

• Improvement Spread – continue to implement the training strategy rolling out

improvement training across the organisation

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• Innovate Depression - in partnership with MIND and a range of local partner

organisations through our Zero Suicide stakeholder platform, develop a range of

innovative service options for people with depression.

8.3 Grow our services

All Trusts remain under continued pressure to sustainably reduce their costs whilst

simultaneously maintaining and improving the quality of care. As a consequence, more

Trusts are seeking to expand services through potential economies of scale in order to

remain viable. At the same time, the broader health economy continues to see an

increase in the number of private providers successfully competing for contracts. This

has given rise to fierce competition for contracts, and for increased competition on price.

In addition, Sustainability and Transformation Plans (STP’s) are driving collaboration

between Trusts on a geographic basis. Whilst in their relative infancy, fewer contracts are

coming to market via traditional commissioning and instead being funded on a

centralised basis through NHS England. It is within this environment that Mersey Care

has developed a clear business development strategy, sales and bid-writing capability,

and innovative service and workforce models that will reduce costs but continue to

deliver on quality.

We will pursue several ‘big ticket’ opportunities based on our strengths and weaknesses

and in response to threats and opportunities in our environment. The big ticket

opportunities for the coming year are the creation of a secure mental health and

learning disability ‘chain’ in new geographies; collaborating with neighbouring mental

health trusts in Cheshire and Merseyside to create an accountable clinical network in

mental health as part of the STP; and genuine service innovation. We will also protect

our existing services through a systematic programme of service reviews.

8.3.1 The creation of a secure mental health and learning disability chain in new

geographies

Providing services across the care continuum from primary prevention up to high secure

care, Mersey Care is well-placed to become a host provider of the secure mental health

pathway, with capitated budgets for the targeted population of people with forensic

health needs. We will explore opportunities to act as host provider which would allow

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us to front-load specialist expertise at points of the pathway where people’s needs are

most complex, (i.e. high secure services, criminal justice system, psychiatric intensive care

units), and maximum value from this specialist knowledge could be extricated by

developing packages of care at the most acute points in the pathway, specifying

optimum lengths of stay, treatment and outcome expectations for the rest of that

person’s journey through services. Using technology, a host provider could use its

position with a view across the full pathway to exploit innovative user of technology,

systems, data and intelligence to enable hard-wiring of electronic flow and decision-

making. This would naturally extend into wider inter-operability across the health and

social care economy.

8.3.2 Developing an accountable clinical network for mental health in Cheshire and

Merseyside

Mersey Care is currently pursuing formal collaboration between Mersey Care, 5 Boroughs

Partnership NHS Foundation Trust and Cheshire and Wirral Partnership NHS Foundation

Trust, with a view to developing an Accountable Clinical Network model for mental

health in Cheshire and Merseyside. Our three trusts share a range of similar issues in

delivering high quality mental health care to a diverse population and our local

communities include marginalised groups in some of the most deprived areas of the

country. We believe that we will be able to be more effective on behalf of those we

serve if we work together.

The needs of people with mental health problems and learning disabilities are often not

seen by commissioners’ as investment priorities, and whilst £1.8bn of sustainability

funding has been earmarked for conditions that include mental health and learning

disabilities, ensuring this funding is actually channelled into mental health and learning

disabilities services will require concerted effort by providers. We believe that specialist

mental health, learning disabilities and addictions providers will have limited success if

they only deploy their own resources, capabilities and levers in addressing the

considerable challenges to their future sustainability. We believe that the three specialist

mental health trusts in the Cheshire and Merseyside STP have a considerably stronger

voice if they work together. A review of the strategies of the three organisations,

reference to Mersey Care’s own experience of acquiring Calderstones NHS Foundation

Trust, and a review of the evidence base on successful hospital chains and networks

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suggests that the three trusts would benefit from a sustained collective focus on the

following areas which will be subject to agreement and attention in 2017/19:

• Reducing variations in clinical practice

• Improving patient safety

• Better workforce planning and recruitment

• Improving the evidence base

8.3.3. Service Reviews

Each year, we will undertake a systematic programme of service reviews in order to

support informed decisions regarding current and future service delivery. Service reviews

will be used to provide an opportunity to reflect on how a service is being delivered, and

consider the evidence for improvements if necessary. The objective of the service reviews

is to enable us not solely to react to the changing landscape of health care, but to

anticipate and proactively manage opportunities to grow, partner and transform

appropriately and sensitively, whilst maintaining exceptional service levels for service

users.

Key deliverables:

• Ensure Mersey Care becomes a specialist provider of secure mental health and

learning disabilities services beyond our current footprint, including:

o achieve preferred provider status for medium and low secure services in the

North West

o extend secure mental health and learning disabilities provision, including

outreach and step -up/ down

• Agree across the accountable clinical network for Cheshire and Merseyside a set of

priorities to focus on and deliver tangible benefits within:

o reduced variations in clinical practise, that drive efficiencies in the broader

health sector leading to improved and sustainable funding

o improved patient safety, enabling the realisation of broader commercial

opportunities in wider geographies

o improved evidence base, resulting in external funding for innovation, research

and development

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• Pursue a ‘retain and grow’ approach to business development, retaining service lines

that drive margin and identify and win contracts that provide economies of scale or

profitable growth

• Identify Mersey Care as an innovation hub via Centre for Perfect Care and manage

opportunities through a commercialisation process

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9. Delivering this plan

We are confident that this operational plan will allow us to build on our achievements to

date in the delivery of our strategy for Perfect Care. We will pursue the genuine service

and workforce transformation described in this plan in order to deliver improvements in

quality and cost.

We will use key measures for each of our transformation programmes, which will allow

us to evidence the impact of our transformation, as set out below. These will also be

supported by our Quality Dashboard.

Local service transformation measures

• Service users in clusters 1-3

• Community mental health team

caseloads

• Outpatients appointments that are not

attended (DNAs)

• Average length of stay

• Unplanned out of area placements

• Bed occupancy rates

• Delayed discharges

Secure service transformation measures

• Long term segregation

• Patient experience score

• Average length of stay


Specialist learning disability transformation measures

• Compliance with retraction plan


Delivery of this plan for 2017/19 will be reported to the Executive Committee,

Performance and Investment Committee and Board of Governors. We will also report

progress to the Council of Governors and Service User and Carer Assembly.

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10. Key risks to delivery of this plan

Risk area Risk/ impact to plan Mitigating actions and

residual risk

Maintaining quality and

safety whilst delivering

transformational change and

efficiency

If cost reduction becomes a

stronger driver than quality,

then the quality of our services

may be adversely impacted,

resulting in quality of care not

meeting required standards.

Re-profiling of CIP targets for

2017/19.

Well managed transformation

programme.

Regular board monitoring of

key quality indicators.

Clear quality governance

process that is understood by

everyone in the Trust.

Constructive challenge/

accountability about service

quality through Committees.

Delivering the required

savings

Savings of £6.23m (2017/18)

and £5.55m (2018/19) are

required.

If the required savings are not

delivered, then we may not

achieve best value from our

financial resources, resulting in

failure to meet financial duties.

Strong management of the

Transformation programmes.

Monitoring of savings delivery

through the PIC.

Development of standard

quality improvement

methodology.

Financial planning.

Availability of capital If national restrictions on

capital prevent the planned

investment, then we may not

achieve best long-term value

from our financial resources,

resulting failure to meet

financial duties.

If national restrictions on

capital prevent the planned

investment, quality of care will

be affected.

Prioritise and sequence capital

investment.

Seek alternative funding

sources.

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Risk area Risk/ impact to plan Mitigating actions and

residual risk

Reduction in income If commissioning income is

reduced, then our ability to

deliver all strategic objectives

could be impaired, resulting in

adverse impacts upon quality

of care and organisational

sustainability.

Contract offer and ‘acting as

one’ principles provide clarity

on 2 year commissioner offer.

Improve and innovate in

model of care to become

provider of choice.

Implement business

development strategy.

Seek opportunities to develop

collaborative relationships with

other providers.

Managing demand for our

services

If demand for our services

increases above the level for

which we are funded, then

both delivery of our services

and our financial resources

may be impaired, resulting in

adverse impacts upon quality

of care and financial

performance.

Seek opportunities to bid for

additional funding released

nationally to support growing

demand.

Manage demand more

effectively in partnership with

primary care.

Standardise pathways of care

in local division.

Innovate to meet needs at

earliest stage in their

condition/ pathway.

Seek opportunities through

provision of physical

community services to support

self care.

Sustainability and

Transformation Plan

If there is reduced investment

in mental health, then there

may be an adverse effect upon

delivery of our services,

resulting in quality of care not

meeting required standards.

Active participation in the STP

North Mersey Directors of

Finance Forum.

Support and active

involvement in STP mental

health workstream to seek

opportunities to promote

mental health and investment

in the STP.

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Our People

AIMS OBJECTIVES PROGRAMMES MEASURES Our Services Improve quality (STEEP)

Save time and money

Getting the basics right

Pursuing Perfect Care

Transformation programmes in our clinical and corporate divisions

Five Year Forward View ‘must dos’

Quality dashboard Service users on clusters 1-3 CMHT caseloads Out patient DNAs Average length of stay Unplanned OATs Bed occupancy rates Delayed discharges

Support managers and effective teams

A productive, skilled workforce

Working side by side with service users and carers

Supporting managers

Recruitment and retention

Health and wellbeing of our people

Recovery College and Life Rooms Southport

Peer support

Sickness absence Attrition rate National staff survey People supported into meaningful activity

Our Resources Technology that helps us provide better care

Buildings that work for us

Future digital capability

IM&T infrastructure

Estates programme

Estate at category B Digital maturity CQUIN Data quality

Our Future Effective partnerships

Research and innovation

Grow our service

Collaborative care with primary care

Strategic alliances with housing providers

Centre for Perfect Care

Standardised improvement model

Pursuit of key business development opportunities

Discharge of service users in clusters 1-3 Targeted services retention rate Externally funded research

2017/19 PLAN ON A PAGE

SLD retraction plan Long term segregation Patient experience score Suicides within our care Use of restraint Physical health checks (CPA) Staff disciplinaries Access targets (FVFV)

agenda for council of governors meetingagenda item no: a4a private council of governors minutes –...

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