derbyshirecommunityhealthservices …...council of governors meeting held on 12 july 2017 carnfield...

Derbyshire Community Health ServicesDCHS Council of Governors

Postmill Centre, Market Close, South Normanton, Alfreton, DE55 2EJ13 September 2017 14:00 - 13 September 2017 16:00

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AGENDA

# Description Owner Time

99 Chair's WelcomeVerbal

Chair

100 ApologiesBrenda Greaves, Peter Ashworth, Veronica Hunting-Young, Lynne Bakewell, Amanda Smith, Kirsteen Farrar, William Jones

Chair

101 Declarations of InterestVerbal

Chair

102 Draft Minutes of Meeting Held 12 July 2017Paper for Decision

102 Minutes July 2017 CoG Meeting.docx 7

Chair

103 Matters ArisingVerbal

Chair

104 Actions MatrixPaper for Information

104 CoG Actions Matrix.docx 15

Chair

105 Patient StoryPaper for Information

105 Patient Story.pdf 17

Carolyn White

106 Performance and Quality - Holding to Account

107 Charitable Funds - Family Centred Care ProjectPresentation

107 Family Centred Care CoG Presentation.ppt 23

Lana-Lee Jackson

108 Quality and Performance ReportPaper for Information

108 Quality and Performance Report.pdf 33

Carolyn White, Chris

Sands

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# Description Owner Time

109 Nominations and Remuneration Committee Summary Report

Paper for Assurance

109 Noms Committee Summary Report.docx 43

109 Appx Noms Committe Summary Report NExT... 45

Chair

110 Updates from Governor Groups: Engagement, Strategy, Quality, Governance

Verbal

Julian Miller, Roz Coldicott,

Lorraine Culpin, Adam

Short

111 Strategy and Planning

112 Chief Executive's ReportPaper for Information

112 Chief Executives Report CoG Sept 17.pdf 53

Tracy Allen

113 Governance

114 Associate Director of Corporate Governance/Trust Secretary's Report

Paper for Information and Decision

114 Trust Secretary's Report.docx 65

Melanie Curd

115 Concluding Items

116 Any Other BusinessVerbal

Chair

117 Council of Governers - Review of MeetingVerbal

Chair

118 Date of Next Meeting - Wednesday 15th November 2017 at 2.00pm. Postmill Centre, Market Close, South Normaton, DE55 2EJ

119 Key Dates and Future EventsPaper for Information

119 Key Dates and Future Events.docx 79

David Boddy

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INDEX

102 Minutes July 2017 CoG Meeting.docx....................................................................................7

104 CoG Actions Matrix.docx.........................................................................................................15

105 Patient Story.pdf......................................................................................................................17

107 Family Centred Care CoG Presentation.ppt............................................................................23

108 Quality and Performance Report.pdf.......................................................................................33

109 Noms Committee Summary Report.docx................................................................................43

109 Appx Noms Committe Summary Report NExT Director placement Overview.........................45

112 Chief Executives Report CoG Sept 17.pdf..............................................................................53

114 Trust Secretary's Report.docx................................................................................................65

119 Key Dates and Future Events.docx.........................................................................................79

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Council of GovernorsMeeting held on 12 July 2017

Carnfield Room, Postmill Centre, South Normanton

Name TitlePrem Singh PS Chair – Non-Executive DirectorBernard Thorpe BT Lead Governor - Public Governor - City of

DerbyRay Asher RA Deputy Lead Governor - Public Governor -

Amber Valley, Erewash & South DerbyshirePeter Ashworth PAs Public Governor - Amber Valley, Erewash &

South DerbyshireValerie Broom VB Public Governor - Amber Valley, Erewash &

South DerbyshireRoz Coldicott RC Public Governor - Amber Valley, Erewash &

South DerbyshirePaul Mason PM Public Governor - Amber Valley, Erewash &

South DerbyshireMichael Perry MP Public Governor - Amber Valley, Erewash &

South DerbyshireAnn Button AB Public Governor - Derbyshire Dales & High

PeakAndrea Cooke AC Public Governor - Derbyshire Dales & High

PeakBrenda Greaves BG Public Governor - Derbyshire Dales & High

PeakLorraine Culpin LC Public Governor - Bolsover, Chesterfield & NE

DerbyshireJulian Miller JM Public Governor - Bolsover, Chesterfield & NE

DerbyshireMaureen Strelley MS Public Governor - Bolsover, Chesterfield & NE

DerbyshireAdam Short ASh Staff Governor - A and C and ManagersSally-ann Coope SAC Staff Governor - NursingVeronica Hunting-Young

VHY Staff Governor - Nursing

Janine McKnight-Cowan

JMC Staff Governor - Nursing

Wendy Hodgkinson WH Staff Governor - Healthcare Support StaffLynne Bakewell LBa Staff Governor - Other Registered

ProfessionalsLouise Holmes LH Staff Governor - Facilities and Estates

Present

Amanda Smith ASm Staff Governor - Medical and Dental

Tracy Allen TA Chief ExecutiveJim Austin JA Associate Director of TransformationApologiesTim Broadley TB Associate Director of Corporate StrategyPage 1 of 7102 Minutes July 2017 CoG Meeting.docx

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Minutes Council of Governors July 2017 2

Rick Meredith RM Medical DirectorAmanda Rawlings AR Director of People and Organisational

EffectivenessCarolyn White CW Director of Quality/Chief NursePaul Kirtley PK Public Governor - Derbyshire Dales & High

PeakDiana Wood DW Public Governor - Rest of EnglandJenny Swatton JSw Appointed Governor - Southern Derbyshire

Clinical Commissioning GroupPeter McDonald PMc Public Governor - Bolsover, Chesterfield & NE

Derbyshire

Janet Hitchenor JH Public Governor - Bolsover, Chesterfield & NE Derbyshire

Tabitha Crapper TC Staff Governor - Healthcare Support StaffSara Nash SN Staff Governor - Other Registered

Professionals

Apologies not Given

Steve Allinson SA Appointed Governor - North Derbyshire Clinical Commissioning Group

Chris Sands CS Director of Finance, Information and StrategyChris Bentley CB Non-Executive DirectorKirsteen Farrar KF Associate Director of Corporate

Governance/Trust SecretaryJo Hunter JH Deputy Chief NurseWilliam Jones WJ Chief Operating OfficerIan Lichfield IL Non-Executive DirectorNigel Smith NS Non-Executive DirectorLauren Shiel LS Engagement Officer

In attendance

David Boddy DB Corporate Governance Manager

Item Description Action75/17 Chairman’s Welcome and Introduction of Governors

PS welcomed the Council of Governors (CoG).

PS updated the CoG: About the proposals regarding future Non-Executive Director (NED)

presentations and how we plan to achieve them In response to governor recommendations at the last meeting, the

agenda for today had been rotated to provide focus to the Strategy and Planning section

76/17 Apologies for AbsenceApologies were noted as above.

77/17 Declarations of InterestThe Chair and NEDs Nigel Smith, Ian Lichfield And Chris Bentley declared an interest in agenda item 88/17.

78/17 Draft Minutes of the Meeting held on 10 May 2017The minutes were approved as an accurate record of the meeting.

79/17 Matters ArisingNone.

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Item Description Action

80/17 Actions MatrixThere were no actions for discussion.

81/17 Patient StoryThe Patient Story provided insight into the Fracture Clinic at the Whitworth Hospital, a new local service now being offered providing follow up care and management for certain fractures.

The story reflected the speed of care provided along with flexible appointments so the patient could return to work.PS said that the story depicted the high level of expertise provided by DCHS outside of an acuity setting.

WJ updated the meeting regarding the availability of the Radiology service.

WJ discussed the nationally planned developments in order to provide a consistent approach to urgent care. The four DCHS Medical Injury Units will become Urgent Treatment Centres.

The meeting went on to discuss the commissioning of different services within the urgent care context.

The paper was received for information.

8217 Strategy and Planning83/17 Better Care Closer to Home and Joined up Care Belper

Better Care Closer to HomeWJ reminded the Council about the proposals that had been originally made. Following completion of the public consultation, the Clinical Commissioning Groups (CCGs) are to meet on 24th July to make a decision regarding the business case. DCHS has planned staff briefings for the morning of the 25th July.

It was emphasised that services should not be closed until replacement services are in place. WJ did explain, however, that there remained challenges to staffing in areas that have been part of the consultation.

The Council asked a number of questions about what the implementation of change may look like. A transition plan would be developed and support would be provided to support staff that are affected. JH and Ash enquired about any additional resource into Resolve/OH to support staff affected by the BCCtH outcome. WJ acknowledged that this would be considered.

PS summarised that following the CCG announcement, clear DCHS communications would be undertaken with speed. However, DCHS has a lot of experience of change and the transition of affected services would be handled carefully, comprehensively and sensitively.

To help manage the BCCH communication process, the guidelines for staff behaviour when using social media are going to be reissued as a reminder.

Joined up Care, Belper



Item Description ActionSouthern Derbyshire CCG have made a case for change with respect to services in Belper. A public consultation is being planned and will be undertaken. Plans will also be submitted to NHS England in August for approval.

WJ set out the proposed changes with respect to: Services to be transferred from Babington Hospital to new premises in

Belper. Change of model of care for patients that currently receive care on

Baron Rehabilitation Ward

The presentation was received for information.

84/17 Chief Executive’s ReportCS updated the CoG regarding:

The decision by Derbyshire Healthcare NHS Foundation Trust (DHcFT) not to continue to pursue the merger with DCHS NHS FT

The Trust’s response to critical operational safety issues regarding:o The May Cyber Attack - there had been minimal impact on clinical

services. Although DCHS did not have the infection it was decided to close the link as a precautionary measure.

o The tragic Grenfell Tower fire incident – DCHS fire certificates have been checked and are all up to date. No DCHS premises have cladding

o In response to a question from JM, WJ updated the CoG that DCHS has major incident plans in place and that these are externally assessed

Progress with agreeing disinvestment in 2017/18 contracts – progress is being made with Southern Derbyshire CCG but there is more to do with North Derbyshire and Hardwick CCGs. CS hopes to provide an update to the CoG regarding affected services at the September meeting

VB asked about how the joint working arrangements with DHcFT for People and Organisational Effectiveness are progressing. It was explained that this is being planned as a contractual joint venture with DCHS as the lead organisation.

The update was received for information.

CS

85/17 Performance and Quality – Holding to Account86/17 Quality and Performance Report

The Council reviewed the Trust’s performance against the quality objectivesand regulatory performance targets.

The CoG received the report for information.

87/17 Patient Experience Report Q4SAC said that patient complaints in Ripley Physiotherapy related to the design of the premises and the lack of privacy. PA confirmed the challenges at the premises to maintaining dignity and confidentiality. SAC requested that changes to the premises might be supported. WJ agreed to check this.

ASm said that patient feedback regarding the Sexual Health Service was

WJ



Item Description Actionincreasingly positive and requested that this should be identified and reported in future reports.PS said that it was good to hear about the improved performance.

The report was report for information.

CW, MH

88/17 Nominations and Remuneration Committee ReportAppraisal, Key Successes and Objectives for the ChairThe Committee acknowledged the important contribution of the Chair to a very successful year for DCHS. Feedback was overwhelmingly positive, particularly with respect to his passionate leadership of DCHS.

Appraisal, Key Successes and Objectives for the NEDsThe Committee reviewed the formal objective setting and performance appraisal process for the NEDs. The report described the high calibre, values driven performance of the NEDs and PS emphasised to the CoG that the contribution of the NEDs was second to none.

The CoG took Significant Assurance from the appraisals of the Chair and the NEDs.

The CoG approved: The Chair is mandated to explore steps to recruit to fill the vacancy

remaining since Barbara-Anne Walker left the Board. This will include approaching NHS Improvement to discuss any support they can offer, particularly with respect to secure a placement from their Next Director Programme and of the ’NHS Women on Boards: 50:50 by 2020’ initiative

Take succession planning steps to secure NED clinical skills going forwards, particularly as the tenure for Chris Bentley ends in October 2018

89/17 Updates from Governor GroupsEngagement Group – LH summarised the work including contribution towards the new look of the Community Newspaper; support for the communications for the forthcoming governor elections; and planning for the Community Week activities.

Strategy Group – LB discussed the work regarding the Operations Plan and also a Plan on a Page.

Quality Group – AC discussed the presentation regarding the Children’s Continence Service; the good Falls performance on Spencer Ward; and the challenges experienced by Ash Green when police deliver to them a patient who falls outside of the remit of the service.

Governance Group – Ash said the meeting had received a presentation from PwC about their work and findings for 2016/17.

The verbal reports were received for information.



Item Description Action

90/17 Governance91/17 DCHS Constitution

The meeting approved amendments to our Constitution with respect to: Increasing the number of public governors in Derby City from one to

two Clarification over the procedure to replace a governor who has

stepped down.

KF said that a more detailed review of the Constitution will take place in 2018.

92/17 Associate Director of Corporate Governance/Trust Secretary’s ReportKF updated the meeting regarding:

2017 governor elections – the arrangements for the 2017 elections re now in place. KF said that we have notified our electoral agents ERS that there may be an increase in governor in Derby City

Members Week/Annual Governors/Annual Members Meeting – the Head of Communications Rebecca Oakley updated the CoG pre-meeting regarding plans for these activities

Council of Governors Self-Assessment – the feedback from governors identified further work to be undertaken with respect to Membership Engagement and protected time for Staff Governors. KF emphasised that if staff governors have difficulty in being released to attend governor activities then they should contact the Chief Executives Department to seek support

The CoG received the information provided by the report.

93/17 Role of the Senior Independent DirectorNS provided a presentation regarding his role as the Senior Independent Director (SID).

In summary the SID: Conducts the appraisal of the Chair on behalf of the CoG Acts as a sounding board for the Chair and other Directors Acts as a point of contact for Governors if they have concerns Is an independent point of contact for anyone raising a concern Appoints independent assessors to determine eligibility for trust

membership if necessary

The information was received by the CoG.

94/17 Concluding items9517 Any Other Business

None.96/17 Council of Governors - Review of Meeting

The CoG agreed that the rotation of the agenda allowed important issues to be discussed first.

Papers had been read by governors prior to the meeting so there was no Page 6 of 7102 Minutes July 2017 CoG Meeting.docx

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Item Description Actionneed for presenters to talk through the detail in their reports. This allowed governors to have a full discussion regarding matters in the meeting time available for each agenda item. It was agreed that this was good practice.

WH said that the finance training session presented by CS and NS in the morning had been really helpful.

KF said that we plan to continue to provide governor training in the morning prior to each CoG. She asked governors to provide feedback regarding this structure and also any further potential subjects for training sessions.

97/17 Time and Date of Next Meeting: Wednesday 13 September 2017 at 2.00pm at The Post Mill Centre, Market Close, South Normanton, DE55 2EJ.

98/17 Key Dates and Future EventsThe Council was advised of the dates, times and venues for meetings in 2017.

…………..………………………………………………… ……………………………………Chairman Date


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COUNCIL OF GOVERNORS - ACTIONS MATRIXDATE: September 2017

Date/Item No:

Item/subject:

Decision taken and/orAction required:

Progress: Responsible Person:

Deadline: Outcome:

Jul 84/17 Chief Executive’s Report

Progress with agreeing disinvestment in 2017/18 contracts –an update will be provided to the September CoG regarding affected services.

Aug Update: Southern Derbyshire CCG – 16/17 dis-investment almost finalised in line with value identified in the contract. Work is now taking place to identify 17/18 savings.North Derbyshire CCG, Hardwick CCG, and Erewash CCG – there is still a significant gap in these CCG’s identifying 16/17 disinvestments in line with the contract value. This is a CCG risk and will be escalated to Contract Management Board (CMB) in September.

Chris Sands Sep 2017

Jul 87/17 Patient Experience Report Q4

Patient complaints in Ripley Physiotherapy relating to the design of the premises and the lack of privacy. William Jones to investigate potential changes and improvements.

Aug Update: A capital project proposal is being developed.

William Jones Sep 2017

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Date/Item No:

Item/subject:

Decision taken and/orAction required:

Progress: Responsible Person:

Deadline: Outcome:

Jul 87/17 Patient Experience Report Q4

Quality Performance Report to reflect potential improvement in patient feedback regarding the Sexual Health Service.

Carolyn White Sep 2017 Agenda Item – Quality and Performance Report

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Council of Governors

Document Title: Anne’s story

Presenter/Title: Carolyn White

Contents of Paper were previously discussed by:

Trust Board May 2017

Author/Title: Anne Allen Mary Heritage, Assistant Director of Quality

Contact Email and Telephone Number:

[email protected] 07500605505

Date of Meeting: 13th September 2017 Agenda Item No: 105/17

No of pages inc. this one: 6

Has an Equality Impact Assessment been undertaken

Yes No X

Document is for: (more than one box can be ticked)

Information X Decision Assurance

Purpose of Paper

The story shows that we are affected by what happens to members of our families – the impact in this story is for Anne both as a family member and as a member of staff. The story is about what happened to Doreen, Anne’s Mother – but mainly about the impact on Anne as a daughter and as an employee of DCHS.

Recommendations

The Council of Governors will gain insight from learning about the experiences of Anne, and Doreen, in relation to:

The impact of providing and arranging care for a family member

The stress of finding a Care Home for a family member

The impact on work

The different ways that health and social care workers support family members

The way that DCHS is able to support people who are supporting family members

Our attitude to people whose transfer of care is delayed while family members seek appropriate placements.

Board Assurance Framework Risk Reference

1.4 There is a risk that DCHS does not provide patient centred care due to a lack of engagement and involvement of service users and stakeholders

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mailto:[email protected]

Financial Impact

Concerns about the cost of care home placement are covered in this story.

Further Information and Appendices

I am Anne. I have been a single mum, divorced 21 years ago when my daughters were 7 and 9. Subsequently I brought them up by myself while working almost full time, and also producing ponies for competition at national level. I’ve worked for DCHS as an analyst for 8 years in an increasingly demanding job within a team which was, until recently, dysfunctional I felt as though I had been running on empty for the previous couple of years and had been finding the rapidly increasing workload more difficult to manage. Although I have suffered with stress related illness all my life I’ve not needed to take time off with it until the end of last year. I am also Doreen’s daughter. Mother and father ran a garage in Northumberland, which was sold by my Mother after my father died over 30 years ago. She was then a ‘lady of leisure’ and lived happily in a town in the North East until her health started to deteriorate in her late seventies. She then moved into a bungalow in the same village where I live, just after her 80th birthday, ten years ago. Very soon she became housebound and totally relied on me to go anywhere. While she was still well she would make my tea after I returned from work and, in return, I would do the shopping and take her to various appointments. Mother drank more alcohol than was good for her and, as a result had a couple of falls resulting in a badly fractured collarbone and a broken wrist. Three years ago she had a UTI and pneumonia and spent a period of time as an inpatient in Derby Hospital, including an emergency re-admission there, with subsequent rehabilitation in St Oswald’s. Scans at that time showed numerous necrotic areas in her brain which were suggestive of transient ischaemic attacks (TIAs). A formal diagnosis of vascular dementia was never made because my Mother was reticent to have any further tests. On discharge from St Oswald’s she had caregivers three times a day and I did the rest. Most of the care was very good, but there were times when they didn’t turn up or their workload affected the quality of care provided. I was always slightly worried about what I might find when I got home from work at night. As someone who has suffered from poor mental health all of my adult life I was becoming increasingly stressed out with the increasing pressure of work and looking after my Mother who was rapidly deteriorating. In Oct 16 my aunt and uncle offered to look after my Mother while I had a few days holiday in Northumberland. Unfortunately my Mother collapsed the morning after I went away and was admitted to Derby. The collapse was due to postural hypertension. Later on I discovered that the collapse had been wrongly attributed to a fall. Mother was transferred to St Oswald’s and, at a family meeting, we were told that she would need 24 hour care due to her incontinence and lack of capacity. It was suggested that she would need to go into a home and, on that day I was given the current list of vacancies in Amber Valley Homes as there were no places available in Derbyshire Dales. With hindsight I feel that it would have been better if I had been given a copy of the Derbyshire Directory of Care Homes instead, not least because there needed to be a nursing and, also, a capacity assessment carried out before a final decision could be made. I was really struggling with the idea that she would have to go into a home particularly because it was against her wish to stay at home. Following the


nursing and capacity assessments a Best Interest Meeting was held in which the family were involved. The outcome of the meeting was that Mother needed 24 hour care and that the best place to give this care would be a Care Home. As she had been assessed as having no nursing needs I was told that Mother would be suitable for residential care. At the suggestion of the social worker I was offered a copy of the Care Home Directory. As it happened, through my knowledge of DCHS services, I had already contacted the DCHS Care Home Support Team and a very helpful administrator sent me a copy of the directory. This had not been offered to me at St Oswald’s following the Family Meeting. It was invaluable to me when I was trying to wade through the minefield of administration that followed the decision for her to go into care. The administrator also passed me onto an OT who gave me some very useful information regarding choice of Care Homes depending on the outcome of the Best Interest Meeting in December. A few days before the Best Interest Meeting I asked my line manager if I could take Carer’s Leave to attend the meeting and also to look at potential Care Homes. She allowed me time out to attend the Best Interest Meeting but was unfortunately not able to provide time to visit some Care Homes I was extremely frustrated with this decision to say the least. Although I had always been given the flexibility at work to take my Mother to numerous doctors and hospital appointments over the years I had never requested any Carer’s Leave and always made the time up at a later date. At a critical time when I most needed that leave my request was denied. On the same day as the Best Interest Meeting I visited 3 Care Homes and it very rapidly became apparent that it was not going to be an easy job to find a suitable one. In addition it is not possible to visit homes in the evenings or weekends because senior staff are not available to show you round. I spent a very stressful weekend trying to work out how I could continue to work as well as search for a suitable home for my Mother not to mention the considerable amount of essential administration to facilitatethe move. Finally I ‘lost the plot’ and realised that the only way forward was to go off sick. In the days/weeks following I became unable to read a newspaper let alone fill in some tricky documentation and required considerable support to make progress. In the days following the Best Interest Meeting my brother and I visited over 20 Care Homes in Amber Valley, Derbyshire Dales, North East Derbyshire and Sheffield between us. On one day I visited 6 of the Sheffield homes near where my brother lives that he had already seen but wanted my take on. It was exhausting emotionally and physically. It was proving to be almost impossible to find a suitable home for numerous reasons. It very quickly became apparent that Residential Care Homes alone were not suitable for my Mother due to her cognitive deficiency. Staff at St Oswald’s agreed that she had Vascular Dementia following numerous transient ischaemic attacks but had never been formally diagnosed as such by clinicians. All of these homes had unguarded stairways and I felt that they would not be suitable for her needs particularly because she was known to wander at night. Any suitable homes we found were non-runners either because they had no vacancies or they were far too expensive. My Mother was self-funding so cost proved to be a major issue. She owned 75% of a very modest 2 bedroom bungalow. Her share was valued at 120k and, as she had very little in the way of savings, the property had to be sold to pay for her care. We calculated that her money would last approximately 3 years if she paid £700 a week for her care. Then she would be thrown upon the mercy of the council and could potentially be asked to leave that home and move into a cheaper alternative. I am aware that this is happening Derbyshire. We really struggled because we had no idea how long she would need to live there. Eventually we found an affordable home in Sheffield (offering both residential and nursing care) that was suitable for her needs and a room was going to be available in the near future. By this stage it was getting close to Christmas so nothing was going to happen quickly. Despite this I got a phone call from the discharge co-ordinator at St Oswald’s advising me that if we did not move my Mother in the near future we would be receiving our 1st warning letter. At this point I got very upset. Already off work due to stress related illness I felt


that I was being put under extreme pressure to move my Mother but felt powerless to do any more about the situation. We could not have any more to facilitate the move and got minimal support from Social Services. As it happened a decision was made at the MDT at St Oswald’s to defer the letter taking the pressure off slightly. On 29 December Mother was in fast atrial fibrillation (AF) overnight that did not settle so was transferred to Derby for assessment. On arrival at A and E in Derby all bays were full with numerous other patients parked in trolleys outside the bays. A decision was made to admit Mother and she then spent nearly 48 hours in MAU before a bed could be found. She was diagnosed with pneumonia and treated with antibiotics as well as additional drugs to regulate her fast AF. I stayed with Mother in A&E and MAU from 9am until 8pm that day. Both departments were extremely busy and noisy. She was so unwell and her heart had been beating so fast for so long. Staff had been taking blood samples from her and frequent BP measurements. She was totally fed up and didn’t want them to do this to her. I wanted to help her but I couldn’t. There was chaos all around her. It took a long while for her to settle. St Oswald’s by comparison was a lovely quiet environment. On 3 Jan, when I arrived to see Mother the senior nurse asked to talk to me. I’d been in regular contact with Liz Peters, ANP at St Oswald’s, who expected her to be transferred back soon. I was told that she was medically fit for discharge from Derby but would not be transferred back as she had no further rehabilitation potential. I was gutted. She wasn’t going back to St Oswald’s where she had been so settled. When I asked where my Mother would go, I was told that she would be discharged to an interim care home. I panicked and said ‘That can’t happen’. I argued that this would not be in Mother’s best interest due to her cognitive issues. She could wander and fall. I remember going home feeling very frustrated and concerned and not sure what to do or how to help her. So after a very sleepless night I spoke to Sarah Youd, the matron at St Oswald’s voicing my despair. I’ve known her for years at work so had this advantage which others might not. Sarah managed to get my Mother transferred to Babington later that day. My Mother was never as settled at Babington as she was at St Oswald’s but at least she was safe. Interestingly the ANP from St Oswald’s told me that my Mother did have further rehabilitation potential on her transfer from Derby so it would have been entirely appropriate for her to have been transferred back to St Oswald’s. On 16th January, Mother finally moved to Alexander Care Court Home in Sheffield. I can still picture the sad look on her face through the window of my brother’s car on her discharge from Babington. Surprisingly she settled at the home very well. She thought she was back in Northumberland which for her was a happy place. In her mind the residents were old friends and she quite enjoyed sitting in the lounge chatting to people. When I last saw her she had a chest infection but she was alert. Sadly she developed pneumonia and died two days later. In the last few weeks of her life she was more settled than in the 6 months leading up to her admission. She was safe and well cared for and the whole family had started to relax again. Mother’s care at the end was excellent. The nurse knew what was happening and she rang me to check whether I wanted her to go into hospital. We agreed that it was more appropriate for the doctor to make her comfortable. A couple of hours later she died very peacefully on February 21st. I was so pleased that we’d taken the time to find the right place for her, even though that delayed the process back in December. I feel she had a good death albeit slightly saddened that she did not live to see her 90th birthday which would have been in May. I returned to work in March having had a total of 84 days off sick related to stress. Because I


was already off I did not need any bereavement leave. I would have significantly benefitted from having paid time off at the point when I needed to find a home for my Mother and sort out all of the associated administration as much as, or maybe more than, I would have needed it after she died. Bereavement for me was the realisation that I could not continue to provide all of her care with the assistance of paid caregivers and then to accept that she needed to go into a home, as she had always said she wouldn’t want that. During my absence I referred myself to Resolve. Despite reservations following a bad counselling experience years ago, I found it supportive and helpful. It’s helped me to get prepared to come back to work and I’ve been given the time out of work to attend since I returned. Following my return to work I was having a conversation with the manager of our team about the analysis of Delayed Transfers of Care (DTOCs). He said that another colleague was looking at the process with a view to streamlining it but in doing so was starting to lose sight of the fact that DTOCs are patients and that behind every patient there is a story to tell. My story is about one of DCHS’s DTOCs who was also my Mother. I hope that it has provided food for thought. Photo of Mother, Doreen, and my daughter taken at St Oswald’s, happy, on Christmas Day

2016:

Doreen 9 May 1927 – 21 February 2017


Post Board Actions This story was presented at Mays trust board meeting and Anne attended to share her story. As a consequence of this story we have changed the format of the letter advising patients on potential discharge arrangements and through our carer’s strategy work and review of our approach to how we support staff at work who are also caring for a family member. One of the trust’s BIG 9 quality improvements this year is to identify the number of staff caring for someone at home. This story will also help inform our thinking and that of colleagues in CCGs and partner agencies as we start to roll out the Better Care Closer to Home proposals and work towards the implementation of the Sustainability and Transformation Partnership.

Monitoring Information Brief Summary

What are the Governor Involvement implications?

For discussion at the Council of Governors meeting September.

What are the Equality and Diversity implications?

This story shows that good care is the right of every person and their family – regardless of age or disability. The needs of family carers are also given equal priority through the Care Act.

What are the Patient, Public, Staff, Member and Stakeholder Involvement implications?

DCHS is promoting the needs of family carers – whether they are the patient, caring for our patient or our colleagues through its work on Family Centred Care, which has been supported by Charitable Funds.

Risk Register

Is the issue on the current Risk Register?

No )

If yes, what is the Risk Number?

Does this update recommend a change in the current risk score? (If so, please provide your rationale below)

No


Family Centred Care ProjectFunded by Charitable Funds Committee

Project Team:Lana-Lee Jackson – Head of Patient and Family Centred CareLisa Brightmore – Patient Involvement Officer and Interim Project LeadJamie Broadley – Staff Wellbeing Lead

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Charitable Funds invested £54000 into this projectWe have been able to improve methods to capture the total number of carers coming into contact with our services as well as to equip staff with information and guidance to better support carers. The project aimed to:

1. Understand the experiences of Carers that access our services2. Raise awareness of the Family Centred Care Project across the organisation as well as to develop lasting partnerships3. Establish processes by which Carers are identified and supported by frontline staff (linked to the Big 9 target)4. Identify and Support Staff Carers


Understanding Experiences

We started this project by undertaking scoping activities and involving carers to better understand their experiences as well as to identify carer needs.

Carers were clear about their expectations and described a “one stop shop” that they wanted to have more information and support options available to them. Carers also wanted advice on involvement opportunities as they did not want these to become tokenistic, instead they wanted real help and support.

A staff carer survey was also undertaken.Page 3 of 10107 Family Centred Care CoG Presentation.ppt

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‘All we ever do is fill in questionnaires about what we

need and nothing is ever done’ – Mrs Buxton, a carer

for her son.

‘I think it’s great that things are being done, I work for DCHS

and so I am really interested in getting involved.’– Mrs

Marshall, a carer for her mother


Caring for Carers

• https://www.youtube.com/watch?v=bwZ10RePqmc

• http://www.carersinderbyshire.org.uk/


https://www.youtube.com/watch?v=bwZ10RePqmc

http://www.carersinderbyshire.org.uk/

http://www.google.co.uk/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=0ahUKEwiLye745f7UAhVFQBoKHWjSCWcQjRwIBw&url=http://www.carersinderbyshire.org.uk/&psig=AFQjCNFGzcRyryxtBoOY0_RuW4G2HpABJA&ust=1499778901483009

Wellbeing of Staff Carers


Project Impact

• Stronger community links to carer groups• Better partnerships across Derbyshire and carer

support services• One stop information hub for carers, developed in

partnership with local organisations• Gained insight into carers experiences to better

raise awareness of their needs• Identified how staff carer needs differed and

considerations from a workforce perspective.


• Changes to systems to identify and record carer details (System1) and monitoring in Big 9

• Development of the DCHS Carers Policy approved by QSC and QPC July 2017.

• “I wish my Manager knew about my Caring responsibilities” and a focused Schwartz Round to share experiences of caring with 30 attendees

• Carers Week - 12 successful events with over 100 staff pledges. Reaching over 600 patients and carers


of 10107 Family Centred Care CoG Presentation.pptOverall of 78

Without the investment from Charitable Funds we may have missed the opportunity to be an active participant with our partners to create better information resources for Carers in Derbyshire. We would have also missed the opportunity to gain insights into staff carer challenges (inc. impact on wellbeing) and the affects this has on service (e.g. absence). We would have missed the opportunity to identify 700+ carers who access our services and support their needs.

With this investment, we have been able to build sustainable infrastructures, allowing us to develop systems and processes across the health and social care economy to better support Carers who access services.

THANK YOU Page 10 of 10107 Family Centred Care CoG Presentation.pptOverall of 78

COUNCIL OF GOVERNORS

Title of Paper:

Quality and Performance Report September 2017

Paper for:

Information

Presenter/Title: Carolyn White, Chief Nurse / Director of Quality and Chris Sands, Director of Finance, Information and Strategy

Author/Title: Carolyn White, Chief Nurse / Director of Quality and Chris Sands, Director of Finance, Information and Strategy

Appendices:

Appendix 1, Quality Report (page 3) Appendix 2, Single Oversight Framework (pages 6 - 7) Appendix 3, Referral To Treatment Waiting Times (pages 8) Appendix 4, Finance Report (page 9) Appendix 5, Big 9 (page 10)

Date of Meeting:

13 September 2017 Agenda Item No: 108/17

No of pages inc. this one: 10

Purpose of Paper

The purpose of this paper is to provide the Council of Governors with an overview of the Trust’s performance against our quality objectives, and regulatory performance targets.

1. Quality Report

The Trust has set itself a number of quality objectives to support the delivery of its Quality Strategy. The objectives are: • Keep patients safe • Put patients (and family) at the centre of care • Get the basics right

The quality section of this report provides Governors with an overview of the Trust’s performance against key performance indicators in each of these three areas for the month.

2. Regulatory Performance Report – Single Oversight Framework

The Single Oversight Framework is designed to help NHS providers attain, and maintain, Care Quality Commission ratings of ‘Good’ or ‘Outstanding’. The Framework doesn't give a performance assessment in its own right.

The framework came into force on 1st October 2016, replacing the Monitor 'Risk Assessment Framework' and the NHS Trust Development Authority 'Accountability Framework'.

The report provides an update on the Trust’s performance against the NHS Improvement Framework.

The position for month 4 (July) shows that the Trust has no area of risk with a red rating.

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2

3. Referral to Treatment Waiting Times RTT Waiting Times information is now enclosed at Appendix 3. All the enclosed RTT measures are reported to NHS Improvement (NHSI). RTT part 2 is the only measure that has a national target, which is currently set at 92%. We are green rated for this measure in month 4 (July) with score of 95.8%. More detailed definitions are now enclosed.

4. Finance Report The Trust is reporting a surplus position of £2.95m at month 4 (July), which represents a surplus variance of £0.25m against the planned surplus of £2.7m. It should be noted that as this is only month 4 of the new financial year the position still requires tight financial control. The cash position is £4.8m ahead of plan. We are forecasting a year end surplus of £4.92m, which is consistent with our control total set by NHS Improvement.

5. Big 9

The Quality and Performance report provides an update of Trust progress against the “Big 9” key performance indicators which were agreed as part of the Annual Planning process. Summary See appendices below. Recommendations The Council of Governors is asked to receive this report for information.


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APPENDIX 1 QUALITY REPORT

1. CQC The Care Quality Commission has published their revised inspection guidance. With effect from Autumn2017 they will adopt a new inspection regime which will be focused around the well-led domain. Each provider organisation will have an annual led inspection and the CQC will select other services to inspect at the same time which will focus on those they have the greatest concern about based upon local intelligence. In addition to the revised inspection format the CQC have changed their key lines of enquiry (KLOE) adding additional criteria into the existing standards. The quality assurance team are currently scoping the impact for DCHS but believe that we are able to provide evidence for the majority of new criteria. Unfortunately the CQC have not been able to accommodate the complexities of community trusts such as ourselves within their new regime and it appears at the moment as if GP practices will continue to be inspected separately. As part of the new arrangements the CQC are recruiting executive level inspectors to support the welled inspections and Rick Meredith, William Jones and Carolyn White have all been successful in their applications to undertake these new roles. This will give us an important insight into the new inspection regime as well as an opportunity to build networks with colleagues.

2. Integrated Sexual Health Services The integrated sexual health service offers a combined approach to traditional family planning clinics and genito-urinary medicine services. Currently the service provides up to 61 sessions per week in 22 different locations across Derbyshire and Derby City. During 2016/17 the service saw 71,264 patients in its clinics and 9483 patients through accredited providers, giving a total of 80,743 patients cared for. The demand for the service is very high. This is a national phenomenon, not just a local issue, with services reporting an increase in demand of up to 25% (http://www.bbc.co.uk/news/health-40802193 ). The integrated sexual health service has been monitoring, reviewing and acting upon patient feedback. The following service developments have been introduced in Sexual Health Services in order to improve the experience of the service for patients following feedback: • Work is presently underway to increase the number of GPs and pharmacies who are accredited providers for the service, in order to reduce the high demand for clinics. Project work is being undertaken to improve rostering of staff within the service to maximise productivity and improve availability of appointments. • Specialist trainers have been employed from Merck and Bayer, to expedite coil and


http://www.bbc.co.uk/news/health

4

implant training for nurses within the service in order that we can meet dual trained requirements of our contracts and ensure maximum flexibility of our core staff in the provision of the service. • Additional coil clinics are being introduced, to meet demand for this service and coil appointments have been extended to 30 minutes to avoid delays for other patients. • Doctor job planning exercises are being undertaken to maximise the use of this vital resource. In addition, innovations are being introduced including online booking and online sexual health screens. During the last few months we have completed the rollout of the new electronic results reporting system across the service and have had the effectiveness of this independently audited by 360 assurance. I am pleased to report that the service met the 10 day reporting of results in all areas 100% of the time. The merger of three different sexual health services under a single management team has been problematic, however, it is pleasing to note that the efforts of the clinical staff and management team are now paying off with improved outcomes for patients and staff reporting improved working arrangements.

3. PLACE results 2017 NHS England and The Department of Health recommend that all hospitals providing NHS‐funded care undertake an annual assessment of the quality of non‐clinical services and the condition of their buildings. These assessments are referred to as Patient‐Led Assessments of the Care Environment (PLACE). The PLACE programme offers a non‐technical view of the buildings and non‐clinical services provided across all hospitals providing NHS funded care. The Assessment is based on a visual assessment, not relying on the application of any technical or scientific tools. The programme was undertaken between March and May 2017. PLACE teams consisted of Patient Assessors and Staff Assessors of equal proportion (i.e. 3 and 3) For DCHS, Graham Smith was appointed Lead Staff Assessor and Assessment Manager and was responsible for the administration before, during and after the assessment, and for submitting the results. The patient assessors have attended safe guarding training and completed DBS (Disclosure and Barring Scheme) paperwork before undertaking the assessments.The patient assessors this year consisted of a mixture of regular assessors and volunteers who had not completed a PLACE assessment


5

previously. The National Average scores have been calculated as below and can be used as a

comparison of the PLACE Scores for DCHS

Cleanliness

Food Privacy and dignity

Condition and maintenance

Dementia

Disability

National Average Score 2017

98.4%

89.7%

83.7%

94%

76.7%

82.6%

DCHS Average score 2017

99.51% 95.29% 88.63% 97.66% 81.95% 90.57%

4. Carter Efficiency Programme

The trust is currently working as a pilot site with other community and mental health trusts applying efficiency tools to key aspects of our work to drive efficiency across the NHS. Projects include examination of procurement methodology and a focus on workforce management. We are currently engaged in a 90 day rapid improvement event working with other trusts to maximise the productivity from electronic rostering systems and assessment of patient dependency. It is clear from working with other organisations that DCHS is ahead of the curve with regard to its use of e-rostering and associated acuity tools and we have been asked to give a presentation at the next project group meeting about our experiences using allocate our chosen e-rostering system. Each team engaged with this work has been asked to develop its own local project and we have chosen to focus on e-rostering with our allied health professional colleagues. We anticipate that this will in turn support the work needed to establish integrated Place teams as part of our STP work.


6

APPENDIX 2 – REGULATORY PERFORMANCE


7


8

APPENDIX 3 – REFERRAL TO TREATMENT WAITING TIMES

AHP-Led Referral to Treatment Schedule in Weeks - Clocks ended in July 2017

Service Line 0-6 7-12 13-17 18+Total

WaitersMax

Waiter

>6 week waiter total

% Waiting over 6w


% Waiting

over 13wPlanned CareAVE MOPP 1,964 467 45 10 2,486 38 522 21.0% 55 2.2%CHE MOPP 1,358 495 21 14 1,888 27 530 28.1% 35 1.9%HPD MOPP 1,304 118 2 1 1,425 19 121 8.5% 3 0.2%Speech and Language Therapy 647 128 6 0 781 17 134 17.2% 6 0.8%

6,580 99 1.5%

ICBSAV 289 74 9 6 378 49 89 23.5% 15 4.0%ERE 267 23 10 3 303 21 36 11.9% 13 4.3%SDSD 280 10 2 2 294 21 14 4.8% 4 1.4%CHE 186 59 0 0 245 12 59 24.1% 0 0.0%NED 439 60 14 5 518 33 79 15.3% 19 3.7%HPD 270 6 2 0 278 16 8 2.9% 2 0.7%DC 197 54 4 24 279 28 82 29.4% 28 10.0%Disability Services 8 1 0 0 9 7 1 11.1% 0 0.0%Respiratory Services 92 70 7 1 170 18 78 45.9% 8 4.7%Learning Disabilities 8 6 4 4 22 46 14 63.6% 8 36.4%

2,496 97 3.9%All Services 7,309 1,571 126 70 9,076 352 1,767 19.5% 196 2.2%

Consultant-Led Referral to Treatment Schedule in Weeks July 17) - Clocks still running (Part 2)

Specialty 0-6 7-12 13-17 18+Total

WaitersMax

Waiter


% Waiting over 6w


% Waiting

over 18wGeneral Surgery 213 95 49 16 373 34.93 160 43% 16 4%Urology 63 31 15 2 111 25.08 48 43% 2 2%Trauma & Orthopaedics 343 179 93 16 631 37.95 288 46% 16 3%Ear, Nose & Throat (ENT) 313 89 51 10 463 22.79 150 32% 10 2%Ophthalmology 395 136 80 5 616 22.10 221 36% 5 1%Oral Surgery 0 0 0 0 0 0 0 0% 0 0%Neurosurgery 0 0 0 0 0 0 0 0% 0 0%Plastic Surgery 0 0 0 0 0 0 0 0% 0 0%Cardiothoracic Surgery 0 0 0 0 0 0 0 0% 0 0%General Medicine 0 0 0 0 0 0 0 0% 0 0%Gastroenterology 78 15 24 9 126 28.62 48 38% 9 7%Cardiology 93 42 20 12 167 30.78 74 44% 12 7%Dermatology 440 152 48 3 643 21.20 203 32% 3 0%Thoracic Medicine 0 0 0 0 0 0 0 0% 0 0%Neurology 0 0 0 0 0 0 0 0% 0 0%Rheumatology 46 33 23 4 106 22.66 60 57% 4 4%Geriatric Medicine 28 7 6 0 41 16.93 13 32% 0 0%Gynaecology 116 55 37 4 212 25.64 96 45% 4 2%Other 115 51 44 7 217 27.80 102 47% 7 3%Derbys Dental 97 97 34 0 228 17.71 131 57% 0 0%Leics Dental 162 97 70 96 425 37.86 263 62% 96 23%All Services 2502 1079 594 184 4359 27.0 1857 42.6% 184 4.2%

Further Definitions

Incomplete pathways are waiting times for patients waiting to start treatment at the end of the month.Admitted pathways are waiting times (time waited) for patients whose treatment started during the month and involved admission to hospital Non-admitted pathways are waiting times (time waited) for patients whose treatment started during the month and did


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APPENDIX 4 – FINANCE REPORT

1. Financial Duties The financial risk of the Trust is assessed using the Finance and Use of Resources metric as part of the Single Oversight Framework introduced in October 2016. Under this framework, a score of 1 represents the lowest risk with a 4 being the highest risk. The Trust is forecasting a rating of 1 at the year-end which reflects the strong balance sheet position and the forecast surplus position.

2. Agency Spend metrics

The Trust’s performance against the Agency Spend metric is detailed below which shows our spend is below the submitted planned run rate.

Measure Indicator Year to date Year End Outturn Actual

£m Target

£m Actual

£m Target

£m Agency Spend Spend against

Planned Trajectory

0.27 0.50 1.00 1.46

3. Month 2 Financial Position

The month 4 (July) position for income and expenditure is a surplus of £2.95m, compared to a plan of £2.70m. This is a favourable variance of £0.25m. It should be noted that as this is only month 4 of the new financial year the position still requires tight financial control. The Trust has a Sustainable Quality Improvement Plan (SQIP) target of £7.2m for 2017/18. The year end forecast is currently showing no under achievement, an improvement of £0.71m since month 2. Further work is progressing to improve the forecast outturn position. At the end of July the cash balance was £4.8m ahead of plan (actual: £23.7m, plan £18.9m). The Trust is therefore planning to meet all its financial duties for the year and to maintain a Finance and Use of Resources rating of 1 (low risk).


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APPENDIX 5 – “BIG 9”


Summary Report from Nominations and Remuneration CommitteeReport To: Council of GovernorsDate: 13th September 2017Name of Reporting Committee / Group: Nominations & Remuneration CommitteeDate of Meeting: 23rd August 2017Presenter: Prem Singh, DCHS ChairAuthor: David Boddy, Corporate Governance Manager

Key Issues discussed at meeting:Include:

Brief summary of issue Decision made/action to be taken Agenda number and title of paper Risks identified

Board Assurance Framework Reference and Level of Assurance Agreed

25/17 Appraisal, Key Successes and Objectives 2016/17 for the Non-Executive Directors James Riley (JR) and Kaye Burnett (KB)JR and KB have successfully completed the transition into their roles with DCHS and both are now very settled.

The Committee discussed the high calibre of JR and KB. JR provides valuable insight because of his local authority background. KB is a strong advocate for staff and is chairing QPC with vigour.

The Committee took Significant Assurance that the Non-Executive Directors had fulfilled their roles and had been subject to a formal objective setting and performance appraisal process for 2016-17.

Significant Assurance4.1

26/17 Non-Executive Director Placement As recommended by the Nominations Committee and agreed by the July CoG, the Chair liaised with NHSI and the NExT director programme to pursue an opportunity to proceed with a learning placement, six months initially and reviewable.

NHSI recommended candidate Karen Hughes whose background would bring skills to bear in Communications and branding. She is current Chair of the charity Action for Pulmonary Fibrosis but will be stepping down in October, having served her term. NHSI said that currently there are no other suitable candidates.

The Chair met Karen and recommended that DCHS secure her placement as an Associate NED.

Significant Assurance4.1

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The Committee held a rigorous discussion about the placement scheme and the recommended candidate. The Committee agreed the recommendation to secure her placement.

As Karen will not be undertaking full duties, remuneration will be in line with NEDs in NHS Trusts, that being both fair and proportionate to our substantive NEDs. Karen will be available from mid-September. The Chair will support and mentor Karen.

The placement will let the organisation evaluate the need for a sixth NED, although this position is not necessarily designed to fill the current gap.

A copy of the scheme is attached to this Summary Report.

Policies ApprovedNone.Issues to be escalated to Board or a CommitteeNone.

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The NExT Director scheme - supporting tomorrow’s non-executives

A practical guide for NHS host trusts and placements

1. Introduction

1.1. Two of NHS Improvement’s (NHSI) key strategic objectives for 2020 are to ‘develop, maintain and enhance effective boards’ and to expect the board of every NHS provider ‘to reflect the diversity of the people it serves’. To help meet these objectives, we have developed the NExT Director scheme to support the creation of a pipeline of strong and diverse candidates for future non-executive director roles in the NHS.

2. What is the NExT Director scheme?

2.1. The NExT Director scheme provides support to senior people from groups who are currently under-represented on trust boards with the skills and expertise necessary to take that final step into the NHS board room. Following a successful pilot in London, the scheme is now being expanded to trusts across the Midlands and East, where the focus will be on supporting women and in London where it will be on people from BAME communities. People with other protected characteristics that are under-represented on boards may also be considered for inclusion in the scheme.

2.2. The NExT Director scheme will give participants a unique insight into the role and responsibilities of being an NHS non-executive director by helping them to bridge gaps in their own experience such as:

Operating at board level

Transition from executive to non-executive roles

Board level exposure in organisations of huge size and complexity

Gain knowledge of NHS structures and accountability, how the money flows, who the key partners are, where all the regulators fit and the board’s role in quality and safety.

2.3. Individual NExT Directors will be offered a placement with one or more NHS healthcare providers in their area, over a 12 month period and will give them the opportunity to learn first-hand about the challenges and opportunities associated with being a non-executive director (NED) in the NHS today. Each placement will be shaped to meet the individual needs of participants but will include a range of support such as:

Access to board and committee meetings and papers, including an opportunity to review and analyse meetings to learn with board members, as appropriate;

The assignment of an experienced NED mentor for the period to help shape the NExT Director’s personal programme and provide regular feedback and advice;

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Access to training and networking opportunities available to substantive non-executive directors.

3. The NExT Directors

3.1. The NExT Directors were identified from a range of sources and have been through a selection process by NHSI’s Non-executive Appointments Team to ensure that they have the attributes needed to be a NED one day and that they are willing and able to make the most of the opportunity provided by the scheme. They were then “matched” with participating trusts based on their geography and any service area preferences before being introduced to the trust chair, to ensure they were a good fit for that organisation.

3.2. All NExT Directors have been subject to due diligence checks and have signed the NExT Director Placement Agreement at Annex A before their placement was confirmed.

4. A strong starting point

4.1. There will be a short planning period before any placement starts to give both the NExT Director and their host trust the opportunity to prepare so that the placement gets off to a strong start. Each placement will be different but before starting NExT Directors and their trust should have a high level, shared understanding of what it will offer and the level of commitment the NExT Director will be able to make.

4.2. In this planning period, and before the placement starts, the trust chair should:

Ensure there is “buy-in” from the whole board and establish some basic rules of engagement that wherever possible are inclusive – ie will the NExT Director have access to confidential sections of board meetings, or be invited to participate in discussions? NB – remember these can always be changed as the relationship between the NExT Director and trust develops over the placement;

Identify an experienced NED from within the trust to act as mentor to the NExT Director – some host trusts identified more than one mentor but it is important everyone understands who is responsible for what;

Ensure the NED Mentor meets their NExT Director to explain the rules of engagement and agree the first set of high level outcome based development objectives. The NExT Director should confirm the time commitment they are able to give to the placement, we estimate a minimum of two days a month, whether they have the support of their employer (where appropriate), and confirm their availability for key board / committee dates which for many trusts will be during the day;

Ensure administrative arrangements to allow NExT Directors to have access to board and committee meetings and papers, as required and to claim travel expenses if required;


3

Ask the NExT Director to sign a confidentiality agreement if he / she will have access to confidential board meetings and sub-committees or other sensitive information;

Ensure that NExT Directors who will receive sensitive information know how to and are able to protect it properly. This may mean creating a secure email address, providing access to the same IT as NEDs and providing the appropriate Information Governance training;

Develop a comprehensive local induction programme for the NExT Director. Individual trusts should determine what this will be and how this is delivered, depending on local circumstances, but it could be based on the induction provided to new substantive NEDs, and include information about the key policies and procedures that may be relevant during the NExT Director’s placement; and

Provide the NExT Director with a tour of the major sites of the trust and an opportunity to meet key members of staff. It is important that he / she is introduced to both the executive and NED team, as well as key members of the trust’s wider management team.

5. NED mentors

5.1. NED mentors are experienced non-executives responsible for making sure their NExT Director is provided with the support they need during their placement and are therefore critical to its success. It is not expected that it will be too time consuming but should include:

Regular diarised meetings with the NExT Director before and after each board meeting to discuss key issues and observations and answer any questions they may have;

Regular and timely feedback between mentors and NExT Directors including honest reviews of development objectives. Regularly refresh these objectives and consider establishing a deliverable project - this will ensure the learning experience is targeted and productive. Experiences and exposures need to be tailored to the development needs of each individual and their journey to step into a NED role on an NHS board;

Arranging opportunities to learn from other board members and key staff, as appropriate.

6. Maximising the placement

6.1. Any programme should be customised to the development needs of each NExT Director (see above). This paragraph provides a list of ideas that will help the trust and the NExT Director get the most from the placement :


4

NExT Directors should take responsibility for their own learning and development by documenting experiences and learning outcomes, and identify areas the trust can help them develop further;

Arrangements should be made to provide NExT Directors with a full briefing on the NHS, the trust and its stakeholders – internal and external - as part of or soon after the induction programme;

NExT Directors should be encourages to feel part of the team and invited to take part in board discussions, if this isn't possible then participating in committee debate may be more appropriate;

Consider inviting NExT Directors to participate in any organised programme of NED ward and / or site visits, or allocate a senior member of staff who could accompany them on such visits;

Opportunities for the NExT Director to shadow key senior staff should be offered, and meetings with representatives from staff and patient groups, HealthWatch, volunteers and hospital charities should be considered.

Consider whether the NExT Director should observe public board meetings of other trusts in the area to gain an insight into other leadership styles and approaches to governance as well as other types of providers;

NExT Directors will be strongly encouraged to network with and learn from other NExT Directors. NHSI will be able to support them in this (see below).

7. Support from NHSI

7.1. All NExT Directors will be invited to attend an NHSI induction event in September 2017. This will give them the opportunity to establish connections and networks with each other and will enable NHSI to provide an overview of working on a board and committees, and governance and accountability in the NHS.

7.2. Workshops, networking events and webinars will take place throughout the year, the agendas for which will be largely driven by the NExT Directors and will give them exposure to subjects of wider interest both within and without the NHS. They will also provide an opportunity to reinforce connections between NExT Directors and allow them to share experience and learn from each other.

7.3. Regular tracker conversations with providers and NExT Directors will enable NHSI to track progress, quickly identify any potential issues and offer advice / guidance to ensure that the scheme provides the best possible experience and outcomes.

7.4. Access to the NExT Director LinkedIn network, reading materials and regular updates from NHSI’s provider bulletin.

8. Moving towards the end of a placement

8.1. Placements with a trust can be for any period of up to twelve months, and NExT Directors can opt to rotate to a placement on a different trust if this matches their


5

development needs. For example, an individual may wish to increase understanding of challenges faced by other service providers or exposure to different approaches to governance. If after six months it is felt that a NExT Director would benefit from such a move they and their current trust should contact NHSI to discuss options before the current arrangement comes to an end.

8.2. At the end of any placement, the trust should provide their NExT Directors with a structured appraisal, including an honest assessment of their progress and how close they are to being “board ready”. The NExT Directors should also be clear about any further development needs and be given guidance on how they might fill any gaps in their knowledge and experience going forward, particularly if the NExT Director is moving on to another placement.

8.3. At the end of the scheme, NHSI will offer NExT Directors additional support in applying for NHS NED roles in the future, including help preparing CVs and applications: independent panel assessment with a mock interview, summing up session, introductions to head-hunters, and scheme evaluation questionnaire.


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Annex A

NExT DIRECTOR PLACEMENT AGREEMENT

This is important information about your placement as part of the NHS Improvement (NHSI)

NExT Director Scheme. Please read it carefully and contact the NHSI Non-executive

Appointments Team if you have any queries.

1. The NExT Director Scheme – provides you with an opportunity to gain first-hand experience of an NHS board through a placement with an NHS trust or NHS Foundation Trust. Although this will give you access to board and committee meetings, you will have no formal board role. This is not a public appointment or employment and does not entitle you to a position with the host Trust or any other Trust at the end of your placement.

2. Principles of public life - Public service values are at the heart of the NHS and Trust boards play a critical role in shaping and exemplifying an organisational culture that is open, accountable, compassionate, and puts patients first. Respect, compassion and care are at the centre of good leadership and governance in the NHS, and organisational and personal interests must never be allowed to outweigh the duty to be honest, open and truthful with patients and the public. You are therefore expected to:

understand and commit to the personal behaviours, values, technical competence and business practices outlined in “The standards for members of NHS boards and clinical commissioning group governing bodies in England” produced by the Professional Standards Authority;

reflect the standards of selflessness, integrity, objectivity, accountability, openness, honesty and leadership set out in the Seven Principles of Public Life;

uphold the policies and procedures adopted by the host Trust;

treat any information that is gained during the course of your placement with the Trust in the strictest confidence.

3. Time commitment – To get the most from your experience, you should attend all of the board, committee and other meetings you have agreed as with your mentor that you should attend as part of your development.

4. Public speaking – You should not make political speeches or engage in other political activities relating to the work of the Trust during your placement.

5. Conflicts of interest – At the beginning of your placement you should declare to the Trust any business interests, position of authority in a charity or voluntary body in the field of health and social care, and any connection with bodies contracting for NHS services that may be relevant to the Trust.

6. Visiting guidelines - Visits to wards or other areas with access to patients must always

be accompanied and planned beforehand, identifying where you are going and who you


http://www.professionalstandards.org.uk/docs/psa-library/november-2012---standards-for-board-members.pdf?sfvrsn=0

http://www.professionalstandards.org.uk/docs/psa-library/november-2012---standards-for-board-members.pdf?sfvrsn=0

7

will speak to. Senior staff should be notified well in advance and always be clear about

who you are and why you are there.

7. Change in circumstances - You should also notify the Trust and NHSI if there is any change to your situation or connections during the period of your placement. Any failure to do so could jeopardise the reputation of the Trust and / or NHSI and result in an end to your placement.

8. Allowances – Your Trust can reimburse you for reasonable and receipted travel and expenses incurred during your placement if necessary.

9. Length of placement – Your placement will last a minimum of six months. You may

leave the scheme at any time by giving notice to your Trust and NHSI. Where possible, you should first speak with the chair of your host Trust.

10. Ending your placement - When your placement comes to an end, for whatever reason, you will immediately return any Trust property in your possession or under your control, and irretrievably delete or destroy any electronic or other information you hold that is relating to the business of the Trust and if requested, provide a signed statement that you have complied with this obligation.

I have read and understand the information above:

SIGNED………………………………………………….. Date………………………..

PRINT NAME……………………………………………….


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COUNCIL OF GOVERNORS

Title of Paper: Chief Executive’s Report

Paper for: Information

Presenter: Tracy Allen, Chief Executive

Author: Tracy Allen, Chief Executive

Date of Meeting: 13th September 2017

Agenda Item No: 112/17

No of pages incl this one: 12

Appendices:

Appendix 1: Extract from Learning from Deaths Implementation Guidance Appendix 2: August STP Update Appendix 3: Organisational Big 9

Purpose of Paper

The Chief Executive's report provides the Council of Governors with information about key national and local strategic issues affecting Derbyshire Community Health Services NHS Foundation Trust.

Summary

The paper includes updates on:

• Implementing the national Learning from Deaths framework • System transformation updates including:

o Derbyshire Sustainability and Transformation Partnership o Development of a single integrated CCG management team o Better Care Closer to Home

• Other key operational issues including: o Progress with CCG disinvestment from 17/18 contracts o PLACE audit results

• Headline organisational performance – ‘the big 9’

Recommendations

The Council is recommended to note the paper.

Page 1 of 12112 Chief Executives Report CoG Sept 17.pdfOverall of 78

Chief Executive Report September 2017

1. Purpose of report

This report provides the Council with information about policy, legislative and developmental issues and changes which affect the organisation and local initiatives across the organisation in the past month. 2. National policy updates 2.1 Implementing the Learning from Deaths framework: key requirements for trust boards NHS Improvement has published guidance for acute, specialist, mental health and community trust boards and specifically trust non-executive directors (NEDs) and non-clinical executive directors. The guidance explains what boards are expected to do in relation to the new Learning from Deaths framework, which placed a number of new requirements on trusts:

From April 2017 onwards, collect new quarterly information on deaths, reviews, investigations and resulting quality improvement;

By September 2017, publish an updated policy on how the trust responds to and learns from the deaths of patients in its care;

From Q3 2017 onwards, publish information on deaths, reviews and investigations via a quarterly agenda item and paper to its public board meetings;

From June 2018, publish an annual overview of this information in Quality Accounts, including a more detailed narrative account of the learning from reviews/investigations, actions taken in the preceding year, an assessment of their impact and actions planned for the next year.

Governors will be aware of the national framework and the new requirements this year. Our Medical Director, Rick Meredith, is the lead executive director with responsibility for implementing the framework and Chris Bentley is the lead non-executive director. The Trust’s policies and procedures for reviewing and learning from deaths have been comprehensively reviewed and developed in line with the framework and the Quality Services Committee will be considering our new policy for adoption, and publication, at its September meeting. Implementing the framework is particularly challenging for non-acute trusts such as DCHS where there are real complexities in determining the scope of deaths to be included in trust review processes. Helpfully NHS Improvement have confirmed that ‘many organisations, particularly mental health and community care providers, have less clarity on methodologies and scope for the new requirements. We are clarifying with national partners and providers what good looks like and we do not expect providers to have developed perfect processes by Autumn 2017. We will support the system to learn over the course of the next 12 months.” The Trust will continue to participate actively in national and regional forums to share experiences, learning and best practice as this work is taken forward.


https://improvement.nhs.uk/uploads/documents/170720_Implementing_LfD_-_information_for_boards_proofed_v2.pdf

Governors will want to assure themselves that the Trust is complying with the new requirements as the year continues and taking every opportunity to maximise the learning that comes from deaths. I have attached as Appendix 1 a short extract of questions from the guidance proposed to support non-executive directors in challenging for continuous quality improvement that I thought may be useful for governors.

3. Local Transformation Updates

3.1 Derbyshire Sustainability and Transformation Partnership (STP) Revised governance arrangements for the partnership have been considered and adopted by partner organisations across the system and work is focusing on moving into implementation of our transformation priorities, along with the development of a system financial strategy that will support them. The latest update from the STP is attached as Appendix 2 for information. 3.2 Derbyshire Clinical Commissioning Groups (CCGs) – development of a single management team and integrated governance structure As governors will be aware, the four Derbyshire CCGs agreed earlier this year to establish a single integrated management team as part of the system developments associated with taking the STP forward and developing a strategic commissioning function. The first phase of this work has concluded with the appointment of a single accountable officer and chief finance officer across the four CCGs during July and August. Dr Chris Clayton has been appointed as the accountable officer for all four CCGs and will be starting in the role at the beginning of October. Dr Clayton is currently the accountable officer of Blackburn with Darwen CCG in the North West. At the time of writing this report we have not been notified of the appointment of the chief finance officer and a verbal update will be provided at the meeting if available. Work will continue on integrating the full management teams and on establishing formal shared decision making and governance arrangements across the four CCGs that support them coming together to make strategic decisions on a system wide basis and pool resources and effort to drive forward the system transformation we have prioritised. We are looking forward to welcoming Dr Clayton into Derbyshire and working with him. At the same time we need to recognise the very considerable uncertainty and anxiety that the organisational consolidation is having on the CCGs and our colleagues working within them. 3.3 North Derbyshire CCG – NHS England Legal Directions As a result of a significant and deteriorating financial position, and governance and leadership capability and capacity challenges, North Derbyshire CCG has been issued with Legal


Directions from NHS England (NHSE) during August (a regulatory intervention for CCGs similar to a Foundation Trust being placed into Special Measures by NHS Improvement). These directions require the CCG:

to produce a full implementation plan for the capability review within the next four weeks;

to set an agreed recovery plan for the end of September 2017, and;

involve NHS England in any process for executive level appointments and develop their executive capability and capacity.

There is a system risk that the work required by NHSE may create some conflict with the STP system wide approach to managing our service transformation priorities and financial challenge and - impacting on the pace and cohesiveness of the development of the integrated management team across the four CCGs. The Trust Board will be working closely with NDCCG colleagues to support them (see item 4.1 below) and through the STP governance structures to minimise this risk wherever possible. 3.4 Progress with the Better Care Closer to Home (BCCtH) At the last Council of Governors meeting William Jones provided an update on the proposals that North Derbyshire and Hardwick CCGs have consulted on and that they were to make a decision at their Governing Bodies in public on 24th July. The CCG Governing Bodies approved all aspects of the consultation proposals and added that they would continue to commission the two respite beds that DCHS currently provide on Spencer ward at Buxton. They also confirmed that they will not commission functional mental illness care from DCHS. A governance structure to support implementation has been agreed with the CCGs with weekly meetings taking place of an Implementation group. On 23rd August Riverside ward at Bakewell was closed. This sad action was in line with the Better Care Closer to Home long-term aspirations but was accelerated as a culmination of a relentlessly challenging position with the retention and recruitment of Mental Health nurses. By the end of September there will be a deficit of 26 full time equivalent nurses across the four Older People’s Mental Health (OPMH) wards. This required the executive team to take urgent action on the grounds of maintaining safety and Riverside was considered the best option to close as occupancy and admissions have been very low. Most colleagues have been temporarily relocated to the remaining three OPMH wards with a small team identified who will work with Derbyshire Healthcare FT (DHcFT) colleagues to establish a pilot Dementia Rapid Response Team (DRRT) in the Dales area. Only one patient was required to transfer to another ward. We are also developing plans with colleagues to roll out the Living Well with Dementia service. This will develop and allow for the OPMH day units to gradually close. For the first full phase of implementation plans are being developed, by engaging with colleagues at Bolsover and Clay Cross Hospitals, to consolidate our rehabilitation services onto one site and establish more Beds with Care in partnership with Derbyshire County Council. We


will also be developing our Integrated Care Teams to increase our capacity to support more people in their own homes. It is not anticipated that much more transformational change will then take place until after the Winter. The People and Organisational Effectiveness Directorate have also established a BCCTH Resource Team. This team will be a dedicated resource to support colleagues and undertake the significant HR work that will be required to support about 500 colleagues that will eventually be part of the proposed changes. 3.5 Joined up Services in Belper – proposed consultation on the future of Babington Hospital by Southern Derbyshire CCG There has been no progress with beginning this consultation due to delays in the assurance process managed by NHS England. The Trust continues to work closely with Southern Derbyshire CCG to support them with this critical stage in taking forward the proposed development. 4. Other Key Operational Issues 4.1 Progress with agreeing disinvestment in 2017/18 contracts As previously reported and discussed in some detail, the 2017/18 CCG contracts with DCHS included a significant element of commissioner disinvestment that was required to make the contracts affordable for the CCGs. It was not possible to finalise the areas of disinvestment in the run up to signing contracts and a joint timetable for resolving the outstanding gaps was agreed in year. The Trust has now almost finalised the 17/18 disinvestment in line with the value in the contract for Southern Derbyshire CCG. However this work has proved much harder with North Derbyshire CCG, Hardwick CCG, and Erewash CCG and there is still a significant gap in this contract. It is important to confirm that this is a CCG risk (i.e. DCHS will be paid in line with the gross contract value until the QIPP disinvestment is identified, agreed and transacted) and will be escalated to Contract Management Board (CMB) in September. There is a clear commitment/requirement for DCHS NHS FT to work as part of the Derbyshire system to address the financial gap and ensure sustainable and affordable contracts going forward. In this context the Trust executive team are working hard to support the CCGs with bridging the gap and making proposals about how the necessary disinvestment can be, at least non recurrently, delivered this year in full while recurrent commissioning changes are planned and implemented. 4.2 National Patient Led Assessments of the Care Environment (PLACE ) audit – DCHS NHD FT results 2017 NHS England and The Department of Health recommend that all hospitals providing

NHS‐funded care undertake an annual assessment of the quality of non‐clinical services and

the condition of their buildings. These assessments are referred to as Patient‐Led Assessments

of the Care Environment (PLACE).


The PLACE programme offers a non‐technical view of the buildings and non‐clinical services provided across all hospitals providing NHS funded care. Across DCHS the PLACE inspections were held between March and May of this year and our local, along with national comparative results, have just been published. I have summarised the trust results below, along with a comparison of our results nationally. Governors will be pleased to note the maintenance of high scores across all areas of the review, with DCHS Hospitals achieving a score above the National Average for all elements Cleanliness, Food, Condition and Maintenance, Privacy & Dignity, Dementia and Disability DCHS overall Organisational Scores (with Year on Year Comparison) 2016 and 2017:

CLEAN-LINESS

FOOD

PRIVACY &

DIGNITY

CONDITION &

MAINTENANCE

DEMENTIA

DISABILITY

2017 99.51% 95.29% 88.63% 97.66% 81.95% 90.57%

2016 99.57% 96.65% 84.81% 97.81% 81.47% 88.36%

PLACE Results National Averages

CLEAN-LINESS

FOOD

PRIVACY &

DIGNITY

CONDITION & MAINTENANCE

DEMENTIA DISABILITY

National Average

Score 2017

98.4% 89.7% 83.7% 94.0% 76.7% 82.6%

DCHS Scores 2017

99.51% 95.29% 88.63% 97.66% 81.95% 90.57%

It should be noted that additional elements were again included in the criteria this year within all sections of the 2017 assessments which impacts on the year on year comparison. Key areas for improvement have been identified through the assessments and include:

Hand rails not in a different colour to contrast with the walls

Not all corridors had hand rails

No small seating areas for patients to have a rest along the corridors

Not all rooms are single occupancy rooms with en-suite facilities

Not sufficient space at all reception desks and in all waiting rooms to have a private conversation


A private room is not always available on the wards where patients can go for a conversation

Not all toilets and bathrooms are for single sex use

Not all wards have a separate treatment room for minor procedures and dressings The Dementia Friendly Environment would be improved if some of the criteria relating to the elements below were addressed:

Ensuring that walls and handrails are of a contrasting colour

Clear signage prominently displayed, showing the hospital name and ward/outpatients name

A large clock visible in all ward areas

Are doors to exits clearly marked, but doors to ‘staff only’ areas disguised

Taps clearly marked as hot/cold e.g. by using red and blue colours

These will be taken forward in the PLACE action planning and Trust Capital Programme. 5. Organisational Performance July 2017 The Trust’s performance against our 2016/17 ‘Big 9’ for July is attached for information at Appendix 3. Appendix 1: Extract from Implementing the Learning from Deaths framework: key requirements for trust boards Appendix 2: Derbyshire Sustainability and Transformation Partnership Update Appendix 3: Headline organisational performance – ‘the Big 9’


Appendix 1

Championing learning and quality improvement – what questions should NEDs ask? Extract from ‘Implementing the Learning from Deaths framework: key requirements for trust boards’ July 2017

· What are the trust’s most significant problems? Where should quality improvement be

prioritised?

· What is the organisation’s strategy for improving the quality of the care it provides?

· What approach and method(s) does it use?

· How well is quality improvement work resourced?

· How does the trust use Learning from Deaths, Serious Incidents and other patient safety-related events to inform quality improvement work? Is good practice identified as well as problems?

· Who is the board executive lead and how well sighted is the board on this work?

· How are the necessary changes in clinical practice supported and enabled?

· How are the wider themes and trends from case record reviews or investigations shared across the organisation and with any others that may have an interest? Are these processes effective?

· How are patients, families and carers involved in quality improvement and sharing learning?

· What changes have been made as a result of this work? Has quality of care improved as a result? How do you know?

Implementing the Learning from Deaths framework | 15 Changing trust policies, training staff and reminding them how something should be done are all relatively weak barriers to error. NEDs should consider how their trust avoids resorting to these weak, simplistic barriers to risk wherever possible and instead invests in more effective and sustainable changes to practice, underpinned by human factor approaches, systems thinking and quality improvement techniques.


Joined Up Care Derbyshire (STP) Update

Welcome to the second edition of the Joined Up Care Derbyshire Update. Joined Up Care Derbyshire brings together eleven partner organisations and sets out ambitions and priorities for the future of the county’s health and care. This month the Sustainability and Transformation Partnership Board did not meet due to many of its members taking a summer break. The STP Board will be meeting next month and we will keep you updated on what is discussed. In the meantime we want to give you a brief overview of the latest STP news. People from across all 11 organisations involved in Joined Up Care Derbyshire (our Sustainability and Transformation Plan, or ‘STP’) have been coming together to launch the workstreams which focus on the priorities set out in our plans. More than 100 people with an interest in mental health gathered at the Postmill Centre, South Normanton this month to launch the Mental Health workstream. The workstream is led by Ifti Majid, acting chief executive of Derbyshire Healthcare NHS Foundation Trust, who started the session by explaining how mental health fits into all areas of the Joined Up Care Derbyshire plans. He said: “We need to get rid of organisational badges and truly begin working together across boundaries. We are no longer in the era where we ‘blame’ commissioners or providers – we are in this together.”

The session involved discussions around the ‘must do’s’ within each of the four Mental Health programme areas and links to work already underway e.g. Better Care Closer to Home, Cost Improvement and Quality, Innovation and Prevention and Productivity programmes. This month also saw the first meeting of the Derbyshire Urgent Care System Group, which brought

together people from across all 11 organisations to discuss how their areas of their work support the

urgent and emergency care vision.

The meeting focussed on understanding how the community and acute patient activity will change to

deliver the vision and how new contracting methods will need to work to support the changes.

Work across all organisations continues on the Financial Recovery Plans which relies upon providers

and commissioners working closely together across health and social care systems.

As part of this Derbyshire’s four clinical commissioning groups are working towards one shared QIPP*

plan and providers are working to one joint CIP* plan. This coordinated approach mean teams can focus

on specific schemes and all organisations can benefit from working together – preventing financial

pressures from being moved around within existing structures and ways of working.

If we continue to work in our organisational silos and do nothing we will have an estimated financial gap

of more than £239m in our health system and £136m in our local authority costs. These figures give us

all an idea of the financial challenge we face, just as all systems do across the country, and they will alter

due to inflation and other issues.

Appendix 2


Regardless of the exact figure we must concentrate our efforts on new ways of managing and sharing

financial risk across the health and care system, including councils, providers and commissioners to help

everyone work towards having a financially stable system over the next few years.

Together with Healthwatch Derby and Derbyshire we have started to get out and about to start the

conversation with people about the future of health and social care. People across the county and city

have given us their views and have answered the questionnaire which aims to raise awareness of the

changes needed to be made to health and social care and get their views on the initial priorities

We will be continuing to get out to as many people as possible with the questionnaire to start the

conversations during September and October. If you have any suggestions about where we could go

either in your organisation or meetings we could attend in your local area in Derbyshire please get in

touch. To answer the questionnaire visit https://www.surveymonkey.co.uk/r/joinedupcarederbyshire

If you are interested in getting involved in Joined Up Care Derbyshire or have a question please contact

[email protected]

*QIPP - The Quality, Innovation, Productivity and Prevention programme is a national Department of

Health strategy involving all NHS staff, patients, clinicians and the voluntary sector. It aims to improve

the quality and delivery of NHS care while reducing costs and making efficiency savings. These savings

will be reinvested to support the front line.

*CIP - Cost Improvement Programmes aim to reduce cost. A CIP is the identification of schemes to

increase efficiency/ or reduce expenditure. CIPs can include both recurrent (year on year) and non-

recurrent (one-off) savings. A CIP is not simply a scheme that saves money as there must not be a

detrimental impact on patients.

Best wishes,

Paul Wood

Chair of Sustainability and Transformation Partnership

Board

Tracy Allen

Interim Senior Responsible Officer for Joined Up Care Derbyshire

IN OTHER NEWS

NEW LEADER FOR THE CLINICAL COMMISSIONING GROUPS

The Governing Bodies of the four Clinical Commissioning Groups across Derbyshire (North Derbyshire

CCG, Southern Derbyshire CCG, Hardwick CCG and Erewash CCG) have confirmed the appointment of

Dr Chris Clayton as their new joint Accountable Officer.

Chris is currently Clinical Chief Officer for Blackburn with Darwen CCG and is also the Chief Officer for

the Pennine Lancashire Transformation Programme. Originally from Rossendale in East Lancashire,

Chris completed his clinical studies in Cambridge and worked in Birmingham and the West Midlands

before joining Darwen Healthcare GP practice in 2004. He has been Clinical Chief Officer for Blackburn

with Darwen CCG since 2012. Chris is due to start his new role on October 2nd


https://www.surveymonkey.co.uk/r/joinedupcarederbyshire


The recruitment for the post of single Chief Finance Officer (CFO) for the four CCGs has also been completed and it has been confirmed an offer has been made to an external candidate. As more details are announced we will keep you informed. NHS Hardwick CCG and NHS North Derbyshire CCG make their decisions following the Better Care Closer to Home consultation After extensive public consultation Hardwick and North Derbyshire CCGs are to replace outdated hospital wards with a clinically proven model of home-based care to help older people recover more quickly from illness and operations. The plans, which were unanimously approved at a joint meeting of the CCG boards during July will now be developed in detail. The CCGs have promised that no current service will stop until a clinically suitable alternative has been put in place

Their decisions now mean that proposals to provide enhanced and more joined up community-based services will now enter an implementation phase which will be guided by a set of agreed implementation principles as outlined in the Post Consultation Business Case. Underlying these principles are three commitments both CCGs made to the people of northern Derbyshire: • No current service would stop until an alternative is in place. • Everyone who needs inpatient care under the proposals put forward would receive it • All NHS-commissioned services to remain free at the point of delivery.

For more information visit http://www.joinedupcare.org.uk/patients-and-public/better-care-closer-to-

home-public-consultation/

Information

To find out more about what was discussed at the Mental Health Workstream Meeting contact

[email protected]

To find out more about the Governance structure visit

http://www.southernderbyshireccg.nhs.uk/publications/joinedupcarederbyshire/governance/

To find out more about the workstream and priorities visit

http://www.southernderbyshireccg.nhs.uk/publications/joinedupcarederbyshire/priorities-work-

areas/

For full plans and information about Joined Up Care Derbyshire visit

www.southernderbyshireccg.nhs.uk/publications/joinedupcarederbyshire/

If you are interested in getting involved in Joined Up Care Derbyshire or have a question please contact Head of Communication and Engagement for Joined Up Care Derbyshire at [email protected]


http://www.joinedupcare.org.uk/patients-and-public/better-care-closer-to-home-public-consultation/

http://www.joinedupcare.org.uk/patients-and-public/better-care-closer-to-home-public-consultation/


http://www.southernderbyshireccg.nhs.uk/publications/joinedupcarederbyshire/governance/

http://www.southernderbyshireccg.nhs.uk/publications/joinedupcarederbyshire/priorities-work-areas/

http://www.southernderbyshireccg.nhs.uk/publications/joinedupcarederbyshire/priorities-work-areas/

http://www.southernderbyshireccg.nhs.uk/publications/joinedupcarederbyshire/


Objective Priorities 2017/18 TargetPlan to end

of July

Insulin safe administration - Right dose, right time

80% (715) of Community Nurses have

completed Insulin Safety e-learning

Training by November 2017

380 101 (RED) 715 (GREEN)

Proportion of services adopting patient related

service outcome measures

37 services reporting to CEG by March

201822 17 (AMBER) 37 (GREEN)

Identification of carers on TPPIdentify 75% of carers who access our

services, a total of 5,7801,500 718 (AMBER) 5,780 (GREEN)


of July

Increase average 12-month attendance rate across

the Trust by 0.5% by year end

Average 12 month attendance to be

95.75%95.72% 95.23% (AMBER) 95.75% (GREEN)

Increase staff engagement in teams with a low

engagement score by 10%57 53 61 (GREEN) 61 (GREEN)

Increase the reporting of Health and Safety Near

Misses by 20% during 2017/18140 42 50 (GREEN) 140 (GREEN)


of July

Demonstration of efficiency across all DCHS

services through the delivery of the Sustainable

Quality Improvement Plan (SQIP)

Delivery of £7.2m SQIP Plan £2.223m £2.065m (RED) £7.2m (GREEN)

Delivery of effective services within the CommunityDelayed Transfer of Care (%) to be 3.5%

by September 20174.20% 9.9% (RED) 8% (RED)

Responding to the main issue raised through staff

feedback by monitoring the perceived improvement

in IT connectivity for staff

Less than 35% of staff Often or Always

Experiencing Connectivity Problems35% 30% (GREEN) <35% (GREEN)

Notes:Delayed Transfer of Care in DCHS

Control3.9%

Quality Business

Achieved to

end of JulyForecast

To ensure an effective, efficient and

economical organisation which promotes

productive working and which offers

good value to its community and

commissioners

Big 9 - July 2017

Quality Service

Achieved to

end of JulyForecast

To deliver high quality and sustainable

services that echo the values and

aspirations of the community we serve

Quality People

Achieved to

end of JulyForecast

To build a high performance work

environment that engages, involves and

supports staff to reach their full potential

Appendix 3


COUNCIL OF GOVERNORSTitle of Paper: Associate Director of Corporate Governance/Trust Secretary’s

ReportPaper for: Information and Decision

Presenter: Melanie Curd, Deputy Trust Secretary

Author:Kirsteen Farrar, Associate Director of Corporate Governance/ Trust Secretary David Boddy, Corporate Governance Manager

Date of Meeting: 13 September 2017 AgendaItem No: 114/17

No of pagesincluding this one: 13

Appendices: Appendix 1 Engagement Policy

Purpose of PaperThe purpose of this paper is to update Governors regarding relevant issues.

SummaryGovernor NewsOwing to health reasons Mike Perry has decided to stand down from the Council of Governors.

Mike has been a Public Governor for the Amber Valley, Erewash and South Derbyshire constituency since the DCHS Council of Governors (CoG) first began in June 2013.

We thank Mike for his contribution and involvement with the CoG and we wish him well in the future.

2017 Governor Elections UpdateThe nominations stage of the 2017 elections closed on 15th August. Nominations have been received for the following constituencies: Amber Valley Erewash and South Derbyshire, Derbyshire Dales and High Peak, Bolsover Chesterfield and North East Derbyshire, City of Derby, Nursing, Other Registered Professionals, Facilities and Estates and Administration Clerical and Managers.

In the case of Bolsover Chesterfield and North East Derbyshire and Facilities and Estates, the number of nominations was equal to the number of vacant seats. This means that in those constituencies the nominees have been automatically elected. Julian Miller (Bolsover Chesterfield and North East Derbyshire) and Louise Holmes (Facilities and Estates) are congratulated on their re-election.

There are three constituencies (Rest of England, Medical and Dental and Healthcare Support Staff) where no nominations were received. This was discussed with the Governance Group and it was agreed that DCHS will re-run elections for these seats in the new year.

We thank all the governors who have given their support during the nomination part of the election.

Page 1 of 13114 Trust Secretary's Report.docxOverall of 78

2.0 Page 2 of 13 September 2017

The next stage of the election is the ballot. Voting packs were dispatched on 7th September. The election closes on 2nd October and results will be declared on 3rd October.

Lead Governor ElectionsThe term of office for the Lead Governor is due to end in September, shortly before the current Public Governor elections are to complete. The Governance Group have considered the forthcoming Lead Governor vacancy and agreed that, although the timing is prior to the results of the Public Governor election, it will provide continuity if the elections for the Lead Governor position proceed in September. This is also in accordance with the DCHS Constitution.

The Governance Group agreed that running the Lead Governor elections before the outcome of the Public Governor elections is preferable to holding the position vacant for several months until new governors have gone through the full induction process. The Governance Group did consider all the possible options and understood that potentially someone who is a current governor and is elected as Lead Governor may possibly fail to get re-elected during the Public Governor elections. In that case we would have to run the Lead Governor elections again.

The elections for the position of Deputy Lead Governor will be arranged for 6 months’ time in order to give new governors an opportunity to participate if they wish. It will also allow the terms of office for Lead and Deputy Lead Governor to be staggered in the future. This will provide continuity when the term of office for each role comes to an end.

We have therefore invited Public Governors who plan to be in office after the 1st November to nominate themselves to stand for election to the role. The election schedule for the role will be:

Deadline for receipt of Nominations: by 5.00pm, Thursday 14th September Ballot papers to be distributed: Friday 15th September Deadline for receipt of ballot papers: 5.00pm, Thursday 28th September Announcement of results: by Monday 2nd October

Nomination forms should be returned to David Boddy. The term of office for the Lead Governor is a maximum of two years or when the term as a Governor expires (whichever is the earlier). A governor who is Lead Governor is eligible for re-appointment at the end of his/her first term (but not any subsequent term). Nominations and Remuneration Committee and Governor Groups UpdateAn impact of the governor elections is that governors who are standing down from the CoG will also be leaving their Governor Groups. As part of the induction process for new governors we will be encouraging them to join the groups that match their interests. Arrangements are being made for new governors to be made fully aware of what each group does.

This will also be the case for the Nominations and Remuneration Committee. Membership to the committee is by election. Details of the election process will be shared once the new governors have joined the CoG.

Annual Governors’ Meeting/Annual Members’ MeetingGovernors are invited to attend the Annual Governors’ Meeting/Annual Members’ Meeting which



is planned for Thursday 5th October 2017. The meeting will take place at Belper Town Football Club, 121 Bridge Street, Belper, DE56 1BA from 12.30pm until 4.30pm.Governors will be able to hear about our achievements and performance during the past year and listen to our key note speaker, Tommy Whitelaw, ‘the man who made Britain cry’, share his experience as a dementia carer.

Governors may recall that this important meeting is when the CoG receive and consider the Annual Accounts, any report by the Auditor, the Annual Report including the Quality Report.

Engagement PolicyThe updated Engagement Policy is attached to this report for the CoG to review and approve prior to presentation at Board. The Governance Group reviewed the policy and made a number of recommendations which have been incorporated into the attached document (Appendix 1).

The purpose of the draft Engagement Policy is for Council of Governor engagement with the Board of Directors where CoG have concerns about performance of the Board, compliance with the Provider Licence conditions or other matters related to the overall wellbeing of the NHS Foundation Trust.

The NHS Foundation Trust (FT) Code of Governance (the Code) was first published in 2006 and was updated in July 2014. The purpose of the Code was to bring the best practice on Corporate Governance from the private sector into NHS Foundation Trusts. It is a requirement of the Code that NHS Foundation Trusts have an Engagement Policy and Statement on the Roles and Responsibilities of the Council of Governors and these were originally developed and approved in September 2014.

The policy has been reviewed in line with the three-year corporate cycle. Minor amendments have been made including job titles and organisation changes. In addition, we have removed reference to referring to the NHSI Panel. In February 2017, NHSI Improvement informed all organisations that Governors were choosing not to make use of the Panel’s facility (including raising substantive questions) in accordance with the referral criteria laid out in legislation and so they have taken the decision to disband it.

The policy will be next reviewed in September 2020.

Statement on the Role and Responsibilities of the Council of GovernorsThe Governance Group also reviewed the Statement on the Role and Responsibilities of the Council of Governors. This document details the roles and responsibilities of the CoG and also describes how any disagreements between the CoG and the Board of Directors will be resolved.

The Governance Group requested a number of amendments to this document. A request is made to the Council of Governors for a postponement of 2 months to allow time to draft the changes. The document can then be presented to the November CoG meeting for approval.

RecommendationsThe Council is asked to:

Discuss the information provided in the paper



Approve the Engagement Policy Approve a postponement of 2 months for presentation of the Statement on the Role and

Responsibilities of the Council of Governors



Appendix 1

ENGAGEMENT POLICY; COUNCIL OF GOVERNORS AND BOARD OF DIRECTORS

Document History

Modified Date: August 2017

Version Number: 2.0 Reference Number:Next Revision Due: September 2020

Author: Deputy Trust Secretary

Policy Sponsor: Associate Director Corporate Governance / Trust Secretary

Approved by: Council of Governors Date: Sept 2017

Ratified by: Trust Board Date:

Category: Corporate

Sub Section: CorporateType of Document: Policy

Have you assessed the Equality Impact of this policy?

Please indicate which groups have discussed this policy:Date(s) discussed:

Has this Policy previously been known under another title? If so please state previous title.Date changed:

Revision History

Version Revision date

Summary of Changes

2.0 August 2017 Minor amendments as part of the three-yearly review cycle.



To help ensure that this policy is as accessible as possible, it has been left-aligned and is available in alternative formats and languages. To obtain a copy of the policy in large print, audio, Braille (or other format) or in a different language, please contact The Communications Team, by Tel: 01773 525099 or email [email protected]




TABLE OF CONTENTS

1. AIM /PURPOSE 42. INTENDED USERS 43. DISCLAIMER 44. DEFINITIONS AND AN EXPLANATION OF TERMS USED 45. FULL DETAILS OF THE POLICY 56. SUPPORT AND ADDITIONAL CONTACTS 87. SUPPORTING DOCUMENTS 88. APPROVAL AND RATIFICATION ROUTE 89. MONITORING/AUDIT 810.EQUALITY IMPACT 9


1. AIM /PURPOSE

The NHS Foundation Trust Code of Governance requires the Council of Governors to establish a policy for engagement with the Board of Directors where they have concerns about performance of the Board, compliance with the Provider Licence conditions or other matters related to the overall wellbeing of the NHS Foundation Trust.

2. INTENDED USERS

Table of Intended Users:

DCHS Chief Executive’s Department YES

Finance Performance and Information NoQuality No

Strategy NoOperations No

People & Organisational Effectiveness NoGP Practice No

This policy is intended for use by the Council of Governors and the Board of Directors

3. DISCLAIMER STATEMENT

It is a requirement that the reader follows this policy and accepts professional accountability and maintains the standards of professional practice as set by the appropriate regulatory body applicable to their professional role and to act in accordance with the express and implied terms of your contract of employment, in accordance with the legal duties outlined in the NHS Staff Constitution (section 3b). If there are any concerns with this document then the reader should initially discuss the specific issue with their line manager or raise it through appropriate “raising concerns” channels. The line manager should agree a course of action that is appropriate and reflect this in the patients notes and with the policy sponsor.

4. DEFINITIONS AND AN EXPLANATION OF TERMS USED

Board of Directors means the Board of Directors as constituted in accordance with the Constitution;

Chair means the person appointed in accordance with the Constitution to that position. The expression “Chair” shall be deemed to include the Vice Chair if the Chair is absent from a meeting or otherwise unavailable;


Chief Executive means the Chief Executive Officer of the Trust appointed in accordance with the Constitution;

Council of Governors means the Council of Governors as constituted in accordance with the Constitution;

NHS Improvement (NHSI) is the body corporate previously known as Monitor, as provided by Section 61 of 2012 Act;

NHS Foundation Trust Code of Governance means the NHS Foundation Trust Code of Governance (Updated July 2014) which is issued by NHSI;

Provider Licence means the Trust’s Provider Licence granted by the independent regulator under Section 87 of the NHS Act 2006;

Senior Independent Director means a person appointed as a Director (whether and Executive Director or a Non-Executive Director) in accordance with the Constitution;

Trust Secretary means the Secretary of the Trust or any other person or body corporate appointed to perform the duties of the Secretary of the Trust, including a joint, assistant or deputy secretary.

5. FULL DETAILS OF THE POLICY

5.1 Informal Communications

5.1.1 Informal and frequent communication between the Governors and the Directors is an essential feature of a positive and constructive relationship designed to benefit the trust and the services it provides

5.1.2 The Chair shall use his/her reasonable endeavours to encourage effective informal methods of communication including:

(a) participation of the Board of Directors in the induction, orientation and training of Governors;

(b) development of special interest relationships between Non-Executive Directors and Governors;

(c) discussions between Governors and the Chair and/or the Chief Executive and/or Directors through the office of the Chief Executive or his/her nominated officer; and;

(d) involvement in membership recruitment and briefings at public events organised by the trust.

5.2 Formal Communication

5.2.1 Some aspects of formal communication are defined by the constitutional roles and responsibilities of the Council of Governors and the Board of


Directors respectively.

5.2.2 Formal communications initiated by the Council of Governors and intended for the Board of Directors will be conducted as follows:

a) specific requests by the Council of Governors will be made through the Chair to the Board of Directors;

b) any Governor has the right to raise specific issues to be put to the Board of Directors at a duly constituted meeting of the Council of Governors through the Chair but if the Chair declines to raise any such issue the said Governor may nonetheless still raise it provided two thirds of the Governors present approve his/her request to do so. The Chair shall then raise the matter with the Board of Directors and provide the response to the Council of Governors;

c) Joint meetings will take place between the Council of Governors and the Board of Directors as and when appropriate as determined by the Board of Directors in its absolute discretion.

5.2.3 The Board of Directors may request the Chair to seek the views of the Council of Governors on such matters as the Board of Directors may from time to time determine.

5.2.4 Communications between the Council of Governors and the Board of Directors may occur with regard to, but shall not be limited to:

a) the Board of Directors proposals for the strategic direction of the Trust and the Annual Report and Forward plan;

b) the Board of Directors’ proposals for developments;

c) Trust performance; and

d) involvement in service reviews and evaluation relating to the Trust’s services.

5.2.5 Some or all of the Board of Directors shall also present to the Council of Governors the Annual Accounts, the Annual Report including the Quality Report and any report of the Auditors in accordance with the terms of the Constitution and of the 2006 Act.

5.2.6 The following formal methods of communication may also be used as appropriate with the consent of both the Council of Governors and the Board of Directors

a) attendance by some or all of the Board of Directors at a meeting of the Council of Governors; or

b) provision of formal reports or presentations by Executive Directors or Non-Executive Directors to a meeting of the Council of Governors; or


c) inclusion of appropriate minutes for information on the agenda of a meeting of the Council of Governors; or

reporting the views of the Council of Governors to the Board of Directors through the Chair, the Vice Chair or the Senior Independent Director.

5.3 Senior Independent Director

5.3.1 The Senior Independent Director (“SID”) shall act as an alternative source of advice to Governors from the Chair

5.3.2 The SID shall be available to Governors if they have concerns that contact through the normal channels has failed to resolve any issues which have been raised or for which such contact is inappropriate.

5.4 Raising Concerns

5.4.1 Governors (operating as a group or on their own) may raise concerns in the following circumstances:

a) the performance of the Board of Directors;

b) compliance with the Trust’s Provider Licence; or

c) other matters related to the overall wellbeing of the Trust.

5.4.2 Governors should raise any concerns with the Associate Director Corporate Governance / Trust Secretary or Lead Governor who may in the first instance be able to resolve the matter informally.

5.4.3 Where the Associate Director Corporate Governance / Trust Secretary or Lead Governor has been unable to resolve the concerns and/or has recommended that they be taken to the Chair, the Governor(s) in question should raise the concern with the Chair and make a request for the matter to be investigated.

5.4.4 The Chair shall review any evidence offered, make such enquiries and hold such discussion with Trust Officers as he/she considers appropriate in respect of that matter.

5.4.5 Following completion of his/her review of the matter the Chair shall meet with the Governor(s) who raised the concern to discuss his/her findings as soon as is reasonably practicable. There are three possible outcomes to this meeting;

a) the Governor(s) is satisfied that his/her concerns were unjustified and withdraws them – no further action is required;

b) the Governor(s) is satisfied that his/her concerns have been resolved in the course of the investigation. The Chair shall write a report on the concerns and the action taken and present it in the next Council


of Governors meeting. If the Council of Governors agrees that the matter is resolved no further action is required.

c) If the matter is not resolved to the satisfaction of the Governor(s), the Chairman shall call an extraordinary meeting of the Council of Governors as soon as is reasonably practicable in accordance with the Council of Governors Standing Orders to consider the matter further. That meeting may resolve to take no further action or to consider referring the matter to NHSI

5.4.6 Minutes shall be taken of the extraordinary Council of Governors meeting to record the outcome of the discussion.

5.5 Resolving Conflict between the Council of Governors and the Board of Directors

Any disputes between the Council of Governors and the Board of Directors shall be dealt with in accordance to the procedure in the Statement of the Roles and Responsibilities of the Council of Governors.

6. SUPPORT AND ADDITIONAL CONTACTS

Chief Executive’s Department – 01773 525065

7. SUPPORTING DOCUMENTS OR RELEVANT REFERENCES

NHSI – The NHS Foundation Trust Code of Governance (July 2014)NHSI – Your Statutory Duties; A Reference Guide for NHS Foundation Trust Governors (August 2013)NHSI – Director – Governor Interaction in NHS Foundation Trusts; A Best Practice Guide for Board of DirectorsDCHS Code of Conduct for Trust Board MembersDCHS Code of Conduct for the Council of Governors

8. APPROVAL AND RATIFICATION ROUTE

This policy will be approved by the Council of Governors and Board of Directors on a three-yearly basis.

9. MONITORING/AUDIT

An audit will be completed on the three yearly review of the policy to record how many times the policy has been implemented and confirm it has been followed correctly.


10. EQUALITY IMPACT

What effect or impact will the new/changed policy have on each of the Protected Characteristics (age, gender, disability, gender reassignment, marriage or civil partnership, pregnancy or maternity, race, religion or belief, sexual orientation)?

Following assessment, this Policy will have a positive impact on all of the protected characteristics. The aim of the policy is to promote positive engagement between the Council of Governors and the Board of Directors and ensure processes are fair and equitable.


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Key Dates and Future Events 2017/18

Date Event Time VenueThursday 28th September 2017

Public Board meeting 1.30pm Arena Church1 Rutland St Ilkeston DE7 8DGTel: 0115 944 2996

Thursday 5th October 2017

Annual Governors’ Meeting/Annual Members’ Meeting

12.30pm -4.30pm

Belper Town Football Club121 Bridge St Belper DE56 1BATel: 01773 825549

Wednesday 15th November 2017

Council of Governors Meeting

2.00pm Postmill CentreMarket CloseSouth NormantonAlfretonDE55 2EJTel: 01773 860296

Thursday 30th November 2017

Public Board Meeting 1.30pm Belper Town Football Club121 Bridge St Belper DE56 1BATel: 01773 825549

Wednesday 10th January 2018


2.00pm Belper Town Football Club121 Bridge St Belper DE56 1BATel: 01773 825549

Wednesday 14th March 2018



Wednesday 9th May 2018



Wednesday 11th July 2018



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Wednesday 12th September



Wednesday 14th November 2018



Board Meetings: Members of the public and staff are invited to join the Board for an informal discussion over lunch from 12.30pm. There will follow a presentation regarding the services provided by DCHS in the area where the meeting is taking place. The Public Board meeting will then commence at 1.30pm.

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derbyshirecommunityhealthservices …...council of governors meeting held on 12 july 2017 carnfield...

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