Contents
- Introduction
- Patient or staff story
- Standing items
- Board assurance committees
- Operating performance, governance, and risk management
- Supporting papers (previously presented at committees)
Minutes of the board of directors meeting, held in public on Thursday 30 May 2024 at 10am at:
Unity Centre
St Leonard’s Road, Eastwood
Rotherham
S65 1PD
Present
- Kathryn Lavery, Chair
- Richard Chillery, Chief Operating Officer
- Ian Currell, Executive Finance Director (Virtual)
- Sarah Fulton Tindall, Non-Executive Director
- Kathryn Gillatt, Non-Executive Director
- Dr Judith Graham, Acting Chief Nurse and Director of Therapies
- Dr Janosz Janokowski, Non-Executive Director
- Dawn Leese, Non-Executive Director
- Toby Lewis, Chief Executive
- Nicola McIntosh, Director for People and Organisational Development
- Justin Shannahan, Non-Executive Director
- Dr Graeme Tosh, Medical Director
- Dave Vallance, Non-Executive Director
- Pauline Vickers, Non-Executive Director
In-attendance
- Richard Banks, Director of Health Informatics
- Philip Gowland, Director of Corporate Assurance and Board Secretary
- Dr Judith Graham, Director of Therapies
8 members of staff and 2 governors and GGI representative (independent observer) joined to the meeting.
Introduction
Welcome and apologies
Reference
Board public 24/03/01 and board public 24/03/02.
Mrs Lavery welcomed attendees to the meeting, in particular Lead Governor Jo Cox.
Apologies for absence were received and noted from Jo McDonough, Sheila Lloyd, Lea Fountain, and Jyoti Mehan.
Mrs Lavery also took the opportunity to inform members that this would be the last board meeting attended by Mr Shanahan and Ms McIntosh, both of whom are leaving the trust over coming weeks.
Quoracy
Reference
Board public 24/03/03.
Mrs Lavery declared the meeting was quorate.
Declarations of interest
Reference
Board public 24/03/04.
Mrs Lavery presented the declarations of interest report which outlined the changes to the register since the last meeting relating to Mrs Lavery and Mr Banks.
The board received and noted the changes to the declarations of interest report.
Mr Gowland presented the paper on NED independence, noting its link to the code of governance and a statement to be contained in the annual report. Members agreed all NEDs to be independent, in line with the requirements set out in the code of governance.
The board received and agreed the proposals contained in the NED independence report and supported the inclusion of the statement in the annual report.
Patient or staff story
Staff story, integrated neighbourhood teams
Reference
Board public 24/03/05.
Mrs Lavery welcomed Kim, Cheryl, John and Ezinne to present the staff story which was focussed on preceptorship within the trust.
Members were informed that the trust had successfully been accredited by the Nursing and Midwifery Council (NMC) and work was underway to develop the preceptorship pathway and policy further to be inclusive across multidisciplinary professions.
Cheryl advised that she had experienced preceptorship as a student at Grounded Research and was currently a ward manager in an acute mental health unit supporting students in her role as LEM. The importance of the role supporting students both professionally and emotionally was stressed.
Ezinne gave a brief outline of her experience, noting that she completed her management placement on Hawthorn ward. She had undertaken the preceptorship programme for the last 6 months and felt that it had enhanced her professional practice, accountability, decision-making skills and has had a positive impact on patient care.
John explained that he had worked in acute medicine across a number of trusts over the last 17 years and now worked on Hazel ward. RDaSH was a very different experience as it has a different ethos to that of acute trusts and undertaking the preceptorship had been positive particularly having peers to share experiences with.
Mr Lewis questioned how the trust was supporting staff to do the full range of their roles, not just care for patient but working with other agencies on discharge planning for example and to what extent the preceptorship formed part of the development pathway. John confirmed there was structured training with a clear progression path and that students were involved with different members of the team and are not therefore isolated in any way.
Members commented and noted the importance of pastoral care for students, structured supervision, assessment, and ensuring support was in place to avoid student isolation.
Mrs Lavery and the board thanked the presenters for taking the time to speak about their experience of preceptorship and noted the intended reflection time later on the agenda.
Standing items
Minutes of the previous board of directors meeting held on 25 January 2024
Reference
Board public 24/03/06.
The board approved the minutes of the meeting held on 25 January 2024 as an accurate record.
Matters arising and follow-up action log and risk management framework
Reference
Board public 24/03/07.
Matters arising and follow-up action log
There were no matters arising from the minutes.
The board received the action log and noted the progress updates. All actions noted as ‘propose to close’ were agreed.
Risk management framework
The revised monitoring and evaluation arrangements within the risk management framework were presented for approval. Mr Lewis requested an amendment to ensure that the board was sighted, at least annually, on all high impact and low likelihood risks. This was agreed.
Mr Lewis also suggested any review of the framework’s implementation needed to demonstrate the positive difference that active risk management had made and that for example robust action planning and implementation had occurred; that risk identification was comprehensive across the trust and that stated risks were indeed risks and not issues. He sought the inclusion of some specific measures in the framework. Mr Gowland agreed to develop these.
Members agreed to discuss this further in April within the board timeout, where the board assurance framework would also be considered.
Action
Chair’s matters
Reference
Board public 24/03/08.
Mrs Lavery provided a verbal update of activities and engagements since the last meeting and expressed gratitude for important input during one-to-one meetings with the non-executive directors and lead governor and additional interactions outside of board meetings.
Mrs Lavery referred to her visits to the Doncaster Pastoral team and their work on mental health issues at schools, South Yorkshire ICB development day, Grounded Research practice day, trust wide visits to and with senior doctors, South Yorkshire Aspiring women’s day with Ms McDonough, and the NHS Providers Chairs and Chief Executive Network meeting.
Fit and proper person framework declaration
Reference
Board public 24/03/09.
Mr Gowland presented the fit and proper person framework paper which highlighted that the trust was compliant with the framework, that checks had been undertaken and that the chair had confirmed that all members of the board are “fit and proper” with no exceptions.
Members were informed all actions to support the declaration were complete however it was noted that information was not yet on ESR, ostensibly a similar position to other trusts.
The board received and noted the update that confirmed the progress and state of readiness for implementing the requirements of the FPPT.
The board received and noted the statement from the chair that, following the receipt of self-attestation statements, she has deemed all members of the board to be fit and proper.
Board assurance committees
Report from the Audit Committee
Reference
Board public 24/03/10.
Ms Gillatt presented the report and highlighted the key points from the meeting in February 2024.
The preparatory work for the annual report and annual accounts 2023/24 was progressing to plan ahead of key submissions of draft documents (24 April), final documents (28 June) and in readiness for the annual members meeting, part of a staff day, on 20 July.
Ms Gillatt, noted that the trust should expect a reduction in the head of internal audit opinion due to the number of audit reviews receiving limited opinion and the reduced follow-up rate of recommendations. The interim opinion was scheduled for the next Audit Committee meeting (April).
She noted the positive assurance report in respect of the clinical coding audit, where standards had been exceeded.
Responding to Mr Lewis’s question about IFRS16 implementation and expected key judgements and estimates in the accounts, Ms Gillatt confirmed that related papers were due to be presented to the Audit Committee in April. Mr Currell confirmed that such would be discussed with Mr Lewis and the auditors to allow for a timely consideration and agreement.
The board received and noted the report from the Audit Committee.
Report from the Mental Health Act Committee
Reference
Board public 24/03/11.
Ms Fulton Tindall presented the report form the Mental Health Act Committee.
The trust associate managers (TAM) are now represented at meetings and had provided feedback in respect of support and ability to fulfil their role, in part, related to their respective training. Dr Tosh noted the planned discussion to address this feedback and also the work with Ms McIntosh to ensure a recent change in the law was actioned, which may result in the TAMs inheriting employee status.
Mr Lewis questioned whether the note was correct in asserting that issues to do with the TAMs represented a question of legal compliance with the MHA. Whilst it was recognised that the TAMs expressed this view, after some discussion it was agreed that presently there are no identified legal compliance issues. Mr Lewis highlighted his frustration and now involvement in the issues associated with TAMs management and indicated he would update the board when it met in May.
The board received and noted the report from the Mental Health Act Committee.
Action
Report from the Public Health Patient Involvement and Partnerships Committee
Reference
Board public 24/03/12.
Mr Vallance presented the report from the Public Health Patient Involvement and Partnerships (PHPIP) Committee.
He highlighted the intent to develop data sets to track progress on equitable service provision to all communities in terms of the draft equity and inclusion plan and protected characteristics. A new approach in partnering and relationship management was planned.
The second of three local public health directors’ visits had taken place to share their perspectives. Mr Shannahan asked whether there was sufficient commonality in approach, and alignment to the RDaSH way to avoid having multiple processes to follow. Mr Vallance advised that it was too early to provide an answer and that further exploration was required.
In response to Mrs Vicker’s query it was confirmed that commissioned eating disorders service would be within the remit of the PHPIP Committee on the cessation of the Commissioning Committee.
The board received and noted the report from the Public Health Patient Involvement and Partnerships Committee.
Report from the People and Organisational development Committee (PODC)
Reference
Board public 24/01/13.
Mr Vallance presented the people and organisational development report.
Mr Vallance highlighted the need for a collective view on the levels of tolerance and impact of reported racist incidents and bullying and harassment. He asked for clear consequences to be outlined and asked if that would include potential exclusion of people from services. Mr Lewis stated the intention for CLE to discuss this matter in April, with a view to agreeing the policy that he had outlined in January at May’s CLE.
Ms McIntosh confirmed to Mr Lewis that recent RIDDOR events would feature in the next related report to POD and that the zero incidents referred to in the paper was for an earlier time period.
In response to a question about the reporting culture and the need to consider near misses, Dr Graham outlined the daily, weekly and monthly tracking of incidents that allowed triangulation in the event of a high number of low-level incidents presenting a potential increased higher risk.
The board received and noted the report from the People and Organisational Development Committee.
Action
TL and NM.
Report from the finance, digital and estates committee (FDE)
Reference
Board public 24/03/14.
Mrs Vickers presented the FDE report and noted the committee’s involvement in reviewing draft versions of related plans.
She highlighted the response to the recently received procurement audit (from internal audit) which had received only limited assurance. The committee received a progress update and Mr Shannahan had also met with Mr Currell to discuss the report in detail. Improvement work was ongoing, and a further update would be presented to FDE in August.
Mrs Vickers noted that the month 10 report showed £7.6 million savings had been delivered with a forecast of £9.4 million delivered by the year end. It was acknowledged that this represented remarkable work by very many leaders across our directorates.
The failure to deliver a major reduction in agency expenditure remained the significant challenge.
Noting his pending departure from the trust Mrs Vickers expressed her thanks to Mr Shannahan for his consistent and thorough contribution to the FDE Committee.
The board received and noted the report from the FInance Digital and Estates Committee.
Report from the Quality Committee
Reference
Board public 24/03/15.
Mrs Leese presented the report from the Quality Committee. She drew attention to the later paper on safe staffing and Mrs Lavery agreed to take both items together.
The safe staffing declaration covered the ward-based staff and whilst the trust fared well on the day-to-day management of staffing, there was a gap in the strategic aspects of staffing levels, numbers and skill mix which applied to wards but should cover all areas within the trust.
Mr Lewis noted that in mid-year he had sought to address these concerns, which he shared, and recognised the failure to follow through on changes in later months. He apologised for that and noted the intention to address the gap with Dr Graham and Mr Forsyth over the next 10 weeks. This will focus initially on transparent reporting of met or missed staffing levels on every shift on each ward, not as percentages. Dr Graham advised that urgent action had been taken in introducing enhanced monitoring of agency usage as a potential indicator of staffing weakness.
In addition, the memorandum of understanding for the MHOST Acuity tool had been revisited and would be relaunched in quarter 1, 2024 to 2025. The updated position on these matters would come to both Quality Committee and the board in May.
Mrs Leese advised members to note improvements in terms of consistency of performance and delivery against required standards in the IQPR data, although further improvement was still required. In addition, the benefits of triangulation and assurance via peer reviews had resulted in valuable consideration about “doing the right things at the right time and in the right place”. This would importantly need to be reflected in the quality and safety plan.
Ms Leese advised that there was a lack of visibility of patient experience in the estates and facilities quality report and that the results of the PLACE audit will be discussed and pursued at a future meeting of the committee. Dr Graham added that there was a portfolio realignment in terms of facilities from 1 April 2024 to support and improve facilities services with a clear plan in place on improvements and getting more feedback from patients and producers.
Concerns relating to resuscitation and Oxevision were agreed to be discussed under the chief executive’s report.
The board received and noted the report from the Quality Committee, and approved the annual safe staffing declaration.
Report from the Commissioning Committee
Reference
Board public 24/03/16.
Mrs Leese presented the Commissioning Committee report, stating the most significant update related to Ellern Mede and that following intervention from the CQC, the Rotherham based private sector unit was now closed to admissions.
She noted the continuing financial challenge with the commissioning arrangements and that this would be discussed later in the meeting, within the private session.
Mrs Leese confirmed that there would be a final meeting of the Commissioning Committee in April to consider any further update in relation to Ellern Mede, and the committee’s wider remit, before such would transfer to the public health, Patient Involvement and Partnerships Committee from then onwards.
Mr Lewis referred to large amount of governance and clinical oversight undertaken by the SYB Commissioning Hub and also within NHS England and requested a pictorial representation of this to provide greater confidence of the arrangements.
The board received and noted the report from the Commissioning Committee
Chief executive’s report
Reference
Board public 24/03/17
Mr Lewis drew attention to four items within his report, which also included the regular update in respect of governors’ priorities.
Prior to introducing those he sought to address the two issues raised earlier in the meeting in relation to Oxevision and resuscitation. This had been brought up within this week’s care group delivery reviews. Those discussions had served to highlight the acknowledged disconnect between discussions, even longstanding ones, inside certain committee meetings, and delivery improvements locally. He felt that the delivery review structure from November was showing promise in closing that gap.
He noted that November 2023, it was agreed that a February audit would be undertaken of the Oxevision tool and specifically the consent by patients to its use. The resulting audit showed only moderate compliance in North Lincolnshire and very low compliance in the other localities. Over the coming weeks a daily focus to make improvements would take place. Should this not result in a better position being achieved the system would be turned off as a default, and only switched on once consent had been expressly received on a patient-by-patient basis.
Responding to Mrs Leese’s comment about staff behaviours and leverage to ensure “must do” tasks are completed, Mr Lewis referred to the focus provided within delivery reviews, but more importantly the intent to introduce real-time data and visual management to better support teams to identify missed tasks and to respond promptly. The importance of medical and clinical leadership across services was noted.
In response to Ms Fulton Tindall’s comment that the “lack of recording” had continued to be an excuse when there was a structural issue with data, Mr Lewis agreed, however, he noted that there had been areas of success within the IQPR. Mr Chillery confirmed that this continued as work in progress, but already more focus and accountability.
Mr Shannahan suggested a way of achieving “more” was rooted in actually asking for “less” and sought to understand how this concept might support the delivery of the promises. In response to Mr Shannahan’s example of the number of training courses Mr Lewis informed of specific review planned to reduce MAST and core training time, that was scheduled to be submitted for CLE for approval in May and that the director of people and OD had agreed to hold more localised training for teams. Mr Lewis referenced the new IQPR as an example of how Mr Shannahan’s concept was working with ‘more’ progress being made on the more refined and defined suite of indicators.
Mr Lewis agreed to update on both items at the next board meeting.
Mr Lewis then referred members to the recently issued national planning guidance which contained priorities consistent with trust priorities. It also referenced productivity, something that the board had previously discussed back in November 2023. Mr Lewis noted the ICB was funding and supporting the MHLDA collaboration with a piece of work on productivity over next six months.
Mr Lewis was encouraged by recent improvement in children or young peoples’ waiting times, reducing from 82 to 43 people who had waited several months in Rotherham. He expressed thanks to Kate Jones and the wider team. He anticipated that by July the trust would not have any children waiting for more than a month, other than with neurodiversity services. This felt like a significant measure, and one consistent with promise 14.
Mr Lewis noted the variable progress made on governors’ priorities and his intent to reflect on how best to address this, with Mr Forsyth’s input likely to benefit the progress of some actions, many of which related to strategic objective one. He highlighted in particular a lack of progress on our ability to signpost people towards agreed and validated digital advice for people experiencing mental health difficulties.
The staff survey had been circulated to all trust employees and shared in other forums with non-executive directors. Mr Lewis noted significant concern in relation to the WRES data and the experiences of discrimination. In 2022 9% of colleagues reported this in respect of their line manager, and this had leapt to 20%. Much more scrutiny was needed during April to understand the underlying issues and solutions. Engagement with the REACH network was essential. The people and OD committee were requested to receive a report at its June committee on this topic and Mr Lewis recommended the inclusion of additional information drawn from sources such as FTSU, PSIRF and trade unions.
Mr Lewis, responding to Mrs Leese, informed that where services received additional funds, some of which were highlighted in his report, the delivery of a set of agreed outcomes would be required. He would soon be discussing at executive group, the trust’s approach to benchmarking data deployment to manage improvements. He also highlighted the paragraph within his report which confirmed the use of outcome measures within a delivery-based approach was resulting in gains and progress.
The board received and noted the chief executive’s report and the forward actions it contained.
Action
TL and CH.
NHS professionals proposal
Reference
Board public 24/03/18.
Mrs Lavery noted that this item was returning having not been agreed in January. She highlighted her intention to ask board members to vote on the proposal at the conclusion of the item, given the extreme seriousness of the potential transfer of several hundred employees, some of whom had dialled into the meeting.
Ms McIntosh presented the updated proposal to move the trust’s bank provision to NHS Professionals (NHSP). Her paper set out why this option was preferred. It also described the need for a TUPE process to take place. Ms McIntosh stated that whilst employed via NHS Professionals, it was imperative that staff that working flexibility, including those on the bank, had a sense of belonging and integration with the substantive workforce. She also highlighted the intent by the trust to fund training for NHSP workers who undertook shifts with RDASH.
Responding to Mr Lewis’s question about the choice of the more expensive option, Ms McIntosh highlighted a key reason as the lack of staff and expertise currently within the trust to support bank arrangements across all geographical areas 24 hours a day, 7 days a week. Further, she noted NHSP’s not-for-profit status and its involvement in the health and social care system and support for the delivery of the NHS long term plan.
Mr Lewis referred to table 4.9 of the report which set out the terms and conditions of both TUPE transferred staff and any new enrollees. There was no apparent loss of contractual protections or status for transferred staff. In response to Mr Vallance’s query on pensions, Ms McIntosh confirmed that current staff would retain their pension under TUPE (as per Agenda for Change) with future, new recruits to NHSP on a different pension benefit. Mr Lewis sought clarification that any decision to change the pension rates within NHSP would not be initiated by the trust but would require Secretary of State approval. Ms McIntosh confirmed that to be correct.
Mr Shannahan noted the absence within the paper of defined benefits realisation information. Ms McIntosh confirmed that medical agency had moved over to NHS Professionals and an additional benefit had been identified through cost of locums. There were a number of agreed KPIs which, post implementation, would be monitored frequently. Ms Mcintosh confirmed that Mr Lewis and the director of people and OD would meet twice a year with NHSP and more frequently, there would be monthly meetings with NHS Professionals and that this was part of the implementation plan.
Mr Lewis highlighted the need for a shift in behaviours by managers and leaders, for example a move away from requests for specific staff to fill shifts. Rachel Kumar, Assistant Director of Nursing would be responsible over the next year to ensure changes in those working practices occurred.
Members recognised the need for a contract that included appropriate remedies if disputes or performance issues arose. Mr Lewis emphasised the need to pursue active dialogue, applying pressure where needed with NHSP before any reference was made to the strongest of remedies such as cancelling contracts. He also wanted to convey, with bank colleagues watching, the expectation that the transfer would be a success. He agreed to summarise key contractual terms for board members outside the meeting.
Mrs Lavery called for the indicated vote, and all voting board members indicated their support for the recommendations and the proposal as below:
The board agreed to contract during 2024 to 2025 with NHS Professionals, recognising the TUPE transfer that such a contract requires, as well as the new ways of working about allowing bank workers being part of RDaSH teams.
The board of directors asked the executive group, executive sponsor and chief executive to establish implementation arrangements as outlined and to escalate if necessary any elevated concerns to the board through routine management reporting.
Action
Draft finance, savings and capital plan 2024 to 2025
Reference
Board public 24/03/19.
With Mr Currell dialling in, it has been agreed Mr Lewis would present the draft finance, savings and capital plan 2024 to 2025 paper. Further work, internally and with ICB partners was required to finalise the plan which would then be presented to the board of directors in May 2024.
The paper set out an intended deficit of just over £3.6 million. However, there was an ICB expectation of meeting a deficit of £2.7 million. The trust had hoped to return in 2024 to 2025 to financial balance, but the expectation of taking a share of the convergence factor made that still more challenging. The draft plan has gone to £3.6 million consistent with this board’s prior decision that full funding needed to be provided for pay awards. Because such funds are handed out at 69% of turnover, but the trust has a pay bill closer to 83% of turnover, each time such awards are made the Trust has a further deficit added to its position.
Mr Lewis highlighted that the paper set out large scale savings to be achieved through broader, cross cutting actions and a small and consistent 0.5% cost saving target for all budgets and a consistent 2.5% vacancy factor. To enact the key area of reducing agency spend, new, strengthened controls would be implemented, which in part would require chief executive approval in some circumstances. Progress on reducing medical agency use, achieved by appointments to a number of vacancies, would continue, although it was perhaps unrealistic to expect to wholly eliminate medical agency spend without creating safety issues.
Mr Lewis noted the two-part approach to the capital plan approval, with a set of immediately identified schemes included in the paper presented (part A) to be supported by a second set, to be agreed once a six-week assessment of clinical safety risks was concluded. This would feature when the plan returned to the board of directors in May 2024.
The latest planning guidance required the submission of a final financial plan on 2 May, ahead of next board meeting in May. If the requirement from the centre remained better than a deficit of £3.6 million, Mr Lewis suggested the need to convene a meeting of the board; with time on the planned timeout session on 25 April the likely solution to facilitate this.
Mr Curell drew attention to the stated risks presented on page 86, that totalled £7.1m, noting the planned mitigation before the May board meeting. Today’s meeting was to review the draft plan in line with other trusts in the region.
Responding to a question from Mr Shannahan regarding a return to break-even in 2025/2026, Mr Lewis summarised that it would need new growth monies, the more meaningful full year effect of savings generated in 2024 to 2025 and a shift in commissioning contracts, such that volume became more influential in the income to the trust and afforded a necessary conversation about productivity, something that the board had already identified was necessary in November 2023. These actions coupled with a robust five-year approach to financial planning, would be needed to help achieve break even in 2025 to 2026.
Mr Shanahan drew attention to the cost pressures funded within the plan. Mr Lewis reminded the board of the process undertaken trust-wide since November. The PYE of these investments would be more modest than the figure cited (as the papers showed). These were each specific safety or quality improvement changes, many referenced within his CEO report. Mr Shanahan indicated that that was helpful clarity, and Mr Currell confirmed no unallocated contingency was contained within the draft plan.
Mrs Leese felt she did not feel sighted on the estates plan and capital spend in connection with it. Mr Lewis confirmed the capital plan had been phased to allow further safety and risk testing to take place. None of the proposals funded would proceed compromising the estate plan, the focus would be on core safety in 2024 to 2025.
She also noted that the Quality Committee had previously utilised the quality and safety impact assessment process to understand the impact of cross cutting programmes of savings work but had struggled to assess the cumulative impact of all such work across the trust. Mr Lewis responded, noting that the savings initiatives referenced in the report were much more precise and targeted than those undertaken in the previous year.
The board noted the draft finance, savings and capital plan 2024 to 2025 and supported the £3.6 million planned deficit. The board agreed to reconvene to discuss the matter further, should there be the need to amend that planned deficit in due course.
CQC preparedness briefing, effective domain
Reference
Board public 24/03/20.
Dr Graham presented the CQC preparedness briefing which focused on the effective domain and which included eight recommendations for the board to consider.
The report demonstrated a range of assurance methods in place against the CQC regulations for effectiveness, such as peer reviews, clinical audit, internal audit and the integrated quality performance report (IQPR). This also included the capture of feedback from those that use services and the report noted the focus on people involvement in service design, review and feedback, with further work planned to enhance this over the next year.
External sources of information were also utilised through the National Institute for Health and Care Excellence (NICE) guidelines, national benchmarking and triangulation with partners.
Mrs Lavery noted the important alignment of the clinical audit plan and Dr Graham reported that clinical audit results for 2023 to 2024 were received by the Quality Committee and that in 2024 to 2025 this would be part of the extended remit of the Audit Committee, who would receive the 2024 draft clinical audit plan in April.
Mr Shannahan complimented the simplicity of the paper and questioned how staff awareness could be improved across the trust. Dr Graham noted the use of effective communications and a collective understanding through clinical leads. Mr Banks highlighted the importance of sightedness and awareness through the corporate services.
With reference to care planning, Mr Lewis sought further understanding around the current position and the timescales for improvement. Dr Graham noted that care planning was part of the top 6 clinical audit areas, she also referenced the change in culture required to meet expectations in terms of improving people’s experience across their care journeys to ensure more personalised care, as well as the implementation of DIALOG+.
The board received the CQC preparedness briefing, effective domain and supported the eight recommendations included in the briefing.
Suicide prevention update
Reference
Board public 24/03/21.
Mrs Lavery provided a safety message to those present that some of the forthcoming discussion was potentially distressing and anyone not wishing to partake in discussions was supported. If additional support was required, this was available from Dr Tosh after the session.
Dr Tosh presented the suicide prevention update which provided an overview of deaths by suicide at RDaSH and detailed the ongoing workaround suicide prevention within RDaSH with partner agencies.
Dr Tosh noted the alignment of the trust’s suicide figures with national trends and posed two questions to the board:
- is a zero suicide target helpful or harmful?
- how can we better work with partners to prevent suicide?
Mrs Lavery referenced the work undertaken at NAViGO around an assessment tool for people potentially at risk of suicide and encouraged the trust to work with a range of partners to support preventing suicide.
Mrs Vickers supported the partnership approach and noted her recent visit with the Community Mental Health Transformation team and its work with local GPs.
Dr Jankowski spoke about the risk of people committing suicide and the management of the different acute pathways. Dr Tosh was in agreement and reflected on the contact that healthcare services had with patients at risk, such as general practitioners (GP) and the processes required to proactively identify this.
Dr Tosh suggested a target of zero was unachievable and potentially harmful. Mrs Leese noted the target was aligned to a range of wider principles and asked what evaluation work had been completed with respect to its impact. Mr Lewis commented that national evaluations were undertaken, however there was less meaningful evaluation undertaken of local findings.
Mr Lewis didn’t think it was the trust’s role launch a suicide intervention proposition for the population, however he suggested the trust may provide a contribution, via research, to the wider work. Mrs Lavery suggested that the consensus did not favour in the room an overt zero suicide commitment.
Mr Lewis reflected on the number of suicides of people within RDaSH services and the longer-term impact this had on staff and the trust’s duty of care to staff. Dr Graham stressing the importance of the trust putting in place sufficient and effective bereavement care and support.
The board received and agreed the recommendations in the suicide prevention update.
Clinical and operational strategy, strategic objective one, nurture partnerships with patients and citizens to support good health
Reference
Board public 24/03/22
Mr Lewis presented the update noting that the paper provided a space for the board to discuss the complexities and difficulties associated with implementing key promises. This was the second in a series of such papers, agreed when the strategy was adopted in July.
He highlighted the following key points:
- the need to ensure the right support is in place as we hugely increase the number of peer support workers across the organisation (promise 1)
- supporting unpaid carers in the community and among staff: we needed to be clear what in practice and at scale this meant (promise 2)
- the importance of hearing from the community of volunteers and effectively capturing patient feedback (promises 3 and 4)
- how we tested the effectiveness of our work to deliver promise 5, potentially through research work
Dr Graham was supportive of the paper and the concept, and noted the cultural changes required in order to work differently.
Mr Shannahan referred to patient feedback, recognising that hearing and responding to negative feedback was the most important in terms of making meaningful improvement.
Mr Gowland linked the discussion with the next agenda item relating to the board assurance framework, highlighting the challenges raised were reflected in the proposed strategic risks.
The board received and noted the report on clinical and operational strategy focused on strategic objective one.
Operating performance, governance, and risk management
Reference
Board public 24/03/23.
Board assurance framework
Mr Gowland presented the board assurance framework (BAF) update, noting that the approach for 2024 to 2025 was to align the identified strategic risks to the strategic objectives within the trust’s clinical and organisational strategy.
Facilitated sessions had been undertaken within the executive group to identify the key risks that were relevant to each objective, and these would be the focus of the BAF going forward. As the BAF was refreshed for 2024 to 2025, Mr Gowland noted the importance of remaining sighted on the previous strategic risks too. In terms of the management of the BAF, each risk would have a robust mitigation plan developed by a lead director and would be aligned to the appropriate committee, with an overarching view provided at the Audit Committee. Mr Gowland and Mrs Gillatt would meet during the year with the lead directors to review progress.
The strategic risks would be considered further at the board timeout in April 2024. Mr Chillery expressed the importance of the board exploring the trust’s risk appetite as part of the further discussions. Mr Lewis provided an explanation of strategic and operational risk, and agreed to further explore this at the board timeout in April 2024 to ensure there was consistent understanding before a final proposal came back to the board in May.
Mrs Leese and Mrs Gillatt, referring to risks which were non-specific to the strategic objectives, noted the potential for such to impact on the delivery of the strategic objectives, with a pursuit of an improved CQC rating and elements of basic, business as usual, as two examples.
The board received and noted the board assurance framework update.
Ms McIntosh left the meeting at 14.15.
On behalf of the board, Mrs Lavery expressed her thanks and appreciation to Ms McIntosh as it was her last board meeting as the director of people and organisational development.
Integrated quality performance report (IQPR) including finance report M11
Reference
Board public 24/03/24.
Mrs Lavery introduced the integrated quality performance report (IQPR) for February 2024, including the finance report for month 11.
The board recognised the achievement of three of the nationally mandated long term plan targets, perinatal mental health services, adults access mental health services, and people accessing CYP services, the board expressed its thanks to all the teams involved.
In terms of the finance report for month 11, Mr Lewis noted that the trust would conclude the year approximately £3 million ahead of plan. This represented a slightly reduced performance to previous estimates following a £600k adjustment.
The board received and noted the integrated quality performance report (IQPR) 29 February2024 including the M11 finance report.
Operational risk report
Reference
Board public 24/03/25.
Mr Gowland presented the operational risk report as at the 18 March 2024. Following moderation by the risk management group in March 2024, there was now one extreme rated risk relating to patient flow and the number of out of area beds. Mr Chillery noted the comprehensive work programme that was planned to mitigate the risk by focusing on the complete pathway. Given the related complexities, he noted that likely longevity of this as a risk.
As part of the new operating model, the Audit Committee would continue to receive reports on the delivery and implementation of the risk management framework as part of the system of internal control oversight. The risk management group was the key operational forum for discussing risk, and risk management would also feature within the monthly delivery review process with care groups and corporate services. The board of directors would however continue to be sighted on any extreme rated risks.
Mr Lewis queried whether the term extreme risks was helpful. He noted that historically the trust’s risks seemed to be largely 12 or below and highlighted his expectation of far more 15 rated risks in the near future. Mr Gowland felt the term should be retained.
The board received and noted the operational risk report.
South Yorkshire mental health, learning disabilities and autism provider collaborative, joint working agreement and terms of reference
Reference
Board public 24/01/26.
Mr Lewis presented the South Yorkshire mental health, learning disabilities and autism provider collaborative, joint working agreement and terms of reference, which outlined the changes made following the collaborative board discussion in January 2024 around the future relationship between the current specialised commissioning governance arrangements and the board of the SY MHLDA PC.
The board agreed the amendments proposed to the terms of reference and joint working arrangements described within the paper.
Supporting papers (previously presented at committees)
Supporting papers
Reference
Board public 24/03/27.
Mrs Lavery informed the board of the following additional reports for information which were presented as supporting papers that had previously been presented at committee level for scrutiny and challenge:
- Mortality quarterly report (November to December 2023 Data)
- Guardian of safe working hours report (1 October 2023 to 31 January 2024 Data)
The following report had already been considered, though listed here.
- Safe Staffing Annual Declaration 2023 to 2024
- Elimination of Mixed Sex Accommodation (EMSA) Annual Declaration
Responding to a question from Mr Lewis, Dr Graham clarified that all psychiatric inpatient care is being provided on the wards had single ensuite bedrooms. For those wards that did not have ensuite facilities (in physical health), clear guidance was provided for the care of patients to ensure that no breach occurred and that patients’ privacy and dignity was maintained. She was clear in her advice that the trust complied with the regulations and the board agreed with this advice.
The board received and noted the additional reports for information.
Any other urgent business
Reference
Board public 24/03/28.
There was no further business raised.
Chair’s summary (actions, decisions, and new risks)
Reference
Board public 24/03/29.
Mrs Lavery gave a brief overview of discussions from the meeting in particular the staff story on preceptorships, gender pay gap, risk reporting, CQC report on Effective domain, suicide prevention, NHSP and risk management framework.
Public questions
Reference
Board public 24/03/30.
There were no questions raised by members of the public.
Resolve
Reference
Board public 24/03/31.
The chair resolved “that because publicity would be prejudicial to the public interest by reason of the confidential nature of the business to be transacted, the public and press would be excluded from the remainder of the meeting, which would conclude in private.”
Next meeting
To be held on Thursday, 30 May 2024.
Page last reviewed: November 18, 2024
Next review due: November 18, 2025
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