Agenda item

Dean Howells and Simon Africanus-Rowe, Camden and Islington Mental Health Foundation Trust were present for discussion of this item, and made a presentation to the Committee, a copy of which is interleaved

During discussion of this item the following main points were made –

·         The key focus of the Trust is the safety and quality of care delivered – key domains – Patient safety, Clinical Effectiveness, Patient Experience

·         Patient Safety Priority 1– an overall trend on the number of incidents suggests continuing reduction. The proportion of restraints that are prone restraints are being kept to a minimum. The use of seclusion continues to decline, and demonstrates the Trust is achieving least restrictive practice in this area

·         It is recognised that sustainability is a key factor to the longer term success of this intervention. Further progress on this priority will be monitored through the Safe Wards project, and Positive and Proactive Air Group as priorities in 2019/20

·         Patient Safety Priority 2 – Provide comprehensive risk – a randomised audit  was undertaken between December 2019-January 2019 – evidence of timely risk assessments and risk formulation. The scores range from 80% to 100%. A rapid inpatient enquiry conducted in February 2019, following a serious incident, highlighted inconsistencies in recording risk assessment on EPR and populating care plans. The Task and Finish Group has achieved initial policy review, and identified documentation and training requirements, and is aligning this work with an STP-wide suicide prevention initiative

·         Patient Safety Priority 3 – Ensure mandatory targets are achieved – overall core skills compliance has reached 88>9%, which is higher than at any point in the last 12 months. CPR and Information Governance remain below the required levels. Weekly reporting has been introduced. Trajectories will form part of this reporting, in order to highlight any issues, and manage supply and demand for face to face programmes. Commissioning of courses will aim to flatten spikes caused by periods of concentrated high demand

·         Clinical Effectiveness Priority 4 – Engage service users/staff in suicide prevention strategies. A risk assessment and suicide prevention group established. This works in collaboration with the Public Health Crisis Concordat. Local strategy implementation delayed due to the complexity in having a local strategy while at the same time working with other stakeholders

·         Clinical Effectiveness Priority 5 – Better involvement of service users in developing and reviewing their care plans. Randomised documentation audit – care plans are co-produced, services users are receiving copies of their care plans, physical care needs are identified and care plans are up to date. The scores for these indicators range from 78% to 95%

·         Clinical Effectiveness Priority 6 – Improving Physical Health – Physical health screening is now embedded, and training covers a wide range of physical interventions. The Physical and Healthwellbeing policy has been comprehensively revised, and is ready for relaunch is June 2019

·         Patient Experience – Priority 7 – Learning from Deaths and serious incidents – Learning from Deaths policy embedded. Trust Mortality Review Group meets on a weekly basis to review all deaths, and it is standard procedure for investigators to approach family and friends and carers, at the outset of an investigation to ascertain their views on care, and to contribute to the investigations terms of reference

·         Patient Experience Priority 8 – Improved communication with carers and families. There are variations in recording next of kin details on EPR, and a randomised audit suggests the range is 36%-100%, in different teams, of patients next of kin details recorded. Feedback is requested from carers and families and the feedback received is positive. The Trust will continue to routinely audit the recording of next of kin details to ensure staff are alerted to gaps in the service

·         Patient Experience Priority 9- Involve service users in the Trust’s Quality Improvement Programme. The QI hub has provided 2 hour training sessions for service users at their forum meetings. Feedback received is positive

·         Improvements in Core Performance Indicators NHSI single assessment framework targets and patient experience indicators. CQUIN – Trust met 3 of the targets, partially met 7 of the targets, and did not meet 2 of the targets, (health and wellbeing of staff, and uptake of flu vaccinations for frontline staff), and increase level of research and audit activities

·         Other achievements include – unannounced inspection of Stacey Street Nursing Home, which provides nursing care to older adults with dementia and long term mental health difficulties rated GOOD. Recovery College continues to offer public courses on mental health and wellbeing. Mental Health matters events are organised informally on a quarterly basis, for service users and staff to discuss issues related to mental health, and public can also attend

·         Summary – significant improvements have been made, and new priorities have been set for 2019/20. The focus will be on reviewing the Clinical Strategy, and embedding cultural pillars, and to continue to ensure that service users/families are central to everything the Trust does

·         The Trust will continue to promote diversity and inclusion and is a learning organisation

·         In response to a question as to the breakdown of the number of BAME accessing IAPT it was stated that this information would be provided to the Committee by the Trust

·         It was stated that in relation to staff wellbeing, the Trust were responding in a more positive manner, and a risk amnesty had been instituted in order for staff to raise issues of concern. The Trust stated that they would provide details to the Committee of how this is progressing

·         In response to a statement Members were informed that in relation to the level of harm experienced, most deaths occurred in the community, and there needed to be better engagement with other health providers in NC London in this regard in future

·         In response to a question, it was stated that the Trust did not have a high staff turnover, compared to nationally. A new HR Director had recently been appointed, and a new wellbeing strategy is being considered by the Trust Board

·         In relation to incidents that have occurred the Trust needed to learn lessons from these

·         Reference was made to the incidence of bullying/harassment which had been a problem that had been highlighted in past reports to the Committee. The Trust stated that it needed to focus on addressing morale in certain teams, and that this needed to be improved. Providers in London faced a number of challenges, and there is a need to bring teams together

·         In relation to BAME staff, the Trust had enabled staff to be more open about reporting issues, and there is now also women’s, disability and LGTB groups where issues can be raised and discussed openly. There is a commitment both at the Trust Board and Governors Committee to improve the situation

·         In response to a question concerning the Transformation programme, it is felt that this will have a significant long term impact and the alliance with BEH, will give a more strategic vision of mental health across the area. In addition, the transfer of services to the Whittington site will improve the environment for both staff and patients

·         The Trust informed Members that they recognised and were committed to giving service users ‘more of a voice’, and that they should be at the forefront of improving and developing services. There is also a need to increase the number of service users involved

·         It was noted that the Trust had a large number of volunteers, and more supported training would be provided. In addition, peer support workers will be provided in teams

The Chair thanked Simon Rowe and Dean Howells for attending