Chief Operating Officer s Report. Public Board Meeting

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Title: Chief Operating Officer’s Report

Report to: Trust Board

Date: 31 March 2014

Security Classification: Public Board Meeting Purpose of Report:

This is a regular report to update the Board on Trust operational matters. The report is to inform and update the Board on the progress of key operational issues across the Service Lines, Estates and Facilities, and Organisational Development.


The Trust Board is asked to note progress made over the period January – March 2014

Report Sponsor: Lee Bojtor, Chief Operating Officer

Report Author: Name: Lee Bojtor

Title: Chief Operating Officer Tel Number: 020 8702 3027

E-mail: Report History: Regular Report

Budgetary, Financial / Resource Implications:


Equality and Diversity Implications:

Equality and Diversity features in how we plan and deliver services.

Links to the Trust’s Objectives, Board

Assurance Framework and / or Corporate Risk Register

Links to the Board Assurance Framework summary (Trust Board agenda item) are indicated where relevant in the attached report.

List of Appendices:  None.


Report 1. Crisis and Emergency Service Line




Service Transformation and Re-design Project up-date

It has been three months since the implementation of the new CRHT and Triage services. Quality is being measured currently through:

 Patient experience questionnaires  GP feedback

 Service User & Carer feedback

 Quality Assurance (deep dive meetings)

 Patient Reported Outcome Measures (PROMs)  SUI’s & complaints

 Datix reports

Meetings are taking place to monitor the impact of the service: 1. Individual and tri-borough service user groups

2. Local clinical governance meetings in each team 3. Senior management team daily telephone-conferences 4. Weekly Service Managers/AD meetings

5. Monthly Operational Steering Group on-going Initial Findings include:

There has been a substantial increase in referrals to CRHT; referrals for Triage service are mainly routed through from the CRHT. There needs to be a review of referral prioritisation practice, senior clinical involvement in CRHT triage is needed. We have increased

engagement with GP’s relating to identifying crisis versus routine referrals and further education of the GP’s is required. Response times within 4 hours are above 97% (manual audit Dec 13). Self-referrals direct to Crisis teams has increased and community orientated assessments are being facilitated. Senior clinicians out of hours are co-located based in a communal hub at Chase Farm hospital in response to reviewing out of hours activity. Issues of delay awaiting service line allocation for treatment following Triage assessment has been highlighted as an issue. The new Band 8a for Enfield has commenced in post. The Haringey 8a CRHT manager takes up post in a month.

Crisis and Emergency Bed Management

Demand for inpatient beds continues to exceed the current capacity within the Trust. Operational Actions to address bed management continues:

 Twice daily bed capacity conference call implemented to pro-actively address capacity status.

 Code back meetings chaired by the COO with all service line attendance (minutes recorded).

 Additional JONAH meeting (clinical review) at 1.00 p.m. to assertively review and manage patient transfers/discharge status throughout the day.

 Daily issues log (service users in delay) updated at each capacity conference call with named staff allocated to actions.

 Summary report completed on the patients in B&B to examine length of stay and delays.

 Length of stays on inpatient beds being reviewed, focusing on all patients who have been in hospital for in excess of 28 days and require a second opinion.


2. Dementia and Cognitive Impairment Service Line 2.1



Rapid Assessment, Interface and Discharge (RAID) Liaison Psychiatry Services at North Middlesex University Hospital (NMUH) and Barnet Hospital

Both of these multi-disciplinary teams, which provide mental health liaison services to the wards and emergency departments within these two local acute hospitals, have

experienced a steady and continuous increase in activity since full implementation in January. With the initial implementation phase almost complete, regular governance and interface meetings will start from April. It is proposed that the Barnet team increase to a full 24 hour RAID model based on the activity patterns and anticipated need in delivering the most impactful service.

To help improve outcomes for the considerable proportion of people in these hospitals who are suffering some form of treatable mental distress, the teams are delivering some

informal awareness raising and teaching as well as a comprehensive formal rolling training package on relevant aspects of mental health care will be delivered to all acute hospital staff from April 2014.

The teams provide a vital role in supporting the acute hospitals meet their four hourly waiting targets and implementation elsewhere has proved to deliver considerable benefits to the wider health economy. Activity and performance targets have been agreed and the comprehensive Dashboard reports will be populated from April.

The Enfield Memory Service, successful in its application for capital funding to the NHS/Kings fund scheme ‘Improving the environment of care for people with dementia’, currently has the builders on site. The works are due to be completed by the end of March 2014 following which multi-agency planning will move into its next phase.

The aim of the project is to develop a dementia resource in the Warwick Centre, Chase Farm Hospital site, which can serve as a ‘dementia hub’ for the people of Enfield,

supporting a multi-agency and collaborative approach to caring for people with dementia and their family carers. The newly refurbished space, partly redecorated to provide more colour, contrast and interest, will support the development of a wide range of services and activities within the building. These will include:

 Memory assessment and diagnostic service  Cognitive Stimulation Group Therapy

 Other agencies (Alzheimer’s Society, Social Services and Age UK) for advice or as part of combined approaches

 A new ‘dementia cafe’ network for Enfield with an open cafe-style space that will provide a supportive space for people with dementia and their carers

 A patient and carer loans library for texts on dementia and a book exchange function  A rolling carers education programme that will involve running an 8-12 week course for

carers at least twice per year

 Multi-media equipment for training, social events and film clubs  Improved underutilised garden space for use by patients and visitors Inpatient Services Improvement Group (ISIG)

The Dementia & Cognitive Impairment service line’s multi-disciplinary Inpatient Services Improvement Group (ISIG) has continued to meet and plan the necessary work in response to CQC’s concerns regarding compliance with the Mental Capacity Act and record keeping. Internal audits indicate substantial improvements across the four inpatient areas in relation to the compliance actions required by CQC and ISIG has provided an updated action plan and comprehensive evidence log with a view to indicating to CQC that we are ready for a re-inspection.


3. Severe and Complex Non Psychotic Service Line 3.1 3.2 3.3 3.4 3.5 Eating Disorders

The Eating Disorder service will be moving to a new service line in June 2014 as part of the changes for specialist services.

Complex Care services

Barnet CCG have informed the Trust that they will not be expanding the Personality Disorder Provision but will continue to commission the 12 places that were part of the interim arrangement. The service continues to inform the commissioners of the pressures in regard to specialist treatment and forward the waiting list currently 33 cases.

Substance misuse

DASH are preparing for the move to the Bruce Grove premises this has been held up because of IT issues that need upgrade by Virgin Media.

IAPT Barnet

The service is working towards the Tender of Barnet IAPT but there need to be a full risk assessment as the financials do not appear to be sufficient to run the service adequately. The Trust is working closely with Whittington Health on this.

Beacon Centre

The service continues to work closely to the Action Plan which has been previously approved by NHS England.

Recruitment for substantive nursing staff is on-going with good progress being made, although we have had to mitigate for the departure of one substantive consultant, and the long term sickness absence of the other substantive consultant, through the utilisation of a locum consultant.

As a result of the above, bed capacity is capped at 12, with the agreement of NHS England, to ensure optimal patient safety whilst working with one consultant.

Indications from contract discussions with NHS England for 14/15 thus far suggest that the Beacon Centre will be contracted to provide acute care and treatment for 15 adolescent patients, with no high dependency beds (HDU) commissioned. The HDU provision issue will be subject to review and further discussion during 14/15.

Service Line Transition arrangements from SCNP to the Specialist Services service line are in place and currently on-going.

5. Enfield Community Services 5.1 Children’s services

Young parents project has been de-commissioned by the Children’s Centres

The 3 staff currently working in it will be re-deployed into permanent posts either in the HV service or in Family Nurse Partnership (FNP).

The HV service will continue to maintain strong links with Partner agencies for the young parents’ pathway.





Family Nurse Partnership

Staff involved in this service attended the National Conference that was held in Birmingham on March 5. The Team continues to enrol young parents at the expected trajectory rate.

District Nursing

The standard establishment for District Nurses has been recruited to.

Four posts have been recruited into the Enhanced service for which additional funding was received. With the help of Specialist recruitment advice and a worker we will continue to build on this success in the coming months to recruit more staff into the enhanced service developing rotational post internally with Magnolia Unit and ICT. We are hoping this approach will encourage more people to apply in the knowledge they will be getting an opportunity to develop skills in a number of areas that help them in their careers for the future.

ECS Tender Update

The Trust have been notified that there will be an Information Event for the tendering of Enfield Community Services on Tuesday 25March 13.30-15.30 p.m. The advertisement for the Tender will go out on the 21 April 2014.

6. Forensic Service Line 6.1




HMP Brixton and HMP Pentonville

The contract start date has been extended to May 1 to allow for recruitment and the necessary authorisations. The staff consultation has started and to date everything is operating to time according to the project plan.

HMYOI Aylesbury

The service design phase starts in April with service start date in July. Preparation work for this has already begun with the refurbishment of a disused unit, which will act as the treatment centre for the service.

Court and Police Liaison/Diversion Service

The London press launch for the pilot is to be hosted by the Trust in Haringey. Lord Adebowale plus other senior figures from NHS England and the Met Police will be in attendance. The Pilot will incorporate staff from the Forensic and CAMHS service and will seek to develop pathways that both reduce offending and health inequalities.


FTAC has won the Excellence in Policing Award 2014 for Diversity. The award recognises a joint policing and NHS approach to assess threat to prominent people from people suffering from mental disorders. The award acknowledges that as a result of the work of FTAC, appropriate services are identified, providing alternative care pathway to the Criminal justice.


7. Estates and Facilities 7.1 7.2 7.3 7.3.1 7.3.2 7.3.3 7.3.4 7.3.5 7.3.6

Following the TDA request to have a more detailed understanding of the current plans for the St Ann’s redevelopment and a view of other potential options, a number of short, medium and long term estates scenarios have been developed which are now undergoing financial assessment and review of feasibility.

Soft Facilities Management – Chase Farm Hospital

Barnet and Chase Farm Hospital and BEHMHT have agreed to a tendering program for Soft FM services, with the view to start a new contract on the 1 November 2014.

The OJEU contract notice/advert for the Soft FM services was issued on the 24January and closed on the 27February. Expressions of interest were received from 32 companies and evaluation through the PQQ’s is being processed. Both Trusts BEHMHT and B&CFHT have completed their service specifications as per the tender programme in order to

issue the ITT documentation to potential bidders’ week commencing 17March. Hard FM

Sliver Birches (DCI, CFH) – The replacement of windows on Silver Birches will be finished by April 2014.

Sage Ward (NLFS, CFH) – Decoration works have commenced and should complete in April depending on access arrangements with the clinicians

Warwick Centre (DCI, CFH) – Alterations to create a new dementia hub within The Elms unit of Warwick will be completed the end of March 2014.

The Oaks (DCI, CFH) – A minor refurbishment to include the creation of a six bed higher dependency unit and a refurbishment of the entrance/reception area will be completed by the end of March 2014.

Suffolk/Dorset Wards (C&E, CFH) – Tenders were returned significantly in excess of the estimate. The scope is now being re-evaluated and funding has been deferred to 2014/15 Mint Ward (NLFS, CFH) – Conversion of a bathroom to a shower room will be complete next week.

Implications 4. Budgetary / Financial Implications

4.1 There are no budgetary / financial implications as a direct result of this report. 5. Risk Management

5.1 There are no risk management implications as a direct result of this report. 6. Equality and Diversity Implications

6.1 None. Ends.