About the Trust - DWMH NHS · 3.4 Valuing Diversity 3.5 Other Partnerships 4. Our Board and...
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E:AR 2010 v4 1
Transcript of About the Trust - DWMH NHS · 3.4 Valuing Diversity 3.5 Other Partnerships 4. Our Board and...
E:AR 2010 v4 1
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Content 1. Introduction
1.1 Chair and Chief Executive’s Foreword
1.2 About the Trust
1.3 Our Vision and Values
2. Services and Quality
2.1 Service Overview
2.2 Our Success and Highlights
2.3 Raising the Quality of our Services
3. People and Relationships
3.1 Involving and Listening to You
3.2 Service Improvements following Staff/Patient Surveys
3.3 Our Staff
3.4 Valuing Diversity
3.5 Other Partnerships
4. Our Board and Committees
4.1 Who sits on the Board
4.2 Board and Committees
5. Performance
5.1 Managing Trust Performance
5.2 Measuring the Standards of Our Services
5.3 Performance Highlights of 2011/12
5.4 Managing the Quality and Standards of Our Services
5.5 Planning for the Unexpected
5.6 Environmental Footprint
6. Our Finances
6.1 Financial Targets
6.2 Financial Trends and Forecasts
6.3 Where Does the Trust’s Income Come From?
6.4 How is the Trust’s Money Spent?
6.5 Capital Expenditure
6.6 Summary Financial Statements
6.7 External Audit Services
6.8 Statement of Chief Executives Responsibilities as the Accountable Officer of the Trust
6.9 Remuneration Report
6.10 Annual Governance Statement
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7. Current Priorities
7.1 Challenging Times
7.2 Transforming Our Services
7.3 Foundation Trust Progress
8. Glossary
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1. Introduction
1.1 Chair’s and Chief Executive’s Foreword
Welcome to the fourth annual report from Dudley and Walsall Mental Health Partnership NHS Trust. We are proud to say that this year has been yet another significant and successful year for the Trust as we continue to develop and strengthen the services we provide. Over the past twelve months we have also progressed with our plans to transform services and implement our new service model as well as make great strides in pushing forward with our application to become a Foundation Trust. Year one of our service transformation plans went ahead as planned although we actively decided to slow down some areas of the planned programme to ensure a cohesive and non-disruptive launch. In 2011/12 the Trust implemented the new model for community services including the successful launch of the Transition and Transfer Team, the consolidation of Community Mental Health Team’s into two Community Recovery Services and the launch of the new Early Access Services that will in 2012/13 provide a single point of access for referrals into secondary care. Over the past twelve months we have successfully completed a number of reviews, assessments and challenges towards our application to become a Foundation Trust (FT). The Trust is delighted to announce that our Foundation Trust application has received approval from the Secretary of State meaning the Trust’s application will now move into the final stage of the application process where we will be reviewed by Monitor (an independent regulator of Foundation Trusts) The Trust has also recruited over six thousand members and generated interest from over two hundred people in becoming Governors of the Trust and helping to support and shape mental health services for the communities of Dudley and Walsall.
We are proud to say that the dedication, flexibility and resilience of staff coupled with strong vibrant leadership, has allowed the Trust to successfully progress with these two programmes of work simultaneously whilst continuing to provide high quality services throughout. There will undoubtedly be further changes and hard work needed during 2012/13 as the Trust approaches the milestone of achieving Foundation Trust Status and the second year of Service Transformation kicks into gear, however we are confident that the commitment and successes of last year will continue into 2012/13.
It gives us great pleasure to present this Annual Report which outlines many of the Trust’s successes and achievements over the last twelve months. We would like to thank everyone who has worked with the Trust in over the past year for their hard work, dedication and support throughout this challenging year. We look forward to working with our members and other stakeholders over the coming year to build on these successes continue to provide services which reflect ‘better together’.
Glyn Shaw – Chair Gary Graham – Chief Executive
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1.2 About the Trust Dudley and Walsall Mental Health Partnership NHS Trust was established in October 2008. It provides a comprehensive range of mental health care with areas of expertise including child and adolescent services, crisis resolution and psychological therapies. We serve a population of approximately 306,600 in Dudley and 255,900 in Walsall, providing core mental health and social care services from 37 locations across the two boroughs and also to neighbouring Trust’s in Worcestershire, Staffordshire, Birmingham and Warwickshire. In addition to clinical services, the Trust provides Human Resources, Payroll and Occupational Health services to local businesses and other NHS Trusts. In the past three years the Trust has established itself as a provider of high quality, safe and effective mental health services for the populations of Dudley and Walsall. This is evidenced by unconditional Care Quality Commission (CQC) registration, NHS Litigation Authority (NHSLA) compliance, Accreditation for Inpatient Mental Health Services (AIMS) and successful performance in a variety of regional and local quality, safety and governance assessments.
1.3 Our Vision and Values
Our Vision
Our Values
The Trust aims to provide high quality, evidence-based mental health services that meet the needs of local communities. We have established a future strategy that will explore opportunities to deliver more services locally and consistently across the local health economy. This strategy supports local objectives as well as national directives and will enable the Trust to secure long term viability. A small but ambitious organisation, the Trust aims to become a high performing Mental Health Foundation Trust with a brand and reputation for excellence. We intend to achieve this through our plans for service transformation to improve the quality of care and experience of patients, as well as fostering efficiency in an economically challenging time.
Better Together - delivering flexible, high-quality, evidence-based services to
enable people to achieve recovery.
Respect and dignity
Commitment to quality of care
Compassion
Improving lives
Everyone counts
Working together for patients.
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2. Services and Quality
2.1 Service Overview Dudley and Walsall Mental Health Partnership NHS Trust provide a full range of mental health treatment and rehabilitation services that manage both “common mental health problems” and “severe and enduring mental health problems”. The main services provided are: Community and inpatient mental health services for adults of working age and Older People.
Health-provided Child and Adolescent Mental Health Services (CAMHS).
National Deaf Child and Adolescent Mental Health Service
Substance Misuse Services in Walsall.
Psychology services
Mental Health social care services which are managed by the Trust on behalf of the Local
Authorities.
Enhanced Primary Care Services
2.2 Our Success and Highlights Throughout the last twelve months we have continued to focus on maintaining the delivery of high quality services and we have celebrated some key achievements which include:
The launch of a new and improved service model within Adult Community Services across Dudley and Walsall.
The introduction of a dedicated Service Experience Desk as the central point of contact for all public concerns and enquiries about services. The Desk was formed following the merger of the PALs and Complaints Departments and offers a way for service users, carers and members of the public to find out more information or to have their say about care they have received
The launch of the PRIDE campaign – a campaign to give all nurses the opportunity to renew their pledge to deliver high-quality, compassionate care and take PRIDE in all they say and do. The PRIDE message highlighted the values and actions delivered by nurses: Professional, Respect, Innovation, Dignity & Effective.
2.3 Raising the Quality of Our Services A fundamental part of our vision is that we will improve and develop services based on feedback from people who use them and this is a key part of our complaints procedure. In June 2011 we set up a new Service Experience Desk (SED) which offers a single point of contact for all complaints, compliments, concerns and enquiries. SED can be contacted by phone, post, e-mail and online and its primary functions are to:
Provide information about mental health conditions and services
Signpost to specialist services or other organisations
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Listen to concerns, comments, compliments and suggestions
Help solve problems that need quick resolution
Manage complaints made about the Trust The introduction of SED has resulted in a 25% reduction in formal complaints compared to 2010/11, achieved through a more proactive approach to complaints handling and offering service users and carers the opportunity to resolve their concerns speedily.
Figure 1: Compliments and Complaints 2011/12 YTD
Despite our focus on quality, we recognise that sometimes people’s experience of our services is not always as positive as we would hope. In October 2007, the Health Service Ombudsman published ‘Principles for Remedy’ as an overall good practice guide for public bodies in dealing with complaints. Our complaints policy is based around these principles which are:
1. Getting it right 2. Being customer focused 3. Being open and accountable 4. Acting fairly and proportionately 5. Putting things right 6. Seeking continuous improvement
During the period April 2011 to March 2012, we received a total of 79 formal complaints. Of these, we responded to 45 within the target; 13 more are still open cases and remain within this target at the time of writing. The number of complaints received is relatively small compared to the number of patients we see and treat each year. Over the last twelve months we are pleased to say we have received 214 written compliments from people who have accessed our services, highlighting cases where the quality of our services has been recognised and appreciated.
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Improvements in Patient/Carer Information During 2011/12, the Trust reviewed the quality of information available for service users and their carers/families. Working with the Trust’s Service User and Carer Reference Group helped to identify a number of areas as needing improvement – Substance Misuse Services, Ward Hospital Packs and Primary Care as examples. The Trust has already produced new information for the wards, which have been developed in partnership with service users and carers’ Work is now underway to refresh leaflets, posters and information cards which can be found within the community settings to ensure service users and carers’ have access to the latest, easy-to-read literature. The information will continue to evolve as the Trust moves forward with its Service Transformation agenda and develops the care and treatment available to service users.
3. People and Relationships
3.1 Involving and Listening to You
As a provider of services, we are committed to ensuring that representatives of those people who use our services and their carers are fully integrated within our decision-making and governance structures. On a day-to-day basis, we work closely with a wide range of Service User and Carer organisations across the two boroughs, seeking their views and ensuring their participation in the planning and delivery of services. Patient knowledge and experience are essential for understanding how best to improve care. The very best user and carer involvement harnesses a passion for making things better and over the past year, we have made enormous progress with implementing and expanding its own involvement strategy. Experts by Experience (EBE) - An EBE is an expert volunteer who uses their experiences of mental health services, as a service user or a carer of someone with mental health problems, to influence the delivery and quality of services we provide. They also help represent the interests and views of other local service users and carers and promote involvement opportunities within the Trust. Our Members – We have now successfully recruited and retained over 6000 members. By continuously engaging and involving our members we are becoming more accountable to our service users, carers, staff and the general public and can offer local people the opportunity to have a more direct influence on the way the Trust operates and develops. Trust Board - We openly encourage all service users and carers to attend the open section of our bi-monthly Board meetings, where they are free to ask questions about the running of the Trust.
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Service User and Carer Reference Group - The Trust runs a bi-monthly service user & carer reference group, which is open to all service users and carers in Dudley and Walsall and provides an opportunity for people to express their views on our services. Policy Working Group - The Trust holds a regular policy working group, on which it has service user and carer representation. This allows service users and carers to give their views on the content of draft policies being developed by the Trust. Learning & Development - We involve service users and carers in the delivery of staff training so employees will have an understanding of the people they are serving from day one. Recruitment and Selection - Our recruitment and selection policy ensures that service users and carers are involved in the appointment of staff where it is relevant to do so. We also continue to work closely with local service user and carer groups including Support Association for Mental Health in Dudley (SAMh), Walsall’s Service Users Empowerment (SUE), Dudley’s Carers in Partnership and the Walsall Carers Network. Our commitment to putting service users and carers at the heart of everything we do is demonstrated by the way that service user and carer involvement is taken into consideration at the forefront of new projects, initiatives and developments. We try to focus on the things that matter the most for patients, communities and staff and emphasise a culture of genuine engagement, involvement and transparency.
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3.2 Service Improvements following Staff/Patient Surveys Feedback from Service Users and Carers Over the past twelve months our eight EBEs have been significantly involved in raising awareness of Trust activities and gaining valuable feedback from service users and carers. We have also gained essential and valuable feedback via informal concerns and comments from the Service Experience Desk, patient surveys and the electronic patient experience trackers. Here are just a few of the selected actions that have been carried out as a result of feedback from those who use our services, their relatives and carers: Figure 2: Comments and Actions Taken Feedback from Staff All staff are actively encouraged to participate in the national NHS staff survey; as such, the Trust has seen its response rate exceed national averages, with a response rate of 62% in 2011. Staff feedback is crucial as it allows the Trust to celebrate the areas where it is performing well and to target areas for improvement. A great deal of work has taken place in order to ensure that staff experience of working within the Trust is positive. A Staff Survey Action Group was formed in early 2010. The membership of this group consists of staff Communications Champions and staff side colleagues to act as ambassadors for the staff survey within their own directorates and to assist senior managers in driving forward
During ‘protected meal times’, visitors were not directed to areas where they could spend time while waiting at Bushey Fields Hospital.
You Said
We Did
We agreed to look at appropriate facilities for visitors during meal times and direct visitors to alternative areas nearby such as the restaurant at Russells Hall Hospital.
Substance Misuse Service users said it would be helpful to have appointment reminders sent via text message.
We looked at the best way to do this and service users now receive prompt reminders about their appointment directly to their mobile phone.
You did not receive a copy of your Care Plan
Our records showed that Care Plans were being given in most cases but may not be easily identified as such. As a result we have introduced ‘orange front sheets’ to clearly indicate to Patients their Care Plan
You asked where and how you could access facilities and resources while in hospital
We developed useful resource packs for both of our inpatient units providing information about all the facilities available during your stay, where they can be found and how you can access these.
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changes which will impact on staff satisfaction. This group will be responsible for ensuring that an action plan is developed to address key areas for improvements in 2012/13. The results of this year’s Staff Survey highlight highlighted a number of areas for staff satisfaction including:
Work life balance - 70% of staff said they felt their immediate manager helped them to find a good work-life balance above the national average of 63%
Job Satisfaction - In terms of job satisfaction that staff felt supported by their immediate Manager. The Trust scored 71% above the average score of 67%. This positive score was backed up with a supplementary question asking whether staff felt their line manager is supportive in a personal crisis - The Trust scored 80% in advance of the national average of 75%.
Training - Staff also said that they had received training in the last 12 months . Scores exceeding the average were in: Equality & Diversity - 58% (national 53%), Health & Safety - 86% (80%), Infection Control - 77% (69%) and Computer Skills - 43% (29%).
The results also highlighted areas for improvement as shown in the table below: Figure 3: Areas highlighted for improvement
Key areas for improvement:
48% of staff reported that they were involved or consulted in changes that affect their work
55% feel satisfied with the recognition they receive for doing good work
55% would be happy with the standard of care provided for a friend or relative if they needed treatment at the Trust
32% of staff reported experiencing work related stress in past 12 months
41% of staff believe that their job is good for their health
These results will form an action plan that will be addressed throughout 2012/13.
3.3 Our Staff We support a culture which is based upon working closely and better together to provide high quality services which put the experience of our service users at the heart of all we do. A total of 1283 staff work for the Trust (1150 Health and 133 Social Care) the majority of whom are clinicians and ‘front-line’ staff. They are our most important resource and without their dedication we would not be able to provide the services that we do. We recognise that building a culture of two-way communication, is crucial in helping to ensure that staff feel recognised and valued and we have developed a number of ways which we engage and communicate with our staff, including:
ASK GARY - A dedicated mailbox set up to encourage staff to email the Chief Executive with any questions they may have about the future of the Trust.
An internet based polling facility where staff can vote on a wide range of issues.
Latest News section on our intranet site.
Monthly Team Briefings which are delivered and presented by the Chief Executive and Chairman.
Active Desktop - Desktop messages which appear on the desktop of all Trust computers.
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Text message alerts - sent directly to all Trust mobile phones, to allow staff to keep informed of the latest news and updates without the need to log onto a Trust computer.
Staff Newsletter ‘Recognise’ - Which highlights some of the great work and achievements carried out around the Trust.
MExT Visibility Sessions - monthly appointments which enable all members of the Management Executive Team to get out and about across all of our sites and encourage staff to put forward ideas or ask any questions they may have.
We always strive to continuously improve our methods of communication so that a culture of two-way communication is fully embedded and maintained at all times. Our Staff and their Achievements We are always extremely proud of the achievements of our staff and we feel it is important to show recognition for the great work they do. In September 2011 we held the second of our staff awards ceremony ‘Recognising Success’. The event was held at The Venue Conference Centre, Dudley and was attended by colleagues from all areas of the Trust. The winners of the seven categories – Everybody Counts, Partnership, Innovation, Leadership, Unsung Hero, Patient Experience and Chairman’s Award – were all presented with glass trophies and a certificate of recognition. In addition, more than 10 people received awards for 25 and 40 years service in the NHS - a fantastic achievement. Staff Health and Wellbeing The wellbeing of our staff is of paramount importance to us. We recognise that the health and wellbeing of our staff has a direct impact on clinical outcomes and the experience of patients, therefore it is important that our staff are energised, motivated and healthy. With this in mind we have launched a dedicated Health and Wellbeing Strategy.
This year we have successfully delivered a range of activities and information offered to staff to assist with lifestyle choices and to assist with positive reinforcement of the impact good health & wellbeing of the workforce has on high quality patient care. Quarterly Health & Well being events have been delivered which have included a look at healthy eating options, positive mental health and relaxation, and physical activity. Under the theme of caring conversations a whole systems review to the Trust approach to appraisals and personal development planning has been undertaken. This has involved introducing the importance of giving and receiving feedback and a conversation about health and wellbeing in addition to job role objectives and training. Plans for 2012/13 will focus on reducing sickness absence which is an area of challenge for the Trust. The plan includes activity and support from Board to Ward in order to assist staff and managers with the management of this high impact issue for service delivery. It includes as an example the production of high level drilled down sickness data to view hotspots and then HR services and the Executive team working with managers to support action plans to help staff return to the workplace.
Staff sickness absence and ill health retirements
2011-12
2010-11
Number
Number
Total Days Lost
10,786
12,272
Total Staff Years
1,060
1,090
Average Working Days Lost
10.18
11.26
Staff sickness absence figures for both 2011-12 and 2010-11 are provided to the Trust by the
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Department of Health on a basis consistent with Department of Health and Cabinet Office measures. They cover the calendar years 2011 and 2010 respectively as opposed to the financial year One person employed by the Trust retired early on ill health grounds in 2011/12.The total additional pension liability accrued by the NHS Pensions Authority in respect of this retirement is £107,000.
In 2012/13 we will continue to take a proactive and engaging approach to enhancing the health and wellbeing of our staff and in doing so hope to reduce our sickness absence levels and improve service quality and efficiency.
3.4 Valuing Diversity
The Trust is committed to ensuring that our services and employment practices are fair, accessible and appropriate for all patients, visitors and carers in the community we serve across Dudley & Walsall, as well as the talented and diverse workforce we employ. We recognise that different people have different needs, which are respected and valued.
The Trust has a zero tolerance approach to any form of discrimination and is committed to ensuring fairness for all and eliminating discrimination on the grounds of:
age
sex
race and ethnicity
disability
religion or belief
sexual orientation
gender re-assignment
pregnancy and maternity
marriage and civil partnership
Equality legislation changed in 2010 with the introduction of the new Equality Act (2010). This act replaced all previous anti-discrimination laws with a single piece of legislation in order to simplify the law, remove any inconsistencies and make it easier for people to understand and comply with it. It also strengthened certain aspects of the law around tackling discrimination and inequality.
Within the overall Equality Act, the Trust has specific duties which need to be fulfilled. This is known as the public sector equality duty. The public sector equality duty consists of a general duty and a number of specific duties.
During 2011/2012 the Trust demonstrates its compliance with the Public Sector Duty by providing information to identify equality issues and information about steps taken to have due regard to the aims of the general equality duty and by implementing the NHS Equality Delivery System (EDS) as a framework. The EDS has four overall goals which are then sub-divided into ten outcomes, the four goals are:
Better health outcomes for all;
Improved patient access and experience;
Empowered, engaged and well-supported staff;
Inclusive leadership at all levels;
Trust Equality Objectives Under the Equality Act 2010, the Trust is required to develop and publish equality objectives, and to set out how we will measure improvement against them over the next 2 years. Further to the equality information published back in January 2012, we have developed our objectives using this information and through implementing the Equality Delivery System (EDS)
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A key component of developing the objectives has been to use the observations, comments and views of patients, carers, stakeholders, staff and the public in Dudley and Walsall, which we have continually gathered throughout our EDS processes of engagement and involvement. The Equality Objectives for the period 2012 -2014 are:
1. Undertake an analysis of the health needs of communities from the nine Protected characteristics (in partnership with other agencies) across Dudley and Walsall and develop plans to reduce key inequalities identified.
2. Improve Trust Interpretation and Translation services to ensure the services are accessible in alternative formats and languages.
3. Further develop meaningful engagement with service users, carers and the local community
to improve and align Trust services to meet needs, and to ensure effective accountability to the local population.
4. Improve the access and experience of communities to mental health support and improve the
accessibility of health information so that it is targeted, useful and accessible.
5. Provide advice, guidance and cultural competence training to staff to enable and support staff to work in culturally competent ways.
6. Identify how the NHS Equality and Diversity Competency framework can be embraced and
incorporated into the Trust’s leadership development programmes. The Trust’s Equality and Diversity Steering Group (a sub group of the Governance and Quality Committee) will monitor progress against the EDS and Equality objectives, and will report on progress at all levels.
Staff with Disabilities We are committed to supporting staff who have a disability or become disabled during the course of
their employment. We display the ‘two tick’ symbol demonstrating that we meet the standard to encourage and make adjustments for applicants with disabilities, and to guarantee an interview to those who meet the person specification for the post. Our Trust actively works with staff who become disabled to seek and make reasonable adjustments which will enable them to continue at work. We also actively support staff with both physical and mental health needs and have a robust Occupational Health and Staff Support service.
3.5 Other Partnerships Mental Health services across the Boroughs of Dudley and Walsall have a successful history of integration between Health and Social Care Services. Our teams work in a multi-disciplinary, integrated model with health and social care staff being managed jointly, thereby helping to ensure that services are more ‘seamless’ for people who use them. We have invested a lot of time and effort into building strong relationships with our commissioners and partners. It is these relationships that will enable us to benchmark, develop and improve services for the future.
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4. Our Board and Committees
4.1 Who sits on the Board
Board Member Profile Committee Involvement Declared Interests
Glyn Shaw, Chair
Glyn has worked and lived in and around the Black Country for over 20 years. Prior to retiring to become a carer for a family member, he was an Inland Revenue Area Director (Compliance) for Birmingham and Solihull. He previously served as a Non-Executive Director of Dudley PCT.
Glyn chairs the Trust Board Meetings, Board Development Meetings, NED team meetings and the Remuneration & Terms of Service Committee.
No interests declared
Mike Higgs, Non-Executive Director
Mike has an extensive professional background and was, until recently, Global Deputy Chief Executive and Group Resources Director of an international industrial minerals group. Prior to this, he was Group HR Director of an international retailer and, before that, a Senior Employment Law and Employee Relations Consultant. BSc (Hons) Physics PG Cert Employment Law & Management Studies
Mike chairs the Finance & Performance Committee
Non-Executive Director of Extra Care Trust
Stuart Hill, Non Executive Director
Stuart’s early career was with British Rail and GKN. After a spell in the Civil Service as Chief Land Registrar, he returned to technology as Managing Director of AEA’s environmental and rail businesses, and chaired subsidiary companies in Canada, Spain and Thailand. Most recently he has set up his own management consultancy and has been appointed as a lay member of a number of Disciplinary and Standards Committees. BA (Eng) First Class Hons, with Distinction PhD, Metallurgy & Materials Science
Acting Chair of the Mental Health Act Scrutiny Committee, Member of the Finance & Performance Committee
Lay Member – Solicitors Disciplinary Tribunal
Chair – West Midlands Police Authority Standards Committee
Lay Member – Chartered Institute of Management Accountants Disciplinary Committee
Consultant – Kynnersley Management Services
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Peter Hodnett, Non-Executive Director
Peter is a professional engineer by background, having worked for British Telecom in the UK and Europe for over 30 years. He also spent 11 years as a consultant in the fields of telecommunications, recruitment and restructuring. He has been a School Governor since 1976 and is Treasurer and Secretary of the Stourbridge and Dudley Branch of Diabetes UK. MSc Environmental Technology Chartered Engineer
Peter chairs the Governance and Quality Committee and is a member of the Audit Committee.
Committee Member representing Diabetes UK on the ‘Dudley Diabetes Improvement Partnership’
David Matthews, Non-Executive Director
David is a qualified CPFA Accountant. He has many years experience working in organisations ranging from large metropolitan councils to medium sized housing associations. David was Director of Resources at Stafford and Rural Homes Ltd until his retirement in 2009. He was also the Non Executive Chair of Caldmore Area Housing Association in Walsall for nine years. CIPFA Qualified Accountant
David chairs the Audit Committee and is a member of the Governance and Quality Committee.
No interests declared
Robin Gutteridge Non-Executive Director
Robin has been a Dudley resident for more than 30 years. For several years she has been a carer for a relative with dementia. Robin has a clinical and academic background: originally a physiotherapist, she now practices as a counsellor and psychosexual therapist for a national charity. Robin is a Chartered Psychologist (teacher/ researcher) working in the School of Health and Wellbeing at a local university. She previously served as a Non-Executive Director for NHS Walsall. Chartered Psychologist (Teacher & Researcher) PhD in Applied Social Studies MA in Gerontology BA (Open University)
Robin is completing a planned programme of induction. To date, she has joined the Audit Committee as a member and the Mental Health Act Scrutiny Committee as Vice –Chair.
Consultant in Health and Wellbeing, School of Health and Wellbeing, University of Wolverhampton
Counsellor and Psychosexual Therapist, Relate Centres Walsall and Wolverhampton
Trustee, Salus Fatigue Foundation, Sutton Coldfield
Chartered Psychologist: Full member Division of Teachers and Researchers
Accredited Member of the British Association for Counselling and Psychotherapy (BACP)
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Member of the College of Sexual and Relationship Therapists (CoSRT)
Non- Executive Director NHS Walsall June 2007- November 2011
Gary Graham, Chief Executive
Gary was previously Deputy Chief Executive of East Lancashire Hospitals NHS Trust. He has enjoyed a wide professional background, having worked in senior posts in the NHS since 2003 and prior to that, having worked within human resources and organisational development within the commercial sector and the British Army. MSc Training and HR Management
PGCE Further Education BSc (Hons) Applied Science
Gary chairs the fortnightly Management Executive Meetings (MExT), the Foundation Trust Programme Board and the Workforce and OD Committee.
No interests declared
Ian Baines, Director of Finance, IT & Estates
Ian joined the Trust from University Hospitals Coventry and Warwickshire NHS Trust where he completed a number of roles including Associate Director of Finance, Planning and Strategy. He began his career in the NHS in 1993 via the NHS Financial Management Training Scheme, before enjoying a long period in the private sector with consultancy firm KPMG. CIPFA Qualified Accountant BA (Hons) Economics & Politics
Ian attends the Audit, Finance & Performance and Governance & Quality Committees. He also chairs the Estates & Capital Planning Group and co-chairs the Health & Safety Committee. Ian is the Senior Information Risk Owner (SIRO) for the Trust.
No interests declared
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Dr William Conlon, Medical Director
Dr Conlon has worked as a Consultant in Adult General Psychiatry in Dudley for the past 25 years. He has held a number of Medical Director posts in local NHS organisations. He has a keen interest in medical education and was previously the Postgraduate Clinical Tutor for the Worcestershire Psychiatric Rotational Scheme. Bachelor of Medicine Member of the Royal College of Psychiatrists
Dr Conlon attends the Governance & Quality Committee and the Finance & Performance Committee. He is also the Chair of the service Transformation Programme Board. Dr Conlon is the Trust’s Caldicott Guardian.
No interests declared
Wendy Pugh, Director of Operations & Nursing
Wendy has worked within the NHS for over 20 years and began her career as a staff nurse in 1989. Since then she has worked in a variety of roles, all of which were in local mental health services. Over the last 5 years Wendy has undertaken a whole systems approach to the delivery of mental health services, and introduced a robust Care Program Approach for services in Dudley and Walsall. Registered Mental Health Nurse
Wendy attends the Governance & Quality, Finance & Performance and Health & Safety Committees. She is vice-Chair of the Service Transformation Programme Board. Wendy is the Director of Infection Prevention and Control (DIPC).
No interests declared
Marsha Ingram, Director of People and Corporate Development
Marsha began her NHS career in 1995 via the NHS General Management Training Scheme. She then undertook a range of general management and service development posts within mental health services in Birmingham and Solihull, before project managing a number of NHS mergers. More recently, she was the Head of Corporate Affairs for Dudley and Walsall Mental Health Trust. PG Diploma Healthcare Management BA (Joint Hons) Economics & Management Studies
Marsha attends the Committees for Finance & Performance, OD & Workforce, Governance & Quality and Mental Health Act Scrutiny. She chairs the Equality and Diversity Steering Group.
No interests declared
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The Board of Dudley and Walsall Mental Health Partnership NHS Trust is ultimately responsible for the actions and decisions of the organisation and notably for service delivery and quality, financial stewardship and strategic direction. It is composed of both Non-Executive and Executive Directors and meets in public in varied and accessible venues every other month; the details of these meetings are publicised via the website. Until recently the Trust Board has involved non-voting members from stakeholder representatives – namely Local Authorities, Staff Side Lead and Experts by Experience. In preparation for our transition to Foundation Trust and to recognise the clear separation between the Trust Board and a Council of Governors changes have been made which mean that these stakeholder representatives no longer sit on the Board but instead participate in the newly established Stakeholder Forum which is chaired by the Trust’s Chairman. This forum provides an opportunity for the existing stakeholder representatives to engage with the Trust Board and develop a framework for how the Board of Directors and Council of Governors will work together.
4.2 Board Committees
The Board has established a number of Board sub-committees to ensure good Board governance and a focus on specific key strategic themes. These sub-committees are: The Remuneration Committee advises the Board on appropriate pay and terms of service for all Board level posts, excluding the Non-Executive Directors whose pay and terms of service are set by the NHS Appointments Commission. The Remuneration Committee is chaired by Glyn Shaw (Chair). The Audit Committee provides an independent and objective view of financial systems and governance, financial information, assurance processes and compliance with regulations governing NHS Trusts. The Audit Committee is Chaired by David Matthews, Non-Executive Director. The Mental Health Act Scrutiny Committee is responsible for ensuring the Trust’s compliance with all aspects of the Mental Health Act and that significant reports, including those from the Care Quality Commission (CQC) appropriately actioned. The Mental Health Act Scrutiny Committee is chaired by Stuart Hill, Non-Executive Director. The Finance and Performance Committee is responsible for reviewing the Trust’s performance against key financial and operational targets. It is also responsible for reviewing the Trust’s key financial strategies and policies. The Finance and Performance Committee is chaired by Michael Higgs, Non-Executive Director. The Governance and Quality Committee is responsible for reviewing and maintaining effective systems for integrated governance, risk management and internal control across all of the Trust’s activities, both clinical and non-clinical. The Governance and Quality Committee is chaired by Peter Hodnett, Non-Executive Director. Management Executive Team (MExT) operates as the Trust’s ‘Operational Board’ and oversees all day-to-day matters of operational and corporate significance. MExT comprises the Executive Team, senior clinicians and professional leads and is chaired by Gary Graham, Chief Executive.
5. Performance
5.1 Managing Trust Performance
Over the course of 2011/12, the Trust has made significant strides in the standard and quality of Business Intelligence used to inform strategic and operational decisions at all levels of the organisation. Key achievements include:
E:AR 2010 v4 20
Driving a performance culture throughout the organisation with clear structures and processes that enable performance to be understood and actively managed at all levels. This includes the introduction of new service line quarterly performance reviews chaired by the Chief Executive.
The introduction of a single electronic patient record system for the Trust, replacing multiple, legacy systems no longer fit for purpose. Buy-in has been obtained from clinical staff, ensuring Trust-wide adoption of the new system. The new system is now embedded in the Trust, with high levels of clinical engagement.
Simultaneous introduction and delivery of a data warehouse solution, and real time performance dashboards, that provides daily accurate and meaningful business intelligence to the Executive Team and operational staff.
Performance reporting has been substantially refreshed with new easy to understand integrated dashboards and performance reports so that areas of underperformance can be identified and improved.
Commissioner engagement on performance and outcomes has been developed to a level where engagement is frequent, transparent and constructive.
Management of an extensive data quality project aimed at improving the accuracy and completeness of clinical recording, to ensure that Trust business intelligence is reliable and timely.
The implementation of a rapid improvement plan which has taken the Trust from an Information Governance toolkit compliance level of 31% to full compliance as at March 2012.
5.2 Measuring the Standards of Our Services
The Trust made significant improvements to its performance management and reporting framework in 2011/12, including reviewing and streamlining reporting structures, and developing and rolling out more accurate, relevant and accessible performance reports. The changes have led to more timely and accurate data available at all levels, as well as better clinical engagement with performance information at a senior level. They also enable real-time, flexible reporting of performance against a wide range of indicators to support business decision making. The Trust reports monthly on all key performance metrics to a Board sub-Committee, the Finance and Performance Committee (F&P). The committee is held every month, chaired by a Non-executive Director, with another Non-executive Director, Trust Chief Executive, Director of Finance, Performance and Estates, Director of Operations and Nursing, and the Medical Director in attendance. Additionally, the Trust reports monthly on achievements against a suite of Contractual Key Performance Indicators (KPIs) and Quality Improvement measures, to NHS Dudley and NHS Walsall through monthly contract review and clinical quality review meetings. These meetings are attended by Commissioners, the Deputy Chief Executive, the Head of Performance and Information, and Associate Directors for community services and acute/older adults. The Trust monitored performance in 2011/12 through three sets of KPIs:
11 National Measures, using the Monitor Governance Risk Rating; and
17 Contractual KPIs;
A new monthly performance report was developed during 2011/12 covering all key areas of performance:
Month on month activity, together with analysis and comparison of activity levels in previous years;
Month on month performance against contractual KPIs
E:AR 2010 v4 21
Month on month performance against National Measures Indicators
Month on month performance against internal Indicators
A report on data quality issues and actions.
There is also a new monthly performance report providing consistent and complete monthly performance information across the Trust. It provides information in a consistent format to Trust managers, the Trust Board and Commissioners. An overarching Performance Dashboard has also been developed to enhance performance reporting to the Trust Board.
E:AR 2010 v4 22
Figure 4: Month 12 Integrated Performance Dashboard
Trust Efficiency
Achieved Target RAG
Referral to treatment (95th percentile) 13 weeks 18.3 weeks
Average length of stay 46 days <64 days Activity (compared to 10/11) 312,850 >323,475
Trust Finances
Achieved Target RAG
FRR EBITA 5.7% 5.2% FRR EBITDA - achieved 110.1% 100% FRR – Return on assets 5.6% 5% FRR- I &E Surplus Margin 1.7% 1.3% FRR – liquidity ratio 49.9 days 48.1 days FRR - overall 3.65 3.65 CIP £2,781 £2,765k Income £62,871 £63,158k Bank/agency/locum spend as % of turnover
6.37% (6.76% in mth 11)
-
Trust Workforce (month 11/ 12)
Achieved Target RAG
Workforce plan WTE (month 11) 1138 1158 Turnover (month 12) 9.62 8% - 14% Sickness (month 12) 4.81% 4%
Trust Quality Achieved Target RAG
Delayed transfer of care (NHS ) 4.6% <7.5%
Readmissions (YTD) 5% 10% Access to CRHT before inpatient admission
99% >90%
7 day follow up on discharges 95% 95% Number of new cases – early interventions (% achieved against contract target)
107% 95%
CPA review in 12 months 95% 95% MRSA 0 0 C-Diff 0 0 Breaches of mixed sex accommodation
0 0
CQC compliance - - Monitor GRR 0 <1.0 Serious Incidents 7
(11 in mth 11) -
Complaints 5 (10 in mth 11)
-
High quality services
Inclusive partnerships
Efficient & effective
resources
Leadership culture
Responsible workforce
Supporting strategies
Service delivery
High quality services,
Inclusive Partnerships
Supporting effective
Service delivery
Resources, leadership, workforce
E:AR 2010 v4 23
5.3 Performance Highlights of 2011/12
Performance against National Targets
Figure 5: Performance against national targets in 2011/12 and a trajectory for the year end, which along with other elements, gives the Trust a Governance Risk Rating (GRR) of 0 against a Monitor target of <2.0.
Indicator
Threshold Weighting Month 12 Performance
Current
RAG
MRSA (breaches) 0 1.0 0
C-Difficile (breaches – traditional method)
0 1.0 0
Referral to treatment (95th percentile) 18.3 wks 1.0 11.29 wks
CPA approach -
Follow-up contact within 7 days; or
95%
1.0
95%
Minimising delayed transfers of care (NHS only)
≤7.5% 1.0 5%
Admissions to inpatients had access to crisis resolution home treatment teams
90% 1.0 99%
Access to early intervention teams (new cases)
95% 0.5 107%
Data completeness: identifiers (NHS number, DOB, postcode, gender, GP, Commissioner)
99% 0.5 99%
Data completeness: outcomes (employment, accommodation & HONOS)
50% 0.5 75%
E:AR 2010 v4 24
The table below highlights how the Trust has improved or maintained performance against the national metrics in 2011/12: Figure 6: Performance against National Metrics
5.4 Managing the Quality and Standards of Our Services The Trust’s Governance and Quality Committee has overarching responsibility for quality and for monitoring and assurance of quality performance. Underpinning this committee’s function are the Service Line Quality Groups which meet monthly and the monthly Quality Review Meetings with commissioners. The Trust has established an annual process for identifying quality priorities based on intelligent data and risk profiles, from which targeted quality improvement plans are developed. The quality improvement plans set out the measures of success and SMART (Specific, Measurable, Accurate, Realistic and Timescaled) objectives and are delivered through a project management approach. Monitoring of the implementation and impact of projects is via quarterly reports to the Governance and Quality Committee. Additional inputs to the Committee’s deliberations come from trend analysis and external assessments which can trigger the development of further specific quality initiatives. The Trust has a good culture of learning lessons and has established a governance process, linked to risk management and incident reporting policy, to facilitate the learning, sharing and implementation of key lessons following serious incidents. This is delivered through fortnightly ‘embedding lessons’ sessions held with senior managers and service user experience representatives. An annual Quality Account is produced by the Trust which sets out the quality priorities and then reports on outcomes in delivering those priorities. Most importantly this Account is subject to scrutiny by commissioners, Health, Overview and Scrutiny Committee, LINK, EBEs and service users. In terms of embedding quality outcomes and being assured by third parties that the Trust is delivering quality this forms a crucial piece of assurance. In preparation for becoming an authorised NHS Foundation Trust, a number of third party assessments of the quality and safety of the Trust’s services have been carried out during 2011. These include the West Midlands Quality Review, a mock Monitor Quality Governance assessment and an SHA Quality and Safety assessment.
1414
Monitoring Service Performance score GRR
mth
5
GRR mth
6
GRR
mth
7
GRR
mth
8
GRR mth
9
GRR mth
10
GRR
Mth
11
GRR mth
12
1. Performance against national measures
National Performance measure
-No failed indicators
- All DQ issues resolved
0
3.5 2.0 2.0 1.5 0 0 0 0
2. Third parties
CQC
-No moderate or major concerns
-No regulatory action
0
NHS Litigation Authority
- Minimum published CNST level in place
0
3. Mandatory services
No declared risk or actual failure to deliver
mandatory services
0
4. Other certification failures
No failures Risk ratings at Monitor’s discretion
5. Other factors
One risk area – IG toolkit
E:AR 2010 v4 25
In 2011 the Trust launched its Quality Improvement strategy which brings together all aspects of quality improvement including service transformation, patient experience and patient safety. The highlights of the Trust’s progress in improving clinical quality are described here.
National/Regional Quality Improvement Priorities
The national and regional priorities for 2011/12 are reflected in the Trust’s quality accounts and in the Provider Management Regime; these are described in more detail in the following sections.
Care Quality Commission
The Trust maintained its CQC registration without conditions. An inpatient inspection in May 2011 raised a number of minor concerns, all of which have been satisfactorily addressed.
Trust Quality Account
Following a process of service review and consultation with staff, service users and carers and other partners, the Trust identified three quality goals to be priority areas for 2011/12. These formed the basis of the Trust’s 2011/12 Quality Account. The following figures show progress against the three priorities outlined in the 2011/12 Quality Account. A full narrative is available in the Trust’s published Quality Account which can be accessed via www.dwmh.nhs.uk Priority 1: Patient Safety Quality Goal - Service users will have clear care plans for the management of disruptive and aggressive behaviour in acute inpatient care. Figure 7: Progress against Priority 1
Measure Status
Clinical audit of the quality of care plans against local standards
The Trust has completed a clinical audit against the standards in the Royal College of Psychiatrists violence and aggression audit. A final report is being prepared with an accompanying action plan.
Incident reporting/National Patient Safety benchmarking
Throughout the year the Trust has monitored levels of incident reporting of disruptive and aggressive behaviour in inpatient care. This has formed part of the inpatient governance report.
Priority 2: Clinical Effectiveness Quality Goal - Service users will have a comprehensive physical health needs assessment which will incorporate the Trust’s three priority High Impact Actions (see below). Figure 8: Progress against Priority 2
Measure Status
Clinical audit results The Trust has completed a clinical audit the final report is being prepared with accompanying action plan
Contractual KPI The percentage of long term patients who receive an annual physical health check (100% target). The Trust has achieved 100% on this target.
E:AR 2010 v4 26
Priority 3: Patient Experience
Quality Goal - Service Users will receive care that is focussed on respect and dignity. Figure 9: Progress against Priority 3
Measure Status
Mixed sex accommodation breaches
The Trust has a contractual KPI to measure breaches of single sex accommodation. The Trust has achieved no breaches on this target.
CQUIN patient experience scheme
The Trust achieved its patient experience CQUIN target, improving on scores in the previous year:
- Average positive response from community patients was 75% (previous year: 71%)
- Average positive response from inpatients was 81% (previous year: 79%)
Complaints relating to staff attitude
Throughout the year the Trust has monitored levels of complaints relating to staff attitude. This has formed part of the patient experience report.
National Community Mental Health Survey 2011
87% of service users felt they had been treated with dignity and respect, in line with national average
Our Quality Priorities for 2012/13
To maintain and improve the cleanliness of the Trust hospitals and community facilities
To embed physical healthcare monitoring consistently into clinical processes
Improve treatment and outcomes for service users who deliberately self harm
Increase the number of care plans that have clear outcomes and are recovery focused
Improve engagement with families and carers in care and treatment
Returning to 2011/12 the following activities underpinned our quality priorities, as part of the Trust’s commitment to quality improvement. High Impact Actions The Trust is committed to the delivery High Impact Actions for Nursing to support improvements in physical health and wellbeing, and so focus was given in the year to the following:
Your skin matters – resource folders, education and training
Keeping nourished – getting better – food labelling, MUST assessment tools
Keeping safe - preventing falls – policy revision, falls audit
This Trust-wide programme is being evaluated to assess effectiveness and assist in developing further actions which will be reported in the Trust’s 2011/12 Quality Account. Essence of Care As part of the Trust’s Quality Improvement priorities, focus was given to the Essence of Care - Respect and Dignity benchmark. The first benchmark across all inpatient services was completed in November 2011 as a baseline and repeated in February 2012 to allow a comparative score and to demonstrate quality improvement. Results from the benchmarking are being collated and will inform further actions required.
E:AR 2010 v4 27
Never Events
Within mental health services, a never event is described as “death by collapsible bed rail in inpatients”. The Trust had no never events in 2011/12.
National Clinical Audits
The audit plan for 2011/12 consisted of seventeen audits completed including the Trust’s involvement in the National Audit of Schizophrenia (NAS) and Prescribing Observatory for Mental Health (POMH). The audits that formed part of the Forward Audit Plan 2011-2012 were based on the intelligence received through incident reporting, national audits conducted and information gained from senior clinicians throughout the Trust. Action plans have been generated from the completed audits. These will be monitored to ensure that they are fully embedded before going through the re-audit cycle in 2012/13.
CQUIN (Commissioning for Quality and Innovation)
CQUIN is a set of targets used jointly by the Trust’s PCT commissioners to monitor quality. A proportion of our income is conditional on meeting the set targets. In 2010/11, the majority of CQUIN targets were fully met resulting in a financial value of £813,010. For 2011/12 the Trust agreed seven CQUIN schemes with its commissioners the annual CQUIN scheme indicators and performance are summarised below. Understanding and improving the experience of service users – A patient experience survey conducted twice a year (quarter 1 and quarter 4). At least 50 patients are surveyed each quarter, with the sample drawn from both community based service users and inpatients. In quarter one, 75% of community based service users and 81% of inpatients answered questions with a positive response. Planned and effective discharge from mental health hospital – This requires an audit of at least 25 discharged inpatients, to establish whether four key aspects of effective patient care have been complied with. Improvements have been delivered each quarter with 76% of discharged inpatients meeting all four aspects of the audit. Medicines management – This required new prescribing guidance for anti-psychotic medication for patients with dementia. The new guidance was successfully put in place, but audits of compliance against the guidance conducted in quarter 2 and 3 showed poor results against some aspects of the audit checklist. The results have been discussed with Commissioners and monitoring of this area will be carrried forward into the medicines management CQUIN for 2012/13. Crisis Resolution Home Treatment Team facilitate early discharge from hospital – This is concerned with patients discharged earlier than might otherwise be clinically possible because of the provision of intensive domiciliary acute care by CRHT. Those patients should be followed up within 48 hours. In Q3, 113 patients were discharged earlier than their planned discharge date, with 78% of this group followed up within 48 hours. Length of stay in inpatient rehab (NHS Walsall only) – This is based on the average length of stay of inpatients discharged from the Walsall rehab ward. There were no inpatients discharges from this ward in quarter 3. In quarter 1 and 2 the discharged patients met all aspects of the CQUIN. Psychiatric liaison (NHS Dudley only) – This measures the success of the new Psychiatric Liaison Service in Dudley. In Quarter 3, 198 patients were referred to the service (81 in October, 56 in November and 61 in December). The average time of referral to appointment was less then one day. Training on the service was being rolled out to clinical staff in the acute hospital. Compliance with emergency assessments – In quarter three, 95% of all emergency assessments were seen in one day or less.
E:AR 2010 v4 28
The Trust expects an under recovery of approximately £48,000 from a potential total of £881,000. The summary performance is shown in the figure below. Figure 10: Summary Performance of Compliance with all Emergency Assessments
RAG at Q3
Forecast year end
1. Understanding and improving the experience of service user (patient experience survey)
2. Planned and effective discharge from Mental Health Hospital (audit)
3. Medicines management
4. Crisis Resolution Home Treatment Teams (CRHT) facilitate early discharge from hospital
5. Length of stay in inpatient rehab wards (NHS Walsall only)
6. Psychiatric liaison (NHS Dudley only)
7. Compliance with emergency assessments
Serious Incidents (SIs)
Figure 11: The chart below shows the number of serious incidents and incidents logged on UNIFY during 2011/12.
Embedding Lessons Some important recommendations have been formulated, shared and evidenced during 2011/2012. These are summarised below: 1. In response to medication errors:
0
50
100
150
200
250
300
Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12
Serious Incidents and Incidents 2011/12 YTD
Serious Incidents Incidents
E:AR 2010 v4 29
- The commencement of the Medicines Management Assessment for all relevant nursing staff
2. In response to abscond behaviour
- Trust-wide abscond meetings.
- Raising the awareness of “tail-gating” at exits (posters and Trust web-site).
- Greater site security at Bushey Field hospital.
- Ward bedroom window replacement for more secure environment.
- Leave care plans formulated and implemented throughout inpatient areas
3. Crisis Resolution Home Treatment service review and improvement plan
NHS Litigation Authority (NHSLA)
In February 2011, the Trust was assessed by the NHSLA against its risk management standards and successfully maintained its Level 1 compliance. The Trust is now working towards level 2 in readiness as an FT.
Patient Environment Action Team (PEAT)
Every year, healthcare facilities in England which have more than ten inpatient beds are inspected and assessed on the standards of the hospital environment through Patient Environment Assessment Team (PEAT) assessments. Each hospital is given an annual rating of excellent, good, acceptable, poor or unacceptable, based on levels of cleanliness, aspects of infection control, the quality of the environment (such as decoration, maintenance and lighting) as well as the standard of food offered to patients. The scores below show that the Trust’s acute sites have either made progress or maintained their high standards in the vast majority of areas. The food has improved across all three hospital sites and privacy and dignity has maintained an “Excellent” rating. We are working to make further improvements in those areas that have not seen significant improvement and appropriate action will be taken to ensure our standards are of the highest quality. Figure 12: Patient Environment Action Team Results
Site Name Year Environment Food Privacy & Dignity
Bushey Fields 2009
2010
2011
Excellent
Excellent
Good
Excellent
Acceptable
Good
Excellent
Excellent
Excellent
Dorothy Pattison
2009
2010
2011
Acceptable
Good
Excellent
Good
Good
Excellent
Good
Excellent
Excellent
Bloxwich Hospital
2009
2010
2011
Good
Excellent
Excellent
Excellent
Good
Excellent
Good
Excellent
Excellent
5.5 Planning for the Unexpected In order to ensure we continue to perform and provide high quality mental health services in almost all eventualities, we have considered how we would respond to a local major incident. As a specialist mental health Trust, the role that we would play in responding to such an incident would be very different from that of our partners in the PCTs, Local Authorities, Acute Trusts and the Ambulance Trusts. Our main focus, as an NHS organisation, is to ensure that internal business continuity procedures are embedded across the entire organisation through effective planning and rehearsal. The Trust has carried out a major business continuity exercise to provide confidence that we can effectively manage the challenges posed by a major business disruption incident. In addition the Trust is undertaking a comprehensive review of its policies, plans, risk assessments and response arrangements in relation to business continuity to further improve the resilience of the organization.
E:AR 2010 v4 30
5.6 Environmental Footprint The Trust drafted its Sustainability Strategy, Policy and Procedure during the course of the year and continued to invest capital money into various projects, whilst continuing to develop our overall contribution to NHS sustainability. The Trust is implementing its sustainability procedure using a three phase approach, targeting key areas within the remit of Estates and Facilities to develop and continue reductions in our carbon footprint. Phase 1 of the procedures is now nearing completion, the principal focus being carbon emissions relating to energy, waste, water and travel. To facilitate this exercise the Trust is working with an independent organisation who specialise in climate change. Nottingham Energy Partnership (NEP) has been commissioned to assess the Trust’s carbon impact within the accounting year 2009/10 which was the first full working year of the Trust. We can then assess our carbon impact since then and quantify the Trust’s contribution to climate change on a site by site basis. NEP will also provide recommendations to support the development of our future activities to ensure our sustainability plans are robust and fit for purpose. The carbon impact data will also provide a platform upon which sustainability targets can be set and measured to ensure that the Trust’s endeavours towards its sustainability agenda are effective. The Trust has ear marked £300,000 for the Sustainability agenda which has been and will continue to be invested over 2011/12, 2012/13 and 2013/14. Works outstanding from 2010/11 have been completed, including replacement boilers and other plant and equipment, maximising energy efficiency across all our major and minor sites. A number of new major initiatives were also completed during the last financial year.
The installation of a unit in Dorothy Pattison Hospital to improve the stability of voltage within the power supply resulting in increased efficiency of electrical systems and equipment.
Our heating systems have also benefited from upgrades to the controls within a number of our main sites. The insulation of the heating systems has been improved on all hospital sites, with a similar programme being rolled out over minor sites in the future.
Two areas of Dorothy Pattison Hospital have also received an upgrade to extra low energy LED lighting, which has reduced the nominal wattage of the lighting system by 80%.
Thermography (thermal imaging to assess heat loss) was programmed for the winter period of 2011/12, but was not carried out due to the warmer than average temperatures. This work will be revisited in 2012/13.
More generally, we are committed to becoming a Trust with an enviable low Carbon Footprint, where the environmental impact is an important consideration during our day-to-day work of providing services to the local community. This will be achieved by transforming the Trust’s infrastructure using effective and efficient systems within each and every property where we have control over the energy consumption, and hence the carbon footprint.
6. Our Finances
6.1 Financial Targets We are delighted to report that the Trust met its statutory targets for the financial year 1
st April 2011 to
31st March 2012. The table below summarises our Trust’s performance against the key financial
duties.
E:AR 2010 v4 31
Figure 13: Performance against Key Financial Duties
Duty Target Performance Comment
Ensuring expenditure does not exceed income
Breakeven A surplus of £1,163k
Achieved - The Trust has
a statutory responsibility
to ensure expenditure
does not exceed
income. Provided the Trust breaks
even or makes a surplus, it has met its
target.
Remain within approved Capital Resource Limit
£1,691,000 £285k underspend
Achieved – This is the
level of expenditure on capital
projects the Trust must not exceed. If net
capital expenditure is less than the limit the Trust
has met its target.
Achieve a capital cost absorption rate of 3.5%
3.5%
(+/- 0.50%) 3.5%
Achieved – This is the return of funds the
Trust must make each year to the
Department of Health. It is
generally regarded as
the long term cost of capital in the public
sector.
Better Payment Practice Code
Creditors should be paid within 30 days of
receipt of invoice
96% of non-NHS invoices paid (by value) within 30
days
Achieved – NHS Trusts
must comply with the Better
Payments Practice Code
to ensure external
E:AR 2010 v4 32
suppliers are paid in a
reasonable timeframe.
Do not exceed the approved External Financing Limit
(£315,000) £387k undershoot
Achieved – The EFL
controls the amount of
cash the Trust can draw
upon from the Department of Health in the
year. The target must
not be exceeded.
The Trust was set a negative
target for 2011/12 to
deliver a cash contribution
of £315k. The Trust
comfortably met this duty by delivering
a cash contribution
of £702k - undershooting the target by
£387k.
6.2 Financial Trends and Forecasts The Trust has continued to build financial strength since its formation in 2008, growing its surplus, developing contracting and relationships with commissioners, transforming services and improving the estate from which services are provided. The following table summarises past and future high level financial information. Figure 14: High Level Financial Information
2008/09 2009/10 2010/11 2011/12
Income £34,186k £66,578k £67,918k £67,298k
Surplus £202k £377k £883k £1,163k
Cash £5,398k £6,132k £6,230k £6,932k
Savings £1,500k £2,000k £1,991k £2,736k
The table above reflects the following factors:
Increasing savings requirements as a result of the challenging economic environment. The Trust is managing this through strong relationships with its host commissioners.
Robust treasury management.
Holding vacancies in order to enhance levels of flexibility for savings delivery, increasing the Trust’s under spend.
Decreasing levels of non-recurrent spend.
E:AR 2010 v4 33
NHS Walsall
NHS Dudley
Sandwell PCT
West Midlands SHA
London SHA
Local Authorities
Other NHS Bodies
Other
Control over usage of temporary staff, managing our cost pressures.
Service transformation to meet the scale of savings requirements ahead.
6.3 Where does The Trust’s income come from?
Trust income from NHS Walsall and NHS Dudley comes through a joint commissioning arrangement, ensuring the Trust and both host commissioners can work together to provide joined up, synergistic services for service users. The Trust has contracts with eight key NHS commissioners for 2011/12. The host commissioners are NHS Walsall and NHS Dudley, with NHS Walsall as the lead commissioner. The Trust also provides services to people who live in the boroughs of Dudley or Walsall but have a GP in a neighbouring borough. These services are covered by contracts with five local PCTs, namely:
NHS Birmingham East & North NHS Sandwell NHS South Staffs NHS Wolverhampton NHS Worcestershire
The Trust also provides mental health services to Deaf Children and Adolescents under a contract with National Commissioning Group. The revenue breakdown and contract duration for commissioned services is shown in the figure below. All key contracts are signed. Figure 15: The Trust’s Income Alongside this the Trust is developing contracting by a “care cluster” currency. This is the development of “Payment by Results” for Mental Health Services, whereby income is received according to patient diagnosis and recovery. The West Midlands is at the forefront of this work.
6.4 How is the Trust’s money spent?
The Trust’s total operating expenditure for the 2011/2012 financial year was £63.3m compared with £66.2m for the prior year. By far the largest cost element relates to salaries and wages. On average the Trust employed 1,152 whole time equivalent staff which equated to £50m or 79% of total operating expenditure.
E:AR 2010 v4 34
Staff Costs
Premises
Services from PCTs
Supplies and Services -Clinical
Supplies and Services -General
Establishment
Depreciation
Other
Figure 16: Summary Expenditure
6.5 Capital Expenditure The Trust has continued to build on the large sums invested into improving the organisation’s estate during 2011/12, spending £1.4m on capital works. Projects include: Figure 17: Capital Works Undertaken
Scheme Value £’000s Progress
Upgrade of Kingshill Clinic to facilitate service transformation and new clinical pathways
561
IT Hardware Upgrade to support Community based teams 192
IT Purchase of additional Microsoft licences. 149
Development of a High Dependency Unit at DPH 123
Upgrade of Bathrooms at DPH to improve in-patient facilities 83
IT Telephony Upgrade to bring the Trust on to a single network 54
Power Perfector Unit at DPH to ensure efficient electricity usage 31
DPH Refurbishment of Windermere Ward 20
Minor Schemes 147
Total 1,360
6.6 Summary Financial Statements (SFS’s)
The summary financial statements are shown in the following page. They are provided in summary format only and may not contain sufficient information for a full understanding of the Trust’s financial position and performance. The full accounts can be obtained free of charge by downloading them from the Trust’s website www.dwmh.nhs.uk or by contacting Ian Baines (Director of Finance, IT and Estates) at Dudley and Walsall Mental Health Partnership NHS Trust HQ, 2
nd floor, Trafalgar House, 47-49 King Street, Dudley DY2 8PS.
E:AR 2010 v4 35
Statement of Comprehensive Income for year ended 31 March 2012
2011-12
2010-11
£000
£000
(restated)
Employee benefits (50,022)
(50,306)
Other costs (13,313)
(15,887)
Revenue from patient care activities 62,989
63,701
Other operating revenue 4,309
4,798
Operating surplus 3,963
2,306
Investment revenue 21
23
Other gains and (losses) (3)
0
Surplus for the financial year 3,981
2,329
Public dividend capital dividends payable (1,299)
(1,245)
Retained surplus for the year 2,682
1,084
Other Comprehensive Income
Impairments and reversals 0
(13)
Net gain on revaluation of property, plant & equipment 0
58
Total comprehensive income for the year 2,682
1,129
Financial performance for the year
Retained surplus for the year 2,682
1,084
Part reversal of previous impairment charges (1,519)
(201)
Adjusted retained surplus 1,163
883
E:AR 2010 v4 36
Statement of Financial Position as at 31 March 2012
31 March 2012
31 March 2011
31 March 2010
(restated)
(restated)
£000
£000
£000
Non-current assets
Property, plant and equipment 41,535
40,038
40,047
Intangible assets 929
925
527
Total non-current assets 42,464
40,963
40,574
Current assets Trade and other receivables 1,488
1,934
2,175
Cash and cash equivalents 6,932
6,230
6,132
Total current assets 8,420
8,164
8,307
Total assets 50,884
49,127
48,881
Current liabilities
Trade and other payables (5,259)
(6,128)
(6,985)
Provisions (33)
(35)
(59)
Total current liabilities (5,292)
(6,163)
(7,044)
Non-current assets plus net current assets 45,592
42,964
41,837
Non-current liabilities
Provisions (476)
(530)
(532)
Total non-current liabilities (476)
(530)
(532)
Total Assets Employed 45,116
42,434
41,305
Financed by:
Taxpayers' Equity
Public Dividend Capital 48,321
48,321
48,321
Retained earnings (3,301)
(5,983)
(7,067)
Revaluation reserve 96
96
51
Total Taxpayers' Equity 45,116
42,434
41,305
E:AR 2010 v4 37
Statement of Changes in Taxpayers' Equity For the year ended 31 March 2012
Public Dividend Capital
Retained earnings
Revaluation reserve
Total reserves
Changes in taxpayers’ equity for 2011-12 £000 £000 £000 £000
Balance at 1 April 2011 48,321 (5,983) 96 42,434
Retained surplus and net recognised revenue for the year
0 2,682 0 2,682
Balance at 31 March 2012 48,321 (3,301) 96 45,116
Changes in taxpayers’ equity for 2010-11
Balance at 1 April 2010 48,321 (7,067) 51 41,305
Retained surplus for the year 0 1,084 0 1,084
Net gain on revaluation of property, plant, equipment
0 0 58 58
Impairments 0 0 (13) (13)
Net recognised revenue for the year 0 1,084 45 1,129
Balance at 31 March 2011 48,321 (5,983) 96 42,434
E:AR 2010 v4 38
Statement of Cashflows for the year ended 31 March 2012
2011-12
2010-11
£000
£000
Cash Flows from Operating Activities
Operating Surplus 3,963
2,306
Depreciation and Amortisation 1,375
1,267
Impairments and Reversals (1,519)
(201)
Dividend paid (1,286)
(1,239)
Decrease in Trade and Other Receivables 446
241
Decrease in Trade and Other Payables (981)
(226)
Provisions Utilised (23)
(13)
Decrease in Provisions (33)
(13)
Net Cash Inflow from Operating Activities 1,942
2,122
Cash Flows from Investing Activities
Interest Received 21
23
Payments for Property, Plant and Equipment (1,071)
(1,532)
Payments for Intangible Assets (190)
(515)
Net Cash Outflow from Investing Activities (1,240)
(2,024)
Net Cash Flow before Financing 702
98
Cash Flows from Financing Activities
Net Cash Inflow from Financing Activities 0
0
Net increase in Cash and Cash Equivalents 702
98
Cash and Cash Equivalents at Beginning of the Period 6,230
6,132
Cash and Cash Equivalents at year end 6,932
6,230
E:AR 2010 v4 39
6.7 External Audit Services The Trust’s external auditors are the Audit Commission, Friarsgate, 1011 Stratford Rd, Shirley, Solihull, West Midlands, B90 4BN. The fee for the statutory audit and services carried out in relation to the statutory audit for the period is £106,000. The Audit Commission have also undertaken an audit of the Trust’s Quality Accounts in 2011/12 for a fee of £15,000. As far as the Directors are aware, there is no relevant audit information of which the Trust’s Auditors are unaware. As a Board of Directors, we have taken all appropriate steps to make ourselves aware of any relevant audit information and to establish that the Trust’s auditors are aware of that information.
Independent Auditor’s Report to the Directors of Dudley and Walsall Mental Health Partnership NHS Trust
I have examined the summary financial statement for the year ended 31 March 2012 which comprises the Statement of Comprehensive Income, Statement of Financial Position, Statement of Changes in Taxpayers Equity, Cashflow and Remuneration Report set out on pages 33-40.
This report is made solely to the Board of Directors of Dudley and Walsall Mental Health Partnership NHS Trust in accordance with Part II of the Audit Commission Act 1998 and for no other purpose, as set out in paragraph 45 of the Statement of Responsibilities of Auditors and Audited Bodies published by the Audit Commission in March 2010.
Respective responsibilities of directors and auditor
The directors are responsible for preparing the Annual Report.
My responsibility is to report to you my opinion on the consistency of the summary financial statement within the Annual Report with the statutory financial statements.
I also read the other information contained in the Annual Report and consider the implications for my report if I become aware of any misstatements or material inconsistencies with the summary financial statement.
I conducted my work in accordance with Bulletin 2008/03 “The auditor's statement on the summary financial statement in the United Kingdom” issued by the Auditing Practices Board. My report on the statutory financial statements describes the basis of my opinion on those financial statements.
Opinion
In my opinion the summary financial statement is consistent with the statutory financial statements of the Dudley and Walsall Mental Health Partnership NHS Trust for the year ended 31 March 2012.
Tony Corcoran 8 June 2012
District Auditor
Audit Commission 1st Floor, 1 Friarsgate 1011 Stratford Road, Solihull West Midlands, B90 4BN
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6.8 Statement of the Chief Executive’s responsibilities as the Accountable Officer of the Trust
The Secretary of State has directed that the Chief Executive should be the Accountable Officer to the Trust. The relevant responsibilities of Accountable Officers, including their responsibility for the propriety and regularity of the public finances for which they are answerable, and for the keeping of proper records are set out in the Accountable Officer’s Memorandum issued by the Department of Health.
To the best of my knowledge and belief, I have properly discharged the responsibilities set out in my letter of appointment as an accountable officer.
29 April 2012
Gary Graham, Chief Executive
6.9 Remuneration Report Directors’ Remuneration and Terms and Conditions The remuneration and terms and conditions for Directors who sit on the Board (except Non-Executive Directors) are set by the Remuneration Committee. For all postholders except the Chief Executive and Medical Director, the remuneration and terms and conditions are in accordance with Agenda for Change terms and conditions. The Chief Executive’s pay has been set using benchmark information for similar Chief Executive positions in other comparable Trusts. All Directors receive regular appraisal. The Non-Executive Directors are appraised by the Chair of the Trust, as is the Chief Executive. The other directors are appraised by the Chief Executive. The Remuneration Committee have not determined any performance related pay arrangements or bonuses. Any inflationary pay award for the Chief Executive is determined annually by the Remuneration Committee. All Directors are on substantive contracts of employment. The Chief Executive is subject to a six month notice period and all other Directors having three month notice periods. Any termination payment would be determined in line with the standard NHS redundancy payment scheme, where appropriate. No termination payments have been made during the reporting period.
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Salaries and Pension Entitlements for Board-level Directors The following table shows the salaries and other related allowances for the Board-level Directors. Figure 18: Salaries and Pension Entitlements for 2011/12
Name and Title
2011-12
Salary
(bands of
£5000)
£000
Other
Remuneration
(bands of
£5000)
£000
Benefits in
kind (rounded
to the nearest
£00)
£00
Glyn Shaw, Chair 15-20
Peter Hodnett, Non-Executive Director 5-10
Michael Higgs, Non-Executive Director 5-10
David Matthews, Non-Executive Director 5-10
Stuart Hill, Non-Executive Director 5-10
Robin Gutteridge 0-5
Gary Graham, Chief Executive 120-125 40
Ian Baines, Director of Finance, IT & Estates 95-100 50
Dr William Conlon, Medical Director 20-25 120-125
Wendy Pugh, Director of Operations & Nursing 80-85
Marsha Ingram, Director of People and
Corporate Development
65-70
The table overleaf shows the pension entitlement details for Board directors. As Non-Executive Directors do not receive pensionable remuneration, there will be no entries in respect of pensions for Non-Executive members.
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Figure 19: Pension Entitlement for all Board Directors
Name and title
Real increase in pension at age 60 (bands of £2,500) £000
Real increase in pension lump sum at aged 60 (bands of £2,500) £000
Total accrued pension at age 60 at 31 March 2012 (bands of £5,000) £000
Lump sum at age 60 related to accrued pension at 31 March 2012 (bands of £5,000) £000
Cash Equivalent Transfer Value at 31 March 2011 £000
Cash Equivalent Transfer Value at 31 March 2012 £000
Real increase in Cash Equivalent Transfer Value £000
Employer’s contribution to stakeholder pension £000
Gary Graham, Chief Executive
0-2.5 2.5-5 10-15 35-40 158 208 44 -
Ian Baines, Director of Finance, IT & Estates
0-2.5 2.5-5 15-20 55-60 190 261 64 -
Marsha Ingram, Director of People and Corporate Development
0-2.5 2.5-5 15-20 45-50 142 201 54 -
Dr William Conlon, Medical Director
0 0 0 0 0 0 n/a -
Wendy Pugh, Director of Operations & Nursing
2.5-5 10-12.5 30-35 100-105 393 537 130 -
*Pension entitlement shown as at 31 March 2012
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A ‘Cash Equivalent Transfer Value’ (CETV) is the actuarially assessed capital value of the pension scheme benefits accrued by a member at a particular point in time. The benefits valued are the member’s accrued benefits and any contingent spouse’s pension payable from the scheme. A CETV is a payment made by a pension scheme or arrangement to secure pension benefits in another pension scheme or arrangement when the member leaves a scheme and chooses to transfer the benefits accrued in their former scheme. The pension figures shown relate to the benefits that the individual has accrued as a consequence of their total membership of the pension scheme, not just their service in a senior capacity to which disclosure applies. The CETV figures and the other pension details include the value of any pension benefits in another scheme or arrangement which the individual has transferred to the NHS pension scheme. They also include any additional pension benefit accrued to the member as a result of their purchasing additional years of pension service in the scheme at their own cost. CETVs are calculated within the guidelines and framework prescribed by the Institute and Faculty of Actuaries. ‘Real Increase in CETV’ reflects the increase in CETV effectively funded by the employer. In takes account of the increase in accrued pension due to inflation, contributions paid to the employee (including the value of any benefits transferred from another scheme or arrangement) and uses common market valuation factors for the start and end of the period. Treatment of pension liabilities in the accounts Trust staff are entitled to join the NHS pension scheme. This is the only pension scheme into which the Trust makes employer contributions. This pension is an unfunded defined benefit scheme that is accounted for as a defined contribution scheme. This is due to the Trust’s share of the underlying assets and liabilities of the total scheme not being separately distinguishable. More information on the Trust’s pension accounting policy can be found in the annual accounts note 1.5. Pay Multiples Reporting bodies are required to disclose the relationship between the remuneration of the highest-paid director in their organisation and the median remuneration of the organisation’s workforce.
The banded remuneration of the highest paid director in the Trust in the financial year 2011-12 was £145,000 (2010-11, £195,000). This was 5.4 times (2010-11, 7.9 times) the median remuneration of the workforce, which was £26,656 (2010-11, £24,554).
The fall in the ratio between 2010-11 and 2011-12 was due to a change in the contract of the highest paid director during 2011-12.
In 2011-12, no (2010-11, no) employees received remuneration in excess of the highest-paid director.
Total remuneration includes salary, non-consolidated performance-related pay, benefits-in-kind as well as severance payments. It does not include employer pension contributions and the cash equivalent transfer value of pensions.
6.10 Annual Governance Statement The Trust has developed and ratified an Annual Governance Statement which describes the overall system of internal control within the organisation. The full version of the Annual Governance Statement can be accessed via the Trust’s public website via the following link: www.dwmh.nhs.uk
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7. Our Current Priorities
7.1 Challenging Times There is no doubt that 2012/13 will be a challenging year for all NHS Trusts. The current economic recession and major system reform have had a significant impact on the NHS and the Trust are faced with the significant challenge of making significant cost efficiencies whilst maintaining and improving the quality of services and the patient experience.
However, with clarity about its future direction, the Trust has a much more straightforward challenge than many. In 2012/13, we will continue to progress with our plans for service transformation adapting as we do so, to external influences and internal pressures. We will also progress with our Foundation Trust application to successful completion and aim to establish the Trust as a high performing Foundation Trust that provides the high quality mental health services that meet the needs of our communities and demonstrate the potential to be ‘better together.’
7.2 Transforming Our Services In January 2010 the Trust published its Clinical and Social Care Strategic Vision which sets out the vision for service delivery over the next five years. In developing this vision the Trust reviewed services, sought stakeholder views, and considered the strategic vision being set locally, regionally and nationally. The Service Transformation Programme is a key driver for change across the Trust, supporting areas and departments to review and redesign pathways and procedures through support, advice and expert knowledge. The Service Transformation Programme is committed to improving the services for local people and delivering improved efficiency. During 2011/12 the Trust launched the new and improved service model within Adult Community Services across Dudley and Walsall. The new model consists of the Early Access Service (EAS), Community & Recovery Service (CRS) and the Transfer & Transition Team (TTT). Wide stakeholder engagement was carried out throughout the year to ensure a good level of understanding across the local health economy. All changes were brought forward in conjunction with our primary care commissioner’s colleagues and involved consultation and engagement, including consideration by the newly formed Clinical Commissioning Boards. A number of service developments took place in 2011/12, including: Phase 1 of the Early Access Service There is one Early Access Service (EAS) in each of the Dudley and Walsall localities working across health and social care. The service acts as a single point of entry for all adult referrals and will provide mental health screening and assessment of all referrals. Its purpose is to create an uncomplicated process for accessing adult secondary care mental health services. A priority for the Trust is to minimise the disruption experienced to service users and their carers, and to maintain safe and effective services throughout the implementation process, and therefore the Early Access Service will be implemented in three phases. Four Community Recovery Services There are two Community and Recovery Teams in each of the Dudley and Walsall localities working across health and social care. The aim of the Community and Recovery Service is to offer evidence-based treatment within a recovery model in order to improve service user independence and access to community care. The service will increase stability in the lives of service users and their carers by providing innovative quality services and prompting autonomy.
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Two Transfer and Transition Teams The Transfer and Transition Team is a recovery based service dedicated to optimising personal strengths and assets of the individual, in order to ensure a long lasting transition from secondary mental health services to full independence. The Transfer and Transition Team will work with service users for up to 6 months to prepare them for discharge back to primary care. Psychiatric Liaison Service in Dudley In July 2011 the Dudley Psychiatric Liaison Service commenced at Russell’s Hall Hospital. The overall aim of the Psychiatric Liaison service is to provide psychiatric and psychological assessment to patients presenting to the Accident & Emergency (A&E) Department. Enhanced Primary Care Service in Walsall The integrated model with primary care mental health & IAPT (Improving Access to Psychological Therapies) began in January 2011. Being financially robust as a relatively small provider of Mental Health Services is key to the continued success of the Trust, and the relationship with our commissioners is a large part of this. During 2011/12, a Mental Health Programme Board was developed locally by commissioners. The Board meets regularly and is made up of key Trust personnel and representatives from all of our commissioners, both Health and Social Care partners. This forum has allowed the Trust to have an open and honest discussion about the development of services and the financial envelope attached, and resulted in agreement that savings required of the Trust will be in line with the NHS Operating Framework 2011/12 and will meet QIPP (Quality, Innovation, Productivity and Prevention) targets also.
7.3 Foundation Trust Progress This year our application to become a Foundation Trust has progressed significantly and we have now received approval from the Secretary of State to progress to the final stage whereby we will be assessed by Monitor (Independent FT Regulator) Between 8
th August and 30
th October the Trust ran a 12 week public consultation on our plans to
become a foundation Trust. The response to the public consultation was very positive; we attended over 40 public meetings, presented directly to around 700 people and gained over 250 formal and informal responses to our plans. We have received many positive comments and feedback on our plans to become an FT with stakeholders showing a real enthusiasm for the Trust’s future plans. In 2012/13 the Trust will carry out Governor’s elections and establish a Council of Governors. In accordance with its Constitution, the Trust will seek to recruit 21 Governors. Governors are a key community link for the Trust. They provide a steer on how the Foundation Trust should carry out its business in ways consistent with the needs of Members and the wider community. Public and Staff Governors are responsible for feeding back to the Trust, via the Council of Governors, the views and ideas of the members they represent. The Trust’s approach to Foundation Trust status will ensure that the Trust, on behalf of the population it serves, truly benefits from the experiences and knowledge of Governors and members, it will also ensure that all decisions taken by the Trust truly take into account patient and wider public perspective. Since 1
st April 2011 through a wide range of engagement events and initiatives the Trust has
successfully recruited over 6,000 public members and 1,100 staff members who are keen to play a part in the future of the Trust and the shaping of mental health services in Dudley and Walsall. This amount of members surpasses the Trust’s expectations at this stage of the recruitment campaign and
E:AR 2010 v4 46
we would like to thank everyone who has shown their support by signing up and been involved in signing up members. Every member will benefit from having the opportunity to more directly influence the development of services, making them more attractive and relevant to local and individual needs.
Staff, through membership, will have greater involvement and ownership of the Trust vision, values and strategic direction, with the ability to influence direction and decisions.
Members and governors can actively reach out into the community promoting positive attitudes to mental health, challenging discrimination and stigma and speaking out for those who use services.
The membership is representative across a number of areas including gender, age, ethnicity and geography and the views of members will play a significant role in how the Trust develops services in the future. Figure 20: Membership Representation by Age and Gender
0
10
20
30
0-16 17-21 22-29 30-39 40-49 50-59 60-74 75+
1.99%
12.96% 14.14%
15.68% 17.19%
12.91%
17.49%
5.86% Perc
en
tag
e
Age
Age
% of Membership
0
10
20
30
40
50
60
70
Unspecified Male Female
0.6%
35.68%
63.72%
Perc
en
tag
e
Genders
Gender
% of Membership
E:AR 2010 v4 47
A member’s magazine is published quarterly and provides updates on the Trust’s application and a range of news about local and national mental health issues. If you have not signed up to be a member yet, please visit www.dwmh.nhs.uk/foundationtrust or call the Membership Team on 01384 364039. You can also send your application in the post. Just send it free of charge to: Freepost Plus RSLK-BXZU-SYKG Dudley & Walsall Mental Health Partnership NHS Trust Corporate Affairs Department, 2nd Floor, Trafalgar House 47-49 King Street Dudley DY2 8PS
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8. Glossary
Acronym
Translation
Meaning / explanation
AIMS Accreditation for Inpatient Mental Health Services
AIMS is an initiative of the CCQI. It is a standards based accreditation programme designed to improve the quality of care in inpatient mental health wards.
A4C Agenda for Change NHS system for job grading and pay determination. A national system which applies to all posts except very senior manager posts and medical staff. Introduced in October 2004, replacing numerous and varied sets of terms and conditions for NHS staff.
AOT Assertive Outreach Team Specific type of community based mental health services which look after people who are ‘hard to engage’ and have a generally high level of complex mental health needs.
BPPC Better Payment Practice Code This is a target that NHS organisations will pay 95% of bills within contract terms or in 30 days where there are no terms agreed.
BAF Board Assurance Framework Reporting infrastructure which enables the Board to monitor progress against the Trust’s strategic objectives.
BAU Business As Usual The time when a project has closed and the new system is used as part of a normal working process.
BFH Bushey Fields Hospital Mental Health Hospital for adults and older people in Dudley. Situated adjacent to Russells Hall Hospital site.
BH Bloxwich Hospital Mental Heath Hospital for older people in Walsall.
BME Black and Minority Ethnic -
CRL Capital Resource Limit This is an expenditure limit determined by the Department of Health for each NHS organisation limiting the amount that may be spent on capital purchases e.g. property or IT equipment.
CARM Contract Activity Review Meeting This is an internal meeting held monthly within the Trust that brings finance, information and operational staff together to discuss the level of patient treatment activity.
C&V/Block Cost and Volume / Block Terminology referring to types of contract. ‘Block’ is a set amount of money which is not related to activity levels. ‘Cost and Volume’ involves payments for services which are related to the quantity of activity delivered. Traditionally, mental health services have been subject mainly to ‘block’ contracts. Gradual move toward C&V.
CAMHS Child and Adolescent Mental Health Services
Mental Health services for under-18s. NB – inpatient beds for under-18s in Dudley and Walsall are provided by Birmingham Children’s Hospital.
CDWs Community Development Workers Posts specific to Mental Health Trusts, established to work with Black and Minority Ethnic communities to improve their understanding of mental health issues and access to services.
CCQI Royal College of Psychiatrists Centre for Quality Improvement
The CCQI provide many national initiatives which aim to improve standards of care in mental health services. They engage directly with managers, clinicians, and service users and support them to take responsibility for improving local services. CCQI also recognises local achievement, offering accreditation. A review process is used whereby high standards of organisation and care are identified and acknowledged.
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CIP / CIT Cost Improvement Programme / Target
Annual targets for reducing costs
CPA Care Programme Approach An overall clinical approach which covers the assessment of individuals’ needs, the planning of their care, evaluation of progress and review of treatment. As a result of CPA, a ‘Care Plan’ is developed and agreed with the service user; this is a comprehensive description of all aspects of the person’s care and treatment.
CQC Care Quality Commission Quality regulator for health and social care providers. In 2010, introduced a system of ‘registering’ providers as a demonstration of quality.
CQUIN Commissioning for Quality and Innovation
CQUIN is a national initiative which aims to embed demonstrable quality improvements within the commissioning cycle for NHS healthcare. The CQUIN payment framework enables commissioners to reward excellence, by linking a proportion of healthcare providers' income to the achievement of local quality improvement goals.
CRHT Crisis Resolution / Home Treatment Specific type of 24-hour community-based mental health service which looks after people when they are in a crisis or acute episode of their illness. Aims to treat the individual at home where possible. If hospital admission is required, this team will ‘gatekeep’ the inpatient beds.
CTO Community Treatment Order Part of the recently revised Mental Health Act which enables someone who remains subject to the Act to be allowed to live in the community, as long as they remain compliant with their treatment.
DAR Donated Asset Reserve The donated asset reserve acknowledges that the Trust has been donated property, plant and equipment from sources external to the Department of Health.
DAAT Drug and Alcohol Action Team Multi-agency team which commissions all drug and alcohol services within a borough.
DGoH Dudley Group of Hospitals NHS provider of acute healthcare services in Dudley. Main hospital site is Russells Hall. They are a Foundation Trust.
DOLS Deprivation of Liberty Safeguards Linked to Mental Capacity Act, DOLS is a governance infrastructure usually used for people in hospitals or care homes who may need to be deprived of their liberty in some way to protect them from harm.
DPH Dorothy Pattison Hospital Mental Health Hospital for adults of working age in Walsall. Situated adjacent to Walsall Manor Hospital site.
DTCs Delayed Transfers of Care A DTC occurs when a patient is ready for transfer from acute care, but whose transfer is delayed due to various reasons, and thus the patient still occupies an acute bed. It is standard practice within the NHS to monitor the percentage of DTCs where the source is attributable to the NHS; this measures the management of these individuals by health and social care.
ECT Electro-convulsive therapy ECT is an effective treatment for a small number of severe mental illnesses, such as severe depression, severe mania or catatonia. ECT consists of passing an electrical current through the brain to produce a carefully controlled epileptic fit or seizure. The exact way in which ECT works remains unknown.
ECTAS ECT Accreditation Service ECTAS is an initiative of the CCQI. It is a standards based accreditation programme designed to improve the quality of the administration of electroconvulsive therapy.
EDS Equality Delivery System This is an optional tool to support NHS commissioners and providers to deliver better outcomes for patients and communities and better working environments for staff, which are personal, fair and diverse.
EIT Early Intervention Team Specific type of community based mental health team which look after younger people experiencing their
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first episode of a psychotic illness. Evidence base suggests that EI approach improves recovery and reduces likelihood of life-long dependency on mental health services.
E- LEARNING
Electronic Learning Training materials that can be used by an individual with or without support as a way of learning and supporting learning.
EUTE End User Training Environment A replica of the software containing fictitious patient data, used to train end users.
EFL External Financing Limit This is a limit set by the Department of Health for each NHS Trust limiting in cash terms the level of external financing it can draw on.
F&P Finance and Performance Committee
This is a sub-committee of the Trust Board that meets monthly
FRR Financial Risk Rating Composite measure of an organisation’s financial ‘riskiness’. Used by Monitor as part of the Foundation Trust application process.
FT Foundation Trust Type of NHS provider organisation which has more autonomy and different governance arrangements. FTs are authorised and regulated by ‘Monitor’. Government policy requires all provider Trusts to be FTs by 2013.
HoNOS Health of the Nation Outcome Scales
HoNOS is a clinical outcome measure that is used to help plan care and interventions for service users, and is completed following the routine clinical assessment of a service users’ needs. 12 simple scales are used on which service users are rated by clinical staff. These ratings can be repeated following a course of treatment or intervention and then compared to the original ones recorded to see if a service users status has changed.
IAPT Improving Access to Psychological Therapies
An NHS programme rolling out services across England offering interventions for treating people with depression and anxiety disorders.
IBP Integrated Business Plan Produced as part of the Foundation Trust application process, the IBP must follow a standard 9-chapter template. The IBP forms the basis of assessment for Foundation Trust readiness.
KPIs Key Performance Indicators These are measures of performance and are used by the Trust to evaluate levels of success in achieving its goals
LD Learning Disabilities LD services are not provided by DWMHPT.
LHE Local Health Economy Term used to refer to a system of health organisations within a geographical area, usually within the boundary of a particular Local Authority.
LINk Local Involvement Network LINks are made up of community groups and individuals working together to improve NHS and social care services. Health and social care providers encourage people to join LINks. They use the information LINks provides to shape the services they deliver.
LOS Length of Stay The length of time that someone remains in hospital.
LTFM Long Term Financial Model Accompanies the IBP. Describes the financial plans for the Trust over at least a 5-year period.
MBC Metropolitan Borough Council DWMHPT covers two: Walsall and Dudley.
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MCA Mental Capacity Act Relatively new piece of legislation which has much wider application than mental health services. Aims to assess individuals’ capacity to make decisions.
MExT Management Executive Team A regular meeting. The Management Executive of the Trust meet regularly to discuss relevant Trust business and progresses.
MHA Mental Health Act Specific legislation which allows mental health Trusts and some other agencies to detain an individual against their will for assessment or treatment. Mental Health Trusts are required to establish a sub-committee of the Board which scrutinises its application of the Act.
MHMDS Mental Health Minimum Data Set Set of information which is used as the basis for measuring, recording and evaluating activity.
MRSA meticillin-resistant Staphylococcus aureus
MRSA is a common skin bacterium that is resistant to a range of antibiotics, including meticillin. ‘Meticillin-resistant' means the bacteria are unaffected by the meticillin. About 1/3 of us carry the SA bacteria on the surface of our skin or in our nose without developing infection, this is known as being colonised by the bacteria. MRSA infection occurs when the bacteria enter the body through a break in the skin and multiply, causing various symptoms (often swelling and redness at the site of infection).
MSNAP Memory Services National Accreditation Programme
MSNAP an initiative of the CCQI. It is a standards based accreditation programme designed to improve the quality of care received by individuals with memory problems and dementia. Focuses is on the assessment and diagnosis process.
NHS National Health Service
NHSLA National Health Service Litigation Authority
A Special Health Authority which deals with legal claims against NHS organisations. Based on a risk-pooling concept, NHS Trusts pay a yearly subscription, based on their risk profile and the nature of services provided. Assesses Trusts against a range of risk management standards. DWMHPT is currently accredited at NHSLA level 1.
NPSA National Patient Safety Agency The NPSA are a body of the Department of Health. It leads and contributes to improved, safe patient care by informing, supporting and influencing the NHS.
NICE National Institute for Health and Clinical Excellence
NICE is an independent organisation responsible for providing national guidance on promoting good health and preventing and treating ill health.
NTA National Treatment Agency A Special Health Authority which oversees drug treatment.
‘Oasis’ - Patient information system implemented by the Trust.
OBD Occupied bed day Unit of activity used in hospital care
OD Organisational Development The development, implementation and review of various strategies and plans to improve an organisation.
OT Occupational Therapy Professional group within mental health
PALs Patient Advise Liaison Service The Patient Advice and Liaison Service, known as PALS, has been introduced to ensure that the NHS listens to patients, their relatives, carers and friends and answers their questions and resolves their concerns as quickly as possible,
PBR Payment by Results System within which there are standardised national prices for healthcare interventions. Mental health services are not currently subject to this tariff.
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PRM Performance Review Meeting with Commissioners
The Trust meets regularly with its Commissioners to discuss the quality and activity performance. Through these meetings, the Trust’s key commissioners can hold the Trust to account.
PDC Public Dividend Capital This is a payment made each year by the Trust to the Department of Health to reflect the investment they have provided. It is calculated at 3.5% of the Trust’s asset base and is generally regarded as being equivalent to the long term cost of capital in the public sector.
PCT Primary Care Trust NHS organisations currently responsible for public health needs assessment, commissioning healthcare services and providing community services. NHS White Paper has stated that PCTs will be abolished.
PEAT Patient Environment Action Team A national programme of assessment managed by the NPSA. PEAT is a benchmarking tool which helps demonstrate how well healthcare providers are performing in non-clinical aspects of patient care, focusing on care environment, food, privacy and dignity.
PID Project Initiation Document Document which is developed at the beginning of a project which describes how the project will be implemented, how decisions will be made and what arrangements for reporting and accountability are in place.
PIP Productivity Improvement Project National project for mental health services which will enable better evaluation of productivity and crucially, help to prepare mental health services for a tariff. Within the Trust, this project is led by Phillip Hogarth.
PMO Project Management Office
RAG Red/Amber/Green A system of categorising performance / risk etc, indicating how a particular plan or action is progressing.
SHA Strategic Health Authority Region-wide NHS body which oversees strategy and performance – there are ten in England. Recent White Paper has proposed that SHAs be abolished.
SI/SUI Serious Incident/Serious Untoward Incident
Any unplanned occurrence which has actual or potential negative impact.
SLA Service Level Agreement Agreement between two organisations where one is providing a service to the other. Describes the nature of the service and usually, the financial arrangements in place to support the exchange. Utilised a great deal within the NHS as contracts between NHS organisations (except Foundation Trusts) are not legally enforceable.
SMHFT Sandwell Mental Health & Social Care Foundation Trust
Partner organisation providing key support for project deployments.
TCS Transforming Community Services National policy directive under which PCTs are required to divest themselves of the management of all provider services. This must be effected by April 2012.
TNA Training Needs Analysis An analysis of the current skills of a learner which is used to determine the skills to be developed.
TtT Train the Trainer
A training course to show trainers how to use software to enable them to train end users.
YTD Year to Date Term often used in financial reporting meaning from the beginning of the financial year to this point in time’.
