AGENDA...Derbyshire Community Health Services Council of Governors Council of Governors 10 November...

Derbyshire�Community�Health�Services

Council�of�Governors

Council�of�Governors

10�November�2016�-�14:00

The�Postmill�Centre,�Market�Street,�South�Normanton�Derbyshire,�DE55�2EJ

AGENDA

111 Chairman’s�Welcome�and�Introduction�of�GovernorsOwner:�Chair

Verbal

112 Apologies:�Maureen�Strelley,�Sally-ann�Coope,�Andrea�Cooke,�Chris�BentleyOwner:�Chair

Verbal

113 Declarations�of�InterestOwner:�Chair

Verbal

114 Draft�Minutes�of�the�meeting�held�on�7�September�2016Owner:�Chair

Paper�for�Decision

114�Minutes�Sept�2016 5

115 Matters�ArisingOwner:�Chair

Verbal

http://www.eshareuk.com

116 Actions�MatrixOwner:�Chair

Paper�for�Information

116�CoG�Actions�Matrix 10

117 Patient�StoryOwner:�Carolyn�White


117�Patient�Story��November�2016 11

118 Performance�and�Quality�-�Holding�to�Account

119 Quality�and�Performance�Report�Owner:�Carolyn�White,�Chris�Sands


119�Quality�and�Performance�Report�Sept�2016 15

120 Staff�Health�and�Wellbeing�Owner:�Jamie�Broadley


120�Staff�Health�and�Wellbeing 27

121 Audit�and�Assurance�CommitteeOwner:�Nigel�Smith

Presentation

121�Audit�Committee�Powerpoint�Presentation 32

122 Nominations�and�Remuneration�Committee�Summary�ReportOwner:�Chair

Paper�for�Information�and�Decision

122�Nominations�Committee�Summary�Report�to�CoG 47122�DCHS�Council�of�Governors�Code�of�Conduct 55

123 Annual�Review�the�Governance�GroupOwner:�Bernard�Thorpe


123�Governance�Group�Annual�Report 66


124 Updates�from�the��Governor�GroupsVerbal

125 Strategy�and�Planning

126 Developing�the�Strategic�and�Operational�PlansOwner:�Tim�Broadley


126�Operational�Planning�Paper 69

127 Chief�Executive’s�ReportOwner:�Tracy�Allen


127�Chief�Exective's�Report�November�16 72

128 Governance

129 Trust�Secretary’s�ReportOwner:�Kirsteen�Farrar


129�Trust�Secretary's�Report 83

130 Concluding�Items

131 Any�Other�Business

132 Council�of�Governors�-�Review�of�MeetingOwner:�Chair

Verbal

133 Date�of�Next�Meeting:Wednesday�11�January�at�2.00pm�at�The�Post�MillCentre,�Market�Close,�South�Normanton,�DE55�2EJ�Owner:�Chair

Verbal

134 Key�Dates�and�Future�EventsOwner:�David�Boddy


134�Key�Dates�and�Future�Events 86

Attendees


Index114�Minutes�Sept�2016.pdf.......................................................................................................5

116�CoG�Actions�Matrix.pdf....................................................................................................10

117�Patient�Story��November�2016.pdf...................................................................................11

119�Quality�and�Performance�Report�Sept�2016.pdf..............................................................15

120�Staff�Health�and�Wellbeing.pdf........................................................................................ 27

121�Audit�Committee�Powerpoint�Presentation.pptx.............................................................. 32

122�Nominations�Committee�Summary�Report�to�CoG.pdf....................................................47

122�DCHS�Council�of�Governors�Code�of�Conduct.pdf..........................................................55

123�Governance�Group�Annual�Report.pdf............................................................................ 66

126�Operational�Planning�Paper.pdf.......................................................................................69

127�Chief�Exective's�Report�November�16.pdf....................................................................... 72

129�Trust�Secretary's�Report.pdf............................................................................................ 83

134�Key�Dates�and�Future�Events.pdf....................................................................................86


Council of Governors

Minutes of the Meeting held on 7 September 2016

Postmill Centre, Market Close, South Normanton, Alfreton, DE55 2EJ

Present

Name Job title

Prem Singh PS Chair – Non-Executive Director

Ray Asher RA Deputy Lead Governor - Public Governor - Amber Valley, Erewash & South Derbyshire

Valarie Broom VBr Public Governor - Amber Valley, Erewash & South Derbyshire

Michael John Perry

MP Public Governor - Amber Valley, Erewash & South Derbyshire

Roz Coldicott RC Public Governor - Amber Valley, Erewash & South Derbyshire

Barry Jex BJ Public Governor - Bolsover, Chesterfield & NE Derbyshire

Bridget Leech BLe Public Governor - Amber Valley, Erewash & South Derbyshire

Maureen Strelley MS Public Governor - Bolsover, Chesterfield & NE Derbyshire

Roger Green RG Public Governor - Derbyshire Dales & High Peak

Brenda Greaves BG Public Governor - Derbyshire Dales & High Peak

Lorraine Culpin LC Public Governor - Bolsover, Chesterfield & NE Derbyshire

Diana Wood DW Public Governor - Rest of England

Bernard Thorpe BT Lead Governor - Public Governor - City of Derby

Peter Ashworth PAs Public Governor - Amber Valley, Erewash & South Derbyshire

Joan Johnson JJ Staff Governor - Healthcare Support Staff

Emma Brooks EM Staff Governor - Other Registered Professionals

Sara Nash SN Staff Governor - Other Registered Professionals

Sally-Ann Coope SAC Staff Governor - Nursing

Adam Short ASh Staff Governor - A and C and Managers

Paul Jones PJ Appointed Governor - Derbyshire County Council

Jenny Swatton JSw Appointed Governor - Southern Derbyshire Clinical Commissioning Group

114�Minutes�Sept�2016.pdfOverall�Page�5�of�86Page�1�of�5


Apologies

Andrea Cooke AC Public Governor - Derbyshire Dales & High Peak

Tabitha Crapper TC Staff Governor - Healthcare Support Staff

Veronica Hunting-Young

VHY Staff Governor - Nursing

Paul Kirtley PK Public Governor - Derbyshire Dales & High Peak

Maggie Parry-Hughes

MPH Staff Governor - Nursing

Amanda Smith ASm Staff Governor - Medical and Dental

Mark Smith MSm Appointed Governor - North Derbyshire Clinical Commissioning Group

Kirsteen Farrar KF Trust Secretary

Tim Broadley TB Deputy Director of Corporate Strategy

Jim Austin JW Associate Director of Transformation

Amanda Rawlings AR Director of People and Organisational Effectiveness

John Coyne JC Non-Executive Director

Nigel Smith NS Non-Executive Director

Barbara-Anne Walker

BAW Vice Chair Non-Executive Director

In Attendance

Carolyn White CW Director of Quality/Chief Nurse

Rick Meredith RM Medical Director

Jen Guiver JG Deputy Director of People and Organisational Effectiveness

William Jones WJ Chief Operating Officer

Melanie Curd MC Deputy Trust Secretary

Ian Lichfield IL Non-Executive Director

Chris Sands CS Director of Finance, Information and Strategy

Rob Steel RS Head of Communications

Lizzie Barrett LB Marketing Officer

Lauren Shiel LS Engagement Officer

David Boddy DB Corporate Governance manager

Item Description Action

94/16 Chairman’s Welcome and Introduction of Governors PS welcomed the governors to the meeting. PS said that the term of office was ending for a number of governors who were not standing for re-election. On behalf of the Board and the Council of Governors he thanked Barry Jex, Emma Brooks, Joan Johnson, Bridget Leech and Maggie Parry-Hughes for their service and their support to DCHS.

95/16 Apologies for Absence Apologies were noted as above.

96/16 Declarations of Interest None.

97/16 Draft Minutes of the Meeting held on 12 July 2016 The minutes were approved as an accurate record of the meeting.

98/16 Matters Arising None.




99/16 Actions Matrix The actions were noted as completed. CW provided further information to address issues of concern raised about the July Patient Story. The story had focused on a patient who was discharged from hospital and the level of support provided by a volunteer. CW reported that the discharge review took place as planned with all the appropriate checks. There was a prolonged assessment on the ward which was followed by an assessment at home. The patient was able to make decisions, and although the discharge from hospital was less than desirable, we had to follow the patient’s firm wish to return home. The discharge prompted the use of the volunteer to help support the patient’s return to home. BG asked about the protection for volunteers when they are working in the patient’s home. CW discussed the training that is provided to volunteers when working with clients.

100/16 Quality and Performance - Holding to Account

101/16 Quality and Performance Report The Council discussed the overview of the Trust’s performance against the quality objectives and regulatory performance targets. Quality CW updated the governors regarding the new “Back to the Floor” initiative that has seen managers and directors from across DCHS working alongside clinical teams to better understand the issues that impede care delivery. Results and feedback from the first event are being collated so that we can ensure that the formal roll out in September goes smoothly. The Council discussed in detail the importance of patient compliance with clinical advice and guidance, particularly with respect to avoidance of Pressure Ulcers. It was agreed that it is important for staff to spend time explaining to their patients so that they can fully understand the importance of the instructions. It was accepted that although it is frustrating, some patients do not accept the advice or the supporting equipment that is recommended to them. CW said the initial feedback from the Care Quality Commission (CQC) visit is that overall it will be providing a good rating. DCHS has responded to the CQC with comments regarding factual accuracy, which are being considered before their report is published. A Quality Summit will be held in September and Lead Governor BT and a member of the Quality Group will be invited to attend. Finance CS commented that nationally the NHS is in a period of change. However, the performance of DCHS in Quarter 1 was very strong. The Financial Sustainability Rating year end forecast is level 4 which represents a low risk, reflecting the strong balance sheet of the Trust and the forecast surplus position. CS thanked the staff for their contribution to this good performance by carefully looking after the resources.




Big 9 The Council reviewed the Big 9 and in particular the performance of Pressure Ulcers and staff health and wellbeing. Following a question from BT, JG updated the governors regarding the work underway to improve the staff health and wellbeing performance. The paper was received for information.

102/16 Strategy and Planning

103/16 Chief Executive’s Report TA discussed the work going on to support the key strategic developments:

Derbyshire Sustainability and Transformation Plan

Better Care Closer to Home Consultation – we have now had the chance to talk to over 1000 staff and we will be developing a formal DCHS response. TA emphasised how impressed she was with the professional response from staff whose teams may be affected. TA said that their expertise is at the heart of what should come out of the consultation.

Collaboration with Derbyshire Healthcare NHS Foundation Trust – the engagement day with DHcFT Board and Council of Governors had been a success in exploring the benefits of closer collaboration. BT said that it had been a very constructive meeting. AS said that sensitivity should be given to the DHcFT staff perception and morale

Sheffield City Region Combined Authority Consultation – the consultation concluded in August

PS commented that the developments across the system are very important because there is a significant connection between economy, housing and health. To bridge the gap in health we must consider the other factors too. TA also highlighted:

Unicef Baby Friendly Re-accreditation - the Trust’s children’s community services teams have successfully achieved reaccreditation as ‘Baby Friendly’ following an assessment by Unicef UK in July

Quality Always Accreditation – the accreditation work has now awarded the gold standard to 6 teams

PLACE inspection results – the PLACE results for 2016 were very positive

The paper was received for information.

104/16 Governance

105/16 Trust Secretary’s Report MC updated the governors regarding: Council of Governors Self-Assessment The assessment concluded in July. We are grateful to the large number of Governors who participated in the survey. A report on the findings from the assessment will be presented to the November Council of Governors with recommendations for the next steps to be undertaken. Council of Governors elections The Nominations stage has successfully concluded with nominations received for all the vacant seats. The results of the voting will be posted on the DCHS




website on 3 October. A number of governors are standing for re-election. They are Andrea Cooke, Roger Green, Lorraine Culpin, Veronica Hunting-Young, Mike Perry and Valerie Broom. PS thanked the governors for their service and support. PS congratulated the Communications team for their efforts in securing the high number of nominations. The report was received for information.

106/16 Concluding items

107/16 Any Other Business PA asked whether DCHS monitor the volume of demand for services. WJ confirmed service usage is recorded. With respect to the particular use of the Heanor Podiatry service, WJ will investigate the demand and report back. SAC asked about the possible impact of the scheduled industrial action by junior doctors on DCHS. WJ and TA talked about the recent industrial action and how it had impacted on the acute hospitals and then across the system, including DCHS Planned Care. PM asked about the processes in place for patients to return equipment. WJ discussed the role of Medequip in distributing and returning equipment. A number of governors reported mixed personal experiences.

WJ

108/16 Council of Governors - Review of Meeting The governors agreed it had been a very good meeting which had been shortened to essential business so that the Annual Governor’s meeting (including the Annual member’s meeting) could then take place.

109/16 Time and Date of Next Meeting: Thursday 10 November at 2.00pm at The Post Mill Centre, Market Close, South Normanton, DE55 2EJ

110/16 Key Dates and Future Events The Council was advised of the dates, times and venues for meetings in 2016.



COUNCIL OF GOVERNORS - ACTIONS MATRIX DATE: November 2016

Date/Item No:

Item/ subject:

Decision taken and/or Action required:

Progress: Responsible Person:

Deadline: Outcome:

Sept 107/16

Any other business

Demand for usage of Heanor Podiatry Services to be investigated and reported back

William Jones Nov 2016 Complete

116�CoG�Actions�Matrix.pdfOverall�Page�10�of�86Page�1�of�1


COUNCIL OF GOVERNORS

Title of Paper: Lizzie’s Story

Paper for: Information

Presenter: Carolyn White, Chief Nurse/Director of Quality

Author: Lizzie Platt, Patient and Nick Firth, Clinical Psychologist

Date of Meeting: 10th November 2016

Agenda Item No: 117/16

No of pages incl this one: 4

Appendices:

Purpose of Paper

To raise awareness of the impact of the Health Psychology Service, as described by Lizzie Platt, a service user who has had a positive outcome.

Summary

Lizzie My name is Claire, but I’m known as Lizzie. I am a 45-year-old mum of two teenagers and a wife. I am also a teacher. I suffer from atypical face pain. My pain is from the trigeminal nerve in the right hand side of my face and it manifests itself in a variety of ways. The first way is that the right hand side of my face is nowhere near as sensitive to touch as the rest of my face; I describe it as feeling like putty. It doesn’t move in the same way, my eyebrow and the corner of my mouth have dropped slightly and I have constant pins and needles across my scalp. The second way is that the nerve feels like it has shooting, electric shock like pain radiating out from my temple to my jaw and around the top and bottom of my eye. The final way is that I get pain deep down in my face; it feels like my face is being pulled down and away from the bones underneath. This condition has affected my life significantly in the last 8 years. At its worst it has left me unable to work or function, off work for months at a time and at its best prevented me from going out to shop or to parents’ evening. I have had to leave jobs I loved, such as a Senior Lecturer at University and an Assistant Headship, as my pain was exacerbated by stress and I found that I was having considerable absence. Even as a classroom teacher I found it hard to work, as the painkillers and preventative medication I took would often leave me groggy and unable to think on my feet. Most significantly my family was suffering, and this was what was upsetting me the most. I would fight to keep going and fight to get over this and get the pain to go away. I was not ready to accept that I had a lifelong condition; I was fighting every step of the way to “get better”.

117�Patient�Story��November�20Overall�Page�11�of�86Page�1�of�4


In 2015 I had an incident in my role as a teacher of special needs children that left me at home recuperating from an injury. My face was hurting me considerably and I was taking Tramadol and other medication to try and control it. I counted once and realised that I was taking 22-28 tablets a day to try and live a normal life. Somewhere amongst the fogginess that accompanied this I had a realisation that this was the 4th job I may well have to walk away from due to the pain in my face. It also hit me that this was never going to go away, tablets would never control it fully, it would never get better, it was something I had to learn to live with and stop fighting it. This was actually the lowest point I had, it was the point I said goodbye to the old me and started to try and find a new me. I went to my GP, who was fantastic. She explained about the service they offer at Walton Hospital and, after discussion, referred me through to them. After an initial assessment, this is when I began working with Nick. I went to the first appointment unsure as to what would happen but with a very clear idea that I would try anything to see if it would help me. I was open minded and prepared to be honest. At times I would talk about things that I had never really voiced to anyone else. Nick would run through ideas of strategies for me to try and would help me by explaining how I could possibly adjust things so they worked for me. He also made sure I would have hand-outs and data of what studies had said and how to practice the techniques and strategies (I’m a scientist and once a scientist, always a scientist!) It wasn’t a magic wand that magically made the pain disappear, but it was like a toolbox of strategies I kept adding to. I was encouraged to keep practicing the techniques even when I didn’t have pain so that if I needed to use it when I was in pain it was easier for me to do so. One strategy was visualisation. This involves seeing the pain in a different way, so instead of seeing it as electric shocks radiating out from my temple, I began to visualise it as a warm feeling gradually spreading like the films you see of mould growing - it worked. There was one strategy that didn’t work for me, but this was ok, we moved on to try another one that did. Through the process I began to accept that whilst I wasn’t the “old me” of pre-face pain, I was a “new me” and that was OK. I think the most significant thing was when I did experience a day of really severe face pain. In the past I would have phoned into work and been off for several days, if not weeks. I would have reached for the pain killers and existed in a fog of drowsiness and pain until it passed. This time I didn’t, I made the phone call to work and took 2 x Co-codamol. I then settled to concentrate on using the strategies I had learnt. I needed no more painkillers and was back at work the next day. This was the first time in 8 years I had needed only one day off, it was also the first time I had not relied on pain medication alone for severe pain. I have also had a medication review recently and am now taking only 9 tablets a day as preventatives, not the 22-28 I was taking in the past. Over the summer break we will be looking at reducing these again. I no longer have Tramadol on repeat prescription. Most importantly I am now a proper mum and wife who has face pain, but doesn’t live in its shadow. I accept I will have bad days, but I also know I have the tools to cope with it and manage it better. It has been a team effort getting to this point, but a team effort that has led me to feel confident enough to “fly solo”.



Nick My name is Nick Firth, and I’m a clinical psychologist with the Health Psychology Service. We are a team of clinical psychologists, psychotherapists, and assistant psychologists. We provide short-term psychological input to adults with physical health conditions across the lifespan. Typically, this might involve 6 to 8 individual sessions, each around an hour long. People usually come to meet with us if their physical health situation is negatively impacting on their mental health, or vice versa. We aim to help people to make positive changes in their lives. Usually this involves focusing on thoughts, feelings, behaviours, and relationships. Lizzie and I met for eight 1:1 sessions, approximately every fortnight. Lizzie’s goals were 1) To manage and cope with pain 2) To work towards acceptance of her condition, and living well with it. We used a collaborative approach, employing a number of different psychological models and techniques. Lizzie is someone with a lot of strength, dedication, and psychological resources to draw on. I aimed to offer Lizzie support and encouragement, knowledge about specific techniques, and a framework to explore new ideas for positive changes. I think that the most important areas of our work together included:

1) Reflection, exploration, and understanding, including themes around identity (for example,

thinking about “old me” versus “new me”), grief and loss, and acceptance.

2) A “toolbox” of specific strategies. These included pain & sleep management techniques

and approaches, relaxation strategies, strategies to respond to difficult thoughts and

feelings, and to re-engage with life and valued activities.

3) Reinforcing Lizzie’s abilities to look after herself, and to seek and receive support from her

friends and family

4) Preparing for setbacks and blips. We discussed appropriate expectations about the future,

and how to deal with challenges. We currently have an open appointment for 6 months,

and Lizzie can arrange a follow-up meeting if she feels she needs one.

What should we learn? 1) We need to recognise the importance of joint working. This work was a partnership, with

each of us bringing knowledge, skills and resources. It is important to value the strengths

and resources of the person we are working with, to work flexibly to meet their needs and

goals, and to respect their history and “the way they do things”. It is also important to have

a strong therapeutic relationship built on respect and openness. This helped us to review

progress, and take note of what was working and what was difficult.

2) We need to remember that even though we can support patients to make important

conclusions, and to discover and learn more about themselves, these decisions and

conclusions need to be reached by the patient themselves, in their own time.

One of the most important parts of this work was engaging with realistic plans for setbacks. This includes being open and honest about what might realistically be expected, as well as what might prove difficult and how to deal with that. Lizzie gave an example of a testing set-back above.



Fortunately, Lizzie was able to work through this and respond differently to how she might have responded previously. And in fact, successfully negotiating this obstacle gave Lizzie even more confidence than she had before! It was Lizzie’s positive and enthusiastic email to me after this setback that made me suggest writing a patient story.

Recommendations

That governors note the collaborative and person centred approach to goal planning for long term pain management.



1


Title of Paper: Quality and Performance Report


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

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



No of pages inc. this one: 12

Appendices:

Appendix 1, Quality Report (pages 3 - 5) Appendix 2, Regulatory Framework (page 6) Appendix 3, Referral To Treatment Waiting Times (pages 7-9) Appendix 4, Finance Report (pages 10 - 11) Appendix 5, Big 9 (page 12)

Purpose of Paper

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

1. Quality Report The Trust has set itself a number of quality objectives to support the delivery of its Quality Strategy. The objectives are: • Keep patients safe • Put patients (and family) at the centre of care • Get the basics right The quality section of this report provides Governors with an overview of the Trust’s performance against key performance indicators in each of these three areas for the month.

2. Regulatory Performance Report The third part of the report provides an update on the Trust’s performance against the regulatory performance indicators included within the Provider License by the regulator of foundation trusts, Monitor, for the first three months of 2016/17. The position for month 6 shows that the Trust has no area of risk with a red rating. The quarterly percentage of Older People’s Mental Health (OPMH) Delayed Transfer of Care is 0% against a target of 7.5%. There is continued focus on discharge planning and escalation of issues.

119�Quality�and�Performance�ReOverall�Page�15�of�86Page�1�of�12


2

3. Referral to Treatment (RTT) Waiting Times RTT Waiting Times information is now enclosed at Appendix 3.

4. Finance Report The Trust is reporting a surplus position of £4.12m at month 6, which represents a £0.53m surplus variance against the planned surplus of £3.59m. We are forecasting a year end surplus of £4.56m, which is consistent with our control total set by NHS Improvement.

5. Big 9

The Quality and Performance report provides an update of Trust progress against the “Big 9” key performance indicators which were agreed as part of the Annual Planning process.

Summary

See appendices below.

Recommendations

The Council of Governors is asked to receive this report for information.



3

APPENDIX 1 QUALITY REPORT

1. Quality performance This report provides governors with an overview of performance for quarter 2 (July to September 2016)

Key Messages

Harm Free Care (HFC) scores continue to perform just below the improvement target of 94%

There were no medication incidents which caused significant harm during Q2

There were no methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia or Clostridium difficile infections reported in Q2

There were 24 falls which resulted in harm reported during Q2

There have been 20 verified avoidable pressure ulcers during Q2

a. Harm free care The NHS safety thermometer is designed to measure local improvement over time using 4 safety

incident measures. Pressure ulcers, venous thrombo embolism, catheter associated urinary infections and falls.

Table 1 illustrates the performance of different areas during Q2

Table 1 Harm Free Care Scores: Jul-16 Aug-16 Sep-16

All Trust 93.29 92.32 92.75

Rehab Wards 92.25 86.89 92.31

Older Peoples MH Wards 97.56 100 97.73

District Nursing 93.21 92.42 92.6

Learning Disability Services

100 100 100

89.00

90.00

91.00

92.00

93.00

94.00

95.00

96.00

% o

f p

atie

nts

re

ceiv

ing

Har

m F

ree

ca

re

DCHS Harm FreeCare Score (HFC)

DCHS Target (HFC)

DCHS DistrictNursing (HFC)



4

2. Quality Improvement

This section reports on some of the quality initiatives undertaken during quarter 2 2.1 Care Quality Commission (CQC)

DCHS is currently in the process of assessing the findings of the recent CQC formal reports. Action plans related to requirement notices (things the CQC identified that the trust ‘must’ improve) have been submitted within the required time frame. All of the recommendations regarding actions that ‘Must’ and ‘Should’ be considered have been collated into a central development plan which will be monitored through divisional governance meetings and reported through our governance processes. We will then work with teams to identify actions needed to work towards the ‘Outstanding’ criteria. Castle Street Medical practice have been notified of their CQC inspection which is now due to take place on 31st October 2016 CQC rating boards The trust is required to display posters of our current CQC ratings at each of the properties used to provide clinical services. This work has been actioned within the required timescales and portable table top displays are available to be utilised by DCHS clinical staff who are providing care within a range of settings. Governors are advised that Derbyshire Healthcare NHS Foundation trust’s (DHCT) CQC report was published on 29th September 2016, overall they were rated as requires improvement. Their report can be found at http://www.cqc.org.uk/sites/default/files/new_reports/AAAF6108.pdf DHCT are awaiting a date for their quality summit.

2.2 Falls Awareness Day

A falls awareness day was held at Babington Hospital Day unit on 7th October. This informative market style event showcased a range of support services for older people to improve falls management including dietary advice, footwear, support for the visually impaired, mobility aids and included voluntary and partner organisation including out local community police team. A range of taster exercise classes were held during the day. The event was open to members of the public and staff.

2.3 Schwartz Round

The trusts first Schwartz round was held in Buxton on 13th October. Schwartz rounds provide a structured forum where staff can come together to discuss difficult emotional and social issues arising from patient care in a confidential and supportive setting. A 5 person panel each shared their experience under the title ‘A patient I will never forget’. The session was attended by a range of staff from the Buxton area including clinical staff, managers and administration staff. The session was observed by a colleague from Derbyshire


http://www.cqc.org.uk/sites/default/files/new_reports/AAAF6108.pdf


5

Healthcare trust who is acting as a mentor to our Schwartz round team.

Further Schwartz rounds will be held across the county over the coming months.

2.4 Quality Always Gold Accreditation Hillside ward Ash Green, Alton ward Clay Cross and Orchard Cottage Respite Core Unit Whitworth all presented their areas for accreditation on 6th October as part of the final stage of the Quality Always accreditation process. Each presentation was unique in its own way and show cased the work of the respective areas. Clients from both learning disability units attended and added to the richness of the presentations and demonstrated how well these services are valued by their users. All three areas received their Gold accreditation which were presented by the Chairman.

2.5 Care Homes Stakeholder Event.

The Care Home Advisory Service held their annual stakeholder event on 5th October.The theme of the event was Dementia care and presentations included the subjects of frailty and falls management. The event was well attended by staff from local care homes and very well evaluated at the end of the day.



6

APPENDIX 2 – REGULATORY PERFORMANCE



7

APPENDIX 3 – RFERRAL TO TREATMENT WAITING TIMES

AHP-Led Referral to Treatment Schedule in Weeks (September 16) - Clocks ended in September

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

Total

Waiters

Max

Waiter

>6 week

waiter

total

%

Waiting

over 6w

>13

week

waiter

total

% Waiting

over 13w

Planned Care

AVE MOPP 2337 286 10 4 2637 25 300 11.4% 14 0.5%

CHE MOPP 1453 419 22 20 1914 32 461 24.1% 42 2.2%

HPD MOPP 1146 126 5 1 1278 18 132 10.3% 6 0.5%

Speech and Language Therapy 594 158 13 0 765 16 171 22.4% 13 1.7%

6594 75 1.1%

ICBS

AV 256 69 18 3 346 29 61 17.6% 21 6.1%

ERE 275 53 7 1 336 23 15 4.5% 8 2.4%

SDSD 234 14 1 0 249 15 92 36.9% 1 0.4%

CHE 217 86 6 0 309 17 55 17.8% 6 1.9%

NED 417 43 8 4 472 22 9 1.9% 12 2.5%

HPD 191 4 1 4 200 31 1 0.5% 5 2.5%

Disability Services 13 1 0 0 14 10 32 228.6% 0 0.0%

Respiratory Services 118 31 1 0 150 15 13 8.7% 1 0.7%

Learning Disabilities 20 11 1 1 33 28 6 18.2% 2 6.1%

2109 56 2.7%

All Services 7271 1301 93 38 8703 0.0% 262 3.0%

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

Total

Waiters

Max

Waiter

>6 week

waiter

total

%

Waiting

over 6w

>18

week

waiter

total

% Waiting

over 18w

General Surgery 5 18 1 1 25 30 20 80% 1 4%

Urology 2 9 23 7 41 33 39 95% 7 17%

Trauma & Orthopaedics 22 25 25 4 76 31 54 71% 4 5%

Ear, Nose & Throat (ENT) 0 2 3 0 5 16 5 100% 0 0%

Ophthalmology 49 74 30 5 158 22 109 69% 5 3%

Oral Surgery 0 0 0 0 0 0 0 0

Neurosurgery 0 0 0 0 0 0 0 0

Plastic Surgery 0 0 0 0 0 0 0 0

Cardiothoracic Surgery 0 0 0 0 0 0 0 0

General Medicine 0 0 0 0 0 0 0 0

Gastroenterology 0 0 0 0 0 0 0 0

Cardiology 0 0 0 0 0 0 0 0

Dermatology 13 17 16 4 50 27 37 74% 4 8%

Thoracic Medicine 0 0 0 0 0 0 0 0

Neurology 0 0 0 0 0 0 0 0

Rheumatology 0 0 0 0 0 0 0 0

Geriatric Medicine 0 0 0 0 0 0 0 0

Gynaecology 1 4 1 0 6 14 5 83% 0 0%

Other 0 0 0 0 0 0 0 0

Derbys Dental 83 28 4 0 115 15 32 0% 0 0%

Leics Dental 15 9 42 9 75 26 60 0% 9 0%

All Services 190 186 145 30 551 33.0 361 65.5% 30 5.4%

Consultant-Led Referral to Treatment Schedule in Weeks (September 16) - Clocks ended in September - Admitted Patient

Care (Part 1A - Unadjusted)



8

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

Total

Waiters

Max

Waiter

>6 week

waiter

total

%

Waiting

over 6w

>18

week

waiter

total

% Waiting

over 18w

Planned Care

General Surgery 30 9 10 16 65 31 35 54% 16 25%

Urology 4 10 7 3 24 37 20 83% 3 13%



Ophthalmology 61 10 5 0 76 17 15 20% 0 0%

Oral Surgery 0 0 0 0 0 0 0 0





Gastroenterology 10 2 2 3 17 21 7 41% 3 18%

Cardiology 3 17 5 0 25 15 22 88% 0 0%

Dermatology 117 50 9 1 177 26 60 34% 1 1%


Neurology 0 0 0 0 0 0 0 0

Rheumatology 3 0 0 0 3 0 0 0% 0 0%

Geriatric Medicine 1 11 1 0 13 16 12 92% 0 0%

Gynaecology 16 18 3 0 37 17 21 57% 0 0%

Other 15 14 3 2 34 29 19 56% 2 6%

Total 380 280 101 34 795 37.0 415 52.2% 34 4.3%

Consultant-Led Referral to Treatment Schedule in Weeks (September 16) - Clocks still running (Part 2)

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

Total

Waiters

Max

Waiter

>6 week

waiter

total

%

Waiting

over 6w

>18

week

waiter

total

% Waiting

over 18w

Planned Care

General Surgery 232 145 41 19 437 31 205 47% 19 4%

Urology 56 56 33 10 155 24 99 64% 10 6%



Ophthalmology 277 156 71 6 510 25 233 46% 6 1%

Oral Surgery 0 0 0 0 0 0 0 0





Gastroenterology 66 48 13 5 132 28 66 50% 5 4%

Cardiology 76 57 47 6 186 26 110 59% 6 3%

Dermatology 379 147 37 5 568 19 189 33% 5 1%


Neurology 0 0 0 0 0 0 0 0


Geriatric Medicine 32 12 6 1 51 18 19 37% 1 2%

Gynaecology 121 52 20 4 197 24 76 39% 4 2%

Other 0 26 0 0% 0 0%

Derbys Dental 97 19 0 0 116 12 19 0% 0 0%

Leics Dental 101 66 28 11 206 26 105 0% 11 0%

Total 2142 1129 450 101 3822 1680 44.0% 101 2.6%

Consultant-Led Referral to Treatment Schedule in Weeks (September 16) - Clocks ended in September - Non-Admitted

Patient Care (Part 1B)



9

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

Total

Waiters

Max

Waiter

>6 week

waiter

total

%

Waiting

over 6w

>18

week

waiter

total

% Waiting

over 18w

Planned Care

General Surgery 5 17 3 0 25 17 20 80% 0 0%

Urology 1 19 19 6 45 24 44 98% 6 13%



Ophthalmology 24 30 10 1 65 19 41 63% 1 2%

Oral Surgery 0 0 0 0 0 0 0 0





Gastroenterology 0 0 0 0 0 0 0 0

Cardiology 0 0 0 0 0 0 0 0

Dermatology 8 22 6 0 36 15 28 78% 0 0%


Neurology 0 0 0 0 0 0 0 0


Geriatric Medicine 0 0 0 0 0 0 0 0

Gynaecology 1 0 2 0 3 16 2 67% 0 0%

Other 3 20 4 1 28 19 25 89% 1 4%

Derbys Dental 0 0 0

Leics Dental 0 0 0

Total 64 142 62 12 280 216 77.1% 12 4.3%

Length of RTT period for patients whose 18 week clock is still running AND a decision to admit for treatment has been made

(Part 2A)



10

APPENDIX 4 – FINANCE REPORT

1. Financial Duties

The financial risk of the Trust is measured by the Financial Sustainability Rating as part of the provider license. A rating of 4 is low risk, whilst a rating of 1 is high risk. The Trust is forecasting a rating of 4 at the year-end. This reflects the strong balance sheet of the Trust and the forecast surplus position. The recent issue of the Single Oversight Framework will result in a change in the way the financial position is monitored by the Regulator. The new reporting will be introduced from month 7 (October), and will be considered by the Audit and Assurance Committee at its October meeting.

2. Registered Nursing Agency Spend metrics

The Trust’s performance against the Agency Spend metric is detailed below which shows our spend is behind the submitted planned run rate due to the impact of Flexing the number of beds DCHS have open and the complexity of patients currently in the beds across the Trust.

Measure Indicator Year to date Year End Outturn

Actual £m

Target £m

Actual £m

Target £m

Agency Spend Spend against Planned Trajectory

0.90 0.63 1.63 1.46

Due to the Actual Spend being significantly ahead of the Planned Trajectory an Exception Report on Bank and Agency spend will be included in the Performance Report.

3. Month 6 Financial Position

The Trust is forecasting a surplus of £4.56m. This is supported by £2.14 million non-recurrent income, and £0.3m non recurrent efficiencies. Therefore the underlying forecast outturn surplus position of the Trust is £2.12m surplus. The Trust has a SQIP target of £5.0m for 2016/17.



11

As at month 6 there is an under achievement against the planned schemes but mitigations have been found to offset this resulting in an over achievement of £0.093m. The year end forecast is currently a 2.8% under achievement of £0.141m by year end. At the end of September the cash balance was £3.4m ahead of plan (actual: £20.8m, plan £17.4m).



12

APPENDIX 5 – “BIG 9”

Objective Priorities 2016/17 Target

Plan to end

of

September

Clinical Effectiveness -Over 75 clients using

our ICS services assessed for frailty (%)95% 0% 0% (GREEN) 95% (GREEN)

Patient Experience - Improvement in time to

respond to complaints80% Within 40 Days 70% 50% (RED) 80% (GREEN)


Plan to end

of

September

Ensuring all staff are complaint w ith essential

learning96% 96% 95.5% (AMBER) 96% (GREEN)

Improving staff w ellbeing by reducing w ork

related stress and anxiety

20% reduction in number of days

lost (300 days) to stress and

anxiety based on 15/16 averages to

below (1,200 days)

20% 9% (RED) 20% (GREEN)


Plan to end

of

September

Demonstration of eff iciency across all DCHS

services through the delivery of the

Sustainable Quality Improvement Plan (SQIP)

£5m Sustainable Quality

Improvement Plan (£000)2,015.9 2,104.3 (GREEN) 4,827 (AMBER)

Measuring the progress tow ards becoming a

more agile organisation by reducing the spend

on non-Clinical estate

Less than 7,270m2 7,270m2 6,520m2 (GREEN) <7,270m2 (GREEN)

Responding to the main issue raised through

staff feedback by monitoring the perceived

improvement in IT connectivity for staff

Less than 35% of staff Often or

Alw ays Experiencing Connectivity

Problems

35% 33% (GREEN) <35% (GREEN)

(GREEN) Increase (GREEN)

Quality Business

Achieved to

end of

September

Forecast

To ensure an effective, eff icient and

economical organisation w hich

promotes productive w orking and

w hich offers good value to its

community and commissioners

20% (293) (GREEN)

Quality People

Achieved to

end of

September

Forecast

To build a high performance w ork

environment that engages, involves

and supports staff to reach their full

potentialImproved position of staff reporting incidents

of violence and aggression they encounter at

w ork

Month on month increase in

reporting compared to 15/16 data29 41

Big 9 - September 2016

Quality Service

Achieved to

end of

September

Forecast

To deliver high quality and

sustainable services that echo the

values and aspirations of the

community w e serve

Patient Safety - To reduce the overall number

of patients w ho incur pressure damage

20% Reduction in Baseline of 793

Pressure Ulcers5% (178)

9.9%

(164)(GREEN)




Title of Paper: DCHS Staff Health and Wellbeing


Presenter: Jamie Broadley, Staff Wellbeing Lead

Author: Jamie Broadley, Staff Wellbeing Lead




Appendices:

Purpose of Paper

This paper provides an introduction to the new Staff Wellbeing Lead at DCHS and an update on all current work relating to Staff Wellbeing.

Summary

Derbyshire Community Health Services takes the health and wellbeing of its staff very seriously. The organisation has a highly regarded, in house, counselling service through Resolve, an Occupational Health service provided through Derby Teaching Hospitals and a network of Wellbeing Champions throughout the organisations sites and services. This summer DCHS have strengthened this provision for staff health further by appointing Jamie Broadley to the position of Staff Wellbeing Lead. This position is tasked with leading the development of the Staff Wellbeing Strategy, contract managing Occupational Health, non-clinical line management of the Resolve service and broadening the staff wellbeing offer at DCHS. Jamie has been in post for 4 months, during which time the focuses have been on delivering a successful flu campaign, responding to the results from the Health Needs Assessment and developing a strategy to reduce staff sickness levels. This paper provides updates on progress made in each of these areas along with wider staff wellbeing workstreams. Wellbeing Commissioning for Quality and Innovation (CQUIN) This year there is a Wellbeing CQUIN that DCHS must respond to and action in order to release the associated finances. The CQUIN covers 3 broad domains: Flu, Healthy Eating and Mental and Physical health initiatives. Our CQUIN strategy was sent to commissioners and was subsequently approved in August with a brief note to add further detail to our physical activity initiatives offering, an area where we had held off until we had the results from the Health Needs Assessment Survey which arrived in September. An update on our Health & Wellbeing CQUIN was sent to commissioners on 12 October. This

120�Staff�Health�and�WellbeingOverall�Page�27�of�86Page�1�of�5


included extra detail around the physical activity initiatives that was requested from our previous submission. These updated initiatives include increasing our use of active travel through cycle to work and ‘park and stride’ schemes, and making available discounted gym and leisure centre memberships for DCHS staff. There is a more detailed update around the Flu campaign below. The first stage in the healthy eating category is now complete as we have now successfully moved chocolates and other sweets away from checkouts across our catering sites. Anecdotal feedback from staff has been mixed and now focuses our attention to the next stages of the healthy eating CQUIN which are to provide an increased range of healthy food to staff through our canteens and vending machines. Flu Prior to the start of the 2016 Flu campaign a thorough review of previous campaigns was conducted which included surveying staff to ascertain their thoughts and feelings on the subject. This review concluded that access to the vaccine was the key barrier and that this year’s campaign needed to focus on improving the logistics behind getting a jab. There was also feedback regarding some staff feeling bullied and harassed about the campaign. In response to this feedback several key improvements to the campaign were made. This included a central hub on the MY DCHS pages which included an interactive google map which highlighted where the nearest vaccine was for each site. A pre-booking system was also utilised where staff could register for a specific time slot at a clinic and would receive reminder emails. Further barriers identified were in regard to needle phobia and beliefs about the vaccine being ineffective. In response to this a video and associated resources were collated with the support of the DCHS Health Psychology team around dealing with needle anxiety and special clinics were run by the School Age Immunisations team. The Infection, Prevention and Control team were also involved in creating a ‘myth busting’ video to shed light on the facts behind the flu jab. The final area addressed was in regard to the issue of bullying or harassing staff with excessive pressure and communications. This year the communications campaign has focused on access to vaccines and the campaign has shifted from being an organisational effort around targets to one owned by clinical staff and making a feature of the clinical responsibility for being vaccinated. The staff flu campaign started on 3 October with several ‘sold out’ flu clinics. Feedback for the pre-booking system was positive and the associated drop in sessions have also been well attended. The communications campaign which includes the option to ‘unsubscribe’ from emails has been well received with many positive comments and some useful data gathered. The immediate challenges to the campaign are the logistics of getting vaccines around the county whilst maintaining the cold chain. We have now struck an agreement through Occupational Health at London Road in Derby to hold a store of vaccines there that can supply our southern clinics which we hope will resolve some of these issues.



The table below demonstrates our progress to date against previous years data:

Date 2014 2015 2016 16/10/ 0 316 533 23/10/ 484 833 1013 28/10/ 768 1075

06/11/ 939 1233 11/11/ 1133 1320 19/11/ 1425 1430 27/11/ 1502 1678 04/12/ 1579 1785 11/12/ 1701 1785 16/12/ 1781 1933 08/01/ 1852 1987 27/01/ 1866 1999

Health Needs Assessment Over the summer DCHS partnered with Derbyshire County Council Public Health to conduct a detailed Health Needs Assessment of the organisation. This included a review of our staff support provision and a detailed survey of DCHS staff which asked a broad range of questions on factors that impact their wellbeing. The aim of this work is to provide the necessary data to be able to structure a wellbeing strategy that responds to the specific needs of our staff. The first stage of feedback from the staff Health Needs Assessment has now been produced and was presented to the Staff Partnership Committee on 6 October. The survey received 920 completions and has identified some clear directions in which we need to focus with future staff wellbeing support. Of particular note are the following:

- 76% of respondents felt that their physical or mental health was adversely affected by their work

- 17% of respondents had been subject to bullying at work and 8% to violence or abuse at work.

- Only 39% of respondents felt that executive and top tier managers understood the difficulties faced in their department.

- Only 52% felt that they had sufficient time to fulfil all their responsibilities - Only 41% felt that there were opportunities within the Trust for them to increase their

physical activity levels - 3% of respondents were experiencing domestic violence or abuse. In real numbers, this

equates to 24 staff members who responded to the survey. - 52% of respondents reported having difficulties making ends meet at the end of the

month.

- 47% had caring responsibilities that were adversely affecting their physical or mental health and wellbeing.

These areas sit within an altogether positive picture of staff wellbeing at DCHS which we should not forget; however, it is clear that there are certain key areas where we need to increase our support. Work has already started in the following areas:



- Promoting the Credit Unions within DCHS and consider linking with Neyber who offer a similar financial wellbeing service.

- Launching a new guide and associated support pages around the issue of domestic violence.

- Launching a ‘caring for carers’ portal to provide advice and support for those in this position.

- Increasing provision of opportunities for staff to increase their activity levels through active travel and discounted gym memberships.

We are now looking at a project entitled ‘things I wish my manager knew’ as a way of tying all these work streams together under one banner. This initiative aims to create a more open culture in DCHS where staff feel able to share vulnerabilities or difficulties and have a full menu of support options available to them to help cope with the challenges they are facing. The above updates represent the current key work streams for DCHS staff wellbeing. Below is a summary of the other areas that sit within this agenda: Resolve Resolve has recently experienced its highest month of referrals since February with 38 new referrals in September. This increase, fuelled in part by the current climate of uncertainty surrounding 21st Century, the Sustainability and Transformation Plan (STP) and collaboration with Derbyshire Healthcare, has meant that referral to appointment times have now slipped beyond the target of 2 weeks for first assessment. The service has recently recruited 4 new volunteer counsellors across the county, each working 1 day per week, and it is hoped that this will reduce the strain on the service. However, until these staff are up to full capacity waiting times have now increased to 4-6 weeks for some venues across the county. In September the service submitted a proposal to Trust Management Executive (TME) to terminate the current Employee Assistance Program contract with supplier Carefirst. This service provides out of hours support and advice for staff but it was found to be very poorly utilised, despite extensive promotion, with only 6 staff members having accessed it in the last year. Given the financial outlay of circa. £10,000pa it was felt that this resource could be better utilised within Resolve to increase the service’s counselling capacity whilst still providing out of hours options through charity and local government helplines such as the Samaritans and the Citizen’s Advice Bureau. This proposal was approved by TME and a contract termination date of 29/12/16 has been confirmed with Carefirst. Occupational Health Occupational Health have recently completed the successful appointment of Tracey Bennett to the role of Deputy Head of Occupational Health. In this fulltime role, based at Walton, Tracey will be able to effectively manage the day to day needs of the service, making it more responsive to DCHS requirements, as well as providing additional clinical hours to reduce wait times for management referrals. We are currently working with Occupational Health to identify the best approach to take with the NHS Innovation grant finances that were made available to increase DCHS staff physio provision.



Mental Health On Monday 10 October, World Mental Health Day, we launched the DCHS commitment to changing the culture around mental health. This was started through a scenario based video from the equalities forum theatre group and the sharing of a staff story, alongside web resources promoting the support available to DCHS staff which includes Resolve, coaching and Schwartz rounds. The next phase of this project will be to produce a manager’s guide to managing staff with mental health conditions, increased promotion of Schwartz rounds and sharing of more staff stories. This work sits under the banner of the Time To Change work plan, where we are working towards getting an agreed mental health strategy for DCHS and being able to sign up to the TTC pledge as recognition of our commitment in this area.

Recommendations

The Council of Governors is asked to reflect on the initiatives and interventions that are planned or are in place to protect and develop the wellbeing of DCHS staff.



Audit and Assurance Committee

Council of Governors10th November 2016

Nigel Smith, Chair of A&AC, Non-Executive Director

121�Audit�Committee�PowerpointOverall�Page�32�of�86Page�1�of�15


Things To Cover TodayThe work of the Audit

Committee…and how we do it



OverviewEffective NHS Boards demonstrate

leadership by undertaking 3 key roles:

• Formulating Strategy• Ensuring Accountability• Shaping a healthy culture



Why Have an Audit Committee? • Required under the Audit Code• The Audit Committee Handbook states:

“The existence of an independent audit committee is a central means by which the Board ensures effective internal control arrangements are in place”• Monitoring the integrity of the financial statements• Reviewing the effectiveness of internal controls• Monitoring and reviewing the effectiveness of internal audit• Reviewing and monitoring the external auditors independence and

effectiveness

• It is “the body charged with governance”



The Audit Code : Good Practice Principles

1. Membership 2. Skills3. Role4. Scope of Work5. Communication and Reporting

§ the Committee should report annually on how it has discharged its responsibilities in line with these principles – today’s session is part of this



1. Membership“The Audit Committee should be independent and objective and each

member should have a good understanding of the objectives and priorities of the organisation”

ü Members should have no executive responsibilities (i.e. NEDs)

ü Should be at least three (NED) membersü Executives should attend to provide

information and participate in discussionü Head of Internal Audit and a representative

of External Audit should attendü Members can sit privately as required121�Audit�Committee�Powerpoint

Overall�Page�37�of�86Page�6�of�15


2. Skills“The Audit Committee should collectively own an appropriate skills mix to

allow it to carry its overall function”

ü Committee is charged with ensuring the Board receives the assurance it needs on governance, risk, the control environment and the integrity of the financial statements, soü Because of the importance of financial management and

reporting at least 1 member should have “recent and relevant” financial experience

ü Other key skills include knowledge of the core business of the organisation, sector developments, and change management



3. Role“The Audit Committee should review the comprehensiveness and

reliability of assurances on governance, risk management, the control environment and the integrity of financial statements”

• Assurance is “an evaluated opinion, based on evidence gained from review”

• Requires an Assurance Framework whichü Identifies the strategic outcomes the organisation aims to deliver and

the associated risks (BAF)ü The sources of assurance available (“3 lines of defence”)ü The level of confidence required in assurances (risk being

appropriately managed, risk inadequately controlled, risk over controlled, or lack of evidence to support a conclusion)



4. Scope (Governance and Risk Management)

“The scope of the Audit Committee’s work should be defined in its Terms of Reference…and should include governance and risk management, the work of internal audit and external audit, and financial reporting issues”

ü The Committee should understand how the Trusts’ governance arrangements support delivery of its strategies and objectives, in particular :ü Mechanisms to ensure accountability, performance and risk managementü The promotion of appropriate ethics and values within the organisation

ü … and understand the risks to the Trusts’ strategy and operating environment, in particular:ü Its policies, attitude to, and appetite for riskü Critically challenge and review the risk management framework to provide

assurance that the arrangements are working effectively



4. Scope (Internal Audit) “The scope of the Audit Committee’s work should be defined in its Terms of

Reference…and should include governance and risk management, the work of internal audit and external audit, and financial reporting issues”

ü Internal and External Audit are the 2 most significant sources of independent and objective assurance

ü Internal Audit is carried out primarily for the benefit of the organisation, and the Committee advises the Board on the results of Internal Audit’s work (including Counter Fraud), and its performance

ü The Head of Internal Audit provides an annual opinion on the overall adequacy and effectiveness of the organisation’s governance, risk management and control processes121�Audit�Committee�Powerpoint



4. Scope (External Audit)“The scope of the Audit Committee’s work should be defined in its Terms of

Reference…and should include governance and risk management, the work of internal audit and external audit, and financial reporting issues”

ü External Audit is not primarily for the benefit of the organisation itself but is still a valuable source of assurance and the Committee should review and consider the wider implications of their work, e.g. Value For Money and Good Practice findings

ü In NHS FTs the Committee also makes recommendations to CoG on the appointment or re-appointment of the external auditors and approval of remuneration and terms of engagement



4. Scope (Financial Reporting)“The scope of the Audit Committee’s work should be defined in its Terms of Reference…and should include governance and risk management, the work

of internal audit and external audit, and financial reporting issues”

• In reaching an opinion on the Trusts’ Financial Reports the Committee should consider:• Key accounting policies (and any changes) and disclosures• Assurances about the financial systems which provide

figures for the accounts• The quality of the control arrangements• The extent and quality of any judgements made• Any differences between those preparing the accounts and

the auditors• Reports, advice and findings from external audit



5. Communications and Reporting“The Audit Committee should ensure that it has effective communication

with all key stakeholders and assurance providers”

ü The Committee should meet at least 4 times a yearü After each a report should be prepared for the Board• The Committee should provide an annual report, timed

to support the preparation of the Annual Governance Statement

• The reports should present the Committees’ opinion on the effectiveness of governance, risk management and control in the Trust, in particular:• Any issues the Committee considers pertinent to the AGS• Financial Reporting• The quality of Internal and External Audit’s work• The Committees view on its own effectiveness

121�Audit�Committee�Powerpoint



Summary• The Committee believes the Trust has made

adequate arrangements for• Monitoring the integrity of the financial statements• Reviewing the effectiveness of internal controls• Monitoring and reviewing the effectiveness of internal audit• Reviewing and monitoring the external auditors independence and

effectiveness

• The Committee believes it’s own effectiveness has been adequate, but needs some minor improvements in keeping with our “good to great” journey



QUESTIONS



Summary Report from Nominations and Remuneration Committee

Report To: Council of Governors

Date: 10 November 2016

Name of Reporting Committee / Group: Nominations & Remuneration Committee

Date of Meeting: 19 October 2016

Presenter: Prem Singh, Chairman

Author: David Boddy, Corporate Governance Manager

Key Issues discussed at meeting: Include:

Brief summary of issue

Decision made/action to be taken

Agenda number and title of paper

Risks identified

Board Assurance Framework Reference and Level of Assurance Agreed

28/16 Review of Nominations Committee performance - the Committee discussed the annual review of the work of the Committee for the period October 2015 to September 2016. It was agreed that the Committee had undertaken a lot of work during the period. Attendance at the meetings by Governor members, Executives and Non-Executive Directors had been good. The meeting agreed that the Committee had successfully fulfilled its Terms of Reference and recommended the Annual Review to the Council of Governors for approval. (Appendix 1). Terms of Reference The Committee reviewed its Terms of Reference and recommended the following amendments:

Inclusion of Key Performance Indicators:

Include the Governance Group in the Communication Links section

The Committee recommended to the Council of Governors that the revised Terms of Reference are approved. (Appendix 2 - amendments in italics). 29/16 Nominations Committee Elections - the Committee discussed the process for elections to the membership of the Committee. This will commence in November 2016. The Committee agreed that the recommended timescales were sensible. The meeting acknowledged that the Nominations Committee has an important statutory function. The Committee went on to reflect on the skills, experience and attributes that are required in order to ensure that the Committee succeeds in achieving its Terms of Reference.

4.1 Significant Assurance Paper for Decision Paper for Decision Paper for Information

122�Nominations�Committee�SummOverall�Page�47�of�86Page�1�of�8


The communications for the nominations process will express some of the skills, experience and attributes required so that Governors may consider whether to self-nominate. 30/16 Review of Code of Conduct for Governors - the Committee reviewed the updated Code of Conduct. The amendments reflected:

The general roles and responsibilities of the Council of Governors set out in the DCHS Constitution

That guidance is now provided by NHS Improvement instead of Monitor.

Further minor amendments The Committee recommended the updated Code of Conduct to the Council of Governors for approval. (Appendix 3 – amendments in tracked changes). Once the document has been approved by the Council, all Governors will be asked to sign the updated version. 31/16 Governor Involvement Report - the Committee reviewed the attendance by individual Governors at Council of Governors meetings and the Governor Groups. The Committee took Significant Assurance that all existing Governors had achieved at least the minimum attendance requirement of 50% of all Council of Governor meetings. The Committee then went on to discuss the commitment of Governors at the Governor groups, Nominations Committee and also other areas of involvement across the organisation. The Committee agreed that there were no areas of immediate concern.

Paper for Decision 4.1 Significant Assurance Paper for Decision

Policies Approved

None.

Issues to be escalated to Board or a Committee

None.



Appendix 1 Annual Review of the Nominations and Remuneration Committee 1. Scope This is the Annual Review of the Nominations and Remuneration Committee. This report covers the work of the Committee for the period October 2015 to September 2016. 2. Role of the Nominations and Remuneration Committee The role of the Committee is to consider and make recommendations regarding issues relating to the appointment and remuneration and other relevant issues relating to the Chair and Non-Executive Directors. The Committee also considers overall performance issues in the Council of Governors. 3. Attendance at Committee meetings October 2015 – September 2016 Governors who attended the meetings are listed below.

22-Oct-15 05-Jan-16 02-Mar-16 28-Jun-16

Prem Singh

Barbara-Anne Walker N/R N/R N/R

Brenda Greaves X X

Barry Jex X

Paul Kirtley X

Adam Short/Sally-ann Coope/Emma Brooks

Bernard Thorpe

Key: Attended X Not Attended N/R Not Required at meeting

All meetings were quorate. The Committee meetings were attended by Executive and Non-Executive Directors (NEDs) and a senior manager. A list of attendees is set out below:

22-Oct-

15 05-Jan-16

02-Mar-16

28-Jun-16

Kirsteen Farrar

Amanda Rawlings

David Boddy



4. Achievements of the Committee 4.1 The Committee reviewed and discussed the following papers:

22-Oct-

15 05-Jan-

16 02-Mar-

16 28-Jun-

16

Review of Nominations Committee Performance (November 2014 September 2015) including Terms of Reference

Chair and Non-Executive Director Appraisal Process

Recruitment Process for Non-Executive Director

Code of Conduct for Governors

Governor Involvement Report

Appointment of Vice Chair

Non-Executive Recruitment

Chair and Non-Executive Directors’ Appraisal Process

Process for Elections to the Nominations and Remuneration Committee

Governor Attendance and Conduct

Appraisal, Key Success and Objectives 2016/17 for the Chair

Non-Executive Director Appraisals 2015/16

Appointment of Additional Non-Executive Director

4.2 Recommendations made to the Council of Governors and other decisions made by the Committee The Council of Governors considered and approved each of the recommendations that were made by the Committee. The recommendations were: 4 November 2015 Recommendations to Council:

The Annual Review of the Committee

The current membership to continue for a further twelve months

Elections to take place for Committee membership in 2016

The revised Terms of Reference 13 January 2016 Recommendation to Council:

The appointment of Barbara-Anne Walker as Vice Chair.

7 March 2016 Recommendation to Council:

The recommendation to recruit an additional NED to the Board.



9 May 2016 Recommendation to Council:

The process for the governor membership of the Nominations and Remuneration Committee

12 July 2016 Recommendation to Council:

The appointment of Kaye Burnett as a Non-Executive Director on a three year term

The appointment of James Reilly as an Associate Non-Executive Director on a one year term

In October 2015 the Committee approved the process for the annual appraisals of the Chair and the NEDs and also an amended Code of Conduct for the governors. In June 2016 the Committee took Significant Assurance that the Chair and all the Non-Executive Directors had fulfilled their roles and had been subject to a formal objective setting and performance appraisal process for 2015-16. 5. Summary This Annual Review summarises the work and achievements of the Nominations and Remuneration Committee for the period October 2015 to September 2016 and demonstrates that the Committee has fulfilled its terms of Reference.



Appendix 2

Nominations and Remuneration Committee

Terms of Reference October 2016

What

To consider and make recommendations regarding issues relating to the appointment and remuneration and other relevant issues relating to the Chair and Non-Executive Directors

To consider and make recommendations regarding issues in relation to the performance of the Council of Governors individually and collectively.

Who

DCHS Chairman (Chair of Nominations Committee) Vice Chairman (Chair of Committee when considering issues relating to the Chair) 5 Governors in total to be constituted of: Lead Governor 3 Public Governors 1 Staff Governor (or agreed named deputy) In attendance: Trust Secretary Director of People and Organisational Effectiveness The Chief Executive, as Accountable Officer, may attend the meeting from time to time, as appropriate.

Quoracy The Chair or Vice Chair and 3 governors including the Staff Governor. In the absence of the member who is the Staff Governor then a named, deputising Staff Governor should receive papers and attend the meeting.

When As required and no less that twice a year

Where To be confirmed

Why

The Nominations Committee is established in accordance with the Constitution for Derbyshire Community Health Services NHS Foundation Trust. The purpose is to identify appropriate candidates for the office of Chairman and Non-Executive Directors and to make recommendations to the full Council of Governors. The Committee will act in accordance with Annex 5 of the Foundation Trust’s Constitution for the appointment and removal of the



Chairman and other Non-Executive Directors (NEDs).

Additionally the Nominations Committee will oversee the performance of the Council of Governors collectively and individually and instigate any measures required.

How

The committee is responsible to the Council of Governors for the following:

Considering and making recommendations to the Council of Governors on the appointment of the Chairman and Non-Executive Directors. The Committee is to satisfy itself that its recommendations fulfil DCHS needs in terms of skills and experience.

Agree the process for recruitment of the Chairman and Non-Executive Directors taking into account the views of the Board of Directors on the process in general and the qualifications, skills and experience required for the position. For NED appointments the Chairman will be asked to Chair the appointments panel. For appointments to the Trust Chair position, the panel will be chaired by the Vice Chair (or in the event of the Vice Chair submitting an application, the Senior Independent Director or other suitable NED).

The Committee will ensure appointments are based on merit and objective criteria as well as meeting the ‘fit and proper’ persons test described in the Provider Licence and Care Quality Commission (CQC) Regulations.

To make recommendations to the Council of Governors on the re-appointment of the Chair and/or Non-Executive Directors where it is sought and is constitutionally permissible. The Committee will look at the existing candidate/s against the required role description.

To consider and make recommendations to the Council of Governors as to the remuneration and allowances and other terms and conditions of office of the Chairman and other Non-Executive Directors.

In conjunction with the Chairman, to contribute to an annual review of the structure, size and composition of the Board of Directors and to make recommendations for changes to the NED element of the Board of Directors to the Council of Governors where appropriate. When undertaking this review, the Committee will consider the balance of skills, knowledge and experience of the Non-Executive Directors.

The Committee will also consider succession planning to include the balance of appropriate skills and experience for Non-Executive Directors which will complement the full Trust Board.

To consider issues relating to the performance and attendance of the Council of Governors (individually and collectively).

To instigate any investigation required into non-compliance with the Governors Code of Conduct and to make recommendations to the Council of Governors regarding the outcome of any investigations.



Sub Committees /

Groups

Not applicable

Communication Links

Board of Directors

Governance Group

Reporting To The Committee will report formally to the Council of Governors through the Lead Governor or other nominated Governor if they are not present at the COG.

Key Performance

Indicators

On an annual basis contribute to the performance appraisal process for the Chair and Non-Executive Directors.

Conduct an annual review of individual governors with respect to attendance at Council of Governors meetings, adherence to the Code of Conduct and Declarations of Interest.

Review Date October 2017



CODE OF CONDUCT FOR THE COUNCIL OF GOVERNORS

Revision History

Version Revision Date Summary of Changes

2.0 October 2015 Amendments to Section 7 Section 13 included

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

Acknowledgement: This document is an adaptation of a document first

produced by Burton Hospitals NHS Foundation Trust

122�DCHS�Council�of�Governors�Overall�Page�55�of�86Page�1�of�11

mailto:[email protected]


CODE OF CONDUCT FOR THE COUNCIL OF GOVERNORS

1. Introduction

This code outlines appropriate conduct for Governors and addresses both the requirements of office and personal behaviour and seeks to expand on and complement the Constitution. The code should be read in conjunction with any relevant documents issued by Monitor NHS Improvement. The Trust’s Constitution embodies the legal requirements for Governors. As a member representative dealing with difficult and confidential issues, Governors are required to act with discretion and care in the performance of their role. Governors are required to maintain confidentiality at all times with regard to information gained via their involvement in the Trust. Members seeking election to the Council of Governors will be required to sign a declaration to confirm that they will comply with the Code in all respects and that, in particular, support the Trust’s Vision and Values and key objectives – see Appendix 1.

2. Qualifications for Office Governors must continue to comply with the eligibility criteria required to hold elected office throughout their period of tenure. The Trust Secretary should be advised of any changes in circumstance which disqualify the Governor from continuing in office. The circumstances under which a Governor may not become or continue as a member of the Council of Governors are set out in the Constitution.

3. The DCHS Way Governors will conduct DCHS business and themselves in a way that reflects the ‘DCHS Way’. Governors will act as Champions of the ‘DCHS Way’ ensuring that our vision, our values and working the ‘DCHS Way’ become embedded within the culture of the organisation. See Appendix 2 – The DCHS Way

4. Role and Functions The role of a Governor is a collective one. Governors exercise collective decision making on behalf of all patients, members, local public and staff. The functions allocated to Governors are not of a managerial nature however they are expected to work with the Trust to ensure the successful development of the organisation. The general roles and responsibilities of the Governors are as follows:

4.1.1 ensure that the Trust operates in accordance with its Constitution;

4.1.2 advise the Board of Directors when requested to do so by the Board of Directors regarding the Trust's future plans and priorities;

4.1.3 monitor the performance of the Trust against its forward plan with a view to satisfying itself that the Board of Directors is fulfilling its responsibilities in this regard. This will be achieved by regular briefings on the performance of

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the Trust at its meetings, and being able to consider and comment on that performance;

4.1.4 ensure continued success of the organisation through overseeing of effective management, partnership working and maintenance of NHS values and principles;

4.1.5 oversee the development of the Trust as an effective social enterprise through focus on the wider public interest and promoting social cohesion in ensuring that the Council of Governors reflects all the interests of the membership community;

4.1.6 to share local responsibility for the success of the Trust, in particular by building and sustaining a wide consensus to the vision for the Trust and by members representing the services to their respective communities and organisations and vice versa;

4.1.7 to instigate or be involved in review of a specific issue, or be involved in further development of a particular strategy through specific working groups;

4.1.8 providing views to the Board of Directors on the strategic direction of the Trust and targets for the Trust's performance and in monitoring the Trust's performance in terms of achieving those strategic aims and targets which have been set;

4.1.9 developing membership;

4.1.10 representing the interests of the Members; and

4.1.11 holding the Board of Directors to account in relation to the Trust's performance in accordance with the Regulatory Framework.

4.1.1 ensure that the Trust operates in accordance with its Constitution;

4.1.2 to monitor the performance of the Trust against its forward plan

ensuring the Board of Directors is fulfilling its obligations;

4.1.3 to share local responsibility for the success of the Trust, in particular by building and sustaining a wide consensus to the vision for the Trust and by members representing the services to their respective communities and organisations and vice versa;

4.1.4 to instigate or be involved in review of a specific issue, or be involved in further development of a particular strategy through specific working groups;

4.1.5 provide views to the Board of Directors on the strategic direction of the Trust

The roles and responsibilities of the Governors also include (subject to the requirements set out in the Constitution:



4.2.1 to appoint or remove the Chairman and the other Non-Executive

Directors; 4.2.2 to decide the remuneration and allowances, and the other terms

and conditions of office, of the Chairman and the other Non-Executive Directors;

4.2.3 to appoint or remove the Auditor; 4.2.4 to receive and consider the annual accounts, any report of the

Auditor on them, the Annual Report and the Quality AccountReport;

4.2.5 to consider resolutions to remove a Governor; 4.2.6 approve the appointment of the Chief Executive subject to an

appointment by the Non-Executive Directors; 4.2.7 give the views of the Council of Governors to the Directors for the

purposes of the preparation (by the Directors) of the forward plan in respect of each Financial Year to be given to MonitorNHS Improvement;

4.2.8 respond as appropriate when consulted by the Directors. The Board of Directors may request the Council of Governors to undertake other functions and it is expected the governors will use their own skill and judgement in the conduct of Trust affairs.

5. Confidentiality

All Governors are, at all times, required to respect the confidentiality of the information they are made privy to as a result of their membership of the Council of Governors and will be required to sign a formal declaration in support of this.

6. Conflict of interests

Governors should act with the utmost integrity and objectivity and in the best interests of the Trust in performing their duties. They should not use their position for personal advantage or seek to gain preferential treatment. They should declare any conflicts of interest which may arise and should not vote on any such matters. It is important that conflicts of interest are addressed and are seen to be actioned in the interests of the Trust and all individuals concerned.

There will be a Register of Interests in which Governors must enter any pecuniary and non-pecuniary interests that might create a conflict of interest. Failure to do so could result in expulsion from the Council of Governors. The Constitution provides detailed advice on all interests which should be declared – if in any doubt the Governor should seek advice from the Trust

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Secretary. 7. Council of Governors meetings

Governors have a responsibility to attend meetings of the Council of Governors. When this is not possible they should submit an apology to the Trust Secretary in advance of the meeting. The minimum attendance expected of a governor will be three meetings in a twelve month period. Absence from the Council of Governors meetings without good reason established to the satisfaction of the Council of Governors is grounds for disqualification. Attendance that is less than the minimum expected of a governor will result in the member being deemed to have resigned their position unless the grounds for absence are deemed to be satisfactory by three quarters of the Council of Governors. Governors are expected to attend for the duration of the meeting.

8. Personal conduct

Governors are required to adhere to the highest standards of conduct in the performance of their duties. In respect of their interaction with others, they are required to:

8.1.1 Adhere to good practice in respect of the conduct of meetings and

respect the views of their fellow elected and appointed members.

8.1.2 Be mindful of conduct which could be deemed to be unfair or discriminatory.

8.1.3 Treat the Trust’s executives, other employees and fellow members with respect and in accordance with the Trust’s policies.

8.1.4 Recognise that the Council of Governors and management have a common purpose, i.e. the success of the Trust and adopt a team approach.

8.1.5 Conduct themselves in such a manner as to reflect positively on the Trust. When attending external meetings or any other events at which they are present, it is important for governors to be ambassadors for the Trust.

8.1.6 Adhere to the Trust’s rules and policies.

8.1.7 Act in the best interests of the Trust at all times.

8.1.8 Contribute to the workings of the Council of Governors in order for it to fulfil its role and function as defined in the Trust Constitution.

8.1.9 Comply with the Trust’s Code of Conduct for Governors and any guidance or best practice advice issued by Monitor NHS Improvement and behave in accordance with the seven Nolan principles of behaviour in Public Life – see Appendix 3.

8.1.10 Comply with the Standing Financial Instructions prepared by the



Director of Finance and approved by the Board of Directors for the guidance of all staff employed by the Trust.

9. Accountability

Governors are accountable to the membership and should demonstrate this by attending members’ meetings and other key events which provide opportunities to interface with their electorate in order to best understand and represent their views.

10. Training and Development

Training and development is essential for governors, in respect of the effective performance of their current role. Governors are expected to take advantage as far as is practicably possible of the training opportunities afforded by the Trust. The Trust may identify training that it deems to be essential for Governors.

11. Visits to Trust Premises

Where the governors wish to visit the premises of the Trust in a formal capacity as opposed to an individual in a personal capacity, the Council of Governors should liaise with the Trust Secretary to make the necessary arrangements.

12. Non-compliance with the Code of Conduct

A Governor may be removed from the Council of Governors if they have committed a serious breach of the Code of Conduct or the Standing Orders for the Practice and Procedure of the Council of Governors. This Code of Conduct does not limit or invalidate the right of the Governor or the Trust to act under the Constitution.

13. Process for dealing with Non-Compliance with the Code 13.1 Local Resolution

If any member of the Council of Governors (including the Chairman) believes a governor has not upheld the Code of Conduct it will, in most circumstances, be preferable for discussion to take place with the Lead Governor and the Chairman to agree local resolution to the issue. If local resolution is not possible or ineffective, the matter should then be raised at a meeting of the Nomination’s Committee. 13.2 Investigation:

The Nominations and Remuneration Committee, supported by the Committee Chair and Trust Secretary, will agree a process for investigation.

The Chairman will notify the Governor concerned in writing of the details of the alleged breach of the Code of Conduct. The communication will set out



a timeframe in which the matter is to be addressed. The Chairman will not disclose the name of the person who raised the matter, unless permission has been provided by that/those individual/s. During the investigation, the Chairman will invite the Governor concerned to meet with him to discuss the matter. It may be considered appropriate to involve the Lead Governor/Deputy Lead Governor, if agreed by all parties. The Trust Secretary will record minutes of the meeting. If the Governor concerned does not accept an invitation from the Chairman to meet and discuss the matter, the Chairman will consider this, in itself, a breach of conduct. In these circumstances, the Chairman will continue to complete his/her investigation considering all other information. The outcome of the Chairman’s investigation will conclude, either:

− no further action necessary, or

− a letter of censure (explaining the breach and required behaviour going forwards) is to be issued,

or, if the governor concerned has committed a serious breach of the code of conduct, or acted in a manner detrimental to the interests of the Foundation Trust and it is considers that it is not in the best interest of the Foundation Trust for them to continue as a Governor, − recommendation to the Council of Governors that the Governor concerned is removed from Office.

The Chairman will write to the Governor concerned confirming the outcome of his/her investigation within the previously stated timeframe.

The Governor may appeal the outcome of the investigation by setting out his/her reasons in writing to the Senior Independent Director within 10 working days from receipt of the Chairman’s letter.

The Senior Independent Director will conduct an independent investigation and report his/her findings to the Governor concerned and to the Council of Governors (in private session).

During the Senior Independent Director’s investigation, he/she will invite the Governor concerned to meet with him/her to discuss the matter. The Deputy Trust Secretary will record minutes of the meeting.

A copy of the Chairman’s letter will be sent to the person who originally raised the matter and, where action is necessary, to the Council of Governors (in private session) if the Governor does not appeal the Chairman’s decision, or if the Senior Independent Director upholds that decision.

The Senior Independent Director’s decision will be final and the outcome will be based upon the options previously stated:



− no further action necessary, or

− a letter of censure (explaining the breach and required behaviour going forwards) is to be issued,

or, if the governor concerned has committed a serious breach of the code of conduct, or acted in a manner detrimental to the interests of the Foundation Trust and it is considers that it is not in the best interest of the Foundation Trust for them to continue as a Governor, − recommendation to the Council of Governors that the Governor concerned is removed from Office.

13.3 Recommendation for removal from office to the Council of Governors

If a recommendation for removal from office is made to the Council of Governors the following process will be followed: The Chairman or Trust Secretary would convene an extra-ordinary meeting of the Council of Governors to be held in private. The Governor concerned would be excluded from this meeting. The Council of Governors will consider the outcome of the Chairman’s investigation and if appealed, the outcome of the Senior Independent Director’s investigation and a vote on the recommendation will take place. If the Governor in question is adjudged to have acted in accordance with any of the grounds specified in Annex 5, Paragraph 4.2 of the Constitution, by a majority of three-quarters of the Council of Governors present and voting, then the Governor will vacate his office immediately.

The outcome of the vote will be applied with immediate effect.



Appendix One

CODE OF CONDUCT DECLARATION

In undertaking the role of Governor of this NHS Foundation Trust all Governors shall sign the following declaration:

I ………………………………………………….…… (Print name) agree to abide by the Code of Conduct for Governors of Derbyshire Community Health Services NHS Foundation Trust and agree that I will:-

i. Seek to ensure that my fellow Governors are valued as fellow

colleagues and that their views are both respected and considered;

ii. Accept responsibility for my own actions;

iii. Show my commitment to working as a team member by working with all my colleagues in the NHS and the wider community;

iv. Seek to ensure that the membership of the constituency I represent is properly informed and given the opportunity to influence services;

v. Seek to ensure that no one is discriminated against because of their religion, belief, race, colour, gender, marital status, disability, sexual orientation, age, social and economic status or national origin;

vi. Comply with the constitution;

vii. Respect the confidentiality of the information I am privy to within my role

viii. Not knowingly make or permit, any untrue or misleading statement relating to my own duties or the functions of the Trust;

ix. Always contact the Communications Department before giving a response to a question from the media;

x. Support and assist the Accountable Officer of the Trust in his/her responsibility to answer to the Regulator, commissioners and the public for the performance of the Trust.

And further that If I am a member of any trade union, political party or other organisation, I recognise that I must declare this fact and that I will not be representing those organisations (or the views of those organisations) but will be representing the constituency (public or staff) that elected me.

Signature: ………………………………………………………………….. Date: …………………………………………………………………………



Appendix Two



Appendix Three

The Nolan Principles of Public Life

Selflessness

Holders of public office should act solely in terms of the public interest. They should not do so in order to gain financial or other benefits for themselves, their family or their friends.

Integrity

Holders of public office should not place themselves under any financial or other obligation to outside individuals or organisations that might seek to influence them in the performance of their official duties.

Objectivity

In carrying out public business, including making public appointments, awarding contracts, or recommending individuals for rewards and benefits, holders of public office should make choices on merit.

Accountability

Holders of public office are accountable for their decisions and actions to the public and must submit themselves to whatever scrutiny is appropriate to their office.

Openness

Holders of public office should be as open as possible about all the decisions and actions that they take. They should give reasons for their decisions and restrict information only when the wider public interest clearly demands.

Honesty

Holders of public office have a duty to declare any private interests relating to their public duties and to take steps to resolve any conflicts arising in a way that protects the public interest.

Leadership

Holders of public office should promote and support these principles by leadership and example.



Annual review of the Governance Group October 2015 – October 2016

Purpose of the Report

To provide the Council of Governors with a more detail account of the group’s work and to compliment the short summaries that have been presented at Council meetings throughout the year.

The Scope of the Governance Group o To support DCHS to provide a robust governance structure.

Governors to take the lead Self-nominated membership Tenure as agreed by the Council of Governors Not a formal nor decision making group

Role of Governance Group

o Monitor CoG performance against Key Performance Indicators (KPIs) o Oversee the mapping document and identify/plug gaps o Review the effectiveness and contribute to any amendments of the

Constitution o Meet bi-annually with the NEDs o Attend Board meetings and committees to see the NEDs in action o Receive feedback from Governors who have attended DCHS meetings o Oversee governors reporting exceptions identified during their activities o Consider key issues raised at pre-meetings o Meet with PwC twice a year. The meetings to be scheduled around

commencement and completion of the process for auditing the annual accounts (January and September).

o Support governor presentations at the Annual Governor’s Meeting/Annual Member’s Meeting

o Support the governor review of the CoG Terms of Reference o Meet bi-monthly, meetings to be scheduled two weeks prior to CoG

meetings

Membership

Governor 22.10.15 01.12.15 02.03.16 26.04.16 28.06.16 30.08.16 25.10.16

Adam Short (Chair) √ √ √ √ * * *

Brenda Greaves √ √ √ √ √

Barry Jex √ √ √ √ √ √ √

Bernard Thorpe √ √ √ √ √ √

Maureen Strelley √ √ √ √ √

Sandra Moody √ **

DCHS

David Boddy (Corporate Governance Manager)

√ √ √ √ √ √

Kirsteen Farrar (Associate Director of Corporate

√ √ √ √ √ √

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Governance/Trust Secretary)

Prem Singh (Chairman)

√ √ √ √ √ √

Others AR/MC MC AR/ AB/ME

NS/ PWC

IL

Notes:

* Adam Short is on a short secondment and Bernard Thorpe is Chairing in the meantime.

** Sandra Moody is no longer a Governor

AR; Amanda Rawlings, Director of People and Organisational Effectiveness

IL; Ian Lichfield, NED

MC; Melanie Curd, Deputy Trust Secretary

NS; Nigel Smith, NED

AB; Price Waterhouse Cooper, Ali Breadon

ME; Price Waterhouse Cooper, Matt Elmer

Outputs o Notes from Meetings o Action points o Reports to Council of Governors

Achievements o The Group feels that it has fulfilled its role as evidenced by the work

undertaken below: o Reviewed and recommended changes to the Constitution, which were

subsequently approved by the Council in January 2016 o Met with and discussed the work of external auditors Price Cooper

Waterhouse (PWC) o Reviewed where Governors are involved across the organisation o Reviewed and made recommendations regarding the Council of Governors’

Terms of Reference Key Performance Indicators o Agreed the annual self-assessment process for the Council of Governors o Reviewed the NED presentations to the CoG and agreed questions to be

raised (e.g. MHAC, QBC, Audit Committee) o Appraised the contribution made by the NEDS at Board and Quality

Committee meetings (e.g. QBC, QSC, Audit Committee) o Discussed issues at other Foundation Trusts and reviewed the work of the

Audit Committee, with respect to financial governance arrangements in DCHS o Discussed Governor participation in

2016 elections, Council of Governors self-assessment, Governor induction and training 2016/17, Lead Governor presentation to the Annual Members Meeting

o Reviewed the contribution the Group has made in pursuant of its role and in supporting the Council of Governors in holding the Trust to account.




Recommendations The Council of Governors accept that the work of the Governance Group provides a valuable use of Governors time safeguarding the DCHS governance processes and that it should continue in its present form. The Group would welcome two more governors be added to the current compliment. Bernard Thorpe, Lead Governor 25.10.2016




Title of Paper: Developing the Strategic and Operational Plans


Presenter: Tim Broadley, Associate Director of Strategy

Author: Tim Broadley, Associate Director of Strategy Claire Scott, Strategy and Planning Manager




Appendices:

Purpose of Paper

This paper is intended to update the Council of Governors with regards to the development of the DCHS Strategic and Operational plans within the context of the Derbyshire Sustainability and Transformation plans (STP) and national planning guidance.

Summary

A. Clinical Strategy This strategy is designed as a clinically focussed refresh of the current Integrated Business Plan (IBP), reflecting the new strategic context of the Derbyshire Sustainability and Transformation Plan (STP). It seeks to distil the key strategic elements of the IBP and avoid duplicating key information that is now reported in other more appropriate publications such as the Annual Report, Quality reporting and Operational Plan routes. Its key aims are to:

• Address the Triple Aim of addressing shortfalls in relation to Health, Outcomes and Cost whilst Closing the Gaps identified in the STP concerning Healthcare, Wellbeing and Quality

• Reflect the National Context and support delivery of the STP • Set the framework for key service strategies and goals which promote high Quality,

resilient and sustainable services • Develop the DCHS aspiration to be a Public Health Organisation that delivers social value • Promote Research and Innovation and a sustainable workforce • Address the financial challenge across the system and reflect the new system delivery,

management and Governance requirements and the significant challenges and opportunities these might offer

The draft, which was considered at the Board Development session on the 6th October, is being revised and will be the subject of further discussion at the Governors Strategy sub group meeting

126�Operational�Planning�PaperOverall�Page�69�of�86Page�1�of�3


on the 7th November. The final version will then be presented to the Board for approval at its November meeting when the full draft of the 2017/18 – 2018/19 operational plan will also be available. The final version of the Strategy will be shared with the Council of Governors at its January meeting B. 2016/18 to 2018/19 Operational Plans Objectives of the Plan The planning guidance sets out the objectives for Providers’ 2016/18 to 2018/19 Operational Plans which are to:

Implement the Five Year Forward View and to drive improvements in health and care

Restore and maintain system financial balance

Deliver core access and quality standards

Reflect the strategic intent of the STP and the organisational impact of the three to five issues critical to their locality.

As such the 2 year Operational plans and contracts will be built on the STPs and will reflect the two-year activity, workforce and planning assumptions that are agreed and affordable within each local STP. As such the aggregate of all operational plans in a footprint will need to reconcile with the STP control total. Structure of the Operational Plan The planning guidance prescribes the structure, format and length of the plan. The plan narrative should be no longer than 16 pages and NHSI note that ‘quality is more important than quality (and) we want to be able to understand each plan. A provider’s inability to summarise its plan coherently and concisely will itself be considered as part of the assessment of risk’. Activity and Financial Planning, together, are allocated up to half of the total content of the plan. Whilst we need to be consistent with other providers to ensure a read across with the STP the guidance also requires Providers to articulate their own plans and approaches e.g. to achieving an ‘Outstanding’ CQC, and to describing its own processes and governance and allowing the individual identities of the organisations to be reflected to Governors and National Health Service Improvement (NHSI). Operational Plan Timetable 2017/18 – 2018/19 The key submission deadlines are: Nov 1st - Submission of summary level operational financial plans Nov 24th - Submission of full draft operational plans Dec 23rd - Submission of final operational plans, aligned with contracts - National deadline for signing contracts Within this timescale November Board will receive the full draft that will be submitted on the same day as the Board meeting. The appropriate sections of this draft will have been considered by the “Q” committees and Quality Business Committee will see a copy of the overall draft.



The Governors Strategy sub group will consider the plan at its 7th November and 6th December meetings and the final submitted version will be shared with the Council of Governors at its January meeting Key Challenges There are a number of key challenges in relation to the preparation and subsequent delivery of the plan:

The tight timescales issued by NHSI and the dependence on contracts being agreed and signed by the December deadline. This will especially apply to the November draft which will be written in advance of contracts being finalised

The agreement of the Strategic Options Case in relation to Derbyshire Healthcare Foundation Trust and the impact this will have, especially on year two of the plan

Mitigation of the financial and interdependency risks, including the outcome of the Better Care Closer To Home consultation in the north and its impact on the delivery of the STP

Capturing all the STP implications in our plans and aligning our delivery with the STP projects

Delivering the commitment to being a public health organisation especially if the Public Health contracts remain outside the STP

Truly understanding the scale and nature of the change that DCHS will face in relation to new systems, financial arrangements, and governance requirements and the leadership challenge that this will present

From this understanding the impact on the DCHS Board Assurance Framework and ensuring that the plan will address the risks

Plan Delivery and Governance It is the intention that the content of the plan should be clearly structured such that key deliverables are easily identified with lead managers, and clear outcome measures and Key Performance Indicators, reporting through to the “Q” committees wherever possible. The Operational Plan delivery Group will be used as the forum to collate the finance, workforce and quality elements of the plan and to coordinate its delivery. Delivery of the plan will be reported bi-monthly to the board and will be the subject of review at the Governors Strategy sub group meetings

Recommendations

The Council of Governors are asked to note the progress to date, and the further work required, in relation to the development and approval of the DCHS Strategic and Operational plans.



1


Title of Paper: Chief Executive’s Report


Presenter: Tracy Allen, Chief Executive

Author: Tracy Allen, Chief Executive

Date of Meeting: 10 November 16 Agenda Item No: 127/16

No of pages incl this one: 11

Appendices:

Appendix A: Better Care Closer to Home Consultation – DCHS NHS FT response Appendix B: 2016/17 Big 9 for September

Purpose of Paper

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

Summary

The paper includes updates on:

• NHS Improvement regulatory framework including: o Single Oversight Framework segmentation rating o 2017/18 control total o Agency spend reporting and oversight

• System transformation including:

o An update on the next iteration of the Sustainability and Transformation Plan o The Better Care Closer to Home consultation o Progress with our collaborative work with Derbyshire Healthcare NHS Foundation

Trust (DHcFT)

• Key achievements and operational issues including:

o Headline organisational performance for September 2016 – ‘the big 9’

Recommendations

The Council is recommended to note the paper.

127�Chief�Exective's�Report�NoOverall�Page�72�of�86Page�1�of�11


2

Chief Executive Report November 2016

1. Purpose of report

This report provides the Council with information about policy, legislative and developmental issues and changes which affect the organisation and local initiatives across the organisation in the past month. 2. National planning and performance context – NHS Improvement (NHSI) regulatory

update 2.1 Single Oversight Framework (SOF) and Segmentation Rating A new Single Oversight Framework (SOF) has now been issued by NHS Improvement (NHSI), following a period of consultation. The SOF aims to provide an integrated approach for NHSI to oversee both NHS foundation trusts and trusts, and identify the support they need to deliver high quality, sustainable healthcare services. The new SOF is effective from October 2016. In carrying out its role, NHSI will assess providers over 5 key themes, as set out below:

Trusts will be allocated a ‘segmentation rating’ from 1-4 (1 representing the strongest performance, 4 the weakest) based on NHSI’s assessment of an organisation’s performance across the 5 areas. Trusts with a rating of 1 will have the lightest touch regulation and be expected to share best practice and take a leading role in local system transformation and



3

transactions. Trusts in segments 3 and 4 will receive mandated support from NHSI specific to their issues (with segment 4 reserved for organisations in special measures). The first new ratings have recently been published and I am delighted to announce that DCHS NHS FT has been given an initial rating of 1. The key risk for the Trust within the new framework relates to the delivery of reduced agency spend in line with the NHSI trajectory we have been set for 2016/17 – see below. 2.2 2017/18 and 18/19 Trust Control Total All NHS trusts and foundation trusts have been issued with ‘control totals’ for 2017/18 and 2018/19 and Boards are required to confirm acceptance or otherwise of the totals by the 24th November. The DCHS NHS FT totals represent a significant increase in the Trust’s required surplus. This increase appears to relate to NHSI assumptions about a large income benefit to the Trust as a result of the introduction of Healthcare Resource Group (HRG) 4+ which does not match our assessment and which we have challenged. NHSI have asked the Trust to complete a detailed pro forma setting out our calculations of the impact of HRG4+ and we are currently awaiting feedback. Accepting the increased total would represent a significant increased financial risk organisationally and the Board will have to consider very carefully whether to accept the total or not if it is not amended. 2.3 Agency Spend reporting and oversight Delivery of the agency expenditure trajectory the Trust has been set by NHSI remains a very significant risk in 2016/17. NHSI has recently written to all Trusts to re-emphasise the importance of achieving the trajectories, to introduce additional controls into the processes of authorising agency staff along with additional reporting requirements. This is an area which the Board continues to monitor very closely and we are keen to continue to improve our position while maintaining quality and staff safety/experience.

Our NHSI agency target for this year is set at £1.46m and we are currently forecasting a year end position of £1.6m. The monitoring of this target is overseen by our Quality People and Quality Business Committees supported by an Operational Workforce Planning Group. Since September, as a result of this performance, we have included from September the detail in our monthly performance report to Board. The current steps we are taking to further control our agency expenditure are:

Securing more resources to our Responsive Workforce team. The team now includes band 5 Staff Nurses, band 6 specialist nurses, a paramedic, and Health Care Assistants. We are



4

currently recruiting to therapy posts. Staff are appointed onto flexible contracts and move across our county whether that be inpatient or community areas, supporting temporary staffing issues such as vacancies or long term sickness. Their assignments usually last between 6 and 12 weeks.

Further strengthening the size of bank including adding sexual health nurses, and therapists. Our bank fill rate remains high in comparison to our peers at 84%. Further consideration is being given to how we can further increase our fill rates.

Implementing ‘Responsive Bank’ shifts to our rosters, these are bank staff who at weekends can be moved at the last minute to respond to patient acuity or last minute sickness.

Running a large scale recruitment campaign for inpatients and community nursing including Derby city, General Practitioners, Minor Injury Units, practice nurses for primary care, Advanced Clinical Practitioners /Advanced Nurse Practitioners, therapy and inpatient wards.

Introduced a central ‘staffing monitoring’ service which provides daily monitoring of staffing, finding solutions to staffing gaps without using agency wherever possible.

Ensuring that the Responsive Workforce Clinical Lead (nurse) challenges and confirms requests for agency spend and works with clinical teams to explore alternative options.

Working with new national clinical staffing framework to avoid ‘over price-cap agency’.

Booking all agency through the electronic BankStaff system and no shifts can be booked without going through the central electronic system.

We commissioned an external audit of bank and agency use in 2016 and have enacted all the recommendations.

Progress with these initiatives will continue to be monitored closely by the executive team and reported through the governance channels outlined above. 3. System Transformation Updates 3.1 Developing the Derbyshire/ Derby City Sustainability and Transformation Plan (STP) The second iteration of the Derbyshire/Derby City STP was submitted to NHS England (NHSE) on the 21st October. This builds on the priorities identified in the summer and shared with governors over the past few months – an increasing focus on prevention, a shift of care from acute hospitals into the community and the development of integrated, place based care. It remains very consistent with the DCHS clinical strategy. System leaders are very keen to begin sharing the key elements of the plan with our local communities and wider staff groups in order that we can start to engage the public and NHS/Local Authority workforce in the meaningful discussions required to develop and refine detailed service proposals. We hope that this process will begin in November once feedback has been received from NHSE. The STP will frame the Trust’s Operational Plan for the next 2 years that the governor’s strategy group are involved in reviewing and shaping. 3.2 Better Care Closer to Home Consultation North Derbyshire and Hardwick Clinical Commissioning Groups (CCGs) Better Care Closer to



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Home Consultation concluded on the 5th October. After taking into account the feedback, ideas, issues and concerns from extensive discussions with governors and colleagues across DCHS, a written response to the CCGs was submitted by the Trust and this is attached for information as appendix A. The CCGs are working with an independent academic team who will be analysing the very high level of responses received before the health and social care partners involved in developing the proposals come back together to consider the key themes and issues that have been raised. 3.3 DCHS/DHcFT Collaboration The joint DCHS/DHcFT Project Board, supported by a joint project team and clinical and professional reference group, have completed the development of a Strategic Options Case (SoC) relating to our proposed collaboration. The SoC describes the case for change, the benefits for patients, staff and stakeholders of greater collaboration and considers which of the various ways in which the two organisations could work more closely together would best achieve these benefits. The SoC will be considered by both boards independently in the confidential sessions of our meetings on the 27 October. Any decision about a preferred option and commitment to continue to work together to develop an outline business case to support it will be shared with our Council of Governors, colleagues across the Trust and key stakeholders following the meeting. 4. Trust highlights and key operational issues 4.1 Care Quality Commission (CQC) Inspection As Governors will be aware the Care Quality Commission published the reports relating to its comprehensive inspection of the Trust on the 23rd September, following a Quality Summit on the 21st September.

The Trust has been given an overall rating of ‘Good with elements of Outstanding’ for the quality

of the services we provide. This is an extremely strong rating and is a credit to the professionalism, dedication and compassion of everyone in the Trust. It should provide assurance and confidence in the local communities we serve, and to our partners, that people in Derbyshire are being supported by a trusted, high quality community services provider. The

‘caring’ domain was rated outstanding overall across the Trust and all the other domains were

good. Two individual services – Urgent care and Dental services – were also rated outstanding.

Only one service, integrated sexual health services, was rated as requiring improvement. The Trust has already started working on addressing the small number of improvement actions that the CQC has identified. Our main focus will be on building on this excellent result and using



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our Quality Improvement and Assurance Framework to secure an outstanding rating overall at our next inspection Two DCHS General Practices have also been inspected in parallel by the Care Quality

Commission’s Primary Medical Services team and the Trust is also working to build on the good

practice identified in these inspections and address the areas for improvement. The third practice is being inspected at the end of October. 4.2 Quality Always Gold accreditation awards Great progress is continuing to be made by teams across the Trust with their continuous improvement journeys and this month another three teams have been awarded gold Quality Always accreditation. I am sure Board members would like to join me in offering our congratulations to Alton Ward at Clay Cross Hospital, Orchard Cottage and Hillside Ward at Ashgreen. All three teams have demonstrated the achievement of the highest standards of care consistently and all three had some very special things to share too about their commitment to quality:

Alton Ward Clay Cross shared some fantastic work on equality, diversity and inclusion and how they had had two patients who had disclosed issues regarding their sexuality where they could meet their individual needs from asking those difficult questions;

Hillside Ward at Ashgreen who told three patient stories which really emphasised the care, compassion and specialist care they provide to clients and their families which makes such a difference to peoples’ lives, and;

Orchard Cottage around the work on end of life care they are doing and how they are helping clients explore the impact of losing a loved one through the development of significant event life stories.

4.3 2016 Extra Mile Awards A number of governors joined more than 350 staff for a fantastic night on the 20th October celebrating the achievements of our colleagues over the last year. There were over 260 nominations and 49 finalists for the 2016 awards - individuals and teams who have been nominated by others for their dedication and caring - all of whom we were able to recognise and thank on the evening. This recognition means a huge amount to colleagues and I know that the Council will want to join with me in congratulating again all the finalists and eventual winners who play such a huge part in making DCHS the organisation it is. I would also like to thank all the governors who were involved in the shortlisting and judging process.

4.4 Organisational headline performance – the ‘big 9’ The Trust’s performance against our ‘big 9’ to the end of September is attached at Appendix B.



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Appendix A 30 September 2016 Steve Allinson, Chief Officer, NHS North Derbyshire CCG Andy Gregory, Chief Officer, NHS Hardwick CCG Scarsdale Nightingale Close Chesterfield S41 7PF

By email

Dear Steve and Andy

21C Joined Up – Better Care Closer to Home – feedback from Derbyshire Community Health Service NHS Foundation Trust Derbyshire Community Health Services NHS Foundation Trust (DCHS) has considered the 21c ‘Better Care Closer to Home’ public consultation at their Board Meeting on 29th September 2016. In terms of the clinical model and proposals for transforming inpatient assessment and treatment services for people with dementia and inpatient intensive rehabilitation and community services, the Board continues to support the plans as described. The new clinical models very much reflect our Trust strategy for the provision of these services and build on changes that we have implemented over the last 3 years. There were a number of important issues and concerns raised in the discussion that we feel need further consideration as part of the consultation process. These are in line with previous feedback regarding the proposals.

The critical importance of carers supporting vulnerable people at home was a key point in our previous discussions and the Board felt that there still needs to be a greater reference to their contribution and how they would be supported with the shifting focus to care at home. The final solution will need to consider dedicated resource to support this important issue.

The Board have previously discussed resilience and how the new services will flex to manage seasonal, or other, surges in demand. Our system resilience response has, up to now, been largely predicated on the opening of additional inpatient capacity. Whilst the focus is shifting in 2015/2016 away from beds, implementation of these new models will require the development of a new approach to managing resilience which we felt requires further consideration.

There are significant workforce transformation challenges built into implementing the new models, including the recruitment of additional direct care capacity which we know is already



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challenging in many parts of the North Derbyshire system. While the financial aspect of the increase in provision is addressed in the business case, there is still a good deal of concern around the practical recruitment, training and retention of this hard-to-find group. The assurance from Commissioners that no service will be removed until the new service is up and running is helpful, but the practical challenge regarding finding the direct care staff still needs to be addressed. The Board appreciates that this is being looked at through the work currently underway in the Strategic Workforce Development Group.

Implementation of the new models will mark a step change in working across integrated clinical and professional community based teams that we feel requires a greater focus and energy to support from the integrated governance enabling workstream. We do not feel fully assured that this workstream has published comprehensive and robust plans to take forward this work.

Members of the DCHS Executive and Senior Management Team conducted a series of staff briefing and drop-in sessions. We spoke to our Governors and with well over 1,000 colleagues face-to-face, taking on board their professional and personal opinions along the way. We were also pleased to be able to support the CCG-led public meetings, both as panellists and partners, to hear public opinion on the proposals. At every opportunity we have encouraged individuals and groups to feed back their comments directly to the consultation team. Additionally, we noted their collective comments, many of which were repeated. For completeness there is a summary attached at Appendix A, which should also be considered as an output from the consultation activity. Best wishes Tracy Allen Chief Executive [email protected] Cc Prem Singh, Chairman, Derbyshire Community Health Services NHS Foundation Trust Dr Ben Milton, Chair, NHS North Derbyshire CCG Dr Steve Lloyd, Chair, NHS Hardwick CCG Appendix A (of letter) Feedback noted by DCHS Executive and Senior Team Members from Trust Governors and staff feedback sessions: 1. In each locality there is vociferous support for their local hospital and wards. The public

recognise the very high standards of care that we deliver and in many cases associate this with the bricks and mortar of the buildings.

2. In the west of the County there was significant feedback about the perceived loss of 2 dementia Respite Care beds at Cavendish Hospital in Buxton. The CCG have confirmed that these beds are not part of this consultation.



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3. The travel distances from the west of the County to Chesterfield for OPMH are seen as onerous and impossible in the winter. Feedback from those in the Dales have made the same point.

4. Consideration needs to be given for family/carer transport solutions. At one meeting there was a commitment made by the Hardwick Chief Officer to fund this inevitable additional burden for those who need to visit in-patients where the travel distance is substantial.

5. There is a concern that clinicians may be less effective and efficient working in a community

team rather than in a centre. This fear relates to clinicians travelling between patient homes and also to equipment availability and the practical element of delivering therapy into people’s homes (e.g. parallel bars, rotundas).

6. A concern that the Dementia Rapid Response Teams (DRRTs) will only operate from 8am to

8pm, and that the out of hours requirements are not being addressed by the proposal. 7. Another particular concern linked to the 8pm-8am model was raised. When accompanied by

the cuts to social care budgets and access to care packages, there is a concern that the system may struggle to respond to a crisis after 8pm. It has been suggested that extending the scope of the current out-of-hours (OoH) nursing model should be considered to complement the existing Derbyshire Health United (DHU) service. Consideration should also be given to an OoH Integrated Community Team that includes the existing DHU nurses and care workers.

8. Significant concern was indicated about the lack of detail on the “beds with care” concept

and the local availability of this type of provision. Additionally some concerns were expressed about the private provision of these beds and that these should be commissioned through the public sector. It was suggested that the Care Homes Advisory Service could provide a useful resource (as has been demonstrated in the Amber Valley).

9. Consideration also needs to be given to the existing intermediate care beds at Eckington,

Dronfield and Staveley (each unit with 8 beds) as there will be implications if the proposed beds with care are commissioned i.e. beds will need to be de-commissioned.

10. A number of comments have been received questioning whether the beds with care could

be attached to, or form part of, the retained inpatient bed base. 11. Any future model must give adequate consideration to accessing equipment and its safe use

in patients’ homes and the “beds with care”. A safe and clean care and working environment must be a priority to safeguard clinical quality. Consideration should be given to in-reach service provision of deep cleaning to those patients who will be cared for at home under the new model.

12. Significant clinical benefits are delivered in the current model to inpatients from receiving

quality food while in hospital. It has been suggested that high quality nutrition should be made available to patients being cared for at home by making food available on prescription from clinicians while they are in the care of the community and DRRTs.



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13. Staff are aware of an imminent review of day services by Derbyshire County Council. We believe it would be prudent therefore to review the day units across the County in partnership with Derbyshire County Council.

14. There were concerns raised that the current Integrated Community Teams already have

capacity challenges managing current demand and that this will need addressing before any expansion. Additionally, there were a number of comments on the training that would be required to help the staff transition into community roles, which acknowledged that this is already happening.

15. While the proposal is clear that the proposed rehabilitation beds at CRH will be managed by

DCHS, there were concerns that at times of significant pressure on beds at CRH that there would be significant pressure to breach the criteria for the ring-fenced rehabilitation beds. There was a request for more detail on how this will be addressed to ensure that only suitable patients were admitted to the rehabilitation beds.

16. The commitment by commissioners that no service would be removed without a new,

appropriate service being in place was welcomed. Commissioners will need to clarify how the demonstration of this will be measured and demonstrated in practice, and over what period.

17. Commissioners will need to clarify how this consultation links into and complements the

system-wide plans (STP), particularly with regard to joint funding across other parts of the County which are not included in the Better Care Closer to Home consultation.



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Plan to

end of

September

Clinical Effectiveness -Over 75 clients using our

ICS services assessed for frailty (%)95% 0% 0% (GREEN) 95% (GREEN)

Patient Experience - Improvement in time to

respond to complaints80% Within 40 Days 70% 50% (RED) 80% (GREEN)


Plan to

end of

September

Ensuring all staff are complaint with essential

learning96% 96% 95.5% (AMBER) 96% (GREEN)

Improving staff wellbeing by reducing work related

stress and anxiety

20% reduction in number of days lost

(300 days) to stress and anxiety based

on 15/16 averages to below (1,200

days)

20% 9% (RED) 20% (GREEN)


Plan to

end of

September

Demonstration of efficiency across all DCHS

services through the delivery of the Sustainable

Quality Improvement Plan (SQIP)

£5m Sustainable Quality Improvement

Plan (£000)2,015.9 2,104.3 (GREEN) 4,827 (AMBER)

Measuring the progress towards becoming a more

agile organisation by reducing the spend on non-

Clinical estate

Less than 7,270m2 7,270m2 6,520m2 (GREEN) <7,270m2 (GREEN)

Responding to the main issue raised through staff

feedback by monitoring the perceived improvement

in IT connectivity for staff

Less than 35% of staff Often or Always

Experiencing Connectivity Problems35% 33% (GREEN) <35% (GREEN)

Big 9 - September 2016

Quality Service

Achieved to

end of

September

Forecast

To deliver high quality and sustainable

services that echo the values and

aspirations of the community we serve

Patient Safety - To reduce the overall number of

patients who incur pressure damage

20% Reduction in Baseline of 793

Pressure Ulcers5% (178) 9.9% (164) (GREEN) 20% (293) (GREEN)

Quality Business

Achieved to

end of

September

Forecast

To ensure an effective, efficient and

economical organisation which

promotes productive working and which

offers good value to its community and

commissioners

Increase (GREEN)

Quality People

Achieved to

end of

September

Forecast

To build a high performance work

environment that engages, involves and

supports staff to reach their full potential

Improved position of staff reporting incidents of

violence and aggression they encounter at work

Month on month increase in reporting

compared to 15/16 data29 41 (GREEN)

Appendix B




Title of Paper: Trust Secretary’s Report


Presenter: Kirsteen Farrar, Associate Director of Corporate Governance/Trust Secretary

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

Date of Meeting: 10th November 2016 Agenda Item No: 129/16

No of pages including this one: 2

Appendices:

Purpose of Paper

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

Summary

Governor news Mark Smith has resigned from his position at North Derbyshire Clinical Commissioning Group (CCG) and will no longer attend the Council of Governors meetings on their behalf. We are currently working to appoint a replacement Governor. Council of Governors elections The elections closed on Friday, 30 September and results were declared on Monday 3 October. There were 38 candidates who stood for election and as a result all 14 vacant seats were successfully filled. The details of the successful candidates are set out below:

Constituency Governors

Amber Valley, Erewash and South Derbyshire Valerie Broom, Mike Perry, Nicola Waller

Bolsover, Chesterfield and North East Derbyshire

Lorraine Culpin, Jane Hitchenor, Christine Mitchell, Julian Miller

Derbyshire Dales and High Peak Andrea Cooke, Ann Button

Nursing Lynn Brailsford, Veronica Hunting-Young

Facilities and Estates Louise Holmes

Other Registered Professionals Lynne Bakewell

Healthcare Support Staff Wendy Hodgkinson

Governors will note that there are 9 new Governors and 5 existing Governors who have been successfully re-elected.

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Council of Governors Self-Assessment The Council of Governors was advised at the July meeting about completion of the Council of Governors Self-Assessment exercise. We were grateful to the large number of Governors who participated in the survey, with 23 out of 27 governors providing responses to the questionnaire. Governors will recall that the Governance Group was originally involved in finalising the self-assessment questionnaire. In August a summary of the self-assessment responses and comments was reviewed by the Governance Group to identify any training needs or areas for improvement and to make recommendations for an action plan. The Governance Group recommended that the main themes and actions are reported to the Council of Governors. The majority of responses were positive, with Governors selecting “Strongly Agree” or “Agree”. The themes that suggested areas for improvement were:

1. Good quality discussion and consultation Actions:

The September Council of Governors pre-meeting discussed and encouraged all Governors to consider and challenge papers and presentations

The September pre-meeting discussed the purpose of the pre-meeting which is for the governors to meet and discuss the agenda without the Board attending. This helps facilitate open discussion and encourages better questions to be raised in the full meetings

The Council of Governors meetings will feature the work of one of the Governor Groups in greater detail. This will provide the rest of the Council with a better knowledge of how the Groups are exploring issues in much greater detail than would be possible during Council of Governors meetings.

2. Governor engagement with members

Actions:

Following the election of new Governors to the Council the membership of the Engagement Group will be amended. Meetings will recommence and report into the Council of Governors meetings.

3. Governor Training and Development Actions:

Plans are underway to provide induction training for new Governors, following completion of the 2016 Governor election. Existing Governors have been invited to attend the training sessions so that they can recap on some of the core information about their role and responsibilities as a Governor. The training may also help Governors who, in the self-assessment exercise, selected “Don’t Know” to particular questions or may be unaware of some of the processes involving the Nominations and Remuneration Committee.

Recommendations

The Council is asked to consider and discuss the information provided in the paper.



Key Dates and Future Events 2016/2017

Date Event Time Venue

Thursday 10th November

Council of Governors Meeting

2.00pm Postmill Centre Market Close South Normanton Alfreton DE55 2EJ Tel: 01773 860296

Thursday 24th November

Board Meeting 1.30pm Arena Church 1 Rutland St Ilkeston DE7 8DG

Thursday 15th December

Board Meeting 1.30pm Belper Town FC Christchurch Meadow Bridge Street Belper Derbyshire DE56 1JJ

Wednesday 11th

January 2017 Council of Governors Meeting


Thursday 26th January

Board Meeting 1.30pm St Thomas’ Centre Chatsworth Road Brampton Chesterfield S40 3AW

Thursday 23rd February

Board Meeting 1.30pm Venue To Be Confirmed

Wednesday 15th March

Council of Governors Meeting


Board Meetings: Members of the public and staff are invited to join the Board for an informal discussion over lunch from 12.30pm. This will include a presentation on the services provided in that area. The Public Board meeting will commence at 1.30pm.

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