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A warm welcome. Trust Annual General Meeting 16 September 2019. Things we are proud of over 2018 /19. Highly motivated and engaged staff. Consistent, continuous, improvement being embedded.
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A warm welcome Trust Annual General Meeting 16 September 2019
Things we are proud of over 2018 /19 Highly motivated and engaged staff Consistent, continuous, improvement being embedded Improving our estate and infrastructure – relocated PICU, new Children’s Hub in Enfield, IT systems Enablement and co-production Clear, ambitious Trust Strategy, co-produced with users, staff and partners Successful transition to new Trust Board, new leadership team in place
What is special about BEH? Our patient-centred focus on enablement and recovery that listens and responds to service users Our caring, diverse and supportive staff culture where staff go the extra mile and have a strong team spirit Ourrange and combination of services encompassing mental and physical health Our high profile specialist services such as forensics and eating disorder services Our caring, diverse and supportive staff culture where staff go the extra mile and have a strong team spirit Our locality focus where we are embedded in the community covering a wide area and responding to local needs
Our priorities for 2019/20 - Excellence for service users • Delivering Brilliant Basics • Ligature anchor points • Risk assessments and care plans • Restrictive practices • S132 rights / capacity to consent • Physical health monitoring • Updated policies in all areas • Embedding safety huddles • Meeting increases in demand and acuity • Opening new ward in Barnet in autumn - 10 additional beds • Urgent Care Pathway Review • Out of Area Placements Recovery Plan • Working with local authorities to reduce delays
Our priorities for 2019 /20 - Excellence for service users • Improving environment for patients and staff • New St Ann’s inpatient unit opening summer 2020 • Competition to name new unit, give us your ideas! • Plans to modernise seclusion rooms and eliminateshared bedrooms • Developing Strategic Outline Case for rest of our estate • Strengthening governance • External review of Trust governance structures and processes from ward to Board • Corporate governance improvement plan in place • Consistent governance structures for new Divisions being developed Current bedroom on Finsbury ward at St Ann’s Future bedroom in new hospital
Our priorities for 2019/20 - Empowerment for staff • Enhancing staff experience and perceptions • Addressing staff perceptions of unfairness • New Diversity and Inclusion Committee chaired by CEO • Active mentoring programme focused at BAME staff • Values and Behaviours Framework to address perceptions of bullying and harassment • Strengthening borough and professional leadership • New multi-professional divisional leadership teams • Strengthened clinical leadership roles within Divisions • Improving staff recruitment and retention • Open days, development programmes, 60 new students from Middlesex University • Quality Improvement Collaborative to address retention in Haringey • Increasing staff engagement • Systematic approach to staff engagement programme e.g. Executive Roadshows, BEH Listen • Introduced - Team leaders sessions and Senior Leadership Forum
Our priorities for 2019/20 - Innovation in services • Embedding Quality Improvement • Increased investment into Quality Improvement • Development of the Quality Improvement Faculty • Training programme • Ensuring learning across services • Pan-Trust Service Leads spreading best practice • New structure will facilitate shared learning across the organisation • Service transformation • Strategic transformation of services - urgent care review- community services in Enfield- new unit at St Ann’s Hospital- Barnet new beds- CAMHS • - releasing time to care (mobility) • Extending ‘Releasing time to care’ programme • 20% of staff already have mobility devices, further roll-out in development, now focusing on changing ways of working
Our priorities for 2019/20 - Partnerships with others • Strategic Alliance with Camden & Islington • Improving patient care • Improving staff experience • Strengthening the voice of mental health at NCL level • Using our limited resources more effectively • 10 work streams identified • Further developing local partnerships • Active engagement in development of new Integrated Care Partnerships • Capitalising on opportunities to strengthen local services in Primary Care Networks • Continuing to play leading role in the North Central London Strategic Transformation Partnership (STP)
Quality Amanda Pithouse Director of Nursing, Quality & Governance
2017 CQC – Enfield Community Health
2017 CQC – main themes Report published January 2018 • Financial challenges • Privacy and dignity – seclusion rooms and bedrooms • Risk assessment processes • Attention to physical health needs • Staff supervision • Care plans • Ligatures
2019 CQC inspection • Two parts: • Core services – 18-27 June • Well led – 29-31 July plus activity throughout July • Received embargoed draft report • Completed our factual accuracy check • Final report and revised ratings expected in October
Feedback – areas of improvement • Flow – out of area placements, use of leave beds, delays in Allied Mental Health Professional assessments, Place of Safety breaches • Sharing learning across teams and boroughs • Physical health monitoring – consistency • Staffing
Feedback – areas of good practice • Caring, committed, passionate, hard working and welcoming staff • Improving trajectory across the services • Leadership • Quality improvement – passionate articulation • Improved care plans – coproduction, focus on enablement • Improved risk management systems – safety huddles, assessments, zonal meetings • Improved environments • No surprises
BEH Quality Priorities, 2019/20 Brilliant Basics • Patient Safety • Safe environments • Reducing restrictive practices • Risk Assessments • Physical Health Monitoring • Patient Experience • Timely access to beds • Care planning • 132 rights/capacity to consent • Effectiveness • Mandatory training • Floor to Board data
Quality Account 2018/19 • Available on our website • Copies to take away here today
Financial Review 2018/19 David Griffiths Chief Finance and Investment Officer
Financial highlights *The Trust’s performance is cumulatively assessed over a rolling-three year period, and the cumulative surplus over that period was £21.8m
Capital investment summary • These investments were funded by: • In-year asset disposals £2.4m • Depreciation £6.9m • St Ann’s sale proceeds c/f £6.2m
Financial performance The Trust’s financial performance was £3.2m better than planned: £0.7m was directly related to careful management of income and expenditure by the Trust £2.5m was additional income received from NHS Improvement as a consequence of our better than planned performance Meanwhile the Trust continues to work hard to deliver further efficiency savings and provide value for money services: In 2018/19 we delivered £7.5m of our cost improvement plans against a target of £8.2m (equivalent to 4% of income) Continued to deliver efficient services – our 2017/18 reference cost index was 97 (100 equals average performance)
Outlook for 2019/20 and beyond For 2019/20 we have set a balanced budget for first time since 2013/14. Our underlying deficit of £5.5m is offset with planned provider sustainability funding of £5.5m Our plan to achieve this requires us to manage three key risks: Recruiting and retaining sufficient staff to improve quality of care and avoid high levels of spending on agency staff The increasing demand for our mental health inpatient services, and service users typically being more unwell Delivering a Cost Improvement Plan of £8.1m – 3.4% of income The North Central London (NCL) health and care system continues to spend significantly more than Clinical Commissioning Group allocations and we are therefore working with partners to: Set out a new five year implementation plan for the new NHS long-term plan priorities Alongside this, develop a NCL system-wide financial recovery plan
Enfield Pain Service Dr Anna Mandeville Enfield Borough Lead for Psychological Therapies Consultant Clinical Psychologist Joint Clinical Lead for EPS with Dr Lucy Ward Consultant in Pain Management
Persistent Pain – Why is it so important? 47255315 35-51% Population 10-14% Severe Disabling Pain 62% Older Adults (75 & above) 30% Younger people
No sole practitioner acting in isolation, whatever their profession, can claim to run a pain management clinic or service.
Experience of pain is physical and psychological • How we think about pain • How we move, stretch, exercise • Mood • Past experiences of pain • Medical interventions Advanced pain processing models Tracey & Mantyh 2007
Redesigning Pain Services in Enfield Excellence Partnership Integrated MDT Pain Service Innovation Enablement
Redesigning Pain Services in Enfield Excellence Partnership MDT all in one place – Chase Farm Pain Consultants, Physios, Nurses, Psychologists Integrated MDT Pain Service Innovation Enablement
Redesigning Pain Services in Enfield Partnership Excellence Royal Free Hospital NMUH Enfield CCG Access to further medical intervention when needed MDT all in one place – Chase Farm Pain Consultants, Physios, Nurses, Psychologists Integrated MDT Pain Service Innovation Enablement
Redesigning Pain Services in Enfield Partnership Excellence Royal Free Hospital NMUH Enfield CCG Access to further medical intervention when needed MDT all in one place – Chase Farm Pain Consultants, Physios, Nurses, Psychologists Integrated MDT Pain Service Close working with Mental Health IAPT Secondary Mental Health Services Health Foundation ?Pilots – Trauma & Pain, SMI Innovation Enablement
Redesigning Pain Services in Enfield Partnership Excellence Royal Free Hospital NMUH Enfield CCG Access to further medical intervention when needed MDT all in one place – Chase Farm Pain Consultants, Physios, Nurses, Psychologists Integrated MDT Pain Service Close working with Mental Health IAPT Secondary Mental Health Services Health Foundation ?Pilots – Trauma & Pain, SMI Supported patient partnership Pain Management skills Patients goals Links with community Enablement Innovation
Right medical interventions Right people Right time Fit for purpose MDT approach GP or self Referral PMP Individual Psychology RFH NMUH APP Consultant First appt CNS Meds Physio & Psychology Community Physio
The story so far… 400 patients 290 seen in 4-6 weeks
“It’s early days but I was very happy with the approach. I am confident that they will be able to help me manage my condition” “Excellent” “The time and attention to me as a whole patient was very appreciated” “Most informative and explanatory in every aspect” “Encouraged me to be active to achieve my goals …advised me as to exercises that will help me to improve my health”
Bed management service Jackie Liveras Managing Director Enfield Mental Health Division
