John Short - Chief Executive

1. Joint Birmingham & Solihull Health Overview & Scrutiny Committee10th September 2014CQC Visit May 2014 John Short - Chief Executive

2. Key issues shared with the CQC in May 2014 Challenges Good News

3. Challenges • Cost improvement programme • Serious incidents / Homicides • Variation between services • Bed occupancy • Management changes (taking place during review period) • Inconsistent commissioning • Under 18 admissions • Restraint

4. Good news • Significant capital investment in recent years – however a number of older buildings require significant improvement • High profile services: RAID, Street Triage, British Transport Police • Range of accredited services eg: AIMS • Maintaining AOT / HTT as National Confidential Inquiry report • Time to Change project – to challenge mental health stigma

5. How was it for us? As described! Felt CQC Risk Assessment (issued to inform the review) was accurate except Bed occupancy issues Staff anxiety but positive reception Feedback on the day

6. Trust Score SUMMARY

7. Our Action Plan • Reports have been shared with all staff • Action Plan drafted and reviewed by Trust Board • Monitoring process agreed by Board • Reports confirm: • Nil enforcement actions • Nine Compliance actions • 8 further improvement suggestions

8. QUALITY SUMMIT: Highlighted contributions of other agencies to our action plan. Approval by commissioners for support where identified. Action plan reviewed by Monitor and CQC.

9. Locations:Barberry, Mary Seacole House, NewbridgeHouse and Bruce Burns unit Issue: Monitoring of safe temperatures for the storage of medicines and that people who require their physical health care medication receive this in a timely manner Trust has reinforced existing procedures are being followed. Weekly checks to confirm arrangements are embedded. Will be ultimately confirmed through annual audit. (NOTE: Actions identified with  were already in place or have been taken)

10. Mary SeacoleHouse: Ensure that the ligature risks are assessed and addressed Risks had been identified.  Actions have commenced replacing taps and doors.  Other controls reinforced (eg in rooms where service users are accompanied by staff). 

11. Accuracy of records on the acute admission service on the Northcroftsite Programme of review / improvement of Care Planning arrangements in place

12. Mary Seacole/ NewbridgeHouse: Staffing to ensure that the physical health care needs of people at and are being met Out of hours medical review being undertaken by Medical Director

13. Ross House: Risks of abuse and ensuring dignity and respect Two nursing staff were suspended and management action commenced / NMC referral.  All care plans have been reviewed.  Additional CPA training session held  Clinical Nurse manager to undertake random audits to ensure changes are embedded.

14. Hollyhill:ensuring that the equipment provided is properly maintained and suitable protection against the risks of receiving care or treatment that is inappropriate or unsafe • Equipment identified - problem addressed (failed battery)  • Guidance provided to ward and will be issued to all areas. • Incident identified – management action taken • Further awareness sessions being undertaken on ward  • Additional monitoring to confirm standards are met and reinforced.

15. Neuropsychiatry service:length of waiting times to be raised with commissioners • Commissioners have agreed to clarify who is responsible for commissioning of the service. • Trust will work with lead commissioner once this is confirmed. • Other controls already in place: • Strict application of criteria to the service  • Arrangements to reduce DNA’s  • Additional staffing support 

16. Actions the Trust should take to improve:(Not compliance actions) The Trust should ensure that the examples seen of good practice on the Ashcroft unit and Rosemary ward are disseminated throughout the rest of the older peoples service.‘Dare to share’ event planned The Trust should ensure that the environment of Ross House is updated to provide care in a safe and rehabilitative environment. Actions being taken The Trust should recruit to staff vacancies in the specialist core rehabilitation services. Actions being taken The Trust should provide specific training for all staff who work with people who have a diagnosis of a personality disorder. Training programme under development The Trust should ensure that the community teams and the Trust pharmacy carry out regular audits of the medication stocks held by the community teams, and that any identified concerns are addressed. Part of core audit programme

17. Actions the Trust should take to improve:Where commissioner support required: • The Trust should work with their commissioners to determine whether older people with functional and organic mental health needs should be accommodated on the same ward. • To be reviewed through existing forum • The Trust should review the referral pathways into the specialist eating disorder service to ensure that care and treatment needs are being met in a responsive manner. • As with Neuropsychiatry to clarify lead commissioner and Trust to work with. • The Trust should work closely with commissioners to ensure that shared care arrangements with general practitioners are established within the youth clinical support team. • Action to be reflected in 0 – 25 service specification led by Central and South CCG. • Bed Occupancy: Trust Bed Occupancy: 96% w/o leave, 115% with leave CQC States: It is generally accepted that, when occupancy rates rise above 85%, it can start to affect the quality of care provided to patients and the orderly running of the hospital. • Currently £2million cost to NHS for out of area placements – identified by commissioners to be available. Bridging costs to be identified. • Based on clear specification Trust can develop service

18. Overall Score … Good