Forensic executive meeting - West London Mental Health NHS Trust

BOARD – SUMMARY REPORTDate of Board meeting: 19 th June 2007Title of Report: Forensic Executive Meeting – 05.03.07Title of Director:Paper Number:Committee ChairmanWL1165Purpose of the report:To brief the Board on the work and progress of the sub-committee.Recommendations to the Board:The Board is asked to review the minutes and note the actions and recommendation(s) of thesub-committee.Action required:As highlighted in the minutes.Relationship with the Assurance Framework (Risks, Controls, and Assurance):Demonstrate accountability of sub-groups to the Board.Healthcare Standards (Core / Developments):This supports the Trust compliance with C7, that the Trust applies principles of sound corporategovernance.Summary of Financial and Legal Implications:As highlighted in the minutes.Equality & Diversity and Public & Patient Involvement Implications:As highlighted in the minutes.

Minutes of Meeting 2Forensic Executive Meeting 05 March 2007WEST LONDON MENTAL HEALTH NHS TRUSTFORENSIC EXECUTIVE MEETINGMONDAY, 05 MARCH 2007BROADMOOR HOSPITALRatified 08 May 2007Present:Sean Payne, Director of Forensic Services [Chair]Dr. Aideen O’Halloran, Clinical Director, Women’s ServicesGemma Stanion, Head of Allied Health ProfessionsDavid Cochrane, Service Head – Social WorkGraham Crennell, Associate Director – Environment, Strategic Service DevelopmentJo Smith, Deputy Director of FinanceLinda Dyson, Deputy Director of H.R.Alan Stirling, Associate Service Director, Women’s ServicesAngela Dolan, Service Director, DSPDDr. Nick Broughton Clinical Director, Men’s West Directorate, West London ForensicServiceJimmy Noak, Deputy Director of NursingMaria Harrington, Associate Director of Clinical Governance, WLMHTProfessor Tony Maden, Clinical Director, D.S.P.D. UnitJo Leech, Associate Director W. London Forensic ServiceSharon Hinsley, Service Director, Women’s ServicesDr. Paul Gilluley, Clinical Director, Men’s Central Directorate, West London ForensicServiceDr. Kevin Murray, Associate Medical DirectorTrish Burns, Service Manager, Men’s London DirectorateAlan Brown, Director of ICTLiz Edghill, Planning & Performance ManagerMaggie Gairdner, Service Director, Men’s South of England DirectorateTrudi Hilton, Chief PharmacistDr. Andrew Payne, Clinical Director, Men’s London DirectorateBarbara Worts, Performance Improvement ManagerIn Attendance:Delore Jones, P.A. to Director of Forensic Services [Minute Secretary]1. APOLOGIESTony Pearson, Non Executive DirectorAndrew Weir, Service Director for Men’s & Adolescent Services, W. LondonForensic Services

Minutes of Meeting 4Forensic Executive Meeting 05 March 2007consideration be given to contacting Geese Productions who visit prisonsand offending institutions as they may have a more suitable programme ofproductions. Dr. Murray will be meeting with the Hospital’s Drama Therapistnext week for further discussion around drama production for service users.4. STRATEGIC DIRECTION4.1. Progress on Service Level Agreements [SLA]4.1.1. London Forensic ServiceJo Leech advised that verbal agreements have been reached with theConsortium on service level agreements. Agreement with NSCAG has alsobeen signed for the Wells Unit with agreed costs per bed night.4.1.2. High SecureSean Payne advised that a recent SLA meeting with the commissionersfailed to reach full agreement. Another meeting is scheduled with theFinance Sub-group of the National Oversight Group [NOG].Women’s Services will remain within the high secure SLA for this year butwill be the subject of discussion with NOG for next year.The DSPD SLA has been agreed and progress will be made towardsopening the fourth and fifth wards. Funding has reverted to NHS London.4.2. Foundation Trust Application UpdateSean Payne updated the meeting on the position of the Trust’s applicationfor Foundation Trust status, which has now been put on hold following theSecretary of State’s decision not to progress FT status to high secure Trusts.The Chief Executives from the three high secure hospitals will be meetingwith the Department of Health to consider a way forward. It appears that theDepartment of Health wishes to support the Trust in developing FT statusbut it is not clear whether the high secure element can be included. Optionswill be submitted to the Department of Health in April.5. PERFORMANCE MONITORING / MANAGEMENT5.1. Business Plan – London Forensic ServiceThe first draft was tabled for discussion and information. Jo Leech advisedthat a subsequent e-mail has been received from Lesley Stephen, Director ofStrategy and Performance, with further objectives. Work is still required ontargets. The final draft will be submitted by 21 March. Ms. Leech advisedthat the draft includes some priorities from last year. Some servicedevelopment targets are included, but further consideration needs to begiven to the implications of not proceeding with the application for foundationtrust status.

Minutes of Meeting 5Forensic Executive Meeting 05 March 20075.2. Business Plan – High SecureAngela Dolan tabled the second draft of the high secure business plan forcomments. The business plan will be further amended in advance of theproposed deadline of 23 March.5.3. Update on Cost Improvement Plans [CIPs]Sean Payne reported that the CIPs were discussed at the Trust Board AwayDay on 27 February and were generally well received. Further work isrequired within the high secure Clinical Directorates to identify the fullrecurrent CIPs.Trudi Hilton reported on issues around the medicines budget and advisedthat the current competition among drug companies may not continue assome competitors may be leaving the market. The current underspend onthe budget will not be written off until the situation is clarified.Sean Payne advised that there have been pressures on ward budgets thisyear and both the Men’s Directorates at Broadmoor are looking to improvemanagement of overtime. Service Directors and Service Managers havebeen asked to agree local targets for each ward. In line with fundedmodernisation plans, there will be a significant increase in staffing levelswhen Women’s Services’ staff are redeployed in September. There is aclear expectation that this will further reduce reliance on overtime.Dr. Kevin Murray advised there needs to be a note of caution regardingSenior House Officers. National interviews are ongoing at present for alldoctors in training, who are being recruited to posts commencing in Augustand there is a need to check that provision for training is still available.Gemma Stanion emphasised that all disciplines need to be involved indiscussions on CIPs. Sean Payne agreed that this is important, whether ornot we move towards foundation trust status. Issues such as changes toshift patterns, etc., will have an impact on savings. Corporate initiatives willalso have to be taken into consideration. Jimmy Noak said it was essentialthat professional heads be involved in any discussions on cost cutting toensure a safe environment of care is maintained.5.4. Mental Health Act Commission Report / Response5.4.1. Barbara Worts reported on the MHAC report and the draft response from theForensic Division. The MHAC report was based on the Commissioners’findings after visits to the service. This is the first time the report hasincluded both Local Services and Forensic Division. The initial report wassent to the Trust in November 2006 for checking for factual inaccuracies andthe final draft was received in January and circulated on 26 January. The

Minutes of Meeting 6Forensic Executive Meeting 05 March 2007Commissioner attended the Trust Board in January and presented thereport. The report is now available with the Trust Board papers on the ‘N’Drive.Mrs Worts reported that comments received so far have been incorporatedwithin the response paper and further comments have been received sincethe deadline for the FEM papers. The next stage is for the response fromthe Forensic Division to be combined with Local Services for submission tothe Trust Board in April.An action plan was tabled and Mrs. Worts requested comments andsuggested amendments to both the action plan and the response to besubmitted to her by 16 March.Action – All5.4.2. Mrs. Worts also tabled a Progress Report outlining progress in addressingissues raised by the Mental Health Act Commissioners during their visits.This has been introduced in an attempt to improve the timing of ourresponse. It was noted that there were 112 issues outstanding from theCommissioners’ visits. There are a number of recurring themes (item 4.1. ofthe Progress Report). By addressing these issues in the action plan andbringing regular updates to the Forensic Executive Meeting, these can beaddressed more systematically. The appendix to the Progress Report is thesuggested draft format for responses.Sean Payne stated that the Directorate must begin to address the issuesraised by the Commissioners in a more timely manner. In a recent letterrelating to Section 132, Stephen Klein, Regional Director of MHAC,expresses his frustration that this issue has not been addressed. Mr. Payneemphasised that matters must be addressed on at least a quarterly basisand improvements made to the current system. Jimmy Noak stated thatlocal monitoring should be in place and we should not be waiting for theMental Health Act Commissioners to draw our attention to the deficiencies.Dr. Paul Gilluley stated that he is aware there have been some problems atthe London Forensic Service in getting comments to Barbara Worts in atimely manner and he will look into this. A similar table has been producedlocally within the service and discussions are taking place with Mrs. Worts toavoid duplication.Action – Service Directors6. POLICY MATTERS6.1. Patients’ Access to Sexually Explicit & Sexually Violent MaterialIt is the intention to use these guidelines as a baseline for a Trust-widepolicy. Jo Leech confirmed that Derek Perkins has been asked to do somework on this policy. Dr. Kevin Murray pointed out that the old policy is still on

Minutes of Meeting 7Forensic Executive Meeting 05 March 2007The Exchange and he will ask the Board Secretary to substitute this with thenew guidelines. Some amendments are required to the list of 18 videos.The policy will be taken up through the Clinical Governance agenda. Thepolicy will be reviewed again in October.6.2. Trustwide Guidance: Help for People Bereaved by SuicideAvailable from www.dh.gov.uk/publications6.3. Policies for ConsultationTabled for information.6.4. Policies IssuedTabled for information.6.5. Fire Procedures (Tony Hillis Wing)This policy was brought to the Forensic Executive meeting for signing off. Ithas already been approved by the Fire Advisor and the local Fire, Health &Safety Committee.The policy was agreed by the meeting.7. GOVERNANCE ISSUES7.1. Finance ReportJo Smith presented the Finance Report to end January 2007. Overall theTrust has underspent by £1.4 million for year to date, which is on target foran underspend of £2.3 million at the end of the financial year.The Forensic Division reported an overspend of £121K for January and£370K for year to date.Sean Payne stated that the overspend figures for the Men’s Directorates atBroadmoor, particularly within the ward areas, were of concern. MaggieGairdner reported that the admission, ICU and high dependency wereoverspent for a variety of reasons, including external escorting costs andincreased observations. Service Directors were asked to review all wardbudgets and take corrective action.Action – Service Directors8. SECURITYThe Security Report for January and February was tabled for information.Sean Payne queried the two absconsions from Bramley Ward on successiveweeks and asked if this was the same patient. Confirmation will be obtainedand given to Mr. Payne outside of the meeting.

Minutes of Meeting 8Forensic Executive Meeting 05 March 2007Jo Leech advised that an audit of Security service standards Ealing hasbeen completed. All standards had to be revalidated by SpecialistCommissioners. An action plan has been prepared to address identifieddeficits. Ms. Leech was asked to bring the action plan to the ForensicExecutive meeting in May.Action – Jo LeechDr. Kevin Murray advised that the annual meeting between Thames ValleyPolice and Broadmoor Hospital took place on 23 February. One issuehighlighted at the meeting was the reporting of assaults to the police. Dr.Murray is keen to have a similar meeting between the medium secureservice and the local police at Ealing. Dr. Gilluley stated that staff are gettingfrustrated when there is no positive outcome to the reporting of assaults andJo Leech emphasised the difficulties which have been experienced inengaging the local police to investigate assaults. Sean Payne pointed outthat the Trust has a responsibility to report incidents of assault. If an incidentwarrants an IR1 form, this should automatically trigger a report to the police.This issue is currently being considered by Gail Miller, Associate Director ofViolence Reduction.Trudi Hilton raised the issue of illicit substances and stated that in someinstances Pharmacy are requested to analyse tablets which have beenfound in patients’ possession. She explained that it is not possible to providethis service. Dr. Aideen O’Halloran stated that she believed it is crucial tohave a substance analysed. Ms. Hilton said that current policy states thatalcohol and/or illicit substances are to be stored, but there is no active policyto address the disposal if illicit substances and alcohol. Ms. Hilton hasalready submitted proposals to address this to the Security Department.Sean Payne asked Ms. Hilton to let him have a copy of her proposals.Action – Trudi Hilton9. OTHER ITEMS FOR DISCUSSION9.1. Future Financing of Learning & DevelopmentSean Payne tabled this paper prepared prepared by the Director of HumanResources. The paper generally set out details of the funding of Learningand Development. Each service area has a local budget for core trainingand the allocations are detailed in Table 4 of the paper. The Trust Training &Education Committee are interested in knowing how the training budgets areutilised across the Trust. Service Directors are being asked to look at theutilisation of funds and ensure that each Directorate has a training plan inplace. This will feature in future business plans.

Minutes of Meeting 9Forensic Executive Meeting 05 March 20079.2. Update of WEMSS Projecto Sharon Hinsley tabled the quarterly update paper on WEMSS andreported on progress:o The Orchard project is on target for completion of build in June.o Recruitment is on-going and In line with national trends, someproblems are being experienced with the recruitment of nursing staff.o Nine referrals have been received, which are currently being assessed.o If all referrals are suitable for WEMSS, then further consideration willhave to be given to recruitment.o In Broadmoor Hospital, Sharon Hinsley and Alan Stirling are workingclosely on patient configuration and managing patients’ anxieties abouttheir moves.o Regular briefing are being held and a video of The Orchard will beproduced for viewing by patients.o On 16 May a national group will be visiting The Orchard.Sean Payne stated that final agreement must be reached on the costs of theservice. Mr. Payne also informed the meeting that at the Carers’ Forum on3 March he made an offer to relatives to visit The Orchard prior to July. Mr.Payne will discuss this with Ms. Hinsley outside of the meeting.Action – Sean Payne9.3. Mental Health Nursing in WLMHTJimmy Noak tabled this paper on behalf of Grant MacDonald. The aim of thedocument is to provide clarification to managers and nursing staff within theTrust on actions and priorities to improve nursing and care delivery.Professor Tony Maden stated that he would like to see more emphasis onthe problems being experienced in recruiting qualified nursing staff. Dr.Murray suggested that the Trust should consider recruiting from theEuropean Union countries. Sean Payne advised that at the BroadmoorCarers’ Forum on 3 March, issues were raised by carers about the quality ofnursing staff, particularly with regard to communication.This matter will be discussed again when Grant MacDonald attends theForensic Executive meeting in May.9.4. DSPD UpdateThis paper was prepared by Angela Dolan. The fourth ward will be openedin March. An active recruitment campaign is ongoing and a web site hasbeen set up. The unit is not yet open to routine admissions and only highprofile patients are being admitted. Mrs. Dolan advised that she will becontacting Kate Caston, Lead for High Security Services & DSPD atDepartment of Health, regarding this and Sean Payne suggested the mattercould be brought up at the Broadmoor Cluster Group meeting on 7 March.

Minutes of Meeting 10Forensic Executive Meeting 05 March 200710. INFORMATION10.1. Executive Team Minutes:15 November 200608 December 200611 January 200710.2. Broadmoor Operational Meeting Minutes:21 December 200618 January 200710.3. I.S.S.G. Minutes 31 January 200710.4. I.P.C.G. Minutes 14 February 200710.5. RiO Programme Board Minutes 31 January 2007Alan Stirling advised that local sub-groups have been set up. The firstmeeting was being held on 5 March to identify membership of the subgroups.The target was to implement RiO at Broadmoor Hospital duringquarter 3.10.6. Strategic Management Team Meeting Action Points09 January 200722 January 200711. ANY OTHER BUSINESS11.1. Local Partnership ForumAngela Dolan advised that the first meeting of the Broadmoor LocalPartnership Forum will take place on 9 March.11.2. Car ParkingGraham Crennell reminded the meeting that applications for car parkingpermits for the Ealing site must be submitted by the 24 March.11.3. Employment CharterGemma Stanion confirmed that the Employment Charter has been issued.11.4. Maggie GairdnerSean Payne informed those present that this was Maggie Gairdner’s finalattendance at FEM before she takes up post as Associate Director –Children, Young People and Substance Misuse at Sussex Partnership. Hethanked Maggie for her work for the Trust and wished her every success inher new job.File Ref.H:\My Documents\DMJ\FEM\2007\May\FEM Minutes 5 March 2007.doc