Council of Members 7 September 2015

Dorothy Griffiths Chair

Dorothy Griffiths Chair

Christine Baldwinson Trust Secretary

Dorothy Griffiths Chair

Annual Report and Accounts Trevor Shipman, Director of Finance

Quality Account Andy Mattin, Director of Nursing

Quality counts, it’s a film and a Quality Account is the trailer! CQC – ‘Requires improvement but the care was outstanding..’ million contacts! 287,795 Patients treated in the community 4,988 Patients treated in hospital Quality Priorities Involvement Carers Compassionate and capable workforce

Effective care and treatment planning, measured by: Patients report feeling definitely Involved as much as they wanted to be in decisions about their care or treatment Patients report their care or treatment plan helped them achieve what matters to them Carers report they felt involved in the care or treatment planning for their loved one

Outstanding Our staff Teams Peer support Involvement

CQC progress Bed management and pathways Restrictive interventions Safer staffing Staff charter….

Tell us! Staff, patients, carers, Carers Council, Healthwatch Our pledge – listen to you, hear what is saod and act on it. Thanks to our staff and to you all

Council of Governors’ Review of the Year Christine Baldwinson Trust Secretary

Chief Executive’s Report and Forward View Claire Murdoch, Chief Executive & Registered Nurse

Quality – central to everything we do Our Quality Account Priority – “Effective Care Planning and Treatment” Patient and family involvement in all we do Achieving and sustaining full CQC compliance – actions to be completed by December 15 Engaging, valuing and supporting our workforce Better use of data – reduced bureaucracy

Operational Sustainability – our effectiveness depends on it Service Redesign – improving efficiency and productivity Reducing unnecessary hospital admissions Single Point of Access – ‘SPA’ Bed rationalisation – with new models of home treatment Agile working – major programme of ICT investment New models of integrated care and partnerships

Financial Viability – never been more challenging £26.4 million savings required this year - £28 million next year Driving down costs e.g. reducing agency spend Better use of our buildings Efficient ‘back-office’ functions Viable contracts with commissioners – and tough decisions when they are not

A focus on: Community, Sexual Health and Mental Health Services Robyn Doran, Chief Operating Officer

Frail and Elderly Integrated Practice Unit Dr Pramod Prabhakaran Divisional Medical Director

Severely frailModerately frailMildly frailPre-frail

Camden Integrated Care Service (CICS) Systematic identification of frailty Care Planning and coordination of care Health and Social Care Multidisciplinary team

But.....

Building on success Frailty IPU – current proposals Value based – truly in partnership with patients/ families/carers Increase identification of frailty through health and social care staff Single Point of Access Risk Stratification Holistic Care Planning based on CGA principles Locality and borough based MDT’s Case Management for those at highest need Care Navigator service

CNWL Sexual Health and HIV Services

London’s most connected sexual health services In Brent, Camden, Hillingdon, Islington and Westminster Mortimer Market Centre off Tottenham Court Road Archway Centre Archway Margaret Pyke Centre King’s Cross

Mortimer Market Centre y GUM Appointments 48,425 42% female / 58% male Females 97% straight, 2% bisexual, <1% lesbian Males 49% straight, 47% gay, 4% bisexual Q1 patient satisfaction (% would recommend) 94% HIV Appointments 21,916, number of patients 4,500 16% female / 84% male Females 98% straight, 0% bisexual, 2% lesbian Males 12% straight, 87% gay, 1% bisexual Q1 patient satisfaction 97%

Archway Centre GUM and SRH Appointments 35,900 70% female / 30% male Females 98% straight, 1% bisexual, <1% lesbian Males 75% straight, 22% gay, 3% bisexual Q1 patient satisfaction 99%

Margaret Pyke Centre SRH and GUM Appointments 21,680 96% female / 4% male Females 99% straight, 1% bisexual, <1% lesbian Males 78% straight, 17% gay, 6% bisexual Q1 patient satisfaction 98%

Sexual and Reproductive Health Brent Appointments 9,526 98% female / <2% male Females 100% straight, very few males Q1 patient satisfaction 100% Hillingdon Appointments 11,357 98% female / <2% male Females 100% straight, very few males Q1 patient satisfaction 98%

Commissioning GUM (income £12.8m) Local authorities, tariff (first/follow-up), Camden lead, total approx. 160 local authorities Sexual and Reproductive Health (SRH) (income £3.9m) Local authorities, block, Camden and Islington, Brent and Hillingdon HIV (income £31.4m) NHS England, fixed and variable funding Health Promotion and Freedoms/Shop (income £2.4m) Local authorities, block, includes pan-London local authorities

Service highlights Largest single site HIV Service in UK Bloomsbury Patient Representatives Links with UCL academic department National and international profile for SRH, GUM and HIV Services Clash Hepatitis C Psychosexual Therapy Freedoms Shop

Bloomsbury Patient Representatives One to one peer support We can empathise and are role models We can offer hope for the future We take medication every day with no visible side effects We can offer practical support for a range of issues We have experience of psychological and psycho-social issues: the crisis of diagnosis disclosure fear of rejection fear of stigma and discrimination

Education – Empowerment We help patients develop self management and coping skills, build their self esteem and confidence - through courses, workshops, forums and social events. Motivational workshops Educational forums Women’s lunch club Choir, summer picnic and fundraisers Hepatitis C co-infection courses Newly diagnosed courses 2,000 patients used Bloomsbury Patient Representative services in 2014 Bloomsbury Patient Representatives

Challenges Reduction in funding from local authorities Competition from other providers Pan-London Sexual Health Transformation Increasing rates of drug related sexual risk taking, ChemSex Infrastructure required to meet changing environment

CQC findings for sexual health services Safe: Good Effective: Outstanding Caring: Outstanding Responsive: Outstanding Well Lead: Good Overall Rating: Outstanding

All the patients we spoke with told us they were very satisfied with the care and treatment delivered to them, and felt included and involved in their care. The services were easily accessible and staff really focused on the individual needs of each patient. The services were a centre for national and international research and innovation. This meant that patients were benefitting from this work and receiving the latest treatment from staff who were committed to improving care and treatment for patients across the world. Managers were dynamic, inspiring and approachable and gave support daily not just when required. Care and treatment provided to all patients were based on national guidelines, directives and research. The care and treatment was audited to monitor its quality and effectiveness, and where needed action had been taken to improve the service. Patients were receiving safe care from appropriately trained, qualified and skilled staff. An extensive programme of training was in place. Staff confirmed that this prepared them for their roles and responsibility.

Brent Mental Health Services Dr Kishore Clinical Director Natalie Fox Brent Borough Director

Brent Mental Health Services Two developments in response to CQC visit, service user feedback, carers feedback and partner organisations. –Single sex ward pilot in Park Royal acute MH services. –Redesign of the model of community provision.

Single sex wards pilot in Park Royal

Single Sex Accommodation was PR prior to the Pilot. –Female and male zones within one ward environment. Pilot of Single Sex wards removed the zoning within the 2 treatment wards. –1 female only ward and 1 male only ward.

Single sex wards pilot in Park Royal Pilot introduced due to the perception of service users safety & due to concern about safeguarding of both male and female patients. There had been positive evidence locally (Hillingdon) & nationally for single sex wards. Pilot was introduced in February 2015.

Single sex ward pilot Comparison data: August Months Prior to Single Sex 5 Months following Single Sex Reduction % Sexual Incidents 29872% Restraints % Seclusions715917% Rapid Tranquilization % Close Observations %

Single sex wards pilot 1st quarter outcomes Patients and staff prefer single sex wards Significantly safer for patients at risk of sexual incident. Leads to reduction in physical restraints, rapid tranquilisation, seclusion and close observations. Gender Specific training & support is critical for staff.

Brent community services redesign

Need for timely access to services. Need to improve shared care with primary care. Need to improve the experience for service users & carers. Need to engage staff in the management of the demands on their roles.

Process we followed Project steering group – meeting every 2 weeks – Multi Organisational with Service User representation. 3 Wider Workshops – Service user involvement Staff engagement – Commissioners & Partners

Co produced guiding principles for redesign Focus on recovery. Service throughput. Streamlined pathways. Easier to navigate for referrers and clients. Reduction in the Length of stay. To fit with the wider service developments of single point of access (SPA) & Home treatment rapid response team. (HTRRT)

Proposed pathway to recovery Referrals in from GP 3 rd sector Self Family Carer Other Single Point of Access (SPA) 24/7 Urgent Care In-patient HTRRT 24/7 Recovery Service 2 Teams (North & South) Full Core Assessment Brief Treatment Independent living skills development Risk Management Regular Reviews Discharge preparation Carer Support Discharge to GP 3 rd sector Family Carer Primary Care Plus.

Next Steps Single Sex Wards PilotCommunity Redesign Report on the 2 nd quarter outcomes of the pilot and make recommendations, whether to sustain this position at Park Royal. Co deliver the proposed pathway

Questions Dorothy Griffiths, Chair

Any other business Dorothy Griffiths, Chair