1st November 2018

Attending: Dick & Hazel L , Rod C, Norma Y, Ann R, Kevin, Brian L Tim W, Thelma Nick, Rod, Michael, Terry G.

Apologies: Carolyn G, Angela D, Kate A Sarah W, Zib L, Francis W, John & Margaret I, Sue C Geraldine M.

Minutes of last meeting 4th October 2018

Matters arisingthere were none.

Guest speakerDr Jane Padmore (Director of Quality and Safety HPFT)

Dick introduced Jane and, having identified some new faces from last time, she said that she would begin by giving us a brief history of her past career then attempt to answer the questions that we had previously sent to her.

Jane identified herself as a ‘South London girl’ who started out as a nurse. She subsequently joined the Maudsley Wimbledon and became a Community Psychiatric Nurse dealing with Personality and Eating Disorders.

After some years in Adult services including working on First Episode Psychosis she moved over to CAMHS.

Here she worked with young offenders and after completing her Masters she became the Lead Clinician for Lambeth CAMHS. Following this she gained her Doctorate working with the issues surrounding street gangs in the area at the time of the Croydon riots.

She spent 2 years as Deputy Director of Nursing at the HPFT under Oliver Shandley and when Oliver left to become Head Nurse for London. she applied and got the post starting in December 2016.

Jane is the Profession Lead for all staff except the Medics and Pharmacists. This wide remit covers Nursing, Social Workers, Spiritual Care, Therapies, Diversity, Confidentiality, Safety, Regulatory issues, Health Effectiveness.  She is also responsible for ensuring services under the Mental Health Act and acts as Hospital Manager. Both Tom Cahill and she are named on the license.

She went on to remind the group that the Trust covers some 50 sites across 4 counties –

Inpatient services for Norfolk and Essex

Outpatient service for Norfolk, Essex, and Bucks

Herts for all services, MH services for Essex

Essex, Norfolk and Bucks for learning Difficulties,

The Mount Prison also receive some services

Overall she stated that she had fantastic staff and teams across the services.

The Trust changed a lot between its pre and post Transformation challenge.  Here she said that it has moved to being forward thinking and proactive from what was mostly seen as being only reactive.

Austerity and budget cuts have meant that the all Trusts have struggled for cash.  Despite this she believes that the HPFT has managed well and has been well led by the Chief Officer and Financial Director ensuring that Service Delivery came first and money second.

Jane then went on to tackle the group’s questions.

Q1          Why did the Trust only receive a CQC rating of Good and not the Great they had hoped for?

The CQC visit was in February 2018 and will visit again in Jan or Feb 2019.  While the Trust has been working to improve, it did not achieve ‘Outstanding’ this year but achieved ‘Good’ with one area to improve Safety. The full CQC report is on the Trust’s website.

Jane believed that the Trust was let down by some small inconsistencies that they should have got right first time but fortunately these were not systemic.

The Trust aims to be as transparent as possible and have been up front in telling the CQC when there are issues.  She also believes that the Trust is guilty of “hiding it’s light under a bushel ie failing to celebrate externally enough.

Some examples were: the perinatal service winning an award and the IAPT service winning an award for accessibility

Q2          Given that the overall vacancies at the Trust have been 15% or more for some time, what are the shortfalls in key skills and experiences at this point?

The vacancy rate of late has been some 12.5 % and this has been a problem nationally.  One big challenge for Herts is that we have a lot of nurses coming up for retirement whose terms and conditions, when they joined, allows them to retire at 55.  The Trust is working on finding ways to bring their experience back into the service in another capacity.  The Trust aims not to go below the minimum number of nurses (qualified and unqualified) per shift without going to ‘Bank staff’.  Safety comes first. Additionally, they are looking for new ways of working for Occupational Therapists and Social Workers where a different approach and thinking in radically different ways would create a ‘cultural shift’ in the way things are done.

The trainee nurses scheme (nurse associates after 2 years) has 2 more cohorts to the first cohort of 40 she spoke about last time.  NB they need a further 2yrs top up to achieve full qualification.

Other new roles include upskilling more Service Users and Peer Experience Listeners to STAR worker roles. They are also looking to fund some nurses with their own funding scheme to replace the bursary that was removed hitherto.

Questions from the group on the night

Dick asked why the CQC did not seek involvement from Carers. Jane replied that the CIH were asked for input (they get an excel spreadsheet with contact details).  The Trust also suggests other Carer Groups but it is for the CQC to decide who they will ask for comments.

As an aside, Jane reported that they get good comments many times more often than they get complaints but it is complaints that everyone concentrates on.  Additionally, the CQC Insight Report fed back that the Trust was above average.  However, the Trust will still strive to be the “Best”.

Dick reported his experiences of the 2015 CQC review meeting as being a shambles and this was perhaps the reason for the lack of Carer involvement this time. So can we be sure that the Trust is fighting for us?

Jane explained that there is a new inspection regime with a whole new team of inspectors.  Yes they do still visit unannounced and will want to speak to staff and to hold focus groups.  Inspections will go on almost continuously throughout the year.  Jane agreed that they would fight to involve carers but would need to talk more about how best to do it.

Rod asked why can’t they keep hold on STAR workers?  He has seen a high turnover in recent months. Jane agreed that there was a 16% turnover of staff and the NHS is setting up a project to look at such a high figure.  The Trust’s staff survey reports that staff are highly motivated even though there is poor retention.  Often they leave and then return after some 2 years or so realising perhaps that the grass is not always greener elsewhere.  The Trust has introduced: flexible hours, internal movement, career breaks, improved team working (people to identify more closely with the team they are working in)

Brian asked about the Key Performance Indicators being used.  Jane replied that the five main criteria/domains the CQC use to judge the Trust’s performance on are: Safe, Effective, Caring, Responsive to people’s needs, Well led.

Ann R stated her hope that the type of response that she got several years ago has now improved.  Jane said yes and a lot of work has gone on.

Kevin said that NHS England are clear that Carers have value and they should be as much a client as the service user.  Jane said that her next step is to ensure that the Clinical Strategy moves to a quality and safety strategy ie that this becomes the driving force that sets the tone for the organisation without becoming a top down directive.  Instead it should be a collective leadership with ideas coming up from below trying out approaches, taking risks and making mistakes.  Clearly not everything is going to work.

Terry praised the work of the involvement/inclusion team then shared his frustrations about working with the Trust on various working groups where the work produced was not actually being implemented with the clinical staff.  The involvement team do not have the clout to make it happen.

He went on to ask that the Trust consider delivering training needs by first identifying and then meeting the job competences involved.

Often staff talk about mandatory attendance at training (not yet the case for carers awareness) to indicate its importance. However, this does not mean mandatory listening or implementation by staff.  As training is always a means to an end (ie performance on the job) it should be based on the true job competencies.  Here line managers need to nurture and own this training of their teams.

Jane believes that the clinical staff are doing a good job

Terry also asked for progress on the reforming the care coordinator procedures to match the small team approach introduced by the First Episode Psychosis Team.  He pointed out that the Carer Council were keen for its general introduction as the way forward some 18 months ago.  Jess has yet to commit to a date for rolling it out.

To Kevin’s question – do staff carers get support? Jane outlined the existence of the Staff Carers Network and the publishing of the staff survey (data available in the New Year).  It should also be noted that from the top down there is a belief that the family should always come first and she gave examples of this.

Rod asked given a case of a Senior Social worker not supporting a carer, who should he go to –   you or Jess Lievesley?  Jane replied to her.

Dick then asked the group to thank Jane in the usual manner.

Upcoming speakers:

Jan 2019 –Julie Nicholson of Mind or her new manager from the Leighton Buzzard Road offices to be asked.  NB also that this will be the second Thursday of the month

Feb 2019 – Ann to approach New Leaf College and Dick to approach Crossroads as possible.

March 2019 – Chris Lawrence Chairman of the HPFT

Feed-back from member’s representatives attending external meetings:

Terry reported that had attended the first meeting of a Task and Finish Group sponsored by the Herts County Council  and supported by the CIH concerning a ‘best practice’ model of Contingency planning.

Any Other Busines:

Terry reminded the group that “Carer’s Rights” day is to be held at the HPFT offices in the Colonnades Beaconsfield Road Hatfield AL10 8YE on the 30th November 9:45 – 16:00 You can book a place online at www.hpftcarersrightsday.eventbrite.co.uk and search for HPFT.

NB after organising for the Wellbeing Team to make a presentation of their service during the daytime at Rod’s Group meeting at the Wellbeing Centre in Hemel Hempstead, apart from Dick, Ann and Terry there were no other members of our evening group attending.

There was to be the first meeting on Thursday 8th November of a new carers group in the HPFT offices Waverly Road St Albans organised by Tanya Hammond of the HPFT from 12:30 – 2:30 please show support and attend if you can.

Please note that you should bring a raffle prize (about £5 ) for the Christmas Dinner on the 6th December.

Date of next meeting – 6th December 2018 Christmas Dinner (7pm for 7:15pm)