Minutes of the meeting
In attendance: Rod C, Anne R, Brian U, Carolyn & Ian, Dick & Hazel L, Brian L, Zib L, John & Margaret I, Terry G, Geraldine M, Tim and Francis W, Dianna W, Rod W,
- Apologies: Were received from Chris & Lawrie S, Angela D, Sue C, Patricia C.
- Minutes of February meeting – The minutes were agreed as a true record
- Matters arising – There were no matters arising.
- Guest speakers – Chris Lawrence – Chairman of the Trust
We asked Chris to provide an overview of the anticipated trends and issues in the external environment, over which the Trust has no control, but will still have to provide services. Perhaps identifying issues that we currently see as important such as:
- economic factors – eg future NHS funding and the amounts that might be allocated to MH
- demographic trends – age, race, gender, MH diagnoses
- legal &political – and any extra / new demands such as to extend MH services into physical health establishments and vice versa?
- trends in social conditions and health and wellbeing expectations – particularly with regard to increases in MH conditions, suicide generally and particularly suicide in prisons
- technological advances that can be employed to advantage
With this as the backdrop, please go on to indicate how the Trust intends to meet the ensuing challenges. Please give us your view with regard to both the Trusts has strengths and weakness. We offer some suggestions of both strengths and weaknesses that we think will allow you to flesh out your response
Internal strengths to build upon
- matching the physical resources and their location to the actual demand across the county
- Staff skills and attitudes and investment in their training
- Quality of services ie the CQC assessment of “Good”
- Investment in quality initiatives (eg Good to Great, adopting right first time on time)
- Relationships with partners in service delivery
Internal weaknesses to address in the future
- Will the physical resources and their location still be adequate
- staff shortages (15% overall) in key roles and treatments eg Care Co-ordinators
- possible low staff morale and increased leavers due to heavy case-loads and increased change
- coping with continuous change will still be there but “change for change sake” should not
- greater investment in clinical staff’s attitude to Carer involvement and team building
- over emphasis in requiring some posts to have qualifications/skills over and above the job’s actual requirement
- better distribution of available treatments/services for MH conditions across the county
Finally, can we ask you “ if you were able to directly influence one issue over all others”
- what would that be?
- why that one?
- how would you change it ?
- what difference do you believe it would make to Service Users and Carers?
The UK Health system since 2010 has been subject to severe cuts. Policy has been moving to smaller Government with the aim to improve services or at least not diminish them. Cuts have led to diminished value and a range of unintended consequences.
Of the £785 billion spent on public sector, the largest £160 billion was on pensions. Health was £145 billion with Welfare & Mental Health at £113 billion.
Senior nurses are among those who can retire early and the challenge over the last 5 years in MH is the loss of experienced workers. For Nurses training to degree level their bursaries have ceased leading to a reduced intake via the student loan funded approach that has replaced it.
In 2012 we were seeing fewer people than we do today. Efficiency gains have run out but the money is still reducing. With the consequential loss of beds there is greater pressure on carers
HPFT has saved £45 million and still managed to invest £100 million (Kingfisher Court included)
With our having University status we have an outstanding record of Training.
- we have some 2900 staff across 50 sites maintained at a cost of £208 million
- 431 Service User contacts daily
- 43,000 referrals to the SPA (170 per day)
Sustainable Transformation Plans for the future delivery of MH includes the HPFT Herts CC + Hospitals working together. We are in reasonably good shape and have continued to invest in our people. From an early look at our internal staff survey, it shows a general 85% satisfaction rate (staff morale is high)
Unfortunately, we still have 15% vacancies which is down from some 20%. Normal operating would likely be some 7% vacancies as there is always some staff turnover. We do have to compete for staff with London and private sector providers who can pay more. Some staff prefer flexibility that agency working can bring them.
The last CCG review gave us a good rating but that is not enough hence our “Good to Great” initiative which is ongoing. We have continued to embed our 5 values into everyday staff behaviour. Since these were derived from working with carers, we expect you to challenge us if you believe that is not happening.
We are a Foundation Trust and expect our Governors to be our ambassadors in the community and connect with our membership. We recognise that relationships are important in MH and understand that for many service users it is likely to be a lifelong journey.
Weaknesses to address
Matching demand with service supply demands flexibility. To avoid over use of the 136 suit at Kingfisher Court we have introduced qualified crisis team workers into police cars (the street triage initiative). We have set up our Home first initiative providing home visits for the frail and elderly. With our “Community Trust Alliance” we have improved joint planning.
There significant shortages of GPs due to leaving and retirement. Consequently, we have encouraged GP Federations where GPs can come together for greater impact. The dispute with junior Doctors was unfortunate.
With the numbers of Service Users we have, we need more joined up working and better use of resources. Watford General is just not good enough. Lister Hospital has some 700 beds. Of those there are 200 people who should be in a care home but can’t be released. Social care has received some 40% cuts
Staff shortages and the importance of Care Coordinators is recognised. Jess Lievesley was named as having the responsibility to address it.
Maintaining a reasonable distribution of services across the county with increased and varied demand is difficult if hospitals etc are no longer in the right place. It is to be expected that a flexible service via hubs and spokes will contribute to removing imbalances.
In recognising that HPFT staff have had to deal with a lot of change, it is important how you respond to that change. Restructuring was inevitable and our staff survey indicates that those who remain, are generally satisfied.
Increasing the clinical staff’s recognition and involvement with carers is being addressed (via the roll out of the Carers Pathway). This roll out was acknowledged by group members and the carer focus of the Involvement and Carers teams welcomed. However, it was believed that they do not have sufficient clout with the clinical teams and the roll out requires a strong endorsement from senior Trust officers.
The most important issue identified as the biggest threat by Chris was that of Social Care. He believed that the Government was not interested and have pushed it to local authorities to deal with at a time when they are also very hard pressed. Working in isolation as “silo providers” will not help. As providers we must work more closely together. Then the quality of care will improve
Discussion – Francis made the point that the CQC were only looking at how their money is being spent via providers ie the HPFT. They are not concerned with and do not monitor Carers (us) who are increasingly being relied upon to deliver “unpaid care” to our loved ones. Social Care is invisible. What there is – is being delivered by carers.
Dick spoke about the new Hub being set up in Hemel Hempstead and re-emphasised the need to include carers in its introduction/operation and not just the Trust alone. We need to find a way to be more involved.
He also raised the issue of not knowing who are the Governors are. Accepting that the Governors meeting are public meetings Governors should be out and about and looking for more ways to connect with the communities. He reported that at the AGM he attended the word Carer was not mentioned once in 90 minutes.
Rod endorsed Dick’s comments about the lack of consideration for carers with the example of having his carer tea morning cancelled at the last minute to let a “Good to Great” session go ahead instead.
Dianna reported that in her view MH is getting left out. She cited the help that is no longer available for her sons there is nowhere for them to go (like day centres) and no one to go visit them even for a short while during the day.
Dick went on to remind us of his view that, while the Trust is good at the complicated things, it still lacks consistency at delivering the basics. Brian asked the number of people on the HPFT database was known. 55,000 was the estimate
Anne asked for confirmation that the percentage of carers who go on to become unwell themselves was in the order of 87% which she had once been told. No confirmation was forthcoming at this time.
5 Possible items to include at our AGM in April
- Chairmen’s review of the year and Finance update
- Report of member’s and Officer’s involvement with HPFT, CIH working groups where they provide a Carer’s viewpoint and identification of any liaison members have with other Carer Groups.
- Future proactivity and projects to pursue in the coming year including allocation of members to contribute or organise. Projects to include – Caring and Coping Course in Hemel Hempstead, Mental Health week in April, Carer’s week in June
- Consideration of our summer day out
- Election of officers for coming year
6 Any Other Business
Terry reminded the group that James Holland was looking for some real examples of Carer safety issues and invited the group to share their scenarios – Dick said that he had this in hand.
Terry asked the group again to consider providing some personal scenarios of what people got out of being a member of the group that we can include on our web site to help possible new members to see how the group might help them.
7 Date of next meeting –6th April 2017 our AGM at which there will be no guest speaker but we will have a quick quiz and some refreshments.