Agenda item

To meet Julian Emms, Chief Executive of Berkshire Healthcare NHS Foundation Trust, with particular reference to the Trust’s mental health and community health services to residents of Bracknell Forest,

The Chairman welcomed Julian Emms, Chief Executive, Alex Gild, Director of Finance, Performance and Information, and David Townsend, Chief Operating Officer, of Berkshire Healthcare NHS Foundation Trust to the meeting to speak on the Trust’s mental health and community health services to residents of Bracknell Forest.

Background information had been circulated to the Panel in advance of the meeting, as follows:

·                     Extract from the Monitor website, setting out details of the Trust’s current ratings;

·                     Extract from the Trust’s website, setting out the Trust’s role and vision, values and goals;

·                     Annual Plan Summary 2014;

·                     The Patient Experience Annual Report;

·                     The Care Quality Commission’s Inspection report for Prospect Park Hospital;

·                     Results of the National NHS Staff Survey 2013.

Julian Emms spoke to the Panel and the points made included the following.  A summary document was also circulated at the meeting.

·                     The Trust was the main provider of community and mental health services to the population of Berkshire.  The Trust had an annual income of around £220million, employed in the region of 4,000 staff and provided services from just over 100 sites.  The Trust’s core values underpinned their operations.

·                     The Trust services were delivered via a locality structure organised around the six areas of Berkshire, matching local authority boundaries.  There were eight main sites in Bracknell Forest, the largest of which was Churchill House.  Each locality was overseen by a Locality Director and Clinical Director.  The Trust provided just under 100 different services, mainly jointly with local authority partners.  These were split approximately half and half between mental and community health services.

·                     Some of the successes of the Trust included 28 major service improvements during 2013/2014, full details of which had been included in the Annual Report.  This included moving a fully-established ward to Prospect Park Hospital.  The Trust ranked in the top 10% nationally for staff engagement, which translated into better patient care.  In addition, the Trust was registered without condition with the Care Quality Commission and held the two lowest risk ratings from Monitor. 

·                     The Trust was on track with its financial plan but improving quality was difficult where the gap between income and cost was widening.  This was anticipated to be approximately £50million by 2018/19.  Internal efficiencies to save £20million had been identified but a gap still remained.

·                     In response to pressures the Trust had revised its Five Year Strategy to close the financial gap, develop new ways of working as a Trust and to reassure stakeholders that sufficient plans were in place to ensure longer-term sustainability. Five workstreams had been established to achieve these goals.

·                     Some of the key challenges facing the Trust included significant increases in demand for particular services; difficulties in recruiting some professional staff and a national shortage of nurses; a risk that the new workstreams would not deliver the identified savings or productivity increases; financial pressures faced by partner organisations; the pace of the reform system; and the complexity of the health and social care system.

The Chairman queried the impact on mental health provision of the shortage of nursing staff on the Trust, particularly as the needs of each patient would vary considerably and a wide range of skills was potentially needed.

It was reported that all areas were safely staffed, and the Trust’s good reputation as an employer meant that it was able to attract staff, but there was still a need to use agency or Bank staff.  However, moving the provision to one site at Prospect Park Hospital had helped mitigate this.  Mental health facilities were challenging places to work, but the Trust recognised this and saw engagement with staff and making them feel valued, at the same time as acknowledging the stressful environment they were working in, as key to maintaining the workforce.  Despite the inherent difficulties of a mental health ward the Trust was confident that it was a safe, ordered and efficient place in which to work.  A greater challenge was the recruitment of District Nurses, as it could be hard to find people with the necessary skills, but flexibility within teams and being able to move staff from one area to another as necessary helped mitigate this.

It was questioned what the Trust’s long-term plans for dementia care were, and what percentage of the budget was spent on this area of care.

It was explained that the Trust was working hard in this area, and concentrating on allowing people to remain in their own homes.  The prevalence of dementia across the area had formed part of the Trust’s planning, and a new ward specifically for treating dementia patients had been established as part of the move to Prospect Park.  Bracknell Forest also had a Memory Clinic, which was one of the first to be accredited nationally to the required standard.  The future of dementia services was hard to predict as it depended on the prevalence of the condition and the shape of services but the increasingly aging population added extra demands.  The Trust was working with GPs to promote recognition of the symptoms and rates of diagnosis were improving.  Specialist skills were needed to care for patients with dementia and the Trust ensured that staff were trained appropriately.  The challenge in the future would be to meet a potential increase in demand in a difficult budget situation and quality would not be sacrificed.

Councillor Birch, Executive Member for Adult Social Care, Health and Housing added that work had been undertaken with local retailers to help them recognise the symptoms of dementia.  As more people were being treated in their own homes this required a specialised set of skills.  Bracknell Forest had a policy of ‘seamless care’, which meant that people would only need to access the health system at one point regardless of their needs.

It was noted the Community Nursing had been integrated into the Trust four years ago, and queried whether this system was working well, and helping keep people out of hospital.  It was also questioned what the impact on this service would be if it was not possible to fill vacancies.

It was reported that the move into the Trust had worked well, and the staff had become part of a larger organisation with access to increased training opportunities.  Bracknell Forest had seen a much lower usage of hospital beds, in a climate of reducing the provision of beds in hospitals, and the Trust was confident that the ‘hospital at home’ model could be successful.  In the short term caring for patients in their own home did not offer financial savings but in the long-term these patients were less likely to require further treatment so future demands on the service were reduced.

Concern was expressed at the results of the NHS National Staff Survey regarding hand-washing, where only 51% of staff had reported that this facility was available.

It was explained that the survey also covered back-office staff, who did not need access to the same level of hand-washing facilities.  For front-line staff monthly infection control audits were conducted, and the results of these were published.

The level of harassment/bullying incidents and the number of staff witnessing incidents were highlighted by the Panel as a concern.  It was queried whether staff received feedback to ensure that they felt safe at work and that concerns they raised were being considered.

It was explained that the Trust was well-regarded as an employer but that there were still issues.  The Trust was tackling this with clear, fair policies on bullying and whistleblowing and providing a clear reporting line to  encourage people to report any bullying.  With regard to staff witnessing incidents, it was reported that staff were encouraged to report any incidents they witnessed, but in general these were low impact so the numbers were not significant, and it was felt that an open culture where staff did feel able to report what they had seen or if mistakes had occurred was a healthy one.  Incident reports were analysed to identify trends and avoid these happening again.  Any learning points identified from this were disseminated to members of staff.

It was questioned whether the Trust’s IT systems were keeping pace with need.

It was reported that the Trust was making some development in IT provision.  All workers in the community now had a laptop and access to the 4G network so that they could access all the records they needed even away from the office.  The core clinical system was being upgraded and the Trust was working with health partners to establish a shared system.  The biggest challenge was helping the workforce adapt to new ways of working.

Mark Sanders of Healthwatch UK queried the Trust’s Care Quality Commission (CQC) report, which had found that some patients did not understand, or had not been involved in, their care plan.

It was explained that this finding related to one particular ward, responsible for treating some of the most serious mental health cases and it could be very challenging to involve them in planning for their own care.  This had been reviewed and the ward had been reinspected to the CQC’s satisfaction.

It was noted that uptake of the travel fund, which allowed family members visiting patients, to claim back the cost of their travel, stood at 33%, and queried how the remainder of the £100,000 was being used.

It was explained that the fund had been established following the consultation on the moving of facilities to Prospect Park Hospital.  Anyone who wished to claim the cost of their travel was eligible but a number of people had been offered the funding and declined.  The Trust had started to use the funding to cover the cost of patients visiting home.  The Trust would continue to honour their commitment to the fund but would be able to divert the funds elsewhere if it had not all been used.

The Chairman raised a recent request from Thames Valley Police to make psychiatric nurses available to support the police in their work.

It was explained that the concern was the amount of police resources being used to respond to Section 136 alerts, where there was a responsibility to take people behaving in a way that caused concern to a designated place of safety.  It was the responsibility of the mental health team to provide these, and in the last six years the percentage of cases taken from the police had increased from fifty percent to ninety-five percent.  There was concern surrounding the impact on ambulance response times of responding to these incidents.  Councillor Birch reported that he had been part of an LGA team looking at a ‘street triage’ pilot in Solihull, during which members of the mental health team had been available to respond immediately and transport patients, taking the pressure off the police and ambulance service.  Discussions with Thames Valley Police were taking place.

The Panel expressed their thanks for a recent visit they had undertaken to see the mental health service facilities available at Prospect Park Hospital.  The visit had been extremely useful and the care and dedication shown by staff towards patients had been clearly evident.