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Stephen Firn, Chief Executive

Good morning folks – that (Magpie Dance) was really impressive, wasn’t it – really inspiring.  My name’s Stephen Firn, Chief Executive, and as the Chair says it’s my role over the next 10 minutes to report on our performance and notable developments over the last 12 months. 

Just before doing  so I thought I’d share that it’s a significant anniversary for me today because it’s actually 30 years to the day since I started my nurse training. (cheers) Thank you!  I wasn’t expecting many whoops but that was a good one.  The other side of course is saying that today is the start of my fourth decade of working in the NHS. It’s fairly daunting, but it has gone very quickly and I have enjoyed it.  But these anniversaries do make you reflect briefly on what’s changed, and a huge amount has changed, but I guess that the thing that strikes me most is the way that professionals, staff, service users, carers, governors and members are now working together much more closely to talk about and identify ways in which we can improve services and I think that really is a huge shift from 1981 when I entered the NHS. If I think  back to the mental health and learning disability services I first went to when training as a nurse there was not very much voice for the user there, very little choice about treatments, most of the care provided in institutions behind large walls away from the public. So that’s changed hugely, and in the general  nursing placements I had I can vividly remember that when the doctor came round we had to go around and tell the patients they weren‘t allowed to  ask any questions and that all the visitors, many of whom were carers, had to go home. So there’s been a huge shift over those 30 years and I think there’s some very impressive initiatives around the room here today where staff and patients and carers are working together to improve services in an atmosphere of mutual respect and I really, really applaud that because I strongly believe that’s the way forward.

Moving on to my review of the year, I’ve called this the year of positive improvement and positive growth and if we go onto this first slide this details the two national bodies that shortly will be licensing all NHS providers. Monitor, on the left, is the regulator of foundation trusts, and they’ve been content throughout the year that we’ve met all our government’s requirements  and all our financial plans.  And on the right, there’s the findings from the Care Quality Commission (CQC), who assess all organisations providing NHS funded care. Once again, they judge us compliant in all our services across all outcomes. They did do a visit, very recently, to the Bracton Centre, where they inspected services, spoke to service users and staff, and I’m really pleased to say they reported no issues or concerns, which we think is unprecedented in the other reports we’ve seen. So well done to all colleagues at the Bracton. The CQC also conduct two national surveys, which they publish on their website and (in) which they compare us against other trusts: the user survey and the staff survey, so I’ll just briefly give the headlines from those.

The National Patient Survey – this is actually a survey of people using community mental health services which is a very important part of our services – but only a section, and we do hope in future the CQC will survey community and learning disability services. The headlines you can see there – 252 replies – nine categories of questions with 1-7 questions in each category and what the CQC do is they look at this statistically and analyse whether they can say whether a trust is better or worse than other trusts against each question. And the majority of trusts – if you look at other reports – the vast majority of analysis says that most questions are about the same.  You see here we’re better in four areas, and those four areas were that service users in Oxleas were:

  • statistically more likely to say that they knew who their care coordinator was
  • that they had a care plan
  • that they’d had a recent care review and
  • that they knew who to contact out of hours if they needed help.

Which are all very good assurances about those fundamental aspects of care. There was one area of concern where we were rated worse by users and that was whether people found their care review helpful, and this is making us sit up and think about what that means and we really need to think about how we can improve both users’ involvement and experience in care planning and care reviews. Dr Okocha’s presentation will touch on one or two of the things that are influencing that.

Coming on to our staff survey, once again this is really good news that – we’ve said this for a number of years now – but this our best ever staff survey which is so important of course, because as I feel I say every year, but it’s something that stays in my heart – so I’ll say it again – we can only really provide those good quality services if we have members of staff who feel properly motivated and supported and with the right skills and empowered to deliver good care. Staff rated us in the top 20% of trusts in the country for the majority of questions. I haven’t listed them all, but I think seven of those were in the top 20% of the really important ones, so high job satisfaction, low intention to leave, good communication between managers and clinicians, effective team working, able to improve services, good levels of motivation, and the one we always say is the clincher: staff more likely to say they would recommend Oxleas as a place to work or receive treatment. And we want to maintain that going forward.

In terms of moving on to how we’ve grown, I feel it’s really important to say, and I can’t really overstate this, that performance that I’ve just described has occurred while we’ve implemented the biggest changes in the size and the nature of our services that we’ve ever done in one year since Oxleas was formed in 1995. So in the last year we’ve welcomed colleagues from mental health in-reach services in Kent Prisons, Bexley community health services and most recently Greenwich community health services and one of the big changes now is that more than a third of colleagues are working delivering community mental health services. But also, on the 1st of April, as you’ll see on the right, we changed our borough based mental health services directorates to cross trust directorates formed around care groups – functional care groups -  so that (there are) three new directorates:

  • older people’s mental health
  • adult acute and crisis mental health and
  • adult complex needs and mental health

and the aim of this is really to try and have consistent standards, consistent practice and level of quality right across the three boroughs, the main three boroughs that we serve for mental health services, and we are seeing benefits already. So, for instance, reductions in the use of beds in our older people’s acute adult services over the last few months. This next slide just gives a little more detail about what those changes mean in terms of things like staff numbers. So staff have increased by 50% in the last 12 months, a two thirds increase in the number of sites, double the number of clinical professionals that work with us in Oxleas, mainly an increase in allied health professionals, and a huge increase in the number of patient contacts across the year. It is a big change, but there’s some real commonalities to all these services and whether it’s in our community, our mental health, or learning disability services. There’s some core values and core principles that we focus on which are:

  • All services are aiming to provide care close to home as much as possible
  • All aiming to promote independence and wellbeing
  • All doing all we can to avoid preventable crises and relapses

So common themes in the aims and the way that people work. 

And we do think that now we’re a combined and hopefully soon fully integrated community, mental health and learning disability provider, we’re in a better position to improve quality of care – more opportunities. We have a three year transformation strategy, which is in its very early days, but some of these things I have listed have already started to happen, so sharing clinical experience across services - one example is we’ve now established a trust wide falls group, with experts in falls from all our different directorates, working on reducing and preventing the number of falls. In terms of looking to integrate or bring together physical and mental health much more, we’re talking to commissioners about ways in which we can bring together physical and mental health expertise to provide more shared care to elderly people – who may have frail conditions and cognitive concerns.

In terms of sharing innovations and learning, areas such as telehealth and videoconferencing, we’re working together and using our resources more efficiently. One of the things we’re planning to happen in the next few months is the transfer of more properties to Oxleas ownership, that have been used for providing community health services, and this gives us a much larger estate and opportunity to use that more effectively for service users, but also more efficiently.  

So that’s all very positive, and looking ahead to next year I don’t think anyone in the audience will be in any doubts that the NHS is facing unprecedented changes and challenges over the next 12 months and beyond, so from next April  - and this is a challenge but an opportunity as well – clinical commissioning groups led by GPs will be operating in shadow form and GPs will be at the forefront of decision making, which in many ways is positive and we will need to continue to develop our relationships. Commissioners are also looking to develop more competition, more choice and more tenders to achieve value for money. Even at the present time we’re engaged in six tender bids around local services, three of which we currently provide and three new ones. I think the pace of that change, the number of tenders is going to increase. Of course the NHS serves a population that’s changing and there are challenges there, for instance rising levels of obesity among young children and the number of older people. And finally, the NHS is planning above 4% efficiency savings for the next few years, and that’s something that has never been achieved in any health service around the world.  So that is going to be a significant challenge. I put those there as challenges and things we need to work on, but I don’t want in any way to be doom and gloom because I think we’re really well placed – as well placed as anyone – to meet these challenges. If we just think of some headlines around Oxleas, let’s remember whilst we haven’t yet got everything right and there’s lots we’re seeking to improve, we are a stable foundation trust. As you’ve seen, we do have a very skilled and motivated workforce, we’ve got a very good reputation for quality of service, and as we’ll hear later, we’ve got a sound financial position at the moment. So that sets us up well for those challenges and what the Board is absolutely clear about is (that) maintaining the quality of our services is what will successfully see us through this change – during this period of upheaval. It’s only if we maintain the quality of services and continue to improve that patients, carers, commissioners will see us as their NHS provider of choice, that we’ll maintain our ratings with the CQC and Monitor which will be our license to operate and that we’ll be able to do things in a more integrated and efficient way which should both improve patient experience and reduce waste, so help us with the efficiencies.

So I’d like to finish just reiterating that first reflection about working together. I really, really believe that we can achieve much more by working together so I’d just like to thank each of you for all that you do and for all you will do in the future to help us improve our services. Thank you. (applause).