On October 11th I attended a meeting of the Council of Governors of 2gether NHS Foundation Trust, Gloucestershire’s mental health trust. Unusually, the Trust’s Chair and Chief Executive were not present. It was particularly disappointing the the Chair, Baroness Fritchie, DBE, could not attend what would have been her last Council meeting, as she has announced here intention to resign at the end of December.
Governors were issued with NHS ID badges (for the first time in this Trust, though others have been doing it for a while). There was a discussion about progress towards allowing governors more access to the Trust’s premises, but the official line in this Trust is still that for governors to visit would violate patients’ privacy and confidentiality. Again, other trusts have been allowing this for a while, though I’m not certain that any other mental health trusts do. I pointed out that while my new NHS badge doesn’t allow me any access, if I put on my LINk badge I could have a statutory right (subject to certain procedures being followed) to “enter and view” any of the Trust’s premises. I think the idea that mental hospitals are secret places where patients are locked away from the outside world is outdated and helps to stigmatize mental illness, and that resistance to change will be temporary.
Making Every Contact Count
A presentation on Making Every Contact Count (MECC) gave some basic information about this trendy new initiative that is being introduced in many NHS trusts. The basic idea is that all staff who have contact with patients should be trained and encouraged to reinforce messages about healthy lifestyles. The focus is on stopping smoking, limits on alcohol consumption, diet, weight, and physical activity.
Several governors were sceptical. One pointed out that weight gain might be a side effect of psychiatric drugs. Another pointed out that eating carbohydrates at each meal has been shown to be beneficial for depression. Another asked about the resources being diverted from other things to this project. I was concerned that this treatment, described by the presenter as an “intervention”, has no evidence base, NICE has not recommended it, it will not be monitored, and its outcomes will not be measured. One governor, however, was convinced that exercise, in particular, is very beneficial for people with mental illness, and anything that encourages patients to exercise is a good thing.
The presenter had nothing substantial to add. This is a done deal and MECC is going ahead whatever anyone says. I predict worsening results in patient experience surveys as this licence to stigmatize certain patients takes hold.
Governors had asked for an update on the building works at Wotton Lawn Hospital. A cunning plan is in action to renovate all the wards, one at a time, without moving the patients out of them. It was acknowledged that patients and staff in the ward where work is in progress find it difficult having builders around. The Trust’s investment in the works is more than £3 million, paid for out of operating surpluses.
One small element of the works has been to increase the height of the fences around the hospital’s internal gardens, as patients had been known to climb over the old fences and abscond. I wondered if this was yet another unforeseen consequence of encouraging patients to get fitter, but I didn’t say it out loud.
NHS Gloucestershire’s draft strategic plan (PDF) for the next five years was presented. The papers said “for endorsement” but in the event the meeting was not asked for an endorsement.
The strategy has been the subject of long consultations. I pointed out that I and another governor had taken part in a consultation event in June, but we had received no feedback and there was no indication that views from that event had been taken into account in the present draft.
I said that the draft began by stating two problems that must be faced: an ageing population, and unequal healthcare outcomes. But by the end of the document these seemed to have been forgotten, and there were only a number of proposals that would not necessarily address either of the stated problems.
It did not seem to me that the present draft really describes a strategy. I compared it to the difference between a pile of bricks and a house. The present draft is like a pile of bricks, many of them good ideas in themselves. But no one has used them to construct anything.
Improving Access to Psychological Therapies
A governor queried figures for the Improving Access to Psychological Therapies (IAPT) programme that had been presented to the Governance and Performance Subcommittee, which had been below the target, but were said to have improved dramatically.
There was a complicated explanation involving local and national discussions. The upshot was that the way the figures are calculated has changed nationally, and the result of the change is a higher figure that exceeds the target. The same governor expressed astonishment and asked for confirmation that the problem had been made to go away simply by moving the goalposts, and it was confirmed that this was indeed what had happened.
I asked whether the target had also changed as a result of the new method of calculation, but I was assured that it had not. I pointed out that the target had previously increased slightly each quarter, and I was told that it is now to remain the same all year at the level it was for the first quarter.
Readers may notice that I am not quoting the actual figures here. That is because I am waiting until things settle down for confirmation of what the figures really are. Recent months appear to have been a period of confusion between national authorities, local commissioners, and the Trust. National authorities have not yet published the revised method of calculation that was described to us, and local commissioners have continued to publish the quarterly rising targets that were agreed at the end of last year. When I see authoritative figures I’ll comment on them here.
I asked a written question, not about the figures themselves but about the lack of clarity around them, and in particular whether the Board receives clear and reliable figures about the Trust’s performance, and whether the Trust’s non-executive directors see it as part of their job to ensure clarity in this area.
The verbal answer was that, yes, the Board’s Delivery Subcommittee does spend a lot of time on the figures. The Board receives detailed figures, while governors only receive summaries that may sometimes be more difficult to interpret. A non-executive director had contributed to preparing the answer.
I was also provided with a written answer that goes into more detail, both about the issues I had raised in my question and about the IAPT figures themselves.
There are seven vacancies on the Council that will be filled by elections for public governors in the local authority districts of:
- Greater England
And for staff governors in:
- Clinical and Social Care Support
- Management, Administrative and Other
Plans are being made for better training and support for new governors, so I would encourage anyone eligible who has the time and interest to prepare for and attend the meetings to consider seeking election. For more information, see: Vacant Governor Positions
Papers for the Council meetings do not seem to be available on the Trust’s website, which is a little disappointing, but anyone interested can easily get hold of them. See: Council of Governor Meetings