Report of the Associate Director of Operations, Associate Director of Nursing and Quality and Associate Medical Director Manchester Care Group

This report provides an overview of the progress being made by Workstream 5 – Leadership and Governance.

The Task and Finish Group considered the report and accompanying presentation of the Associate Director of Operations, Associate Director of Nursing and Quality and Associate Medical Director Manchester Care Group that provided an update regarding the progress to date on the Greater Manchester Mental Health NHS Foundation Trust (GMMH) Improvement Programme, with specific reference to Governance and Leadership.

Key points and themes in the report included:

·         Describing the actions taken to improve governance arrangements;

·         Describing the actions taken to improve leadership arrangements;

·         Describing organisational wider improvements, with reference to Manchester specific actions; and

·         Next steps.

Some of the key points that arose from the Task and Finish Group’s discussions were: 

·         Who would sit on the Evidence Review Panels that were being introduced;

·         Commenting that visibility of senior staff was very important as it set the tone of the organisation;

·         Recognising the important role the new Chief Executive would have in setting the correct tone for the whole of the Trust;

·         What was the approach to appointing the new Chief Executive;

·         Had issues relating to senior leadership visibility been identified through the Freedom to Speak Up mechanism;

·         Had any consideration been given to implementing a ‘mystery shopper’ type programme to seek an additional level of assurance that poor practice was eradicated; and

·         How was the patient voice that articulated their experience of care captured.

The Deputy Chief Executive and Chief People Officer, GMMH described that the Evidence Review Panels would assess and test the actions identified, and the panels would be bespoke to the specific issues being considered, adding that these would include service user and staff representatives. He said that the outcomes of these Panels would be recorded and scrutinised by the Board. The Chair commented that information on the outcomes of these Panels should be included in any future update reports to meetings of the Health Scrutiny Committee at the appropriate time.

The Executive Member for Healthy Manchester and Adult Social Care commented that the Shanley report had identified the lack of visibility of the former Chief Executive and Board Chair as a significant issue and had contributed to feelings of lack of empathy. He said that he would encourage the new Chief Executive, once appointed to visit the Community Mental Health Teams and meet with staff. He placed on record his appreciation to the Chief Operating Officer, GMMH for his frank and honest dialogue that he had engaged with him over the previous 18 months, especially around the issue of Community Mental Health Teams.

The Associate Director of Operations, GMMH stated that regular visits were undertaken by senior leaders to meet with services and staff were very open to conversations and felt comfortable to raise issues. The Associate Director of Nursing and Quality, GMMH also commented that leadership visibility on the wards was very important, with regular walkabouts on the wards were now embedded. She also referenced the importance of Matrons on the wards as a visible role model and as a point of contact. She commented that staff responded well to these initiatives and gave the staff confidence to raise or discuss any issues they may have. She added that if a specific issue was raised this would be escalated and tracked using appropriate and agreed channels. The Associate Medical Director, GMMH noted the comments raised regarding the Community Mental Health Teams and the challenges these teams had faced due to recruitment, however he stated that improvements were being made in regard to engagement and dialogue with staff across all levels. The Associate Director of Operations, GMMH advised the Group that a pastoral role had been provided to the staff working in Community Mental Health Teams to offer additional support to those staff around the issue of supervision and appraisals. This had recently commenced and would be available for 12 months and then assessed. She added that Risk Summits specifically around Community Mental Health Teams and the workforce had been developed by local Service User and Carer Groups and the findings of these would be shared with partners as part of the considerations of the wider prevention work that was discussed by the Executive Director Adult Social Services.

The Deputy Chief Executive and Chief People Officer, GMMH stated that the Freedom to Speak Up channel tended to identify staff-related issues, adding that this mechanism was one way for staff to raise concerns with the confidence that these would be listened to and addressed, however it was his experience from visiting services and meeting staff in person that they were confident to raise issues directly with senior leaders and managers. He commented that this notion of visibility with purpose was central to improved governance arrangements across all services. He provided an example of when he had met with a group of internationally recruited nurses to learn of their experience. He said these conversations and learning of their lived experience was invaluable and would inform future planning.  

The Deputy Chief Executive and Chief People Officer, GMMH commented that all what had been described was to provide an assurance that safeguarding was central to all activities and was ran throughout all workstreams of the Improvement Plan. He said staff had the confidence and were empowered to speak up and raise issues, with an assurance that they would be listened to with the appropriate action taken and learning captured. He added that it was the responsibility of all leaders across all services to be the ‘eyes and ears’ on the ground to ensure patient safety. He commented that whilst the topic under discussion today was governance the importance was the improvements that were being made across the Trust in relation to culture and leaders leading by example.

The Associate Director of Nursing and Quality, GMMH made reference to the many different ways in which the service user voice was captured, these included the Service User Survey; a PALS officer who worked directly with service users and linked directly into the governance and quality assurance structures; established Service User Forums and a recently appointed Patient Engagement Lead. The Associate Medical Director, GMMH commented that meetings were facilitated for patients to meet with the ward manger to discuss aspects of care and what was working and what was not, he added that these were very powerful meetings and an opportunity to hear the service user experience. The Associate Director of Operations, GMMH said that Manchester had an established service user and carers group, called ‘Our Care Matters’ who met monthly and were representative of all services. She added that service managers and operational managers attended these group meetings. She added that the Patient Engagement Lead had coproduced with service users and cares a ‘Better Together Strategy’. She stated that a specific service user and carer group had also been established to consider and feed into the development at Park View in North Manchester, adding that these were very well attended. She commented also that an engagement day with CHARM had also been facilitated recently and had resulted in a number of actions to be progressed. The Chief Operating Officer, GMMH commented that the initial feedback from that session with CHARM had been very positive despite some challenging conversations.

The Chair commented that it was important to recognise the importance of challenging conversations to drive improvements and foster honest and open dialogue.

The Associate Director of Corporate Governance, GMMH said that it was important to learn and embed all the learning from the many various opportunities and mechanisms to capture feedback, including but not restricted to, analysis of Freedom to Speak Up and the Staff Survey. He said all this data and information, both formal and informal would be triangulated and used to inform all future planning and priorities. 

The Deputy Chief Executive and Chief People Officer, GMMH advised the Group that an extensive programme to recruit the new Chief Executive had been initiated, with a search company undertaking proactive conversations with potential candidates. These conversations were predicated on an understanding of system wide expectations of candidates and clear discussions regarding the challenges the role would present. He said that the selection process would include all candidates meeting with a range of stakeholder panels, that included staff and service users with feedback obtained from each panel to help inform any final decisions.

Decision

To note the report.