Board summary May 28 2025

Non-Executive Director Liz Harrison provided an update on the Finance, Performance and Digital Committee meetings from April and May.

• Master plan for efficiencies - Liz Harrison emphasised the need for a single master plan to align efficiencies and bring them together in one place, to ensure clarity on the outcomes and actions required.

• Finance report to March 2025 (month 12) and end of year financial position for 2024/25 - The Board is asked to note the financial position for CWP for March (month 12) and the end of year financial position - a number of significant pressures which have impacted the financial performance of the Trust which have been consistent all year. The report is to be read in conjunction with the reported overall Cheshire and Merseyside Integrated Care System (ICS) financial position.

• Financial plan 2025-26 - no major changes, but due to the significant system challenges felt both within CWP and across Cheshire and Merseyside Integrated Care Board (ICS), the ICS has asked all Trusts to assure themselves that they have implemented a number of control measures to meet this programme. 

• CWP month one financial update: The planned £4m surplus end of year position included a £5.4m system risk which had been profiled for month 12. The Committee noted that £1.8m of efficiency schemes had been transacted in month 1, capital spend was £0.5m off target but no areas for concern, a Better Payment Code rate of 100% was reported for month 1, and the cash position was £27.1m at the end of April.
• Out of area bed usage: The Committee highlighted the achievements regarding out of area bed usage, noting that there had been 0% inappropriate out of area beds and an improvement in appropriate out of area bed usage. This position had enabled the Trust to reduce its number of appropriate out of area beds by six with effect from August.
• Reduction in agency spend: The Committee received a deep drive report on the use of agency and congratulated colleagues across the Trust for working collectively to achieve a significant reduction in agency spend over the course of the year. 
• Finance report to March 2025 and end of year provision: The Trust’s surplus exceeding its target, alongside key financial challenges such as inpatient services overspend and efficiency savings. Operational efficiencies have been successfully met, reducing the carry-forward pressure into 2025/26. The Trust has maintained strong financial discipline, meeting national targets for agency spend and payment practices. Capital expenditure remains on track, and the Trust holds a healthy cash balance heading into the new financial year. Full figures available in the board papers.
• Car salary sacrifice scheme - the Committee received a detailed deep dive report reviewing the current salary sacrifice car scheme, the outcome of a market testing exercise carried out through the procurement department, and considered a recommendation to adjust the mileage rate for staff with electric vehicles through the salary sacrifice scheme so that they are equal to those with private vehicles. The committee asked for Board approval of the recommendation to move the CWP scheme to NHS Fleet Solutions, an organisation which has the most experience providing schemes across the NHS - this was approved by Board.
• Cycle to Work Scheme - the Committee asked Board to approve the recommendation to set up a separate account for band 2 and 3 colleagues with an individual employer code to pass on the 15% employer’s National Insurance contributions. This action would enable all staff access to join the cycle to work scheme - this was approved by Board.

Julie Higgins, Non-Executive Director, provided an update on the Quality Committee meeting from May 2025.

• Community Mental Health Survey - Julie discussed issues related to the accessibility of mental health services, based on the Community Mental Health Survey and the importance of addressing social determinants of health, such as housing and employment.
• Continued progress with implementing CWPi - noted that the governance arrangements for reporting on CWPi delivery requires the Quality Committee to oversee the ‘providing best outcomes through great care’ and ‘improving health equity and reducing inequalities’.
• Noted progress with improvement actions in the regulatory CQC action plans at Trust level for well-led and for the CWP core service ‘acute wards for adults of working age and psychiatric intensive care units’.
• Noted the ‘Reporting, Learning and Improvement, from Patient Safety Incidents’ which includes patient safety incidents during trimester 3. Full report available in the board papers (Page 92).
• Noted the Mental Health Law Annual Report 2024/25 which includes the key legislative activity including informal admissions, admissions, Community Treatment Orders, Inpatient Detentions, Independent Review Panel Hearings, and complaints related to the use of the MHA. Full report available in the board papers (Page 115).
• Noted the Quality Improvement Report, Edition 4, January-May 2025. The report updates people who access and deliver our services, carers, the public, internal groups, our NHS and non-NHS partners, commissioners, and external scrutiny groups, on our progress in improving quality across our services. Full report available in the board papers (Page 145).

Gary Flockhart, Director of Nursing, Therapies and Patient Partnerships and Farhad Ahmed, Non-Executive Director, presented the assertive outreach action plan.

Assertive Outreach (AO) is a mental health model that focuses on actively engaging with individuals who have severe mental illness and are often struggling to access or maintain engagement with traditional mental health services. 

• Self-assessment - CWP is required to complete and return a self-assessment checklist to the Integrated Care Board (ICB) to provide assurances around the work we are doing in this area.
• Challenges identified - challenges identified in the self-assessment included not having dedicated assertive outreach teams within the Trust (this function is part of our community mental health teams) and the need for improvements to our electronic patient record systems.
• Good practice - a lot of good practice was also identified around focus rehabilitation, and good engagement with families/carers. 
• Inclusivity in Care - the importance of inclusivity in care was emphasised, ensuring that patients who are more difficult to engage receive appropriate support that meets their individual needs and preferences.
• Coordination with ICB - coordination with Cheshire and Merseyside ICB was discussed as crucial for addressing gaps in provision and ensuring effective care delivery.
• Next steps - next steps include actively engaging in Cheshire and Merseyside workshops and sharing learning with Mersey Care.

We need to shift the way we think about these individuals - rather than them being difficult to engage with it is more about how we can think differently around the best ways to engage with them.

We need to be focusing on inclusivity of care, not exclusivity of care, helping everybody to understand what's happening that is leading to the person not wanting to engage. 

Having separate AO resource previously has taken this group away from the mainstream whereas we need to make mainstream services more inclusive for everyone - this is the long term aspiration.

Eric Solomons, Non-Executive Director, provided an update on the most recent Audit Committee, including:

• Internal audit - Merseyside Internal Audit Agency (MIAA) progress report - Eric reported substantial assurance received in the internal audit report, indicating strong governance and control processes, including suicide prevention, inpatient discharge and committee effectiveness.
• The Head of Internal Audit Opinion reported Substantial Assurance - that there is a good system of internal control designed to meet the Trust’s objectives, and that the controls are generally applied consistently.
• Noted an update to the conflict of interest registers and register of seats, which were both approved by the audit committee at the last meeting.

Farhad Ahmed, Non-Executive Director, provided an update on the most recent People Committee meeting.

• Guardian of Safe Working 2024/25 Annual Report and Q1 2025/26 report: Low levels of exception reporting noted with no exceptions raised in Q3/4 though anecdotal evidence of unreported exceptions and other issues including unsatisfactory leave request processes and medical staffing issues.
• Actions in place to reduce barriers to exception reporting including improved access to digital platform, timeliness of rota issue and encouragement of exception reporting through local forums and awareness raising. New requirements from NHS Employers in place from September 2025 require trusts remove barriers to exception reporting, reduce detriment from exception reporting and improve timeliness of payments.
• National/regional update: New Board Member appraisal framework published; VSM pay framework expected soon. National redundancy programme discussions ongoing. New Chief Officer for Delivery and Recovery in place at the ICB, supporting workforce controls. Vacancy freeze risks noted driven by national requirements responding to financial challenges, with mitigation through workforce monitoring.
• Workforce metrics: Turnover at 9.13%, improving against 11% target; sickness at 6.19% (just over 6% target). Agency spend at 3.14%, meeting 3.2% target. 2025/26 metrics under review, linked to new NHS Performance Assessment Framework.
• Statutory and mandatory learning: New local framework launching June, national rollout by September 2025. Concerns raised over increasing local role-essential training, contradicting efforts to boost productivity. Further governance framework due July 2025.
• Noted the People Committee Workforce KPIs. Full report available in the board papers (Page 203).
• Noted the annual report on safe working hours of doctors and dentists in training. Full report available in the board papers (Page 221).
• Noted the reduction in the use of agency staffing and reduction in staff turnover.

"Well done to People Services on the reduction in turnover and agency spend" - Liz Harrison, Non-Executive Director

Farhad Ahmed, Non Executive Director, provided an update on the commissioning assurance committee, discussing the impact of commissioning changes on the system.

• Board to note the potential risk associated with the unsigned NHSE Head Agreement with CWP for the Lead Provider Collaboratives. 
• Board to note the potential impact and risk associated with delegation of specialised commissioning responsibility from NHSE to ICBs - delayed discussion until future Board meeting when we have more information about what's happening and what the changes will mean. System changes present risks so we need to keep our eye on this. 

• Adult Eating Disorders and Level Up CAMHS Tier 4 Lead Provider Collaboratives launched in April 2022, improving financial performance, patient involvement, and care quality.
• Standardised referral criteria, expanded mental health care models, and enhanced risk management.
• LPCs' Experts by Experience (EbE) programme won top awards for two consecutive years.
• Shadow live since April 2025; full launch expected in September with Seren Lodge funding transfer.
• Six major events held over three years, strengthening stakeholder collaboration for service improvements.
• Additional LPC developments outlined in the Commissioning Assurance Committee Chairs Report.
• Noted the NHSE delegation and future of LPCs:
  • NHSE delegation: Specialised mental health commissioning delegated to North West ICBs from April 2025.
  • LPC reconfiguration: Five options proposed; workshop planned for summer, final decision expected in September 2025.
  • Contract status: NHSE contract with CWP for LPCs remains unsigned.
  • Governance discussions: Positive meeting with C&M ICB identified actions, including possible contract extension to 2027.
  • Next steps: Focus remains on LPC work programme and strategic service planning.

Julie Higgins, Non-Executive Director provided an update following a meeting with CWP committee chairs, discussing the importance of timely papers, the need for clear narratives from data interpretation to support with assurance, and the capacity and capability to deliver required actions going forward, particularly in light of current pressures, as well as the need for safe spaces to talk through issues.

Farhad Ahmed, Non-Executive Director, provided an update on the Board Assurance Framework, discussing the review of strategic risks, the need to revisit risk appetite, which has changed significantly, and the plan to meet with committee chairs to align risk management.

• The Audit Committee and subsequently the Board of Directors approved a new risk management policy in September 2024, and this remains under implementation - this will be an integrated document with everything in one place.
• A new Executive Risk Management Group is in place.
• A new Board Assurance Framework for 2025/26 is under development based around the indicative strategic risks reviewed in March 2025.
• Discussions will be brought back to a workshop in June. 

Jennie Birch, Director of Business and Value, presented the Financial Plan for 2025-26, discussing the submission of the final version, the control total for the Cheshire and Merseyside system, and the capital plan, including national bids and ongoing maintenance.

• For 25/26 Cheshire and Merseyside Integrated Care System (ICS) was required to reach a planned deficit position of £178m (control total).
• Each organisation was given a control total in order to reach this overall quantum. CWP's control total was £1.6m. 
• Since the time of the financial plan submission, Cheshire and Merseyside ICS has written out to organisations (1 April) to confirm that plans as a system submitted on 27 March demonstrated a combined ICS deficit position submission of £255.2m, consisting of £278.7m deficit on the NHS provider side and a £23.5m surplus on the ICB side. 
• As a result, Directors of Finance met as a collective group with Mandy Nagra (Chief Officer for System Improvement and Delivery) to identify ways to close the pending gap.
• Full report is available in the board papers (Page 252).

The Care Quality Commission (CQC) Annual Statement of Compliance was approved by Board.