Oxleas_Review_2012_website_version_1

2012
Oxleas
Annual
Review
1 OXLEAS NHS FOUNDATION TRUST
ANNUAL REVIEW 2012

1OXLEAS NHS FOUNDATION TRUST
ANNUAL REVIEW 2012
Contents Editorial
1 Editorial
2 A therapeutic environment for dementia care
4 Falls prevention improves quality of life
5 Txt msg service is GR8 4 young PPL in Bexley
6 The meaning of life - Baroness Neuberger
7 Baby feeding programme wins UNICEF approval
8 Connecting with service users and carers
9 Understanding patients’ experiences - Keith Miller
10 Financial overview – Ben Travis
12 A night of many artists - Kim Noble
13 Out and about - Maeve Malley
14 Caring about our carers - Anna Chan
16 Involving people in our services - Jo Mant
17 Work Fair offers hope for mental health service users
& Gynaecology service champions women’s health in Woolwich
18 Making a difference - Stephen Firn
20 How understanding autism brought peace to a family
21 Integrated services will deliver better care for children - Stephen Warren
22 New directorate structure explained
23 A wonderful opportunity for children’s services - Stephen Whitmore
24 Meeting the physical health needs of older men in prison
26 Keeping quality at the top of the agenda - Dr Ify Okocha
28 CQC visits trust sites
29 Clozapine testing services are going trust wide
30 What does our best ever staff survey say about Oxleas?
32 V2W helps Alex back into work
33 The personal touch
34 Communicating through dance is Magpie’s bright object
36 In times of change, the role of governor is more
important than ever - Raymond Sheehy
T
he last year has been a busy and rewarding one for all of us in Oxleas.
Staff from community health, mental health and learning disability
services have continued to work together to focus on patient
experience and provide more integrated care for mind and body.
Finding out what people think of our services means that we can continue
to improve them and there have been some interesting developments in
this area. The focus within our Adult Acute Services (see page 8) has been
a new initiative around care, compassion and engagement to ensure that
staff are fully responsive to patients’ needs. Keith Miller, Chair of our
trust wide Patient Experience Group, explains on page 9 how listening to
patients can improve services and you can read about how comfort rounds
are putting this into practice in our intermediate care unit on page 33.
When community health services joined us, staff from across the trust were
given an opportunity to improve care by working together to provide more
integrated services. On page 21 you can read about our new integrated
children’s services in Greenwich which went live on 1 September and, on
page 23, Stephen Whitmore talks about our new trust wide Children and
Young People’s Services, which he will lead as director from 1 October. This
will bring together child and adolescent mental health services (CAMHS)
and children’s community health services for the first time. For an older age
group, the Community Falls Team (see page 4) has been working hard with
colleagues from other services to promote falls awareness and promote
a trust wide approach to managing falls.
Our centre pages include an interview with Chief Executive Stephen Firn,
who talks about his desire to make a difference to health services and some
of the challenges we face in a changing NHS.
A thriving membership is essential to any foundation trust and, on page 16,
Head of Stakeholder Engagement Jo Mant talks about how we are striving
to involve more local people and make membership more relevant to them.
Lead Governor and Deputy Chair of the Council of Governors Raymond
Sheehy gives his views on how governors can help improve our services on
pages 36/37.
However, all that we do and hope to achieve is dependent on the trust
being on a sound financial footing and, on pages 10/11, Director of Finance
Ben Travis explains that while we are not immune to financial pressures,
we have had a successful year financially and are in a sound position to
meet the challenges ahead.
Details of how to contact us and further information on all
our services is available on our website at www.oxleas.nhs.uk

2 3
ANNUAL REVIEW 2012
OXLEAS NHS FOUNDATION TRUST
A therapeutic
environment for
dementia care
A
re people with dementia disabled by their condition or by their
environment? This intriguing question was raised by Stuart Bertram,
an occupational therapist (OT) at the Woodlands Unit, Queen Mary’s
Hospital, Sidcup.
Stuart started work in Woodlands in January of this year. Since then he has been
a key figure in designing and creating a therapeutic environment on Camden Ward
that engages patients with dementia and promotes their independence.
He previously worked as an OT for social services in Hertfordshire.
For someone keen to increase his experience of working with older people in
a variety of health settings, Stuart joined us at an exciting time. A completely
new directorate for older people had recently been established and a project
looking at how older people’s services were delivered had resulted in the
decision to establish a centre of excellence for the care of people with dementia
at the Woodlands unit. This was to comprise two dedicated dementia wards:
Camden Ward for men and Leyton Ward for women. Stuart takes up the story:
“The idea was to refurbish the wards and provide a new conservatory that
would be accessible from both wards and allow access into the garden. Estates
and Facilities were already working with architects experienced in buildings for
people with dementia, but we wanted to be able to have the work accredited.
I was aware of the excellent work in this area done by the University of Stirling’s
Dementia Services Development Centre so we purchased their Dementia Design
Audit Tool.”
Based on research carried out by the University of Stirling, the tool gives detailed
guidance on how to create an environment that will best support people with
dementia. Stuart used it to carry out an audit of Camden Ward, and sent the
resulting report to Estates and Facilities Project Manager Colin Cope. Colin worked
with Stirling University’s audit tool to ensure we were able to meet basic design
principles of what is considered a dementia friendly environment. Work began
in late January 2012 and was completed in June. Stuart again: “People with
dementia need more light to help with clarity of vision and have a diminishing
ability to differentiate between colours and difficulty seeing in three dimensions.
For example, if floors, skirting boards and walls do not contrast, a person with
dementia may not be able to perceive where the floor ends and the wall begins.
This can be incredibly disorientating, cause undue
stress and anxiety, worsen symptoms of dementia
and increase risk of falls. So, when designing the new
colour scheme for Camden Ward, we concentrated
on providing contrast so that each object could be
clearly perceived. Bathrooms with white walls, sinks
and toilets are a particular problem so we used
strongly contrasting colours for toilet seats and
handrails. As well as minimising risk, this encourages
people to use the bathroom by themselves, thus
promoting independence.”
Careful thought was also given to how patients
navigate themselves around the ward, and find
their way back to their rooms. The three corridors
are colour coded purple, yellow and blue, and the
furnishings in the bedrooms match these colours.
There is also a correspondingly painted wooden panel
on each bedroom door and a sign with their name
and a photograph or picture chosen by the occupant
of that room.
Signs are wherever possible placed on the door to
which they relate and sited about four feet from the
ground where they can be easily seen by older people
who may have lost muscle strength in their shoulders
causing their heads to hang down.
Flooring with a matt finish was also installed as people
with dementia often perceive shiny finishes as being
wet and may be too nervous to walk on them. This
also encourages them to move about independently.
Dead ends, for example where there is a locked door
at the end of a corridor, can be a particular problem
causing frustration and anger, but
Stuart explains there is a solution:
“We create interest in these areas, for
example by placing old photographs of the
local area that spark reminiscence, or ‘memory
boxes’ which could contain things like coins, old bus
tickets etc. These things help to distract patients,
prevent distressing thoughts and provide a means
of spontaneous reminiscence.”
For Stuart, creating the ideal environment is all about
‘normality’. So there is a sitting room area complete
with comfy chairs, coffee table, fireplace, TV and
bookcase. The chairs have arms and ‘wing backs’
that support patients to sit comfortably and safely
and some have detachable arms for wheelchair users.
Patients can also move freely between the two wards,
socialise and form friendships. Stuart points out that
by creating a stimulating and calming environment
people are happier and the need for drugs may be
reduced: “We want to create a culture of activity
where we can assist people to carry out everyday
activities such as cleaning their teeth or brushing
their hair. We have introduced menus giving people a
choice of meals and we encourage them to help lay
the tables and clear up afterwards. Changes to the
environment, such as those we have introduced on
Camden, can enable people to do normal things that
will help them to be as well as they can. This will help
patients when returning home or moving into
a residential unit.”
A limited refurbishment of Leyton Ward focusing on
sanitary facilities and storage areas is due to start
late this year. Work will be in line with what is good
practice for people with dementia.
Stuart Bertram

5OXLEAS NHS FOUNDATION TRUST4
ANNUAL REVIEW 2012
Txt msg service is GR8
4 young PPL in Bexley
T
he school nurses in Bexley have pioneered a
new and confidential text messaging health
service for young people aged 11-18 in the
borough’s 17 secondary schools. Young people text
the School Nursing Team with their query and receive
a reply by text.
Since it was introduced last year, the text messaging
service has gone from strength to strength with
increasing numbers of young people texting in to
ask about a range of issues including sexual health,
contraception, emotional health and smoking
cessation advice.
School Health Advisor Jane Sweeny was instrumental
in setting up the service which she says addressed an
existing need: “As school nurses, we were getting
feedback from the children that they wanted some
sort of confidential advice service outside of the
one hour a week drop in service we operate in each
school. We sent a questionnaire to 150 young people
asking them how they would like to receive health
advice. 57% responded saying they would prefer to
receive advice by text and 15% said they would use
this method although it wouldn’t be their first choice.
We launched the text messaging service as a result of
this positive feedback. I really believed in it and pushed
for the service to be set up.”
This included formulating operating guidelines,
steering it through governance and quality assurance
and winning the support of Transformation Manager
Maria Tanner. Jane and the team then promoted
the new service and number to text in schools with
posters and at-a-glance information in credit card size
format. In the first year the team dealt with 456 texts
and this year had received 280 up to July.
The team is based in the Erith Health Centre and
at Wrotham Road, Welling and the text messaging
service is run by five qualified school nurses.
Texts are received and responded to 9am-4pm,
Monday to Friday, on two dedicated phones, one at
each location. Jane is clear about the benefits: “Young
people can now get help and advice throughout the
year rather than once a week during term time. And
because it is anonymous, it’s easier for them to ask
questions that might be difficult face to face. In this
way we can reach more people than previously. Most
of the queries are about sexual health, though we also
receive questions about emotional and mental health.“
If the team think more help may be needed, they give
people details of their school nurse and drop in service
or direct them to other sources of advice and support.
Patient experience is monitored by automated texts
sent following the advice thanking the young people
for using the service and asking if they found it useful.
Responses so far have been overwhelmingly positive.
Young people in Bexley can text for advice on
07880 783 560, or 07880 784 446
F
alls represent a serious problem for older people;
they occur in around 30% of over 65s and
50% of those aged over 80 every year, often
resulting in serious consequences, both physically and
psychologically. In addition to bruising, fractures, and
in some cases, death, a fall can destroy confidence,
increase isolation and reduce independence.
Falls affect people whether they use our physical,
mental or learning disability services and our
Community Falls Team has been working hard to
promote falls awareness and prevention by forging
links with colleagues across these services.
The falls team, which joined us with Greenwich
Community Health Services in 2011, is part of the
Community Assessment and Rehabilitation Team,
which looks after people with long term physical
health conditions and has a particular focus on
avoiding hospital admissions.
Falls team lead Wendy McDermott points to solid
achievements over the last year: “We’ve set up a trust
wide falls and bone health steering group whose first
objective is to develop a falls policy that encompasses
all our services. Falls team staff have also provided a
consultation service where we give help and advice on
falls awareness and prevention to colleagues including
those in mental health and learning disability services.
For example, we have shared our falls screening tool
and care pathway with colleagues across the trust. We
have provided falls training to staff in a number of care
homes and district nursing teams. We have worked
Falls prevention
improves quality of life
Adapted Tai Chi exercises at the Bevan Unit, Thamesmead.
in partnership with Active for Health Greenwich that
runs exercise groups in the community, providing
them with evidence based exercises. We also support
colleagues to carry out falls audits in their areas and
make appropriate recommendations.”
The team has attended local public events to promote
falls awareness and falls prevention including events
during Falls Awareness Week in June. During these,
they were on hand to offer information and advice
at a Nepalese exercise class in Woolwich and a Thai
Chi session at West Thamesmead’s Bevan Unit, which
cares for those finding it difficult at home or who
need support and rehabilitation before returning
home from hospital.
During the last calendar year (January to December
2011) the falls team received 1,090 referrals, an
average of 91 per month. The team conducts regular
reviews to gather patient experience of the service,
undertaking 210 in this period. These showed that
86% of patients had not fallen following a six month
review, demonstrating the impact of good falls
management. No serious injuries or fractures were
reported.
Upon discharge, satisfaction questionnaires are sent
to patients, and of 231 returned, 225 said they had
benefited from the service. Things that patients found
particularly valuable included: advice and information;
encouragement; having someone to contact; exercises
and being able to do things for themselves.
Jane Sweeny
Thai Chi group at the Bevan Unit

ANNUAL REVIEW 2012
S
taff fortunate enough to hear Baroness
Neuberger talk at our Getting Older – Living
Well conference in March probably expected
a polished talk. What they may not have bargained
for was an inspirational account of the meaning and
purpose of our lives - all delivered in 15 minutes.
Baroness Neuberger has had a distinguished career in
public life. She is a noted social commentator and is
currently Chief Rabbi of West London Synagogue and
a crossbench peer in the House of Lords.
Staff from our mental health, learning disability
and community health services got together at the
conference to consider how integrating these services
could provide better care for older people. During
the morning, speakers explored themes including
the relationship between physical and mental health,
social isolation, how staff can work together and
caring for people at the end of life. In the afternoon,
round table discussions debated whether integrated
care for older people can make a difference and
universally decided that improving and maintaining
communications between different services was
essential.
But the highlight of the day was Baroness Neuberger’s
thoughts on the meaning and purpose of life for older
people. Not mincing her words, she said the way
our society often treats older people is disgraceful:
“Feeling loved and cherished and wanted is a huge
part of what makes life worth living. Even when things
are not going well, if we feel secure of our place in
society we are ok. The problem for older people is that
they are often abandoned by society.”
The baroness summed up what she thought health
professionals need to take account of: “We all need
a sense of purpose and to feel needed. We need this
all of our lives, including when our physical or mental
capacity isn’t great. Friendship is also important to
us throughout our lives. People with dementia still
react when you touch, sing, or talk to them. Our need
for human contact lasts to the end of life, even with
dementia. Finally, we need to recognise the suffering
and loss that older people experience. People are
often afraid to talk to them about what they imagine
may be painful memories, but this is wrong. Older
people want to remember and talk about the past.
It’s the memory of people they have loved and lost
that consoles and sustains them every day.”
Baby feeding
programme
wins UNICEF
approval
A
10 year collaboration in Greenwich has
resulted in us becoming one of the first trusts
in the country to achieve joint UNICEF Stage
3 Baby Friendly accreditation.
Health visiting teams from Greenwich Community
Health Services, which joined us in 2011, worked in
partnership with colleagues from Queen Elizabeth
Hospital, Woolwich, the University of Greenwich
and Greenwich Council children’s centres to ensure
that mums in the borough had access to the highest
standards of breastfeeding and infant feeding advice.
This partnership is called the Greenwich Breastfeeding
Strategy and its aim is to increase breastfeeding rates
in Greenwich and ensure that mums get the best
quality information and support.
Breastfeeding rates in the UK are still among the
lowest in Europe and mums have been working with
healthcare professionals to change this.
In pursuit of this goal, the Greenwich Breastfeeding
Strategy worked with UNICEF UK, a charity that
focuses on children and child rights worldwide. Their
Baby Friendly Initiative works with healthcare systems
to ensure a high standard of care in relation to infant
feeding for pregnant women and mothers and babies.
It accredits maternity and community facilities that
adopt internationally recognised standards of best
practice in three stages. Stage 3 assesses the care
provided to pregnant women and new mothers.
Liz Ginty is one of two infant feeding advisors, the
other being Janet Blake. Liz said: “There has been lots
of user involvement from the start and this has really
given the project impetus. For example, the Greenwich
MUM2MUM project is a network of local volunteer
mums who receive training to help them promote
breastfeeding in their local communities.”
Janet, also a health visitor, said: “This success reflects
all the hard work by health visiting teams in supporting
Greenwich mothers and families. UNICEF particularly
praised our breastfeeding support groups that run
every day in children’s centres across Greenwich.”
UNICEF staff visited children’s centres across
Greenwich and talked to mums about the advice
they had received from our staff. Questions included
whether mums received advice on how to express milk
(a way of taking milk from the breast without the baby
suckling) and a staggering 98% told UNICEF they had.
The
meaning
of life Baroness Neuberger A breastfeeding group in Greenwich

ANNUAL REVIEW 2012
Connecting
with service
users and
carers
Understanding
patients’
experiences
Angus Gartshore, right, with members of ResearchNet
Keith Miller
D
iscussions earlier this year around how things
could be improved within Adult Acute Services
have led to an exciting new initiative that puts
patient experience at the top of the agenda.
Led by Service Manager Angus Gartshore, Care,
Compassion and Engagement (CCE) aims to improve
the services that patients receive by ensuring that the
staff who deliver them are fully responsive to patients’
needs. It was launched at Oxleas House, Queen
Elizabeth Hospital, in April 2012.
Angus explains: “Feedback from recent patient surveys
suggests that interaction between staff and patients
and carers is not always as good as it could be.
Complaints have also led to the conclusion that staff
attitudes could be better.
“Our plans to address this include implementing CCE
right from recruitment and only employing people
who share the trust’s values. For example, we will be
holding group discussions as part of the interview
process for nurses.”
CCE will be also be incorporated into job descriptions,
personal development reviews (PDRs) and supervision.
Angus says they have started with inpatient units as
these areas currently receive the most complaints. In
the future, it will be rolled out to other areas including
community teams; home treatment and crisis teams;
intake and liaison and short term intervention (ILT and
SIT) teams; day treatment and psychotherapy services.
A number of CCE initiatives are already well underway.
One of these is experience based co-design,
originally developed by the King’s Fund, a charitable
organisation that seeks to understand how the health
system in England can be improved.
L
ooking at services from a patient’s perspective,
and acting upon what they tell us, has become
an integral part of our activity in recent years.
It ensures that staff at all levels stay connected with
the experiences of those using our services, and
helps us to develop those services to better meet
patients’ needs.
Chair of the trust wide Patient Experience Group
(PEG), Keith Miller has been hard at work for the last
18 months driving this process forward. Keith said:
“We’ve made great progress gathering information
on patient experience across a wide range of services.
This is strongly supported by our Chair and Chief
Executive because it’s fundamental – if we don’t get
this right nothing will be right.”
In addition to chairing the quarterly meetings of the
trust wide PEG, Keith regularly liaises with the PEG
leads for each directorate to ensure that activity
is coordinated across the trust. These are in turn
supported by the Quality Team who assist with
collecting information and producing reports.
Information is gathered using a variety of methods
including the National Patient Survey, the Oxleas
Patient Experience Questionnaire, the Patient
Experience Tracker (an electronic device used on
wards) and patient consultation events.
Keith pointed out that once information is collected
it must be acted upon: “Our real priority is in taking
action where issues come to light. We are working
with the Quality Team to ensure that, following
feedback, each directorate PEG identifies two or three
priority areas where action will be taken and puts a
plan in place to carry this out. Simple things can make
a huge difference to patient experience. As a result of
feedback, we have improved signage within a podiatry
clinic, de-cluttered reception areas, and introduced a
This innovative approach allows patients and staff
to work together to design services and/or care
pathways. Patients are filmed talking about their
experience of the services they receive. The film is then
played back to focus groups consisting of staff from
a range of professional backgrounds. Bromley based
members of ResearchNet, a service user and carer
research group, have made a film which has been
piloted successfully on Betts Ward, Green Parks House.
They are also collaborating with staff in the re-design
of services. Betts Ward is a triage ward for Bromley
residents aged 18-65 with mental health problems.
Angus says this is the first time the approach has ever
been used in a mental health setting.
According to Angus, discussions with ResearchNet
have already yielded valuable insights: “They tell us
that the first 24 hours of a person’s admission to an
inpatient ward is the most important to get right, as
they are in crisis and this is their first impression of us.
“It’s not rocket science. It’s basic stuff like getting staff
to put themselves in patients’ shoes and think ‘if that
was me how would I like to be treated?’ We want
each team to come up with an initiative to help us all
look at how we can do things better – for example
Oxleas House now has an employee of the month
scheme, with nominations coming from service users
and carers. And Lesney Ward in the Woodlands unit
has introduced protected meal times (times set aside
solely for patients to eat meals) with flowers and
tablecloths on the tables. In other words, simple things
that added together can change services for
the better.”
new appointment system at health visitor clinics.
In essence, it’s a process of continual improvement.”
While feedback from community health services has
been extremely positive, Keith explained that some
patient experience is less straightforward: “When
people are admitted to an acute psychiatric unit,
for example, they are often in real need of human
support and understanding. It can also be hard for
them to understand what’s going on because they
will not have a clear expectation of what admission
may involve. It’s challenging, but absolutely crucial to
get patient experience right, because if people don’t
engage with our services it’s harder to help them.
An exciting project which is already showing positive
results is experience based co-design, where patients
share their experiences with staff through film and
discussion.” (See page 8.)
Our child and adolescent mental health services
(CAMHS) have also been looking for ways to routinely
assess patient experience. They are members of the
national CAMHS Outcomes Research Consortium
(CORC), which publishes results annually. This year’s
results show that our CAMHS have performed
favourably in comparison to other CORC members
in providing a good patient experience.
Perhaps the most successful way of gathering
feedback has been the Oxleas Patient Experience
Questionnaire, where volunteers gather information
during a one-to-one interview with patients and
carers. Since it began in 2010 around 1,200 interviews
have been conducted across mental health and
community health services by volunteers who
may be patients, carers, governors or non-
executive directors. The response rate is
around 70% compared to the national
average of 33% obtained by the National
Patient Survey. Keith said that perhaps
the most important question asked is
whether people would recommend the
service they had received to a friend:
“If we really think about patients’ experiences
we can design services better to ensure staff
interact meaningfully with them and support
them.”

10 11OXLEAS NHS FOUNDATION TRUST
ANNUAL REVIEW 2012
T
his has been another successful year for us from a financial perspective, as
illustrated by the achievement of a Monitor (the independent regulator of
NHS foundation trusts) risk rating of 5 (where 1 represents the highest risk
and 5 the lowest).
We have grown significantly as Greenwich Community Health Services joined us in
April 2011. This resulted in income rising from £159m in 2010/11 to just over £200m
in 2011/12.
We achieved a surplus for the year to 31 March 2012 of £5.1m. This compares to a
surplus in 2010/11 of £3.9m. The 2011/12 surplus includes an adjustment of £1.6m
which is a result of adjustments made to the way that we calculate our private
finance initiative (PFI) liability. This is a one-off accounting adjustment that has no
cash impact on us. The surplus excluding this adjustment for the year was £3.5m.
It is important to maintain our financial strength as it enables us to fund necessary
changes and take advantage of opportunities. It also gives us the ability to continue
to plan for the longer term and avoid short term fixes.
Efficiencies
There was a 4.0% efficiency requirement for the year which comprised a 1.5%
reduction in contract values as set out in the NHS Operating Framework, coupled
with cost inflation of 2.5%. In addition, Bexley and Greenwich primary care trusts
required further efficiency savings.
During the year, the most significant challenge from a financial perspective was
achieving these efficiency savings without affecting our front line services.
We substantially achieved our efficiency targets by service
reconfigurations and cost reductions. For example,
in 2011/12, due to lower demand, we reduced
the number of hospital beds for older people.
This saved money and we were able to use
some of the savings to increase community
services and develop specialist inpatient
services for older people (see article on
pages 2/3). This meant that the quality
of patient care did not suffer. We anticipate
that these funding reductions will continue
to provide the greatest financial challenge over
the coming years.
Financialoverview
Statement of Comprehensive Income for the year ended 31 March 2012

2011/12 2010/11
£m £m
Operating income 200.5 159.2
Operating expenses (193.2) (152.8)
Operating surplus 7.3 6.4
Net finance costs (2.2) (2.5)
Surplus for the year 5.1 3.9
Ben Travis, Director of Finance
Cash
Our amount of available capital has been further
strengthened during the year, and cash balances were
£71.1m at 31 March 2012.
The Board has developed plans to use this cash
resource over the coming years, and has earmarked
cash to the following areas:
• Working capital requirement/cash buffer to cover
unforeseen eventualities;
• Organisational development fund to support
investment in areas such as service improvement
projects, clinical systems, and IT;
• Estates programmes – projects to improve
our buildings.
Looking ahead
It’s clear that there are significant financial pressures
facing the NHS as patient demand rises, costs increase,
and funding reduces. We will be required to make
further efficiencies over the coming years whilst
continuing to provide high quality patient focused
services.
We will continue to keep management and corporate
costs as lean as possible to make sure we spend as
much money as we can on patient care. For instance,
the changes we are making in 2012/13 in the
management of adult community health and children’s
services will bring positive benefits whilst reducing
management costs.
For all the uncertainty and efficiency requirements
ahead, it is worth restating that we are in a good
financial position and as well placed as anyone in the
NHS to meet these challenges.
Bexley Care Trust
Bromley PCT
Royal Borough of Greenwich
Greenwich TPCT
Lewisham PCT
Other
22%
18%
3%
45%
3%
9% 3%
7%
5%
5%
7%
73%
Depreciation impairments
Drugs supplies
NHS non-NHS services
Other
Premises
Staff costs
Full accounts are
available on our website
at www.oxleas.nhs.uk.
Where our funding comes from How we spend it

ANNUAL REVIEW 2012
Out and about
I
t would be hard to find a more positive role model
for lesbian, gay, bisexual and transgender (LGBT)
staff and patients than Maeve Malley. A winning
combination of energy, enthusiasm, commitment
and laughter, Maeve is a Consultant Systemic
Psychotherapist who has worked for Oxleas for
more than six years.
Maeve has always been ‘out’ at work and believes that
this is important to her clinical practice: “To be the
best you can be at work you have to use the whole
of yourself, and that includes your sexual identity.
This is important when building trust and relationships
with other people. In my own area – systemic
psychotherapy – we work with families, couples,
even organisations, and focus on the many different
systems – or relationships - that surround people,
rather than just on their internal worlds. I think it is
important that clinicians help patients who are LGBT
to feel safe discussing the whole of their lives as this
has a beneficial effect on outcomes.”
Maeve thinks the issue of visibility is key:
“It’s very important that people get their heads
around visibility. I’ve genuinely noticed a change for
the better since I joined the trust and I think this
is down to the role of the trust’s LGBT Network.
It provides a focus and an LGBT identity within
Oxleas and also performs a proactive role, for
example producing leaflets and posters.”
According to Maeve, the presence of LGBT posters
and leaflets in waiting rooms is a visible recognition
by the trust of sexuality: “Heterosexuality is always
the default and people who are LGBT can become
invisible. So the acknowledgement of difference is very
important. My experience is that when this happens,
both staff and patients are able to be ‘ordinary’ talking
about, and being asked about, their lives. It also makes
a difference to who chooses to work for us and who
uses our services.”
A
night
of
many
artists
I
magine having 20 ‘main’ personalities sharing your
body. They are all different and many of them are
artists. Well, a Bromley audience of 120 people
enjoyed a fascinating evening last November with such
a person – Kim Noble.
Kim Noble has dissociative identity disorder (formerly
known as multiple personality disorder). This is a
complex disorder that many people find hard to
believe (including, at one point, Kim). This has caused
many problems over a 35 year period resulting in
chaotic involvement with mental health services.
However, Kim is a mother and a very successful artist.
The Central Library crowd found out how art has
changed Kim’s life. Her work is widely sought after
and she has made numerous TV appearances including
The Oprah Winfrey Show.
The event was produced and run by ResearchNet, a
service user and carer research group interested in all
aspects of mental health. It was designed as part of
a research project to look at public attitudes toward
mental health issues. The evening introduced Kim’s
fascinating story and showcased her art. People had
the opportunity to purchase a signed copy of Kim’s
autobiography – All Of Me.
Many ResearchNet members are on our innovative
Volunteer to work scheme and two were extremely
accomplished on the night in their Master of
Ceremony duties.
Another highlight of the evening was the question
and answer session. Kim was asked ‘Do all your
personalities paint?’ Kim replied: “No. Fourteen of
them do but I have 20 personalities one of whom has
requested that her artwork is not shown.” Another
member of the audience asked if Kim had a different
wardrobe for each of her personalities. She said it’s
calmed down a bit now – but that she used to change
outfits several times a day.
This is important when one considers that earlier
models of psychotherapy traditionally regarded
people who were LGBT as being emotionally or
mentally disordered. Maeve says: “It was not benign
to LGBT identification issues. So increasing visibility
helps people to feel more comfortable using our
services, whether they choose to talk about their
lifestyle or not. And as this group is more vulnerable
to anxiety because of their sexuality, it is likely that
a disproportionate number of our patients will
be LGBT.”
Maeve Malley
Kim Noble

ANNUAL REVIEW 2012
S
upporting families and carers is one of our
priorities and the philosophy behind our Carers’
Strategy. The first Carers’ Strategy (2008-2011)
focused on involving the carers of people with mental
illness or learning disabilities as partners in care while
the new strategy (2012-2015) includes the carers of
people with physical illnesses.
The driving force behind recent improvements for
carers is Trust Carers’ Lead Anna Chan. One of the
most important initiatives has been Family Inclusive
Practice Training, facilitated by the Psychological
Therapies Team, which involves carers in helping staff
to understand what it’s like to be a carer. According
to Anna: “In the two years to March 2012, we trained
75 mental health and learning disability teams. Teams
heard carers talking about their experiences and this
was the most powerful part of the course.”
Another key element has been the establishment of
carers’ support groups in mental health services. Anna
again: “Both the number of groups and attendance at
them has grown steadily. All mental health acute units
now have carers’ support groups and most recovery
teams have them too.”
Caring
about
our
carers
Anna Chan
Susan St James has cared for her son who has had
mental illness since 1999 and is a firm believer in the
importance of support groups: “When my son was
first diagnosed I found it traumatic. I didn’t know
what questions to ask the doctors or nursing staff.
That’s why carers’ support groups are so important.
I think that details of local groups should be included
in carers’ packs and these should be the first thing
new carers receive when they walk through the door.”
Before carers can be supported we need to find out
who they are, and this is why, according to Anna,
recording their details is so important: “Once we have
their details, we can offer them a carer’s assessment,
consult them on changes, let them know about
training for carers and invite them to carers’ events.”
One of the ways we do this is by recording the carers
of patients on Care Programme Approach (CPA) on
our clinical system. Under Anna’s leadership recording
is running at 92.9%.
Anna again: “The trust recognises that carers’
assessments are essential for identifying carers’ needs
so staff have been trained to carry them out. My
own background in IT enabled me to design monthly
reports that measure the number of carers being
offered carers’ assessments by different teams.
This has enabled teams to plan workloads better
and driven up the number of assessments being
carried out.
“Carers’ assessments are so important because they
enable us to build a picture of each carer’s situation
and how they cope. They gather information about
things like shopping; banking; or how their caring
role affects their physical or mental health, work or
relationships. This enables staff to offer suggestions
on how to cope, for example giving information about
counselling or carers’ support groups, or discussing
medication and medical conditions.”
Susan St James supports carers’ assessments and is
frank in her appraisal of how they should work. She
said: “They should be about me, what I can and can’t
do. The last two were all about my son, but they need
to know how I care for him and what my abilities are.
For example, I have arthritis and have just had a hip
replacement. I made sure that staff knew about this
but often they don’t think about the support that
carers need – and don’t ask.”
The new 2012-2015 strategy seeks to consolidate
and build on progress already made and,
crucially, will apply to everyone who receives
services from us or who works for us. This is
not without its challenges, as Anna explained:
“The need to find cash releasing efficiencies
means that in future we are planning to offer
care awareness training as an e-learning course.
A big challenge concerns community health
services (CHS), where at present we have very
little information recorded about carers. We are
planning to train CHS staff to address this.
“Confidentiality is a big issue for many carers
and other plans include a common sense
confidentiality guide to inform carers
what sort of information they can
expect to get from staff and why
some information can’t be shared
with them. The guide will be
available later this year.
“The trust website already has lots of information
about mental health conditions that carers can access
and this will be expanded to include physical health
conditions. Carers will be able to access this directly
or staff can print out information for them.
“Another important part of the new strategy has been
to set up the trust wide Family and Carers Strategy
Group. Its role is to monitor and help progress
implementation of the strategy and also to review
trust publications to ensure they take account of
carers’ needs.”

17OXLEAS NHS FOUNDATION TRUST16 OXLEAS NHS FOUNDATION TRUST
ANNUAL REVIEW 2012
Involving people in
our services
H
ead of Stakeholder Engagement Jo Mant
cares passionately that we should have a
vibrant, involved and growing membership.
Jo explains that stakeholder engagement is about
involving people who may be affected by the
decisions we make as a trust or who can influence the
implementation of those decisions: “This can include
patients, staff and partner organisations, for example,
and the best way for people to become involved in the
work of the trust is to join as a member or stand for
governor. Members can have their say and influence
the development of our services. It’s all about having
a voice and being able to hold us to account.”
With community health services (CHS) from Bexley and
Greenwich joining us in the last two years, a particular
focus has been to increase membership among
people interested in this area. Jo points to spectacular
success: “It’s important that our membership is
balanced and reflects mental health, learning disability
and community health services. So we’ve taken our
membership stand to a number of public events and
our CHS members have grown from a total of 34
(including public and service user and carer members),
in July 2010 to 362 by May 2012. We have also beaten
our target to increase membership among people with
learning disabilities by 100% over the last year.”
An important element of attracting new members is
the membership form, which Jo explains has recently
been redesigned: “We are now looking to gather a
wider range of information about people including
sexuality, faith and disability. This is important as it
helps us to understand members better and means
that we can for example consult them about areas
that may be of particular interest to them.”
Jo sits on our Membership Committee, and reports
that they have been very busy over the last year
promoting trust membership at events across the
trust: “We participated in World Mental Health Day
in Greenwich last October and ran the three Borough
Focus Groups in January where we seek members’
views to inform our priorities for the annual planning
process. And in March we took part in a successful
World Health Day event in Thamesmead town centre
hosted by Trust Thamesmead’s Health and Wellbeing
Partnership Forum. In July we attended the Danson
Festival in Bexley for the second year running and
despite very wet conditions still managed to recruit
over 40 new members.”
A new development over the last year has been the
introduction of Associate Membership, offered free
to our local third sector (voluntary and community)
organisations and businesses. Jo again: “We began
in December 2011 and already have 42 associate
members. Third sector organisations provide the
backup in the community for the people who use our
services so it makes sense to have much closer links
with them. We send them regular information about
our services, invite them to events, and publicise their
work in our service information. I’m gradually meeting
them all and one of the areas I’m exploring with
them is work opportunities
- paid, voluntary and
apprenticeships
for our service
users who have
experienced
health problems
but feel ready
to venture
back into the
workplace.”
Work Fair offers hope for mental
health service users
L
ast autumn, we held our first ever Work and
Job Fair for people with experience of mental
ill-health at the Education Development
Centre in Bromley.
Over 150 people from Bromley, Bexley and Greenwich
boroughs came along to find out about paid and
voluntary work and to take part in interactive
workshops.
Dressing well is always important for interviews and
visitors had the opportunity to purchase smart clothes
that had been donated for this purpose.
The event was organised jointly by Social Inclusion
Project Manager Japleen Kaur and volunteer Julia
Vater, who said: “Events such as the Work and Job
Fair help to break down barriers and provide an
opportunity for people to gain the confidence to deal
with issues that really impact upon their lives.”
L
ocal female residents and shoppers in Woolwich
town centre were encouraged to think about
their ‘female’ health in March when we
launched our Community Gynaecology Service with
an exhibition stand outside St James Pharmacy on
Powis Street.
Specially trained nurses and a doctor were on hand to
provide information and advice about women’s health
problems and answer any questions or concerns that
they had.
The new service, which is run by our Contraception
and Sexual Health (CASH) Service, means that a
wide range of symptoms and conditions can now be
assessed and treated without the need to be referred
to hospital.
Gynaecology service champions
women’s health in Woolwich
Japleen trying on one of the donated coats
Dr Jane Dickson with colleagues at the exhibition stand
Jo Mant
To become
a member,
please see
back cover.

ANNUAL REVIEW 2012
the world, but unless you’ve got the right culture you
can’t deliver anything. We’ve got a good culture and
we mustn’t lose that.”
In leading the trust, Stephen believes in a hands-on
approach: “I meet all new staff at induction and write
to them a few weeks later to see what they think. I
spend at least one day a month visiting a particular
service, typically meeting about 10 teams. I always say
I’m not there to give them a lecture but to listen and
learn about what they’re doing and what I can do to
help them to do things better.
“I couldn’t do this job unless I enjoyed it. It’s a
privilege. Every job has its difficult moments but
I enjoy it hugely and 10 years have flown by.”
Makingadifference F
or Stephen Firn, becoming Chief Executive of Oxleas in 2002 was the
culmination of a lifelong desire to make a positive difference to people’s lives.
Originally from Yorkshire, Stephen lives in South London with his wife
and three sons aged from nine to 20. He is a keen runner and has successfully
completed four marathons.
In the early 1980s, Stephen went travelling in Europe where he met a group of
nurses who inspired him, on his return, to apply for a position in a local psychiatric
hospital. Stephen takes up the story: “I asked if they had any jobs and started the
next day. There was no induction and no Criminal Records Bureau (CRB) checks.
While there I met an inspirational dementia ward manager who had made a
haven for the patients – in contrast to the rest of the institution. I thought, wow,
you can really make a difference to people’s lives, so I applied for nurse training.
I came to London in 1985 and spent the next 11 years at the Maudsley Hospital.
I then worked as a research nurse, a lecturer, and at the Department of Health.
All the time I was trying to make a difference. This has been the common thread
throughout my career but, to some extent, I always felt frustrated. But when I got
the opportunity to come to Oxleas in 1996, as a manager in an organisation that
provided care directly, I felt most able to have an impact on the quality of patient
services.”
Looking back over an eventful year, Stephen has enjoyed welcoming new
services and staff to the trust: “Getting to work alongside and support people in
community health services, including clinical staff such as paediatricians and a new
range of allied health professionals like dentists and music therapists has been very
rewarding.
“We are already seeing really good collaborations that are helping us to treat mind
and body. For example, our specialist integrated children’s service that began in
September. And we will see even more of this when our new Children and Young
People’s directorate is launched in October.
“One of the most impressive things I have seen has been the collaboration between
staff from older people’s mental health services and their physiotherapist colleagues
over falls prevention.
“Results from the Staff Survey this year have also been very positive. This is
important as what colleagues say and feel about working for Oxleas has a direct
relationship to the quality of care they provide. We were the second best trust
overall in the country which is incredibly encouraging. And we came top for seven
questions, including staff’s satisfaction with the quality of care they are able to
provide, which is so important.”
A recent challenge has concerned the administration process at South London
Healthcare NHS Trust (SLHT). According to Stephen: “This has created uncertainty
for our colleagues in SLHT and for local people. Our responsibility is to work
with the administrator, commissioners and other providers to help to resolve the
uncertainty as soon as possible and to help deliver safe
and sustainable services.”
Foremost among the difficult experiences that Stephen
has had over the last year has been meeting with
the family of Sally Hodkin, who died as a result of an
incident involving one of our patients. Stephen said:
“Meeting bereaved families is always difficult, but it
is an essential part of my job because they need to
know firstly that we take the incident seriously and
investigate it and secondly that we learn any lessons
and act upon them.”
Looking ahead at Oxleas’ role in a changing NHS,
Stephen remarked: “In future more care will have to
be delivered in the community and in people’s own
homes. We can no longer afford to have so many
large expensive hospitals and these are not always
the best way to deliver patient choice. Most people
at all stages of life would rather receive care at their
local health centre or at home, and this is true from
giving birth right through to end of life care. In this
environment, Oxleas will continue to have a vital role
as a major community provider of both mental and
physical healthcare services.
“There will be more voluntary sector (not for
profit) providers and more opportunities to work in
partnership. For example, the trust already works
closely with local mental health charity Bridge, whose
Chief Executive Officer is our lead governor. It’s
about more patient choice and that’s not a bad thing.
“Local commissioning of services is going to be
clinically led by GPs so working closely with primary
care partners will be absolutely critical. One of the
things we have done is to ask all our local GPs to see
what they think of our services and how we can work
better with them.”
While Stephen clearly believes there are opportunities
to improve services, he is not complacent about the
risks. “Too rapid expansion, for example, runs the risk
of losing our focus on existing services. It has taken
many years to build the positive and distinctive culture
in Oxleas. I think it’s true that ‘culture eats strategy for
breakfast’ and you can have the greatest strategy in
Stephen Firn, Chief Executive

20 21
ANNUAL REVIEW 2012
How understanding
autism brought
peace to a family
Integrated
services
will deliver
better care
for children
Stephen Warren
I
ntegrated services for children have been the Holy
Grail for both providers and commissioners for
years. Child and adolescent mental health services
(CAMHS), community health services and local
authorities have all sought greater integration in the
belief that it would deliver better care more efficiently.
Now, in 2012, developments within Greenwich are
going some way to make this vision a reality. The
trust has recently won a tender from NHS Greenwich
to provide a new integrated children’s service in
Greenwich. This will be an extension of some existing
services currently provided by Oxleas and South
London Healthcare NHS Trust (SLHT) and also three
new specialist services for children with epilepsy,
attention deficit hyperactivity disorder (ADHD) and
a dietetics service. These services went live on 1
September and on 1 October the new trust-wide
Children and Young People’s directorate will be
formed.
Among those who have joined us from SLHT is a team
of community children’s nurses. Based at Wensley
Close, Eltham, the team will work closely with existing
services. Kate Medhurst, Team Lead, said: “All of us
are paediatric nurses and have undertaken further
training to support children and young people in the
community.”
Integrated children’s services include: community
paediatric dietetics; ADHD service; epilepsy service;
community children’s nursing; and children’s
continuing care and end of life care.
M
any families look forward to meal times
as opportunities to spend quality time
together. But, for one Blackheath family,
they could be more like a battleground before they
were referred to our services.
For Marcus, then aged 13, had undiagnosed autism.
We have chosen him for our front cover because his
family are happy for us to tell his story and want to
share their positive experience of our services.
Mum Jo takes up the story: “We didn’t know what
was wrong. So we thought he was being awkward
when he wouldn’t do as he was asked or refused to
eat his food. I was also getting calls from his teachers
every day complaining about his lack of concentration.
The breakthrough came when Marcus changed
schools, aged 13, and his new teachers noticed
unusual behaviour. His head teacher suggested that
we should consult our GP about a possible referral.”
Marcus was referred to our Community Paediatric
Service based at Wensley Close, Eltham, where he was
assessed by a total of four doctors.
Jo again: “The final consultation lasted all day and
involved all of us. This is when we found out that
Responsible for planning and assembling the new
ADHD team is CAMHS’ Consultant Child and
Adolescent Psychiatrist, Stephen Warren. Stephen
explained why Greenwich commissioners had
invited bids for the new service structure: “Health
commissioners looked at a number of things including
how to reduce visits to AE and hospital admissions.
They wanted the service to encompass the full range
of children’s health needs and the needs of their
families.”
An important element of the services sought by the
commissioners was to provide support for some
children with ADHD. According to Stephen, it is
particularly important for children with ADHD to be
seen early as this has a positive effect on outcomes:
“I hope the new service will lead to improved joint
working for all children with ADHD but those with
more complex problems will still be supported by
CAMHS or community paediatrics.”
Stephen continued: “This will be the first example of
an integrated children’s service that bridges CAMHS
and specialist children’s services and I will be working
with clinical managers and the heads of therapeutic
services within community and local health services to
develop it.”
Marcus was on the autistic spectrum. The whole
process was quite fast and we are very happy with
the support we have received. Oxleas’ staff taught us
about things like how the texture or colour of food
could upset him, how to talk to him and helped us
understand what makes him stressed. They equipped
us as a family to enable Marcus to carry on as
normal and helped us make his teachers aware of his
condition. I have put a chart on his wall showing his
daily activities and his teachers have adapted the way
they speak to him so he feels comfortable. We are
less stressed as a family and meal times are much
calmer. He’s 15 now, getting on fine and doing very
well at school.
“Marcus has been discharged and thanks to the
support we have received, we are managing his
condition at home. But we know that we can always
contact Oxleas if we need help.”
Our children’s services, including community
paediatrics, will be joining our child and adolescent
mental health services (CAMHS) in a new Children
and Young People’s directorate from 1 October
(see page 23).

ANNUAL REVIEW 2012
New directorate structure explained
Adult Complex
Needs and
Recovery Services
Adult Acute
Mental Health
Services
Children and
Young People’s
Services
Adult Community
Health Services
Older People
Mental Health
Services
Forensic and
Prison Services
A wonderful
opportunity for
children’s services
T
he man tasked with making Oxleas new
Children and Young People’s directorate a reality
is no stranger to children’s services. Stephen
Whitmore began his working life as a social worker
quickly specialising in working with children and, when
he joined us in 2003, it was as Director, Child and
Adolescent Mental Health Services (CAMHS) and Adult
Learning Disability Services.
In his new role as Service Director, Children and Young
People’s Services, Stephen will play a central role in
creating and establishing the new directorate. It will,
for the first time, bring together CAMHS services and
children’s services that were previously within Bexley
and Greenwich community health services.
Stephen said that the new structure will help us
to promote the integration of mental health and
community health services and improve care for
children and families: “It will provide children and
families with one logical place to go for their support
and will make their involvement with services more
straightforward. It will also clarify who is responsible
for care and make it easier for referrals to be made
and for partner organisations to access the service.
A substantial minority of children and young people
need two or more separate (mental and community
health) services and it has been hard for them to find
their way through the system. At present, it can be
frustrating for families to find that their care is not
coordinated and have to make multiple appointments
so we are aiming to make access to services a more
joined up experience. For example, by having different
clinicians together in one place, we will reduce the
need for multiple visits.”
F
rom 1 October 2012 we will be adopting a new structure to the way in which our services are managed.
The new structure outlined below is designed to improve patient care and efficiency however the changes
are management based and will not affect the services that people receive.
In April 2011 we moved our adult and older adult mental health services into directorates based on specialities
rather than boroughs. We are carrying out a similar process with community health services and the changes will
see all services for children and young people in one directorate, adult community health services in another and
adult learning disability services joining the Adult Complex Needs and Recovery directorate.
Stephen Whitmore
In a difficult economic climate, the new structure also
aims to achieve savings through greater efficiencies in
service delivery and management costs while at the
same time maintaining and continuing to improve the
quality of service.
While the people that children and families see will
not change, the places where they see them may.
Stephen again: “We are looking to bring together
services where possible in centres which will reduce
the numbers of places families have to travel to. Joint
working with our partners will mean that these places
may include, for example, schools and children’s
centres. Key to the whole process however will be
providing as much continuity as possible. I think that
the new directorate will be a wonderful opportunity
to see how we can use our resources in new and
different ways for the benefit of children and
young people.”
• Greenwich Time To Talk
• Liaison and intake teams
• Short term intervention teams
• Adult inpatient wards
Trevor Eldridge, Director
Dr Anthony Akenzua,
Clinical Director
• Bracton Centre Medium
Secure Hospital
• Bracton Community Team
• Specialist physical and mental
health services in Kent prisons
John Enser, Director
Dr Jackie Craissati, Clinical Director
• Unscheduled care services
• Long Term Conditions
• Planned care
Jane Wells, Director
Suzy Taylor, Clinical Director
• Inpatient wards
• Community teams
• Day and memory services
Estelle Frost, Director
Dr Adrian Treloar, Clinical Director
• Child and adolescent mental
health services (CAMHS)
• Specialist community
health services
• Universal community
health services
• Therapies
• Services for adopted and
looked after children
Stephen Whitmore, Director
Dr Joanna Sales, Clinical Director
• Adult Learning Disability
Services (ALD)
• Recovery teams
• Early intervention services
• Assertive outreach teams
• Community rehabilitation
services
• Inpatient rehabilitation units
• Horizon House
Iain Dimond, Director
Dr Jonathan West, Clinical Director
Lorraine Regan, Associate Director
Clinical Director, ALD Services

24 25
ANNUAL REVIEW 2012
Meeting the physical
health needs of older
men in prison
L
ast December, we began providing primary
healthcare services in Her Majesty’s Prison (HMP),
Maidstone, through a new organisation, the
Kent Healthcare Consortium. Physical health services
are provided by a small team based permanently in
the prison while mental health services are delivered
by a prison in-reach team. A significant challenge for
the team in HMP Maidstone is meeting the physical
health needs of older men, an often forgotten group
in prisons.
HMP Maidstone is a Category ‘C’ men’s Training
Prison. Around 60% of its residents are sex offenders,
the remainder are foreign nationals, amounting to 646
in total. The prison population has an unusually high
average age. Of the 646 offenders, 365 are over 40,
190 are over 50 and some of the 91 patients over 60
are in their eighties. Many of the offenders participate
in work related training schemes including horticulture,
and the prison boasts lovingly tended and beautiful
gardens plus an organic fruit and veg plot.
Clinical Nurse Manager Ian Bicker heads a team
comprising two nurses, a healthcare assistant and a
pharmacy technician who together coordinate a full
primary healthcare service. Ian pointed out that the
prison environment can adversely affect offenders’
health: “You can add about five years to prisoners’
real ages, which means we have to screen people
much earlier. Because of this, and a generally older
population, we have a disproportionate amount of
people with chronic diseases such as asthma, chronic
obstructive pulmonary disease (COPD) and cardiac
problems.”
The team is overseen by Head of Healthcare, Steve
Norman, who also looks after East Sutton Park
women’s open prison and Blantyre House men’s
resettlement prison. Steve said that the biggest unmet
need in the prison is social care for older men: “There
is currently no external provision for social care in the
prison and we have lots of problems with mobility,
washing and dressing that need to be addressed. We
have mobility scooters and walking frames but there
is still a need for cell adaptations and special beds for
the disabled, for example.”
Older and disabled patients may have difficulty in
visiting the prison’s healthcare centre and Healthcare
Assistant Donna Godbold plays a key role in ensuring
that this group’s needs are met: “I try to visit prisoners
on the wings every day to see if they have any issues.
For example, I check if they are eating and drinking
properly and if they have problems with incontinence
or their hearing aids. I also assess what equipment
they may need, such as walking aids, handrails, or
toilet raisers (a commode seat with handles) and
report back to Steve Norman. I check if they are
diabetic and if so we monitor their blood levels daily.
Some older men tend to lie in bed, so I encourage
them to get up, have a full wash and walk about.
I also get lists of the medications they need as many
wouldn’t know how to request them otherwise.
If they need other care I can put them on the dentist
or GP’s lists, for example. Sometimes I just chat to
them in their cells, which is actually a very good way
of keeping tabs on things. I really love my job, but
there are challenges. For example, older men can have
difficulty keeping their cells clean and making their
beds. I think we need greater links with social care
to address issues like these.”
Steve has already taken steps to address the health
problems caused by COPD. This is a chronic condition
affecting the lungs, often of people who smoke or
have smoked for a long time. Nurse Nina Turner is a
specialist in COPD and joined the team in May this
year. She has been busy setting up a programme of
pulmonary rehabilitation (PR), which she says can
significantly improve the quality of life of people with
COPD: “We have a spirometer machine which we are
using to screen people. It tells us if they have COPD
and, if so, how severe it is. We have identified 12 cases
already but there will be many more. The PR treatment
programme uses a combination of gentle exercises
and education sessions and the aim is to run sessions
twice a week for seven weeks. All the equipment we
need is in the prison gym and we are really excited
that this will be the first prison in the country to run
a PR programme.”
Nina has been working closely with Helen Jefford,
PR lead in our Greenwich Community Health Services,
to set up the programme, which they hope to begin
shortly. Nina again: “We hope in time that people will
come here from other prisons for the programme,
returning to their own prisons after seven weeks with
improved long term health.”
Left to right: Nina Turner, Steve Norman, Donna Godbold and Louisa Dockery
Pharmacy Technician Louisa Dockery has also been
doing her bit to improve the health of older smokers
in the prison – by encouraging them to quit. Over the
last three years she has had remarkable success with
her smoking cessation clinics, having been awarded
certificates in 2010 and 2011 for the most quitters in
any prison. (Figures for 2012 are not out yet.) Louisa
said: “I design a personal programme for each person,
and explain how quitting can have health benefits
such as lower blood pressure and increased fitness.”

adolescent mental health (CAMHS) services. I’m also optimistic that this integration
will benefit care pathways for common conditions such as autism and attention
deficit hyperactivity disorder (ADHD) and support families and carers of children
who also have mental illness.
How do you think information on medication for service users and carers can
be improved?
Many of our clinicians have worked tirelessly over recent years to improve our
provision of information to patients. However, the recent National Patient Survey,
of people who have used community mental health services, suggests that we still
do not give enough information about medication. To address this, I am leading a
programme of communications which will include leaflets, posters and information
on our website promoting information about medication. We will also distribute
note pads among patients to write down questions they may want to ask about
medication. We are saying to doctors that every time they prescribe medication,
or see someone who is on medication, they should ask questions about side-
effects and check patients’ understanding about their medication. To back this up,
we are making sure that all clinics, teams and directorates have access to routine
information about commonly used medication. And lastly, we are reminding
colleagues that they can call the pharmacy helpline for advice or run clinics or
groups with the help of the pharmacy where service users can come and ask
questions about medication.
Why is the Quality Report important and why should people
read it?
The Quality Report gives an account of how we’ve done
against the priorities we’ve set ourselves as well as
those set by external organisations like Monitor, the
foundation trust regulator, our commissioners or our
CQUIN targets. It also gives members of the public
the opportunity to see how we are doing compared
to other trusts and what people who use our services
think of us. It’s an honest account that sets out areas
of concern as well as our achievements and reports
how we are doing in those areas and where we need
to improve.
We have included articles about many of the
items included in the Quality Report in this
Review. You can read the full Quality Report on
our website at www.oxleas.nhs.uk/ar
ANNUAL REVIEW 2012
Keeping quality
at the top of
the agenda
W
hat have your priorities been over the
last year?
As lead for quality, my main priorities
have been to try to embed quality structures in our
organisation and ensure that all staff embrace a
process of continuous improvement. For example, to
make sure that clinicians are aware of feedback from
patients and to find the right way both to measure
how our services are performing and put in place
solutions where necessary.
Another important area has been our Commissioning
for Quality and Innovation (CQUIN) targets introduced
by the Department of Health. Last year 1.5% of our
income was dependent on meeting our CQUINs and
this year (to the end of March 2013) it will be 2.5%
This funding helps us to improve practice so a priority
has been to put in place systems to help us meet the
targets and to ensure that staff know what they are.
What were your personal highlights from last year?
Moving into the community health arena has been
very exciting. Our focus on improving the physical
health of mental health patients and reducing the use
of antipsychotic medication for dementia sufferers, for
example, will mean that in coming years we will see a
reduction in the mortality rate in these groups.
In my role as Medical Director, I am responsible for
the revalidation of doctors – the process whereby the
General Medical Council confirms the continuation
of a doctor’s licence to practice in the UK. I’ve taken
great satisfaction from the work we have done to
develop SARD JV - which stands for Strengthened
Appraisal Revalidation Database Joint Venture. This
helps us to track appraisals and support revalidation.
We own a majority 51% share in the SARD JV
company and plan to sell this high-tech system to
other health organisations with profits going back
into patient services.
How has your role been affected by community health
services joining us?
It’s been a steep learning curve. Firstly to understand
how community health services (CHS) function and
then how to monitor quality of care in order to
prioritise areas for quality improvement.
There is no doubt that there are huge gains to be
realised from teams working together. For example,
CHS staff work on long term physical health
conditions and if they can gain a basic understanding
of mental health conditions like depression, they can
flag suspected cases to GPs. Similarly, support from
CHS staff can help us improve the physical health of
mental health patients. I’m hopeful that the creation
of a new directorate for children and young people
will bring together children’s services and child and
Dr Ify Okocha
Medical Director

ANNUAL REVIEW 2012
CQC visits
trust sites
Clozapine testing
services are going
trust wide
A
pilot scheme to see if we could provide single
point of care testing for patients on the
antipsychotic drug Clozapine has been so
successful that it is being rolled out across the trust.
Our first Clozapine clinic was launched in November
2011 at the Bexleyheath Centre where it runs every
Tuesday. It has revolutionised the way that patients
who are prescribed Clozapine receive their medication
by testing their blood, dispensing medication if safe
to do so and checking their general health - all in
one visit.
The pilot scheme was a joint initiative between the
Bexley Recovery Team and the Pharmacy and the first
of its kind in Oxleas. Julia Ives, Practice Development
Nurse, was one of the project leads. She explained
that the new service is thanks to one very clever piece
of kit: “A blood sample is taken from each patient and
this is instantly tested by the blood analysing machine.
The blood tests are essential as they are required
to make sure there is no abnormality of the blood
cell count, which ensures that Clozapine is safe to
be given.”
Julia, whose groundbreaking work on the scheme
was recognised by her being named Nurse of the Year
2012 at our Annual Nursing Conference, undertook
an evaluation of the pilot which has led to an
extension of the service. A Greenwich twice weekly
I
n January the Care Quality Commission (CQC),
the independent regulator of health and adult
social care in England, published two reports on
services provided by Oxleas. These were Atlas House,
a specialist treatment and assessment unit for adults
with learning disabilities and challenging behaviour,
and the Bracton Community Psychiatric Nursing Team,
who offer an in-reach service in Kent prisons
Both reviews concluded that Oxleas met all essential
standards and no concerns were identified.
Atlas House was part of a targeted programme of
150 unannounced inspections by the CQC of hospitals
and care homes that care for people with learning
disabilities.
The aim of the programme was to look at whether
people experience safe and appropriate care,
treatment and support and whether they are
protected from abuse.
At the visit in October 2011, the CQC talked at length
to patients, carers and staff and reviewed paperwork
and facilities. The findings show that patients and their
relatives feel safe and cared for using Atlas House and
have a very positive relationship with staff.
Sharon Rodrigues, Specialist Support Worker, speech
and language therapy, was one of the Atlas House
staff interviewed by CQC inspectors. Sharon says that
evidencing everything is key: “For example,
I was asked how we support people with a learning
disability to make decisions about their care and
treatment. I evidenced this by showing them accessible
care plans and patient satisfaction questionnaires
completed during patient meetings.”
In its report on Atlas House, the CQC said: “One
person told us ‘The staff support me well and discuss
things with me. I understand my care plan because
staff sat down and did it with me. They help me
with my medication and diabetes and get me special
diabetic biscuits and chocolate.’
service was launched at The Heights, Charlton, in May
and a new monthly service run by DISH (Dispersed
Intensive Supported Housing) shares the machine at
the Bexleyheath Centre. There are plans to open two
more services in Bromley in the Autumn at Yeoman
House, Penge and Carlton Parade, Orpington.
The great advantage of the service for patients is that
the whole process has been speeded up and made
more comfortable. Julia again: “In the past, patients
had to go to their local pathology service for a blood
test. Results took 24 hours and these were sent to the
Pharmacy and then to us. As tests need to be carried
out at intervals of two to four weeks, this could be
fairly onerous for patients. Now all this is done in
one short visit. The service is also delivered in local
surroundings that are familiar to the patients by staff
that they know, so it’s far more responsive to their
needs.“
When patients have been tested they proceed to an
adjoining room for health checks. Julia believes this
all adds up to an improved, more joined up service:
“Patients are weighed, their blood pressure is taken
and any side-effects are monitored. This is a more
coherent way of working which improves the patient
experience and delivers time saving efficiencies.”
“We saw that another person had a pictorial weekly
plan on their wall that staff had made for them. They
told us that this reminded them of the activities they
were doing each week.”
The CQC report on the Bracton Community Psychiatric
Nursing Team found that each of the four people
they spoke to were treated with respect by mental
health service professionals, that their privacy was
acknowledged and that they were always seen in
private.
The CQC has also visited our forensic services and
published a report on the Bracton Centre, our medium
secure unit, in August 2011 following a visit the
previous month. The review concluded that the centre
met all essential standards and no concerns were
identified. In the last 18 months, the CQC has visited
four of our nine Kent prisons’ in-reach services. They
were very positive about what they saw and found
them all to be fully compliant.
A music group at Atlas House

ANNUAL REVIEW 2012
I
t’s official. Oxleas is the best place in the NHS to
work across the whole of London and the South
of England and the best NHS trust that provides
mental health and learning disability services in the
country, according to the results of the national staff
survey which were published in March by the Care
Quality Commission (CQC).
The CQC rate the responses across 38 categories
and in 28 of these the trust’s scores were in the top
20% of NHS trusts. Seven of these were the best score
nationally, including staff satisfaction with quality of
patient care and their ability to contribute
to improvements.
But what lies behind these results?
Head of Employee Relations and Staff Engagement,
Lynda Town, believes a key element of this success
is the way our values are displayed right from the
top starting with our Board of Directors: “They are
cascaded down through senior management to
staff. Other trusts may have similar staff engagement
policies, but they are not seeing the same
staff survey results. It’s how people act and behave on
a day to day basis that really makes the difference.”
Lynda works closely on staff engagement with
Head of Partnership Working Wendy Lyon. Together
they carry out regular visits to our services around
the trust. Wendy says this is all about engaging staff:
“We talk informally to the staff. We may ask, for
example, about morale, team communications or
what local forums they have. Another part of the
staff engagement work is holding focus groups with
staff and reporting findings back to senior managers
including directors. This helps to ensure that staff
have a voice.”
Wendy points out that the excellent survey results
have happened against a background of new staff
joining us from community health and prison services
and changes in the wider NHS: “We have had
different working cultures joining us and when we
meet new staff we explain that our culture is one of
partnership and engagement between management
and staff, rather than ‘them and us.’ We invite new
staff to meetings and they are often surprised to
hear about my role of partnership working and how
this actually works in practice. It’s a stand-alone role,
reporting to the Chief Executive, so there is no conflict
with line managers and I can remain unbiased and act
for all staff.”
Lynda adds that our culture is reflected in our
excellent reputation with other health organisations:
“Before joining Oxleas, staff in Greenwich
Community Health Services were consulted about
which organisation they would like to work for and
70% said they would prefer to work for us.
“The strength of this culture is also demonstrated
by how we treat staff in challenging times. People
are more able to accept difficult decisions if they
are involved in the decision making process and
understand why changes are necessary. We have to
be honest with staff, especially where savings are
needed, and acknowledge that changes will happen
and that they will affect all of us. Where problems
arise there needs to be honest and open conversation
with staff that is based on mutual trust and respect.
At Oxleas we have worked hard over the years to
achieve just that.”
Managing change is something that Fiona
Starkey-Norman, Bexley Service Manager,
Complex Needs and Recovery, knows all about:
“It’s been a hard year. We’ve had to close
Oakwood House, a home in Bexley for people with
mental health problems. And we’ve reconfigured
Horizon House, our Bromley Clubhouse and the
Community Team in Greenwich.
But we’ve helped staff to understand why we’re doing
this, that there are clear and logical reasons for our
decisions. We’ve spent a lot of time communicating
with staff, not by email, but face-to-face. I think the
staff survey results are impressive when you think
that tough decisions may directly affect people
with mortgages and children. That really tells you
something. Supporting staff in difficult times is
not about platitudes, but about practical help and
we’ve had open house meetings and an open door
policy where people can come for help and advice.
For example, we have helped staff with interview
techniques and filling in application forms.”
Having the opportunity and the freedom to innovate
also makes a difference to overall staff survey results
and this is something that our staff rate the trust
highly on. Fiona points to the recently introduced
Clozapine clinics (see page 29) as a good example
of this: “The Clozapine clinics enabling people
prescribed with this medication to get same day blood
tests and health checks close to where they live have
been great for patients and staff. The really good
outcomes from this project have been achieved by the
input, ideas and enthusiasm of a wide range of staff.”
Lynda Town
Fiona Starkey-Norman
Wendy Lyon
What does
our best
ever staff
survey
say about
Oxleas?

ANNUAL REVIEW 2012
V2W helps Alex back
into work
A
lex Field thought she would never work
again. But after taking part in our Volunteer
to Work (V2W) scheme, she is back in paid
employment.
The V2W scheme was launched by Social Inclusion
Project Manager, Japleen Kaur, in January 2010 to
support people who use our mental health services
back into paid work by volunteering for the trust.
Since then, 160 people have joined the scheme, of
which 104 are still participating. Of the 43 people
who have completed or left the scheme, 13 have
found paid work. Such is its popularity, there is a
waiting list to join.
The long term goal of the scheme is to help the
volunteers along their journey into paid employment,
so once they have completed three months of their
placement they become eligible for a reference
from Oxleas.
Paid employment is exactly what was achieved by
volunteer Alex Field this July. Alex, who is in her 30s
and lives in Bromley, spent the previous nine months
as a volunteer at Green Parks House (GPH), the
borough’s mental health inpatient unit.
Alex volunteered in the Occupational Health unit at
GPH. She first found out about V2W when she was
a service user at Carlton Parade, the Orpington based
Community Mental Health Centre. Speaking in early
July, Alex, who used to have a high powered job as
a PA to the financial director at Earls Court, said:
“I used to have a personality disorder but now it is
totally under control. When I used to go to Carlton
Parade my art therapist told me about V2W.
“I decided to give it a go and here I am about to start
paid employment as a Technical Instructor with the
Day Treatment team – albeit just one day per week.
I hope I can get more paid work in future.”
The personal touch
C
ommonsense might be the best way to
describe a new way of working that has
already produced benefits for patients,
families and staff at an intermediate care unit at
Queen Mary’s Hospital Sidcup.
Introduced around a year ago at the Step up, Step
down (SUSD) unit, comfort rounds are checks carried
out every two hours by staff to see if patients need
any particular care or attention. Patients may be asked
if they want to use the toilet, if they are in pain, or
offered a drink, for example.
SUSD is a 24 bed service for adults aged over 18,
though in practice most patients are elderly. Patients
may be admitted from home (step up) for short term
nursing help, occupational therapy or physiotherapy,
or from a hospital ward (step down) where extra
nursing help or therapy is needed to ensure a safer
return home.
Comfort rounds have their origins in feedback from
patients, families and carers that suggested that
staff could be more attentive to patients’ needs. Unit
Manager at SUSD Alison Malka explains: “It was
taken for granted years ago that staff would speak
to patients, but in recent years nurses got busier than
ever and the personal touch was often lost. Comfort
rounds are a way of formalising and evidencing regular
patient contact in a standard operating procedure.
At the bottom of each bed is a form on which staff
record each comfort round. For example, if patients
requested a drink, or said they were in pain, and the
appropriate action that was taken. Information from
the forms is also stored on RiO, our electronic patient
information system.”
Alison says that comfort rounds have quickly become
accepted as the norm by patients, families and carers
and staff and that results are encouraging: “There
has been a noticeable reduction in falls and there are
fewer complaints. Because patients are seen on a
regular basis we can closely monitor them and meet
their needs before problems develop.”
Following their success in SUSD, comfort rounds are
now being introduced in other physical and mental
health units across the trust. Alison again; “It’s good
to see something that started here spreading out
through Oxleas. I hope other people get as much
benefit from comfort rounds as we have.”
In her new role Alex is helping to prepare patients
about to leave GPH. She will offer advice about how
they can integrate back into society with relevant
information and practical help. Alex again: “For
instance, I might put a pack together that could help
them pursue their hobbies or interests, including
information about groups and organisations they
might be interested in.
“If it hadn’t been for the support of the V2W team,
especially Japleen Kaur, I would have deemed myself
as unemployable. Now I have the potential for a whole
new career. The Day Treatment team here at GPH
has been fantastically supportive to me as has my line
manager Sue Carter. I would like to thank them all.”
Alex Field
Anna Ding on comfort round with Arthur Harper

34 35
ANNUAL REVIEW 2012
Communicating
through dance
is Magpie’s
bright object
P
atients and staff in our learning disability
services at our Goldie Leigh site have been
taking part in an inspiring programme that
has dance at its core.
Magpie Dance, a Bromley based charity that works
with people with learning disabilities (LD) through
the medium of dance, has been funded by the Big
Lottery Fund to deliver a total of 30 weekly sessions
at Goldie Leigh in 2012 in which patients and staff
from day and inpatient services participate equally.
Half these sessions are delivered to a group from
the Older Person’s Service and the rest to a mixed
group from Tall Trees and Atlas House, an adult
learning disability inpatient unit.
The Big Lottery Fund awards money from the National
Lottery to community groups and projects that
improve health, education and the environment.
We visited the sixth of the 15 sessions being held for
the mixed group in the hall in Tall Trees and spoke to
the Magpie Dance facilitators. Alison Ferrao started
out as a professional dancer and has worked with
Magpie Dance for the last 15 years. Her involvement
with the organisation includes working with an adult
group of people with LD who perform dance in public.
Readers who attended last year’s Annual Members’
Meeting will remember the inspiring performance
given by this group. Annie Roberts also has a dance
background and completed the Magpie Dance training
programme before joining as a facilitator. She works
with Magpie’s youth group. Both are involved in
outreach programmes like the one at Goldie Leigh.
Alison said: “We held a workshop for Atlas House
staff last year and this programme developed from
that. It’s about working with staff and patients
and helps them to develop non-verbal ways of
communicating with others. This could include eye
contact, gesture and touch.”
Musical accompaniment is by drummer Hans Ferrao
who has been a freelancer with Magpie for 12
years. Hans said: “Working with people with LD is
fascinating. They have their own sense of rhythm
and I fit sounds to their movements. Even a swaying
movement has a set number of beats per minute.”
Sessions start with a warm up exercise to ensure
there are no injuries later on. Alison and Annie use
‘props’ to help with this. These could be a large
sheet or ribbon, with everyone spaced round and
holding it. This provides structure, where to stand,
and a platform from which movement can be
coordinated and originated. Alison explained that
this helps participants to develop confidence in not
just their own movements, but in how they move
in relation to others. Annie said that they monitor
participants’ progress during sessions and record
it afterwards: “We look for things like non-verbal
communication, cooperation, dance skills in terms of
how they are progressing physically, stamina, copying
and confidence to do things by themselves. We also
look at engagement time – how long they take part
in the group activities as opposed to sitting down,
for example. It has been great to see some members
of this group who were not very engaged at first
gradually building up their involvement week by
week. The props are a good way of involving people
at first, but as the sessions progress and confidence
grows we move away from them. Our aim is to help
people be more aware of their bodies and how they
interact with others – and this is the same for staff and
patients. At the end of the session, after cool down
stretches, we encouraged the group to reflect on what
has happened, what they did and what they enjoyed.
This helps to improve communications skills and build
confidence.”

ANNUAL REVIEW 2012
In times of
change,
the role of
governor
is more
important
than
ever
R
aymond Sheehy has had a busy year. Chief
Executive Officer of Welling based mental
health charity Bridge, Raymond is also an
appointed voluntary partnership governor and last
year became Lead Governor and Deputy Chair
of the Council of Governors (COG). Somehow he
manages to combine his trust roles with a busy job
working with people with mental illness including
those using forensic services. Bridge works in close
partnership with our mental health services to support
local people and Raymond feels that he has lots to
contribute as a governor.
Raymond is passionate about the importance of
governors and firmly believes that their active
involvement can help improve our services. He said:
“Governors want to be kept abreast of developments
and changes and part of my role has been to reflect
what governors want, for example in ensuring that
service directors come to COG meetings to answer
questions. For example, the director of Nursing and
Governance has twice given presentations about
serious incidents, explaining how they are dealt
with and what action will be taken as a result. One
of my focuses as lead governor has been to ensure
that governors are kept involved throughout the
year and to make sure that recommendations are
followed through. It’s also important that information
for governors is sent out promptly, can be clearly
understood and that major issues are summarised
accurately so that we can ask better informed
questions.
“Training is also a priority and I have been involved in
the induction of new governors and also organised a
governors’ away day in May this year where we looked
at the new roles and responsibilities for governors
arising from the Health and Social Care Act (2012).
We looked at a skills audit identifying the strengths of
governors and highlighting areas for development. It’s
so important that governors are comfortable in their
role and fully skilled to discharge their responsibilities.
Examples of development include root cause analysis
training (dealing with serious incidents) and governors
attending Foundation Trust Network events around
the country to look at best practice elsewhere.”
Raymond said that service user/carer governors have
been very active over the last year ensuring that the
voice of service users and carers is heard and their
views taken forward with the trust: “Promoting the
views of service users and members is a priority and
information gathered at Borough Focus Groups held
annually in January informs Board planning.”
Raymond’s projects with the trust over the last year
have been too numerous to list, however highlights
included chairing the meeting of the Nominations
Committee that reappointed Dave Mellish as the best
person to chair the trust in a period of uncertainty and
change. He also undertook visits to police stations in
Bexley, Bromley and Greenwich and to Kent prisons
to find out first-hand how our staff are working to
improve care pathways in forensic services. He said:
“Community psychiatric nurses liaise with police
stations to see if people who are admitted are known
to mental health services and to decide what help
they need. And in Kent prisons, inpatient services also
assess people once they have been admitted. I think
this could be improved if they saw people as soon as
they arrive at the prisons. But the mental and physical
health services Oxleas run in prisons are great. Proper
screening is so important to ensure people get the
help they need.”
Looking ahead, Raymond said: “Governors will want
better information, more transparency, and to ask
more questions. They will look to the trust to continue
to make improvements and will expect their voice to
be heard. We’ve accomplished a lot this year but there
is always more we can do. One change I’d like to see
is a greater diversity of ethnic backgrounds among
governors that reflects the communities we represent.
I’d also like to see more young people getting involved
with the trust. It would also be good to see more
governors encouraging people in their constituencies
to become members and stand for governor.”
For information on becoming
a member or a governor please
see back cover.
Raymond Sheehy

38 OXLEAS NHS FOUNDATION TRUST
ANNUAL REVIEW 2012
Contact us
oxleas.nhs.uk
Patient Advice
and Liaison Service
If you require information,
support or advice, please
contact us free on:
Tel: 0800 917 7159
Trust membership
To become a member of
Oxleas NHS Foundation Trust
contact us on:
Tel: 0300 1231541
Email: foundation.trust@oxleas.nhs.uk
or join online at
www.oxleas.nhs.uk
Careers
For the latest information on vacancies
at Oxleas, please visit our website at
www.oxleas.nhs.uk
Annual Report and Accounts
Our Annual Report and Accounts including
our Quality Report are available on our
website at www.oxleas.nhs.uk
Twitter
@OxleasNHS
Facebook
www.facebook.com/OxleasNHS

Oxleas_Review_2012_website_version_1

More Related Content

Viewers also liked (17)

Similar to Oxleas_Review_2012_website_version_1 (20)

Oxleas_Review_2012_website_version_1