13/01Minutes of the Meeting Held on 28Th November 2012

Minutes of the St Helens and Knowsley Hospitals NHS Trust Board held on Wednesday 30th January 2013 in the Boardroom, Whiston Hospital

Public Board

DECLARATION OF INTERESTS

No Board member declared any interest relating to the business to be discussed at the Board meeting.

13/01Minutes of the meeting held on 28th November 2012

(a)Correct Record

Resolved: that the minutes of the meeting held on 28th November 2012 be accepted as a correct record.

(b)Matters Arising

Page 3 Performance Framework: the latest position on flu vaccination is 75.1% against a target of 75%, but encouragement of staff to take up the vaccination is continuing.

Page 4 Finance Report: PFI funding has been confirmed and money received.

Page 6 Business Case for the Development of PACS System: Ms D. McLaughlin confirmed the Trust has achieved all the necessary milestones and all relevant Trusts are signed up.

Page 6 Annual reports Clinical Audit: Mrs. C. Cooke confirmed that some of the clinical audits had not been completed in the timescale set. Timescales have been reviewed and the Clinical Audit Team has improved the reporting procedure. It was confirmed that there is no extra payment or operational pressure on the Trust, just the timescale is affected.

Page 7 Annual Reports R&D: Prof. K. Hardy confirmed that the old CLRN Board had been dissolved and a new one established. The latest benchmarking has been extremely positive for the Trust against the CLRN matrix.

Page 7 Infection Control: actions relating to antibiotic prescribing are complete and departmental audits are in hand. Prof. K. Hardy will report back to the Board in due course.

Page 8 Review of Safeguarding/Saville Allegations: Mrs. C. Cooke reported that work on children’s safeguarding is behind schedule. Mrs. Cooke has now agreed with Commissioners that the Trust will not meet the original target it had set itself but has made significant improvement in the level 2 training on safeguarding children which has now gone up to 65%. Commissioners are satisfied that the Trust is improving and next year is aiming to achieve virtually 100% compliance. Difficulty has been experienced in accessing specialised training from the Local Authority, however commissioners have now increased their efforts in support. Work is ongoing with Learning and Development about packages available on e-learning. The need to make sure that training data is accurately recorded was reiterated.

The Chaperoning Policy will go to Patient Safety Council in February. Work is still ongoing on this to ensure it is a robust document. Mrs. A-M. Stretch confirmed that all high profile visitors should be 100% chaperoned whilst on the premises.

Mrs. C. Cooke reported that work was underway to review staffing levels and that she continued to ensure Francis report recommendations were taken account of. An update would be reported at February Strategy Board and a subsequent Public Board.

13/02Knowsley Public Health Transition

Dr. Sarah McNulty, Public Health Consultant Knowsley, advised the Board on key elements of the Health and Social Care Act 2012, which affected the makeup and functions of the new Public Health system and commissioning responsibilities. Dr. McNulty updated on the Public Health transition and the role of the Health and Wellbeing Boards. The Board asked and received answers to questions throughout the presentation.

The Chairman thanked Dr. McNulty for the useful presentation.

The Chairman brought forward Dr. Francis Andrews’ report on Organ Donation as Dr. Andrews had to leave the meeting early.

13/03 Organ Donation Committee NHST(13)011

Dr. Francis Andrews, Organ Donation Lead/Assistant Medical Director and ICU Consultant, provided a summary relating to potential and actual organ donors for the Trust, during the six month period April-September 2012. The Trust has correctly identified patients for testing for brain stem death and the consent rate and actual donation rates are slightly above average.

Dr. Andrews continues to be involved with the national organ donation service, and is involved in drafting strategic documentation and presenting on this subject nationally.

By the end of April national figures will be available for the last 5 years. Organ donation will have reached 48% throughout the UK against a target of 50%. As a result of ongoing work, the number of patients on the waiting list for transplantation is now dropping. NHSBT have a 5 year strategy to see how this can be further improved.

In answer to a query, Dr. Andrews confirmed that organs are matched for recipients on a national rather than local basis.

The Board discussed the national criteria for organ donation. Dr. Andrews explained that there is a problem with thoracic transplantation in the UK compared to Europe and the US and this anomaly is being reviewed.

13/04Patient Story

Deborah Beck, Dissection Nurse Specialist, described how the new outreach service works to enable patients with stage 3 malignant melanomas to receive follow up treatment and be monitored at home. Mr. Bryan Capstick, a patient who had received this service, informed the Board of his personal experience, highlighting the benefits for patients of treatment at home, 24/7 contact with a named member of staff and the positive effect for families of the patient.

Mr. Capstick was asked if there were any negatives and he noted that whilst the outreach service was excellent with the one point of contact, he had six different people visit him for dressings from the Community and it would be better to have had the outreach team do this.

Issues about the availability of the Outreach nurse, numbers of patients which can be accommodated at any one time on the Outreach service and considerations about the expansion/emulation of the service into other areas were discussed and a review of possible areas where this could be done was suggested, ensuring that the Informatics Team is part of any such proposals. The positive impact on patients was noted. The necessity to support outreach staff and for them to manage their time was noted and it all should be costed appropriately. Accessibility is really important to improving the patient experience. Ms Beck was credited for her excellent work and input.

Mr. Capstick noted that his overall impression of the hospital was very positive, such that he had previously written to the Chief Executive to express this.

The benefit of patient comments within the Patient Storey item on the Board was noted and consideration will be given to this for future stores, e.g. the use of DVDs.

The Chairman thanked Ms Beck and Mr. Capstick for the informative presentation and discussion.

OPERATIONAL PERFORMANCE

13/05Performance Report NHST(13)001

Ms D. McLaughlin noted that the Performance Report had been discussed in detail in the preceding Finance Committee but noted some key points;

-infection control: there have been 7 cases of MRSA bacteraemia and action on MRSA has been discussed at previous Boards.

-there is a comprehensive action plan for quarter 1 for A&E which has been managed. It has been agreed that Minor Injuries can now be included in the figures which means the Trust is achieving the 95% target year to date.

-mixed sex accommodation has been added to the dashboard.

The Board discussed the report. With regards to infection control, external reviews have confirmed there is nothing further that the Trust is aware of that can be done additionally. Mrs. C. Cooke emphasised the importance of ensuring the Trust makes continuous efforts as any lapse in practice can lead to MRSA bacteraemia.

The Board discussed the issues. Mrs. Cooke confirmed that significant changes had been made to the process for RCA and issues for improvement have been identified through the process. So much work has been done to eliminate the cause of contamination and to follow practice that there is a high degree of assurance of the Trust’s processes, with external review confirming that.

Activity has been much higher than planned and both operational and financial pressures have caused problems. The Trust is now able to plan for next year, with near year’s CIP being a particularly important consequence.

Mrs. A-M. Stretch confirmed that sickness had been discussed in the preceding Finance Committee. There remains room for improvement. Work has been done on the sickness policy framework to support attendance management and focus is now turning to concentrate on the whole staff experience and support of staff. Health Works and Wellbeing is an later item on the agenda.

13/06Finance Report NHST(13)002

Mr. D. Finn noted the key headlines from the Finance Report and explained that the report had been overtaken by recent negotiations with Commissioners and the SHA. It has been agreed, working within the local parameters, for the Trust to outturn less surplus which helps the wider health care community.

i)NHS Planning Guidance 13/14: Summary Paper NHST(13)003

Mr. Finn took the Board through the paper which is still work in progress. Contractual negotiations will influence this. There are two key documents for next year which will feed into the process from the National Commissioning Board and the NTDA.

Mr. Finn highlighted issues relating to day work as a theme particularly in diagnostics, emergency care, working towards more transparency and more choice, emphasis on real time patient feedback, data quality, high standards and safety care (Francis Report).

Mr. Finn reported that the NTDA has taken over SHA/DoH and Appointments Commission role. They will oversee Trusts going through FT application and provide systems of assurance and quality.

The Trust has to provide its financial and work force developments and priorities for the next year to NTDA. The Trust is focussed on improving quality, increasing feedback from patients, opportunities for IT, support and development of staff, and FT status.

The Trust has been asked to identify 5 specific areas of improvement from the following after benchmarking:

1.Infection control zero tolerance for MRSA.

2.Improving on C.difficile target.

3.Readmission rates.

4.A&E Performance.

5.Day case rate as a priority.

Areas where the TDA could help are with networking with other aspirant FTs, best in class information, leadership and developmental programmes.

Further details will be provide to the Strategy Board in February.

The Board discussed planning guidance issues including intensive support schemes and community issues.

13/07FT Pipeline Self-Certification: Single Operating Model NHST(13)004

Mr. D. Finn noted a slight technical change in the form. VTE will be added into the submission The Trust is now reporting amber/red with a high probability of escalation to red due to performance of C.difficile, MRSA and A&E.

The phrase ‘di minimis’ was queried and discussed. Possible options of its meaning were muted. It was agreed the Executive would discuss outside the meeting what this actually means in this context

Board statements: Mr. D. Finn explained the issues relating to information governance and work is being done to rectify that.

Mr. D. Mahoney asked how infection control and urgent care issues were being dealt with. Mrs. C. Cooke explained that in relation to C.difficile, the Trust has taken actions in strengthening its infection control practices across the board, e.g. ANTT practice and hand hygiene and is constantly trying to make changes to general care and treatment across the hospital and health economy.

With regards to A&E, there is an Intensive Support Team urgent care programme ongoing. This will be reported on in more detail to the next meeting to give a level of assurance. Prof. K. Hardy said that major infrastructural changes across the health economy are needed on urgent care and this is being progressed.

Work was advancing in plans for 7 day consultant cover for wards and assessment units – early findings were promising on the clinical benefits.

The SOM was approved by the Board for submission.

13/08Informatics report NHST(13)005

Mr. N. Darvill reported that the Medway Maternity system had been successfully deployed on schedule for booking and antenatal appointments, with phase 2 due to go live in February 2013 for birth and postnatal records. This is a significant benefit to the Department.

The new upgrade of Ward Order Comms was introduced in 6 existing ward areas, with a roll out plan for the remaining in-patient wards. There have been no further system reliability issues.

Deployment of discharge summaries via the ICE system across all wards in the Trust is on track. E-discharge is now going very well in the wards with very positive feedback from users. It is planned to deliver the e-discharge summaries electronically to GP practices by end March 2013. Outpatient attendance letters are now sent electronically to GP practices, as are A&E CASCARDS. Mr. Darvill confirmed that electronic prescribing has been included in the Informatics Strategy for the forthcoming financial year.

Prof. K. Hardy noted that the new Clinical IT Group is having a beneficial impact. He said there is no process for embedding of systems once installed and Clinical Directors are being brought to bear on this.

Mr. Darvill highlighted an issue with GPs requesting paper based discharge summaries during the changeover period. Prof. Hardy and Mrs. C. Cooke have raised this with the CCGs.

Mr. Darvill noted some concern by St. Helens CCG with the issuing electronically of CAS CARDS with an electronic message. The Trust is meeting its CQUIN target on this.

With regard to Outpatient attendance letters, this is now at 80% sent within 14 days which is good, but with some opportunity for improvement.

Mr. Darvill highlighted the charts containing the performance information on calls answers and faults logged.

The Chairmen said we have achieved success with current strategy and it looks positive for the future. Mr. N. Darvill understands clinical priorities in terms of IT and to prioritise the improvement in safety through the Clinical IT Committee. Prof. K. Hardy will present the Clinical Strategy to the Strategy Board in February.

Mr. L. Howell noted the importance of CQUINs and their dependency on IT projects. Mr. Darvill said we now have clinical leads for projects who can interpret on clinical/safety impacts etc. and he will report on progress to a future Board.

Mr. Darvill highlighted 3 priorities for next year’s plan form the IT strategy:

1.Electronic prescribing - to computerise drugs prescribing.

2.Fully focused on patient safety with early warning calculations, clinical observations captured by nursing staff in real time using an electronic system with automatic escalation.

3.From a user perspective, a piece of software to wrap all system access efficiently into one view whilst embracing patient context and single sign-on.

13/09Reports from Committees

i)Audit Committee NHST(13)006

Ms S. Rai, Chair of the Audit Committee noted key points from the meeting held on 31st January 2013, including an update on the latest position with regard to the Trust’s IG Toolkit performance, changes in the Trust’s Governance structure, an update on the forthcoming audit of the Trust’s 2012/13 accounts, and an MIAA report on audits recently finalised.

ii)FT Programme Board NHST(13)007

Mr. L. Howell, Chair of the FT Programme Board, noted key points from the meeting held on 11th December 2012 and 17th January 2013. Specific issues raised were:

1. Training for Non-Executive Directors – following the disbanding of the Appointments Commission, there is a gap in NED induction and other training and Mrs. A-M. Stretch will raise this with the TDA.

2.Resource to manage the process: Mr. D. Finn is progressing this.

iii)Governance Board NHST(13)008

Mr. L. Howell, Chair of the Trust Governance Board, noted key points from the meeting held on 23rd January 2013, including a radiology complaint update, transfusion patient incident update, intranet search engine update, feedback & minutes from Councils and proposals for revision of the governance arrangements. The title of the Committee will change to Quality Committee from March.

iv)Finance Committee NHST(13)009

Mr. D. Mahony, Chair of the Finance Committee noted key points from the meeting held on 28th November 2012, including the Chief Executive’s update, performance and finance reports, Integrated Performance Report and St. Helens Income and Expenditure review.

v)HIS Board NHST(13)010

Mr. R. Swainson, Chair of the HIS Board noted key points from the meetings held on 11th December 2012 and 8th January 2013 including finance and performance update, programme highlights and shared services update.

The Board received, noted and commented on the reports.

CLINICAL QUALITY

13/10Patient Safety NHST(13)012

Mrs. C. Cooke presented the half yearly report on patient safety incidents and initiatives to inform the Board of developments in managing patient safety and action, progress and improvement in relation to incident analysis from April to September 2012. She noted the positive increase in reporting from the Datix system, particularly on low and no harm incidents, giving assurance that patient safety mechanisms are effective. There has been improvement in pressure ulcer management. As part of the Trust’s monitoring of patient safety incidents, all grade 3 and 4 pressure ulcers are reported as serious incidents to the Commissioner via the Strategic Executive Information System. Investigations also showed that there had been some pressure ulcers being classified and reported inappropriately. The Trust's performance figures have now been adjusted to reflect this.