Agenda Item 4.1

ROYAL UNITED HOSPITAL BATH NHS TRUST

MINUTES OF THE PUBLIC TRUST BOARD MEETING

WEDNESDAY, 2 JULY 2008

Royal United Hospital, Bath Education Centre

Present:
Voting Directors
Moira Brennan, Non Executive Director
James Carine, Chairman
Michael Earp, Non Executive Director
Diane Fuller, Director of Patient Care Delivery
Jonathan LLoyd, Non Executive Director
Catherine Phillips, Director of Finance
James Scott, Chief Executive
Francesca Thompson, Director of Nursing
Peter Tomkins, Non Executive Director
Lynn Vaughan, Director of Human Resources
John Waldron, Medical Director
Stephen Wheeler, Non Executive Director
Non-Voting Directors
Brigid Musselwhite, Director of Planning & Strategic Development, Deputy Chief Executive
Lynn Vaughan, Director of Human Resources / In Attendance:
Alison Spears, Trust Board Secretary
Jill Tompkins, Chair of Patient and Public Involvement Forum
Jan Lynn, Assistant Director of Nursing, Surgery; Alison Tucker, Matron; Gill Messer, Matron; Julie Stone, Clinical Services Manager – Item 13 only which was taken first.
1 member of the public (left during Item 7.1)

BD/08/07/01 – Written questions submitted in advance by the Public

None received

BD/08/07/02 – Apologies for absence

None

BD/08/07/03 – Declaration of Board Member Interests

None

BD/08/07/04 – Minutes of Public Trust Board Meeting 16 June 2008

The minutes were approved and the Chairman signed them as a true record of the meeting.

BD/08/06/05 – Action List and Matters Arising

Action 3: The Chief Executive met with the Chief Executive of BANES PCT, the discussions are continuing but are fairly positive at this point in time. Can be removed from action list.

Action 5: Will be addressed at next Clinical Governance Committee meeting in August.

Action 6: This has been discussed and reviewed, action can be removed from the list.

Action 7: This is complete and Annual Report has been submitted, action can be removed from action list.

Action 8: This is complete and Annual Report has been submitted, action can be removed from action list.

BD/08/07/06 – Chairman’s Report

The Chairman presented his report.

The Board noted the Chairman’s report.

BD/08/07/07 – Reports from Non Executive Directors’

The Non Executive Directors gave verbal updates on the key activities and meetings that they had attended since the last Board meeting.

The Board noted the Non Executive Directors’ Reports

BD/08/07/08 – Chief Executive’s Report

The Chief Executive presented his paper and the Board noted that:

  • The Patient Safety First campaign for England had been launched at the NHS Confederation Conference in June with a major launch in September. A fuller report would be available in September outlining what this campaign means.
  • The Trust was visited by the Strategic Health Authority as part of its review of Stroke Services. The visiting team were very complimentary about the services. A report will be produced which will make a number of recommendations. The Trust successfully thrombolysed its first stroke patient.
  • The Trust is holding a number of events to celebrate the 60th Anniversary of the NHS. The Chief Executive would be opening a public exhibition entitled “History and Innovation” this afternoon. The Communications Team were thanked for their work on putting together the events.
  • Lord Darzi had published a number of documents over the last week:
  • High Quality Care for All
  • Draft Constitution; and
  • High Quality Workforce.

In addition a consultation document had been published “Improving Health: Ambitions for the South West”. The Board was asked to provide any comments which they would like added to the response to the Trust Board Secretary.

Action: All

Some time would be put aside at the Development Board to discuss this document and how this might change the Trust’s strategic direction. It was suggested that the Director of Public Health be approached to give an external perspective.

The Board noted the Chief Executive’s Report and supported the Trust’s involvement in the Patient Safety First Campaign

BD/08/07/09 – Assurance Committee Updates

(i) Non-Clinical Risk Committee – Update Paper

The Chair of the Non-Clinical Risk Committee presented the report and asked the Board to note:

  • Work was taking place to consolidate ways of working and to ensure that the Committee had the correct committees and groups reporting into it and to help all understand their role in providing the required assurance.

(ii) Audit Committee

The Chair of the Audit Committee presented the report.

The Board noted Assurance Committee reports.

BD/08/07/10 – Performance Monitoring

(i) Trust Key Performance Indicators

The Chief Executive presented the paper and the Board noted:

  • This was the greenest scorecard that had been presented this year. The scorecard was now very comprehensive and the breakthrough goals had been added. Some work was needed to clarify goals.
  • One primary cause death from Clostridium Difficile had been recorded. However, the root cause analysis shows that this was not the primary cause of death. The Trust is investigating whether it can amend the death certificate.
  • Mortality rates normally operate in the low 90’s and work is taking place to understand the rise in this target. It should be noted that this is still within national normal range.
  • The target for call handling had fallen. The new Divisional Manager for Medicine will be visiting Wessex Water to learn from their call centre success.
  • GP referral target may move to a three month rolling target to ensure best data and accurate reflection of this target.

The Board noted the Trust Key Performance Indicators Report

(ii) Performance Report

The Director Patient Care Delivery presented the report and the Board noted:

  • Emergency Access 4 Hour target – improvement is resilient and the Trust delivered 98% for the whole quarter (RUH only). There has been an increase in A&E attendance and the Trust is working with the local community to understand this.
  • 18 weeks –The Trust is confident that it will achieve the South West SHA Early Achiever June 18 Week Target. The Trust has been above trajectory for non-admitted patients since January, currently at 98.9%; and for admitted patients the Trust has been at or above trajectory since January, currently at 91.9%
  • There has been improvement in the delayed transfer of care which hit the 3.5% target. The last two weeks has seen this figure maintained at below 4%.
  • There is still no update on the 62 day Cancer waiting times and this will come to the September Trust Board.

There was some discussion around the way the Trust measured its productivity. It was noted that the Trust used NHS productivity indicators, reference costing and benchmarking. However you could never compare like with like. It was also noted that many improvements to patient care and experience actually decrease productivity. The Trust focuses on outcomes not outputs. It was noted that Productive Ward and Service Line Management were both intended to increase productivity.

The Director of Nursing updated the Board on infection control.

  • MRSA–For June there had been one pre 48 hours which was unpreventable and one post 48 hours. The post 48 hour case could have been prevented and the root cause analysis had indicated gaps in screening.

The NICU colonisation had been concluded and the Director of Nursing informed the Board that work with the NICU staff was continuing in order to improve working practices.

  • C.Diff–29 cases for May (target 20) was due to a cluster around surgical wards. As the surgical wards are so busy it was not possible to decant and fully deep clean. Instead a staggered approach had been taken. The following actions are taking place to address this target:
  • Introducing regular antibiotic ward rounds to eliminate poor practise, although vacancies are hindering this.
  • The Laboratory will move to seven day testing.

There were 17 cases in June.

  • There is a focus on infections for quarter two which is taking a taskforce approach with weekly actions within a 90 day cycle.
  • The analyst post had been filled.

The Board noted the Performance Report

(iii) Finance Report

The Director of Finance presented the report and the Board noted:

  • The variance in income and expenditure had been consistent in April and May and therefore the Director of Finance was confident that there were no data issues.
  • Expenditure - front profiled element of divisions savings.
  • The capacity plan is being reviewed to identify whether this trend will continue after achieving the 18 week target.
  • There may be opportunity to offer capacity to other areas.
  • Orthopaedic out sourcing costs are being reviewed; the hand surgeon has been appointed; feet will continue to be outsourced; and a review on the spine work strategy is taking place.
  • Whilst utility prices are rising the Trust should not be affected in the financial year as we forward buy. However, the Trust will likely be hit next year.

The Board noted the Finance Report.

BD/08/07/11 – Human Resources Report

The Director of Human Resources presented the report and the Board noted;

  • The report will now come quarterly and be focussed on business targets and national strategies as the Non-Clinical Risk Committee paper will cover other areas.
  • The Darzi Workforce report focuses on three key areas:
  • Education and training;
  • Strategic workforce planning; and
  • Leadership development, especially around clinical roles.
  • The targets in the scorecard are stretch targets and it should be noted that turnover is reducing. Exit interviews show that in 40% of cases the Trust is unable to control the loss. There are some gaps in the information and therefore any member of staff who has left without completing an exit interview will be posted a form to complete.
  • Sickness, compared with other acute trusts our figures are quite low.
  • Vacancies – progress on recruitment for HCA posts has been good but the recruitment of registered nurses has been slower. An analysis shows that the development of an adaptation programme would be helpful in the longer-term to capture those who do not have acute experience. Further recruitment will take place going forward.
  • Appraisals – there is no capacity for the HR team to police the appraisal process. Lack of time for managers is an issue in achieving this target.
  • European Working Time Directive – this target will remain red for the remainder of the year as it will be a struggle for the Trust to achieve the August 2009 deadline. There is some talk of an extended deadline.

The Board noted the Human Resources Report

BD/08/06/12 – Review of Race Equality Scheme

The Director of Human Resources presented the report and the Board noted the following:

  • There is a statutory requirement to review this scheme.
  • Good progress has been made on integrating race quality measures in workforce matters and providing awareness training.
  • Further work is required to integrate race equality into strategic planning of service provision and delivery of care.

There was discussion around the target figures quoted for minority ethnic and women’s representation in executive posts at Board level and the percentages shown for the Trust’s position.

Action: Director of Human Resources

The Board noted the Report

BD/08/06/13 – Matrons Scorecard

The Surgical Matrons gave their presentation it was noted that:

  • Compassion is hard to measure, although this will be captured on the feedback tool at discharge.
  • The patient story used was chosen at random.
  • It would be useful to capture comments and patients sometimes feel more comfortable commenting rather than complaining or even complimenting.

The Board noted the report

The next meeting of the Trust Board would be held on 3 September 2008, Room C Education Centre, RUH.

The meeting closed 11:35a.m.

Signed ……………………………………………………….

Date ……………………………………………………………

Public Trust Board

3 September 2008

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