MINUTES OF PART 1 BOARD OF DIRECTORS MEETING
HELD ONWEDNESDAY29thOCTOBER 2014
Call to Order
Present:Alan Tobias- Chairman
David Parkins - Deputy Chairman
Sue Hardy - Acting Chief Executive
James O’Sullivan - Chief Financial Officer
Tim Young - Non Executive Director
Jon Findlay - Chief Operating Officer
Fred Heddell - Non-Executive Director
Neil Rothnie - Medical Director
Qadir Bakhsh - Non-Executive Director
Tony Le Masurier - Non-Executive Director
Mike Green - Non-Executive Director
Jan China - Director of Estates & Facilities
Keith Warrior - Acting Director of HR
Cheryl Schwarz - Acting Chief Nurse
Also in attendance:
Angela Bosnjak-Szekeres - Trust Secretary
Cheryl Auger - Assistant to Trust Secretary (minutes)
Lucy Thomas-Clayton - Staff
Denise Townsend - Staff
Les Catley - Lead Governor
David Hobbs - Governor
Pamela Challis - Governor
Tony Dunn - Governor
Majzoub B Ali - Member of the Public
Trevor Johnson - Member of the Public
Paul Sly - Southend CCG
Lynne Collins - Member of the Public (for item 311/14)
Mr Julian Sturt - Consultant Surgeon (for item 311/14)
Ann French - Urology CNS (for item 311/14)
Kumar Nair - Ward Manager (for item 311/14)
Mike Green, Non Executive Director, on behalf of the Board, congratulated and presented a certificate to the October winner of Hospital Heroes Kumar Nair, a Ward Manager on Southbourne ward.
306/14 / Welcome and Apologies
The Chairman welcomed Directors, Governors, staff, and members of the public to the meeting; he also extended the welcome to Sue Hardy, in her first meeting as Acting Chief Executive and to Cheryl Schwarz, in her first meeting as Acting Chief Nurse.
Apologies:
There were no apologies.
307/14 / Declaration of conflicts of interest
No conflicts of interest beyond those registered, were declared.
308/14 / Approval of Part 1 minutes of 24th September 2014 meeting
The minutes of the previous meeting were agreed as an accurate record.
Item, 2mins
309/14 / Matters Arising
277/14 Nursing Establishment: Mike Green, Non Executive Director, informed the Board he did raise the issue of “all Trusts reporting on a like for like basis” at the Regional Audit Chairs meeting,it was clear other Trusts had not considered the issue.
Item,2min
310/14 / Consideration of Part 1 Action Tracker
Decision:
- The Action Tracker was approved as presented.
311/14 / Patient Story
Lynne Collins shared with the Board the treatment journey her husband Clive has been on and her experiences as his carer, since he was diagnosed with prostate cancer two and a half years ago.
The Board was informed of a new outpatient clinic for pelvic radiation disease patients set up by Mr Julian Sturt, only the second one in the country. It was explained that many patients are “cured” by their cancer treatment but have to live with the consequences of that treatment.
The Chairman thanked Mrs Collins and her husband for sharing their experiences and expressed a wish that she and her husband take some comfort that the new clinic will help others as well. The whole Board wished Mr Collins well.
Item, 20 minutes
312/14 / Nursing Establishment - Monthly Update
Cheryl Schwarz, Acting Chief Nurse, gave the report to the Board.The report relates to fill rate against planned staffing, in current funded establishment.
Key Points:
- There were 23 occasions where high risk triggers were initially identified on the wards; however there were no occasions where risk remained high following mitigating actions. No high risk triggers were identified in A&E.
- Concerns were raised regarding the continuing high number of vacancies in paediatrics; the Board was informed that work is ongoing with HR and recruitment agencies to recruit (from Southern Irelandas well as the UK).
- The Board was given a brief update on how the nurses recruited from Spain are settling in, and the support the Trust is providing to ensure they are happy to stay with the Trust.
- In July 2014 NICE published recommendations on “Safe staffing for nursing in adult in-patient wards in acute hospitals”. The document recommends a systematic approach at ward level to ensure safe staffing. The Board was informed that self- assessment against the guidance demonstrates a moderate level of compliance, however there are some areas which may require changes to some systems and processes in order to meet the recommendations. Of particular note is the guidance that ‘red flag’ events should be used as a marker to escalate concerns about nurse staffing levels.Senior nurses are reviewing the actions required to meet the recommendations of the NICE guidelines; the Duty Matron Role will support / oversee the process, and a summary of any ‘red flag’ events will be incorporated into the Nursing Spreadsheet
- The Board noted the report
313/13 / CQC Feedback report
Cheryl Schwarz, Acting Chief Nurse, advised the Board the CQC Report had only been received that morning and therefore there had not been a chance to read it. However, the summary outlined three key actions for the Trust:
- Improve the cleaning schedule in A&E
- Improve security and storage of medicines in A&E immediately
- Increase the number of Consultants and Paediatric Nurses in the department
Actions:
- Copy of the follow up action plan to go to QAC
- Copy of the CQC report to be circulated to Board Members
- Copy of the CQC report to be published on the Trust Website
- The Board noted the verbal report and agreed actions
314/14 / Sign Up to Safety
Mr Neil Rothnie, Medical Director, gave the report to the Board.
Key Points:
- The report gave an overview of an initiative by NHS England to reduce avoidable harm in the NHS over the next 3 years with the aim of saving 6,000 lives Nationally as a result.
- The Board was asked to review the 5 key safety pledges that have been identified, so that the next stages of signing up to the campaign can be taken forward. The 5 Key pledges are:
- Put safety first - Commit to reducing avoidable harm in the NHS by half and make public the goals and plans developed locally.
- Continually learn - Make organisations more resilient to risks, by acting on the feedback from patients and by constantly measuring and monitoring how safe their services are.
- Honesty - Be transparent with people about our progress to tackle patient safety issues and support staff to be candid with patients and their families if something goes wrong.
- Collaborate - Take a leading role in supporting local collaborative learning, so that improvements are made across all of the local services that patients use.
- Support - Help people understand why things go wrong and how to put them right. Give staff the time and support to improve and celebrate the progress.
- The Board was informed that much of what is outlined above is not new and is already being done.
- The Board received the report
315/14 / Emergency Preparedness Resilience and Response Assurances (EPRR)
Jon Findlay, Chief Operating Officer, gave the report to the Board with input from Paul Hepworth, Emergency Planning Officer.
Key Points:
- EPRR is defined by a series of statutory responsibilities under the Civil Contingencies Act (2004) and Health and Social Care Act (2012), which require NHS funded organisations to maintain robust capability to plan for, and respond to incidents or emergencies that could impact on health or services to patients such as;
- Major Incidents/Emergencies (Major Accidents, Acts of Terrorism or National Incidents e.g. fuel shortage)
- Surge Capacity (Winter Pressure, Pandemic Flu or Public Health Outbreak)
- Internal Business Continuity incidents/ Disruptions to Service (Loss of facilities, staff, IT/Data or Suppliers)
- NHS England recently issued the 2014 EPRR Assurance Process. This requires all trusts to carry out a self-assessment against the NHS England EPRR Core Standards, and to produce an action plan to deliver the standards that are, as yet, not fully met.
- There are 4 levels of compliance that trusts can achieve; they are Full, Substantial, Partial and Non-Compliant. It is the view of the Trust’s Emergency Planning and Liaison Officer that the Trust is at ‘Substantial’level. There is still some work to be carried out or completed, but not against multiple standards. Where possible (due to national guidance and work being undertaken by the Local Health Resilience Partnership) the work on outstanding core standards will be completed, at the latest, by the end of September 2015.
- The Board was asked to note the level of EPRR assurance achieved, note the action plan for achieving full assurance and agree the inclusion of the NHS England Sitrep report into the CCG Incident Response Plan
- The Board received the report and agreed inclusion of the NHS England Sitrep report into the CCG Incident Response Plan
Paul Hepworth and Denise Townsend left the meeting
316/14 / Monthly Integrated Performance Report
The IPR report was given to the Board by Jon Findlay, Chief Operating Officer, with input from the Medical Director, the ActingDirector of HR, the Director of Estates & Facilities, andthe Acting Chief Nurse.
Key Points:
- RTT: Performance for September was 80.94% against a 90% target; this deterioration in performance was expected and is mainly due to the extra work undertaken by the Trust as part of the waiting list initiative to reduce its backlog. Additional monies, to address and reduce 18 week backlogs (Nationally) and achieve 16 weeks at speciality level, have been made available by NHS England (the Trust has received an additional £1.2m to deliver on this by the end of November). To support this, a detailed action plan was submitted to the CCG and NHS England; this has been accepted. An action plan has also been sent to Monitor for approval. The Board was informed the rules have changed and that the Trust will now be judged by Monitor on aggregate scores as opposed to each speciality individually.
- A&E: The Trust achieved compliance in September and in Quarter 2 and was the only hospital in Essex to achieve Quarter 2. Consultant capacity in the department has been increased to 4 substantive posts; this includes an innovative approach regarding a ‘Consultant in Training’ post for one of the existing middle grades. The work to increase capacity in the department has started and the new cubicles should be open in December.
The Board was advised the department has struggled to cope with surges in demand over the last 2 weeks; however, it is still only halfway through the recovery action plan therefore there is still an area of fragility. The Board was informed that if demand is similar to last winter, due to changes that have been put in place, the department can deliver compliance against the 95% target; however if demand continues to ‘spike’ at 300+ attendees per day, on a regular basis, the department will struggle as it does not have the capacity to cope with that level of demand.
- Short Notice Cancellations: In September the 28 day readmission target failed as a result of one cancellation failing to be re-admitted with 28 days.
- MRSA Screening: Work is ongoing; there is an issue regarding assessments being carried out prior to admission to AMU.
- Friends & Family: The decrease in response rates has been attributed to all the ward movements and the ward closure. In maternity there was a reduction in the number of telephone surveys conducted due to annual leave of the volunteers who carry out the surveys. Following a recent review of the Friends and Family test it is proposed that the percentage of respondents that would / would not recommend the service, be used in place of the Net Promoter Score.
- Complaints: An increase was noted in September however there has been a decrease in the number of complaints about staff attitudes.
- Cleaning: In September all four risk category areas achieved the expected National Cleaning Standards target.
- Catering: In September Medirest met all but two elements of the ‘Very high’ standard, achieving 96% against the 99% target; this is a significant improvement on last month’s score of 85%. The CQC cleaning scores for ward kitchens was 87% which was below the expected score target of 100%; this had an impact on the overall percentage score for this category; immediate actions were taken to rectify the cleaning issues.
- Nutrition: The Board was informed how the nutritional content of food given to patients is monitored and who checks that menus meet the requirements for the different groups of patients.
- Workforce: There has been no reduction in agency spend but actions implemented are beginning to take hold, 100 less places were booked last month. 91 new staff members joined the Trust in September. The appraisal compliance rate improved by 5.24% in September to 77.47% for the year (against a target of 85%). Statutory and mandatory training improved by 3.18% to 72.46%. Sickness absence rates remained stable at 3.6% year to date against a stretch target of 3.5%
- Staff Turnover: The net staff turnover for September was 14.22% which is a slight improvement; this includes approximately 165 full time equivalent staff transferred to IPP following the establishment of the pathology joint venture. The Board was advised there is a ‘stocktake’ of vacancies taking place, a longer term review, looking to see if there are other more cost effective options; it was pointed out there are no restrictions on nursing vacancies/recruitment. There was a brief discussion on Consultant recruitment, during which it was pointed out that it is a worrying situation if “interviews are being held in January” as Consultants may have found a post elsewhere in that time.
- RTT:Chief Operating Officer to ensure trajectories are sent to the NED subgroup on a weekly basis
- Friends & Family: Show correlation and trends since April, after applying percentage methodology, and present to the next Board meeting (include in the IPR)
- Medical Director and Acting Director of HR to look into why interviews are being booked into January etc.
- The Board noted the report and agreed actions.
317/14 / Workforce & Patient Equalities Quarterly Report
Keith Warrior, Acting Director of HR, gave the report to the Board.
Key Points:
- The Board was informed of progress against delivery of the action plan,in particular the secondment role for leading diversity and inclusion which has been developed and is due to be advertised internally.
- The Diversity Committee has been re-started and has commenced work in relation to EDS 2 (Equality delivery system from NHS England).
- The Committee has updated its terms of reference and these will be finalised shortly.
- A day of activity organised by the BME Network as part of the celebration of Black History Week took place on 21st October 2014. The Group is re-launching itself as the Ethnic Minority Network, so that it is more clearly inclusive of all national and ethnic minorities.
- The Board noted the report.
318/14 / Financial Position
James O’Sullivan, Chief Financial Officer, gave the reportto the Board.
Key Points:
- There was a deficit of £0.9m in September which increased the cumulative deficit to £4.5m.
- Pay costs increased to £15.3m with agency costs representing £1.69m of the amount; there were pay overspends in every business unit.
- Clinical income was ahead of plan by 3.3% in September (mainly elective in-patients and A&E attendances); activity for both of these areas was considerably above the September plan and, in the case of in-patients, affected most specialties and reflected the additional work associated with 18 week waits.
- Pay costs incurred in relation to meeting the RTT 18 week target were £267k in the month (£596k YTD).
- CIP delivery in September was £281k. Cumulative CIP delivery is £1,934k or 50% of plan.
- Cash balances at the end of September were £18.8m which were above plan and significantly above the Trust’s internal cash floor of £10m.
- A year-end deficit of £7.8m is forecast although a financial recovery plan is being coordinated by the recently appointed Transformation Director and an improvement on this position should be achievable.
- The Trust’s Continuity of Service Risk Rating is a 2 for both the year-to-date position and the forecast
- The Board noted the report aware that there is a further report in part two.
319/14 / Part 1 Report from the Chairman
The Chairman updated the Board as follows:
Monitor: Adam Cayley will be standing down from the position of Regional Director at the end of November 2014. Kath Cawley who currently works in Monitor’s enforcement team and who has been leading on the administration of Mid Staffordshire NHS Foundation Trust will be taking over as Regional Director from the 1st December 2014 with handover taking place in the latter part of November. The Chairman informed the Board he had written to Adam thanking him for his fairness and support.
Monitor Performance Review Meeting: The Chairman advised the Board that the meeting appeared to have gone well, that Monitor were receptive to the Trusts plans regarding finance, A&E and RTT but made it clear we will be judged on how we cope this winter.
‘Southend’s Got Talent’: A vote of thanks was given to the Roslin Hotel who sponsored this “superb” evening and also donated a further £5k to the A&E department. A formal letter of thanks will be sent.
Item,9mins
320/14 / Part 1 Report from the Chief Executive
The Acting Chief Executive,updated the Board as follows:
Closure of Windsor Ward: The Board was informed that the team had been working together on the ward for 20 years, that they had always been adaptable and flexible with any changes and always worked well together. The team were only given two weeks’ notice of the ward closure which caused a lot of angst and upset. As a thank you, and in recognition of this long standing team being split up, charitable funds paid for the whole team to go to Sands Restaurant for tea.
Item, 3 mins
321/14 / Monitor Quarterly Submission
Having noted the Trust’s performance, the Board responded as follows to the following statements:-
For Finance that: “The Board anticipates that the Trust will continue to maintain a continuity of service risk rating of at least 3 over the next 12 months”
The Board stated ‘Non Confirmed’ to this statement, and provided details in the narrative of the response.
For Governance that: “The Board is satisfied that plans in place are sufficient to ensure: ongoing compliance with all existing targets (after the application of thresholds) as set out in Appendix A of the Risk Assessment Framework; and a commitment to comply with all known targets going forwards”
The Board stated ‘Non Confirmed’ to this statement, and provided details in the narrative of the response.
“The Board confirms that there are no matters arising in the quarter requiring an exception report to Monitor (per compliance framework)”.
The Board ‘Confirmed’ this statement.
The Board also approved the Capital Expenditure declaration.
Item, 2 minutes
322/14 / Finance & Investment Committee Report
David Parkins, Chair of the Finance & Investment Committee, gave the report to the Board.
Decision:
- The Board noted the report
323/14 / Review of Standing Orders
Angela Bosnjak-Szekeres, Trust Secretary, gave the report to the Board.
The Non-Executive Directors asked for more time to go through the paper, and the revised Standing Financial Instructions, pointing out that it was contingent on other documents, especially the Procurement Strategy. It was noted this was just the start of the process.
Action:
- A small sub group will review both documents, incorporating other documents i.e. Procurement Strategy; once agreed,both documents will then go to Exec Team meeting prior to sign off by the Board.
- The Board noted the paper (s) and agreed action.
324/14 / Review of Standing Financial Instructions
See Item 323/14
325/14 / Quality Assurance Committee Report
Fred Heddell, Chair of the Quality Assurance Committee, gave the report to the Board.
There was a brief discussion on Clinical Audit.
Decision:
- The Board noted the report
326/14 / Review of Board Calendar
The Board Calendar was reviewed
Decision:
- The Board approved the calendar
327/14 / Date of Next Meeting
The next Board of Directors’ meeting will be held on Wednesday10thDecember 2014 in the Trust Boardroom.
There were no questions from governors or members of the public.
The Chairman thanked members for their contribution and declared Part 1 of the meeting closed at 12:31
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