Mrs Kath Allenpublic Governor

Present:

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Dr Jim WhittinghamChairman

Mrs Kath AllenPublic Governor

Mrs Caroline BriggsStakeholder Governor

Mrs Susan DiackPublic Governor

Mrs Maureen DobsonPublic Governor

Mr Harold EdwardsPublic Governor

Mrs Sheila FisherPublic Governor

Mr John FrostPublic Governor

Mr Paul GrinellLead Governor

Mr Makani HemadriStaff Governor

Mr Roy TaylorPublic Governor

Mr Tony WhyteStaff Governor

Mr Max WithringtonPublic Governor

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In Attendance:

Mrs Pam ClipsonDirector of Strategy and Planning

Mrs Tara FilbyDeputy Chief Nurse

Mrs Karen GriffithsChief Operating Officer

Mr Marcus HassallDirector of Finance

Mrs Kathryn HelleyDeputy Director of Performance Assurance

Mrs Karen JacksonChief Executive Officer

Mr Jug JohalDirector of Facilities

Prof. Carrock SewellAssociate Medical Director and Consultant Immunologist

Mr Alan BellNon-Executive Director

Mr Neil GammonDeputy Chairman and Senior Independent Director

Mrs Linda JacksonNon-Executive Director

Mrs Anne ShawNon-Executive Director

Mr Stanley ShreeveNon-Executive Director

Ms Bev DentonMembership Manager

Mrs Alison HurleyMembership Manager

Mrs Sarah MainprizeHead of Communications & Marketing

Mrs Lynsey ChessmanMembership Officer (Minutes)

1WELCOME AND INTRODUCTION

Dr Jim Whittingham welcomed everyone to the Council of Governors meeting, noting Mr Granville Scowcroft, a Trust member, was also in attendance.

Dr Whittingham informed the meeting that Mrs Karen Jackson needed to leave the meeting at 3.30pm to attend another important meeting and that Mrs Karen Griffiths would cover in her absence. He proposed to bring forward agenda items 8 and 9.2, to after agenda item 4 to allow Mrs Jackson to deal with these items. Members agreed to this change to the order of the agenda.

2APOLOGIES FOR ABSENCE

Apologies were received from Public Governors Miss Helen Blow, Mr Ian Davey, Miss Iona Scott, Mr Jeff Shaw, Mrs Liz Stones, Staff Governor Mrs Louise Salt; Stakeholder Governor Cllr Rob Waltham. Apologies were also received from the following members of the Board of Directors, Mrs Wendy Booth (Director of Performance Assurance, represented by Mrs Kathryn Helley, Deputy Director of Performance Assurance); Dr Karen Dunderdale (Chief Nurse, represented by Mrs Tara Filby, Deputy Chief Nurse); Dr Neil Pease (Director of Organisational Development & Workforce), Dr Mark Withers (Medical Director, represented by Prof. Carrock Sewell, Associate Medical Director).

3DECLARATION OF INTERESTS

Dr Jim Whittingham invited members to draw the Council’s attention to any conflict of interest relating to specific agenda items or to any updates to their annual declaration of interests. Mr John Frost informed the Council that he had recently been appointed as Chair of the Community Partnership for Goole and Howdenshire. There were no other declarations of interest.

4GOVERNOR ELECTIONS AND GOVERNOR CHANGES

Dr Jim Whittingham informed members on progress on current elections for Public Governors. He advised that there had been an uncontested election result for North East Lincolnshire, with Mrs Liz Stone being duly re-elected. The election for the North Lincolnshire seat is on-going and due to close on the 19th November 2014.

Dr Whittingham varied the order of the agenda to consider agenda item ‘8 - Chief Executives Report’ and item ‘9.2 - Sustainability Plan’ out of turn, as agreed earlier in the meeting.

5TO APPROVE THE MINUTES/PAPERS OF THE PREVIOUS MEETINGS:

5.1CoG Business Meeting – 23 July 2014

Members noted the following corrections:

a) Minute 2 – Mrs Anne Shaw, not Miss;

b) Minute 6.1, paragraph 3 – “the Quality Development Plan will be sent on 8th August”

c) Minute 6.3, paragraph 4 – A&E is not a single entity;

d) Minute 10.5.1 – Amendment to the minute to relate to the past tense (not future tense).

The minutes were approved subject to these amendments.

Mr Jug Johal joined the meeting at 15.35.

5.2CoG Annual Members’ Meeting – 11 September 2014

Members noted the following corrections:

a) Mrs Karen Griffiths was in attendance;

b) Minute 1 – the meeting commenced at 3.10pm

c) Minute 5.12 – “He then explained the balance sheet and confirmed that…”

d) Minute 5.22 – “usually they choose big teaching hospitals, therefore this leaves the District General to a disadvantage…”

e) Minute 6.8 – “no good having a seven day hospital service if GPs…”

The minutes were approved subject these amendments.

6MATTERS ARISING FROM THE MINUTES

Mr Harold Edwards welcomed Mrs Linda Jackson as the newly appointed non-executive director, taking up the position vacated by Mr Phillip Jackson. Dr Whittingham thanked Mr Edwards and explained that Mrs L Jackson brings a wealth of experience having worked as a director at board level in both private and public sectors, including the NHS. He added that he felt that Mrs L Jackson would be a real asset to the Trust.

Members agreed there were no matters arising from the previous minutes which were not captured on the agenda.

7CHAIRMAN’S REPORT

7.1Chairman’s Report

Dr Whittingham informed members that as an outcome of the Keogh review and re-inspection, the Trust had been removed from “special measures” and the conditions that had been placed on the Trust’s licence relating to quality had been removed. However, because of the financial risks faced by the Trust, Monitor (the Trust’s regulator) had left conditions in place regarding leadership capacity of the Board and clinical leadership. He explained that Monitor and the Trust Board share concerns about progress on the locality’s sustainable services plan and there is little doubt that the conditions that have been left in place are to provide assurance to Monitor that the Trust and the wider Health Community are making the required progress.

Dr Whittingham reminded members about short-term 2014-15 concerns about the current absence of a 2014-15 commissioning contract with the North Lincolnshire Clinical Commissioning Group (CCG) and advised that there will be a Board to Board meeting with the CCG in the coming week to work towards resolving the immediate contracting issue and working together on the community-wide sustainability plan. He advised that Governors will be briefed in more detail on these issues at the forthcoming Governor and NED briefing session on 13th November 2014.

Dr Whittingham confirmed that quality would remain high on the Trust agenda to ensure continued improvements in safety and quality including mortality.

Mr Makani Hemadri asked how many Trusts have conditions on their licence due to leadership issues. Dr Whittingham did not have this information to hand, but directed Mr Hemadri to Monitor’s website where the information would be in the public domain.

7.2Questions on the Trust Board Minutes

Referring to the minutes, Mr Harold Edwards asked about the current status on the Trust’s contracting position with the CCGs. Dr Whittingham informed Mr Edwards that this issue would be covered in agenda item 7.3 in more detail, but reminded members that as yet there is no agreement in place on the 2014/15 contract with the North Lincolnshire CCG. This would be a matter of discussion at the Board to Board meeting to be held on 13th November 2014. He added that there remains a strong argument for the Trust to seek arbitration.

7.3Board Highlights Report

Dr Whittingham informed Governors that he will endeavour to issue the Board Highlights reports on a monthly basis from November onwards and invited questions or comments on the report.

Mrs Sheila Fisher was concerned to read about the locum situation within the Trust and asked how many locums had been hired in 2014 and at what cost. Mr Marcus Hassall and Mrs Karen Griffiths reported that medical staff cover was constantly reviewed to keep services safe and effective. Currently, medical vacancies across the Trust equal 85 whole time equivalents (wte). Therefore, to ensure safe staffing levels, there is no alternative than to employ locum and agency staff, noting that this is often to cover rotas rather than the complete role. Mr Hassall advised that the spend to date is £10.1 million. The Trust is active in recruitment, with some success in the early part of the year and further innovative work being undertaken in the next 2-3 months which should reap some benefits. However, this is an extremely serious long term issue and it will take time to get to a more sustainable position. Mr Hassall asked members to note that this issue was outlined in detail in the staffing and finance reports received by the Board on a monthly basis and the Board’s discussions are reflected in the Board minutes as circulated to Governors.

Mr Alan Bell asked members to note that there appears to be an increasing preference for doctors to work as locums. This brings additional difficulties in recruiting, although he added that the Trust has made improvements and medical staffing vacancies has reduced from 106 to 85 wte in the past 6 months.

Mr Makani Hemadri referred to the recent problems encountered by the Trust arising from the reduced numbers of trainee doctors supplied to the Trust by the Deanery and asked if there was any correlation to the Keogh review (and the Trust’s reputation). Mrs Griffiths reported that there did not appear to be any link and that she felt that a key issue is the lack of control with the medical school have over where trainees choose to work.

Mrs Anne Shaw recognised that there is a national issue with recruitment into medicine; the same with nursing, and there is not enough capacity in the system. She also felt that there is a regional problem with both private and public businesses within our region struggling to recruit. She added that she is encouraged by the Trust’s innovative approach and the measures being taken to make the Trust more attractive to potential staff.

Dr Whittingham invited any further comments or questions and none were received.

Council Action – The Council received the Board Highlights Report.

8CHIEF EXECUTIVE’S REPORT

Taken ahead of agenda item 5.

Mrs Karen Jackson asked members to note that the Trust had achieved all of the performance measures contained within Monitor’s national Risk Assessment Framework for the month of September.

She advised that Viv Duncanson, who is the Trust’s Senior Infection Control Nurse, had received the National Infection Control Practitioner of the Year award from the Infection Prevention Society. Mrs Jackson felt that this was a great achievement. She noted that Viv’s work has led to some wards being C Difficile free for two years, which was a great achievement by Viv and the ward staff.

She added that, as outlined by the Chairman, removal of the conditions placed upon the Trust’s licence in respect of quality had been achieved. This had to be applied for and was supported by Monitor. The conditions relating to leadership remain in place due to the financial challenges faced by the Trust with our Commissioners and because of the challenges to the sustainability of the Trust’s services into the future.

She reported that this year’s Our Stars event was a great success and recognised the work being done around the Trust by our dedicated staff. Many of the Board were in attendance. Mr Paul Grinell had also attended. Mr Grinnell added that he felt that it had been an uplifting and rewarding night.

Mrs Jackson referred to recent NHS industrial action and recognised the effectiveness and value of the preparation work undertaken by the Trust in ensuring that critical services and patient safety were maintained when staff exercised their right to strike during the recent two episodes of industrial action. Mrs Jackson understood that no complaints or concerns had been received arising from the industrial action.

Dr Whittingham thanked Mrs Jackson and invited any further comments or questions and none were received.

Council Action – The Council received the Chief Executive’s Report.

9STRATEGY AND PLANNING

9.1Quality Development Plan and Monitor Compliance Certificate

9.1.1Quality Development Plan

Mrs Kathryn Helley introduced the Quality Development Plan (QDP) and informed members that this plan follows on from the Keogh Plan, which had been extremely effective in supporting the Trust’s progress and achievement of the removal of the quality conditions placed upon the Trust’s licence. The QDP pulls together all of the actions from the CQC visit earlier in the year and also actions from the recent Deanery visit. It also includes the residual actions from the recent KPMG reviews commissioned by the Trust and from the incident reviews earlier in the year. The intention was to develop and maintain the QDP as a single integrated plan. Mrs Helley explained that the QDP is monitored weekly by the Executive Team and is also included on the Board agenda every month.

As the QDP has been developed and new quality improvement objectives identified, these have been mapped to a new suite of Key Performance Indicators (KPIs) to monitor and measure performance improvement and to be more relevant. The latest version of the QDP will be presented to the November Board meeting and will be disseminated to Governors in due course. From December, the Board will be supported by more detailed scrutiny of the QDP and the associated KPIs by the Board’s sub-committees which will each be allocated their own portion of the plan and KPIs. The Board’s Trust Governance and Assurance sub-committee will review the QDP in full.

Mrs Helley invited any questions or comments about the QDP or the KPIs.

Mr Edwards was concerned about the performance trends for the stroke KPIs and asked what this meant for patients. Mrs Griffiths responded that all patients are reviewed at the stroke Multi-Disciplinary Team (MDT) meeting on a weekly basis, with each patient being reviewed individually and a personalised pathway being followed.

Mr Edwards reported that, as a member of his local Patient Participation Group, he had been approached by a number of patients who had alleged that GPs had not been receiving electronic discharge letters. Mrs Pam Clipson advised that there had been a “glitch” in the system in Quarter 1 of this financial year because some GPs’ email addresses were not up to date. This had now been corrected and significant improvement had been made in the last couple of months. Mrs Clipson also reported on a pilot underway to introduce WebV into GP practices within North East Lincolnshire (which would cover 50% of the population) and would provide GPs with direct access to the Trust’s systems. There are also plans to audit the receipt and content of discharge letters.

Mr Grinell felt that WebV is a huge, initiative with fantastic potential and should be recognised as such.

Dr Whittingham asked members to note that the KPIs are intended to support continuous quality improvement, in other words they are intended to highlight areas where we need to improve.

Mrs Sheila Fisher asked when there would be a final decision regarding the location of the hyper-acute stroke unit. Mrs Caroline Briggs reminded members of her role within the CCG and updated members on the CCGs’ perspective on this issue. She asked members to note that the outcome of the CCGs’ recent consultation on stroke and the future location of the Ear Nose & Throat (ENT) in-patient service and the preferred option on both services will be presented for approval to the CCGs’ governing bodies on Thursday, 13th November. She reported that the preferred option is to retain the 24/7 hyper-acute stroke service at Scunthorpe General Hospital (SGH) and to move the ENT in-patient service to Diana Princess of Wales Hospital (DPoW), Grimsby. However she asked members to note that the final decision remains with the commissioners’ governing bodies. Members were asked to note that the consultation related to retaining the hyper-acute stroke service at SGH and that the 24/7 acute stroke service in place at DPoW will remain. Mrs Griffiths added that the Trust is now achieving the required standard of care needed by patients in the hyper-acute service.

Dr Whittingham invited any further comments or questions and none were received.

Post meeting note – The commissioners’ governing bodies, at the meetings held on 13th November 2014, approved the preferred options for both services

Council Action – The Council received the Quality Development Plan and KPIs.

9.2Sustainability Plan

The Council considered this report before agenda item 5.

Mrs Karen Jackson asked members to note that the sustainability plan includes both an internal component, which will be led by Mrs Wendy Booth and the assurance team, and an external component, through Healthy Lives Healthy Futures.

The internal plan, led by Mrs Booth, will be based on similar processes to those which the Trust used for the Keogh plan. Mrs Jackson added that we once again need to galvanise our teams around the quality agenda and emphasised the importance of the sustainability plan being led by quality rather than being simply about cost cutting. She added that, in addition to the internal arrangements for the development and progression of the plan, the Trust had commissioned external support from Mr Eric Morton to take on a similar role of independent director to that which he took through the Keogh review (this time employed by the Trust). She advised that once the detailed plan is produced, it will be presented to the Board’s Resources sub-committee, the Board and Council of Governors. Progress will be monitored weekly by Mrs Booth and her team. Expected key themes for the internal plan will include the management of medical staffing, nurse staffing and the effective use of locum, bank and agency staff. Mrs Jackson expected that the internal sustainability plan will be extremely challenging and will put extreme pressure on the system.

Mrs Jackson explained that the external sustainability plan has moved on from the first phase of Healthy Lives, Healthy Futures into phase two. Phase two will be owned by the entire health community and will face some difficult decisions about the overall provision of health and care in the locality. She asked members to note that she had been approached to take the lead on developing the community’s sustainability plan, planning how services will look in the future. The target for completion of the plan was March 2015. Mrs Jackson stressed that during this process her role as the Trust’s accountable officer will not change, but she will need to adjust her day to day work to create the space and time to undertake this new role. Mrs Jackson accepted that there are risks in the Trust’s chief executive taking on this role as well as in not doing so. On balance Mrs Jackson felt that the role is to the overall benefit of the Trust and the services which it provides. Dr Whittingham advised members that the board supported this development which he felt was potentially a turning point. He noted the importance of the Trust’s Executive Team in supporting Mrs Jackson to enable her to take on this additional role and that the Board will need to ensure that the organisation continues to be effectively led and managed.