Minutes of the Trust Board meeting held on Wednesday 22 July 2009 at 10.00
in the Board Rooms at WestmorlandGeneralHospital, Kendal
PRESENT:Mr N Ballantyne
Mr T Bennett
Dr J Greenwell
Mr T Halsall (Chief Executive)
Ms J Holt
Professor E Kane (Chair)
Mr F McLaughlin
Mr S Smith
Mrs P Thomas
Mr I Tomlinson
Mr S Vaughan
IN ATTENDANCE:Mrs A Munday
Mr R Wilson
09/169APOLOGIES FOR ABSENCE
Apologies were received fromMr P McGahon, Mrs A Long and Mr D Goodfellow.
09/170MINUTES OF THE TRUST BOARD MEETING HELD ON 20 MAY 2009
Wereaccepted as a true record with the following amendments:
a) 09/153 5th paragraph
lst lineshould read ‘….Band 2 due to unavailability ….’
4th line should read ‘Mr Wilson was asked ..’
b)09/154 line 4 should read ‘position of recovery to sustainability’.
line 5 beginning ‘Mr Smith .. …..July’ to be deleted
MINUTES OF THE TRUST BOARD MEETING HELD ON 10 JUNE 2009
Were accepted as a true record with the following amendment:
09/167 should read ‘Wednesday 21 July…
09/171MATTERS ARISING
None.
09/172ACTION SHEET
Ward Staffing Audit from Audit Commission – deferred to 23 September Trust Board.
09/173CHAIRS ITEMS
NW Financial Summit
Professor Kane advised that he, Mr Halsall and Mr Dyer had recently attended a NW Financial Summit held at the SHA. The forecast had not been encouraging. It had been decided that local health economies would have to work more closely together and ensure work was not duplicated between ourselves and the PCTs. The Summit will reconvene in November when the national situation would be clearer.
Nursing & Midwifery Strategy Event
Professor Kane reported that the Nursing & Midwifery Strategy launch would take place on 23 July with Dame Chris Beasley being the key note speaker. Final copies of the strategy are available for directors.
Appointment of Contractors
Professor Kane noted the following:
a) Refurbishment of Pointer Court for pre-op assessment & Employment Svs - RLI
Askam Construction Ltd
b) Replacement of roof covering – phase 2 – FGH
Mitie Tilley Ltd
09/174CHIEF EXECTUIVE’S REPORT
Mr Halsall advised of the following:
Board discussion with NLancs/Cumbria PCTs
The Financial Summit had been on the Board agenda together as a topic of conversation with other CEOs in the area. There had been a mixture of views and a desire to try to develop some cohesive way of working. The health economy needed to stay in balance whilst continuing to develop innovative initiatives eg Diabetes at FGH/Cumbria and how to progress a further Xray centre at WGH. We were looking positively how to go forward building relationships with other organisations during these difficult times. Formal meeting schedules had been agreed and the Board will be advised of future developments.
Foundation Trust
A decision was still awaited from Monitor/Care Quality Commission as to what additional information they might still require. Mr Halsall was in receipt of a letter from the Head of Monitor expressing the hope that the matter be sorted within the next few weeks. However, inevitably there would be a fair amount of work that would need to be repeated.
09/175INTEGRATED BOARD REPORT
Finance
Mr Bennett spoke to the Executive Summary and explained that, from a performance perspective, the Trust had achieved a surplus year to date of £386k ahead of where we had expected to be. However there were some worrying factors:
i)Within month 3 the Trust was behind plan – largely due to under recovery of income (particularly Surgery). A contributory factor had been the impact of high level of medical vacancies leading to loss of activity.
ii)The planned Urology service development had not yet been delivered. A revised business case was being considered.
iii)There had been a delay in getting the Pre-op assessment up and running. Now expected to be Autumn.
iv)Case-mix had dropped, clinical leads unable to explain why, should this continue it could lead to an unaffordable financial pressure.
Mr Wilson observed that he had emailed a spreadsheet prior to the meeting which explained the medical vacancies and the actions taken to ensure they were filled to give the Board the assurance the matter was being addressed. Mr Smith queried whether less staff would equate to a drop in expenditure. Mr Bennett explained that this was not the case as locums would be brought in to cover services and are more expensive.
Mr Ballantyne requested clarity on the £483k over budget spend on non pay costs. Mr Bennett responded that it wasn’t in one single area. However, there had been an increase in masks/gloves which had been a significant outlay. This was thought to be due to wards/departments beginning to stock up for Swine flu. Mr Bennett confirmed that he was confident that the overspend in this area would come down in month 4.
Mr Ballantyne queried the unbudgeted income of £50k for EWTD and £40k for mixed sex wards. Mr Bennett explained that the £40k would be spent on capital alterations to specific wards/bathrooms. The Trust had also received additional funding for EWTD following a successful bid to the Strategic Health Authority. The budgets were not adjusted but funding would be reflected in over recovery of income.
Dr Greenwell commented that she had concerns with the Trust’s comparison of Planned and Actual Activity. Dr Greenwell explained that the Non-Executive Directors had an awareness session with CHKS and felt that changes might increase income. Dr Greenwell sought assurance from Mr Bennett that he would take that into consideration. Mr Bennett responded that the Trust was bound by the PBR Code of Conduct but he would take her comments into account. He went on to explain that the number of spells were higher in June than was expected as there had been 2 additional working days compared to the previous month.
Mr Tomlinson spoke of the medical vacancies and explained that concern had been raised regarding increased costs at the last meeting of the Finance & Performance Scrutiny Committee (FPSC). Mr Tomlinson felt there was a need to predict any income risk.
Professor Kane concurred and requested that the next report cover what actions had been taken to address the situation together with the implications. Mr Halsall also requested that Mr Wilson followed up with the Deanery and confirmed that Junior Doctors were not under our control.
Mr McLaughlin queried why it took so long from interview to start date. Mr Dyer explained that as far as Consultants were concerned there were recommended guidelines which had to be adhered to. There could be delays in acquiring a RoyalCollege representative. There were strict rules when training came to an end. Mr Dyer together with Mr Wilson would shortly be meeting an HR Consultant to discuss the issue. There was a need to separate Consultants from others and as Mr Halsall had already pointed out, we had more control over our Consultants than our Junior Doctors.
Mr McLaughlin then asked if there was capacity in Surgery why patients couldn’t be called in from the waiting list to improve income. Mr Vaughan advised this would be possible but there was a need to cover Emergency activity at a premium cost and PCT contracts did not encourage this form of activity. Mr Bennett further explained that the national contract terms which we had agreed with PCTs meant that they could refuse to pay for activity if this was as a result of the Trust reducing the waiting times below the contract specification.
Mr Halsall added that the Trust was doing extremely well in recruiting Consultants indeed two excellent Anaesthetists had recently been employed at FGH.
National Targets
Mr Vaughan reported that the 18 week target of non-admissions had been met. However the Cardiology target had not, this was due to the impact of patient backlog clearance at FGH which is likely to continue until July. The SHA had reviewed the process and a letter was expected. Neurosurgery was also an ongoing issue. There were so few patients in Cardiothoracic that it will also breach. The new national Cancer targets had altered performance levels nationally and the Trust’s performance in June dropped below in several indicators, although these were unvalidated at present and final performance would improve. The Trust is compliant in the other Cancer standards. A&E were achieved in the first quarter at RLI however there had been breaches since. These had mainly occurred during the night which is a new pattern of breach. A remedial action plan was in place.
Call to needle : 2 breaches in June, discussions with all agencies were ongoing. Small volumes but made a huge difference. A root cause analysis was being undertaken and action plan in place. Mr Halsall observed the importance of each case having a root cause analysis to discover the cause. Mr Vaughan confirmed that discussions regarding the issue of Neurosurgery and PCT contractual framework was in the process of being resolved.
Professor Kane requested this be a specific item for the next Trust Board.
Dr Greenwell commented that although the number for Thrombolysis (call to needle) were small it did make an enormous difference. Mr Vaughan advised that there was now a group made up from all the relevant agencies who were now looking at the issue.
Workforce
Mr Wilson advised that during a recent summit of local businesses 2 out of 4 had declared that they were preparing for an economic downturn in the NW.
Absence Management : down to 6.3% with assistance from managers, staff side and HR personnel.
Appraisal Compliance:
Medical Services -action plans being completed for all appraisals to be undertaken
Surgery, CC & FS – plans are in place for all appraisals to be completed by 31/7/09
Core Clinical – action plans being completed for all appraisals to be undertaken
Estates & Facilities – on track for all staff to be appraised by 31/7/09
Corporate areas – information sent to all areas for verification
Additional Staffing
A close down and professional approach was being maintained with a clear plan in place using a multi agency approach with shared services. Agency spend was significant.
Professor Kane requested a report in greater detail for the next Trust Board.
DIPC Quarter 1 report
Mrs Holt spoke to the above and reported 5 MRSA cases in quarter 1. The first 4 cases have been analysed by the Divisions and action plans identified. The 5th case will be reported at the end of the month. All cases were reviewed within the Trust target of 14 days and a new target of a 10 day turnaround had now been set. Training clinical staff in Aseptic None Touch Technique (ANTT) began in April 09. An ambitious target of 90% of all appropriate clinical staff to be trained and assessed by the end of December had been agreed. Progress will be reported via the Infection prevention KPIs.
The Infection Prevention team will lose a number of experienced staff due to retirement/semi retirement in the near future and one member of staff commences maternity leave. Plans are in place for an interim structure and a proposal for the future is being worked up. A programme had been developed at the University of Cumbria for 100 link nurses to attend this specialist course in September.
Mr McLaughlin asked what actions were being taken to limit the rate of infection that visitors might bring into the hospitals. Mrs Holt responded that there was a high awareness campaign in progress with stations at the entrance of each ward/department and leaflets. She is planning to refresh the communications campaign with the assistance of the Communications department. The Trust is confident but not complacent that all that can be done is being done. A ‘mystery shopper’ scheme will come into force in August. This is our internal version of a mini Code of Hygiene Inspection. This would involve a team, consisting of our staff together with colleagues from other regions, arriving anytime, anywhere and would carry out assessments on the 9 standards within the Code of Hygiene.
Mr Ballantyne queried the whereabouts of the MRSA cases and if it would be easier to deal if it was just one site. Mrs Holt advised that standards had to be maintained on all sites and cases, although small in number have occurred on our two main sites. Professor Kane commented that he was hopeful that perhaps the Department of Health might find a more sensible way of measuring MRSA in the future.
09/176APPROVAL OF EXPENDITURE
The Board approved the following:
i)Refurbishment of Pointer Court for pre-operative assessment & Employment Svs RLI by Askam Construction Ltd at a cost of £389.069.00
ii)Replacement of Roof covering, Phase 3 FGH by Mitie Tilley Ltd at a cost of £189,223.11
APPROVALS OF STRATEGIES
Risk Management Strategy 2009-2012
Mr Dyer spoke to his paper and explained that the document was a revision and replacement of the 2006-2009 version. It had been hoped to bring to the January Trust Board but the NHSLA assessor kindly agreed to view it prior to the September 2009 assessment. She had very helpfully given some amendments which had now been incorporated. Mr Dyer was happy that the strategy was now in line with NHSLA requirements and added that the Board had been involved in the development during the last two years.
Professor Kane commented that Board members had seen before and requested any final questions.
Dr Greenwell thought it an excellent document, however she had some concerns. One regarding the contrast for the Non Executive Directors and Monitor/Foundation Trust in relation to documents and a perception of front line managing risk.
Dr Greenwell also observed that the NHSLA assessor had previously requested monthly induction that the Trust was unable to provide and enquired if this would put the achievement of NHSLA level 2 at risk.
Mr Wilson responded that this would be a gold standard and would require a unified start date within the divisions that would be both impracticable and difficult. The induction process had since been improved with changing the way in which it was delivered at RLI with FGH to follow shortly. Although not up to gold standard it was sufficient for purpose and within the NHSLA guidelines.
Mr Dyer gave assurance that he had since discussed the issue with the assessor and she had agreed the improvements. He continued to explain that a quality summit had been arranged for September for Integrated Risk/Mrs Holt/CHKS which would be looking at how to se up a quality report for the Trust and the framework for this year and how to provide a dashboard report for the Trust Board next year.
Mr Halsall observed, with regard to reporting mechanisms, that Committees were asked how risks were being managed and were not expected to solve issues. Should risks escalate they would be managed and then reported to the Committees on how they were being dealt with. The operational arm of the Trust deals with solving issues and is separate from the Non Executive role.
Mrs Thomas enquired whether the strategy covered purely clinical risk. Mr Dyer responded and explained that the Trust had moved to Integrated risk as it was not considered possible to separate clinical from non clinical.
Mr Halsall commented that the document was around the NHSLA assessment. All Trust Board committees reported to the Audit Committee and all committees fed into Internal Audit.
Following discussion the following amendments were agreed:
i)Pg 37 Appendix 7 – final right hand box to read ‘Referred to Directors via the HMT or Clinical Quality and Safety Committee as appropriate….
ii)Pg 17 Paragraph 1 – strengthen by reference to policies in force
iii)Pg 18 amend diagram to improve connections between Audit Committee and Patient Service & Experience Sub-Committee
iv)Include Terms of Reference for Audit Committee as appendix
The Board approved the strategy subject to the above amendments being included. Professor Kane to sign off prior to Trust Board members being circulated with amended document.
Nursing and Midwifery Strategy 2009-2014
Mrs Holt advised that the Strategy had emerged following patient, staff and public feedback with 4 staff focus groups having taken place earlier in the year. The Strategy sets out the strategic direction for the next 5 years. There were 6 key themes ie:
- Caring with kindness and compassion}
- Safe care in clean and comfortable environments} top 3 public themes according to feedback
- Listening to patient sand improving the way we work}
- Developing confident, ambitious and inspirational leaders
- Working with partners for the benefit of patients
- A questioning and analytical workforce
The real test is in making the Strategy a reality. Roadshows would be held during the coming months to communicate it to all staff. Dame Christine Beasley, England’s Chief Nurse, would be speaking at the launch of the strategy taking place tomorrow.
Mr Vaughan expressed the general feeling that it was excellent and was looking forward to being part of the implementation.