King’s CollegeHospital NHS Foundation Trust BOARD OF DIRECTORS
Minutes of the meeting of the Board of Directors held at 14.00 hrs on
Tuesday, 27th November 2007 in the Dulwich Committee Room, King’s CollegeHospital
Present: / Michael Parker (MP) / ChairDr Martin West (MW) / Non-Executive Director
Robert Foster (RF) / Non-Executive Director
Maxine James (MJ) / Non-Executive Director
Prof Alan McGregor (AM) / Non-Executive Director
Malcolm Lowe-Lauri (MLL) / Chief Executive
Dame Jacqueline Docherty (JD) / Deputy Chief Executive/Executive Director of Nursing & Operations
Michael Griffin (MG) / Executive Director of Human Resources
Simon Taylor (ST) / Executive Director of Finance & Information Services
Prof John Moxham (JM) / Executive Medical Director
Non-voting Directors: / Roland Sinker (RS) / Director of Strategic Development
Ahmad Toumadj (AT) / Director of Facilities
Jane Walters (JW) / Director of Corporate Affairs
In attendance: / Sally Lingard (SL) / Head of Corporate Communications
Jessica Chamberlain (JS) / Patient Safety & Service Quality Research Centre
Rita Chakraborty (RC) / Assistant Board Secretary
Item / Subject / Action
07/173 / Apologies
Rita Donaghy
07/174 / Declarations of Interest
(07/180) Martin West declared an interest as a Director of Drivers Jonas, whois advising SLaM on the sale of property that the trust wishes to acquire. Dr West is not connected with the matter on behalf of either trust.
07/175 / Chair’s Action
The Chair had signed two contracts following successful tenders. Further information was available from the Director of Finance. The Board RATIFIED the Chair’s actions.
07/176 / Minutes of the meeting held on 23rd October 2007
The minutes of the meeting held on 23rd October 2007 were AGREED subject to the following amendments.
Attendance list – add Prof Alan McGregor and Dame Jacqueline Docherty.
07/168– Grievance Procedure
- (p.8 - penultimate paragraph, 1st sentence) -amend to read “his concern that the wording of the Grievance Procedure indicates Director involvement whereas it is only Executive Director in practice. The procedure and practice needed to be aligned.
- (p.9 – second paragraph) – replace “She further queried independence of the current process.” with “She felt that the NEDs could bring independence to the process.”
- (p.9 – penultimate paragraph, after first sentence) – add “The issue had been further highlighted by the Equality and Diversity Committee.”
- (p.9 – penultimate paragraph, last sentence) – replace “personal” with “collective”.
07/177 / Matters Arising
Actions on the list:
07/146 - Comments have been forwarded to the Foundation Trust Network as part of a collective response to the DoH. In addition, feedback has been forwarded directly to the DoH.
07/148 - Safeguarding Children – update: a small group will report back to the Governance Committee
07/163 – Finance Report – ST will clarify the relevant income target with the Finance Committee
07/164 – Annual Healthcheck – completed
07/168 – Grievance Procedure – actions completed
07/178 / Chair & Non-Executive’s Report
The Board NOTED the Chair and Non-Executive’s Report.
The Chair informed the Board that Professor Alan McGregor had been re-appointed by the Board of Governors for a term of 4 years commencing on 01 December 2007. The Board congratulated Prof McGregor on his re-appointment.
The following verbal report, which had been omitted from the written report in error, was given by Prof McGregor.
26th October – AMC Cardiology Exemplar Work stream
31st October – KCNI Meeting – Site Options
1st November – Clinical Research Facility Fundraising Meeting
2nd November – Medical Manpower Committee
5th November – Amanda Delaw – Trust Fundraising Strategy
6th November – Clinical Directors’ Meeting
AMC Cardiology Exemplar Work stream
7th November – KCNI Fundraising Meeting
8th November – Remuneration & Appointments Committee
Performance Committee
12th November – Meeting of Trust Executive with KCL PCT
15th November – Governance Committee
07/179 /
Chief Executive’s Report
Malcolm Lowe-Lauri (MLL) introduced the report and provided the following additional information:
Healthcare Commission Assessment of Maternity ServicesPreliminary results from the assessment of nationwide maternity services,and based, in part, on women who had used the services, had just been released. Although the final position would not be known until January., the trust would be querying the provisional assessment.
An article in that day’s Evening Standard on the National Maternity Survey claimed erroneously that KCH was one of 15 failing trusts in London.
It was noted that, overall, London had scored less well than the rest of the country. Furthermore, there was a big difference in the volume of patients treated across London’s trusts. KCH had amongst the highest scores for London trusts.
AM asked if any feedback would be available on the data. A report to the Governance Committee showed that, in some instances, the trust’s assessment was based on targets outside if its control. MLL replied that there was time available to request feedback and to query the rating. A more detailed report would be circulated, when available.
Visit by Ruth Carnall, Chief Executive, NHS London
Earlier that day, Ruth Carnall had visited the trust. In addition to a private meeting with MLL,she had spent time in the Stroke Unit, Intensive Care, Liver and Blood Sciences, and had participated in a group discussion with a variety of trust clinical staff.
She was supportive of the proposals for an academic medical centre, the associated work in relation to south east London, and the ‘King’s @’ model Assurance was given that consultation in south east London would include stroke, trauma and maternity services.Collaboration between the trust and a district general hospital for stroke was also likely. Finally, Ruth Carnall had been impressed by the trust’s Blood Sciences Centre and its potential for providing services to outer south east London.
Strategy
Tighter management arrangements were being introduced for cancer, stroke and trauma services.
First Choice
A pilot project was underway to using hand-held devices on some wards to record patient vital signs and to assess the impact on clinical management, patient safety and efficiency. The trust was collaborating with the University of Portsmouth to integrate this information into the patient costing system.
The Board NOTED the Chief Executive’s Report and CE Brief.
07/180 / Finance Report – Month 6
Simon Taylor (ST)introduced the Finance Report which included data from month 6. A complete version of the report was tabled. The Trust’s financial results indicated that King's was still on track to achieve the full year I&E surplus of £7.3m. Liquidity remained a key issue as this prevented the Trust from achieving a risk rating of more than 3 under Monitor’s rules.
ST asked the Board to note the following:
- The patient costing system was being rolled out to all care groups
- In conjunction with the Foetal Medicine Foundation, the trust was pursuing purchase of 5 buildings on Windsor Walk near to Denmark Hill station owned by SLaM. The plan was to move non-urgent maternity services to this site to free up space for midwife-led services in the Golden Jubilee wing. Martin West declared an interest (see 07/174).
- The Audit Commission would be featuring Agnentis as an example of effective collaboration between an NHS finance team and clinicians.
07/181 / Management Letter
Robert Foster introduced this item. The Audit Committee were happy with theexternal auditor’s recommendations and were satisfied that the trust was responding appropriately. On the issue of capital asset management and the treatment of impairments, the District Valuer was currently undertaking valuation of several major assets. Martin West suggested that the use of external valuation advisors could also prove useful.
MLL noted that slow progressin Practice-Based Commissioning in Londoncould be due to PCT focus on primary care issues.
AM noted the auditor’s praise for the trust’s approach to equality and diversity issues (p.4, rec.5).
The Board NOTED the Annual Management Letter.
07/182 / Auditor’s Evaluation of Self-Governance Arrangements
RF introduced this item. The external auditor found the trust to have robust arrangements following its transition from an NHS trust to a foundation trust.
MJ suggested that the trust could attract more young members in conjunction with existing local forums and representatives, such as Lambeth’s Youth Mayor.
The Board NOTED the Auditor’s Evaluation of Self-Governance Arrangements.
07/183 / Counter Fraud Update
As Lynda May, Head of Counter Fraud, was on sickness absence, Simon Taylor introduced the report.
Following several high profile frauds in recent years, the trust now employed 2 staff specialising in counter fraud - considerably more resources than most trusts. The Counter Fraud Team focussed on 7 generic areas as recommended by the NHS Counter Fraud and Security Management Service with equal time spent on deterrence and follow-up from referrals.
In recent months, the team had sought legal redress resulting in prosecutions, repayments and recovery from frozen assets.
The impact of the service was reflected in the large numbers of staff approaching the Counter Fraud Team to investigate a suspected fraud. MJ wondered whether the improvement in resources had resulted in a fall in fraud. ST responded that Lynda May was tackling more appropriate cases earlier than before. Closure reports with recommendations were circulated to the Audit Committee and relevant staff to strengthen internal controls.
In response to John Moxham’s query, ST explained that it was difficult to compare KCH’s results with those of other trusts. However, the trust’s zero-tolerance approach to fraud culture was generating higher awareness scores, as reflected in an Audit Commission staff survey.
MW noted that organisations outside the NHS were reluctant to reveal the impact of their counter fraud measures, therefore, it was perhaps preferable for the trust to internallyidentify a level that it was prepared to accept.
Mike Griffin commended Lynda and her team for fulfilling a valuable role in the trust.
The Chair suggested that efforts should be focussed on ensuring that over-payments were repaid.
The Board NOTED the Counter Fraud Update.
07/184 / Healthcare Commission Investigation into Outbreaks of Clostridium difficile at Maidstone and Tunbridge Wells NHS Trust
Jacqueline Docherty introduced the item. Following the Healthcare Commission’s investigation, London trusts had been asked to undertake a gap analysis in relation to the report’s recommendations and to share these findings with their Board.
A number of issues had been identified at Maidstone and Tunbridge Wells NHS Trust as contributory factors. These included the lack of an effective surveillance system; a lack of clarity in the management of overall care; inadequate nursing levels; delays in announcements and information to the Board following an outbreak; inadequate isolation and cohorting of patients and the standard of environmental cleaning.
1. Trust’s Position
JD highlighted the trust’s position on the following issues:
Isolation/cohorting
Levels in General Medicine, previously an area of concern at the trust, had improved greatly. AM asked whether the ranking of infections had changed, e.g. C diff in relation to Tuberculosis. JD responded that Tuberculosis was still considered a more serious infection but a TB patient who had contracted C diff would be cohorted with other C diff patients.
Environment and cleaning
- Numerous directives had been received from the Department of Health. The trust would monitor compliance via care group matrons and clinical directors reporting to the Performance Committee, and then via the Performance Report to the Board of Directors.
- Paula Townsend, Assistant Director of Nursing, was overseeing environmental audits and the gathering of information for consideration by the HPC Liaison Committee and Performance Committee.
- Ahmad Toumadj added that the fines imposed on Sodexho for failure to meet agreed cleaning standards stood at £0.5m but the full year effect was £1.0m.
The trust was introducing clearer signage and guidelines.
2. Gap Analysis and Action Plan
The Board moved on to the key findings of the gap analysis and the corresponding actions.
It was acknowledged that the ineffectiveness of hand gels in combating C difficile could cause confusion amongst patients and visitors.
An outbreak of C.diff was classified either as 2 cases in a ward in 1 week or 3 cases in a ward in a month.
At present, the target monthly measures were as follows:
MRSA – 4 (trust on target)
CDT – 13 (significant reduction required)
VRE – 3 (significant reduction required)
The Board expressed concern at the failure of HPC to maintain adequate cleaning standards in public areas, as this not only represented a risk to infection control but also damaged public confidence in the service.
The timetable and process were discussed for assessment of performance against the existing contract and a possible re-tendering exercise. AT explained that data would be compiled at the end of December to establish benchmark levels and pricing based on the existing specification and for drawing up a new specification. The trust would arrange workshops for care groups and user groups to feed into the process. Final tendering documentation would be ready by March or April. MW queried whether the Board should also monitor this process in addition to the Executive Team. It was noted the process will be signed off at Board level.
MP noted that trust policies should undergo a revision process before their transfer onto Kwiki, the intranet directory.
The Board NOTED the trust’s position in relation to the report from the Healthcare Commission and the gap analysis and action plan.
07/185 / Report and actions from 25 September Governors/Directors Workshop
Jane Walters introduced the report. The Audit Commission’s report and action plan had been considered and supported by the Board of Governors the previous week. There were a number of actions to be implemented by both Boards and JW asked the Board to note the action plan and offer any comments.
The Board NOTED the action plan from the Governors/Directors Workshop.
07/186 / Constitution Issues
Jane Walters introduced the report. Now that King’s had been operating as a foundation trust for 1 year, it was an appropriate time to identify potential areas where the constitution could be refined and improved. Other FTs had followed a similar approach.
The intention was to address any issues arising out of the application of the constitution rather than a comprehensive review. These were listed in the accompanying table.
The Board of Governors had considered this paper recently and made some suggestions. JW invited the Board of Directors to raise any issues. Once solicitors had incorporated all the changes, a revised constitution would be presented to both Boards for approval before its submission to Monitor in March 2008.
MP queried whether the constitution specified that executive directors should not comment directly on the re-appointment of a non-executive director. JW responded that issues of process were covered in the terms of reference of the Nominations Committee, which oversaw NED and Chair re-appointments.
The Board NOTED the issues set out relating to the constitution.
07/187 / Application of the Formal Disciplinary Procedure
Mike Griffin introduced the report. The number of staff that were the subject of a disciplinary procedure in 2006/7 was a relatively small proportion of the workforce (1.8%). However, it was part of the trust’s duty to monitor employment practices to ensure that procedures are fairly applied. The report sets out some demographic factors which are connected with the application of disciplinary procedures, together with steps taken to ensure fairness of practice. These issues are kept under review by the Equalities and Diversity Committee.
Analysis of monitoring data carried out so far had identified the following significant factors:
- Ethnicity – BME staff represented 46% of the workforce as a whole but accounted for 70% of disciplinaries
- Grade – Staff in the entry grades 2 and 5 were the most likely to be subject to disciplinary procedures where the proportion of BME staff exceeded 60%.
- Age – a significant proportion of disciplined staff were under 25
- Length of service – staff with less than one year’s service
- Gender – more men than women were the subject of a disciplinary
The use of workforce procedures such as discipline and capability was on the increase, influenced by greater focus on performance, anti-fraud measures, behaviour standards, and the introduction of the Knowledge and Skills Framework.
Analysis of data from neighbouring NHS organisations showed that they also experienced a similar ethnic skew.
The Chair commented that the data and earlier publicity surrounding a certain case could be cited as evidence of institutional racism. MG responded that the report reflected the findings of our routine monitoring of practice, not complaints of unfairness. He advised that whilst a great deal of attention was paid to this issue and was frequently reviewed by different groups within the Trust, there was no evidence that the skew was due to a duality of standards.
MG advised that as part of the continuous review of this issue, ACAS would be carrying out some focus group discussions amongst the most affected groups to obtain more qualitative information.
MJ suggested that it might be useful to utilise an external agency, such as Ethnas or Focus Consulting to help the trust identify issues, particularly as ACAS, who were assisting the trust at present, might have their own institutional issues. Secondly, external support for the trust’s half day equality and diversity training might be of help. MP suggested using low cost or free resources for training interview panellists in equality and diversity. MG responded that internal resources were being used already.
MLL recommended the use of regression analysis of the variables identified. JM felt that accurate conclusions could not be drawn from such a small data set, therefore data from prior years should also be considered. MG responded that the quality of historic data may not be consistent enough for this purpose.
AM commended MG on the quality of the report. He queried whether staff
whopermanently absented themselves from work (18 in total) and who were predominantly BME, should be included in the figures. MG advised that because the Trust had to ‘dismiss’ the non-returners in their absence, they had to be included in the data. However, the important aspect of the use of discipline and capability procedures was to make clear the standards of behaviour and performance required and to assist staff meet these standards through prompt and appropriate intervention.
ST noted that the data did not suggest a general ethnicity issue as there were wide differences between different ethnic groups. He asked why doctors were so under-represented in the data. MG explained that trainee doctors were subject to a separate monitoring regime. MLL felt that there were weaknesses based on the rotation system and possibly a reluctance of the Deanery to threaten a trainee doctor’s career prospects.
Action:
To consider using additional specialist external resource to support the Trust’s action plans, including training on this issue. / MG
07/188 / Information Items
The Board NOTED the following:
Re-structure of Nursing/Operations
- The trust had consulted with the Joint Staff Committee on the proposed re-structure.
- Care Groups would become Divisions - a term more widely used within NHS trusts.
- A new post would be introduced for General Manager of Operations
- Some roles would be merged
- The trust’s mini MBA programme would include opportunities for Board exposure for senior managers
- There would be standing items on nursing and midwifery at key meetings including the Board of Directors
Unconfirmed Minutes of Committee Meetings
- Finance Committee – 06 November
- Governance Committee – 19 July
- Performance Committee – 11 October
- Finance Committee – 16 October
07/189 / Any other Business
None.
07/190 / It was resolved that the public should be excluded from the meeting whilst the remaining business was under consideration as publicity would be prejudicial to the public interest by reason of the confidential nature of the business to be transacted.
07/191 / Date of Next Meeting:
Tuesday 18th December 2007 at 2.00 pm in the Dulwich Committee Room.
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