MINUTES OF THE 24th MEETING OF THE COUNCIL OF GOVERNORS OF THE
ROYAL DEVON & EXETER NHS FOUNDATION TRUST
Held on 20 January 2010 at 1400 in
The FlyBe Suite, St James’ Centre, Exeter City AFC
Present: / Apologies:Angela Ballatti - Chairman / Peter Halse – East Devon District Council
Paul Nielson – Mid, North, West Devon & Cornwall
Public Governors / Dianne Pearson – Mid, North, West Devon & Cornwall
East Devon, Dorset & Somerset: / Did not attend:
Jean Clark / Mark Overton – Peninsula Medical School
Christopher D’Oyly / Mike Jeffreys – Medical & Dental
Jill Gladstone
Malcolm Harrington
Linda Vijeh (for Items 5 - 10)
Stan White / In Attendance:
Linda Fryer (for items 1-9)
/ Jeff Chinnock – Divisional Manager Corporate AffairsExeter & South Devon: / and Communications
Keith Broderick / Bernadette Coates – Membership Services Manager
Kate Caldwell / Angela Pedder – Chief Executive
Rachel Jackson / Suzanne Tracey – Director of Finance and
Imraan Jhetam / Business Development
Brian Perriss / Richard Schofield – Service Manager, Corporate Affairs
Richard May /
Marie-Noelle Orzel – Director of Nursing & Patient Care
Mid, N. W. Devon & Cornwall:
/ Lynn Lane – Director of Human ResourcesMartin Perry / Vaughan Pearce - Joint Medical Director
Dianah Pritchett-Farrell / David Bishop – Senior Independent Director
Cynthia Thornton
Appointed Governors:
Bob Deed – Mid Devon District Council (for items 1-10)
Derek Hathaway - Devon PCT
Norman Shiel – Exeter City Council (for items 1-9)
Staff:
Tony Cox - Allied Health Professionals
Monica Overy – Nursing & Midwifery
Loveday Varian – Admin, Clerical & Managers
Jason Maddocks – Hotel Services & Estates
Item / Minute
1. / 280.10 / APOLOGIES AND QUORUM CHECK
Apologies were noted as listed above. The meeting was confirmed quorate.
2. / 281.10 / DECLARATIONS OF INTEREST
There were no new declarations of interest.
3. / 282.10 / SECRETARY’S NOTES
The Secretary reported the following:
1) The Foundation Trust Network is holding a South West Governor event in Bristol on Friday 5 February. Information had been sent out regarding this to Governors.
2) FTGA – the latest Essential Brief from the FTGA, on NED and Chair appraisal, was tabled at the meeting.
3) Governor Effectiveness Questionnaire - the Executive Summary from the recent governor effectiveness questionnaire was tabled. The full results are available on request.
4) Council of Governors pre-meeting – it was proposed by the Steering Group that Governors meet prior to CoG meetings in order to discuss the agenda. All governors are invited.
5)‘Medicine for Members’ - a successful talk took place on 12 January. Despite the cold weather, 50 members attended to hear Mr Ian Daniels, Colo-rectal surgeon, and Joan Garwood, Nurse Specialist, talk on bowel cancer.
6) Governor Representatives on the Involving People Steering Group - Rachel Jackson and Stan White are currently the CoG representatives on the Involving People Steering Group. As both Mrs Jackson and Dr White come to the end of their terms during 2010, there is a need to plan their replacements on this Group. The next meeting is 24 March 10.30-12.30 and it is requested that two Governors put themselves to forward to shadow Rachel and Stan and attend this meeting. Any Governors interested in this role are asked to contact the Corporate Affairs Office by 29 January.
The Council of Governors noted the Secretary’s Notes.
4. / 283.10 / CHAIRMAN’S REMARKS
1. New Governor
Since the last meeting, Cllr Peter Halse had been nominated by East Devon District Council as their representative on the Council of Governors. Unfortunately he was unable to attend the meeting. Ms Ballatti formally welcomed Cllr Halse to the Council of Governors.
2. December Board Development Day
The joint meeting held with the Board on the 17 December to discuss stakeholder engagement was well attended and a useful meeting. The discussion on stakeholders and their engagement is an important part of the on-going strategy review process as well as the local input into our Quality Accounts.
3. Non-Executive Director Recruitment
An open evening for people in interested in applying to become a NED is being held on the evening of 27 January. The Board and members of the Nominations Committee have been invited to attend.
The Council of Governors noted the Chairman’s remarks.
5. / 284.10 / MINUTES OF LAST MEETING / MATTERS ARISING
The minutes of the meeting held on 7 October 2009 were approved and signed as a true record subject to the following amendment:
Minute 275.09 – Attendance Committee – should read “The proposal was agreed by the Council”.
Matters arising:
Martin Perry queried the Devon County Council vacancy on the Council of Governors as had been vacant for several months. Ms Ballatti asked the FT office to look into this matter.
ACTION: FT Office to contact Devon County Council regarding their vacancy
Minute 275.09 – Keith Broderick said that the time commitments for each of the CoG committees was not included in the document that was circulated.
ACTION: FT Office to add time commitments to descriptions of CoG committees.
Minute 276.09 – Community Theatres. Jill Gladstone asked how the Community Theatres project was progressing. Angela Pedder, Chief Executive, replied that it was progressing well and was due to be in place by 1 April 2010.
6. / 285.10 / CHIEF EXECUTIVE’S PUBLIC REPORT
Angela Pedder gave a verbal update to the meeting.
1) Marie-Noelle Orzel leaves her post as Director of Nursing and Patient Care on 7 February. Jane Viner, Deputy Director of Nursing, has been appointed as Acting Director of Nursing. The post is currently being advertised.
2) Upper GI – the transfer to Plymouth had gone well with service arrangements in place. Patients are now having surgery there.
3) Gynaecological cancer service review– there had recently been a 2 day peer review of this service at the Trust. The service was deemed to be an exemplar to be followed and has been designated as a specialist centre. The review has recommended Cornwall as the second designated centre, a decision which will now go to the Overview & Scrutiny Committee.
4) Head & Neck cancer service review – this new service at the Trust had also been peer reviewed but the report had not yet been finalised. A decision about designation was also still to be made. An update will be given at the next Council of Governors meeting in April.
Malcolm Harrington asked, following the three recent cancer service reviews, if any more were due to take place? Mrs Pedder replied that there was a national programme of peer review and the recent reviews have ensured that the Trust is up-to-date within that rolling programme. The next designation review is for Sarcoma and the Trust have expressed an interest in being a centre for this. The Board of Directors will discuss whether or not the Trust is in a position to bid for it.
Stan White asked if Minimally Invasive Oesophagectomy (MIO) was available in Plymouth now that the Upper GI service had moved. Mrs Pedder replied that the surgery was taking place in Plymouth but that it had ceased in Exeter. Patients from October onwards had been informed about the change in location of the service and will not have had the expectation of MIO surgery.
ACTION: Update on Head & Neck cancer service review to be given at April CoG
5) Care Quality Commission (CQC) – legislation required the Trust to register all its activities across the Peninsula. It was a major undertaking which involved mapping the Standards for Better Health across to the registration application. The application will be submitted on 29 January. The Trust plans to fully register and to declare full compliance with the regulations. Feedback will be received from CQC at the end of March.
6) Infection Control - for 2010-11 there will a different method of counting infections. For example, the C. Difficile rate will be measured per 1000 bed days. The Trust is currently amongst the top 10 best performing Trusts using this measure.
7) NHS Devon’s new Chief Executive, Ann James, started on 1st January and Mrs Pedder said the Trust was looking forward to working with her on the challenges ahead.
7. / 286.10 / QUARTERLY PERFORMANCE UPDATE
OPERATIONS
Mrs Pedder presented the quarterly update, highlighting the following key issues:
Hospital Acquired Infections
Good progress continues to be made against infection control targets. There were 4 incidences of MRSA up to the end of November against a target of 18. In terms of C. Difficile, the performance continued to be strong with 66 incidences against a target of 183. The strategic aim continues to be no hospital acquired infection.
Cancer waiting times
Mrs Pedder informed the meeting that the Trust was fully compliant with the targets. In response to a questions from Linda Vijeh about the patients who are not seen within the expected timescales, she explained that some patients ‘fail’ a waiting time target due to the diagnosis of cancer coming during their treatment pathway. Some patients will fail due to choosing a different treatment date to the one offered. There are also occasions when the resources cannot be put in place in time. All patients who are affected by delays are managed on a case-by-case basis and the Trust is aware of the impact the delays can have.
Emergency Department (ED) 4 hour waits
Both the Trust and the whole health community were struggling during November and December to meet the 98% target. This will be flagged in the Trust’s quarterly return to Monitor. Issues having an impact have included the bad spell of weather and increased numbers of attendances. Mrs Pedder reported that between 28 December – 4 January there was a 28% increase in attendance at ED, coming at a time of delayed discharges due to the weather and Norovirus. She reported that January had seen a slightly improved situation and that the Trust expected to be on target overall at year end.
Referral to Treatment times
Mrs Pedder confirmed that the 18 week Referral to Treatment target will be in place by March 2010 for all specialties; however there are difficulties within orthopaedics as this speciality had been significantly impacted on by the winter pressures and cancelled operations.
Cancelled operations
The figures for cancelled operations had improved during December but the target of 0.8% was unlikely to be met at year end. Mrs Pedder confirmed that the Trust do re-admit patients within 28 days if their operation is cancelled on the day. The Trust is very mindful of the disruption a cancellation can cause. She stated that during the period 28 December – 4 January, 260 more patients were admitted than during the same time last year. Emergency admissions are given priority and this can lead to cancellations.
Current capacity pressures
Mrs Pedder said that Norovirus, the winter vomiting bug, had caused several wards and bays to be closed to new patients. This had led to around 50 beds being blocked or empty due to transfers being unable to take place. The adverse weather conditions during late December and January had seen a significant increase in attendance at the Emergency Department, particularly with fractures. The weather also caused short-term difficulties in transferring patients out of the RD&E. There had also been an increase in predominantly elderly medical patients having to be moved to surgical and orthopaedic beds, impacting particularly on orthopaedics 18 week target.
In order to manage these pressures the Trust was providing more cleaning staff to deep clean wards affected by Norovirus to ensure they were re-opened as quickly as possible. Additional medical and nursing staff have been deployed at weekends and evenings in the Emergency Department and Trauma and Medical wards. Ward rounds were being rolled out across the Trust. Additional bed and day case areas have also been opened as an exception with extra capacity for elective orthopaedic work being made possible by a Vanguard mobile theatre and ward. The Trust is working hard to maximise the number of patients being treated and is hopeful of a return shortly to a normal elective pattern.
Dianah Pritchett-Farrell asked about the role of Devon Health & Social Care Complex Care teams. Mrs Pedder replied that they were a Multi Disciplinary Team, set up by Devon Provider Services, who assess patients in hospital before deciding whether they should be discharged to home or a community facility. She also explained that discussions were being had around the criteria for GPs to admit patients directly to community hospitals. This would avoid unnecessary admission to acute care and led to a more integrated system of care.
Keith Broderick asked for clarification on ward rounds. Mrs Pedder replied that Consultants undertake ward rounds at the start of each day. Between ward rounds it is important to ensure that was said is done or any issues raised are resolved. An initiative is therefore being rolled out across the wards to ensure that problems are dealt with rather in a timely manner rather than waiting until the next ward round.
Richard May asked in relation to Emergency Department waiting times if the RD&E transferred patients out of the department and into transition areas in order to ensure the four hour wait was met. Mrs Pedder replied that the RD&E did not do this and was in fact very strict in how it deals with the four hour wait.