THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST
Minutes of the Board of Directors Meeting held on 25th November2015
Part A: Public Session
Present:Mr K W Smith (Chair)Chairman
Professor C P DayNon-Executive Director
Dr B C DobsonNon-Executive Director
Mrs A DragoneFinance Director
Sir Leonard FenwickChief Executive
Dr P KestevenNon-Executive Director
Mrs H LamontNursing & Patient Services Director
Mrs L RobsonBusiness and Development Director
Mr D G StoutNon-Executive Director
Mr A R WelchMedical Director
In Attendance:
Mr S R ReedTrust Secretary
Mrs J Moon Head of Patient Safety & Risk (minute ref.15/155(ii) only)
15/151Apologies for Absence
Apologies were received fromMrs H A Parker,Non-Executive Director and
Mr E Weir, Non-Executive Director.
15/152Declarations of Interest
There were no declarations of interest on this occasion.
15/153Minutes of the Meeting held on 28th October 2015
These wereagreed to be a correct record, subject to amendment of minute ref. 15/137(i) to read “… was moving to Clinical Commissioning Groups and then ultimately the direction of travel was likely to be to Local Authorities…”.
15/154Strategic Issues
i)Report of the Chief Executive
Sir Leonardspoke of a number of topics of current interest. It did appear that NHS Foundation Trusts were under threat nationally, with extensive reach-in and micromanagement which was proving to be very obstructive and occupied a great deal of Executive Team time.
With regard to the threatened junior doctors and dentists industrial action, it was noted thatcontingencies were in place. It was disappointing that future clinical leaders were likely to go so far as to strike. Mr Welch thought that matters had been handled ineptly at national level. Currently the proposal was that the action set for 1st December 2015 and lasting for 24 hours would be for junior doctors to work as if on-call only and hence only see and treat emergency case. The proposed second and third days of action were likely to be eight-hour strikes. Circa 700 staff could be involved, amounting to around half of the Medical & Dental workforce. The priority for the Trust was securing patient safety and contingency measures were in place in this regard. It was noted that there was a great deal of support for the junior staff and the proposed industrial action from senior medical staff. The attempt to alter the junior doctors’ contract nationally was seen as a further step to breaking upthe NHS. Where necessary, juniorstaff had cooperated in training seniors in areas such as e-Prescribing and there were no great concerns regarding patient safety.
Given the ever-tightening financial constraints on the NHS, the Trust continued to seek best value as far as it could. With regard to the scope for redevelopment of land in its control, the Trust was making steady progress, including at the Campus for Ageing and Vitality,where grant aid had been received from government via Newcastle City Council and Newcastle University.
Increasing emergency caseload presentation was having significant effects on the Trust, including the impact of patients from the Tyne Valley and North Tyneside. In consequence the Emergency Department and Emergency Assessment Suite were both experiencing overcrowding, there was more boarding out of patients andadditional costs were being incurred. The role of the North East Ambulance Service appeared to be varying from the agreed protocols, albeit in favour of patient safety. Allied to this, winter pressures were adding to already stretched capacity and the Trust could ideally do with more beds.
It was noted that the Care Quality Commission had issued its second document call for the January 2016 inspection and the volume of material was likely to run into hundreds, if not thousands, of files.
Sustaining innovation and service delivery was occupying the Executive Directors. Nurse staffing recruitment continued to be a national challenge and the picture locally was little different. There was undoubtedly a case for decentralised Education & Training for the profession. In this context, the Chairman commented that the Trust was still providing high quality care and ensuring patient safety and a good experience and, in the face of significant challenges, was still a success story. Once the Specialist Emergency Care Hospital had Cramlington had been built, it had always been maintained that Tyne Valley patients would go to the Royal Victoria Infirmary. The Great North Children’s Hospital had continued to flourish.
Attention was drawn to a number of key impact documents received from government and regulators. The Care Quality Commissionhad published its five-year strategy. The Nuffield Trusthad also published a five-year strategy in terms of policy for health and social care. NHS England had issued a series of Quick Guides for preparing for winter. With regard to Learning Disability care, a three year implementation plan had been announced and Sir Leonard highlighted that the Trust took this field of service provision very seriously.
The Department of Health had published a response to the consultation in the summer on pricing. Mrs Dragone advised Directors that there had been little chance for comment, and, worryingly, the ability of Foundation Trusts to object to tariff proposals had effectively been taken away. An impact assessment would be presented in January 2016. The Chairman commented that NHSEngland should either fix an appropriate tariff; or be honest about what would no longer be provided nationally. Sir Leonard noted that many professionals did understand the detail of tariff and how it was applied and the proposed amendments were likely to cause further damage to major specialist centres like Newcastle.
The King’s Fund and NHS England had produced a report on Diversity and Inclusion in the NHS and the opportunities to benefit from a wider pool of talent and ability through better engagement with minority groups.
Eight key priorities for cancer service performance had been published by NHS England, monitor and the NHS Trust development Authority. Mr Welch commented that these targets were now 15 years old and effectively out of date. Holding listening events on an amended breach allocation processwas unlikely to be helpful when the real issue was very late referrals to Newcastle by other Trusts.
The pressure to meet targets meant that there was a risk that clinical priorities could be distorted, often due to the tight timelines for diagnostic investigations. 62-day breaches in the Trust were only due to referrals received on or after 42 days. The Trust had breached for the first time in August 2015 but that patient had been referred after 62 days. The situation was likely to continue due to the late referrals from neighbouring Trusts. Sir Leonard added that the Shelford Group waspressing at nationallevel for a fairer and more pragmatic process.
With regard to the devolution proposals, it was noted that the North East Combined Authority din not include either North or South Tees. A commission had been established and was to report by summer 2016. The Chairman noted that, while Manchester was one Northern Powerhouse, the North East was currently split in two, both with elected mayors. The timetable for the commission was tight and the context was complex. Mrs Robson advised Directors that the first meeting of the Commission had been set for 26th November 2015 and the Trust would be represented. There were wider issues to consider, including the workload undertaken for NHS Scotland.
A new national whistleblowing policy was out for consultation until 8th January 2016. The Chairman highlighted the Trust culture of openness and the desire for the word “whistleblower” to be unnecessary within the organisation.
Finally, it was noted that the Care Quality Commissionwas consulting on its fee structure for 2016/17. It was inevitable that they would be increasing and for a Trust of this size the fees were likely to be in six figures.
15/155Safety, Quality and Performance
i)Healthcare Associated Infections
Mrs Lamont advised of the position as at the end of October 2015. In the past month, there had been nine cases of Clostridium difficile, bringing the year-to-date total to 49 against a year-end target of 77. However, seven cases had been appealed successfully and a further eight were being considered for appeal.
Regrettably there had been seven MRSA bacteraemia cases reported in the year to date, including two in October. However, only one of these had been attributed to the Trust and for the other the Trust was seeking to have it assigned to a third party. The Chairman reminded Directors that the Trust took MRSA seriously,including ensuring that Root Cause Analysis was carried out for every case.
Mandatory training rates were noted to be improving and further effort would continue to be focused in this area, in order to drive achievement of the very demanding target of 95% overall. The current rate was 85%.
C. diff. awareness roadshows had been mounted for clinical staff in inpatient areas. The staff flu vaccination rate to date was 28.58%, ahead of the level achieved at the same time lastyear (25.9%). It was highlighted that the voucher scheme for staff, in partnership with Lloyds Pharmacy, made it difficult to capture and count those cases where staff had received their vaccination other than on Trust premises.
It was resolved:
to receive the briefing and note the current position.
ii)Quality Report
Mrs Moon, Head of Patient Safety & Risk, was in attendance and presented the report for October 2015. Patient falls had been below both local and national target levels, which was encouraging but still contributed to reportable Serious Incidents. While there had been some increase in Medication incidents,this was attributed in large measure to a recent drive to improve reporting rates. There had been no ‘never events’ since Quarter 1 of 2015/16.
It was highlighted that four of fiveradiation incidents had occurred in the Northern Centre for Cancer Care. However, the Care Quality Commissionwas not concerned, albeit one patient should not have received an x-ray. Dr Dobson advised Directors that the Health and Safety Committee encouraged reporting of near-missesand asked whether they were included in the report. Mrs Moon advised that they were not but the Radiation Protection Committee examined each and every case in detail. Mr Welch added that the Northern Centre for Cancer Carereporting rate had increasedin consequence of the introduction of stereotactic radiotherapy, where repositioning scans were required if the patient moved by even a few millimetres.
Sharps and needlestick injury rates were improving. The Standardised Hospital Mortality Indicator was still below the national average, notwithstanding that the index had been increasedto reflect last winter’s raised death rate.
The Chairman commented that it was pleasing to see the Trust patient falls target (which was tougher than the national standard) being achieved.
It was resolved:
to receive the briefing and note the current position.
iii)Clinical Assurance Toolkit
Mrs Lamont presented an overview. Trend information on the overall CAT scores showed that these had been consistently between 94% and 95% in recent months. October’s overall CAT score had been 95%, which meant that scores had not been adversely affected by the usual six-monthly question changes. Staff Knowledge was now at 89%, following changes to the wording of some questions to reflect feedback from clinical staff.
Each month an aspect of CAT was analysed in more detail. This month the focus had been on the Theatres questions at a Trust level. Scores for these questions were high, which demonstrated that appropriate pre-operative checks had taken place and that appropriate post-operative action had been taken for any infectious patients.
An overview was received of the areas with red scores for two consecutive months which had been escalated to Matrons in 12 areas. Cleanliness checks had been red in only one area for the two months ending October 2015.
Details were given on progress in the Acknowledging Continual Excellence (ACE) Awards. In consequence of renewed publicity about the scheme, a number of Matrons had now begun the process of applying for ACE Awards for their areas.
The Chairman commented that the CAT report wasa very valuable and useful report for the Board, drilling right down to ward level and facilitating rapid intervention and support where called for.
It was resolved:
to receive the briefing and note the current position.
iv)Nursing and Midwifery Monthly Staffing Exception Report
Mrs Lamont introduced the monthly report. Attention was drawn to the continuing difficulties in recruiting to establishment, although fill rates, particularly for night shifts, had been slowly improving through the year.
An update was received regarding the Nursing and Midwifery Staffing Reviews. Thesehighlighted that, having carefully reviewed and considered all staffing data,
the Nurse staffing establishments were fit for purpose in the majority of inpatient areas. Further work was required in Medicine, Critical Care, Urology, Special Care Baby Unit and Children’s services.
An update on Planned and Actual Staffing average fill rates was received, which remained constant, with a slight increase in the Registered Nurse fill rate. Wards continued to prioritise Night shift over Day shift where fewer staff were available.
The Trust’s Facebook presence continued to be well-used and was achieving national and international awareness of employment opportunities. In this regard, it was highlighted that 34 Filipino nurses would be joining the Trust on 30th November 2015. There was now a drive to establish local training programmes in the Trust, to compensate for national shortcomings. Sir Leonard highlighted that the Trust was held to account for staffing levels but that there were continuing national constraints on training places. The nurses from the Philippines were well trained and the original cadre who had arrived ten years ago were largely still here. There had been good media coverage nationally of the successful recruitment.
Dr Dobson asked about nurse staffing retention. The Chairman replied that on a recent leadership walkabout he had met anursefrom South Tyneside who had expressed trepidation at moving in to the Trust but was now a strong advocate for Newcastle. Anecdotally,retention was reasonable and indeed in recent times a number of staff who had left to work in neighbouring Trusts had subsequently returned. A specific metricfor retention was to be developed. Mrs Lamont drew attention to the internal transfer scheme which was now available for Trust staff.
It was resolved:
to receive the briefing and note the content.
v)Patient Experience
Mrs Lamont presented the report, including thelatest Friends and Family Test (FFT) dashboard, setting out an overview of the results for September 2015. The Complaints Management dashboard, as presented to the Complaints Panel in November 2015, was also received, along with the Real Time Patient Feedback data for October 2015.
Key points of note included a summary of changes in Complaints Management.
Survey activity had shown positive results in a number of patient audits, in the Central Operating Department (Freeman Hospital), Pharmacy and the nurse-led thyroid cancer clinics.
Telehealth developments were described, along with their positive impact on the patient experience.
The national report on BAME equity had been analysed and the Trust’s work in addressing the identified issues was enumerated.
The FFT results from September 2015 had been as follows:
-98% of inpatients would recommend the Trust (1% would not).
-89% of ED attendees would recommend the Trust (7% would not).
-98% of maternity patients would recommend as the place to give birth (0% would not)
-97% would recommend the Postnatal ward (1% would not)
-100% would recommend the Postnatal Community Service
-94% of Outpatient would recommend the Trust (2% would not)
-100% of patients receiving community services would recommend the Trust
While these scores were good, it was highlighted that the response rates had been falling through the summer but had picked up somewhat in September. With regard to theEmergency Department scores, it was noted that 7% of attenders would not recommend Newcastle. However, this was based upon a very small proportion of a small number of respondents. It was recognised that there did need to be explicit identification of any recurrent themes. Mr Welch thought that there was also a risk of self-selection amongst this patient group.