Mr Grahame Paine(GRP)Chairman (V)

Minutes of the Trust Board in Public Meeting of Weston Area Health NHS Trust held on Tuesday 5 May 2015 at 10.00 am in the Executive Board Room,

Weston General Hospital

Present:

Mr Grahame Paine(GRP)Chairman (V)

Mr Nick Wood(NW)Chief Executive (V)

Ms Bronwen Bishop(BB)Director of Strategic Development (V)

Mrs Karen Croker(KC)Director of Operations

Mrs Sheridan Flavin(SF)Director of Human Resources

Mr Rob Little(RL)Director of Finance(V)

Miss Bee Martin(AGM)Executive Medical Director (V)

Mrs Brigid Musselwhite(BM)Non Executive Director (V)

Mrs Christine Perry(CP)Director of Nursing (V)

Dr George Reah(GRR)Non Executive Director (V)

Mr Ian Turner(IT)Non Executive Director (V)

Mrs Gillian Hoskins(GH)Associate Director for Governance and

Patient Experience

Mrs Margaret Blackmore(MB)Vice Chair, Patients’ Council

(V) Denotes Voting Director

In Attendance:

Mrs Julie Fisher(JEF)Executive Personal Assistant

(Minute-Taker)

Mrs Rebecca Rafiyah Findlay(RRF)Head of Communications

988.15WELCOME AND APOLOGIES FOR ABSENCE

GRPextended a welcome to Mrs Margaret Blackmore (MB), Vice Chair of the Patients’ Council and Mr Tim Evans (TE), Healthwatch Representative.

The following apologies for absence were noted:

Mr Geoff Pye Chair, Hospital Medical AdvisoryCommittee

Mr Nathan MeagerChair, Patients’ Council

Delyth Lloyd-EvansChair, North Somerset Community Partnership

DECLARATION OF BOARD MEMBERS’ INTEREST

There were no declarations of interest to note.

CONSENT AGENDA

989.15MINUTES AND MATTERS ARISING FOLLOWING THE TRUST BOARD MEETING HELD ON TUESDAY 3 MARCH 2015

The Minutes of the Trust Board Meeting held on Tuesday 3 March 2015 were agreed as a true and accurate record subject to two amendments:

Item 977.15 – Business Planning 2015/16: Update (Page 11)

3rd Paragraph: “GRP raised a point ….” to be removed.

Item 983.15 – Date of Next Trust Board Meeting (Page 15)

To include “Meeting” after ‘Open’ Session.

Resolution:
The Minutes of the Open Session of the March 2015 Trust Board Meeting were APPROVED as a true and accurate record of the meeting.

The Table of Matters Arising had been reviewed and updated following the meeting held on Tuesday 3 March 2015, with a further update provided as follows:

Minute Reference 976.15 – Integrated Performance Report

Section 5 – Finance Report

RL advised that the Capital Planning Committee had met on Tuesday 28 April 2015 to agree the key actions for further development.

BM asked as to whether there was capacity within the Estates Team to deliver the 2015/16 Capital Plan, to which RL responded acknowledging the challenge and confirming a number of options were being considered.

In relation to the Theatre Refurbishment, KC advised that an external Project Manager has now been appointed which has released some of the demand placed on the Estates Team.

MINUTES FOLLOWING THE EXTRAORDINARY TRUST BOARD MEETING HELD ON TUESDAY 31 MARCH 2015

The Minutes of the Extraordinary Trust Board Meeting held on Tuesday 31 March 2015 were agreed as a true and accurate record subject to one amendment:

Item 987.15 – Date of Next Trust Board Meeting (Page 3)

To include “Meeting” after ‘Open’ Session.

Resolution:
The Minutes of the Extraordinary Open Session of the March 2015 Trust Board Meeting were APPROVED as a true and accurate record of the meeting.

There were no Table of Matters Arising for review.

QUALITY, PATIENT SAFETY AND PERFORMANCE

990.15CHIEF EXECUTIVE’S REPORT

NW noted the Trust’s efforts in reversing the normal seasonal trend for 18 week RRT waits; this has been recognised by the NHS Trust Development Authority and is a considerable achievement given the tight timeframe and other operational pressures which we have faced over the last few months. Furthermore the Trust is now assisting Taunton and Somerset NHS Foundation Trust and other local Trusts in reducing their waiting times.

BM acknowledged this as a tremendous achievement for the whole Team.

In readiness for the Care Quality Commission Inspection in May 2015, NW has now commenced a series of Roadshows which will be held throughout various wards and departments within the Trust with the aim of alleviating any concerns and anxieties of staff.

GRR referred to the statement raised by a member of staff at one of the Team Brief Sessions: “We underestimate how good we are!” suggesting that this might be reflected within the Chief Executive’s Presentation to the Care Quality Commission.

In acknowledgement to Helen Anderson’s recent Award success, GRR thought it would be opportune to publicise in the Main Entrance, subject to Helen’s permission. RRF was asked to take this forward.

Resolution:
The Trust Board NOTED the Chief Executive’s Report.

991.15INTEGRATED PERFORMANCE REPORT

Section 1 – Executive Summary

NW introduced the Executive Summary focusing on the improved performance on a number of clinical and performance indicators at the yearend despite a number of challenges.

Financially, the Trust has overachieved on its original plan which outlined a projected £4.95m deficit; this has been improved in year with the actual confirmed as a £3.902m deficit which is an improvement of £1.048m on the Plan.

The focus on efficiency plans throughout the year have resulted in the Trust’s Savings Plan of £4.5m for the year being delivered, achieving £4.504m.

KC acknowledged the significant winter investment within the Emergency Department, which was to ensure safe staffing of the department, however despite this investment delivery of the Emergency Department target remains challenging.

Section 2 - Quality and Patient Safety

CP presented the Quality and Patient Safety section of the Integrated Performance Report, drawing reference to the Patient Story relating to post-operative care on Steepholm Ward. CP was able to assure the Board of recruitment into a Pain Relief Nurse role which had been identified as an action.

BM was keen to receive further detail in respect of the learning and actions taken from this story. AGM was able to confirm that feedback of all investigations and incidents is provided to clinical staff along with the Deanery who ensure that this is included within Doctors’ ‘reflective practice’ as part of the mid and end of year reviews. BM asked if the Doctor within this story had made an apology to the patient which AGM was unable to confirm, although a formal apology had been made by the Trust. BM asked whether the patient had been satisfied with the Trust’s response and the subsequent action taken. CP responded advising that the patient’s satisfaction to the action taken was unclear however she would ensure that this is followed through and furthermore would ensure that this level of detail is included within future Patient Stories reported to the Trust. CP added that patient feedback can also be deemed ‘anonymous’.

CP referred to the measures which have been in place over the winter period as detailed within Section 2.3 ‘Nursing Metrics’. CP noted two errors within Figures 2 and 3 on Page 13 of the report – ‘Staffing Numbers Achieved’ which for ITU should read 100%.

The Board’s attention was drawn to the 750 patient incidents reported in February and March 2015 with the top three themes confirmed as pressure ulcers, falls and medication. On closer inspection the Trust has seen an increase in incidents reported under: Access/Admission/Transfer, Documentation and Slips from a height/chair or bed.

There was a total of 87 staff incidents reported in February and March 2015. CP noted theintroduction of a Working Party, which was one of the recommendations taken from the Staff Survey, and an area for which the Trust had agreed to concentrate its efforts.

In reviewing the complaints received within the Trust, CP advised that one new complaint had been referred to the Complaints Ombudsman in March 2015. CP added that changes within the operational structure will have a significant positive impact in the future management of the complaints process.

An acknowledgement was made to the cases processed by the PALS Team during February and March 2015 and the noticeable increase in issues raised regarding medical care which mirrors the theme for formal complaints. CP and AGM were able to assure the Board of the early actions which are in place to mitigate these concerns.

The Trust’s engagement within the Friends and Family Test has shown that for the month of March 2015 many areas had achieved 100% of people recommending our NHS service. The National CQUIN standard for the response rate was also achieved for the year with the Trust having met each milestone agreed and also for the last quarter.

In reviewing Infection Prevention and Control performance, CP reported on the outbreaks of Norovirus which have continued to have a major operational impact on the Trust throughout both February and March 2015, with 21 separate Norovirus outbreaks reported during this financial year compared to 11 in 2013/14. Levels of gastroenteritis in the local health community have also been much higher than the national average since December 2014.

The Trust had no reported incidents of Clostridium difficile in March or April 2015 and the focus on the Antimicrobial Stewardship Programme continues with compliance now at 92%, its highest recorded compliance.

The Board will receive a more detailed brief within the ‘Healthcare Associated Infection Update Report’ which CP is presenting at the ‘Closed Session’.

CP acknowledged today as World Hand Hygiene Day, passing thanks to the Patients’ Council who are participating in this event within the Main Reception area.

GRR noted the Trust’s failure to achieve the ‘Two Week Cancer Wait’ (Line 26 of the Summary Scorecard) for the last three months. KC responded advising that firstly, a number of patients had been unavailable to attend their appointments which is being addressed with Primary Care; and secondly, an administration error had occurred during February which had resulted in the breach of five out of 40 patients, fortunately all were eventually confirmed as not having a diagnosis of cancer. KC assured the Board that steps have since been taken and staff have been retrained accordingly.

Action:
GRP referred to the emerging theme for medication errors with 11 out of a total of 34 complaints involving medication being reported, and asked how this can be improved. CP agreed to provide specific detail, along with a summary as to where our actions have been focused, within the next iteration of the Integrated Performance Report.
By Whom:
Christine Perry

Section 3 - Operational Performance

KC presented an update on Operational Performance, with the key headlines as included within the Executive Summary.

As illustrated within Figure 13 of the report, KC was pleased to report that emergency readmissions within 14 and 30 days continue to improve, and although there was a slight rise during March 2015 numbers are still low for the year to-date.

The Trust had seen a drop in the average Length of Stay to 2.5 days in March 2015 which is encouraging and reflective of appropriate care planning and the focus on discharge throughout inpatient areas. In addition to the work streams already underway as part of the Trust’s Business Plan, the Operational Teams are focussing on optimising the ward board rounds.

The 62 days Cancer standard had been achieved for February and March 2015 and Quarter 4, although the Trust had failed to meet the Upgrade standard for the same period due to one breach. The Trust’s active participation in the BNSSG Cancer Strategy Group is helping to gain a better awareness of likely peaks in demand to assist with capacity planning, and this group is also leading on pathway work between the Trusts.

Although the Trust had achieved the stroke target of patients diagnosed with a stroke spending 90% of their time on the Stroke Unit in February, the target had been missed in March 2015 as a result of the Stroke Unit being closed during the month to new admissions following an outbreak of Norovirus. KC advised that in instances of outbreak on the Stroke Unit, beds on the High Care Unit are allocated with Medical Teams providing specialist care and support to diagnosed stroke patients. February had seen an elevated number of Stroke patients admitted, with six additional beds being opened on the Stroke Unit in order to provide the best care possible for these patients.

KC advised that achievement of the Emergency Department four hour standard has proved a huge challenge since July 2014 with a yearend reported position of 92.55%. This has been as a result of two key factors: outbreaks of Norovirus and increased Length of Stay for patients especially those over 80 years old causing issues with patient flow throughout the Trust; and an increase in activity out of hours of both walk-in patients and ambulance arrivals.

KC referred to the actions being taken, one of which is today’s launch of the ‘Bouncing Back to Green’ week which aims to focus on patient flow. This will also provide an opportunity to look at the Discharge Lounge and the number of discharges before 12.00 noon which is reportedly low.

KC added that daily North Somerset System Escalation calls are continuing along with daily Leadership Briefings within the Emergency Department. Externally issues have been identified with Social Care, nursing home beds and lack of domiciliary care package providers.

The Trust continues to deliver the RTT targets. The challenge has now moved to Choose and Book with the Trust having missed the 96% target for Choose and Book slots in February and March 2015.

KC drew the Board’s attention to a new inclusion within the ‘Operational Performance’ section of ‘Bed Stock’ with the Trust’s usual funded bed base confirmed as 234. However, as part of the winter plan this was increased between October 2014 and March 2015 to allow for a further 20 impatient beds, currently located on Cheddar Ward, which have remained open until the end of April 2015. KC was able to confirm that the six unfunded beds which had been consistently in use on the Stroke Unit during February and March have now been closed.

Section 4 - Workforce

SF introduced the Workforce Report with the headlines as included within the Executive Summary.

SF was pleased to report on a very successful open evening held in January 2015 which had specifically targeted newly qualified Nurses. The Trust had been successful in appointing ten students from the University of the West of England who will complete their Nursing Degrees in June and will receive their Nursing and Midwifery Council (NMC) PINs in September 2015. It is anticipated that these staff will commence employment with the Trust in July whilst awaiting their NMC registration.

SF provided the Board with a progress update in respect of recent medical recruitment appointments along with the Consultant Interviews which are scheduled over the next three months.

Sickness absence remained high in both February and March 2015, although the Trust’s sickness rate has fallen below the national average. As recently reported through the Quality and Governance Committee, an Action Plan is now in place to reduce sickness absence through effective but supportive management of sickness absence and employee health issues.

The Trust’s Statutory and Mandatory training compliance was 83.26% in March 2015 against a target of 90%. As previously reported to the Board, the Trust had taken a decision to apply formal action against staff who are a year or more out of date with one or more of their core training requirements. Of the 127 staff to which this had applied, SF confirmed that 109 are now fully compliant, with 16 fulfilling their training requirements since publication of this report and therefore only two who will be subject to disciplinary action. SF confirmed the continuation of this process.

The Appraisal compliance rate rose again in March 2015 to 88.24%, with the Trust consistently achieving above the 85% target for the past ten months. SF added that the focus has now moved to the quality of the Appraisals being undertaken.

SF drew the Board’s attention to Figure 27 of the report which outlines the various overseas recruitment activities which have taken place over the last couple of years and clearly demonstrates a higher dropout rate of candidates in more recent campaigns when compared to our successful recruitment campaign in Spain in 2013. Recognising the competitiveness of the recruitment market, both nationally and internationally, the Trust is now working on a partnership arrangement with another Hospital in Europe, with a recruitment event scheduled to take place in May 2015.

Section 5 - Finance Report

RL presented the Finance Report for Month 12 with the Trust reporting a deficit of £3,902k which is an improvement of £1,048k compared to the plan. RL extended his thanks to the various Teams in helping the Trust to secure this yearend position.

Other key headlines as reported by RL include:

• The Accounts were submitted by the deadline to the NHS Trust Development Authority and the External Auditors on Thursday 23 April 2015.

• The Financial Dashboard for Month 12 which is ‘green’ in all reported areas.

• The Savings Plans which have delivered £4,504k against the profiled plan of £4,500k for the 12 months. RF referred to the ‘SIP Planned Savings and Actual Achievement by Month 2014/15’ graph on Page 60 of the report, acknowledging that the legends have recently been changed.

BM acknowledged the Capital Programme as at 31 March 2015 commending RL and colleagues for the performance to-date.