Page 1 of 12of Minutes of a Public Meeting of the Trust Board of Directors held on 28 November2013 at 10:30 in The Conference Room, Trust Head Quarters, Marlborough Street, Bristol, BS1 3NU
BoardMembers Present- John Savage – Chair
- Robert Woolley – Chief Executive
- Paul Mapson – Director of Finance & Information
- James Rimmer – Chief Operating Officer
- Sue Donaldson – Director of Workforce & Organisational Development
- Deborah Lee – Director of Strategic Development and Deputy Chief Executive
- Helen Morgan – Acting Chief Nurse
- Sean O’Kelly – Medical Director
- Lisa Gardner – Non-executive Director
- Guy Orpen – Non-executive Director
- Emma Woollett – Non-executive Director
- Julian Dennis – Non-executive Observer
- Jill Youds – Non-executive Observer
- David Armstrong – Non-executive Director
Others in Attendance
- Charlie Helps – Trust Secretary
- Fiona Reid – Head of Communications
- Sue Milestone – Governor - Carers of Adults
- Florene Jordan – Staff governor
- Peter Bayliss – Rapid Response Nurse
- Tony Tanner – Public governor
- Brenda Rowe – Public governor
- Anne Skinner – Patient governor
- Marc Griffiths – Appointed governor
- Ruth Hendy –Cancer Specialist Lead Nurse
- Susan Ahlquist – User Representative Cancer Board
- John Steeds – Patient governor
- Mo Schiller –Public governor
- Wendy Gregory – Governor - Patient Carers
- Neil Havercroft – Foundation Trust Member
- Jeanette Jones – Appointed governor
- Clive Hamilton – Public governor
- Debbie Corrigan – Health Research Authority (Public)
- Bob Skinner – Foundation Trust Member
- Pauline Holt (Management Assistant to the Trust Secretary)
Item / Action
- Chairman’s Introduction and Apologies
- Declarations of Interest
There were nodeclarations of interest.
- Minutes and Actions from Previous Meeting
Actions:
There were no Action responses to note.
Matters Arising:
There were no matters arising.
- Chief Executive’s Report
- UH Bristol was to host the Local Clinical Research Network for the West of England from 01 April, on behalf of the National Institute for Health Research.Consequently the Chief Executive was pleased to announce that DrStephen Falk, Consultant Clinical Oncologist and HonorarySenior Lecturer at the Bristol Haematology/Oncology Centre, had been appointed as Clinical Director for the West of England Clinical Research Network.
- The successful Forget-me-not event on Dementia was attended by 130 staff, governors and members of the public. Natalie Godfrey, Dementia Nurse had won the national award for ‘Best Dementia Nurse Specialist’ and dementia lead for 2013 at the National Dementia Care Awards.
- The staff award event, Recognising Success, had been a great evening with many staff groups represented. On the same evening the South West Leadership Academy had awarded Dr Emma Redfern the ‘Emerging Leader of the Year’. He declared this to be “great for the profile of the Trust”.
- Chaplain Veronica Lee had won the ‘Spiritual Care Award’ in the Butterfly Awards, a charity supporting people overcoming infant loss.
- Finally the Board noted a Gold Level Audit Report from the National Security Inspectorate for the Security Team in the Trust. He said that UH Bristol was the only Trust to have achieved gold status.
Lisa Gardner asked when the Welcome Centre was due to open and Deborah Lee advised 16 December with a formal opening ceremony after Christmas 2013. She concluded that there was a programme of formal orientation and would ensure that Non-executives Directors and governors had the opportunity to attend.
There being no further questions the Chief Executive concluded his report. / Action
215
Action
216
Delivering Best Care
- Quality and Performance Report
Patient Experience
Helen Morgan presented the report and described it as a “salutary lesson on how not to discharge a patient from care”. She explained that the incident reported had occurred during a period of black escalation and much had been learnt, particularly surrounding the importance of good communication on handover. Progress included the opening of the new Discharge Lounge facility which was receiving positive feedback from patients. Wider organisational changes such as those involving Lloyds Pharmacy and a review of the whole mobile phlebotomy service were taking place.
Lisa Gardner asked which checks had taken place regarding the dispensing of drugs by Lloyds Pharmacy to match the Bristol Royal Infirmary Pharmacy prescribing policy. Helen Morgan to report following further consultation with the Head of Pharmacy.
Emma Woollett asked if safeguards were in place for those patients who were not discharged via the Discharge Lounge. Helen Morgan advised that checks were routinely in place. However, thepatientreferred to in the report had been discharged during a period of black escalation which had affected the quality of care.
Anne Skinner, who was in attendance, asked if patients were routinely moved at night. Helen Morgan said there was a clear policy not to do so under normal circumstances.
Performance Overview
The monthly Quality & Performance Report detailed the Trust’s current performance on national frameworks, and a range of associated Quality, Workforce and Access standards. Exception reports were provided to highlight areas for further attention and actions that were being taken to restore performance.
Deborah Lee advised the Board that:
- There had been a small improvement in the overall “health of the organisation” with six months of stability or improved positions. Significant improvement had been shown in the area of recruitment toresearch trialsand hospital cancelled appointments. An area where insufficient progress had been made was staff sicknessabsence but with an improved focus on disseminating the learning received from well performing divisions.
- Patient Experience had retained a green rating across all measures and the Trust had maintained aGREEN position in relation to efficiency.
- The Emergency Department(4-hour waiting time) standard had been achieved for the third month in a row at a time when emergency admissions were at a high and when ambulance arrivals were higher than was typical for the period. This indicated that work around patient flow was being embedded and delivering sustained improvements.
- Finance was reported for the first time under the new risk assessment framework issued by Monitor. It described a relatively positive position except in the area of Cash Reducing Efficiency Savings. With an expectation of Quarter 4 being delivered successfully, the team’s focus remained on notcommencing the year 2014/5 with any “carry forward”, underlying deficit.
- In regard to the Trust overall assessment, October had heralded a new approach to Monitor’s assessment of Trusts with either a GREEN, RED or ‘under investigation’ status. UH Bristol had achieved a GREEN rating, despite the C difficile target having breached the trajectory standard set by Monitor. This breach represented the third quarter failed resulting in the expectation that Monitor would investigate. Preliminary discussions with Monitor appeared toindicate that they had a level of assurance based on previous Trust examinations over recent times in relation to infection control. The Trust had provided Monitor with significant evidence regarding infection control practice and Deborah Lee described the current position as a reflection of many other Trusts. Expectationswere that a GREEN rating would be restored in Quarter 4 should no further deterioration take place in other areas.
John Savage, as acting Chair of the Quality and Outcomes Committee explained that the purpose of the Committee was to thoroughly examine, question and assess the performance of the Trust on behalf of the Board.He advised that particular note had been made of the position on C difficile, 62 day screening and referral to treatmenttimes and that good steady progress had been made. The inclusion of the monthly Serious Incident Reportallowed the Committee, on behalf of the Board, to take an early detailed look at incidents whilst awaiting root cause analysis of each case to conclude.
The Chair invited Sue Donaldson to expand on sickness absence. She advised that the assessments being undertaken centred around both the causes and the consequences of sickness absence. The Human Resources team was working closely with line managers and Occupational Health on this work.
She highlighted the importance of health prevention promotion amongst staff noting particularly the ‘flu vaccination programme to combat one of the highest reasons for staff absence’.Also of note was stress/anxiety related absences and much effort had been put into workshops to inform and raise awareness of the need for early provision of support to staff under these circumstances.
Jill Youds asked Sue Donaldson if there was a correlation between sicknessabsence and morale/engagement at UH Bristol. She was advised that a wider analysis featuring a better understanding of how the metrics were related was to be undertaken, not looking at sickness absence in isolation but viewing it “in the round”.Sue concluded that she had been encouraged by her first impressions of the general level of staff enthusiasm and morale.
The Chief Executive asked Dr Richard Brindle, who was in attendance, for an overview of the Trust’s position regarding C difficile compared to national and regional benchmarks.Dr Brindle replied that UH Bristol target figures were very low thereby allowing one or two cases to change the Trust’s rating from green to a red. Nationally, C difficile showed a smooth curve with a slightly “bumpier” curve for the region. Much was being done with pharmacy colleagues checking antibiotic prescribing. His overall conclusion was that the C difficile figures for UH Bristol were a reflection of (perhaps) a wider than averageprevalence for C difficile in the local community than that for the rest of the country.
Deborah Lee informed the Board that constructive discussions with Commissioners regarding 62 day cancer pathways had led to an agreement for a piece of work to develop incentives and possible penalties, within the contract framework for next year. The intention being that providers would be incentivised to examine their processes contributing to the delay to tertiary services at UH Bristol. She welcomed this as a new sense of engagement and commitment from Commissioners to solve the pre-hospital aspect of the pathway.
Emma Woollett noted the first AMBER in high risk cannula antibiotic compliance. Helen Morgan explained that there was a very clear action plan surrounding cannulas and there was a pilot of a new monitoring machine to detect if there was any biological material in areas being cleaned.
Lisa Gardner expressed concern regarding turnover figures in the Trust and asked Sue Donaldson if comprehensive exit reviews were undertaken. She advised that these were done but the value received as a result was being examined. A new piece of work was being commissioned which would focus on viewing figures departmentally to compare recurring patterns between the turnover and sickness absence rates.
The Chairman asked for questions from the governors present.
Wendy Gregory, who was in attendance, asked for clarification as to where delays came concerningthe 62 day cancer target.Deborah Lee explained that delays occurred in the phase where a patient was undergoing investigation for a possible diagnosis of a cancer and was referred by another hospital to a tertiary provider.
On a different subject, Wendy Gregory pointed out that members of staff may be carers and asked if the Trust recognised that as a factor in sickness absence figures.Sue Donaldson said there was a need to better understand the performance matrix and how the figures “came together”. For staff engagement it was clear that there was a need to have clear objectives and to be part of an effective team. To conclude she advised that in the light of the Francis Report a piece of work was being undertaken with data as it evolved to further understand the drivers.
Clive Hamilton, who was in attendance, asked if the Trust was“deflecting effort disproportionately” to the achievement of quality benefits as opposed to cash reducing efficiency savings. Deborah Lee explained that those were the quality priorities that the Board had set for itself as important for the benefit of patients.
Clive Hamilton, referring to the report (p66) asked how ward transfers affected the risk of “patient misdosing”. Sean O’Kelly explained that although one ward had been performingpoorly against the standard much work had been undertaken to improve performance. He informed the audience that electronic prescribing would improve the situation and was a move that was expected within the next year.
There being no further questions the Chairman drew this item to a close. / Action
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- National Cancer Survey and Action Plan
Helen Morgan presented the report advising that it summarised the key findings for UH Bristol from the 2012 National Cancer Patient Experience Survey.
Of the 60 overall questions relating to hospital care:
-45 UH Bristol scores were in the mid-60% of Trust scores nationally
-15 UH Bristol scores were classed as being among the lowest 20% nationally
-No UH Bristol scores were classed as being among the highest (best) 20% of scores nationally
The two UH Bristol scores that were “firmly” within the worst 20% were among the most important drivers of a good patient experience for people with cancer:
-Whether the patient found it easy to contact their Cancer Nurse Specialist (66%)
-Whether the patient was given written information about their cancer (60%)
The quantitative results of the survey were disappointing (despite methodological concerns) and the Trust was committed to improving these results.
The action plan was focused on:
-Improving accessibility to Clinical Nurse Specialists
-Information provision.
Ruth Hendy, Cancer Specialist Lead Nurse,spoke of a focus on identifying good practice and a sharing of this across teams. Links were being made across divisions and a review of cancer specialists generally. This review had enabled a “pulling out” of gaps in service provision and enabled these to be addressed. There was, she said clinical and divisional buy-in and although the review was annual there would be localised repeats within teams to enable early warning of changes in performance.
Wendy Gregory interjected, stressing the importance of Cancer Nurse Specialists,and asked for reassurance that the lack of a nurse specialist for Melanoma would be addressed. Ruth Hendyadvised that a strategywas being discussed by divisions for cross-working as people progressed on their pathways and would form part of divisional operating plans.
Mo Schiller, who was in attendance, stressed the need for specialist nurses across the Trust. Paul Mapson advised that this was a decision for Commissioners. The Chief Executive clarified that both the risk and the priority were fully understood by the Trust.
Emma Woollett suggested an update on Cancer Nurse Specialists be provided to the Board after six months.
There being no further questions the Chairman drew this item to a close. / Action
218
- Francis Report Trust Response
Sean O’Kelly presented the report, explaining that the paper set out the actions UH Bristol NHS Foundation Trust Board of Directors had taken to accelerate improvements for patients and support for staff in the context of the second Francis Report, the Keogh Reviews and the Berwick Report.
The paper described the challenges generated by these reports and the actions the Trust had taken to assess itself against and meet thoserecommendations.