PRESENT:Mr T Bennett (Director of Finance)

Minutes of the Trust Board meeting held on Wednesday 19 October 2011 at 11am at Royal Lancaster Infirmary, Lancaster

Mr P Dyer (Medical Director)

Dr J Greenwell (Non-Executive Director)

Mr T Halsall (Chief Executive)

Ms J Holt (Director of Nursing & Modernisation)

Professor E Kane (Chair)

Mr P McGahon (Director of Service & Commercial Development)

Mr S Smith (Non-Executive Director)

Mrs P Thomas (Non-Executive Director)

Mr I Tomlinson (Non-Executive Director)

Mr S Vaughan (Director of Operations and Performance)

Mr R Wilson (Director of Human Resources & Organisational Development)

IN ATTENDANCE:Mrs N Barnes (Trust Board Secretary)

Ms A Botterill (for item 11/147 only)

Mr C Caldwell, Consultant Anaesthetist (for item 11/147 only)

Ms J Duckworth (for item 1 only)

Mrs L Jones (for item 11/146 only)

Mr K Panter (Staff Side Representative)

Miss P Patel, Consultant Colorectal Surgeon (for item 11/147 only)

Ms M Plackett (for item 1 only)

Ms R Rowan (Head of Legal Services)

Mr H Walker, Ward Manager, (for item 11/147 only)

Mr P Woodford (Head of Communications)

Mrs L Wyre (for item 11/146 only)

11/144APOLOGIES FOR ABSENCE

Apologies for absence were received from Mr Ballantyne and Mr McLaughlin.

11/145PATIENT STORY / MATERNITY SERVICES UPDATE

Ms Holt and Ms Wells (Head of Midwifery) provided an introduction to the Board to demonstrate two patients’ journeys. The patients gave an honest account of their pre and post-natal care including their experience during labour. Although the stories were positive, they highlighted areas for improvement, for example one of the patients had to repeat her birth plan to different members of staff several times during labour. A member of the public challenged the Head of Midwifery and felt that the Trust deliberately selected positive stories. He added that this had not been his personal experience and requested an explanation for this. Ms Wells explained that in order to present patient stories to the Board, the Trust needed to gain consent from women and although the stories were positive overall, there were still learning points, particularly around communication.

Ms Janet Duckworth (supervisory midwife) and Ms Mandy Plackett (supervisory midwife) provided a presentation to explain the role of supervision within maternity. The ultimate aim of midwives and supervisors is to ensure that mothers and babies receive high quality; evidence-based sensitive and safemidwifery care which is continually developed and can withstand external scrutiny which supports the Trust’s ethos of “the needs of our patients will drive everything we do”. The Board thanked the midwives for their presentation.

A member of public addressed Professor Kane and referred to the recent Nursing and Midwifery Council Report in relation to the quality of maternity services at the Trust. Ms Wells acknowledged the recommendations made in the Nursing and Midwifery Council Report and explained that within the report it does note that as an organisation the Trust has identified areas for improvement and we are already working towards a number of key recommendations. The Trust is having an open and fresh approach to how supervision is structured. The same member of public alluded to the Fielding Report in 2010 and asked Professor Kane for an explanation as to why this report had not been shared with Monitor. In response, Mr Halsall explained the Fielding Report had been part of a detailed discussion with the Care Quality Commission and Nursing and Midwifery Council and a very detailed action plan has been scrutinised by the Board which was shared with the Care Quality Commission and Monitor.

11/146GURU PRESENTATION

Ms Holt gave an introduction to the Board. Senior nurses representing the Medical and Surgical Division presented divisional reports from GURU covering the period May to September 2011.

Surgery and Critical Care Division

Ms Lynne Wyre (Divisional Senior Nurse) presented the data for the Surgery and Critical Care Division. Ms Wyre outlined divisional issues which include staff failing to complete their mandatory training (core quiz and information governance quiz). This issue will be rectified by December 2011. Work is currently being carried out to address the issue of staff failing to complete the observation tool and the falls safety bundle audit. A discussion took place regarding the slips, trips and falls data. Ms Wyre explained that there are two particular wards in the division where there is likely to be an increase in falls: elderly care ward and trauma ward. Ms Holt explained that the threshold for falls is being analysed and the volume of slips, trips and falls has decreased with a reduction in falls causing major harm. The slips, trips and falls data is scrutinised at the Clinical Quality and Safety Committee.

Medicine Division

Ms Louise Jones (Divisional Governance Lead) presented the data for the Medicine Division. Ms Jones explained that work is being carried out with the tissue viability nurse regarding pressure sore reporting. The Division have tasked the most senior nurse on each ward to ensure all patient details are recorded to provide accurate up-to-date admission, discharge and transfer data. There has been an increase in the number of slips, trips and falls since September 2011. Ms Holt explained that patients are often admitted with a history of falling. Ms Jones explained that if patients are admitted as high-risk from falling the ward nurses place the patient in the most visible ward area with the lights left on at night to reduce the risk of falling.

11/147ENHANCED RECOVERY PROGRAMME

Ms Wyre explained that the Trust had successfully secured funding for the enhanced recovery programme which improves patient care post-surgery and introduced key members from the enhanced recovery programme team who will give presentations outlining the benefits of the programme. The enhanced recovery programme has been embraced by the colorectal team at Furness General Hospital. Miss Patel (Consultant Colorectal Surgeon) outlined the benefits and key principles of the programme. The principles involve providing education and counselling at the pre-operative assessment, minimisingthe stress response to surgery with neweranaesthetic, surgical techniques and analgesia and aggressive post-operative rehabilitation. The average length of stay for patients after following the enhanced recovery programme is five days as opposed to 14 days following the traditional post-operative recovery process. Dr Coldwell (Consultant Anaesthetist) provided a presentation outlining the benefits of the enhanced recovery programme for an anaesthetic perspective. Two presentations followed by Ms Botterill (enhanced recovery programme co-ordinator) and Ms Walker (Ward Manager) outlining the benefits of this programme from their perspective.

11/148MINUTES OF THE TRUST BOARD MEETING HELD ON 20 JULY 2011

The Minutes of the meeting were agreed as an accurate record.

11/149MATTERS ARISING

None

11/150ACTION SHEET

Noted

11/151CHAIR’S ITEMS

North Cumbria Acute Acquisition

A decision was made outside the meeting cycle to not proceed with the North Cumbria Acquisition process. Section 6.1 of the Standing Orders for the Board of Directors refers to the powers of the Board being exercised in an emergency by the Chief Executive and / or Chair. This is required to be reported to the Board for formal ratification.

Revised Trust Constitution

To confirm that Monitor’s communication approving the changes to the Constitution redefining the boundaries was circulated to the Board on 3 October 2011. Widened and re-titles as follows:

Barrow and West Cumbria (previously Barrow and parts of Copeland)

Lancashire and North Yorkshire (previously Lancaster and parts of Craven and Wyre)

South Lakeland and North Cumbria (previously South Lakeland and parts of Eden)

Non-Executive Director Appointments

The Council of Governors agreed at the meeting in July 2011 to reappoint Steve Smith and June Greenwell with effect from 1 October 2011.

11/152CHIEF EXECUTIVE’S ITEMS

Breach of Trust’s Terms of Authorisation

Monitor have formally announced the Trust is in significant breach of its Terms of Authorisation. Following this, Monitor has requested a clinical diagnostic review of maternity services is undertaken. A team from Manchester Children’s Hospital (Consultant Paediatrician and Consultant Midwife) will carry out the diagnostic review and bring together all the action plans. Mr Halsall welcomed this review. A wider governance and risk review is also being undertaken; the Terms of Reference have yet to be agreed and finalised.

11/153INTEGRATED BOARD REPORT

Performance

Mr Vaughan presented the performance section of the Integrated Board Report outlining the exceptions. The Trust did not achieve the A&E standard in September due to significant pressures placed on the Department; the pressure has since eased. It is likelt the Trustwill not achieve the 62 day cancerscreening target due to a one off issue in August and September. Thiswill affect the Trust’s overall performancefor quarter 2 which is submitted to Monitor.

Finance

Mr Bennett presented the finance section of the Integrated Board Report. The financial performance in September was worse than planned by £201k, with a deficit of £7k incurred compared to a planned surplus of £194k. The deficit for the year to date is £1,153k which is £799k worse than planned at this stage. The Trust has delivered savings of £3,820k against the target of £5,090k for the year to date. Performance in September was £317k worse than planned. The Trust has cash balances of £24.6m. Although the Trust incurred a deficit of £7k in September, the Financial Risk Rating (FRR) remained at 3 at the end of quarter 2 in line with the previous Board declaration.

The main area for concern is the delivery of the cost improvement programme which has had an adverse effect on pay costs. A paper with proposals to address this issue will be discussed at the Board meeting in November. The Board were asked to note that Geoff Hammond had been appointed to head up the Programme Management Office. Since the approval of the Investment Policy there had been a down grading of most of the major bank’s risk rating affecting the Trust’s current investments. A revision to the Investment Policy was therefore required. Mr Bennett will provide a revised paper to the November Board meeting.

Mr Tomlinson acknowledged the reduction in locum costs. In response to Mr Tomlinson’s question as to why there has been an increase in A&E activity and decrease in non-elective activity, Mr Bennett explained there was no specific reason for the extra pressure experienced in A&E. With regard to the reduction in non-elective activity, the principle area seems to be a reduction in the number of patients admitted to the Royal Lancaster Infirmary from Cumbria. The conclusion the Medicine Division reached is this is due to the introduction of the primary care assessment service in the South Lakes locality. Mr Bennett and Mr Vaughan will provide a paper to the December Board meeting regarding the proposed response.

Workforce

Mr Wilson presented the workforce section of the Integrated Board Report. The absence figure for August 2011 was 3.04%; the Trust remains on trajectory to meet the 3.5% target for 2011/2012.

Mortality

Mr Dyer presented the mortality section of the Integrated Board Report. The Risk Adjusted Mortality Index for 2010/11 is 103, which is above the target index of 100. In month for August, the figure was just below 80. Processes have recently been implemented to improve data quality by checking each week that patient deaths are allocated to the correct clinical specialty. The Department of Health have introduced a new standardised method of measuring death rates that has taken effect from April 2011. The new method, called the National Summary Hospital-Level Mortality Indicator (SHMI) will calculate the deaths of all admitted patients in all care settings except specialist hospitals.

11/154DIPC QUARTER 2 REPORT

Ms Holt presented the DIPC quarter 2 report. The infection prevention team are currently driving forward improvements in emergency screening of patients with MRSA. Both the Royal Lancaster Infirmary and Furness General Hospital have had short outbreaks of norovirus in quarter 1 affecting several wards. Isolated cases have also been seen in quarter 2 which were controlled very quickly.

11/155INTEGRATED PATIENT EXPERIENCE REPORT

Ms Holt presented the integrated patient experience report for the quarter April to June 2011. This report is discussed in more detail at the Clinical Quality and Safety Committee.

11/156STROKE ACTION PLAN

Mr Vaughan presented the paper to provide an update of actions being taken to improve the care provided for stroke patients by increasing the amount of time they spend in dedicated stroke facilities. The Trust is currently working with the Cardiac and Stroke Networks in Lancashire and Cumbria (CSNLC) and local commissioners to oversee and develop appropriate actions and to deliver improvements in service. An action plan has been developed from the outcomes of the Stroke Sentinel Audit based upon the aspects of the acute stroke pathway. At the September meeting of the North Lancashire Primary Care Trust’s Urgent Care Network there was a detailed discussion about the improvements required in all aspects of the stroke overall pathway. As a result of this meeting, the PCT have set up a specific group to review this. Dr Greenwell would like to know the number of patients who are treated outside the stroke unit and requested an audit is carried out if the number was significant.

The Board noted the progress.

11/157APPROVAL

Ratification of the action of the Chairman and Chief Executive in signing the following:

Passive Fire Protection / Compartmentation – Furness General Hospital and Royal Lancaster Infirmary

Appointment of Contractor: 7 Fire Protection

11/158BUSINESS PLAN 2011/12

Mr McGahon presented the business plan for 2011/12 and progress for quarter 2. In response to Mr Halsall’s question as to whether the plan reflects current risks around maternity and outpatients, Mr McGahon assured Mr Halsall that this will be reflected in the quarter 3 report.

The Board noted the report.

11/159HEALTH AND WELLBEING UPDATE

Mr Wilson presented the report to provide the Board with progress regarding the staff health and wellbeing action plan.

11/160CAPITAL EXPENDITURE 2011/12 PROGRESS REPORT QUARTER 2

Mr Bennett presented the report to provide the Board with progress to 30 September 2011 against the capital expenditure plan.

11/161RESEARCH AND DEVELOPMENT CAPABILITY STATEMENT

Mr Wilson confirmed that funding had been secured for the Head of Research and Development for the next two years to drive forward the research and development agenda.

11/162COUNCIL OF GOVERNORS REPORT / ACTIVITY

Professor Kane presented the report on behalf of the Lead Governor. The Board noted the report.

11/163OUTPATIENT PROJECT

Mr Vaughan presented the paper which provides an overview of the outpatients project and progress to date. The Board noted the report.

11/164ANY OTHER BUSINESS

None.

11/165DATE, TIME AND PLACE OF NEXT MEETING: Wednesday 25 January 2012, Truckhaven, Carnforth