Veronica Worrall, Chairman
Jan Bloomfield, Director of Personnel & Corporate Resources
John Cullum, Non Executive Director
Nichole Day, Director of Nursing & Community Relations
Jane Harper-Smith, Director of Modernisation
Colin Hilder, Non Executive Director
Mary Jones, Non Executive Director
Judith Lancaster, Non Executive Director
Keith Mansfield, Director of Finance & Information
Kwee Matheson, Medical Director & Director of Education
John Parkes, Chief Executive
Peter Richards, Non Executive Director
Neil Adams, Clinical Director, Surgical Services
Roy Bannon, Clinical Director, Support Services
Michelle Judd, Clinical Director, Midwifery & Children’s Services
Linda Davey, Chief Officer, Community Health Council
Jennifer Ellin, PA to Chairman
2003/1 APOLOGIES FOR ABSENCE
Clare Laroche, Clinical Director, Medical Services
Anne Nicolson, Clinical Director, Medical Services
Jessica Watts, Associate Director of Strategy
Stella Jackaman, Chairman, Community Health Council
2003/2 The Chairman welcomed the Board back after the Christmas recess and also informed members that it would be Nichole Day last meeting of a little while as she was about to go on maternity leave. Best wishes to Nichole were given on her future event.
2003/3 MINUTES OF THE PREVIOUS MEETING OF 29 NOVEMBER 2002
The minutes were accepted after minor corrections.
Corrections: Page 2, item 95.2, second paragraph, third line should read “those staff who felt they needed it” and not “those staff you……..”
Page 4, item 97.1, second paragraph, first line should be “John Cullum ….” and not “Colin Hilder” as stated.
2003/4 MATTERS ARISING FROM THE MINUTES
4.1 National Recruitment
Jan Bloomfield, Director of Personnel and Corporate Resources referred to the national leaflet campaign. She informed the Board that leaflets had been placed at the two main line feeder stations to Bury St Edmunds, Kings Cross and Liverpool Street with a view to attracting quality candidates for recruitment from outside the area. She also remarked on and circulated a copy of the high quality leaflet that the specialist recruitment agency Cornith had produced.
4.2 St Edmundsbury Borough Council
John Parkes reported to the Board that they had an extremely successful meeting on 11 December with members of St Edmundsbury Borough Council. Council members attending took part in discussions on major issues relating to site development. He commented that West Suffolk Hospitals Trust is a major contributor to the planning process. Car parking was a high priority issue and planning applications are still outstanding. A further visit by St Edmundsbury Borough Council’s Planning Committee are to visit the site on 23 January with a Planning Committee scheduled to take place on 6 February to discuss additional car parking.
Mary Jones, Non Executive Director commented on the extremely good review that the Bury Free press had published regarding the car parking issue.
4.3 Improving Working Lives
Jan Bloomfield was extremely pleased to announce to the Board that the Trust had received the Improving Working Lives and Work Life Balance Accreditation. She made reference to the Improving Working Lives and Work Life Balance Assessment Team who were particularly impressed with good HR policies and practice. She also informed the Board of the letter the Trust had received in which it recorded that West Suffolk Hospitals Trust was the first NHS Trust in the country to receive the accreditation for Work Life Balance.
Communications Manager would liase with Jan Bloomfield to convey the good news to all staff, The Chief Executive asked for presentations to be held for the Strategic Health Authority and Primary Care Trusts on the Improving Working Lives and Work Life Balance Assessment. A huge thank you from the Board went to Jan Bloomfield and her team for this achievement.
4.4 Integrated Care Update
Nichole Day informed the Board that the BBC would be filming the Integrated Care Unit next Wednesday (22 January). They would be focusing on the innovative approach to this Trusts, Social Services and Primary Care partnership working in relation to delayed discharges.
Mary Jones, Non Executive Director was concerned as to patient involvement as she did not wish the patients and/or their families to have any undue worries, distress or extra concerns at such a crucial time in their rehabilitation. Nichole Day reassured the Board that permission had been sought from patients and there was plenty of support from staff to alleviate worries and concerns.
The Chairman was keen to ensure that coverage of this filming would be from a patient point of view. John Parkes was equally keen to state that coverage of integrate care was not seen as a long-term solution to the problem of delayed transfers of care and the right angle should be portrayed by the press. Nichole Day commented that since the opening of the unit there has been a throughput of patients with the majority being mobilised back into a home environment.
4.5 CHI Action Plan
The Board was informed that, unfortunately, there had been a timescale slippage in the production of the CHI Action Plan. This will now be presented at the next Board meeting.
4.6 Trust Wide Planning Day
Jane Harper-Smith reported that an important meeting had been held on Wednesday evening (15 January) to discuss issues surrounding the Local Health Delivery Plan. Members agreed on the top twenty-five priorities to be included in the SWICH and LHDP which are to be submitted to the Strategic Health Authority by 28 February.
SWICH proforma being completed by 24 January for SWICH assessment on 3 February.
Veronica Worrall commented that this is a highly significant meeting and the Board must be briefed on the process.
4.7 Financial Allocations
Keith Mansfield informed the Board that the three year financial allocations had been received prior to the Christmas holidays. There will be an increase in the PCT’s allocation of 9.38% for 2003/2004, and an overall increase of 30% over the three years. Although the allocation for 2003/2004 is less than that received in the current year, the three year allocations would enable the Trust to plan more effectively for the future. Contained within the 9.38% is £1.4 million, which is to be used on capacity issues to enable the health system to deliver the NHS Plan targets. The funding formula has been revised and the PCT is now considered to be £1.8m over target. The main changes to the national formula are updated deprivation and population projections.
2003/5 PATIENT
5.1 Non-Emergency Transport
Jane Harper-Smith was asked to present the paper on Non-Emergency Patient Transport. The project was undertaken to look at aspects surrounding best value for money and the savings that can be made in relation to non-emergency patients transport.
She made reference to the current contract and stated that the average cost for every patient transported was £26.20 per return journey. Jane Harper-Smith commented on the number of car journeys made to end November giving an excess to the contract of £41,383. The estimated excess to contract by year end will be £58,000 but with a unit cost rebate of 7%, negotiated with the East Anglian Ambulance Trust, for under usage the excess should be down to £48,000. She also referred to the table of comparison on number of non-emergency transport journeys on a monthly basis and stated that since June there had been significant increase to reduce activity but unfortunately this did not realise a saving to contract. The Trust is using less transport this year than last even though there is increased patient activity and no additional funding is available for transport.
From April 2003 the commissioning and budget for non-emergency transport will pass to the Primary Care Trusts.
The Board was asked to endorse the recommendations in the report. Items 1 to 6 were duly endorsed, but the Chairman felt that there should be further discussions surrounding items 7 and 8. Control passes to the PCT in April and it is important the hospital remains involved in negotiations regarding these recommendations.
Jane Harper-Smith wished to record her thanks to the G Grade Ward Sister, Jacqui McDonald, who has worked diligently and has done an excellent job in producing this paper.
2003/6 STAFF
6.1 Locum Expenditure
Jan Bloomfield gave additional information, for December 2002, to her paper on Locum Expenditure, which was a report produced at the Board’s request for information on audit of locum expenditure for the year.
Orthopaedic locum expenditure was high due to a doctor taking unpaid leave and study leave being taken, cover of this area needed to be maintained.
Kwee Matheson made reference to the fact that study leave cannot be avoided as this was a requirement for career progression and also if exams fall when other doctors are on annual leave this also cannot be avoided.
Discussions around this area continued with Veronica Worrall asking whether there was some way of planning ahead in order to avoid situations where a number of doctors from the same specialty were on leave at the same time thus minimising cost implications.
Peter Richards made general points with regard to leave arrangements stating that it was difficult to compare specialties, but nevertheless it was expected to be able to organise within specialties.
Peter Richards mentioned the introduction of the New Deal, compliance and long term structure, which should be taken into account in the whole picture. Jan Bloomfield advised the Board that the requirements to meet the New Deal was part of the Trust Business Plan and she was in the process of pulling together a SWICH bid for funding which included extra medical staff for example two Specialist Registrars in Medicine and support staff.
Jan Bloomfield is to give a monthly report and monitor performance month on month.
Neil Adams informed the Board that in ENT the Trust has a two-year involvement with Addenbrooke’s and with the new equipment and buildings it was anticipated that this would attract newly qualified doctors to take up appointments and significantly increase numbers being trained in this area.
Michelle Judd stated that Obstetrics and Gynaecology was committed to being locum free, but two new medical posts were required but fortunately due to educational requirements the Trust would not be able to appoint to additional medical posts. She mentioned that their SHOs were compliant in December, by allowing them to go off duty 10.30 pm and non-medical staff assisting in theatre during the night. Ideally the Trust would like Maternity Care Assistants to perform this role but Michelle Judd felt she had been faced with a number of barriers. Judith Lancaster asked whether this was a problem made by the Trust. Nichole Day confirmed that due to professional regulations associated with the transfer of role the Trust needed to ensure that staff were competent to carry out the role in Theatres and work was now progressing.
John Parkes mentioned that the Trust would be interviewing and anticipated appointing a new consultant in Obstetrics and Gynaecology which would to some extent alleviate the situation in this area.
Veronica Worrall commented that there seems to be so many constraints. Jan Bloomfield said there are good systems in place to control and monitor situations and with medical workforce planning the Trust would predict and plan for the future.
2003/7 PERFORMANCE AND INFORMATION
7.1 Finance
Keith Mansfield, Director of Finance and Information reported to the Board that there had been a slight increased to deficit on the previous month, mainly attributable to the additional out of hours work being done to achieve the activity targets. He stated that achieving a financial balance and meeting access targets will inevitably be challenging.
He gave a summary by directorates with each directorate showing an increase in expenditure with the exception of Corporate Directorates who he was able to report a similar or reduced spend for December compared to the November period.
Discussions took place regarding bank and agency costs ie why there was such high spending and the rational behind this. Nichole Day commented that there was an 8.5% vacancy factor and in some areas 9.5% sickness levels. The additional oversees nurses on an induction period, which means continued reliance of bank and agency staff.
The Chairman asked whether the graphs reporting agency costs could be changed to show a break down on how/where agency staff used over a past months. Nichole Day stated that there would be difficulty with retrospective analysis as the system of reporting was different from last year to this. The Chairman was also concerned as to whether everything possible was being done to minimise these costs. Nichole Day responded by saying that the Trust is encouraging bank nurses to take substantive posts and changes are being made to withdrawn agency staff.
John Parkes asked what the correlation was between bank and agency personnel and what we, as a Trust were doing about this problem. Jan Bloomfield stated that the Trust is avidly encouraging bank and agency staff to sign on with NHS Professionals and the PCT are also steering agency personnel towards NHS Professionals. From 1st April there will be funding for a Project Manager with Workforce Development and Jan Bloomfield mentioned that she would be more than happy to report on the project Plan to the Board.
Further discussions ensued regarding the reporting of sickness and absence data and Jan Bloomfield said that she would prepare a full report on sickness and absence to date giving month on month improvements.
John Parkes reiterated that after taking account of the measures already in place, the Trust needs to identify further savings of £250,000 in order to achieve the Trust’s statutory financial duty to breakeven.
7.2 Activity
Jane Harper-Smith reported on the activity to end December, but stated that the information supplied was an estimation as month end figures would not be available until the 8th working day of the month. This was taken into consideration by the Board.
She went on to report that the total inpatient waits had dropped in December but were rising in January. There were three reasons for this increase ie a slippage in timescale for the opening of F10, the temporary theatre (now due 3 February) and extra beds on G8, still not opened.
There were no patients waiting more than 15 months, with increases in December on 12 month waits due to the Christmas break. A reduced 9 month wait but the Trust is not expected to meet year end target in this area. Jane Harper-Smith reported that in A&E only 82% of patients spent less than 4 hours waiting. This is an area of significant concern and despite work being undertaken in this area it will be difficult to achieve an average of 90% during the last quarter. The Trust is confident that there will be no breaches in the 26 week wait. Examples of working being undertaken include a Discharge Planning Manager in post, a new Discharge Lounge, additional portering and care co-ordinators and by 14 April there will be a temporary ward for GP referrals in EAU. Last minute cancelled operations continue to be low level. Jane Harper-Smith pointed out that it was the first month in achieving 100% in the 2 week cancer waits, (referral to outpatient appointment within 14 days) this being partly due to the appointment of the new consultant urologist and there was now a system in place to sustain this target. There were no breaches of the 26 week outpatient waits and the 21 week wait was on target to be met.
Discussion took place on delayed transfers of care and the impact on the Trust in reducing these figures. Mary Jones asked whether Sudbury and Newmarket delayed transfers of care figures were included in the report. The figures reported on were for West Suffolk Hospitals only. Additional detail on delayed transfers of care will be provided to the Board.
The recommendations within the paper were supported, as long as the costs were agreed with the Finance Director.
Overall the Board agreed that the format of reporting activity was good but a definition of red, amber and green and of the target abbreviations was needed for the public Board.
2003/8 GOVERNANCE AND QUALITY
8.1 Update on MAJAX and Emergency Planning
Paul Thacker, Directorate Support Manager, Clinical Support gave a presentation to the Board on Emergency Planning for Major Incidents. He gave a definition of a major incident, spoke about the MAJAX plan, how it is generated and how the hospital operates a major incident situation.
He went on to highlight challenging areas for training such as lack of dedicated time, availability of training staff, decontamination equipment etc. He stressed the frequency and speed with which new requirements are introduced and how these have to be addressed within the organisation.
The Trust has now set up a permanent Emergency Planning Team to focus on the work required by NHS guidance, scheduled during 2003. Mandatory training has been changed to replace ‘lost’ sessions and the new Major Incident Controllers (MICs) take on their role. Training has commenced and they officially took office 1 January 2003.
Paul Thacker made reference to the fact that the Trust was well prepared for a major incident despite the fact that some decontamination equipment was still outstanding. Colin Hilder was interested as to know how many decontamination suits the Trust held. Paul was able to inform the Board that eight suits were available and when these were used the Ambulance Service would provide replacements. He was also able to reassure the Board that he was confident in the Trusts ability to deal with an emergency even with limited resources and that the Trust was better equipped than others in the region. He also mentioned that the West Suffolk Hospital had a modern decontamination area where people can enter without contaminating other areas of the hospital. Staff of the Facilities Directorate have offered their services with the decontamination process – this will be pursued during the coming year.
John Cullum raised the issue of health input into the County Emergency Planning arena. He asked who the current representative is. Since the recent health restructuring, this is not clear. Jane Harper-Smith will investigate and report back at the next meeting.
JHS
Discussions pursued the communications aspect; how the MAJAX was activated and how the information was cascaded throughout the organisation. Mary Jones wondered about the linkage to other organisations such as Primary Care Trusts, Social Services etc.
John Parkes wished to record his thanks to Paul Thacker and the Emergency Planning Team. He did not underestimate the enormous amount of work involved in order to maintain an efficient and effective service. Also he praised the Ophthalmology Team for their dedication and the work they have carried out during their time in office. Grateful thanks also to Michelle Judd and the Obstetric and Gynaecology Team who have now taken on this role.
2003/9 ITEMS FOR INFORMATION
9.1 Back to the Floor
Back to the Floor is an annual event where the Trust Board participates and tries to understand issues and the challenges that face the workforce who are at the forefront of caring for patients on a daily basis.
Jan Bloomfield’s purpose in bring this paper to the Board was to inform the Board that Nikki Ruffles, Assistant Communications Manager will shortly be contacting the Board to arrange their personal work plan for the day.
A typical ‘Back to the Floor’ day would start with a pre-meeting with the Manager, Back to the Floor visit to department, ward or area. This would commence approximately 9.30am and finish about 4.00pm, after which a feedback session would take place with the Manager and staff discussing positives and negatives of the day. There would then be a further meeting involving Trade Union staff and colleagues to agree an Action Plan.
Jan Bloomfield was keen to emphasise that this initiative was not purely to enhance the profile of the Board, but done to promote good working relations and communications with frontline staff to enable them to play a part and influence the planning process of the Trust.
The Chairman emphasised Jan Bloomfield’s words and hoped that it was not seen a purely a PR exercise for the Board. The Board should ensure good public working relations with all staff with good feedback sessions involving all staff to enable then to see what action has been taken from Back to the Floor initiative.
General debate continued on the subject and the suggestion was made as to whether Back to the Floor could be for a whole month rather than a one-day exercise.
John Parkes asked that the report back from the initiative be purely Back to the Floor and not Improving Working Lives initiative.
9.2 Organisational Risk Committee
John Cullum reported on the 11 December meeting of the Organisational Risk Committee. Main items were:
· The Trusts report on emergency procedures MAJAX
· Clinical coding backlog is now clear and work was in hand to sustain this position
· Management of waiting lists in respect of patients who were unfit for surgery
· Issues surrounding health professional and nursing notes being kept separate from medical notes
· Increased fire safety training of staff due to work place training.
He also reported on the issues raised by the Committee on Controls Assurance where they reviewed three priorities
· Funding issues on Professional and Product Liability
· Implementing risk management policy
· Risk register
John Cullum underlined these priorities adding that there was slow progress, which was due to lack of funding, implementation of the Risk Management Policy into Directorates and the introduction of a Risk Register. A little progress had been made on the introduction of a Risk Register and work in this area would be combined with a review of Risk Management Policy and Procedures.
Jane Harper-Smith mentioned that there are two external audits due shortly. One being CNST (Clinical Negligence Scheme for Trusts) and emphasised that it was important that the Trust achieve audit standards. A penalty of £100,000 would be incurred if the Trust did not meet these standards, therefore it is essential that procedures, polices etc are in place for a successful outcome of the audit reviews.
John Parkes was concerned regarding the development of governance risk initiatives and the implications on the Trust if funding was not available. It was suggested that a Board Workshop be arranged to cover issues surrounding planning systems and risk management.
9.3 Clinical Governance Committee
Judith Lancaster gave a summary of 5 December meeting of the Clinical Governance Committee. Points raised were as follows:
· Patient Information
· Caldicott Group
· Update on Directorate Governance Action Plan
She highlighted two areas of concern; incidents involving operator error, where they agreed to undertake further work to review practice in ‘high-risk’ areas and; Incident reports where a report on action for ‘red’ incidents and the importance of the process of reporting ’red’ incidents were discussed. Further work is being carried out in this area.
She also mentioned that the Committee agreed that each directorate would develop an agreed work programme by April 2003. This would them form the basis for audit and governance activities for the coming year.
9.4 Audit Committee
Colin Hilder tabled a summary of the main points raised at the Audit Committee meeting of 20 December 2002. He outlined the main points of discussion; Internal Audit in which was mentioned that the Trust have a Risk Register based on the Trust’s objectives and for a system to be in place to judge how the risks are managed. Work in this area is ongoing.
He also informed the Board that the NHS had produced news standards for internal audit and that a report to the next Audit Committee would be given showing how Suffolk Internal Audit compared to those standards.
Counter Fraud was also discussed with a need for more publicity within the organisation to promote an anti fraud culture. Colin Hilder is to seek advice from the Personnel Department on circulation of leaflets attached to payslips and review posters around the Trust.
He went on to the main points recorded in Price Waterhouse Cooper’s audit letter, which gives an annual summary of work undertaken, and which he thought significant in bringing to the Boards attention. He quotes
“The accounts of the Trust and of its charitable trust funds were again prepared to a high standard. Our audit opinions were unqualified, the accounts were submitted on time and there were no matters of significance arising from our audit”.
“In our opinion, the Trust’s most important priority must be to return recurring financial balance as quickly as possible, in line with a timetable agreed with its commissioners and the Strategic Health Authority”.
The Trust should continue to work closely with others in the health system and with Suffolk Social Services towards reducing strains placed on its financial position caused by any levels of delayed transfers of care that are higher then those agreed with commissioners in the SaFF”.
“It has been become, however, increasingly evident over the last two years that the financial resources and reserves available within the Suffolk health system are no longer sufficient to sustain the Trust’s existing levels of health care expenditure”.
2003/10 ANY OTHER BUSINESS
10.1 Standing Financial Instructions (SFI)
Keith Mansfield tabled an amendment to the Trusts Standing Financial Instructions, Standing Orders and Reservations of Powers to the Board, Scheme of Delegation.
The purpose of this amendment was to prevent, in the absence of the Director of Finance and Chief Executive, undue delay in processing urgent approvals and define and tighten powers of counter signature.
Discussions took place and it was recommended that counter signatures should be restricted to Acting Chief Executive or Deputy Director of Finance. A revised amendment to be tabled at the next Board meeting.
10.2 Breast Screening
The Chairman informed the Board that she had received a letter from Dr Ravisekar inviting the Board to view the new Breast Screening facilities.
Dr Bannon recommended that before they visit and in order to gain the maximum impact on the new facilities they should firstly make a visit the old site and then compare it with the new facility.
John Parkes asked about an official opening of the Unit as this was an important development and would be a good publicity opportunity for the Trust. Jan Bloomfield mentioned that there would be a formal opening of the Unit on completion.
The Non Executives were asked if they were interested in a tour to the new facility after the February meeting of the Board. The Chairman would write to Dr Ravisekar asking if this was possible without too much disruption to the working of the Unit.
10.3 Date of next meeting
The next meeting will be held on Friday 28 February 2003.