MINUTES OF THE TRUST BOARD HELD ON FRIDAY 31 OCTOBER 2003
Present:
Veronica Worrall Chairman
Roy Bannon Medical Director
Jan Bloomfield Director of Personnel & Communications
John Cullum Non Executive Director
Nichole Day Director of Nursing & Community Relations
Colin Hilder Non Executive Director
Mary Jones Non Executive Director
Judith Lancaster Non Executive Director
Steve Moore Director of Facilities
John Parkes Chief Executive
Peter Richards Non Executive Director
Jessica Watts Director of Strategy
In attendance:
Pam Chrispin Clinical Director
Stella Jackaman Chairman CHC
Jennifer Ellin PA to Chairman & Director of Strategy
2003/122 APOLOGIES
Apologies received from Jane Harper-Smith, Director of Modernisation, Michelle Judd, Clinical Director, Anne Nicolson, Clinical Director, Linda Potter, Director of Finance and Dermot O’Riordan, Clinical Director
2003/123 INTRODUCTION
The Chairman extended a warm welcome to those attending on a specific invite and gave her thanks to Lindsay MacIntyre, Director of Modernisation and David Burton, Non-Executive Director who agreed to give a presentation to the Board on behalf of the Strategic Health Authority.
It had been a busy month for the Board with a Joint Board meeting being held with Addenbrooke’s NHS Trust and a visit to Cambridge University to review the Cambridge Graduate Course in Medicine.
The Chairman was also pleased to inform the Board of the appointment of Colin Muge, who has now become the Chairman of Suffolk West PCT. Mr Muge was the former Deputy Chair of Suffolk West PCT.
Dr Roy Bannon was introduced to his first meeting in his new role as Medical Director.
2003/124 MINUTES OF THE MEETING HELD 26 SEPTEMBER 2003
The minutes were accepted after the following amendments:
1. Page 4, first paragraph the word ‘interviews’ to be inserted after the words ‘return to work’ and correction of the word ‘personal’ to personnel.
2. Page 6 the sixth paragraph should read ……….referrals were less than……. and not as previously recorded.
2003/125 MATTERS ARISING FROM THE MINUTES
125.1 Consultant Contract (Item 113.3 refers)
It was agreed that this item would be discussed at the end of the meeting under ‘Any other Business’.
125.2 Procurement Strategy (Item 113.4 refers)
The Board was informed by John Parkes, Chief Executive that the Supply Board had met for the first time and set targets across Norfolk, Suffolk and Cambridgeshire to try and save some £1.2m through increase efficiency and joint procurement.
125.3 Out-patient follow-up ratios
Jessica Watts, Director of Strategy presented the Outpatient follow-up ratios to the Board for information as requested at the previous Board meeting. She commented that reducing the number of follow-up outpatient appointments was seen to be good practice i.e. more patients are followed-up in primary care or changes in practice means follow-ups are not required. It was stressed that the Trust should be looking at the ratios against national benchmarking figures, which would highlight any action needed to improve clinical practice.
2003/126 CHIEF EXECUTIVE’S REPORT
126.1 Car Parking
The Chief Executive reported and clarified the situation relating to car parking and wheel clamping at the hospital.
He mentioned that the Trust had increased the number of car parking spaces by 20% and invested £460K to create additional capacity. In order to aid funding of recent and future costs the Trust had adjusted car parking charges to staff by 5p from 35p to 40p. A season ticket would cost £8 per month with a fixed charge of £2 per day being introduced for visitors. The revised charges were introduced after gaining feedback from other Trusts, local Councils etc. The front car park had now been designated a parking area for visitors to the hospital. Staff are to use the various other car parking areas around the hospital site.
Mr Parkes commented that by the end of the year the number of spaces would have increased to 1350 with future plans in hand to increase capacity to the front car parking area.
Mr Parkes went on to clarify the situation regarding wheel clamping and stated that there had only been two vehicles clamped this year. He stressed that the clamping of vehicles would only take place if:
a) a car was parked in a dangerous position or blocking access roads.
b) clamping would only occur after the vehicles owners had been given at least six to eight warning notices
126.2 Emergency Activity
The Chief Executive also informed the Board that there has been a 6% increase in activity in both elective and emergency admissions. This compared to last year gave rise to increasing pressure within the organisation. A ‘medical majax’ was declared, as last week there were severe pressures on the Accident and Emergency Department with ambulance staff not being able to move patients etc. This was due to the hospital experiencing high levels of medical emergencies. Ipswich and Addenbrooke’s also had high demands on their services. The clinical staff are reviewing the situation but to try and alleviate the situation the Trust had to cancel routine surgical operations and also move a small number of patients out of acute beds to Newmarket and Sudbury Hospitals.
126.3 Mid Year Review
A mid-year review meeting had been held with the Strategic Health Authority. The review forms part of the Trusts accountability to the Strategic Health Authority and looks at the Trust performance as part of the whole systems approach to healthcare within the locality, which includes social care, mental health and primary care.
The Chairs and Chief Executives of Suffolk are meeting with the Strategic Health Authority on the 14 November to try and achieve improvements to patient access and review financial balance.
Judith Lancaster, Non Executive referred to issues on car parking and signage.
Firstly, she was concerned about patients coming to the hospital and not being able to park close to A & E if the patient was unable to walk.
Secondly, she asked that the car park signage be looked at again.
Colin Hilder, Non Executive Director wondered whether the ‘medical majax’ and the moving of patients was due, in some way, to delayed transfers of care.
John Parkes commented that on that day there were 60 delayed transfers of care patients, which obviously had some impact on admissions. A package of community care has been agreed with Social Services but this, as yet, had not gained any significant impact on the situation. The Trust is continuing to work with the PCT on a capacity plan based on 60 delayed transfers of care which would inevitably will have an impact, stated John Parkes.
Mary Jones, Non Executive Director was concerned about discharge planning, as it seems to get more difficult to achieve.
John Parkes responded by informing the Board that there is a very helpful report by the Change Agent Team, which looks at this issue and the frequency of patients, moves which does impact on situations like these. He suggested that this report be brought to a future Board meeting for discussion. JP
The Chairman mentioned the recent Joint Modernisation Steering Group meeting in which delayed transfers of care was a key item of discussion.
Both the Change Agent Team and Secta reports set out clear proposals for better care in the community and work in this area is still continuing. She asked that both the reports be brought to the next Board meeting for further discussion.
2003/127 THE HEALTH DELIVERY PLAN
A presentation by Lindsay MacIntyre, Director of Modernisation and David Burton, Non-Executive Director of Norfolk, Suffolk and Cambridgeshire Strategic Health Authority (StHA) on the role of the StHA and the Health Delivery Plan was given to the Board.
The aims and vision of the StHA was highlighted which is: to work with the eight health and social care systems in the area to improve the health of the population.
They explained how the StHA sets direction, devolves responsibility, develop organisations and focuses on delivery and that this is done by performance managing and providing development support to the NHS organisations through the eight local health systems to ensure effective health delivery across organisational boundaries.
They informed the Board on
· the Health Atlas website
· health service planning
· networking and the implementation of the NSF
· working with modernisation team
· IT national implementation etc
The presentation generated much questioning of the document, the aims and achievements for the health of the population.
There were questions on:
· IT strategy and the implementation
· Delayed Transfers of Care
· Local Delivery Plan
· GP referrals
· Waiting lists
· Diagnostic Treatment Centres
· Demand Management
· Foundation Trusts
The Chairman thanked the Board for the depth of questioning and pertinent questions that will challenge the system. She also expressed her thanks to Lindsay MacIntyre and David Burton for a very information presentation.
A full copy of the Health Delivery Plan can be found on website: www.nscsha.nhs.uk.
2003/128 PATIENT CHOICE
The Trust received the national consultation document on Choice, responsiveness and equity in the NHS and Social Care. It was agreed to delay discussion on this item to the next Board meeting. JP
2003/129 FOUNDATION TRUST APPLICATION
This was the first public discussion on the Trust’s application for Foundation Trust status.
The Chief Executive informed the Board of the NHS huge reform agenda, which will deliver better responsiveness of services for the needs of the patient. He reported on the key points of NHS Foundation Trust status.
· Foundation Trusts will still be part of the NHS, but as a Foundation Trust will be controlled locally rather than nationally and will have greater financial freedoms and autonomy to delivery a first class service.
· There will be no shareholders and surplus monies will be reinvested locally.
· NHS Foundation Trusts would not be free to turn themselves into private hospitals
· NHS Foundation Trusts would still have to meet national standards and inspection i.e. Commission for Health Improvement (CHI) and publish performance ratings
· NHS Foundation Trusts have a legal duty of partnership and co-operation with other parts of the NHS to improve the quality of services for the benefit of the health economy
· They have a legal duty to provide education and training for all NHS Staff
A NHS Foundation Trust has to elect a Board of Governors, which should be broadly representative of membership i.e., staff, public and stakeholders.
The Chief Executive went on to explain that the Board of Governors appoints a Chair and Non-Executives and also approves the appointment of the Chief Executive and Executive members. The current applicants for NHS Foundation Trust have between 29 – 59 members.
There were 25 wave 1 applicants for NHS Foundation Trust status including Addenbrooke’s and Papworth NHS Trusts, all of which had 3 star ratings and were invited to express and interest in becoming a Foundation Trust. West Suffolk Hospitals Trust is one of 32 in the second wave 1a applicants of those interested in becoming a Foundation Trust and by 2008 all NHS Trusts will become Foundation Hospitals.
“For the Trust to move forward with its application it must retain 3 star rating, be financially sound, with HR and robust governance arrangements in place, otherwise the Trust will not be able to progress to Foundation Trust status”, said Mr Parkes. The Trust will be subject to an assessment of these in January 2004.
John Parkes was thanked for his brief but informative presentation.
Professor Richards, Non Executive Director commented that he was fully supportive of Foundation Trust status and said that Foundation Trusts do not undermine the principles of the NHS. He also stated that there would be good opportunities for beneficial partnerships and that Foundation Trusts would be a partnership of equals and West Suffolk would have the same flexibilities that Addenbrooke’s and Papworth share.
129.2 Addenbrooke’s and Papworth Consultation Documents
The members of the Board were asked to comment on the consultation documents of the two applications by Addenbrooke’s and Papworth for NHS Foundation Trust status. Responses of the documents are needed by the end of November.
Judith Lancaster wondered about governance arrangements and noted that Papworth was proposing to maintain the status quo with Non Executive Directors on its Board whereas this would not be the case with Addenbrooke’s.
The number of members on the Board of Governors is an issue that needs to be addressed and consideration be given to the minimum and maximum number of members.
Stella Jackaman, Chairman of the Community Health Council queried the impact that collocation of Addenbrooke’s and Papworth could have on the proposed governance arrangements.
The Chief Executive made reference to proposed representation of referring Trusts in their respective applications. The Papworth governance arrangements include one representative from their nine main referring hospitals. The Addenbrooke’s proposals include cooption of three neighbouring hospitals including West Suffolk.
John Parkes asked that the Trust support both applications and with a caveat to seek further clarification on the proposed governance arrangements.
2003/130 PERFORMANCE OVERVIEW AND ACTIVITY
130.1 A summary of the key performance information was given to the Board for information.
Jessica Watts presented the traffic light report, which is based on the StHA’s monitoring template, which shows how the Trust gauges the StHA view of performance, and provides a summary by month and range of key targets.
She highlighted the key points as:
· A&E targets met for the second month in succession.
· A&E performance measured at the end of year will cover an average of the months July – March so it is important to sustain performance for the remaining months of the year.
· There was a significant rise in elective activity affecting the Trust’s ability to hit waiting time targets.
· There was a 17% increase on last year from GP referrals with 60 delayed transfers of care against a planned level of 20 preventing headroom for winter planning.
· Outpatients and inpatients waiting lists were a cause for concern. Action is being taken by reviewing with the PCT to try and manage demand better.
· A detailed action plan for delayed transfers of care has been agreed with Social Care and the PCT, which includes increasing capacity in the community i.e.
40 nursing/residents home placements
28 transitional care
19 Intermediate care hospital at home
10 rehabilitation at home
Tenders are out to secure these places and the Performance Improvement Plan (PIP) clearly identifies managers to turn the problems around.
There will be monthly Trust Management Team (TMT) reporting and PIP monthly reporting of targets and turnaround position.
John Cullum, Non Executive Director was concerned about the 48 cancelled outpatient clinics whereby 358 patients had been inconvenienced and wondered whether the Trust was yet in control of the situation.
Roy Bannon, Medical Director responded stating that work in this area is in hand and information data would be available at the next board meeting.
RB
Judith Lancaster raised a number of points.
1. Have other hospitals had increased level of GP referrals? It was noted that both Addenbrooke’s and Hinchingbrooke levels had increased by 7%.
2. Why was the Trust over performing in elective activity but under performing on day cases?
Kevin Barnes, General Manager stated that this could mainly be due to the Day Case Theatre being closed for a significant period because of flooding/leakage by contractors and patients being moved to the main hospital. The opening of the Diagnostic Treatment Centre (DTC) should alleviate problems in the future.
Colin Hilder, Non-Executive said “we need evidence that the Trust is in control with systems in place” and also asked “what are we learning from good practice?”
John Parkes reassured the Board that the Trust is not being complacent and all partners including Social Care and the Primary Care Trusts are doing what they can to address this situation.
130.2 Finance
Tim Budge, Deputy Director of Finance reported on the financial position to month 6, end of September 2003.
He stated that the Trust had a shortfall of income against expenditure of £1m and an increase in expenditure over the previous month of approximately £300k.
It was anticipated that the current levels of overspend will not be maintained and the current position will be improved. The current projection is that the Trust will overspend by £1.4m at the year-end.
Key areas of expenditure were identified as start up costs for the establishment of the DTC. The Trust is considering with the StHA ways of recouping these costs.
Every effort is being made and action taken to ensure the Trust reaches breakeven by the end of the financial year.
Colin Hilder said that “the Board should be concerned and that as a Board it has responsibility to monitor this and know the reasons why it is moving in this direction. Budgets which have been set by the Board are not approximate, arbitrary or abstract, they are absolute”. It was his intention to suggest an exploration with independent audit colleagues to see if the Board should bring individual Directorate heads to explain why budgets are moving out of sync.
Judith Lancaster also raised a point relating to the CRES, which, in some areas, seems to have resulted in increased expenditure and wondered if the implication of CRES had been adequately thought through and also wondered whether the assumptions are robust and evidence based.
The Chief Executive suggested that these assumptions be revisited.
130.3 Performance Improvement Plan
The Performance Improvement Plan was brought to the Board for approval.
Due to the Trust’s financial position and performance a recovery plan has been produced for those areas that are not achieving planned performance. The plan set out what action will be taken to ensure performance is brought back to plan and the financial position is improved.
Jessica Watts went on to explain the key points for the successful implementation of the plan and that there would be regular monitoring with monthly updates to the Board. She asked that the Board approve the PIP.
Approval was given.
2003/131 IMPROVING WORKING LIVES
131.1 The Improving Working Lives report was brought to the Board to give an overview of progress and achievement against the Trusts IWL Action Plan.
131.2 Draft HR Strategy
The draft HR Strategy was presented to the Board by the Director of Personnel and Communications, Jan Bloomfield and she asked the Boards support and approval in principle of the document.
The Board gave its support for the draft Strategy to be circulated amongst stakeholders and the Chairman asked that the document be brought back to the Board after wider consultation.
131.3 Agenda for Change
Agenda for Change is a complete overhaul of the pay and terms of reference for all NHS staff, but not doctors. It is the biggest pay modernisation in the world and it is anticipated that the cost of implementation from one payroll system to another will cost in the region of £1.2 billion.
West Suffolk Hospitals Trust has not been designated as a pilot site, but as from October 2004 the new pay system will be implemented.
The Action Plan asked that a lead Director be appointed and Jan Bloomfield was appointed to oversee the project. She was asked to consider the potential for joint working with the PCT and health economy.
Jan Bloomfield commented that Agenda for Change represents a challenging workload, one that would be helped enormously by ensuring all staff have an up-to-date job description that accurately reflects their roles and responsibilities.
2003/132 CLINICAL GOVERNANCE COMMITTEE
Judith Lancaster gave a brief summary on the meeting of the Clinical Governance Committee held on 4 September.
She highlighted three areas:
1. The Ombudsman’s investigation report in which, the community asks that the Medical Director looked at communications between consultants and junior medical staff.
2. Incident Reporting.
That an appropriate Action Plan is drawn up and carried out and that the Complaints procedure is carried through in a timely and appropriately dealt with.
3. Litigation.
All claims should be treated as incidents with immediate effect and that a risk assessment should be undertaken.
2003/133 ORGANISATIONAL RISK COMMITTEE
John Cullum reported on the meeting of the Organisational Risk Committee held 8 October 2003.
Three main areas that he highlighted were:
Missing patients – A draft Missing Patients Procedure was presented to the Organisational Risk Committee. Various issues within the document need to be addressed before final version is submitted to the Trust Management Team.
Salmonella Outbreak – A robust Action Plan had been drawn up and presented that addressed the Environmental Health Officers recommendations and issues identified by the Trust. John Cullum reported that the cause of the outbreak at Sudbury Hospital was found to be raw shell from eggs. Action had been taken to address the recommendations raised.
Portering role in security and incidents of violence and aggression – it was brought to the Organisational Risk Committee’s attention that Trust policies did not refer to a role for porters in such incidents, but that custom and practice had resulted in porters attending such incidents. It was felt that there was a need for the Trust to identify this gap in procedures and meet the needs, training etc of the Portering staff. Further work is being carried out in this area and a report to the Trust Management Team and the Trust Board will be presented.
2003/134 ANY OTHER BUSINESS
134.1 Consultant Contract
Jan Bloomfield informed the Board that the new terms and conditions for consultant staff had been accepted. She explained briefly the key elements of the new terms, which included:
· Working hours
· Job planning
· Salary Scale
· Extra activities
Job planning will be an integral part of the new terms. This process will commence over the next three months and will be an extremely busy and challenging time for the Medical Director, Clinical Directors and General Managers of each directorate.
The estimated cost for acute Trusts is approximately £1m per 100 consultants. Only £500k has been ring-fenced for West Suffolk consultant in the west health economy.
For the Trust to implement the new terms the Trust Management Team are to agree a process that the organisation will use to introduce job planning. Jan Bloomfield stated that this would take into account the planned service profile for the Trust, specialty issues and compliance with Working Time Regulation.
2003/135 QUESTIONS FROM THE PUBLIC
No questions were received. The Chairman thanked members of the public for their attendance at the meeting.
2003/136 DATE OF NEXT MEETING
The next meeting of the Board will be Friday, 28 November 2003 in the Committee Room at West Suffolk Hospitals NHS Trust.