MINUTES OF THE TRUST BOARD MEETING HELD ON
FRIDAY 27th FEBRUARY 2004
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
Dermot O’Riordan Clinical Director
John Parkes Chief Executive
Linda Potter Director of Finance
Jessica Watts Director of Strategy
In Attendance:
Gerald Kelly Patient Access Development Manager
Diane Matthews Communications Manager
Gary Morgan Elective Service Improvement Manager
Colin Muge Chairman, Suffolk West PCT
Yvonne Wood PA
The Chairman thanked all present for attending due to the inclement weather.
04/15 APOLOGIES
Apologies were received from Jane Harper-Smith & Peter Richards.
04/16 MINUTES OF THE MEETING HELD ON 30th JANUARY 2004
The minutes of the meeting held on 30TH January 2004 were accepted subject to the following amendments:
Page 11: last bullet point should state ‘… the Trust relied on the South Norfolk PCT…’
‘Following paragraph ‘…the Trust was currently working with GPs on the periphery…’
Page 12: Third paragraph ‘…the Trust should focus on increasing income as well as decreasing expenditure…’
Page 14: Violence & Aggression – ‘..security issues and a conflict resolution approach was agreed in addition to extra training in high risk areas.’
04/17 MATTERS ARISING FROM THE MINUTES
Older Persons Panel (159 refers)
Nichole Day provided feedback from the Older Peoples Survey Report and reported that an action plan has been drawn up for consideration by the Trust and is being progressed. However, the majority of the recommendations have been acted upon or are in the process of being acted upon. Nichole Day will write to Mary Jones to confirm this and provide a copy of the action plan.
ACTION: ND
GP Out of Hours Service (Page 8)
Colin Muge stated that direct action had been taken to ensure that the GP Out Of Hours service provision would not impact on A&E attendances.
Patient Choice/Generic Referrals (Page 9)
Colin Muge reported that this item remains outstanding but that every effort would be made to ensure that an appropriate meeting between himself and Jessica Watts would take place before the next Board meeting.
ACTION: CM/JW
Balanced Scorecard Workshop (Page 10)
A Workshop is planned to take place in April or May.
04/18 FOUNDATION TRUST APPLICATION
Jessica Watts reported that the bid to become a Foundation Trust was officially launched in Bury St Edmunds market place on 21 February at which around 1,000 leaflets were handed out and which received good press coverage. The application is also out to public consultation, which includes the public sector, patients and staff. Information events are to be held at West Suffolk and Walnuttree Hospitals and for the Friends of the Hospital. Additional events are to be held in the Bury St Edmunds Library on 31 March, in Sudbury on 18 March, and Newmarket on 2 April together with two dates in Haverhill.
The service development strategy continues to be developed, together with the workforce strategy and financial assessment with KPMG.
Jessica Watts confirmed that a distribution of 100,000 leaflets is planned to past patients of the Trust and that Computershare, an independent company, will be used to undertake the mailout.
It is stated on page 20 of the Consultation Document that at least 1/3 of the Foundation Trust Board will be made up of Non-Executive Directors. Veronica Worrall asked that she be advised of any queries or comments regarding the content of the Consultation Document as this is a public consultation document.
John Parkes advised the Board that a member application has been received from Colin Muge.
04/19 SUDBURY PROGRESS REPORT
Jessica Watts reported that the revised model of care is now complete and thanked Jonathan Williams for his work in conjunction with the Strategic Health Authority.
Accommodation schedules have been finalised with input from Walnuttree staff and costings for the development are being finalised. An advert for a private developer will appear in the European Journal in May. A newsletter is due to be published within the next fortnight which will include dates of the project timetable.
Jessica Watts updated Walnuttree staff on the development at the Foundation Trust event which took place on 18 March.
It was noted that it was recognised that primary care services will be delivered from the site.
04/20 CAPITAL PROGRAMME 04/05
Steve Moore presented the proposed Capital Programme for 04/05 for approval by the Board. He explained that the following was not included:
· Land sales and income from the Strategic Health Authority.
· SOCs until approved.
Steve Moore informed the Board that it was proposed to move CCU out of ITU and HDU into ITU. A new location for CCU, possibly F2, is being considered.
Steve Moore also informed the Board that items indicated in green are an indication of intended schemes as a capital reward for sustaining 3 Star Status. This income cannot be assumed but, if received, would free up block capital for other developments and Mr Moore proposed that the Board receive a six-monthly update review.
In response to a request for an update regarding the National Plan for IT from Colin Hilder, Mr Moore explained that pre-commitments would be carried forward from this year to next and that it was generally felt that the £125,000 allocated was insufficient.
John Parkes asked that it be noted that, under the National IT Scheme, the Trust will have a new PAS in 2005 which represents a significant investment.
Mr Parkes also asked that it be noted that items not funded from the Capital Programme still received support from the Board and funds for these schemes would be sought from the Strategic Health Authority via business cases. The Strategic Health Authority has allocated some capital reward money for maintained performance in A&E and it is proposed to build an X-ray facility in A&E if the Trust is successful in obtaining this funding.
It was agreed that the National IT Strategy and the resulting impact on IT systems within the hospital would be discussed at the March Board meeting and that a paper on this would be presented to a future Board.
ACTION: SM
04/21 PATIENT
21.1 Patient Access Policy
Gerald Kelly explained the aims and emphasis of the Patient Access Policy which was to define the processes already in place and also to define the responsibilities of both staff and patients. Mr Kelly informed the Board that the Policy has been widely circulated to all clinicians, TMT, PEC and the Local Medical Committee.
It was noted that the policy has already made a difference to Did Not Attend (DNA) rates and how clinic cancellations are managed. A scoring system to generically refer patients is being successfully used in the Gynaecology Department.
A discussion took place regarding generic referrals. Judith Lancaster reported that GPs may not appreciate the difference to the Trust that referring generically makes. Although all GPs have been sent correspondence regarding this, it was felt that there was a communication issue.
Gerald Kelly informed the Board that only 15 – 20% of referrals are required to be generic to achieve equity and reduce waiting times. As waiting times reduce, the ability to direct patients to specialist consultants becomes more important.
John Parkes stated that it was worth noting that actions contained within the Policy are designed to reflect best practice across the country and that it was important that the Board support the protocol to be agreed with clinical staff as to how patients are managed.
Colin Muge stated that the redistribution of referrals could work counter to the concept of Patient Choice and it was agreed that a paragraph would be added to 1.0 Key Principals first paragraph, to state that this would only be carried out with the patient/GP agreement. However, the status of patients experiencing longer waits as a result of exercising Patient Choice would be clarified in the Patient Choice agenda.
Gerald Kelly assured the Board that when any patient was moved to achieve waiting times, it would be with full involvement from relevant clinicians.
Judith Lancaster sought assurance that patients roles and responsibilities should be explained clearly in order that they comply with their responsibilities for booking arrangements, attending appointments and changes of circumstances. Gerald Kelly explained that this matter would be resolved via letters to patients. Dermot O’Riordan asked that clinicians are involved in any forum where letter templates are amended in order that they are able to have appropriate input and Gerald Kelly will advise Mr O’Riordan of the date of the next forum.
It was agreed that hospital cancellations for Surgery and Inpatient activity need to be managed as carefully as cancellations for Outpatients and John Cullum asked that this be included in the Policy.
Dermot O’Riordan also asked that patients be copied letters sent to GPs removing them from list due to DNA. This is a separate issue to the Trust’s decision (due to funding issues) not to copy other information to patients.
John Parkes asked the Board to note that the document is designed to be transparent and a living, working document which works in partnership with patients, GP’s and clinical staff within the hospital.
Therefore the Patient Access Policy was approved subject to the following amendments:
1. Ensuring patients/GPs are involved when redistribution of referral took place.
2. Copy letters to patients when removed from waiting list.
3. Inpatient cancellations by the hospital to be included in regular reporting arrangements.
Veronica Worrall recorded thanks to Gerald Kelly for his tremendous work in putting together the excellent document.
21.2 PPI Update
Nichole Day reported that the PPI agenda is in a transitional state with various local forums in place which are obliged to have a representative from the Trust. At present it is proposed that this should be an Executive Director. Additionally, the Trust is undergoing self-assessment for the Performance Improvement Framework which will be, in turn, assessed by the Strategic Health Authority.
ICAS is based in Ely and covers Norfolk, Suffolk & Cambridgeshire. John Cullum asked if complaint leaflets had been amended to reflect that ICAS support can be sought by patients. It was noted that, on an internal basis, complainants’ attention would be drawn to the service at the same time bearing in mind ICAS strategy. It was also noted that the newly appointed Complaints Manager was working on making the complaints process easier for patients.
John Parkes felt that Appendices A & B were complicated and hoped that a clearer strategic way would emerge as part of the Foundation Trust application.
21.3 Emergency Care Strategy
Jessica Watts and Gary Morgan gave a presentation and report on processes within emergency collaborative work which considered the medium and long term impact of changes in strategy – eg. GP Out of Hours. Ms Watts explained that A&E was important but only one part of a much wider pathway which spans patient self-treating to admission to ITU/HDU and that the key to success lies with partnership with the PCT and the Ambulance Service.
The following points were explained and discussed in relation to targets and progress to date, together with how emergency care sits within the Foundation Trust application
· Context
· Emergency Care Reform
· Emergency Care SMT & Network Local Objectives
· A&E Targets – 4 hour wait
· Emergency Care Pathway
· Emergency Collaborative Progress
Gary Morgan informed the Board that there has been a sustained increase in performance around the A&E 4 hour wait which currently stood at 97%. The target will be 98% from January 2005 with capital payments as incentives. Approximately 36,000 people per year pass through A&E which included a 10% increase over the previous year.
John Cullum felt that public involvement was important in the design of the strategy and Gary Morgan assured the Board that patient opinion was sought. In addition, a patient panel was planned together with a patient representative on the EAU Project Group.
Judith Lancaster asked what percentage of A&E attendance could receive alternative care. Mary Jones asked what proportion of A&E attendance was made up of older people in order that this can be compared to the DoH checklist on how to care for this group of people. Answers to both these questions will be established through forthcoming audits to be overseen by Gary Morgan.
John Parkes asked that it be noted that it was important not to lose sight of the fact that the unit is for Accident and Emergency and that patients are to be encouraged not to attend if alternative care is available.
Roy Bannon stressed the importance of developing our own practitioners and skills and the role in education within the Trust. Jan Bloomfield agreed that regulations, pay and education and training were of equal importance to redesign.
Thanks were recorded to the A&E team, PCT teams and GPs for their support during the recent pressures in A&E.
04/22 PERFORMANCE & FINANCE
22.1 Performance Report &
22.2 Projected Year End Position
Jessica Watts reported that A&E 4 hour target stood at 97% for the last two weeks, taking the quarterly average to 90%. However, over the last three quarters, the average stands at just under 90% and if this is the time over which the final figures will be taken, then the internal target to be achieved for the remainder of the final quarter is 95%.
Cancer targets have been achieved for the sixth month running.
DTOC figure stands at 18 which needs to be sustained or improved.
All Inpatients have been dated to the end of the financial year including the use of the private sector.
Areas at risk in 17-week Outpatient wait target are Endoscopy and Dentals. Endoscopy patients have been redistributed and extra Dental clinics have been set up.
The West Suffolk Hospital and Suffolk West PCT have agreed not to implement Patient Choice until 1 April. However, this should be achieved within four to six weeks of start of new financial year.
Everything possible is being done to work with the Norfolk & Norwich Hospital to reduce their waiting lists by using the Treatment Centre.
John Parkes asked that it be noted that the Trust has demonstrated significant improvements to the local community both in primary care and within hospital waiting times and that it was a very positive report.
It was agreed that Jessica Watts and Roy Bannon would present clinical cancellations to a future Board once data currently being collected is available. Clinical cancellations represent only a very small actual percentage and it was noted that the figure stands at approximately 3% of total clinics rather than 20% as previously thought.
ACTION: JW/RB
John Parkes asked that it be noted that Tony Ranzetta is committed to tackling demand from point of source. It was agreed that Jessica Watts and Colin Muge would identify inappropriate referrals.
ACTION: JW/CM
22.3 Finance
Linda Potter reported that the position is as projected and is consistent with previous reports.
Veronica Worrall asked how reference costs figure is reached. Linda Potter explained that reference costs were compiled from an annual collation of information from every Trust in the country, recognising that London is more expensive in market forces terms. Individual Trusts are then scored against an average of 100 (95 for this part of the country), with West Suffolk Hospital’s score at 80. This means that overall we are cheaper and more efficient than other Trusts and are the lowest in the country for Non-specialist Acute Trusts. In response to a query from Mary Jones as to whether the Trust was being penalised for its efficiency, Mrs Potter stated that it was difficult to judge. However the reference costs figure reinforces Green & Kassab’s difficulty in identifying additional efficiency savings.
It was agreed that income streams (eg; Treatment Centre, Accident Income) were to be maximised and this action would be taken forward. The need to agree volume of work with the PCT and subsequent budgets with managers was discussed as the link between income, activity and budgets will be a fundamental change in working practices for the forthcoming year. Roy Bannon stated that marketing to GPs and more widely will aid income generation and Judith Lancaster felt that patient awareness of services would be also benefit.
Linda Potter informed the Board that additional resources were to be made available to assist Mark Balaam to identify and achieve the agreed level of activity.
22.4 Local Delivery Plan Progress Report
The Board were informed that discussions were ongoing following an offer from the PCT which is being discussed.
There is to be a meeting of the JMSG next week at which there will be additional invitees.
04/23 STAFF
23.1 Consultant Contract Update
Jan Bloomfield informed the Board that the Consultant Contract is two paragraphs from completion. There is an average of 12 PAs per consultant to which adjustments can be made if necessary. Once the job planning templates are complete, it is hoped that each consultant will be offered the contract by 31 March 2004.
04/24 GOVERNANCE
24.1Maternity Services – Risk Management Policy
It was recognised by the Board that an exception needed to be made to consider this policy prior to consideration by the Clinical Governance Committee due to the forthcoming Clinical Negligence Scheme for Trusts Assessment for Maternity Services which is due on 25 March 2004. The Risk Management Policy was therefore approved subject to the following:
· Subject to scrutiny by the Clinical Governance Committee and TMT
24.2Report of the Clinical Governance Committee
Judith Lancaster drew attention to item 6 under the Revised Centralised Training Record Action Plan
Linda Potter informed the Board that the CNST premium is a key driver to what is what is happening nationally and the number of staff employed. A 10% discount is applicable as a result of policies in place.
24.3Report of the Joint Modernisation Steering Group
West Suffolk Hospital, PCT and LHP meet regularly to jointly ensure achievement of targets for the year.
04/25 ANY OTHER BUSINESS
Nichole Day formally reported that the Trust was successful in achieving 85% in Risk Pooling Scheme for Trusts, which entitles the Trust to 10% liability discount. Ms Day recorded thanks to all staff who were involved in the process of the assessment.
All Board members have received a copy of the Acute Hospital Portfolio Year III report.
Colin Hilder reported on a recent meeting, which focussed on the national project for IM&T strategy. This is a huge agenda around workforce and planning with short timescales and therefore Mr Hilder asked that the Board be aware that Diane Milan is under huge pressures regarding this additional workload. Project management is to be undertaken to identify what work is the responsibility of the Trust and what is the responsibility of Accenture (a consortium of companies which has the tender to be the local service provider). Mr Hilder also expressed concern that the Trust may be at risk of losing staff to Accenture and requested that an overview of this should be discussed at the next Board meeting.
There is to be a roadshow for the National Project for IM&T Strategy on 9 March from 3:00 – 5:00 pm in the PGME Lecture Hall and from 6:30 – 9:00 pm in the Education Centre and all Board members were requested to attend if possible.
BT were awarded the data highway contact on 19 February.
Diane Milan will produce a project management structure similar to the agenda to change proposal.
Mary Jones informed the Board that the Older Persons User Panel have produced a survey and asked how the Trust planned to respond to it. Mrs Jones also brought the Board’s attention to Standard 4 of the National Service Framework and queried how the Trust is meeting it. Veronica Worrall asked that these items be brought to a future Board meeting.
Judith Lancaster asked that Generic Referrals, Patient Choice and communication issues with patients be discussed at a future Board meeting. It was agreed that this subject would go on the agenda for April or May.
East of England Development Agency – representative needed.
Veronica Worrall gave a report on the Addenbrooke’s Council of Members which she has not been invited to represent the Trust on.
04/26 QUESTIONS FROM THE PUBLIC
None.
04/27 DATE OF THE NEXT MEETING
Friday 26th March in the Committee Room at 10.00 a.m.