MINUTES OF A MEETING OF THE TAMESIDE HOSPITAL NHS FOUNDATION TRUST BOARD 27 JANUARY 2011

Transcription

1 MINUTES OF A MEETING OF THE TAMESIDE HOSPITAL NHS FOUNDATION TRUST BOARD 27 JANUARY 2011 Present Mr T Presswood Mrs C Green Mr P Dylak Mr A Anderson Mr T Ward Miss K Brown Mrs D Bates Dr T Mahmood Mr A Griffiths Mr R Corless Ms T Kalloo Position Chairman Chief Executive Director of Nursing Director of Finance Medical Director Director of Clinical Services In Attendance Mr D Wilkinson Director of Human Resources 13/11 Apologies for absence There were no apologies for absence 14/11 Minutes of the meeting held on 6 January 2011 The minutes were approved as an accurate record of the meeting 15/11 Matters arising from previous meeting There were no matters arising 16/11 Chief Executives Report Questions and comments were invited on Mrs Green s report, which included the following items: Q3 Monitor submission HIT update Operating Framework 2011/12 Capacity update Safety Express Enhancing Patient Safety Mrs Green reported that in respect of the Q3 Monitor submission, there was a further issue which she wished to report to Board. She advised that as at 24 January, the hospital reported 18 cases of C.Diff in the month. This constituted almost 3 months target, and means that only a further 2 cases can be reported before the Trust exceeds its target for the financial year. In this respect Mrs Green advised the Board that it would be appropriate to formally inform Monitor that the Board is unlikely to

2 achieve the annual target. It was stressed that this was not an outbreak and that the key issues would be discussed under item 8 on the agenda. Mrs Green went on to state that performance on the 62 day urgent GP referral to treatment cancer standard had not achieved the target in Quarter 3. It was noted that. Tameside Hospital is very reliant on tertiary centres such as the Christie Hospital and the University Hospital of South Manchester, and capacity pressures in these organisations also have a direct impact on the Trust s performance. In addition to looking at in-house performance, both organisations have been approached and actions have been agreed to ensure performance improves over the Q4 period. Dr Mahmood stated that subject to clinical appropriateness, patients are being referred over to tertiary centres as soon as possible on the cancer pathway, in an attempt to compensate for any capacity issues at the receiving hospitals. In response to a comment, Mrs Green reported that everything has been done to address the issues relating to the moderate concern and that there should be ample evidence to support this. Following discussion on the three issues driving the governance rating, the Board approved the Q3 Monitor declaration, with the amendment in respect of the CDiff position. In respect of HIT, Mr Corless enquired if there has been any further progress in relation to the opening ceremony that is being planned to officially mark the commissioning of the HIT development. Mrs Green stated that the Chairman has written to the Lord Lieutenant and is still awaiting a response. The Lord Lieutenant s office has however been in contact with the Associate Director of Facilities to discuss the opening. Advice is still being sought from the Lord Lieutenant about the possibility of changing the Hospital s name. Mr Ward asked if there was a possibility of the Board receiving an early indication of the benefit realisation arising from the HIT project. Mrs Green responded by stating that the HIT team were following a prescribed and quite complex process, and that an early draft will be available in August However, it was noted that savings arising from the HIT project will be factored into the budget-setting process for 2011/12. The Board noted the key elements in the Operating Framework and in particular the re-ablement funding. In response to a capacity-related question from Mr Corless about the number of ambulance diverts that had been requested, Mrs Green explained that the Ambulance Service can in fact trigger a divert if it considers a hospital is under pressure and there is the possibility of detaining ambulance crews. Executive Directors can also request a divert and this gives the clinical staff the opportunity to generate capacity and ease the pressure on the A&E department and ward areas. Mr Griffiths advised that hospital requests were infrequent. He was aware of making two such requests but only one had been agreed by NWAS, due to conurbation pressures. Mrs Bates requested a copy of the recent Tribal Report, however it was explained that the report was commissioned by the PCT and the final report was not sent to the

3 Trust. Mr Griffiths has copies of a presentation relating to the report and agreed to circulate this to Mrs Bates. The Board discussed and noted the contents of the Chief Executive s report and approved the amended Q3 Monitor submission. 17/11 Finance and Activity Report December 2010 The finance position at the end of December 2010 was reported at a cumulative deficit of 1,483k against a revised planned deficit of 1,145k. The in month position had been a deficit of 331k giving an overall variance of 339k. The financial risk rating of 2 was noted. There was a detailed discussion of the underlying causes of the position including the key issue being the reduction in clinical income and the reasons behind this which included the impact of Non Elective activity and the spike in DNAs by patients. The actions taken were noted including those that would prevent such a situation arising in future. The need to recover the shortfall in year was also noted and endorsed as an absolute requirement. The position on CIP delivery was discussed with regard to 2010/11 and 2011/12 recurrently. The categories against which CIPs had been posted were also discussed. The savings arising from input from consultants were flagged as this was currently shown against divisional and specific work streams e.g. theatres and not grouped under the Q&E work stream. The release of funding from PFI transitional funds was also noted following a reconciliation of future commitments. The Finance and Activity Report was discussed and noted. 18/11 Statement of Position December 2010 The reduction to the capital programme in year was also noted at a value of 0.6m. The importance of maintaining the liquidity position and cash flow balances was reiterated. The Statement of Position Report was discussed and noted. 19/11 Performance Report December 2010 In relation to the 18 weeks position, it was noted that although the December targets were achieved on both admitted and non-admitted care, the Q3 performance narrowly missed the target by 0.1%. The 18 weeks position for quarter 4 was also discussed, with the Board noting that two more months were likely to miss the old 18 week target. The position with regard to the cancer targets was also discussed including capacity constraints at tertiary centres, and the importance of ensuring quarter 4 performance, especially in the light of the CDiff issue. The Board discussed and noted the Performance Report

4 20/11 Infection Prevention and Control Report The significant deterioration in C.Diff performance was discussed in some detail. Mr Dylak stated that each case is investigated via Root Cause Analysis. It is evident from such investigations that compliance with the Trust s antibiotic prescribing policy at weekends and holiday periods is a major challenge. The Antimicrobial team is visiting ward areas on a daily basis and some of the prescribing conventions within the antibiotic prescription policy are being reviewed in order to initiate immediate remedial action. Mrs Green suggested that consideration should be given to making it a requirement for the Anti-Microbial team to be available at weekends and holiday periods in future. Mrs Bates asked what action Dr Mahmood was taking, given that the issues were about medical prescribing. Dr Mahmood stated that he contacts the relevant Consultant to discuss each case of C Diff that is reported. All those involved receive a follow-up letter. Dr Mahmood also remarked that at a recently well-attended Grand Round he had raised this key issue with Consultants and Junior Doctors, stressing the importance of adherence to the antibiotic prescribing policy. The Board noted the Trust s performance to date, and the actions being taken to address the Trust s performance. 21/11 Patient Survey (2009) Final Report The Board noted the final report on the Patient Survey (2009) and formally signed off the report. 22/11 Human Resources Report Quarter 3 Mr Presswood commented on the signs of improvement to pay expenditure evident in this report. Mrs Green enquired about the arrangements for next years work permit allocation for overseas medical staff. Mr Wilkinson responded by saying that no information has been received yet, but the organisation needs at least 8 permits for next year. In relation to the sickness absence position by division, Mr Anderson enquired about the reasons for the adverse variances being recorded by the Facilities and Corporate Divisions. Mr Wilkinson stated that these mostly related to long term sickness absence and was assured that these were being managed appropriately. With respect to spend on the nurse bank and agency and medical locums, Mr Ward enquired if the level of reductions in this area were predicted to continue into quarter 4. Mr Wilkinson confirmed that both trends were anticipated to continue due to the actions being taken to address pay overspends. The Board noted the report. 23/11 Sealed Documents Quarter 3 The Board noted that there were no sealed documents to discuss

5 24/11 Quarterly Nurse Director s Dignity in Care Report In response to a question about the small number of items raised by the report, Mr Dylak stressed that Matrons and DNMs understood that the Trust was working towards zero tolerance. With regard to hand hygiene, Mr Dylak advised the Board the Trust s performance was recognised to be exemplary. In relation to gender segregation issues, it was noted that this related to MAAU, which has been affected by a recent national policy change. Staff at Tameside Hospital tend to be extremely vigilant and transparent, and as a result they are very quick to report what they perceive to be gender segregation issues. Many hospitals had not submitted data. Mr Ward asked a number of questions about the documentation audit. He remarked that it covered an impressive range of areas. Mrs Bates asked when the paediatric service expected to be compliant. Mr Dylak said it was the first time the paediatric tool had been used and he would expect the action plan put in place following the audit results would achieve a higher rate of compliance next time. The Board discussed and noted the Quarterly Nurse Director s Dignity in Care Report. 25/11 Quality Account Update Mrs Green enquired if Mr Dylak is satisfied that the actions taken made to date reflect the areas identified within the revised national guidance that has recently been published. Mr Dylak confirmed the approach taken by the Trust to the development of the quality account appears to be congruent with the guidance. The Board discussed and noted progress in relation to the Quality Account. 26/11 National Service Frameworks and Cancer Plan Report This item had been deferred to the February meeting. 27/11 Clinical Excellence Awards Report Mr Presswood reported that the Trust has complied with the national guidance related to consultant clinical excellence awards, and that the committee met on 20 December 2010 to discuss and agree any local awards payable from 1 April The Board discussed the Clinical Excellence Awards Report and endorsed the recommendations of the panel. 28/11 Charitable Funds Annual Accounts 2009/10 Report The Board as Trustees of the Charitable Fund formally approved the Annual Accounts for 2009/10, and endorsed the representations and commitments included in the letter.

6 29/11 Non - Executive Reports Mr Presswood formally reported that Mrs Green, Miss Brown, Mr Griffiths and he had attended a meeting with Monitor at the beginning of January 2011, to discuss the Trust s financial position and performance. 30/11 Any Other Business i. Director of Finance Vacancy Mrs Green stated that as a result of the nationally determined recruitment and selection process that has to be followed, several strong potential candidates expressed an interest in the post. The Board will be involved in the selection process in the usual way. ii. GP Consortia Mr Ward asked if there has been any progress in developing relationships with GPs within Tameside and Glossop responsible for leading the GP Consortia. Mrs Green responded by saying that to date there has been no indication which GPs will be leading on the development of the Consortia. Dr Mahmood added that an election process is about to be held to address this issue. 31/11 Date and Time of Next Meeting The next meeting will be held on Thursday 24 February 2011 at am in the Darnton Meeting Room.