BARTS AND THE LONDON NHS TRUST TRUST BOARD MEETING

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1 BARTS AND THE LONDON NHS TRUST TRUST BOARD MEETING Minutes of the open meeting of the Trust Board held on Wednesday 26 January 2005 at 11.30am in the Old Library, School of Medicine and Dentistry, Turner Street, London E1 1BB Present: In attendance: Apologies: Dr J Ashworth (Chairman) Mr J Adshead (Vice Chairman) Mr P M White (Chief Executive) Ms K Fenton (Director of Nursing and Quality) Mr J Goulston (Director of Finance and ICT) Dr C Gutteridge (Medical Director) Mr S Saunders (Director of Capital and Facilities) Ms M Elford (Non Executive Director) Miss B Ubhey (Non Executive Director) Professor N Wright (Non Executive Director) Mrs G Beer (Director of Performance Management and Planning) Ms S Cunnington-King (Director of Communications) Ms M Dover (Director of Service Transformation) Ms A Macintyre (Director of Human Resources) Mr I Walker (Trust Secretary) Ms K Banks (Chair, Patient and Public Involvement Forum) Ms J Chadwick (Head of Healthcare Governance) items 07/05 and 08/05 Mr L Rahman (Non Executive Director) Professor D Rampton (Chairman of Medical Council) 01/05 WELCOME AND INTRODUCTION The Chairman welcomed everyone to the meeting. 1

2 02/05 DECLARATION OF INTERESTS Attendees were reminded of the need to declare any interests they may have in connection with the agenda or interests acquired since the previous meeting, including gifts and hospitality. Mr Adshead reported that he was no longer acting as a consultant to Accenture. 03/05 MINUTES The Minutes of the open meeting of the Trust Board held on 15 December 2004 were received and approved as a correct record of the proceedings. The Minutes were duly signed. 04/05 MATTERS ARISING There were no matters arising. 05/05 CHIEF EXECUTIVE S ADDRESS Mr White gave a summary of recent developments and achievements in the Trust. NHS Champions Members of Trust staff consultant breast surgeon Robert Carpenter and porter Dennis Renton had won two of this year s five NHS Champions Awards in the doctor and support staff categories respectively. The awards, which were run by the Evening Standard in association with The King s Fund and ITV s London Tonight, recognised and celebrated exceptional NHS staff working in and around London. Members of the Trust Board joined Mr White in congratulating the winners. IWL Practice Plus accreditation 2

3 The Trust had recently received confirmation that it had been awarded Practice Plus accreditation in the national Improving Working Lives (IWL) initiative the first trust in London, other than the pilot sites, to be accredited at this higher level. BBC Trauma series The BBC had recently begun filming the next series of the documentary programme Trauma at The Royal London Hospital, focusing primarily on A&E and pre-hospital care with the Helicopter Emergency Medical Service (HEMS). In the meantime, the previous series was being re-run on BBC1 on Wednesday evenings. A recent article on the work of The Royal London in the Irish Times had attracted considerable interest and the Trust would be attending a health recruitment fair in southern Ireland in February. Nursing Times Awards 2005 The Trust had agreed to jointly sponsor with the North East London Strategic Health Authority an award in the midwifery category of the 2005 Nursing Times Awards. Primary angioplasty service The Trust s pioneering primary angioplasty service based at The London Chest Hospital had recently been expanded to make available advanced heart attack treatment to almost 2 million patients across north east London. Improving Health in Tower Hamlets Tower Hamlets PCT and The London Borough of Tower Hamlets had recently published a discussion document on the priorities for health and social care in Tower Hamlets over the next 10 years. Copies were available on both organisations websites. Good Going campaign Over 180 staff and visitors at The Royal London Hospital had signed a pledge to support Tower Hamlet s Good Going campaign which was 3

4 encouraging people to walk, cycle or use public transport instead of their cars whenever possible. Nursing placement awards Garrod Ward at Barts had won the City University Placement of the Year Award. The ward was selected by student nurses as their favourite placement area during their training. Two other clinical settings in the Trust were awarded runner-up prizes Paulin Ward at The Royal London Hospital and the Outpatients Department at The London Chest Hospital. The Trust Board congratulated all three wards and departments on this achievement. CNST level 1 re-accreditation The Trust had received level 1 re-accreditation in the national Clinical Negligence Scheme for Trusts (CNST) programme. The inspection team had encouraged the Trust to apply for level 2 accreditation which had already been achieved by the Trust s maternity service. Norovirus outbreak An outbreak of norovirus had necessitated the closure of The London Chest Hospital to new admissions. Steps had been taken to isolate the outbreak and make arrangements for patients who were due to be admitted. The Trust expected to reopen The London Chest to admissions within the next few days. 06/05 PERFORMANCE DASHBOARD Mrs Beer gave an update on the Trust s performance against key performance indicators to December The following points were highlighted in discussion: There had been a continued increase in the number of people attending the Trust s A&E department, with attendances up by 12 per cent over the past year per cent of patients had been seen and either admitted or discharged within four hours during December 2004 compared with the national target of 98 per cent. Further steps were being taken to reduce waiting times, including working closely with Tower Hamlets PCT to 4

5 ensure that patients used the most appropriate services available such as GPs and Walk-in Centres as well as A&E. The Trust was meeting the target for the percentage of urgent GP cancer referrals seen within two weeks and had recently received a positive report from the Audit Commission on its management of this target. The number of inpatients and daycase patients waiting more than six months rose only marginally in December 2004 compared with the previous month despite the closure of many theatre services over the Christmas period. The Short Stay Surgical Service at Barts was having a positive impact by reducing the number of patients requiring overnight admission, thereby freeing up beds and reducing cancellations and delays. The number of outpatients waiting longer than 13 weeks for a first appointment remained unchanged in December compared with the previous month. The percentage of breast treatments received within a month had fallen in the past two months, partly reflecting staff sickness absence. Work to redesign patient pathways as part of the move into the new Breast Care Centre was continuing. The Trust expected to be fully or partially booking per cent of outpatient appointments by March 2005 compared with a target of 80 per cent. Other trusts were finding this target particularly challenging. The Trust continued to expect to break even in 2004/05 although the financial position remained tight. In line with other trusts, this assumed that Agenda for Change would be cost neutral in the current year. Financial pressures associated with Agenda for Change would be more significant in 2005/06. The Trust Board noted the report. 07/05 HEALTHCARE GOVERNANCE 5

6 Ms Fenton gave a presentation on the new framework for healthcare governance which was being developed in the Trust. The aim of the new structure was to create an effective and integrated framework for healthcare governance and risk management, drawing together the key components of research, information, corporate (including financial) and clinical governance. These arrangements would help to ensure compliance with the new Standards for Better Health and high performance against the Healthcare Commission s new assessment framework from 2005/06 onwards. The development of the new framework was due for completion by April The key elements of the new framework were: The creation of a new Healthcare Governance Directorate, merging the former Medical and Nursing directorates under the joint leadership of the Medical Director and the Director of Nursing and Quality. The creation of a new corporate Healthcare Governance Steering Group. New directorate structures and processes, including directorate healthcare governance steering groups and directorate leads. Mechanisms to support greater matrix working across the organisation. More effective, regular and integrated reporting on performance against healthcare governance standards. The development of Key Performance Standards which aimed to monitor and support implementation of the new framework and monitor progress against specific work programmes. 6

7 The Trust Board endorsed the new Healthcare Governance framework and supported its further development in advance of full implementation from April /05 STANDARDS FOR BETTER HEALTH Ms Fenton and Ms Chadwick introduced the Trust s draft response to the Healthcare Commission s consultation on the new approach to assessing the performance of healthcare organisations in England. The Trust had participated in various consultation events including a recent workshop organised by the Strategic Health Authority. Many of the views to emerge at these events were similar to those included in the Trust s draft response. The key points of the draft response were: An overall welcome for the objectives of the new assessment framework and specifically the focus on fairness and transparency, issues that matter to patients and the public, the recognition of differences in the local environments in which organisations operate and the aim to make assessment less of a burden for those being inspected. Concern, in practice, about the large amount of work involved for healthcare organisations in assessing performance against the full set of standards and associated prompts and the assurance task for Boards. The risk that a focus on self assessment could leave the process open to a significant degree of interpretation and individual judgement. Despite spot checks and checks against other information sources, this could result in less transparency than under the current framework. The hope that, wherever possible, assessment would be focused away from process measures and towards implementation. The risk of focusing too much on process was that organisations would respond by resourcing multiple processes with little quality check. The following points were made in discussion: 7

8 The governance framework should provide effective crossdirectorate and cross-function working to achieve the best possible outcomes for the Trust as a whole. This would be supported by the identification of both directorate and corporate Key Performance Standards. The Trust s objectives for would be discussed by the Trust Board at its April meeting. Directorates would be developing action plans setting out how they would contribute to the achievement of the Trust objectives. The importance of local targets and taking local factors into account in performance assessment should be emphasised in the Trust s response. It was a welcome development that there would be locally-based Healthcare Commission staff but disappointing that local target setting could not be implemented immediately. A greater understanding of the use of self assessment in performance assessment was required. There were a number of possible reasons other than actual performance as to why one trust might self assess itself differently to another. It would also be helpful to have guidance on how to handle the inevitable degree of variation in performance within large, complex organisations. The importance of working with other organisations in the health economy and beyond to deliver coordinated health and social care should be emphasised. The Trust was undertaking work to assess how well it was working with others. There was a drive both nationally and internationally to provide more information to patients on hospital outcomes. There were many factors which could lead to variations in outcomes and the challenge for trusts would be to explain the information and how it should be interpreted. It should also be recognised that the publication of information had the potential to change clinicians behaviour. The Trust Board approved the Trust s consultation response subject to any further comments which should be sent to the Trust Office by 4 8

9 February Mr White would submit the final response on behalf of the Trust. 09/05 CONSULTANT APPOINTMENTS AND LEAVERS The paper outlined progress on the continuing programme of consultant recruitment. There had been two new consultant appointments in December 2004 and no consultant leavers. The Board approved the consultant appointments detailed in the paper. 10/05 ANY OTHER BUSINESS There was no other business to report. 11/05 QUESTIONS FROM MEMBERS OF THE PUBLIC The Chairman invited questions from members of the public. A number of questions were received and duly answered by members of the Board. 12/05 DATE OF NEXT MEETING The next open meeting of the Trust Board would be held at 2.00pm on Wednesday 30 March 2005 in the Main Lecture Theatre, The London Chest Hospital, Bonner Road, London E2 9JX. Signed. Dated. Ian Walker Trust Secretary

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