BOARD OF DIRECTORS MEETING IN PUBLIC. Friday 6 th May 2016, 10:00 13:00 Venue: Boardroom, Frimley Park Hospital. Final. Non-Executive Director

Transcription

1 BOARD OF DIRECTORS MEETING IN PUBLIC Friday 6 th May 2016, 10:00 13:00 Venue: Boardroom, Frimley Park Hospital Final Present: Pradip Patel Chairman Mark Escombe Dawn Kenson Mike O Donovan Andrew Prince Rob Pike Thoreya Swage Andrew Morris Chief Executive Helen Coe Director of Operations (Frimley) Lisa Glynn Director of Operations (Wexham) Timothy Ho Medical Director Janet King Director of HR & Corporate Services Nicola Ranger Director of Nursing & Quality Martin Sykes Director of Finance & Strategy In Attendance: Susanne Nelson-Wehrmeyer Company Secretary Sheila Connor (minutes) PA to Chief Executive & Chairman Ian Fry Director of Pathology 1. Welcome and Apologies for Absence The chair welcomed the governors and public to the meeting. There were no apologies for absenc Declarations of Interest There were non Minutes of the Previous Meeting The minutes of the meeting held on Friday 1 st April were approved as a correct recor Action Log from Previous Minutes This was note There were no matters arising. Chief Executive s Report Chief Executive s Report Page 1 of 9

2 5.2 g. h. The Chief Executive reported that the Trust was on track to meet all Monitor standards for Qtr 4 with the exception of the 4 hour A&E target. Frimley Health s performance of 91.6% remained in the top quartile of Trusts nationally. The year-end financial performance was a 1m surplus. This was driven by non-recurrent support from the DoH, moving capital to revenue and good delivery of CIPs. A key concern that will need to be addressed this year is agency spend which has to be done in order to reduce the underlying deficit. 2016/17 Updated Board Objectives These were approved by the boar Frimley Health will receive non-recurrent support from the Department of Health as part of the transaction agreement. Support has been given to Trusts and the objective for Frimley Health is to deliver a 22m surplus at year en Andrew Prince asked whether the settlement for Junior Doctors (JDs) had been factored in and the implications of this on the current proposal. The Chief Executive confirmed there was nothing factored in, so any additional costs will be a down side on the year. Janet King had a meeting with the payroll manager regarding the new national software which is designed to assist with JDs rotas. Unfortunately this does not seem to work, so payroll have volunteered to do it manually, until the software is fixe The best current estimate is that implementing the new JD contract will cost 0.5m 1m. The Chief Executive reported on changes to bank pay and the on-going drive to recruit nurses so that a reduction in the use of agency staff could be achieve Nicola Ranger reported on the work she is doing with Universities (UWL and Surrey) on apprenticeships for nurse training. This will help us get good quality trained nurses into the Trust going forwar Rob Pike queried the accuracy of reporting of some Board Objectives which were green but had not been achieve He suggested that milestone targets be included in order to get a better sense of direction of travel. The Chief Executive informed the board of changes to the Stroke services at Wexham. The CCG want to move the acute element to High Wycombe, whose results for stroke are very goo The Trusts offer at Wexham Park has been in a difficult place, largely by not having enough Consultants. 6 stroke Consultants are required and unfortunately due to recruitment difficulties we only have 2. We are in discussion with the CCG on our role in the stroke pathway and we should be able to offer a Rehabilitation servic The Chairman reported a successful Staff Awards Evening. 51 awards were presented on the night. Special thanks were given to Janet King and her team for all their hard work to create a great event. Feedback from the event was very good and the event was well run and enjoyabl AVM Page 2 of 9

3 5.3 i. j. k Sustainability and Transformation Plan (STP) The Chief Executive updated the board on the STP work for Frimley Health. This is progressing well with Jane Hogg playing a key role in the work. Early work indicates that our Place deficit is ~ 110m by 2020/21, which is smaller compared to some others such as SW London at 800m, Kent at 500m and Hampshire at 400m. There is a period of intensive work over the next few weeks to get our plans ready for submission at end of Jun The team have agreed the 5 key priorities to focus on and the next phase of the work is to determine the two or three actions under each priority that will make the biggest differenc The Chairman asked that once the plan has been signed off by NHSE and NHSI, a fuller briefing is arranged for both the board and the council of governors. Ward Presentation Parkside Ward The chairman welcomed Angela Lawes and Aine Pope who presented to the Board the work done by Parkside team. The presentation will be posted on the websit Rob Pike asked if Private patients are concerned when NHS patients are alongside them in Parksid Angela Lawes responded that this wasn t an issue as private patients tend to keep to themselves in their own rooms. Dawn Kenson enquired about hand hygien Angela responded that this was good with regular audits being carried out which includes everyone attending the ward to ensure ownership. It is a challenge sometimes with Consultants and Doctors. All patients have access to sinks and every bed has alcohol gel to help with hand hygien Mark Escombe enquired about the condition of the waiting are Angela responded that patients don t stay in the waiting room that long but the Outpatients area does need refurbishing as the wallpaper is out-date The Chairman thanked the Parkside team for a good presentation and the whole team for the discussion that followe There is clearly great leadership in place in Parkside and the Chairman asked for the thanks of the whole board to be taken back and shared with the team. Quality Improvement Plans (QIPs) Tim Ho highlighted that there was good progress on delivery of the CQC action plan for Wexham Park. There is still an on-going challenge to recruit the number of Consultants in ED, due to a national shortag Tim also informed the board that we now have one Quality Committee covering all our sites and whilst there were many cross sites issues, good progress was being made to address them. Dawn Kenson enquired if the internal staff transfer scheme was having an impact. Janet King reported that there was a slight delay to implementing the scheme but this AVM SNW Page 3 of 9

4 would soon be resolved and she will report back at a future stage on the results from the schem Recruitment was still a live issu g. Thoreya Swage asked why the action against King Edward VII was rated red when it appeared that all the actions had been achieve In response Tim Ho indicated that this was an error and should have been reported as green. Mike O Donovan asked about recruitment to the 2 year fixed term Cancer pathway post. Tim Ho reported that although the employee structures were established, recruitment was still an on-going process. Lisa Glynn reported that due to problems at Wexham, where cancer patients did not know where they were going to be treated, recommendations had been made to streamline this process. Cancer Care Presentation A presentation was given by Ian Laidlaw (Consultant in General Surgery) and Liz Howells (Associate Director). The presentation was well received and was followed by a number of questions. The Chair commented that it may be worth taking this presentation to a council of governors meeting and maybe to the constituency meetings, given the interest in cancer. Quality and Performance Report Nicola Ranger reported the general improvement in C.Diff, with each quarter showing an improvement. There was also very good improvement in pressure ulcers. There were 24 less SI s than last year and 13 less falls. The biggest concern was with the number of never events, with a total of 6 in the Trust compared to only 2 in the previous year. Mark Escolme asked about pressure ulcers and whether this had a high enough priority. In response Nicola Ranger advised that the key to preventing pressure ulcers was the basic care provided by nurses and ensuring the patients were kept comfortable and confirmed it was a high priority. Tim Ho reported that mortality at both sites is improving. Rob Pike enquired about the number of high deaths in March 2016 and whether we knew the reason for this. Tim Ho responded that the information was not yet available but reassured the board that all deaths across the Trust are now required to be investigate Nicola Ranger reported that with respect to mealtimes the target had not been met. It was apparent that the wards needed assistance with mealtimes and recruitment of additional volunteers was underway to assist in this are Some very good progress on Patient Complaints was reporte In comparison to last year there were 231 less complaints overall. Thoreya Swage queried the progress on the standard of responding to complaints in 25 day from receiving them. Nicola Ranger indicated we were not meeting the threshold, however, there was now more focus on the quality of the response, which Page 4 of 9

5 is leading to a lower percentage of complaints being re-opene The total amount of complaints is reducing and we can now focus on targeting turnaroun h. i. j. k. l. m. n. 10. The chief executive indicated that whilst we missed the 4 hour A&E target in the last quarter, the last 2 weeks had improve The 18 week target has been made more difficult as the Trust has had to deal with 6 days of the Junior Doctors strik On the issue of waiting lists, Helen Coe reported that number of patients waiting for an outpatient appointment had increased and more work was needed to reduce waiting levels. Janet King reported some good news that the nursing and midwifery vacancies had reduced by 2%, as 30 nurses from EU had joined and another 35 EU nurses had been made offers. Last month 55 offers were made to final year students. Skype interviews conducted with nurses in India have resulted in 10 more offers. Turnover at Wexham which had averaged 21 nurses per month last year, was down to 14 in the last quarter, as a result of a real drive on retention. For doctors there are 24 offers outstanding. Wexham has particular challenges in Medicine and ED departments. For Frimley there are 16 live offers out across all specialities. Currently there are adverts out for paediatrics and elderly care Consultants. Much depends on the availability of work permits and Certificates of Sponsorship. Both Wexham and Frimley need to have harmonised terms and a standardised pay system. Janet commented that the 3% sickness absence rate requires closer attention, as there may be a data error, as you would expect absence rates to fluctuate month by month. In relation to the appraisals for non clinical staff, although the data shows a poor performance, other sources such as the annual staff survey shows a much higher figure for staff having had an appraisal. Uploading this data onto the system has been problematic and improvement is neede Dawn Kenson queried whether the Trust had an electronic appraisal system and Janet King confirmed this was not in place but could be considered in futur Rob Pike queried whether agency spend comprised 13.4% of the pay bill or whether it was more like 8%? The chairman requested confirmation of these figures. Dawn Kenson suggested that text messaging patients would help reduce missed appointments. CIP Update Helen Coe presented the report on CIP. Rob Pike enquired about the CCG s and spending which Martin Sykes responded to. Pradip Patel thanked Helen Coe & Lisa Glynn and asked them to thank their teams on behalf of the board for their excellent work to deliver the CIP for 2015/16. They should be very proud of what they have achieve The Board noted the report. JK Page 5 of 9

6 c g. h. i. Finance Report Month 12 Highlights: We have achieved 1m surplus. The story for the year is one of significant income over performance, a 3m transfer from capital to revenue, good CIP delivery and non recurrent support from the DoH. Year-end cash balance was 72m, which was higher than plan. Agency costs were 37m. Pay was close to plan. CIP achieved 94% delivery against plan. Temporary staffing was a key area of underperformanc The report was note 2015/16 Capital Programme & Capital Out Turn Report & Update on major schemes Janet King reported that the outturn for the year was 13.9m versus a plan of 27.7m. The main reasons for this was either delays or postponement to some schemes. Janet brought the board s attention to two specific schemes: G6 project. Tendering has been complete It has been difficult to vacate the wards due to demand for beds, so the work has been delayed but it is hoped to be completed by November. Block 40 Mental Health Building which is going to be occupied by Corporate Services functions. The budget to get the block ready was 5.5m but surveys have confirmed that the cost will be ~ 11m to get the building up to modern day standards. The plan is to complete one floor at a tim Catering facilities will still need to be provided for the staf Heatherwood Re-development we are still two weeks away from signing off the drawings. There is a large amount of work to be completed before the submission of the planning application. For the ED project the limit was 50m. Janet King reported that she met with Kiers contractors whose initial costing was nearer to 52m. Work is under way to bring this figure back to 49m. Janet King is exploring options with the team to achieve this. There is a public engagement event planned to showcase the ED scheme on the 25 th May and all members of the board and governors are invited to atten The maternity project is progressing well and is within budget. Andrew Morris reported that there is a real opportunity to drive this service due to changes in surrounding hospitals such as Ealing closure of Maternity, Hillingdon and Royal Surrey. Rob Pike reported that we are 0.5m under budget for the car park. This is the first time we have used this contractor and he is very impressed with them. Janet King will be working with Mark Escolme on various FBC s so that the CDIC can review them before they come to the boar Page 6 of 9

7 13. Annual Report from the Director of Infection Prevention & Control Ian Fry presented the report. The key metrics were: 2 Trust apportioned MRSA, both at Wexham Park 41 C.Dif cases of which 18 were at Frimley and 23 at Wexham. On root cause analysis, lapses in care were identified for 13 of the cases. On Hand Hygiene, Frimley is back on track at 95% in Q4, whilst Wexham Park is well below this at 77%. The National Standard is 95%, so there is more work required to achieve this. 2 outbreaks of GRE at Frimley Park. There was a seven day closure for the Norovirus of the female side of a ward at Wexham Park. Theatre ventilation no problems to not Vacancies at Wexham Park for infection prevention and control have now been fille Martin Sykes commented on the C.Diff lapses in care and wondered whether we were being too hard on ourselves. In some cases the lack of a soap dispenser may have contributed to these cases. Mike O Donovan commented that we should wear gloves at all times. Rob Pike noted that our figures are much better than last year except for hand hygien In response Ian Fry indicated that C.Diff is multi-factorial but success is based to a large extent on hand hygien Ian Fry was going to meet with the pharmacy team to discuss and agree the priorities for antibiotic prescribing. 14. Corporate Risk Assurance Register The Chief Executive introduced the report and noted that the risks have not changed from last year and into this year. The report was note 15. Monitor Board Declarations Martin Sykes introduced the session and the board gave its approval to the CEO and Chair to sign the declarations. Page 7 of 9

8 Clinical Governance Committee Report The report was presented to the board and a discussion ensued on cross site integration with the Royal Berkshire Hospital and the Surrey Pathology Servic Rob Pike advised that there was discussion at the Audit Committee and that the auditors would be auditing the Surrey Pathology Servic Open Slot for Directors There were no issues raise Meeting Review There is a need to allow more time to do justice to some sessions. Andrew Prince indicated that the Cancer session was very informative but required more tim Mark Escolme agreed that the Parkside presentation was good but it wasn t in the format we have previously agreed for ward to board sessions. There was discussion regarding the patient s stories and whether they added value at board meetings or whether there was a better forum for them. A query was raised as to whether the Patient Experience Forum was the best place for this item. Nicola Ranger reported that we are still capturing learning from patient stories and use them to improve patient care and experienc Questions from Members of the Public Sylvia Thompson informed the Board that patient stories were of interest and relevant to the public and that we shouldn t lose sight of this and should continue to have them at the board meetings. Jan Barrett asked with regards to the RCA reports if we have a robust process to minimise occurrences in futur Nicola Ranger responded that we do have a process for any incidents. We have clinical expertise, objectives and MDT s. We also have a patient safety committee where we discuss these issues. We do recognise that more can be don We are currently analysing the data for last year and will be bringing it back to the Board when it is complete Another member of the public agreed that patient stories should be shared at public board meetings as there is a need to hear the things that had gone wrong publicly. Julia Long asked with regards to the cancer care presentation, if a private patient expects priority and if so does this upset the planning for NHS patients or are there not many cancer private patients for this to be an issu Timothy Ho responded that there wasn t an issue as the framework within the MDT meetings allows for private patients to be discussed alongside public sector patients by the lead consultant to get peer review. Page 8 of 9

9 g. 23. Graham Leaver asked whether the acoustics could be improved in the meetings as this was a problem. The Chairman said that he will follow this up and if there wasn t a technical solution, he will invite people to speak up when presenting. Mary Probert advised that she had heard the patient story at PEF and this was excellent forum for them. She agreed these should be presented publicly and maybe they could also be shared at constituency meetings. The Chairman said that the board will consider all the points raise Any Other Business Nicola Ranger informed the board that there had been a story in a Slough newspaper about a patient and the care he had received at Wexham Park. Nicola Ranger reported that she was disappointed about this as she and Sally Brittain had visited this patient and spent over two hours with him at his home to go through his car Health Watch are also very active in Slough and they had also spent a lot of time with this patient. Tim Ho reported to the Board that Andrew Morris is now an honorary Fellow of the Royal College of Physicians. The Board and all present recorded their congratulations to Andrew as this is a real accolade and recognition of his contribution to the health servic 24. Date and Time of Next Meeting 10am Friday 3 June 2016 PGMC, Wexham Park Hospital. Page 9 of 9