Chair s report and Draft Minutes of the meeting of the Trust Management Committee held on 21 March 2014

Transcription

1 Chair s report and Draft Minutes of the meeting of the Trust Management Committee held on 21 March 2014 Agenda Item No: 16.1

2 CHAIRMAN S SUMMARY REPORT Name of Committee/Group: Trust Management Committee Report From: Chief Executive Date: Action Required by receiving committee/group: X For Information Decision Other Aims of Committee: To oversee and co-ordinate the Trust operations on a Trustwide basis To direct and influence the Trust service strategies and other key service improvement strategies which impact on these, in accordance with the Trust overall vision, values and business strategy. Drivers: Are there any links with Care Quality Commission/Health & Safety/NHSLA/Trust Policy/Patient Experience etc. The matters highlighted below are not driven directly by the CQC, Monitor, or any other outside body. They are driven by the need and desire to enhance patient experience, ensure patient safety, maximise operational efficiency and effectiveness, improve the quality of services, and safeguard the financial position of the Trust. Main Discussion/Action Points: Considered and approved the business case to increase the number of Immunology Consultant Sessions purchased by RWT and to become part of a spoke and hub service with HEFT. This will enable patients referred to a consultant Immunologist to be seen locally and increase on-site immunology expertise as well as retaining the laboratory immunology contract with the Birmingham Children s Hospital Approved the business case for appointing a Consultant Microbiologist to replace Dr Mary Ashcroft who is leaving the Trust in April Discussed and approved in principle the business case for the appointment of a consultant Ophthalmologist with specialist training in Vitreo-Retinal Surgery. This should improve the on-call service, assist with the reduction of the patient backlog, and help ensure continuity of service as three existing consultants anticipate retirement. Approved a business case to use Levobupivacaine instead of Bupivacaine in local anaesthetic and epidural settings. The former is less cardio toxic and therefore safer for patient use and more easily treated if it enters the blood stream. Approved the business case for the introduction of a ADS/RWT Trust Management Committee Page 1 of 2

3 Percutaneous Tibial Nerve Stimulation service in the Obstetric and Gynaecology Department. This procedure is for the treatment of the symptoms of an overactive bladder, and is less invasive than the alternative procedures. Discussed and endorsed the business case for alterations to the arrangements for test result notifications in Head and Neck, in order to avoid bringing patients back to the Maxillofacial Department for a consultant-led appointment when all-clear test results will require no further action. Approved the business case for the use of Iluvien to treat Diabetic Macular Oedema in Ophthalmology. Approved the business case for the use of Jetrea for the treatment of Vitreo-Macular Traction in Ophthalmology Supported the proposals for SOS appointments in Dermatology and Acute Paediatrics, as part of the larger Joint Outpatient Project between RWT and the WCCG, designed to reduce the number of avoidable outpatient attendances. Noted that in the last 4 years there has been an increasing number of referrals into Wolverhampton s Looked After Children s (LAC) Service, with an 85% increase in the LAC population in the city (778 children in care). Additional resource is required to deliver statutory health assessments within prescribed timescales as well as universal healthcare services to the children concerned, and a business case has been approved for the funding a recruitment of consultant, nursing and administrative staff to cover the increasing workload. Supported a business case to directly employ the Independent Domestic Violence Advisor attached to A and E, in order to continue to enhance the service provided to victims of domestic violence. Risks Identified: Include Risk Grade (categorisation matrix/datix number) The Trust Management Committee has had regard to any risks identified in respect of these matters. The TMC also has a standing item on every agenda, at which point anybody present may raise any matter which is deemed to be worthy of consideration for inclusion on a risk register. ADS/RWT Trust Management Committee Page 2 of 2

4 The Royal Wolverhampton NHS Trust TRUST MANAGEMENT COMMITTEE Minutes of the meeting of the Trust Management Committee held at 1.30pm on Friday 21 March 2014 in the Boardroom, Clinical Skills and Corporate Services Centre, New Cross Hospital, Wolverhampton Present: Mr D Loughton CBE Chief Executive Mr G Argent Divisional Manager, Estates Mr I Badger Divisional Medical Director, D1 Ms R Baker Head Nurse, D2 Dr M Cooper Head of Infection Prevention Dr J Cotton Head of Research and Development Dr M Cusack Divisional Medical Director, D1 Ms M Espley Director of Planning and Contracting Ms C Etches Chief Nursing Officer Mr M Goodwin Head of Estates Development Mr L Grant Deputy Chief Operating Officer, D1 Ms D Hickman Head of Midwifery Dr C Higgins Divisional Medical Director, D2 Dr J Odum Medical Director Ms G Nuttall Chief Operating Officer Dr D Rowlands Lead Cancer Clinician Dr B M Singh Lead IT Clinician Dr S Smith Divisional Medical Director, D2 Mr K Stringer Chief Financial Officer Ms Z Young Head Nurse, Division 1 In Attendance: Mr A Sargent Trust Board Secretary Apologies: Ms D Harnin Director of Human Resources Dr L Dowson Divisional Medical Director, D2 Mr T Powell Deputy COO, Division 2 14/73: DECLARATIONS OF INTEREST No interests were declared at this meeting. 14/74: MINUTES OF THE MEETING OF THE TRUST MANAGEMENT COMMITTEE HELD ON 21 FEBRUARY IT WAS AGREED: that the minutes of the meeting of the Trust Management Committee held on Friday 21 February 2014 be approved as a correct record. 14/75: MATTERS ARISING FROM THE MINUTES Arising from minute 14/42, Dr Cusack confirmed that the temporary facilities were functioning but that there remained some troubleshooting to be completed. 1

5 14/76: ACTION POINTS In response to a question by Mr Loughton, Mr Goodwin indicated that discussions regarding the condition of wards tended towards carrying out essential improvements where required, rather than a wholesale refurbishment ward by ward as and when resources became available. Mr Loughton asked where this left the business case for the refurbishment of the Gynaecology Ward. Mr Grant reiterated the wish of the Division for this to proceed, and in response to Ms Etches Ms Hickman confirmed that this remained the top priority for the Department. IT WAS AGREED: That the business case for the refurbishment of the Gynaecology Ward D7, as presented to the meeting in February, be approved. 14/77: THE INTEGRATED ELECTRONIC PATIENT MEDICAL RECORD Dr Singh presented the quarterly report on implementation of the integrated electronic patient record. Ms Young and Dr Cusack referred to difficulties experienced with historical archived notes which could be unwieldy to work through online, because of the time it could take to scroll down large PDF documents. Dr Singh said that generally the electronic records for current patient episodes were working well, but he acknowledged that the team would have to revisit the position regarding large scanned episodes (Dr Dev Singh). Dr Odum indicated that he continued to feed concerns to Dr Singh as and when they arose. He reminded the meeting that it could be equally difficult to work through pages of paper notes, which could often be organised haphazardly and out of order. He had found that most of the electronic records which he had recently seen were of an acceptable standard and it was clear that the scanning staff were making an effort to put the notes into order and to undertake their task thoughtfully. IT WAS AGREED: That all services must be compliant with the recommendations approved by the TMC in March 2013 in support of the integrity of the electronic medical record; That all elective and non-elective contemporary inpatient records will be scanned in line with the procedure outlined to TMC in March 2013, and that this will be fully implemented by the end of May 2014 in a continuous planned rollout; That all such scanned episodes will be shredded after a one-month period of retention; That, following scanning of the episode, no marker will be placed within the case notes as all clinicians will view the patient record as being split between electronic and paper methods; That, Trust-wide, the historical paper medical record will not be made available for acutely admitted patients unless requested, but if so requested it will be made available within 30 minutes, the planned date for this to commence being 1 September 2014; That the cost of medical records (inpatient elective, non-elective and outpatient) will be allocated to services proportional to their paper case record usage, proposed to be developed in shadow form and shared with the divisions during 2014/2015 starting in quarter 3, with recharges in place from quarter /

6 14/78: CANCER SERVICES Dr Rowlands submitted the quarterly report on Cancer Services. Mr Badger said that actions were being taken to ensure attendance at MDT meetings. IT WAS AGREED: that the quarterly report on Cancer Services be noted. 14/79: GOVERNANCE REPORT DIVISION 1 Ms Young introduced this item and highlighted the red risk regarding the quality of nursing care offered on Ward A6. She gave an assurance that detailed work, supported by HR, was ongoing, and that the situation was under weekly review. With regard to the occurrence of never events, Ms Etches requested all areas to risk assess (and document the assessment process) the use of nasal gastric feeding tubes. Dr Odum added that a training module was being developed around the process for checking the tubes, and would be released in the near future. IT WAS AGREED: that the monthly Governance report for Division 1 be noted. 14/80: NURSING, MIDWIFERY AND QUALITY REPORT - DIVISION 1 Ms Young highlighted good progress on infection prevention during February. IT WAS AGREED: That the report on Nursing, Midwifery and Quality in Division 1 be noted. 14/81: CLINICAL IMMUNOLOGY SPECIALIST SERVICE Dr Cusack presented a business case for an increase in the number of immunology consultant sessions purchased by the Trust, in order to become part of a hub and spoke service with HEFT. IT WAS AGREED: that the business case for the purchase of additional consultant sessions to increase the Clinical Immunology Specialist Service be approved. 14/82: REPLACEMENT CONSULTANT MICROBIOLOGIST Dr Cusack submitted a business case for a replacement consultant microbiologist, following the resignation of Dr Ashcroft. IT WAS AGREED: That the business case for the replacement of a Consultant Microbiologist be approved. 14/83: APPOINTMENT OF CONSULTANT OPHTHALMOLOGIST WITH SPECIALIST TRAINING IN VITREO-RETINAL SURGERY Mr Badger requested the Committee to approve this business case to recruit one consultant ophthalmologist with specialist training in vitreo-retinal surgery, to be funded by relinquished PAs from three existing consultants and by using existing funding from elsewhere within the budget. 3

7 IT WAS AGREED: That the business case for the appointment of a consultant ophthalmologist with specialist training in vitreo-retinal surgery be approved. 14/84: LEVOBUPIVACAINE Mr Badger introduced this item. IT WAS AGREED: that the business case for the use of Levobupivacaine instead of Bupivacaine in local anaesthetic and epidural settings be approved. 14/85: PERCUTANEOUS TIBIAL NERVE STIMULATION (PTNS) Mr Badger submitted this business case for approval. IT WAS AGREED: That the business case for the introduction of Percutaneous Tibial Nerve Stimulation be approved, subject to the Commissioner also approving the business case. 14/86: TEST RESULTS FEEDBACK HEAD & NECK Mr Badger outlined the business case for changes to arrangements for test results feedback in Head and Neck, in order to reduce the number of avoidable outpatient attendances. IT WAS AGREED: That the business case to effect changes to the provision of test results feedback in Head and Neck be approved. 14/87: BUSINESS CASE ILUVIEN (OPHTHALMOLOGY) Mr Badger presented this business case. IT WAS AGREED: That the business case for the use of Iluvien in Ophthalmology be approved, subject to the approval of the Commissioner. 14/88: BUSINESS CASE JETREA (OPHTHALMOLOGY) Mr Badger summarised the salient points of this business case, which was for a treatment for Vitreo-Macular Traction in adults. IT WAS AGREED: That the business for the introduction of Jetrea for the treatment of Vitreo-Macular Traction in Ophthalmology be approved, subject to the approval of the Commissioner. 14/89: NURSING AND QUALITY REPORT - DIVISION 2 Ms Baker reported that the Division continued to monitor quality and safety on Ward A7 on a weekly basis. IT WAS AGREED: That the Nursing and Quality report for Division 2 be noted. 14/90: GOVERNANCE REPORT - DIVISION 2 Ms Baker summarised the monthly Governance report from Division 2. She highlighted that the Division continued to have one red risk and five high amber risks on the risk register. IT WAS AGREED: That the monthly Governance report for division 2 be noted. 4

8 14/91: SOS APPOINTMENTS IN DERMATOLOGY Dr Higgins presented the business case relating to a reduction in the number of avoidable outpatient attendances in Dermatology. IT WAS AGREED: That the business case for SOS appointments in Dermatology be approved. 14/92: SOS APPOINTMENTS IN ACUTE PAEDIATRICS Dr Higgins submitted this report for approval. The business case had been designed to reduce the number of avoidable outpatient attendances in acute paediatrics. IT WAS AGREED: That the business case for SOS appointments in Acute Paediatrics be approved. 14/93: INCREASING CAPACITY TO MEET THE INCREASING DEMANDS OF THE LOOKED AFTER CHILDREN (LAC) SERVICE Ms Baker introduced this item. IT WAS AGREED: That the business case for the increase in capacity to meet the increasing demands of the Looked After Children Service be approved, subject to being supported by the Commissioner. 14/94: INDEPENDENT DOMESTIC VIOLENCE ADVISER IN THE ROYAL WOLVERHAMPTON NHS TRUST Dr Higgins introduced this report. IT WAS AGREED: That the business case for the permanent establishment of the post of Independent Domestic Violence Adviser be approved, subject to being supported by the commissioner. 14/95: NURSE RECRUITMENT Mr Loughton reported that it had become apparent that midwives should not be recruited from Greece, and therefore attention was now turning to Southern Ireland. IT WAS AGREED: That the report be noted. 14/96: 2013 NATIONAL NHS STAFF SURVEY RESULTS Mr Loughton indicated that the survey had attracted only a low level of staff participation, and because the work areas could not be identified the survey was of limited use to management. IT WAS AGREED: That the report be noted. 5

9 14/97: INTEGRATED QUALITY AND PERFORMANCE REPORT Ms Nuttall mentioned certain areas by exception. She expressed her gratitude for recent work across the organisation which had resulted in significant improvements in A and E since the middle of March, with corresponding improvements to the experience of both patients and staff. She said that there was a greater focus nationally on the 18 week target, which was overall green, but general surgery and orthopaedics were still falling short. She also reported that there were ongoing difficulties with the 62 day cancer wait targets, predominantly due to late Tertiary referrals, and she had written to the Chief Executives of the trusts concerned highlighting poor practices evident in the referral of patients here. Turning to the quality aspects of the report, Ms Etches pointed out that the Trust had now reached its target of 39 C.difficile cases, and there was still some time before the end of the year. She also highlighted the positive contribution of using text messages to obtain responses to the Friends and Family Test, which made it likely that the Trust would not lose the CQUIN payment. IT WAS AGREED: That the monthly Integrated Quality and Performance report be noted. 14/98: WASTE MANAGEMENT Mr Argent drew out the salient points of this report. He confirmed that the new Waste Manager would take up his duties on 28 April. The meeting noted the fall in sharps-related incidents. Mr Argent confirmed that the waste management arrangements for community premises would be in-sourced, leading to considerable cost savings. IT WAS AGREED: That the report be noted. 14/99: TRUST STRATEGIC GOALS Q3 PROGRESS PERFORMANCE MANAGER Ms Nuttall indicated that this report was for information only. IT WAS AGREED: That the report on progress against the Trust s Strategic goals at Quarter 3 be noted. 14/100: FINANCE REPORT FOR M11 Mr Stringer reported that at the end of Month 11 the Trust s surplus was 7.3m, which was 187k above plan. Although income for the Trust was currently above plan, contracted patient activity income was underperforming by 2.1m. He referred also to the cost improvement plans, and confirmed that the position for February showed a withdrawal of CIP from annual budgets of 13.99m, representing 65.7% of the total. As in previous meetings, he highlighted the huge challenge which CIP would pose for 2014/2015. IT WAS AGREED: That the report on the Trust s financial position at the end of M11 be noted. 14/101: CAPITAL PROGRAMME 2013/14 M11 UPDATE Mr Goodwin reported that the position at month 11 identified an over commitment of 9,180. IT WAS AGREED: That the progress of the Capital Programme 2013/14 at the end of February 2014 be noted. 6

10 14/102: CAPITAL PROGRAMME 2014/ /19 Mr Goodwin submitted the revised five year capital programme. IT WAS AGREED: That the five year capital programme for 2014/ /19 be approved. 14/103: EMERGENCY CENTRE FULL BUSINESS CASE Dr Odum summarised the most recent developments regarding the development of the proposed new Emergency Centre, and it was noted that discussions with the CCG were ongoing in this regard. He expressed the hope that as a result of these discussions it would be possible to continue with the proposed development which was in line with the Urgent Care Strategy, which had itself been approved across the local health economy following consultation. IT WAS AGREED: That the oral update on the progress of the proposed new emergency centre be noted. 14/104: RESEARCH AND DEVELOPMENT Dr Cotton presented the progress report on the Trust s research and development activities. Dr Singh expressed disappointment over the recent decision to challenge aspects of the recruitment to participate in research in Diabetes. Dr Cotton shared the disappointment but said that he understood the reasons for the decision. Dr Cotton also highlighted that the R and D AGM was due to take place in May and would like clinical and non-clinical staff to be encouraged to attend and take part. Dr Odum gave an update on the development of the NIHR, saying that the clinical director had recently resigned, but that the role had now been filled again, and a long serving manager from this Trust had been seconded to work as Project support during the period leading to launch of the host organisation early in 2014/2015. There remained much to be done around human resources, the development of an annual plan, the clinical workforce and finances. IT WAS AGREED: That the report be noted. 14/105: IG TOOLKIT SUBMISSION 2013/14 Dr Odum reported that the Trust had achieved the required Level 2 for the IG Toolkit submission. IT WAS AGREED: That the IG Toolkit scores detailed in the report be approved in order to make the final submission on the standards to the Department of Health by 31 March, and that the IG Assurance Statement set out in appendix 1 to the report be accepted. 14/106: RED INCIDENTS, RED COMPLAINTS AND HIGH LEVEL OPERATIONAL RISKS FOR CORPORATE AREAS IT WAS AGREED: That the report be noted. 14/107: HEALTH AND SAFETY REPORT 2012/13 Ms Etches introduced this report which covered health and safety activity at the Trust for the 18 month period until October It was noted that, in the event of a merger with Cannock 7

11 hospital, responsibility for managing health and safety on that site would have to be determined. IT WAS AGREED: That the report be noted. 14/108: NURSING WORKFORCE REVIEW SIX MONTHLY UPDATE Ms Etches drew out the salient points of this report. She said that the Safe Hands technology should eventually provide the means whereby the staff numbers on each shift would match the acuity of the patients in the hospital. There was as yet no professional judgement given in this report, but over time this would change. Dr Odum queried the differences in certain wards between June 2013 and January Ms Etches replied that staff were still getting used to the Safer Nursing Care Tool, and for this reason results over a longer period of time needed to be considered before any conclusions were reached. The Heads of Nursing confirmed that the exercise would be repeated every 20 days which would enable staff to become better accustomed with using the tool. In response to a question by Dr Cusack, she said that as the data regarding the dependency of patients became more accurate, nurses could be redeployed according to need, although it should be noted that wards might initially resist. IT WAS AGREED: That the six monthly update on the Nursing Workforce Review be noted. 14/109: CONTRACTING AND COMMISSIONING UPDATE Ms Espley updated the meeting on the recent progress regarding contract sign-off for 2014/15. Agreement had been reached with the lead Commissioner and also for specialised services and, broadly speaking, the contract values were not dissimilar to those for the current financial year. She said that among the risks for the next financial year were the intention by the Commissioner to review aspects of New to Review, and Procedures of Limited Clinical Value. She also drew attention to notification on the Supply4Health website of two potential opportunities to tender for NHS contracts and said that the Trust had registered an interest in providing a model for end of life and cancer care for the Staffordshire CCGs. Mr Loughton congratulated Mr Stringer and Ms Espley on the work done to conclude contract negotiations for the next financial year. IT WAS AGREED: That the progress update on contracting and commissioning be noted. 14/110: CHANGE PROGRAMME BOARD Ms Espley submitted this item. IT WAS AGREED: That the monthly report on the Change Programme be noted. 14/111: RISK - CONSIDERATION OF RISKS TO BE ENTERED ONTO A RISK REGISTER No new risks were identified at this point in the meeting. 14/112: ANY OTHER BUSINESS Mr Loughton referred to recent adverse newspaper coverage of the Trust, and of himself in particular, and refuted the points published. He said that the Chief Operating Officer had also unwittingly been drawn into the controversy, and as a result had received hate mail. The 8

12 outcome had been that an independent person would now undertake a review of the whistle blowing allegations which had become public knowledge and executive directors and certain other staff would shortly be interviewed as part of that process. The Committee received an oral update on progress in regard to the proposed dissolution of the Mid Staffordshire NHS FT, which would require a Parliamentary Order to take effect because it was an FT. Mr Stringer informed the Committee that the TSA governance process included a Transition Board which met weekly. A high level transaction business case should be ready by the end of April, and the business case for the capital investment at Cannock hospital by the middle of June. A number of work streams had been established to make progress on the disaggregation of services currently provided by MSFT, and this Trust had appointed various specialists to assist with this work. Ms Young requested that consideration be given to site safety management, for example around the on-call arrangements and the designation of a senior person at Cannock. Ms Nuttall confirmed that this was being discussed in the context of how services provided at Cannock would fit into the existing Trust management structure. Ms Young also said that there was the question of clinical services across the whole of MSFT, such as VTE nurses, and how RWT could obtain its share of them. Ms Espley said that there was a meeting with the Cannock and Stafford CCGs on 11 April to discuss the levels of activity which they had approved for 2014/2015. Dr Odum said that the clinical group comprising doctors from RWT and UHNS had met and was sharing views about the potential division of services between the two receiving organisations. In response to comments by Dr Singh, it was emphasised that all parties remained focused primarily on the interests of patients. Dr Odum confirmed that there were ongoing discussions about how IT would affect patients at the Wolverhampton and Cannock sites, having regard to the need to ensure that any system would support the needs of patients wherever they received their treatment. 14/113: DATE AND TIME OF NEXT MEETING It was noted that the next meeting of the Trust Management Committee was due to be held on Friday 25 April, 2014 at 1.30 p.m. in the Board Room of the Clinical Skills and Corporate Services Centre, New Cross Hospital. The meeting closed at 3.30pm 9