COFNODION Y CYFARFOD BWRDD IECHYD PRIFYSGOL CYMERADWYO / APPROVED MINUTES OF THE UNIVERSITY HEALTH BOARD MEETING

Transcription

1 COFNODION Y CYFARFOD BWRDD IECHYD PRIFYSGOL CYMERADWYO / APPROVED MINUTES OF THE UNIVERSITY HEALTH BOARD MEETING Date and Time of Meeting: 09.30AM THURSDAY 2 ND JUNE 2016 Venue: LLANDYBIE PUBLIC MEMORIAL HALL, WOODFIELD ROAD, LLANDYBIE, CARMARTHENSHIRE, SA18 3UR Present: In Attendance: Mrs Bernardine Rees, Chair, Hywel Dda University Health Board Mrs Sian-Marie James, Vice-Chair, Hywel Dda University Health Board (part) Mr Don Thomas, Independent Member Mrs Margaret Rees-Hughes, Independent Member Mr David Powell, Independent Member Mr Mike Ponton, Independent Member Mrs Julie James, Independent Member Cllr Simon Hancock, Independent Member Mrs Judith Hardisty, Independent Member Mr Adam Morgan, Independent Member Professor John Gammon, Independent Member Professor Steve Moore, Chief Executive Mr Joe Teape, Deputy Chief Executive & Director of Operations Miss Teresa Owen, Director of Public Health Dr Eiry Edmunds, Cardiac Consultant (deputising for Dr Philip Kloer, Medical Director & Director of Clinical Strategy) Mrs Caroline Oakley, Director of Nursing, Quality & Patient Experience Mrs Karen Miles, Director of Finance, Planning & Performance Mrs Lisa Gostling, Director of Workforce & Organisational Development Ms Jill Paterson, Interim Director of Commissioning, Primary Care, Therapies and Health Science Mrs Joanne Wilson, Board Secretary Ms Paula Martyn, Chair Stakeholder Reference Group Mr Jake Morgan, Carmarthenshire County Council, Director of Social Services, Local Authority Representative Mrs Mandy Davies, Assistant Director Quality and Service Improvement Mr Ray Hine, Vice Chair, Community Health Council (deputising for Mr John Phillips, Chair Community Health Council) Mr Grant Duncan, Welsh Government (part) Mr Keith Jones, General Manager Women s & Children s Services (part) Dr. Warren Lloyd, Associate Medical Director Mental Health & Learning Disabilities (part) Mrs Nicola O Sullivan, Head of Public & Patient Engagement (part) Dr. Sarah Wright, University of Wales Trinity St. David (part) Mrs Alyson Thomas, Chief Officer, Hywel Dda Community Health Council Miss Anna Alderson, Committee Services Officer (Minutes) PM(16)48 PUBLIC FORUM The Chair, Mrs Bernardine Rees, informed Members of 6 questions received for the Public Forum section of the Board meeting from Miss ACTION Page 1 of 33

2 Paula Taylor. Mrs Rees advised that the responses to Miss Taylor s questions have been shared with Welsh Ambulance Service Trust (WAST) and the Welsh Air Ambulance Service for a robust and collective response. Prior to responding to Miss Taylor s questions Mr Joe Teape highlighted a critical point in the question which related to transporting women whilst in stage 2 labour which meant a statement from the Welsh Air Ambulance Service had been misquoted. Question 1 - With regard to the reconfiguration of obstetric led maternity services at Withybush Hospital, why have the Health Board failed to confirm the suitability and viability of the Air Ambulance to transfer women in active stage 2 of labour prior to the reconfiguration? Mr Teape, responding on behalf of Dr Philip Kloer, advised that Miss Taylor s question referenced a quote from the Welsh Air Ambulance Service which was unfortunately incorrect. Instead of stating that It is unlikely the Wales Air Ambulance would airlift a woman in labour because our crews can provide critical care for both adults and neonates on scene, her question included the quote It is unlikely the Wales Air Ambulance would airlift a woman in labour because our crews cannot provide critical care for both adults and neonates on scene. Mr Teape explained that Wales Air Ambulance are indicating that whilst they would assess each situation, their general preference is to deliver the baby at scene with their skilled crews, including doctors, as part of the Emergency Medical Retrieval & Transfer Service, rather than airlift and risk delivery in mid air. They would then make a decision on whether and how to transfer mother and baby should this be required. The University Health Board (UHB) does not therefore believe there is any failure on its part to confirm the suitability and viability of the air ambulance to transfer women in active stage 2 of labour prior to the reconfiguration. Mr Teape advised that whilst this mis-quote impacts on the UHB s response to Miss Taylor s subsequent questions, the UHB would respond to each question in turn for completeness. Questions 2 - Can the Health Board please clarify how they intend to notify the RCPCH and Welsh Assembly of their error in this regard? Mr Teape commented that as previously advised, due to the statement from Wales Air Ambulance Service having been misquoted, the UHB does not believe there is any error in this regard. Question 3 - Will the Health Board issue a public apology to Pembrokeshire residents for the potential of putting their and their babies lives at even great and unnecessary risk? Mr Teape commented that as with the previous response, due to the Page 2 of 33

3 statement from Wales Air Ambulance Service having been misquoted, the UHB does not consider there is a need to issue a public apology. Question 4 - Clearly the RCPCH decision was made without all the correct material facts, thus making their decision invalid. Given the invalidity of the use of helicopter transport, the RCPCH need to revisit their review with urgency. Will the Health Board and Welsh Assembly re-approach the RCPCH inviting a second review? Mr Teape commented that as with the previous response, due to the statement from Wales Air Ambulance Service having been misquoted the UHB does not consider there is a need to re-approach the RCPCH inviting a second review. Question 5 - In the light of this very serious error, will the Health Board consider returning obstetric led maternity services and SCBU to Withybush Hospital prior to signing off on the Phase 2 development at Glangwili Hospital? Mr Teape commented that as with the previous response, due to the statement from Wales Air Ambulance Service having been misquoted, the UHB does not consider there is a need to return obstetric led maternity services and SCBU to Withybush Hospital prior to signing off the Phase 2 development at Glangwili Hospital. Question 6 - Will the Health Board issue a public apology to Pembrokeshire residents for the potential of putting their and their babies lives at an even great and unnecessary risk? Mr Teape commented that as with the previous response, due to the statement from Wales Air Ambulance Service having been misquoted, the UHB does not consider there is a need to issue a public apology to Pembrokeshire residents. Mrs Rees advised of the need for clarity around this and requested Mr Teape and Dr Philip Kloer discuss directly with Miss Taylor to reach a level of understanding with both WAST and the Welsh Air Ambulance Service. Mrs Rees undertook to provide a formal written response to all questions raised by Miss Taylor. JT/PK BR PM(16)50 INTRODUCTIONS & APOLOGIES FOR ABSENCE Mrs Rees welcomed all to the meeting, thanking Llandybie Public Memorial Hall for the use of their facilities for the Public Board meeting and for previous UHB engagement events. Mrs Rees advised Members and the public that the UHB will continue to hold Public Board meetings in different community venues across all Counties within the Hywel Dda area. Page 3 of 33

4 The following apologies for absence were noted: Dr Philip Kloer, Medical Director & Director of Clinical Strategy Ms Sarah Jennings, Director of Governance, Communications & Engagement Mr Phil Parry, Healthcare Professionals Forum Mr Owen Cox, LMC Representative Mr John Phillips, Chair of Community Health Council PM(16)51 DECLARATIONS OF INTERESTS No declarations of interest were made. PM(16)52 MINUTES OF THE PUBLIC BOARD MEETING HELD ON 31 ST MARCH 2016 RESOLVED - that the minutes of the meeting held on 31 st March 2016 be approved as a correct record subject to the following amendments: To amend the attendance list to include Cllr. Simon Hancock. PM(16)33 REPORT OF THE CHIEF EXECUTIVE To amend The UHB has achieved the 4,595 performance target around referral to treatment times (RTT) seeing for the first time a reduction in waiting times. to The UHB has achieved the 4,595 performance target around referral to treatment times (RTT) seeing for the first time a reduction in the number of people waiting for referral to treatment. PM(16)34 REPORT OF THE AUDIT & RISK ASSURANCE COMMITTEE To amend Mrs Sian-Marie James commented that the UHB will be responding to a consultation document within the next month, which will... to Mrs Sian-Marie James commented that the Law Commission will be publishing its response to its consultation on Mental Capacity and DoLS shortly, which will... PM(16)35 UPDATE ON HEALTHCARE SERVICES IN CARMARTHENSHIRE To amend Mrs Sian-Marie James fed back on a recently attended meeting with the Welsh Ambulance Service Trust (WAST) Board where discussions were held with General Practices, Paramedics and the public about the PPH Front of House scheme. To Mrs Sian-Marie James fed back on a Welsh Ambulance Service Trust (WAST) Board meeting she had attended on behalf of the Chairman, where in the afternoon discussions were held with Paramedics, WAST staff and stakeholders about the PPH Front of House scheme. PM(16)36 INTEGRATED PERFORMANCE ASSURANCE REPORT: o To amend Mr Teape advised Members that the UHB s performance has been poor across all Tier 1 targets. To Mr Teape advised Members that the UHB s performance has been poor in relation to unscheduled care Tier 1 targets. o To amend Mr Keith Jones, Women s & Children s Directorate General Manager, has projected the position of delayed follow up appointments and developed a detailed operational plan to tackle the issues involved. To Mr Keith Jones, Women s & Children s Directorate General Manager, has projected the position of the urgent cancer standard and developed a AA Page 4 of 33

5 detailed operational plan to tackle the issues involved. o To add the following sentence to the first paragraph on page 15 This one patient was planned to be treated on the last day of the month meaning the Health Board should end the year with no breaches of the 8 week standard. o To amend Mrs Lisa Gostling advising that a workforce advisor has been appointed to specifically focus on sickness absence and their appointment has already made a difference with the sickness absence figures for February 2016 representing a slight improvement against the rolling 5.47% average of 5.54%. to Mrs Lisa Gostling advising that a workforce advisor has been appointed to specifically focus on sickness absence and their appointment has already made a difference with the sickness absence figures for February 2016 representing a slight improvement. PM(16)53 MATTERS ARISING & TABLE OF ACTIONS An update was provided on the table of actions from the meeting held on 31 st March 2016 and confirmation received that all outstanding actions had been progressed. Matters arising from the Board meeting held on 31 st March 2016: PM(16)31 MATTERS ARISING & TABLE OF ACTIONS: PM(16)16 COMMUNITY SERVICES DEVELOPMENT IN SOUTH EAST PEMBROKESHIRE It was previously agreed to provide a report on the evaluation of the pilot undertaken in Tenby; this has been deferred and will be presented to the July 2016 Board meeting. Ms Jill Paterson confirmed as per the agreement with the Chair of the UHB that the South East Pembrokeshire network were to be asked to support the development of a set of options for the future model of service provision in that area, and provide a clear recommendation, This would form the basis of the paper to be considered at the July 2016 Public Board meeting, at which point the Board would be asked to make a decision. A Business case would then be developed to support the implementation of the preferred option. PM(16)40 HYWEL DDA INTEGRATED MEDIUM TERM PLAN Professor John Gammon requested an update in respect of the Primary Care workforce strategy and Mrs Lisa Gostling responded that the UHB has recently appointed an officer who will shortly commence work on this. JP PM(16)54 REPORT OF THE CHAIRMAN Mrs Rees informed Members that this represented Mrs Caroline Oakley s final Board meeting prior to her retirement from the UHB. Mrs Rees thanked Mrs Oakley for the significant work, time, energy, ambition and passion that she has given to the UHB, on behalf of the Board, the UHB and the population and patients of Hywel Dda. Mrs Rees discussed a number of key areas from her report including the Mental Health Twinning, where staff from UHB welcomed colleagues from Trieste, Italy in May The event marked the first Page 5 of 33

6 anniversary of the signing of the first formal Mental Health International Twinning Agreement in Wales. Mrs Rees advised that this agreement has had significant benefits for the UHB, providing the opportunity to work with professionals from Trieste which is recognised by the World Health Organisation as a centre of excellence for the delivery of mental health services. It is of great interest to the population of UHB to continue this opportunity, and a tribute to the Mental Health teams who are supporting this work. Mrs Rees welcomed Mr Adam Morgan who has recently joined the Board as an Independent Member (Trade Union representative). Mrs Rees also expressed her regret at the resignation of Mr Paul Hinge who served as Chair of the Community Health Council (CHC), and who had worked alongside the UHB through what had been some challenging times. However Mr Hinge has developed a significant platform for the UHB to continue working with the CHC, with both the Chief Officer, Ms Alyson Thomas, and the newly appointed Chair, Mr John Phillips. Mrs Rees also informed Members of Mr Steve Moore s, professorship which he had recently been awarded by the University of Wales Trinity Saint David and congratulated him on the achievement. Cllr. Simon Hancock was pleased to note another two community pharmacies within Hywel Dda had been awarded the Investors in Carers bronze level award in recognition of their innovative ways of working, highlighting the importance of the work they do to provide a service to the population of Hywel Dda. The Board SUPPORTED the work engaged in by the Chair since the previous Board meeting. PM(16)55 REPORT OF THE CHIEF EXECUTIVE Professor Steve Moore introduced his report on relevant matters undertaken as Chief Executive of the UHB since the previous Board meeting held on 31 st March Professor Moore drew attention to the recent Ombudsman Case which features on the Public Board agenda, acknowledging the catalogue of errors that had been made during this case. Professor Moore advised that the way in which the UHB had approached this case had been indefensible, and that he offered his apologies to both the complainant and the Ombudsman on behalf of the Board and to highlight how seriously the Board takes these issues. Professor Moore acknowledged how hard Mrs Oakley and her team had worked to clear the backlog of complaints, advising that the UHB and Board are not complacent in dealing with incidents and complaints when they occur. Professor Moore referred to the issue identified through the staff story which had been played before the April 2016 Board seminar meeting. Professor Moore highlighted the impact for staff when reading negative social media posts about the UHB s Women and Children s services, and how disappointed they felt by the lack of response from the UHB Page 6 of 33

7 and senior leaders. The Board recognises the pressures on staff that social media websites can bring, however the Board does have to make difficult decisions at times concerning services. The Board wants to be open and transparent about the challenges faced, however it needs to recognise the staff delivering services are not responsible for the decisions made and should therefore not be targeted individually. The Board endeavours to protect its staff as far as it can and would take relevant action where needed. Professor Moore drew Members attention back to the table of action to provide a further update in relation to the development of services with South East Pembrokeshire. Professor Moore referred to a pilot that had been undertaken in Tenby during the Easter holidays where a model had been piloted involving UHB staff to deliver a minor injuries service, which treated over 180 people. The evaluation of this pilot is now near completion and identifies some successes as well as some challenges namely the impact on WGH and Accident & Emergency with staff involved in the pilot scheme. The UHB has re-commissioned the Red Cross for Summer 2016 and is developing an options appraisal taking into consideration the learning identified from the pilot which will be discussed at the Board at its meeting in July It is hoped that the options appraisal will present opportunities to develop a sustainable service model for Tenby going forward. Mrs Rees added that it is essential the options appraisal is delivered in partnership with the GP Practices and the South East Pembrokeshire Health Network and added this timeline could not be delayed further noting the Board would have a full discussion on the options at the July 2016 meeting. JP Other areas of work Professor Moore highlighted not included within the report include discussions which are taking place across Wales regarding the development of major trauma centres. The engagement process will commence in September 2016 and the establishment of a major trauma network has been agreed which will allow better coordination of services; however this will not change existing services. A report will be presented to the Board when there is more detail available. On behalf of the Board, Professor Moore welcomed Ms Jill Paterson and Mrs Mandy Davies to the Executive Team who had both undergone a rigorous recruitment process to be appointed into the interim posts of the Director of Commissioning, Primary Care and Therapies and Health Sciences, and Director of Nursing, Quality and Patient Experience respectively. Professor Moore took the opportunity to publicly recognise the work of Professor Kathryn Davies and her role on the Board following her recent departure, and to record his thanks to Mrs Oakley for the enormous passion and leadership she has given to the UHB and the impact this has made to both the staff and the population of Hywel Dda. Mrs Alyson Thomas referred to the participatory engagement master class which had recently been provided to UHB staff, suggesting an opportunity may have been missed to extend this training to partner Page 7 of 33

8 organisations, and asked whether the UHB would consider extending this master class to external partners which the CHC would welcome. Professor Moore supported this suggestion advising that whilst the master class had been a starting point for the UHB, the UHB would welcome engagement from partners and the CHC going forward. SJ Mrs Julie James informed Members that following the previous Public Board meeting in Glangwili General Hospital (GGH) she had visited the paediatric department, and having had the opportunity to speak to staff and patients, fed back on a conversation with one couple who had shared their concerns about what they had heard on social media regarding women and children s services. However their experience had been entirely positive, reporting that staff had been extremely professional. This highlights the need for an awareness of the impact social media has on patients and families. Mrs Thomas acknowledged the risks in the use of social media however highlighted the benefits which allow organisations to directly communicate with its services users and is therefore an extremely useful tool to share information and feedback quickly and efficiently. The Board ENDORSED the Register of Sealing s since the report presented to the Board meeting held on 28 th January The Board also ENDORSED its ongoing support to the Clinical Network transfer process, subject to the final outcome of the current staff consultation. The Board NOTED the status report for consultation documents received and responded to up to 12 th May 2016 and NOTED the work engaged in by the Chief Executive since the previous Board meeting held on 31 st March PM(16)56 REPORT OF THE AUDIT & RISK ASSURANCE COMMITTEE Mr Don Thomas presented the report of the Audit & Risk Assurance Committee (ARAC) providing a summary of the previous three meetings held in April, May and June Mr Thomas advised that Executive Directors had been asked to attend ARAC in April 2016 to discuss their management responses to outstanding recommendations from Wales Audit Office (WAO) Reports. The UHB values external opinion and ARAC had identified a lack of cohesion to management responses and also that some of the recommendations needed to be addressed at pace. As ARAC remains concerned regarding the lack of assurance around the clinical audit report received and the risks identified, the Committee has requested a further update be provided at the next meeting to provide assurance to the Committee that the risks identified within the report are being addressed. Mr Ponton added that this lack of assurance is an ongoing issue and an area which needed more focus from the Board. ARAC approved the WAO NHS Waiting Lists and Private Patients report and the recommendations made in detail. ARAC recognised that this report alongside the Internal Audit review had highlighted major Page 8 of 33

9 concerns and risk. Mr Thomas noted this would be a significant piece of work to take forward and thanked Mr Teape for agreeing to become the Executive Lead for this work and to progress the actions, it was noted that an update detailing progress made would be presented to ARAC in 6 months time. At the ARAC meeting on 10 th May 2016 the Committee discussed concerns around failures identified within the NWSSP: Accounts Payable Function, and the recent events which led to a breach of the UHB s statutory obligation to pay a contractor in accordance with the BPP, meaning some of the UHB s emergency networks were compromised. ARAC received a further update report in respect of the NWSSP: Accounts Payable Function at its meeting on 1 st June 2016, where a report outlining the joint action plan that had been developed with the UHB and NWSSP to address the issues with the Accounts Payable Function was received. ARAC will continue to monitor delivery of the action plan on a regular basis. ARAC also continues to monitor the UHB s financial forecast expecting to see those improvements which were evident at the end of the 2015/2016 financial year continue into the current financial year to ensure there are no slippages with the financial position and savings. Mr Thomas added ARAC will continue to seek assurance from BPPAC that robust financial controls are in place. At the ARAC meeting held on 1 st June 2016 the Committee approved and recommended the draft Annual Accounts 2015/2016, the Annual Governance Statement and the Accountability Report to the Board for approval. Referring to clinical audit, Mrs Margaret Rees-Hughes advised that the Quality Safety & Experience Assurance Committee (QSEAC) is monitoring this through its Effective Clinical Practice Sub-Committee, and is a key area of focus on QSEAC s agenda which will feedback to ARAC. PK/MD It was agreed for Dr Philip Kloer as Executive Lead for Effective Clinical Practice Sub-Committee would be required to take this work forward in order to provide ARAC with the assurance it seeks. The Board NOTED the Audit & Risk Assurance Committee update report. PM(16)57 INTEGRATED PERFORMANCE ASSURANCE REPORT MONTH /16 Professor Moore introduced the Integrated Performance Assurance Report for Month /16 which outlines the end of year performance, against the Tier 1 targets set out in the Welsh Government Delivery Framework for 2015/16. Professor Moore reminded Members that the challenge set in 2015/16 was to stabilise the UHB s position across a number of service areas. This in itself had been a huge challenge. Staff are working extremely Page 9 of 33

10 hard to deliver services across the UHB, and during 2015/16 the UHB saw a number of successes including an improved position in respect of Category A ambulance calls, whilst accepting that there is still further work to do. The 4 hour Accident & Emergency (A&E) waiting times have largely been maintained despite an increase in demand, with one of the UHB s hospitals recently becoming one of the best performing hospitals in Wales against this target. Conversely, the UHB s A&E 12 hour performance has worsened. Professor Moore added there was still a significant amount of work to be undertaken as in many areas the UHB were still not providing the level of service which the population deserves. In regard to scheduled care, the UHB achieved the projected outcome of less than 4,595 patients waiting 36 weeks and over, with a total of 4,281 reported, and also achieved the required diagnostics target, having no patients waiting 8 weeks and over across all diagnostic tests. Conversely however, the UHB was worst performing Health Board in Wales in terms of elective surgery waiting times with the 52 week target increasing. Members were informed that a good deal of work has been undertaken in respect of cancer services with a focus on putting appropriate cancer pathways in place, and Mr Teape advised that compared to other Health Boards in Wales, the UHB performs well. It was also noted that a concern area for the UHB was in relation to waiting lists for therapy services. However, there are continued concerns around the financial position and its growing deficit, specifically in relation to variable pay. 2016/17 will therefore see a focus on stabilising the UHB s financial position and ensuring that the position does not deteriorate further. Professor Moore advised that improvements have been made against almost every indicator across workforce. Professor Moore highlighted that work had been undertaken in relation to the recruitment of overseas nurses and the newly registered nurses. This area remains the greatest challenge for 2016/17 and will continue to be a focus. 2016/17 will see a renewed focus on performance as the UHB has demonstrated it can prevent performance from deteriorating and can also demonstrate areas of improved performance. Focusing on the finances and workforce will allow the UHB to commence 2017/18 in a stronger position. Professor Gammon raised trend data and benchmarking as areas on which the UHB should focus upon to have a comparison of its own performance against others across Wales and the UK. Professor Gammon suggested that data within the year end integrated performance report and the month one integrated performance report shows a differing picture. Also, the data provided in the reports uses a variety of denominators for different figures, and suggested that for consistency purposes the same denominators are used for reporting on Page 10 of 33

11 local and national data. Professor Gammon advised that he had undertaken his own benchmarking exercise which provides an alternative view of the data within the integrated performance assurance reports, however suggested that whether a benchmarking exercise is undertaken by the Board or its Committees, it is important to have a view of the UHB s performance compared to others in the UK. Professor Gammon raised a further concern around the issue of therapists and whether as a Board, there should be a focus on stabilising the position within therapies, as it appears to be in a worsening position. The Board agreed that therapies are key enablers to many service pathways and it was agreed that the Board should focus on this area. Mrs Miles further advised that whilst focused work has commenced with therapists, there are a number of issues facing the service including accommodation and workforce. This work will continue and be reported through the UHB s Committee structure. Responding to Professor Gammon s first concern, Mrs Karen Miles advised that going forward common denominators would be used and that the UHB has access to data to undertake some benchmarking exercises. With regards to waiting times, Mrs Miles advised that the UHB s ambition is to reduce the number of people on waiting lists to 3,000, however significant financial and workforce issues are impacting on the ability to do this. It is clear that the UHB has the worst performance across Wales in respect of waiting lists, which needs to improve. Mrs Miles added that the position had deteriorated from year end from 4281 to Mr Teape suggested extending the benchmarking exercises to undertake comparisons across England as well as Wales, and welcomed a follow up to this, recognising there are some waiting times including within referral to treatment (RTT) are not simply good enough. A plan to address RTT will be key and this will need to be prioritised by clinical safety issues and treating those patients who require the most urgent treatment, however acknowledged that the UHB will not be able to resolve all the issues involved immediately within the finances and resources available. Mr Teape also acknowledged that therapies require further investment to recruit additional therapists to the service. Mr Ponton advised that Business Planning & Performance Assurance Committee (BPPAC) received a Wales Audit Office (WAO) report which recognised the improvements made by the UHB in the previous year. The WAO report also compared the UHB to other Health Boards across Wales and recognised that benchmarking is an issue for all. Mr Ponton suggested it is the responsibility of Independent Members to identify what is needed from performance reports, in order that they receive an appropriate level of information. Mrs Thomas commented that the CHC welcome the honest debate in Page 11 of 33

12 public and noted that the UHB is not a high performing organisation, and that the integrated performance assurance report needs to focus on the impact performance makes to patients and that behind each number is a patient waiting for treatment. However Performance reporting is increasingly improving as is demonstrated within the report around pressure ulcers, but this needs to be demonstrated across the whole of the integrated performance assurance report as it is the impact to patients that drives improvements. Professor Moore responded that it is clear that the UHB has mixed performance acknowledging the challenges faced including RTT, however the UHB has to focus on its highest risks and managing the clinical needs of its patients. Professor Moore welcomed the discussions around therapists, which have not always been at the forefront of Board discussions. Professor Moore added that a strategy for the service needs to be brought back to the Board for further discussion. JT/JP Ms Jill Paterson fed back on her meeting with the UHB s Head of Therapies where a significant amount of commitment was demonstrated from these professional groups to develop a strategic plan and to deliver different models of care. Mr Adam Morgan advised of the difficulty in determining how therapies will impact on performance figures, as the UHB needs to consider how therapies impacts on each individual patient and in turn how this then makes a positive impact to the UHB i.e. such as supporting patients out of hospitals to help achieve performance targets. The Board DISCUSSED and NOTED the Integrated Performance Assurance Report Month /16. PM(16)58 INTEGRATED PERFORMANCE ASSURANCE REPORT MONTH /17 With reference to the executive summary section within the Integrated Performance Assurance Report Month 1, and postponed admitted procedures (PAP s), Mr Teape advised of concerns raised at the previous BPPAC meeting on whether patients who had their procedures cancelled had been treated. At the time of the Committee meeting only one patient was waiting to be treated, who has now been treated. A report on cancelled operations is being presented to the next QSEAC meeting on 21 st June 2016 to consider the qualitative effect cancelled procedures has on patients and their families and carers. Unscheduled care targets remain a challenge, and are outlined within the UHB s Operational Plan which has been divided into 5 themes. The UHB is also working with WAST on its Operational Plan to improve the unscheduled care position. Monthly meetings are in place for unscheduled care which Mrs Rees-Hughes attends for Independent Member scrutiny, and it is evident that staff are committed to delivering services, and that the leadership teams which have been introduced to the four hospital sites are starting to make an impact, with staff beginning to feel more supported. Page 12 of 33

13 Performance within Withybush General Hospital (WGH) and Glangwili General Hospital (GGH) remains a key area of focus with actions taking place on each hospital site, and with fortnightly performance updates received by the Director of Operations which are then reported to BPPAC. Mr David Powell referred to page 41 of the Integrated Performance Assurance Report Month 1 which includes graphs showing the 2016/17 operational plan profiles for the year, both for the UHB and by hospital site. As a general point Mr Powell commented that the operational plan profiles demonstrate an improving level and set timelines for performance targets; however the Board has already seen two of the UHB s hospitals struggle with performance targets suggesting the Board needs to monitor these trajectories closely over the next year. Professor Moore formally asked BPPAC to monitor the operational plan profiles for the year. KM Cllr. Hancock referred to the slight decrease in performance for Delayed Transfers of Care indicated within the report and given the shortage of Occupational Therapists within Mental Health services, queried the actions in place to improve the position. Mrs Lisa Gostling responded that she was unaware of any specific recruitment issues within this service area, advising that the UHB are actively recruiting to vacancies as and when they arise. Mr Teape advised of discussions held by Mrs Miles with therapy services. As mentioned above a 3 year plan is being developed to look at how to fill these gaps in provision, which will need to be introduced in a phased way working with Finance to identify the budget to support this. Since the UHB has seen an increase in Occupational Therapists from 36 to 50, there has been an improvement in performance. Mr Jake Morgan commented that there are a number of areas which have significant gaps in therapy provision which impacts on performance targets, as a person s functionality has a huge impact on a number of supporting services such as domiciliary care services provided by the local authority who support people when their functionality is compromised. Within the domiciliary care sector, there is a high turnover of staff which impacts upon this therefore therapies have a key role in supporting patients. Mr Morgan suggested there needs to be greater investment at certain points in patient pathways to support this. Miss Teresa Owen advised that as an integrated Health Board there is a role for all. The entry and exit points to the UHB are key and therapies play an important role in this as well as doctors and nurses. Miss Owen informed Members of great enthusiasm from therapists to support the delivery of services and to strive for performance targets, which are also very patient focused. Mr Teape provided an update on the work that had been undertaken Page 13 of 33

14 with the Delivery Unit, was noted that the activity on each site was very visible and the sites were feeling much more supported and PPH & BGH were making good progress in terms of targets. Mrs Oakley advised that there are still some performance indicators which have yet to be defined within the Integrated Performance Assurance Report and the nursing team are actively working with Welsh Government to establish these. Mrs Thomas welcomed the broader framework which the UHB has introduced for 2016/17, requesting clarity around the numbers of overseas nurses recruited, which had previously been reported as 167 accepted nurses, and is now reported at 70. Mrs Gostling clarified that the UHB is still working with 167 overseas nurses but out of these, 67 have signed agency contracts, with the reminder having signed contracts with the recruitment agency involved. Mrs Gostling explained the reasons for the delays which were out of the Health Board s control. In terms of Stroke Quality Improvement Measures, it is anticipated that the UHB will see an improved position through the year, considering the impact workforce challenges have on the service, with four improvement measures set out within the executive summary. Performance for formal swallow assessment within 72 hours decreased in April 2016 because out of the 9 patients who required this assessment, 2 patients were too unwell to have the test. There are still challenges around the Direct Admission to Acute Stroke Unit within 4 hours as the UHB does not have robust in-patient systems to manage stroke wards. The previously discussed therapy investment and investment into rehabilitation facilities as well as having the appropriate bed capacity will help to improve this position. Mr Teape informed Members that there is a plan in place for Urgent Suspected Cancer throughout 2016/17. Performance in respect of Non Urgent Suspected Cancer is above the profile and target at 98.3% based on two breaches. In respect of Urgent Suspected Cancer performance, for April 2016 this stands at 91.4% which is the highest performance achieved by the UHB, whilst accepting that there are significant challenges to address such as the continuing lengthy delays for tertiary thoracic surgery at Abertawe Bro Morgannwg University Health Board (ABMUHB) which have been escalated with both ABMUHB and Welsh Health Specialised Services Committee (WHSSC). There are also local delays in accessing urology and dermatology which both face capacity and demand issues, however there is a plan being developed to support urology in conjunction with the Mid & West Wales Healthcare Collaborative. Mr Teape added an options paper for urology was currently in the process of being developed and would be discussed at a future Executive Team meeting. With regard to RTT, the UHB had 4,653 patients waiting 36 weeks and over at the end of April This is an increase of 372 patients Page 14 of 33

15 compared to the previous month meaning the UHB has not achieved its operational plan profile of 4,375, however the UHB is in a better position than at the same time the previous year. The UHB has asked the Delivery Unit (DU) for more support this year to achieve its aim of having no patients waiting 52 weeks and over by the end of 2016/17. Mr Teape informed Members that the identified senior responsible officer and Mrs Miles are working through each specialty, in order that there is a clear plan in place with the risks identied and actions set which will then report to BPPAC. In terms of Diagnostic Waiting Times, the UHB had 5 ultrasound patients waiting 8 weeks and over at the end of April 2016, thus narrowly missing the target, although all have now received treatment. In terms of Delayed Follow up Appointments, the UHB continues with the validation phase to manage these waiting lists. The Board had a challenging discussion on performance and it was noted the Board would continue to undertake this action at the Public Board meeting going forward. Professor Gammon had undertaken a bench marking exercise and it was agreed it would be extremely beneficial to include this comparative data moving forward. Mrs Miles referred to the Financial Performance summarised within the executive summary, stressing the difficulty in measuring this during month 1 of the financial year as the UHB is running 2 years of accounts concurrently and that not all the information is available to report upon. Overall, the UHB is still incurring premium pay and has not achieved all of its savings, which is set out on page 74 of the report. By month 2, Members should receive a more complete financial position, and Quality, Innovation, Productivity and Prevention (QIPP) savings will also be reported going forward showing where savings have been made and the challenges faced. Mrs Miles commented that unless the UHB reduces its workforce bill, this will have a significant impact on the year end financial position Mrs Rees stated that the Board cannot head into this financial year without having a firm handle on its financial plans. The UHB has faced financial challenge for a number of years, and it was agreed at the September 2015 Public Board meeting that the UHB would ask for an external review to be undertaken on the UHB finances to allow the organisation to start making improvements. Due to mitigating circumstances the external review was not undertaken, however as Chair of the UHB, Mrs Rees formally requested this now be undertaken and discussed with Welsh Government. The UHB is currently in the second year of its Integrated Medium Term Plan (IMTP) and 3 yearly budget, and will not have the opportunity to recover its financial position adequately in year 3 of the IMTP. The UHB has to improve and Mrs Rees advised that the external review of finances will provide a clear picture of the current position and clarify the type of assurance the Board should be expecting from Month 1 onwards in respect of Page 15 of 33

16 finances which can then be translated into the UHB s Operational Plan. Mr Thomas expressed his disappointment and concern at the reported slippage in both performance and the financial position in Month 1 of 2016/17.Mrs Miles responded that both performance and the financial position are linked to variable pay which makes up 60% of the UHB s core business. Until the UHB undertakes service redesign to alter the pathways, and has the workforce in place to support these pathways, the issues around variable pay will not be resolved. Mr Thomas referred to page 74 of the Integrated Performance Assurance Report which identifies that the majority of service areas are already above their core budget, asking for clarity on the difference between variance on variable pay and variance on substantive pay. Mrs Miles responded that both the core and staffed budget are presented within the table on page 74 of the report, however going forward these will be separated making the difference between variable pay and substantive pay clearer. Mr Thomas further queried the percentage of variable pay that relates to the employment of nurses and doctors. Mrs Gostling responded that 6.5 million of the UHB s budget is spent on nursing staff and 5 million on medical staff. There are however plans in place to reduce variable pay; the UHB has 65 newly qualified nurses joining the UHB in addition to the nurses recruited from overseas and general recruitment. The UHB has also been in discussion with agency staff providers, who differ in cost, to ensure they provide the best value for money to the UHB. To support this there is now a protocol in place to avoid using the high cost agency staff providers, which can only be authorised for use by Mrs Gostling and Mrs Oakley dependent upon clinical need. The Workforce Team is also analysing the reason for use for agency workers. Health Care Support Workers (HCSW) are a further area of high agency spend, and the UHB is looking to make substantial changes into how it supports gaps in medical and nursing rotas. The UHB has recruited 120 HCSW in Carmarthenshire and is looking to achieve additional recruitment for Pembrokeshire and Ceredigion; the UHB has also reduced the induction time to allow new recruits to come into post more quickly whilst still ensuring they are competent workers. Mrs Gostling advised that there are approximately 620 current vacancies within the UHB. In regard to medical recruitment, the UHB has not been able to recruit from within the UK and from overseas. Whilst some success has been seen it remains a, challenge to recruit to some of the UHB s specialty areas which is a national issue and is also affected by the UHB s geography and the workforce package offered. The UHB is trying different approaches to attract the medical workforce required, and is working with Dr Philip Kloer and clinicians to undertake targeted recruitment. Mr Thomas also expressed his significant concern regarding the under achievement and in some cases non achievement of savings budgets. Mr Thomas queried if Page 16 of 33

17 some of the targets were ever achievable and whether the financial control was significantly robust. Mr Thomas questioned the financial report in a significant amount of detail and supported the Chair that it was essential that the external review was progressed at pace. Mrs Rees asked Mr Thomas to review the UHB s variable pay plan with the agreement of Professor Moore. It was agreed for Mr Thomas to meet with Mrs Miles to further discuss variable pay to review the financial position in detail. KM Cllr. Hancock raised sickness absence as a further significant factor impacting on variable pay. The previous financial year saw the UHB receive funds from Welsh Government for performance and for the exceptional challenges faced at WGH, and queried whether these monies would be recurring. Mrs Miles clarified that the monies provided were non recurrent. The UHB now has a sickness absence coordinator in post who will audit the UHB s position. There has also been investment in Occupational Health which promotes staff welfare and healthy activity. Mrs Judith Hardisty queried when the savings scheme profiles would be achieved, commenting that as medical recruitment is such a significant challenge, further detail around the actions being taken to address this and the plans that are to be put in place if the UHB does not recruit to the required medical vacancies, would be welcomed. In relation to medical staff, more detail is anticipated around medical recruitment through the operational plan, the focus of which is outlined on page 31 of the report. It was agreed Dr Kloer would need to work with the workforce team to progress this element. PK Mrs Rees-Hughes acknowledged the UHB s corporate responsibility and the need for an early focus on managing the budget effectively, but highlighted the importance of quality and safety, and ensuring that mechanisms are in place at the right level to ensure patients remain the key focus. Mr Thomas queried whether the UHB has considered the impact of how a potential exit vote from the European Union may affect overseas recruitment. Mrs Gostling responded that she had not but there were now language tests for nurses from both European & International overseas nurses so did not anticipate this affecting the current recruitment plans. Professor Moore welcomed the debate on the Integrated Performance Assurance Report and the fact that Month 1 issues are being dealt with as they occur rather than leaving them until later in the year. The workforce challenges faced by the UHB are also affecting Health Boards across the UK. The UHB has the commitment from staff and a robust plan in place to manage the difficult workforce situation, and requested ARAC consider the workforce plan and report back to the Board on the UHB s position. SJ The UHB has a set of plans which try to maintain or improve services as well as identifying savings within the budget. Mrs Miles and Mr Page 17 of 33

18 Teape will indicate what the UHB can realistically achieve this year through the plans, which will be managed by the executive team. Professor Moore advised that whilst it had previously been agreed to undertake an external review of the UHB s finances, this had not been undertaken during 2015/16 due to issues that arose within WGH and the new beds being introduced in GGH and BGH. However Professor Moore advised that with the support of Mrs Miles, Mr Teape and Welsh Government, the UHB will undertake a review of its financial position and controls, to ensure the financial position does not worsen. The Board DISCUSSED and NOTED the UHB s financial and operational performance at the end of April PM(16)59 IMPROVING EXPERIENCE REPORT 2015/16 (INCLUDING PUBLIC SERVICES OMBUDSMAN FOR WALES REGULATION 22 REPORT CASE NUBMER ) Mrs Sian-Marie James joined the Public Board meeting. Mrs Oakley advised that the Improving Experience Report 2015/16 includes two elements, one of which is the Ombudsman Report Case Number , which is to be formally received by the Board. As previously indicated by Professor Moore, the Ombudsman Report demonstrates an unacceptable position and systematic failures can be identified throughout. The key area requiring further traction, being a case management system in conjunction with the concerns complaints team to map each step within the concerns and complaints process to ensure that this is being effectively managed. There is now an escalation process in place which is reported to Mrs Oakley, Mr Teape and Dr Philip Kloer when system delay failures are identified. Mrs Oakley offered her own personal apology to the Ombudsman and the patient involved, noting that the UHB is now in a much improved position in respect of concerns and complaints. Mrs Rees queried whether this Ombudsman report has been followed up with the patient and whether they are aware of the discussions taking place at the Board. Mrs Oakley advised she would need to clarify the position with her staff and would do so. Later in the meeting she was able to confirm that Louise O Conner advised the issues had been followed up with the family. The UHB is currently awaiting confirmation of the Ombudsman s Annual Report acknowledging that the UHB works well to the Ombudsman standards. Mrs Oakley advised that the Improving Experience Report 2015/16 reflects on the totality of incidents and complaints during the year and represents an open and honest report. Mrs Oakley thanked Mrs Julie James for her contribution in helping to structure the report to be more robust. The report is sub-divided into location and service area and provides various analyses, including elements relating to actions that have been taken and lessons learnt. Going forward, the report will be Page 18 of 33