SOUTH EASTERN HEALTH AND SOCIAL CARE TRUST

Transcription

1 SOUTH EASTERN HEALTH AND SOCIAL CARE TRUST Minutes of a Public meeting of the South Eastern Health & Social Care Trust Board held on Wednesday 30 November 2016 at 11.00am in the Conference Room, Trinity Conference Centre, Lisburn PRESENT: Mr C McKenna, Chairman Mr H McCaughey, Chief Executive Mr N Brady, Non-Executive Director Dr M Briscoe, Non-Executive Director Miss F Graham, Non-Executive Director Mr N Guckian, Director of Finance and Estates Mr N Mansley, Non-Executive Director Mr M Mawhinney, Non-Executive Director Mr C Martyn, Medical Director Ms N Patterson, Director of Primary Care, Older People and Executive Director of Nursing Mr J Trethowan, Non-Executive Director IN ATTENDANCE: Ms R Coulter, Director of Planning, Performance & Informatics Ms B Mongan, Director of Adult Services and Prison Healthcare Mrs M Weir, Director of Human Resources and Corporate Affairs Mr B Whittle, Director of Children s Services and Executive Director of Social Work Miss I Low, Board Secretary/Assistant Director, Risk Management and Governance Sr A Bartlett, Neonatal Sister (for item 118/16) Miss C Hughes, Personal Assistant APOLOGIES: Mr S McGoran, Director of Hospital Services OPENING REMARKS At the outset, the Chairman welcomed everyone to the meeting. 118/16 PRESENTATION OF A PATIENT/CLIENT STORY Ms A Bartlett, Neonatal Sister and Ms S Burns, Mother, were in attendance Ms Patterson introduced Sr Bartlett, Neonatal Sister, and the Burns family. She extended a special welcome to baby Alfie Burns, the youngest attendee at Trust Board. Sr Bartlett explained that Alfie had been a patient in the Neonatal Unit for six weeks and his Mum, Sarah Burns, would outline her experience. Sr Bartlett commented that she had received an from Mrs Burns sister which outlined their appreciation of the Neonatal Unit and detailed the strength, love and care provided by Alfie s mother. Sarah Burns commenced by saying that when she had first attended the Maternity Unit and viewed the Tiny Life posters, she had never thought she would be the mother of a premature baby. She detailed the events surrounding Alfie s 1.

2 premature birth, approximately 10 weeks early, and the fears and concerns they had experienced as parents watching their baby in an incubator with wires and monitors. The hours and days spent praying that their small baby would survive another day were alleviated by the calm, caring and professional attitude of staff, both doctors and nurses. They learnt to read the signs staff mentioned and throughout staff delivered advice very honestly and, whilst the news was not always easy to hear, the reassurance offered was very much appreciated. Alfie spent a week in the Belfast Trust and then returned to the Ulster Hospital and throughout they were kept fully informed. Sarah noted that the nursing staff were very aware of Alfie s changes and supportive to her when she became anxious and stressed, particularly when test results were due. The scan which revealed a bleed on his brain was very distressing but staff remained reassuring and professional throughout. Sarah noted that without the support of nursing staff she would not have had the perseverance to become a successful breast feeding mother. Staff had taught them how to wash, change and care for Alfie. They brought Alfie home feeling confident of caring for their beautiful baby. During discussion congratulations were extended to Sarah and her husband and she was thanked for her insight into this service provision. In response to queries Sarah advised that Alfie was 3lbs 11ozs at birth, dropped to 3lbs 7ozs and is now 7lbs 9ozs. The Chairman thanked Sarah, her husband and the proud grandparents, and especially Alfie, for attending. He noted that the Trust is proud of all its staff and this is an excellent example of the support they have given to the Burns family. He thanked all the attendees for the story, which was very informative and enlightening. He also thanked Sr Bartlett for attending. 119/16 DECLARATION OF POTENTIAL CONFLICT OF INTERESTS WITH ANY BUSINESS ITEMS ON THE AGENDA No conflict of interest with any business item on the agenda was declared. 120/16 CHAIRMAN S BUSINESS The Chairman informed members that he attended a number of events, since the last meeting, including the Older Persons Celebration; the NHS Confederation Board of Trustees; a visit to Lakewood; the Leadership Conference and Awards; Friends of Kiwoko event; the Chief Executive s Forum; NICON meetings; a Volunteering Befriending function in Ballynahinch; the opening of Supported Living for Care Leavers in Lisburn with the Minister for Communities; Social Work Awards; the CIPFA Chairs forum and he also hosted a NICON farewell dinner for Gerry Guckian the former Chair of the Western Trust. The Chairman advised that this would be the last formal Trust Board to be attended by Miss Graham, Mr Mansley and Mr Trethowan who have provided a tremendous service to the South Eastern Trust. The Chairman extended his personal gratitude to them for extending their period as Non-Executive Directors as a personal favour to him and the Trust. 2.

3 The Chairman advised members of the public that the Trust Board had met immediately prior to this meeting to discuss some items of confidential business. The Annual Public meeting was held prior to the public Trust Board meeting. 121/16 CHIEF EXECUTIVE S BUSINESS Mr McCaughey advised that he had no business items to raise. 122/16 MINUTES OF THE PREVIOUS TRUST BOARD MEETINGS The minutes of the Trust Board meeting, and the Annual Public Meeting, held on 5 October 2016, having been previously circulated, were agreed and signed by the Chairman as a true and accurate record. 123/16 MATTERS ARISING FROM THE PREVIOUS MINUTES (a) Update on the Trust Delivery Plan Ms Coulter advised that the Trust Delivery Plan (TDP), approved by Trust Board on 4 August 2016, had been submitted to the Health & Social Care Board (HSCB). Some queries had been raised by the HSCB regarding demography spend but these have all been responded to and a further breakdown of information provided. The Trust s TDP is now expected to be presented at the HSCB Trust Board on 8 December During discussion concern was again expressed regarding the delays in this process. In response to a member s query, Ms Coulter advised that there are no operational delays caused by this process and everything has been effectively implemented as envisaged. The 2017/18 TDP process has commenced. The Chairman stated that further assurance should be sought from our Health & Social Care partners that there will be no delays to the 2017/18 TDP process as this is required to effectively operate our business. 124/16 FINANCIAL REPORT FOR THE PERIOD ENDED 31 OCTOBER 2016 Members received, for discussion, Paper No: SET/70/16, Financial Report for the period ended 31 October 2016, which had been circulated with papers for the meeting. In presenting the paper, Mr Guckian advised that there were problems with the computer systems in Month 7 in that the link between the payroll and finance (General Ledger) system did not work. Whilst able to provide accurate overall financial information the drill down into Directorates and Whole Time Equivalent (WTE) detail was not available. Mr Guckian stated that the Month 7 financial information has remained steady and a small increase in the forecast deficit should not be viewed as overly concerning. The main issues relate to Hospital and Children s Services. At the previous Trust Board it had been indicated that funding would flow to Directorates to provide accurate positions but this did not take place due to the increased workload on staff associated with the computer issues. However he assured Trust Board that the details are in balance behind the scenes. The position will be 3.

4 updated for Month 8 provided that the computer issues do not recur. He noted that the capitalisation of minor equipment is on target. The financial position is on target to reach breakeven and the main issues which could affect that position are the legal cases or regional issues but Mr Guckian advised that it is not possible to know about legal issues until after the Court cases and no major accounting policy changes are anticipated. Mr Guckian noted that the solutions to the 2016/17 financial issues were mainly non-recurrent and therefore there is a significant deficit for 2017/18. The current projected deficit for the next financial year does not include any pay award next year, non-pay inflation or pay inflation in partner organisations. In addition to the revenue consequences of Phase B ( 12m) the HSCB and Department of Health are aware of this additional funding requirement. HSCB should have included this amount within the Trusts projected deficits, demography and any pay award for the service in their funding requirement for 2017/18. He believed that all Trusts are in a similar position. The Chairman advised that Mr McCaughey and himself had raised the system wide recurrent deficit position at a meeting with the Permanent Secretary and will do so again at the next opportunity. Mr Mawhinney advised that at the Finance Committee he had been assured of the financial position and would be meeting again on 19 December Detailed discussion took place regarding the financial position and Mr Guckian advised that variances in the Domiciliary Care spend relates to supplier invoicing issues and this will balance out to continue to spend over 3m in this area. Miss Patterson commented that the Risk Register makes reference to the difficulties in meeting demand for Domiciliary Care and this is a capacity issue. In response to queries Mr Guckian advised that the underspend currently apparent within Adult Services and Primary Care relates to income for service developments which, as detailed within the TDP, are slippage which will address the Trust s deficit. These Directorate positions will be adjusted in Month 8. Regarding demography funding for 2016/17, Mr Guckian advised that this was split between Hospital Services and Primary Care. This position will not be as equitable next year due to the creation of additional bed capacity. During discussion of the projected deficit for 2017/18 Mr Guckian noted that it is not due to overspending within the Trust but, as clearly documented previously, the Treasury charge on National Insurance which was the single biggest element of this year s deficit and HSCB requirement for Trusts to increase tariffs in residential homes, along with normal cost increases such as the pay award, Demographic Pressures and non-pay inflation. 125/16 PERFORMANCE MANAGEMENT REPORTS Members received, for discussion, Paper No: SET/71/16, Corporate Scorecard (October 2016), Paper No: SET/72/16 Dashboard (October 2016), which had been circulated with papers for the meeting. Ms Coulter advised that the Scorecard and Dashboard had been updated to include more narrative following comments at recent Board Development days. She hoped that members would find these amendments helpful. In presenting the 4.

5 report, Ms Coulter said that the Trust remains concerned regarding the extremely long waits which are unacceptable for our patients. This issue continues to be raised at accountability meetings with HSCB and DoH. She noted that the red information relates to worst case waits rather than average waits. Trust staff are also working with LCG and GPs to have some waiting lists revalidated to ensure appropriateness of referrals, particularly for Urology and Cardiology Overall there has been a downward trend in length of stay. Ms Coulter noted that some Trusts do not include all the General Medicine specialties which are included within South Eastern Trust, eg thoracic, which may contribute to a higher average length of stay. In October 2016 the Ulster Hospital Emergency Department experienced record levels of attendances 220 more than in September 2016 and 306 more than October Despite this Ms Coulter indicated that it was the best four hour performance at 81.5%. In relation to the 12 hour performance, 52 patients breached (44 in the Ulster Hospital and 8 in the Downe Hospital). As of 21 November 2016 there have been hour breaches in the Ulster Hospital due to increased pressure on the Emergency Department and the impact of infection within inpatient wards. In relation to fractures, 81% of patients were treated within 48 hours. Ms Coulter reminded members that the Trust will be unable to meet the 95% target due to only being commissioned for unscheduled care. There were 6 breaches for neck of femur patients. Ms Coulter advised that all urgent breast cancer patients were seen within 14 days and the Trust is confident that this position can be sustained whilst preparing for Christmas leave. In relation to patients diagnosed with cancer, there were 9 breaches of the 31 day target for treatment but the longest wait was 34 days, ie within 3 days of the target. The worse performance is in relation to treatment of patients urgently referred with a suspected cancer to begin their definitive treatment within 62 days there were 30 breaches. The main areas of concern relate to Urology and UGI and discussions have taken place with HSCB to improve this performance. A fourth Urology Consultant has now been appointed and additional cystoscopy and scope lists scheduled. Ms Coulter noted that whilst there is an increasing number of red flag cases the number of cancer diagnoses has remained steady with no significant increases. In respect of delayed discharges there were 27 patients delayed 7 days or more but none stayed longer than 29 days. Mrs Coulter noted that there were 254 complex discharges of which 106 were delayed over 48 hours. The average length of stay break for South Eastern Trust patients was 2.4 whilst Belfast Trust patients were 4.4. This reflects the improvement work carried out with the Trust and dialogue will continue with Belfast Trust staff. Psychological Therapies performance remains below where it should be and Mrs Coulter noted that work is continuing with HSCB colleagues to improve this position. A recovery plan has been developed and Well-Being Hubs are being funded from non-recurrent slippage to target third party providers. Despite an increase from 46 to 60 in October 2016, Mrs Coulter reported that the Autisim performance remained at 100%. 5.

6 Within Children s Services Mrs Coulter noted that there were 179 unallocated cases. The Trust has the second highest number of children on the child protection register and there is now a focus on the criteria for being placed/ retained on the register across the region. During discussion concern was raised regarding the current waiting lists and Mrs Coulter advised that whilst it will take time to resolve this issue the Transformation Implementation Group is examining proposals for Elective Care and Treatment Centres. It is hoped that the Minister for Health will make an announcement regarding Elective Care in January In the short term the need for Independent Sector services is recognised however in the medium/long-term additional waiting list work capacity could be provided. Mr Martyn commented that it will take some time to appoint sufficient staff to carry out this volume of work. A member noted that the poor waiting list position has overshadowed the improving target performance and sustained target achievement. During discussion of this point an update to the Scorecard and Dashboard was requested to show work which is being carried out and the trend which is improving. This issue could be further discussed at the Trust Board Workshop scheduled for Friday, 2 December The Chairman formally recorded the appreciation of Trust Board to all staff for the work carried out. 126/16 UPDATE REPORT BOARD ASSURANCE FRAMEWORK AND CORPORATE RISK REGISTER Members received, for discussion, Paper No: SET/73/16, Update Report Board Assurance Framework and Corporate Risk Register (CRR), which had been circulated with papers for the meeting. In presenting the paper, Mrs Weir advised that this report detailed high level information in relation to the Corporate and Directorate Risk Registers. This information is regularly updated and reports provided to both the Governance Assurance and Corporate Control Committees, as appropriate. During discussion, it was noted in the cover report that there had been no amendments to the report since the last meeting. However, Miss Low highlighted an error in the report advising that she had received recent notification that one item has been closed off (ID 1893) and this had inadvertently been omitted from the report presented today. She confirmed that the report, therefore, would be amended to reflect this reduction from 17 to 16 items on the register. In response to concerns expressed regarding items remaining upon the register for a period of time, Mr Guckian noted that this can be advantageous to the Trust, for example the risk to the Ulster Hospital estate was a major issue and resulted in the Phase B development. Ms Mongan commented that the delayed discharges and resettlements is on track for achievement but some of the delays have been related to the complexities of clients requirements in the community. She noted that the business case for Mental Health provision is currently being updated in order to reflect actions taken to improve safety measures. In addition, a member raised an issue about the number of extreme risks listed on the Corporate Risk Register and Mrs Weir responded to this matter and explained the rationale for this by way of illustration using the Laundry risk issue. Members were reminded 6.

7 that a workshop was planned for Trust Board members in the new year to take them through the construction and scoring arrangements for risk registers and, in particular, the Corporate Risk Register. 127/16 INTERVAL REPORT ON THE DELEGATION OF STATUTORY PERSONAL SOCIAL SERVICES FUNCTIONS AND CC302 CORPORATE PARENT REPORT Members received, for approval, Paper No: SET/74/16, Interval Report on the Delegation of Statutory Personal Social Services Function and CC302 Corporate Parenting Report, which had been circulated with papers for the meeting. Mr Whittle advised that the Annual Report had been submitted in March 2016 and this was a Mid-Year Report. He noted that there was a typographical error in the introduction (2014/15 should be 2016/17) and this would be amended. Mr Whittle reported that there was significant compliance across all delegated statutory areas. There were some issues, including Older People and Primary Care, and these are being addressed. There is a capacity issue which has resulted in unallocated cases but steps are being taken to address this position. He noted that all child protection referrals are allocated. A Trust Board Workshop on Corporate Parenting is scheduled for Wednesday 7 December 2016, and Mr Whittle indicated that any queries can be addressed in that forum. The Chairman sought, and received Trust Board approval to, the Interval Report on the Delegation of Statutory Personal Social Services Functions and CC302 Corporate Parenting Report. 128/16 NURSING AND MIDWIFERY ANNUAL REPORT 2015/16 Members received, for information, Paper No: SET/75/16, Nursing and Midwifery Annual Report 2015/16, which had been circulated with papers for the meeting. In presenting the paper, Ms Patterson stated that this is the second Annual Nursing and Midwifery Report and, whilst not a mandatory requirement, demonstrates the professional contribution to a vast range of services and initiatives. During brief discussion the excellent layout and content of the Report was noted. 129/16 QUARTERLY REPORT ON UNALLOCATED CASES JULY TO SEPTEMBER 2016 Members received, for information, Paper No: SET/76/16, Quarterly Report on Unallocated Cases July to September 2016, which had been circulated with papers for the meeting. In presenting the report, Mr Whittle noted the capacity issue which resulted in the unallocated cases and advised that a short term plan has been devised to recruit staff from waiting lists to provide resources to progress this issue. 7.

8 130/16 REPORT AND MINUTES ON THE CHARITABLE FUNDS COMMITTEE MEETING HELD ON 5 OCTOBER 2016 Members received, for information, Paper No: SET/77/16, Report and Minutes of the Charitable Funds Committee held on 5 October 2016, which had been circulated with papers for the meeting. Mr Mansley noted the work being undertaken to encourage charitable donations. 131/16 REPORT AND MINUTES ON THE AUDIT COMMITTEE MEETING HELD ON 6 OCTOBER 2016 Members received, for information, Paper No. SET/78/16, Report and Minutes of the Audit Committee meeting held on 6 October 2016, which was circulated with the papers for the meeting. Mr Brady stated that this was his first meeting as Chairman of the Committee and highlighted the key issues discussed at the meeting including a closed meeting with External and Internal Auditors following the Audit Committee. 132/16 REPORT AND MINUTES OF THE FINANCE COMMITTEE MEETING HELD ON 24 OCTOBER 2016 Members received, for information, Paper No. SET/79/16, Report and Minutes of the Finance Committee meeting held on 24 October 2016, which was circulated with the papers for the meeting. Mr Mawhinney noted that the papers were presented for information and that the next meeting is scheduled for 19 December /16 ANY OTHER BUSINESS (a) Non-Executive Directors Mr McCaughey, on behalf of the Executive Management Team, formally thanked Miss Graham, Mr Mansley and Mr Trethowan for their contribution to the Trust over the past 10 years. He encouraged them to reflect on the many achievements throughout these years including the Downe Hospital, LARC, Phase B development of new services and extended existing services. 134/16 DATE AND VENUE OF NEXT MEETING The Chairman confirmed that the next meeting of the Trust Board will be held on Wednesday 18 January 2017 at am in the QIIC, Trust Headquarters, Ulster Hospital. Mr Colm McKenna Chairman Public_TBMins_30 November 2016 Date: 8.