A G E N D A Item description Item presenter Appendix

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1 Meeting Name: COUNCIL OF GOVERNORS Chair: JANE STICHBURY 1 Date: Tuesday 28 April 2015 Welcome to new Governors - Sarah Berridge, Petrina Taylor and Philip Copson Time: 08:30 Venue: Conference Room A G E N D A Item description Item presenter Appendix Chair 2 Apologies for Absence Chair 3 Declaration of Interests Chair 4 Approval of the Minutes of the Meeting held on 22 January MATTERS ARISING 5.1 Actions Log from Minutes of the Meeting held on 22 January DECISION 08:40 08:45 Chair Chair 6.1 Trust Secretary s Report (item 2 only) Sarah Anderson D A B C 7 STRATEGY 08:45 09: Clinical Services Review (CSR) Update Paula Shobbrook 8 PERFORMANCE 09:00 10: Workforce Report Karen Allman E 8.2 Results of Staff Survey Vicky Douglas F presentation 8.3 Quality Performance Report Paula G Shobbrook 8.4 Performance Report Richard Renaut H 8.5 Financial Performance Stuart Hunter I BREAK 10:30 10:45 9 DECISION 10:45 11: Appointment of External Auditors Pete Papworth Report to be tabled/short presentation Council of Governors Meeting Agenda - Part 1 April 2015 Page 1 of 3 Oral

2 Item description Item presenter Appendix 9.2 Trust Secretary s Report (other than item 2) Sarah Anderson J 10 FOR INFORMATION 11:10 11: Role of Governors with actions from Governors Workshop Sarah Anderson Oral held on 30 March Forward Planner Sarah Anderson K 10.3 Governor Sub-Committee Meeting Reports Reporting Governors Membership Development Committee (MDC) David Triplow L Governor Training Committee (GTC) Colin Pipe Governor Involvement with Patient and Public Engagement Committee (GIPPE) David Bellamy Reporting 10.4 Trust Sub-Committee Reports Governors Carbon Management Committee Mike Allen M Charitable Funds Committee Graham Swetman Diversity Committee Colin Pipe Editorial Group Various End of Life Strategy Keith Mitchell External Auditors Paul Higgs/ Roger Parsons/ Graham Swetman Governor Finance Briefing Group Graham Swetman/ Eric Fisher/ Roger Parsons Healthcare Assurance Committee (HAC) Eric Fisher/ Ian Knox Infection Prevention and Control Committee (IPCC) Keith Mitchell Organ Transplant Committee Sarah Berridge Patient Experience and Communications Committee (PECC) David Bellamy (GIPPE Chair) David Triplow (MDC Chair) Eric Fisher Patient Information Group (PIG) David Bellamy Valuing Staff and Wellbeing Group Keith Mitchell Workforce David Triplow Council of Governors Meeting Agenda - Part 1 April 2015 Page 2 of 3

3 Item description Item presenter Appendix 10.5 Reports from Governors Reports from Appointed Governors Appointed Governors No reports received Report from Staff Governors Staff Governors No reports received Governor reports of activities attended outside the Trust 11 DATE OF THE NEXT COUNCIL OF GOVERNORS MEETING Wednesday 15 July 08:30 Conference Room, Education Centre Royal Bournemouth Hospital All Governors To resolve that under the provision of Section 1, Sub-Section 3, of the Public Bodies Admission to Meetings Act 1940, representatives of the press, members of the public and others not invited to attend be excluded on the grounds that publicity would prove prejudicial to the public interest by reason of the confidential nature of the business to be transacted. N Council of Governors Meeting Agenda - Part 1 April 2015 Page 3 of 3

4 Council of Governors Meeting THE ROYAL BOURNEMOUTH AND CHRISTCHURCH HOSPITALS NHS FOUNDATION TRUST REGISTER OF GOVERNORS INTERESTS as at 20 April 2015 The following Governors of The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust have declared interests as listed below: NAME/CONSTITUENCY DECLARED INTEREST ELECTED GOVERNORS Public: Bournemouth and Poole David Bellamy The Chairman of the Patient Panel of a local GP Group Carole Deas Partner Roger Parsons, Public Governor Paul Higgs None Colin Pipe Member of the team at the Office of the Police and Crime Commissioner (PCC) as Special Advisor (volunteer position) Roger Parsons Partner Carole Deas, Public Governor Keith Mitchell None David Triplow None Monika Whitmarsh None Vacancy Public: Christchurch and Dorset County Chris Archibold Wife is a member of staff employed in the Orthopaedic Department, based at the Royal Bournemouth Hospital Paul McMillan None Derek Chaffey Member of the Stanpit and Mudeford Residents Association Eric Fisher Member of East Dorset Locality Health Network Group (in a personal capacity) which is arranged through the Dorset CCG Member of the Patient and Public Engagement Group (PPEG) with Dorset CCG as part of the Clinical Services Review Doreen Holford None Brian Young Consultant (salaried) for Immunotec Public: New Forest, Hampshire and Salisbury Mike Allen None Bob Gee None Graham Swetman Member of the Conservative Party Director, Family Property Investment Companies Staff Sarah Berridge Medical and Dental Awaiting declaration COG/Register of Governors Interests Page 1 of 2

5 Council of Governors Meeting Dean Feegrade Administration, Clerical and Management Ian Knox Allied Healthcare Professionals, Scientific and Technicians Petrina Taylor Nursing, Midwifery and Healthcare Assistants Richard Owen Hotel Services and Estates None None Awaiting declaration None NOMINATED GOVERNORS Local Authority Governors John Adams Bournemouth Borough Council Colin Jamieson Dorset County Council Phil Goodall Poole Borough Council Councillor Bournemouth Borough Council Member of the Conservative Party Chairman of the Dorset Police and Crime Panel Elected member of Christchurch Borough Council Elected member of Dorset County Council Chairman of the Christchurch Planning Committee Cabinet Member for E Reserve Member of the Dorset Health and Wellbeing Board Member of the Cabinet of Dorset County Council (Economic Growth and Enterprise Portfolio) Wife is a Constituency Agent for the Conservative Party Councillor Poole Borough Council Member of Dorset Police and Crime Panel Director of Streetwise (West Howe) Partnership Governors Philip Copson The Royal Bournemouth and Christchurch Hospitals Volunteers Group Dr Gail Thomas Bournemouth University Awaiting declaration None Primary Care Trust Governors Dr Tom Knight General Practitioner CCG Dorset Board Member of Dorset Clinical Commissioning Group (CCG) COG/Register of Governors Interests Page 2 of 2

6 Name: Date: Present: Apologies: Non Attendance: In Attendance: Council of Governors Chair: C Jane Stichbury Thursday 22 January Conference Room, Time: 08:30 Venue: 2015 Education Centree Jane Stichbury (JS), Chairman Mike Allen (MA), Public Governor (New Forest, HampshireH e and Salisbury) David Bellamy (DB), Public Governor (Bournemo outh and Poole) Derek Chaffey (DC), Public Governor (Christchu rch and Dorset County) Carole Deas (CD), Public Governor (Bournemouth and Poole) Dean Feegrade (DF), Staff Governor ( Administrative, Clerical and Management) Eric Fisher (EF), Public Governor (Christchurch and a Dorsett County) Bob Geee (BG), Public Governor (New Forest, Hampshire and Salisbury) Phil Goodall (PG),, Appointedd Governor (Boroughh of Poole) ) Paul Higgs (PH), Public Governor (Bournemouthh and Poole) Doreen Holford (DH), Publicc Governorr (Christchurch and Dorset County) Colin Jamieson (CJ), Appointed Governor (Dorset County Council) Ian Knox (IK), Staff Governor (Allied Health Professionals, Scientific and Technical) Paul McMillan (PM), Public Governor (Christchur rch and Dorset County) Keith Mitchell (KM), Public Governor (Bournemouth and Poole) Richard Owen (RO), Staff Governor (Hotel Services and Estates) Roger Parsons (RP), Public Governor (Bournemouth and Poole) Colin Pipe (CP), Public Governor (Bournemouth and Poole) Graham Swetman (GS), Public Governor (New Forest, F Hampshire and Salisbury) Gail Thomas (GT), Appointed Governor (Bournemouth University) David Triplow (DT), Public Governor (Bournemouth and Poole) Brian Young (BY),, Public Governor (Christchurchh and Dorset County) Chris Archibold (CA), Public Governor (Christchurch and Dorset County) Glenys Brown (GB), Public Governor (Bournemo outh and Poole) Tom Knight (TK), Appointed Governor (NHS Dorset Clinical Commissioning Group) Monika Whitmarsh, Public Governor (Bournemouth and Poole) John Adams (JA), Appointedd Governor (Bournemouth Borough Council) Dily Ruffer (DR), Governor Co-ordinator Anneliese Harrison (AH), Legal Assistant to the Trust T Secretary (minute taker) Sarah Anderson (SA), Trust Secretary Stuart Hunter (SH), Director of Finance Richard Renaut (RR), Chief Operating Officer Sandy Edington (SE), Associate Director Servicee Development Karen Allman (KA), Director of Human Resources Jo Sims (JSi), Associate Director Clinical Governance Ian Metcalfe (IM), Non- Executive Director January 2015 Council of f Governors Meeting Minutes Part 1 1

7 MINUTES The meeting commenced: 08:30 15/01 Welcome JS welcomed everyone attending the meeting of the Council of Governors. Action 15/02 Apologies for absence As listed above. 15/03 Declarations of interest None. 15/04 Approval of the minutes of the Meeting held 28 October 2014 The minutes were confirmed as an accurate record. MATTERS ARISING 15/05 Actions Log from Minutes of the Meeting held on 28 October 2014 KM queried the results of the Audit on patient food from page 11 of the minutes. STRATEGY 15/06 Developing the Trust s Annual Plan 2015/16 SE advised the Council that the Trust were due to submit a brief draft of the 2015/16 Annual Plan on 27 February. The final plan will be submitted to Monitor in April and Governors will be consulted during the Governor Training day on 18 March. PS/EB It was emphasised that the Clinical Services Review (CSR) would feature in the strategy along with the 5 year forward view and the Dalton organisational models. The strategy will be formed to help reconcile plans across the health economy and to focus on sustainability and resilience. The Trust s strategic priorities will be split into four strands: Develop 7 day services and centres of excellence through the Dorset CSR; Integration with primary social and community services Internal improvement programme focusing on urgent care, cost and quality improvement; Building a healthy organisation by developing organisational capabilities, culture and values and strategy and planning. Currently there are a number of CSR working groups working together to identify the best model of care for Dorset. The clinical working groups have been discussing components and pathways of models of care. As a result of the Dalton Review and the five year forward view there has been a focus on further integration with social and community care with GPs, social services and primary care working together. The potential models were outlined and included a multi-specialty community provider, primary and acute care system or an accountable care organisation which would be a Labour Government initiative. January 2015 Council of Governors Meeting Minutes Part 1 2

8 SE outlined the model of care for 2015/16 and how the strategy will be achieved: Community services - tendering services to develop more urgent care services. The Trust has recently collaborated with external parties to develop the services to provide more primary care at the front door; Sexual health - this service is currently run by Public Health Dorset. The service is to be tendered this year and the Trust will collaborate with a bid against this tender over the spring/summer to make this a more community integrated service; Shared IT arrangements with GPs services; Shared back office support and procurement facilities; Internally the strategy will focus upon unscheduled care improvements and length of stay. The Trust will be working to a streamlined model of care with a focus at the front door and work is underway for urgent care pathways; Focusing on national quality priorities such as the sign up to safety pledge, of which the Trust is a part, Sepsis, AKI, antibiotic prescribing and 7 day working; The Trust s Improvement Programme; RBCH Quality Improvement Model - Sepsis, simple discharge, the World Health Organisation (WHO) checklist, 2 week treatment process in GI and non-elective laparotomy audit and action; Building a healthy organisation - implementing a leadership development programme and increasing focus on the workforce and work streams. BG highlighted a boundary issue with Hampshire and that this needed to be included when considering the services that the Trust will provide. SE assured that this was an area of focus within the CSR. JS summarised that the clinical input was the priority for the Trust and access to services. It was noted that until the models have been identified it would be difficult to ascertain what services the Trust will provide. The Governors will receive further information about funding formulas when applicable and the slides were to be circulated for information. SE advised that Governors are to view the draft plan before it is submitted to Monitor. DR SE PM queried how staff rotations will be managed in terms of the organisations responsibility to train employees. SE responded that this is in place already and further aggregated education processes would benefit this. DC queried the community hospitals and provided feedback that the Kings Park community hospital was a favourable area. SE responded that this had been considered as part of the clinical services review. The whole of the estate is to be reviewed and public consultation will follow which will provide an opportunity to discuss this. 15/07 Patient and Public Engagement Group (PPEG) EF updated the Council on the recent PPEG for the Clinical Services Review highlighting that Hampshire had been recognised as a January 2015 Council of Governors Meeting Minutes Part 1 3

9 catchment area that required further involvement in the review. Governors were encouraged to sign up to the Dorset Vision website for updates on the progress on the review and meetings are due to take place in Christchurch, Bridport and Blandford in February. The Council were advised that the emerging themes from the meetings were focused upon maternity, urgent and emergency care, specialist care, long term illnesses and the frail and elderly population. Challenging questions had been raised at the forum around Monitor s role within the review and assurance was also provided. It was emphasised that clinicians feedback was provided to the PPEG group and that members of the public were able to participate and voice concerns through different routes of involvement. It was proposed that the dates for the PPEG group meetings were circulated to Governors. KM raised a query about the tendering process for services and requested a clearer response to the issue. JS advised that further information would be provided at the public stage but that this issue could be discussed at the next Governor session on the review. DR CSR update Agenda item PERFORMANCE 15/08 Workforce Report KA updated the Council upon the January figures from the workforce report highlighting the following: There had been a continued drive on recruitment and the Trust was being innovative in its approaches; At the end of December there had been little change in statistics although there had been some improvement with appointments made in surgery and some specialities have also improved although vacancies remain difficult to recruit into; Difficulty remains in recruiting registered nurses however this is a national issue. The Trust is developing a return to acute nursing programme to increase registered nurses and is the only Trust implementing this type of programme currently; Consultant medical staff and recruitment for some services remains challenging however the Trust has secured recruitment from overseas and training will be provided to those who are appointed; There are a number of events taking place to attract new staff to the Trust and a recruitment video has been produced to promote working at the Trust and the incentives available. The Governors would be shown the promotional video material once completed; The Trust is also looking at attending the RCN conference and further advertisements on transport and within popular newspapers; The Trust is encouraging managers and members of staff to have a dialogue with those staff who raise concerns when leaving the Trust; Developments have been made with mandatory training with a new virtual learning environment due to launch in March which January 2015 Council of Governors Meeting Minutes Part 1 4

10 will make the process more efficient and beneficial to staff; Medical compliance is an area that the Trust is struggling with and the Trust is looking to support those staff with more clinical ward based training; The HCA tea party to thank staff had been successful and positive feedback received. DB queried the data for staff sickness and the turnover within estates. KA responded that the merger with Poole had impacted upon this. The managers were reviewing the reasons for this and would be challenged through performance management and at Board, if necessary. EF requested feedback from staff about their perceptions of working at the Trust. KA commented that the FFT data reflected good feedback and the national staff survey had seen an improvement. KA confirmed that the data would be provided at the next CoG meeting in April. April CoG Agenda item IK commented upon the turnover of staff in theatres noting the difficulty of retention in this area. He proposed the Trust increased training opportunities. KA added that a work stream within theatres was being implemented. Further there are a number of places funded by Health Education Wessex and the Trust funds the backfill to allow for staff to take part in training and are supporting the development of roles. KM queried the low levels of tissue viability training of Doctors in mandatory training. KA advised that this had been raised at the Board and the reasons behind this are being investigated. The Trust needs to ensure that the platform for training is flexible but must enforce that it is mandatory. 15/09 Quality Performance Report JSi noted that the report had been provided to Governors for their comments and welcomed questions. EF requested an update on the improvements on pressure ulcers and the results of the audit by the District Nurse. JSi advised that a review had been completed in December. The report was due to be reviewed at the Healthcare Assurance Committee (HAC) but overall the Trust s strategy, resources, training had received positive assurance that the Trust had the right processes in place. It was acknowledged that the Trust had been collecting pressure ulcer damage data differently to other Trusts by recording patients with existing pressure ulcer damage as new pressure ulcer damage. It was confirmed that the Trust was conducting a review of the figures and as such there would be a variation in the figures that have been provided previously. The review did not signify anything for improvement and the Trust has been asked to present at the next Wounds UK event. JS supported that this topic is discussed and scrutinised thoroughly at HAC. Improvements were being seen and the Trust was moving in the right direction with progress in the standards of documentation, good reporting, care plans being completed and a multi disciplinary team collaborative approach on wards. January 2015 Council of Governors Meeting Minutes Part 1 5

11 KM queried if the process had been commended why the statistics were increasing. JSi supported that it was not acceptable and although there was a reduction in figures it was not reducing quickly enough. Those patients admitted with existing pressure damage are complex and difficult to address which impacts upon these statistics. More patients are being admitted from home with existing pressure damage. Additional training is being provided with a ward team approach and lessons are being circulated to staff. CJ and PG arrived at the meeting 09:50am IK queried whether a different strategy should be considered for pressure damage and a different method for Water Low. JSi commented that the Water Low score risk assessment is recommended by NICE as a tool and the Trust was making changes in the way this was recorded. This is being implemented along with VitalPac and is included in assessments. The Trust has a preventative strategy for pressure ulcers and upon assessment patients are put on the highest level of mattress and this is reduced if required following subsequent assessments as appropriate. RO arrived at the meeting at 10:00am 15/10 Performance Report RR presented to the Council the performance report reflecting data for the key Monitor performance targets and highlighted the following: A detailed stroke paper would be provided for the Board meeting next week; There were a number of outliers with 60 medical patients, the majority being elderly, which was a main risk for the Trust. This is subsequently linked to delayed transfers of care which have doubled within the last year; The Trust achieved 92% for the Emergency Department target last week and this continues to be a national struggle due to increased pressures. Domiciliary care within the community was highlighted as a weak link in the process; The Trust is struggling to achieve 95% up to March for governance targets within ED; RTT 18 week non-admit performance is also an area of concern particularly in Dermatology due to a Consultant vacancy and increased waits for referrals. Additional clinics are in place for Gastroenterology and Orthopaedics currently; It is predicted that the Q4 return for cancer 62 day waits will be compliant with more patients being managed through the increase in robotic surgery; Cancer standards for 2 week breaches in Q3 - The Trust has implemented a number of changes to address the pressures and was running at 99% within the last week; 18 week RTT exceptions - up to 150 referrals per month, with increases also in Urology and Dermatology; Outpatients is currently an area of concern for the Trust; The Trust s ability to recover was recognised due to the January 2015 Council of Governors Meeting Minutes Part 1 6

12 introduction of ambulatory care services and clinics. The staff redesigning the way services work has contributed to the increase in discharges upon recovery; 600 beds in the hospital and 90% of these are used by emergency patients with an average age of 84 and length of stay of 13 days; Stroke outreach team is available to different areas within the Trust. Investment has been made in additional members of staff and recruitment is currently underway. The team is now in place and is working to achieve the 4 hour target; o The recruitment for Radiographers for an on-site out of hour s service is also taking place which is an expensive investment and impacts greatly upon staff. Performance has improved upon 24 hours in the last year with staff working 7 days; o The Trust is working to achieve the 1 hour target with further recruitment and consultation will be required with staff due to the impact upon working life balance. DH commented on domiciliary care and questioned whether this was being flagged with the Clinical Commissioning Group (CCG). RR confirmed that this was occurring on a regular basis although there was a lack of workforce at present to support this. Recruitment for rehabilitation assistants is being actioned. BG commented on the definition of Accident and Emergency (A&E) and Emergency Department (ED) and the impact this has upon public attendances. He further queried whether the Trust would be incorporating a minor injuries department as this would impact upon pressures. RR responded that the Trust has made provisions for this with a triage service for minor injuries at the front door. KM requested comments around the cause of admissions and the population impact. RR advised that numbers have increased beyond the underlying factors. Calls to NHS 111 have also increased and this may be due to a lack of a GP seven day service and may be why as such the Trust has experienced higher volumes at the front door. DB queried the impact of winter pressures upon the cancellation of surgical operations. RR confirmed that the Trust had cancelled 100 operations in the last 6 weeks which were planned in Orthopaedics to allow for additional capacity. RO advised that there is a theme amongst staff about recruitment issues and he encouraged the recognition and praising of staff in order to attract further recruitment. He further commented on incentive payments. RR advised that a geriatric incentive payment had recently been introduced and emphasised that the Trust would trial this and look to implement similar incentives where appropriate. JS proposed that there was a joint communication with the Chief Executive to thank staff for their work and how well the Trust has performed in light of the challenges faced. The Council supported this proposal. January 2015 Council of Governors Meeting Minutes Part 1 JS/TS 7

13 15/11 Financial Performance SH outlined the financial performance for December noting the following key information: The deficit had been set at 1.9 million The Trust may not achieve the revised plan due to emergency pressures and a reliance upon agency costs; December was a heavy month of expenditure and it was likely that January will be of a similar position; For Q2 only four acute Foundation Trusts, nationally, had a financial surplus; Monitor has worked with the Trust and is challenging to ensure that safe services are being provided in light of the pressures experienced. Next Thursday Monitor are due to visit the Trust to provide support for its approach going forward; The tariff system is inefficient and does not operate where there is a declining income coming into an organisation. Following the withdrawal of the draft tariff, Monitor have submitted a consultation on next year s tariff although this will still feature a short stay reduction; It was emphasised that the Trust will need to work with the CCG during the transition to provide safe and healthy care in Dorset; Cash position is important and the Trust is in a favourable position but this needs to be managed and capital must be spent appropriately; Throughout the transition of the CSR it will be necessary to manage spending efficiently and continue to deliver the cost improvement plan; Schemes will be quality assured such as electronic document management and VAT cost improvements on drugs. CJ queried ward staffing templates and whether the Trust was being efficient with this. SH responded that the templates are continually reviewed to ensure staff are being efficiently utilised whilst ensuring safe care. Electronic processes and investments in IT and back office functions are examples of some of the ways the Trust is working to reduce expenditure. GS queried the extent of the support of the CCG next year. SH responded that there would be 3 million transitional funding. There has also been an announcement that an additional 2.5 million would be available for the NHS however Dorset will not receive the amount it believes reflects the population. It was noted that if the tariff system had been more efficient an additional 1.2 million would have been available. DC queried the domiciliary care and whether the CCG would consider funding. SH added that local councils have funds but do not have the staff to implement this. JS supported that the Trust needed the resources to support continued services and emphasised the changes that have been made to support the Trust s financial position. January 2015 Council of Governors Meeting Minutes Part 1 8

14 FOR INFORMATION 15/12 Events for Membership DT updated the Council on the additional recruitment that the Membership Development Committee had achieved over the past year. He added that 252 new members had been recruited, quite a few of whom are under 18 years of age, and that a new initiative for young people was being implemented with a staff blog to increase interest in NHS careers. The Council were encouraged to help increase membership and DT requested suggestions and consideration of other events within the community for the harder to reach groups. CJ queried whether the Governors were attending events for 6 th formers and colleges. DT confirmed that this was occurring but this needed to expand to areas such as Poole, Ferndown and Wimborne. DR advised that the MDC were developing a presentation to use at recruitment events and encouraged Governor involvement. JS proposed that a standard script should be devised for use at groups and events to attract members and the MDC were to lead on this. MDC KM proposed that medical presentations that were of interest to the public would attract more members. DR added that equipment at venues must be identified for presentations like this and welcomed suggestions for new venues to be used. JS commended the work of the MDC in increasing membership and notably harder to reach groups. 15/13 Website Task and Finish Group BG updated the council that a storyboard and script was being developed for a film to feature on the website for membership and explaining the role of Governors. The new website homepage is now quicker with better visibility and the FAQs have been updated. It was also noted that the films on the website have been updated. The Council acknowledged that the public were now able to navigate the website more efficiently and that the statistics supported this. Personal profiles were requested from Governors to update the Governor section of the website. All Governors 15/14 Forward Planner The item was noted for information. 15/19 Governor Sub-Committee Meeting Reports Membership Development Committee (MDC) Governor Training Committee (GTC) Governor Involvement with Patient and Public Engagement Committee (GIPPE) January 2015 Council of Governors Meeting Minutes Part 1 9

15 Governor Scrutiny Committee The reports were noted for information. 15/20 Trust Sub-Committee Reports The reports were noted for information. 15/21 Reports from Appointed Governors CJ advised that a review was due from Dorset Healthcare on Sexual Health and also there would be a pilot study of teenage pregnancy and premature babies as a result from smoking. MA commented on the progress in traffic solutions with the Council and queried whether there was an expert available to consult upon this issue. JS added that a positive meeting had taken place with the Council and changes were consulted upon by relevant experts. CJ suggested that the Bournemouth Council appointed governor was approached. 15/22 Report from Staff Governors The reports were noted for information. 15/23 Governor reports of activities outside the Trust The reports were noted for information. 15/24 Date of the next Council of Governors Meeting The meeting concluded at 11:35am. Next meeting to be held on Tuesday 28 April 2015 at 08:30am Conference Room, Education Centre Royal Bournemouth Hospital To resolve that under the provision of Section 1, Sub-Section 2, of the Public Bodies Admission to Meetings Act 1940, representatives of the press, members of the public and others not invited to attend be excluded on the grounds that publicity would prove prejudicial to the public interest by reason of the confidential nature of the business to be transacted. January 2015 Council of Governors Meeting Minutes Part 1 10

16 Council of Governors Meeting Part 1 22 January 2015 THE ROYAL BOURNEMOUTH AND CHRISTCHURCH HOSPITALS NHS FOUNDATION TRUST Actions carried forward from a meeting of the Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust Council of Governors Part 1 held on 22 January Actions Log from Minutes of the Meeting held on 22 January 2015 MATTERS ARISING 15/05 Actions Log from Minutes of the Meeting held on 28 October /71 KM queried the results of the Audit on patient food from page 11 of the minutes. STRATEGY 15/06 Developing the Trust s Annual Plan 2015/16 PS/EB Awaiting update Presentation slides to be circulated DR Completed Governors are to view the draft plan before it is submitted to Monitor. SE Completed 15/07 Patient and Public Engagement Group (PPEG) The dates for the PPEG group meetings are to be circulated to Governors. KM raised a query about the tendering process for services and requested a clearer response to the issue. JS advised that further information would be provided at the public stage but that this issue could be discussed at the next Governor session on the review. DR CSR update agenda item Completed February meeting dates circulated CSR Update given on 19 February. A further update will be given at next CoG meeting PAGE 1 OF 2

17 Council of Governors Meeting Part 1 22 January 2015 PERFORMANCE 15/08 Workforce Report EF requested feedback from staff about their perceptions of working at the Trust. KA commented that the FFT data reflected good feedback and the national staff survey had seen an improvement. KA confirmed that the data would be provided at the next CoG meeting in April. 15/10 Performance Report A joint communication from the Chairman and Chief Executive thanking staff for their effort and contribution over the Christmas/New Year period was proposed. FOR INFORMATION 15/12 Events for Membership DR advised CoG that the MDC were developing a presentation to use at recruitment events and encouraged Governor involvement. JS proposed that a standard script should be devised for use at groups and events to attract members and the MDC were to lead on this. 15/13 Website Task and Finish Group Personal profiles were requested from Governors to update the Governor section of the website. April CoG agenda item MDC All Governors April CoG agenda item Workforce Report (item 8.1) Completed Poster/Screen Saver message shared Agenda item at the next MDC meeting planned on 20 June 2015 On-going PAGE 2 OF 2

18 COUNCIL OF GOVERNORS Meeting Date and Part: 28 April 2015 Part 1 Subject: Section: Author of Paper: Trust Secretary s Report (item 2 only) Decision Sarah Anderson, Trust Secretary Details of previous discussion and/or dissemination: Not previously discussed Key Purpose: Patient Engagement Governance Performance Strategy X Action Required by Council of Governors: Summary: Approve the appointment of Guy Rouquette as a publically elected governor for Bournemouth and Poole Constituency with effect from 28 April 2015 Glenys Brown, Public Governor for Bournemouth and Poole Constituency resigned with effect from 31 March The next highest polling candidate is Guy Rouquette, who has accepted the appointment subject to the approval of the Council of Governors. Strategic Goals & Objectives: Links to CQC Registration: (Outcome reference)

19 Council of Governors 28 April 2015 Part 1 Trust Secretary Report 1. Introduction This report sets out a number of issues that the Council of Governors needs to be informed about or needs to make a decision on. 2. Filling the Bournemouth and Poole Constituency Vacancy The resignation of Glenys Brown, Public Governor for Bournemouth and Poole Constituency on 31 March 2015 has left a vacancy. The constitution at paragraph states that the Council of Governors can invite the next highest polling candidate to fill the seat. Elections were held in August 2014 for this constituency and there were four candidates who were not successful. The next highest polling candidate is Guy Rouquette. The Trust Secretary and Governor Co-ordinator have met with Guy to confirm that he is still interested in becoming a governor. He has accepted the appointment subject to the approval of the Council of Governors. The Council of Governors is requested to: Approve the appointment of Guy Rouquette as a publically elected governor for Bournemouth and Poole Constituency with effect from 28 April 2015 Authorise the Trust Secretary to appoint the next highest polling candidates in any constituency in the event of a governor resigning during the financial year 2015/16. No further approval from the Council of Governors will be required. Trust Secretary Report Page 2 of 2 For Decision

20 COUNCIL OF GOVERNORS Meeting Date and Part: Subject: Section: Author of Paper: Details of previous discussion and/or dissemination: Key Purpose: Action Required by Council of Governors: Summary: 28 April 2015 Part 1 Workforce Report Performance Karen Allman Workforce Committee 16/4/15 Board of Directors 24/4/15 Patient Engagement For Noting. Governance Performance Strategy This report is a variation on that tabled at Board and shows Trustwide figures for a range of workforce metrics. The report includes an update on recruitment, appraisal and staff surveys. X Strategic Goals & Objectives: Links to CQC Registration: (Outcome reference) To listen to, support, motivate and develop our staff Outcomes 12, 13 & 14 - Staffing

21 Council of Governors Meeting Part 1 28 April 2015 WORKFORCE REPORT This report contains information concerning the end of year workforce data for , information regarding initiatives relating to recruitment and other key workstreams. 1. Workforce Data as at 31 st March 2015 The monthly workforce data is shown below, both by care group and category of staff. Trust targets of 100% appraisal compliance and 3% sickness absence have been set and performance has been RAG rated against these targets. Care Group Appraisal Compliance At 31 Mar Mandatory Training Compliance Sickness Absence Joining Rate Turnover Rolling 12 months to 31 Mar Vacancy Rate (from ESR) At 31 Mar Surgical 66.5% 75.9% 4.55% 11.8% 10.0% 2.3% Medical 75.9% 76.4% 3.71% 18.0% 12.6% 5.0% Specialities 69.0% 73.0% 4.55% 9.7% 10.4% 3.5% Corporate 71.8% 75.7% 3.60% 14.0% 16.0% 4.5% Trustwide 71.3% 75.5% 3.93% 13.8% 12.2% 3.9% Areas to note include the joining rate is higher than the turnover rate indicating that more staff are joining the organisation than leaving. Mandatory training compliance( Essential Core Skills ) and appraisal compliance remain challenging. The vacancy rate remains stable showing a small decline from last month. 2. Recruitment Recruitment to certain key posts remains challenging although some good progress has been made with nursing and medical posts. The Trust has launched its refreshed recruitment portal on the Trust website which contains easily accessible information about vacancies, staff benefits and living and working locally. We have developed some new marketing material including videos and have been advertising opportunities on local buses and embracing social media opportunities to publicise working at the trust. We continue to attend regional and national job fairs - exhibiting at an RCN event in Glasgow over the weekend of the 9/10 April. Directly from this event six confirmed offers have been made to qualified nurses for areas including OPM (Older Peoples Council of Governors: 28 th April 2015 Workforce Report Page 1

22 Council of Governors Meeting Part 1 28 April 2015 Medicine), Endoscopy and Surgery, and a further cohort of interviews being arranged from contacts made at the event. We are delighted that 14 overseas nurses will be joining the Trust from European Union countries on18th May and a further 16 Filipino nurses have confirmed offers - 14 for Theatres and 2 for Endoscopy - to join the Trust later in the year. A programme of support and adaptation to the NHS is being developed and further overseas interviews are scheduled for the end of April and into May. An open day with interviews for newly qualified nurses is planned for Saturday 16th May. We have 60 interviews already booked and have a full programme of visits and tours in hand for this event. An appointment has also been made for a new ED consultant which is excellent news. 3. Appraisal A significant amount of work continues on the roll out of the new Trust appraisal system. The new system links with the Trust values and behaviours and is a significant change the NHS KSF (knowledge and Skills Framework) which is competency rather than behaviourally based. 200 staff have already been trained since the launch in March and there is a comprehensive programme of further training planned. Early feedback from participants has been excellent and we will be monitoring progress of appraisal completion against an agreed trajectory on a regular basis at the Board and in detail at the Workforce Committee. 4. Staff Survey The Council of Governors will receive a presentation about the national staff survey results at this meeting in April. There are individual care group and directorate action plans as well as a corporate action plan. We will be using the Friends and Family Test for staff to delve deeper into some of the areas for actions from the annual staff survey and also plan to survey the whole organisation in 2015 rather than the normal sample size. 5. Friends & Family Test Our Quarter 4 mini Staff Impressions survey went live at the end of February. In this we ask the standard FFT questions and a standard how are you feeling question, but each quarter we are able to ask some additional questions. For this quarter these are based on those areas from the Staff Survey where our rankings were lowest, as follows. Council of Governors: 28 th April 2015 Workforce Report Page 2

23 Council of Governors Meeting Part 1 28 April Is this a trust that listens and responds to your views? Yes/No & Comments box. 2. How frequently do you get to hear the important messages about what's going on in the Trust from your line manager? Always, Most of the time, Sometimes, Not often, Never. 3. What ways of communicating important messages work best for you? Comments box. 4. Would you feel it is safe to raise concerns, confident that they will be listened to and acted on? Yes/No & Comments box. 5. Do you feel that the Trust regularly recognises the good work of our staff? Yes/No 5a What ideas do you have for saying Thank you and well done? Comments box. 6. Do you have a set of clearly defined objectives for your role that you agreed at your last appraisal? Yes/No The survey closed at the end of March; outputs will shortly be available and a verbal update will be provided at the meeting. Council of Governors: 28 th April 2015 Workforce Report Page 3

24 COUNCIL OF GOVERNORS Meeting Date and Part: 28 April 2015 Part 1 Subject: Section: Author of Paper: Staff Survey Performance Vicky Douglas, Human Resources Manager Details of previous discussion and/or dissemination: Not previously discussed Key Purpose: Patient Engagement Governance Performance Strategy X X X Action Required by Council of Governors: To note the report Summary: Results of the 2014 Staff Survey Strategic Goals & Objectives: Links to CQC Registration: (Outcome reference)

25 STAFF SURVEY RESULTS

26 Top strengths Staff are reporting errors, near misses or incidents witnessed in last month Feedback from patients/service users is used to make informed decisions in directorate/department Fewer than average staff feel pressure from work Fewer than average staff are working extra hours Staff feel secure raising concerns about clinical practice

27 Most improved Fewer experiences of harassment, bullying and abuse Care of patients/service users is a higher priority More staff are able to meet conflicting demands of their time at work More adjustment(s) made to enable disabled employees to carry out their work

28 Weaknesses X Staff experiencing physical violence from colleagues in the last twelve months X Staff attending work when feeling unwell X More physical violence from patients/service users, their relatives or other members of the public X Health and safety training not attended by some X Some staff have not received an annual appraisal

29 Corporate Action plan Action to be taken against staff who exhibit physical violence against others need to find out where cases are occurring Health and Wellbeing initiatives for staff to include fitness to work and mental health awareness. Physical violence from patients/service users, their relatives or others to be firmly addressed Security Manager Health and Safety training sessions to be monitored and poor attendance to be reported to Directorates for follow up. Launch of new Appraisal system in 2015, with robust followup for managers who fail to complete appraisals for staff.

30 Actions started Whistleblowing policy being reviewed and up-dated in accordance with latest recommendations. Director of Nursing is leading on Francis Report Freedom to Speak Up mapping of recommendations against current status. Mental health awareness sessions were held 23 April On-going B & H awareness sessions The Head of Security significantly increased the number of conflict resolution sessions being delivered over last 12 months, which is also supported by e-learning. An evaluation is underway with statistics being made available shortly. New appraisal system has been launched Care group action plans

31 Questions

32 Council of Governors Meeting Date and Part: 28 April 2015 Part 1 Subject: Quality Report Section: Executive Director with overall responsibility Author(s): Performance Paula Shobbrook, Director of Nursing and Midwifery Joanne Sims, Associate Director Quality & Risk Action required: The Council of Governors is asked to note the report. Summary: This report provides a summary of information on Patient Safety and patient experience indicators for Q4. Related Strategic Goals/ All Objectives: Relevant CQC Outcome: All Risk Profile: i. Have any risks been reduced? No ii. Have any risks been created? No Reason paper is in Part 2 Not applicable Y:\COG MEETINGS\CoG packs\papers\2015\28 April 2015\Part 1\G1_2 Quality report Q4 to CoG April 15.docx 1

33 Quality & Patient Safety Performance Exception Report Q4 January - March Purpose of the Report This report accompanies the Quality/ /Patient Performance Dashboard and outlines the Trust s performance exceptions against key quality indicators for patient safety and patient experience for Q4 January - March Serious Incidents 20 Serious Incidents (SI s) were confirmed and reported on STEISS in Q4 January-March The Trusts reporting of Serious Incidents is in line with other Acute Trusts in Dorset. The following graphs and tables summarise the Serious Incidents that were reported across Dorset CCG during Quarter (Q4) 01/01/ /03/2015. RBCH is Trust C. There were 64 SIRIs reported in this period between 01/01/ 2015 and 31/03/ Trust A Trust B Trust C Trust D The next graph shows the number and category of SIs reported by alll Dorset CCG Providers during Q Y:\COG MEETINGS\CoG packs\papers\2015\28 April 2015\ \Part 1\G1_2 Quality report Q4 to CoG April 15.docx 2

34 3. Incident Reporting The latest national reporting and learning system (NRLS) report (issued 12/4/15 for the time period April-Sept 14) places the Trust in the middle quartile for incident reporting. This is positive as it demonstratess an open culture of reporting. 4. Safety Thermometer All inpatient wards collect the monthly Safety Thermomete Harm Free Care data. The survey, undertaken for all inpatients the first Wednesday of the month, records whether patients have had an inpatient fall within the last 72 hours, a hospital acquired category 2-4 pressure ulcer, a catheter related urinary tract infection and/or, a a hospital acquired VTE. If a patient has not had any of these events they are determined to have had harm free care. Y:\COG MEETINGS\CoG packs\papers\2015\28 April 2015\ \Part 1\G1_2 Quality report Q4 to CoG April 15.docx 3

35 The results for the 2014/15 data collection for Q4 are as follows: NHS SAFETY THERMOMETER Safety Thermometer %Harm Free Care Safety Thermometer % Harm Free Care (New Harms only) Monthly survey using Safety Thermometer (Number of patients with Harm Free Care) 13/14 Av per month 14/15 Target Jan Feb Mar 89.0% 95% 91.82% 90.73% 91.47% 97.5% 97.41% 97.3% 97.22% 480 NA Results are as follows: Number of Patients surveyed New Pressure Ulcers New falls (Total) 13/14 Jan Feb Mar 14/15 Total Total New VTE New Catheter UTI This demonstrates an improvement in all the indicators in Pressure damage remains a priority for Comparison with National averages: National Average (Oct 14) Jan 2015 Feb 2015 Mar 2015 National Average (Jan 15) HarmFree Care 93.98% 90.73% 91.47% 92.56% 93.88% Pressure Ulcers 4.36% 7.39% 8.88% 7.54% 4.54% - All Pressure Ulcers 0.99% 2.2% 2.51% 2.58% 1.05% - New 0.65% % Falls with Harm Catheter & new 0.35% 0.6% 0.39% 0.2% 0.30% UTIs New VTEs 0.39% % Y:\COG MEETINGS\CoG packs\papers\2015\28 April 2015\Part 1\G1_2 Quality report Q4 to CoG April 15.docx 4

36 5. Patient Experience Feedback from our patients remains strong, which is demonstrated through performance with the family and friends test (The number of patients who would recommend the service), for inpatient wards and Emergency Departments. Inpatient scores December 2014 January 2015 February 2015 FFT Ranking 4 th (with 21 others) 5th (with 33 others) 4 th (with 22 others) Our score 97% 96% 97% Trust sample size Top score 100% 100% 100% Emergency Department December 2014 January 2015 February 2015 FFT Ranking 4 th (with 7 others) 5th (with 10 others 7 th (with 10 others) out 138 hospitals) Our score 96% 94% 92% Number of patients who would recommend service Trust sample size Top score 100% 98% 98% 6. Risk Register Significant risks on the Trust risk register have been reviewed monthly at QARC, HAC, TMB and Board of Directors. Mitigation action plans are in place for all significant risks. 7. Recommendation The Council of Governors is invited to note the report Y:\COG MEETINGS\CoG packs\papers\2015\28 April 2015\Part 1\G1_2 Quality report Q4 to CoG April 15.docx 5

37 COUNCIL OF GOVERNORS Meeting Date and Part: Tuesday 28 April 2015 Part 1 Subject: Performance Summary Report Quarter Section: Performance Author of Paper: Richard Renaut Details of previous discussion and/or dissemination: Key Purpose: TMB / BoD Patient Engagement Governance Performance Strategy Action Required by Council of Governors: Summary: To note the Trust s performance against key Monitor and national/local indicators and actions highlighted in relation to noncompliant or at risk indicators. This report provides a summary of the key performance highlights and non compliances in Q4 2014/15. It outlines the key challenges and context of the non compliances as well as our outline trajectories for recovery Key non compliances for Quarter 4 were: A&E 4 hours Cancer 2 week wait 62 day (1 st treatment and screening) 31 days (1 st and subsequent surgical treatment); and RTT non-admits

38 6 week wait diagnostics 12 hour waits from decision to admit in ED Cancelled operations not offered a date within 28 days. Three key streams of work are underway, implementing detailed action plans for the recovery of our key performance indicators: Cancer RTT ED - 4 hour and Flow Strategic Goals & Objectives: Performance Links to CQC Registration: (Outcome reference) Caring Well lead Membership Development Strategy Page 2 of 2 For Decision

39 Council of Governors April 2015 Purpose of the Report Performance Summary Report Quarter /15 This report provides a summary of the key performance highlights and non compliances in Q4 2014/15. It outlines the key challenges and context of the non compliances as well as our outline trajectories for recovery. Detailed information on performance targets is available in the monthly Board of Directors Performance Indicator Matrix and Exception Report. As an overview of the key risks for our final Q4 position, these are non-admitted waits (especially Dermatology, Orthopaedics and Poole based specialties), Cancer 2 week, 62 day and 31 day waits, and 4 hour ED compliance. The report also includes brief headlines in relation to our detailed recovery action plans. Quarter 4 Position Monitor Governance Indicators 2 standards returned to compliance: 2 week waits breast symptomatic, and 18 week Referral to Treatment (RTT) admitted 1 Non-compliant areas: A&E 4 hours; Cancer 2 week wait, 62 day (1 st treatment and screening), and 31 days (1 st and subsequent surgical treatment); and RTT non-admits At risk for Q4 is RTT incomplete pathways, which due to the methodology of reporting cannot be confirmed until 21/4/15. Our current expectation is that this will be compliant Whilst 5 cases of C. Difficile were reported in March, which is over the monthly Monitor target of 1, we are still within both the Monitor cumulative and local cumulative targets (25) with a year total of 21. Looking over the coming four quarters, and Q1 in particular, the best estimate for predicted performance is as set out below: Quarterly summary of Monitor Risk Assessment Framework 2013/ / /16 Target or Indicator (per Risk Assessment Framework) % Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4* Q1 Q2 Q3 Q4 Referral to treatment time, 18 weeks in aggregate, admitted patients 90 Referral to treatment time, 18 weeks in aggregate, non-admitted patients 95 Referral to treatment time, 18 weeks in aggregate, incomplete pathways 92 A&E Clinical Quality- Total Time in A&E under 4 hours 95 Cancer 62 Day Waits for first treatment (from urgent GP referral) 85 Cancer 62 Day Waits for first treatment (from Cancer Screening Service) 90 Cancer 31 day wait for second or subsequent treatment - surgery 94 Cancer 31 day wait for second or subsequent treatment - drugs 98 Cancer 31 day wait from diagnosis to first treatment 96 Cancer 2 week (all cancers) 93 Cancer 2 week (breast symptoms) 93 C.Diff objective MRSA Access to healthcare for people with a learning disability *Note the final validated reporting upload for RTT is 21/4/15 All indicators have a risk of non-compliance, which is actively managed. Predicted breach Potential breach risk Some risk 1 Note, this is based on our current unvalidated position for RTT pending the final March reporting upload on 21/4/15. Performance Monitoring Page 1 of 3 For Information

40 Council of Governors April 2015 Following submission of our Q3 performance position, the Trust has been notified by Monitor that The Trust s governance risk rating will remain Under Review pending further investigation. A full report and detailed recovery action plans in response to all of the performance areas has been prepared in response. Quarter 4 Position Indicators within the Everyone Counts: Planning Guidance/ Key Contractual Priorities 2 standards returned to compliance: VTE and 52 week waits (incomplete pathways) Non-compliant areas: 6 week wait diagnostics, 12 hour waits from decision to admit in ED, cancelled operations not offered a date within 28 days. Overarching Context and Challenges in Q4 In line with the pressures across the Dorset-wide system, on the demand side, the high level of ambulance conveyances, ED attendances and urgent admissions (13% increase) continued. This presented an ongoing challenge to our A&E 4 hour and 12 hour from decision to admit targets, whilst also putting pressure on capacity for elective care as well as resulting in cancelled operations. The declining availability of care home and domiciliary care packages was also evident through the quarter, resulting in significant bed pressures and delays in transfers of care. In addition, the growth through the year in elective care with a 7% increase in referrals, particularly in Orthopaedics and Dermatology, and 20% increase in cancer fast track referrals has put additional pressure on our Referral to Treatment (RTT) non admitted target and Cancer targets. On the capacity side there have been key vacancies and shortages in medical staffing both here (e.g. Breast, Dermatology, Urology, Orthopaedics and Endoscopy) and at Poole Hospital; the latter having contributed to a deterioration in our waits for their visiting specialities ENT, Oral Surgery and Neurology. These have impacted on both RTT and Cancer performance. Recovery Plan Three key streams of work are underway, implementing detailed action plans for the recovery of our key performance indicators: Cancer, RTT and ED, 4 hour and Flow Cancer performance is improving on many indicators, with the 62 day standard, especially for Breast and Urology, remaining a heightened risk for Q1. Completion of key changes already underway, particularly with Dorchester Hospital and recruitment of breast medical staff will be crucial to success. RTT non-admitted will remain non compliant in Q1 as our recovery plan focuses on ensuring long waiters are treated during the Quarter whilst pulling forward outpatient and non admitted pathway waits. This includes a joint plan from April/May with Poole Hospital to support the visiting specialities. This has a potential subsequent knock on risk for Incomplete Pathways, and admitted care, including rebooking cancelled operations. However, RTT Admitted is currently expected to maintain a compliant aggregate position. Performance Monitoring Page 2 of 3 For Information

41 Council of Governors April 2015 Feb 2015 Actual 91% (323 breaches) July 2015 Projected 95% (143 breaches) Table: clock stop breaches, current and predicted. Note: progress against Poole specialties is considered a key risk 4 hour performance is planned to return to 95% or above - with risks, many outside of our control, but mitigation plans to enable achievement. Confidence is based upon our compliant March performance largely resulting from the implementation of our rapid assessment and treatment model - BREATH. This will also have a knock on positive impact in relation to 12 hour from decision to admit breach risks. Outsourcing of Endoscopy procedures during Q4 has resulted in a significant improvement against the 6 week wait target in March. Ongoing work to recover this position continues with a current plan to return to compliance during Q1. The Trust response to the challenges is to plan on these higher levels of activity becoming the norm, to improve our service resilience for unplanned mismatches in capacity and demand, and to tighten operational management. There is also considerable service redesign to better align our limited staffing and budgets to ensure safe, timely care within the national standards. We are also redoubling our efforts for working with partner organisations, such as Poole Hospital. When their emergency and elective services are under strain we are regularly affected. RICHARD RENAUT CHIEF OPERATING OFFICER Performance Monitoring Page 3 of 3 For Information