Northern Health and Social Care Trust

Transcription

1 Northern Health and Social Care Trust Minutes of the twentieth meeting of Trust Board held on Thursday 18 December 2008 in the Conference Room, Holywell Hospital, Antrim Present: Mr J Stewart Dr C Ackah Ms N Evans Dr P Flanagan Mr S Forsythe Mr N Guckian Mr G Houston Ms P Montgomery Mr J Moore Mr R McCann Mr M Rankin Miss B Scott Professor D Whittington In attendance: Ms B Donaghy Mr O Donnelly Mrs J Melaugh Mr M Sloan Mrs M Mulholland Mrs M McDowell Chairman Non Executive Director Chief Executive Director of Medicine and Governance Non Executive Director Director of Finance Director of Women s and Children s Services/ Executive Director of Social Work Non Executive Director Non Executive Director Non Executive Director Non Executive Director Director of Emergency, Primary Care and Older People s Services/Executive Director of Nursing Non Executive Director Assistant Director of Planning and Modernisation Director of Mental Health and Disability Services Director of Human Resources Director of Elective, Acute & Corporate Services Head of Communications Executive Assistant Mrs J Montgomery, Northern Health and Social Services Council, and Miss M Trimble, Mrs A Milliken and Mr D Lowry from Staff Side were present. The Chairman was also pleased to welcome Mr P Archer, newly appointed Chair of the Northern Ireland Ambulance Service and nine consultant medical staff who were attending as Observers as part of the Consultant Induction Programme. TB158/08 Chairman s Business The Chairman advised that on: 26 November he attended the DHSSPS Quality awards and dinner at the Conference of the Institute of Healthcare Management [IHM (NI)]; 28 November he visited Antrim Area Hospital with Mr D Ford, MLA; 1

2 3 December he met with Mr A Gilbert, Secretary of NICON, to discuss a new strategy for Northern Ireland for the next three years; 5 December he attended the Mid Ulster Health Hub event, which focused on the health benefits of being alcohol aware; 10 December he visited Abbey House at Whiteabbey Hospital; 12 December he attended a meeting of NICON at the Hilton Hotel, Templepatrick; 17 December he visited a ward at Causeway Hospital and then met with the Chairs of Trusts ; 18 December he attended the Consultant Medical Staff Induction programme that morning and had enjoyed the opportunity to meet with Consultants. Mr Stewart also advised that five Christmas receptions had been held at venues throughout the Trust during December and he thanked those staff who had attended these events. Members were pleased to note the awards which Trust staff had recently received and agreed that letters of congratulations should be sent on behalf of Trust Board. At the dinner the evening before the IHM Conference: o Multi agency Support Team for Schools project had won the DHSSPS Quality Awards; o Roy Hamill, Community General Manager with responsibility for Podiatry and Occupational Therapy Services had been named winner of the Astra Zeneca Experienced Manager Award;.and o Fiona Brown, Head of Children s Nursing, was the joint winner of the RCN Nurse Manager Award. The Multi-Agency Support Team (MAST) had also been short listed as Finalist in 2009 UK Awards for Allied Health Professionals and Healthcare Scientists in their section for innovative team working. Breathe Easy Causeway Support Group had recently won the Breath of Fresh Air UK Award, which celebrated outstanding achievement within the Breathe Easy network, which was affiliated to British Lung Foundation (BLF) London. 2

3 Donna Buick had been short listed for the RCM Midwifery Awards for 2008/2009 for the project The Role of the Midwife in improving care for women with diabetes. The winners would be announced in London on 22 January It was also noted that Dr Paul Darragh had been appointed Deputy Chair of the NI Branch of BMA. TB159/08 Minutes of previous meeting The minutes of the meeting held on 25 November 2008, copies having been circulated were approved, on the proposal of Mr Forsythe, seconded by Dr Ackah. TB160/08 Matters arising (a) Infection Control Dr Flanagan reported that 16 new cases of C Difficile had been reported during November, which was a slight decrease from the previous month. Again it was found that a significant number of these new cases were either community acquired cases or longer term relapses. No deaths associated with C Difficle had been reported during the last month. Members noted that the two cases which had been reported at Holywell during October had been controlled and there were no new cases to report. Recognising the particular difficulties in isolating the infection in a dementia assessment unit, members paid tribute to the viligence of the staff in the ward for bringing the situation under control in such a high risk area and recognised the support provided by the infection control team in the Trust. Dr Flanagan reported that the Trust C Difficle Outbreak Control Team had been stood down in November and he would now be chairing a newly established Infection, Prevention, Control and Environmental Hygiene Committee, which would meet on a monthly basis to oversee progress against the Trust s Corporate Plan for HCAI. Mr Houston reported that three infants in the neo natal unit at Antrim Area Hospital had tested positive for MRSA during December, with a further two cases being suspected. As a precautionary measure, the neo natal unit had been closed until further notice and all necessary action was being taken to bring the situation under control. Members recognised the implications of this action regionally with the very limited number of neo natal cots available in the province and hoped that the situation would be resolved as quickly as possible. 3

4 (b) Modernisation Programme Ms Donaghy advised that the first phase of consultation on the Trust s CSR proposals would end on 19 December 2008, with the second phase due to commence on 8 January She advised that, during the first round of consultation, in addition to the documentation being available on the Trust s website, the Chief Executive had led meetings with local District/Borough Councils, the HSS Council, and a number of MLAs. A workshop had been held with GP representatives and the Northern Board, and detailed consultation had taken place on specific proposals such as those affecting Cherry Lodge and Broadway Workshops. It was noted that the Chief Executive would be undertaking staff briefings at ten venues during January 2009 and four public meetings had been arranged for February Members noted that a special Trust Board workshop had been arranged for 6 January 2009 to consider the response received during the first round of consultation before proceeding to the second phase. It was also hoped that Non Executive Directors would be able to attend some of the public meetings during February. The Chief Executive advised that a letter had been received from the Vice Chair of the Committee for Health, Social Services and Public Safety requesting information on the Trust s proposals and the consultation process and she would be responding before the requested date of 9 January It was also anticipated that the Chief Executive would be invited to attend a meeting of the Health Committee in due course to discuss the Trust s CSR proposals. In response to a query from Mr Rankin, it was acknowledged that if alternative options were identified during the consultation process further Equality Impact Assessments may be required to be undertaken where considered necessary for areas proposing significant change. The Chairman highlighted the importance of effective engagement with stakeholders, including staff and staff organisations, services users and public representatives and confirmed that the Trust was committed to a thorough and meaningful consultation and engagement process. TB161/08 Performance Report In presenting the performance report for November 2008, Ms Donaghy highlighted that good progress continued to be made or sustained in waiting times for AHP, breast cancer, hospital out patients, inpatient/day cases and diagnostics. Complex delayed discharges, 4

5 recruitment of foster carer and cancer response times had all seen marked improvements over recent months. Ms Donaghy advised that, due to ongoing efforts to recruit foster carers, it was now anticipated that the Trust would exceed the target of 447 by the end of March, with a position of 447 being achieved as at 5 December She reported that, although seven patients had been waiting beyond 13 weeks at the end of November, work was ongoing to sustain the excellent progress made by the Child and Adolescent Mental Health Service (CAMHS) to achieve the target in October. Members noted that referrals to the service had increased by 11% and this challenging position had been drawn to the attention of the Northern Board. Although the target to reduce the number of children in care by 3% by March 2009 and 12% by 2011 remained a red indicator on the progress chart, it was noted that the Department was currently reviewing this target due to the concerns which had been expressed by Trusts that the care and safety of children was the top priority. Ms Donaghy advised that, although 88% of patients being referred with suspected cancer were beginning their first definitive treatment within 62 days, the current target of 75% would increase to 95% by March Although health care associated infections were being well managed and closely monitored, it was noted that the targets set did not take account of the outbreak of C Difficle in the Trust during 2008 and therefore this area represented a particular challenge. Members noted that only 39% of patients were receiving dialysis via a fistula at 5 December 2008 against a target of 50% by the end of March. It was reported that vascular access was accessed from Belfast HSC Trust and the target was dependent on their capacity to provide this for Northern Trust patients. Legal advice was being secured about extending the PFI provided renal dialysis service in Antrim from 20 to 40 haemodialysis stations without engaging in a totally new procurement process. Members recognised that a key issue for the Trust related to the targets in Accident and Emergency Services, with 20 patients waiting in excess of the 12-hour target during November % of patients had been seen and discharged from accident and emergency services within four hours during the last month but a target of 95% was to be achieved across all individual sites by March Miss Scott referred to the capacity issues within Antrim Area Hospital and referred specifically to the significant increase in attendances, with 5

6 an estimated 64,000 patients attending a unit originally designed for 30,000 patients and nurse staffing for 52,000 attendances. It was also reported that, in addition to the staffing difficulties which were reported at the previous meeting and which still existed, an early virulent flu virus had affected both patients and staff and this had a knock on effect by reducing the availability of beds in other areas of the hospital. This situation was also being experienced by other hospitals in the province. Miss Scott advised that discussions were ongoing with the Service Delivery Unit and a detailed action plan continued to be implemented. In addition, a Trust group, chaired by the Chief Executive, had been established to review options and closely monitor the situation and this group was currently meeting on a weekly basis. Members again recognised the significant challenges with continuing to provide services on four acute sites in the Trust but it was recognised that no action could be taken to implement the proposals for Whiteabbey and Mid Ulster Hospitals until the CSR consultation process had been completed. Ms Donaghy reported that access targets and waiting times continued to be achieved for elective and day cases with no breaches of the 21- week target being reported during November With regard to the target of 13 weeks at 31 March 2009, there were currently 529 patients waiting longer than this time. There were no breaches of the 13-week target during November for an outpatient appointment and there were 357 patients waiting longer than the new target of 13 weeks by end of March It was also noted that hospital cancellations for non-clinical reasons had increased to 3%, which was above the 2% target, and Mr Sloan clarified that the major reason for this position was the unavailability of beds. Ms Donaghy reported that action plans continued to be implemented to achieve targets by March However, with heavy reliance continuing to be placed on the independent sector and the Trust exceeding activity volumes to achieve the targets, members recognised the financial implications of reaching this position. Again the difficulties of receiving funding on a non-recurrent basis in relation to the recruitment of staff were recognised and the Chief Executive advised that negotiations were still ongoing with the Northern Board to agree the Service and Budget Agreement for the current year which she had not yet signed. Members recognised the significant capacity issues for the Trust and that efforts were being made, involving the Department, the Services 6

7 Delivery Unit and the Northern Board, to address this complex situation. TB162/08 Patient Safety/Governance Issues (a) Approval of Policies Dr Flanagan referred to two papers which had been discussed by the Trust Board on 23 October 2008, and had been further considered by the Governance Committee at a meeting on 24 November He now presented the documents to Trust Board for final approval. Risk Management Strategy This document provided a framework for managing risk within the Trust and considered the strategy and the management systems for the production of the risk register. Dr Flanagan drew members attention to the revised Governance Accountability Framework within this document and highlighted the following points: -It was proposed to change the name of the User Feedback Committee to the User Feedback and Involvement Committee and Dr Ackah, as Chair of the Committee, advised that this title reflected a more proactive stance on user involvement. -The Infection Prevention, Control and Environmental Hygiene Committee would report directly to the Governance Management Board and would prepare an annual report for Trust Board. -An Obstetric Risk Management Team had been established and would report to both the Trust s Risk, Governance and Patient Safety Group and Directorate Governance Management Teams. The Risk Management Strategy and revised Governance Accountability Framework were approved by Trust Board. Incident Management Policy and Procedure This document described the arrangements for recording, reporting and managing incidents, including those deemed to be Serious Adverse Incidents. At Mr Moore s suggestion, it was agreed that the document should make clear that the lessons learned from incidents would not be restricted to the Directorate in which the incident arose but would be applied Trust wide, as appropriate. 7

8 Subject to this addition, Trust Board approval was given for this document to be implemented. (b) Corporate Risk Register Dr Flanagan then presented the Corporate Register of Top Risks at December 2008 which showed those risks with a current risk rating greater than 20. This showed the changes and additions made since October Some concern was expressed that the Risk Register did not adequately reflect the seriousness of some of the issues, and it was agreed that explanatory notes would be included in future reports to ensure that there was a common understanding of the action being taken to reduce risks. Dr Flanagan highlighted the risk relating to the inability to fill 30 medial training posts across the Trust from 1 February 2009 and indicated that the Chief Executive would be bringing this matter to the attention of the Permanent Secretary, Chief Medical Officer and other Chief Executives. It was recognised that this risk required to be addressed on a regional basis and Dr Flanagan indicated that he would be raising this issue with the Chief Medical Officer at a meeting on 19 December TB163/08 Finance (a) Position at 30 November 2008 In presenting the Finance report as at 30 November 2008, the Finance Director reported that the current Trust deficit was now standing at 6.5m and the projected year-end deficit was 9.750m, which was 304,000 higher than the previous month. It was noted that this had been caused primarily by community care costs (domiciliary and residential/nursing), which had increased by 500,000 from the previous month. Mr Guckian advised of the work being undertaken to demonstrate the Trust s activity and costs for both domiciliary and residential care and he stated that the current deficit in this area had been identified at 3m. Referring to the other key corporate deficits, Mr Guckian advised that a number of bids submitted under the Elective Care Reform process were still under review by NHSSB and he was hopeful that these would be supported. Members noted that an exercise was currently underway to assess all costs associated with the C Difficle outbreak and that a locum review group had been established to develop strategies to reduce the 4.88m deficit estimated for medical costs. 8

9 With regard to the deficit in Children s Order costs of 2.3m, it was reported that these were related to the costs of external foster care and taxi costs. In his report, the Director of Finance stated that through lobbying the Commissioners, discussions with DHSSPS and continued implementation of the Trust s Contingency Plan, the Trust could be in a position to achieve breakeven by March However, he said that without external support and with 3-4 months to address a deficit of approximately 10m, it was now unlikely that the Trust would breakeven in 2008/09. Following questions from Directors, Mr Guckian stated that he felt the best case scenario would be a deficit of 4m. Members noted that a strict scrutiny process had recently been introduced to restrict the filling of posts and a central corporate committee had been established and was chaired by the Chief Executive to review requests for filling of vacancies on a weekly basis. It was also confirmed that the Senior Management Team was committed to the process and principles within the Contingency Plan and all efforts would continue to implement the measures required. With regard to the progress report on CSR savings, it was noted that to date 5,190,000 had been achieved against a target of m in year one and it was noted that there were a number of areas where it had not been possible to make the required cost reductions. Progress in payment of Agenda for Change Arrears was noted at the end of November with 7,400 cases processed to date. This meant that in excess of 80% of the current staff had now received payment of arrears. The Chief Executive advised that information was sent to staff at the Department on a monthly basis to keep them advised of the Trust s financial position and meetings would be held on the situation between Department and Trust officers. (b) Recovery Plan With the Northern Trust s recurrent deficit in 2008/09 and recurrent income being insufficient to cover recurrent commitments, the Finance Director advised that this Recovery Plan was designed to restore longterm financial stability to the organisation. He said that, based on the six-month financial position, the amount of the deficit had been identified at 1.9m. However, with the significant problems already identified in the CSR efficiency savings proposals, the plan aimed to achieve 22m, identifying 10m to address Year 2 CSR savings. Members noted from the recovery plan that, although some of the proposals related to good management, without affecting the delivery 9

10 of services, some of the proposals would potentially have a direct impact on patients and clients and affect the achievement of PFA targets. These included such areas as community care services, acute mental health beds and the provision of community equipment. Mr Guckian said that robust accountability arrangements would be necessary to achieve the proposed savings and that monthly meetings with Directors and additional accountability meeting with Directorates would be held. The key risks to the recovery plan were recognised and it was noted that an exercise would be required at the appropriate time to rebase budgets and ensure budget and expenditure were stable again. In this connection, Professor Whittington enquired about recognition of creativity and reward and she was advised that reinvestment would be made for further efficiency programmes where appropriate. A comment was made that the Recovery Plan did not reflect the Trust s under funded position and that demand for Trust services continued to increase each year and Mr Guckian agreed to include a statement on assumptions in the covering letter when action plans were being submitted to the Department. After robust discussion, Trust Board approval was given to the Recovery Plan. However, it was agreed that further consideration would be given to writing to the Northern Board to advise of Trust Board s concern on the inequities for the Northern Trust on the underfunding position. TB164/08 Corporate Parenting Report Mr Houston presented the corporate parenting report for the period 1 April 30 September 2008, which described the activity engaged in by Trust staff in support of children in need and those looked after by the Trust. It was noted that the number of children in need had increased slightly from 2963 at 31 March 2008 to 2971 at the end of September The number of children with a disability had decreased from 624 to 569 and this was due in part to children reaching the age of majority. With regard to the number of unallocated cases being reported as 65 within disability teams and 100 for other children in need, Mr Houston advised the increase in numbers was a result of the DHSSPS introducing new arrangements and definitions for monitoring unallocated cases. An additional social worker had been appointed on a temporary basis to address the number of unallocated cases in disability teams and this issue had been drawn to the attention of the Northern Board. Mr Houston indicated that he continued to report to 10

11 SMT on unallocated cases on a regular basis and he would bring any concerns to the attention of Trust Board if required. A continuation of the steady increase in the number of children on the Trust Child Protection Register since September 2003 was noted, with an increase of 10% over the six month period March September Mr Houston referred to discussion at the previous Trust Board meeting when concerns had been raised about the targets set for reducing the number of children needing to be placed on the Child Protection Register and he re-assured members that the Trust would make sure that social work staff would continue to place the interests of children as the top priority at all times. Although figures indicated a continuing increase in the number of children whose names were on the register for over one year, it remained the case that only approximately one in ten children remained on the register for more than two years. In relation to the 510 looked after children, Mr Houston advised that it had been necessary to have a small number of children placed with an independent provider. Due to the costs associated with some of these placements, alternative options were being explored. On referring to the 42 children who had four or more placement moves, Mr Houston advised that appropriate action was being taken to reduce the number of placement moves experienced by looked after children. On reporting on the progress made by young people leaving care, Mr Houston was pleased to report on some very notable achievements. Trust Board congratulated Mr Houston on his report and agreed that this should be forwarded to the Northern Board. TB165/08 Draft Placement Policy Equality Impact Assessment Ms Donaghy advised that the draft Placement Policy: Nursing Home and Residential Home Accommodation set out the Northern Trust s proposals for the selection and procuring of such residential and nursing home placements in independent sector homes to meet patient/client assessed needs, both for permanent placement, respite care and intermediate/step down care beds. In outlining the present arrangements for funding placements, Ms Donaghy indicated that the revised policy proposed that the Trust would meet the full payment of a placement within a home that met the client s needs when considering the Trust s whole locality rather than the current boundary of a 30 mile radius from a person s residence. This may mean offering a place in a home some distance from the person s current place of residence. 11

12 Members noted that an Equality Impact Assessment had been carried out on the Draft Placement Policy from 1 August 30 September 2008 and from the responses received, they noted that some concern had been raised regarding the distance of the homes in which residents may be placed. During the discussion, which followed, it was intimated that the Northern Trust had a high proportion of homes applying a higher rate per week than the regional tariff and that the Trust had an obligation to make placements within tariff rates, where possible. Reference was also made to the ruling contained in a recent report from the Ombudsman regarding third party contributions. Mrs J Montgomery identified with the concerns, which had been expressed regarding distances, and the difficulties for families required to travel but acknowledged the Trust s corporate responsibility to live within budget and obtain placements within tariff levels. Ms P Montgomery referred to the assessment of potential and actual impacts of the EQIA and highlighted that some of the information for the equality categories was not routinely monitored by the Trust. It was agreed that as much information as possible should be sought to enable the impact of this policy to be monitored. Trust Board gave approval for the placement policy to be implemented for a period of six months, following which it would be reviewed and referred back to the Trust Board for further consideration. TB166/08 Review of Structures Mrs Melaugh advised that, prior to the Northern Trust coming into existence in April 2007, the Chief Executive had given a commitment to a formal review of the directorate structures. To ensure a level of independence in the evaluation process, the Chief Internal Auditor had facilitated an evaluation and a report of his conclusions had been circulated to members. In general the comments received related to the acute sector and the split between the emergency care in patient activity, elective care activity and obstetric and gynae services. The Senior Management Team had concurred that a directorate managing all acute hospital activity was deemed to be the most appropriate model for the future provision of acute services. Mrs Melaugh circulated a paper, which proposed the following structure for operational directorates: Director of Acute Hospital Services Director of Community Health and Social care Director of Children s Services Director of Mental Health and Disability Services 12

13 It was also proposed that: the Director of Children s services would carry the Executive Director of Social Work role; all support services would be managed within the Directorate of Strategic Planning and Performance Management; a decision was required on whether the clinical support services should sit in the Strategic Planning and Performance Directorate. Trust Board approval was given for the Chief Executive and Senior Management Team to proceed with discussions with Staff and Staff Side on the above basis to change structures from 1 April With Mr Houston s imminent departure from the Northern Trust to take up the post of Chief Executive of RQIA, members recognised the importance of appointing a replacement as soon a possible, particularly with the Executive Director Social Work role and the responsibility for discharging statutory social services functions. Approval was therefore given for the recruitment process to commence for the post of Director Children s Services/Executive Director Social Work. TB167/08 Maternity Services Members heard a report of the attendance by Ms Evans, Miss Scott, Dr Flanagan and Mr Houston at a meeting of the Committee for Health, Social Services and Public Safety on 4 December 2008 regarding Maternity services. It was agreed that a copy of the official report (Hansard) would be forwarded to members for information. Ms Evans advised that the Committee had requested a commitment from the Trust to receive regular updates on progress on the implementation of the recommendations from the maternity services review. It had been agreed with Ms M O Neill, Deputy Chair, that a progress report would be forwarded at the end of February Mr Stewart acknowledged the important contribution Ms Evans had made to the radio interview with the BBC Good evening Extra programme following her attendance at the Health Committee meeting. TB168/08 Communications The communications report, which provided an update on media, public affairs and event activity was noted by members. TB169/08 Public Questions Miss Trimble referred to the placement policy, which had been approved for implementation and highlighted the implications of the 13

14 proposal to replace five residential homes under the modernisation programme. In response to a comment supporting pre operative assessment for elective surgery, Mr Sloan advised that a project had commenced in the Trust to examine this matter. Mr Archer thanked the Chairman for inviting him to the meeting and advised that some of the issues, which had been discussed, such as the CSR proposals and PfA targets, were presenting challenges for the Ambulance Trust. TB170/08 Date of next meeting It was noted that next meeting would be held at 2.00pm on Thursday 22 January 2009 at Trust Headquarters. TB171/08 Resolution for Closed session There was resolution for the Chairman, Non Executive Directors, Chief Executive and Director of Human Resources to go into confidential session to consider remuneration issues. 14

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