THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST. Minutes of the Board of Directors Meeting held on 23 rd February Part A: Public Session

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1 Agenda Item: A3 THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST Minutes of the Board of Directors Meeting held on 23 rd February 2017 Part A: Public Session Present: Mr K W Smith (Chair) Chairman Mrs A Dragone Finance Director Mrs H Lamont Nursing and Patient Services Director Mrs L Robson Business and Development Director Mr A Welch Medical Director Mr J Jowett Non-Executive Director Professor K McCourt Non-Executive Director Mr E Weir Non-Executive Director In Attendance: Ms K Douglas, Trust Secretary Mrs O Brien, Director of Quality and Effectiveness 17/19 Apologies for Absence Apologies were received from, Professor C Day, Non-Executive Director, Mrs H A Parker, Non-Executive Director, Mr D Stout (Vice-Chair), Non-Executive Director, and Dr P Kesteven, Non-Executive Director, 17/20 Declarations of Interest Mr Weir declared an interest in any matters pertaining to Newcastle City Council. 17/21 Minutes of the Meeting held on 26 th January 2017 These were agreed to be a correct record. 17/22 Strategic Issues i) Report of the Chief Executive Mr Welch and Mrs Robson spoke of a number of topics of current interest. Mr Welch referred to the visit undertaken last week by Dr Kathy McLean (Executive Medical Director, NHS Improvement) in which Dr McLean praised the organisation and requested that NuTH was highlighted as an exemplar in a number of areas in order to support other Trusts experiencing challenges. Scoping of the potential colocation of Paediatric Cardiac Surgery with Children s Services at the Great North Childrens Hospital (GNCH) had commenced and three options had been explored to date. A more detailed report would be provided at the March meeting of the Board of Directors. Reference was made to Great Ormond Street whereby adult congenital heart patients are not co-located. 1

2 Professor McCourt queried what evidence was available to demonstrate colocation resulted in better outcomes. Mr Welch explained that evidence was available to support colocation for Paediatrics but the evidence was not significant. He added that for NuTH it would be more beneficial as it would assist in the recruitment and retention of staff. Mr Welch outlined that consideration was being given to the Intensive Care Unit (ICU)/Burns Unit re-alignment at the Royal Victoria Infirmary (RVI). The current Burns Unit was due a capital refurbishment for 1.5m to make improvements. In addition Inspectors had criticised the footprint in this area. Mrs Lamont advised that there was some urgency required with the refurbishment as the work could only be performed in the Summer period and therefore would need to be procured imminently. Engagement and collaboration with neighbouring Trusts was discussed in order to facilitate improvement and rationalisation of appropriate patient pathways. Northumbria Healthcare NHS Foundation Trust was keen to work together. Reference was made to the recent IT system failure experienced by Northumbria FT whereby NuTH assisted in taking patients from Cramlington Specialist Emergency Hospital. Mr Jowett queried the NuTH contingency planning arrangements to which Mr Welch agreed to obtain the detailed information from the Trust s Business Continuity Manager and feedback accordingly (ACTION01). Mr Smith advised that he had been contacted by the Chairman from Northumbria Healthcare NHS Foundation Trust and had therefore met with him in person. Mr Smith advised that the recent press speculation regarding a proposed takeover from Northumbria Healthcare NHS Foundation Trust was completely unfounded. Mr Jim Mackey s two year secondment was scheduled to end in November and the Northumbria Medical Director was due to retire in November with the expectation of Mr Mackey returning back to Northumbria Foundation Trust. Both agreed the importance of working together to remove duplications and improve pathways. In terms of arrangements with Gateshead Health NHS Foundation Trust Mrs Robson stated that NuTH was working on strategic service collaborations in a number of areas, hyperacute stroke services had successfully transferred to the Royal Victoria Infirmary. Work was continuing with City Hospitals Sunderland NHS Foundation Trust and County Durham and Darlington NHS Foundation Trust regarding Hepatology Services and further requests for support. Mr Welch expressed his concern regarding the increasing number of spinal infections faced by the Trust and referred to Executive Team agreement made to upgrade the Spinal Surgery Unit on Ward 42, RVI as soon as possible. Mr Welch referred to the high profile Sign up to Safety work stream progress and in particular the ongoing work on catching deteriorating patients early to aid 2

3 recovery. A Business Case will be implemented fully this year regarding use of clinical alert charts and electronic whiteboards. A pilot whiteboard had been set up in Ward 5 which provided real time data and provided more visual awareness of patient allergies. All agreed that a whiteboard demonstration be provided at the March Board of Directors meeting (ACTION02). Reference was made to the Medication Incident Reporting Tool developed by Mr Neil Watson and the Surgical Safety work performed by Dr Karen Beacham on WHO checklists. Good progress had been made in improving the patient consent process, Sepsis compliance, neonatal transport and foetal monitoring. Mr Welch confirmed that the Trust was part of a 7 Day Services pilot covering four of the priority standards. Four areas of improvement were identified including imaging, particularly at weekends; and shortage of radiologists. Mr Weir queried whether the 7 day services work was part of a whole care review system such as the Better Care Fund to which Mrs Robson agreed that in her view seven day priorities should be part of Better Care Fund and further consideration was required in conjunction with the local authority (ACTION03). Mr Welch confirmed that discussions had commenced regarding the Transplant Unit efficiency given the significant footprint of the unit. Mr Welch highlighted the challenges in addressing winter pressures and commended the work of the Trust Patient Services Co-ordinators and all staff; particularly in ensure quality of service was not compromised. Mrs Lamont advised that the safety culture survey results were very positive. Mr Jowett queried when the Trust would be subject to its next CQC inspection to which Mrs O Brien stated that Outstanding Trusts are inspected every 5 years and in addition some Trusts were targeted under the well-led framework. Mrs Lamont referred to the current well-led framework consultation and explained that the CQC may undertake more ad hoc themed visits. Mrs O Brien outlined that from April a more formal Peer Review Programme for Directorates was scheduled which followed a similar process to the CQC inspection process. This process started in Mrs Lamont referred to the recent staff engagement events, including one event which was dedicated to building on one year on from the CQC inspection. Positive feedback was received which demonstrated good progress had been made in a number of areas. Mrs Robson advised that the Trust was involved in work to support a re-licensing process for the Academic Health Science Network. The getting it right first time programme (GIRFT), designed to reduce unwarranted variation in the NHS was discussed. Mr Welch confirmed that such unwarranted variation could relate to practices, length of stay and process variation. 3

4 Mr Weir queried the impact of Brexit on the workforce to which Mrs Lamont confirmed that for nursing staff, recruitment efforts were focussed outside of the EU and historically European nursing staff did not stay employed within local Trusts for long periods of time. A reduction in the number of applicants for the Nursing Degree Programme at local Universities was evident. Mrs Lamont advised that the Trust we value diversity posters had been updated following the Brexit announcement. to receive the briefing and note the current position. ii) Congenital Heart Disease (CHD) Consultation Mrs Robson presented the report and explained that on 9th February 2017, NHS England (NHSE) launched a 4-month public consultation on the review s proposals. Public engagement events were scheduled for each area of the country and there was a need for NuTH to work together with NHSE to ensure that clinical representation was present at the events to facilitate better understanding of the matters. Directors were reminded that the review proposed the closure of CHD units in Leicester and the Royal Brompton, as well as adult services in Manchester. Mrs Robson explained that NuTH had been recommended to remain as a Level 1 unit, despite the challenges in meeting the standards relating to the number of surgeries (375 by April 2017) and co-location with key paediatric specialties. This recommendation was due to NuTH s key role in providing services for advanced heart failure, particularly transplantation and VAD. Mrs Robson advised that the Trust was continuing to explore the best solution regarding co-location. The Newcastle public engagement consultation event was scheduled for 11 th May and the Trust is working in tandem with the Local Authority to coordinate the event. NHSE are also scheduled to present at the North East Joint Scrutiny meeting next week, which the Trust will attend. A further discussion will be held at the next Wellbeing for Life Board and Health Scrutiny meetings in the City. to receive the briefing. 17/23 Safety, Quality and Performance i) Integrated Quality Report The report was presented by Mrs Lamont and Mrs Moon. Mrs Lamont presented the January HCAI 2017 position. No further MRSA cases had been attributed to the Trust in January, meaning that the year-to-date total had remained at five cases. 4

5 There were four C. difficile cases, giving a total of 68 cases. Of these, sixteen were successfully appealed reducing the total to 52 cases against a target of 64 or fewer for the year to date. In January there were eight MSSA bacteraemia attributed to the Trust bringing the year-to-date total to 80. As reported previously, reducing MSSA bacteraemia incidence in the Trust was a top priority for the Infection Prevention and Control (IPC) Team and significant effort had been focussed on the Root Cause Analysis process In January there were 16 E.coli bacteraemia attributed to the Trust, bringing the year-to-date total to 171. Work in this area was still under review. There were 2 outbreaks of diarrhoea and vomiting and two outbreaks of Influenza A on wards in January. Mrs Lamont advised that January 2017 saw a reduction in the total number of falls and falls/1000 bed days compared to December The reduction in falls was most significant in the Neurosciences and Medicine and Care of the Elderly directorates, both of which have very high risk patients but have been working closely with the Falls Prevention Coordinator to embed the Falls Care Bundle and the No Falls On My Patch strategy. It was anticipated that the year-end position would demonstrate a 5% overall reduction in the number of falls. The number of pressure ulcers had increased since the previous month but was lower than January Directorate-based task forces had been established, with the specific aim to find local solutions to local problems for the prevention of pressure ulcers. January was the month for pressure ulcers in the Year of Harm Free Care which has seen a number of well-attended open sessions taking place. At the end of January, learning from the Root Cause Analysis was presented at the Safety Briefing. Mrs Lamont advised that the corporate task force was preparing the Action Plan for in order to demonstrate renewed commitment to build on the successes and learn from the challenges of the last twelve months. An increase in the Band 5 vacancy factor was noted for December, which was expected based on seasonal trends. Mrs Lamont highlighted that it was expected that the Band 5 vacancy factor will continue to increase in the coming months as many active vacancies have been allocated to March qualifying new registrants. A dedicated Peri-operative staffing recruitment event was held in March. Mrs Lamont advised that overall CAT scores had increased slightly but continued to 96% in January, with staff knowledge scores at 92.28%. A peer review exercise was undertaken in August, October and December to provide additional assurance over the process. In relation to Harm Free Care, the Trust continued to exceed the 95% target. All four sites demonstrated an increase in care hours, despite the reduction in fill rates. Mrs Lamont explained that this was likely to be linked to bed closures due to 5

6 infection outbreaks, although this cannot be confirmed because the data was not collected in real time. Mrs O Brien reported that there were eight Serious Incidents and none of which were Never Events. The Incidents related to two falls causing fractured femurs, three pressure ulcers graded as a 3, one data loss due to hacking of a 3rd party resulting in a potential risk of identity theft, one delay to treatment and one neonatal death whereby foetal monitoring had not repeated and the investigation highlighted that actions could have been performed differently. Incident reporting continued to rise which was deemed to be a positive reflection of the Trusts the patient safety culture. The Trust-wide patient safety culture survey identified a 12% increase in the number of respondents who believed positive management action had been taken and fewer staff believed that any mistakes would be held against them. Mrs O Brien explained that representatives from the Newcastle-Gateshead CCG undertook an unannounced visit on Monday to some of the Trust theatres regarding concerns about the Trusts increase in the number of Never Events reported. Mrs Lamont reported that informal positive feedback had been received which referred to visible leadership and good use of checklists. Mrs O Brien added that it was clear that staff understood their roles and responsibilities. The formal report was awaited. Mrs Lamont highlighted that the Trust had consistently good recommendation rates from the Friends and Family Test, although the number of responses had reduced in December. Feedback from the Picker Institute was good and the receipt of real time comments facilitated more timely action being taken. The number of complaints was reducing year on year, although some of which were of a more challenging nature. Professor McCourt commended the complaints staff for their work in this area. Mrs O Brien explained that mortality levels had increased as expected during the winter period and the SHMI was stable. HSMR was increasing but was still within the expected range. The coding mechanism in palliative care had been reviewed and updated. Mr Welch had chaired the first Mortality Group and in April new mortality reporting requirements would commence in accordance with recently issued guidance. Ms Douglas queried the requirement for a Non-Executive lead to be identified to which Mrs O Brien confirmed that Professor McCourt had agreed to be the lead Non-Executive Director. Professor McCourt referred to the data presented regarding medication reporting and highlighted that staff were still concerned about reporting incidents. 6

7 Mr Welch advised that historically the Trust used to send a letter to staff stating that reporting of medication incidents could result in action under the Trust disciplinary process however a decision had been taken to remove that letter. A discussion ensued relating to bank staff and how the Trust could identify if a member of bank staff was the subject of regular medication incidents. It was agreed that Mrs Lamont meet with Mrs O Brien to discuss further (ACTION04). to receive the briefing and note the current position. ii) Business Delivery and Performance Report Mrs Robson presented the report and explained that the Trust had achieved the 18 week referral to treatment (RTT) target Trust-wide despite significant whole system pressures. Nationally, RTT performance was at its worst level since March NuTH was the second best performer within the Shelford Group this month. The Trust met the 6 week diagnostic standard in January 2017 however pressure from elective care was evident and it was expected that the performance level may stabilise in May/June. The Trust met all but one of the Cancer standards in December Performance in this area was particularly strong although the Trust had identified further improvements were required regarding bowel cancer screening. Although patient choice was a factor, analysis had identified a number of areas for improvement which were being addressed with the relevant tumour site team. Mrs Robson explained that the Corporate Cancer Team continued to work with all tumour groups to establish robust processes to support the new breach reallocation guidance. As the national IT system would not be available until April, providers have been required to work together to implement local solutions for reporting; this is proving challenging. Whilst applying the breach re-allocation methodology in December the results showed a deterioration of the 62 day standard at a Trust level and, in some tumour groups, there was a significant shift in compliance. Reference was made to the Trust agreed control total and therefore there was potential for the Trust to bid for and receive Sustainability & Transformation Funding (STF). Mrs Robson explained that the Trust failed to meet the A&E 4hr target in January 2017 at 91.0% which was the lowest performance this fiscal year. Unfortunately, the A&E performance for Type 1 (main RVI ED) missed meeting the standard at 85.8% for the 6th consecutive month. The department cited beds waits, patient flow issues as well as significant Delays to Be Seen (DTBS) as the main breach reasons. This was being further exacerbated by significant medical staffing pressures, particularly the junior and middle grade gaps in the Emergency Department rota. Significant press coverage was evident nationally on Emergency Department performance. 7

8 The year to date A&E performance (all types) was currently at 94.6% which was a remarkable achievement given the national position. A national 90 day improvement programme has been established with the aim of improving compliance against the A&E target. Mrs Robson advised that NHS Improvement and NHS England had asked the Trust to commit to delivering a 96% performance level in March however added that the Trust could not agree such a target given the significant pressures that the Department was facing. The Trust reported 37 ambulance handover delays in January 2017 which was the highest number reported since April However, all but one delay was due to the administrative process of handing over the patient on the IT system with the other due to competing pressures. The Trust reported a reduction in delayed bed days to 1,060 in December However, the number of patients awaiting assessment significantly increased in December although may be due to the Christmas holiday period. Repatriation to other hospitals was still a major cause for concern as well as the evident social care pressures. Mr Smith commended staff for the positive performance levels outlined in the report. to note the content of the report. iii) Patient Experience Update Report Mrs Lamont presented the report and highlighted that the results had been received for a number of the National Patient Survey 2016 areas. Preliminary results demonstrated a good response rate and positive feedback. Initial results from the Picker Institute for the Inpatients 2016 showed that 90.5% of patients rated their care as 7 out of 10 or above. Mrs Lamont confirmed that a more detailed report would be presented at a future meeting. With regard to the Children and Young People survey Mrs Lamont advised that the fieldwork for this survey was delayed due to Trusts having to resubmit their samples. The Disabled Go Project, previously described to the Board, was due to complete with a launch of the accessibility guides for disabled visitors and patients on 8 th March Reference was made to the pilot providing 24/7 video remote British Sign Language interpreting is due to launch in February 2017 with the delivery of the required hardware to the Trust. This project will allow staff to communicate 8

9 immediately (or within 30 minutes out of hours) with deaf patients or carers via a BSL interpreter when a face to face interpreter is not available. Mrs Lamont highlighted that The Changing Times, Challenging Times event scheduled for 24 th May 2017 was being developed by the Trust s Equality and Diversity Lead in partnership with stakeholder organisations. The event would focus on how services, commissioning and workforce changes can be made to ensure inclusivity and accessibility for trans people. Mrs Lamont advised that there were a number of changes to staffing within Patient Relations which may have impacted on turnaround times for complaints. 17/24 Finance to receive the briefing and support the work outlined in the report. i) 2016/17 Month 10 Finance Report Mrs Dragone presented the position as at 31 st January At Month 10 the Trust was still tracking the planned position with an actual surplus of 9.9m (before impairment). As reported previously the Trust had received a revised Control Total for 2016/17 and was now forecasting delivery of a 7.5 million surplus, subject to the removal of fines and penalties for Q3 and Q4. Negotiations were still under way regarding whether the Trust would receive any Sustainability and Transformation Funding prior to the financial year end. In addition the Trust was still awaiting receipt of the anticipated PDC for the capital investment relating to the two Linacs. Cash holdings stood at a healthy million, some 12.9 million higher than plan, mainly due to slippage on the capital programme Capital expenditure was 800 thousand higher than plan, at 24.4 million, as a consequence of the deed of variation to the PFI contract taking effect, which had resulted in the addition of phase 9 with a value of 11.4 million. Accounting for this non-cash addition the true under spend on the capital programme was 10.6 million. Under spends had materialised on Estates planned maintenance and new and replacement equipment budgets. Mrs Dragone explained that the Trusts overall Risk Rating was 1 on a scale from 1 to 4, lower numbers reflecting lower risk. The Trust was forecasting a risk rating of 2 at the financial year end to which Mrs Dragone advised that further discussion was required with Mr Tim Rideout (ACTION05). Mrs Dragone highlighted that the Trust was expecting to deliver 30.6 million of savings in 2016/17, 2.7 million less than target with a projected 4.2 million recurrent shortfall. As at 31 st January million of planned savings had been recognised, equating to 10/12ths of 30.0 million. Mrs Dragone referred again to the reliance on non-recurrent income in achieving the CIP level. 9

10 17/25 Items to Receive to receive the report and acknowledge the overall financial position for the period to 31st January i) Managing Conflicts of Interest in the NHS Ms Douglas explained that the guidance had been recently issued and agreed to review the Trusts process in light of the publication (ACTION06). to receive the publication. The meeting closed at 2.10pm. The next scheduled meeting would be held at 12-45pm on Thursday, 23 rd March