X For Information Decision Other

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1 CHAIRMAN S SUMMARY REPORT Name of Committee/Group: Trust Management Committee Report From: Chief Executive Date: 27 November 2015 Action Required by receiving committee/group: X For Information Decision Other Aims of Committee: To oversee and co-ordinate the Trust operations on a Trustwide basis To direct and influence the Trust service strategies and other key service improvement strategies which impact on these, in accordance with the Trust overall vision, values and business strategy. Drivers: Are there any links with Care Quality Commission/Health & Safety/NHSLA/Trust Policy/Patient Experience etc. The matters highlighted below are not driven directly by the CQC, NHS Improvement, or any other outside body, but are driven by the need and desire to enhance patient experience, ensure patient safety, maximise operational efficiency and effectiveness, improve the quality of services, and safeguard the financial position of the Trust. Main Discussion/Action Points: Received and approved the business case for the use of new anticoagulants (NOACs) in patients with atrial fibrillation, deep vein thrombosis and pulmonary embolism Considered and approved the business case for the expansion of the heart failure in-reach service currently offered to patients with LV SD heart failure within the hospital, in order in future to include all patients, in line with NICE Guidance and the new best practice tariff for heart failure 2015/16. Approved a business case for the use of Jaydess Intra- Uterine System and its addition to the Wolverhampton Formulary for use within the Sexual Health Service. Received and approved the business case for the use of the Sayana-Press Contraceptive Injection, as a more reliable form of contraception for approximately 10% of the current cohort using Depo Provera. Agreed that the business case for the use of Dolutegravir / Triumeq be approved for the treatment of HIV, and added to the Wolverhampton Formulary for use within Sexual Health services. Discussed and approved the business case for NICE Technology Appraisal TA333 Axitinib. ADS/RWT Trust Management Committee Page 1 of 2

2 Approved the business case for NICE Technology Appraisal TA326 Imatinib for the adjuvant treatment of gastrointestinal stromal tumours. Approved the business case for the provision of Canagliflozin and Empagliflozin drugs in type 2 diabetes. Endorsed the business case for the provision of Tobi Podhaler, Colobreathe and Caysten drugs For cystic fibrosis patients. Approved the business case for relocation of portering services into the former pharmacy area in order to facilitate the construction of a new adult Cystic Fibrosis facility at the rear of the current Respiratory Centre Supported the Research and Development Business Case for a new model for the distribution of commercial research income, which would provide a framework for supporting research activity and enable the reinvestment of R and D income into enhancing research delivery. Approved the business case for additional revenue funding to support the increased levels of activity in the new UECC, provided the cost is funded by the WCCG. Risks Identified: Include Risk Grade (categorisation matrix/datix number) The Trust Management Committee has had regard to any risks identified in respect of these matters. The TMC also has a standing item on every agenda, at which point anybody present may raise any matter which is deemed to be worthy of consideration for inclusion on a risk register. ADS/RWT Trust Management Committee Page 2 of 2

3 The Royal Wolverhampton NHS Trust TRUST MANAGEMENT COMMITTEE Minutes of the meeting of the Trust Management Committee held at 1.30pm on Friday 27 November 2015 in the Boardroom, Clinical Skills and Corporate Services Centre, New Cross Hospital, Wolverhampton Present: Mr D Loughton CBE Chief Executive (Chair) Mr I Badger Divisional Medical Director, D1 Ms R Baker Head Nurse, Division 2 Dr M Cooper Head of Infection Prevention Prof J Cotton Head of Research and Development Dr L Dowson Divisional Medical Director, D2 Ms C Etches Chief Nursing Officer (part) Mr M Goodwin Head of Estates Development Dr C Higgins Divisional Medical Director, D1 Mr S Mahmud Programme Integration Director (pt) Ms G Nuttall Chief Operating Officer Dr J Odum Medical Director Ms T Palmer Head of Midwifery Mr T Powell Deputy COO, Division 2 Ms S Roberts Acting Divisional Manager, Estates and Facilities Dr S Smith Divisional Medical Director, D2 Mr K Stringer Chief Financial Officer In Attendance: Ms C Griffiths Mr A Sargent Deputy Director of HR Trust Board Secretary Apologies: Mr L Grant Ms C Hobbs Ms L Holland Dr D Rowlands Dr B S Singh Deputy Chief Operating Officer, D1 Head Nurse, D1 Interim Director of HR Lead Cancer Clinician Lead IT Clinician DECLARATIONS OF INTEREST No interests were declared at this meeting. 15/302: MINUTES OF THE MEETING OF THE TRUST MANAGEMENT COMMITTEE HELD ON 23 OCTOBER IT WAS AGREED: that the minutes of the meeting of the Trust Management Committee held on Friday 23 October 2015 be approved as a correct record, subject to the name of Dr Morrell on page 3 being amended to read Dr M S Norrell. 15/303: MATTERS ARISING FROM THE MINUTES 1

4 There were no matters arising from the minutes of the previous meeting. 15/304: ACTION POINTS LIST It was noted that the matters relating to winter pressures and capacity in Cardiology were ongoing. IT WAS AGREED: That the Action Points list be noted. 15/305: VERTICAL INTEGRATION Mr Mahmud gave a presentation on vertical integration (VI), using a series of PowerPoint slides. He outlined the background to the initiative, which was an unprecedented national financial gap ( 30bn required by 2020/21, 8bn committed by the Government - 3.8bn frontloaded next year and 22bn still to be found). He mentioned also the Care and Quality Gap and the Funding Gap (particularly in Primary Care). After summarising the five Vanguard models of Care, he described the options which were open to acute trusts, namely hospitals as islands, hospitals as part of integrated care systems, and (the preferred approach) hospitals in population health systems. Turning to vertical integration, Mr Mahmud listed some of the main features and benefits: Integrated Primary, Secondary and Community Care GPs and primary care staff employed by the Trust Unified approach to ALL care management Information Continuity Easy Access to appropriate care- point of need Moving towards an Accountable Care Model He showed the amount spent by two Wolverhampton GP practices in buying services from RWT. Finally, he indicated the next steps required to enable a pilot to go live from 1 April During the ensuing discussion, a number of issues were raised, and information requested. Mr Loughton indicated that from the information available it appeared that a relatively small number of patients of the practices mentioned were consuming a disproportionate amount of services provided by RWT. If they could be identified and their needs reviewed, one benefit of vertical integration would be to review and revise their care pathways in order to keep them in primary care for more of the time. Dr Odum added that the GPs with whom the Trust had engaged on VI were enthusiastic about the opportunity of more accurate tailoring of care pathways. Mr Loughton acknowledged that some of the patients who made high use of our services might have mental health issues and for that reason it would be essential to engage mental health and community services. Without them, seven day care would be impossible to deliver. In response to Professor Cotton, Mr Mahmud said that 9 pilot sites in the UK were already developing metrics by which to evaluate success, and clear criteria for evaluating the VI pilot would be produced and communicated in the Trust. Dr Dowson said that chronic care management was not a new idea, but although it seemed to be widely supported, it was difficult to make it work. His experience was that every 2

5 intervention in a patient s healthcare tended to lead to an increasing number of hospital admissions. He pointed out that a patient with COPD who was breathless, in pain and frightened in the night was likely to attend hospital. Mr Loughton answered that now there were different drivers at work in the health economies and that when all agencies were within one organisation there was a better chance of making it work. Dr Odum accepted that unless patients were managed in a better way this approach would not work, and Mr Loughton asked whether one yardstick of improvement might be that Dr Dowson s hypothetical COPD patient would have his/her hospital admissions reduced by a half. Dr Odum said that there was evidence in kidney management that good case management had cut hospital admissions. Mr Badger added that specialties other than that represented by Dr Dowson might also see this proposal in a more positive light, and he welcomed in particular the prospect of better working relationships with GPs. Mr Loughton stressed that the GPs involved in the pilot were supportive and enthusiastic. IT WAS AGREED: That the proposed pilot Vertical Integration project be supported. 15/306: GOVERNANCE REPORT - DIVISION 1 Mr Badger introduced this item and highlighted that there had been no new red complaints and one open red risk for the Division, along with 8 open high amber risks which remained under review. He highlighted also the claim against Trauma and Orthopaedics which had led to a high pay-out, and had been raised across Directorates in order to learn from it. IT WAS AGREED: that the monthly Governance report for Division 1 be noted. 15/307: NURSING, MIDWIFERY AND QUALITY REPORT - DIVISION 1 Mr Badger presented this report on behalf of Division 1. IT WAS AGREED: That the report on Nursing, Midwifery and Quality in Division 1 be noted. 15/308: NOACS BUSINESS CASE Mr Badger presented the business case for the use of new anticoagulants (NOACs) for use in patients with atrial fibrillation, deep vein thrombosis and pulmonary embolism. IT WAS AGREED: that the business case for the use of new anticoagulants (NOACs) for use in patients with atrial fibrillation, deep vein thrombosis and pulmonary embolism be approved, subject to the approval of the commissioner also being obtained. 15/309: HEART FAILURE IN-REACH BUSINESS CASE Mr Badger presented this business case. IT WAS AGREED: That the business case for the expansion of the heart failure in-reach service currently offered to patients with LV SD heart failure within the hospital in order in future to include all patients, be approved in line with NICE Guidance and the new best practice tariff for heart failure 2015/16. 15/310: NURSING AND QUALITY REPORT - DIVISION 2 Ms Baker summarised the monthly nursing and quality report from Division 2. It was noted that there had been 40 reported breaches in agreed staffing numbers during October across the Division, and WTE qualified vacancies. Staffing remained a major concern and was reflected in the Governance report, with the number of nursing vacancies having been 3

6 escalated to the Trust Risk Register as a red risk. Ms Etches indicated that although nurses were being recruited from the Philippines, they would have to show that they held the IL7 in order to gain NMC registration. It was suggested that somebody be employed in the Philippines to help would-be recruits to obtain their IL7. AGREED: That the monthly Nursing and Quality report for Division 2 be noted. 15/311: GOVERNANCE REPORT - DIVISION 2 Ms Baker presented the monthly governance report from Division 2. She indicated that there were no new red complaints opened during the period, there was one red risk, and there were 6 existing high-level amber risks, with 3 risks awaiting approval for inclusion on the Trust Risk Register. IT WAS AGREED: That the Governance report for Division 2 be noted. 15/312: SAYANA-PRESS CONTRACEPTIVE INJECTION Mr Powell submitted the business case for the use of the Sayana-Press Contraceptive Injection, as a more reliable form of contraception for approximately 10% of the current cohort using Depo Provera. IT WAS AGREED: That the business case for the use of the Sayana-Press Contraceptive Injection be approved. 15/313: JAYDESS INTRA-UTERINE SYSTEM Mr Powell presented the business case for the use of Jaydess Intra-Uterine System IT WAS AGREED: That the business case for the use of Jaydess Intra-Uterine System be approved and added to the Wolverhampton Formulary for use within the Sexual Health Service. 15/314: BUSINESS CASE FOR DOLUTEGRAVIR / TRIUMEQ Mr Powell introduced the business case for the use of Dolutegravir / Triumeq. IT WAS AGREED: That the business case for the use of Dolutegravir / Triumeq be approved for the treatment of HIV, and added to the Wolverhampton Formulary for use within Sexual Health Services. 15/315: NICE TECHNOLOGY APPRAISAL TA333 AXITINIB Mr Powell submitted a business case for NICE Technology Appraisal TA333 Axitinib for treating patients with advanced renal cell carcinoma after failure of treatment with a first line kinase inhibitor or cykotine. IT WAS AGREED: That the business case for NICE Technology Appraisal TA333 Axitinib be approved. 15/316: NICE TECHNOLOGY APPRAISAL TA326 IMATINIB FOR THE ADJUVANT TREATMENT OF GASTROINTESTINAL STROMAL TUMOURS Mr Powell introduced this business case for the use of a new drug in Oncology and Clinical Haematology. 4

7 IT WAS AGREED: That the business case for NICE Technology Appraisal TA326 Imatinib for the adjuvant treatment of gastrointestinal stromal tumours be approved. 15/317: BUSINESS CASE FOR THE PROVISION OF CANAGLIFLOZIN AND EMPAGLIFLOZIN DRUGS IN DIABETES Mr Powell requested the Committee to approve the business case for the provision of Canagliflozin And Empagliflozin drugs In type 2 diabetic patients. This is a new class of oral anti-diabetic drug which reduces blood glucose by an insulin independent mechanism. IT WAS AGREED: That the business case for the provision of Canagliflozin and Empagliflozin drugs In type 2 diabetes be approved. 15/318: PROVISION OF TOBI PODHALER, COLOBREATHE AND CAYSTEN DRUGS FOR CYSTIC FIBROSIS PATIENTS Mr Powell presented a business case for the Provision Of Tobi Podhaler, Colobreathe And Caysten Drugs For Cystic Fibrosis Patients. IT WAS AGREED: That the business case for the Provision Of Tobi Podhaler, Colobreathe And Caysten Drugs For Cystic Fibrosis Patients be approved. 15/319: REVISED FINANCES FOR URGENT AND EMERGENCY CARE BUSINESS CASE Mr Powell introduced this report. The assumptions in the original business case had been overtaken by higher than expected levels of demand, and also the award of the Urgent Care contract to Northern Docs had had a negative impact on Trust finances. IT WAS AGREED: That the Business Case for revised finances for Urgent And Emergency Care be approved, subject to the amount needed being fully refunded by the WCCG. 15/320: EXECUTIVE HR REPORT The Committee noted the update on the Trust headcount, sickness absence, local and bank costs, agency spend, overseas recruitment, local recruitment, and medical recruitment. Ms Griffiths reported that HR were checking the alignment of policies around sickness absence, and would promote a greater focus on discussing with staff their individual patterns of sickness absence. For this to happen, work on the IT platform was needed. She also highlighted that the Workplace Wellbeing Charter had now been signed, and the response rate to the NHS National Staff survey had been 24%. Other methods of staff engagement were therefore under consideration. In response to Mr Loughton s question, Dr Cooper said that 46.4% of staff had now received their flu innoculation (43.4% this time in 2014). Ms Griffiths was asked to look into the possibility of issuing more reminders to staff about taking advantage of the innoculation available. Dr Dowson alerted the meeting to the looming 20% junior doctor vacancy rate from next April. Despite a rolling programme of adverts to recruit, progress was slow. The Trust must, he said, do more to emphasise what it could offer to trust fellows by comparison with other trusts. Ms Etches asked whether all new joiners were automatically placed on the bank. Ms Griffiths agreed to find out (CG). 5

8 IT WAS AGREED: That the Executive Summary HR report be noted. 15/321: INTEGRATED QUALITY AND PERFORMANCE REPORT Ms Nuttall reported that in October we had had the worst ED performance ever, reflecting the national picture. Highlights for the month included: Winter Plan revised TDA template now received, and the submission to the TDA would be circulated for information Cancelled operations: performance satisfactory in October, but deteriorated in November Cancer 62 day waiting time: national recovery plan in place Head and Neck Cancer: more resources needed to meet demand for referrals and operations Obstetrics and Gynaecology: still in breach (slightly) Ms Etches commented on the increased number of falls shown on the safety thermometer. There had been no breaches in October for the duty of candour. The public would be able to input via the website their own details for the FFT. The Complaints Policy was due for review shortly. She indicated that today s meeting of the Infection Prevention Group had spent much time discussing C.Difficile in the Trust. IT WAS AGREED: That the monthly Integrated Quality and Performance report be noted. 15/322: MAJOR INCIDENT PLAN Ms Nuttall presented the revised Trust Major incident Plan, which would be considered also by the Board on 30 November. IT WAS AGREED: That the revised Trust Major Incident Plan be approved. 15/323: FINANCE REPORT FOR M7 (OCTOBER 2015) Mr Stringer reported that at the end of Month 7 the Trust s deficit was 5,141,000 which was adverse to the month 7 plan by 228,000. Income for M7 stood at 292,000,000, below plan by 1,800,000. He summarised the elements of this week s Chancellor s Statement insofar as it related to the NHS and social care. IT WAS AGREED: That the report on the Trust s financial position at the end of M7 (October 2015) be noted. 15/324: CAPITAL PROGRAMME 2015/16 M7 UPDATE Mr Goodwin reported that the total spend for the Trust as at month 7 stood at 24,173,181, against a predicted spend of 30,538,000. IT WAS AGREED: That the M7 update report on the capital programme 2015/16 be noted. 15/325: RELOCATION OF PORTERING SERVICES INTO FORMER PHARMACY AREA BUSINESS CASE Mr Goodwin outlined this business case. 6

9 IT WAS AGREED: That the business case for relocation of Portering services into the former pharmacy area be approved, in order to facilitate the construction of a new adult Cystic Fibrosis facility at the rear of the current Respiratory Centre. 15/326: URGENT CARE AND EMERGENCY CENTRE Dr Odum updated the meeting on the opening of the new Centre and the closure of the old Emergency Department on 25 November, all of which had gone smoothly. There had been no clinical incidents during the day, but there had been enormous pressure from the moment it opened, with a total of 150 ambulance arrivals during the first day of operation. The AMU would move to the top floor of the UECC on 28 November. IT WAS AGREED: That the oral report be noted. 15/327: EDUCATION The Committee noted the quarterly report on Education at the Trust. IT WAS AGREED: That the quarterly report on Education be noted. 15/328: RESEARCH AND DEVELOPMENT BUSINESS CASE Professor Cotton presented a business case for a new model for the distribution of commercial research income, which would provide a framework for supporting research activity and enable the reinvestment of R and D income into enhancing research delivery. IT WAS AGREED: that the Research and Development Business Case be approved. 15/329: RED INCIDENTS, RED COMPLAINTS AND HIGH LEVEL OPERATIONAL RISKS FOR CORPORATE AREAS The Committee noted this report which included one new operational high-level risk and five existing high-level risks. IT WAS AGREED: That the report be noted. 15/330: SAFE STAFFING: PLANNED VERSUS ACTUAL STAFFING BY WARD OCTOBER 2015 DATA The monthly report on the planned versus actual staffing by ward was submitted. It represented a deteriorating position. Ms Etches indicated that work was being done to establish the extent to which we could achieve greater efficiencies such as around e- rostering, and study and sick leave. Mr Loughton commented that any further measures to follow up more rigorously on sickness absence would be welcomed. Ms Griffiths mentioned the possibility of discussing with employees their previous record of sickness absence; in some cases they might need to be reminded that it could be linked to the commencement of capability proceedings. There was a discussion around the extent to which managers suspected staff took time off work due to sickness, when they were actually fit for work. IT WAS AGREED: That the monthly update on planned versus actual staffing by ward be noted. 15/331: NURSING WORKFORCE SKILL MIX REVIEW 7

10 The Committee received the six monthly report on the nursing workforce skill mix review, which was due to be discussed also by the Board on 30 November. Ms Etches indicated that this report confirmed bigger gaps on D2 than on D1, and she said that a number of actions were being taken within the organisation, such as around e-rostering, to try to increase efficiency and avoid having to put forward a business case for more nurses. In response to a question she confirmed that a separate review of the skill mix in paediatrics and neonates was underway. IT WAS AGREED: That the six monthly report on the nursing workforce skill mix review Group be noted. 15/332: TRANSFORMATION PROGRAMME MONTHLY UPDATE The Committee noted this report. IT WAS AGREED: That the monthly report on the Transformation Programme be noted. 15/333: INTEGRATION PROGRAMME CANNOCK CHASE HOSPITAL Mr Mahmud indicated that there was no update on Cannock Chase hospital this month. 15/334: POLICIES FOR APPROVAL The Committee considered 2 policies for approval. IT WAS AGREED: That the following policies be approved: OP67 Patient Escort Policy IP03 Prevention and Control of MRSA, VRE and other anti-biotic resistant organisms policy 15/335: RISK - CONSIDERATION OF RISKS TO BE ENTERED ONTO A RISK REGISTER No new risks were identified for a risk register during the course of this meeting. 15/336: BOARD ASSURANCE FRAMEWORK The relevant section of the BAF was circulated and noted. 15/3337: ANY OTHER BUSINESS Mr Stringer confirmed that the national cap on NHS Agency staff fees came into operation on 23 November. He referred to arrangements which provided for overriding the cap but cautioned that trusts were being required to submit weekly reports showing any breaches of the cap. 15/338: DATE AND TIME OF NEXT MEETING It was noted that the next meeting of the Trust Management Committee was due to be held on Friday 18 December 2015 at 1 p.m. in the Board Room of the Clinical Skills and Corporate Services Centre, New Cross Hospital. The meeting closed at 3.40 pm 8