COUNTY DURHAM & DARLINGTON NHS FOUNDATION TRUST ANNUAL GENERAL MEETING

Transcription

1 COUNTY DURHAM & DARLINGTON NHS FOUNDATION TRUST ANNUAL GENERAL MEETING Minutes of the sixth Annual General Meeting of County Durham and Darlington NHS Foundation Trust (CDDFT) held on Wednesday 18 September 2013 at 5.30 pm in the Auger Suite, Radisson Blu Hotel, Frankland Lane, Durham City. TRUST BOARD MEMBERS PRESENT Mr Tony Waites Chairman Rt Hon Baroness Armstrong Non-Executive Director Dr Ian Robson Non-Executive Director Mrs Lynne Snowball Non-Executive Director Mrs Sue Jacques Chief Executive Mr Peter Dawson Executive Director of Finance Prof Chris Gray Executive Medical Director Mr Mike Wright Executive Director of Nursing Mr Tom Hunt Executive Commercial Director COUNCIL OF GOVERNOR MEMBERS PRESENT Mr Derek Atkinson Public Governor (Sedgefield) Mr Roy Beckwith Public Governor (Derwentside) Mr Stephen Coad Staff Governor (Community) Mr Bill Davies Public Governor (Sedgefield) Dr Ken Davison Public Governor (Wear Valley & Teesdale) Mrs Marjorie Dunn Public Governor (Darlington) Mrs Barbara Dyer Public Governor (City of Durham) Mr Bob Erskine Public Governor (City of Durham) Ms Janice Fenny Staff Governor (Nursing & Midwifery) Mr Simon Gerry Public Governor (Derwentside) Ms Tricia Gordon Staff Governor (Nursing & Midwifery) Mr Keith Gunning Staff Governor (Medical) Mr Stephen Guy Appointed Governor (Durham County Council) Mr James Heap Public Governor (Tees Valley, Hambleton, Richmondshire) Mr Jed Hillary Staff Governor (Admin, Clerical & Managers) Mr Kevin Hull Staff Governor (Ancillary) Prof Paul Keane OBE Appointed Governor (Local Universities) Mrs Linda Moore Public Governor (Sedgefield) Mr Alex Murray Public Governor (Easington) Mrs Sue Pringle Public Governor (City of Durham) Mrs Liz Sanderson Public Governor (Darlington) Mr John Short MBE Public Governor (Teesdale) Mr Laurence Welsh Public Governor (Derwentside) Mrs Cate Woolley-Brown Public Governor (Wear Valley & Teesdale) IN ATTENDANCE FOR THE TRUST Mr Warren Edge Senior Associate Director of Assurance & Compliance Mr Bill Headley Executive Director of Estates & Facilities Ms Chris Lisle Executive Director of HR and Organisation Development Mr Edmund Lovell Associate Director of Marketing & Communications Dr Robin Mitchell Deputy Medical Director Ms Donna Swan Trust Secretary Page 1 of 12

2 Mr Ben Eke Ms Gaye Ferguson-Boyes Ms Charlotte Mather Mr Alex Miles Ms Shelly Regan Ms Suzanne Jarvis Foundation Trust Office Foundation Trust Office Foundation Trust Office Foundation Trust Office Foundation Trust Office Minute Taker There were also in attendance 48 Trust Members and 16 members of the public whose names were recorded separately. 1 Welcome & Apologies for Absence The Trust Chairman welcomed everyone to the AGM. It was noted that apologies for absence had been received from: Dr Mike Waterston Non-Executive Director Mr Andrew Young Non-Executive Director Ms Carole Bailey Staff Governor (Nursing & Midwifery) Mrs Adele Bone Public Governor (Chester le Street) Dr Carmen Martin Public Governor (Chester le Street) Mrs Dorothy Teasdale Appointed Governor (NE Ambulance Service) 3 (a) (b) Minutes and Matters Arising from the Annual General Meeting held on 12 September 2012 Accuracy The Minutes of the previous meeting were signed as a true and fair record. There was no dissent. Matters Arising from the Minutes of the Previous Meeting Item 8 Open Question & Answer Session (page 6) Mr Matt Pallister, voluntary chaplain at UHND, put on record his thanks to both Mrs Jacques and Baroness Armstrong for reinstating the lists of the religious denomination of patients. Those lists were essential to the function of the Chaplaincy. Mr Harry Henson took this opportunity to ask if it would be possible to produce the Minutes of previous AGM meetings in large print format and for attendees to be able to view those Minutes prior to the AGM. The Chairman invited any attendee with similar issues to make these known to the organisation in advance of future meetings. Mrs Diana Sanderson questioned why Mr Palliser s question had referred only to elderly patients. The Chairman advised that the question had been posed in those terms but that no actual distinction was made by the Chaplaincy between elderly and younger patients in the care of the Trust. 4 Chairman s Opening Remarks The Chairman advised that the manner in which this meeting was to be conducted would be a little different to that which had been the case in the past. Specifically the 2012 Health & Social Care Act had made certain changes to the proceedings. At previous AGMs, the Trust s Annual Report had been presented to the Governing Council following it having been laid before Parliament. As a result of the 2012 Health & Social Care Act, the Governing Council was now known as the Council of Governors. The Trust s Council of Governors had examined the draft Annual Page 2 of 12

3 Report prior to it being laid before Parliament on 1 July Today, at this AGM, the Annual Report was being formally presented to Trust members. It was put on record that the AGM was open to public attendance and it was very much hoped that those members of the public who were present, and who were not already Trust members, would seize the opportunity to sign up as members of the Trust. Hitherto any changes to the Trust s Constitution had required the approval of Monitor, the regulator of NHS foundation trusts. Under the new legislation, any changes to the Constitution that related to the Council of Governors had to be approved by Trust members. Later on the agenda, the Chairman of the Council of Governors Audit & Governance Committee was to propose certain changes to the Constitution and Trust members, as opposed to the general public present, were to be asked to vote upon the proposed changes using the electronic devices provided in the room. The Chairman emphasised that, not only the AGM was open to public attendance, but also meetings of the Trust s Board of Directors and Council of Governors. Although members of the public, including Trust members, did not have statutory rights of address at those meetings, the Chairman did always invite comment and questions from any members of the public at the end of each meeting as obviously would be the case under Item 9 of this agenda. It was noted that, at the previous AGM, the Chairman had advised that a substantive appointment had been made to the post of Executive Director of Nursing from 5 November The Chairman was very pleased to introduce Mr Mike Wright to his first AGM as Executive Director of Nursing. During the course of the previous year the Trust had also appointed a new Executive Medical Director, Professor Chris Gray, whom the Chairman was also pleased to welcome to his first AGM. Both appointees brought a wealth of experience to the Trust Board. It had been known at the previous AGM that Dr Robin Mitchell had been Acting Executive Medical Director but that he intended to stand down once a substantive appointment to the post was made. The Chairman took this opportunity to extend his thanks to Dr Mitchell for the support he had given to the Trust in that role as Acting Executive Medical Director and for the continued support he provided as Deputy Medical Director. The Chairman welcomed Mr Peter Dawson, recently appointed as Executive Director of Finance, who had extensive experience with the Trust. Thanks were also expressed to Mr Tom Hunt who, during the course of the last year, had combined his substantive role as Executive Commercial Director with that of Acting Director of Finance until the appointment of Mr Peter Dawson in April It was noted that there had also been a number of changes in the composition of the Council of Governors during the year. Whilst the Chairman did not intend to list all of those changes, he publicly put on record his thanks to Governors, both past and present, for the effective and constructive manner in which they worked with the Trust. Finally, the Trust Chair advised that his Executive colleagues were to present the key points from the Annual Report with Mrs Sue Jacques to summarise as her first year as Chief Executive. Mrs Jacques would then give an assessment of Page 3 of 12

4 performance within the current year: The Chairman expressed his own view that Mrs Jacques had done an excellent job in her first year as Chief Executive. He also expressed his thanks, with the support of Mrs Jacques, to the 8,000 Trust staff for the contribution they make to the success of the Trust. The Chairman was certain that Governors and members of the public would recognise just how significant a contribution had been made by all of those staff to the welfare of communities across County Durham and Darlington. 5 Presentation of the Annual Report & Accounts The Chairman called upon Mr Mike Wright to commence the presentation of the Quality Accounts for Mr Peter Dawson, having thanked Mr Tom Hunt for his support upon his appointment to the substantive post of Executive Director of Finance, delivered a presentation on the Annual Accounts and the financial position of the Trust. The Chairman thanked both Mr Dawson and Mr Wright for their extremely informative presentations. 6 Chief Executive s Review of and the Year Ahead Mrs Jacques was then invited to summarise the Trust s performance over the previous year and to put that performance into the context of how the Trust would develop over the next two to three years. Mrs Jacques opened her presentation by highlighting that the Trust serves a population of 650,000 across the North East. Essentially, then, the Trust provided more health care than any other NHS organisation in the North East. This entailed huge responsibilities. It was particularly important that the Trust had a secure financial platform in order to make those investments described by Mr Dawson. The Trust was responsible for the provision of community and hospital services throughout County Durham and Darlington and, therefore, must be socially responsible in the discharge of its duties to the population of the area. As one of the biggest employers, the Trust brought wealth into local communities and contributed to the economic wellbeing of those communities. An example of this commitment to the local area had been when, rather than continue with the Private Finance Initiative (PFI) catering contract at the University Hospital of North Durham (UHND) which had involved food being prepared at the other end of the country and transported to the hospital, the Trust had renegotiated that contract to enable the excellent kitchen facilities at Darlington Memorial Hospital (DMH) to be used to provide meals to UHND patients. The award winning provision of locally sourced food across the entire Trust had since been recognised in the national media. Mrs Jacques shared her view that investment in the local community would, inevitably, serve to contribute to the health of the community. The Chairman thanked Ms Jacques for her clear presentation 7 Constitutional Changes: Members Vote The Chairman referred to his opening remarks in which he had touched upon the Page 4 of 12

5 changes to regulations in respect of constitutional changes and he then invited Mr John Short MBE, Chairman of the Council of Governors Audit & Governance Committee, to address the AGM on the issue of those changes to the Constitution which both the Trust Board and the Council of Governors had already approved but which also required the endorsement of Trust members. Mr Short, Public Governor for Wear Valley & Teesdale, then spoke on behalf of the Council of Governors. It was put on record that the following changes to the Trust s Constitution required ratification by those Trust members present full details of which were included in agenda packs: Clauses 14.3 and 14.4 Paragraphs re-worded to provide some flexibility around the length of tenure for Trust Governors, and Annex 3, paragraph 3 Composition of the Council of Governors with Clinical Commissioning Groups replacing predecessor organisations. Using the electronic devices provided, Trust members formally voted as follows: For the changes 96% Against 4% 8 Council of Governors and Membership Ms Donna Swan, Trust Secretary, delivered a presentation on Trust membership and Governor elections. It was noted that the number of public members at the end of had been 8,000; Ms Swan hoped to achieve a membership of 10,000 by the end of Open Question and Answer Session The Chairman then opened up the floor to receive questions from members of the public. Mrs Susan Gilbey asked how big the problem of lost paper medical records was. Specifically, her husband s notes had gone missing and he could not get proper treatment without them. Mrs Jacques advised that the Trust had committed to bringing in electronic records in order that paper notes did not go missing in future. In introducing the new system, it had been known that at any particular time about 2% of notes did not get to the right place and to the right patient. It was envisaged that the new system would provide greater reliability. Obviously, electronic notes would not be lost in transit. The implementation of the new system would be complete by Christmas Mrs Jacques apologised to Mrs Gilbey for the problems she and her husband were experiencing and she offered to obtain all details at the end of the meeting. Mr Karl Bennzini advised that he had already had several of his questions answered by Dr Robin Mitchell and he thanked him for that information. He then raised the issue of UHND car parking charges and questioned if the Trust could take over the operation of the car park, rather than a third party and then, using the profit, employ more nurses or doctors with that revenue. Page 5 of 12

6 Mr Headley reported that car parking at UHND formed part of the Trust s contract with its PFI provider. Parking charges did not operate as a profit making measure and, clearly, there were costs in relation to barriers and lighting etc. The Trust was, however, considering returning to the in-house operation of car parking at UHND. Mr Benzini then raised the issue of waiting times in A&E at UHND sharing his view that the department was like Piccadilly Circus. Prof Gray agreed that this was a really important issue. The Trust Board was very conscious of the pressures on A&E and its service to patients. The organisation would not tolerate harm to patients. Patients were at risk in such a situation and this was not satisfactory. Prof Gray hoped that all those present appreciated those pressures on A&E departments. The Trust was currently considering its clinical strategy and priorities and its biggest priority was unscheduled and emergency care. The Trust was the third busiest in the country and, whilst it could decide to build a new A&E department, that would not address the problem. A complete redesign of systems was required. Many of those patients who attended A&E could be much better cared for in the community - with better outcomes. As a consequence, there was a need to liaise much better with the community and with primary care practitioners. Those individuals who did present at A&E should also consider whether they actually needed to be seen in A&E. The decision on where patients were cared for was made by a health care professional. It was very difficult to recruit doctors and nurses into emergency care and patients may not necessarily see a medical member of staff as there was an excellent nursing team within A&E. There was also a need to ensure that those patients coming through A&E, and who were admitted, were directed to the right area as soon as possible and some patients who were admitted may not necessarily go through A&E. As part of its clinical strategy the Trust was looking at all of those issues and patient pathways in order to provide better care. This was about re-engineering the workforce - with significant transformation required. The Trust must do this incrementally and engage with its staff. Radical moves had already taken place in paediatrics with four consultants delivering care at the front door. That initiative had resulted in a 50% reduction in the number of children admitted. In maternity care there were now two resident consultants providing 24 hour cover two days a week. It was hoped to expand and enhance that service and to extend consultant care in other areas over the day and into the night. Work continued to refresh The Trust s clinical strategy and to reconfigure the workforce. Prof Gray put on record his thanks to A&E staff, who worked under considerable pressure, delivering more than 120,000 consultations each year. Unless the Trust got its systems right, there was no point in building a new A&E department which would not be suitable in five years time. Mrs Sanderson reported that, in her experience, A&E was not at all like Piccadilly Circus and that she had been sent from A&E to the right place immediately. Mr Benzini highlighted that the Government had provided 250m for A&E in certain areas, but none north of York, and he asked how the Trust would cope if there was a bad winter. Page 6 of 12

7 Mrs Jacques advised that the Trust had already made plans for winter which did not rely on the money recently announced by the Government which was intended for trusts that were failing. Because trusts in the North East had delivered A&E targets, no local organisations were eligible for that money. Going forward, it would be necessary to deliver care in a very different way. Mr Wright s presentation had talked about investing in quality and disinvesting in harm and the Trust s Executive Team was committed to making changes in clinical services going forward. Mrs Jacques stated that, whilst obviously she would have liked to access some of the extra money being made available, the Trust was not constrained by money in doing what it considers necessary. The Trust had determined to transform and, if that money had been available, that impetus for change may not have been seized. As a result, Ms Jacques believed that the Trust would become stronger. Mr Pallister reiterated his thanks that the Chaplaincy was now receiving lists of patients with their religious denomination. He reported that some patients had died without the attention of a chaplain and the first the Chaplaincy had heard of this had been from the patient s family. This was usually in respect of a church-going patient who had a non-church going family. Mr Pallister was hopeful that, having restored the lists, the Chaplaincy could be with you all the way. Mr Simon Gerry, Public Governor Derwentside, referred to Mr Wright s presentation and the number of patient falls reported in relation to the target. He asked what was different about the falls bundle this year. Also, if the Trust was setting stretch targets, did this have an impact upon staff morale? In relation to patient falls, Mr Wright stated that these would never be completely eradicated with many patients being frail and elderly. However, the Trust had to do everything it possibly could to assess patients who were at risk of falling and to put measures in place to prevent falls where possible. Simple things could make a different and the Trust had introduced a system of intentional rounding on wards to check if patients wanted to go to the toilet. By these means it was hoped to prevent patients getting out of bed on their own in the dark. The falls bundle had been revised to make it less assessment heavy, and with less paperwork, to enable staff to work more effectively. A lot of falls occurred when patients were using the toilet and so the organisation had introduced a system of alarms which could be attached to patients clothing so that they could alert staff. Nurses had very difficult decisions whether to remain with the patient in the toilet cubicle or to wait outside and the patient s dignity must always be considered. Although a certain number of patients would fall when in hospital, Mr Wright assured Mr Gerry that the Trust was not complacent. Mrs Jacques advised Mr Gerry that, when he had the opportunity to talk with clinical staff, he would understand that they wanted to achieve the highest standards. The Executive Team was working collaboratively with staff and attempting to give them everything that they needed. Mrs Jacques did not believe that this had a negative impact upon morale and she expressed the view that, when the Trust appeared near the top of some of the league tables, this gave staff a tremendous boost. Every effort was being made to make the environment conducive for staff. Page 7 of 12

8 Dr Ken Davison, Public Governor Wear Valley & Teesdale, had been referred by his GP into the Trust for urgent treatment. However, he was concerned that his outpatient appointment was not until 21 October Prof Gray stated that it was difficult to comment upon this without knowing the details of Dr Davison s personal history. He undertook to have a conversation with Dr Davison at the end of the meeting. Mr Fred Sudder raised an issue in respect of consultant surgeons who, as independent contractors, traditionally took work outside of the NHS. He expressed the view that this was not good practice as consultants should not work long hours after a full day s work for the Trust. This could be dangerous for patients but had been tolerated in the past. Since the Health & Social Care Act, he believed that the situation had changed dramatically - with CCGs now commissioning for NHS patients to be referred to private hospitals who were in direct commercial competition with the NHS. Mr Sudder questioned if it made sense for the Trust to allow its employees to work for their competitors. This would not happen in private industry. Mr Sudder understood that the consultant contract had not been changed since 2004 and he asked if those contracts should be amended as the future of the NHS may be dependent upon this. For clarity, Mrs Jacques advised that, well before April of this year, there had been competition in the NHS and it had been possible for GPs to refer patients to private hospitals for private care. This had been part of the landscape for a number of years. Obviously, the Trust would rather that patients came into this organisation, but that choice was available to patients and was embedded in the NHS Constitution. Mrs Jacques felt that Mr Sudder had raised a very interesting point about ensuring that any clinicians employed by the Trust were fit to provide services for the Trust. She also reported that there had been a national call for the consultant contract to be reconfigured. Prof Gray was then invited to comment. Prof Gray acknowledged that there had been a lot of changes for the NHS and the health community. He informed Mr Sudder that the Trust s consultants were employees and not independent contractors. All had Job Plans agreed with the Trust which reflected the number of hours worked for the Trust and for which they were remunerated. Management of those Job Plans was very stringent. An attraction for some individuals going into medicine was the independence of being able to work in the private sector and, quite simply, some doctors would not work for the NHS unless they also worked within the private sector with agreement to this in their Job Plans. The issue about patient safety was, however, very important. Prof Gray advised that, each year, every doctor had an appraisal which was conducted by their major NHS employer and which also took account of all of the work carried out both for the NHS as well as in the private sector. Private employers were obliged to provide detailed evidence and feedback from patients and clinical colleagues in the private sector. In this region, there was a system whereby some private hospitals had engaged with the Trust and routinely provided print-outs of consultants performance. The system for the renewal of consultants licences was therefore very transparent. As an organisation, the Trust looked to have professional conversations with its consultants about what was needed for patients and how consultants could provide those needs. Essentially, this was Page 8 of 12

9 about engagement and asking consultants what they were prepared to do for the Trust. Prof Gray shared his view that accountability on the part of employees was much better than it had been in the past. The Chairman then invited observations from Mr Keith Gunning who was the only Trust consultant in the room. Mr Gunning advised that these issues had been raised before. The position was that private hospitals dealt with spare capacity and had shorter waiting lists than the NHS. Baroness Armstrong shared her view that the Trust would be in trouble legally if it was to restrict consultants ability to work for more than one employer. She believed that employees were free to work in different ways and to run a business alongside their employment. Mr Sudder asserted that that was not true. Commercial companies had contracts which stated that employees could not work for another employer at the same time. Baroness Armstrong disagreed, stating that this would be a restriction of human rights. The reality was that the Trust must ensure that it employed its consultants in a way to obtain the best productivity. That was why the Trust was working to ensure the more effective use of its employees and to improve productivity on the part of consultants and that they were more available to patients for longer hours than has been the case before. Mr Sudder maintained that consultants would be tired after working all day for the NHS. Ms Pat Doyle asked when the Trust was going to train people to treat the elderly. She related the circumstances when a friend, who was over 90 years of age, had been discharged by the Trust and then had had to be re-admitted two weeks later. The lady subsequently within 48 hours of the re-admission. Ms Doyle felt that staff should be trained to treat the elderly better. Mr Wright thanked Ms Doyle for her question and offered his condolences. This was not acceptable. He offered to take the specific details of this case at the end of the meeting. On a more general note, Mr Wright emphasised that all patients should be treated with dignity, respect and compassion. Unfortunately some of those aspirations were sometimes lost in the system. That was also not acceptable and the Trust had a zero tolerance in this regard. Where unacceptable behaviour on the part of staff had been witnessed, this was addressed and where there was evidence this was acted upon straight away. Regrettably, it was necessary to continue to remind colleagues about a number of fundamentals of care including the washing of hands. This was about setting the standard of expectations of nurses and midwives, challenging poor performance and eradicating it. Mr Wright advised that the Nursing & Midwifery Council was now looking towards similar standards of revalidation for nurses as was already in place for doctors. Prof Gray felt very strongly about contacts with the elderly. He acknowledged, however, that many doctors did not interact well with elderly patients. There was a need to recruit more doctors who were interested in the care of the elderly. Further, on inpatient wards, surgeons should be supported by clinicians who understood elderly patients and their concerns. Page 9 of 12

10 Mrs Diana Sanderson took this opportunity to note that she was proud of the NHS. If it were not for the NHS she would not be here. Mrs Sanderson went on to question why things did go wrong within the NHS. She shared details about a friend who had been seen in A&E by a very young doctor and then sent home. This lady had then been repeatedly admitted, again by young doctors, before the cause of her medical problem was established. This lady was also seen by a geriatric nurse who had had a very poor attitude. As a consequence her friend was very nervous to leave her home unless she could be collected by car and had now lost her independence. Mrs Sanderson felt that all of this could have been avoided had care been taken to ensure that her friend had been admitted to hospital on that first occasion. Specific incidents experienced on the ward had been that a nurse had offered to help her wash and then had never returned. Nurses were constantly talking amongst themselves but not to patients. Ms Sanderson shared her view that the solution would be to take computers away from wards. On behalf of the Trust, Mrs Jacques apologised for that experience which was not one that anyone would wish for. With reference to young doctors, she advised that there was growing amount of evidence that having a senior clinical decision maker involved in the initial stages of care led to better outcomes for patients. Mrs Jacques invited Prof Gray to comment. Prof Gray also extended his apologies for that lady s experience within the Trust. He explained that the NHS depended upon doctors in training to deliver services. This was unsatisfactory. Prof Gray asserted that patients must see the right person at the right time, with the correct investigation and diagnosis, so that the right treatment was delivered immediately. Prof Gray believed that the NHS must reduce its dependence upon junior doctors and he highlighted that, across the country, foundation trusts already struggled to get junior doctors into A&E. There had also been a reduction in the availability of training in respect of Obstetrics & Gynaecology. Prof Gray suggested that the NHS needed consultants and trained doctors and that this was core to the Trust s strategy going forward. The issue of re-admissions was extremely important and having the right individual in place upon admission would bring about better patient outcomes and reduce their average length of stay. It was essential to move in that direction. There was then a question from the floor about the Remuneration Committee and, in particular what sort of criteria were used to establish management levels of pay and how did this relate to the income of the majority of Trust employees. The Chairman advised that, at Trust Board level, Non-Executive Directors determined the level of remuneration in respect of the Executive Directors. A key issue was that external advice was sought at the time of any appointment and that that reflected the market for a particular set of skills. Market forces were very largely the determinant at that level. Away from Executive Director level, there were a series of rules and agreements and the Chairman asked Mrs Jacques to outline those arrangements. Mrs Jacques stated that, because of the focus on this area, not necessarily within the NHS, but in general business, the NHS had produced a requirement that trusts declare within their accounts the band of the highest paid director. NHS trusts Page 10 of 12

11 were also required to compare that salary with the median salary within the organisation and to present this as a ratio of highest to median pay. Currently the Trust s ratio stood at 7.5%. Moving further down the organisation, in terms of pay structure, there were national systems for staff remuneration which took into account the requirements of the job to obtain a level of consistency and to avoid some of those issues which had occurred in local authorities when women had sometimes been paid less for doing the equivalent job to that of a man. If a member of staff disagreed with their level of salary there was the right of appeal and they could approach the Trust for a review. A question was then raised with regard to recent legislation through Parliament, under competition rules, which entailed that contracts in the NHS must be put out to tender and the possibility that private providers might undercut the NHS. The questioner asked if the Trust anticipated any problems with this particularly in relation to community services. Specifically, had any contracts gone to private providers who were supplying services more cheaply? Mrs Jacques confirmed that there was competition within the NHS. This had been in place for some time. In terms of contracts moving out of the organisation there were initiatives such as Any Qualified Provider which allowed other providers to compete against NHS organisations. Mr Ray Taylor put on record his praise for the work of the Trust. He had recently suffered a stroke when he had been taken directly to the Stroke Unit where the treatment he had received had been wonderful. He thanked all those staff who had been involved in his care. In turn, the Chairman thanked Mr Taylor for his comments. Mr Tony Wolfe, repeated those thanks expressed by Mr Taylor. He himself had had an episode of illness earlier in the year when he had been taken to the Urgent Care Centre at Bishop Auckland Hospital where his treatment had been excellent. He had then been transferred to the cardiac ward at Darlington Memorial Hospital where he had been treated with great dignity and enormous care. The food had also been very good. Mr Wolfe was concerned to highlight that bad stories about the NHS always made media headlines. Earlier in his own NHS existence, Mr Wolfe had dealt with complaints and he was aware that, for every complaint, there were 40 commendations which never made the news. Whilst, on occasions, things did go wrong, NHS services were under incredible pressure as well as subject to financial pressures from Governments which did not want to invest in the service. Mr Wolfe was very proud of the NHS which, he observed, was not available anywhere else for free. The Chair thanked Mr Wolfe for those observations. 10 Any Other Business There was no other business. 11 Chairman s Closing Remarks Page 11 of 12

12 The Chairman thanked all those present for their time in attending the meeting. He hoped that, throughout the various presentations on the performance of the Trust, attendees would appreciate how serious the Trust was in its ambition to provide high quality health care and to do that in an appropriate framework. The Chairman also hoped that, from the responses made to those questions which had been posed, members of the Trust and the public would be aware how deeply concerned Trust staff were when anything went wrong. The Chairman hoped that those present were assured that the Trust would deal openly and frankly with any concerns raised. The Trust looked to provide the highest quality of health care that it could supply across the communities of County Durham and Darlington. It had been gratifying to hear those good comments made and to understand that, most of the time, the organisation did actually succeed. Absolutely every one of the 8,000 staff of the Trust could not get everything right all of the time but, when it did go wrong, the Trust wanted to be informed, to deal with the issue and to rectify matters immediately. The Chairman reiterated his thanks for the obvious support for the endeavours of the Trust. The meeting was formally declared closed at 7.40 pm. 12 Meetings held in Public: Announcements Trust Board Wed 23 October 2013 Time & venue tbc Trust Board Wed 27 November 2013 Time & venue tbc Joint Trust Board & Council of Governors Wed 18 December 2013 Time & venue tbc Page 12 of 12