POOLE HOSPITAL NHS FOUNDATION TRUST BOARD OF DIRECTORS

POOLE HOSPITAL NHS FOUNDATION TRUST BOARD OF DIRECTORS Part 1 Minutes of the meeting of the Board of Directors of Poole Hospital NHS Foundation Trust held at 2 pm on Wednesday 17 December 2008 in the Board Room, Poole Hospital. Present: Mr Peter Harvey Chairman Mr Charles Cunningham Non-Executive Director Mrs Elizabeth Hall Non-Executive Director Mrs Heather Hauschild Director of Operations Mr John Knowles Non-Executive Director Mrs Jean Lang Non-Executive Director Mr Martin Smits Director of Nursing & Patient Services Mr Guy Spencer Non-Executive Director Mrs Sue Sutherland Chief Executive Mr Robert Talbot Medical Director In Attendance: Mr Michael Beswick Company Secretary Mrs Pauline Malins Director of Communications Mrs Debi Reeves Deputy Director of Human Resources Mrs Sara Elkin Secretary PHFT 320/08 Apologies for Absence Apologies for absence were received from Dame Yvonne Moores and Mr Taylor. PHFT 321/08 Declaration of Interests There were no declarations of interest pertaining to the Board agenda. PHFT 322/08 Part 1 Minutes of the Board Meeting held on 26 November 2008 (A/12/08) The minutes were AGREED as a correct record. PHFT 323/08 Matters Arising 295/08 Trust Performance Report Mr Talbot said a copy of current mortality rates was available from his office. He noted that the review of the last 100 unexpected deaths would be reported to the Clinical Governance Committee. 298/08 Infection Prevention & Control Report Mr Smits said the deep cleaning programme had now been stopped. A detailed report on the programme would be discussed by the Infection Control Committee. 1

300/08 Quarterly Complaints Summary Report: Quarter 2 2008/09 Mrs Hauschild said a report on outpatient appointments would be brought to the next Board meeting. HH 310/08 Any Other Business iv) Health & Safety Executive (HSE) Mr Smits reported that following the HSE visit all staff were to be trained to recognise early signs of contact dermatitis. This would be included in the education programme. vi) Board Seminar Mrs Sutherland reported that she had written to NHS Bournemouth & Poole and the Royal Bournemouth Hospital about potential risk in the overlapping maternity services between Bournemouth and Poole. She had also written to Mr Callingham of the SHA with regard to his review of maternity services. NHS Bournemouth & Poole was to facilitate a meeting of the two acute trusts to discuss the problem. PHFT 324/08 Documents Sealed in November 2008 (B/12/08) PHFT 325/08 Board Seminar The Chairman noted the morning s Board Seminar had been on the Trust s pharmacy services. PHFT 326/08 Draft Audit & Governance Minutes: November 2008 (C/12/08) The draft minutes were NOTED. PHFT 327/08 Draft Finance & Investment Committee Minutes: November 2008 (D/12/08) Mr Cunningham noted a special F&I Committee meeting to review the Maternity Unit business case had been arranged for 23 January. All Board members were invited to attend. The draft minutes were NOTED. PHFT 328/08 Draft Council of Member Representatives Minutes: November 2008 (E/12/08) The draft minutes were NOTED. PHFT 329/08 Trust Performance Report (F/12/08) Mrs Hauschild spoke to her report, noting the following: i) All standards in the Monitor framework had been achieved in October; 2

ii) The Trust was continuing to exceed the 18-week referral to treatment (RTT) target. Good progress was being made on the PCT s 13-week RTT target although the position on admitted patients was fragile and Patients were reluctant to have their operations at this time of year it was not permissible to discount all patient initiated cancellations; iii) NHS Bournemouth & Poole had agreed additional investment for the stroke service. There was an error in paragraph 4.4 of the report performance had been 41% as shown on the scorecard; iv) Additional trauma lists were now in place; v) There was concern about the current level of A&E performance there had been 76 breaches of the 4-hour rule the previous weekend. The projected performance for the end of Quarter 3 was 97.6%. She noted: The whole of NHS South West was experiencing unprecedented levels of emergency activity for both adults and children. The Ambulance Service also reported a significant increase in workload; The Trust had 100 more ambulance admissions per week than the same period last year even though overall numbers remained the same; A teleconference had been held with the PCT, Ambulance Service and other acute trusts; The Trust s bedstate had been at -40 during the current week with patients waiting at home for admission. The take had been diverted to the Royal Bournemouth on one occasion RBH had been very helpful; Performance had been adversely affected by ward closures due to norovirus at the Royal Bournemouth Hospital; The Children s Unit had been closed to admissions on a number of occasions as had paediatric units in other hospitals. Mrs Sutherland noted the increase in emergencies was a national problem. The NHS Confederation had conducted a quick survey of all chief executives on the problem and had sought views on what policy changes were required to help deal with the issue - she had suggested removal of the referral to treatment target and the 4-Hour A&E target. It was AGREED that an exception report should be sent to Monitor. Mr Cunningham asked about the bedstate figures in relation to escalation beds. It was agreed that future reports to the Board would include two sets of bedstate figures, one based on funded beds only and the other including escalation beds. Mrs Reeves noted that sickness absence rates were above trajectory for November. However, it was noted that the Trust was using fewer agency staff as there were now more staff on temporary contracts. PHFT 330/08 Finance Report (G/12/08) Mr Goodwin spoke to the report, noting the following: 3

i) The Trust s current surplus of 191k was not as high as planned although a year-end surplus of 4m was still forecast; ii) There had been an overspend of 92k on gas and electricity in November. There was no additional funding source for this and the problem was expected to continue all winter; iii) Due to the timing of the Board meeting, the November figures had been produced earlier than usual so did not include all activity for the month. Prudent estimates had been included including an allowance for overactivity; iv) The cash position was good. The Finance & Investment Committee had agreed to divert investment away from the Paymaster General Office the proposed change in investment should generate 43k additional interest; v) New guidance on private patient income had been received from Monitor. Restrictions on the use of charitable vehicles were being analysed; vi) The Finance Department was restating the accounts under IFRS rules these had to be sent to Monitor by 31 December; vii) Agreement had been reached with the auditors on reporting PFIs off the balance sheet viii) A review of all medical leases had been undertaken these would now appear on the balance sheet. Mr Goodwin reported that the 2009/10 tariff had now been issued. There was to be a 1.7% baseline uplift after deduction of a 3% efficiency savings target and allowance for the recent reduction in VAT. The market forces factor had been recalculated which would result in a downward movement for the Trust although there was a 2% cap on upward/downward movements. Changes to the tariff which would benefit the Trust included new planned/same day and short stay elective tariffs and removal of the 50% reduction in payment for overactivity. In addition, trusts would be allowed to make a surplus on block contracts. However, many of the Trust s procedures had moved to a nonmandatory tariff so would have to be negotiated with the commissioners. Mrs Sutherland noted that the PCTs had been given an average of 5% growth for the next two years although this was likely to be spent outside the acute hospitals. The Board agreed that Monitor s position on private patient income was very disappointing. Mrs Hall congratulated the Finance Department for achieving the restatement of accounts. It was AGREED that the Chairman, Mrs Sutherland, Mr Taylor and either Mr Cunningham or Mrs Hall would sign off the restatement of the Trust s accounts PHFT 331/08 Infection Prevention & Control Report (H/12/08) Mr Smits spoke to his report, noting the following: i) The Trust was ahead of both contractual and stretch targets for MRSA and c.difficile performance; 4

ii) iii) The rate of improvements in hand hygiene had slowed down an action plan had been drawn up to re-energise efforts across the Trust; National guidance was to be issued on screening all elective patients from 1 April 2009 and all patients by 2011. The Chairman said it was disappointing to note the fall in hand hygiene performance in some areas. Mr Smits said this was being followed up in individual areas. PHFT 332/08 Six-Monthly Report on Management of Pressure Ulcers (I/12/08) Mr Smits spoke to his report, noting the following: i) Percentages for incidence and prevalence had been omitted from the cover sheet these should have been 0.95% and 1.77% respectively; ii) New organisational arrangements for the management of pressure ulcers had only been in place for four months. Results were encouraging but it was too early to be sure they were effective; iii) Root cause analyses were to be undertaken on all grade 3 pressure ulcers; iv) It was difficult to benchmark performance against other trusts as no other local trusts had such sophisticated systems for reporting pressure ulcers; v) It was thought that the Trust was now preventing more patients from acquiring ulcers. Mr Talbot noted that no grade 2 ulcers developed into grade 3 or 4. Mr Smits noted a number of patients were admitted with pressure ulcers this was being discussed with the PCT. PHFT 333/08 New Style Board Agenda (J/12/08) The Chairman noted the agenda had been re-styled following Dame Yvonne Moores and Mr Knowles attendance at a Patient Association event where it had been advised that more emphasis should be place on patient safety on Board agendas. It was suggested that there should also be a "Patient Experience" heading. Mr Talbot noted ongoing work on clinical outcome measures, to be included in the performance report. It was AGREED that the Chairman and Mr Beswick should further review the agenda with a view to trialling this in the New Year. PH/MB PHFT 334/08 Audit & Governance Committee: Terms of Reference (K/12/08) Mrs Lang, Chairman of the Audit & Governance Committee, noted that the only amendment to the Terms of Reference had been the frequency of their review. 5

The Terms of Reference were APPROVED. PHFT 335/08 Information Governance: Policy Intent (L/12/08) Mr Goodwin noted the paper had been approved by the Information Governance Committee. The Information Governance Policy Intent was APPROVED. PHFT 336/08 Safeguarding Children: Update (M/12/08) Mr Smits spoke to his paper, noting the following: i) The paper had been written in the context of the death of Baby P and the issues surrounding this; ii) The paper detailed the assurance the Trust had through joint working with the local authority; iv) The Safeguarding Board was reviewing local arrangements and would report by the end of February 2009; v) Bournemouth and Poole Boroughs had both been rated as "good" by Ofsted; vi) The Trust had a designated doctor and nurse for safeguarding children; vii) The Trust policy for safeguarding children had been reviewed and approved by the Hospital Executive Committee in June 2008. Mrs Sutherland noted that she was involved in serious case reviews and said she was very confident in the Trust s named doctor, Dr Kelsall, who reviewed all contacts with the Trust in the event of a child s death. Dr Kelsall would brief the Board at the January Board seminar. Mrs Sutherland noted the action plan arising from case reviews would be monitored in the Trust s quarterly performance reviews. Mr Talbot noted the problems of ensuring child protection training for locum staff. PHFT 337/08 Emergency Department Patient Survey 2008 (N/12/08) Mr Smits said the survey had placed the Trust in the top 10 (of 151) best performing trusts in the country for overall patient satisfaction with the Trust s A&E doctors and nurses rated as being in the top 20% of trusts this was against a background of a very busy department with physical constraints. Mrs Hauschild said the survey results had been communicated to the A&E staff. An action plan had already been produced to deal with areas identified for improvement with a focus on pain relief. Mrs Sutherland noted the results would be conveyed to general staff via the team briefing process. The Chairman thanked the A&E staff for their excellent work in difficult circumstances. 6

PHFT 338/08 Questions from the Council of Member Representatives The Chairman noted he had received no written questions from the Council of Member Representatives. PHFT 339/08 Any Other Business i) Open Day The Chairman said the displays at the Open Day had been superb. He said it was disappointing there had not been more attenders at the event although it was noted that there had been over 200 visitors to the day theatres. ii) Board to Board Meeting The meeting discussed dates for a board-to-board meeting with the Royal Bournemouth Hospital, to be hosted at Poole Hospital. iii) Operating Framework 2009/10 Mrs Sutherland noted that the NHS Operating Framework for 2009/10 had been published. This was a Department of Health document setting out the way the NHS would work, and would be used to underpin the Trust s Annual Plan. There were no new targets for 2009/10 and the NHS priorities were identified as: Cleanliness and hospital-acquired infections; Access (18 week referral to treatment target); Improving health Improving patient experience Improving staff satisfaction and engagement; Emergency preparedness especially for pandemic flu. Mrs Sutherland said the Operating Framework made much mention of "financial prudence" and said that very significant efficiency savings would be required in 2010. Although NHS funding would include an extra 0.5% for quality this may be held back. Quality would be measured in terms of safety, effectiveness (eg mortality and clinical outcomes), patient experience and quality accounts. She noted that Mr Taylor had been invited to be on the national working group for quality accounts. iv) Visiting Times Mr Cunningham asked about the restricted visiting times on the wards. Mr Smits said this had been the subject of a long debate with patient representatives and staff. Generally, patients found unrestricted visiting too intrusive and tiring, and staff found it disruptive, so visiting times had been introduced along with restrictions on the number of visitors allowed round the bed. v) Top-Up Funding Mr Knowles asked about the current position on top-up funding for drugs. Mrs Sutherland said a paper was out for consultation. She said the Trust would have proper arrangements in place but there were many issues to be 7

worked through. She said there was concern as top-up payments were to be counted as private patient income. Mrs Sutherland noted the present procedures for seeking additional funding from the PCT for individual cancer patients and said NHS Bournemouth & Poole had not yet refused to fund any patient. PHFT 340/08 Date and Time of Next Meeting Wednesday 28 January 2009 at 2.00 pm PHFT 341/08 Withdrawal of Press and Public The Chairman moved that any members of the public and representatives of the press should withdraw from the meeting. 8