ROYAL UNITED HOSPITAL BATH NHS TRUST MINUTES OF THE PUBLIC TRUST BOARD MEETING WEDNESDAY, 8 APRIL 2009 ANNETT ROOM, RICE CENTRE, RUH Present: Voting Directors Moira Brennan, Non Executive Director James Carine, Chairman Michael Earp, Non Executive Director Catherine Phillips, Director of Finance James Scott, Chief Executive Francesca Thompson, Director of Nursing Peter Tomkins, Non Executive Director John Waldron, Medical Director Stephen Wheeler, Non Executive Director Non-Voting Directors Howard Jones, Director of Facilities Brigid Musselwhite, Director of Planning & Strategic Development, Deputy Chief Executive Lynn Vaughan, Director of Human Resources In Attendance Alison Spears, Trust Board Secretary Jill Tomkins, PPI Representative LINKs Banes and Wiltshire Mandy Rumble, Matron Emergency Department (Item 7 only) Gareth Howells Assistant Director of Nursing Medicine (Item 7 only) BD/09/04/01 None Questions from the Public BD/09/04/02 Apologies for Absence Jonathan LLoyd, Non Executive Director BD/09/04/03 None Declaration of Board Member Interests BD/09/04/04 Presentation withdrawn until May 2009 BD/09/04/05 Safeguarding Children including Haringey Review The Director of Nursing presented the report and the Board noted: The Joint Area Review (JAR) action plan was included. The review gave positive assurance which was borne out by the Standards for Better Health feedback; The potential gaps identified at the RUH related to the following; Agenda Item: 8.1 Page 1 of 9
o Insufficient training records; o A need to review the level of child protection training given to relevant staff; o A need to review how safeguarding practice is monitored and what indicators should be used to monitor performance; o A need to review the level of reporting on safeguarding to the Trust Board It was believed that the Trust had trained more staff than recorded and more rigour was required to ensure that appropriate records were kept. MLE captures training carried out through the Education Centre but not the expert based training carried out either internally or externally; The Trust had made one referral to the Local Safeguarding Board but had not been one of the relevant parties; A review of how external agencies work together will be undertaken; The need for a robust whistle-blowing policy had been highlighted. The Trust had this in place but the effectiveness of the policy needed to be checked. The Board NOTED the report. BD/09/04/06 Children s Hospital Services Healthcare Commission Follow Up Review 2008/09 The Chief Executive presented the report and the Board noted: Standard S1A only dedicated Children s hospitals are able to achieve this standard; The Trust had identified a need to concentrate its children s services to ensure that it had an appropriate number of dedicated surgeons and anaesthetists; As identified in paper 5.1 the Trust needed to do more in terms of training; An audit had taken place regarding criminal record bureau checks and the Trust had been given significant assurance in this area. The Board NOTED the report BD/09/04/07 Investigation into Mid Staffordshire NHS Foundation Trust The Assistant Director of Nursing for Medicine and the Matron of the Emergency Department gave a presentation on national recommendation 2 which was the main thrust of the report. The Director of Nursing presented the report including Appendix 1 and the Board highlighted the following in respect of the national guidance: Recommendation 1: The Trust used Dr Foster s Real Time Monitoring Agenda Item: 8.1 Page 2 of 9
Tool and had a Hospital Standardised Mortality Rate of 97.3 on average, monitored monthly by the Board; Recommendation 2: Covered via the presentation which confirmed that the department was on target to recruit to establishment and had Divisional backing to increase the number of substantive consultants from five to seven; Recommendation 3: the Trust had implemented the Executive walkabouts; Recommendation 6: the Operational Governance Committee and the Clinical Governance Committee received relevant reports and representations in the various aspects of nursing care. National Metrics had not been published yet but the Patient Experience Tracker would further assist in measuring patient experience; The last two recommendations focussed on not losing sight of operational matters when undertaking key change programmes such as an NHS Foundation Trust Application; The Director of Nursing would lead on addressing the gaps identified in Appendix 1 and report progress via the Clinical Governance Committee. It was confirmed that the Trust had a number of systems by which performance could be measured some of which are led by the professionals or specialisation rather than the Trust. It was noted that the Divisional Performance Reviews focussed on performance indicators which included the quality as well as target outcomes. The Board welcomed the presentation from the Emergency Department, discussed the findings within the report and agreed that the Director of Nursing should refine where necessary and then implement the actions noted in Appendix 1. BD/09/04/08 Minutes Public Trust Board Meeting (i) Minutes of the Public Trust Board Meeting held 4 March 2009 The following amendments were noted: Moira Brennan was in attendance, Howard Jones was a non voting Director Jill Tompkins gave apologies Pg 6 paragraph under the action was removed Second bullet under paper 13.3 amount should read 5.6m After making the above changes the minutes were approved and signed as a true copy by the Chairman. (ii) Minutes of the Extraordinary Public Trust Board Meeting held 24 March 2009 The minutes were approved and signed as a true copy by the Chairman. Agenda Item: 8.1 Page 3 of 9
BD/09/02/09 Action List and Matters Arising Action 1: on the agenda, action can be removed. Action 2: on the agenda, action can be removed. Action 3: Purchasing had agreed to split the boxes of chloraprep, action can be removed. Action 4: Somerset PCT service level agreement had been signed, action can be removed. Action 5: Basingstoke had refused to accept claims that one of the Trust s MRSA bacteraemia cases had come from them, still ongoing but action can be removed. Matters Arising; The Patient Experience Tracker data is planned to be included in the quarterly report due in May. BD/09/04/10 Chairman s Report The Chairman presented the report and the Board noted: Jill Tompkins would now represent the LINKS for Banes and Wiltshire; The Trust would be the first in England to have an online system for translation services including British Sign Language, coupled with deaf awareness training. Francesca Thompson, Director of Nursing had been awarded a Florence Nightingale Scholarship. The Board NOTED the report and congratulated Francesca Thompson, Director of Nursing, on the award of a Florence Nightingale scholarship. BD/09/04/11 Chief Executive s Report The Chief Executive presented the report and the Board noted: The Trust was expecting a Ministerial Visit from Ben Bradshaw on the 20 April to include a visit to the MRI / CT suite, the Emergency Department and the official opening of the Breast Unit; Improving Outcomes Guidance: The process of evaluating the changes and costs involved in the two options identified to meet Improving Outcomes Guidance for gynaecology / oncology would start next week and was expected to last approximately two months. The Board NOTED the report Agenda Item: 8.1 Page 4 of 9
BD/09/02/12 Assurance Committee Updates (i) Clinical Governance Committee The Chair of the Clinical Governance Committee presented the report and the Board noted: The Committee had reviewed the evidence for the Standards for Better Health and were assured and able to recommend the declaration to the Board; The Committee had agreed to extend the review dates of some policies where the content was still in use and valid; Ophthalmic Serious Untoward Incident during the internal investigation the Trust s Medical Physics Team had discovered that the industry standard microscope light-filter settings were incorrect. Risk management the review of the Trust Wide risk register had not yet been completed but good progress had been made; MHRA Blood Bank Inspection Report the Trust was declared compliant following a visit on the 10 March 2009. (ii) Audit Committee The Chair of the Audit Committee presented the report and the Board noted: PriceWaterhouse Cooper s, the Trust s new Internal Auditors, had produced a draft workplan which would be refined and adopted at the next Audit Committee meeting; The Counter Fraud services report and 2009/10 workplan had been received. Any interested member could review the workplan. (iii) Non Clinical Risk Committee The Chair of the Non Clinical Risk Committee presented the report and the Board noted: The European Working Time Directive action plan was still fragile; the fire safety report had been received and an action plan would be taken to the Committee s next meeting; the Committee reviewed the Standards for Better Health declaration and spent time interrogating the evidence and was assured and able to recommend the declaration to the Board except in relation to standard C4c around decontamination where the Trust was awaiting the outcome of the Hygiene Code Inspection. Agenda Item: 8.1 Page 5 of 9
(iv) Charities Committee The Chair of the Charities Committee presented the report and the Board noted Each of the Trusts charitable funds had prepared spending plans for 2009/10 which were reviewed by the Committee; The Committee requested that the Arts Strategy Group confirm its focus and ensure that its objectives were aligned to those of the Trust. The Board NOTED the Assurance Committee updates. BD/09/04/13 Performance Monitoring (i) (ii) Trust Key Performance Indicators; and Performance Report The Chief Executive presented the report and the Board noted: 4 hour target year end position 97.63% which was an improvement on last year. The last few weeks had been difficult due to norovirus and diarrhoea and vomiting which resulted in loss of system benefits; 18 week target the Trust achieved the year end target and was planning to meet 13 weeks by the end of June 2009; MRSA year end total was 26 which meant that the Trust met this target; C.Diff the Trust had achieved this target with 248 case against a target of not more than 269; Hospital Standardised Mortality Rate it was noted that this had risen in December but this remained within the expected range of month to month variation. Nursing vacancy rate this is improving and the Trust was on trend. A skill mix review was underway. It was requested that the average waiting time for callers to the Appointment Centre was included on the scorecard. Action: Director of Planning and Strategic Development (iii) Finance Report The Director of Finance presented the report and the Board noted: The Trust earned an additional 8m in income for the year which was reduced by 2.8m as agreed with the commissioners; The Trust met its Capital Resources Limit and Capital Expenditure targets; The Trust s performance in paying suppliers under the Better Payment Practice Code improved in March after a fall in February; Agenda Item: 8.1 Page 6 of 9
The Trust s current cash position was healthy, however, as an NHS Foundation Trust there would be a requirement for higher levels of cash. The Board noted the current and forecast financial performance against the Trust s financial duties (paragraph 1.1). The Board noted the requirement from the SHA to achieve a control total for the Financial year of 5.6m surplus (paragraph 1.3) The Board noted the negotiations concerning the Performance Notice and the resulting settlement for 2008-09 (paragraphs 2.2.6 2.2.8). The Board noted the resolution of the Trust s discussions with its auditors and the SHA regarding Millennium expenditure (see paragraph 2.3.4). The Board noted the expenditure to date against the capital resource limit (section 4). The Board discussed and understood the actions to mitigate the risks (section 5). The Board NOTED the performance reports. BD/09/04/14 Standards for Better Health Draft Final Declaration 2008/09 The Director of Nursing presented the report and the Board noted: The report provided the final Standards for Better Health Declaration for approval; The three assurance committees had reviewed the evidence of the standards that they were responsible for and had recommended the declaration to the Board; The Trust had received feedback from a number of stakeholders; feedback from the Overview and Scrutiny Committee was generally more positive. The Trust was still awaiting the report following the Hygiene Code Inspection from the Healthcare Commission and would review the report before declaring assurance on standard C4c; The Chief Executive had minor concerns around standard C2 but these concerns were not material; A letter had been received from Concordat which presented the view of 10 auditors / regulators on the Trust s performance which showed no concerns. The Chairman and Chief Executive, with support from the Director of Nursing could decide on the level of compliance around C4c once the Agenda Item: 8.1 Page 7 of 9
Healthcare Commission report was received the Board APPROVED the Standards for Better Health declaration. Action: Chairman / Chief Executive / Director of Nursing BD/09/04/15 Review of Standing Orders, Standing Financial Instructions, Scheme of Delegation and Terms of Reference for Reporting Committees The Chairman and Trust Board Secretary presented the documents and the Board noted: The Standing Orders, Standing Financial Instruction and Scheme of Delegation had been reviewed by the Audit Committee; The Standing Financial Instructions had only minor amendments; The Standing Orders had been updated in line with the Department of Health s model; The Scheme of Delegation focussed on delegation from the Board and a separate document should be provide for further delegation to staff; The Terms of References for all committees had been approved by the relevant committee except for the Remuneration Committee. The Board APPROVED and ADOPTED the Standing Orders, Standing Financial Instructions and Scheme of Delegation and Approved the Terms of Reference for the Audit Committee, Charities Committee, Clinical Governance Committee, Non Clinical Risk Committee, Remuneration Committee and Management Board. BD/09/04/16 Business case for a new consultant anaesthetist to lead central pre-operative assessment The Chief Executive presented the Business case and the Board noted: Management Board had reviewed the financial implications which were positive; The post would provide senior clinical leadership in the department. The Board APPROVED the business case but wished to see fuller details in future cases. Action: Trust Board Secretary BD/09/04/17 Staff Survey The Director of Human Resources presented a summary of the staff survey findings and provided the following handouts: 08 Staff Survey Results; and HSE: Tackling Stress Agenda Item: 8.1 Page 8 of 9
The Board NOTED the presentation and handouts. BD/09/04/18 Annual Disability and Gender Equality Report The Director of Human Resources presented the report and the Board noted: The Annual Report was presented to comply with statutory equalities duties and demonstrated progress in embedding the understanding of the statutory equalities duties More education and training was required to increase awareness; Key developments had been taken forward during 2008/09; The Central Pre-operative Assessment Department would assist in increasing the level of data captured; Currently there was no statutory duty to patients around age. Patientline is currently not installed in the Older People s Wards due to the fact that Patientline s national policy is not to install the system into areas which, in it s view were not financially viable. The Board NOTED the report BD/09/02/19 Review of Board Performance The Chairman reviewed the Board performance and was content that time had been spent on the priorities of the business and the agenda had been covered effectively. BD/09/02/20 Any other business Jeremy Martin, Head of Business Development and Improvement had been successful in his application for the Director of Strategy position at Yeovil District Hospital NHS Foundation Trust. The Board wished him luck in his new position. BD/09/02/21 Date of Next Meeting The next meeting of the Trust Board would be held on 13 May 2009, Annett Room, RICE Centre. The meeting closed 13:00. Signed. Date Agenda Item: 8.1 Page 9 of 9