Minutes of the Joint Trust Board and Membership Council Meeting held on Wednesday 28th July 2010 Present John Savage Membership Council Public Governors Elizabeth Corrigan Anne Ford Heather England Sian Evans Mo Schiller Jade Scott-Blagrove Mary Hodges Pauline Beddoes Patient and Carer Governors John Steeds Ken Cockrell Jacob Butterly Pam Yabsley Anne Skinner David Aldington Neil Auty Suzanne Green Phil Mackie Wendy Gregory Garry Williams Staff Governors Florene Jordan Belinda Cox Jim Catterall Jan Dykes Chris Swonnell Appointed Governors Sylvia Townsend David Tappin Partnership Governors Frank Palma Jeanette Jones Trust Board Robert Woolley Jonathan Sheffield Paul Mapson Steve Aumayer Tony Ranzetta Paul May Lisa Gardner Kelvin Blake Dr Jackie Cornish Chairman Constituency North Somerset (Governor Representative) North Somerset Bristol Bristol Bristol Bristol South Gloucestershire South Gloucestershire Constituency Local Patients Local Patients Local Patients Local Patients Local Patients Local Patients Tertiary Patients Tertiary Patients Carers of patients under 16 yrs Carers of Patients under 16 yrs Carers of Patients under 16 yrs Constituency Nursing and Midwifery Nursing and Midwifery Medical and Dental Non-Clinical Healthcare Professionals Non-Clinical Healthcare Professionals Bristol City Council Bristol Primary Care Trust (part) Voluntary Group Joint Union Committee Acting Chief Executive Medical Director Director of Finance Director of Workforce and Organisational Development Interim Chief Operating Officer Non Executive Director Non Executive Director Non Executive Director Head of Division Women and Children s (part) Date Tuesday, August 03, 2010 Author V Goodwin Page 1 of 11
Dr Chris Monk Dr Lis Kutt Dr Paula Murphy Chris Perry In attendance Ben Hume Cathy Gane Anne Reader David Seabrooke Maria Fox Vicki Goodwin Head of Division - Medicine Head of Division Diagnostics and Therapies (part) Chair Trust Medical Committee Director of Infection, Prevention and Control, representing Chief Nurse Head of Business Planning Young Persons Involvement Worker Assistant Director of Governance and Risk Management Interim Company Secretary Membership Manager Membership PA 80/10 Welcome and Apologies John Savage welcomed everyone to the meeting. He noted the following: Executive vacancies these should be of no concern to Governors as turnover at this level was normal and suitable interim arrangements were being put in place Formally announced the departures of Jonathan Sheffield, Medical Director at the end of September and Irene Gray, Chief Operating Officer in July and wished them well Papers he apologised for acronyms and all should strive to create reports avoiding jargon. Apologies Jason Edgar Lorna Watson Phil Quirk James White Chris Payne Massimo Pignatelli Jane Britton John Newman Deborah Lee Alison Moon Irene Gray Iain Fairbairn Selby Knox Emma Woollett Dr Mike Nevin Dr Peter Wilde Governor - Public Bristol Governor - Carers of patients under 16 yrs Staff Governor - Other Clinical Healthcare Professional Appointed Governor - North Somerset Primary Care Trust Appointed Governor - South Gloucestershire PCT Appointed Governor University of Bristol Partnership Governor - Avon & Wiltshire Mental HealthTrust Partnership Governor - Great Western Ambulance Service Interim Director of Corporate development Chief Nurse Chief Operating Officer Non Executive Director Non Executive Director Non Executive Director Head of Division Surgery, Head and Neck Head of Division Specialised Services It was confirmed that the Trust Board and Membership Council were quorate. 114/10 Declaration of Interests Belinda Cox informed the meeting that she was working with the Safer Bristol Scheme. Neil Date Tuesday, August 03, 2010 Author V Goodwin Page 2 of 11
Auty ran a business conducting research into agency costs. 115/10 Minutes The minutes of the meeting of the Trust Board on 28 June were agreed as a correct record with an additional bullet-point in minute 103/10 reflecting the committee s concerns about overperformance on activity. The Board action list was reviewed. The minutes of the meeting of the Membership Council on 27 May were agreed as a correct record, subject to the amendment of members to governors in minute 82/10, reference item 62.19 a). 116/10 a) b) c) d) e) f) Acting Chief Executive s Report Robert Woolley reported to the meeting on the following: Liberating the NHS (Health White Paper): the Department of Health was bringing out a series of consultation papers and a process would be established for the compilation of a response by the Trust in accordance with the 11 October deadline. Key features emerging so far: The abolition of the primary care trusts and strategic health authorities by 2013 All NHS providers to become Foundation Trusts by 2013 No privatisation, but removal of private patient cap All but specialist commissioning functions transferred to GPs accountable to NHS Commissioning Board A greater focus on patient outcomes over process targets Monitor to become an economic regulator Merger and acquisitions process simplified There was an opportunity for the Trust to take a leadership role in the changes to the healthcare system. The Trust was also developing a plan to engage with the GPs. Governors would discuss the White Paper at the governors informal meeting on 6 September. Board level changes: long term arrangements for the Chief Operating Officer and Medical Director posts would be made when the substantive Chief Executive was appointed in September. Deborah Lee remained as Acting Director of Corporate Development, Tony Ranzetta had started as Acting Chief Operating Officer and arrangements to cover the Medical Director role would be announced in due course. Graham Rich had now left the Trust. Histopathology: the final report was expected at the beginning of October and arrangements were being made for its publication Patient Safety - a lessons learned report would be made following a report on the unauthorised administration of opiates to patients by a nurse practitioner between 2000 and 2002; Robert Woolley assured the meeting that the Trust did not stock this particular drug Homeopathy the Government s response to the Science & Technology Select Committee report had confirmed that contracting these services was a matter for primary care trusts to determine. The Trust would continue to provide homeopathy services on the basis of contracted demand from commissioners. Baby-friendly city Bristol was the first UK city to have been awarded baby-friendly status Date Tuesday, August 03, 2010 Author V Goodwin Page 3 of 11
Paul May noted that some local planning functions of primary care trusts would pass to local authorities. Robert Woolley gave assurance that there would be partnership working to respond to this. Frank Palma asked about the pressures to reduce admissions and length of stay and the alternative community provision. Robert Woolley agreed that GPs were likely to be incentivised to use alternative community-based provision; Jonathan Sheffield added that the Trust would work with community providers to shape these services. Neil Auty asked about sources of funding and how negotiations would be conducted under the new arrangements. Robert Woolley stated that while specialist commissioning would be managed nationally, GPs would assemble into consortia. Community pathways would add to the range of available patient pathways and the Trust would work with GPs to co-ordinate activity. Jim Catterall asked about the development of incentives for GPs to reduce hospital admissions by referring patients to community services. Robert Woolley responded that the incentives had yet to emerge; there was however a concern that spending reductions of 25% in allied services would affect services provided by the Trust. 117/10 a) b) c) d) e) f) Governors Report Liz Corrigan presented the governors report. At the last informal governors meeting they had looked at a range of issues including communication, and the way that the governors interact with the Trust. She highlighted: New Governors - Liz formally welcomed the 12 new governors and two returning governors for a second term in office. Vice Chair/Governor Representative At the last Informal Meeting the governors discussed the implications of the current Vice Chair/Governor Representative title and Monitor s suggested title of Lead governor. The governor s proposed the title of Governor Representative. This decision was proposed by Jeannette Jones, seconded by Mary Hodges and voted upon and carried. The Governors agreed the title of Governor Representative. Executive Team departures - on behalf of the governors Liz Corrigan wished Jonathan Sheffield and Irene Gray good luck in their new ventures. Governor Response to the Government s White paper - Liz suggested that the governors work in groups, each taking a section of the white paper and then formulate a joint response after the informal meeting in September in time for the October deadline. Constitutional Changes Other than the changes recommended by the Nominations and Appointments Committee, there were no other suggested changes to the Constitution this year. However Liz Corrigan suggested that the governors should make time to explore the Constitution over the next year. Executive Walk Rounds - Robert Woolley updated the governors on the Executive walk rounds. He felt that a large group of people may restrict staff s ability to talk confidentially to the Executives. He suggested that the governors who are currently signed-up to attend can Date Tuesday, August 03, 2010 Author V Goodwin Page 4 of 11
proceed, but in September he aimed to introduce a new quality walk round. Governors will be invited to join these. Liz suggested that the governors should discuss this at the September meeting. g) Governor Involvement - Anne Skinner was concerned that governors have been asked to join Trust-wide committees that are currently fully subscribed. Anne Reader suggested that if any governor is interested in joining any committees that they approach her, and she will contact the group chair to see if any additional governors can join. John Savage confirmed that he welcomes the governors involvement throughout the Trust. The Membership Council received the Governors Report. 118 /10 Performance & Quality Report On behalf of Deborah Lee, Ben Hume introduced the report. Steve Aumayer reported on the workforce section as follows: Workforce numbers, including bank and agency continued to decline Sickness rates were worse than was targeted, but the target and the actual continued to converge Appraisal rates were 4% below the target A detailed action plan was in place to improve compliance with child protection training In relation to the use of bank and agency staff, it was noted that agency staff were often a less expensive way to deliver ancillary roles, for example in Estates & Facilities. It was preferred to use bank staff for nursing and midwifery roles. However, bank staff could be expensive when employed for unsocial hours. In response to a question from Frank Palma about the Agency Workers Directive, Steve Aumayer said that in order to keep the distinction clear who about who is seen as an agency worker s true employer, it was important that workers performed work for other clients in addition to the Trust. In a response to questions from Lisa Gardner about compliance with infection control training and appraisal, Steve Aumayer stated that his directorate continued to work hard to address these issues. The Chair emphasised that the Trust could not afford to lose focus on control of infection. Jonathan Sheffield reported on the Quality section and highlighted the introduction of orthopaedic hot clinics in the emergency department. In the thoracic and colorectal areas, an enhanced recovery pathway had been introduced which helped ensure patients were fit for surgery and this improved recovery rates. The Board also received an account of an actual patient experience. It was noted that hand hygiene compliance was improving and the antibiotic compliance was being emphasised in the trainee doctors induction programme; this was reinforced through the introduction of electronic prescribing. The use of the World Health Organisation pre-surgery checklist continued to be promoted as some theatres were not making use of it frequently enough. Executives were addressing the slippage in the proportion of patient safety walk-rounds completed. Date Tuesday, August 03, 2010 Author V Goodwin Page 5 of 11
John Steeds asked about the implementation of patient safety alerts and it was noted that detailed compliance with these was monitored on the Board s behalf by the Governance & Risk Management Committee. Wendy Gregory reported that she had met with Helen Morgan to discuss several issues her family had encountered at the BRI. These covered problems with estates, pharmacology, and delays in fracture diagnosis. Jonathan Sheffield confirmed that an expert diagnosis of all fractures will now be done within 24hrs. Tony Ranzetta presented the patient access section of the report. In June, the Trust had achieved the 62 day cancer standard on GP referrals; however, the Trust expected to fail this target in quarter 1. The possible inclusion of the figures relating to patients seen by the Avon Breast Screening service could have a bearing on the final figure. A reduction in thoracic surgery sessions was being addressed. Performance on two week referrals was improving and breast screening has improved to 82% against a standard of 93%. Capacity would be added to address this. A breach due to capacity should be regarded as a never event. In response to a question from Neil Auty it was noted that patients sometimes chose to delay treatment, which caused the Trust to breach. To help sustain performance on 31 day standards, a need for additional intensive care capacity had been identified and a business case was being considered by the Trust s commissioners. On 18 weeks, there was only one area not achieving 90% for admitted patients and one speciality 95% for non-admitted patients. A recovery plan for cardiology services would be reported to the August Trust Board meeting. On A&E, high levels of attendances continued to be seen; the Trust had achieved the 98% target in quarter one and had performed at 98.8% in July to date. The Trust continued to work with the Emergency Care Intensive Support Team. Chris Perry presented the update on infection control. Cases of C. Diff had been escalated and outbreaks addressed and cases were now reducing. Hand hygiene continued to be audited monthly, supplemented by a 15 minute observational check. The patient survey had reflected on staff s hand hygiene and it was noted that in some areas of the hospital, basins were located outside of patients view. Use of the hand gel at the end of the bed needed to me made more overt. The Trust s standard for new builds included a hand basin by each bed. Paul May emphasised the need to make a priority of infection control training. In response to a question from Kelvin Blake about the availability of cleaning equipment at the Bristol General Hospital, Chris Perry informed the meeting that there was no hydrogen peroxide vaporisation equipment based at the General Hospital, but that it could be provided there where necessary. Pauline Beddoes asked if they linked up with other departments like dietetics to improve the overall good health of the patient. Chris Perry confirmed that they work with other departments to look at patient safety, pressure sores, dietetics and other factors to improve general good health. 119/10 Financial Report Date Tuesday, August 03, 2010 Author V Goodwin Page 6 of 11
The Board and Council received a report of the meeting of the meeting of the Board s Finance Committee held on 23 July. Lisa Gardner reported that the Trust had generated a surplus of 1.295m to 30 June and that the Trust s financial Monitor risk rating was being declared as 3 in accordance with the plan. This would move back up to 4 in later quarters. The Trust continued to use non-recurring reserves to cover recurring overspends by divisions. The Trust s earnings before interest, tax, depreciation and amortisation were slightly below plan, due to a provision for C.Difficile fines. A year-end shortfall on cash releasing efficiency savings of 3.154 was projected. Concerns remained about levels of activity which were higher than provided for by service level agreements; the committee had reviewed a range of risks associated with unplanned activity and non-delivery of key performance indicators. Paul Mapson added that elective activity levels were stable, but increases were mainly through emergency admissions. Provision had been made for performance fines. GPs would in future control the Trust s activity levels although it was not yet clear whether they would continue to be able to exact penalties from providers. Robert Woolley added that the tariff should provide performance incentives whilst avoiding the need for fines. The Board received the finance report. 120/10 Monitor Compliance Framework The Board received an information report detailing changes that Monitor had made to the Compliance Framework, reflecting changes made by the Department of Health to the NHS Operating Framework. This included a change to a 95% threshold for 4hr/A&E and no requirement to certify against the 18 week targets. However, targets reflecting the position originally set out in the NHS Operating Plan remained in place through the NHS Constitution and the Trust s contracts with its commissioners. The Board noted the report. 121/10 Quarter 1 Reports for Monitor Submission The Board received a report setting out draft submissions for finance and governance required by Monitor. The finance self-declaration was 3 in accordance with the annual plan and the governance self-declaration was red because of the anticipated failure to meet the 62 day cancer standard over four consecutive quarters. The submission included the results and turnout of the recent governor elections. Robert Woolley noted that Monitor were not proposing formally to intervene in the Trust s case. The Board approved the draft submissions for Monitor. 122/10 Report of the Trust Executive Group The Board received a report setting out matters considered by the Trust Executive Group during July. Robert Woolley highlighted that head and neck services would centralise at the Trust from spring 2012. Paul May requested an update on the work of the transformation programme, which Robert Woolley agreed to provide. 123/10 Updating the Constitution The Board received a report setting out proposals to review the Trust s Constitution to incorporate provisions made by the latest Monitor Model Constitution. The proposals established the annual joint meeting as the main forum for approval of changes sought by the Board and the Membership Council. The report detailed clarifications of the Membership Date Tuesday, August 03, 2010 Author V Goodwin Page 7 of 11
Council s terms of reference. The Constitution currently gave details of the two discretionary committees established by the Board and it was proposed that these should not be referred to here; however it was confirmed that this change in no way affected the committees status. The report also set out a statement of the Chair s and Chief Executive s respective responsibilities which was a requirement of the Code of Governance. A statement of matters reserved to the Board was provided for information and for adoption when the Board reviewed the scheme of delegation. The Board approved the report. 124/10 National Research Ethics Service Hosting Arrangements The Board received a report giving the recommendation of the Finance Committee that, subject to the completion by the Director of Finance of a due diligence review and a legal agreement that the Trust should agree to host this service. The benefit to the Trust was that this re-enforced its role as the leading medical research body in the south-west. The Board approved the recommendation as set out above. 125/10 Review of Governor Sub-Groups Chris Swonnell presented a paper to the Membership Council proposing an amendment to the current structure of the governor sub-groups. At the last Governors informal meeting it was agreed that a review of the sub groups should take place to resolve the overlap with other sub groups. He proposed the following re-structure. The current Involvement sub group becomes a Membership working group, with the other involvement activities transferring to the Quality working group. That certain common practices are adopted by all sub groups, in particular that sub groups are chaired by Governors. The Membership Council agreed: The proposed restructure of the Involvement sub group to become a Membership working group with the other involvement activities transferring to the Quality working group. The Membership council agreed that all working groups be chaired by governors. Details to be discussed at the next Governors Informal meeting on 6 th September 2010. 126/10 National Inpatients Survey 2009 The Board received a report detailing the findings of the survey, which had been the subject of an earlier presentation. Jonathan Sheffield drew attention to the action plan which accompanied the report. 127/10 Corporate Objectives Annual Plan Progress The Board received a report showing generally good progress with the Trust s objectives set out in the annual plan. Paul May highlighted the need to continue with training on infection control in support of objective PE04. Date Tuesday, August 03, 2010 Author V Goodwin Page 8 of 11
Frank Palma was concerned by an apparent sudden increase in the levels of serious untoward incidents. Jonathan Sheffield gave assurance that fluctuations in the ratings were a regular feature and that and the report was designed to highlight any adverse trend. 128/10 Bristol Royal Infirmary redevelopment update The board received a report updating it on the progress of this project. Robert Woolley informed the Board that the programme was delayed by 6 months and that there was now a risk to completing the project to co-incide with the opening of the new Southmead hospital in May 2014. The delay was due to messages arising from the national Quality, Innovation, Productivity and Prevention (QIPP) programme regarding reducing the reliance on acute hospital beds. The Trust was also investigating a commercial loan to finance the project. Paul Mapson added that the prudential borrowing limit would apply to either publicly or privately derived finance. The Trust had been capping the expenditure on design work for variants to the scheme. The design work completed had shown that value for money reduced in line with reductions to the scale of the proposed scheme. The Trust was therefore working to deliver the model of care shown in the original outline business case on the basis of fewer beds, but providing for new models of care. It was noted that the BRI entrance scheme was currently on hold; charitable funding may need to be sought for this. The Chair emphasised that one of the key benefits of the redevelopment scheme would be to improve the environment for many of the Trust s inpatients. Kelvin Blake asked that governors continue to support the redevelopment scheme within their constituencies. 129/10 a) Reports of Governor sub-committees Nominations and Appointments Committee Jeannette Jones presented the report on behalf of the committee. Revision of Terms of erence - The Committee proposed revisions to paragraph 10.3 of Annex 7 of the Trust s Constitution: Standing Orders of the Membership Council which set out the composition of the Nominations and Appointments Committee and is reflected in its terms of reference. The amendments have been suggested to allow the Committee to be less restrictive of its governor membership, and to allow the committee to be more flexible in its attendance in order to be quorate. The proposed changes were that the committee should comprise four public patient or carer governors, two Appointed Governors and one Staff Governor. In addition, it was proposed that paragraph 10.3.5 be removed: No two governors will be appointed from the same Public constituency, nor from the same class of the Patient and Carer constituency. The Committee also proposed to revise its quorum from four governors plus the Chair to three governors plus the Chair. The Membership Council and the Board accepted the Committee s recommendation to revise the Trust s Constitution to reflect the proposed amendments to the Nomination and Date Tuesday, August 03, 2010 Author V Goodwin Page 9 of 11
Appointments Committee s terms of reference. b) c) Non-Executive Director Recruitment and Re-appointments - The Membership Council noted the status of the Non-Executive Director recruitment and future re-appointments. Governor Vacancies on the Committee - There are currently two governor vacancies on the committee: one for a patient governor and one for a public governor. With the imminent Non- Executive Director recruitment campaign, the Committee had agreed to progress filling the vacancies on its current basis rather than wait for the revised Constitution. There have been two expressions of interest from patient governors, and one from a public governor. Mo Schiller had offered to fill the vacancy of public governor on the Committee. It was proposed to conduct a vote with the local patient governors to fill the remaining vacancy on the Committee. The Membership Council noted the status of the Committee vacancies, approved Mo Schiller as a public governor on the Committee, and agreed the proposal to conduct a vote between David Aldington and John Steeds in the local patient constituency to fill the patient governor vacancy. Anne Ford presented the Strategy sub group report for information. There was no report from the Quality sub group. Youth Council Cathy Gane made a presentation on the Youth Council. She covered: Analysis of the Youth Council membership (ages, ethnicity, recruitment of Foundation Trust members etc) Involvement activity (inspecting hospitals and services, ensuring information is young people friendly, research opportunities etc) Two youth council members were recently elected by the public and patient members to be governors. Future reports on youth council activity to the Membership Council will be conducted by Jade Scott-Blagrove and Jacob Butterly. 130/10 Annual Governance Reports The meeting received for information the following: Infection Control Health & Safety Complaints Annual Report and Patient Advice & Liaison Service Annual Report Information Governance Audit and Assurance Committee Annual Report Phil Mackie was concerned to hear that the Disabled Children s Working Group was advertising for a leader for 18.5 hours per week, and felt this warranted a full time post. Steve Aumayer offered to investigate further. Date Tuesday, August 03, 2010 Author V Goodwin Page 10 of 11
131/10 Research & Innovation Quarterly Update Jonathan Sheffield highlighted the research funding award of 1.5m to a project led by Dr A V Ramanan. 132/10 Dates of Future Meetings Annual Public Meeting and Annual Members Meeting: 22 September 2010 Membership Council: 4 November 2010 Trust Board: 26 August 2010 Joint meeting: 27 July 2011 Date Tuesday, August 03, 2010 Author V Goodwin Page 11 of 11