BOARD OF DIRECTORS OPEN MEETING MINUTES, ACTIONS & DECISIONS

BOARD OF DIRECTORS OPEN MEETING MINUTES, ACTIONS & DECISIONS Date: Thursday 26 February 2015 Time: 14:00-17:30 Venue: Present: Conference Room, Field House, Bradford Royal Infirmary Chair: Non-Executive Directors: - Professor Lord Patel of Bradford OBE (KP) - Professor Grace Alderson (GA) - Dr Trevor Higgins (TH) - Mr David Munt (DM) - Mrs Pauline Vickers (PV) - Professor James Walker (JJW) - Mr Amjad Pervez (AP) - Dr Mohammed Iqbal (MI) Professor Lord Patel of Bradford OBE (KP) Executive Directors: - Professor Clive Kay, Chief Executive (CLK) - Mrs Helen Barker, Chief Operating Officer (HB) - Ms Juliette Greenwood, Chief Nurse (JG) - Mr Matthew Horner, Director of Finance (MH) - Dr Robin Jeffrey, Medical Director (RJ) - Ms Pat Campbell, Director of Human Resources (PC) - Ms Cindy Fedell, Director of Informatics (CF) - Ms Donna Thompson, Director of Governance and Corporate Affairs (DT) In Attendance: - Mr Chris Allcock, Trust Secretary (CA) - Ms Lorraine Cameron, Head of Equality (LC) - Nahida Mafuz, Minute Taker (NM) Observers: - One Public Governor - Three members of staff Apologies: - No apologies No. Agenda Item Action B15/23.0 Apologies for absence There were no apologies to note. B15/24.0 Patient Story The Board received a patient story from the step daughter of a deceased patient who had received treatment at the Bradford Royal Infirmary (BRI) in June 2013. The patient had been in a care home due to vascular dementia following a stroke and he had fallen and fractured his shoulder prior to his admission to BRI. The patient was transferred to Eccleshill Hospital where his condition deteriorated and he suffered a suspected blood clot upon which he was transferred back to BRI. Following further treatment he was once again transferred to Eccleshill Hospital but suffered further 1

complications and was again transferred to BRI. The step daughter of the patient highlighted a range of concerns about the subsequent care prior to his death. The step daughter did wish to emphasise however that the staff she dealt with when registering his death were very good as were the ward hospitality staff and volunteers. KP thanked the patient s step daughter for sharing the experience of the patient and his carers. Post meeting note: It was agreed that an investigation into the matters raised would be completed and the outcome would be fed back to the Quality and Safety Committee. B15/25.0 Minutes of the Meeting held on Thursday 29 January 2015 The minutes of the last meeting were accepted as a correct record subject to some minor changes. B15/26.0 Matters Arising: The following items were concluded from the action log: - 8.6 (27/11/14): Equality and Diversity report to February meeting this item was on the agenda (B15/27.0). - B15/8.2 (29/01/15): Update Monitor on RTT position this item was on the agenda (B15/31.3). - B15/10.0 (29/01/15): Risk Management Policy Health & Safety Committee has been included within the policy but the purpose also needs to be included. Action concluded B15/26.1 Risk Management Training The training had been secured pending suitable date and time. B15/27.0 Equality and Diversity Presentation Lorraine Cameron (LC), Head of Equality and PC presented the Equality and Diversity six monthly update. The presentation included the information that was provided to the Equality Panels in December 2014 who assessed the Foundation Trust s progress against the Equality Objectives that were set across Bradford in 2012. Two key areas that the Foundation Trust had made good progress with and which were previously red rated were: Ensure that services better meet the need of transgender people and Increase the diversity of Boards and their understanding of equality issues. The Equality Panels also highlighted that the Foundation Trust had shown good work in relation to Project SEARCH. One of the achievements was that another seven organisations nationally had established Project SEARCH programmes following the coverage on Radio 4. LC explained that the Workforce Race Equality Standard (WRES) will be 2

included in the NHS contract from 2015/2016 and there are nine key areas that will need to be reported on. LC presented the statistics of where the Foundation Trust currently stands with some of these standards. PC added that when putting these in context against other Trusts the Foundation Trust is below average in some of these. KP agreed that this is a very important area to consider and is very high on the agenda of the CQC. MI expressed his concern that broadly speaking this area had not been tackled in Bradford but was pleased to see that is being addressed at the Foundation Trust. AP agreed and said it is very important to work with local partners and regional bodies to help progress this. PC stated that the Foundation Trust was working collaboratively with Bradford District Care Trust (BDCT) which had a strategy in place. They had an aspirational target to change the composition of the workforce to 35% BME. The Foundation Trust proposed to match this but set a timescale of 10 years to achieve this. TH challenged the 35% being the correct figure of the BME working age population. LC/PC believed this was correct and agreed to circulate the report from BDCT which demonstrated this. Pat Campbell PC asked the to note the progress and further action required to ensure compliance with the requirements of the Equality Act 2010. The approved the target of achieving a workforce which reflects the local working age population of 35% BME staff over a 10 year timescale. B15/28.0 Report from the Chairman KP reported he had continued with a variety of meetings and functions to progress a variety of work. He had also continued to work with facilitators with regards to the Development Day next week. B15/29.0 Report from the Chief Executive CLK presented his report and drew attention to the following: CLK was pleased to announce that the new substantive Medical Director post had been offered to Dr Bryan Gill, currently Deputy Medical Director at Leeds Teaching Hospitals. CLK wished to express his sincere thanks to Dr Robin Jeffrey who had done a sterling and outstanding job to a very high standard during the interim period. CLK is continuing to work with the Bradford District Integrated Change Board regarding the New Models of Care Programme and the outcome would be known by the end of the day regarding whether the proposal had been shortlisted. Following the CQC inspection in October 2014 the Quality Summit had been delayed due to internal reasons at the CQC. It is now likely to take place w.c. 20 March 2015 but a confirmed date had not yet been agreed. 3

PwC would be undertaking the Governance Review as required by Monitor over the next few weeks. PwC will attend the next Board of Directors meeting and various Committee meetings. A further round of CEO Listening Events is taking place across all hospital sites and dates had been circulated to staff via global email. CLK will be accompanied by one or more executive colleagues at these events. MH explained the new tariff arrangements proposal for 2015/16. An enhanced tariff offer had been published and NHS providers are providing daily bulletins with regards to this which showed 60% of providers are opting for the enhanced tariff currently and this is the better option for the Foundation Trust. The date of the submission of the annual plans had also been delayed due to the delay in new tariff arrangements. If no agreement is made then the existing tariff would be rolled forward until a decision is made. B15/30.0 Patient Safety, Experience and Clinical Effectiveness B15/30.1 Report from the Quality and Safety Committee February 2015 JJW presented the report from the meeting of the Quality and Safety Committee held on 12 February 2015 and made the following key points: Information governance incidents in relation to lost handover sheets: work is being done to address this issue but this does appear to have been a recurring problem. KP asked if the Committee was assured with the work being done to address the issue. JJW said it was a concern and discussions had taken place with further actions being undertaken in relation to education of staff but also providing facilities for the paperwork. Spanish nurses recruitment: there is a delay in the nurses receiving their registration. Serious incidents: four of the seven serious incidents were related to pressure ulcers. The remaining serious incidents were discussed at the Committee meeting. Quality & Safety Business Schedule: the Committee is trying to streamline this as well as the overall reporting and how this is fed back to the. There are various obligations that need to be met whilst some items are annual reports. This was currently work in progress. HB wished to inform the that the validation of the 205,000 patient pathways in relation to non-clinical validation had been completed. B15/30.2 Infection Prevention and Control Report JG apologised for a typing error on page 7 of the report where the last sentence should be March 2015 not March 2014. 4

JG presented the monthly report and made the following key points: A total of 5 cases of MRSA bacteraemia have occurred to date in 2014-15. The post infection reviews had shown no contributory factors or issues but did highlight issues that may be relevant in other cases There have been no further cases of Trust acquired CPE on Ward 6 but a consistent steady number of readmission of patients with CPE had been noted. MI asked how the targets are set and JG explained that the targets are set nationally. TH confirmed these targets vary for each Trust. B15/30.3 Nurse Staffing Report JG explained this paper reports on the nurse staffing data for January 2015 and demonstrates the actual staffing levels in place against the plan. JG highlighted an error on the first page key point 2 should state HCAs not registered nurses. JG explained that the percentage figures of day and night fill rates are expected to be different to the plan due to the needs of the patients. There were 11 incidents raised by staff on Datix during January in relation to staffing concerns. There were occasions when one registered nurse or midwife was on duty at any one time and the report provides details of these occasions along with the mitigation that was put in place. The Foundation Trust is yet to adopt the use of red flags as per NICE guidance with the intent being to capture these via the proposed procurement of the software system ipams. However in the absence of this JG is exploring if there are any approaches that can be instigated to start to develop this agenda. The key issue is raising the red flag, responding to it within the nationally defined timeframe through escalation and capturing the red flag by location, issues and time plus actions taken. JG said that the Safe Staffing Guidance for Midwifery Staffing is due to be published 27 February. A review of the impact of this and actions required will be provided to the April Meeting following internal analysis. Juliette Greenwood CLK asked who undertook the assurance walk rounds and JG said this was the Head of Nursing and Matrons. Any concerns from patients were acted on and reported. AP said the paper reports on the functionality of staffing but where is the connection with value and experience of patients. JG explained that the report provides the assurance that the Foundation Trust had the right staffing levels in place based on the needs of the service. TH explained the reports that are provided to the Performance Committee and Quality & Safety Committee encompass not only data but also patient experience, patient safety and patient complaints. GA queried the different scales on the graphs in relation to day fill rates 5

and night fill rates and said it would be easier to compare if they were within the same range. JG said this would be corrected in the next report. Juliette Greenwood GA asked how often the bed meetings take place and HB confirmed these take place every four hours during the day. JJW asked how the closures of beds are managed due to not having safe staffing levels. JG said activity is managed closely and monitored and the decision to close beds is considered carefully. B15/30.4 Workforce Report PC presented the report which was also presented to the last meeting of the Quality & Safety Committee. There had been an improvement to recruitment but the report also highlights some known pressures. With regards to consultant and junior medical recruitment there are no particular concerns from the Divisions. The Sexual Health TUPE consultation is currently underway. The long shifts consultation is due to be completed on 6 April 2015. The mandatory training performance was reported to the last Performance Committee meeting and it was that agreed that any compliance concerns will be reported to the Quality & Safety Committee. B15/30.5 Complaints Report JG provided the Quarter 3 update on complaints. 142 complaints had been received during the quarter. December 2014 received 58 complaints in comparison to 34 in December 2013. Compared to the previous year there was a decrease in the number of moderate complaints and an increase in the number of low complaints. JG explained that the Heads of Nursing in each Division are doing work in relation to the grading of complaints. Three complaints had been graded as extreme during the quarter. There is an internal target of completing investigations into complaints and respond to complainants within 25 days but this is currently not being achieved. Following the Clwyd/Hart report 43 recommendations were made of which 26 were applicable to the Foundation Trust and 22 of these have been implemented. The remainder are being actioned and monitored through the Complaints Steering Group and the Internal Audit Team will be undertaking a deep dive of these. AP asked how feedback is obtained from patients. JG explained that all patients are encouraged to complete the Friends and Family Test to provide feedback. There are also additional varying approaches across 6

the Foundation Trust in terms of obtaining patient feedback. The Foundation Trust is also currently looking into real time feedback via electronic devices. AP asked how we are encouraging feedback from particular communities with differing educational attainment. JG said that work is being done to consider access for patients with different languages e.g. interpreters. For patients who do not have cognitive awareness work is being done with carers to look at this. GA asked who decided who will undertake the training and the grading of training. JG replied that it was predominantly Matrons and Heads of Nursing. B15/30.6 Quality Improvement Strategy RJ explained that the Patients First Strategy has been incorporated into the Quality Improvement Strategy to give the full picture of Quality Improvement. One of the main drivers for the strategy was the SAFE! Improvement Plan which has had good feedback. The Quality Improvement Strategy forms a key stream within the Transformation agenda. GA said the Health Foundation Framework for the Measurement and Monitoring of Safety could be very useful for the, Divisions and clinical areas as well as individuals when looking at the aspect of safety. HB said the patient flow collaborative is also using this principle. CLK said that he would consider inviting Charles Vincent to visit the Foundation Trust and to deliver a presentation to the. JJW agreed this would be useful and help understand how it could be implemented. Clive Kay The strategy was approved by the. B15/30.7 Minutes of Quality and Safety Committee January 2015 The received and noted the minutes of the Quality and Safety Committee for January 2015. B15/31.0 Performance B15/31.1 Report from the Performance Committee February 2015 TH gave a brief summary of the key issues which had been covered in the meeting of the Performance Committee held earlier in the morning: January metrics achieved were excellent bearing in mind the AED pressures from December. TH wished to thank the Executive Directors for their efforts. Progress on EPR will be reported through the informatics report monthly. The sickness absence rate in December was 6.1% which is a concerning issue. It was agreed by the Committee that a fresh look at this is needed as it is costing the Foundation Trust. The Internal Audit Team will be involved to ensure the data is correct and the process 7

will also be looked into. Some new ideas will also be introduced as PV will be working with PC in relation to some of the improvements made at Royal Mail recently. The financial position was similar to that which had been previously reported. The RTT target is expected to be achieved from April 2015. B15/31.2 Finance Report MH presented the finance report. The Foundation Trust was reporting a surplus of 1.9m at the end of January which was behind plan. The Continuity of Service Risk Rating remains at 4 and there is a degree of headroom before a rating of 3 is triggered. The Foundation Trust is reporting an EBITDA return of 12.09m which equates to 4%. When compared to the national context at the end of Quarter 3 the national average is 3.2% and when compared to other medium sized Trusts it is 2.3%. A 4% return represents a deterioration over recent years but the level of reduction is not as steep as fall reported across the FT sector. MH also noted that at the end of Quarter 3 60 out of 83 Acute Foundation Trusts were reporting deficits. There were concerns from an expenditure perspective for the Division of Surgery & Anaesthesia and the Division of Medicine. The Division of Surgery & Anaesthesia had reduced their expenditure but have had difficulty from an income perspective due to the elective income position. The Division of Medicine had had to use agency staff in order to maintain safe staffing levels. The majority related to costs incurred with the agencies charging high hourly rates (as a result of being unable to source shifts from the TNR or regular agencies). For 2015/16 the Foundation Trust faces a challenge of saving 16-18m. The next few weeks will focus on the QIPP opportunities for 2015/16. The revenue budget plan proposal for the Foundation Trust will be presented to the next meeting of the. GA pointed out that the agency spend was significant and this should be addressed. MH confirmed that work is being done through the Transformation Board and as part of the process the piloting of a Neutral Vendor model has been put in place which will help reduce the cost. AP asked if there was a plan in terms of revenue generation opportunities with overseas income identified. MH said this is something the Foundation Trust will be considering but noted that the appropriate infrastructure and capacity needed to be in place to progress this. B15/31.3 Performance and Productivity Report HB highlighted the key performance issues: Performance for January was good and recognition was given to the management team who had worked hard to get the Foundation Trust to this position. With regards to the Emergency Care Standard Silver Command 8

remained in place until January and the Foundation Trust was one of a small handful of Trusts that had delivered consistently this month. The diagnostic waiting times performance had been sustained. Cancer targets had been delivered except for 31 Day Subsequent Surgery which failed in December however it was worth noting that three out of the five failures were due to late referrals from other providers. In relation to the RTT HB had formally written to Monitor reporting the Foundation Trusts position. The RTT Admitted position was a fail for January but the Executive Directors had made the decision to deal with the longest waiters. Non Admitted performance may be at risk in February due to the team focusing on the Admitted target. All Divisions have a plan in place. The Intensive Support Team are working with the Foundation Trust and looking at the administration element with regards to the Centralised Patient Booking Service (CPBS) to ensure the processes support safe patient care. B15/31.4 Informatics Performance Report CF presented the Informatics Performance Report. The key points to note were: EPR preparation work was progressing well. There had been was an unplanned outage of the network and this was being investigated. A report will be provided when the investigation has been completed. Income was lost within clinical coding due to data not being coded in time. This is being worked through to ensure correct information is available. DM said Clinical Coders are hard to recruit and require lengthy training. DM asked if the EPR will make this easier and CF confirmed that it will. Corporate Information continues to experience resource issues impacting our ability to provide the organisation with information needed to run the business. There had been four Information Governance breaches and an action plan was in place with a number of steps already taken. CF noted that the Information Commissioner has formally requested additional information from us. A campaign has been planned. RJ added that he had written out to all consultants, junior doctors and nurses to remind them of their obligations. Oracle was currently undertaking an audit at the Foundation Trust. B15/31.5 Minutes of Performance Committee December 2014 The received and noted the minutes of the Performance Committee. B15/32.0 Strategy and Investment B15/32.1 Birthrate Plus JG explained that Birthrate Plus was the only available tool for workforce planning and strategic decision making for midwifery in the UK. The tool helps to identify the optimal requirements of midwives. 9

JG said that having reviewed the current regional position of midwives to birth ratio which is 1:30 the Foundation Trust is at 1:31. To get to the position of 1:30 requires an additional 6.5 midwives and 2.61 Midwife Support Workers. This equates to a financial investment of 337,269 in the short term. JG said that significant discussions have taken place at the Executive Directors meetings regarding this and Safer Nursing and her recommendation to the was to prioritise this investment 178,612. The accepted the findings and supported the recommendations as detailed within the paper. B15/33.0 Governance B15/33.1 Security Report April 2013-November 2014 HB presented the annual security report and made the following points: Clinical condition related assaults had increased and a group has been set up to look at this The Foundation Trust continues to maintain good relationships with the local Police. The security management team had received two awards during 2014 in recognition of commitment to partnership working with the police and for helping to ensure the safety and security of patients, visitors and staff. B15/33.2 Annual Fire Safety Report 2014 GA commented that the report is informative and very clear. GA queried fire training for the and asked if this could be organised. Chris Allcock PV highlighted that two of the incidents mentioned are in relation to lighters and this is a concern from a health and safety point of view. B15/33.3 Information Governance Toolkit CF explained the Information Governance Toolkit and said it was a requirement for the Foundation Trust to submit a self-assessment with regards to information governance. The toolkit was approved by the. B15/33.4 Report from Integrated Governance & Risk Committee February 2015 CLK updated that one new risk with regards to safe disposal of confidential waste had been added to the Corporate Risk Register. DT explained the background to the risk. 10

B15/33.5 Minutes from Audit and Assurance Committee November 2014 The received and noted the minutes of the Audit and Assurance Committee. B15/34.0 Issues to add to Corporate Risk Register There were no issues to add to the Corporate Risk Register. B15/35.0 Issues to escalate to Monitor There were no issues to escalate to Monitor. B15/36.0 Issues to be reported to Care Quality Commission (CQC) There were no issues to be reported to CQC. B15/37.0 Any other business Pre - Election Period: CA advised that the pre-election or purdah period would commence on 30 March and would continue until the new government is formed after the election on 7 May. During this period it is important that public bodies do not do anything that could influence or be seen to influence the election. Formal guidance was awaited however a summary of issues to consider had been received from NHS Providers which would be discussed at the next meeting of the Executive Directors. A further update will be given when guidance becomes available. Chris Allcock B15/38.0 Dates of future meetings: 26 March 2015, 2pm, Conference Room, Field House, BRI B15/39.0 Resolution to exclude members of the public and press At this point, due to the commercially sensitive nature of the business to be discussed, it was resolved to exclude members of the public from the next section of the meeting. The Chairman thanked all observers for attending. 11

Date of Meeting Agenda Item BRADFORD TEACHING HOSPITALS NHS FOUNDATION TRUST ACTIONS FROM BOARD OF DIRECTORS OPEN MEETING 26 FEBRUARY 2015 Required Action Lead Timescale Comments/Progress 27/11/14 6.3 Consideration of need for Workforce Review. PC 30/04/15 29/01/15 B15/7.6 End of Life Care: review of mandatory training. RJ 30/07/15 29/01/15 B15/10.0 Risk Management: training and development on risks for to be organised. 26/02/15 B15/27.0 Equality & Diversity Presentation: to circulate the findings from the BDCT study examining BME recruitment and experience. DT PC 30/04/15 26/03/15 26/02/15 B15/30.3 Nurse Staffing Report: update on the use of red flags JG 30/04/15 26/02/15 B15/30.3 Nurse Staffing Report: amend scales on graphs showing fill rates. 26/02/15 B15/30.6 Quality Improvement Strategy Health Foundation Framework for the Measurement and Monitoring of Safety: invite Charles Vincent to come and talk to the and do a presentation as well as a wider presentation to the Foundation Trust. 26/02/15 B15/33.2 Mandatory training for the to be organised. 26/02/15 B15/37.0 Pre-Election Period: a further update will be given at the March meeting of the Board. JG CLK CA CA 26/03/15 TBD 26/03/15 26/03/15 Secured the training but need to confirm the best time and date. 12