BOARD OF DIRECTORS OPEN MEETING MINUTES, ACTIONS & DECISIONS

BOARD OF DIRECTORS OPEN MEETING MINUTES, ACTIONS & DECISIONS Date: Thursday 25 June 2015 Time: 13:00-15:30 Venue: Present: Shears Foundation Lecture Theatre, Listening for Life Centre, Bradford Royal Infirmary Non-Executive : - Professor Lord Patel of Bradford OBE (KP) - Professor Grace Alderson (GA) - Dr Trevor Higgins (TH) - Dr Mohammed Iqbal (MI) - Mr David Munt (DM) - Mr Amjad Pervez (AP) - Mrs Pauline Vickers (PV) - Professor James Walker (JJW) Chair: Professor Lord Patel of Bradford OBE (KP) Executive : - Professor Clive Kay, Chief Executive (CLK) - Ms Jackie Ardley, Interim Chief Nurse (JA) - Ms Bernie Bluhm, Interim Director of Operational Management and Transformation (BB) - Ms Pat Campbell, Director of Human Resources (PC) - Ms Cindy Fedell, Director of Informatics (CF) - Dr Bryan Gill, Medical Director (BG) - Mr Matthew Horner, Director of Finance (MH) - Ms Donna Thompson, Director of Governance and Corporate Affairs (DT) In Attendance: - Mr Chris Allcock, Trust Secretary (CA) - Nahida Mafuz, Minute Taker (NM) Observers: - One Public Governor - Two members of the public - Five members of staff (for patient story) Apologies: - No apologies to note B15/114.0 Apologies for absence There were no apologies for absence. B15/115.0 Declaration of Interests There were no declarations of interests to note. B15/116.0 Patient Story The Board heard from a patient who had had an inpatient stay at the Bradford Royal Infirmary (BRI) in April 2015. He explained that following a surgical procedure he felt ill and very 1

low. A visit from a volunteer of the Chaplaincy Service, Mary Charlton, helped him feel better. Following this visit, Mary arranged for Joe Fielder, a member of staff from the Chaplaincy Service to come and visit him the same afternoon. Joe talked to him, prayed and read some of his favourite scriptures following which he felt his recovery improved and believes this was due to the intervention from the Chaplaincy Service. The patient complemented the care and service provided by Mr Griffith, Consultant General Surgeon and his team as well as the nursing staff on Wards 20, 21 and 8. He made some constructive suggestions which JA agreed to action as follows: Chief Nurse He had not been aware of the bedside folder of Patient Information which would have helped make him aware of the Chaplaincy Service. This was discussed and it was felt that a re-usable key information card which could be more prominent e.g. in or on the bedside locker might be useful to patients and could e.g. alert them to key aspects of patient support such as Chaplaincy and PALS teams. It was agreed that we should review how consistently we check a patient s religious faith and if we are pro-active in asking if they would like a visit from the chaplaincy team, whether they have a specific faith or not, and whether, for planned admissions, this could even be done before admission and recorded. JA to explore these suggestions with the relevant teams. To ensure that staff are aware of the patient story videos available on the internet. He also wished to highlight the difficulties faced by patients when accessing the toilets on Ward 8. There are a limited amount of toilets and some are too far down the ward for patients who have had surgery and may struggle to walk. KP thanked him for sharing his story and said it was good to hear about the excellent support provided by the Chaplaincy Team which is a crucial service for the Foundation Trust. B15/117.0 Minutes of the Meeting held on Thursday 28 May 2015 The minutes of the previous meeting were accepted as an accurate record. B15/118.0 Matters Arising: The following items were concluded from the action log: - B15/51.0 (26/03/15): The Foundation Trust is working through the 2

recommendations from the Savile report and CLK will be providing a response to Monitor in relation to this. Action covered at agenda item B15/121.8. Action concluded. - B15/53.2 (26/03/15): QIPP: GA asked if Clinical or Senior Managers from specialties could come and talk to the about the challenges they face and CLK said this would be considered. A rolling programme of attendance at the Quality and Safety Committee has been agreed. Action concluded. - B15/100.0 (28/05/15): Patient story JA reported on four actions: will visit Ward 14 and look at the ward facilities regarding dignity etc. To work with our own service and the Care Trust re poor quality of the consumables provided. To look at the creation of an Expert Panel to support the work with patients driving the agenda. Administration processes are currently being reviewed particularly protocols around results being available to GPs. BG, JA and BB visited Ward 14 and this is a big piece of work which will be ongoing. The Care Trust changed back to the old consumables within a week due to the number of complaints received. Expert panel work is ongoing with the team. JA will inform the patient to say all actions have been completed. Action concluded. - B15/104.1 (28/05/15): Chairman s Report: Letters from the Chairman to Palliative Care team and Chair of Bradford Care Trust. Action concluded. - B15/105.3 (28/05/15): Nurse Staffing Report: Separation of fill rates for SLH and Community Hospitals. Paper presented to Quality & Safety Committee. Action concluded. - B15/105.3 (28/05/15): Nurse Staffing Report: Use of consistent scales on graphs. Paper presented to Quality & Safety Committee. Action concluded. - B15/105.3 (28/05/15): Nurse Staffing Report: Remove name from report. Action concluded. - B15/108.3 (28/05/15): Corporate Priorities 2015/16: review emphasis on equality and diversity. Action discussed at agenda item B15/118.1. Action concluded. B15/118.1 Corporate Priorities 2015/16: review emphasis on equality and diversity PC described that the objective in relation to equality and diversity to promote equality and diversity across the organisation includes the following components: Comply with the Workforce Race Equality Standard and EDS2: Continue progress against existing equality objectives (agreed in 2012) Revise our equality objectives in consultation with local community and other key stakeholders (in accordance with 3

Equality Act requirement to review every four years). B15/119.0 Report from the Chairman KP reported that he had met with a wide range of external bodies and stakeholders over the previous month. MI asked if attempts had been made to engage with the three new MPs in Bradford and KP said this was on his agenda. B15/120.0 Reports from the Chief Executive B15/120.1 Chief Executive Report CLK provided highlights from his report. Discussion took place regarding a number of recent significant announcements from NHS Providers and the Foundation Trust is working through these to understand the implications of them. MH said that there was some financial benefit out of some of the changes but the need to continue to make efficiency savings still remains. BG said we also need to think of the here and now as well as focussing on redesign for the coming years and work needs to be done with the health economy to help achieve this. B15/120.2 Board and Committee Meeting Schedule CLK explained that following recommendations made by PwC and feedback from Board members the timetable for Board and Committee meetings has been reviewed. Attendance at the Committee meetings will include all Executive and all Non-Executive except the Chair and Vice Chair of the Board. The proposal is for the Quality and Safety Committee and Performance Committee to meet on the last Wednesday of each month and the Board meeting to take place two weeks and a day later. TH expressed his concern with the changes, particularly for when a member is on holiday for two weeks they shall miss a block of meetings. CLK explained the changes are required as per the recommendations of PwC and Monitor and explained that in the past issues had not been formally escalated due to the timing of the meetings and this will ensure a written audit trail is in place for any escalations. TH requested that the new schedule of meetings is reviewed in due course and KP agreed to this. CA circulated the key proposed dates. CLK proposed that the Meeting is held in the morning followed by a training session and for a timeout to take place on a quarterly basis. 4

DT said consideration needs to be given to holding some of the Board of Director Meetings within community settings and this will be considered within the new schedule. JJW felt the new schedule provided a better method of working and GA agreed. The approved the revised schedule. B15/121.0 Patient Safety, Experience and Clinical Effectiveness B15/121.1 Report from the Quality and Safety Committee June 2015 JJW presented the report from the meeting of the Quality and Safety Committee held on 11 June 2015 and made the following key points: The Non RTT situation was discussed and this has now progressed since the meeting of the Committee. Coronial Referrals and Conclusions were discussed discussion took place around the lessons learnt. Discussion took place regarding Serious Incidents. Claims were discussed and the Committee noted that the number of liability claims were relatively static. Staffing: JJW explained that detailed discussions had taken place regarding Paediatric staffing and community services staffing. The had previously signed off the staffing levels in January 2015 however, the new arrangements are different and will be reported to the once they have been finalised. JJW explained that the new arrangements were in fact better now than what was signed off. MRSA two cases had been attributed to the Foundation Trust. Level two Information Governance incidents discussions had taken place regarding handover sheets. JJW explained that compliance levels for Information Governance training were improving. PV said that during a walkround the previous week it was useful to see the signs and communication regarding handover sheets. Nursing recruitment now moved to recruit from the Philippines. Nursing recruitment is an ongoing issue as it is with other Trusts. JA said CLK had spoken to the Chief Nursing Officer from Monitor who has asked JA to do some work with the Nursing and Midwifery Council. B15/121.2 CQC Action Plan DT explained that a response had been provided to the CQC in relation to all the Must Do compliance actions via an action plan and feedback has not been received from the CQC regarding these yet. The CQC had also recommended twenty Should do actions and these are currently being put into a relevant format and will be monitored. DT explained that we have also gone through the CQC 5

report to identify and themes or issues and these will be shared with operational divisions as appropriate. DT provided an example of the action plan. A number of KPIs have been identified against the actions. A dashboard will be used to monitor progress against the actions. This includes a RAG rating against each action as well as progress against each KPI. BG said it was crucial that this was embedded into the quality dashboard so it gives the total picture and DT agreed this was important. CLK said if there are areas of concerns that come out of the hospital inspection programme they would be added to this and be monitored in the same way. DT agreed and said that the hospital inspection programme would highlight issues for the Foundation Trust to work on before a CQC inspection. JJW felt that the action plan was useful as it not only looks at solutions but also helps to implement them. GA said the Board needs to be assured that we are looking at all areas to ensure patient quality and safety improvements are in place and be in the driving seat. CLK said that although this takes time and resource to implement it is needed and is the right thing to do. MI was pleased to see that Healthwatch will be used. DT said if we could use Healthwatch to look at particular areas they will respond to that and be engaged. CF asked if any of the actions are already in progress and DT confirmed they are and the reporting processes are being finalised. B15/121.3 Planned Access CLK said that as this was a key issue for the Foundation Trust it was felt appropriate to provide a presentation to the. BB went through the presentation. BG explained that from the first cohort of patients, all patients who needed to be seen have now been seen. There were 13 forms submitted of which 12 are of low harm. The patients from cohort two will now be reviewed and reported back to the Quality and Safety Committee. KP asked if there was a potential for a further cohort to emerge and BB explained that this would be an ongoing challenge which will need to be managed. JJW said that although there may be a concern that more patients could be affected previous experience shows they are of administrative errors therefore he felt comfortable that we are working on the solutions to the problem. 6

TH added that capacity and demand is now also being reviewed which is a positive aspect that has come from the issue. B15/121.4 Infection Prevention and Control Report and Annual Report JA said all details were covered within the report. JA added that going forward we need to consider exception reporting rather than a detailed report and KP agreed that would be better. BG said we also need to consider benchmarking within the report and GA suggested that is done on an annual basis. B15/121.5 Nurse Staffing Report JA provided the following key points from the report: Reviewing our safer staffing: Staffing arrangements on each ward against acuity had been discussed the previous day. This will be reported to the Quality and Safety Committee. GA highlighted that the short term sickness was exceptional for this time of year. JA said she had been assured the previous day that sickness was being managed closely by the wards and HR were supporting this. PC said a reduction in sickness had been seen from February to April this year. MI commented he was pleased to see the assurances received in relation to daily fill rates for April and May and asked if this was the expected trend going forward. JA said we will be challenged as an organisation in the summer in terms of numbers of nurses but the work being done as part of patient flow will help and it is about mitigation and balance. CLK queried the average day care fill staff which was 135% at SLH. JA said this related to additional activity on the ward as well as looking at qualified staff against non-qualified staff. B15/121.6 Workforce Report PC explained all details were covered within the report. GA queried what the Bradford factor was and PC explained this was a formula to measure sickness absence and had been implemented by Bradford District Care Trust. GA asked whether we ask for reasons in relation to the early withdrawals of candidates applying for nursing posts. PC said this was generally due to candidates accepting a number of offers before deciding which one to progress. B15/121.7 Open and Honest Care Report JA provided the following key points from the report: There were no falls resulting in moderate or severe harm. 7

There is more work to be done to reduce pressure ulcers and this will be now be undertaken. GA said it was disappointing that only 59% of staff would recommend working at the Foundation Trust. B15/121.8 Savile Report Action Plan JA provided a brief overview of the report. JA said the lessons learnt and the recommendations need to be considered. The Foundation Trust has a very clear action plan against the recommendations that has been returned to Monitor. GA queried Recommendation 7 regarding the DBS checks the recommendation is to carry out a DBS check every three years however this should be strengthened through contracts by stipulating that staff and volunteers must declare any convictions. GA asked whether this was in place and PC explained that it was within contracts for staff to declare any convictions but she will check whether this is in place for volunteer contracts. KP said there are a number of actions to consider and the action plan should be discussed at a particular forum maybe at the Board development sessions. JA agreed to provide an update in six months regarding progress against the action plan. Director of Human Resources Chief Nurse The report was noted by all. B15/121.9 Minutes of Quality and Safety Committee May 2015 The received and noted the minutes of the Quality and Safety Committee for May 2015. B15/121.10 Workforce Race Equality Standard and Equality and Diversity Update June 2015 PC explained this was a follow up paper to the presentation delivered by herself and Lorraine Cameron, Head of Equality and Diversity at the February Meeting. The first submission of the Workforce Race Equality Standard (WRES) will be made by the 1 July to NHS England and CCG. The purpose of the WRES is to address areas where BME people are either underrepresented or report poorer staff experience. The BME workforce was 24.7% in March which is the highest BME workforce within the regional benchmarked Trusts. 7.59% of senior managers are BME which is quite low and there is work to be done on improving this. The report also indicates that BME staff are less likely to be appointed to a post from shortlisting than white staff. This has been monitored 8

over the last few years and the position improved slightly. AP asked what the ethnicity makeup of the recruitment panel usually is and PC said it was predominantly white due to the composition of senior managers. The Foundation Trust has a lower level of BME staff entering a formal disciplinary process that other Trusts which is positive. KP felt some good work had been done at this very early stage and this needs to be built on with further analysis following additional data and benchmarking as this becomes available. B15/122.0 Performance B15/122.1 Report from the Performance Committee June 2015 TH provided a brief summary of the key issues which had been covered in the meeting of the Performance Committee held earlier in the day: There were two cases of MRSA attributed to the Foundation Trust in May. There were three cases of C.difficile and these were awaiting post infection review. The RTT admitted and non-admitted indicators are of concern. Non RTT was discussed in detail. The Committee felt assured from a safety perspective that we now understand the issues that are causing the problems and the big challenge is to now to work on fixing the problem but there is a lot of work to be done. Monitor Cancer target there were three failures in April The 62 Day Cancer target is expected to fail The Emergency Care Standard is expected to fail for the quarter. A continued management effort is being put into sustaining a pass Workforce: sickness absence was discussed which looks better than it was previously with four months of improving performance. The Attendance Committee meets twice a month and reports to the Performance Committee. Finance: the Foundation Trust has a Continuity Service Rating of 3 which has fallen from 4. The year to date deficit is 2.8m which is behind plan. Informatics: Information governance was discussed KP said the failure of targets is of concern. CLK said there was work to be undertaken with an enormous amount of work to be done in relation to the booking processes. It is expected to get worse before it gets better whilst definitive solutions are put in place. In terms of the Emergency Care Standard we are currently at approximately 94.3% but we were one of 32 Trusts last year who met the standard. A discussion took place about the impact of targets on patient care and patient safety. BB confirmed that the design of pathways needs to be focussed on quality and safety at all times. 9

B15/122.2 Finance Report There has been a step change in the deficit and this is due to rephasing the plan. The Foundation Trust had not accounted for bank holidays in April and May as a straight working day proportion had been calculated through the year therefore a 3.5m deficit is still being maintained but there has been a 2.4m deficit which means it is 400,000 off plan. MH wished to highlight the following key issues: The Foundation Trust is significantly behind the delivery of QIPP at the end of month two and assurances around delivery are not very high although recovery planning processes are in place with the Divisions. The Foundation Trust is committing to new expenditure which were not in the underlying plan. These are due to resilience issues, validation and a number of other areas where investment is needed. KP asked whether the 3.5m deficit would give the Foundation Trust a Continuity Service Rating of 4 and MH said it would. However three new metrics may be introduced into the Risk Assessment Framework which could affect the rating in the future. B15/122.3 Performance and Productivity Report There were no further key points to make item covered at agenda item B15/122.1. B15/122.4 Informatics Performance Report CF made the following key points from the report: There was an information governance incident reported to the Information Commissioner in May which was from March and another has also been reported making the total of two. There was a missed deadline for submission of data but CF reported she is not expecting any action to be taken against the Foundation Trust. The national e-referral system came into place a week ago but there have been some issues with the system and it is not working very well. KP asked how the recruitment situation is within Informatics and CF explained that a number of interviews have been conducted recently and she hopes this will help. CF reported she is working with the University of Bradford regarding sustainability for future. MI asked whether the website suggestion he made had progressed and CF said it was approved and completed. 10

B15/122.5 Minutes of Performance Committee April 2015 The received and noted the minutes of the Performance Committee. B15/123.0 Strategy and Investment B15/123.1 New Hospital Wing Update MH explained the update is available within the report. B15/123.2 Electronic Patient Record (EPR) Update CF updated that the recruitment was almost complete and most staff will be in post within the next couple of weeks. A lot of progress is being made regarding visiting other sites both those that are doing well and those that are not doing so well. B15/124.0 Governance B15/124.1 Report from Integrated Governance & Risk Committee June 2015 CLK made the following key points from the report: Joint Stroke Service with Airedale: the hyperacute stroke service is no longer sustainable at Airedale and after extensive discussions it had been agreed to offer the service from the Foundation Trust. The process has been expedited as the locums at Airedale are leaving and Airedale will not be able to offer a service from 1 August 2015. There are a number of risks to the Foundation Trust and these are being worked through. MH is working with colleagues at the CCGs and Airedale Trust regarding the financial risks. There are also clinical risks in relation to the impact on patients with the increased number of stroke patients from 1 August. CLK reported that the Performance Committee agreed to escalate to the Corporate Risk Register the issue of the e-referrals system which is not working and the risks this brings. B15/124.2 Corporate Governance Statement and other Declarations CA explained there are three statements that need to be submitted to Monitor by the end of the month. The statements were reviewed by the Integrated Governance and Risk Committee and the proposed responses are highlighted within the paper. In two cases it is proposed to respond as not confirmed. GA asked what the implications of this are and CA explained it will be a matter for discussion at the next Monitor call. The Board approved the statements and declarations. 11

B15/124.3 Minutes from the Audit & Assurance Committee May 2015 The received and noted the minutes of the Audit & Assurance Committee. B15/124.4 PwC Governance Review Item retracted. B15/124.5 Appointment of new Responsible Officer The Medical Profession (Responsible Officers) Regulations 2010 require that all Designated Bodies appoint a Responsible Officer (RO). Compliance to the regulations is part of the Care Quality Commission s surveillance model. The was asked by the Chief Executive to appoint a new Responsible Officer, Dr Bryan Gill, Medical Director, with effect from 2 July 2015, by which time Dr Gill will have undertaken the appropriate training. Dr Bryan Gill, Medical Director, has been a medical practitioner for nineteen years and from 1995 has held a succession of medical leadership roles at a local, regional and national level. He was appointed to the post of Medical Director, on 5 May 2015, following an open competitive process. The approved the nomination and acknowledged the need to resource the Responsible Officer adequately for the discharge of his responsibilities. B15/125.0 Issues to add to Corporate Risk Register It was agreed to escalate the issue of the e-referrals system which is not working to the Corporate Risk Register. Trust Secretary B15/126.0 Issues to escalate to Monitor There were no issues to escalate to Monitor. B15/127.0 Issues to be reported to Care Quality Commission (CQC) There were no issues to be reported to CQC. B15/128.0 Any other business There were no other items of business to discuss. 12

B15/129.0 Dates of future meetings: 30 July 2015 at 1pm, Conference Room, Field House, BRI. B15/130.0 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. 13

BRADFORD TEACHING HOSPITALS NHS FOUNDATION TRUST ACTIONS FROM BOARD OF DIRECTORS OPEN MEETING 25 JUNE 2015 Date of Meeting Agenda Item Required Action Lead Timescale Comments/Progress 29/01/15 B15/7.6 End of Life Care: review of mandatory training. Medical Director 26/03/15 B15/52.2 Following the outbreak of CPE a lot of work has been done in relation to cleaning schedules and resources. A report in relation to this is due to be discussed by Executive imminently and the outcome will be presented to the for assurance. 30/04/15 B15/77.8 Freedom to speak up : Paper to be presented at a future meeting which should include the process and description of the role of the guardian. 28/05/15 B15/104.1 Bradford Children s Centre: Further consideration of suggestion. 28/05/15 B15/105.4 Workforce Report: Number of recruiters in Human Resources Department to be considered 28/05/15 B15/105.5 Complaints Report: Future reports to be submitted to the Q&S Committee prior to the Board 28/05/15 B15/106.1 Performance Committee Paediatric Walk-in Centre: Review proposal 25/06/15 B15/116.0 Actions from patient story: Patient Information: review and consider a reusable key information card which could be more prominent e.g. in or on the bedside locker to alert patients to key aspects of patient support such as 14 Chief Nurse Medical Director Chairman/Chief Executive Director of Human Resources Chief Nurse Chief Nurse / Medical Director Chief Nurse 24/09/15 Transferred to Quality and Safety Committee, 26 August 2015. Further work is being undertaken on this and some of the financial assumptions are being revisited therefore deferred to a future meeting. Deferred to July 2015

Chaplaincy and PALS teams. To check on how consistently we check a patient s religious faith and if we are pro-active in asking if they would like a visit from the chaplaincy team, whether they have a specific faith or not, and whether, for planned admissions, this could even be done before admission and recorded. To ensure that staff are aware of the patient story videos available on the internet. Peter also wished to highlight the difficulties faced by patients when accessing the toilets on Ward 8. There are a limited amount of toilets and some are too far down the ward for patients who have had surgery and may struggle to walk. 25/06/15 B15/121.8 Savile Report Action Plan: PC to check whether volunteer contracts stipulate that they must declare any convictions. Director of Human Resources KP said there are a number of actions to consider and the action plan should be discussed at a particular forum maybe at the Board development sessions. JA agreed to provide an update in six months regarding progress against the action plan. Chief Nurse 14/01/16 25/06/15 B15/125.0 Issues to add to Corporate Risk Register: it was agreed to escalate the issue of the NHS e-referral Service which is not working to the Corporate Risk Register. Trust Secretary Discussed at Integrated Governance and Risk Committee on 16 July 2015. Based on latest information decision taken not to include on the CRR. 15