Board of Directors Minutes of the meeting held in Public Training Rooms South, Colchester General Hospital On 26 March 2015, at 2.00pm PRESENT: Mr Peter Wilson, Acting Chair Dr Lucy Moore, Chief Executive Mr Roger Baker, Non-Executive Director Mr Jude Chin, Non-Executive Director Mr Tom Fleetwood, Non-Executive Director Dr Shane Gordon, Chief Operating Officer Mrs Lynn Lane, Director of Human Resources and Organisational Development Miss Julie Parker, Non-Executive Director Mrs Dawn Scrafield, Director of Finance Dr Angela Tillett, Medical Director Dr Barbara Stuttle CBE, Director of Nursing and Quality IN ATTENDANCE: Dr Ann Alderton, Company Secretary Mr Nick Chatten, Director of Special Projects Ms Tammy Diles, Deputy Company Secretary Mr David Linghorn-Baker, Lead Governor 1.1 WELCOME AND APOLOGIES FOR ABSENCE Mr Wilson welcomed everyone to the meeting. He gave a special welcome to Dr Angela Tillett, to her first Board Meeting as Medical Director and to Dr Shane Gordon to his first Board Meeting as Chief Operating Officer. Mr Wilson thanked Sandy Spencer, interim Chief Operating Officer and Jacqueline Brown, interim Director of Transformation, for their support over the last few months as they would be leaving the organisation soon. Apologies for absence had been received from Sandy Spencer, interim Chief Operating Officer and Diane Leacock, Non-Executive Director. 1.2 DECLARATION OF INTEREST Miss Parker reported that she was a member of the Joint Audit Committee for the Police and Crime Commissioner and Essex Police. 1.3 PATIENT SAFETY There were no issues of patient safety to report. Page 1 of 8
1.4 PATIENT STORY This month s patient story came from Paul, who had multiple sclerosis. Paul first experienced symptoms in 1976 and received a diagnosis in 1981. He has needed to use a wheelchair since 2001. Despite his illness he has remained a proactive member of the community. As a result of his MS Paul cannot walk, has little bladder control and experiences constipation. He experiences MS fatigue and neuropathic pain which are both variable in time and intensity. His recent use of healthcare services at CHUFT included: 1. Annual review with Dr Sharief, consultant neurologist; 2. Consultations with MS Nurse Zoe Evans - to discuss hip problems and neuropathic pain medication; 3. Attendance at A&E because of an injury in May to his hip which included an X-ray; 4. Abdominal CAT scan because of various pains this turned out to be neuropathic but had to be checked out; 5. Physiotherapy twice with Sasha Wyman to help recover from the hip accident In all these visits Paul and his wife, who is his carer, were treated well. Two areas of improvement were recommended: Firstly, his stay in A&E had been much longer than it should have been because of a delay in getting the results of a blood test. He was unaware of why there was a delay as he was in too much discomfort to ask and just wanted to get home with his pain killers. He was initially concerned he had broken his hip but fortunately it had turned out to be soft tissue damage. His second concern was the amount of time it took to get a physio appointment to help him recover from a hip accident. He contacted the neuro-physios in mid-may but did not get an appointment until 28th July. There would appear to be a capacity problem here; one he suspected would get worse as the population ages and more people develop neurological conditions. Dr Gordon thanked Paul for sharing his experience and asked whether there were any other areas that could be addressed or improved. Paul stated there were no areas of concern other than those he had already highlighted. He did, however, want the Board to note that the MS nurse, Zoe Evans had a workload that was in excess of guidelines. He reported that she was an extremely kind and dedicated member of the team. The Board discussed issues around the communication of blood test results. Paul reported that he was a vocal patient other than when he was in pain, and the Board acknowledged that not all patients would be as assertive in following things through. Mrs Scrafield requested to know whether Paul s planned attendances could have been dealt with quicker. Paul reported that other than the wait for the Physio appointment, there had been no issues. Mr Wilson thanked Paul for attending the meeting and sharing his experience of Colchester Hospital. Resolved: That the Board noted the Patient Story Page 2 of 8
1.5 DRAFT MINUTES OF THE PREVIOUS MEETING The draft minutes of the meeting held on 26 February were approved as a correct and accurate record for signature subject to the following change suggested by Mrs Lane. Page 5 under the heading Workforce, Mrs Lane wanted it noted that she had explained to the board that this was due to the substantive post-holder being on a long-term secondment and interim arrangements had not been sufficient to support the Trust with the challenges presented by this objective. This has now been resolved. Mr David Linghorn-Baker was in attendance. 1.6 MATTERS ARISING AND ACTION LOG Matters arising from the action checklist were discussed and updates provided. 1.7 ANY KEY QUALITY / OPERATIONAL / FINANCIAL ISSUES There were no areas of quality, operational or financial issues to discuss. 1.8 CHAIR S REPORT Mr Wilson presented his report and highlighted the following: The Trust continued to face the challenge of recruiting to the Band 5 Nurse vacancies. Rectifying this issue as quickly as possible continued to be one of the top priorities; The Trust had decided to not tender to be the lead provider for Care Closer to Home, but was holding productive conversations with the three main bidders to work collaboratively; Dr Moore and Mr Wilson had attended meetings both with Essex County Council and Tendring District Council; Mr Wilson reported that this would be his final meeting as Acting Chair and that he was also stepping down as Non-Executive Director from the Board. He reported that he had enjoyed his term of office and thanked staff for their hard work. He concluded that this was a good performing hospital and that he would continue to keep a very close eye on Colchester Hospital. Resolved: That the Board noted the Chair s Report 1.9 CHIEF EXECUTIVE S REPORT Dr Moore presented her report and highlighted the following: A meeting had taken place with the Chief Executive, Director of HR&OD and April Strategy Team to discuss the Trust s proposed response to the staff survey results. Following this meeting, it was proposed that the At our Best programme would be reinvigorated and an approach to improve staff engagement, starting with time out for a board awareness session with view to developing an OD strategy, would be pursued. Resolved: That the Board noted the Chief Executive s Report and the proposed way forward regarding staff engagement 1.10 PRIVATE BOARD MEETING Dr Moore reported to the public board meeting the items that had been discussed in the private board meeting and highlighted the following: The Essex County Hospital sale was making progress along with the relocation of services; The Board had received a presentation that morning from the Chair and Chief Executive from the Pathology Partnership. This was a contractual joint venture Page 3 of 8
that the Trust was a part of with five other acute hospitals, creating a shared pathology service organised on a hub and spoke model. There were financial issues however, in its inaugural year and Mrs Scrafield was working closely with the partnership s Director of Finance to establish full engagement with a potential solution and way forward; The Trust was continuing to liaise with potential providers for the Care Closer to Home tender; The Trust was continuing to focus on nurse recruitment as one of its key priorities. Resolved: That the Board noted the update 2.1 FINANCE AND PERFORMANCE REPORT & EXCEPTIONS INCLUDING RTT & ED PERFORMANCE QUALITY Dr Tillett presented the quality report and highlighted the following: The financial year for HSMR to November figure was 98.82, which was positive; Dr Miller was currently reviewing patient records for deceased patients over the period straddling Christmas and New Year, when there was a marked increase in mortality levels, something that was not unique to Colchester during this period. The majority of these patients were respiratory cases. Coding was also having an impact and this was being investigated along with missing records by the coding manager; Work was on-going regarding never events; The Board discussed the deteriorating performance levels of VTE Risk Assessment, discharge summaries within 24 hours, the numbers of avoidable pressure ulcers and learning from serious incidents. These had been reviewed and discussed at the Quality and Patient Safety Assurance Committee. Dr Tillett reported that the clinical portal had affected some of the results and IT were reviewing this. Mr Fleetwood reported as Chair of the Quality and Safety Assurance Committee that although C-Diff was over trajectory, the Board should also recognise the good work that the team were undertaking. The committee wanted to escalate its concern about cleaning levels. Due to a recent consultation into reducing staff numbers and related roster changes for cleaning, there had been a recognised impact on cleaning standards, which required further investigation. FINANCE Mrs Scrafield presented the finance report and highlighted the following: In February the Trust incurred an in-month I&E deficit of 1.6m which was on plan. This compounded to a year to date I&E deficit of 22.6m, representing an adverse variance of 1.8m against plan; Pay had continued at previous rates of spend but was showing a positive variance of 0.3m in the month; Non-pay was also having a positive variance at 0.3m in the month; The CIP programme under-delivered by 1.2m against a cumulative CIP target of 7.8m for month 11. Miss Parker reported as Chair of the Finance Assurance Committee that the grip and controls in place were not giving greater benefit for 2014/15 going forward. Page 4 of 8
Mr Baker reported that due to unforeseen circumstances he had not been able to meet with Dr Gordon and Mrs Scrafield regarding the symbols contained within the report, he confirmed that the meeting had been rescheduled for the following week. WORKFORCE Mrs Lane presented the Workforce report and highlighted the following: Sickness absence had increased from 3.8% to 5.08% in February 2015. An audit of all sickness was being undertaken along with work at divisional level to understand the contributory factors; Fitness to Practice training compliance had increased by 12.94% since March 2014 and by 4% in the last quarter; Focus was continuing on local and EU recruitment through an increased activity with agencies; To date 243 offers of employment to Band 5 nurses had been made and accepted; It was expected that 20 nurses would join the Trust in April and May; Mr Fleetwood reported on behalf of Mrs Diane Leacock, the chair of the People and Operational Development Assurance Committee, that the Committee was focussing on the OD Plan and he was pleased to report that Ruth Robertson had joined the organisation as the Interim OD Lead. PERFORMANCE Dr Gordon presented the performance report and highlighted the following: CDU was open 24 hours for short stay medical issues and this was taking the pressure off the Emergency Department; MDU would be opening shortly; Attendances in Emergency Department had fallen; On-going issues remained with regard to ambulance turnaround times Dr Moore updated the Board regarding the Trust s decision not to report 18 week RTT standards currently. For reasons to do with the implementation of the Clinical Portal and concerns that the data recorded was incorrect it had been agreed with the Trust, Monitor and NHS England that the Trust would not report its RTT performance until there was confidence that the data was correct. This was not uncommon when Trusts transitioned to a new patient administration system, and there were other Trusts that had taken the same decision when facing similar issues. It was expected that the issue would be addressed by the end of Q1, allowing reporting from the beginning of July. Resolved: That the Board noted the finance and performance report 2.2 DRAFT CORPORATE OBJECTIVES Dr Moore presented the draft corporate objectives stating that this would drive the individual Executive and senior managers objectives. Discussions ensured around sharing the objectives with all wards and departments along with the vision and values of the organisation. Members congratulated Dr Moore on the layout of the document and the way the objectives were presented. Resolved: That the Board approved the report 2.3 THE YEAR AHEAD A) 2015/16 BUDGETS (INCLUDING CAPITAL, REVENUE, CASH) Mrs Scrafield presented the 2015/16 budgets and reported that this was the framework that was supporting the Trust in managing the 2015/16 budgets. Work was Page 5 of 8
being undertaken with the Divisions to ensure their understanding of the budgeting process and the budgets produced as a result. B) FINANCIAL RECOVERY PLAN Mrs Scrafield reported that a more detailed version of this document had been discussed in the private part of the meeting due to the sensitivity of its content. A full report for the public would be shared at the April board. This plan would require further work before being submitted to Monitor on 10 th April. C) MONITOR FINANCIAL PLAN Mrs Scrafield presented the Monitor financial plan. Due to the hospital being in financial distress, CHUFT had to submit its plan to Monitor to an earlier deadline than Trusts not in financial difficulty. Discussions ensued around CIPs, tariff deflation and cost inflation. Overall, the trust had modelled efficiency and financial pressures assumptions that were broadly in line with Monitor s guidance. Miss Parker discussed the capacity planning timeline and reported her concern that the live testing was not taking place during months that the hospital was stretched. Dr Moore requested to formally record her thanks to Mrs Scrafield and her team for very well produced documents. The plans included investment in two new CT scanners, relocation of the Pathology Service and upgrade on Wivenhoe Ward. Members noted that with the CCG having less money to commission services, the Trust would have to look at other ways of working more efficiently, providing services further afield and establishing a clear clinical strategy. Dr Alderton requested that more pro-active Governor involvement in the forward planning process was considered for future planning cycles. Resolved: That the Board noted the reports 3.1 BOARD ASSURANCE FRAMEWORK Dr Alderton presented the Board Assurance Framework. This had recently been reviewed and updated by the Executive Team members. It reported the top risks of the organisation. It needed to be aligned with the Corporate Risk Register and it was agreed that it would be reviewed quarterly from now on. The Board discussed the way risks were scored and it was agreed that further work needed to be undertaken. A Board workshop was being planned to ensure a shared understanding of the approach. Resolved: That the Board noted the report 3.2 NURSE FILL RATES Mrs Stuttle reported that the Nurse Fill Rates paper had recently been presented to the Quality and Patient Safety Assurance Committee. Mrs Stuttle confirmed that she was having conversations with neighbouring Trusts around their fill rate, noting that this Trust had a bigger vacancy gap which was proving difficult with the fill rates. Every Trust was facing issues due to shortages and were all targeting the same groups of job seekers. When holding conversations with other Trusts she was suggesting that if they were over recruiting that they could direct some nurses to CHUFT. Mrs Stuttle reported also that when speaking with nurses on the wards she was asking whether they had friends that wanted to come and work at CHUFT. Page 6 of 8
Bed meetings were taking place daily, four times a day and risk assessments were taking place. It was reported that the mornings were the most difficult shifts to fill, at midday shifts improved and nights were easier to cover due to higher rates of pay. CVs of nurse staff were being reviewed to ensure that the nurse was being placed in the most relevant department or ward. Mrs Stuttle requested to formally record the Board s thanks to the Trust s nursing staff due to the additional hours that nurses were covering. She wished to acknowledge that they were working exceptionally hard and in difficult circumstances. Members reported that the data being reported was better than in previous reports and that it helped to see how other Trusts were reporting. Mr Fleetwood stated that nurses at other organisations with better fill rates were just as likely to report that numbers were below template and insufficient to meet demand. Resolved: That the Board noted the Nurse Fill Rates report 4.1 CQC IMPROVEMENT PLAN Dr Moore reported that this paper had recently been presented to the Quality and Patient Safety Assurance Committee. Progress was being made although it was frustratingly slow. Work continued to make progress in preparation for the CQC visit taking place in Q2. Resolved: That the Board noted the CQC Improvement Plan 4.2 CANCER HELPLINE COMPLAINTS AND SERIOUS INCIDENTS Mrs Stuttle presented the report on the Cancer helpline dealing with complaints and serious incidents. The paper focussed on the themes and the learning that had arisen from the cancer helpline established to support the general public as a result of the concerns relating to cancer care raised by the CQC in November 2013. Mrs Stuttle reported that the document needed to be shared with the colleagues that had supported the helpline, who had been on the frontline of receiving some distressing calls. Miss Parker requested to know how this document would be taken forward and used in clinical practice. Dr Tillett reported that it was being shared with all staff through Divisional and cancer MDT meetings and had been presented to the cancer board meeting. Resolved: That the Board noted the Cancer helpline report 4.3 MONITOR Q3 LETTER Dr Moore reported that the Monitor Q3 letter was part of the regular feedback, there were no surprises and no change and the next performance review meeting would be taking place 10 April. Resolved: That the Board noted the report 4.4 MATERNITY CONSULTATION FEEDBACK Mrs Stuttle presented the maternity consultation feedback paper. Between 15 October and 10 December 2014, a public maternity consultation had taken place outlining two possible options. Option one proposed that Clacton and Harwich would remain as on demand midwife led units, with antenatal and postnatal care to continue. Option two was for Clacton and Harwich to return to the status of midwife led units 24/7 with antenatal and postnatal care to continue. Page 7 of 8
Both the CCG and Colchester Hospital were keen to ensure that the views of the local people and their families featured as a core aspect of service provision, guaranteeing that maternity services reflected the need of the local population. The Board agreed to support the recommendation from the consultation panel and to recommend to the CCG that the Maternity services at the coastal units in Tendring is provided in line with option one of the consultation proposals. It was, agreed that Mrs Stuttle and Dr Tillett would feedback the Board s recommendations. Action: To support option one of the Maternity Consultation proposals Resolved: That the Board approved the report 4.5 PUBLIC QUESTIONS A question was raised regarding Harwich Maternity Unit and the cost per lady. Mrs Scrafield reported that although she had not yet visited the unit, the clinical space was larger than required for the level of activity that it supported, costing around 9,000 per lady in Harwich. Mrs Scrafield reported that she did not have the numbers for Clacton however; she would be able to source them. 5.1 SEALING OF DOCUMENTS Mr Wilson informed the Board there had been no sealing of documents since the last Board meeting. 5.2 ANY OTHER BUSINESS Dr Moore reported that this was Mr Wilson s final Board Meeting as Acting Chair and that he would be stepping down from the board and the Trust. She requested to formally record the thanks of everyone at Colchester Hospital for his service since October 2014 and wished him well for the future. 5.3 DATE OF NEXT MEETING 30 April 2015 Meeting declared closed Page 8 of 8