LONDON NORTH WEST HEALTHCARE NHS TRUST Approved Minutes of the Public Trust Board Meeting held on Wednesday 25 th May 2016 at 9.15am Northwick Park Hospital Present Mr Peter Worthington Jacqueline Docherty DBE Professor David Taube Mr Martin West Mr Andrew Farrell Mrs Janet Rubin Mr Andrew van Doorn Mr Ruwan Weerasekera Dr Vineta Bhalla Dr Charles Cayley Mr Simon Crawford Ms Amanda Pye Mr Jon Bell Mr Lee Martin Chairman Chief Executive Medical Director Director of Strategy and Deputy Chief Executive Chief Nurse Interim Chief Finance Officer Chief Operating Officer In Attendance Mr Nigel Myhill Director of Estates and Facilities Ms Claire Gore Director of Human Resources and Organisational Development Ms Rosemary Heed Divisional General Manager, Women and Children s Health (for Item 8) Mr John Hutchins Divisional Clinical Director, Paediatrics (for Item 8) Ms Kay Larkin Children s Head of Nursing (for Item 8) Raj Bathula Lead for Clinical Audit, Consultant Stroke Physician (for Item 10) Mrs Gurjinder K Nisar Acting Board Secretary (Minutes) Apologies None Item Discussion Action 1. 1.1. Patient Experience Story Amanda Pye introduced Mr Simmonds and his advocate, Mr Taylor, who shared the story concerning the late Mrs Simmonds experience at the Trust and that of Mr Simmonds. Geraldine McVeigh-Head of Nursing, Ms O Neill- Nurse, Fiona Sutherland- Clinical Governance Co-ordinator, Abhay Chopada, Colorectal Surgeon, and Chris Robbins, General Manager were also present. 1.2. 1.3. The Board were shown a pre-recorded video of Mr Simmonds explaining the history of Mrs Simmonds cancer and the pathway of the patient. Following this, Mr Simmonds, supported by his advocate, made further comments and suggestions which were discussed with the Board. Peter Worthington thanked Mr Simmonds for attending the Board meeting and sharing his story. He also thanked Mr Simmonds for the generous spirit of his comments, noting that there was a lot for the Trust to learn from it and certainly carried a powerful message to the Trust. 2. Welcome and apologies for absence There were no apologies. Page 1 of 13
3. Declarations of Interest There were no new declarations of interest. 4. Minutes of the meeting held on 30 th March 2016, Ref. 16/05/01 With one minor amendment, the minutes of the previous meeting were agreed as a true record of the proceedings. 5. Matters arising and review of action points, Ref. 16/05/02 The Board members reviewed the action points and noted the progress update provided ahead of the Board meeting, captured within the actions register as well as the updates provided at the meeting. 6. 6.1. 6.1.1. 6.1.2. 6.1.3. 6.1.4. 6.1.5. 6.1.6. Chair s Report Peter Worthington provided the following summary of his activities since the last Board meeting. (NED) meetings: Completion of NED appraisals for 2015-16 Committee roles and responsibilities allocation agreed Pre-Board and Committee meetings Meeting held with Trust stakeholders: Lunch: Tom Hayhoe, Chair, West London Mental Health Trust Meeting: Carolyn Regan (CEO) and Tom Hayhoe (Chair) of the West London Mental Health Trust with the Trust s CEO Lunch: Dr. Keith Bragman, immediate past president of the Faculty of Pharmaceutical Medicine The Royal Colleges of Physicians of the United Kingdom Meeting: Richard Sumray, Chair The Hillingdon Hospitals Trust St. Mark s Foundation Prof. Robin Phillips and Anthony Cummins St Mark s Foundation: fund-raising event in the House of Lords Harrow CCG: Healthcare in Harrow Public Event HSJ/McKinsey Workshop: New Care Models Making them a Reality Attended following: Patients & Staff Board Committee Clinical Excellence Board Committee comments provided to Chair/NEDs only Finance & Performance Board Committee (2) Audit committee Integrated Governance Committee (2) Chaired the following Board Committees: Annual Clinical Excellence Awards for Trust Strategy Committee Charitable Funds Committee Board workshop: (i) Medical Division presentation and review; (ii) Capital planning for Shaping a Healthier Future Appointments & Remuneration Committee One Consultant Appointment Panel other panels chaired by NEDs; and preparation to chair panel for Board Secretary role Internal meetings: CEO meetings Training: Equality & Diversity module Page 2 of 13
7. 7.1. 7.2. 7.3. 7.4. 7.5. 7.6. 7.7. Chief Executive s Report, Ref. 16/05/03 Jacqueline Docherty summarised her report of Trust activities since the last report to Board. Changes to Children s Services at Ealing Hospital - On 18 th May 2016, Ealing Clinical Commissioning Group (CCG) agreed the proposed changes to Children s services at Ealing Hospital. As a result of their decision on 30 th June 2016, the Children s Ward at Ealing Hospital will close and from that date Ambulances will no longer take children to Ealing s A&E department. A demonstration had taken place on 21 st May 2016. Year End Position - Jacqueline Docherty and Peter Worthington expressed their appreciation to staff across the Trust for their collective efforts in achieving the planned deficit of 88.2m for year ending 31 st March 2016. Sustainability and Transformation Plans (STP) - The report outlined the background and purpose of the STP. London North West Healthcare NHS Trust (LNWHT) is part of the NWL STP which brings together organisations working across primary, acute, community, mental health and social care to agree a shared approach to improving health and healthcare. The three key areas of focus for the Trust are a) Right care, right place, right time b) improving consistency of services 24/7 and c) improving outcomes for cancer, heart disease and respiratory illness. NHS Staff Survey Focus Groups - The results of the Trust s NHS Staff Survey 2015 identified five main areas for further analysis and understanding. Focus group sessions were organised across the Trust to explore these areas in greater detail. An online survey was being developed to allow staff to respond anonymously. The HR Team would analyse the outcomes and themes and share the findings with staff side. A final report and action plan would be submitted to the Patient and Staff Committee. Nursing and Midwifery Council (NMC) Consultation - The report outlines the Government s consultation. The changes being consulted on are designed to modernise midwifery regulation by removing midwifery supervision and assessment from the NMC s legislation to improve how it deals with those who fall below the required standards expected of nurses and midwives. The consultation closes on 17 th June 2016. Following the recent Local Supervisory Assessment at Northwick Park Hospital, the maternity department achieved green in all areas of the assessment. The Trust would look to maintain this assessment going forward but recognised it would no longer be a statutory requirement. National Guardian s Office Freedom to speak up - Following the Freedom to speak up (FTSU) review published in February 2015 one of the recommendations was to appoint a national guardian to promote and reinforce best practice in supporting staff to speak up safety through a network of FTSU Guardians. Following consultation, the Department of Health s 2016/17 contract with Trusts includes the provision to nominate a FTSU guardian in every Trust by 1 st October 2016. The Trust is currently considering the role and developing an action plan for the implementation of the recommendations of the review. Awards and recognitions - The report outlined awards to: Dr Arun Rajendran, St Mark s Hospital Research Fellow for the American Society for Gastrointestinal Endoscopy; Page 3 of 13
Dr Stephen Ashford, NIHR Clinical Lecturer and consultant physiotherapist RHRU was awarded a Fellowship of the Association of Chartered Physiotherapists in Neurology; 7.8. 7.9. 7.10. Kathy Abernethy, the Trust s Senior Nurse Specialist in Menopause Unit was elected as Chairman of the British Menopause Society (BMS) and it was recognised this is the first time since the BMS was formed a nurse has been elected as Chair. The Board extended congratulations to Kathy Abernethy on this achievement. German School Children - The children from the German School who were on a school exchange programme in Harrow extended their thanks to LNWHT for their excellent attendance to them when their party of 72 experienced an outbreak of Norovirus. The arrangements for the Open day were noted as were the list of policies recently ratified by Committees, the use of the Trust seal in quarter 4 of 2015/16 and consultant starters and leavers during March and April 2016. The Board noted the report. 8. 8.1. 8.2. 8.3. 8.4. 8.5. Paediatric Implementation Plan Update Rosemary Heed, Kay Larkin and John Hutchins attended the meeting for this item. Further to the Chief Executive s Report at item 7, Rosemary Heed briefed the Board on the implementation of the closure of the Paediatric Inpatient Unit and Paediatric Emergency Department at Ealing Hospital on 30 th June 2016. A letter of readiness from LNWHT was submitted to Ealing CCG on 29 th April 2016 and a letter of assurance from LNWHT, Ealing UCC and LCW was submitted on 2 nd May 2016. Peter Worthington acknowledged the earlier detailed discussion at the March 2016 Board and noted the update provided in respect of the implementation plan, and sought assurance that the Trust had identified and effected appropriate plans and mitigations. In response, John Hutchins informed the Board that a considerable amount of work had taken place to plan for the closure particularly around pathways. The key risk relates to children walking into A&E. Discussions had taken place with London Ambulance Service (LAS) regarding holding and transferring children. Risks of walk-in patients (children) would be inevitable, however the Paediatric team were confident that the risks would be minimised. Information in relation to special arrangements for children had been collated and arrangements would be communicated on a consultant-to-consultant basis. The responsibility of the transfer for this group of children would remain with LNWHT until full transfer dialogue completed. Pathways for Child and Adolescent Mental Health Services (CAHMS) patients was underway. A NWL CAHMS helpline is in place. The work with the UCC was positive and work was underway to up-skill their staff. Rosemary Heed added that the RAPID access clinics at Ealing Hospital were established in November 2015 and by 30 th June 2016 they would provide a 7 day service. The Paediatrics Assessment Unit (PAU) at Northwick Park Hospital is a consultant led service proactively managing the pathway and Page 4 of 13
would be open 24 hours per day. It would reduce the Trust s inpatient admissions and had been factored into sector wide modelling with the intention for it to be open before 30 th June 2016. It was in place at West Middlesex University Hospital with positive outcomes. 8.6. 8.7. 8.8. 8.9. 8.10. 8.11. 8.12. 8.13. 9. 9.1. The publicity material related to the planned closure was ready and would be communicated via the Shaping a Healthier Future (SaHF) team. Professor Taube enquired about the GP s general level of skill, knowledge and experience with respect to paediatric care and the changes about to take place. John Hutchins advised that GPs have a good degree of understanding and nursing skills were being increased. An improvement programme in terms of the pathway and the skills was being developed. Kay Larkin advised that the Trust s consultants and senior nurses were actively working with peers to ensure a smooth handover and transition. Professor Taube enquired that in the event of a seriously ill child arriving at Ealing Hospital, would the hospital be equipped to deal with the situation? John Hutchins advised that the Trust would be adequately resourced with the resuscitation team taking responsibility for stabilising the child for transfer. The Emergency Department staff would be receiving additional training in respect of paediatric care. Dr Bhalla enquired about level of intubation training and readiness within A&E. John Hutchins advised that staff have non-invasive airway control training rather than intubation training and that a clear policy is in place for these types of situations and communicated to staff. Janet Rubin enquired about local news, petitions and discussions at the House of Commons and what the Trust was doing to communicate with the media. Jacqueline Docherty informed the Board that the SaHF lead had met with the Local Authorities and would be meeting with MPs on 25 th May 2016. Simon Crawford advised that Peter Worthington had circulated the communication concerning public information release with the NEDs for information. In response to Martin West s query regarding the paediatrics surgery and day care data on page 6 of the report, John Hutchins advised that the information was estimated based on last year s return. In the context of the current paediatric capacity at NPH, Martin West enquired about the impact of the Ealing service change on NPH. Rosemary Heed advised that it was expected to result in an approximately 5% increase in patient flow, predominately on day care, and therefore not a significant impact. Rosemary Heed advised that dashboards are available to monitor activity. It was agreed it would be useful for the Board to review the impact of the Ealing paediatric care changes and the effectiveness of the closure plans and risk mitigations in six months time. A final paper on the closure implementation would be presented to the June Board. The Board noted the update and a final paper would be presented to the June Board. Claims and Inquests Quarter 4 Report The report summarises the Trust s legal services and an analysis of the outstanding claims and Coroner s Inquests for quarter 4 of 2015/16. L Martin S Crawford Page 5 of 13
9.2. 9.3. 9.4. The report was discussed in detail at the May 2016 Integrated Governance Committee. The actions following the Committee discussion included entering the data on the Datix System, reviewing annual data and lessons learnt. Professor Taube made reference to the number of claims in orthopaedics and enquired whether there was an issue requiring attention. Amanda Pye advised that this issue was discussed at the Integrated Governance Committee and the data would be reviewed and triangulated with other information including a review of annual data to ascertain and understand the issues. The report in this respect would be submitted to the Clinical Excellence Committee and the Integrated Governance Committee. In response to Dr Bhalla s question regarding the communication of the data, Amanda Pye confirmed that this data is shared with the various clinical divisions. The Board noted the report and the actions being taken forward as discussed at the Board Committees. 10. 10.1. 10.2. 10.3. 10.4. 10.5. 10.6. Mortality Report and London North West Healthcare NHS Trust Mortality Strategy 2016-2020 Dr Cayley and Raj Bathula presented the Mortality Annual Report 2015/16 and the LNWHT Mortality Strategy 2016-2020. The annual report was discussed in detail at the Clinical Excellence Committee and it was agreed that a Board Workshop would be arranged to discuss the topic of Mortality in more detail. Raj Bathula outlined the aims and the key principles of the Mortality strategy with the aim of moving to a proactive process instead of a reactive process. Dr Cayley and Raj Bathula recognised that the Annual Report was not clearly sign-posted but future reporting would be improved with the aid of a clear vision and strategy. Jacqueline Docherty noted that this was the first Mortality Annual Report the Trust had produced and thanked the staff involved noting that further work was needed to improve it. Jacqueline Docherty enquired about the process for ratification and whether the current process is adequate as it was imperative for the divisions to have a clear line of sight. Dr Cayley informed that the clinicians attend the Clinical Cabinet which reports to the Clinical Excellence Committee. In the spirit of transparency, Dr Cayley questioned whether it was appropriate for him to Chair the Clinical Cabinet as he was also the responsible director for Mortality. Jacqueline Docherty and Dr Cayley would discuss and agree a resolution of the issue. In terms of the National ICNARC data for LNWHT which showed a rising trend in mortality for ITU patients over the last 18 months, Professor Taube enquired whether there might be a problem requiring attention. Dr Cayley informed the Board that a meeting with ICNARC was being convened to conduct a further in-depth analysis and NHS Improvement were also assisting the Trust in this respect. Jacqueline Docherty added that the Trust has insufficient ICU capacity and a medium term solution was being developed along with a long term solution as part of the SaHF programme. C Cayley J Docherty Page 6 of 13
10.7. 10.8. 10.9. 10.10. 11. 11.1. 11.2. 11.3. 11.4. 12. 12.1. 12.1.1. At Professor Taube s request, Dr Cayley would provide the crude mortality data to Professor Taube. Martin West enquired about the definitions of expected death and unexpected death. Dr Cayley advised that although the definitions provided were national, there was acknowledged variance in how those definitions were applied in practice. Andrew Farrell enquired how the Trust assures itself that the junior doctors are not marking their own homework in relation to classification of deaths. Dr Cayley advised that junior doctors are required to liaise with the attending consultant. Raj Bathula advised that a list is sent to all consultants and each speciality is reviewed using the peer review methodology. Jacqueline Docherty requested that the list of all deaths is also shared with the Divisional General Managers. Before the Board Workshop, Dr Bhalla requested that mortality Board reports from other Trusts are circulated to the Board to provide some comparative data and context. The Board noted the report and the actions arising from the discussion would be taken forward. Appointment of Auditor Panel and Terms of Reference Jon Bell informed the Board that the Local Audit and Accountability Act 2014 requires every relevant authority to appoint an Auditor Panel. The Auditor Panel will advise the Board on the appointment of their External Auditor. As the 2017/18 appointment must be made by the end of the preceding year, Auditor Panels need to be in place in early 2016. The report outlined the legal requirements for the Trust to fulfil its responsibilities along with the Terms of Reference for Board review and approval. Jon Bell confirmed that progress was monitored through NHS Improvement FIMS reporting. The requirements and the Terms of Reference were discussed at the March 2016 Audit Committee and April 2016 Executive Team Meeting. The recommendation was that the panel consists of three s who are members of the Audit Committee and two Executive Directors. The panel would be chaired by the Chair of the Audit Committee. Andrew Farrell advised that the membership should include the Chair of the Audit Committee, a NED member from the Finance and Performance Committee and a NED member from the Audit Committee along with two Executive Directors. With this amendment the Board approved the appointment process of the Auditor Panel and the Terms of Reference. Annual Statutory Items Jon Bell informed the Board that the Audit Committee had taken place on 25 th May before the Board meeting and the following reports were considered: Annual Accounts 2015/16 The year-end accounts for 2015/16 were presented to the Board for approval. The Internal Auditors had provided overall reasonable assurance. The C Cayley C Cayley C Cayley J Bell Page 7 of 13
External Auditors provided an unqualified opinion and the section on Value for money was discussed in detail with the Trust requesting revised wording to provide context around the financial performance and the trajectories relating to the Trust failing to meet the national targets in relation to A&E, RTT (admitted and non-admitted) and 62 day cancer. 12.1.2. 12.1.3. 12.2. 12.3. Andrew Farrell informed the Board that the Annual Accounts had been presented to, and then challenged and discussed by, the Audit Committee in March and May 2016. Key points discussed were the adequacy of the provisions and balance; a comprehensive review of the internal audit report providing an overall reasonable assurance opinion noting that further work was required in relation to Health and Safety for which limited assurance was provided. The accounts were audited by Grant Thornton, External Auditors and no material adjusted or unadjusted misstatements were made. An unqualified audit opinion in respect of the financial statements would be issued by Grant Thornton. Jon Bell informed the Board that the final accounts were consistent with the month 12 position. The Board noted that as there had been no April Board the month 12 position had been appended to the Finance and Performance Committee minutes at item 17.1. Annual Governance Statement 2015/16 The Annual Governance Statement was considered by the Audit Committee and recommended for Board approval with an amendment to the text in relation to Board oversight regarding mortality data. Annual Letter of Representation 2015/16 The annual letter of representation was noted by the Board for submission to the external auditors. The Board received and approved the Annual Accounts, Annual Governance Statement and the Annual Letter of Representation and delegated authority to the Audit Committee Chair and the Chief Financial Officer to sign the accounts on behalf of the Board. 13. 13.1. 13.2. 13.2.1. 13.2.2. Governance Report Amanda Pye outlined the April 2016 position. Patient Safety - Zero Never Events recorded for April 2016. Year to date the Trust has zero Never Events. Eight Never Events were reported for 2015/16. Serious Incidents (SIs) - There was a significant reduction in overdue serious incidents which were being progressed and concluded at pace. April 2016 saw a decreasing trend in the number of SIs reported. Nine grade 3/4 pressure ulcers were reported and none so far for May 2016. This was a significant improvement. Work was progressing to review unexpected deaths and falls. In response to Professor Taube s question regarding the reference to misdiagnosis in Table 1 and delayed diagnosis, Amanda Pye confirmed this was the same case as the patient story heard by the Board earlier in the meeting. Dr Bhalla suggested that an overview of the root cause analysis data, trends and action plans would be useful to the Board. Amanda Pye advised that this information is available and discussed at the Integrated Governance Page 8 of 13
Committee. 13.3. 13.4. 13.5. 13.6. 13.7. 13.8. 13.9. 14. 14.1. 14.2. 14.3. 14.4. 14.5. Datix reporting - Work was progressing to address the outstanding Datix incidents. The outstanding/unopened incidents were being managed by the Clinical Quality and Risk Committee. NHS Safety Thermometer - April 2016 shows under performance in regard to Harm Free Care and the data would be triangulated with other quality metrics and staffing levels. Healthcare Associated Infections - The infection control data would be reviewed in detail at the Clinical Excellence Committee particularly a review of MRSA and C-Diff. Clinical Claims Three clinical claims were closed during April 2016. HM Coroners Inquests Eight inquests were closed during April 2016. Complaints and PALS Performance for Quarter 4 2015/16 Integrated reporting for the Ealing and NPH will be provided from 2016/17. Previous data will not be fully comparable due to different reporting systems for the legacy Trusts. Lessons learnt The Board noted the lessons learnt in respect of incidents. Amanda Pye advised that temporary staff must complete a comprehensive local induction process and adhere to Trust policies and protocols which must be documented. Claire Gore concurred and stated that an audit trail and checklist should be in place and managed by divisions and departments. Staff should be made aware that they have a duty to ensure that they are properly inducted and fully appraised of the Trust s policies and processes. Andrew Farrell suggested that as policies are being reviewed and updated they should contain a specific reference to mandatory training. The comments were noted. The Board noted the report. Nursing Staffing and Workforce Report Amanda Pye outlined the acute and community hospital wards/units staffing levels for February and March 2016. Janet Rubin welcomed the report and commented that the Trust must encourage staff to have their regular scheduled breaks. Amanda Pye advised that daily safety briefings have been initiated on wards at which such items such as reporting on Datix are reiterated and the appropriate staffing levels having regard to quality of care, patient safely and levels of acuity of wards are discussed. The Trust would liaise with the Imperial College Health Partners who were doing some work around what makes staff feel safe or unsafe. Andrew van Doorn enquired about the Health Visiting (HV) predicted vacancy rates and the overall vacancy rates. Amanda Pye advised that since the Health Visiting national implementation plan A Call to Action was published by the Department of Health in 2011, the Trust successfully recruited over 103 WTE, however 32 WTE failed to transition into substantive roles. The HV service remains on the local risk register until appointed staff transfer into L Martin, C Gore Page 9 of 13
substantive posts. 14.6. 14.7. In response to Janet Rubin s question, Amanda Pye confirmed that as part of Lord Carter s report, the national team were looking to introduce a new dashboard of safer staffing indicators which would translate into Trust reporting dashboards. Professor Taube welcomed the data which he felt was re-assuring and enquired specifically about the staff ratio on the Denham ward. Amanda Pye advised that the ratio was due to a twilight shift which was being addressed. The Board noted the report. 15. 15.1. 15.2. 15.3. 15.4. 15.5. 15.6. 15.7. Integrated Performance and Finance Report Lee Martin summarised the operational performance over April 2016 which was scrutinised at the Finance and Performance Committee. A&E Average daily site attendances in April 2016 were 952 (928 in April 2015) and 1054 in March 2016. In was anticipated that the attendances for May would increase. McKinsey were on site to review LAS time using LNWHT as an exemplary case where ED performance had improved and was being maintained following the work McKinsey had undertaken with the Trust. Cancer In month the Trust achieved all standards except for the 62 day GP Referral to first definitive treatment standard. In month performance was 84% based on 66 treatments. The Trust was providing assurance to CCGs on performance and over 62 day backlog clearance. A sustainable recovery plan had been submitted, delivering the national standard by August 2016. 18 Weeks Referral to Treatment - Performance increased from the previous month reporting at 88.17% against the trajectory of 88.8%. An RTT recovery plan commenced with planned recovery by July 2016 accounting for backlog removal. Six Week Diagnostic Standards - The trajectory for recovery of diagnostic performance was on track. There was a backlog of 219 pathways which reduced from 264 reported in the previous month. Additional capacity was agreed to support specialty areas and divisional tracking was underway. In response to Martin West s question, Lee Martin and Simon Crawford advised that performance in respect of A&E and 62 day cancer waits would get worse before it improves and that for February and March A&E performance was significantly better than Imperial College Healthcare NHS Trust and Hillingdon Hospitals NHS Trust. In response to Andrew van Doorn s question regarding underperformance of the Length of Stay metric, Lee Martin advised that the pace of actions had increased particularly around the number of patients going through Delayed Transfers of Care. Lee Martin assured the Board that a recovery plan was in place for Length of Stay performance and that a number of workgroups were feeding into a central plan. Following the redesign and Breaking the Cycle programme initiated in January 2016 which was designed to improve patient flow and safety by reducing delays through focused activity, a number of themes and work plans emerged as outlined in the report. Some of these were being delivered with the Page 10 of 13
15.8. 15.9. 16. 16.1. 16.2. 16.3. 16.4. 16.5. 16.6. 16.7. 16.8. 16.9. 16.10. Emergency Care Improvement Programme and other work plans continue. Dr Bhalla commented that it would be useful for the Board to see the improvements in future performance reports. Lee Martin noted the request. Lee Martin would discuss the reconciliation aspect of the performance scorecard with Janet Rubin. In response to Peter Worthington s question regarding the full tariff, Jon Bell informed that if the performance was over the level experienced in 2008-2009 then only 70% of tariff would be applicable. Future financial performance reporting would include this information. Finance Jon Bell summarised the Finance report for Month 1. Income was 0.5m behind plan predominantly relating to under delivery of income relating to CIP schemes and the impact of the Junior Doctor s strike. The activity levels had been agreed and would be included in the month 2 report. Pay and Non-Pay Costs the expenditure position was underspent in month of 0.4m against the plan. Pay costs were underspent and non-pay was overspent by 0.2m. Forecast the Trust has a planned deficit of 61.5m in 2016/17 and was on track to achieve this based on a number assumptions including receipt of 21.5m Sustainability and Transformation Funding (STF) and delivery of 34.7m of 2016/17 savings. Guidance in respect of STF trajectories was expected. CIPs The CIP requirement for 2016/17 is 34.7m. In addition, the full year effect of 2015/16 savings is valued at 14.6m. The total delivery in April 2016 was 3.1m. Cash The Trust s cash balance at the end of April 2016 was 5.3m. An electronic process for invoices was expected to improve payment performance. Public Sector Payment Policy performance for the year to date was 49% for trade creditors in volume and 69% in value against a target of 95%. The Trust has access to an interim Revolving Working Capital Facility (RWCF) of 58.4m, of which it had a balance of 13.339m at the start of the financial year. No monies were drawn down in April. The Trust would apply to the Interim Trust Financing Facility (ITFF) in September to convert its RWCF to a Revenue Support Loan of 61.5m, equal to the Trust s planned deficit in 2016/17. Capital Capital expenditure in April was 154k against a plan of 114k. The capital plan for 2016/17 is 29m however the programme would be reviewed due to urgent requests. An updated report in this respect would be submitted to the Board after discussion at the Finance and Performance Committee. The Trust is on track to deliver against the Capital Resource Limit. Key risks: The PBR contract for 2016/17 provides opportunities and risks. L Martin L Martin Page 11 of 13
Penalties associated with new to follow up ratios. The trajectories in relation to the STP were unknown as yet. 16.11. 16.12. Contracts - The text in relation cervical screening to be updated as it is a primary care service. The Quality aspects were covered under the Governance report and the detail provided within the report. The Board noted the report. 17. 17.1. 17.2. Eliminating Mixed Sex Accommodation The NHS Operating Framework requires all providers of NHS funded care to confirm whether they are compliant with the National definition to eliminate mixed sex accommodation except where it is in the overall best interests of the patient, or reflects their personal choice. Declaration of Compliance must be updated annually and uploaded on to the Trust s internet website. The report provides an assurance on the Trust s Declaration compliance and requirements with regard to recognising, reporting and eliminating mixed sex accommodation breaches. Dr Bhalla enquired about financial implications in the case of non-compliance. Amanda Pye confirmed that penalties are applicable for non-compliance and assured the Board that breaches are recorded on Datix. The Board noted the report. 18. 18.1. 18.2. 18.3. 18.4. 18.5. 18.6. 19. 19.1. 20. 20.1. Approved Board Committee Minutes The Finance and Performance Committee minutes of the meetings held on 22 nd February and 24 th March were noted. The Clinical Excellence Committee minutes of the meetings held on 12 th February and 18 th March were noted. The Integrated Governance Committee minutes of the meeting held on 15 th January 2016 were noted. The Patient and Staff Committee minutes of the meetings held on 18 th January, 15 th February and 21 st March 2016 were noted. The Charitable Funds Committee Minutes of the meeting held on 11 th December 2015 were noted. The Audit Committee Minutes of the meeting held on 27 th January 2016 were noted. AOB There was no other business to report. Questions from the Public A public member reported a positive experience following the service provided in A&E at Ealing Hospital advising that the doctors and staff were friendly and suggested the receptionists smile a little more. Page 12 of 13
20.2. 20.3. A public member stated that there were more than 60 demonstrators at Ealing Hospital in respect of the closure of the paediatrics department. Regarding the Sustainability and Transformation Programme, a member of the public member enquired about the relationship between the CCGs and Councils across the eight Boroughs as the public member felt that LNWHT was being effectively treated like a contractor. Simon Crawford advised that this was not the case and he was actively involved and attending the Council and CCG meetings. 21. Date and time of next meeting Wednesday, 29 th June 2016, 09.15am to 12pm in the ACAD, Meeting Room 1, Park Royal Suite, Central Middlesex Hospital. Approved as a true and correct record. Signed ------------------------------------------------------------------ Peter Worthington, Chairman Date: Page 13 of 13