Minutes of Trust Board meeting held in Public Thursday 30 th November 2017 Room AD77, East Surrey Hospital Present (AM) Alan McCarthy (MW) Michael Wilson (DH) Des Holden (FA) Fiona Allsop (PS) Paul Simpson (AS) Angela Stevenson (PB) Paul Biddle (RD) Richard Durban (DS) David Sadler (CW) Caroline Warner (DP) Daphnee Pushparajah In Attendance Chairman Chief Executive Medical Director Chief Nurse Chief Finance Officer Chief Operating Officer (Designate) (Associate) Chairman Deputy Chief Executive Medical Director Chief Operating Officer (MP) Mark Preston (GFM) Gillian Francis-Musanu (IM) Ian Mackenzie (AAP)Anouska Adamson-Parks (CP) Colin Pink (DHe) David Heller Director of Organisational Development and People Director of Corporate Affairs Director of Information & Facilities Director of Strategy Head of Corporate Governance Chief Pharmacist (agenda item 2.1) 1. General Business 1.1 Welcome and Apologies for absence AM opened the meeting by welcoming Trust Board members, governors, members of the public and staff. Apologies for absence were noted from Pauline Lambert and Richard Shaw. 1.2 Declarations of Interest No additional interest were declared. 1.3 Minutes of the last meeting The minutes of the meeting held on 26 th agreed as a true record. October 2017 were reviewed and 1.4 Action Tracker The Board reviewed the action tracker and GFM confirmed: TBPU23: is on the agenda and closed TBPU36: is due in March 2018 Page 1 of 12
There were no other matters arising. 1.5 Chairman s Report for Assurance AM congratulated Bob Alexander on his appointment as the Chair of the local STP. Bob Alexander brings a wealth of experience and knowledge of the local health system to the post and has met with the Chairs of local organisations within the STP. Currently the CCGs are reconfiguring around the local area and the Chair is taking the opportunity to listen to the plans and issues that have been identified. AM spoke about the recent NHS Providers Conference and HSJ Summit, highlighting the main focus of conversation being the budget and the impact of Brexit. There had also been discussion of the development of STPs and accountable care systems. The growing need of the development of the national workforce and was also discussed in detail. No questions were raised. The Board duly noted the report. 1.6 Chief Executives report for Assurance The Board noted the report in advance of the meeting. MW introduced the report highlighting how busy the Trust is and thanking staff for their hard work. Activity levels are starting to rise nationally marking the start of winter and its impact on the NHS. NHS Improvement (NHSI) has published its latest iteration of the single oversight framework, following consultation and discussion with NHS leaders. The framework represents a good step forward and will drive quality and safety improvements across the NHS. The Trust has reviewed the document and are assured on its alignment and sight of the indicators identified in the framework. MW highlighted the annual staff awards which had been well received and had been a great showcase of Trust staff and the dedication of volunteers. AM and MW discussed the focus of the new indicators in the framework such as E coli. blood stream infection and ambulance response times. MW noted that it was expected that indicators and access targets not included in the framework would be monitored and delivered by the Trust. DH reflected that although E coli. is considered a community related issue, the NHS will not improve its management until the situation in monitored, with focus comes improvement. AS highlighted record numbers of ambulance attendances and spoke of the commitment to continue to improve the Trust s management of the emergency flow. AM asked if E coli. is actively being discussed at ward level. FA highlighted the new nursing patient safety post and plans to develop supporting work. DH highlighted that E coli. is not easily transmissible and that the focus will be on the management of patients care such as catheters. AM highlighted the redecoration of one of the Trust s isolation rooms following the generous charity donation made by a child s parents to SASH Charity. The Page 2 of 12
redecoration to make the room more colorful and welcoming for children will have a real benefit for local children who need isolation post chemotherapy. Action GFM to write to the family and thank them for their charitable work and donation. 1.7 Board Assurance Framework & Significant Risk Register for assurance and approval The Board noted the report in advance of the meeting. GFM presented the BAF and SRR highlighting the six red risks on the BAF and the new risk that had been added to the SRR. The new risk that has been added to the SRR relates to the immediate delays to the strategic plans to develop a full electronic patient record for the Trust. PS highlighted the positive change in financial management between the CCG s and the Trusts and how this is reflected in the BAF risk 5.1. Dispute positions have been resolved which is a good step forward for the Trust, should this position remain the Board may want to consider downgrading the associated risk in the next few months. PB commented that it was reassuring to see positive movement in financial risk 5.1 as this will impact on 5.3 and 5.4. RD commented on the new risk relating to delays in development of electronic patient record. RD praised the team who had developed a review of what could be done with available capital which had been discussed at the Finance and Workforce Commttee. AM asked whether the risk should be added to the BAF. CP commented that risks could be added to the BAF at the Boards discretion, at this time the Trust is reviewing the situation. The BAF is formally refreshed at the start of each financial year. RD concurred reflecting on managements actions to date and highlighting that it will be reviewed before adding to the BAF. The Board duly noted, took assurance and approved the report. 2. Quality of Care 2.1 Clinical Presentation Pharmacy Transition Plan - for assurance The Chairman welcomed David Heller, Chief Pharmacist, to present the quarterly review of the pharmacy transformation plan. DHe reflected that this was the second update of the Trust s pharmacy service actions to support Model Hospital work. Reflecting that had been significant support from the new administration team. Similarly the work of staff on the Lean for Leaders course was identifying opportunities and improvements in systems. NHSI have reviewed the plan and its implementation, they have made recommendation recently which will be included in the next quarterly review. Since the last presentation a new medicines optimisation group with Chief Pharmacists from across the CCG had commenced which is a good step forward. DH highlighted the need to increase the number of independent prescribing Page 3 of 12
pharmacists by 50% by 2020. There is work to do with local universities to develop a course to support this developmental need. MW asked what progress had been made to date. DH reflected that six are in place already with a further seven in training or ready to start, equivalent to 25% of the target. MW reflected on the training and development needs of the local NHS workforce, noting the need to develop rounder training for clinical staff. FA noted that by 2021 new nurses will be qualified prescribers and that the Trust needs to develop how this new skill will be used. DP asked what benefits would be seen for electronic prescribing. DHe stated that there would be improvements in safety and effectiveness as human errors linked to handwriting would be eliminated. As part of a pilot the Trust has developed necessary codes to work with electronic systems and now awaits go ahead of the project, linked to capital. DP asked what the benefits of increasing independent prescribers would be for the Trust s patients. DH reflected on the holistic approach that would be adopted; medical staff are specialists in what they do and may have knowledge of the full range of benefits or interactions of medications available to patients. CW asked what benefits had been realised from the SASH+ initiative. Joanne Rhodes, Associate Chief Pharmacist, spoke from the audience of huddles that had been implemented at 2pm to trouble shoot and review the days remaining work, potential delays and how to resolve them. RD and DHe discussed how easy it would be to establish electronic prescribing. DHe reflected that the coding would need to be updated to reflect updates since the initial pilot and that implementation across the Trust would be significant but technically relatively straight forward. AM thanked DHe and his team for their report. The Board duly noted the report and took assurance from the discussion. 2.2 Safety & Quality Committee Chair Update for assurance The Board received and noted the report in advance of the meeting. CW presented the report, highlighting that the meeting had been the quarterly assurance meeting and that good assurance had been provided. In particular there was assurance over quarter 2 delivery of CQUIN schemes. 2.3 Safer Staffing and Care Hours Per Patient Day Report for assurance The Board received and noted the report in advance of the meeting. FA presented the report which showed a broadly similar position for the Trust with increasing pressures on the wards. PB asked what impact the Trust vacancy rate was having on the situation. FA noted how the teams managed safe staffing, highlighting how Abinger ward had been covered by the ward manager and the Matrons. Similarly Capel has a high vacancy rate which is not apparent from the report as the situation is well managed. Page 4 of 12
MW highlighted how the half term holiday had impacted on the use of bank staff and agencies. There continues to be a significant national challenge linked to the agency cap and the workforce overall, the issues are not specific to the Trust. 2.4 Medical Directors Report for assurance The Board received and noted the report in advance of the meeting DH presented the paper highlighting that the Trust had been successful in its appointment of both academic posts with the University of Surrey. These are the first academic posts that the Trust has offered. Both, Dr. Ben Field and Dr. Christian Heiss are involved in research into elderly care models which are significantly relevant to our local health needs. AM welcomed this news, a great step forward for the Trust. Consultant appointments in Radiology, dentistry and ophthalmology have been made since the last Board. These posts have been traditionally hard to fill. The Trust has signed a Memorandum of Understanding with the Amrita Institute of Medicine in Kerala, India (AIMS). This follows a successful visit from their senior leadership to the Trust to which there is real desire to work in partnership which could benefit our local population and our staff. CW asked if the two new academic posts would be considering new models of care. DH reflected that both would have a positive impact on the development of new models of care and would attract further staff interested in research at Ph.D. level. AM reiterated how positive this was for the Trust and the population it serves. 2.5 Learning from Deaths Dashboard for assurance The Board received and noted the report in advance of the meeting. DH introduced the report which supports the requirement to discuss all deaths of patients with a learning disability at Board level. The paper provided assurance that systems have been put in place to support the new national expectation. DH reflected that there had been four such deaths in the last two quarters, which had been reviewed internally at the Clinical Chiefs group and will also be reviewed externally. This process is well established for patients in Sussex. This represents 1% of all deaths of patients under the Trust s direct care, all four were expected and no concerns were raised. DS asked if these would be reviewed as serious incidents. DH stated that incidents would be reviewed as serious incidents if they met the criteria defined in the Trust policy, this initiative focuses on learning from all death and care of patients with a learning disability. AM requested that when possible the report would include narrative that compares the Trust to similar organisations, DH agreed that this would be done in the future when possible. Page 5 of 12
The Board noted and took assurance from the report. 2.6 Integrated Performance Report (M06) - Overview for assurance The Board received and noted the report in advance of the meeting. AS provided an overview of the integrated performance report. Safe, Caring and Effectiveness domains are good overall, the report identified serious incidents that were reported in month. The emergency department access standard was not met in October and ambulance handover remains an issue, however the Trust benchmarks well for the emergency department four hour standard nationally. Cancer access standards are challenged, which will be discussed later in the agenda. Staff survey response rate is good and the Trust is developing systems to support inclusion and engagement with stakeholders. The Trust is reporting a 5.3 million surplus which is good news but 1.8 million lower than planned surplus to deliver the control target. It is felt that the target is still achievable with some risk. There were no questions at this point in the report. 2.7 Safety & Quality Indicators for assurance FA highlighted that the safety thermometer score for the Trust was at its highest level to date, noting that it was a national tool and expected to benchmark well when data was available. CW and FA discussed nursing retention. The Trust is aiming for 13% turnover rate and is putting in plans in place with oversight from NHSI. The Trust is holding focus groups with its staff to be better understand the issue. MW reflected that people s expectations have now changed and individuals are now looking for portfolio careers, workforce continues to be a national issue. MP concurred highlighting that on top of this issue the organisation continues to expand which increases the need to improve retention. AM and AS discussed discharge and those patients medically ready for discharge. The teams are focusing on people who are ready for discharge and the supporting pathways and those who need support coordinating long term care. The Trust is expecting to see a drop in delayed transfers of care. AM asked that discharge metrics in Board reporting is reviewed to reflect the changing focus. 2.8 Patient Experience Indicators for assurance The Board discussed the patient experience metrics noting that patients and Governors were involved in the signage and way finding project. GP streaming is in place in the emergency department and is going well. It is expected that the new service will have post impact on ED performance and reduce admissions. MW reflected on the aspects of patient education that would be provided by the GP service at the front door. Page 6 of 12
3. Operational Performance Report 3.1 Operational & Access Performance Indicators For assurance AS reported that the Trust continues to benchmark favorably for national access standards. At the end of October there were 22 patients waiting over 52 weeks for elective treatment, there remains an element of patient choice as people are deferring to after Christmas. Plans are in place for all long waiters and there is focus on specialties with particularly issues including review of elective activity at weekends and out of hours. MW highlighted that particular specialties are struggling nationally which is linked to gaps in workforce and spread of service. The Trust is pulling patients from outside its catchment area which is impacting on waits. AM and AS discussed the effect of waiting times on patients, AS confirmed that waiting would be having a negative impact on experience of care but the Trust is reviewing each case to minimise risk of avoidable harm. Similarly diagnostic issues are linked to specific specialties where demand is putting pressure on deliver of standards. AS stated that the issue highlighted in October s data was caused by an inability to find suitable external support during the month and the position has already been recovered. The Board discussed cancer access standards. October s performance is represented as a percentage the month s data represents a few patients who were referred to the Trust late in the pathway and for the purposes of national data the Trust records a breach in standard. 4. Operational Performance 4.1 Workforce performance indicators for assurance MP introduced the workforce section of the report highlighting new resources to support the development of talent management within the Trust which will start in March. Achievement review compliance and flu vaccination KPIs for October are good and there has been another good return for the staff survey, 61% vs 30% nationally. The Trust will be able to access a nursing associate apprenticeship from the 12 th March from Brighton University. DP asked for an update on the staff wellbeing activities. MP highlighted exercise classes such as circuit training and palliates, there are now groups who champion walking groups around the site and the SASH choir is up and running. PS and MP discussed frustrations around the national apprenticeship levy focusing on the need to develop schemes that support the development of the majority and specialisms of the workforce in the NHS. Page 7 of 12
4.2 Finance and Use of Resources Performances Indicators for assurance The Board received the paper in advance of the meeting. PS introduced the financial elements of the report. At the end of month seven the Trust is reporting a 5.3 million surplus. This is however red rated as it is 1.8 million adverse to the financial plan to achieve the annual surplus control target. This figure does not include funding from the sustainability and transformation fund. Activity continues to increase and there is encouraging movement in terms of elective plans that will help to recover RTT and improve the financial position. There are greatly improved working relationships with CCGs and there has been agreement on a refreshed annual contract value, leading to payment of additional cash in month. This is a positive step forward which is reflected in the financial elements of the BAF. Agency usage remains higher than plan with associated costs and impact on financial plan. There remains risk to the achievement of the annual surplus control target but the Trust is maintaining its forecast. Risk sits at 16 million. The Trust is anticipating a continued improvement in its better payment practice code (BPPC) figures as cash flow becomes stronger. At present the Trust is not anticipating drawing funds from its agreed working capital facility, this is a reassuring position overall. The BBPC will reduce in November as a backlog creditors are paid, but will improve after that action. DS indicated that the narrative in respect of capital plans did not fully align with the plans discussed at the Finance and Workforce Committee (FWC), PS agreed and stated that this would be aligned with the plans discussed at FWC in the next report. The Board discussed delivery of the savings plan noting that the plan is being achieved with the use of the planned contingency fund. This is described in the Trust s internal controls framework and is amber rated as there is acknowledgment that saving plans are challenging and require contingency to mitigate risk. 4.3 Finance and Workforce Committee Chair Update for assurance The Board received the report in advance of the meeting. RD presented the report. The Committee had reviewed and agreed the Trust s internal controls framework for financial systems, this will be taken to the Audit and Assurance Committee as part of its rolling review. The controls included the cost improvement program, which is amber rated as discussed earlier. Overall there is assurance that there are strong internal controls that support the Trust s financial management. Page 8 of 12
A post implementation review of the medical records project was received this provided good assurance in particular the use of resources and benefits of space realisation. The Committee discussed the outline MRI business case. The preferred option was not to fund a new scanner out of capital funds and as such the Trust is considering potential options to lease equipment. There are benefits to a lease agreement which could be maximised through competitive tender exercise and it provided better value for money The capital plan had been reviewed, focussing on the option to lease MRI scanner, pathology developments and the review of how to implement EPR without capital loan funds. The review of implementation of EPR was well received and highlighted which elements of the plan could be done within the capital budget. PS highlighted that the reference cost for the Trust has been reported by the NHS at 83, previously 86. This is very good assurance of the Trust s systems and is the lowest reference cost of any acute trust in the country. 4.4 Finance and Workforce Committee Annual Report for approval 5 Strategic Change The Board received the report in advance of the meeting. RD presented the report. The Committee focussed on review of finances, activity and workforce information. It seeks factual assurances that supports the discussions of Board and decision making process. Themes have emerged throughout the year which have received significant focus. The main themes have been productivity, considering the application of the range of streams of work that the Trust is pursuing and financial scrutiny in particular forecast position and financial plans. Both themes are discussed thoroughly and in a timely manner. RD noted that the terms of Reference (ToR) need to be reviewed and updated to reflect the work that is undertaken by the Committee, in particular the review of strategy is now a Board level conversation. Action RD / GFM to review ToR of FWC and align with current Board review of strategy. The Committee has identified a number of challenges for the next years work these include modelling and planning for potential implications of a local accountable care system. Maintaining a review of financial plans and workforce will remain a focus at a time of increasing pressure on NHS finances and workforce models. Finally the Committee will continue to develop its review of benefits realisation. Overall the Committee believes that it is delivering on the key elements of its terms of reference and provides good assurances to the Board. AM agreed and thanked the Committee members for their continued good work. The Board duly noted, approved and took assurance from the report. Page 9 of 12
5.1 SASH+ Quarterly Update for assurance The Board received the paper in advance of the meeting. SJ introduced the report and supporting videos. The Trust had received very good feedback from its recent open day. This was an opportunity to show case the work that had been done across the Trust. Future events are planned for December and March. The feedback received will be discussed by the Trust Guiding Team and will influence the refresh of the plans that will be detailed into the next report to Board. SJ provided an update on the work to date highlighting the numbers of people who were in the Lean for Leaders program, indicating that the KPO had capacity to train 120 people a year. Four staff had completed advanced lean training strengthening capacity of the team to run RIPW. The next key step is to develop systems to fully capture all SASH+ work across the Trust. SJ presented a video which highlighted development of standard work for one of the radiology clinics, setup reduction in therapies and reducing dispensing errors in pharmacy. The Board discussed the report highlighting a need to get a better understanding of the overall impact on quality of care. MW reflected on the very real benefits for patients, the cultural change that had started, particularly linked to the cardiology and management of diarrhoea value streams. 5.2 Emergency Planning Resilience Report for assurance The Board received the paper in advance of the meeting. AS introduced the report which detailed an overview of national assessment of preparedness to manage an emergency. The report indicates that the Trust scores well overall but that there is work to do with supporting actions in place. The Board discussed the items recorded in the attached action plan. AS confirmed that all the actions were achievable and had been agreed with the Trust as particle solutions. DS asked to what extent plans are tested and rehearsed. AS stated that there is regular table top and training exercises there are six training events in the diary for coming months. DS asked for sight of the embedded documentation. Action AS to share embedded core standards documents within report. 5.3 Local Escalation Plans for Winter for approval The Board received the paper in advance of the meeting. AS introduced the report which details the Trust s response to national winter briefing notes which detail NHS England and NHSI expectations. Local winter teams are in place both within the Trust and across the system. Similarly local Page 10 of 12
escalation plans are in place which are being monitored at the SASH System A&E Delivery Board. These include outbreak and escalation plans. AM asked if plans are being tested. AS reflected that the plans are in place and are effectively been enacted each day at different levels across the system already. Following every significant event such as declaring OPAL level 4 there is a post event review which is externally scrutinised. MW stated that the Trusts preparation for winter was one of its highest priorities, the Trust is developing good plans and is expecting significant operational pressures. Going on to highlight that national the Trust s plans had been highlighted as amongst the best plans for the year. The Board duly noted, approved and took assurance from the report. 6 Leadership and improvement capability No agenda items to discuss under this heading Other Items 7 7.1. Minutes of Board Committees to receive and note 7.1.1 Safety and Quality Committee to receive and note The minutes of the Committee were noted with no questions raised. 7.1.2 Finance and Workforce Committee to receive and note The minutes of the Committee were noted with no questions raised. 7.2 Any Other Business No further business was raised. 7.3 Questions from the Public There were no questions from members of the public. 7.4 Review of the Meeting The Board discussed the meeting. The meeting was generally well received with no adverse comments. There were no other points raised. 7.5 Date of the next meeting Thursday 25 th January 2018 at 11.00am in Room AD77, Trust Headquarters, East Surrey Hospital Note: This is a public document and therefore will be placed into the public domain via the Trust s website in the interests of openness and transparency under Freedom of Information Act 2000 legislation. These minutes were approved as a true and accurate record. Alan McCarthy Page 11 of 12
Chairman: Date: Page 12 of 12