Agenda item: 5 EAST AND NORTH HERTFORDSHIRE NHS TRUST Minutes of the Trust Board meeting held in public on Wednesday 25 th February 2009 at 2.00 pm in Rooms 2 and 3 at Hertford County Hospital DRAFT Present: Mr Richard Beazley Chairman Mrs Alison Murray Vice Chairman Mr Nick Carver Chief Executive Mrs Alison Bexfield Mr Stephen Brooker Mr Neil Dardis Director of Operations Mr Michael Gibbons Ms Sue Greenslade Director of Nursing & Clinical Governance Mrs Wendy Hull Director of Finance Mr Ian Morfett Mr James Quinn Medical Director In attendance: Mr Stephen Posey Mr John Webster Mrs Jinjer Kandola Mrs Victoria Fisher Ms Grace Norman Mrs Heather Schulz Mr Peter Gibson External Attendees: Mrs Liz Conder Ms Emma Black Mr Graeme Jones Director of Strategic Development Director of Corporate Development Deputy Director of HR Trust Secretary Board Committee Secretary Board Committee Secretary Head of Public Affairs Patients Panel GlaxoSmithKline NHS East of England 09/30 CHAIRMAN S OPENING REMARKS ACTION 09/30.1 The Chairman apologised for the meeting start time being delayed and explained that this was due to the Trust Board undertaking mandatory fire training. The Chairman thanked the Fire Risk Manager, on behalf of the Board. 09/30.2 The Chairman assured the public that any decisions made in the private session of the meeting, because of their commercially sensitive nature, would accurately reflect the strategies and decisions already taken in public. 09/31 DECLARATION OF INTERESTS There were no declarations of interest relevant to the agenda or to any potential conflict of interest. 09/32 QUESTIONS FROM THE PUBLIC There were no questions from members of the public. 09/33 APOLOGIES FOR ABSENCE 1
Apologies were received from Ms Janet Lynch, Director of HR and OD, who was represented by Mrs Jinjer Kandola, Deputy Director of HR. 09/34 MINUTES OF THE PREVIOUS MEETING The Board approved the minutes as an accurate record of the meeting of 28 th January 2009. 09/35 MATTERS ARISING The Board was satisfied that all actions were completed or were on track. 09/36 CHIEF EXECUTIVE S REPORT 09/36.1 The Board reviewed the Chief Executive s monthly update on recent developments, which included the staff briefing meeting on DQHH (Delivering Quality Healthcare for Hertfordshire), a visit from the Herfordshire County Council s Overview and Scrutiny Committee at the Mount Vernon Cancer Centre and the heroic efforts made by staff to get to work during the recent adverse weather. 09/36.2 The Chairman joined the Chief Executive in thanking all the staff who made extra effort to come to work so that many services could continue without disruption. 09/36.3 The Chief Executive drew particular attention to the staff briefing meeting which had taken place on 23 rd February. There had been an encouraging attendance with over 100 staff. Additional sessions have been scheduled, both at the Lister and QEII. 09/36.4 The Chairman expressed his thanks to the PCT for their involvement. 09/37 DQHH UPDATE 09/37.1 The Board considered an update report on progress towards the consolidation of acute services under Delivering Quality Healthcare for Hertfordshire (DQHH). The report had been discussed in detail by the Finance and Performance Committee (FPC). 09/37.2 The Board noted that it would receive the Estates Strategy in March 2009. 09/37.3 The Board discussed the implications of the Maternity Services completion date being delayed by six months. It was explained that this was rooted in providing the best clinical care and patient experience, owing to the need to add a second phase. It was important to ensure that the financial implications of the delay were fully understood as well as being built into the financial model. 09/37.4 The Board noted that the first three phases of DQHH have made 2
significant progress and phase one (the Independent Sector Treatment Centre, ISTC) was at the commercial negotiation phase. The Board had spent considerable time reviewing the commercial, business and clinical issues and was likely to finalise the negotiations on the 2 nd March. This project would constitute the first of three major commitments, and which will form a significant component of DQHH. The Chairman thanked the Executive team, the PCT, the SHA and all other staff involved for their hard work in bringing the ISTC negotiations to this stage. 09/38 PATIENT SAFETY & INFECTION CONTROL 09/38.1 The Board considered a paper outlining the Trust s current performance in relation to MRSA and C. difficile, together with a number of patient safety indicators. 09/38.2 The Board was informed that there had been two cases of MRSA in February and four cases of C. difficile. The Board queried whether the increase in cases of C. difficile presented in December and January was because of seasonal variation and was informed that this was the case. The Trust remained below trajectory for the year. 09/38.3 The Board queried whether the origin of the MRSA cases could be identified and discussed with the PCT to prevent recurrences. It was informed that the Director of Nursing meets monthly with the wider health economy to discuss issues and practices. However, in the next financial year, community cases will be counted separately in order to provide more detailed information about the Trust s performance. 09/38.4 The Chairman noted that since June there had been no post 48 hour incidents which suggested that learning was now becoming fully embedded. This was a significant improvement in the care provided to patients. 09/38.5 The Board also questioned whether the MRSA and C difficile targets for the next financial year are sufficiently ambitious. The Director of Nursing confirmed that the Trust would set its own internal ambitious targets for MRSA irrespective of those set externally, in addition to reporting on the external target. 09/38.6 The HSMR (Hospital Standardised Mortality Rate) was also discussed, with the Board requesting that when the next set are of figures released, the six highest and six lowest scoring areas are reported to the Board in order to identify areas for further improvement. The Medical Director cautioned that a high HSMR score did not necessarily reflect the quality of care, but that there could be alternative explanations, such as issues with coding. Medical Director 09/38.7 Finally, the Board questioned whether there were other infections or patient safety standards which it should be monitoring more proactively, and was informed that the new CQUIN (Commissioning for Quality and Innovation) standards would become the key areas for focus. There would also be 3
new areas such as patient prophylaxis to reduce the risk of hospital acquired thrombosis. The Board asked that all these aspects be pulled together in one paper to be presented to the RAQC (Risk and Quality Committee) in the first instance. The Medical Director agreed to address this by expanding the follow up report to his Improving Patient Outcomes paper. Medical Director 09/39 COMPLIANCE & CLINICAL EFFICIENCY REPORT 09/39.1 The Board considered a report demonstrating the progress achieved against the Healthcare Commission core standards and national targets, together with exception reports on A&E, cancelled operations, delayed transfers of care and two new cancer targets (14 day cancer referral to review and 31 days from diagnosis to treatment and 62 day of referral to treatment), and a report on performance against a number of clinical efficiency indicators. 09/39.2 The Board noted that the report had been reviewed in detail by the FPC. 09/39.3 The Director of Operations explained that to date thresholds for compliance with the three new cancer targets had not been set so the Trust was currently measuring them against the old thresholds. However, the Director of Operations explained that the reason the thresholds are likely to be lower to account for a proportion of patients choosing not to accept an appointment. 09/39.4 The Board noted that the lack of community care had resulted in a large number of beds being blocked in January which had an impact on the A&E and cancelled operations targets. 09/39.5 The Chairman articulated the Board s concern that the Trust was not achieving compliance on standards where the control lay with another organisation. Specifically, the thrombolysis target was not being met because the Ambulance Trust was unable to meet their part of the target; therefore up to 15% of beds were blocked by patients who should have been referred to community care. 09/39.6 The Board noted that the clinical efficiency paper had been under development, and both the FPC and Board would now be receiving a shorter paper. The Board asked that this should provide some analysis on the standards and identify the areas of difficulty on an exception basis so that it could assess the wider strategic issues. The Board noted that achieving upper quartile performance linked to a strategy for organisational development that would be presented in the next two to three months. Director of Operations 09/40 FINANCE AND PERFORMANCE COMMITTEE REPORT The Board noted the issues raised by the FPC the detail of which was considered in the following agenda item. The FPC emphasised the need for cross cutting initiatives to improve a number of processes. 09/41 FINANCE REPORT AT MONTH 10 4
09/41.1 The Board considered a report setting out the Trust s financial position at the end of Month 10 compared with plan, together with a number of technical annexes. The paper had been discussed in detail by the FPC. 09/41.2 Income recovery had improved in January, at 0.2m over plan, and spending has been maintained in line with the plan. Reserves had been issued as planned and the Trust had confidence of delivering a year end surplus of 2m baring exceptional circumstances. 09/41.3 The Board questioned whether the 2m surplus was contingent on achieving stringent CIPs and was informed that these would further protect the position but are not crucial. 09/41.4 The Board also queried what impact the snow in February would have had on the financial position. The Director of Finance explained that there had been little unexpected use of bank staff, and few staff had been unable to come in to work, many making significant efforts. The Chairman, on behalf of the Board, thanked all staff for their efforts to come in despite the adverse weather. 09/41.5 The Chairman noted that the Board was receiving a great deal of information about the financial position and asked for a review of the appropriate level of detail to be undertaken. It was agreed that this would be reviewed by the FPC in conjunction with the new Director of Finance. 09/41.6 The Board questioned the workforce data and was informed that currently as many staff members were leaving the Trust as joining. Nursing staff, in particular, were under establishment by 250 whole time equivalents. Retention was the key and the Board asked to be provided with the detail of the succession planning policy to address this. Director of HR & OD 09/42 NOLAN PRINCIPLES 09/42.1 The Board was asked to adopt the Nolan principles formally and to support their wide dissemination throughout the Trust. Trust Secretary 09/42.2 The Board unanimously passed a vote in favour of adopting the principles. 09/43 REPORT FROM THE FOUNDATION TRUST COMMITTEE The Board noted the report from the Foundation Trust Committee. The Director of Corporate Development requested that all members attend the next meeting since the Trust s strategy as reflected in IBP would be the main agenda item. 09/44 REPORT FROM THE RISK AND QUALITY COMMITTEE 09/44.1 The Board noted the issues escalated by the RAQC. 09/44.2 The Board noted the interconnection of a number of the issues, 5
such as problems of medical records and an increase in complaints. This highlighted the need for Trust wide crosscutting initiatives and measurable outcomes to improve productivity and efficiency, as previously discussed. 09/45 ANY OTHER BUSINESS There being no further business, the Chairman proposed that the Board move into private session at 3.30pm. 09/46 DATE OF NEXT MEETING The next Board meeting would be held on Wednesday 25 th March 2009 at 2.00pm at the Lister Education Centre`. Richard Beazley Chairman 6