Meeting of the Operational Board

+ ( Meeting of the Operational Board Item 6.3.5 Minutes of the Operational Board meeting held on 30 th September 2016 Present: Jane Tomkinson Tony Bennett Steven Colfar Hayley Kendall Lucy Lavan John Morris Sue Pemberton Raphael Perry Lisa Salter Nigel Scawn Lyndsey Vlasman Robin Wiggs Tony Wilding Jay Wright Chair, Chief Executive Divisional Head of Operations (Clinical Services) Head of Nursing (Clinical Services) Divisional Head of Operations (Surgery) Associate Director of Corporate Affairs Associate Medical Director (Medicine) Director of Nursing and Quality Medical Director/Deputy Chief Executive Head of Nursing (Surgery) Associate Medical Director (Clinical Services) Head of Nursing (Medicine) Divisional Head of Operations (Medicine) Chief Operating Officer Clinical Lead for Research In Attendance: Helen Turner Wendy Stables Ruth Dawson Jim Davies Tracey Graham Lynda Robinson Joan Mathews Richard Williams Executive Assistant Lead Nurse Innovation Head of Education and Learning Deputy Chief Finance Officer Deputy Divisional Head of Operations Head of PMO and Business Transformation Head of Nursing (Corporate) Clinical Lead (Surgery) Apologies: Mark Jackson Debbie Herring Associate Director Research and Informatics Director of OD and Strategy 1

Tony Bennett Aung Oo Divisional Head of Operations (Clinical Services) Associate Medical Director (Surgery) 1. Apologies for Absence Action As above 2. Declaration of Interest Relating to Agenda Items None declared 3. Patient Story Instead of a Patient Story, Sue Pemberton updated Operational Board on the outstanding celebrations for patients. 4. Delivering Our Strategy 4.1 Apprenticeships Levy Ruth Dawson gave an update to Operational Board on the impact to LHCH of the apprenticeships levy which could potentially cost LHCH 340K. Ruth Dawson confirmed that 0.5% of the pay bill is to be put into a digital account which can only be used for apprenticeships and 34 new apprenticeships per annum are needed to recoup the money. Operational Board noted the report and the actions being taken to mitigate the levy and discussed opportunities such as Medical Engineering where apprenticeships could be created. 4.2 ACHD Update Operational Board noted the update from Tony Wilding, on the ACHD work following the minded decision to award the contract to Liverpool Heart and Chest hospital and partners and the next steps Meeting convened by NHSE on 5 October with Central Manchester, chaired by Mike Gregory LHCH will have representation at the meeting Telecon arranged between Andrew Bibby and LHCH Public consultation will begin in December and will last for 3 months Final decision in May 2017 2

Tony Wilding confirmed that Dr Glenn Russell was stepping down as the clinical lead and there was cover in the interim period. Action Circulate note on outcomes of the NHSE 5 October 2016 meeting to Operational Board 4.3 Patient Flow Operational Board received a presentation on patient flow the Trust s first major project working within the internal PMO office. TW The primary issues that have driven the work are: Nursing ratios Non-standardisation of patient administration which requires engagement from Consultant staff. The challenging financial position and the review of back office and medium office functions to reduce cost base. The aims and benefits of the project are to: See a more efficient use of the Trust s estate Adherence to agreed processes and reduced variation of practice Streamline the current patient pathway process to realise financial and other efficiencies and enhance the patient experience Improve referral between Providers Improvements in exchange of patient information Operational Board discussed the project and were told that the project in the first six months of implementation will realise minor savings and the following six months would see further efficiencies. However the Board stated that more detail was needed and made explicit that change and efficiencies were essential in the current financial climate and the need to realise 4 million of savings in the next financial year was the primary driver for the project. It was also recognised that staff needed to understand that the pathway work was a continuation of the improvement work started with LiA and not something new. Operational Board approved the proposal and Terms of Reference subject to: Amending the name from Patient Pathway Project Board to Patient Pathway Project Group Changing the executive sponsor to Dr Raphael Perry Reflecting that the group was time limited Action Governance structure needs to be reflected in the document. Action Update the business cycle to reflect the patient pathway project reports. LR/JM LR/JM 3

4.4 Surgeon of the Day Review LR/JM Hayley Kendall and Richard Williams presented a paper on the Surgeon of the Day pilot started in April 2016 and the next steps to build on the work. The background and reasons to the pilot were stated and while improvements had been made, further work was required to solve the access to urgent cardiac surgery and historical problems associated with it. In line with standard practice at other Trust s the paper proposed introducing Cardiac Surgeon of the Week (CSOW) which in contrast to Surgeon of the Day the CSOW would operate in the morning freeing time in the afternoon for referrals, access to advice etc and would allow an extra four cases per week. The risks to the proposal were identified as anaesthetic and theatre capacity as well as reduced activity in outpatients. Operational Board discussed the proposals and acknowledged that there was concern that the impact on Clinical Services income was already being experienced. Therefore Operational Board asked for the following action at the next meeting, 4 November 2016: Comprehensive financial impact assessment of CSOW/SOD across all Divisions and corporately. Operational Board approved the 6 month pilot 4.5 Update on Theatre Consultation HK Operational Board received and noted an update from Hayley Kendall on theatre consultation for 7 day working which aims to commence April 2017. Discussions with the unions start week beginning 10 October followed by consultation with nursing and perfusion staff; medical staff are not included at this point. Once the consultation and organisational change is complete a period of protected pay should be expected. It was confirmed that staff morale had not been unduly affected by the prospect of consultation but the future financial impact may contribute to a decline in morale. Operational Board discussed the possibility of losing the good will of staff who work longer shifts than contracted for. 4.6 STP and Cross Cutting Cardiac Work Operational Board received and noted an update on the STP and cross cutting cardiac work by Jane Tomkinson. It was noted that the STP was a mandate for the sector to work in a different and leaner way. There are currently 44 STPs across the country which may be reduced to 20 over the next few years. LHCH is leading on the cardiac services cross cutting work a 4

programme board has been formed and members have been chosen for breadth and depth of experience to bring new ideas and energy. It was noted that Liverpool Health Partners (LHP) have also been added to the board at an advisory level. Cardiac services has seven core work streams with influence over the patch and of those streams Raph Perry, Joe Mills and Debbie Herring from LHCH are leading. Action STP Cardiac Cross Cutting Services standing item on Operational Board agenda 4.7 Birch Ward Review Operational Board received and noted a presentation by Lead Nurse Innovation, Wendy Stables which explored the use of a lounge model for Birch Ward to address inefficiencies, address capacity which is particularly important given financial restrictions on recruitment and improve the quality of care for patients It was stated that the purpose of bringing the presentation to Operational Board was to illustrate a model that could be replicated throughout the Trust. It was also noted that the revised operational plan dates would afford the Trust an opportunity to address a number of capacity issues. It was confirmed that Maple and Cherry ward staffing issues would also be addressed through the review. HT/JT Action Review of Holly Suite Action Protocol needed on admitting Cardiology patients from other Trusts. Action ANP review presented to 25 November 2016 Operational Board 4.8 Medical Workforce Strategy Operational Board received and noted the medical workforce strategy from Dr Raphael Perry which had historically not been of sufficient rigour. The purpose of the strategy was to address the gaps in the workforce and anticipate need in the next 3 years. Wendy Stables Robin Wiggs Sue Pemberton 5. Ensuring Strong Performance 5.1 Divisional Reports 5.1.1 Strategic Objectives Dashboard Operational Board received and noted the month 5 strategic objectives dashboard update from Tony Wilding the salient points being: Red indicators for month 5 were: Quality and Experience: Falls 5

Sepsis Discharges by lunch Compliance with post cardiac surgery pathology protocol Mortality reviews Service and Innovation Cancer RTT not meeting target (62 day wait) Recruitment to 100000 genomes project Value CIP SLR Reduction of premium expenditure Workforce needed more work as the numbers were not sufficiently available for analysis Red indicators year to date included delayed transfers of care which had for the first time in the year been green in August. Operational Board discussed the backlog of mortality reviews and the change in the mortality review process was explained in that two thirds of deaths should be reviewed in 14 days and the other third in 30 days. A discussion ensued on non-compliance of some consultants to do mortality reviews and whether nurses should be included amongst the six consultants appointed as screeners to address the backlog Action RAP to meet with AMDs to discuss the improvements to mortality reviews 5.1.2 Surgery Operational Board received and noted the month 5 surgery performance report presented by Hayley Kendall. They noted that: RAP/AMDs Access 18 week Referral to Treatment at Month 5-80.62%, for England, this equates to 95 patients waiting over 18 weeks treatment. The Trust maintained compliance at Month 5. Cancelled operations remain challenging although positive performance compared to the same period last year due to overnight emergencies. Income for surgery is 6.96% above plan YTD. Cancer YTD targets are being achieved Quality Falls YTD are above target however back on target for Month 5. 6

Finance and Activity Cardiac Surgery - Strong cardiac surgery performance over performing by 657k mainly due to cardiac valve procedures. 44 cases over plan YTD at Month 5. Thoracic Surgery Month 5 showed an increase in thoracic activity however still remain behind plan YTD. Thoracic - complex over performance of 135k. Other points raised included: Decline in time to hire due to change in Occupational Health provider and HR staff. Update on nurse staffing levels issue which was a combination of maternity leave, sickness, ward managers stepping up, HR issues. Cedar/Oak ward swap should address some of the high turnover but in the meantime may have to go to agency to address the problems as well as other means being used. It was confirmed that the Cedar/Oak ward swap, thoracic surgeons were consulted and were supportive and that the mix of cardiac and thoracic patients on the same ward was not working. It was suggested that research nurses should be used as an interim measure as was done in other Trusts. No growth in outpatients despite clawing back activity through cardiac surgery and therefore a revised forecast Action - Outpatients data for the surgery waiting list will conclude in the next 2 weeks and information will be circulated to the Operational Board 5.1.3 Medicine Operational Board received and noted the month 5 surgery performance report presented by Robin Wiggs. They noted that: The only 2 red indicators on the dashboard were for CIP and VTE prophylaxis HK Value While hitting the CIP target for 2016/17 continues to be a challenge, preparation for next year s CIP continues and forecasts that pay costs should fall. The Division was 10% ahead on devices 2.3% ahead on NHS patients Income YTD is currently 3.85% above plan which equates to 405K above plan (last period was 1.25 %.). Quality and Experience Bathroom work continues in the Division to address falls and the call don t fall initiative in place 7

Dementia screening has seen a positive increase Divisions requested sight of the in train process work by Mark Jackson and Gill Gow on medication errors. Of the errors this month no harm to patient and no themes emerging. VTE red indicator work continues through nursing staff working with medical staff to ensure compliance. Feasibility of ANP completing VTE being scoped. Nursing turnover on Birch ward due to promotion Action More rigour using Datix system to record errors Risk Register The same risks reported as last year and the downgrading of some risks will begin shortly Confirmed that mitigation of the reduction in EP TCI cases was being dealt with through additional lists and that the backlog was sue to lost OPD capacity due to strike and urgent surgery. Biggest Divisional risk is the CIP gap DHoOs Forward planning work continues on Annual Planning - activity planning and physical / workforce capacity calculations Birch Ward - Training, Flow and medical Input ACS weekend - finalisation of consultation paper for staff. Cath Lab Refurbishment Relationship visits - IoM, Warrington, WUTH Community EPR LAAO / PFO CtE cessation. Appraisals - medical and non-medical Matron role recruitment PCI Clinics - switch Registrar for ANPs/CNPs. 5.1.4 Clinical Services Operational Board received and noted the month 5 clinical services performance presented by Steven Colfar and Tracey Graham. They noted that: The red indicators on the dashboard for August were DNA rates project in place to resolve Turnover Income underperforming due to critical care bed delays & OPD/radiology outpatient activity actions are in place to resolve Contribution (although had increased in Month 5) Other points raised included 8

Anaesthetic staffing risk was discussed by the Board and the mitigations in place to recruit Consultant anaesthetists including incentives, funding to appoint new Registrars (unsuccessful) and further advertisements, Operational Board noted the progress made with recruitment.. Operational Board discussed bed modelling, critical care activity and beds in the context of lack of anaesthetic cover and asked that: Action Analysis of Critical Care activity to inform opening of further beds. It was stated that the biggest risk facing Clinical Services was financial but that with 28 level 3 cases in critical care, income should increase considerably. 5.1.5 Finance Month 5 update and CIP Steering Group Report Operational Board received and noted the Month 5 finance performance and CIP Steering Group Report presented by Jim Davies. They noted and discussed that: TB/SC/NS Month 5 is the second lowest month for activity/income. September November essential there is an increase in activity and income to hit targets and mitigate CIP under delivery. Expenditure over plan due to delivering on excess activity. CIP still remains under plan and is unlikely to be delivered this year. Essential the plan is delivered to secure further funding Recurrent solutions needed to deliver CIP target this year and future years suggested that vacancies could provide the solution. CIP Steering group deep dives by Divisions and departments with workshop arranged. CIP Steering group will morph into Business Transformation Group. Confirmed that the medical representative on the group is Aung Oo. Negotiations continue with Aintree to manage LHCH estate which could net a 17.5% saving. Reinforced that finances sit with clinical teams and corporate services. Difficult decisions will need to be made in the coming financial year but preferable they are made collegiately as a Leadership Team than top down. 5.2 Governance 5.2.1 Minutes of Divisional Governance Meetings* Operational Board noted the minutes and it was confirmed that the Governance meetings for Medicine and Surgery had been cancelled due to Quarterly Patient and Family Experience 9

Committee taking place and therefore no minutes were available. 5.2.2 Minutes of Divisional Performance Meetings* Noted and no further comments or questions 5.2.3 1/4ly Quality Patient and Family Minutes* Noted and no further comments or questions 5.2.4 Capital Management Group Terms of Reference Operational Board agreed the Terms of Reference subject to changing the minutes to be presented monthly at Operational Board to an annual report 5.2.5 Operational Board update Terms of Reference Operational Board approved the amendments to the Terms of Reference subject to inclusion of reports from the following groups CIP (up to as and when it becomes part of Business Transformation Group) Patient Flow Business Transformation Jim Davies 5.2.6 Digital Healthcare Progress 1/4ly Report from CCIO Operational Board noted the progress made in the last 6 months of digital healthcare and that divisional engagement has been key. There have been a number of links with external organisations which has aided progress and that the backlog of requests for change to the EPR system continues to be dealt with. Operational Board also noted that Carol Moss has been excellent in her role. HT 6. Risk Management 6.1 Risk Register Operational Board noted the Corporate Risk Register; discussed the risks of cardiac surgery that no risks had increased and agreed that the Junior Doctors strike could come off the risk register but noted the new risk of Junior Doctors cover, imposition of the national contract and patient safety and waiting times. 7. CEO s Briefing* Operational Board noted the Chief Executive s report and that it had been submitted as part of the private agenda due to sensitivities contained within it. 8. Policy Review (As required) 10

None required 9. E-pack No further questions 10. Approval of Draft Minutes of 29 July 2016 Approved as a true record 11. Action Log Action 2 deferred until 25 November 2016 meeting Action 3,5 & 6 complete Action 7 oral update given Action 8 complete covered in Item 6.1 Action 9 complete covered in Item 5.1.4 12. Date and time of Next Meeting: Friday 4 November 9.30am 4.30pm Strategy Day with Clinical Leads 11