Agenda Item: A3 THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST Minutes of the Board of Directors Meeting held on 27 th July 2017 Part A: Public Session Present: Mr K W Smith (Chair) Chairman Mrs A Dragone Finance Director Mrs L Robson Business and Development Director Mr A Welch Medical Director Mrs H Lamont Nursing and Patient Services Director Mr K Godfrey Non-Executive Director Mrs H A Parker Non-Executive Director Professor K McCourt Non-Executive Director Professor D Burn Non-Executive Director (from 1.45pm) In Attendance: Mrs K Jupp, Trust Secretary Mrs A O Brien, Director of Quality and Effectiveness 17/117 Apologies for Absence Apologies were received from Mr E Weir, Non-Executive Director, Mr D Stout, Non-Executive Director and Mr J Jowett, Non-Executive Director. 17/118 Declarations of Interest There were no declarations of interest on this occasion. 17/119 Minutes of the Meeting held on 22 nd June 2017 These were agreed to be a correct record subject to a correction within the second sentence on Page 11 which should have stated Mrs Robson highlighted rather than Mr Welch highlighted. 17/120 Patient Story Mrs Lamont presented the story and explained that the paper detailed the experience of Mrs W, a new mother who had lost some precious momentos and experienced service which she viewed as above and beyond the expected standard. She added that Mrs W was particularly touched by the generosity, kindness and compassion shown by a member of staff, highlighting that staff went the extra mile to help her. It was noted that little acts of kindness made a big difference. Mrs Lamont highlighted that at this year s Nursing and Midwifery Conference the Trust launched the #AddValueToday campaign which promoted the significant impact small acts of kindness have on patients and those that care for them. This campaign had been well received by staff and would continue to be promoted. 1
Mr Smith commented that it was very beneficial to hear the patient stories and to receive assurance that where actions were taken where required. Mrs Parker queried whether Mrs W s letter had been shared within the department to which Mrs Lamont confirmed it had been. Mrs Parker advised that she had recently undertaken a disciplinary hearing regarding a member of staff who had been rude and uncaring towards patients therefore it was important that lessons were learned in that such behaviour was not appropriate. to receive the patient story. 17/121 Safety, Quality and Performance i) Integrated Quality Report Mrs Lamont and Mrs O Brien presented the report. Mrs Lamont presented the June HCAI 2017 position and confirmed that there were no MRSA bacteraemia cases in June. There were ten cases of C. difficile in June, giving a year to date of 14, compared with 15 in 2016/17 and was within trajectory. This was a significant increase from the previous month and the position was being monitored closely. The year-todate C. difficile rate per 100,000 bed days at the end of June was 12.22 against the target of 16.3 or less. In June there were five MSSA bacteraemia attributed to the Trust, giving a total of 20 to date which was an improvement on the previous year (27). As reported previously, reducing MSSA bacteraemia incidence in the Trust was a top priority for the Infection Prevention and Control (IPC) Team and every Directorate now presented their action plan at the Serious Infection Review Meetings, and the reduction of line-related MSSA bacteraemia was a key topic of discussion and action. Root cause analysis continued for all cases, with improved medical staff engagement. In June there were 24 E.coli bacteraemia. In addition there were 4 cases of Klebsiella, bringing the total to 12 for the year and also 1 case of Pseudomonas, bringing the total to 5 for the year. Mrs Lamont highlighted that the number of patient falls had reduced this month and Mr Smith commended the work of the team in reducing the number of patient falls. Root cause investigations were continuing for serious falls. In terms of pressure ulcers, Mrs Lamont highlighted that this was still an area of challenge albeit the numbers had reduced in the last month and had been at the lowest level to date. In May, the total nursing vacancy factor had increased slightly to 9.65% which was expected due to the timing of recruitment activity. This would be offset partially through 150 Band 5 Nurses who were in the recruitment process and were due to 2
be deployed between now and October. In addition a further cohort of 14 Filipino Nurses had arrived in May and would be supported to complete their registration process with the Nursing and Midwifery Council (NMC). Mr Smith queried how the Filipino nurses were settling in to which Mrs Lamont explained that feedback received noted that Trust staff had been hugely welcoming and the nurses had settled in well. It was noted that in the last cohort of 7, the OSCI results had not been as good with the majority failing the assessment which was disappointing. The CAT results demonstrated a stable set of results over the last six months, with total scores between 95% and 96%. Mrs O Brien reported that there were eight Serious Incidents in June, one of which was a Never Event. The Incidents related to two falls causing fractured femurs, four Pressure ulcers Cat 3 or above, a radioactive seed was unintentionally left in situ and one Never Event being the removal of the wrong tooth (which was reported verbally at the last meeting). The radioactive seed was identified by the pathology department and the patient was required to go back to theatre for the seed to be removed. In relation to the Never Event, the supervisor was present when the forceps were attached to the correct tooth however these fell off after the supervisor had moved on and were re-attached to the wrong tooth. Mrs O Brien referred to the query raised at the previous Board meeting regarding the actual numbers of incidents where patients suffered severe harm or death (as percentages were reported) and confirmed that in April there were 4, in May there were 13 and in June there were 14. One of the incidents had resulted in death being in relation to C.difficile death. This had been discussed in detail at a Serious Incident panel meeting. It was noted that in regard to incident report, the Trust used a live database and therefore some incidents were downgraded appropriately following investigation. Mrs O Brien agreed to update the Integrated Quality Report to include a summary of the incidents in which serious harm or death occurred (ACTION01). Mr Smith queried whether staff were more comfortable in reporting incidents and near misses as a result of the increased focus on driving a no-blame culture. Mrs O Brien confirmed that this was the case and it was viewed that increased numbers of incidents reported demonstrated a better patient safety culture. It was noted that nationally 0.5% reported incidents resulting in serious harm or death. Mr Welch commented that staff can also submit a greatix form to highlight areas of good practice. Medication incident reporting numbers and radiation incident reporting had reduced. There were 12 radiation incidents report, three of the incidents related to non-patient overexposure: twice in Radiology the fluoroscopy foot pedal was left on, on one occasion it was accidentally stepped on and exposed a nurse to 3
unintended radiation. The third non-patient incident occurred when a work experience student did not wear a monitoring badge. Professor McCourt queried whether the incident with the work experience student was being investigated to which Mrs O Brien confirmed that the Radiation Protection Supervisors were investigating. Professor McCourt asked whether sufficient induction training was provided to which Mrs O Brien confirmed that it had been. The most recent SHMI results showed that the Trust had scored 96 which was lower than the previous quarter. This remained lower that the national average and within the as expected category. In June 2017, 140 deaths were recorded within the Trust with 74 documented as receiving a full in-depth review in the Trust s mortality database. No deceased patients were identified as having a learning disability and no deaths were considered potentially avoidable. The most recent HSMR results showed there had been a decrease for the month of February, however as advised previously this result may change as the percentage of discharges coded increased. It was noted that the Mortality Surveillance Group reviewed the detail of cases. Mr Godfrey queried whether the MSSA post had been successfully recruited to, to which Mrs Lamont explained that the post had gone out to advert again. Mrs Lamont advised that the Friends and Family Test recommendation rates were doing well overall. Complaints numbers had increased over the last few months and this was being monitored. Mr Smith asked Mr Godfrey for his views on the format of the Integrated Quality Report to which Mr Godfrey explained that it was easy to read and noted that the CAT process was very good. to receive the briefing and note the current position. ii) Learning Disability Update Report Mrs Lamont presented the report and explained that the Board received two updates per year on the work of the Learning Disability team. She added that this report provided assurance that the Trust was compliant with related Monitor and CQC requirements. Recent work had focused on identifying and then applying an electronic alert to patients records (referred to as flagging, which informed staff of the presence of Learning Disability, especially expectant mothers with learning disabilities). A small team of two delivered a significant volume of complex work in relation to provision of learning disability support and in addition Midwifery Services were the focus of the Trusts Learning Disability Awareness Week in June 2017. 4
Mrs Lamont advised that work was continuing with Learning Disability Mortality Reviews and the Trust was an active member of the Learning Disability network. She added that the Trust had been approach to explore the possibility of hosting a newly developed training post for a GP Post-CCT Fellowship- Learning Disabilities. The team were piloting the use of an NHS England toolkit for Learning Disability Health Quality Checkers for Emergency Departments in partnership with Skills for People (a local Health Checker organisation). Mr Smith commented that the Trust Board of Directors were very supportive of the work of the Trust Learning Disability Team and Professor McCourt commended the work of the team. In preparation for the identification of Children and Young People with learning disabilities the Learning Disability Liaison Team worked in partnership with colleagues from the Children s Directorate in the development of a visually aesthetic Young People s Hospital Passport which provided vital information to health professionals regarding the patient s individual needs. This work was recognised and rewarded at the recent Trust Nursing and Midwifery Achievement Award. to i) note the content of the report; ii) note the progress made; and iii) endorse the ongoing work. iii) Clinical Assurance Toolkit Report Mrs Lamont presented the report and highlighted that the trend information demonstrated that the overall scores were between 95% and 96% between April and June. She added that the focus of this month s report was on Outpatient Waiting Room questions and the findings identified that there had been some communication delays and complaints, and the display boards were not wellsuited. Mrs Lamont advised that one of the Trust Governors had contacted her directly regarding some concerns that they had had regarding outpatients and some work had commenced in this area. In terms of the number of areas with red scores, there were 6 areas in April, 11 in May and 3 in June. Cleanliness checks were red in 6 areas for the two months ending April, 8 areas for the two months ending May and 9 areas for the two months ending June. Mrs Lamont advised that with regard to the Acknowledging Continuous Excellence (ACE) Awards, 69% of areas had now received an award. Mrs Robson queried whether outreach clinics were part of the assessment to which Mrs Lamont agreed to confirm (ACTION02). 5
to note the content of the report. iv) Business Delivery & Performance Report Mrs Robson presented the report and explained that the Trust had delivered a strong performance in that it had achieved the A&E 4 hour waiting time target for the previous 6 weeks. Unfortunately however the Trusts overall performance for the quarter did not achieve the target. As reported previously, the main reasons for not achieving the target were Delays to Be Seen (DTBS) in the Emergency Department which was being compounded by significant medical staffing pressures, particularly junior and middle grade gaps in the rota (SHO and registrar level). Mrs Robson explained that the A&E improvement plan was continuing at pace with dedicated clinical and nursing leadership driving the improvements. It was noted that the Trust had met the 18 week referral to treatment (RTT) key three targets and had met all but one (2 week Symptomatic Breast) of the Cancer standards in May 2017. Mrs Robson explained that in relation to the 2 week Symptomatic Breast Cancer target, the reason for non-achievement was due to patient choice for appointments to be delayed/rescheduled. The Trust did not meet the 6 week diagnostic standard in June 2017. As reported historically, Mrs Robson advised that although the RTT incompletes, admitted and non-admitted targets were achieved overall, there were specialty level breaches in Trauma and Orthopaedics. It was noted that the department had seen its first reduction in waiting list numbers and was moving closer to achievement of the RTT target. The Trust reported 13 ambulance handover delays in June 2017 due to the administrative process of handing over the patient on the IT system. The ED department was currently working with North East Ambulance Service (NEAS) to try and rectify the issues, particularly as the patients were appropriately streamed directly to wards but were not being captured on the system. Further work was required in better measuring/capturing the data. It was noted that the delays would incur a financial penalty of 2.6k in June. Mrs Robson confirmed that the mandatory training and appraisals targets had been achieved. 17/122 Strategic Items to note the content of the report. i) Report of the Chief Executive Mr Welch and Mrs Robson presented the report. 6
Mr Welch referred to the continued prioritisation of safety and quality issues through Directorate Quality Reviews, proactive intervention, mortality surveillance and the successful Sign up to Safety campaign. He added that there were four Directors within the Trust who had additional responsibilities in terms of leading the Trusts Quality and Patient Safety agenda. Work was progressing in terms of reviewing Estates infrastructure and scoping of the Trust Estates strategy. Mrs Robson commented that a Board Away session was scheduled in August to discuss the Trust Estates strategy. Mr Welch advised that the Trust had appointed an interim Estates risk manager to focus on estates governance. Mrs O Brien commented that the individual had significant experience and had commenced in July with reviewing the Estates governance structures. Mr Welch referred to the position with regards to Trust building cladding and reminded Governors that the Trust did have some cladding equivalent to that in Grenfell Tower which was situated on the first floor of the Freeman Hospital in the Outpatients area. This cladding was in the process of being replaced. Mr Welch highlighted that the Trust was in regular dialogue with Tyne and Wear Fire Brigade. At the RVI, there was some further cladding which required replacing in the link corridors in the Leazes Wing however this cladding was not the same as in Grenfell Tower and had a much lower risk associated. This work was more difficult due to the height of the cladding and the requirement to re-design. The establishment of the Trust-wide Quality Initiative (QI) Programme was noted and Mr Welch highlighted that the aim of the programme was to encourage quality initiatives from the ground upwards in order to assist in transformation. White Board installation progress for NEWS assessment of patients was reported with Mr Welch highlighting that this was a movement away from a reliance on paper records. Mr Godfrey queried whether there were any issues regarding confidentiality to which Mr Welch advised that this had been discussed and patients were given the option of not displaying their name on the Boards. Implementation of the Infinnitt/Carestream RICS/PACS system transfer was discussed. Mr Welch explained that RICS/PACS was the x-ray recording system and the Trust had changed provider. Significant work was involved and some difficulties had been encountered, primarily around the backlog in reporting. Actions were being taken to resolve the reporting backlog and Mr Welch commended all of the staff involved in the transfer and in dealing with the backlog in reporting. Mr Welch advised that ongoing dialogue had continued with local Clinical Commissioning Groups (CCGs) on matters relating to Procedures of Limited Value and Advice and Guidance. In terms of procedures of limited value, the Trust had expressed its concerns to the CCGs as did not agree with all of the 7
procedures listed as being of limited value as many of the conditions listed deteriorate and result in further treatment or delayed referrals. Procedures included in the listing were noted as hernia s (groin), varicose veins, carpel tunnel syndrome and back pain. Mr Godfrey queried the mechanism for payment in relation to such procedures to which Mr Welch explained that a PAT was required. Mrs Robson advised that the concept of such procedures had been in existence for a long time of time however responsibility had shifted previously to secondary care. This had been imposed on the Trust from 1 st August. Professor Burn joined the meeting. Professor McCourt queried how patients were being informed of the changes to procedures of limited value to which Mr Welch stated that the CCGs had agreed to write a briefing. Mrs Robson commented that there had been no agreed publicity from the CCG regarding this matter. With regards to equity of access to treatment commissioned by CCGs, Mr Welch referred to a recent paediatric patient whereby the parents of the child from outside of the region had written to Mr Smith requesting that a research trial be undertaken on their child who had spinal muscular atrophy. This Trust was noted as one of 2 research trial units and had agreed to undertake the trial on compassionate grounds. The Trust had received another request letter which unfortunately had to be declined further to discussions with Commissioners. Mr Welch advised that he had undertaken a refresh of the Medical Team as it had been four years since the previous review. He welcomed John Crossman and Mike Clark to the team and advised that there had been some retirements. It was noted that the Trust was receiving regularly requests for support from other regional Trusts. Mr Welch confirmed that the Trust was happy to discuss such requests but would not wish to provide any support which would compromise this Trust. Mr Godfrey queried the relationship between Cumbria and Northumbria Trusts to which it was noted that the previous level of support from Northumbria seemed to be diminishing. A public announcement had been made for funding for the new Cancer Centre in Carlisle however there had been no commitment for revenue funding support. The NHS Improvement Resources Committee was due to discuss the proposal further. Mr Welch commented that the Trust was reviewing its social media usage and noted that the use of What sap had been very helpful in getting groups of staff together urgently. The Trust had learnt from the near major incident on Westgate Road recently. Professor McCourt commented that at the Trust Information Governance meeting the Trusts policy on social media was discussed and highlighted that there was a need to update this policy for the use of What sap and for the use of Twitter at conferences. Professor McCourt agreed to feedback this matter to the Trust Head of Information Governance (ACTION03). 8
In relation to Winter Planning, Mrs Robson commented that the Trust was planning early and was scheduled to participate in local and national assessments in August. Mrs Robson referred to the recent CCG ratings that had been published, noting that the Trusts 3 main CCGs all were rated as requires improvement for financial reasons. 17/123 Finance to receive the update. i) 2017/17 Month 3 Finance Report Mrs Dragone presented the position as at 30th June 2017 and highlighted that at Month 3 the Trust reported a deficit of 0.1 million which did not include any Sustainability Transformation Funding (STF) as the Trust had not yet agreed a Control Total with NHS Improvement. In terms of the Use of Resources metrics, an overall risk rating of 2 was noted. However because a Control Total has not been signed an override meant a score of 3 was assigned. Operating income for the period was 251.7 million, 5.5 million behind Plan and total operating expenditure was 238.9 million, 4.8 million behind Plan. The Trust had an EBITDA surplus of 12.8 million which was 0.7 million behind Plan. Mrs Dragone advised that the Trust s Plan required 27 million in cost improvements. The Trust was reviewing plans to deliver the target and had voluntarily engaged with Ernst & Young as part of the NHSI-led Financial Improvement Programme. The aim being to firm up on existing CIP plans, develop additional CIP opportunities and potentially deliver a further 4.6 million of savings. Mrs Dragone forecasted that the year-end position was likely to be a 10 million deficit. The Capital Plan was in the region of 32 million and year to date expenditure was running at 4.9 million which was on plan. Capital expenditure was higher than expected and was being monitored closely. The Cash balance at the end of the period was strong at 121.7 million; 14 million higher than Plan. Working capital movements improved cash by 14 million. to receive the report and acknowledge the overall financial position for the period to 30 th June 2017. 17/124 Items to Receive 9
i) NHS Providers The State of the Provider Sector Report ii) NHS Providers Briefing National Developments with the Better Care Fund and Delayed Transfers of Care iii) NHS Providers Briefing A review of Winter 2016/17 i) iii) to receive the items. The meeting closed at 2.15pm. The next scheduled meeting would be held at 12-45pm on Thursday, 28 th September 2017. 10