HERTFORDSHIRE COMMUNITY HEALTH SERVICES Minutes of the Hertfordshire Community Health Services Board Meeting Held on Thursday 22 nd July 2010 in the Boardroom, Howard Court Welwyn Garden City. Key Points from the Meeting for the Board to note: * Performance Indicators show red for the following targets: Q2 P8 P13 P14 P30 P31 W6 W9 Proportion of Complaints Resolved within timescale % of Patients still at home 91 days after discharge from community hospital with rehab / IMC Community Hospitals No of Patients per week whose discharge or transfer is delayed due to NHS delay Community Hospitals % of bed days lost due to delayed transfer of care Chlamydia Screening Assist PCT in reaching its target by screening patients in family planning services HPV % of eligible children immunised % of eligible staff who have received mandatory fire training in the last 12 months % of staff who have received an appraisal in the last 12 months * The Month 3 Financial position showed an Overspend for Qtr 1 of 311k although 140k was awaited from the PCT as contract variation payments, which would reduce this to 171k. A slight surplus was still being forecast for year end. * The following were ratified: Information submitted to EoE SHA for the Trust Establishment Order The Quality Improvement Plan as a Workplan for HCGC The Action Plan in response to the NHS Hertfordshire Review of HCHS * The following were received & noted: The Board & Executive Team Register of Interests The Board Assurance Framework as at July 2010 EoE SHA Letter on the HCHS Annual Plan 1
Present: Declan O Farrell (DO F) Chair Julian Laite (JuL) Independent Committee Member Anne McPherson (AM) Independent Committee Member Alan Russell (AR) Independent Committee Member Heather Moulder (HM) Managing Director Gloria Barber (GB) Director of Workforce Joel Bonnet (JB) Medical Director Robert Kirton (RK) (Interim) Director of Finance Jessica Linskill (JL) Director of Quality Karen Taylor (KT) Director of Operations Clive Appleby (CA Company Secretary In Attendance: Malcolm Rainbow (MR) LINk Representative (A) Preliminaries & Board Governance Action 116/10 Welcome, Introductions and Apologies No apologies for absence 117/10 Chair s Announcements / Notice of Urgent Business No items 118/10 Members Declarations of Interest There were no declarations of interest. 119/10 Ratification of Chair s / Managing Director s Action taken since last meeting under Standing Order 5.2 No Actions had been taken since the last meeting which required ratification 120/10 Minutes of the Meeting held 24th June 2010 Agreed as an accurate record 121/10 Matters Arising from the Minutes of the Meeting Held on 24 th June 2010 114/10 (a)(3) Trigger Definitions Discussion deferred until August 114/10 (d)(1) DTC Project Group Agreed that AR will be the ICM representative. KT confirmed that a proposal had been received from the company to take this forward and the work will start in September. 2
(B) (B(1) 122/10 Performance / Standing Reports: Managing Director s Report HM highlighted the following: The White Paper, Equity & Excellence, Liberating the NHS and its implications for HCHS, will be discussed in more detail during the briefing session following the Board meeting. (ii) Close relatives of some members of staff have recently been killed in Afghanistan. The Board members wished to convey their sincere condolences to those bereaved (iii) The programme of MD Roadshows was going well and most issues raised by staff tended to be local issues. It was noted that a template has been prepared for recording key issues arising from the Roadshows and the programme of site visits. This will be circulated to ICMs as well as Executive Directors. The outcomes from the Roadshows and the programme of site visits will be considered by the Executive Team and issues shared as relevant with the Board. FAQs will also be put on the staff intranet once enough visits have been completed. HM The MD s Report was received and noted. (B)(2)1 Integrated Board Performance Report (June 2010) 123/10 (Presented by KT/JL and GB) (1) General It was noted that: Targets showing red were now highlighted specifically in the introduction. (Agreed that ref no. be shown in summary to link with main report) KT (2) Safety Standards: (a) General S9-S18 (Incidents) to be an area for a deep dive 3
focussed examination by the Board, via HCGC. (Including trend analysis and mapping to complaints and claims) (ii) S14 No of patient related incidents reported This year will be spent collecting baseline data and benchmarking opportunities (b) Targets Showing Red S16 No of Incidents in Qtr which allege abuse of patients which have been reported via incident reporting Performance = 1; YTD Target = 0 Noted: Not a HCHS patient. Abuse in a residential home and ACS informed. S18 All CAS alerts are managed within agreed timescale Performance = 60%; YTD Target = 100% Noted: SHA indicate that HCHS is progressing well (3) Quality Standards: (a) General No items (b) Targets Showing Red Q2 Proportion of Complaints Resolved within timescale Performance = 42% ; YTD Target = 80% Noted: On trajectory but still not at target level (4) Performance Standards: (a) General (ii) P1: 18 weeks wait is no longer a national target but is still a contractual target with the commissioner P20: Community Matron average caseload is a local, commissioner target (b) Targets Showing Red P8 % of Patients still at home 91 days after discharge from community hospital with rehab / IMC Performance = 66%; YTD Target = 80% 4
Noted: still at home is national terminology and means not in care; allowance is made for 20% of readmissions being for different episodes. P13 P14 Community Hospitals No of Patients per week whose discharge or transfer is delayed due to NHS delay Performance = 19.3 per week average; YTD Target = 10 per week Community Hospitals % of bed days lost due to delayed transfer of care Performance = 11.8% (NHS+ACS); YTD Target = 2% Noted: For P13 and P14 it was difficult to link performance with the text in the summary. Actual numbers to be included to give clearer picture. P30 Chlamydia Screening Assist PCT in reaching its target by screening patients in family planning services Performance = 378; YTD Target = 624 Noted: PCT were planning to give out free cinema vouchers as an incentive. Competing services impacts on HCHS ability to meet target and puts CQUIN money at risk (ii) The risk would be highlighted better by referring to extent under target in the summary rather than the % achieved P31 HPV % of eligible children immunised Performance= 76% dose1, 75% dose2, 71% dose3 Full Year Target = 85% for doses 1, 2 and 3 Noted: A national issue affecting ability to meet target is that following a high profile case, many parents are reluctant to approve immunisation (5) Workforce GB tabled workforce data at the meeting. It was noted that: (a) General W5 (turnover) and W7 (sickness absence) will have different metrics in future reports to give a clearer picture of hotspots. 5
(ii) W1 (pay spend) To be taken out (iii) Target W3 has been deleted as was similar to target W4 (iv) W4 (agency spend) needs to link to identifying a balance between cost and quality/safety and to also identify hotspots. HR input into data for HCGC required through exception reporting by Business Unit. (v) Targets W10 (Employment Tribunals) and W11 (Grievances) act as an indicator of possible cost implications if a grievance proceeds to a tribunal claim) (b) Targets Showing Red W6 % of eligible staff who have received mandatory fire training in the last 12 months Performance = 47.2%; YTD Target = 90% W9 % of staff who have received an appraisal in the last 12 months Performance = 56%; YTD Target = 90% Noted: data is for a rolling 12 month period not a fixed year The Performance Report was Received and Noted. (B)(2)2 Finance Report (Month 3) 124/10 RK presented the Finance Report for Month 3. It was noted that: The report had been considered in detail by the Audit Committee (ii) An overspend of 311,000 was being reported for Qtr 1 (Apr-June) although contract variation funding of 140k was due for the Qtr, reducing the overspend to 171k (This payment form the PCT was not a cash flow issue but related to signed confirmation of payment). (iii) The Results were carrying 461k of costs arising during financial year 2009/10 (iv) The pay budget was currently underspent due to vacancies 6
(v) The main area of overspend was estates and facilities. CIPs were being worked up by the PCT s AD Estates, and estates spend is subject to detailed scrutiny by the Audit Committee (vi) All areas of overspend are subject to weekly scrutiny and assurances are obtained from the Business Units (vii) In the overall CIP, further schemes were being worked up around skill mix in community hospitals and this will help to offset any slippage in other projects. This review was taking account of RCN standards (See also (1) below). (viii) Year end forecast was for a slight surplus, but this was dependant on CIPs delivering the projected savings (ix) AR observed that the Total YTD figure on p1 of the Report should read 25,300 rather than 24,353 It was agreed that: (1) The Board will be informed via communication from KT on the process for the skill mix review ((vi) above refers). JL will go through a quality assurance process with AM on behalf of the ICMs (2) The tables presented should include a brief analysis (3) Areas of financial risk to be incorporated under forecasting. KT JL RK RK (B)(3)1 EoE Performance Self-Certification (June 2010) 125/10 The submission for June 2010 (May data) was noted (B)(3)2 Board and Executive Team Register of Interests 126/10 The Register of Interests as at 1 st July 2010 was noted. AR reported an additional interest to be recorded, which was being a member of West Herts Hospitals NHS Trust as a Foundation Trust AM reported an additional interest to be recorded, which was undertaking consultancy work for NHS Hertfordshire. CA CA (B)(4) (C) 1 127/10 Annual Reports No items Information Provided to DoH via EoE SHA for HCHS Establishment Order as a NHS Trust The Board ratified the information required for the Trust Establishment Order provided to EoE SHA. 7
It was noted that: Information had also been supplied for the statutory Transfer Order. The bigger piece of work was the drawing up of a Transfer Agreement to underpin the Transfer Order. This would address detail and give clarity to transfer arrangements. It was agreed that because of timescales and meeting dates Chair s action may be required under SO 5.2 to authorise approvals on behalf of the board, which will then be reported to the next Board meeting. (ii) The PCT may also need to take Chair s Action and Stuart Bloom had been advised of this. (iii) A meeting has been arranged with PCT Officers and Capsticks solicitors to progress the Transfer Agreement (iv) Although the DoH and EoE had stated that TUPE applies to staff transfer, GB did not believe that this was the case and that legal advice on this issue was not required. (D)1 Board Assurance Framework 128/10 The BAF as at 1 st July was received and noted. CA reported that the BAF had been considered by the Audit Committee and it was reviewed and updated monthly by the Executive Team. The following observations were noted: The BAF is a register of strategic risks, so operational risks such as renegotiating microbiology SLA for infection control support will appear in Business Unit or the High Level risk registers (ii) The risks are defined by cause, risk, effect at the top of each heading and the relevant strategic objective is identified in the first column (iii) The current risk score was crucial in identifying the real time current position and the residual risk score identified the level of risk after all actions were taken and controls were in place. This also represented the basis for discussion on the extent of risk that the Board was prepared to live with. (iv) Ref 05/10 4 The Board has not yet seen the proposed 8
re-structuring, so cannot make a judgement at this stage on the effectiveness for risk mitigation. JuL also expressed concern about the desirability of business development coming under the finance function. (D)2 Quality Improvement Plan 129/10 The Quality Improvement Plan was received. JL reported that: The plan has been approved by the HCGC and consolidates action plans under the various quality headings. It effectively sets out the workplan for the HCGC (ii) An additional column will be added to record progress (iii) The plan takes into account the impact of becoming a NHS Trust including Terms of Reference for the HCGC and the Clinical Governance Strategy (iv) Quality Accounts are likely to be subject to external audit. (v) This was a starting point and the plan will be subject to refinement and development over time, including trend analysis for key areas. It was agreed that: (1) The date for having a stand-alone HCHS SUI policy in place needed to be earlier than December 2010 (2) Additional sources of external assurance (eg benchmarking) needed to be looked at in cases where the PCT was currently identified as the only source of external assurance (3) The Plan as updated will be presented to the Board quarterly JL JL CA to note for business cycle Subject to (1) and (2) above, the Plan was agreed as being the workplan for HCGC. (E)1 NHS Hertfordshire Review of HCHS 130/10 The NHS Hertfordshire Review of HCHS undertaken by Simon Rouse, Director of Strategy, and the action plan derived from the report were received. It was noted that 9
the report was also annotated with the comments that HCHS had fed back to the PCT. It was noted that there were no issues raised in the report that the HCHS Board was not already aware of and that considerable progress had been made since the time the report was produced and issued. Progress will be reported and assurances given to the PCT at a meeting with them in w/c 26 th July. Key issues are likely to be the financial position (especially control of estates spending) and relationships with GPs. The Action Plan was approved (E)2 EoE SHA Annual Plan Letter 131/10 The letter from EoE SHA by way of feedback on the HCHS Annual Plan was received. It was noted that the SHA letter was generally very positive about progress being made by HCHS and that they considered HCHS to be a self-aware organisation in respect of identifying and being open about areas that needed improvement or more work. (F) Items for Receipt / Noting (Internal) No Items (G) Items for Receipt / Noting (External) No Items (H) HCHS Meeting Minutes For Note 132/10 The Minutes of the following meetings were received and noted: (a) (b) Audit Committee (HCHS) a. Meeting of 25th May 2010 b. Meeting of 22nd June 2010 Healthcare Governance Committee Meeting of 18 th May 2010 (ii) Meeting of 22 nd June 2010 (J) (K) Urgent Business No Items Date & Time of Next Meeting(s) 133/10 Thursday 26 th August 10.00 17.00 at Howard Court, Welwyn Garden City. Meeting (Board Members Only) + Board Members workshop) Thursday 23 rd September 10.00 17.00 at Howard Court, Welwyn Garden City. (Formal meeting + Board Members workshop) 10
Common Abbreviations CQC = Care Quality Commission DoH Department of Health EoE SHA = East of England (Strategic Health Authority) HCGC = Healthcare Governance Committee IBP = Integrated Business Plan ICM = Independent Committee Member LINk = (Hertfordshire) Local Involvement Network MD = Managing Director PCT = NHS Hertfordshire (Hertfordshire Primary Care Trust) QA = Quality Account RAG = Red/ Amber / Green ratings YTD =Year to Date 11