Board of Directors Meeting summary minutes a.m.

Meeting Time Board of Directors Meeting summary minutes 09.30 a.m. Date 28 th February 2012 Venue RBH Boardroom Present:- Abbv. Mr C Morris Chair CM Mrs M Blenkinsop Non-Executive Director MB Mrs C Davies Non-Executive Director CD Mr A Rawlinson Non-Executive Director AR Mr R McMullan Non Executive Director RM Mr E Adia Non-Executive Director EA Mrs B Andrew Director of Corporate Services BA Dr J Bene Medical Director JB Mr G Raphael Director of Finance GR Mrs D Sissons Director of Patient Safety and Experience/Chief Nurse DS Mrs A Schenk Director of Service Development AMS Mrs N Ingham Director of Workforce and Organisational Development NI In attendance:- Mrs E Steel Trust Secretary ES Mrs C Gaze Interim Chief Executive Assistant CG Mrs I Derbyshire Associate Director of Employment Services (item 8.2) ID Mrs C Monaghan Mental Wellbeing Manager (item 8.2) CaM Apologies Mrs L Doherty; Mr. A Cogan Declarations of Interest None Patient Story JB presented a patient story of a 76 year old orthopaedic patient who sustained a fractured wrist following a fall on the ice. JB advised that this story illustrates how the length of stay for elderly orthopaedic patients can creep up. JB advised that this clearly illustrates the need to get smarter and more proactive at supporting discharge through seven day working. As a Trust we should capitalise on the services we now manage and provide weekend home visits to support discharge in a case such as this. In answer to a question from EA, JB advised that the changes needed are cultural, expertise is needed in the care of old people and at times it is important to balance risks rather than taking the easy option and passing things on. DS advised that as part of the restructure the matron role would be reviewed, it was envisaged that the new role will enable culture change with matrons as the lynch pin to oversee these services. Board of Directors minutes February 28 th 2012 Page 1 of 9

CM asked for a report to be brought to the next board meeting to outline on actions to be taken to address the issues raised by the story, AMS suggested that this could include 30 day feedback from the recent BICs event in this area. GR advised that as previously discussed, the Trust length of stay compares well with other trusts, our admission rate is low and our readmission rate is also low however it is clear that the message from this story is that there are still some patients who could safely be discharged sooner. Resolved: The Board noted the patient story. Minutes of the Board of Directors meeting held on January 31 st 2012 Resolved - The minutes of the meeting held on January 31 st were approved as an accurate record. Matters Arising Action Sheet FT/12 /04 FT/12 /07 ES advised that Non Executive Directors can now access infoflow from either the computer in the Chairman s office or the one in her office. ES agreed to send out the link to the IG training programme for NEDs to access. Chief Executive s Report GR advised that it had been agreed with the Chairman and other Executive Directors that he would continue to cover for Lesley and also provide operational cover. Andrea Bennett would be asked to provide cover as Acting Director of Finance. GR invited updates from the Executive Directors: AMS advised that the Trust had recently signed up to the integration discovery community with AQuA and the Kings Fund, further information on this would be brought to a future meeting. AMS advised that the GM cluster has now published an operating plan which sets out a framework for achieving safe and sustainable services beyond 2013, AMS agreed to circulate a summary of this paper to all Board members. DS advised that the Trust was one of eight that had participated in a transparency pilot which had looked at what we publish regarding harm to patients and harm to staff. The Bolton results showed a mixed picture, the Trust is in the middle of the pack and not an outlier. DS advised that the Head of Communications was working on a press release to accompany the publication. AR asked what the benefits of this pilot would be, DS advised that by participating in the pilot it may be possible to influence future data requirements. RM commented that a media focus would be inappropriate for such a small sample, the extremes run the risk of being singled out for attention. MB suggested that there should be caution with regards to initiatives we take on when staff are already under pressure; DS advised that the data used is already collected. GR advised that he had been briefed the previous evening about criminal activity on the Trust site. The matter which is now under police investigation related to the attempted theft of metal and damage to an oxygen pipe which will be repaired as soon as possible and the Trust are working closely with the police. There will be media interest in the story and the Trust and the police will work together to issue a joint statement. GR advised that a substantial part of the contract for 2012/13 has now been agreed. The commissioners have agreed to fund activity for 2012/13 based on the outturn of 2011/12. There are still some areas of contention in the ongoing negotiations; these include payment for outpatient follow ups and the number of Board of Directors minutes February 28 th 2012 Page 2 of 9

CQUINS targets. AMS advised that the transfer of maternity and neonatal services from Bury as part of MiB had now been completed, a meticulous plan had been managed across the whole of Manchester and all was going well. Urgent Care Update GR provided an update on the continuing pressures in A&E and events of the previous week leading up to the cancellation of elective surgery. Following a meeting at the cluster Greater Manchester Trusts had been placed on level three alert in response to difficulties being experienced by NWAS with seven out of ten A&E departments not meeting the 95% four hour target and ambulance crews experiencing long waits to hand over patients. Trusts had been asked to consider cancelling elective surgery, this was discussed at the Executive Directors meeting on Wednesday 22 nd February 2012 and in light of this and concerns being raised internally it was agreed to cancel routine elective patients up to and including Monday 26 th February 2012. GR advised that he had appraised the Chairman of the situation and all NEDs had been briefed either by the Chairman or through attendance at the Urgent Care task force meeting on Friday 24 th February 2012. GR advised that he had been advised by the General Manager for Electives that this places the 18 week target more at risk but it is still achievable and most of the cancelled patients have already been offered an alternative date. The cancellations made a significant difference and although all the medical wards were full there was capacity for medical patients to outlie on surgical wards in answer to a question from MB, JB assured the Board that only medical patients who have had a senior review and are deemed fit enough are allowed to outlie. GR advised that the Urgent Care Task force had met twice since the last Board meeting to provide scrutiny of the process. In answer to a question from AR, GR advised that although the Board had been assured of patient safety at the January meeting both DS and JB felt the pressure had increased to a point where positive action was required, DS advised that staff were expressing concerns and it was felt that although there had not been any incidents there was the potential for harm which would be addressed through the actions proposed and discussed at the urgent care task force. GR advised that the actions taken do put the 18 week target at risk, this had been discussed with the commissioners and meetings were planned with the clinical leads to agree the transfer of patients to different consultants this will only be done when patients are happy to accept the change. DS presented a briefing paper outlining actions taken and further actions planned, she advised that the Executive Directors had recognised the risk to the 18 week target but had agreed to act in response to concerns about patient safety. CM advised that following the quarter 3 submission, the Trust had now been rated red for governance and members of the Board had been asked to attend a meeting in London on 16 th March 2012, dependant on the outcome of that meeting the Trust may be deemed to be in breach of its terms of authorisation. In answer to a question from RM, JB advised that the recent actions were taken in response to an increase in pressure across the whole of Greater Manchester, the number of admissions had increased, the clinical explanation for this increase is the end of the cold snap resulting in an exacerbation of airway disease, A&E was becoming congested and patients were not moving through. DS advised that she regularly walks round the wards and talks to staff and in addition to the anecdotal voicing of concerns she had received three clinical incident reports. Staff have not been able to take breaks and although there is no evidence of harm this is a poor experience for patients and staff and there is the potential for harm. AR asked for assurance that staffing levels are sufficient to provide a safe service. NI advised that a Board of Directors minutes February 28 th 2012 Page 3 of 9

comprehensive review of staffing levels is being conducted. DS advised that the additional ward was opened in line with escalation plans and staffed from existing wards with the vacancies created being filled by bank and agency nurses. An amnesty on long hours and overtime has been allowed. CM asked for assurance that the protocol for agreeing outliers is robust and that patients are not placed at risk. DS advised that a protocol is in place to agree which patients can outlie; these tend to be active patients who are nearly ready for discharge. Initial planning included the conversion of general outpatients into a Clinical Decision Unit (CDU), the creation of an additional medical ward and the increased, planned use of private sector accommodation for elective surgery. CM asked if the possibility of a unit at Leigh was still an option, GR advised that Phil Wyckes (orthopaedic surgeon) is discussing this with colleagues in Wigan. AR asked for assurance that staff are being given the support they need, GR advised that all the Executive Directors provide support for operational issues and work together as a team. RM recognised the pressure that Exec Directors and staff are under and expressed support. DS thanked the Non Executives for their support; she advised that she had visited every ward area last Thursday night to say thanks to staff and a particular thank you to theatre staff who had been supporting staff on the wards. CD asked if there were other targets which may be compromised by the current pressures. NI advised that a dip in appraisals and training in general was anticipated but it was accepted that the priority at this time was patient care. Resolved: The Board noted the update on urgent care, and the minutes of the urgent care meeting. It was agreed that the task force would continue to provide scrutiny to the management of the current pressures in urgent care and 18 weeks. Marketing/Reputation Management AMS and CG gave a presentation on marketing and reputation management The following areas were highlighted: The Trust needs to be prepared for a more competitive NHS It is important to remember that the senior managers at the front line are the same people who will be required to contribute to this. Thought has been given to how a private company would respond to the increase in competition facing the NHS. The marketing and communications function is moving to the Directorate of Strategy and Improvement. The revamped marketing team will continue to develop communications and engagement with a view to managing communications and reputation management and increasing market share where appropriate. AMS asked Board members to consider the proposed actions and if there is more the Trust should be doing to compete in a more competitive NHS. DS commented that the work would need to link with the engagement strategy and ongoing work on patient information, CG advised that Maria Sinfield has attended one of the meetings of the Marketing Delivery Group. NI advised that the staff are the biggest ambassadors, it is therefore important that staff understand the importance of this. NI added that there are also opportunities to market the non clinical areas for income Board of Directors minutes February 28 th 2012 Page 4 of 9

generation e.g. providing HR support to GPs and other organisations across the Bolton economy. In answer to a question from CD regarding keeping the website up dated, CG advised that a fixed term dedicated web content administrator has been appointed to work with named individuals from each clinical area on ensuring that content is current and accurate. RM advised that from past experience of reputational management there is a need to look at the management of bad news, good media and stakeholder relationships are vital for pro-active timing and a mix of good and bad news it is important not to be afraid of being pro-active with the less palatable news. Resolved: The Board noted the update on marketing and reputation management. Annual Plan Update AMS provided an update on the development of the Annual Plan for 2012/13. The annual objectives on the L1 have been debated by the Executive Board and cascaded to divisions. The divisions have defined their priorities and the corporate directorates have defined priorities to support the divisions. The Board reviewed the improvement priorities on the L1: 1. Redesign clinical staffing model to deliver seven day response for high risk and deteriorating patients in hospital and community JB advised that the aim was to address the inequity of care from five day working and to have senior decision makers available at nights and weekends. There will be an additional issue with a reduction in trainee doctors which may change the way in which services are delivered. In answer to a question from RM, JB advised that the target for 2012/13 will be defined by divisions, different divisions are at different stages for example the implementation of MiB in the families division means they have already achieved this in many areas. Medicine also has seven day working in a number of specialties although there is a need for further redistribution of the way this is delivered. 2. Improve management and leadership capacity, capability and accountability NI advised that the aim is to support managers and leaders to be the best they can be. In 2012/13 the workforce directorate will work with leaders to address the challenges facing the Trust through proactive measures including a flexible workforce to meet capacity and demand with appropriate use of bank and agency and full implementation of e-rostering. The new Trust values will be launched after the next Board meeting and will underpin a behaviour framework to allow challenge if individuals are not in line with the values. The health and well being of staff continues to be a priority and staff will be supported to improve attendance looking at methods to prevent sickness. 3. GR advised that AC will be leading the priority to develop flexible capacity to ensure variable demand can be met in the right place at the right time with achievement of the access targets for elective care and urgent care. 4. Work with one pathway in each division to achieve a high volume pathway of operational excellence AMS advised that the aim was to achieve at least one major pathway of excellence in each division, to meet this standard all the required access targets must be met, unnecessary steps must be reduced, overall costs would be reduced and employee engagement score improved. The selected pathways would be confirmed in the next two weeks and a VSA event conducted in May/June for each pathway. 5. Complete strategic review a business development plan would be developed to establish accurate assessment of financial and clinical positioning of Trust services; this would link with the work of the marketing strategy group and work previously discussed on reputation management. AMS advised that further detail of each of these priorities would be captured in the annual plan. Resolved: The Board noted the development of the Annual Plan Ingrid Derbyshire and Carol Monaghan joined the meeting Board of Directors minutes February 28 th 2012 Page 5 of 9

Workforce Dashboard NI presented the workforce dashboard - she advised that as discussed previously the pressures in the organisation was impacting on the capacity of staff to complete appraisals and performance against the appraisal target is currently at 75%. This is being monitored. There has been an increase in sickness in part due to norovirus but the highest reported reason for sickness is stress. In answer to a question from RM, regarding staff off sick for three months or more, NI advised that the majority of these are for genuine reasons including treatment for cancer and back injuries. AR asked if the Trust has a policy for ill health retirement; NI advised that there is a policy although it is difficult to apply in emotive cases such as cancer. Long term sickness is taken seriously and employees have had their employment terminated on the grounds of sickness. In answer to a question from CM, NI advised that suspension is taken very seriously and is used as a last resort CM requested that this information be incorporated in the workforce dashboard. Resolved: The Board noted the workforce dashboard Health and Wellbeing Report NI introduced Ingrid Derbyshire (Associate Director of Employee Services) and Carol Monaghan (Mental Wellbeing Manager) in attendance for this item ID thanked the Board for the invitation to provide an update on workforce health and wellbeing the following areas in the report were highlighted: the scorecard shows that all targets for the quarter have been achieved although the turnaround time for screening has increased. The wellbeing team are working towards SEQOHS (safe and effective, Quality Occupational Health Service) Accreditation Exercise on prescription is being developed NICE public health guidance the areas of good practice should be promoted CaM advised that she joined the Trust approximately two years ago, at that time there were over 70 members of staff on the waiting list for mental wellbeing assessments with an average wait of 3 6 months. Now there is just one person waiting and they will be seen within two three weeks. The service now operates a well being drop in service which staff can self refer to for a ten minute session which can lead to counselling or other services if required. NI referred to the dashboard which shows 43% of referrals are self referrals compared to 40% management referrals, this demonstrates the trust staff have in the service. AR thanked CaM for the update and asked what steps were being taken to achieve more prevention of absence due to stress. CaM advised that there is a policy for stress risk assessments, in January 80% of staff who had indicated they felt stressed were still in work, the risk assessment provides the opportunity for staff to discuss stress with their manager and to agree actions. The stress risk assessment also makes returning to work easier. NI advised that CaM has a map showing the areas of the Trust with the highest incidence of stress, she uses this information to look proactively at the root of the problem in specific areas. CaM advised that she has regular meetings with the HR Business advisors to discuss staff health clinics and physical and mental wellbeing. RM asked who is responsible for ensuring the Trust comply with the obligation to make reasonable adjustments to address stress; CaM advised that if staff are seen following a management referral this is passed to the HR advisor for follow up. NI advised that the workforce directorate are working as a team to build on the good positive work. AMS asked if there are any comparators available to show how Bolton compare to other organisations with Board of Directors minutes February 28 th 2012 Page 6 of 9

regard to workplace health and wellbeing, it was agreed that this would be considered for inclusion in the next quarterly report. Resolved: The Board noted the report on workplace health and wellbeing. Ingrid Derbyshire and Carol Monaghan left the meeting Clinical Quality DS advised that she and JB were discussing a range of indicators to incorporate in the performance dashboard. Health Care Associated Infections (HCAI) Briefing DS provided the Board with an update on plans to manage HCAI in 2012/13. The Board were asked to note the challenging target for the coming year which is 5 avoidable MRSA and 28 CDT for Bolton NHS FT. DS asked the Board to support the continued partnership working to reduce HCAI and to agree the proposed internal governance arrangements. AR noted that the target gets more and more difficult and queried if it was possible to improve on the previous year. DS advised that her belief was that improvement was possible although it would be a real challenge and there would be no guarantee that such a challenging target could be met. Resolved: The Board noted the MRSA and CDT trajectories for 2012/13 and supported the continued partnership working and internal governance arrangements. Performance Dashboard GR presented the performance dashboard and highlighted the following areas: VTE is now 76.4%; performance against this target has improved but is still under target. From 1 st February data will be collected on admission Performance against the stroke target has deteriorated; this is as a result of C4 being closed due to norovirus. RTT 18 week admitted the Trust failed to meet the RTT target Diagnostic - - the number of diagnostic waiters has increased; discussions are ongoing with the commissioners to identify additional capacity. A&E as discussed earlier in the meeting this continues to be a challenge. AR noted that performance against the DNA target was showing red and asked for further information on the work discussed with Governors. GR agreed that there some good work had been done however performance has gone back to previous levels. AMS advised that some of the initiatives were just in two areas, consideration needs to be given to rolling this out wider. CM asked if there are occasions when the patient doesn t attend simply because they now feel well. GR advised that for the 62 day from consultant screening cancer target the Trust had previously reported that this had been achieved in quarter three this was based on a prediction. The final position with regard to that target is that one additional breach has now been validated and this pushes performance below 90%. The declaration with Monitor has been amended and this places the Trust on four penalty points. Resolved: The Board noted the performance dashboard. Board of Directors minutes February 28 th 2012 Page 7 of 9

CLIP report Q 3 BA presented the CLIP report and advised that this had been discussed in more detail earlier in the week in the Clinical Governance and Assurance Committee and this had highlighted some issues around response times to complaints. It was noted that these had deteriorated but that the team are working on this. Resolved: The Board noted the CLIP report Finance and Activity GR presented the Finance and Activity dashboard and highlighted the following areas of the report: Capital expenditure is coming back into line with plan Savings are getting close to the target required although it is anticipated that the Trust will be 1.7m short of plan. I&E for December/January is broadly in line with plan and it is still possible to achieve the financial objectives. Negotiations with the PCT regarding penalties and CQUINS payments are ongoing There is a shortfall on cash balance, some activity has still not been paid for, and the PCT owe the Trust approximately 5m. GR advised that he has discussed this with his finance team and stressed the importance of raising an alert if there are cash issues. Resolved: the Board noted the Finance and Activity report Resource Assumptions GR provided an update on financial planning assumptions for 2012/13. GR confirmed that the Trust will still be looking to achieve 5% savings in 2012/13 and a surplus of 1.7m GR advised that the report had been discussed and approved at the last Finance and Investment Committee. Resolved: The Board noted the planning assumptions report. Compliance with the FT Code of Governance BA presented the report on compliance with the FT Code of Governance. She advised that we are compliant with all aspects of the Code and would ensure that the required declarations were included in the Annual Report. Resolved: The Board noted the report of compliance with the FT Code of Governance. Emergency Preparedness BA presented the Emergency Planning Annual Report, she advised that this demonstrates the enormous amount of work required to meet the training and preparation arrangements. BA advised that guidance requires the Board to be assured that they are prepared for any sort of emergency. AR asked if future editions of the report could include a glossary of terms. Resolved: The Board noted the Emergency Planning Annual Report. Executive Board Minutes Board of Directors minutes February 28 th 2012 Page 8 of 9

Finance Committee Minutes Charitable Funds Minutes Summary Board Minutes Risk and Assurance Minutes The Board noted the minutes of the assurance providing committees Any Other Business NI advised that the threat of industrial action in the NHS has not been resolved, the BMA has now decided to ballot members on industrial action and it is likely that the impact of future action could be more significant. Date and Time of Next Meeting Tuesday 27 th March 2012 Board of Directors minutes February 28 th 2012 Page 9 of 9