Minutes of the Membership Council Meeting. held on 29 January 2009

Minutes of the Membership Council Meeting held on 29 January 2009 Present John Savage Public Governors Mo Schiller Heather England George Wynne Willson Anne Ford Elizabeth Corrigan David Clark Pat Robinson Patient and Carer Governors Clive Hamilton Heather Saunders Pam Yabsley Christine Webb Allan Attwood Rosemary Chalmers Des Osborne Philip Mackie Lorna Watson Wendy Gregory Staff Governors Jim Catterall Belinda Cox Martin Long Phil Quirk Jan Dykes Appointed Governors Bill Payne Partnership Governors Jeanette Jones Frank Palma In attendance Graham Rich Emma Woollett Chair Bristol Bristol Bristol North Somerset North Somerset South Gloucestershire South Gloucestershire Local Patients Local Patients Local Patients Local Patients Local Patients Non-local Patients Non-local Patients Carers of patients under 16 yrs Carers of patients under 16 yrs Carers of patients 16 yrs and over Medical and Dental Nursing and Midwifery Non-Clinical Healthcare professionals Clinical healthcare professionals Non-clinical healthcare professionals Bristol City Council Joint Union Committee Voluntary Groups Chief Executive Non Executive Director (Deputy Chair) Page 1 of 13

Lindsey Scott Iain Fairbairn Kelvin Blake Irene Scott Anne Reader Claire Buchanan Paul Tanner Sue Clark Andrew Monk Huw Thomas Kate Lindsay Maria Fox Tania Farries Chief Nurse and Director of Governance Senior Independent Non-Executive Director Non-Executive Director Chief Operating Officer Assistant Director of Governance Acting Head of HR/Deputy Director of Workforce Head of Finance Associate Director Service Development Assistant Director Above & Beyond Charities Consultant Respiratory Paediatrician, Cystic Fibrosis Team Physiotherapist, Cystic Fibrosis Team Membership Manager Membership PA/Administrator 1. Welcome and Apologies John Savage welcomed the new governors to the Membership Council. They were: Jason Edgar, Public Bristol Governor James White, North Somerset Primary Care Trust He also welcomed and introduced Elizabeth Obileye to her first council meeting and Iain Fairbairn to the Membership Council, as the Senior Independent Non-Executive Director. The Chairman apologised for the alternate venue for the Membership Council Meeting. He explained that it was due to the refurbishment at the Foundation Trust Headquarters and that hopefully the new conference room would be available in the spring. Apologies were received from: Professor John Duffield John Newman Jane Britton Anne Skinner Sylvia Smith Andrew Yerbury Deborah Lee Dr Chris Payne Wendy Hurn Professor Massimo Pignatelli University of West of England Great Western Ambulance Service Avon and Wiltshire Mental Health Trust Local Patients Carers of patients 16 yrs and over Community Group Bristol Primary Care Trust South Gloucestershire Primary Care Trust Nursing and Midwifery Staff University of Bristol It was confirmed that the meeting was quorate. 2. Declaration of Interests and Minutes of last meeting There were no new declarations of interest. Page 2 of 13

The following amendments to minutes of meeting held on the 29 th October were agreed: 2.1 Item 3 d) FTN governor development event at Exeter held 25 th November 2009 The FTN governor event was attended by 19 UH Bristol governors and this was an opportunity for them to meet fellow governors from other Foundation Trusts. It proved to be a useful and well received experience. 2.2 Item 3 e) Foundation Trust Governors Association Governors were reminded that they now have access to this website (http://kf.hubola.com/ft_governors). Details have previously been circulated, but can be requested from Tania Farries if required. Two governors have come forward as links between Membership Council and the Association. They are Christine Webb and Liz Corrigan. 2.3 Item 3 f) Production of posters to publicise the governors and their role. This has been progressed and it is anticipated that these will be available by the end of February. 2.4 Item 5 Membership Council sub-groups Following the last meeting the Terms of Reference for the Quality subgroup were amended as requested and have been re-circulated. Dates for the subgroup meetings have been distributed to governors. The next meeting dates are: Involvement (2 nd Feb) Strategy (19 th Feb) Quality (3 rd March) In the early stages it is anticipated that the groups will determine their priorities for 2009/2010 and report into the full Membership Council at appropriate times. Action: Governors who would like to join a sub group but have not already put their name forward, were asked to e-mail Tania Farries (Tania.Farries@uhbristol.nhs.uk) or phone 0117 342 3764. 2.5 Item 13 Appointing External Auditors At the last Council meeting governors were invited to put themselves forward to join the project group to oversee the tendering process to appoint the external auditors for a contract commencing April 2010. Expressions of interest have been received so far from Jason Edgar and Jeanette Jones. Action: At least one other governor was invited to put themselves forward to ensure representation on the project group. Page 3 of 13

2.6 Item 15 NHS e mail addresses for governors Following the last Membership Council meeting it was established that the governors will be able to have NHS e mail addresses. We are in the process of setting these up. Please note that to activate their e mail address for the first time governors will need to do so from an NHS computer. There will be two computers available in the governor s room, which we anticipate will be available around the end of February. As soon as the governor s room is available you will be notified. 2.7 Questions raised by the governors included: 2.7.1 Clive Hamilton requested clarification of Item 3 c) Involvement of Governors. He wanted to know if it was appropriate for governors to raise questions of concern at the Membership Council meetings. The Chair replied that it was appropriate for general questions to be raised. 2.7.2 Belinda Cox asked if planning permission had been granted for Air Ambulance Access. Graham Rich replied that it had been granted. 3. Chairman s report John Savage reported to the Membership Council for the period of October to December 2008. He highlighted: 3.1 Nominations and Appointments Committee Members Following requests to the appointed governors for volunteers, it was announced that Bill Payne, governor for Bristol City Council, has taken up the remaining vacancy on the Nominations and Appointments Sub-Committee of the Membership Council. The committee is now at full complement. 3.2 Annual Health Check 2008/09 The Chair formally invited the governors to provide a third party commentary on the Trust s performance in relation to Standards for Better Health 2008/09. Karen Taylor, from the Healthcare Commission will be holding a seminar for the governors on 13 th March 2009. She will be able to further advise the governors of the nature and process for third party commentary. It was announced that the Board will be making its public declaration on 29 th April 2009 and the deadline for third party commentaries on the draft declaration will be 15 th April 2009. Action: Governors to provide any third party commentary on the Trust s performance in relation to Standards for Better Health Commission by 15 th April 2009. 3.3 Information re the Trust s performance Page 4 of 13

It was announced that Andrew Yerbury specifically requested that the governors receive information regarding the Trust s performance. In response the monthly Trust Board performance reports are freely available on the Trust s website www.uhbristol.nhs.uk In addition; the Membership Council receives a quarterly paper on the governance submissions to Monitor which contains performance against a number of national targets and all of the Healthcare Standards. 3.4 Involvement of Governors Hard copies of governor activity to date were circulated at the meeting for governor information. The Chair expressed the Board s gratitude for all the work the governors have been involved in so far. 3.5 Governor Communications A governor communications meeting was held on 10 th December 2008 to map out communications between governors and their key stakeholders. The meeting was well attended and those present identified three priorities to address gaps in governor communications as: a. On the UHBristol website, an E-mail hyperlink for members from the governors page b. A joint meeting of the Trust Board and Membership Council c. Membership forms in hospital bed end folders Anne Reader confirmed that the priorities raised were in hand and being progressed. Notes of the meeting were circulated to all the governors 4 Chief Executive s Report The Chief Executive s addressed the Membership Council and reported the following: 4.1 The Trust had experienced its busiest period ever in October 2008. This was mainly due to an increase in flu and respiratory illness and the Norovirus outbreaks in the hospitals. Staff have been working very hard to deal with these challenges but were finding difficulty in meeting some targets. 4.2 There are the two new executive vacancies: Chief Nurse and Director of Governance Director of Workforce and Organisational Workforce The interviews will be taking place at the beginning of March 2009. The Chair on behalf of the Membership Council thanked Lindsey Scott, Chief Nurse and Director of Governance, for her hard work over the last ten years. 4.3 The Chief executive briefed the governors on the Bristol Haematology and Oncology Centre project which looked at patient experience. It had proved to be a very promising project highlighting the patients/public perception of the Trust. Page 5 of 13

Patient experience is very important to the trust and the objective is to get all of our 7,000 staff to treat all patients in the same way and provide the same high quality experience across the entire trust. 4.4 NHS South West has submitted a bid for an Academic Health Science Centre, which would enable the whole of the south west to be designated as a research area. Examples of other hospitals which already hold this status are Kings College Hospital, Guys and St Thomas NHS Foundation Trusts in London. 4.5 The Bristol Heart Institute is doing well and is on target and due to be operational in May 2009. 4.6 St Michael s Hospital is the first NHS Trust to have achieved Level 3 UNICEF Baby Friendly Award managing to meet the required standard in only 1 year. 4.7 We are already looking forward to next year and assessing how the global financial crisis will affect the NHS finances. Presently, we are undergoing difficult negotiations with the Primary Care Trust s (South Gloucestershire, North Somerset and Bristol). It is important we look at how we can continue our drive and efficiency for tighter years ahead, even if resources coming in are static. 5. Quarter 3: 2008/2009 Declaration and Monitor Submission Irene Scott gave a presentation n Performance during quarter 3 of 2008/2009 which covered the months of Oct/Nov/Dec 2008. She highlighted the following areas: 5.1 Clostridium Difficile There has been significant improvement over the last 5 months which is a real success, bringing cases right back onto target. The Board have therefore decided it is no longer a risk which needs to be reported to Monitor. 5.2 Methicillin Resistant Staphylococcus Aureus (MRSA) This target has become a challenge because the Health Care Commission is measuring both pre and post 48 hours cases added together. Whilst Monitor are measuring post 48 hour case only as in our contract with NHS Bristol. Therefore the Trust complies with its target set by the Primary Care Trust but does not meet the target being measured by the Health Care Commission. At year end the Trust will state its case to the Health Care Commission. 5.3 Call to needle times We are above the 68% national standard with 75% being seen and treated in the set period of time. 5.4 Key Challenges Page 6 of 13

5.4.1 Emergency access 4-hour target: Since October 2008 there has been a far higher admittance rate with a 10% increase in emergency admissions, but with no real reason other than the fact that the population is ageing. People appear to be more sick than usual. In the 1 st and 2 nd quarter of 2008/09 the Trust achieved its targets but the 3 rd quarter became difficult due to the impact of October increase in illness which provided challenges in bringing numbers back on target. It has been noted in the patterns of admission that they appear to peak on Mondays and increased discharges at the weekend. A trust wide audit is taking place to look into these patterns and North Bristol NHS Trust is piloting a tool to do this at present. 5.4.2 31 and 62 day cancer targets Emergency demand has resulted in cancellations and inability to schedule elective surgery which has had an impact on meeting these targets. We are very careful however in selecting which patients are chosen to wait, so that it doesn t affect their health, treatment and well being. Late tertiary referrals also have an impact as in some cases this has left us only two days to treat individuals, causing delays for in meeting targets 5.5 Comments made by the Governors were: 5.5.1 Concerns were raised about the monitoring of Clostridium Difficile with regards to A & E and patients presenting symptoms for surgery: Irene Scott replied that it would be very unusual for a patient to be presented for surgery if they had contracted Clostridium Difficile, but if that were the case they would not be operated on. If there is any suspicion of Clostridium Difficile in A & E the patient will be immediately placed in a side room. 5.5.2 It was asked if all admissions were being screened for MRSA: Irene replied that to date 70 % of admissions are being screened and by the end of March that percentage would be 100%. Emergency admissions are presenting the most difficult challenge. 5.5.3 Clive Hamilton asked if admissions were being staggered: Irene replied that admissions were being staggered and a significant amount of day surgery had been moved to St Michael s Hospital. 5.5.4 Frank Palma asked if there could be more done with involving community care to reduce the bed occupancy rate: Page 7 of 13

Irene explained that the issue with Social Care packages are the delays involved with having the patients initially assessed and then putting the care packages in place. 5.5.5 Heather Saunders asked about the effects of having GP s working in A & E to reduce the time taken up lower risk cases: Irene explained that this had proved to be very successful and primary care trusts want to place more GP s within A & E. 6. Chair and Non-executive Director Appraisal/Performance Evaluation Anne Reader and Claire Buchanan presented the paper for the Membership Council to approve the process recommended by the Nominations and Appointments Committee for conducting Chair and Non-Executive Director appraisal. 6.1 The following comments were made by the Governors: 6.1.1 Jason Edgar asked how external consultants would be chosen: Anne explained that with Claire and other colleagues help they had been putting together a list of possible candidates. The process would need to fall within the remit of receiving 3 quotes then the selection process, followed by the choices circulated to the Nominations Committee. It was emphasised that the candidates would have to have good working knowledge of Foundation Trusts. They are making good process with the candidate selection so far. 6.1.2 Frank Palma asked if the recommendations regarding appointment of future Non-Executive Directors could be swayed by the Membership Council. The Chair replied that they could. 6.1.3 Jason Edgar asked if there were plans for colleagues to assess each other. Anne replied not this time but this will be considered in the future 6.2 The Membership Council approved the process for the Chair and Non-Executive Director Appraisal / Performance Evaluation. 7. Business Planning Sue Clark presented the business planning proposal on behalf of Robert Woolley and Ellen Rule. The presentation consisted of a brief overview of the business planning so far and they highlighted the following: Page 8 of 13

The current planning round concludes in April 2009 (for financial year 2009/10). The Annual Plan for 2009/10 is to be submitted to Monitor in May 2009. The purpose of the presentation to the Membership Council was to seek the governors approval of the proposal to delegate their involvement in the Annual Plan to the Governors Strategy Group. The December Strategy Sub Group meeting was well attended and membership and terms of reference were agreed. The governors approved delegation to the Strategy Sub Group to ratify: a) That the due process has been followed in the Business Planning Round. b) To Sign off the Monitor Annual Planning Document. ACTION: Further training will be provided re the Annual Planning Process on 11 th February at 11:30 13:30pm, in The Board Room, Trust Headquarters 7.1 Comments raised by the Governors were: 7.1.1 David Clark asked how the downturn in revenue has effected the BRI redevelopment and if the trust will need to borrow any money. Graham Rich explained that in 2010/11 it has been projected that there will be tighter resources and therefore an adjusted future forecast is needed to compensate for this. It is projected that the trust will need to borrow some money, but not a significant amount in the next two to three years. 7.1.2 Philip Mackie asked if the de-evaluation of properties will affect our strategy for closing the Bristol General Hospital. The Chair replied that the Trust will not be selling the Bristol General Hospital until the time is right. Graham explained that following vacation the hospital would be shut down and secured. The staff would be transferred to the South Bristol Community Hospital or redeployed within the Trust. 8. Quarterly Review of Performance against the Annual Plan Sue Clark presented the quarterly review of the Annual Plan with the purpose of informing the Membership Council of in year progress against the Trust Annual Plan Objectives for 2008-9. The Council was asked to note the overall progress to date against the plan. The following areas were highlighted: 8.1 All red issues fall within the category of Service Quality and Performance. They are as follows: Page 9 of 13

Target 1: Main reason is due to cancellations of patients operations with greater than 95% being patients whose operations were cancelled at last-minute and then readmitted within the 28-day standard. Progress: The main cause of cancellations and inability to re-book within target is lack of available beds within the Bristol Royal Infirmary. Improvements will continue to be progressed through the 4-hour improvement programme and via weekly operational meetings Target 2: Letters to be produced within 5 working days of patient being seen in clinic (90%) Target 3: To continue to reduce delays in discharge summaries, letters to be sent to GP s within 72 hours (90%) Target 4: To standardise discharge summaries and clinic letters, percentage of letters in the standard format (90%) Progress for 2/3/4: A pilot process is in place with new software and has been well received by GP s in other areas. New system will be piloted in quarterly 4 with rollout during 2009/1010. A standard format for discharge summaries as previously agreed with the PCT will be applied. Comments raised by the Governors were: 8.2 George Wynne Wilson asked what the way forward is with Target 1. Graham Rich replied that the emphasis is on How long people stay in hospital for? There are a number of reasons for delays in treatment; including waiting for procedures prior to actually seeing the doctor. We need to focus on improving the patient flow. There have been 40 extra beds opened this winter but at the same time 25 beds have been closed on wards due to the Norovirus. We need a better way of planning for the year as more beds do not mean better service if the original service wasn t effective to start with. 8.3 Clive Hamilton commented on staff shortage on the children s ward and asked if clinical posts having been frozen. Lindsey Scott replied that the Woman s and Children s Division have a base line deficit. The nursing budget is not over spending, it is managing within budget, even though the over all budget is over spending. No clinical posts have been frozen. It was highlighted that staff shortage is at its height during periods of illness and summer holidays. 8.4 Christine Webb commented that we should be focusing on how to retain older nurses within the workforce. It was confirmed that this was in progress. Page 10 of 13

8.5 Des Osborne suggested considering utilising nurses from countries whose summer months coincided with England s winter months to assist nurse recruitment 9. Governor Expenses Policy Revisions Anne Reader presented the following amendments made to the Governors expenses policy: The Membership Council were asked to a) receive and approve the expenses policy and b) consider and respond on the Quality Impact Assessment of the policy 9.1 New paragraph 2.2 has been inserted to read In line with principle of transparency for good governance, UH Bristol, along with other NHS Foundation Trusts, is required to publish expenses paid to governors in its Annual Report. 9.2 Paragraph 3.2 has been amended to read In extreme circumstances (for example, due to physical disability / medical reasons/late evening meetings in circumstances when personal safety may be compromised), reimbursement may be considered for reasonable taxi fares and agreed in advance by the Trust. 9.3 New paragraph 3.5 has been inserted to read The Trust will aim to provide the governors with hard copies of meeting papers, however, on occasions where this does not happen, the Trust will reimburse governors for out of pocket expenses for personal office equipment disposables and stationery up to a maximum of 50.00 per year. 9.4 Paragraph 4.2 has been amended to read: Receipts must be provided for any travel, carer and other expenses as outlined in Paragraph 3.5 (with the exception of vehicle mileage). 9.5 Equality Impact Assessment of the policy has been amended to reflect the needs of gypsies and travellers. 9.6 Governor Expenses Form Appendix B has been amended to reflect the requirements for appropriate insurance cover. 9.7 Amendments considered but not made 9.7.1 Mileage payments requested for pedal cycles have not been increased because: To do so would treat governors more favourably than staff. All the mileage rates in the policy are in line with staff payments which have been debated and agreed nationally. Applying a car mileage rate to pedal cycles cannot be justified as covering Page 11 of 13

out of pocket expenses and could be construed as payment for undertaking the governor role. The Membership Council received and approved the amendments to the policy. 10 Cystic Fibrosis Team - Feedback on Carers Survey Huw Thomas and Kate Lindsay presented the feedback on Carer s survey given to 72 families in March 2008 with 50% of the questionnaires being returned. The feedback was as follows: 10.1 The overall consensus was that people were satisfied they were getting a high standard service in the centre and that staff involved them in decisions about their children s care and treatment. Parents felt they were being given enough time to discuss and ask questions about their children s condition 10.2 Free text responses however highlighted the following issues: Parking and access needs to be improved as causes a lot of stress Long waits for medicines from the pharmacy this is probably due to a recruitment issue and slows down discharge but is improving Food services were highlighted as an area needing improvement. It is not the menu as this has been approved as a balanced diet by dieticians. It is the delivery which is failing. Lindsay Scott commented that the trust is looking to implement Productive Care where time is set aside for nurses to give better care for such issues as serving food on time. Smoking was also raised as an issue, especially outside the children s hospital. Lindsay Scott explained that there is a white line smokers should beyond, but acknowledged how difficult it is for staff to enforce this with people. Trust looking into other trust policies for effective strategies, some possibilities are putting in special smoke detectors and issuing cards with smoking policy information on. Other access issues raised were for adolescents whilst in hospital are finding it isolating at times when then can t access the internet from a social aspect but also for studying. Access would really boost their moral and wellbeing. ACTION: On behalf of the Membership Council it was asked that the Quality sub group deals with the clinical outcomes of the patient experience survey and the Involvement sub group deals with general feedback as a whole. For a hard copy of the patient experience feedback survey please contact Tania Farries on 0117 342 3764 11. Above and Beyond presentation Andrew Monk, Assistant Director of Above and Beyond presented the Membership Council with information about the charity. An information pack was distributed at the meeting explaining how to get involved and future events. If you would like to receive further information or get involved please visit the website at www.aboveandbeyond.org.uk or Page 12 of 13

telephone 01179277120 12 Any Other Business There was no other business 13. Date and time of next meeting: The next meeting of the Membership Council is on Thursday 29 April 2009 at 13:00 16:00pm. Venue to be confirmed. Page 13 of 13