Meeting of the Board of Directors Held on 30 April 2014 In the Boardroom, Trust Headquarters

PART I Meeting of the Board of Directors Held on 30 April 2014 In the Boardroom, Trust Headquarters Present: John Schofield Chairman Michael McCourt Chief Executive Martin Roe Executive Director of Finance & Deputy Chief Executive Katy Calvin-Thomas Executive Director of Planning, Performance & Information Ian Trodden Acting Executive Director of Nursing Dr Henry Ticehurst Medical Director Robert Ainsworth Non-Executive Director Alan Moran Non-Executive Director Tony Berry Non-Executive Director Dawn Edge Non-Executive Director In attendance: Judith Crosby Director of Finance Richard Spearing Director of Service Development & Partnerships Bev Worthington Director of Workforce & OD Louise Bishop Trust Secretary Lisa Howarth Secretary to the Board of Directors - minutes Governor attendance: Michael Armstrong Public Governor (Trafford) Irving Normie Public Governor (Trafford) 1. Apologies for Absence Apologies were received from Colin McKinless 2. Declaration of Interest There were no declarations of interest. 3. Patient Story Ian Trodden presented a patient story to the Board for information: Bury District Nursing, thank you letter Mr Trodden presented a thank you letter from a daughter of a patient whose father had terminal cancer and recently passed away. The letter advised of the excellent care received from the Bury District Nursing Service, and in particular the nurse named within the letter. The named nurse was described as kind, considerate, patient, knowledgeable and professional, allowing the patient to die with dignity and at peace. 1

Mr Trodden reported that the patient was at the late stages of end of life, and although seen by five GPs, her symptoms were not assessed, and it wasn t until the paramedics were called that a referral was made to the end of life team. The Board discussed the referral system and how in an imperfect system the team were able to provide excellent and dedicated care. Mr Trodden reported the letter had been shared with the team and a letter would be constructed from the Board to the team. Mr Trodden welcomed Dr Ian Watson, Oldham GP and Associate Medical Director to the Board. Dr Watson presented a patient story to the Board from the doctor s perspective. Oldham Community Health Services, District Nursing Service Dr Watson reported that two patients in his care had recently passed away, but fortunately for them they were able to die at home very peacefully surrounded by family. For both patients their care was dignified, not rushed and extremely professional. Dr Watson reported on the excellent team working and trusting relationship and most importantly making the patients and their families feel supported. The team were dedicated and often worked beyond their normal working hours to ensure patient care was not rushed. Dr Watson celebrated the excellent care that community teams performed and as such wanted to highlight their dedication and commitment, and to give thanks where praise was due. Dr Watson presented a further story from a carer s perspective. The carer was a GP within Oldham and the son of a patient, who had been diagnosed with a terminal illness. Due to the support of the primary and community health team his mother was able to die at home with dignity and pain free, surrounded by her loved ones. The family praised the team for the care their mother received. The team responded rapidly and efficiently and in the last days managed to allay the patient s fears of dying. Dr Watson advised the two patient stories had been circulated throughout the practice to ensure staff received feedback. The Board thanked Dr Watson for his attendance. 4. Previous meeting of the Board of Directors 4.1 Minutes of a meeting of the Board of Directors held on 26 March 2014 The Chairman presented the minutes from a meeting of the Board of Directors held on 26 March 2014 (PI). Referring to page 5, Mr Ainsworth clarified it was not his intention to amend the sequence of priorities within the vision and strategy but to rephrase priority 5. Mr Spearing advised the vision and strategy would be discussed further at the Transformation Group on Thursday 1 May ahead of final approval by Mr McCourt. 2

The Board approved the minutes as an accurate record. 5. Matters arising and action plan 5.1 Action plan arising from meetings of the Board of Directors The Chairman presented the action plan arising from meetings of the Board of Directors for approval. The Board approved the action plan. 6. Strategy 6.1 Chief Executive s update Michael McCourt presented an update on the Chief Executive s activities in April to the Board for information. Mr McCourt reported the Trust s 2-year operational plan and Vision and Strategy had been presented to the Joint Health Overview and Scrutiny Committee (JHOSC), who expressed confidence in the direction of travel for the organisation but were concerned about the size of the financial challenge over the coming years. The committee asked to be kept briefed as plans progressed and anticipated that the Trust would need to go out to formal consultation regarding the size and scale of proposed changes. Mr McCourt met with the Chief Operating Officers at the North East Sector/Pennine Care Interface Business meeting; this was the first of a series of planning meetings with individual CCGs to press home the reality of the financial impact on the Trust. The Trust s Transformation Group was developing the plans for the 5-year strategic plan ahead of the June submission to Monitor, noting the work on the detail of the plan would take the remainder of 14/15 to complete. Two key aspects for the Transformation Group were to ensure that the Trust co-produced (i.e. developed plans with those who use our services) and strived towards integration (i.e. strengthened partnerships). The Vision and Strategy was due to launch in May 2014, and would be followed up with detailed thinking on longer term plans for redesign at scale. Mr McCourt referred to internal leadership, noting the ED review had been completed and the Leadership Academy had been appointed to support the recruitment of the Executive Director positions. The first meeting would take place on 12 May and interviews were anticipated in late July. An informal meeting had been held with senior consultant psychiatrists and Dr Ticehurst, to discuss mental health investment and cross-subsidised income, challenges on managing quality against saving plans, integration of mental health and physical health and potential future opportunities for growth. Dr Edge enquired as to the potential to combine discrete budgets for mental health and physical health to ensure joined-up, holistic systems. Mr McCourt responded, consultants were not opposed to the direction of travel but had raised concern that complex and specific pathways should not be diluted. 3

Positive meeting had been held with the Executive Team, Service Directors and GP leads to develop models for medical roles in community and primary care to support out of hospital care models. Recruitment had commenced for the Oldham Service Director post. Mr McCourt referred to external leadership and reported meetings and telephone calls remained ongoing with CCG and LA leads to progress partnership working and plans for further integration. A meeting had been held with Mark Hunter MP to discuss the Trust s strategy and challenges. A meeting had been held with Debbie Abrahams MP to discuss community service models and procurement following the Oldham tender. Mr McCourt reported an FOI request had been received from the Labour party nationally regarding the cost of procurement, as their view was that the cost of procurement was diverting resources away from front line care. Briefing updates had been provided by Manchester CCG and Manchester Mental Health and Social Care Trust; a Partnership Board had been established to consider options for the future provision of mental health services in the city. Procurement remained an option for the CCG but all options were being explored before this route was taken. This was being progressed in tandem with discussions with the Trust Development Agency (TDA). Mr McCourt and Mr Roe attended Manchester and Trafford JHOSC where scrutiny of the progress around changes made at Trafford A&E (now urgent care centre) were discussed. No concerns were expressed regarding the Trust s enhanced care provision in Trafford, which was part of the overall design. EDs attended a Tameside and Glossop market day and subsequent integration workshop attended by Mr McCourt and Mrs Worthington. Both sessions consulted on options for future procurement and operations of health and social care in the borough. The proposal for commissioning intentions was a year of discussions and pilots, with a view to procurement in 2015/16. A meeting had been held with Stockport Council s CEO and executive team to consult and discuss their strategy and transformation plans. There was a shared view of the need to work closely in order to align strategies and integrate planning. A meeting had been held with Mike Burrows, Director of Manchester Local Area Team as part of Mr McCourt s induction into the Chief Executive role. A positive meeting had been held with Gillian Fairfield, CEO of Pennine Acute Hospitals NHS Trust, where agreement to work closely to align plans to support both organisations was sought. An invitation had been extended to Pennine Acute to attend the Oldham Partnership Board Trade Fair in order to develop relationships. A further meeting had been arranged for mid-may and a proposal to hold an ED to ED meeting in June. Referring to commissioning and contracting, Mr McCourt reported that the North East Sector had established a Health and Social Care Leadership Group; the group was seen as a key forum to lead the redesign of hospital and out of hospital services and 4

community and primary care services. The first meeting would be held on 18 June 2014. Mobile Working had made some progress with an outline agreement, following a series of meetings and presentations led by Mr Roe. The Trust s InSight model had been presented to the Heywood, Middleton and Rochdale Public Service Reform Board, where it was well received as an innovative approach to measuring community and mental health productivity. Mr McCourt reported the Trust was running a joint conference promoting the links between health and sport in July 2014. The event would be held at Salford Red Devils Rugby League ground in partnership with the club and the Rugby League s charity Rugby League Cares. Stakeholders, commissioners and Public Health leads had been invited to the conference and Mike Farrar had agreed to speak at the event. 6.2 Trafford Benefits and Realisation Report Katy Calvin-Thomas presented the Trafford Benefits and Realisation report to Board for information. Ms Calvin-Thomas presented the final benefits realisation report and the progress made in the first 12 months of the contract against each of the specified benefits. Ms Calvin-Thomas reported the benefits realisation plan had been subject to an internal audit by KPMG. Through the work completed the benefits had been expanded to a comprehensive set of benefits and built into the Trafford Business Plan. Benefits were supported by KPIs as part of contractual obligations, and were driving change with the development of the urgent and enhanced care services. The benefits had created real changes in services for the people in Trafford, the Trafford division was being managed within an integrated health and social care governance structure that included the Trust and Trafford Council. Ms Calvin-Thomas reported the benefits to be realised would continue to be tracked and monitored throughout 2014/15 as part of the Trafford DBU business plan to reflect their long term nature. Referring to the reference on page 25 regarding to the referral figures quoted in relation to the urgent and enhanced care service, Mr Moran queried whether, in view of the fact that 131 (approx 20%) of the 605 referrals received by the service were subsequently referred to hospital, it was creating an additional layer in the system for patients; alternatively, whether lessons were being learnt in the system, whereby those patients needing hospital treatment were referred directly. Ms Calvin-Thomas responded the aim of the service was to shift activity from acute to community services, thereby bringing care closer to home. The service was a neighbourhood-based system which worked within the district nursing and hub teams and over 80% of the referrals received were managed within the community. However, it was entirely appropriate for clients who were clinically deteriorating to be admitted to hospital via planned admission. 5

Mr Trodden suggested comparing data to inform how many of the 600 plus referrals would have been admitted to hospital previously. Ms Calvin-Thomas reported the focus of the service was to expand community services and to provide better levels of care. Data comparison was a challenge as different systems were in place to the acute trust. A critical piece of work was taking place to describe and evidence an urgent or enhanced care response. Ms Calvin-Thomas offered to share a copy of the KPIs regarding Trafford services with Board in order to provide a holistic view of the benefits. Mr Ainsworth enquired whether any areas of the organisation had not achieved objectives as set out within the plan. Ms Calvin-Thomas reported lessons learnt had been identified regarding the Urgent Care Business Case and Enhanced Care Service. During the negotiations and the transfer of services from Trafford, the business case was excluded from the discussions; in hindsight this should have been included in the process. Although the CCG had approved the business case there was insufficient detail of how the service would operate. The Service Director was therefore faced with a huge challenge of working through the implications to produce data and demonstrate progress. Dr Edge referred to page 31 regarding the building of community resilience and noted the dialogue referred to working with patients contained little detail on health promotion, disease prevention, etc. Dr Edge enquired if this was taking place but not reflected in the progress update. Ms Calvin-Thomas reported children s services were fully integrated and therefore community resilience was within their mind set and excellent community work was conducted, and noted that Adult services were entirely patient focused. Mr Schofield enquired as to any IT and system issues. Ms Calvin-Thomas reported the Trust was struggling to get networks transferred; the team was working hard with the CSU. Ms Calvin-Thomas further reported discussions had commenced with the CCG to transfer systems from ipm to Paris. Mr Ainsworth enquired as to the progress of the integrated management of specific services (i.e. incontinence and stoma services) from 3 into 1 (Bury, Oldham and HMR) to 4 into 1 (including Trafford). Ms Calvin-Thomas advised little progress had been made in Trafford due to internal staff movements and the move to devolved autonomy. Mr McCourt further advised the change from PCT to CCG drew the organisation away from 3 into 1, noting commissioners wanted something more distinct for each town. 6.3 Service Development Strategy (SDS) Richard Spearing presented the Service Development Strategy plan on a page for 2014/15 to Board for information. Mr Spearing noted that, at the previous meeting, the Board had approved the Service Development Strategy and proposed presenting the key programmes for the next 12 months, shown as a plan on a page. The format of the plan was aligned to the Trust s Vision and Strategy and Principles of Care. The draft format had been shared with the North East Sector, and with Tameside and Stockport commissioners and had been well received. Feedback from 6

commissioners was that they recognised the content was in sync with their organisational objectives. Mr Spearing presented the layout of the plan, addressing each of the key headings. The 9 key objectives were taken from the SDS and the 7 transformation programmes agreed at the Transformation Group on the 1 April 2014, the programmes effectively fitted around the spine of the Long Term Financial Model, five year plan and strategic framework. The Board was asked for comments on the format of the plan, prior to approval at the Transformation Group on 1 May 2014. Dr Edge proposed featuring workforce in a prominent place within the plan. Mr Moran enquired as to whole person care and asked for assurance that the principle of an allocated named clinician had been addressed. Mr Spearing confirmed the principle of a named clinician had been addressed under the heading of care coordination. Mr Schofield enquired as to any clash between the Trust s Principles of Care and the nationally mandated Six C s (compassion, courage, competency, commitment, care and communication). Mr Trodden responded the principles of care were the trust s values and in co-operation with Bev Worthington, the Six C s had been closely aligned with them. 7. Integrated Governance 7.1 Integrated Governance Report: March 2014 Henry Ticehurst presented the Integrated Governance Group report for March to the Board for assurance. Referring to the mental health dashboard, Dr Ticehurst referred to the amber RAG rating within the clinical quality section of the dashboard report, which referred to the CPA 7 day follow up, reporting 93.7%, and noting 7 breaches had been recorded within the month. Overall for the quarter the reporting was on target. Audit work remained ongoing with PwC regarding seven-day follow-up, which was in its final stages of sampling. Mr Schofield enquired as to the reasons for the breaches. Dr Ticehurst advised evidence identified some breaches had been due to administrative errors in allocating the appointments, although the majority of breaches referred to clients being discharged out of area and clients not responding to appointments. Dr Ticehurst reported a suspected homicide involving two clients. A client known to Drug and Alcohol Services had been charged with murder, and arson with intent to endanger life. The victim had been undergoing an assessment with the Rochdale CMHT. Dr Ticehurst reported a number of suspected suicides across the Trust footprint, all of which were STEIS reportable and would be followed up. 7

Referring to infection control, one case of CDiff had been reported in Stockport and one case of CPE at Tameside. Referring to the community health dashboard report, Dr Ticehurst reported unsafe discharges remained high. Community Governance Managers continued to report unsafe discharges to governance colleagues in the Acute Trust to support improved discharge planning and share lessons learned. The total number of complaints for the month had increased spread across the community health services. Pressure ulcers had reduced from the previous month and any exceptions from May would be reported to the Quality Governance and Assurance Committee (QGAC). Mr Trodden reported the highlights from the pressure ulcer review would be presented to QGAC on 20 May. 7.2 Response to National Quality Board s and Hard Truths Commitments Ian Trodden presented, for approval, the response to the National Quality Board s Guidance on Nursing, Midwifery and Care Staff Capacity and Capability and Hard Truths commitment regarding the publishing of staffing data. Mr Trodden advised the report presented to the Board followed on from the detailed Board Development Session held on 16 April 2014. The report addressed the Board s response to the National Quality Board s ten expectations and outlined the timetable of actions from NHSE and the CQC regarding the Publishing of Staffing Data. Mr Trodden presented the response to each of the ten expectations in detail noting the key responsibilities of the Board and actions required from the Trust. In conclusion from June the Board would: receive monthly monitoring updates from the Director of Nursing on nurse staffing levels; receive 6-monthly reports on nurse staffing, capacity and capability Mr McCourt proposed noting the following actions: EDs to include the above exercise in discussions with commissioners, to ensure commissioners understood and there was a clear purpose for the exercise; Transformation Group to ensure services currently provided were effective and viable and to be mindful of redesign from the configuration of the current model The Board was asked to approve the responses to the ten expectations and to note that from June they would receive a detailed overview of nurse staffing of all inpatient wards across the Trust. The Board was further asked to note assurance that the Trust had met the requirements as outlined in the Timetable of Actions detailed in Appendix One of the report. Mr Trodden formally thanked Clair Carson and the team for the work undertaken. The Board approved the responses to the ten expectations and noted the responsibilities of the Board. The Board further noted assurance as outlined in the timetable of actions. 8

7.3 Financial overview as at 31 March 2014 Martin Roe presented the financial overview report as at March to the Board for assurance. Mr Roe reported the year end accounts had been discussed in detail at Finance Strategy Group on 29 April. In summary Mr Roe reported the Trust had a year-end surplus of 758k against a target of 3,425k which was an adverse variance of 2,717k. The normalised year end surplus, which removed restructuring costs as they were not included in Monitor s risk rating calculation, was 5,674k against a planned target of 4,968k. 7.4 Delegation of Authority to approve the Annual Accounts 2013/14 Mr Roe advised that the annual accounts had been submitted to the auditors on 22 April. To ensure a full review of the accounts ahead of the submission deadline, the Board was asked to grant delegated authority to the Audit Committee to receive and approve the annual accounts at its meeting on 28 May 2014. The Board granted delegated authority to the Audit Committee to approve the 2013/14 annual accounts. 7.5 Performance and Information Assurance Commentary: Q4 2013/14 Katy Calvin-Thomas presented the Performance and Information Q4 Board Report for March to the Board for assurance. Ms Calvin-Thomas reported the early intervention service achieved both the Q4 target and the YTD position. Discussions were underway with CCGs and CSU regarding a Trust wide review. The Trust further declared compliance against all the Monitor targets for Q4, including the 7-day follow-up target. Following authorisation of the InSight business case, a temporary project resource was established until the end of March to begin pathway work for a number of key services across the Trust. This concluded on 31 March and the review of patient pathways against agreed services had been completed. The pathways were currently with service leads for sign-off in preparation for input; the deadline for this process was 31 July 2014. The Trust had received excellent feedback on the InSight tool from commissioners. Ms Calvin-Thomas reported that demand from services to generate information had resulted in significant pressure. Discussion had taken place at EDs and a review of the programme s capacity was being undertaken. Referring to CQUIN and KPIs, Ms Calvin-Thomas reported all requirements for the quarter were on track for commissioner review in May 2014. 2014/15 CQUIN s had been developed and weightings agreed with commissioners, with final detail to be agreed during Q1. Ms Calvin-Thomas reported between now and Q2 2015/16 the Trust was required to respond to eight Information Standard Notices data submissions to ensure ongoing compliance. Each dataset return required significant system changes, business process changes and report development requirements. Ms Calvin-Thomas gave assurance that resources were available within the team. 9

In December the Board requested a review of the Trust s performance against DNAs and cancelled appointments. The key findings confirmed DNAs were falling across all areas of services due to the deployment of text messaging and changes in recording. The cancellation of appointments generally remained consistent over the last two years with some variation in services. Ms Calvin-Thomas responded the deployment of Paris would enable standard detailed reporting against cancellations. Ms Calvin-Thomas reported feedback from the review would be addressed through the Quality Group and Divisional Business Units. 7.6 Workforce report: March 2014 Bev Worthington presented the workforce report for March to the Board for assurance. At the meeting in March the Chairman enquired when Trafford data would be incorporated into the overall workforce report. Mrs Worthington clarified Trafford compliance and reporting would be fully integrated into to the workforce and OD structure once implemented; and through the progress of DBUs and corporate compliance reporting. Mrs Worthington reported the March dashboard reflected the following five areas of key variance: 1. Slight decrease in sickness absence 2. IPDR compliance decrease 3. Increase in bank spend, increase in agency spend 4. Reduction in employee relation cases 5. Decrease in workforce movement 7.7 Core Skills Compliance Report: Q4 2013/14 Bev Worthington presented the core skills compliance report for Q4 up to 31 March 2014 to the Board for assurance. Mrs Worthington presented the update report on the Core and Essential Skills Training (CEST) compliance and highlighted trends at an organisational level. The compliance report highlighted that although most areas were showing as red and therefore not compliant, the report also emphasised that the increased focus on compliance had seen an improvement in many of the compliance areas, with three core skills rated green. Contained within the report were a range of actions to maintain compliance and system continuity to provide meaningful information, along with timetables for completion. Individual queries were being addressed case by case, with any issues affecting large scale compliance addressed as a priority. The Core Skills Plus programme continued, to ensure staff maintained compliance with core statutory and essential to role training, with the aim of minimising time away from clinical services. 10

The Board was asked to note the compliance report and trend analysis presented, and the areas identified as non-compliant; to acknowledge improving organisational compliance and maintained focus on interactions with DBUs through the developing performance management process; to note the on-going development work through OL&D to improve system functionality and support the take up of e-learning. Discussion took place regarding the target of compliance of 75% of staff compliant with fire safety of inpatient wards. The Board noted its disappointment with the noncompliance of fire safety training for all staff, reporting at 67%. Mr Roe reported as the ED Lead for Health and Safety and Fire Safety that he had requested targets to be issued by the end of May and as ED Lead for these targets had made a commitment to interview managers where teams were showing noncompliance. Mr McCourt reported it was critical for the organisation to get to a starting place where systems and processes were embedded within services. The compliance report highlighted the increased trend in movement across the majority of core skills. Mr McCourt proposed progressing discussion through EDs with a commitment to push through individual DBUs. 7.8 OL&D Dashboard Report: Q4 2013/14 Bev Worthington presented the OL&D dashboard report for Q4 to the Board for assurance. Mrs Worthington reported all targets had been completed or were on track, and further advised the full-year report would be presented to Board in June. Mrs Worthington reported in line with PEF activity outcomes had been submitted to the Health Education North West (HENW), the Trust had been awarded silver level compliance, which was an improvement on the previous year. Mrs Worthington reported a significant increase in compliance reporting during February and March, and it was anticipated reporting would increase with the ESR e- learning platform. Mr Schofield enquired to the year-end push for compliance training and how this could be managed more effectively. Mrs Worthington advised steps were being put in place to encourage staff to take a more proactive approach to avoid a last minute rush. Mr Ainsworth enquired to the training activity graph, with particular emphasis in the spike in activity during October and November. Mrs Worthington advised the graph reported overall face to face activity, during the months October and November activity coincided with the wider promotion of Core Skills training. 7.9 Monitor Governance Submission Q4 2013/14 Michael McCourt presented the Monitor governance submission for Q4 for assurance. Mr McCourt formally thanked the Council of Governors for the amount of activity during 11

the reporting period and the important role they played within the organisation. 7.10 Gifts and Hospitality Register 2013/14 Michael McCourt presented the gifts and hospitality register to the Board for assurance. 7.11 Register of Charity Donations 2013/14 Michael McCourt presented the charity donations register to the Board for assurance. 7.12 Report on use of Corporate Seal 2013/14 Michael McCourt presented the report on the use of the corporate seal to the Board for assurance. 7.13 Declarations of Interest 2013/14 Chairman presented the declarations of interest register to the Board for assurance. 8. Audit Committee Alan Moran presented the minutes from the Audit Committee meeting on 12 March 2014 to the Board for information. 9. Council of Governors 9.1 Council of Governors dashboard report Mr Schofield presented the Council of Governor s dashboard report for the period January to March to the Board for information. 10. Other Reports 10.1 Board Appointment and Remuneration Committee Mr Schofield presented a briefing note from the Board Appointment and Remuneration Committee held on 26 March 2014 for information. 12

10.2 Review of Board and Sub-Committee Structure Louise Bishop presented a report to the Board on the review of the Board and Sub Committee Structure, for approval. The Board was asked to formally approve the revised Terms of Reference for the Board of Directors and the formal sub-committees. Ms Bishop noted detailed discussion regarding the terms of reference had been held at a Board Development session on 9 April 2014. The Board approved the report and subsequent terms of reference: Board of Directors Quality Governance and Assurance Committee Service Development and Transformation Committee Finance Strategy Committee 10.3 Information circulated to Board since last meeting The Chairman presented a report on information circulated to the Board since the last meeting. 10.4 Report on recently ratified policies Michael McCourt presented a report on recently ratified policies to the Board for information. 11. Any other Business No other business was discussed. 12. Questions Mr Armstrong enquired as to the interim arrangements for Service Director supervision in light of the vacant post of the Director of Operations and the move to devolved management. Mr McCourt advised in order to maintain operational leadership Service Directors had been twinned with an ED for support and guidance. 13. Date and time of next meeting The next scheduled meeting of the Board of Directors will take place on Wednesday 28 May 2014 in the Boardroom, Ground Floor, Pennine Care NHS Foundation Trust Headquarters, 225 Old Street, Ashton-under-Lyne, commencing at 9.30 am. 13