CoG (07/16) Item 6.2. Council of Governors. Dr Jim Whittingham. Dr Jim Whittingham. Board Highlights Report N/A

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1 CoG (07/16) Item 6.2 DATE 14 th July 2016 REPORT FOR Council of Governors REPORT FROM Dr Jim Whittingham CONTACT OFFICER Dr Jim Whittingham SUBJECT Board Highlights Report BACKGROUND DOCUMENT (IF ANY) N/A EXECUTIVE COMMENT (INCLUDING KEY ISSUES OF NOTE OR, WHERE RELEVANT, CONCERN THAT THE COG NEED TO BE MADE AWARE OF) Draws the Council of Governors attention to specific topics discussed by the Board. COUNCIL ACTION REQUIRED Receive report 1

2 Board Highlights Report The revised Council of Governors Engagement Policy includes further measures to strengthen the links between the Board and the Council of Governors, including the agreement by the Board of those issues, from each of its meetings, which it wants to specifically draw to the attention of the Council of Governors. The Board has agreed that these may be from both the public and private Board meetings. The Board Highlights Report may be read in association with the Board s (for matters from the Board s meetings in public). This Highlights Report includes the public and private meetings of the Board in March, April and May 2016 Meeting of the Board on 29 March 2016 A. Meeting of the Board in public The Board agreed to highlight the following issues to the Council of Governors: 1 Healthy Lives Healthy Futures This highlight is based on both public & private minutes. 8.1 The Board discussed progress and issues on HLHF as part of both the public and private agendas. Mr Bob Deans (of Attain) attended the private board to provide an independent report from Attain on the new preferred option and the structures that would be required to lead and manage implementation. The basics of the proposed structure included a new System Board (led by an independent chair) operating across northern Lincolnshire and place based Accountable care organisations (ACOs) in N and NE Lincolnshire to develop those services that should and could be determined by place. The Board also understood that Attain recommended that there should be a single executive lead responsible to the Independent Chairman and the System Board for implementation, although the Board was unclear as the extent of support for this proposal outside of the Trust. Attain also recommended the establishment of a strategic commissioning board as another essential part of the structure. Members of the Board had a number of reservations about the proposed option 4 and concerns that lack of clarity and other issues created a risk to both outcome and progress. Nonetheless, on the balance of risk, the Board agreed to provide its support for both option 4 and Attain s structure proposals. However the Board also restated that it expected that the outcome of option 4 should be an integrated, sustainable northern Lincolnshire health and care system responding to place but on the basis of clinical and financial efficiencies. The Board also agreed that, also on the balance of risks, it wanted to see the Trust s CEO appointed as the executive lead, as most likely to achieve a successful outcome. Recognising that this meant that the Board would need to appoint an interim CEO to allow Mrs Jackson s release. With the Board s agreement, for the sake of transparency, the Chairman subsequently wrote to Mr Deans, the chairs of the HLHF organisations and the chairs of NHSI and NHSE to set out the Board s position. The Board noted that a meeting was to be held on 7 th April in order to ensure that all of the HLHF organisations were signed up to Attain s proposals Governors continue to receive frequent private briefings on progress and issues on HLHF Finance Plan The Board approved the Trust s Finance Plan. In doing so the Board noted in particular: The achievement of the I&E target agreed with Monitor of a 25m

3 deficit; The forecast of an underlying deficit of 23.3m; Monitor s proposal of a control total deficit of 12.27m with an associated additional income support package (subject to performance conditions) of 11.5m The Board noted the significant risks to the achievement of these forecasts, not all of which are under the Trust s control: Uncertainties about commissioning income; Activity cost risks arising from uncontrolled growth in demand above forecast; Additional unknown regulatory or quality investment requirements; Inflationary pressures exceeding Monitor s guidance; The achievability of the Trust s internal sustainability plan of a further 13.85m of internal savings Governors should note the connection between several of these risks and the risks of delay on the HLHF programme The Board also considered the Trust s capital programme and the current significant liquidity gap and noted that closing the gap depended on support from Monitor. In addition to the obvious issue of cash-flow, Governors should also note the connection between the capital programme and the Trust s ability to support the ongoing costs of transformation. Also the connection with initiatives to improve recruitment, in particular clinical staff accommodation. B. meeting of the Board in private 1 HLHF See above 2 Further update on the CQC visit and report The Board was advised about the current timetable for the publication of the CQC report. The Board also received an update on progress on the current action plan which was based on the CQC s informal feedback following the inspection itself. Members were concerned about aspects of the CQC s process and especially the continued delay in publication of their report. Finally members discussed progress on elements of the current action plan and in particular, the planned establishment of a pilot on selected wards of supernumerary ward co-ordinators and the out-patient ophthalmology service. 3 Further update of preparations for the planned junior doctors strike The Board discussed preparations for the planned 10 hour strikes (full walk-outs). 3

4 Meeting of the Board on 29 th April 2016 A. meeting of the Board in public The Board agreed to highlight the following issues to the Council of Governors: 1 National Staff Survey The Board discussed the Trust s response to the 2015 national staff survey. The initial focus was on concerns about the relatively low response rate and the need to increase the participation of Trust staff. Dr Dunderdale updated the board on the development underway of an integrated improvement plan. 2 The Financial out-turn Mr Hassall confirmed that the end of year headline deficit was 26.04m. Excluding revaluation and impairment adjustments the deficit was 25.27m which was just over 0.5m better than plan. The end of year liquidity position was positive and it had not been necessary to draw on the emergency working capital facility agreed with Monitor during March although this would be required during April and May. Mr Hassall also advised the Board that the Trust was now engaged in formal arbitration with the N and NE Lincs CCGs because of its inability to agree acceptable commissioning contracts with the CCGs through normal process internal sustainability plan The Board received an update on progress on completion of the internal sustainability plan. The plan consists of 8 work-streams and there are currently serious risks to the achievement of 5 of the 8. Work was underway to mitigate the risks against deadlines. There was a general discussion about the challenges created by the yearon-year requirement to make savings on this scale and recognition from the NEDs about the achievements of the executive team and the Trust s staff. Members agreed that the NEDs would provide independent challenge and support to each of the workstreams. s B. meeting of the Board in private 1 Healthy Lives Healthy Futures The Board received a further update on progress and issues on HLHF. Mr Deans of Attain attended to provide an independent perspective. The Board was disappointed to hear about further difficulties and, in particular, further delays in agreeing a way forward. Post meeting update: sufficient progress was made subsequently to enable the Board to agree to continue to engage. Governors will be briefed on the latest HLHF position at the Cog Business meeting on 14 th July. 2 Dermatology strategy The Board received and supported proposals from the Trust s Dermatology Service (led by Drs Butt and Gowda) on a revised strategy for the service. The strategy was partially driven by the decision of the N Lincs CCG to commission Virgin Health as the main provider of secondary care dermatology in N Lincs. The strategy therefore proposes the consolidation of a strengthened Trust service into NE Lincs and the development of a networked approach with Hull for more complex cases, especially those requiring plastic surgery. The objectives are a high quality, competitive and sustainable service 3 Critical Care strategy 4

5 The Board received and supported proposals from the Trust s critical care services (led by Dr Dharmarajah) on the critical care strategy. The Board considered, in particular, the plan to increase the number of ITU/HDU beds at SGH and the plans for recruitment of consultant intensivists and the associated recruitment risks. 4 Goole Neuro Rehabilitation Centre (GNRC) The Board approved the proposed refurbishment of the GNRC and the re-structuring and remodelling of the service to improvement the financial framework and its appeal to prospective users, subject to the development of a business case. There was discussion of the Trust s relationship with BIRT (Brain Injuries Research Trust) who are the Trust s partner in GNRC and options for that partnership in future. 5 MRSA colonisation The Board received a report on a MRSA colonisation incident at the SGH NICU. The Board was reassured that no actual infections had taken place and that the patients were safe and were being de-colonised. Several had already been discharged. Nonetheless an investigation was underway and the incident illustrated the need for continued vigilance on MRSA and hospital acquired infections generally. Governors will be aware that there were no hospital acquired MRSA infections during and that non have been reported to date during Governors will recall that the Board has recently re-established Infection Prevention & Control Committee as a board sub committee to ensure that the Board is fully sighted on this area. Meeting of the Board on 31 May 2016 A. Meeting of the Board in public B. The Board agreed to highlight the following issues to the Council of Governors: 1 Current financial position The Board receives a regular monthly update on the Trust s financial position. On this occasion the report was on the Trust performance at the end of the first month of the financial year (April). At this point the Trust reported a deficit of 1.43m (slightly ahead of plan) but noted that this should not be taken as an indicator of positive progress. In particular the Board was concerned about risks to commissioning income and about the need to make progress on the Trust s internal sustainability plan. s The Board was advised that the cash position was stable and that the Trust was drawing on the 18m working capital facility provided by NHSI/Monitor. The Board was concerned about the current lack of clarity from NHSI/Monitor on capital and asked Mr Hassall to being work on options in the event that NHSI/Monitor failed to approve the Trust s capital plan. Governors will recognise that current uncertainty reflects the national economic position and the state of NHS finances generally. A. meeting of the Board in private 1 Healthy Lives Healthy Futures The Board discussed the appointment of Mr Ian Atkinson who has been appointed by the commissioners as the Independent Chair of the proposed System Board. The System Board is key part of the proposed structure to take HLHF forward. Mr Atkinson is currently working on 5

6 the establishment of a full governance and leadership structure and had provided preliminary draft terms of reference for the Trust s consideration. Mr Atkinson had also asked the Trust to second Mrs Jackson to act as the executive lead for the at scale part of the proposed future HLHF programme. Following a long discussion about the balance of risks the Board agreed to support Mr Atkinson s proposals in principle subject to the Board gaining assurance that governance and leadership arrangements would be sufficiently robust to provide reasonable assurance of success. The Board therefore also agreed to ask Mr Atkinson to provide draft terms of reference for all of the proposed structure and commissioned a comprehensive formal risk assessment. The Board also asked that NHSI/Monitor were made aware of the position. The Board subsequently held and extra-ordinary board meeting on 8 th June to which Mr Atkinson was invited to consider the draft terms of reference and to review risks and issues. The Board gained further assurance at that meeting and made a number of in principle commitments to Mr Atkinson. These were confirmed at the meeting of the Board on 28 th June. Governors will receive an update at the meeting of the Council on 14 th July. 2 Clinical Admin Review The Board received a further update on progress and issues on the CAR and, in particular, feedback from the feed-back session held with staff on 20 th May. The Board also received an update on progress and issues on the Out-patient backlog. Significant capacity issues were being encountered in ophthalmology in terms of both clinical staffing and clinic space. Additional sessions were being provided as part of the Trust s immediate response to these issues and very high levels of activity and demand. However the Board noted that a significant transformation of the service in the hospital and the community was now required. 3 Contract risks and risks to the Trust s plan The Board was advised about the successful conclusion to the arbitration process on 9th May and about the means by which it had been achieved. The Board noted the significant remaining risks to the Trust and the Trust s Plan and in particular concern as to whether the commissioners would be in funds to meet their contractual commitments. Dr J Whittingham, July

7 Previous Board Highlights reports Highlights report for meeting of the Board on Considered by meeting of Council of Governors on 29 September November October November November January December April January April February April March July April July May July June November July November August November September November th October January November January th December May th January May th February May st March July th April July th May July th June th November th July th November th August th November th September th November th October th January th November th January December April January April February April

Board of Directors Finance Presentation 2015/16. Friday 25th September 2015

Board of Directors Finance Presentation 2015/16 Friday 25th September 2015 1. Summary of 2015/16 financial position This presentation is to update the Board in public of our latest financial position.