MINUTES OF THE NINTH MEETING OF THE COUNCIL OF GOVERNORS OF THE ROYAL DEVON & EXETER NHS FOUNDATION TRUST

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1 MINUTES OF THE NINTH MEETING OF THE COUNCIL OF GOVERNORS OF THE ROYAL DEVON & EXETER NHS FOUNDATION TRUST Held on Tuesday 11 April 2006 at 2.00 pm in The FlyBe Suite, St James Centre, Exeter City AFC Present: Professor Ruth Hawker (Chairman) Public & Staff Governors East Devon Robert Doy Stanley White Margaret Green Linda Fryer Gail Nunan Trish McKenzie Mid Devon Gordon Davis Roger Smith Ivor Watts Reuben Miles Other Regions Victor Bloom Christopher D Oyly Appointed Governors John Dowell, Exeter Primary Care Trust David Cox, East Devon District Council Prof Janice Kay, Peninsula Medical School Alan Griffiths Mid-Devon District Council Apologies Brian Perris (Other Parts) David Johnstone (Devon County Council), Liz Smith, East Devon Primary Care Trust Exeter Andrew Webber Rachel Jackson Imraan Jhetam Miles Kinchin Terry Roberts Staff Medical & Dental Paul Marshall Nursing & Midwifery - Monica Overy Allied Health Professionals Tony Cox Admin, Clerical & Managers, Sue Greenall Hotel & Estates Brian Croft In Attendance: Director of Finance - Mike Stevens Director of Operations - Elaine Hobson Foundation Trust Secretary - Tony Taylor Hazel Poppleton (Minutes) Margaret Read (Exeter) John Shepherd (Exeter City Council) Marguerite Shapland, ND District Council * Denotes rest of Devon, Dorset, Somerset, Cornwall, Isles of Scilly APOLOGIES AND QUORUM CHECK Apologies were as listed above. A quorum check confirmed that the meeting was quorate MINUTES OF PREVIOUS MEETING The minutes of the meeting held on 18 January 2006 were agreed as a true record. However, Mr Cox requested that in minute SHA/PCT Reorganisation the following sentence was added at the end of the third paragraph on page 8: Mr Cox stated his concern that the PCT reorganisation was taking place, and would be decided, prior to the outcome of the local Government re-organisation which was expected to be announced later this year. This therefore meant that there was a possibility of having to re-align PCT boundaries to the new local authority government boundaries at a later stage. 1 of 6

2 MATTERS ARISING Minute Performance Report: Miss Hobson reported on the new arrangements for recording the monitoring of the number of MRSA infections, whereby community acquired figures would be split from RD&E figures and reported separately. This meant that the RD&E would now plan to meet the in-year target for a reduction in the number of MRSA infections NOTIFICATION OF INTERESTS The Secretary asked for all Governors to return the annual notification forms which had been included with the COG papers to him as soon as possible. He reminded the Governors that the details were required for inclusion in the Annual Report SECRETARY S NOTES a) 3 new dates were announced: 7 September 2006 Annual Members Meeting at St James Park starting at (This meeting was previously scheduled for the afternoon of 10 October) 10 October 2006 Quarterly COG meeting at St James Park (previously scheduled for that morning) 11 July 2007 Quarterly COG meeting at St James Park The Secretary reminded the Council that dates of all meetings up to 15 months in advance are always available on the internet at the following web address: b) The Trust has a new Membership Services Manager, Bernadette Coates who has replaced Tori Paterson. Her contact details are unchanged. c) The Chief Executive has sent apologies as she had been called away from the hospital for personal reasons CHAIRMAN S REMARKS Professor Hawker began by stating that this was her last CoG meeting as Chairman. She considered it a privilege to have been the Chairman and thanked the governors for their support and input in helping to make the first two years as a foundation trust such a success. She also made the following remarks: a. NED Recruitment Process. The process to recruit a replacement for Mr Evans, who has resigned from the board for personal reasons, had begun. The Nominations Committee met and agreed a process using Grieves Pryce as the executive resourcing company to search for candidates. Grieves Pryce was used in this capacity for the previous two NED recruitment campaigns and provided very good service. The council would be asked at Item 8 to approve a revised Policy for the Composition of NED on the Board, which has been reviewed by the Board as part of a routine process. It is the Board s wish that Mr Evans replacement will be drawn from one of the experience categories listed, namely: A qualified lawyer in practice, or a professor of law in an academic department, preferably with experience of corporate law; or, a person with commercial experience, where contract law has been a significant part of their role. The search and advertising campaign begins shortly and will complete at the end of May. The Nominations Committee will shortlist candidates on the 8 June and interviews will be held 21 June. The committee s recommendation for appointment will be submitted to the CoG for governors approval at their part 2 meeting 11 July. 2 of 6

3 b. New Governors. 4 new governors were welcomed to their first meeting: Brian Croft is the Staff Governor for Hotel and Estates. Miles Kinchin and Terry Roberts have filled the 2 vacant Exeter Public Constituency vacancies. Professor Janice Kay has replaced Paul Webley as the PMS appointed governor. This brings the CoG to a total of 32 governors. The remaining vacancies are all among appointed positions Voluntary Services (2), Mid-Devon PCT (1) and North Devon/Teignbridge/Torridge PCT (1). c. Attendance. Professor Hawker referred to a separate letter from her to all governors on the subject of attendance by governors at CoG meetings. This would be discussed in the Pt 2 meeting QUARTERLY PERFORMANCE UPDATE a) FINANCE UPDATE Mr Stevens reported that this had been an extremely busy time both to finalise the end of year accounts and also set the budgets and plans for the next financial year. The financial position to the end of February 2006 showed a deficit of just 600k against a planned figure of 1.3m. This should translate into an end of year deficit of 2.3m against a plan of 2.8m. The Trust had achieved 92% of its CRES target this year and would have improved on this but for the delayed receipts from a land sale. The cash balance showed a surplus of 14m against a planned figure of 3.8m. The excess is explained by the recent loan drawdown of 12m plus the public dividend capital loan of 7.7m. This latter loan is from the Department of Health for schemes either in place or planned when the Trust became a Foundation Trust in Overall he felt that the Trust had performed extremely well to achieve its outturn deficit figure of 2.3m adding that this figure had remained consistent over the last quarter. Turning to 2006/07, he highlighted certain areas of particular significance. Payments by results (PbR). Significant changes were expected with PbR. From 1 April 06 PbR would apply across the whole of the NHS for all procedures whereas prior to this only elective activity had been subject to the PbR regime in non-foundation trusts. The original predictions for PbR across the NHS had shown a 3b shortfall and therefore had to be re-calculated. New tariff prices were published late in the day in January 06, then withdrawn because they were found to be inaccurate and were re-issued in mid-march. This meant that much work with the PCTs was required at very short notice to ensure our future plans were correct and sound. In addition, new rules were brought into existence at the same time by the Department of Health. In particular, if emergency activity was greater than planned, the Trust would no longer receive full funding for work above planned activity levels and would only receive a maximum of 50% of the full rate. This had a significant impact on our financial planning. On the plus side, the Trust would now receive payment for clinical procedures undertaken at the same time as an outpatient appointment. In addition, multi-professional outpatient attendances would be paid according to the range of services received, rather than just for one attendance. New rules of engagement clarifying how the system would work were also introduced so that all organisations could plan effectively and interact sensibly with one and another. Contracts 06/07. Significant progress had been made in this area and in general agreed levels of activity to be delivered had been reached with commissioners. There remained a difference of approximately 3m worth of activity to be resolved which did represent a financial risk for both provider and commissioner. In response to a question, Mr Stevens stated that this was a matter of affordability for the PCTs. 1.8m of the 3m centred upon implementation of the new charging regime for critical care services, and does not represent a disagreement of principle, rather one of affordability. One solution might be to introduce the new charging regime over a longer period but this would have an impact on our finances. The debate over discharge summaries had been long and the need for a clear procedure in the future which everyone would follow was still required. Budget 06/07. The Trust would introduce a new regime for budgets whereby both income and 3 of 6

4 expenditure were looked at collectively rather than in individual budgets. Whilst the Trust understood expenditure very well, it needed to refine its understanding of income streams, and it was fundamental to know how the delivery of services affected the bottom line. Simplistically, a contract should accurately define the income budget which in turn would allow the Trust to define the expenditure budget. Any gap between the two would have to be the subject of further debate. An initial look at next year s difference suggests a figure of approximately 12m excess over income, and the way to manage this would be via the Financial Recovery Programme on which the Governors were briefed in January. Capital. Planned completion dates of capital schemes are as follows: Phase 4 December 06 Cardiology November 05 ICU early 07 Diabetes August 06 LinAc starts May 06 completes May 07 Discussions and questions from the Governors followed: There was concern over the impact on our income if PCTs did not commission services from us. In reply it was felt that there had to be a balanced judgement on the part of the PCT on just what could be delivered, and by whom. There was concern over the 50% reduction in ED tariff for activity over plan. Was this not a double whammy on the Trust? The Trust had limited control over the level of emergency activity and may suffer consequently? Mr Stevens responded that the PCTs do have plans to manage emergency activity outside the secondary care setting where appropriate. If the PCTs do not fund the 3m gap, it does not mean a reduction in services. Either the Trust must become more efficient through the Financial Recovery Programme or other providers would have to be found to do the work. Concerns over the level of activity created by 999 calls which could not be predicted were also crucial to the funding question. It was still too early to come to any conclusions on this but it was part of the bigger problem to provide alternatives to the Emergency Department solution where possible. For example, Walk-in Centres and Devon Doctors on- Call being located close to our own ED had helped in this respect. Would the provision of Breast Screening activity away from the RD&E from 30 April 06 mean a loss of income? In reply Mr Stevens said there would be a loss of income but as the Trust was no longer providing the service we would also be able to reduce expenditure. The Governors noted the Quarterly Finance Update b) PERFORMANCE REPORT Miss Hobson reported a very positive performance in meeting the key targets. Emergency Care targets. The Trust had met with great success in meeting these targets in what had been the busiest quarter of the year, and despite the effects of closed wards due to the Norwalk virus. The new information system had also proved very helpful in monitoring the flow of patients through the ED. All Cancers: 2 week wait. The Trust had met this target in full. Cancer 31/62 days. The Trust had met the 31-day target for decision to treat to treatment and was close to meeting the 62-day target for referral to treatment, having achieved 94% against a target figure of 95%. The Trust was hopeful of meeting this target shortly and had learned greatly from improvements made to other waiting times and systems. The introduction of a fast-track system had also allowed better and faster decisions across cancer specialties. The lessons learned from improving cancer waits were being read across into actions to achieve the 18-week referral to treatment target for all patients. Elective patients waiting longer than standard. The Trust continued to meet this target in full. Outpatients waiting longer than the 13 week standard. The Trust continued to meet this target in full. Booking. The Trust continued to meet this target in full. MRSA Bacteraemia. As reported under Matters Arising, the new regime for assessing MRSA 4 of 6

5 infections now meant that the Trust would meet the in-year target for reductions in the number of MRSA infections. In addition, Miss Hobson reported that the levels of C diff infections had decreased to their pre-escalation levels, although Norwalk virus continued to affect the hospital. Mr Roberts noted that Breast Screening was not a target and asked about the current situation in the Trust with regard to this activity. The Chairman asked Mr Roberts to table this remark formally in writing and an answer will be provided at the next meeting. In response to a question Miss Hobson reported that the average level of activity in the Emergency Department ranged from between approximately 120 up to 200 patients per day. The Governors noted the Quarterly Performance Update NED REMUNERATION COMMITTEE (NEDRC) The Governors approved the following: a) the revised Terms of Reference. b) the following recommendations of the NEDRC: No market rate increase is required for Chairman and NED rates of remuneration for financial year 06/07. An inflationary adjustment in line with NHS employer s recommendations should be awarded up to a maximum of 3% for financial year 06/07. In future years (financial year 07/08 and beyond) an inflationary adjustment may be automatically awarded up to a maximum 3% without further approval by the COG POLICY FOR COMPOSITION OF NED ON THE BOARD The Governors considered the revised policy, particularly noting the amended wording in paragraph 4a, which had broadened the experience category required (see Chairman s Remarks above sub para a.). In particular, this new descriptor would be used in the current NED recruitment campaign to find a replacement for Mr Evans. The Governors approved the revised Policy for the Composition of NED on the Board of Directors NATIONAL FT GOVERNORS FORUM MINUTES OF ORGANISATIONAL STRUCTURE AND FINANCE WORKING GROUPS The Governors noted the minutes of these two working groups which had taken place during March and were asked to decide on the issues of principle outlined in the Organisational Structure Working Group minutes. Considerable discussion resulted in the Governors agreeing that: All Governors should be eligible for election onto the Executive Committee of the national Governors Forum. Elections to the Executive Committee should be exercised by the vote of the individual forum representative. Changes to the Forum s constitution should be made by a percentage of Forum representatives. The Forum should be hosted by the King s Fund SMOKE-FREE ENVIRONMENT IMPLEMENTATION PROPOSAL This matter was introduced by Miss Orzel, Director of Nursing & Service Improvement. She explained that the paper had already received Board approval and she was now asking the Governors for their opinion on the proposal. There was still much more work to do prior to the introduction and implementation of a formal Trust policy. Lively debate ensued and the main points to emerge from this 5 of 6

6 are summarised below: The Trust should provide areas for patients and staff smoking, particularly during staff breaks. There should be a robust stop smoking campaign for staff, noting that nicotine was perhaps harder to give up than heroin. Patients who smoke are further stressed by not being able to smoke. There should be a gradual implementation of the policy. How would we police the policy? Why was there any reticence to the introduction of the policy? It was sensible, reflected the national trend and similar introductions in other public workplaces across the country. What were the exemptions to be? Miss Orzel replied that there were likely to be extremely limited and confined to patients who are likely absconders and some patients with mental health problems. There was a cost to the organisation from people who smoked, i.e., from lost time taking smoking breaks. Recent experience elsewhere showed that there was a risk to smokers going off into the grounds for a smoke break. Staff smokers would have to go onto Barrack Road to smoke legally. Was this sensible? Miss Orzel replied that the policy will provide guidance on this. Will there be signs at the extremities of the non-smoking boundaries stating clearly that people were approaching a no-smoking zone. Miss Orzel replied that the definition of grounds was crucial to the implementation of the policy. What about people in cars parked in RDE car parks? Other health organisations in Australia had limited the no-smoking boundary to within 40 metres from buildings. They also insisted that staff take their breaks. More than just patches would be needed for patients in hospital to assist them to stop smoking. The Governors will have sight of the policy when it is finalised. Miss Orzel thanked the Governors for their input and would take them into account when formulating the eventual policy and implementation procedure QUESTION ON NOTICE The Governors noted the response to a question from Dr Perris ANY OTHER BUSINESS Miss Margaret Green, Deputy Chairman of the COG, made a statement paying tribute to Professor Hawker s tenure as Chairman of the Council of Governors. She reflected that the Chairman had spent 50 years in the NHS and 10 years as Chair of the Trust, the last 2 of which as Chair of the Governors. She commented that Professor Hawker had always been a very fair Chairman with time for all and the Governors unanimously had appreciated her leadership during this bedding-in period. She wished Professor Hawker every success for the future. In response Professor Hawker thanked the Governors for their kind words adding that she felt that the Governors were really now starting to make a difference and contribute to the Trust s strategy. It had been a privilege to be their Chairman DATE OF NEXT MEETING Tuesday 11th July 2006, in the St James Centre. 6 of 6