Minutes of the 10 th Trust Board Meeting held on 20 November 2008 at 10.00am, in the Boardroom, Belfast City Hospital Present: Mr P McCartan

Transcription

1 Minutes of the 10 th Trust Board Meeting held on 20 November 2008 at 10.00am, in the Boardroom, Belfast City Hospital Present: Mr P McCartan Mr W McKee Mr J O Kane Mr L Drew Ms J Allen Mr T Hartley Mr C Jenkins Professor E Evason Mrs W Galbraith Miss V Jackson Dr T Stevens In Attendance: Mr H McCaughey Mr B Mullen Ms D Stockman Mrs J Welsh Dr P Donnelly Mrs D Curley Mr P Ryan Apologies: Dr V McGarrell Miss B McNally Mrs M Mallon Miss P O Callaghan Chair Chief Executive Director of Finance Director of Nursing Medical Director Chief Operating Officer/Deputy Chief Executive Director of Mental Health & Learning Disability Services Director of Planning & Redevelopment Director of Specialist Services Director of Clinical Services Head of Communications Head of Office of Chief Executive Director of Social Work Director of Human Resources Director Mr McCartan welcomed everyone to the meeting including staff side representatives and members of the On Board Programme. TB Minutes of the Previous Meeting The minutes of the Trust Board meeting held on 18 September 2008 were read and approved. TB Matters Arising There were no matters arising. TB Chairman s Business Mr McCartan advised the Board of his diary commitments and he highlighted in particular his participation in the opening of the Grove Health and Well-being Centre and the Carlisle Health and Well-being Centre. He had also attended the sod cutting ceremony for the Child and Adolescent Psychiatric Unit on the Forster Green site. Mr McCartan commended the Trust staff for the very successful Leadership Conference on 6 November 2008 and he praised the winners of the Chairman s 1

2 Awards. These were Protecting Patients Hyperkalaemia, Pharmacy Input Maximum Output; Telemedicine Home Support Programme; Dental Services for Belfast Homeless and Summer Fun at the Belfast Trust. There were over fifty entries. TB Report of the Chief Executive Mr McKee presented the Report of the Chief Executive. Death of Baby P in Haringey Council Area Mr McKee addressed the issue of Child Protection arrangements within the Belfast Trust. He advised that Mr Cecil Worthington, Co-Director Family and Child Care Services would speak to the issue later in the meeting. Capital Developments Mr McKee advised the Board of the Ministers announcement on 13 November of plans to invest 180 million in capital in the Belfast Trust. This was part of a planned total investment of 580 million over the next ten years for health and social care in the Belfast Trust area. The Capital Investment included the new Child and Adolescent Psychiatric Unit, the new Health and Care Centre for Castlereagh, a new Mental Health Inpatient Unit for the Belfast area, a new Mental Health Community Facility in North Belfast and the replacement of other mental health and learning disability facilities at Muckamore Abbey Hospital. Mr McKee advised the Board however that the Trust had capital bids over 1.3 billion. The shortfall in capital required would present significant challenges for the Trust. The New Women and Childrens Hospital Mr McKee advised the Board that the Minister had announced that site enabling works would begin in 2011, with construction of the Womens Hospital beginning in 2015/16 with an expected completion date of 2017/18. Construction of the Childrens Hospital was not due to start until 2017/18 with completion expected in 2021/22. Mr McKee expressed his disappointment with this announcement. He advised the Board that the decision to centralise Maternity Services in Belfast had been taken in Consultation on Service Change Mr McKee set the context for the agenda items which were before the Board. He set out the context of the Belfast Way, a Vision for Services in Belfast and the New Directions Document which set the strategic direction of service change and modernisation. These documents would be followed by further Excellence and Choice Consultation Documents at the December Board meeting which would detail proposed service changes in unscheduled care, mental health, services for older people and services for people with a learning disability. The meeting today would discuss the responses to the New Directions document for which Mr McKee thanked all of the respondees. 2

3 Mr McKee also drew the attention of the Board to the Trusts Strategic Response to the Comprehensive Spending Review and the overarching Equality Impact Assessment (EQIA) which was a legislative requirement by the Trust in responding to Section 75 and Schedule 9 of the Northern Ireland Act Mr McKee finally advised the Board of the Corporate Management Plan which was now available in published format and had already received Board approval. Prof Evason thanked Mr McKee for his report but expressed her deep concern at the timeframe announced by the Minister for the new Womens and Childrens Hospitals. She stated that the current services were not in suitable facilities and did not meet modern standards. The proposed timeframe should not be acceptable to the Board of the Belfast Trust. She advised that the Board of the Trust should be discussing the matter with the Health Committee. Mr Hartley supported the comments of Professor Evason. He stated that the current buildings were old and over-crowded and did not offer any future modern service of the highest standards which the citizens of Belfast deserved for future generations. Ms Stockman advised the Board of the profile for capital investment in Health and Social Care Services over the next ten years. She stated that the Trust had invested almost 2.4 million in the Womens and Childrens Hospitals in recent years to address Health and Safety issues, refurbishment and improve ward environments. Mr O Kane asked that the Board engage more with the public and at a higher level if necessary to ensure a re-prioritisation within the Investment Strategy for Northern Ireland in order to secure the development of the new Womens and Childrens Hospitals sooner. Mr Jenkins sought clarification on the position of PPP/PFI in relation to the proposed development. Mr McKee advised that PPP/PFI was an issue across all programmes of government. Mr McCartan advised the Board that there had already been an Assembly debate on the issue of Maternity Services. In discussion the Board asked the Chief Executive to bring forward a paper highlighting a way forward on this matter. Decision: The Report of the Chief Executive was accepted by the Board. TB Report of the Director of Planning and Redevelopment New Directions Consultation Paper Response and the Way Forward Ms Stockman presented the New Directions Consultation Responses. She thanked the many people and organisations who had responded to the Consultation. Overview and Consultation Process Mrs Stockman described the New Directions document as the start of a dialogue with the people of Belfast and the users of the Trust services. She recapped on the guiding principles and the format of questions on the key stages of life and access to the Trust services. 3

4 Mrs Stockman described the consultation process which lasted from 29 August to 7 November She outlined the range of pre-consultation meetings including a presentation to representatives of over 200 community groups, carers, charities, patient advocates and voluntary organisations. The document had been distributed to over 2509 service users and key stakeholders, ensuring that the Trust consulted as widely as possible. Both the Chief Executive and the Director of Planning and Redevelopment had attended over seventeen meetings and presentations in public. There were seventy-one written responses to the Consultation. Summary of Responses to Consultation Guiding Principles Mrs Stockman advised that there was general agreement with the Guiding Principles. Specific points related in particular to Carers who formed and integral part of our services. Mrs Stockman advised that this would be formally acknowledged within the revised New Directions document. There was absolute support for the Trust to address health inequalities and to use its resources in a targeted manner to achieve this goal. Mrs Stockman re-affirmed the Trusts commitment to partnerships in promoting better health outcomes and addressing inequalities. In relation to Community Health and Social Care Services there was general acceptance of the Trusts principle to localise where possible and centralise where necessary. The respondents wished to see the range of services in the Wellbeing and Treatment Centres expanded. Where do I go if I am having a baby? There was general agreement with the principles. The challenge presented to the Trust was to ensure that women continue to have the right to choose how and where to give birth. Ms Stockman advised that there was no significant opposition to the Trusts favoured model of care but she stated that the key proposal for change, the creation of a single inpatient obstetric unit will be the subject of separate and ongoing consultation and engagement with stakeholders. A number of responses highlighted the need for investment in the new Womens and Childrens Hospitals. Where do I go if I need to access services for children? Ms Stockman advised that there was general agreement with the principles and no opposition to the model of care. A number of responses suggested that consideration should be given to explicitly stating the Trusts responsibility regarding child welfare, safeguarding and child protection. The Trust was asked to put in place robust arrangements to ensure that the transition from child to adult service provision was appropriate to meet the needs of the individual child or adolescent. Where do I go if I need support or care because of my physical or sensory disability? Ms Stockman advised that there was general agreement with the principles and no opposition to the model of care. The role of carers was emphasised. The transfer of neurology services from Forster Green to Musgrave Park Hospital was generally supported but a number of comments were received relating to operational issues in the delivery of neurological rehabilitation services. These highlighted respite care, the importance of neuropalliative care and the delay in transferring services from Forster Green to Musgrave Park Hospital. 4

5 Where do I go if I need support because I have a learning disability? Ms Stockman stated that there was general agreement with the principles and no opposition to the model of care. Concern was expressed at the delay and lack of funding in progressing the resettlement of patients from Muckamore Abbey Hospital. Where do I go if I am an adult and need Mental Health Services or I have an acute Mental Health Illness? Ms Stockman advised the Board that there was general agreement with the principles but the Trust recognises from the responses that more detail is required in relation to the model of care. The aim of the New Directions document was to present an initial direction of travel. It would not have been possible to address each individual service provided by the Trust. Mrs Stockman advised that the Trust was committed to engaging further on each key proposal for change. Where do I go if I need support because I am an older person? Ms Stockman reported to the Board that while there was general agreement to the principles outlined for older persons services, concern was raised that the principles applied to older peoples services could be interpreted as being prejudicial. The Trust should reflect in New Directions that older people should have equity of access to all services provided by the Trust. In relation to acute hospital care only being accessed for assessed need, Mrs Stockman emphasised that no one will be denied access to acute care where their illness requires this care. Main themes from Responses Ms Stockman outlined the main themes from the responses. These related to concerns about efficiency savings, the need for mention of regional services, more detail on specific services and conditions and carers. Several comments indicated that re-organisation of services must not be based solely on financial pressures but must be clinically led and evidence based. Throughout the consultation process it was highlighted that the Trust needed to encompass the totality of the patient/client pathway, including the importance of respite care. A significant theme emerging from the Consultation written responses and in discussion was the importance of tackling heath and social care inequalities. In particular the core purpose of the Trust to improve health and well-being and to reduce inequalities in health found resonance with the Partnership Boards across Belfast. Next Steps Ms Stockman finally outlined the next steps with regards to the New Directions document. These were: a commitment to ongoing engagement with service users, carers, staff and public a specific consultation process on mental health and unscheduled care, learning disability services and services to older people the sharing of the responses with existing planning groups within the Trust a revised New Directions document a commitment to regular review of strategic direction and a commitment to working with communities in particular on health inequality issues Mr McCartan thanked Ms Stockman for her presentation. 5

6 Prof Evason congratulated the staff on their efforts. She felt however that the Trust was not being ambitious enough in relation to the services provided in the new Wellbeing and Treatment Centres. She asked to see a presentation of proposals on their future use. Ms Stockman advised that cross programme work was being undertaken and she would report back to the Board. Mr Hartley discussed the need to get across to the public the key public health messages, on how healthcare was changing. We needed to get the public on board. Mr McKee re-emphasised the Trusts commitment to engage with users, staff and the public. Mr Hartley and Mrs Curly discussed the importance of communication in relation to the key messages. Mr O Kane supported the importance of a communication strategy going forward. He felt that people had consultation fatigue and the Trust needed to be smarter in engaging the public in health and social care changes. Mr McCaughey felt that this would be an ongoing challenge for the Trust. Decision: The Board approved the response to the Consultation document and the way forward in relation to the New Directions document. TB Report of the Director of Human Resources Strategic Response to the Comprehensive Spending Review Section 75 and Schedule 9 The Northern Ireland Act 1998 An Equality Impact Assessment Mrs Peden, Co-Director, Workforce Governance, Employment, Equality and Improving Working Lives presented the report in ordinary text. Mrs Peden set the strategic context for this consultation document, in the Trusts MORE Programme and the Equality Legislative Framework. She described the overarching Equality Impact Assessment which was linked to the reduction in funding of 9% over the three year period for the Trust. She emphasised the Trusts statutory obligation to promote equality of opportunity. Mrs Peden described the purpose of the overarching EQIA to set out: The regional and local context to the Comprehensive Spending Review The Trusts approach and proposals to meet the Comprehensive Spending Review proposals to date To outline the consideration of data available and measures to mitigate potential adverse impacts To engage with stakeholders and provide a mechanism for feedback on the proposals and the Equality outcomes to date The Consultation document would be issued from 28 November to 16 January 2009 and comments were invited on the screening outcomes, any additional relevant evidence or information, potential adverse impacts, mitigating measures and seeking views on Human Rights. 6

7 Prof Evason congratulated the staff and emphasised the importance to the Trust in getting this consultation right. She emphasised the role of the Equality Commission. Mrs Peden outlined the tight timescale and the next priority to prepare the EQIA in relation to unscheduled care proposals and Mental Health proposals for change. Mr Hartley emphasised the importance of connecting the document to the issue of health inequalities in areas within the Belfast Trust. He sought reassurance that the proposals would not have an adverse impact upon services. Mr McKee advised that this was a response to the budget agreed by the Assembly. The Trust was required to make a 9% efficiency saving over the three year period and this excluded issues of capitation and underlying deficits. This document was intended to evidence the Trust intentions not to adversely impact upon sections of our society. Decision: The Board approved for Consultation the Trust Strategic Response to the Comprehensive Spending Review Section 75 and Schedule 9 The Northern Ireland Act 1998 An Equality Impact Assessment. TB Report of Chief Operating Officer Performance Report Mr McCaughey presented the Performance Report for October He summarised the key sections of the Report, in relation to key performance indicators, quality and safety and service and budget agreements. Target 1 - Elective Access Mr McCaughey advised that the Trust was still struggling to meet the 13 week target for outpatients. The vast majority of those waiting longer were due to a lack of capacity in a small number of specialities which have staffing shortfalls paediatric orthopaedics, paediatric cardiology, paediatric neurology, community paediatrics and genetic cardiology. The Trust had continued to make progress however towards reducing the waiting time to nine weeks by March Target 3 - Cancer Targets Mr McCaughey advised that the Trust was marginally below target levels. The two specialities with the biggest challenge in maintaining the 98% (31 day) target and moving towards the 95% (62 day) target are urology and gynaecology. Both these areas have ongoing capacity short fall issues. Target 4-95% of patients who attended A&E should be either treated and discharged home or admitted within four hours of their arrival. Mr McCaughey advised that overall the Trust was doing well against the 12 hour target but it will be challenging to achieve the four hour target. Bids have been made to Commissioners for funding for additional observation beds. There was a pressure on the Mater Accident and Emergency because of the changing pattern of Accident and Emergency services in Whiteabbey Hospital. This has not been fully resourced by the Northern Board. Mr McCaughey advised of the continued review of systems, processes, length of stays and day case rates. 7

8 Target 8 - By March 2009, the number of Children in Care should be reduced by 3% (against a baseline of 604 in March 2008). Mr McCaughey explained to the Board the concerns in relation to this target. A 3% reduction would set a target of 570 children in care. He emphasised that the Trust would do the right thing for children irrespective of this target. Targets 14 To reduce absence levels by 10% by March 2009 (Compared to 2007/08). The Trust target for 2008/09 is 5.18%. Mr McCaughey advised that the Trust was seeing an improvement across all workforce groups with the exception of the medicine workforce. Target 16 & 17 Organisational and Workforce Development Mr McCaughey advised that movement towards these targets had been extremely challenging. This has to be viewed in the context of the high number of specialist areas in the Belfast Trust. Target 16 Hospital Productivity The 3% hospital productivity target is calculated as hospital weighted activity per head of staff. Assuming the Trust maintains its first quarter performance in respect of activity gain and staff change for the remainder of the year, Belfast should be on target to achieve a 3% improvement from 2007/08. Quality & Safety MRSA Bacteraemia / MSSA BACTERAEMIA / C Difficile Rates (to October 2008). Dr Stevens advised of the reduction in MRSA rates and ongoing work between the Trust and the Department. It was more difficult to achieve reductions in the MSSA Bacteraemia. The figures indicate that C Difficile isolates are in control but remain above the target of not more than 22 cases per month. During July, a significant increase was reported but the Trust had responded quickly to identify the outbreak and get control of it. Since then the rates each month have decreased. Ventilator Acquired Pneumonia Dr Stevens advised of the progress towards decreased levels of ventilator acquired pneumonia rates. This measure is at present in effect only in the Mater and the Royal Hospital site however a process to roll this out across the Trust has been initiated. Central line infection Royal Hospital/Mater Hospital Dr Stevens advised of the overall improvement in this area and the work of Trust staff to achieve a consistent reduction. Mr McCaughey concluded his performance report with reference to the Service and Budget Agreement Performance, Priority for Action supplementary targets and progress on the Management Plan, corporate objectives. 8

9 Mr Drew drew the attention of the Board to the number of days lost through absenteeism. Mrs Galbraith in response outlined the key issue of cover arrangements and back-filling of posts which had to be strictly managed. She described the establishment of the nurse bank and the essential feedback to managers. Prof Evason drew the attention of the Board to Target 8, to reduce the number of children in care by 3% by March She asked to put on record her view that the Trust Board should not approve of this target. The number of children in care would be determined by professional staff. It was agreed that the Trust would meet with the Department to review the value of this target which was not acceptable to the Board of the Belfast Trust. Mr O Kane referring to specific patient safety targets asked that a timetable be established for their roll out beyond the Royal and the Mater Hospital to all hospitals within the Trust. Dr Stevens advised the Board that he would be presenting a paper to the Assurance Committee describing the roll out of the patient safety initiatives. Mr O Kane, addressing the performance report referred to the number of emergency re-admissions to the Belfast Trust Acute Hospitals noted these were nearing the control limits. He asked about the resource implications of this. Mr O Kane also highlighted the presentation of information on the Service and Budgetary Agreement in relation to Trauma and Orthropaedic Elective Inpatients. Mr McCaughey reassured the Board members that the readmission rates were kept under review and reviewed with the control limits and a pattern or natural variations. With regards to the Service and Budgetary Agreement he clarified that Trauma and Othropaedics was subject to regional change and the level of activity expected by Commissioners was still being negotiated. Decision: The Board approved the Performance Report for October TB Report of Director of Social Work Mr Worthington, Co-Director Family and Child Care presented the report of the Director of Social Work Death of Baby P Mr Worthington detailed the Child Protection arrangements within the Belfast Trust and sought to reassure the Board following the events in Haringey, after the death of Baby P. He set the context for the integrated structures in Northern Ireland and the benefits this offered in terms of overall communication between professional staff and agencies. He re-affirmed the well established structures of supervision within the Belfast Trust and the progress in the development of caseload weighting. As overall manager reporting to the Director of Social Work, he had the ability to move and transfer social work staff between teams if vacancies or deficits became evident. Staffing levels were kept constantly under review. There was an open culture of reporting within Belfast, the staff side representatives were very active in this regard and serious case reviews were chaired by an independent person appointed by the Boards or Department. 9

10 Mr Worthington reassured the Trust Board that there were clear supervision policies and joint protocols with the Police Service of Northern Ireland. He described the progress within the Belfast Trust in establishing the gateway service and the strong training programmes for staff. He re-affirmed that Miss McNally would be raising with the Department, the target for a reduction of children in care. McIlhill Review In relation to recent press coverage of the tragic McIIhill family deaths, Mr Worthington advised that the Belfast Trust did not use social work assistants in initial childcare assessment work but only qualified staff. He advised also that outof-hours staff had full access to data bases held by the Trust. Mr Worthington stated that he recognised the need to re-emphasis to staff the importance of whistleblowing. Prof Evason thanked Mr Worthington for his report which she found very helpful. Mr Jenkins reminded the Board of their Corporate Parenting responsibilities. Mr O Kane emphasised the importance of public confidence in the Trust and good communication with the public. Mr Worthington advised the Board of the re-launch of the Trust Child Protection Panel pending the establishment of the new Safeguarding Board. Child Protection Panel Report 2007/08 Mr Worthington presented the Child Protection Panel Report for 2007/08. He described the roles and responsibilities of the panel, the meetings held during 2007/08 and the future direction. The establishment of a Safeguarding Panel will be a statutory responsibility for all agencies. Decision: The Child Protection Panel Report was approved. Adoption Service Annual Report 2007/08 Mr Worthington presented the Annual Adoption Report 2007/08. He highlighted the three parts of the Adoption Service for Belfast domestic adoption, inter-country adoption and post-adoption work. He drew the attention of the Board to activity levels and staffing issues. He advised of the strong drive by the Department of Health, Social Services and Public Safety for adoption services to be delivered on a regional basis. The Trust had expressed an interest in this. Mr Worthington also drew attention to the new adoption legislation. Mrs Allen described the Adoption Service as a positive way of meeting targets and expressed the view that there should be formal discussions with the judiciary where policy changes related to contact between adopted children and natural parents were being considered. Decision: The Adoption Annual Repor 2007/08t was approved by the Board. TB 71/08 Report of Director of Finance Mrs Galbraith presented the Finance Report for the period ending 30 September

11 Financial Position as at 30 September 2008 Mrs Galbraith advised the Board that she had reviewed all of the income and expenditure assumptions made in the Trust Delivery Plan. The Trust was reporting a deficit of 13.5 million at the end of September comprising an income deficit of 17.1 million, a pay underspend of 5.8 million and a gross overspend of 2.2 million. The Trust had incurred a substantial increase in its goods and services costs this year. The was in part attributable to rising energy costs but also a significant increase in water and waste charges as well as inflationary drugs pressures. Mrs Galbraith reported good progress towards the Trusts workforce efficiency savings with a 5.8 million salaries and wages underspend. Progress within the MORE framework should enable the Trust to deliver its projected outturn of 15 million or below. Forecast Position for the Year Mrs Galbraith advised that in order to ensure the achievement of the 15 million projected deficit the Trust had initiated a series of internal measures including a comprehensive review of discretionary spend which should address any shortfall against planned savings to date. Service groups are seeking to bring forward modernisation schemes that were planned for late 2008/09 or 2009/10 in order to compensate for the delay in original schemes. Mrs Galbraith advised that areas being explored by the Trust related to recurring care management funding from the Eastern Health and Social Services Board, retaining slippage on developments to effect pressures in related areas, securing additional energy cost pressures and negotiating bridging from the Eastern Health and Social Services Board in relation to future efficiency savings in the acute sector. Outstanding Financial Risks Mrs Galbraith advised that the major outstanding financial risk related to access targets which were deemed to be a regional capacity issue out with the Trusts control. The Trust was engaging with Commissioners in this area. Mrs Galbraith reaffirmed the Trusts statutory requirement to break even. Mr O Kane referred to Table 3 in the Financial Report and the need to reallocate budgets between service groups. Mrs Galbraith in response recognised the need for adjustments which would be reflected in the 2009/10 report format but advised the Board that the service groups were very clear about their MORE targets. Prof Evason made reference to the collapse in the housing market and sought reassurance about the implications for older people selling houses to move into residential care. Decision: The Financial Report for 30 September 2008 was noted by the Board. 11

12 Charitable Trust Funds Annual Accounts Year ended 31 March 2008 and Charitable Trust Funds Trustees Report Mr Drew presented the Charitable Trust Funds Annual Accounts. They had been audited by KPMG who had given a clean bill of health. Mr Drew advised that the Belfast Trust was the Board of Trustees of the Charitable Funds but had delegated to the Charitable Funds Committee the day to day management of the funds. Mr Drew advised that for the year ending 31 March 2008, the net income was 532k. Decision: The Charitable Trust Funds accounts were approved by the Board. TB 72/08 Board Approvals Director or Planning and Redevelopment Cardiac Surgery Instrumentation Ms Stockman presented the business case for Cardiac Surgery Instrumentation. She detailed the plans to relocate the Cardiac Surgical Unit to Phase 2B in 2012 within the Royal site. She outlined the imperatives for this decontamination service to ensure compliance with current legislation, standards and guidance associated with Medical Devices Directives and HSS (MD) 4/01. The total cost was 790,000. The business case was being forwarded to the Department for approval of funding. Decision: The Board approved the Business Case for Cardiac Surgery Instrumentation. Disposal of 23 Alexander Gardens, Belfast Ms Stockman presented a paper on the disposal of 23 Alexander Gardens for approval. She outlined the history of the building and its current condition. She advised that the Trust had no further use for this building. She advised that the Northern Ireland Hospice wished to redevelop its facility on the Somerton Road and would be interested in expanding into the space occupied by 23 Alexander Gardens. Ms Stockman recommended the disposal of 23 Alexander Gardens, Belfast. Decision: The Board approved the disposal of 23 Alexander Gardens, Belfast. Director of Specialist Services Transcatheter Aortic Valve Implantation Mrs Welsh presented a paper seeking approval for funding of Transcatheter Aortic Valve Implantation from Charitable Trust Funds. This request was for approval to use charitable funds to extend a research study. Mrs Welsh confirmed the research governance and procurement arrangements. The researchers had sought the use of charitable funds from the Regional Medical Cardiology Committee (RMCC). The funding requested amounted to 233K. The Trusts Charitable Funds Committee had approved the use of 233K to extend the study and this was now being recommended to the Trust Board for approval. 12

13 Mrs Welsh advised that a regional group was examining further funding for this through conventional means. The Trust would be looking at clinical outcomes and was in discussion with Commissioners. Dr Stevens advised that this was cutting edge research but must be viewed in the context of a research study. Mr O Kane supported the proposal, as a good example of the strategic use of charitable funds which if successful could be an opportunity for peer review research applications. Decision: The Board approved the use of Trust Charitable Funds for Transcatheter Aortic Valve Implantation. Director of Finance Mrs Galbraith presented the PACS Software Licence Agreement for the Cancer Centre for approval. This had to be drawn up by one of the legacy Trusts but required Belfast Trust Board approval. Decision: The Board approved the PACS licensing agreement. TB 73/08 Any Other Business The Corporate Management Plan and the Belfast Way were tabled as published documents. TB Date of Next Meeting The next meeting will take place in the Boardroom, Trust Headquarters on 18 December 2008 at 10.00am 13