MINUTES OF THE TRUST BOARD MEETING HELD ON 2 APRIL 2014, 13:00 HRS BOARD ROOM, TRUST HEADQUARTERS, QUEEN S HOSPITAL

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1 Present Dr Maureen Dalziel Mr Matthew Hopkins Mr Stephen Burgess Mr Robert Cooper Mrs Dorothy Hosein Mr William Langley Mr Keith Mahoney Ms Flo Panel-Coates Prof Anthony Warrens Ms Caroline Wright MINUTES OF THE TRUST BOARD MEETING HELD ON 2 APRIL 2014, 13:00 HRS BOARD ROOM, TRUST HEADQUARTERS, QUEEN S HOSPITAL Chairman Chief Executive Interim Medical Director Interim Director of Finance Chief Operating Officer Non-executive Director Non-Executive Director Director of Nursing Non-executive Director Non-Executive Director In attendance Ms Mary Joseet Mr Steve Russell Mr Mark Smith Secretariat Ms Andrea Saville Director of Planning Improvement Director Director of People Development Head of Governance/ Trust Secretary Welcoming members of the public to the meeting, Dr Maureen Dalziel, Interim Chairman introduced Mr Matthew Hopkins, the Trust s new Chief Executive. 2014/43 APOLOGIES FOR ABSENCE Apologies for absence were received from Mrs Jackie Nugent, Director of Estates and Mr Steve Huddleston, Chief Information Officer. A quorum was confirmed. Ms Caroline Wright, Non-Executive Director apologised for her late arrival and joined the meeting at 13.15hrs. 2014/44 DECLARATIONS OF INTERESTS 44.1 The Chairman asked Board Members if there were any declarations of interest to be made relating to agenda items. Mr Hopkins declared that his wife is an Associate Director of North West London Commissioning Support Unit. 2014/45 MINUTES OF MEETING HELD ON 5 MARCH The minutes of the meeting held on 5 March 2014 were approved as a correct record and signed by the Chairman. 2014/46 MATTERS ARISING AND ACTION LOG 46.1 Members agreed that the following actions should be closed: 2014/31, 31.4 Acute reconfiguration Progress Report The acute reconfiguration programme team is aware of the Board s concern that information systems are considered when any changes are made in supporting the implementation of H4NEL and/or the Clinical Strategy and will build support systems into the detailed plans. 5

2 2014/36, 36.1 TRUST PERFORMANCE REPORT - Dementia Standards This item was included in the items for discussion. 2014/36, 36.1 TRUST PERFORMANCE REPORT 18 weeks pathway - This item was included in the items for discussion. 2014/36, 36.1 TRUST PERFORMANCE REPORT Metrics in Improvement Plan It was confirmed that the metrics by which improvements would be measured would be clearly identified for the Board. Itemised Matters Arising from the Minutes of 5 March MEDWAY PAS REPLACEMENT UPDATE Ms Joseet presented this report, which outlined the outstanding issues from the implementation of the new Patient Administration System and in addition, highlighted that there were emerging risks which had now been entered onto the Trust Risk Register. The Trust was still unable to report the Referral to Treatment Time (RTT) and the data required careful validation. The issues relating to Outpatient appointment letters and the impact on patients remained very concerning. Despite local resolution of the increase in telephone calls about appointments, the ongoing issues had caused a significant increase in referrals to the Patient Advice and Liaison Service. Mr Hopkins, Chief executive identified this matter as one for swift resolution. The Trust needed to: 1. ensure that the system was working the way it was expected to 2. resolve the operational issues arising from the change of system DECISION: It was agreed that the report next month needed to focus on the two issues outlined above: 1. The technical operation of the system and 2. The consequences of implementation Director of Planning DEMENTIA STANDARDS BREACH RECOVERY PLAN Presenting this report, Mr Stephen Burgess, Medical Director confirmed that a new proforma was now in use to document and report on the standards and the main issues relating to the change over to the new Patient Administration System had been resolved. There remained some compliance issues which were being addressed on a ward by ward basis. In answer to questions from the Chairman and Mr Langley, Non-Executive Director, Mr Burgess established: The Trust had been managing the reporting closely prior to December ensuring all data was entered. In December, during change over of systems the ability to capture data was temporarily lost. Staff were not able to use the new system unless they had completed the Information Governance training mandated by the Trust, resulting in a reduction in the numbers of people inputting data. The actions taken since included using additional staff to input. Achievement of the Dementia standards was a CQUIN and the Trust could 6

3 lose money for non-achievement although the year end income had been agreed by Commissioners. Delivery of the service and recording that it had been done was a clinical responsibility which would be followed up by the Medical Director. The Chief Executive assured the Board that, going forward, the delivery of quality and cost improvements underpinning the operational plan would be managed through a new Programme Board which would be chaired by himself. It would meet fortnightly initially and become monthly later in the year. Members noted the report. 2014/47 CHAIRMAN S REPORT 47.1 In addition to her report, the Chairman indicated that she wanted to rotate Board meetings between Queen s Hospital and King George Hospital and asked that, if a room was available, this could start in May In answer to a question from Ms Caroline Wright, Non-Executive Director, Ms Panel Coates, Director of Nursing confirmed that the options for how the Patient Safety Walkaround visits could be conducted would be brought back to the next meeting. ACTION: Present options for conduct of Patient Safety Walkaround visits for 2014/15 DoN 2014/48 CHIEF EXECUTIVE S REPORT 48.1 Mr Hopkins thanked everyone for the very warm welcome especially from the staff on one of the care of the elderly wards on his first day. He added his own commitment to ensuring Board meetings would be held at both hospital sites and confirmed he had agreed that executives would spend one day each week at King George Hospital. The visibility of the executive team was critical and, once established, he would determine whether one day a week was sufficient. Open staff meetings were being held the following day at King George Hospital and Queen s. 2014/49 DIRECTORATE REVENUE BUDGETS for 2014/ Tabling a corrected budget spreadsheet, Mr Cooper, Director of Finance introduced the 2014/15 draft budgets advising that, although the Trust had not yet completed the business planning process, the Board needed to set budgets for the year and submit a draft to the Trust Development Authority by Friday 4 April The draft budgets presented were based on 2013/14 outturn and included an outline cost improvement programme. Cost pressures for the year were highlighted and service developments were being considered although any developments would need to be funded from efficiencies elsewhere as the key message was that the Trust had no money to invest and needed to provide services within its current resources. Mr Cooper further advised that the budgets would be refined over the next six weeks and he would update the Board once they were finalised. Deloitte LLP was working with Directorate teams to further develop robust cost improvements which 7

4 would deliver sustainable change. Deloitte LLP was confident sufficient savings could be found to achieve a control total of 37.9m. In answer to questions from Mr Langley and Prof Warrens, Non-Executive Directors, Mr Cooper made the following points: Agreement with Commissioners in relation to 2014/15 contracts were almost complete. The arrangement was that there would be a collar and cap arrangement which means there is an upper and lower limit to income. This was pertinent to the issues still being resolved around Medway implementation and the Trust s ability to capture all the activity it was undertaking. The Trust would be constantly reviewing and refreshing cost improvements throughout the year and these will be presented to the Finance and Investment Committee. The Education/ R&D line represented income. Mr Hopkins, Chief Executive advised that, in addition to the one year operating plan and budget the Trust needed to develop a rolling two year plan which means, at this time of year, the process for developing quality and cost improvement plans for the following year would be commencing in June. DECISION: The Trust Board approved the Revenue Budgets for 2014/ /50 CQC AND SPECIAL MEASURES IMPROVEMENT PLAN 50.1 This report, presented by Ms Panel Coates, Director of Nursing was a brief update on the CQC compliance and special measures improvement plan. Members noted the progress and that the Trust Development Authority had commented on the second draft. The feedback had been positive and it was anticipated the Improvement Plan could be finalised with the Chief Executive s input. 2014/51 TRUST PERFORMANCE REPORT 51.1 Introducing the Integrated Performance Report, Ms Mary Joseet, Director of Planning highlighted the following: The Friends and Family test score for inpatients fell in February without apparent reason. The A&E 4 hour target trajectory set by the Trust Development Authority had been met although the 95% standard was not met. There had been no change in the reasons for the breaches. Performance fell below target for five of the six national measures for cancer services although the 62 day target should be achieved from April 2014 onwards. The Commissioners have agreed that the 2 week wait standard 8

5 will return to compliance in June The Trust remains unable to report the 18 week referral to treatment time position across all pathways due to issues highlighted with the implementation of the new Patient Administration System. Additional validation and tracking has now been active for 4 weeks. The Trust continues to work with the Trust Development Authority and the Commissioners to address the issues. The Intensive Support Team has also started work to assist in the development of the interim reporting solution. 30 day readmissions remain high in Emergency and Acute medicine. In answer to questions from Ms Caroline Wright, Non-Executive Director and Dr Maureen Dalziel, Chairman, Mrs Hosein, Chief Operating Officer, Mr Burgess, Medical Director and Ms Flo Panel Coates, Director of Nursing advised: The Trust had predicted the short term fall in meeting the 62 day cancer standard and it was anticipated to improve next month. Additional resource had been provided to meet the 18 week referral to treatment standard. An audit was underway to understand the reasons for the readmissions in Acute and Emergency Medicine. Areas identified as having a lower-than-expected Friends and Family score are being supported individually. Complaints have increased in the area of appointments and although additional resources have been sought, it has been a challenge to secure the right people. In the interim, the areas are supported by the Deputy Director of Nursing. There remains work to do to ensure outpatient appointment letters provide the correct information and explanations and are delivered in time for the patients to act on them. Mrs Elaine Clark had worked tirelessly in outpatients to help patients and her weekly reports to the Director of Nursing had proved invaluably. The Trust could now negotiate with complainants to flex the timescale for a final complaint response. Any negotiated extension often incorporated time for a face-to-face meeting between the Trust and the complainant. The SHMI is the most up-to-date and most reliable measure of hospital mortality Members of the Board discussed how the Integrated Performance report could be improved saying that it would be helpful if co-dependent or linked measures for example length of stay and bed occupancy could be grouped within the report. Mr Hopkins advised that the Improvement Plan provided an ideal opportunity to refresh some of the indicators and focus on high impact improvements and measuring progress. The Trust should be striving for excellence and aspire to be better than expected in national measures. Members noted the report. 9

6 51.2 Finance Report Summarising this report, Mr Cooper presented the month 11 overall position. The cumulative deficit forecast was 32.6 million. The forecast outturn remained unchanged from month 10 at 38.1 million as validated by Deloitte LLP. NHS England has now agreed to pay the High Cost Living Allowance received by staff so it is unlikely the predicted outturn figure will change. Mr Mahoney confirmed that he and the rest of the Finance and Investment Committee had repeatedly asked for the format of the Finance Report to change as well as the Performance Report. Areas of focus needed to be more prominent and demonstrate delivery or not. Mr Langley supported the development of the 2 year rolling programme in order that cost improvement proposals could be developed early to remedy the current practice of back-loading realisation of benefit until the end of each financial year. Mr Cooper undertook to review and revise the Finance Report over the coming months. Members noted the report. ACTION: Review and revise the Finance Report DoF 2014/52 SELF CERTIFICATION TO NHS TRUST DEVELOPMENT AUTHORITY COMPLIANCE STATEMENTS 52.1 This report was introduced by the Director of Planning. It is a monthly return to the Trust Development Authority stating where the Trust does not comply with the standards that would apply if it were established as a Foundation Trust. This Return represented the February position and would be submitted to the Trust Development Authority following agreement by the Board. Members agreed the report. 2014/53 COMMITTEE REPORTS Finance and Investment Committee (meeting 20 March 2014) The Committee Chairman had nothing to add to his report. Quality and Safety Committee (meeting 25 March 2014) The Committee Chairman had nothing to add to his report. Workforce Committee (meeting 2 April 2014) Mr Langley, Workforce Committee Chairman reported the majority of the meeting had focused around the employee / education elements of the Improvement Plan and concentrated on identifying robust measures to show progress of achievement and sustainability. Members noted the Committee reports 10

7 2014/54 USE OF THE TRUST SEAL 54.1 The Board noted the occasions on which the Trust Seal had been used since the last meeting. The full register was available at the meeting for inspection. 2014/55 QUESTIONS FROM THE PUBLIC Questions asked and answered at the meeting: 55.1 Questions from Mr John Skillman Q1. Much of the overspend was attributed to Agency staffing especially for hard-torecruit posts. Should the Trust make additional effort to recruit substantive staff? Mr Cooper responded Efforts are being made to recruit substantive staff and many are beginning to start work with the Trust over the next few months. Much of the deficit is the product of non-delivery of the cost improvement proposals for the year. Deloitte is helping the Trust ensure efficiency plans for 2014/15 are strong and deliverable Q2. In the performance report the Trust is stating there are 7.2 permanent consultants in A&E against an establishment of 21wte. Has the Trust improved on this measure at all this year? Mr Burgess responded There has been improvement in the number of consultants recruited. One who started in February has a background in A&E and a special interest in Paediatric A&E medicine and a second A&E consultant is due to commence in April. There is one further interview for a consultant this month and in addition, the middle grade doctors from India are beginning to begin work with the Trust. Three are starting this month and more will begin over the next six months Q3. The Trust has a staff shortage of 645 people. Is there any intention to recruit permanent staff? Mr Smith responded The Trust, at any one time can be actively recruiting to 580 vacancies to ensure that the vacancy rate is reduced. Mr Hopkins added that, from a quality and cost perspective, it is greatly preferable to have substantive staff who are properly inducted, trained and monitored. The Trust must not only fill vacancies but retain staff Q3. Is the Friends and Family score a measure of patient experience? Does this replace the hand held patient satisfaction questions available last year? Ms Panel Coates responded The Friends and Family score is a measure of patient experience and does replace the hand held patient satisfaction questions available last year. The Trust had the Kiosks removed as they were underused and the technology has changed. It is the Trust s intention to make better use of the technology available but more needs to be done to improve the availability of live feedback rather than retrospective feedback. The Trust needs to be in a position to take immediate remedial action based on feedback. 11

8 AGENDA ITEM 1.3 Questions from Andy Walker 55.5 Mr Hopkins asked if he could spend time with Mr Walker at the meeting tomorrow in order to fully understand the issues he raises. 2014/56 BOARD MEMBERS REGISTER OF INTERESTS 56.1 The Board noted the register of interests. 2014/57 ANY OTHER BUSINESS 57.1 The guidance on good governance in the NHS requires each NHS body to consider annually the appropriate definition of a senior manager for the purposes of disclosing their remuneration in the Remuneration Report (part of the Annual Report). The Board agreed that the remuneration of all members of the board (voting and non-voting members) should be disclosed in the 2013/14 Annual Report The Chairman and Chief Executive endorsed the view that half the Board meetings should be held at Kind George Hospital. This was agreed pending the availability of a suitable venue being found. Post Meeting Note: The date of the next meeting is 7 May 2014 at 1.00pm in Room 6, James Fawcett Education Centre, King George Hospital. The meeting closed at 14.40hrs. Signed Date... Chairman 8 12

9 Board Minute Ref No. / Action Date 2014/ Action PAS Implementation Recovery Plan Update It was agreed that the report next month needed to focus on the following two issues: The technical operation of the system and The consequences of implementation TRUST BOARD MATTERS ARISING FROM 2 APRIL 2014 MEETING Lead Target Closure Date DoP/ ID AGENDA ITEM CB1.5 Current Position On Agenda 7 May 2014 meeting Agenda item 4.3 Status Suggest close 2014/ Present options for conduct of Patient Safety Walkaround visits for 2014/15 DoN On Agenda 7 May 2014 meeting Agenda item 4.4 Suggest close 9 13

EAST SUSSEX HEALTHCARE NHS TRUST ANNUAL GENERAL MEETING

EAST SUSSEX HEALTHCARE NHS TRUST ANNUAL GENERAL MEETING The Annual General Meeting of will be held on Wednesday, 3 rd August 2016, commencing at 13:45 in the Ashdown Room, Uckfield Civic Centre AGENDA