TB Minutes of the Previous Meeting The minutes of the Trust Board Meeting held on 10 December were read and approved.

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1 Minutes of the 19 th Trust Board Meeting held on 21 st January 2010 at 10.00am, in Room One, Central Dining Hall, Knockbracken Healthcare Park Present: Mr P McCartan Mr W McKee Professor E Evason Ms J Allen Mr T Hartley Mr C Jenkins Mr L Drew Mr J O Kane Mrs W Galbraith Ms B Creaney Dr T Stevens In Attendance: Apologies Mrs M Mallon Ms D Stockman Ms C McNicholl Mrs J Welsh Mr B Barry Mrs D Curley Mrs J Champion Mr J Growcott Dr V McGarrell Miss B McNally Mrs P Donnelly Chair Chief Executive Deputy Chief Executive/Director of Finance Director of Nursing and Patient Experience Medical Director Director of Human Resources Director of Planning & Redevelopment Director of Performance & Service Delivery (Acting) Director of Specialist Services Acting Director of Older People, Medicine and Surgery, T&O Head of Communications Head of Office of Chief Executive (Acting) Co-Director Social Work/Social Care Governance Director of Social Work Director of Clinical Services Mr McCartan welcomed everyone to the meeting and offered his compliments for the season and stated he was looking forward to a productive year. He also welcomed Miss Brenda Creaney who was attending her first meeting in her new role as Director of Nursing and Patient Experience. TB Minutes of the Previous Meeting The minutes of the Trust Board Meeting held on 10 December were read and approved. TB Matters Arising There were no matters arising. TB Chairman s Business a. Trust Board Dates 2010/11 Mr McCartan tabled the proposed Trust Board Dates for 2010/11. He advised that it had been proposed to move the Trust Board meetings to the fourth Thursday of the month to fall in line with both performance and financial reporting periods. He requested feedback from Non Executive Directors as to any potential conflicts with busy diaries. 1

2 b. Director of Performance and Service Delivery Mr McCartan offered congratulations to Ms Catherine McNicholl following her recent appointment as Director of Performance and Service Delivery. c. Diary Commitments Mr McCartan detailed his diary commitments since the last meeting. He advised that the Annual Chairman s Award Ceremony was to be held on the 28 th January 2010 at Knockbracken Hall, Knockbracken Health Care Park. Mr McCartan was pleased to note that 40 schemes had been submitted this year and that they were of a high quality. He reported that the Awards panel which included external representatives had had a difficult task in deciding which of the schemes to shortlist. TB Report of the Chief Executive Mr McKee presented the report of the Chief Executive. a. Pandemic Flu Preparedness Update Dr Tony Stevens, Medical Director, presented a real time verbal report on the Pandemic Flu situation. Dr Stevens reported that the peak of the pandemic flu had been in October/November and that there was no further evidence at this time of a further surge. He advised that regionally we were below the threshold level for both pandemic and seasonal flu. He further advised that it was unlikely that it would surge again within this winter period. Dr Stevens advised that the Vaccination Programme was ongoing and that over 4,000 staff had been vaccinated. He highlighted that the Programme had been a highly successful Trust endeavour. Dr Stevens reported that the Emergency Planning team would commence a debriefing exercise to ensure that any lessons from this Pandemic are identified. Mr McKee confirmed that there would be no further report to Trust Board unless circumstances changed. He took the opportunity to pay tribute and thank all staff for their hard work during the period. b. Acute Service Pressures Mrs Jennifer Welsh, Operational Director of Acute Services, presented a verbal report on acute service pressures. Mrs Welsh reported that service pressures had been extreme over the past number of weeks, with particular pressure on the Accident and Emergency Departments on the RVH and BCH sites and hence on patient flow through the system. She advised that additional pressure had been created as currently there were 2 wards closed due to an outbreak of norovirus. Mrs Welsh confirmed that Directors and Co Directors were undertaking daily walkrounds to ensure optimum patient flow and that the Trust were also working in close partnership with the NI Ambulance Service (NIAS). 2

3 Ms McNicholl, Director of Performance and Service Delivery, presented a verbal report on the impact of winter pressures on elective access performance. Ms McNicholl advised that during the previous 3 week period as a result of extreme winter conditions that the number of patients attending with fractures had doubled compared to the same period in the previous year. She further advised that the pressures had highlighted systems and process delays and blockages that will have to be addressed. Professor Evason commented that staff have performed very well and queried how the Trust was tackling the issue of people attending Accident and Emergency Departments who should have been seen by GPs. Mrs Welsh confirmed that the Trust was working with Local Commissioning Groups and with the HSC Board in relation to this issue. Mrs Welsh confirmed for Mr Hartley that the Trust had to be flexible in times of pressure and that the further development of the use of swing wards was a key action point. Mr McKee advised that the Trust would focus on 4/5 key action points over the next 2 months to ensure that we modernise our processes internally and that externally the Trust would be reviewing the wider systems relationships with other Trusts, the NIAS and Primary Care. Mr McCartan requested ongoing reports to the Trust Board in relation to progress against the key action points. Decision: The Board accepted the Report of the Chief Executive. TB Report of the Deputy Chief Executive/Director of Finance Mrs Galbraith presented the Report of the Deputy Chief Executive/Director of Finance for the period ended 30 November a. Finance Report Mrs Galbraith recapped on the previous reported financial position. She confirmed that the Trust had received a formal response from the DHSSPS in relation to its contingency plan on 27 October and that on the basis of the recommendations approved within that response, a review of expenditure positions and release of superannuation funding held within the Trust, the Trust revised its financial position to a projected deficit of 14m. Mrs Galbraith advised that the Trust had again provided a number of options which would have enabled the Trust to breakeven albeit these would have inevitably impacted on service provision and were deemed unacceptable by the Department. Mrs Galbraith reported that the Permanent Secretary acknowledged in a letter to the Trust in December that the Trust would not be able to achieve financial balance without further assistance from the Department. As a result, it was agreed that a non-recurrent allocation of 12m will be made to the Trust. Mrs Galbraith confirmed that the Trust will be expected to address the remaining 2m through further contingency measures. 3

4 Mrs Galbraith advised that a number of the HWIP developments have been delayed this year and the Trust will use the slippage on these to contribute to the outstanding deficit. She further advised that the Trust would also release its outstanding RPA provision of circa 0.4m as part of its contingency process. Mrs Galbraith confirmed taking into account the aforementioned non-recurrent funding of 12m to the Trust at the end of the year and providing the Trust generated additional savings of around 0.8m, the financial balance should be achievable by 31 March She highlighted that this would mean significant challenges for the organisation and that the Trust would have to address discretionary spend, reduction in payroll and on backfill. Mrs Galbraith also advised the Board that the Trust had incurred substantial costs in relation to the achievement of the Ministerial targets and that in order to meet the original 9 and 13 week targets for elective outpatients and inpatient/day cases in 2009/10 the Trust would have required approximately 10m more funding than the HSCB allocation. She highlighted that even with financial assistance some of the targets would not have been achievable given capacity issues within the Trust and in some case in the independent sector. She reported that as a result of a number of meetings with the HSCB a series of new maximum waiting times have been agreed, tailored by specialty depending on resource, capacity and priority. She advised that the revised waiting times are believed to be achievable within the financial resources available to the Trust. Mrs Galbraith reported that the Trust was attempting to maximise the use of additional in-house measures but that it was also currently tendering for independent providers to help facilitate residual capacity shortfalls. She emphasised that performance would be stringently reviewed on a regular basis to ensure that the revised maximum waiting times are achieved. In relation to the projected deficit of 12m for the year ending 31 March 2010 Mr Jenkins suggested that should the Trust not have been prevented from implementing its proposals regarding, by way of example, Windsor House, Belfast City Hospital A&E, 150 beds and Victoria Day Centre, then the Trust would have achieved a break-even situation and the subvention of 12m from the DHSSPS would not have been required. He stated that it was important that this be noted in the light of any future claim that the Trust had failed to achieve its required break-even position when in fact it could have but for the intervention of the Minister/DHSSPS. Mr O Kane commented on the need for the provision of high quality and timely financial and performance information. Mrs Galbraith advised that the Trust was currently working with systems that are 20 years old that could not provide real time data and that there had been for some time an expectance of the development of new regional financial systems. She advised that, as had already been highlighted by Mr McCartan, there was a proposal to revise the Trust Board meeting schedule for 2010/11 to allow for more timely reporting on financial and performance matters. Mr McKee confirmed that there would be a focus on modernisation and reform not just over the next 100 days to 31 March but for 2010/11. He advised that this matter would be a key agenda item for discussion at the February Trust Board Workshop. 4

5 Mr McCartan advised that the Trust received a letter from the Permanent Secretary which had been responded to by the Chief Executive and that he had attended a meeting with the Permanent Secretary at the DHSSPSNI. He reported that he had assured the Permanent Secretary that the Trust would do everything within its power to meet financial and performance targets. Decision: The Board noted the report of the Deputy Chief Executive/ Director of Finance TB Report of Director of Older People s Services (Acting) a. Excellence and Choice - Consultation on the Future Use of Shankill House, Elderly Persons Home (EPH). Mr Barry, Director of Older People s Services (Acting) presented the Excellence and Choice document entitled Consultation on Future Use of Shankill House, EPH. Mr Barry set the context for the proposal and advised that Shankill House was a 40 bedded residential facility that was approximately 30 years old. He reported that the staff offered excellent care however there was need to move to a new model of care. He advised that the paper discusses the background and reasons for seeking Trust Board approval to proceed to public consultation on the closure of Shankill House, EPH. He further advised that this proposal is a further stage in the implementation of the Department, Regional Authority and the Trust strategy to reshape services for older people, which seek to maintain older people in their owns homes supported by a network of care services that enable them to maintain their quality of life. Mr Barry confirmed that it is recognised that within the Trust the need for specials dementia services, including housing and support will continue to grow and the Trust wishes to plan and develop alternative models of care and support. In consideration of the closure of Shankill House this will enable the Trust to free up resources to fund a new model of care. Mr Barry confirmed for Mr Hartley that all the residents were currently suitable for transfer to the new facility. Professor Evason offered her support for the move to new model of care and welcomed the proposal. Mr Barry advised that subject to Trust Board agreement the Trust would proceed to initiate a 3 month public consultation on the closure of Shankill House. It is proposed the consultation period would commence on 28 January Equality Impact Assessment on Consultation on Future Use of Shankill House, EPH. Mrs Mallon, Director of Human Resources, presented the Equality Impact Assessment on the Consultation on Future Use of Shankill House, EPH. She advised that the Trust had undertaken an Equality Impact Assessment in accordance with its Statutory Duties under Schedule 9 and Section 75 of the Northern Ireland Act Mrs Mallon outlined the process of the Equality Impact Assessment. She advised that the purpose of the Assessment was to engage with internal and external stakeholders on the proposed closure of Shankill House and move to the provision of supported housing in partnership with Helm Housing. She confirmed that the Trust in its consultation document Excellence and Choice in Older People s Services, provided an assurance that anyone currently living in a residential home will not be asked to leave and no change will be made without their consent. 5

6 Given that assurance the Trust would advocate that any potential adverse impact on the ground of Section 75 would be either completely removed or significantly minimised for the current residents of Shankill House. Mrs Mallon reported that the current population of the home is 100% white, 100% Protestant, which is largely in line with the catchment area and locality the home has traditionally served. All residents are over 65 and have no dependent children and all would be deemed to have a disability. Mrs Mallon advised that the Trust considered the closure of Shankill House and move to supported housing could potentially positively impact on the current residents. She confirmed that each individual resident will be involved and his or her wishes upheld and respected in regard to the proposal. Mrs Mallon advised that in relation to staff, it is anticipated that the care staff will be given the opportunity to work within a range of older people s services providing both domiciliary care within the proposed supporting people development in the Shankill area and catering and domestic staff will be redeployed within the local area, where possible, within the Trust. Decision: The Board approved for consultation the Excellence and Choice Document entitled Consultation on Future Use of Shankill House, EPH. TB Report of Director of Performance and Service Delivery Ms McNicholl presented the report of the Director of Performance and Service Delivery for the end of November Ms McNicholl reported that the Trust was achieving, on target to achieve or marginally behind target in relation to 25 of the reported performance areas. a. Key Target Areas Ms McNicholl advised that six of the performance areas had not achieved or were unlikely to achieve targets by March These include; Elective Access target, Fracture 48 hour target, Accident and Emergency 4 hour target, Learning Disability (100% Discharges within 90 days) target and MSSA target. b. Elective Access Ms McNicholl informed the Board that following the meetings with the HSCB and clarification on additional elective access target funding that will be made available to the Trust, the HSCB and Trust have agreed maximum waiting time backstop by March 2010, for a number of specialties which were detailed in the Report. She confirmed that all other specialties would be subject to the 9/13 week standard. Ms McNicholl advised that the HSCB had acknowledged that, for some specialties, there are factors contributing to breaches which the Trust cannot immediately or easily resolve, for example staff shortage and significant recurrent funding issues. Ms McNicholl reported that in relation to Allied Health Professional (AHP) Services that the majority of breaches had occurred within Occupational Therapy (OT) due to capacity shortfall issues. 6

7 She advised that the Trust had appointed a number of additional staff to enable the delivery of the 9 week target by March 2010, with the exception of OT. She further advised that the HSCB have agreed a revised maximum waiting time of 13 weeks for OT. c. Fractures Ms McNicholl reported that performance in meeting the fractures target which had been above 75% for the preceding 2 months had dropped to 70% in November. She advised that the likely position for December would be 72%. She confirmed that the Trust was continuing to stress to the HSCB that there was inadequate capacity to deal with peaks in demand and the provision of specialist surgery within 48 hours at the RVH as some specialist lists are only weekly at present. Ms McNicholl advised that as had been previously highlighted there was a huge increase in numbers of fracture patients in the preceding 3 week period as a result largely of the extreme cold spell with 55 patients waiting for surgery. She reported that it was hoped that by the forthcoming weekend that that backlog would be cleared. d. Cancer Ms McNicholl advised that the main limiting factor in achieving the 31 and 62 day targets remains the lack of capacity within Urology with 60% of the patients breaching the standards in November being Urology patients. She advised that the performance in relation to the 62 day target also dipping in November was mainly due to an overall increase in the number of Urology patients waiting over 62 days. Preliminary indications for December indicate performance improvement. Ms McNicholl reported that it was important to note and recognise the strong and sustained performance in this area to date. e. Accident & Emergency Mrs McNicholl advised that in relation to A & E targets the majority of delays in excess of 4 hours continue to relate to patients requiring admission. She confirmed that there was still a strong focus on improving patient pathways through the hospital to reduce length of stay and free up beds to facilitate faster admission from A & E. f. Complaints Ms McNicholl reported that during April to June 2009 a total of 322 complaints were received, 50% were responded to within 20 working days and 83% were responded to within 30 working days. During July to September 2009, 361 complaints were received, 50% were responded to in 20 working days and 90% within 30 working days. In relation to absenteeism, Mrs McNicholl advised that the Trust had experienced a small rise from the previous reported position; from 5.60% to 5.830% although the overall trend for the year to date remains downward as the position at the end of 2008/09. She confirmed that the recent rise was to be expected with a rise in flu like illnesses during winter months. 7

8 g. Quality and Safety Indicators Ms McNicholl was pleased to report the Trust s continuing improvement in performance in relation to Quality and Safety indicators and in particular the reduction in levels of Healthcare Acquired Infections. She highlighted the improving position for hand hygiene in relation to both compliance and participation. The Trust remains ahead of the cumulative C Difficile target and is in line with the cumulative target for MRSA. She reported that the HSCB had advised that the MSSA target is likely to be dropped in 2010/11. Ms McNicholl advised that Mortality rates and Re-Admission rates have remained within acceptable limits. Dr Stevens clarified for Mr Hartley that the change in rate for Mortality in January was related to seasonal flu and highlighted that it had returned to acceptable limits very quickly. Decision: The Board agreed to note the report of the Director of Performance and Service Delivery November TB Report of the Medical Director/Director of Human Resources Dr Stevens, Medical Director and Mrs Mallon, Director of Human Resources presented for approval Procedures for processing consultants job planning appeal recommendations within the Belfast health and Social Care Trust. Mrs Mallon set the context and advised that job plan appeals for consultants are undertaken in accordance with Schedule 4 of the Consultant contract (NI) 2004 Terms and Conditions of Service. She further advised that such appeals are undertaken when there has been a failure to agree and implement a job plan for a consultant and that appeal panels are only heard after a facilitation process. She confirmed for Mr McCartan that no disputed element of the job plan would be implemented until confirmed by the outcome of the appeal process. Mrs Mallon advised that as the current pattern of meeting of the Board of Directors would make it difficult to comply with the terms and conditions it was proposed to delegate authority for the final decision making on appeal panel recommendations to a panel of Directors or their deputies. Decision: The Board agreed to delegate authority for processing consultant job plan appeals. TB Any Other Business There were no items raised. TB Date of Next Meeting The next meeting will be held on Thursday 25 th March 2010 at 10.00am in the Conference Room, Knockbreda Wellbeing and Treatment Centre. 8

Minutes of the Trust Board Meeting Held on 3 March 2016, 2016 at am in the Boardroom, Trust Headquarters Belfast City Hospital

PRESENT: Minutes of the Trust Board Meeting Held on 3 March 2016, 2016 at 10.00 am in the Boardroom, Trust Headquarters Belfast City Hospital Mr Peter McNaney Dr Michael McBride Mrs Miriam Karp, Dr Paddy