Royal National Orthopaedic Hospital Trust. Minutes of the Trust Board Meeting. Held on Monday, 20 th December 2010

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1 Royal National Orthopaedic Hospital Trust Minutes of the Trust Board Meeting Held on Monday, 20 th December 2010 Present: Trust Board Members Mr G Billington Mr R Hurd Mr A Koray Mrs L Hill Mrs K Corder Mr L Milsted Mr A Watson Prof S Shorvon Prof A Flanagan Senior Non-Executive Director, Meeting Chair Chief Executive Director of Finance Director of Operations Deputy Director of Nursing/Clinical Governance Non-Executive Director Non-Executive Director Non-Executive Director Joint Medical Director In attendance: Mr M Masters Director of Projects, Estates & Facilities Dr S Patel Director of IM&T Mrs S Puckett Director of Service Transformation Dr B Jacobs Director of Children s Services Mr M Vaughan Director of Human Resources & Corporate Affairs Prof A Goldstone (RNOH Chairman Elect) Mr J Wilson (RNOH Director of Finance Elect) Ms E Cockshoot Minute Taker Apologies: Ms C Wiley Director of Nursing Prof D Marsh Director of R&D, Professor of Clinical Orthopaedics Prof T Briggs Joint Medical Director PART ONE (Open) 1. Apologies for Absence All apologies noted. 2. Minutes of the meeting held on the 25 th November 2010 The minutes of part one of the meeting held on Thursday, 25 th November 2010 were agreed as a correct and accurate record of the meeting. 3. Matters Arising The Board noted the matters arising. 4. Declarations of Interest Mr Billington asked those present whether they had any interests to declare with regards to the items on the agenda. No interests were declared. 5. Chairman s Report Mr Billington said he had no report to present. 1

2 6. Chief Executive s Report Mr Hurd gave his report dated December Key points included: Redevelopment Plans Mr Hurd advised that the NHS London Capital Investment Committee (CIC) had met on the 14 th December 2010 and approved the Trust s scheme progressing to the next stage; going out to market. A letter confirming their approval will be issued and it will explain that approval is subject to the procurement documentation being approved by the Department of Health s Private Finance Unit (PFU). The PFU have indicated that the core OJEU documentation requirements are ready for sign off. Mr Hurd said the Board had considered the optimum timing for placing the advert in the OJEU given the wider Foundation Trust Application. This was discussed at the Board Development session and it was agreed that the Trust would go out to the market in mid-january 2011 rather than in December 2010 as previously planned. He said the Trust had taken this decision so that going out to market would coincide with the submission of its Integrated Business Plan (IBP), an integral stage of the Foundation Trust application process. Mr Hurd said the Trust believed the availability of the IBP would give the market additional confidence and information as the Board had now had the chance to review the IBP and take into account comments received from North Central London Sector and NHS London. Capacity Expansion Projects Mr Hurd referred to his summary relating to the capacity expansion projects and advised that an update on the Ronald McDonald Children Charity House Parent and Child Accommodation project would be given in Part 2 of the meeting. Payment by Results (PbR) and Commissioning Specialist Orthopaedic Services Mr Hurd advised that the final PbR tariff and the NHS Operating Framework for 2011/12 would be published later in the month and once received an assessment of the full financial impact can be undertaken. However, initial sense checks have indicated an estimated loss of income for the RNOH and other Specialist Orthopaedic Trusts for next year to be in the region of 1m. He said that a meeting had taken place with the Director General of Finance & Performance at the Department of Health and the Chief Executives of the Specialist Orthopaedic Alliance (SOA) Trusts. At this meeting SOA members were advised of a number of changes that would benefit the position next year compared to previous iterations of the tariff. Mr Hurd said the changes were listed in his Chief Executive report under section 3.0 (page 4). He also outlined the agreements that were made at the meeting, which he said included: A Specialist Orthopaedic sub group of the National Orthopaedic Expert Working Group (EWG) involving the RNOH (Rob Hurd and Professor Briggs) and other SOA clinicians to work with the Department of Health to agree coding algorithms to recognise specialist work and pay more attention to specialist problems with HRGs than the EWG has been able to in the past. The SOA will propose a vision for commissioning specialist orthopaedics on a regional or national basis and this will be used as part of the consultation on rolling out new commissioning arrangements in the NHS Mr Hurd went on to advise the Board of the meetings and discussions the Trust s host sector agency, NHS North Central London, had held in relation to the Healthcare for London Reconfiguration of Services Review. He said the Trust needed to respond to 2

3 a letter received from the Sector Chief Executive, Rachel Tyndall, requesting suggestions for areas where there may be opportunities to do things differently to collectively meet the financial challenges that lay ahead for the sector. The Board discussed how the Trust should respond, its position within the sector as a specialist orthopaedic hospital and agreed that reference should be made to: The Trust s focus on delivering the rebuild of its hospital on the Stanmore site and to become a Foundation Trust. Its commitment to input into some of the wider sector issues, however this could be limited given the nature of the RNOH as a specialist centre The cascading of the Trust s examples of best practice and expertise as a specialist orthopaedic hospital Professor Goldstone queried whether it would be beneficial to include a suggestion that a proportion of the sector s routine orthopaedic work be referred to the RNOH which would ensure the continuation of the Trust s teaching and training programme. Mr Hurd agreed to include this in his response. The Board asked Mr Hurd to respond to Ms Tyndall s letter highlighting the above points. Action: Mr Hurd For Presentation 7. Foundation Trust - RNOH Integrated Business Plan (IBP) Mr Hurd said the Board had been provided with the latest iteration of the Trust s IBP and summarised the key points that had been discussed and agreed earlier in the day at the Board Development session. The growth assumptions, zero percent growth Further explanation on how the Trust defines specialist and routine work and how the reduction of routine work will affect the Trust s teaching and training capability. How joint working with other Trusts within the sector and other partners, including the London Deanery, could mitigate this issue Agreement to a set of principles when joint appointments are appropriate Expand on the evidence that the Trust is a world class hospital, include clinical outcomes, highlight consultants lecturers and presentations, and the work the RNOH undertakes that other hospitals do not Workforce analysis include a detailed model on how the Trust will reduce the workforce by 14% of the headcount to fall in line with the zero growth assumptions. Changes in tariff take a firmer line when tariff changes do not benefit the Trust More emphasis on the Joint Academic Strategy Low infection rates outline the economic case Detail the Trust s paediatric work; cradle to grave Mr Hurd confirmed that the changes would be incorporated in the document ready for the next submission (17 th January 2011). Professor Goldstone queried whether it would be useful for the RNOH to have advice from the UCL research unit on how the Trust s data can be used to its best advantage. He suggested the Trust may want to fund a research fellow to undertake this piece of work. Mr Hurd said the Trust had struggled to work up the joint academic plan theme based on outcomes and benefits. Professor Goldstone agreed to make the necessary introductions. 3

4 Performance Reports 8. Integrated Performance Report including an update on the 18 week programme, the Partnership Forum and the Service Delivery Plan Mr Koray presented the integrated performance report for the financial year 2010/11 (1 st April 30 th November 2010) which he said had been reviewed and discussed by the Performance Committee earlier in the day. Key points included: Finance - an in month surplus of 119k. The cumulative deficit position is 698k compared to a planned surplus of 1.7m. The surplus position has been achieved because there has been an increase in activity levels especially in spinal and private patient activity. Nutritional assessments 79% for November Mrs Corder said she expected the number of nutritional assessments undertaken to increase as the assessment would become part of the admission process. She said the assessments did not take long to undertake and that the Trust was reviewing whether there was an issue with evidencing that an assessment had been completed. Bolsover Street Overage Mr Koray advised the Board that there was a significant risk in terms of the Bolsover Street overage position as it could be less than planned. In response to Mr Watson s query, Mr Koray said the level of the Bolsover Street overage had originally been based on an assumption of the potential sale receipts. The Trust s Auditors have indicated that a more cautious estimation would be prudent given the current economic climate. Mr Hurd said that in terms of the Trust s overall financial position it was more important to achieve a surplus rather than the level of surplus and therefore the Bolsover Street overage would only be accrued if the Trust needed to achieve a surplus at the end of the 2010/11 financial year. He said the Trust s Cost Improvement Plans were on track and its run rate was consistent with what the Trust needed to achieve by the end of the financial year. Mr Billington suggested that the Bolsover Street overage and when it should be accrued be discussed further at the next Board Development session or Board Away Day. Action: Mr Billington/Mr Hurd/Mr Koray In response to Professor Goldstone s comment, Mr Hurd agreed that the Trust s focus in terms of the financial position should be on increasing spinal activity. He explained that the Trust was working with consultants on a demand and capacity plan and that consultant sign up to deliver the required activity and the additional capacity from the new theatre would give the Trust an opportunity to increase its activity and income levels. The Board went on to discuss the fragility of the Trust s financial position and how sensitive and vulnerable the position is to unforeseen circumstances. Mr Koray explained that a slight reduction in the number of spinal cases, for example, could result in a loss of 0.5m. Dr Jacobs said he felt that pressure should continue on the Department of Health in terms of the tariff issues and that the Trust s financial position should not be reliant on one particular unit. Mr Billington suggested this issue be discussed further at the next Board Development session or Board Away Day and should be addressed as a medium term objective. Action: Mr Billington/Mr Hurd/Mr Koray 4

5 Management and Leadership target no overspend of pay expenditure Mr Koray advised the Board of concerns relating to the pay expenditure overspend which had arisen because of the increase in the workforce headcount. He said that a detailed review of pay expenditure variances against establishment would be undertaken and reported back through the Performance Committee. Action: Mr Koray (Performance Committee) 18 week access target Mr Koray said the Trust had maintained its achievement of the target but there were concerns that the backlog for admitted was increasing. He said the Trust may need to consider accessing the private sector for assistance with Joint reconstruction and spinal cases and as a result the Board may be required to make a decision in terms of contracts with these providers. Mrs Hill said the Trust had undertaken a capacity and demand exercise to validate the non-admitted and admitted pathways and had taken steps to clear the backlog, which she said were outlined in the performance report. She said that although she expected the backlog to reduce to zero by the end of March the 18 week access target could slip if the additional actions are not progressed during the last quarter. 9. RNOH 2010/11 Capital Programme mid year review Mr Koray presented the mid year review of the 2010/11 capital programme. He said the initial capital expenditure control total for 2010/11 was 4.5m which comprised of 3m from internal resources and 1.5m donated from the Special Trustees for the proposed Outpatient Department refurbishment project. Mr Koray advised that the scale of the refurbishment project had been reconsidered and as a result funding from the Special Trustees had been deferred. He said the executive summary outlined how the 3m was divided and explains how the budget overshot its Capital Resource Limit (CRL) by 900k despite a number of mitigating actions being taken. As a result of the overshoot the Trust has had to submit a request to NHS London for an increase in the Trust s CRL. The Trust has also submitted a request for a capital investment loan for 900k, which was approved by the Department of Health. Mr Koray concluded that provided that no further commitments are agreed or entered into, the increased capital budget will mean the Trust will meets its capital resource limit for 2010/11. In response to Mr Milsted s query, Mr Koray said that the equipment purchasing plans that had to be postponed included the replacement of ITU monitors ( 280k) and new theatre trolleys ( 200k). He said that a number planned estate schemes had also been postponed including a 4 bed Paediatric Post-Anaesthetic Care Unit as an extension to Ward 1. The Board discussed the reasons for the overspend, the projects that were rolled over from 2009/10 that impacted on the 2010/11 capital programme and the additional works required to complete the theatre project, for example, theatre staffing accommodation and the additional asbestos removal. There was general agreement that including additional work on an agreed project and budget was not best practice but in some cases unavoidable. Updates from the sub-committees of the Trust Board 10. Update from the Service Transformation Committee Mrs Puckett presented the update from the Service Transformation Committee, which she said reflected the position as at the end of November She said the 5

6 executive summary outlined the current CIP and Transformation savings position and the key themes and achievements from the Transformation projects, including an update on the Productive Theatre and Ward Programmes, the repatriation of routine work, the Enhanced Recovery Programme and developing Clinical Leadership. She went on to outline the additional resources that had been put in place to support and progress the programme and referred to Appendix 1 the Transformation Programme Project monitoring information, which she said gave an overview of the progress made to date in terms of the work streams. In response to Professor Goldstone s comment regarding theatre slot utilisation, the Board discussed the availability of detailed data and the planned cascading of this information to the consultant staff. The Board also discussed the 6 weeks notice of leave rule and how vacant theatre slots and sessions are offered to other units and consultants. In response to Professor Flanagan s query, Mrs Hill said that access to ITU beds had not been a problem because of the implementation of the HDU outreach service and by using the recovery unit resources when needed. Dr Jacobs said the paediatric unit had had difficulty in accessing HDU beds on occasion but this would be resolved once the HDU extension project was completed. 11. Update from the Risk Management Committee The Trust s Clinical Governance and Risk Manager Mr Coalwood presented the update from the Risk Management Committee, which he said outlined the issues that were discussed at the Committee meeting held on the 30 th November He said the Trust s Assurance Framework and Corporate Strategic Risk Register would be presented to the Board in January 2011 following a review and re-assessment to bring it in line with the revised risk matrix. NHS Litigation Authority (NHSLA) Assessment The Trust has been successful in retaining Level 2 status following a visit from NHSLA in November The full report will be available before the end of the year. Clinical Governance 12. Mid Staffordshire Action Plan Update Mrs Corder presented the updated action plan, which she said was developed in response to the Mid Staffordshire enquiry. The Trust has considered where assurances are already in place and identified key actions based on the recommendations made in the enquiry report. She advised that the updates are outlined in the action plan but additional updates include: Following the report in September 2009 on inpatient staffing levels at the Trust presented by the previous Director of Nursing, a follow up review is being undertaken and will be presented to the Executive team in January 2011 Performance indicators for ward areas have been agreed and IMT are working on an INSIGHT dashboard A new induction program will be launched in January 2011 Trust clinical audit lead will launch structured mortality and morbidity review meetings linking to clinical audit committee which will be established in early 2011 A checking mechanism for ensuring any complaints identified as requiring an incident report is now in place 6

7 Senior nurse visible leadership program has been launched ensuring timely audit and feed back of clinical practice and documentation Executive team and senior nurses are now undertaking structured night visits Dementia pathway will be launched in January 2011 In response to Professor Goldstone s query, Mr Hurd confirmed that he reviewed all the complaints received and the Trust s responses. Mr Billington referred to the action plan, item 7 the Board should give priority to ensuring that any member of staff who raises an honestly held concern about the standard or safety of the provision of services to patients is supported and protected from any adverse consequences, and should foster a culture of openness and insight. He said the Trust had already revised and publicised its Whistle blowing policy and queried whether this therefore needed to be a key action. Mrs Corder said she would raise this with the Director of Nursing. 13. RNOH Patient Group report on their visit to Ward 4 and the Stanmore Outpatient Department The Board noted the report from the RNOH Patient Group. In response to Professor Flanagan s comment, Mr Masters said he would investigate the issue raised by the Central Book office staff about the toilets in the outpatient department. Action: Mr Masters 14. RNOH Patient Group Action Plan Update Mrs Corder presented the action plan which she said had been developed and based on the recommendations from the RNOH Patient Group following their fact finding visits around the Trust during 2009/10. The RNOH Patient Group has expressed their satisfaction with the recommendations that have been completed and with the reasons that some actions remain outstanding. Mrs Corder said the Trust would need to focus on the mixed sex breaches as fines will be imposed in the future. She went on to refer to page 6 of the action plan and the business case for a new telephone system to be implemented in the Physiotherapy department. She said the business case would be resubmitted in the next financial year (2011/12). 15. Patient Experience Report (November 2010) The Board noted the Patient Experience Report for November Policies, Procedures, Business Cases for Approval 16. Trust Board meeting dates for 2011 The Board approved the 2011 Trust Board meeting dates. For Information 17. Communications Update Mr Vaughan presented the Communications Update. The Board discussed the potential for media coverage once the Trust places its OJEU advert and how the Trust obtains the information relating to news articles of particular interest. There was a discussion on how the search could extend its scope to include articles and publications written by the Trust s medical and clinical staff. Mr Vaughan said the 7

8 Communications department was proactive in their approach to consultant staff and making staff aware that good news stories would be welcomed. 18. Any Other Business The Departure of the Director of Human Resources & Corporate Affairs Mr Hurd reminded the Board that Mr Vaughan would be leaving the Trust at the end of December (2010). He thanked Mr Vaughan for his 10 years of service at the RNOH, for his commitment and fundamental support to the Chief Executive and executive team and the challenging agenda the Trust has faced in the past and in the future. He said that Mr Vaughan had developed a well respected Human Resources team. Date of next meeting Thursday, 27 th January pm, Seminar Room 1, Teaching Centre 8

The total efficiency programme was 161,272 behind target in Month 4.

The total efficiency programme was 161,272 behind target in Month 4. Royal National Orthopaedic Hospital Trust Trust Board Meeting - Executive Summary Report/Paper: Update on Service Transformation Programme Date: Aug 2013 Purpose of Paper: To give the Board assurance and