MINUTES OF THE DARTFORD & GRAVESHAM NHS TRUST BOARD MEETING HELD ON THURSDAY 29 th MARCH 2007 AT DARENT VALLEY HOSPITAL Present: Sarah Dunnett Chairman Mark Devlin Chief Executive Dr Gill Jenner Medical Director Paul Traynor Finance Director Susan Acott Director of Perf. & Service Development Jenny Kay Director of Workforce Development Brian Bowes Kam Cheema Richard Hamilton Glen Ridout In Attendance: Glyn Oakley Communications Manager Fay Trodd Head of Personnel Jane Blair PA to Chief Executive Christine Giles Assistant Director of Governance Part 1: TB1/01/03/07 APOLOGIES FOR ABSENCE: Kate King, Acting Director of Nursing, Ron Edmondson. Dr Jenner was stepping down as Medical Director in May and this was her last formal Trust Board meeting. On behalf of the Board, the Chairman thanked Dr Jenner for her measured and sound guidance on all medical matters over the last three years which had been invaluable to the Board. She also thanked her for taking forward the Governance agenda. It was noted that no conflict of interest was declared by any member of the Trust Board. TB1/02/03/07 MINUTES OF MEETING HELD on 25 th January 200: The Minutes of the meeting held on 25 th January 2007 were agreed and signed as a true record. TB1/03/03/07 MATTERS ARISING: Matters arising had been actioned or were included in Directors reports in addition to the following: The Chairman had emailed Non-Executive Directors seeking a nomination to take on the role of Risk Management. National Patient Safety Agency feedback report: This showed the Trust was reporting a slightly above average number of falls. The Acting Director of Nursing would be asked to provide an assessment of falls within the Trust. Quarterly Incident Report: The Acting Director of Nursing would be requested to provide information on claims settled and the timescale for settlement.
Glen Ridout thought that the Board should recognise that there were some longer outstanding complaints which fall outside of the 28 day response target, such as re-opened complains or complaints against local resolution. It was agreed that the Board would be provided with a half yearly historic analysis in order to give assurance in this respect. The Board requested that satisfaction levels of complainants be included in reporting of complaints. It was noted that the Acting Director of Nursing had met with the member of the public who had attended the last Board meeting to discuss his concerns. The Director of Workforce Development suggested that the Board discuss what was required at Board level with regard to the Equality and Diversity agenda. It was agreed this would be a topic at an informal Trust Board briefing. Action: Director of Workforce Development It was agreed that a review of the new Assurance Framework would be undertaken at the June Informal Trust Board briefing. Action: Director of Performance and Service Development A summary sheet of all key committees outlining what was discussed and resulting actions would be produced for the May formal Board. Action: Executive Directors TB1/04/03/07 ITEMS FOR DISCUSSION: 4.1 CHIEF EXECUTIVE S REPORT The Chief Executive reported on the following topics: Financial Position: Month 11 position showed a small surplus position. A breakeven position at year end was now forecast. This was a significant achievement and staff were congratulated on their efforts in this respect. Heads of Terms on Service Level Agreements had been agreed with both the Trust s main commissioners. Both Agreements were in line with the financial planning assumptions for this year. Healthcare Standards - Draft Declaration of Compliance: This document is presented to assure the Board as fully as possible of the Trust s compliance with Core and Developmental Standards. The Board was asked to consider its position and raise any queries to be dealt with before the deadline for submission on 1 st May 2007. Strategic Objectives: The Strategic Objectives for 2007/08 focus on the three major areas for the Trust in the coming year and were presented for approval. Discussions were taking place with the Strategic Health Authority about the appropriate timing of the Trust s Foundation Trust Status application. Medical Director: Dr Huw Alban-Davies has been appointed as Medical Director with effect from 11 th May 2007. He would also act as Caldicott Guardian for the Trust. 2
The Chief Executive thanked Dr Jenner for her contribution as Medical Director over the last three years. 4.2 FINANCIAL REPORT MONTH 11 The Finance Director said that the finance paper had been discussed in detail at the Finance Committee meeting held earlier in the week. Month 11 showed a small surplus and the Finance Director was confident that breakeven at the end of March 2007 would be achieved, although Quarter 4 still had to be reconciled. With regard to the compulsory purchase of land by the Kent County Council for the Fast Track scheme, a meeting was planned for April to try to bring the matter to a conclusion. Cash flow remains difficult. However, it was anticipated that the position would improve in 2007/08. It was disappointing that the capital position was under spent more than anticipated but it was hoped to carry forward most of the funds into next year, particularly to fund the NCRS and PAS. Glen Ridout, a member of the Finance Committee explained the Committee would focus on financial planning for future years, procurement hub and recurring cost savings and benefits. Brian Bowes asked whether the one-off savings in the Finance Recovery Plan had been realised. The Finance Director replied that he will provide information at year end giving percentages of savings which are recurrent and those which are one-off savings. Action: Finance Director 4.3 CLINICAL ACTIVITY SCORECARD The Director of Performance and Service Development said that no further Performance Metrics had been issued since the last Board meeting. She outlined the main performance issues. The Heart Centre opened officially on 28 February. Sexual Health performance was maintaining its improved position of 78% of patients seen within 48 hours. Due to an flaw in the IT system nationally it was not possible to report on appointments offered at this time. Therefore, the Health Protection Agency survey of patients was included in this report. The Trust has asked the Healthcare Commission to discount the first quarter performance due to the restraints imposed by the PCT. Performance against the 18 week target was making good progress. Kam Cheema had recently attended an NHS Confederation meeting where the 18 week target was discussed and she informed the Board that feedback sought from Trusts. Appointments through the Choose and Book system accounted for 32%. Brian Bowes asked if there was an even take-up locally by GPs. The Director of Performance and Service Development replied that there was a high take up by Bexley GPs but Dartford and Gravesham GPs had only just began to come into the process. With regard to the stroke indicator, the Chairman understood that the National Service Framework required 100% of patients to be seen in a Stoke Unit whilst the Trust s target was 58%. The Director of Performance and Service Development replied that it was important to capture those patients who would benefit from being seen in a Stroke Unit. The Medical Director commented that more beds had been made available in the Stroke Unit. The Chairman was concerned that reporting may be constrained by the reporting framework and what was important was that those patients should be measured who would benefit from being seen in a Stroke Unit. 3
Glen Ridout asked about the sickness level which had increased significantly. The Director of Workforce Development responded that focus would be maintained on this issue. Sarah Dunnett was concerned at the level of cancelled operations. The Director of Performance and Service Development replied that this was in part due to pressures on ITU beds this year. The A&E waiting times performance was just under 98%. Richard Hamilton asked whether there was a Board committee reviewing performance. The Chief Executive replied that the Clinical Directors Board had this responsibility. There were also regular meetings with key staff looking at ways to improve the position. The opening of the Urgent Care Unit by the PCT in January was now showing some improvement in the position. 4.4 EMERGENCY ACCESS REPORT There were no questions on this report and it was noted by the Board. 4.5 PROGRESS REPORT ON HEALTHCARE COMMISSION STANDARDS 2006/07 The Medical Director and Christine Giles, Asst. Director of Governance, presented this report which sets out the progress of the self assessment of Standards for Better Health to enable the Trust to make its final declaration by the 1 st May 2007. This report gives an overview of the background and the current position of the Core and Developmental standards. The Board discussed the Core Standards and Christine Giles drew the Board s attention to the key points outlined in the report including areas of concern. The Chief Executive said it was important that the Board should have plenty of time to understand the Trust s current position and to raise awareness before the final declaration required by 1 st May 2007. Kam Cheema was concerned that little progress seemed to have been made since last year s declaration with regard to the translation of leaflets. Christine Giles said that this year there would be an action plan to be monitored by the Audit Committee on a regular basis. The developmental standards were discussed. In response to the Chairman, Christine Giles confirmed that the Trust would not be measured on the developmental standards this year. TB1/05/03/07 ITEMS FOR DECISION: 5.1 STRATEGIC OBJECTIVES 2007/08: The Chief Executive explained that the Strategic Objectives had been produced following consultation with Executive and Non-Executive Directors. These reflect the key areas of strategic and service focus for the Trust in the year ahead. The sub-points provide an explanation for stakeholders and patients. Brian Bowes sought assurance that there were measurable objectives behind these high level objectives. The Chief Executive confirmed that there was a second level which would support the framework. The Board agreed the Strategic Objectives for 2007/08. 5.2 SOUTH EAST COAST COLLABORATIVE PROCUREMENT HUB The Finance Director advised the Board that this had been discussed in detail at the Finance Committee. The amount of investment was relative low at 40k over three years. A small 4
specialist buying team would negotiate deals with suppliers for the whole of the South East Coast health economy. The Trust would retain the right to choose to buy from other suppliers should it wish to do so. The return on investment was expected to be in the region of 5.4% for this organisation. Glen Ridout said that in his absence, Ron Edmondson had asked him to pass on his comments. He did not feel the savings were as ambitious as they could be and the benefits to the Trust needed to be established. He also asked whether this was part of a longer term strategy in terms of procurement for this Trust. The Finance Director confirmed that other organisations had also raised the question of whether the scheme was ambitious enough. However, the business case provided a measured approach to what is to be delivered. Glen Ridout asked whether it would be possible to differentiate between the savings from the procurement hub and those made by the Trust. The Finance Director said that in his opinion this was the right way forward to fill the gap between the higher level of procurement and the Trust s team. With regards to the risks involved, Brian Bowes asked whether this organisation would incur extra costs if all Trusts did not sign up to the scheme. The Finance Director replied that most Trusts have now signed up and those which had not, were intending to do so by the end of March. The amount to be paid by the Trust would not change. TB1/06/03/07 ITEMS FOR INFORMATION: The following reports were presented for information and reported on by exception. 6.1 DRAFT MINUTES OF AUDIT COMMITTEE MEETING HELD 16 th FEBRUARY 2007 Richard Hamilton, Chair of the Audit Committee said that this meeting had been the first since the updated Terms of Reference had been agreed. The Committee would provide assurance to the Board on a range of issues. The Committee intended to be proactive and would invite Executive Directors to attend at least once a year. 6.2 PATIENT PUBLIC INVOVLEMENT ANNUAL REPORT 2005/06 This report gives an overview of progress against the Patient Public Involvement strategy agreed in early 2006. The Board noted this report. 6.3 EDUCATION AND TRAINING ANNUAL REPORT 2005/06 This report provides an overview of education and training activity in 2006/07 and plans for 2007/08. The Director of Workforce Development confirmed that the training budget would be restored to last year s original level. The Director of Performance and Service Development said investment would be needed to ensure staff were trained in basic IT skills. Brian Bowes asked whether specific training for key staff would be required with regard to Foundation Trust progression. The Chief Executive replied that existing team meetings would be used to raise awareness and share information. 6.4 NEW CONSULTANT APPOINTMENTS The Medical Director informed the Board of recent Consultant appointments as detailed in her report. 5
6.5 CODE OF CONDUCT FOR NHS MANAGERS The Medical Director drew the Board s attention to the Code of Conduct for NHS Managers. Its purpose was to guide NHS Managers and employing health bodies in the work they do and the decisions and choices they make and to reassure the public that these important decisions are being made against a background of professional standards and accountability. Kam Cheema thought the Code should apply to all Managers but appeared to only apply at a certain level. The Finance Director replied that it was expected to apply to all senior managers in the organisation. The Chairman asked whether there was a substantive action plan to deseminate this Code. The Finance Director replied that Senior Managers were reminded of the Code yearly and are sent a copy to ensure they have access to it. He would check it was referenced in Managers contracts. Action: Finance Director Richard Hamilton asked whether there was a Code of Conduct for all staff. The Director of Workforce Development responded that all professional staff abide by their professional codes. There was also a Trust Handbook issued to all staff. TB1/07/03/07 QUESTIONS FROM MEMBERS OF THE PUBLIC There were no questions from members of the public. TB1/08/03/07 ANY OTHER BUSINESS i) Glen Ridout had attended a Connecting for Health meeting. There was recognition that this organisation was leading the way in this respect. ii) The Finance Director informed the Board that a decision on the RAB issue would be made shortly by the Department of Health. A note would be added to the Trust s accounts which highlights which part of the deficit relates to RAB as agreed with the Trust s external Auditors. iii) The Finance Director informed the Board of work was being done with the Carbon Trust on a combined heating power plan for this site. The Trust was eligible to bid for capital monies from the Department of Health and the Strategic Health Authority required the Board to be supportive of the bid for these monies for this project. Terry McCarty, General Manager of The Hospital Company explained the emissions training scheme. He confirmed that at present the Trust falls below the threshold, however, there was a potential in the future for issues. An operator over the threshold would have to apply for a permit with stringent penalties. Henry Stanley, General Manager of Carillion said that the Carbon Trust had identified potential savings of 60,000 per annum by generating its own electricity. The Board supported the bid for capital monies to support this project. iv) The Director of Workforce Development informed the Board that the Staff Satisfaction Survey would be published tomorrow. v) Kam Cheema asked what progress had been made in the use of the retail unit. Terry McCarty said that some ideas were being considered. 6
TB1/09/03/07 DATE OF NEXT MEETING: The next scheduled formal meeting, open to the public, will be held at 9.00 a.m. 24 th May 2007 in the Board room, Darent Valley Hospital. It was agreed that part of the Informal Trust Briefing to be held on 26 th April 2007 would be a formal Board meeting to agree the Healthcare Standards Declaration for 2006/07, to meet the submission date of 1 st May 2007. The following topics were presented and discussed at the Informal Trust Briefing held on 27 th February 2007: Update on Infection Control HR Strategy Month 10 Financial Position 2007/08 Financial Plan 7