Trust Board papers November 2012 - Barking Havering and ...

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2012/053 TRANSFORMATION BOARD UPDATE
Mrs Hosein informed the Board that against the CIP target of £23.1m, the Trust had identified £17.6m,
following a review carried out by Ernst & Young. Further schemes were being worked on to address the
gap and the Project Management Office/Service Transformation Team was working with the Workstream
Leads to strengthen the existing schemes, in order to ensure delivery.
The Programme had delivered the target for last month and would be working towards achieving a £2m run
rate by the end of March. One Ward had been closed and the Team was currently working up a further
proposal to close another Ward. Accountability meetings with the SRO’s were continuing to ensure the
Programme was kept on track. The Board was asked to refer to a table within the Finance Report, which
set out the workstreams and the deliverables for the CIP.
Mr Langley raised the issue of improving and embedding controls in relation to bank and agency staff and
Mrs Hosein confirmed that a lot of work had been put into this with the Wards and they would now be
concentrating and drilling down on the medical spend. Each Directorate had been asked to identify their
medical staff expenditure and to come back with their short, medium and long term actions on how they
would reduce their bank and agency spend in this area, albeit there were obviously still recruitment issues
in some areas, e.g. Emergency Department.
The Trust Board noted the update report.
2012/054 ANNUAL AUDIT LETTER 2011/12
The Trust Board noted the Annual Audit Letter 2011/12 submitted to the Trust from the Audit Commission.
2012/055 END OF LIFE CARE ADVISORY BOARD – BRIEFING PAPER
Ms Heather Wright, Team Leader for Palliative Care and Dr Andrew Gage, Palliative Care Consultant
presented their end of life video. Dr Gage informed the Board that along with Dr Claire Bates, they had
developed the End of Life Care (EOLC) Advisory Board (ELCAB), which aimed to facilitate the
implementation of the EOLC Strategy (2008) and NICE End of Life Quality Standards (2011) within the
Trust. The Strategy was comprehensive and would assist the Trust in improving practices in the short term
and for the longer term change the culture of End of Life Care. Dr Gage highlighted that there were a high
number of deaths in Outer North East London (ONEL), compared with the rest of the Country and the
ONEL community palliative care services were poorly resourced, with inequity across the Boroughs. The
Board noted that there was a CQUIN for EOLC, which commenced in April this year following negotiation
with the Commissioners to ensure there was a realistic, but challenging goal agreed (c.£478k to the Trust).
It was acknowledged that the education of Doctors was important and they had developed a bespoke DVD
for the ‘Dying Matters Week’ in order to empower and support Trust clinicians to take on the responsibility
themselves. Ms Wright informed the Board that the Dying Matters Coalition wanted to put the Trust’s DVD
on their website, after addressing any copyright issues.
The Board was advised that there were Borough Facilitators who trained staff in the nursing and residential
homes, but access to specialist palliative care seven days a week, or ’out of hours’, was difficult, as the
community and the acute sector were not joined up at the moment.
The Directorate had been highlighting since 2004 the requirement for an additional nurse at the Trust. The
organisation also needed to address the under resourcing of specialist beds. The number of in hospital
deaths occurring on the Liverpool Care Pathway was raised by the Interim Chairman, as well as the
available bed base. Dr Gage confirmed that the current figure for these beds in this locality was three per
100k population, against seven in Tower Hamlets and 4.55 for the Trust, which was below the National
average. Dr Gage also informed the Board that Redbridge and Waltham Forest were under resourced for
24 hour cover. Mr Wood would take this up outside of the meeting, in order to assist in moving things
forward in this area.
It was noted that this paper had not been through the normal channels and discussions had not taken
place at Executive Director level. The Quality & Safety Committee would therefore review the issues
raised and recommend the appropriate actions to be taken.
Trust Board Minutes Part I – 5 September 2012