Agenda and supporting papers - Plymouth Hospitals NHS Trust

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Item 3 the Forum in targeting winter funding. Bed Programme The aim of the Bed Programme was to deliver the appropriate bed base for the Trust’s patient flow by: • Ensuring patients were cared for in the most appropriate setting. • Preventing the D cancellation of surgical patients. • Operating at a manageable occupancy rate across medicine and surgery to provide personal, high quality, safe care. The Bed Programme identified the difference between current and optimal capacity as 56 beds. It proposed the establishment of: R • 20 short stay medical beds driven by the known increase in patients who stay 0-2 days. • 26 Healthcare of the Elderly beds on Monkswell ward. • 10 in-ward escalation beds. A The cost of this investment in the current year was £2.246m for the additional 74.05WTE staff, with a full year effect of £3.388m. In addition, capital costs associated with relocating services, including a further relocation of the Preoperative Assessment Unit, totalled £665k. The main risks associated with delivery were: F • Recruitment. • Internal professional standards. Mr Brown drew the Board’s attention to the risks to delivery and to their mitigations set out in the presentation and in the accompanying report. Mr Brown suggested T that the most significant risk was the failure to deploy the enhanced community workforce to support patients in an alternative environment when winter pressures hit. Dr Williams stated that there was no reason why the Trust should not be proactive in this regard. Mr Baber agreed, staff could function outside of the footprint of the hospital; other organisations did so with a significant positive impact on bed availability. The Board considered the proposals. In so doing, the main points of discussion were: • Uncertainty as to whether 26 beds was sufficient to cope with the variation in demand and whether this number would meet changing local demographics. Ms O’Brien stated the Trust would require thirteen additional beds to cope with future demand and a work stream was reviewing this. • Mr Wilkins queried the degree of clinical involvement in these proposals. Mr Baber stated that the Care Group Directors had 7
Item 3 been involved and there was service line support. Mr Brown stated that the proposals had been routed through the relevant clinical groups to ensure support. • Dr Williams stated that the Board could not be sure that these proposals would save money and be better for patients. Success would be dependent on a tight grip on the associated operational issues. The discharge element, which was dependent on D other parties, was crucial and there was limited assurance that this would be delivered in the short term. • Mr Teape identified the requirement for a clear audit trail for admissions/discharges to be shared with commissioners. Mr Teape and Mr Baber would shape this. R • Mrs Raikes asked whether this investment would add to the existing CIP programme. Mr Teape stated that it would not and that the costs were included in the £5m ‘investment for quality’ projects discussed at the May Board. • Successful nurse A recruitment was crucial to the plan’s success, both operationally and financially. Mr Dix stated that nurse recruitment was just keeping pace with internal turnover and it was likely that it would be necessary recruit internationally. Whilst Ms James agreed in principle, she felt there was more that could be done in local advertising and this should be pursued. F Concluding the Board’s discussions, Ms James stated that the Senior Management Team must develop range of KPIs for Board level oversight. Agreement of these proposals would send confirmation to staff that the Board had listened and acted on two of their concerns: T • The importance of minimising patient and staff moves to meet operational imperatives. • The Board: The importance of supporting staff to deliver the consistently high levels of care that they would wish. • Noted the internal actions being taken to support improvements within the ED pathway and improve hospital-wide support for patients within the ED. • Noted the community-wide actions required to support hospital based Emergency Care in the longer term. • Approved the actions described within the Bed Programme and the associated investment necessary to 8
Page 1 and 2: Trust Board Friday 5 July 2013, 9.0
Page 3 and 4: Members of Plymouth Hospitals NHS T
Page 5 and 6: Item 3 observer. The Chairman requi
Page 7 and 8: Item 3 Board oversight of contribut
Page 9: Item 3 the Board next month. • Th
Page 13 and 14: Item 3 continuing to build. Mr Babe
Page 15 and 16: Item 3 to Norovirus, Professor Lewi
Page 17 and 18: Item 3 • Careful communication of
Page 19 and 20: Item 3 • Approved the writing off
Page 21 and 22: Updated: prior to July Board Item 4
Page 23 and 24: Updated: prior to July Board Item 4
Page 25 and 26: Item 8 Quality Impact Assessment Pa
Page 27 and 28: Item 8 3.2 Quarterly Summary Hospit
Page 29 and 30: Item 8 4.4 Monthly Proportion of Pa
Page 31 and 32: Item 8 Inpatient falls are currentl
Page 33 and 34: Item 8 REI signage PALS were contac
Page 35 and 36: Item 8 Complaints received listed b
Page 37 and 38: Item 8 The graphs below illustrate
Page 39 and 40: Item 8 5.5 Friends and Family Test
Page 41 and 42: Item 8 1. Pressure Ulcers (EoC) 2.
Page 43 and 44: Item 8 Observations The essence of
Page 45 and 46: Item 8a SUMMARY REPORT Trust Board
Page 47 and 48: Annex 2 Item 8a Summary of Serious
Page 49 and 50: Item 9 Key Recommendations The Trus
Page 51 and 52: Item 9 Effective Care (Section B2 o
Page 53 and 54: Item 9 Description 31 days from 'de
Page 55 and 56: Item 9 4.6 Non Elective Activity is
Page 57 and 58: Item 9 Summary of performance excep
Page 59 and 60: Item 9 Ensure that all patients adm
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Item 9 Forecast Significant progres
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Item 9 Update on previous actions C
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Contents EXECUTIVE SUMMARY D FINANC
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B1 Safe care Description Hospital S
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Response Rate Recommender Score B3
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B5 Other safety & quality metrics D
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C2 Non-Elective Activity Descriptio
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C4 Referral To Treatment (RTT) Desc
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C6 Other access & activity metrics
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D2 Cost improvement programme (CIP)
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D4 Cash Management Description Revi
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E1 Staffing numbers Description Est
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E3 Sickness absence PERFORMANCE IND
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Risk Rating F2 Monitor's Financial
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Item 10 DETAILED REPORT Trust Board
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Item 10 4. Key Issues for the Board
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Item 11 SUMMARY REPORT Trust Board
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Item 11 DETAILED REPORT Trust Board
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Item 11 • Challenge in respect of
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Item 11 Over the past two years, me
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Item 11 Getting it Right Charter An
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Item 11 Outcome of review with exte
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Item 11 Learning Disabilities Natio
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Item 11 Peer Review 2.5 Peer Review
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Item 12 Next Steps 1. Conversation
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Item 12 2. Board Inclusion Developm
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Item 12 EDS Grades and E & D Object
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Item 12 Plymouth Hospitals Trust -
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Item 12 3.6 The workforce is suppor
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Item 13 Key Recommendations The Tru
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Item 13 Telephone conversations.
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Item 13 19. The Medical Director ha
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Item 15 incident investigations to
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Item 15, Annex 1 3. Review of Actio
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Item 15, Annex 1 • Top three issu
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Item 15, Annex 1 The Chair asked SS
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Item 16 COMMITTEE MINUTES Finance,
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Item 16 pay and staffing, highlight
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Item 16 • PACS contract - likely
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Item 17 Terms and Conditions of Emp
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Item 17, Annex 1 29/2013 Minutes an
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Item 17, Annex 1 31/2013 Francis Re
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Item 18 Next Steps The Audit Commit
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Item 18, Annex 1 Matters arising 4/
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Item 18, Annex 1 time to embed and
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Item 18, Annex 1 Payroll & Expenses
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Item 18, Annex 1 The Committee note
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Item 18, Annex 1 Going Concern Revi
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Item 18, Annex 1 if Internal Audit
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Agenda and supporting papers - Plymouth Hospitals NHS Trust

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