June Minutes - Plymouth Hospitals

Item 2
Present:
In Attendance:
Plymouth Hospitals NHS Trust
Minutes of the Trust Board meeting held
on 28 June 2007
in the Conference Room, Level 7, Derriford Hospital
9.00 am - Opportunity for Questions
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Angela Edmunds, Director of Professional Practice (AE)
John Bull, Chairman (JB)
Lesley Darke, Acting Director of Planning (LD)
Terence Lewis, Medical Director (CTL)
Vera Mitchell, PPI Forum Representative (VM)
Paul Roberts, Chief Executive (PDR)
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Gill Hunt, PA to Chairman (GH)
JB welcomed members of the public to the Trust Board meeting and invited
questions.
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A member of the public referred to the Board's approval at their May 2007 to
the purchase of a modular operating theatre and queried whether a penalty
clause had been negotiated on which the Trust could claim should the theatre
not be delivered on time. PDR responded that no doubt there would be such
a clause but the Trust was bound by a procurement procedures which
governed the purchase of
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such items and the contract had not yet been
placed.
The same member of the public referred to the Infection Control Annual
Report, which had been circulated with the papers for the meeting, and asked
about seasonal trends for D&V, reported on page 25 of this report. AE
confirmed that such trends
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were the result of an air-borne virus and affected
not only hospitals, but also schools, nurseries, indeed, any environment in
which large numbers of people gathered and interacted.
The same member of the public referred to item 15, Audit Committee
Meetings minutes, 11 June 2007, which had been circulated with the papers
for the meeting, and was concerned by the comments made by a Non
Executive Director regarding "sloppiness and inattention to detail on the part
of the Trust" when discussing internal audit reports. PDR agreed and
advised the questioner that he had met with the Non-Executive Director
concerned. As a result, the NED would be inviting more middle managers to
appear before the Audit Committee.
Referring again to the Audit Committee meetings, the same member of the
public asked how much the hospital lost to fraud each year. PDR advised
that this was a trivial amount. It was, however, important to investigate
thoroughly as doing so sent the right message to the organisation.
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Referring to the HR Director's report, circulated in the papers for the meeting,
the same member of the public referred to a comment that appeared on page
14 regarding the re-instatement of proper lunch breaks. She was surprised
that they had ceased. PDR responded that, from personal experience, he
was aware that busy staff sometimes chose to work through their lunch
breaks but this was not encouraged.
With the ban on smoking in public places shortly to come into effect, VM
raised the matter of Trust staff
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who smoked and felt that as members of the
public may recognise individual staff members, employees should be
discouraged from smoking as this set a poor example. It was recognised that
this was a matter of personal choice and impossible to police.
VM advised that the Forum had received numerous comments from patients
regarding the citing of the smoking
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shelter in close proximity to the pedestrian
crossing which gave access to the main hospital reception. Patients were
advising the Forum that they did not wish to have to pass quite so closely to
the groups of smokers using the shelter in order to gain access to the
crossing. LD noted VM's comments and consideration would be given to
relocating this shelter.
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Plymouth Hospitals NHS Trust
Minutes of the Trust Board meeting held at
9.30am on 28 June 2007
in the Conference Room, Level 7, Derriford Hospital
Present:
In Attendance:
Apologies:
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Lesley Darke, Acting Director of Planning (LD)
John Bull, Chairman (JB)
Tony Beecher, Non Executive Director (TB)
Ian Douglas, Non Executive Director (ID)
Angela Edmunds, Director of Professional Practice (AE)
David Edwards, Director of Operations (Emergency Services) (DE)
Louise Hardy, Non Executive Director (LH)
Terence Lewis, Medical Director (CTL)
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Christine Lloyd Jennings, Director of Human Resources (CLJ)
Vera Mitchell, PPI Forum Representative (VM)
Lee Paschalides, Non Executive Director (LP)
Tony Rice, Director of Operations (Specialist Services) (TR)
Paul Roberts, Chief Executive (PDR)
Margaret Schwarz, Non Executive Director (MS)
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Nick Thomas, Director of IM&T (NT)
Paula Vasco-Knight, Deputy Chief Executive (PVK)
John Yarnold, Finance Director (JDY)
Gill Hunt, PA to Chairman
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(GH)
Amanda Nash, Head of Communications (AN) – part meeting
Andy Ibbs, Director of Planning (AI)
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The Chairman noted that AI would be attending the Trust Board later in
the day.
83/07 Apologies
Action
In order to accommodate staff delayed by other commitments, some
papers were taken in an alternative order to that set out on the agenda.
84/07 Minutes of the meeting held on 24 May 2007
The minutes of the previous meeting were agreed as a true and
accurate record.
85/07 Matters Arising
In response from a query from TB, the Board noted that no decision had
yet been received in respect of the rollover of underspent CRL.
86/07 Review of Actions
It was noted that the timetables of other agencies had affected some
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delays to scheduled papers. With regard to the delayed Workforce
Plan, JDY advised that this had not yet been signed off at Directorate
level, despite continued pressure by the Executive team.
87/07 Organisational Culture Change Programme Vision and Values
CLJ introduced her report to the Board. This provided a comprehensive
overview of the initial action taken to kick-start the organisational culture
change programme within the Trust during the three months, March to
May 2007. This cultural change
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programme would address some of the
concerns highlighted in the recent Staff Survey results. Staff alignment
with, and engagement in, a shared core vision and values would be
crucial to success as a Foundation Trust and was a matter which the
Executive team and the Trust Board took very seriously.
88/07
Key to the success of this
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programme would be the development and
implementation of a more user-friendly appraisal scheme for staff. The
Board agreed and discussed the Behaviours Framework as the basis for
the 360 degree appraisal scheme proposed for senior managers. It was
agreed that the staff concerned must be adequately prepared for this
process in order to take on board the resulting feedback in a
constructive manner. It was
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noted that the scheme would require
costing, as funds had not yet been earmarked for the current year.
The Board noted the positive ideas that had emerged from staff
consultation sessions and Executive members were able to give
examples of feedback they had received as a result of ward visits,
walkabouts and attending various
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staff meetings and discussion fora. It
was agreed that the Executive team would adopt a higher profile within
the hospital and its associated sites by paying regular visits to clinical
areas. CLJ, supported by AN, would give consideration to allocating an
Executive and a Non Executive Board member to 'zones' within the
Trust and would set up a visits schedule.
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The Board supported the work so far carried out and agreed that it was
imperative to be seen to follow-through on this scheme and to
implement the many positive ideas that had emerged.
Approval of new Standing Financial Instructions
JDY presented revised draft SFIs which had been updated to reflect the
model document published by the Department of Health in March 2006.
In the build-up to Foundation Trust status, it was important that the
Trust's SFIs complied with the new nationwide model. JDY would bring
to the July Board revised draft Standing Orders and Scheme of
Delegation for consideration and approval.
The Board noted the accompanying Annex which summarised the
amendments proposed. JB invited questions. ID asked how fixed
assets were controlled and JDY confirmed this was through a dedicated
register. The trigger figure for asset capitalisation was £5K. JB queried
why the Finance Director should be responsible for the IT Risk
CLJ
JDY
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Assessment. JDY noted that this was illogical and would be amended.
It was noted that there was incorrect referencing in Section 18 and JDY
would amend this.
Subject to these amendments, the Board agreed to approve the draft
SFI's presented to them.
89/07 Learning from Complaints: quarterly update
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highlighted recent positive feedback from the Healthcare Commission
regarding the manner in which the Trust dealt with complaints and
asked the Board to note the specific learning points, detailed in her
report, with which the HCC had been particularly impressed. She
acknowledged that responding to complaints within the timeframe
stipulated proved an ongoing
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challenge and in order to improve the
Trust's performance in this regard, each Directorate's performance
would be measured and, where appropriate, challenged. HCC feedback
on directorate involvement had been positive, as their involvement in
complaint responses and their effective resolution improved the learning
process for the Trust as a whole.
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AE presented her report and the accompanying Annexes.
The Board recognised and applauded the excellent work carried out by
Mary Anderson, Complaints Manager, and her small team. CTL agreed,
MA had been a revelation in the department and her team worked
incredibly hard. The appointment of a Medical Advisor to Complaints
had helped as this had facilitated the involvement of the consultant body
in complaints responses and
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resolution. TB and LH welcomed this.
The Board noted the details contained in the Annexes to AE's report. It
was agreed that priority must be the timely response to complaints and
the Board noted the performance management of Directorates in this
regard.
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90/07 Elective Efficiency Projects
James Palmer, Assistant Medical Director, (JP) attended to give a
general update on the current status of four Elective Efficiency projects
ongoing within the Trust. The Board noted the accompanying report
and JP tabled progress reports each project; Bed Rebasing, Office
Rebasing, Admission Pathway and Scheduling. Each report clearly
identified the problem to be solved, its background, current condition,
analysis, target condition, implementation plan, follow up action required
and results report. The Board welcomed this format and the clarity it
provided.
Bed Rebasing
The bed re-basing exercise carried out last year had left a number of
residual problems that required corrective action. The Board noted that
a bed rebasing exercise, of limited degree, was now envisaged at the
start of each year.
AE
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Office Rebasing
The problem had been a long standing shortage of office space and JP
explained the aims of the exercise. These concerned the requirement to
ensure staff had offices close to their specialty; the provision of
consistent, clear, affordable signage and the need to maximise the
space temporarily available in Rowans. The Board noted that
Neurosciences would move to this facility and as many patients for this
regional specialty travelled considerable distances by car in order to
attend clinics, the improved
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access would be a great improvement for
them. CTL agreed; office moves related to Plateau had been a
significant improvement for patients and staff.
Admission Pathway
This problem resulted from the requirement to minimise day of surgery
cancellation and was a particularly
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important project for the Trust. JP
explained the requirement to standardise admission processes and
ensure zero wait from the time of clinic appointment to addition to the
waiting list. The Board noted the steps taken to implement this and the
improvements for patients that would ensue.
The Board noted that, under
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Choose & Book, should a patient at
outpatient clinic opt not to be treated at the Trust, that patient would be
required to return his/her GP to progress their treatment.
Scheduling
JP advised that Kate Silvester was supporting work on this complicated
project, which involved redesigning
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the scheduling of patients into a
more efficient model, benefiting both patients and the Trust. JP
explained that underpinning this project was the principle that waiting
equated to waste. Linking closely to this project were the Trust's
pathway to FT, training implications for staff and the values work which
CLJ had presented earlier to the Board.
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The Board had received an update on this project last month. Progress
was on target. Communications with staff were greatly improved and
were ongoing on a regular basis.
91/07
Infection Control Annual Report, 2006/2007
Peter Jenks, Director of Infection Prevention Control, (PJ), and Claire
Haill, Lead Nurse Infection Control, (CH), attended for this item.
The Board noted the annual report and the excellent improvements
achieved by PJ and his team detailed in the report's executive summary;
the Trust had become a centre of excellence for infection control. PJ
explained that achieving further reductions in infection figures was a
difficult task and focus would be applied to staff at directorate level to
take this forward. AE agreed, it was important that the Board support
PJ and his team in challenging practices that restricted further
improvements. Junior doctors were a staff group that caused concern
and the importance of infection control would be covered at induction. It
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was anticipated that increased awareness of the importance of infection
control amongst graduates from the Peninsula Medical School would be
noticeable. The Executive team would pay particular attention to Renalrelated
services; PJ explained that screening in the haemodialysis unit
had helped and the routine screening of all admissions to Carey ward
would commence in August.
On behalf of the Board, JB thanked PJ and his team for their excellent
work, over a number of years,
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in reaching such high standards which
had transformed patient care. JB assured PJ that he had the full
support of the Board in educating and training staff on the benefits of
infection prevention and control throughout the Trust.
92/07 Finance and Performance Report
JDY introduced the new-style
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finance and performance report to the
Board. The report briefed the Board on performance against the
business plan, explained variances to that plan and, where appropriate,
set out corrective action. Some elements of the report had yet to be
included in the new format and JDY invited constructive comments on
improvements.
A
PVK presented the performance report. Progress against Standards for
Better Health was green; progress against measured standards was
amber.
Cancelled Operations
A continued problem and higher Fthan the national average. However,
PVK asked Board members to consider this in the context of the
ongoing theatre rebasing work.
MRSA
9 cases were identified in April, 6 through transfers from other health
facilities. This would be addressed
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with commissioners in order to raise
awareness in the local health community.
Thrombolysis
Excellent performance in May after a poor start to the year in April.
Access and Activity Targets
The Board noted that there had been one breach of the 20 week wait,
resulting from an administrative error. The Board noted the Trust's
failure to meet the Cancer Waiting Times target, mostly due to the
number of urology breaches. Recruitment for a fifth Urologist had
commenced.
A&E
Performance had been 97.5% in the month of May. LH asked whether
the Executive team were ready for the usual increase in A&E
attendance during the summer months, coupled with the new rotational
intake at this time. TR had been working closely with A&E staff in recent
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weeks; he could report that a PCT representative now attended daily
bed meetings and good cooperation had resulted in a decreased
number of delayed discharges. There was, however, a need to improve
the minors stream in A&E and work was ongoing to this.
The Board noted the performance report and no changes to the layout
were requested by the Board.
JDY presented the finance
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section of the report. SLA income for the
period was £45,804k, £1,380k less than plan. There was concern at
shortfalls in outpatient and non-elective income, the latter resulting from
the Trust's inability to increase capacity quickly enough. JDY drew the
Board's attention to paragraph 4.1.3 which detailed the factors behind
this. Reviews with Directorates in deficit at the end of month 2 reinforced
the requirement for Executive
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team focus on this.
JDY reported that, overall, the Trust delivered a surplus of £1.4m in the
first two months of the year but this was £1.341k behind plan for the
period and unless the run rate improved, this level of performance would
be insufficient to enable the Trust to meet the target set by the SHA of a
surplus of £15.m at year end.
A
This position highlighted the risk attached
to delivering surplus through service re-design; it was therefore vital to
have further contingency plans in hand. The Board noted the position
and reflected upon the situation.
LP wished to be able to take a view next month on the optimistic
elements of the CRES programme;
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JDY would look again at projected
savings through procurement, rostering and absence planning. PDR
advised that a formal forecast for Quarter 1 would be undertaken;
papers may not be ready in time for the Board but the Executive team
would be in a position to give a view to the July Board. He counselled
on the need for the Board to hold its nerve on the ongoing major
projects.
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The Board noted the finance report and the need to maintain pressures
on delivery change. No changes to the layout were requested.
93/07 Chief Executive's Report
PDR did not wish to add anything to his previously circulated report,
excepted to mention the forthcoming Hospital Ball on 1 September
2007, which he encouraged Board members to support. The Trust's
Deputy Director of Professional Practice, Madeleine Jephcott, was
organising this.
94/07 Human Resources Director's Report
The Board noted this report.
The Board briefly discussed procedures for consultant panels. CLJ was
aware that these procedures required sharpening and was acting on
various comments that had been brought to her attention. The
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procedure for the Workforce Panel was also discussed and the
importance of maintaining strict controls on recruitment was noted; when
all Directorates had had their workforce plans signed off and financial
autonomy granted to those Directorates who had earned it, the
requirement for the Workforce Panel would be reviewed. In the
meantime, whilst the procedure may sometimes result in delays due to
individuals failing to provide the information requested of them, it would
continue.
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95/07 Documents Signed and Sealed Report
This was noted by the Board.
96/07 Minutes of the Charitable Funds Committee meeting, 3 May 2007
This was noted by the Board.
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98/07 Any Other Business
JB reported that Nigel Taylor's
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term of office as NED had come to an
end and he had now left the Trust. Consequently, there was a need to
appoint a new deputy Chairman of the Trust Board. JB had asked
Louise Hardy to take up this position and she had accepted. The Board
approved this appointment.
97/07 Minutes of the Audit Committee meeting, 11 June 2007
JB invited MS to comment. MS requested PDR attend one meeting
annually in order to comply with the Committee's Terms of Reference.
There was no other business
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and the meeting closed at 12.20 pm.
99/07 Exclusion of the Public
The Board has formally resolved to exclude the public from the next Part
II of the meeting. The resolution is in accordance with Section 1, subsection
2 of the Public Bodies (Admissions to Meetings) Act 1960, and
with the Trust’s Standing
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Orders: 3:1 and 3:2. The Part II agenda
excludes the public on the grounds that publicity would be prejudicial to
the public interest by reason of the confidential nature of the business to
be transacted.
100/07
Date of Next Meeting: Friday 27 July 2007
Signed
Date
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