Minutes of the meeting on 24 April 2009 - Plymouth Hospitals NHS ...

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Plymouth Hospitals NHS Trust
<strong>Minutes</strong> <strong>of</strong> <strong>the</strong> Trust Board <strong>meeting</strong> Part I
held on 24 April 2009
in <strong>the</strong> old Medical Library, Level 7, Derriford Hospital
1.30 pm Opportunity for Questions
Present:
John Bull, Chairman (JB)
Peter Burroughs, Non-Executive Director Designate (PB)
Ian Douglas, Non-Executive Director (ID)
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Karen Grimshaw, Director <strong>of</strong> Nursing & Midwifery (KG)
Angela Lamb, Chief Operating Officer (AL)
Barry Lucas, Patient Representative (BL)
Alex Mayor, Medical Director, Pr<strong>of</strong>essional Practice (AM)
Lee Paschalides, Non-Executive Director (LP)
David Pond, Non-Executive Director (DP)
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Margaret Schwarz, Non-Executive Director (MS)
John Yarnold, Director <strong>of</strong> Finance (JDY)
In Attendance: Julie Hendry, Director <strong>of</strong> Nursing & Midwifery (JH)
Gill Hunt, Foundation Trust Board Secretary (GH)
Christine Lloyd-Jennings, Director <strong>of</strong> Human Resources (CLJ)
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Amanda Nash, Head <strong>of</strong> Communications (AN)
Nick Thomas, Director <strong>of</strong> Strategic Planning & Information (DNT)
There were no questions.
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Present:
Plymouth Hospitals NHS Trust
<strong>Minutes</strong> <strong>of</strong> <strong>the</strong> Trust Board <strong>meeting</strong> Part 1
held at 2.00 pm on 24 April 2009
in <strong>the</strong> old Medical Library, Derriford Hospital
John Bull, Chairman (JB)
Peter Burroughs, Non-Executive Director Designate (PB)
Ian Douglas, Non-Executive Director (ID)
Karen Grimshaw, Director <strong>of</strong> Nursing & Midwifery (KG)
Angela Lamb, Chief Operating Officer (AL)
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Barry Lucas, Patient Representative (BL)
Alex Mayor, Medical Director, Pr<strong>of</strong>essional Practice (AM)
Lee Paschalides, Non-Executive Director (LP)
David Pond, Non-Executive Director (DP)
Margaret
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Schwarz, Non-Executive Director (MS)
John Yarnold, Director <strong>of</strong> Finance (JDY)
In Attendance: Julie Hendry, Director <strong>of</strong> Nursing & Midwifery (JH)
Gill Hunt, Foundation Trust Board Secretary (GH)
Christine Lloyd-Jennings, Director <strong>of</strong> Human Resources (CLJ)
Amanda Nash,
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Head <strong>of</strong> Communications (AN)
Nick Thomas, Director <strong>of</strong> Strategic Planning & Information (DNT)
Apologies: James Palmer, Medical Director, Clinical Services (JP)
Paul Roberts, Chief Executive (PDR)
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39/09 Welcome and Apologies
JB welcomed members <strong>of</strong> <strong>the</strong> press and public and noted apologies
from Paul Roberts and James Palmer.
40/09 <strong>Minutes</strong> <strong>of</strong> <strong>the</strong> last
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<strong>meeting</strong> held on <strong>the</strong> 27 March 2009
The minutes <strong>of</strong> <strong>the</strong> previous <strong>meeting</strong> were agreed as a true and
accurate record.
41/09 Matters Arising
The Board noted that <strong>the</strong>re had been no adverse feedback on <strong>the</strong>
changes to car parking charges.
42/09 Review <strong>of</strong> Actions
The Board noted <strong>the</strong> action table.
43/09 2009/10 Outline Annual Business Plan
JDY introduced <strong>the</strong> outline Annual Business Plan (ABP) and drew
<strong>the</strong> Board’s attention to <strong>the</strong> key objectives for <strong>the</strong> Trust in 2009/10,
toge<strong>the</strong>r with <strong>the</strong> measurable outcomes that underpinned <strong>the</strong>m.
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The ABP had been formulated in <strong>the</strong> context <strong>of</strong> <strong>the</strong> national
requirement implicit in <strong>the</strong> PbR tariff that trusts deliver a minimum
3% CIP in 2009/10. The Trust had achieved a surplus <strong>of</strong> £5,015k in
2008/09 and plans were in place to achieve a surplus <strong>of</strong> £9m in
2009/10. JDY detailed <strong>the</strong> frameworks in place to ensure <strong>the</strong>
successful implementation <strong>of</strong> <strong>the</strong> business plan and realisation <strong>of</strong> <strong>the</strong>
planned benefits. The Trust would be working to ensure that savings
were achieved on a timely and proportionate basis as <strong>the</strong> year
progressed.
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JDY stated that <strong>the</strong> Trust had recently finalised its position with its
commissioners and colleagues in Primary Care were exploring
alternative means <strong>of</strong> providing some services to ensure appropriate
referrals. These plans were expected to be in place by June. There
had been a 7.5% increase in GP referrals in 2008/09 and by March
2009 this had increased
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to 12% overall - c7% from GPs with <strong>the</strong>
balance from consultants. Agreement had been reached with
commissioners that tariff for patients in excess <strong>of</strong> agreed referrals
would be split 25/75% between <strong>the</strong> referring PCT and <strong>the</strong> Trust,
respectively.
JDY drew <strong>the</strong> Board’s
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attention to <strong>the</strong> revisions to <strong>the</strong> Trust’s capital
plan and noted that investment in <strong>the</strong> Vanguard Gateway scheme
and Digital Mammography was dependent upon <strong>the</strong> Board’s
confidence at Quarter 2 that financial performance was on target.
44/09
The Board approved <strong>the</strong> outline business plan for 2009/10 and
<strong>the</strong> revised capital investment plan.
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Standards for Better Health Declaration
Annette Penney-Cousins, Assurance & Governance Manager,
attended for this item.
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The Board had previously considered <strong>the</strong> evidence to support its
declaration in <strong>the</strong> private part <strong>of</strong> <strong>the</strong> <strong>meeting</strong>; discussion in this part
<strong>of</strong> <strong>the</strong> Board focused on those standards on which compliance had
been agreed as ‘not met’ and ‘not met at year end’. PC stated that
Internal Audit had verified <strong>the</strong> evidence files and supported <strong>the</strong>
assessments made.
C2 – assessed as ‘not met’ due to insufficient availability <strong>of</strong> L3
training places. The Board noted this was a multi-agency problem.
Agreed by <strong>the</strong> Board.
C4a – assessed as ‘not met’ due to Care Quality Commission (CQC)
intervention. Agreed by <strong>the</strong> Board.
C4c – assessed as ‘not met’ due to CQC intervention. Agreed by
<strong>the</strong> Board.
C5a – assessed as ‘met at year end’ due to carry over <strong>of</strong> pre-2006
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tags. AM stated that pre-September 2006 guidance had been
reviewed and evidence agreed with clinical teams; <strong>the</strong> Trust was
compliant at year end. Agreed by <strong>the</strong> Board.
C7a – assessed as ‘met at year end’. The issue concerned <strong>the</strong>
breach <strong>of</strong> <strong>the</strong> Hygiene Code in July 2008, this was flagged in
February. Agreed by <strong>the</strong> Board.
C9 – assessed as ‘not met’. DNT stated that progress was slow but
o<strong>the</strong>r Trusts were
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in <strong>the</strong> same position.
C20b – assessed as ‘met at year end’. KG stated that she was
satisfied with <strong>the</strong> evidence at year end and <strong>the</strong>re was now improved
reporting and monitoring <strong>of</strong> mixed sex bays. Agreed by <strong>the</strong> Board.
C21 – all elements
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not met and assessed as ‘not met’ and agreed by
<strong>the</strong> Board.
On completion <strong>of</strong> <strong>the</strong> review, five standards were identified as ‘not
met’ and four standards were identified as ‘met at year end’. The
Board noted that on this basis <strong>the</strong> Trust would be scored as ‘partly
met on both counts’ and <strong>the</strong> overall score for service could be no
better than ‘fair’.
The Board agreed that standards C2, C4a, C4c, C9 and C21
were ‘not met’ and standards C4b, C5a, C7a and C20b were ‘met
at year end’.
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The declaration would include third party opinion on <strong>the</strong> Trust’s
services and comments received to date had been broadly
supportive. PC circulated <strong>the</strong> Standards for Better Health declaration
sign-<strong>of</strong>f sheet and asked voting Board members to append <strong>the</strong>ir
signature.
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On behalf <strong>of</strong> <strong>the</strong> Board, JB thanked PC and his team for <strong>the</strong>ir hard
work in collating and verifying <strong>the</strong> evidence and guiding <strong>the</strong> Board
through each <strong>of</strong> <strong>the</strong> standards.
45/09
Complaints and PALs Report
AM presented <strong>the</strong> Complaints and PALs report. Information from
complaints and feedback from patients was extremely valuable to
<strong>the</strong> Trust in terms <strong>of</strong> helping to understand where <strong>the</strong> Trust failed to
meet users’ expectations and where services could be improved.
Complaints were taken extremely seriously and provided a rich
source <strong>of</strong> learning for <strong>the</strong> Trust. The Board noted <strong>the</strong> breakdown <strong>of</strong>
complaints by category and noted that <strong>the</strong> trend towards a decrease
in formal complaints and PALs contacts had not been maintained in
<strong>the</strong> final quarter <strong>of</strong> <strong>the</strong> year.
BL queried <strong>the</strong> reporting <strong>of</strong> swabs retained in patients following
surgery. AM stated that all three cases were highly complex, indeed
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The Board noted <strong>the</strong> Complaints and PALs Report.
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one had involved a twelve hour operation. In one instance <strong>the</strong> swab
had not been removed for clinical reasons. All <strong>the</strong> cases had been
investigated by a senior consultant surgeon and as a result a new
policy for swab counting had been instigated in <strong>the</strong>atres. BL queried
<strong>the</strong> procedure for counting swabs and AM explained this in some
detail.
More generally, <strong>the</strong> Board discussed <strong>the</strong> increase in complaints
regarding information provision and <strong>the</strong> requirement to satisfy
patients’ thirst for knowledge.
46/09 Performance Report
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JDY stated that <strong>the</strong> Trust achieved a net surplus <strong>of</strong> £5,015k in line
with its forecast control total <strong>of</strong> £5,000k. The annual accounts had
been completed by <strong>the</strong> required deadline and <strong>the</strong> external auditors
would be with <strong>the</strong> Trust next week. On behalf <strong>of</strong> <strong>the</strong> Board, JB
thanked JDY and his team for achieving <strong>the</strong> tight turnaround time set
by <strong>the</strong> Department
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<strong>of</strong> Health.
Finance
Performance
AL highlighted performance against key standards. The Trust
continued to strive to achieve <strong>the</strong> A&E performance target and
special measures taken over Easter had worked extremely well;
<strong>the</strong>se would be repeated
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over <strong>the</strong> two Bank Holiday weekends in
May.
61 escalation beds remained open but pressure was easing
gradually and AL was cautiously optimistic <strong>of</strong> sustained
improvement. The Chief Executives’ escalation <strong>meeting</strong> was due in
<strong>the</strong> coming week.
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The Board noted that thrombolysis performance was uneven, <strong>of</strong>ten
<strong>the</strong> result <strong>of</strong> <strong>the</strong> logistics resulting from <strong>the</strong> geography <strong>of</strong> <strong>the</strong> Trust’s
catchment area. All cases were reviewed on a monthly basis to
learn where improvements might be made.
AL reported that GP diagnostic referrals had increased. Problems
may arise if PCTs were unable to manage demand effectively.
The Board noted <strong>the</strong> Performance Report.
47/09 Human Resources Director’s Report
CLJ presented highlights from her report and <strong>the</strong> Board noted that
workforce performance indicators for March were positive and in line
with Trust objectives. Sickness absence had increased slightly and
much work had been done at Directorate level to improve sickness
absence, particularly that <strong>of</strong> nurses. KG stated that work was
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ongoing with Occupational Health to manage long term sickness
rates. Work to date had been productive and she was confident that
fur<strong>the</strong>r reductions would be achieved.
The Board noted <strong>the</strong> information on workforce planning and
recruitment and DP queried <strong>the</strong> mechanism for ensuring <strong>the</strong>
workforce pr<strong>of</strong>ile matched <strong>the</strong> Trust’s Integrated Business Plan. CLJ
stated that <strong>the</strong> Workforce Planning Group reviewed service needs,
skills mix and establishment. The Board discussed <strong>the</strong> staffing <strong>of</strong>
escalation beds and
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noted that careful planning was necessary to
ensure appropriate governance around staffing. A paper on
Intermediate Care beds would be brought in June.
The Board welcomed <strong>the</strong> update on mandatory and statutory training
and agreed that a range <strong>of</strong> methodologies had helped improve takeup,
which had now
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reached 92.2% for <strong>the</strong> last twelve months. This
figure compared very favourably with o<strong>the</strong>r trusts.
The Board noted <strong>the</strong> HR Director’s report.
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48/09 Medical Directors’ Report
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AM drew <strong>the</strong> Board’s attention to <strong>the</strong> European Working Time
Directive update and to <strong>the</strong> regional support required on <strong>the</strong>
recruitment <strong>of</strong> junior doctors. Plans were in place nationally to fast
track <strong>the</strong> process.
The Board noted
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<strong>the</strong> infection control update. JH explained that
Bickleigh, Shaugh, Hexworthy, Bracken and Birch wards rarely used
central lines and <strong>the</strong>refore observational evidence under <strong>the</strong> Saving
Lives initiative was extremely difficult to obtain from <strong>the</strong>se wards.
More generally, KG stated that administrative procedures were being
improved to ensure more accurate and appropriate reporting <strong>of</strong>
infection control data
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from wards.
The Board noted <strong>the</strong> Medical Directors’ report.
50/09 Chief Executive’s Report
In PDR’s absence, JB stated that despite <strong>the</strong> delay to <strong>the</strong> Trust’s
Foundation Trust application, <strong>the</strong> Board intended to engage with <strong>the</strong>
public and staff on <strong>the</strong> future <strong>of</strong> <strong>the</strong> Trust and although <strong>the</strong> elected
governors would not now have any formal role, <strong>the</strong> Trust would meet
with elected and appointed representatives, as originally planned on
1 May, to update <strong>the</strong>m on <strong>the</strong> process.
51/09 Any O<strong>the</strong>r Business
MS requested an update on fractured neck <strong>of</strong> femur. AL stated that
<strong>the</strong> business case was complete and was due to be considered by
<strong>the</strong> Business Investment Group at its next <strong>meeting</strong>. Two evening
trauma lists were in place, toge<strong>the</strong>r with a dedicated orthopaedic
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discharge co-ordinator, all self-funding through existing resources.
52/09 Date <strong>of</strong> next <strong>meeting</strong>
Friday 29 May 2009
Signed
Dated
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