View March's Board Pack - Royal Bournemouth Hospital

THE ROYAL BOURNEMOUTH AND CHRISTCHURCH HOSPITALSNHS FOUNDATION TRUSTA meeting of the Board of Directors will be held on Friday 11 March 2011 at 8.30am in theCommittee Room at the Royal Bournemouth HospitalIf you are unable to attend on this occasion, please notify me as soon as possible on 01202704777.Rebecca LawryTRUST SECRETARYA G E N D A1. APOLOGIES FOR ABSENCEAPPENDIX2. MINUTES OF THE PREVIOUS MEETING(a) To approve the minutes of the meeting held on 11 February 2011 A(b) To provide updates to the Actions Log B3. MATTERS ARISING(a) Contract Update (Ref 15/11(c)) Richard Renaut Verbal(b) Assessment of ED standards (Ref 16/11(a)) Helen Lingham Verbal4. PERFORMANCE(a) Performance Report Helen Lingham C(b) Financial Overview Stuart Hunter D5. STRATEGY(a) Update on the Annual Plan Richard Renaut Verbal6. DECISION(a) Appointment of new Nurse Director Tony Spotswood E(b) Director Interests Rebecca Lawry F7. DISCUSSION(a) Briefing – Location and Provider of In-PatientHaematology Services(b) Equity and Excellence: Liberating the NHS –Managing the TransitionTony SpotswoodTony SpotswoodGH(c) PMO Strategy Update Helen Lingham I8. INFORMATION(a) Response to the White Paper from FTGA Tony Spotswood JBoD/Agenda 11.03.2011 Page1 of 2

THE ROYAL BOURNEMOUTH AND CHRISTCHURCH HOSPITALSNATIONAL HEALTH SERVICE FOUNDATION TRUSTMinutes of a Meeting of the Royal Bournemouth and Christchurch Hospitals National HealthService Foundation Trust Board of Directors held on Friday 11 February 2011 in the CommitteeRoom Royal Bournemouth HospitalPresent:Mrs J StichburyMr T SpotswoodMrs H LinghamMrs K AllmanMr B FordMr S HunterMr S PeacockMr R RenautMs B AtkinsonMr P Davé(JS)(TS)(HL)(KA)(BF)(SH)(SP)(RR)(BA)(PD)Chairman (in the chair)Chief ExecutiveChief Operating OfficerDirector of Human ResourcesNon-Executive DirectorDirector of Finance and ITNon-Executive DirectorDirector of Service DevelopmentDirector of Nursing and MidwiferyNon-Executive DirectorIn attendance:Mrs R LawryMs T HallMrs D RufferMrs J RichardsMr M DesforgesMr K HockeyMrs S Carr-BrownMs M NevilleMs L WitchellMr C Wakefield(RL)(TH)(DR)(JR)(MD)(KH)(SCB)(MN)(LW)(CW)Trust SecretaryHead of CommunicationsGovernor Co-ordinatorSecretary to Trust SecretaryGovernorGovernor PCTGovernorChairman of the Friends of the BournemouthEye UnitPALS Co-ordinatorHead of LINKsApologies:Ken Tullett Non-Executive Director, Mr D Bennett Non-Executive DirectorDr M Armitage, Medical Director, Mrs Alex Pike, Non Executive DirectorNEW NON-EXECUTIVE DIRECTORJS welcomed Pankaj Davé as the new Non-Executive Director to the Board.13/11 MINUTES OF MEETING 14 JANUARY 2011The minutes of the meeting held on the 14 January 2011 (Appendix A) werereceived, accepted as a true record and signed accordingly by theChairman.14/11 Actions Log (Appendix B)(a)QIPP National Workstream (Ref: 02/11 (a)) - SH advised ameeting will be held with Poole Hospital with a business case tobe presented in April.SH_____________________________________________________________________________________BOD/PT 1 MINS 11.02.11 PAGE 1 OF 8

attending has an impact on SWAST performance. HL confirmedthat it could because we always prioritise clinically.SP noted that cancelled operations were high for December, HLadvised that this was due to consultant availability (sickness) andalso the water decontamination problems in endoscopy.SP queried the implications of the red indicator on the RTT datacompleteness scores. HL advised that we have spoken to theSHA and they are not alarmed as performance data is much moreindicative.TS asked HL for a summary of where we rank against theEmergency Department standards. HL to bring the action plan toBoard in March.HLJS noted this was a very positive report especially in light of thewinter pressures.(b) Financial Overview (Appendix E)SH introduced the report and noted the following key points: Surplus is currently £667k ahead of plan. Capital is now back in line with revised forecast and weexpect to reach this by year end. Sickness levels are around 4% and this is being reviewed. Monitor indicators are now all green.JS noted that sickness levels continue to be of concern. KAcommented that sickness levels within the Trust are deemedaverage when compared to other trusts. She advised that theWorkforce Committee are reviewing practice in high performingtrusts but commented that this invariably relies on rigorousmanagement control of sickness. TS noted that positive resultshave been evident in areas where we have undertaken in depthreviews. He suggested that attempts should be made to reducesickness by 1% as this would have a significant impact. TS askedKA to bring a report back showing the monthly tracking. HLsuggested adding this to the performance report from April.KA(c)Transformation Updates17/11 STRATEGYSH noted that there was nothing further to add here.Annual Plan(Appendix F)RR introduced the draft Annual Plan and explained that this year we haveengaged external parties for the pre consultation phase. RR noted that thisaddresses improving patient outcomes and the Transformation Programme._____________________________________________________________________________________BOD/PT 1 MINS 11.02.11 PAGE 3 OF 8

18/11 DECISIONHe reported that there are four areas:1. Emergency services and front door services2. Our relationship with GPs3. High dependency beds4. Discharge and readmission processTS commented that the structure was excellent and suggested that weerect explanation boards at Christchurch describing how the changes willimpact on services and give local people the opportunity to express viewsaround the two options. TS noted that we need to make the savings that wehave identified more visible as this will provide reassurance to staff and alsothe GPs.JS thanked everyone for their hard work on this.(a)Stroke Business CaseHL advised that this is a clinically driven business case and willallow rehabilitation to start from the point of admission. She notedthat the focus has been on getting the quality of care right andthen delivering our performance targets. HL explained that ifapproved we will have the integrated Stroke Unit by early Autumnand this will enhance multi professional working by making thebest use of all staff. As a consequence of improved quality of carewe will be able to concentrate the number of beds needed whileenhancing the skill mix.BA advised that the proposed design of the unit, will ensure wewill have the correct levels of staff to enable the proper function ofthe service.SH advised that this case was discussed at the FinanceCommittee and there are commercial interests which will need tobe discussed in the Part II Board meeting.RR advised that this will lead to better outcomes for patients. Thenumber of patients treated will be the same even with a reductionin beds.BF noted that Christchurch is more like a rehabilitation centre thana ward and wanted some assurance that this will be replicated. HLadvised that clinicians and patients have been involved in thedesign and they will continue to be involved to ensure we get itright.KA noted the need for an equality impact assessment. HL agreedto ensure this is done.HL_____________________________________________________________________________________BOD/PT 1 MINS 11.02.11 PAGE 4 OF 8

19/11 DISCUSSIONTS noted the need for sensitivity given the charitable funding thathas gone into the existing stroke service. He also enquired aboutthe flexibility of the design. HL advised that the unit will be builtaround a 36 bedded model but only 32 will be commissioned, thiswill allow flexibility for peaks in admissions and create more siderooms for managing infection.PD asked for assurance that the future service has beenconsidered given the demographics and age profile within thearea. HL confirmed that we have looked over the next 5 yrs andbelieves the unit has been sized correctly.SP asked if it is to be a 24/7 service. HL advised that it will be a 7day service model across all grades. SP asked how same sexaccommodation will be catered for in this area. HL advised thatHDU does mix patients of both genders because of the level ofcare required and this is agreed through guidance, but other areasof low acuity will be.It was noted that the Board supports the plan and furtherdiscussion of the financial detail will ensue in Part II of the Boardmeeting before making a final decision.(a)Strategy and ConsultationTS reported on feedback received so far on the Annual Plan: There is concern for the future pattern of care for Maternityand how that links with Obstetric Services at Poole. Henoted that this discussion is ongoing with GPs, the PCTand Poole. There is concern for the services provided at Christchurch.He noted that the nursing staff have consistently said weneed to centre all inpatient services on one site here atRBH, but added that we need to think about this for winterpressure 2012/13. Neil Butterworth had been briefed and was helpful inconfirming areas of wider public interest. MPs have been generally supportive.TS noted following a meeting with the GP Commissioning Teamthat there is some work to be done on understanding the impactand consequences of decisions. TS advised that there was somepotential interest from GPs to use the site in the future, but thePCTs have not agreed this.TS confirmed that the consultation process has started well andwe must work to explain the two options clearly to allow allstakeholders to understand and make their views known._____________________________________________________________________________________BOD/PT 1 MINS 11.02.11 PAGE 5 OF 8

(b)Health and Social Care BillTS advised on the impact of the Bill. He noted in particular: the extended role that the Governors will play andsuggested that input be sought from the FTN and FTGA. the private patient cap will probably not become statuteuntil late 2011. FTs will no longer be required to denounce their FT titlesduring M&As. He noted that there is still significant work tobe undertaken before it becomes a simpler process but thisis a step forward. A new Chairman is being appointed to Monitor and weawait to hear who has been appointed.(c)Spinal SurgeryTS advised that Poole withdrew from the bidding process as itwould not have the theatre capacity to accommodate this workparticularly in light of plans it had to temporarily resite capacity forcaesarean sections.HL advised that this is an exciting opportunity but also achallenge. A clinical group has been set up and she noted that weneed to look at it as a musculoskeletal service not just spinalsurgery. The bid is joint with Southampton as we do not takeorthopaedic trauma. The service will be configured withpredominantly elective surgery here and trauma at Southampton.HL noted that this does pose some operational challenges and weneed to make sure that the contracting process is right to ensurequality care. To accommodate this within our existing theatretemplate we will need to make some significant changes, runningan 8.00-6.30 timetable. This will go to the Finance Committee andcome back to Board in due course.RR advised that many spinal units make a loss, but thecontracting has changed this year. We intend to be lessinterventional and provide non surgical care and painmanagement where appropriate.HL agreed to bring back an overview in March of the criticalplanning with the resourcing process. TS suggested addinginpatient Haematology and other developments to this.HL20/11 INFORMATION(a)Cancer reform strategy_____________________________________________________________________________________BOD/PT 1 MINS 11.02.11 PAGE 6 OF 8

HL advised that the national strategy paper was released recentlyand Sue Higgins is looking at local implementation.HL suggested putting this in a Blue Skies session. JS agreed andsuggested including benchmarking and more information onpalliative care and education.HL(b) Core Brief (Appendix N)The Report was noted for information and TS reminded the Boardthat the Picker feedback will be presented on 22 nd Feb in theEducation Centre.(c) Communications Update (Appendix O)RR advised that the staff awards are opening again and the eventwill be held on 7 th September.TS commented on the patient films, he noted that this is a greatsuccess in terms of how we communicate with patients. It is aneffective way of getting over to the patients what they are going toexperience and is a process of reassurance.(d) Board of Directors Forward Programme (Appendix Q)21/11 DATE OF NEXT MEETINGRL requested any updates to the programme in advance of theMarch Board paper deadline. She noted that going forward theplaner will be used to drive the monthly agendas.Friday 11 March 2011 at 08.30am in the Committee Room at RoyalBournemouth Hospital22/11 ANY OTHER BUSINESS(a)Audit Committee membershipRL advised that due to sickness and annual leave the AuditCommittee would be short of a Non-Executive Director. PankajDavé volunteered to attend and the Board agreed.(b)JigsawRR advised that the Events Programme has increased the numberof events and noted in particular the Twilight walk for women.23/11 3 Communications points for staff1. Annual plan2. Stroke Unit_____________________________________________________________________________________BOD/PT 1 MINS 11.02.11 PAGE 7 OF 8

3. Continued preparations for the changes in Health Bill4. Thanks to staff for their performance24/11 QUESTIONS FROM GOVERNORS1. MD requested that further training be offered for Governors.2. MD asked if going forward total numbers can be given for allperformance data thereby providing context. HL advised that theyare revising the report currently and will look to where we can give abetter indication of volumes of work.3. MD asked why we are having difficulty in reaching the 60% target forseeing stroke patients. HL advised that 7 day working is not done inany hospital yet. She noted that improvements are being made andagreed that timeliness must be addressed.4. SCB advised that she had held a meeting with Department of Health(DoH) and the Foundation Trust Network and had suggested thatthere must be a national push to ensure Governors can fulfil theposts required of them._____________________________________________________________________________________BOD/PT 1 MINS 11.02.11 PAGE 8 OF 8

THE ROYAL BOURNEMOUTH AND CHRISTCHURCH HOSPITALSNATIONAL HEALTH SERVICE FOUNDATION TRUSTActions carried forward from a Meeting of the Royal Bournemouth and Christchurch Hospitals National Health Service FoundationTrust Board of Directors held on Friday 11 February 2011.14/11 Actions Log (Appendix B)(a)QIPP National Workstream (Ref: 02/11 (a)) - SH advised ameeting will be held with Poole Hospital with a business case tobe presented in April.SHAgenda item15/11 MATTERS ARISING(a)TS noted that in light of David Flory’s letter, further discussionwould be needed with the PCT on our end of year position. RR Verbal update(b)TS advised on the Clinical responses to downturn, that MA hasasked Clinical Directors to look at these and will raise this at TMBand then report back to the Board.RRDeferred to April(c)On the Contract update, RR noted that there is more work to bedone and agreed to bring this back in April. RR Agenda item16/11 PERFORMANCE(a) Performance Report (Appendix C) DToC our winter ward was put in place from January toimprove DToC and we have spent £1/2m to reduce impactof winter for Dorset. HL is pursuing this with both PCTs.TS asked HL for a summary of where we rank against the HL Verbal updateEmergency Department standards. HL to bring the action plan to__________________________________________________________________________________________________________________BOD/14.01.2011 PAGE 1 OF 2

18/11 DECISIONBoard in March.(b) Financial Overview (Appendix E)TS suggested that attempts should be made to reduce sicknessby 1% as this would have a significant impact. TS asked KA tobring a report back showing the monthly tracking. HL suggestedadding this to the performance report from April.(a) Stroke Business CaseHLKAAgenda itemAgenda item19/11 DISCUSSIONKA noted the need for an equality impact assessment. HL agreedto ensure this is done. HL Verbal update(b) Spinal Surgery20/11 INFORMATIONHL agreed to bring back an overview in March of the criticalplanning with the resourcing process. TS suggested addinginpatient Haematology and other developments to this. HL Deferred to April(a) Cancer reform strategyHL suggested putting this in a Blue Skies session. JS agreed andsuggested including benchmarking and more information onpalliative care and education. HL To be arranged__________________________________________________________________________________________________________________BOD/14.01.2011 PAGE 2 OF 2

THE ROYAL BOURNEMOUTH AND CHRISTCHURCH HOSPITALSNHS FOUNDATION TRUSTBOARD OF DIRECTORSMeeting Date and Part: 11 March 2011 (Part 1)Subject:Performance ReportSection:PerformanceExecutive Director with overallresponsibility:Helen Lingham, Chief OperatingOfficerAuthor of Paper:David Mills, Head of InformationSummary:Monthly review of performanceagainst DoH targetsStandards for Better Healthdomain:GovernanceAction required by Board ofDirectors:Note for information

Board of Directors (Part 1)11th March 20111 Purpose of the ReportPerformance MonitoringThe report outlines the Trust’s position against key access and performancetargets for the month of January 2011 as set out in the Monitor ComplianceFramework and Quality Care Commission requirements.2 Cancer Waiting TimesThis report illustrates the Cancer Waiting Times performance figures forDecember 2010. The targets are as follows: Maximum 14 day wait from urgent GP referral for suspected cancer Maximum 14 day wait for systematic breast patients Maximum 31 day wait from diagnosis to treatment for all cancers Maximum 31 day subsequent treatment Maximum 62 day wait from urgent referral to treatment for all cancers Maximum 62 day consultant upgrade Maximum 62 day screening patients.Table 1 illustrates the December 2010 figures against the new thresholds.Table 1 December 2010 New Thresholds2 week wait 93.0% 93%2 week wait for symptomaticbreast patients100% 93%31 Day – 1 st treatment 99.1% 96%31 Day – subsequenttreatment100% 96%62 Day – 1 st treatment 95.9% 85%62 day – Consultantupgrade100% 90%62 day – screening patients 100% 90%In December 2010 all the cancer targets were achieved. Variance from100% was due to patient choice.Performance Monitoring Page 1 of 13For Information

Board of Directors (Part 1)11th March 2011Non-Admitted Pathways (Target 95%)The Trust achieved 99.7% for the aggregate non-admitted performance inJanuary. All specialities achieved the 95% target.Part 1b - Total Non-Admitted Patients Clock StoppedCodeTreatment function/clinical18 WeekareaPerformance TotalNo's % No's100 General Surgery 393 99.7% 394101 Urology 115 100.0% 115110 Trauma & Orthopaedics 171 98.8% 173120 ENT 125 99.2% 126130 Ophthalmology 418 100.0% 418140 Oral surgery 100 100.0% 100150 Neurosurgery 0 0.0% 0160 Plastic surgery 0 0.0% 0170 Cardiothoracic Surgery 0 0.0% 0300 General medicine 432 99.1% 436301 Gastroenterology 0 0.0% 0320 Cardiology 197 99.5% 198330 Dermatology 261 100.0% 261340 Thoracic Med 220 100.0% 220400 Neurology 80 100.0% 80410 Rheumatology 273 99.6% 274430 Eld Med 0 0.0% 0502 Gynaecology 226 100.0% 226Other 853 99.8% 855Total 3864 99.7% 3876RTT Data Completeness IndicatorThis is a data quality measure to validate the 18 week RTT data. It comparesthe number of admitted and non-admitted clock stops with the number ofoutpatient first attendances and elective admissions.The target range for the 18 week data completeness indicator is to be within75% to 125%. Failure of the data quality test for admitted or non-admittedpatients can result in the relevant part being validated as “data not returned”and could lead to failure of the overall indicator.December’s RTT performance was close to failing the upper indicatorthreshold, this was due to a reduction in the ratio of first outpatientattendances to the number of elective spells.RTT Data Completeness ScoresScore Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11Admitted 105.5% 103.0% 108.8% 106.3% 107.9% 108.6% 107.1% 109.2% 106.6% 108.3%Non-Admitted 103.3% 96.9% 102.4% 95.2% 103.9% 95.0% 109.5% 111.6% 123.3% 103.8%Performance Monitoring Page 3 of 13For Information

Board of Directors (Part 1)11th March 20114 4 Hour Emergency TargetEmergency access95% of patients to wait 4 hours or less in Emergency Department fromarrival to admission, discharge or transfer, across the local health communityFor the month of January the Trust achieved 99.2% overall against the 4hour turnaround target. The year to date performance is 99.2%.Weekly Emergency Department 4 hour Performance from April 09100.0%99.0%98.0%97.0%Percentage96.0%95.0%94.0%DataAverageLower limitUpper limit93.0%92.0%91.0%90.0%05/04/0905/05/0905/06/0905/07/0905/08/0905/09/0905/10/0905/11/0905/12/0905/01/1005/02/1005/03/1005/04/1005/05/1005/06/1005/07/1005/08/1005/09/1005/10/1005/11/1005/12/1005/01/1105/02/11Ambulance handover delaysHandover timesAmbulance Crews should take no more then 15 minutes to off load andhandover patients to the Emergency DepartmentThe graph below illustrates the latest validated performance in ambulancehandover times over 15 minutes compared to the total number of ambulancehandovers. From the 24 th January 2011 SWAST started to report theagreed validated position.Performance Monitoring Page 4 of 13For Information

Board of Directors (Part 1)11th March 2011500Patient Handovers -Over 15 Minute Trajectory45040035030025020015010050020/04/0908/06/0927/07/0914/09/0902/11/0921/12/0908/02/1029/03/1017/05/1005/07/1023/08/1011/10/1029/11/1017/01/11w.c>15 Minute Actual >15 Minute Trajectory Validated >15 minutes Total HandoversThe emergency department continues to experience some particular peaksin activity which has created acute backlogs on a few occasions. At thesetimes, the Trust’s Escalation and Business Continuity Policies have beenimplemented to ensure sufficient capacity and restore ‘flow’ through theEmergency Department, whilst also trying to reduce the impact onambulance handovers.A detailed action plan has been developed to improve performance againstthis target and particularly to reduce long delays, which includes a formalescalation process for ambulance delays. The Trust also continues to workjointly with SWAST.Performance Monitoring Page 5 of 13For Information

Board of Directors (Part 1)11th March 20115 Infection ControlMRSAIn January there were no hospital acquired bacteraemia. This year the Trusthas a de minimis target of 6 (Monitor) and a stretch target of 4 (PCT/SHA).MRSA Monitoring 2010/117654MRSA cases pre 48 hrsMRSA cases post 48 hrsCumulative casesTarget - ContractTarget - Stretch3210Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11MRSA ScreeningThe Trust continues to meet the MRSA screening target for elective patients.Achievement over 100% occurs as this target is calculated by dividing thenumber of admissions by the number of screens. Some admitted patientsreceive more than one screen.MRSA Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11Elective Admissions 3466 3371 3762 3582 3497 3698 3722 3944 3608 3488No of MRSA Screens 4141 4254 4558 4363 4084 4205 4075 5169 4511 4828% MRSA Screening 119% 126% 121% 122% 117% 114% 109% 131% 125% 138%Internal audit of the new non elective screening shows good compliance.Data will be produced routinely following approval of exclusions with thePCT.Performance Monitoring Page 6 of 13For Information

Board of Directors (Part 1)11th March 20118 Cancelled OperationsCancelled operationsAll patients cancelled on the day of admission or after admission fornon-medical reason to be admitted for treatment within 28 days orhave their treatment funded at the time and hospital of the patient’schoiceTarget:

Board of Directors (Part 1)11th March 20119 15 Key Diagnostic TestsThe table below reflects the patients currently waiting for one of the 15 keydiagnostic tests. At the end of January there were 95 patients waiting over 6weeks.As previously stated we will not clear this in total until the end of thisfinancial year.January 2011 15 Key Diagnostic TestsCategoryImagingPhysiologicalMeasurementEndoscopyDiagnostic Test< 06 06 < 07 07 < 08 08 < 09 09 < 10 10 < 11 11 < 12 12 < 13 13+Magnetic Resonance Im 566 0 0 0 0 0 0 0 0Computed Tomography 371 0 0 0 0 0 0 0 0Non-obstetric ultrasound 902 0 0 0 0 0 0 0 0Barium Enema 5 0 0 0 0 0 0 0 0DEXA Scan 234 0 0 0 0 0 0 0 0Audiology - Audiology A 0 0 0 0 0 0 0 0 0Cardiology - echocardio 295 0 0 0 0 0 0 0 0Cardiology - electrophys 0 0 0 0 0 0 0 0 0Neurophysiology - perip 0 0 0 0 0 0 0 0 0Respiratory physiology 0 0 0 0 0 0 0 0 0Urodynamics - pressure 117 0 0 0 0 0 0 0 0Colonoscopy 119 12 15 9 8 7 4 0 1Flexi sigmoidoscopy 115 12 6 4 2 2 0 0 0Cystoscopy 186 2 1 0 0 0 0 0 0Gastroscopy 196 3 2 1 1 2 0 1 0Total 3106 29 24 14 11 11 4 1 1The appointment of the new Fellow has now commenced with theConsultant appointment due late February. It is expected that this will assistin reducing the endoscopy 6 week wait breaches. A recent meeting with thePCT and GP representatives demonstrated that the trend in increasingdemand is appropriate and further work is required to understand capacityrequirements for the future.Performance Monitoring Page 10 of 13For Information

Board of Directors (Part 1)11th March 201110 Delayed Transfers of CareDelayed transfers of care to be maintained at a minimal levelNumber of patients whose transfer of care was delayed as aproportion of the total numbers of patients admitted, reported on aweekly basisThe position for January is 1.8% of acute patients were reported withdelayed transfers of care.Weekly Delayed Discharges Occupancy Rate for 2010.11DTOC Actual for WeekDTOC Actual YTD3.5% Trajectory9.0%8.0%7.0%6.0%5.0%4.0%3.0%2.0%1.0%0.0%29/03/10-04/04/1012/04/10-18/04/1026/04/10-02/05/1010/05/10-16/05/1024/05/10-30/05/1007/06/10-13/06/1021/06/10-27/06/1005/07/10-11/07/1019/07/10-25/07/1002/08/10-08/08/1016/08/10-22/08/1030/08/10-05/09/1013/09/10-19/09/1027/09/10-03/10/1011/10/10-17/10/1025/10/10-31/10/1008/11/10-14/11/1022/11/10-28/11/1006/12/10-12/12/1020/12/10-26/12/1003/01/11-09/01/1117/01/11-23/01/1131/01/11-06/02/1114/02/11-20/02/1128/02/11-06/03/1114/03/11-20/03/11The table below shows the site split for all delayed transfers of care patients.Performance Monitoring Page 11 of 13For Information

Board of Directors (Part 1)11th March 2011RBHChristchurch403530252015105001/11/10 ‐ 07/11/1008/11/10 ‐ 14/11/1015/11/10 ‐ 21/11/1022/11/10 ‐ 28/11/1029/11/10 ‐ 05/12/1006/12/10 ‐ 12/12/1013/12/10 ‐ 19/12/1020/12/10 ‐ 26/12/1027/12/10 ‐ 02/01/1103/01/11 ‐ 09/01/1110/01/11 ‐ 16/01/1117/01/11 ‐ 23/01/1124/01/11 ‐ 30/01/1131/01/11 ‐ 06/02/1107/02/11‐13/02/1114/02/11‐20/02/11The table below shows the breakdown of January SITREP reportabledelayed transfers of care by reason.Acute Delayed Discharges by Reason for Delay:A) Completion of AssessmentHealthSocialServicesB) Public FundingC) Further non acute NHS care (includingintermediate care, rehabilitation etc)D) Care Home placementi) Residential Home 2 4ii) Nursing Home 2E) Care package in own home 2F) Community Equipment/adaptionsG) Patient or family choiceH) DisputesI) Housing ‐ patients not covered by NHS andCommunity Care ActTOTAL 2 8Performance Monitoring Page 12 of 13For Information

Board of Directors (Part 1)11th March 201111 Venous Thromboembolism (VTE)Prevention of Venous Thromboembolism (VTE)The number of adult hospital admissions who are being risk assessedfor Venous Thromboembolism (VTE) to allow appropriate prophylaxisbased on national guidance from NICE (Target 90%)This is a new target which started in June 10. Performance continues to beexcellent; the Trust achieved 92.8% of patients being risk assessed for VTEin January.Venous Thromboembolism (VTE)Score Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11VTE Assessments 88.4% 90.6% 90.2% 91.5% 94.3% 91.8% 92.8% 92.8%12 RecommendationThe Board of Directors is requested to note performance and theongoing work which will support compliance with the new Monitorregulations from December 2010.HELEN LINGHAMCHIEF OPERATING OFFICERPerformance Monitoring Page 13 of 13For Information

APPENDIX 12010/11 Performance RAG Report for March 2011 TMB and Board MeetingsTargetPeriodIndicator Key Performance Indicators National Stretch Jan-11YTD(1011)InfectionControlCancerElectiveAccessEmergencyAccessCardiacStrokeMRSA Bacteremias: Hospital & Community Accquired 6 4 0 1Clostridium difficile year on year reduction 4/1000 83 2 402 weeks - Maximum wait for urgent suspected cancer referrals from GP 93% 93% 93.0% 93.6%2 week wait for symptomatic breast patients 93% 93% 100.0% 97.9%31 Day – 1st treatment 98% 96% 99.1% 99.4%31 Day – subsequent treatment 98% 96% 100.0% 100.0%62 Day – 1st treatment 86% 85% 95.9% 89.2%62 day – Consultant upgrade 86% 90% 100.0% 100.0%62 day – screening patients 86% 85% 100.0% 98.5%18 weeks referral to treatment - Admitted 90% 90% 96.9% 97.1%18 weeks referral to treatment - Non Admitted 95% 95% 99.7% 99.7%Inpatient waits - No. of patients who breached 26 weeks 0 0 0 0Outpatient waits - No. of patients who breached 13 weeks 0 0 0 015 Key Diagnostics - Patients who breached 6 weeks 0 0 95 627% of patients meeting 4 hour maximum wait in Emergency dept 98% 98% 99.4% 99.1%% of patients meeting 2 hour maximum wait in Emergency dept 50% 55.4% 53.1%Ambulance - Ensure all patients are transferred within 15 mins of arrival 100%RAPC - Patients to be seen within two weeks 100% 100% 100.0% 100.0%Reperfusion - Call to needle time within 60 minutes 68% 68% 80.0% 92.6%Revascularisation - Maximum wait of 13 weeks 100% 100% 100.0% 100.0%MINAP AuditStroke patients are treated on a dedicated stroke ward for 90% of spell 65% 65% 67.0% 74.2%% of high risk TIA cases investigated & treated within 24hrs 60% 60% 53.0% 49.0%GUM GUM - Patients offered an appt within 48 hrs of contacting the service 100% 100% 100.0% 100.0%Cancelled OPs No. of cancelled operations not rebooked within 28 Days 100% 100% 0 8DTC Delayed Transfers of Care - kept to a minimum level 3.5% 2.5% 1.8% 4.2%

THE ROYAL BOURNEMOUTH AND CHRISTCHURCH HOSPITALSNHS FOUNDATION TRUSTBOARD OF DIRECTORSMeeting Date:11 th March 2011, Part ISubject:Financial PerformanceSections:PerformanceExecutive Director with overallresponsibility:Stuart Hunter, Director of Finance & ITAuthor of Paper:Phil Trevorrow, Deputy Director ofFinanceSummary:Review of the financial performance forJanuary 2011Standards for Better Health domain:GovernanceAction required by TrustManagement Board:Note for Information

Board of DirectorsMarch 2011Financial Performance1. IntroductionThis report summarises the Trust’s top-level performance for January 2011.This includes patient activity, income and expenditure and key financialindicators.2. OverviewThe cumulative position for the Trust as a whole is a favourable one, withincome on plan and expenditure variances being within 0.4% of the year todate (YTD) plan. The very positive position previously reported continues anddemonstrates overall stability in the management of the budgets.3. ActivityJanuary has seen a continuation in inpatient over-performance with the yearto date variance standing at 2,027 (4.2%). Non-elective spell varianceincreased to by 203 cases in month to 1293 YTD (5.6% variance to plan. Outpatientactivity YTD is now stands at 15,162 attendances above plan (6%variance) although the actual activity is less than that recorded for the sameperiod in the previous financial year. Emergency department attendances arebelow plan by 778 (1.4%) YTD.4. IncomeIncome overall was ahead of plan in January by £42k, with the YTD positionnow ahead of plan at £46k favourable compared with the YTD budget. Aftermarginal adjustments, PBR income has over-performed by £92k YTD withsmall variances across all points of delivery. The majority of non-PBRunderperformance is due to interest receivable being lower than planned by£156k YTD.5. ExpenditureJanuary’s expenditure was close to budget overall recording a favourablevariance of £62k. There were high levels of cost and volume drugsexpenditure in month, off-set with the income received. YTD expenditure isnow £729k under plan. Pay is currently £1,619k under-spend against planYTD highlighting successful budgetary control.6. Summary FinancialsKey Performance Indicators (KPI’s)Earnings Before Interest, Taxation, Depreciation and Amortisation(EBITDA)Financial Performance Page 1 of 2For information

Board of DirectorsMarch 2011The EBITDA ratio is one of the key KPI’s the Foundation Trust is monitoredagainst and shows an 8.3% return YTD against the annual target of 6.1%.This is a favourable position cumulatively. In terms of the Monitor financial riskrating; this performance combined with other indicators in the matrixtranslates to a financial rating of 4 and compares with a planned rating of 3.The highest rating is 5.Net SurplusThe net surplus is recorded at £5,329k against the plan YTD of £4,555k,resulting in a YTD favourable variance of £775k.Transformation Programme (TP)The programme continues to over perform against target. As at month 10, therecorded savings amount to £9,078k against a target of £7,616k. The forecastoutturn savings figure now stands at £10,676k. Of this sum, £2,038k is nonrecurrent.Capital expenditureExpenditure is currently under target, standing at £3,358k (£208k under).Expenditure on the X ray room 10 scheme was made during the monthbringing the scheme to completion. Outturn is forecasted to be on target forthe year at £4,862k.7. WorkforceStaffing numbers continue to be below establishment by 155 wte’s in themonth (4.2%). The establishment has temporarily increased for winterpressures for the second consecutive month. Sickness levels remain similarto previous levels at 4.2% and very close to the target of 4%.8. Monitor Risk IndicatorsAll indicators are green.9. RecommendationThe Board is invited to note this report.Phil TrevorrowDeputy Director of Finance22 nd February 2011Financial Performance Page 2 of 2For information

The Royal Bournemouth & Christchurch Hospitals NHS Foundation Trust - Summary Performance Report as at 31st January 2011ACTIVITY 2010/11YTD2009/10Actual YTD Plan YTD ActualYTDVarianceFull yearplanPlanned same day / day cases 39,396 36,781 40,190 3,409 44,277Elective spells 11,675 11,239 9,857 -1,382 13,461Non elective spells 24,089 23,004 24,297 1,293 27,440Outpatient attendances 230,863 198,723 213,885 15,162 245,701ED attendances 55,342 55,437 54,659 -778 70,529Full yearforecastForecast vsplanvarianceINCOME 2010/11YTD2009/10Actual YTD budget YTD actual VarianceFull yearbudgetFull yearforecastForecast vsbudgetvariance£000 £000 £000 £000 £000 £000 £000Planned same day / day cases 37,722 26,253 29,222 2,969 31,769 35,872 4,103Elective spells 20,768 31,924 29,305 -2,619 38,006 33,968 -4,038Non elective spells 45,885 44,049 43,744 -306 52,501 53,749 1,248Outpatient attendances 24,952 26,024 25,996 -28 31,351 32,493 1,142ED attendances 3,661 4,198 4,234 36 5,008 5,216 208Cost and volume 18,624 14,926 14,824 -102 22,234 22,650 416Block 16,682 16,510 16,510 -0 20,159 20,159 0MFF 6,724 6,670 6,812 142 7,995 8,076 81Interest receivable 286 517 361 -156 620 400 -220Non contracted 16,211 21,514 21,623 109 20,915 18,233 -2,682Total 191,514 192,586 192,631 46 230,559 230,816 257EXPENDITURE 2010/11YTD2009/10Actual YTD budget YTD actual VarianceFull yearbudgetFull yearforecastForecast vsbudgetvariance£000 £000 £000 £000 £000 £000 £000Pay 116,840 116,178 114,560 1,619 139,695 138,260 1,435Drugs 16,803 16,902 17,773 -872 20,117 21,063 -946Clinical supplies 28,994 27,881 28,596 -714 33,789 34,298 -509Other costs 16,251 16,020 15,304 717 23,102 22,335 767Depreciation 6,419 6,979 7,002 -23 8,375 8,375 0Dividends payable 4,249 4,071 4,071 0 4,885 4,885 0Total 189,556 188,032 187,305 727 229,964 229,216 748OTHER FINANCIALS 2010/11YTD2009/10Actual YTD plan YTD actual VarianceFull yearplanFull yearforecastForecast vsplanvariance£000 £000 £000 £000 £000 £000 £000EBITDA 12,341 15,087 16,038 951 13,235 14,460 1,225EBITDA margin 6.5% 6.1% for year 8.3% 2.2% 5.8% 6.3% 0.5%Net surplus / (deficit) 1,959 4,554 5,327 773 595 1,600 1,005Transformation Programme 10,074 7,616 9,078 1,462 8,882 10,676 1,794Capital expenditure 9,266 3,563 3,358 205 4,862 4,862 0STATEMENT OF FINANCIAL POSITION 2010/11YTD2009/10ActualYTD actualFull yearplanFull yearforecastForecast vsplanvariance£000 £000 £000 £000 £000Non Current Assets 145,154 142,939 145,426 145,426 0Current assets 43,310 52,178 42,306 42,306 0Current and Non Current liabilities -23,196 -24,332 -21,241 -21,241 0Total assets employed 165,268 170,785 166,491 166,491 0Public dividend capital 78,674 78,674 78,674 78,674 0Income and expenditure reserve 13,942 20,461 15,739 15,739 0Revaluation reserve 67,035 65,957 65,957 65,957 0Donated asset reserve 5,617 5,693 6,121 6,121 0Total funds employed 165,268 170,785 166,491 166,491 0WORKFORCE 2010/11YTD2009/10Actual Establish ment Actual VarianceFull yearplanFull yearforecastForecast vsplanvarianceStaff (whole time equivalents) 3,658 3,700 3,545 155 3,656 3,550 106Sickness rate 4.7% 4.0% 4.2% -0.2% 4.0% 4.2% -0.2%Turnover rate 11.7% 13.5% 12.0%ACTIVITYBelow target 0 to 5%Below target by more than 5%Above target 0 to 5%Above target by more than 5%SUMMARY FINANCIALSEBITDA as per income rulesSurplus as per income rulesCIP as per income rulesCapex as per Monitor rules i.e. 25%The 5% rulesINCOMEEXPENDITUREBelow budget 0 to 5% Below budget 0 to 5%Below budget by more than 5% Below budget by more than 5%Above budget 0 to 5% Above budget 0 to 5%Above budget by more than 5% Above budget by more than 5%BALANCE SHEETWORKFORCEPlan variance 0 to 5% Below target 0 to 5%Below plan by more than 5% Below target by more than 5%Above plan 0 to 5% Above target 0 to 5%Above plan by more than 5% Above target by more than 5%

Proposed indicatorUnplanned decrease in Earnings before Interest,Tax, Depreciation & Amortisation (EBITDA)margin in two consecutive quartersPotential financial weaknessDeteriorating trend in operating performance andcash flow generationQ12010/11ActualQ22010/11ActualM10ActualQ42010/11PlanQuarterly self-certification by trust that theFinancial Risk Rating (FRR) may be less than 3in the next 12 monthsIdentified risk of potential financial breach withinthe next yearFRR 2 for any one quarterIn year deterioration in financial performanceWorking capital facility (WCF) agreementincludes default clause. This will require all truststo review their WCF agreements.Risk that WCF, whilst included in calculation ofliquidity days for the purpose of FRR, may not beavailable if and when required e.g. FRR 1 or 2.Debtors more than 90 days past due account formore than 5% of total debtor balancesPotential for payment / debtor collectionconcernsCreditors more than 90 days past due accountfor more than 5% of total creditor balancesPotential for build up in creditors, resulting infuture liquidity concernsCapital expenditure is less than 75% of plan forthe year to dateCapital expenditure plans are delayed toconserve cashQuarter end cash balance less than 10 days ofoperating expenses or less than £4 million.Potential liquidity concerns and ability to meetliabilities as they fall dueInterim Finance Director in place over more thanone quarter endAbsence of permanent / substantive appointmentto key positionTwo or more changes in Finance Director in atwelve month periodMultiple changes in a short period of leadfinancial officer

THE ROYAL BOURNEMOUTH AND CHRISTCHURCH HOSPITALSNHS FOUNDATION TRUSTBOARD OF DIRECTORSMeeting Date: 11 March 2011 Part 1Subject:Appointment of new Nurse DirectorSection:DecisionExecutive Director withoverall responsibility:Tony Spotswood, Chief ExecutiveAuthor of Paper:Tony Spotswood, Chief ExecutiveSummary:Recruitment of Director of Nursing withamended job descriptionStandards for Better Healthdomain:GovernanceAction required by Board ofDirectors:For Decision

Board of Directors11 March 2011THE ROYAL BOURNEMOUTH & CHRISTCHURCH HOSPITALSNHS FOUNDATION TRUSTAppointment of new Nurse DirectorAs many members of TMB and the Board of Directors will be aware, BelindaAtkinson has taken the decision to retire from her post as Director of Nursingeffective from the end of August 2011. Together with Executive colleagues I havetaken the opportunity to review the content of Belinda’s role prior to advertising for anew Director of Nursing. A draft Job Description is appended. It includes onesignificant change which is responsibility for Infection Prevention and Control as thenominated Director.I would welcome comments from the Board on the content of this post. It isproposed, with the agreement of the Board, to proceed to advertisement in lateMarch with interviews being held in late April/early may to allow an appointment tocoincide with Belinda’s retirement date.Tony SpotswoodChief ExecutiveAppointment of new Nurse DirectorFor decision

ROYAL BOURNEMOUTH & CHRISTCHURCH HOSPITALS NHS FOUNDATIONTRUSTROLE DESCRIPTIONJOB TITLE:SALARY:DIRECTORATE:REPORTS TO:DIRECTOR OF NURSING AND MIDWIFERYAS CURRENTCLINICAL GOVERNANCE DIRECTORATECHIEF EXECUTIVEJOB PURPOSE:The post holder is an Executive Director of the Trust and a fullmember of the Board of Directors and Trust ManagementBoard. As such the post holder carries full corporateresponsibility for the effective running of the Trust.To provide professional advice, guidance and leadership onmatters pertaining to the provision and development ofnursing, midwifery services and allied health professionals.To fulfil the role of Clinical Director for the Midwife-ledMaternity Service, working closely with the Head of Midwiferyand the Lead Obstetrician at Poole Hospital NHS FoundationTrust.To contribute to and help shape the future strategic direction ofthe Trust, ensuring that nurses and midwives work to highprofessional standards, and that the development of these andother nursing and midwifery services is in line with the Trust’sstrategic direction.Lead the Clinical Governance and Risk Management work ofthe Trust in conjunction with the Medical Director.Take the lead for the Trust in assuring compliance with theCare Quality Commission Essential Standards for Registrationand the NHS Litigation Authority’s Risk ManagementStandards.Take the lead executive role for Patient and PublicInvolvement and Adult and Children’s Safeguarding. Chair theTrust Safeguarding Committee.

Act as the Trust’s Director of Infection Prevention and Control,working closely with the Consultant Microbiologists andInfection Control team to ensure high standards of infectionprevention and control are maintained in accordance with bestpractice guidance.Main Responsibilities / Principal AccountabilitiesNursing and Midwifery1. To provide professional leadership to the Trust’s nurses, midwives and allied healthprofessionals ensuring that they have a clear overall direction and understand thecontribution required of them to meet the Trust and professional nursing standards.2. To ensure the development of a leadership structure, to include leadershipdevelopment, within the profession which supports the Clinical Directorate model andadvise on the setting of nursing standards and objectives within each Directorate.3. To participate in the continued development of the Trust’s strategic direction as amember of the Board of Directors and the Trust Management Board, providingadvice on issues concerning the nursing, midwifery and allied health professions andother matters pertaining to direct patient care.4. Monitor nursing and midwifery staffing levels and skill mix in the organisation, relatingthese to patient dependency and ensuring effective use of the nursing and midwiferyworkforce. Encourage the continued roll-out of electronic rostering.5. In conjunction with the Director of Human Resources and the Associate Director ofNursing – Professional development, ensure that robust local arrangements are inplace for the continued professional development and training of nurses, midwivesand support workers.6. To liaise as required with representatives of Bournemouth University and the Directorof Workforce Development (NHS South West) to ensure the appropriate provision ofeducational opportunities for nurses, midwives and support workers.7. Support the development of the Young Apprentices Programme in Health Care inliaison with the Director of Human Resources and the Trust Training Manager.8. Lead the Trust’s work with regard to the recruitment and retention of nurses andmidwives.9. Lead the continued modernisation of nursing roles and practice ensuring that rolesprovide value for money and benefit to the organisation.

10. Lead the nursing agenda and promote creative approaches to the development ofclinical quality and quality performance management. In particular lead on:- The Productive Ward – releasing time to care- The CNO’s Eight High Impact Nursing Interventions- Essence of Care- The recommendations of the Prime Minister’s Commission on Nursingand other initiatives as developed by the Chief Nursing Officer.11. Provide professional leadership to the Trust’s Consultant Nurses, participating in theirappraisal process with the relevant Clinical Directors.12. Support the development of further Practice Development Units within theorganisation and promote opportunities for the sharing of good practice developedwithin this process.Public and Patient Involvement1. Lead / contribute to the development of a Trust strategy for ensuring widerengagement with the public and patients / carers, optimising the role which patientsand the public’s representatives can play in key functions such as advising on theprovision of patient services.2. Manage the PALs service and pursue opportunities for its continued developmentincluding liaison with volunteer agencies and relevant independent third partyagencies.3. Manage the Trust Chaplaincy service.4. Manage the Trust Volunteers, ensuring that optimal use is made of this resourcewithin Trust services and departments.5. Manage the complaints and claims (clinical and non-clinical) service ensuring that allrelevant standards for the management of complaints, including referral to the HealthService Ombudsman are adhered to.6. Act as the Trust’s executive lead for the management of patients with learningdisabilities.7. Act as the Trust’s executive lead for the management of patients with dementia andthe implementation of the national Dementia Strategy in conjunction with the leadconsultant physician.8. Act as the Dignity Champion for the TrustClinical Governance and Risk Management1. Advise the Healthcare Assurance Committee on matters pertaining to nursing andmidwifery care.

2. Act as the executive lead, and main point of contact, for matters related to the CareQuality Commission including compliance with the Trust’s registration requirements.3. Act as the executive lead for matters related to NHS Litigation Authority accreditationand compliance with the Risk Management Standards.4. Support the development and implementation of the Trust’s Clinical GovernanceStrategy and plan, providing leadership to aspects of risk management as part of theTrust’s general approach to controls assurance and corporate governance.5. Advise / input as required on the completion of the regular compliance reports toMonitorChildren’s Services1. Lead the work of the Trust in ensuring that services for children meet the requiredstandards – including work associated with child protection and safeguarding, CareQuality Commission Reviews and Inspections, and the on-going implementation ofthe Children’s National Service Framework.Infection Control1. Undertake the role of Director of Infection Prevention and Control, liaising with theconsultant microbiologists and the infection control nursing team.2. Ensure that staff meet the requirements of the Code of Practice for Hospital AcquiredInfection and other national standards for infection control practice as may be set.3. Provide regular infection control reports to the Board of Directors, Trust ManagementBoard, and Healthcare Assurance Committee.4. Liaise with the relevant external agencies and forums in matters pertaining to hospitalacquired infection and general infection control practice.General Responsibilities1. Work closely with the Chief Operating Officer to support the smooth admission anddischarge of patients to / from the Trust in line with required standards / targets andthe Trust’s organisational objectives.2. Provide professional leadership to the Trust’s Clinical Site Team.3. Represent the Trust with partner organisations on matters pertaining to nursing andmidwifery services.4. Contribute to wider management issues within the Trust as agreed with the ChiefExecutive.

5. Advise on the general quality of patient care supporting the Medical Director, ChiefOperating Officer and Chief Executive.Clinical Director for Maternity Services1. Manage the Midwife-led Maternity Unit, working closely with the Head of Midwiferyand the consultant obstetricians at Poole Hospital, to ensure the on-goingdevelopment of the unit in conjunction with Poole Hospital.2. Manage the Directorate within its agreed budget.3. Ensure rigorous arrangements are in place which address all risk managementissues and meet clinical governance requirements for Maternity Services.4. Implement the Better Births strategy in conjunction with NHS Bournemouth andPoole and Poole Hospital.

THE ROYAL BOURNEMOUTH AND CHRISTCHURCH HOSPITALSNHS FOUNDATION TRUSTBOARD OF DIRECTORSMeeting Date and Part:11 March 2011 – Part ISubject:Register of Directors’ InterestsSection:DecisionExecutive Director with overallresponsibility:Tony Spotswood, Chief ExecutiveAuthor of Paper:Rebecca Lawry, Trust SecretarySummary:Update of the Register of InterestsStandards for Better Health domain:GovernanceAction required by Board ofDirectors:Approval

THE ROYAL BOURNEMOUTH AND CHRISTCHURCH HOSPITALS NHS FOUNDATION TRUSTDECLARATION OF BOARD OF DIRECTORS’ INTERESTS AND REGISTER OF INTERESTS01 APRIL 2010 TO 31 MARCH 2011MEMBERMRS J STICHBURYChairmanMr. D BENNETTNon-Executive DirectorMR P DAVÉ (from 01.02.11)MR B FORDNon-Executive DirectorMR I METCALFENon-Executive Director (to 12.11.10)MR S PEACOCKNon-Executive DirectorMRS A PIKENon-Executive DirectorMR K TULLETTNon-Executive DirectorMRS K ALLMANDirector of Human ResourcesDr. M ARMITAGEDirector of MedicineMS B ATKINSONDirector of NursingMR S HUNTERDirector of Finance and ITMRS H LINGHAMChief Operating OfficerMR R RENAUTDirector of Service DevelopmentMR A SPOTSWOODChief ExecutiveINTERESTS Board Member – England and Wales Cricket Board Governor – Bournemouth School for Girls Advisory member of Youth at Risk (charity) Director and majority shareholder in Davox Consulting Limited, acompany providing management consultancy services on strategyand logistics in the healthcare and technology sectors. TheCompany has no business dealings with the Trust Director and majority shareholder of P. Hempson Limited, amanagement consultancy company operating in non health relatedfields and with no relationships with the Trust Associate Director of Kurt Salmon Consulting, part of theManagement Consulting Group plc. Working within the Finance andPerformance Management (FPM) Practice with a primary focus onOil and Gas and Energy company clients. The FPM practice has nobusiness dealings with the Trust Trustee at Kidney Research UK effective March 2010. No identifiedconflict of interest Treasurer: Macmillan Caring Locally Director of six companies operating in non health related fields withno relationships with the Trust Financial and Business Consultant advising clients on non healthrelated business Member of the credit committee of the Foundation Trust FinancingFacility No relevant and material interestsNo relevant and material interestsGroup Marketing Director of Simple Health & Beauty LimitedNo relevant and material interestsNo relevant and material interestsSome Private work in addition to NHS work, plus work as SeniorClinical Advisor to Department of Health (reimbursement to Trust)No relevant and material interestsNo relevant and material interestsNo relevant or material interestsMarried to Christine Renaut, a Pharmacist employed by the TrustBoard member of the Foundation Trust Networkbod/register of interests 20010/11RL22.02.2011

THE ROYAL BOURNEMOUTH AND CHRISTCHURCH HOSPITALSNHS FOUNDATION TRUSTBOARD OF DIRECTORSMeeting Date: 11 March 2011 Part 1Subject:Briefing – Location and Provider of In-Patient Haematology ServicesSection:Information/DiscussionExecutive Director withoverall responsibility:Tony Spotswood, Chief ExecutiveAuthor of Paper:Tony Spotswood, Chief ExecutiveSummary:Report on the process underway to identifya single provider of Tier 3 HaematologyServices in DorsetStandards for Better Healthdomain:Clinical and Cost effectivenessPatient FocusAction required by Board ofDirectors:For information/Discussion

Board of Directors11 March 2011THE ROYAL BOURNEMOUTH & CHRISTCHURCH HOSPITALSNHS FOUNDATION TRUSTBriefing to determine the future location andprovider of In-Patient Haematology ServicesNHS Dorset and NHS Bournemouth and Poole have now launched a process toidentify a sole provider of In-patient Haematology services for the population ofDorset. Members of TMB and the Board will be familiar with the background for thiswork including broad agreement amongst clinicians from the 3 Acute Trusts that asingle integrated in-patient service would offer benefits for patients. It is intendedthat the in-patient centre would operate as a hub and include laboratory, researchand MDT facilities. Out-patient and Day Case treatment will continue to be providedat all 3 hospitals. Further work is required to consider how the patient needs ofHampshire and South Wiltshire are best met should there be a shift of services awayfrom the Royal Bournemouth Hospital. NHS Dorset is to commence discussionswith NHS Hampshire and NHS Wiltshire concerning this matter.The PCTs have indicated that the decision on the future provider of these serviceswill be determined through competitive tendering exercise. To support this processwork is underway with the full involvement of local clinicians to develop a servicespecification. The service specification will set out the key outcomes, standards andthe service infrastructure required to provide level 3 Haematology. The Trust hasconfirmed with Commissioners that JACIE accreditation will be a pre-requisite forany provider wishing to offer level 3 services. At this stage both Poole HospitalFoundation Trust and the Royal Bournemouth and Christchurch Hospital FoundationTrust are competing to provide the service. We have agreed that both Poole andRoyal Bournemouth and Christchurch Hospitals need to apply separately for JACIEaccreditation by 1 July 2011. It is likely that Trusts will hear the outcome of theirindividual applications by Christmas 2011. Further criteria underpinning the decisionmaking process will be made transparent by PCTs and developed through aniterative process of discussion with the provider organisations and external advisorsincluding the British Society of Haematologists and the National Cancer ActionTeam.One consideration Commissioners will have is the building work required toaccommodate an in-patient unit of between 26-30 beds. This in itself is likely todetermine the time scale for transfer of facilities across Dorset. A further update ofthe commissioning process will be given as more information becomes available.This paper is provided for information and discussion.Tony SpotswoodChief ExecutiveBriefing – Location and Provider of In-PatientHaematology Services Page 1 of 1For Discussion

THE ROYAL BOURNEMOUTH AND CHRISTCHURCH HOSPITALSNHS FOUNDATION TRUSTBOARD OF DIRECTORSMeeting Date: 11 March 2011 Part 1Subject:Equity and Excellence: Liberating the NHS- Managing the TransitionSection:Information/DiscussionExecutive Director withoverall responsibility:Tony Spotswood, Chief ExecutiveAuthor of Paper:Tony Spotswood, Chief ExecutiveSummary:A description of actions underway to helpmanage the transition to the new NHSStandards for Better Healthdomain:GovernanceAction required by Board ofDirectors:For information/Discussion

Board of Directors11 March 2011THE ROYAL BOURNEMOUTH & CHRISTCHURCH HOSPITALSNHS FOUNDATION TRUSTEquity and Excellence: Liberating the NHSManaging the TransitionPlease find enclosed a copy of a letter recently issued by Sir David Nicholson, ChiefExecutive of the NHS which sets out his plans for managing the transition to fullimplementation of Equity and Excellence. The first part of the letter is concernedwith the importance of maintaining a stable provider base in the context of difficultwinter pressures and rising expectations from members of the public. In particular, itdraws attention to the importance of maintaining short waiting times and ensuringthat patients are seen and treated within the confines of the NHS Constitution.As a means of maintaining stability within PCTs, proposals are now well advancedfor the clustering of PCTs across England. Within the South West less clustering istaking place than in other parts of England although the Management Team ofBournemouth and Poole PCT and NHS Dorset is coming together to form a newExecutive; effective from 1 April. A National Commissioning Board Executive shouldbe in place by October 2011 with the central role of improving health outcomes. Therole is further described on page 5 of the letter and includes responsibility forproviding leadership to the commissioning system, describing the challenges andpriorities for commissioners, supporting the authorisation process for GP Consortiaand allocating budgets to the Consortia.Significant focus is currently being applied to ensuring non foundation Trusts gainFoundation Trust status or move to another organisational form by 1 April 2014.Greater emphasis is also being placed on providing more information to patients toensure they are able to make informed decisions about their care. The new NHS isparticularly complex with the establishment of Health and Wellbeing Boards whichare designed to ensure Local Authorities work in consultation with GP Consortia overtheir commissioning plans. These Boards will be established subject to legislation by2013 and will run in shadow form from 2012.One aspect of the new NHS which is particularly relevant to providers is theproposals for changing education and training functions. Healthcare providers willtake on existing NHS workforce functions and responsibilities from 2012 and willwork closely with a new executive body Health Education England to determine whattraining and education needs the NHS requires at a local level and how these arebest met. SHAs have been asked to ensure a smooth transition to support themigration of these functions to providers and further discussions are currently takingplace with the South West Strategic Health Authority to shape arrangements locally.Currently a significant sum of money earmarked for education and training is topsliced by the Strategic Health Authority and held as a contingency against otherEquity and Excellence Liberating the NHS:Managing the Transition Page 1 of 2For Discussion

Board of Directors11 March 2011pressures. Going forward there is the potential for this money to be reintroduced tosupport its primary purpose.The National Quality Board have been asked to advise on what changes arerequired to respond to quality failings within the NHS.With regard to the impact these changes have on individuals, particularly thoseemployed in Primary Care Trusts a range of HR policies and processes have beenput in place aimed at both supporting and reducing the size of the workforce.Significant work continues at a local level to plan as smooth a transition from PrimaryCare Trusts to GP Commissioning as possible. As part of this process new GPleads are currently engaged on an induction programme including visits to localTrusts to help build their understanding and familiarity with many of the challengesthat lie ahead. Their clear message is that the acute hospital sector needs to reducein size.The letter includes some important new guidance which has emerged since detaileddiscussion of aspects of the Health and Social Care Bill. Importantly, theDepartment of Health and Government have clarified that they do not expect to seecompetition on the basis of price. This extends to PCTs not using price as adeterminant when tendering. For the first time the Department of Health areconfirming their clear intention to develop more integration between Primary andSecondary services and this will open up opportunities to provide more efficient andeffective care in consultation with the new GP Consortia.This paper is provided for information and discussion.Tony SpotswoodChief ExecutiveEquity and Excellence Liberating the NHS:Managing the Transition Page 2 of 2For Discussion

From the Office of Sir David Nicholson KCB CBEChief Executive of the NHS in EnglandRichmond House79 WhitehallLondonSW1A 2NSdavid.nicholson@dh.gsi.gov.ukTo:All Chief Executives in NHS Trusts in EnglandAll Chief Executives in NHS Foundation Trusts in EnglandAll Chief Executives in Primary Care Trusts in EnglandAll Chief Executives in Strategic Health Authorities in EnglandCc:Commissioning consortia pathfindersAll Chairs of NHS organisations in EnglandAll Chief Executives of Arm’s Length Bodies in EnglandAll Chief Executives of Local Authorities in EnglandChief Executives of independent sector partnersMonitorCare Quality CommissionLocal Government AssociationGateway ref: 1559417 February 2011Dear ColleagueEQUITY AND EXCELLENCE: LIBERATING THE NHS – MANAGING THE TRANSITIONIntroductionI last wrote to you in December 2010, alongside the publication of Liberating the NHS: Legislativeframework and next steps and the Operating Framework, to set out the overall transition path forthe health and social care system over the next 4 years. There have been importantdevelopments since then with the publication of the Health and Social Care Bill; the rapidexpansion in the number of pathfinder consortia, and the publication of guidance on forming PCTclusters. This letter provides an update in light of these developments, focussing in particular onthe new commissioning system. The publication of the Bill in particular has prompted widespreaddebate about the proposals for the new system and Annex B below offers clarification on some ofthe most commonly raised issues.Current performance and planning for 2011/12It is critical during this period of complex change that maintaining day-to-day delivery of highstandards of care for our patients remains our central priority. The prevalence of influenza,1

combined with the exceptionally cold winter, have placed considerable pressures on the servicein the last two months. Our staff across the NHS have again responded very well to thischallenge, continuing to provide high quality care, in spite of these pressures, through theirdedication and professionalism.Whilst absorbing the pressures of winter, the NHS has continued to perform very well in a rangeof areas; among other things, continuing to reduce hospital acquired infections and maintainingshort waiting times. These are fantastic achievements and we should thank our staff at all levelsof the service. As is normal at this time of year, we require a renewed focus on referral totreatment times for elective patients now that planned work has restarted after the Christmasbreak and in time to secure the strong level of aggregate performance that we expect to see bythe end of the financial year.In my travels around the service, I have encountered some misunderstandings about theGovernment’s intentions in respect of waiting times. Let me be clear that the Government hasstated its strong support for the rights in the NHS Constitution, which established patients’ right toaccess services within maximum waiting times or to be offered a range of alternative providers ifthis is not possible. Timeliness of diagnosis and treatment is what patients expect and remainsessential to providing high quality care.The Government has signalled that the process of meeting these waiting times standards shouldnot distort clinical priorities, but patients should still be able to expect the most clinicallyappropriate treatment within the defined standards for elective, urgent and emergency care. Localcommissioners should hold providers to the Constitutional rights and their contractualcommitments, including achievement of maximum waiting times, with firm action to tackleoutliers. If we are to maintain and improve quality for our patients, we cannot allow waiting timesto increase, nor can we allow distortion of clinical priorities. I hope that clarity will be helpful aslocal organisations put together their plans for 2011/12 and as providers and commissionersagree their contractual commitments.This planning round is more important than ever as we need to put in place plans across thesystem that will see continued improvement in quality, greater efficiency in the use of resourcesin line with QIPP, and establish the key building blocks of the reformed NHS system envisaged inthe White Paper. PCTs locally and SHAs regionally remain the organisations statutorilyaccountable for putting together those plans and executing them. They should engage emergingGP consortia and PCT cluster leads as far as is practicable so that those new organisations willtake shared ownership of those plans for the longer term during 2011/12.It is critical that the plans we agree for 2011/12 support us to meet the QIPP challenge right up to2014/15. The sustainable improvements in quality and productivity that we need to achieve£20bn efficiency savings over the Spending Review period will not be realised through a series ofshort-term solutions. They require us to plan with one eye on the medium and longer term,something we have been preparing for throughout the past 18 months, and we must lay thefoundations for this in 2011/12. As part of this, it is essential that PCTs and clusters engage withproviders, GP consortia and local government in order to communicate to the community arounded, coherent and system-wide picture of local plans. Only if we do this can we haveconfidence in our plans to invest these savings to meet changing demands and to deliverimproved clinical services.Developing the new commissioning systemSince being asked to be the Chief Executive of the NHS Commissioning Board, I have beendiscussing how the new commissioning system should work with colleagues from across theNHS, and particularly with the leaders of emerging GP consortia. I want to set out some initial2

thoughts about what the system is for, how it will operate, and how we will work collaboratively todevelop it, building on the progress already made at national and local level.Progress on implementationAs well as developing the statutory framework for the new commissioning system, we have madeimportant recent progress in building the new system on the ground. Most significantly, thenumber of pathfinder commissioning consortia is expanding rapidly with 141 pathfinders nowconfirmed. Pathfinders now cover more than half the population, some 28.6 million people, andthe number will continue to grow. That gives us a really strong foundation to test and develop thenew arrangements and shows the energy and urgency at local level to bring the new system intobeing. I have been struck in my discussions with pathfinder leaders by the innovative andpragmatic approach being taken to implementation.The 2011/12 Operating Framework set out a clear package of support for pathfinder consortia,including a £2 running cost allowance per head of population and access to key staff to supportdevelopment. We are also developing guidance to support the broader assignment of suitablePCT staff to emerging consortia, an approach which will also be applicable in other areas such aspublic health. A formal learning network will also be available to pathfinders and this group willplay an important part in developing the broader commissioning architecture.The rapid emergence of pathfinder consortia is an important reason for consolidating PCTs intocluster arrangements: the development of clusters will create space for pathfinders to take ondelegated responsibilities earlier where they are ready. In addition, the creation of clusters willallow us to sustain our focus on delivery during the transition, rather than allowing an unplannederosion of PCT capacity and capability whilst the new system develops. We have now publishedguidance to support the development of clusters by June 2011, in line with our commitment in the2011/12 Operating Framework.We have chosen to create a national timeline and framework for the formation of clusters,although the process will be driven locally. This national consistency is important in order to keepa tight grip on finance, performance and quality during the transition, and because the end-pointwill be a single organisation covering the whole country and supporting a vibrant system of localconsortia: the NHS Commissioning Board. That is very different from the current system ofseparate statutory organisations, and we therefore need to develop a more consistent anduniform approach during the transition.As I set out in December, clusters will also identify staff whose future role will be to supportcommissioning. Clusters will support staff to reshape and redefine their roles and subsequentlysupport them to create social enterprises or joint ventures to offer commissioning supportservices.Regarding the development of the NHS Commissioning Board itself, my intention is to set out thehigh level structure of the organisation in Spring 2011. Proposed structures for the newDepartment of Health will be set out at the same time. The appointment of the Board’s chair isnow underway and my aim remains to have the Board’s executive team in place by October2011. I can also confirm that the headquarters and main base for the Board will be at QuarryHouse in Leeds and that the Board’s London offices will be at 4-8 Maple Street, the current baseof the National Patient Safety Agency.Purpose of the systemIn taking forward the legal and practical changes necessary to create the new commissioning3

system, it is critical that we do not lose sight of what that system is designed to achieve. Thecentral role of commissioners is to drive improvements in health outcomes. Trends indemography, demand and technology, alongside the need to improve quality and value formoney, are driving changes in healthcare systems across the world, encouraging thedevelopment of better demand management, enhanced primary care and more preventativeservices. Commissioners will be active leaders of this change, pursuing a compelling vision forthe future healthcare system and harnessing the opportunity of being independent of Governmentto create and implement such a vision.Commissioners will lead the improvements in quality and productivity required to make the NHSsustainable, spearheading the drive to generate up to £20bn of efficiency savings by 2014/15 forreinvestment in frontline care. Realising the savings needed to invest in improving outcomesmeans moving from a system configured to diagnose and treat, to one configured to predict andprevent. And it means driving the improvements in clinical care that will have the greatest impacton improving quality and value, particularly by transforming the management of long-termconditions, moving services closer to patients, and containing demand for urgent care.In order to make these improvements a reality, commissioners will need to lead efforts toempower patients by expanding access to information, extending the range and nature of patientchoice, and designing clinical services to suit patient needs. Commissioners will need to harnessclinical advice and leadership from across different sectors and professions. Effective informationsystems will be critical to enabling the development of new patterns of care, and commissionerswill require sophisticated methods of gaining insight from patients, public and staff to shapedecision-making. That will require an externally-oriented commissioning system, highly engagedwith and learning from partners across different sectors and industries.An integrated commissioning systemThese are stretching ambitions, and commissioners will need strong levers and a pro-activeapproach in order to achieve them. GP consortia, working individually and together, will providethe engine for the commissioning system locally, assuming statutory responsibility forcommissioning the bulk of services. Consortia will need support and direction in order to carry outthis critical role effectively and providing and shaping that support will be the central role of theNHS Commissioning Board. The Board will be confident about leading change at scale – notthrough top down diktat, but neither being shy about claiming a leadership role.This national role of the Board is a vital aspect of the new commissioning system, although it hasnot been the main focus of public discussion and debate. My ambition is to lead a Board at thecentre of a wider commissioning system focused on improving quality and outcomes for patientsand making the NHS sustainable for the future. The Board will safeguard the core values of theNHS, ensuring a fair and comprehensive service across the country and promoting the NHSConstitution. It will champion the interests of patients, using choice and information to empowerpeople to improve services. It will directly commission a wide range of services, including bothlocal primary care and the most specialised services in the country, meaning it will have directresponsibility for around £20bn of commissioning spend. It will be accountable nationally for theoutcomes achieved by the NHS, as set out in the national mandate, and for contributing toimproving broader public health outcomes, as well as for how the NHS commissioning budget,totalling around £80bn, is spent and for maintaining financial control across the system.In order to discharge these vitally important accountabilities, the Board will provide support toconsortia and provide a national framework for local commissioning. It will offer a spectrum ofsupport, from empowering and facilitating success, to intervening to support consortia in difficulty.In particular, it will:4

• Provide leadership to the commissioning system in improving health outcomes;• Describe the challenges and priorities for the commissioning system, based on patientand public insight and the requirements of the national mandate;• Support consortia to achieve authorisation, and will operate a rules-based interventionregime to ensure consortia remain fit for purpose;• Make financial allocations to consortia and set the financial strategy for thecommissioning system;• Provide leadership and support for quality improvement across the system;• Champion a patient-centred approach to developing health services;• Set the Commissioning Outcomes Framework to track local delivery and design thequality premium to create financial incentives for consortia to improve quality andoutcomes and drive value for money, and• Translate national Quality Standards into commissioning guidance for consortia andstandard contract and pricing mechanisms for local use.So while consortia will have the freedom to shape services and drive improvements locally, theywill do so within a national framework and with support and guidance from the NHSCommissioning Board. This will mean creating an integrated system between consortia and theBoard, which supports the delivery of national accountabilities as well as local priorities. At locallevel, consortia will also need to work closely with health and wellbeing boards to ensurealignment and integration between commissioning for the NHS, public health and social care.Our approach to developing the new systemThe way we go about developing the new system will shape the outcomes we ultimately achieve.In September 2010, I set out ten "design rules" for how we should approach the transition as awhole. These rules highlight the critical importance of focussing on purpose; continuing to deliver;working collaboratively; and maximising local freedoms, whilst maintaining clear accountability. Asummary of these rules is at Annex C and I believe they continue to hold good.Alongside these broad design rules, I want to stress some particular features of the approach todeveloping the new commissioning system which draw on our four principles of change. First, coproductionis more important than ever. In developing the new system of authorisation and theCommissioning Outcomes Framework, the Board and consortia must work together. In designinglocal commissioning arrangements, NHS commissioners and local authorities must worktogether. In driving the redesign of services to improve quality and productivity, commissionersand providers must work together. And if we are to realise the ambition of truly empoweringpatients, of ensuring there it “no decision about me, without me”, then we must work withpatients, carers and the public on all aspects of the design of the new system. It is vital that thisco-production characterises our approach from the outset, both nationally and locally.Second, our assumption will be that things are done locally unless they need to be done atanother level of the system, what I have referred to in the past as subsidiarity. I have describeda strong national framework for commissioning, but the bulk of powers and responsibilitiesnonetheless remain with local consortia. Inherent in the design of the legislation is an assumptionthat services are commissioned locally unless otherwise specified or agreed, so this approach isbuilt into the new commissioning arrangements.Third, clinical leadership will drive the commissioning system at all levels and the way we buildthat system. Clinicians will be at the heart of local consortia and the Commissioning Board willhave strong clinical input across all of its functions. And the commissioning system will be5

underpinned by the evidence-based Quality Standards produced by NICE, meaning the pursuit ofclinical quality is written into the DNA of the commissioning system.Finally, alignment of the different parts of the system will be critical to developing effectivecommissioning at local and national level. Locally, alignment between NHS, public health andsocial care and other commissioners in local and national government will be vital, and healthand well-being boards will provide an essential forum for achieving this. Nationally, the Board willneed to work closely with a range of key partners: with CQC on maintaining quality and safety;with Monitor on critical processes such as price-setting and the approach to identifying"designated" services, and with the Department of Health and Ministers on agreeing and aligningpriorities. During a complex change, maintaining alignment is more important than ever and weare planning to held a series of whole system alignment testing events in SHAs, starting inMarch, to begin to test out processes, policies and behaviours.To many people reading this I know these will seem like warm words. And I fully accept that weshould be judged in the coming weeks and months by what we do, not what we say. But Isincerely believe that if we remain true to the approach I have described then we will giveourselves the best possible chance of building a strong and effective commissioning systemwhich can bring the Liberating the NHS vision to life and drive better outcomes for patients acrossthe NHS.Progress on other aspects of the transitionIn general, the approach to the transition I set out in December remains in place and thetimetable, subject to Parliamentary approval of the new arrangements, is broadly unchanged,with some exceptions noted in this letter. An updated timetable is provided at Annex A and thissection provides further detail on the various aspects of the transition which have emerged sinceDecember.Developing the new provider landscapeWork on the Foundation Trust pipeline continues with SHAs and individual NHS Trusts workingtowards an all FT sector. Following the 30 November returns from the NHS, the ManagingDirector of Provider Development has visited SHAs to meet with aspirant FTs, commissioner andSHA teams to understand the specific actions required for all Trusts to become an FT; be part ofan existing FT, or move to another organisational form by 1 April 2014. These visits will informaccountability agreements to be signed by the end of March 2011 by aspirant Trusts, SHAs andDH. In each case the agreement will set out what needs to be done to support FT status, who isgoing to do this and by when issues will be resolved and an application made. The ProviderDevelopment Authority, which will take over the responsibility for NHS Trusts in governance,performance management and pipeline management terms, will begin in shadow form later in2011, working with SHAs, before assuming its full responsibilities from April 2012.Good progress has been made on Transforming Community Services and the OperatingFramework objective of separation of provider arms from PCTs has been achieved in all but twocases where specific issues are being addressed. Substantial progress towards divestment hasalso been largely achieved across the service and I am grateful for all the hard work of PCTs,Trusts and SHAs in achieving this. We have made real progress with this agenda including thedevelopment of a significant social enterprise sector and other new organisational forms that willdeliver improved pathways of care for patients. Regarding PCT estates, David Flory will shortlybe writing to Chief Executives of PCTs and SHAs to set out that PCTs should not enter intotransactions involving property without the prior written consent of the SHA. This is to ensuresuch transactions do not adversely affect the transfer of PCT owned property to other NHS or6

non-NHS organisations. Community services have a critical role in delivering the quality andproductivity improvements we seek across our system and this part of the provider sector is nowwell placed to deliver.We also need to continue to embed patient choice and control in the culture of the NHS. Animportant first step is the management of the transition of independent sector providers from thecurrent Extended Choice Network by PCTs, which must be done in a way that maintains patientchoice and fair competition. We also need to prepare for the gradual introduction of choice of AnyWilling Provider – we anticipate issuing detailed guidance on this in the Spring. We areparticularly keen to involve patient groups in developing policy in this area and in helping us todecide how to sequence this introduction of Any Willing Provider.Increasing patient information, empowerment and choiceAs set out in my most recent letter on the transition, I have put in place a programme to deliver aculture shift at every level of the system to realise the vision set out in the White Paper. TheTransforming the Relationship Across Citizen and Service programme has been furtherdeveloped in the spirit of ‘no decision about me, without me’, with the content of the programmedrawing on the series of recent public consultations, in particular those for Liberating the NHS,extending choice and the information revolution. In January, a dedicated workshop broughttogether a wide range of perspectives in order to develop the content of the programme.The programme will focus on the transformation in relationships which will be required to achieveour goal of delivering better health outcomes; the technical changes required to support this, andhow we can significantly raise the offer of how services are experienced by individuals and theircommunities. Particular focus will be on increasing the visibility of information to support informedchoice and a greater sense of control; development of multi-channel services for convenienceand access for all parts of society, and community accountability for health and care servicesthrough HealthWatch and a variety of approaches to public participation.Key emerging workstreams within the programme include shared decision making, communityaccountability and participation, multi-channel delivery of services, visibility and availability ofinformation, and the technical infrastructure to support greater access to personal information,and the efficiency and safety of clinical practice. The programme will be a cross-cuttingprogramme drawing on activities and resources which sit across a variety of organisations. As aprogramme which is about transforming a relationship, it will also explore how we can drive andcapitalise on the active participation and support of the broader system and public to deliver alasting and transformational impact.Health and wellbeing boardsDavid Behan wrote to all local authority Chief Executives in January 2011 setting out theleadership role for councils and in particular the role of health and wellbeing boards. TheGovernment’s vision is for health and wellbeing boards to drive a genuinely collaborativeapproach to commissioning. GP consortia and councils’ commissioning plans will be firmlyunderpinned by a shared understanding of the needs of the community, through joint strategicneeds assessments, and by a shared strategy which addresses those needs within the collectiveresources available through the joint health and wellbeing strategies.Subject to Parliamentary approval, health and wellbeing boards will be established from 2013,running in shadow form from 2012. Our ambition is for shadow health and wellbeing boards to bein place in each local authority area by April 2012. Many councils are already considering how toenhance existing partnership arrangements with PCTs in order to lay the foundations for new7

health and wellbeing boards. It will be crucial to learn from developing good practice and so wehave been working with an initial group of 25 councils to design the focus and approach of abroad network of early implementers.We cannot deliver this agenda from Whitehall – it will be driven by local councils, health bodiesand their partners. Our role at national level will be to hold the agenda together and providesupport, working with Local Government Group and SHAs. We would like as many people aspossible to be early implementers, to support our ambition of shadow health and wellbeingboards being in place in every top tier local authority by April 2012. To become an earlyimplementer, you can write to earlyimplementer@dh.gsi.gov.uk. The initial deadline forapplications is by 1 March 2011, but further expressions of interest are welcome after that date.Public healthAnita Marsland, Chief Executive of NHS Knowsley and Executive Director of Wellbeing Servicesfor Knowsley Metropolitan Borough Council, has been appointed to lead the transition to the newpublic health system. This work will involve establishing clear ways of working between PublicHealth England, local Directors of Public Health, health and wellbeing boards and GP Consortiato deliver public health services at local level. This will include setting out the roles andresponsibilities of local Directors of Public Health for achieving outcomes for health improvementfor their local population. It will also include working in partnership with local authorities, the NHSCommissioning Board and GP consortia on the delivery of Public Health England.We have been very clear in the Operating Framework that, during the transition year 2011-12 theNHS must continue to lead on improvements to public health, ensuring that public health servicesare in the strongest possible position when responsibilities are devolved to local authorities. Aswe deliver the very significant cost savings required of us, it is important that our plans reflect theneed to retain staff with scarce specialist public health skills. This will ensure that sufficientresources are retained within the system to deliver critical public health functions during transitionto the new arrangements and in the future.A detailed implementation plan to deliver our objectives for public health is due for completion inMarch 2011. By October 2011, the Chief Operating Officer for Public Health England (PHE) willbe in post.InformaticsInformation and Information Technology are essential components required to deliver theambitions outlined in the White Paper and a strong informatics capability is necessary to deliveron our intent. The consultation on the 'Information Revolution' closed on January 14th witharound 750 responses received. These responses are being analysed and will be an importantinput to the Information Strategy document due in the Spring.We continue to work to develop the arrangements for delivering informatics functions during thetransition. SHAs and PCTs were asked to provide a detailed analysis of their current systems andinformatics capability by January 31st. This has created a baseline that will be used to form thetransition plan. We expect to continue to refine the information received through the month ofFebruary with the baseline finalised early in March. One major issue identified is the need toclarify how the National Programme for IT services currently delivered by the SHAs and PCTs willbe maintained during the transition. Proposals on this are being prepared for consideration bythe National Programme Board.8

A working hypothesis for the 'future state' of informatics delivery has also been developed and iscurrently being tested with key stakeholders. The model includes dedicated informatics teams ineach part of the organisation as well as arrangements to share scarce skills and improveefficiency.Education and trainingLiberating the NHS - Developing the Healthcare Workforce was published on 20 December,setting out proposals for the new framework for planning and commissioning education andtraining. This framework envisages healthcare providers as the engine of the new system.Providers would take on existing SHA workforce functions, with quality of education and trainingremaining under the stewardship of healthcare professions and clinical leadership raisingstandards at every level. All providers of NHS-funded services would have an obligation to worktogether in networks to commission the whole workforce and ensure longer-term sustainability,working with social care providers, Local Authorities, public health and the education sector.A new executive body, Health Education England, will be in place by April 2012 to provideleadership and support to provider 'networks', in the same way that the Commissioning Board willsupport consortia within an integrated system. HEE will bring together the interests of providers,the professions, staff and patients, building on the work of Medical Education England andprofessional advisory bodies, involving patients and promoting equality. HEE will work with theprofessional regulators to assure national standards for professional training that are responsiveto the changing needs of patient and local communities. The provider networks and HEE willwork together and with partners in education, to commission high quality education and training inresponse to the strategic commissioning plans of consortia and the Commissioning Board.SHAs will lead the transition and support a smooth migration of functions to providers so thatthere is continuity of planning for education programmes. Providers would need to work closelywith SHAs as they set up new arrangements for 2012. They should consider how to retainknowledge and expertise in the system on workforce planning, education commissioning and totake on deanery functions. There is scope now to design a more streamlined system that givesproviders greater autonomy and accountability and creates the environment where people andorganisations have more freedom to improve outcomes and respond to their patients andcommunities. The consultation closes on 31 March and it is important that those who will beleading in the new framework get involved now and share their views on design andimplementation. SHAs will be running consultation events throughout February and March.Quality and safetyI explained in December that I have asked the National Quality Board to advise on what changesare needed to ensure we have the optimal ability to prevent, detect and respond to quality failingswithin the NHS. I asked the NQB to take on this role as quality is a systemic issues and the NQBbrings together all the national level bodies currently responsible for quality in the NHS.The NQB will issue a first phase report in the next few weeks providing advice on how tostrengthen resilience for quality during 2011/12. This report will emphasise the importance of allparts of the system understanding and implementing the NQB’s previous report “Review of EarlyWarning Systems in the NHS” published in February 2010. Although there will be many changestaking place next year as we pave the way for the formal implementation of the new systemarchitecture from April 2012, the current statutory responsibilities of organisations remainunchanged which means the roles and responsibilities set out in that report hold good. The firstphase report is also likely to emphasise the need to:9

• Listen to and capitalise on those parts of the current system that remain constantthroughout the transition. For example, the roles played CQC, GPs as providers andpatients;• Promote the critical importance of the culture and behaviours within and betweenorganisations in maintaining and improving quality;• Harness existing and new processes to provide further assurance around quality.For example, ensuring that quality is put at the heart of the approval process for applicantFoundation Trusts and the future authorisation process for GP commissioning consortia;• Keep the service focussed on delivering continuous improvements in quality ratherthan just focussing on mitigating any risks, and• Put in place robust handover strategies to ensure the wealth of soft intelligence onquality in the system does not get lost.Following publication of the first phase report, the NQB will turn its attention to describing howquality will be stitched into the fabric of the new system architecture set out in the White Paperlookingacross commissioning, provision and regulation.Human ResourcesWe continue to develop the strategy and detailed processes to support the changes to staff rolesand responsibilities needed to ensure a successful transition. The national Mutually AgreedResignation scheme attracted nearly 2200 applicants. The scheme will provide a significantsaving to the NHS whilst also avoiding redundancies. The MAR scheme was extended to 31January 2011 and further applications are being processed.The Pre-authorised MAR scheme announced in December 2010 will now be known as theRetention and Exit Terms Scheme (RETS). The scheme will support one of our key HRobjectives: to sustain business continuity during the transition. It will identify and help to retainthose staff who are critical to sustaining such capacity and capability by offering some certaintyaround severance terms during the transition and on exit. Details of the scheme will be publishedshortly.In December 2010 we also set out the policy of assigning to consortia relevant staff in PCTs whocurrently work the majority of their time in functions which are scheduled to transfer to consortia.Assignment will also be applicable to other functions including commissioning support, providerdevelopment, public health and workforce and education. For consortia, assignment will takeplace in the context of their freedom to decide how they will carry out their future functions butwith a recognition that existing staff skills and experience should be retained and utilised tosupport the transition and minimise redundancy costs. We are working with PCTs and GPconsortia to develop national guidance on assignment and best practice case studies to showhow assignment is already being used effectively at local level. Guidance will be finalised byMarch 2011.We also committed in December 2010 to publishing a more detailed update of the people andfunctions mapping work by the end of January 2011. This work has two aims: to identify existingbusiness functions and staff numbers in the current system; and to outline how this will mapacross to the new organisations. To support this we have recently asked all SHAs and PCTs toprovide us with a comprehensive picture of current functions and staffing by mid February 2011.We are carrying out a similar exercise for DH and the ALBs. The information will be used todevelop assignment, transfer and selection plans for the new organisations.Work on the over-arching HR Frameworks is progressing. These frameworks will outline theprinciples covering transfers between different organisations, including TUPE, with different terms10

and conditions. The NHS, DH and the ALBs also have individual detailed frameworks to describethe specific arrangements for staff working within their own organisations. The draft Departmentof Health HR framework was sent out in December 2010 and staff comments were received backduring the week of 17 January. In the NHS, every SHA has a regional HR Framework in place,although some are being updated to achieve consistency where needed.ConclusionsLooking across this very challenging agenda, I am once again struck by the dedication andprofessionalism of managers, clinicians and other staff across the NHS who continue to deliverhigh quality care for patients whilst building the new system, even at a time of personal andprofessional uncertainty for many. I want to thank you and your staff for your continuing efforts,particularly during the challenging recent winter period. We have made real progress ondeveloping and beginning to implement the new arrangements while maintaining delivery, andleaders across the NHS should take real credit for that.Yours sincerely,Sir David Nicholson, KCB CBENHS Chief Executive11

Annex A: Summary timeline2010/11: Design and early adoption• Design framework confirmed, subject to Parliamentary approval, and Health and SocialCare Bill introduced• Pathfinders and early implementers model the new arrangements and explore key issuesfor wider roll-out2011/12: Learning and planning for roll-out• First year of QIPP delivery as part of broader delivery on Operating Framework priorities• SHAs to establish PCT cluster arrangements by June 2011• High level structure for NHS Commissioning Board and Department of Health set out inSpring 2011• NHS Commissioning Board executive appointments completed by October 2011• Shadow national arrangements progressively implemented for the NHS CommissioningBoard, new Monitor, Public Health England, Health Education England and the ProviderDevelopment Authority• Sharing lessons from first wave adopters of consortia pathfinder and early implementersystems of health and wellbeing boards• More pathfinders and early implementers, including local HealthWatch• Plans drawn up for consortia, involving all GP practices• Emerging consortia to lead the process of securing staff, including PCT staff being madeavailable• Plans to be drawn up for health and wellbeing boards• NHS trusts to apply for foundation trust status, or be planning application in 2012/132012/13: Full preparatory year• Second year of QIPP delivery• From April 2012, NHS Commissioning Board and new Monitor come into effect, SHAs areabolished, PCT clusters become accountable to the Board, and the Department will have12

made substantial progress on its change programme and established Public HealthEngland. The Provider Development Authority oversees NHS trusts• More learning from GP pathfinders and health and wellbeing board early implementers• Authorisation process of comprehensive system of consortia begins, with all practices asmembers, acting under delegated arrangements with PCTs• Health and wellbeing boards are in place• Comprehensive local HealthWatch arrangements in place• From April 2012, local authorities to fund local HealthWatch to deliver most of their newfunctions• Consortia notified of 2013/14 allocations• By the end of the year, a significant number of NHS trusts have achieved foundation truststatus2013/14: First full year of the new system• Third year of QIPP delivery• April 2013, PCTs abolished and all consortia assume new statutory responsibilities• April 2013, health and well being boards assume their statutory responsibilities• April 2013, Monitor’s licensing regime is fully operational• April 2013, local authorities to have responsibility for commissioning NHS complaintsadvocacy• By March 2014, the firm aim is that all NHS trusts have become foundation trusts. NHStrust legislation is repealed, and the Provider Development Authority ceases to exist.13

Annex B: Frequently Asked Questions on the Health and Social Care Bill1) Do the new proposals mean the introduction of price competition in the NHS?Services subject to tariff will continue to compete on quality: there is no question of introducingprice competition. We want patients to be able to choose, where appropriate, from a range ofqualified providers that are accredited to provide safe, high quality care and treatment. In its newrole, Monitor will ensure that competition works in the public interest, widening choice and drivingimprovements in quality and efficiency. From 2012, Monitor and the NHS Commissioning Boardwill decide the best structure and price levels without interference from government.Final guidance on the 2011/12 tariff rules clarifies that the introduction of a new flexibility to agreeprices below the national tariff rate is not intended to facilitate a move towards price competition.The guidance makes clear that the flexibility is intended for use in exceptional circumstances.The use of this flexibility should not in any way affect quality, patient choice or competition.Commissioners will be responsible for ensuring that the quality of services purchased using thisflexibility is at least equal to, if not better than, services purchased at full tariff price.2) What do the proposals mean for integrated care? Will this prevent primary andsecondary care clinicians from working together?The Department intends for more integration of services and more competition – these things arenot in conflict. In future, commissioners will have greater scope to develop integrated carepathways where this makes sense, working with a range of local clinicians, and new health andwellbeing boards will promote integration across the NHS, social care and public health. We areencouraging GPs to work with local hospitals to improve care pathways. This is clearly goodpractice and is not anti-competitive. Clinician-led commissioning will support integrated care andcommissioners will have the flexibility they need to be able to bundle services together across apathway where this makes most sense.3) What impact will the extension of the “any willing provider” model have on thecommissioning of services?The consultation on plans for developing patient choice, including the extension of “any willingprovider” (AWP) model, closed in January and the Department is currently considering itsresponse. This means that several key policy decisions are yet to be determined, in particularwhether and to what extent AWP would be mandated nationally for particular services, andwhether the accreditation process would be undertaken at national or local level, or whetherresponsibility would be shared. Subject to the outcome of the consultation, we would expect AWPto apply to many NHS-funded services in future. The 2011/12 Operating Framework made clearthat AWP will be introduced for community services during 2011/12.There have also been questions about the implications of AWP for contracting and tendering.This will also be addressed in the response to the recent consultation. In essence, providers willneed to be licensed (where this is required by CQC) and hold an appropriate NHS StandardContract. They will be obliged to work within the standard business terms of that contract,including meeting specified national quality standards, where appropriate additional localstandards and referral protocols, and the agreed price.Where service integration and continuity of care is important to secure the best clinical outcomes,patient experience and value for money (for example, in end of life care), the intention is thatcommissioners will be able to go to competitive tender and offer the service to one provider or'prime contractor'. Under this model, patients would still have choice of treatment, setting and14

lead clinician, and potentially of provider for certain services within the pathway. In essence, wewant commissioners to adopt the model of commissioning (AWP or tendering) which delivers thebest results for patients and taxpayers.15

Annex C: Summary of design rules1. Delivering high quality care within the available resources whilst making the transition tothe new system is our central priority. These remain the twin responsibilities for currentboards and of new organisations as they are formed through the transition period. No oneshould drop any of their current roles and accountabilities, unless these are transferred,handed over, or have been formally agreed to stop;2. At every level, clinical and managerial leaders, from both primary and secondary care,should work together across organisations to design the new arrangements;3. We will only do at national level what needs to be done at national level, leaving themaximum possible opportunities for flexible local implementation and innovation;4. Strategic Health Authorities will hold the ring on the transition process during 2011/12 andon balancing differing interests in implementing the new system. The SHA’s role shouldinclude overseeing the shift of functions required to create the new Public Health service;5. Authority and accountability will be inextricably and transparently linked at every stage ofthe transition. This encompasses both accountability within the system, which will not bereduced, but also to local communities. The engagement with local authorities on thecreation of Health and Wellbeing Boards and the future Public Health Service is criticallyimportant;6. In designing the new system, the test for us will be what provides the best quality andoutcomes for our patients and the best value for our communities, not the preferences ofsectional interest groups within or outside the system. To this end, patients also need tobe involved at every level in creating the new arrangements;7. We will not wait for all of the elements of the new system to be in place before seeking toprovide more information to the public on quality and outcomes and further supportpatients in making informed choices about their care;8. Running costs need to start and remain low in the new system in line with the reductionsalready planned. This will require lean solutions, shared capacity and focussing ofmanagement effort on the areas of highest priority;9. We want to enable new organisations, and particularly GP consortia, to have themaximum possible choice of how they operate and who works for them;10. At the same time, we want to support current employees of SHAs and PCTs through thechange and, where it is the right thing to do, support them in moving into neworganisations, minimising the cost and complexity and ensuring we retain essential talentand capability through the transition. Those creating new organisations, and individuals inthe change process, will need to be provided with developmental support to enable themto undertake their future roles.16

THE ROYAL BOURNEMOUTH AND CHRISTCHURCH HOSPITALSNHS FOUNDATION TRUSTBOARD OF DIRECTORSMeeting Date and Part: 11 March 2011 Part 1Subject:Programme Management OfficeStrategy UpdateSection:InformationExecutive Director with overallresponsibility:Helen Lingham, Chief OperatingOfficerAuthor of Paper:Geraldine Sweeney, TransformationProgramme ManagerDonna Parker, Deputy ChiefOperating OfficerSummary:To update on the ProgrammeManagement Strategy and changesto the structure of the ProgrammeManagement OfficeStandards for Better Healthdomain:Clinical and cost effectivenessGovernanceAction required by Board ofDirectors:To note for information

Board of Directors Part 111th March 2011Trust Programme Management Strategy Update1 IntroductionThe purpose of this document is to provide an update on the Trust’s ProgrammeManagement Strategy (PMS) and on structural developments that will continue tosupport the delivery of this strategy from April 2011.2 BackgroundProgramme Management is a vital component in the delivery of change. It coversthe planning, financial management and governance of multiple projects that makeup a programme.The current Programme Management Office (PMO) provides the support, guidance,monitoring and exception reporting to ensure the successful delivery of the Trust’sTransformation Programme objectives. The Transformation Programme is made upof a number of projects that are managed as a single entity through the PMO. Thetwo-monthly Transformation Steering Board is responsible for providing assurancethat the overall transformation programme remains on course to deliver the benefitsas defined in the individual workstreams and in line with Trust strategy. PMO staffalso attend the weekly Executive Directors’ meeting to provide updates by exception.Furthermore, since the PMS (which included expansion of specialist skills andknowledge) was agreed at TMB in April 2010 the PMO has developed workingrelationships with the Information Department to provide ongoing productivitymeasures, reports and analytical support to projects. There is also now a dedicatedfinancial resource reporting on realised savings as a measure of progress againstplan.In addition to the existing Transformation Programme, a number of other changeprojects and business cases exist or are in development, which do not currentlyfeature within that programme structure. These include: Spinal Surgery, Back OfficeReview and other QIPP related work, IT developments and process improvementrelated to the delivery of key performance targets. Such work is supported in avariety of ways which includes support from the Service Development Team, ITDevelopment Team and/or from specific directorate structures.Whilst this works well in many instances, there is an opportunity to benefit frombringing together both the projects and the range of skills and resource availablewithin these various support teams. These skills include: structured programme andproject management, coaching and facilitation, financial, informationmonitoring/analysis and IT technical and developmental. In addition, this would bringtogether a background of both clinical and non clinical experiences from variouslevels throughout the Trust and furthermore, would more fully support the expandedremit of the Trust’s Programme Management Strategy.PMO Strategy Update Page 1 of 3For information

Board of Directors Part 111th March 20113 Programme Management ModelIn order to realise the above benefits and ensure the Trust is able to fulfil theexpanded remit and objectives of the PMS, it is proposed that the currentProgramme Management model is reorganised, as in Fig. 1, bringing together stafffrom current the PMO, Service Development, IT development and projectmanagement. This team will be line managed by the Deputy Chief Operating Officerin order to support the appropriate links into the operational structures within theTrust where transformation and development will be realised, whilst also retaining anoverview of the operational and financial implications of such changes.In line with the PMS, where projects are of a size and complexity that warrant aformal approach then they should be managed using a standard process andstructure. Projects will also need access to facilitators who have experience intechniques such as process mapping and facilitating workshops to generate ideas.Fig 1PMO Strategy Update Page 2 of 3For information

Board of Directors Part 111th March 2011The new model will be in place from the 1 st April 2011 and will provide the Trust witha centre of excellence with respect to programme and project management and giveus a basis for cascading these skills throughout the organisation at all levels. Furtherwork is underway to define and develop the scope and detailed structure of theProgramme Management model and team.4 RecommendationThe Board of Directors is asked to note the above report forinformation.HELEN LINGHAMCHIEF OPERATING OFFICERPMO Strategy Update Page 3 of 3For information

THE ROYAL BOURNEMOUTH AND CHRISTCHURCH HOSPITALSNHS FOUNDATION TRUSTBOARD OF DIRECTORSMeeting Date:11 March Part ISubject:Response to the White Paper from theFoundation Trust Governors’ Association(FTGA)Section:InformationExecutive Director withoverall responsibility:Tony Spotswood, Chief ExecutiveAuthor of Paper:Tony Spotswood, Chief ExecutiveSummary:Copy of response to White Paper preparedby FTGAStandards for Better Healthdomain:GovernanceAction required by Board ofDirectors:For Information

Board of Directors – Part I11 March 2011THE ROYAL BOURNEMOUTH & CHRISTCHURCH HOSPITALSNHS FOUNDATION TRUSTResponse to the White Paper from the FoundationTrust Governors’ Association (FTGA)I enclose for information a copy of the response to the White Paper prepared by theFTGA.Tony SpotswoodChief ExecutiveResponse to the White Paper Page 1 of 1For Information

Headline Brief January 2011Command PaperIntroductionAfter considering 6,000 responses to its consultation on the NHS, the Government haspublished ‘Liberating the NHS: Legislative Framework and next steps’ 1 . The 170-page paperindicates how the proposed NHS reforms will be framed in a Health and Social Care Bill to beintroduced this year.The Government has recognised that aspects of itsproposals will take longer than first envisaged and hasmade modifications to reflect this. Its aims, however, havenot been altered by the consultation because respondentssupported its high-level vision:1) Putting patients at the heart of the NHSthrough the principle of “no decision about mewithout me”;2) Focusing on improving outcomes byorienting the NHS towards high-quality care, notnarrow processes; and3) Empowering local organisations andprofessionals by making NHS services moredirectly accountable to patientsand communities.Under the proposals Strategic Health Authorities (SHAs)will be abolished by April 2012, and Primary Care Trusts(PCTs) by April 2013. Their duties and responsibilities willbe replaced in April 2013 by General Practitioner (GP)consortia, an NHS Commissioning Board, and Monitor,acting as the NHS’s financial regulator. By April 2014 alltrusts are expected to have foundation status.Strengthened GovernanceThe Government accepts at least 20 trusts face significantchallenges to meet the criteria for foundation status.However, the Government sees foundation trust (FT)governors, alongside HealthWatch, the Care QualityCommission (CQC) and Monitor, as central to minimisingthe risk of failure.The paper says: “The primary responsibility for quality lieswith providers. The proposed new duties on foundationtrusts will ensure that governors are given a strong andmeaningful role and will place genuine responsibility forperformance on the organisations themselves.” 2The FTGA welcomes this emphasis on the role of thegovernor and it has helped draft sections of the Healthand Social Care Bill, which will include measures to:• make explicit the duty of governors to hold the boardof directors to account, through the chair and nonexecutivedirectors (whom they have power to appointand remove);• give governors power to require trust directors toattend a meeting;• extend to FT directors the duties imposed on directorsunder company law, such as the requirement topromote the success of the organisation;• require FTs to hold annual general meetings at whichmembers would be able to discuss the annual reportand accounts, including directors’ pay and expensesand governors’ expenses.• strengthen the power of the governors by requiringtheir agreement to any changes to an FT’s constitution.• allow FT members to overturn any constitutionalchange concerning the governors’ own role within theorganisation if a significant majority of the membersvoting at an annual meeting opposed it.• require an FT’s governors to agree any merger,acquisition, separation, or other change that the FT’sconstitution defines as “significant”.• give Monitor power to host an independent panel toconsider complaints from governors that trusts arenot complying with their constitutions. The panel’sdecisions will be published but will not be binding.• give the Government power to set the votingmechanism for changing the constitution andgovernance of an FT.After representation from the FTGA, Foundation TrustNetwork (FTN) and CQC on a proposal mooted in the1 Both of these documents can be downloaded from the Department of Healthwebsite at http://www.dh.gov.uk/en/Healthcare/LiberatingtheNHS/index.htm2 See page 43 Liberating the NHS: Legislative Framework and next stepsJoin the discussion at www.ftgovernors.org.uk

original White Paper to allow employee-only membershipof FTs, the Government has decided this model wouldbe at odds with the ideal of public accountability and hasdropped the concept from the Bill. However, it intendsto “explore” the possibility of giving trust employeesthe “right to request” to set up an employee-led socialenterprise to run an “innovative service” 3 . Governorsmight want to consider whether this proposal could leadto the cherry picking of a trust’s most viable services. Theimplications of this proposal are not clear but the FTGAwill monitor any development.Training GovernorsThe paper also recognises that councils of governorswill need additional support to “develop their skills andunderstanding”. This training is seen as essential to“empower governors to hold the organisation to account”.The paper states: “We recognise the significance ofthis issue and will clarify that FTs are responsible forsupporting governors to fulfil their roles. We will alsodiscuss with the Foundation Trust Governors’ Association,the Foundation Trust Network and Monitor what actionneeds to be taken to develop the capability of FTgovernors.” 4 The FTGA has meetings arranged to pursuethis area. The other organisations the Government seesas essential to minimising the risk of failure of its reformsare Monitor, the CQC and HealthWatch.MonitorMonitor’s shift from regulator of FTs to economicregulator of the entire NHS will be more gradual than firstenvisaged and the Government has accepted many trustswill need help to gain FT status.The Health and Social Care Bill will set up a special healthauthority (the Provider Development Agency) that willprovide specialist “turnaround support” to trusts. Toensure a phased transition, Monitor will retain its powersto direct trust boards and remove members up to 2014or for no more than two years after a new FT has beenauthorised. The Bill will compel Monitor to set up a ringfencedcommittee to manage its functions separatelyduring the transition.Once the transition is complete Monitor’s power ofintervention will cease and its only function will be toregister new trusts.Ultimately Monitor will have no power to scrutinise orintervene in an FT’s internal governance. If a governorcomplains to Monitor that a trust is not complying withits own constitution all Monitor will be able to do is hostan independent panel which could publish a non-bindingreport.Governors might want to consider whether this representsa viable check on a trust which is failing to comply with itsconstitution.Care Quality CommissionThe Bill proposes strengthening the CQC’s qualityinspector role. It will make judgements based on a widerange of information and sources. Patient feedback, staffexperience and complaints will play a significant part in itsdeliberations as will information from local HealthWatch,councils and Health and Wellbeing Boards.Where the CQC judges patients and services are at riskit will have the power to suspend or remove registration,effectively closing the service or provider. However, theBill will remove the CQC’s responsibility for inspecting NHSservice providers. The Government believes this does notamount to a reduction of scrutiny because its plans foran “information revolution” will “transform the amountand quality of available information and make providersmore directly accountable for the results they achieve”.Governors should note that this ambition is not currentlysupported by the information now available on providersof NHS services.The Bill will also give local councils’ Overview and ScrutinyCommittees (OSCs) the power to require any NHS-fundedprovider or commissioner to attend scrutiny meetings orprovide information.Governors might want to consider whether informationalone can take the place of inspection and whetherPatient Environment Action Team (PEAT) inspections willbecome more important as a result. Although with thedemise of the National Patient Safety Agency it is unclearwho will oversee PEAT inspections.HealthWatchIn order to create “a more powerful patient voice” a neworganisation called HealthWatch England will be createdwith branches in all local authorities. The organisationswill evolve from Local Involvement Networks (LINks),which the Government believes work well.HealthWatch England will be a consumer championestablished as an independent committee within the CQC.The Bill will say that HealthWatch has a role in promotingand supporting public involvement in the commissioning,provision and scrutiny of local care services. LocalHealthWatches will be able to make recommendations tothe HealthWatch England committee to ask the CQC toconduct investigations into health and care services.The legislation will allow local authorities to commissionHealthWatch to provide advice and information to enablepeople to make choices about health and social care. Thiscould include helping people to access information aboutprovider performance and safety.The paper says HealthWatch will work “alongside the roleof public members and governors of foundation trusts”.However, it does not stipulate how this will be done.The FTGA believes that governors should seek to fostergood links with their local HealthWatch representatives.3 See page 115 Liberating the NHS: Legislative Framework and next steps 4 See page 115 Liberating the NHS: Legislative Framework and next steps

Enquiries should also be made locally by governors to seeif representation on each other’s boards is practical anddesirable.Health and Wellbeing BoardsThe Bill will introduce Health and Wellbeing Boards toallow local authorities to lead on improving the strategicco-ordination of commissioning across the NHS, socialcare and related children’s and public health services.Core members of the board will be GP consortia, thedirector of adult social services, the director of children’sservices, the director of public health and a representativeof the local HealthWatch. Beyond this it is up to the localauthority to invite onto the board. Trusts could be invitedbut the local authorities will need to treat all providersequally. Governors’ input into these boards may bethrough an invitation to attend, via HealthWatch or simplyby attending the meetings which should be public.NHS Commissioning BoardUnder the new NHS structure the NHS CommissioningBoard will set up GP consortia and set the standardsGPs have to work to in the form of a National OutcomesFramework. The Commissioning Board will also beresponsible for commissioning a few specialist nationalservices. All other decisions about which services aredelivered, who provides them and at what price, will betaken by GP consortia.The NHS Commissioning Board is not supposed to beseen as the headquarters of the NHS. The Government iscommitted to a bureaucratic change and for GPs to leadthe NHS. Instead of looking to SHAs and the Departmentof Health, FTs should now be looking at how to help GPconsortia achieve the clinical outcomes they will be setby the Commissioning Board. This potentially representsa significant shift in the political culture of the NHS whichshould be noted by governors.OutcomesOne of the principal tenets of the proposed reforms isa shift from productivity targets, e.g. four-hour waits inAccident and Emergency, to performance measures basedon patient outcomes.The Government is clear that professionals and the publicshould be involved in every stage of developing theseoutcome measures. The FTGA believes that governorsshould ensure they are involved in and understand thisprocess locally.The first NHS Outcomes Framework published inDecember 2010 5 reflects the treatment activity forwhich the NHS is responsible, structured around the fivedomains as proposed in the consultation document:• Domain 1: Preventing people from dying prematurely;• Domain 2: Enhancing the quality of life for peoplewith long-term conditions;• Domain 3: Helping people to recover from ill health orinjury;• Domain 4: Ensuring people have a positive experienceof care; and• Domain 5: Treating and caring for people in a safeenvironment and protecting them from avoidable harm.Any willing providerThe Bill will attempt to increase choice and competitionin the NHS by enabling patients to choose between anywilling provider that meets NHS standards and prices.This will be possible because money will follow the patientand providers will have greater freedom to respondto patients’ needs and preferences. The Governmentenvisages that GP consortia will specify the services andquality standards required and any provider that meetsthese standards should be able to provide the serviceat the specified price. This enables patients to choose(usually at the point of referral) from whom they wantto receive a service, and it enables a wide range ofproviders (including, where appropriate, GP practices) tooffer to provide the services without the need for longprocurement processes.Governors need to be aware of how this may affect theirFT’s income stream. In part it will be affected by therelationship a trust has with its surrounding GP consortiawho under the Bill will be responsible for describing theservices and standards required.Freedom to earn Private IncomeTo balance the move towards “any willing provider”the paper confirms that the Bill will remove the privateincome cap from FTs. The only caveat is the provision ofseparate accounts, to allow public scrutiny and to allowthe FT to demonstrate that it is reinvesting the privateincome in NHS services.There is no discussion of how governors play a role insetting a trust’s strategic approach to private income. Forinstance, how do governors satisfy themselves that NHSwaiting lists are not lengthening as a result of increasedprivate work? In assessing a trust’s strategic goals,governors should remember the rights and responsibilitiesin the NHS Constitution.What it means for GovernorsThese reforms represent a concerted attempt bythe Government to change the dynamic of the NHS.Governors should be aware of the new role proposed forthem and the new opportunities and risks. The legislativechanges proposed place responsibility to govern on FTsthemselves rather than on Monitor. Strikingly the paperstates: “Ultimately…the responsibility for ensuring thattheir governance systems are fit for purpose will lie withfoundation trusts themselves.” 6The expansion of the FT model clearly offers enormousopportunity for governors to become a significant national5 Go to this link on the Department of Health website http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_123138.pdf6 Page 124 Liberating the NHS: Legislative Framework and next steps

voice. The emphasis on the need for more training ofgovernors is also an opportunity for FTGA members toshare best practice with the new cohort of FTs. The FTGAis talking to the Department of Health about how it canhelp provide a national training programme for governors.The FTGA will liaise with its members to understand howthe regulations set out in the Health and Social CareBill work on the ground. Overall the FTGA believes theproposed Bill enshrines the position of governors in theNHS and places their role on a firmer footing.Timetable of ReformsChange ProposedDate52 GP Pathfinder Consortia named December 2010Health and Social Care Bill starts passage through Parliament January 2011Provider Development Authority established April 2012NHS Commissioning Board established April 2012Monitor takes on new role April 2012SHAs abolished April 2012Local Authorities to start funding HealthWatch April 2012Public Health England established within Department of Health April 2012All FT applications must be in March 2013All GPs formed into consortia and given budgets April 2013PCTs abolished and GP consortia take over April 2013Local Authority Health and Wellbeing Boards established with full powers April 2013Health and Wellbeing boards take on statutory authority for public health April 2013Monitor is fully operational as a licensing authority April 2013Local Authorities take on responsibility for NHS complaints April 2013The Provider Development Authority ceases to exist March 2014All NHS trusts have to become FTs April 2014This Headline Briefing has been written to deliver to FTGA members, the key factsand background about priority news stories concerning the NHS and healthcare.Join the discussion at www.ftgovernors.org.ukFoundation Trust Governors’ Association11-13 Cavendish Square, London, W1G 0ANTelephone; 020 7307 2628www.ftgovernors.org.ukHosted byDesign www.fabrikbrands.com

THE ROYAL BOURNEMOUTH AND CHRISTCHURCH HOSPITALSNHS FOUNDATION TRUSTBOARD OF DIRECTORSMeeting Date: 11 March 2011 Part 1Subject:Changes to Executive TeamResponsibilitiesSection:InformationExecutive Director withoverall responsibility:Tony Spotswood, Chief ExecutiveAuthor of Paper:Tony Spotswood, Chief ExecutiveSummary:Changes in Executive DirectorresponsibilitiesStandards for Better Healthdomain:GovernanceAction required by Board ofDirectors:For Information

Board of Directors11 March 2011THE ROYAL BOURNEMOUTH & CHRISTCHURCH HOSPITALSNHS FOUNDATION TRUSTChanges to the Executive Team ResponsibilitiesI am proposing some revision to our local management arrangements to support theongoing transformation work in the Trust whilst ensuring we have the necessarycapacity to lead a Southern England cluster of Trusts who could form a newcommissioning consortia for non-pay products. Effective from 1 April a widertransformation team will be established to include a number of the ServiceDevelopment Directorate and the existing Project Management Office. This work willbe jointly lead by Helen Lingham, COO and Stuart Hunter, Director of Finance.By bringing these teams closer together greater support will be available to helpdrive improvement to transform the quality and cost effectiveness of our services. Inparticular, by bringing together skills such as project management and ITdevelopment and team coaching we will provide an exciting blend of skills andtalents to ensure that we can successfully deliver the transformation required.The second area of change is the transferance of the estates function to the ServiceDevelopment Directorate. The developing estate strategy and especially the futureof Christchurch Hospital forms work already being lead by Richard Renaut, Directorof Service Development. This transfer of responsibility will ensure that we can alsostrengthen work in other areas such as improving the patient environment andexperience and build closer links between our business planning and fundraisingactivities.Undoubtedly 2011/12 will be a challenging year; the wider plans we are nowconsulting on for service change and development, together with these changesshould leave us well positioned to continue to improve our services and care topatients.Tony SpotswoodChief ExecutiveChanges in Exec Team Responsibilities Page 1 of 1For Information

THE ROYAL BOURNEMOUTH AND CHRISTCHURCH HOSPITALSNHS FOUNDATION TRUSTBOARD OF DIRECTORSMeeting Date and Part: 11 March 2011 Part 1Subject:Care and Compassion? Report of theHealth Service Ombudsman on teninvestigations into NHS care of olderpeople.Section:InformationExecutive Director with overallresponsibility:Belinda Atkinson, Director of Nursing andMidwiferyAuthor of Paper:Belinda Atkinson, Director of Nursing andMidwiferySummary:The attached report was published by theHealth Service Ombudsman on 15February 2011. It details significantinadequacies in care given to ten elderlypatients, whose families subsequentlyasked for their complaint to be referred tothe Ombudsman.Core Standards domain:GovernanceAction required by the BoardThis paper is for information. A fullernarrative will be brought to the Board afterreview by the Clinical GovernanceCommittee.

Care and compassion?Report of the Health Service Ombudsman onten investigations into NHS care of older peopleFebruary 2011

Care and compassion?Report of the Health Service Ombudsman onten investigations into NHS care of older peopleFourth report of the Health Service Commissioner for EnglandSession 2010-2011Presented to Parliament pursuant to Section 14(4) of the Health Service Commissioners Act 1993Ordered byThe House of Commonsto be printed on14 February 2011HC 778London: The Stationery Office£15.50

© Parliamentary and Health Service Ombudsman 2011The text of this document (this excludes, where present, the Royal Arms and all departmental and agency logos) may be reproduced free ofcharge in any format or medium providing that it is reproduced accurately and not in a misleading context.The material must be acknowledged as Parliamentary and Health Service Ombudsman copyright and the document title specified.Where third party copyright material has been identified, permission from the respective copyright holder must be sought.Any enquiries regarding this publication should be sent to us at phso.enquiries@ombudsman.org.uk.This publication is also available on http://www.official-documents.gov.ukISBN: 9780102971026Printed in the UK by The Stationery Office Limitedon behalf of the Controller of Her Majesty’s Stationery OfficeID: 2413164 02/11 PHSO-0114Printed on paper containing 75% recycled fibre content minimum.2 Care and compassion?

Contents571113ForewordIntroductionMr and Mrs J’s storyHospital staff at Ealing Hospital NHS Trust leftMr J forgotten in a waiting room, denying himthe chance to be with his wife as she died.Mr D’s storyRoyal Bolton Hospital NHS FoundationTrust discharged Mr D with inadequate painrelief, leaving his family to find someone todispense and administer morphine over a bankholiday weekend.2729Mr C’s storyStaff at Oxford Radcliffe Hospitals NHS Trustturned off Mr C’s life support, despite hisfamily’s request that they delay doing so for ashort time.Mr W’s storyMr W’s life was put at risk when Ashford andSt Peter’s Hospitals NHS Foundation Truststopped treating him and then discharged himwhen he was not medically fit.172123Mrs R’s storyMrs R’s family were concerned that she wouldnot receive food and drink while in SouthamptonUniversity Hospitals NHS Trust unless theythemselves helped her to eat and drink.Mrs Y’s storyMrs Y died from peritonitis and a perforatedstomach ulcer after her GP Surgery missedopportunities to diagnose that she hadan ulcer.Mrs H’s storyWhen Mrs H was transferred from Heart ofEngland NHS Foundation Trust to a care home,she arrived bruised, soaked in urine, dishevelledand wearing someone else’s clothes.313337Mrs G’s storyMrs G’s doctors at her local surgery failed toreview her medication after she left hospital,with serious consequences for her health.Mr L’s storyThe care and treatment that Surrey andBorders Partnership NHS Foundation Trust gaveMr L contributed to a loss of his dignity andcompromised his ability to survive pneumonia.Mrs N’s storyWhile doctors at Northern Lincolnshireand Goole Hospitals NHS Foundation Trustdiagnosed Mrs N’s lung cancer, they neglected toaddress the severe pain that she was suffering.Report of the Health Service Ombudsman on ten investigations into NHS care of older people 3

Foreword by HealthService Ombudsman,Ann AbrahamI am laying before Parliament, under section 14(4)of the Health Service Commissioners Act 1993(as amended), this report of ten investigationsinto complaints made to me as Health ServiceOmbudsman for England about the standard ofcare provided to older people by the NHS.The complaints were made about NHS Trusts acrossEngland, and two GP practices. Although eachinvestigation was conducted independently,I have collated this report because of the commonexperiences of the patients concerned and thestark contrast between the reality of the care theyreceived and the principles and values of the NHS.Sadly, of the ten people featured in this report,nine died during the events described here, or soonafterwards. In accordance with the legislation, myinvestigations were conducted in private and theiridentities have not been revealed.I encourage Members of both Houses to read thestories of my investigations included in this report.I would ask that you then pause and reflect on myfindings: that the reasonable expectation that anolder person or their family may have of dignified,pain-free end of life care, in clean surroundingsin hospital, is not being fulfilled. Instead, theseaccounts present a picture of NHS provision thatis failing to respond to the needs of older peoplewith care and compassion and to provide even themost basic standards of care.The report is also available to read and downloadon our website at www.ombudsman.org.uk.Ann AbrahamHealth Service Ombudsman for EnglandReport of the Health Service Ombudsman on ten investigations into NHS care of older people 5

These accounts present a pictureof NHS provision that is failingto respond to the needs of olderpeople with care and compassion.Ann Abraham, Health Service Ombudsman6 Care and compassion?

IntroductionThis report tells the stories of ten people over theage of 65, from all walks of life and from acrossEngland. In their letters to my Office, their familiesand friends described them variously as lovingpartners, parents and grandparents. Many of themwere people with energy and vitality, active in theirretirement and well known and liked within theircommunities. Some were creative, while otherstook pride in their appearance and in keeping fit.One enjoyed literature and crosswords and anotherwas writing a book.One woman told us how her father kept busy,despite recurring health problems: ‘My dad reallyenjoyed his work as a joiner. Even after he retiredhe still did that kind of work, usually for me andmy siblings. We used to ask: “Dad can you do this,Dad can you do that?” and he always would’.Another relative described her aunt to us: ‘Shewas very adventurous and very widely travelled.She even took herself off, at the age of 81, toDisneyworld in Florida’.These were individuals who put up with difficultcircumstances and didn’t like to make a fuss. Likeall of us, they wanted to be cared for properlyand, at the end of their lives, to die peacefully andwith dignity. What they have in common is theirexperience of suffering unnecessary pain, indignityand distress while in the care of the NHS. Poor careor badly managed medication contributed to theirdeteriorating health, as they were transformedfrom alert and able individuals to people whowere dehydrated, malnourished or unable tocommunicate. As one relative told us: ‘Our dad wasnot treated as a capable man in ill health, but assomeone whom staff could not have cared lesswhether he lived or died’.These stories, the results of investigationsconcluded by my Office in 2009 and 2010, are noteasy to read. They illuminate the gulf between theprinciples and values of the NHS Constitution andthe felt reality of being an older person in the careof the NHS in England. The investigations reveal anattitude – both personal and institutional – whichfails to recognise the humanity and individualityof the people concerned and to respond to themwith sensitivity, compassion and professionalism.The reasonable expectation that an older personor their family may have of dignified, pain-freeThese stories illuminate the gulf betweenthe principles and values of theNHS Constitution and the felt realityof being an older person in the careof the NHS in EnglandReport of the Health Service Ombudsman on ten investigations into NHS care of older people 7

Introductionend of life care, in clean surroundings in hospital isnot being fulfilled. Instead, these accounts presenta picture of NHS provision that is failing to meeteven the most basic standards of care.These are not exceptional or isolated cases. Ofnearly 9,000 properly made complaints to myOffice about the NHS in the last year, 18 per centwere about the care of older people. We accepted226 cases for investigation, more than twice asmany as for all other age groups put together.In a further 51 cases we resolved complaints directlywithout the need for a full investigation. The issueshighlighted in these stories – dignity, healthcareassociated infection, nutrition, discharge fromhospital and personal care – featured significantlymore often in complaints about the care ofolder people.It is incomprehensible that the Ombudsmanneeds to hold the NHS to account for themost fundamental aspects of careThese complaints come from a population ofhealth service users that is ageing. There are now1.7 million more people over the age of 65 thanthere were 25 years ago and the number of peopleaged 85 and over has doubled in the same period.By 2034, 23 per cent of the population is projectedto be over 65. As life expectancy increases, so doesthe likelihood of more years spent in ill health, withwomen having on average 11 years and men 6.7 yearsof poor health. Nearly 700,000 people in the UKsuffer from dementia, and the Alzheimer’s Societypredicts that this figure will increase to 940,000by 2021 and 1.7 million by 2051. The NHS will needto spend increasing amounts of time and resourcecaring for people with multiple and complex issues,disabilities and long‐term conditions and offeringpalliative care to people at the end of their lives.The nature of the failings identified by myinvestigations suggests that extra resource alonewill not help the NHS to fulfil its own standardsof care. There are very many skilled staff withinthe NHS who provide a compassionate andconsiderate service to their patients. Yet the casesI see confirm that this is not universal. Instead, theactions of individual staff described here add up toan ignominious failure to look beyond a patient’sclinical condition and respond to the social andemotional needs of the individual and their family.The difficulties encountered by the service usersand their relatives were not solely a result ofillness, but arose from the dismissive attitude ofstaff, a disregard for process and procedure and anapparent indifference of NHS staff to deplorablestandards of care.Sadly, of the ten people featured, nine died duringthe events described here, or soon afterwards. Thecircumstances of their deaths have added to thedistress of their families and friends, many of whomcontinue to live with anger and regret.Such circumstances should never have arisen. Thereare many codes of conduct and clinical guidelinesthat detail the way the NHS and its staff shouldwork. The essence of such standards is captured inthe opening words of the NHS Constitution: ‘TheNHS touches our lives at times of basic humanneed, when care and compassion are what mattermost’. Adopted in England in 2009, the Constitutiongoes on to set out the expectations we are allentitled to have of the NHS. Its principles includea commitment to respect the human rights ofthose it serves; to provide high-quality care that issafe, effective and focused on patient experience,to reflect the needs and preferences of patientsand their families and to involve and consultthem about care and treatment. Users of NHSservices should be treated with respect, dignityand compassion.8 Care and compassion?

IntroductionIt is against these standards and my ownOmbudsman’s Principles that I have judged theexperiences presented here. I also expect theNHS to take account of the principles of humanrights – fairness, respect, equality, dignity andautonomy – that are reflected in the NHSConstitution. Some of the events recounted in thisreport took place before the NHS Constitutioncame into effect, but this does not excuse adismissive response to pain, distress or anxietyor a failure to take account of patients’ needsand choices.When an NHS user complains to my Office, havingfailed to resolve their complaint locally, we firstseek to establish what should have happenedand then to investigate what did take place. Weconsider whether the shortcomings betweenwhat should have happened and what did happenamount to maladministration or service failure.In each of the accounts included here, a complaintwas first made to the NHS body or trust concerned.Not only did those who complained to meexperience the anguish of the situations described,but throughout the NHS complaints process theirconcerns were not satisfactorily addressed.The first priority for anyone with illness ishigh‐quality effective medical treatment, availablequickly when needed. The outcome should be areturn to health or as near as possible. If illness isterminal, the priority should be palliative care, withadequate relief of both pain and anxiety. This is notalways easy or straightforward. Often, older peoplehave multiple and complex needs that requirean understanding of the interaction between avariety of different medical conditions to ensurethat one is not addressed in ignorance or at theneglect of others. A person’s physical illness may becompounded by a difficulty with communicationor by dementia. Inattention to the suffering ofolder people is characteristic of the stories in thisreport. Inadequate medication or pain relief thatis administered late or not at all, leaves patientsneedlessly distressed and vulnerable.Alongside medical treatment, effort should beput into establishing a relationship with theindividual that ensures their needs will be heardand responded to. Where older people are notable to take part in decisions about their care andtreatment, families or carers must be involved.Above all, care for older people should be shapednot just by their illness, but by the wider contextof their lives and relationships. Instead, ourinvestigations reveal a bewildering disregard of theneeds and wishes of patients and their families.One family, whose story is recounted here, sufferedvery great distress when the gravity of their lovedone’s condition was not communicated to themproperly or appropriately, and his life support waslater turned off against their express wishes.The difficulties encountered by theservice users and their relatives were notsolely a result of illness, but arose from thedismissive attitude of staff, a disregardfor process and procedure and theapparent indifference of NHS staff todeplorable standards of careThe theme of poor communication and thoughtlessaction extends to discharge arrangements,which can be shambolic and ill-prepared, witholder people being moved without their family’sknowledge or consent. Clothing and otherpossessions are often mislaid along the way.One 82‐year‐old woman recalled how, on beingdischarged from hospital after minor surgery, shewas frightened and unsure of how to get home.She asked the nurse to phone her daughter. ‘Hetold me this was not his job’, she said.Report of the Health Service Ombudsman on ten investigations into NHS care of older people 9

It is incomprehensible that the Ombudsmanneeds to hold the NHS to account for the mostfundamental aspects of care: clean and comfortablesurroundings, assistance with eating if needed,drinking water available and the ability to callsomeone who will respond. Yet as the accounts inthis report show, these most basic of human needsare too often neglected, particularly when theindividual concerned is confused, or finds it difficultto communicate.Half the people featured in this report did notconsume adequate food or water during their timein hospital. I continue to receive complaints inwhich, almost incidentally, I hear of food removeduneaten and drinks or call bells placed out ofreach. Arrangements such as protected meal times,intended to ensure a focus on nutrition and thatnurses have time to support those who needassistance with eating, have been distorted. Carersor members of the family who might wish to helpthe patient eat and drink are not permitted to doso, and help with eating is not forthcoming fromnursing staff.The NHS must close the gap betweenthe promise of care and compassionoutlined in its Constitution and the injusticethat many older people experienceOlder people are left in soiled or dirty clothesand are not washed or bathed. One woman toldus that her aunt was taken on a long journey toa care home by ambulance. She arrived strappedto a stretcher and soaked with urine, dressedin unfamiliar clothing held up by paper clips,accompanied by bags of dirty laundry, much ofwhich was not her own. Underlying such acts ofcarelessness and neglect is a casual indifference tothe dignity and welfare of older patients.That this should happen anywhere must causeconcern; that it should take place in a settingintended to deliver care is indefensible.As Health Service Ombudsman, I have sought toremedy the injustice experienced by the peoplewhose complaints are set out in this report. Thereis no adequate redress for the distress or anguish atthe death of a loved one, but my recommendationsto trusts often require them to apologise andprepare action plans addressing the failings thathave been identified. My intervention can also leadto financial remedy where appropriate. But financialresource alone will not ensure such circumstancesare not repeated. An impetus towards real andurgent change, including listening to older people,taking account of feedback from families andlearning from mistakes is needed. I have yet tosee convincing evidence of a widespread shift inattitude towards older people across the NHS thatwill turn the commitments in the NHS Constitutioninto tangible reality.I am grateful to all the people who have givenpermission for their stories, and those of theirloved ones, to be told here. These often harrowingaccounts should cause every member of NHS staffwho reads this report to pause and ask themselvesif any of their patients could suffer in the sameway. I know from my caseload that in many casesthe answer must be ‘yes’. The NHS must close thegap between the promise of care and compassionoutlined in its Constitution and the injustice thatmany older people experience. Every member ofstaff, no matter what their job, has a role to play inmaking the commitments of the Constitution a feltreality for patients. For the sake of all the peoplefeatured here, and for all of us who need NHS carenow and may do so in the future, I hope that thiswill be their legacy.10 Care and compassion?

Mr and Mrs J’s story‘Care and compassion arewhat matter most’NHS Constitution‘A shabby, sad end to mypoor wife’s life’The storyMrs J was 82 years old. She had Alzheimer’s diseaseand lived in a nursing home. Her husband visitedher daily and they enjoyed each other’s company.Mr J told us ‘She had been like that for nine years.And I was happy being with her’. One evening,Mr J arrived at the home and found that his wifehad breathing difficulties. An ambulance was calledand Mrs J was taken to Ealing Hospital NHS Trust atabout 10.30pm, accompanied by her husband. Shewas admitted to A&E and assessed on arrival by aSenior House Officer who asked Mr J to wait in awaiting room.Mrs J was very ill. She was taken to the resuscitationarea, but was moved later when two patientsarrived who required emergency treatment. Mrs Jwas then seen by a Specialist Registrar as she wasvomiting and had become unresponsive. It wasdecided not to resuscitate her. She died shortlyafter 1.00am. At around 1.40am the nursing stafftelephoned the nursing home and were told thatMr J had accompanied his wife to hospital. TheSenior House Officer found him in the waitingroom and informed him that his wife had died.In the three hours or so that Mr J had been in thewaiting room, nobody spoke to him or told himwhat was happening to his wife. As a result he cameto believe that her care had been inadequate. Hethought that he had been deliberately separatedfrom her because hospital staff had decided tostop treating her. ‘They let her slip away under thecloak of “quality of life” without stopping to thinkof any other involved party.’ He felt the hospitalhad denied them the chance to be together in thelast moments of Mrs J’s life and he did not knowwhat had happened to her.Mr J complained to the Trust. Their responsewas timely, and he met with staff in an attemptReport of the Health Service Ombudsman on ten investigations into NHS care of older people 11

Mr and Mrs J’s storyto address his concerns. The Trust apologisedthat staff had forgotten that Mrs J had beenaccompanied to hospital by her husband, describingthat as ‘a serious breakdown in communication’,but then took no appropriate steps to tacklethis failing.What our investigation foundWe investigated the circumstances surroundingMrs J’s death and the Trust’s response to Mr J’scomplaint. Our investigation found that Mrs Jwas not monitored properly after she arrived atthe hospital. No observation chart was started,no further assessments were documented afterthe first assessment and she waited for a medicalreview which did not take place. No attempt wasmade to contact the nursing home or a familymember until after she had died. The Trust’s carefell below the level set out in national guidance.Mrs J was denied the right to a dignifieddeath with her husband by her sideWe sought expert advice on the decision not toresuscitate Mrs J. Our Clinical Adviser’s opinionwas that attempts to resuscitate a patient as ill asshe was would have been ‘futile and undignified’.The hospital failed, however, to involve Mr J inthe decision-making process and nobody toldMr J what was happening to his wife until she haddied. It was crucial that Mr J was involved in thedecision-making and the move to compassionateand supportive care in his wife’s last moments.Mrs J was denied the right to a dignified deathwith her husband by her side. In Mr J’s own words,‘They decided that enough was enough withoutbothering to include me in’.Aspects of Mrs J’s care and treatment and theTrust’s failure to involve Mr J in decisions aboutthem, fell below the level set out in nationalguidance and established best practice. The impactof these failings on Mr and Mrs J was that Mrs J didnot receive the appropriate level of care and didnot have her husband with her when she died. Mr Jwas understandably distressed that he was nottold what was happening; not involved in his wife’scare; and was unable to be with her at the end ofher life. In addition to this, the Trust’s failure toaddress the issues in Mr J’s complaint unnecessarilyprolonged the complaints process. ‘It was a shabby,sad end to my poor wife’s life.’We upheld Mr J’s complaint about the Trust.What happened nextThe Trust apologised to Mr J for their failings andpaid him £2,000 in recognition of the distress hehad suffered. The Trust’s Chief Executive metwith Mr J and explained the procedural changesthey had made, which included asking patientsattending A&E if they are accompanied, recordingthe response and ensuring that staff keep theaccompanying person informed about what ishappening to the patient.At the conclusion of the investigation, Mr J thankedthe Ombudsman’s staff for ‘pursuing his case sofaithfully and with such dedication’.12 Care and compassion?

Mr D’s story‘We respond with humanityand kindness to eachperson’s pain’NHS Constitution‘His tongue was like a pieceof dried leather’The storyMr D was first admitted to the Royal BoltonHospital NHS Foundation Trust with a suspectedheart attack and discharged a week later withfurther tests planned on an outpatient basis. Fourweeks later, Mr D was readmitted with severe backand stomach pain. He was described by cliniciansand nurses at the hospital as a quiet man, well-liked,who never complained or made a fuss. He did notlike to bother the nursing staff.Mr D was diagnosed with advanced stomachcancer. His discharge, originally planned for Tuesday30 August, was brought forward to 27 August,the Saturday of a bank holiday weekend. On theday of discharge, which his daughter describedas a ‘shambles’, the family arrived to find Mr Din a distressed condition behind drawn curtainsin a chair. He had been waiting for several hoursto go home. He was in pain, desperate to go tothe toilet and unable to ask for help because hewas so dehydrated he could not speak properlyor swallow. His daughter told us that ‘his tonguewas like a piece of dried leather’. The emergencybutton had been placed beyond his reach. His driphad been removed and the bag of fluid had fallenand had leaked all over the floor making his feetwet. When the family asked for help to put Mr Don the commode he had ‘squealed like a piglet’with pain. An ambulance booked to take him homein the morning had not arrived and at 2.30pm thefamily decided to take him home in their car. Thiswas achieved with great difficulty and discomfortfor Mr D.On arriving home, his family found thatMr D had not been given enough painkillersReport of the Health Service Ombudsman on ten investigations into NHS care of older people 13

Mr D’s storyOn arriving home, his family found that Mr D hadnot been given enough painkillers for the bankholiday weekend. He had been given two bottlesof Oramorph (morphine in an oral solution),insufficient for three days, and not suitable as bythis time he was unable to swallow. Consequently,the family spent much of the weekend drivinground trying to get prescription forms signed,and permission for District Nurses to administermorphine in injectable form. Mr D died, three daysafter he was discharged, on the following Tuesday.His daughter described her extreme distress andthe stress of trying to get his medication, fearingthat he might die before she returned home. Shealso lost time she had hoped to spend with himover those last few days.The family spent much of the weekenddriving round trying to get prescriptionforms signed, and permission forDistrict Nurses to administer morphine• he was left without access to drinking water ora clean glass• his pain was not controlled and medication wasdelayed by up to one and a half hours• pressure sores were allowed to develop• no check was made on his nutrition• his medical condition was not properlyexplained to his family• he was told of his diagnosis of terminal canceron an open ward, overheard by other patients.What our investigation foundWe found that Mr D’s care and treatment fell belowreasonable standards in a number of ways. Thosefailings in care and treatment, and also in dischargeplanning and complaint handling, caused distressand suffering for Mr D and his family.Mr D’s daughter complained to the Trust and theHealthcare Commission about very poor care whilein hospital. When she still felt her concerns had notbeen understood she came to the Ombudsman.She described to us several incidents that hadoccurred during her father’s admissions. She said:• he was not helped to use a commode andfainted, soiling himself in the process• he was not properly cleaned and his clotheswere not changed until she requested this thefollowing day• the ward was dirty, including a squashedinsect on the wall throughout his stay and nailclippings under the bedFailings in care and treatment caused distressand suffering for Mr D and his familyWe found no service failure in the time takento diagnose Mr D’s cancer, nor in the way theTrust communicated the diagnosis to his family.However, there were a number of service failuresduring both of his admissions. There was no careplan for his malaena (blood in his stools), and norisk assessments relating to pressure ulcers orfalls were carried out. Mr D’s nutritional statuswas not properly assessed, while a lack of recordsmeant that it was impossible to assess his fluid orfood intake.14 Care and compassion?

Mr D’s storyEven as Mr D’s condition deteriorated and his needsincreased, no further detailed nursing assessmentswere undertaken, nor was an appropriate careplan drawn up. Pain relief for Mr D was not alwayseffective, yet no formal pain assessments werecompleted. In his daughter’s own words, she was‘disgusted that a dying man was left in a chair foralmost a month, with no‐one ever trying to makehim comfortable in bed, no‐one relieving his painadequately, checking for pressure sores or ensuringhe ate or drank’.Considerable guidance existed at the time ofMr D’s discharge relating to discharge and care forterminally ill patients, and in some respects theTrust’s discharge planning was good. For example,they contacted Macmillan and District Nurses andsocial services. But other aspects of the dischargeplanning were not good. In particular, the changeof Mr D’s discharge date should have prompteda complete review of his condition, needs anddischarge arrangements. That did not happen;the palliative care team were unaware of Mr D’schanging medication needs, and the medicationprescribed on discharge did not meet his needs. Hisdaughter graphically described to us the family’sexperiences on the day of discharge and thefrantic efforts they made to obtain pain relief forMr D. The uncertainty about whether he wouldstill be alive on their return from their trips, orhow much pain they would find him in, must havebeen harrowing.concerns she had raised. The Trust apologisedto her for the shortcomings in Mr D’s care, butdid not give her evidence that they had fullyimplemented improvements recommended by theHealthcare Commission.We upheld this complaint.What happened nextThe Trust apologised to Mr D’s daughter and paidher compensation of £2,000. They also told uswhat they would do to prevent a repeat of theirfailings. Their plans included a review of all nursingdocumentation; the introduction of a five-day painmanagement course available to all Trust staff; andthe introduction of an ‘holistic assessment tool’to be used by the palliative care team to makesure that a person’s care needs are met and theirdischarge is properly planned.The Trust apologised for theshortcomings in Mr D’s careThe Trust’s response to Mr D’s daughter’sfirst complaint contained inaccuracies, and alater response did not address all of the newReport of the Health Service Ombudsman on ten investigations into NHS care of older people 15

‘From the moment cancer wasdiagnosed my dad was completelyignored. It was as if he didn’texist – he was an old man andwas dying.’Mr D’s daughter(page 13)16 Care and compassion?

Mrs R’s story‘We do not wait to beasked because we care’NHS Constitution‘There was a lack ofconcern and sympathytowards patients ... andthe family’The storyMrs R lived with her husband in a warden‐assistedflat. She had limited mobility and was verydependent on him for support to walk. InMarch 2007 Mrs R was admitted to SouthamptonUniversity Hospitals NHS Trust with worseningmobility, recurrent falling and confusion. She wasdiagnosed with dementia the following month. Herhealth deteriorated and she was given palliativecare. She died in July 2007.Her daughter complained to the Trust and then tothe Ombudsman about various failings in nursingcare during her mother’s time in hospital beforeshe died. She said that staff had not offered Mrs Ra bath or shower during her 13‐week admission.She told us that when she and her sister hadtried to bath Mrs R themselves, they were left ina bathroom on another ward, without supportfrom staff or instructions on how to use the hoist.They felt unable to risk using the equipment andso Mrs R went without her bath. Her hair wasunwashed and her scalp became so itchy that, atthe family’s request, nurses checked her hair for lice.Mrs R’s daughter complained that staff had to beasked on four consecutive days to dress an openwound on Mrs R’s leg, which she said was ‘weepingand sticky’. She said that when she raised concernsabout this with staff on the ward she was told therewas no complaints department. Mrs R’s daughtersaid that her mother was not helped to eat, eventhough she was unable to do it herself. She saidthis had once happened when several nurses were‘chatting’ at the nurses’ station. Nurses left foodtrays and hot drinks out of reach of patients andMrs R’s family felt she would not receive food ordrink unless they gave it to her. Her daughter feltthe fact that staff did not give her mother food ordrinks was effectively ‘euthanasia’.Report of the Health Service Ombudsman on ten investigations into NHS care of older people 17

Mrs R’s storyMrs R’s daughter also said Mrs R had suffered fourfalls in hospital, including two in 24 hours (she wasunaware that her mother had actually sufferednine falls), and that the family’s requests for cotsides to be used had been declined on the groundsthat their use might compromise her mother’srights. One fall led to Mrs R sustaining a large facialhaematoma with bruising, which greatly distressedher family when they viewed her body before thefuneral. Mrs R’s daughter described her father as arobust man but he was in tears seeing the bruises.He died shortly afterwards and she felt he had ‘diedof a broken heart’.Overall, Mrs R’s daughter was left feeling that ‘therewas a lack of concern and sympathy towardspatients/deceased and [the] family’.What our investigation foundWe found that Mrs R had nine falls while in hospital,yet only one fall was noted in the nursing records;the Identification of Risks of Falls and InterventionTool was completed just twice; and both entrieswere reviewed only once. There was no evidencethat Mrs R’s risk of falling was kept under review, nodetailed care plans, or any incident forms followingher falls. No advice or support was sought from aspecialist falls practitioner.Mrs R had nine falls while in hospital,yet only one fall was noted inthe nursing recordsWe found that no consideration was given tooffering Mrs R help to bath or shower, althoughshe was washed in bed. There was no furtherassessment of her nutritional needs, and noevidence in the nursing records that she wasoffered frequent fluids to prevent dehydration orencouraged to drink. Nurses failed to co-operatewith medical recommendations and requeststo provide hip protectors for Mrs R, to place amattress next to her bed and to encourage her todrink. Dressings were applied to Mrs R’s leg woundbut we could not judge from the nursing records ifthe wound was appropriately treated.The nursing care provided for Mrs Rby the Trust fell significantly belowthe relevant standardsIn response to her daughter’s complaint, the Trustapologised for the lack of bathing facilities andacknowledged the need to support families wishingto use facilities on other wards. The Trust said theyhad introduced protected meal times (times whenpatients can eat without interruption) and a systemto identify patients who may need help. Volunteerswere being recruited to help with this. The Trustapologised that Mrs R’s family were told that cotsides could not be used as they would compromiseher rights, when it would have been better to sayit was her safety that might be compromised. TheTrust also acknowledged Mrs R’s daughter’s concernabout repeatedly having to ask for the leg woundto be dressed.However, the Trust did not identify failings inmeeting Mrs R’s nutritional needs and in relation toher falls, and they did not discuss the issue of cotsides at their falls group, as they had told Mrs R’sdaughter they would. Her complaint about the legdressing was not addressed.We found that the nursing care provided for Mrs Rby the Trust fell significantly below the relevantstandards, causing her and her family considerableand unnecessary distress. The Trust’s handling ofthe subsequent complaint left her without full18 Care and compassion?

Mrs R’s storyThe Trust did not identify failingsin meeting Mrs R’s nutritional needsand in relation to her fallsexplanations or assurances that they had learntlessons. She was understandably dissatisfied withthe Trust’s responses and she had to come to theOmbudsman for further answers.We upheld this complaint.What happened nextThe Trust apologised to Mrs R’s daughter and puttogether an action plan to address their failings innursing care and complaint handling. Their plansinclude ensuring that patients and their carers areoffered a choice in how their personal hygieneneeds are met; changing the way patient mealsare delivered so that staff are able to help witheating; centralised complaint handling so that allcomplaints are dealt with consistently and bestpractice is shared; and removing the distinctionbetween complaints made informally, formally,orally or in writing.Report of the Health Service Ombudsman on ten investigations into NHS care of older people 19

‘My aunt’s basic human rights asa person, never mind her specialneeds and rights as a person withseveral disabilities, were totallydisregarded and neglected.I am certain that she was ingreat distress and felt totallyalone and abandoned.It makes me feel so angry.’Mrs H’s niece(page 23)20 Care and compassion?

Mrs Y’s story‘Providing a comprehensiveservice’NHS Constitution‘I am concerned that anotherwise healthy elderlylady was allowed todeteriorate so quickly’The storyMrs Y lived on her own. Her relative described heras always being in good health, and having ‘excellentenergy and vitality for her age’. In May 2008 Mrs Yhad a fall at home which she did not report atthe time; her relative said she was of a generationwho ‘tended to put up with things’. A week laterMrs Y’s family persuaded her to attend the A&Edepartment at Epsom and St Helier UniversityHospitals NHS Trust, as she was obviously in somediscomfort. Mrs Y was diagnosed with a fracture ofpart of her pelvis. She was kept in overnight, anddischarged the next day with painkilling medicationthat included ibuprofen.No follow-up care was arranged for Mrs Y and itwas only five days later on 2 June that the hospitalfaxed a discharge summary to Mrs Y’s GP. Thesummary did not contain details of the medicationwhich had been prescribed.Mrs Y began to feel sick after returning home andshe developed severe constipation. Her relativesaid she was not her usual lively self and was‘unusually low’. She was eating little and losingweight. Eventually, Mrs Y’s neighbour telephonedthe GP on 10 June to ask her to carry out a homevisit. The GP telephoned Mrs Y but did not visit.She recorded that Mrs Y was constipated and had apoor appetite and advised her to phone again thenext day if she remained concerned.The following day another neighbour drove tothe surgery to say that Mrs Y seemed confused.The GP telephoned Mrs Y again, offering to visitthat afternoon. Mrs Y said that would not beconvenient: a visit was arranged for two days later,which was the day after her 88th birthday. Duringthe visit the GP assessed her mental conditionand prescribed paracetamol. She told Mrs Y thatarrangements would be made for a carer to visit.Report of the Health Service Ombudsman on ten investigations into NHS care of older people 21

Mrs Y’s storySadly, Mrs Y was found dead on the upstairslanding of her home the next day, by a neighbourwho had become very concerned that she wasnot answering her telephone. A post‐mortemestablished that Mrs Y had died from peritonitisand a perforated stomach ulcer.Her relative and his wife complained to the Trustthat the hospital had not arranged follow-up carefor Mrs Y after her discharge, and did not informthe GP promptly about her attendance at the A&Edepartment. They also complained that the GP didnot see Mrs Y until three days after a home visithad been requested and that the GP’s assessmentof Mrs Y had not been sufficiently thorough.As her relative put it, ‘I am concerned that anotherwise healthy elderly lady was allowed todeteriorate so quickly following her self‐admission,in circumstances known to be potentially serious’.What our investigation foundAlthough Mrs Y’s hospital discharge wasappropriate, planning for the discharge should havestarted earlier. There should have been an earlierreferral to the GP and Mrs Y should also have beenreferred to a specialist falls service. The dischargesummary gave no details of the medicationprescribed for Mrs Y. This was significant, because itis quite likely that her ulcer developed as a result oftaking ibuprofen.The likelihood is that Mrs Y was showingsignificant symptoms related to her ulcer whenthe GP examined her, and we concluded that theGP’s assessment of her was not thoroughenough. We could not say that Mrs Y’s deathdefinitely resulted from the failure to identify thesymptoms from the ulcer, but the opportunity totreat it was missed.The GP’s assessment of herwas not thorough enoughWe concluded that the GP had not met theGeneral Medical Council standard that good clinicalcare must include adequately assessing a patient’scondition taking account of their history. Whilea telephone assessment might initially have beenappropriate, the GP should have arranged to visitwhen she received a message of further concernfrom the neighbour the following day.We upheld the complaints about both the Trustand the GP Surgery.What happened nextThe Trust and the GP Surgery both apologisedto Mrs Y’s relatives and drew up plans to preventrecurrences of their failings. Among the actionstaken or planned were new procedures forensuring that discharge summaries were completedpromptly; a matron-led review of the nurse’s rolein the A&E observation bay; and regular teachingsessions for A&E doctors about prescribing andmonitoring medication. The Trust also said thatthey would share the lessons learnt from thecomplaint to reduce the risk of others suffering thesame experience.For their part, the GP Surgery drew up a protocolfor the care of elderly people living alone, whohave problems after their discharge from hospital.22 Care and compassion?

Mrs H’s story‘High‐quality care focusedon patient experience’NHS Constitution‘Little attempt was made toascertain that she ... fullyunderstood her situation’The storyMrs H was a feisty and independent womanof high intelligence who loved literature andcrosswords. She was a dignified woman whoseclothes were important to her. She lived in her ownhome until the age of 88, needing relatively littlesupport. Mrs H was deaf and partially sighted andcommunicated through British Sign Language anddeaf-blind manual although she could still read largeprint. She was an active member of her local deafcommunity and one of the founder members ofthe local Institute for the Deaf. Her only relative,her niece, lived in New Zealand but maintainedclose contact and held power of attorney for her.Following a fall at home, Mrs H moved to anintermediate care centre for treatment. From thereshe was admitted to the Elderly Care AssessmentUnit of Birmingham Heartlands Hospital (part ofHeart of England NHS Foundation Trust) withacute confusion. She remained there for aboutfour months. Social workers identified a care homefor residents with dementia, which Mrs H’s niecedeclined because it had no facilities for residentswith sensory impairment. This led to a longer stayin hospital. Her niece eventually found a place at acare home in Tyneside and arranged for Mrs H tomove there. While Mrs H was in hospital:• she had a number of falls, one of which brokeher collar bone, but her niece was not informed.Several injuries and falls were not included onher discharge summary• poor nursing records were kept and nopersonalised plans for her non‐medical needswere developed• although at low risk of malnutrition atadmission, Mrs H lost about 11 lbs during her firstthree months in hospitalReport of the Health Service Ombudsman on ten investigations into NHS care of older people 23

Mrs H’s story• communication with Mrs H was difficult and herspecific needs were not met. No activities orstimulation were provided for her• her valuables and clothing were brought to theward but there was no record of their receipt• communications around the dischargearrangements were poor with no handover tothe home• despite her niece’s requests, no arrangementswere made with social services for Mrs H’sclothes to be laundered.During a lengthy journey to the home, Mrs Hwas strapped onto a stretcher in the back of anambulance for her safety. (The Trust told us thatthis was because the potential consequences ofher becoming more distressed and confused onthe journey could have been very serious.) Mrs Hwas accompanied by a male nurse who had nursedher on the ward. She was agitated and distressedbut was not given any medication despite it beingavailable. (The Trust told us that this was because itcould have increased her confusion.) When Mrs Harrived at the care home, the Manager noted thatshe had numerous injuries, was soaked with urineand was dressed in clothing that did not belong toher which was held up with large paper clips. Shehad with her several bags of dirty clothing, much ofwhich did not belong to her, and few possessionsof her own. Mrs H was bruised, dishevelled andconfused. She was highly distressed and agitatedand the following day was admitted to a localWhen she arrived at the care home,she had numerous injuries, was soakedwith urine and was dressed in clothing thatdid not belong to her which was held upwith large paper clipsMrs H’s niece complained that Mrs H’sright to dignity was not respectedhospital due to concerns about her mental stateand her physical condition.Sadly, Mrs H died in August 2010 shortly before theconclusion of our investigation.Mrs H’s niece complained that Mrs H’s right todignity was not respected and that she hadbeen treated with contempt and disdain. Shecomplained that Mrs H’s property and clothing hadnot been taken care of whilst in hospital, and thatno arrangements had been made to launder herclothes. She said that her aunt suffered distress andindignity, her mental health had suffered prematuredeterioration and she needed to be admitted toanother hospital on her arrival at Tyneside. Shealso complained that some of Mrs H’s property andclothing had been lost.Mrs H’s niece complained that Mrs H sustainedunexplained injuries in hospital and that she wasnot informed of these. She believed the dischargeand transfer arrangements for Mrs H were whollyinadequate and inappropriate.What our investigation foundWe found evidence that the care given to Mrs Hfell significantly below the applicable standardin relation to meeting her cultural and linguisticneeds, maintaining her comfort and wellbeingand safeguarding her property and clothing. Wealso found serious shortcomings in the Trust’scommunication with her niece. Underpinningthese serious shortcomings were failures to carryout appropriate assessments and to developpersonalised care plans, failures to understandMrs H’s relationship with her niece and failure to24 Care and compassion?

follow local and national policy and guidance. Takentogether, this amounted to service failure.As a result of this we found that Mrs H sufferedadditional unnecessary distress which could havebeen minimised by care tailored to her needs,which allowed her to exercise choice and controland have her preferences met. The failure topersonalise her care meant that her dignity andindividuality were compromised. She sufferedfinancial loss through the Trust’s failure to safeguardher property.Mrs H’s niece also suffered unnecessary distress asa result of the Trust’s failure to keep her informedabout Mrs H’s falls and condition.We upheld these complaints.What happened nextThe Trust apologised to Mrs H’s niece for thedistress and indignity that Mrs H had suffered andfor losing her property. The Trust also paid herniece compensation totalling £1,500 and reimbursedher £300 for the loss of her aunt’s belongings.The Trust also drew up plans to prevent the samefailings from happening again. The actions takenor planned include the development of studydays to determine staff’s attitude, knowledge andbeliefs surrounding dementia; the introduction ofa password‐protected system to enable staff togive confidential information to family membersover the telephone; reminders to staff abouthow to access interpreting services for patientswith impaired hearing; and the appointment of anAdmission and Discharge Co-ordinator.Report of the Health Service Ombudsman on ten investigations into NHS care of older people 25

‘The nurses completed all thedischarge forms and told me Iwould be leaving. I was quitefrightened. I was recovering fromminor surgery. I am 82 years oldand did not know how I was toget home. I asked the nurse if hecould phone my daughter.He told me this was not his job.’Mrs N(page 37)26 Care and compassion?

Mr C’s story‘We find time for those weserve and work alongside’NHS Constitution‘Staff decided that we hadbeen given as much timeas we were allowed’The storyMr C was described by his daughter, Miss C, asmentally active and creative – he was in the processof writing a book.He became unwell and underwent heart surgery(a quadruple coronary artery bypass) at OxfordRadcliffe Hospitals NHS Trust, an operation whichstarted at midday and was expected to last forthree hours. Mr C’s wife and daughter remainedalone in the waiting room for five hours. They toldus that during that time they tried unsuccessfullyand with increasing desperation to find someone togive them some information. They eventually foundthe Consultant, who indicated that the surgery hadgone well.Sadly, about two hours after the operation,Mr C’s condition deteriorated and he suffered aheart attack.Mr C underwent open heart massage, while his wifeand daughter waited nearby for news, occasionally‘wander[ing] the corridors looking for someone totell us what was happening’. A Registrar spoke toMiss C, but his English was ‘very poor and broken’.The exchange left Mr C’s wife and daughter unclearas to whether Mr C had died – ‘my questionasking if he was alive kept getting sidesteppedyet the question – is he dead – also got a no. Theconfusion was terribly distressing’. They asked tosee Mr C and did so at around 9.30pm. At 9.15pm,unknown to Mr C’s family, a ‘Do not attemptresuscitation’ note was made in his medical records.A nurse told Miss C that her father was onlybeing kept alive by the ventilator and that he had‘flatlined’ (meaning that there was no heart beat).His wife, who was totally distraught, wanted totelephone her sons.Report of the Health Service Ombudsman on ten investigations into NHS care of older people 27

Mr C’s storyMiss C told the nurse that they were going tomake a phone call and stated expressly that the lifesupport was not be switched off as she was comingback to sit with her father. She was still hopefulof a recovery. Miss C later told us that, had sheknown her father was going to have his life supportswitched off, she would have wanted to help him‘go peacefully after being battered by so manymedical procedures and surrounded by strangers’.However, she and her mother returned to findthat Mr C’s ventilator had already been switchedoff. Miss C felt that ‘the staff decided that we hadbeen given as much time as we were allowed’.Mr C was pronounced dead at 10.25pm.Mr C’s daughter complained first to the Trust,and then to the Ombudsman that she had beenleft with no clear understanding of her father’scondition during his final hours, and why his lifesupport had been turned off against her expresswishes. As she observed in one letter to the Trust‘This is just one of many such events in the workinglife of your staff but it has lifelong repercussionsfor us’.What our investigation foundWe found that the Trust’s communications withMr C’s family were below standard. There wereseveral examples of this.Staff did not explain to Mr C’s family that hiscondition had worsened, nor tell them about the‘Do not attempt resuscitation’ decision. This wascounter to the Trust’s own policy which says thatdiscussion with families should aim to secure anunderstanding of why the decision was reached.Although a nurse spoke to Mr C’s family after hehad stopped responding to treatment, there waslittle information about what they were told. Theuse of the term ‘flatlined’ in a conversation with hisdaughter was inappropriate and insensitive and didnot communicate the clinical significance of Mr C’sheart having stopped.The Trust have no formal policy that indicates whenit is appropriate for nurses to turn off a patient’slife support, but in practice the Trust allow seniornurses to do this, if the patient’s family is presentand in agreement. If the family disagrees, nursesmust seek a medical opinion. Here, by turning offMr C’s life support against his family’s wishes, staffacted contrary to the Trust’s practice. Staff couldreasonably have accommodated the family’s wishesand delayed switching off Mr C’s ventilator for afew minutes, even if he had already died and lifesupport was no longer serving any purpose. Ashis daughter said later ‘We would have liked theopportunity to have the peace of mind of sittingwith my father and of praying for him. I have thefeeling that I failed my father’.The records do not show if Mr C had died beforeor after his life support was turned off, and sowe could not say for certain whether that actiondenied Miss C the opportunity to be with herfather when he died. Nevertheless, the Trust’sactions caused her unnecessary distress. Indeed,his daughter has told us she is ‘very aware of howdeeply this handling of my father’s death hasaffected me’.We upheld Miss C’s complaint.What happened nextThe Trust apologised to Mr C’s daughter forthe distress they had caused her and paid hercompensation of £1,000. They also began to reviewsome of their policies and arranged further trainingfor staff in end of life care. The Trust also drewup plans to share the lessons they had learnt fromMiss C’s complaint, and acknowledged the need topromote effective communication.28 Care and compassion?

Mr W’s story‘Everyone counts’NHS Constitution‘Probably as good as he isgoing to get’The storyMr W was 79 years old. He suffered from dementiaand depression, was frail and had not long beenwidowed. He was admitted to St Peter’s Hospital(part of Ashford and St Peter’s Hospitals NHSFoundation Trust) with recurrent dehydrationand pneumonia.The hospital treated Mr W with intravenous fluidsand antibiotics, which were stopped when his chestinfection cleared up. A week later, his daughter,herself a former nurse, told a doctor caring forMr W of her concerns that his general conditionhad deteriorated during his admission and that hewould be better off receiving intravenous fluids.The doctor said he could not do this as it would‘prevent his leaving hospital’ and that ‘he can meethis needs orally’. Mr W’s daughter disagreed ashe frequently refused to eat and drink more thanvery small amounts. The doctor said that Mr Wwas medically fit for discharge, but that he wasfrail and prone to further infection and any furthertreatment should be palliative. He told Mr W’sdaughter that Mr W was ‘probably as good as he isgoing to get’.Over the next few days Mr W continued to eatand drink very little, refused most meals and drankonly about one cup of fluids each day. Feeding himthrough a percutaneous endoscopic gastrostomy(PEG) tube was considered but ruled out because ofthe high risk of death associated with PEG feedingof patients with advanced dementia.Despite his daughter’s concerns about Mr W’scondition, the hospital discharged him to a carehome on Christmas Eve. He weighed just 6 st 7 lbs.They did not communicate with his family whotherefore ‘could do nothing to stop it’. Mr W’sdaughter said ‘Our Dad had this big move on hisown even though I had made it clear to the wardthat I wanted to be with him when he moved …upset[ting] us all greatly’.Report of the Health Service Ombudsman on ten investigations into NHS care of older people 29

Mr W’s storyThree days later, at 2.00am, Mr W was admittedto a different hospital with breathing difficulties.He was severely dehydrated and had pneumonia.That hospital treated Mr W’s pneumonia and fedhim through a PEG tube. His daughter told usthat once the tube had been inserted and Mr Wreceived adequate nutrition and fluid, he hadbeen ‘transformed’. She told us that following thistreatment not only was Mr W still alive, but he hadnot needed to be hospitalised since, enjoyed life,and participated in the activities in the care home,including playing dominos.After complaining first to the Trust and then to theHealthcare Commission, Mr W’s daughter came tothe Ombudsman. She felt the Trust had put Mr W’slife in danger by discharging him when he was notmedically fit. In one letter she wrote ‘As yet wehaven’t even been able to mourn our mother aswe have and are continuing to fight for any kindof quality care for our Dad’.What our investigation foundIn Mr W’s case, the Trust did not follow theirown discharge policy or national guidance whichstate that patients should be fit for discharge. TheTrust’s policy also notes that a patient’s fitnessfor discharge does not necessarily indicate thatit is safe to go ahead. Indeed, taking account ofMr W’s very low weight, his inadequate nutritionand hydration and the development of suspectedC.diff (a serious hospital-acquired infection), weconcluded it had not been safe to discharge him.Mr W’s nutritional and fluid intake needs were notbeing met, and this continued until his discharge.His medical fitness for discharge was not reviewedor addressed and no plan was made to increasehis nutrition and fluid intake, other than by simpleencouragement. This was wholly inadequate, yetthe doctor saw no need for further considerationor intervention. His daughter’s repeatedly expressedconcerns about her father’s deterioration werenot taken seriously or acted upon. This lack ofrespect for her views caused her considerableunnecessary distress.We uncovered very troubling possible explanationsfor the failure to review Mr W’s fitness fordischarge. The doctor caring for him was no longeractively treating him; the implication being thathe would develop another chest infection fromwhich he would die. The tone of emails exchangedbetween a social worker and Trust staff suggestedthey regarded Mr W’s daughter’s concerns as anuisance, and as potentially preventing a bedbeing freed over Christmas. This appeared to betheir priority.The lack of treatment given to Mr W put his lifeat risk. His discharge and subsequent treatmentat a different hospital saved his life. His daughterhad pushed to have Mr W admitted to St Peter’sHospital because she was anxious about hiscondition and thought he would be safe there.The opposite was true.We upheld this complaint.What happened nextIn line with the Ombudsman’s recommendations,the Trust apologised to Mr W’s daughter and paidher £1,000 compensation for the distress they hadcaused her. They also drew up plans to stop thesame mistakes from happening again. The actionsthe Trust planned included a review of theirdischarge policy; more junior doctors working atweekends; advanced communication skills trainingfor doctors; and the introduction of a Pledge,setting out the behaviours expected of all clinicaland non-clinical staff.30 Care and compassion?

Mrs G’s story‘Aspiring to the higheststandards of excellence’NHS Constitution‘I just feel let down bythe system’The storyMrs G, who was 84 years old, had played animportant part in her granddaughter’s life. She hadlooked after her as a small child and had lived withher for almost her entire life. Her granddaughterdescribed her grandmother as ‘an amazing lady’who was ‘perfectly healthy’ before she suffered afall and underwent hip surgery.Following surgery, Mrs G was discharged to anursing home with a prescription which includeddiclofenac (a non-steroidal anti-inflammatory drug– NSAID), and given a two-week supply of thedischarge medications. Mrs G was described by hergranddaughter as being at this time ‘very mobile …and had most of her faculties with her’. She saidMrs G was looking forward to moving out of thehome to live with her.In the meantime, following receipt of the hospital’sdischarge summary, administrative staff at Mrs G’slocal GP Practice added the medications, includingdiclofenac, to her list of repeat medications. ThePractice continuously prescribed diclofenac toMrs G for the next eleven months, without reviewand without an accompanying proton‐pumpinhibitor (which may help protect againstNSAID‐associated duodenal ulcers). Mrs G wentto live with her granddaughter as arranged. Hergranddaughter soon noticed that Mrs G washaving difficulty with food and that her health wasdeteriorating. Things came to a head on ChristmasDay, when Mrs G was ‘violently sick, was as whiteas a ghost, could not move and was in pain’. Shewas taken to hospital and underwent emergencysurgery for a perforated duodenal ulcer. Sadly, shedied two months later from septicaemia, acuterenal failure and urinary tract infection.Report of the Health Service Ombudsman on ten investigations into NHS care of older people 31

Mrs G’s storyMrs G’s death caused her granddaughter ‘immensegrief due to the fact that I only recently lostmy mother’.Realising that Mrs G had taken diclofenaccontinuously for eleven months, her granddaughtercomplained to the Practice about what hadhappened. The Practice accepted their failure tocheck and review Mrs G’s medication, and theyalso conducted a significant event review. Thelearning from that review was that doctors (notadministrative staff) should add medication torepeat medication lists so that they can considerappropriate co-prescribing, and that they shouldprescribe NSAIDs in accordance with the Practice’sprotocols. (The Practice’s first audit found 20 otherpatients taking NSAIDs without a proton-pumpinhibitor, but a subsequent audit revealed that thishad been rectified.)A 22‐year‐old student doing her final year exams,still getting over the loss of her mother andgrandmother, Mrs G’s granddaughter then broughther complaint to the Ombudsman. She said thatalthough the Practice had admitted errors, they hadnot said why they had occurred. She wanted toknow why it had taken her grandmother’s death tohighlight the mistakes, and whether her death hadbeen preventable. She said ‘I just feel let down bythe system and that my Nan died to save others’.What our investigation foundThe errors in Mrs G’s case occurred partlybecause the Practice’s administrative staff wereinappropriately involved in the processing of hermedication. However, the major cause was thefailure by doctors at the Practice to follow theirprotocols, or the professional standards relatingto prescribing and reviewing medication. Theyissued repeat prescriptions for the entire elevenmonths that Mrs G received diclofenac. As a result,no consideration was given to whether Mrs G stillneeded diclofenac, or whether a proton-pumpinhibitor should be prescribed.The advice at that time from the British NationalFormulary (the standard reference book forprescribers describing drugs, dosage andcontraindication) was that NSAIDs should beused with caution in elderly patients and that aproton‐pump inhibitor may be considered forprotection against NSAID-associated gastric andduodenal ulcers.Mrs G’s granddaughter specifically asked whetherher grandmother’s death had been avoidable. Wecould not say that the ulcer and the chain of eventswhich led to her death were the consequenceof the diclofenac prescription. However, theprolonged prescription, especially without aproton-pump inhibitor, put Mrs G at increased riskof developing the duodenal ulcer.We upheld this complaint.What happened nextThe Practice apologised to Mrs G’s granddaughterfor their failings.Our report was discussed at a significant eventsmeeting, attended by all their doctors, nurses,receptionists and clerical staff. Robust procedureswere put in place for prescribing and reviewingmedication, and the Practice increased awarenessof the need to follow their review processes strictlyand to monitor the prescription of NSAIDs. ThePractice Nurse is now qualified in prescribing andconducts the medication reviews.Commenting on our report, Mrs G’s granddaughtersaid that she was very happy with the outcome andpleased that her complaint ‘will hopefully make adifference to other patients’ lives’.32 Care and compassion?

Mr L’s story‘We value each person asan individual’NHS Constitution‘They took away everylast ounce of dignity myhusband had left ’The storyMr L was 72 and suffered from Parkinson’s disease.His wife described him as a brilliant architect,and someone who had enjoyed keeping fit allhis life. He was taking medication to manage hissymptoms, but this disturbed his mental health andwas stopped. Mr L experienced further episodesof hallucinations and paranoia, disturbed andaggressive behaviours which were sufficientlyfrightening for his daughters to administerdiazepam and take him to A&E at Epsom GeneralHospital. From there, Mr L was transferred toWest Park Hospital (part of Surrey and BordersPartnership Foundation NHS Trust), whichspecialised in assessing elderly patients with mentalhealth difficulties.On arrival at West Park Hospital, Mr L was movedto Bluebell Ward for assessment at around 3.00amand was said to be ‘in a calm and pleasant mood’.Nevertheless, he was given 10mg olanzapine,an antipsychotic drug. Mrs L visited her husbandlater the same day and was ‘devastated’ by whatshe saw. Before his admission, his wife said he hadbeen able to eat, drink, talk coherently, see to hispersonal care and do some weight training, but nowhe had been ‘turned into a zombie, a ragdoll’.Over the next few days, despite his family’sconcerns, Mr L was given more antipsychotic andtranquillising medication, which his family sayrobbed him of his dignity. Mrs L said the ‘image of[Mr L] haunts us to this day’ – he had to be takento the toilet, could not walk unaided, had to be fedand could not speak coherently.Five days after his admission to West Park Hospital,Mr L was transferred back to Epsom GeneralHospital for a routine echocardiogram, but onarrival, he complained of shortness of breath anda cough. On examination, crackles were heard inReport of the Health Service Ombudsman on ten investigations into NHS care of older people 33

Mr L’s storyboth lungs and he was dehydrated. A chest X-rayindicated that Mr L had pneumonia and he wasadmitted. He did not recover from this and diedtwo weeks later.Mrs L wanted assurance that future patientswould not be treated in a similar wayMrs L and her family complained to the Trustthat Mr L had been given antipsychotic drugsunnecessarily, which they said had led directly tohis death. Dissatisfied with the Trust’s response, thefamily complained to the Healthcare Commissionand then to the Ombudsman. Mrs L said that herhusband should not have been given olanzapine,which had reduced him to a state in which hecould not function, and that he had developedpneumonia which had not been recognised. Thesefailings had ‘fast-tracked her husband to hisdeath’ and the Trust ‘took away every last ounceof dignity my husband had left’. Mrs L wantedassurance that future patients would not be treatedin a similar way.What our investigation foundWe found that although it had not beenunreasonable to prescribe olanzapine to Mr L, theinitial dose was incautious and too high for anelderly man with his symptoms. Once it was realisedthat Mr L was over‐sedated, the prescription waschanged to a lower dose, to be given as requiredif he became very agitated or psychotic. However,this new instruction was not written up on thedrugs chart and the nurses continued to give Mr Lolanzapine on a regular basis, even though he didnot meet the criteria for its administration.Shortcomings in the nursing and medical caremeant that Mr L’s deteriorating physical healthwas not noticed. There was no evidence that careplans were drawn up to meet Mr L’s physical needs.Fluid charts, poorly kept as they were, showedthat he was at severe risk of dehydration. Nursesrecorded that Mr L had passed very concentratedurine, yet did not draw the correct conclusionsor act appropriately to address his developingdehydration. The nursing records, which fell shortof the standards required by the Nursing andMidwifery Council, led to a failure to recognisethe implications of the observations that weremade, or to take appropriate action to tackle theproblems that were developing.There was no evidence thatregular nursing observations were takenand none were recordedDespite concerns and a specific request by doctorsthat Mr L should be monitored, there was noevidence that regular nursing observations weretaken and none were recorded. This meant thatwhile we found no evidence that Mr L showed signsof pneumonia during the time he was in BluebellWard, staff did not put themselves in a positionto be able to state confidently that Mr L was wellwhen he left them. (For their part, Mr L’s family areconvinced that he had contracted pneumonia whilein Bluebell Ward and that he was already seriously illwhen he arrived at Epsom General Hospital. There isnothing to contradict this view.)We concluded that the care and treatment given toMr L fell significantly below the applicable standardand this was service failure. Although we couldnot be certain that Mr L’s death was avoidable, theservice failures put him at greater risk, probablycontributed to his decline in physical and mentalhealth and loss of dignity, and compromised hisability to survive pneumonia. All of this was an34 Care and compassion?

Mr L’s storyinjustice to Mr L. It also affected Mrs L and herfamily who found it ‘heartbreaking’ to see hiscondition deteriorate to the extent it had. Thelength of time taken to complete the complaintprocess, which included two separate reviews bythe Healthcare Commission, meant the complaintwas not concluded for more than four years.We upheld this complaint.The care and treatment given to Mr L fellsignificantly below the applicable standardWhat happened nextThe Trust apologised to Mrs L for their failings andagreed to pay her £1,000 compensation for thedistress and anxiety caused to the family.Mr L’s family did not seek compensation and didnot wish to accept the Trust’s compensationpayment. They have told us that their complaintwas never about compensation and that the awardadded insult to injury.As Mrs L and her family were keen that the Trustshould learn lessons from this complaint, we askedthem to prepare plans aimed at ensuring thatlessons were learnt and mistakes not repeated. TheTrust told us about a number of actions they weretaking, which included: wards carrying out their ownmonthly record keeping audits; identifying trainingneeds around the Care Programme Approach andmedication; and benchmarking themselves againstthe Essence of Care standards for privacy anddignity involving people who use their service andtheir carers.Report of the Health Service Ombudsman on ten investigations into NHS care of older people 35

‘ I wanted the Ombudsman toensure that the treatment mygrandmother received wouldnever, ever happen again to anyother vulnerable and dependentelderly person.’Mrs G’s granddaughter(page 31)36 Care and compassion?

Mrs N’s story‘Reflecting the needsof patients, familiesand carers’NHS Constitution‘Our mother continued tosuffer for too long’The storyIn October 2007 Mrs N was provisionallydiagnosed with lung cancer by her GP. She wentto Scunthorpe General Hospital (part of NorthernLincolnshire and Goole Hospitals NHS FoundationTrust – the Foundation Trust) for tests to confirmthe diagnosis. The results were inconclusive anda biopsy was carried out. When Mrs N next sawher Consultant, he said it was very likely that shehad lung cancer, but further tests were needed toconfirm this. Mrs N underwent tests at Castle HillHospital (part of Hull and East Yorkshire HospitalsNHS Trust) where a scan showed that the cancerhad spread to her chest and spine.While waiting for the results of the ScunthorpeGeneral Hospital tests, Mrs N began to suffer fromsevere pain. Her daughter told us that because hermother had not been given a diagnosis, she was notgiven adequate pain relief. The lack of a diagnosisalso prevented Mrs N claiming full attendanceallowance – something that would have helped thefamily to care for her. The Christmas period was aparticularly distressing time for everyone, as Mrs N’sfamily witnessed her suffering without being ableto help. Another daughter, who spent a large partof each day caring for Mrs N, became ill herself as aresult of the distress.In January 2008 Mrs N attended ScunthorpeGeneral Hospital for the test results. A differentConsultant confirmed that she had lung cancer,but that the particular type of cancer could not beidentified. He told Mrs N that there had probablybeen enough evidence from the first tests todiagnose inoperable lung cancer.A few days later Mrs N – who described herself as‘disorientated and in extreme pain’ at the time –was admitted to Scunthorpe General Hospital tocontrol her increasing pain. A pain managementplan was drawn up specifying that Mrs N shouldreceive medication on an ‘as required’ basis, butReport of the Health Service Ombudsman on ten investigations into NHS care of older people 37

Mrs N’s storyit was five days before she received adequatepain relief. Mrs N said that she was in ‘unbearablepain’. On one occasion Mrs N had asked for painrelief, only to be told that she had already taken it.However, when the Macmillan Nurse checked thedrugs chart, that was not the case. As her daughterobserved ‘our mother continued to suffer fortoo long’.Mrs N was then moved to a different hospitalfor radiotherapy treatment, but was still unawarethat the cancer had spread to her spine. She wastransferred back to Scunthorpe General Hospitaland then discharged home. Mrs N complained tothe Foundation Trust about several issues includingpoor communications between the departmentsand hospitals caring for her, and delays receivingtest results. She queried if some of the tests(which she found distressing) had actually beennecessary. She sought ‘some reassurance thateverything possible will be done to stop anyoneelse experiencing the problems I have experienced’.In March 2008 Mrs N had an MRI scan. Only thendid she learn that the cancer had spread to herspine. She died the following month, aged 82.Seven months after Mrs N’s death, the FoundationTrust sent their full response to her daughters.During the local resolution process, the FoundationTrust acknowledged failings in Mrs N’s care, offeredtheir apologies and described actions they hadtaken to improve their practices. However, Mrs N’sdaughters escalated matters to the Ombudsman,seeking a more detailed response and apologies.What our investigation foundThe Foundation Trust should have concluded inOctober 2007 that it was likely that Mrs N hadinoperable lung cancer. Instead, they focusedon obtaining a full diagnosis and neglectedto manage her pain. Both this and delays inscheduling investigations and reporting the resultscontributed to Mrs N not being treated for hersymptoms within two months of her referral (in linewith Department of Health guidance). The delayeddiagnosis also meant that Mrs N was ineligible forfull attendance allowance, which could have helpedthe family to care for her, until January 2008.Although a pain management plan was in placefor Mrs N, nurses seemed unaware of her specificpain management requirements. That was notin accordance with the Nursing and MidwiferyCouncil’s guidelines. The lack of adequate painrelief greatly distressed Mrs N and her family.Mrs N should also have been told that the cancerhad spread to her spine before the MRI scan. TheFoundation Trust delayed unnecessarily providinga full response to Mrs N’s complaint. The fact thatshe did not receive the response before she diedcompounded the family’s distress.We upheld the complaint about the NorthernLincolnshire and Goole Hospitals NHSFoundation Trust.For their part, Hull and East Yorkshire HospitalsNHS Trust communicated poorly with Mrs Nabout the investigations at Castle Hill Hospital andcontributed to the delay in her receiving the results.We did not uphold the complaint about them,however, as these shortcomings added little to thedelay in treating Mrs N’s cancer and the Trust hadalready apologised for them.What happened nextNorthern Lincolnshire and Goole Hospitals NHSFoundation Trust apologised to Mrs N’s daughterand paid her compensation of £2,000. They alsodrew up further plans to improve their service,by taking such steps as arranging training for wardstaff in pain and symptom control; improvingsystems for scheduling investigations and reportingthe results; and planning to appoint an additionallung cancer nurse.38 Care and compassion?

Visit our website at www.ombudsman.org.uk to read this report online,download it as a PDF and hear some complainants’ stories in theirown words.This report is also available in alternative formats. Please contact us torequest extra large print, high contrast or audiobook versions.Helpline 0345 015 4033phso.enquiries@ombudsman.org.ukwww.ombudsman.org.uk

Helpline 0345 015 4033phso.enquiries@ombudsman.org.ukwww.ombudsman.org.ukThe Parliamentary and Health Service OmbudsmanMillbank TowerMillbankLondonSW1P 4QPYou can read this report online, download it asa PDF and hear some complainants’ stories intheir own words.This report is also available in alternativeformats. Please contact us to request extralarge print, high contrast or audiobookversions.Published by TSO (The Stationery Office)and available from:www.ombudsman.org.ukOnlinewww.tsoshop.co.ukMail, Telephone, Fax and EmailTSOPO Box 29, Norwich, NR3 1GNTelephone orders/General enquiries 0870 600 5522Order through the Parliamentary Hotline Lo-Call 0845 7 023474Fax orders: 0870 600 5533Email: customer.services@tso.co.ukTextphone: 0870 240 3701The Parliamentary Bookshop12 Bridge Street, Parliament Square,London SW1A 2JXTelephone orders/General enquiries: 020 7219 3890Fax orders: 020 7219 3866Email: bookshop@parliament.ukInternet: http://www.bookshop.parliament.ukTSO@Blackwell and other Accredited AgentsCustomers can also order publications fromTSO Ireland16 Arthur Street, Belfast BT1 4GDTelephone orders/general enquiries: 028 9023 8451Fax orders: 028 9023 5401

THE ROYAL BOURNEMOUTH AND CHRISTCHURCH HOSPITALSNHS FOUNDATION TRUSTBOARD OF DIRECTORSMeeting Date and Part: 11 March 2011 (Part 1)Subject: Delivery of Stroke Targets 2011/12Section:InformationExecutive Director with overallresponsibility:Helen Lingham, Chief OperatingOfficerAuthor of Paper:Helen Lingham, Chief OperatingOfficerSummary:To present the action plan forachieving the four key Strokestandards going forwardStandards for Better Healthdomain:GovernancePatient focusAccessible and responsive careAction required by Board ofDirectors:To note for information

Board of Directors Part 111 th March 20111 SummaryDelivery of Stroke Targets 2011/12Monitor has yet to confirm the exact Stroke target it will include in itscompliance framework dashboard.Attached is the Stroke Service action plan that will ensure we continue toredesign the service to meet the following four key standards:1. Direct access to the Acute Stroke Unit.2. Direct access to the Acute Stroke Service within 4 hours of arrival.3. 90% of stroke patients’ stay is on a stroke ward.4. 60% of high risk TIA patients to be seen and treated within 24 hours offirst contact with a healthcare professional.The two risks to highlight to the Board at this time are:a) The impact that delayed transfers of care could have on the ability todeliver the first three targets if these patients are delayed on the strokeward.b) The requirement for 6/7 day Acute Stroke Unit service senior medicalreviews to improve care and speed up discharges. This is currently beingdiscussed.This action plan will be monitored weekly through the Trust PerformanceManagement Group (PMG).2 RecommendationThe Board of Directors is asked to note the content of the actionplan and associated timescales.HELEN LINGHAMCHIEF OPERATING OFFICERDelivery of Stroke Targets 2011/12 Page 1 of 1For information

Royal Bournemouth Christchurch NHS Foundation TrustStroke Performance Indicator Action Plan - Version 1: 25/02/11Action To Improve: Timescale Lead1 a) “Direct access to the Acute Stroke Unit”1 b) “Direct access to the Acute Stroke Unit within 4 hours of arrival)”1 c) "90% stay on a Stroke Ward"1.1)Bleep alert (2528) of ASU CL by CDU Nurse-in-Charge. From March 7th JK/IN(Patients presenting as FAST/ROSIER-positive).1.2) (In Hours) Senior Stroke clinician to screen FAST/ROSIER-positive From March 7th JK/INpatient on CDU within 0.5 hour; arrange scan as necessary; andaccept patient straight to ASU thereafter. P/t clerked on ASU.1.3) During this time, the ASU CL will make arrangements to receive From March 7th IN/DHthe patient on ASU.1.4) 2 of the 4 escalation beds on ASU withdrawn from general use From March 7th BJW/CSTand reserved for Stroke patients only. (To create immediate capacityto take patients directly from CDU).1.5) The ASU CL will advise CST and Medical Directorate Management From March 7th DH/CST Medical Directorate Managementof any patients at risk of failing to reach ASU within 4 hours of arrivalto CDU (In Hours). Actions to expedite will ensue.1.6) Instances where patients fail to reach ASU within 4 hours From March 7th IN/DH(In Hours) will be recorded by the ASU CL for review/audit.1.7) The ASU CL will continue to liaise with the CST regarding patients Ongoing DH/CSTready for onward transfer/discharge, to optimise the capacity totake patients directly.2) “60% of high risk TIA patients to be seen and treated within 24hours of first contact with a healthcare professional”2.1) New Stroke SpR will enable later pm TIA clinics will be introduced From March 7th JK/IN/SHto expand same-day access.1

Royal Bournemouth Christchurch NHS Foundation Trust2.2) New Stroke SpR will provide more flexible back-fill to cover TIA From March 7th JK/IN/SHclinics previously cancelleddue to consultant absence (A/L, sickness etc).2.3) The newly trained ASU Staff Nurse will cover the TIA bleep to screen From March 1st SH/RB/DHGP referrals when the TIA Nurse Specialist is absent.2.4) The newly trained ASU Staff Nurse represents the first step in WIP SH/RB/DHincreasing our ability to deliver 7-day screening for TIA referrals.(Note - The Trust awaits the outcome of the Stroke Network TIA workinggroup meeting - 30/03/11 - which will determine 7-day service parameters).2.5) To provide the TIA Nurse Specialist and trained ASU Staff Nurse with a WIP IN/SHrelay' mobile phone to receive incoming referrals from GPs. This will enablethe 'live' screening of patients at the time of their GP appointment, ratherthan reply to faxed referrals often sent by the GP practice administrators atthe end of the day.2

THE ROYAL BOURNEMOUTH AND CHRISTCHURCH HOSPITALSNHS FOUNDATION TRUSTBOARD OF DIRECTORSMeeting Date and Part:Subject:Section:11 th March Part IProduction Schedule for Annual Report2010/11InformationExecutive Director with overallresponsibility:Author of Paper:Richard RenautDirector of Service DevelopmentRichard RenautDirector of Service DevelopmentSummary:Timetable to approve the Annual ReportStandards for Better Healthdomain:Action required by Board ofDirectors:GovernanceTo note for information

Production Schedule for Annual Report 2010-11Below is the production timetable for the following statutory documents:Annual Report (lead: Tracey Hall, Head of Communications)Quality Report (lead: Joanne Sims, Associate Director of Clinical Governance)Financial Accounts (lead: Mike Wilkinson, Finance)The following versions will be produced and distributed to the following groups/committees:Version 1: Draft Annual Report and Quality Accounts (Word format) distributed tothe April CoG.Version 2: Draft Annual Report, Quality Accounts and Financial Accounts (notdesigned) distributed to the May Board (incorporating comments from the CoG)Version 3: Final Draft Annual Report, Quality Accounts and Financial Accounts (indesign format)Version 4: Final Annual Report, Quality Accounts and Financial Accounts to theAudit Committee and Board of Directors for approval and sign off.Date - 2011Early MarchRequests for information for Annual Reportsent out to Directors and HoDsWhoTracey Hall23 March Annual Report text submitted Tracey Hall All directors/lead8 th April Draft Annual Report and Quality Report –Version 1 - to Dily Ruffer for April CoG19 th April April CoG CoG to receive Version 1: Draft AnnualReport and Quality Report. All comments/feedback to be receivedby 19 th AprilTracey HallJoanne Sims19 th April to 18 thMayDesign work of: Annual Report Quality Report Financial AccountsTracey HallJoanne SimsMike WilkinsonOne combined and completed documentneeded by 18 th May2 nd May Submit Version 2 of Draft AnnualReport, Quality Report and DraftAccounts to Rebecca Lawry for MayBoD.13 th May May BoDBoard to receive Version 2: Annual Report,Quality Account and Draft Accounts.Papers to be distributed 6 th May. Allcomments back to Tracey Hall from theBoard by 13 th May.Tracey HallJoanne SimsMike WilkinsonBoard of DirectorsDraft 18-1-11

18 th May Auditors to complete review of AnnualReport and Financial Accounts.20 th May Version 3: Designed Annual Report,Quality Report and Financial Accounts(Version 3) to Rebecca Lawry to bedistributed to:Mike WilkinsonTracey HallJoanne SimsMike WilkinsonFinance CommitteeCouncil of Governorscc’d to Board of DirectorsComments from the above groups to bereceived by 27 th May.27 th May CoG Governors to receive Version 3 of theAnnual Report, Quality Report andFinancial Accounts. The lead for each document is requiredto attend the CoG, i.e. Tracey Hall,Joanne Sims and Mike Wilkinson.Tracey HallJoanne SimsMike Wilkinson27-31 May Final changes to be done followingfeedback from Finance Committee andCoG.31 st May Version 4: Final Annual Report, QualityReport and Financial Accounts to RebeccaLawry for distribution to the Board ofDirectorsTracey HallJoanne SimsMike WilkinsonRebecca Lawry1 st June Special Finance Committee Mike Wilkinson3 rd June 2-3pm Audit Committee 3-4pm Special BoD. The Board isrequired to sign off the Annual Report,Quality Report and Financial Accounts.Title page to be agreed with Tim ElmsAt DoH (tim.elms@dh.gsi.gov.uk)7 th June Final AR and Accounts to be sent to Monitorand AuditorBy 30 th June In-house printing of AR and Accounts forMonitor/ParliamentTracey HallMike WilkinsonCommunications30 th JuneSubmissiondeadline around 7 thJulySubmitted to Accounts for ParliamentMike WilkinsonDraft 18-1-11

THE ROYAL BOURNEMOUTH AND CHRISTCHURCH HOSPITALSNHS FOUNDATION TRUSTBOARD OF DIRECTORSMeeting Date and Part:11 March Part ISubject:Core BriefSection:InformationExecutive Director with overallresponsibility:Tony Spotswood, Chief ExecutiveAuthor of Paper:Tracey Hall, Head of CommunicationsSummary:The Core Brief distributed within theTrust in February 2011Standards for Better Healthdomain:N/AAction required by Board ofDirectorsNote for information

Core BriefFebruaryFrom: Tony Spotswood, Chief ExecutiveAnnual PlanYour views are invited on a range of proposals torespond to the challenges facing the FoundationTrust. These include developing options for thefuture of Christchurch, including exciting optionsfor preserving existing services and developingan older people’s village.The proposals can be found in the FoundationTrust’s draft Annual Plan 2011/12 which is nowout for staff and public consultation until 29th April.The Plan sets out proposals for improving patientoutcomes and achieving efficiency savings, includinglooking at patient pathways and estate options.Focusing on improving patient outcomes:• Avoidable mortality and better end of life care• Long term conditions - self management, reducingadmission and quality care• Emergency hospital care• The patient experience• Patient safetyThe draft plan also asks for comments on:• Whether some smaller specialist services canbe improved by working more closely with otherspecialist services in neighbouring hospitals.• How we can transform our services to reducewaste, delay and duplication; so that they arebetter for patients and staff alike.What are the proposals for Christchurch?There are two options proposed for ChristchurchHospital. The first would see a full range ofoutpatient, day hospital, diagnostic, phlebotomy andpalliative care services preserved at Christchurch.A broader range of new services for local peoplecould include an older people’s village providing GPaccommodation, an NHS dentist, a nursing homeand a commercial pharmacy.The second option would see all services move toRBH, except palliative care and blood testing (there2011would be a separate public consultation on this.The remaining site becomes a larger older people’svillage, including assisted living homes, and possiblysome key worker or other housing.Option 1 is achievable for the Trust with interestexpressed from potential external partners for anolder people’s village. There would be no gain fromthe sale of the Christchurch site as there is a costin relocating services to, and refurbishing areas at,Bournemouth.Tony Spotswood, Chief Executive, said: “As anorganisation we are on course to achieve £10.5m inefficiency savings this year. To find similar savingsover the next couple of years will be very difficult andwe will clearly need to be more creative in how weachieve this. The challenge now is to improveoutcomes for patients while making £30m ofrecurrent savings over the next three years.“I would urge you to read about the options and giveus your feedback,” he added.How can you find out more and give our views?You can read about the consultation and give us yourviews in the following ways:• Online at www.rbch.nhs.uk• Ask the Exec sessions (for staff) - your chanceto ask any question that you want and tell us whatyou think!- 28th FebruaryRBH Conference Room - 12:30pm.- 10th MarchChristchurch HowardCentre - 12:30pm.• Request a copy of theconsultation document atcomments@rbch.nhs.ukor on 01202 704271.The consultation closeson Friday 29th April 2011.DraftAnnual Planfor PublicConsultation2011/121

Introducing Tidy TuesdaysBournemouth Council has initiateda three month project, in conjunctionwith the Waste Management Group,to enable safe and eco-friendlydisposal for all unwanted items ofequipment or furniture.The council has arranged for thePrince’s Trust volunteers programto help support the initiative. Youngvolunteers will work with thePortering Team to help identify anddispose unwanted items across theRoyal Bournemouth Hospital.If you have any unwanted itemsplease identify and tag them fordisposal. Please clean if necessary.Volunteers will then safely removethese from your area. This willreduce equipment/furniture beingleft in the main hospital streets.No item is too big or too small,and depending on its condition,all efforts will be made to recycleany items collected.To arrange the collection of yourunwanted items, pleasecomplete an application formavailable at http://rbhintranet/2011pdf/tidy_tuesday.doc and return to Ann Gibson atann.gibson@rbch.nhs.uk who willthen arrange for the volunteers toremove items from your area withthe minimum of fuss.Malcolm Keith, Portering ServicePortering ManagerImproving canceroutcomesThe Royal Bournemouth andChristchurch Hospital’s CancerServices have been applaudedby the recently published‘Improving Outcomes: A strategyfor Cancer’ and rated highly bythe 2010 National Cancer PatientExperience Survey.To date, the collaborativeBournemouth After CancerSurvivorship Programme(BASCUP), has benefited 200referred participants and 52“buddies” from one-to-onepersonalised guidance and goalsetting, health and fitnessscreening and a wide range ofcommunity based activityopportunities.The recognition of the BACSUPprogramme within the Strategy forCancer is evidence of the positiveimpact it has had on participants.In addition to the recognition bythe Improving Outcomes report,the 2010 National Cancer PatientExperience Survey also reportedoverall patient satisfaction forCancer Services at the RoyalBournemouth Hospital.The survey, designed tomonitor national progress ofcancer care, invited 780 patientsfrom the hospital to complete anational cancer patient surveyand 72% responded.The results demonstrated thatoverall cancer patients were verysatisfied with the treatment andcare they receive from the Trust,and performance was above thenational average in manycategories.The Trust will be looking at thecancer survey results closely toidentify where we can maintainthe standard already achievedalongside areas we may be ableto do better. There is always roomfor improvement.Sue Higgins, Cancer LeadFirst FridayFitness -4th March 2011The monthly First FridayFitness sessions continue tobe successful, with many staffreturning each month to havetheir blood pressure and/orweight monitored.The next session is scheduledfor 4th March 2011 and will beheld in the Deli Bar between12:00 and 1:30pm. Informationwill be available on thefollowing topics:• Healthy Heart.• Blood pressures.• Healthy eating.• Weight management.• Cycle to Work.• Health and Wellbeingfree gifts.For further information pleasecontact me on ext 4460 orSue Dawson in OH on ext 4217.Vicky Douglas,Human Resources ManagerFriday 4th March 2011from 12:00 to 1:30in the Deli Bar.Come along for some friendly advice.Topics will be:• Healthy hearts• The truth about saturated fats• Weight Management• Blood pressures• Cycle to work

New OCT equipment couldhelp save lives of cardiacpatientsCardiac patients at the RoyalBournemouth Hospital are amongthe first in the country to benefitfrom state of the art heartimaging technology to identifyand treat disease of heart arteries.Coronary Artery Disease (CAD),also called coronary heart disease,is a condition in which plaquebuilds up inside the coronaryarteries. These arteries supplythe heart muscle with oxygen-richblood. When these arteries arenarrowed or blocked,oxygenated blood cannot reachthe heart muscle, which can leadto angina or a heart attack.Catheter-based imagingtechnology called OpticalCoherence Tomography (OCT)is an exciting new techniquethat takes high resolutionthree-dimensional images fromthe inside of coronary arteries inThird ThursdayMedicine forManagerspatients who attend hospitalwith cardiac chest pain. Theseimages help to determine thecharacteristics of coronary plaqueallowing the cardiologist to offerthe best treatment available.During angioplasty and stentingprocedures, cardiologists oftenuse intravascular ultrasound(IVUS) to look at disease of heartarteries. As OCT uses light wavesrather than sound waves, it givesa much higher resolution (up to20 times that of IVUS). Thismeans that OCT can detectabnormalities too subtle to beseen by IVUS. Using thistechnology cardiologists are evenable to ensure that the tiny metalstruts of stents are appropriatelypositioned at the end of anangioplasty, reducing the riskof stent related problems.Suneel Talwar,Cardiac ConsultantPlease be aware that program for the first half of thisyear is:14 April 2011 Mr Richard Byrom, ConsultantSurgeon Bariatric Service and UpperGastrointestinal Surgery.16 June 2011 Dr Khaled Amar, ConsultantPhysician, Medicine for the Elderly“Parkinson’s Disease or not Parkinson’s Disease- that is the question?”.A buffet lunch will be available in the Lakeside Delifrom 12.30pm with the lecture starting at 1.00pm inthe Lecture Theatre, Postgraduate Centre(the lectures last 40-45 mins).Dr Mary Armitage, Medical DirectorRecordingannual leaveThe process for recordingannual leave is changing fromthe 1st April 2011. All annualleave will now be recorded inESR (Electronic SicknessRecording).The ESR programme is aDepartment of Health ledinitiative, providing anintegrated HR and Payrollsystem across the whole ofthe NHS in England and Wales.They system also supportsinformation regarding absenceincluding sickness, annualleave and maternity. Data isused to calculate pay entitlementwhilst absent and a number ofreports enable management tomonitor sickness levels down toindividual employee level.Could anyone that isn’t set up todo this please contact me at lisa.cain@rbch.nhs.uk or on ext 5605as a matter of urgency.Lisa Cain, Human ResourcesESR LeadTennis classesThe Trust is in negotiation with a localtennis coach who is able to offer eitherindividual or group tennis coaching onthe hospital tennis court (situated at theback of the hospital).The sessions will be either by blockbooking or pay-as-you-go, for one hour.Sessions being offered are:Monday morningfrom 8:00amTuesday eveningfrom 6:30pm(only in the summer)Thursday between 12:30 and 2:00pmFriday between 1:00 and 3:00pmSaturday between 1:00 and 2:00pmSunday between 2:00 and 3:00pmIf you are interested please contact meon ext 4460, so I can then co-ordinatenumbers.Vicky Douglas, Human Resources Manager

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THE ROYAL BOURNEMOUTH AND CHRISTCHURCH HOSPITALSNHS FOUNDATION TRUSTBOARD OF DIRECTORSMeeting Date and Part: 11 th March, 2011 – Part 1Subject:Communications UpdateSection:InformationExecutive Director with overallresponsibility:Author of Paper:Summary:Standards for Better Healthdomain:Action required by the Board ofDirectors:Richard Renaut,Director of Service DevelopmentTracey HallHead of CommunicationsAn overview of communications activity. Theupdate also includes Read All About (mediacoverage for February 2011).Patient focusAccessible and responsive carePublic HealthFor Information

Board of Directors – Part I11 th March 2011Communications activityMarch 20111. IntroductionThe March Communications Report focuses on: Events update E-communication development Web analysis Annual Plan consultation update2. Events updatesUnderstand Health 2011 programmeUnderstanding Health is a series of consultant talks held at the Village Hotelfor the public. These events remain very popular and are communicated widely.Understanding Cardiology held earlier attracted 178 advance bookings and wereceived regular positive feedback.The dates for the remaining Understanding Health talks for this year are:6 th June Understanding Breast Cancer28 th March Understanding eye conditions of aging (170 people bookedalready)26 th September Understanding EndoscopyBecause these talks are so popular places must be pre booked on 01202704271.Open DayThe Trust’s Open Day will be held in the atrium at RBH on Wednesday 25 thMay. All stands have already been pre-booked by staff. Consultants talk willtake place in the Chapel at RBH on the following topics:10.30am11.30am1.30pmBowel CancerHelp us to help you – preparing to leave hospital and thesupport available.Supporting your rehabilitation (neurological patients)Places on these talks are already filling up quickly and places must be bookedin advance on 01202 704271.3. e-communication developmentTrust barcode readersThe Communications Team has produced a smarter and faster way tocommunicate information and promote our new website www.rbch.nhs.uk forpeople with a smart phone.Communications activity – March 2011 Page 1 of 3For information

Board of Directors – Part I11 th March 2011Individuals use a bar code scanner app, which can be downloaded onto theirsmart phones, to scan and read codes on Trust media (e.g. posters, documentsor leaflets). This links directly to the relevant web page and avoids trying toremember web links.For example, when scanning the bar code on your right, usinga smart phone with a barcode app, you will be directedimmediately to the Board of Directors pages of the newwebsite http://www.rbch.nhs.uk/index.php?id=531.The system will be used to promote communication campaigns and informationto the general public and staff. The system is already being used for sexualhealth education by the GU Medicine team.It is anticipated that this innovation will increase accessibility and traffic to ournew website and patient/public information.3. Web analysisInitial web analysis on the Trust’s new website shows that the top five mostpopular pages at from 8 th December 2010 to 23 Feb 2011 were:1. Our services search page: http://www.rbch.nhs.uk/index.php?id=552. Vacancies: http://www.rbch.nhs.uk/index.php?id=1343. HR http://www.rbch.nhs.uk/index.php?id=584. Patients and visitor section : http://www.rbch.nhs.uk/index.php?id=545. Our trust section : http://www.rbch.nhs.uk/index.php?id=56The GU medicine page (http://www.rbch.nhs.uk/index.php?id=216) has themost time spent on it with an average of 1m 50s for each visitor.Others include: 1m 36s - Eye Unit consultant profileshttp://www.rbch.nhs.uk/index.php?id=470 1m 33s - Ward visiting times and contact infohttp://www.rbch.nhs.uk/index.php?id=516 1m 19s - Consultation page http://www.rbch.nhs.uk/index.php?id=557 1m 17s - Car parking charges http://www.rbch.nhs.uk/index.php?id=513 1m 10s - Vacancies page http://www.rbch.nhs.uk/index.php?id=134More detailed analysis will be produced with regular measures reported to theMarketing Committee.4. Annual Plan consultation updateSince the Trust’s Annual Plan public consultation began on 2 nd February, 400copies of the consultation document have been sent to a range of partnerorganisations and members of the public, including: LINKS – Dorset, Bournemouth and Poole PALS Health Scrutiny PanelsCommunications activity – March 2011 Page 2 of 3For information

Board of Directors – Part I11 th March 2011 Local authorities MPs GPs NHS partners Disability groups Social Services Bournemouth Partnership Strategic Partnerships – Poole, Bournemouth, Dorset and Hampshire Age Concern Bournemouth Help the Aged Hospital Charities Minority Groups Patient Groups Youth organisations Christchurch Resident Associations Resident Association/Community Groups Parish CouncilsThe Trust’s website has received 682 hits to the consultation page in the pastmonth.In addition to the communication activities mentioned at the last Board, noticeboards providing a summary of the options for Christchurch have beendisplayed with voting slips and freepost envelopes at:ChristchurchLibraryInformationCentre,Christchurch HighStreetChristchurchCouncil OfficesChristchurchHospital – DayHospital, mainentrance,outpatients andoutside theHoward CentreRBH –the atriumand Eye UnitentrancesTracey HallHead of CommunicationsMarch, 2011Communications activity – March 2011 Page 3 of 3For information

Read All About It...February 2011Protect yourselfYou may have found romance but you don’t wantto put yourself at risk of a sexually transmittedinfection (STI).STIs are diseases passed on through intimatesexual contact. They can be passed on duringvaginal, anal and oral sex, as well as throughgenital contact with an infected partner. CommonSTIs in the UK include chlamydia, genital wartsand gonorrhoea.The numbers of diagnosed cases of STIs in theUK are going up. The age group most affectedis 16 to 24-year-olds. Even though they make upjust 12% of the population, young people accountor more than half of all STIs diagnosed in the UK.his includes 65% of new chlamydia cases and% of new cases of genital warts. Older peopleno exception, STI’s can affect everyone.re are a number of places where you can getned for STIs including some GP surgeries,The February media report includes positive coverage abouta number of subjects including the Trust’s new OCT scanner,improving cancer outcomes, Purbeck ice cream available atthe RBH, a patient letter praising our staff and the care theyreceived while in hospital, £78,000 raised for charity by RBH cafesand an article about a patient from the Women’s Health Unitencouraging support for the appeal.The Trust’s Annual Plan 2011/12 also received coverage by anumber of media agencies which ranged from both neutral andpositive reports on the subject.l health and contraception clinics, andyal Bournemouth GUM (genitourinaryne) clinic. Here we offer:t diagnosis and treatment of all sexuallyissible infections including HIVArticles are published with the kind permission of the Daily Echo, Advertiser,the New Milton Advertiser and the Stour and Avon Magazine.sis and treatment of genital skinscy Contraceptionoms and safer sex advicell sexual health services arehis means that your personaly information about your visit andatments that you have will not beone outside that service withoutfamily planning, there are soontraception to choose from.time to find out more aboutu can choose contraceptionto protect yourself and yourusing a condom andtional Condom Weekis a reminder to all, thatSummary of media coverage:February 2011Online 6Print 20Radio 0Television 0if you’re under 16,from communityl health and GUMs services, andalso buy condomsets.ethodssexualgestchich2011 Coverage*Positive 18Negative 2OK 4February 2010 Positive 15 Negative 2 OK 4*This does not include Mary Armitage’s Echo columnFebruary 2011 l 1

DatePublicationInformationTitlePage numberArticle size2 February 2011Daily EchoAn article about local people beinggiven the chance to say what theythink of the two options for thefuture of Christchurch Hospital.YOUR choice for hospital’s future9Half pageFebruary 2011 l 2

DatePublicationInformationTitlePage numberArticle size7 February 2011Daily EchoAn article focusing on Christchurch residentsbeing urged to respond to a consultation onmajor changes to the local hospital.Don’t miss chance to have your say12Half pageFebruary 2011 l 3

DatePublicationInformationTitlePage numberArticle size7 February 2011Daily EchoA leter from a grateful patientthanking staff for his treatment atthe Derwent.‘Thank you for looking after me’19Eighth of a pageDatePublicationInformationTitlePage numberArticle size9 February 2011Daily EchoMedical column.Your views on our plans for theyear ahead17Third of a pageYour views on our plansfor the year aheadThroughout February to April we are inviting our staff,the public and our partners to give their views on ourfuture plans. Each year the Annual Plan sets out thechallenges and how we plan to meet these, whilecontinuing to provide excellent quality services.Over the past year, by focusing on getting care right,first time and using best practice, we have been ableto provide better health and better value. We wereawarded the safest hospital award while we alsoreduced our costs by £15m (7%). We have achievedthis, for example, by redesigning some patientpathways. This has led to better clinical outcomeswhich means patients recover faster, spend less timein hospital and as a result fewer beds are needed.The challenge now is to improve outcomes forpatients while making £30m of recurrent savings overthe next three years. The Annual Plan for 2011/12sets out how we will achieve this, including looking atpatient pathways and our estate options. We set outa range of measures focusing on improving:• Avoidable mortality and better end of life care• Long term conditions - self management, reducingadmission and quality care• Emergency hospital care• The patient experience• Patient safetyThe draft plan also asks for comments on a range ofissues, including:• The balance of services between Christchurch andBournemouth Hospitals and the balance betweenusing our funding to maintain buildings andmaintaining staff levels.• Whether some specialist services can be improvedby working more closely with other specialistservices in neighbouring hospitals.• How we can transform our services to reducewaste, delay and duplication; so that they arebetter for patients and staff alike.Comments on specific proposals and new ideas arerequested.You can find out more in the consultation documentat www.rbch.nhs.uk or from the CommunicationsDepartment on 01202 704271. You can then give usyour views:• Online at www.rbch.nhs.uk• In writing to the Chief Executive, Tony Spotswood,the Royal Bournemouth Hospital, Castle Lane,Bournemouth, BH7 7DW• In person at one of the following public meetings:- RBH, Lecture Theatre, Education Centre,8th March at 6.00pm- Christchurch Borough Council, Council Chamber,Civic Centre, Christchurch, Tuesday 29th Marchat 6.00pm.Your views are important to us and we lookforward to hearing from you.The consultation runs from Wednesday2nd February to Friday 29th April.A summary of the feedback receivedwill be available at www.rbch.nhs.uk,or by calling us on 01202 704271,from Mid-May.February 2011 l 4Dr Mary Armitage, Medical Director.medical@rbch.nhs.uk

DatePublicationInformationTitlePage numberArticle size10 February 2011Daily EchoAn article about the new £2.2 million combinedstroke unit at the Royal Bournemouth Hospitalwhich will initially have 20 fewer beds and 29 fewerstaff than the current set up.Fewer beds in £2.2 million stroke unit4Sixth of a pageDatePublicationInformationTitlePage numberArticle size10 February 2011Daily EchoAn article that mentions that heart patients atthe Royal Bournemouth Hospital are among thefirst in the country to benefit from new imagingtechnology.Imaging technology gets hearts racing8Eighth of a pageFebruary 2011 l 5

DatePublicationInformationTitlePage numberArticle size11 February 2011Stour & Avon MagazineAn article about cardiac patients at the Royal Bournemouth Hospitalwho are among the first in the country to benefit from state ofthe art imagining technology to identify and treat disease of heartarteries.Saving lives of cardiac patients27Sixth of a pageDatePublicationInformationTitlePage numberArticle size11 February 2011Stour & Avon MagazineAn article highlighting how RBCHcancer services have been rated highlyby the recently published ‘ImprovingOutcomes; ‘A strategy for Cancer’and the 2010 National Cancer PatientExperience Survey.Improving cancer outcomes27Sixth of a pageFebruary 2011 l 6

DatePublicationInformationTitlePage numberArticle size11 February 2011Stour & Avon MagazineAn article focusing on local peoplehaving a say on the future ofChristchurch Hospital.Christchurch could have an older people’svillage27Sixth of a pageFebruary 2011 l 7

DatePublicationInformationTitlePage numberArticle size10 February 2011Daily EchoAn article focusing on Purbeck IceCream - recently voted best diaryproduct in the country - beingavailable for patients at the RoyalBournemouth Hospital.Just what the doctor ordered16Eighth of a pageDateWebsiteTitleInformation14 November 2010www.thisisdorset.co.ukCardiac patients at the Royal Bournemouth HospitalAn online article about how cardiac patients at the RoyalBournemouth Hospital are among the first in the country tobenefit from state of the art heart imaging technology toidentify and treat disease of heart arteries.DateWebsiteTitleInformation14 November 2010www.bbc.co.uk/newsCouncil to discuss hospital plansAn online article about local councillors meeting to discussplans for Christchurch hospital.DateWebsiteTitleInformation14 November 2010www.bournemouthecho.co.ukFewer beds in the Royal Bournemouth HospitalAn online article about the new £2.2 million combined strokeunit at the Royal Bournemouth Hospital that will initiallyhave 20 fewer beds and 29 fewer staff than the current setup.DateWebsiteTitleInformation14 November 2010http://topnews.usStroke unit of £2.2million at The Royal BournemouthHospital to have fewer bedsAn online article Reports about the new combined strokeunit of £2.2 million at the Royal Bournemouth Hospital willinitially have 20 fewer beds and 29 fewer staff than thecurrent set up.February 2011 l 8

DatePublicationInformationTitlePage numbersArticle size12 February 2011New Milton AdvertiserAn article about the future of Christchurchhospital and how it has been plunged intodoubt by NHS plans to save £30m over the nextthree years which could see all services moved toBournemouth.£30m cost-cutting threat to hospital1 and 2Fifth of a pageDatePublicationInformationTitlePage numberArticle sizeFebruary 2011VIEWPOINT magazineAn article about a young girl giving upall her birthday presents to raise £400 forcancer sufferers.Birthday party adds for Jigsaw9Quarter pageFebruary 2011 l 9

DatePublicationInformationTitlePage numberArticle size14 February 2011Daily EchoAn article about the radical plans that will decidethe future of Christchurch Hospital will be debatedby the borough council’s scrutiny committee.Hospital plans coming up for debate6Quarter pageFebruary 2011 l 10

DatePublicationInformationTitlePage numberArticle size17 February 2011Daily EchoAn article about two small cafes in the RoyalBournemouth Hospital have managed toraise £78,000 for charity.Tea bar brews up pots of cash24Third of a pageFebruary 2011 l 11

DatePublicationInformationTitlePage numberArticle size18 February 2011Daily EchoAn article about how hospital chiefs havebeen urged to consult further with users ofChristchurch Hospital.More talks needed over hospital’s futureoptions11Half pageFebruary 2011 l 12

DatePublicationInformationTitlePage numberArticle size19 February 2011New Milton AdvertiserAn article mentioning how borough councillorshave warned Christchurch residents that theycould be left with a poor quality hospital ornone at all.Borough councillors attack £30m hospitalsavings plan6Quarter pageFebruary 2011 l 13

DatePublicationInformationTitlePage numberArticle size19 February 2011New Milton AdvertiserAn article about a Milford marine engineer who died fromswine flu and his family’s fury at an alleged lack of actionby NHS doctors and ambulance staff but praised staff at theRoyal Bournemouth Hospital.Family fury at dad’s death from swine fluFront pageQuarter pageFebruary 2011 l 14

DatePublicationInformationDateWebsiteTitleInformationDateWebsiteTitleInformationTitlePage numberArticle sizeDatePublicationInformationTitlePage numberArticle size22 February 2011www.salisburyjournal.co.ukJigsaw leaves Moya the picture of healthAn on-line article about a 72 year-old exerciseteacher that is urging people to raise funds forthe unit that helped her fight breast cancer.22 February 2011www.thisisdorset.co.ukWest Moors cancer survival unit appealAn on-line article about a patient whowas successfully treated for breast cancerat the Women’s Health Unit at the RoyalBournemouth Hospital is calling on people tohelp support the unit that made it all possible.DatePublicationInformationTitlePage numberArticle size23 February 2011Daily EchoMedical column.Protect yourself17Third of a page23 February 2011Avon AdvertiserAn article about a 72 year old, Moya Botterill whofollowing a 10 week of surgery, a mastectomy andbreast reconstruction organised two sponsoredexercise classes, raising £1,250 for the Jigsaw Appeal.Moya’s charity efforts6Third of a page24 February 2011Daily EchoAn article about Moya Botterill and her two fitnessleague groups in Fordingbridge and Westmoorsthat raised £1250 with sponsored exercise sessionsand a raffle for the Women’s Jigsaw Appeal.Cancer fighters22Eighth of a pageProtect yourselfYou may have found romance but you don’t wantto put yourself at risk of a sexually transmittedinfection (STI).STIs are diseases passed on through intimatesexual contact. They can be passed on duringvaginal, anal and oral sex, as well as throughgenital contact with an infected partner. CommonSTIs in the UK include chlamydia, genital wartsand gonorrhoea.The numbers of diagnosed cases of STIs in theUK are going up. The age group most affectedis 16 to 24-year-olds. Even though they make upjust 12% of the population, young people accountfor more than half of all STIs diagnosed in the UK.This includes 65% of new chlamydia cases and55% of new cases of genital warts. Older peopleare no exception, STI’s can affect everyone.There are a number of places where you can getscreened for STIs including some GP surgeries,sexual health and contraception clinics, andthe Royal Bournemouth GUM (genitourinarymedicine) clinic. Here we offer:• Expert diagnosis and treatment of all sexuallytransmissible infections including HIV• Diagnosis and treatment of genital skinproblems• Emergency Contraception• Free condoms and safer sex adviceRemember, all sexual health services areconfidential. This means that your personalinformation, any information about your visit andthe tests and treatments that you have will not beshared with anyone outside that service withoutyour permission.When it comes to family planning, there are somany methods of contraception to choose from.It is worth taking the time to find out more abouteach one so that you can choose contraceptionthat suits you.One of the best ways to protect yourself and yourpartner from STIs is by using a condom andpracticing safer sex. National Condom Week(13th to 19th February) is a reminder to all, thatsex should be safer sex.Whatever your age, even if you’re under 16,you can get free condoms from communitycontraceptive clinics, sexual health and GUMclinics, some young people’s services, andsome GP surgeries. You can also buy condomsin pharmacies and supermarkets.For more information on the methodsof contraception available and sexualhealth advice, visit our GUM pagesat www.rbch.nhs.uk/gum or watchour ‘condom, no condom’ film whichis also available on these pages.February 2011 l 15Dr Mary Armitage, Medical Director.medical@rbch.nhs.uk

THE ROYAL BOURNEMOUTH AND CHRISTCHURCH HOSPITALSNHS FOUNDATION TRUSTBOARD OF DIRECTORSMeeting Date and Part:11 March 2011 Part ISubject:Board of Directors Forward ProgrammeSection:InformationExecutive Director with overallresponsibility:Author of Paper:Rebecca Lawry, Trust SecretaryRebecca Lawry, Trust SecretarySummary:Copy of the Board of Directors ForwardProgrammeStandards for Better Health domain:GovernanceAction required by Board ofDirectors:For Information

Board of Directors Business ProgrammeBoard of Directors - Meeting Map 1What Who Where Before Jan Feb Mar Apr May Jun Jul Sep Oct Nov Dec Where AfterAnnual PlanBoard Objectives TS Chief Executive N/AAnnual Plan - BoD approve Draft for Public Consultation RR TMB BoDAnnual Plan - Feedback from Consultation to BoD RR CoG BoDAnnual Plan - Final Draft for BoD Approval RR TMB BoD PublicationStrategy Tracker - Quarterly RR Service Development N/ABudgetBudget for next financial year SH Finance N/ACapital Plan for next financial year SH CMG & Finance N/ACode of Conduct for Payment by Results RR Service Development N/APCT Contract Sign Off RR Service Development PCTAnnual reportAnnual Report & Accounts First Draft SH Finance N/AAnnual Report - Audit Committee IM Audit N/AAnnual Report - Finance Committee BF Finance N/AAnnual Report - Healthcare Assurance Committee BA HAC N/AAnnual Report & Accounts - Final draft for approval SH Finance & Audit Cttees MonitorAnnual Report & Accounts - Going Concern Statement SH Finance & Audit Report & A/CsCQC RegistrationQuality and Risk Profile Update BA HAC CQCCharitable FundsAnnual Report & Accounts SH Charity Cmtte Charities Commission?HealthcareAssurance Framework BA HAC N/AChild Protection & Safeguarding Annual Report BA HAC N/AClinical Governance - Quartency Report BA HAC N/AClinical Governance - Annual Report BA HAC N/ADr Foster Quarterly Report MA Medical Director ?Quality Accounts - First Draft BA Clinical Governance N/AQuality Accounts - Final Draft for Approval BA Clinical Governance PublicationInfection ControlBoard Statement of Commitment to prevention of Healthcare Associated Infection BA Infection Control ?Infection Control - Annual Report BA Infection Control N/AInfection Control - Quarterly Update BA Infection Control N/AMonitorMonitor Quarter 1 Report HL Director of Ops MonitorMonitor Quarter 2 Report HL Director of Ops MonitorMonitor Quarter 3 Report HL Director of Ops MonitorMonitor Quarter 4 Results HL Director of Ops MonitorMonitor Annual Risk Assessment TS External Monitor?Monitor's FT Sector Overview - Annual Risk Assessment TS Chief Executive N/AMonitor Self Certification - Board Statements RL Trust Secretary MonitorStaff

What Who Where Board Before of Directors - Meeting Jan Map Feb Mar Apr May Jun Jul Sep Oct Nov Dec Where After 2Staff Excellence Awards - Chairman's Prize RR Awards Panel Staff AwardsStaff Excellence Awards - Process for current year RR Service Development N/AStaff Survey - Results KA Workforce ?Workforce Committee - Quarterly Report KA Workforce N/ALocal Clinical Excellence Awards MA Remuneration ?Local Clinical Excellence Awards - Annual Report MA Remuneration N/AGovernanceRegister of Interests RL Trust Secretary FileConstitutional Documents - Annual Review RL Trust Secretary CoGCode of Governance Disclosure Statement RL Trust Secretary MonitorMeeting Dates for Next Year RL Trust Secretary N/AForward Programme RL Trust Secretary N/AMinutes of Subordinate groupsAudit Committee Cttee Audit N/ACharity Committee Cttee Charitable Funds N/ACouncil of Governors RL CoG N/AFinance Committee Cttee Finance N/AHealthcare Assurance Cttee HAC N/AInfection Control Cttee Infection Control N/AMarketing Committee Cttee Marketing N/ARemuneration Committee Cttee Remuneration N/ATrust Management Board Cttee TMB N/AWorkforce Committee Cttee Workforce N/AReview Performance & Terms of Reference subordinate GroupsAudit Committee IM Audit File - RLCharities Committee KT Charitable Funds File - RLFinance Committee SH Finance File - RLHealthcare Assurance Committee BA HAC File - RLInfection Control Committee BA Infection Control File - RLMarketing Committee RR Marketing File - RLRemuneration Committee SC Remuneration File - RLTrust Management Board TS TMB File - RLWorkforce Committee KA Workforce File - RLCommunicationsCommunications Audit Action Plan RR Marketing ?Inpatient Annual Survey Results RR Marketing Publication?Marketing & Communications Report RR Service Development N/APutting Patients First - Quarterly Progress Report RR Marketing N/ARead All About It RR Service Development N/AService Guide RR Service Development ?