ATTACHMENT (A)

HERTFORDSHIRE COMMUNITY NHS TRUST

Minutes of the Hertfordshire Community NHS Trust Board Meeting

Held in Public on Thursday 26th January 2012 in the Focolore Centre,

Welwyn Garden City, Herts.

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Key Points from the Meeting for the Board to note:

* DO’F announced the new substantive appointments of David Law as CEO and Dr. Hemal Desai, as Medical Director. The Board expressed its appreciation to Karen Taylor, Deputy CEO who will be leaving shortly to take up a new post. DO’F also welcomed Eric Marshall to his fist Board meeting as LINk observer, replacing Malcolm Rainbow.

* The Quality Strategy was approved.

* The following were received and considered:

Quality Account Progress Report

Dignity and Nutrition Inspection Internal Assurance Report

Board Assurance Framework (as at Dec 11)

High Level Risk Register (as at Dec 11)

FT Progress Report

HCT’s response to NHS Hertfordshire’s “A Vision and Strategy for Intermediate Care Services in Hertfordshire”

Interim CEO’s Report (including):

* West Essex Children’s Services Contract

* Board Governance Assurance Framework

* Confirmation that HCT has achieved Level 1 in NHSLA Risk Management Standards

Integrated Performance Report (as at Dec 11)

Midlands and Eastern SHA Cluster PMR Return (Dec 11)

* Meeting minutes/verbal reports were received from the Chairs / Acting Chairs of the following Committees:

Healthcare Governance

Audit

Finance, Business & Investment

FT Steering Group

Remuneration

Present: Declan O’Farrell (DO’F) Chair

Anne McPherson (AM) Non Executive Director

Jeff Phillips (JP) Non Executive Director

Alan Russell (AR) Non Executive Director

Alison White (AW) Non Executive Director

Julie Hoare (JH) Acting Director of Operations

Sean McKeever (SM) Director of Finance & Commerce

Krystyna Ruszkiewicz (KR) Interim Director of Workforce

Derek Smith (DS) Interim Chief Executive

Clive Appleby (CA) Company Secretary

In Attendance: Jaci Church (JC) AD Quality & Governance

(for Clare Hawkins)

Eric Marshall (EM) LINk Representative (Observer)

(A) /
Preliminaries & Board Governance
/

Action

01/12 / Welcome, Introductions and Apologies
DO’F welcomed those present and also welcomed EM to his first meeting of the Board as LINk observer, replacing Malcolm Rainbow
Apologies for absence were noted from:
Julian Laite NED
Karen Taylor Deputy CEO
Clare Hawkins Dir. Of Quality & Governance
Dr. John Riordan Interim Medical Director
02/12 / Notice of Urgent Business
See 23/12 below
03/12 / Members’ Declarations of Interest
None
04/12 / Ratification of Chair’s / CEO’s Action taken since last meeting under Standing Order 5.2
No items
05/12 / Minutes of the Meeting held on 24th November 2011
Agreed to be signed by the Chair as an accurate record subject to:
p.2 154/11 Members Declarations of Interests:
to read:
AW reported that she has been appointed (i) as shadow chair of the General Osteopathic Council from 1st December, taking up the role as Chair from 1st April 2012 and (ii) as a member of the GMC’s Fitness to Practice Panel…….
06/12 / Matters Arising from the Minutes of the Meeting Held on 24th November 2011 (Board Tracker)
The Tracker for the meeting held on 24th November was received and noted. DO’F thanked the Executive Team for matters actioned.
(B) / Clinical Safety & Quality
07/12 / Quality Account Progress Report
(JC for CH)
The Quality Account Progress Report as at January 2012 was received.
The Board noted:
(i) The positive feedback on the Quality Account 2010/11 received further to its formal review by the Strategic Health Authority
(ii) That HCT will receive third party assurance on the data validity and governance processes for the Quality Account 2011/12 as part of its scheduled internal audit programme and that the Account will also be subject to external audit.
(iii) That the Quality Account is integrated into the overall quality improvement agenda in HCT with ongoing stakeholder engagement throughout the year.
(iv) That the progress report was considered by the Healthcare Governance Committee at its meeting on 19th January.
(v)  Guidance on the QA for 2011/12 is the same as for 2010/11
(vi) A set of indicators for clinical effectiveness, safety and experience will be reported through the Integrated Performance Report.
It was agreed that:
(1) The Quality Account for 2011/12 follow a similar style and format as for the 2010/11 version. / CH/JC to note
08/12 / Dignity & Nutrition Inspection (DANI) Internal Assurance Report
(JC for CH)
A Dignity & Nutrition Inspection (DANI) Internal Assurance Report was received.
It was noted that:
(i)  The report was considered by the Healthcare Governance Committee in December 2011 and was presented to the Board as a “One Off” to advise the Board of the outcomes of an internal assurance local inspection programme of HCT’s 12 bed based units, which was carried out between October – November 2011.
(ii)  The purpose was to test against findings from the CQC national report on the (Acute Trust) DANI programme. (Dignity and Nutrition Inspection). This focussed on CQC Outcomes 1 (Respecting and Involving people who use services and 5 (Meeting Nutritional Needs).
(iii) There was overall positive assurance that the bed based units are meeting the majority of the key elements for QCQ standards for Outcomes 1 and 5. Two areas that stood out were:
(a) availability of call bells in “public areas” on wards and
(b) staff needing to devote enough time to patient needs at mealtimes without being distracted by undertaking other activities.
(iv) Recommendations for improvement were made where assurance was not available and these, along with the original findings, have been submitted to The Senior Sister, Locality Manager and ADO.
(v) Where assurances related to staffing this was relevant to the level of staffing rather than attitudes, behaviours or lack of understanding.
(vi) Staff welcomed the exercise and responded positively.
(vii) Privacy and Dignity and Nutrition will also be reviewed between January to March 2012 as part of PEAT inspection visits, which were currently in progress. The internal DANI visit will also be repeated in Qtr 1 of 2012/13.
(viii) CH and JC were looking at consolidating the reporting from the variety of visits to services which were undertaken.
EM observed that he had taken part in a PEAT visit at the Herts & Essex Hospital the previous week and the feedback he had received from patients on nutrition and dignity had been very positive. This included reports from some patients that they were putting on weight while in Hospital.
09/12 / Quality Strategy
The (draft) Quality Strategy for 2012 – 2014 was received and discussed
It was noted that:
(i) Board members had been consulted on the draft content and the strategy had also been through HGC. Changes had been made as a result.
(ii) The strategy was shot term and aimed to be realistic as to what was achievable rather than too ambitious.
(iii) The strategy will be evolved and will also have input from the newly appointed Medical Director.
(iv) Implementation actions will be reported to the Board through the Quality Improvement Plan (QIP), which will be presented to the Board quarterly.
The Strategy was approved, subject to:
(1) p.6 delete “…open and honest co-operation”; insert “……open and honest communication”.
(2) s. 5.2 add in a reference to internal clinical audit as a contributory factor to improving clinical effectiveness.
It was agreed that:
(1) Revised iterations be circulated to Board members and that the Strategy, in common with all Trust strategies, to be formally reviewed by the Board annually. / CH
(C) / Compliance, Risk & Assurance
10/12 / Board Assurance Framework (January 2012)
The BAF for January 2012 was received and discussed.
It was noted that:
(i)  The January version had not been reviewed in advance by the Audit Committee because of meeting timings, but it had been reviewed and updated by the Executive Team.
(ii)  One risk has been revived from archive:
“Taking on estate ownership may lead to liabilities resulting in financial loss, either from asset risk or underuse of capacity”, with a current risk score of 3x3 = 9
(iii) Two risks were recommended by the Executive Team for removal to archive:
Ref: 07 11 (1): “Insufficient "front line" staff capacity through vacancies and/or sickness absence may lead to services not being delivered to accepted standards, resulting in damage to reputation, inability to fulfil contractual requirements or possibility of increased risk to patients”
This was on the basis that there are periodic capacity issues in some services, but this is now deemed to be at a level where it may have operational but not strategic impact. Specific risks may therefore feature in Business Unit and the High Level Risk Register, but not in the BAF.
Ref: 09 11 (02): “Failure to achieve NHSLA Level 1 Risk Management Standards results in the SHA being unlikely to support the FT application to proceed to Secretary of State Phase”
The proposed removal of Ref 07 11 (1) to archive was discussed. It was acknowledged that there had been a significant shift in the risk following recruitment since the risk was first identified, but there was concern as to whether:
(i) staffing capacity across the Trust was still a sufficiently widespread issue as to constitute a strategic risk and
(ii) there was sufficient evidence to assure the Board that the risk had been mitigated, given that detailed data on vacancies, recruitment, absence and turnover by Business Unit, was not included in the Integrated Performance Report.
It was also noted that capacity didn’t only relate to the numbers of staff but also to capability.
It was agreed that:
(1) The recommendation of the Executive Team be accepted that Risk Ref 7 (11) 1 be removed to the BAF archive but that:
(a) The Executive Team circulate supporting evidence to the Board by way of assurance to qualify the risk for removal to the BAF archive and
(b) The risk be kept under review by the Executive Team and
(c) staffing data by business unit is re-instated into the Integrated Performance Report, thereby supporting evidence of assurance. / DS
11/12 / High Level Risk Register (January 2012)
The HLRR for January 2012 was received and discussed.
It was noted that:
(i) There are four risks on the HLRR compared to three in the previous version.
(ii) Ref: 10/11/48 (Family Planning Vacancies): This had been discussed in the context of vacancies generally under the BAF. The risks identified for sexual health had not materialised to date over the previous three months.
(iii) Ref 11 11 51 (Pressure Ulcers): The issue of pressure ulcers was to be a subject of a “deep dive” by the Healthcare Governance Committee (HGC). A contributory factor is likely to be high staff turnover in the West. Although the “London factor” may be relevant in recruiting staff, there were a significant number of applications for vacancies.
(iv) Ref: 11 11 50 (Possible overspend on temporary staff at Danesbury)
Noted that the Exec Team will be discussing this issue to consider solutions.
(v) General (Capacity) The Executive Team review sickness absence rates monthly although the Board hadn’t looked at this is in detail since the September briefing. (See also min. 16/12 (x) below, re workforce data and Integrated Performance Report)
(D) / Strategic Direction
12/12 / Foundation Trust Progress Report (January 2012)
The Foundation Trust Progress Report as at January 2012 was received.
Progress to date on achieving FT status by April 2013, future actions, and principle risks were noted and discussed. It was also noted that the FT programme was on track.
13/12 / HCT’s response to “A Vision and Strategy for Intermediate Care Services in Hertfordshire” (NHS Hertfordshire Engagement)
The HCT draft response to NHS Hertfordshire (Hertfordshire PCT) on the above was received and discussed.
It was noted that whilst HCT accepted that the Royston and Hitchin Hospital estate was no longer suitable, concerns were primarily:
(i) In the proposed alternative model to a hospital bed based service, the PCT had underestimated what was required for “intermediate care” and the associated costs and quality implications. This was particularly the case in respect of therapy support specifications and additional resources that will be required for the necessary level of community healthcare support. (Noted that HCT has provided comments on the specifications, which were not particularly detailed).
(ii) The impact on staff, possible associated costs, and the fact that HCT is the employer of the staff affected rather than the PCT. This is relevant in relation to the redeployment of staff.
(iii)  The ability for HCT to maintain safe staffing levels during transition.
(iv) Disparity between what the PCT have said in their original consultation and the current position as to which organisation(s) will provide therapy support under the proposed model of care. (Commitment to HCT providing the service was stated in the formal consultation yet this has shifted to “unspecified provider”).
(v) The variation in healthcare support within care home provision as the proposed alternative to Hitchin and Royston Hospitals was such that it wasn’t comparing “like with like”.
It was further noted that the closing date for replies was 6th February and responses will be considered by the PCT Board in late February.
It was agreed that HCT’s approach be to
(1) offer to work with the PCT
(2) raise concerns openly and diplomatically and
(3) to consider the formal reply in this context
and that
(4) The final version of the response will be shared with Board members.
. / DS
(E) / Items for Approval / Ratification
14/12 / No items
(F) / Performance Reports
15/12 / Interim Chief Executive’s Report
The Interim CEO’s report for January 2012 was received and noted.
Topics covered were:
(a)  Executive appointments
(b)  Strategy development
(c)  West Essex Children’s Services Contract
(d)  Assistive technology
(e)  Intermediate Care Strategy
(f)  The Board Governance Assurance Framework (BGAF)
(g)  NHSLA Risk Management Standards Level 1
Of particular note were:
(i) The Board appreciated the inclusion of information on the “wider picture” of healthcare issues which were external to the Trust, but which may impact upon the Trust’s strategic direction.
(ii) The West Essex Children’s Services contract whereby HCT was preferred bidder, covered a wide range of services, but HCT had declined to provide a specialist service for autistic disorder. The contract was likely to be valued at £3.1m.