THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST
COUNCIL OF GOVERNORS
MINUTES OF MEETING HELD ON 21st JULY 2016
Present: Mr K Smith
Public Governors (Constituency 1)
Public Governors (Constituency 2)
Public Governors (Constituency 3)
Staff Governors
Appointed Governors
Mrs A Dragone, Finance Director
Sir Leonard Fenwick, Chief Executive
Mrs H Lamont, Nursing and Patient Services Director
Mr A Welch, Medical Director
In attendance: Mr S Stoker, Clinical Effectiveness Manager
Mr E Hindle, Head of Workforce Engagement and Information (minute ref. 16/43 item 11iv)
Ms J Levey, Service Improvement Facilitator (minute ref. 16/43 item 11ii).
16/34 Apologies for absence
Apologies were received from Dr A Aggarwal, Professor C Day, Ms K Douglas, Mr B Ions, Mrs V Mitchinson, Mr W Reed, Mrs L Robson, Professor A Wathey and Mr F Wyres.
Governors who have resigned since the previous meeting
Mr B Keegan and Dr L Murthy.
16/35 Presentation of Acknowledging Continuous Excellence (ACE) certifications
Ms Coghill introduced and explained that the ACE Awards were formally endorsed by the Trust Board in November 2014 and build on the previous Ward Accreditation Scheme. The ACE Awards were designed to provide recognition to those clinical areas consistently meeting the highest of standards defined in the Clinical Assurance Toolkit (CAT) covering five categories:
i) Environmental Cleanliness – Matrons monthly cleanliness checks.
ii) Patient Experience – Patient satisfaction, harm free care, nursing complaints.
iii) Measure of Patient Quality – MRSA screening and risk assessments.
iv) Measure of Clinical Quality – Saving lives documentation.
v) Staff Knowledge – Infection Prevention and Control, risk assessments and hand hygiene.
Matrons nominate their areas based on constant high standards and once an area is nominated in all five categories a Governor is invited to complete a validation visit. Three Governors volunteered their time to review the standards in the clinical areas i.e. - Mr Venables, Mrs Houliston and Dr Lucraft.
To date, 34 areas across the Trust have achieved success in 2-4 categories within the last year however this is the first time all five categories have been awarded in six areas. The award winners were:
• Freeman Hospital Outpatients Department;
• RVI Outpatients Department;
• Sir Bobby Robson Clinical Trials Centre;
• Clinical Ageing Research Unit;
• Newcastle Clinical Research Facility; and
• Dental Clinical Research Facility.
Each area received their certificates from the Chairman and on behalf of the Governors, who congratulated the areas on achieving the award.
16/36 Statutory Business
i) Nomination Committee
Mr Ramsden updated the Governors on the current situation regarding the recruitment and appointment of a new Trust Chairman. Interviews had been scheduled for 20 May 2016 for the five shortlisted candidates but these had been cancelled following receipt of correspondence from NHS Improvement seeking clarification as to the process being undertaken. The Nomination Committee had since met on 11 July 2016 to discuss potential interim arrangements if a new Chairman could not be appointed before the end of September 2016 when the current Chairman’s term of office was due to expire. The Trust Secretary had organised a meeting to recommence the appointment process.
Governors noted that Mrs Hargreave had not re-stood in the Governor 2016 elections and a ballot of Public Governors had appointed Mr Chaffer as the new Nomination Committee member.
The Nomination Committee will commence the process of appointment for a new non-Executive Director following Dr Dobson’s decision to stand down having served for two terms of office i.e. six years. It was noted that during July 2016 all Non-Executive Directors and the Chairman will undertake a performance appraisal with a report being presented at the next Council meeting.
It was resolved:
to i) receive the report ii) note the ongoing recruitment process for a Trust Chairman and iii) receive an update at the next meeting.
ii) Governor Elections 2016 update
Mr Smith advised that for 2016 ten governorships were up for election. Ms Houliston was returned unopposed (staff volunteers) and in all other constituencies a ballot had been held on 23 June 2016 resulting in the following successful candidates: Mr Chaffer, Mr Ions, Mrs Nelson and Mrs Richardson (all Public – Newcastle upon Tyne), Mrs Errington, Mrs Lucraft and Mr Richardson (all Public – Northumberland Tyne and Wear), Dr Laws (Staff – Medical and Dental) and Mrs Mitchinson (Staff – Health Professionals Council).
Mr Smith expressed his thanks and appreciation to those Governors who had resigned and also those who had decided not to re-stand in the elections.
It was resolved:
to i) receive the briefing and ii) note the Election outcomes.
16/37 Minutes of the Meeting held on 19 May 2016
These were agreed as a correct record, subject to an amendment to record that Mr Bedlington had visited the site with the Assistant Chief Fire Officer and not the Chief Fire Officer.
16/38 Current issues
i) Executive Report
Sir Leonard spoke of a number of issues of current interest. Huge progress had been made in relation to Equality and Diversity with the Care Quality Commission (CQC) referencing this during the recent inspection visit.
Sir Leonard highlighted the potential impact emanating from the ever-evolving multi-factorial operational / strategic / exponential reach-in regulatory scenarios within the constraint of a finite, diminishing resource.
It was noted that the Trust had managed to sustain Level1 in terms of Children’s Cardiothoracic Services against extreme uncertainty.
Sir Leonard advised on progress in bringing about a resolution to the shortcomings and associated financial challenges surrounding the Newcastle Hospitals Private Finance Initiative. In particular, the difficulties and significant delays which had been experienced in relation to the Clinical Resource Buildings at the Royal Victoria Infirmary.
Sir Leonard commented on the Trust’s performance in being rated “Outstanding” by the Care Quality Commission. Newcastle was the fifth Trust to be rated Outstanding under the CQC Inspections Programme and only the first major Teaching Trust to achieve the rating.
It was noted that progress had been delayed in certain key priority capital developments due to the need to realign capital investment. The RVI multi-storey car park however was to progress and design/fundamental content options to redevelop the Queen Victoria Road frontline was still being followed through.
Sir Leonard referred to a plethora of key impact documents / statements from Government / Regulators / Advisory bodies. In particular The NHS England “Achieving World-Class Cancer Outcomes: Taking the Strategy Forward” demonstrated the future plan for cancer services and it was noted that the Trust was in a very strong position in terms of what the document recommended.
Mr Smith commented on the NHS Improvement “Single Oversight Framework” consultation document explaining that the content clearly demonstrated an ever-increasing centralisation and the insatiable demands being placed on the Trust for yet more and more information. Whilst as a Foundation Trust the commitment to work in partnership was long established this should not be at the expense of having freedom and flexibility to make informed-choices which best served its patient population. Ultimately, the Trust would not compromise on the standard and quality of care it delivered to its patients against an ever-increasing requirement from various authorities to make substantial cost savings which were unrealistic. Furthermore, it was noted that whilst the documents were largely aligned to a Trust’s geographical location, Trust’s such as Newcastle were not just local but were international in terms of the specialist range of services provided. Mr Ramsden commented that the overall picture was becoming most disheartening and centralised control would not fare any better than the current position particularly in relation to already Trust high achievers. The Governors emphasised that they fully supported the Trust’s stance in this matter.
Sir Leonard referred to the NHS England “Paediatric Cardiac and Adult Congenital heart Disease: Standards Compliance and Future Service Configuration”. The report identified the commissioning decisions which had been taken to ensure the provision of consistent, high quality services across the country. As indicated earlier, the Newcastle Hospitals NHS Foundation Trust retained its current recognition as a specialist surgical (Level 1) service and it was noted that NHS England would be working with the Trust to ensure progress is made towards achieving all necessary standards. Sir Leonard said that the outcome reflected great credit to all involved, staff / parents / families and children who had all combined to advocate the Trust as “international standard, best class”. It was also noted that NHS England had decommissioned the University Hospitals of Leicester NHS Trust and Royal Brompton & Harefield NHS Foundation Trust, although specialist services may be retained in Leicester.
Sir Leonard drew attention to the NHS Improvement document “Rostering Good Practice Guidance”. Mrs Lamont indicated that the document did pose a significant challenge with processes having to be established for publishing rosters six weeks in advance and reviewing Trust key performance indicators such as proportion of staff on leave, training and appropriate use of contracted hours. Furthermore, the whole process had to contain arrangements for audit and feedback. Mr Venables asked that a more detailed briefing of the requirements be provided for the next meeting.
Sir Leonard indicated that the Trust had been requested by NHS Improvement to report back, by end of July, indicating proposals for consolidating ‘Back Office’ and also Pathology Services with outline plans, initially on an Sustainability and Transformation Programme footprint basis but ultimately with a mind to consolidating across a much larger geographical catchment.
It was resolved:
to note the content of this report.
ii) Fire Safety within the Trust PFI Estate – Governor visit feedback
Mr Bedlington advised that he had visited the Royal Victoria Infirmary (RVI) site being briefed on the serious concerns raised; in particular the failings in relation to Fire Safety and which had come to light across the PFI Estate and all this entails. Work was now ongoing to address the remedial requirements with Sir Leonard reporting that Arup Consulting Engineers had been appointed by the Trust to act as Independent Expert Witness Fire Engineers. Fire marshals had been appointed to patrol the PFI Estate (RVI and Freeman Hospital) day and night and whilst the fire alarm system was deemed satisfactory the inherent as built structure was not. The Tyne & Wear Fire & Rescue Service had been notified of the situation.
Sir Leonard spoke of concerns re the robustness of the inspection process, by the relevant authorities, which had been undertaken in receiving Building Regulations approval and similarly he commented that as the Trust did not have any clerking rights when the PFI buildings were constructed, it had had to rely on the fire safety certification provided by Faithful and Gould, the Independent Tester as the Trust did not have ‘clerking rights’ throughout the construction process.
It was resolved:
to note the current situation and receive and update at the meeting.
iii) Nursing Models of Education
Mrs Lamont reported that nationally there were extreme Nursing workforce challenges, with the profession now officially on the shortage occupation list. To meet this challenge, the Trust was considered in a strong position as “the NHS employer of choice” and implement “Growing our own’’ Nurse Strategy; thereby offering a range of routes to become a Registered Nurse.
The Executive Team has agreed to support working in partnership with Sunderland University to develop a self-funded Adult Nursing Degree Programme to commence in March / April 2017. The Trust was to work with a local University to support an additional 30 self-funded adult nursing places, on a three year adult Nursing BSc programme, with the respective student responsible for all financial costs. The intention was for the Trust to deploy a self-funded student loan repayment model, offer an additional payment to the nurses of approximately £500 per Nurse per annum for a five / ten year period. Payments would be made in arrears at the end of the financial year. The Trust will enhance participants’’ experiences through becoming active members of a Trust wide group e.g. Nutritional Steering Group, Harm Free Care Group and provide access to Trust education programmes e.g. “Grand Rounds” or “Schwartz Rounds”.
Mrs Lamont agreed to keep Governors updated on progress.
16/39 Business and Development
i) Working Group Report
Mr Bedlington advised that, in early June 2016, the Group had been involved in the business planning process and at its next meeting, the Group would be assessing the key performance indicators in relation to the Trust External Auditors.
In response to a query regarding the delivery of patients by helicopter, Sir Leonard confirmed that there was an issue regarding helicopters landing on the Royal Victoria Infirmary heliport following national change and the introduction of Bristow. Bristow were deploying the Sikorsky S-92 helicopter to carry out air sea rescues however the Sikorsky S-92 was not landing on “raised helipads”. Consequently, Coast Guard Search and Rescue helicopters were not using the helipad, albeit the Air Ambulance or Police continue to use the facility on a regular basis.
Bristow were currently landing on the Town Moor and most understandably there were a number of risks which this entails, including time scale of transferring patients and the land being open ground with public access and grazing cattle. It was agreed to keep Governors up to date as the situation develops.
ii) Finance Report
Mrs Dragone presented the financial position for the period ending 31 May 2016. The Trust had reported a surplus of £1.5 million before impairment, £2.8 million behind the Financial Plan.
The Trust operating income was £0.9 million behind Plan and the Trust operating expenditure for the year was £2 million greater than the Plan. The Plan requires £33.3 million cost improvements, with plans currently being reviewed. Capital expenditure was £0.2 million ahead of the Plan, primarily as a result of expenditure on equipment replacement. The Cash balance was £8.6 million higher than the plan, mainly due to working capital movements.
The figures demonstrated why the Trust had chosen not to sign up to “Controls Totals” as if it had then the situation would have been less than ideal and simply served to introduce problematical scenarios as to financial integrity as a public benefit corporation.