THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST
COUNCIL OF GOVERNORS
MINUTES OF THE MEETING HELD ON 17th SEPTEMBER 2015
Present: Mr K W Smith (Chairman)
Public Governors (Constituency 1) 8 (out of 9)
Public Governors (Constituency 2) 5 (out of 11)
Public Governors (Constituency 3) 4 (out of 4)
Staff Governors 2 (out of 7)
Appointed Governors 3 (out of 5)
(attendance schedule attached)
Mrs A Dragone, Finance Director
Sir Leonard Fenwick, Chief Executive
Mrs H Lamont, Nursing and Patient Services Director
Mrs L Robson, Business and Development Director
Mr S R Reed, Trust Secretary
Mr A R Welch, Medical Director
In Attendance: Mrs C McGarry, PCPI Manager (minute ref. 15/54(i) only)
15/45 Apologies for Absence
Apologies were received from Mrs Cartner, Ms Coghill, Mrs Hargreave, Mrs McCalman, Dr Oliver-Jenkins, Mr W Reed, Mr Venables and Mr Wyres.
15/46 Statutory Business
i) Nominations Committee
Mr Ramsden presented an update on Committee business. As previously reported, there had been a vacancy for a Public Governor in the Committee membership and Dr Saunders had now joined it.
There had been a high standard of applications for the Non-Executive Director vacancy and four candidates were to be interviewed on 22nd September 2015.
With regard to the reappointment of Mr Stout as a Non-Executive Director for a second term of office, he had been formally interviewed by the Committee, which was now pleased to make a unanimous recommendation to the Council of Governors to do so.
It was resolved:
to i) receive the briefing ii) note the current actions and iii) endorse the reappointment of Mr Stout for a second term.
15/47 Minutes of the Meeting held on 16th July 2015
These were agreed to be a correct record.
15/48 Executive Report: Current Issues
Sir Leonard spoke of a number of topics of current interest. The Dental Hospital & School was currently in internal ‘special measures’ due to shortcomings in waiting times performance. It was noted that the CQC inspection of the Trust would now take place in mid-January 2016 and Newcastle could expect a very large team of inspectors – perhaps as many as 100.
Capital and revenue investments continued to be made across the Trust, including in European and world firsts.
With regard to the continuing national dialogue on Children’s heart surgery, Newcastle was acknowledged to have one of the best units in the world but the national politics would be important. Planning for a new facility was progressing. Co-location with other Children’s services was a challenge, in terms of striking the right balance between an integrated Regional Cardiac Surgery Centre versus alignment with the Great North Children’s Hospital. The clinical outcomes should speak for themselves.
Attention was drawn to national Vanguard policy initiatives. Changes in management structures would require primary legislation but it was apparent that a number of initiatives were being forced through.
Governors were very familiar with the ongoing PFI dispute and it was saddening to note that it was now three years and three months since the Clinical Resource Building at the Royal Victoria Infirmary had been completed but was still not handed over formally to the Trust, due to a number of significant defects. Currently the Trust was in mediation with the project company.
In terms of Nursing & Midwifery staff recruitment, the Trust had issued a challenge to the Secretary of State for Health with regard to recent changes on the employment of non-EU staff and the issuing of Certificates of Sponsorship. There were 300 Nursing vacancies across the Trust right now.
Site developments were under development in a number of non-hospital locations and the Trust held the freehold for its sites in Walkergate, Sanderson, and the Campus for Ageing & Vitality.
Sir Leonard highlighted that the Education & Training of medical and other clinical staff was not in the gift of the Trust and that national moves were proving very frustrating in terms of the ability to recruit staff.
With regard to financial stability, it was noted that many Foundation Trusts and NHS Trusts were in trouble, including a majority in the North East and most teaching hospitals nationally. It was clear that the future of the entire Foundation Trust establishment was under threat.
Governors were advised that the Review of the Year for 2014/15 was to be published at the Annual General Meeting/Annual Members Meeting on 23rd September 2015.
It was highlighted that there was a continuing surge in volumes of urgent and emergency patients, with an additional 8-12 ‘blue light’ ambulances per day arriving at the Emergency Department, including from Tynedale.
Attention was drawn to the precarious state of North Tyneside Clinical Commissioning Group, which had a £20 million shortfall to remedy by the end of March 2016. There would undoubtedly be an impact on the Trust.
The Accountable Officers Group, facilitated by Newcastle City Council, was looking at pooled health and social care. Two thirds of the Trust’s business was not for Newcastle residents, however.
It was noted that winter planning for 2015/16 was well underway.
Attention was drawn to a number of key impact documents received from government and regulators. With regard to the Five Year Forward View, it was understood that a development in Scotswood was being planned. Changes had been heralded in Referral To Treatment operational standards and reporting.
A ‘25 Year Vision’ had been published, which included the effective merger of Monitor and the NHS Trust Development Authority under a single management structure as ‘NHS Improvement’.
Governors were advised of recent publications in relation to Safeguarding requirements. A review of Professional Codes of Practice had been completed. The NHS Pay Review Body report had been published. Further guidance had been received on Raising Concerns and Speaking Up.
Monitor had updated the Risk Assessment Framework and also published a report on A&E Delays. The NHS in Five Years’ Time had been published by Parliamentary communications agency Dods, which contained the results arising from a survey of 2,608 health workers’ attitudes on the future of the NHS.
Further information had been issued with regard to transforming Urgent & Emergency Care nationally. A study reported on unplanned admissions in those aged 85 years and older. New guidance had been issued with regard to spending on agency staff. The national Maternity Review had been published. The Care Quality Commission had announced the appointment of a Whistleblower Guardian. The CQC had issued its Strategy and Business Plan 2016-2021.
Close attention was being paid to ‘Devo Manc’, as there were potential parallels for developments in the North East.
Northumberland CCG was noted to be seeking to establish an Accountable Care Organisation, which would potentially put £110 million of Trust income at risk.
The Chairman highlighted that the Foundation Trust model of freedoms and flexibilities, include reinvestment of surpluses into services, was now under distinct threat. The original core driver had been to improve quality and generation of surpluses was interdependent with this and included the interplay with R&D. The Trust was treating ever increasing patient numbers, aided by its growth. It must ensure that it maintained this position. NHS England believed that the FT model was no longer appropriate and was seeking to impose central control of providers. There was no mention of patients or choice in any of the current rhetoric.
Commissioning was effectively being abolished, with providers holding the ring, patient choice disappearing, and significant conflicts of interest emerging. The Trust must influence the debate and where necessary fight it legally. Mr Bedlington noted that the array of issues was numerous and diverse. The Chairman thought that many were operational and for the Executive Team and Board to address. Governors needed to keep their focus on the Foundation Trust model and its core principles. Dr Saunders thought that it would be difficult for the Trust to fight its corner on its own and needed to be in a wider group for support. Sir Leonard advised that the Shelford Group was for lobbying and had originally been about R&D excellence. High cost, low volume services tariffs were being unpicked and the London supplement withdrawn. Eight of the ten Trust in the Group had crashed financially. Newcastle was still viable financially. Professor Corris thought that the threats and pressures were daunting.
Locally, North Tyneside CCG was most worrying and there could be scope for collaboration with Northumbria Healthcare NHS Foundation Trust. Mr Welch advised that there was open collaboration between the Trusts at Medical Director level and he sought to encourage it in areas such as repatriation of patients to base hospitals. The Trust must look to its own lights first and foremost, however. If the Northumbria A&E was successful, Newcastle would be successful. There was no need for Northumbria to develop specialised services when Newcastle was the regional provider but there was no strategic authority to moderate these decisions.
The Chairman noted that the major changes in national policy were coming through NHS England and hence the Trust must engage in a national dialogue. Dr Page asked how two CCGs had been taken over by a provider. Mrs Robson replied that NHS England was creating ‘disruptive change’ deliberately. Northumbria was the ‘Vanguard of Vanguards’ and expected to go further and faster and before any legal challenge could be mounted. Northumberland as a whole had agreed jointly to do this. The North Tyneside situation was different and the financial risk was being pushed into Northumberland. It was recognised that competition and governance were being ignored. Mr Ramsden commented on the dramatic implications of a reorganisation of the NHS by the back door. Mrs Robson added that the penalties had been increased with regard to RTT performance and hence currently waiting lists were not allowed to grow.
Mr Stewart-David thought that it would be helpful if the strategic and operational issues could be presented separately. Emergency admissions were difficult to manage; elective work was easier to plan and more lucrative potentially but there was an emerging risk of this being moved to Trusts in (financial) difficulty. Mr Welch added that the increase in emergencies was not directly affecting the quality of elective care in the Trust. NHS England accepted that target problems were systemic, not local. The 111 service did not work but GP triage and ambulatory care could help with turnaround. However, the Trust probably needed 60 more inpatient beds. Amelioration measures included improved diagnostics at the front end and more options at discharge, including step-down beds and use of care homes but a continuing programme needed CCG and Local Authority support.
The Chairman highlighted that nationally, deficits had built up over a 4-5 year period and the Five Year Forward View forecast £22 billion more would be taken out of the NHS but only £8 billion would be put back in. Mr Welch advised Governors that the Trust prided itself on never closing its doors.
Dr Murthy noted that the survival of Foundation Trusts was under threat and asked if there was any support in government and what could the Council of Governors do to support the Trust. This was currently an NHS England view and it was hard to see where government stood on the matter. It was likely that it would all come to a head in the 2016/17 contract negotiations. Mrs Robson noted the uncertainty as to who the Trust would be negotiating with, as it could include Northumbria Healthcare as the Accountable Care Organisation for Northumberland. Mr Welch added that pronouncements from NHS England were undermining staff morale across all professions. Councillor Streather thought that the matter would need to addressed by the Accountable Officers Group and Health and Wellbeing Board. Seven local authorities in the North East were noted to be in discussion on devolution but there had been little mention of health to date. Mr Taylor thought that Governors would need to be updated regularly. The Chairman advised that, as the picture became clearer, Working Groups and/or a special meeting could be called together.
15/49 Business and Development
i) Working Group Report
Mr Bedlington advised that the Working Group had reviewed the Key Performance Indicators (KPIs) for the external auditors on 1st July 2015 and proposed that they were fit for purpose at that time. On 16th July 2015 the Council of Governors had given approval to the Working Group to use the KPIs to assess the performance of the external auditor.
The Group, on behalf of the Council of Governors and assisted by Mr Bestford, Assistant Finance Director, had carried out the assessment on 4th September 2015 and had been satisfied with the performance of PricewaterhouseCoopers.
The Working Group Chairman had contacted Mr Stout, Chair of the Trust’s Audit Committee and on 7th September 2015 had received confirmation that he was also satisfied with the performance of PwC.
In consequence, the Council of Governors was asked to approve the process whereby the performance of the external auditor had been assessed this year, to note the positive outcome of the process and to accept the recommendation of the Working Group.
At its meeting on 17th September the Working Group had considered the Transforming Newcastle Hospitals PFI scheme and the current challenges around the final phases and offered its support for any practical solution which the Trust could reach. It would review the project again in six months.
It was resolved:
to i) receive the briefing and ii) endorse the recommendation that the current external audit provider, PricewaterhouseCoopers, be re-appointed from October 2015 for the period allowed by the current contract and subject to continuing annual review by the Council of Governors.
ii) Month 3 2015/16 Finance Report
Mrs Dragone presented an overview of the financial position as at 30th June 2015.
An Income & Expenditure surplus of £661,000 was reported before impairment, £40,000 ahead of the Financial Plan. It was highlighted that NHS R&D income had increased by 10% to £30 million this year.