UNCONFIRMED MINUTES OF THE ANNUAL MEMBERS’ MEETING
20 JULY 2016 at 6.00 pm
MINUTES
1. / AttendanceMr Dominic Dodd / Chairman, board and council of governors
Mr Peter Atkin / Elected patient governor
Mrs Frances Blunden / Elected patient governor
Ms Ann Brizan / Elected staff governor
Prof Montgomery Cole / Elected patient governor
Ms Linda Davies / Elected patient governor
Mr Will Huxter / Appointed governor – NHS England
Mr John Kireru / Elected staff governor
Mr Richard Lindley / Elected public governor
Dr Patrick McGowan / Elected staff governor
Mr Donald McGowan / Appointed governor – London Borough of Enfield
Mr David Myers / Elected patient governor
Dr Richard Stock / Elected public governor
Dr Morvarid Woollacott / Elected public governor
Cllr Peter Zinkin / Appointed governor – London Borough of Barnet
Ms Deborah Oakley / Non executive director
Prof Anthony Schapira / Non executive director
Ms Caroline Clarke / Chief finance officer and deputy chief executive
Prof Stephen Powis / Medical director
Ms Deborah Sanders / Director of nursing
Ms Kate Slemeck / Chief operating officer
Mr DavidSloman / Chief executive
Mr David Grantham / Director of workforce and OD
Ms Emma Kearney / Director of corporate affairs and communications
Mr Andrew Panniker / Director of capital and estates
Dr Steve Shaw / Divisional director – urgent care
Mr William Smart / Chief information officer
Ms Julie Dawes / Interim trust secretary
Ms Alison Macdonald / Board secretary
120other attendees including trust members – patient, public and staff and other management and staff representatives
2. / Welcome and introduction
The chairman welcomed everybody to the annual members’ meeting. He introduced the governors and members of the trust board who were in attendance.
3. / Progress, challenges and future direction
The chairman and chief executive delivered a presentation highlighting key developments and achievements from the past year, concluding with the challenges and the future direction.
The chairman highlighted the improvements made in patient safety and the fact that the trust had better than average mortality rates. He also referred to the trust’s excellent performance in prevention and control of hospital acquired infections, noting that in the past year there had been no cases of MRSA bacteraemia in any of the trust’s hospitals.
The chief executive spoke about how the trust aimed to improve care in a challenging NHS environment, in particular the growing health needs of the population, with many people living much longer but in poorer health, in a time of financial constraints. He showed the increase in hospital activity in recent years, which had been in the context of increased spending on the NHS. However going forward, the NHS was facing a period of serious financial constraints, but with no reduction in demand. The trust had always previously been in financial surplus but had finished 2015/16 with a deficit for the first time.
The chief executive then highlighted the following priorities:
- quality improvement…and through that, better value for money
- supporting staff and helping everyone to feel that they belong
- unprecedented levels of investment in services for patients
- new partnerships and new ways of working
The RFL’s view was that the solution to the current and future challenges lay in developing the group model and partnership with other organisations to drive out variation and reduce cost.
4 / Review of the year 2015/16
The chief finance officer and deputy chief executive presented the annual report and accounts for 2015/16. She reported that the trust had finished the year with a £15.3 million overspend, largely due to:
- a reduction in the price received for the trust’s specialist services
- continuing high levels of agency staff - £45 millionacross the organisation in 2015/16
- pathology services
- the trust’s renal strategy
- growing market share in maternity
- post-acquisition efficiency savings
- reducing agency spend to £29 million
- accelerating nurse recruitment programme to increase workforce by 400 by March 2017
- providing greater rigour around requests for agency staff
- saving £5 million through price negotiations with suppliers
- saving £5.5 million by eliminating wastage of clinical and general supplies
- saving £1.6 million on drug spending
- asking staff to identify money-saving opportunities in their own areas
- patient safety
- clinical effectiveness
- patient experience
She reported that the trust’s membership had grown by 5.5% in 2015/16 and outlined the composition of the council of governors, comprising patient, public and staff governors plus governors from partner organisations.
She then highlighted the ways in which the council of governors had fulfilled its key role of holding the board to account, including:
- joint trust board and council of governor meetings
- governors aligned to trust priorities and represented on trust steering groups
- governor observers on board quality committees
She concluded by highlighting the ways in which the trust and governors engaged with members including participating in ‘go-see’ visits with non-executive directors and active participation in PLACE assessments, regular medicine for members events and a monthly newsletter to members and the public
Going forward, the priority was to promote the expansion of the membership of the trust to include surrounding areas which used the trust services strengthening links with local Healthwatch organisations.
5 / Questions & answers
The chairman then invited questions from the audience, as follows.
What are the implications for the trust of the referendum result for the UK to exit the EU?
The chief finance officer responded that there were two main aspects:
- The NHS’s financial situation was closely tied to the national financial position, so if the economy suffered from Brexit, so would NHS finances.
- The trust was highly dependent on staff from overseas – currently 2,800 staff were from outside the UK, with about half of these being from the EU – they needed to be reassured that they were valued and that they would continue to be able to stay in the UK.
There is a focus on achieving the 4 hour A&E standard but people could die waiting this long to be seen.
The divisional director – urgent care responded that the standard was for 95% of patients to be seen and treated or sent home in four hours. This had been achieved for 93% of the 332 attendances at the Royal Free the previous day. However patients were assessed on arrival and more seriously ill patients were seen more quickly. Patients with a heart attack went straight to the heart attack centre and those with a stroke to the hyper acute stroke unit. Other seriously ill patients were taken straight through to the resuscitation area and did not wait with other patients.
Why were patients not informed about the decision to share information with Google DeepMind, or asked for their consent?
The medical director stated that it was important to explain why the trust was working with DeepMind. National work had been taking place on reducing the number of patients who suffered from acute kidney injury (AKI) while hospital patients, and early identification was the key to this. This was through a particular blood test result which was could be used to predict the likelihood of the patient suffering from AKI. The Stream App developed with DeepMind, enabled this test result to be sent to a clinician’s hand-held device in real time to alert the specialty doctor that the patient needed urgent attention. The app was therefore for the direct benefit of patients.
The chief information officer explained that this was one of many data sharing agreements in place and that not data was given to DeepMind, the trust continued to be the data owner and DeepMind processed it on the trust’s behalf in their secure data centre. The data was fully encrypted. Patients were given notice via the trust’s website of the ways in which their data would be used. The wider issue of the use of patient data was currently being considered at national level and the trust would of course implement any recommendations and best practice resulting from this work.
How is the trust going to achieve the level of savings needed?
The chief finance officer responded that the trust needed to save £40m in 2015/16, and the trust had been required to achieve this level of savings over a number of previous years. This was getting more difficult each year and the trust needed to work in partnership with other organisations which was part of the impetus for developing the group model.
Why is the trust suggesting that PROM (patient reported outcome measures) results should be improved by better patient information rather than by improving surgery and techniques?
The medical director explained that PROMS measured the patient’s perception of how their treatment had gone, complementing other outcome measures such as readmission rates, mortality, morbidity and infection. The recommendation in the quality account was not about managing patients’ expectations but about understanding why patients felt the way they did about the outcome and what action the trust needed to take to address this. The trust also acknowledged that information provided to patients prior to treatment could be improved.
How is the trust going to recruit so many more nurses?
The director of nursing responded that there were about 10,000 vacant nursing in London and that Royal Free London’s vacancy level was average for London. There were some specialist areas with particular recruitment difficulties, for example intensive care and emergency care. This was partly because of the limited number of nurses with specialist training and partly because the trust had increased the capacity of both areas and needed more staff.
The trust was looking at both recruitment and retention. The trust was in touch with about 600 student nurses who were close to qualifying to encourage them to choose to work at the Royal Free London. The trust had developed a programme for nurses with overseas nursing qualifications to gain UK registration, and was also working with the national refugee council.
She added that nurses would be more inclined to stay at the trust if they were supported, could develop their careers and there were good education and development opportunities. The trust was shortly commencing ‘career clinics’ to help staff find opportunities within, rather than outside, the trust. The trust was also assisting staff with accommodation issues.
If a patient complains about a consultant, does the trust protect the consultant at the expense of the patient receiving a fair hearing?
The medical director responded that nobody wants to make a mistake and that this is a painful experience for staff as well as patients. He said that the many thousands of incidents which were reported indicated a culture which was open to admitting that mistakes had been made and putting them right. All incidents were subject to review and if a serious mistake was made the patient or their family were always informed under the trust’s duty of candour. There was a formal investigation process for serious incidents, sometimes involving external experts. If a problem was found it was fixed and the trust also had a process of thematic reviews, to see if there were common themes requiring wider action. There was a formal appraisal process for doctors, which required them to reflect on complaints made about them or their services. The chairman added that learning from serious incidents was a regular item on the board agenda, which set the tone that mistakes should be admitted to and learnt from.
It is not always easy to know who to complain to if there is a problem on the ward.
The director of nursing apologised for this being the questioner’s experience when he was a patient in hospital. She added that every ward was under the supervision of a matron, whose contact details should be easily available. In addition the trust had introduced mats on meal-trays with information about ward routines including who to contact in case of problems.
6 / Closing remarks
The chairman thanked the board, governors and members for attending the meeting and hoped that they had found it interesting and informative.
Agreed as a correct record
Signature …………………………………..Date 19 July 2017…………………………….
Dominic Dodd, chairman