Trust Board Meeting

TRUST BOARD MEETING

IN PUBLIC

Held on Thursday 9 December 2010 at 12.00 midday

In the Oasis Centre, QueenAlexandraHospital

M I N U T E S

Present:David Rhind, Chairman

Elizabeth Conway, Non Executive Director

Mark Nellthorp, Non Executive Director

Ursula Ward, Chief Executive

Julie Dawes, Director of Nursing

Simon Holmes, Medical Director

Jim O’Connell, Interim Chief Operating Officer/HR Director

In Attendance:Peter Mellor, Company Secretary

Steve Gooch, Deputy Director of Finance

Paula Taylor (Minutes)

Item No. / MINUTE
130/10 / Apologies
Apologies were received from Brett Gill, Non Executive Director, Mark Greenwood, Non Executive Director, Alan Cole, Non Executive Director and Robert Toole, Director of Finance and Investment.
Declaration of Interests
None.
131/10 / Minutes of the last meeting held on 4 November 2010
The Minutes of the meeting held on 4 November 2010 were approved as a true and accurate record of the meeting.
132/10 / Matters Arising/Summary of Agreed Actions:

• Minute 98/10: Assurance Framework: the Company Secretary advised that this action was now complete, with the Director of Nursing reporting on her risks under agenda item 140/10.

• Minute 108/10: Chief Executive’s Report – letters of thanks to staff and governors who participated in the Open Day: This action had now been completed.

• Minute 117/10: Any Other Business – Care Quality Commission Essential Standards: the Director of Nursing confirmed that the website has been adjusted to make the Trust’s compliance with the CQC’s Essential Standards more easily accessible.

133/10 / Notification Of Any Other Business
Mr Will Purvis, member of the public, asked if there would be an opportunity at the end of the meeting for the Chairman to take questions from the public. The Chairman advised that there would be, but from the beginning of next year, this Trust would take the same stance as many other Trusts, whereby questions from the public would be welcomed in advance of the Board meeting, and be read out and answered at the end of the meeting. The Company Secretary also advised that this would allow for a more informed response to any question raised. The dates of other public meetings throughout the year would be published, and attendance at those meetings was encouraged. All Board papers for the public part of the meeting would continue to be published on the website.
Post Meeting Note: There will be a ten minute agenda item at the end of each meeting of the Trust Board in public for questions from the floor regarding the business conducted during the meeting.
134/10 / Chairman’s Report
The Chairman informed the meeting that he had written to the Secretary of State with regard to the Trust’s Foundation Trust status progress. The Chairman had also written previously to the Secretary of State to advise of the costs related to PFI.
The Chairman explained that his latest letter had been based on recent conversations with Primary Care Trust and Strategic Health Authority colleagues. A number of issues had been set out with regard to finance. The Chairman advised that the Trust was confident that all criteria could be met in respect of the Foundation Trust application, with the exception of finance, wherea lot of work had to be done to ensure that the Trust was in a sustainable position for the future. The Strategic Health Authority was in agreement with the Trust’s position, and in January 2011the Chairman would again write to the Secretary of State.
The Chief Executive advised that the Trust was working towards Foundation Trust Status in July 2012. A steering group would be set-up in January 2011 to ensure deadlines along the timeline were met. There would need to be elections to ‘top up’ existing governors, and discussion would begin with the Council of Governors to decide on the future make-up of the Council.
135/10 / Chief Executive’s Report

• Acknowledgement to Staff: the Chief Executive wished to thank all of the staff for managing services so well during the period of snow. The Chief Executive advised that lessons had been learnt during the spate of extreme weather earlier in the year, and the hospital had been much better prepared this time around. Acknowledgement was also given to the City Council and the Trust’s healthcare partners. The Trust was most grateful to Snows garageswho had allocated four wheel drive vehicles to collect staff in rural areas. As a consequence, a significant amount of staff had been collected and delivered to work. The Chairman advised that he had written a letter of thanks, to all those involved, and asked that it be published in the local media.

• National Awards: the Chief Executive acknowledged the success of the Diabetes Inpatient Team who had won a national award, and of Professor Gary Smith, who had won a national innovation award.
• Dr Foster: the Chief Executive explained that the Dr Foster organisation produced reports on an annual basis for each care organisation within the NHS, and reported on how well it was doing, or not doing, on a number of different factors. The reports also provided important benchmarking information. The most recent report had just been published and the Medical Director was in the process of compiling a paper for the Board to be presented in January,detailinghow this Trust had performed. The Chief Executive did advise that there were no major concerns in respect of PHT as an organisation. There was an area to note in respect ofcancelled operations due to lack of patient note availability, but the Medical Director advised that this information was now out of date, and processes had been changed within the Trust to minimise the likelihood of this happening in the future. The Chief Executive assured the Board that PHT was reflected positively in the Dr Foster report.

• Back Office Efficiency: the Department of Health had recently published a report which presented NHS provider organisations with ways to reduce their back office costs. This report would be reviewed by the Executive Team, and the Board would be updated in the future.

• Single Sex Accommodation: the Chief Executive explained that this was very high on the ministerial agenda, with documentation being published on a weekly basis. The problem was very high on the Director of Nursing’s agenda.

• G5: The Chief Executive reported that the closure of G5 had now been referred to an independent review panel. The Executive Team welcomed the review. It would commence in January 2011, with the Chair of the review panel being a General Practitioner. The exact details were yet to be confirmed.

• Healthy Lives, Healthy People: the Chief Executive advised that this was a recent report published by the Department of Health. The report was concerned with the Government strategy on how public health issues are tackled, for example Diabetes, and it was important for this Trust to work closely with its partners to ensure the long term health agenda for the local community.

140/10 / Integrated Performance Report

• Quality:

The Director of Nursing highlighted the following items from the report:

• There continued to be an improvement in the reduction of formal complaints made to the Trust. The Director of Nursing explained that,whilst in part, some of the reduction could be attributed to changes made to the grading process, there was alsoa real reduction in the number of complaints. There was a clear definition of what was a complaint, or alternatively a Patient Advice and Liaison Services’ (PALS) issue. She explained that there were many examples of good practice in the organisation, and advised how some of the medical wards triedto deal with any concern raised by a patient or relative as it arose. The Chief Executive had recently visited the rehabilitation wards, and advised that staff there meet once a weekwith relatives to dealwith any concerns and issues as they occur. This was important because of the long stay nature of these patients, and further enhanced the high quality service that is provided.

• There continued to be good progress with regard to pressure ulcers, with a continued reduction in their occurrence. The Director of Nursing advised that the Trust was doing everything possible to reduce pressure ulcers, and shewas extremely pleased with the results being achieved.

• Unfortunately, in respect of single sex accommodation, this had been the worst month for breaching the target since collection of the data had started. The breaches had occurred mainlyin the Medical Assessment Unit, and could be attributed to pressures within the Emergency Department. New guidance and implications had just been received, and these would be covered fully in the Board report next month. The reporting mechanism had changed, whereby non clinical breaches were now reported directly to the Strategic Health Authority. Clinical breaches were still only required to be reported to the Primary Care Trust. The Director of Nursing explained that data collection methods around the country varied, but now guidance had been issued to ensure the same practices were being undertaken. The Director of Nursing also explained that there might be an increase in breach reporting whilst these changes became established. However, The Director of Nursing did stress that she was confident that the Trust’s processes were excellent in this area. The contract allows Primary Care Trusts to applya financial penalty for each breach, and the Trust would work through with the Primary Care Trusts how they might do this. The Director of Nursing felt that the Medical Assessment Unit would continue to be the main area of challenge.

• Performance:

The Interim Chief Operating Officer highlighted the following points from the
report:

• Cancelled Operations: the position was improving.

• Venous Thrombo-embolism: month on month improvement continued.

• Stroke Care: the October figure was 59.5% of patients meeting this target. However, the Interim Chief Operating Officer had been advised that the current figure was 67% and was continuing to improve. It was stressed that this Trust had an excellent stroke service, and sometimes patients were treated and discharged with the appropriate care package in effect too quickly, and, therefore, did not get to stay on a dedicated stroke unit, whichas a consequence, would have a negative effect on the target. Work was continuing on admissions direct to the stroke unit. The Medical Director had invited the national lead for stroke to visit Portsmouth Hospitals NHS Trust, and he had reassured the Medical Director that the service provided by the Trust was good.

• Referral to Treatment Target/18 weeks: the Interim Chief Operating Officer explained that this target was now changing to median waits, and the current performance was 80.5% against a national target of 90%. The Trust had now moved into an ‘adequate’ position for the first time. The number of referrals still continued to exceed capacity in certain areas, and whole systems work was required to ensure that this target was met in the future.

• Cancer – fast track referral to appointment within 2 weeks: the Interim Chief Operating Officer advised that work had been undertaken in rearranging clinics, which would increase the percentage of patients being able to attend within two weeks. He explained that one of the reasons for not achieving this target was down to patient choice, whereby patients chose not to accept an appointment within two weeks of their referral.

• Staff Surveys: it was hoped that there would be more detail on the results of the pulse survey at the next Board meeting, but the detail received so far was very encouraging.

Mark Nellthorp, Non Executive Director, was concerned about the possible tension between the Emergency four hour and the single sex targets as the Trust moved into the winter period. The Director of Nursing advised that virtually all breaches of the single sex target were due to the need to meet the four hour target. 10% of all single sex breaches were audited each month to ensure that breaches had occurred for this reason only. The Chief Executive confirmed that within Portsmouth Hospitals NHS Trust the safety of patients would always be of paramount importance.
There was a discussion regarding the four hour treatment target, and the Chief Executive felt that the ‘Choose Well’ campaign was beginning to take effect, with patients choosing to be seen at more appropriate centres. However, there were patients still arriving at the Emergency Department who did not need to be seen there, and it was felt that this might be because some patients were not able to benefit from a clinical opinion in the community. The Interim Chief Operating Officer advised that following a recent case note audit, 27% of patients did not need to have been seen in the Emergency Department. The Chief Executive wished to thank Rachel Hawthorn, from the Portsmouth News, for her assistance with publicising the ‘Choose Well’ campaign.

• Finance

The Deputy Director of Finance highlighted the following items from the report:

• The financial position still remained a significant challenge for the Trust. At the end of October the Trust had a £(5.0)m deficit, and this assumed that the Primary Care Trust payments would be according to plan. The Deputy Director of Finance advised that the Trust continued to spend £700k per month more than it received inincome.

• There were some positives in that the paybill in October was the lowest so far this financial year. Temporary staffing had also decreased.

• The Deputy Director of Finance advised that the deficit was primarily due to the £37m savings gap at the start of the year. This was a huge challenge, and the Strategic Health Authority had been long aware that the Trust could only achieve £31m savings without outside support.

There followed a discussion about how to best address the gap, and the Chairman asked if funds could be borrowed through the capital programme. The Deputy Director of Finance advised that thiswas not appropriate as capital funds were separate from revenue funds. There were very clear processes regarding the spending of capital through the various committees. The Chief Executive confirmed that overall the Trust could demonstrate that the underlying financial position was improving. The Deputy Director of Finance confirmed that this was the case, but unfortunately the goalposts continued to move, and next year would provide even further challenge.

• Workforce

The Interim Director of Human Resourcesadvised that appraisal figures had dramatically increased and those areas not meeting their target had been written to. The sickness/absence target was 3.5%, against a Trust target of 4%. The areas which were still not achieving the target were slowly improving, and were in a much better position than a year ago.
Liz Conway, Non Executive Director, asked if there were any implications in respect of new legislation for temporary staff. The Interim Director of Human Resources promised to clarify this.
Action: Interim Director of Human Resources
Mark Nellthorp, Non Executive Director, was very impressed with the reduction in temporary staffing. The Chief Executive confirmed that it was necessary that some areas would explicitly require temporary staffing, but that the Trust had reduced its workforce more than any other organisation in South Central Health Authority area.
137/10 /

Sustainability Strategy and Workstreams

The Chief Executive introduced this paper which outlined how the Trust needed to work from next year, and how it linked into QIPP plans. A previous workshop had explained this strategy in detail. Massive improvement had taken place, with real innovation in terms of change. The Chief Executive advised that this Strategy had been taken to the Senior Management Team, and she now sought the approval of the Board.
There was discussion on the success of the previous Turnaround Programme, and how with the structure of the Clinical Service Centres, it was easier to provide intensive support where and when it was required. There was much more reliable information available, supported by a comprehensive risk register. The Medical Director advised that clinical leadership would also be very evident in the new year.
The Board approved the three year strategic approach to sustainability.
138/10 / Responsible Officer – Revalidation
The Medical Director explained that revalidation had arisen from public concern regarding accountability of the medical profession. Revalidation was seen as a positive step. The Medical Director advised that all consultants in the hospital already had appraisals and revalidation should, therefore, not be difficult. The Responsible Officer for our organisation was the Medical Director, and the tasks involved with this role were outlined in the paper.