Minutes of the Trust Board meeting held on Wednesday 26 May 2010 at 9.30amin the Board Rooms, Westmorland GeneralHospital, Kendal
PRESENT:Mr N Ballantyne
Mr T Bennett
Mr P Dyer
Dr J Greenwell
Mr T Halsall (Chief Executive)
Ms J Holt
Professor E Kane (Chair)
Mr F McLaughlin
Mr S Smith
Mrs P Thomas
Mr S Vaughan
IN ATTENDANCE:Miss L Fleming
Mr M Hopper
Mr P McGahon
Mr K Panter
Mr R Wilson
Mrs N Barnes
Mrs E Wright
10/053APOLOGIES FOR ABSENCE
Apologies for absence were received from Mr Ian Tomlinson.
10/054MINUTES OF THE TRUST BOARD MEETING HELD ON 24 MARCH 2010
10/020 Integrated Performance Report
Neurosurgery service management will be provided by the host Trust from 10 May 2010, not April 2010.
The remainder of the Minutes were agreed as an accurate record.
10/055MATTERS ARISING
None.
10/056ACTION SHEET
The content of the action sheet was noted.
10/057CHAIR’S ITEMS
Visits with North Lancashire PCT Chair / Medical Director
Professor Kane explained that he visited the wards of the Royal Lancaster Infirmary with Jackie Holt (Director of Nursing and Modernisation), the Chair and Medical Director of North Lancashire PCT on 4 May 2010. This was arranged in order for the PCT Board to acquire direct connection between their Board and the Trust’s services. In turn Professor Kane will visit a group of GP surgeries with the Trust’s Director of Nursing and Modernisation or Medical Director.
Shadow Council of Governor Changes
Professor Kane announced that Councillor John Barnes had agreed to take up the vacant Lancaster, Craven & Wyre seat due to the sad death of Mr Rob Healeylast year.
He also advised that Dr Geoffrey Thompson had recently resigned his seat in the South Lakes & Eden constituency. A replacement would be found.
There is currently a vacancy for the Lancashire Voluntary Sector representative following the previous nominee leaving their employ. Details of a replacementwere awaited.
10/058CHIEF EXECUTIVE’S ITEMS
Tony Halsall presented this report. Following attendance at the Cumbria and Lancashire Comprehensive Local Research Network event in May 2010, heexplained that Dr Andrew Smith had stood down as the Trust’s Research and Development Lead and had been replaced by Dr Andrew Higham. Tony Halsall provided an update on contracts and explained that althoughdiscussions were ongoing, significant progress had been made since last month. In the context of the EQIP programme, Tony Halsall is leading one of the SHA workstreams regarding provider productivity. Christine Connolly (Director General of Informatics and Chief Information Officer for Health) and David Flory (Deputy Chief Executive NHS) visited the Trust on 21 May 2010 in relation to the implementation of Lorenzo and explained she was very impressed, particularly with GURU. The Trust continues to plan and implement “go live” over the Bank Holiday weekend, providing final sign off from the Department of Health and SHA is received. Tony Halsall assured the Board that he will inform Board members if there were any problems.
10/059INTEGRATED BOARD REPORT
Finance
Tim Bennett explained that a shortened version of the monthly finance report had been produced for April. IPR 4 showed the Trust’s budget profile as included in the Trust’s LTFM submission and agreed by the Trust Board. This shows that in certain months, the Trust plans to make a deficit whilst in others it plans to make a surplus. A full finance section of the IPR will be produced from May. The Trust recorded a deficit of £366k in April compared to a planned deficit of £346k, a shortfall of £20k. Performance meetings are being held with all Divisions on 19 May 2010 to review April performance. Both Medicine and Surgery and Critical Care Divisions have produced plans to recover the overspending seen in April. Other Divisions were underspent in April. The Medical Division is reviewing month 1 performance with overspent budget-holders on 20 May 2010; budget-holders will be required to bring their budgets back in balance in the coming months. Savings of £621k were achieved against the target of £640k; a shortfall of £19k.
Performance
Steve Vaughan explained that the Trust’s performance in March 2010 had exceeded the standards in all indicators except the 62 day screening standard. All indicators exceeded the standards for quarter 4 and the year 2009/10 as a whole. The performance for April 2010 to date shows achievement similar to March 2010. In quarter 1 2010/11, the Trust has to achieve the 18 week standard in all specialities. Due to the low volume of “other” admitted patients, the performance will be disregarded by the Department of Health and Care Quality Commission (just one patient breached the 18 weeks target). The Trust failed neurosurgery non-admitted in April 2010. This service is not delivered by the Trust but uses our premises. The management for the service has now transferred to the providing Trust. There will be, therefore, no further neurosurgery breaches attributable to the Trust. The 2009/10 quarter 4 call to needle times are much improved with an achievement of 75% for the quarter. The call to needle target was missed with two patients failing in this category. Steve Vaughan explained the reasons for this. April 2010 door to needle performance is 100%. Steve Vaughan and Peter Dyer will re-engage with the North West Ambulance Service Medical Director with regard to call to needle. At the end of April, the Trust met the A&E waiting time standard achieving 98.35%. In relation to cancelled operations, there were 36 last minute cancellations in April 2010; none breached the 28 day standard.
Mortality
Peter Dyer provided an update regarding the mortality data. Palliative care data is being assessed by CHKS and will be discussed in greater detail at the forthcoming Clinical Quality and Safety Committee meeting.
A discussion took place regarding the Intensive Support Team visiting the Trust on 27 May 2010 to work with the Consultant Physicians on the clinical model. Steve Vaughan provided an update on the action plans.
A discussion took place on possible further improvement to the overall presentation of Board information and Eddie Kane agreed to discuss this further at one of the Board’s development sessions.
Workforce
Roger Wilson confirmed that the Trust target for sickness absence is 4.5% not 4.0% as stated in the report. The sickness absence percentage from April 2009 to March 2010 is 4.06%.
10/060DIPC QUARTER
Jackie Holt presented this report and explained that this is the first year since the trajectory set for reducing MRSA bacteraemia has been achieved in 2009/10. A ceiling of 12 cases has been in place since 2005/06 and during 2009/10 there were 12 cases of MRSA bacteraemia. With regard to the clostridium difficile trajectory, during the year there were 85 cases against a ceiling of 192 cases set by the PCT for 2009/10. The Trust internally stretched this target to 154 which was achieved. Hand hygiene training and aseptic non-touch technique (ANTT) training continues to be driven forward. Jackie Holt explained that the Trust’s measurement for screening of elective admissions goes further than the guidance issued by the Department of Health. The Trust have gone one step further and now select a random audit of 200 cases of emergency and elective admissions to ensure they are being screened. Unannounced hygiene code inspections continue with wards being targeted either randomly or where there has been an MRSA bacteraemia. Mid-October saw the start of the first outbreaks of norovirius (diarrhoea and vomiting) which resulted in many wards being affected. The operational impact during 2009/10 saw 450 bed days lost due to the norovirus. Jackie Holt outlined the action plan to address emerging themes from the MRSA RCAs in 2009/10. A discussion took place regarding antimicrobial prescribing. June Greenwell sought Peter Dyer’s advice regarding this. Peter Dyer provided background context and explained the reason for doing this as there will always be instances where there are no alternatives but to use antibiotics. The Pharmacy Department is providing good support to the wards by reviewing the drug charts on the wards. Jackie Holt confirmed more audits will be carried out throughout 2010/11.
10/061PEOPLE STRATEGY PHASE 2
Roger Wilson presented this report. The Trust Board had approved phase 2 of the People Strategy in May 2010; this paper provides an update for the Board on the final position statement for phase 2 of the People Strategy. Phase 3 (which was approved by the Board in March 2010) is already in progress and overall progress is good.
The Trust Board noted the final position of implementation of phase 2 of the People Strategy.
10/062IMPLEMENTATION OF NICE RECOMMENDATIONS
Peter Dyer presented this report to inform the Board of the implementation of NICE guidance within the Trust during the period 1 November 2009 to 30 April 2010. During this period, a total of 27 NICE recommendations were received which consisted of 5 clinical guidelines, 19 interventional procedures and 3 technology appraisals. The position at the end of April 2010 showed 19 are not applicable to the Trust; 5 are believed to be compliant for which clinical audits are being planned to confirm compliance; 1 is being audited as part of a national audit due for completion in June 2011; 1 is understood to be primarily the responsibility of the PCT, although confirmation is awaited (if applicable an audit will be planned) and 1 is being implemented in conjunction with an NHSLA pilot standard (a combined audit will be planned to assure compliance with all the above). A discussion took place regarding the “not applicable” recommendations.
The Trust Board approved the content of the report.
10/063SUMMARY OF INPATIENT SURVEY RESULTS
Jackie Holt informed the Board of the results of the National Inpatient Survey 2009 which were validated and released by the Care Quality Commission on 19 May 2010. On the majority of questions (38 out of 64 in total), the Trust performed the same as otherTrusts. The Trust performed well and was amongst the best performing 20% of Trusts on 17 questions. These results have been used to inform the priorities of the Trust’s Quality Improvement Strategy 2010/11. In order to measure ongoing improvement, the Trust will be developing systems for capturing real-time feedback via hand held electronic devices. Jackie Holt explained that although there is some work to do, overall these results were pleasing. A discussion took place regarding the areas which require improvement. The work on GURU is a major step forward for the Trust. A discussion took place regarding the patients’ “leaving hospital” leaflet.
The Trust Board considered and approved the required actions in the context of setting the priorities for the Trust’s Quality Improvement Strategy 2010/11.
10/064FRAUD AND CORRUPTION POLICY
Tim Bennett presented this policy to update the Trust’s Counter Fraud Policy taking into account administrative, legislative and national guidance changes. This policy will be further discussed at the forthcoming Audit Committee.
The Trust Board approved the policy.
10/065QUALITY ASSURANCE REPORT
How the Board is Assured of Quality
Peter Dyer explained that the purpose of this paper was to assure the Board that the governance arrangements are robust and that the right information is being received by the Board in a timely and clear fashion. Since January 2009, the governance structure of the Trust has reflected Lord Darzi’s definition of quality within its committee structure.
Peter Dyer explained that the reporting and investigation of a patient safety incident or a serious incident is governed within three Trust policies. As Medical Director, Peter Dyer has introduced meetings with the Integrated Risk Manager on a monthly basis to assess the “red” and “orange” graded incidents and to ensure that the policy for investigation has been undertaken. If an incident is reported that requires attention by the Medical Director before the monthly meeting, the Integrated Risk Manager will liaise immediately with the Medical Director and an action plan is instituted. Incidents requiring wider dissemination to PCTs are reported through the Strategic Executive Information System (StEIS) and are initiated by the Chief Executive or Medical Director. Peter Dyer explained that four years ago, all incidents were reported by paper. Two years ago, the Trust moved over to an electronic reporting mechanism which has made reporting much tighter and speedier. The report from the action plans are discussed at the Clinical Quality and Safety Committee. Jackie Holt confirmed that a Trust-wide lessons learnt bulletin had been published this month. A discussion took place regarding the incident reporting mechanism for patients.
The Trust Board approved thereport.
Board to Ward Assurance on Fundamental Standards of Nursing and Midwifery Care
Jackie Holt presented this paper. The introduction of the Nursing and Midwifery Assessment Tool and the development of the ward dashboard have been significant milestones for the Trust. This paper provides an overview of the Nursing and Midwifery Framework and presents the first prototype of the GURU ward dashboard for consideration by the Board. Staff have been instrumental in the development of GURU. Jackie Holt explained that work is being undertaken with the Health Informatics team to develop the management reporting aspects. Jackie Holt explained that she would like to bring quarterly reports to the Board starting in July 2010and asked the Board for clarification on how they would like this information reported in future papers, ie paper base and / or presentation from the senior nursing team.
Following discussion it was decided that a paper report would be submitted to the next Trust Board meeting on 21 July 2010 with a presentation from senior nurses, ensuring ward cover is not compromised.
10/066QUALITY IMPROVEMENT STRATEGY
Jackie Holt presented this paper. The Trust has signed up to and developed various national and local quality initiatives as part of the determination to continuously improve quality and drive up standards. These initiatives will be brought together under the overarching framework of the Quality Improvement Strategy 2010-2013. The strategy reflectsLord Darzi’s definition of quality and goes further by explaining how improvement will be encouraged and the role of staff in driving improvements. The Trust’s quality accounts will be presented at the next Trust Board meeting on 9 June 2010.
The Trust Board approved the content of the Quality Improvement Strategy 2010-13.
10/067SERVICE DEVELOPMENT PROGRESS REPORT
Patrick McGahon presented this report and provided the Board with an update on key service development initiatives being pursued by the Trust. There has been additional progress regarding the chemotherapy development on the WGH site in that additional charitable funding has been secured. With regard to Mohs surgery, the key issue to resolve is securing cross-cover arrangements for sickness etc with another centre. An update was provided regarding treatment of wet age related macular degeneration. In relation to children’s services (Cumbria), the Associate Medical Director (Dr Paul Gibson) has been appointed and recently met with Tony Halsall and Peter Dyer. Funding has not been secured from the PCT for a dedicated project team that could have consequences for delivery of the project. An update was given regarding North Lancashire transforming community services. Following Niven Ballantyne’s request on the status of the business cases for these initiatives, Patrick McGahon confirmed that business cases for Mohs surgery and wet age related macular degeneration are close to completion, subject to the earlier points on Mohs. The business case for the ambulatory cancer centre will take at least six months to complete due to the details that require resolution with Lancashire Teaching Hospitals NHS Foundation Trust. The business case for the children’s services (Cumbria) requires further information before work can commence.
The Trust Board noted the progress made on key service development projects
10/068STAFF ENGAGEMENT FRAMEWORK
Roger Wilson presented this paper and explained that the Staff Engagement Strategy had been developed in response to the Trust’s financial challenge over the next five years, given the requirement for the NHS nationally to make savings in order of £20billion by 2014/15. This framework is an integral part of the EQIP programme. A discussion took place on how to take this forward and engage with staff.
The Trust Board approved the Staff Engagement Framework.
10/069PUBLIC HEALTH AND UHMB
Peter Dyer presented this paper and explained the purpose was to update the Board on the progress of public health improvement developments at the Trust since December 2008, when the Trust’s public health group was formed. This year the Trust has joined the WHO International Network of Health Promoting Hospitals and Health Services: Integrating health promotion into our hospitals and health services. The Trust’s Public Health Strategy will be submitted to the next Trust Board meeting on 21 July 2010.