THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST
Minutes of the Board of Directors Meeting held on 22nd July 2015
Part A: Public Session
Present: Mr K W Smith Chairman
Professor P H Baylis Non-Executive Director
Dr B C Dobson Non-Executive Director
Sir Leonard Fenwick Chief Executive
Dr P Kesteven Non-Executive Director
Mrs H Lamont Nursing & Patient Services Director
Mrs H A Parker Non-Executive Director
Mrs L Robson Business and Development Director
Mr D G Stout Non-Executive Director
Mr A R Welch Medical Director
In Attendance:
Mr S R Reed Trust Secretary
Mrs A O’Brien Director of Quality & Effectiveness (minute ref. 15/103(ii) only)
Dr A Price Director of Infection Prevention & Control (minute ref. 15/103(vii) only)
Mr D Reynolds Deputy Finance Director
15/99 Apologies for Absence
Apologies were received from Professor C P Day, Non-Executive Director, Mrs A Dragone, Finance Director and Mr E Weir, Non-Executive Director.
15/100 Declarations of Interest
There were no declarations of interest on this occasion.
15/101 Minutes of the Meeting held on 24th June 2015
These were agreed to be a correct record.
15/102 Strategic Items
i) Report of the Chief Executive
Sir Leonard spoke of a number of topics of current interest. With regard to the patient experience, there was an ongoing challenge to continually improve. In respect of Children’s Cardiothoracic Surgery, Mrs Robson advised that the NHS England Board was due to meet on 23rd July 2015 regarding the 200 standards it had promulgated and their potential consequences. The Trust was working on network arrangements for sustainability. It was conceivable that there might be closure of some children’s heart surgery sites. There had been constructive engagement with commissioners on the Newcastle position. NHS England would apparently make final determinations by October 2015, for next April’s contracts. The Chairman commented that few sites were likely to be able to comply with all of the standards. Sir Leonard added that a key advisor to NHS England had made highly negative comments about the future of the Newcastle service in an open forum recently.
Staff recruitment was currently focused on Nursing in particular, where there was a national shortage overall, a skills shortage, and poaching of staff by neighbouring Trusts. The government’s Migration Advisory Committee position on non-EU appointees had worsened the position. Mrs Lamont commented that European nurses were simply not there to be recruited and those that were tended not to stay for any length of time. There was a national shortage of some 24,000 nurses. The introduction of Revalidation for Nurses and Midwives was likely to have a further negative impact. There was a clear need to have more students in the system but this would not happen until 2017. The Shelford Group of Trusts was to lobby both the Migration Advisory Committee and the Secretary of State for Health. The Chairman commented on the outrageous stance by the Migration Advisory Committee and the Department of Health.
The ability of the Trust to influence Health Education North East with regard to the recruitment and retention of junior doctors was also limited. Mr Welch added that the Trust trained the majority of junior doctors in the region. The national selection process could take the good prospects away from both the region and Newcastle. Health Education North East was not regionally focused and the system was designed to distribute trainees away from centres of excellence.
In terms of financial stability, the Trust was cognisant of the potential impact of the position of neighbouring Trusts and of failing Clinical Commissioning Groups. Gateshead, Sunderland, Durham and South Tees hospitals were all facing difficulties. Six of every ten Foundation Trusts were not going concerns this year. There was growing uncertainty around the continuing viability of the Foundation Trust model.
Sir Leonard highlighted that the Review of the Year for 2014/15 would be published formally at the Annual General and Annual Members’ Meeting, to be held at 6-00pm on 23rd September 2015 in the Education Centre, Freeman Hospital.
Attention was drawn to the surge in unheralded presentations of emergency patients, especially children. The peaks were approaching winter levels this summer. The financial impact of subsidising the Specialist Emergency Care Hospital in Cramlington was beginning to become apparent to local commissioners. Mrs Lamont added that anecdotal evidence supported this view.
For North Tyneside Clinical Commissioning Group, its worsening financial position had delayed signing of contracts with providers, including the Trust. Mrs Robson advised that the Trust had finally reached an acceptable contract position with North Tyneside CCG, with caveats and conditions.
The ‘Vanguard’ initiative was developing across the region, including Healthy Towns for Newcastle. Mrs Robson advised of the introduction of three types of Vanguard, including acute hospital chains and urgent and emergency care. The latter was being embraced for the North East but had been introduced without the full endorsement of Foundation Trusts. Healthy Towns was the third model. The £200 million funding made available nationally for Vanguards had largely been swallowed up already, by bureaucracy.
Sir Leonard advised that it was now more than three years since the Independent Tester had declined to accept Practical Completion of the Clinical Resource Building at the Royal Victoria Infirmary, as Phase 8 of the nine phase PFI project. Continued lack of resolution of the dispute was delaying further development of the site, including enhancements to clinical services.
The Board was mindful of the need to sustain the financial stability of the Trust and this was reported upon in further detail under minute ref. 15/104 below.
Working in partnership with Newcastle City Council, the Trust was driving integration of care services for Newcastle.
Key impact documents received from government and regulators in the past month had included the ‘Five Year Forward Vision - into action’ from NHS England and in this regard there was some potential for a development in Scotswood.
NHS England had also published a 25 Year Vision for the NHS. The Virginia Mason Hospital model of working was being promulgated in terms of its patient safety culture.
With regard to seven day working in the NHS, it was noted that Salford Royal Hospital was held up as an exemplar. Mr Welch commented that staff morale there not great and the recent statement by Sir Bruce Keogh regarding increased death rates at weekends was not backed up by robust evidence.
The Chairman commented that one benefit of Foundation Trust status was being at arm’s length from central interference, although it certainly did not feel like this was the case any longer. The model had changed however and the centre was increasingly dominant. Tariff was being squeezed out, which threatened the stability of those Trusts which offered significant volumes of specialised services.
With regard to new guidance on Safeguarding, Mrs Lamont advised that there were no concerns for the Trust and indeed there were many examples of good practice in the local setting.
Attention was drawn to the review of professional codes of practice, seeking to align them more and to make explicit inter alia the duty of openness and candour. The NHS Pay Review Body had reported to government in recent weeks and the government response had been challenging.
With regard to Raising Concerns and Speaking Up, the government had announced on 16th July 2015 that every NHS Trust was to have a local whistleblowing guardian. In addition, a National Officer for Whistleblowing at the Care Quality Commission was to be created.
15/103 Safety, Quality and Performance
i) Healthcare Associated Infections
Mrs Lamont presented the report for June 2015. A final eight Clostridium difficile cases from 2014/15 had been discussed at the Appeals Panel at the beginning of June and had been upheld, bringing the total for 2014/15 down to 65, against a target of 80 for the year.
Six cases of C. difficile had been reported in June, bringing the total to date to 14 against a year-end target for 2015/16 of 77, i.e. below trajectory.
No further cases of MRSA bacteraemia had been reported during June, maintain the position of two cases reported in the year to date.
In June, compliance with IPC Mandatory Training had been 76%, an increase on previous months. All the IPC mandatory training programmes had been refreshed in April 2015 and there was no longer a level 2 programme, which had been for Nursing and Midwifery staff only. Instead, there were now seven bespoke programmes to cater for the needs of different staff groups and each staff member was allocated their appropriate programme.
Professor Baylis stressed the need for the Trust to keep the pressure on mandatory training rates if the 95% target was to be attained in the course of the year.
It was resolved:
to receive the report and note the current position.
ii) Quality Report
Mrs O’Brien, Director – Quality & Effectiveness, was in attendance and presented the report for June 2015. It was pleasing to note the continuing downward trend in reported numbers of patient falls, both in absolute numbers and rate per 1,000 bed/days. The number of sharps and needlestick incidents had remained steady over the past quarter.
In response to Dr Dobson’s inquiry at the June 2015 meeting, there had been further investigation of the number of reported radiation incidents under IRMER regulations and the Trust had been described as ‘comfortably mid-range’.
Five Serious Untoward Incidents had been reported in the month – one category III pressure ulcer and four falls resulting in fractures. There had been no ‘never events’ in June.
With regard to mortality indices, it was noted that between October and December 2014 the Standardised Hospital Mortality Index had been rebased nationally and the Trust value was now at 98 (for May 2015), a small increase on the previous month. This was an expected rise and Monitor had been alerted as required. This still put the Trust below the national average. In this regard, it was noted that a recent national report had questioned the validity of mortality rates and they were not to be used as the sole indicator of the quality of clinical care.
The complaints dashboard for the twelve months of 2014/15 was received and it was highlighted that one formal complaint was received for every 2,380 patients attending the Trust. 98% of complaints had received a response within the agreed timetable, versus a target of 95%.
It was resolved:
to receive the briefing and note the current position.
iii) Clinical Assurance Toolkit
Mrs Lamont presented the report. Following the question changes in April 2015, scores had fallen from an average of 97% in March to an average of 93% in April, recovering slightly to 94% in May, and still further to 95% in June. Both the decrease and recovery had been expected, given the new areas of assurance being tested following April’s changes.
Directors were aware that the specific focus of the report varied each month, as a particular aspect of practice was reviewed. This month, the focus had been on Infection Prevention & Control (IPC) Practice questions.
For patients who had potentially infectious diarrhoea, it was important that they were isolated promptly. CAT questions therefore asked staff whether they had been able to comply with the Trust standard to isolate patients after the first episode of diarrhoea, and send a sample on the second episode of diarrhoea. Patients were isolated on the first episode of loose stool in 95% of Wards during June, with a specimen sent to the lab on the second episode of loose stool on 100% of Wards. Sending a specimen at this time was important in order to identify the cause of the infection. Both of these results demonstrated good practice.
The reporting of escalated ‘red scores’ to the Board occurred on the second consecutive month reported to be red. There had been 19 areas with an overall red score for two consecutive months in June, which was much higher than usual (as with last month), mostly due to question changes for Smoking Cessation and Safeguarding staff knowledge. NEWS documentation compliance had improved steadily since January and was now above 80% for the Trust but this continued to have an impact on scores for adult inpatient wards. However, question changes for NEWS had been agreed and would come into force this month, following discussions at the Deteriorating Patient Steering Group. This involved the addition of a ‘Not Applicable’ answer option for all patients who did not require piped oxygen. It was expected that the change would improve scores for adult inpatient wards.
The same process for two months of consecutive red scores applied to the Matrons’ cleanliness checks. There had been three areas with an overall red score for two consecutive months in the June cleanliness checks, which had been followed up with the respective Matrons.
The Trust now gave Acknowledging Continual Excellence (ACE) Awards to those clinical areas where high CAT scores had been maintained for four out of six months, in order to encourage and reward Clinical Leaders. Awards had been presented at the Clinical Leaders’ Forum, with Ward 37 ICCU Freeman Hospital receiving an award for cleanliness and assurance in July, as well as Pre-assessment Clinics (Freeman Hospital and Royal Victoria Infirmary), which had been awarded for assurance measures and clinical assurance.
It was resolved:
to receive the report and note the current position, including the ACE awards.
iv) Nursing Midwifery Staffing – Exception Report
Mrs Lamont presented a supplement to the planned and actual staffing data which was published on the Trust Internet and NHS Choices web pages, as recommended by the National Quality Board and NICE (2014).
With regard to the Nurse Staffing Review (NSR), there were now regularly scheduled six monthly reviews of nurse staffing for inpatient wards, using the recognised NICE endorsed staffing ‘toolkit’, the Safer Nursing Care Tool (SNCT), key performance indicators, and the Professional judgement of the Sister, Matron, NSR lead and the Senior Nursing Team. The Trust’s Nursing & Midwifery Staffing Guidelines were currently being refreshed, to ensure they were available to support staff in planning their work and in escalating any concerns.