RNOH trust board meeting notes 2nd october 2012 - Royal National ...

Royal National Orthopaedic Hospital Trust
Minutes of the Trust Board Meeting
Held on Tuesday, 2 nd October 2012, at 5.00pm
Present: Trust Board Members
Prof A Goldstone Chairman
Mr R Hurd Chief Executive
Mr G Billington Vice-Chairman
Mrs L Hill Deputy Chief Executive, Director of
Operations & Transformation
Mr J Wilson Director of Finance
Ms C Wiley Director of Nursing
Mr A Watson Non-Executive Director
Dr S Patel Director of Workforce, IM&T and
Corporate Affairs
Mr M Shaw Medical Director
Prof D Isenberg Non-Executive Director
In attendance: Dr B Jacobs Director of Children’s Services
Mr M Masters Director of Projects, Estates &
Facilities
Mr P Bolton RNOH Patient Group
Mr T Raymond RNOH School representative,
Stanmore Residents Association
Dr S Warren Consultant Microbiologist, Royal Free
Hospital
Mr A Shah RNOH Chief Pharmacist
Dr R Zarnegar Consultant in Pain Management
Ms E Cockshoot Minute Taker
Apologies: Mr L Milsted Senior Independent Director (NED)
Ms J Brodie Non-Executive Director
Prof A Hart Professor of Clinical Orthopaedics
PART ONE (Open)
1. Apologies for Absence
All apologies noted.
2. Minutes of the meeting held on the 29 th August 2012
The minutes of part one of the meeting held on Wednesday, 29 th August 2012
were agreed as a correct and accurate record of the meeting.
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Mr Watson referred to page 3 of the minutes, Redevelopment Plans, and
queried whether the Stanmore site master plan had been submitted in
September. Mr Hurd advised that due to continued dialogue the London
Borough of Harrow Council and the Greater London Authority the master plan
would not be submitted until mid-October 2012.
3. Summary of the items discussed in the closed part of the Trust Board
meeting held on the 29 th August 2012
The Board approved the summary.
4. Matters Arising
The Board reviewed the matters arising.
• Communications Update
Dr Patel advised the Board that a number of work strands that feed into the
Communications Strategy were ongoing, for example, the Trust’s values and
branding, the organisational development strategy and fundraising strategy.
The tender specification for the PR company, developed to assist the Trust
with its planning application has been extended to include assistance with the
Trust’s corporate PR and branding. Dr Patel said that Ms Brodie has been
reviewing the tender specification and proposals. She concluded that once all
the work strands had been concluded and the PR company appointed she
would be able to present the Communications Strategy to the Board, which
would be in December 2012.
Professor Goldstone said that he and Ms Brodie had met with Roger
Davidson, Deputy Director of Communications at the NHS Confederation, to
determine whether the NHS Confederation could assist the Trust. Professor
Goldstone said he had been working with Mrs Hill on how to publish clinical
good news stories.
5. Declarations of Interest
Professor Goldstone asked those present whether they had any interests to
declare with regards to the items on the agenda. No interests were declared.
6. Chairman’s Report
Professor Goldstone welcomed Elizabeth Mohr and Alice Breeden, from
McKinsey to the meeting and advised that they would be observing the Trust
Board meeting as part of the Trust’s independent assessment of the
Foundation Trust Board Governance Assurance Framework (BGAF)
application process.
Professor Goldstone also welcomed Mr Peter Bolton, the new Chair of the
RNOH Patient Group. He thanked Mrs Williams for her support and
commitment during her tenure as Chair of the Group and reiterated the
importance to the Trust Board of the Group’s visits to the clinical and medical
areas of the hospital.
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Professor Goldstone said the next 10 to 15 months would be the most
important years for the RNOH as it seemed likely the Trust would be closer to
having its new hospital facility and being a Foundation Trust. This would be a
positive step forward for the organisation after many years of uncertainty. He
said this would be an upward gain for the Executive Directors in terms of
health service management potential to make a difference and for the Non-
Executive Directors this would be considered the real reason they have come
to this hospital to also make a difference. He said the next few months would
require members of the Trust Board to increase their efforts toward these
routes for the organisation and the vitally important work that is undertaken
especially as the population ages. The RNOH will be a paradigm for
orthopaedics in the UK.
Professor Goldstone referred to the meeting agenda, which he said would
provide an update on quality, governance and the Trust’s financial position.
The root cause analysis reports into the cases of clostridium difficile and the
antibiotic stewardship presentation are examples of the Trust moving forward
in terms of identifying issues, analysing and addressing them. There will also
be an update on the Trust’s progress in relation to its redevelopment plans
and Foundation Trust application process.
Professor Goldstone said the information provided by Mr Hurd in terms of the
support services provided to the RNOH by other NHS organisations
demonstrates the keenness to support the RNOH and the work it undertakes.
The report that will be presented by the RNOH Pain service has highlighted
that this service has been considered a Cinderella service of the NHS.
Professor Goldstone said he believed the RNOH could be a major centre in
pain control for the musculoskeletal system and it was therefore important the
Trust consider the expansion proposals outlined by the Pain service.
Professor Goldstone said he had noted the low staff appraisal rates, however,
the Chief Executive has advised that because of the revalidation of doctors
requirement the numbers should increase.
7. Chief Executive’s Report
Mr Hurd presented his Chief Executive’s report dated September 2012.
Mr Hurd advised the Board that the Royal Liverpool hospital had had its PFI
scheme approved. The RNOH remains on track for the submission of its
planning application and continues discussions with the local authority to
incorporate their input and any issues arising from the consultation process.
Mr Hurd asked the Board to note the key messages, as outlined on page 1
and 2 of his report relating to;
• the need for the disposal of surplus land with the benefit of residential
planning permission to deliver the funds to secure the future of the
hospital,
• the green belt issues,
• the need to understand that at the end of certain phases there would be
more footprint on the site than existing, and
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• the need to be aware of the extremely tight project programme, requiring
the planning application to be submitted by the end of October in order to
target a February Planning Committee meeting and secure a Decision
Notice by the 31 st March 2013. The timescale was essential to keep the
full Government approved business case NHS timetable on track for
phase 1 of the new hospital.
Mr Hurd went on to advise that the competitive dialogue stage was
progressing well and would be extended by 4 months following a change in
the process advised by the Private Finance Unit which has increased the
extent to which competitive dialogue has to be completed before moving to the
preferred bidder stage. The Trust’s overall timetable to financial close has not
changed.
• Foundation Trust Application – Delivering the NHS Foundation
Trust Pipeline: Single Operating Model (SOM), implementation of
the oversight process
Mr Hurd referred to attachment 1 of his report, the Single Operating Model
(SOM), which he said would be presented to the Board on a monthly basis.
The SOM represents one common set of tools, processes and guidance for
Foundation Trust (FT) development and application, and is more closely
aligned with Monitor’s authorisation approach. The RNOH will complete this
monthly self-certification template which monitors the Trust’s FT application
progress.
Mr Hurd said the Trust’s overall risk assessment for its FT application has
been rated externally by NHS London and Commissioners as amber/green.
This rating reflects the slippage to the PFI timetable, which occurred last year
as the Trust pursued approval to move to the competitive dialogue stage.
In response to Mr Watson’s comment, Mr Hurd said it would be useful for the
Board to provide a formal view in terms of the slippage which the Trust had
had no control over. Professor Goldstone said the Board could be assured
that he and Mr Hurd regularly reminded individuals how the delay occurred
and that it was outside the Trust’s control. He said the Board could also be
assured that the Trust remained strong and robustly managed issues that
arise with regards to the redevelopment project.
Mr Billington commented that a number of questions from local residents were
raised at the Trust’s recent annual general meeting and queried whether the
Trust took a proactive rather than reactive approach to their concerns as the
Trust became closer to rebuilding the hospital. Mr Hurd said he regularly
attended meetings with the Stanmore Residents Association to advise them of
the redevelopment plans and planning application implications. Mr Raymond
said the Stanmore Residents Association were predominantly in favour of the
Trust’s redevelopment plans and that he himself had regular meetings with Mr
Hurd so he could be kept fully updated on the issues and the progress made.
• External Clinical Services
Mr Hurd referred to attachment 2 of his report, schedule of clinical support
services provided by other NHS organisations. Mr Hurd said the schedule
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showed the Trust relied on a high number of different organisations to provide
a range of clinical support services which he said represented a strategic risk.
He confirmed there were mechanisms in place to monitor clinical service
provision to the Trust’s patients. The Trust was, however, considering the
benefits of a single support provider, for example, UCL Partners through the
back office support consolidation project.
Mr Hurd said the purpose of the schedule was to support the Trust’s risk
register and Board assurance framework to provide assurance that there are
mechanisms in place to monitor the clinical services provided to the RNOH.
He said he would present the schedule on a 6 monthly basis for review by the
Trust Board.
• External Environment Issues – Specialist Commissioning
Mr Hurd said that despite 80% of the Trust’s work being defined as specialist
only 15% to 20% is commissioned through the Specialist Commissioning
groups. He said the Trust was working toward increasing this percentage and
advised that himself, Mr Shaw and Professor Briggs were involved with the
relevant task force groups to take this forward.
• Briggs Report – Getting It Right First Time
Mr Hurd asked the Board to note that Professor Briggs’ report which was
launched at the beginning of September at the House of Commons and that
Professor Briggs would be proposing an audit of provision in each health
economy in England with a view to setting up networks with executive
authority for patient flows and will be making a recommendation to the new
national clinical director for acute services.
• British Orthopaedic Association (BOA) Commissioning Guidance
Project
Mr Hurd advised the Board that the BOA, with the Royal College of Surgeons,
were undertaking a project to develop appropriate best practice pathways to
improve the quality of care for routine orthopaedic procedures. RNOH
consultants are involved with this project.
8. Assurance Framework
Ms Wiley presented the Assurance Framework dated September 2012. She
said the principal risks had not changed and the gaps had been fed into the
Trust’s Risk Register where appropriate. The high rated risks continue to
relate to the volatility of the financial environment and the poor nature of the
Trust’s estate.
For Presentation
9. Antibiotic Stewardship
Ms Wiley introduced Dr Simon Warren, Consultant Microbiologist from the
Royal Free and Ashik Shah, the Trust’s Chief Pharmacist, who she said would
give a presentation on Antibiotic Stewardship, which supports prudent
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antibiotic prescribing in hospitals for the prevention of infection only where the
benefits have been proven.
Dr Warren outlined the background to antibiotic stewardship and the change in
policy introduced by the Department of Health. He said the antibiotic
stewardship supported the use of single dose for surgical prophylaxis which
plays an important part in the prevention of post-operative wound and deep
wound infections. The key principle in this use is to have a high concentration
of the antimicrobial agents in the relevant tissues at the time of the operation.
He said that for most operations a single dose of an antimicrobial at induction
of anaesthesia is required. The Trust has adopted this guidance in its policy.
Dr Warren outlined the key guidelines and highlighted the number of cases
reported at the RNOH. He went on to brief the Board on the context to the
use of prophylaxis, the evidence, guidance and the RNOH position. He said
the Trust was able to identify any policy compliance problems through a
number of routes; root cause analysis, audits and antibiotic ward rounds.
Mr Shah briefed the Board on the results of audits undertaken in April and
September 2012. The audits highlighted a number of issues, for example,
delays in giving antibiotics and very few prescriptions that are compliant with
policy. A stewardship committee has been established to address the issues
identified.
Professor Goldstone thanked Dr Warren and Mr Shah for their presentation.
He said it was clear there had been a number of significant changes and
improvements in this area, led by Mrs Hill, including, reduced clinical errors in
relation to prescribing, an improved Pharmacy function and improved
microbiology provision established by the Royal Free hospital through its
service level agreement with the RNOH.
Mrs Hill agreed and said that having a microbiologist on site for the majority of
the week at the RNOH and the introduction of regular antibiotic ward rounds
had made a significant difference. She queried whether the Trust’s clostridium
difficile trajectory for 2012/13 could be challenged because of the national
changes to testing, which now requires a two stage test that is more sensitive.
Mrs Hill concluded that the poor fabric of the estate could become an issue
within Pharmacy as the Trust’s activity levels increase.
Mr Hurd said he believed the key issue for the Trust was whether its low
surgical site infections could be at risk if the appropriate antibiotic use is not
adhered to by clinical and medical staff. Dr Warren said that there was no
evidence that prolonged use of antibiotics is beneficial and that should not be
the case. He said that a clinical study could be initiated to review this matter.
Mr Shaw said that those clinical and medical staff who do not adhere to the
protocols could be asked to present evidence to support their actions at the
relevant forum.
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Items for Information
10. Clinical Audit at the RNOH
Dr Zarnegar gave her presentation and introduced Ms Stillwell, the Trust’s
Clinical Audit Lead. She outlined the recent changes the Trust had made in
terms of clinical audit, including, appointing a clinical audit lead and a
consultant lead for clinical audit, the formation of a clinical audit group, fixed
format for Trust-wide audit presentations and Trust-wide morbidity and
mortality presentations.
Dr Zarnegar went on to explain the recent process changes and the
introduction of a clinical audit intranet page. She said that performance had
been enhanced through improved clinical engagement in clinical audit and
internal evaluation of clinical audits. Overall attendance at clinical audit
presentation meetings had improved, however, consultant attendance had
remained steady.
Dr Zarnegar outlined the future plans, which she said included the recording,
review and validity of outcome measures and the introduction of a more
systematic approach to clinical audit that will develop a comprehensive annual
audit programme for each unit and department. She said that to achieve
these future goals the service would require improved IT facilities and
sufficient time and staff resources to guide the comprehensive audit
programme.
Dr Zarnegar said she believed the morbidity and mortality presentations were
an important improvement that had facilitated discussions in an open forum.
Mr Shaw agreed this was an important step forward. He congratulated Dr
Zarnegar on the improvements to the clinical audit function and agreed that
further investment was needed.
Professor Goldstone thanked Dr Zarnegar for her presentation and said he
looked forward to the increased activity in this area.
11. RNOH Pain Service
Dr Zarnegar presented the report into the Trust’s Pain Service. Dr Zarnegar
said the pain service offered a range of interventional, physical,
pharmacological and rehabilitation therapies for the management of chronic
pain in a multidisciplinary setting.
Dr Zarnegar outlined the referral sources and services users and briefed the
Board on the opportunities for expansion and new service developments. She
said the report also identifies the service capacity limitations and threats.
Mrs Hill said the workload of the service had increased year on year but that
staffing resources did not match activity levels. She said it was clear that
there was a service decline in district general hospitals, however, this would
give the RNOH an opportunity to grow its pain service with appropriate
investment. She confirmed that associated costs would be minimal.
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In response to Ms Wiley’s query, Dr Zarnegar agreed the RNOH pain service
could be provided at other NHS organisations and premises in a hub and
spoke type arrangement.
In response to Mr Watson’s query, Mrs Hill said this paper had been
developed in response to a visit by the RNOH Patient Group to the
department and a request for further information on the service by the Trust
Board. She said the Trust would consider the development of a business
case to progress and expand the service.
Performance Reports
12. RNOH 2012/13 Operating Plan Update
Mr Wilson advised the Board that agreement had been reached with two key
commissioners, however, contract discussions with the remaining
commissioner remained on-going, with the issue over the charging of complex
imaging being the outstanding issue. Mr Wilson said that North Central
London continued to support the RNOH in this matter and would be attending
a meeting with the RNOH and the commissioner.
Mr Wilson said that the outstanding contract was worth approximately £12m.
13. Update from the Performance Committee
The Trust’s Integrated Performance Report for the financial year 2012/13 (1 st
April – 31 st August 2012) was presented and the key headlines from the
September Performance Committee meeting were presented by Mr Wilson,
Mrs Hill and Ms Wiley.
• Quality
Ms Wiley advised the Board that there had been no cases of MRSA
bacteraemia reported for August. There was one pressure ulcer acquired in
August and one case of clostridium Difficile. In addition one further cases of
clostridium difficile was reported in September taking the Trust 2 cases over
its trajectory.
• Access targets
Mrs Hill said that August was a good month operationally. All the 18 week
standards were exceeded and there was 100% performance on all cancer
standards. The cancer staging metrics are still to be agreed with the Trust’s
commissioners and therefore the Trust has not been required to make any
submission to date.
Mrs Hill advised that in-sourcing would begin during the following week with a
team going to Belfast on the 9 th October. The Trust has agreed to take
patients from Kent and Medway and has negotiated for tariff plus 18% MFF.
The Trust has selected a group of spinal patients from St Georges and is
developing a service level agreement.
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Mrs Hill concluded her report by advising that the number of theatre
cancellations for August was 0.7%, which is below the Trust’s target of 0.8%.
The target was therefore achieved.
• Finance
Mr Wilson advised the Board that a deficit of £87,000 was reported for August
against a budgeted loss of £249,000, representing a favourable variance of
£178,000. On a cumulative basis for the year, the Trust has achieved a
surplus of £61,000 against a budgeted surplus of £239,000, an adverse
variance of £178,000.
Mr Wilson outlined the key points of note, including, the NHS patient income
position, which he said was exceeded by £633,000 as patient activity was 42
cases higher than planned. Mr Wilson advised that private patient income
underperformed by £71,000 due to lower complexity of case mix. Overspends
on pay, and medical supplies and equipment costs relating to the activity overperformance
were noted, whilst the reduction in the Trust’s Better Payment
Practice Code (BPPC) compliance from 31% in July to 13% in August due to
continued delays over payment from several commissioners was discussed.
Mr Wilson also briefed the Board on the cumulative cost improvement plan
(CIP) savings of £742,000, against a budgeted savings of £1.27m, an adverse
variance of £325,000.
The Trust has undertaken a snap shot of its waiting list position and concluded
that the number of patients has increased by 7%, however, the complexity of
case mix had decreased by over 9%. The first quarter of 2012/13 in particular
had seen considerably lower complexity of activity then that seen in the prior
financial year. Mr Wilson believed that existing adverse variance could be
retrieved, however if action was not taken then the Trust was forecasting an
outturn position of £1.8m. Mr Wilson said this potential £500,000 shortfall from
plan was being monitored closely. Mr Hurd agreed and said if the Trust did
not take action to improve the income position through its casemix, the Trust
anticipated the surplus position at year end to be £1.8m (the targeted surplus
for 2012/13 is £2.3m). Mr Hurd said the in-sourcing projects were critical to
achieving the surplus target and Mr Wilson’s message about the financial
position was clear.
The Board discussed the position, the number of working days during the
remainder of the year and the referrals required to improve the financial
position. Mr Wilson said that October and November were the key months in
terms of the financial position.
Business Cases, Policies etc for Approval
14. Consultant Appointment: Consultant Anaesthesia and Pain Medicine
Consultant
The Board approved the appointment of Dr Fernandez to the post of
Consultant in Anaesthesia and Pain Medicine.
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Clinical Governance
15. Update from the Clinical Governance Committee
Ms Wiley presented the Clinical Governance Committee update and
highlighted the issues discussed by the Committee as its meeting on the 7 th
September, as noted in the executive summary.
16. NHS London Healthcare Associated Infections (HAI) Peer Review of the
RNOH
Ms Wiley presented the HAI peer review report produced by the London
Strategic Health Authority following their visit to the RNOH on the 17 th July
2012. Ms Wiley said her executive summary highlighted the areas of good
practice and the principle risks that were identified through the peer review,
including, prudent prescribing and antibiotic stewardship, maintaining
assurance of competence of aseptic non touch technique for both devices and
wound care. The review also highlighted that some clinical areas were
carpeted, which Ms Wiley said had since been removed in some areas. In
response to their comment in relation to the need to strengthen the Trust’s
root cause analysis (RCA) process, the Director of Nursing or the Deputy
Director of Nursing will now attend every RCA meeting relating to infection
control issues.
Professor Goldstone commented that the view that clinical areas should not
be carpeted was not universally accepted and there was no substantial
evidence to support the theory about the hazards of carpet in relation to
infection.
17. Patient Experience Report (August 2012)
Ms Wiley presented the Patient Experience Report for August 2012. She said
there had been one category 2 pressure sore reported for the month, which
had been reviewed and determined as preventable. There has been one
spinal surgical site infection and one death during the month. The details of
these are noted in the Patient Experience report. Mr Shaw said the spinal
team had been informed of the increases in surgical site infections and
planned to review the evidence.
Mr Watson referred to page 4, real time patient feedback breakdown of
questions, and queried the benefits of asking whether patients were happy to
complete the questionnaire.
18. Root Cause Analysis (RCA) report into the Clostridium Difficile case
reported in July 2012
Ms Wiley presented the root cause analysis report into the clostridium difficile
case reported in July 2012 and referred to the executive summary which she
said highlighted the incident and the issues that were identified.
Ms Wiley referred to the action plan, which she said outlined the actions.
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19. Root Cause Analysis (RCA) report into the 31 day subsequent cancer
treatment breach
Mrs Hill presented the root cause analysis report which she said provided a
more detailed review of the circumstances leading to the delay of a 31 day
subsequent cancer treatment in a 42 year old female patient.
Mrs Hill said the patient was seen every three months for the first two years
post diagnosis in 2008 and then moved to 6 monthly follow-up in 2010. In
June 2011 the patient was seen in outpatients and a recurrence of the lesion
on the ring finger of her right hand was suspected. An MRI was booked and in
August 2011, a recurrence was confirmed, however, the report was not
prioritised as urgent. The patient requested surgery after October 2011, but it
was still not noted as a recurrence and the patient was not admitted within 31
days for subsequent treatment.
Mrs Hill said the failure to treat this patient was not identified until June 2012
because the SpR who completed the MRI booking form did not refer the
patient to the MDT (multidisciplinary team) even though it was stated in the
clinic letter that this was necessary.
Mrs Hill said the sarcoma service was very busy and that referrals had
increased three-fold over the last 3 years although the incidence of sarcoma
remains static. Mr Shaw agreed and said he believed that once the backlog
list had been treated the service would be more sustainable.
In June 2012, the management team undertook a validation process which
identified the patient. The patient was admitted for treatment as a priority.
Mrs Hill said the tumour had not metastasised due to the low grade nature and
that the patient remained well.
Mrs Hill said there were 3 main recommendations identified that would make
the process more robust:
• All patients with a potential recurrence will now be placed onto a 31 day
pathway
• Patients will be not removed from the pathway until a negative diagnosis is
made
• All tumour recurrences that are confirmed by radiological investigation will
have priority results
Mrs Hill concluded by saying the issue of the 18 week backlog had improved
with the introduction of the 92 nd percentile for incomplete waits over 18 weeks
and there was a stronger focus on validation of the breached patients in the
backlog list.
Professor Goldstone thanked Mrs Hill for her report and said it was clear there
were lessons to be learnt. He said the Board were pleased to hear the patient
was well.
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20. RNOH Response to the Prosthetic Rehabilitation patient survey
facilitated by the RNOH Patient Group
Mr Hurd advised the Board that a survey was undertaken by user groups
following the relocation of the Prosthetic Rehabilitation service. The Trust
agreed the report should be presented through the RNOH Patient Group and
that the Trust would provide a management response.
Mr Hurd reminded the Board of the decision to move the Prosthetic
Rehabilitation service and explained he had undertaken a back to the floor
session with the service so he could gauge the impact of the relocation on the
service users. He agreed the survey and report were contradictory in certain
areas, however, there was an understanding that some of the issues related to
snagging problems, which were being addressed and issues that would
remain until a more permanent location for the service was identified.
21. RNOH Patient Group visit to the Spinal Cord Injury Centre and Podiatry
clinic
Ms Wiley presented the RNOH Patient Group visit reports and said that both
visits had gone well. She said that the majority of the problems highlighted by
the visits related to estate issues, which the Trust has had difficulty in
addressing because of the capital programme issues.
• Visit to the Podiatry Clinic
Ms Wiley said the problems with empty hand gel dispensers was not
acceptable and would be addressed.
Ms Wiley said the Podiatry service was managed by a single Podiatrist and
agreed with the report that the condition of the premises that housed the
service was poor. She queried whether a review of the premises should be
undertaken.
In response to Mrs Hill’s comment, Ms Wiley confirmed the service was
contracted from Harrow PCT through a service level agreement.
The Board discussed whether the Care Quality Commission considered the
poor estate as a risk to clinical outcomes. Ms Wiley said they did not because
the Trust’s evidence proves that despite the poor estate the Trust has good
clinical outcomes and low infection rates.
• Visit to the Spinal Cord Injury Centre (SCIC)
Ms Wiley said the visit by the RNOH Patient Group had correctly identified
higher than normal levels of absenteeism through sickness and maternity
leave. She said the visit had also identified issues with the patient menu for
the long stay patients who felt it was repetitious. Ms Coultry, the SCIC
Matron, said that an alternative menu had been put in place, however, due to
the financial implications, she was unsure as to whether the alternative menu
could continue. Professor Goldstone suggested the Board look into this issue.
Action: Mr Masters
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In response to Mr Shaw’s query, Ms Wiley said that a Trust-wide staffing
review would be undertaken during November. She also confirmed that
manual handling of patients was an issue but that risk assessments are
carried out and that manual handling training and training to undertake risk
assessments was mandatory for nursing staff.
Ms Wiley said that the number of staff not at work had resulted in fewer staff
available to undertake the advanced tasks which had put pressure on all the
staff on the unit, however, admissions were reduced.
Professor Goldstone said it was clear there were positive aspects to the visit
by the RNOH Patient Group and in spite of the adverse conditions, the SCIC
should be congratulated on its leadership and how staff dealt with the issues
they are facing.
Professor Goldstone went on to thank the RNOH Patient Group for their visits,
which he said had helped the Board understand the issues that affect patients
and staff.
Ms Wiley advised that action plans had been developed for both visits and
were attached to the reports.
Corporate Affairs
22. Update from the Foundation Trust (FT) Steering Group
Dr Patel presented her update and advised that the independent assessment
of the Trust’s Board Governance Assurance Framework (BGAF) would be
available from November. She said the 360 review by NHS London was
nearing completion and would be presented to the Board at the next meeting.
23. Media Update
Dr Patel presented the Media update and referred to the Daily Mail article
about NHS hospitals sending confidential notes to India to be typed up. Dr
Patel assured the Board that dictation sent abroad by the Trust does not have
identifiable patient information included.
Updates from the formal sub-Committees of the Trust Board
24. Update from the Service Transformation Committee
Professor Goldstone asked that the Service Transformation update be
presented earlier on the agenda.
Mrs Hill said the transformation savings were slightly behind plan by £31,000,
the cumulative total achieved to date was £615,000 against a target of
£646,000. She said that prosthesis and ad hoc working was ahead of plan,
however, the areas that were under achieving were temporary staffing and
roster changes. Mrs Hill said she anticipated this would improve once the
vacant wte (whole time equivalent) posts were removed.
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Mrs Hill said there were concerns that the start time in theatre had seen a dip
over the past 6 months to below 50% as noted on page 15 of the
transformation report. To address this issue the Medical Director has
implemented a traffic light system to categorise why and take action, and there
will be a monthly summary included from next month.
In response to Professor Goldstone’s query, Mr Shaw agreed that there was a
scheduling problem in relation to the MDT (multidisciplinary team) meetings
and the theatre start times. He agreed that MDT meetings were important and
should be encouraged, and confirmed that a sensible solution would be
sought. He said there were a number of other issues that delayed theatre
start time.
Mrs Hill said that work had accelerated in terms of the environment upgrades
in outpatients, and that the new reception desk and signage were now in
place. The Costa coffee shop has also been scheduled for later in the year.
Mrs Hill referred to page 4 of the transformation report, which she said showed
the CQUIN and throughput challenge. She said the executive team were
confident the cost improvement programme, the service transformation
programme and CQUIN targets would be achieved at year end. She said she
did not expect the transport savings to be achieved and that this would be
discussed further by the Performance Committee.
Mrs Hill concluded her report by confirming that all savings were quality
assessed and approved by the Medical Director and Director of Nursing.
25. Update from the Redevelopment Programme Board
The Board noted the update from the Redevelopment Programme Board.
26. Trust Board sub-Committee effectiveness: Children’s Services Strategy
Committee
Dr Jacobs presented the review of the Children’s Services Strategy
Committee’s effectiveness. He said he believed the function of the committee
had improved significantly as it had Board and clinical support.
27. Any Other Business
• Inaugural RNOH Spinal Myeloma meeting, 12 th October 2012
Mrs Hill briefed the Board on the spinal myeloma meeting the Trust had
arranged for the 12 th October. She said that 130 delegates would be
attending the meeting and this would be the first step towards a
myeloma/kyphoplasty service, for which Mr Sean Molloy and colleagues from
North West London Hospitals (NWLH) and University College London
Hospitals (UCLH) had developed the guidelines.
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• An RNOH Clinical Nurse Specialist has been awarded a Research
Fellowship
Ms Wiley advised the Board that Ms Julie Woodford, CNS (Clinical Nurse
Specialist) had been awarded a research fellowship place. Ms Woodford
would be seconded from the Trust to undertake a research project that would
be attributed to the RNOH. The research project will review patients treated at
specialist centres.
• PR Consultant
Mr Hurd asked the Board to authorise Ms Judith Brodie to appoint the PR
consultant, following her review of the proposals.
The Board agreed that Ms Brodie could approve the appointment of a PR
consultant.
Date of next meeting
Tuesday, 30 th October 2012, 5.00pm
Seminar Room 2, Teaching Centre
15