03 CoG mins 19 Mar 09 - 44KB [PDF] - Newcastle Hospitals

THE NEWCASTLE UPON TYNE NHS FOUNDATION TRUST
COUNCIL OF GOVERNORS
MINUTES OF THE MEETING HELD ON 19 th MARCH 2009
Present:
Mr K W Smith (Chairman)
Appointed Governors 4 (out of 11)
Staff Governors 4 (out of 7)
Public Governors (Constituency 1): 6 (out of 9)
Public Governors (Constituency 2): 10 (out of 10)
Public Governors (Constituency 3): 1 (out of 3)
(Attendance record attached)
Mr D Allison, Operations Director
Mrs A Dragone, Finance Director
Sir Leonard Fenwick, Chief Executive
Mrs M Hornett, Nursing & Patient Care Director
Mr S R Reed, Trust Secretary
Dr T J Walls, Medical Director
09/19 Apologies for Absence
ACTION
Apologies for absence had been received from Mrs J Binns, Dr J Court, Professor
T Goodship, Dr M Holliday, Professor J Potts, Dr M Prentice, Ms G Tiller and Mrs
S Webster.
09/20 Presentations
i) Ward Accreditation Programme
Mrs Hornett introduced an overview of the ward accreditation process, which was
intended to improve and maintain standards of hygiene and infection prevention
and control. Two wards had been the first to undergo independent assessment,
following three consecutive months of “green light” self-assessment.
The Chairman presented certificates of achievement staff representatives of
Ward 1, Freeman Hospital and Ward 30, Royal Victoria Infirmary. Each ward was
also to receive an item of equipment of its choosing. Dr Tapson (Clinical Director),
Pam Yanez (Directorate Manager), Matron Julie Harding, Sister Judith Heckles
and Charge Nurse Graham Chambers received the awards on behalf of the
service.
ii)
Pandemic Flu
Mrs Joanne Kerr, Pandemic Flu Lead for the Trust, gave a presentation on the
state of readiness of the Trust and the region if a pandemic flu outbreak was
identified. Governors raised questions about the role of volunteers in providing
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assistance, staff replacement when staff were themselves victims of flu, stockpiling
of vaccine, and the escalation protocol, i.e. who decided when there was a
pandemic (in essence, the UK Chief Medical Officer).
ACTION
iii)
Quality Accounts and Quality Measures
Mr Allison and Dr Walls gave presentations on current work within the Trust to
develop a “quality account” and the types of measures of quality which were
already in use and which could be brought into the account.
Mr Harvey asked where the requirements came from. Many of them were
embodied in the new national NHS with contract. Professor Burt commented on
the mismatch between the CQUIN elements and the Trust’s proposed quality
account measures. Sir Leonard highlighted that the potential risk was up to £2.5
million in fines by commissioners for non-compliance with CQUIN, which could
threaten the “going concern” basis of the Trust. There was a further issue with the
national contract in terms of the provisions for Intellectual Property Rights, which
could stifle all innovation; and there were apparent restrictions on trade too.
Consequently it was necessary to ensure that the contract was unambiguous and
this might require side letters or agreements. Mr Briggs commented that it
appeared to be a common feature of Foundation Trusts to be in conflict with
Primary Care Trusts and there was a need for a national “trade body” to represent
their interests. It was noted that an FT Network had been established but had not
been particularly successful. Negotiations had been with NHS North of Tyne and
not with individual PCTs. Professor Arthur asked if there were any national
measures or benchmarking for quality accounts. These were for local agreement
but were based upon national markers. Revd Dr Saunders asked what would
happen if the Trust did not negotiate. Sir Leonard replied that there was little
sanction available to NHS North of Tyne. It was likely that PCTs across the North
East would agree with the North of Tyne position, however. Mr Venables asked
about the costs of collecting the data. Mr Allison replied that it was not clear what
would have to be collected as yet but was likely to be significant. Dr Johnson
wondered how quickly the contractual obligations would fall away if a pandemic
was identified.
09/21 Minutes of the Meeting held on 15 th January 2009
The minutes of the meeting held on 15 th January 2009 were agreed as a correct
record, subject to inclusion of Professor Goodship amongst those present. Mr
Reed reported that the RVI new build A&E access would have 18 drop-off parking
spaces. Professor Arthur reported that a bid had been submitted in relation to the
Shared Decision-making research project and he had attended one meeting. It
was not yet clear if the project would go live, or when.
09/22 Matters Arising
i) Equitable Access – update
Mrs Hornett gave an update on progress with the projects. The modular buildings
had been ordered but limited availability was likely to delay the “go-live” dates to
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ACTION
early June 2009 at the earliest. Planning approval had been received for the
Cowgate/Blakelaw health centre scheme and was awaited for the Battle Hill health
centre and Walker GP surgery. With regard to community engagement, Mrs
Hornett outlined the programme of activities which was underway. The concerns
of Walker residents would be the backdrop to the planning hearing for that
scheme. Recruitment to the projects was going well. It was noted that installation
of IT systems by the Primary Care Trusts could be a possible source of delays.
ii)
Future of the Newcastle Healthcare Charity and The Newcastle upon Tyne
Hospitals NHS Charity
Professor Goodship said that the Working Group was not yet in a position to report
and hence this item was deferred to the May 2009 meeting.
Prof.
Goodship
iii) ENT Services in South of Tyne
Mr Allison gave an update on the continuing development of outreach ENT clinics
in South of Tyne, including the percentage of patients seen who then sought to
come to Newcastle for treatment. Sunderland City Hospitals NHS Foundation
Trust had raised an issue with regard to provision of Audiology support at Palmer
Community Hospital but Mr Allison thought that there might well be scope to take
over the whole service in due course. The possibility of providing the ENT prime
contract for Northumbria needed to be understood first. However, Northumbria
Healthcare NHS Foundation Trust was seeking more than £1 million for a facilities
fee, plus £350,000 for consumables and £50,000 for records transfers.
Mr Venus pointed out that the South of Tyne service did not appear on the Choose
& Book website and hence patient choice was being constrained. Sir Leonard
commented that choice was a major issue in the North East and did not appear to
be actively promoted on the Choose & Book site. Mrs Randall asked if the Trust
still provided outreach to Northumberland. Mr Allison confirmed that this was the
case, at least for the medium term, as the review of the prime contract developed.
iv)
Children’s Services Working Group
Ms Harvey reported the proposed establishment of a working group for Children’s
Services and the governor nominations to join it. Council approved the Terms of
Reference for the group. The proposed inaugural meeting date of 31 st March 2009
was to be confirmed.
It was noted that the new menus for children would go live on 8 th April. It was
pleasing to note also that the sponsored run by crew members of HMS Dauntless
had raised £1,660.
v) Care Quality Commission Registration
Mr Reed reported that the Trust had been the first in the country to apply for
registration with the Care Quality Commission, which had now been received and
was a statutory requirement arising from the Code of Hygiene.
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09/23 Governors’ Terms of Office and Election Timetable
Mr Reed presented the schedule of expiring and vacant governorships, along with
the election timetable to fill them. The report was received and noted.
09/24 December 2008 Away Day - Action Plan
Ms Harvey reported on progress by the Development Group in implementation of
the agreed action plan. It was highlighted that the Governors’ room at the Royal
Victoria Infirmary needed to be used more. It could be used by governors to meet
up informally prior to scheduled RVI site visits. PC access was to be followed up,
including the issuing of Trust email addresses for governors. In terms of the
Membership drive, a sub-group had been established, led by Revd Dr Saunders.
The focus of activity would be on facilitating communication by governors with their
Members and using this to underpin Membership recruitment. The website would
be developed further to facilitate this and zoning of Members to governors by
Postcode would be investigated. The Development Group was to work up plans
for open days on the key hospital sites and governors were also encouraged to
canvass patients and visitors for Membership when visiting the RVI or Freeman
Hospital. Revd Dr Saunders mooted the possibility of governors manning a
recruitment stall at the hospital main entrances. It was noted that Harrogate
offered Members the opportunity to join a discount scheme and Mr Reed agreed to
follow this up. Governors with ideas about Membership recruitment were asked to
contact Mr Reed in the first instance, who would then advise the Development
Group.
Mr
Reed
09/25 Governors’ Questions and Items for the Next Agenda
i) Drain Containers
Dr Johnson commented on problems with drain containers for thoracic patients
who had returned home and could not obtain them from their GP. There was a
need for improved liaison. Sir Leonard spoke of the scope for governors to advise
on discharge policy.
ii)
Quality Measures
Dr Sanders asked if, in relation to quality accounts and quality measures, had
NHS North of Tyne accepted Dr Wall’s proposals, would the Trust have accepted
the financial rewards and penalties. Dr Walls would have been happy to discuss
these but had not been happy with some of NHS North of Tyne’s proposals. The
Chairman commented on the current work with Monitor and other Foundation
Trusts on developing the quality account.
Professor Arthur commended the Dermatology Department on its quality of care
and commented that the NHS was a service and not a business.
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ACTION
iii)
Winter Ward
Mr Atkinson asked if, for next winter, the winter ward at the Royal Victoria Infirmary
could be set up differently, to avoid the problems of staff absences and
cleanliness. Mrs Hornett replied that the ward was due to close at the end of
March and she was not aware of any cleanliness issue. Indeed, the Healthcare
Commission had inspected this ward as part of the recent unannounced visit. The
ward was very pressured, like the Emergency Admissions Unit and was managed
by a very experienced Internal Medicine Sister. Every area had to give up an
experienced nurse to staff it safely. Not having it would not be good for patient
safety. There was a debrief on the winter plan post-closure and governors were
welcome to participate in this. This year had been better than last. Senior
clinicians were engaged in the Emergency Admissions Steering Group and in
liaison with the Ambulance Service and Social Services.
iv)
Operational Services
Ms Harvey indicated that the Catering Manager would welcome governor
engagement in the Operational Services Forum.
All to
note
v) Care of Older People
Mrs Haigh wished to commend Newcastle Hospitals for the kindness shown to
older patients and Mr Green echoed this sentiment. The Marketing Group could
follow this up. Mrs Haigh commented on the signage and number of disabled
parking spaces for the Northern Centre for Cancer Care. Sir Leonard said the
point was well made and the Operational Services Manager was to follow this up.
vi)
Outpatients – Delay Announcements
Revd Dr Saunders asked whether the Outpatient clinic delay announcement
boards had been audited recently. Mrs Hornett agreed to follow this up. Mr
Harvey reported that the Musculo-Skeletal Outpatients review would address this.
Mrs
Hornett
09/25 Governors’ Reports
i) Patients’ Food Tasting, Ward 20, Royal Victoria Infirmary
Mr Green presented the report. There were no issues of substance. Mr Green
invited governors to attend the next tasting, on 17 th April at Newcastle General
Hospital.
All to
note
ii)
A&E Department, Newcastle General Hospital
Mr Atkinson reported on a late evening visit to the A&E Department on 30 th
January 2009. The police presence was noteworthy but otherwise there were no
issues of substance to highlight. The relocation of the Department to the Royal
Victoria Infirmary in due course was thought likely to bring new problems arising
from proximity to the city centre.
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iii)
Walkergate Hospital
Mr Atkinson reported on a visit to Walkergate Hospital on 12 th February 2009. The
report was received and it was noted that the Director of Nursing and Patient
Services was addressing the issue of an appropriate space for treatment and
wound dressing, in order to improve ability to comply with the ward accreditation
programme.
iv)
Dental Hospital
Ms Harvey presented a report of a visit to the Dental Hospital in March 2009,
which was received and noted. With regard to the Conservation Clinic, Sir
Leonard commented that this was a project which the Trust wished to pursue but
the substantial capital cost was an issue. It would need to be addressed in the
context of the 2009/10 capital programme.
v) National Service Framework for Older People
Mrs Randall presented the Steering Group minutes of 20 th January 2009 and
noted the need for support of audits and the requirement for specialist nurses in
Care of the Elderly. The Stroke service was an international exemplar. Mrs
Hornett commented on the short term redeployment of Walkergate Hospital Ward
3 staff when demand had been low.
vi)
Ophthalmology Department, Royal Victoria Infirmary
The written report was received, for information, a verbal presentation having been
given at the previous meeting.
vii)
Infection Control Working Group
It was noted that the working group would report at the end of May 2009, as
governors were still engaging in hand hygiene audits.
viii)
Organ Donation Committee
Mrs Abrahams reported that the Committee had met in January and March 2009
and had been briefed on the role of the organ donation “champion” (Dr Vincent)
and of the transplant co-ordinators. It appeared that the Trust was further ahead
in this field than many others. A full report would be submitted to the Medical
Director by July 2009.
09/26 Executive Report
i) Current Issues
Sir Leonard reported that Mrs Dragone had been appointed formally as Finance
Director on 9 th March 2009. With regard to Healthcare Associated Infection, the
MRSA bacteraemia target set by NHS North of Tyne for 2009/10 was no more
than 30. It was highlighted that, in relation to the Equitable Access scheme in
Walker, some GPs locally had objected and viability of that scheme was now in
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question. The Sir Bobby Robson Clinical Trials Unit had opened formally on 20 th
February 2009. In the Renal Services Centre, there continued to be issues
regarding the safe supply of Reverse Osmosis water for dialysis. On the Royal
Victoria Infirmary site, the Trust was to clerk the new build works. 23 rd March
would see handover of the first part of the atrium, including the 170 seat catering
area with a very high footfall. Catering provision would no longer be by the
League of Friends and WRVS and the Trust was seeking to use these volunteers
elsewhere.
Copies of the Academic Health Science Centre (AHSC) application were tabled,
for information and it was disappointing to note that the Trust had not been
successful in progressing to the final selection round. The view of the International
Selection Panel had been that the bid was “excellent but too narrow in breadth”.
Professor Burt commented that it had been very disappointing not to make the
short list, as there had been confidence in the quality of Newcastle’s healthcare,
education and research, being either sixth or seventh in the UK for medical
specialties. The intention was to carry on as if Newcastle had in fact achieved
AHSC status. Mr Venables said that three out of five AHSCs being designated in
London seemed disproportionate.
With regard to the eRecord, “go live” was still planned for early August, with
significant national interest in progress.
Sir Leonard highlighted a risk for the NHS that, in the current economic climate,
HM Treasury might seek to claw back any cash surpluses. It was thought that
Foundation Trusts would be exempt from this, however.
Turning to the redevelopment of the Newcastle General Hospital site, it was
reported that the planning applications had been rejected by Newcastle City
Council on 27 th February. There was now a risk that the Walk-in Centre would
become isolated and that there could be vandalism of the site. There was no
doubt that this was a significant lost opportunity. Tesco was considering an
appeal. The Campus for Ageing and Vitality would be considerably enhanced if
Tesco proceeded, as would the Brighton Grove development for translational
medicine.
In the light of recent publicity about standards of care at Mid Staffordshire Hospital,
the Healthcare Commission report was available upon request. The “Dr Foster”
list of Standardised Mortality Ratios was tabled and it was noted that the Trust was
amongst the lowest, i.e. death rates were lower than the average.
ACTION
ii)
Healthcare Associated Infection
Mrs Hornett gave a presentation on the infection position in the Trust. With
regard to MRSA bacteraemia, in March 2009 to date two cases had been
reported. Total cases to date were 38 against the national target for the year of
46. The most pressing issue now was achievement of 100% pre-admission
screening for all elective patients, including Daycases, since the new NHS contract
included quarterly penalties of £50,000 for non-achievement. In response to a
question it was noted that Laboratories capacity appeared to be sufficient to
handle the volume of tests. 32 of the 38 case had been emergency admissions.
Mrs Hornett reported that the MRSA bacteraemia target for 2009/10 was 30, which
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ACTION
would be challenging but ought to be achievable. C. difficile performance was
well within trajectory, at 270 against the year-end target of 550.
Mrs Hornett commented on the recent unannounced inspection by the Healthcare
Commission. Informal feedback had Identified examples of good practice such as
the Hand Hygiene posters, compliance with “bare below the elbows”, the Saving
Lives posters and campaign, Infection Control notice boards for patients and staff
and the visibility of the Infection Control Nurses “on the floor”. There had been few
clinical concerns and some hotel services storage issues had been addressed
immediately. The draft report from the Commission was expected within weeks.
iv)
Patient Care Performance
Mrs Hornett presented the activity and performance report and highlighted that,
while A & E had been very busy, the national target had been met. Department of
Health thresholds for the cancer waiting times had still not been published.
With regard to the 18 Weeks Referral to Treatment targets, Mr Allison reported
that the Trust was in good shape overall, with the exceptions of Dental Non-
Admitted Patient care and Orthopaedics Admitted Patient care, which would be
compliant by September, as agreed with commissioners and hence there would
not be penalties with regard to this specialty. Musculo-Skeletal Outpatients were
part of a region-wide review. Data quality had improved substantially. Regrettably
commissioners had not committed any funding to the public health targets of
smoking in pregnancy and breastfeeding initiation.
Professor Arthur commented that Did Not Attend (DNA) rates in Outpatients
appeared high. Mr Allison said that this was affected by school holidays and
other, socio-demographic factors. A recent pilot with NHS Direct, using text
message reminders, had halved the rate.
v) Annual Plan 2009/10
Mr Allison gave an overview of the annual plan development process and progress
to date. He highlighted the extent of Consultant engagement and their inputs to
the development of the annual plan. The increasingly important role of Practice-
Based Commissioning was noted. Marketing of services was being developed.
Key strategic developments were itemised, including the Institute of
Transplantation, Great North Children’s Hospital, Midwifery-led Maternity Unit, the
Northern Centre for Cancer Care and redevelopment of the Newcastle General
Hospital site. An advanced draft of the plan would be brought to the next meeting,
for consideration by governors.
Mr
Allison
vi)
Commissioning Requirements
Mr Allison reported that activity volumes had now been agreed with all PCTs
including North of Tyne. An additional £4 million of activity had been ordered by
the North East Specialist Commissioning Group. Overall, an additional £10 million
of income was anticipated for the forthcoming year. The outcomes of HRG4, the
new basis for clinical coding of activity, had been disappointing in the initial
modelling.
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Governors were reminded of the service quality improvements expected from the
Transforming Newcastle Hospitals project and the need for significant cost
reductions to ensure that the Unitary Payment was affordable. In addition, the
Trust would need to deliver a substantial programme of cost improvements, to
meet cost pressures arising from the national pay awards and proposed service
developments.
ii) Finance Report
Mrs Dragone presented the outlook for the financial year-end and was confident
that all targets would be met in full. Professor Arthur commented that the EBITDA
rating at 3 needed examination, due to its disproportionate impact on the overall
financial risk rating, which stood at 4. As had been highlighted by Sir Leonard,
there was a potential risk of cash stripping by government. Mr Briggs thought that
all Foundation Trusts were in same boat, in terms of striving to increase quality,
drive down costs and attempt to increase their market share. There was scope for
sharing lessons both within the Trust and with others.
09/27 Catering Survey
The national catering survey report from 2008 was received and noted.
09/28 Patient, Carer and Public Involvement Patient Survey
The national report on Inpatient experiences in 2008 was received and noted.
09/29 Monitor 2008/09 Quarter 3 Overview
The report on the performance of NHS Foundation Trusts in the period 1 st October
to 31 st December 2008 was received and noted.
09/30 Care Quality Commission – Statement of Involvement
The consultation document “Voices of Power” was received and it was noted that
the Trust’s response would be brought to the next meeting, for information.
Mr
Reed
09/31 Date and Time of Next Meeting
The next meeting would be held at 2-00pm on Thursday, 21 st May 2009, with the
draft annual plan as the key item.
At the close of the meeting, the Chairman and Mr Harvey thanked Mrs Hornett for
her outstanding service to the Trust and wished her every success in her new post
with Lothian Health Board.
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COUNCIL OF GOVERNORS
GOVERNORS ATTENDANCE, 19 th MARCH 2009
2 Mrs Heather Abrahams YES
2 Professor Fenwick Arthur YES
2 Mr Peter Atkinson YES
A Mr Syd Atkinson YES
3 Mrs Jennifer Binns APOLOGIES
A Mr Paul Briggs YES
S Mr Peter Brigham YES
A Professor Alastair Burt YES
1 Dr Jennifer Court APOLOGIES
S Mr David Crawford YES
S Mrs Bernadette Crittenden YES
1 Mrs Jane Donnelly YES
S Mrs Joan Duckett NO
S Mrs Christine Eddy YES
S Professor Tim Goodship APOLOGIES
1 Mr Eric Green YES
2 Mrs Grace Haigh YES
2 Ms Margaret Hall YES
2 Mr Maurice Harvey YES
1 Ms Sandy Harvey YES
S Dr Malcolm Holliday APOLOGIES
2 Dr Alan Johnson YES
2 Mrs Naomi Kenny YES
A Councillor Liz Langfield NO
1 Professor Jean Potts APOLOGIES
A Dr Mike Prentice APOLOGIES
1 Mrs Ethel Randall YES
1 Dr William Ryder YES
1 Dr Gill Sanders YES
3 Revd Dr Michael Saunders YES
2 Mrs Deborah Staley-Bush YES
A Ms Gina Tiller APOLOGIES
2 Mr Christopher Venables YES
A Mr Raymond Venus YES
A Mr Cameron Ward NO
A Professor Andrew Wathey NO
1 Mrs Sally Webster APOLOGIES
3 (Public 3 vacancy) XXXXXXXXXXXXXXXXXXXXXXXX
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