Minutes - Alder Hey Childrens Hospital

2013/83
BOARD OF DIRECTORS
Minutes of the meeting held on Tuesday 28 May 2013 in the Boardroom
Present: Sir D Henshaw – Chairman (DH)
Mrs J Adams – Chief Operating Officer
(JA)
Mr D Alexander – Director of HR
(DA)
Ms G Core – Director of Nursing
(GC)
Mr P Huggon - Non-Executive Director
(PH)
Mr S Igoe - Non-Executive Director
(SI)
Professor I Lewis – Medical Director
(IL)
Mr E Oliver – Non-Executive Director
(EO)
Mr I Quinlan – Non-Executive Director
(IQ)
Mrs L Shepherd – Chief Executive
(LS)
Mrs S Sellers – Non-Executive Director
(SES)
Mr A Hamid – Non-Executive Director
(AH)
In attendance: Mr M McEwan – Interim Marketing & Comms Director (MMc)
Mrs K Critchley – Executive Assistant (minutes)
(KC)
Ms E Saunders – Director of Corporate Affairs
(ES)
Miss M Simmonds – Associate Director of Finance &
Development
(MJS)
Mr D Powell – Development Director
(DP)
Ms J Flynn – General Manager (2013/99 only)
(JF)
Mr S Earnshaw (Clinical Governance Lead - CAMHS)
(2013/99 only) (SE)
Dr P Venugopal, Consultant Cardiac Surgeon)
(PV)
Ms J Riley, Service Manager )item 2013/ (JR)
Mr I Atkinson, General Manager ) 102 only (IA)
Apologies: Professor I Greer - University Advisor to the Board (IG)
2013/94 MINUTES OF THE PREVIOUS MEETING HELD ON 7 th MAY 2013
The minutes of the meeting held on 7 th May 2013 were approved as an accurate
record.
2013/95 MATTERS ARISING & BOARD ACTION LIST
i
International Partnership Working
IL briefed the Board following a positive meeting with senior representatives of
the School of Tropical Medicine who were keen to collaborate with Alder Hey.
A particular area for development was translational medicine and child health.
This would facilitate the exchange of initiatives with developing countries and
would fit with Alder Hey’s international strategy. There would be potential for
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the development of key academic posts that would help enhance relationships
with the Tropical School and develop a joint platform. The Tropical School
had submitted a bid to develop a new centre for child and maternal health in
the centre of Liverpool.
It was also noted that the Director of Kanti Children’s Hospital in Nepal would
be visiting Alder Hey during his 10 day visit to the UK. During the visit the
Memorandum of Agreement, previously agreed by the Board, would be
formally signed.
ii
CBU Performance Framework - Escalation Process to Board
It was envisaged that a report would be submitted to the next meeting of the
Board.
iii
Quarterly BAF review
As agreed – the BAF review had been rescheduled to reflect the timings of
Corporate Risk Committee meetings.
iv
Joint Working with University
IL and LS provided feedback on discussions that had taken place over the
previous month, particularly around joint funding for the Research and
Education Facility at Alder Hey. However, the funding streams had not yet
been confirmed.
The Board was informed of on-going discussions in relation to a call for bids
for Academic Health Science Centres. The University had expressed its
intention to bid for a biomedical research centre, with all LHP partners at the
heart of it, but its financial support for this was not fully supported by the
partners. LS had met with IG and he was keen to move forward with a
children’s health theme and suggested developing proposals for the
biomedical research unit located at Alder Hey to support children’s research.
IG would be encouraging other partners to support this approach. The
development of a BCU at Alder Hey would be a major component of an LHP
BRC and would give an integrated approach to paediatric research. A
proposal would now be prepared setting out a business case, the investment
required and funding streams. Discussions regarding this approach were
on-going with the Chief Executive and Mayor of the City Council.
PH asked which other institutions had pledged funding for the education and
research facility. LS responded that subject to the business case, Edge Hill
University had agreed.
DP said that discussions were on-going with the Charity around funding for
the education facility.
AH said that there might be a possibility of funding from the LEP; he would
explore this further and keep LS informed.
DP said it would be important to have certainty around the funding
arrangements for the education and research facility by the end of July in
order to complete the specification. MS said that confirmation was awaited
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from Monitor as to whether or not a significant transaction assessment would
need to be undertaken, as the impairment of the old building means that we
will now reach the 25% of assets threshold even on lower costs schemes
until the move to the new hospital.
v
Update on Engagement Action Plan
LS provided feedback following the SLT Time Out that had focussed on
engagement and how to help senior leaders engage with staff in their areas.
The session had been facilitated by the Real World Group and the speaker
had been Professor Beverley Alimo-Metcalf – a renowned psychologist with
expertise in improving performance through engagement. SLT had gone
on to think about next steps. An action plan was now being devised and that
would be presented to the Board at the strategy meeting in July.
2013/96 KEY ISSUES
LS said that Joe Gibson had joined the Trust as Interim Head of Programme
Management in order to support the establishment of new Programme Management
Office arrangements designed to deliver the transition to the new hospital.
JA updated on progress with the resolution of the Theatres dispute. Further work was
required around a mutually agreed severance scheme and staff would be invited to
submit expressions of interest. It was hoped that the issues would be resolved within
the next three weeks but if that was not possible, the next stage of the disputes
procedure would be reached.
JA was pleased to announce that the Surgical Pathway Redesign Project had reached
the final round of a competition for innovation funding. Positive feedback had been
received following a presentation in London and the outcome was awaited. JA also
reported on the launch of the Abdominal Pathway, the development of which had been
based on patient and family experience. This was a fantastic example of clinical
leadership and a methodology that could be used across the Trust.
DA fed back on the current position with regard to HR Shared Services. It was agreed
that DA and SI would discuss the approach to resolving the ongoing issues with Capita
ahead of the Extraordinary Audit Committee.
GC provided feedback following her recent visit to Cleveland Children’s Hospital, Ohio,
where she had been exploring their approach to patient experience. She had been
encouraged that the visit had reinforced her view that the approach to patient
experience at Alder Hey was the right one, with many examples of good/innovative
practice. The aim now would be to ensure that those practices were embedded
consistently in all services across the Trust. GC would be presenting her findings in full
to CQAC.
DP said that the AHP scheme was progressing well.
MM reported that the Internal Communications Strategy was being refreshed. The
newly appointed Head of Internal Communications had taken up her post. Feedback on
the new intranet had been positive.
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IL said that the recruitment process for two new Clinical Directors was underway.
IL informed the Board that the Department of Health was seeking joint bids from local
authorities and trusts for integrated pioneer projects around long term conditions.
Whilst this primarily related to adult services, there had been an indication that a bid
from Liverpool around children’s services would be welcomed. This was now being
worked through with Liverpool CCG and Liverpool City Council.
MS briefed the Board on preliminary discussions with Aintree regarding a potential joint
venture agreement around decontamination. Options would be presented to the Board
in due course.
IQ had attended the recent FTN NED Network meeting.
2013/97 MONITOR PLAN
The Board reviewed the Strategic Plan prior to submission to Monitor.
Approach Taken to Quality – SES suggested that it would be helpful to include the
context of the Quality Aims and that these would be achieved over a longer period than
2013/14 as many are aspirational or stretch targetes. The wording to be amended to
set out the Trust’s aim and processes to reach the targets.
Nursing and AHP Workforce - DH asked that reference to the short term issues arising
from the new model of working in the new hospital be included.
Clinical Sustainability – The Board noted that further work was needed to fully
understand the impact on the sustainability of the Ophthalmology service model and
workforce arising from of the national service specification.
Subject to the amendments above, the Plan was APPROVED for submission to
Monitor.
2013/98 2012/13 ANNUAL REPORT AND ACCOUNTS
The Board received the 2012/13 Annual Report and Accounts. In response to a
question from SES, ES confirmed that the number of pressure ulcers contained in the
quality report was correct.
The Board APPROVED the 2012/13 Annual Report and Accounts.
2013/99 CARE QUALITY COMMISSION ACTION PLAN – MENTAL HEALTH REGISTRATION
The Board was reminded that the CQC had visited the Dewi Jones Unit in February and
three key issues had been identified for specific attention in advance of a further visit on
19 th June.
An update against the action plan to address the issues raised was presented to the
Board by Dr Steve Earnshaw, Clinical Governance Lead for CAMHS and Jacqui Flynn,
CBU General Manager.
• Safe Room/Seclusion – Capital investment had been approved and JF was
confident that the work would be completed by the time of the visit.
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• Policy/Guideline Issues – The policies/guidelines were currently being revised
and would be submitted through the appropriate governance channels for
approval.
• Interpretation of the Mental Health Act in relation to availability of RMN/LD Nurse
cover – It was noted that the required actions had now been taken to ensure the
required cover at DJU but that legal advice had been sought with regard to the
wider hospital.
SES suggested that in view of the implications for the wider Trust, the policies, and in
particular the Restraint Policy, should be reviewed by appropriate individuals in other
specialties. They should then be submitted to the Clinical Quality Steering Group for
review prior to approval by CQAC.
IL was concerned that requirements for registration as an adult provider of mental
health services were being applied to children’s services and that some of these were
not appropriate. He would be raising these issues with the CQC nationally.
The Board NOTED the action plan.
2013/100 NOTES OF THE AUDIT COMMITTEE MEETING HELD ON 25 th APRIL AND 23 rd MAY
2013
SI provided and overview of key issues discussed at the Audit Committee meeting held
on 25 th April 2013.
The notes of the Audit Committee meeting held on 25 th April were NOTED.
SI provided a verbal update on discussions held at the Audit Committee meeting of 23 rd
May 2013, which was predominantly to scrutinise and approve the Annual Accounts and
associated year end processes. KPMG had looked at data controls within the Trust and
had reported positively. Issues remained with the Capita contract and these would now
be addressed separately by the Audit Committee. Positive external assurance on the
Quality Report had been received.
It was recommended that the Letter of Representation for the Quality Report be signed
by the Chief Executive on behalf of the Board.
MS reported that following some testing of controls, KPMG had recommended that the
Trust should introduce an independent control process around starters and leavers.
This would now be formally introduced and reviewed on a monthly basis.
SI recommended to the Board, on behalf of the Audit Committee, that the Annual
Accounts be APPROVED.
2013/101 MORTALITY REPORT
IL presented the Mortality Report for Quarter 4, January to March 2013. Contained
within the report was a review of the Hospital Mortality Review Group, including
progress of the HMRG and how the HMRG is meeting its aims. He reported that there
had been 68 deaths from January to December 2012, which was a reduction of 10% on
the previous year. The vast majority of these cases had been subject to a primary
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service review and independent review within the timescale set. There had been 5
cases where the HMRG mortality review conclusions were discordant with the Service
Review/Department review. IL gave reassurance around the outcomes of those
reviews.
IL went on to brief the Board in detail on the cases set out in the report that had
potentially avoidable factors. In 22% of the cases death had been assessed as
inevitable before admission, withdrawal of care occurred in 35% of deaths, there were
documentation issues in 21%, possible medical management aspects (before arrival
and whilst at Alder Hey) in 9% and examples of good practice in 16%, even in the face
of losing a child.
The monitoring of mortality trends in cardiac surgery continued, using the funnel plots
produced by NICOR to compare the SMRs of the various cardiac centres. Based on
current monitoring, taking account of adjustments for comorbidity, Alder Hey was
positioned within the normal range.
IL gave an assurance that recurring themes were addressed through the internal
governance structures. There were no current indications of patterns of concern.
SES said that she was grateful for the work undertaken by the HMRG which had
provided learning for Alder Hey and other trusts. She was comfortable with the level of
reporting and timeliness. SES asked that the information be shared across the Trust.
The Board NOTED the conclusions of the Mortality Report.
2013/102 IMPROVING CARDIAC OUTCOMES
PV, IA and JR were welcomed to the meeting. PV gave a very detailed presentation on
clinical outcome reporting for cardiac surgery both nationally and at Alder Hey. He said
that the clinical outcomes for cardiac surgery were measured via mortality and morbidity
indicators. Data was submitted to the National Institute for Cardiovascular Outcomes
Research (NICOR) via the Central Cardiac Audit Database (CCAD). It was noted that
NICOR would expect a mortality rate of 3% and that Alder Hey’s position was 3.3%.
However, this did not take account of co-morbidity. All cardiac units were now in the
process of including co-morbidity factors in data analysis and the outcome of this
exercise was awaited.
PV gave detailed analysis of Alder Hey’s outcomes in cardiac surgery including
mortality and described how they were monitored through the Hospital Morbidity and
Mortality Group. The Board received a breakdown of the case mix for elective surgery
over the last 6 years against the mortality rates. In the proportion of neonates
undergoing surgery, the mortality rate had shown a decreasing trend despite the
neonatal group having the highest predictive mortality. Despite more complex surgery
being undertaken, mortality rates were deceasing and were well below the national
average.
Whilst the data did not reveal any concerns regarding outcomes for Alder Hey, PV said
that that there would not be room for complacency and the cardiac team would strive for
continuous improvement. To that end several actions had been identified:
• An away day had been planned for 4 th July where the whole team would come
together to look at improving outcomes. The Board looked forward to receiving
feedback following that session.
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• Looking to increase expertise amongst cardiology consultants
• Better utilisation of ECG department
• Bespoke database and database manager
• Case selection, to balance against risk averse practice
• Dedicated session once per month at the Quality Assurance meeting rather than
M&M meeting. SES said that she would welcome that approach as being a
positive move.
There were other wider interdependency considerations that were being addressed and
these were set out in the report.
The Board agreed that PV’s presentation should be circulated to Governors.
The Board NOTED the report and next steps identified. The Board was reassured
regarding the process for monitoring and the rigour applied.
2013/103 CLINICAL QUALITY ASSURANCE COMMITTEE
SES provided an overview of discussions at the Clinical Quality Assurance Committee
meeting held on 14 th May. The Terms of Reference had been reviewed and it had been
agreed that reference to the Trust’s duty of candour should be included to reflect the
culture of the organisation and the Committee’s role in monitoring this.
The Board NOTED the verbal update and looked forward to receiving the formal
minutes in due course.
2013/104 ALDER HEY IN THE PARK
MS reported on a meeting with Acorn regarding the outpatient department variation and
the external fees that would be incurred by Acorn. Counsel opinion was awaited on
whether these should be met by the Trust or Acorn. DH asked that a top level meeting
be arranged with Acorn to take stock of the overall scheme.
2013/105 DELIVERING OUR VISION
LS introduced JG, Interim Head of PMO, who came into post 10 days ago to help the
Trust move forward to the next phase in its transition to Alder Hey in the Park. He
would be advising how to develop a coherent programme incorporating the new build,
IT and transformation projects. JG explained the background to programme
management in the NHS and other sectors. He set out his proposals for the
programme.
DH emphasised that staff engagement would be key and that this should be given
particular attention. PH said that clinical involvement must be a priority. LS said that it
would be important to have CBU and in particular, service line management
involvement in taking the PMO forward.
Discussion took place on the proposal that the Executive Directors, as Executive
Sponsors, would receive a detailed overview report on a weekly basis. The SLT would
act as the Programme Board and proposals around this would be developed and
presented to SLT for consideration at its meeting on 20 th June.
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The Board discussed the process for Board assurance. Directors were conscious of
time limitations at Board meetings and felt that it would be appropriate for high level
exception reporting to be received. In order to address any issues expeditiously, it was
proposed that an informal group be established comprising:
o Trust Chair
o Chair of each Trust Assurance Committee
o CEO / Exec as required by the issues to be discussed
This group would meet as required to resolve particular issues.
The Trust Board would receive the minutes of the Senior Leadership Team meeting in
order to gain the assurance required.
It was AGREED:
2013/106 WORKFORCE BRIEFING
• SLT to be the Programme Board, reporting to the Trust Board on an
exceptional basis. Board to receive SLT minutes;
• Transformation Committee to be disbanded
• To establish a small group comprising Trust Chair and Chairs of
Assurance Committees to meet as required.
The Board received an update of activity on the key strategic and operational HR issues
arising during April and May 2013.
In respect of HR shared services DA reported that during April there had been 108
advances of pay necessary, 67 of which had been as a result of failings by Capita. This
was far worse than in previous months and was indicative of the poor level of service
being experienced. These issues had been discussed with Capita and a new suite of
KPIs was being developed.
DA said that at a recent Shared Services Steering Group meeting notice had been
given that a formal contract review process would be entered into. Careful
consideration would be essential when looking at other prospective providers of this
service.
SI reported that KPMG had identified a number of control weaknesses around Capita’s
processes. Discussions were underway between the consortium and Capita to address
those issues.
MS briefed the Board on the financial detriment being incurred by Alder Hey as a result
of another trust withdrawing from the consortium. The legal position surrounding this
was being explored.
It was noted that Capita’s local Operations Director would be invited to a meeting of the
Audit Committee within the next few weeks.
The Board NOTED the contents of the workforce briefing.
8

2013/107 CORPORATE REPORT and BOARD ASSURANCE FRAMEWORK
JA presented the newly formatted Corporate Report for the period ended 30 th April.
It was hoped that the new format would enable a greater focus on actions to improve
services to patients. Discussion took place on the format and ways in which it could
be improved. SES suggested that benchmarking data should be included. JA
agreed to continue to refine the document in line with input from other directors.
SES asked whether the reported increase in the number of complaints was as a
result of the data being recorded differently. GC agreed to look into this and to report
back.
JA reported 95% achievement against A&E targets and said that Alder Hey was one
of the few trusts that had achieved the four hour wait standard in 2012/13, despite
some challenging issues.
The Board received the proposed approach to the development of the Board
Assurance Framework for 2013/14. The risks were clearly set out, together with the
mitigations/actions. The Board was asked to provide any comments to ES.
The Board NOTED the Corporate Report for Month 1 and the Board Assurance
Framework for 2013/14.
2013/108 Car Parking
The continuing problems associated with car parking were discussed, together with
the actions being taken to alleviate them. The City Council had been approached
with a view to securing land for off-site parking for staff.
JA agreed to keep the Board updated.
2013/109 MINUTES OF THE RABD MEETING HELD ON 24 th APRIL 2013
The Minutes of the RABD meeting held on 24 th April 2013 were NOTED.
Signed: _____________________________ Sir David Henshaw, Chairman
Date: 2 nd July 2013
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Action List
Date No Action Who When
05/04/11 2011/58 International partnership
working to be explored
1/05/12 2012/79 Escalation process to Board to
be agreed with reference to the
CBU Performance Framework
28/05/12 2012/88 Quarterly BAF review to be
scheduled
05/02/13 2013/19 Cardiac Safe & Sustainable
Implementation Report
05/02/13 2013/25 Progress Report re joint
working with the University
05/02/13 2013/33 Progress re-funding the
Research and Education facility
D Henshaw /
I Lewis
J Adams
Actions ongoing -
private UK and
international
patients business
case being taken to
the March CoG
meeting
Framework to be
brought back to
April meeting
E Saunders February 2013
May 2013
September 2013
November 2013
Cardiac CBU
I Lewis
L Shepherd
April meeting
May meeting
April meeting
10