Minutes of previous meeting - East and North Herts NHS Trust

Agenda item: 5
EAST AND NORTH HERTFORDSHIRE NHS TRUST
Minutes of the Trust Board meeting held in public on Wednesday 28 th November 2012
at 2.00 pm in the Postgraduate Centre at the QEII Hospital
Present: Mr Ian Morfett Chairman
Mrs Alison Bexfield Vice Chairman
Mr Nick Carver
Chief Executive
Mrs Dyan Crowther Non-Executive Director
Mr Neil Dardis
Director of Operations
Dr Karen Pettit
Non-Executive Director
Ms Angela Thompson Director of Nursing & Patient Experience
Mr Paul Traynor Director of Finance
Mr Douglas Smallwood Non-Executive Director
In attendance:
From the Trust: Mr Stuart Gavurin Non-Executive Director (Designate)
Mr Greg Allen
Director of Workforce and Organisational Development
Mr Stephen Posey Director of Strategic Development
Dr Jon Baker
Deputy Medical Director
Ms Jude Archer Company Secretary
Mrs Victoria Fisher Trust Secretary
External: Ms Helen Mundy People & Performance Ltd (Observer)
Mr Richard Youell People & Performance Ltd (Observer)
Mrs Audrey Allaker Chairman, East Herts NHS Retirement Fellowship
Mr Donald Allaker East Herts NHS Retirement Fellowship
Mr Yogi Parashara O2 Health
12/209 CHAIRMAN’S OPENING REMARKS
ACTION
12/209.1 The Chairman welcomed everyone to the meeting and reported
that the Board had enjoyed a productive development session
that morning, with contributions from a number of community
stakeholders and other service providers.
12/209.2 The Chairman explained that, as part of the Board’s development
work, the Board meeting was being observed by two
representatives from People & Performance Ltd, the company
assisting the Board in this work. A further Board development day
would be held on Friday 30 th November.
12/210 DECLARATION OF INTERESTS
There were no declarations of interest relevant to the agenda.
12/211 QUESTIONS FROM THE PUBLIC
There were no questions from members of the public.
12/212 APOLOGIES FOR ABSENCE
Apologies were received from Miss Jane McCue, Medical
Director, who was represented by the Deputy Medical Director,
and Mr Julian Nicholls, Non-Executive Director.
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12/213 MINUTES OF THE PREVIOUS MEETING
The Board approved the minutes as an accurate record of the
meeting of 24 th October 2012.
12/214 MATTERS ARISING
The Board reviewed the actions log and was satisfied that all
actions were either completed or on track for completion.
12/215 CHIEF EXECUTIVE’S REPORT
12/215.1 The Board reviewed the Chief Executive’s monthly report, which
captured the major themes of the past month and gave an
overview of the issues that had concerned the Executive, as well
as an update on recent developments. The floodlight scorecard
showing the Trust’s performance against key indicators was
appended to the report.
12/215.2 The Chief Executive began by reporting the names of the winners
of the 2012 ‘Celebration of Excellence’ staff awards held on 15 th
November. The Board then watched a brief video demonstrating
the pleasure and surprise with which the recipients had reacted to
their awards. Winners in the public nominations category had
been particularly humbled to have been nominated in this way.
12/215.3 The new Standards for Members of NHS Boards and Clinical
Commissioning Group Governing Bodies in England, which was
published by the Professional Standards Authority and outlined
the values to be adopted by NHS Boards, was appended to the
report. The Chief Executive welcomed this as an important
publication which aligned closely with the Trust’s values and the
work ongoing under the ARC programme for organisational
change. The Board would be discussing the document further,
not only as a Board but with partner organisations, in order to
adopt a common set of values.
12/215.4 The Chief Executive reported that the Midlands and East
Specialised Commissioning Group (SCG) Vascular Project Board
was expected to make a recommendation on vascular
reconfiguration across Hertfordshire and Essex to the SCG
shortly. A number of senior Trust clinicians had been actively
involved in providing supporting information and an options
appraisal had been carried out on 26 th November.
12/215.5 The Trust had recently celebrated the fortieth anniversary of the
opening of the Lister Hospital with the dedication of a special oak
tree by Her Majesty’s Lord Lieutenant of Hertfordshire. The
ceremony had been attended by a number of members of staff
past and present, including some who had been present at the
opening.
12/215.6 The Chief Executive sought approval for the Executive
Committee’s revised terms of reference, which had been updated
and reviewed for consistency with the Trust’s Standing Orders
and Scheme of Delegation. Following discussion with the
Chairman and the Company Secretary, it had also been decided
that a summary of the issues discussed at the Executive
Committee would be included in the Chief Executive’s monthly
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eport to the Board. The Board approved the Executive
Committee’s terms of reference.
12/215.7 The first of a new round of ARC meetings had now taken place at
Mount Vernon and had been well received. This series was
focusing on the need for line managers to be personally resilient
and to manage the stress levels of their teams as well as their
own. The Chief Executive commended the sessions to all Board
members, to attend one if possible.
12/215.8 Finally, the Chief Executive reported that NHS Hertfordshire and
the East and North Herts Clinical Commissioning Group (CCG)
Board had now stopped all new referrals for major joint surgery to
the Surgicentre. Clearly this added to the concerns previously
discussed for the potential reputational harm to the Trust arising
from Clinicenta’s management of the Surgicentre. Further
commercially confidential discussions would be held in the Part II
meeting.
12/215.9 Mrs Crowther asked the Chief Executive to expand on the
reference within his report to visiting locality groups, since this
would appear to be an important initiative to continue. The Chief
Executive explained that he and a number of colleagues had
attended the Welwyn Hatfield Target Group meeting on 8 th
November and had had the opportunity to brief GPs and practice
managers in that area on current developments and to receive
feedback on the Trust’s services. On 20 th November he and
colleagues had met with the Stevenage locality group and had
briefed a similar audience on the Trust’s change agenda and the
challenging period of transition as well as, again, receiving
feedback from GPs. Both groups felt it important for Trust
representatives to attend on a regular quarterly basis, a move that
the Trust very much welcomed.
12/216 FINANCE AND PERFORMANCE COMMITTEE (FPC) REPORT
12/216.1 The Board reviewed the key issues discussed at the FPC meeting
of 21 st November 2012.
12/216.2 On behalf of the Chair of the FPC, the Vice Chairman presented
the report and welcomed the fact that counter fraud awareness
training had been included once more in the Trust’s core induction
programme rather than being delivered through a stall at induction
sessions. This had been requested by the FPC following
concerns raised by the Audit Committee and was felt to be
particularly important in the current climate.
12/216.3 The Vice Chairman reported that the FPC had spent a
considerable amount of time discussing the financial position and
the revised forecast, and had asked for a number of additional
analyses to help understand the full implications. It had looked at
the areas of concern, particularly Mount Vernon, and it had also
asked to see clearly the recurring operational financial position in
future reports, as against the non-recurrent issues.
12/216.4 The FPC had considered an analysis of private patient
profitability, provided at its request, in order to be sure that this
work was contributing to the funds available for NHS work and
had not become a drain on them. It had requested further work
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on volumes and actions with timescales.
12/216.5 The FPC had been concerned that the patient level costing
system (PLICS) was not being used to best effect and it had
received, at its request, some proposals to develop the use of the
system. The Committee had sought assurance on the clinical and
financial benefits, and recognised that effective use of PLICS
required some significant cultural change. It recommended that a
discussion of the issues and risks should take place at a future
Board meeting. The Chairman added that the Committee was
strongly supportive of moving to PLICS as the standard reporting
tool but it was important to understand how this could be achieved
and the associated risks.
12/216.6 In terms of workforce issues, the FPC had been pleased to note
the reduction in bank and agency expenditure. It had also
discussed a project plan for the full implementation of ESR
(electronic staff record) modules and had noted that the Audit
Committee would be discussing an internal audit review of the
project governance. It was vital that the project now remained on
track.
12/216.7 In its review of data quality metrics, the FPC had been concerned
at performance against the indicator for level of accuracy of
referring GP. Clearly this was a key area in the context of the
Trust’s relations with GPs and the Committee had asked for a
plan to address the matter.
Finance Report at Month 7
12/216.8 The Board considered a report setting out the financial position of
the Trust at the end of October 2012. The paper had been
discussed in detail by the FPC.
12/216.9 The Director of Finance reported that the Trust had delivered a
surplus both in month and year to date, but was now behind plan
by £2,726k. On the positive side, the Trust had maintained its
financial risk rating (FRR) of 3 and was forecast to continue to do
so.
12/216.10 October had been a relatively positive month for activity and
income although a variance had still been seen at Mount Vernon.
The most significant issues had been the negative outcome of a
legal matter and a revision to the plan for transformation funding.
As a result of these and all the contributory issues and risks set
out in the paper, the Trust had revised its forecast surplus from
£3.6m to £0.5m and had communicated this to the Strategic
Health Authority (SHA) and to commissioners. The FPC had
required a clear set of actions - some of which were already under
way, such as establishing the impact of the revised forecast on
the long term financial model (LTFM) - including an assessment of
the short, medium and long term issues.
12/216.11 In relation to the variance at Mount Vernon, the FPC had
requested the attendance of senior representatives from the
Cancer Division at its next meeting, and would be expecting a full
report and recovery plan.
12/216.12 The cash flow position had been discussed in detail at the FPC.
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Although this was £3.6m behind plan, it was pleasing that the
Trust had maintained performance against the Better Payment
Practice Code (BPPC) at almost 80%: this was a considerable
improvement upon previous years. In terms of capital, there was
a small over-commitment on the capital programme but the
Capital Control Group was monitoring projects carefully and was
confident that expenditure would come in on target. Operational
capital had been the subject of some debate at the FPC, which
had sought assurance that this would not be squeezed below an
acceptable level.
12/216.13 Mr Smallwood challenged the Director of Finance on his level of
confidence that the Trust would achieve a surplus and how an
FRR of 3 could be maintained in view of the new position. In
relation to the latter, the Director of Finance explained that the
FRR was now a weaker 3 than it had been previously and any
further deterioration in the position would put this at risk. As far as
the surplus was concerned, he was reasonably confident:
revising a forecast had significant implications for the Trust and
for the SHA, and it was therefore important to put forward a
realistic figure.
12/216.14 Mrs Crowther asked how the Executive intended to manage the
revised position from a reputational perspective and how the
Board could best help with this. There was also a danger of staff
feeling that the position left the Trust with planning blight. The
Director of Finance said that the Executive had already been
briefing stakeholders within the wider health economy on the
reasons for the revised forecast, and would maintain a close
dialogue with commissioners. In addition, analysis showed that
the Trust was sustainable in the medium and long term, the
current position being the result of short term issues. The Chief
Executive added that internally the reasons for the revised
position were being communicated but the strong message was to
continue to focus on delivering operational performance – which
continued to be good – including cost improvement programmes
(CIPs) and reduction in agency costs.
12/216.15 The Chairman queried whether the revised position would have
an impact on CIPs in the current year. The Director of Finance
said that there was no plan to revise the current year’s CIPs: the
aim was for Divisions to adhere to the tough targets that had been
set originally.
12/216.16 Given the tightness of the position, with no further contingency
available, the Vice Chairman questioned the Trust’s resilience to
any severe weather conditions and potential loss of activity. The
Director of Operations said that the Trust had always
demonstrated a resilient approach in such circumstances but
clearly both winter pressures and the risk of loss of activity
through the centralisation of services were challenges that
remained. The Director of Finance added that, while there was no
specific contingency to cover snow days, the planned phasing of
working days allowed for a lower level of activity than expected,
albeit not for a prolonged period.
12/216.17 Dr Pettit sought assurance on the robustness of longer term plans
in terms of covering any future non-recurrent issues. The Director
of Finance said that the Trust remained viable, albeit with a
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educed level of surplus. However, the situation was complicated
by the fact that the Trust was in mid-reconfiguration, which meant
that some issues would be recurrent only until full consolidation
whereas others would persist beyond that. There was a balance
to be struck between an appropriate level of contingency and
strengthening the surplus and cash position, as well as the LTFM.
The Chief Executive added that if Treasury approval for the final
Phase 4 business case was not forthcoming by early December,
the Trust would not be able to complete its reconfiguration by
October 2014. As things stood, because of the delays already
experienced in gaining approval, services had had to be
reconfigured in a way that produced excellent clinical
improvements but was not the most efficient in other ways, such
as the centralisation of fracture neck of femur services at the QEII.
This had added to the Trust’s current financial pressures and it
was important that the wider health system saw the current
position in that context.
12/216.18 Mr Gavurin welcomed the high degree of confidence in the
revised forecast but stressed that the Trust could not afford to
revise it again.
12/216.19 In conclusion, the Chairman said that it would be crucial, in such a
tight period, to be vigilant in monitoring quality and patient safety
to ensure that these did not suffer in any way.
Performance Report
12/216.20 The Board considered a report summarising the Trust’s
operational performance at Month 7. Details of progress against
the Trust’s performance framework standards, including Monitor’s
Compliance Framework and the SHA Governance Risk Rating,
NHS Operating Framework standards, contract standards and
local standards were provided in a data pack, together with
exception reports for stroke admissions within four hours of arrival
and MRSA emergency screening, and an improvement trajectory
for meeting the local 18-week target in four specialties. The
report had been discussed in detail by the FPC.
12/216.21 The Director of Operations reported a positive month’s
performance, with all national standards delivered and a green
governance risk rating. It was especially pleasing to see a high
level of performance maintained in A&E, despite a period of
considerable pressures, as well as the continuing improvement in
DNA (did not attend) rates and readmissions. Good progress was
also being made by the Transforming Inpatient Management
Programme (TIMP), particularly on length of stay.
12/216.22 Turning to the exception reports, the Director of Operations said
that it had been a disappointing month in terms of meeting the
local target for 18 weeks for all specialties, but all except Oral
Surgery and Trauma and Orthopaedics were on course to have
recovered by the end of November and the trajectories had been
agreed with the PCT. In the case of Trauma and Orthopaedics,
performance was affected by the increase in case complexity
resulting from the case mix transferred to the Surgicentre. As far
as stroke services were concerned, the issues were the same as
the previous month, with 13 of the 19 breaches taking place out of
hours. In the majority of cases there were no significant delays.
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The seniority of staff out of hours was being increased but not all
remedial actions were in place as yet.
Workforce Report
12/216.23 The Board considered a report that provided information on the
standard monthly metrics and Trust-wide issues relating to
management of the workforce. Detailed indicators were attached
in the data pack. The report been discussed in detail by the FPC.
12/216.24 The Director of Workforce reported that the Board development
session on 19 th December would focus on workforce issues, with
a view to feeding in to the revised People and Workforce
Development Strategy. At a national level, it was important to be
aware that proposals for changes to the terms and conditions of
Agenda for Change had now been agreed for consultation and
these would have a significant impact on the pay framework from
1 st April 2013, if endorsed.
12/216.25 Turning to the key indicators, the Director of Workforce drew the
Board’s attention to the detailed analysis of vacancies in the
report. The nursing cohort of 60.64 whole time equivalents (WTE)
that was reported as starting in October was in fact a cohort of
c.58. Divisional workforce plans were being finalised and would
feed in to a Trust-wide workforce plan, the first draft of which was
expected to be considered by the Executive Committee before the
end of December. As the Board had requested, reasons for the
medical staffing vacancies in Surgery were set out in some detail,
together with the actions being taken to address these: the
Division had not sought to hold any medical staffing vacancies.
12/216.26 A remedial plan for the implementation of the e-learning and self
service modules of the electronic staff record (ESR) had been
presented to the FPC, as it had requested, and an internal audit
review of the project was due to be considered by the Audit
Committee on 3 rd December. The Vice Chairman, as Chair of the
Audit Committee, explained that this had been designed to focus
on the governance of the project, to ensure that this was fit for
purpose for the future.
12/216.27 In relation to vacancies, the Chairman said that he had received
good assurance on the position on a number of wards that he had
visited. The Director of Nursing said that some areas had higher
vacancy rates than others but these areas were being targeted,
with different strategies put in place such as rotating staff across
sites. Where necessary, bank staff were used to ensure safe
staffing levels. The vacancy position was monitored on a monthly
basis and, while there had been some successful recruitment
initiatives, there were also a number of leavers. Exit interviews
were always conducted and it was clear that those staff who left
had valid reasons for doing so.
12/217 RISK & QUALITY COMMITTEE (RAQC) REPORT
12/217.1 The Board reviewed the issues discussed by the RAQC at its
meeting of 21 st November 2012.
12/217.2 Mrs Crowther, as Chair of the RAQC, took the Board through the
issues that had been referred to the Committee and the RAQC’s
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approach to those issues, as follows:
The issue of bed occupancy, which had arisen from a
discussion on the nursing metrics, would be included in the
review of next year’s indicators for the floodlight scorecard;
The RAQC would look again at palliative care and would
receive a paper or presentation on this at its January meeting;
The issue of identifying and developing high performing
individuals had been discussed at some length and the RAQC
had agreed that the term “high potential individuals” was more
appropriate. It had also agreed that, rather than creating a
new initiative, a mechanism for identifying and developing
such individuals should be built into the revised People and
Workforce Development Strategy;
Finally, in relation to a letter from the Department of Health to
all trusts following the recent allegations of abuse involving the
late presenter Jimmy Savile, it was clearly appropriate to
review the Trust’s safeguarding arrangements. A review was
already under way and the RAQC had asked for a report back
from the Director of Nursing.
12/217.3 The RAQC had reviewed the new Quality Governance and Risk
Management Strategy and had welcomed this as a good piece of
work. It had made some minor recommendations to refine it
further and had also recommended that a simpler, easy to read
summary should be produced for use across the Trust. The
strategy would now be reviewed by the Audit Committee before
being presented to the Board.
12/217.4 The RAQC had debated the key measures for measuring the
Trust’s success in achieving its vision “to be amongst the best”
and had decided that further work was needed, including
consultation with other groups, such as patient focus groups. The
RAQC had therefore agreed to defer bringing the measures back
to the Board until this work was completed.
12/217.5 The RAQC had received two comprehensive reports from the
Director of Nursing, on patient safety and patient experience, and
had welcomed particularly some excellent work on the nursing
establishment review. The Committee felt that this was a good
model and it was encouraging that staff on the wards had
engaged positively with the review. It also felt that it was
important not simply to respond to the model but to use it as a key
decision-making tool.
12/217.6 In relation to the RAQC’s discussion on high potential individuals,
Mr Smallwood highlighted the fact that the Committee had
focused on clinical performance as part of this, in line with the
Board’s request. It had asked the Medical Director to include
more detail on this aspect in her next report.
12/217.7 In relation to the key measures of success for the Trust’s vision,
the Vice Chairman urged that the Trust should not focus solely on
targets. It was important to be sighted on areas where the Trust
was not necessarily amongst the best, and particularly where
clinicians felt that the Trust was not achieving best practice, in
order to inform the Board’s discussions on resources. The Chief
Executive added that it was also important to discuss with
stakeholders what they felt that being amongst the best would
mean. The Chairman agreed with the points made but since the
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Board had asked some time ago for measures to be developed,
he felt that it was important now to come to some conclusions
even though further work would need to be done to refine and
develop the measures.
12/217.8 The Board asked the RAQC to take its views into account when it
considered the measures again.
Chair of
RAQC
12/218 ANY OTHER BUSINESS
12/218.1 The Chairman congratulated the Chief Executive on all that he
had achieved since being appointed to his post ten years ago.
His passion for putting patients first and for excellence had shone
through at all times.
There being no further business, the meeting closed at
3.25pm.
12/219 DATE OF NEXT MEETING
The next meeting would be held on Wednesday 19 th December
2012 at 2.00 pm in the Lister Education Centre.
Ian Morfett
Chairman
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