A G E N D A 1. APOLOGIES FOR ABSENCE Ian Metcalfe 2 ...

• nurse staffing was already being reviewed as PS hadalready commented;• the business case for the Acute Outreach Team was beingprepared and needed to consider whether nurses or alliedhealth professionals could deliver this service;• the number of doctors was more difficult and getting to a 7day consultant presence presented a real challenge andneeded to be reviewed in the context of the general medicaltake and required creative thinking about how to do this inorder to make it affordable although it had been consideredin the context of the merger; and• discussions regarding continuing health care assessmentsin community settings had been discussed earlier.SP emphasised the need to reach agreement on what needed tobe done and to do so quickly in order to avoid a further dip inperformance. JS agreed and added that the Trust may need tolook closely at the need for investment.TS/HLTS added that there was a risk when looking at one service inisolation as HL had already stated. He noted that any additionalinvestment would need to be looked at in the and it needed to belooked at in the round in the context of other pressures in Urologyand in the Acute Admissions Unit ensuring the Trust maintained asustainable financial position. SH confirmed that this had not beendiscussed in detail as part of budget-setting.JK added that the Stroke Unit had demonstrated the benefit interms of patient outcomes on mortality, infection rates, venousthromboembolism, Adverse Incident Reports, readmissions andpatient satisfaction despite the process deficiencies highlightedbut maintaining outcomes for patients was causing some strain forthe service. He highlighted that an investment in processimprovement may lead to outcome improvement and also thatthere was a huge seasonal variation which could be reflected infuture funding, and the same was true of Medicine for the Elderly,and the Stroke Unit could also work more closely with Medicine forthe Elderly and the Acute Medical Unit to deliver therecommendations.AP and SCB shared some frustration that these recommendationshad not been discussed in budget-setting meetings.SCB was also concerned that the Board and the Governorspresent were also hearing this for the first time. She asked whatlevers the Trust had around discharge planning. HL added that theTrust was dealing with discharge planning across all areas and notjust the Stroke Unit. She described some of the actions includingthe ability for the Trust to instigate some re-ablement packagesdirectly and having social workers as part of multi-disciplinaryteams and agreed to bring information back to the Board toHLBOD/Part 1MINS 10.05.13 PAGE 11 OF 16