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TRUST BOARD OF DIRECTORS (PUBLIC)

Minutes of the Public Meeting held on Tuesday, 7 July 2020 at 9.00 am

Via Video Conference

For the purpose of transacting the business set out below

Present: Mr Terry Moran CB Chair Mr Jim Hayburn Interim Director of Finance Mrs Ellie Monkhouse Chief Nurse Mr Shaun Stacey Chief Operating Officer Dr Kate Wood Medical Director Mrs Linda Jackson Vice Chair Mr Antony Bramley Non-Executive Director Mr Neil Gammon Non-Executive Director Mrs Sandra Hills Non-Executive Director Mr Michael Whitworth Non-Executive Director In Attendance: Mr Ade Beddow Associate Director of Communications Mrs Elaine Criddle Deputy Improvement Director Mrs Kathryn Helley Improvement Programme Director Mrs Helen Harris Trust Secretary Mrs Alison Hurley Membership Manager & Assistant Trust Secretary Mr Jug Johal Director of Estates & Facilities & Interim Director of Digital Services Mrs Claire Low Acting Director of People & Organisational Effectiveness Mr Ivan Mcconnell Director of Strategic Development Mr Brian Page Lead Governor Mr Ian Reekie Public Governor Miss Jane Warner Head of Midwifery Services (for item 3.4) Mrs Sarah Meggitt Personal Assistant to the Chair, Vice Chair & Trust Secretary

(for the minutes) Cumulative Record of Board Director’s Attendance (2020/21) Name Possible Actual Name Possible Actual Mr Terry Moran 2 2 Mrs Sandra Hills 2 2 Dr Peter Reading 2 1 Mrs Linda Jackson 2 2 Mrs Jayne Adamson 1 0 Mr Jug Johal 2 2 Mrs Wendy Booth 1 1 Mrs Claire Low 2 2 Mr Antony Bramley 2 2 Mr Ivan Mcconnell 2 2 Mr Neil Gammon 2 2 Mrs Ellie Monkhouse 2 2 Mr Stuart Hall 2 1 Mr Jeff Ramseyer 1 0 Mr Marcus Hassall 2 0 Mr Shaun Stacey 2 2 Mrs Helen Harris 1 1 Mr Michael Whitworth 2 2 Mr Jim Hayburn 2 2 Dr Kate Wood 2 2

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1. Business Items

1.1 Chair’s Opening Remarks Terry Moran declared the meeting open at 9.00 am and welcomed Helen Harris to her first Trust Board meeting in her new role as Trust Secretary. He also welcomed to the meeting Brian Page, the Lead Governor, Elaine Criddle, the Deputy Improvement Director, Ian Reekie, a public Governor and Richard Peasgood, the Executive Business Assistant to Shaun Stacey. He then welcomed Kathryn Helley, the Improvement Programme Director and advised she would now be attending Trust Board meetings. Terry Moran thanked everyone present and their teams for the pace of work which had been maintained throughout the COVID-19 pandemic. He recognised that although this was now having a reduced impact, the Trust were required to continue to manage this and face the important challenge of restoring as many services as possible. He asked that members noted the importance of being open and transparent about the challenges posed going forward over the next few months, and to appropriately escalate as required. Due to the pandemic, the format of Board meetings had changed over recent months, and Terry Moran informed members that this would now revert back to normal scheduled business meetings from August. He requested that everyone should aim to continue to work with leaner papers where possible, as per the process over recent months. He confirmed that further Board development sessions would also be held going forward.

1.2 Apologies for Absence Apologies for absence were received from Dr Peter Reading and Stuart Hall.

1.3 Declarations for Interest Terry Moran asked if anyone present had any declarations of interest in relation to the business to be transacted. Linda Jackson referred to the Annual Maternity Review and declared that she had two relatives who worked in this area.

1.4 To approve the minutes for the Trust Board Self -Certification Meeting held on 27 May 2020 – NLG(20)127 The minutes of the meeting held on Wednesday, 27 May 2020 were approved as a true and accurate record of the meeting and would be duly signed by the Chair.

1.5 To approve the minutes of the Public Meeting held o n 2 June 2020 – NLG(20)128 The minutes of the meeting held on Tuesday, 2 June 2020 were approved as a true and accurate record of the meeting and would be duly signed by the Chair.

1.6 Urgent Matters Arising Terry Moran invited Board members to raise any urgent matters which required discussion and were not captured on the agenda. No matters were raised.

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1.7 Trust Board Action Log – Public by exception NLG(20)129

Terry Moran invited Board members to raise any further updates by exception in relation to the Trust Board Action Log. The Board Development Strategy action will be discussed outside of the meeting to clarify the additional work required.

1.8 COVID-19 Trust Board Decision Log: Use of Emergency Powers and Matters Deferred or Dealt with via a Different Route – NLG( 20)091 Terry Moran provided an overview of the purpose of this paper and requested the review date for the Board Development Programme be updated to reflect the new date of 30 August 2020. Terry Moran sought any comments or questions. Tony Bramley advised that in respect of the outcome of the Board Sub-Committees review, the Audit, Risk and Governance Committee (ARGC) update would be provided at the 4 August 2020 Trust Board meeting. Dr Kate Wood referred to the Medicines Management Annual Report and advised this would not be timely for sharing with Board members at the August 2020 meeting, and agreed to discuss this outside of the meeting with Helen Harris.

1.9 Chief Executive’s Briefing As Acting Chief Executive, Ellie Monkhouse advised she had no specific update to deliver from Dr Peter Reading on this occasion. Staff were thanked for their work over the weekend for undertaking additional shifts in light of “Super Saturday” which had coincided with the 72nd birthday of the NHS, which meant services had been maintained. Although the Trust’s Accident & Emergency Departments had not been as busy as expected. In respect of COVID-19, the Trust only had one in-patient across all sites at that time and continued to plan for Phase 2 of the pandemic along with winter planning, and the capital planning funding request had been submitted. Ellie Monkhouse informed members that the Care Quality Commission (CQC) had released their Emergency Supportive Framework which related to infection prevention and control, and advised there would be more discussion on this item later in the meeting. Linda Jackson queried whether there had been any specific issues over the weekend in respect of “Super Saturday”. Ellie Monkhouse confirmed there been no issues raised, the Trust was currently working as “normal” in respect of attendance figures and briefed Board members with an overview of the social distancing measures being utilised.

2. Review of Assurance Committees & Highlight Reports

2.1 Audit, Risk & G overnance Committee

2.1.1 Highlight Report from the Audit, Risk & Governance Committee (ARGC) – NLG(20)131 Tony Bramley shared the report with the Trust Board and advised that the recent ARGC meeting had addressed the Annual Accounts and highlighted that the Trust

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had received nine audit reports since the previous meeting. One of these was in draft, one had received ‘high’ assurance and the remaining seven had received ‘significant’ assurance. Terry Moran thanked Tony Bramley for his succinct report and update and sought any comments or queries. None were received.

2.2.2 Audit, Risk & Governance Committee Annual Report 20 19/20 – NLG(20)131a Tony Bramley shared the report with the Trust Board and advised it summarised the Committee’s work over the previous year. He explained that the report had included changes made by the Committee in respect of COVID-19, which were included in section 7. Terry Moran sought Tony Bramley’s perspective of the assessment of the effectiveness of changes to governance arrangements during the COVID-19 pandemic in his role as Chair of the Committee. Tony Bramley confirmed that from a governance perspective, it had been recognised that there had been no significant issues and the Trust had performed well. Jim Hayburn expressed his interest in benchmarking how well the Trust had performed against other Trusts and although a streamlined approach had been adopted, it had not felt like a reduction in time had been spent on key issues or oversight requirements. Terry Moran concurred, and added that the reduced levels of bureaucracy had been welcomed whilst appropriate and effective oversight had been maintained.

Board Assurance Framework (BAF) – NLG(20)132 Terry Moran informed members that development of the BAF was ongoing. He drew attention to page 23 in relation to the strategic objective around being a good employer and the inability to secure numbers of appropriately skilled staff, noting that there had been an increase in this risk rating. Helen Harris confirmed this was due to staff recruitment in respect of the number of current vacancies, and potentially the early retirement of staff due to the pandemic. The Trust was due to strengthen the BAF in future by streamlining some assurances and ensuring target dates were detailed against each area. An additional sentence had been added in respect of the “delivery of core services” for Strategic Objective 3 on page 10. Terry Moran sought an update from Ellie Monkhouse on the points made by Helen Harris in respect of staffing. Ellie Monkhouse advised that issues around staffing had partly been due to COVID-19 but also formed part of an ongoing organisational trend for the Trust due to the geographical area. The Trust had around 100 whole time equivalent (WTE) vacancies over the last 18 months which at times had reduced to 70. In order to address this issue, One-stop Recruitment Shops had been introduced on site and held on a quarterly basis. These had led to the Trust successfully employing approximately 25 to 30 people per day into vacant positions, but unfortunately due to COVID-19 and social distancing requirements, these had not been held recently and would require adaptation in future. Ellie Monkhouse explained that part of the retention and recruitment plan was to place international nurses, and the Trust had linked in with Health Education England (HEE) on their Global Learners Plan to these aims. This could allow the Trust to recruit between 50 to 80 international nurses and 40 nurses were currently waiting to commence at the Trust. This presented a short-term difficulty as sufficient accommodation, educational or pastoral support was not available for so many nurses to be recruited at the same time. The Trust would also need to establish a

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new Band 6 post to support the nurses whilst they transitioned into their new roles. Ellie Monkhouse provided an update on the Trust sign up to the Aspiring Nurse Programme which had brought very positive results, and 80 year three student nurses were hoping to remain working at the Trust. The work she had undertaken with Shaun Stacey to reduce the bed base due to social distancing and the need to ensure and sign-off safer staffing levels with any ward configuration changes. Linda Jackson referred to the 203 WTE vacancies detailed in the staffing report and queried whether it could include a diagram which demonstrated the information and positive developments being implemented and queried why the unregistered staff vacancies had increased back to 6.5%. Ellie Monkhouse advised work was being undertaken to address this and once Board meetings were fully reinstated, then the standard paper would be distributed again which contained greater detail about the vacancy information. There had been a blockage in the approval at establishment reviews in relation to the unregistered staff vacancy rate, however, this had now progressed and approximately 75 unregistered nurses were trained and ready to commence with the Trust. Neil Gammon queried if there was anything more the Board could support with in respect of the international nurse issues, and whether there was a plan to fill the gap if they were unable to commence immediately. Ellie Monkhouse advised the Trust had a dual international approach which included the link with HEE so they were able to seek their support. The Trust also had an international recruitment drive through the talent pool which she had amalgamated with Claire Low, and this had created a pool of additional international nurse’s pool. In addition the Trust would be part of a planned significant international nurse recruitment drive once the pandemic eased through the Chief Nursing Officer for England. Terry Moran inquired whether Board members thought each Board meeting should focus on two specific strategic risks with associated in-depth discussions, as he found this useful in his chair role at Hull University Teaching Hospitals NHS Trust (HUTH). Board members were asked if they felt the Trust was not managing the Trust finances effectively by not filling the vacancies. Linda Jackson confirmed that if nursing vacancies were filled the Trust would be able to reduce the premium costs of agency staff. Shaun Stacey concurred and explained the Trust needed to review how it attracts and retains its’ workforce. The inability to fill vacancies due to the location of the Trust had not always been considered as part of the long term recruitment process, and some appointments processes were better developed in other parts of the country. Ellie Monkhouse advised that the approval process through the Trust establishment was very lengthy, created further difficulties for some vacancies and explained the Trust was not adhering to the Carter Principles in respect of filling posts due to staff covering maternity leave. This is due to the issues around the Nursing Establishment, whereby the Trust is currently filling vacancies with agency staff which incur higher costs. Greater investment was required to address workforce cover for the night programmes and seven day working requirements. Sandra Hills also felt the Trust were losing therapists due to a lack of structured career development. Improvements were evident over the last three years but more was required to retain staff alongside front-loaded investment. Jim Hayburn recognised the need to address such issues and requested consideration also be given to the Trust’s financial deficit position, advising of the

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importance to prioritise such funding and investment. Claire Low confirmed earlier comments around the historical difficulties the Trust’s geographical location posed for recruitment and retention. Helen Harris referred to the point raised by Terry Moran in respect of focussing on two strategic risks at Board meetings, and suggested the first one to focus on would be Strategic Risk 1 – ‘To Give Great Care’ as this held the high level of risks at present. Terry Moran queried whether Board members thought it would be useful to hold a Board Development Session to discuss staff recruitment and retention issues, and establish improvements which could be made. Ellie Monkhouse referred back to the paper discussed at the August 2019 meeting in respect of the nursing establishment and sought support to progress the recommendations, as many had been discussed within the meeting. Terry Moran asked Board members whether they felt the increased risk rating was appropriate and this was agreed. The risk ratings were approved and Terry Moran thanked everyone for a rich discussion.

2.2 Quality & Safety Committee

2.2.1 Outcome of the Review & Refocus of the Quality & Safety Committee – NLG(20)133 Tony Bramley shared the paper with Board members and advised that some shortcomings had been identified following the self-assessment and review, and actions had been established to address these. Minor amendments had been made to the Terms of Reference which were detailed within the document. Tony Bramley drew the Board’s attention to section 7.1 in relation to the Committee membership and a discussion around attendance levels of Executive and Non-Executive Directors (NEDs). It had been agreed to change the core membership to NEDs only, with the additional attendance of the Chief Operating Officer or Deputy, Medical Director, Chief Nurse and Associate Director of Quality Governance. This would approach would also be reflected within other sub-committees. He concluded that the review had been a lengthy but positive process overall and very productive. Terry Moran sought comments or approval to the changes made within the Terms of Reference. The changes were approved.

2.2.2 Highlight Report from the Quality & Safety Committe e – NLG(20)134 Tony Bramley shared the report and highlighted the key the revised simplified trial arrangements for pressure ulcers, which had been welcomed by the Quality & Safety Committee (QSC). Cancer services had been an area of concern for the Committee, and Tony Bramley informed members that this had been discussed at the last meeting. Board Members were asked whether the Trust had the correct oversight of this issue at the QSC, as it sat between this committee and the Finance and Performance Committee (FPC), and appropriate oversight would be critical going forward. Terry Moran noted these concerns and suggested they be considered further following the Quality Improvement development session due to take place that afternoon.

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Shaun Stacey thanked Tony Bramley for the report and queried why the mental health report shared at the June committee meeting was not reflected within the highlight report. The changes required further oversight from Board members in respect of the concerns raised around the management of patients in the organisations’ care who came under the Mental Health Act. Although this was a small element, the CQC would require recorded recognition in light of their previous concerns raised and suggested distributing an update to members in respect of good governance following the meeting, and this was agreed. Sandra Hills confirmed that this issue had been discussed previously at the committee and felt greater Trust recognition was required on this issue. Tony Bramley agreed with the points raised, apologised for this omission and confirmed that this would receive greater emphasis at the committee going forward. Linda Jackson welcomed the Ophthalmology update, as it had been some time since previous updates. A future update was requested in respect of the regional project, which was agreed. Actions: Tony Bramley and Shaun Stacey

2.3 Finance & Performance Committee

2.3.1 Outcome of the Review & Refocus of the Finance & Pe rformance Committee – NLG(20)135 Neil Gammon shared the report with Board members and confirmed that there had been no amendments required to the Terms of Reference, but to ensure consistency across the sub-committees it had been agreed that core membership would be two of the three NEDs plus two Executive Directors, one being the Chief Operating Officer or Director of Finance. The 2020/21 work plan had been adapted to become an evolving document which would be presented and considered at each meeting. Jug Johal queried whether the Chief Information Officer would be included in the core membership of the committee and Neil Gammon confirmed this role would be included for attendance but not be a core member. Trust Board members agreed to the Terms of Reference changes.

2.3.2 Highlight Report from the Finance & Performance Com mittee – NLG(20)136 Neil Gammon drew the Board Members attention to the concerns of the committee around the limited progress of CQC actions which he hoped would be addressed in the Quality Improvement session due later that day. The BAF strategic risks 8 and 9 detailed excellent ongoing work to address these risks and highlighted they had also linked into the recovery activity which the Trust was progressing.

2.4 Workforce Committee

2.4.1 Outcome of the Review and Refocus of the Workforce Committee – NLG(20)137 Sandra Hills referred to the Terms of Reference within the report and explained they had been reviewed together with work plan. The first committee meeting had taken place on the 30 June following the pandemic, and following a discussion it had been agreed to retain the original name of the Workforce Committee. It was agreed to include a member of staff to represent Black, Asian and Minority Ethnic (BAME) groups of staff, a Governor member and a staff side representative as part of the

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Committee Membership. Core membership was agreed as three NEDs along with the Director of People and Organisational Effectiveness. Brian Page agreed to discuss the Governor committee member with Sandra Hills outside of the meeting. Terry Moran sought approval or comments on the Terms of Reference. The Terms of Reference were approved. Linda Jackson thanked the NED Chairs and Executive Leads for the extensive work that they had completed in respect of reviewing the sub-committees and stated this would provide greater assurance in respect of the focus of the committees going forward.

2.4.2 Highlight Report of the Workforce Committee – NLG(20)138 Sandra Hills shared the report and drew attention to the committee’s concerns in respect of the impact of COVID-19 on staff, particularly in relation to morale and fatigue. It was noted that this could worsen over coming months due to also entering the winter planning period. The committee had requested the BAF include further details around the highest risks to allow further discussion at the next meeting. CQC progress had been discussed and the committee were concerned that the report did not provide the level of assurance required. Linda Jackson had agreed to discuss this outside the meeting with Lucy Kent. The Internal Audit report for Equality & Diversity had been received by the committee but had highlighted that it did not capture data in relation to patients and service users, so further work was required to address this. The Staff Lottery Annual Report had been received by the committee and was attached to the highlight report for information to comply with their constitution. Sandra Hills informed members that the Doctors’ predicted fill rate for the next intake was 92.97%, which was a considerable improvement on previous years and due to the work involved by various teams within the Trust. Dr Kate Wood concurred and provided an overview of the work undertaken across the organisation and Trust Board which led to these substantial improvements. Linda Jackson noted that the committee had also acknowledged the work undertaken by Lucy Kent in respect of CQC actions, although further work was required to improve assurance. The Quality Improvement Session was due to meet later that day and the CQC Next Steps group would be resurrected to oversee progress is made. Dr Kate Wood informed members that she had attended a meeting the previous day with CQC and NHS England/Improvement (NHSE/I), being 6 July, where positive feedback had been received. Comments were provided on the work being undertaken within Medicine after meeting with the team and the Trust had been requested to also evidence further work being undertaken. Helen Harris referred back to the action log in respect of the People Strategy, and confirmed this item could be closed as it was included in the highlight report on page three. Claire Low advised that further amendments to the People Strategy had been requested at previous Board meetings, which had been implemented and she sought formal approval. Board members confirmed their approval. Sandra Hills confirmed that Michael Whitworth would now commence as the new

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Chair of the Workforce Committee. Terry Moran sought approval or comments of the amended Terms of Reference of the committee. The Terms of Reference were approved.

2.5 Health Tree Foundation Trustee’s Committee

2.5.1 Highlight Report from the Health Tree Foundation Tr ustee’s Committee – NLG(20)139 Neil Gammon shared the report with the Board and highlighted that the committee had considered how the donations received from NHS Charities should be spent. It had been suggested to utilise some of the funds for patient care in the community, and to specifically include BAME patients. Tony Bramley confirmed that following on from this, he was due to meet with the Health Tree Foundation staff to progress the community work. Terry Moran advised that he had previously been involved in research in respect of BAME patients and families, and had a document that he could share in respect of this to help with how this could be approached.

3. Urgent Items for Discussion

3.1 Our patient impacts: quality & safety issues and p rogress against relevant priorities including the Trust’s response to the CQ C ‘must dos’, key risks arising and decisions required by the Trust Board – NLG(20)141 Dr Kate Wood shared the paper with Board members and advised this would be the last time the paper would be shared due to Board meetings returning to normal business practice as of August 2020. Neil Gammon referred to the CQC Ambassador roles for Scunthorpe and Grimsby hospitals and queried whether it would be extended to include Community services and Goole hospital. Dr Kate Wood confirmed this did include Goole and would advise on Community as she was not entirely sure. Action: Dr Kate Wood Terry Moran thanked Dr Kate Wood for the very helpful report, referred to the mortality reviews and sought clarification on the number undertaken. Dr Kate Wood confirmed 185 mortality reviews had been undertaken by clinicians currently working from home. In respect of mortality, Terry Moran referred to the section on sepsis and queried to what extent this was a concern. Dr Kate Wood advised that robust data was not yet available which presented an ongoing issue; confirmed that Early Warning Score (EWS) reporting was now more accessible and significant progress had been made on the sepsis reporting issues which were almost resolved. Sandra Hills explained that complaints had been flagged in respect of lessons learnt and how the Trust had addressed these at the recent QSC meeting. Although responses achieved the set timescales, they did not particularly demonstrate a compassionate response to complainants and queried whether this would be a future focus. Ellie Monkhouse confirmed this was a key area which the team were now focussed on and this would be demonstrated once Patient Stories were again

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added to the Board agendas. Terry Moran queried what Dr Kate Wood’s biggest concern was at present in respect of patient care. Dr Kate Wood explained this was the length of the waiting lists and the risk stratification to ensure patients receive safe and effective care. Work was underway to address this, but it still remained her key concern. Shaun Stacey confirmed that he felt this was a significant risk for the Trust although organisational plans were in place to rectify the issue but felt more was required which he had fedback to the Trust Board and Executive Team. An emergency meeting was due to take place to discuss this further. Terry Moran referred to data recently shared by Richard Barker, the Regional Director for NHSE/I, which had evidenced waiting lists are an issue for all Trusts at present and especially in light of COVID-19. He queried whether the Trust had processes in place to ensure patients did not come to harm whilst on the waiting lists. Shaun Stacey explained robust processes were in place, including clinical harm minimisation, risk stratification and a need for additional capacity to sustain this work whilst also supporting staff. Linda Jackson recognised the need for greater pace and improved sight for the Board on the requirements to address this. She queried whether a Board development session was required to discuss this further and establish what processes could be put in place. Jim Hayburn agreed with points made by Shaun Stacey and Dr Kate Wood and added that the Trust were under greater scrutiny compared to other Trusts. There is a clear direction from NHSE/I that the Trust should not invest without their agreement, and clarity had been sought on what could be achieved within existing resources and what additional resources would achieve. Ivan Mcconnell supported the earlier comments and suggested escalation models should include a Trust-wide waiting list narrative to explain the historic and current position whilst also detailing current issues. Kathryn Helley referred to the planning process and advised that confirmation of any additional funding was not expected until August. Shaun Stacey expressed his concern that waiting until August would cause greater risk and confirmed that he planned to deliver within the base case activity levels. Elaine Criddle highlighted that the Trust had been praised regionally for the good pieces of work produced, especially the diagnostics work and explained that NHSE/I had linked in with Lorna Gibson, the National Lead on Referrals to Treatment (RTT), to complete some diagnostics work. Lorna Gibson had also linked in with the Trust and would be an observer on the Recovery Board for the Trust to help ensure the pace required could be demonstrated. She would also support the Band 8b post reporting to Shaun Stacey which had been funded through NHSE/I. Ellie Monkhouse stated that she would welcome a Board discussion in respect of waiting lists and felt that the narrative required stronger language to be clear that this could not be delivered within the current capacity levels and footprint. Neil Gammon robustly supported the comments made by Ellie Monkhouse and Linda Jackson, felt the Board required improved sight on the waiting list conundrum and recognised the Trust could not expand services without prior approval. Clarity was sought around the confidence levels that the Trust was operating as efficiently and effectively as possible with current practices. Terry Moran recognised the Board required a greater understanding of the waiting

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lists position and processes involved, and advised of the need to embark on this work without the clarity of funding due to the aspects of patient safety involved. A Trust Board session on waiting lists will be organised. Action: Helen Harris Ivan Mcconnell advised that the Diagnostics team were compiling an appropriate and comprehensive case to enable effective internal and external escalation as required. Terry Moran thanked Dr Kate Wood and her colleagues.

3.2 Our people impacts: resilience, safe staffing, abs ences, progress against relevant priorities, key risks arising and decision s required by the Trust Board – NLG(20)142 Claire Low advised the Trust had received 73% of staff risk assessments to date, which continued to increase. In respect of mental health support for staff, she advised that the Trust now had a more rigorous approach in place and she was very proud of the team involved. Work continued in respect of providing a dashboard to managers illustrating compliance for staff appraisals and mandatory training. In relation to overseas nurses, Board members were informed of a recent discussion with a local Member of Parliament (MP) around the delay for them commencing work at the Trust, who had agreed to address this and establish whether the process could be accelerated. Dr Peter Cowling had provided an update at the MPs meeting, confirming the Trust had not had a positive COVID-19 result for a member of staff result since the end of May even though 300 staff had been tested. Terry Moran added that he had felt encouraged by the MPs at the meeting. Tony Bramley referred to mandatory training compliance at 90% and queried whether this still reflected that some areas had better compliance than others. A previous query had been raised in respect of issues within Occupational Health due to there being a “bottle neck” for staff to be seen and queried whether this issue had been addressed. Claire Low advised a deep dive would be undertaken in respect mandatory training information to improve transparency and illustrate areas of low non-compliance which would enable effective reviews and appropriate challenge with department leaders. In respect of the query in relation to Occupational Health, a large investment had been undertaken with the team to extend working hours and increase administration support. However, it was noted that this was a peak time for the team due to the doctors’ intake in the August rotation.

3.3 Our financial impacts: progress against relevant p riorities, key risks arising and decisions required by Trust Board

3.3.1 Finance 2020/21 – Month 03 – NLG(20)143 Jim Hayburn advised that the Trust continued to report a balanced financial position due to the COVID-19 top up payment from NHSE/I, which would continue until the end of July. The Trust had underspent to date but flexibility was affected due a lack of information around the final financial allocation. The waiting list discussions earlier in the meeting confirmed that this was the highest priority for the Trust, together with the need to establish what levels of risk were acceptable, what could be done differently and what could be maximised to increase productivity. The Finance Department had commenced a piece of work to establish what could be undertaken going forward, which had been shared within the Executive Team meeting.

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Terry Moran thanked Jim Hayburn for his update and added there was an increased element of risk due to the demand and scrutiny on the Trust, which could mean the Trust’s risk appetite could be understandably low. Board members were encouraged not to inhibit thinking, but to consider greater scope and opportunity going forward which could be considered by the Board. Jim Hayburn added that the likelihood was that there would be a financial amount to support this work, and the Trust would need to work within reason to manage within it. Elaine Criddle supported Ivan Mcconnell’s escalation and due diligence approach. The Trust should progress forward with this plan and take required risks providing due diligence was in place, whilst escalating to NHSE/I in respect of funding requirements. Terry Moran thanked everyone for their input and counsel; and explained that if a case could be reasonably evidenced and demonstrated, he would expect it to receive support.

3.4 Annual Maternity Review – NLG(20)144 Ellie Monkhouse introduced Jane Warner, Head of Midwifery, and thanked her for attending the meeting and presenting the report. Jane Warner advised this was the first annual Midwifery review utilising the National Quality Board and NHSE/I principles. The review included the Better Birth Tool alongside Maternity Metrics and that the Trust had previously used Birth Rate Plus in respect of reviewing safe staffing levels within midwifery. The Trust had never closed any of the units due to working closely with the sister sites. The review process had included meeting with all clinical leaders to understand any issues, which had been captured as part of the process. Although the service was considered to be safe, Jane Warner informed members of the recognition that more staff were required due to current demands. The review had already incorporated considering how current roles could be adapted, utilised to undertake alternative way of working to address the required tasks and had identified the Trust required an additional 11.76 whole time equivalents (WTE) Midwives and 3.45 WTE Support Workers. Terry Moran queried whether a financial assessment had been undertaken to ascertain the requirements and associated funding, as felt the Board were unable to take a decision until this was available. Jim Hayburn advised the Finance Team would need to review the paper and consider alternative funding arrangements and confirmed this had also been included within the CQC costs that would be raised with NHSE/I. Ellie Monkhouse confirmed there had been financial involvement throughout the process which had included the divisional establishment. The Board were required to receive the recommendation from the Chief Nurse and Head of Midwifery on staffing levels to ensure a safe service was in place. The organisation had been significantly behind in respect of the continuity of care requirements over recent months, but had progressed to now being in a position to offer advice to other organisations on how this was undertaken. The Trust would receive some support from NHSE/I from an improvement perspective in relation to maternity services, as raised by the CQC and would be scrutinised going forward.

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In respect of these discussions, Terry Moran sought approval or comments from Board members on the review subject to finances being available. Tony Bramley advised the paper had been shared at the Q&SC, where the report had been welcomed. The committee had been supportive of the recommendation in respect of staffing levels; however, they had been clear it would need to go through the business planning process. Sandra Hills noted the national difficulties in respect of recruiting midwives and queried what the practicalities would be in respect of recruiting at the Trust. Ellie Monkhouse advised they felt this would not be an issue at the Trust due to current student midwives wanting to remain with the organisation. Terry Moran concluded the discussions and sought approval or further comments from Board members. Board members accepted that there was a need for increased staff in this area, and the associated funding elements required working up. The report was to be resubmitted to the Board if funding was not made available. Jim Hayburn advised the funding would need to be considered as part of the wider funding requirements and risks at the Trust, which could be included with the CQC issues. Terry Moran thanked Jane Warner for attending to share the paper with the Trust Board.

3.5 Infection, Prevention and Control Board Assurance F ramework – NLG(20)145 Ellie Monkhouse shared the report with Trust Board and advised that it included embedded documents to evidence additional information. A comprehensive review had been undertaken which provided significant assurance to the Trust Board in terms of delivery, with the framework assessment would be held on the 23rd July 2020. The risks were highlighted and detailed on the front page of the report, and stated that good practice had been identified. Following this review, a Working Group had been established to progress the CQC Supportive Emergency Framework which included various other teams around the Trust. Terry Moran thanked Ellie Monkhouse for the clear document provided and queried the next steps. The Q&SC received this document on a quarterly basis or when there were significant changes to guidelines and queried whether the same approach could be taken in respect of sharing this with the Trust Board. The Trust Board agreed to this approach.

4. Urgent Items for Approval

4.1 NED Responsibilities – NLG(20)146 Linda Jackson provided a summary of the key elements, which had come into effect from the 1st July 2020. One of the changes to note was that all NEDs would now attend the Remuneration and Terms of Service (RATS) Committee; and changes had been made to the Champion roles. The Trust Board supported the paper and changes to NED roles and responsibilities.

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5. Items for Information: To raise any urgent concern s or questions by exception

Terry Moran sought any issues or comments from Board members. No comments or queries were received.

6. Any Other Urgent Business

Terry Moran queried whether there was any other urgent business that needed to be raised. No items were raised under this item. Terry Moran sought feedback on the meeting from Governors. Brian Page felt it had been a very positive meeting and he had been particularly pleased to see the paper shared on the Midwifery establishment. The successful fill rate for the doctors’ intake which had increased from last year and that the Council of Governors had previously raised issues in respect of the waiting lists and had found it helpful to note the Trust Board also recognised these issues. Ian Reekie referred to the Terms of Reference of the sub-committees and queried why a Governor had not been included to sit on the Finance & Performance Committee the same as the Q&SC. Neil Gammon confirmed that Brian Page attended these meetings as Chair of the Governor Assurance Group.

7. Date and Time of the next meeting: Tuesday, 4 August 2020 Time: 10:00 to 14:45 hours Via video conference Private Trust Board meeting to follow at 15:00 to 16:00 hours via video conference Terry Moran closed the meeting at 11.54 am.