royal devon and exeter healthcare nhs trust · 2019-07-03 · march 2017), ottery st mary (13 march...

Board Minutes Public 22 February 2017 of 17

MEETING OF THE BOARD OF DIRECTORS OF THE ROYAL DEVON AND EXETER NHS FOUNDATION TRUST

22 February 2017 Held at Boardroom, Noy Scott House, RD&E Hospital

MINUTES

PRESENT: Mr J Brent Chairman

Mr P Adey Director of Operations

Mrs J Ashman Non-Executive Director

Mrs T Cottam Executive Director of Transformation & Organisational Development

Mr P Dillon Non-Executive Director

Professor J Kay Non-Executive Director

Mr D Robertson Non-Executive Director

Ms M Romaine Non-Executive Director

Mr P Southard Acting Chief Financial Officer

Mrs S Tracey Chief Executive

Mrs E Wilkinson-Brice Deputy Chief Executive/Chief Nurse

Mr A Willis Vice-Chairman/Senior Independent Director

APOLOGIES Mr A Harris Executive Medical Director

IN ATTENDANCE: Miss B Coates Governance Coordinator

Dr M Daly Deputy Medical Director/Associate Medical Director – Surgical Services

Miss M Holley Head of Governance

Mr D Thomas Assistant Director of Nursing – Surgical Services

Miss L Vine Executive Support Officer

ACTION

16.17 CHAIRMAN’S OPENING REMARKS

Mr Brent welcomed Governors, colleagues and members of the public to the meeting, in particular Mr Oliver who was presenting the Integrated Performance Report (IPR), Mr Thomas who was presenting item 11.1 and Dr Daly who was deputising in Mr Harris’ absence. Mr Brent reminded the meeting that it was a meeting held in public, but was not a public meeting. Questions would be welcome from members of the public at the end and he reminded the public that the questions should relate to the meeting agenda.

17.17 APOLOGIES

Apologies had been received from Mr Harris, with Dr Daly attending on his behalf.


18.17 DECLARATION OF INTERESTS

Miss Holley said there were no new declarations. Mr Brent reminded Board members to flag any interests if they arose during the course of the meeting.

19.17 MATTERS TO BE DISCUSSED IN THE CONFIDENTIAL MEETING AND TO BE DISCUSSED IN THE BOARD SESSION

Mr Brent informed the meeting that the Board would be discussing in its confidential meeting a vascular services paper, the Board Composition Policy (ahead of the recruitment campaign for two new Non-Executive Directors), and fitness for referral. In the lunch break, the Extraordinary People Awards would be taking place and Mr Brent said that he was very pleased to see the number of nominations had increased again, all of which were of very good quality.

20.17 MINUTES OF THE LAST MEETING HELD ON 25 JANUARY 2017

The minutes of the meeting held on 25 January 2017 were agreed as a correct record subject to the following amendments:

Minute 08.17, third paragraph, penultimate sentence to read: ‘Mrs Wilkinson-Brice said the Trust was seen as embracing the opportunities with community services throughout the Transfer of Community Services (TCS) and this would include working across the Eastern Devon localities.’

Minute 08.17, fifth paragraph, final two sentences: in regard to Mr Willis’ comment on third sector involvement, it was agreed to add an action to the minutes as follows:

ACTION: The Non-Executive Directors to be sighted on the work of the Eastern Locality System Board in relation to third sector involvement.

Minute 10.17, third paragraph, penultimate sentence, to read: ‘…this was in part linked to the …’

Minute 10.17, fourth paragraph, final sentence to read: ‘…she could see how a variety of factors could come together and she appreciated the challenges faced by staff.’

Minute 13.17, first paragraph, penultimate sentence to read: ‘For the year 2017/18…’

21.17 MATTERS ARISING AND BOARD ACTION SUMMARY CHECK

Action check

The actions were as per the tracker with the following additions:

Minute 11.17 (Discussion on the topics of the Schwartz Rounds to be held, including having a focus on issues relevant to the operationally challenged ward areas): Miss Holley, in Mr Harris’ absence, provided an update to the Board, stating that Mr Harris had discussed this with Dr Sarah Jackson, Schwartz Round lead, and they had agreed that the relevant ward should be identified by the Deputy Chief Nurse/Midwife. The Schwartz Round lead will meet with the team to agree a topic for presentation/discussion by the ward at


a future Schwartz Round. The action was completed.

Minute 12.17 (Internal Audit to be asked if comparative data for rate for staff declarations of interest is available): Miss Holley provided an update to the Board stating that once she had received the information she would report back to the Board. The action was extended to March 2017.

22.17 CHIEF EXECUTIVE’S REPORT

Mrs Tracey raised the following with the Board:

1) The ‘Your Future Care’ consultation closed on 6 January 2017 with NEW Devon Clinical Commissioning Group (CCG) currently compiling the post-consultation report and decision-making business case ahead of the CCG’s Governing Body meeting on 2 March 2017. Mrs Tracey said that work was on-going within the Trust on how Trust staff would be informed of the decision.

2) Mrs Tracey drew the Board’s attention to a number of Acute Services Review (ASR) events which were taking place throughout March 2017. The purpose of the events was to engage the public and discuss the decision-making criteria in the first stage of the work. Mrs Tracey said that there were three events being held in the Eastern locality: Tiverton (6 March 2017), Ottery St Mary (13 March 2017) and Exeter (20 March 2017).

3) Mrs Tracey was very pleased to report that the Trust had achieved the highest uptake of the ‘flu vaccination (76%) across the South West peninsula, including a 50% improvement in the community services. She gave her thanks to all involved and this was echoed by the Board.

The Board noted the Report from the Chief Executive.

23.17 COUNCIL OF GOVERNORS EQUALITY AND DIVERSITY RECOMMENDATION

Mr Brent presented the paper which contained recommendations on Equality and Diversity (E&D) from a task and finish group of the Council of Governors (CoG). Mr Brent said the paper had also been presented to the Council of Governors (CoG) at its meeting on 17 February 2017. As well as himself, Ms Romaine, Mr Robertson, Mr Dillon and Mrs Wilkinson-Brice had also been present at the meeting. He added that Mrs Wilkinson-Brice had raised a valid point at the CoG meeting in saying that it should be referred to as inclusion rather than E&D and he agreed.

Mr Brent highlighted the need to avoid discrimination against the protected characteristics and said it was important to ensure there was a tangible outcome from any actions agreed rather than for it to be seen as a ‘box ticking’ exercise. He said the CoG were broadly supportive of the paper but it welcomed feedback from the Board about how to enact it and increase inclusion. Mr Brent added that inclusion was a Trust-wide issue, with the Board just one component part, and he reminded the Board that David Matthewman (Head of HR Specialist Services) was leading on this piece of work. Mr Brent proposed that a response to the paper from the Board was prepared outside the meeting and once agreed by the Board, it would be submitted to the CoG. Mr Brent invited questions from the Board.

Mrs Tracey echoed Mr Brent’s comments and said she was pleased to see the issue being raised by CoG. She said the Board needed to be innovative with


its agenda to incorporate inclusion.

Dr Daly said that he welcomed a discussion on inclusion and added he would welcome broadening this to include obesity, which, although not a protected characteristic, did leave some staff and patients feeling excluded.

Mr Willis gave his support for the paper. He asked how it would be taken forward and what the timeframe was. Mr Brent said it was a priority for the CoG and so it was planned to approve the Board’s response at the March 2017 Board meeting in order for it to then go to the next CoG meeting.

Mrs Cottam said that, having just received the initial results from the 2016 Staff Survey, there were clear themes within some staff groups that required further interrogation. Mrs Cottam agreed to complete this analysis before producing a response to the paper for the Board to sign off at its meeting in March 2017.

Ms Ashman reminded the Board that she had previously requested that consideration be given to the Trust adopting the social model for disability and suggested this paper seemed an appropriate opportunity to consider it. This was noted by Mrs Cottam. Ms Ashman further commented that whilst she agreed that inclusion was a Trust-wide issue as noted by Mr Brent, she believed it had to be led by the Board.

ACTION: Staff survey results to be analysed to aid response to the CoG Equality and Diversity recommendations to be produced for sign off at the March 2017 Board meeting.

The Board agreed to draft a response to the CoG recommendations for approval at its March 2017 meeting.

TAC

24.17 INTEGRATED PERFORMANCE REPORT

Mr Oliver said the report outlined the Trust’s performance during January 2017 and highlighted the following to the Board.

The Trust experienced significant operational pressures in January 2017, resulting in 19 days being rated at Operational Pressure Escalation Level or OPEL 3 (previously Red), 4 days rated OPEL 2 (previously Amber) and 8 days rated OPEL 1 (previously Green).

Mr Oliver said that whilst emergency medical admissions were in line with forecast across January 2017 as a whole, a high level of emergency admissions in the two weeks post-Christmas 2016 was experienced. During this time 108 medical patients above plan were admitted resulting in an average of 53 medical outliers across the month. Mr Oliver said that despite additional bed capacity being opened, 37 patients had their procedure cancelled on the day of admission. All urgent and cancer operations continued as planned and all 37 patients affected now had either received treatment or had a date to be treated in February 2017.

Mr Oliver reported that performance against the 4-hour target was 91.0% in January 2017 against the target of 95% and against the recovery trajectory of 94.8%.

Delayed transfers of care from the acute hospital increased slightly, with an average of 66 delayed patients a day compared to 54 in December 2016. Within the community hospitals, delayed transfers remained stable with an average of 29 patients, compared to 31 the previous month.

Mr Oliver said that the draft position for January 2017 was forecasting that the


Trust would achieve four out of the nine key cancer waiting time targets. The Referral to Treatment (RTT) final position was confirmed as 91.01% compared to the 92% target.

Moving on to Patient Experience, Mr Oliver reported that there were 66 complaints and concerns received in the acute hospital during January 2017, an increase from 37 in December 2016 but within normal variation. There were four complaints and concerns in relation to community services which is an increase from two in December 2016. Mr Oliver said there was no top theme identified in either the acute or community settings.

Mr Oliver informed the Board that there had been no cases, in either acute or community, requested by the Parliamentary Health Service Ombudsman (PHSO) for review during January 2017. One acute final report was received in January 2017 which the PHSO partially upheld, and this would be reported to the Patient Experience Committee.

On a more positive note, Mr Oliver informed the Board that there were 62 written compliments received by the acute hospital during January 2017 and an additional five received by the community, with the main theme relating to staff attitude.

During January 2017 seven wards were subject to CQAT (Care Quality Assessment Tool) audit with six wards achieving Silver and one Bronze.

There were no clinically unjustified single sex accommodation breaches in January 2017.

Mr Oliver said that there were some excellent examples of making a difference following feedback from patients and highlighted this section of the report to the Board.

Moving to safety and clinical effectiveness, Mr Oliver said specialling requirements across the four acute Divisions totalled 81.6 Whole Time Equivalents (WTE), a sharp decrease of 39.63 WTE in comparison to the previous month. Mr Oliver said the details were contained in full in the report but added the reasons were primarily related to cognitive impairment, mental health issues and the need for enhanced observations. Mr Oliver said that the Safer Staffing Return at Appendix 2 to the report detailed the full Trust-wide position and showed that 32 ward areas had not met their planned hours at some stage during January 2017. On all wards the Matron and Senior Nurses reviewed patient acuity and dependency and were satisfied that the wards were safely staffed.

Mr Oliver said up to 27 unplanned escalation beds had remained open in the acute hospital for 25 days during January 2017 and required an additional 49.56 WTE to provide safe staffing; an increase of 33.87 WTE compared with the previous month.

The investigation of the single case of Clostridium Difficile identified in December 2016 had been completed and agreed with the CCG as unavoidable.

Mr Oliver reported that the number of cases of influenza continued to rise across the South West. A three month trial of point of care testing in the Medical Triage Unit (MTU) and Acute Medical Unit (AMU) had helped support early diagnosis and treatment. The volume of cases exceeded the availability of single rooms and bay cohorts were established to isolate Influenza A patients. Mr Oliver explained that Influenza B always started later in the season than Influenza A and the Trust had recently identified the first two cases this season. Patients with Influenza A and B cannot be mixed so this


would have an increasing impact upon patient flow within the hospital in the event that the numbers increase.

Mr Oliver informed the Board of a serious incident in which a patient underwent a right internal jugular vein central venous catheter procedure involving insertion of a catheter over a guidewire. When a chest x-ray was taken to confirm position of the central line, endotracheal and nasogastric tubes, the x-ray showed that the guidewire had been retained. The guidewire was removed by an interventional radiologist that evening, with no obvious harm to the patient. Duty of Candour had been undertaken and a full investigation was underway.

Mr Oliver said that the National Reporting and Learning System (NRLS) incidents per 100 admissions continued to report above target. This was because, with effect from 1 October 2016, data in respect of NRLS reportable incidents included the Community Division incidents reported by community based teams for which there was no admission, leading to the increased rate of reportable incidents per 100 admissions. The threshold for this indicator would be reviewed once an established set of baseline data was available, including data for the community services.

Mr Oliver informed the Board that no cases were referred to the General Medical Council (GMC) during January 2017.

Moving onto clinical effectiveness, Mr Oliver said that in January 2017, 90% of Fractured Neck of Femur patients received surgery within 36 hours, meeting the target threshold. The action plan outlined in the previous month’s report continued to be implemented to support sustainable delivery of the target.

Mr Oliver said the proportion of stroke patients spending more than 90% of their admission on a Stroke Unit had remained above the 80% target for six consecutive months.

The Trust-wide figures for antimicrobial prescribing compliance in January 2017 were: 86.1% for inclusion of a duration on the drug chart; 87.3% for inclusion of an indication on the drug chart and 93.7% for guideline compliance. In response to the current compliance rates a number of actions had been taken including the Medical Director writing to all medical staff and ward management teams to reinforce the importance of achieving compliance with these best practice standards.

Mr Oliver reported that in January 2017 94.5% of acute hospital eligible admissions and 100% of community hospital eligible admissions were assessed for the risk of venous thromboembolism. Further validation is being undertaken in the acute hospital and the position was anticipated to improve.

In terms of operational delivery, pressure on the Emergency Department (ED) was sustained throughout January 2017 resulting in significant issues with patient flow. For the A&E maximum waiting time of 4 hours, performance for the month was 91.0%. Mr Oliver said the interventions described in the ED action plan, detailed in the report, up until December 2016 had been implemented and work was continuing to maximise the benefits of these interventions.

Mr Oliver reported that the pathway for psychiatric patients waiting for Mental Health Act assessments or inpatient psychiatric admissions remained challenging. Extensive system-wide discussions were taking place and as a result, Devon Partnership Trust (DPT) was in the process of assessing options to provide capacity to admit psychiatric patients waiting in ED as a priority.

To put the Trust’s ED performance in context, in the latest comparison data


published for December 2016, Mr Oliver said the RD&E continued to perform well and ended the month 18 out of 138 organisations for performance.

Mr Oliver reminded the Board that, as described in the previous month’s report, temporary closure of the Breast Care Unit had resulted in appointment delays beyond the two week target timescale for a significant number of patients. As anticipated, this had resulted in the failure of both the two week wait cancer and the two week wait symptomatic breast targets during January 2017. Mr Oliver said that good progress had been made with the plans to recover the position by the end of February 2017. In addition Urology, where performance had been improving in line with the planned recovery trajectory, had a challenging month with patients breaching the standards in a number of areas. Mr Oliver said this was due to continued medical workforce shortages and a surge of cystectomy patients who required all day operations.

Mr Oliver stated that at the point of writing the report, the Trust was achieving both of the two key NHSI 62-day cancer standards with the wait from urgent GP referral at 85.92% against a target of 85% and the wait from screening service referral at 100% against a target of 90%.

In diagnostics the Trust had improved its position in a number of modalities, including endoscopy, cardiac MRI and sleep studies. The improvements had seen the number of patients waiting beyond six weeks fall to 99 at the end of January, 15 patients in excess of the recovery trajectory. Mr Oliver reported that the planned clearance of the MRI backlog was taking longer than anticipated as a result of limited additional capacity within the independent sector, and the limited capacity of the static pod for which the mobile Breast Care Unit was given priority. It was now forecast that the MRI backlog would be cleared by the end of February 2017.

Mr Oliver said the final position on delivery of the 18 week RTT waiting times target for December 2016 was 91.01%, narrowly missing the 92% target. The greatest challenges continued to be within the Orthopaedics, General Surgery, Cardiology and Urology specialities. This position was principally caused by cancellations of elective activity during the first two weeks of the month due to medical outliers.

Implementation of the key actions to recover the position continued as planned and were being closely monitored via the monthly divisional performance review process as well as the fortnightly Trust Access meeting. Mr Oliver highlighted that two new Consultant Cardiologists were joining the team over the next two months which was of particular significance.

Mr Oliver said that at the end of January 2017, there were seven patients waiting longer than 52 weeks for treatment. All were dated for their procedures in February 2017 except one cardiology patient who had deferred treatment, by choice, until May 2017 and a patient awaiting breast surgery for which treatment options were currently being considered and discussed with the patient. There were no breaches of the 28-day rebooking standard for hospital cancellations during January 2017.

In terms of workforce, Mr Oliver said overall Trust performance was within expected ranges and/or thresholds across all indicators with the exception of turnover and sickness absence.

The aggregate annual staff turnover rate rose slightly to 12.7% in January 2017 from 12.4% in December 2016. The turnover rate for the acute services remained stable at 13.5% and the increase was due to changes in community services turnover up to an estimated 10.8% in January 2017 from 10.6% in December 2016. Mr Oliver said the predominant staff groups driving acute


staff turnover continued to be registered nurses and midwives at 15.6%, unregistered nursing at 15.7% and unregistered AHP staff at 16.5%. In the community teams the highest turnover occurred in ancillary staff (18.1%), registered AHPs (12.1%) and admin and clerical staff (10.9%). Mr Oliver said the focus of the Turnover Task & Finish Group had moved to developing and confirming the action plan for implementation later this month which would be monitored by the Workforce Governance Committee and reported to the Governance Committee.

Acute hospital sickness absence increased from 3.86% to 4.25% in January 2017 with the 12 month rolling rate remaining at 4.1%. The cost of this sickness absence for January 2017 equated to £515,858 excluding any additional costs of replacement cover. Mr Oliver said that the Community Services were not yet using Electronic Staff Record (ESR) self-service and so the Trust was unable to report on sickness absence in the same way as for acute services. The latest monthly rate available was for December 2016 at 3.4% with the estimated 12 month rolling rate of 3.72%.

Mr Oliver said that although January 2017 had seen a fall in stress and mental health related sickness, and a marked increase in coughs, colds and flu, stress and mental health continued to be the most common reason recorded for absence.

Requests for temporary cover for Nursing and Midwifery shifts in the acute hospital increased as expected this month due to winter pressures. Despite the increasing demand the Trust successfully filled 1863, or 84%, of these shifts with Trust bank workers. Mr Oliver reported that this was the highest fill rate since February 2016. Community services also experienced a significant rise in demand of 20% on the previous month. Community shifts filled by Trust bank workers increased to 64%, the highest since the transfer of services. This emphasised the impact of the continued focus on promoting and encouraging work via the Trust’s internal bank provision rather than the use of agency staff.

At the end of January 2017, Mr Oliver reported that vacancies for Band 5 registered nurses increased from 83 FTE to 92 FTE including 38 FTE vacancies in community hospitals. There were 30 FTE unregistered nurse vacancies in acute and 4.5 FTE in community hospitals. Mr Oliver assured the Board that whilst these levels were challenging, they remained low in comparison to neighbouring Trusts. Mr Oliver reported that recruitment remained difficult and the Trust remained focused on recruitment solutions of both registered and non-registered nurses through a range of initiatives including exploring further overseas recruitment opportunities in collaboration with Sustainability and Transformation Plan (STP) Trust Partners. A recent recruitment ‘Open Day’ was very successful with 43 nurses interviewed and offered positions and 25 unregistered nurses appointed with an additional 7 appointments made in Community Services. Of the total, 41 were students and therefore would not join until they graduated later in the year.

Mr Oliver said the total number of contracted staff equalled 6,895 FTE. The agreed establishment was 113 FTE under the workforce plan as submitted to NHS Improvement (NHSI). At the end of January 2017 a total of 391 vacancies were being actively recruited to as summarised in the report.

In terms of compliance the overall statutory and mandatory training compliance rate increased to 86.5% in January 2017 and remained well above the 80% threshold. Both nursing and medical staff revalidation was at 100%.


Moving on to finance, Mr Oliver reported that at the end of January 2017 a deficit of £1.5m had been incurred compared to a budgeted deficit of £2.5m, a deterioration of £610k compared to last month’s report. The deterioration was £226k better than planned, mostly related to an improvement in expenditure offset by a deterioration in patient income.

Mr Oliver said NHSI had informed organisations of a Sustainability and Transformation Fund (STF) incentive scheme for 2016/17. The scheme would reward, on a pound for pound basis, providers that improved their control total. The Trust had reviewed the financial position at month 10, and was able to improve its operational financial position by £1.7m, reduced to £1.1m after loss of operational STF income. The incentive scheme would further improve clinical income by £1.7m.

The Trust was therefore forecasting a deficit of £3.8m, an improvement of £2.8m from last month’s position. Excluding the incentive funding the Trust would be forecasting a deficit of £5.5m, a £1.1m improvement compared to budget and plan.

Mr Oliver reported that clinical income, including private patients, was under-recovered by £2.4m, a deterioration on last month’s report of £710k. Clinical income was forecast to under-recover by £2.3m at year end, a deterioration from last month’s report of £338k. This mostly related to an adjustment made to return any community services underspend to the CCG as part of the agreement for 2016/17 and an increase in the STF funding due to be received.

Mr Oliver said that commercial income had over-recovered by £212k year to date, an improvement in the month of £89k and was forecast to end the year with an over-performance of £26k.

The Trust was planning to receive £11.1m of STF funding for the year including incentives of £1.7m and Mr Oliver drew the Board’s attention to the details in the report.

Mr Oliver reported that the Trust pay bill for January 2017 was 0.9% under the planned expenditure submitted to NHSI as part of the annual workforce plan. Pay was underspent by £1.6m year to date, an improvement of £474k in the month and was forecast to end the year with an underspend of £1.3m, an improvement of £536k. From an agency perspective, total spend as at end January 2017 across the Trust equated to £5.3m, with £486k in January 2017, including £126k relating to the community. Mr Oliver said that although spend for registered nurses increased in January 2017, overall agency expenditure reduced as a result of all other staff groups reporting a drop over the previous month. The year-end forecast for agency expenditure remained at £6.5m, including £793k for agency use in the community. This position still remained favourable against the NHSI ceiling of £8.3m and the Trust’s internal target of £6.7m.

Mr Oliver said that non-pay expenditure at the end of January 2017 was £922k underspent, an improvement of £269k compared to last month and was forecast to end the year with an underspend of £451k.

The current year Cost Improvement Programme (CIP) target for 2016/17 had increased from £12.2m to £14.6m due to the addition of the £2.4m Success Regime (SR) target relating to Bed Based Care and Planned Care. The addition of the full year SR target of £6.8m resulted in a revised full year target of £19.0m. Mr Oliver said £11.9m of the £14.6m current year target had been achieved and plans were in place for £1.7m of the remaining £2.7m; with reserves identified to meet the shortfall.


Mr Oliver said recurrent schemes totalling £7.4m had been achieved against the target of £19.0m and £5.8m required still to be delivered in 2016/17 of which £1.9m was considered high risk. A further £5.8m was not expected to be achieved and formed part of the CIP requirement for 2017/18.

The cash balance was £14.9m, £9.1m higher than plan and £5.3m higher than budget. The forecast cash balance at the end of the financial year was estimated to rise from £6.7m to £13.8m. Mr Oliver said the increase was mainly due to the deferral of an element of capital expenditure until 2017/18 and the reduction in the planned deficit.

Moving on to leadership and governance, Mr Oliver informed the Board that the Care Quality Commission (CQC) had issued the Trust with a new Certificate of Registration to reflect the new services which the Trust now provided following the transfer of community services.

In regards to Duty of Candour, there were 22 incidents involving patients graded with an actual impact of moderate, major or catastrophic closed between 1 October 2016 and 31 December 2016, of which 14 met the Duty of Candour criteria. Mr Oliver said that all of the incidents except one had met the requirements but for the one remaining incident, the family had requested that the sharing of the report was delayed until the beginning of March 2017. Mr Oliver invited questions from the Board.

Referring to the STF funding information contained within the report, Mr Robertson commented that it was clear the priorities of the STF were financial rather than clinical and the pressure to hit the financial targets was enormous.

With regards to the CIP schemes, Mr Robertson queried if the £5.8m under-recovered CIP would add to the £20m CIP target for 2017/18 or if it was already taken into account. Mr Southard replied that the 2017/18 target was £20m and this included the £5.8m expected not to be achieved in the current financial year. Mr Willis commented on the CIP target for 2017/18 and requested the Board discuss its credibility and the confidence in its delivery. Mrs Tracey said the Board had discussed it several times as part of the Operational Plan 2017/18 process. Mr Southard added that a paper on the Trust’s 2017/18 budget would be presented to the March 2017 meeting and he would ensure to add further detail on the CIP target.

Mr Robertson referred to the current rate of medical bed occupancy, and said that anything above 85% was perceived by the public as potentially unsafe. As a result, he asked if the rate should also be reported in aggregate for the Trust alongside the medical bed rate. Mr Adey said that this information could be provided if agreed by the Board; however Mrs Wilkinson-Brice added that it was important to continue to express the split between the bed pools. She said that the medical bed pool could be run safely at 90% and the elective bed pool at 95%; however this was not the same for other bed pools and one aggregate rate would not be accurate for all.

ACTION: The aggregate bed occupancy rate for the hospital to be provided alongside medical bed occupancy rate in the Integrated Performance Report.

Referring to the Duty of Candour incidents in the report, Mr Robertson asked how many of the 22 incidents were classified as ‘major and how many as ‘catastrophic’. He asked how a catastrophic incident compared to a Never Event. Mrs Wilkinson-Brice assured the Board that full scrutiny was given to all of the incidents through the Safety and Risk Committee (S&RC) and then via the Governance Committee (GC) and suggested that if the Board required further sight of this it should be through the GC report to Board. Mr Daly

PA


added that a Never Event was not necessarily worse than a ‘catastrophic’ incident but rather a Never Event was something that good adherence to safe practice (such as safe site surgery) should prevent as opposed to a ‘catastrophic’ incident which was associated with the measure of impact on the patient(s) and whilst it may have been preventable, it is not one of the registered ‘Never Events’. The distinction is to emphasise those events that should not happen with safe modern practice. Mr Brent asked what was meant in the report when it said that 14 of the incidents met the Duty of Candour criteria and asked if the Trust was compliant. Mrs Wilkinson-Brice replied that Duty of Candour occurs in two main places; immediately as the incident has occurred, and then with sharing the final investigation report hence there is often a delay with reporting completion of Duty of Candour. Mrs Wilkinson-Brice confirmed the Trust was compliant with Duty of Candour and added that sometimes the family do not always wish to see the final report.

Ms Romaine noted the drop in performance in January 2017 for the ‘Babies who had temperature taken within one hour’ indicator. Mrs Wilkinson-Brice said that this was likely to be an issue with the data but agreed to check and report back.

ACTION: Data given for the ‘Babies who had temperature taken within one hour’ indicator to be validated particularly in relation to January 2017 performance and confirmed to the March 2017 Board.

Ms Romaine said it was pleasing to see that community shifts had been filled with staff from the Trust’s internal staff bank rather than using agency staff. She also said that the number of registered nursing vacancies was not a surprise; however, she was concerned by the number of admin and clerical vacancies. She asked if this reflected the conversations that had previously taken place at Board regarding the perceived lack of progression within this staff group. Mrs Cottam replied that the admin and clerical staff group had the fourth highest turnover and one of the reasons for this was the perceived lack of progression. Ms Romaine asked that, as the Trust recognised the problem, did it have a plan to proactively deal with it. Mrs Cottam replied that it had and it was a priority for the Trust. The recently received 2016 Staff Survey results had also highlighted a range of common themes which would be explored.

Ms Ashman noted that at the time the report was written, the Trust was achieving the cancer 62 day wait target but that it was likely to fail once the histology reports for patients treated in January 2017 were confirmed. Mr Adey replied that histology confirmed a cancer diagnosis and said that the figures quoted within the report were awaiting validation. He said there was a time lag in reporting cancer performance. The Board currently receives information close to month end when the data was not validated and the only way to avoid this would be to report the data five weeks in arrears. Mr Brent commented that it was preferable for the Board to receive interim data rather than to delay reporting. Mrs Tracey reminded the Board that a breach for only one or two patients was often all that was required to alter the position.

Commenting on the National Reportable and Learning System (NRLS) reportable incidents and the changes to the way in which incidents are reported, Mr Dillon expressed concern that this might give the impression that there were more incidents and commented that the Trust needed to manage public perception. Mrs Wilkinson-Brice noted Mr Dillon’s remarks and said that this had to be reported as an aggregate figure; however she suggested it also be split by acute and community. This was agreed.

ACTION: Future reporting of the NRLS incidents indicator to include the

EWB


breakdown of the data by acute and community

Referring to the workforce section of the report, Mr Dillon acknowledged the significant amount of work undertaken particularly in relation to agency usage; however he commented that the section read rather defensively and sometimes underplayed the negatives. He said that he was concerned to ensure that the team responsible had the appropriate support and that they were aware of the Board’s support for their work. Mr Oliver said he noted Mr Dillon’s remarks. There was recognition within the team that there was interest and support from the Board and this was welcomed by the team. Mrs Wilkinson-Brice said Mr Dillon’s point was important as it was acknowledged there were challenging times ahead, particularly in regards to recruitment, and ‘bad news’ may need to be reported to the Board. Mr Dillon added that innovation was required by the Trust to meet the workforce challenges faced.

Mr Dillon commented on the pound for pound STF incentive scheme and said that assuming the Trust’s Q2 and Q3 performance appeal against the A&E and Cancer targets were successful, and the Q4 appeal for A&E and Referral to Treatment (RTT) was unsuccessful, the Trust would fall short of the planned funding by £600k. Mr Southard confirmed that this was the current understanding. Mr Dillon asked if the risks to the 2017/18 STF were yet known and Mr Southard replied that the rules around the STF operational target were not yet clarified but the Trust was expecting them to be the same as for the current year. Mr Dillon asked if the Trust should consider investing money in an operational target that is predicted to fail in order to achieve the STF funding. Mr Robertson challenged this as he said the Trust risked losing all of its STF funding if it did not meet its financial targets. Mr Southard added there were other factors which affected the funding so it would not be quite as straightforward as suggested. Mr Willis asked if any modelling had been undertaken to assess if it would be worthwhile investing in risk areas in order to avoid a loss of STF funding. Mr Southard replied that the Trust was reviewing this for 2017/18; however he reminded the Board that being eligible for STF funding was a straightforward pass or fail and so the Trust would not have access to the operational funding if it failed the financial target. Mr Adey added that the Monthly Divisional Performance Review meetings scheduled for 3 March 2017 would be dedicated to looking at demand and the financial position for 2017/18. Professor Kay said that she would find it useful for the Board to have a focussed discussion on STF funding. This was agreed.

ACTION: Focussed discussion on STF funding to be added to the Board agenda for March 2017.

Mr Dillon said it was pleasing to note that diagnostic waiting times had improved. He asked if any learning could be taken to help the Trust predict future performance challenges. Mr Adey said the Trust was reviewing the learning from diagnostics and agreed to report this to the Board.

ACTION: Learning from the diagnostics waiting time issues to be reported to the Board.

Professor Kay commented on the adverse spend in relation to the junior doctors’ contract and said that the Trust would have been aware in advance of this additional expenditure. Dr Daly said that it was still relatively early days with regard to implementation of the new contract and consequently the exception reporting was still not fully understood but that the Trust was working this through.

Professor Kay noted the improvements being made in maternity as a result of complaints from patients and GPs regarding inconsistent information being

EWB

PS

PA


given to women during early labour and asked what was being done to address this. Mrs Wilkinson-Brice said the complaints were being thoroughly evaluated but she welcomed the new telephone triage system which would enable consistent advice to be given in future. She added that the effectiveness of the new system would be evaluated.

Professor Kay asked for further details in relation to the exploration of basing specialty doctors in the ED. Dr Daly said that it was a particularly complex issue as it was important to find the right balance between staffing the ED and the specialities, particularly at night. Mrs Wilkinson-Brice added that the first joint Nursing, Midwifery and Allied Health Professional and Medical Workforce Strategy Group meeting had taken place the previous day and this would be looking to discuss these issues. Mrs Wilkinson-Brice said it had been agreed the entire patient pathway would be mapped in order to see how the workforce could be matched to patient need.

Mr Brent said that he fully understood the issues surrounding the Breast Care Unit and asked if all actions to mitigate the impact on waiting times were being taken. Mr Adey assured the Board that the clinical team continued to review the situation weekly and that they expected minimal, if any, impact on the 62 day wait.

Referring to the position with NHS Receivables within the finance section of the report, Mr Brent noted that this was not currently an issue for the Trust but it had the potential to be so in the future. He said the Trust should consider how it can start a conversation about NHS organisations paying other NHS organisations on time. Mr Southard noted Mr Brent’s comments. With regards to the current NHS Receivables position, Mr Southard said this was mostly in relation to specialist commissioners and the STF funding.

Mr Brent said it had been suggested that providers that met their STF target would have preferential access to a capital expenditure fund. If this was the case, he encouraged the Trust to ensure it is able to access the fund in a timely manner. Mr Southard said he noted Mr Brent’s views and added that the Trust had a loan application being considered at the moment.

Ms Ashman noted that the Devon Partnership Trust (DPT) was currently assessing options to provide capacity to admit psychiatric patients waiting in ED as a priority and, bearing in mind that this issue had been recognised for some considerable time, she asked what the timeframe was for putting this capacity in place. Mr Adey said that a meeting with the DPT was scheduled for the following week and the expected outcome of that meeting was for patients to be removed from the ED much more quickly. He agreed to provide an update from the meeting to the March 2017 Board. Dr Daly added that he had seen a dramatic difference in psychiatric support on the Acute Medical Unit (AMU), although there were still challenges in providing this for patients under 17 years old.

ACTION: Report from the meeting with Devon Partnership Trust (DPT) on DPT providing capacity to reduce mental health patient delays in ED to be provided to the March 2017 Board meeting.

The Board noted the Report.

PA

25.17 GOVERNANCE COMMITTEE REPORT

Ms Romaine presented the report and said there were no items for escalation. The following items were raised for information.


Ms Romaine reported that the Trust had performed well in the National Cancer Patient Experience Survey, with areas for improvement to be addressed as part of the Trust’s ‘Living Well and Beyond Cancer’ project. The Trust had also performed well in the Sentinel Stroke National Audit Programme (SSNAP). The Trust had improved its rating from a grade D (in 2013) to a grade B. Ms Romaine said that whilst there were areas for improvement, both audits were very positive.

Ms Romaine said that the draft Internal Audit Plan 2017/18 had been reviewed ahead of its presentation to the Audit Committee on 27 February 2017. The only amendment proposed by the Committee was a request to include the role of the Freedom to Speak Up Guardian to ensure formal sight by the Board of this role.

Referring to the Annual Report from the Volunteer Leads Forum, Ms Romaine said she had been delighted to see the excellent work undertaken by the volunteers and how this enhanced patient experience. Of particular note was the tapestry provided for the chapel and the baskets for the safekeeping of patients’ dentures and glasses. Ms Romaine said that whilst this appeared a simple initiative, it would have a very positive impact for patients and for the Trust, particularly as the loss of these items often had financial implications.

Ms Romaine informed the Board that, following an update to the Committee provided by John Groom (Integration Director) and Diane Walker (Assistant Director of Nursing for Community Services), she was assured that the community services had good governance and assurance arrangements in place, particularly relating to safeguarding training and the requirements of the Mental Capacity Act. She said that there were no indications in the reporting to suggest there were any issues.

The Board noted the report.

26.17 ARMED FORCES COVENANT

Mr Thomas, Assistant Director of Nursing for Surgical Services, presented the report and said that the Trust was categorised as an Armed Forces friendly employer and currently held a bronze Employer Recognition Award. He said that, over the course of the next year, there were a number of initiatives to be undertaken to help the Trust achieve a Silver or Gold Award. Mr Thomas said that in order to achieve either a silver or gold Award, the Board would be required to sign the Armed Forces Covenant. The Trust currently served in the region of 100,000 veterans and had a strong affinity with the armed forces community. The Covenant was individual to the Trust. The Board was also requested to support improved engagement in order to achieve an improved Award. Mr Thomas invited questions.

Mr Willis gave his support to the proposals and said that he believed the Trust should aim for the highest Employer Recognition Award possible. He added that he did not always believe the Trust was effective at transferring skills across from armed forces personnel and this should be improved.

Mr Dillon echoed Mr Willis’s support and referred to section 1.1 of the Covenant. He asked if the Trust was aware of any examples where a member of the community had suffered a disadvantage in the provision of services. Mr Thomas confirmed that he was not aware of any examples.

Professor Kay gave her support to the proposals. She asked if any initiatives had been excluded from the Covenant and Mr Thomas replied that there were


not. He added that should the Board wish to suggest any further initiatives for inclusion this could be actioned accordingly. Mrs Tracey commented that a number of the initiatives were already in place but required enhancement. She added that the Trust had accepted an invitation in September 2016 to join a pilot network of NHS Veteran Hospitals. Dr Daly commented that his experience of working with medical armed forces staff at the Trust was very positive.

Mr Brent queried whether it was appropriate for the Trust to assist recruitment to the Armed Forces from its own employees as stated in the Covenant. Mr Thomas said that, as a member of the Reserves, he believed he had access to a range of skills within the Armed Forces that he otherwise would not which in turn enhanced his role within the Trust. The Board acknowledged this. The Board approved the proposals.

The Board agreed to sign the Armed Forces Covenant and approved the proposal for an increased employer engagement award.

27.17 ANY OTHER BUSINESS

There was no other business.

28.17 PUBLIC QUESTIONS

Referring to the Workforce section of the Integrated Performance Report, Mr Bradley, a public Governor, noted that there had been an increase in the number of vacancies compared to the previous year but no increase in the number of exit interviews. Mrs Cottam said the policy change discussed at January 2017 Board in relation to exit interviews was not yet in place and she expected it to be in place from March 2017. She therefore anticipated that the Board would start to see this reflected in the data after three to six months.

Mr Bradley further noted that the number of Registered Nurse vacancies remained the same as for December 2016 at 121 yet there had been an increase in January 2017 of the number of Band 5 Registered Nurses. Mrs Cottam replied that the number of 121 included Band 5 to Band 8b Registered Nurses and that some vacancies had been filled during the month.

Mrs Llewellyn and Miss Foster, both Public Governors, thanked Ms Romaine and Mr Thomas respectively for the recognition of the contribution of volunteers and Armed Forces veterans at the Trust.

There being no further questions from the public, the meeting was closed.

DATE OF NEXT MEETING

The date of the next meeting was announced as taking place at 9.30am on Wednesday 29 March 2017 at the Royal Devon and Exeter Hospital.


MEETING OF THE BOARD OF DIRECTORS Held on 22 February 2017

ACTIONS SUMMARY

This checklist provides a status of those actions placed on Board members in the Board minutes, and will be updated and attached to the minutes each month.

PUBLIC AGENDA

Minute No. Month raised

Description By Target date Remarks

128.16 Nov 2016 Report on the impact of the Operational Capacity and Resilience Plan 2016/17 to be presented to Board.

PA May 2017 An evaluation will be presented at the Board meeting in May 2017.

06.17 Jan 2017 Information on the changes to the patient pathway and anticipated impact on Delayed Transfers of Care at the Trust to be presented to the March 2017 Board meeting.

PA/ EWB March 2017 A presentation will be given to the March 2017 Board meeting.

08.17 Jan 2017 The Non-Executive Directors to be sighted on the work of the Eastern Locality System Board in relation to third sector involvement.

ST March 2017

A reference group for the Eastern Locality System Delivery Forum is to be established with suggested membership from third sector. Action complete.

09.17 Jan 2017 A session with the Community Services Senior Management Team to be arranged for March 2017 Board meeting.

EWB March 2017 This is on the Board’s programme for March 2017. Action complete.

09.17 Jan 2017 Targets for length of stay (LoS) indicators are to be set as soon as possible.

PA March 2017

Aggregated LoS does not readily lend itself to such target setting due to seasonality, case mix and recording variation between providers. LoS is monitored through the Operational Capacity meeting at Divisional level.

10.17 Jan 2017 Update on the staff turnover plan to be presented to the April 2017 Board meeting

TAC April 2017

12.17 Jan 2017 Internal Audit to be asked if comparative data for rate for staff declarations of interest is available

MH February 2017

March 2017

Not currently available, but Internal Audit will contact counterparts in the South West Consortium to try to ascertain this. MH will report back to the


Board once she has received the information. Action ongoing.

15.17 Jan 2017 Future IPRs are to include numbers alongside percentages in order to provide context to the reader.

PA March 2017

IPR spark chart formatting has been updated to reflect numerical performance alongside percentage performance where appropriate. Contributors to the narrative section of the report have been asked to ensure that the number is included alongside the percentage performance in future reports.

23.17 Feb 2017 Staff survey results to be analysed to aid response to the CoG Equality and Diversity recommendations to be produced for sign off at the March 2017 Board meeting.

TAC March 2017 A response was circulated to the Board on 22/03/17 for consideration.

24.17 Feb 2017 The aggregate bed occupancy rate for the hospital to be provided alongside medical bed occupancy rate in the Integrated Performance Report.

PA March 2017

An additional spark chart demonstrating aggregate acute adult bed occupancy has been added to the IPR template.

24.17 Feb 2017 Data given for the ‘Babies who had temp taken within 1 hour’ indicator to be validated particularly in relation to January 2017 performance and confirmed to the March 2017 Board.

EWB March 2017 An update will be provided at the March 2017 Board meeting.

24.17 Feb 2017 Future reporting of the NRLS incidents indicator to include the breakdown of the data by acute and community.

EWB March 2017 An update will be provided at the March 2017 Board meeting.

24.17 Feb 2017 Focussed discussion on STF funding to be added to the Board agenda for March 2017.

PS March 2017

This will be covered in the 2017/18 Budget paper presented to the Confidential March 2017 Board meeting.

24.17 Feb 2017 Learning from the diagnostics waiting time issues to be reported to the Board

PA April 2017

24.17 Feb 2017 Report from the meeting with Devon Partnership Trust (DPT) on DPT providing capacity to reduce mental health patient delays in ED to be provided to the March 2017 Board meeting.

PA March 2017 An update will be provided to the March 2017 meeting.

Signed: James Brent Chairman

royal devon and exeter healthcare nhs trust · 2019-07-03 · march 2017), ottery st mary (13 march...

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