POOLE HOSPITAL NHS FOUNDATION TRUST BOARD OF DIRECTORS
Part 1 Minutes of the meeting of the Board of Directors of Poole Hospital NHS Foundation Trust held at 2.00pm on Wednesday 29 July 2009 in the Board Room, Poole Hospital.
Present: Mr Peter Harvey Chairman
Mr Charles Cunningham Non-Executive Director Mrs Elizabeth Hall Non-Executive Director Mrs Heather Hauschild Director of Operations
Mrs Jean Lang Non-Executive Director Dame Yvonne Moores Non-Executive Director
Mr Martin Smits Director of Nursing & Patient Services Mr Guy Spencer Non-Executive Director
Mrs Sue Sutherland Chief Executive Mr Robert Talbot Medical Director
Mr David Taylor Director of Finance In Attendance: Mr Michael Beswick Company Secretary
Mr Philip James Interim Director of HR Designate
Mrs Pauline Malins Director of Communications & Marketing Mrs Debi Reeves Deputy Director of HR
Mrs Sara Elkin Secretary
The Chairman welcomed a number of observers to the meeting including three of the Trust’s governors and in particular Mr Michael Wilkins, the new nominated governor for the Borough of Poole. He also welcomed Mr Philip James, Interim Director of Human Resources from 3 August.
PHFT 197/09 Apologies for Absence
Apologies for absence were received from Mr John Knowles, Non-Executive Director.
PHFT 198/09 Declaration of Interests
There were no declarations of interest pertaining to the Board agenda. PHFT 199/09 Part 1 Minutes of the Board Meeting held on 24 June 2009 (Paper A) The minutes were AGREED as a correct record of the meeting.
PHFT 200/09 Matters Arising
168/09 Matters Arising
142/09 Directors’ Expenses
Mr Taylor tabled a paper on directors’ expenses written in response to the recent Freedom of Information Act request for details.
148/09 i) Board to Board Meeting with NHS Bournemouth & Poole
The Chairman noted the meeting with the PCT had taken the form of a briefing to governors of the three Dorset acute trusts on 14 July.
Mrs Lang drew attention to the late delivery of papers for the current meeting and said it was important that Board members had adequate time to read them. Mrs Sutherland apologised for the lateness which had been the result of the papers being sent out later than usual and delays in the Royal Mail. PHFT 201/09 Infection Prevention & Control Report (Paper B)
Mr Smits spoke to his paper, noting the following:
i) There had been strong performance across the Trust with no MRSA bacteraemias year-to-date and only two cases of c.difficile in June; ii) Hand hygiene had been on target for the first time, however, there
would be no let up on the drive to achieve compliance;
iii) The Trust had achieved the target of 100% of eligible patients being screened for MRSA. However, detailed audit work suggested that the current method of measuring performance may not be accurate – further work was being undertaken on this;
iv) Screening of elective admissions only identified 0.7% of patients who were positive for MRSA;
v) There had been good compliance on the domestic contract;
vi) There had been no patients with confirmed swine influenza although a number of patients had been tested for the virus. Nationally, the NHS had now moved form the containment to treatment stage of the pandemic. The clinical impact of the virus was relatively mild but there were some issues with people with pre-existing illness. A large amount of work on planning for pandemic influenza was ongoing, led by Mrs Hauschild.
Mrs Hauschild said the pandemic influenza plan was being further refined with action plans at specialty level also being developed. Plans would also take account of normal winter pressures. She said she was keen to ensure good communication with hospital staff - twice weekly ‘flu bulletins would be published on the hospital Intranet.
The report was NOTED.
PHFT 202/09 Annual NHSLA Policy Review: Claims (Paper C)
Mr Talbot said the review reassured the Board that claims against the Trust were being managed in accordance with the Trust’s policy and NHSLA requirements. He noted the recommendations on page 5 of the report, in particular the need to respond more promptly to requests for patients’ medical records.
The report was NOTED.
PHFT 203/09 Annual NHSLA Policy Review: Complaints (Paper D)
Mr Talbot said the review reassured the Board that complaints were being managed in accordance with the Trust’s policy and NHSLA requirements.
Mr Talbot noted the new complaints regulations did not stipulate timescales for responding to complaints and said the Trust proposed to continue to work to the original timescales. He noted timescales could be difficult to meet, especially if a number of people were required to report on the complaint and required the patient’s case notes.
The Chairman noted that the Chief Executive signed off all complaints and that he saw copies of all complaints and responses.
The report was NOTED.
PHFT 204/09 Summary Complaints Annual Report 2008/090 (Paper E) Mr Talbot spoke to the report, noting the following:
i) The number of complaints received by the Trust was fairly stable; ii) Most complaints were still received by letter although an increasing
number were sent by email. Complainants who used email frequently sent subsequent emails raising supplementary issues;
iii) Communication continued to be an issue - this had been discussed at the July Risk Management & Safety Committee. Staff needed to listen to patients better and to establish whether patients/carers had concerns whilst they were still in hospital;
iv) The Trust was good at being open about issues.
Mr Smits noted he was to lead work with the matrons on communication and staff attitude and how these might be improved. He said training was clearly an issue.
Mrs Hauschild noted that work was being undertaken on cancellation of outpatient appointments. A report would be going to the Hospital Executive Committee in September analysing the reasons for the high level of cancellations and what might be done to reduce them.
The report was NOTED.
PHFT 205/09 Annual Report on Children’s Safeguarding Arrangements 2008/09 (Paper F)
Mrs Sutherland spoke to the paper, noting the following:
i) The report followed on from the morning’s Board seminar on safeguarding;
ii) The report should be read in the context of the Care Quality Commission’s review of safeguarding which had identified some gaps and Monitor’s subsequent letter to Chief Executive’s on the governance issues for Boards. Monitor had asked trusts to respond with a statement of compliance on their website;
iii) The minimum that Monitor expected the Board to satisfy itself on was: • CRB checking;
• that relevant policies were up to date, including the need to check on children who missed appointments;
• all relevant staff to have safeguarding training;
• that there was a nominated Board member responsible for safeguarding – this was the Director of Nursing;
Mrs Sutherland noted the Board had received safeguarding training at the May Board seminar.
Mr Smits said the morning’s seminar on safeguarding demonstrated the value of senior experienced staff. He said it was essential not to burden clinical staff with bureaucracy so they had sufficient time to pick up on clues. Mrs Sutherland said this message needed to be conveyed to Safeguarding Boards.
Mr Smits noted the increase in the number of cases related to domestic violence.
The Board noted that the organisation had more to do in relation to missed Outpatient appointments, and strengthening the recording of training still further.
The Board AGREED that the Assurance Declaration would be published to include the current weaknesses and the Declaration would be updated as the actions were delivered.
PHFT 206/09 Mid-Staffordshire Action Plan (Paper G)
Mr Smits noted the Board had extensively discussed the Healthcare Commission’s investigation into the care of patients at Mid Staffordshire NHS Foundation Trust at the April meeting. The April report had highlighted areas in the Mid Staffordshire report that the Trust needed to address – three of these were dealt with in the current paper with the fourth, on waits for trauma surgery, being the subject of a separate pre-existing plan.
Dame Yvonne Moores asked for a final report to be brought to the November Board meeting, for sign off.
Action: MS
The action plan was APPROVED. PHFT 207/09 Trust Performance Report (Paper H)
Mrs Hauschild spoke to her report, noting the following:
i) The Trust had again achieved all Monitor compliance framework standards and access targets;
ii) As agreed at the June Board meeting, an exception report had been sent to Monitor on the potential breach of the Quarter 1 A&E 4-hour wait target. In the event, the Trust had been able to meet the target. However, the situation in the Emergency Department remained fragile due to staffing shortages and patient numbers;
iii) The Trust continued to deliver the 13- and 18-week targets in addition to a range of other targets such as cancer waiting times;
iv) There was continued improvement on strokes with performance ahead of target. The Trust was part a local stroke network;
v) A reduction in delayed transfers of care had helped improve bed occupancy rates;
vi) The main risk to further improvement in the rate of operating on fractured neck of femur patients was lack of theatre staffing due to vacancies and sickness. There were plans to develop the Trust’s own staff but this would take time;
vii) The PCT was unlikely to be able to support extensive development plans this year or next.
Mrs Hauschild said her team was to provide more comprehensive performance reporting which would show previous years’ data. This would be available on the Intranet - a summary would be provided to the Board.
The report was NOTED. PHFT 208/09 Finance Report (Paper I)
Mr Taylor spoke to his report, noting the following:
i) The Trust was almost £0.5 million behind plan. Work was being done to pull back costs especially on enhanced payments for additional activity;
ii) The Trust was reviewing the CRES schemes and finding alternatives where necessary;
iii) The cash position was good; iv) The financial risk rating was 3.
Mrs Sutherland reported that she had been advised by the SHA of their intention to topslice 15% (approximately £800k) of the Trusts’ central allocation – this funding supported a range of services such as the library, clinical excellence awards and junior doctors’ training. Mrs Sutherland said the Trust had refused to accept the adjustment and was working with other trusts across the whole of South West to reach a resolution. She noted that Monitor had sought reassurance about the Trust’s autonomy when it became a Foundation Trust as the Trust had been subject to topslicing at the time. The non-executive directors expressed concern and were opposed to accepting a topslice. They asked to be kept informed.
Action: DT/SS Mrs Sutherland reported there was significant overperformance against contract and that consequently she had written formally to the PCT under Schedule 14 asking them to reconsider the contracted activity levels. She said it appeared much of the overactivity was driven by the lower waiting times available at Poole – GP referrals were up by some 25%.
The report was NOTED.
PHFT 209/09 Quarterly Monitor Submission: Quarter 1 2009/10
Mrs Sutherland noted the Trust was required to make a quarterly submission on governance to Monitor and suggested the Trust should make a clean declaration for Quarter 1.
Mrs Sutherland said it appeared the Trust was required to determine its own RAG (Red/Amber/Green) rating and would declare green status. Other information to be submitted to Monitor included:
• A report on the unannounced Care Quality Commission’s Hygiene Code inspection on 27 May;
• The election of AVM Geoffrey Carleton and Mrs Isabel McLellan as public governors of the Trust;
• The announcement of her intention to retire in 2010 and details of the recruitment process for a new Chief Executive.
Mr Taylor noted that the Finance & Investment Committee had confirmed the details of the financial submission.
The Board APPROVED the submission.
PHFT 210/09 Quarterly Workforce Report: Quarter 1 2009/10 (Paper J) Mrs Reeves spoke to her paper, noting the following:
i) There had been an increase in the use of temporary staff. Work was being undertaken to reduce the figures – the numbers were lower in July. Bank usage was highest for unregistered nursing staff;
ii) Turnover had been within target and was projected to be significantly below the year end target of 11%. Turnover for unregistered nursing staff was recorded separately and was projected to be close to the year-end target of 13.5% for this group of staff ;
iii) Sickness rates had been excellent for the year-to-date period;
iv) The first stage of the e-recruitment process had been successfully piloted. This would be launched as soon as some technical difficulties were resolved. It was hoped to pilot stage 2 by September;
v) Training on equality and diversity had commenced. An audit was being conducted to ensure the Trust was meeting best practice in equality and diversity;
vi) There was a small number of vacancies for junior medical staff for the August intake. The Trust had successfully applied for derogation from EWTD in Anaesthetics, Paediatrics Trauma & Orthopaedics and Emergency Medicine;
vii) The directorate was finalising the HR element of the pandemic influenza plan.
Mr Spencer asked about recruitment issues from the previous quarterly report, especially delays in sending out letters of job offers. Mrs Reeves said letters would be sent electronically or by text in future – this would speed up the process. She said there were timescales in the new system which would be automatically flagged up if not met. The system also incorporated a reporting mechanism to identify bottlenecks in the recruitment process. Mrs Reeves said she would keep the Board informed of progress.
Action: DR With regard to the August intake, Mr Talbot said the Trust was almost at full recruitment on paper but would have to wait until the day to see how things turned out as often appointees failed to turn up or were sick. However, he assured the Board that the hospital would be working safely from 1 August as there were contingency plans in place – any necessary cover would be provide by senior medical staff.
Mr Cunningham asked about payment for voids in Parkstone House. Mr Taylor noted the Trust had the ability to reduce the number of units held under the contract with the housing association but needed to ensure the association was applying the contract vigorously. He noted the Trust had other accommodation and needed to review overall usage.
The report was NOTED.
PHFT 211/09 Board Development Plan and Review of Board Assurance (Paper K) Mrs Sutherland said the report detailed action plans in respect of two recent documents - the outcome of the KPMG Board review and “Taking it on Trust”, the Audit Commission’s review of how Boards obtained assurance.
Mrs Sutherland noted the KPMG report had been discussed at the May Board meeting and had been considered in full at the June Board seminar. An action plan with named responsibilities had now been drawn up to address the key tasks recommended by KPMG - the morning’s Board seminar on strategic performance had started the process. A six-monthly update would be brought to the Board.
Action: SS Mrs Sutherland noted that the Audit & Governance Committee scrutinised the Trust’s governance arrangements. She believed these were generally robust. Mr Smits noted there was a twice-yearly report to the Board of Directors on the Trust’s Risk Register. In addition, all new red and amber risks were reported at every Audit & Governance Committee meeting. However, Mrs Lang, Chairman of the Audit & Governance Committee, noted that the Committee only met five times a year and suggested this may be too infrequent for the review of corporate risks. It was agreed that the Audit & Governance Committee should review the process for reviewing risks.
Action: JL The Board Development Plan and Review of Board Assurance were APPROVED.
PHFT 212/09 Register of Interests (Paper L)
Mrs Sutherland said the Register had been updated to take account of Mr James’ full Board membership whilst Interim Director of Human Resources. The Chairman noted he had ceased to be a Trustee of Dorset Healthcare Trust.
Action: SE It was agreed that the Company Secretary would bring a paper to the August Board meeting to clarify what interests had to be declared.
Action: MB The report was NOTED.
PHFT 213/09 Draft Council of Governors Minutes: June 2009 (Paper M) The draft minutes were NOTED.
PHFT 214/09 Draft Finance & Investment Committee Minutes: June 2009 (Paper N) The Chairman noted the Committee had met that morning and approved the June minutes.
Mr Cunningham, Chairman of the Finance & Investment Committee, noted that the figures discussed in the June minutes had been enhanced before the Month 3 meeting.
The minutes were NOTED. PHFT 215/09 Board Seminar
The Chairman noted the presentation on children’s’ safeguarding made at the Board seminar by Dr Janet Kelsall (named doctor for Safeguarding) Kate Roberts (named nurse for Safeguarding) and Penny Jarvis ( Associate Director of Operations for Women’s and Children’s Services). The seminar had looked at the past performance, current issues and the future challenges for Safeguarding.
Mrs Sutherland reported that the Care Quality Commission had published a report following a review of the arrangements in the NHS for Safeguarding Children. This review identified gaps in service provision which must be addressed prior to formal registration in April 2010. As a consequence of the Report, Monitor (the independent regulator of NHS Foundation Trusts) has written to Chairmen and Chief Executives reminding them of the importance of Boards assuring local safeguarding arrangements.
The five important areas were Criminal Record checks, Child Protection systems and policies, including the need to follow-up children who missed Outpatient appointments, staff training, clarity of the role of named professionals and that they had sufficient time and resource and that there was a named Executive Lead for Safeguarding
The Board noted that the organisation had more to do in relation to missed Outpatient appointments, and strengthening the recording of training still further.
The Board agreed that the Assurance Declaration would be published to include the current weaknesses and the Declaration would be updated as the actions were delivered.
The Chairman noted there had been a second Board seminar presentation and discussion on the Trust’s strategic performance objectives.
PHFT 216/09 Questions from the Council of Governors
The Chairman said he had received two questions from the governors: i) From Mr Tom Buckby, elected governor for Poole:
At the PCT briefing session for governors of the acute trusts, held on 14 July, a number of general questions were raised regarding A&E. I presume patients are seen as they come in, ie on a rota.
A lady at the meeting raised the question of Poole A&E. Apparently she had a son with a disability who cut his hand and was bleeding. The question I would like to raise is should children with disabilities "jump the queue”?
She said the treatment he received when his time came was excellent and could not fault it.
Mrs Hauschild explained the Emergency Department had a system of prioritisation based on clinical need, regardless of whether patients arrived in an ambulance or not. After that, the order of priorities for treatment was:
• Children;
• Police officers and police-escorted patients; • Older People;
• Others.
Mrs Hauschild said how promptly an individual patient was seen depended on what other cases had presented.
ii) From Mrs Diana Calcraft, Clinical Staff Governor:
Whilst employees recognise that financial and efficiency savings need to be made, can the Board give a detailed response as to how proposed savings and service restrictions will meet financial and quality targets whilst appropriately managing risk?
Mrs Sutherland said this was a difficult question. Whilst quality was the number one issue for the Board, and was always at the forefront of what the Board did, financial robustness was equally important as it impacted on the Trust’s ability to treat patients. She said that when savings targets were set consideration was given to the likely impact on quality. In looking for savings, trusts could not continue to make a series of little cuts in budgets – this was now being raised widely as an issue for the NHS
PHFT 217/09 Any Other Business i) Geoffrey Walker
The Board congratulated Geoffrey Walker, Matron, on being awarded an OBE in the recent Birthday Honours List.
ii) Poole Africa Link (PAL)
Dame Yvonne Moores reported that a team of hospital staff was to go to Wau in November. The team would most likely comprise a paediatrician, a midwife, a paediatric clinical nurse specialist and an obstetrician – this group would meet the Wau hospital’s own priorities.
Dame Yvonne said fundraising was underway to support the team. She noted that details of the “Pennies form Heaven” and Give As You Earn charitable donation scheme were to be attached to the July staff payslips. Bournemouth University was organising a major fundraising event in support of the PAL. Dame Yvonne reported that the Bishop of Salisbury had consented to be a patron for PAL fundraising.
The Chairman thanked Dame Yvonne for her enthusiasm and support for PAL.
iii) Senior Staff Appointments
Mr Smits reported that Denise Heming had been appointed as the new Matron for Oncology, Andrea Moxham as the new Cancer Lead Nurse and Helen Williams as the deputy Head of Midwifery.
iv) Tyneham Ward
Mrs Sutherland reported that following refurbishment Tyneham Ward was to be renamed “Sandbanks Ward”. This name had been chosen by the ward staff.
v) NHS Financial Position
Mrs Sutherland noted it was becoming increasingly clear that growth in public expenditure would be limited and there would be considerable need for cost control. The Chief Executives of the Dorset health organisations had met to discuss the situation and had agreed a list of areas to focus on.
PHFT 218/09 Date and Time of Next Meetings Wednesday 26 August 2009 at 2 pm PHFT 219/09 Withdrawal of Press and Public
The Chairman moved that any members of the public and representatives of the press should withdraw from the meeting.
