MEETING OF THE BOARD OF DIRECTORS AGENDA Wednesday 28 January 2015 Conference ...

133 Pages·2015·3.69 MB·English

MEETING OF THE
BOARD OF DIRECTORS

AGENDA

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Wednesday 28 January 2015

Conference Room 1
Homerton Hospital
MEETING OF THE BOARD OF DIRECTORS IN PUBLIC OF
HOMERTON UNIVERSITY HOSPITAL NHS FOUNDATION TRUST

th
Wednesday 28 January 2015 at 8:30 a.m.

Conference Room 1
Education Centre,
Homerton Hospital

AGENDA PART ONE
No. Item

Attachment time
1. Chairman’s welcome and introduction TM-R 08:30

2. Apologies for absence

3. Declaration of interests regarding items on the agenda

4. Minutes of the meeting held on 17/12/2014 and matters arising TM-R 15/01 08:35

5. Chief Executive’s Report TF 15/02 08:40

6. Integrated Board Report SA/MK/DW/JF/DJ 15/03 08:55

7. Quality and Safety 09:40
7.1 Preparation for CQC Visit SA 15/04

8. Corporate Governance 9:55
8.1 Monitor 2014/15 Q3 Declaration TF 15/05
8.2 Board Assurance Framework TF 15/06
8.3 Approach to Producing the Annual Plan 2015/16 TF 15/07

9. Committee Reports 10:20
9.1 Audit Committee Minutes MS 15/08
9.2 Risk Committee Minutes VT 15/09
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10. Any Other Business 10:30

11. Questions from Public 10:35

Dates of forthcoming meetings
Board of Directors - Wednesday 25th February 2015

Joint Council of Governors and Board of Directors - Thursday 19th February 2015 5:30pm
BOARD OF DIRECTORS

Meeting date: 28th January 2015 Agenda Item: 1
Paper: 15-01

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Title: Minutes of the meetings held 17 December 2014

Summary This document records the items discussed at the Board of
Directors meeting in public, held on 17th December 2014

Action: The Board is asked to approve the minutes as a correct
record of the meeting.

Prepared by: Sam Armstrong Interim Head of Corporate Governance
Presented by: Tim Melville-Ross, Chairman

Compliance: NHS Provider Licence
Meeting of the Board of Directors
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Wednesday 17 December 2014
Part 1 - Public

Present: Tim Melville-Ross Chairman
Sir John Gieve Non-Executive Director
Martin Smith Non-Executive Director
Vanni Treves Non-Executive Director
Susan Osborne Non-Executive Director
Jude Williams Non-Executive Director
Polly Weitzman Non-Executive Director
Tracey Fletcher Chief Executive
Sheila Adam Chief Nurse & Director of Governance
Dylan Jones Chief Operating Officer
Dr Martin Kuper Medical Director
Daniel Waldron Director of Organisation Transformation

In Attendance:
Sam Armstrong Interim Head of Corporate Governance
(minutes)
Matthew Tattersall Deputy Director of Finance (for Jo Farrar)
Dr Alleyna Claxton Director of Infection Prevention and Control
(item 7.1)
Two members of the public were in attendance.
1.0 Welcome and Introduction
The Chairman opened the meeting and welcomed all present.
2.0 Apologies for absence
An apology was received from Jo Farrar, Director of Finance.
3.0 Declaration of interests regarding items on the agenda
There were no declarations of interests.
4.0 Minutes of the previous meeting held on 26/11/2014 and matters arising
The minutes of the previous Board of Directors meeting were agreed as a correct record
of the meeting.
It was agreed to add on-going actions to the annual Board reporting schedule.
As a matter arising, the Board discussed actions related to the integrated board report. It
was noted that a review of the current indicators would be a significant undertaking. The
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new EPR system will assist with data presentation and it was agreed to leave current
indicators for a time to observe their benefits.
It was agreed to remove actions related to indicators for the integrated board report, as
related suggestions and agreement will appear in the minutes for review.
In response to a question it was confirmed that the nurse staffing report would be
presented and discussed at an extended Board seminar.
The Board received a verbal response to the bank and agency staff differential costs
action. It was confirmed that bank costs were aligned to costs of a fulltime employee: it
was suggested that savings could best be achieved by focusing on agency costs.
The actions log and updates were agreed by the Board.
5.0 Chief Executive’s report
It was noted that RiO had been selected as the community EPR system, following an
extensive procurement process. The Trust had RiO as its system, as it had been
provided through the national contract. The Health Information Exchange (HIE) was
about to go live after a successful pilot; the Cerner compatible functionality provided a
method for the different GP and Trust systems to view each other’s records.
In response to a question, it was stated that the new system will not directly link data
between acute and community, however information will be viewable through HIE. In
response to a question, it was reported that London Borough of Hackney had noted
systems that would link through HIE as part of their procurement process for an
upgraded system. It was noted that multiple patient identifiers had presented an ongoing
problem across the sector; however this had been improved, with social care agreeing to
use patients’ NHS numbers as identifiers. The Board recognised that there was more
data on EPR presently than there had been 18 months ago.
The Trust had won several awards at the recent Quality Awards Evening run by Health
Education NCEL, including the quality award for the Norwood Family Centre for
Promoting Healthy Living through Education and Training. Commendation awards were
won for the following categories: Child Protection training, the Simulation Centre,
Student of the Year, Trainee of the Year and Apprentice of the year.
Ben Stevens would take up the post of Divisional Operations Director for SWSH in
January 2015.
The Board noted the report.
06. Integrated Board Report
The Board reviewed the Integrated Board Report, presented by the executive team.
The positive results demonstrated by the Patient Safety Thermometer were noted. The
Trust had the best harm-free care rate in its comparator group and continued to
demonstrate low levels of instances of pressure ulcers. In response to a question, it was
noted that the Trust was taking part in a national programme to reduce the incidence of
pressure ulcers through the use of improved mattresses. In response to a question, it
was reported that more work was needed to decrease instances of pressure ulcers that
occurred in the community, including the need to lower resistance from patients’ families
to allowing equipment and maintaining the regular moving of the patients; in answer to a
follow-up question, it was stated that a strong link with carers was required to achieve
significant improvements in the community, which would involve the introduction of a
training programme. It was reported that there did not appear to be a common element
to the last four c.difficile infections. In response to a question about red-rated safe
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staffing areas of the Trust, it was noted that recruitment of nurses continued and that the
recent recruitments from reported targeted events had yet to take up their positions;
however HR was working to fast-track their commencement at the Trust.
It was noted that the governors, and much of the Board, had seen a presentation on the
patient feedback system, which would provide a greater level and quality of patient
feedback, in real time. A&E patient response rates were low and it was thought this was
due to there being one tablet available as well as problems with the paper alternative. A
bid had been placed with the CCG to fund more tablets and feedback kiosks. Scores
collected from A&E, however, indicated a high approval rating. The presence of i-pads
on the wards had resulted positively in terms of response rates; however, there was a
need to achieve a better quality of results. In answer to a question, it was reported that
maternity had four separate points for survey during the entire pathway, and that it could
be challenging to ensure were all completed. It was suggested that some thought be
given to an incentive that would encourage mothers to complete all surveys. It was
clarified that the maternity figures presented were an average of the four points. In
response to a question, it was confirmed that responses would be sought from the
community from March next year. Although a complex area, thought was given to using
cards with web links as the primary means for gaining completed feedback.
It was noted that readmission rates had dropped. In answer to a question, it was stated
that the discharge group would analyse the data and report to the Quality and Safety
Board. The VTE assessment rate was recognised as good. HSMR and SHMI outcomes
were noted. The cardiac arrest rate was much lower than the national average.
A Non-Executive Director requested information outside of the meeting on sickle cell
readmissions. It was stated that the readmissions were generally not the fault of the
Trust.
Action: MK to provide further information on sickle cell readmission rates to Polly
Weitzman (MK: Jan 2015).
In answer to a question, it was pointed out that the actual VTE assessment rate was
over 97% and that results below 100% might be attributable to technical problems, or
instances where patients are quickly discharged before VTE assessment can be done.
It was noted that November was a challenging month and the Trust just achieved the
A&E 4-hour wait target with 95.06%. It was pointed out that two particularly busy
weekends, due mostly to unavailability of beds, brought the performance down: it would
otherwise have been 95.63%. The primary driver leading to this pressure is bed
availability and the issues associated with patient flow. December appeared to be as
challenging as November and the risks to achieving the target were noted. In answer to
a question it was noted that there were approximately 20 delayed transfers last week. As
of today the number was 11 with seven of that number linked to social care issues.
Recent ambulance diversions had contributed to the overall pressure the Trust had
experienced, however the Trust was still in the top two for ambulance transfers. There is
clearly great pressure across London, and the Trust continued to feature in the top 50%
of performing Trusts each week. In answer to a question it was noted that the Trust had
a CQUIN with the CCG to require a district nurse to attend at the Trust within 48 hours of
admission to offer support to get the patient back to social care. The Trust had not
cancelled any elective procedures during November. In answer to a question it was
noted that there were 448 attendances at A&E last month against an expected average
of 330; there was no epidemic or pattern to explain the number of attendances. In
answer to a follow-up question it was stated that it was difficult to link length of stay to
particular wards, specialities or specific illnesses. In response to a question, it was
stated that work was underway to establish the short term cover for some discharge
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team vacancies as well as that required for the winter plan, however it was very
challenging. It was pointed out that the consistent achievement of the A&E target was a
strategic asset for the Trust. In answer to a question it was noted that while the Trust
worked hard to ensure no delays to discharges occurred, there would be some instances
associated with particular medical conditions or rehabilitation and the circumstances of
the place to which a patient was to be discharged. In answer to a question, it was noted
that while a blitz team to prepare a patient’s house does exist, it was not a team
belonging to the Trust.
It was reported that the Trust’s 2-week cancer position was strong, which was related to
the plan to achieve appointments in seven days rather than 14. Overall for cancer the
Trust was in a better position than six months ago, however the challenges with Barts
Health NHS Trust continued. In answer to a question about activity rates, it was noted
that A&E activity had been mostly flat and that the Trust’s capacity pressure was not
activity driven.
It was reported that the £175k overspend was likely to be related, in part, to the winter
plan spending. The response rate for the recent staff survey was lower than the previous
survey, however it remained higher than other places. The Board was made aware of
the crude results from the recent nation staff survey: the Trust was above average in 60
questions, below average in 4 questions and at average in 26 questions. The details will
be presented at a future Board meeting. Data validation had been successful with
appraisal rates, which staff accepted. Sickness and training outcomes were noted.
Turnover was considered to be high and work to further understand why this occurred
was needed. In answer to a question it was clarified that the Trust was subject to the
inner London high cost area supplement, which would add approximately £4k to an
average Trust salary; this was an advantage when recruiting. The vacancy rate at the
Trust was decreasing. The Board agreed that achieving mandatory training was
necessary. In answer to a question it was noted that the elderly care unit and the
delivery suit used bank and agency as their staff needs tended to vary more than other
areas of the Trust. The overall reduction in agency use was noted. It was requested that
nursing and midwifery figures for turnover and recruitment be separated.
In answer to a question it was stated that the estate does feature as an issue in the staff
survey responses; the department had been challenged with leadership turnover and is
currently covered by an experienced interim director while the right person is sought for
the substantive role.
Financial performance for month eight yielded a deficit of £262k, which was adverse to
plan by £56k. The Trust year-to-date deficit was £216k, £1.9m adverse to plan. There
was £6.5m achieved to date on QIPP with a shortfall on central schemes; this was
£1.1m behind plan. Saving on medical locums and agency nurses was expected to show
soon. The Trust still expected to deliver its revised plan of £2m surplus. Cash balance
was £12.1m and capital expenditure was £300k behind its revised plan at end of month
8. Risks to the finance outcomes were noted, particularly unconfirmed funding from City
and Hackney CCG. In answer to a question, the risks associated with the projected
outcome for the financial year were noted; these included the impact of unpredictable
shifts in activity during winter and the Trust’s view of the most likely outcome of ongoing
discussions with City and Hackney CCG. It was agreed that the reserves line in the
report needed further details.
Action: Provide further details for reserves in future reports (JF, Jan 2015).
In answer to a question it was pointed out that costs to deliver activity were higher than
last year and tariffs continued to diminish each year.
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The Board noted the report and subsequent discussion.
7.0 Quality and Safety
7.1 Infection Prevention and Control Quarter 2 Report and SSI Update
It was noted that the report format had been improved. The Trust had received a
suspected ebola patient who had been isolated and subsequently released after being
declared clear of the disease; all ebola protocols had been followed. In response to a
question it was reported that the number of needle-stick injuries to staff was not a
significant number; the indicator included more than just suture incidents and included
blood splash as well as other needle related incidents. All cases were investigated and
any issues addressed. It was requested that separate data for suture and other aspects
of the indicator be presented in future.
Action: Provide detailed indictors for needle stick injuries (SA/AC, March 2015).
In answer to a question, it was reported that approximately 40% of staff had received a
flu vaccination. In response to a follow up question it was confirmed that the flu
vaccination was thought effective. It was noted that the vaccination was voluntarily
accepted by staff and could not be mandatory across the Trust. It was requested that a
report be presented to a future Board meeting on whether new contracts could require
staff to receive an annual flu vaccination. It was also agreed to place the charts back in
the report, however without accompanying text.
Action: Place charts back in the Infection Prevention and Control Report (SA/AC,
March 2015).
Action: Report on feasibility of requiring flu shots in new staff contracts to be
presented to the Board (DW, February 2015)
In response to a question, it was agreed to explore whether the renegotiated cleaning
contract could have additional costs.
Action: Confirm if additional costs could result from the new cleaning contract
being negotiated (SA/CA, March 2015).
In answer to a question it was pointed out that electronic prescribing would improve the
antibiotic stewardship rate and the Board would note outcomes in the next report. It was
agreed to make a qualitative comment on MSSA in future reports and add a chart.
Action: Future reports to include qualitative comment on MSSA (SA/CA, March
2015)
The Board received an additional report on surgical site infections associated with
orthopaedics, which illustrated the point between the number of operations undertaken
and cases of infection that occurred. The Board noted the variations since 2007. The
recommendations implemented in 2010/11 had achieved improvements, however, a
sharp increase had subsequently been observed, to which the Trust responded with
additional support. The Trust engaged the then HPA SSI surveillance team who
analysed the outcomes: they could not find any significant defects in the Trust’s
processes.
The Trust now had a new lead consultant in place and robust governance arrangements.
Internal reviews have not been able to find anything significant as a cause. The RCA in
appendix two was noted. A summary of cases to date was presented and an updated
report would be presented to the Patient Safety Committee in January 2015. The Trust
was looking into the possibility of a dedicated ‘clean’ surgical ward. In answer to a
question it was confirmed that weekend staff levels, case mix and antibiotic use had
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been reviewed and did not indicate any particular problems in relation to infection
outcomes. The action plan and its progress were noted. In answer to a question it was
stated that a patient care pathway with dedicated staff was generally the best approach
for a patient, however it is difficult to know if this approach would improve infection rates
at the Trust. In answer to a follow-up question it was suggested that, as the data was
mostly historical, the Trust should monitor results for observed improvements from the
implemented actions; the Trust may also invite the SSI surveillance team, now PHE,
back to undertake a further review. In answer to a question it was clarified that the Trust
does not have access to infection rates of its surgeons when undertaking private work;
however it could be possible to include a review of this at appraisal.
The Board agreed to the ongoing action plan and to a review report to be presented in
six months time. It was expected that data would continue to be presented in infection
prevention and control reports and that live, not-yet benchmarked data would be added
as well. It was agreed that Dr Claxton would continue to present the quarterly infection
prevention and control report with SSI.
Action: Review of SSI instances to be presented to the Board (SA/CA, June 2015).
The Board noted the report and agreed the action plan.
7.2 Quality Accounts (QA) Report
It was noted that the report provided an early view of the Account, although the final
document would look quite different to that presented. The Quality and Patient Safety
Board had an obligation to ensure the Trust delivered on its quality goals. SHMI
outcomes (p8) were noted: the Trust was currently achieving its goal of being in a lower
than expected band. Community nurses and GP services were working hard to support
achievement of lower readmissions. Although not consistent, work continued to improve
2 clusters. In answer to a question it was stated that a small number of patients can be
better off being allowed to die peacefully than to endure attempted resuscitation; it was
added that conversations with patients, and their families, were needed in advance of
resuscitation attempts in order to ensure that all were clear on the patient’s wishes. In
answer to a question it was pointed out that both doctors and nurses are leading on
various QA priorities. It was noted in a follow up question that the Trust now had a
dementia nurse in place. There was a correction on p21 to read ‘more than’ rather than
‘less than’ 90%. In answer to a question it was noted that the QA is included in the
Annual Report as the Quality Report. It was agreed to include a summary of how the
Trust had performed and what can be done better.
The Board noted the report.
8 Corporate governance
8.1 Monitor 2014/15 Q1 Results
The Board noted the Monitor letter confirming governance at green rating and a COS of
4, as planned.
The Board noted the report.
8.2 Board Assurance Framework
It was noted that contract paperwork had been exchanged between the Trust and
London Borough of Hackney. Work on the Community Health Services contract
continued.
It was noted that work between the Trust, CCG and London Borough of Hackney to
achieve integrated care continued, however it had taken longer to progress than first
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