Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust Finance Report for ...

227 Pages·2015·10.31 MB·English

Frank Collins  4358
Chairman
BBOOAARRDD OOFF DDIIRREECCTTOORRSS
2266TTHH MMAARRCCHH 22001155 AATT 99..3300 AA..MM..
TTHHEE BBOOAARRDD RROOOOMM

AAGGEENNDDAA

PPAARRTT OONNEE -- PPUUBBLLIICC MMEEEETTIINNGG

1.0 Apologies:
2.0 Minutes of the previous meeting held on 26th February 2015 Paper 1
3.0 Matters Arising
4.0 Declarations of Interest

SSTTRRAATTEEGGYY
5.0 Getting It Right First Time:
National report by Professor Tim Briggs Paper 02/
Presentation
RJAH report Paper 03
6.0 2014 Inpatient Survey Paper 04
7.0 2014 Staff Opinion Survey Paper 05
8.0 Policy Framework Strategy Paper 06
9.0 Foundation Trust Membership Update Paper 07

PPEERRFFOORRMMAANNCCEE
10.0 Month 11 Integrated Performance Report Paper 08

GGOOVVEERRNNAANNCCEE,, QQUUAALLIITTYY AANNDD SSAAFFEETTYY
11.0 Monitor Quarter 3 Feedback Paper 09
12.0 Use of Trust Seal 2014-15 Paper 10
13.0 2015-16 Clinical Audit Plan Paper 11

14.0 Any Other Business: None notified

15.0 Questions from the Public

16.0 Date and time of next meeting: 9.30 a.m. on 30th April 2015, The Board Room, RJAH
Orthopaedic Hospital NHS Foundation Trust, Oswestry

Questions from the Public on Agenda items – time limit of 15 minutes
There will be an opportunity for the public to ask questions on agenda items. These should be limited to two questions per person
and the time in total for each person should be limited to five minutes. If topics are likely to exceed this, they should be the subject
of discussions between the hospital management and the individual concerned or there should be a formal request agreed by the
Trust Board for the item to be included on the next agenda. If questions are detailed and require information that is not instantly
available, the hospital will respond to the question within ten working days.
To resolve, in accordance with Trust Standing Orders, that representatives of the press and other members of the public be
excluded from the remainder of this meeting having regard to the confidential nature of the business to be transacted, publicity on
which would be prejudicial to the public interest.
(Section 1(2) Public Bodies (Admission to Meeting) Act 1960)

U:\Trust Board & Committees\Public Trust Board\2014-2015\March 2015\2015_03_26_Board_of_Directors_Agenda.doc
AAGGEENNDDAA

PPAARRTT TTWWOO –– PPRRIIVVAATTEE CCLLOOSSEEDD SSEESSSSIIOONN
17.0 Minutes of the previous meeting held on 26th February 2015 Paper 12
18.0 Matters Arising

19.0 Chief Executive’s Update Verbal
20.0 2015-16 Draft Financial Plan Paper 13

21.0 Any Other Business

22.0 Date and Time of Next Meeting: 30th April 2015 following the Public Board of
Directors meeting

U:\Trust Board & Committees\Public Trust Board\2014-2015\March 2015\2015_03_26_Board_of_Directors_Agenda.doc
Paper 1

Frank Collins  4358

Chairman
BBOOAARRDD OOFF DDIIRREECCTTOORRSS
2266TTHH FFEEBBRRUUAARRYY 22001155
MMIINNUUTTEESS OOFF MMEEEETTIINNGG

PPRREESSEENNTT:: Frank Collins, Chairman
Wendy Farrington Chadd, Chief Executive
John Grinnell, Director of Finance
Jayne Downey, Director of Nursing and Service Delivery
Steve White, Medical Director
Richard Clarke, Non-Executive Director
Ian Davis, Non-Executive Director
Alastair Findlay, Non-Executive Director
Hilary Pepler, Non-Executive Director

IINN AATTTTEENNDDAANNCCEE:: Ruth Tyrrell, Associate Director of HR
Margaret Surrage, Head of Board Governance (Trust Secretary)
Ann Ashworth, Trust Secretary Designate
Janet Cox, Minutes Secretary

PPAARRTT OONNEE –– PPUUBBLLIICC MMEEEETTIINNGG

The Chairman welcomed everyone to the meeting and said that he felt immense pride in
being invited to take on the Chairman’s role at the hospital. He thanked the Executive
Directors for their help in guiding him through his first few weeks in post and asked for
patience from colleagues whilst he familiarises himself with the organisation’s protocols and
processes. He also thanked the previous Chairman, Russell Hardy, for his great contribution
to the Trust.

MMIINNUUTTEE NNOO TTIITTLLEE AACCTTIIOONN
26/02/1.0 AAPPOOLLOOGGIIEESS
There were no apologies.

26/02/2.0 MMIINNUUTTEESS OOFF TTHHEE PPRREEVVIIOOUUSS MMEEEETTIINNGG
29/01/8.0 Month 09 Integrated Performance Report
Domain 1 Patient Safety
The Director of Nursing and Service Delivery confirmed that
all patients are risk assessed for pressure ulcers and MMIINNUUTTEESS
requested that the word ‘elective’ be removed from the 7th SSEECCRREETTAARRYY
bullet point on page 3 of the minutes.

Following this amendment the minutes were approved as an
accurate record.

26/02/3.0 MMAATTTTEERRSS AARRIISSIINNGG
The Chairman went through the actions which had all been
completed or diaried for future agendas.

Investment Decision Making Policy
The Director of Finance confirmed that the Policy had been
updated and that the Business Risk and Investment
Committee would have further discussion around the
investment metrics.
U:\Trust Board & Committees\Public Trust Board\2014-2015\March 1
2015\2015_03_26_Board_of_Directors_Paper_01_Minutes_of_the_Meeting_held_on_26_February_2015.doc
Paper 1
26/02/4.0 DDEECCLLAARRAATTIIOONNSS OOFF IINNTTEERREESSTT
The Head of Board Governance (Trust Secretary) confirmed
that the Chairman’s declarations had been added to the
website.

There were no additional new declarations of interest to
record.

SSTTRRAATTEEGGYY
26/02/5.0 RESEARCH STRATEGY
The Medical Director presented the Research Strategy which
had been designed to ensure a robust programme of research
to support improvement in patient outcomes at the hospital
and in the wider community. He explained that it will ensure
appropriate Clinical Governance arrangements are in place to
safeguard patients, staff and the Trust. He gave thanks to Mr
Andrew Roberts, Research Director and Consultant
Orthopaedic Surgeon for his leadership and help in
developing the Strategy.

A discussion took place on the promotion of research within
the Trust and whether this was ‘visible’. It was acknowledged
that there is a lot of surgeon and physician involvement and
that more could be done to encourage the nursing and allied
health professional staff to participate in research, not just as
support to clinicians but in their own right.

The Board of Directors welcomed the Strategy and requested HHEEAADD OOFF
that an update be provided in 6 months’ time when funding BBOOAARRDD
streams and the themes identified in the document have been GGOOVVEERRNNAANNCCEE
progressed. It also supported and encouraged the links with ((TTRRUUSSTT
academic institutions – suggesting that this include Glyndŵr SSEECCRREETTAARRYY))//
University as they have technical areas of expertise which MMEEDDIICCAALL
may be useful. In addition, it was felt that the Director of DDIIRREECCTTOORR
Nursing and Service Delivery should be the co-Responsible
Director to reflect the need for research to include the nursing DDIIRREECCTTOORR OOFF
and allied health professional body. This was agreed. NNUURRSSIINNGG &&
SSEERRVVIICCEE
An explanation of what CRN means was requested and the DDEELLIIVVEERRYY
Medical Director confirmed that this means Clinical Research
Network which is part of the National Institute of Health
Research. The RJAH comes under the Birmingham and
Black Country office which provides support to the
organisation such as measuring outcomes. If the organisation
performs well, more money is potentially available to support
research.

A discussion then took place on the Institute of Orthopaedics
and its link to the Board of Directors and it was noted that this
link is at Executive-level and will continue as the direction of
travel for Research evolves.

The Board of Directors noted that research is viewed and run
as a trading arm within the organisation and welcomed this
approach. It agreed that this approach emphasises how
critical it is to ensure that there is a mix of work to make
research sustainable as it is not just about the awarding of
grants.

The Board of Directors discussed and approved the draft
Research Strategy.

U:\Trust Board & Committees\Public Trust Board\2014-2015\March 2
2015\2015_03_26_Board_of_Directors_Paper_01_Minutes_of_the_Meeting_held_on_26_February_2015.doc
Paper 1
26/02/6.0 TTHHEE DDAALLTTOONN RREEVVIIEEWW
The Chief Executive presented the executive summary of the
Dalton Review ‘Examining new options and opportunities for
providers of NHS care’ which had identified five key themes:
One size does not fit all.
Quicker transformational and transactional change is
required.
Ambitious organisations with a proven track record
should be encouraged to expand their reach and
have greater impact.
Overall sustainability of the provider sector is a
priority.
A dedicated implementation programme is needed to
make change happen.

She then gave a presentation which is available here.

She explained that a number of recommendations had been
identified under these themes and gave a brief explanation of
what these were:

A new ‘kitemark’ of success should be developed for
ambitious organisations to aspire to
A credentialing process to be developed which looks
at things which are done well at organisations and
then transfers these to other parts of the sector.
From this, new partner organisations to be identified.
A procurement framework to then be developed which
allows credentialed organisations to register for
management contract and/or development
opportunities.

Leadership capacity and capability
Leadership Academy to take a more proactive role
which is co-ordinated at a national level.

Monitor and TDA need more options to prevent deterioration
in quality of care
Buddying system to be expanded.
Monitor to have more intervention powers.

She concluded that it is likely that this comprehensive piece of
work will be further developed post-Election but that the Board
needs to be thinking about the impact of these
recommendations as we progress our planning process into
2015-16.

The Board of Directors welcomed the themes identified and
the opportunities that this may present for the Trust. In
particular it noted that the organisation has good quality
templates of care which could be transferred to enhance its
own reputation as well as benefiting the wider health
economy. It noted that these themes will be addressed as the
2015-16 operational plan is finalised.

The Board of Directors noted the report.

PPEERRFFOORRMMAANNCCEE
26/02/7.0 MONTH 10 INTEGRATED PERFORMANCE REPORT
The Chief Executive introduced the Month 10 integrated
performance report which demonstrated strong performance
U:\Trust Board & Committees\Public Trust Board\2014-2015\March 3
2015\2015_03_26_Board_of_Directors_Paper_01_Minutes_of_the_Meeting_held_on_26_February_2015.doc
Paper 1
in the key metrics across all five domains. She confirmed that
the quality and patient experience metrics had continued their
strong performance throughout the year and improvements in
the efficiency domain were now showing progress. She
added that continued improvement in this area is key in
supporting the Trust in delivering its efficiency targets. She
concluded that the financial performance in January was very
positive.

Domain 1 Patient Safety
The Medical Director reported that strong performance in this
domain had continued. He highlighted that:
There were no hospital acquired infections in month.
One serious incident was recorded in month. Full
investigation would be undertaken and the results
presented to the next Quality and Safety Committee.
There were no patient deaths.
There were two instances of hospital acquired venous
thromboembolism in month. Both patients had been
risk assessed.

There were 17 medication incidents with no harm

recorded.

Four patients were readmitted as an emergency

within 28 days of discharge.

The Director of Nursing and Service Delivery reported that:

There were 13 patient falls in month - seven patients

were not complying with medical advice at the time of

their fall. Two minor harms were experienced. Work

is continuing to understand the reasons behind this

and to analyse the data. Work has also been

undertaken around medical advice given and to check

patients understanding.

The Trust scored 99.36% in providing harm-free care

using the safety thermometer tool which is above the

national twelve month average of 97.53%.

There were no hospital acquired pressure ulcers (of

any grade) in month.

The Board of Directors noted that the Quality and Safety

Committee would be reviewing the serious incidents in more

detail and that an audit was currently being undertaken.

MMEEDDIICCAALL
A question was asked about the readmission rate of 0.69%
DDIIRREECCTTOORR
and whether this was accurate and it was agreed that this

would be reviewed.

Domain 2 Patient Experience

The Director of Nursing and Service Delivery reported that all

metrics were forecast green at year-end with the exception of

Welsh access times. She highlighted that:

The net promoter score was 88.80 which was above

the target of 71.

The Trust remains within the top 10 acute trusts with

regards to satisfaction rates. During December this

was 98.1% against the national target of 94.5%.

111 formal compliments were received with no

additional feedback on the NHS Choices website.

Six complaints had been received which is within
tolerance levels. All have been investigated within the
U:\Trust Board & Committees\Public Trust Board\2014-2015\March 4
2015\2015_03_26_Board_of_Directors_Paper_01_Minutes_of_the_Meeting_held_on_26_February_2015.doc
Paper 1
required timescales.
There were three delayed discharges (on the Spinal
Injuries Unit). The delays were measured in days
rather than in months as had previously been the
situation.
Access targets relating to bone tumour, diagnostics
and English Referral to Treatment targets had been
maintained. Work is continuing with Welsh
Commissioners to meet their access targets with
85.23% of patients completing their pathways within
36 weeks.
The NHS England RTT validation team are due to
finish on 27th February 2015.

A question was asked regarding the delayed discharges on
the Spinal Injuries Unit and whether this had caused delays in
admitting new patients. The Director of Nursing and Service
Delivery confirmed that no delays had been caused in
admitting new patients to the Unit.

A question was then asked about the suggestion that Trusts
write to all patients who are waiting over 12 weeks to check
whether they should still be on the waiting list. It was noted
that the validation work being undertaken by NHS England
would address this. A discussion then took place on the open
pathway target which in the past has had more headroom and
was there anything which could be done to improve this. It
was noted that whilst this is challenging to meet every month,
there is a robust patient tracking system in place and there
are no underlying issues that needed addressing.

Domain 3 Efficiency
The Director of Nursing and Service Delivery reported that 8
of the 10 metrics were rated green in month as a result of
improvements in efficiency. She highlighted that:
Demand for services had decreased in line with
seasonal variation during December 2014, although
referrals had continued to increase during the year.
Commissioners have acknowledged this increase and
discussions are ongoing with regards to the pressures
on resources and the need for pathway review and
achievement of QIPP schemes to reduce demand.

Activity was marginally behind plan in the Surgical

Division.

Daycase performance increased in month and was

above the 50.5% target at 52.92%. The BADS rate

remained below the target of 87% at 83.85% in

month.

Theatre efficiency was above target at 96.88%.

Cases per session remained on target at 2.2.

Average length of stay decreased to 3.58 days which

was reflective of casemix.

A significant increase in the number of patients

discharged within 3 days of their operation was

achieved in month as a result of progress with the

enhanced recovery programme.

Bed occupancy on adult orthopaedic wards was

behind the target range at 77.69%.

Outpatient productivity: Did Not Attend rates

increased slightly but the rate remains below the

quarter 1 baseline performance that is being used to

U:\Trust Board & Committees\Public Trust Board\2014-2015\March 5
2015\2015_03_26_Board_of_Directors_Paper_01_Minutes_of_the_Meeting_held_on_26_February_2015.doc
Paper 1
benchmark the success of the text reminder system
which will be rolled out to all services by the end of
the financial year.

A discussion took place on the reduction in the surgical
activity and it was noted that further review was required
although it was not thought that there was any underlying
reason for this. This then led to a discussion on the increase
in the number of referrals and whether there had been any
change in approach from Commissioners. It was noted that
there had been increases in certain sub-specialties and
discussions were continuing with Commissioners to
understand the reasons for this. HHEEAADD OOFF
BBOOAARRDD
A suggestion was made for an update to be provided to the GGOOVVEERRNNAANNCCEE
Board of Directors on the progress made with the Enhanced ((TTRRUUSSTT
Recovery Programme and it was agreed that this would be SSEECCRREETTAARRYY))
included in the Board Business Programme. DDIIRREECCTTOORR OOFF
NNUURRSSIINNGG &&
A question was asked regarding Outpatient activity and what SSEERRVVIICCEE
plans were in place to bring this to target. The Director of DDEELLIIVVEERRYY
Nursing and Service Delivery explained that work was
ongoing in a number of areas to support achievement of this
metric.

Domain 4 Resources
The Director of Finance reported that:
A £180k surplus had been delivered against a plan of
£80k.
Cumulatively the surplus is £880k which is £40k
ahead of plan.
In month, the EBITDA margin was 6% and
cumulatively is 5%.
Income levels were over plan by £110k predominantly
as a result of increased activity in the medicine
division.

Pay costs were underspent by £60k. Non-pay costs

were overspent by £130k reflecting consumable costs

and over-performance on pathology costs which is

linked to activity.

Cost improvements of £324k were realised in month.

Year to date savings are ahead of plan and full

achievement of the £3m programme is forecast.

Cash balances increased in month to £4.5m as a

result of an interim cash settlement from Shropshire

CCG.

Settlements regarding year-end positions have been

agreed with most Commissioners.

Capital expenditure was £304k in month.

To achieve the year-end financial surplus target of

£1m, £120k needs to be delivered in the remaining

two months of the financial year.

A question was asked regarding the Cost Improvement

Programme and what schemes were included in the

Corporate Division. It was agreed that the Director of Finance

would respond outside of the meeting.

HHEEAADD OOFF
A discussion then took place on the underspend on pay costs
BBOOAARRDD
and the reasons for this. It was noted that there were two key
GGOOVVEERRNNAANNCCEE
elements – reduced out of job plan spend and the proactive
((TTRRUUSSTT
U:\Trust Board & Committees\Public Trust Board\2014-2015\March 6
2015\2015_03_26_Board_of_Directors_Paper_01_Minutes_of_the_Meeting_held_on_26_February_2015.doc
Paper 1
management of nursing staff linked to capacity and flexibility. SSEECCRREETTAARRYY))
It was suggested that the Spinal Injuries Ward Manager DDIIRREECCTTOORR OOFF
provide an update to the Board of Directors on the work that is NNUURRSSIINNGG &&
being done around acuity and staffing levels. This was SSEERRVVIICCEE
agreed. DDEELLIIVVEERRYY

Domain 5 External Perception
The Trust maintained its ‘green’ governance rating and level 4
continuity of services risk rating.

The Board of Directors noted the Month 10 Integrated
Performance Report.

GGOOVVEERRNNAANNCCEE,, QQUUAALLIITTYY AANNDD SSAAFFEETTYY
26/02/8.0 REVISED STANDING FINANCIAL INSTRUCTIONS AND SCHEME OF
DELEGATION
The Director of Finance presented the Standing Financial
Instructions and Detailed Scheme of Delegation which had
been reviewed and recommended for approval by the Audit
Committee. He explained that there was a proposed change
in the Significant and Material Transactions wording to align
with the Trust’s Constitution; changes to the wording in the
Scheme of Delegation relating to the practicalities of
delegating budgetary control and capital expenditure and how
this is managed once signed off by the Board of Directors and
quotation and tender limits have been updated.

The Audit Committee Chairman confirmed that the Audit
Committee had discussed the changes in detail and had
approved the changes proposed.

The Board of Directors approved the revised Standing
Financial Instructions and Detailed Scheme of Delegation.

26/02/9.0 FREEDOM TO SPEAK UP – REVIEW BY SIR ROBERT FRANCIS
The Chief Executive presented the correspondence received
from the Secretary of State for Health and Monitor Chief
Executive following the publication of the Freedom to Speak
Up Review by Sir Robert Francis. She confirmed that the
correspondence had been disseminated throughout the HHEEAADD OOFF
organisation as requested and suggested that this is BBOOAARRDD
discussed further at the April Board of Directors meeting with GGOOVVEERRNNAANNCCEE
regards to any ongoing impact on the organisation. She ((TTRRUUSSTT
confirmed that the lead executive is the Director of Nursing SSEECCRREETTAARRYY))//
and Service Delivery. DDIIRREECCTTOORR OOFF
NNUURRSSIINNGG &&
The Board of Directors agreed that it was important that SSEERRVVIICCEE
whistleblowers were treated fairly and agreed to discuss this DDEELLIIVVEERRYY
at the Board meeting in April.

26/02/10.0 BOARD GOVERNANCE PACK INCLUDING MATTERS RESERVED TO
THE BOARD
The Head of Board Governance (Trust Secretary) presented
the Board Governance Pack which had been updated to
confirm the change in Director responsibilities approved by
the Board in January 2015 and reflect the new regulations on
the Fit and Proper Person Test. She added that no changes
were proposed to the Matters Reserved to the Board.

It was noted that the documents made reference to ‘Vice HHEEAADD OOFF
Chair’ and it was agreed that this would be changed to read BBOOAARRDD
‘Deputy Chair’. GGOOVVEERRNNAANNCCEE
U:\Trust Board & Committees\Public Trust Board\2014-2015\March 7
2015\2015_03_26_Board_of_Directors_Paper_01_Minutes_of_the_Meeting_held_on_26_February_2015.doc
Paper 1
((TTRRUUSSTT
The Board of Directors approved the proposed changes to SSEECCRREETTAARRYY))
the Board Governance Pack and confirmed that the Matters
Reserved to the Board remain unchanged.

26/02/11.0 NON-EXECUTIVE DIRECTOR BOARD AND COMMITTEE ROLES
The Chairman presented the paper which proposed changes
to the Non-Executive Director Board and Committee Roles
following the departure of Peter Jones, Non-Executive
Director. He explained that it was his intention to defer
discussion around individual roles to the closed private
session with the role of the Senior Independent
Director/Deputy Chairman to be discussed in the public
session. He reminded the Board that it is the Council of
Governors role to appoint the Deputy Chairman whilst the
Senior Independent Director was a Board appointment to be
made in consultation with the Council of Governors. He
described how he had spoken to Board colleagues regarding
this appointment. He confirmed that his recommendation was
for Alastair Findlay, Non-Executive Director to be appointed to
the role of Senior Independent Director as it was his view that
he had the necessary experience, competence and
professionalism to fulfil the role. He added that he would
recommend to the Council of Governors that the Senior
Independent Director would also assume the role of Deputy
Chairman. He concluded that if the Board of Directors were in
agreement with his recommendation, he would discuss this at
the Council of Governors meeting later in the day.

The Board of Directors approved the recommendation for
Alastair Findlay to become the Senior Independent Director
and to recommend to the Council of Governors that he should
be appointed as Deputy Chairman.

26/02/12.0 BOARD DECLARATIONS 2014-15
The Head of Board Governance (Trust Secretary) presented
the statements which are required to be included in the
organisation’s annual report concerning the independence of
the Non-Executive Directors and the balance and
completeness of the Trust Board as required by the NHS
Foundation Trust Code of Governance. She explained that
there were a number of assurances to support these
statements, namely the fit and proper person test for the new
Chairman, whose leadership skills and experience will
strengthen the Board, the refresh of the Directors declarations
of interest and the balance of the Board which was discussed
at the meeting in January 2015.

The Board of Directors approved the statements as
presented for inclusion in the Trust’s annual report.

26/02/13.0 RREEPPOORRTTSS FFRROOMM BBOOAARRDD CCOOMMMMIITTTTEEEESS::
AAUUDDIITT CCOOMMMMIITTTTEEEE –– 1133TTHH JJAANNUUAARRYY 22001155
Richard Clarke, Non-Executive Director and Chairman of the
Audit Committee presented his report of the Audit Committee
held on 13th January 2015. He explained that the Committee
had received its usual reports relating to finance, governance,
counter fraud and risk management. The Committee had also
discussed and recommended a 2 year extension to the
external audit contract. The Board agreed with the rationale
for extending the external audit contract and noted that this
U:\Trust Board & Committees\Public Trust Board\2014-2015\March 8
2015\2015_03_26_Board_of_Directors_Paper_01_Minutes_of_the_Meeting_held_on_26_February_2015.doc