Council of Governors Meeting

9.30am to 12.30pm on Tuesday 13 October 2015

Mickerson Hall, Chichester Medical Education Centre, St Richard’s Hospital, Chichester, West Sussex, PO19 6SE

AGENDA

1 9.30 Welcome and Apologies for Absence Mike Viggers

2 9.30 Declarations of Interests Verbal Mike Viggers

3 9.30 Minutes of Meeting of the Council of Governors held on 16 July 2015 To approve

Enclosure Mike Viggers

4 9.35 Matters Arising from the Minutes

To note Enclosure Mike Viggers

LISTENING AND REPRESENTING

5 9.40 Lead Governor’s Report To receive and agree any necessary action

Enclosure Margaret Bamford

6 9.55 Membership and Public Engagement

To receive and agree any necessary action Enclosure Vicki King

7 10.05 Staff Governors Report

To receive and agree any necessary action Enclosure Staff

Governors ACCOUNTABILITY

8 10.15 Board Report to Council including Patient First Update To receive and agree any actions

Enclosure Marianne Griffiths

9 11.05 Update on Trust Workforce Issues

To receive and agree any necessary action Presentation Denise

Farmer

10 11.25 Outpatients Improvement Programme To receive and agree any necessary action

Presentation Marianne Griffiths

11 11.45 Audit Committee Feedback

To receive and agree any necessary action Presentation Jon Furmston

GOVERNANCE

12 12.05 Autumn 2015 Governor Election To receive and agree any necessary action

Enclosure Andy Gray

OTHER ITEMS

13 12.15 Other Business Chair

14 12.20 Questions from the Members of the Public

15 12.30 Resolution into Board Committee To pass the following resolution: “That the Council now meets in private due to the confidential nature of the business to be transacted.”

Verbal Chair

16 12.30 Date of Next Meeting

The next meeting of the Council of Governors is scheduled to take place on 21 January 2016 at 9.30am in the Denham

Room, Conference Centre, Worthing College, 1 Sanditon

Way, Worthing, BN14 9FD

Chair

Andy Gray Company Secretary Tel: 01903 285288 / Mobile: 07785332416

Minutes

Minutes of the Council of Governors Meeting held in Public from 09.30am on

Thursday 16 July 2015 at the Charmedean Centre, Forest Road, Worthing, West

Sussex, BN14 9HS

Present: Mike Viggers Chairman Margaret Bamford Public Governor – Arun Barbara Porter Public Governor – Adur John Todd Public Governor – Adur Vicki King Public Governor – Chichester Shirley Hawkridge Public Governor – Worthing David Langley Public Governor – Worthing Beda Oliver Public Governor – Worthing Jennifer Edgell Patient Governor Greg Daliling Staff Governor Helen Dobbin Staff Governor David Walsh Staff Governor Gillian Keegan Appointed Governor, Chichester District

Council Peter Pimblett-Dennis Appointed Governor, Brighton & Sussex

Medical School Jane Ramage Appointed Governor, Friends of WSHFT

Hospital and WRVS Val Turner Appointed Governor, Worthing Borough

Council In Attendance:

Bill Brown Non-Executive Director Joanna Crane

Jon Furmston Lizzie Peers Mike Rymer

Non-Executive Director Non-Executive Director Non-Executive Director Non-Executive Director

Dr George Findlay Karen Geoghegan Jane Farrell Denise Farmer

Medical Director Director of Finance Chief Operating Officer and Deputy Chief Executive Director of Organisational Development and Leadership

Andy Gray Company Secretary Alison Ingoe

Mike Jennings Deputy Director of Finance Commercial Director

Barbara Mathieson Assistant to Company Secretary (Minutes) Maggie Davies Deputy Director of Nursing (For Item 10) Paul King Ernst and Young (To end of item 6)

Item No Item Title Action COG/7/15/1

1.1

1.2

Welcome and Apologies for Absence The Chairman welcomed everyone to the meeting of the Council of Governors and particularly Gillian Keegan who was attending her first meeting. Apologies for Absence were noted from : Executives – Marianne Griffiths , Karen Geoghegan, Amanda Parker Governors – Paul Benson, Richard Farmer, Stuart Fleming, Jenny

Minutes page 2

Garvey, Brian Hughes, Alison Langley, Nigel Peters and Abigail Rowe

COG7/15/2 Declarations of Interest

2.1 There were no declarations of interest.

COG/7/15/3 Minutes of the Council of Governors Meeting held in Public on 14

April 2015

3.1

3.2

3.3

3.4

3.5

3.6

3.7

3.8

The Council of Governors received the minutes of the meeting held on 14 April 2015. Present : Change Val Tuner to Val Turner COG/4/15/6.1 First Sentence change word rolls to roles COG/4/15/7.8 Third sentence – change word unstainable to unsustainable COG/4/15/10.3 - First sentence add in word violence so reads ‘experiencing violence from….’ COG/4/15/10.11 – Second sentence remove word take COG/4/15/10.12 – Add at end “Helen Dobbin questioned how embedded Patient First was across all areas of the trusts and all staff groups. Marianne responded that it was still at early stages with much still to be accomplished but that plans were in progress to try and achieve Trust wide engagement. The minutes of the meeting of the Council of Governors held on the 14 April 2015 were approved, subject to the amendments above and it was agreed that they should be signed by the Chairman.

COG/7/15/4 Matters Arising from the Minutes

4.1

4.2

4.3

4.4

4.5

The Matters Arising from the meeting held on the 14 April 2015 were noted by the Council of Governors. COG/4/15/4.3 Share information in Capital Spend and planned 2015/16 Capital Programme for the Trust. It was confirmed that this item had been completed. However it was also noted that a Six Facet Survey was in the process of being commissioned and would feed into the final Estates Strategy which would be shared once complete. COG/4/15/8.3 Share budget for Council of Governors It was confirmed that this had been completed. COG/4/15/9.3 Develop section on the Trust website to share assurance / performance documents with the Governors It was confirmed that the section of the website was now live and had been well received. Thanks were noted to James Roser who had undertaken the work.

Minutes page 3

COG/7/15/5 Chief Executive’s Performance Report

5.1

5.2

Jane Farrell, Chief Operating Officer and Deputy Chief Executive presented the Performance Report. She confirmed that the paper included information to the end of May but that she would supplement this with data from June where available during her presentation. Jane began her presentation with some highlights of activities within the Trust from the previous quarter. These included:-

Being confirmed by the local Clinical Commissioning Group as the prime provider for Musculoskeletal (MSK) services within the local area.

The Outline Business case for Ophthalmology Services at Southlands was approved by the Trust Board.

The Bed Reconfiguration programme was approved.

The Integrated Sexual Health Services – contract, run by the Trust on behalf of the County Council was extended.

New nursing staff recruitment campaigns were launched.

The Patient First and related improvement programmes were well underway.

5.3

5.4

5.5

5.6

5.7

5.8

During the period capacity and workforce constraints continued to be a challenge and this was alongside local health economy fragility especially within the local community. Despite this compliance against A&E arrival to treatment times were 96.8% for May and 97.5% for Quarter 1. Western Sussex Hospitals NHS Foundation Trust (WSHFT) was confirmed to be the best performing Trust in Surrey and Sussex and within the top 20 nationally for this metric. Jane also confirmed that a revised plan for sustainable compliance against the Referral to Treatment Time targets was agreed with Coastal West Sussex Clinical Commissioning Group. Compliance against cancer metrics had been difficult to achieve due to increased demand for the services. It was also noted that the Crude non-elective mortality for the Trust reduced from 3.23% in April to 2.82% in May and was lower than May 2014 when it was 3.07%. During the Quarter the results of the Sentinel Stroke National Audit Programme for January 2015 to March 2015 were announced and the Trust was very pleased that both hospitals had improved. St Richard’s Hospital improved its score from 63 to 67 remaining as Band C and Worthing Hospital improved its score from 66 to 78 moving from Band C to Band B. The context of these scores was considered and it was noted that 202 units were included in the audit. Of these only 23% were branded as B the achievement of the Trust in this field of care was felt to be particularly significant. It was confirmed that the workforce capacity within the Trust continued to exceed budgeted establishment with a continued over reliance on temporary staffing solutions. To help try to resolve this, a series of Nurse Recruitment Days had been set up and were proving successful. Also an International Recruitment had taken place in the Philippines which had resulted in 149 places at the Trust being offered.

Minutes page 4

5.9

5.10

5.11

Another concern was the continued frailty within the local health economy. Nationally there was a target of 3.5% for delayed transfers of care and locally the various agencies tried to keep this to 2%. However it was noted that at the beginning of Quarter 1 the figure was 3% and currently was4.5%. Jane did however stress that all partners continued to engage and communicate in a positive way to try and resolve these issues. During May the Trust accrued a deficit of £415k in month bringing the year to date position to £1.2m deficit. At year end it was noted that the Trust was forecasting delivery of a surplus of £992k and a Continuity of Service rating of '3'. The Efficiency Programme had delivered cumulative savings of £1.78m against a plan of £1.84m (96.4%). To conclude her presentation Jane confirmed the key risks to on-going improvement and sustainability within the Trust. These were:-

Continuing workforce challenges – both short and long term

Balancing capacity & demand

Achieving the Efficiency Programme (circa £19m (4.75%))

Maintaining the focus & catalyst for continuous improvement and the quality of the patient experience against the challenging background.

5.12

5.13

5.14

5.15

David Walsh asked about the award of the MSK contract to the Trust as the prime provider. He noted that the Trust had initially lost some staff and had failed to attract others when there had been uncertainty regarding the service. Mike Jennings confirmed that there had been initial challenges with attracting new staff within Imaging which had been linked to this. Staff turnover was now static and areas of the services were being redesigned to take account of any shortfall in staff. David then asked if the Trust perceived that there would be any threat to the new Ophthalmology Services planned for Southlands from the Panacea Medial Centre which had been set up to provide private care in Worthing. The members of the Board confirmed that they did not believe this was the case for several reasons including the fact that currently there was a challenge around meeting the demand. Mike Jennings confirmed that the issues with transport for patients to Southlands was being resolved and that the Business Case was predicated on growth in the service. David also raised the difference in the scores for the Stroke Services across the hospitals. George Findlay reminded the members of the Council of Governors that this did not represent a difference of outcomes and the scores related to the provision of different services. He also confirmed that there had been a considerable improvement in the scores as just 12 months previously St Richard’s had been in Band E. Stuart Fleming noted that there had been a 15% turnover in Trust staff over the last year and asked if Exit Interviews were routinely offered. Denise Farmer confirmed that the current focus within the Workforce teams was on recruitment however Exit Interviews are routinely offered to all staff leaving the Trust. Many opportunities were taken up but Denise confirmed that the use of information gained from them did need to be improved. She also acknowledged that there were variable areas of pressure across the Trust and plans were progressing to align staffing with areas of concern. This would then be supplemented with the use of

Minutes page 5

5.16

5.17

5.18

5.19

5.20

5.21

agency staff as needed. Denise also confirmed that there continued to be workforce issues across all local Health Economy Partners. Helen Dobbin asked for further information about the various recruitment campaigns taking place across the Trust. In particular how were offers being converted to the actual uptake of roles? Denise confirmed that there was currently a time lag with many of the posts within the domestic nursing recruitment campaign as several of the people offered roles were student nurses who were not due to qualify until the autumn. For the international recruitment the new nurses would be starting at the Trust in late 2015/ early 2016. It was however recognised that there would need to be another step increase in nursing recruitment as a result of the planned bed reconfiguration but it was expected that this could be covered within domestic recruitment. Helen also commented that the previous uncertainty with the MSK services was still impacting on Physiotherapy services within the Trust as several staff had joined other Trusts who were further ahead with developing new style roles. Mike Viggers recommended that the agenda for the next Council of Governors meeting included an update and opportunity for discussion on workforce issues. Vicki King asked that actual response rates for the Friends and Family Test Scores were routinely provided and how the figure for staff recommending the Trust compared to national figures. Denise confirmed that it would be difficult to compare the figures as the Trust recorded in real time on a monthly basis whereas national figures were only available on a quarterly basis. She did however confirm that the Trust was running ahead of national ratings. Gillian Keegan asked about the impact of the National Budget announcements and the changes to the minimum wage and would this result in a recruitment issues for the Trust? Denise confirmed that changes would be considered nationally in the set pay bands which all NHS organisations used. It had been estimated that for the Trust there would be an extra £60k cost per annum and it was confirmed that improvements particular within Terms and Conditions for some staff within the Facilities and Estates Division were being considered. Peter Pimblett-Dennis asked that in future reports mortality figures were expressed in whole integers. He also asked why Private Patient income was less than planned. Mike Jennings confirmed that due to the period of business continuity which had happened earlier in 2015 there was a lower baseline of activity than expected but he was confident that the expected income would pick up to meet the plan. It was also noted that there had been some changes of staff including Consultants who made use of the units and this had impacted on the income. This had more of an affect than competition from external services and the bed reconfiguration and ring fencing of elective capacity would help to provide a more stable service for private patients in the future. Barbara Porter asked what impact the bed reconfiguration initiative would have on the provision of Community Beds which the Trust was still providing. It was agreed that Dr Rob Haigh be asked to present the Bed Reconfiguration Plan to a Governor seminar. Jane Farrell confirmed that Community Beds had been provided throughout Quarter 1 and that discussions were still taking place regarding the continuation of this into Quarter 2.

AG/DF AG GF AG

Minutes page 6

5.22

5.23

Barbara then commented on the good stroke results within the Trust but highlighted the fact that patients who had suffered with one were then more likely to suffer a TIA (Transient ischemic attack). She particularly referenced the cumulative affect of these and asked what provision was made for care for patients after they had recovered from an initial stroke. George Findlay confirmed that the incidence of stroke was reducing and that this was attributable to the focus on the TIA service. There was also a rapid access service for all patients with an expected TIA. Val Turner asked about concerns within Outpatients and how some patients were continually being rebooked. She asked how these cases were monitored and recorded. Mike Viggers confirmed that in some areas the Trust were not delivering the Outpatient Services in the way it would wish too. Jane Farrell confirmed that within some areas there were no issues but it was widely acknowledged that there was not a consistent high level of Outpatient Services throughout the Trust. Improvements in monitoring of concerns were taking place and information was shared weekly within the Divisions. Targeted improvements within Outpatients were confirmed to be a key component of the Patient First Transformation Programme. George Findlay confirmed that the diagnostic phase of this work would be the completed by the end of August.

COG/7/15/6 External Auditors Report on Quality Account

6.1

6.2

6.3

6.4

6.5

6.6

Paul King, Ernst & Young, presented their “Letter to Governors 2014/15” which outlined the audit work that they had undertaken for the year ending 31 March 2015. It was confirmed that the letter was a high level summary of the work undertaken with respect to Ernst & Young’s responsibilities of auditing the Trusts Accounts. Paul confirmed that there were no major issues found during the audit. It was confirmed that the actual audit fee increased by £2,950 from the plan due to Monitor’s requirements for Foundation Trust’s to adopt the NHS Foundation Trust Code of Governance (July 2014). This introduced revised auditor reporting requirements. It was widely recognised that the Trust was in a challenging financial position and it was acknowledged that there had been revision of the outturn forecast which was agreed at Month 9 with Monitor. A major initiative within the financial year was the disposal of part of Southlands Hospital and Ernst & Young had confirmed that although the accounting process for the disposal may have appeared overly complex they concluded the profit on disposal had been correctly calculated. Also during the 2013/14 Audit it had been recommended that the Trust improved its journal controls. It was confirmed that this had been implemented. It was also confirmed that Ernst & Young had undertaken a review of the Trust’s Quality Report and noted that it complied with the required guidance. Barbara Porter commented on section 3.3 Performance Indicators and that the correct mandated indicator was “emergency re-admissions within 30 days of discharge from hospital”. Paul King agreed to clarify the point. To conclude the item Paul paid credit to the Trust’s Finance Team for the

PK

Minutes page 7

6.7

success of the 2014/15 audit.

COG/7/15/7 External Auditor Performance Report

7.1

7.2

7.3

7.4

7.5

Jon Furmston, Chair of the Audit Committee and Alison Ingoe, Deputy Director of Finance presented the External Audit Performance Report and reminded the Council of Governors that it was a requirement that the Trust’s Audit Committee reports annually to the Council of Governors on the External Auditor after the completion of the year’s audit. Alison confirmed that there were no performance concerns with regards Ernst &Young. It was acknowledged that External Auditors had to achieve a careful balance and provided appropriate challenge. Also they were felt to provide good value for money given the size of the Trust. The appointment of Auditors for 2016/17 was then discussed by the Council of Governors. It was confirmed that the Council of Governors had agreed at the July 2013 meeting that they would consider an extension of Ernst &Young’s appointment for 2016/17 in July 2015. At the same time the Council of Governors also agreed that it would not extend their appointment beyond 2016/17 without market-testing. It was noted that Monitor’s guidance stated that an auditor should be appointed for a period that would allow it to develop a strong understanding of the NHS Foundation Trust, normally three to five years therefore allowing continuity of service. Monitor also recommended that external audit services were subject to market-testing at least once every five years. It was recommended that an extension to 2016/17 with market-testing for auditor appointment from 2017/18 would be fully compliant with Monitor’s requirements. Other considerations that needed to be taken into account were that there would be a change to the key post of audit manager during this period. Also the Audit Committee had observed that it had taken longer for relationships with the new internal auditor to form and stabilise than expected. The learning from this was that the tender process for new auditors should allow an appropriate transition time between contract award and the start of the appointment. A Foundation Trust could not be without an external auditor and so this put additional pressure on the tender timescale. The Audit Committee considered that it would be prudent to extend the tender timescale to allow for adequate transition and mobilisation for the successful auditor. Given the forthcoming governor elections, an extended timeline would also ensure that governor engagement could be maintained. After discussion it was agreed that there was no imperative in either governance or financial terms to tender for an auditor to be in place prior to April 2017. The Council of Governors therefore agreed with the recommendation of the Audit Committee that the best course of action was to extend the appointment of Ernst & Young for 2016/17. As such the Council of Governors and Audit Committee would from Autumn 2015 begin the work for tendering for external audit services which it was expected to take about 18 months to complete given Monitor’s guidance on undertaking this work. David Langley asked how many external staff took part in the audit process and Alison Ingoe confirmed that there was a Core Team who were usually on site for four weeks. The team would be supplemented with additional staff but she added that there was always good continuity

Minutes page 8

7.6

through-out the audit period. The Council of Governors APPROVED the appointment of Ernst and Young to carry out the Audit for 2016/17 for Western Sussex Hospitals NHS Foundation Trust.

COG/7/15/8 Lead Governor’s Report

8.1

8.2

8.3

8.4

Margaret Bamford presented the Lead Governors Report. She confirmed that a Governors’ Review Day was undertaken in June which was felt to have been a valuable exercise. Margaret outlined the highlights which included that there continued to be difference of opinion around the question of redacted minutes which the members of the Council of Governors were now receiving. It was noted that a Governor was now attending the Trust’s Charitable Funds Committee which was proving to be beneficial. The Membership Committee was felt to be discharging its duties well although it was agreed that increasing membership and engagement was a responsibility of all Governors. The Patient Experience and Engagement Committee was now felt to be well embedded and that the local Healthwatch Team felt it valuable to attend. Margaret advised that amendments to the structure of the Agenda for future meetings had been suggested. Barbara Porter also confirmed that several of the Governors were involved in the working groups that were contributing to the development of the new Ophthalmology Services at Southlands. Barbara particularly commented that the project would bring new vigor and life into the hospital at Southlands. Mike Viggers confirmed that the Full Business Case for the service would be brought to the November Trust Board and that detailed design work was currently being undertaken.

AG

COG /7/15 /9 Membership Committee

9.1

9.2

9.3

9.4

Vicki King presented the update from the Membership Committee and confirmed that work was continuing on developing the action plan which supported the Membership Strategy 2015/18, which had been circulated at the last Council of Governors meeting. This work included redrafting existing materials and literature to reflect the new membership structures. Vicki also confirmed that an aim was to try and achieve a balance membership of the Trust and therefore the recruitment would focus on younger age groups, minority ethnic groups and men. At the next meeting it was confirmed that the Committee would be considering membership data for the various categories to establish a baseline against which improvement could be measured to show improvement against Another intended activity over time would be to develop a microsite of the website for members. The various recruitment activities and initiatives which were taking place were outlined and Governors who were not part of the Committee were encouraged to help with this. Finally it was confirmed that all volunteers who work across the three hospitals would now automatically become members of the Trust unless they choose to opt out. Denise Farmer commented that all the work that was being undertaken to

Minutes page 9

connect with the Membership of the Trust fitted in well with the CQC’s definition of a good organisation which would be a benefit for the forthcoming inspection.

COG /7/15/10 CQC Inspection

10.1

10.2

Maggie Davies, Deputy Director of Nursing joined the meeting and gave a presentation on the forthcoming CQC Inspection Visit. She confirmed that 8 weeks prior to the site visit the Trust would receive a request to provide a standard set of evidence and confirmed that this would have to be submitted within 10 days. The visiting team would be on site for 4 days and there would be an unannounced follow up visit within 6 weeks. Maggie confirmed that all areas of the Trust would be subject to inspection and that there would be 5 Key Questions:-

Is it safe?

Is it effective?

Is it caring?

Is it responsive?

Is it well led?

10.3

10.4

10.5

10.6

10.7

10.8

It was also confirmed that several areas of focus such as “End of Life” care would be considered within the different departments and specialties within the Trust.

Each area inspected would be given a rating against the questions outlined above which would then inform the overall rating for the Trust. As such, a service could be considered “Outstanding”, “Good”, “Requires Improvement”, or “Inadequate”. Most Trusts would aim to meet the requirements of being rated as good and it was confirmed that just two within the country met the rating of “Outstanding”. Other important factors would include observations of interactions between staff and evidence of person centered care. As well as the CQC Teams visiting the areas within the hospital where they would observe practice and review records Maggie confirmed that there would be a number of opportunities for staff to speak to CQC inspectors including via focus groups, individual interviews and a dedicated contact line. Also, CQC would set up public consultation meetings immediately prior to the visit within the local area. Gillian Keegan asked if the CQC team would consider past patients and Maggie confirmed that they would ask to review notes and would hold telephone conversations. Greg Daliling raised the concern that many staff had regarding the number of manual beds that there are within the Trust. He felt that staff thought that they were hard to manage and that there are safety concerns and that staff may raise this with the CQC Inspectors. Maggie confirmed that these concerns had already been raised within the Trust and acknowledged the priority of keeping staff and patients safe. She confirmed that the Divisional Director of Operations for Core had been asked to undertake a piece of work on reviewing the bed stock within the Trust in order to make recommendations for any appropriate change. Gillian Keegan asked if the Trust had previously been a subject of a CQC Inspection. It was confirmed that there were several visits prior to the

Minutes page 10

10.9

10.10

10.11

approval of the application to become a Foundation Trust but this would be the first visit as part of the new inspection regime. It was however confirmed that the Trust had been subject to a routine inspection which had considered compliance with Mental Health Regulations. Vicki King commented that in the past Governors had been asked to be involved in mock CQC visits and asked if these would be happening again. Maggie confirmed that the visits were currently being re-designed and their format agreed. Barbara Porter asked why recently there seemed to be a shortage of the availability of pillows at Worthing. Jane Farrell said that she would raise this concern with the appropriate staff and said that it was an important consideration along-side the quality of the bed stock for all patients. Barbara stressed the need to balance financial concerns against any patient safety concerns Post Meeting Note: The CQC inspection visit to Western Sussex Hospitals NHS Foundation Trust would take place from the 8th to 11th December 2015.

JF

COG /7/15/11 Finance and Investment Committee Feedback

11.1

11.2

11.3

11.4

Mike Viggers gave an update to the Council of Governors on the work of the Finance and Investment Committee and confirmed that the purpose was to ensure that all appropriate action was taken to achieve financial objectives thereby supporting the achievement of the Trust’s Quality Strategy and Operational Plans. Mike spoke about the current financial strain across the Health Sector and noted that out of all the Foundation Trusts over half had finished the last financial year in deficit. Financial stability was a key enabler for being able to continue to make improvements in patient care. Over the last financial year; of particular concern was the continued need for reliance on Bank and Agency staff and the associated high financial cost. It was also noted that it was particularly important to ensure the right mixture of activity between elective and non-elective activity to ensure sufficient income. Mike also commented that for the financial year 2014/15 the Trust achieved £19m of financial savings through the Efficiency savings which represented 4.5% of the Trusts income. Mike confirmed that Monitor’s primary financial metric was the Continuity of Services Rating (CoS) and that through this metric the Council could assess the achievements of the Trust Board in relation to finance. This metric was published on Monitor’s website. However it was confirmed that the CoS rating metric was under-review by Monitor. The key duties of the Finance and Investment Committee were noted to include:-

Financial Management

Annual Financial Plans and Targets

Income and Expenditure performance

Activity monitoring against plan

Workforce planning

Cost improvement planning and delivery

Procurement oversight

Oversight of the Efficiency and Transformation Programme.

Minutes page 11

11.5

11.6

As well as receiving regular reports and updates on the above items the Committee received and scrutinised all business cases which required Board approval. Within this discussion the Committee considered the fit within the Strategic Plan, the Quality Impact, the impact on Patient Experience, and the financial viability and sources of funds. Mike gave some examples of the recent initiatives and these included:- Emergency Floor, Pathology, new Endoscopy facilities at Worthing and a new CT scanner for St Richard’s. Mike then confirmed that the Committee also considered the priorities for the Facilities and Estates areas within the Trust along with information and technology improvements – such as the Single Sign On and E-Prescribing. To conclude his presentation Mike confirmed that one of the key responsibilities of the Finance and Investment Committee was to provide assurance against the Trust’s Financial Plan.

COG/7/15/12 Governor Code of Conduct

12.1

12.2

12.3

12.4

12.5

The Governor Code of Conduct – Process for Investigating Non-Compliance was considered by the Council of Governors. It was acknowledged that whilst not a member of staff, it was reasonable for the Council of Governors and Board of Directors to expect a standard of behavior from Governors in line with Trust values. The proposed process would provide a framework for reviewing any alleged Non-Compliance. Jane Ramage shared the views of several Governors regarding their concern over the wording within item 2.6 that anybody who accompanied a Governor should be a person associated with the Trust. Their feeling was that the Governor may not know or feel appropriately supported by somebody from the Trust. Denise Farmer confirmed that there had been learning within the Trust from the internal disciplinary processes and reminded the Council of Governors that it was not a legal process. It was important that anybody involved choose the most appropriate person to support them, who would be able to help them understand the scenario/culture. This kind of guidance may not be forthcoming from somebody not associated with the Trust. Val Turner stressed that there should be flexibility and that who would be most appropriate to accompany the Governor would be dependent on the complaint. Margaret Bamford shared that the process should be consistent with Trust process and therefore any person accompanying the Governor should not have a legal background. The Council of Governors debated their concerns and then those present voted by a unanimous show of hands to remove the words “ by any person associated with the Trust” from section 2.6

COG/7/15/13 Council of Governors Declaration of Interest 2015/16

13.1 Andy Gray presented the Council of Governors Declaration of Interests paper and confirmed that it was a Monitor requirement that the records were kept.

COG /7/15/14 Other Business

Minutes page 12

14 .1 There was no further business

COG /7/15/15 Questions from the Members of the Public

15.1

There were no questions from the Public.

COG /7/15/16 Resolution into Committee

16.1

The Council passed the resolution that it met in private due to the confidential nature of the business to be transacted.

COG /7/15/17 Date of Next Meeting

17.1 The next meeting of the Council of Governors would take place at 09.30 am on Tuesday 13 October 2015 in the Mickerson Hall, Chichester Medical Education Centre, St Richard’s Hospital, Chichester, West Sussex, PO19 6SE.

Barbara Mathieson

Assistant to Company Secretary

July 2015

Signed as an accurate record of the meeting

………………………………………………….

Chair

…………………………………………………

Date

MATTERS ARISING FROM COUNCIL OF GOVERNORS MEETINGS

MATTERS ARISING FROM THE MEETING HELD ON 16 July 2015

Minute Ref Description of Action Responsible Person

Deadline Report

COG/7/15/5.17 Include an update and opportunity for discussion on Trust Workforce Issues on Agenda for the next meeting

DF/AG Oct On Agenda for meeting on 13 October 2015

COG/7/15/5.18 Include actual response rates for Friends and Family Test Scores in future reports

AG/AP Oct Included in item 8 of Agenda for meeting on 13 October 2015

COG/7/15/5.20 Express mortality figures in whole integers in future reports

AG/GF Oct Included within item 8 of Agenda for meeting on 13 October 2015

COG/7/15/5.21 Ask Dr Rob Haigh to present the Bed Reconfiguration plans to Governors in a Seminar

AG Date to be confirmed

Date to be confirmed. To take place in Oct/November 2015

COG/7/15/6.6 Clarity within External Auditors report on Quality Account the timing of the emergency re-admissions indicator

PK Oct

Confirmation received from Ernst and Young that the position is that 28 days is set out in the national indicator specified in the regulations for inclusion in the Quality Report.

COG/7/15/8.3

Use suggestions from the Pre Council of Governors meeting held in June for the revised structure of Agenda for the future Council of Governor meetings

AG Oct Completed.

Cog/7/15/101.10 Discuss availability of pillows with Housekeeping staff

JF Oct

The issue around pillow shortages has recently been brought to the attention of Facilities and Estates. Following a review of how many there are in the system, we can confirm that there are more than sufficient pillows to service both main sites.

1

13th October 2015

To: The Council of Governors Agenda Item: 5

From: Margaret Bamford, Lead Governor

TO RECEIVE REPORT FROM LEAD GOVERNOR Introduction We were very sad to hear of the death of David Langley on 7th September in Worthing Hospital. His financial knowledge and his commitment to the role of the governor were greatly appreciated and he will be missed by us all. The sympathy of the governor group has been extended to his wife and family. This month we welcome newly elected and re-elected colleagues who bring a wealth of varied and extensive experience to the governor group. We look forward to the contributions they will make to the work of the Council. We say farewell to those governors who have left the Council and are very grateful for all they did in helping to establish such an effective working group. We particularly appreciate the offers of those who have said they wish to continue to be involved and support the aspirations of the Trust. 1. Nomination and Remuneration Committee

There have been no meetings of this committee since the last Council meeting but governors have raised some issues in the meantime 1.1. The appraisal process for the Chair and NEDs. It is suggested that this is reviewed at

the next meeting

1.2. The governor non-compliance procedure, with amendments, was agreed at the last meeting of Council. There are some minor queries to be resolved about where the policy is to be located and a further amendment about reference to an independent assessor in the event of any disagreement.

2. Membership Committee

Under the able chairmanship of Vicki King this group has gone from strength to strength. Governor members of the group have worked hard to recruit new members from under-represented groups in the community. Those governors involved in talking to the public about the Trust learn so much about what patients have really appreciated about their hospital care. They also learn about when things have gone wrong and how distressing it has been for them and their families. All these experiences are fed back to the Trust to be used to learn and constantly improve services. Vicki’s separate report, giving more detail, is the next item on the agenda.

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In the meantime Council is assured that governors are aware that central to their role is engagement with members and the public to seek and represent their views. Hitherto only a small group of governors has been actively involved. Efforts will continue to seek the support of all constituency governors in future initiatives.

3. Patient Engagement and Experience Committee (PEEC)

Concerns about duplication with the membership committee have been resolved. It has been accepted that the emphasis of this outward facing group with external representation and a clear engagement role is different. At the end of year review the balance between public and hospital representation will be considered; specifically extending external membership to include the Local Authority (?Public Health), and the Community Trust. Governors note that dual membership of staff and a NED on PEEC, with the Trust’s Patient Experience Committee, should ensure a coherent approach and facilitates a clear feedback loop between the committee and the Trust. Clarification is being sought about the link into the strategic planning process The following message from the CCG’s patient representative NED (Jean Barclay) indicates the degree to which involvement is appreciated;

“I wanted to let you know of a very positive development within WSHFT … to increase the trust's focus on listening to patients and public …… [The public engagement team] team at the CCG has been keeping track of developments and attending some meetings …… I am very encouraged.

…. [the Committee] is now much more clearly embedded into the Trust's systems of governance and very much more "action orientated". ….. It is intended to be the forum where governors can be seen formally to be challenging the Executive through the NEDs and be assured formally about actions being taken. The meeting will be used for the Trust formally to receive reports and for responses to be reviewed….. It will also report to the Council of Governors.

…….I welcome the fact that the CCG is considered part of the membership and the openness and transparency around the issues being addressed.

4. Strategy Group Involvement in strategy development is an important role for governors, and they are uniquely well placed to contribute a community perspective, but there is still some uncertainty about whether current arrangements meet Monitor’s expectations. The meeting on 8th September covered important areas of activity including: Improving Stroke Services, Radiotherapy provision, MSK re-design, Urgent Care and Ophthalmology at Southlands, all of which are recognised priorities, which governors support. While there was a constructive and open discussion it remains unclear how governors have been involved in the selection of these services as priorities.

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Governors are aware of many of the sources from which information is available but feel that further work is needed as to how they recorded and are then reflected in the strategic planning process. A feedback loop demonstrating this has been requested.

5. Assurance Governors continue to seek to improve openness and transparency to ensure that they represent the views of the community. 5.1. Six monthly meeting with NEDs. As requested the last meeting on 8th September

had been agenda’d and minuted; Governors had been invited to notify issues in advance and; NEDs had been invited to give accounts of their activities in the preceding period. While the adjusted format was considered to be more effective it is suggested that stricter timetabling would allow for a longer question and answer session for governors to pursue particular issues.

5.2. Governor attendance as observers at Trust Board Committees and redacted minutes. This is work in progress. A small group of governors led by Vicki King has been seeking information about practice in other trusts. The response rate has been limited at 32% from 104 Trusts, and so far has failed to return any consistent pattern of practice.

6. Revised proposed agenda for CoG

Governors note that their proposals for reordering the agenda have been accepted reflecting more precisely the role of Council.

7. Issues for Future Governor seminars 7.1. Notwithstanding the excellent seminar last year, Governors would welcome further

clarification about the complexities of NHS finances. Specifically, sources and applications of funds together with what the annual financial plan looks like and how/ why deficits are planned in some months while working towards an end of year financial surplus. Additional detail on the efficiency programme would be helpful.

7.2. Governors remain concerned about the high staff turnover rate and welcome the item on today’s agenda

7.3. The extent to which the Private Patient strategy has been implemented remains of interest and will be pursued through the strategy group.

7.4. An evaluation of the bed reconfiguration initiative exercise is awaited 8. Patient First improvement Programme

Governors remain fully supportive of the Trust’s commitment to culture change, and continuous improvement and are very enthusiastic about representing the voice of the communities they represent. They are involved in groups concerned with: improving hospital discharge, 7 day working, and the far ranging outpatient improvement programmes. More detailed reports will be provided to future Council meetings.

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8.1. Ophthalmology Governor Members of the user group contributing to the design of

the Ophthalmology service on the Southlands site are challenging some of the assumptions and design proposals from the Steering Group. There is concern about the importance attaching to the issues raised by the governors. How their views are fed into the Steering Group is unclear. Details of the particular issues have been passed to the Executive Director lead for resolution. Additionally John Todd, the governor representative on the Communications Group reports that a draft Press Release has been prepared and will be circulated widely detailing progress. It is planned that updates will follow at regular intervals. John has also produced a draft diagrammatic flow chart for patients. Once approved it will be circulated widely including St Richards.

8.2. MSK Work on an improved service continues. Two governors (Abigail Rowe and Shirley Hawkridge supported by willing colleagues when they are not available) are members of the Patient and Public engagement group ‘to provide expert patient and user perspective, advice and input to the MSK Redesign Programme’. The group is concerned to ensure that the Patient and Carer voice is a priority for a ‘redesigned’ and ‘transformed’ system. They feel the needs of patients and carers are not complicated or unreasonable. An excellent clinical service is fundamental but so is consistently integrated communication and practice with primary care and community services. As long as the treatment/care pathway remains segregated there will be duplication and frustration for patients and carers. Governors will continue to do all they can to keep these issues to the forefront of planning the new service.

8.3. The Outpatients’ Improvement programme is still in the diagnostic phase but this is a complex exercise. Governors will be involved in the work streams as they are established.

8.4. Governors have also participated in PLACE (patient led assessment of the care

environment) assessments, randomly timed ’Sit and See’ sessions in out, and in-patient environments; and have taken part in mock CQC assessments in preparation for the Commission’s visit in December.

9. Conclusion

This is my last report as Lead Governor. I thank colleagues for their support and hard work during first 24 months of being a Trust. Much has been achieved. While there have been many robustly expressed differences of views, and lots of adjustments and learning, there is no doubt about the absolute commitment from all governors to improving the quality of service offered to all patients. It has been good being part of such a high performing Trust which at every level is similarly committed. I wish my successor well. MB. 03.10.15

Council of Governors 13 October 2015 Agenda Item 6

REPORT TO COUNCIL OF GOVERNORS FROM MEMBERSHIP COMMITTEE

13 October 2015

The Membership Committee met on the 22 July and the 24th September. The Council is

asked to endorse the activities of the committee and in particular the revision of the Action

Plan. The objectives of the Action Plan remain in line with those in the Membership Strategy

2015-2018 previously circulated to the Council Governors.

REVISIONS PROPOSED TO THE ACTION PLAN TO IMPLEMENT MEMBERSHIP

STRATEGY 2015-2018

To prioritise recruiting members such that our public membership is representative

of the catchment population of the Trust in terms of age, gender, disability, ethnicity

and geographical constituency. Currently membership is;

o within the numerical target for ages 59 to 74+ but under-represented in the

age range 17 to 59 years;

o within the representative index range for White British, Irish and other White

background and Black British – Caribbean but under-represented in Mixed,

Asian or Asian British, Black British - African.

o within the target percentage of the population (1.5%) for Adur, Arun, and

Chichester but under for Worthing (1.5%) and Horsham (0.5%)

o under review for disability and gender mix.

To prioritise collecting information on engagement levels of existing public, out of

area and staff members.

To place at a lower level of priority

o establishing different levels of membership ie bronze, silver and gold and

therefore re-drafting existing membership materials

o launching The Trust membership Impact Fund

o developing a dedicated microsite for Members.

SETTING MEMBERSHIP TARGETS AND MONITORING PROGRESS

The Committee has set numerical targets to be achieved by March 2018 (using

March 2014 as a baseline) for public, staff, out of area patients and geographical

constituencies and Representative Index targets for age, gender, disability and ethic

group.

The Committee is developing a Dashboard of Membership Data so that progress

towards the Membership Targets can be monitored.

RECRUITMENT INITIATIVES

A Recruitment Event took place in August at Penguin Corner in Worthing Hospital

and this raised awareness of the relevance of Trust Membership and the role of

Governors. The new pop-up banners were used and more than 15 new members

recruited. Patients, family and friends encouraged to contribute comments about

hospital services on a tablecloth.

Visits to playgroups and a language group for Polish Mums in the Treehouse Family

and Children Centre in Bognor Regis, took place in September and this resulted in

recruitment of around 50 new members in the younger age groups.

Visits to Car Boot sales held at Ford and Fontwell were made in August and

September, targeting recruitment of some ethnic minority groups;

Letter sent to all County, Borough and District Councillors in West Sussex asking for

their support in raising awareness of the existence of Trust membership among their

local constituents. Also offering a forum, i.e. Trust Governors, through which

comments about hospital services can be expressed and giving a voice to the

community in the provision and development of hospital services.

Membership leaflets sent to BSUH Medical School for distribution at their events

aimed at those young people interested in a career in Medicine

Feedback about hospital services gathered as a result of the above recruitment initiatives is

collated and sent to PALS and the Patient Engagement and Experience Committee.

It would be helpful if Governors could contact Vicki King to discuss their potential

involvement in one or more of the above recruitment initiatives, an important responsibility of

Governors.

Compiled by Dr V King on behalf of the Membership Committee, October 2015

Council of Governors 13 October 2015 Agenda Item 7

Staff Governors Report October 2015

Current staff governors welcome the election of Andrew Harvey to represent the Admin &

clerical constituency. We also note, with disappointment, no staff coming forward from the

Medical practitioners & Estate & facilities and look forward to these by-elections later in

2015.

The first of now regular meetings between the staff governors and the Chair & company

secretary was held. The following points were discussed

Mike gave an update on overall trust position

We talked about staffing / workforce challenges and how its feeling for staff. Together with recruitment initiatives.

We talked about financial challenges

We talked about how staff are feeling, recognising its busy for everyone

There was a specific question and conversation around car parking. Staff are struggling.

We talked a bit about winter planning

We talked about CQC work

We had a conversation about staff governor elections – the next round this autumn

I would also say that a several occasions Mike recognised currently challenges and thanked staff for all of their efforts

Current hot issues amongst staff are

The continuing activity on the wards.

The impact that staff vacancies is having on wards and departments particularly in nursing

The issue of car parking, particularly amongst staff that have to move between the main hospital sites to commitments in the community and back into the hospital again.

Compiled by D Walsh

This report can be made available in other formats and in other languages. To discuss your requirements please contact the Company Secretary on 01903 285288.

To: Council of Governors

Date of Meeting : 13th October 2015 Agenda Item: 8

Title

Chief Executive’s Performance Report

Responsible Executive Director

Marianne Griffiths, Chief Executive Officer

Prepared by

Andy Gray, Company Secretary

Status

Disclosable

Summary of Proposal

The Chief Executive will update the Council of Governors on the performance of the trust over the past quarter in its strategic context, to enable a discussion by Governors on overall performance against targets and strategic objectives, and the performance of the board in leading the trust’s achievements. The update will cover patient safety, patient feedback, activity, finance and workforce. The board has received detailed monthly reports on each of these areas, and these are available for governors on the trust’s public website and via the Governors website page. At the time of writing the latest available performance data is to the end of August 2015.

Implications for Quality of Care

Patient Safety and Quality of Care are covered in the presentation

Link to Strategic Objectives/Board Assurance Framework

The quarterly report demonstrates progress against all the strategic objectives

Financial Implications

The financial position is covered in the presentation

Human Resource Implications

Workforce is covered in the presentation

Recommendation

The Council is asked to: NOTE the report and ask any questions of the Executive Directors.

Communication and Consultation

The information included is publicly available and has been discussed by the board.

Appendices

None

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To: Council of Governors

Date: 10 October 2015

From: Marianne Griffiths, Chief Executive

Agenda Item: 8

FOR INFORMATION

1. INTRODUCTION

This paper sets out how the trust has performed and gives an overview of the quality metrics since the last Council meeting, setting that in the context of the local and national picture. It also gives an update on the Patient First Programme and key strategic projects currently taking place within the Trust that have not been covered elsewhere on the Council of Governors Meeting Agenda.

Performance and Quality is reviewed monthly by the Trust Board in public, and these papers are available on the Trust website for governors wishing for further background information. In addition Governors and members of the public can make use of the information provided at the new Governors Assurance page, on the Trust website. 2. OVERVIEW AND SETTING THE CONTEXT

The Council of Governors has previously been updated on the high level of activity within the Hospitals, the issues we have had regarding compliance with Referral to Treatment Targets (RTT), the challenging financial position and particular concerns regarding recruitment. We shall update on all of these key items as well as provide some additional information on the upcoming Care Quality Commission Inspection in December. At the outset I would bring the Council’s attention to continued workforce pressures facing the Trust. You will hear more about this under the Workforce Update section of today’s agenda by Denise Farmer. 3. PERFORMANCE SUMMARY

Based on provisional Month 5 positions, the Monitor Risk Assessment Framework performance was notionally one penalty point which related to continued ‘managed failed’ in Referral to Treatment (RTT) as part of an agreed recovery planning process.

Key indicators of operational pressure during August included:

11,682 A&E attendances compared to 11,791 in August 2014 (-0.9%).

3,848 emergency admissions compared to 3,821 in August 2014 (+0.7%).

Formally reportable delayed transfers of care totalled 3.17% for August 2015. However, this has risen during September with some significant peaks.

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3.1. A&E Compliance The Trust was fully compliant in August with 97.28% of patients waiting less than four hours from arrival at A&E to admission, transfer, or discharge, against a national target of 95%. 3.2. Cancer Metrics Compliance The provisional position for August shows the Trust to be compliant against all 7 Cancer metrics in month. However whilst compliant, the Trust continues to face significant and sustained challenges in delivery against the 2 week referral rules. As a forecast outcome of planned recovery actions, August shows the Trust has maintained compliance for patients referred with breast symptoms attending hospital within two weeks, with 93.2% of patients seen within 2 weeks against a target of 93.0%. For context, latest nationally published data relating to July 2015/16 shows national aggregate compliance for cancer attendance within two weeks of referral to be 93.9% and 92.4% for Surrey and Sussex Providers (excluding WSHFT) compared to 93.2% at WSHFT. 3.3. Referral to Treatment (18 Weeks) During August the Trust completed 10,196 RTT patient pathways, 259 cases (-2.5%) below the planned recovery volume for the month. Cumulatively the Trust remains 905 (+2.5%) cases ahead of recovery plan commitments in the year to date and completed 4,120 (8.0%) more cases than the same period of 2014/15. Whilst numbers of referrals have been high this year, in August the Trust saw a marginal reduction in the overall RTT waiting list, decreasing from 34,666 in July to 34,234 in August. However, as urgent referrals are treated by necessity as priorities, the number of patients actively waiting greater than 18 weeks increased from 4,918 in July to 5,139 in July. In response, Coastal West Sussex CCG (CWSCCG) and WSHFT have jointly agreed the establishment of a Project Management Office to manage all NHS funded capacity in both the independent sector and NHS as an integrated health economy to treat the longest waiting patients. This has already seen some significant improvement in managing the overall waiting list. 3.4. Diagnostic Test Waiting Times

The Trust was non-compliant against the diagnostic waiting time metric in August with 282 patients of 6,187 patients (4.56%) waiting over 6 weeks against the requirement of no greater than 1%. Actions to mitigate demand and to regain compliance included:- • MRI - 1,812 tests August 2015 compared to 1,439 August 2014 (+25.9%). Continuation of this increased run rate will provide the tactic response to restore compliance in September. • NOUS – extensive recovery programme implemented in Sept to augment tactical reallocation of sonographer and radiologist resources implemented in August. Through these actions an additional 181 slots have been created across 5 differing diagnostic non-obstetric ultrasound modalities. These actions will restore compliance in October. Further details of other actions are given in the Trusts Performance reported presented to the September Board Meeting.

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4. QUALITY REPORT

The full Trust Quality report, together with its dashboard of indicators, is presented in public each month at the trust Board meetings. The dashboard is based on national and regional benchmarks where available. In the absence of established benchmarks, locally agreed targets or levels have been defined.

The highlights from the Quality Report taken to the September Trust Board reporting data are as follows; 4.1. Mortality The Council have previously been advised of the improvements made in crude mortality rates which have fallen year on year. Crude non-elective mortality increased from 2.66% in July to 3.15% in August. Although an increase against the previous month, this is lower than the equivalent month in 2014 (August 2014 = 3.44%). The 12 month mortality fell to 3.23%.

During August there were 160 deaths, relating to 5072 non-elective spells (3.15%). 4.2. NHS Patient Safety Thermometer The NHS Patient Safety Thermometer is used across all relevant acute wards. This tool looks at point prevalence of four key harms (falls, pressure ulcers, urinary tract infections and deep vein thrombosis (DVT) and pulmonary embolism (PE)) in all patients on a specific day in the month. The harm-free care score for the Trust in August was 95.6% better than the target of 93.8% (target based on national average for 2014/15). The Safety Thermometer includes harms suffered by the patient in healthcare settings prior to admission. The actual number of patients with no new harms during their inpatient stay at WSHFT was 97.6%. A new target of 99% of patients suffering no new harms following admission for 2015/16 has been set within the Trust Quality Account. This will prove a stretching target as it is considerably higher than the national average of 97.7%.

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4.3. Infection control There were zero cases of Methicillin-Resistant Staphylococcus Aureus (MRSA) bacteraemia during the current year. There were three cases of hospital attributable Clostridium difficile during August. The 3 cases in August equate to a rate of 11.6 cases of C diff per 100,000 bed days compared the national average for 2014/15 of 15.1 cases per 100,000 bed days (interquartile range 10.3 to 17.6). Of the three cases in August, root cause analysis identified none were related to a lapses of care. For the year to date there have been 4 cases of C Diff within the Trust where a lapse in the quality of care has been noted. 4.4. Exception Reports Relating to Safety: Never Events: Unfortunately the Trust reported a Never Event during August. This was in relation to a retained swab following a gynaecology procedure. A full investigation is underway and a detailed report and action plan will be presented to the Trust Board once complete. 4.5. Friends and Family Test (FFT) In line with national guidance the Friend and Family test is now reported as a ‘percentage recommending’ score (calculated as the percentage of respondents indicating they were either ‘highly likely’ or ‘likely’ to recommend the service divided by the total respondents including ‘don’t knows’). National performance is published on the NHS England website: http://www.england.nhs.uk/statistics/statistical-work-areas/friends-and-family-test/friends-and-family-test-data/ The table below shows the latest local scores against national benchmarks:

Percentage recommending

WSHFT in August (year to

date in brackets)

National median (April 2014

to March 2015)*

Inpatient care 94.6% (94.8%) 94.1%

A&E 90.6% (91.5%) 86.8%

Maternity: Delivery care 91.4% (95.3%) 95.4%

Outpatient care 87.9% (88.0%) No benchmark

Trust actual response rates are given in lines X24, X25 and X33 of the Quality Scorecard which is presented to the Board as part of the monthly Quality Report.

National benchmark for response rates: National data comes out a few months in arrears, but to give an idea of where we stand the following response rates are the national averages for July 2015. • Inpatients: 26.7% • A&E: 15.2% • Maternity: 22.4%

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5. ORGANISATIONAL DEVELOPMENT AND LEADERSHIP REPORT

Workforce issues will be the subject of a presentation and discussion from Denise Farmer – Director of Organisational Development and Leadership during the Council of Governors Meeting. However headlines as of the end of August 2015. 5.1. Recruitment activity Recruitment continues to be a priority in the organisation. Nursing – following the unanticipated delays in the post-recruitment processes of the nurses from the Philippines, it has been agreed to proceed to recruit an additional 40 nurses from Europe. A two-centre campaign in Portugal and Spain, including targeting specialty areas such as Theatres has commenced. Assessment and selection will take place in the week beginning 28th September, using the same successful format used in the Philippines. This should facilitate the first cohort arriving in the Trust by November. The frequency for domestic nursing recruitment has been increased from every six weeks to every four weeks and two Saturday drop in days have been arranged for September. The attrition rate for newly qualified nurses, recruited earlier in the year, has been minimised by maintaining regular contact, with 29 students anticipated to join the Trust by the end of October. Other innovative working practices are also being piloted with the introduction of Band 4 nurses on four medical wards. 5.2. Workforce Efficiency Sickness absence during July increased marginally to 3.9%, with the rolling 12 month position remaining at 4.1%. This continues to be an area of concern particularly as the percentage of staff on long term sickness of one month or more, is at similar levels to the winter months. 5.3. Staff Turnover A report on staff turnover 2014/15 has recently been prepared and presented to the Workforce Efficiency Programme and also presented to the Trust Board. The analysis of staff turnover for the period will inform future retention strategies. It is acknowledged that Staff turnover in the Trust has been steadily rising over the last 12 months and increased by 1.1% between April 2014 and March 2015 to 8.4%. 5.4. Media Work

The last few months have been very successful in terms of positive media work for the Trust. BBC South Today featured a special report on the fact that Worthing Hospital was first in country to host new 30sec hand scanner for visitors, detecting abnormal heart rhythms that can lead to strokes. BBC South Today also covered the work of the Trust relating to Sepsis Week and The Trust’s new Welcome Home Packs project, being piloted in Worthing, which helps older patients settle better back home after a longer stay in hospital by providing them with some basic foodstuffs, was also the subject of a special report on BBC South Today.

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6. FINANCE REPORT In August the Trust reported a deficit of £892k bringing the year to date position to £1.53m deficit, which is £1.06m adverse to the year to date plan. The Trust delivered a Financial Sustainability Rating of '3' in the month. The forecast for 2015/16 is to deliver a surplus of £0.99m and a financial sustainability risk rating of '3' in line with the plan approved by the Trust Board in April and as per the 2015/16 plan submitted to Monitor

6.1. Financial position

The Trust reported an adverse variance of £390k in month due to a shortfall in income from clinical activities and pay pressures. Non Pay expenditure was below plan for the month as a result of activity case mix.

6.2. Efficiency and Transformation Programme

At the end of August, the Efficiency Programme delivered cumulative savings of £6.3m against a plan of £6.5m (97.7%). The programme is forecast to deliver total savings of £19.1m by year-end

6.3. Key Financial Risks are;

6.3.1. Management of patient flow to ensure that activity is able to be delivered

within funded capacity and that delayed transfers are minimised so that capacity can be managed in line with activity levels. The Trust is working closely with health economy partners to ensure that the levels of fit for discharge patients and community bed capacity is managed.

6.3.2. Delivery of savings within the efficiency programmme. As in 2014/15 the Trust

has a signficant efficiency requirement in order to deliver its planned surplus. The savings profile increases in Q2 and again in Q3 in order to deliver the total programme.

6.3.3. The impact of QIPP schemes and the ability to either take out stranded costs if

schemes deliver in full or the affordability for commissioners to pay in full for over-performance above contracted activity levels. Activity levels in year and being closely monitored and escalation triggers for significant variances to plan have been agreed with commissioners.

7. PATIENT FIRST PROGRAMME Introduced in November 2014, Patient First is the Trust’s approach to ensuring patients receive safe, high quality care, now and in the future. The philosophy behind the programme is centred on: • The patient being at the heart of every decision • Empowering staff to build on existing high standards • Continuous improvement of services through small steps of change • Standardising practices to ensure consistency of service The Patient First Programme Board oversees and assures delivery of all improvement and transformation work in the Trust.

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Patient First has a strong focus on safety and we have prioritised changes that directly support that focus. For example the introduction of daily Safety Huddles, where everyone working on a ward comes together at the same time each day to discuss how they will provide a safe service that day, including ensuring they have the right staff and resources. The focus of the Patient First Programme over the summer couple of months has been recruitment to the Patient First Kaizen Office, full establishment of the transformation workstreams and delivering the next steps of the Patient First Improvement Programme in line with the Roadmap. Also over the summer the Programme entered a period of intense activity as Ward Accreditation was implemented. 8. CARE QUALITY COMMISSION STANDARD INSPECTION 8TH – 11TH DECEMBER 2015

The confirmed dates for the standard inspection by the CQC are December 8-11 this year. The inspection is an opportunity for us to demonstrate the excellent care our teams provide. We will be asking local people to support our staff by sharing recent personal experiences of care and commending staff for their compassion - and passion - to continually provide outstanding care. Whilst lots of preparation is taking place across the Trust ahead of the visit it is important for us to remember that it is “Business as usual” for our patients. We are currently preparing our “Submission of Provider Information”. Two drop in sessions have been arranged for Governors to learn more. These are :- Thursday 30th October 2015 – from 3.00pm McBrien Lecture Theatre Worthing Health Education Centre, Worthing Hospital and Tuesday 24th November 2015 – from 4.00pm Boardroom, Stillman House, St Richards 9. CONCLUSION AND RECOMMENDATIONS

The Council is asked to NOTE the report and ask any questions.

1

To: Council of Governors

Date of Meeting : 13th October 2015 Agenda Item: 12

Title

Autumn 2015 Governor Election

Responsible Executive Director

Andy Gray, Company Secretary

Prepared by

Barbara Mathieson, Assistant to Company Secretary

Status

Disclosable

Summary of Proposal

This paper seeks approval from the Council of Governors to extend the term of office for Governors due to be elected during the autumn of 2015. Specifically the following Constituencies :

Horsham

Staff – Medical and Dental

Staff – Estates and Facilities

Implications for Quality of Care

None

Link to Strategic Objectives/Board Assurance Framework

None

Financial Implications

None

Human Resource Implications

None

Recommendation

The Council of Governors is asked to approve the proposal to extend the term of office of these Governors until 30 June 2019, thereby serving an initial term of office of three years and six months.

Communication and Consultation

The information included is publicly available

Appendices

None

To: Council of Governors Date: 13 October 2015

From: Andy Gray Agenda Item: 12

FOR APPROVAL

GOVERNOR ELECTION

1.00 INTRODUCTION

1.01 This paper seeks approval from the Council of Governors to extend the term of office for Governors due to be elected during the autumn of 2015.

2.00 GOVERNOR ELECTION AUTUMN 2015

2.01 Following recent elections some Constituencies remained unfilled and additional by-elections will be undertaken during the autumn of 2015.

2.02 Elections are needed within the following constituencies to fill the unexpired terms of office until the 30 June 2016:

Public – Horsham (One Governor)

Staff – Medical and Dental (One Governor)

Staff – Estates and Facilities (One Governor)

2.03 It is proposed to run an election to fill these vacant positions during the autumn of 2015 with a proposed date of appointment for these new Governors of 1 January 2016 which would mean that they would only be able to serve a period of six months before having to stand for re-election.

2.04 On this occasion it is therefore recommended that the term of office for these Governors is extend until 30 June 2019. This would negate the need for potential new Governors to serve an initial term of only six months.

3.00 RECOMMENDATION

3.01 The Council of Governors is asked to approve the proposal to extend the term of office of these Governors until 30 June 2019, thereby serving an initial term of office of three years and six months.