COUNCIL OF GOVERNORS MEETING Minutes of the Meeting held on Tuesday, 11th April 2017, from 14:00 to 17:00 hours

in the Lecture Room, GDH Present: Mrs Anne Shaw Trust Chair Cllr Melanie Dickerson Stakeholder Governor Cllr John Barrett Public Governor Mr Tim Mawson Staff Governor Mr Jeremy Baskett Public Governor Mr Eddie McCabe Stakeholder Governor Mr Chris Bayne Public Governor Mr Brian Page Public Governor Mrs Janthea Capitani Public Governor Mr Rob Pickersgill Public Governor In Attendance: Mrs Pam Clipson Director of Strategy and Planning Mr Paul Corlass Deputy Director of Finance (representing Mr Robert Toole) Mrs Susan Cousland Non-Executive Director Mr Jeremy Daws Head of Quality Assurance (representing Mrs Wendy Booth) Mrs Karen Dunderdale Deputy Chief Executive Ms Jackie France Assistant Chief Operating Officer Mr Neil Gammon Non-Executive Director Ms Jane Heaton Deputy Director of Organisational Development & Workforce Mrs Alison Hurley Membership Manager Mrs Linda Jackson Non-Executive Director Mr Jug Johal Director of Facilities and Estates Mr Paul Kirton-Watson Associate Chief Nurse Mrs Jane Lacey-Hatton Interim Associate Director of HR (representing Mrs Jayne Adamson) Mr Stan Shreeve Non-Executive Director Miss Serena Mumby Membership Officer (minutes)

1. WELCOME AND INTRODUCTION Mrs Shaw opened the meeting by welcoming everyone to the Council of Governors (CoG) meeting.

2. APOLOGIES FOR ABSENCE

Apologies were received from:

Public Governors: Mr Harpreet Atwal, Mrs Maureen Dobson, Mr Paul Grinell, Mrs Ann Maggs, Mr Robin Perry, Mrs Liz Stones and Mr Roy Taylor

Staff Governors: Mr Tony Whyte Stakeholder Governors: Mr Richard Young

Apologies were also received from: Executive Directors: Mrs Jayne Adamson (represented by Mrs Jane Lacey-Hatton), Mrs Wendy Booth (represented by Jeremy Daws), Mr Robert Toole

(represented by Mr Paul Corlass), Mr Richard Sunley (represented by Dr Karen Dunderdale), Mrs Tara Filby (represented by Mr Paul Kirton-Watson) and Mr Lawrence Roberts (represented by Ms Jane Heaton)

Attending Officers: Mr Steve Vaughan

2

Non-Executive Directors: Mr Anthony Bramley and Mrs Sandra Hills Mrs Shaw informed members that Mr Grinell and Mr Taylor were unable to attend due to health related issues. Mrs Shaw welcomed Mr Brian Page as Interim Lead Governor. Mrs Shaw added that Mr Sunley, Mrs Adamson, Mr Roberts and Mrs Filby have submitted their apologies as they have been called to attend an urgent NHS Improvement (NHSI) meeting in Leeds. Mrs Shaw informed members that Mrs Cheryl George had resigned from her post as Public Governor due to existing work commitments. Mrs Shaw explained that there have been a number of changes to the order of the agenda and therefore an updated version had been tabled. These changes were to further align with the Trust Board processes and documentation.

3. TRUST CHAIR’S REPORT 3.1 Trust Chair’s Report

Mrs Shaw explained that Mrs Karen Jackson was on a secondment, working with NHSI. This post was initially for six months and will be reviewed later this month. Mrs Shaw added that if anyone has any further questions relating to Mrs Jackson’s secondment, then NHSI can advise further. Mrs Shaw re-iterated that the Trust ambition is to have a long term Chief Executive Officer in post as soon as practicable. Mrs Shaw then provided a brief overview of the quality and finance special measures and the review of the Trust Board sub-committees, and explained that these would be discussed in greater detail within the meeting. Mrs Shaw invited questions. None were received. Council Decision: The Council received the Trust Chair’s Report.

3.2 Board Highlights Report Mrs Shaw explained that the Board Highlights report was taken from the private Trust Board meeting on 28th February 2017. Mrs Shaw provided an overview of the Board Highlights report and summarised the positive position of WebV Solutions Ltd and its’ year one trading report. She referred to the holistic Improvement and Sustainability programme and the finance recovery update and explained that they will be discussed in further detail as per the agenda. Mrs Shaw informed members that Mr Corlass will cover ‘Item 12 - Finance and Use of Resources’ following agenda Item 8 (the Chief Executive’s Report). Mrs Shaw invited questions. None were received. Council Decision: The Council received the Board Highlights Report.

3.3 Questions on the Trust Board Minutes

3

Mrs Shaw provided a brief overview of the Trust Board minutes for members, and invited comments or questions. None were received.

Council Decision: The Council received the Trust Board Minutes.

4. DECLARATION OF INTERESTS

Mrs Shaw requested members of the Council to raise any conflicts of interest relating to specific agenda items or any updates to their annual declaration of interests. There were no further declarations of interests.

5. TO APPROVE THE DOCUMENTS FROM THE PREVIOUS MEETING Council of Governors Business Meeting - 1st February 2017

Mrs Shaw invited members to approve the minutes of the previous CoG Business meeting held on 1st February 2017. The minutes were approved as a true and accurate record. Mr McCabe pointed out that he was not listed as present at the meeting. The minutes will be amended to reflect the attendance of Mr McCabe, and were otherwise accepted as a true and accurate record. Council Action: Membership Office to add Mr McCabe to the attendance list of the minutes of the CoG Business meeting held on 1st February 2017

6. COUNCIL OF GOVERNORS ACTION LOG The action log was reviewed and the CoG were in agreement with a number of action closures and updates. Council Actions to be updated:

Action 15 - This meeting is to be re-arranged by the Membership Office

Action 102 - This meeting is to be re-arranged by the Membership Office

Action 131 - This meeting is to be re-arranged by the Membership Office

Actions 110, 116, 117, 118, 119, 121, 122, 123, 124, 130, 132, 133, 134, 135, and 136, are to be closed as these are on the agenda for today

Action 137 – update on outpatients letter review was not covered within the meeting and the Membership Office will obtain an update for the next CoG meeting

7. MATTERS ARISING FROM THE APRIL COG MEETING MINUTES 7.1 Stakeholder Governor Representatives

Mrs Shaw explained that she had liaised with Mr Andy Barber at the Shine network in relation to seeking further stakeholder representation from the third/charitable sector. She provided a brief overview and the conclusion that the timing was not appropriate to seek such stakeholder governor representation as charities are currently changing the way in which they work, and until these changes have been implemented and embedded. Those present agreed to defer these plans until the charitable sector had clarification on their immediate future.

4

7.2 Governor Tablets Business Case

Mrs Hurley explained that funding was being investigated in order to provide Governors with IT tablets and that it was not suitable to seek funding from the League of Friends or other charitable funds. She informed members that she had produced a draft business case and will attempt to seek Trust funds through the Trust’s Tech Shop process whilst continuing to look at sponsorship options. Mrs Clipson and Mrs Hurley agreed to meet to discuss such options prior to submitting the order through to the Tech shop.

Mrs Shaw thanked Mrs Hurley and invited questions. None were received.

Council Action: Mrs Hurley and Mrs Clipson to meet to discuss the funding options for Governor IT tablets prior to submission to the Trust’s Tech Shop.

7.3 Interim Deputy Lead Governor

Following a balloted process involving three nominees, Mrs Hurley explained that Mr Page had been successful in being appointed as Interim Deputy Lead Governor to cover the period of absence for Mr Grinell. Mrs Dickerson felt that a Curriculum Vitae (CV) would be useful in such future ballots to enable a more informed choice. Mrs Hurley agreed that this would be beneficial and proposed that all future ballots will require a CV. Governors were in agreement. Mrs Shaw thanked Mrs Hurley and invited questions. None were received.

Council Action: Mrs Hurley to amend the appointment process of the Lead Governor to include submission of a CV for interested Governors to aid the ballot process.

7.4 Infection Control Executive Update

Mr Shreeve informed members that this will be covered later on the agenda under ‘Item 10.4 - Infection & Prevention Control Committee (IPCC) Highlight Report’.

7.5 Key Performance Indicator (KPI) Report

Mrs Hurley explained that a meeting had taken place where it had been decided to create a document which incorporates all of the at a glance summaries for Performance, Quality, Mortality, Staff and Finance, into one document. Governors agreed that this would be a useful reference document and wished to keep this item on future agendas. Following a discussion, Mr Daws confirmed that the Quality Accounts would continue to be a separate document.

Mrs Shaw thanked Mrs Hurley and invited questions. None were received.

Council Action: Key Performance Indicator Report to remain on future CoG agendas.

5

7.6 Proposal for Third Sector Organisations on the CoG

Mrs Shaw pointed out that this item had been addressed under agenda ‘Item 7.1 - Stakeholder Governor Representatives’, and Mrs Hurley added that in relation to stakeholder Governor seats, North Lincolnshire Council were still to appoint a Governor following meetings with Mrs Shaw.

7.7 Recruitment Update

Mrs Lacey-Hatton assured Governors that every opportunity had been taken in the recruitment of Non-Executive Directors (NEDS), and the Trust were currently at full capacity. The issue of expanding the Trust boundaries to allow recruitment of NEDs outside of this area was a complex one, and involved establishing an additional Trust Constituency etc., as Mrs Booth had previously explained to members. It was agreed that at this was not a priority at present as there are no current vacancies, but it would be considered again prior to recruitment of any new NEDs. Governors agreed that this would be an important consideration to bring back to the CoG. Mrs Shaw thanked Mrs Lacey-Hatton and invited questions. None were received.

7.8 Staffing Levels and Skills Mix

Mrs Hurley reminded Governors that an update had been provided at the Governor and NED Briefing in February and added that this item will also be covered under the agenda item for staff morale.

7.9 NICE Guidance, CQUINS & Electronic Referrals

Mr Daws provided an update on NICE guidance and CQUINS and reminded members that NICE guidance was available in a monthly report and CQUINS was available in a quarterly report. Mr McCabe questioned how the Trust will manage moving to electronic referrals. Mrs France responded that all appointment slots would need to be published, and there are three possible approaches, as follows:

Option one is a staged approach aiming to have 75% of referrals on the Electronic Referral Service (ERS) by the second quarter moving to 100% by March 2018. The focus will be on the speciality, capacity and demand, then other specialities.

Option two would involve putting all referrals through ERS. If there are no slots available due to waiting list position, then patients would then would go on to an external provider list. An advantage of this generic approach is that it would be the same for all specialities but would involve significant work.

Option three is the Big Bang option, where all appointment slots available would be published and all patients would have the choice to wait for an appointment at a later date or look for external providers if they chose. The Trust would need to plan for this to ensure the impact to patients and administrative staff is reduced. An advantage of this approach is that all referrals can be monitored and tracked.

6

Mrs France informed members that Mrs Clipson is the project lead and the deadline to choose an option is the end of June 2017. Mr Pickersgill asked if this was a way of addressing the patient backlog following the Care Quality Commission (CQC) report. Mrs Clipson explained that there was a tracking element which will improve GP and patient assurance, and that the guidance received to address the backlog had been Consultant led. Mr Shaw was concerned patients may have to wait a long time. Mrs France explained that the phased approach would take longer and would require General Practitioners to speak to their patients and ask if they wish to be seen by another provider. Mr Gammon asked if all referrals would be added to this programme, and Mrs France assured members that eventually all referrals would be encompassed. Mr Gammon added that this was a fascinating and technical piece of work for the Trust and invited Mrs France to the next CoG to provide a further update. Mrs Shaw agreed and suggested this becomes a standing agenda item. Mr Page felt that the option where patients can book in would be an advantage as the patient has a set date. Mrs France explained that further work is required from the Trust regarding WebV recording and confirmed the Trust were working with the national team on this. Mrs France added that this functionality enables a dialogue with GPs and the Trust to implement this in the future as it will ensure that all patient information will be available to them. Mrs Clipson added that the Trust were working with NHS Digital who will set this agenda and the work undertaken was to ensure all patients from hospices and care homes are kept in their place of residence rather than going back and forth between their care setting and the hospital. Mr McCabe explained there are concerns from commissioners regarding not using nationally supported systems and asked if the data collected will be suitable in the future. Mrs Clipson added that this information was required to keep the patients out of hospitals. Mrs Shaw concluded this update and explained that this was an exciting opportunity to look at new ways of working. She thanked Mr Daws and invited further questions. None were received. Mrs Capitani left the meeting to cover the Goole Governor Drop-In session and Mrs France left to attend a further meeting at 15:00 hours.

Council Actions:

Mrs France to attend the July CoG and provide a further update on Patient Administration and E-Referrals;

Patient Administration and E-Referrals to be added to future CoG agendas as a standing agenda item;

Mrs Hurley to request Governors to inform the Membership Office if they sit on a Patient Participation Groups (PPG) and state which one.

8. CHIEF EXECUTIVE’S REPORT

Dr Dunderdale provided a general overview on Trust performance pressures. She then referred back to the minutes of the previous CoG meeting regarding the current Trust difficulties. She confirmed that demand remains high, although numbers have reduced since January 2017 and the A&E position was getting back on track with regards to the 4 hour waiting target. She added that some fresh trajectories are being discussed with NHSI.

7

Dr Dunderdale informed members that the draft final visit report from the CQC had been received and had rated the Trust as inadequate. This came with a recommendation to NHSI to put the Trust in Financial Special Measures, which has now been done. She explained that a Quality Summit had been arranged for 20th April, which will be supported by a member of Mrs Booth’s team. The CQC and all stakeholders will be invited, including Governors, to discuss the Trust’s response to the visit findings and agree any support required. She advised that the Improvement Director from NHSI, Mrs Claire Pacey continues to support the Trust in the development of improvement plans in line with the ‘Improving Together’ programme. Dr Dunderdale invited questions. None were received. Mrs Shaw thanked Dr Dunderdale and added that a cultural shift was required within the Trust. She explained the legal requirement to have a quality summit meeting, which would incorporate the process of the creation of a Quality Improvement Plan from the meeting, which will headed by Mr Warren Brown. She then provided an update on the processes and meetings and progress to date. Mr Daws informed Governors that the Improving Together programme (item 9.2 on the agenda) went to the last board meeting, and explained that the Trust were receiving support from NHSI and Mrs Clare Pacey, NHSI Improvement Director. He added that there will be additional support available from NHSI going forward. It was hoped that the quality summit will provide ideas to improve communication in the Trust. Mrs Hurley informed those present that listening events are being arranged to further engage with the public. Mr Pickersgill asked if there a commitment to ensure the financial position of the Trust will improve. Mrs Shaw explained that there was an expectation of this, though the focus will remain on the quality of care provided. Mr Pickersgill felt that the Trust financial position links back to the recruitment and retention of medical staff difficulties the Trust had experienced. Mrs Clipson confirmed that the use of temporary, bank and agency staff were only used if essential to fill required roles to ensure the safe and quality level of care was delivered. Dr Dunderdale added that agency staff come at premium rates to the Trust and sites within the health system context. Mr Corlass explained that this would be further addressed later on the agenda. Mrs Lacey-Hatton added that the use of these staff also has an impact on substantive staff morale and the Trust continue to work to recruit to vacancies. Mrs Shaw made members aware of the new Trust Board approach to undertake walk-arounds in the Trust to informally chat to front-line staff, and added that the next will be in Grimsby. Mr Page asked how staff are presented to the Board members, and Mrs Shaw clarified that the Trust Board will go to wards and speak to the staff there for 20 to 30 minutes. Dr Dunderdale added that this will be good experience for the Board members and a discussion ensued about the increased presence and accessibility of the Board members and the need to tweet about their visits. Mrs Cousland and Mrs Lacey-Hatton left the meeting at 15:14 hours. Mr Baskett enquired about how this information and outcomes are fed back to the staff. Mrs Shaw explained that this will form part of the Listening into Action programme which Mrs Adamson was leading on, and Dr Dunderdale clarified that it will be clinically led and added that Governors will start to hear more about this from the Chief Executive’s office. Mrs Lacey-Hatton returned to the meeting at 15:16 hours. Mrs Shaw explained that she had recently spoken with the chair of Morecambe Bay Trust about the strict programme, the need to commit and follow it through. He had asked if Mrs

8

Shaw was enjoying her new role as chair and she confirmed that these are exciting times in which she feels energised about the future direction of the Trust. Mrs Cousland returned to the meeting at 15:16 hours. Mrs Shaw thanked Dr Dunderdale and invited any questions. None were received. Council Decisions:

The Council received the Chief Executive’s Report

The Council received the CQC Update.

Mrs Shaw informed members that she would vary the order of the Agenda to consider Items 12.1, 12.2, and 12.3 before returning to Item 9 in order to accommodate speakers needing to leave early. Members were in support of this change.

12. FINANCE & USE OF RESOURCES

12.1. Financial Special Measures

Mr Corlass explained that as of the 24th March 2017, the Trust was placed in Financial Special Measures and he provided members with an update on the Trust’s next steps and the financial position at the end of quarter 3. He added that the accounts for 2016/17 are closed as of today, and there will be a diagnostic position assessed by an external financial provider. A discussion took place about other Trusts in the same position and the processes they are undertaking. Mr Corlass explained that the forecast deficit for 2017/18 is £36.6 million excluding the Sustainability & Transformation Fund (STF) support. Mr Corlass added that the financial pressure from medical staffing was due to unprecedented vacancy rates.

Mrs Shaw thanked Mr Corlass and invited questions. Mr Pickersgill enquired as to how much of the deficit was due to agency pay. Mr Corlass explained that the current spend on agency staff is £23 million. Mr Shaw asked if lost income to the Trust was due to the work being undertaken in the A&E departments at Grimsby and Scunthorpe. Mr Corlass explained that this is one of many reasons the Trust is losing expected income. Ms Heaton left the meeting at 15:24 hours. Mr Baskett asked if the money has been lost, and asked if there were any way to create a transformation plan for next year. Mr Corlass explained that the unachieved money has been allocated to the NHSI who are feeding the money back to the Trust where money was required. Ms Heaton returned to the meeting at 15:26 hours.

Mr Page left the meeting at 15:27 hours. Mr Corlass explained that this year the Trust lost £6 million which was non recurrent and explained that he is working with Mrs Clipson to look at service level reporting. Mr Page returned to the meeting 15:29 hours. Mr Corlass explained that at end of April 2017 it was anticipated that the Trust could be looking at a £35 million deficit. The expenditure process has been capped to prevent

9

further overspends and added that any system operating out of NHS will also be capped, including the North Lincolnshire CCG as North Lincolnshire have been identified as requiring financial support. North East Lincolnshire were currently excluded from this. Mr McCabe explained that there has not been a formal letter received by NEL CCGs as yet but added that discussions are taking place on how to engage with the process.

Mr Barrett left the meeting at 15:35 hours. Mrs Shaw thanked Mr Corlass and invited any questions. None were received. Council Action: Mr Corlass and Mrs Clipson to provide a formal report on Financial Special Measures for the July CoG.

12.2 Resources Committee Highlight Report

Mr Gammon informed members that this report was based on the March Resources Committee meeting which recently went to the Trust Board. He explained that he did not intend to go into great details and would take the report as read and highlight key areas. He referred to capacity and demand and the significant amount of effort being invested in the waiting list data quality issues and added that the Trust was aiming to return to the planned Referral to Treat (RTT) trajectory by the end of March 2017. Mrs Clipson felt that there will be difficulties across beds, theatres and outpatients and explained that she will discuss these in detail under agenda ‘Item 11 - Strategic Change and Innovation’. Mr Gammon explained that Mr Corlass had already provided an update on Financial Special Measures, and went on to explain that Service Line Reporting (SLR) was a gathering of data which enables the Trust to understand in detail, each of the services provided by the trust and highlight if there was a profit or loss. He advised that this information was provided at quarterly intervals but the Trust has not been able to review it at present or therefore, modify the way in which the services are delivered. Mr Corlass provided further details around the SLR and the difficulties in being able to demonstrate the variance to plan, and Mrs Shaw agreed and confirmed that this will form the basis of some structured changes going forward. Sustainability was a more positive update, explained Mr Gammon as the Sustainability Programme had delivered £12.4 million against a year-to-date (YTD) plan of £12.5 million, which relates to additional savings on corporate cost reductions, central controls and drug savings. Current analysis predicts a forecast delivery of £13.7 million against a plan of £13.8 million. Mr Barrett returned to the meeting at 15:39 hours. Mr Gammon explained that Mrs Adamson will elaborate on the Workforce update later in the agenda and Mr Daws will cover Performance. Mrs Shaw thanked Mr Gammon and invited questions. None were received. Council Decision: The Council received the Resources Committee Highlight Report.

10

12.3 Audit Committee (AC) Highlight Report Mr Shreeve informed members that the Audit Committee were anxious to ensure there were no surprises for the Trust Board and CoG members and they would be taking a ‘deep-dive’ into the balance sheets and general finances. Mr Shreeve added that earlier in the year a number of reports have been put in place to look at the balance sheet which offers a considerable amount of assurance. He explained that although Trust finances have been deteriorating, the position was being controlled and internal audit will be utilising a risk analysis approach to assess high strategic risk and establish the internal audit programme. Mr Pickersgill stated that budgetary control was an issue he faces frequently. Mr Shreeve confirmed that the budgetary control was not too bad and provided members with examples. Mrs Shaw thanked Mr Shreeve and invited any questions. None were received. Council Decision: The Council received the Audit Committee Highlight Report.

Mrs Shaw advised that the meeting would now return to the original agenda order and Item 9

9. QUALITY, SAFETY & PERFORMANCE

9.1 Board Assurance Framework (BAF)

Mr Daws explained that the Board Assurance Framework (BAF) document had been covered in detail at the earlier Governor and NED briefing, prior to this CoG meeting. He therefore provided an overview and drew members’ attention to the ‘at a glance summary’ on page six. He explained that work was being undertaken to improve processes. Mrs Cousland added that a lot of work had gone into the BAF and she thought this was the best version she has seen to date. Mrs Shaw concurred. Mr Daws invited questions. None were received. Council Decision: The Council received the Board Assurance Framework.

9.2 CQC Report & Trust Response – Improving Together Programme

This item had been discussed as part of ‘Item 8 - Chief Executive’s Report’.

Mrs Shaw advised members that the meeting would flow smoother by considering agenda Items 11.1, 11.2, and 11.3 before returning to Item 10. Members were in support of this change.

11. STRATEGIC CHANGE & INNOVATION 11.1 Sustainability and Transformation Plan (STP) & Healthy Lives, Healthy Futures

(HLHFs) Update Mrs Clipson suggested that it may be helpful to take Items 11.1, 11.2, and 11.3 together and provide one overview, and members agreed. The following were therefore addressed together:

11

11.1 Sustainability and Transformation Plan (STP) & Healthy Lives, Healthy Futures (HLHFs) Update

11.1.1 Humber Coast & Vale STP

11.2 Trust Contract Update

11.2.1 North East Lincolnshire Together Accountable Care Partnership

11.2.2 North Lincolnshire First Accountable Care Partnership

11.3 Draft Trust Strategy 2021

Mrs Clipson provided members with an overview of the STP and explained that the Trust continues to deliver to the best of its ability. She advised that there are a number of options under consideration moving forward. Three of these options included the use of Goole & District Hospital. The first option was to utilise Goole & District Hospital as a daytime doctor led centre. The second option was to establish an elective centre where the Trust becomes an orthopaedic centre of choice. The third option was about becoming a centre for excellence supporting the patients. This option would return Goole & District Hospital to a fully occupied hospital where GPs would utilise the hospital premises. Mrs Shaw invited any questions. None were received. Mrs Clipson informed Governors that the hospital key plans involve bringing together the concept of acute care, mental health services, accountable-care and social care into one accountable care organisation. She advised that this programme would be the North Lincolnshire’s equivalent of North East Lincolnshire’s Together Accountable Care Partnership programme. She explained that GPs want to join this process but need to work through the details and practicalities. Mrs Lacey-Hatton left the meeting at 16:14 hours. Mrs Clipson updated members on the work to potentially create a one-stop shop with a GP service and ophthalmology at Glanford Park in Scunthorpe. She explained that the timely scale of change required was vast and the Trust is entering into discussions with the community hubs. She added that a ‘front door’ was required and a bid was submitted recently regarding having one model of care across Scunthorpe and Grimsby hospital areas. This was supported by NHSI and would involve having a GP in the front door at all sites and having nurses streaming patients into the correct areas.

Mrs Lacey-Hatton returned to the meeting at 16:15 hours. Mrs Clipson explained that approximately 90% of patients seen in orthodontics should be seen in a primary care setting and not acute care but a new orthodontist was needed at present. Mrs Clipson informed members that WebV and new documentation will be discussed in more detail at the April Trust Board and electronic prescribing has been through the governance process and will be launched during quarter 1. Mr Baskett felt that WebV was excellent but explained that the GPs in Grimsby don’t have this. Mrs Clipson explained that this was being rolled out to GPs shortly. Mrs Shaw thanked Mrs Clipson and invited any questions.

Mr Page asked if patients will bypass their own GP to use these services and Mrs Clipson advised that this service will only be for those patients who can’t see their own

12

GP. It will run from 8am to 11pm, 7 days a week. Patients will be screened on arrival and will be re-directed back to their GP for an appointment if they do not meet the criteria. Mr McCabe agreed that this this option should not be made too attractive or be an alternative to an appointment with the patients’ registered GP. Mr Barrett expressed the need to promote such positive progress. Mr Pickersgill raised a concern that the British Medical Association (BMA) state there are not enough GPs in the community, and wondered whether this would present difficulties. Mrs Clipson advised that these considerations were captured in the plans and it would be good for GPs to be able to work across primary and acute care. Mrs Shaw invited any further questions. None were received

Council Decisions:

The Council received the Humber Coast & Vale Sustainability and Transformation Plan (STP) & Healthy Lives, Healthy Futures (HLHFs) Update;

The Council received the Trust Contract Update for North East Lincolnshire and North Lincolnshire First Accountable Care Partnerships;

The Council received the Draft Trust Strategy 2021 update.

Mrs Shaw advised that the meeting would now return to the original agenda order and item 10

10. SUB-COMMITTEE HIGHLIGHT REPORTS & BOARD CHALLENGE

(please also refer to the supporting documents listed at Appendix A)

10.1 Trust Governance and Assurance Committee (TGAC): 10.1.1 TGAC Highlight Report

Mr Shreeve provided this update on behalf of Mrs Cousland and explained that the Joint Advisory Group (JAG) Accreditation had been lost. He advised that preparations are in place for re-accreditation with support from the NHSI support team, and it would remain an agenda item for this group. Mrs Clipson left the meeting at 16:31 hours. Mr Shreeve informed members that good progress was being made on the priority actions agreed with NHSI. As performance and CQC and Improving Together had been covered earlier in the meeting, he did not intend to cover them again and just wished to raise the remaining data quality issues which may be a risk to the Trust’s ability to model a robust Referral to Treatment (RTT) delivery trajectory. Mr Shreeve informed members that the current statutory supervision for midwives will end on 31st March 2017. He added that a new model will be introduced, with guidance and support provided, but currently nobody knows what this was and it will remain on the agenda until clarity was provided. Mrs Cousland advised that the National Midwifery Council (NMC) advice was to continue with existing practices until new guidance has been provided. Mrs Shaw thanked Mr Shreeve and invited any questions. None were received.

Council Decision: The Council received the TGAC Highlight Report.

13

10.2 Quality Patient Experience Committee (QPEC) Highlight Report

Mrs Jackson took the report as read and provided an update for members. She explained that the Raymond’s model was covered as part of the Bi-annual Governor and NED Briefing which took place in February 2017. She informed members that a sepsis pilot with East Midlands Ambulance Service (EMAS) took place between May and November 2016, and over 90% of patients were screened for sepsis and provided with appropriate antibiotics, with importance on the ‘call to needle’ time. EMAS are interested in the results and want to implement as a wider service. Work was ongoing with monthly reports being provided by the Transfer and Discharge Group to give assurance on key aspects relating to the effectiveness of the discharge process and the impact on the patient experiences.

Mrs Jackson informed members that dementia screening at SGH had not achieved the set target. This is the first time in 12 months that was has not been achieved due to the assessment not being completed within a 72 hour period. The appointment of 2 dementia nurse specialists will help to ensure ongoing achievement of this target. There has been an increase in avoidable falls in recent months. Quality matrons will review trends. Mrs Jackson provided an updated on complaints and the fact that they have been increasing since November. A key issue has been caused by poor or conflicting communication between staff and patients’ families when moving patients. Mr Kirton-Watson invited Governors to liaise with Ms Kay Newton if they wish to visit the ops centre at Diana, Princess of Wales hospital (DPoW) to view new technology and its’ transformational links with stakeholders. Mrs Shaw thanked Mrs Jackson and invited any questions. None were received. Council Decision: The Council received the QPEC Highlight Report.

10.3 Mortality Assurance & Clinical Improvement Committee (MACIC) Highlight Report

Mrs Cousland took the report as read explained that she and Dr Kate Wood had been

to a national Learning from Death conference in March which consisted of medical directors, members of the public and NEDS. She explained that the Trust had already partially embedded the use of best practice methodology (Structured Judgement Review) for the review of case notes, and that a Board report in April would detail the review on how we look at mortality.

Mrs Cousland then informed members that the stroke unit was now considered an A1 service and they will be delivering a ‘Stroke Masterclass’ on 30th March. A higher than expected number of respiratory patients are evident for the service which reflects the current national picture. Overall mortality remains within the expected range explained Mrs Cousland, whilst crude mortality figures are increasing, the out of hospital mortality relates to patient choice. Concerns remain regarding the Stillbirth work stream and work was ongoing to embed and evidence the required actions. Mrs Shaw thanked Mrs Cousland and invited any questions. None were received.

Council Decision: The Council received the MPAC Highlight Report.

14

10.4 Infection & Prevention Control Committee (IPCC) Highlight Report

Mr Shreeve informed members that as the IPCC meeting was only held the day before, he would deliver a verbal overview as the highlights report. He drew members’ attention to the 4 new cases of Methicillin-resistant Staphylococcus aureus (MRSA) in the recent months, after none in the last couple of years. Two were community acquired and a further one was believed to be community acquired at present, and it was expected that the fourth will also be found to be community acquired. Mr Shreeve added that there have been 26 cases of Clostridium Difficile (C.diff) for the full year which was a modest reduction from 33 last year. Of these cases, 4 were accountable to the Trust, which in context relates to 0.25 per 1000 bed days which was quite a low number. He added that a lack of isolation and hand basins at DPoW are an issue and the Trust are working to address this as DPoW cases are three times higher than at Scunthorpe General Hospital (SGH). Mr Kirton-Watson informed members about the new guidance for C.diff reporting, where a patient has acquired C.diff who has attended the hospital in the last 4 weeks will be classed as healthcare acquired. If a patient has acquired C.diff and has previously attended the hospital in the last 12 weeks, it will be classed as both community and healthcare acquired. Mr Shreeve drew members’ attention to the anticipated national shortage of certain antibiotics during the April to July 2017 period, which may lead to an increase in infection rates.

Mr Shreeve concluded, and clarified that work was underway to address the difference in staff practices across sites to address infection rates. As current examples of good practice are all coming from SGH. Mrs Shaw thanked Mr Shreeve and invited any questions. None were received. Council Decision: The Council received the Infection and Prevention Control Committee Highlight Report.

Mr Kirton-Watson left the meeting at 16:52 hours.

Mrs Shaw advised that the meeting would now return to the original agenda order and item 13

13. LEADERSHIP & IMPROVEMENT CAPABILITY (WELL LED)

13.1 Chief Executive Update & Briefing on Trust Board Changes

This item was covered earlier in the meeting.

13.2 Leadership in Action

Mrs Lacey-Hatton informed members that this was now called Listening into Action

(LiA) and would be funded by NHS Improvement (NHSI). She explained that LiA is a

model linked to staff engagement and covers such things as the ‘big conversations’,

key projects for identified areas to be addressed, utilises a ‘quick win’ approach to

resolve minor issues or those which could be quickly addressed and the project teams

will be clinically led and accountable. She explained that although current staff

appraisal rates are good, staff morale was lower than the national average.

15

Mr Page agreed engagement was key for effective appraisals and improving staff morale, and noted that the quality of annual appraisals were improving which was outstanding with the current pressures and workloads. Mr Baskett asked if finance and human resources teams will be involved in this, and Mrs Lacey-Hatton explained there was a commitment to integrate all key personnel. Mr Barrett asked if this can be broken down to individual managers and Mrs Lacey-Hatton explained that it was difficult to establish each ward level but it will be drilled down where possible.

Mrs Shaw thanked Mrs Lacey-Hatton and invited any further questions. None were received. Council Decision: The Council received the Leadership in Action update.

13.3 Staff Survey

Mrs Lacey-Hatton informed members that the results of the staff survey have now been published. Mr McCabe raised a concern that as it was not completed by all staff, it was not really reflective of the all Trust staff. Mr Shaw added that there a change in culture was required. Mrs Shaw thanked Mrs Lacey-Hatton and invited any questions. None were received. Council Decision: The Council received the Staff Survey update.

14. REPORTS FROM COUNCIL OF GOVERNOR SUB-GROUPS

14.1 Steering Group

Mrs Hurley took the report as read and provided an overview on behalf of the group chair, Mr Grinell. She explained that some of the items on the report had already been addressed within the meeting and drew members’ attention to the Governor induction documentation which would be circulated to Governors shortly for comments as part of the review. Ward Review documentation will also be updated in August following the Ward Review process in conjunction with the Quality Review Group and Mrs Graves. Mrs Shaw thanked Mrs Hurley and invited any questions. None were received.

Council Decision: The Council received the Steering Group Highlight Report.

14.2 Quality Review Group (QRG)

Mr Pickersgill explained there was not a highlight report on this occasion as there has not been a meeting since the last CoG, and the next meeting was scheduled for 3rd May. He advised that a lot of work was going on in the background and he was happy to take any questions. Mrs Shaw thanked Mr Pickersgill and invited any questions. None were received. Council Decision: The Council received the Quality Review Group update.

16

14.3 Membership Working Group (MWG)

Mr Bayne took the report as read and provided an overview for members. He asked everyone to consider suitable venues for community engagement events and to feedback to the Membership Office. Mr Bayne provided an update on a recent ‘Women in Business’ recruitment event at Grimsby Institute supported by Mrs Stone which had been particularly successful at signing up new young members. Mrs Shaw asked members to consider what we can give back to local colleges following recruitment events and the benefits of recruiting at such venues in terms of gaining interest for future staff. Mrs Hurley suggested that sessions could be delivered on work experience, volunteering and careers in the Trust for students. Mr Bayne explained that there are two pages allocated to Governors and Membership in each of the bi-monthly Staff and Members’ magazines, and asked for Governor volunteers to draft articles or suggest ideas for stories. He added that Mrs Hurley currently writes the majority of these articles and it should really be Governor driven, and that Mrs Hurley and Mrs Webster from the Communications Teams are happy to work with Governors to draft up articles. Mrs Shaw suggested that Mrs Deb Rojahn could do an article on a ‘birds-eye view of the Trust Chair’s office’. Ms Heaton left the meeting at 17:12 hours. Mrs Shaw thanked Mr Bayne and explained that if no Governor volunteers are forthcoming, a schedule of Governors may be devised by Mrs Shaw and Mrs Hurley. She invited any questions. None were received. Ms Heaton returned to the meeting at 17:13 hours. Council Decision: The Council received the Membership Working Group Highlight Report

Council Action: Mrs Shaw to request Mrs Rojahn to draft an article on a birds-eye view of the Trust Chair’s office for the next Staff and Members’ magazine.

14.4 Appointments and Remuneration Committee (ARC)

Mrs Hurley took the report as read and provided an overview on behalf of the group Chair, Mr Grinell. She drew attention to the review of the Chair and NED appraisal process and the review of the NED remuneration, and sought Council approval for the recommendation that no general increases in NED remuneration should be awarded at this time. Mrs Hurley referred to the planned reviews of the Deputy Chair and Senior Independent Director positions and the agreement to create job descriptions and consider enhanced remuneration. An update would be made at the next CoG meeting. Mrs Shaw thanked Mrs Hurley and invited any questions. None were received. Council Decisions:

The Council received the Appointments and Remuneration Committee highlights report;

The Council approved the recommendation that no general increases in NED remuneration should be awarded at this time.

17

15. ITEMS FOR APPROVAL

15.1 Quality Accounts 2016-17

Mr Daws referred to the Quality Accounts 2016-17 document and explained that internal approval by QPEC was required prior to seeking stakeholder comments by 19th April 2017 with a deadline of 28th April. He explained that efforts continue to keep the report within 100 pages as per feedback each year (which has just been achieved). He advised that there are two nationally mandated audits to be undertaken, one of which was for the Governors to choose. Mr Daws recommended ‘data completeness for data entry in the community’ to Governors. Mr Pickersgill, Chair of the Quality Review Group (QRG) explained that this will look at how the data was gathered. Mr Daws and Mr Pickersgill were due to meet the next day with Mr Baskett and agreed to discuss this in greater detail. Mr McCabe asked if this would just be looking at North Lincolnshire or the whole of the Trust area, and Mr Daws confirmed that it would be for North Lincolnshire. Mr Shaw asked if hydration would be a useful audit and a discussion took place. Mrs Shaw thanked Mr Daws and invited further questions. None were received. Council Decision: The Council approved the Quality Accounts document. Council Action: Mr Pickersgill (chair of QRG) and Mr Daws to liaise outside of the meeting to further discuss quality accounts.

15.2 Council of Governors’ Register of Interests

Mrs Hurley provided the Council with an updated Register of Governors’ Interests. Council Decision: The Council approved the Council of Governors’ Register of Interests.

15.3 Revised Trust Constitution

Mrs Hurley drew members’ attention to the minor amendments made and the addition of the safeguarding section to the Trust Constitution. Council Decision: The Council approved the Revised Trust Constitution.

16. ITEMS FOR COG DECISION

There were no items requiring CoG decisions.

17. ITEMS FOR DISCUSSION

17.1 Governor Attendance at the CoG & Sub-groups

Mrs Hurley brought the Council’s attention to attendance levels of the CoG and the CoG sub-groups.

18

Mrs Hurley invited comments or questions and none were received. Council Decision: The Council received the Governor Attendance at CoG & Sub-groups update and report.

17.2 Attendance at Governor Briefings, Training and Development Opportunities

Mrs Hurley brought the Council’s attention to attendance levels at briefings and training and development opportunities. Council Decision: The Council received the Governor Briefing, Training and Development Opportunities document and update.

17.3 Additional Patient/Carer Trust Constituency

Mrs Hurley provided an update to members and explained the progress so far and the considerations in creating an additional patient/carer constituency together the legal obligations this would bring. Following discussion, it was the council’s recommendation that this was not done at present. Mrs Shaw thanked Mrs Hurley and invited any questions. None were received. Council Decision: The Council received the additional patient/carer Trust constituency update and decided against creating an additional constituency at this time.

17.4 Maximise Staff Governor Seats

Mrs Shaw provided an update on considerations to increase staff Governor seats by two. Mrs Hurley explained that two additional staff Governor seats could be created whilst still maintaining the legal requirement to have a majority of public Governors on the Council. She advised that this could be helpful as the current four staff Governors all share the same term in office dates, due to end in July 2017, and it would be in the best interests of the Trust to wait until the November elections to create any new seats. Mrs Shaw advised that staff commitment to becoming Governors needs to also be considered. Following a discussion, the Council agreed in principle to increase the number of staff Governors by two. Mrs Cousland suggested that this would be an excellent idea for an article for the staff and members’ newsletter, and Mrs Hurley agreed to action this. Council Decision: The Council received the staff governor seats update. Council Action: Mrs Hurley to write an article on the staff Governor role for the September Staff and Members’ Newsletter.

17.5 Future Sustainability and Transformation Plan (STP) & Healthy Lives, Healthy

Futures (HLHF), Governor Updates/Briefings & Improving Together Programme This item was covered earlier in the meeting.

19

18. ADDITIONAL STANDING AGENDA ITEMS 18.1 Questions from Governors

There were no questions. 19. ITEMS FOR INFORMATION

Mrs Shaw drew members’ attention to the documents listed in Appendices section of the agenda.

20. ANY OTHER URGENT BUSINESS

None received.

21. QUESTIONS FROM THE PUBLIC There were no members of the public present.

22. DATE AND TIME OF NEXT COUNCIL OF GOVERNORS MEETINGS AND BRIEFINGS

Council of Governors Annual Review Meeting Date: 13th June 2017 Time: 14:00 - 17:00 hours Venue: Lecture Theatre, Diana Princess of Wales Hospital

Governor & NED Pre-CoG Briefing - Senior Independent Director role Date: 11th July 2017 Time: 12:45 - 13:45 hours Venue: Small Meeting Room, Diana Princess of Wales Hospital

Council of Governors Business Meeting Date: 11th July 2017 Time: 14:00 - 17:00 hours Venue: Lecture Theatre, Diana Princess of Wales Hospital

Please notify the Membership Office of any apologies for these events. PROTOCOL FOR CONDUCT OF COUNCIL OF GOVERNOR BUSINESS

In accordance with Standing Order 2.4.3 (at Annex 6 of the Trust Constitution), any Governor wishing to submit an agenda item must notify the Trust Chair’s Office in writing at least 10 clear days prior to the meeting at which it is to be considered. Requests made less than 10 clear days before a meeting may be included on the agenda at the discretion of the Trust Chair.

Governors are asked to raise any questions on which they require information or clarification in advance of meetings. This will allow time for the information to be gathered and an appropriate response provided.

Mrs Shaw thanked members for their attendance and contributions. The meeting closed at 17:25 hours.