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May 2012
May 2012 Tuesday 1st - 9.30am
Education Centre Birmingham Heartlands Hospital
AGENDA
Apologies
.01
Declaration
of interest
.02
Minutes
from
previous
meeting
.03
Matters
Arising
.04
Chairmans
report
.05
Chief
Executives
report
.06
Quality and
Performance
Monitoring
.07
Board
Committee
Reports
.08
Trust News
and External
Environment
.09
Governing
Body and
Membership
.10
Any Other
Business
.11
Agenda May 2012
1. APOLOGIES
2. DECLARATIONS OF INTEREST (Enclosure)
3. MINUTES:
6 March 2012 (Enclosure)
4. MATTERS ARISING AND ACTION POINTS (Enclosure)
5. CHAIRMAN‟S REPORT (Enclosure)
6. CHIEF EXECUTIVE‟S REPORT (Enclosure)
QUALITY AND PERFORMANCE MONITORING
7. FINANCE & PERFORMANCE REPORT (AS) (Enclosure)
8. IPROC REQUISITIONS FOR APPROVAL (AS) (Enclosure)
9. BUSINESS PLAN 2011/12 – Q4 UPDATE (SH) (Enclosure)
10. BUSINESS PLAN 2012/13 (SH) (Enclosure)
11. MONITOR ANNUAL PLAN DRAFT INCLUDING BUDGET SETTING 2012/13 (AS) (Enclosure)
12. UPDATE ON NOROVIRUS (MS) (Oral)
13. SAFETY SITREP REPORT (INC ASSURANCE FRAMEWORK) (SW) (Enclosure)
14. HR & OD UPDATE (HG) (Enclosure)
15. WHISTLE BLOWING ANNUAL REPORT (HG) (Enclosure)
16. CIP UPDATE (AS) (Enclosure)
REPORTS FROM BOARD COMMITTEES
17. AUDIT COMMITTEE REPORT (RH) (Oral)
18. DONATED FUNDS COMMITTEE MINUTES (23/1/12) (Enclosure)
19. FINANCE AND PERFORMANCE COMMITTEE REPORT (RH) (Oral)
20. FINANCE AND PERFORMANCE COMMITTEE MINUTES (27/2/12 & 26/3/12) (Enclosure)
21. GOVERNANCE AND RISK COMMITTEE REPORT (AE) (Oral)
22. GOVERNANCE AND RISK COMMITTEE MINUTES (13/2/12 & 19/3/12) (Enclosure)
23. HR STRATEGIC COMMITTEE REPORT (PH) (Oral)
24. HR STRATEGIC COMMITTEE MINUTES (19/3/12) (Enclosure)
25. STAKEHOLDER & COMMUNITY ENGAGEMENT COMMITTEE REPORT (NH) (Oral)
26. STAKEHOLDER & COMMUNITY ENGAGEMENT COMMITTEE MINUTES (9/3/12) (Enclosure)
TRUST NEWS AND EXTERNAL ENVIRONMENT
27. COMMUNICATIONS UPDATE (LT) (Enclosure)
28. PATIENT EXPERIENCE REPORT (LT) (Enclosure)
COUNCIL OF GOVERNORS AND MEMBERSHIP
29. UPDATE (PH/LD) (Oral)
30. COUNCIL OF GOVERNORS MEETING (14/3/12) (PH) (Oral)
ANY OTHER BUSINESS
DATE OF NEXT MEETING
3 July 2012 Harry Hollier Lecture Theatre, Partnership Learning Centre, Good Hope Hospital
EXCLUSION OF THE PRESS AND PUBLIC
The Board will be asked to resolve “That representatives of the press and other members of the public be excluded from the remainder of this meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest”.
PART 2
1. Mr. IP UPDATE (Enclosure)
.01
.03
May 2012
Apologies
.01
AGENDA
Apologies
.01
Declaration
of interest
.02
Minutes
from
previous
meeting
.03
Matters
Arising
.04
Chairmans
report
.05
Chief
Executives
report
.06
Quality and
Performance
Monitoring
.07
Board
Committee
Reports
.08
Trust News
and External
Environment
.09
Governing
Body and
Membership
.10
Any Other
Business
.11
.01
.03
May 2012
Declaration of
interest
.02
AGENDA
Apologies
.01
Declaration
of interest
.02
Minutes
from
previous
meeting
.03
Matters
Arising
.04
Chairmans
report
.05
Chief
Executives
report
.06
Quality and
Performance
Monitoring
.07
Board
Committee
Reports
.08
Trust News
and External
Environment
.09
Governing
Body and
Membership
.10
Any Other
Business
.11
.01
.03
Declaration of Interests
May 2012
REGISTER OF DIRECTORS and REGISTER OF DIRECTORS‟ INTERESTS
VOTING TRUST BOARD MEMBERS
NAME
DATE OF
APPOINTMENT
INTEREST (if any)
DATE OF NOTIFICATIO
N
DATE OF TERMINATI
ON OF INTEREST
Dr Aresh Anwar 01.03.11 1. South Asian Health Foundation : Member of Diabetes Working Group
01.03.11
Ms Mandy Coalter 24.07.06 1) Prior to Ms Coalter‟s appointment HEFT contracted „Q Learning‟ to provide an Organisational Development programme. This contract is under review and since the Q Learning contact is a personal friend of Ms Coalter‟s, she has delegated all decisions about the future of the contract to Theresa Nelson (Head of OD).
2) Ms Coalter‟s husband, Lee Moreton, is a professional tennis coach and he will potentially be working with the Trust on the staff sports programme. Ian Cunliffe was the executive lead for the contract negotiations.
3) Joined the Appointments Sub - Committee of the National Trust Midlands Region as an independent, voluntary and unpaid member
23.01.07
12.07.10
02.03.2012
Ms Anna East 01.07.05 01.05.10
01.09.10 01.08.12 01.04.12
1) Director of Dudley Building Society 2) Non Executive Director Midland
Heart Housing Association 3) Regional Panel CEAA 4) Chair of Dudley Building Society 5) Non Exec Director of Entrust
01.01.08 25.10.10
25.10.10 13.10.11 13.10.11
Mr Simon
Hackwell
01.03.07 Board Director for a 1 year term of office
at MidTECH - one of a network of nine regional NHS innovation hubs, established by the Department of Health to identify, protect and commercialise innovative ideas from within the NHS.
09.10.09
Ms Najma Hafeez 01.04.07 Chair of Postwatch 01.01.07 30.10.08
Mr Richard Harris 01.05.08 1) Brambles Limited Shareholder and Chair of UK Pension Fund
2) Trustee of Action for Children Superannuation Fund.
3) Birmingham Community Foundation Trustee
4) RSA Academy - Governor 5) Flora Forster Students‟ Fund
Trustee 6) Director and Shareholder, Gorilla
Box Limited.
01.05.08
01.05.08
01.05.08
01.05.08 01.05.08
04.08.09
04.08.09
.1
.5
AGENDA
Apologies
.01
Declaration
of interest
.02
Minutes
from
previous
meeting
.03
Matters
Arising
.04
Chairmans
report
.05
Chief
Executives
report
.06
Quality and
Performance
Monitoring
.07
Board
Committee
Reports
.08
Trust News
and External
Environment
.09
Governing
Body and
Membership
.10
Any Other
Business
.11
.01
.03
14.09.10
7) President, Solihull School Parents Association
8) Richard Harris‟ wife is a volunteer
WRVS worker at Solihull Hospital (half a day per week)
9) Non executive director of Simplyhealth Group Limited
10) Member of the Audit & Risk Committee of the RSA (Royal Society for the encouragement of Arts, Manufactures and Commerce).
11) Trustee of StartHere
a charity based in West London
engaged in developing information
databases on health, social
services, housing services and a
range of other information, all
targeted at people in need, and in
particular accommodating people
who do not have access to
computers or who are not
computer literate.
04.08.09
19.07.10
4.11.10
29.11.11
Mr Paul Hensel 01.08.05 1) Paul Hensel‟s wife has been appointed as a non executive director of the Royal Orthopedic Hospital. No conflict is foreseen but it is registered for the sake of good order.
2) Non Executive Director of Kplus Software Limited (small company
involved in development and delivery of Mobile Data Solutions)
3) Non Executive Director of the John Taylor Hospice
30.01.07
22.02.07
08.02.12
01.08.07
Rt Hon Lord Philip Hunt PC OBE
01.10.10 1) Member and Deputy Leader of the Opposition, House of Lords
2) Self-Employed Consultant on NHS and wider health issues, t/a Phillip Hunt Consultancy
3) Trainer and Policy Analyst, Cumberlege Connections Ltd. (NHS leadership/awareness programmes)
4) Philip Hunt Consultancy consultant
and trainer, 5) President, British Fluoridation
Society 6) Trustee, Terrence Higgins Trust 7) President, Royal Society of Public
Health 8) President, Health Care Supply
Association 9) Chair, Birmingham University
Policy Commission on Nuclear
Energy 10) Member of the National Advisory
Council of the Easy Care Foundation
11) Chamberlain Sixth Form College (where Lady Hunt is Vice Principal) has occasionally since 1993 utilised the services of HEFT OH Dept. There is no formal contact, neither Lord nor Lady Hunt are involved in the arrangement and the value is
11.10.10
11.10.10 11.10.10
26.04.11
June 2011
June 2011
01.10.2011
17 Oct 2011
17.08.11
Declaration of Interests
May 2012
.2
.6
AGENDA
Apologies
.01
Declaration
of interest
.02
Minutes
from
previous
meeting
.03
Matters
Arising
.04
Chairmans
report
.05
Chief
Executives
report
.06
Quality and
Performance
Monitoring
.07
Board
Committee
Reports
.08
Trust News
and External
Environment
.09
Governing
Body and
Membership
.10
Any Other
Business
.11
.01
.03
Declaration of Interests
May 2012
approx £1,500pa
12) Patron/Ambassador of Saving Lives
13) Lord Hunt‟s wife, Selina Stewart,
Vice Principle at Chamberlain Sixth Form College, is working with HEFT on a volunteer programme.
14)
Nov 2011
03.01.2012
Mr Les Lawrence 01.04.12
Dr Mark Newbold 01.08.10 1) Member of Multidisciplinary Professional Advisory Panel of BabyLifeline (Charity)
01.01.2012
Prof Edward Peck 01.04.12
Prof Laura Serrant-Green
01.04.12
Mr Adrian Stokes 01.07.08 (as voting board
member)
1) Director of HECL 2) Pfizer Virtual Customer programme
1) On app‟t
2) 20/6/2011
Ms Mandie Sunderland
01.12.08 Nothing to declare
Dr Sarah Woolley 07.05.07 Energy & Home Condition Surveys Ltd – Company Secretary
16.03.07 July 08
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.7
AGENDA
Apologies
.01
Declaration
of interest
.02
Minutes
from
previous
meeting
.03
Matters
Arising
.04
Chairmans
report
.05
Chief
Executives
report
.06
Quality and
Performance
Monitoring
.07
Board
Committee
Reports
.08
Trust News
and External
Environment
.09
Governing
Body and
Membership
.10
Any Other
Business
.11
.01
.03
Declaration of Interests
May 2012
REGISTER OF INTERESTS
NON VOTING TRUST BOARD MEMBERS
NAME
DATE OF
APPOINTMENT
INTEREST (if any)
DATE OF
NOTIFICATION
DATE OF
TERMINATION OF INTEREST
Mr Andy Laverick
Nothing to declare 18.12.08
Mrs Claire Molloy
01.05.11 Nothing to declare 01.05.11
Ms Susan Moore
01.09.2011 Nothing to declare 01.09.11
Mr John Sellars 08.01.07 Nothing to declare 16.04.08
Ms Lisa Thomson
23.10.08 1) Non Executive Director of Multistory
2) Trustee of a charity ... Redditch United Football In the Community
22.12.08
07.11.11
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AGENDA
Apologies
.01
Declaration
of interest
.02
Minutes
from
previous
meeting
.03
Matters
Arising
.04
Chairmans
report
.05
Chief
Executives
report
.06
Quality and
Performance
Monitoring
.07
Board
Committee
Reports
.08
Trust News
and External
Environment
.09
Governing
Body and
Membership
.10
Any Other
Business
.11
.03
May 2012
Minutes from previous meetings
Minutes of meeting held on 6 September 2011
12.014 Apologies and Welcome
12.015 Declarations of Interest
12.016 Minutes of Previous Meeting
12.017 Matters Arising
12.018 Chairman’s Report
12.019 Chief Executive’s Report
12.020 Quality and Performance Monitoring
12.020.1 Finance & Performance Report
12.020.2 IPROC Requisitions for Approval
12.020.3 Update on Business Plan
12.020.4 Corporate Strategy Goals
12.020.5 Reshaping HEFT
12.020.6 Infection Control Update Report
12.020.7 Update on Norovirus
12.020.8 Nursing and Midwifery Update
12.020.9 Board Assurance Framework
12.020.10 Safety SITREP
12.020.11 T&O Update Report
12.020.12 HR Quarterly Update Report
12.020.13 Ambulatory Care & Diagnostic Project (ACAD)
12.020.14 Contract Arrangements
12.021 Reports from Board Committees
12.021.1 Donated Funds Committee Report
12.021.2 Finance & Performance Committee Report
12.021.3 Finance & Performance Committee Minutes
12.021.4 Governance & Risk Committee Report
12.021.5 HR Strategic Committee Report
12.021.6 HR Strategic Committee Minutes
12.021.7 IM&T Committee
12.021.8 IM&T Committee Minutes
12.021.9 Monitor Standing Committee Minutes
12.022 Trust New & External Environment
12.022.1 News Update
12.022.2 Patient Experience Update
12.023 Council of Governors and Membership
12.024 Corporate Governance
12.024.1 Schedule of Matters Reserved for the board
12.024.2 Monitor Standing Committee Membership
12.025 Any Other Business
12.026 Date of Future Meeting
.01
.03
AGENDA
Apologies
.01
Declaration
of interest
.02
Minutes
from
previous
meeting
.03
Matters
Arising
.04
Chairmans
report
.05
Chief
Executives
report
.06
Quality and
Performance
Monitoring
.07
Board
Committee
Reports
.08
Trust News
and External
Environment
.09
Governing
Body and
Membership
.10
Any Other
Business
.11
.01
.03
Minutes from previous meeting - 6th March 2012
May 2012
Minutes of a meeting of the
BOARD OF DIRECTORS of Heart of England NHS Foundation Trust held
the SIMTR Centre, Damson Parkway, Solihull on 6 March 2012
PRESENT: Lord P Hunt (Chairman)
Dr A Anwar Mrs A East Mr S Hackwell
Ms N Hafeez, Mr R Harris Mr P Hensel Dr M Newbold Mr R Samuda Mr A Stokes Ms M Sunderland
Dr S Woolley
IN ATTENDANCE: Mr A Laverick Mrs C Molloy Ms S Moore Mr M Pye Mr J Sellars Mrs L Thomson
Mrs A Hudson (Minutes)
Members of the Public
12.014 APOLOGIES and WELCOME
Apologies were received from Ms M Coalter and Ms H Gunter.
The Chairman welcomed everyone to the meeting. He then introduced members of the Heart of England Catering Team, Mike Towler Trust Catering Manager, Barbara Green CPU Manager, Graham Ancorn Chef and George Taylor Catering Assistant who are based at the Solihull Catering Processing Unit. There had recently been an excellent article in the Birmingham Post recognising the quality of food produced and served at the Trust. The Chairman on behalf of the Board of Directors and Governors thanked the team for the enormous amount of effort and the quality of the food produced.
12.015 DECLARATION OF INTEREST
.1
.10
AGENDA
Apologies
.01
Declaration
of interest
.02
Minutes
from
previous
meeting
.03
Matters
Arising
.04
Chairmans
report
.05
Chief
Executives
report
.06
Quality and
Performance
Monitoring
.07
Board
Committee
Reports
.08
Trust News
and External
Environment
.09
Governing
Body and
Membership
.10
Any Other
Business
.11
.01
.03
Minutes from previous meeting - 6th March 2012
May 2012
The following new declaration of interests were noted:
Paul Hensel has joined the Board of the John Taylor Hospice as a Non Executive
Director.
Mandy Coalter has joined the Appointments Sub Committee of the National Trust
Midlands Region, as an independent, voluntary and unpaid member.
12.016 MINUTES OF LAST MEETING
The following amendments were noted to the draft minutes of 3 January 2012
meeting:
12.007.5 Solihull Local Safeguarding Children‟s Annual Report 2010/11.
Bulletpoint 2 should read “There are no areas of significant concern raised at the
Trust”. Bulletpoint 4 should read “ ..... to discuss the broader issues of looked after
children.”.
12.007.8 Site Strategy Update. Paragraph 7 should read “.... Mrs East asked
about the amount of equipment that comes to the end of its useful life at the same
time.”.
12.007.9 Safety SITREP Report. Paragraph 2 Delete last two sentences and
replace with “Mrs East added that she was unsure why the report had been
submitted to the Board as the Paediatric security risk was being managed by
Governance & Risk Committee and the Committee would report progress to the
Board.”
Following these amendments the minutes were approved by the board and signed
by the Chairman.
12.017 MATTERS ARISING
The Schedule of Matters Arising was discussed and the following actions noted:
11.98.1 Coroner Invitation - Mrs East advised that there had been a discussion at
Governance & Risk Committee about inviting the Coroner to the January 2012
meeting and it had been decided, after much consideration, that as there was
nothing specifically for the Committee to talk to him about it would not invite him to
attend; however, the Committee would keep this under review.
11.98.11 Harrop Inquest – no letter received as yet from the Coroner‟s office.
11.122 Update on NED involvement in Consultant Update – Dr Anwar advised that
there was now a group looking at Consultant appointments and a meeting was planned; however, nothing had been addressed at the present time.
11.125 Never Events - Dr Woolley advised that these were being managed
through Governance & Risk Committee and an update is in the progress report
later in the agenda.
11.126.6. Number of staff receiving flu vaccine – Ms Sunderland advised that she
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.11
AGENDA
Apologies
.01
Declaration
of interest
.02
Minutes
from
previous
meeting
.03
Matters
Arising
.04
Chairmans
report
.05
Chief
Executives
report
.06
Quality and
Performance
Monitoring
.07
Board
Committee
Reports
.08
Trust News
and External
Environment
.09
Governing
Body and
Membership
.10
Any Other
Business
.11
.01
.03
Minutes from previous meeting - 6th March 2012
May 2012
was undertaking another drive to encourage staff to have their vaccination and an end of season update would be presented to the May meeting.
11.127.3 PHSO Review of Complaint Handling - No response to the Chairman‟s letter has been received.
12.009.2 Explore Link between performance, staff morale and patient experience – deferred to next meeting.
All other outstanding items will be picked up within items on the agenda.
12.018 CHAIRMAN‟S REPORT
Lord Hunt presented a summary of his written report and drew the Board‟s attention to several items:
The first joint Board to Board meeting with the Cluster proved very successful and it has been agreed to continue collaborative work and to develop a concordat for joint working arrangements. Dr Newbold advised that monthly meetings have also been arranged with the Chairs of the Clinical Commissioning Groups. The Chairs are also to be invited to the next Cluster Board to Board meeting.
A meeting had been held with Mr Liam Byrne, MP and the Head and Deputy Head of Waveley School to explore how the Trust might work closer with the school to support job creation and opportunities for students. Dr Newbold added that Waveley School had put in a bid to develop a Studio School on Belchers Lane that is designed to develop teenagers to undertake more apprentice based careers. HEFT is acting as a partner and will offer a number of places in both healthcare and non-healthcare areas in conjunction with the apprenticeships that the Trust already offers. A bid has been submitted and we will hear back in due course.
Mr Harris commended this initiative and asked if there will be links with other schools within the hospitals catchment areas? The Chairman confirmed that this was the case. Mrs Thomson also confirmed that a mapping exercise had already been undertaken that was being picked up through the Membership Committee, adding that we already have very close school links around both Good Hope and Heartlands Hospitals. Health seminars are also being run in both community settings and schools and these have been very well attended.
The Chairman welcomed suggestions from Directors for other potential links and engagements. Ms Hafeez added that these were great initiatives and wondered whether the Trust could work with schools to target those areas where there are skills shortages (e.g. radiography)? Mr Harris suggested extending this to further education and colleges.
Dame Sally Davis, Chief Medical Officer had a very good session with our professorial chairs and members of the research and development teams who were able to share their visions for the Trust as well as hearing the current policies and activities being undertaken nationally.
The HEFT nursing and midwifery badge has been launched by the Nursing Directorate and the Chief Nurse and the Head Nurses have been inviting application from those nurses and midwives who meet the criteria.
.3
.12
AGENDA
Apologies
.01
Declaration
of interest
.02
Minutes
from
previous
meeting
.03
Matters
Arising
.04
Chairmans
report
.05
Chief
Executives
report
.06
Quality and
Performance
Monitoring
.07
Board
Committee
Reports
.08
Trust News
and External
Environment
.09
Governing
Body and
Membership
.10
Any Other
Business
.11
.01
.03
Minutes from previous meeting - 6th March 2012
May 2012
The Chairman and the Chief Executive have both received a number of emails from consultants concerning instances of patients, public and possibly staff smoking outside the Maternity Suites at Heartlands. The Chairman referred to the no smoking policy that the Trust previously had in place and suggested that this was an issue that should be referred to the Council of Governors to investigate possible solutions. Mrs Thomson added that the subject had been raised at the recent joint meeting of the Governors Patient Experience Committee and the Membership & Community Engagement Committee and they had commissioned her to undertake a piece of work to look at how big the problem really is. The joint committee took the issue of smoking on hospital property very seriously and had, of its own volition, already started that debate.
Mr Sellars added that there had indeed been a no smoking policy in place which banned people smoking on hospital sites but this had led to people smoking at the hospital entrances and it had been thought that the installation of smoking shelters would prevent this.
Mr Stokes added that he was able to recall the debate at the time and one of the key issues had been the reluctance by people to challenge smokers and those who were challenged were sometimes quite aggressive. It had been difficult to police and, therefore, the decision to have shelters was agreed. Mr Stokes also commented that the attitude towards smoking had moved on in those eight years and, therefore, it was right for a fresh debate to take place on the subject.
Dr Newbold was pleased to know that Governors are willing to get involved and added that the Trust needs to be resolute about the decisions ultimately made. He was also able to comment that Mr Griffin, Consultant, had told him that City had banned smoking on their site but Dr Newbold had spoken to their Chief Executive who confirmed that they had a similar policy to HEFT‟s in that they provided smoking shelters.
Dr Newbold was also of the view that we need to look at some specific action for maternity and Mr Sellars, Mrs Thomson and he were due to meet to discuss implementing and trialling a harder line around maternity; this will be coupled with a communication campaign. Mr Sellars advised that security could be increased around maternity to more frequently challenge smokers.
The Board agreed to support the interim initiatives around the maternity units and also to refer the matter to the Council of Governors to seek a view on the options around a no smoking policy.
The Chairman had attended a Hindu Women‟s Network Health Awareness Day in Sparkhill where a number of our consultants had presented to the women on diabetes, kidney failure etc. The day had been a huge success and, in terms of health promotion campaigns in the community, be believed it was the start of something of which the Trust could do more in the future.
12.019 CHIEF EXECUTIVE‟S REPORT
Dr Newbold presented a summary of his pre-circulated written report and highlighted to the Board the work that had been undertaken around the restructuring plans. The first phase involved a move from having five separate clinical groups to a matrix structure comprising three dedicated hospital based teams and two Clinical Divisions (Clinical Services and Women‟s & Children‟s).
.4
.13
AGENDA
Apologies
.01
Declaration
of interest
.02
Minutes
from
previous
meeting
.03
Matters
Arising
.04
Chairmans
report
.05
Chief
Executives
report
.06
Quality and
Performance
Monitoring
.07
Board
Committee
Reports
.08
Trust News
and External
Environment
.09
Governing
Body and
Membership
.10
Any Other
Business
.11
.01
.03
Minutes from previous meeting - 6th March 2012
May 2012
The consultation period finishes today and responses to feedback will be sent this week.
Dr Newbold had been invited to speak at a parliamentary seminar on the „Nicolson Challenge‟ at an all party meeting of both Houses, including senior figures from across the healthcare sector. The seminar allowed an opportunity to address MPs and Peers openly and directly in relation to how the NHS will meet the Nicholson Challenge. The Chairman added that he had received very positive feedback on Dr Newbold‟s address especially around the Trust‟s engagement in the community and the recognition that the role of acute hospitals must change in the future.
Dr Newbold added that he believed that there was also an increase in understanding and realisation within the Birmingham area that the Trust is keen to keep people well and out of hospital.
12.020 QUALITY AND PERFORMANCE MONITORING
12.020.1 Finance & Performance Report
Mr Stokes presented a summary of his pre-circulated report setting out the finance and key performance indicators for month nine. The yearend forecast remains the same with a projected surplus of £7.2m. A better than anticipated outcome with new to follow up negotiations has been achieved and agreement secured with PCTs to push some transitional funding into 2012/13. The only item which could materially adversely impact the year end position would be the capital charges revaluation; however, Mr Stokes was confident that this would not significantly impact his projected year end position.
There has been a fairly significant reduction in the number of toxin positive CDiff cases in the first three months of 2012. There are no further cases of MRSA and the Trust is confident it will achieve its Monitor targets by year end. Mr Stokes added that he considered this result to be impressive given the number of cases seen at the start of this financial year and gave recognition for the amount of work that has been undertaken around infection control.
Although a reduction in numbers has been seen there continues to be a backlog of patients waiting over 18 weeks. Action plans continue to be monitored on a monthly basis by the Finance and Performance Committee.
February has been a difficult month for the Trust such that the A&E 95% 4 hour wait performance is down to 92.79%, which leaves a very tight position to achieve the 95% year-end Monitor target. Good Hope is under extreme pressure; however, the site teams are working to recover the position.
Lord Hunt asked what the Monitor implications might be if we achieve all our targets with the exception of the A&E 4 hour target and might the Trust be escalated by Monitor? Mr Stokes was of the view that the Trust would probably not be escalated and Monitor would take into account both the performance against last year and the progress it had achieved with the A&E 95% 4 hour position, adding that achievement of the 4 hour target for quarter 4 had proved difficult across lots of organisations within the region.
The only area of concern could relate to the unannounced CQC visit in October 2011. Dr Woolley added she had recently submitted a plan to CQC detailing
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.14
AGENDA
Apologies
.01
Declaration
of interest
.02
Minutes
from
previous
meeting
.03
Matters
Arising
.04
Chairmans
report
.05
Chief
Executives
report
.06
Quality and
Performance
Monitoring
.07
Board
Committee
Reports
.08
Trust News
and External
Environment
.09
Governing
Body and
Membership
.10
Any Other
Business
.11
.01
.03
Minutes from previous meeting - 6th March 2012
May 2012
evidence to show that the Trust is now compliant with the outstanding actions. Mr Stokes went on to add that there is still a risk that by the time we submit Q4, CQC may not have had time to clear the conditions through their internal recording systems.
Lord Hunt acknowledged the tremendous amount of work that has been undertaken to achieve the reduction in the number of cases and hoped for achievement of target. The 18 weeks target was discussed extensively at the last meeting of the Finance and Performance Committee and the Trust will continue to prioritise the reduction in waiting times.
Mrs East challenged as to whether the Trust had made any real progress on the A&E target given that the weather had been mild, with the exception of the cold snap at the start of February and whether this was the only real reason for the improvement? Mr Stokes responded that he would bring back a more detailed report to the next meeting with graphs to show the real term year on year improvements. Mrs East added that it would be helpful to better understand the trends in order to be able to be confident of the underlying improvements and that they are fully embedded in the system. It had always been such a complex issue and it was important to ensure that everyone was taking responsibility for the position. She would like to understand what has changed fundamentally in order to give the Board confidence that the Trust can deal with cold weather periods better in future years. Mr Stokes will bring back a presentation to show the real improvements made and added, as an example, that one of the things the Trust was much better at, especially on the Good Hope Hospital site, was managing the breach position when there are no beds in the system. Mrs Moore added that since the Christmas period the site had seen increased activity, due to night closures across the region, in the A&E department with complicated co-morbidities; however, the systems and processes are being followed and work was needed to look at facilitating discharges more readily. Dr Newbold added that he was pleased to be having a more detailed discussion about what was a very complex area that was being monitored in a one dimensional way. However, he was able to reassure the Board that patient‟s needs were put first in what had been a crisis period over the whole of the region. Dr Anwar recognised that every year the Trust will experience a period when it will need to manage higher levels of demand and the challenge was to better manage those times in the year when capacity was not so challenged so as to build headroom in the A&E 4 hour target. Mr Samuda asked if the new contractual changes will have any impact on dynamics of the A&E 4 hour target? Mr Stokes responded that it would not. The Chairman looked forward to discussing this again at a future meeting including plans around capacity and looking at how the Trust can improve its discharge policy.
The Chairman asked about the CIP shortfall and the implications of this for 2012/13? Mr Stokes advised that the Trust will achieve £18m against a target of
£23m and was moderately pleased with the position given the scale of the challenge. The Trust has a surplus going in to the next year but the challenge is to secure further savings in the region of £23m.
Mr Harris advised that Finance & Performance Committee had looked at the budget for 2012/13 and noted that the CIP for the next financial was going to be exceptionally demanding and it would be good for the whole Board to understand in more detail the individual projects in a bid to gain an appreciation of the scale of the CIPs and so as to ensure they do not impact on patient care. It was agreed that a presentation would be made to the Board.
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AGENDA
Apologies
.01
Declaration
of interest
.02
Minutes
from
previous
meeting
.03
Matters
Arising
.04
Chairmans
report
.05
Chief
Executives
report
.06
Quality and
Performance
Monitoring
.07
Board
Committee
Reports
.08
Trust News
and External
Environment
.09
Governing
Body and
Membership
.10
Any Other
Business
.11
.01
.03
Minutes from previous meeting - 6th March 2012
May 2012
Mr Hensel asked about the general approach to CIPs and whether the Trust had considered having CIP targets that could be taken over a longer period than the current annualised arrangements. Mr Stokes responded that this approach has been taken for the last three years and Clinical Directors met about 12 months ago to look at medium term efficiencies and the plan is to undertake this review again. He offered the Reshaping HEFT project as a good example of this form of longer term planning. Mr Hensel was concerned that failing to meet CIP targets year on year would seem to set itself up for failure. The Chairman added that the Board finds it puzzling why it is assumed that the Trust will only hit 75% target. Mr Stokes responded that if a lower target of £18m were to be set it would likely still only achieve 75%. The Chairman suggested that perhaps it was a matter of terminology and the Board may be more comfortable with the term „stretched target‟. Dr Newbold reminded the Board that the Trust commences each year with an activity assumption that always turns out to be erroneous and a proportion of the CIP is around closing capacity based on a reduction in demand that never happens. Mr Harris added that he was in favour of setting stretched targets but if we are not quite achieving the targets some appreciation of the reasons were required. Lord Hunt advised that Mr Harris was due to chair a Suppliers Conference for the companies that supply goods and services to the Trust to get across the message that their help is essential in meeting efficiencies.
The Chairman asked about the Key Performance Indicators and the red ratings around A&E. The A&E unplanned re-attendance rate of less than 5% was a stretched target set by the Department of Health with the majority of re- attendances actually being around alcohol and drugs rather than clinical decisions, as the target was aimed to measure. The time to initial assessment is an indication of how quickly we process patients. Dr Newbold believed that the target to take the most assurance from was the time to treatment which had been consistently on track despite attendance pressures.
12.020.2 Iproc Requisitions for approval
There were six iproc requisition presented for approval:
• 669585 Synergy Health for general and surgical linen for the Good Hope site.
• 670225 University of Birmingham for SLA post associated with Medical
Education.
• 669843 Sandwell and West Birmingham Hospitals NHS Trust for
Neurophysiology provision for Birmingham Heartlands, Good Hope and Solihull hospitals.
• 671413 South Staffordshire Water for the provision of water services to Good
Hope Hospital.
• 671450 Severn Trent Water Ltd for the provision of water services to Solihull
Hospital.
• 671424 Severn Trent Water Ltd for the provision of water services to
Birmingham Heartlands Hospital
The Board approved the above requisitions.
12.020.3 Update on Business Plan, Budgets and Monitor Annual Plan
Mr Stokes gave an update on the work being undertaken in preparation for the
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AGENDA
Apologies
.01
Declaration
of interest
.02
Minutes
from
previous
meeting
.03
Matters
Arising
.04
Chairmans
report
.05
Chief
Executives
report
.06
Quality and
Performance
Monitoring
.07
Board
Committee
Reports
.08
Trust News
and External
Environment
.09
Governing
Body and
Membership
.10
Any Other
Business
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Minutes from previous meeting - 6th March 2012
May 2012
budgets, Business Plan and ultimately the submission of the Annual Plan to Monitor. Discussions have been undertaken with key stakeholders and the Trust is in a good position in respect to tariff and contract agreements. Work around the costs associated with inflation is on track. The Trust has undertaken Confirm and Challenge events for next year‟s CIP targets which have been discussed on a regular basis at Finance & Performance Committee. The Chairman reminded the Board of the need to be assured of the balance between safety, quality and efficiencies. There is still some work to be done on the details of how the Capital allocation will be spent with decisions around ACAD and Reshaping HEFT still to be agreed. Budget setting has been discussed in detail at Finance & Performance Committee and a paper is to be presented to the next meeting of the EMB. The narrative around the Business Plan including the corporate priorities and Reshaping HEFT is underway and meetings are being held with all directorates to agree budgets. Overall, Mr Stokes was content with the work undertaken to date and was confident that plans were within the required timescales. Mr Stokes added that Finance and Performance Committee would be going through the numbers in detail at next meeting prior to submission to the May meeting of the Board of Directors for approval.
12.020.4 Corporate Strategic Goals
Mr Hackwell presented a summary of his pre-circulated paper. The report is an update against progress on the sixteen priorities set 12 months ago in defining vision and strategy. Overall good progress has been made. Many of the priorities are by nature on-going aspirations rather than short term task and finish projects and are likely to require three or more years to achieve a paradigm shift. Some areas require further thought by the Executive Team and the Board because they represent a new direction of travel and it is important that continued focus and attention is given to deliver against these in the day to day busy operational, financial and regulatory running of the Trust. Meetings have been held with colleagues to better understand where progress has been made. The Board is asked to identify those areas needing further consideration and how it would like to monitor. The Chairman added it was a question of how the Board secures assurance on the way in which priorities are implemented.
Mr Harris appreciated the amount of work that is underway but would like clarity on the timescales involved for some of the projects and an understanding of the financial costs and returns against respective projects.
Mrs East considered these to be strategy objectives and felt the Board should be spending time strategising in order understand what they mean without getting drawn in to the operational issues. Strategy days were set to pull these together and spending time following these through was very important in reshaping the organisation. The Chairman would consider how best for the Board to receive updates and monitor progress.
Mr Samuda was in agreement and suggested quarterly or half yearly meetings to discuss, understand and put the 16 priorities into context including being able to measure against timelines and some performance criteria defined in order to be able to track progress.
Mr Samuda raised a specific point in relation to the staff engagement target of 5% improvement, which did not seem to be a huge step forwards and was there a specific staff turnover target in relation to the NHS environment? Dr Newbold
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AGENDA
Apologies
.01
Declaration
of interest
.02
Minutes
from
previous
meeting
.03
Matters
Arising
.04
Chairmans
report
.05
Chief
Executives
report
.06
Quality and
Performance
Monitoring
.07
Board
Committee
Reports
.08
Trust News
and External
Environment
.09
Governing
Body and
Membership
.10
Any Other
Business
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Minutes from previous meeting - 6th March 2012
May 2012
responded that historically staff turnover was 6% but this may reflect the economic situation rather than the engagement level. One option would be to timetable these into the Board Strategy sessions and invite the group clinical directors to meetings to aid the discussion including progress and measures. Mr Samuda asked about hitting targets for appraisals and would like to think that the staff getting good appraisals are not the staff leaving. Mr Stokes responded that the Trust tracks voluntary staff turnover but does not directly relate them to the appraisal quality of the staff leaving.
Ms Sunderland added that she welcomed a certain amount of turnover as it gives the organisation an opportunity to import fresh ideas and new staff, as well as our staff being promoted to other roles; so some staff turnover is healthy.
Mr Hackwell added that the Board needed to take a collective view of these priorities to understand and define parameters.
Mrs East reflected that the conversation had taken a more operational direction and illustrated how important it was that the priorities needed more definition in order to focus on the strategic objectives and not to fall into operational detail.
Mr Harris remarked that following on from Mrs East‟s comments the Board needed some assurance that some of these objectives does not cut across functional priorities and drivers. Mr Hackwell commented that these had been considered as part of the annual Business Plan.
The Board was supportive of the corporate priorities and asked for an updated report to be bought back to a future meeting including a review of the objectives to ensure that they are strategic rather than operational so that the Board can decide how best to monitor them.
12.020.5 Reshaping HEFT
Mr Hackwell presented a summary of his pre-circulated paper. The Reshaping HEFT document is to be used as a key piece of communication as the Trust begins to deliver its programme to stakeholders both internally and externally. A programme office is being established to oversee the implementation of the portfolio of projects contained within the Strategy. The first step is to develop project documentation for each project and set out timescales and resources against each project. Work has already commenced in some areas (e.g. a review of stroke facilities) but in most areas the work will commence on April. The document has been presented to the Council of Governors Finance and Strategy Committee which reviewed the document in details and is being presented to the Council of Governors meeting on 14 March 2012 for consideration and final sign off.
Mr Hensel complimented Mr Hackwell on an excellent document that sets out clear strategic goals and asked what the level of clinical engagement has been? Mr Hackwell responded that all the projects had come out of the workshops that had been held at the end of 2011, all projects having a clinical lead and team to lead the work.
The Chairman asked if our key stakeholders had received copies of this strategy and Mr Hackwell confirmed that they had. Ms Hafeez asked if they had been given the chance to feedback their comments? Mr Hackwell responded that feedback
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AGENDA
Apologies
.01
Declaration
of interest
.02
Minutes
from
previous
meeting
.03
Matters
Arising
.04
Chairmans
report
.05
Chief
Executives
report
.06
Quality and
Performance
Monitoring
.07
Board
Committee
Reports
.08
Trust News
and External
Environment
.09
Governing
Body and
Membership
.10
Any Other
Business
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Minutes from previous meeting - 6th March 2012
May 2012
and comments have been invited and this was now to be extended to all stakeholders when the document was more widely circulated. Dr Newbold added that there has been a wide degree of involvement and congruence with commissioners and work groups. Ms Hafeez was pleased to hear that our stakeholders have been involved as their support and involvement was key and asked what mechanisms and support are in place to manage the work-streams? Mr Hackwell advised that the project will be run as a formal project management project with regular progress report being presented to EMB and then to the Board.
Mr Harris asked what mechanisms were in place to support and help clinicians deliver these change-management programmes as change-management is not generally part of the natural skill base of NHS staff? Clearly some of the projects will come at a cost and he asked for assurance that assessments have been made of these costs in next year‟s budgets and if these new patient pathways will be cost effective? Mr Stokes responded that the financial viability of each project will be looked at; however, all currently looked viable and in line with new contracts, adding that the CoG Finance & Strategy Committee had also raised the same point. There was some concern around stroke and elective care at Solihull and these would be monitored carefully.
Dr Woolley added that the Reshaping HEFT programme was the biggest single risk for the Trust due to the transformational challenges together with the huge amount of work involved to deliver the programme, and as such, was included on the Assurance Framework and Strategic Risk Register. The organisation needs to have high calibre support to ensure that this is a successful programme. The Chairman added his concerns around the use of a „virtual programme office‟ and the need to ensure that the programme was not using people already in post and undertaking other roles in order to manage these projects as they may not have the spare capacity in their current roles. The Chairman also asked for consideration of the possible transport issues for patients (e.g. stroke redesign) to ensure that any potential travel issues for patients will have been considered and made as easy as possible.
Ms Moore added that she would like to see more transparent links to the values of the Trust and to see that Commissioners, especially around South Staffs and North Birmingham, are engaged and have recognised and signed these off.
Mr Hackwell responded that he was very aware that the projects identified were at a very high and inspirational level, there is a programme manager in place who is looking at defining the work in more detail including measurement metrics and capacity required and once this work has been undertaken a report will be presented. In response to Ms Moore‟s point on engagement, the Trust is looking to set up GP forums around the Good Hope and Heartlands sites, as these are key to moving forward.
Lord Hunt asked about the implications for patients and public attending outpatient appointments and needing to travel to other sites as a consequences of transforming services. Mr Hackwell responded that as part of the defining of the projects patient stories will be taken on board, considered and noted. Dr Newbold added that there was not a lot of general elective surgery moving to different sites.
The Board supported the strategy but was concerned about project management capacity. It was agreed to report back progress three times per year with individual projects coming to the board as and when required.
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AGENDA
Apologies
.01
Declaration
of interest
.02
Minutes
from
previous
meeting
.03
Matters
Arising
.04
Chairmans
report
.05
Chief
Executives
report
.06
Quality and
Performance
Monitoring
.07
Board
Committee
Reports
.08
Trust News
and External
Environment
.09
Governing
Body and
Membership
.10
Any Other
Business
.11
.01
.03
Minutes from previous meeting - 6th March 2012
May 2012
12.020.6 Infection Control Update Report
Ms Sunderland presented a summary of the pre-circulated paper.
There have been no cases of MRSA in quarter 3 and we are on target to achieve a Monitor green risk rating. There have been 250 clear days since the last case of MRSA bacteraemia.
There has been a significant reduction in the number of toxin positive CDiff cases since January 2012; this follows on from the introduction of the new dual test in September 2011 and we are now on target to achieve a Monitor green risk rating. The Department of Health has issued new guidance standards for CDiff testing and these will come in to effect from 1 April 2012 whereby all trusts will be testing and counting cases in the same way.
The Board recognised the progress made and work that had been undertaken to achieve this position.
12.020.7 Update on Norovirus
Ms Sunderland gave a verbal update on Norovirus. This year, outbreaks have been managed with minimal disruption. Following a request at the last board meeting, a new scorecard has been included to look at infection prevention controls and this will continue to be developed.
Dr Newbold recognised the excellent infection control reports and the progress made in achieving these results and particularly recognised the work that Dr Gupta has undertaken with dual testing for toxin positive CDiff
Mr Harris referred to the MRSA graph and asked if it was measuring correctly as the numbers were so out of line with historic trends. Ms Sunderland confirmed the numbers were correct. There has definitely been a real reduction in the numbers. Dr Newbold added that he had met with Dr Gupta, and challenged her about the same topic and was reassured as to their accuracy.
The Board acknowledged the huge amount of work undertaken by Dr Gupta and the infection control team.
12.020.8 Nursing and Midwifery update
Ms Sunderland presented a verbal update on nursing and midwifery and the following key items were noted:
• VITAL- fourteen areas of fundamental care are tested. Last year all of our adult
registered nurses had the opportunity to take part. Nurses can access in the trust or at home with over 52% of nurses completing the modules at home. 1,350 adult nurses have achieved 100% of their VITAL testing which is more than 1/3 or all nurses in the Trust. There is centralised data for all nurses reporting against CQUINS: HIA / MHSLA. Over 1,700,000 questions have been answered since VITAL was launched. Several requests to buy VITAL have been received
• HEFT Nursing Badge has arrived and the process to apply for a badge has been launched. In order to receive a badge, nurses have to complete an on-
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AGENDA
Apologies
.01
Declaration
of interest
.02
Minutes
from
previous
meeting
.03
Matters
Arising
.04
Chairmans
report
.05
Chief
Executives
report
.06
Quality and
Performance
Monitoring
.07
Board
Committee
Reports
.08
Trust News
and External
Environment
.09
Governing
Body and
Membership
.10
Any Other
Business
.11
.01
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Minutes from previous meeting - 6th March 2012
May 2012
line form with criteria including getting 100% in all their VITAL scores. The first presentation and celebration event is planned for May/June 2012.
• iSkills – The Faculty of Education and Corporate Nursing has received regional
funding of £70,000 to help develop these podcasts having worked together to create 17 clinical skills podcasts that can be accessed via the trust intranet site. These podcasts create opportunities for staff in all roles and settings to review skills and techniques that are relevant to delivering high quality care.
The Chairman thanked Ms Sunderland for her update.
12.020.9 Board Assurance Framework
Dr Woolley presented a summary of her pre-circulated report. The Strategic Risk Register has been reviewed with each Executive Director and then presented to Executive Management Board for further review and is now presented to the Board for endorsement. Three of the four risks have been downgraded to amber. The Reshaping HEFT work is rated red due to the work still to be undertaken and reassurance is required around the implementation of the programme.
Lord Hunt asked why the impact of the NHS Reforms are not on the risk register? Dr Woolley responded that although it is a huge amount of change there was not thought to be a massive impact on the organisation at the moment. Mr Hensel presumed that there was not much the Trust could do in terms of mitigation and if a risk was on the register then there needed to be some action that could be taken to mitigate that risk. However the Chairman asked that this be referred back for further consideration as he firmly believed that the NHS Reforms should be on the Risk Register.
The Chairman went on to ask about the potential risk that the CCGs will not sign up to the contracts but Mr Stokes advised that these had already been agreed.
Mrs East‟s view was that the risk register should contain only specific risks rather than global risks as specific risks could be mitigated and monitored.
Dr Newbold added that these should be risks to stop the organisation hitting its strategic objectives.
The Chairman asked if the register could be more explicit about risks. Dr Woolley will undertake a review and articulate and define risks that continue to be an issue for the Board and how these can be mitigated.
The Chairman advised that following the publication of the Francis enquiry report in June 2012 he would like a board session to discuss the implications for the organisation.
12.020.10 Safety Sitrep
Dr Woolley presented a summary of the pre-circulated Safety Sitrep report. There are currently three red risks: the security system on paediatric ward, Grasby pumps and manual handling. There is a new risk around the GP Assessment area in the AMU at Good Hope Hospital that relates to capacity and flow. Operations Committee have a plan and will be monitoring progress on these risks.
Dr Woolley advised that there had been one new Never Event incident in maternity .12
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AGENDA
Apologies
.01
Declaration
of interest
.02
Minutes
from
previous
meeting
.03
Matters
Arising
.04
Chairmans
report
.05
Chief
Executives
report
.06
Quality and
Performance
Monitoring
.07
Board
Committee
Reports
.08
Trust News
and External
Environment
.09
Governing
Body and
Membership
.10
Any Other
Business
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Minutes from previous meeting - 6th March 2012
May 2012
and the investigation outcomes will come back to the Board in due course.
HEFT has achieved Level 2 in the NHSLA risk management standards assessment for acute services. This is a positive recognition of the safety arrangements in place. Ms Molloy asked how this related to community services? Dr Woolley advised that the organisation will need to be assessed within 2 years of integration of community services.
The Chairman asked about the close down report for laprascopic surgery and whether there were some wider lessons around supervision. Dr Woolley advised that these had been picked up and some related to the type of procedures in which new surgeons are trained. Laproscopic procedures form the majority of surgery undertaken compared to open surgery with the consequence that there are very few surgeons who are skilled to undertaken open surgery which is leading to a national skills shortage.
12.020.11 T&O Update Report
Dr Anwar presented a summary of his pre-circulated report. The report gives assurance following a number of concerns that had been highlighted through routine deanery visits. An external independent review of services has been undertaken. The department has been fully engaged in a programme to address issues highlighted and an action plan and balance scorecards have now been produced in order to track and monitor progress. Details on progress has been presented and continues to be presented and monitored through Finance and Performance Committee.
Mrs East enquired if, following the actions taken, there was a sustained management force in T&O that could continue with the improvements and would take ownership of governance and risk issues? Dr Anwar confirmed that the consultant body was fully engaged and there is a framework in place for measuring quality and engagement and the assurance framework to deliver quality was a good indication that improvements will continue to be seen. Mrs East believed that it was essential to ensure that improvements continue and progress reports will be ongoing to Governance and Risk Committee. Dr Anwar advised that T&O were providing assurance to Finance & Performance Committee on productivity and performance and they will keep this under scrutiny and added that credit should be given to the clinician and nursing staff who are dealing head on with this challenge.
Dr Woolley added that, historically, she had shared Mrs East‟s concerns; however, she wanted to give the board a level of assurance on its ability to deliver on the action plans and workstreams that were in place.
The Chairman congratulated the T&O team on progress made to date and was very encouraged that improvements will be seen and the Board will continue to periodically monitor.
12.020.12 HR Quarterly Update Report
Consideration of this report was deferred to the next meeting.
12.020.13 Ambulatory Care & Diagnostic Project (ACAD)
Mr Sellars presented a summary of the pre-circulated report. The paper set out
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AGENDA
Apologies
.01
Declaration
of interest
.02
Minutes
from
previous
meeting
.03
Matters
Arising
.04
Chairmans
report
.05
Chief
Executives
report
.06
Quality and
Performance
Monitoring
.07
Board
Committee
Reports
.08
Trust News
and External
Environment
.09
Governing
Body and
Membership
.10
Any Other
Business
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Minutes from previous meeting - 6th March 2012
May 2012
the key changes in circumstances that have resulted in the proposal to cancel the ACAD building project. The Board has previously discussed the already approved ACAD building project and the current Reshaping strategic redesign work in the context of the new financial climate.
The Chairman asked for consideration to be given to the current outpatient facilitates and to undertake a programme of improvements. Mr Sellars confirmed that a programme of work was underway.
The Board agreed to cancel the proposed ACAD works.
12.020.14 Contract Arrangements
Mr Stokes presented a summary of the pre-circulated report. The paper set out the benefits and risks of moving away from a cost and volume contract to a jointly managed risk agreement (JMRA) for 2012/13. The JMRA will set a financial envelope for 2012/13 based on 2011/12 outturn plus funding for an agreed level of growth. The key benefits and risks of agreeing a financial envelope are:
• HEFT will receive upfront funding for growth
• HEFT is incentivised to manage demand
• The financial risk of not achieving KPI targets will be contained.
• The key risk is that funding allows for 3% growth and although there has been
a flat growth during last year and there are internal and external initiatives to contain growth further, the risk remains.
There was been a huge amount of work undertaken with the clusters, CCG and Governors to gain buy in for this type of contract. It will create a culture shift in the organisation where the incentive is to reduce activity and start to manage an organisation with flat cash in the medium term. Payment by results will continue to act with the same disciplines including tracking a full set of performance KPI‟s and CQUINs. A review will be undertaken in the contract approach at month 6 and a progress report will be bought back to the Board.
The Chairman asked about communicating with our clinicians in order for them to better understand the differences in the contracts. Mr Stokes advised that there is a detailed communication plan including meetings with clinicians to go through the contracts and also involving directorate action plans. Dr Newbold stressed the linkage between the different elements of work and that clinicians are generally supportive. The Reshaping HEFT work is also aligned to these contract arrangements.
The proposal better aligns with the clinical requirements of patients.
Ms Molloy asked for clarity of what is being put in to place in terms of accountability, governance and communication around managing the internal system needs and what mechanisms are in place across the health economy to agree what the Trust will be undertaking collaboratively? Dr Anwar advised that there are meetings in place with CCG Boards, Planned Care Boards and the Integrated Pathway Programme Boards to monitor and develop the systems, which appear to have solid foundations around collaboration. The Risk Pool will also be monitoring performance and HEFT will be subject to penalties if quality or performance slips. There is also an imperative for commissioners to support what has been agreed in order to protect HEFT if demand rises.
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AGENDA
Apologies
.01
Declaration
of interest
.02
Minutes
from
previous
meeting
.03
Matters
Arising
.04
Chairmans
report
.05
Chief
Executives
report
.06
Quality and
Performance
Monitoring
.07
Board
Committee
Reports
.08
Trust News
and External
Environment
.09
Governing
Body and
Membership
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Any Other
Business
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Minutes from previous meeting - 6th March 2012
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Mr Hensel asked about the risk related to growth and if HEFT is sharing this risk with the commissioners in a formalised way and what are the arrangements around growth? Mr Stokes advised that for growth up to 2% the risk is carried by PCT, up to 3% is shared jointly and above 3% is carried by HEFT. He added that there are rules in tariff that would mean that it would be very hard to earn much above 3%.
The Chairman added that overall the new contracts were beneficial from a patient perspective but there were risks associated with the changes and these would need to be monitored closely by Finance & Performance Committee and EMB.
The Board approved the new contract arrangements.
12.021 REPORTS FROM BOARD COMMITTEES
12.021.1 Donated Funds Committee Report
Mr Hensel advised that the Committee had met on 23 January 2012 and the main items of discussion were:
• It was noted that the tender process to obtain external independent
investment advice had not been successful and the Company Secretary had been asked to pursue alternative avenues to secure this advice.
• The Committee had received an Internal Audit Report from KPMG which gave
„significant assurance‟ with only minor changes to process being needed.
• It had been noted that the year to date fall in the value of investments and the
excess of expenditure over income resulted in a total reduction in funds of £598k as at the end of November 2011.
• The Committee had agreed to deposit £1m with Co-op Bank in order to
improve the return on liquid assets.
• The Committee had considered and approved the draft budget for 2012/13.
• It had reviewed the Standing Financial Instructions applicable to Donated
Funds.
• The committee had also reviewed in detail the Fundraising Policy.
• It had noted that the majority of fundraising projects are currently in line with
expectations.
12.021.2 Finance & Performance Committee Report
Mr Harris, Chair of the Finance and Performance Committee, gave an update of the key points discussed at the recent meeting.
• The new Jointly Managed Risk Agreement contract arrangement was
discussed in detail and the Committee will be monitoring the risks and financial progress on a monthly basis to ensure that the effect of this would not undermine the quality agenda.
• 2012/13 is going to be demanding year with challenging cost improvement plans and assumptions made about productive and pay controls.
• It will be very important to get assurances that there will be real responsibility
and acceptance at clinical level around control of costs in order to manage budgets.
• Procurement continues to be very important and procurement objectives that
factor into next years budget will be reviewed.
• Discussions were held around 18 weeks, A&E and infection control issues.
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AGENDA
Apologies
.01
Declaration
of interest
.02
Minutes
from
previous
meeting
.03
Matters
Arising
.04
Chairmans
report
.05
Chief
Executives
report
.06
Quality and
Performance
Monitoring
.07
Board
Committee
Reports
.08
Trust News
and External
Environment
.09
Governing
Body and
Membership
.10
Any Other
Business
.11
.01
.03
Minutes from previous meeting - 6th March 2012
May 2012
18 weeks is seen as an area of extreme importance and a plan is in place to reduce the number of patients waiting.
• The Committee will be looking in detail at capital spending and the process for approval and implementation particularly of smaller and frontline pieces of equipment and will report back on progress.
12.021.3 Finance & Performance Committee Minutes
The draft minutes from the meeting held on 30 January 2012 were noted.
12.021.4 Governance and Risk Committee Report
Mrs East, Chair of Governance and Risk Committee, updated the Board on the meeting held on 13 February 2012:
• The committee is to change the way in which it operates to ensure it functions
at the right level and will come to the Board for agreement. A dashboard is being compiled and will be presented to the Board for discussion.
• The Committee is seeing some developing trends from the Patient Experience Report and reviewing how these translate into clinical areas.
• The quarterly CQC meetings have gone well and they are pleased with how the Trust is proceeding.
12.021.5 HR Strategic Committee Report
Lord Hunt deferred this report to the next meeting.
12.021.6 HR Strategic Committee Minutes
The minutes from the meeting held on 9 January 2012 were noted.
12.021.7 IM&T Committee
Mr Hensel, Chair, advised that the IM&T Committee had met on 10 February 2012 and had discussed:
• The capital spend available and agreed that £1m will be made available for projects identified by the Clinical IT Group.
• Electronic Patient Records and the implementation of Concerto Clinical integration tool which has a proposed live operational date of 1 April 2012.
• The Ward pilot projects and underlined the importance of progressing these.
• The status of medical records scanning and received a presentation of an improved facility for viewing these.
• E-prescribing system and noted the emphasis being placed on the requirement for a viable solution.
• Solihull community work and GP liaison work.
• Work to provide inpatient functionality being designed to replace HISS.
• Implementation of „patient at glance‟ screens that are being provided across the Trust and the possibility of using these to provide patient alerts.
Lord Hunt raised a point that had been raised with him during a recent patient safety visit to Theatres at Solihull around nursing staff who do not have access to any electronic notifications and it had been suggested that screens with notifications displays be provided.
.16
.25
AGENDA
Apologies
.01
Declaration
of interest
.02
Minutes
from
previous
meeting
.03
Matters
Arising
.04
Chairmans
report
.05
Chief
Executives
report
.06
Quality and
Performance
Monitoring
.07
Board
Committee
Reports
.08
Trust News
and External
Environment
.09
Governing
Body and
Membership
.10
Any Other
Business
.11
.01
.03
Minutes from previous meeting - 6th March 2012
May 2012
The Chairman requested an update on Concerto post implementation.
12.021.8 IM&T Committee Minutes
The minutes from the meeting held on 10 February 2012 were noted.
12.021.9 Monitor Standing Committee Minutes
The minutes from the meeting held on 30 January 2012 were noted.
12.022 TRUST NEW AND EXTERNAL ENVIRONMENT
12.022.1 News update
Mrs Thomson presented a summary of her written report which sets out the high
level of activity in the external environment. There had been 92 pieces of positive
media coverage. The Trust is holding a month long „tweetathon‟ on the paediatric
department to engage and get feedback from young people.
The Chairman was pleased to see the rise in the amount of positive news stories
the Trust was receiving.
12.022.2 Patient Experience Update
Mrs Thomson presented the patient experience report, as circulated, drawing the
Board‟s attention to the following:
• 98% of inpatient ward areas were surveyed in January 2012.
• All of the CQUIN targets were met in January 2012.
• There has been an improvement in the majority of A&E measures.
• The results from the outpatient demographics survey are now available and
work is being undertaken to analyse by speciality as well as overall around how patients are rating their outpatient experience.
• The Trust is now working with the Patient Association and patient opinion to
work smarter and how we use them to engage with our patient‟s population.
The Chairman asked about the red flags around discharge and asked for a
discussion to be held at the next meeting. Mrs Thomson will bring a report back.
The Chairman was pleased to see that the Trust continues to maintain its position in the NHS Choices recommender index and acknowledged the work that is underway to increase the volume of patient feedback. The Chairman asked why
the numbers were so low for Solihull? Mrs Thomson responded that the numbers for Solihull were very small, work is underway with the patient information centre and she is working with the clinical teams to encourage patients to feedback responses. Dr Newbold advised he will be including patient feedback in his team briefs with a comment about what patients are saying.
12.023 COUNCIL OF GOVERNORS AND MEMBERSHIP
.17
.26
AGENDA
Apologies
.01
Declaration
of interest
.02
Minutes
from
previous
meeting
.03
Matters
Arising
.04
Chairmans
report
.05
Chief
Executives
report
.06
Quality and
Performance
Monitoring
.07
Board
Committee
Reports
.08
Trust News
and External
Environment
.09
Governing
Body and
Membership
.10
Any Other
Business
.11
.01
.03
Minutes from previous meeting - 6th March 2012
May 2012
The Council of Governors met on 16 January 2012;
• It was agreed that an update on the Outpatient Booking system would come
to a future meeting.
• The Council had received an update on the debt due from Birmingham City
Council.
• The Council had received a site strategy update presentation.
• Update reports from the various Council of Governor Committee meetings
that had met during the preceding two months were received.
The Chairman thanked the Executive Directors for the work they are undertaking
with the Council of Governor Committees.
12.024 CORPORATE GOVERNANCE
12.024.1 Schedule of Matters Reserved for the Board
The schedule had been updated to reflect the discussions at the last meeting and
the Board agreed the new document.
12.024.2 Monitor Standing Committee Membership
It was agreed to add to the Committee Membership
• Richard Harris in his capacity as Chair of the Board‟s Finance & Performance
Committee
• Director of Safety & Governance
12.025 ANY OTHER BUSINESS
There was none.
12.026 DATE OF FUTURE MEETING
1 May 2012
....................................... Chairman
.18
.27
AGENDA
Apologies
.01
Declaration
of interest
.02
Minutes
from
previous
meeting
.03
Matters
Arising
.04
Chairmans
report
.05
Chief
Executives
report
.06
Quality and
Performance
Monitoring
.07
Board
Committee
Reports
.08
Trust News
and External
Environment
.09
Governing
Body and
Membership
.10
Any Other
Business
.11
.01
.03
May 2012
Matters Arising
.04
AGENDA
Apologies
.01
Declaration
of interest
.02
Minutes
from
previous
meeting
.03
Matters
Arising
.04
Chairmans
report
.05
Chief
Executives
report
.06
Quality and
Performance
Monitoring
.07
Board
Committee
Reports
.08
Trust News
and External
Environment
.09
Governing
Body and
Membership
.10
Any Other
Business
.11
.01
.03
Matters Arising
May 2012
BOARD OF DIRECTORS Schedule of Matters Brought Forward and Action Points
Date raised
Minute No
Detail
Action
Due
Status
Completed
5 July 2011
11.98.11
Harrop Inquest Respond to Coroners letter when received Brief Governors
MN PH
No letter yet received
8 Nov 2011
11.122 (11.111.14)
Update on NED involvement in Consultant interviews
AA
11.124
Report on Clinical changes
MN
11.126.6
Number of Staff receiving flu vaccine
MS
1/5/12
To be covered in matters arising
11.127.3
Update on Complaint numbers and processes
LT
The Chairman has written to Ombudsman
3 Jan 2012
12.007.9
Update on Two Red risks
SW
12.007.9
Paper on prioritisation of capital spend and the arbitration mechanism to deal with boundary issues.
SW
12.009.2
Explore link between performance, staff morale and patient experiences feedback.
HG
1/5/12
6 Mar 2012
12.020.1
Detailed report to show real improvements in A&E 4 hours wait position
AS
1/5/12
12.020.1
Update report on CIP Progress
AS
1/5/12
On agenda
12.020.4
Update on Corporate Strategic Goals
SH
1/5/12
On agenda
12.020.9
Make SRR more explicit and more clearly define what can be mitigated
SW
12.020.9
Board Strategy session to consider implications of Francis report on Mid- Staffs
PH
12.020.14
Update report on new contract arrangements
AS
Nov 2012
12.022.2
Update report on „red flags‟ around delays in discharge
LT
1/5/12
.1
.29
AGENDA
Apologies
.01
Declaration
of interest
.02
Minutes
from
previous
meeting
.03
Matters
Arising
.04
Chairmans
report
.05
Chief
Executives
report
.06
Quality and
Performance
Monitoring
.07
Board
Committee
Reports
.08
Trust News
and External
Environment
.09
Governing
Body and
Membership
.10
Any Other
Business
.11
.01
.03
May 2012
Chairmans report
Update Report (ENCLOSURE)
.05
AGENDA
Apologies
.01
Declaration
of interest
.02
Minutes
from
previous
meeting
.03
Matters
Arising
.04
Chairmans
report
.05
Chief
Executives
report
.06
Quality and
Performance
Monitoring
.07
Board
Committee
Reports
.08
Trust News
and External
Environment
.09
Governing
Body and
Membership
.10
Any Other
Business
.11
.01
.03
Chariman's Report
May 2012
Chairman’s Report - Update to Board of Directors May 2012
I wanted to start my report by welcoming our new non executive director colleagues.
Mr Les Lawrence, Non-Executive Director
Les is Cabinet Member for Children’s, Young People and Family at Birmingham City Council, a post he has held since 2004. He has previously chaired the Royal Orthopaedic Hospital NHS Foundation Trust and the Alexandra Hospital (Redditch). He has substantial NHS and local government experience.
Prof Edward Peck, Non-Executive Director
Edward is a Pro-Vice Chancellor Head of College of Social Science at the University of Birmingham. Edward joined UoB as Director of the Health Services Management Centre, one of the leading centres for research, teaching and consultancy in health policy and practice in the UK. His work in health and social care policy making has included membership of the steering group of the Department of Health’s Integrated Care Network.
Prof Laura Serrant-Green, Non-Executive Director
Laura is Director of Research and Enterprise/Professor of Community & Public Health Nursing at the School of Wellbeing at the University of Wolverhampton. She has worked at a very senior level in both nursing and teaching with particular emphasis around marginalised and hard to reach populations in health and social care. Laura has also worked for the Department of Health, most recently as a member of the Prime Minister’s Commission on the future of nursing and midwifery.
As a result of these appointments, I am proposing the following changes to our Board Committees:
Philip Hunt – I will now be the non executive lead at the Board representing volunteering.
Richard Harris – will now Chair Audit Committee and come off Finance & Performance Committee, HR and Monitor Review. Richard will also now be a member of Governance & Risk Committee and the Stakeholder Committee.
Les Lawrence – will chair Finance & Performance Committee and also join IM&T Committee and Monitor Review.
Laura Serrant-Green - will join Governance & Risk Committee and the HR Committee.
Edward Peck – will join Finance & Performance Committee and the Stakeholder Committee.
Safety, Quality and the Cost Improvements Programme
I, along with many of my NED colleagues, continue to attend the programme of safety walk rounds. I recently attended two safety visits, one to Ward 24 (ECAU) and the other to Ward 16 at Good Hope Hospital. These provide an opportunity to discuss and debate where we can improve the safety for our patients and I remain very impressed with the level of engagement of staff at all levels in making our hospitals as safe as possible for our patients.
.1
.31
AGENDA
Apologies
.01
Declaration
of interest
.02
Minutes
from
previous
meeting
.03
Matters
Arising
.04
Chairmans
report
.05
Chief
Executives
report
.06
Quality and
Performance
Monitoring
.07
Board
Committee
Reports
.08
Trust News
and External
Environment
.09
Governing
Body and
Membership
.10
Any Other
Business
.11
.01
.03
Chariman's Report
May 2012
Visits/Meetings
Since the last Board meeting I have continued to go out and about internally and externally and these visits have included:
Sir Roy Griffiths Public Lecture – I attended and took part in the Sir Roy Griffiths Public Lecture at Keele University giving a presentation on The NHS at 64. Dr Mark Newbold also attended this and we took the opportunity to review both how far we have come and the challenges ahead and to explore further links with the university.
Jenni Ord – I met with Jenni Ord as part of my regular catch up meetings with Chair of the Cluster. This was a good meeting where we reaffirmed our commitment to joint working and the Concordat we proposed at our joint Board to Board meeting back in November.
Bishop David Urquhart – I have a meeting with Bishop David Urquhart and had an opportunity to discuss chaplaincy functions and how trusts can work better to improve the services we provide to our patients. I also took the opportunity of discussing our proposals for fundraising and invited him to become part of our Presidents Club.
Inaugural Meeting for the Provider Chairs for West Midlands –I attended a good meeting of chairs and with officers on the NHS Commissioning Board.
Justin McCraken, CEO of the Health Protection Agency - I have also met with Justin McKraken, Head of HPA and it was a very friendly meeting. They are very keen for a City wide strategy signed up to by stakeholders. I stressed importance of us being round the table.
Trust Supplier Conference – I was invited to attend and take part in a HEFT Trust Supplier Conference. This was extremely well attended by our suppliers and provided an opportunity to share the challenges facing the NHS in terms of the need to drive efficiencies as well as the wider environmental challenge. It was clear that our suppliers are keen to work with us an support us as we develop and shape our services going forward.
Hyper-acute stroke service review engagement day at Blakesley Hall,Yardley - Along with some of my non-executive colleagues, executive colleagues and Governors I attended a hyper-acute stroke service review at which Prof Matthew Cooke presented his initial findings following a review of the new standards and the options for the Trust to improve care for stroke patients. As you are aware Professor Matthew Cooke has commenced a review of the hyper acute stroke service. In order to ensure wider participation in the review this stakeholder day was held where Matthew presented his findings to date and it enabled further discussions to take place.
Nishkam Centre, Handsworth, Birmingham - I had a very successful visit to the Nishkam Centre where we looked at the work undertaken on the health and explored how this can be further enhanced via collaboration and networking. Lisa Thomson and the team will be working alongside the Association supporting their community health activities, encouraging people to become involved in their local hospital.
Long Service Awards
One of the highlights of the month for me was attending the Trust’s Long Service Awards presentation. Each year we celebrate those staff who have worked for the organisation for 25 years and over. A group of 12 staff from the Hospital attended the ceremony and received awards for their longstanding dedication.
.2
.32
AGENDA
Apologies
.01
Declaration
of interest
.02
Minutes
from
previous
meeting
.03
Matters
Arising
.04
Chairmans
report
.05
Chief
Executives
report
.06
Quality and
Performance
Monitoring
.07
Board
Committee
Reports
.08
Trust News
and External
Environment
.09
Governing
Body and
Membership
.10
Any Other
Business
.11
.01
.03
Chariman's Report
Governors
May 2012
The Governors’ working groups are continuing and they are getting involved in Trust activities supporting improvements and patient experience. These groups are now reporting to the Council and we were given
an update on their work at our Council of Governors meeting on the 14th March.
The Governors and Board held a very interesting joint meeting on the 23rd March. We had presentations from The Boston Consulting Group who gave an overview of key healthcare trends over the next 5/10 years, followed by a presentation on the Trust’s priorities from Dr Mark Newbold. Sharon Lamb and Janice Smith from Capsticks Solicitors discussed the Health and Social Care Bill (which is nearing the end of its passage through Parliament) with particular reference to the implications to the responsibilities affecting both Governors and Directors. The debate particular around governance issues raised by Capsticks highlighted the need for further work and we will be continuing this over the coming months. This forum proved very successful and will be something we will schedule in over the coming year.
We had a very lively Breakfast Meeting with Steve Taylor where we discussed at length the HIV Service. This is a very strong service doing a great deal of initiative work in the community to raise awareness. We agreed that following this meeting we would like to
The very successful and engaging visit to the Chest Clinic (pictured below) has been followed by Governors visiting the Renal services we provide in community settings.
Following are some of Governors with staff at the Chest Clinic.
.3
.33
AGENDA
Apologies
.01
Declaration
of interest
.02
Minutes
from
previous
meeting
.03
Matters
Arising
.04
Chairmans
report
.05
Chief
Executives
report
.06
Quality and
Performance
Monitoring
.07
Board
Committee
Reports
.08
Trust News
and External
Environment
.09
Governing
Body and
Membership
.10
Any Other
Business
.11
.01
.03
Chariman's Report
May 2012
The Governors find these visits very useful and the Governors’ Patient Experience Committee is planning, as part of their work, to carry out a series of visits across the Trust.
Over the past two months we have held two membership seminars, one on Diabetes and Health Eating
where 81 members took part. Dr Mark Newbold and I held an open forum with members to discuss developments at the Good Hope site where 36 members and visitors attended.
Patients Association Conference – Thursday 26th April 2012
We hosted the first ever Patients Association conference in the West Midlands on David Cameron’s five
point plan and the ‘CARE’ campaign. This took place at Heartlands from 10am to 4pm with the speaker’s, their presentations and the audience debates relayed to Solihull and Good Hope Education Centres so staff across the Trust could join the debate.
This was a hugely successful event with speakers including Jill Finney, Deputy Chief Executive CQC; Kathryn Hudson, Deputy Ombudsman, Parliamentary and Health Service Ombudsman; and Professor David Oliver, National Clinical Director for Older People, Department of Health.
Chairman’s Lectures
Our series of Guest Lectures continue to prove popular and we have recently been visited by Sir Michael Rawlins. Sir Michael Rawlins has been chairman of the National Institute of Health & Clinical Excellence (NICE) since its formation in 1999. He is also an Honorary Professor at the London School of Hygiene and
Tropical Medicine, University of London, and Emeritus Professor at the University of Newcastle upon Tyne.
His lecture created a great deal of discussion and was very well attended by senior leaders across the Trust.
Charity Work
Potential presidents have been approached to form a Presidents Club to support our fundraising efforts.
The Rt Revd David Urquhart, Bishop of Birmingham and Paul Sabapathy CBE, Her Majesty’s Lord-Lieutenant of West Midland, have both accepted.
Our focus on grant making organisations and corporate funding (which has seen and increased by 27% and 7% respectively in the last five years) continues to deliver results. Our work with Baby Lifeline now means
that we have been able to purchase:
• Comfy chairs for the three delivery suites (two for each)
• V shaped pillows (two for each unit)
In addition, via our work with the Steve Bull Foundation we have negotiated the first funds for the CTG Monitor Sonicaid Team Duo IP Twins Intrapartum and trolley. It is currently being ordered.
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.34
AGENDA
Apologies
.01
Declaration
of interest
.02
Minutes
from
previous
meeting
.03
Matters
Arising
.04
Chairmans
report
.05
Chief
Executives
report
.06
Quality and
Performance
Monitoring
.07
Board
Committee
Reports
.08
Trust News
and External
Environment
.09
Governing
Body and
Membership
.10
Any Other
Business
.11
.01
.03
Chariman's Report
May 2012
2012 Staff Recognition Awards
As you will be aware each year we take time out to celebrate the outstanding work done across the Trust. All of the awards are open to staff and the public to nominate and these can be submitted for individual staff member, team and volunteer who work for the Trust.
This year’s awards are:
Chairman's Award Chief Executive's Award Chief Nurse's Award Clinical Excellence Award Non-Clinical Excellence Award Patient Safety Award Impact Award Community Award Patient Carer Award Paul & Phyllis Winter Essence of Care Award Governors' Going Above and Beyond Award Volunteer of the Year
As in previous years the awards ceremony will be held at the Crescent Theatre in Birmingham town centre and the date for your diary is Wednesday, 14th November 2012 commencing at 7.30pm.
Joint Compact with Birmingham Solihull Cluster
Following on from our Board to Board meeting in November, a Compact has been agreed by all parties in the Birmingham and Solihull Cluster. We discussed and agreed the principles when we met as two Boards at Aston Conference Centre a few weeks ago. Essentially we now have three components in place to tackle the challenges across the health economy:
1. A contract drawn up as a jointly managed risk agreement
2. A System Plan which describes the key strategies for managing the QIPP challenges
3. A Compact which describes our commitment to collaborative working.
I believe these represent a really strong set of documents which are underpinned by a genuine wish to work collaboratively across Birmingham and Solihull in order to address the key priorities faced by the system.
.5
.35
AGENDA
Apologies
.01
Declaration
of interest
.02
Minutes
from
previous
meeting
.03
Matters
Arising
.04
Chairmans
report
.05
Chief
Executives
report
.06
Quality and
Performance
Monitoring
.07
Board
Committee
Reports
.08
Trust News
and External
Environment
.09
Governing
Body and
Membership
.10
Any Other
Business
.11
.01
.03
May 2012
Chief Executive's
Report
.06
AGENDA
Apologies
.01
Declaration
of interest
.02
Minutes
from
previous
meeting
.03
Matters
Arising
.04
Chairmans
report
.05
Chief
Executives
report
.06
Quality and
Performance
Monitoring
.07
Board
Committee
Reports
.08
Trust News
and External
Environment
.09
Governing
Body and
Membership
.10
Any Other
Business
.11
.01
.03
Chief Executives Report
May 2012
Chief Executive’s Report - Update to Board of Directors May 2012
Restructure
The first phase of our proposals to realign the organisation to better support each of our Hospital sites as well as our centralised services is now complete and the posts filled. As I have reported previously, this takes the Trust from having five separate clinical groups to a matrix structure comprising three dedicated hospital-based teams and two Clinical Divisions (Clinical Services and Women’s and Children’s).
Clinical Directorates will remain as the fundamental unit and indeed will be increased in number, and will be based within the five teams as appropriate.
The second phase of the consultation is progressing well and is expected to be finalised over the coming weeks. This will ensure both Directorates and hospital sites have sufficient operational cover.
Meetings and Events
I attended the Birmingham and Solihull Chief Executives Forum where we discussed the rising demand on acute hospitals over the recent years, and agreed the system plan and associated ‘compact’ which describes how health and local authority partners will be working together to address the challenges in care across the area. I also attended the Provider Chief Executive’s meeting where we reviewed the pathology laboratory transformation project being undertaken in the East of England and the plans for pathology services locally.
I was invited to attend an academic debate at Warwick University as part of a series of early evening events, designed to promote interdisciplinary academic thinking and debate with internal and local audiences. This event explored the multi-disciplinary theme “Science and Technology for Health”. Led by Professor Sudhesh Kumar the themes of three broad research areas of healthy ageing, healthcare in resource-poor settings and early diagnosis and treatment of disease were discussed.
I attended an event hosted by the Kings Fund and including Mike Farrar, Chief Executive of the NHS
Confederation and Alan Milburn former Health Secretary where we debated the need for and benefits
of a more open and engaging leadership in the NHS.
I was invited by the Health Service Journal to take part in a ‘Round Table’ event: Addressing the NHS
Operating Framework Challenge through effective use of technology. This was an illuminating discussion which has now been published in the journal.
With Simon Hackwell I attended the Spring Term Meeting at University of Birmingham where I met with Professor Lawrence Young – Head of College of Medical & Dental Sciences and Professor Paul Stewart – Dean of Medicine, where we discussed a range of issues of common interest to both HEFT and the University.
Simon and I also met with Helen Dickinson at the University of Birmingham. Helen is the Director of the Public Service Academy in the College of Social Sciences, and we discussed the role and remit of the
.1
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AGENDA
Apologies
.01
Declaration
of interest
.02
Minutes
from
previous
meeting
.03
Matters
Arising
.04
Chairmans
report
.05
Chief
Executives
report
.06
Quality and
Performance
Monitoring
.07
Board
Committee
Reports
.08
Trust News
and External
Environment
.09
Governing
Body and
Membership
.10
Any Other
Business
.11
.01
.03
Chief Executives Report
May 2012
Public Service Academy (PSA). The PSA seeks to coordinate public service activities across the University and will also provide the basis for collaboration between the University of Birmingham and Birmingham City Council. Although there is a range of established links between the University and the City Council, the PSA will provide a better structure to build on these and facilitate a more strategic relationship between these partners. The PSA is part of a wider University agenda to develop its City and regional role. Building on the recent Policy Commission into the future of public services, the PSA will explore the changing role of local government and public servants. It was evident that there is much common interest between our organizations in respect of the wider public service agenda.
This Public Health theme continued as Simon Hackwell and I met with Professor Jayne Parry at Birmingham University where we debated the development of a Public Health function in the Trust. This was a very positive discussion, in which we discussed the joint establishment of two Public Health posts within HEFT. These would bring expertise in, and understanding of, the wider aspects of health and healthcare to support the Trust strategy.
Carrying on the Public Health theme, I met with Dr Chris Spencer Jones, Senior Officer at Birmingham CCG, to discuss potential areas of mutual public health interest between the CCG and ourselves. I took the opportunity to stress our interest in positioning our hospitals and services within a broader, integrated, system of healthcare in our localities.
I presented a talk on Leadership at the NHS Institute for Innovation and Improvement’s Graduate and Gateway to Leadership Scheme in London. The Board may remember that the Trust hosted a visit from one of their cohorts to support wider leadership development in the NHS. The Gateway to Leadership programme is part of a talent management process to identify and nurture talent in the NHS. It attracts senior managers from the private and third sectors to further their careers in the NHS.
With Claire Molloy I met with Lorely Burt MP to discuss a range of issues including the investment plan for Solihull Hospital. This is part of a series of regular briefing meeting we hold with our local MPs.
I was invited to speak at Keele University as part of the University’s Consultants' leadership programme. This reviewed the leadership challenges for Consultants in the present environment, the current health policy and their likely impact on clinical practice. I also undertook a similar session for Staff and Associate Specialist doctors run by Keele Management School.
The Trust hosted a Knowledge Exchange Forum which is led by Professor Richard Lilford and has been established by the NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRC) for Birmingham and Black Country (BBC). An essential idea of the knowledge exchange forum is to facilitate academia and health practitioners to work together. In this meeting we discussed the future of local hospitals.
I recently presented at a Digital Strategy conference in London which looked at the use of social media in the public sector. My session concerned the use of social media to create and support open and accessible public sector leadership.
I have been asked to take on the role of Chair of the Birmingham and Solihull Local Education and Training Council. This carries with it a seat on the Local Education and Training Board and is part of the national reform of education and training. This is important for HEFT as the reforms give a stronger voice for hospitals in how training of health professionals is planned and delivered.
.2
.38
AGENDA
Apologies
.01
Declaration
of interest
.02
Minutes
from
previous
meeting
.03
Matters
Arising
.04
Chairmans
report
.05
Chief
Executives
report
.06
Quality and
Performance
Monitoring
.07
Board
Committee
Reports
.08
Trust News
and External
Environment
.09
Governing
Body and
Membership
.10
Any Other
Business
.11
.01
.03
Chief Executives Report
May 2012
Finally, I recently attended a lecture by Sir David Nicholson at the Health Services Management Centre at Birmingham University. This was followed by a wide ranging discussion on the NHS including the impact of the recent Health and Social Care Act.
Information Standard surveillance visit Outcome - Heart of England NHS Foundation Trust (18305)
At the beginning of April we received notification that following a recent Surveillance Review the Trust had successfully demonstrated that its service delivery continues to comply with the requirements of The Information Standard. This has been achieved for the second year running.
The Information Standard was established to help patients make informed choices about their lifestyle, conditions and treatment/care options, by providing a recognised and trusted quality mark that will indicate reliable sources of health and social care information. It defines good quality information as:
Clear, relevant, evidence based, authoritative, complete, secure, accurate, well-designed, readable, accessible and up to date.
By achieving this standard the Trust has shown that all the information that the Trust provides adheres to the quality standard. All the leaflets produced since February 2011, apart from the Pan Birmingham, now displays the Information Standard logo.
EMC IIG (Documentum) Study Tour
The Trust has been invited, along with other NHS trusts, to take part and input at round table event and a study tour being hosted by the EMC Information Intelligence Group. EMC is a global leader in transformation and information technology delivery. The Trust’s work on digital scanning and its innovative approach to ICT is of specific interest and repenting the Trust at the event will be Andrew Laverick.
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AGENDA
Apologies
.01
Declaration
of interest
.02
Minutes
from
previous
meeting
.03
Matters
Arising
.04
Chairmans
report
.05
Chief
Executives
report
.06
Quality and
Performance
Monitoring
.07
Board
Committee
Reports
.08
Trust News
and External
Environment
.09
Governing
Body and
Membership
.10
Any Other
Business
.11
.01
.03
May 2012
Quality and Performance
Monitoring
Finance & Performance Report (AS) (ENCLOSURE)
IPROC Requesitions for Approval (AS) (ENCLOSURE)
Business Plan 2011/12 Q4 Update (SH) (ENCLOSURE)
Business Plan 2012/13 (SH) (ENCLOSURE)
Monitor Annual Plan draft including budget setting 2012/13 (ENCLOSURE)
Update on Norovirus (MS) (ORAL)
Safety SITREP report (inc assurance framework) (SW) (ENCLOSURE)
HR & OD Update (HG) (ENCLOSURE)
Whistle Blowing Annual Report (HG) (ENCLOSURE)
CIP Update (AS) (ENCLOSURE)
.07
AGENDA
Apologies
.01
Declaration
of interest
.02
Minutes
from
previous
meeting
.03
Matters
Arising
.04
Chairmans
report
.05
Chief
Executives
report
.06
Quality and
Performance
Monitoring
.07
Board
Committee
Reports
.08
Trust News
and External
Environment
.09
Governing
Body and
Membership
.10
Any Other
Business
.11
.01
.03
85
Finance and Performance Report
May 2012
FINANCE EXECUTIVE SUMMARY & KEY PERFORMANCE INDICATORS
Month 12 to 31st March 2012 Adrian Stokes, Finance and Performance Director
EXECUTIVE SUMMARY
The Trust achieved a £6.7m surplus for 2011/12.
I&E £m
Forecast 7.0
Actual 6.7
Movement (0.3)
The key variances for the Trust were:
• Higher than anticipated pay costs associated with capacity, additional „four hour‟ measures and
holiday accruals.
• Higher than anticipated costs of delivering 18 weeks utilising private sector capacity.
These were largely offset by:
• A reduction in capital charges.
• Additional PCT support for 18 week delivery.
The focus going forward is delivery of the 2012/13 efficiency targets and regaining control of the Trust wide pay bill.
2011/12 FINANCIAL YEAR
2011/12 proved a difficult year delivering a cumulative loss until December and supported in the main by non recurrent PCT efficiency monies (released June, September and March) and a level of pay control in the middle of the year. The below chart shows performance by month:
£m
.1
.41
AGENDA
Apologies
.01
Declaration
of interest
.02
Minutes
from
previous
meeting
.03
Matters
Arising
.04
Chairmans
report
.05
Chief
Executives
report
.06
Quality and
Performance
Monitoring
.07
Board
Committee
Reports
.08
Trust News
and External
Environment
.09
Governing
Body and
Membership
.10
Any Other
Business
.11
.01
.03
Finance and Performance Report
May 2012
2011/12 INCOME
Income was surpressed at the start of the year increasing in the last quarter but overall broadly flat compared to 2010/11 marking a very definite change to previous year on year growth.
2011/12 PAY
Pay costs rose sharply at the start of 2011/12 with Trust Wide measures providing control and some reduction mid-year. Costs have steadily risen since December due to winter pressures, delivery of 18 weeks and A&E performance. The below chart illustrates monthly pay bill for 2011/12:
£m
We are now seeing early signs of lapses in control and all additional costs in relation to capacity need to cease as a matter of urgency.
2011/12 CIP
2011/12 typically saw a slow start to efficiency delivery with the GAP narrowing throughout the year achieving 87% in November, however, this level was not maintained in the remaining months. The shortfall therefore creates a further pressure at the start of the new financial year. The below chart demonstrates performance against CIP in 2011/12:
We need to avoid a slow start to avoid further turnaround measures in 2012/13.
CONCLUSION
A slow start to CIP and continuation of the current level of pay costs would place us in a financial situation similar to June last year.
A Stokes
Finance and Performance Director, Heart of England NHS Foundation Trust.
March 2012
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AGENDA
Apologies
.01
Declaration
of interest
.02
Minutes
from
previous
meeting
.03
Matters
Arising
.04
Chairmans
report
.05
Chief
Executives
report
.06
Quality and
Performance
Monitoring
.07
Board
Committee
Reports
.08
Trust News
and External
Environment
.09
Governing
Body and
Membership
.10
Any Other
Business
.11
.01
.03
Finance and Performance Report
May 2012
From: Adrian Stokes
Title: Finance Executive Summary & Key Performance Indicators
The purpose of this report is to update and inform the Trust Board on the financial position for 2011/12
The key variances for the Trust were:
• Higher than anticipated pay costs associated with capacity, additional „four hour‟ measures and holiday accruals.
• Higher than anticipated costs of delivering 18 weeks utilising private sector capacity.
These were largely offset by:
• A reduction in capital charges.
• Additional PCT support for 18 week delivery.
The focus going forward is delivery of the 2012/13 efficiency targets and regaining control of the Trust wide pay bill.
.3
.43
AGENDA
Apologies
.01
Declaration
of interest
.02
Minutes
from
previous
meeting
.03
Matters
Arising
.04
Chairmans
report
.05
Chief
Executives
report
.06
Quality and
Performance
Monitoring
.07
Board
Committee
Reports
.08
Trust News
and External
Environment
.09
Governing
Body and
Membership
.10
Any Other
Business
.11
.01
.03
Finance and Performance Report
May 2012
KEY ISSUES
The total commitment against the capital plan at March is £25.3m with total expenditure of £18.7m.
March expenditure by allocation is as follows:
• Block Allocations - £3.4m
• Estates Strategic - £231k
• Carry Forward Schemes - £3.1m
• Central Strategic - £5.6m • Site Strategy - £4.9m
• Contingency - £0.6m
Total debt reduced by £17.3m during March, partly due to BEN PCT paying an efficiency invoice for £4.0m in month, whilst two efficiency credits totalling £6.0m issued to BEN PCT & Solihull PCT in month remain outstanding.
A final warning letter has now been sent to the Chief Executive at Birmingham City Council over debts of £3.6m from
March 2009 to October 2011, mostly for delayed discharge penalties, stating legal action is imminent.
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AGENDA
Apologies
.01
Declaration
of interest
.02
Minutes
from
previous
meeting
.03
Matters
Arising
.04
Chairmans
report
.05
Chief
Executives
report
.06
Quality and
Performance
Monitoring
.07
Board
Committee
Reports
.08
Trust News
and External
Environment
.09
Governing
Body and
Membership
.10
Any Other
Business
.11
.01
.03
Finance and Performance Report
May 2012
KEY ISSUES
Month end cash balance remains strong at £97.2m.
This is £12.2m above the plan with adverse operating performance being offset by favourable working capital
movements and underspend on capital expenditure.
All cash was returned to GBS at the year end.
The Trust is currently placing funds in attractive commercial deposit for the 2013 financial year. Overall interest
receivable outturn of £1.4m was £0.4m ahead of plan largely due to the negotiation of higher than expected interest rates over the course of the financial year.
.5
.45
AGENDA
Apologies
.01
Declaration
of interest
.02
Minutes
from
previous
meeting
.03
Matters
Arising
.04
Chairmans
report
.05
Chief
Executives
report
.06
Quality and
Performance
Monitoring
.07
Board
Committee
Reports
.08
Trust News
and External
Environment
.09
Governing
Body and
Membership
.10
Any Other
Business
.11
.01
.03
Key Performance ndicators 2011/12
MRSA
C difficle
62 day cancer
A&E 4 hours
A other cancer
Finance and Performance Report
May 2012
Key Performance Indicators 2011/12
MONITOR COMPLIANCE
FRAMEWORK
MRSA
C.difficle
62 day cancer
3.5
3 2.5
2 1.5
1 0.5
0
MRSA Cases C.Difficile
20
18
16
14
12
10
8
6
4
2
0
18 weeks 95th percentile
A&E 4 hours
Apr-11 Jun-11 Aug-11 Oct-11 Dec-11 Feb-12
Out-turn Target
Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12
Out-turn Target
All other cancer
62 day cancer 18 weeks RTT - 95th percentile
Learning disabilities
Monitor overall
PCT CONTRACT
Other 18 week RTT
Other A&E targets
Exception Notices
Performance Notices
Year end compliance
1
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
62 day cancer Apr-11 Jun-11 Aug-11 Oct-11 Dec-11 Feb-12
Out-turn Target
25.0
20.0
15.0
10.0
5.0
0.0
Referral to treatment waiting times - admitted (95th percentile)
Apr-11 Jun-11 Aug-11 Oct-11 Dec-11 Feb-12
Out-turn Target
FINANCE AND PERFORMANCE REPORT.xls - KPIIs
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AGENDA
Apologies
.01
Declaration
of interest
.02
Minutes
from
previous
meeting
.03
Matters
Arising
.04
Chairmans
report
.05
Chief
Executives
report
.06
Quality and
Performance
Monitoring
.07
Board
Committee
Reports
.08
Trust News
and External
Environment
.09
Governing
Body and
Membership
.10
Any Other
Business
.11
.01
.03
Key Performance nd cators 2011/12
for a four quarters of the
on 2010/11
Ambulance handover
mproved from 30% n Q1
Finance and Performance Report
May 2012
Key Performance Indicators 2011/12
A&E 4 HOUR TARGET
Achieved 4 hour A&E target for all four quarters of the
year
Performance at BHH and GHH improved signifcantly
98.0%
97.0%
96.0%
95.0%
94.0%
93.0%
92.0%
91.0%
90.0%
Trust A&E 4 hour (Inc walk-ins) Heartlands A&E performance 2010-12 (Exc walk-ins)
100.0%
98.0%
96.0%
94.0%
92.0%
90.0%
88.0%
86.0%
84.0%
82.0%
on 2010/11
Ambulance handover within 15 minutes
Apr-11 Jun-11 Aug-11 Oct-11 Dec-11 Feb-12
Out-turn Target
80.0% Q1 10/11 Q2 10/11 Q3 10/11 Q4 10/11 Q1 11/12 Q2 11/12 Q3 11/12 Q4 11/12
Out-turn Target
improved from 30% in Q1 to over 50% in Q4
A&E quality indicators currently meeting 2 out of
5 in Mar12, which is a detioration in performance on previous months, where
3 out of the 5 indicators have been achieved.
100.0%
98.0%
96.0%
94.0%
92.0%
90.0%
88.0%
86.0%
84.0%
82.0%
80.0%
Good Hope A&E Performance 2010-12 (Exc walk-ins) Solihull A&E performance 2010-11 (Exc walk-ins)
100.0%
98.0%
96.0%
94.0%
92.0%
90.0%
88.0%
86.0%
84.0%
82.0%
80.0%
Q1 10/11 Q2 10/11 Q3 10/11 Q4 10/11 Q1 11/12 Q2 11/12 Q3 11/12 Q4 11/12 Q1 10/11 Q2 10/11 Q3 10/11 Q4 10/11 Q1 11/12 Q2 11/12 Q3 11/12 Q4 11/12
Out-turn Target
Out-turn Target
FINANCE AND PERFORMANCE REPORT.xls - A&E
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AGENDA
Apologies
.01
Declaration
of interest
.02
Minutes
from
previous
meeting
.03
Matters
Arising
.04
Chairmans
report
.05
Chief
Executives
report
.06
Quality and
Performance
Monitoring
.07
Board
Committee
Reports
.08
Trust News
and External
Environment
.09
Governing
Body and
Membership
.10
Any Other
Business
.11
.01
.03
Key Performance ndicators 2011/12
MRSA - missed the target of 7 by one out turn ng at 8 cases an mprovement by one case on 2010/11 outturn
C uster.
Cha enges for 2012/13
Where the number of cases s ess than or equa to the de minimis limit no forma regulatory action (including scor ng n the governance r sk rat ng w be taken) however f a Trust exceeds ts nat ona object ve above the de minimis limit Mon tor w app y a red rat ng and cons der esca ation for the Trust.
Finance and Performance Report
May 2012
Key Performance Indicators 2011/12
Challenges in 2011/12
MRSA - missed the target of 7 by one out turning at 8 cases, an improvement by one case on 2010/11 outturn
C.difficile - poor performance early in the year had a significant impact on the delivery of this target for the rest of the year- but achieved year end target
62 day cancer - poor performance in January impacted on the delivery of our monitor Q4 compliance
18 weeks all national targets met but this has resulted in a significant backlog of patients waiting over 26 weeks for treatment , particularly in T&O - resulting in scrutiny from SHA and Cluster.
Challenges for 2012/13
MRSA - target of 6 cases for the year -changes to Monitor compliance framework states: Where the number of cases is less than or equal to the de minimis limit, no formal regulatory action (including scoring in the governance risk rating will be taken), however If a Trust exceeds its national objective above the de minimis limit Monitor will apply a red rating and consider escalation for the Trust.
18 weeks RTT some changes to measuring of performance Monitor 95th percentile target replaced by target of 92% of patients on an incomplete pathway - this will allow us to clear the over 26 week wait backlog. For the national contract 18 weeks admitted and non-admitted targets need to be met in all specialties, currently an issue for T&O and plastic surgery.
Cancer targets - remain as last year but close monitoring will be required to ensure that all Quarterly Monitor targets are met.
A&E - ongoing achievement of the A&E 4 hour indicator must be maintained. There are 5 A&E quality targets to be met in the national contract we only met two of these in Mar12. This was a detioration on previous months' performance, where 3 out of the 5 indicators were achieved
Data completeness in community services - a new Monitor target relating to this has been introduced, this has been run in shadow form for last 6 months , and targets achieved, but becomes live in Monitor Compliance Framework from April
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AGENDA
Apologies
.01
Declaration
of interest
.02
Minutes
from
previous
meeting
.03
Matters
Arising
.04
Chairmans
report
.05
Chief
Executives
report
.06
Quality and
Performance
Monitoring
.07
Board
Committee
Reports
.08
Trust News
and External
Environment
.09
Governing
Body and
Membership
.10
Any Other
Business
.11
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May 2012
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AGENDA
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of interest
.02
from
previous
meeting
.03
Arising .04
report .05
Executives
report
.06
Performance
Monitoring
.07
Committee
Reports
.08
and External
Environment
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Body and
Membership
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Business
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AGENDA
Apologies
.01
Declaration
of interest
.02
Minutes
from
previous
meeting
.03
Matters
Arising
.04
Chairmans
report
.05
Chief
Executives
report
.06
Quality and
Performance
Monitoring
.07
Board
Committee
Reports
.08
Trust News
and External
Environment
.09
Governing
Body and
Membership
.10
Any Other
Business
.11
