Northern Devon Healthcare NHS Trust - Trust Board 6 December 2016 … · 2019-04-27 · Trust Board 6 December 2016 Executive Summary – Minutes of 4 October 2016 Trust Secretariat

Trust Board 6 December 2016 Executive Summary – Minutes of 4 October 2016

Trust Secretariat G:\BOARD SECRETARIAT\MEETINGS\Board\Meetings\2016-17\06.12.16 Page 1 of 23

Chair’s Intials

EXECUTIVE SUMMARY REPORT TO: Trust Board

DATE: Tuesday 6 December 2016

AGENDA NO: 1.4 AGENDA ITEM: Minutes of the Trust Board Meeting held on the 4 October 2016 SPONSOR: Roger French, Chairman

PREPARED BY: Geraldine Garnett-Frizelle, PA to the Chairman

PRESENTED BY: Roger French, Chairman

Purpose

The purpose of this report is to present the minutes of the Trust Board meeting held on 4 October 2016 [minute numbers 102/16 to 124/16].

Decision

Approval

Receive Ratify

Key Issues

Key issues include: Significant Issues

Minute 109/16 Patient Story. The Board received a patient story which had been part of a national awareness raising campaign by the National Institute for Health Research, Clinical Research Network.

Minute 110/16 Quality Assurance Committee. The Board discussed non-participation in audits and the new requirement in contracts with the Commissioners that Trust’s should participate in national audits. However, it was agreed that the language used when describing this requirement and any non-compliance should be looked at again by the Committee, as there are no sanctions attached to this.

114/16 Finance Report. The Board noted that the target for agency had been breached in month 5 but cumulatively the Trust remains under the cap and is now back on track.

Key Risks Discussed

Minute 111/16 Integrated Performance Report. The Board was informed that, due to issues with Urology capacity and shared pathways with the Royal Devon and Exeter NHS Foundation Trust, the 62 day cancer Sustainability and Transformation Fund constitutional standard will not be met for Quarter 2, which will carry a financial penalty. This will be factored in to the financial plan. It was however expected that the position would be recovered.

Minute 111/16 Integrated Performance Report. The Board was informed that there was a continued upward trend regarding higher numbers of staff leaving than are being recruited, a significant proportion of which relates to community hospitals and medical workforce, with a similar trend developing with therapies. Work is being undertaken to address this.



Chair’s Intials

Key Decisions Taken

Minute 116/16 Auditor Panel – Appointment of External Auditor. The Board approved the appointment of KPMG as the Trust’s External Auditors for a period of two years as a single tender action.

Minute 118/16 Emergency Preparedness, Resilience and Response Core Standards Submission 2016/17. The Board approved the Statement of Compliance against the Trust’s self-assessment.

Supporting Information

The minutes are attached.

Controls and Assurance The minutes of the meeting are considered by the Trust Board for accuracy. Following discussion, amendments may be recorded as appropriate. The minutes are then formally approved by the Board. An accurate record of the proceedings of the meeting is required in order to ensure that the Board meets its duties in accordance with the Trust’s Scheme of Delegation, Standing Orders and Standing Financial Instructions. The arrangements and actions of the Trust Board are reviewed by the External Auditors and are reported in the Annual Audit Letter. The Board is also assessed by Internal Audit as part of the Head of Internal Audit Opinion based upon the Chief Executive’s Annual Governance Statement.

Impact Assessments Explanation

Quality There are no implications for patient safety, experience or clinical effectiveness.

Equality and Diversity The Trust aims to design and implement services, policies and measures that meet the diverse needs of our service, population and workforce, ensuring that none are placed at a disadvantage over others. No adverse or positive impacts have been identified from this report.

Regulatory & Legal The Trust is required to produce minutes of its formal meetings in accordance with the organisation’s Standing Orders.

Finance There are no cost implications

Potential Risk to the Organisation

If the minutes are not approved, the Trust will be at medium risk of not acting in accordance with the organisation’s Standing Orders

Board / Committee Prompts

• Has the Board had an opportunity to raise questions or concerns with the Chairman of the Trust Board?

• Do the minutes accurately reflect the meeting?

References

None

Strategic Objectives The Trust’s strategic objectives are reviewed by the Board on an annual basis. This paper supports the achievement of the following strategic objectives:



Chair’s Intials

We will deliver high quality care measured by effectiveness, safety and the person’s experience of care.

We will ensure access to a sustainable range of services that are delivered locally through partnerships and networks.

People will tell their story only once. We will deliver integrated health and social care, seamlessly to meet the needs of individuals.

We recruit and develop a flexible, fulfilled and multi-skilled workforce fully engaged in turning our vision into a reality.

We will efficiently and effectively run our services to benefit our local communities.

We will work in partnership with stakeholders to promote independence and well-being.

We will support individuals and communities to have more influence over how services are delivered and encourage others to do likewise.

Annual Corporate Objectives

This paper provides evidence to support the achievement of the following annual Corporate Objectives for 2016/17.

Does not contribute to this year's Corporate Objectives Choose an item. Choose an item.

Principal Risks

The Trust’s principal risks have been identified through the Trust’s risk management processes. They are updated as they are identified by the Risk Management Committee. This paper supports the mitigation of the following principal risks:

Financial planning & management Clinical records management

Strategic & business planning Leadership & management

Workforce numbers Unsafe behaviour

Workforce skills External demands

Procedural management Partnership arrangements

Equipment & facilities arrangements Communication



Chair’s Intials

Minutes of the Meeting of the Trust Board of Northern Devon Healthcare NHS Trust Held in the Chichester House Boardroom at North Devon District Hospital on Tuesday 4 October 2016.

PRESENT

Ms Andrea Bell Assistant Director of Nursing (Deputy) Mr Colin Dart Acting Director of Finance Dr Alison Diamond Chief Executive Dr Tim Douglas-Riley Non-Executive Director Mr Robert Down Non-Executive Director Mr Roger French Chairman Mrs Pauline Geen Non-Executive Director Mr Nick Lewis Non-Executive Director Mr Tony Neal Non-Executive Director Mr Rob Sainsbury Director of Operations Dr George Thomson Medical Director

IN ATTENDANCE

Mr Darryn Allcorn Director of Workforce and Development Ms Andrea Beacham Patient Engagement Lead (for Minute Number 109/16) Mr Jonathan Broad Associate Non-Executive Director Ms Stella Doble Assistant Director, Health and Social Care North Devon (Observer) Mrs Fryer and Ryan Fryer Patient Story (for Minute Number 109/16) Ms Geraldine Garnett-Frizelle PA to the Chairman Ms Linda Henderson Head of Research & Development (for Minute Number 109/16) Mr Andy Ibbs Director of Strategy and Transformation Dr Stuart Kyle Associate Medical Director (for Minute Number 122/16) Mr Iain Roy Director of Facilities Ms Amanda Skinner Research Nurse (for Minute Number 109/16)

102/16 Chairman’s Remarks

The Chairman welcomed everyone to the meeting and introduced Stella Doble, Assistant Director Health and Social Care North Devon, who was attending the meeting as an Observer. He also welcomed Mrs Fryer and her son Ryan who were in attendance to present the Patient Story, together with Amanda Skinner, Linda Henderson and Andrea Beacham.

103/16 Apologies

Apologies were noted for Dr Nicola Ryley, Interim Director of Nursing. It was noted that Andrea Bell, Assistant Director of Nursing, was attending as her Deputy.



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104/16 Register of Interests

The Chairman asked if there were any updates for the Register of Interests to be noted.

Andy Robinson had been removed from the Register as he has now left the Trust and Colin Dart has been added as Acting Director of Finance.

Alison Diamond informed the Board that her entry under Any Other Interest had been updated to reflect her spouse’s new position as Director of Finance for the Success Regime.

Jonathan Broad advised that he had also updated his entry under Any Other Interest to reflect that following his marriage, it was his spouse, rather than partner, who was an employee of the Trust.

It was also noted that George Thomson had added an entry as he was now an Associate Editor for the International Journal of Clinical Practice.

The Board NOTED the updates to the Register of Interests which had been posted on the Trust’s website on 30 September 2016.

105/16 Minutes of the Meeting held on 2 August 2016

The draft minutes of the meeting held on Tuesday 2 August 2016, numbers 075/16 to 101/16 were considered and Nick Lewis raised a query regarding minute number 086/16 Customer Relations Performance Report Quarter 1 2016/17. In discussion relating to a complaint upheld by the Ombudsman, Jonathan Broad had advised that the Audit and Assurance Committee had asked for a further report on this case to establish whether it had been looked at in more detail so that any learning could be picked up. Nick Lewis informed the Board that he did not believe the Audit and Assurance Committee was the most appropriate place for this report and suggested that it should either go to the Quality Assurance Committee or the Board. Following discussion, it was agreed that as this related to clinical learning it should go to the Quality Assurance Committee and this would then be picked up through the Committee’s minutes when presented to Board. The Board agreed. AI

The minutes were APPROVED.

106/16 Matters Arising

The Board reviewed the Action Grid attached to the Minutes of 7 June 2016 and noted the following update: Action 15 – 085/16 Nursing Staffing and Quality Report Andrea Bell advised that it had not been possible to incorporate the requested changes into this report for this meeting of the Board but that the report to be presented to the December Board meeting will reflect changes, such as bed closures. Action ongoing Action 16 – 086/16 Customer Relations Performance Report Quarter 1 2016/17 Andrea Bell informed the Board that the Strategic Objectives and Principal Risks section of the Executive Summary submitted for future quarterly Customer Relations Performance Reports would be looked at in more details to ensure all relevant areas are covered. Action complete.



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All other actions were completed and closed. Jonathan Broad asked for the Executive Summary for the minutes presented to be looked at and updated to remove the reference to the Audit Commission. He also suggested that the Impact Assessments be looked at as they currently showed no impact. Andy Ibbs advised that there are statutory requirements to do Quality and Equality Impact Assessments if the paper presented will make a change to a service, which the minutes in themselves do not do. With regard to Regulatory, Legal and Finance, Impact Assessments are less clear, although the Regulatory and Legal box should be ticked. This would be amended for the next set of minutes produced. The Board NOTED the matters arising and AGREED the updated action on the Action Grid.

107/16 Chairman’s Report October 2016

The Chairman advised he did not propose to go through each of the items noted in his report but asked if the Board had any questions they wished to raise.

There were no questions raised and the Board RECEIVED the Chairman’s Report for October 2016.

108/16 Chief Executive’s Report October 2016

The Chief Executive advised that, in addition to the report presented, she wished to inform the Board that this would be the last meeting that Rob Sainsbury would attend, as he was due to leave the Trust to take up his new role as Chief Operating Officer for the Northern, Eastern and Western Devon Clinical Commissioning Group. She thanked Rob Sainsbury, on behalf of the Board, for all the work he had undertaken for the organisation since joining in 2014. The Board RECEIVED the Chief Executive’s Report and update for October 2016.

109/16 Patient Story

The Chairman welcomed Mrs Fryer and her son, together with members of the Research and Development team, to the meeting to present the patient story. The Board was informed that:

The National Institute for Health Research, Clinical Research Network has a national awareness raising campaign called Patient Stories.

The patient was a 13 year old boy who was a patient of Caroline Thorpe Ward who had a rare kidney condition. He was recruited to a randomised controlled drugs trial in 2013.

The whole family had been involved in visits at home by the Research Nurse and felt they had received a great deal of support from participating in the study.

He was approached by the South West Communications team and agreed to be part of the patient story campaign and had told his story in the form of a comic strip which has been used across the South West Peninsula, as well as nationally.

He had also attended the Trust’s recent Research Symposium, where he had received a framed copy of his comic strip story.

The Chairman commended Mrs Fryer and her son for taking part in the research study and the remarkable team effort which had helped this Patient Story be developed.



Chair’s Intials

The Board thanked Mrs Fryer and her son and members of the Research and Development Team for attending and RECEIVED the Patient Story.

[All attendees for Patient Story left after the presentation]

110/16 Quality Assurance Committee

Tim Douglas-Riley, Non-Executive Director and Chair of the Committee, presented the draft minutes of the Quality Assurance Committee meeting held on 13 September 2016. The Board noted the significant issues highlighted from the draft minutes:

Research and Development – the Trust has performed very well against the national recruitment targets for Research and Development, however the Trust has been advised to expect a funding cut of 5%. A project is being undertaken to increase commercial income as this stands outside central funding.

The Patient Experience Annual Report was presented and was on the agenda for presentation to the Trust Board.

The Learning from Patient Experience Group will be reviewing the Patient Experience Strategy.

Audits – the Trust is not undertaking two national audits, due to lack of resource and the Committee was advised that this would mean that the Trust is in breach of contract. Nick Lewis asked for clarification of what this meant for the Trust and what sanctions might be imposed for any breach. Andy Ibbs responded that this was a relatively new requirement for contracts with Commissioners but there were no sanctions that would be imposed currently. The Board discussed the implications of the language used, ie breach and sanctions and noted that it was important to have an agreed form of words that would satisfy the requirements of both NHS England and NHS Improvement and also accurately reflect the Trust’s position. Alison Diamond suggested that this should be tied in to the NHS Improvement Framework which is already aligned to the Care Quality Commission. Andy Ibbs agreed that this would be raised at the next meeting of the Quality Assurance Committee to agree a form of words. AI Alison Diamond added that all clinical audits would be looked at in detail before any decision not to participate was made, to establish what time and manpower would be needed to complete them and what participation would add in terms of benefits to patients. The audits that are focussed on are those that Trusts are expected by the Care Quality Commission to undertake and those mandated nationally. George Thomson added that the Audit Department had also been undertaking a substantial audit for the Department of Health on seven day working which would have attracted penalties if not completed.

Data quality and coding – minutes of the Data Quality Group will in future be received by the Quality Assurance Committee.

The Board RECEIVED the draft minutes of the Quality Assurance Committee meeting held on 13 September 2016.

111/16 Integrated Performance Report



Chair’s Intials

The Director of Operations, Assistant Director of Nursing and Director of Workforce presented the Integrated Performance Report for Month 5 2016.

Quality & Performance

Rob Sainsbury highlighted the following key issues from the Performance section:

Sustainability and Transformation Fund constitutional standards: o .62 day cancer – there had been good performance against this standard for August,

which helped to offset the deficit in July. However, September has fallen short due to issues with Urology capacity and shared pathways with the Royal Devon and Exeter NHS Foundation Trust. This will be the only Sustainability and Transformation Fund standard which will not be met for Quarter 2 and there is a £40k financial penalty for this which will be factored in to the financial plan. However, Rob Sainsbury assured the Board that this standard had performed well for the previous three quarters, as well as in August of this quarter, and he believed that the cancer pathway was right and he fully expected that the position would be recovered. He further reported that he had met with the Team to discuss capacity going forward and they are working on a resolution for the vulnerability around Urology capacity.

o RTT – met the standard. There had been very low activity during the summer. o Diagnostics is vulnerable; however there are no financial penalties for this. Quarter 2

overall will be below standard, however performance had been much better for September. Breach tolerance will be back in normal parameters for October.

o A&E – the standard was met for the quarter.

Cancer – there has been improvement in 2 week waits. There had been difficulties regarding breast compliance against the standard, however there have been significant improvements for this in September. Roger French asked what the reasons for this were and Rob Sainsbury responded there had been severe capacity restrictions for the breast pathway. There have been positive discussions with the Royal Devon and Exeter on how to address this, as they are similarly affected.

RTT – it had been previously reported that there were five 52 week breaches, however on closer examination this was determined to be four. All have now been treated, so this standard is now compliant. As a result of these breaches, a deep dive from NHS Improvement took place. A team spent a day at the Trust, and a self-assessment against best practice for the RTT pathway took place. Formal feedback on the deep dive had not yet been received; however preliminary informal feedback was generally positive. The main recommendation related to the Weekly Patient Target List. The way the list is managed in future will be reshaped and a surgeon has been identified to support this.

Stroke standard – there had been good performance in August.

Sickness absence – slightly above target. Darryn Allcorn added that there has been an increase in long term sickness absence. George Thomson asked if there were any hotspots evident and if there was understanding of what factors might be influencing this. Darryn Allcorn responded that there was some increase in musculo-skeletal issues which was easy to link to clinical areas and age profile and the staff physiotherapist and back care team are looking at this; however there had also been a number of staff with significant cancer diagnoses.

Delayed transfer of care - there had been a slight reduction in delayed transfer of care in the acute and northern community, although there had been no change in eastern community.



Chair’s Intials

Length of Stay – there had been a continued reduction in length of stay, which helped support bed closure position across period.

A&E Type 1 – there will be vulnerability for performance with the loss of the Eastern Minor Injury Units. There has been gradual improvement in compliance. The Trust will retain the Walk in Centres, and it will also retain one of the Eastern Minor Injury Units for a short period of time, which will help deliver this standard for Quarter 3, however Quarter 4 will be a period of pressure. Therefore a new approach to pathways needs to be in place in Quarter 3 to counter this.

Mortality – George Thomson advised that the Hospital Standardised Mortality Ratio moved from consistently red to green. One area of exception was the Eastern community hospitals, however with the transfer on 1 October it is expected that the trend will continue as green. The target with the Summary Hospital Mortality Indicators is 100 or below. This indicator has risen to the 100 mark having been below for some time and there is an issue with not all diagnostic codes being captured. The Data Quality Group are addressing this and will report in to the Quality Assurance Committee. George Thomson further informed the Board that the Trust is doing very well within the wider NHS for 28 day readmission rates and the organisation’s long length of stay is significantly lower than elsewhere.

Workforce

Darryn Allcorn highlighted the following key issues from the Workforce section of the report:

There is, as previously reported to the Board, a continued upward trend around higher numbers of staff leaving than are being recruited. This is the sixth month of this trend. A significant proportion of this relates to community hospitals and medical workforce, however there now appears to be a similar trend developing with therapies. There is work ongoing to address this and it seems that for community nursing and the acute hospital, this trend is starting to turn around.

Roger French asked the Board if there were any questions regarding the Integrated Performance Report.

Alison Diamond noted that compliance with the WHO surgical checklist had been just below 95% for most of the preceding year having previously, following considerable work in this area, shown significant improvement. She added that there had been a number of incidents where it had been shown that a checklist would have been useful outside the theatre environment. She asked if this below target performance was an indication that clinicians do not appreciate the benefits of a checklist and therefore are also not appreciating the value of using one outside a theatre environment. George Thomson replied that there was no evidence that there was systematic failure to use the WHO checklist, adoption had been almost universal with surgeons and anaesthetists, but there were exceptions. There is work ongoing with the clinicians concerned to address this. The Board discussed whether some focussed work should take place to look at this more closely and it was agreed that George Thomson would take this forward through the Quality Assurance Committee. GT



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Jonathan Broad raised his concerns around the high rate of coding error and asked if there was confidence in Informatics and data. Rob Sainsbury responded that the Trust had been intensively reviewed by NHS Improvement, in the main as they wanted to share the Trust’s good practice for cancer and validation. The Trust has in the past exposed where coding has been incorrect and has changed its approach where needed to address this. He acknowledged that issues had been identified around mortality coding which is being addressed but this should not undermine confidence in other data, where good validation is undertaken.

Pauline Geen noted that the report stated that all requirements had been met for Quarter 1 for the Sustainability and Transformation Fund, however the table showed a number of categories as red and she asked for clarification of this. Rob Sainsbury advised that this is a language difficulty in describing how these requirements work. The Trust had met all the standards for Quarter 1 where it would have incurred a financial penalty had it failed to do so, however there were standards not met but which did not incur a financial penalty.

Pauline Geen further asked for an explanation as to why some of the values and targets for National CQUINs were blank and whether there were any financial implications around these. Colin Dart replied that Trust’s biggest commissioner is the Clinical Commissioning Group and normally there would be financial consequences in the contract of not achieving CQUINs. However, this is not applicable in this financial year and therefore no value has been included. The indicator is around demonstrating responsibility and achieving the national quality indicator. Darryn Allcorn added that the flu vaccine CQUIN has a target of 75% uptake by frontline clinical staff by quarter 4. Colin Dart added that for some indicators, including sepsis, agreement with NHS England has not yet been reached.

Alison Diamond summarised that they are not being monitored as there is a block contract with no financial penalties for non-achievement. This was agreed as part of the Success Regime. However, all organisations will try to deliver them.

Alison Diamond said although dementia screening was good to a large degree, for those who might be confused for other reasons it did not appear that screening was happening. Andrea Bell responded that there had been a change in documentation which had allowed for this to happen, however this has since been corrected. She added that patients are asked the questions on admission and this is not always documented.

George Thomson noted that the Trust has a very good track record for MRSA screening and asked if there were any plans to increase the target as it had been under 95% for some time. Andrea Bell responded that this would continue to be monitored through the Infection Prevention and Control Committee.

The Board RECEIVED the Integrated Performance Report for Month 5 August 2016.

112/16 Nursing Staffing and Quality Report

Andrea Bell, Assistant Director of Nursing, presented the Nursing Staffing and Quality Report for July and August 2016. The Board noted the key issues highlighted from the report:

There had been a slight increase in nursing variable pay in July, although this had reduced for August.

The number of falls across the Trust has decreased.

Pressure damage incidence has remained static.



Chair’s Intials

Patient harm cannot be attributed to nursing vacancies or use of temporary staffing. Tony Neal asked for clarification regarding this and was advised that on examination of incidents, no correlation could be found between them and staffing levels on the wards on which they had taken place.

Assurance is gained through reporting three times a day on acuity for all patients in inpatient areas and a visible senior nurse presence.

Monitoring staff redeployment. Pro-actively moving staff in real time when there are vacancies.

There has been an influx of newly qualified registered nurses and EU colleagues

Exploring alternative roles such as assistant practitioners and a pilot of the nursing associate role.

Enhanced observation policy

Benchmarking for healthcare support workers and for registered nurses has been undertaken against peer organisations and the rest of the UK.

George Thomson asked if any change in trend had been noted in relation to recruitment and retention of EU nurses in light of Brexit and was advised that no change had been noted. Robert Down noted that the report showed four months of increases in variable pay and one month of decrease and queried whether this indicated the response time for correction of this trend. Andrea Bell responded that there is continuous scrutiny on how to use staff more effectively and efficiently. Alison Diamond added that there are weekly discussions around this, looking at what is effective and further actions need to be taken. She added that there will be some variation due to sickness, annual leave, vacancies, and beds open. Tim Douglas-Riley noted that there were increases in a number of areas for pressure damage reported and asked how this was being managed. Andrea Bell advised that there are a number of areas of good practice which are being shared with other areas that are perhaps more challenged. The Trust is also planning messaging on worldwide Stop Pressure Damage day in November. Alison Diamond added that there were additional challenges in community teams in that staff see patients intermittently at home, with other teams also involved in care. Patients at home may not always be compliant with advice given by teams and this is a more challenging environment for staff to work in, particularly in terms of not being there at all times to prompt patients regarding the advice they have been given. Stella Doble informed the Board that the community nursing workforce is currently stable. The Board RECEIVED the Nursing Staffing and Quality Report.

113/16 Patient Experience Annual Report 2015/16

Andrea Bell, Assistant Director of Nursing, presented the Patient Experience Annual Report 2015/16.

The Board was advised that the key points were:

Patient experience features as the third element of the Trust’s quality strategy.

The report details activity undertaken to capture feedback and respond to feedback through improvements.



Chair’s Intials

In addition to the Friends and Family Test data, the National Inpatient Survey results, “You Said, We Did” report, the report also gives details of a communications deep dive and how patient experience data is used to support transformation.

Robert Down asked why, on the table detailing trends by wards, there were a number of columns containing a question mark and Andrea Bell replied that she would take this back to the report’s author.

The Board RECEIVED the Patient Experience Annual Report 2015/16.

Roger French advised the Board that Colin Dart had had to leave the meeting unexpectedly and therefore the Chief Executive would present the next report.

114/16 Finance Report – August 2016

Alison Diamond, Chief Executive, presented the Finance Report with the Trust’s financial position at 31 August 2016.

The Board was advised that the key points were:

At the end of August there were variances due to the delay in TCS from June to 1 October.

The Trust had an objective to achieve a surplus of £1.4m, which required delivery of a £12m Continuous Improvement Programme.

The Trust is submitting an on-track plan to regulators.

The target for agency was breached in month 5, but cumulatively the Trust remains under the cap and is now back on track. An immense amount of work has taken place to reduce nursing agency, however medical agency is still challenging. There has been a targeted approach to challenge the assumption that a locum is always needed. There are weekly tactical meetings to provide assurance that every agency worker used in the organisation can be justified as addressing a safety issue for patient care.

Nick Lewis added that figures are not that meaningful currently, because of the delay in transfer of community services. This was discussed at Finance Committee and it was agreed that this would either be rebased for the next report or some further analysis will be undertaken. There is a capital expenditure issue which had been discussed at a Board Briefing. There are limited actions the Trust can take and one of the key messages to staff is that agency spend must be kept under control. Alison Diamond added that the assumptions in the Continuous Improvement Programme are being looked at and as they are refined, the assumptions move and put risk in the system.



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Robert Down advised that because of capital restraint, requests are beginning to come through Charitable Funds for equipment where the enhancement was not always clearly identified to meet the charitable funds rules. Alison Diamond responded that there will be greater calls on charitable funds when capital is restrained and that it may be that applications need to be looked at more closely in terms of how they are worded to identify what are enhancements rather than essential items. Iain Roy added that all new equipment bids should go through the Clinical Services Executive Committee for approval before any request for funding should be made. In addition, replacement equipment requests are scrutinised and there is money available where replacement is needed. Roger French suggested that this could be discussed in more detail at the next Charitable Funds meeting in November. Jonathan Broad commented that the delay in transferring community services was outside the Trust’s control and the organisation had budgeted against the original delivery date, and asked whether it was possible to recoup any money from the Clinical Commissioning Group. Alison Diamond responded that services are paid for until 30 September so there is no deficit for that. Andy Ibbs added that the costs of the transfer had been discussed with the Clinical Commissioning Group and a ballpark figure had been agreed with them. Roger French informed the Board that he had received an email from James Brent, Chairman of the Royal Devon and Exeter NHS Foundation Trust, expressing his thanks to the Board and the Trust for the manner in which the services had been transferred and the cooperation shown by Trust staff with those from the Royal Devon and Exeter. Nick Lewis raised a query about Tariff modification Alison Diamond confirmed that there was still ongoing work to align the values of both the remaining community contract and the acute contract. The Board RECEIVED the Finance Report for August 2016.

115/16 Audit and Assurance Committee

Nick Lewis, Non-Executive Director and Chair of the Audit Committee, presented the draft minutes of the Audit and Assurance Committee meeting held on 9 August 2016. Key issues included:

The Committee, as the Auditor Panel, had recommended the appointment of KPMG as external Auditors under Single Tender Action. A separate paper regarding this was on the agenda for discussion by the Board.

Holsworthy – following an Internal Audit report on a visit to Holsworthy Hospital, the Committee had requested training visits to other Community Hospitals by Internal Auditors to help embed learning from audits. Nick Lewis added that the issues identified were administrative, rather than patient safety and it was hoped that the training visits would have more impact with staff than simply actions suggested by management.

The Board RECEIVED the draft minutes of the Audit and Assurance Committee meeting held on 9 August 2016.

116/16 Auditor Panel – Appointment of External Auditor



Chair’s Intials

Andy Ibbs, Director of Strategy and Transformation, presented the paper recommending the appointment of KPMG as the Trust’s External Auditors. The Board was advised that:

The Audit Committee, in its role as the Auditor Panel, had met to consider the recommendation of the appointment of KPMG as External Auditors.

KPMG have only done one year as External Auditors for the Trust.

They have submitted a proposal, at less cost than their previous costs and which compares favourably with other External Auditor costs.

The procurement rules have been checked and single tender action can be used.

The decision for the Board, if the recommendation of the Auditor Panel to appoint KPMG is accepted, is whether to appoint for one year or two. Three years is not a possibility as this would be a breach of OJEU.

The Head of Procurement has suggested one year, however it was felt that to maximise benefit to the organisation, in terms of relationship building and knowledge, two would be preferable.

Robert Down said that he would strongly support a two year appointment, as it would be difficult for Auditors to thoroughly get to know a complex organisation in one year. He asked if it would be possible to have a two year contract with a renewal point midway with an internal review, with the option to roll on without a formal process if satisfactory. Jonathan Broad added that he also supported the two year appointment and Robert’s suggestion of a renewal point. Iain Roy said that he recognised the benefit of two years, however he felt that the Head of Procurement’s advice should be taken into account. He felt that one year should be gone for and then a tendering process during the course of that year. Robert Down said that if there were a tender process, the weighting of the hard and soft money elements would be crucial to that. Nick Lewis clarified that the recommendation would be to use the Crown Commercial Services framework which would be a mini tender. George Thomson said that he did not think the intention of OJEU was that organisations would not be allowed to sign up to annual renewable contracts and why therefore this could not be the case in this instance. Andy Ibbs said that for Auditors there should not be an annual rolling contract as this could lead to the relationship becoming too “comfortable”. Iain Roy said that with increased monitoring, there will be greater pressure on Trusts to use frameworks, not to use single tender action and standardise products and he felt the appointment for a two year period might attract pressure from the centre. Alison Diamond said that she did not understand the risk of not following the guidance from the Head of Procurement regarding challenge on the procurement process. Andy Ibbs said that all Trusts were in the same position needing to appoint Auditors by December. He added that he had only been approached by one company to ask what the Trust will be doing. Nick Lewis added that he believed the risks were minimal. He added that he would abstain from the vote.

[Colin Dart rejoined the meeting]



Chair’s Intials

The benefits of the two year appointment were recapped as to ensure that the Trust has Auditors who already have existing knowledge of the organisation and there is an advantage in having them in place for a longer period. Colin Dart added that there was benefit for the Finance Team not having to rebuild relationships on an annual basis and there is already a level of trust in place. He also stated that there were no concerns about quality and they were good value for money. The Chairman informed the Board that the recommendations were:

award a one year contract and undertake a tender process during the course of the year; or

award a two year contract He asked the voting members of the Board to indicate their preference and the decision was the award of a two year contract. The Board APPROVED the appointment of KPMG as the Trust’s External Auditors for two years.

117/16 Workforce and Organisational Development Committee

Iain Roy, Director of Facilities and Vice-Committee Chair, presented the draft minutes of the Workforce and Organisational Development Committee meeting held on 16 August 2016.

The Board noted the significant issues highlighted in the report and in particular:

Junior Doctors’ Contract – the Trust was issuing offers, acceptances were being received and new doctors were joining rotas.

The Committee had received the Workforce Race Equality Standards and had discussed how the organisation could ensure that it engaged fully with its BME staff.

Supervision – it was noted that in 35 completed appraisals staff had stated that they had had no supervision and for 28 of these the appraiser had agreed with this statement. Following discussion the Committee had requested that this be looked at in more detail to establish if this was the case and if so, to decide on how to address this.

Workforce plans by Directorate – the Committee noted that there was lack of engagement from all directorates reported around workforce plans. An action plan was being developed to address this and raise engagement post transfer of eastern services.

The Committee had also discussed the ongoing trend of more staff leaving than joining the organisation, particularly in therapies and clinical staff in the East and the possibility that this could trigger a spike in Allied Health Professional agency usage.

Tim Douglas-Riley asked whether it was up to individual Trusts whether they imposed the Junior Doctors contract. George Thomson informed the Board that the British Medical Association had now called off all planned strike action and the contract will be implemented. He added that, in common with many Trusts, there are a number of gaps in Junior Doctors and this is a risk. There will need to be rotas that comply with national guidance. He added that there is a cost to the Trust of implementing this.



Chair’s Intials

Darryn Allcorn advised that a Safe Working Guardian has been appointed and the contract will be implemented through HR.

The Board RECEIVED the draft minutes.

118/16 Emergency Preparedness, Resilience and Response Core Standards Submission 2016/17

Rob Sainsbury, Director of Operations, presented Emergency Preparedness, Resilience and Response Core Standards Submission for 2016/17.

The Board was informed that:

The Trust is fully compliant with 49 out of 51 of the core standards and partially compliant with 2, with a work plan in place to achieve full compliance within the next 12 months.

The Board was required to submit a Statement of Compliance against the Trust’s self-assessment which was included with the paper.

The Board APPROVED the Statement of Compliance.

119/16 National Inpatient Survey 2015

Andrea Bell, Assistant Director of Nursing, presented the Care Quality Commission National Inpatient Survey 2015 and the Trust’s action plan to address any areas identified for improvement.

The key issues noted were:

There had been a good response rate of 50% of eligible patients

Overall, the results for the Trust were good with the Trust rated as better than other Trusts for six questions and not rated as worse than other Trusts for any questions.

The two areas for improvement noted were patient information at discharge and noise at night and work is in progress to address these areas.

The Board RECEIVED the National Inpatient Survey 2015.

120/16 Board Assurance Framework 2016/17, Quarter 2 Update

Andy Ibbs, Director of Strategy and Transformation, presented the Board Assurance Framework 2016/17 Quarter 2 Update.

The key issues highlighted from the report presented were:

Good progress has been maintained against delivery of the annual corporate objectives, with assurance provided through the Appendix to the report which detailed how this could be evidenced through presentations and updates on progress to Board, Clinical Services Executive Committee and sub-Committees of the Board.

There are no changes to the risk heat map since the last quarter. Sustainability and efficient and effective strategic objectives are of most concern and scores remain high.

Alison Diamond asked the Board if it felt that the right information was being presented at Board Briefings to provide assurance and it was agreed that Board Briefings were working well and offered the Board opportunity to discuss issues in depth.



Chair’s Intials

Pauline Geen queried whether it might be useful to have a standing agenda item for the formal Board meeting on the Success Regime to increase visibility, although she added that it was reported through the Chief Executive’s report to Board, under Emerging Issues and via regular updates at Board Briefings. However Roger French said that as this was covered in a number of ways, he did not believe a standing agenda item was necessary.

The heat map was discussed and it was felt that a greater debate at a board briefing was required. The Board discussed whether the RAG rating was correct. Alison Diamond said that with the depleted junior doctor and physician workforce which has a knock on effect agency, this is a challenging environment and this was still the highest risk.

Roger French suggested that this should be discussed in more detail outside the meeting and Alison Diamond added that a presentation could be brought to the next Board Briefing in October for the Board to review.

The Board RECEIVED the Quarter 2 Update.

121/16 Emerging Issues

The Chairman asked if there were any emerging issues members of the Board wished to raise. Control Total The Board was informed that the Trust has been allocated its control totals for the next two financial years and a more detailed paper will be presented to the Board on this at a future meeting. They are significantly higher than the control total for this financial year. Work is being undertaken to work through the implications of this. Colin Dart added that achievement of the Sustainability and Transformation Fund will become more onerous in relation to monthly performance. Axminster Iain Roy informed the Board that there had been a flood reported at Axminster Community Hospital on 3 October 2016 as a result of a burst water main. The flood had affected the basement area of the hospital and the fire brigade had attended the site to pump the water out. As the IT and electrical systems equipment were located in the basement, this had resulted in a power outage and IT access at the site. The leak has now been resolved and the basement accessed to restore power, however theatres cannot currently be used as the generators are not working. Replacements are being sourced and it is expected that services will resume by the evening of Thursday 6 October. IT services at the Royal Devon and Exeter NHS Foundation Trust are looking at the IT system. Although Eastern services transferred to the Royal Devon and Exeter on 1 October, the Northern Devon Healthcare NHS Trust has retained responsibility for the eastern estate until it is transferred to NHS Property Services in December and therefore has responsibility for any repairs. There has been no damage to other areas of the hospital. Tim Douglas-Riley stated that he would like to commend the Executive Director team on the transfer of eastern services and in particular the communications that have been issued to staff and the Board to update them, which he added were not only informative, but sincere and genuine in tone. Alison Diamond responded that she would convey this to the Communications Team.

[Stuart Kyle joined the meeting]



Chair’s Intials

122/16 Medical Revalidation Annual Organisational Audit (AOA) Comparator Report

Stuart Kyle, Associate Medical Director, presented the Medical Revalidation Annual Organisational Audit (AOA) Comparator Report.

The key issues highlighted from the report presented were:

Section 1 – Designated Body and Responsible Officer results are positive and in line with same sector Designated Bodies. Question 1.6 in this section relates to funds, capacity and other resources which are currently judged to be sustainable. This had been discussed with the Medical Director and independent review from NHS England and it may need to be looked at again in future.

Section 2 – 94% of senior doctors had completed annual appraisal. This compares to 87% in same sector Designated Bodies. Tim Douglas-Riley asked for clarification on how junior doctor appraisal is undertaken and was informed that this takes place through a different process through the Deanery.

Seven doctors had an approved incomplete or missed appraisal and two doctors had unapproved incomplete or missed appraisal.

There are a sufficient number of trained appraisers currently, however it was noted that two trained appraisers will withdraw from the process during 2016/17 due to increased clinical demands and staff shortages.

Section 3 – the Medical Director has reviewed the number of case investigators. George Thomson advised that training will take place during the next week of 11 or 12 case investigators. Places on this training course have been made available at cost to other organisations. –

Next year the audit is changing and in future all appraisals will have to be completed within a 12 month window, rather than, as currently, a 9 – 15 month window and there will be no extension allowed beyond this. Stuart Kyle informed the Board that in future there will be no flexibility and appraisal must be undertaken in the exact month of the original appraisal. It is likely that this will impact on the number of doctors with an incomplete appraisal.

Alison Diamond asked if non-medical appraisers had been considered and Stuart Kyle responded that there was a feeling that using non-medical appraisers may devalue the pastoral role of appraisers.

The Board RECEIVED the report.

[Stuart Kyle left the meeting]

123/16 Questions from Members of the Public

There were no questions raised.

124/16 Date of the Next Meeting

The next meeting of the Trust Board will take place at 10.00 a.m. on Tuesday 6 December 2016 in the Chichester Boardroom, North Devon District Hospital, Barnstaple.

125/16 Exclusion of Press / Public

It was formally MOVED by Nick Lewis, and, SECONDED by George Thomson and unanimously RESOLVED that under the provision of Section 1, sub-section 2, of the Public



Chair’s Intials

Bodies (Admission to Meetings) Act 1960, that the public be excluded from the confidential section of the meeting on the grounds that publicity would be prejudicial to the public interest by reason of the confidential nature of the business to be transacted.



Chair’s Intials

ACTION LOG AS AT 28 NOVEMBER 2016 No Minute Item Action Comments Lead Outcome

1 December 2015

1 178/15 Integrated Performance Report

Cardiac Output Monitoring – Evidence for the process and whether the percentage the Trust is aspiring to is correct to be looked at by lead medical staff to ascertain the true benefits and for which cohort of patients. To be discussed further at Quality Assurance Committee.

Dec 15 – This will be added to monthly reporting to the Clinical Services Executive Committee. The Medical Director will also discuss with anaesthetists. Feb 15 – Anaesthetists would be asked to stop monitoring cardiac output as the Trust would always appear as “red”. A briefing report to be presented to the Quality Assurance Committee to explain the reasons for this change. Apr 16 – the Anaesthetists had been asked to stop monitoring cardiac output. This had also been discussed at the Quality Assurance Committee where it had been agreed that this should be removed from the Integrated Performance Report.

GT Closed

2 February 2016

2 010/16 Integrated performance Report

A briefing paper on Endoscopy Urgent Waits to be presented to the Board meeting in April.

Apr 16 – This had also been raised at the Clinical Services Executive Committee and would be discussed further at the next Board Briefing.

GT/RS Closed


DA to discuss with the Performance Team whether the ranges can be changed in relation to in-month sickness

Apr 16 – The ranges in relation to in-month sickness were being reviewed so they were less confusing.

DA Closed

4 011/16 Variable Pay and Quality Report

Briefing to be provided for Jono Broad /Tony Neal on deep dive undertaken in relation to the level of agency vs harm events.

Apr 16 – this briefing had taken place.

NR Closed

5 April 2016

5 031/16 Integrated Performance Report – CQUIN Activity

Summary to be provided at Board Briefing of CQUIN activity and compliance against objectives.

Apr 16 – To be added to Board Briefing Programme under Any Other Business. May – Added to the Board Briefing Programme

RS Closed

6 031/16 Integrated Performance Report – mortality data / LOS

Devise smarter way of monitoring mortality / LOS in the Integrated Performance Report

Apr 16 – GT advised that the minute should be amended, as monitoring is already appropriate and smart, but Dr Foster data on LLOS and 28 day readmissions should be added to the reports that the Board receive.

RS/GT Closed



Chair’s Intials

No Minute Item Action Comments Lead Outcome

7 036/16 Board Assurance Report

Bring proposition for automatic population to Board Briefing.

Apr 16 – Delivered at Board Briefing 11.04.16

AI Closed

8 036/16 Board Assurance Report

Discuss at Board Briefing how the Board could know that the responses were quality assured.

Apr 16 – Delivered at Board Briefing 11.04.16

AI Closed

7 June 2016

8 051/16 Patient Story Board Report authors to be reminded when submitting Executive Summaries for Board papers that all sections of the summary should be completed appropriately to reflect the paper presented.

Jul 16 – Reminder email sent to all authors regarding appropriate completion of the Executive Summary.

GGF Closed

9 052/16 Quality Assurance Committee

Minutes of 12.04.16 – CQC Inspection Process A Board Briefing session to be added to the programme to look at paper-based assurance & staff perception and the balance to be achieved between, how staff are supported for the inspection process. To be followed by a session looking at the Trust’s successes where services & staff are exceeding standards. AD will confirm details to GGF for the programme.

Jul 16 – A session was presented to the Board at the Board Development Day held on 5 July on the inspection process and how staff are supported.

AD Closed


Medicines Reconciliation – It was agreed that the low performance against this target should be raised through the Safer Care Delivery Committee with a report to the Quality Assurance Committee detailing how this could be addressed to improve performance.

Jun 16 – A report and action plan to be presented to the next Safer Care Delivery Committee meeting to take this forward.

AD/NR Closed

11 054/16 Nursing Quality and Safer Staffing Report

As this report combines data over a two month period, it was agreed that for future reports the monthly position would be broken down for clarity.

Jul 16 – A revised report including the monthly position breakdown was circulated to the Board.

NR Closed



Chair’s Intials


12 066/16 Health and Safety Six Monthly Report

Feedback of the outcome of the presentation of the onsite security business case to the Clinical Services Executive Committee to be provided.

Jul 16 – The Business Case has been presented to CSEC in July. Director of Workforce and Development advised that:

Full business case approved to increase security to 24/7

There are processes aligned to this that will support escalation and need for any intervention

As this is an augmentation of an existing contract the Trust should be able to move forward quickly

Skills of security staff will be enhanced to focus on health related rather than generic security training.

AD Closed

13 069/16 Board Development Plan

Clarification on how mandatory training had been achieved by the Non-Executive Directors.

Jun 16 – This has been discussed through the Workforce & Organisational Development Committee & there is no need for Non-Executive Directors to attend additional training. There is discussion regarding additional training that may require updating relevant to role on set committees such as Safeguarding which will be identified on an individual basis.

DA Closed

2 August 2016

14 078/16 Minutes of the Meeting held on 7 June 2016

Amendment requested as follows: Minute number 066/16 Health & Safety Six Monthly Report, last sentence to be amended to read “Tony Neal asked if there were any health and safety liabilities and responsibilities associated with the Devon Cares contract and Andy Ibbs responded that these would be passed on.

Aug 16 – Minutes amended as requested.

GGF Closed

15 085/16 Nursing Staffing and Quality Report

The report to be updated for its next presentation to October Board to reflect the changes, ie bed closures.

Sep 16 – No update available. Oct 16 – The report will be updated before presentation to the next meeting on 06.12.16. Nov 16 – Report has been amended to reflect this.

NR Closed



Chair’s Intials


16 086/16 Customer Relations Performance Report Q1 2016/17

The Strategic Objectives and Principal Risks section of the Executive Summary for this report to be looked at in more detail for future reports to ensure all relevant areas are covered.

Sep 16 – No update available. Oct 16 – Action complete.

NR Closed

4 October 2016

17 105/16 Minutes of the Meeting held on 2 August 2016

Customer Relations Performance Report Q1 16-17 (Minute Number 086/16) – A further report on the case upheld by the Ombudsman to be presented to the Quality Assurance Committee.

Nov 16 – Head of Corporate Governance has looked at the Ombudsman’s Report and the complaint file in detail and has provided a summary of the findings to AI. Dec 16 – AI advised that this will be presented to Quality Assurance Committee.

AI Closed

18 110/16 Quality Assurance Committee

National Audits – The Trust is not participating in two national audits and this constitutes a “breach of contract”. Following discussion, the Board agreed that the language used to describe this needed to be looked at, as breach implied sanctions and there were no sanctions attached. To be discussed further by QAC.

Dec 16 – Has been discussed at Quality Assurance Committee and a form of words agreed.

AI Closed.


Workforce – The Board discussed compliance with the WHO surgical checklist which had below target performance and it was agreed that some focussed work should take place to look at this more closely, to be taken forward through the Quality Assurance Committee.

Nov 16 – Agreement in principle that an audit of compliance is required in order to form a PDSA QI cycle. No dates have been agreed as yet. Dec 16 – GT updated the Board that an audit of those areas that are not compliant has been scheduled for the New Year.

GT Closed

Chairman’s Signature ………………………………………………………………..

Date ………………………………………………………………………………………….

Documents

Northern Devon Healthcare NHS Trust - Trust Board 6 December 2016 … · 2019-04-27 · Trust Board 6 December 2016 Executive Summary – Minutes of 4 October 2016 Trust Secretariat