Minutes of the Leeds Teaching Hospitals NHS Trust Board Meeting
                     held on Thursday, 3rd November 2005
            in the Board Room at St James’s University Hospital

Present:           Mr Martin Buckley, Chairman
                   Ms Rachael Allsop, Director of Human Resources
                   Mrs Catherine Beardshaw, Director of Operations
                   Mr Frank Bedi, Non-Executive Director
                   Mr Gavin Boyle, Director of Operations
                   Mr Neil Chapman, Director of Finance
                   Ms Charlotte Dyson, Non-Executive Director
                   Mr Howard Cressey, Non-Executive Director
                   Professor Ed Hillhouse, Non-Executive Director
                   Dr Valerie Kaye, Non-Executive Director
                   Mr Keith Lilley, Director of Facilities
                   Mr Neil McKay, Chief Executive
                   Prof Hugo Mascie-Taylor, Medical Director
                   Miss Maureen Naughton, Chief Nurse
                   Mr Nik Patten, Director of Corporate Planning and Performance
                   Mrs Susan Silverstone, Non-Executive Director

In Attendance:     Members of the Public and Press
                   Mr Eddie Mack, PPI Forum
                   Mrs Mandy Bailey, Director of Quality
                   Mr Brian Derry, Director of Informatics
                   Mr Ross Langford, Acting Director of Communications &
                          Corporate Affairs
                   Mr Trevor Reed, Executive Support Manager
                   Mr Graham Nunns, RSM Robson Rhodes, (for item 2222)

     An apology was received from Mr Goldman.

     There were no declarations of interest.

     i)   Finance Report (paragraph No. 2119)
          It was pointed out that the final sentence on page 5 should have read
          “Mr Chapman described the need for the Trust to reduce staffing levels
          by one hundred whole time equivalents per month…..)

             Subject to the above change the Minutes of the meeting held on 6 th
             October 2005 were accepted as an accurate record and signed by the

     i)  Informatics Risks
         Further to the discussion on ‘Connecting for Health’ at the Board
         meeting on 6th October, Mr Derry presented a paper on Informatics
         Risks. He explained that these risks concerned not just IT systems, but
         also encompassed how the systems were used, the need for sufficient
         specialist staff with up-to-date skills, and potential lost opportunities to
         improve services by not keeping up with technological developments.
         He drew attention to Annex ‘A’ of his paper, which outlined the key
         informatics items in the Trust risk register and the measures being put
         in place by the Trust to address them.

             The National Programme for IT was discussed briefly. Reference was
             made to Sir Nigel Crisp’s recent comments that the Choose and Book
             implementation programme was around a year behind schedule and to
             the delays to PAS implementations. Mr Derry explained that the Trust’s
             main involvement in the national programme was in relation to the
             national IT network (“N3”) and - subject to cost and a formal business
             case - the possible further roll out across the Trust of the Picture
             Archiving and Communications System for digital x-ray and other
             diagnostic images.

             Professor Mascie-Taylor emphasised the rapidly increasing reliance on
             IT within the NHS, including for directly supporting clinical care, and
             thus the importance of resilient systems and hardware, and round-the-
             clock technical back-up.

             The interface between the Trust and the PCTs was discussed briefly.
             Mr Derry described a number of areas where technology is enabling the
             secure sharing of information, such as pathology and screening results
             and waiting times, to support patient care and patient choice.

             The Board welcomed Mr Derry’s paper and agreed that it would be very
             helpful to receive regular updates on the Informatics Strategy. The
             Chairman observed that the Trust could have confidence in the skills
             and professionalism of its informatics staff.

      ii)    Quality Structure Review
             Mr Mack made the Board aware that the Patients’ Forum continued to
             have concerns about its opportunities for representation within the
             Trust’s Quality Structure, explaining that a letter was in the post to the
             Chief Executive on this topic.

             Dr Kaye observed that repeated assurances had been given to the
             Forum that there would be ample opportunities for representation once
             the new Quality Structure had been agreed. She explained that the
             enhanced Audit/Quality Committee constituted the likeliest place for
             Patient Forum representation, as discussed at the most recent Quality
             Committee meeting. Mr McKay assured Mr Mack that the Patients’
             Forum would continue to be fully involved and confirmed that he would
             respond formally to the letter when it arrived.

     Mr Graham Nunns (RSM Robson Rhodes) was welcomed for discussion of
     this item. Mr Nunns explained that the Audit Letter summarised work carried
     out by the external auditors during 2004/05 and described their activities in
     three main areas:-
          Financial aspects of Corporate Governance
          Auditing the Accounts
          Aspects of Performance Management
     He drew attention to key messages for the Trust outlined on pages 2-4 of the
     Audit Letter and highlighted some of the main themes:-
          The continuing challenge presented by the Trust’s financial position.
             Mr Nunns observed that breakeven would require considerable levels
             of savings and highlighted the need for a fundamental review of the
             services provided by the Trust as opposed to continually attempting to
             trim budgets. Making Leeds Better was crucial in this respect.
          The Capital Budget – it was suggested that the Trust still had much
             work to do to maximise the use of this important resource.
          Performance Management – Mr Nunns drew attention to the scope for
             improvement highlighted within Section 1.16 of the Audit Letter.

      Mr Nunns stressed that the Executive Summary should not be taken out of
      context. The Audit Letter identified many areas of good performance and
      there was no wish to detract from these but Trust still faced an extremely
      challenging agenda.

      Responding to a question about the Auditors’ Local Evaluation process,
      Mr Nunns confirmed that this would take place the following September and
      would contribute to the Healthcare Commission’s scoring mechanism. He
      explained that the Department of Health had recently stated that a failure to
      achieve financial balance would automatically result in the lowest possible
      score of 1, emphasising the need for the Trust to achieve breakeven.

      Mr McKay thanked Mr Nunns for his report, observing that it had been
      perceived as very fair and reasonable. The Trust had achieved its financial
      targets the previous year despite significant challenges such as the new
      Consultants’ Contract but the need for a more fundamental review of services
      was accepted and it was agreed that Making Leeds Better was the way
      forward. The Foundation Trust diagnostic tool would also assist the Trust in
      its short-term planning for the following year.

     Dr Ayres gave a presentation reminding the Board of the need for effective
     medical management and describing its benefits. He drew attention to Trust
     policy and guidance on this topic which had been consulted on over the
     summer. Reference was also made to the paper describing the proposed
     remuneration process for Clinical Directors and the Action Plan for medical
     management development. It was explained that the Trust’s policy was
     currently being updated to:-

             Provide clarity on the roles and responsibilities of Clinical Directors
             Introduce a new level of “Specialty Lead”

           Strengthen assessment, appraisal and feedback mechanisms
      An opportunity was also being taken to review the Clinical Director structure
      as part of this process, with a view to a new structure being in place from
      1st April 2006.

      Mr McKay reminded the Board that the Trust’s current medical management
      structure had been in place for around three years and had contributed greatly
      to the increased involvement of clinicians in the management process. He
      paid tribute to Dr Ayres for his recent work, observing that it was a further
      major step in the right direction.

      Mrs Beardshaw explained that the process of reviewing the Clinical Director
      structure had already commenced with the assistance of Deputy Medical
      Directors. The concept of “Specialty Leads” was welcomed as a means of
      encouraging talent, assisting succession planning, and also helping with
      communications. Mr Boyle explained that Dr Ayres’ work concerned the
      development of a suitable framework. Directors’ responsibilities included
      populating the structure and ensuring that people delivered.

      The Board welcomed Dr Ayres’ recent work and the Policy and Guidance on
      Medical Management Arrangements were supported.

     Mr Patten explained that, following discussions at the recent Board Time-Out,
     his paper constituted high level guidance on the tactics to be used to ensure
     continued momentum towards realising the Trust’s Vision and assisting the
     process of achieving Foundation Trust Status. The process would provide a
     real opportunity for CMTs to articulate their own vision for services. A
     complex programme of work was already in progress with a view to enabling
     the Board to sign off the Business Plan in March 2006.

      The Board welcomed the Business Planning Framework and the Chairman
      observed that the timetable of dates and responsibilities was particularly

     Mr Lilley briefed the Board on legislative changes relating to food safety that
     were due to come into effect in January 2006. These would see the Trust
     assume a vicarious liability for all food produced on Trust premises. Mr Lilley
     explained that a new Food Safety Manual was being launched in response to
     the new legislation and also described a training programme that was to be
     carried out across the Trust, including annual food safety sessions for Charge
     Nurses and Ward Sisters. Miss Naughton highlighted the issue of relatives
     bringing their own food onto Trust premises for children and it was confirmed
     that the new manual included specific guidance on this topic.

      Following discussion, the Board supported the introduction of the new Food
      Safety Manual and the wider programme of training.

     Professor Mascie-Taylor explained that Dr Smye’s paper sought approval to
     proceed with a bid to host the Department of Health’s Research Commissioning
     and Management Function – the Central Commissioning Faculty. He explained
     that the bid would be submitted jointly with the National Co-ordinating Centre
     for Research Capacity Development and the UK Co-ordinating Centre for
     Clinical Research Networks. The paper described risks associated with the bid
     and set out responses to them. The biggest risk was around staffing and the
     Board was assured that the bid reflected the true cost of employing the
     additional staff.

      There was strong support for the bid amongst Board Members but there was
      also a query as to whether or not this was core business for the Trust.
      Following discussion it was agreed that the benefits of the bid outweighed its
      risks. A successful bid would assist the Trust’s desire to develop its R&D
      portfolio and would also heighten the Trust’s profile. The bid received the
      Board’s approval in principle.

     Mrs Beardshaw explained the background to this business case and after
     discussion it received Board support.

      Mr McKay confirmed that there would be an update to the next Board meeting
      on changes to the Scheme of Delegation in relation to the approval of
      Consultant Business Cases.

     Mr Patten briefed the Board on a series of changes that were essential to
     facilitate the centralisation of Trauma Services at the Leeds General Infirmary.
     Following discussion, the following schemes received Board approval:-
          The reconfiguration of in-patient accommodation on Wards 55, 56 and
              61 at Clarendon Wing
          The conversion of the Professorial Unit on ‘D’ Floor Clarendon Wing
              into clinical accommodation for Gastro-Intestinal Surgery
          The refurbishment of Wards 60 and 62 at Clarendon Wing
          The relocation of the Rheumatology out-patient department from the
              Leeds General Infirmary to Chapel Allerton Hospital.

     i)   Health & Safety Management Policy
          Mrs Bailey explained that the Health & Safety Management Policy had
          been revised to ensure that the Trust would meet the Health & Safety
          Executive’s requirements. Recent changes reiterated and re-
          emphasised existing roles and responsibilities for Health & Safety with
          clear links to the Standards for Better Health. The policy changes would
          be supported by awareness-raising and the provision of all necessary

             Mr McKay paid tribute to Mr Lilley and his staff for their involvement in
             the changes to the policy, which received Board endorsement.

      ii)    Serious Untoward Incident Policy
             Mrs Bailey briefed the Board on key changes to the Serious Untoward
             Incident Policy, including the involvement of named Board Directors,
             the establishment of a rota of lead investigators, and the use of a robust
             audit trail. Linkages to the “lessons learned” process were discussed
             briefly and the revised Serious Untoward Incident Policy received the
             Board’s endorsement. It was agreed that the policy would be
             implemented from 1st April 2006 to enable delivery of the
             implementation plan.

     Mr Chapman told the Board that the Trust’s current forecast overspend was
     down from £12m to between £6m and £8m. Figures for the first half of the
     year showed that income and activity was holding up well against forecasts.
     PCT decommissioning plans had not adversely affected income and the PCTs
     had recently acknowledged that they would not achieve their projected levels
     of decommissioning.

      Mr Chapman warned the Board that expenditure was not falling quickly
      enough to achieve financial balance by the year-end. During September,
      spending on payroll had remained static and payroll numbers had fallen by
      41 whole time equivalents but bank and agency spend had increased by
      £100,000 and non-pay expenditure by £450,000. Analysis was currently
      ongoing to identify any cost runaways.

      Directors of Operations outlined a series of actions designed to bring spending
      back on track, including:-
          Plans for reducing bank and agency spend by £3m over the last five
             months of the financial year
          A tightening of recruitment restrictions and more flexible use of staff in
             order to save an additional £3m on payroll costs
          Proposals to save £1m on non-pay costs.

      The Board discussed the Trust’s ability to make the necessary recurrent
      savings. Directors of Operations explained that workforce plans taking
      account of this need were to be agreed with the CMTs over the next few
      months. Mr McKay stressed the need for the Trust to achieve financial
      balance recurrently, observing that the Trust was now very near to achieving
      this without any external financial support.

     Mr Patten reported that the Trust had met key access targets in September in
     relation to A&E waits, rapid access chest pain clinics and revascularisation.
     Other performance successes included:-
          A reduction in MRSA bacteraemia from 51 during April-June to 33
            during July-September.
          Significant progress towards the new December waiting time targets for
            in-patients (6 months) and out-patients (13 weeks).
          A fall in the number of cancelled operations.

      The Board was told that the Trust still faced significant challenges in some
      areas, notably:-
           Meeting new cancer waiting time targets from December (31 days from
             diagnosis to treatment and 62 days from urgent referral to treatment)
           Meeting the December target of 100% elective and out-patient
             booking. Current performance was around 67%.

      A report was also presented on progress towards meeting the targets within
      the “Care, Environment and Amenities” domain of the Standards for Better
      Health. Whist the Trust did not yet meet this standard in full, good progress
      was apparent in relation to fire training, zero tolerance of abusive behaviour,
      replacing Nightingale Wards and maintaining ward cleanliness.

      Mr Mack asked about the possibility of elective surgery cancellations in
      January. It was explained that the Trust’s Winter Plan included the ability to
      flex admissions whilst still achieving access targets and also included the
      creation of additional capacity for medical patients.

      The Board welcomed the continued good performance in relation to the 4-hour
      target. It was explained that the Winter Plan included city-wide contingency
      arrangements and these would be accelerated in the near future.

     Mr McKay briefed the Board on the following items:-

      i)     R&D
             The Trust’s bid to establish a clinical research facility on the St James’s
             site had been short-listed.

      ii)    Making Leeds Better – Gateway Review
             The recent report had been very complimentary about project
             management arrangements. It was agreed that the report would be
             distributed with the next set of Board papers.

      iii)   Board Development
             It was confirmed that further discussions were to be organised with
             Anthony Owens. Non-Executive Directors were to be represented by
             Mrs Silverstone and Dr Kaye.

      iv)    Consultation on Adult Social Care in England
             There was a need to understand the impact on the Trust fully, along
             with any potential opportunities. A briefing was to be provided for the
             Board in due course.

     The Board received the following papers:-
         Preparedness for Foundation Trust Status
         Minutes of the Audit Committee meeting held on 16th September 2005
         2006 Board Meeting dates and venues
         Use of the Trust Seal


      i)     Agenda for Change
             Ms Allsop expressed confidence that the Trust was on track to achieve
             its December targets.

      ii)    Electronic Staff Record
             Ms Allsop reported that the first weekly payroll had recently been
             produced successfully and the level of queries had been no greater
             than usual.

      iii)   Mr Keith Lilley
             Mr McKay reminded the Board that Mr Lilley was attending his final
             Board meeting prior to taking up a new position with the University of
             York. He thanked Mr Lilley for his contributions to the Trust over the
             years and wished him every success in the future.

     It was confirmed that the next Board meeting would take place on Thursday,
     1st December 2005 at 9:30 a.m. in the Board Room at St James’s Hospital.

     The Board resolved that because the publicity of subsequent business would
     be prejudicial to the public interest, representatives of the press and public
     should be asked to withdraw from the meeting.


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