Minutes of the Meeting of the Board of Directors by P068jl


									                       Minutes of the Meeting of the Board of Directors
                               held on Friday, 3 February 2012
                 in the Fred and Ann Green Board Room, Montagu Hospital

Present:                    Mr C Scholey      Chairman
                            Mrs N Atkin       Non-Executive Director
                            Mr J Barnes       Non-Executive Director
                            Dr R Bolton       Medical Director
                            Mrs H Bond        Director of Nursing & Quality
                            Mrs G Broderick   Non-Executive Director
                            Mr R Calvert      Chief Executive
                            Mr D Crowe        Non-Executive Director
                            Mr J Parker       Non-Executive Director
                            Mr D Pratt        Director of Finance, Information & Procurement

In attendance:              Mrs H Brand       Communications Manager
                            Ms M Dixon        Head of Corporate Affairs
                            Mr I Greenwood    Director of Strategic and Service Development
                            Mrs S Michael     Trust Minute Secretary
                            Mrs L Rothwell    Director of Performance
                            Mrs H Selvidge    Deputy Director of Human Resources

Governor Observers:         Mr J Humphrey     Patient Governor
                            Mr D Shaw         Public Governor – Doncaster
                            Mr H Taylor       Public Governor – Doncaster
                            Mr G Webb         Public Governor – Doncaster

            Apologies for Absence
C/12/02/1   Mr J Brayford
            Register of Directors’ Interests
C/12/02/2   No changes reported.
            Minutes of the Meeting held on 3 January 2012
C/12/02/3   The minutes of the meeting held on 3 January 2012 were APPROVED as a true
            and accurate record, and were accordingly signed by the Chairman, with the
            following amendments:

C/12/02/4   (C/11/12/73) Mr Barnes noted for the record that the minutes bound in at the
            December 2011 meeting were updated by the paragraph on charitable funds.

C/12/02/5   (C/12/01/06) Where it reads “Yorkshire and Bassetlaw”, this should read “South
            Yorkshire and Bassetlaw sub-regional business case.

C/12/02/6   (C/12/01/59) This paragraph to be amended to read “Mr Barnes noted the good
            work carried out to remove systemic overtime, and asked what action was being
            taken to reduce the number of consultant PAs. He had noted that some
            consultants were being paid on a block basis for 26 PAs in return for working a
            maximum of 20 PAs. Mr Calvert replied that a working group had been set up to
            investigate where PAs were allocated across the Trust, although he advised that
            those with a higher number of PAs were few and far between and it was not
                                                  Page 1
             possible for every consultant to be restricted to 10 PAs.”

C/12/02/7    (C/12/01/68 i) This paragraph should read “It was proposed to use the same
             strategy in 2012/13 as was used in 2011/12. Mr Calvert would be leading a
             refreshment of the strategy during the year.”

             Matters Arising from the minutes of the meeting held on 3 January 2012
C/12/02/8    None
             Chairman’s Correspondence
C/12/02/9    i)     Several members of the public attended the Board of Governors meeting
                    held on 31 January 2012 and the meeting went well. Mr Crowe was re-
                    elected as a Non-Executive Director for a further term of office from 1 April
                    2012 to 31 March 2015.

C/12/02/10   ii)    The next Board of Governors timeout would be held on 9 March 2012.

C/12/02/11   iii)   Recruitment of Executive Directors had progressed and interviews would be
                    held on 28 February and 1 March 2012.

C/12/02/12   iv)    A Monitor visit would take place on 30 April 2012.
C/12/02/13   v)     Mr Scholey had attended a training event on Ward C2 where he noted the
                    increasing willingness to improve practice and performance.

C/12/02/14   vi)    Mr Scholey had attended a recent meeting of Ward Sisters and was pleased
                    to see that they had received a presentation on mortality by Mr Cuschieri.

             The Chairman’s Report was NOTED.
             Chief Executive’s Report
             Mr Calvert reported on the following:
C/12/02/15   i)     College of Emergency Medicine (CEM) Visit – A review visit had been held
                    on 25 January 2012. Terms of Reference had previously been agreed and
                    the CEM had been provided in advance with relevant material concerning
                    patient numbers, performance, existing and previous service models and
                    staffing profile. The PCT’s Chief Operating Officer and a number of GPs had
                    attended the review.

C/12/02/16          A formal report was awaited and a follow up visit would be undertaken at
                    Easter. The Trust had already carried out a number of actions which the
                    CEM would have recommended and they were pleased to see how well the
                    rest of the Trust had responded. They advised that consultants should be
                    more frontline and recommended an increase of 6 consultants, bringing the
                    total to 12, with increased support for registrars.

C/12/02/17          The CEM had recommended that the Trust should concentrate on achieving
                    improvements at DRI in the first instance, and agreed with the proposal that
                    one pool of consultants should be on-call for both Bassetlaw and DRI. It was
                    noted that A&E Consultants had an overwhelming workload and one of the
                    top priorities while building the workforce and implementing changes, would
                    be to provide them with more support.

                                                     Page 2
C/12/02/18          Increasing support for Specialist Registrars was a Trust-wide issue. Mr
                    Scholey advised that he was proposing to include training as a specific issue
                    in the Chief Executive’s objectives for 2012/13. It was necessary to improve
                    training facilities to attract trainees to the Trust.

C/12/02/19          In response to a query from Mr Parker, Mr Calvert replied that the response
                    from consultants regarding the review had been positive. A number of
                    events, to be attended by members of the Executive Team, Clinical Directors
                    and General Managers, had been scheduled to discuss business planning
                    objectives which would include the requirement to increase the consultant
                    workforce. Actions would also be built in to ensure that registrars received
                    more support. The Board of Directors would be adopting a refreshed
                    strategy in the Autumn and a Management Board timeout was to be
                    arranged to discuss this and other topics of importance.

C/12/02/20          Mr Crowe asked if CEM had confirmed that the steps the Trust had taken
                    were the right ones or were there other things which the Trust could be
                    doing. Mr Calvert replied that they had said that a lot of good work had
                    already been undertaken. It was noted that following Mrs Rothwell’s input
                    into the A&E service in November, significant improvements had been made,
                    although it was felt that primary care should be doing more. It was unlikely
                    that the PCTs would be able to reduce attendance at A&E and therefore the
                    Trust’s systems should be geared up accordingly. Mrs Bond added that the
                    new 111 telephone service which was in place in other parts of the country
                    should deflect some people from A&E.

C/12/02/21          Mrs Broderick requested that the induction programme be reviewed as there
                    appeared to be no sense of welcome at the Trust. Mr Scholey replied that
                    this had started to happen and he and Mr Calvert had arranged some
                    informal lunch sessions to meet with consultants who had joined the Trust   BB
                    from January 2010 onwards. It was agreed to discuss the induction process
                    in more detail at a Board Briefing session.

C/12/02/22   ii)    Breast implants – No women had been given the PIP implants directly by this
                    Trust, although patients did receive the implants at Park Hill Hospital, which
                    is operated by Ramsay Health Care who lease the site from the Trust.
                    Ramsay would be offering all patients affected, with appropriate support and
                    assistance, including a free consultation and screening scan with a specialist
                    breast surgeon. Following discussion with a surgeon, if women wished to
                    have their PIP implants removed and replaced then Ramsay would
                    undertake the surgery at no cost to the patient or the taxpayer.

C/12/02/23   iii)   Academic Health Science Networks – A recent paper, launched by the
                    Department of Health entitled “Innovation, Health and Wealth – accelerating
                    adoption and diffusion in the NHS” would attempt to drive reconfiguration as
                    part of the agreement to shift care and move away from small provider units.
                    This was believed to be a significant threat to the Trust. At a recent meeting
                    on 9 January 2012, it was proposed to establish a Sheffield/South Yorkshire
                    AHSN which would encompass all acute and mental health trusts in South
                    Yorkshire, the Universities and a GP provider representative. Sheffield
                    Teaching Hospitals would be developing a paper to be shared with
                    colleagues in February, with a view to deciding whether a collective bid could
                    be developed.

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             The Chief Executive’s Report was NOTED.
             Quality Report
             Mrs Bond reported on the following:
C/12/02/24   i)    The following were within trajectory:

                      HCAI: MRSA and C.Difficile – from an unconfirmed report it was noted
                       that there had been 6 cases of C.Difficile in January 2012 and no cases
                       of MRSA
                      Patient Falls
                      Complaints regarding attitude of staff
                      VTE Risk Assessments

C/12/02/25   ii)   There was concern regarding the following:

                      Healthcare Acquired Pressure Ulcers within a hospital setting – The
                       number of ungradable pressure ulcers acquired whilst an inpatient
                       continued to rise. One Grade 3 pressure ulcer and two Grade 4
                       pressure ulcers were reported which had resulted in the loss of part of
                       the CQUIN payment. Root cause analysis was being undertaken and
                       learning would be identified from this.

                      Cardiac Arrests – 25 cardiac arrests occurred during December 2011
                       and a brief analysis was provided. Case note reviews were undertaken
                       on 12 patients and no concerns were raised regarding care.

C/12/02/26         In response to a query from Mr Parker regarding the delay in reporting, Mrs
                   Bond explained that it was a process issue relating to Critical Care not
                   alerting the risk office of the occurrence of a Category 4 pressure ulcer in a
                   timely manner, although it was noted that this was completion of a weekly
                   return over the Christmas/New Year period.

C/12/02/27         Mrs Broderick enquired how much impact the reduction in the specialist
                   Tissue Viability team had had. Mrs Bond replied that there was currently one
                   specialist nurse in post. The two “task force” roles had terminated, therefore
                   only serious and complex issues could be addressed and direct support to
                   CSUs could no longer be undertaken. A business case to increase capacity
                   in the Tissue Viability service was progressing through BSG. Although many
                   specialties agreed that the service was necessary, some CSUs were
                   overspent and were unable to support the proposal; therefore this
                   requirement would go through the 2012/13 budget setting process.

C/12/02/28         Mr Pratt was proposing, within the budget setting process, to identify a
                   centrally held sum for financing smaller projects such as this.

C/12/02/29         In response to a query from Mr Crowe, Mrs Bond agreed that the Trust had
                   been too optimistic with regard to the trajectory, as it had hoped to achieve a
                   significant improvement. The increase in pressure ulcers in November and
                   December was cyclical and it was noted that staff were much more aware
                   and were identifying more occurrences. Criteria definitions were being
                   investigated and it was noted that commissioners recognised the amount of
                   work being undertaken by the Trust.

                                                    Page 4
C/12/02/30          Mr Barnes requested information regarding the root cause analyses in next         HB
                    month’s Quality report.

C/12/02/31   iii)   Complaints – There had been shared learning with regard to the good results
                    shown by Women’s and Maternity Services and Orthopaedics. Mrs Bond
                    advised that on page 12 of the report, line 4 of the text relating to clinical
                    care complaints should read that Nursing and Medical staff were the ‘main
                    groups’ who deliver clinical care, rather than the only group as stated.

C/12/02/32          Mr Calvert reported that the process regarding complaints had changed and
                    CSUs were taking direct responsibility for writing and co-ordinating
                    responses before sending a draft to the central office which was an incentive
                    to try to avoid complaints. Mr Calvert continued to sign every complaint and
                    there had been a slight improvement in numbers. Increased focus would be
                    put into areas which were outliers.

C/12/02/33          With regard to the accountability meetings, Mrs Atkin reported that a letter of
                    apology had been received from the General Manager of A&E who had not
                    yet attended an accountability meeting. Some CSU action plans had been
                    received, although it was thought they contained too much dialogue and not
                    enough target setting to ensure that outcomes could be seen.

C/12/02/34   iv)    VTE – The final position recorded for December 2011 was 96.5% against the
                    national trajectory of 90%. It was noted that the local CQUIN target was
                    100% which the Trust had missed by one set of records in quarter and would
                    therefore lose part of the CQUIN income.

C/12/02/35   v)     Out-Patient Survey – A number of downward trends were noted.

C/12/02/36   vi)    In-Patient Survey - Mr Parker commented that the Trust had reported that it
                    had not breached the Eliminating Mixed Sex Accommodation guidance, yet
                    15% of patients had reported that they had shared patient accommodation
                    with people of the opposite sex. Mr Barnes queried why there was a sudden
                    increase in numbers in December. Mrs Bond explained that this was likely to
                    be patient perception as there had been no areas which had experienced
                    unjustified mixing of sexes. Mrs Atkin suggested that there might be
                    communication issues with some patients. Mrs Bond would investigate               HB
                    whether patients were being correctly advised of the guidelines.

C/12/02/37   vii) Picker Outpatient Survey 2011 – Results of the findings from the National
                  Outpatient Survey 2011, presented, which compared data against other
                  Trusts and also the Trust’s performance in 2009. It was anticipated that the
                  Picker data would be fed into the CQC report, which was to be published on
                  14 February 2012.

C/12/02/38          It was recognised that there were a number of areas where more work
                    should be carried out. Mrs Bond agreed to circulate a detailed report by
                    specialty where available. Two Matrons would be attending a national              HB
                    workshop to learn from other organisations.

C/12/02/39          With regard to sending letters to patients (copies of letters sent between
                    hospital doctors and GPs), it was believed that the Trust was disadvantaged
                    by the question asked, as an ‘opt in’ process was operated by the Trust.
                                                     Page 5
C/12/02/40   vi)   Mortality – Dr Bolton explained the new process which had been developed
                   with regard to analysis of weekend deaths. Data on each death was
                   circulated to the Review of Mortality Group, Mr Cuschieri, individual
                   consultants and Clinical Directors for analysis. Information was provided
                   regularly to the Patient Safety Review Group and the Clinical Governance
                   Standards Committee to see what lessons could be learned.

C/12/02/41         Dr Bolton advised Mr Scholey that availability of consultants at weekends
                   had not been identified as a factor impacting on deaths at weekends. Dr
                   Bolton added that junior doctor training, perception and attitude was
                   changing, EWTD rotas were causing difficulties with continuity of care and
                   significant work was being carried out to promote better team working
                   between consultants and trainees.        It was noted that the working
                   environment at the Trust was highly intensive, with some consultants feeling
                   pressured and unable to take enough time with their juniors.

C/12/02/42         Following publication of the Dr Foster data, two audits had been carried out
                   and results from these showed that there were no different problems at
                   weekends than during the week. Work to try to improve practices where
                   patients were deteriorating continued.

C/12/02/43         Mrs Rothwell advised that the issue about senior decision maker availability
                   at weekends had been recognised and considerable work had been carried
                   out. Dr Noble, Clinical Director for General and Acute Medicine had moved
                   a number of sessions into weekends and had ensured that senior doctors
                   were available 7 days a week.

C/12/02/44   vii) Fractured Neck of Femur – In response to a query from Mrs Broderick, Dr
                  Bolton advised that the best practice tariff figures were not nationally
                  published, although information was available relating to the Yorkshire and
                  Humber region. It was noted that significant work had been put in at both
                  Bassetlaw Hospital, which had shown a 10% improvement, and DRI and
                  both sites were working hard to improve performance.

C/12/02/45   viii) CQUINS – Quarter 2 update – With regard to encouraging staff to stop
                   smoking, it was noted that the Staff Health and Wellbeing Group were
                   addressing this issue at their quarterly meetings. With regard to the CQUINs
                   target of 33% of smokers receiving advice which was based on a survey of
                   smoking patients, Mr Barnes asked if this target should be revised to 100%.    HB
                   Mrs Bond to contact Mr Barnes following the meeting with clarification.

             The Quality Report was APPROVED.
             Financial Performance Report as at 31 December 2011 (Month 9)
             Mr Pratt reported on the following:
             Corporate Trading Position
C/12/02/46   The Trust recorded a trading surplus of £1.731m, which was in-line with the
             original and re-phased plans for the year to date.

C/12/02/47   The reported £317k surplus in month was artificially inflated by the impact of a
             nationally required change in accounting treatment showing an actual gain in the
             December position of £231k, giving a surplus in-month of £86k. Monitor would
                                                   Page 6
             make adjustment for any technical gains/losses when calculating the Trust’s risk
             assessment, therefore a surplus of £3.4m would be required to demonstrate
             delivery of the original plan.

C/12/02/48   Income receivable to date of £247.715m was £5.660m above plan, although only
             £91k related to the afore-mentioned technical change. On a like-for-like basis,
             income performance was down by £563k on the monthly average for the year,
             against an expectation of £300k.

C/12/02/49   Pay costs remained broadly in line with previous months, although there was a
             rise from £18.141m to £18.212m in December. There was an increase in agency
             spend of £62k relating principally to A&E and Paediatrics.

C/12/02/50   Overtime (£79k) and additional sessions (£96k) were at new lows for the year.
C/12/02/51   Savings of £1.674m achieved was a small increase on previous months and this
             level was required for the final 3 months of the year. However reduced
             achievement of £1.455m was reported due to the loss of CQUIN income relating
             to failure against the pressure ulcer target.

C/12/02/52   A number of schemes would be online in January, significant savings were
             anticipated from the implementation of social care redesign.

C/12/02/53   The first two weeks of trading by the outsourced Co-op outpatient pharmacy had
             been successful, resulting in higher gain share returns to the Trust than outlined
             in the business case.

C/12/02/54   Mr Pratt advised that he believed that the Trust was in a positive position to
             achieve savings of £1.7m over the next 3 months, providing that strong cost
             control was maintained throughout the Trust.

C/12/02/55   The final income position with Doncaster PCT would be signed off in the next few
             weeks. The PCT would be making a £2m payment with regard to outstanding
             over-performance work. The Trust would be receiving £800k from Doncaster
             PCT and £200k from Bassetlaw PCT with regard to reducing waiting times across
             a range of surgical specialties from now to the end of the year.

C/12/02/56   Mr Crowe asked if the e-rostering scheme had been rolled out to all wards and
             what general savings were expected. Mr Pratt responded that a review had taken
             place with regard to base establishments and a paper had been presented to
             Management Board in November 2011.

C/12/02/57   Mr Crowe had been informed that there were significant grievances regarding the
             impact which e-rostering had had on staff and work patterns. Mrs Selvidge was
             unaware of this and reported that the e-rostering project had a great deal of
             support from the workforce for implementing limits and rules regarding core
             working hours and standardisation of working patterns. From feedback she had
             received, there were no formal grievances from either staff or staff side

                                                  Page 7
             The Financial Performance Report was APPROVED.
             Service Performance Report as at 31 December 2011 (Month 9)
             Mrs Rothwell reported on the following:
C/12/02/58   Monitor/Headline Targets – The Trust had achieved the targets with regard to
             C.Difficile, MRSA and Cancer targets.

C/12/02/59   IND109a: Referral to Treatment Waits (Median Wait Measures) – Admitted 18
             week target - all Trust targets had been achieved, although there were issues
             within GI and Ophthalmology, and also a capacity and demand issue in General

C/12/02/60   IND112b(ii): A&E total time in A&E 95th Percentile - The high incidence of
             Norovirus had impacted on performance, due to a large proportion of beds at DRI
             being unavailable.

C/12/02/61   IND115 and IND115a: Emergency Re-admissions within 30 days (Prior Elective
             and Prior Emergency) - A detailed project was well underway and an
             improvement was starting to be shown. A comprehensive report on re-                 LR
             admissions by specialty would be developed by the end of the financial year.

             Integrated Performance Measures for National Oversight
C/12/02/62   IND118: Cancelled Operations – An area of concern as significant cancellations
             had occurred due to bed constraints caused by the Norovirus outbreak.

             Supporting Measures – Quality (Safety, Effectiveness and Patient Experience)
C/12/02/63   IND111: Implementation of Stroke Strategy – TIA Patients Assessed and Treated
             within 24 hours – This target was of significant concern and although a number of
             additional sessions had been carried out, it was likely that the PCT would issue
             the Trust with a Performance Notice. Capacity had been underestimated and the
             Trust was now carrying out 3 sessions per week instead of the one session
             previously carried out. The issue was being dealt with by an Executive Director
             and the position would be improved upon.

C/12/02/64   IND153: Infant Health & Inequalities Breastfeeding Initiation – An improvement
             was starting to be seen.

             Supporting Measures - Resources
C/12/02/65   IND141: GP Referrals – The cumulative year to date position had increased

C/12/02/66   CSU Dashboard – The CSU dashboard for General Surgery was noted.
C/12/02/67   CQC Quality Risk Profile – Mrs Rothwell reported that information regarding the
             high red risk relating to Outcome 11 had now been submitted to CQC.

C/12/02/68   Mr Scholey and Mr Calvert thanked Mrs Rothwell for her work in A&E to improve
             performance in 8 of the 9 indicators.

C/12/02/69   Mr Calvert noted that he remained concerned about 4 areas of performance:

                     Total time in A&E – Throughout the year the Trust had not achieved the
                                                  Page 8
                        4-hour wait for admitted patients – he felt that CSUs had significant
                        work to do to support A&E and achieve this target.
                       Emergency Re-admissions – The Trust was an outlier and increased
                        pace would be vital to enable to achieve the associated income. Mrs
                        Rothwell responded that in comparison with data from Dr Foster the
                        Trust was performing significantly better than reported.
                       Stroke Strategy – This was a high profile indicator and Mr Calvert felt
                        that there had been poor capacity planning which should be addressed.
                       Day Case Procedure rate – Mr Calvert felt that 70% was too low and
                        should not have been impacted upon by the outbreaks of norovirus.

C/12/02/70   Mr Calvert felt that poor performance was a symptom of poorly organised
             services and there was a significant issue with the planned and operational
             delivery of those services. Mrs Rothwell was asked to prioritise these areas for
             next year and Mr Greenwood was asked to ensure that there was adequate
             emphasis on the need to capacity plan and to revise the associated underpinning
             of systems and processes.

             The Service Performance Report was APPROVED.
             Capital Performance Monitoring Report as at 31 December 2011
             Mr Pratt reported on the following:
C/12/02/71   i)     Capital expenditure for the first three quarters of the 2011/12 financial year
                    was £7.966m.

C/12/02/72   ii)    Total funds available as at 31 December 2011 were £17,897, predicated on
                    £1m receipts of which £672,000 had been reserved. £300k was held in
                    reserve to offset potential undershoot.

C/12/02/73   iii)   The main areas of undershoot were: IT/computers, pharmacy automation,
                    Bassetlaw Breast care, the education centre and the day surgery facility.
                    The first three areas were projected to return to the budgeted level of
                    expenditure for the year in the last quarter. There would be a smaller
                    undershoot on the education centre at the end of March than in December.

C/12/02/74   iv)    The schemes which were behind profile were partially offset by the Estates
                    Strategy work which was ahead due to the expedition of the first phase of the
                    Bassetlaw A&E development and the refurbishment work on Ward 18 at DRI.

C/12/02/75   The forecast year-end outturn predicted a £1.285m undershoot, of which three
             schemes should return to the budgeted level of expenditure in the last quarter
             and the other two being:

                        An undershoot of £200k on the education centre as reported at the end
                         of the second quarter;
                        An undershoot was yet to be identified with regard to the development
                         of the Theatre/Day Surgery scheme. The Trust was working through
                         and finalising a revised scheme to ensure that single sex compliance
                         was addressed and achieved.

C/12/02/76   Mr Pratt advised that the principle of developing the day surgery facility was
             acceptable as the incentive to carry out day cases would increase. The scheme
             would be reviewed and carried forward to next year. The undershoot was well
                                                     Page 9
             within the Monitor tolerance levels.

C/12/02/77   Mr Barnes asked if the Trust was spending enough money on replacement of
             medical equipment. Dr Bolton replied that the Medical Equipment Group held a
             register of all medical equipment in the Trust which was monitored and
             equipment was replaced as necessary. It was estimated that the Trust would
             need to spend around £25m to bring all medical equipment up to date. There
             was no automatic replacement plan for when equipment reached a certain age
             and maintenance was carried out via service agreements or internally by Trust
             maintenance staff.

C/12/02/78   In response to a query from Mr Parker, Dr Bolton replied that he was not
             concerned about the age of equipment per se, as long as it was fit for purpose.
             The Medical Equipment Group was regularly briefed with regard to equipment
             which required replacement.

C/12/02/79   In response to a query from Mr Crowe, Dr Bolton suggested that an additional
             £5m would make a significant difference, and £10m would revolutionise the         BB
             equipment stock. It was agreed to discuss this further at a Board Briefing. Mrs 23.04.12
             Bond advised that the Capital Equipment Budget related to items over £5k and
             there was a large amount of equipment which cost less than this which required
             replacing. Mr Calvert suggested that the business planning process would take a
             strategic view of capital requirements and would feed into the business plans

             The Capital Quarterly Report as at 31 December 2011 was APPROVED.
             Human Resources Quarterly Report as at 31 December 2011
             Mrs Selvidge reported on the following:
C/12/02/80   i)     Sickness absence for quarter 3 of 2011/12 was 3.89%, which was slightly
                    above the 3.5% target. The cumulative rate for the year was currently
                    3.74%. Areas which had exceeded the target continued to be reviewed.

                    47 staff had been recorded as being off sick for 90 days or more, although of
                    these 10 had since resigned, been dismissed on the grounds of ill health, or
                    had returned to work in the first 3 weeks of January 2012.

                    From benchmarking data accessed via the Strategic Health Authority,
                    overall, the Trust compared favourably to other Foundation Trusts.

C/12/02/81   ii)    141 staff left post in Quarter 3, with the majority of staff leaving as a result of
                    retirement or cessation of fixed term contracts. In addition, 11 staff had been
                    dismissed from employment by reason of either capability or conduct. In
                    total 3 staff were made redundant during the quarter.

C/12/02/82   iii)   The table of individual and collective grievances submitted was noted, as
                    was the table relating to appeals.

C/12/02/83   In response to a query from Mr Crowe, Mrs Selvidge anticipated that the sickness
             rate at 31 March 2012 would be approximately 3.8%.

C/12/02/84   The number of employee tribunal claims had increased over the last two years,
             although not all had progressed to a full hearing. This was thought to be a
                                                      Page 10
             significant risk to the Trust in the future.

             The Human Resources Quarterly Report as at 31 December 2011 was

             Transformation Report – Changes to Social Service provision
C/12/02/85   Mrs Rothwell reported that relationships with social care provision were much
             improved and following some process changes, there had been significant
             improvement with regard to length of stay.

C/12/02/86   Patients now followed two pathways and since implementation of these
             pathways, there had been a considerable increase in the number of patients who
             had been discharged home, saving an average of 150 bed days in just over one
             month, which equated to a reduction of 40-50 beds over a six-month period.

C/12/02/87   It was agreed to cascade and publish this information as a ‘good news’ story.           LR

             The Transformation Report – Changes to Social Service Provision was

             Budget Setting 2012/2013
C/12/02/88   Mr Pratt explained the external context and National Tariff 2012/13 requirements
             and outlined the internal priorities and framework, and the proposed approach to
             contract negotiations and arrangements with commissioners.

C/12/02/89   The aim was to set budgets which promoted ownership, accountability and
             responsibility for delivery.

C/12/02/90   Development of a robust savings programme continued and CSUs had been
             asked to produce 6% efficiency plans. Existing and new cost-cutting and
             transformation schemes would also continue to be implemented.

C/12/02/91   The risks to delivering the budget for 2012/13 were noted.
C/12/02/92   Mr Greenwood welcomed the idea of a £1.2m general investment reserve to
             support future ‘invest to save’ pump priming and in year pressures, subject to
             business cases.

C/12/02/93   Mr Crowe requested that implementation of savings schemes should start at the
             beginning of the financial year. Mrs Broderick was concerned about future
             changes in the Trust’s income level and suggested that more work should be
             done at CSU level, on the impact on the Trust of care being provided closer to
             home and asked for financial modelling to be carried out. Mr Greenwood advised
             that in terms of outpatient pathways and care closer to home, a significant       IG
             amount of work had already been carried out with commissioners, which had        BoD
             been costed. It was agreed that Mr Greenwood would present a report on this to 06.03.12
             the Board.

             Budget Setting 2012/2013 was APPROVED.
             Governance and Financial Declaration to Monitor – Q3
C/12/02/94   The Quarter 2 bottom line income and expenditure position of £1.731m surplus
             was in line with the original Monitor plan phasing for the year to date, resulting in
                                                      Page 11
             a financial risk rating of 3. The Governance declaration for Quarter 2 remained

C/12/02/95   Mrs Bond commented that the indicator relating to ‘Compliance with requirements
             regarding access to healthcare for people with a learning disability’ should not be
             reported as N/A as it was relevant and the Trust was compliant with this indicator.
             This was noted.

             The Governance and Financial Declaration to Monitor – Quarter 3 was NOTED
             Equality Act 2010 – Publishing Requirements
C/12/02/96   Mrs Selvidge advised that the Trust had published information on the Trust
             website with regard to the Equality Act 2010 and had met its statutory duty. The
             general duties of the Act, and the way in which the Trust was addressing these
             duties were noted.

             The Equality Act 2010 – Publishing Requirements was NOTED.
             Reconfiguring the Montagu and Tickhill Road Hospitals
C/12/02/97   Mr Greenwood presented an update on the reconfiguration of Montagu and
             Tickhill Road Hospitals. The final decision by commissioners to progress the
             changes to some services was not expected until 20 February 2012.

C/12/02/98   A start date had yet to be agreed and it was noted that the build would take
             around 15 months to complete. Mr Tyson was currently working on the business
             plan, and when the cost of the development was known, an ad-hoc meeting
             would be organised of the Fred and Ann Green Charitable Fund Committee.

             Reconfiguring the Montagu and Tickhill Road Hospitals was NOTED
             Minutes of the Audit and Non-Clinical Risk Sub-Committee meeting held on
             16 December 2011

C/12/02/99   The minutes of the Audit and Non-Clinical Risk Sub-Committee meeting held on
             16 December 2011 were NOTED.

             Minutes of the Clinical Governance Standards Committee Accountability
             meetings held on 16 December 2011

C/12/02/100 This was the third quarterly accountability meeting held with the following CSUs:

             i)     General and Acute Medicine
             ii)    Children’s Services
             iii)   Ophthalmology
             iv)    Genito-urinary Medicine

C/12/02/101 In response to a query from Mr Barnes, Mr Pratt reported that a business case
             had been developed with regard to the difficulties experienced with
             Ophthalmology accommodation. It had been flagged as a risk on the CSU risk
             register and the corporate risk register and had been included in the business
             plan for 2012/13 and capital bids 2012/13.

C/12/02/102 Mrs Atkin was advised that Mr Cuschieri and Mrs Humphries had developed a
             schedule of indicators to assess the degree of progress.
                                                  Page 12
              The minutes of the Clinical Governance Standards Committee Accountability
              meetings held on 16 December 2011 were NOTED.

              Actions from the Previous Minutes
C/12/02/103 Actions from the Board of Directors meeting held on 3 January 2012 were
              reviewed and updated.

              Any Other Business
C/12/02/104 In response to a query from Mr Crowe with regard to car parking at Bassetlaw, Mr
              Scholey advised that there had been an update at the Board of Governors
              meeting on 31 January 2011. One of the issues which arose was a requirement
              to address the cost of parking for part-time staff.


              Date and Time of next Meeting
C/12/02/106 It was confirmed that the next meeting of the Board of Directors would be held at
              9am on Tuesday 6 March 2012 in the Fred & Ann Green Boardroom, Montagu

              Governor comment and questions
C/12/02/107 Mr Shaw was pleased to note that the Trust was investigating how to improve the
              out-patient facility at DRI.

C/12/02/108 Mr Webb noted the number of attendees at the public meetings with regard to the
              reconfiguration of Montagu and Tickhill Road Hospitals and requested an update
              on the respite care which had been provided at Tickhill Road Hospital.

              Mr Greenwood advised that 60 people had gone through an assessment process
              by RDaSH, who had managed the process well.

C/12/02/109 Mr Scholey reported that Mr Brayford would retire on 24 February 2012.         A
              presentation would be held in the Boardroom at 12.30pm on that date.

C/12/02/110 Mrs Selvidge would be leaving the Trust shortly and Mr Scholey thanked her for
              her work and wished her well in her new job.


              ………………………………………………… ……………………………………………………..
              Mr C Scholey        Date

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