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BD080501 – Written questions submitted in advance by the

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					              ROYAL UNITED HOSPITAL BATH NHS TRUST
            MINUTES OF THE PUBLIC TRUST BOARD MEETING
                     WEDNESDAY, 8 APRIL 2009
                  ANNETT ROOM, RICE CENTRE, RUH

Present:
Voting Directors
Moira Brennan, Non Executive Director
James Carine, Chairman
Michael Earp, Non Executive Director
Catherine Phillips, Director of Finance
James Scott, Chief Executive
Francesca Thompson, Director of Nursing
Peter Tomkins, Non Executive Director
John Waldron, Medical Director
Stephen Wheeler, Non Executive Director

Non-Voting Directors
Howard Jones, Director of Facilities
Brigid Musselwhite, Director of Planning & Strategic Development, Deputy
Chief Executive
Lynn Vaughan, Director of Human Resources

In Attendance
Alison Spears, Trust Board Secretary
Jill Tomkins, PPI Representative LINKs Banes and Wiltshire
Mandy Rumble, Matron – Emergency Department (Item 7 only)
Gareth Howells – Assistant Director of Nursing – Medicine (Item 7 only)

BD/09/04/01              Questions from the Public
None

BD/09/04/02      Apologies for Absence
Jonathan LLoyd, Non Executive Director

BD/09/04/03              Declaration of Board Member Interests
None

BD/09/04/04              Presentation withdrawn until May 2009

BD/09/04/05              Safeguarding Children including Haringey Review

The Director of Nursing presented the report and the Board noted:
• The Joint Area Review (JAR) action plan was included. The review gave
  positive assurance which was borne out by the Standards for Better
  Health feedback;
• The potential gaps identified at the RUH related to the following;
   Author: Alison Spears, Trust Board Secretary                 Date: 14 April 2009
   Document Approved by: Alison Spears, Trust Board Secretary          Version: 1.0
   Agenda Item: 8.1                                                     Page 1 of 9
       o Insufficient training records;
       o A need to review the level of child protection training given to
          relevant staff;
       o A need to review how safeguarding practice is monitored and
          what indicators should be used to monitor performance;
       o A need to review the level of reporting on safeguarding to the
          Trust Board
•   It was believed that the Trust had trained more staff than recorded and
    more rigour was required to ensure that appropriate records were kept.
    MLE captures training carried out through the Education Centre but not
    the expert based training carried out either internally or externally;
•   The Trust had made one referral to the Local Safeguarding Board but
    had not been one of the relevant parties;
•   A review of how external agencies work together will be undertaken;
•   The need for a robust whistle-blowing policy had been highlighted. The
    Trust had this in place but the effectiveness of the policy needed to be
    checked.

The Board NOTED the report.

BD/09/04/06               Children’s Hospital Services – Healthcare
                          Commission Follow Up Review 2008/09

The Chief Executive presented the report and the Board noted:

•   Standard S1A – only dedicated Children’s hospitals are able to achieve
    this standard;
•   The Trust had identified a need to concentrate its children’s services to
    ensure that it had an appropriate number of dedicated surgeons and
    anaesthetists;
•   As identified in paper 5.1 the Trust needed to do more in terms of
    training;
•   An audit had taken place regarding criminal record bureau checks and
    the Trust had been given significant assurance in this area.

The Board NOTED the report

BD/09/04/07               Investigation into Mid Staffordshire NHS
                          Foundation Trust

The Assistant Director of Nursing for Medicine and the Matron of the
Emergency Department gave a presentation on national recommendation
2 which was the main thrust of the report.

The Director of Nursing presented the report including Appendix 1 and the
Board highlighted the following in respect of the national guidance:

•   Recommendation 1: The Trust used Dr Foster’s Real Time Monitoring
    Author: Alison Spears, Trust Board Secretary                 Date: 14 April 2009
    Document Approved by: Alison Spears, Trust Board Secretary          Version: 1.0
    Agenda Item: 8.1                                                     Page 2 of 9
    Tool and had a Hospital Standardised Mortality Rate of 97.3 on
    average, monitored monthly by the Board;
•   Recommendation 2: Covered via the presentation which confirmed that
    the department was on target to recruit to establishment and had
    Divisional backing to increase the number of substantive consultants
    from five to seven;
•   Recommendation 3: the Trust had implemented the Executive
    walkabouts;
•   Recommendation 6: the Operational Governance Committee and the
    Clinical Governance Committee received relevant reports and
    representations in the various aspects of nursing care. National Metrics
    had not been published yet but the Patient Experience Tracker would
    further assist in measuring patient experience;
•   The last two recommendations focussed on not losing sight of
    operational matters when undertaking key change programmes such as
    an NHS Foundation Trust Application;
•   The Director of Nursing would lead on addressing the gaps identified in
    Appendix 1 and report progress via the Clinical Governance Committee.

It was confirmed that the Trust had a number of systems by which
performance could be measured some of which are led by the
professionals or specialisation rather than the Trust.

It was noted that the Divisional Performance Reviews focussed on
performance indicators which included the quality as well as target
outcomes.

The Board welcomed the presentation from the Emergency Department,
discussed the findings within the report and agreed that the Director of
Nursing should refine where necessary and then implement the actions
noted in Appendix 1.

BD/09/04/08         Minutes Public Trust Board Meeting
(i) Minutes of the Public Trust Board Meeting held 4 March 2009
The following amendments were noted:
Moira Brennan was in attendance,
Howard Jones was a non voting Director
Jill Tompkins gave apologies
Pg 6 paragraph under the action was removed
Second bullet under paper 13.3 amount should read £5.6m

After making the above changes the minutes were approved and signed
as a true copy by the Chairman.

(ii) Minutes of the Extraordinary Public Trust Board Meeting held 24 March
2009

The minutes were approved and signed as a true copy by the Chairman.
    Author: Alison Spears, Trust Board Secretary                 Date: 14 April 2009
    Document Approved by: Alison Spears, Trust Board Secretary          Version: 1.0
    Agenda Item: 8.1                                                     Page 3 of 9
BD/09/02/09               Action List and Matters Arising

Action 1: on the agenda, action can be removed.

Action 2: on the agenda, action can be removed.

Action 3: Purchasing had agreed to split the boxes of chloraprep, action
can be removed.

Action 4: Somerset PCT service level agreement had been signed, action
can be removed.

Action 5: Basingstoke had refused to accept claims that one of the Trust’s
MRSA bacteraemia cases had come from them, still ongoing but action can
be removed.

Matters Arising;

The Patient Experience Tracker data is planned to be included in the
quarterly report due in May.

BD/09/04/10      Chairman’s Report
The Chairman presented the report and the Board noted:

•   Jill Tompkins would now represent the LINKS for Banes and Wiltshire;
•   The Trust would be the first in England to have an online system for
    translation services including British Sign Language, coupled with deaf
    awareness training.
•   Francesca Thompson, Director of Nursing had been awarded a Florence
    Nightingale Scholarship.

The Board NOTED the report and congratulated Francesca Thompson,
Director of Nursing, on the award of a Florence Nightingale scholarship.

BD/09/04/11               Chief Executive’s Report

The Chief Executive presented the report and the Board noted:

•   The Trust was expecting a Ministerial Visit from Ben Bradshaw on the
    20 April to include a visit to the MRI / CT suite, the Emergency
    Department and the official opening of the Breast Unit;
•   Improving Outcomes Guidance: The process of evaluating the changes
    and costs involved in the two options identified to meet Improving
    Outcomes Guidance for gynaecology / oncology would start next week
    and was expected to last approximately two months.

The Board NOTED the report
    Author: Alison Spears, Trust Board Secretary                 Date: 14 April 2009
    Document Approved by: Alison Spears, Trust Board Secretary          Version: 1.0
    Agenda Item: 8.1                                                     Page 4 of 9
BD/09/02/12                  Assurance Committee Updates

(i)            Clinical Governance Committee

The Chair of the Clinical Governance Committee presented the report and
the Board noted:

•      The Committee had reviewed the evidence for the Standards for Better
       Health and were assured and able to recommend the declaration to the
       Board;
•      The Committee had agreed to extend the review dates of some policies
       where the content was still in use and valid;
•      Ophthalmic Serious Untoward Incident – during the internal
       investigation the Trust’s Medical Physics Team had discovered that the
       industry standard microscope light-filter settings were incorrect.
•      Risk management – the review of the Trust Wide risk register had not
       yet been completed but good progress had been made;
•      MHRA Blood Bank Inspection Report – the Trust was declared
       compliant following a visit on the 10 March 2009.

(ii)           Audit Committee

The Chair of the Audit Committee presented the report and the Board
noted:

•      PriceWaterhouse Cooper’s, the Trust’s new Internal Auditors, had
       produced a draft workplan which would be refined and adopted at the
       next Audit Committee meeting;
•      The Counter Fraud services report and 2009/10 workplan had been
       received. Any interested member could review the workplan.

(iii)          Non Clinical Risk Committee

The Chair of the Non Clinical Risk Committee presented the report and the
Board noted:

•      The European Working Time Directive action plan was still fragile;
•      the fire safety report had been received and an action plan would be
       taken to the Committee’s next meeting;
•      the Committee reviewed the Standards for Better Health declaration
       and spent time interrogating the evidence and was assured and able to
       recommend the declaration to the Board except in relation to standard
       C4c around decontamination where the Trust was awaiting the
       outcome of the Hygiene Code Inspection.

       Author: Alison Spears, Trust Board Secretary                 Date: 14 April 2009
       Document Approved by: Alison Spears, Trust Board Secretary          Version: 1.0
       Agenda Item: 8.1                                                     Page 5 of 9
(iv)           Charities Committee

The Chair of the Charities Committee presented the report and the Board
noted

•      Each of the Trusts charitable funds had prepared spending plans for
       2009/10 which were reviewed by the Committee;
•      The Committee requested that the Arts Strategy Group confirm its
       focus and ensure that its objectives were aligned to those of the Trust.

The Board NOTED the Assurance Committee updates.

BD/09/04/13                  Performance Monitoring

(i)            Trust Key Performance Indicators; and
(ii)           Performance Report

The Chief Executive presented the report and the Board noted:

•      4 hour target – year end position 97.63% which was an improvement
       on last year. The last few weeks had been difficult due to norovirus and
       diarrhoea and vomiting which resulted in loss of system benefits;
•      18 week target – the Trust achieved the year end target and was
       planning to meet 13 weeks by the end of June 2009;
•      MRSA – year end total was 26 which meant that the Trust met this
       target;
•      C.Diff – the Trust had achieved this target with 248 case against a
       target of not more than 269;
•      Hospital Standardised Mortality Rate – it was noted that this had risen
       in December but this remained within the expected range of month to
       month variation.
•      Nursing vacancy rate – this is improving and the Trust was on trend. A
       skill mix review was underway.

It was requested that the average waiting time for callers to the
Appointment Centre was included on the scorecard.
             Action: Director of Planning and Strategic Development

(iii)          Finance Report

The Director of Finance presented the report and the Board noted:

•      The Trust earned an additional £8m in income for the year which was
       reduced by £2.8m as agreed with the commissioners;
•      The Trust met its Capital Resources Limit and Capital Expenditure
       targets;
•      The Trust’s performance in paying suppliers under the Better Payment
       Practice Code improved in March after a fall in February;
       Author: Alison Spears, Trust Board Secretary                 Date: 14 April 2009
       Document Approved by: Alison Spears, Trust Board Secretary          Version: 1.0
       Agenda Item: 8.1                                                     Page 6 of 9
•   The Trust’s current cash position was healthy, however, as an NHS
    Foundation Trust there would be a requirement for higher levels of
    cash.

The Board noted the current and forecast financial performance against
the Trust’s financial duties (paragraph 1.1).

The Board noted the requirement from the SHA to achieve a control total
for the Financial year of £5.6m surplus (paragraph 1.3)

The Board noted the negotiations concerning the Performance Notice and
the resulting settlement for 2008-09 (paragraphs 2.2.6 – 2.2.8).

The Board noted the resolution of the Trust’s discussions with its auditors
and the SHA regarding Millennium expenditure (see paragraph 2.3.4).

The Board noted the expenditure to date against the capital resource limit
(section 4).

The Board discussed and understood the actions to mitigate the risks
(section 5).

The Board NOTED the performance reports.

BD/09/04/14               Standards for Better Health – Draft Final
                          Declaration 2008/09

The Director of Nursing presented the report and the Board noted:

•   The report provided the final Standards for Better Health Declaration
    for approval;
•   The three assurance committees had reviewed the evidence of the
    standards that they were responsible for and had recommended the
    declaration to the Board;
•   The Trust had received feedback from a number of stakeholders;
    feedback from the Overview and Scrutiny Committee was generally
    more positive.
•   The Trust was still awaiting the report following the Hygiene Code
    Inspection from the Healthcare Commission and would review the
    report before declaring assurance on standard C4c;
•   The Chief Executive had minor concerns around standard C2 but these
    concerns were not material;
•   A letter had been received from Concordat which presented the view of
    10 auditors / regulators on the Trust’s performance which showed no
    concerns.

The Chairman and Chief Executive, with support from the Director of
Nursing could decide on the level of compliance around C4c once the
    Author: Alison Spears, Trust Board Secretary                 Date: 14 April 2009
    Document Approved by: Alison Spears, Trust Board Secretary          Version: 1.0
    Agenda Item: 8.1                                                     Page 7 of 9
Healthcare Commission report was received the Board APPROVED the
Standards for Better Health declaration.
           Action: Chairman / Chief Executive / Director of Nursing


BD/09/04/15               Review of Standing Orders, Standing Financial
                          Instructions, Scheme of Delegation and Terms of
                          Reference for Reporting Committees

The Chairman and Trust Board Secretary presented the documents and
the Board noted:

•   The Standing Orders, Standing Financial Instruction and Scheme of
    Delegation had been reviewed by the Audit Committee;
•   The Standing Financial Instructions had only minor amendments;
•   The Standing Orders had been updated in line with the Department of
    Health’s model;
•   The Scheme of Delegation focussed on delegation from the Board and a
    separate document should be provide for further delegation to staff;
•   The Terms of References for all committees had been approved by the
    relevant committee except for the Remuneration Committee.

The Board APPROVED and ADOPTED the Standing Orders, Standing
Financial Instructions and Scheme of Delegation and Approved the Terms
of Reference for the Audit Committee, Charities Committee, Clinical
Governance Committee, Non Clinical Risk Committee, Remuneration
Committee and Management Board.

BD/09/04/16               Business case for a new consultant anaesthetist
                          to lead central pre-operative assessment

The Chief Executive presented the Business case and the Board noted:

•   Management Board had reviewed the financial implications which were
    positive;
•   The post would provide senior clinical leadership in the department.

The Board APPROVED the business case but wished to see fuller details in
future cases.
                                      Action: Trust Board Secretary

BD/09/04/17               Staff Survey

The Director of Human Resources presented a summary of the staff
survey findings and provided the following handouts:

•   08 Staff Survey Results; and
•   HSE: Tackling Stress
    Author: Alison Spears, Trust Board Secretary                 Date: 14 April 2009
    Document Approved by: Alison Spears, Trust Board Secretary          Version: 1.0
    Agenda Item: 8.1                                                     Page 8 of 9
The Board NOTED the presentation and handouts.


BD/09/04/18               Annual Disability and Gender Equality Report

The Director of Human Resources presented the report and the Board
noted:

•   The Annual Report was presented to comply with statutory equalities
    duties and demonstrated progress in embedding the understanding of
    the statutory equalities duties
•   More education and training was required to increase awareness;
•   Key developments had been taken forward during 2008/09;
•   The Central Pre-operative Assessment Department would assist in
    increasing the level of data captured;
•   Currently there was no statutory duty to patients around age.
    Patientline is currently not installed in the Older People’s Wards due to
    the fact that Patientline’s national policy is not to install the system into
    areas which, in it’s view were not financially viable.

The Board NOTED the report

BD/09/02/19               Review of Board Performance

The Chairman reviewed the Board performance and was content that time
had been spent on the priorities of the business and the agenda had been
covered effectively.

BD/09/02/20               Any other business

Jeremy Martin, Head of Business Development and Improvement had
been successful in his application for the Director of Strategy position at
Yeovil District Hospital NHS Foundation Trust. The Board wished him luck
in his new position.

BD/09/02/21      Date of Next Meeting
The next meeting of the Trust Board would be held on 13 May 2009,
Annett Room, RICE Centre.


The meeting closed 13:00.



Signed ……………………………………………………….

Date ……………………………………………………………

    Author: Alison Spears, Trust Board Secretary                 Date: 14 April 2009
    Document Approved by: Alison Spears, Trust Board Secretary          Version: 1.0
    Agenda Item: 8.1                                                     Page 9 of 9

				
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