Agenda Item 31 by decree

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									                                                                              Agenda Item: 3.1

                     ROYAL UNITED HOSPITAL BATH NHS TRUST
                   MINUTES OF THE PUBLIC TRUST BOARD MEETING
                            WEDNESDAY, 14 MARCH 2007
                        ROOM C, EDUCATION CENTRE, RUH
Present:                                                    In Attendance:

Voting Directors                                            Avril Baker, Communications Advisor
James Carine, Chairman                                      Yvonne Kirby, PA to Chairman
Mark Davies, Chief Executive                                Clare O’Farrell, 18 Week Project Manager/Choose &
Michael Earp, Non Executive Director                        Book Lead
Jonathan Lloyd, Non Executive Director                      Jill Tompkins, Chair, RUH PPI Forum
Maura Poole, Non-Executive Director
Francesca Thompson, Director of Nursing
                                                            4 Members of the public
Peter Tomkins, Non Executive Director
John Waldron, Medical Director
Stephen Wheeler, Non-Executive Director
John Williams, Director of Finance

Non-Voting Directors
Stephen Holt, Director of Facilities
Brigid Musselwhite, Director of Planning &
Strategic Development
Lynn Vaughan, Director of Human Resources

BD/07/03/01: Apologies for absence

Apologies had been received from Diane Fuller, Director of Patient Care Delivery.

BD/07/03/02: Declarations of Interest

None.

BD/07/03/03: Minutes of Public Trust Board 9 January 2007

The minutes of the Public Trust Board held 9 January 2007 were approved and signed.

BD/07/03/04: Presentation - Reducing Elective Waits Delivery 18 week pathways for patients

Clare O’Farrell, 18 Week Project Manager and Choose & Book Lead highlighted that delivering the
18 week pathway would require whole health community working and fundamental changes to
current processes. She confirmed that in terms of 2006/07 diagnostic wait, only Somerset PCT
would deliver. B&NES and Wiltshire PCTs had not commissioned the necessary activity from the
Trust. The 18 week target is a priority for 2007/08 and urgent work was required regarding
capacity planning.

It was highlighted that the 2007/08 milestones set levels of expectation, but were not strict targets.
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The Chairman thanked Clare O’Farrell for her presentation.

The Board noted the Presentation entitled: Reducing Elective Waits Delivery 18 week pathways for
patients.

BD/07/03/05: Action List & Matters Arising

BD/07/01/06: Presentation – Cancer Peer Review Action Plan. Strategic Plan for Cancer Services
would be brought to the Trust Board March 2007. Deferred until May Trust Board because Dr
Goddard had been asked to be involved in the national cancer peer review.

BD/07/01/11: Integrated Governance Report. Junior Doctors’ Revue to be shown to Trust
Development Board. Completed.

BD/07/03/05: Chairman’s Report

Proposed Movement of Post Mortems from RUH Bath to New Mortuary.

The Chairman asked the Director of Planning and Strategic Development to brief the Board on the
above issue. A written summary of this briefing is attached to these minutes as:

3.1 Minutes of Public Trust Board meeting held 14 March 2007
Appendix 1: Brief: Proposed Movement of Post Mortems from RUH Bath to new Mortuary.

Having received this briefing, the Trust Board asked for the following statement to be placed on
record in the minutes:-

“The Trust Board is extremely disappointed at the decision to move post-mortems from RUH Bath
and at the decision of the B&NES Overview and Scrutiny Panel that this does not constitute a
substantial variation to services.    The Board believes that the move will add stress to a very
difficult and emotional time for relatives of patients for whom a post mortem is necessary. It is
not viewed as being in the interests of good patient care.         The Trust Board also expressed
concerns at the increased financial pressure that this will place on families who will need to pay
additional transport costs (in the region of £60) to have bodies returned from Flax Bourton for
burial or cremation. The Trust Board does not support this proposed move.”

The Chairman had attended a meeting with the Secretary of State for all Acute Trust Chairmen in
London on 30 January 2007 and he had noted that the Royal Cornwall had a fully automated
pharmacy. The Director of Facilities informed the board that the Trust was working through a
similar automated solution to improve dispensing.

The Chairman confirmed that Lord Geddes, who visited the RUH on 12 February 2007 had been
very impressed.

The Chairman informed the Board that Professor Osborne would be attending the next Trust Board
meeting.

The Board noted the Chairman’s Report




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BD/07/03/06: Chief Executive’s Report

The Chief Executive Officer (CEO) confirmed that during his time as a CEO in the NHS, he had sat
in on 130 trust board meetings, most recently as CEO of RUH Bath. He confirmed that he felt this
was a super hospital with great staff who gave excellent care to patients.

He particularly wished to thank the executive team and highlighted that managers do care deeply
for patients and the health services. He thanked them all for their achievement. In addition, he
thanked the Trust board and observed that none of those who had appointed him were still on the
Trust Board having finished their terms of office.

The Chief Executive wished to convey his thanks to all staff over the 3 year period of his tenure.
He was certain that the hard work had been worthwhile as the Trust was a successful vibrant
organisation. He wished the staff and James Scott, the new Chief Executive, well for the future.

The Chairman pointed out that the RUH had been viewed as one of the worst performing hospitals
in the country at the time of Mark Davies’ appointment, but this year it was set to break even. Its
progress and its high standards of care had recently been commended by the Chief Executive of the
Strategic Health Authority. He thanked Mark Davies for this achievement.

The Board noted the Chief Executive’s Report.


BD/07/03/07: Reports from Non Executive Directors

(i)     Michael Earp, Non Executive Director (ME)

ME reported that he had sat on the panel relating to the appointment of the new Chief Executive.
He had also been involved with the process of selecting external consultants to support RUH 2010
change programme. ME confirmed that he had attended a meeting with GPs, PCTs and the Director
of Patient Care Delivery relating to Choose & Book. ME had sat on the Audit, Strategic
Improvement, Governance, Clinical Audit, Infection Control and C.Diff & MRSA committees.

(ii)    Jonathan Lloyd, Non Executive Director (JL)

JL reported that he had been involved with a night visit to the RUH with the Director of Nursing
and highlighted that the hospital was a very different place at night. The staff had been pleased to
meet them during the night. He informed the Trust Board that the Director of Nursing does a night
visit every two months. JL had attended several public meetings about the mortuary service and
was on the Arts Committee.

(iii)   Maura Poole, Non Executive Director (MP)

MP highlighted that she was primarily involved with finance and audit and had attended an Audit
Committee meeting in January and had attended meetings with the internal auditors. These items
were in addition to the regular briefings on the financial position.

(iv)    Peter Tomkins, Non Executive Director (PT)

PT reported that during his first two months with the Trust he had attended a formal induction
programme and had a number of informal meetings with 7 of the 9 directors. PT informed the
board that he would be attending a 2 day orientation meeting in Leeds at the end of April.


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(v)    Stephen Wheeler, Non Executive Director (SW)

SW reported that he had attended the Chief Executive candidate presentations. He had his first
experience of the Audit and Charities Committee. He had accompanied the Director of Nursing on
ward rounds on 17 January 2007 SW stated that he would like to do a night shift with the Director
of Nursing. SW had sat on a regrading panel on 22 February 2007. He also chaired the Equality &
Diversity Committee meeting.

BD/07/03/08: Performance Monitoring

(i)    Integrated Performance Report

Mark Davies, Chief Executive reported that the key message was financial success. Members of
the Executive Team and the PCTs had met with Sir Ian Carruthers who had congratulated the Trust
on its performance. Financial balance was the key objective for 2006/07. He reported that the
RUH was set to break even this year for the first time in its history as public confidence in the local
NHS and GPs had improved due to our financial success.

The Chairman highlighted that there was a real sense of financial ownership recognised by all.

Michael Earp, Non Executive Director, queried if appropriate efforts were being made to improve
discharges. The Medical Director reported that the medicine target was difficult to achieve, but that
surgical ward rounds generally finish by 9 a.m. Medical ward rounds were complex by their very
nature and would take longer.

The Trust Board noted the Integrated Performance Report.

(ii)   Finance Report

John Williams, Director of Finance reported that since October 2006, the Trust had been in balance
for income and expenditure month on month. He said it was a credit to the Director of Patient Care
Delivery and her team that they maintained elective surgery given the emergency pressures. Draft
February figures also show an under spending against budgets.

Members of the Executive Team had met with PCT colleagues and Sir Ian Carruthers who had
emphasised how well the Trust had done and asked that this message of congratulations was
cascaded to all members of staff.

The Director of Finance stated that the historic debt had been resolved by the issue of a £38m loan
from the Secretary of State for Health (lender) repayable over a 20 year period with an interest rate
fixed for period of loan at the prevailing rate – currently in the region of 5%, with the ability to
repay earlier if possible. The Director of Finance asked for formal resolution to accept the loan of
£38m over a period of 20 years at the interest rate prevailing on the date of the loan.

The Trust Board approved the loan on the terms set out.

Brigid Musselwhite, Director of Planning & Strategic Development reported that the Picture
Archiving & Communications System (PACS) had been successfully implemented and asked that
the Board write to the clinical lead and project manager to acknowledge their work. The Trust
Board agreed that the Chairman should write on its behalf.                  Action: Chairman



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The Chief Executive highlighted that the message to staff should be that the Trust was in recurrent
balance and that accumulated debt had been resolved as the Trust now had a favourable loan which
would clear the debt.

The Medical Director noted that the Trust was earning more than it was spending and was being
supported by the Health Authority. He was pleased to note that the Trust was in a position to take a
loan on very good terms.

Michael Earp, Non Executive Director referred to Millennium computer system and asked whether,
in the light of what has happened at one other Trust, the Trust reconsider its position. The Director
of Finance reported that the Trust should wait and see if the recording issues can be resolved. The
earliest go live date for Millennium at this time is July 2007.

The Trust Board noted the Finance Report.

BD/07/03/09: Human Resources Report

The Director of Human Resources reported that the New Year’s Honours presentation evening on 5
March 2007 was very successful.

Electronic Staff Records (ESR) testing took place in February 2007 which identified issues that
need to be put right. The Director of Human Resources apologised for a typing error in item 2.4
relating to ESR – the go live date should read June 2007.

The Director of Human Resources reported that the Staff survey results would be published next
week and would be presented to the next Trust Board.    Action: Director of Human Resources

Jonathan Lloyd, Non Executive Director asked for an update on the no smoking policy. The
Director of Human Resources reported that there was a difficult area around the pharmacy access
road about which residents have complained. There were only limited smoking patrols in place
currently.

The Director of Planning & Strategic Development noted that the turnover and sickness figures and
trends had improved substantially over the last year. This was a significant improvement.

Stephen Wheeler, Non Executive Director complimented the Director of Human Resources
regarding the workforce strategy which he felt was a clear and succinct document which made this
Human Resources Report easier to compile.

The Trust Board noted the Human Resources Report.

BD/07/03/10: Integrated Governance Report

The Director of Nursing wished to highlight the following issues in her report.

(i)    The Department of Health issued the Health Act: Code of Practice for Infection Prevention
       and Control which is an absolute priority. The Trust is fully compliant with the code
       relating to Clostridium difficile and MRSA. The code is regulated by the Healthcare
       Commission who have authority to inspect organisations’ assessment for compliance
       commences from April 2007.



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(ii)    MRSA improvement plans were still under way and it was noted that the Trust missed the
        trajectory by one in January. The Director of Nursing reported that the Trust would not
        reach its end of year target but, that it was back on trajectory for February. She highlighted
        that a better understanding of figures and hot spots would help.

(iii)   There had been an inspection of the Safety Alert Broadcast System (SABS) process, which
        is a national alert system via the University of York. The verbal feedback was that the Trust
        was outstanding in some areas of practice and they had been extremely impressed.

(iv)    The Director of Nursing reported that the Trust received a significant number (46) of
        complaints in January which was an enormous volume. Despite this, response target times
        had been achieved for 100% of complaints. Resources in Complaints Department had some
        difficulties. She had liaised with the Divisional Management teams and had requested better
        engagement around quality and time of responses. In April next year there was likely to be
        a new core standard around performance and quality of response to complaints.

        The Director of Planning & Strategic Development informed the Board that the
        Appointments Centre would be putting additional staffing in place and that 5 posts had been
        advertised and there had been 2 appointments to date.

The Trust Board noted the Integrated Governance Report.

BD/07/03/11: Revenue & Capital Budget 2007/08

The Director of Finance had worked with budget holders and thanked all those who had given
support in producing this report.

He highlighted that the Trust still had to repay debt of £38m at a rate of £4m per annum (interest
and principal). In addition there were necessary developments in CT scanner, PACS, cleaning and
infection. The Department of Health requires Cash Releasing Efficiency Savings (CRES) of 2.5%
in 2007/08. However, Payment by Results (PbR) gain will mitigate some of this and therefore, the
budget sets £3.4m new recurrent savings this year.

Agreement has been reached on provider to provider services. The Trust has recovered all aspects
of that service and will now be paid for what it is actually providing. The Trust was very close to
signing the service level agreements.

Peter Tomkins, Non Executive Director referred to item 9.1 of this report and asked the level of risk
relating to the financial position of Wiltshire PCT. The Director of Finance said 85% to get down
to 18 week target. The Trust’s performance is good and they acknowledge that this Trust was better
than the other 2 major providers to the PCT.

The Chief Executive stated that this was a new and more identifiable and manageable risk. The
Director of Finance reported that this risk was not relating to 2007/08 but the risk was actually
relating to the period 2008/09 when the additional income for 18 weeks would disappear.

Michael Earp, Non Executive Director referred to item 9.6 and asked the Director of Finance how
he assesses these risks. The Director of Finance reported that these were not gross amounts and that
effectively the Trust was in surplus. These related to low risk, fairly simple work. The Trust now
had to think more smartly regarding complex tests. Over the next 2-3 years there would be greater
risk to the Trust due to Independent Sector Treatment Centre contracts.


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Michael Earp, Non Executive Director stated this was a remarkable achievement but asked who was
responsible for holding budget holders accountable. The Director of Finance reported that much of
the overspend in the early part of the year had been around looking at the reduction of 300 posts.
The Trust had lost only 11 posts through compulsory redundancy thanks to the Director of Human
Resources and staff side.

The Chief Executive noted that clinical ownership of systems were in place and he wished to
reassure the Board that the Trust does have systems in place.

The Chairman thanked all those who had been involved in the budget setting process.

The Trust Board approved the Revenue & Capital Budget 2007/08.

BD/07/03/12: Business Cases

(i)    Consultant Paediatrician – 7 Sessions per week

This is a replacement part time post for a Consultant in Paediatrics at 7 PAs per week supported by
funding from the previous post holder and SIFT.

The Trust Board approved the Business Case: Consultant Paediatrician – 7 PAs per week.

(ii)   Additional Consultant Microbiologist/Infection Control Doctor

This business case to appoint an additional Consultant Medical Microbiologist would bring medical
staffing in Microbiology nearer to Royal College guidelines and act as Infection Control Doctor to
assist in meeting the increasing demands regarding hospital acquired infections. The Director of
Nursing reported that the three Divisions had agreed to share in the cost of this business case.

The Trust Board approved the Business Case: Additional Consultant Microbiologist.

BD/07/03/13: Final Self Assessment Report Standards for Better Health Declaration

The Director of Nursing requested approval of this report which is the final assurance report on the
Trust’s assessment of compliance with the core standards set out in the Department of Health
document Standards for Better Health for the period April 2006 - March 2007, this would be
submitted on line on 1 May 2007 and a full copy of the declaration is available electronically.

The Director of Nursing was satisfied that this had been a rigorous process and would be happy to
provide information to the Audit Committee.

The Director of Nursing wished to record her thanks to Jill Tompkins, Chair, RUH PPI Forum for her
assistance. She also wished to record thanks to Glyn Young and Viv McHale for their involvement and hard
work relating to this document.

Michael Earp, Non Executive Director thanked the Director of Nursing for the excellent standard of this
document.

The Trust Board approved the Final Self Assessment Report Standards for Better Health Declaration.




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BD/07/03/14: Equalities Report

The Director of Human Resources highlighted that the purpose of this paper was to bring to the
Trust Board a report illustrating the composition of the workforce.

Michael Earp, Non Executive Director asked for reassurance regarding parity of pay for male and
female staff. The Director of Human Resources reported that there was one equal pay claim being
considered at the moment.

The Trust Board approved the Equalities Report.

BD/07/03/15: Facilities Report

The Director of Facilities reported that new evening cleaning teams had been introduced recently
and that next year funding would be provided for a second deep clean team.

The Director of Facilities thanked the PPI Forum who led an inspection on 16 February 2007 and
noted that the official results of this visit would be provided in June.

Forbes Fraser demolition commenced last week. The land would be cleared to provide additional
staff car parking. It was noted that there would be an element of asbestos stripping involved with
the demolition works.

The Director of Facilities highlighted that the Art displays had been very popular and wished to
express thanks to Hetty Dupays, Arts Co-ordinator.

The Chairman highlighted item 12.1 referring to travel plan and congratulated the Director of
Facilities on the Trust being awarded a silver award for its transport plan by the Council under the
National Best Practice Scheme. The Director of Facilities informed the Board that it was hoped the
Trust would be awarded gold next year.

Following a query raised by Michael Earp, Non Executive Director regarding theatre filtration, the
Director of Facilities confirmed that the theatres were aseptic. The Director of Facilities informed
the Board that there was a large increase in standards for statutory items through legislation and
health guidance. This is to ensure that the NHS has higher standards than that required under
statutory legislation to protect all patients particularly the vulnerable in the hospital environment.
The Director of Facilities informed the Board that the minor capital programme was funded with
regard to these issues.

It was noted that there had been a number of plant failures throughout the summer and capital has
been made available for plant replacement and centralisation to improve reliability.

The Trust Board noted the Facilities Report.

BD/07/03/16: Minutes

(i)    Minutes of Strategic Improvement Committee held 14 December 2006

The Trust Board noted the minutes.




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(ii)    Minutes of Management Board held 20 December 2006

The Trust Board noted the minutes.

(iii)   Minutes of Management Board held 31 January 2007

The Trust Board noted the minutes.

(iv)    Minutes of Governance Committee held 20 December 2006

The Trust Board noted the minutes.

(v)     Minutes of Audit Committee held 9 October 2006

The Trust Board noted the minutes.

BD/07/03/17: Date of next meeting

The Chairman apologised for having to change the previously published date for the next Public
Trust Board meeting. The next Public Trust Board would be held on Wednesday, 9 May 2007 in
the Sports & Social Clun at the RUH.

The meeting closed at 12.25pm




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                                                                                    Agenda Item: 3.1
                                                                                        Appendix 1


3.1 Minutes of Public Trust Board meeting held 14 March 2007

Appendix 1 - Brief:
Proposed Movement of Post Mortems from RUH Bath to new Mortuary.


Responsibility for the provision of post mortems rests with the Coroner. The Avon Coroner has
decided that a new mortuary should be built at Flax Bourton, south of Bristol to provide facilities
for all adult and child post-mortems for the Avon area. This is in response to three issues: the need
to have appropriate specialist forensic post-mortem facilities, problems with public post-mortem
facilities in Bristol and the desire to provide specialist children’s post-mortem facilities within the
area. The Coroner has determined that this new facility will include post-mortems from the B&NES
area currently provided at RUH Bath (approximately 600 per annum). There is no issue with the
care standards of the services currently provided by RUH Bath. Body storage and body viewing
facilities would remain at RUH Bath.

The Trust has been disappointed by this proposal and the lack of discussion or involvement with its
staff. These concerns were raised with B&NES Health and Social Services Overview and Scrutiny
Panel (OSP) given their implications on the delivery of a key service for B&NES residents.
Particular concern was expressed at the implications for relatives of the deceased in terms of local
bereavement support and assistance and the overall impact on the community of transporting bodies
to a more distant location for post mortem.

B&NES OSP called representatives of the Avon Coroner and Bristol City Council to a meeting to
discuss these proposals on Friday, 9 March 2007. As a result of that meeting, the OSP determined
that the benefits of local children’s post mortem facilities had to be balanced with the proposed
movement of local adult post mortems and that it was the Panel’s decision that the change did not
constitute a substantial variation. Planning for the move would therefore need to be undertaken and
it was suggested that this must now include representatives of RUH Bath.

The Director of Planning & Patient Care Delivery stated that the Trust must engage in planning the
detail about how the new system would work as currently this was not clear.




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