September 2010 - LUTON AND DUNSTABLE HOSPITAL NHS FOUNDATION TRUST

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September 2010 - LUTON AND DUNSTABLE HOSPITAL NHS FOUNDATION TRUST Powered By Docstoc
					                                              Annual Members Meeting

     Minutes of the Annual Members Meeting held on 20 September 2010 at 7.00 pm at the Riverside Suite,
                                    Vauxhall Recreation Centre, Luton


Governors present:

Public Governors:
Luton constituency:                      Dunstable & S Beds:                Herts & Beds:
P Ashton                                 J Curt                             J Harris
K Barter                                 A Dayton                           M Rainbow
Peter Brown                              M Dewar
M-F Capon                                R Gunning
A Coutinho                               R Harrison
B Gupta
G Hinds
V Skates
J Wright
J Young

Staff Governors:
P Brown                                  M Jagdeo
L Groves                                 B Turner
B Hanley

Appointed Governors:
C Smart

Board of Directors present:
Spencer Colvin, Chair (SJC)
Pauline Philip, CEO
Anthony Palmer, Deputy CEO
Dr Danielle Freedman, Medical Director
Cliff Bygrave, Non-Executive Director
Roger Stokoe, Non-Executive Director
Alison Clarke, Non-Executive Director
Jagtar Singh, Non-Executive Director
Andrew Harwood, Director of Finance
Simon Chapman, Director of Business Development
Elaine Hide, Director of Quality/Acting Director of Nursing
Clare Edmondson, Director of Organisational Development
Neil Permain, Interim Chief Operating Officer
Dr Mark Patten, Assoc Medical Director (Patient Safety)

In Attendance:
J Payne, PA to Executive team (taking minutes)

And 105 Public and Staff Members

Apologies: P Aspell, E Askew, K Edmunds, D Mellon, R Turner, T Cossey, J Kane, G Hiscox, P Hassan



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1.   Chairman’s Welcome

     Spencer Colvin (SJC) welcomed everyone to the Annual Members Meeting and noted that the format of this year’s
     meeting will include some formal business of the Council of Governors as well as a review of our performance and
     highlights of the year. He noted that we are a public benefit organisation accountable to our local community via a
     Council of Governors and regulated by an independent statutory body called MONITOR.

     SJC asked for a show of hands from the following constituencies:
     Luton
     Dunstable & South Bedfordshire
     Bedfordshire and Hertfordshire
     Staff – Nursing & Midwifery
     Staff – Medical and Dental
     Staff – Allied Health Professionals
     Staff – Ancillary and Maintenance
     Staff – Admin, Clerical and Managerial

     The Board Secretary confirmed that the meeting was quorate and could proceed to business.

     Minutes of the AMM held on 21 September 2009 were approved at the November 2009 Council of Governors meeting
     and are posted on the website. SJC apologised for the lateness in sending the invitations for the AMM although the
     notice was posted on the website before the end of August. SJC asked for approval that those who have forwarded
     questions in advance take priority at question time.

2.   Election Results

     S Colvin proceeded to announce the results of the 2010 Governor Elections – the fourth time we have had elections
     since we became a Foundation Trust in 2006.

     19 candidates stood for election in 9 seats covering 4 constituencies:
     Dunstable and S Beds – 2 seats, 4 candidates
     Luton – 5 seats, 12 candidates
     Staff: Nursing & Midwifery – 1 seat, 1 candidate
     Staff: Ancillary staff and Maintenance, 1 seat, 2 candidates
     Sheet 2a shows that in March this year we held an internal election following the resignation of one staff Governor.

3.   Appointment of new Governors

     Appointment of Governors as follows:

     Dunstable and South Beds:
          Andy Dayton – re-elected
          Gill Hiscox – re-elected
     Luton:
          Keith Barter – re-elected
          Peter Brown – re-elected
          Anthony Coutinho – re-elected
          Anthony Scroxton – new
          Ushrat Sultana – new
     Staff:
          Nursing & Midwifery: Martin Jagdeo – uncontested
          Ancillary Staff and Maintenance: Bart Hanley – re-elected
          Admin, Clerical & Managerial (March 2010): Nonna Alomaja – uncontested
     Appointed Governors:
          NHS Luton (May 2010) – Keith Edmunds


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         NHS Hertfordshire (May 2010) – Elaine Askew
         University of Bedfordshire (Sep 2010) – Donald Harley

     T Theron referred to the pack circulated and noted that this contains a complete list of the Council of Governors as of
     today. S Colvin congratulated those who have been elected and re-elected and thanked our outgoing Governors for
     their support and contribution:

              Paedar McKenna
              Aliya Ali
              Phil Spencer
              Sarah Brant
              Clive Underwood
              Margaret Berry
              Esme Hill
              Andrew Slade

4.   Report from Deputy Chair, Council of Governors
     Progress on membership strategy and appointment of Non-Executive Directors

     SJC handed over to Andy Dayton, Lead Governor and Deputy Chair of Council of Governors. A Dayton defined the
     meaning of governance, what it is and how it should be used.

     Membership Strategy – there has been a 3 year review carried out by the Membership Committee and approved by the
     Council of Governors. The Governors have been involved with the FT Network and will be incorporating some of the
     ideas. Members being eligible to join the Foundation Trust will, subject to approval of this meeting change from age 18
     to age 16. In March 2009 there were 13,745 and in 2010 there were 13,295 members. In 2006 we had a membership
     of just over 8000. The Trust needs to recruit more members. The Trust priority is to engage with existing members
     and to that end more meetings are being held in the community i.e. at GP surgeries, healthcare centres. Need to
     reach out to potential members in Herts and Beds and for a democracy point of view we are relooking at boundaries for
     responsibilities of Governors as presently there is a democratic imbalance. Very successful medical lectures have
     been held on swine flu and cardiac services and one for bowel cancer is planned. There is a new look Ambassador
     magazine. Are also revamping the website with a Foundation Trust members’ page.

     There are 2 standing committees within the Trust and Governors have successfully implemented working groups to
     deal with urgent matters such as the constitution working group.

     Update on appointment of NEDS – existing appointments were reviewed during the year and it was discovered that the
     duration of some appointments were not calculated correctly i.e. with effect from the Trust becoming a Foundation
     Trust in August 2006. The Remuneration and Nomination committee agreed the required revision and the 3 NEDs
     concerned agreed to an extended term of office to end July 2012. Following the completion in service of one NED at
     the end of July 2010, the Trust will be embarking on a recruitment process to fill this vacancy.

     A video was then shown from last year’s AMM to remind us where we were last year.

5.1 Report from Chief Executive

     S Colvin handed over to Pauline Philip, Chief Executive. P Philip confirmed that she has taken much time in reviewing
     the hospital before she took up post. She has listened to both staff and patients and has discovered a story of
     transformation.

     Highlights for 2009/10 include:
          CQC rated the hospital double excellent in 2009 – the L&D was said to be the best acute hospital in the EoE.
          Focus on patient safety
          Meeting national targets
          Improving the staff experience


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        Excellent financial stewardship
        Further service development

P Philip noted that over the last 4/5 years, tremendous emphasis has been on patient safety and the L&D is at the
leading edge of patient safety throughout the country and became one of the first hospitals to join the Patient Safety
Campaign. In 2008 some high level goals were set for the patient safety agenda and improvements have been made
year on year including:
     Reducing mortality rates – in 2009 significant progress was made –a figure in the mid 80s was achieved.
     Reducing level of harm that patients are experiencing on a day to day basis. The number of cardiac arrests
         on a level per 1000 patients is constantly dropping.
     Patients falls – again moving in the right direction .
     Safe Surgery checklist – idea is that every patient who has surgery has certain checks done – the L&D
         compliance with the checklist is almost 100% and this demonstrates emphasis placed on patient safety.
     Zero tolerance to infections. There was a significant reduction in C.Difficile rates and a record low as far as
         HA C.Difficile is concerned. MRSA – L&D is at the leading edge of the work being taken. MRSA screening is
         taking place on all admissions including emergency.
     Central line infections – only one in ITU during 2009.

Reflecting on 2009 there has also been good news stories with regard to meeting national targets (the agenda is
changing):
     Cancer services – 100% patients waited less than 31 days for treatment, 93% were seen within 2 weeks of
         GP referral
     18 week target was met

P Philip noted that none of this would have been possible without the dedication of the staff and last year staff voted
the L&D in the top 100 of healthcare organisations.

With regard to financial stewardship, income was in excess of £200 million, surplus £3 million to be reinvested in
patient care, £4 million spent on capital schemes. The unqualified report has been received from the independent
auditors.

Looking towards the future, this is a time of change as far as the NHS is concerned. The direction of change is not
inconsistent with the past and the change seems to continue to put patients at the centre of the NHS and patients
choosing where they want to go based on clinical experience. This gives us a number of challenges but we feel well
placed and this will give us a lot of opportunities. The L&D needs to focus on maintaining performance on a day to day
basis and then looking strategically at what services we want to provide in 5 years time, what services we need to
provide in hospital and what services we could provide outside the hospital. We need to listen to our outpatients and
inpatients to see what they want.

With regard to maintaining day to day performance, P Philip reassured everyone that we have a robust delivery plan
and with a number of workplans focussing on the key challenges that we face, including the QIPP agenda.

When we reflect on experiences of 2009 it is clear that there are areas that we would have liked to have done better.
In particular emergency pathway and patient experience.

Emergency pathway – much work has been done in the last couple of years to drive up A&E performance and there
have been a large number of initiatives. 3 quarters of the year were very good but in quarter 3 performance
decreased. Therefore, in the last couple of months there has been focus on redesigning that pathway. P Philip asked
Mr Dhinakharan to speak about the changes that we are making.

Mr Dhinakharan has been a consultant in A&E for the past 4 years, and previously as a registrar on 2 occasions at the
L&D. He talked about the major transformation that is taking place in the A&E service and what this will mean for
patients using the service.




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     P Philip continued to talk about patient experience. She noted that the organisation has felt disappointed with the
     results of the national patient survey as an awful lot of work and energy has gone into improving the patient experience
     and she believes that 95% of staff come to work motivated to improve patient care.

     Professor Anthony Palmer, Deputy Chief Executive, was asked to give an overview of the Patient First initiative being
     put in place to improve the patient experience. He noted that the L&D wants to be the hospital of choice where
     patients choose to go every time. There is a need to see the ‘person’ in the patient. The L&D has made some
     progress but we want to go further and faster and need to redesign how we lead improvements. To that end the Trust
     is seeking input from members, GPs, staff and patients and wish to link with our patient safety approach. Part of the
     process will be an accreditation and award scheme. Today is census day – 15,000 questionnaires have been sent out
     and we urge everyone to complete them and return them. We want patients to understand that their needs come first.

     P Philip concluded that there are some challenges over the next year. She expressed the opportunities of engaging
     Governors and members to make the L&D the hospital of choice.

6.   Service Development

     P Philip handed over to Dr Danielle Freedman, Medical Director. She highlighted that the L&D has a level 3 NICU and
     have centralised head and neck cancer services. We also run a bariatric service serving most of the east of England
     and patients coming from the south of England. The Trust has one of the largest breast screening services.

     D Freedman gave an overview of progress this year:

     Bowel screening services – the L&D is working in partnership with Bedford Hospital and this service will enable a 16%
     reduction in mortality risk. There is a members lecture for bowel screening services on 21 October 2010.
     Stroke services – the L&D is the first accredited hospital giving 24/7 thrombolytic treatment. We can offer an early CT
     scan and are working in partnership with Bedford Hospital with their stroke clinicians.
     I-Summer (IT initiatives) – A team from the L&D visited Arras in France which has a ‘paperless’ hospital. The Board
     has agreed to invest £3.6 million capital into IT initiatives to make the services safer, help staff to do their job, and give
     faster diagnosis and treatment. Robotics is being introduced to our pharmacy which should be up and running in the
     next few months and it is hoped that we would be able to reduce drug errors. Also e-prescribing project is underway.
     Another IT initiative that the Trust commenced last year was with regard to vital packs. This has enabled, in particular,
     junior doctors to be able to see in real time the monitoring of critically ill patients. This is only based on ACU and the
     respiratory unit at the moment and will be rolling out to further wards in due course.
     Midwifery-led birthing unit has now opened which will be run by midwives and allow mothers the choice of where they
     want to go. It is hoped that this will help to reduce the caesarean section rate and hence a better outcome for mothers
     and babies.
     Obesity services – the L&D is recognised as a centre of excellence in the east of England.
     NICU – Building is due to commence for the new NICU unit. Dr Freedman thanked Sarah Newby and her team in
     raising considerable funds for this unit.
     Tender for joint Muskuloskeletal (MSK) service – Dr Freedman thanked S Chapman and his team in winning the tender
     to take this hospital service into community locations. Patients are being seen out in the community at a one stop clinic
     giving faster diagnosis and treatment and hopefully leading other services.
     Cardiac services – our population is one of the highest and at the moment our patients have to travel to London and
     Papworth for services. The Trust is investing £5.4 million to establish a new cardiac Cathlab which will enable us to
     offer the service on site.
     New emergency pathway – the L&D is very proud to have become a rapid improvement site in the East of England for
     work in keeping children out of hospital wherever possible. Thanks to Dr B Adler and the team in paediatrics. We
     have been asked to present this work nationally.
     Clinical leadership – Dr Freeman referred to the Mid Staffs report where they were criticised for lack of clinical
     engagement. The L&D has been very supportive for developing clinical leaders. This year there has been a change in
     structure with the introduction of 4 divisional business units – Surgery, Womens & Childrens, Clinical Support Services,
     Medicine. There are now 14 members of the Executive team, 9 of who are clinicians. There have been a number of
     new consultants throughout the year and junior doctors.



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6.   Questions from the Floor

     Question: Concern about the process for elections to be a Governor – seems very restricted – could public vote before
     becoming a member?
     Response: T Theron – as a Foundation Trust covered by Monitor’s code of governance we had to have a member
     base. It was a requirement that a Council of Governors should then be elected through the members, therefore giving
     representation from constituencies.

     Question: ageism – With regard to the bowel screening being offered to a certain age group – is this not ageism?
     Response: Dr Freedman agreed that the scheme should be offered to a wider age group but it needs to start
     somewhere and going forward the age will be extended to 75 and also hopefully offered to younger patients. This will
     be taken forward with our PCT.

     Questions/comments: Generally excellent experience of the L&D. In children’s outpatients the wait is usually at least
     an hour before being seen. The gentleman also wished to note that there are no plugs in the basins and he was not
     told that bowls are handed out – nurses need to communicate this.
     Response: N Permain – much work has taken place in many clinics to reduce waits but it is much to do with how we
     book clinics. However, we know that there is lot of work to do and are about to reconstitute a group to tackle this.

     Question: Newly elected Governor – All patient information will be put on screen and not on paper - concern raised as
     to how far back the information will be available.
     Response: Dr Freeman noted that it is the way the whole country will be going. Across the UK the NHS has been
     wasteful in implementing information technology, we want to scan notes that are there already but not sure how far we
     can go back as notes that are over 10 years old are stored off site. S Chapman confirmed that there are a number of
     risks but the benefits of scanned records becoming electronic means that a number of clinicians can get access to the
     information at the same time and therefore better efficiencies for the patient. The plan is to backscan records and
     priority will be based on the patients who visit the hospital more regularly. Individual sub folders will be created. Will
     only remove the paper record when feel safe to do so.

     Question: Learning disabilities and the desire to better engage with patient groups, will there be group learning around
     patients with disabilities. The Deputy CEO has made reference to patient focus – how are we going to identify with
     patients with learning disability.
     Response: E Hide responded that we have Ilona Rose, Learning Disability Co-ordinator, working with patient groups
     and relatives. Also have tools for an ‘About Me’ booklet giving information about the patient that staff can use in their
     delivery. Ilona is not employed directly by the Trust but is working within the Trust. P Philip noted that much work has
     taken place nationally and internationally to ensure that patients with learning disabilities are provided with safe
     services. We need to work with the groups, and have education programmes in the whole of the organisation. We
     need to be able to see each patient as an individual with completely different sets of needs. A Palmer confirmed that
     he has had discussions with Governors and other patient representative groups and we need to broaden the debate to
     all groups that we serve. A Dayton is keen to get more Governors involved in these activities.

     Question: What is the hospital doing about smoking – it is of concern to see patients at the front of the hospital
     smoking.
     Response C Edmondson agreed that this is an issue. When it comes to staff smoking it is easier to manage. The
     Board have consulted on the subject about whether a dedicated area should be sought for smokers. We have tried
     cessation education but this has not worked. Difficulty is the policing of it and the amount of abuse that is received
     when asking patients not to smoke. The Trust will be consulting with the public/members to come up with ideas for
     tackling the issue.

     Question: Looking for more detail on how we are going to improve patient experience.
     Response: A Palmer noted that we are in the research phase of our initiative and hope to be in a position to have
     made progress by the next Governor’s meeting. It will be a significant culture change and the Trust will have to change
     people’s attitudes, people’s thinking, people’s behaviour – will be a medium to long term strategy. Ward Managers are
     being made supernumerary.


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     Question: What is the Trust’s plan with regard to missed appointments?
     Response: N Permain - Some clinics have taken initiatives. One initiative being taken in theatres is to use a reminder
     system using text SMS service and telephone call prior to surgery. This may then be rolled out to outpatients services
     but need to be aware of the cost of resource which could outstrip the benefit. Also, looking at making a booking at the
     consultant appointment before the patient leaves the hospital.

8.   Constitutional Changes

     S Colvin referred to proposed changes to constitution, approved by the Council of Governors, as per the paper
     circulated which proposes, amongst others the reduction to the age limit to 16 for eligibility to become a Foundation
     Trust member.

     In terms of the Constitution, the proposed changes were unanimously approved - P McKenna proposed, P Ashton
     seconded.

     In terms of the Trust’s Scheme of Reservation, the changes will be considered at the Board meeting on 24 September
     2010.

9.   Closing Remarks

     S Colvin reported that 15,000 patient census forms have been circulated and encouraged everyone to complete and
     return a form. He also welcomed feedback from this evening’s meeting and referred to the evaluation form.
     All members are welcome to attend the Council of Governors public meetings and the next meeting is Wednesday 17
     November at 6.30 pm in the Comet Lecture Hall at the L&D.

     S Colvin closed by saying that it has been a very pressured year and he acknowledged the exceptional hard work and
     commitment of our staff and volunteers and the time input by our Governors. Sincere thanks particularly to Terri
     Denton and Sarah Coulthard for organisation of the AMM and thank you to those who were manning the stalls.

     The Annual Members meeting closed at 2050 hours.


‘These minutes may be subject to disclosure under the Freedom of Information Act 2000, subject to the
specified exemptions, including the Data Protection Act 1998 and Caldicott Guardian principles’.




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