Leeds Community Healthcare NHS Trust Public Board Meeting Minutes. Friday 1 November

Transcription

1 Leeds Community Healthcare NHS Trust Public Board Meeting Minutes Friday 1 November AGENDA ITEM /96 Venue: Boardroom, Stockdale House, Victoria Road, Leeds, LS6 1PF Present: Neil Franklin OBE Chair Rob Webster Chief Executive Angie Clegg Dr Tony Dearden Non Executive Director (TD) Anooj Kotecha Non Executive Director (AK) Robert Lloyd Non Executive Director (RL) Bryan Machin Executive Director of Finance and Resources Jagdeep Passan Non Executive Director (JP) Sam Prince Executive Director of Operations Dr Amanda Thomas Executive Medical Director In Attendance: Sue Ellis Director of Workforce Victoria Pickles Director of Corporate Affairs and Company Secretary Emma Fraser Foundation Trust Programme Director Paul Morrin Director of Integration Apologies: Jane Madeley Non Executive Director (JM) Note Taker: Laura Parsons Assistant Board Secretary Item No Discussion Item /80 Introductions and apologies Apologies were received on behalf of a Non Executive Director (JM). The Chair informed the Board that the Trust would receive an update on the Foundation Trust pipeline from the NHS Trust Development Authority as part of the Board away day on 8 November. He also highlighted the review of NHS complaints by Ann Clwyd MP and Professor Tricia Hart which had been published recently /81 Declarations of interest A Non Executive Director (JP) declared a general interest in the items to be considered at the meeting in his capacity as Chief Executive Officer of Leeds Involving People (a member of the consortium responsible for HealthWatch Leeds) /82 Minutes of Previous Meetings and Matters Arising The minutes of the meeting held on 4 October 2013 were approved as a correct record, subject to two amendments: second action on page 7 to clarify that the Quality Committee should consider whether Executive and Non Executive Directors should undertake unplanned visits; 1

2 and third paragraph of Minute /78 to be amended as follows: the consequences of the revised CQC inspections of safeguarding and looked after children Actions and Matters Arising /74-1 the informed the Board that feedback had been received from the NHS Trust Development Authority (TDA) regarding the Quality Visit action plan. The final action plan was due to be submitted to the TDA by 8 November. The Chair asked whether the TDA s feedback was proportionate. The explained that she had requested to meet Jacquie McKenna, Deputy Director of Nursing, TDA to discuss some issues in more detail. The Chair requested that a final position and way forward be agreed with the TDA /74-3 the Director of Corporate Affairs and Company Secretary confirmed that a staff engagement plan would be presented to the Senior Management Team in November. The proposals had already been piloted with the Adult business unit, and the feedback received would be used to develop the presentations used. Engagement would take place with the children and specialist business units during the following week. Actions: Minutes to be amended as agreed /83 Chief Executive s Report The Chief Executive introduced a report setting out the context in which the Trust works. He began by providing some feedback from the residential course which is provided for children who are receiving care from the stammering support centre. He informed the Board that he had attended the course for part of the previous day and the course involves both physical and mental challenges for the children, and at the end of the week they are asked to give a presentation to the whole group. Two of the children who took part in the course last year were acting as mentors for this year s cohort. The Chief Executive had spoken to some of the Speech and Language Therapists who had informed him that the course can accelerate the progression of the children taking part as it provides them with an opportunity to work with peers and talk openly about their issues. The Chief Executive suggested that this was an example of an innovative approach to providing the best possible care that helped improve the lives of patients and families. The Chief Executive informed the Board that the Trust had been successful in its bid to become an integration pioneer. The Trust had also been featured heavily at a recent social care conference, and the attendees were interested to learn more about the work being undertaken in Leeds. The Trust had also been a finalist in the Nursing in the Community category of the Nursing Times Awards. The Chief Executive referred to the complaints review by Ann Clwyd MP and Professor Tricia Hart. The report focussed on hospital care, but some of the recommendations were relevant to the Trust. The assured the Board that the report was being taken into account as part of the review of the Trust s complaints policy. The Francis Sub-Group had met earlier in the week, and it had been reported that there would be an Autumn statement from the Government regarding the Francis Report. The Chief Executive highlighted the need for a coherent framework taking into account the recommendations from the Francis Report, as well as the Clwyd, Berwick, Cavendish and Keogh reviews. The Chief Executive had met with the Clinical Commissioning Group (CCG) network on 15 2

3 October. Following the meeting, a letter had been received from the network setting out that the CCGs were supportive of the Trust s Foundation Trust application; they would support the Trust entering the revised CQC inspection process either earlier or later, but would prefer a later date to allow time to discuss the Trust s plans in more detail; and they would like to work together with the Trust on engaging the member practices. A Non Executive Director (RL) asked whether the Trust would explore the engagement with GPs more at its away day on 8 November. The Chief Executive explained that he had met all of the CCGs separately, who had all spoken about different things relating to primary care, and agreed that this should be discussed further at the away day. A Non Executive Director (AK) asked about the mood of the organisation given the recent changes. The Chief Executive explained that the mood varies in different areas of the Trust, for example the mood is positive in York Street Practice, which has been awarded some additional funding, but in other areas there is concern about the restructure. He acknowledged that there was more to do on staff engagement. A clear message would be given to staff following the discussion about future direction at the Board away day on 8 November. The Chair reported that some of the staff he had met expressed a concern that the level of clinical leadership in the Trust would be reduced as a result of the restructure, therefore there was some work to do to assure staff that this isn t true. The Director of Corporate Affairs and Company Secretary added that the feedback from the engagement with the Adult business unit had signalled that staff felt that the cost improvements were unique to the Trust, rather than the NHS as a whole. The reported that a quality impact assessment could be undertaken now that more detailed leadership proposals were in place. The Chief Executive added that the General Managers had appreciated that the quality implications were being taken into account as well as the need to reduce costs. In response to a query raised by a Non Executive Director (AK), the Chief Executive explained that there had been no further indication from commissioners regarding Any Qualified Provider. A current risk was the potential for GPs to extend into community services, therefore it would be necessary to demonstrate to GPs why it is preferable for the Trust to continue providing community services. The Board noted the contents of the report /84 Questions from Members of the Public No questions were received from members of the public /85 Integrated Performance Report The Executive Director of Finance and Resources presented a report providing the Board with an assessment of the Trust s performance against its four strategic objectives. Providing high quality, safe services The informed the Board that the Trust was taking account of the Health Select Committee report After Francis: making a difference report in its Francis action plan. The Executive Director of Operations had received confirmation that the Improving Access to Psychological Therapies (IAPT) target had been met during October as well as September. 3

4 The Chief Executive clarified that only two of the Key Performance Indicators under the quality objective were rated as red, rather than four as indicated in the report and asked that this be amended. A Non Executive Director (JP) noted that the Health Select Committee s report stated that vulnerable patients may not complain about care, and asked whether this was true for the Trust. The confirmed that the Trust does receive some complaints from or on behalf of its vulnerable patients. In response to a query raised by a Non Executive Director (RL), she also confirmed that the Trust has not awarded any special severance payments. A Non Executive Director (RL) asked what the Trust s position is in relation to the training of healthcare assistants. The explained that the Trust has a training programme for non-registered staff, and is seen as regional lead in this regard. The Director of Workforce informed the Board that informally it was understood that a national regulatory system for non-registered staff would not be introduced. A Non Executive Director (RL) sought further information regarding the diabetes study, and whether this would be rolled out to other areas. The Director of Quality explained that commissioners were not supporting any further studies at the moment. The Board had a discussion about the merits of the study and the approach to be taken. It was felt that the organisation should be more decisive about matters within its control. It was agreed that the Trust should decide whether it wished to resource the roll out of this study. It was agreed that the Senior Management Team and Quality Committee should consider this further. A Non Executive Director (TD) asked how the Trust compared to others in relation to the number of incidents that may result in personal injury. The Director of Quality explained that the Trust is comparable to others, and the usual cause of these types of incidents is slips and trips. The Chief Executive noted that 8 of the 18 moderate harm incidents affecting patients were not as a result of the care provided by the Trust. The confirmed that now the Trust has the ability to assess which incidents were not attributable to the Trust, this data would be benchmarked and analysed. The Chief Executive informed the Board that the results from the audit of the end of life pathway will be sent to the statutory bodies and hopefully used to inform the replacement for the Liverpool Care Pathway. Working in partnership The Director of Corporate Affairs and Company Secretary informed the Board that the first Members Meet event had been held with the Speech and Language Therapy service, and an event focusing on sickle cell anaemia would be held in partnership with the Black Health Initiative later in the year. A Non Executive Director (JP) highlighted the importance of ensuring that the membership is representative of Leeds. The Director of Corporate Affairs and Company Secretary assured the Board that the members are representative of the population of Leeds through excellent work with the voluntary sector. For example, work had been undertaken with Carr Manor school to engage young people. Make the Grade had agreed to support the roll out of this work to other schools. The Chair congratulated the membership team on their work. The Director of Integration added that members had been involved in the design of integrated services and had taken part in the recruitment of staff to integrated posts. 4

5 Engage and empower workforce The Director of Workforce confirmed that the number of staff inductions completed within 2 months had improved over the last month (after a scheduled dip), as had the level of sickness absence. The sickness absence policy was currently being revised, and would be discussed at the Joint Negotiation and Consultation Forum meeting in the following week. The Chair was pleased to note the improved performance on sickness absence and training. Become a viable and sustainable organisation The Executive Director of Finance and Resources informed the Board that the surplus was 1m ahead of plan, and the Business Committee had discussed ways of using this, for example for the Electronic Patient Record project. Some other non-recurrent charges were expected, such as a reduction in the value of some assets and potential redundancy costs. The following points were highlighted: There was no longer a risk of an additional VAT charge following changes to estates arrangements. There was currently a 0.5m shortfall in the delivery of Cost Improvement Plans (CIPs). Performance on the % payment of invoices had deteriorated, mainly due to not meeting the 14 day terms of a non-nhs supplier. Activity was below target, therefore recording issues would be investigated, particularly within the District Nursing service. Leeds South and East Clinical Commissioning Group had expressed a concern about activity levels at the latest Contract Management Board meeting. The expressed a concern regarding the level of vacancies coming into the Winter period, and asked whether any HR support was being provided for this. The Director of Workforce confirmed that the recruitment team was at full capacity, and a bid had been submitted for an additional post to help with Winter flexibility. A Non Executive Director (JP) asked whether the activity levels were below target due to less demand or the way outcomes were measured. The Executive Director of Finance and Resources explained that there were recording issues, and urgent work was underway to ensure that this was rectified. The Chair asked whether the long term impact of not recording all data would result in less funding. The Executive Director of Finance and Resources explained that this could result in less increased funding. The Chief Executive added that staff have reported anecdotally that their workload has increased, and there was not yet sufficient assurance regarding the quality of the activity data. The Executive Director of Finance and Resources confirmed that an update on the data quality badge process would be presented to the Business Committee in December. The Chair of the Business Committee (Non Executive Director (AK)) provided an update from the Business Committee meeting held on 23 October. The Committee had received a briefing on complaints; some progress had been made but there was more work to do to embed the actions. The Quality Committee would review the number of harm incidents. CIPs were off track, but a lot had been achieved against a challenging target. The Board noted the Trust s performance against its strategic objectives. Action: SMT and Quality Committee to consider whether diabetes study should be rolled out. 5

6 2013-4/86 Board Assurance Framework The introduced a report providing the Board with an overview of the status of risks to the principal strategic objectives reported through the Board Assurance Framework (BAF). Further to discussions at the last Board meeting, the informed the Board that it had been agreed not to amend the score for risks 534 and 358 (harm to young children and vulnerable adults through the failure of safeguarding procedures). A Non Executive Director (RL) sought an update in relation to the deadlines for risks 312, 364 and 229. In relation to risk 312 (failure to deliver CIPs), the Executive Director of Finance and Resources confirmed that the date to reach target should be March 2014 rather than He explained that risk 364 (loss of income from Any Qualified Provider and from other competitive contractual approaches) was at the target risk level, and that risk 229 (development of service line management) could be considered by the Business Committee following the completion of the head of service restructure. The Chief Executive requested that risk 358 (harm to young children and vulnerable adults through failure of safeguarding procedures) be revisited in light of the action plan arising from the adult safeguarding incident. A Non Executive Director (AK) noted that none of the risks on the BAF related to the Executive Medical Director s portfolio, and sought assurance that no risks had been omitted. The Executive Medical Director provided assurance that there is a risk register for her staff, but none of the risks are of a sufficient level to be included on the BAF. The Board was informed that the BAF would now be the responsibility of the Director of Corporate Affairs and Company Secretary. It would be refreshed, and the amended version would be presented at the December Board meeting. It was agreed that further consideration would be given as to whether to include any risks from the Executive Medical Director s portfolio as part of this refresh. The Board: reviewed the red risks, new risks and Board Assurance Framework risks; and accepted the Board Assurance Framework and Risk Register Report /87 Programme Management Board Report The Chief Executive presented an overview of the Trust s transformation and efficiency programme following the Programme Management Board meeting held on 21 October There was an in-year shortfall of 0.5m on the Cost Improvement Plan (CIP), and a recurrent shortfall of 1.8m. The re-phased plans for 2014/15 and 2015/16 were being developed, and would be presented to the Business Committee in November. The Executive Director of Finance and Resources highlighted that the shortfall would mean that the Trust would have to achieve an increased recurrent CIP in 2014/15, and some of the schemes planned for 2015/16 would be brought forward. A Non Executive Director (RL) informed the Board that he had recently visited the Community Dental service, who had reported that they were unhappy with the time taken to progress changes. The Executive Director of Operations explained that time had been taken to engage staff in relation to the proposed changes prior to implementing them. A Non Executive Director (JP) asked whether any integration plans would be brought 6

7 forward given that Leeds had been awarded integration pioneer status. The Director of Integration explained that the Target Operating Model was being tested in South Leeds, which would give an indication of the savings that could be made across the whole city. The FT Programme Director informed the Board that the model for the service reviews was currently being tested. The Chief Executive explained that plans for the first six services would be presented to the Board in February The Board noted the report from the Programme Management Board on the delivery of the Trust s transformation and efficiency programme /88 Quality Governance Framework Self Assessment The presented an update on the Trust s Quality Governance Framework self assessment and the process adopted to verify the self assessed rating. A fresh eyes review of the rating was undertaken on 16 September, which resulted in the proposed score being increased from 3.0 to 5.0. The Board discussed the requirement to consider how all of the quality related action plans could be consolidated, given the range of inspections and regulatory frameworks we are required to support. This will be presented to Quality Committee and subsequent Board meetings. A Non Executive Director (TD) clarified that a number of actions were due for completion by April 2014, but it was not clear whether these actions would bring the overall score down to 1.5. He requested that this be considered as one of the next steps. The Chair sought assurance that the actions would support the right culture that was needed to ensure that staff escalate all issues appropriately. The explained that she had seen a tangible change, and some recent issues regarding safeguarding and staffing levels had been escalated immediately. The Chief Executive cautioned that there was not yet full assurance that all issues were being escalated, and there was more work to do to ensure that all staff were clear on escalation processes. The Chief Executive asked for the Executive Medical Director s view on culture. She responded that staff do know how to escalate issues, but the culture on the front line is that sometimes issues are not escalated if they are repeats of previous issues. Some staff have said that they don t have time to report such issues. A Non Executive Director (RL) sought assurance that the score for section 4B (is the Board assured of the robustness of the quality information?) had actually reduced from amber/green to green. The explained that the quality information had been subject to internal audit processes, and had been strengthened, therefore the score had decreased from 0.5 to 0. The Chair suggested that the evidence supporting the score for section 4B be shared with a Non Executive Director (RL). A Non Executive Director (AK) asked how the Board could be assured that the score wasn t higher than 5.0, given that it had increased, and he wasn t previously aware of any culture problems. The explained that the score had increased due to a stricter review and some recent issues including a safeguarding incident and feedback from the NHS Trust Development Authority s quality visit. Many staff are also anxious at the moment due to the restructure. The Chair added that due to a national focus on quality, several trusts Quality Governance Framework scores have increased, some of which were self assessed, and some of which were assessed by Monitor. A Non Executive Director (AK) suggested that a target score be agreed. The FT Programme Director reminded the Board that given the experience of other trusts, the aim 7

8 should be to have a score of 2.5 or less prior to the Monitor assessment. The Chair thanked the and the Quality Committee for their work in reviewing the self assessment. The Board noted the contents of the report. Action: Consolidated quality action plan to be presented to the Quality Committee and the Board /89 TDA Monthly Report on Board Statements and Monitor Licence Conditions The Foundation Trust Programme Director presented the report for the NHS Trust Development Authority (TDA) regarding compliance with TDA Board Statements and the sub-set of Monitor Licence Conditions for September There had been some slippage in the actions relating to condition G8 (patient eligibility and selection criteria). The Trust was aiming to be fully compliant with the conditions by April It had been confirmed that the Trust would not receive a licence on 1 April 2014, but the TDA would continue to have oversight of performance. A Non Executive Director (TD) asked whether the approach taken in relation to condition G8 was consistent with other trusts. The FT Programme Director explained that various approaches were being taken to this condition. The Director of Corporate Affairs and Company Secretary added that there is a recognition that this condition will apply differently to different types of trusts. A Non Executive Director (JP) asked whether the equality and diversity implications had been taken into account. It was confirmed that there was a requirement to publish the eligibility and selection criteria on the Trust s website, and work was being undertaken with partner organisations such as Change to ensure that any equality and diversity implications were fully addressed. The Board: approved the assessment of full compliance with the TDA Board Statements; approved the assessment of compliance with the TDA sub-set of Monitor Licence Conditions - that the Trust was non-compliant with Conditions G8 and C1; and approved the action plans for Conditions G8 and C /90 Approval of Lease for 2 nd Floor Stockdale House The Executive Director of Finance and Resources asked the Board to ratify the action taken by the Chair and Chief Executive (under the Chair s Action Procedure, in accordance with Standing Order 5.2), to approve the lease for the 2 nd Floor of Stockdale House. The Board ratified the action taken by the Chair and Chief Executive to approve the lease for the 2 nd Floor of Stockdale House /91 Leeds Safeguarding Children Board Annual Report 2012/13 The Executive Director of Operations presented the Leeds Safeguarding Children Board (LSCB) Annual Report 2012/13. She drew the Board s attention to the impact and actions for the Trust, which were highlighted in the cover report. 8

9 A Non Executive Director (RL) sought assurance that the Trust had adequate resources to deal with the impact, and asked whether the Cost Improvement Plans would have any effect on this. The Executive Director of Operations confirmed that the actions constituted good practice that should be implemented as a matter of course, and no additional funding should be required. The Executive Medical Director highlighted that these actions would put the Trust in a good position, given the recent publication of the Chief Medical Officer s report. The Chief Executive sought assurance that the learning from recent national cases relating to child safeguarding would be captured in the LSCB s plans for 2013/14. The Executive Director of Operations confirmed that child safeguarding cases are discussed by the LSCB as appropriate. A Non Executive Director (TD) noted that a training programme would be designed for practitioners involved in the child protection core groups, and asked whether it was clear which gaps needed to be addressed by the training. The Executive Director of Operations explained that this action had arisen from an audit where it had been found that some members did not take full responsibility for the whole group or challenge each other effectively. The Executive Medical Director assured the Board that there were no issues with the practitioners competency in child protection. The Board: accepted the LSCB Annual Report 2012/13; and noted the impact for the Trust /92 Minutes from Sub-Committees The Chair invited the Chairs of the Board Sub-Committees to highlight any points from the minutes that they wished the Board to note. Audit Committee The Deputy Chair of the Audit Committee (Non Executive Director (RL)) presented the matters arising from the Audit Committee meeting held on 18 October The clarified that the Internal Auditors could not give assurance on three areas of the Francis action plan because they don t have the required expertise to do so, not because the actions are not sufficient. The Board received the minutes. Business Committee The Chair of the Business Committee (Non Executive Director (AK)) confirmed that all of the issues raised by the Business Committee had been discussed as part of other items on the Board agenda. The Board received the minutes. Quality Committee The Chair of the Quality Committee (Non Executive Director (TD)) presented the matters arising from the Quality Committee meeting held on 7 October The Board received the minutes. 9

10 Community Foundation Trust Programme Committee The Chair of the Community Foundation Trust Programme Committee (Chief Executive) confirmed that the Board was aware of all of the issues covered in the minutes. The Board received the minutes /93 Date and time of next public board meeting: Friday 6 December 2013, Headingley Enterprise and Arts Centre, Bennett Road, Headingley, LS6 3HN Signed: Neil Franklin, Chair Date: 10

11 Agenda Number Meeting held on 30 March /99a-1 Action Agreed Lead Timescale/Deadline Status Minutes of the Audit Committee Sustainability Strategy to be submitted to the Board in July Meeting held on 22 March /140-2 Tele-technology Strategy Present a cost/benefit analysis to the Board in relation to the Tele-technology Strategy. Executive Director of Finance and Resources Executive Director of Operations Deadline to be confirmed September updated to December 2013 To be submitted to the Board date to be confirmed. Additional capacity being sought to lead on this work. Meeting held on 2 August /45 Service Issues and Developments Schedule time at a future workshop to review the District Nursing service in detail. Meeting held on 6 September /58-1 Integrated Performance Report Provide an update to the Quality Committee on the current condition of the four patients who were subject to a major harm incident during July /58-2 Integrated Performance Report Provide assurance to the Board regarding incident reporting /58-4 Integrated Performance Report Provide an update to the Board regarding GP engagement. Executive Director of Operations To be considered at the Board workshop on updated to Complete Serious Incident report included on private agenda To be considered at the Board workshop on Meeting held on 4 October /69-1 Performance Report - Quality Committee to review benchmarking data around Serious Incidents and falls /69-2 Performance Report - Quality Committee to consider whether NEDs should undertake unplanned service visits and how they should report back /70-2 Board Assurance Framework - Assurance process around risk to be reviewed by the Board /72 Service Issues and Developments - Board to be appraised of outcome of debate on clinical leadership for integrated services /78 Minutes of Leeds Safeguarding Children Board - Board to be provided assurance around capacity to deal with safeguarding issues as a city Executive Director of Operations Executive Director of Operations Complete updated to To be considered by Quality Committee on Leadership model for LCH integrated services being implemented through restructure process Assurance LSCB risk register. 11

12 Agenda Number Action Agreed Lead Timescale/Deadline Status Meeting held on 1 November /82 Minutes of Previous Meeting Minutes to be amended as agreed. Assistant Board Secretary Complete /85 Integrated Performance Report - SMT and Quality Committee to consider whether diabetes study should be rolled out /88 Quality Governance Framework Self Assessment - Consolidated quality action plan to be presented to the Quality Committee and the Board updated to To be considered by Quality Committee on