THE HILLINGDON HOSPITALS NHS FOUNDATION TRUST

Transcription

1 THE HILLINGDON HOSPITALS NHS FOUNDATION TRUST MINUTES OF THE TRUST BOARD MEETING HELD ON WEDNESDAY 31 st AUGUST 2011 IN THE BOARD ROOM, MOUNT VERNON HOSPITAL Meeting held in public (approved following review by the Trust Board on 28 th September 2011) Present: Mike Robinson (MR) Chairman Katey Adderley (KA) Non-Executive Director Marie Batey (MB) Executive Director of the Patient Experience and Nursing Shane Degaris (SD) Deputy Chief Executive & Chief Operating Officer Susan LaBrooy (SLB) Medical Director Alan McLeod (AM) Non-Executive Director Pradip Patel (PP) Non-Executive Director James Reid (JR) Deputy Chairman and Non-Executive Director Craig Rowland (CR) Non-Executive Director David Searle (DS) Executive Director of Corporate Development Paul Wratten (PW) Finance Director In Attendance: Karen Johnson (KJ) Executive Assistant minutes Also Present: Six members of staff and public Apologies: David McVittie (DMcV) Chief Executive Patricia Rushton (PR) Non-Executive Director Claire Gore (CG) Director of People David Coombs (DC) Trust Secretary Declaration of Hospitality or Amendments to Register of Interests 01/08/2011 Minutes of the last Meeting 02/08/2011 None declared. The Board noted that PP had no interests to enter into the Register of Directors Interests. The draft minutes of the Board meeting held in Public on 27 th July 2011 were approved as an accurate record. 1

2 Actions following last Board Meeting 03/08/2011 Declaration of Any Other Business 04/08/2011 The Board noted the updates on the actions arising from the Board meeting held in Public on 27 th July None declared. SECTION A STRATEGY 05/08/2011 Chief Executive s Report DMcV had presented his apologies for the meeting and the Board noted the self-explanatory report. SECTION B QUALITY, OPERATIONAL & FINANCIAL PERFORMANCE 06/08/2011 Quality and Operational Performance Report SD presented the Quality & Operational Performance Report to the Board stating that it contained more detail than previous reports specifically relating to cancer. SD stated that the report continued to be a mix of areas of concern and good performance. SD stated that the Infection Control report showed three cases of C-diff in quarter 2, with three MRSA bacteraemias for the year to-date, which leads to an overall position of amber/red in this area. SD stated that cancer target relating to 62 days screening to treatment remained red: in June four patients were treated on this pathway; two of which were breaches and two non breaches. SD stated that the administration of cancer targets has now significantly improved and the cancer patient tracking list is now monitored at a weekly meeting chaired by the Director of Operations, at which the booking rules are reviewed and improved upon. SD confirmed that Parkhill Audit are looking into cancer pathways across the organisation to undertake a full review to assure the Trust on the quality of data. In addition, NHS Elect have given a preliminary report to enable the Trust to move forward with implementation of changes in practice where appropriate. 2

3 SD stated that Hillingdon Hospital is one of the best performing Trusts in London with regards to A&E but there remains the need for further discussion on maternity at the next CQG meeting with local Commissioners. MB added that there have been 13 C-diff infections to the end of August and the Trust is therefore under trajectory for the year. The total number of MRSA cases remains at three. MB stated that better performance tracking and leadership is however still required in tackling infection control and added that three cases of C-diff had been identified after incidental findings on the ward. MB felt that there was the need to confirm from the ward why incidental patients had been analysed. MB also felt that there remained the need to look at the governance of prescribing antibiotics and to talk to other Trusts to seek out best practice. SLB added that whilst the compliance rate in the Trust is very good, the need to look at other good practices from across the NHS remains paramount. With regards to MRSA, SLB felt that when deciding whether to take MRSA blood cultures doctors should be taking the steer from Senior Registrars and Consultants and a two person approach leading to that decision should be taken. There should also be a better approach to identifying carriers at A&E and change practices to do this. SLB confirmed that NHS London had been approached for support on cross organisation sharing of good practice in this area. MR thanked SD for the work undertaken on the cancer targets which had already shown excellent results. MR asked SD if he was confident that this ongoing work would rectify the problems previously encountered. SD replied that the Trust was now using national best practice but he believed the work being undertaken by Parkhill Audit would identify further problems, which are mostly administrative, and determine solutions to ensure better practice. SD added that there is now a need to look at the 18 week process to ensure that this is robust. AM asked if there had been any feedback from the Cluster with regards to readmissions. PW replied that he had been promised written feedback but figures had already been based on plans put forward, which had been agreed. SLB added that she had attended a meeting with the Cluster where all organisations noted the challenges they are each facing in reducing readmissions. With regard to readmissions within seven days of discharge, SLB stated that surgery had done well especially in regard to pain, constipation and infections. However with patients being discharged after a shorter stay in 3

4 hospital, the Trust is reliant on GPs picking up problems early. SLB stated that this important impact of Primary Care highlights the need to continue monthly dialogue with Primary Care colleagues. SLB added that alcohol related readmissions remains a significant issue for the Trust but this continues to be out of the Trust s specific control. SD added that a Clinical Forum is being established to enable clinical discussions around these issues. PP asked if the Trust went further than their remit to establish contact with GPs on difficult patients. SLB confirmed that this is not in place but considerable discussions with clinical groups are taking place to identify best practice. DS asked if the rapid recovery programme now in place had identified any lessons to be learned. SLB replied that new processes had been put in place, which are proving very helpful specifically with discharge. The Board welcomed the progress being made and requested that data quality continues to remain a focus for management and continues to feature in the Board report. 07/08/2011 Financial Report PW informed the Board that the July results had followed a similar pattern to the first quarter and showed a growing shortfall on efficiency savings. PW stated that a final summit, with all Divisions, was being held next week to scrutinise and challenge CIP plans. PW stated that it now seemed very unlikely the Trust will achieve its original financial plan surplus for the year and added that the revised forecast will be discussed at the next Board meeting. PW added that monthly meetings had now been established with the Divisions, headed up by himself and SD. PW stated that the biggest risk on under achieving against budget remained the Surgical Division, followed by A&E; the other Divisions had more robust plans to bring their monthly finances back into balance. PW also stated that he felt the updated CIP forecasts from the Divisions for the year-end were overly optimistic and there was a need to critically review these. He added there was unlikely to be any improvement in August but that after the holiday period the position would have to start to get back on plan. CR asked why the Trust was doing so badly against the CIP plan. SD said that it was always more difficult to introduce genuine cost savings and efficiencies and that the level of the challenge now was very much more difficult. SD assured the 4

5 Board that the management team were now refocusing to ensure plans are realistic and deliverable. SD stated that whilst focussing on CIPs is important, it remained equally important for divisions to remain concentrated on their overall expenditure and bottom-line financial performance. CR said the Trust appeared to be on a financial knife edge and asked if there was a risk that the Trust would drop below a financial risk rating of 3. PW confirmed that it was imperative that the Trust significantly improves its financial performance or there is a risk the rating could fall to 2. PW added that Monitor had requested the Trust to reforecast its financial position. SLB added that given the financial position, it is essential to examine where investment should be focused. JR asked if there was a need to look at issues in a more radical way given how hard it is becoming to achieve savings in the traditional way. MR said he felt the main issue is that activity is flat and commissioners are further tightening acute activity. MR added that he felt the Trust was running on an efficient basis, compared to other acute Trusts but it was important to get back on track during September; if necessary using a more radical approach. MR added that he endorsed SD s approach that the focus should not be entirely on focusing on savings but to continue to review everyday expenditure. SD added that the team are working closely together to ensure getting back on plan was achieved. PW said the third CIP summit was taking place the following week with all the Executives, key Clinicians and Managers to see what could be done to generate more savings. PW said he also felt it would in future be more effective to focus on a smaller number of schemes, but which have a larger impact. SD added that since the departure of Joanne Joynes, Jane Roy had now taken over both Service Improvement and the CIP Programme Office and had aligned both to ensure more joined-up working. PP asked if the Divisions held formal monthly meetings to seek support from each other and to gain a sharper focus on the temporary staff issues. SD added that weekly reviews of the staff figures take place and there are central controls in place over this expenditure. MR emphasised that there is a need to step up the pace of delivering the savings, make decisions by September on how to address the financial position, bring back the figures as close to plan as possible, and to focus strategically for next year. SD said this should be the main focus for the Board Strategy Day being organised for late September. The Board noted the report. 5

6 08/08/2011 Infection Prevention and Control Annual Report MB introduced the Trust s Infection Control Annual Report for the period 1 st January 2010 to 31 st March MB stated that as is usual practice, the document will be condensed into a more patient friendly document. JR asked if during the compilation of the report, full representation was gained from all of the Divisions. MB assured him that the Divisions were fully involved in the report, and Divisions were tasked with identifying plans to address infection control issues in their area. PP asked if anyone was missing from the Infection Control Committee, such as representation from the cleaning contractors. MB said that Estates and Facilities, which oversee the cleaning and catering contractors, were fully represented and would take up any issues in relation to the contractors performance. MB added that infection control issues are picked up at the regular contractual meetings. CR asked if more national comparative data could be made available for C-diff. MB stated that each MRSA and C-diff infection is followed up with a root cause analysis where lessons are learnt and the infection pathway followed through. MB stated that infection prevention and control is of paramount importance to the Trust: infections cause additional pain for patients and can lead to extra length of stay in hospital. MR asked how many infections are attributed to the Trust and how many to the Primary Care Trust. MB assured the Board that the Trust and the PCT work collaboratively on all issues, as demonstrated this year by the work on flu. MB stated that there continues to be a drive to increase the screening of nonelective admissions. The Board noted the report and requested that MB circulate further national comparative data on C-diff rates. MB SECTION C RISK & SAFETY 09/08/2011 No items discussed. SECTION D REGULATORY 10/08/2011 No items discussed. 6

7 SECTION E OTHER 11/08/2011 Transfer of the Education Centre at Hillingdon Hospital to the Trust PW introduced the report and stated that in April the Board approved the transfer of the asset of the Education Centre to Hillingdon Hospital subject to it being determined as a donated asset. PW stated that this paper was to seek approval from the Board to take on the Education Centre as an asset irrespective of the classification of the asset type; an approach supported by the Audit & Assurance Committee. The Board agreed to amend its earlier decision and approved the early surrender of the lease between the Hillingdon/Brunel Education Centre and the Trust, and the subsequent transfer of the Education Centre to the Trust irrespective of classification of the asset type. 12/08/2011 Use of the Trust Seal The Board noted the use of the Trust Seal on the contract between the Trust and ICS Cool Energy Ltd for the installation of three chillers and associated electrical elements. 13/08/2011 Any Other Business No further issues were discussed. 14/08/2011 Questions from the public Mr Bishop asked if as a Foundation Trust the organisation is allowed to withhold data with regards to complaints. SLB informed Mr Bishop that the Trust continues to produce an annual complaints report and this practice will continue. Mr Bishop referred to an article in the Guardian newspaper where the Chef James Martin had asked to investigate hospital food and a considerable number of Hospitals had refused him access. Mr Bishop asked if Hillingdon had been approached and turned Mr Martin down. MR confirmed that no such approach had been made to the Trust by Mr Martin. Mr Bishop asked for clarification on the wording contained within the finance report for the July meeting. PW explained the wording and confirmed that this was common business terminology. Mr Bishop referred to an article in the Guardian newspaper which had explained the problems with patients who are considered to be bed blockers. Mr Bishop asked if Hillingdon 7

8 had an issue with bed blockers. SD explained that all hospitals had similar issues but Hillingdon did not currently have any significant problems as the Trust has excellent relationships with Hillingdon Council s Social Services and the PCT who all work in unison to avoid such problems. However, all parties are not complacent to the problems these patients can cause and work hard to avoid these circumstances. Mr Bishop referred to a report that referred to a patient suffering from DVT in Kent suing their local Trust. Mr Bishop asked if Hillingdon had a focus on DVT. SLB confirmed that as much as possible patients with a risk of DVT were identified, with relevant treatment and prevention actioned as appropriate. SLB went on to explain that some patients have a pre-disposition to DVT and total avoidance of the condition is impossible. Mr Bishop asked who in the Trust deals with and responds to the NHS Safety alerts. SLB stated that she deals with the reports which are then presented to the Clinical Quality & Standards Committee. Mr Bishop said that some hospitals had identified an excellent way of ensuring patient privacy by placing a note on the curtains of patients being examined, ensuring that no one enters at that time. He asked if the Trust had any such system in place. MB responded by saying that the Trust had a system called red peg in place for over three years, and was in fact, a leader in this programme. A red peg is placed on the curtains around a patient being examined and no one is allowed to enter the area during that time, thus preserving modesty and patient privacy. The system worked excellently and patients and staff were very happy with the outcome. Mr Bishop asked for clarification on the wording that Monitor requests reports quarterly. PW explained that quarterly referred to each quarter of the year, i.e. 4 times a year. Mr Bishop said that he had been informed that the last Governors meeting had been very lively but he had not seen a report on this go to the Trust Board. MR explained that the Trust Board deals with the day to day business of the Trust and reports on its work to the Council of Governors, rather than vice versa. MR confirmed that the Council of Governors meetings were always lively and were a very robust group. He added that the agendas and minutes of these meetings were freely available on the Trust website. Miss Hosking wished it noted that as a recent patient in the Hospital, she was very satisfied with the food which was both acceptable and adequate. She also wished it noted that she did not have an issue with MR chairing both the Trust Board 8

9 Date of Next Meeting meeting and the Governors meeting. Mrs Hosking said that she had heard that senior members of staff were being made redundant and that vacancies were not being sent outside of the organisation. SD confirmed that all clinical posts go straight to the medical staffing office and there was continued scrutiny on all other posts. The next meeting is scheduled to take place on Wednesday 28 th September 2011, at 2.00pm in the Furze Conference Room, Hillingdon Hospital. Mike Robinson Date Chair 9