Leeds Community Healthcare NHS Trust Public Board Meeting Minutes. Friday 6 December

Leeds Community Healthcare NHS Trust Public Board Meeting Minutes Friday 6 December 2013 09.00 AGENDA ITEM 2013-4/111 Venue: Boardroom, Stockdale House, Victoria Road, Leeds, LS6 1PF Present: Neil Franklin OBE Chair Rob Webster Chief Executive Angie Clegg Dr Tony Dearden Executive (Nurse) Director of Quality Non Executive Director (TD) Anooj Kotecha Non Executive Director (AK) Robert Lloyd Non Executive Director (RL) Jane Madeley Non Executive Director (JM) Sam Prince Executive Director of Operations Dr Amanda Thomas Executive Medical Director In Attendance: Sue Ellis Director of Workforce Emma Fraser Cherrine Hawkins Foundation Trust Programme Director Assistant Director of Finance Paul Morrin Victoria Pickles Director of Integration Director of Corporate Affairs and Company Secretary Apologies: Bryan Machin Jagdeep Passan Executive Director of Finance and Resources Non Executive Director (JP) Note Taker: Laura Parsons Assistant Board Secretary Item No Discussion Item 2013-4/94 Introductions and apologies Apologies were received on behalf of a Non Executive Director (JP) and the Executive Director of Finance and Resources. The Chair welcomed the Assistant Director of Finance to the meeting. 2013-4/95 Declarations of interest A Non Executive Director (JM) declared an interest in agenda item 2013-4/97 (Chief Executive s Report) in her capacity as Finance Director at the University of Leeds. 2013-4/96 Minutes of Previous Meetings and Matters Arising The minutes of the meeting held on 1 November 2013 were approved as a correct record. Actions and Matters Arising 2011-2/99a-1 The Board was informed that the Executive Director of Finance and Resources was aiming to complete the Sustainability Strategy by 31 March 2014. 1

2012-3/140-2 - The Executive Director of Operations confirmed that some capacity had been secured to lead on the Tele-technology Strategy, and a report would be presented to the Board in the first quarter of 2014-15. 2013-4/85 The Executive (Nurse) Director of Quality explained that the Senior Management Team and Quality Committee would discuss whether the findings from the diabetes study should be rolled out. 2013-4/88 The Executive (Nurse) Director of Quality confirmed that the draft consolidated quality action plan was presented to the Quality Committee on 2 December 2013, and an updated version would be presented to the Board at its meeting on 7 February 2014. 2013-4/97 Chief Executive s Report The Chief Executive introduced a report setting out the context in which the Trust works. He informed the Board that he had recently attended a meeting with some of the Expert Patients Programme tutors. The tutors are trained by the Trust to work with patients on managing pain, for example. They had spoken about being more confident as a result of becoming a tutor and having the ability to help to improve other people s lives. The Chief Executive highlighted the importance of recognising people as assets and incorporating the contribution they make into business planning. He provided an update on the following issues: the Government s response to the Francis Report, which was being reviewed by the Executive (Nurse) Director of Quality s team; confirmation that NHS trusts cannot be authorised as a Foundation Trust until they have passed the new Care Quality Commission (CQC) inspection, and the Trust was not likely to go through this process until Autumn 2014; Winter planning was underway, and the Board would be asked to approve the Winter Plan at this meeting; the revised National Mandate for NHS England had been published; Leeds Innovation Health Hub (LIHH) had hosted an international symposium on health. Victoria Betton, Deputy Director of Partnerships and Innovation, Leeds and York Partnership NHS Foundation Trust was leading on the tele-technology work; the Trust s Dietetic and Nutrition Team won the Primary Care Innovation Award at the Health Service Journal (HSJ) Awards; the outcome of the operational leadership restructure was due to be reported to the staff affected by 11 December 2013; the CQC had recently inspected South Leeds Independence Centre (SLIC), and the outcome of this would be reported at the private Board meeting as it had not yet been finalised; the second annual Leaders for Leeds event was held on 5 December. The network had resulted in some good partnership work for the Trust, for example with Change and the Black Health Initiative; the Board was asked to review the resourcing proposal for the Leeds Health and Social Care Service Strategy and provide feedback to the Leeds Transformation Board. The Executive Director of Operations was pleased to note that the Health and Wellbeing Board and Children s Trust Board were included in the Health and Social Care Strategy, and sought assurance that mental health issues and primary care transformation would be included as well. It was confirmed that the Chief Executive of Leeds and York Partnership NHS Foundation Trust is a member of the Transformation Board, but it has been challenging to find ways of ensuring that the transformation of mental health services dovetails with the integration of health and social care services. The Chief Executive acknowledged that it was not clear where the primary care contribution would fit in. 2

A Non Executive Director (RL) was uncertain regarding the different roles of the Health and Wellbeing Board and the Transformation Board. He questioned whether the structure of the Transformation Board, which was composed of both commissioners and providers, was appropriate. The Chair informed the Board that he had received a letter from the Leader of Leeds City Council explaining that it was not proposed to offer a seat on the Health and Wellbeing Board to providers in the short term, but this would be considered when the Council reviews its Constitution in May 2014. The Chief Executive reminded the Board that the Trust had supported the proposal not to include providers when the Health and Wellbeing Board was being established, but he agreed that the Trust should continue to discuss this with the Council. He explained that the Transformation Board will look at how the Health and Wellbeing Board s priorities are delivered and therefore having both commissioner and provider members was appropriate. A Non Executive Director (AK) asked how much resource would be allocated from the Trust s senior team to this area of work, and whether it would result in a reallocation of resources to the Trust. He also suggested that the progress on engagement with GPs be discussed at a future workshop. The Chief Executive explained that this would depend on the final structure of the Transformation Board s portfolio management office. The Trust s Director of Integration was leading on the transformation priorities, and as this work develops it will come within the Executive Director of Operations portfolio. If the priorities become long term conditions and older people s care then there may be a reallocation of resources to the Trust, but nothing had been confirmed as yet. The FT Programme Director informed the Board that the Trust was awaiting a response from the Clinical Commissioning Groups (CCGs) regarding its transformation plans. It was acknowledged that further work was required on the Trust s relationship and regular communication with GPs. The Chief Executive added that the Executive Director of Operations and the Executive Medical Director are able to address any concerns at meetings of the Local Medical Committee. The Director of Corporate Affairs and Company Secretary assured the Board that the Trust sends information to GPs via the Communications Team in order that they receive a single, co-ordinated pack of information each month. A stakeholder newsletter was also being developed. A Non Executive Director (JM) commented that the Health and Social Care Strategy document was not clear on responsibilities and more structure, including a Terms of Reference, was required. She asked how the Strategy was linked to delivery. It was agreed that the paper presented to the Overview and Scrutiny Committee would be circulated to the Board, as this provided more clarity. The Chief Executive explained that the Health and Wellbeing Board agrees the Health and Social Care Strategy, and the Transformation Board oversees its delivery. He also suggested that the Chair of the Transformation Board and the Executive Member for Health and Wellbeing be invited to attend a Board workshop to discuss the Strategy. The Chair agreed that this should be arranged. A Non Executive Director (TD) agreed that the Strategy was the right thing to do, but raised a concern that the document did not describe what would be achieved, and did not include timescales or any SMART objectives. The Chief Executive explained that the Strategy would need to fit with the requirements set out in the planning guidance. Some support for health economics was currently being commissioned. The Chief Executive summarised that the Board was supportive of the development of a Portfolio Management Office for the Transformation Board, but had requested clarification on the governance arrangements between the different boards, and the proposed workstreams. He asked whether the Board was supportive of appointing a Transformation Director to lead the Portfolio Management Office. The Executive (Nurse) Director of Quality felt that the current level of leadership was strong, and couldn t see the added value of creating an additional post. The Chair felt that it could be advantageous to appoint 3

someone independent who would be able to challenge. The Executive Medical Director could see the benefits of both options, and highlighted the importance of any appointee having the appropriate level of influence in order to be effective. The Director of Workforce suggested that the Transformation Board be advised that the Trust would like the benefits and drawbacks of appointing a Transformation Director to be assessed before making a decision. A Non Executive Director (JM) also requested to see the objectives for the role. A Non Executive Director (AK) felt that the Trust could use this opportunity to shape the agenda, and the Transformation Director could drive the reallocation of the budget. The Chief Executive felt that this could be seen as a threat as well, and supported the Director of Workforce s suggestion to assess the benefits and drawbacks before coming to a decision. He asked the Director of Corporate Affairs and Company Secretary to consider how the Board can receive more regular updates on the Transformation Board. A Non Executive Director (RL) congratulated the Nutrition and Dietetics Team on winning the HSJ Award. The Chair informed the Board that he had recently visited HMP Leeds where he had seen the involvement of prisoners with the Trust s services and the link they can provide with other prisoners. He suggested that all Non Executive Directors visit the prison if they have not done so already. The Director of Workforce provided an update regarding the process for recruiting a new Chief Executive for the Trust. The Trust was working with NHS Executive Search, and an advert for the post would be published in the Health Service Journal the following week, and again after Christmas. The closing date would be 27 January 2014. Members of the Board would be given the opportunity to input into the process. The Director of Corporate Affairs and Company Secretary informed the Board that the Chair had been reappointed by the NHS Trust Development Authority, until 7 May 2016. The Board: noted the contents of the report; noted the publication of the response and the arrangements for assessing the Francis action plan; noted the delay in the Foundation Trust pipeline; noted that an unannounced inspection of South Leeds Independence Centre took place on 27 November 2013 and the final report is awaited; noted that the Trust will be required to produce a two year detailed plan by March 2014 and a five year plan by May 2015; reviewed the approach described within the paper and provided feedback for representation at the Leeds Transformation Board and the proposed contribution to resource the early staged of the Portfolio Management Office, including the Transformation Director; noted progress on the Leeds Innovation Health Hub, including the successful symposium, and noted that the final report is awaited; noted the success of the Trust s Dietetic and Nutrition Team at the Health Service Journal Awards; noted the active role that members play in the Trust, noted that a special edition of Community Health Matters would be produced following The Event ; and noted the actions being taken to address changes to the Board membership. Actions: Circulate the Overview and Scrutiny Transformation Board paper to the Board. Invite the Chair of the Transformation Board and the Executive Member for Health and Wellbeing to attend a Board workshop. 4

Consider how the Board should receive updates regarding the Transformation Board. 2013-4/98 Questions from Members of the Public The Chair welcomed Linn Phipps, Chair of Healthwatch Leeds who had requested to introduce herself to the Board and say a few words. She informed the Board that the shadow Healthwatch Leeds Board was in operation, and they were currently recruiting members in order that the full Board could be operational by February 2014. The shadow Board was focusing on some short term priorities, including access to GPs for patients with learning and/or language difficulties, young people s access to dentistry and the upcoming Care Quality Commission inspection of Leeds Teaching Hospitals NHS Trust. Complaints processes were also being reviewed and Leeds Community Healthcare would be contacted as part of this. Volunteers from the shadow Board would also work with each Trust in developing their Quality Account. In future, Healthwatch members will receive appropriate training in order that they can attend Trust Board meetings and ask questions. Members of the Leeds Community Healthcare Board were invited to attend a city wide Healthwatch meeting that would be held in late January as part of the Board recruitment process. 2013-4/99 Integrated Performance Report The Assistant Director of Finance presented a report providing the Board with an assessment of the Trust s performance against its four strategic objectives. 100% of patients who had died while being cared for on the End of Life pathway during October had died in their preferred place of death, and performance against the Improving Access to Psychological Therapies (IAPT) targets had improved. Three Key Performance Indicators (KPIs) were forecast to be red at the end of the year, namely smoking cessation number of quits, sickness absence and staff appraisals. Providing high quality, safe services The Executive Director of Operations highlighted the good improvements made within the IAPT service. The targets had not been met during November, but the Executive Director of Operations was confident that this was a temporary issue and would be recovered. The smoking cessation issue was a national problem, as not enough patients were choosing to enter the service. The Trust was working with the Director of Public Health on an alternative approach. The Chief Executive asked why the IAPT targets had not been met during November. The Executive Director of Operations explained that this was due to the wait between screening and entering therapy. The average wait was previously 18 weeks, but is now down to 8 weeks. The Executive (Nurse) Director of Quality informed the Board that patient satisfaction was above target. There had been an increase in the number of incidents, and the target percentage of no harm incidents is achieved when incidents that were not attributable to the Trust are discounted. A Non Executive Director (TD) informed the Board that the Quality Committee had asked the Health, Safety and Experience Governance Group to look into moderate harm incidents. A Non Executive Director (JM) noted that the Business Committee had not discussed issues relating to the District Nursing service. The Executive (Nurse) Director of Quality explained that she had met a Non Executive Director (RL) to discuss this as requested by 5

the Business Committee, and the detail would be provided at the next Business Committee meeting. The Executive Director of Operations added that metrics would be included on the District Nursing action plan. All teams were currently on amber. There were now fifteen additional District Nurses (Whole Time Equivalent) in post. Activity was in line with expectations, and referrals had increased. Specific actions were being taken to address the levels of sickness absence and ensure that all staff have an appraisal. A Non Executive Director (JM) sought assurance that the Trust was recruiting as many District Nurses as possible. The Executive Director of Operations provided assurance that the Trust was aiming to recruit over establishment, but had not yet achieved this. A Non Executive Director (AK) sought clarification as to the meaning of amber. The Executive Director of Operations explained that this meant that the teams were at full capacity. There were some newly appointed staff who wouldn t be able to manage the same workload as more experienced staff. The level of sickness absence was a contributing factor as well. The Chair informed the Board that the Nominations and Remuneration Committee had agreed that when providing bank cover, staff should be paid at their substantive rate, or at the top of the pay band for the bank role (whichever is the lower). It was hoped that this would reduce the need to use agency staff. The impact would be evaluated in due course. A Non Executive Director (RL) informed the Board that the Business Committee was due to receive targets and trajectories relating to the District Nursing metrics (sickness, training, activity, staff turnover, etc.) at its meeting on 20 December 2013. The Director of Workforce informed the Board that the National Quality Board had published guidance regarding safer staffing levels, which set out the expectation that establishment reviews should be carried out every six months from April 2014. The Trust would start implementing the reviews as soon as possible. A Non Executive Director (AK) highlighted the need to recruit more staff than agreed with commissioners, given that the Trust had aimed to have sufficient staff in post by December, and this had not been achieved. The Executive Director of Operations acknowledged that not as many District Nurses had been recruited as initially planned, but assured the Board that the full benefits of the recruitment had not yet been realised as some staff were still due to start and some leavers needed to be replaced. All teams should achieve a green status when the service is fully staffed, but it was not possible to provide a target date given the national issues which are outside of the Trust s control. It was agreed that the Board would continue to receive regular updates on District Nursing. Engage and empower workforce The Director of Workforce drew the Board s attention to the sickness absence performance against trajectory which was set out on page 18 of the report. The Business Committee had noted that there was a need to train more managers in relation to the sickness absence policy. It was forecast that there would be a shortfall of 100 managers undertaking the training against the target set for March 2014. The Chief Executive asked whether the November sickness absence figure was known. The Director of Workforce had been advised that it was 5%. A Non Executive Director (AK) informed the Board that the Business Committee had reviewed the appraisals trajectory, and had not accepted the proposed target for District Nursing which was 70%. Become a viable and sustainable organisation 6

The Assistant Director of Finance informed the Board that there had been an increase in the pay underspend. The biggest risk area was Cost Improvement Plans (CIPs). The current year s CIPs would be achieved, but the recurrent position had not yet been finalised. The Business Committee had been informed that the Trust s reference costs were currently at 108. A Non Executive Director (JM) highlighted that the Trust was under establishment, but still had high reference costs. The Assistant Director of Finance explained that resources would need to be moved internally, and this provided a potential CIP opportunity. More detail would be provided to the Business Committee. The Board noted the Trust s performance against its strategic objectives. 2013-4/100 Board Assurance Framework The Director of Corporate Affairs and Company Secretary presented the revised Board Assurance Framework (BAF) for approval. It had also been presented to the Audit Committee on 29 November 2013. The Audit Committee had requested more clarity in relation to timescales, a greater level of detail, and a review of the risk levels. The Board would also receive a high level risk register report at every meeting, and would receive all risks at level 8 and above every six months. The tolerance level for each risk would be reviewed to ensure that it is achievable, and recommended levels would be presented to the Board at its meeting on 10 January 2014. The Internal Auditors had confirmed that the revised BAF was in line with best practice guidance, and it would be discussed with the External Auditors during the following week. The Executive (Nurse) Director of Quality commented that the BAF was easy to read. The Chief Executive requested that the four strategic risks set out in the Integrated Business Plan be reflected more clearly in the BAF. The Director of Corporate Affairs and Company Secretary agreed to discuss this with the FT Programme Director. The Chief Executive asked why all risks at level 8 and above would be reviewed by the Board. It was clarified that these risks would be presented to the Board every six months in order that the Board can assess whether there are any clusters of amber risks that may give rise to a red risk. The Executive (Nurse) Director of Quality added that a thematic analysis would be provided to the Board as part of this process. A Non Executive Director (JM) informed the Board that the Audit Committee had agreed to recommend that all red risks (i.e. level 15 and above) should be presented to the Board. The Director of Corporate Affairs and Company Secretary confirmed that the high level risk register report would include all red risks, and a summary of the changes or movements in the red risks over the previous month. A Non Executive Director (RL) sought clarification of the timeline associated with the rating given to each risk, for example the risk relating to the Cost Improvement Programme (CIP) was currently red, but the Trust was forecast to achieve its CIPs for the current year. The Director of Corporate Affairs and Company Secretary agreed to clarify the associated timelines, and include this in the version of the BAF that would be presented to the Board at its meeting on 10 January 2014. A Non Executive Director (JM) noted that the risk relating to safeguarding had increased from 8 (amber) to 16 (red). The Executive (Nurse) Director of Quality explained that this was due to a recent safeguarding incident. The agreement of a Standard Operating Procedure and the implementation of relevant training would reduce this risk. The Chief Executive highlighted that the target date to reduce this risk to the tolerance level was June 2014, which would allow new processes to be embedded. The Board reviewed and agreed Appendix 4, which set out a proposal for each risk on the 7

previous BAF; either transfer to the risk register or amend/merge the risk and transfer it to the new BAF. The Board: approved the format of the revised Board Assurance Framework, subject to the clarification of timescales and the inclusion of more detail relating to the risks; agreed that the Board should receive all red risks, i.e. level 15 and above; and agreed to review and approve a tolerance level for each risk at the next Board meeting, on 10 January 2014. Actions: Amend the BAF as discussed and present to the Board meeting in January 2014 for approval. 2013-4/101 Programme Management Board Report The FT Programme Director presented an overview of the Trust s transformation and efficiency programme following the Programme Management Board meeting held on 21 November 2013. There was a recurrent shortfall of 1.8m. The Business Committee had focused on the programme status for 2014/15 and 2015/16. The plans for 2014/15 and 2015/16 would be developed and approved as part of the business planning process. A Non Executive Director (JM) noted that the risk on the Board Assurance Framework (BAF) relating to Cost Improvement Plans (CIPs) had a rating of 3 (green), and requested that this be reviewed given the recurrent shortfall. The Director of Corporate Affairs and Company Secretary clarified that this rating was included on the previous BAF as the risk related to the delivery of in year CIPs. On the revised BAF, this risk had now been amended to include future years CIPs and the rating had increased to 16 (red). A Non Executive Director (JM) asked whether any recurrent CIPs had been identified, and whether there would be any slippage as the plan was not due to be developed until January 2014. It was confirmed that no recurrent CIPs had been identified using the new methodology yet. There would be some slippage as not all CIPs would be identified by 1 April 2014, but the timing of the different schemes would be managed in order to mitigate this. A Non Executive Director (TD) asked when the service review methodology would be presented to the Board. The FT Programme Director explained that the methodology was being tested in two services, and on average it would take ten weeks to develop options arising from the review. The Chair sought assurance that the reviews were being undertaken with a target in mind. The FT Programme Director confirmed that targets have been agreed and the Service Managers are aware of them. The Chief Executive noted that a number of the programmes for 2014/15 and 2015/16 were rated as red and there were some significant risks. The opportunities within services had been assessed, and the service reviews would show how these could be achieved. He assured the Board that the Executive team is aware that there is further work to do, and he acknowledged that the detailed work had not been shared with the Non Executive Directors. A Non Executive Director (RL) raised a concern that it would be difficult to undertake the service reviews until the revised operational leadership structure is in place. The Executive Director of Operations provided assurance that the General Managers are aware of what is required, and there should be no slippage in the service reviews as a result of the restructure. A Non Executive Director (AK) asked how the Non Executive Directors would be provided 8

with the appropriate level of detail in order to allow them to sign off the first draft of the Annual Plan, including CIPs prior to the NHS Trust Development Authority (TDA) submission date of 13 January 2014. It was suggested that a separate Board workshop or one to one sessions be arranged. A Non Executive Director (JM) felt that a separate workshop should not be required as there is a reporting route to the Board via the Programme Management Board (PMB) and the Business Committee. She asked why the relevant information had not been presented to the PMB, and expressed concern that the Board had not yet been provided with the detail around CIPs and service reviews. The Chief Executive explained that the Senior Management Team and Programme Assurance Meeting had reviewed the detailed plans. The Chair raised a concern that the Trust may not have the capacity required for the service reviews. The FT Programme Director confirmed that the key skills required to deliver the reviews had been identified, and any additional resource required would be included in a business case. Discussions had been held with NHS Improving Quality regarding how they could help with the reviews. The Executive Director of Operations provided an example relating to the podiatry service which had developed a new model with lower costs as a result of a previous service review. The Chair summarised that there was further work to do, and some assurance had been provided around the capacity available for service reviews. The Chief Executive offered to provide the Non Executive Directors with further detail if required. A Non Executive Director (AK) agreed that further detail should be provided to the Board, and agreed to develop a separate paper with the FT Programme Director in order to provide clarity around CIPs and service reviews. The Board noted the report from the Programme Management Board on the delivery of the Trust s transformation and efficiency programme. Actions: FT Programme Director to work with AK to develop a paper to clarify CIPs and service reviews. 2013-4/102 Service Issues and Developments The Executive Director of Operations provided an update to the Board on issues and developments affecting service delivery either currently or in the future. She informed the Board that additional nursing and therapy staff had been recruited at South Leeds Independence Centre (SLIC) for the winter period and the Trust would look at extending this. At the recent Urgent Care Board meeting, all providers had reported that they were finding it difficult to recruit the right number of staff. A Non Executive Director (TD) sought an update in relation to intermediate care. The Executive Director of Operations explained that there were a number of vacancies, but an additional twelve beds would be available by the end of the following week. Admissions were being accepted again at the Community Intermediate Care Unit (CICU) following the closure of eight beds to allow for the completion of safeguarding training. There had been some winter funding for intermediate care but additional beds were needed. The Chief Executive highlighted the need to convey that intermediate care beds are full as well as hospitals, which can result in delayed discharges. The Director of Integration informed the Board that he had met with representatives from the Department of Health and NHS England regarding integration pioneer status and the next steps. There remained a lack of clarity on expectations and process and further communication was expected following the meeting. The single point of access contact centre staff were now based at Westgate Point (an 9

Adult Social Care building) as part of phase one of implementing the single gateway to services. The Executive (Nurse) Director of Quality highlighted the large amount of work put into developing the single gateway and congratulated the Director of Integration on this achievement. The Chair drew the Board s attention to the Winter Plan attached at Appendix 2 to the report. The Board approved the Plan. The Board: noted the continued focus on the District Nursing service and South Leeds Independence Centre; approved the Winter Plan; noted that plans are being implemented to improve capacity and resilience over the winter period; noted that the process around the Operational Leadership restructure is now drawing to a close; noted that the programme of work in school nursing continues to progress and that there has been a small success in trading with schools; noted the ongoing process to develop and deliver the Adult Health and Social Care integration/transformation programme; and noted the continuing development of integrated teams within children s services. 2013-4/103 Community Foundation Trust Programme Update The FT Programme Director provided an update on the Community Foundation Trust (CFT) Programme since the last Board meeting. It had been confirmed that the Trust would be required to undergo an inspection under the new Care Quality Commission (CQC) regime prior to being approved to progress to the Monitor stage. Some proposed revised governance arrangements for the CFT Programme would be presented to the Board. The Chair informed the Board that he was due to attend a Foundation Trust Network (FTN) meeting for aspirant FTs on Monday 9 December, and there was an upcoming dinner for Chairs and Chief Executives with David Bennett, the Chief Executive of Monitor. He asked Board members to let him know if they had any comments or questions for the FTN. A Non Executive Director (RL) asked whether the Trust s members had been informed of the delay in the FT application. The Director of Corporate Affairs confirmed that information regarding the delay had been included in the most recent membership newsletter. The Membership Team would continue to work with members, and potential governors would be contacted in the new year. The Chief Executive added that the Chair had spoken to the Trust s partners, including Leeds City Council, regarding the delay. A meeting would be held with key partners regarding integration and organisational form in January 2014. The Board received the Community Foundation Trust Programme update and noted the progress made. 2013-4/104 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 October 2013. There had been no change in the 10

assessment of compliance since the previous month. The timescales on the action plan would be reviewed. A Non Executive Director (JM) asked why the actions had not yet been implemented. The FT Programme Director explained that the Trust had received confirmation from DAC Beachcroft that there is no requirement to comply with all conditions by 1 April 2014. The Trust is aiming to progress the actions but other issues had been prioritised. Revised deadlines for the actions would be presented to the next Board meeting, on 10 January 2014. 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 noted progress with the action plans for Conditions G8 and C1. 2013-4/105 Governance Update Report The Director of Corporate Affairs and Company Secretary presented the governance update report. The Board was asked to review the Board member register of interests. It was noted that a Non Executive Director s (TD) interests had been omitted from the register in error. He confirmed that his only declarable interest was his role as a fee paid member of the First Tier Tribunal (Health, Education and Social Care Chamber). The Board then reviewed the proposed amendment to the Quality Committee terms of reference, to include an additional position for a Non Executive Director. The Board approved the amendment, and the appointment of the Trust Chair to fill the additional position from 1 January 2014. A Non Executive Director (RL) asked whether section 7.3.1 of the terms of reference would include engagement with GPs. The Director of Corporate Affairs and Company Secretary agreed to review this section, as engagement with GPs links to the work of the Business Committee as well. The Director of Corporate Affairs and Company Secretary highlighted the proposed amendments to the Nominations and Remuneration Committee terms of reference, and asked the Board to approve the appointment of a Non Executive Director (JM) to sit on the Committee if a meeting was required during January 2014, when the Chair of the Committee would be on annual leave. The Board approved the amended terms of reference and the appointment of a Non Executive Director (JM) to the Committee on a temporary basis. The Chief Executive requested that the Board work plan be amended in light of the agreement to review the frequency of updates regarding the Transformation Board. The Board: reviewed the registers of interest and the list of declarations made at meetings, attached at Appendices 1-4 to the report; approved the amendments to the Quality Committee terms of reference as attached at Appendix 5 to the report; approved the appointment of the Trust Chair to the Quality Committee to fill the additional Non Executive position from 1 January 2014; approved the proposed amendment to the Standing Orders, as set out in paragraph 2.9 of the report; approved the amended Nominations and Remuneration Committee terms of reference, as attached at Appendix 6 to the report, and approved the 11

appointment of a Non Executive Director (JM) to the Committee on a temporary basis during January 2014, if a meeting is required; noted the approved action plan following the NHS Trust Development Authority quality visit, as attached at Appendix 7 to the report; approved the 2014/15 Board meeting dates as attached at Appendix 8 to the report; and reviewed the Board work plan as attached at Appendix 9 to the report. Actions: Review section 7.3.1 of the Quality Committee terms of reference in relation to GP engagement. 2013-4/106 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 Chair of the Audit Committee (Non Executive Director (JM)) presented the minutes of the Audit Committee meeting held on 18 October 2013, and provided a verbal update from the meeting held on 29 November 2013. The Committee had reviewed the revised Board Assurance Framework, and the Committee s comments were discussed as part of agenda item 2013-4/100. The Committee had supported the internal audit recommendation to develop an overall framework relating to data quality, and had agreed that the Board should be sighted on how the Trust is responding to all external reviews. The Executive (Nurse) Director of Quality explained that recommendations from all external quality related reports would be built into the consolidated quality action plan, which would clarify the origin of each action. The Chief Executive reminded the Board that the Government had recently released its response to the Francis Report, which incorporated the response to all related reviews, including the Keogh, Cavendish, Berwick, and Clwyd reviews. The Executive (Nurse) Director of Quality was currently reviewing the Government response to ensure that all recommendations were captured in the quality action plan. This would be presented to the Quality Committee and the Board. The Chair of the Audit Committee thanked the Quality Committee for responding to the issues referred to it by the Audit Committee. 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 minutes of the Quality Committee meeting held on 7 October 2013, and the matters arising from the meeting held on 11 November 2013. He informed the Board that the key issues discussed were clinical supervision, pressure ulcer prevention and the Francis action plan. A Non Executive Director (RL) sought clarification of the concerns raised in relation to clinical supervision. The Executive (Nurse) Director of Quality explained that the 12

Committee had debated clinical supervision and the fact that monitoring was no longer in place. Some members of the Committee had supported a proposal to link the monitoring with the appraisal process. She acknowledged that there was further work to do to ensure that clinical supervision is taking place, and to meet the target. The Director of Workforce suggested that Board members could ask staff about clinical supervision as part of their service visits. The Chief Executive explained that supervision would be reintroduced to the Quality Framework and included in the appraisal process. Staff were also being asked about supervision when receiving their flu jab. A Non Executive Director (RL) asked whether a timescale had been agreed. The Executive (Nurse) Director of Quality confirmed that the requirements would need to be defined before a deadline can be confirmed. A Non Executive Director (TD) added that he would expect to see this issue included on the risk register. The Board received the minutes. Nominations and Remuneration Committee The Director of Workforce informed the Committee that the Nominations and Remuneration Committee met on 3 December 2013 and discussed the recruitment process for the new Chief Executive. The Committee had also agreed amendments to the way in which bank staff are paid, as highlighted by the Chair under agenda item 2013-4/99. 2013-4/107 Minutes of the Leeds Safeguarding Children Board and Leeds Safeguarding Vulnerable Adults Board Leeds Safeguarding Children Board The Executive Director of Operations presented the minutes of the Leeds Safeguarding Children Board (LSCB) meeting held on 13 September 2013. A Non Executive Director (RL) asked whether the LSCB s risk register would be visible through future minutes, and whether the minutes were targeted for members of the LSCB or external partners. The Executive Director of Operations agreed to attach the risk register with the minutes when it had been finalised, and cross reference it to the Trust s risk register. She explained that the minutes were written for the members of the LSCB, and were provided to the Trust Board for information. The Chief Executive highlighted that the Trust has a statutory duty to comply with safeguarding arrangements and therefore needs to be assured that they are working properly. He requested that future cover reports for the LSCB minutes clarify where issues are being dealt with by the Trust s Safeguarding Committee. The Executive Medical Director reminded the Board that the LSCB Annual Report, which was presented to the Trust Board on 1 November 2013, described how the statutory safeguarding duties had been fulfilled. The Board was informed that the Executive Medical Director had been appointed as the Designated Doctor for Leeds, and would share this role with Dr Donald Hodge from Leeds Teaching Hospitals NHS Trust. As a result, she had resigned as the Named Doctor for Leeds. The Board received the minutes. Action: Attach the LSCB risk register with the LSBC minutes and cross reference to 13

the LCH risk register. Leeds Safeguarding Vulnerable Adults Board The Executive Director of Operations presented the minutes of the Leeds Safeguarding Vulnerable Adults Board meeting held on 20 August 2013. The Board received the minutes. 2013-4/108 Date and time of next public board meeting: Friday 10 January 2014, 09.00 Boardroom, Stockdale House, Victoria Road, Leeds, LS6 1PF Signed: Neil Franklin, Chair Date: 14

Agenda Number Meeting held on 30 March 2012 2011-2/99a-1 Action Agreed Lead Timescale/Deadline Status Minutes of the Audit Committee Sustainability Strategy to be submitted to the Board in July 2012. Executive Director of Finance and Resources 31.03.14 To be submitted to the Board by 31.03.14 Meeting held on 22 March 2013 2012-3/140-2 Tele-technology Strategy 2013-17- Present a cost/benefit analysis to the Board in relation to the Tele-technology Strategy. Meeting held on 2 August 2013 2013-4/45 Service Issues and Developments Schedule time at a future workshop to review the District Nursing service in detail. Meeting held on 6 September 2013 2013-4/58-4 Integrated Performance Report Provide an update to the Board regarding GP engagement. Chief Executive September 2013 - updated to June 2014 Executive Director of Operations Executive (Nurse) Director of Quality / Executive Director of Operations Additional capacity has been sourced to lead on this work. A report will be submitted to the Board during the first quarter of 2014/15. 06.09.13 To be considered at the Board workshop on 10.01.14. 04.10.13 To be considered at the Board workshop on 10.01.14. Actions to be agreed at the workshop. Meeting held on 4 October 2013 2013-4/69-2 Performance Report - Quality Committee to consider whether NEDs should undertake unplanned service visits and how they should report back 2013-4/70-2 Board Assurance Framework - Assurance process around risk to be reviewed by the Board Meeting held on 1 November 2013 2013-4/85 Integrated Performance Report - SMT and Quality Committee to consider whether diabetes study should be rolled out. 2013-4/88 Quality Governance Framework Self Assessment - Consolidated quality action plan to be presented to the Quality Committee and the Board. Meeting held on 6 December 2013 2013-4/97-1 Chief Executive s Report Circulate the Overview and Scrutiny Transformation Board paper to the Board. 2013-4/97-2 Chief Executive s Report Arrange a Board workshop with Andy Harris and Cllr Lisa Mulherin. Executive (Nurse) Director of Quality Executive (Nurse) Director of Quality Executive (Nurse) Director of Quality Executive (Nurse) Director of Quality 11.11.13 - updated to 02.12.13 07.02.14 Complete Complete verbal update to be provided on 10.01.14. 06.12.13 Verbal update to be - updated to 10.01.14 provided on 10.01.14. 07.02.14 Quality action plan to be presented to Board on 07.02.14. Director of Corporate 13.12.13 Complete Affairs Assistant Board Secretary 07.02.14 In progress. 15

Agenda Number Action Agreed Lead Timescale/Deadline Status 2013-4/97-3 Chief Executive s Report Consider how the Board should receive updates regarding the Transformation Board. 2013-4/100 Board Assurance Framework - Amend the BAF as discussed and present to the Board meeting in January 2014 for approval. 2013-4/101 Programme Management Board FT Programme Director to work with AK to develop a paper to clarify CIPs and service reviews. 2013-4/105 Governance Update Report Review section 7.3.1 of the Quality Committee terms of reference in relation to GP engagement. 2013-4/107a Minutes of Leeds Safeguarding Children Board - Attach the LSCB risk register with the LSBC minutes and cross reference to the LCH risk register. Director of Corporate Affairs 07.02.14 Proposal to be presented to the Board on 07.02.14. Director of Corporate 10.01.14 Complete Affairs FT Programme Director 10.01.14 Verbal update to be provided on 10.01.14. Director of Corporate 13.01.14 Proposal to be presented to Affairs the Quality Committee on Executive Director of Operations 13.01.14. 07.02.14 To be presented to the Board on 07.02.14. 16