a g e n d a - guy's and st thomas...of ambition and the challenges facing the evelina including...

@BCL@140E188E

COUNCIL OF GOVERNORS

Meeting to be held on 23rd October 2019 6.00pm – 7.30pm, Robens Suite, Guy’s Hospital

A G E N D A

1. Welcome, apologies and opening remarks

2. Minutes of meeting held on 24th July 2019

(CG/19/32)

3. Matters Arising

4. Reflections session on Board of Directors meeting

verbal

5. South East London Integrated Care System A focus on the cancer pathway Julie Lowe & David Cheesman

Presentation

6. 7. 8.

Nominations Committee Update Hugh Taylor External Audit Contract Extension Proposal John Pelly Governors’ reports – to note and for information

1. Lead Governor report Devon Allison

2. Quality and Engagement Placida Ojinnaka

3. Service Strategy Annabel Fiddian-Green

(CG/19/33)

(CG/19/34)

verbal

(CG/19/35)

(CG/19/36)

9. 10.

Questions and Answers ~ for information Any other business

(CG/19/37)

verbal

11. Date and time of next meeting:

Wednesday 22nd January 2020, Shepherds Hall, St Thomas Hospital, Westminster Bridge Road, London, SE1 7NJ

Board of Directors meeting 3.45pm – 5.30pm Council of Governors meeting 6.00pm – 7.30pm

Agenda

1 of 53Council of Governors Meeting, 23rd October 2019 , 6.00pm – 7.30pm, Robens Suite, Guy’s Hospital-23/10/19

CG/19/17 Approved by the Chairman

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Council of Governors

Minutes of the 65th meeting of the Council of Governors held on Wednesday 24th July in the Robens Suite, Guy’s Hospital

Present:

Tahzeeb Bhagat Margaret McEvoy John Chambers Alice Macdonald Marcia Da Costa Lucilla Poston Annabel Fiddian-Green Samantha Quaye Tony Hulse Samantha Quaye Mary Stirling Peter Yeh

Apologies: John Balazs Matthew Patrick Robert Davidson Sue Slipman Jacqui Dyer Jane Fryer

Warren Turner Yu Tan

Anita Macro Placida Ojinnaka

In Attendance: Executive Directors: Dr Ian Abbs Amanda Pritchard Julie Screaton Martin Shaw Eileen Sills

Non Executive Directors: Felicity Harvey John Pelly Reza Razavi Sheila Shribman Priya Singh Sir Hugh Taylor (Chair) Steve Weiner

Other Attendees:

Devon Allison Lead Governor Steven Davies Director of Finance Adam Dunlop Chief Digital Information Officer Alastair Gourlay Director of Essentia

CG/19/ 23 Welcome, apologies and opening remarks

CG/19/ 24 Minutes of the meeting held on 24th April 2019

The minutes of the meeting held on 24th April 2019 were approved as a true record.

Peter Allanson Farhan Quadri

Trust Secretary and Head of Corporate Affairs Membership and Governance Coordinator

Paul Dossett Grant Thornton

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Tab 2 Minutes of meeting held on 24th July 2019


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CG/19/ 25 Matters arising

There were none. CG/19/ 26 Reflections session on Board of Directors meeting

Governors raised a number of issues, mainly arising from the public Board meeting held earlier: 1. Diversity data: in response to a comment relating to triangulating speaking

up information with diversity data, it was explained that whilst there was more that could be done on accessing groups finding it difficult to raise issues, the Trust used hard and soft data to draw conclusions. Some reports were anonymous and although diversity questions would be added to the feedback forms, providing answers was not compulsory. There were regular Workforce and Staff side discussions to try to identify trends.

2. Sexual Health: there were currently no measurements of the impact of the reductions of public health spending and PHE would be normally track prevalence trends carefully. The Trust would raise this with the local public health teams; some impact on health and health inequalities could be expected.

3. Childbirth: The media suggested that more black women died in child birth

than white women. Although mortality data was available in the Trust it was not broken down by ethnicity; it was agreed to review whether more detail could be provided and this would be published through the Q&A matrix. The number of maternal deaths was small and the statistics monitored rigorously by DHSC. There was likely to be a correlation with those who had social deprivation issues.

4. Capital Planning: it was confirmed that schemes planned and funded by the

Charity fell outside CDEL. It was not yet clear how much of the enabling activity would be affected by the current availability of capital. Given the size of ambition and the challenges facing the Evelina including its taking on work from the Royal Brompton, the Trust was discussing its total programme with DHSC. There would be a special business case for this in any case. It was hoped that this year’s reduction would not affect the 2019-20 plans adversely particularly as the main spend on the Evelina was not scheduled for the current year.

5. CQC: the Council of Governors congratulated the Trust on the outcome of

the CQC report and in particular the achievement in the Community. 6. Demand Planning: The Trust commented that it was looking at three

dimensions:

Reducing level of growth by relying on ICS partners both commissioners and other local providers as they stabilised so rebalancing could take place.

Capacity – there was a considerable build programme for theatres which needed to be maintained, workforce to use it and the wrap arounds including diagnostics needed to be factored in - There would be 15 additional operating theatres planned over the next few years that it was hoped would meet demand.

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Reviewing how to become a 6 day hospital. Improving productivity through process and pathway changes to give more flexibility with consequent implications for job planning and management.

The Trust was working with Lewisham in particular to strengthen their services and so enabling referrals to remain local – this included making joint appointments.

CG/19/27 2018-19 Annual Report & Account: The External Auditor introduced the 2018-19 Annual Report and Accounts. The

role of the Auditor was to audit the financial statements, give an opinion on value for money and on the quality report.

The opinion showed no concerns on the financial statements.

The value for money opinion on financial sustainability for the current and future position of the Trust was positive given the outturn so the conclusion was unqualified. The Quality Report was a statutory requirement and auditors were asked to confirm compliance and to test some of the indicators with an emphasis on key ones nominated by DHSC. A&E waiting times and the 62 day cancer target had been selected. The 62 day figures were satisfactory though there were some errors identified on waiting times which led to a limited assurance opinion. This was a satisfactory outcome for the auditors and the Council received the 2018-19 Annual Report and Accounts on behalf of the Trust members. The Council congratulated the Finance Director and Chief Financial Officer on the achievements. This was a key part of the Governor’s assurance that the Board was working effectively and that additional assurance was being given by the external auditors.

CG/19/ 28 Nominations Committee Update

John Chambers introduced the update on behalf of the Nominations Committee.

1. Priya Singh – Renewal Priya Singh’s first four year appointment and a non-executive director of the Trust was due to come to an end on 31st October 2019. The Nominations Committee had accepted the Chairman’s recommendation that she should be invited to serve a second and final four year term. She had chaired the Quality and Performance Committee of the Board since June 2016 and subsequently taken on the associated role of independent chair of the Serious Incident Assurance Panel. She also sat on the Audit Committee, the Remuneration Committee and the Transformation and Major Programmes Committee (and, in the case of the latter its predecessor bodies the Corporate Management Committee and the Digital Committee). The Committee agreed that she had made an excellent contribution to all these Committees – as well as to the main Board and to meetings with the Council of Governors. The Council agreed and unanimously supported her reappointment until 31st October 2023.

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2. NED Recruitment

Dr Chambers briefed the council on two recruitment exercises for non-executive directors: the first to replace Girda Niles whose second term of office was due to come to an end at the end of 2019. Green Park had been appointed to support this and they have been working on the longlist for about 2 weeks. Early indications were that there was substantial interest with over 450 “hits” on the microsite. The interview were scheduled for early September and it was hoped to agree an appointment, on the recommendation of the Nominations Committee in advance of the October meeting of the Council of Governors, for formal ratification at that meeting. The other recruitment was originally intended to replace David Perry’s expertise and knowledge on matters digital with a NED appointment. However, the Trust’s decision to appoint a Chief Digital Information Officer in conjunction with KCH suggested that this should be reassessed.

. CG/19/ 29 NHS Current Context

The Chief Executive introduced her thoughts about the prospects for the next couple of years for the NHS generally and the trust in particular. Contextually, there had been more organisational and personnel change in NHS England and NHS Improvement than since 2012. Currently, a large number of staff were moving into new structures. This had coincided with a deterioration in the achievement of access targets. A number of trusts were also struggling financially. The delivery of the NHS long term plan through systems rather than organisations would be challenging. Workforce had been identified as key to the delivery of the plan including inclusion and diversity. The Trust’s revised strategy matched the aims of the NHS plan and was being handled actively in the Trust. The Trust’s position in terms of performance mirrored the national picture. The drive to perform well for patients was important. The Trust was on track financially and the CQC report was positive. People wanted to work in the Trust and the values and culture were palpable even though further work was needed to improve inclusion. Innovation, improvement and research activity gave the Trust real advantages and there were major opportunities ahead including the EHR programme, the estates development and the wide range of partnerships. At national level challenging issues included capital availability, finding a national solution to the pension problem for senior clinicians and the preparation for exiting the EU. There were major opportunities for this Trust on integrated care which was a leading edge service across all domains, specialist networks across South London with GSTT as an anchor to the benefit of patients. This was noteworthy because specialist services and tertiary trusts did not feature widely in the Long Term Plan. Some partnerships could be “game changers” for patients notably KCH, RBH and KHP.

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CG/19/30 Lead Governors Report

The Lead Governor welcomed the new governors and congratulated the Trust on the CQC outcome. She was grateful for the support from Essentia on patient transport in preparing for a meeting with the Deputy Mayor and TFL to discuss the classification of patient transport. There would also be an attempt to persuade them to look at finding ways to support junior staff with transport costs. Listening Line continued to develop.

CG19/31 Governors’ Reports

Council noted the reports from the Working Groups reported: Membership Development, Involvement and Communications Working Group MEDIC wanted to increase members so that there was a better understanding of local needs. There had been good feedback from recent health seminars. It had also discussed setting a protocol for handling complaints and queries. Improving the knowledge of the work of the Governors through patient and other groups. There was to be a by election to fill the two patient vacancies and two staff vacancies – there were now six and nine nominees respectively for each and the election would open on 30th July with results announced on 23rd August. Quality and Engagement Working Group The Group had discussed end of life care, the transition from children’s to adult services and taken updates on quality and PPE. It had been interested in the call quality assessment reports and gaps in the system especially if patients needed to return calls. Patient transport was discussed regularly and it was hoped that there could be improvements before the contract was retendered. Service Strategy Working Group

The Group fulfilled one of the Council’s statutory functions to advise the Trust on its plans and strategies. It had considered the Integrated Care system and the Healthcare Alliance.

CG/19/ 33 Date and time of next meeting

The next meeting will be held on 23rd October 2019, Robens Suite, Guy’s Hospital Board of Directors meeting 3.45 – 5.30pm Council of Governors meeting 6.00 – 7.30pm

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CG/19/14

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Signed: Date:

2



2019 NED Appointment


Appointment of Non Executive Directors

10th September 2019 CoG/19/XX

This paper is for: Sponsor: Sir Hugh Taylor

Decision X Author: Peter Allanson

Discussion Reviewed by: Nominations Committee

Noting CEO*

Information ED*

Board Committee*

TME*

Other*

* Specify

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1. Summary The Nominations Committee has been working to find a replacement for Girda Niles whose second term of office comes to an end on 31st December 2019. It is clear to all that the challenges facing the Board over the coming years will need considerable strength and resilience to navigate. This upcoming vacancy on the Board is for an individual who is able to contribute effectively to the Board’s whole agenda and who can make a particular contribution to our community engagement and inclusion agendas. A short account of the interviews that the Committee held is annexed to this paper. 2. Request to the Council of Governors

The Council of Governors is accordingly invited to approve the appointment of the following Paul Cleal as a Non Executive Directors of the Trust for a term of four years renewable for a further four year term subject to final checks and satisfactory performance.

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3. Report to the Council of Governors The Nominations Committee presents its proposals for the appointment of a non executive director to replace Girda Niles. It sought comment on the job and person specification from the Council and the Board and appointed Green Park to advise it on the selection and search for candidates after a competition between advisers. The position was advertised in the South London Press as part of the selection process and Green Park constructed a microsite in the internet that was widely available. There were more than 3,200 visits to the microsite and there were 37 applications in total. Green Park engaged with over 160 possible applicants, 80% of whom were Black, Asian and Minority Ethnic persons. The Nominations Committee met to consider those applications alongside a proposed long list of 12 applicants from which they created a shortlist of 5 candidates for interview using the key criteria in the person specification in arriving at their decision. The panel interviewed the 5 candidates on 9th September 2019. The discussion with all of them was based on a common interview framework covering how they would discharge the responsibilities of being a non executive director, meeting the current challenges facing the NHS, demonstrating the Trust’s values and in particular understanding the needs of our local communities and patients and how the Board should lead and support the diversity and inclusion agenda. The Committee was grateful to Green Park for producing an interesting and high quality list of candidates and strongly recommends that the Council of Governors approves the appointment recommended.

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Appendix

Candidate 1 This candidate was a digital specialist who having worked in larger organisations was now running a small consultancy. She had little experience of having to tackle as wide a range of issues as the trust Board faces all the time and was not able to demonstrate readiness for a non executive appointment in an organisation of the scale and complexity of the Trust. The panel was interested in the discussion about digital matters but did not support her candidature and do not put her forward for appointment. Candidate 2 With early training as a nurse and previous experience as a non executive of a hospital trust, this candidate clearly understood what would be needed even if she perhaps underestimated the scale of change in the NHS since her last appointment. The Panel warmed to her. She was very engaging. The Panel appreciated her clear understanding of our communities and was confident that she would live up to her claim of being calmly persistent in questioning to obtain information. She came across as honest and direct with a useful ability to see both sides of an argument and see issues in a wider context. She was appointable. Candidate 3 The third candidate was the senior executive of a charity. He was thoughtful and contemplative, almost thinking aloud as he talked to the Panel who did not feel he really got to grips with what they wanted to know. His early background as a therapist was evident in his approach – contemplative and interrogative as he gained information. Politically aware the Panel was concerned he might be too immersed in detail. He too had no non executive board experience and was unable to persuade the Panel on this occasion that he would be able to rise to the challenges he would meet at the Trust. He was not recommended for appointment.

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Candidate 4 This individual impressed the panel with his measured approach and deep understanding of the local communities, within which he works. He was calm and personable. He spoke well of his own experience of health inequalities and was clearly passionate about wanting to make a contribution as a non executive director. The Panel thought he would become an effective non executive director. The Panel’s view was that he was appointable. Candidate 5 This was the stand out candidate. Coming from a consultancy background – he had been a partner in one of the major firms – he would add value on a number of issues including finance and workforce. He was persuasive on community engagement and had good experience of the diversity and inclusion agenda from a personal perspective and at both local and national levels. He had a close personal association with the Trust and came across as having a passionate and thoughtful commitment to wider social policy issues and as fully aligned to the Trust’s vision, values and strategy. He is the Panel’s preferred candidate for appointment.

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23rd October 2019 Council of Governors – External Audit contract extension proposal 1


External Audit contract extension proposal

23rd October 2019 CG/19/34

This paper is for: Sponsor:

Decision X Author: Catherine Eyre, Chief Accountant

Discussion Reviewed by:

Noting CEO*

Information ED*

Board Committee*

TME*

Other*

* Specify

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1. Summary

The Trust contract for external audit services with Grant Thornton expires on 16 July 2020.

There is an option for a two year extension, on a 12 monthly basis.

The Audit Committee agreed on 4th September to recommend to the Council of Governors that this contract is extended for another two years, until 16 July 2022.

2. Request to the Council of Governors

It is recommended that the Council of Governors agree to extend the external audit contract by two years.

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3. Detail 3.1 Grant Thornton were awarded the external audit contract in 2017 for three years. The audit services are

provided to the Trust and all it’s subsidiaries. The contract covers the external audit of the annual accounts and the quality audit.

3.2 Grant Thornton have now performed two year end audits at the Trust, the final audit under the existing

contract is this year end, 31st March 2020. The costs that have been paid to Grant Thornton for their audit work are shown in Table 1 below, and are reported in the Trust annual accounts. Grant Thornton’s external audit fee is a consistent total figure including VAT of £139k.

Table 1: Trust expenditure on external audit services

Year ended 31 March 2019 £’000

Year ended 31 March 2018 £’000

Audit services – statutory audit 108 108

Other audit services – quality audit 8 8

VAT 23 23

Total payable for audit services 139 139

3.3 The Audit Committee have been satisfied with the work carried out by Grant Thornton. 3.4 The Audit Committee Terms of Reference require a recommendation to be made by the Committee to the

Council of Governors regarding the renewal or extension of the external audit contract. 3.5 The Audit Committee are recommending that Grant Thornton be appointed for two further years, until 31st

March 2022. If instead, the Trust decided to appoint new auditors, the decision would need to be agreed

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by the Governors, and therefore the appointment would need to be made at the 22nd April 2020 Council of Governors meeting.

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23rd October 2019 Council of Governors – Quality and Engagement Working Group report (September 2019) 1


Quality and Engagement Working Group report (September 2019)


This paper is for: Sponsor: Placida Ojinnaka

Decision Author: Mark Tsagli

Discussion Reviewed by: Placida Ojinnaka

Noting CEO*

Information X ED*

Board Committee*

TME*

Other* X Council of Governors

* Specify

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1. Welcome and apologies for absence

This report details the meeting of the Quality and Engagement Working Group (QEWG) which took place on 24th October 2019 at the Burfoot Court Room, Counting House, Guy's Hospital. In attendance: This meeting was attended by: Sarah Allen (Head of Patient Experience), Devon Allison (Lead Governor), Peter Bennet (Facilities Services Director), Marcia Da Costa (Public Governor), Margaret McEvoy (Public Governor), Paula Lewis-Franklin (Public Governor), David Gravells (Head of Central of Services), Annabel Fiddian-Green (Public Governor), Felicity Harvey (Non-Executive Director), Alison Knox (Deputy Director of Quality and Assurance), Betula Nelson (Public Governor), Placida Ojinnaka (QEWG Chair), Mark Tsagli (Patient Experience Specialist), Anna Grinbergs - Saull (Patient and Public Engagement Specialist). Apologies were received from: John Balazs (Lambeth CCG), Tahzeeb Bhagat (Staff Governor), Elaine Burns (Public Governor), Andrea Carney (Trust Patient and Public Engagement Manager, Priya Singh (Non-Executive Director), Simon Yu Tan (Patient Governor), Peter Yeh (Public Governor). 2. Notes from the last meeting The notes were approved as an accurate record of the last meeting.

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3. Patient Transport (PT) The Head of Hotel Services Operations gave an overview of the Patient Transport service highlighting some of the challenges facing the service, initiatives undertaken so far, and planned future improvements. The presentation covered the following:

The Trust's Patient Transport services undertake about 23,000 patient journeys a month comprising - Renal patients, Outpatients and On the Day patients (OtD).

The increasing acuity of renal patients, unpredictability of OtD patients, patients having three or more journeys a week are key issues facing the service.

The team shared plans for the future delivery of the service; how they aim to modernise and improve the service. They outlined work already undertaken in engaging and involving patients, selecting experts in the field to help provide an exemplar future service.

It was mentioned that the services of external experts have been engaged and challenged to help deliver and test what an expert service would look like for the Trust.

Friend and Family Test (FFT) - Performance on the FFT is high despite the challenges. Governors were informed that an average of 92% of patients said they will recommend the service in recent data collected.

Involving patients in service change and delivery is important to the service. The team have undertaken a significant amount of engagement meetings over the years and have a good body of evidence to help identify the key issues confronting patients using the service.

Governors were further advised about the extensive stakeholder engagement work that has been undertaken and patient involvement throughout this exercise. Some of the activities include patient workshops carried out in December 2017 and patient surveys to understand what matters most to users of the service. Some findings from the survey revealed issues around improving driver attitude, the use of patient friendly vehicles, better communication, less waiting and the need to review the booking system.

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Additional challenges to the service were highlighted namely; challenges with onsite parking access particularly at the Guy's site where a significant number of drivers queue to park. A number of planned changes such as introducing penalty charge notices for persistent offenders, introducing redlines to prevent drivers from parking at unauthorised locations were outlined.

Public transport: The Facilities Director also raised the possibility of encouraging some patients who are able to use public transport to help ease the pressure on parking facilities.

Governors were reassured of continuing and ongoing engagement with patients to ensure their voice is heard throughout these improvements. He also made the point of having patients' representation on the award of contracts and the evaluation panel and to continue using the user groups and steering groups.

Governors thanked the team for the insightful presentation. In discussion, they raised a few questions relating to logistics and challenges with parking at Guy's. If patients are going to be encouraged use public transport, for those with mobility requirements will they have access to wheelchairs to move them about? Most of the patients are acutely unwell, can they be easily encouraged to use public transport? Could localised or satellite renal units help, can patients be supported to dialyse at home which could be better for them and for the Trust? Responding, the Facilities Services Director welcomed the suggestions and reiterated some of the measures being taken to address some of the challenges of delivering an effective service such as unauthorised parking from repeat offenders - which to a large extent is causing delays for patients. He made the point that the criteria for assessing patient transport needs is made by non-clinical staff so can be difficult for staff to assess who is extremely unwell which means the numbers using the service can be significantly higher than expected. If GP's were involved, this could help assess those who really need the service. In reference to the question raised about parking challenges, he stressed the importance of ensuring measures are in place for dealing with unauthorised parking at the sites. He made the point that penalty charge notices

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are not intended as a revenue generation mechanism and reassured Governors that the Trust has final say on reviewing any unfair penalty charges. In response to the question on promoting and encouraging home dialysis, the Deputy Director of Quality and Assurance explained to governors that some of the barriers to expanding home dialysis were much broader, and could be due to constraints in patients' home settings preventing them from taking full advantage of this.

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4. Quality update: The Deputy Director of Quality and Assurance provided an overview on quality improvement measures in place at the Trust.

The Deputy Director of Quality and Assurance drew attention to the Trust's performance in the recently published CQC inspection report, highlighting particularly the Trust's overall "Good" rating, and the "Outstanding" rating recorded for both the Adult Community Services and the "Well Led" aspect of the inspection.

Reference was made to Outpatient services which was identified as 'Requiring improvement' in relation to a number of safety related domains. She further advised the group of the Outpatient Transformation Programme which has also been incorporated into the Digital Patient Journey programme to help address some of the issues raised following the CQC inspection. She advised of a significant amount of ongoing work in the Trust to make Outpatient services more modern, safe, and tailored to what the outpatient population need.

She took the opportunity to summarise the key pillars of the recently published NHS Patient Safety Strategy which is expected to ensure NHS care is delivered in the safest possible way. She informed the group of the three aspects of this strategy: Insight (driven by data), changes to data collection, changes to recording incidents (never events etc.): Involvement - which includes equipping patients, staff and partners with the skills and opportunities to improve patient safety: Improvement which is designing and supporting programmes that deliver effective and sustainable change in the most important areas.

Quality Priorities - The Trust Mental Health Strategy (one of the chosen priorities) has been published and will be launched on October 10th 2019 to coincide with Mental Health Day. Referring to the other priorities, the group was informed of achievements in the number of patients screened for Sepsis against planned

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targets. The group noted the achievements made so far made in this area evidenced by the increase in patients receiving their IV antibiotics within one hour - a target which has been met in adult clinics.

Another quality initiative mentioned was to make sure the Trust is also learning from excellence. Making sure staff are able to report positive experience akin to the existing process of reporting of incidents and never events.

It was suggested that any follow up questions relating to the presentation be sent through the Working group's Governance and Membership Co-ordinator so these can be responded to.

6. Patient Experience (PE) and Patient and Public Engagement (PPE) updates

The Trust Patient and Public Engagement Specialist summarised key points from the Patient and Public

Engagement Update report. The following points were noted:

The PPE team are continuing to support ongoing work on digital transformation programme and are leading

work to support the involvement of patients to inform the Trust’s E-HR procurement requirements.

Royal Brompton and Harefield NHS Foundation Trust and King’s Health Partners Programme: The

partnership continues to involve patients and the public in its work. To date, the team have undertaken three

patient and carer events including organising successful webinars.

Call Quality Assessor (CQA) - Performance has so far been positive in relation to staff greeting the caller

and offering assistance. There have been some decreases in communication skills - maintaining an

appropriate pace and explaining any gaps in silence. The representative from the team reassured governors

that the CQA report will be sent to the call centre team and will be used as part of their quality improvement

process.

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The Head of Patient Experience summarised key points from the Patient Experience Update report. The

following points raised in the discussion were noted:

Strong improvement in the Trust's performance on the 2018 National Inpatient results. Areas where the Trust

improved were on 'Noise at night' - a performance also reflected in our local surveys. Some of the other

areas of improvement were on 'clear written information on medicines', 'patients knowing what will happen

next with their care', and 'knowing which nurse what in charge of their care'.

The Trust also performed strongly within the Shelford group. Areas where the Trust has not performed

particularly well were on making sure additional copies of leaflets and posters were available in wards and

clinics. This, however, was a focus in April to address this issue.

The Emergency Department's Friends and Family Test (FFT) performance in April was in line with national

and regional averages, their response rates continues to be strong and above target. Their 'recommend'

scores were not particularly strong and this is partly due to increasingly high volumes of patients the

department is seeing, and the challenges of manage waiting times. Outpatients' performance is in line with

national averages. Patient Transport scores in April outperformed regional and national averages.

With regards to areas of high and low performance, 'noise at night' has consistently been above target in the

last few months. The biggest area for focus is in keeping patients informed about delays in clinics and how

patients can contact staff after they have left.

With regard to the Patient Experience Priorities of patients contacting the Trust, the Head of Patient

Experience also drew the group's attention to ongoing work to upgrade the customer contact centre

technology platform.

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Keeping patients informed - the Head of Patient Experience informed the group of ongoing work with the

Trust's Mental Health Lead to organise pilot training sessions to help frontline staff in outpatients clinics deal

with challenging behaviour, which oftentimes is a key barrier for staff informing patients about delays in

clinics. Funding for the pilot is expected to end this month and plans are in place to make representations

for further funding depending on successful evaluation of this.

In relation to information to support self-care at home, it was mentioned that discharge booklets are being

piloted on two wards to encourage patients think about what they need to have before they go home.

There are plans to roll out self-check in a call forward screens across the Trust. A significant amount of work

for revised self-check in and call forward screens has been done to involve patients already and patients will

also be involved once a prototype has been developed for patients to evaluate and make sure this works for

all.

7. Reports and updates from committees (those recently attended by Governors) Quality and Performance Committee: No notes tabled Cancer Services Committee,

No notes tabled

End of Life Care Committee (EOC):

No notes tabled

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The Lead Governor also informed the group that she was no longer sitting on the EOC committee and invited

interested governors to avail themselves of this opportunity.

8. Matters arising from the last meeting and any other business

Additional information

Review of access to sites: The Lead Governor touched on an informal discussion recently with a few governors

about conducting a review on access to sites at the Trust. The aim is to reach out to groups of patients with limited

mobility to ensure the Trust knows what their challenges are, and how their ideas can be harnessed to help improve

accessibility and make this easier for them. It was reported that this is work in progress and further updates will

be shared with governors on how they can get involved.

9. Date of next meeting:

Tuesday, 3rd December 2019, Burfoot Court Room, Counting House, Guy's Hospital, London Bridge.

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23rd October 2019 Council of Governors - Service Strategy Working Group report (Oct2019) 1


Service Strategy Working Group

Service Strategy Working Group report (October 2019)


This paper is for: Sponsor: Annabel Fiddian-Green, SSWG Chair

Decision Author: Jessica Levoir, SSWG Secretariat

Discussion Reviewed by: Annabel Fiddian-Green, SSWG Chair

Noting CEO*

Information X ED*

Board Committee*

TME*

Other* X Council of Governors

* Specify

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1. Attendees: Annabel Fiddian-Green (Chair), Devon Allison, John Powell, Tahzeeb Bhagat, Placida Ojinnaka, Laura James, Christine Yorke, Rachel Williams and Mary Stirling. Jackie Parrott (Chief Strategy Officer), Martin Shaw (Chief Financial Officer), Caroline Sweeney (Lead for Mental Health) and Claire Wills (Relationship Manager, Guy’s and St Thomas’ Charity) attended from Guy’s and St Thomas’. Apologies were received from Margaret McEvoy, Lucilla Poston, Martin Bailey, Samantha Quaye, Simon Yu Tan, Elaine Burns, Tony Hulse, Robert Davidson, John Knight, Peter Yeh, John Chambers, Betula Nelson and Alice Macdonald.

2. Notes of the previous meeting and matters arising

2.1 The notes of the meeting held on the 9th July 2019 were approved as a true record.

3. Mental Health Strategy

3.1 Caroline Sweeney (Lead for Mental Health) joined the meeting for this item. Caroline explained that her role was established in order to take the mental health strategy forwards. Caroline set out that the purpose of today’s agenda item was to provide an update on the mental health strategy since the consultation closed and the strategy discussed at Trust Management Executive (TME). There have been some minor changes made to the version governors have seen as a result of the consultation. The strategy will be launched on World Mental Health Day, which is on the 10th October 2019.

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3.2 Caroline explained that the strategy was patient focused, although some objectives were relevant to staff wellbeing given the impact of this on patients. The strategy particularly focuses on children and young people’s mental health and prevention.

3.3 Caroline set out why the strategy was needed; a significant number of Trust patients have mental health

conditions and, when admitted, these patients experience longer waits for beds than other groups. In some instances, patients with mental health conditions have had to wait as long as two days for a bed. The Trust has five Mental Health Liaison Teams, all of which have seen an increase in referrals. The Trust needs to ensure it can meet the various needs of this patient group.

3.4 At the end of 2017, the Trust commissioned two external pieces of work to review activity across the

emergency pathway, which included a deep dive by Niche on relevant data held by the Trust. This work produced a series of recommendations the Trust agreed to take forward, including: improving senior escalation when there are bed issues; ensuring psychiatric nurses are available overnight; creating a Mental Health Flow post and a Lead for Mental Health; and reviewing the mental health governance structures. Caroline highlighted that whilst this work has had a positive impact, it only addresses the tip of the iceberg and more remains to be done.

3.5 To develop the strategy, seven workshops were held across the Trust, with good representation from across

staff groups, patients and external stakeholders. All workshops were aligned to the Trust strategy, and aimed to understand what the Trust should do in order to ensure services meet the needs of all groups. The outputs of the workshops then led to the development of the mental health strategy objectives.

3.6 The revised mental health governance structures have led to numerous developments and the adoption of

good practice by the Trust, including: focused training for staff across the Trust on recovery and stigma; work with district nurses on improving awareness of mental health pathways and how they can access these for their patients; Evelina Primary Care Hubs for adolescents; and improved partnership working with South London and Maudsley NHS Foundation Trust (SLAM);

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3.7 The strategy covers a three year period, and sets clear objectives to improve experience for patients with mental health conditions for each year, so that it is clear what the Trust aim to achieve year by year. The strategy also details what success looks like according to the Trust’s three key strategic priorities outlined in ‘Together We Care’; patients, people, and partnerships. Caroline highlighted that, whilst some key strategic partnerships are already established, there is more work to be done on this.

3.8 The next steps to implement the strategy include directorates producing their own delivery plans, and the

creation of a Trust-wide delivery plan, to be managed through the mental health governance structures. During questions and discussion the following was highlighted:

This paper was brought to this group as a result of the governors’ away day in July, when a request was made to hear more about the Trust’s approach to mental health and wellbeing.

The governors commended the strategy workshops.

There are multiple reasons for the increase in demand for mental health services, especially in the last five years, and there are significant pressures on mental health services as a result. What with the publication of the NHS Long Term Plan, there is a renewed commitment to increase funding for mental health services.

Working with our partners to ensure patients present to the right place for their treatment is important, as is improving patient pathways to reduce the number of steps a patient must go through to receive treatment. Work has been done to develop services in the community, especially Lambeth where SLAM have created a Crisis Outreach Team, however more can still be done.

Ensuring all staff receive necessary training is challenging, and there is a need to think creatively as to how different training methods and partnership working can be used to overcome this. The future workforce are receiving training already i.e. NMC Future Nurse, so all nurses will need to upskill.

The focus on improving prevention and children and young people’s mental health services is right, however this is a complex area and there is more work the Trust can do with partners in regards to this.

The most significant barriers to implementing the strategy mirror the challenges most of the health system faces today, including scarcity of resource and the financial challenge. However, the Trust is dedicated to ensuring the strategy is implemented.

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Work with a staff focus is ongoing in the Trust, led by the heads of nursing for occupational health and workforce. Whilst this work has been fed into the mental health strategy, it primarily sits under Julie Screaton, Chief People Officer, who has overall responsibility for its delivery.

4. Guys and St Thomas’ Charity and Fundraising

4.1 Claire Wills (Relationship Manager, Guy’s and St Thomas’ Charity) joined the meeting for this item. Claire explained that the Relationship Manager role is part-funded by the Charity. Claire set out that the purpose of the item was to give governors an overview of how the Trust work with the Charity to fundraise, and how the Charity fundraise across health and care partners.

4.2 Claire explained how the Charity fundraising teams are set up, and how the Trust work with King’s Health Partners (KHP). The Trust’s fundraising team is employed by King’s College London (KCL) but fully funded by the Charity, whereas the KHP fundraising team is employed by KCL but joint-funded by the Trusts that make up KHP, KCL and the Charity. This structure tends to work well, as the fundraisers are able to inform possible donors about work ongoing across KHP.

4.3 The Charity is one of the biggest in the country. Whilst it is a hospital charity, the Charity also has another, different role to other hospital charities. As well as providing grants to support initiatives in the Trust, the Charity has a remit to support the health and wellbeing of the people of Lambeth and Southwark more widely as an Urban Health Foundation.

4.4 As an Urban Health Foundation, the Charity funds a wide range of partners, and looks to understand how living in a city impacts on people’s health and wellbeing. The Charity focuses on a few, complex, priority health issues at any one time, and works with partners to find solutions to these. For example, adolescent mental health (currently being scoped), and the effects of air pollution (which involves the Charity working with the Trust, as one of the biggest polluters in the area, and other partners to reduce the impacts of air pollution).

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4.5 The Charity’s fundraisers are funded by an endowment, instead of donations raised. Through this endowment, the Charity also makes philanthropic donations, and supports areas of strategic importance to the Trust.

4.6 The Strategic Fund supports activities of importance and value to the Trust, with the aim of creating a positive environment for staff, patients and visitors. This includes funding for Breathe Performing Arts, which for example has funded musicians to perform in outpatient clinics.

4.7 The Charity has four fund committees, enabling donors to choose where their donation goes; these are the Charitable Fund, Cancer Fund, Evelina London Fund and Special Purpose Funds. Committees meet four times a year, and anyone from the Trust can apply to a committee for funding. The Charity delegates authority for Special Purpose Funds to ‘fundholders’, who then manage these funds, and ensure donations fund activities classified as ‘above and beyond’. Examples of ‘above and beyond’ activities the Charity has funded include the refurbishment of St Thomas’ chapel, support groups, and digital technology such as Apps.

4.8 The fundraising strategy has set ambitious targets for the Trust to meet over the next four years, aiming to raise up to £17m by the end of 2023. To achieve this, the Charity has committed to expand the fundraising team. The Trust’s current fundraising performance puts it in the middle of the league table of leading hospital charities. Last year’s performance was exceptionally good, but this was due to charitable gifts and funds from Libor fines gifted by the Chancellor of the Exchequer. To implement the fundraising strategy, the Trust will work closely with the Charity’s fundraising teams.

4.9 Various strategic enablers for the strategy are currently in development, such as improving the Charity’s digital infrastructure. A Charity brand review has commenced, as it is recognised branding could be improved in order to signpost donors more effectively. A new Charity communications role has been established in the Trust’s communications team; the new post-holder started in March, and the Charity has recently gained some national press coverage, a success given this has not been achieved before. The Relationship Manager role will be key in supporting the delivery of the strategy. To note, fundraising governance is currently under review.

4.10 Of the KHP fundraising priorities, children and young people’s mental health is the most developed.

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During questions and discussion the following was highlighted:

The group was asked how often it would like to receive updates on the progress of implementing the

fundraising strategy. It was agreed that there should be an agenda item on the strategy once a year, and a

paper update when there is a major milestone.

Fundraising is vital; it enables patients and the public to say ‘thank you’. The Charity has funded ‘above

and beyond’ improvements to patient care and experience that the Trust would unlikely have been able to

do otherwise.

Donor stewardship is an important part of the strategy, and the Charity are looking to improve this. There is

training ongoing currently for Trust staff on major donor stewardship, which some of the Trust Executives

are attending. Governors shared their experiences of best practice as well as areas of improvement with

regards to stewardship of donors.

Staff, basic equipment, and medicines cannot be funded by the Charity. Staff training can be in some

instances through individual staff awards. The Charity only funds local initiatives in Southwark and

Lambeth.

There was discussion around how best to raise awareness amongst staff to help fundraise for the Charity.

Staff can fundraise for the area they work in and request that money be put towards a specific cause,

where suitable. Governors are also able to help by getting involved in fundraising, signposting donors and

helping to build connections for the Charity.

The work to improve the Charity’s branding is important and must involve patients and other groups in any

redesign; new branding would likely be rolled-out around spring 2020.

The Trust and the Charity need to ensure good news stories about what has been achieved with Charity

funding are told. There has been significant investment in communications resource to support fundraising,

which should improve this.

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5. Any other business

5.1 The working group suggested the following future agenda items;

Business planning

The cancer strategy

5.2 Dates for 2020 meetings have yet to be set. The working group will likely continue to be held at 17:00-19:00 in Burford Court.

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Council of Governors meeting, 23rd October 2019 ~ Questions and Answers 1


Questions and Answers


This paper is for: Sponsor: Corporate Affairs

Decision Author:

Discussion Reviewed by:

Noting CEO*

Information X ED*

Board Committee*

TME*

Other*

* Specify

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1. Summary This report provides a list of queries which have been raised by governors. Answers are included or are ongoing and will be provided to governors once available. We would like to encourage governors to continue to raise questions. Note: Governors are asked to send any queries to the Membership and Governance Co‐ordinator or the Director of Corporate Affairs and not directly to directorates. We will log questions and ensure they are properly handled. 2. Request to the Council of Governors The Council of Governors is invited to note the report.

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3. Detail/Commentary

Matters of interest/question Issue number & date raised

Responses Progress/further information

Completed date

Loss of bursaries is an issue in the recruitment of new nurses. GSTT should be lobbying government to bring them back.

18/20041 2019-09-04 Governor at Accountability meeting

We expected a huge fall in numbers in the first year after the bursary was removed. Our numbers fell slightly and since then we have increased our numbers in nursing & midwifery at GSTT. The removal of the bursary allowed HEI’s and Trusts to work more closely to fulfil workforce needs as places were no longer commissioned by Health Education England giving greater flexibility. The student loan is higher than the previous bursary supporting students with their living costs, even though they will have to repay it once earning. When students received a bursary we always had to deal with a small number of students who had undertaken nursing for the wrong reasons, we no longer have that as they are taking on a loan and therefore their commitment is greater. There are projects happening all over the UK on increasing student placement capacity so that we can recruit more students and there is still a high uptake to undertake a nursing, midwifery or AHP degree in the UK. 2019-10-14

RRP - difficult to recruit to scientific roles should be looked at.


Where an RRP has been applied to posts that are difficult to recruit or the Trust wants to ensure staff remain in post to support service provision, these are reviewed by a multidisciplinary panel on an annual basis. An RRP panel would also consider applications where managers at a local level have identified challenges in being able to recruit to posts. 2019-10-14

Lambeth schools ‘diverse curriculum p’ pilot, 18 primary schools and 16 secondary schools aimed at black Caribbean pupils. Connecting in this with programme. (Can provide further details).

18/20039 2019-09-04 Martin Bailey, Accountability meeting

We are drafting a two year WP strategy with a key focus on our local schools we would like to hear more on how we can connect this as part of the wider offering including our schools , colleges and Guys' and St Thomas's offering i.e. work experience and apprenticeships. 2019-10-14

Identify which staff live in cold spot areas to find out what community groups are in the area.


We will review ESR records to find out postcodes of distribution of the staff living in Lambeth & Southwark. We will then look to target interventions and seek support of staff to promote employment opportunities in these areas. 2019-10-14

We should use our own buildings and real estate to advertise jobs and opportunities.

18/20037 2019-09-04

We will explore this proposal with colleagues in Essentia. 2019-10-14

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Governor at Accountability meeting

Can we have the data on work experience in the trust from our local communities - how many from our local communities and what do they do?


102 local residents across Lambeth, Southwark Lewisham and Greenwich took part in work experience over the last 12 months and will continue to engage with our local community to support employment initiatives. 2019-10-14

How can we use more local volunteers to better access our schools, colleges etc


Currently we are scoping all of the departments and individuals who currently volunteer. As we develop our new widening participation strategy and objectives we can work closely with volunteers so that they can be better equip when engaging with the local schools. 2019-10-14

Tier 2 visas for scientists are a challenge. Can we do more to lobby government on this?


The Trust works through NHS Employers to influence government on occupations that are added to the shortage occupation list. GSTT are a member of the NHS Employers workforce supply reference group who provide evidence on shortage roles to the Migration Advisory Committee (MAC). 2019-10-14

How do we better use partnerships with local organisations to get more people into employment?


We are working with the local colleges and local community groups and are currently setting up structures to share vacancies and opportunities for work experience. 2019-10-14

Promote all jobs, not just about Drs and Nurses.


The Trust use various campaign methods to promote all jobs for clinical and non- clinical staff. 2019-10-14

Can we ensure that OD, equalities and people teams are all linked up with MeDIC to deliver on these objectives, particularly in relation to local schools and community groups? Using Governor links is part of the engagement strategy that has been proposed and there is the potential for


The Equalities Team would like to share the Widening Participation and Equality Diversity and Inclusion Strategies with MeDIC. Following the objectives from the widening participation strategy there will be a clear remit with measureable outcomes which will support more aligned working. 2019-10-14

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duplication of effort if we don’t join up internally in the first instance.

How can we link up the Workforce objectives with an ambition to maximise apprenticeships? It seems to be a win-win situation but requires initial investment to promote careers within the local community and requires alignment between strategy and operational delivery.


There are current plans to further develop closer working relations between the apprenticeship and widening participation team. This will initially focus on working with our local colleges to ensure that their employability and traineeship programmes prepare the local community with the necessary skills, knowledge and where necessary work experience to support their applications for either an apprenticeship programme or a vacant post at the Trust. The team already support local career events to promote careers and apprenticeships and work closely with KHP on a number of Widening Participation events. These activities are currently under review to ensure a more strategic approach and to ensure that we optimise a return on investment. 2019-10-14

The word “BAME” is an offensive word to Black people and should be remove from the Trusts culture. Not inclusive can it be removed?


We will write Black Asian Minority Ethnic and not use the acronym BAME in all formal correspondence at present this is the most inclusive term available. 2019-10-14

Given that a huge number of doctors will retire prematurely what are the trust planning to do to manage the shortage

Traditionally the NHS has recruited from

overseas. Is the Trust saying to government

that despite Brexit we need to do the same

now?

18/20027 2019-05-22 Mary Stirling

We do not envisage that a large number of doctors will retire

prematurely. However, we are aware that nationally the NHS is seeking

to address the current issues with the NHS pension scheme and how this

affects lifetime allowances for a number of NHS employees. 2019-06-04

10% of the Trust workforce is EU national. We have seen a rise in a

number of EU applications and appointments in recent

months. Traditionally we have not run overseas recruitment campaigns,

and we do not foresee this changing for medical staff. Guy’s and St

Thomas’ remains an attractive employer of choice for healthcare

workers. 2019-06-04

Does Essentia have data on satisfaction of ‘customers’ within the Trust for works being undertaken (e.g. new computer points, painting a clinical room, inserting a new

18/20026 2018-10-25 John Chambers

Essentia does not routinely gather and report detailed data on the satisfaction of customers in respect of works carried out. However, a review of the minor works process is currently being carried out which includes how we gather customer feedback which we are aiming to be completed by the beginning of April 2019. In addition to overall quality

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was-basin) e.g. time to obtain quotes, time to completion of job, value for money.

and satisfaction, this will also survey other key performance indicators such as time to quote and complete work and value for money. The expectation is that through our helpdesk and building management system we will send out a survey link on completion of all jobs, the output of which will be included in Essentia’s IQPR. 2019-01-08

There are 3 ways in which we seek feedback on IT Satisfaction: 1. The first is through our day to day Incident Management Process. We don’t have a specific process document but below is an extract from the incident management process that describes it at a high level. In essence we ask the user via the resolution email. Process Extract:8.7.3 Customer Survey and Incident Ticket Closure. The resolution email includes survey questions to measure the users satisfaction with IT on the handling of the Incident or request “Were you satisfied with IT’s handling and resolution of your Incident or request? YES/NO”. IT Service Desk follows up all negative responses to understand how IT Service Support can be improved. All positive feedback will be given to the individual, and their Team Leader. 2. The second is via a formal feedback process which covers the formal

complaints, compliments and general feedback. 3. The third is via our Business Relationship Managers and the Heads

of Service of the areas that they support. 2019-01-15

At the Trust Board Meeting yesterday, 24 Oct, Julie Screaton referred to low morale in middle management. Would it improve this to encourage management by people who have learned the job by career growth within the service e.g. secretaries managed by senior secretaries. This is seen as a positive feature of Essentia. Secondly the manager could be encouraged to be actively engaged with the clinical service. Many managers do not visit the clinical area they manage and often do not know how the system works. This leads to inefficiencies to which the response is to appoint

18/20025 2018-10-25 John Chambers

We have promoted the development of staff from all backgrounds and

professional groups into management careers and are especially proud

of our internal graduate scheme which takes staff with potential onto a

fast track programme. Staff do not need to be graduates to be on the

scheme (despite the name!) and so we have a wide range of people

taking part. We are clear that all staff with managerial responsibility must

be visible and available to their staff and promote the monthly email free

Friday where EDs are ‘out and about’. I will talk to CDs about the

concerns you raise about managers not being au fait with their services

as you suggest as this is not something I was aware of. The morale issue

we believe stems from increasing workload and competing priorities as it

is often the volume of email traffic that gets in the way of our middle

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progressively more assistant service managers. This has led to a large cadre of managers separate from the clinicians, secretaries and clerks who deal directly with patients. Do you think that reducing the number of managers and more closely integrating them into clinical teams might improve efficiency and morale?

managers being able to keep on top of the busy operational work. I don’t

think we are over managed but I do think we need to focus more on the

development and support of those less senior managers at the early

stages of their careers.

2019-01-02

Please can DPJ share the list of as well as demographics within, of the groups / audiences that it has consulted to understand what patients want from their ‘digital’ journeys at GSTT in the future? A recent paper presented to the digital committee made a number of patient statements and it would be useful to understand how representative of our overall patient group those views are, or if they are specific to certain groups.

18/20024 2018-07-25 Heather Byron

Awaiting further details from Heather Byron

The GSTT Governors wish to know whether any GSTT or Community staff has lost their jobs as a result of the Home Office policy requiring employers to confirm residency rights, now widely referred to as the 'Windrush scandal', and if they have, what steps are being taken to rectify the situation for those employees?

18/0023 2018-06-07 Devon Allison

We do not record any dismissals through this category, but we have no record of appeals on that basis. 2018-07-03

Is the Trust aware of any applicants who might have been denied employment for the same reasons?

18/0022 2018-06-07 Devon Allison

Similarly, we would not know of any applicants that had been denied employment on that basis but I can confirm that no offers of employment have been withdrawn due to right to work status. 2018-07-03

The organisation seems to work in a hierarchical way, could this be unhelpful when thinking about the future and changes/transformation?

18/0021 2018-02-21

The organisational structure has been given a considerable amount of

careful thought over the past three years as we have started to move into

a ‘group-like’ structure. The main purpose of the shift towards the

Strategic Business Unit model, starting with the Evelina London, was to

move decision-making closer to the front-line so that the organisation can

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become more agile and respond to the significant transformation agenda.

The next phase of the SBUs was discussed at Trust Management

Executive on 17 May 2018, which includes Integrated Care and Cancer

SBUs being mobilised for April 2019.

2018-05-31

What impact will the technology of tomorrow (AI/robotics) have on the staff of today?

18/0020 2018-02-21

Data, Technology & Information (DT&i) continue to track and engage with technological advances, from Gartner Hype cycles, trade articles, Industry demonstrations and research. This thought leadership informs the refreshing of the Digital, Technology and Information strategies. The use of these technologies is already occurring beyond the bounds of traditional IT, in medical and pharmaceutical equipment. The Trust deploys robotics live today in Pharmacy, and theatres and we will continue to explore way they can help in other areas. This will be supported by the necessary change and transformation activity to ensure maximum impact is seen across the Trust. Artificial Intelligence (AI) is an area we have already started to look in to through exploring with industry and research partners different ways data can help with the delivery of care throughout the Trust (Care Re-Design – is an example). We are also looking in to how the industry can help accelerate our maturity. It is expected that EHR will significantly help our ability to use data moving forward. 2018-05-31

Does the digital committee focus enough on current IT issues?

18/0019 2018-02-21

Chief Digital Information Officer and DT&I Senior Leadership Team provide an Operational update to the 16 May 18 Digital Committee, these are planned as routine updates twice a year, and follows on from the update in Dec 17. The Agenda is re-focussed to provide an operational and current issues at these meetings, over the routine strategic updates and decisions that the Digital Committee focusses upon across its agenda. These operational updates focussed on key issues and the DT&i strategy to address through a series of taskforces looking to stabilise services. The Committee received updates on and discussed the improvements to Wi-Fi (Wireless point refresh); Networks (replacing end of life equipment and reconfiguring for reliability); Monitoring (now monitoring key applications to predict and address issues); Cyber security (responses and plans to the reviews on risk and capability); Desktop Services (addressing Windows10 usability and optimization)

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and Mobile devices (progressing usability and use). DT&i also shared their Directorate scorecard across all KPIs and performance. 2018-05-31

How can we get our IT people out into clinical services so the requirements of EHR are better understood?

18/0018 2018-02-21

EHR requirements will not be gathered by sending IT people out in to clinical services to better understand requirements. The approach we intend to take is to a) set up structures and forums that will allow clinical services colleagues to define or validate EHR requirements alongside IT colleagues and b) ensure that EHR requirements are understood by all relevant parties prior to EHR requirements being signed off for use in an EHR procurement. 2018-05-31

How are we going to manage the transformation associated with EHR/IT implementation?

18/0017 2018-02-21

Alongside the Outline business case for the EHR, the trust has created a transformation plan which aims to realise our vision for the future. The costs of that plan were considered and ratified alongside the EHR OBC and we are now moving into implementation. The transformation plan brings together our existing resources and initiatives, coordinating them around a single agenda and dovetailing with the IT implementation. 2018-05-31

How aware do you think the Trust is to the level of change that is required to achieve the current agenda and the level of effort it will take?

18/0016 2018-02-21

Our Team Brief system, senior leadership conferences and listening exercises help ensure we are well connected to staff providing front line services. However, we know there is more to do to ensure we are agile enough to respond to the changing world we live in. Technology will be a key driver of change and the implementation of a new EHR will require a large transformation programme that is currently in development. 2018-05-31

How equipped are we to manage the cultural change needed to effectively implement EHR?

18/0015 2018-02-21

The size of programme and cultural change that EHR requires has not been undertaken by the Trust before and therefore needs careful planning. We are fundamentally changing the way the majority of our staff experience work and with that in mind a full, underpinning HR and OD programme is currently in the planning. We will learn from others who have gone through this change and our approach is to engage staff at all levels and work with them to develop our new ways of working in a co-developed way to ensure ownership and buy in from the outset. 2018-05-31

Are the clinical outcomes we achieve visible enough and do we have the focus we should?

18/0014 2018-02-21

Increasingly in recent years there has been a focus on transparency and publishing more clinical data, both in terms of outcomes but also around incidents and lessons learnt. Asa a Trust we report positively and we

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report to the Board through quality & performance committee our clinical performance on a range of things, from our pressure ulcer rate, falls with harm, hospital acquired infections and our mortality rates. We have as a Trust supported the national requirements tom publish some clinical outcome data, but in doing so we are conscious it must be accurate but also presented in a way that is meaningful, accurate and responsible, so that members of the public can use it in the right way. 2018-05-31

How do we balance the pressure to focus less on long term follow up of our patients with the push to see new cases - doesn't this reduce access to meaningful outcome data of what matters to patients?

18/0013 2018-02-21

Our clinicians will only discharge back to the GP when it is clinically appropriate to do so. There are very few patients who have or require long term - life long follow up and this has always been the case. Therefore in terms of meaningful outcome data this has and will continue to be a challenge until we have one integrated clinical record 2018-05-31

How well are the governors able to hold the NEDs to account - does the Council of Governors do its job effectively?

18/0012 2018-02-21

We are always looking for suggestions from governors about what we can do differently to support them to discharge their duties more effectively. Currently we encourage all governors to attend public Board meetings, include governors in Board Committee meetings, hold accountability sessions twice a year and support three working groups. We will be putting together a programme of visits within the Trust for NEDs and governors. To the extent that the Trust continues to be financially successful, to have a good reputation for quality and service and an effective board regularly looking at risk, strategy, culture and patient experience I hope that suggests that we have got the make up, calibre and quality of the Board team right and as the governors recruit and appraise the non execs, we can conclude that in this respect, the governors are doing an effective job. 2018-05-31

Would informal meetings with Governors and the NEDs be useful?

18/0011 2018-02-21

This is not something we’ve done though other trusts facilitate this type of encounter. Overall, we think there are enough opportunities for governors to observe and interact with directors at board meetings, committees, council and working group sessions. Our accountability sessions are different to what any other trust does and we will continue to work on their format so that they provide a more effective platform for discussion.

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2018-05-31

How effectively do you think NEDs influence the executive members of the Trust - is the Board is driven by a few personalities?

18/0010 2018-02-21

The Nominations Committee has worked closely with us to make sure that we have a Board that is diverse, capable and balanced – the non executives and executives sit together as a unitary group each with an individual and distinctive voice. How each and every vacancy is to be filled is agreed with the Nominations Committee and the person specification adjusted accordingly. We generally use external recruitment advisers to help to search out the right people. There are some new people around the board table and it always takes some time for the group to reform itself after any change but we feel that it is working well and will be a powerful, supportive and challenging group – everybody is willing to ask questions and seek assurance. This is an important group in a large organisation – we think we have the right balance at the moment to move the Trust forward in powerful ways that will be good for our patients and local residents. 2018-05-31

What is the overall strategy of the Trust and do the NEDs have an impact on the strategy? Is there a forum where NEDs get briefed on the strategies of the Trust?

18/0009 2018-02-21

As governors may recall, in addition to the quarterly public meetings, the Board meets “in committee” several times a year and has 2 away days every year 1 day in March and 2 days in September. The bulk of these events are dedicated to longer term plans and ideas. Some matters develop, others do not and there are also opportunistic possibilities that present themselves. Some of our commercial activities are strategic and innovative – the recently announced agreement with Johnson and Johnson to modernise orthopaedics and improve quality and purchasing is an example – and are developed privately until they can be shared more widely and there is NED involvement. The Chairman has a small group of executive and non executive colleagues who meet from time to time to talk about strategy so overall there are ample opportunities for NEDs to be involved and influential in the strategic arena. 2018-05-31

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Do you think, as a Board, that the Trust is doing enough long term planning (10/20 year plans)?

18/0008 2018-02-21

We will be launching our strategy refresh in July. Whilst this concentrates on the next few years there is a huge amount of work going on around planning what the estate might look like to support care in the next 10-15 years – we shared this with governors at a recent Council meeting and will continue to do so over the next couple of years. The scale of ambition is huge and our delivery plans are innovative. In the context of the clinical and academic ambitions of the Trust, an estate development strategy has been developed in conjunction with King’s College London (KCL) and the Guys and St Thomas’ Charity that will facilitate the delivery of that strategy over the next 15 to 20 years, subject to financing being available. This strategy was approved by the Trust Board in March 2018. At St Thomas’, in partnership with KCL, we will be refurbishing the building known as Block 9 to create a comprehensive education and training centre within the next 5 years. Our ambition for the expansion of the Evelina London Children’s Hospital will also involve the construction of a new building adjacent to the existing building within a five year period. In the longer term, in support of our partnership agreement with Royal Brompton and Harefield NHS Trust and our strategy to improve our cardiovascular service with King’s College Hospital, we are developing estate plans that will see the replacement of Gassiot House within a 10 year timeframe. At Guy’s, our clinical and academic strategy focuses on cancer and cell regeneration. The Estate development plan for Guy’s involves the demolition and reprovision of Borough Wing, which is at the end of its useful life, and the construction of taller buildings on the site which, in conjunction with KCL, will enable biomedical partner organisations to work with us in translational medicine and the life sciences agenda looking to the next generation of healthcare practice. 2018-05-31

Why don't we focus more on research and education and not just clinical services when looking at strategy and performance - how do we measure research performance?

18/0007 2018-02-21

We can assure governors that the Board does focus on research and education, as we focus on Clinical Quality and performance, as part of the Boards commitment to the tripartite agenda. As an academic foundation trust this tripartite agenda of commitment to excellence clinical care, research and education underpins our strategic and tactical

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plan. Specifically, in research we have made major investments with our university partners in the creation of infrastructure both on the Guys and St Thomas’ campuses to facilitate world class research. This is recognised in our relationship with NIHR from whom we have received considerable funding both for BRC and other NIHR Infrastructure. The commitment to research is not only an Infrastructure development. In addition to capital investment we have made significant investment to support our workforce to undertake research, a commitment that has been recognised by many by the awards for academic appointment within the university for NHS consultants. In education, we have committed considerable investment to enhance education delivery on both campuses. Importantly the Trust is committed to the development of St Thomas’s education centre, a £45 million joint investment. 2018-05-31

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Essentia doesn't seem to be talked about a lot at Board level, would like the NEDs to ask more about this area - understanding the roles and the differences between Essentia core services and Essentia TL would be helpful

18/0006 2018-02-21

Essentia is the Capital, Estates and Facilities Directorate in the Trust

providing services ranging from catering, cleaning, transport and

portering, to building, engineering, capital planning and asset

management, as a dedicated in-house resource. The name “Essentia”

was adopted in 2012, emphasising the essential services we provide to

the acute sites and across the community for GSTT and other Trusts.

Our purpose is focused on creating the best possible patient environment

and supporting the best possible patient care. We provide quarterly

updates to the Board of Directors through:

• the Quality & Performance Committee which primarily focuses on

performance of Essentia services against agreed KPIs and allows

Essentia the opportunity to highlight issues that may have had an

adverse impact on performance.

• the Corporate Management Committee where on a quarterly basis an

update is provided on progress with capital projects currently underway

and the investment strategy which primarily is about how the Estate may

be configured in the future to ensure it is fit for purpose and aligned to

advances in clinical and research activity.

Essentia Trading Limited is a wholly owned subsidiary of Guy’s and St

Thomas’ NHS FT and was created in response to demand from other

NHS trusts and public sector organisations seeking advice in how to

become more efficient and more effective. It employs approximately 60

members of staff and turns over about £7m, this has increased each year

since its creation and all profits are provided back to Guy’s and St

Thomas’ NHS FT. Essentia Trading also makes a contribution to the

revenue plan that Essentia has to deliver and by doing so, it protects the

quality of services currently being provided by Essentia at Guy’s & St

Thomas’ NHS FT. 2018-05-31

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We appear to be very acute focused - why don't we discuss community services more?

18/0005 2018-02-21

From an adult perspective, community services are discussed at the Adult Local Services Committee which includes three governors in its membership. The minutes are shared with the Board. Local services and integration are a key strategic priority for the Trust and there have been occasions when governor working groups have had presentations on community services. If governors would like to hear more about community services, we are very happy to attend appropriate meetings. We are currently working towards a presentation at the July public board/council of governors meeting. Similarly, Children’s Community Services are regularly discussed at the Evelina London Board, which 2 governors attend. Integrated local child health services are one of Evelina London’s four strategic priorities, and there are a range of initiatives supporting this, including our contribution to partnership programmes in Lambeth & Southwark. 2018-05-31

Are we doing enough about succession planning for EDs and senior managers?

18/0004 2018-02-21

The Leadership and Management framework allows the Trust to identify and develop potential future leaders and senior managers to fill business critical positions in the short and long term. Succession planning is a crucial issue not just for senior managers but also for a pipeline for business critical roles. We have developed a leadership and development programme available for operational leaders band 7-8a, non clinical and clinical leaders to support this and we are building on this in 2018/19 with the development of the Operational Excellence programme. We have focussed on team development in our senior roles with our Leading for the Future programme. With the exception of clinical senior roles, until the recent appointment of the CEO we have traditionally recruited externally for key Executive posts due to the stretch in requirement, however the development of the Strategic Business Units and the requirement for different leadership capabilities has meant that we are currently considering our approach to talent management at senior levels and are approaching this with other members of the Association of Health and Care Provider Groups and working closely with NHSI and the Leadership Academy. 2018-05-31

How do we prepare for the workforce of tomorrow?

18/0003 2018-02-21

To ensure we can continue to deliver services to our patients and populations, we need to both retain and develop our existing staff as well as ensuring that we continue to recruit new people. We undertook some

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research on what different generational groups want from work found that our younger workforce want more of a portfolio and flexible career. We are therefore trying to think differently about job design and career paths as well as building better links with our communities and schools so we get more local people into employment. 2018-05-31

How do we obtain staff views - how is the resilience of all staff groups (but particularly those in less visible areas) assessed and supported at a time of unrelenting pressure?

18/0002 2018-02-21

We get intelligence from the annual NHS staff survey, the quarterly Friends and Family test. We are launching 'Big Conversation' this month with a focus on diversity and inclusion. Our staff survey is full census every year to allow directorates to specifically take responsibility for their own staff and hear from them. Our Speak Up Guardian also play a vital role. We are currently exploring how we 'test the silence' with different staff groups and undertake temperature tests without overwhelming the staff, who already fill in between 4 and 6 surveys per year. 2018-05-31

What options are there to address the affordable housing issue for our staff - many of whom travel long distances to work here - what collective response could be offered in partnership with others?

18/0001 2018-02-21

The Trust has 324 room available for nurses and AHPs to occupy on short term leases to support recruitment. We offer interest free loan rental deposit loans to nurses and AHP staff (around 20 have taken up the offer). We have discussed with Estates a longer term strategy and discussions have taken place with developers within Lambeth & Southwark to have an allocation of units within the current new housing developments. The developers are keen to work in partnership on this. We are also working with Corporation of London to develop ideas to provide affordable homes on land owned by the Trust in the community. 2018-05-31

I wonder whether the below is something we can support either as a CoG or raise up to the Children's Services committee given it has impacted the clinical process and patients? Problem Statement: The lab is facing some lapse in service from the Royal Mail around a business delivery service that is in place for the prompt delivery of newborn screening / monitoring blood spot tests. Whilst this hasn't yet a systemic

16/0016 2016-07-28 (Heather Byron)

The Head of Nursing for Children's Medicine & Neonatology responded as follows: I have some insight into this, as this must originate from the paediatric metabolic service - she worked in this team for many years, & is well used to the challenges of bloodspot screening, ongoing monitoring & Royal Mail. Just in terms of assurance with regards to delays in NBBS after birth, the national “fail safe” system does provide some reassurance and ensure if a sample is mislaid or significantly delayed a baby would have a repeat sample taken in a timely way.

Further update has been sought.

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problem, talking to the lab and the dietitians, there have been a number of incidents which clearly causes concern both from the perspective of delay to patients on results but also any potential risk / harm resulting from tests which do not arrive or cant be read in the lab. Context / Risk: It is hard to quantify the scale of late delivery of the risk to newborns / patients as the lab never knows exactly how many newborn screening / monitoring blood tests are being sent in. However, we know the implications of a late results, especially in the newborn screening where in many of the conditions being screened for require immediate intervention / treatment. Its concerning that we may not receive a sample and isn't clear whether there are robust processes in place across the community network to identify promptly if a newborn test results hadn't been returned and therefore a further test taken. I fear, more often than not, it would be missed for some time, which could have medical and/or quality of life implications. Whats next: There are a number of things which could happen to support the labs in dealing with the problem so that the service becomes reliable and they are spending valuable time chasing RM.

develop a simple, consistent escalation process to Royal Mail (admin driven not lab driven) so that we are consistent in our escalations and have a clearer audit behind us

I will look into the other issues raised with the teams involved and will feedback progress around these points. Thank you again for sharing this with us. (26-08-2016)

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of the issues encountered (this could be a simple form on the portal for example)

as part of the wider Royal Mail relationship drive some escalation discussions (the sense is that in isolation this isn't 'important enough' to deal with by the RM.

review whether Royal Mail is the right partner to be responsible for the delivery of such important blood samples or whether a commercial agreement should be made with another party (whilst on the surface the 'cost' of the RM business reply service may seen competitive, I wonder when you look at the total cost including the courier costs to bring post from RM to GSST, it may not be... not to mention the slightly unreliable nature of the service.

I am very happy to support any next steps, but wanted to share with you for your guidance as to whether this is something we are at liberty to raise awareness to and have the possibility to help resolve?

Governors understand, from documentation released at Board Committee meetings, that Consultants are helping to identify cost improvement opportunities for FY 2016/17 and that Lord Carter has similarly identified savings opportunities. Could the Board outline the nature of these opportunities and give some understanding of the impact they would have on the operation of the FT.

16/0011 2016-06-22 (John Porter)

The Trust commissioned PWC, following a tender process, to perform a six week diagnostic study to identify and quantify in year savings opportunities for the Trust in 2016/17. The report shows a number of cost saving opportunities over and above existing savings schemes. PWC and the Carter team have provided benchmark data demonstrating potential efficiency savings for the Trust when compared to other similar service providers. This output forms part of the continuing cost improvement plan.

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The CEO says that there is a programme of work underway by the Medical Director to address "hospital at night concerns". What progress I wonder? I realise how difficult it is to control events at night in a busy hospital, but I have had recent experience of unnecessary noise at night in the wards

2014-04-29 Hospital at Night is about the clinical operating model for looking after patients out of hours. We are currently looking at the future clinical model that will be required at GSTT and the implications this will have for our workforce, given activity changes and the anticipated shift towards a 24/7 care model at a national level.

A further response/update has been sought.

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