board of directors - county durham and darlington minutes open tb - 25th... · agreed minutes of...

AGREED Trust Board Minutes (Part 1: Open): 25 September 2019 of 18

BOARD OF DIRECTORS

AGREED Minutes of the Meeting of the Board of Directors of County Durham and Darlington NHS Foundation Trust held on Wednesday 25th September 2019 from

09:00hrs Prospect House, Durham

Part One (Open) Present: Prof Paul Keane OBE Chairman Mr Michael Bretherick Non-Executive Director Ms Jenny Flynn MBE Non-Executive Director Mr Paul Forster-Jones Non-Executive Director Mr Simon Gerry Non-Executive Director Ms Sue Jacques Chief Executive Mr David Brown Executive Director of Finance Mr Jeremy Cundall Executive Medical Director Ms Carole Langrick Executive Director of Operations Mr Noel Scanlon Executive Director of Nursing In Attendance: Ms Morven Smith Director of Workforce & Organisation Development Mr Warren Edge Senior Associate Director of Assurance and Compliance Ms Alison McCree Managing Director – CDD Services Ms Hayley Robertson Corporate Affairs Manager (Minute Taker) Dr Richard Scothon Lead Governor (from item 130/20)

Action

121/20 Welcome and Apologies for Absence The Chairman welcomed Board members and others present. Apologies for absence were received from; Mr Steve Crosland, Non-Executive Director.

122/20 Declarations of Interest Any Board Member who was aware of a conflict of interest relating to any item on the agenda was required to disclose it at this stage or when the conflict arose during consideration of a particular item. Mr Forster-Jones and Ms Alison McCree declared their interests as Directors of Synchronicity Care Ltd (SCL). Mr Edge confirmed that there were no items on the agenda, or from the previous minutes, which presented a conflict of interest for Mr Forster-Jones or Ms McCree.


123/20 (a) (b) (c)

Minutes and Matters Arising from the Previous Meeting held on Wednesday 31st July 2019 Accuracy The minutes were agreed as an accurate record of the meeting, subject to the following amendments: Item 76/20, Governor Views, Board Visits and Public Engagement: Page 3, first paragraph: The month ‘July’ to be added to the date referred to in the first sentence. Item 77/20, Patient Safety and Experience and Nursing Staffing: Page 8, penultimate bullet point, penultimate sentence: To read “Ms Flynn noted that the numbers of patients brought to a place of safety under Section 136…” Item 77/20, Patient Safety and Experience and Nursing Staffing: Page 12, final bullet point: References to ‘Nursing Associates’ to be updated to ‘Nursing Associate Apprentices’. Matters Arising from the Minutes Item 75/20 (23/10) Organ Donation: Mr Forster-Jones advised that the stone for the memorial planned for DMH had arrived and was being carved. It was anticipated that it would be complete by the beginning of November and an unveiling date following that was to be agreed. In respect of donors, the numbers were down nationally, reasons for which were unknown. Ms Brady, Specialist Nurse for Organ Donation, was leaving the Trust, having been successful in securing a promotion. Item 78/20 Mortality and Learning from Deaths: The Chairman advised that he had recently met with members of the coding team, whilst attending a walk around of the recently refurbished Memorial Hall. A comment had been received that ‘coders were only as good as the information on the patient record’. Mr Cundall concurred and assured the Board that work on coding, initiated by the Mortality Lead, considered the quality of the notes as well as the coding of morbidities from the information included. Action Log Those actions ‘greyed out’ were accepted as complete: Actions 1 (233/19(b)), 2 (235/19(a)), 3 (236/19), 4 (22/20(b)) and 5 (28/2). Updates were noted for the remaining actions as follows: Action No.6 (77/20), You Said, We Did posters on wards at UHND: Mr Scanlon advised that the Communications Team had developed a patient information board with a slot for You Said, We Did. Action to be closed. Action No.7 ((77/20) old text in Nursing and Midwifery Staffing Report: Mr Scanlon advised that the text had been updated. Action to be closed. Action No.8 (78/20) Mortality Reports to identify cases involving discharge and subsequent readmission deemed to be poor care: Mr Cundall advised that the action had been addressed by the report included later on in the meeting agenda. Action to be closed.

FTO


Action No.10 (79/20) Timing of IQAC and Board meetings against availability of data for the Integrated Performance Report: Mr Edge advised that an appropriate timetable had been agreed. Action to be closed.

124/20 (a) (b)

Feedback from Council of Governors meeting and AGM and from Board Member Visits Annual General Meeting The Chairman advised that the Trust’s Annual General Meeting held on Wednesday 11th September 2019, had been very successful. The number of questions asked by members of the audience had been minimal; however, the Chairman took this as a positive sign that the information provided during the meeting had been at a sufficient level of detail. Feedback had been received from attendees in respect of the transparency and honesty of the meeting, which the Chairman was pleased to receive. Ms Jacques added that it was particularly pleasing that the event was held on Trust premises and indicated the intention to continue using Trust sites in future. Although the space for the health information stalls was limited, the efforts of staff and the engaging displays provided had been impressive, in Ms Jacques’ view. Ms Jacques also wished to formally thank the Trust’s PFI providers for providing the catering and accommodating the event. Ms Flynn commented that the acoustics of the room and the sound engineers had been good. The Chairman thanked Mr Edge for including Dr Scothon in the update on Governors and members, as Lead Governor, which he felt made the presentation more inclusive and impactful. Board Member Visits The Chairman advised that a number of Trust Open Days, covering all of the main Trust sites, including community hospitals, had commenced. These had been successful and well attended to date and good feedback had been provided by attendees in respect of transparency and involvement. Ms Jacques wished to thank the Trust departments who took part in these events and gave up time to talk to members of the public during the tours and showcasing facilities. Mr Forster-Jones asked how often the Trust held Open Days and whether there was potential to increase the number held, given that they were so successful. Ms Jacques advised that the Open Days were held once a year but covered multiple sites over a month. It was felt that the number of events held was about right, when looked at in the round with other events and opportunities that the Trust provided. An example of this was the virtual tour of the Maternity Department for expectant parents.


(c)

Public Meeting at Barnard Castle Ms Jacques advised that she and the Chairman, along with Ms Gillian Curry and Ms Elaine Shaw had attended a public meeting to discuss out of hours services at the Richardson Hospital, at the request of MP Helen Goodman. Ms Jacques clarified that the services involved were not part of the Trust’s contract and the meeting was solely focussed on the changes being implemented by the CCG, who were challenged at the meeting and asked whether the public members in attendance could reverse any changes. The outcome had been that the meeting took place at too late a stage in the proceedings to enable any changes to be made. Ms Jacques and other Trust representatives had not received any questions and the purpose of their attendance was in respect of any wider issues or questions raised. In conclusion, the service was due to cease in October 2019 and the CCG would be providing a transport service to enable patients to attend the alternative provision. Ms Jacques reported that there might be an impact on activity at BAH but it was expected that this would be minimal. The Chairman felt it had been beneficial for the Trust to be involved in the discussion, even though it was not directly involved or impacted. The opportunity to learn lessons from the public consultations of others was valuable. The Trust Board NOTED the updates from the Chairman and Chief Executive.

125/20 Staff Friends and Family Test / Other Relevant Surveys Ms Smith advised that the Staff Friends and Family Test Update had been withdrawn. Having been reviewed in detail at IQAC and the headlines included in the IQAC preface, it had been agreed that it was not required to be presented to the Board as a separate item.

126/20 National Patient Survey Results Mr Scanlon advised that there had been some duplication of papers which could be disregarded by Board members. The relevant pages of the pack were from page 41 onwards, commencing with the National Adult Inpatient Experience Survey cover page. National Adult Inpatient Experience Survey It was noted that, overall, the results for CDDFT were positive and illustrated an improvement in the experience of care the Trust’s inpatients were receiving, in comparison with the 2017 results. The Trust scored in the top 20% of Trusts on two questions using patient perspective benchmarking data. Compared with all Trusts reported in the survey by the Care Quality Commission, none of the Trust results were in the bottom 20%. National Cancer Patient Experience Survey


It was noted that, overall, the results for CDDFT were positive and showed an improvement in the experience of care the Trust’s cancer patients were received, in comparison with the 2017 results. Out of the 59 questions asked, only two results were lower than the 2017 survey, with many more showing improvement. Mr Scanlon advised that there continued to be a great emphasis on the experience of cancer patients in CDDFT and the personalised care elements of the long terms plans which were being implemented to support this. The Lead Cancer Nurse for CDDFT was the clinical lead for Personalised Care for the Northern Cancer Alliance and was adopting a collaborative approach to improvements, with patient involvement integral to the approach. Mr Scanlon advised that NHSI had produced a tool to support Trusts in identifying priorities for improvement in patient experience and engagement. The draft gap analysis had been completed and was currently in consultation. Once completed, suggested actions would be brought forward to address any areas which had scored three of less. Action plans would then be monitored by Patient Experience Committee, EPSEC and IQAC. Mr Scanlon highlighted the timetable included in the slide pack which outlined when other survey publications would be available. Children and Young People and Emergency Department survey results would be ready for the subsequent Trust Board meeting to be held in November 2019. Questions and comments were invited. Mr Gerry commented on the national comparisons graph which identified the Trust as being in the middle 60% of Trusts. Mr Gerry felt that the variation was too wide. Mr Scanlon explained that the national comparisons chart had been taken directly from the national data produced and further analyses providing more detail were provided later in the slide pack. In respect of providing information to patients, Ms Flynn advised that she had attended the ‘Join the Dots’ stall hosted by Trust staff at the AGM. This was an initiative to provide cancer patients with financial advice and appeared very positive. In Ms Flynn’s experience of working as a solicitor, such a service was invaluable in advising patients and their families and providing a holistic approach. Ms Jacques commented that the outcomes within the report were the best and most improved she had seen in respect of patient experience surveys and she asked that staff were commended accordingly. The Chairman agreed with Ms Jacques’ comments, adding that the actions of staff endorsed the values of the organisation.

NS (Nov 19)


The Trust Board NOTED the findings of the National Adult Inpatient Experience Survey and the National Cancer Patient Experience Survey.

127/20 Guardian of Safe Working Report The item was deferred due to the Guardian of Safe Working’s unavoidable absence.

128/20 (a)

Chief Executive’s Report Ms Jacques provided the following updates. CEO Update

North East and Cumbria ICS – an updated ICS Memorandum of Understanding was shared, which was recommended for approval and incorporated the feedback that CDDFT’s Board, along with other Boards had provided. The governance arrangements were intended as a means to develop consensus and commitments on shared priorities, together with how they were best implemented but did not override the autonomy of individual constituent organisations.

Pensions and medical staff and flexibilities – NHS Employers had issued guidance for Trusts which the Executive was considering, as the subject was kept under weekly review. The guidance was appended for information.

UHND Paediatric ED – the area had opened as planned at the beginning of September. Details had been shared in previous Board meetings.

Sustainability – the first meeting of the Sustainable Development Group chaired by Ms Jacques was scheduled to meet on 8th October 2019.

Consultations and Overview and Scrutiny Committee (OSC) - 1. The consultation on the changes to services at the Friarage had commenced and a letter was attached for Board members’ information. 2. In respect of Ward 6 at BAH and Stroke Services, an update on the engagement work had been presented to the County Durham Health and Wellbeing Overview and Scrutiny Committee. There remained a level of concern about a number of issues; reducing beds on Ward 6; domiciliary care, questions about readmission rates; the use of escalation beds and the perceived risk of costs being transferred from health to social care. In respect of Stroke, the main concerns were loss of service at BAH; the adequacy of physical space at UHND and also transport and parking at UHND. It had been agreed, however, to begin the consultation on both proposed changes. This would begin on 7th October 2019 and run for 10 weeks.


3. In relation to the change to out of hours services overnight at Peterlee, the CCG proposal to reduce GP cover overnight at Peterlee Urgent Care Centre had been agreed on the basis of the engagement with no requirement for formal consultation. 4. An update on engagement relating to Shotley Bridge was scheduled to be heard by Durham OSC on 3rd October 2019.

Quarterly Review Meeting – the Quarterly Review Meeting with NHSI was held on 13th September 2019, under the new oversight arrangements, albeit no system partners were involved and NHSI/E acknowledged that their arrangements had not yet incorporated aspects of the new Single Oversight Framework. Nothing of significant note was identified.

Spend Analysis Report – SCL had agreed to develop a procurement strategy to address both the recommendations of the spend analysis report brought to the Trust Board in September 2019, but more importantly ensure a strategic response to procurement across the CDDFT group. The strategy would be presented for approval in January 2020.

Mr Gerry expressed caution at the pace of change in relation to the ICS, which he felt was lacking in governance and legislative arrangements. Ms Jacques advised that a programme of legislation was due; however the timing was unknown. A further update would be provided on the ICP in the private and confidential element of the meeting. Mr Gerry asked what would be likely to happen if the legislation was introduced before all of the ICSs across the country were established. Ms Jacques advised that the plan was for all ICSs to be established by 2021/22 and cited the example of Foundation Trust status; all Trusts had been required to become a Foundation Trust by an agreed date; however, due to financial issues there were many Trusts who had been unable to achieve the deadline. As a result, there had been two different systems operating ever since that time. The Chairman advised that a national workshop was due to be held for Chairs and Non-Executive Directors to discuss ICS arrangements and the role of Non-Executive Directors. In relation to the pensions and flexibilities update; Mr Cundall advised that Mr Andrew Thacker, Associate Director of Workforce and OD was due to attend the Care Group Directors meeting to discuss the subject that following day. Ms Jacques added that there were a range of options that the Trust could put into place; however, the first stage was to hold the initial dialogue with clinicians. Ms Smith added that the Trust had carried out work over the summer period to review financial advice and wrap around care and the current stage was to delve further into the detail. Mr Cundall added that it appeared that the Trust was not as affected as some other Trusts in this area. Ms Langrick added a note of caution, advising that the impact appeared now to be


(b) (c)

increasing and there were potentially issues that were not recorded, such as clinicians refusing additional sessions. Moving on to comment on the Paediatric area at UHND ED, the Chairman advised that he had visited the department, along with Ms Jacques. He commended the facility, which from a clinical perspective appeared to be working very well. Care Quality Commission (CQC) Update Ms Jacques updated Board members on the status of the ongoing CQC inspection of the Trust, the latest position with respect to CQC Insights and the actions being taken in relation to indicators flagged as ‘worse’ or ‘much worse’ than peer organisations. As outlined in the report, it had been expected that the draft report would be issued early in the current week; however, the Trust had recently been informed of a delay in the production of the reports. It was now understood that the draft would be received by mid-October, although no firm date had been provided. Ms Jacques pointed out the risk that if the report was not written promptly there was more potential for inaccuracies. In relation to the Insights indicators, it was noted that three indicators had improved since they were last reported on, including the management of glucose in children with diabetes, reflecting improvements seen as a result of the action plan previously shared with the Board. Another related to Equality, Diversity and Inclusion, which was rated above the average of the Trust’s peers in the NHS Staff Survey 2018. Three new ‘worse’ indicators had been introduced, belatedly, based on the Trust NHS Staff Survey 2018. All but one of the indicators which had deteriorated or new indicators flagged as ‘worse’ involved matters previously identified by management with action plans underway. The number of ‘better’ and ‘much better’ indicators continued to outweigh the number of negative indicators. Board Assurance Framework (BAF) Ms Jacques invited Mr Edge to summarise the main updates to the BAF. The purpose of the report was to provide the Trust Board with the level of assurance available for each of the Trust’s 16 principal business objectives. Additionally to provide an analysis of the movement in risk scores over the last quarter and the resulting Red, Amber, Green (RAG) ratings for the strategic risks the Board managed through the BAF, along with a summary of key risks together with their mitigating actions. It was noted that nine out of 16 objectives were meeting their target risk scores. The remaining seven, although not in line with their target risk scores, were in line with the risk management trajectory agreed by the Board. Reasons were outlined within the report.


Board members noted the assurance outcomes in the quarter, which provided the underlying evidence supporting the reductions in risk outlined. The specific operational risks in the Trust’s risk register relevant to each objective had been identified and the risk scores noted. Ms Jacques advised that the Trust was establishing a Sustainable Development Group, which she would be chairing, to give focus to the sustainability agenda going forward. The group would meet for the first time during October 2019. In order to give prominence to the full breadth of the sustainability agenda, ECL had endorsed a recommendation from the Executive, that the BAF include a new objective for sustainability from October 2019. In respect of the risk around financial sustainability, Mr Gerry highlighted two developments which would impact on the risk rating, within the next month. Nationally, it was expected that information would be received in respect of the financial settlement for the year ahead. Locally, there was a focus on the joint cost reduction schemes which did not appear to be delivering. Mr Brown would provide a more detailed overview as part of the finance update. The Trust Board APPROVED the memorandum of understanding for the Cumbria and North East Integrated Care System. The Trust Board APPROVED the addition of the sustainability objective to the BAF. The Trust Board RECEIVED and NOTED the reports and briefings from the Chief Executive.

Patient Safety & Quality

129/20 Integrated Quality Assurance Committee (IQAC) Preface Ms Flynn presented the IQAC preface, which provided an overview of the meeting had been held on 17th September 2019. Ms Flynn outlined the key items of business discussed at the meeting, which were as follows;

A proposal to change Committee’s way of working with the aim of reducing duplication of reporting and allowing the interrogation of quality and performance at a local level by the Committee. It had been agreed that a new approach of bringing Care Groups to the Committee on a rotational basis would be trialled.

Updates from Clinical Effectiveness Committee and Patient Safety and Experience Committee meetings held in September.


The Committee received an update on the expected date of the draft CQC report and a summary of the last four months’ Insight reports.

An update on Perfect Ward audits which covered all inpatient areas.

The Integrated Performance Report had not been presented as there had been no-one in attendance to present the report.

An update on the position in respect of infection control.

Serious incidents were reviewed and noted. Action plans were reviewed for the two most recent Never Events. It was noted that the outstanding actions were being progressed by the Surgery Care Group.

A review of the BAF for all objectives under its remit. No changes were proposed to any of the risk ratings or commentaries.

Care Group reports setting out performance risks and action plans were discussed. It was noted that higher than normal sickness absence rates was a theme across the reports.

The Q1 Staff Friends and Family report relating to Clinical Specialist Services and Surgery was discussed. An improvement in percentage of staff who would recommend the organisation as a place to work was noted.

Ms Flynn advised of the specific matters the Committee wished to bring to the attention of the Board; the continued, higher than normal sickness absence rate and the inconsistent attendance at CEC and CSTC by medical staff. Ms Flynn advised that the last part of the meeting had unfortunately not been quorate. Mr Gerry asked how the inconsistency of medical staff attendance would be addressed. Mr Cundall advised that, in respect of CEC, he would follow up with Care Group Directors the week before the meeting to determine who would be in attendance. Mr Edge advised that there had been a reduction in attendance of nominated clinicians at CSTC; however Care Group Directors had been made aware of this and were now in the process of reviewing the barriers to either re-invigorate attendance or re-evaluate who should attend.

130/20 (a)

Patient Safety and Experience and Nursing Staffing Patient Safety & Patient Experience Report Mr Scanlon presented the key matters from his report which had been provided for the purpose of updating and assuring the Trust Board with regard to HCAI and serious incidents and patient experience measures. Mr Scanlon apologised for the duplication in the reports and advised that pages 226 to 234 should be disregarded.


It was noted that, as of Tuesday 27th August, the Trust had achieved one year with no reported MRSA Bacteraemia cases. A bulletin had been sent out thanking staff and acknowledging the achievement. A number of new serious incidents were summarised for Board members information. In respect of falls, it could be seen from the comparative data identified that the number of falls had decreased at UHND; but increased at DMH. Falls per 1,000 bed days at UHND remained on local level benchmarking target, whereas DMH were above target for July 2019. Further analysis had been undertaken and no trend of over or under reporting level of harm was found. Mr Forster-Jones asked whether there was any evidence to link C-Diff incidence with poverty, deprivation or social circumstances. Mr Scanlon advised that there was a general link between poverty and ill health but not specifically with respect to C-Diff. In relation to the serious incident with respect to a patient not receiving thrombectomy, Mr Cundall advised that a root cause analysis had taken place and it had been advised that patients arriving at the Tertiary Centre after 4pm did not receive a thrombectomy as a matter of course. The service was highly specialised and was provided to the fullest extent possible. In relation to the three cases related to the Maternity Department, all were subject to review by the Healthcare Safety Investigation Branch. Mr Scanlon advised that Falls Awareness Week was currently taking place and a workshop had been held with staff. Falls rates were diminishing which was encouraging. Mr Bretherick commented on the data presentation in the report in respect of falls. Due to the different scales used for the charts, the difference between falls on acute and community sites appeared, falsely, to be significant at first glance and needed to be looked at in-depth to understand the true picture. Ms Jacques noted from the data that it appeared the number of falls had reduced significantly on some sites, asking whether there were any learning points to be shared across other departments. Additionally, Ms Jacques asked how many patients who had experienced a fall had had the appropriate falls assessment carried out and whether this was a matter of routine. Mr Scanlon advised that falls assessments were universally well done across the Trust. This was monitored through Nervecentre and dramatic improvements had been seen. In terms of the variation, the numbers involved in the Community Hospitals data were relatively small but it was known there


were outliers such as the Richardson and Sedgefield which had been subject to special measures. The Chairman made an observation in respect of the patient incidents outlined in the report; suggesting that an impression could be given to lay people that the Trust was becoming complacent, particularly as there was comparatively little commentary on learning and actions in the report, albeit that such information was apparent in reports to IQAC and in the Board’s discussions. It was important for the Trust to be open and transparent; however, the Chairman pondered whether some of the information should be reported through the Private Board meeting. Mr Scanlon advised that a value based decision had been taken to report every case through Public Board meetings unless there was a pressing need to protect the patient’s data or it was particularly sensitive. In terms of transparency and demonstration of continuous learning and tracking themes, Mr Scanlon advised that he personally was content with the approach taken and moreover, CQC and NHSI had complemented the Trust on the transparency of the approach. In terms of benchmarking, as a large organisation, the number of incidences although regrettable, did constitute any evidence that the Trust was an outlier. Ms Jacques agreed with Mr Scanlon’s comments in respect of the importance of transparency; however she acknowledged that the reader of the report did not receive an update in terms of the actions outlined in the report. Ms Jacques suggested that a summary of the consequences of the actions could be brought into the report periodically or could be included in the IQAC preface. Ms Flynn confirmed that the actions were interrogated at IQAC and a quarterly report was received on common themes. Mr Gerry asked whether any work had commenced on reviewing the data provided in the suite of Nursing Director Reports to utilise an SPC approach, in line with the Integrated Performance Report. Ms Langrick confirmed that some early work had been undertaken and an iterative approach was being taken to incorporating information from the Nursing Directorate into the Integrated Performance Report. Nursing and Midwifery Ward Staffing Report Mr Scanlon summarised the key points from his report:

RN and HCA overtime usage over all areas continued to remain negligible, as it had for the past year and continued to comply with the December 2017 plan.

Overall, total Trust overtime usage had almost doubled in August 2019 when compared with previous months, which had been carried out in community areas.

The Richardson Community Hospital and CCU DMH had jointly received the title of model wards of the month for utilising no additional staffing time via bank, agency, overtime and additional hours. An excellence report had been submitted.

JF (Nov 2020)


There were 152.18 RN vacancies and 29.56 HCA vacancies as at August 2019. Some 12 Nursing Associate Apprentices had been recruited for September 2019 following the approval of a business case.

The Trust Practice Placement Team had attended a Jobs Fair at Teesside University in March with good interest. Invitations to apply for posts had subsequently been sent.

Two further staff had been appointed through overseas recruitment efforts, and had taken up posts during September 2019.

Midwifery staffing was somewhat concerning. Staffing matched to demand at UHND was 51%, DMH 35%. The causes were multi-factorial; however, September was the peak month for births. A number of possible contingencies for September were being looked at.

The Chairman asked whether there was a specific reason identified to explain the increase in vacancies. Mr Scanlon advised that, for the first year, there had been more retirements from Nursing registry than entrants and the Nursing workforce was diminishing. In respect of the Midwifery staffing position, the Chairman noted the possible contingency to close labour wards electively if required. He asked whether this would be detrimental the delivery of patient care. Mr Scanlon advised that patients would be diverted to other hospitals in that circumstance. He added that the labour wards were fully established but a number of staff were on maternity or sick leave. The Chairman noted that the Trust’s e-rostering approach was to be rolled out across the rest of the country. Mr Scanlon advised that he and Mr Brown had recently signed a bid for match funding which was expected to deliver a 15% return on investment over five years. E-rostering practice had been very successful for the Trust. The Chairman asked Mr Scanlon to expand on the comment in the report that overtime in Community areas had increased significantly but was not well monitored. Mr Scanlon advised that the Trust’s emphasis had been on reducing overtime by encouraging staff to take up bank work; the culture in community areas was a factor which would be reviewed. Mr Forster-Jones asked whether the Trust was keeping track of EU employees who would be affected post Brexit. Ms Smith advised that the Trust was well aware of which individuals would be affected and all staff had received a letter from a member of the HR team within the last week, encouraging them to applky for settlement status. Dr Scothon joined the meeting at this juncture (11.16am). Mr Scanlon added that every Matron had been asked to hold a personal conversation with EU Nursing staff within their teams. To


date no negative feedback had been received through those conversations. The Trust Board RECEIVED and NOTED the reports from the Executive Director of Nursing.

131/20 (a) (b)

Mortality and Medical Workforce Mr Cundall introduced the report, which was for the purpose of providing the Board with;

an overview of the Medical Workforce Strategy 2019-2022; an overview of learning from deaths and progress with the

establishment of the medical examiner function; and, an overview of the annual position in respect of medical

appraisal.

Mr Cundall apologised for the late additions to the pack which were due to the timing of the Mortality Reduction Committee meeting. Medical Examiner Service at CDDFT Mr Cundall introduced the report, which had been prepared by Miss Noblett, Lead Medical Examiner, and set out the arrangements to be put in place within the Trust, in respect of the newly introduced medical examiner system. The proposed model for the Trust was a medical based service allowing relatives to liaise directly with qualified but independent senior doctors. It was anticipated that the Trust would be in a position to go out to advert for the remaining medical examiner positions and medical examiner officer positions shortly. The Chairman asked for clarification with respect to the positions within the model. Mr Cundall advised that Miss Noblett had been appointed as the Lead Medical Examiner and it was anticipated that she would be supported in her role by seven or eight other individuals covering up to 14 PAs across the Trust’s main sites. Mortality Report Mr Cundall introduced the mortality report, which outlined the Trust’s position in respect of learning from deaths and the dashboards, which had been developed to provide an overview as to where care had been excellent and where care could have been better, in parallel to highlighting deaths that might potentially have been avoided. It was noted that, although the Trust’s SHMI and HSMR positions were still within the funnel plots they were at the top end and SHMI was close to outlier status, which was undesirable. A number of actions were in place to address this issue, including the ongoing work to improve escalation plans and decision making. In particular, detailed reviews of cases in specialties where SHMI was high had been initiated.


(c)

Ms Jacques noted that an action had been included on the action log to review readmissions where there had then been a death where care is poor or very poor. Mr Cundall agreed to take away the action to check. Medical Appraisal It was noted that 98.2% of medical staff appraisals had been completed. Mr Cundall advised that there were no concerns in respect of appraisal and Chairman and Chief Executive’s signatures were required for the submission to NHSI. Trust Board Members NOTED the contents of the Medical Director’s Reports.

JC (Nov 19)

Compliance and Performance Management

132/20 Operational Performance & Efficiency Ms Langrick introduced the Integrated Operational Board Report, which was to inform the Board in the form of an integrated dashboard report, to triangulate operational and quality performance across key indicators for July and part of August 2019. In terms of the format and content of the report, Ms Langrick explained that the commentary focussed in those areas showing special cause variation and / or those that were indicating they would not achieve the target or standard set. There were a number of ‘spotlight’ areas that were covered in the report, which were also covered in the wider Board agenda such as falls. As the report was still in the development stage, Ms Langrick cautioned that there might be some elements of duplication which would be removed in further iterations. It was noted that the key was missing from the charts, which would be included going forward. The key issues were summarised as follows:

18 Weeks RTT – performance remained below the national standard of 92%, at 89.72% for August. The Trust was working towards recovery in November 2019.

A&E 4 Hour standard – The Trust continued to fall short of the national A&E 95% target and agreed NHSI targets. Attendances had been particularly high in July and August and the growth in Type 1 activity was continuing at both sites. The County Durham and Darlington System was now in escalation with NHSE/NHSI to further review Trust and whole system recovery plans. A system-wide summit was taking place, to agree actions and deliver a step change in October 2019.

Cancer standards – 2 week wait performance in July was 90.63%, below standard but the 62-day national standard was delivered. Cancer was protected from non-elective pressures but was nevertheless subject to demand pressures.


Diagnostics standard – the Trust continued to achieve the standard although risk existed in Endoscopy and 2 week wait capacity.

Finance – performance against the NHSI plan was £6,368k deficit which was £216k ahead of the planned Month 5 deficit of £6,584k.

Workforce – recent internal changes to bank staff payment processes had led to some bank staff reducing the hours they would work for the Trust. The situation was being reviewed urgently. Several other key staff risks were being monitored closely via monthly performance reviews including nurse recruitment; sickness levels with stress and MSK being the two main reasons; staff appraisals.

Spotlight reports on ED 4 hour performance and 18 Weeks RTT were noted. In respect of ED 4 hour performance, Ms Langrick advised that the Trust was coming under increased scrutiny from NHSI and NHSE due to the dip below 90% in this area and had recently attended a meeting with the bodies to discuss the challenges faced. The Trust’s team had fully explained the actions being taken as a system, along with the summit planned for October and the work on the ‘Perfect Quarter’. Ms Jacques added that the Trust had raised the counting issue again, which had been acknowledged and NHSI / NHSE had undertaken to review the issue in terms of how they could help. The Chairman asked whether any feedback had been received on the new methodology in respect of ED activity which was being piloted by North Tees. Ms Langrick advised that the new methodology did not enable performance to be captured against the 4 hour standard and therefore, North Tees and other Trusts involved in the pilot had been credited with 100% performance as the default setting; however, this was not actually being measured. The result of this was that the average performance was artificially inflated. In terms of other feedback, North Tees had been asked not to share information; however, a small insight had been received, in that the results were very variable across the country and therefore inconclusive. In respect of RTT, Ms Langrick advised that the Trust continued to aim to be back on trajectory for November; however this objective carried increased risk because of to the combination of unforeseen factors played in, such as the impact or otherwise of pensions and therefore the willingness of staff to carry out additional sessions; and the impact of weekly and monthly pay and taxation. In addition, there was an issue relating to CSSD theatre trays and confidence of clinicians. Ms Langrick handed over to Ms Smith to comment on the workforce metrics.


Ms Smith highlighted the four key metrics included in the report, emphasising the continued concerns around sickness. Levels of core essential training compliance were improving and turnover at voluntary levels was being maintained. In relation to the metrics on finance, Mr Brown summarised that the Trust was currently performing ahead of plan in terms of the overall position and CIP delivery. Agency use was continuing to be reported as part of the Use of Resources Indicator; however, this was well within the cap level set with no forecast that it would change going forward. The cash position was slightly ahead plan partly due to the changes in the capital programme which had been discussed previously. The Trust Board NOTED the contents of the Integrated Performance Report.

Other Business

133/20 Other Business UHND Bereavement Centre Mr Gerry asked for an update on the recently refurbished Bereavement Centre at UHND. Ms Flynn advised that discussion had taken place at IQAC and significant improvements had been made. A visit was being arranged for Non-Executive Directors. Mr Scanlon added that a short video was available for those who were unable to attend the visit. Mr Scanlon agreed to circulate the link. Future Focussed Finance Award Mr Brown advised that Mr Rikki Siddle, Associate Director of Finance, had attended a national conference in the previous week, where he had been presented with an award, recognising his achievement in this area. Board members congratulated Mr Siddle and the rest of the Finance team.

NS (Nov 19)

134/20 Motion to Exclude Press & Public The Chairman moved the following motion. “That representatives of the press and other members of the public be excluded from the remainder of this meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest.” There were no objections to this motion.

135/20 Close and Announcement of Next Public Meeting


There being no further business, the Chairman announced the date of the next meeting, as noted below and declared the meeting closed at 12:04hrs Open Trust Board Meeting Date: Wednesday 28th November 2019 Time: From 09:00hrs Venue: Prospect House, Durham

Chair – Prof Paul Keane OBE ……………………………. Date: ………………………………………………….. 2020

board of directors - county durham and darlington minutes open tb - 25th... · agreed minutes of...

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