MOORFIELDS EYE HOSPITAL NHS FOUNDATION TRUST
Minutes of the Public meeting of the Board of Directors
held on 27th May 2014
Board members
present:
Sir R. Jackling (Chair: item 1548)
R. Markham (Chair: item 1549
onwards)
D. Flanagan
D. Harris
Sir P. Khaw
T. Luckett
P. Luthert
C. Nall
A. Nebel
J. Pelly
M. Sherry
Non-voting
directors
present:
S. Davies
R. Elek
S. Storey
I. Tombleson
In attendance:
O. Brady
H. Wilcox
C.Brookes (item 1548)
H.Gibbons (item 1548)
2 attendees from Novartis
Membership Council:
B. Dolan
A. Edwards
B. Faulkner
R. Jones
Apologies:
K. Jeffreys
S. Sinha
S. Williams
14/1548 NURSING STRATEGY PRESENTATION
Tracy Luckett, Helen Gibbons and Carmel Brookes gave a presentation updating the Board on
the progress made since the implementation of the nursing strategy one year ago. They outlined
the many objectives that had been achieved including leadership programmes; development of
the nursing workforce and nurse-led collagen cross linking. A postgraduate certificate in
ophthalmic practice, the first of its kind, would begin in September in joint collaboration with UCL.
A Healthcare Assistant and Technician course has commenced with good feedback as well as
the development of a range of study days, both for internal and external students. A start had
been made on expanding nursing research projects in joint collaboration with City University.
Nurses were noted to have given numerous presentations at conferences both locally and
internationally. Amongst the challenges and opportunities for the year ahead were the
implementation of the nursing recruitment campaign and also a need to understand the workforce
requirements. Tracy informed the Board that interviews were scheduled next week for the first
nurse consultant at Moorfields.
Roger Jackling thanked the team for the very interesting presentation. He enquired whether the
course for the HCAs was accredited and Helen indicated that it was not at the present time but it
was hoped this would be a possibility in the future. Declan Flanagan congratulated the team on
the large increase in the number of intravitreal injections now undertaken by nurses. He also
noted that the introduction of nurse-led collagen cross linking was the first major change in the
treatment of keratoconus in 15 years.
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Rob Jones enquired to what extent the nursing programme could be expanded for allied health
professionals (AHPs). Tracy explained that work was underway with UCL and the Institute of
Ophthalmology to provide an advanced certificate in glaucoma care for optometry. She also
noted that there were a number of courses that optometrists had completed. Moorfields now had
3 consultant orthoptists who were taking on additional roles. She explained that there was still a
way to go with AHPs but an update would be brought back to the Board in due course.
The Board congratulated Tracy Luckett and her team on the excellent job that had been done in
developing and implementing the nursing strategy.
14/1549 MINUTES OF LAST MEETING
The minutes of the meeting held on 24th April were agreed as an accurate record. Deborah
Harris enquired if the six month report Rob Elek would be bringing back to the Board in
September would cover the full sustainability strategy. Rob confirmed this could be included as
the Trust had a sustainability strategy. The Chairman reminded Directors that any outstanding
responses to the Trust Board evaluation should be delivered promptly.
14/1550 REPORT FROM CHIEF EXECUTIVE
Received: Chief Executive’s report
John highlighted the following points:
 Monitor’s Annual Plan Review (APR): This was noted to have taken place on 12th May and
the outcomes of the discussions were positive, with Monitor reporting that the operational plan
was one of the most comprehensive and clear plans that they had reviewed. Thanks were
recorded to Rob Elek for putting together the plan.
 Ophthalmology services at Croydon: A visit had been made by the executive team to
Croydon on 15th May to meet the team. The satellite was noted to be an excellent facility with
enormous potential. Thanks were recorded to Chris Canning, Sheila Richards, Mary Sherry
and team for the tremendous job done in setting up this service.
 Association of Research in Vision & Ophthalmology (ARVO): Peng provided a report on
the annual meeting of ARVO held in Orlando at the beginning of May. He noted this had been
a very successful meeting and indicated the importance of the hospital’s participation as this
was a showcase for research in the world. The Chairman asked why the hospital did not
have such a presence at the Asia meeting and Peng indicated that this was largely due to the
cost involved in sending clinicians. The Chairman suggested it would be worthwhile looking
at all the things done to promote the excellence of both Moorfields and the Institute nationally
and internationally and to reflect on whether there was any need to shift that emphasis. He
felt it was unfortunate to miss out on international research-led forums because of budgeting
pressures.
 NIHR clinical research facility (CRF) open day: This event took place on 20th May with the
event forming part of international trials day. Peng Khaw reported that this had been a very
successful event which had helped to publicise the research being done at the Trust.
14/1551 PATIENT SAFETY
Received: Patient Safety report Q2-4
Declan Flanagan said that this report had been discussed at the Quality & Safety Committee. He
drew the Board’s attention to the following points:
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Serious Incidents (SIs): The SIs were outlined along with the recommended action points to
prevent recurrence.
Complaints: These remained at a similar level year on year.
Claims: As some of the claims related to possible inadequate consenting of patients for
treatment, Declan confirmed that training of staff continued with particular emphasis in regard
to thorough discussions with patients around the pros and cons of any procedure.
Infection control: The Trust continued to have very low rates of infection. Endophthalmitis
continued to be monitored using a risk tool, with the Trust recording a level well below the
“norm”.
Phil Luthert was hopeful that as the sector as a whole became a little more open about patient
safety, not only would there would be the opportunity to improve quality but we would be better
able to judge our level of patient safety against that of others. Andrew Nebel queried the results
of the modified Global Trigger Tool (mGTT) which had highlighted various areas which required
improvement. Declan said that the mGTT was a means of ensuring that we do the routine things
consistently well. Andrew Nebel also enquired regarding the subject of prescription errors.
Declan indicated that these had been discussed at both the Quality & Safety committee and also
TMB and they would be reported on in future. Also future reports would include a section about
Moorfields Dubai.
The Chairman noted the increase in the number of incidents being reported now that the
electronic reporting system was in place and staff were more sensitised to that. However, he
wondered whether we had yet reached a ceiling and the numbers would now plateau. Declan felt
that the number of incidents reported were likely to rise a little further before this happened. He
noted that we had been well below the national benchmarks until recently but were getting closer
to these benchmarks now. Phil Luthert noted that the occurrence of more severe incidents was
not increasing but the threshold for reporting was lower and this was leading to larger numbers of
incidents being recorded.
Declan noted the emphasis being placed on maintaining standards when taking on new satellites.
He reported that a clinical governance half day had been run at the recently opened Croydon
satellite with emphasis on ensuring that everything should done to a safe standard.
The Board noted the progress made with regard to patient safety and thanked Declan and his
team for the immense amount of time devoted to analysing the Trust’s activity.
14/1552 ANNUAL COMPLAINTS REPORT
Received: 2013/14 Annual Complaints, PALS & Compliments report
Tracy Luckett presented her report and noted the following points:
 Complaints: The background to the changes within the complaints team were noted. The
number of complaints fully resolved within 25 days had risen to 90% although work was
continuing to reach 100%. Following a peak in the number of complaints received in July
2013, a reduction had been seen in the following months. Tracy explained that a quarterly
complaints report would now be brought to the Board. Many complaints were about clinical
areas including issues concerning consenting and patients’ expectations although these were
not always upheld. Others were about communications and Tracy indicated it was hoped to
have actions in place to improve this by October.
 Compliments: There had been an increase in the number of compliments received this year.
Andrew Nebel noted an increase in complaints within the Medical Retina department and
Declan believed this may be due to the increase in workload, for example 16% rise in
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intravitreal injections within the year. He indicated there had recently been 3 additional
consultants appointed within the service and it was hoped this would reduce the number of
complaints received.
Phil Luthert enquired about the criteria for a complaint to reach SI level. Declan explained the
matrix for this and it was noted that one of the complaints within Tracy’s report may have reached
SI level. Declan agreed to investigate this further. Roger Jackling noted the fact that a clerical
error could have clinical consequences and sought reassurance that this was really brought
home to staff in areas of training. Both Declan and Tracy noted that this was the case and in
particular this was an item covered at the clinical governance days.
Bernard Dolan asked whether an independent person sat on the panel for grading complaints.
Tracy explained that this historically had been done by the complaints team but these were now
graded by the Risk & Safety team. If a complaint was considered as a potential SI, it would be
graded at an independent panel. The Chairman suggested it might be helpful to occasionally
obtain peer review of the complaints we receive in order to get some context around the mix of
the gradings and the matrix used. Rob Elek asked if the next report could indicate how many
complaints were flagged as an SI or possible SI, how many of the complaints were upheld and
whether the compliments could be mapped by service to gain a better understanding of possible
problem areas.
The Chairman thanked Tracy for the comprehensive and transparent report. He noted the need
to continue to maintain vigilance in this area.
14/1553 PATIENT EXPERIENCE
Received: Quality & Safety: Patient Experience Annual report
Tracy Luckett outlined what had happened in the last year with regard to the experiences of
patients. All CQUINs (quality targets) had been reached; minute cards had been rolled out and
the target achieved in respect of dementia training. Two positive CQC inspections had been
carried out.
Tracy explained that the friends and family test had been rolled out to A&E and inpatient areas.
The Trust’s achievement in this area was above the national target. This mirrored the complaints
report with the main issues being waiting times, staff attitudes and communications. She noted
that overall the Trust was doing really well but needed to continue to focus on the areas that
patients were telling us about. Deborah Harris queried the issue of not capturing some views of
patients due to the fact that forms were not always available and encouraged the exploration of
other routes of capture, for example SMS message, by post or online.
Roger Jackling thanked Tracy for the very impressive report. He felt the way in which we try and
capture the patient experience was good as was the way we compared how we were doing with
many others. He was also encouraged by the fact that we were constantly striving to improve.
He felt this was evidence of a very healthy organisation. Peng Khaw also indicated he was
pleased to see the positive feedback from patients as he felt the promotion of these views was
incredibly important. Rob Elek noted that there was a lot of work being done around alternative
means of communications with patients and ways in which companies did their survey work were
being explored in order to improve our systems. This may well include ways of thinking which
would be quite radical for the NHS.
The Chairman thanked Tracy and her team for the report and the Board noted that the overall
position of the hospital was very good. He confirmed the comment made by Roger that it was
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very evident that the hospital was “constructively dissatisfied” with the level we are at but equally
we should not overlook the tremendous progress being made and sustained.
14/1554 OPERATIONAL REPORT
Received: Monthly Operational Performance report
Rob Elek presented the first report of this financial year.
 Mary Sherry updated the Board on the current position with regard to RTT18 performance.
Admitted pathways were reached at 80.7%. Since February an additional 748 surgical
procedures had been undertaken, 472 new outpatient appointments and 836 follow up
appointments. A number of formal business cases would be coming on stream over the next
couple of months and efforts were being made to further increase activity in the short term to
bring the percentage up. Work continued with the IST.
 Rob reported that there had been one breach during April for a patient who was not treated
with 28 days of their operation being cancelled. This was currently being investigated.
 The board noted that all other national targets for month 1 had been met.
 A new indicator for 2014-15 for patient to ward nursing ratios would be in place from June.
 The report was being reviewed to make sure everything was being picked up and different
ways of reporting information were being explored.
 The table included within the report relating to FTFF scores was noted to be incorrect and
Rob agreed to amend this.
 Andrew Nebel enquired whether further modelling work was being done around future
demand and was this being fed into the sizing required for the new hospital. Rob replied that
this process was currently underway and work was starting on strategic planning and
development of a business case for the new hospital.
14/1555 FINANCIAL REPORT
Received: Monthly financial report & Finance report for 2013/14
Charles Nall presented the financial reports.
 With regard to the 2013/14 report, Charles noted that the £9.3M was in line with the flash
figures and also in line with the audited financial statements. Key trends were as previously
noted, particularly strong on the NHS side. Our continuity of service rating was recorded at 4
and FRR at 5.
 The monthly report recorded a surplus of £0.7M against a planned surplus of £0.4M due to
the continuing trend of strong NHS activity. Commercial income opened on a weak note.
 Cash was reported as satisfactory.
Matters with regard to certain debtors had been
escalated in order to retrieve debt.
 The cost improvement programme for the current year was noted to have started slightly
slowly and remained a continued area of focus.
 Roger Jackling queried the comment regarding NHS income and the fact that this continued
to be above plan particularly at City Road. He asked whether this suggested that the appetite
for use of our satellite sites was not as strong as expected. Steve Davies said that
attendance at some satellite sites was dropping and this did need reviewing with perhaps
more to be done in engaging patients in dialogue around their choice of site for treatment.
 Deborah Harris said she was interested to read the lessons learned from last year and which
would be applied to the CIP programmes for this year. She noted that there were particular
directorates who had not reached their targets last year and asked whether these were being
taken into account for this year. Steve Davies replied that this was the case to a certain
extent. He explained that the executive group was drawing directorates together in a
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cohesive way to share ideas and engineer more cost saving across the board with a strong
focus on project management and monitoring around the CIP schemes.
Andrew Nebel asked for clarification of a number of items within the reports and Charles Nall
responded and agreed to provide further comment outside the meeting.
With regard to the “Welsh” debtors, Steve explained that his team was going through a
continuing process with Declan and the consultant body to look at Welsh patients within our
system and making decisions regarding each one as to whether they should continue under
our care, be transferred to a local ophthalmic service in Wales, or safely discharged back to
their GP. Steve added that a robust process was now in place to ensure that for all new
patients, treatments were fully funded.
Roger Jackling noted that the reports indicated that our financial position and financial
management were pretty healthy and commended the team for this.
14/1556 STAFF SURVEY
Received: 2013 Staff Survey results and action plan
Sally Storey summarised the report. She reminded the Board that Moorfields scored particularly
well in terms of staff engagement, with the Trust ranking fourth best in the country for staff
recommending it as a place to work and receive treatment.
However she explained that there were a number of areas in which the Trust needed to do some
more detailed work. There were some repeated themes from previous years and these included
the proportion of staff feeling bullied, harassed or discriminated against, equal opportunities for
career progression or promotion, and the reporting of errors, incidents or near misses.
A range of actions had been developed in response to the survey results. In terms of trust-wide
actions, the major staff engagement project ‘The Moorfields Way - Developing a Culture of
Courage and Ownership’ was well under way. The project combined work on a range of fronts,
some arising within staff focus groups, and linked closely with the principles behind the Francis
Report recommendations. The second Trust-wide action was the establishment of a new
Contact Officer scheme to support staff who had concerns but were not sure where to turn, or for
whatever reason were reluctant to raise it with anyone in authority.
In terms of local, departmental responses to the findings, Sally reported that a wide range of
actions had been developed and implemented. She highlighted four examples that were
described within her report. She also confirmed that progress would be monitored and reported
quarterly to TMB and the Trust Board within the HR and Workforce Report.
In response to questions Sally confirmed that both the Trust-wide actions, and the departmental
actions, focused specifically on the areas of greatest concern.
The Chairman thanked Sally and her team for the comprehensive report which included a lot of
interesting comments in terms of activity. He also noted the disappointing outcome with regard to
the percentage of staff surveys completed. Sally indicated that she felt the Moorfields Way
project would go some way to solving this problem. The Chairman enquired whether it was felt
there may be an element of fatigue in completing these surveys and wondered whether it was
time to take a fresh look at the ways in which we could achieve an increase next year in the
response rate.
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14/1557 ANNUAL REPORT & ACCOUNTS
Received: Annual report & Accounts 2013/14 including Quality Report
Report of Audit Committee to the Board year ending 31 3 14 (tabled)
Deborah Harris summarised the annual committee report which had been tabled. The committee
was providing additional reporting requirements following the updates to Monitor's Code of
Governance in January 2014. This now included a report of significant issues considered and a
discussion of how the committee conducted its review of the effectiveness of the external audit
process.
The Board noted the committee's recommendations with respect to data quality, IT
implementations, assurances for future additional Board declarations and adequately resourcing
the additional volume of clinical activity due to new locations. The Board also noted the
substantial assurance rating from the head of internal audit and that an unqualified report was
expected from the external auditor.
Deborah stated that an annual report of the committee to the Membership Council would be
issued following final completion of the accounts. As this report already addressed the new
requirements of the recent updates to the code of governance, its format and structure would be
unchanged. She also recorded thanks to Stephen Dunham and Charlotte Sparrow for their hard
work in bringing the audit in place. In conclusion, Deborah reported the Audit committee’s
recommendation to the Board to approve the audited accounts and financial statements for
2013/14.
The Chairman thanked the Audit Committee for their rigour and attention to detail which had
provided the Board with the assurance that all matters that needed to be covered were covered.
He said the Board should feel comfortable with the work done by the Audit committee. Authority
was delegated to John Pelly and Charles Nall to complete any minor amendments and to John
Pelly and the Chairman to sign the accounts on behalf of the Board.
Phil Luthert reported that the draft Quality report had been reviewed by the Quality & Safety
committee on 23rd May. A number of issues had been reviewed, most of which had been
discussed at the Board throughout the year. The committee had also looked at provision of the
objectives for the coming year and there had been a strong sense that these had been set
relatively high. Overall, the Quality & Safety committee were content with preparation of the
Quality report.
14/1558 STRATEGY & INVESTMENT COMMITTEE
Received: Annual report of the S&I Committee 2013/14
Roger Jackling noted the report of the Committee’s work during the year and recorded thanks to
the committee for that work and the help provided throughout the year. He felt the Committee
was effective in the strategies they developed and the plans derived from them. He felt the
Committee should aspire always to have a hard focus on the outcome they were seeking to
achieve through the work being done. He also felt the Committee could be a little more rigorous
in dealing with the “lessons learned”. He asked the Board to note the Committee’s thanks to
Emily Dover, who had recently left the Trust, for all her hard work in organising and minuting the
meetings.
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14/1559 PROJECT ORIEL COMMITEE
Received: Annual report of the Project Oriel Committee (POC) 2013/14
Andrew Nebel presented the report which summarised the work done for the last year and the
way the POC was structured and had addressed the work. He indicated that the Board could be
assured that the work was proceeding in an efficient and appropriate way. The challenge of
finalising the preferred site for the new build remained, along with ensuring that the size and
configuration of the facility met the future needs of our patients and also was affordable.
14/1560 EQUALITY DIVERSITY & INCLUSION (EDI)
Received: Equality Diversity & Inclusion Steering Committee Annual report 2013/14
Deborah Harris presented the report and informed the Board that the EDI steering group
continued to work to embed the issues for equality, diversity and inclusion into the culture and
leadership for the organisation. She stated that the Board could take assurance that activities
conducted in 2013/14 followed a coordinated approach and that objectives were being
progressed. She noted the proposed changes to the Terms of Reference as outlined in the
paper that reflected the changes due to the NHS Act. The Board noted the report and approved
the updates to the Terms of Reference.
14/1561
Noted.
BOARD CALENDAR
14/1562 NEXT MEETING
The next meeting of the Board will be held at 9am on Thursday 26th June 2014.
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