MOORFIELDS EYE HOSPITAL NHS FOUNDATION TRUST
Minutes of the Public meeting of the Board of Directors
held on 20th November 2014
Board members
present:
R. Markham (Chair)
D. Flanagan
D. Harris
Sir P. Khaw
Sir R. Jackling
T. Luckett
P. Luthert
C. Nall
A. Nebel
J. Pelly
M. Sherry
S. Sinha
S. Williams
Non-voting
directors
present:
S. Davies
R. Elek
S. Storey
I. Tombleson
In attendance:
O. Brady
M. Hassard
J. Hughes
K. Jeffreys
D. Siriwardena
H. Wilcox
Membership Council
R. Jones
J. Wakefield
14/1627 PRESENTATION ABOUT RESEARCH
A presentation was given by Peng Khaw, Phil Luthert and Maria Hassard. The Board were
updated on developments following the first full year of the joint research strategy
implementation.
The Chairman asked what percentage of research funding was spent on “proof of principle”. Phil
explained that broadly speaking for the Institute of Ophthalmology (IOO) approximately 50% was
spent on discovery and the rest on translational research. In response to a query from the
Chairman about the amount of research being undertaken, Phil noted that there were far more
ideas than we were able to get money for to develop further. Peng indicated the critical link with
UCL and UCLP in respect of expertise and lobbying when applying and obtaining grants. With
regard to publications, Moorfields and UCL were noted to have the highest proportion of
collaborative papers compared to all NHS Trusts in England.
Phil outlined the loss of research talent that would occur in the coming months due to retirement
of a few key top ranking researchers. Maria talked about the integration of Moorfields and the
IOO and mechanisms around delivery of that from a research support perspective. She
explained the importance of innovation through integration and also the relevance of this to
patients in getting from science into new clinical treatments.
In conclusion Peng felt that we were doing very well and continued to do better than before.
However, this put enormous pressure on the system. The biggest challenge to maintain and
grow activity was capacity and the talent needed to take us forward. He said this also shaped
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what we wish to describe ourselves as – either a “hospital that does some research” or a
“research hospital”.
Andrew Nebel thanked the team for their stimulating presentation. He noted the need to raise the
profile of ophthalmology to attract further funding. He asked where innovation sat within research
and development. Phil explained that the innovation issue was very timely, we could do much
more but the challenge was having the right numbers and the right people to do it. Peng noted
the need for a clinical system to work with the innovation framework. Innovators required time
and freedom and the strategy aimed to set up a support structure to allow this. Steve Williams
felt that the presentation showed real endorsement of the joint strategy and highlighted the
challenge to grow even bigger. Roger Jackling said he was hugely encouraged in the way the
UCLP partnership was developing and this endorsed our decision to join. Rob Jones suggested
part of the strategy should contain explanations about how research was generated from high
level science through to general use.
John Pelly felt that more Board time should be spent considering research and suggested that it
should come to the Board 2 to 3 times a year. He noted that there was no doubt that we wished
to remain a “research hospital” rather than a “hospital that does some research”. He concurred
with the major issue of attracting and developing new talent along with maintaining the talent we
have already. He noted the necessity for the hospital to grow but perhaps at a slightly slower
pace than had occurred over recent years. He also said there was a need to give much greater
focus to the joint strategy and to devote more management time and effort to delivering it.
The Chairman thanked Peng, Phil, Maria and Julian for their inspirational presentation. With
regard to future discussions at the Board, he suggested a few topics to be covered:
 The shape and balance of the portfolio between the bright ideas and the capacity to deliver
them.
 To give some visibility to the challenges around the next generation of talented people.
 Size and capacity regarding people and infrastructure.
 The challenge of how we stand compared to our competitors.
 Funding sustainability.
 Understanding Informatics and the link to OpenEyes.
 Do we sufficiently describe the “hospital” aspect of research.
 How can the Board help in developing and implementing this strategy successfully.
The Chairman noted the good progress made over the last 5 to 6 years and the continuing focus
needed to sustain this.
14/1628 MINUTES OF LAST MEETING
The minutes of the meeting held on 30th October were agreed as an accurate record with the
amendment to the spelling of Sir Ludwig Guttmann Health & Wellbeing Centre.
14/1629 REPORT FROM CHIEF EXECUTIVE
Received: Chief Executive’s report
John Pelly expanded on the following points:
 Moorfields Pharma (MPh): The independent investigator had now started work on review of
the HR aspects of the whistleblowers’ letters. The technical investigation would be
commencing in December. BDO were noted to have been engaged to support a strategic
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review of MPh. The part of the MHRA that looks at medical devices were noted to have
visited yesterday for a single day inspection and no major problems had been reported.
Recruitment of very senior posts: In view of the fact that in the medium term there were
likely to be a number of NED and ED posts to fill, the Chairman had agreed that a firm of
search consultants be appointed for the next two years, hopefully on the basis of a reduced
fee. Proposals had been received from 6 companies and it was expected that a decision on
who to appoint would be made shortly.
Unison strike: This was planned for 24th November and it was expected to have little or no
impact on service delivery.
OpenEyes: Mary Sherry informed the Board that we were going into a slightly different phase
with OpenEyes. Following advice, it had been noted that some of the infrastructure of the
system required review. This was linked to how much bigger and more widespread the
product could become in covering all of our subspecialties and also stretching the product
itself for the wider commercial application
Senior appointments: Two senior appointments had recently been made. Mr. Parham
Azarbod had been appointed as glaucoma consultant based within Moorfields South and Mr.
Dion Alexandrou as consultant paediatrician to support paediatric ophthalmology services.
Mr. Alexandrou would be our named doctor for safeguarding purposes. It was also noted that
interviews had been held for the post of Medical Director, Dubai and an offer made to the
successful applicant. A response was awaited.
14/1630 RTT18 PERFORMANCE
Mary Sherry informed the Board that the position was significantly improving in terms of data
clean up. Regarding specific projections for December, we were noted to now be above the
target for open pathways and getting closer to the non-admitted pathways. The big challenge
remained the admitted pathway. Daily monitoring and scrutiny was being undertaken of the
number of patients breaching. Mary noted we were on track for a 90% delivery in December but
that it would be extremely tight. She therefore could not guarantee compliance by the end of
December but every effort was begin made. Increased activity would be undertaken over the
Christmas and New Year period with normal operating lists on 29th and 30th December.
Outpatients would be running on normal days with a 3pm finish on Christmas Eve and New
Year’s Eve. Mary also updated the Board on the theatre refurbishment project. She noted we
were in the final stages of planning and were targeting the first quarter of 2015 for work to begin.
A further review of the plan would be taking place next week which would include the potential
contingency for treating patients outside of Moorfields. It would also include the potential of
accelerating, on a temporary basis, 7 day working to make use of theatres on Sundays. A further
more thorough update would be brought to the next Board. Declan reminded the Board that our
infection rates still remained well below the expected levels.
 ACTION
Update on theatre refurbishment project to be brought back to December Board – MS
14/1631 OPERATIONAL REPORT
Received: Monthly Operational Performance report for October 2014
Rob Elek noted the position at month 7 and outlined some of the key risks mentioned within the
report. A&E had again seen the highest number of A&E attendances in a month, at 8,386,
surpassing the previous record of 8,373. Despite the additional activity, performance remained
strong and waiting times within target and stable. He asked the Board to note that a strategic
review was being undertaken of the whole “urgent care” pathway and in due course the Board
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would be updated about the outcome of this. Declan Flanagan emphasised the need to ensure
the provision of robust urgent and emergency cover at our satellites.
ACTION
 Board to be updated about the outcomes of an urgent care review – DF
14/1632 FINANCIAL REPORT
Received: Monthly financial report for October 2014
Charles Nall presented the report and noted the revised forecast surplus from £5M to £3M, noting
that the organisation was under pressure and this had been brought to the attention of the
commissioners. Deborah Harris noted we were down to a projected year end £13M cash
balance and was keen to ensure we had enough to continue operations plus providing for the
new build project. Charles explained that there was enough cash for the current year. He noted
there was also a £6M working capital facility were we to require it. Andrew Nebel noted
expenditure to be £1.5M over budget and asked what had triggered the increase in operating
costs. Steve Davies explained that a large amount of additional work was being carried out in
relation to RTT which in turn created additional payments for staff working at weekends etc.
However, this was expected to tail off once we reached the point of compliance with target. The
outlook for research infrastructure funding remained a concern. Charles noted that the forecast
was subject to a number of significant factors and these were being monitored. Any change to
the forecast would in due course be reported to the Board.
The Chairman noted the significant downturn in forecast. He asked the Board to note the point
that the impact of shortfall in income from Moorfields Pharmaceuticals (MPh) was both significant
and enduring and thought was needed to the longer term impact. John Pelly noted that the
forecast surplus had been reduced from £5M to £3M and asked what the implications of that
would be regarding our risk ratings with Monitor. Charles explained that this would have no effect
for the current year but may do for the following year – this was being explored in the current
business planning and budget round.
14/1633 ESTATES REPORT
Received: Estates and capital projects six monthly report
Rob Elek presented his report and made the following comments:
 He asked the Board to note the backlog work done over the last six months, in particular the
lift upgrades.
 Thinking was now going on as to how we maintain the building over the coming years until the
completion of a new hospital. This was likely to take longer than originally foreseen.
 Details regarding the capital works at City Road were outlined including improvement of the
environment from the patient perspective and it was noted that a significant improvement had
been made in and around the front entrance to the hospital.
 In terms of the provision of the Moorfields facility at St. George’s, discussions had flagged up
a number of clinical issues and operational constraints including anaesthetic support to a freestanding building, the increasingly complex case-mix of our activity there and the impact of
SGH’s designation as a regional trauma centre. The consequence of these issues being that
SGH had stated that the planned development could not proceed in its current form. There
was now ongoing dialogue around the way forward and a further report would be brought
back to the Board.
 A summary was given of the current position regarding call handling at our satellites. Rob
explained that they were starting to look at potential solutions of rolling out our City Road
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telecom system at satellites and a report on this would be included in the next telecoms
report.
The Chairman enquired whether there was any essential backlog work required that had been
excluded because we could not afford to do it and Rob indicated that there was not, but the
phasing should be noted in order to do essential work in an operational hospital.
14/1634 CARBON REPORT
Received: Annual sustainability report 2013-14
Rob explained that the carbon target represented a 10% reduction in carbon emissions over the
5 years from the baseline year of 2008/9 to 2014/15 and our performance at the end of the 4th
year was as follows:
 Absolute carbon emissions had decreased by 1%.
 Emissions from electricity had reduced by 3%, those from gas had increased by 2%.
 Emissions from City Road had decreased by 4% whilst those from the RDCEC had increased
by 21%.
He explained that the 10% reduction had not been achieved predominantly due to the increase in
work that we were doing. However, Rob said our carbon usage per patient was down by
approximately 29% but in terms of an absolute number, the amount of carbon we actually used
had only gone down by 1% in the last 4 years. Rob outlined the marginal financial impact of not
hitting the required target. He also noted the reputational impact which he felt was fairly minimal.
Sumita Sinha felt it would be helpful to compare ourselves with other hospitals and learn from the
ways they were dealing with this target and also indicated the need to ensure duty of care to our
patients. Sumita noted that the premises assurance model was useful to use as a checklist and
suggested it would be helpful to engage staff and patients into saving energies. Finally, she
asked to see water statistics within the next report and Rob agreed that this would be included.
Deborah Harris asked that future reports include the whole area of sustainability, not just the
carbon aspect.
The Chairman encouraged focus to continue on those things that really make a difference and
we could influence to avoid devoting too much time to analysing things which were out of our
control. He asked for the next ‘carbon’ report to include the full sustainability agenda including
such things as employment of people with visual impairments. Roger Jackling felt it should be
noted that although we had failed to meet the required target, in terms of the essence of
initiatives, we were doing very well.
 ACTION
Next ‘carbon’ report to include the full sustainability agenda – Rob Elek / Tracy Luckett / Sally
Storey
14/1635 BOARD CALENDAR
Noted.
14/1636 NEXT BOARD MEETING
To be held on Thursday 18th December 2014 at 9.30am.
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