MINUTES OF THE TRUST BOARD MEETING IN PUBLIC
Held on Wednesday, 7th October 2015, 9.30am to 12.30pm
Austen Seminar Room Shirley House, Croydon University Hospital
Present Voting
Michael Bell
John Goulston
Jayne Black
Azara Mukhtar
Nnenna Osuji
Godfrey Allen
Louise Cretton
Steve Corbishley
Dr James Gillgrass
Mike Bailey
Hannah Miller
Chairman
Chief Executive Officer
Chief Operating Officer/Deputy Chief Executive Officer
Director of Finance
Medical Director
Non-Executive Director
Non-Executive Director
Non-Executive Director
Non-Executive Director
Non-Executive Director
Non-Executive Director
(MBe)
(JG)
(JBl)
(AM)
(NCO)
(GA)
(LCr)
(SC)
(JGi)
(MBa)
(HM)
Present Non-Voting
Michael Burden
Jamal Butt
Lisa Chesser
Helen Astle
Director of Human Resources & Organisational Development
Associate Non-Executive Director
Director of Planning and Informatics
Director of Quality Assurance & Governance
(MBu)
(JBu)
(LCh)
(HA)
In Attendance:
Marcia Marrast-Lewis
Mike Hayward
Dr Nicola Beech
Committee Secretary
Deputy Director of Nursing [In place of Michael Fanning]
Consultant Oncologist [for item 7]
(MML)
(MH)
(NB)
Apologies
Michael Fanning
Director of Nursing Midwifery and Allied Health Professionals
(MF)
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Welcome and Apologies
The Chairman welcomed Board members, staff and members of the public to the
meeting and recorded his thanks to Steve Ebbs the former Medical Director who
retired in September. MBe formally congratulated NCO on her appointment as the
Medical Director and welcomed her to the Board. MBe also welcomed Hannah
Miller to the Board as a new Non-Executive Director.
Apologies were received from Michael Fanning Director of Nursing, Midwifery &
Allied Health Professionals
The Chairman confirmed that John Thompson, Non-Executive Director who had
been appointed in 2013, had completed his term of office; MBe expressed his
thanks on behalf of the Board to John Thompson for his work and commitment to
the Trust during his time as a Non-Executive Director and as the Chair of the
Finance & Performance Committee.
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Declaration of Interests
No interests were declared that related to the business discussed at the meeting
and there were no further declarations of interest beyond those already noted in
Board Minutes Part One 7 October 2015
Page 1 of 11
the Register of Interests.
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Chair’s actions
Contracts Awarded in excess of £25,000
AM updated the Board on Chairs action taken since the last meeting.
Company
Detail
Total Contract
Value
Norland Managed Services Ltd
Mayday House Boiler Works
£220,231
Allocate Software Ltd
5 year annual support and
maintenance fee for NHSP
interface and Cloud Hosting
Services
£173,700
Use of Trust Seal
The Board received and accepted the report on the Use of the Trust Seal.
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Minutes of the last meeting
Minutes of the meeting held on 29 July 2015 were considered and agreed as an
accurate record.
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Matters Arising/Action Tracker
It was noted that all items on the Action Tracker have been completed.
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Chief Executive Officer’s Report
JG presented his report highlighting the recent CQC inspection, the executive
appointments of Helen Astle to Director of Quality Assurance and Governance and
Hannah Miller as a Non-executive Director. The report gave details on the Patient
Safety week, the Annual General Meeting which took place in September 2015
and extended an open invitation to all members to attend the Trust’s first ‘Croydon
Conversation’ on 27th October 2015. The report summarised progress on the
Emergency Department Decant which will see the re-location of the Accident &
Emergency Department in November, followed by the commencement of the
construction of the new Accident and Emergency department scheduled for
completion in 2017.
JG talked through a presentation on the findings of the Chief Inspector of the Care
Quality Commission (CQC). Their findings concentrated on 3 key areas,
Children’s Community services; Adult Community services and the Hospital. JG
explained the CQC scoring system used to assess the Hospital and Community
Services and gave details on where significant improvements had been achieved
since the last inspection. JG noted that 13 areas were identified as delivering
‘outstanding’ practice, with 4 “must do’s” to improve. Overall the Trust achieved a
‘required improvement’ score.
JG noted that out of CQC’s 5 domains, Effective and Caring were rated as ‘good’,
which represented a significant improvement since the last inspection and which
clearly demonstrated the commitment of staff at the Trust. JG advised that many
of the areas that were identified as ‘requires improvement’ fell marginally short of a
‘good’ rating which indicated that improvements would be relatively easy to
achieve. JG listed some of the areas that were ranked as good as well as the
areas that required improvement. It was noted that the Trust was criticised on
mandatory training where a target of 90% compliance was not achieved. JG
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assured the Board that staff would continue to embed good systems around
clinical governance and risk management, continue with the programme of
refurbishment of theatres once the necessary capital investment was secured and
drive the programme of mandatory training.
In terms of when the next CQC Inspection would take place, JG explained that the
CQC could take up to 2 years before the next planned inspection was carried out,
but could at any time carry out a random inspection. JG explained that as the Trust
was moving to a new model of care in medicine and the building work of the new
emergency department, it would most likely prompt an earlier inspection. Details
of the Chief Inspectors report would be made available on the Trust’s website by a
link to the report on the CQC’s website, accessible by the public as well as NonExecutive Directors.
JG confirmed that local Councillors had enquired about the Trust’s financial
position and asked how long it would take for the Trust to move from a ‘required
improvement’ rating to a ‘good’ rating. JG explained that in theory the financial
position should not impact negatively on the performance of staff.
He
acknowledged that operational pressures could prevent staff from attending
training and therefore operational issues rather than the financial situation would
hinder progress. A reduction in staffing levels to manage financial resources could
negatively impact on care standards.
JGi asked if the CQC would give any warning before the next planned inspection.
JG advised that the Trust would receive a 6 months warning in advance of the
planned inspection, but that the CQC was still at liberty to carry out a random
inspection. JGi asked what could be done by way of preparation for a random
inspection. JBl confirmed that the issues raised in the Inspectors report have been
considered and there were a number of ways in which the Trust would ensure it
was prepared for an unplanned inspection. These ranged from continuing with
executive walk rounds to carrying out mock inspections. JBl confirmed that that it
was important to create a culture of inspection so that staff did not become
complacent and that a state of readiness was maintained.
LCr noted that the CQC Quality Summit had recently taken place and asked if
there had been a positive response by stakeholders to share responsibility for the
improvements that were needed. JG explained that external stakeholders
including Councillors, the Chair of the Scrutiny Committee and members of the
Clinical Commissioning Groups attended the Summit and were pleased to support
the Trust achieve improvements. In addition the Director of Health Education
South London also pledged to support the organisation secure highly trained
Health Care Assistants by assisting with training needs.
MBe agreed that 2 years was the likely timetable for the next inspection but the
CQC have suggested that they would like to come back before then. SC asked if
an action plan would now be developed to give more granularities with the
monitoring of progress. JG confirmed that the Quality Experience and Safety
Programme (QESP) is being refreshed and would link to the Inspection report. The
QESP programme of work would be formally submitted to the Board for approval
in December 2015.
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Patient Story – Acute Oncology Service
The Board welcomed Dr Nicola Beech, Advanced Nurse Practitioner/ Lead
for Acute Oncology Service. NB informed members that she had been
employed with the Trust as a nurse practitioner since 2012 promoting the
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new cancer service for the care of cancer patients in an Acute Trust setting.
NB talked through the structure of the service advising it comprised of 1
ANP, 1 CNS (clinical nurse specialist), 2 par time medical oncologists and
one full time administrator. Members heard that establishing a wellresourced team made a significant difference to services that can be
offered to patients. NB explained that the Service sees patients with a
known cancer diagnosis and those with suspected cancer. The team
provide face to face assessment and support to 750 in-patient referrals per
year, triaging treatment so patients receive the right treatment in the right
place. Positive outcomes result in a reduction in the length of stay and
significant cost savings to the Trust. NB confirmed that the Service could
take direct referrals from cancer centres so that patients don’t have to go
through the Emergency Department and if patients are seen earlier in an
ambulatory setting they can move through the pathway quickly. NB stated
that referral waiting times for patients with urgent suspected cancers have
reduced over the past 18 months which has made a significant difference to
cancer patients with positive outcomes. Further engagement with Clinical
Commissioning Groups has been sought and the service has been
shortlisted for rolling out as a national programme so that cancer patients
can receive a diagnosis at stage 1 and 2 instead of stages 3 or 4. Patients
have expressed a willingness to work closely with the Cancer Service to
increase patient satisfaction. The Board were shown a video on the Acute
Oncology Service entitled “Putting Patients First”.
LCr asked what developmental plans would be implemented over the next
12 to 36 months. NB explained that increasing nursing support was
particularly challenging to improve the level of nursing care to cancer
patients together with improved service development. JGi asked how
aware were GPs of local cancer services and how the service related to 2
week rules in place. NB confirmed that GPs were aware of local services
and that NB had also joined the CCG Early Diagnosis Group with a view to
strengthening pathways. The Service also had plans to develop an early
diagnostic telephone service to be piloted imminently. NB assured the
Board that current NICE Guidelines have provided a framework which
accords with much of what the GPs already do. However more complex
issues would require a more strategic and planned process and on-going
work with GPs was still in progress.
MBa asked if skilled nurses contacted patients or the referrer first when
radiology reports with red flags were received. NB stated that nurses would
always attempt to contact the referrer first however if there was a need to
approach patients the Referrer would be informed. NB added that currently
the service was a Monday to Friday service but there was a desire to
ensure 7 day access to information and support. This would require coordination with other services.
JG stated that as part of the South West London Cancer service there was
an opportunity to develop a cancer vanguard site collaborating with the
London Royal Marsden noting that Croydon was the only Borough where
patients had to travel to receive chemotherapy and that such a vanguard
would provide an opportunity to develop a locally run chemo service. NCO
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agreed that the Royal Marsden would be a very helpful partner to develop
chemo service on site. On behalf of the Trust Board MBe thanked NB for
her attendance at the meeting noting with interest the importance of subject
matter and the valuable work carried out by the Team. NB left the meeting
QUALITY
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Quality & Clinical Governance Committee – Minutes of the meetings held on
18th June and 18th July 2015
GA presented the minutes of the Quality & Clinical Governance Committee
meetings held on 18th June and 18th July 2015.
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Report of Quality & Clinical Governance Committee meeting held on 17th
September 2015
GA provided a verbal report of the Quality & Clinical Governance Committee
meeting which took place on 17th September 2015. GA advised that the
Committee received and discussed the Annual Report of the Palliative Care Team
and the report of the Local Supervisory Audit. GA highlighted the contents of the
report which discussed the activity of the Palliative Care Team from 1st April 2014
to 31st March 2015, noting that the report would be presented to the Board at the
next Public Board Meeting in December.
GA summarised the Local Supervising Authority (LSA) Annual Report which
outlined the work carried out by the Supervisor of Midwifery Practice and the
outcome of the LSA Audit carried out during the week of 15th June 2015. GA
confirmed that all standards had been met for the first time in Croydon which
endorsed the continued improvement of the maternity services at the Trust.
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Quality Experience & Safety (QESP) Update
HA summarised the report on the progress of the Quality Experience & Safety
Programme (QESP) advising that the QESP will be revised following
recommendations received from the CQC’s inspection report as well as the
outcome of the Quality Summit which took place on 2nd October 2015. HA
confirmed that the QESP would be revised in in 2 phases, phase 1 would
incorporate lessons learned from the CQC inspection and phase 2 would see the
implementation of a governance structure to monitor and track progress through
the Operational Delivery Group on a fortnightly basis.
HA confirmed that the agreed QESP action plan will be presented to the Trust
Board for final approval in December 2015. HA agreed to drive the action plan
forward to make sure progress is achieved. HA referred the Board to Appendix A
of the report, where the most important actions were detailed noting the
importance of engagement with directorates and assuring the Board that
directorates would be supported through the process by the Corporate
Governance Team to improve clinical governance across the Trust.
JG advised that directorate action plans would be integrated and cross referenced
to form the basis of a single action plan. JBl confirmed that the action plan would
need to be incorporated as ‘business as usual’ (BAU) in the directorates to ensure
delivery. LCr expressed her hope that this would build the confidence of the Trust
and the staff so that the culture is transformed and becomes engaged in the
programme of improvements. It was agreed that a fully updated QESP would be
completed for consideration and approval at the next Board meeting in December
2015. The Board noted the report.
Board Minutes Part One 7 October 2015
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Action
Update QESP to incorporate CQC recommendations and directorate action
plans to form a revised QESP for consideration and approval at the next
Board Meeting.
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Trust Quality Report
MH summarised the Trust Quality Report noting that the report underlined the
achievements made by the Trust which has been reflected in CQC report in
relation to the “good” rating achieved in the ‘Caring’ domain. MH explained that
the Trust had undertaken a total of 61 quality rounds which represented a 17.3%
increase from the previous reporting period. Areas RAG rated as red will be
addressed at Nursing Boards, and directorates are working with operational teams
and matrons to improve quality across the wards. MH confirmed that the Listening
into Action (LIA) programme of work has made a significant difference in the
organisation particularly on Visible Wednesdays.
In relation to the ‘Safe’ domain MH advised that the Trust achieved safe staffing
levels based on patient need during the months of June and July 2015. MH added
that despite the challenging nurse recruitment campaigns the Trust achieved the
best recruitment levels for 2 years with fill rates at 98.52% in June and 97.8% in
July. Croydon Health Services (CHS) when benchmarked against other South
West London Trusts was second behind a SW London District Hospital in terms of
its safe staffing position in the month of June 2015. MH confirmed that through the
efforts of LIA there was a consistent reduction in the incidence of pressure ulcers
and a reduction in catheter infections. In terms of Clostridium Difficile Infections
there had been 2 further incidents which brought the Trust’s total up to 12 against
a trajectory of 16. MH confirmed that the Trust has an action plan in place and
was supported by Public Health England as well as a good Infection Control team
to address the incidents of hospital acquired infections.
MH stated that under the ‘Responsive’ domain the Trust can now demonstrate that
all services across the organisation are using the Friends and Families Test (FFT)
however improvement is required in both A&E and Outpatients to improve
response rates.
MH highlighted improvements made in the Complaints
Department culminating in the revision of the Trust Complaints Policy to
incorporate learning.
NCO talked through the Mortality Report noting that the hospital was performing as
expected with outliers in cardiac dysrhythmias which would be audited to ascertain
reasons. NCO advised mortality for acute bronchitis was double the expected rate
and that Imperial College would review this, adding that the mortality lead had
taken an initial look at respiratory diseases at the hospital, which revealed there
was a lower bronchitis rate but a higher pneumonia rate, which carried a higher
mortality rate. Review of this work was on-going. NCO confirmed a total of 7
serious incidents and no never events for the reporting period. VTE risk
assessments stood at 87.25% which was above the national figure of 86.02%. In
terms of medication safety, NCO advised that a review of incidents by patients and
type would be carried out to ascertain reasons for errors. Quarter 2 was similar to
Quarter 1 but was moving at pace with increased reporting on Datix. NCO noted
that the reporting system was improving with increased training for staff.
JBl queried the rate of medication errors asking if they were connected to nursing
levels on wards. MH confirmed that medication errors were discussed at the
monthly matrons meetings however NCO confirmed that errors were investigated
and it was ascertained that there was no correlation between medication errors
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and nursing levels. NCO also stated that although it appeared that medication
errors had increased, it was the actual reporting that had increased which was a
positive action.
JBl observed that data related to discharges was not visible on ward’s white
boards and asked if this could be incorporated into the quality rounds.
MH
confirmed that the “perfect ward” initiative was in place which would provide an
opportunity to expedite discharges before 11:00 am and that work through LiA
would provide opportunity to roll this initiative out across all wards. JGi asked how
well information acquired through the quality rounds is being aligned with and CQC
recommendations. MH confirmed that the quality rounds were not only a dynamic
process but also work in progress. MH confirmed that it was recently recognised
that patients should be involved in quality monitoring and the Improving Patient
Experience Committee would be taking this forward. SC queried in terms of safer
staffing, how serious a red RAG rating was on the ward dashboard. MH explained
that there was a set of safety measure that are reviewed a daily which represented
a snapshot of nurse staffing levels. This is undertaken each morning to enable the
redeployment of staff to wards with staff shortages which reduces the RAG rating
from red to amber or amber/green. MBu stressed that an amber ward is safe in
relation to the acuity of patient. Reporting first thing in morning moves RAG
ratings significantly by mid-morning. LCr asked if safe staffing is maintained by
overstaffing. MH explained that specialing has driven the amount of nurses
needed but the TDA was in the process of looking at the way Trusts use Specials
to ensure best practice.
In relation to Duty of Candour, MBe suggested that this should be a regular feature
in the Quality Report and should also include recommendations. The Trust Board
noted the Quality Report.
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Update on the Emergency Department Redevelopment
JBl updated the Board on progress of the operational planning and structural
works for decanting the Emergency Department in readiness for the re-build of the
new Emergency Department. JBl confirmed that project plans have been
discussed at various Project Boards and groups and preparations were in progress
to carry out the decant on 8th November 2015. JBl confirmed the refurbishment of
Kenley 2 ward had been completed to accommodate the observation ward. The
Discharge Lounge had moved and was working well in its new location. JBl added
that IM&T was progressing well and that a mapping exercise was coming to an
end where all equipment was now mapped to its new location. JBl informed
members that a number of table top events and external events had also been
carried out by way of preparation and the clinical teams would put into practice
patient pathways with scenarios around major incidents and patient arrests in
corridors. The local CCG have registered their support for ambulance diverts to
surrounding Trusts who will also support the decant. JBl confirmed that the decant
was scheduled to take place on 8 November barring any major incident and could
take up to 5 hours to complete. JGi asked as the Non-Executive Director lead on
the Programme Board, for reassurance on all the work that was in progress and
whether any concerns have been identified. JBl explained that the main concern
related to contractual issues, confirming that discussions around elements of the
contract were still in progress. She would update the Board when these issues are
resolved in 2 or 3 weeks but it was not expected that these would hinder building
works.
GA stated that information in relation to the Emergency Department decant should
be readily available to the public and should also be updated through
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Communications. JG provided assurance that the Communications Team were
leading this but that there was also an opportunity to recruit some extra volunteers
to assist with the public on Decant Day. MBe asked if a clinical triage would be in
place rather than the administrative one. NCO confirmed that the Trust was
moving to a clinical model. JBl also confirmed that volunteers were engaged with
the process and were ready to help on the day.
JBl stated that the 3rd week of October which was school half term holiday had
been identified as a date to carry out a small version of a ‘safer faster’ week and it
was agreed with the CCG that the final week of October would be used to carry
out a 7 day ‘safer faster’ week. JGi noted that it was very important to consider
security because of the different ways that patients would access the hospital and
the Emergency Department through the Woodcroft Road entrance and therefore
recommended all staff should be conversant with the new entrances and layout
around the hospital. The Board noted the ED planning process and the
contractual position of the Trust in relation to the Guaranteed Maximum Price.
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Major Incident Plan
JBl presented the Trust’s Major Incident Plan noting that the plan was essentially
the same plan ratified by the Board in September 2014 subject to 3 amendments
as noted. It was agreed that the Plan would not require any further updating to
accommodate the ED decant. The Board noted the Plan.
Resilience Plan
JBl presented the final draft of the Operational Resilience and Capacity Plan. JBl
explained that the Plan ensured the Trust maintained normal business during the
winter period. JBl confirmed that the Plan had undergone a table top exercise to
test its efficacy. She talked through the issues in relation to the Plan in particular
discharge and work around the “golden patient” model. JBl advised that a review
of pathways was undertaken and it was noted that the implementation of the Rapid
Access Unit (RAMU) would make a positive impact on patient flow. JBl confirmed
that the Plan had been scrutinised by the Finance & Performance Committee and
the Chair of the Committee confirmed that various drafts had been presented. JG
stated that surgical assessments should be working as part of resilience team
while LCr stated that the Resilience Plan would need to achieve budgeted targets
which would pose a challenge.
JBl talked through the completion of the Edgecombe Unit stating that it
represented a real change in clinical models which would have a positive effect on
the way services were delivered. It was a joint post between Croydon University
Hospital and CCG teams which was driven by considerable effort and
organisation. The Edgecome Unit would provide an ambulatory area and also
accommodate an outpatient facility so that the frail and elderly could be seen in
one area.
JBl added that although a dedicated Acute Medical Unit (AMU) was replaced by 12
beds, it was anticipated that patients would benefit from an improved experience
and that this model should see a reduction in the length of hospital stays. NCO
expressed her enthusiasm for the new model of care, stating that it would help
patients avoid the need to be admitted into hospital and provide a safety net for
patients who are ready for discharge. HM asked if some medical assessments
would move away from hospital, i.e. care homes or in the community. JBl
confirmed that this was the first stage of patient pathway redesign in the hospital
and the next stage would look at community services as part of the Resilience
Plan. JGi asked what steps would be taken to measure the outcomes. JBl
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explained that there were key performance indicators in place to measure
performance which would be monitored and reported back to the Board, The
Board noted the Resilience Plan.
Action
Report to the Board on Resilience Plan performance against KPIs.
GOVERNANCE
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Minutes of the Meeting of the Audit Committee Held on 20th May and 15th July
2015
SC presented the minutes of a meeting of the Audit Committee which took place
on . SC advised that the minutes recorded discussions largely around the Annual
Report and Accounts.
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Report of the Audit Committee meeting held on 16th September 2015
SC talked through a verbal report of discussions which took place at the meeting
of the Audit Committee on 17th September 2015. SC recounted discussions on
how the Trust could progress issues raised at previous meetings, in particular, how
Internal Auditors would carry out a stocktake on recommendations. SC advised
that a report on a deep dive in relation to the Information Commissioner’s audit
and report was considered and the Internal Auditors briefing report on cyber
security was also discussed. The Committee considered issues on the outcome of
the off-payroll review and how the Trust monitored these transactions. The
Committee discussed in detail and, also agreed, the Audit Committee’s annual
report.
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Corporate Risk Register and Board Assurance Framework
HA talked through the Corporate Risk Register dated 22 September 2015,
advising it was a snapshot of the Trusts corporate risks taken on one day but the
document itself was a dynamic document subject to change and amendment by
risk owners. HA advised that there were 27 risks noted on the corporate risk
register of which 13 were overdue for review. HA talked through the methods
employed to capture and report risks noting that there were a number of risks to
review and a number still in a ‘holding area’ awaiting review. Risks requiring
validation, still needed to be considered but queried whether those risks should be
reported to Board.
HA reminded members that it was agreed at the last Board meeting that overdue
risks be reduced by 20% by November and to date a reduction of 4% has been
achieved. The Governance team would therefore work closely with directorates,
and rekindle discussions with lead directors to achieve the agreed target. HA
confirmed that the risk relating to Core Skills training was escalated, noting the risk
to the reputation of the Trust.
PERFORMANCE
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Finance & Performance Committee minutes of the meeting held on 7th July
2015 and 12th August 2015
LCr presented the minutes of the meetings of the Finance & Performance
Committee dated 7th July 2015 and 12th August 2015. LCr advised that the
meeting in August was an extra meeting as it was agreed that the gap between the
meeting in July and September was too long to keep on top of the Trust’s financial
position and performance.
Board Minutes Part One 7 October 2015
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Report of the Finance & Performance Committee meeting held on 29th
September 2015
LCr talked through a verbal update of the meeting of the Finance & Performance
Committee which took place on 29th September noting that a full and detailed
discussion took place on the Trust’s financial position. LCr informed the Board
that Non-Executive Directors voiced their challenge with regard to the
implementation of financial controls and operational measures to meet the Trust’s
revised financial targets together with the discussion on the proposed Agency
Nurse Staffing Cap by the TDA designed to cap spending on agency nurses
nationally. The Committee discussed the shortfall in QIPP targets and the issues
around non-compliance of Core Skills Training and PDRs. LCr noted the
discussions on the Emergency Department decant and Operational Resilience.
JG updated the Board on the meeting of the Financial Recovery Board which
followed the Finance & Performance Committee on 29th September 2015. JG
advised that the meeting agreed a number of actions to enable QIPP to meet its
£10.5m target and discussed the actions that still remained to achieve a stretch
from £10.5m to £12.5m. JG confirmed the development of key actions to manage
pay spend, such as specialing which could involve a radical change whereby
carers could come into hospital rather than paying for specialing. Other initiatives
were discussed, in particular an embargo on administrative and clerical staff. JG
confirmed that a revised plan would be sent out to the Board the following week for
consideration. LCr noted the change in date for the next Finance & Performance
Committee on 27th October 2015.
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Finance Report Month 5
AM talked through the Month 5 Finance report noting that it was discussed at the
Finance & Performance Committee on 29th September 2015. AM advised that the
Trust had realised a year to date adverse variance of £2m against a planned
deficit of £14.8m. Income had over-performed by £0.7m with the main driver for
the overspend being pay. However this would be positively impacted with the
implementation of stricter controls. AM confirmed that a revised financial plan has
been submitted to the TDA and a response was still awaited. AM informed
members that the pay overspend was driven by temporary staffing and overestablishment and in particular agency nurse spending used to pay for specialing
on resilience wards which were open longer than expected. A large element of the
over-establishment was limited to specialling. In relation to QIPP schemes, AM
advised on the slippage but advised that there were plans in place to address this.
SC asked for further detail on the precise nature of cash releasing reserves. AM
confirmed that it was a budgetary reserve. MBe extended an invitation to all of the
Non-Executive Directors to attend the next Finance & Performance Committee on
27th October 2015 to seek assurance around the revised financial plans.
The Board noted the Month 5 Finance Report.
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Performance Report Month 4
LCh summarised the Month 4 Trust Performance Report confirming that this report
was considered at the recent Finance & Performance Committee. LCh highlighted
key areas of the report noting:
 The Trust performed well across 4 of the 5 domains
 The A&E 4 hour waiting times were met in the month of July
 The Trust exceeded the Referral to Treatment (RTT) targets
 Cancer waiting times have met targets in seven out of eight Cancer Waits
Standards
Areas requiring improvement included:
Board Minutes Part One 7 October 2015
Page 10 of 11


Friends and Family Test response rates in A&E and outpatients;
Core Skills training compliance.
MBu observed that staff needed to implement urgent action around their Core
Skills training, which has negatively impacted on the overall rating received from
the Care Quality Commission. The Board noted the report.
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Business Planning.
It was agreed that the paper on the Progress against 2015/16 Business Plan was
deferred to the next meeting of the Trust Board in Public.
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Board Forward Plan
The Board received and noted the Board Forward Plan. MBe requested that all
Committee annual reports should be made available for consideration by the
Board at the meeting scheduled to take place on 9 December 2015. Chairs should
liaise directly with the Director of Quality Assurance and Governance with regard
to the format of the report.
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Any Other Business
None
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Date and Time of Next Meeting
Wednesday, 9th December 2015 at 9.30am.
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Questions from the Public
Graham Cross a service user conveyed his thanks to Jayne Black for the
notification of the re-opening of the hydro pool which is now up and running. JBl
confirmed that a formal opening ceremony was yet to take place.
Mr Cross also thanked staff in A&E for care received by his son who attended in
August stating that service was very good.
Mr Cross also queried whether new signage indicating the new entrance for the
A&E department would be erected, JBl confirmed that there would be new signs
all over the hospital and additional parking for patients would be made available in
the staff car park in Woodcroft Road.
There being no further questions from the Public the Chairman brought the
meeting to a close.
15/233
Resolution: Under the terms of the Public Bodies Act the Board resolved to
exclude the public from the remainder of this meeting by reason of the
confidential nature of the business to be transacted.
_____________________________
Michael Bell, Chairman
Board Minutes Part One 7 October 2015
Date____________________
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