GLOUCESTERSHIRE HOSPITALS NHS FOUNDATION TRUST
NOTES OF THE ANNUAL MEMBERS’ MEETING
HELD IN THE LECTURE HALL, REDWOOD EDUCATION CENTRE,
GLOUCESTERSHIRE ROYAL HOSPITAL, GLOUCESTER
ON THURSDAY 24 SEPTEMBER 2009
PRESENT
DIRECTORS
GOVERNORS
Dame Janet Trotter
Mr John Henry
Dr Frank Harsent
Mr Graham Lloyd
-
Dr Sally Pearson
Dr Sean Elyan
Mr Dave Smith
-
Mrs Maggie Arnold
Mrs Maria Bond
-
Michael Gordon-Smith Prof Michael Orme
Sr E-M Pantekoek
Ms Paula Tambling
Ms Fannie Storr
Ms Jean Cox
Mrs Shân South
-
Chair
Senior Non-Executive Director
Chief Executive
Director of Corporate Governance &
Facilities and Trust Secretary
Director of Clinical Strategy
Medical Director
Director of Human Resources and
Organisational Development
Nursing Director
Non-Executive Director
Public, Out of County/Patient
Public, Cotswolds/Deputy Chair of
Governors
Public, Forest of Dean
Staff, Non-Clinical
Public, Gloucester
Public, Stroud
Staff, Nursing & Midwifery
MEMBERS
19 Public Members and 1 Staff Member
IN ATTENDANCE
Mr Andrew Collis
Mrs Gill Brook
Mrs Katherine Holland -
Assistant Trust Secretary
Head of Patient Experience
Patient an Public Involvement Officer
APOLOGIES
Mr Museji Takolia
Mr Michael Evans
Mr Wallace Dobbin
Mr Gordon Mitchell
Mr Graham Bennett
Ms Evelyn Barker
-
Miss Nicola Turner
Mr Geoff Fox
Dr Colin Roch-Berry
Cllr Klara Sudbury
Mr David Miller
Mrs M Clayton-Ives
Mr David Drew
Miss Rita Holmes
Mrs Jan Stroud
Mr Nick Adams
Mrs Barbara Marshall
Mr Paul Edwards
Miss Jill Crook
Dr Steve Cooke
Ms Judi Brown
Mr Stuart Baker
23 Members
-
Non-Executive Director
Non-Executive Director
Non-Executive Director
Non-Executive Director
Interim Finance Director
Deputy Chief Executive and Director of
Service Delivery
Staff, AHPs
Public, Cheltenham
Public, Tewkesbury
Appointed, Local Authority
Public, Cheltenham
Public, Cotswold
Public, Stroud
Public, Tewkesbury
Staff, Nursing & Midwifery
Staff, Non-Clinical
Appointed, LINks
Appointed, Hereford PCT
Appointed, PCT
Staff, Medical and Dental
Public, Gloucester
Public, Forest of Dean
Notes of the Annual Meeting
24 September 2009
Page 1 of 7
1.
WELCOME
The Chair welcomed everyone to the meeting and explained that the Annual
Meetings provided an opportunity for the Trust to be held accountable to the public
for its performance over the last year and to give members a platform for asking
questions of the Trust.
The Chair explained that there would be a number of presentations on Trust
progress over the past year followed by an opportunity at the end of the meeting
to ask more general questions that might not be addressed by the presentations.
She then introduced the Chief Executive and invited him to present a review of the
year.
2.
ANNUAL REPORT AND FINAL ACCOUNTS
The Chief Executive presented his report on 2008/09, highlighting in particular the
Trust's three major strands of work:
− Saftey:
•
Infection Control
− MRSA - He explained that the Trust was not measuring
community acquired MRSA and its aim was to have no
cases. In 2007/2008 there had been between 30-40 cases
but only 8 cases from April 2008 to March 2009
− Clostridium Difficile: the Trust had reduced the level of
hospital C diff dramatically
•
MRSA Screening: Screening had been introduced for all admissions
•
Venous Thromboembolism (VTE): The Trust was implementing a
programme to ensure all patients were assessed as set out in
government targets and best practice
•
Global Trigger Tool Screening: The tool was a device to identify
issues that required attention. The Trust had selected 20 sets of
notes at random per month to investigate
•
Director of Safety: Employed to take forward the safety agenda
across the Trust
•
Executive Director Safety Walkabouts: These planned visits to talk
about safety issues in specific areas had identified areas for
improvement and follow up work
•
Quality Committee: The role of this new Committee was to seek
assurance about the quality of care across a range of issues on
behalf of the Board
− Patient Experience:
•
Patient Survey System: The hand-held survey devices had been
used throughout the last year by volunteers to input data that was
then fed back to the wards to improve the patient experience
•
Head of Patient Experience: The Head of Patient Experience was
working on a range of programmes to improve the patient
experience
•
Patient Stories: The Board had heard a carer's story about how it
had failed to provide a quality service for the patient: it was important
for the Trust to learn from such incidences. This practice would be
continued
•
Working with Carers: The Head of Patient Experience was
progressing this important work with carers and related
organisations
− Continuous Improvement:
•
Rapid Improvement Events: Groups of between 25-30 staff across
grades had been given the opportunity to redesign processes and
systems within:
Notes of the Annual Meeting
25 September 2009
Page 2 of 7
−
−
−
−
−
−
−
Gynaecology
Out-patient
Chemotherapy:
Where
teams
were
implementing new processes designed by staff
De-cluttering The Hospital: Where £40K of stock was
returned to stores from wards as a result of over stocking
Histopathology
−
•
Utopia
Achievements:
•
Clostridium Difficile Rate Reduced by 33%: This was significant and
due primarily to impressive staff effort
•
MRSA: Reduced to 8 with a best run of 172 days without a case
•
Increased Activity:
− 4.3% in GP Referrals
− 9.5% in Emergency Admissions
•
Referral to Treatment Waiting Time Target Met
•
Diagnostic Waiting Times Reduced
External Views:
•
In-Patient Survey: An independent body had reviewed A&E in-year
and the Trust had appeared in the top 20% of Trusts
•
Unannounced Healthcare Commission Inspection on Hygiene
Code: The Trust was found to be fully compliant
•
Care Quality Commission: The Trust had achieved unconditional
registration
•
Catering Team of the Year: A prestigious national award had been
received for the quality of the Trust's food
•
Medical Innovation Futures Awards: Both Dr Rob Johnston and
Prof Andy McNaught had received national recognition for an
electronic patient record system and a non-invasive light system
respectively
•
Healthcare 100: The Trust had appeared in the top 100 nationally
for support of staff
Developments:
• Wireless network: Clinical information was now available at the bed
side via laptops and a newly installed network
• ICU at GRH: Open (£2.9M)
• St Luke’s Phase II at CGH: Open (£16M): The Trust has now two of
the best intensive care facilities in the country
• Oncology Centre/Endoscopy at CGH: Handed over in September
2009 (£7.6M)
• Pathology: Work on both sites had been completed (£3.5M)
• Out-Patients/Office Block at GRH: Open (£3.9M)
• Women’s Centre at GRH: Construction Started (£29M)
the priorities for 2009/10:
•
UTOPIA
•
Programmes
− Patient Experience
− Safety
− Continuous Improvement: event in July focussing on
Discharge Planning
•
Pandemic Flu Planning: The next phase of flu was likely to affect a
major group of children as the older generation was likely to have a
degree of immunity. There would be a high demand for intensive
care and the Trust had developed plans to triple intensive care
facilities in the worst case scenario
•
Finance Plan: £25M savings target: work was progressing to
achieve the target
•
Capital Schemes: The next scheme to start would be the upgrade
of Hazelton Ward
Notes of the Annual Meeting
25 September 2009
Page 3 of 7
•
−
Satellite Radiotherapy: The Trust aimed to have a business case to
build a LINAC facility at Hereford in 2011
the Income and Expenditure and the Annual Accounts: He explained
that the previous year's £8M surplus was due primarily to monies received
following the floods and that the overspend for 2008/09 was disappointing
but a minor part of the overall income/expenditure.
The Chief Executive thanked Members for their attention and invited questions.
3.
QUESTIONS ON THE CHIEF EXECUTIVE’S REPORT
There were no questions for the Chief Executive.
4.
SINGLE-SEX ACCOMMODATION
The Nursing Director presented a review of progress on Single-Sex
Accommodation and highlighted:
− The need to understand the definition of single-sex wards and described
each of the terms accordingly:
• Single sex wards: where the whole ward was occupied by men or
women only
• Single rooms: with adjacent single sex toilets
• Mixed wards: where men and women were in separate bays or
rooms. Men and women should also have access to separate toilet
and washing facilities, ideally within the ward bay or room.
− The importance of privacy & dignity and noted that the Health Secretary had
made a statement in January 2009 that ‘men and women should not share
sleeping accommodation’ and that the South West Strategic Health Authority
(SHA) had made a commitment 'to eradicate mixed sex accommodation by
30 June 2009’
The Nursing Director described the Trust's implementation plan to achieve
single-sex accommodation and highlighted improvements made to date. These
included:
− Single-sex shower rooms and wet rooms
− Dignity and privacy curtains
− Monitoring of compliance against the policy with audits completed by the bed
management team for assurance to the Trust Management Team
The Nursing Director then described the successful SHA review of the Trust's
implementation of single-sex accommodation and the challenges of sustaining
same-sex accommodation with an aging estate.
The Chair invited questions from the members.
5.
QUESTIONS ON SINGLE-SEX ACCOMMODATION
i.
Mr Senneck noted that one of the photographs in the Nursing Director's
presentation showed toilet facilities with moveable locking bars for disabled
access: he reported that he was aware that the insufficient strength of these
bars had been brought to the attention of the Trust more than one year
previously and that the original problem still existed.
The Trust Secretary explained that a number of issues had been raised and
changes proposed and that the majority of these had been implemented
during the redesign work in the disabled toilet facilities. Included among
these was the adjustment in the heights of mirrors and the replacement of all
waste bins with DDA compliant items. He reported that the toilet facilities
had handrail bars as well as upright locking bars.
Notes of the Annual Meeting
25 September 2009
Page 4 of 7
ii.
Mr Senneck explained that his concern was for the safety of the person
using the toilet and reported that the upright locking bars did not provide the
right level of support.
Sr Elly-Maria Pantekoek, Forest of Dean Constituency public governor and a
disabled facility service user, agreed that the bars wobbled in use but stated
that she found them to be a perfect solution because the bar could be
moved out of the way. The Chair noted that it was difficult to accommodate
every type of disability adequately and that even though the facilities were
already DDA compliant the Trust would revisit this topic.
iii.
Mr Ebbutt noted that while the new dignity and privacy curtains reduced the
opportunity for patients to be overseen a recent PCT survey had revealed
that a key issue for patients was privacy in the sense of being overheard
during conversation. The Nursing Director agreed and explained that where
practicable patients would be moved to a separate room for particularly
sensitive conversations with staff and or family/carers.
iv.
Mrs Howe congratulated management and staff on how quickly single-sex
accommodation compliance was achieved.
The Chair thanked Mrs Howe for her kind comments and acknowledged that
staff had worked exceptionally hard to ensure compliance with the policy.
6.
DEVELOPMENTS IN EMERGENCY SERVICES
The Medical Director reported that there had been much publicised about project
UTOPIA in recent months and that Dr Harsent had mentioned previously of the
pressures the Trust faced with the volume of emergency admissions. He informed
members that:
− there were approximately 100,000 A&E attendances in one year
− there were approximately 50,000 admissions per year and that 85% of
hospital discharges had started as emergency admissions
− the discovery phase of the project had identified that the solution to
improving the process was for the right care, first time in the right place
− the approximate investment in the project was £5M and this would fund
infrastructure work and additional staff including consultants, administrators,
porters and nurses
− the project had been running for seven weeks and that while there had been
some teething problems there had also been some early realisation of
considerable benefits in terms of patient care
− senior decision makers were sending patients to the right place straight
away. The length of stay had been compressed and reduced in most cases
and surgeons had admitted to finding it easier to manage patients more
appropriately
− the challenge was to off-load patients from ambulances quickly enough
The Medical Director explained that the project was closely monitored by the Trust
Main Board and that the Board and the project team were keen on continuous
improvement and would refine the project as it progressed.
The Chair thanked the Medical Director for his presentation and invited questions
from the Members.
7.
QUESTIONS ON DEVELOPMENTS IN EMERGENCY SERVICES
i.
Mr Gladstone remarked that a pathologist friend had reported that
historically a percentage of death certificates were inaccurate and that a
project with the emphasis on the correct and timely diagnosis was the right
route to take.
Notes of the Annual Meeting
25 September 2009
Page 5 of 7
The Medical Director agreed that swift access to treatment was pivotal and
that the project had cut the lead time by enabling earlier access to a senior
decision maker. He explained that the Trust was ahead of many Trusts in
respect of death certification and was part of a Department of Health project
on the subject. He informed members that the Trust was an early adopter of
the McCarthy system that was likely to become the national system for
death certification and one aspect of this would be that the certificate would
not be not signed until a conversation had taken place between a senior
doctor and senior histopathologist.
ii.
Mr Jones reported that a friend had recently experienced the new front-end
system and had praised the Trust for the for speed of access to a senior
consultant and the subsequent fast-track operation.
He asked if
concentrating on the access point for emergency admissions meant a
change in the level of care further into the system.
The Medical Director explained that the number of beds might reduce even
further than it had recently. He described the virtuous circle and noted that
releasing specialists from general work back to their specialisations would
benefit the service and allow surgeons to concentrate on the surgical
emergencies: this was, however, dependent on recruitment.
8.
MEMBERSHIP STRATEGY
The Head of Patient Experience, Mrs Gill Brook, presented the Trust’s
Membership Strategy; in particular she explained that members helped to hold the
Trust to account and to help the Trust understand what needed improving. She
remarked that the patient experience was central to the ethos of the Foundation
Trust and informed the members of the membership statistics:
− Currently 11541 members
− End of year target is 14176
− 2653 members required to achieve target
− Recruitment target of 439 members per month
The Head of Patient Experience then introduced Professor Michael Orme, Deputy
Chair of the Governors, to talk to members about membership engagement.
Prof Orme stressed the importance of the link with members and explained that
the aim was for each governor to spend time talking to patients to find out what
areas they felt the Trust needed to improve and to sign up members:
− at outpatients at CGH and GRH
− at community events
− through an opt-out programme for staff leavers
− through an opt-out programme for volunteers
He described opportunities for engagement and involvement for members existed
through:
− Seminars & tours
− Project Groups
− Members Forum
− Surveys
Prof Orme described future work to improve the Foundation Trust Members
webpage and the means of membership contact.
The Chair thanked Mrs Brook and Professor Orme for their presentation and
invited questions from the Members.
Notes of the Annual Meeting
25 September 2009
Page 6 of 7
9.
QUESTIONS ON MEMBERSHIP STRATEGY
i.
Ms Cox, Stroud District Council Area public governor, remarked that
patients in outpatient clinics were in a vulnerable position and would
probably be sensitive about being approached with regard to Trust
membership.
The Chair noted that membership recruitment in outpatient clinics had been
found to be successful in other Trusts. She explained that that if it was
found that people felt under pressure the Trust would reconsider the matter.
ii.
Ms Cox asked how the Trust could help governors contact their members.
The Chair agreed that this was a challenging task and that communication
with members often seemed one-way with the hospital dominant in
contacting members. She explained that efforts must be put into developing
the relationship.
iii.
Mr Simpson asked what steps had been taken to ensure membership
recruitment from minority, ethnic and other groups. The Head of Patient
Experience reported that a joint event with NHS Gloucestershire was
planned for the Slovak community and that she was due to meet this week
with Chinese women's guild. She explained that further work was planned
to identify ways of reaching the blind and deaf communities.
iv.
Mr Ebbutt suggested that linking to coffee mornings held by other
organisations (e.g. Macmillan) was good way of recruiting.
The Head of Patient Experience noted Mr Ebbutt's suggestion and sais she
would consider this in future planning.
10.
QUESTIONS FROM THE FLOOR
i.
Mr Simpson asked if the second wave of pandemic flu would cause extra
pressure on the hospitals and if services might be rationed or curtailed.
The Chief Executive explained that the second wave of pandemic flu was
expected imminently and might last for an eight-week period. He explained
that should services be greatly impacted elective surgery would be the first
service to be cancelled. He noted that the Trust needed to wait for the
arrival of the second wave to assess its impact and remarked that it might be
able to continue with day surgery. He reported that the Trust had spent a
considerable amount of time and effort developing robust and flexible
contingency plans and these would be employed in response to the events
as they arose.
The Chair thanked everyone for attending and for caring about what happened in
their local hospitals. She stated that the Trust was passionate about providing the
best possible service and that it always welcomed members views.
The meeting closed at 7.50 p.m.
Notes of the Annual Meeting
25 September 2009
Page 7 of 7