The Princess Alexandra Hospital NHS Trust
Minutes of the Public Trust Board Meeting (Part A)
Held on Thursday 26th November 2009 in the Boardroom, PAH
PART A
Present:
Mr Gerald Coteman
Mr Chris Matthews
Dr Sylvia Thompson
Mr John Wright
Mr Alan Dean
Mr Tim Escudier
Mrs Janet Dalrymple
Mr Chris Pocklington
Mrs Yvonne Blucher
Mr Alan Farmer
Mr Gordon Flack
Mr Darren Leech
Mr James Day
Dr David Pencheon
Sara Howlett
Apologies
Sandra Dimmock
Medical Director
In Attendance
Mr Colin Green
(CG)
One member of the public
attended.
Associate Director - Estates
Mr Charles Jackson
26/11/01
(GC)
(CM)
(ST)
(JW)
(AD)
(TE)
(JD)
(CP)
(YB)
(AF)
(GF)
(DL)
(JWD)
(DP)
Chairman
Non Executive Director
Non Executive Director
Non Executive Director
Non Executive Director
Non Executive Director
Non Executive Director
Chief Executive
Executive Director Nursing/Patient Care
Executive Director of Workforce
Executive Director of Finance
Executive Director of Delivery
Trust Secretary
NHS Sustainable Development Unit
Assistant Provider Development Manager
NHS East of England
HEALTH AND SAFETY BRIEFING
The Secretary outlined required action in the event of a fire.
26/11/02
APOLOGIES FOR ABSENCE
Apologies were received from Dr Sandra Dimmock
26/11/03
CHANGES AND ADDITIONS TO INTERESTS DECLARED
There were no changes to declarations made.
26/11/04
THE NHS IN A LOW CARBON WORLD – OPPORTUNITIES FOR THE NHS
TO LEAD: ROLES OF BOARDS
GC handed Chairmanship of this section of the meeting to AD.
AD welcomed Dr David Pencheon of the NHS Sustainable Development Unit.
DP indicated that there were advantages for NHS organisations in terms of
business organisation regulation and reputation in addressing sustainability
issues. Staff commitment was enhanced as it was recognised as the right thing
to do.
PAH had done a number of very worthwhile carbon saving activities and the
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Trust was regarded as being on the front foot.
There were benefits about appearing favourably in public league tables in
addition to the obvious benefits of avoiding further harm to the environment.
There was a clear financial business case for energy conscious sustainable
initiatives, not least because the saving in energy costs, the retention of the
workforce and hopefully the quality of healthcare delivered by the increased
efficiencies.
What was required was for Boards to be visionary and to look outside the day
job to act as leaders for tomorrow. The NHS was good at dealing with
immediate crises but less good at forward planning.
DP asked if there were any questions coming from the previously circulated
sustainability pamphlet. JWD, in acknowledging his support for sustainable
initiatives and carbon saving sought details of the science that had
acknowledged a 2 degree warming to be a tipping point. DP provided a number
of examples that would show how warming would accelerate once melting had
increased, and in particular the release of methane from arctic perma frost and
the reduction in the area of reflective ice which usually served to radiate heat
away from the earth. DP indicated that the evidence for warming occurring was
greater than the evidence often available prior to some form of medical
intervention. In response to AD, DP outlined the level of waste within the health
service in relation to the production, transport and waste of medicines.
Achieving value for money would save carbon. This confirmed the need to do all
things well and to consider how they could be made better.
Energy procurement and saving provided opportunities to be seen to be leading
the public. It was easy to make relatively small changes which gave good
messages such as the use of LED lights instead of fluorescent tubing. In each
case there was a calculation to be made relating to internal investment but there
were savings to be made in a number of ways. This included pooled
procurement to avoid reduced transport costs.
DP outlined the carbon trading scheme which highlighted the need to be energy
efficient because of the cost of buying carbon production permits.
One of the advantages the Trust could take was micro metering of energy
usage. On both a private and public basis it was interesting and fun to monitor
energy usage and could lead to healthy competition.
It was important to recognise that Monitor now place great store on sustainable
development and carbon saving.
DP indicated that there were opportunities within the health service that had
been embraced by other organisations which could save carbon and improve
the quality of working life. One such option was greater use of teleconferencing
that could allow people to travel at off peak times and thus improve their
life/work balance.
Another option was to not allow car parking other than for electric or hybrid
vehicles. This had been introduced in a hospital in Ghent. It was recognised
that media relations would need to be handled carefully but it was interesting to
know that most unions and some of the local press were critical of schemes not
being ambitious enough.
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CP indicated that it was important for the Trust to articulate how such a radical
proposal in Harlow would fit with the needs and perceptions of patients. It was
accepted that searching for parking space did little to add to a positive patient
experience. CP also indicated that the Trust probably had not embedded
sustainable and carbon initiatives in the Trust as well as it might.
DP indicated that there were US initiatives including nurse led triage and
support networks for sufferers that considerably reduced outpatient demand and
therefore outpatient journeys. Relatively small changes that could increase the
use of Primary Care would be beneficial and this could include the use of tele
medicine which had the prospect of being popular with patients. There were,
however cultural issues to overcome with GPs.
CG outlined to the Board his engagement with the local Harlow energy saving
group which was set to increase.
The Trust had also been successful in being nominated for various energy
saving awards.
DP indicated that there was benefit in subscribing to a policy of good corporate
citizenship and websites existed to encourage this.
The Trust was already on the front foot with regard to sustainability and micro
metering would further improve this.
To be successful there need to be good Board appreciation of the issues, the
Trust needed to subscribe to good corporate citizenship, there is a need to
monitor and report the creation of carbon and there was a need to raise
awareness with staff and throughout the organisation.
AD thanked DP for attending.
DP provided a number of slides to assist the Board and these will be forwarded
by separate e mail.
26/11/05
APPROVAL OF THE MINUTES OF PART A OF THE BOARD MEETING OF
THE 29TH OCTOBER 2009-12-02
These were approved with amendments.
26/11/06
ACTION POINTS ARISING FROM PAST MEETINGS
JWD went through the action points. It was noted that Workforce and
Governance matters were subject to Board review and it was important that
these were not lost.
AF indicated that following on from the APPLE presentation at the last Board
meeting all the projects had NED sponsors.
26/11/07
CEO REPORT
The Trust faced a significant challenge as a result of the Board to Board follow
up meeting on the 24th November. There was a £6.6million gap between what
the Trust was expecting to be paid by the PCT in relation to the work the PCT
was through putting when compared to what the PCT was intending to pay. This
was despite there being the same basic model agreed by both Trusts.
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Without this basic agreement the Trust’s Recovery Plan was regarded as
lacking at a basic level.
It was necessary to agree with the PCT basic volumes and this would be a
mechanical process based on the agreed models. Outpatient activity was
increasing but it was fortunate that there was agreement that the respective
CEOs needed to agree the way forward and that meetings were proposed in the
near future.
Sir Neil McKay had agreed there would be an SHA role in the event of there
being any difficulties as it was important that the SHA, Department of Health and
Monitor were in alignment.
The SHA had also articulated a request for improved information flows and turn
around of requests. It was noted, however, that the Trust had not defaulted.
The way forward was to agree a subsequent date with the SHA where sign off
was still the intention. The Trust did still occupy favourable territory provided
there was better alignment with Commissioners.
JW asked if the outcome was surprising. CP indicated that this was unexpected
in that the PCT had not indicated any difficulty with the model or payment until
the Friday beforehand.
JD indicated that it remained important for the Trust to keep in contact with the
PCT. TE indicated that this backward move by the PCT might possibly have
been as a result of there being a new CEO and the need to re-establish the
previously close relationship. CP agreed with JD. He was equally concerned
that the size of the gap put local people in an invidious position. CP considered
it was his role to develop a progressive and sensible relationship with the PCT
and to do his utmost to manage this, particularly to flush out material difficulties
such as this funding surprise.
DL indicated that it was important that the Hertfordshire and West Essex PCT’s
had the same coordinated approach to commissioning particularly to avoid the
reputational damage of not providing the treatment people have been expecting
to receive.
CP indicated that the financial difficulties in the Hertfordshire PCT compared
with West Essex were less and that there was a higher recognition by the
Hertfordshire PCT of the work through put and the need to pay the hospital.
TE indicated that this was all health service money being pushed around but
there needed to be evidence of volume from which to base the numbers. It
might be necessary to compromise on the year end surplus. CP indicated that
there needed to be a stepped strategy with agreement by the host PCT of the
relevant model.
GC indicated that there had been a pledge to work with the PCT on immediate
and long term issues. However, the relationship was hindered by the absence of
some contractual control and this would not be resolved in this year. What was
required was an Action Plan as to when various action would take place and the
resource and capacity to deliver. It was important to manage perceptions and
nuances for the moment. CM indicated that agreeing to a date was key. CP
stressed the arbitration role the SHA might need to carry out.
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Otherwise the financial recovery for the Trust was proceeding in good order.
The QIPP initiative has been progressed with the Chair and Chief Executive
meeting and DL now had good contact with Kirsty Boetcher at the PCT to drive
efficiency and free beds operationally. The Trust was busy with patients having
a high acuity.
The A & E and year to date 18 week targets were under significant risk. It was
appropriate to thank YB and her Emergency team for managing the many
pressures. It was still important to maintain the right capacity at the right time.
26/11/08
SWINE FLU
YB indicated that the Surge Plan was in place. 800 staff have been vaccinated
and staff sickness had reduced.
GC indicated his support for thanks to YB and her team. He recognised the
pressure on front line staff.
26/11/09
FINANCIAL UPDATE AND DASHBOARD SUMMARY
GF spoke briefly to the Dashboard Summary. There had been an over
achievement of the recovery scheme as a result of expenditure reduction and an
increase in Elective work. Temporary and agency staff were now being used at
lower levels.
In relation to the SHA and PCT it was important that the Trust’s planning was
entirely based on actual and predictive activity rather than theory. The Trust was
now meeting it’s recovery target.
Infection Control remained admirably low, access targets were being met and
the Trust had made progress to bring PRDP levels over 51% therefore allowing
the Trust to be able to declare future compliance. This had the effect of reducing
the Governance Risk Ratio to 0.9 (green).
It was important however to recognise that there remained pressure on the
Trust particularly in regard to cancellations and DNA wastage.
AF indicated there had been an improvement in Statutory and Mandatory uptake
within Induction uptake exceeding the Trust’s minimum compliance level.
Refresher training had not yet met its target and was under pressure from
increased workload expectation. There was nevertheless the opportunity to
capitalise on e learning (NELMS).
JD indicated that in the Governance Committee it had been discovered that the
Head of Security was planning to deliver all conflict resolution and breakaway
training, but at a simple statistical level this was bound to fail given the amount
of time available and the number of staff requiring training.
It was agreed that a pragmatic approach to providing adequate training was
required. CP indicated that in so doing there maybe legitimate professional
sensibilities as to the necessary level of training required JD indicated she
appreciated that such training as resuscitation and breakaway required a
physical presence and so this was limiting.
AD indicated that his experience was that if trainers were trained there could be
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a cascade which was adequate.
TE indicated that it was important that a transformational frame of mind be
adopted. The Trust needed to stop being busy being busy. A peaceful period
was required to help move the Trust forward. CP indicated that the NHS was
good at managing crises and making water flow up hill.
26/11/10
APPROVAL OF SHA RETURN
JWD spoke to the SHA return which was approved.
26/11/11
DECLARATION OF SAME SEX ACCOMMODATION COMPLIANCE
YB indicated that the SHA required the PCT to provide assurance that
commissioned hospitals were meeting the expectations of providing Same Sex
Accommodation. In turn the PCT had asked the Trust to make a Declaration of
Compliance.
The Trust could make this Declaration and had been complimented recently by
the PCT and SHA in a high level inspection.
Guidance had been updated. There was some expectation that there would be
an NED Champion but the Board considered the provision of Same Sex
Accommodation to be a whole Board responsibility. Areas where more work was
desirable included Radiology and ADSU but these were compliant if guidance
was followed.
Declaration of Compliance was approved. Congratulation was extended to YB
and Colin Green in relation to achievement of the standard, the physical
environment allowing this to take place and the cultural change that had taken
place. The Trust was enjoying good feedback in this area. JWD confirmed that
the PCT would be informed and that this would be placed on the Website.
It was agreed that this would be reviewed in the Governance Committee bimonthly it would be escalated to the Board if non compliance developed.
26/11/12
DECLARATION OF SAFEGUARDING CHILDREN COMPLIANCE
YB indicated that the Department of Health had required a Declaration of
Compliance to be placed upon the Trust’s website. To support a Board decision
a schedule of Evidence of Action was provided showing how the Safeguarding
of Children process and training had taken place to meet the assurance
requirement.
It was confirmed that the Trust aspired to a Gold Standard of Child Protection
which would also extend to Vulnerable Adults and that best practice would be
adopted. The Board again confirmed that the Declaration could be made. JWD
indicated that the tabled evidence of Compliance would form the basis of the
Website Declaration.
JD indicated that her work outside the Trust involved Safeguarding Children and
Vulnerable Adults and that she would be available to assist the Trust if required.
GF asked how recruiting foreign nurses who had not yet undergone CRB
checks would be handled. It was confirmed that such nurses would only work
under supervision until such time as their CRB checks had been completed.
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The Assurance Matrix is attached to and forms part of these minutes.
26/11/13
INFORMATION
The Chair’s report on Activity was noted as was the Board Record of
Attendance.
Mr. Charles Jackson raised a question about workforce levels and vacancies
and AF was able to confirm that the vacancy levels were coming down as a
result of a month on month drive to recruit to available posts.
26/11/14
RETIREMENT OF MR ALAN DEAN
GC indicated that this was the last Board meeting of AD who had served the
Trust as a Non Executive Director over the past 7 years. It was with thanks and
gratitude that AD’s contribution was noted. AD was presented with some gifts in
recognition of his service.
AD thanked the Board members for their kindness and indicated that over the
past 7 years a large number of things that needed to be improved had been
improved The challenge had been met and progress had been made. People
had been able to work together to improve the service for patients. Whilst it was
frustrating that the Trust had not yet achieved FT status it was possible to
identify so many things that had changed for the better. The Trust would go on
to become more impressive because a team was in place that enabled delivery.
AD indicated his sadness at leaving just as the Sustainability Agenda was
beginning to take off but he remained hopeful that a new champion would
emerge and that all the initiatives would be maintained.
26/11/15
CLOSURE OF PART A
EXCULSION OF THE PUBLIC
The Board resolved that representatives of the media and other members of the
public should be excluded from the rest of the meeting having regard to the
confidential nature of the business to be transacted, publicity on which would be
prejudicial to the public interest: Section 1(2) Public Bodies (Admission to
Meetings Act) 1960.
26/11/16
DATE & TIME OF NEXT MEETING
Tuesday 22nd December
1.30 p.m.
Board Room, PAH
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Safeguarding Children and the Care Quality Commissioning Review:
Princess Alexandra Hospital (PAH) NHS Trust Compliance Declaration.
In July 2009 the Care Quality Commission (CQC) published a report on their review of
arrangements in the NHS for safeguarding children. In line with this PAH NHS Trust has
considered its own processes, procedures and policies with regards to safeguarding children
and has worked with its partners to respond to initiatives and reviews at both national and
local levels.
This declaration will be a key part of the Care Quality Commission Registration from April
2010.
The following table, outlines the current position for PAH NHS Trust November 2009
Assurance Requirement
PAH NHS Trust meets its
statutory
requirements in relation to
Criminal
Bureau checks on
relevant employees
Child Protection policies
and systems
are up to date and robust
A process is in place for
following up
children who miss
outpatient
appointments.
.
An alert system is in place
to flag up children for
whom there are
safeguarding concerns
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Compliance
Yes
Yes
Yes
Yes
Additional Information
From 2009 the Independent
Safeguarding Authority (ISA) is
responsible for the Vetting and Barring
scheme of all employees and volunteers
who work with children and vulnerable
adults. PAH NHS Trust has identified
key actions to ensure it meets the ISA’s
registration requirements.
PAH NHS Trust has robust Child
Protection policies and systems in place.
These will be reviewed annually to
ensure that they reflect current Local and
National guidance.
The policy is available to all staff through
the Trust Intranet and hardcopies in key
clinical areas.
Staff also have access to the Southend,
Essex and Thurrock Child Protection
Handbook 2006.
The Access Policy for the Trust
addresses this topic. Staff at PAH NHS
Trust have access to the West Essex
Child Protection guidance documents.
A review of the process is being
undertaken to further improve
information sharing across the health
economy
PAH NHS Trust has clear systems to
identify children where there are
safeguarding concerns, including a
flagging system on the computer system
for children who attend A+E and
are subject to child protection plan.
A paediatric registrar and consultant are
available for advice 24/7.
External systems are available 24/7 via
Essex County Council to ascertain if a
child is subject to a child protection plan
or known to Children Services.
The Trust’s Safeguarding Children and
Young People policy, identify the action
8
needed to be taken by clinicians.
All staff working in health
care settings
(clinical and non-clinical)
have
undertaken level 1
safeguarding
training. This is the level
of training set
out in Safeguarding
Children and Young
People: Roles and
Competencies for
Heath Care Staff
Named professionals are
clear about their roles and
have sufficient time and
support to undertake
them.
Yes
Yes
All staff, clinical and non clinical,
receive safeguarding training as
part of their induction. Further steps
have been taken to ensure all Trust staff
receive further update on safeguarding
information at Level 1 by Dec 2009.
The training strategy is being reviewed
to ensure that the Trust will be compliant
with emerging training requirements and
an action plan has been set in place to
incorporate those new requirements as
they arise.
Named Professionals are in post with
clear job descriptions and service
agreements to define their role and
responsibilities. There will be a regular
review of these roles and
responsibilities. The Designated Nurse is
the our nominated member on the Essex
Safeguarding Children’s Board subgroups.
Board level Executive
Director Lead for
safeguarding has been
identified.
Yes
The Executive Director for Nursing and
Patient Care is the safeguarding lead for
the Trust. Quarterly Safeguarding
reports are produced for Clinical
Governance and are shared with the
Board. Safeguarding children has been
incorporated into the audit programme
for the year.
The Board is assured that
robust audits
are in place to ensure
safeguarding
systems and processes
are functioning
effectively.
Yes
Following the CQC review a
comprehensive audit programme for
2010/11 has been produced to monitor
safeguarding activities within the Trust.
PAH NHS Trust will partake in a Section
11 Audit in line with statutory
requirements
(Children Act 2004) July 2010.
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