Brighton and Sussex University Hospitals NHS Trust
Minutes of the Sixtieth Board Meeting
held on 2 October 2007
Present:
Glynn Jones, Chair
Non Executive Directors
Professor Jon Cohen
Julie Nerney
Simon Turpitt
Executive Directors
Duncan Selbie, Chief Executive
Matthew Fletcher, Medical Director
Alison Robertson, Chief Nurse
Chris Adcock, Acting Director of Finance
Amanda Philpott, Director of Strategy
Ali Mohammed, Director of Human Resources
Michael Wilson, Chief Operating Officer
Phil Thomas, Divisional Clinical Director, Elective/Turnaround
Des Holden, Divisional Clinical Director, Specialised Services
Ian Tait, Director of Facilities and Estates
In Attendance
Janet Cheesman, Associate Director Operations, Emergency
Kerry Dearson, Trust Board Manager
Mark Sargent, Staff Side Representative
Janice Kent, PPIF Representative
Apologies for Absence
Lynette Gwyn-Jones
Tim Crosbie
Michael Pitts
Lee Soden, Director of Capital Strategy and Turnaround
60/1
Minutes of the Meeting held on 4 September 2007
The Minutes of the Meeting held on 4 September 2007 were approved subject to the following
amendments (n bold):
a)
59/7 Fit for the Future
second paragraph - … she therefore proposed to present a fully worked-up option for
Princess Royal Hospital for consideration and/or endorsement by the Trust Board at its
November meeting.
Last paragraph The Trust Board noted the progress report and that it would discuss the
Trust’s formal response to the public consultation at its November meeting.
b)
59/8 Annual Health Check 20072008
second paragraph – Action plans had been produced ….. and would be monitored
through the Healthcare Standards Steering Group.
seventh paragraph – Amanda advised that … the Corporate Information Unit was
working with the Division …
c)
59/10 Complaints Quarterly Report
second paragraph – Response times …… compared to the Trust’s targets of …
60/2
Chair’s Opening Remarks
Glynn Jones welcomed everyone to the sixtieth meeting of the Brighton and Sussex University
Hospitals NHS Trust Board.
A warm welcome was extended to a number of new Trust Consultants who were attending the
Board Meeting as part of their Induction Programme; and to the Specialist Registrars who
were attending the Board Meeting as part of their management development.
He advised that since the last Board Meeting he had attended a number of Fit for the Future
public meetings; he and the Medical Director had met with David Nicholson (NHS Chief
Executive) and Professor Lord Darzi, Parliamentary Under Secretary of State for Health as
part of their review of NHS services; he had escorted Professor Sir Graham Catto and John
Wilderspin around the Royal Sussex County Hospital; he had attended a number of NHS
Confederation meetings; the Rockinghorse Appeal AGM; the Princess Royal Hospital League of
Friends 50th Anniversary; together with Duncan Selbie he had met with Kim Hodgson and John
Lewes, Chief Executive and Chair of East Sussex Hospitals NHS Trust and the Trust Board had
held a Board Seminar on Risk Management and Patient Safety and its Annual General Meeting.
Glynn concluded his remarks by advising that Lee Soden, Director of Capital Strategy and
Turnaround, would be leaving the Trust at the end of October to take up a new position with
Kent and Canterbury University. He stated that the Trust had been privileged to have had
one of the best if not the best Director of Facilities in the country working for it for so long
and he wanted to place on record the Trust’s sincere thanks to Lee for his hard work, total
professionalism, enthusiasm and commitment for so many years and to wish him well in his
new post.
60/3
Chief Executive’s Comments
Duncan Selbie advised that he would reserve his comments for the discussion on individual
agenda items.
60/4
Declaration of Interests
No interests were declared at this meeting.
60/5
Business Planning 2008/2009
Amanda Philpott presented a paper setting out an integrated process for developing the
Trust’s Corporate Objectives and Business Plan for 2008/2009. The paper also proposed a
timetable to complete this work for presentation to the Board at its February 2008 meeting.
She advised that the process had been drafted following discussion with Simon Turpitt and
Michael Pitts. The paper proposed two principal changes to the previous arrangements;
specifically a single process for identifying and prioritising/risk-rating the 2008/09 objectives,
including Turnaround, rather than a series of separate action plans; and a formal process of
2
‘granulating’ the corporate objectives into objectives for each Division/Directorate (and
thereafter to at least the level of ward/department manager) rather than
Divisional/Directorate plans which only cross-referenced the corporate objectives.
Simon Turpitt stated that there would be future market opportunities which were not in
current Trust plans and it was important that the business planning process was sufficiently
flexible to allow the Trust to develop these.
Duncan Selbie commented that whilst the paper set out the formal process, it had to be
communicated to staff in a more meaningful way so that they understood their part in the
process. It was also important to involve the Medical School so that over the next year a
single research, clinical and site strategy was developed which was wholly interdependent
with the Medical School.
The Chair indicated that the process would need to be kept under review bearing in mind the
demands of Monitor for Trusts considering Foundation Status.
The Trust Board approved the integrated process for developing the Trust’s Corporate
Objectives and Business Plan for 2008/2009.
Action: Amanda Philpott
60/6
Temporary Staffing Strategy
Ali Mohammed presented a strategy for the future management of temporary staffing. He
advised that in 2006/2007 the Trust spent £1.7 million on nursing agency workers which
represented nearly 25% of total spend on temporary nursing staffing. The Temporary Staffing
strategy aimed to eliminate all agency usage by 31 March 2008 through the implementation of
a number of initiatives including maximising use of the Trust Nurse Bank and greater control
over the demand for temporary nurse staffing. During 2008/2009 the same approach would
be adopted for other staff groups including Allied Health Professionals, Medical and Dental
staff and Administrative and Clerical staff.
Ali stated that the Strategy described a number of simple steps designed to drive down
agency spend. The first step was to relocate the Bank Office to the main hospital site so that
it was visible and accessible and operated on a seven days a week basis. There would also be
a major recruitment drive to significantly increase the numbers of bank nurses with improved
rates of pay and increased training. He added that temporary staffing should only be a short
term solution and used as a last resort and that ultimately it was incumbent on the Trust to
resolve its recruitment issues.
Jon Cohen expressed his concern regarding the proposed zero tolerance to agency staffing as
this could potentially present difficulties in circumstances when the appropriate staffing was
not available. Ali acknowledged that there was no easy answer hence the six month lead in
period to recruit onto the specialist bank staff. Matthew Fletcher added that the Trust was
currently largely reliant upon unknown temporary staff when it opened up additional beds
and that this created a clinical safety risk. Jon acknowledged this and added that he was
concerned to ensure that staff were provided with appropriate guidance and knew how to
deal with such situations.
3
In response to a query from Julie Nerney, Ali advised that the benchmark Trusts were chosen
as they were similar size Trusts. In response to a query from Simon Turpitt, Ali confirmed
that there would be no contractual issues in incentising nursing staff to migrate to the Trust
Bank.
Duncan Selbie concluded discussion by stating that the Strategy was designed to eliminate
agency spend within the Trust whilst improving the overall quality and numbers of flexible
labour and improve patient care.
The Trust Board endorsed the Temporary Staffing Strategy and the target of eliminating
nursing agency spend by 31 March 2008.
Action: Ali Mohammed
60/7
Privacy and Dignity
Alison Robertson presented a paper which outlined the local and national progress in relation
to privacy and dignity, scoped local performance within the Trust and identified priorities for
future work.
She advised that earlier in the year the Chief Nurse for England published a report into mixed
sex accommodation in the NHS. The report included a list of hospitals identified as needing
support from their Strategic Health Authority and the Trust had been one of those.
Information used to generate this list was based on the 2005 patient survey results and 2005
PEAT results. Alison commented that the Trust had recognised the importance of privacy and
dignity and regarded it as a fundamental part of the patient’s experience. The report she
presented to the Board outlined a wide variety of activities to address privacy and dignity in
the Trust. She advised that findings suggested that privacy and dignity was successfully
embedded in the Trust’s objectives and the Strategy for Nursing and Midwifery, and these
were supported by a number of projects and training programmes. She added that a Privacy
and Dignity Panel had been established, with patient representation, to monitor progress
within the Trust.
In response to a query from Mark Sargent regarding bed spacing, Ian Tait advised that all new
beds within the Trust would be compliant with current guidance and that monies which the
Trust had been granted as part of the Clostridium Difficile initiative would be used in part to
transfer beds out of the Barry Building where space was a particular issue. Duncan Selbie
added that the Trust’s long term strategy was to demolish the Barry Building within the Phase
III capital developments but until such time the Trust would continue to provide the best care
it could in such an environment. Janice Kent acknowledged the attention the Trust was
paying to privacy and dignity concerns and agreed to let Duncan know whether there were
any further improvements which the Trust could make.
Glynn Jones concluded discussion by stating that privacy and dignity was of great importance
to patients and their carers and that the Trust needed to ensure it maintained the right focus
and that it was everyone’s responsibility to ensure that patients were respected.
The Trust Board received and noted the paper on Privacy and Dignity within the Trust.
4
60/8
Patient and Public Involvement Annual Report 2006/2007
Alison Robertson presented the Patient and Public Involvement Annual report which set out
progress made and key achievements during the year, highlighted issues arising from the Trust
2006/2007 Patient and Public Involvement Strategy and presented forthcoming plans for
2007/2008.
She advised that the Department of Health had announced that Patient and Public
Involvement Forums would be abolished during the spring of 2008 and replaced with Local
Information Networks linked to local authorities although it would be the legal responsibility
of Primary Care Trusts to ensure that there was effective engagement at all levels of
healthcare provision. Tony Reynolds (PPIF representative) expressed his concern that the
Brighton and Hove Council had yet to establish such a forum; Glynn Jones advised that he and
Duncan Selbie would pick this up through their regular dialogue with the local authority.
The Trust Board received and noted the Patient and Public Involvement Annual Report
2006/2007.
60/9
Clinical Governance Strategy
Alison Robertson presented the Trust’s Clinical Governance Strategy and advised that the
Strategy had been updated to reflect the NHSLA requirements which had been happening in
practice but needed to be more detailed with regard to process and monitoring.
Julie Nerney queried whether the document could be distilled into a more user-friendly
format for dissemination around the Trust. Alison advised that she would look into this.
The Trust Board received and approved the Clinical Governance Strategy.
60/11 Clinical Governance Annual Report
Alison Robertson presented the Trust’s Clinical Governance Annual Report for 2006 – 2007.
The Report provided an overview of the main activities of the Clinical Governance team;
which comprised of Patient Safety, Risk Management, Complaints, Chaplaincy, Patients’
Advocacy and Liaison Service, Patient and Public Involvement and Clinical Audit and
Effectiveness. Alison advised that the individual functions had provided more detailed
summaries which had already been or would shortly be presented to the Trust Board in their
annual reports.
In response to Julie Nerney’s query regard the outcome of the National Clinical Governance
Support Team’s review of the Trust’s maternity services, Alison advised that the final report
with recommendations would be presented in due course to the Trust Board. Des Holden
advised that much midwife cross-site working was now taking place and in particular there
had been good feedback from the education programme although there was more to do on
consultant integration.
The Trust Board received and noted the Clinical Governance Annual Report.
5
60/12 Nursing and Midwifery Strategy – Six Month update
Alison Robertson presented a six month update on the Nursing and Midwifery Strategy. She
reminded Board members that the aim of the Strategy was to provide a clear direction for
nursing and midwifery staff and ultimately to continuously improve patient care. The paper
provided an update against the 10 themes of the Strategy which reflected national and local
priorities, professional body requirements and also provided evidence for the Healthcare
Commission core standards. She advised that in August the Chief Nurse for England’s Annual
Plan had been distributed; the three aims of which were patient safety, patient and user
experience and leadership. It was proposed that these would be incorporated into the next
version of the Strategy.
Alison also reminded Board Members that the next annual Nursing and Midwifery Conference
would take place on 19 October 2007 and that all Members were invited to attend.
The Trust Board received and noted the six month update on the Nursing and Midwifery
Strategy and requested that its congratulations be forwarded to Kim Bateup, a ward manager
at Hurstwood Park, who had recently presented a paper at a national nursing conference in
Manchester on developing an effective learning environment.
60/13 Lean Thinking for Clinical Pathways
Amanda Philpott and Des Holden jointly presented a paper on Lean Thinking. The paper
provided an update on the Trust’s approach to transforming organisation-wide performance
through the practical application of Lean Thinking Principles in a programme led by the
Process Improvement Group.
Amanda reminded Board Members that Lean thinking was a systematic approach to
transforming organisational performance and it aimed to enable organisations to identify
activities that add no value to their customers but consume time, money and resources.
Many of these ideas were not new as the Trust had been undertaking service improvement for
a number of years and participated in modernisation networks and collaboratives such as
cancer, cardiac, emergency and critical care.
Des Holden advised that through the Turnaround Process Improvement Group, work was
focused on removing constraints and improving processes. The Group had a number of
workstreams. Des added that the Process Improvement Group was ensuring that lessons
learnt were disseminated through the Trust. He added that it was important, however, that
one area was not improved at the expense of another.
Through Des Holden, Glynn Jones encouraged the Process Improvement Group to disseminate
its work throughout the Trust and to concentrate its efforts on those areas of quick gain.
Amanda stated that she and Des Holden were keen to receive details of further projects
which could be the subject of Lean Thinking.
The Trust Board noted the process improvement work underway within the Trust to support
improvement in patients’ experiences of its services.
60/14 Trust Performance
Michael Wilson presented the Trust Performance report for month 5.
6
He advised that a comprehensive set of actions supported the report presented to the Board.
Part of the action plans which had been developed to ensure the Trust achieved the18 week
target was the secondment of Sally Howard from the National Performance Support Team. In
addition Nick Chapman, National Director of 18 weeks, would be spending half a day per
month within the Trust; not only to support and challenge the Trust on what it was doing but
also to enable him to learn what happened at ground level and to take lessons learnt back to
the Department of Health.
There had been three reported MRSA cases within September. The clostridium difficile rates
were in the normal range but needed to come down. The Department of health Control of
Infection Team had been invited to test the Trust’s arrangements for Infection Control and
they would be on site on 31 October 2007. Delayed transfers of care was an area which
required more work and the Trust was working closely with other organisations to improve
this. He added that social service delays within East and West Sussex had improved and the
areas of greatest concern were elderly mentally ill placements, self funding and housing;
further meetings were being held with Brighton and Hove City Council although an
acknowledged shortage of available placements caused significant difficulties.
Duncan Selbie commented that improvement in the A&E 4 hour performance standard was
encouraging but the Trust’s ambition was to achieve 98% consistently and over the year as a
whole. He stated that he was delighted that Sally Howard and Nick Chapman would be
assisting with the 18 week target as they both had considerable practical experience which
they would bring to the Trust. He added that together with achieving financial breakeven
and a reduction in MRSA and clostridium difficile rates, these formed the top priorities for the
Trust, alongside patient safety and determining a clinical strategy.
The Trust Board received and noted the Performance Report for month 5.
60/15 A&E 4 Hour Performance Standard
Janet Cheesman presented a report on progress against the A&E 4 hour standard during the
past month.
She advised that performance had improved since the last Board report with a quarter to date
figure of 98.13% and a year to date average of 96.68%. She added that A&E attendances had
slightly decreased although admission rates had increased and patient flow was essential to
maintain this improved performance and this would be greatly assisted by the Real Time Bed
State which was being rolled out across the Trust.
In response to a query from Julie Nerney, Janet advised that the draft Winter Plan had been
presented to the Executive Team the previous week and would be discussed with the Trust’s
healthcare partners later in the month with the intention of a joint plan being produced.
Matthew Fletcher commented that it was not a co-incidence that MRSA and A&E had improved
simultaneously as both reflected changes in behaviour and improved patient flow.
Duncan Selbie commented that performance in A&E, control of infection rates and 18 weeks
were a barometer as to how the hospital was performing and whilst staff had every reason to
be feeling confident, that it would get tougher as winter drew nearer. He predicted that the
7
Trust had a further four weeks of preparation time to ensure that everything was in place for
the winter.
The Trust Board received and noted the report on the 4hr A&E Performance Standard and that
it would receive the Winter Plan at its next meeting.
Action: Michael Wilson
Janet Cheesman
60/16 Turnaround Programme – update
The Trust Board received and noted the progress report on the Trust’s Turnaround
Programme.
60/17 Oracle Learning Module
Ali Mohammed presented a briefing paper on the use of the Oracle Learning Module within
the Trust. He advised that this was an additional service that had recently been developed
so that it was a usable training management tool which could be used for the administration
of training courses, recording and reporting on training activity, identifying the need for
update training by linking to competencies and identifying staff who had undertaken statutory
and mandatory training and those who hadn’t. He added that the Learning and Development
department was carrying out a full feasibility study with a view to planning its
implementation in late 2007. It was proposed that the Module would be trialled in a couple
of areas before it was rolled out across the organisation by the end of the year.
The Trust Board received and noted the use and implementation of the Oracle Learning
Module within the Trust.
60/18 Trust Board sub-committee minutes
The Trust Board received and noted the minutes of the Governance and Risk Committees held
on 9 January, 26 March and 10 July 2007 and the PFI Project Board held on 21 August 2007.
60/19 Summary of NHSE Documents
The Trust Board received and noted the summary of NHS documents and publications received
since the last meeting of the Trust Board.
60/20 Questions from the Public
Tony Reynolds stated that the financial implications of the Trust’s performance were clearly
illustrated at Board Meetings and within Board papers but he believed that the implications
for patients should be given equal prominence. Duncan Selbie acknowledged this as an
excellent suggestion and that thought would be given as to how this could be incorporated.
Alison Robertson would lead on this.
60/21 Next Meeting
The next meeting of Brighton and Sussex University Hospitals NHS Trust would be held at
10.00 am on Tuesday 6 November 2007 at the Princess Royal Hospital.
8
60/22 Exclusion of Press and Public
The Board resolved that representatives of the press and other members of the public be
excluded from the remainder of the meeting having regard to the confidential nature of
business to be transacted, publicity on which would be prejudicial to the public interest
[Section 1(2) Public Bodies (Admissions to Meetings Act 1960)].
--ooOoo--
9