MEETING OF THE BOARD OF DIRECTORS HELD AT
9.30AM ON WEDNESDAY 25 JANUARY 2017 IN THE SEMINAR ROOM,
AIREDALE GENERAL HOSPITAL, SKIPTON ROAD, STEETON, KEIGHLEY
PRESENT:
Professor Michael I Luger, Chairman (in the Chair)
Miss Bridget A Fletcher, Chief Executive
Ms Jill Asbury, Interim Director of Nursing
Mr Andrew Copley, Director of Finance
Mr Jeremy Cross, Non-Executive Director
Mr Andrew Gold, Non-Executive Director
Professor Anne Gregory, Non-Executive Director
Dr Maggie Helliwell, Non-Executive Director
Ms Stacey Hunter, Chief Operating Officer
Mr Karl Mainprize, Medical Director
Mrs Lynn McCracken, Non-Executive Director
Mr Shazad Sarwar, Non-Executive Director
IN ATTENDANCE:
Ms Helen Bourner, Director of Strategy and Partnerships
Mr Nick Parker, Director of HR and Workforce
Mrs Jane Downes, Company Secretary
Mrs Sharon Katema, Assistant Company Secretary
Mrs Anne Chafer, Professional Development Midwife (item 02/17)
Mrs Caroline Lowe, Lead Midwife for Parent Education (item 02/17)
Also in attendance were Governors and staff members.
An apology for absence was received from Mr Rob Dearden, Director of Nursing.
01/17
DECLARATIONS OF INTEREST
There were no declarations of interest.
02/17
PATIENT STORY
Ms Asbury introduced Mrs Caroline Lowe who provided a brief outline of the four
week hypnobirthing course offered by the Trust’s Maternity Services Parent Education
Team.
Mrs Lowe informed the Board that hypnobirthing was accredited by the Royal College
of Midwives and sought to combine methods of breathing and deep relaxation with
positive mind-sets. This would in-turn increase the threshold of having a calm and
natural birthing experience. She invited the Board to listen to a recording from Mrs
Jasmine Pickard who was the subject of the patient story for January.
Jasmine Pickard stated that she had started to listen to hypnobirthing cd’s when she
was around 25 weeks pregnant following recommendations from friends. Like her
friends, her experience was so positive that she wanted to share it with the Board and
wider.
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Jasmine and her husband Ryan had attended the course when she was 36weeks
pregnant and these sessions taught them what to expect as first time parents.
Jasmine was very engaged with the course and described how it made her feel really
confident and excited.
Jasmine narrated that she was due to be induced but her labour had started naturally
on the 18th of December. She had stayed at home throughout the contractions and
attended the hospital at 10pm. It was whilst she was in the birthing pool, where she
stayed for 6hours without gas and air, that she had to rely on all her hypnobirthing
techniques. Jasmine had brought with her a birthing necklace whilst Ryan had read
through the scripts and positive birthing cards which friends had made for her. They
had both meditated and kept a positive mind-set which had helped they remain
completely calm throughout the process.
Jasmine described Jasper’s birth as a calm, beautiful experience stating that she had
pushed for 30 minutes with no assistance whilst visualising waterfalls and blowing
dandelions. Baby Jasper Dylan was born on the 19th November weighing 8lbs 10oz.
Jasmine concluded by thanking the midwives and everyone at Airedale who had
made the birth special and stated that she would happily go through the whole
hypnobirthing experience and would highly recommend it.
Prof Luger thanked Jasmine and Ryan for having shared their story and the Maternity
Services Parent Education Team. He asked if hypnobirth was unique to Airedale or if
it was widespread. Mrs Lowe responded within the region, Harrogate offered the
course and charged £100 whist Airedale offered the service free of charge. The
sessions were held monthly in Group settings with an average of five couples
attending each month. With regard to the level of demand, this varied but people who
attended were either referred or keen to practice their breathing and relaxing
techniques.
Miss Fletcher thanked Mrs Lowe and her team for all the hardwork and asked if there
were any broader benefits of hypnobirth. Mrs Lowe responded that there was no clear
evidence. However, it helped the mothers maintain a positive attitude during birth
resulting in the babies being born in a calmer environment.
Ms Asbury asked about the number of people within the team who were trained to
deliver the classes and the cost of training a larger cohort. Mrs Lowe stated that there
were three trained midwives and the inhibiting factor was the cost which was around
£500 to £600.
Prof Gregory queried the wider benefit across the Trust and if there was any
transferable learning. In agreeing with Mrs Lowe’s comment that there were benefits
across the Trust, Ms Asbury added that there was scope for extending the calm and
relaxing technique as a pain management technique to patients recovering after
surgery.
Dr Helliwell enquired if there were any plans to engage with members of the wider
community as served by the Trust. Mrs Lowe responded that they were continually
trying to raise awareness across the whole community served by Airedale.
The Board agreed that hypnobirthing was an area that the Trust could expand on and
there was a need to consider the offer to women from different cultural backgrounds.
The Chair thanked the midwives and maternity services for being great ambassadors
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of the Trust.
03/17
MINUTES
The minutes of the Board meeting held on 30th November 2016, were approved as a
correct record.
04/17
MATTERS ARISING NOT COVERED ELSEWHERE ON THE AGENDA
Collaboration Schematic (minute ref. 226/16)
Ms Bourner tabled a schematic showing the current collaboration initiatives and how
they were linked together.
NICE Guidance (minute ref. 231/16)
Mr Mainprize was asked to provide additional information to demonstrate that the
Trust had reviewed NICE guidance and that the Trust was at as full compliance as it
could achieve. Mr Mainprize informed the board that the work was complete and
would be presented at the March Board meeting.
Flu Vaccination Campaign
It was noted that the Trust had achieved the target take-up of flu vaccinations. The
introduction of peer vaccinators for the first time had made a significant contribution.
05/17
CHAIRMAN’S BRIEFING
The Chairman’s Briefing was taken as read.
Prof Luger reported that the inaugural Board Finance Committee had met on 23
January and stated he was assured that the Trust was making progress in introducing
new approaches to being more efficient. He extended gratitude to the executives and
all members of staff who were constantly working hard in spite of the challenges
faced. He informed the Board that discussions at the HFMA Chairs’ Conference had
focussed on finance and the benefits of using technology as a means of improving
finance and quality outcomes. Prof Luger added that he remained proud of the fact
that Airedale was reputed to be an innovation pioneer with regards to Telemedicine
and acknowledged there was a need to do more in order to maintain that reputation.
Prof Luger advised the Board that he had also attended the Northern Chairs’
networking event in Leeds which proved effective in ensuring that lines of
communication were open. Citing the joint pathology venture with Bradford as an
example of advancing partnerships, Prof Luger spoke of the continued relationship
commitment to cooperate on this and other future partnerships.
The Chairman’s Briefing was received and noted.
06/17
REPORT OF THE CHIEF EXECUTIVE
Miss Fletcher presented the Chief Executive’s Report, which was taken as read.
Miss Fletcher advised the Board that the Trust was under huge pressure and the
added focus was on financial planning. She stated that no feedback had been
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received as yet from NHSI, following the submission of the final two year operational
plan on 23 December 2016.
Miss Fletcher reported that the first two weeks of January had been very challenging
in terms of increased activity. She thanked staff for their staff for their hard work
during this difficult time.
(i) National Developments and publications
Miss Fletcher drew attention to Appendix 1 which provided an overview of the
significant national developments that had taken place since the previous Board
meeting including:
 The publication of the National Tariff 2017-2019 by NHS Improvement in
partnership with NHS England; and
 The Learning, Candour and Accountability Report by the CQC.
During December 2016 the first group of junior doctors in England had moved onto
the new contract and some of the groups within the Trust were now on the new 2016
Junior Doctors’ contract. A quarterly report by the Trust’s appointed Guardian of Safe Co Sec
Working (GOSW), Dr Martin Kelsey would be presented at the March Board meeting.
(ii) Local Health Economy Developments
Miss Fletcher informed the Board that in addition to collaborating on new models of
care, the Trust was continuously working with health and care partners in a bid to step
up activities and meet the challenges ahead.
The Pathology Joint Venture had gone-live on the 9th January 2017. Miss Fletcher
extended gratitude to the teams who worked extremely hard to achieve this, including
John O’Dowd, Consultant Histopathologist and Afruj Ruf, Head of Pathology and
asked that the Board reaffirms this.
The Trust had developed a 12month apprenticeship scheme in partnership with
Keighley College. The apprentices would be studying for a Diploma in Health and
Social Care and all classroom-based sessions would be delivered by Keighley
College. The scheme was designed to help apprentices onto the first rung of their
health care career with the added guarantee of a permanent job on completion. Ms
Asbury added that the first cohort of apprentices had started in November/December
and had settled in well with the majority agreeing that they have made the right
choice. The second cohort would commence in March/April.
Miss Fletcher reported on a new initiative to encourage non-clinical staff to assist
patients at mealtimes with eating and drinking. She extended the invitation to the
Board of Directors and the Governors. Dr Helliwell informed the Board that she had
taken up the offer and was looking forward to supporting Ward 10.
In referring to the non-achievement of the 4 hour standard, Miss Fletcher apologised
to patients and their families stating that this was not the standard the Trust aspired
to. She highlighted the increase in local and national pressure which had resulted in 4
out of 10 hospitals in England declaring a major alert during the first week of 2017 on
A&E pressures. Miss Fletcher expressed concern regarding the de-standardisation of
the system and acceptance that this was now the norm instead of the exception. Prof
Luger commented on the remarks by the Secretary of State for Health, Mr Hunt
whereby he had stated his intention to change the 4hour standard criteria.
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(iii) Airedale Foundation Trust Update
Miss Fletcher highlighted the following key points from this January’s Board pack
including:
 The learning from this month’s patient story following a mother’s hypnobirthing
experience at Airedale;
 The forecast plan at month 9;
 The Exception reports regarding A&E 4 hour standard and staff sickness;
Miss Fletcher reported that the Trust had become a pilot site for Training Nurse
Associates. This was seen as a good development and would help transform the
working practices and role of trainee nurses. This was a regulated role designed to
support the registered nurse across a range of functions. The associate nursing
trainees would be employed by the Trust and would undertake a two year Foundation
degree programme attending University one day each week.
Miss Fletcher informed the Board of the re-inspection by the CQC in the last week of
March and the preparations now underway.
With regards to the Good news to celebrate.
 Miss Fletcher advised the Board that she had been invited to be a part of a
delegation to China set up by the Mayor of Rotherham. The visit had been
successful with particular interest being shown in the process of remote
consultations. A memorandum of Understanding had been signed between the
Trust and XI’an, Yan Liang Health Informatisation Construction Management
Centre to explore opportunities for collaboration on remote online clinical
consultation cooperation.
 Sarah Broadhead-Crofts had commenced her role as the Trust’s Freedom to
Speak Up Guardian. The Board invited her to the March or April Board meeting.
 Dr Helen Livingstone was awarded an MBE for services to the end of life
healthcare;
 The third Pride of Airedale awards would be held on 9 March 2017.
The Report of the Chief Executive and attachments were received and noted.
07/17
RIGHT CARE PORTFOLIO PROGRAMME REPORT
Miss Fletcher presented the Right Care Portfolio Programme Report which was taken
as read.
The report sought to highlight the activity and work under-pinning the Right Care
Strategy. The majority of programmes were showing amber at Q3 as a result of
slower than anticipated progress against planned delivery. This was due to the impact
of financial and activity pressures across the Trust as well limited staff resource to
simultaneously manage the programmes. The programme boards continued to hold
monthly meetings aimed at providing direction, governance and an escalation point
for the projects, reviewing the highlight reports, financial status and progress against
plan.
Miss Fletcher informed the Board that the Admin and Clerical Review had been
completed and the restructuring had created 10 specialty teams. It was anticipated
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that the specialty teams could be developed further through engagement sessions
with staff. Miss Fletcher stated that the use of digital technology systems in patient
care allowed for flexibility and new ways of working.
Prof Luger asked if the Trust could expect a reverse of DNAs as a result of
advertising the cost of ‘no-shows’. Miss Fletcher advised incentives such as text
messages and the large advertising banners which were in display in patient waiting
areas were aimed at reducing the number of DNAs. She added that clinics were
always overbooked by 6% to allow for DNAs. Ms Hunter advised that she was
currently working with the Informatics Department so clinic utilisation metrics would
also be recorded.
Dr Helliwell queried if there was an alternative plan in place in instances where the
clinic was overbooked. Ms Hunter responded the aim was to achieve full clinic
utilisation and gave assurance that whenever this situation occurred, patients booked
into the clinic would be attended to.
The Right Care Portfolio Programme Report was received and noted.
08/17
NURSING AND MIDWIFERY STAFFING REPORT
Ms Asbury presented The Nursing and Midwifery Staffing Report for December 2016
which was taken as read.
The report highlighted the following key points:
 The number of vacancies and opening of beds to meet the increase in activity had
impacted on staffing in the Integrated Care Group (ICG) wards and right across
the Trust;
 Plans to upskill the Health Care Support Workers in areas such as ward 2 (AMU)
were benefitting the ward as staff achieved their competencies;
 The increase in fill rate of unregistered staff was reported, however this was due
to the number of nurses still awaiting PINs, and also reflected the increased
numbers of Health Care Support Worker’s used to support the deficit in
Registered Nurses numbers at times;
 December had seen an increase in the number of falls, with the Integrated Care
Group wards reporting three falls resulting in significant harm, two on ward 10 and
one on ward 6. The number of pressure ulcers reported had also increased in this
group, and a grade 3 pressure ulcer has been reported on ward 6. In contrast,
despite the staffing difficulties, Ward 10, an intermediate care ward had achieved
fifteen falls free days. Ms Asbury added that the introduction of ‘Safety Huddles’
in November had resulted in an improvement in the prevalence of falls.
 Ward 15 open for the first 17 days in December to manage the increase in nonelective activity, had met the standard for planned and actual staffing
requirements.
 The next intake of apprentices was underway, with an expected start date of
March 2017.
Ms Asbury informed the Board that following the request to report leavers and joiners
on a monthly basis, she was not in a position to provide this at this point, but would so
from March. She added that the position was expected to improve once all individuals
have received their PINs.
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The Nursing and Midwifery Staffing Report was received and noted.
09/17
MORTALITY REPORT
Mr Mainprize presented the Mortality Report which was taken as read.
The report had highlighted that the Trust’s crude mortality rate was 1.48%. In
December 2016, there were 77 reported deaths across the Trust during December
2016. One of the deaths had occurred following a planned admission, with 12 deaths
occurring within two days of admission. There had been no Maternal or Paediatric
deaths.
Mr Mainprize reported that the number of deaths had increased in December
although this was in line with previous trends. A process was now in place to review
whether any deaths were avoidable. He highlighted that a Fracture Neck of Femur
Steering Group had been established to review trend data and extract learning for
dissemination across the Trust.
Dr Helliwell made reference to the role of the Trust and its collaboration with primary
care providers and the community, now and in the future. Mr Mainprize said the Trust
was currently reviewing the ‘CQC’s Report in to the way the NHS review and
investigate the deaths of patients in England’ and would respond to the
recommendations within the report. Ms Hunter referred to the work of ACO’s whose
purpose it was to bring the system together to look at a service design model with
health care partners.
In response to Mr Cross’s comment about visibility of the shared learning, it was
noted that the Quality Assurance and Improvement Group would see the outputs as
part of the specialty reviews.
Mr Mainprize explained in response to Miss Fletcher’s question about two recent
deaths of patients with learning disabilities, that the Mortality Review Group would
review these deaths using a national toolkit in order to give assurance of process.
The outcomes would then be disseminated to the relevant areas. In line with the
CQC Report, the reviews would be subject to the same process as Serious Incident
Reviews. Mr Mainprize confirmed that the reviews had taken place and the final
reports would be scrutinized via the Mortality Surveillance Group.
The Mortality Report and Scorecard to December 2016 was received and noted.
10/17
FINANCE AND PERFORMANCE REPORT
The Finance and Performance Report for the period ended 31 December 2016 was
taken as read.
(i) Finance Report
Mr Copley stated that the NHSI control total which excludes donated assets but
includes STF funding, showed a surplus of £4,072k against a planned surplus of
£4,063k, £9k better than plan at month 9. He added that income for month 09 had
improved by £200k since the Board report had been produced. Mr Copley
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emphasised the importance of understanding that although the Trust had delivered
3% efficiency savings, this had been aided by the recent redundancy schemes. Both
inflationary pressures and tariff pressures would mean an increasing level of
efficiencies required for 2017/18.
The following key points were noted:
 The underlying position, before the release of non-recurrent support, showed a
deficit of £1.8m. After support, the position showed a surplus of £52k, £54k better
than plan;
 Within the position there was a 30% of non-elective threshold abatement,
equating to £555k that had not been reinvested into services;
 EBITDA performance was £84k worse than plan. This position delivers a
utilisation of resources (‘UoR’) rating of 1 against a plan of 1;
 PbR Income is £983k below plan;
 CIP had achieved £4,542k against a plan of £6,609k, £2,067k behind plan. This
was £976k worse than the contingency set aside, therefore contributing to the
deterioration of EBITDA.
(ii) Performance Report
Mr Copley presented the Executive Performance Report which provided a summary
of the Trust’s position. Of note were the following summary key points:
 The NHS Improvement Single Oversight Framework Governance rating was
Amber due to the A&E 4 hour standard being 87.0% for December.
 The potential risk of a formal Governance trigger by NHS Improvement as a
result of the A&E 4 hour standard not being achieved for four of the last five
quarters remained. Pressures on the RTT standard were potentially increasing
this risk further;
 The Trust continued to declare risks on Clostridium difficile and the A&E 4
hour standards for 2016/2017;
 Following further details received from NHS Improvement regarding the
Sustainability and Transformation Funding, the Trust
achieved the
requirements for Quarters 1 and 2 following a successful appeal regarding the
A&E standard as a result of the system wide pressures reported over several
months;
Ms Hunter commented on the hard work and focussed effort that the General
Managers and Clinical Colleagues had put in to achieving the 18week RTT Standard
for patients.
The Finance and Performance Report was received were noted.
(iii) Exception Report on the 4 hour Emergency Care Standard (ECS)
The Emergency Care Standard Exception Report was taken as read.
Ms Hunter informed the Board that the Trust had achieved 89.2% for the Emergency
Care Standard for Quarter 3. This position was being reviewed in relation to all acute
providers in England in the same period given many of the challenges and constraints
to delivery of this standard are consistent for acute providers. Ms Hunter echoed Miss
Fletcher’s apology to all patients and families that had experienced the long wait in
the Emergency Department.
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It was noted that despite significant focus and effort some of the challenges such as
rising number of delayed transfers of care, increases in the number of patients
medically fit for discharge stranded in a hospital bed coupled with increased demand
continue to have a detrimental impact on both the experience of patients and their
families and on staff.
Ms Hunter acknowledged the continued efforts and hard work of all the staff working
across emergency and urgent care who were managing this on a day to day basis.
The Emergency Care Exception Report was received and noted.
11/17
INTEGRATED GOVERNANCE DASHBOARD REPORT
Mr Copley presented the Integrated Governance Dashboard Report and drew
attention to the following key points.
 The NHS Improvement Risk Assessment Framework rating was Amber for Q3 due
to the A&E 4hour standard not being achieved four times in the previous five
quarters;
 The overall ‘Financial use of Resources’ risk rating for December was 1.0 due to
pressures on CIP delivery, bank and agency expenditure and income through
undertrades. The underlying position showed a forecast deficit of £1.8m;
 Outpatient DNA Rates were above the aspirational target set in the Annual Plan of
6% for December 2016.
The Integrated Governance Dashboards were received and noted.
(i) Staff Sickness Exception Report
Mr Parker presented the Staff Sickness Exception Report which provided a
comparison with other Trusts between staff groups and by cost and absence reason.
The following key points were noted
 Airedale NHS FT’s sickness absence rate had been higher than target for the last
seven months.
 The health sector had higher levels of sickness absence than other sectors with
Yorkshire and Humberside region having higher levels of sickness absence than
other regions (except the North West and North East).
 Sickness absence levels at Airedale were in line with other local Trusts, though
two Trusts have consistently lower levels in the comparison period.
 Absence levels amongst some staff groups such as estates and ancillary;
additional clinical services; and nursing and midwifery were higher due to the
nature of work undertaken.
 Monday was the most prevalent day of absence, followed by Tuesday.
 Despite absence reasons differing between short and long term absence, mental
health related absences remained an area of concern.
 There was a need to strike the right balance between the active management of
absence and steps to improve overall staff health and well-being.
Mr Parker informed the Board that The Trust had a comprehensive range of support
and interventions to deal with sickness absence and staff well-being. Options to
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further strengthen these arrangements through reviewing the sickness absence
management approach and the use of the Bradford Factor methodology as well as
increasing HR capacity were all in train.
The Board discussed the action being taken to reduce staff sickness. Whilst
acknowledging the steps being taken, the Non-Executive Directors said the focus of
future reporting should be on actions rather than comparisons.
Mr Sarwar
commented on the role that managers had in reducing sickness and supporting staff,
whose efforts should be recognised during times of increased pressure. Miss Fletcher
asked the Board to read the Report in the context of the current increased pressure in
the hospital and said that correlation with the Staff Survey was a key measure.
The Staff Sickness Exception Report was received and noted.
12/17
COMPANY SECRETARY’S REPORT
The Company Secretary’s Report was taken as read.
Mrs Downes highlighted the following points which were received and noted:
(i)
Reporting Requirements – Annual Report and Accounts
NHS Improvements had published changes to the annual reporting requirements
requiring inclusion in the Trust’s 2016/17 Annual Report and Accounts.
(ii)
Airedale NHS FT Charitable Funds Report
The charity spent over £31k and received donations and legacies of over £25k,
including £8k from Sovereign Health Care during November and December 2016.
The Board thanked members of the public for their generous donations.
(iii)
The Board Work Programme 2017
The Board Work Programme for 2017 was received and noted.
(iv)
Board Action Log
The Board action log was reviewed and those items deemed completed agreed for
deletion.
13/17
ANY OTHER BUSINESS
There were no other business items raised.
14/17
CLOSE OF MEETING
There being no further business, the Chairman declared the meeting closed.
The next meeting of the Board of Directors would be held at 9.30am on Wednesday
29th March 2017 in the Seminar Room, Airedale General Hospital.
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