POOLE HOSPITAL NHS FOUNDATION TRUST
BOARD OF DIRECTORS
Part 1 Minutes of the meeting of the Board of Directors of Poole Hospital NHS
Foundation Trust held at 9.00 am on Wednesday 29 January 2014 in the Board Room,
Poole Hospital
Present:
Dame Yvonne Moores
Mr Chris Bown
Mr Mark Friedman
Mrs Jean Lang
Mr Ian Marshall
Mr Michael Mitchell
Ms Jackie Nicklin
Mr Martin Smits
Mr Guy Spencer
Mr Robert Talbot
Mrs Sarah-Jane Taylor
Mr Paul Turner
Mr Nick Ziebland
Non-Executive Director (Vice Chair)
Chief Executive
Director of Transformation
Non-Executive Director
Non-Executive Director
Non-Executive Director
Acting Joint Chief Operating Officer
Director of Nursing & Patient Services
Non-Executive Director
Medical Director
Director of HR and Organisational
Development
Director of Finance
Non-Executive Director
Mr Michael Beswick
Miss Jill Retigan
Company Secretary
Secretary
In Attendance:
The Vice Chair welcomed the governors and members of staff present to the
meeting.
PHFT 010/14 Apologies for Absence
Apologies for absence had been received from Mrs Angela Schofield
Chairman and Mr Peter Gill, Director of Informatics.
PHFT 011/14 Declarations of Interest
There were no declarations of interest appertaining to the agenda.
PHFT 012/14 Part 1 Minutes of the Board Meeting held on 27 November 2013 (Paper 1)
The minutes were AGREED as a correct record of the meeting.
PHFT 013/14 Matters Arising – Action List (Paper 2)
418/13: Mrs Lang reported that Miss Peddie had notified her of a delay to the
information on number of vacancies against establishment. This was due to
necessary validation of figures and the information would be with her by the
end of the day.
421/13: Mr Beswick noted that work had been undertaken on the report on
compliance with Monitor’s Licence and the document was currently with
Board members to strengthen further before submission to the March
meetings of the Audit & Governance Committee for scrutiny and the Board of
Directors for approval.
It was noted and was agreed all other matters arising unless the subject
of this or future Board of Directors agendas have been executed.
PHFT 014/14 Chairman’s Report
The Vice Chair reported on the following items:
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The Lord Lieutenant, Mrs Valerie Pitt Rivers had retired on 22 January.
Her successor was Mr Angus Campbell former Leader of Dorset County
Council. Mrs Pitt Rivers would be standing down as a Joint Patron of
the Poole Hospital Appeal and the Board requested that Mr Campbell
be approached to succeed her.
ACTION: YM/KH
There had been an unannounced visit from the Care Quality
Commission (CQC) on 24 January. Mr Smits noted that the focus of the
visit was to check that actions had been carried out following the last
CQC visit, check on the position with safeguarding and follow up
concerns raised in relation to Pathology. Mr Smits reported that the
informal feedback had been very positive with the Inspectors stating that
the concerns in Pathology appeared unfounded and all other areas of
the inspection had been found satisfactory. The formal report was
awaited and should this reflect the informal feedback the Trust would be
fully compliant with all CQC Standards.
A major incident had occurred on 20 January when there had been a
complete power outage. Mr Bown reported that the emergency
generators had started, staff had responded quickly and appropriately
and no patients had been harmed. A formal debrief was scheduled and
resulting actions would be followed up by the Hospital Executive Group.
The Vice Chair noted her thanks to all staff and it was agreed a report
on the incident and outcomes would be presented to the February
meeting of the Board.
ACTION: JN/BP
Local MP’s had met with secretary of state, Jeremy Hunt, to discuss the
implications of the prohibition of the proposed merger.
Subject to approval from the Appointments Committee a number of
executive positions had been filled from a very strong field. Paul Miller
would take up the role of Director of Finance from 7 April and Tracey
Nutter would commence as Director of Nursing from 1 May. The start
date for the new Chief Operating Officer, Mark Mould, was yet to be
agreed.
A meeting of representatives of the two Boards of Poole Hospital and
Dorset Clinical Commissioning Group (CCG) took place on 10
December. This was had provided a helpful opportunity to raise issues
regarding medium-term plans for the Trust.
Mr Bown and Mrs Schofield had met with the Chair and Chief Executive
of the Wessex Local Education & Training Board (LETB) to discuss the
Trust’s views on their priorities.
At the last private meeting of the Board of Directors it had:
 Approved a Business Case for Health Records Scanning
 Scrutinised a number of reports including the Risk Register: New
Red Risks Summary Report and considered the Planning Process
for 2014/15
An Extraordinary meeting of the Board of Directors had taken place on 8
January, it had approved:
 The terms of appointment for the Transformation Director
 The preliminary position on financing the capital programme
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The investment in a baseline savings scoping and assessment
exercise
The Long Service Awards had taken place on 23 January with 64
members of staff eligible to receive an award. Three members of staff
were recognised for 40 years of service and 61 members of staff were
recognised for 25 years of service at this excellent event.
At their meeting on 16 January the Council of Governors had approved:
 The Reappointments of two Non-Executive Directors;
Mr Guy Spencer to 24 April 2015 and Mr Ian Marshall to 31
January 2017
 The Council of Governors 2014/15 Governance Cycle
 The Chairman’s and Non-Executive Directors Appraisal Process
for 2013/14 and onwards
 Revised Terms of Reference for the Nomination, Remuneration &
Evaluation Committee and transitional arrangements for tenure of
its membership
 Mrs Vivian Duckenfield had taken up the role of Lead Governor
and AVM Geoffrey Carleton was the new Deputy Chairman of the
Council of Governors. The Vice Chair noted her thanks to Mr
Jamie Pride, who had been an excellent Deputy Chairman for the
previous three years.
Upcoming Fundraising events were noted, including the Dorchester
Beerex 2014, taking place on 7-8 February and raising funds for
Gully’s Place, the Virgin London Marathon on Sunday 13 April 2014, a
Lapland Husky Dog Sled Trail and the Costa Rica Coast to Coast
Cycle in early April 2014. More information on these and other events
could be obtained from the Fundraising Office.
The report was NOTED.
PHFT 015/14 Chief Executive’s Report (Paper 3)
Mr Bown presented his report and noted the following key points:
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The hospital remained busy, particularly in the Emergency Department
and associated wards. The four hour A&E target had been achieved
for the second quarter thanks to the hard work of staff. This target had
not been achieved for January and work to retrieve the position for the
third quarter was ongoing.
Monitor had indicated their interest in performance targets particularly
in the Emergency Department.
The Trust continued to work closely with community partners to
address the challenge of discharge and patient flow.
Discussions regarding the problems with the new provisions for patient
transport continued with the CCG.
There had been some cases of Norovirus in the hospital and these
had been effectively managed by the Infection Control Team.
Seven Day Working was gathering pace and a project plan, led by the
Medical Director, would be produced. Mr Bown noted that this initiative
would have financial implications that would be a challenge for all
acute trusts.
The Monitor investigation continued and the next meeting with them to
discuss the financial position was scheduled for 14 February. The
instigation of a robust Financial Recovery Plan to stabilise the cash
position for the next two years would help close the investigation.
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Mr Friedman had started his work as Director of Transformation and
would present a report later in the meeting. The Board had agreed to
commission a piece of work to assist with informing Monitor and
provide the Board with tools to identify potential financial savings with
the emphasis that quality and safety remained central to any future
plans
The work to maintain clinically and financially sustainable services
across Dorset led by the Clinical Commissioning Group (CCG)
continued although timescales were not yet known.
Following initial guidance on 4 November, Monitor Planning Guidance
for 2014/15 Annual Plan Review had been published on 23 December
2013 and sets out Monitor’s expectations in more detail. Due to the
Trust’s current position and the need to develop a strategy absent of
merger, the plans required by Monitor for years 3, 4 and 5 may not be
meaningful and discussion with Monitor to agree a way forward was
underway.
In December NHS England released details of ‘Never Events’ for
Quarters 1 and 2 of 2013. The Trust experienced two events in this
category during this period and whilst there was no continuing adverse
effect on patients these incidents were considered as completely
unacceptable and the Medical Director had undertaken a full
investigation into each so that lessons could be learnt. These incidents
had previously been considered by the Quality, Safety & Performance
Committee and reported to the full Board of Directors.
The November and December Monitor Bulletins had been issued with
the report and Mr Bown noted that the January issue had just been
released and was available on request. The directors were aware of
the requirements published in the bulletins
The report was NOTED.
PHFT 016/14 Patient Story (Paper 4)
Mr Smits presented the story a patient who was wheelchair bound and the
difficulties they had encountered with washing facilities. The case had not
been subject to a formal complaint and highlighted the benefit of raising issues
immediately; either through ward staff or the advocate service PALS, and
allowing the trust to provide an instant response.
Due to the issues highlighted the Trust was emphasising the requirement for a
needs assessment for patients on admission, and considering a hospital wide
review of facilities by disabled people. Mr Smits reported that an assessment
of shower facilities was underway.
The report was discussed and NOTED.
PHFT 017/14 Chairman’s Report of the Quality, Safety & Performance Committee held
on 27 January 2014
The Vice Chair referred to her tabled report and noted the following:
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Before the meeting she had met with Mr Ramchandani and Mr Davies to
discuss the National Head and Neck Cancer Audit. The survey for last
year would provide individual surgeon data which would be published.
Assurance on the service and support provided by the hospital had been
provided.
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Two areas had been identified as potential gaps for the Trust following
the Government’s response to the Francis Report, Hard Truths. The first
was that quality information and staffing levels would be displayed on
each ward for patients and their families to see. The Quality, Safety &
Performance Committee (QSPC) would play a key role in identifying the
quality indicators to be included. The second issue was ensuring that
staff were aware of the Whistleblowing Policy and the facility to have a
confidential discussion with a Non-Executive Director. How the policy is
communicated to staff would be taken forward by Mr Spencer and the
Workforce Committee.
ACTION: GS/SJT
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A formal inspection by the CQC was expected to take place in 2014 and
in preparation the Trust would be holding a mock inspection.
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The committee had discussed the Quality Impact Assessment (QIA)
which would be applied to each Cost Improvement Programme (CIP). An
early draft framework had been presented and considered. The Vice
Chair noted that the committee would continue to monitor this vital work.
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Two national patient surveys had been presented and discussed. The
feedback from the Maternity Survey and resulting action plan would be
discussed with maternity leaders at their next meeting. The committee
had scrutinised the draft results from the National Patient Survey and
noted some very positive results. A poor result had been achieved for
the issuing a discharge letter, and the committee had requested that a
discharge letter be issued to all patients as routine rather than the
current practice of asking each individual their preference.
The report was NOTED.
PHFT 018/14 Proposals for Collection and Analysis of Patient Feedback (Paper 5)
Mr Smits presented the report and provided an outline of all current forms of
patient feedback. The report included proposals for achieving further patient
feedback and potential indicators that could be included in the Integrated
Performance Report
The report was discussed in detail; the Non-Executive Directors expressed
their interest in having robust and timely feedback from patients along with a
method to plot any changes in results. It was agreed that a report detailing
best practice with cost implications would be presented to the April meeting to
enable the Board and the Trust to have access to valid and timely views from
patients.
ACTION: MSm/MBa
The report was NOTED.
PHFT 019/14 Hard Trusts and Francis Report: Trust Response and Fit and Proper
Board Member Tests (Paper 6)
Mr Smits presented the report in response to the publication of Hard Truths;
the Government’s response to the Francis Report. Two gaps had been
identified for the Trust. These were the display of quality information and
staffing levels on wards and staff awareness of the Whistleblowing Policy.
Mr Smits highlighted the training that would be introduced for Health Care
Assistants. Following discussion it was agreed that the Workforce Committee
would consider arranging a meeting with the hospital and education partners
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to discuss how this should be delivered and what was transferable from
current training.
ACTION: GS/SJT
Mrs Taylor reported that all board members would be subject to a Fit and
Proper Person Test and although there was a difference between the CQC
position and Monitor licence position the Trust needed to abide by the licence
position. A detailed report would be submitted to the September meeting
when it was hoped the CQC position would be clearer.
ACTION: SJT
The report was discussed and NOTED.
PHFT 020/14 Update on the Process for Managing the Trust’s Various Quality, Safety
and Governance Action Plans (Paper 8)
Mr Smits presented the report which detailed action plans currently in place
for the Board. Mr Smits noted that there were many action plans at all levels
across the Trust.
The high number of actions plans were noted and it was agreed that the Trust
should look at combining plans were possible and check if any could be
closed.
ACTION: EDs
The Board also noted that approximately 50% of the action plans related to
clinical audit plans and these would be discussed at the proposed seminar
with the clinical audit team.
The Chairman noted that item 3 Board Governance Plan should be jointly led
by the Chairman and Chief Executive.
The report was NOTED.
PHFT 021/14 Report on the Better Together Programme (Paper 9)
Mr Bown presented his report and noted that the Better Together Programme
was the local response to the Government’s integration agenda, which
required the NHS and local authorities to join up services and pool budgets to
provide seamless care. He reported that the Better Care Fund (previously
referred to as the Integration Transformation Fund) was announced in June
as part of the 2013 Spending Round.
Mr Bown reported that within Dorset the implementation of the Better
Together Programme was being led by a Better Together Board. Mr Bown
noted that the joint sponsors for the Better Together Programme were: The
Chief Executives of Dorset County Council, Bournemouth Borough Council,
the Borough of Poole, Royal Bournemouth & Christchurch Hospitals NHS
Foundation Trust, Poole Hospital NHS Foundation Trust, Dorset County
Hospital NHS Foundation Trust, Dorset Health Care Foundation Trust, and
the Chief Officer of NHS Dorset Clinical Commissioning Group (CCG).
A bid by the three local authorities in Dorset and the five NHS bodies to the
Department for Communities and Local Government (DCLG) for a share of its
Transformation Challenge Award was made. The bid outlined the
partnership’s planned Better Together programme for joint working and
integration of the three councils’ adult social care functions with the health
sector. Mr Bown reported that the bid had been successful and the Better
Together programme would receive £750,000. Mr Bown reported that the
Better Together Programme Board would continue to oversee how the fund
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was deployed as well as the Dorset Clinical Services Review. He noted that it
was expected that the two Health and Wellbeing Boards would make or guide
the decisions on how the fund was spent.
Mr Bown emphasised that the fund was not made up of new money but a top
slice of funds paid to the CCG for acute services. He also noted that local
authorities had recently been subjected to cuts in service.
The report was discussed and it was agreed that at their June meeting the
Board would receive an update on how decisions related to this fund would be
made.
ACTION: CB/DF
The report was NOTED.
PHFT 022/14 Chairman’s Report of the Finance & Investment Committees held on 16
December 2013 and 27 January 2014
Mr Mitchell referred to his tabled report and noted that the new Executive
Directors would have major issues to face on how the Trust would manage its
financial position. He reported that a lot of preparatory work, including the
identification of cost improvement programmes, was underway to inform the
new team in their choices for leading the Trust into the future.
The report was NOTED.
PHFT 023/14 Chairman’s Report of the Workforce Committee held on 16 December
2013
Mr Spencer referred to his tabled report and noted the following:
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The Deputy Medical Director for Revalidation had provided an update on
the first year of the mandatory General Medical Council revalidation
process and progress on this would be reported to the next Workforce
Committee in February 2014 and to the Board in April.
ACTION: RT/RDay
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The Auxiliary/HCA avoidable turnover rate was discussed and drill down
information provided by the senior HR team.
The report was NOTED.
PHFT 024/14 Integrated Trust Performance Report (Paper 10)
Mr Turner, Ms Nicklin, Mr Smits and Mrs Taylor presented the report and
highlighted key areas.
Detailed discussion took place particularly in regard to:
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The December financial position was in line with the forecast.
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An additional £1m from the 2014/15 contract would be paid in the
current year by the CCG.
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The hospital had achieved a strong performance for the month.
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The 16 week Referral to Treatment Target (RTT) had not been met for
Ophthalmology and an action plan had been put in place.
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The Endoscopy RTT target had slipped as predicted due to the
temporary arrangement for washing scopes and refurbishment work,
due for completion by the end of February. The new washers had
been delivered in December and the plan to get these operational was
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on track with the expectation they would be operational by the end of
January.
The RTT target in Radiology had not been met for CT and MRI scans.
The reasons for this were discussed and it was noted that there had
been a 12% increase in referrals. Ms Nicklin reported that a plan to
clear the list by the end of February had been introduced.
The high rate of Health Care Assistant turnover discussed under
minute 023/14 was a national problem.
The hospital continued to have a high number of outlying patients
which increased the pressure on staff.
An increase in the incidents of falls and ulcers had been noted for the
month and this would be closely monitored.
The report was NOTED.
PHFT 025/14 Transformation Programme Update (Paper 11)
Mr Friedman presented his report and provided an overview of the work
undertaken during the first month of the Transformation Programme.
Mr Friedman reported that a governance plan had been put in place. Sixteen
Steering Groups had been formed and they would all meet fortnightly. It was
noted that Terms of Reference had been agreed for each group.
The importance of maintaining quality while driving cost savings was noted by
Mr Friedman. He stated that each scheme would not be taken forward without
meeting the rigorous quality impact assessment requirements.
The report was discussed and NOTED.
PHFT 026/14 Chairman’s Report of the Audit & Governance Committee held on 8
January 2014
Mrs Lang referred to her tabled report.
Two reports by Internal Audit were highlighted; both were an assessment of
the attainment in benefits stated in business cases. One was for the Critical
Care Clinical Information System and the other the Private Patients Unit. It
was noted that the Deputy Director of Finance would be more involved in
business cases in future to ensure that benefits put forward were
attainable and measurable. Mr Mitchell reported that the Finance and
Investment Committee had recently agreed that any cases approved over
a certain financial tolerance, would be required to submit a benefits
realisation report to them twelve months after implementation of the
project.
A further report by Internal Audit into the Trust data reported to Monitor
under the “Compliance Framework” had been undertaken and assurance had
been provided that this data was robust.
The report was NOTED.
PHFT 027/14 Mandatory Training for the Board of Directors (Paper 12)
Mr Talbot presented the report which provided an update to the Board on the
current position of statutory and mandatory training and patient and personal
safety training within the Trust.
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The report was discussed and the Board were pleased to note that the plan to
achieve 85% of appropriate staff trained to level 2 in safeguarding by April
was on track.
The report was NOTED.
PHFT 028/14 The Revised Monitor Code of Governance (Paper 13)
Mr Beswick presented the report which was discussed. It was noted that a
report on the Trust’s compliance with the revised code of governance would
be submitted to the Audit & Governance Committee for scrutiny and the
Board of Directors for approval in March.
ACTION: MB
The report was NOTED.
PHFT 029/14 Governance Agenda Summary (Paper 14)
Mr Beswick presented the report and noted it had been produced to ensure
the Board were aware the large, complex and challenging governance
agenda to be managed by the Trust over the next few month.
The report was discussed and NOTED.
PHFT 030/14 Register of Interests (Paper 15)
Mr Beswick presented the report and asked directors to ensure that any
amendments to the register were notified to the Company Secretary’s office.
The change noted by Mr Spencer to his son-in-law’s title would be made.
ACTION: MB
The report was NOTED.
PHFT 031/14 Today’s Board Seminar
The Vice Chair reported that the subject of the day’s Board Seminar would be
Mandatory Training for the Board.
PHFT 032/14 Questions from the Council of Governors
No questions from the Council of Governors had been received.
PHFT 033/14 Any Other Business
There was no other business.
PHFT 034/14 Date and Time of Next Meeting
Board meeting to take place at 9.00 am on Wednesday 26 February in the
Board Rooms, Poole Hospital.
PHFT 035/14 Withdrawal of Press and Public
The Vice Chair moved that any members of the public and representatives of
the press should withdraw from the meeting.
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Agreed as an accurate record of the meeting:
Chairman:
Date:
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