Council of Governors - Heart of England NHS … · August 2012 Margaret Morcom ... 16 July 2012...

$: Council of Governors - Heart of England NHS … · August 2012 Margaret Morcom ... 16 July 2012 Stuart Stanton ... \GOVERNORS\COG FULL MEETINGS\2012\21 NOV 2012\WORD DOCS\COG MINUTES$

WelcomeDeclaration

ofInterest

Apologies Minutes Matters Arising

Chairman'sReport

Chief Executive's

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Financial Performance

2012year to date

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Council ofGovernors

21 November 2012 4.00pm

Cranmore ParkSolihull

WelcomeDeclaration

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AgendaNovember 2012

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A G E N D A

1. Welcome

2. Apologies

3. Declarations of Interest

(Enclosure)

4. Minutes of meeting held on 18th September 2012

(Enclosure)

5. Matters Arising

(Enclosure)

6. Chairman’s Report Lord Philip Hunt

(Enclosure)

7. Chief Executive’s Report

Dr Mark Newbold

(Enclosure)

8. Financial Performance 2012 year to date Mr Adrian Stokes (Enclosure)

9. Winter Experience Review

Dr Aresh Anwar (Presentation)

10. Committee Membership Review

Lord Philip Hunt (Enclosure)

11. Concerto – IM &T demonstration

Mr Andrew Laverick (Presentation)

12. Reports from Committees: 12.1 Constitution Review Meeting 12.2 Constitution Review Minutes (19/10/12) 12.3 Finance & Strategic Planning Committee Report 12.4 Finance & Strategic Planning Committee Minutes (10/09/12) 12.5 Hospital Environment Committee Report 12.6 Hospital Environment Committee Minutes (08/10/12) 12.7 Patient Experience Committee Report 12.8 Patient Experience Committee Minutes (07/09/12 & 19/10/12) 12.9 Quality & Safety Committee Report 12.10 Quality & Safety Committee Minutes (17/10/12) 12.11 Annual Transforming Patient Experience Conference – Kings Fund

Lord Philip Hunt Mr Barry Orriss Mr John Roberts Mr Michael Kelly Mrs Liz Steventon Mike Kelly

(Oral) (Enclosure) (Oral) (Enclosure) (Oral) (Enclosure) (Oral) (Enclosure) (Oral) (Enclosure) (Oral)

13. Any Other Business

14. Dates of Future Meetings

21 January 2013 19 March 2013 22 May 2013

Refreshments will be available from 3.30pm Charlotte Jinks Company Secretary 12th November 2012

November 2012

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Welcome

November 2012


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Apologies

November 2012


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Declarations ofInterests

Council of GovernorsNovember 2012

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Declaration of Interests

Q:\GOVERNORS\COG FULL MEETINGS\2012\21 NOV 2012\WORD DOCS\ITEM 3. GOVERNOR REGISTER OF INTERESTS.CURRENT.DOC

COUNCIL OF GOVERNORS

REGISTER OF INTERESTS NAME INTEREST DECLARED DATE

DECLARED DATE CEASED

Arshad Begum Nothing to declare 21 Nov 2011 Kath Bell Company Secretary, Succeed Services Ltd 21 Nov 2011

Prof Ian Blair Nothing to declare 21 Nov 2011

Elaine Coulthard

Nothing to declare 21 Nov 2011

James Cox 1.Assessor & Verifier for GPs into Practice, West Midlands Deanery 2.Trustee, Re-Co

21 Nov 2011

Dr Olivia Craig No declaration Received

Kevin Daly Nothing to declare 21 Nov 2011

Albert Fletcher Nothing to declare 21 Nov 2011

Dr Tim Freeman

No declaration received

Neil Harris Nothing to declare 21 Nov 2011

Patricia Hathway


Rocio Hernandez

Nothing to declare 02 Mar 2012

Richard Hughes

1.Chairman, Homestart (Tamworth) 2.Chairman, Tamworth Credit Union Ltd 3.Director, The Pathway Project 4.Director, Tamworth Community Advice Network CIC 5.Chairman, Tamworth Talking Newspaper Ltd 6.Trustee, The Rawlet Trust 7.Vice Chairman – Standards Committee, Tamworth Borough Council 8.Divisional President, St John’s Ambulance 9.Member, Appeal Committee, St Giles Hospice 10.Retired CEO & President Secretary, Tamworth Cooperative Society 11. Mr Hughes’ son holds a very senior managerial position with Barclays Bank 12.Chairman, Tamworth Community Advice Network CIC 13. Independent Member Tamworth MBC Nominations Committee 14. Member Conservation Advisory Committee, Tamworth MBC 15. President Tamworth Male Voice Choir 16. Treasurer St Andrew’s Methodist Church, Tamworth

21 Nov 2011

Amended 23 Oct 2012 6 Feb 2012 23 Oct 2012 23 Oct 2012

23 Oct 2012

23 Oct 2012 23 Oct 2012 23 Oct 2012

23 Oct 2012 23 Oct 2012 23 Oct 2012 23 Oct 2012


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Declaration of Interests

17. Shareholder BP 18. Shareholder Santander

23 Oct 2012 23 Oct 2012

Dr Syed Raza Hussain


Phillip Johnson Nothing to declare 21 Nov 2011

Michael Kelly Nothing to declare 21 Nov 2011

Marek Kibilski Nothing to declare 21 Nov 2011

Dr Sunil Kotecha

1. Full time GP, Bernays & Whitehouse Medical Partnership

2. Managing Director, Bernays & Whitehouse Ltd,

3. Director of Solihull Healthcare and Walkin Centre,

4. Trustee, Hindu Community Centre, Asian Health Forum

5. Sirius Locality member - part of Solihull Health CCG

6. Member, BMA 7. Fellow, Royal College of GP 8. Consultant Committee Member, Spire

Parkway Hospital 9. Member of 7 Partners LLP – lease

property in medical service 10. Director of Central Solihull Supplies-

pharmaceutical Business

21 Nov 2011 Sept 2012 Sept 2012

Heidi Lane 1.Member of Church, Renewal Christian Centre 2.Husband is an Elder of the Church. 3.Trust uses Christian Renewal Centre for conferences & meetings

21 Nov 2011

Cllr Ian Lewin Nothing to declare 1. Declared Interest in Mee Healthcare

21 Nov 2011

August 2012

Margaret Morcom

1.CEO, Stepping Stones Ltd 2.Deacon, Small Heath Baptist Church

21 Nov 2011

Veronica Morgan


Florence Nash No declaration Received

Barry Orriss Nothing to declare 21 Nov 2011

John Roberts Nothing to declare 21 Nov 2011

David Roy Employed Full time at HEFT 21 Nov 2011

Cllr Jim Ryan No declaration Received

Neil Smith Full time employee at HEFT 21 Nov 2011


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Bridget Sproston

Nothing to declare Diabetes Outcomes Director, Novo Nordisk (note this company supplies medicines, including range of insulins to NHS (inc HEFT)

21 Nov 2011

16 July 2012

Stuart Stanton Nothing to declare 21 Nov 2011

Liz Steventon Friends of Solihull Hospital 21 Nov 2011

David Treadwell

1.Shareholder, Lloyds TSB 2.Shareholder, STW 3.Shareholder, Nation Grid

21 Nov 2011

Thomas Webster

1.Pensioner, Ex-Production Director of subsidiary company – ICI/IMI 2.Committee Member, North East Panel, Duke of Edinburgh Award 3.Assistant Organiser, Marlbrook Golden Circle Club 4.Occasional Host, Grey Court Holiday, Arnside, Lancashire

21 Nov 2011

November 2012


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Minutes of Meetingheld on 18 September 2012


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Q:\GOVERNORS\COG FULL MEETINGS\2012\21 NOV 2012\WORD DOCS\COG MINUTES 18 SEPT DRAFT.DOCX


Minutes of the Annual General Meeting of the Council of Governors of Heart of England NHS Foundation Trust

held at the Education Centre, Good Hope Hospital, Sutton Coldfield, on 18 September 2012

PRESENT: Lord Philip Hunt (Chairman)

GOVERNORS: Mrs Kath Bell Prof Ian Blair Mrs Elaine Coulthard Mr James Cox Mr Kevin Daly Mr Albert Fletcher Mr Richard Hughes Dr Syed Raza Hussain Mr Phillip Johnson Mr Michael Kelly Dr Sunil Kotecha Ms Heidi Lane Cllr Ian Lewin

Mrs Margaret Morcom Mr Barry Orriss Mr John Roberts Mr David Roy Cllr Jim Ryan Mr Neil Shuker-Harris Dr Neil Smith Ms Bridget Sproston Mr Stuart Stanton Ms Liz Steventon Mr David Treadwell Mr Thomas Webster

Directors in attendance: Dr Aresh Anwar Mrs Anna East Ms Hazel Gunter Mr Andy Laverick Mr Les Lawrence Ms Claire Molloy

Ms Sue Moore Dr Mark Newbold Mr John Sellars Mr Adrian Stokes Ms Mandie Sunderland Mrs Lisa Thomson

Members of the public

12.52 APOLOGIES Apologies were received from Ms Arshad Begum, Dr Olivia Craig Prof Tim Freeman, Ms Patricia Hathway, Ms Rocio Hernandez, Mr Marck Kibilski, Mrs F Morgan and Ms Florence Nash.

Apologies were also received from Ms Mandy Coalter, Mr Simon Hackwell (representing CEO at another event), Mr Paul Hensel and Dr Sarah Woolley.

Minutes 18 September 2012


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The Chairman welcomed everyone to the Annual General Meeting of the Council of Governors. Dr Anwar introduced the Safety September Campaign on behalf of Dr Woolley. The purpose of the Campaign was to raise the awareness and importance of safety throughout the Trust. The safety campaign is being led by front line staff and has been a great success obtaining media interest and national interest throughout the NHS. The Safety September video was then played.

12.53 DECLARATIONS OF INTEREST The Chairman referenced the Declarations of Interest Schedule included within the meeting pack. It was noted that Cllr Ian Lewin had a new interest in Mee Healthcare. The Chairman asked that anyone with any new interests to declare should notify the Company Secretary’s office so the schedule could be updated accordingly.

12.54 MINUTES OF MEETING 16 July 2012

The minutes of the Council of Governors meeting held on 16 July 2012 were approved by the meeting and signed by the Chairman.

12.55 MATTERS ARISING

The following matters arising were noted: 11.35 Governors Governance Review. To be dealt with under agenda item 10.4. 12.39.3 Update on Jubilee Train Scheme. Lisa Thomson (Director of Corporate Affairs) advised that the Trust had already taken delivery of some linked wheelchairs and these were in operation on each of the sites. Security arrangements for the train scheme were being investigated. 12.50 Update on the Cash machine repairs at Heartlands Hospital. John Sellars (Director of Estates and Facilities) advised that a new cash machine (from a new provider) had been installed in July and no further complaints had been received. 12.51 Worcestershire NHS Trust Consultation on closure on A&E department. The Chairman advised that an update would be presented to the next meeting of the Council of Governors. David Treadwell (Birmingham Central) advised that he had some ongoing concerns about the report and asked if there were any implications for HEFT’s A&E Departments? James Cox (Solihull Central) asked if the response could include the position in relation to walk-in facilities.



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The Chairman advised that Mark Newbold (Chief Executive Officer) would be addressing this point within his report in agenda item 7.

12.56 CHAIRMAN’S REPORT

The Chairman referenced his pre-circulated written report and also highlighted the following recent events which were not included in his report. . Good Hope Hospital had held its first Open Day Fete on Saturday 8 September 2012 and this had been a huge success. He formally thanked Sue Moore, Managing Director at Good Hope Hospital and all the staff who had been involved in organising the event. The Central Production Unit at Solihull had hosted a very successful visit from the Mayor of Solihull who was very impressed with the facilities and the nutritious food produced. The Mayor had ‘tweeted’ some very positive comments during visit. John Roberts (Sutton Coldfield) added he had also attended the visit and it had been an excellent event.

12.57 CHIEF EXECUTIVE’S REPORT

Dr Newbold (Chief Executive Officer) referenced his pre-circulated report which was taken as read. He then delivered a presentation to the meeting which reviewed the Trust’s achievements in the past last 12 months and then looked to the future and the challenges for the organisation. The Trust highlights included: • Continuing to promote its strategic priorities to be Safe and Caring, Efficient,

Locally Engaged and Innovative. • Continuing to focus on performance and safety. • There has been a local emphasis with each of our hospital base units having

its own unique culture and site teams including the new appointments of managing directors for the Solihull and Good Hope sites.

• There has been a change in the way all sites are led with each site having a leadership team of doctors, nursing and managers.

• Celebrating our staff and Trust achievements. • A move into community-based services. • Strengthening our engagement with our local communities, GPs, stakeholders,

and beyond to better understand the needs of our patients. • Nursing has made particular progress and Mandie Sunderland, Chief Nurse

and her team, are to be congratulated. • The HEFT Nursing and Midwifery Badge has been launched and the first

awards event is being held at end of November. • All wards are now monitored monthly using the nursing care standards; • Launch of VITAL and i-skills programmes.

• Continuing to work to being a more ‘open’ organisation. • Setting 16 Goals to further our advance our priorities. • The Trust delivered an end of year financial surplus of £6.6m against a plan of

£11.1m: • 15% cost reduction still remains a challenge for the Trust and has yet to

be fully met. • There have been additional costs of delivering additional activity.

• The Trust achieved: • A&E 95% 4 hour target in each of the four quarters last year for the first



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time since the targets came into existence which was a huge achievement and reflects the quality and safety work undertaken.

• CDiff target achieved. • MRSA continues to be a challenging target and the trust just missed out

on achieving its target ending the year with 8 cases against target of 7. • Patient experience feedback has seen a steady improvement.

Looking forward, the challenges for the Trust over the next three years include: • An economic and financial situation including 5% pa internal efficiencies and

managing a 5% growth pa with no extra available funding meaning that finances for coming year are going to be a challenge. CIPs will be approx £25m per annum year on year which means that a focus on efficiency, without affecting quality and service, will be key. The Trust is working towards a surplus plan of £5m.

• The changing roles of acute hospitals including the need for a smaller bed base.

• An increasing emphasis on keeping people well including preventative health, the management of long term medical conditions and a focus on the care of frail elderly.

• Continuing our work on Reshaping HEFT including working on how our services will look and work differently within next 3 years eg. having more maternity clinics in community.

• No changes are expected in performance and quality targets. Monitor have rated the Trust as:

• Financial risk rating – 3 • Governance risk rating – Green • There are no outstanding conditions from the CQC

• The Trust achieved the quarter 1 A&E 95% 4 hour target. Quarter 2 has seen an unusually difficult summer, which has been echoed across the region with many other trusts in a similar position; work continues in order to hit the Q2 performance.

• Infection control. Overall the Trust’s performance to date is one of the best in the West Midlands at the present time. The Trust is currently under its trajectory target for C.Diff to date compared to this time last year. MRSA continues to be a very difficult target due to the very low numbers involved, our target is 7 this year and there have been 2 outbreaks to date.

• Our Patient metrics are improving including the Family and Friends and Net Recommender Index and the Trust is seeing more positive feedback from patients and visitors. 62% of patients would recommend the Trust through NHS choices and the Trust has invested in working to improve these targets.

• Dr Newbold address Messrs Treadwell and Cox’s questions around the potential closures and changes to A&E departments and walk-in facilities. There are no new plans to make any changes. During the last year there has been a national re-designation of major trauma units which take the very severe casualties of road traffic accidents in the West Midlands to the Queen Elizabeth, Coventry and Stoke, these three hospitals also have neuro-surgery centres. HEFT has a trauma unit status which is the next tier down and Solihull and Good Hope Hospitals are local A&Es. There are no national plans to change this at the present time. Good Hope will be moving into its new A&E facility in December. There may be some changes to Solihull’s Emergency Department to include the walk-in centre and the GP Badger Unit on the same site but as yet these are yet to be agreed. Solihull is a very busy Emergency Department with approximately 140 attendances per day. The Trust would like to see a much closer working relationships with GPs and the



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walk-in centre but there are no changes planned at the present time. Dr Newbold asked if this had addressed the question raised earlier in the meeting relating to this topic. It was confirmed that it had.

• The Trust would continue to invest in its infrastructure, investing £45m capital, with all three hospitals having a number of schemes underway, including the Pathology Lab at Heartlands; the new A&E department and new day surgery unit at Good Hope. Solihull is undergoing an internal re-shape to ensure that it has in place the best possible arrangements for the high volume of elective surgery and outpatient day speciality work that is planned. Planning approval for the car parking plans for the multi-storey car park on the Yardley Green Road site had been received. Further planning permission is being sought to develop decked car parking on the Heartlands and Good Hope sites.

• Going forward, HEFT will continue to develop its core business which is to run good quality local hospital based healthcare systems. The Trust will continue to push its transparency agenda and is very keen to continue to conduct its business in public. It will continue to focus on nursing excellence and will take an increasing interest in the wider population health, which is a new departure for acute hospitals. He advised that we will be working with the University of Birmingham to appoint some public health specialists to help guide that work. Looking at the diverse population we serve and the nature of the illnesses we treat there is no doubt that a lot of our expertise and staff could be well employed in the community helping to prevent some of the acute illnesses seen at our hospitals. We cannot continue to work in isolation and this will continue to be a developing theme for the Trust. We have a growing research facility with an increasing number of clinical trials in the region and our research strategy will also incorporate the work on the public health agenda. We are also interested in the wider development of Birmingham since, apart from Birmingham City Council, the Trust is the biggest single employer in Birmingham. We are a large customer of local businesses, we train a significant number of apprentices, graduates and school graduates in our organisation and as such we have a wider responsibility to its community. Each of the hospitals will continue to work and engage with each of its communities.

The Chairman thanked Dr Newbold and invited questions.

Q David Treadwell had listened to the report with interest and noted the undercurrent in the system around savings. He asked what was the cut off point where no more savings could be made?

Q Chairman asked how can the Trust make 5% savings which equated to £25m?

A Mark Newbold responded that the Trust could continue to see 50% achieved in

CIPs without any damage to service quality. The Trust had, in the past, managed to achieve its CIP using its additional income together with the annual rise in the level of income. However, this would not be the case going forward. There is no annual rise expected in the foreseeable future and the Trust income is set through the new Jointly Managed Risk Agreement. The Trust could not achieve these savings alone and needed to work with its commissioners, GPs and community services through a whole systems approach to achieve savings. Birmingham Health Community were working towards having agreements in place to achieve these savings but it would take time to see them through. Dr Newbold felt that the Trust was in a reasonable place to achieve 50% of the savings but it would be the remaining 50% which would need imaginative-thinking to achieve.



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Q Albert Fletcher (Birmingham North) noted the nursing standards and was pleased

to see the improvements made but it needed to be remembered they are only part of the team: Nurses do an extremely good job but doctors and auxiliary staff should not be forgotten and similar scrutiny schemes should be in place to monitor their performance.

A Dr Newbold commented that when he commenced as Chief Executive one of the

main messages he received was that nursing standards were a major concern for the population we served but agreed wholeheartedly with Mr Fletcher that it was a team effort.

Q Cllr Jim Ryan (Solihull Metropolitan Borough Council) welcomed the statement on the continued support for Solihull Hospital and encouraged the Trust to communicate its plans to the wider community who felt the future of the hospital to be vulnerable. He suggested that such a statement would be welcomed. Cllr Ryan then referred to the statement of efficiency savings of £25m pa and said that some might suggest that if the Trust could make these savings now without affecting services then perhaps it has been overfunded in the past.

A Dr Newbold replied that some of the efficiencies the Trust could make depended

on other parts of the system playing their part. For example, in order for us to discharge patients in a timely fashion, the Trust is reliant on a whole systems approach which was much more likely to work better now than it had a few years ago. The Trust had also previously been paid by tariff which meant some hospitals achieved more income than others. The new Jointly Managed Risk Agreement now means that the Trust has been able to agree services with its stakeholders.

A Chairman advised that he and Adrian Stokes (Finance Director) had recently met with the new CCG Chairs and he was able to report that they were supportive of JMRA and our plans to create room in which to transform services. The Chairman advised that once plans for Solihull had been developed we would make this information available to the public.

Q Barry Orriss (Staffordshire South) advised that the A&E department at Mid Staffordshire Hospital is closing overnight. He asked if the Trust was in a position to see a change in pressure due to this closure and if it this had an impact on the 95% A&E 4 target Good Hope Hospital?

Q Chairman noted the pressures on the Good Hope A&E adding that the new A&E department at the hospital was due to open in December 2012. The new department had been specifically designed to ensure patient flow was easier but asked if there was a risk that the new A&E facility would attract more people?

A Dr Newbold agreed that there was a risk, however, since the inception of the 95% A&E 4 Hour target, more people have attended A&E with minor conditions because they know they will be treated within that time frame. He advised that there had been no material impact on Good Hope Hospital due to the Mid Staffordshire Hospital overnight closing albeit a small increase had been seen at Burton, Wolverhampton and Walsall Hospitals. Overall there was no significant impact.

Q Barry Orriss asked about whether the Trust was working to promote research and



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innovation in order to gain as much income as possible and whether we were attracting all available research grants available to the Trust.

A Dr Newbold responded that we were probably attracting all available grants but that we had recently appointed Professor Don Milligan as Head of Research and part of his remit was to grow the number of clinical trials at the Trust which would increase income. The Chairman thanked Dr Newbold and staff for the considerable amount of progress made this year and asked the meeting to receive the report. The report was received.

12.58 ANNUAL REPORT AND ACCOUNTS Ms Cat Little from PriceWaterhouseCooper (PWC), the Trust’s Auditors, presented the Audited Annual Accounts for 2011/12. She explained that the role of appointed auditor in the preparation of the Annual Audited Accounts and the Quality Report process. She advised the meeting of the significant amount of work that goes on behind the scenes by the finance department to produce the accounts. She added that in comparison to other Foundations Trusts and the rest of NHS, HEFT was in a healthy financial position and is looking ahead at how it can deliver services in the current and future financial constraints. She further advised that all Governors had been invited to an informal session with PWC and members of the Trust Finance team immediately prior to the AGM to give Governors an opportunity to raise any queries they had in relation to the Audited Accounts as presented at this meeting for approval. The financial standing for the Trust was as follows: Operating Surplus of £14.17m for 2011/12. Net surplus of £6.68m. Improved financial outturn from 2010/11 as no impairment of the estates

(unlike in the prior financial year) and there was also some tightening of control over costs.

Cash balance at 31 March 2012 was £97.2m (£98.3m at 31 March 2011). Over performance came down last year and PWC were pleased to see the

Trust had the JMRA in place.

Internal financial control: There were no significant weaknesses and there continued to be

improvements in capital accounting. Quality Report: The format of the report is directed by Monitor. Opinion on content and consistency with other information and indicator

testing was given. There was a marked improvement in presentation from 2010/11.

PwC have given an unqualified opinion on report and accounts and Charitable Fund financial statements

Continuous improve auditors for last 7 years. Lots of changes over last couple of years

Ms Little added that looking ahead to 2012/12 the Trust needed to consider the



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following considerations that may impact the Trust: • The Birmingham health economy and the Trusts financial standing • Future changes in income and activity • Development of cost savings plans, including ensuring delivery. • Priorities for investment in the Trust estate. • The demise of primary care trusts and the establishment of GP

Commissioning Groups. • Future of the NHS in relation to the changes to acute hospitals and community

services • Human resources and cultural changes this may have on the organisation. • The Reshaping HEFT programme.

Ms Little was pleased to hear from the discussions during the meeting that the Trust is looking ahead and was reassured to hear that all issues raised by the Auditors have been covered in this evening’s discussions and was comforted by the strategy and plans in place to look at the significant issues being faced by the Trust including the challenging CIP. Overall PWC were pleased to issue an unqualified audit opinion on the Trust’s 2011/12 financial statements and had not matters to report on arrangements to secure economy, efficiency and effectiveness. Income settlement received for additional delivery of activity (over-performance) was again lower than in previous years. Accounting judgements around the recognition of restructuring costs and changes in the use of assets were consistent with their findings in 2010/11. PWC were content and had issued an unqualified opinion on Charitable Funds financial statements.

Q Jim Ryan questioned the difference between the operational surplus of £14.17m 2011/12 and the reported net surplus of £6.68m

A Cat Little explained that operational surplus was pure income over expenditure,

this is the £14.17m. Adjustments for other direct costs eg interest payments, PDC dividends plus any other accounting adjustments eg impairment are then removed, this gives the net surplus £6.68m.

A Adrian Stokes advised that the largest adjustment was the PDC dividend of £10m

that the Trust has to repay back to the Government. Q Jim Ryan further asked whether the surplus of £6.68m had been made in addition

to the savings of £25m? A Adrian Stokes responded that the £25m of savings will have been taken out of the

system during the year and the £6.6m surplus is the amount we have left after delivering those savings. Going forward into next year our income or inflation will account to £25m so in order for the Trust to remain in its current financial position it would need to make further savings of £25m. Each year our income normally reduces by 1.5% known as ‘tariff deflator’ where the price tariff effectively drops by 1.5% on average, and in addition to that will be the cost of inflation, wages inflation, increases in insurance premiums, energy etc equates to about 3.5%. The 3.5% cost increases and the 1.5% income fall equates to the 5% challenge we face.

Q Barry Orriss asked where the surplus was invested and whether the Trust got a

good rate of return?



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A Adrian Stokes advised that the return was between 0.9% and 1½%.

Q Barry Orriss noted that this seemed a very low return on investment based on the

amount of money we invest. A Cat Little advised that there were some very strict rules where you invest which

restricted the rates. Q Chairman asked if PWC satisfied that the Trust was adhering to the rulings? A Cat Little responded that PWC had looked at this in the past and was satisfied

with the returns received. A Adrian Stokes added that the Trust’s Treasury Management Committee also

looked at what rates were available as well as checking which banks were in distress and took action to cease investing with them.

A Richard Harris (Non Executive Director and Chair of Audit Committee) added that

the most important factor was to ensure that cash is safe and as such the Trust chose with great care the banks we deposit with and there was much more a focus on safety rather than rate of return.

Q Chairman suggested that as this was an issue raised by Barry Orriss that this was an issue that the CoG Finance and Strategy Committee may wish to take a look at over the coming months.

A Barry Orriss agreed to raise this at the committee.

The Chairman thanked Ms Little and the team at PWC as well as the finance team which had resulted in an unqualified report and they were to be commended on the quality of information. Adrian Stokes passed on his own thanks to the PWC team on the work they had undertaken. Albert Fletcher complimented the team on the quality of the performance. The Chairman asked the meeting resolve that the Audited Accounts, Directors Report and Auditors Report be and are hereby received. Agreed

12.59 FINANCE AND BUSINESS UPDATE

12.59.1 Financial performance year to date Mr Stokes presented his pre-circulated report and noted the following key points in particular: The Annual Report and Accounts including the Quality Report were submitted

to Monitor within the allocated deadline on 31 May 2012 following which they were presented to Parliament in July 2012.



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PriceWaterhouseCooper (PWC) had given the Trust a clean audit opinion for both the Annual Report and Accounts and the Quality Report and he expressed his thanks to PWC for the work they had undertaken.

The Trust had ended the year 2011/12 with a surplus of £6.6m which was as presented to the May 2012 meeting.

The Trust has a challenging year ahead of it in terms of its financial performance and was looking for a year end surplus of £5m. In order to achieve this it has in place more rigour around delivery of plans to ensure it does not lose control of areas of spend including CIP delivery and pay controls. The CoG Finance and Strategy Committee chaired by Barry Orriss will be examining our performance in detail throughout the year.

The planned Capital expenditure budget for the coming year is £40m and with some big investments underway including Good Hope A&E and Theatres and Heartlands Pathology all of which are progressing well and due for completion in 2012/13.

The Trust is achieving all its Monitor Performance Standards, including A&E 95% 4 hours, Infection Control and 18 weeks. However the level of challenge and the hard work which goes into achieving these targets should not be underestimated. Quarter 2 will be challenging around the A&E 95% 4 hour target but the Trust has a renewed focus going forward.

Birmingham City Council Debt. The Trust has now taken a firmer stance for response and resolution and had written to the BCC (appendix 2). The Trust had received a response from the BCC on 3 September 2012 with an offer which the Trust Board would consider at their next meeting. The Chairman opened the floor for comments;

Q Albert Fletcher thanked Mr Stokes for the update on the Birmingham City Council

debt and noted that the Council of Governors had first highlighted the need for resolution some two years ago. He wanted to impress on the Board the strength of the feeling that action should have been taken then. The matter has been raised at each meeting of the Council of Governors since that time and he was of the view that the matter could no longer continue. The situation was now a matter of urgency and the Council of Governors wanted to impress on the Board the urgency for resolving this matter. He was aware there had been discussions held with the BCC over a long period of time to try and resolve the situation amicably and without any adverse impact on working relations. History showed that the BCC had not supported the Trust, for example, when the Trust wanted to use the Belchers Lane land, car parking fees at Good Hope etc. A meeting to discuss the debt had been planned for August but had been rescheduled to October at the request of the BCC. Mr Fletcher therefore suggested the following recommendation “that if the Trust did not receive a satisfactory conclusion, in that the BCC admitted to owing this money and agree to pay at the meeting in October the Board ought, at its meeting in November, to agree to immediately take the BCC to court as a matter of urgency and without delay”.

A Michael Kelly supported the Chief Executive’s letter (Appendix 2) and the suggestion for the BCC to pay the suggested £2.7m. He hoped that the BCC would settle.

A Jim Ryan disagreed with Mr Fletcher’s proposal and thought that the stance taken with BCC ought to be through intelligent negotiation. He added that he did not feel that taking a legal route was the way forward. He suggested that a meeting was sought between the Chairman and Sir Albert Bore to discuss a way forward as a



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matter of urgency and report back to the next meeting of the Council of Governors on the outcome of that meeting.

Q Chairman noted this topic had been discussed for some time and clearly it would

be much more preferable to be able to resolve this matter without the need for litigation. He was aware that there was a sense of frustration shared by both the Council of Governors and the Board. The Chairman asked Les Lawrence, Non Executive Director and Chair of the Finance and Performance Committee, who had been taking a keen interest in this matter, if he had anything he wished to report at this point?

A Les Lawrence confirmed that he had great sympathy with Council of Governors and since he had taken over as Chair of Finance and Performance Committee he had sought to gain a degree of co-operation with the new administration. He was assured that the new leader now understood the size and seriousness of the position. BCC saw the debt as a charge on their resources and one that they did not have any resources to underpin. Mr Lawrence felt that this commitment from the BCC showed they were willing to find a resolution and felt that it was appropriate that, should the Council of Governors agree, the Trust explore this route before taking a path of litigation.

Q Najma Hafeez (Non Executive Director) was under the impression that there was

a meeting arranged between Sir Albert Bore and the Chairman and that this meeting ought to take place in order for the BCC to be made fully aware of the feelings of the Trust.

A The Chairman clarified that Sir Albert and he were due to have an introductory meeting next week where a number of issues would be discussed.

Q Kath Bell (Patient Governor) asked whether the Trust was expecting them to pay in full or pay in instalments? She commented that we needed to look at a reasonable way to take this forward.

A Adrian Stokes noted that today’s discussions were a good example as to why the Board had struggled to decide a way forward.

Q Chairman asked Mr Fletcher for his views on the suggested course of action given

today’s discussion and debate.

A Albert Fletcher indicated that this matter had been going on for a long time and that if the matter had not been resolved amicably by end of October then it was his view that the Trust should go to Court to gain settlement.

Q Chairman accepted all the comments made by Governors regarding this matter and recommended that he, as Chairman, should give the Council of Governors a guarantee that Board would take a firm view at its meeting in November and he would report back to the Council of Governors following that meeting. He asked Mr Fletcher if he was content with this action?

A Albert Fletcher responded that this would be dependent on what the firm view would be.

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November would be that, having received an offer of settlement, might this amount be agreed as sufficient payment towards the debt. The Board would need to have discretion in deciding the next appropriate action to take.

Albert Fletcher suggested changing the proposal to say that “the Council of

Governors would recommend that if there is no further progress in resolving this issue with BCC then, at the Board meeting in November, the Board will determine to take this matter to Court”

Philip Johnson suggested writing to Sir Albert Bore to advise him of the topics to be discussed at the forthcoming meeting.

Q Neil Shuker–Harris asked whether the BCC accept that they owe us this money?

A Adrian Stokes advised that historically they have advised that that they don’t fully own the debt

Q Neil Shuker–Harris commented that if they do not own the debt then there is no

point trying to negotiate. Albert Fletcher suggested course of action is correct there is no point in delaying taking legal action.

A Adrian Stokes confirmed that there was recognition from the BCC that they do owe the Trust money. The Chairman summed up the discussion by reiterating Mr Fletchers original recommendation:

“that if the Trust did not receive a satisfactory conclusion, in that the BCC admitted to owing this money and agree to pay at the meeting in October, the Board ought, at its meeting in November, to agree to immediately take the BCC to court as a matter of urgency and without delay”. This was followed by Jim Ryan’s request for an amendment “for no action to be taken until after the Chairman and Sir Albert Bore had met to be able to discuss the debt and the BCC were given a window of opportunity to resolve the debt but if no resolution was forthcoming then legal action should be pursued”. Following which Albert Fletcher suggested the following motion; “the Council of Governors would recommend that if, at the Board meeting in November, no progress towards a resolution has been made then there would be a recommendation to the Board to take legal action”. The Council of Governors were asked to vote for or against this course of action. The motion was carried unanimously.

Q Jim Ryan asked whether the information given on the Performance - Monitor Standards (page 56) could also show figures as well as the percentages shown.

A Adrian Stokes agreed to do so.

12.59.2 Annual Safeguarding Report Ms Sunderland (Chief Nurse) summarised the HEFT Adult and Children’s Safeguarding Annual Report 2011/12. The report provides an overview of the



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activities and achievements in relation to the safeguarding of both adults and children and informs the Board of priorities and plans for the coming year. The CQC declared the Trust compliant in relation to the CQC Standards. The priorities for safeguarding vulnerable adults for 2012/13 will focus upon developing an integrated Safeguarding Unit combining adult and child, acute and community safeguarding teams with the addition of on-site children’s social work services. The priorities for safeguarding children for 2012/13 will continue and further develop education programmes particularly level 3 workforce, the supervisory framework for maternity /medical supervision and participation in a National Research study looking at the transferability of a variety of Patient Safety first measures in the safeguarding children arena.

Q Barry Orriss asked that, in relation to adults, do we utilise patient’s friends to protect our vulnerable patients interests?

A Mandie Sunderland confirmed we used patient advocates to do so.

Q Barry Orriss asked if we share information with other Trusts to guard against parents taking vulnerable children to other hospitals? With so many hospitals within the area it would be easy for a parent/carer to take a child to several different hospitals for treatment. He suggested that it would be easy to overlook a vulnerable child if this happened and asked if it was possible to set up a joint monitoring systems for vulnerable children?

A Mandie Sunderland advised that where children are under a care order their details are automatically flagged when they arrive at A&E for treatment. In relation to sharing information with other Trusts, if there was a concern about a child, social services would be informed. She confirmed that there was a register in existence that is shared between social care, education and health across the city. Neil Shuker–Harris also advised that the Trust was unable to set up a joint monitoring system as it had no actual action against children, just a suspicion and therefore Trust would be leaving itself wide open to criticism from parents/carers as well as in breach of the Data Protection Act.

A Mandie Sunderland confirmed that there was a register held of children who are considered to be at risk.

Q Liz Steventon (Solihull) noted that she had recently taken one of her own children to Solihull A&E and had been asked if her child was on the ‘Child at Risk Register’. She asked what was to stop a parent saying they were not, would their name automatically flag up when it was entered into the system?

A Mandie Sunderland advised that if a child is at risk and under a child protection

plan then they would automatically be flagged as at risk. The report was received.

12.59.3 Annual Report on Infection Control Mandie Sunderland (Chief Nurse) presented a summary of the pre-circulated report setting out the activities for the infection prevention and control team (IPCT) at HEFT during 2011/12. The report demonstrated the systems the Trust has in



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place for compliance with the Health and Social Care Act 2008: Code of practice for the NHS on the prevention and control of healthcare associated infections and related guidance. The Trust set out to continue the commitment to improve performance in infection prevention and control practice. It rose to the associated challenges and met all but one of its key goals. The Trust missed its MRSA target by one case during the year including two contaminants. A letter had been written to the SHA to seek a derogation but was declined; the Department of Health has advised that contaminants will remain as ‘poor practice’. The Trust has since put in place a real time contaminants assessment. The prevention and control of healthcare associated infection (HCAI) remained high on the Trusts agenda. The work of the IPCT maintained the significant efforts in the reduction of HCAIs and achieved its mandatory trajectory with an 11% reduction in MRSA bacteraemia and a 28% reduction in Clostridium difficile infections in the calendar year 2011/12 compared to 2010/11. No questions were raised and the report was accepted.

12.59.4 Update on Shift Patterns, On Call arrangements, 12 hour working and E-rostering Mandie Sunderland (Chief Nurse) presented a summary of the pre-circulated report. The report details on the working of shifts exceeding 12 hours on e-rostering and compliance with the Trust’s Rostering Policy. The e-rostering system, Healthroster, was introduced at HEFT in June 2010 and is electronically rostering 90% of inpatient wards as well as many of the Trusts specialist areas and teams. Time and attendance and absences are also recorded and reported. Whilst the rostering policy states that no shift should exceed 13 hours inclusive of breaks, there have been concerns raised that in practice some staff are working in shifts in excess of 12 hour shifts. The Chief Nurse recognised that there are instances where shifts in excess of 12 hours have been worked and will continue to be, however, these are unplanned exceptions and not routine practice due to service need and/or maintenance of patient safety. These instances will continue to be monitored as part of the nursing KPIs.

Q Michael Kelly confirmed that he had raised the question of shift patterns following complaints by several members of staff on how often they are expected to work shifts in excess of 12 hours. He asked how often are the shifts extended to cover sickness and what constitutes a long day and what breaks are staff entitled to?

A Mandie Sunderland advised that staff working a long day were entitled to 1 hour unpaid break and then a 20 minute break. Any additional hours worked due to an extended shift were expected to be taken as TOIL (Time Off In Lieu), no overtime payments were given. The report was received.

12.59.5 Re-Shaping HEFT – Stroke Services Update

Dr Anwar (Medical Director) presented a summary of the pre-circulated report on behalf of Mr Hackwell. The paper set out the model of care for the hyper acute and acute phases of Stroke Care and sets out the recommendations by Professor Matthew Cooke’s report to locate the hyper acute services to the Heartlands site. The NHS Midlands and East Stroke Services Specification was officially launched



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on 11 July 2012. The specification sets out the suggested criteria that different parts of the stroke pathway have to meet to deliver high quality care to patients and to achieve the improvements the review seeks. The report had been presented to the September meeting of the Board where it had been discussed in detail and had received approval in principle and tasked the Stroke team with developing an implementation plan based on this, should the Trust be commissioned to develop its services in line with the regional review findings. The Chairman opened the floor for questions:

Q Richard Hughes raised concerns around the 30 minute window for treatment and

what if it wasn’t possible to get to hospital within this timeframe?

Q Barry Orriss commented that there were assumptions that travel was based on a maximum timescale of 30 minutes and asked about the effect on beds at Good Hope and Solihull due to the repatriation of work?

Q Neil Shuker–Harris asked if the ambulance services were on-board with this new system?

A Dr Anwar advised that there was no perfect solution but that Professor Cooke’s suggestion is based on the best possible outcome for patients. Agreement had been sought from the ambulance service and they were confident that they would be able to transport patients within a 30 minute timescale.

Q Sunil Kotecha advised that a discussion had been held at the Solihull CCG and they were supportive of the hyper stroke services model, however, there were concerns about number of strokes coming to one unit and confidence in how they were to be processed.

Q Kath Bell noted that in Prof Cooke’s report it advises that the Heartlands site will be the main unit and noted that Heartlands did not have the facilities required.She asked what were the plans for development, implementation and cost?

A Dr Anwar responded that there would be about six or seven extra patients being seen at the Heartlands site, and work on the changes to current pathways was to be undertaken.

Q Neil Shuker–Harris queried some new marker for strokes around what time a stroke occurred and the subsequent thrombolysis treatment, if that test was to come in what effect will this have on the process?

A Dr Anwar advised thrombolysis is only one small segment in the treatment of stroke. The use of the new biological marker will be focussed only on those patients who have a stroke during their sleep.

A Dr Newbold responded that it was not proposed to move the individual hospital

site units to Heartlands. There was a question around the Trust being able to afford to set up on one site; however, this will be discussed further during the regional review. He confirmed that today’s discussion would be fed back to the team undertaking the work.

Q Ian Lewin (Joint Lichfield & Tamworth Borough Council) asked how many patients will the unit accommodate?



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A Dr Anwar responded that there were sixty to ninety beds assigned to stroke; these

are fragmented in the current service so there will be a need to consolidate services.

A The Chairman commented that the Department of Health was determined to reduce the number of units to three or four within the West Midlands region and the Board had focused its discussion around this. The report was received.

12.60 GOVERNANCE ARRANGEMENTS

12.60.1 Appraisal of Non Executive Directors

The Chairman requested that Non Executive Directors to leave the room for this section of the meeting. Following this the Chairman advised the meeting on his appraisal of non executive directors. The process followed was very similar to that used for all HEFT staff which consisted of a self appraisal by the individual from a number of pre-set questions and then a 360 degree anonymous review by six colleagues comprising the Lead Governor, the Chairman, two other NEDs, the Chief Executive and Company Secretary. The appraisal process would be used to inform the reappointment of existing NEDs by Governors. Each of the appraisals identified areas of development for individuals over the next 12 months. The Chairman had discussed the details of each appraisal with the Lead Governor, Richard Hughes. Albert Fletcher confirmed his approval of the new appraisal system and asked for an explanation of the 360 degree review. Chairman advised that the NED had to nominate a number of colleagues to give their opinion on their performance and areas of strength and identify areas in need of further development. The Chairman then left the meeting.

12.60.2 Appraisal of Chairman Anna East (Deputy Chair) and Richard Hughes (Lead Governor) advised the meeting on their appraisal of the Chairman which they had recently undertaken. This had followed the same process as the NED appraisal system and the following points were noted:

The process followed was the most thorough that had been undertaken to

date. Twenty-seven people had been invited to comment on the Chairman’s

performance of which nineteen responded. All the responses were very good with the majority considering he had

strengths in each of the twelve groups. It was felt that there was an overall considerable improvement in

Chairmanship of the Trust. The priorities for the next twelve months have been considered and include

finance; in particular, payroll and the transformation required by the



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organisation to meet the Nicholson agenda. The Chairman himself felt it was also important to spend time on internal relationships and improve engagement with clinicians.

Michael Kelly added that he felt the Chairman was exemplary and HEFT was very

fortunate to have him as Chair. Richard Hughes highlighted the challenge for Governors in the coming year in that they would need to recruit two new NEDs as a consequence of Anna East and Paul Hensel reaching the end of their respective terms of office. He also noted that the Chairman would be following up with NEDs their development plans and tracking their progress to ensure they have achieved their goals, all of which set the tone for a challenging 12 months. Michael Kelly noted that following the election of the new NEDs, one had not, as yet, managed to attend the Council of Governor meetings. Albert Fletcher thanked Mr Hughes for the work that he had undertaken since his appointment as Lead Governor especially for the work around the appraisals which he considered to be exemplary.

Jim Ryan thanked the Deputy Chair and Lead Governor for presenting the reports and asked colleagues to accept these in their entirety. He also asked that a further area for consideration might be – “Would like to consider equality and diversity as an area for development in the coming year” - as he felt that this area was at times absent from reports.

Lisa Thomson responded that the Chairman took Equality and Diversity very seriously and, as such, had requested that a special seminar be held to address this matter. She advised that a similar seminar could also be held for Governors if they would like this. The reports were received and the Chairman and Non Executive Directors were invited to rejoin the meeting.

12.60.3 Governors Attendance Record

The Chairman presented his pre-circulated paper setting out Governor attendance at Council of Governor meetings during 2011/12. He thanked the Governors for their time and input to the meetings they attended. The attendance record was noted and received.

John Roberts (Sutton Coldfield) advised he was in attendance at meeting held on 23 March.

The Chairman confirmed that the record would be amended. 12.60.4 Governors Governance Review Update

The Chairman presented the Annual Governors Governance Review which set out recommendations made following the informal review held in July 2012 of the Governance Structure that had been put in place in September 2011.



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Q Albert Fletcher referred the meeting to the recommendation on page 154 and challenged the decision to merge the Membership and Community Engagement Committee with the Patient Experience Committee due to the lack of quorum at the last few meetings. It was also felt that the roles of these committees overlapped and, as such, an agreement by the Council of Governors to amalgamate the two committees was sought. Mr Fletcher was of the view that this was not what was agreed and challenged the amalgamation of those committees. He believed that the meeting schedules for both of these committees had been agreed without consideration of the members’ diaries and no opportunity to rearrange the meetings had been given. It was his view that these two committees should not be merged and asked members for their views.

A The Chairman opened the meeting up for comments on the merging of these two committees.

A Michael Kelly was happy for the joining of these committees and was of the view that this had been agreed.

A Elaine Coulthard (Sutton Coldfield) Chair, Membership and Community Engagement committee advised that she has resigned as Chair due to other commitments and Jim Cox had taken over the Chairmanship in the interim. Her resignation had left the committee a member short.

A Kath Bell confirmed that there was a need to keep patient experience committee as they do very good work.

A Chairman confirmed his agreement as there was clearly a need for a Patient Experience Committee.

Q Stuart Stanton (Solihull North) noted that the Constitution Review Committee had referred questions to the Membership & Community Engagement Committee for them to do some work so that it could progress with the review. As the meeting had not met to action this he asked if this had therefore held up the review?

A Malcolm Pye responded that the Constitution Review meeting had tasked the Board Stakeholder & Community Engagement Committee rather than the Governor Membership & Community Engagement Committee in this regard. He also confirmed that the various Governor Committee meeting dates are set by the members of those individual committees and were not driven by the executive leads.

A David Treadwell suggested that if the decision to amalgamate the Membership and Community Engagement Committee was based on the shortage of members could we not send an invitation to Governors to join the committee.

A John Roberts advised that it was up to the members of the committees to agree to amalgamate.

A Ian Blair noted that if the terms of reference for the committees overlapped then they may be able to easily merge them.

A Albert Fletcher felt that the officers of the meeting had made a decision not to meet until an amalgamation of these two committees had been agreed and that they had driven the decision and not the members.



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The Chairman summed up the discussion by noting that there was clearly a general desire to keep the committees separate. The Company Secretary would write to all Governors asking for volunteers and report back to the next meeting on the outcome.

12.60.5 Directors Attendance Record

The Chairman reviewed his pre circulated paper setting out the Executive Directors attendance at Board Meetings during 2011/12. It was noted that attendance had been very good. The report was received.

12.60.6 Constitution Changes The Chairman presented a paper setting out a number of changes to the constitution as a result of the Health and Social Care Act 2012 following it receiving Royal Assent earlier this year and it was noted that: Implementation was being phased and the various sections of the Act will

come into effect upon the issue by the Secretary of State for Health of Commencement Orders.

Commencement Orders 1 and 2 have recently been issued, implementing various sections with effect from 1 October 2012 following which Monitor has now issued instructions requiring FTs to make amendments to their Constitution to incorporate the changes consequent on the first and second Commencement Orders.

The paper sets out the changes required. These changes are all purely consequential to the Commencement Orders and Monitor has asked that FTs do not make any other changes as part of this update.

The changes to the Constitution need both Board and Council of Governors approval.

The changes were presented and approved by the Board at its meeting on 4 September.

The Council of Governors is requested to authorise the Chairman and the Chief Executive to approve any necessary changes to the Constitution for submission to Monitor.

Q Albert Fletcher referred to Annex 6 and asked what this was?

A Malcolm Pye (Company Secretary) advised that it sets out the terms should there

be a disagreement with between the Board and the Council of Governors and requires that in respect of a disagreement 2/3rd of governors need to agree before a change can be implemented. He further advised that the amendments to be agreed today were those directly deriving from the Act, Monitor have requested that the Trust should not make any changes other than those stated and tracked as red in Appendix 1.

Q Mike Kelly noted that in 8.10.1 the period of office for Governors was 3 years and asked why we re-elected after two years.

A Chairman confirmed that this was under review as part of the Governance Review which is currently underway. The next meeting is planned for the end of October with conclusion by the end of December 2012.



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Q Richard Hughes pointed out a typographical error in the last line on page 185.

A Malcolm Pye confirmed that this would be corrected.

Q David Treadwell asked if Governors will need to stand for re-election? A The Chairman advised that currently Governors could only stand for two terms

and the recommendations are that following the changes to the constitution Governors will be able to stand for a third term.

The Chairman further advised that the changes in the constitution presented today only references the Monitor changes as set out. The changes were approved.

12.61 REPORTS FROM COMMITTEES of the Council of Governors

12.61.1 Finance & Strategy Committee Report

Barry Orriss advised that the Committee had met on 10 July 2012 and 10 September 2012 and discussed:

The key assumptions around the finances in detail The rectification plans The traditional approach to generate CIP and the recognition of the

limitations of this approach Re-Shaping HEFT. Simon Hackwell had given an update on the current

status of the programme and Mary Ross, Clinical Director for Therapies, gave report on ‘HEFT at Home’ trial.

Les Lawrence, Non Executive Director and Chair of Finance & Performance Committee had attended the meeting.

12.61.2 Finance & Strategy Committee Minutes

The draft minutes of the meeting held on 10 July 2012 were noted.

12.61.3 Patient Experience Committee Report Michael Kelly reported that the Committee had met on 7 September 2012 and noted that: Mr Gerry Robinson, Chair of the Consultative Health Committee, had attended

to give an update on the Visiting Concordat. Joanna Hodgkiss, Head of Planning, and Mary Ross, Clinical Director of

Therapies, gave an update on Re-Shaping HEFT. Ann Edgar, Matron for Elderly Care, gave an update on dementia noting that

length of stays are significantly up against the national average and that 97% of nurses have no dementia expertise for nursing dementia patients.

Lack of A&E signage in Sutton Coldfield Town Centre was discussed and John Sellars (Director of Estates and Facilities) and Sue Moore (Managing Director, Good Hope Hospital) have agreed to look at this and will report back to the next meeting. Lisa Thomson responded that this was being looked at as a priority.

He had attended a lecture at Aston University for the presentation of the AMAS (Aston Medication Adherence Study) report which looked at patients



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with four specific conditions. He had distributed copies to the Chairman and the Chief Executive. The survey consulted over 4000 patients and 170 GPs in 75 practices and found that in inner city areas 70% of patients struggled to adhere to their medication regime and found that 30–50 long term patients failed to take their medication with a cost to the NHS of £3m. The report also commented that some articles in the media had an impact on patients taking medication especially in the elderly population.

12.61.4 Report from FTGA Representative

Michael Kelly reported that he had attended an FTGA meeting on 6 September 2012. David Amos had given a presentation (copies of which were available at this meeting) on the role of the Board of Directors. Earlier indications were that 50% of Trusts were not achieving financial balance. He went on to add that Mr Amos had highlighted the success of HEFT and had been very complimentary about what we had achieved as a Trust. He had also noted that the communication with members was paramount and again mentioned that HEFT had exemplary, high quality communications with its members.

12.62 ANY OTHER BUSINESS Q David Treadwell asked on behalf of a local Patient Participation Group within

South Birmingham if we had experience of IT difficulties in accessing patient records and issues regarding the lateness of results being returned to the GPs?

A Neil Shuker-Harris responded that the system was fully automated and was also a very good system. It was down to the GP to review the results.

Q Thomas Webster noted that the meeting had been very well run and that the AGM was an ideal opportunity to publicise the success and achievements of the Trust over the last 12 months. He suggested that the Trust needed to communicate more of its positive stories to the general public.

Q Neil Shuker-Harris asked about the team which were currently undertaking an audit regarding outsourcing the Trust’s IT function and commented that he could not remember this being previously presented to the Council of Governors for discussion. He asked if they could have an explanation as to future IT plans.

A Andy Laverick (Director of Information and Chief Information Officer) responded

that the Trust was not looking at outsourcing its IT function but rather looking for cost saving opportunities and efficiencies within the organisation. The Trust was also looking at ways in which it might generate income by offering its services to other Trusts.

Q David Roy (Staff Governor) advised the meeting that he had recently been

admitted to the Blakesley Ward following a cycling accident and praised the staff and Gill Edmunds from the ward on the exemplar care that he had received.

………………………………

Chairman


November 2012


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Q:\Governors\GCC Full Meetings\2012\ROLLING MATTERS ARISING SCHEDULE.doc

AGENDA ITEM 5


SCHEDULE OF MATTERS BROUGHT FORWARD and ACTION POINTS

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15 July 2011 11.35 Establish Young

Governors Council LT Nov 2012

Being trialled in Solihull – an update will be brought to November meeting.

11.35 Further Governance Review meeting Chair Sept

2012

Summary paper to be brought to September meeting.

18/09/12

12.16 Transportation Strategy Update - Final Business Case Review

JS Jan 2013

Update on Business Case to be brought to November meeting for Governor review ahead of final decision being made. Delayed until Jan 2013

12.25.5 Winter Experience Review

AS/ AA

Nov 2012

23 May 2012 12.33 Session to Review

Quality Data Chair Autumn To be arranged

12.38 Concerto EPR/Clinical Portal – update on progress to date

IT Nov 2012

12.39.3 Update on Jubilee Train Scheme (buggies)

LT Nov 2012

Verbal update on Train Scheme and Jubilee Benches

16 July 2012 12.44

Update on Shift Patterns, On-call arrangements, 12 hour working and e-rostering

MS Sept 2012

18/09/12

12.47

Birmingham City Council – update on debt resolution discussions

AS Nov 2012

To be included as a regular item within Financial Performance Report.

12.50 Update on cash machine repairs at Heartlands

JS Sept 2012

18/09/12

12.51 Worcestershire NHS Trust consultation on closure of A&E depts.

Chair Autumn 2012

18 Sep 2012 12.60.4 Committee

Membership Review Chair Nov 2012

12.60.6 Recommendations from Constitution Committee

Chair Jan 2013

Matters Arising

November 2012


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Chairman's Report

Chairman’s Report to the Council of Governors – November 2012 In addition to the items I presented at the recent Trust Board (6th November 2012) I would like to take this opportunity to bring the Governors up to date on the recent media coverage concerning Mr Ian Paterson. Mr Paterson On 7th November, Thomson Solicitors held a press conference giving the media the opportunity to speak to Mr Ian Paterson’s patients, both from the private sector and from the NHS. There has been an increase in press interest about Mr Paterson after he was suspended by the GMC, which is why this event was held. In the NHS, the issues are around Mr Paterson performing a surgical technique for mastectomies which was not performed on all patients but which was, following an external review, considered to be not an appropriate technique and was stopped in 2007. The Trust was alerted formally to concerns around Mr Ian Paterson’s practices in 2007 and instigated a detailed review, which included an independent assessment of the surgeon’s practice and a targeted recall programme.

This review of breast surgery services provided through Solihull Hospital, identified that a surgical technique for mastectomies used by one of its consultants, Mr Ian Paterson, required closer scrutiny to establish whether it represented best practice, based upon current clinical knowledge. This procedure was not performed on all patients undergoing mastectomy. An external review highlighted that this was not a usual procedure and that Mr Paterson had not followed guidelines to introduce a new technique. This Trust’s position, after careful consideration, was that the technique was not an approach considered appropriate going forward, and the method was therefore stopped. The Trust then began a process of identifying patients who may have undergone this procedure, to ensure we reviewed their current clinical condition.

As a consequence of the Trust’s ongoing concern, the surgeon was excluded from the Trust in 2011 and the recall programme was extended to include all patients who had undergone a mastectomy – a programme that is now complete.

The Trust has been working with the Regional Cancer Network to increase its understanding of the clinical issues. The Trust has invited all of Mr Paterson’s patients who underwent a mastectomy, to see an alternative surgeon for a review of their treatment and care. This includes patients who have been discharged. Specialist clinics were arranged and all patients were seen by the end of March 2012. Every patient who may be affected has been given an opportunity to be personally reviewed and the Trust has set up an advice line 0121 424 5473 which is available between the hours of 9am and 12midday, Monday to Friday, with the opportunity to leave a message at other times. The Trust has continued to publicise this and encourage anyone who is at all concerned to get in touch. The Trust has seen 553 patients. It has also met with patients and relative and is continuing to offer advice and support.


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The Trust is committed to ensuring whatever learning is needed from these complex events, is achieved and shared widely and are currently planning an Independent Review, led by a QC, which once completed will be made publically available. It is anticipated that the review will establish a complete timeline and understanding of the sequence of events, based on a look back over what we now know, including considering more general concerns raised in 2003/4 around breast services. In addition, it will invite patients and staff to give their views. The Trust will be sharing this information as it becomes available. We will keep the Governors fully informed of all progress.

The Birmingham Bereavement Project

The Trust is leading the implementation of the Birmingham Bereavement Project which was a city-wide collaborative approach to develop and test an integrated bereavement support model. Its aim was to deliver high quality care and outcomes for bereaved people, service providers and organisations.

Many stakeholders were involved along the bereavement pathway from the primary, secondary, tertiary, voluntary and private sectors and bereaved relatives. The project explored new ways of working and moving from task-focussed to patient and relative-centred care. For example, a follow up service for bereaved relatives demonstrated that our care does not end when a patient dies and that immediate, short and long term support can be provided to relatives. This has also allowed early identification and intervention for any concerns, questions about the care received following the death of a patient and if further support was required. A robust training and education package on end of life and bereavement care has enabled our staff to be more confident and competent when dealing with these sensitive situations.

As the first national early adopters of the new death certification reforms, the Trust can clearly demonstrate a whole system approach through the implementation of the medical examiner role, including open and honest communication with relatives, guidance for junior doctors and appropriate scrutiny of all deaths in our care. Initial feedback from relatives and medical examiners has been overwhelmingly positive.

The Trust has been invited to be the national flagship for ‘Compassionate Carers and Compassionate Employers’ by the National Council for Palliative Care and the Dying Matters Coalition. This exciting and ground breaking opportunity, with executive director support from Mandie Sunderland Chief Nurse, will allow us to showcase compassionate care for all, which is at the heart of excellence in nursing.

Visit by Norman Lamb MP Tuesday 13th November saw Normal Lamb MP, Health Minister at the Department of Health, visit Heartlands Hospital to gain an introductory overview of the Rapid Assessment, Interface and Discharge (RAID) service which is run by Birmingham and Solihull Mental Health Foundation Trust at five hospitals in Birmingham and Solihull.

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Sue Turner, Chief Executive of Birmingham and Solihull Mental Health NHS Foundation Trust (BSMHFT), Mark Newbold and I met the Minister, giving him a tour of A&E at Heartlands followed by an opportunity to meet with our frontline medical staff who work with RAID at Heartlands. The RAID service was launched as an 18-month pilot scheme at City Hospital in December 2009, to provide an in-house psychiatric liaison service to help reduce waiting times and streamline patient care, as well as make significant savings. At the time, RAID was the first service of its kind to ensure patients presenting at acute settings received help for their mental health as well as their physical health in the same place, at the same time. Previously, people could face lengthy waits before being referred onto the relevant mental health service but, under RAID, clinicians are able to assess patients within an hour of arriving at A&E or within 24 hours if on a ward. This partnership approach has not only resulted in better patient care but has also avoided unnecessary admissions to busy medical wards. RAID has shown it can reduce the length of stay for patients with dementia, to save the equivalent of two medical wards. Recruitment of Non Executive Directors In Spring 2013, Anna East and Paul Hensel will be reaching the end of their final terms of office as Non Executive Directors. I have convened a meeting of the Governors Appointments Committee for 7th December to consider the qualities and experiences needed for their replacements with a view to the adverts being placed in early January. The Committee will update governors on progress.

CHAIRMAN’S REPORT TO THE BOARD I thought you may be interested in a copy of the report I presented to the recent Trust Board on 6th November 2012: Safety, Quality and the Cost Improvements Programme I am pleased that the programme of safety walk-rounds continues and I have been especially supportive of, and reassured by, the recent Safety September campaign. From the feedback from staff we have seen high levels of engagement in all areas of the Trust in improving safety for our patients and on behalf of the Board I would like to thank Sarah Woolley and her team for the work in raising the profile of key issues across the organisation. I would continue to encourage all of my Board colleagues to take part in the safety walk-rounds to support this vital agenda.

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VISITS & MEETINGS Since the last Board Meeting I have continued to go out and about internally and externally and these visits have included: Sir Albert Bore, Leader of Birmingham City Council I met with Sir Albert to discuss the importance of closer working relationships and the need for a collaborative approach to solving issues which affect healthcare delivery across the region. Chairs of the Clinical Commissioning Groups (CCGs) We are continuing to build the important relationships with the CCGs and, along with Adrian Stokes, I have met with the Chairs, where we discussed priorities for the health economy and the continued importance of working collaboratively. Mentoring Debate Breakfast Meeting I met with a group of the Trust’s general managers as part of a mentorship programme which provides an opportunity for this key group to gain access to current themes as well as to discuss and debate current topics regarding political and strategic development which directly impact on the NHS and, more locally, the Trust. The Group recently visited the Houses of Parliament with the aim of gaining insight into processes of national governance. I found this meeting very informative and was impressed by the level of commitment from these staff. Wisdem and Warwick Medical School Annual Clinical Symposium I attended the 2012 Wisdem and Warwick Medical School Annual Clinical Symposium which focused on tackling ‘Grand Challenges in Diabetes 2012: High Quality, Cost-Effective Specialist Diabetes Care in the Community’. The speakers included Professor Andrew Boulton, President, European Association for Study of Diabetes & Professor of Medicine at University of Manchester; Dr Roger Gadsby MBE, Associate Clinical Professor, Warwick Medical School; and Jill Hill, East Birmingham Community Diabetes Care. This was an inspiring event where we discussed new approaches to healthcare delivery, including mobile healthcare to improve diabetes and obesity management. Ward Sister Challenge Many of us attended an update on the Ward Sister Challenge where we heard more about the initiatives being undertaken and the important work to deliver improved care and patient safety across the Trust. ‘Topping Out’ Ceremony of the Trust’s new pathology building at Heartlands I took part in celebrating the Trust’s partnership with the Health Protection Agency (HPA) and the launch of the new Pathology building with a traditional ‘roof topping’ ceremony.

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The jointly funded £8 million development involves a two storey extension to the current pathology building on the Heartlands Hospital site and will accommodate a new centralised core laboratory. It will also house a state of the art molecular biology laboratory for the diagnosis of infectious diseases and genetically acquired conditions. The team of 400 laboratory medicine and HPA staff currently working in the laboratory turn around more than 2.6 million clinical sample requests every year for the Hospital Trust and GPs in the surrounding community plus public health samples from across the region. The extension will increase the laboratory’s capacity in line with demand, whilst modernising and improving the services provided for patients and Public Health. I was part of a team placing the last tile on the building’s roof, thereby completing this key stage of the building development. Awards I am pleased to announce that nursing colleagues within the Trust have been recognised by the Patients Association for innovations in patient care. The Patients Association is a healthcare charity which for nearly 50 years has advocated for better access to accurate and independent information for patients and the public; equal access to high quality health care for patients; and the right for patients to be involved in all aspects of decision making regarding their health care. In its recently published document ‘Practices in C.A.R.E. Review’ Autumn/Winter 2012, the Trust has three different initiatives mentioned as examples of best practice. Some of this work will shortly be discussed in the Nursing Standard journal. Copies of the Patients Association Review can be found at www.patients-association.com. Certificates of Achievement – 6th Form Students During the summer we had 18 sixth form students undertaking research projects across the Trust. Upon completion of their findings, the projects will be submitted for a Gold CREST extended project award. I was delighted to be able to meet the students, review their work, discuss their placement experiences and present them with Certificates of Achievement. Chairman’s Lectures The series of Chairman’s Lectures continued with October seeing Dr Peter Carter, General Secretary and Chief Executive of the Royal College of Nursing present to a wide ranging Trust audience. These lectures present a unique opportunity to hear a national perspective on changes within the NHS and how implementation and changes are affecting the whole of the health economy. They are open to all staff and we will be encouraging anyone interested to attend as we expand these with video links going forward.

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Trust Board Away Day I feel the Board had a very productive away session last month where we discussed key strategic areas including how we are going to drive our openness agenda. Our finance and performance continues to be under close scrutiny via the Finance and Performance Committee and I know that the Chair, Les Lawrence and Adrian Stokes, will provide us with an update today. Following this meeting we have restructured our Board meeting today, with each of the sites having dedicated time to discuss progress against plans. Non Executive Directors Richard Harris, Non-Executive Director and Mark Newbold, Chief Executive, attended the Annual Foundation Trust Network Conference, which they both found very useful and informative. I have asked Richard to give a brief oral report to the Board at this meeting. Governors Our series of Breakfast Seminars continue to be very popular. Since I last reported in September, Tania Carruthers, Clinical Director for Pharmacy and Chris Wright, Associate Head Nurse, gave a presentation on delayed patient discharges, outlining the issues and how these are being tackled from both sides – pharmacy vs wards/patient-side. Sue Moore, Managing Director of Good Hope Hospital, held an afternoon session which focussed on Good Hope and its engagement with the local community and Clinical Commissioning Groups. She also touched on current issues at the hospital site, including the impact of reconfiguration works. Dr Aresh Anwar, Medical Director and Dr Mark Temple, Consultant Physician, attended an additional follow-up meeting to discuss delayed discharges. They shared the processes which contribute to delays in discharges including processing of prescriptions (discussed last month) and the processes involved in discharging patients, what causes the delays and work which has been completed to try and reduce them, including the Golden Hour Ward Round. All of our meetings were well attended and proved very informative. They generated lively discussion and Governors welcomed the open conversation as well as praising their work with patients and staff to improve and develop services. Volunteering The annual report for the Trust’s volunteering service is being finalised and is to be presented to the Stakeholder Trust Board Sub-Committee. Overall the Trust has increased volunteer numbers by 50%, replacing many short-term student volunteers by long-term local resident volunteers. Levels of attrition have reduced from 60% to less than 5% improving continuity and enabling the service to focus on improving recruitment and training.

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The volunteer service will be recognised at the Trust’s forthcoming Staff Recognition Awards for the contribution they play in supporting patients and relatives. 2012 Staff Recognition Awards – celebrating 10 years of success With the closing date for nominations for the current staff recognition awards now passed, and the judging completed, we are looking forward to the awards ceremony which is being held at the Crescent Theatre in Birmingham City Centre and the date for your diary is Wednesday, 14th November 2012 commencing at 7.30pm. Joining us again for the evening is Michael Collie. Michael is one of the presenters of Midlands Today and of The Politics Show on Sundays. He first came to the Midlands to study Drama & Theatre Arts at the University of Birmingham in 1981 and apart from one year in London he has been here ever since. Health Services Management Centre (HSMC) Health Policy Lecture Last month I attended the HSMC Health Policy Lecture given by Professor Jon Glasby, Professor of Health and Social Care and Director of HSMC on Equity and Excellence. This was followed by a panel discussion with participants including Professor Viv Bennett, Director of Nursing, Department of Health; John Wilderspin, National Director, Health and Wellbeing Board Implementation, Department of Health; Dr Judith Smith, Head of Policy, Nuffield Trust and Dr Nick Harding, Interim Chair, Sandwell and West Birmingham Clinical Commissioning Group. This was a lively debate which reinforced our approach for working across the health economy, both for shared learning, and for driving change and improvements for patients. Lord Philip Hunt of Kings Heath Chairman

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Chief Executive’s Report to the Council of Governors November 2012 In addition to the report I presented to the Trust Board in November I should like to bring the following items to the attention of the Council of Governors: Charity Donations The Starlight Children’s Foundation has donated a Fun Centre to the Hospital’s Emergency Department Children's Area. The robot-shaped mobile entertainment unit, worth £3,000, includes a Nintendo Wii console, four Nintendo DSis, DVD / Blu-ray player, internet access, flat screen TV and will be used to help distract children and help them feel better whilst they are being treated on the unit. Starlight is a national charity that provides entertainment in hospitals and hospices and grants wishes for seriously and terminally-ill children. We are very grateful for their generous donation. Staff Recognition Awards On 14th November 2012, we held our 10th Staff Recognition Awards Ceremony. A full house at the Crescent Theatre was treated to what was an entertaining and inspiring evening. I was delighted to be joined again this year by well known BBC presenter, Michael Collie, who helped me and the Chairman award and celebrate the achievements of our staff. On the night we presented 12 awards and I thought that the Governors would like a list of the winners:

Award Winner Runner-up

Chairman’s Award Alison Byrne Steve Taylor

Chief Executive’s Award Simon Jarvis Joint Runners-up: Dermatology Department/ Out of Hospital Services Team

Chief Nurse’s Award Helen Meehan Thersha Maharaj

Clinical Excellence Award Maria Kilcoyne Dementia Outreach Team

Faculty of Education IMPACT Award

Tissue Viability Team Bala Katyal

Governors’ Going Above and Beyond Award

Rahul Mukherjee Heidi Lane

Heart of England Charity Community Award

Jackie Benzecry

Non-Clinical Excellence Award Multi Media Team Touch Screen Project Team

Patient Carer Award Janina McMahon and Pauline Scialdone

Julie Smith

Patient Safety Award Julie Bradley Ward 11, Heartlands

Paul and Phyllis Winter Essence of Care Award

Ward of the Year Award; Ward 5 BHH

Most Improved Ward: Ward 9 GHH

Chief Executive's Report

Volunteer of the Year Award Joint Winners: Clair Johnson and Kayleigh Tricklebank

Performance Update Adrian Stokes, Deputy Chief Executive and Finance Director, will be presenting a detailed update on finance and performance. As an overview, I would like to highlight that the Trust’s underlying financial position continues to cause concern, with no material change in the month of September 2012. The challenge of the Trust’s underlying paybill and delivery of CIP remains with little or no improvement, and the Finance and Performance Committee continues to review rectification plans and monitor progress against these plans. In addition to the local plans, the Trust in November launched a MARS (Mutually Agreed Resignation Scheme). This is where staff are invited over a period of two months to voluntarily seek to leave the organisation. At the time of writing this report, it is too early to say the level of interest, and the numbers of staff who have been accepted to take up this opportunity; I will provide a further update at our meeting. We are in the second quarter of operation under the Jointly Managed Risk Agreement, which allows directorates to reduce activity whilst mitigating the financial impact of this on the Trust. Reviewing the agreement, we are in a similar position in terms of income as if we had stayed with Tariff, and through this joint working approach, have developed our relationships which will continue to prove very important going forward with our commissioners. We have a series of meetings across the Trust, inviting all staff to hear more about this agreement, and the challenge going forward, which can be illustrated by:

HEFT’s Current Trajectory


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Volunteer of the Year Award Joint Winners: Clair Johnson and Kayleigh Tricklebank

Performance Update Adrian Stokes, Deputy Chief Executive and Finance Director, will be presenting a detailed update on finance and performance. As an overview, I would like to highlight that the Trust’s underlying financial position continues to cause concern, with no material change in the month of September 2012. The challenge of the Trust’s underlying paybill and delivery of CIP remains with little or no improvement, and the Finance and Performance Committee continues to review rectification plans and monitor progress against these plans. In addition to the local plans, the Trust in November launched a MARS (Mutually Agreed Resignation Scheme). This is where staff are invited over a period of two months to voluntarily seek to leave the organisation. At the time of writing this report, it is too early to say the level of interest, and the numbers of staff who have been accepted to take up this opportunity; I will provide a further update at our meeting. We are in the second quarter of operation under the Jointly Managed Risk Agreement, which allows directorates to reduce activity whilst mitigating the financial impact of this on the Trust. Reviewing the agreement, we are in a similar position in terms of income as if we had stayed with Tariff, and through this joint working approach, have developed our relationships which will continue to prove very important going forward with our commissioners. We have a series of meetings across the Trust, inviting all staff to hear more about this agreement, and the challenge going forward, which can be illustrated by:

HEFT’s Current Trajectory



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CHIEF EXECUTIVE’S REPORT TO THE BOARD Please find following a copy of the report that I presented at the recent Trust Board.

Quality Standards and Finance

We are continuing to focus on delivery, especially with regard to the rigorous implementation of Cost Improvement Programmes, without adversely affecting clinical safety. This remains a priority. As I have previously reported to the Board, the Finance Director and I are personally involved in monitoring our progress, and managing the escalation processes that occur when agreed budget trajectories are not being maintained.

We have made some key appointments over the last two months and this includes critical medical management posts. I am delighted to report that we now have a full complement of Associate Medical Directors:

Dr Alan Jones, Clinical Director and Consultant for Pathology, has been appointed Associate Medical Director for Clinical Support Division;

Dr Rex Polson, Consultant physician and gastroenterologist at Solihull Hospital, has been appointed as the Associate Medical Director for Solihull Hospital; Mr Richard Steyn, Consultant Thoracic Surgeon and Clinical Director Thoracic Surgery / Respiratory, has been appointed as the Associate Medical Director for Surgery; Dr Adedeji Okubadejo, Consultant Anaesthetist has been appointed as the Trust Revalidation Lead.

One of the key changes we are introducing for the next two months (November/December) is a MARS (Mutually Agreed Resignation Scheme) programme. The aim is to offer those staff who are not frontline, the opportunity to exit the organisation. This will be used as an opportunity to reduce overall staffing costs which have steadily continued to rise year-on-year, over and above the additional budget provided. This will be carefully monitored and each request will be assessed for impact, to ensure safety and quality for our patients.

Medical Revalidation Sir David Nicholson, NHS Chief Executive, and Professor Sir Bruce Keogh, NHS Medical Director, have written to all trusts on behalf of the Department of Health and NHS Commissioning Board, in connection with the Secretary of State’s announcement with regard to the commencement of revalidation in England from December 2012. The aim of this is to provide additional assurances to patients by improving clinical governance and appraisal processes for doctors. We remain committed to the improvements this will bring and our programme of work is being led by Dr Aresh Anwar, Medical Director. This includes the completion of the Organisational Readiness Self Assessment and widespread engagement with clinicians across the organisation.



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MEETINGS and EVENTS attended: - Good Hope Fellowship Meeting I attended the Good Hope Fellowship Meeting and met with many of our retired employees to provide an NHS and Trust update. This was a valuable opportunity to engage with former staff who still support the Trust, and, in particular, Good Hope, by holding events and raising funds. Community Health Fair Along with the Chairman, I presented a Trust update to Trust members, Governors and members of the public, as part of our Community Health Fair held at Millennium Point. Those who attended the event supported the Trust’s focus on safety and quality and the need to expand its services. Local Safeguarding Children Board (LSCB) I have met with Mark Rogers, Chair of Solihull Local Safeguarding Children Board (LSCB), as part of their annual review process. The purpose of the review is to ensure that the Trust is sighted on key issues that the LSCB has identified as local challenges, either for our agency, collectively for all partner agencies, or for the LSCB itself, and to explore how the Trust can further support the safety of children and young people. Key areas we discussed included securing Executive Board Lead for Safeguarding attendance at LSCB, and communicating key learning/messages with the frontline (including commissioned and contracted services) and promoting the practitioner forum; considered particularly important given the forthcoming changes to Working Together (2010). In addition, we discussed details regarding the forthcoming Safeguarding Peer Review and explored how the Local Authority and its partners should put forward to pilot a new joint inspection of multi-agency arrangements for the protection of children in December 2012 - January 2013. GP Meetings Over the last two months, I have met with GP colleagues and members of the Clinical Commissioning Groups (CCGs), including meeting with Patrick Brooke from Solihull CCG, to discuss future arrangements and working collaboratively to improve patient care and outcomes. Adrian Phillips, Director of Public Health I have met with Adrian Phillips, Director of Public Health who shares our vision for improving public health across the region and is keen, as are we, to work collaboratively on this important agenda. NHS Midlands and East Chairs and Chief Executives, CCG Leads and SHA Cluster Executive meeting I continue to attend the NHS Midlands and East Chairs and Chief Executives, CCG Leads and SHA Cluster Executive meeting. Chaired by Sarah Boulton, Chair of NHS Midlands and East and Sir Neil McKay, Chief Executive, we discussed the latest healthcare news and policy as well as cluster-wide developments. Bike North Birmingham Project Board I attended the Bike North Birmingham Project Board which has made significant progress on improving routes and has commenced work on a Sutton Coldfield town centre route. The Board is reviewing approaches to attracting further third-party funding, particularly for schools/businesses – encouraging them to make either a contribution toward improvements outside of their premises or internal modifications, to improve cycle access. In addition, it is reviewing issues of maintenance that have arisen with recently constructed sections of routes.



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Keele University I was invited to speak at Keele University on their Consultants' leadership programme, sharing the leadership challenges for Consultants in the present environment, and an insight into the reforms in practice and their likely impact on clinical practice. University of Birmingham HSMC MSc programme I met with colleagues at the University of Birmingham to input into their HSMC MSc programme. I also attended the HSMC Breakfast Club which considered the Francis Inquiry report and implications for the NHS. Aston University I have met with Dr Paul Golby (Pro-Chancellor and Chair of Council) and Professor Julia King (Vice-Chancellor) of Aston University with regard to Membership of Council of Aston University, which included a tour of the University’s School of Life and Health Sciences. I also attended the first meeting of the Council. Dr Foster Global Comparators Founders Board I took part in the Dr Foster Global Comparators Founders Board meeting, to discuss progress on monitoring, delivery and reporting on clinical standards. NHS Institute I am taking part in the NHS Institute’s Change Model which is being led by Dr Helen Bevan, Chief of Service Transformation at the Institute and Jim Easton, National Director of Improvement and Efficiency. This is an opportunity to discuss the Leadership framework and the NHS Change Model and its effectiveness in delivering the changes required in the NHS. HSJ I was invited to take part in a HSJ Round Table being held with the Kings Fund. This was to review enormous changes facing hospitals, including the pressures to centralise many acute services, more routine care being provided in the community, and a continual demand to do more at the same - or less - cost. This Round Table looked at what hospitals are doing - and will need to do - to cope with these demands and ensure they have a viable future. For some trusts this will be as simple as avoiding falling into the failure regime, whilst others may have a longer-term aim of reshaping their services. I was also asked to be part of the 2012 judging panel for the HSJ Clinical Leader of the Year Awards. This included interviews with all those competing in these prestigious awards. British Medical Association (BMA) Protecting Whistleblowers Conference Along with Sarah Woolley, I attended the BMA’s Protecting Whistleblowers Conference Hospitals Forum, where we discussed working together to create a safer culture for patients and doctors. Mergers, Acquisitions and Hospital Reconfiguration Conference I was invited to attend a conference on Mergers, Acquisitions and Hospital Reconfiguration held at the Kings Fund. This highlighted the need to ensure that Trust plans are flexible and that we continue to review opportunities as they arise. There is a movement to encourage more pro-active mergers and acquisitions and support reconfigurations nationally.



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GE Healthcare Conference I was invited to attend and take part in the GE Healthcare Conference. This was an inspiring meeting at which colleagues shared international challenges and practices. It looked at how we can learn from around the world in delivering the NHS’s challenging agenda. NHS Confederation Meeting I attended a meeting hosted by the NHS Confederation to review developing greater commercialism within the NHS. Colleagues across the NHS are reviewing how they can work together and with the private sector to improve efficiency and drive improvements. Foundation Trust Network Annual Conference and Exhibition 2012 I attended and was part of the Foundation Trust Network Annual Conference, where I chaired a discussion on ‘delivering a 5-star service: what does patient feedback mean’. This was a very informative conference, where the need for collaboration and mergers/partnerships were viewed as key to delivery in the future. Hospitals Forum I have been asked to Chair the Hospitals Forum, launched on 18 October by the NHS Confederation. The Hospitals Forum will work on behalf of all types of hospitals, integrated hospitals and community service providers, to help shape the policy and politics that affect them. The forum will allow its members to identify the innovative work being done by hospitals around the country and help NHS organisations learn from each other on how to best deliver the highest standards of care for patients. The hospital sector is facing some really big challenges in the years ahead, not least improving the quality of care for patients, whilst trying to find unprecedented savings. There are many hospitals providing great care around the country, but the pressures on them are growing, and we need to look at how we can change services to best respond to people's needs. Now, more than ever, the NHS Confederation needs to speak up about these issues on behalf of its members. It needs to provide a space where people can come together to tackle the really big issues facing the hospital sector. This forum will bring together organisations from across the whole health system to trigger the necessary debate with politicians, the public and those in the health service, about why we need to change the way we provide and deliver care to our patients in the future. The Impact of Diversity on Professional Practice Conference The Impact of Diversity on Professional Practice Conference is being held at Heartlands Hospital’s Education Centre on 30 October 2012; registration 8.30 am. This has been opened to all local GPs and Board members are also welcome to attend. Hosted by the Trust and RCN West Midlands, this is a free conference for all nursing staff to explore how to deliver quality health care to a diverse, multi-cultural population – and the challenges this can present.

The event will also consider whether nurses and health care assistants from black and minority ethnic backgrounds have fair access to employment and career progression opportunities.

In celebrating Black History Month, the event will be followed by an optional workshop for nurses interested in applying for a Mary Seacole Leadership or Development Award.



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Looking forward to the festive period As our busy time of year approaches, we seek to both manage the complexity of patients and deliver on the important safety and efficiency agenda. We are widely communicating our plans and this has commenced this month with a programme of meetings being led by Adrian Stokes, and supported by the site team, highlighting the financial challenge facing the organisation over the next three years. In addition, as I have previously mentioned, November sees the launch of the new HEFT Nursing Badge. This recognises those nurses who have topped up their training and received positive citations from colleagues and patients about the high standards of the care they provide to patients. Dr Mark Newbold Chief Executive


November 2012


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Financial Performance 2012 year to date


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Financial and Performance Update


NOVEMBER 2012of Governors

FINANCE AND PERFORMANCE UPDATE


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Financial Risk Rating of 3 at quarter 2.£0.8m YTD surplus at the end of September (month 6), £11.2m overspend against operational budgets.

CURRENT AND FORECAST FINANCIAL PERFORMANCE

Forecast remains at £5m.If rectification is not achieved we will start 2013/14 with a recurrent deficit of £6m

£m Surplus

Key areas of overspend are;- CIP slow delivery (65% of plans)- £4.6m, Pay Control (medical and nursing)- £1.1m, Private sector - Additional flex capacity to meet additional capacity.

Non recurrent income


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RECTIFICATION STEPS

- Executive Vacancy Control Panel

- Pay roll challenge

- Executive Management Board Subgroup

-Site rectification plans

- Theatre project

- CIP Board

- Escalation framework

- Winter planning group

Focus on Pay control and CIP delivery

CONTINUED FOCUS ON PAY CONTROL AND CIP DELIVERY

Review Group UpdateExecutive vacancy control panel Where a directorate is off plan, only the CEO or

Deputy CEO can review a request.

Payroll challenge Meets monthly, chaired by HR to discuss effectiveness of pay controls, review medic and nursing costs and implement any further changes required.

Site Rectification plans Latest plans have been produced and presented to Finance and Performance Committee in September and October. Where sites are off track they have been escalated to meet with Deputy CEO.

Theatre project Theatre efficiency project developing daily theatre KPI/ metrics that will go live on intranet in next few weeks. Theatre Management Information System, phase 1 is rolled out at Heartlands, Solihull roll out planned for September , then Good Hope. Phase 2 rollout to be completed across all sites by the end of the year.

CIP Board Meets monthly chaired by Finance. Where plans not hit part of escalation framework.

Escalation framework Agreed at Finance and Performance Committee in July and is being implemented. Some areas escalated to deputy CEO for review.

Winter planning group Initial meeting held, now meeting monthly, chaired by operations. First draft of plans being produced.

Trust Board Review Trust Board focus on finances is high. Chief Executive letter to all staff. MARS scheme approved in October.


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All Monitor

targets achieved

No material concerns

raised by PCT

Monitor target

at risk or heightened

PCT concern

Rectification Plan required

Material or projected

variance from agreed

trajectory

Continued failure to mitigate risk and

Trust overall performance/

reputation at risk

Budgetary

Balance

<2%

Overspend

>2% Financial

Rectification Plan

to F&PC

Material Slippage

from agreed trajectory

Continued failure to mitigate financial

risk and Trust position impacted

LOCAL MANAGEME

NT REVIEW

F&PC

ESCALATE TO DEPUTY

CEO

ESCALATETO CEO

FINANCE

CONTRACTING & PERFORMANCE

ESCALATION TABLE

ACTION

IMPROVEMENT


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RED

RED

RED

AMBER

A&E Good Hope

Solihull Finances

Heartland Finances

Women’s & Children’s Finances

Cancer Targets, Diagnostic targets, Heartlands A&E, Good Hope Finances

AMBER

ICT & Public Affairs Finances

CURRENT ESCALATION LEVELS

RED


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CAPEX

Good progress being made on all schemes.Forecast remains at £40m

Budget£m

Month 6 YTD £m

Operational Capex 7.5 6.7

Other Large Schemes 13 2.5

Cross site strategy Schemes

20 7.7

Total 40.5 16.9

New schemes in the pipeline;•Specialist radiology and vascular hybrid theatres ,•Neonates works at Heartlands to resolve immediate issues,•Refurbishment of outpatients department,•Endoscopy , and•Car parking.

Ongoing ward refurbishment programme, especially at Good Hope.


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Performance – Monitor Standards

Quarter 2 Monitor Governance rating amber-green.Sep-12 Performance Information

KPI Month Target

In Month

position

YTD target

YTD position

A&E 4 hour wait 95% 94.33% 95% 95.17%

C Difficile 11 5 62 43

MRSA 0 0 3 2

18 weeks admitted 90% 92.58% 90% 92.56%

18 weeks non-admitted 95% 96.53% 95% 97.16%

18 weeks incomplete pathway 92% 95.47% 92% 95.91%


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A&E Performance

The failure to meet the target in Q2 relates to 167 breaches out of a total of 24, 835 patients attending

the Trust A&E departments

Q195.66%

Q195.10%

Q190.86%

Q1,99.14%

Q2,94.30%

Q293.56%

Q2,90.21%

Q2,98.66%

84.00%

86.00%

88.00%

90.00%

92.00%

94.00%

96.00%

98.00%

100.00%

Trust (inc Wis) Heartlands Good Hope Solihull

HEFT A&E 4 Hour Performance - Q1 and Q2 2012/13


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Performance – Monitor Standards

Q2 Cancer Performance Information

KPI QTR

Target Q2

positionYTD

target YTD

position

Cancer 2 week wait > 93% 93.22% > 93% 93.56%

2 week wait- breast symptoms > 93% 94.72% > 93% 95.08%

Cancer 31 day > 96% 96.64% > 96% 96.48%

Cancer 31 day - surgery > 94% 97.84% > 94% 97.04%

Cancer 31 day – drug treatment > 98% 100.00% > 98% 100.00%

Cancer 62 day - GP referral (A breach of 1% =4 patients)

> 85% 85.57% > 85% 85.52%

Cancer 62 day - national screening service

> 90% 100.00% > 90% 100.00%


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In deciding whether to take legal action the following arguments were considered;

For Against

The legal advice given to the Trust is that the money is owed. However, recommendation to pursue mediation/negotiation was advised.

BCC has offered arbitration plus has made the first movement with a cash offer.

If found in favour of the Trust there will be a potential £3.7m positive Income & Expenditure impact.

Concern regarding impact on future relationship.

A legal precedent will be set. Potential damage to health economy.

Time and cost of pursing legal action.

Need to work together with future social service budget cuts.

Notwithstanding the legal opinion –possibility of not reaching an entirely positive outcome.

Board Decision Agree to arbitration and avoid legal action if at all possible.

Birmingham City Council Update

November 2012


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Winter Experience Review

(Presentation)

November 2012


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CommitteeMembership Review


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Governors Committee Membership Review.v1. Nov 2012.Co Sec

1

Governors Committee Membership Review

October 2012

At the Council of Governors meeting in September, it was agreed that a review of committee membership should be undertaken. The purpose of the review was to ensure that all committees had sufficient membership to be effective and meet quorum requirements as well as providing Governors with the opportunity to resign or be appointed to alternative committees. As good governance, this review will also form part of the Annual Governors Governance Review going forwards.

The attached table summarises the membership per committee to date.

Membership and Community Engagement Committee:

The membership of this committee has reduced from six to five members but still remains within quorum of four. To this end, and in accordance with its Terms of Reference, this committee will be convened as/when required.

All other committees have more than sufficient membership to be quorate.

Remuneration Committee:

Following the resignation of the Chair of the Remuneration Committee, Ian Blair, a replacement Chair requires appointing. I should like to strongly recommend and nominate Richard Hughes, Lead Governor, to this position. Richard already sits on the Governor’s Appointments Committee and, as these committees are very closely linked, I believe it is appropriate that he should be appointed Chair of the Remuneration Committee.

Appointment of Deputy Chairs

In replication of Board Committees and to allow for clearer structure and flexibility around meetings, it is recommended that all Governor Committees appoint a Deputy Chair. The names of appointed ‘deputies’ should be forward to the Company Secretary as soon as agreed by the respective committees. The Committee Terms of Reference will be amended to this effect.

Committee Membership Review


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Council of GovernorsCOMMITTEE MEMBERSHIP REVIEW

October 2012

GOVERNORS Appointmen

ts

Committee

Audit

Appointmen

ts

Remunera

tion

Committee

Quality

and

Safety

Patien

t

Experi

ence

Finance

&

Strateg

ic

Planning

Members

hip &

Community

Engagem

ent

Hospita

l

Environmen

t

Constitutio

n

Committee

FTGA

Quorum 5 4 4 4 4 4 4

Tahir Ali

Arshad Begum • • •Kath Bell • • •Ian Blair •Elaine Coulthard • • •James Cox • • • • • • • • •Olivia Craig •Kevin Daly • •Carol Doyle

Albert Fletcher • • • •Tim Freeman

Patricia Hathway • • •Rocio Hernandez • •Richard Hughes • • • • •Syed Raza Hussain

Philip Johnson • •Michael Kelly • • • •Merck Kibilski • • • •Sunil Kotecha

Heidi Lane •Ian Lewin •Margaret Morcom • •Veronica Morgan • • • •Florence Nash •Barry Orriss • • •John Roberts • • •David Roy • •Jim Ryan

Neil Shuker-Harris • •Neil Smith

Bridget Sproson • •Stuart Stanton • • • •Liz Steventon • • •David Treadwell • • •Thomas Webster • •

Committee Membership Review

November 2012


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ConcertoIM & T Demonstration

(Presentation)


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Reports fromCommittees

12.1 Constitution Review Meeting

12.2 Constitution Review Minutes (19/10/12)

12.3 Finance & Strategic Planning Committee Report

12.4 Finance & Strategic Planning Committee Minutes (10/09/12)

12.5 Hospital Environment Committee Report

12.6 Hospital Environment Committee Minutes (08/10/12)

12.7 Patient Experience Committee Report

12.8 Patient Experience Committee Minutes (07/09/12 & 19/10/12)

12.9 Quality & Safety Committee Report

12.10 Quality & Safety Committee Minutes (17/10/12)

12.11 Annual Transforming Patient Experience Conference - Kings Fund (Oral)

(Oral)

(Oral)

(Oral)

(Oral)

(Oral)


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Minutes of a meeting of the CONSTITUTION REVIEW COMMITTEE of the COUNCIL OF GOVERNORS of Heart of England NHS Foundation Trust

held in the Devon House, Heartlands Hospital on 19 October 2012

PRESENT: Lord Philip Hunt (Chairman) Albert Fletcher Richard Hughes Barry Orriss Stuart Stanton Liz Steventon IN ATTENDANCE: Malcolm Pye, Company Secretary

12.01 APOLOGIES Apologies were received from Kath Bell, James Cox, Phillip Johnson and Veronica Morgan. 12.02 MINUTES

The minutes of the meeting held on 11 December 2011 were approved by the meeting and signed by the Chairman.


The Chairman confirmed that he had heard back from Monitor about changes to the Constitution and was directed towards the Monitor Model Core Constitution as a basis to use.

12.04 REVIEW MEMBERSHIP AND GOVERNOR NUMBERS The meeting reviewed, in some detail, the outline proposal put forward by the Board’s

Stakeholder and Community Engagement Committee, relating to membership and Governor ratios, etc.

It was not readily apparent why the Trust necessarily needed a membership of 100,000+.

The proposed use of auto-enrolment meant that the numbers would progressively increase, mainly, it was felt, amongst individuals who had little or no interest in the Trust. The Chairman believed that having such a large number allowed for full and proper representation from the membership. It was agreed that auto-enrolment was acceptable provided there was a facility to opt-out.

It was also felt important that the Board’s Stakeholder and Community Engagement Committee used all efforts to ensure full engagement with as many actual and prospective members as possible.

The meeting then went on to consider the proposed constituency restructuring and

consequent Governor allocation. It was agreed that aligning HEFT membership

Constitution Review Committee Minutes


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Page 2 of 3

constituencies with those of local authorities was an appropriate step to take. It was felt that having the same Governor allocation across greater Birmingham was inappropriate as there would be fewer patients from the constituencies further afield. Following further detailed discussion, it was decided to allocate two Governors to each of the constituencies most closely linked to the three sites. Those constituencies not having Governor representation would be included within the Patient and Public at Large Constituency.

The meeting considered the proposed list of Partnership Organisations who would be offered a Governor place and agreed three for Local Authority Councils (as existing structure) and four for local Universities with whom the Trust has closest ties.

The outcome of the discussion would be for: Publically elected Governors to reduce from 28 to 22 Staff Governors remain unchanged 5 to 5 Partnership Governors to reduce from 11 to 7 _______ Resulting in an overall reduction from 44 to 34 _________ This would bring HEFT more into line with the total number of Governors of other FTs,

relative to size. 12.05 INTERIM REVIEW OF CONSTITUTION

The meeting reviewed the track-change version of the constitution showing a considerable number of previously agreed proposed amendments. It was noted that this version would need to be further amended to accommodate:

The changes to constituencies previously discussed

Compliance with the Monitor Model Core Constitution

The implementation of the 2012 Act

The meeting went on to consider a number of suggested changes to the Constitution, noting those that had been discussed and agreed in principle at previous meetings.

A number of minor and consequential amendments were noted and suggested by Committee members that would be incorporated into the next draft; these are not detailed in these minutes. In particular, the following additional matters were agreed:

Volunteers would be removed from the staff constituency as they would be eligible to be members (and thus Governors) through their home constituency.



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Page 3 of 3

A two-thirds majority of Governors actually in attendance and voting would be required on all matters of a ‘disciplinary’ nature unless legislation required a larger proportion.

Consequent on the reduction in overall Governor numbers, the quorum would be

reduced from 15 to 12 (i.e. approximately one-third of the total number of Governors).

A discussion took place around the best method of achieving transition to the new

constituency structure as the change of boundaries would impact on every elected Governor. Following detailed debate, it was agreed that all elected Governors would be asked to stand for election at Impact Date. Of the 27 elected Governors, 6 were subject to the re-election process by mid-2013 in any event, and the remaining 21 had been elected only until March 2014. At worst, this would mean those 21 Governors standing down between 12 and 9 months before their due date.

Mr Fletcher asked if it was absolutely necessary that a prospective Governor’s

political affiliation be declared in the Candidate’s Statements. This would be investigated.

The outline timescale for implementation of the amendment is:

November 2012 – Further amended draft of constitution and commentary to Governors December 2012 – Solicitor input into the drafts to ensure compliance 8 January 2013 - Board Approval 21 January 2013 – CoG Approval

It was not clear how long it might take Monitor to approve all the proposal changes and consequently, Impact Date is not yet clear. It was hoped to have all the changes in place between 1 April and 1 July 2013.

12.06 ANY OTHER BUSINESS

There was none.

12.07 DATE OF NEXT MEETING TBA

...........................................

Chairman



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FINANCE & STRATEGIC PLANNING COMMITTEE

Minutes of a meeting of the FINANCE & STRATEGIC PLANNING COMMITTEE

of the Council of Governors of Heart of England NHS Foundation Trust

held in, Education Centre, Heartlands Hospital

on 10 September 2012

Present: Barry Orriss (Committee Chairman)

Albert Fletcher Richard Hughes Phillip Johnson Les Lawrence Bridget Sproston

In attendance: Adrian Stokes Joanna Hodgkiss Angeline Jones Claire Walker

Director of Finance Head of Planning & Development Chief Financial Controller Executive Assistant (minutes)

12.38 APOLOGIES

Apologies were received for Olivia Craig, James Cox and Stuart Stanton.

12.39 MINUTES OF MEEETING – 10 JULY 2012 The minutes of the meeting held on 10th July 2012, were accepted as a correct record once Bridget Sproston’s apologies were added.


All items under matters arising are on the agenda and would be covered in the sections below.

12.41 RESHAPING HEFT UPDATE – HEFT @ HOME

Mary Ross, Clinical Director for Therapies attended the meeting (this item only) to give a more in-depth overview of the HEFT @ Home project within Reshaping HEFT. Ms Ross gave a presentation (attached for information) the key points noted were:

• A change in pathway is needed for the acute care and discharge of older patients with a better interface between acute, community and social care.

• Long stays in hospital are not conducive to recovery for older patients and where possible alternatives should be found.

• Services are being developed around admission avoidance and early supported discharge (ESD) schemes.

• Partnership working is being further developed with Birmingham Community Health Care (BCHC) and their Single Point of Access (SPA) team, Birmingham City Council (BCC) to access Reablement services and Solihull Community services on admission prevention.

• The progress so far for admission avoidance is investment in Comprehensive Geriatric Assessment and the Rapid Assessment Team (REACT) at GHH. BHH are looking at alternatives to hospital admission along with working with SPA team

Finance and Strategic Planning Committee Minutes


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from BCHC. Solihull and The Hub in South East Staffs helping to reduce the length of stay.

• Progress with early supported discharge (ESD) is some stroke patients at SOL have been able to go home earlier since piloting from March. GHH has partnered with a private provider to facilitate the ESD 10 patients per week, this is due to start in September. BHH is working with BCHC to deliver 30 patients at any one time to be supported at home commencing November 2012.

• Next steps in the project are to monitor patient experience and satisfaction, evaluate the financial stability of schemes and expand to other areas.

A discussion followed and clarification was given that when the admission avoidance and early supported discharge schemes were underway any beds that were freed up would be closed as the Trust would not have the resourses to support patients in the home in addition to running the beds in hospital. The Trust would have to close beds to release funding in order to provide in the community. It was confirmed that it can be more cost effective to care for patients at home. The question was raised regarding patients at home needing to see consultants, the patient would need to attend hospital for this to happen however by the time patients have been discharged to their home setting the likely hood of needing to see a consultant is greatly reduced. Concerns were aired as to why schemes like these could be successful now when they have not been in the past. Members were informed that the difference now is that HEFT are going ‘out there’ and providing some of the care and taking responsibility rather than just relying on other providers and partnerships. Regarding Reshaping HEFT as a whole Ms Hodgkiss confirmed that Professor Matthew Cook had completed his review and that it was recommended that the hyperacute unit should be on the Heartlands site and that the Board had accepted this recommendation last week. She confirmed again that a rehab stroke service would continue to be provided and all three sites. The Board have tasked the Reshaping HEFT team with putting together an implementation plan. The Committee requested high level reports be presented to future meetings along with an update on the project looking at the reshaping of non clinical areas.

JH

12.42 FINANCE & PERFORMANCE POSITION

Mr Stokes summarised the key points within the report and confirmed that the Trust’s Annual Plan had been submitted to Monitor at the end of May. The Trust is not being subjected to an in-depth review by the Governing body. A meeting has however been arranged and the Chairman, Chief Executive and Finance Director will be attending this later in September. Mr Stokes confirmed that the year remains ‘tricky’ and that the Trust had not made huge progress over the last couple of months, the underlying deficit remains at £6.6m, with next year’s efficiency challenge to deliver as well. Under the contracting scheme there is a level over attendance, however Mr Stokes confirmed that long term the Jointly Managed Risk Agreement was the correct thing for the Trust to do. An audit has been completed on the levels of attendance which has help to identify ‘hot spots’ where specific GP’s and practises over refer. The Trust is currently only delivering about half of its efficiency plans, however an escalation framework has been agreed and Divisions now have to see the Chief Executive and Finance Director about recruiting to vacancies. A question was raised as



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to whether the Trust was providing enough training on finance to our clinical staff. Mr Stokes however thought that the main issues were around rostering and managing of staff’s annual and maternity leave etc rather than finances. It was confirmed that most cover is provided by our in house bank rather than through agency, although on occasion the Trust has no choice for specialist areas such as A&E Consultants, which are few and far between. Regarding performance, confirmation was given that all year to date ratings are currently green, the Trust has however, slipped on cancer and A&E targets in month and these are currently red. The two particular problem areas for cancer targets remain as urology and thoracics. Members of the Committee confirmed that they would find it useful to see actual numbers as well as the percentage. Mr Stokes gave an update on the Birmingham City Council debt and that their response to the latest letter had been chased, the Trust has been informed that a full response will be received by 11th October. Frustrations were aired by Members that this issue still remained unsolved. Assurance was given that this was a high priority on the Executive’s agenda and that they thought that part of the problem with accepting the debt is that BCC would essentially be admitting that there is a flaw in their support services. Mr Fletcher informed Mr Stokes that at the Council of Governors AGM that he would be suggesting that the Trust start legal proceedings, a discussion took place suggesting that this action may be detrimental to future working relationships with the Council, however Mr Fletcher thought that this issue had been going on long enough and Members of the Committee supported his suggestion.

AS

12.43 FUTURE HEFT STRATEGY

Non-Executive Director, Les Lawrence attended the meeting to give an update on the Board’s opinion on issues within the Trust. Mr Lawrence informed Members of the Committee that CIP is not progressing as effectively as it should be and that the Board are now starting to look at and think about alternative options that would enable the Trust to get back on track. The Trust is considering getting together with other Trusts that are performing better than us in various areas to gain ideas and understanding of where improvements could be made. A paper is being prepared for the Away Day which is taking place at the beginning of October. It is planned that Mr Lawrence will attend the meeting of this Committee in March to give a further opinion of the Board.

12.44 ANY OTHER BUSINESS

No further items were discussed under any other business.

12.45 DATE OF FUTURE MEETINGS 05 November 2012 at 10.00 at Solihull Hospital. 04 January 2013 at 10.00 at Birmingham Heartlands Hospital. 01 March 2013 at 10.00 at Good Hope Hospital.

.....................................

Committee Chairman



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COUNCIL OF GOVERNORS HOSPITAL ENVIRONMENT COMMITTEE

Minutes of a meeting of the Hospital Environment Committee of the Council of Governors

held in Room 4, the Education Centre, Heartlands Hospital, on 8 October 2012 PRESENT: John Roberts (Chair)

Mark Kibilski David Treadwell

IN ATTENDANCE: John Sellars, Director of Asset Management

Tony Wright, Estates Manager, Heartlands Hospital (walkabout) Tony Morgan, Fire Safety Specialist Advisor (walkabout) Sarender Chana, Head of Design and Compliance (presentation) David Roy, Principal Lead Retinol Screener Angela Spencer, Diabetes and Endocrinology OPD Manager (walkabout)

Richard Hughes, Lead Governor (part) Ann Harwood, Executive Assistant to Director of Asset Management (minutes)

12.27 APOLOGIES Apologies for absence were received from James Cox, 12.28 TOUR ROUND THE FOLLOWING AREAS AT HEARTLANDS HOSPITAL Tony Wright, Estates Manager and Tony Morgan, Specialist Fire Safety Advisor, accompanied the group on a walkabout to look at the following areas: 12.28.1 Pedestrian access from Bordesley Green Road to the Heartlands Hospital site At the last meeting John Roberts had raised concern about the pedestrian access from Bordesley Green Road to the Main Entrance as he felt that access is more traffic friendly than pedestrian friendly. The walkabout commenced at the Bordesley Green Road entrance and proceeded along the pedestrian footpath to the pedestrian crossing by the Car Parking office and across the car park to the Main Entrance. The following points were noted/ discussed:- John Sellars advised that discussions had taken place with West Midlands Travel re

diverting buses onto the BHH site via a roundabout so that patients/ visitors travelling by bus could access the site more easily. However, West Midlands Travel had been unable to provide the funding to support this.

The issues relating to car parking were discussed. John Sellars informed members of the plans re Bordesley House, which is currently occupied by Asset Management and ICT services. Asset Management will be moving to the first floor of the new Workshops building in March 2013 and at the same time ICT Services will be moving out of Bordesley House to the Partners in Health building on Yardley Green Road. Following demolition of Bordesley House It is proposed, subject to planning permission, to erect a decked car park on the Bordesley House slab, which will extend back to the Oncology Bungalow. Access to the car parks on the BHH site will then be reconfigured so that staff will access the site from the Bordesley Green Road entrance and patients/ visitors will access the site from the Yardley Green Road entrance. At the same time the pedestrian walkways will be

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reconfigured to make them more user friendly. Work on this project is likely to commence in approx 18 months time.

Members felt that the signage at the entrance to the site from Bordesley Green Road could be improved with clearer signage to the Main Entrance and additional signage re the speed limit of 10 miles per hour. John Sellars/ Tony Wright to review.

John Sellars also gave an update on the short-term plans to reconfigure the visitors‟ car park. These include installing an additional barrier by the parking office so that there are two „In‟ barriers and one „Out‟ barrier. The visitor car park will then be moved to extend into the current staff car park up to the MIDRU building. The staff car park will be moved into the current visitor car park. If practicable these changes will be made over three weekend periods.

It was noted that recently 200 staff parking spaces on Yardley Green Road have been lost on land that had been leased from BEN PCT as the PCT have re-claimed the land for building purposes. To try and mitigate this an additional 100 staff parking spaces have been created on the B-Braun land on Yardley Green Road, together with off site parking being provided at Birmingham City Football ground with a shuttle service running to and from Heartlands Hospital.

In the long-term, planning permission has been given to erect a multi-storey staff car park on Yardley Green Road, which should be completed in June/ July 2013.

12.28.2 Helipad Tony Morgan accompanied members on a visit to the helipad. The following points were noted/ discussed: Funding for the installation and running of the helipad had been obtained by the A&E

Directorate and it had been their decision to close the facility. The helipad is linked directly to A&E and is suitable for helicopters weighing up to 5

tonnes and 15 metres in length. The helipad is currently closed and would need to be refurbished up to standard and re-

registered with the Civil Aviation Authority before it could be re-opened. A fire fighting team consisting of three members of staff has to attend all helicopter

landings and has to be on the helipad prior to a helicopter landing, Any decision to re-open the helipad would be a clinical decision and this is not an issue for

the Hospital Environment Committee. David Roy had prepared a presentation on the helipad which he would be giving to

Governors following the Hospital Environment Committee meeting. It was noted that there are operational helipads at the University Hospital in Birmingham,

the University Hospital of Coventry and a helicopter landing pad on the road adjacent to Birmingham Children‟s Hospital.

12.28.3 Emissions from Generator Testing Angela Spencer attended the walkabout to highlight concerns in relation to the three generators which are sited in the area around the MIDRU building and the fumes that are emitted when the generators are tested. The fumes are causing staff and patients to feel ill with headaches, nausea and in some cases vomiting, and breathing problems. The following points were discussed:- Tony Wright advised that the generators have to be tested every month for a period of 5

hours.



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Testing of the Pathology generator has been moved to a Saturday. It was noted that this generator is due to be replaced in April 2013 with a new generator with lower emissions.

The generator supplying the Elderly Block has been fitted with a catalytic convertor to reduce emissions.

It was felt that the third generator for Twin Theatres is the main cause of the fumes/ emissions. Tony Wright agreed to look at the costs involved in moving the testing of this generator to a Saturday.

It was also agreed that when the Pathology generator has been replaced in April 2013 then the testing of this generator could take place in the week and the Twin Theatres generator testing moved to a Saturday.

John Sellars agreed to review this issue at the meeting in April 12.28.4 Medical Day Hospital Signage During the walkabout it was noted that the signage around the Medical Day Hospital is confusing. Tony Wright to review the signage in this area. Members thanked Tony Wright for the tour and requested that their thanks be passed on to Tony Morgan. 12.29 MINUTES OF THE MEETING HELD ON 25 JUNE 2012 The minutes of the meeting held on 25 June 2012 were approved as an accurate record. John Sellars highlighted the fact that the meeting was not quorate as the Terms of Reference state that “the quorum necessary for the transaction of business shall be four members of the Committee”, and there were only three members present. It was agreed to continue with the meeting although no formal decisions could be made. 12.30 ACTION SHEET FROM MEETING HELD ON 25 JUNE 2012 12.30.1 A&E Signage at Good Hope Hospital This item would be discussed as part of the Way Finding Strategy presentation. 12.30.2 Heartlands Hospital Main Entrance Escalators John Sellars confirmed that the escalators in the Main Entrance at Heartlands Hospital are due to be replaced in November 2012. There is no cost to the Trust as the Main Entrance is a PFI building. During the installation period of approx one month there will be some disruption due to these works. However, the main period of disruption will be managed over a weekend when the Main Entrance doors will be closed and patients/ visitors will access the building via the side doors. 12.31 UPDATE ON RECYCLING IN THE TRUST John Sellars circulated an update report on recycling carried out across all Trust sites, including the Birmingham Chest Clinic, from January to October 2012. The report showed that 36 containers had been collected from Birmingham Chest Clinic

during this period with no cost to the Trust. This was for confidential paper only. There is



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no plastic recycling on this site. Computer and electrical equipment is taken to the Heartlands Hospital site for disposal. Drugs are disposed of as part of waste disposal and there is no glass recycling across the Trust due to the risk of contamination.

The report showed the costs to the Trust for recycling and the rebate value. The cost for recycling in the Trust for the period was £2,021.20. This had been offset by a total rebate value of £1,122.40, giving the total cost to the Trust for the period as £898.80. It was noted that the value on rebates for WEEE was still to be added to the report.

John Sellars gave an update on ISO14001 accreditation across the Trust as follows: Solihull Hospital: Estates, Medical Engineering, Hotel Services and Waste Streams are all

certified to ISO14001. Good Hope Hospital: it is envisaged that certification for the above areas will be

completed by the middle of 2013. Heartlands Hospital: there is currently no proposed completion date for certification in

these areas. 12.32 UPDATE ON THE WAY FINDING STRATEGY AT GOOD HOPE HOSPITAL Sarender Chana, Head of Design and Compliance for the Trust, attended the meeting to give a presentation on the Way Finding Strategy at Good Hope Hospital. The following points were noted/ discussed: A Way Finding Group had been set up in September 2011 to agree the strategy and

oversee implementation. A consultant has been appointed to work with the group. An audit and review of current signage and way finding has been carried out following

which the Way Finding Strategy and principles have been developed. A report had been prepared which would be discussed with the Way Finding Group and Sue Moore, Hospital Director, the following day.

Once the strategy has been approved the detailed design will be developed and schedules will be prepared. Funding will need to be approved by the Executive Management Board and Board of Directors prior to implementation.

Patients/ visitors will be signposted from when they enter the site, either by car or public transport, to where their appointment is. This will include external signposting, site signposting and internal signposting.

Methods for signposting patients/ visitors will include - Maps and signs: maps will orientate with the relevant signage - Appointment letters – there are a significant variety of letters being sent to patients

across the Trust and these will be revised to ensure consistency across the Trust - Editorial - to achieve consistency in names of departments and ward numbering - Verbal instructions and staff training - Trust website - Navigation aids e.g. touchscreens - Identifying landmarks/ focal points – artwork will be used to fit with the zones/ blocks

which will be colour coded with 4 different colour schemes. Sarender Chana advised that people with colour blindness have been consulted with regard to the appropriate colours to use.

- The proposals for a new main entrance in the Richard Salt Unit will provide an easily identifiable central point. Car parking will be reconfigured in this area.

- Notice boards will be controlled to ensure they only contain relevant and up-to-date information



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John Roberts queried whether anything can be done to improve signage on the roads approaching the hospital. However it was noted that this would need to be managed by the local authority.

John Sellars advised that when the car parks are reconfigured on the Good Hope Hospital site, Birmingham City Council will be requested to move the bus stop nearer to the new main entrance.

Members thanked Sarender Chana for an interesting and informative presentation. 12.33 CAR PARKING UPDATE John Sellars advised that he will give an update on the Car Parking Strategy together with the plans for all three sites at the next meeting in January. 12.34 ANY OTHER BUSINESS 12.34.1 Hospedia David Treadwell raised a concern regarding the use of the patient bedside televisions. He queried why the credits which patients have to buy to use the system run out after the set time period regardless of whether they have watched the television during the set time. He felt that patients should only have to pay for the time they are watching the television. John Sellars advised that the charging system is part of a National agreement with Hospedia which has been agreed by the DoH. HEFT therefore has no control over the charging system. It was noted that the Hospedia system is much more flexible and cheaper than the previous Patient Line system. It was agreed that David Treadwell would e-mail his concerns to David Roy who will raise the issue at the Patient Experience Committee. 12.35 DATE OF NEXT MEETING 2.00 p.m. on Thursday, 3 January 2013, in Room 2, the Education Centre, Solihull Hospital.



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MEETING of the

PATIENT EXPERIENCE COMMITTEE of the

COUNCIL OF GOVERNORS of HEART OF ENGLAND NHS FOUNDATION TRUST

Minutes of the meeting held in Room 4, Education Centre, Good Hope Hospital

Friday 7th September 2012 at 11:00

Present Kath Bell Patient Governor Elaine Coulthard Public Governor Michael Kelly (Chair) John Roberts Public Governor Gerry Robinson Chair, CHC David Roy Staff Governor Thomas Webster Public Governor In Attendance Ann Edgar Matron for Elderly Care Jo Hodgkiss Head of Planning and Development Simon Jarvis Head of Patient and Public Involvement Mary Ross Clinical Director for Therapies Lisa Thomson Executive Director of Corporate Affairs Minutes Bev Bellerby Executive Assistant to Lisa Thomson Welcome and Introductions Mike Kelly welcomed everyone to the meeting and thanked them for attending. Apologies Apologies were received from James Cox, Jamie Emery, Sam Foster, Patricia Hathway, Marck Kibilski, Margaret Morcom and David Treadwell. Minutes of the Previous Meeting It was pointed out that Elaine Coulthard’s name had been recorded incorrectly. Also, James Cox had been shown as Patient Governor, but he was a Public Governor. The minutes of the previous meeting would be amended to reflect the corrections. Action: BB to amend June’s minutes to show corrections above. Actions from the Previous Meeting Lisa had arranged a provisional date on which to meet with Holte School in Lozells; to feedback to next meeting. Action: LT to feedback to next meeting re Holte School Simon agreed to feedback to each meeting on the Friends and Family CQUIN. Action: BB to add to future agenda Bev had rearranged the January Patient Experience meeting from 11th to 10th January; 11:30-13:30 in the Boardroom, Devon House.

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Issue re lack of hospital signage in the roads leading to Good Hope Hospital – Mike had spoken to the Highways Department at Birmingham City Council who had said they thought the signage was suitable. The council had said that HEFT could pay for more if they thought they were needed. Mike was keen not to let the issue drop as patients were arriving late for appointments due to the lack of directions. Lisa would speak to the Faculty of Education to see if anyone was available to attend the Patient Experience meeting. Action: LT to contact Faculty of Education to ask for a speaker to attend one of the meetings The faulty cash point in the Main Entrance at Heartlands had been replaced and there had been no further complaints. Elaine suggested that an extra one was needed at Good Hope, near A&E. Lisa offered to raise the issue. Action: LT to speak to Facilities about an extra cash point at Good Hope CHC Site Visit Gerry Robinson advised that CHC had visited Ward 17 at Good Hope and had distributed the report before the meeting. They had also recently visited Ward 21 at Heartlands; report to follow. Gerry advised that he would like staff feedback from the report and asked Lisa Thomson to arrange that. Action: LT to arrange for staff from Ward 17 at GHH and Ward 21 at BHH to attend a feedback session Training would be needed for any of the Governors that wanted to do the ward visits, to make the visits more effective. Gerry had run 2 courses but the attendance was low. It was important for those doing the visits not to touch the patients or the items on their bedside, for infection control reasons. The main area of concern during the visits was patients’ medication being left on cupboards or tables and patients not being supervised by staff whilst taking their drugs. Lisa Thomson commented that the visits were invaluable as changes could be made, based on the findings at those visits. The initial visit could be the first signs that something was wrong on a ward. Mike and Gerry both commented that the leaflets in the Information Centre in the Good Hope Treatment Centre had fallen off the walls and also that the hospital corridors were very long and bland with no information on them. David Roy suggested asking the Trust’s Arts Team to put up some art, as had been done at Heartlands, maybe with an Olympic theme. Local schools were often happy to provide the artwork. He was also keen to get some signage done to help staff that needed multi-lingual or literary assistance. Mike Kelly added that some of the walls had scuff-marks and knocks on them that needed tidying up by Estates. Lisa Thomson advised that the CHC report on the Princess of Wales Maternity Unit had been accepted by the Trust, and would be collated with another internal report, and would be distributed shortly. The maternity staff would be invited to be at the meeting to hear the report and give their information, going forward. Gerry Robinson advised that Joy Payne was going to the November CHC meeting to feedback and that work was already underway to put things right. Lisa added that the visits mirrored the safety risks on the maternity wards, especially regarding patient care. Simon Jarvis was keen to let staff know that there was also some very good work being done in maternity, so that they did not only hear about the things that had not gone well. Gerry said that all of the information needed to be put together; HEFT reports, Governors’ reports and CHC reports. Lisa advised that the reports and minutes were freely available and went to EMB. Lisa worked closely with Sarah Woolley to pick up the problem areas within the Trust. She was keen for the areas to be revisited in a year’s time to see how things had changed.



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Gerry Robinson advised that there had been an article in the Solihull News about the maternity service but he added that he did not think there was a need to send stories to the press. Gerry said that Local involvement Network Staff sat on CHC but Gerry was keen for them to be observers rather than members so that the visits would be without their input. Gerry would be meeting with the Birmingham LINk person soon to get the name of their representative and would ask that they have regular attendance at the meetings. Gerry and Anne, Vice-Chair, would train up people and after taking part in a couple of inspections they would be able to lead an inspection under supervision, after which they would be able to conduct/lead on inspections. He needed 6 or 7 teams of people to be trained. Gerry told the meeting that the PEAT visits would be done by lay-people in 2013, rather than having a majority of Trust staff leaving. He was not sure if the new method would be as good. There would be a new marking system, but it had not been rolled out at the time of the meeting. It needed to be more specific and have a higher scoring range. Reshaping HEFT Jo Hodgkiss and Mary Ross presented at the meeting. Jo advised that Reshaping HEFT was a 3-year clinical strategy, but did not yet cover the whole of the Trust. It was a vision that had been agreed by the Trust Board. Jo told the meeting that there were many challenges but Jo was concentrating on 5 key ones. The most important thing to understand was that the Trust was part of the healthcare system and needed to work with those outside the Trust that may work differently, such as the council, community services, third sector, etc. The Trust Board agreed it was the way forward. Healthcare was at the heart of the community. The vision was to supply services that provided trust and pride, asking patients for their feedback on their local hospitals. The goals and priorities were to be safe and caring, locally engaged, innovative and efficient. In the previous 18 months, the Trust had started to change how it saw itself. Rather than be one large organisation, leadership changes had seen the Trust move away from that and look at the 3 hospitals with their different issues and needs. Each hospital would have its own identity: Heartlands Large hospital specialising in research and education Good Hope Medium district general hospital, which would utilise the corporate functions Solihull Small hospital; integrated healthcare with community services Some services would go out to tertiary providers (other hospitals outside the Trust that provided different specialist health services). Jo advised that she and Simon Hackwell started Reshaping HEFT a year ago. They went to clinical areas to explain the changes and challenges and let the teams know what they could do to address those challenges. They did 18 workshops to roll out the objectives, trying to advise staff of the need for change. More work was needed regarding operational improvement, theatre utilisation and scheduling. They looked into relocating services, ensuring pathways were correct, utilise community services and reduce the number of bed days, especially for frail elderly. Jo and Simon had arranged12 projects in a programme of work looking at the reconfiguration of services. Stroke was being looked at, especially the first 48 hours. Should the treatment be on 1 site or all 3? Patients that needed thrombolysis would start at a specialist site and then be repatriated. HEFT needed one ‘hyper acute stroke unit (HASU)’, but at which hospital? A regional review panel would decide how many HASUs would be needed in the region and then HEFT could decide which hospital to use, if need be. Professor Matthew Cooke was doing a clinical review of services, looking



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at the best configuration. Research was done in London, 2 years previously, and the best outcome for stroke patients was by using a HASU. All HEFT hospitals would still have acute stroke units; the ability to put in therapies for patient aftercare was also vital. Patients required lots of rehabilitation. Mary Ross was looking for more areas in which to do rehabilitation but also looking to help patients in their own homes. Jo advised that a reconfiguration of surgery was also being looked into, separating emergency and elective surgery, to be more effective. However, it would not see immediate changes as it was a 3 year strategy. The Chest Clinic in the city centre was a very cheap building, but lease was up in 2014. It was in a prime site and patients were happy going there but it was not fit for purpose, and had fire safety concerns. It could move to elsewhere in the city centre but that would be expensive. Other services could use the building instead, such as Sexual Health. Chronic disease management would need to be done differently, with the possibility of doing it outside hospital. Some pilots were being looked at, with respiratory medicine being first, trialing a small bay at Solihull and creating a Respiratory Day Hospital. However, it may be able use the building where the Chest Clinic was, instead. Elaine Coulthard asked what was going to happen to the cottage hospital in Sutton Coldfield. Mary Ross advised that it was an out patients facility but had poor wheelchair access and toilets. It was owned by Birmingham Community Healthcare so HEFT had no control over it. Jo advised that work was also being done in aiming to convert inpatient stays into day case stays, with a more holistic approach. A chemotherapy service at Solihull was being looked into as patients had to go to BHH for cancer treatment and the area was small and not entirely suitable for purpose. Chemotherapy at home was also being looked into. Jo added that there was no budget for the changes but that Executive Management Board accepted that some savings would fund some of the changes. Lisa Thomson added that money would be moved to where it would be best spent. If savings could not be made, neutral cost would be the best option and it would be all clinically-led. Mike Kelly said that involving GPs in patients’ discharges had been discussed at the Chairman’s breakfast meeting. Les Lawrence was looking at Jonah so that things were set up for patients before they left hospital. Mary Ross advised that she led the HEFT at Home strategy. All literature had been reviewed to see what patients needed, concentrating on patients over 65 who had been admitted as emergencies and stayed for 14 days. Changing their pathway made a big financial difference and by performing as well as the best trusts in the country, HEFT could reduce by 122 beds and provide a better service at home. Long stays in hospital were bad for patients; they recovered better in their own homes. HEFT would aim to avoid admission and support patients on discharge by working in partnership with Birmingham Community Healthcare and Birmingham City Council for ‘re-ablement services’. Links would need to be developed with Solihull Community Services, South Staffordshire Community Services and GPs. The councils were in charge of social care for their residents, which was chargeable. To avoid admission, a geriatric assessment team and Rapid Assessment Team was set up at the front door, Monday to Friday, but needed to be 7 days a week. It had been running at Heartlands and Good Hope for 12 months, with 9 patients currently being supported at home. The service would be built upon and would include Solihull more.



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Mary advised that all projects would interact with each other to reduce admissions and length of stay. Stroke patients would have an early supportive discharge at Solihull. There was some funding for staff but more was needed. Because of the intervention, 120 stroke patients went home early. There were also plans for frail elderly patients in a pilot at Heartlands. Healthcare at Home was commencing on 24th September, which was paid for by the Trust and involved a mixture of nurses, carers and therapists. Work was done to see how it worked privately and compared this with NHS and Community Services. At present, 12 months had been signed up for. Patients would get 1 week’s support on discharge and 6 weeks’ for stroke patients, but some may require more and would get this if necessary. Private agencies were used to provide the care and any social care would be given by Social Services employees. Patients could have up to 6 months enablement help for free but they would have to be assessed for funding. It should give patients a better experience of the healthcare service. Dementia Presentation Ann Edgar, Matron for Elderly Care on all 3 hospital sites, gave a presentation on dementia services in HEFT. She advised that treating dementia patients cost £34bn per year, £1.2bn of that in NHS hospitals, which was more than cancer, cardiac and stroke together. Two-thirds of NHS beds were used by patients over 65 and 40% of that two-thirds would have a diagnosis of dementia. It still had the Mental Health stigma, so was often overlooked and misunderstood. There were 106 variations of dementia. Ann told the group that hospital was the worst place for dementia patients and on average they spent 19.4 days in HEFT, which was 10 days longer than the national average. Ann did some work on a recent Alzheimer’s report and then was involved in the dementia strategy audit. Recommendations from that audit showed that a clinical lead was needed. Ann spoke to patients’ relatives and many of them were unhappy about the rigid visiting times, which were not helpful for dementia patients. There was a need for a cultural change. Relatives reported a poor knowledge of patients’ symptoms and many nurses had not training in dementia. Ann added that dementia patients needed stimulation; just seeing a clock to allow them to determine place and time was really helpful, but often they would be facing a blank wall, which caused delirium. There was poor communication between staff and relatives and no information available to support relatives. Patients were not given enough time to eat food of offered finger food, which was easier to eat. More education of staff was required. There were no day rooms for patients to sit out in so they would either stay in bed all day or walk around the ward, at risk of falling. Pain management was hard to recognise and manage in dementia patients and they often get dehydrated as they feel isolated. Feedback from nurses identified that they felt frustrated when trying to nurse dementia patients and did not understand what to do for patients with challenging behaviour. They have no time to sit with patients at meal times to ensure they eat their food. Looking after patients with dementia was demanding but satisfying. Ann advised that there was a small team of elderly care staff, 1 Mental Health nurse on each hospital site with a Band 6 educator working with them. The lack of staff knowledge would be addressed and there were some good courses for staff to attend. Good Hope and Solihull were improving, with help from some good volunteers. Ward 11 at Good Hope had started using music therapy with patients on Wednesdays, 11:00 to 13:00, which really cheered up the dementia patients. They also did arts therapy and as no two patients were the same, different things were tried to see what they responded to.



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Ann added that the ‘Butterfly Scheme’ had been introduced in HEFT to identify patients with dementia. A small butterfly logo would be used to highlight patients that needed more care. It was an opt-in scheme so patients and relatives were asked if they wanted to be involved, by filling in a form, with the patients’ likes and dislikes and agitation triggers. Other trusts had used the scheme and had 100% opt-in. All of the information about the Butterfly Scheme was available on the Alzheimer’s website. The project had been running at HEFT for 6 months and had had very good feedback. Ward 21 at Good Hope commenced first and the Mental Health nurses had a different approach to patient care. There were help cards that gave tips on how to approach dementia patients, as staff injuries had occurred because of the way patients with challenging behaviour had been approached. Any Other Business Having had 2 presentations at the meeting, it ran out of time so the other agenda items would move to the next meeting, to be presented by Simon Jarvis:

Good Hope ward inspection Family and Friends CQUIN Concordia update

Date and Time of the Next Meeting The next meeting had moved from the original date of 12th October to the new date of 19th October, 11:30 to 13:30, Room 2, Education Centre, Solihull Hospital

Action Log

Date of Action Action Owner Completion Date

28.06.12 Feedback re meeting with Holte School, Lozells

Lisa Thomson At October meeting

28.06.12 Add Friends and Family CQUIN to all future meeting agenda

Bev Bellerby Immediately

28.06.12 Contact Faculty of Education to see if they would send a representative to a Patient Experience meeting

Lisa Thomson Before next meeting

28.06.12 Speak to Facilities about an extra cash point near A&E at Good Hope

Lisa Thomson Before next meeting

07.09.12 Update June’s actions Bev Bellerby Before October meeting

07.09.12 Arrange for staff from Ward 17 at GHH and Ward 21 at BHH to attend a feedback session

Lisa Thomson Before October meeting

07.09.12 Add Good Hope ward inspection, Friends and Family CQUIN update and Concordia update to October’s agenda

Bev Bellerby Before October meeting



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MEETING of the

PATIENT EXPERIENCE COMMITTEE of the

COUNCIL OF GOVERNORS of HEART OF ENGLAND NHS FOUNDATION TRUST

Minutes of the meeting held in Room 2, Education Centre, Solihull Hospital

Friday 19th October 2012 at 11:30

Present Kath Bell Patient Governor Elaine Coulthard Public Governor Michael Kelly (Chair) Marck Kibilski Public Governor John Roberts Public Governor Gerry Robinson Chair, CHC David Treadwell Public Governor Thomas Webster Public Governor In Attendance Simon Jarvis Head of Patient and Public Involvement Lisa Thomson Executive Director of Corporate Affairs Sandra White Membership Manager Minutes Bev Bellerby Executive Assistant to Lisa Thomson Welcome and Introductions Mike Kelly welcomed everyone to the meeting and thanked them for attending. Apologies Apologies were received from Jamie Emery, Sam Foster, Margaret Morcom and David Roy. Minutes of the Previous Meeting All agreed the minutes of the previous meeting were an accurate representation of the meeting. However, the item discussing signs in Sutton Coldfield, directing staff to the hospital did not specify that it was Good Hope Hospital Action: BB to amend minutes by adding in Good Hope Hospital Actions from the Previous Meeting Holte School, Lozells – Lisa had arranged a meeting for January 2013 and would feed back to the next meeting after that. CQUIN update was put on the agenda, for each meeting. Faculty of Education had been invited to a meeting; awaiting confirmation of when they could attend. Extra cashpoint at Good Hope, near A&E. Lisa had spoken to Estates and it would be considered as part of the A&E reconfiguration. A telephone point would also be added at Good Hope main entrance. Di Eltringham would be attending the meeting to give an update on Ward 21 and 17 visits.



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CQUIN and Concordat had been updated. Friends and Family CQUIN Update As Di Eltringham had not arrived, Simon Jarvis gave a slide show on the Friends and Family CQUIN. He showed the report of the scores for each ward at each HEFT hospital site. He advised that a positive score was 9 or 10, a passive score was 7 or 8 and a detractor was 0-6. Simon told the group that there was a financial penalty for not meeting the CQUIN target; up to £1m of income could be withheld by the SHA. The Trust currently needed to ask 10% of all inpatients being discharged if they would recommend the hospital to their family and friends. The Trust had used several methods to collect the information, such as texting patients, using face-to-face cards and also the beside television service. The television had not been very successful as patients thought they were being asked to recommend the television service, rather than their hospital stay. However, a new questionnaire would be used on the screens that would be more self-explanatory. As well as meeting the SHA criteria, Simon advised that he was keen for the responses to be relevant, as they were fed back to the individual wards. Simon advised that the SHA had amended the criteria again, by increasing the amount of patients that neededto do the cards from 10% to 15%, changing the questions and also the collection method; they wanted HEFT to stop using the face-to-face method. That method had been very successful across the three hospitals, as it allowed patients to say everything they wanted to, good and bad, about their stay. Some of the things that were complimented were staff and the quality of the food. The things that patients complained about was communication and the time waiting in the discharge lounge for their medication to take home. Staff recognition was fed back to the individual wards; Simon hoped in future that staff could be given a letter of congratulations, signed by the CEO and Chief Nurse. Rather than asking patients to score their stay in hospital and if they would recommend it, they would be asked the question differently: ‘How likely are you to recommend our ward to friends and family if they needed similar care or treatment?’ There would be no scoring system of 0-10; patients would be asking to decide from ‘extremely likely’ to extremely unlikely’. However, only by marking ‘extremely likely’ would the Trust get a positive score; everything else would be marked as a detractor. It would mean that the current Trust score of 64 would drop to around 20. Using the cards, face-to-face would stop in March 2013 but Simon would see if he could work around not using staff to do the cards, and use volunteers instead. Cards could be used, but staff would have to direct the patients to the cards and ask them to fill them in. It would be likely to reduce the number of cards completed; approximately 1300 responses would be required every month (dependent on actual numbers of discharges). Simon showed the meeting the screen that would be used on the Hospedia system for the questionnaire and that it would be free for one quarter. More details would be available towards the end of 2012. A&E would also be targeted, for those patients that were not admitted, but it would be likely to be done by post, which historically gave a poor return rate. Whatever process was decided, HEFT would use it to drive safety. Simon linked the Friends and Family results to the Patient Metrics and Nursing Metrics to get as much data as possible. Nurses who were working towards their HEFT nursing badges needed patient recommendations as part of the criteria, so the comments on the cards could be used for that. Gerry Robinson thought that it would be good for patients to see the figures; they could go on the website. The website would be re-launched in November but would always be ‘work in progress’ and it would always be added to and improved and would be linked to CHC. Gerry added that he was worried that CHC were not always in the loop; he had not been aware of the change to the car



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parking situation at the Trust. Lisa advised that it went to the Governors Environment Committee but should have also been fed back to Patient Experience. The meeting thought that parking at the Birmingham City Football Club ground was very impractical for most staff. Lisa added that not too many staff had raised concerns to-date. Simon advised that Discharge Lounges would be situated on the wards, which would be easier for patients and would, hopefully, see quicker patient discharges home, with the added safety of having doctors and nurses close by. At Good Hope, only 28% of patients left via the Discharge Lounge in September. Gerry added that the pre-discharge forms needed to be filled in for every patient. Lisa offered to invite Sue Moore, Managing Director at Good Hope, to speak at a Patient Experience meeting about discharges. Action: LT to invite Sue Moore to report on discharging patients from Good Hope site Concordat Simon advised that feedback from inpatients indicated that they felt that there were too many people visiting the wards and that it was an intrusion. Because of this, Simon developed a visit concordat (copies passed out to the group). There were a few exemptions to the concordat, such as CHC, CQC, Health Watch and LINk, but it prevented other people turning up to inspect the wards on an ad hoc basis. It protected patients and was also good for infection control. In 2013 the PEAT (Patient Environment Action Team) visits would be done by lay people and not Trust staff. They undertook one external visit per year. Gerry advised that their marking was poor and did not provide useful feedback. The concordat may need to be amended for the PEAT visits. Gerry added that he had done a role description for LINk members. They would not have full rights and would not receive inspection reports. Confidentiality needed to be adhered to and all Governors should sign, or have already signed, the Confidentiality Act. Lisa asked if the CHC visit dates could be made available for all Governors who wished to take part. Gerry said they could but all Governors would need to have some training first. Lisa suggested having the next training session before the next Council of Governors meeting on 21st November to try to get better attendance. All agreed that visits needed to be coordinated so patients did not feel harassed. There was a mixture of announced visits and unannounced visits (even the unannounced visits would get a telephone call an hour before, to check for infection control issues, etc). John asked if the public were aware of the visits and their results. It would be useful to put the results on a board in the main entrances to show that hospitals are inspected, independently. Simon to look into displaying the results. CQC results were put on the internet. Action: SJ to look at displaying the visit results in public areas in the three hospitals Gerry added that ward sisters were dubious of CHC visits four years ago but now accepted them as CHC would take staff comments back with them, as part of the report. CHC had a unique relationship with the HEFT Board, which should be advertised. Simon had all of the information to collate, regarding the visits, which would be available soon. Kath Bell advised that she had received her CRB but that it was only a general one. Lisa confirmed that that was fine as long as she was not alone with patients, but would take Kath’s comments back to HR. Action: LT to speak to Human Resources regarding the type of CRB clearance given to Governors Heartlands Ward Inspection Update



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Di Eltringham did not attend the meeting to give her presentation. Simon Jarvis would contact her to ask her to attend the next meeting in January. Action: SJ to contact Di Eltringham re attending the next Patient Experience to give her presentation on the ward inspections Any Other Business David Treadwell advised that he had received comments from a patient who had been living abroad but came home for some cardiac treatment and was very complimentary about his hospital stay. The only issue he raised was the hospital television package, supplied by Patientline. When a card was charged for 24 hours viewing time, it ran out in 24 hours, whether or not the television had been used. Charlotte Jinks had spoken to the company who confirmed that was what would happen. There was a week’s viewing card that was better value but not much use to patients only in hospital for a few days. Lisa offered to find out how long the contract had left to run and maybe ask the company to attend a meeting, to discuss the service they offered. Action: LT to find out when Patientline contract expired. Also, to try to get a representative of the company to attend a Patient Experience meeting CQC had been invited to attend a meeting, but refused. David wondered if the Health Minister would attend to discuss policy, etc. Lisa informed the Committee that this would be put to Lord Hunt as part of his Chairman’s lectures and the Committee was informed that Sir David Nicolson would be visiting the Trust in the New Year. Action: LT to ensure the Governors are invited to the Chairman’s lectures David Nicholson was visiting the Trust on 11th January and would be speaking in the Lecture Theatre at Heartlands from 11:30. David Treadwell asked about the Major Incident arrangements at the Trust and in the region. Lisa advised that Kellie Jervis was the Head of Emergency Planning and she coordinated staff in case of a major incident. Hospital CEOs would be Gold Commanders, so Mark Newbold would be on the rota for the West Midlands and Lisa would be the second-on. Elaine asked if any decisions had been made about the heli-pad but Lisa advised that no final decisions for the region had been made. Mark Newbold had recently been appointed as the Chair of the new National Hospitals Forum. John Roberts asked if there was an update on overseas patients, following the Panorama programme. Lisa advised that the Trust believed it had correct processes in place. The patient featured on the programme had an NHS number and had been referred by his GP for an MRI scan. False NHS numbers were being procured for a cash payment and the police had started an investigation, accordingly. The member of staff involved had been suspended. Lisa would feed back to the next meeting. Action: LT to feedback to next meeting re Panorama exposé Marck Kibilski asked if the Members committee dates were confirmed. Lisa advised that attendance had been poor so no meetings had been held for a few months. She would feedback when she had more information. Marck also asked about an open day for members. Lisa and Sandra White would arrange to meet Marck, to discuss. Action: LT and SW to meet MK to discuss members’ open day


3

parking situation at the Trust. Lisa advised that it went to the Governors Environment Committee but should have also been fed back to Patient Experience. The meeting thought that parking at the Birmingham City Football Club ground was very impractical for most staff. Lisa added that not too many staff had raised concerns to-date. Simon advised that Discharge Lounges would be situated on the wards, which would be easier for patients and would, hopefully, see quicker patient discharges home, with the added safety of having doctors and nurses close by. At Good Hope, only 28% of patients left via the Discharge Lounge in September. Gerry added that the pre-discharge forms needed to be filled in for every patient. Lisa offered to invite Sue Moore, Managing Director at Good Hope, to speak at a Patient Experience meeting about discharges. Action: LT to invite Sue Moore to report on discharging patients from Good Hope site Concordat Simon advised that feedback from inpatients indicated that they felt that there were too many people visiting the wards and that it was an intrusion. Because of this, Simon developed a visit concordat (copies passed out to the group). There were a few exemptions to the concordat, such as CHC, CQC, Health Watch and LINk, but it prevented other people turning up to inspect the wards on an ad hoc basis. It protected patients and was also good for infection control. In 2013 the PEAT (Patient Environment Action Team) visits would be done by lay people and not Trust staff. They undertook one external visit per year. Gerry advised that their marking was poor and did not provide useful feedback. The concordat may need to be amended for the PEAT visits. Gerry added that he had done a role description for LINk members. They would not have full rights and would not receive inspection reports. Confidentiality needed to be adhered to and all Governors should sign, or have already signed, the Confidentiality Act. Lisa asked if the CHC visit dates could be made available for all Governors who wished to take part. Gerry said they could but all Governors would need to have some training first. Lisa suggested having the next training session before the next Council of Governors meeting on 21st November to try to get better attendance. All agreed that visits needed to be coordinated so patients did not feel harassed. There was a mixture of announced visits and unannounced visits (even the unannounced visits would get a telephone call an hour before, to check for infection control issues, etc). John asked if the public were aware of the visits and their results. It would be useful to put the results on a board in the main entrances to show that hospitals are inspected, independently. Simon to look into displaying the results. CQC results were put on the internet. Action: SJ to look at displaying the visit results in public areas in the three hospitals Gerry added that ward sisters were dubious of CHC visits four years ago but now accepted them as CHC would take staff comments back with them, as part of the report. CHC had a unique relationship with the HEFT Board, which should be advertised. Simon had all of the information to collate, regarding the visits, which would be available soon. Kath Bell advised that she had received her CRB but that it was only a general one. Lisa confirmed that that was fine as long as she was not alone with patients, but would take Kath’s comments back to HR. Action: LT to speak to Human Resources regarding the type of CRB clearance given to Governors Heartlands Ward Inspection Update


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Date and Time of the Next Meeting Thursday 10th January 2013, Boardroom, Heartlands Hospital (moved from the original date of 11th January because of David Nicholson’s visit on that day).

Action Log

Date of Action Action Owner Completion Date

19.10.12 Add ‘Good Hope’ to the 7th September minutes

BB Immediately

19.10.12 Invite Sue Moore to a Patient Experience meeting to discuss discharges at Good Hope

LT Before January’s meeting

19.10.12 Display results from ward visits, publicly, on all 3 sites

SJ Before January’s meeting

19.10.12 Speak to HR re CRB clearance for Governors Update: Charlotte Jinks advised that CRBs have all been completed at ‘enhanced’ level but without the ‘barred’ checks, i.e. for children and vulnerable adults. This is sufficient for Governors as they should be accompanied by qualified staff/nurse/ doctor when visiting wards, and not left alone with patients.


19.10.12 Contact Di Eltringham to ask her to present at January’s meeting

SJ Immediately

19.10.12 Find out expiry date of current Patientline contract


19.10.12 Ensure the Governors are invited to the Chairman’s lectures and ask the Chairman about inviting the Health Minister to one of the lectures, too.


19.10.12 Feedback on Panorama exposé LT At January’s meeting

19.10.12 Meet up to discuss Members’ Open Day

LT, SW, MK Before January’s meeting



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Quality and Safety CommitteeMinutes

DRAFT (until approved at meeting on 12th December 2012)

Minutes of a meeting of the

COUNCIL OF GOVERNORS QUALITY AND SAFETY COMMITTEE

of Heart of England NHS Foundation Trust held in the Board Room, Devon House, Heartlands Hospital on 17th October 2012

Present Title Initials STEVENTON, Liz CHAIR (Governor Solihull Central) LS LANE, Heidi Staff Governor HL ORRISS, Barry Governor Staffordshire South BO ROBERTS, John Governor Sutton Coldfield JR ROY, David Staff Governor DR TREADWELL, David Governor Birmingham Central DT WEBSTER, Thomas Governor Birmingham North TW In attendance BLACKBURN, Rachael Head of Corporate Risk and Compliance, HEFT RB KEOGH, Ann Director of Medical Safety AK REES, Alison Executive Assistant to Sarah Woolley (minutes) AR TANDY, Elaine Governance Manager, HEFT ET WOOLLEY, Sarah Director of Safety and Governance, HEFT SW Presentations RICHMOND, Jo Corporate Nurse (Safety and Quality) JR RODEN, Helen Clinical Nurse Specialist (Tissue Viability) HR SHRIVASTAVA, Dr Madhur Consultant Orthopaedic Surgeon MS

1. Apologies for absence

Apologies were received from: Kath Bell, Elaine Coulthard Not in attendance: Kevin Daly, Veronica Morgan

2. Minutes of the previous meeting (27th June 2012)

The minutes of the meeting held on 27th June 2012 were agreed as a true record. Updates from previous actions: SW reported that the Care Quality Commission (CQC) recently visited HEFT and that the conditions relating to medicines management on all sites have been lifted and we are now fully compliant with all standards published by the CQC. SW provided an update regarding the asbestos risk at Good Hope Hospital. This related to an incident several months ago concerning asbestos on the Good Hope site. This was immediately reported to the Health and Safety Executive (HSE). Internal investigations were carried out in conjunction with the HSE. It was established that any asbestos exposure was very limited and any staff that were involved had been referred to Occupational Health. The HSE have confirmed that they were happy with how we dealt with the situation but that they did still have concerns about our overall asbestos processes. John Sellars (Director of Estates and Facilities) has reviewed our asbestos processes and has reiterated that we are managing things appropriately. We register asbestos on all sites and these areas have all been marked. Additionally, when any contractors come on site, they will be advised of any asbestos locations.


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3. Nursing dashboard / metrics

Helen Roden and Jo Richmond gave a presentation about nursing metrics. The objectives of nursing metrics are as follows:

Patient safety and high quality care Standard setting Staff engagement and accountability Patient feedback Trust Board assurance Sharing best practice

Overview of metrics

Nursing metrics started off as an approach to measure processes, safety and quality. Mandie Sunderland, Chief Nurse first implemented nursing metrics in the North West where she worked as Chief Nurse prior to joining HEFT.

JR explained that three years ago, we had lengthy excel spreadsheets of results which took a significant amount of time to review and feed back to the wards. It was recognised that we wanted to have real time data which allowed us to provide immediate results to wards.

The Corporate Nursing team visit every ward on each site every month to review the notes of 10 patients (approximately 500-600 records per month). These visits are unannounced. Data is then triangulated with existing data.

Outcomes

The nursing metrics have been instrumental in providing assurance to the Trust Board. There has been a significant improvement to nurses‟ ability to collect and use data to

enhance the quality and safety of care for our patients. We are able to provide real time quantitative data – 450 patients are audited every

month (5974 records during 2010) Nurses are able to benchmark their performance.

Heidi Lane explained how the nursing metrics had improved performance on her ward and gave staff clear drivers to perform and improve on their scores. She reiterated that the metrics gave clear information as to which areas of the ward needed addressing and gave clarity about what the standards were and improved ownership and team work. Dissemination Every month, metric news goes out to the Trust and wards with information about our key focus for that month. Jo Richmond to forward copies of the “Metrics news” to all members of the Committee. Questions:

David Treadwell What is the role of a Corporate Nurse? Jo Richmond This is a central role within the nursing team, setting standards and

ensuring that things are run corporately, centralising systems and creating consistency in working practice. Community Nursing also now have their own metrics, which have been live for two months, providing real time data.

David Treadwell Could you explain about the integration between community nursing and the rest of HEFT with regards to nursing metrics?


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Sarah Woolley Community nursing is very different to that in an acute setting. Over the last 18 months, we have done a lot of base lining and working collaboratively to see how the metrics processes can be adapted to community nursing. Jo Richmond reported that she was impressed with how the community have come on board in aligning their processes with HEFT.

4. Pressure ulcers

Helen Roden gave a brief presentation about the work we are undertaking with regards to pressure ulcers. Our main ambition is to reduce harm from pressure ulcers and a key quality and safety work stream is taking place nationally which our work fits into. It was noted that there had been a general downward trend of pressure ulcers over the past four years. This had been achieved by:

Continued support for staff, increased awareness and focussed education. Proformas and processes redesigned. Definitions tightened for consistency. Ownership – RCA scrutiny / performance monitoring (dashboards).

Initiatives Initiatives which are already in place to reduce harm from pressure ulcers are: Nursing metrics (see agenda item 3) National Safety Thermometer (NST) – This encompasses falls, VTE assessment and pressure ulcer care. This is part of a wider pressure ulcer reduction ambition. NST replaces our pressure ulcer prevalence survey when we reviewed every single patient. Ward Managers now collect data on every in-patient in every area on one date so that we can easily benchmark against other organisations. „Harm free care at HEFT‟ – This is part of the five key areas of harm. Some patients have „combined harms‟, eg pressure ulcers / falls and we are currently progressing work with regards to this. Pilots – change teams and champions – Using our data, and looking at metrics and NST, we are able to identify three target wards on each site and an intensive care programme is being developed to support this with a clear aim to reduce pressure ulcer incidents. Celebrate success

JR reported that HEFT is performing well with regards to managing pressure ulcers and that are results are slightly ahead of the rest of England.

NST data - our total pressure ulcers (including all grades) is 1.86% (this includes 0.3% grade 3‟s and 0% grade 4 pressure ulcers for 5 months). This data is based on ALL patients.

It was noted that a friend of Tom Webster had been in Good Hope Hospital since May 2012 and did not have any pressure ulcers to date. JR thanked Tom for sharing this story.

In conclusion, it was noted that great strides had been made with regards to reducing harm through pressure ulcers. There was still work to continue with leadership and communication and work is ongoing with Corporate Nursing and Ward Managers regarding the fundamentals of nursing care.


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.Questions:

Barry Orriss Barry – is increase in obese patients related to increased pressure ulcers.

Helen Roden Yes, this does have an impact on the prevalence to pressure ulcers and there is also considerable evidence nationally to support this data.

Barry Orriss Do we train staff with regards to regularly turning patients? Helen Roden Yes, there is lots of work progressing with regards to patient

engagement, training and use of appropriate equipment. John Roberts Why would somebody get a pressure ulcer on their heel? Helen Roden Patients are encouraged to try and push themselves up off their bed

using their heel and this can sometimes result in a pressure ulcer.

5. Fracture neck of femur walk round feedback

Liz Steventon provided some feedback with regards to the recent fracture neck of femur walk rounds : Positives Process of patients moving through the fracture neck of femur pathway was very good (particularly the front end of the pathway) Areas for improvement No dedicated theatre trauma at Good Hope. Systems and processes deteriorated once the patient got to the ward (this was particularly apparent during the weekend). Overall, the fracture neck of femur pathway walk rounds showed a very positive experience for patients with no issues that we are not already aware of. The committee felt that the main weakness in the fracture neck of femur treatment pathway was the information that was provided to patients. Whilst it was noted that the pathway would continue to be scrutinised and monitored, LS proposed that the committee focus on the information leaflet. AR will circulate the patient information leaflet for discussion at the next meeting.

6. Fracture neck of femur update

Mr Madhur Shrivastava (Consultant, Trauma and Orthopaedics) gave an update on fracture neck of femur and took any questions with regards to this. Key points to note:

Historically fracture neck of femur made up 50% of trauma & orthopaedic injuries.

Mortality figures for FNoF patients was previously at 18% but since changes in process and other proactive measures, it has reduced to 8% (6.5% in August) – this is on par with national mortality.

We treat approximately nine hip fractures per week (500 hip fractures annually across GHH and BHH).

Foundation Year Doctors used to be under the care of Trauma and Orthopaedics but in last 12 months, Foundation Year 1 and Year 2 Doctors have been transferred to the geriatric unit - this has had a very positive impact with regards to the optimisation of patients as the needs of the patients are elderly needs.

Since April 2012, theatre hours have increased (from 10am – 4.30pm to 9.00am –


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5.00pm) – this has had a very positive impact with numbers of patients receiving operation increasing from 3.4 patients per trauma list to 5-7 patients per list.

Since April 2012, annual reviews of career progression of Doctors have been commenced and all mid grade Doctors shadow an SHO on call to assess patients for surgery.

36-hour turnaround - priority is given to those patients most likely to breach the time limit, followed by the planned FNoF list. Our target is 85% of patients into theatre within 36 hours (we are currently at 60%). Recruitment is in progress for a data manager who will take over the National Hip Fracture Database and capture those patients that are likely to breach.

„Enhanced Recovery Protocol‟ – Mr Shrivastava explained that this very new initiative involves getting patients up and mobile four hours post surgery (if in no pain). He confirmed that 30-40% of patients are mobile within four hours.

Length of stay – in 2007, LoS was 37 days for fracture neck of femur patients. Currently, it is at 20 days with some patients going home in 3-5 days. Mr Shrivastava was confident that if we can get 70-80% of patients mobilised in four hours, LoS will drop.

Questions

Sarah Woolley What happens at weekends? What would the service be? Mr Shrivastava Friday afternoon / Saturday / Sunday - patients would be seen by an

anaesthetic practitioner to ensure they are fit for surgery. They would most likely not be seen by an ortho-geriatrician until the Monday but they would still have the operation. The patient would be operated on as soon as possible following admission whether it is a mid-week or weekend admission.

Lis Steventon Is there a need for a specific trauma and orthopaedics theatre at Good Hope?

Mr Shrivastava We need more theatre time and ortho-geriatric input. SW explained that some of the clinical changes that have been implemented at Heartlands have not yet been adopted at Good Hope.but that we are planning to translate the same methodology at Good Hope. There will be continued scrutiny and as an organisation, we will not lose sight of that. It is early days and work is ongoing.

John Roberts Is it possible to move patients from one site to another? Sarah Woolley It’s a strategic issue that will need to be picked up collaboratively

between sites to establish the best way forward. Tom Webster Do Nursing homes realise the challenges we face with regards to

discharging elderly patients post surgery? Mr Shrivastava There is definitely a need for a rehabilitation facility (not in hospital)

for patients where they can recover prior to going home or being moved to a nursing home. It is important to note that patients originate in the community and we are serving them for their acute episode only. We do need to put pressure on social services to take over the care of the patient post surgery. SW reported that this is an issue nationally and not just for HEFT.

LS requested that the committee continue to receive information regarding pathways, performance and results going forwards. BO requested that the committee continue to monitor performance to show good practice on both the Heartlands and Good Hope site. Elaine Tandy will invite Carolynne Scott (General Manager, Trauma and Orthopaedics) to attend the December meeting to give feedback on integration between the two sites.


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AK will send comparative data (Good Hope and Heartlands) to committee members before the December meeting. LS thanked Mr Shrivastava for attending the meeting.

7. SIT REP Report The Safety SIT REP was provided to all committee members prior to the meeting and printed copies were also distributed. The paper was taken as read. SW confirmed that there were no new serious untoward incidents to report and that we were planning a refresh of the SIT REP as some of our internal processes have changed. SW proposed that the Safety SIT REP was provided at each meeting but that it would be for information only and not part of the formal agenda. Committee members were of course welcome to raise any issues during the AOB section of each meeting.

8. Any other business

The possibility of the Care Quality Commission attending a future meeting was discussed. SW confirmed that Lesley Ward, Compliance Manager, attended our April 2012 meeting and that we agreed we would invite her to our committee annually. Liz Steventon will be in regular contact with Lesley and will confirm a date for Lesley Ward to meet with us in 2013.

9. Date of next meeting

The date of the next meeting is Wednesday 12th December 2012. Please confirm your attendance / send apologies, to Elaine Tandy ([email protected]) / 0121 424-3094. Parking is booked at Devon House on a first come, first served basis. Please let Elaine Tandy know if you require a parking space.

Council of Governors – Quality and Safety Committee ONGOING ACTIONS – 17th October 2012

Date of mins

Action Target date Owner

Oct 2012 Patient information leaflet regarding fracture neck of femur to be distributed to all committee members.

ASAP AR

Oct 2012 AK to provide comparison data (Good Hope and Heartlands) to all committee members.

ASAP AK

Oct 2012 Jo Richmond to forward copies of the “Metrics news” to Alison Rees to circulate to all members of the Committee.

ASAP JR / AR

Oct 2012 ET to invite Carolynne Scott to attend the December meeting. Dec 2012 ET

November 2012


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November 2012


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• 21January2013• 19March2013• 22May2013

Dates of Future Meetings

Agenda

Produced by the Company Secretary’s Office

Council of Governors - Heart of England NHS … · August 2012 Margaret Morcom ... 16 July 2012...

Documents

Transcript of Council of Governors - Heart of England NHS … · August 2012 Margaret Morcom ... 16 July 2012...