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MINUTES OF A MEETING OF THE COUNCIL OF GOVERNORS HELD ON 16th DECEMBER 2009 IN THE BOARDROOM, TRUST HEADQUARTERS, AT 6.30 PM PRESENT: Mr L Higgins Chairman Mr T Frost Deputy Chairman/Lead Governor Dr K Ardern Appointed, ALW PCT Mr T Ashton Staff, Nursing & Midwifery Mr T Barton Public England & Wales Ms R Cowburn Appointed, UCLAN Mr A Foster CEO Mr V France Public Worsley Mr A Gallagher Public Worsley Ms M Hughes Public Makerfield Ms J Irvine Staff Nursing & Midwifery

Mr G Jackson Public Leigh Mr F Lever Public Makerfield Mr D Oultram Public Leigh Mrs C Swann Staff, All Other Ms A Vernengo Public Leigh Mr R Walker Appointed, 5 Borough Mr J Walls Public Wigan IN ATTENDANCE: Mrs A Arkwright Head of Engagement Mrs J Berry Corporate Services Administrator Mrs H Hand Trust Board Secretary Mr S Hand Membership & Engagement Officer Mr E Kerr Head of Marketing & Communications COG51/09 APOLOGIES Received from Councillor K Cunliffe, Miss K Fussell, Mr G Ghaly, Mr B Greenwood, Mrs P Gregory, Mrs J Heyes, Ms M Hilton, Mr J Maloney, Dr P Marwick, Mr D Partington, Mr G Roberts, Dr G Young. COG52/09 GOVERNORS INTERESTS A declaration of interest was made by LH on the item regarding NED terms and conditions which would be discussed later in the meeting. COG53/09 MINUTES OF A MEETING OF THE COUNCIL OF GOVERNORS ON

10.8.09. The minutes were agreed as a correct record. COG54/09 MATTERS ARISING No further matters from the meeting on 10th August 2009 were raised.

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COG55/09 CHAIRMAN’S VERBAL REPORT LH stated that the Trust had gone through a challenging twelve month period whilst adjusting to becoming a Foundation Trust. It had achieved a CIP of £14.5m. Difficulties had been experienced regarding contract negotiations. The new Operating Framework had recently been published which would bring even more challenges. A further report would be brought to the Governors in the near future on how the new Operating Framework would impact on services without directly affecting patients. COG56/09 ECONOMIC PROSPECTS AND STRATEGY PERFORMANCE AND FINANCE UPDATE AF gave a brief presentation on the Trust’s economic prospects and strategy as well as an update on Performance and Finance. GJ asked what could be attributed to the reduction of MRSA incidents in the Trust and AF responded that staff had a relentless determination to reduce occurrence by responding in the same way as an adverse incident. Some cases were due to contaminated samples rather than patients actually having MRSA and techniques were being improved in this area. KA added that MRSA screening was being introduced for electives with a view to it also being an integral part of emergency admissions in 18 months. When questioned about the CQC ratings, AF explained that the CQC measures demonstrated how organisations were performing but did not prevent adverse incidents occurring. He added that in September 2009, the Trust had been selected at random by CQC and had been tested against 19 parameters. Feedback had shown that the Trust had scored 100% against those parameters. VF enquired about the rise in care in the community and how this would impact on a patient who acquired an infection. He was informed that patients had a much higher risk of acquiring infections in hospitals than in their own homes. If patients acquired an infection they could be treated at home or, if necessary, could be admitted to hospital in a more specialised environment. FL asked for clarification on whether the PCT expected the same level of service from the Trust with 4% less funding. AF confirmed that this was the case but that, through partnership working, discussions were taking place on how the risks could be shared. The Department of Health expected health organisations to work together to deal with the economic downturn. The PCT had also had to have its own financial recovery plan to deal with the difficult financial future. AF added that the Trust had taken legal advice on the various options open to the Trust and there seemed to be three alternatives:

all local organisations regroup as a single organisation PCT invite the Trust to have franchise management of the services. a joint venture with the PCT/WWL.

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AF stated that national guidance was recommending vertical integration but the PCT was not in favour of this option. The Local Authority was not in favour of becoming a joint single organisation either. It was hoped that clearer direction would be forthcoming from the SHA. PCTs had been asked to inform SHAs by April 2010 of their plans for dealing with the economic downturn and these had to be approved. KA stated that the PCT’s Secondary Care Services Review also included Primary and Community Services. A Quality Innovation Productivity and Prevention (QUIPP) Board was being established by the PCT as a result of a joint summit with the Trust and the Local Authority. A Joint Strategic Intelligence Group had also been established with representatives from organisations in the borough. LH stated that the Trust would ensure that Governors were kept informed about any developments on this matter. COG57/09 MARKETING AND COMMUNICATIONS REVIEW The Marketing and Communications Review circulated with the agenda gave details of activities over the last six months and an outline of the priority areas for the following three months. It linked in with the Marketing and Communications Strategy which had been agreed at Trust Board earlier that year. Concern was raised regarding the use of Choose and Book and the option of choosing Wrightington Hospital not being available due to the long waiting times. It was stated that the option of direct referrals to the preferred hospital was also available but it was acknowledged that this was not always known by patients. COG58/09 CAR PARKING CHARGES A number of Governors had been disappointed that a press release had been issued on the revised car parking charges prior to being fully briefed. LH apologised for this incident and assured Governors that the Trust would endeavour to keep them more fully informed in the future. Minutes of Trust Board were now available on the Trust’s website but it was also agreed that copies of the minutes would be sent to Governors in future. Action: Copies of Trust Board minutes to be sent regularly to Governors.

(HH/JB) COG59/09 PATIENT EXPERIENCE (i) Real Time Patient Experience Survey (Pilot Study) AA explained that the survey covered 10 wards and the objective is to reach 85% satisfaction rates of patients. Some of the Governors had offered their assistance in conducting the surveys and training was being arranged in January. Volunteers were also assisting with the process. (ii) Complaints Report

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The Complaints Report had been circulated for information. For the period April to November 2009, 585 comment cards had been received, 499 of which had been positive. An action plan had been produced so that the negative comments could be addressed. Action: LH suggested that this item be placed on the agenda earlier in the

meeting in future so that sufficient time could be allocated to this important subject. (HH/AA)

COG60/09 GOVERNOR REPORTS (i) Communications Sub Committee HH informed the meeting that this Sub Committee had been working on the Winter edition of the Members Newsletter. AV enquired as to the reason why lay readers were involved in producing the newsletter. HH explained that it was helpful to have them read this from a different perspective. (ii) Membership Engagement Sub Committee HH reported that this Sub Committee had worked very hard at organising two very successful open events. Some learning points had been gained and these would be taken into account with the organising of another two events. (iii) Audit Task and Finish Sub Committee HH stated that this Sub Committee had been established purely to agree the process for the re-appointment of the Trust’s external auditors and was also one of the statutory duties of the Governors. They had met for the first time the previous week and agreed the Terms of Reference. Another meeting had been arranged to take place in January 2010 and it was hoped that the process would be finalised by March 2010. (iv) Remuneration Sub Committee Resolved:

to approve the new contact for Non Executive Directors, as recommended by the Remuneration Sub Committee and to agree the successful completion of the Chair’s appraisal 2009.

Governors confirmed that it was not necessary for LH to leave the meeting for this item. HH stated that a considerable amount of work had taken place with the HR Department and the Trust’s Solicitors in producing a new contract for Non Executive Directors. Prior to becoming a Foundation Trust, NEDs had been appointed through the Appointments Commission. The Remuneration Sub Committee recommended formal approval by the Council of Governors to the issuing of the new contracts to the Non Executive Directors. The SID’s report on the completion of the Chairman’s appraisal had been received and approved by the N&R sub committee. This was noted and approved.

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(v) Any Other Reports MH reported that she had attended two conferences – one on the National Audit Review and the other on Rheumatoid Arthritis Services - and was happy to provide further information to interested Governors. JW reported that he had recently attended a Clinical Audit Sub Committee and had found it to be fascinating. As part of the discussions, mention had been made of purchasing some equipment. He enquired as to the process in place for the acquisition of equipment. He was informed that business cases were considered for approval at Management Board meetings and that charitable funds were also made available for such items via the Charitable Funds Committee. TF reported that he had recently been able to be involved in a series of site tours and found them to be very informative and interesting. He commended these tours to Governors and stated that HH would be arranging further site tours in 2010. COG61/09 DATE OF FUTURE MEETING Joint Meeting of the Council of Governors with Trust Board on 19th January 2010 in the Long Drawing Room, Wrightington Hospital at 6 pm.

GOVERNORS COUNCILREPORT

16th December 2009

Andrew FosterChief Executive

Wrightington, Wigan & LeighNHS Foundation Trust

PERFORMANCE HEADLINES

• £900k in the red after eight months but still expecting a year end surplus of £700k

• On track for our biggest ever savings of £14.5m

• Only three MRSA this year• C Diff still way below our limit• Mortality rate continues to fall• A&E Performance is back under pressure• 18 week target achieved but getting tougher

FINANCE

• Our toughest year so far• Prices reduced by 3%• Inflation 1% more than budgeted• PCT funding 4% less than expected• Total savings target £14.5m without

reducing quality or accessibility• We are on track to achieve this

MRSA Bacteremia

0

2

4

6

8

10

12

14

16

18

20

April

May

June July

Augus

tSep

tem

ber

Octo

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Novem

ber

Decem

ber

Janu

ary

Febru

ary

Mar

ch

Cas

es

Total MRSA Bacteremia(Cumulative) 07/08

Total MRSA Bacteremia(Cumulative) 08/09

Total MRSA Bacteremia(Cumulative) 09/10

Trajectory 2009/10

Clostridium difficile cases (Inpatient)

0

50

100

150

200

250

300

350

400

AprilMayJune

JulyAugust

Sep temberOcto

be rNovemberDecember

JanuaryFebruary

March

Cas

es

2007/8 Actual

2008/9 Actual

2009/10 Actual

2009/10 Trajectory(cumulative)

STANDARDISED MORTALITY

ACTUAL DEATHS IN HOSPITALComparison of Hospital Deaths by Year & Month

0

50

100

150

200

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

Month

Nu

m o

f D

eath

s

0708 All Specialties (Excl Still Births) 0809 All Specialties (Excl Still Births) 0910 All Specialties (Excl Still Births)

-214

-84

A&E PERFORMANCEWWL Health Economy % Performance

85.0%86.0%87.0%88.0%89.0%90.0%91.0%92.0%

93.0%94.0%95.0%96.0%97.0%98.0%99.0%

100.0%

2008/09 2009/10 98% Target

2008/09 98.0% 98.8% 98.5% 96.8% 97.4% 97.9% 96.9% 97.9% 93.7% 93.7% 97.0% 94.6%

2009/10 97.7% 98.1% 98.5% 98.7% 98.4% 97.5% 95.3% 96.1% 97.8%

98% Target 98.0% 98.0% 98.0% 98.0% 98.0% 98.0% 98.0% 98.0% 98.0% 98.0% 98.0% 98.0%

APR M AY JUN JUL AUG SEP OCT NOV DEC JAN FEB M AR

OTHER HEADLINES

• CQC ratings ‘Good’ for Quality and ‘Good’ for use of resources

• It looks likely now that Swine Flu will be nowhere near as bad as feared

• Tony Chambers, Director of Operations, leaves this month. Duties shared amongst other Directors

• Chris Chandler, Medical Director, retires in March. Successor to be announced soon.

DIRE ECONOMIC PROSPECT

What does it mean for WWL?

Trends in NHS Expenditure (Source:- King's Fund & IFS "How Cold Will It Be?")

0 1 2 3 4 5 6 7

Annual real spend increasesince 1948

20th century average annualincrease

21st century average annualincrease

Lowest annual average byGovernment administration

(1951 - 63)

Highest annual average byGovernment administration

(1997 - 2011)

Budget commitment for realgrowth across public sector

beyond 2010/11

Percentage Real Growth in NHS Expenditure

NHS FUNDING FROM 2011/12Key Headlines

Target £15bn – £20bn efficiency savings 2011/12 2013/14

WWL NHS FT assumptions: 19% reduction; £95m across the economy

System changed and costs released by 1 April 2011 i.e. 15 months lead time from NOW

THE CHALLENGE

• No longer more work for more income

• It will be more work for less income

• How to become 15-20% smaller– Without reducing quality

– Without increasing waiting times

• How to sustain a comprehensive hospital service in Wigan and Leigh?

THE PCT VIEWSECONDARY CARE SERVICES REVIEW

A review started in November 2008

– Strengthened Practice Based Commissioning

– More services delivered in the community

– Better demand management

– Reduced outpatient activity

– Improved productivity

– More investment in prevention

– Estimated savings £10-13m

THE TRUST VIEW

• The health economy needs savings of £95m

• The PCT proposals are– very sensible but ….

– don’t give enough savings

– have not worked in the past

– are only aimed at secondary care

• We need a radically new approach

SIX KEY ELEMENTS

1. IT enabled care pathways, mandated across primary, community and secondary care supported by the Map of Medicine and a single, multi-agency health and care record for each local resident

2. Hub and spoke delivery of care with significant reduction in hospital based care matched by growth in community delivered care

3. A system financially designed to encourage less secondary and more community care

SIX KEY ELEMENTS

• Raising the entry bar to costly long term continuing care and

providing better alternatives

• An assertive approach to prevention and health promotion underpinned by population health records

• An integrated approach to Long Term Conditions supported by a risk-based register

All of this enabled by having a single, integrated provider of health care

SAVINGS

• Unscheduled care £5m• Scheduled care £5m• Continuing care £3.2m• Organisational costs £1.7m• Estates costs £5.2m• Sub-total £20.1m• Plus reduction in waste and duplication via

mandated care pathways - £20m+??

VERTICAL INTEGRATION• Merger, franchise or joint venture• Directly releases organisation and estates costs

£6.9m• Enables realisation of other savings and benefits• Overcomes seams between organisations • Overcomes financial disincentive to move from

hospital to community• Means that providers have the same goal rather

than competing priorities• Means that patients experience a single system

SUMMARY

• A genuine response to the huge challenges we face

• Provides a realistic achievable solution• Concurs with many of the themes in the PCT

paper• Concurs with the Tribal analysis of efficiency

opportunities• And from best practice elsewhere in the world• Needs further detailed analysis

WHAT HAPPENED NEXT?

• The PCT rejected our proposals and will continue with their own review

• But the government has come out strongly in favour of vertical integration

• More detailed guidance is due later this week