Minutes of the 17 th Trust Board Meeting held on 12 th November 2009 at 10.00am, in the Betty Chambers Room, Musgrave Park Hospital

Transcription

1 Minutes of the 17 th Trust Board Meeting held on 12 th November 2009 at 10.00am, in the Betty Chambers Room, Musgrave Park Hospital Present: Mr P McCartan Mr W McKee Professor E Evason Dr V McGarrell Ms J Allen Mr T Hartley Mr C Jenkins Mr L Drew Mr J O Kane Mrs W Galbraith Dr T Stevens Mrs N Patterson Chair Chief Executive Deputy Chief Executive/Director of Finance Medical Director Director of Nursing (Acting) In Attendance: Mrs M Mallon Ms C McNicholl Mrs J Welsh Miss B McNally Mr J Growcott Mr I Jamison Mr B Barry Mrs D Curley Mrs J Champion Director of Human Resources Director of Performance & Service Delivery (Acting) Director of Specialist Services Director Social Services, Family Childcare and Mental Health Co-Director of Mental Health & Learning Disability Acting Head of Patient & Client Services Acting Director of Older People, Medicine & Surgery, T&O Head of Communications Head of Office of Chief Executive (Acting) Apologies Miss B Creaney Mrs P Donnelly Ms D Stockman Director of Social Services, Family & Childcare (Acting) Director of Clinical Services Director of Planning and Redevelopment Mr McCartan welcomed everyone to the meeting and made a special welcome to Mr Tim Attwood, the representative of the Patient and Client Council. He also advised the Board that participants of the Get on Board course may be attending. TB Minutes of the Previous Meeting The minutes of the Trust Board Meeting held on 24 September, 2009 were read and approved. There was one amendment on page 3 Mr McKee set the wider context of the report and highlighted in particular the impact of the underlying deficit of 40 million which had been inherited by the Trust. 1

2 TB Matters Arising There were no matters arising. TB Chairman s Business Health Committee Copies of the minutes of the Health Committee held on the 14 October were tabled for information. Mr McCartan congratulated the Chief Executive and the Deputy Chief Executive/Director of Finance on the quality of their presentation to the Health Committee. Professor Evason and Mr Jenkins endorsed this opinion. Diary Commitments Mr McCartan detailed his diary commitments since the last meeting and thanked Professor Evason and Mr Drew for attending events on his behalf. TB Report of the Chief Executive Mr McKee presented the report of the Chief Executive. Mr McKee reported that the Trust had performed well against a number of PfA targets, in particular Health Care Associated Infection (HCAI) and cancer targets. He advised that the Trust was continuing to sustain performance in relation to 12 hour breaches but was facing difficulties in achieving 4 hour target in A & E. He further advised that there were major challenges in achieving elective access targets which would be highlighted in the Director of Performance and Service Delivery Report. Mr McKee reported that in relation to the Trust s financial position there was ongoing discussion with the HSC Board and the DHSSPS. He advised that the Trust had received a response from the DHSSPS in relation to its contingency plan and that the Minister had rejected a number of measures. Mr McKee reported that the Executive Team had attended a work shop on the 22 October and were developing a Twenty Point Action Plan which would be used to support the 2009/10 Corporate Management Plan and would provide a basis for the 2010/11 plan. Key themes were around tackling the last 5 months with regard to access targets, consultant job planning and rotas and the development of a leadership programme for ward managers. Mr McKee advised that the Action Plan would be discussed further with Trust Board at its December workshop. Mr McKee highlighted the success of the Leadership conference held on the 5 November 2009 in Grove Health and Wellbeing Centre. The conference was attended by 180 leaders in the organisation. Mr McKee advised that the Knockbreda Health & Wellbeing Centre had been successful in winning a Royal British Architectural Award. Pandemic Flu Preparedness Update Dr Tony Stevens, Medical Director, presented a real time verbal report on the Pandemic Flu situation. 2

3 Dr Stevens advised that across Northern Ireland 527 hospitalised cases had been reported with 11 deaths to date. It had earlier been predicted by the Chief Medical Officer that the last 2 weeks of October or November would be the peak weeks in Northern Ireland for the current wave of H1N1 pandemic influenza. Dr Stevens reported that there was a decrease in the percentage of positive laboratory tests during the past week and that the Out-Of-Hours service which had faced significant pressure over the past 3 to 4 weeks with a 30% cases reporting flu like illness were now reporting that this had dropped to 15% over past few days. He advised that it was likely that Northern Ireland may already have experienced the peak week. Dr Stevens reported that the current pressure on the organisation was dealing with suspected cases in order to prevent cross infection. In relation to training, Ms Patterson, Acting Director of Nursing, reported that 500 ward staff had been up-skilled to deal with High Dependency patients and 150 theatre nurses had been trained in critical care. She advised that whilst we may not need these staff at this point of the current pandemic flu the training had not been wasted as it prepared us for the future and gave the organisation the benefit of a more flexible workforce. Dr Stevens reported that the vaccination programme had represented a substantial undertaking. He advised that the Trust had vaccinated approximately 4,000 staff including those in the Independent Sector and Primary Care. The programme had been led by Ms Brenda Creaney Acting Director for Social Services, Family and Childcare. Dr Stevens advised that the Trust were currently only vaccinating front line staff, defined as staff actually laying hands on patients. He reported that over 2,000 pregnant women had been vaccinated; largely at weekend clinics and that the Trust had offered vaccinations to children in special schools. Dr Stevens confirmed that the children in special schools had probably been compromised because of complex physical health problems and that generally those people who have died of or with swine flu have significant underlying health issues. Mr O Kane expressed concern about the media attention surrounding the deaths of children from special schools. Mrs Curley confirmed that there was a weekly media briefing by the DHSSPSNI. She advised that that the media had accepted the need for privacy for the families. She confirmed that the families are asked about the level of detail that they wish to disclose. The Trust Board discussed the natural history of pandemics. Dr. Stevens advised that we may also face a different virus in the future eg avian flu. He further advised that if the uptake of both H1N1 flu and seasonal flu vaccinations in the community was good that this would positively impact on future hospital admissions. Dr Stevens confirmed that the virus will be factored into future vaccination programmes and that the design of next year s seasonal flu vaccine will already have started. Mr McCartan commended the staff for all their hard work in pandemic flu planning; including the provision of training and a successful vaccination programme. He reminded the Non Executive Directors of the opportunity to attend one of the vaccination clinics and receive their seasonal flu vaccination. Decision: The Board accepted the Report of the Chief Executive. 3

4 TB Report of the Deputy Chief Executive/Director of Finance Mrs Galbraith presented the Report of the Deputy Chief Executive/Director of Finance for the period ended 30 September Finance Report Mrs Galbraith set the context and referred the Board to further detail provided in her report. She reported that as had been previously highlighted at the September Trust Board the Trust would not achieve its earlier projected expenditure position. Mrs Galbraith advised this was attributable to the emergence of a number of inescapable cost pressures in 2009/10 and to slippage in elements of the MORE programme. Mrs Galbraith reiterated that the Trust has incurred significant expenditure in relation to sewage charges, drugs including 1.2m for HIV, infection control, medical staffing issues and a number of other pressures across a range of services. She advised that the net cost of cost pressures arising in 2009/10 is expected to be in the region of 5.4m. Due to the lack of growth monies in the system the HSC Board had not been able to provide additional monies for this as would probably have been the case in earlier years. In relation to the MORE programme, Mrs Galbraith reported that a review of progress had revealed slippage of approximately 6.5m. There were a number of reasons for this including non achievement of regional procurement savings, which the Trust had reasonably assumed would be achievable, the impact of consultation and equality considerations and wider political/economic influences. The Trust had identified a number of these earlier in the year and had put in place an internal contingency plan to address the gap, but in part due to the intense managerial commitment of the HSC planning for swine flu over the summer period, these have also slipped. The Trust was therefore anticipating a deficit in the region of 23m and this had led to the submission of a formal contingency plan to the DHSSPS in September. Mrs Galbraith reported that the Trust was incurring substantial costs in relation to the achievement of the Ministerial targets and that during September the Trust had been advised that 20m had been set aside for access targets. This had led to the earlier decision to pause referrals to the independent sector pending an engagement with the HSC Board and the DHSSPS to agree a way forward. Mrs Galbraith reported that at the end of October the Trust was advised that a further circa 17m would be provided to meet its access target pressure in year. She reported that, on the basis of current information, the cost of achieving the targets in all but a few specialties, where there is not a regional solution, would result in a shortfall of around 6m to 7m. Discussions were ongoing and the key challenge for the Trust in the last four months of the financial year would be to maximise the activity that could be achieved internally. Mrs Galbraith advised that the Trust were reporting an income deficit of 11.67m as at 30 September. Mrs Galbraith reported that detailed discussions were ongoing with service group directors to confirm that expenditure reductions proposed earlier in the year in relation to additional vacancy control and other contingent measures will be delivered from November onwards in order to recover the position. 4

5 Mrs Galbraith reported that the Trust had received a formal response to its plan at the end of October. However, a number of the contingency measures proposed had subsequently been rejected by the Minister, which meant at this stage a balanced financial position was not yet achievable. Members were advised that discussions were ongoing with the DHSSPS and HSC Board. Mr McKee clarified for Professor Evason that the Trust could not provide a definitive forecast position to March 2010 at this time. He advised that the HSC Board had been open and supportive and discussions were on going with the HSC Board and the DHSSPS. He further advised that no decisions had been taken with regard to restarting referrals to the independent sector and that the Trust would have to decide how to make the most effective use of what was available. Decision: The Board noted the report of the Deputy Chief Executive/ Director of Finance. Charitable Trust Funds Annual Accounts Mrs Galbraith presented the Charitable Trust Funds Annual Accounts for 2008/09 for approval. Mrs Galbraith reported that the Accounts have been fully considered by the Audit Committee and received an unqualified audit opinion by the Northern Ireland Audit Office. Decision: The Board approved the accepted the Charitable Trust Funds Annual Accounts for 2008/09. TB Report of the Director of Performance and Service Delivery (Acting) Ms McNicholl presented the report of the Director of Performance and Service Delivery September Ms McNicholl reported that the Trust was achieving, on target to achieve or marginally behind target in relation to 26 of the 31 reported performance areas. Key Target Areas Ms McNicholl advised that in five of the reported performance areas achieving targets would remain a significant challenge this year. These are; Elective Access target, Accident and Emergency 4 hour target, Fracture 48 hour target, Learning Disability (100% Discharges within 90 days) target and MSSA target. Ms McNicholl advised that the decision in September to pause further referrals to the Independent Sector would have an impact on elective access target areas. She highlighted that the impact would be significantly higher on a number of specialties such as orthopaedic, urology, dermatology, cardiac surgery, neurosurgery, gastroenterology, plastics and paediatric surgery. Ms McNicholl informed the Board that the Trust has been having ongoing discussions with the HSC Board Officers and that the Trust should be receiving formal notification of a further allocation to support elective access in the very near future. 5

6 She advised that this allocation would not be expected to fully address the shortfall projected by the Trust and that discussions would be ongoing with the HSC Board regarding levels of performance. Mr McCartan allowed Mr Attwood, the representative from the Patient and Client Council, to seek clarification on waiting times. Mr McKee confirmed that in real terms this meant that waiting times were 2-4 weeks longer and that the Trust was avoiding the long waiting times of 5 years ago. Ms McNicholl advised that performance in meeting the fractures target over the past 2 months had been consistently above 75% which was an overall improvement. She confirmed that the Trust was continuing to highlight to the Board that there was inadequate capacity to deal with peaks in demand and the provision of specialist surgery within 48 hours at the RVH. Ms McNicholl advised that a regional group was meeting to review the issues of capacity/demand and that a report of the group was not yet available. Ms McNicholl advised that in relation to A & E targets the majority of delays in excess of 4 hours continued to relate to patients requiring admission. She confirmed that a Trust action plan was in place to improve patient pathways, reduce length of stay and free up beds to facilitate faster admission from A & E. Actions include rolling ward audits, more effective discharge monitoring, consultant assessment within 24 hours of admission and rolling out nurse led discharge. Ms McNicholl reported that the Trust had requested a benchmarking exercise to compare staffing levels with other A & E units. In relation to absenteeism, Ms McNicholl advised that the Trust had experienced a small rise from the previous reported position; from 5.39% to 5.60% although the overall trend for the year to date remains downward. Mrs Mallon advised of the link with swine flu and confirmed that this level may rise again over the next month or so. Quality and Safety Indicators Ms McNicholl was pleased to report the Trust s improvement in performance in relation to Quality and Safety indicators and in particular the reduction in levels of Healthcare Acquired Infections. Dr Stevens commended the hard work and commitment within the Service Groups for the continuing improvement in relation to the quality and safety indicators. Mr O Kane sought clarification in relation to Service and Budget agreements. Mrs Galbraith confirmed that the report excluded the activity of Musgrave Park Hospital. PfA Bi-Annual Report Summary of Performance (not included in Sections 1 and 2) Ms McNicholl presented the PfA Bi-Annual summary of performance report at end September 2009 and highlighted the three targets not likely to be achieved. She advised that the Trust had submitted an updated action plan to the DHSSPS re the Live Donor Transplant programme and confirmed that the Trust had secured the services of an experienced transplant surgeon and that training has taken place. Mr McKee clarified the term Live Donor. 6

7 Ms McNicholl reported that in relation to Autism target areas the Trust was not currently meeting this target. She further advised that although the additional resources which had been identified through HWiP would not allow the Trust to meet the March 2010 target it would result in an enhanced service. Ms McNally confirmed that there was a capacity issue across the region. Ms McNicholl confirmed that an action plan had been submitted to HSC Board for review. In relation to pre-operative assessment Ms McNicholl advised that data validation was on-going and that there were a number of initiatives were being developed. She confirmed that the Trust was continuing to work with the HSC Board to agree the data which would be used to measure this target. Bi-Annual Corporate Management Plan Progress Report Ms McNicholl presented the Bi-Annual update on progress against the Corporate Management Plan for 2009/10. She advised that the majority of objectives would be delivered within the expected timescale or were underway but completion dates may be extended. Decision: The Board agreed to note the report of the Director of Performance and Service Delivery September TB Report of Director of Mental Health and Learning Disability Mrs Miriam Somerville, Co Director Mental Health and Learning Disability Services presented the Excellence and Choice Document entitled A consultation on the future provision of Learning Disability Services in Belfast. Mrs Somerville advised that the document focused on where people live, access to community support, access to respite services, access to inpatient and treatment services and the resettlement of patients from long stay wards into the community. Mrs Somerville advised that the document had been developed in partnership with colleagues in primary and acute care. She further advised that an easy read version had been developed to facilitate consultation. A copy of this version was tabled for information. Mr McCartan thanked Mrs Somerville for her presentation. Decision: The Board approved for consultation the Excellence and Choice Document entitled A consultation on the future provision of Learning Disability Services in Belfast. TB Report of Director of Social Work Ms McNally presented the following annual reports; Residential Child Care, Adoption Service and Child. Residential Child Care Annual Report Ms McNally presented the Annual Residential Child Care Report 2008/09 and advised that the report is required to be presented to the Trust Board under the Regulation and Guidance for Children s Homes (Children s Order 1995). 7

8 Ms McNally highlighted that the report reviews the nine children s homes across Belfast and that it makes comment on the progress of the Trust s Children s Homes Residential Strategy. She advised that the implementation of the strategy has been successful particularly in respect of the long-term homes which have been able to operate within their Statement of Purpose and provide a high degree of stability for their young people. Ms McNally advised that the Trust was facing three key challenges. The HSC Board was unable to complete redevelopment programmes due to lack of funding. This has resulted in homes having to at near one hundred percent capacity as opposed to the eighty percent under the Children Matter Strategy. Ms McNally further advised that this pressure had been worsened with the increase in referrals to the children s residential sector and admissions of young people aged 17+ who have been classified as homeless following a recent House of Lords Ruling. Ms McNally reported that many of this cohort of young people present extremely challenging behaviour. Adoption Service Ms McNally presented the Annual Adoption Service Report 2008/09 and advised that the report is required to be presented to the Trust Board for approval under the regulations and guidance of the Adoption (NI) Order Ms McNally thanked Ms J Allen and Mr L Drew for their continuing support and hard work in this field. Professor Evason commended the hard work of staff in this area. Ms McNally highlighted the challenges for the Inter-Country Adoption Service with increases in the trend in this area. Child Protection Ms McNally presented the Annual Child Protection Report 2008/09. Ms McNally highlighted the work of the Trust s Child Protection Panel which has sought to build on the work of the legacy Trust Panels/Committees and has established a Business Plan. She also highlighted the work of the Trust s gateway Service, a single point of entry for all professional and public referrals in relation to concern about the welfare of a child. Ms McNally advised the Trust Board on the findings of the RQIA inspection of Child Protection Services in July 2008 which is a Regional inspection conducted over a two-year period in a number of stages. She reported that the report was positive; however there was room for improvement in record keeping. Decision: The Board approved the report of the Director of Social Work. 8

9 TB Audit Committee The minutes of the Audit Committee of the 27 May 2009 were presented to the Board for noting. Mr O Kane presented the Annual Report of the Audit Committee 2008/09. Decision: The Trust Board approved the Annual Report of the Audit Committee 2008/09. TB Assurance Committee The minutes of the Assurance Committee 3 rd June 2009 were presented to the Board for noting. TB MORE Programme Assurance Board Mr Jenkins presented the report from the MORE Programme Assurance Board (PAB). Mr Jenkins set the context of the MORE PAB and advised that the report provided detail on the financial and economic climate within which the MORE programme operates. Members were advised that the Programme Assurance Board had gained positive independent assurances from the BSO Internal Audit service regarding governance and performance management structures. Mr Jenkins reported that the PAB was reassured that the Trust had developed positive industrial relations with Trade Union colleagues, which included representation on the PAB. However, Mr Jenkins was disappointed to report that the Trade Unions had withdrawn at this time. Mr Jenkins advised that the PAB was satisfied with the MORE programme s performance management process and supported the Trust s position that short-term measures could not be the main focus and was reassured that the focus on reform and modernisation was the appropriate vehicle to deliver the efficiency savings required. The PAB applauded the Trust s approaches to build capacity to achieve the reform and modernisation objectives. However, whilst supporting the Trust s analysis that the scale and pace of change required to successfully modernise services was unprecedented and he felt that there may now be a question mark over full deliverability in the timescales required. Mr Jenkins reported that it was the belief of the PAB that a number of practical steps could be put in place at regional level which would enhance the change process, for example the creation of a central spend to save fund. Mr Jenkins went on to confirm the importance which the Trust placed on the MORE programme and he was confident, as Chair of the PAB, to report to the Board that significant benefits had been delivered. However, he raised his concerns regarding proposals which the Trust had been unable to take forward, even though they were felt to be right thing to do. Mr Jenkins called on Non Executive colleagues to support the Directors in the achievement of the targets and expressed concern over the deliverability of the level of savings required, without the required levels of growth in the system 9

10 Mr McKee thanked the Chairman of the MORE Programme Assurance Board for his detailed report and comments and reassured members that he and the Director s would continue to raise these concerns during interface meetings with Commissioners and the DHSSPS. TB Any Other Business There were no other items of business. TB Date of Next Meeting The next meeting will take place on the 10 December 2009 at 10 am in Room One, Knockbracken Healthcare Park. 10