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Agenda Item A3
THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST
Minutes of the Board of Directors Meeting held on 25th May 2016
Part A: Public Session
Present:
Mr K W Smith (Chair)
Sir Leonard Fenwick
Mrs A Dragone
Mr A Welch
Mrs L Robson
Dr B C Dobson
Professor K McCourt
Dr P Kesteven
Mrs H A Parker
Mr D Stout
Chairman
Chief Executive
Finance Director
Medical Director
Business and Development Director
Non-Executive Director
Non-Executive Director
Non-Executive Director
Non-Executive Director
Non-Executive Director
In Attendance:
Ms K Douglas
Mrs A O’Brien
only)
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Trust Secretary
Director of Quality and Effectiveness (minute ref. 16/69(ii)
Apologies for Absence
Apologies were received from Professor C P Day, Non-Executive Director and Mr
E Weir, Non-Executive Director.
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Declarations of Interest
None on this occasion.
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Minutes of the Meeting held on 27th April 2016
These were agreed to be a correct record subject to a typographical correction on
page 3 to amend the reference to Mr Hunter rather than Mr Hunt.
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Strategic Issues
i)
Report of the Chief Executive
Sir Leonard spoke of a number of topics of current interest.
Sir Leonard reported that good progress had been made with regards to the
mediated settlement with the PFI provider and acknowledged the good work
performed by Robin Smith.
Sir Leonard confirmed that Lord Carter had visited the Trust premises. Despite
reservations in the accuracy of the database used by Lord Carter to generate his
report, the Trust had sought external support from PwC to assist. Dr Dobson
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questioned which areas the Carter review covered. Sir Leonard advised that this
was use of clinical and non-clinical space.
Sir Leonard explained that the local authorities were looking at bringing together
assets. For NUTH, site planning had been undertaken at Walkergate and work
was progressing at the Sanderson Hospital site.
Mrs Parker highlighted that Mr Simon Stevens had recently commented to the
Select Committee that organisations were progressing well with the Carter
recommendations.
Sir Leonard confirmed that the most relevant data for NUTH would be through
comparison with Shelford Group peers.
With regards to ACO developments, Sir Leonard advised that the Shelford Group
appear to be favouring block allocations over pbr which is contrary to NUTH view.
Mr Stout confirmed that he had chaired the Audit Committee on 24th May 2016,
one or two issues had been identified but overall the financial statements audit had
gone well.
Sir Leonard expressed his concerns over the DH Transaction Review process
whereby the Trust was visited by Deloitte. The Trust had requested that PwC be
present at the meeting.
The Trust had held a successful Equality and Diversity conference at the RVI
recently.
Sir Leonard advised that the Local Clinical Excellence Awards (2015/16) Panel
assessment had been undertaken and recommended outcomes developed. The
recommended outcomes will be considered by the Trust Remuneration Committee
which had not yet convened.
Sir Leonard confirmed receipt of the draft CQC reports and that these reports had
been reviewed for factual accuracy prior to re-submission with additional
information on 10th May 2016. It was evident that there had been a significant level
of interference regarding the outcome of the report however it was important to
monitor staff morale.
Sir Leonard reported that there appeared to be a widening of the scope of NHS
Improvement work.
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Safety, Quality and Performance
i)
Healthcare Associated Infections
Mrs Lamont presented the April 2016 position. There had been 7 Clostridium difficile
cases in April, against a target of 7 for the month. Of the 7 cases reported in April
2016, 3 are being considered for appeal. April’s C. difficile rate per 100,000 bed days
is 15.6 against the target of 16.3.
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The 2015/16 final year-end C. difficile figure was 67 cases (94 cases and 27
successful appeals), against a target of 77.
No MRSA cases have been attributed to the Trust in 2016/17 to date.
In April there were 9 MSSA bacteraemia attributed to the Trust. This compared
with 5 cases in April 2015. On average, there were 7 cases a month during
2015/16.
Mrs Lamont explained that Root Cause Analysis (RCA) is now undertaken in all
cases of MSSA identified post-48 hours of admission and where appropriate cases
presented and discussed at the Serious Infection Review Meetings.
In April there were 19 E. coli bacteraemia attributed to the Trust. This compared
with 13 cases in April 2015. Of the 171 Trust-attributed cases during 2015/16, the
urinary tract was the primary source in 32% of cases. On average, there were 14
cases a month during 2015/16. As part of the Year of Harm Free Care,
educational materials are being developed to promote ‘no catheter, no CAUTI’
(catheter-associated urinary tract infection) in June.
Mrs Lamont highlighted that the IPC Mandatory Training figure was 33.67% in April.
She explained that the new rule to ‘reset the clock’ had taken effect whereby all
mandatory training which was due to expire at any point during 2016/17 automatically
expired on 31st March 2016 instead. Therefore, it is expected that all Mandatory
Training figures will be lower in April but will improve throughout the financial year.
Mrs Lamont confirmed that Influenza has continued to be seen at lower levels
throughout April. This winter, ‘point of care’ testing for influenza was introduced on
the Assessment Suite in an attempt to identify infected patients earlier, prioritise
isolation and prevent exposure of other patients. Initial clinical impressions are that
this has had a significant positive impact due to timely diagnosis, meaning that
there are fewer contacts with other staff and patients and the potential for
influenza to spread is reduced. Full evaluation of point of care testing is ongoing.
Mrs Lamont explained that even when the diagnosis is confirmed, the limited
isolation capacity in the Assessment Suite and within the Trust generally remains
a critical issue.
Mrs Lamont also referred to the IPC Activity undertaken in March, as set out on
page 4 of the paper.
It was resolved:
to receive the briefing and note the current position.
ii)
Quality Report, including Complaints Dashboard
Mrs O’Brien presented the April 2016 Quality Report and explained that there had
been an increase in the total number of patient incidents reported this month in
comparison to April 2015. The Sign up To Safety Campaign aimed to increase
incident reporting rates within the Trust therefore the increase was as expected.
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The number of incidents reported per 1000 bed days in April 2016 was higher than
the number of incidents reported in the same month during 2015. Higher rates of
incidents again suggests a positive patient safety culture.
Six Serious Incidents had been reported in April, with no never events being
reported. Mrs O’Brien advised that the Trust was required to inform its
commissioners when serious incidents were identified.
In relation to the unexpected death of a patient following a myocardial infarction
(MI), Mrs O’Brien confirmed that this had been reported in time and the
investigation identified that the MI was ‘old’ and therefore would not have changed
the outcome. The remaining Serious Incidents related to one breach of information
governance (lost medical notes), three pressure ulcers graded 3 or above and one
death due to hospital acquired C difficile.
Mrs O’Brien advised that the timely investigation of incidents was becoming more
challenging due to stricter reporting timescales and additional requirements.
Additional training had been scheduled so that more staff were trained to
investigate incidents.
The number of patient falls reported per 1000 beds days in April 2016 is below the
national and local target. There has been an increase in the number of pressure
ulcers reported this month when compared to the same spell last year.
The reporting of medication incidents has decreased slightly this month. Work
continued to ensure that these incidents were investigated in a timely manner.
The most recent Standardised Hospital Mortality Indicator (SHMI) data showed
that the Trust was performing ‘as expected’. The crude number of deaths for April
2016 was 161 which was lower than those reported in the same month last year.
During April 16 there were 19 radiation incidents reported, an increase of six from
the same time period of the preceding year.
Dr Dobson referred to the query he raised at the last meeting to ask why there was
no equipment failures reported for radiation incidents in 2014/15, compared to 37
this year. Mrs O’Brien confirmed that in the last Quality Report (March data – April
Board) radiation incidents due to equipment failure were noted to be 0 for the
period April 14 - March 15, against 37 for the period April 15 - March 16. This was
an error and the true figure for April 14 - March 15 was 13. She advised that since
that report was published a further two incidents relating to equipment failure were
reported retrospectively bringing the total for April15 - March 16 to 39. Therefore
whilst the difference between the two years in question is not a big as previously
reported it is still significant.
Mrs O’Brien explained that 23 of the 29 incidents were reported on Tomotherapy
units. A second such unit was commissioned in 2015 which resulted in a
significant increase in activity. Every patient scheduled for treatment on these units
must undergo a daily pre-treatment verification CT scan to ensure they are in the
correct position for treatment. If a machine error occurs during the acquisition of
this scan, the scan will terminate and the imaging data that has been acquired
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is lost. The scan therefore has to be repeated. NCCC work closely with the
machine manufacturers and inform them of every incident that occurs to identify
the root cause and implement preventative actions where possible.
Furthermore some of the general increase in 2015/16 equipment failure incidents
is thought to reflect an improvement in staff awareness and willingness to report
incidents as there was also a significant increase in the reporting of near miss
incidents during the same period.
NEQOS have mapped the Trusts performance in the National Inpatient Survey
onto the NICE Quality Standard for Patient Experience. The Trust has
either performed as well as or better than the national average on all measures.
Mrs O’Brien confirmed that there is a continuing decrease in the number of
complaints received (14% from the previous year).
Mrs O’Brien highlighted that progress against the CQUIN indicators will be
reported from next month.
Mrs Lamont highlighted that in ward 46 there had been no pressure ulcers
reported in the last two years, which was a good turnaround as they previously
reported 2 or 3 per month. Mr Kingsley W Smith acknowledged the good news and
expressed his congratulations to the ward.
Dr Dobson referred to the Annual Report on health and safety incidents and
queried why the Board do not receive feedback on assaults, of which there appear
to be a significant number of. Mrs O’Brien confirmed that this is reported to the
Corporate Governance Committee. Action 1: Mrs O’Brien agreed to include a
section in the Quality Report on health and safety themes/trends and that
annually a report on Health and Safety would be brought to the Board.
Mrs Lamont confirmed that she personally signs letters detailing support
information to all staff subject to an assault.
Mrs O’Brien confirmed that at the Clinical Governance and Quality Committee the
Trust was reported as an outlier by Dr Foster on intercranial deaths. Consequently
the Trust had completed some internal work relating to this.
Mr K W Smith queried whether the Trust had informed Dr Foster of the work
undertaken. Mrs O’Brien agreed.
It was resolved:
to receive the briefing and note the current position.
iii)
Nursing and Midwifery Monthly Staffing Exception Report
Mrs Lamont presented the report for March 2016.
Mrs Lamont highlighted that a Trust Nursing and Midwifery Staff Nurse
Recruitment Event was held on 4th May 2016, targeting Registered Nurses and
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those about to qualify in September along with those considering returning to
practice. Feedback was very positive with over 70 attendees.
The collaborative work with Job Centre Plus had resulted in 22 Candidates being
identified suitable for interview in the HCA Centralised recruitment event in May.
For night staffing, more senior staff are being supplemented by unqualified support
staff but this is difficult to plan particularly when staff phone in to work to confirm
they are too unwell to attend.
Fill rates demonstrate only very slight month by month variation, with March
seeing a reduction for the third consecutive month in overall Registered Nurse fill
rates.
Following Lord Carter of Coles report (2016), a new metric ‘Care Hours per Patient
Day’ will be reported from June alongside the Planned and Actual fill rates. This is
the actual hours of Registered Nurses and Support staff divided by the number of
patients on the Ward at midnight. Mrs Lamont confirmed that tis new metric is not
meaningful and has raised her concerns about its use as a measure.
Mrs Lamont highlighted that video for recruitment of nurses in the Philippines had
proven popular with over two million views.
It was resolved:
to receive the briefing and note the current position.
iv)
Clinical Assurance Tool
Mrs Lamont presented an overview, including the trend information on the overall
CAT score which continues to be above 96% in April. The staff knowledge scores
show a slight improvement in April.
Mr Stout expressed his concerns over the staff knowledge levels however
acknowledged that the questions in this area were complication. Mrs Lamont
advised that this was in part due to the constant turnover of staff therefore
impacting on staff knowledge.
Mrs Lamont advised that question changes took effect from April.
The new outpatient assurance measures (checks on documentation of advice,
maintaining a patient’s dignity and respect, and ensuring that a patient has
understood the advice given to them) were the focus for April. April’s results
demonstrated much good practice across the Trust. Although these are new
questions on CAT (with the exception of the smoking status question), compliance
is high, indicating that good practice was prevalent before their introduction.
There were six areas with an overall red score for two consecutive months in April,
compared with two in March. Staff knowledge scores were an issue for all six of
the areas, which caused the red score; Matrons have been informed and are
following up. Cleanliness checks were red in 3 areas for the two months ending
April.
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Over the last three weeks the Practice Development Coordinator and three of the
Governors have visited five areas and validated their application for an ACE
Award for all five categories. The profile of the ACE awards is also increasing.
Dr Kesteven queried the level of mandatory training. Mrs Lamont confirmed that
the Trust had aimed for 40% but the actual was 70%, however based on the
criteria set out, the Trust had failed the criteria.
It was resolved:
to receive the briefing and note the current position.
v)
Patient Experience
Mrs Lamont presented the report. The Complaints Management dashboard was
also received, as presented to the Complaints Panel in May 2016.
The new supplier of the on-line and postcard Friends and Family Test (FFT)
solution, Quality Health, has been working on the survey links and the change
over to the electronic solution on all kiosks took place on 1 April 2016.
Initial feedback from the Sisters in Outpatient Departments is that the survey is
quicker to use.
The Trust received 576 formal complaints in the year up to the end of February
2016. The projection based on this figure shows the Trust will receive 14% fewer
formal complaints in 2015/16 when compared to the previous year. During
February 43 formal complaints were received. Work is focussing on those
complaints which ‘bounce back’.
The Trust has signed up to John’s Campaign which is focused on ensuring that
carers of people with dementia are able to support their loved ones at whatever
time is most helpful to the patient and practicable for the carer.
Further to the results of the 2015 National Inpatient Survey being received, a
workshop style event was held on 18th April with staff and stakeholders within the
Trust to share the findings, examine trends and themes, and agree priorities for
further action. The event included presentations from the Picker Institute Europe
and a patient representative from our Community Advisory Panel and the Head of
Patient Experience.
As reported last month, the Trust is working in partnership with DisabledGo to
create a new resource which will offer a detailed access guide to disabled patients
and visitors accessing Trust premises. Newcastle Hospitals will be the first Trust in
the North east to provide such information to members of the public.
The DisabledGo surveying team will start the surveying work on 6th June 2016
with a view to launching the access guides online from September 2016. A
session was held on 5th May to introduce key staff and service users to the project
and an induction session will be held for the surveying team to ensure that the
requirements for security, infection control and privacy and dignity are adhered to.
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The Telehealth team are continuing to undertake an on-going assessment of the
use of Florence, a text messaging service, with Gestational Diabetes patients.
It was resolved:
to receive the briefing and note the current position.
vi)
Learning Disability
Mrs Lamont confirmed that this was a six monthly learning disability report and
that the Trust had continued to develop its infrastructure and working practice to
improve care for people with learning disabilities.
Mrs Lamont highlighted that the Trust continued to declare compliance with the six
CQC learning disability standards.
Recent work has focused on identifying children who have a clear diagnosis of a
learning disability to enable a flag to be placed on e-record as soon as diagnosis is
confirmed.
The learning disability liaison service has recently started to provide placements
for, children, adult and learning disability nurse students and feedback has been
very positive
The Trust continues to undertake formal Learning Disability Mortality Reviews and
is still participating in work to identify a Multi-Agency process and panel to review
local cases. This is part of ongoing national work to identify how premature
mortality for this group of patients can be reduced.
Audit work is continuing to improve practice regarding clinical staffs’
documentation of good practice and reasonable adjustments.
Mr K W Smith acknowledged the good progress of work undertaken.
Professor McCourt highlighted that at the Nursing Conference previously there
was a high standard of learning disability awareness and good quality of care was
evident.
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Finance
i)
2016/17 Month 1 Finance Report
Mrs Dragone presented the position as at 30th April 2016. At Month 1 the Trust
was behind plan and reported a surplus of £944k million before impairment
compared to the planned surplus of £2.3m. This was attributed to the junior
doctor’s strike and bank holidays (£225k per strike day), the Trust refusing to
participate in the CQUIN of £1m for patient tracking, exceptional spend in Estates
and lack of identified recurrent CIP schemes.
Cash holdings stood at £106.6 million, some £1 million higher than plan and
capital expenditure was higher by £292k, at £1.6 million, despite capital progress
being behind plan. The Continuity of Services financial risk rating was 3.
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Mr K W Smith acknowledged the worsened financial position. Mrs Dragone
confirmed that she had always reported that this year would be the last year of
financial surplus.
It was resolved:
to receive the briefing and note the current position.
The meeting closed at 1.50pm.
The next scheduled meeting would be held at 12-45pm on Wednesday,
22nd June 2016
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