SEVENTH MEETING OF THE GOVERNING COUNCIL minutes cog... · 2018. 6. 20. · Ms Tricia Gordon Staff...

Agreed Council of Governors’ Minutes: 14 February 2018

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PUBLIC MEETING COUNTY DURHAM & DARLINGTON NHS FOUNDATION TRUST

AGREED MINUTES OF THE MEETING OF THE COUNCIL OF GOVERNORS

held in the Executive Board Room, Darlington Memorial Hospital on Wednesday 14 February 2018 from 17:00hrs

Present: Prof Paul Keane OBE Chairman Ms Muriel Browne Public Governor (Sedgefield) Mr Alan Cartwright Public Governor (Wear Valley & Teesdale) Mr Oliver Colling Public Governor (Tees Valley, Hambleton, Richmondshire) Dr Ken Davison Public Governor (Wear Valley & Teesdale) Mr Cliff Duff Public Governor (Durham City) Ms Kath Fawcett Public Governor (Darlington) Ms Kathryn Featherstone Public Governor (Chester le Street) Ms Tricia Gordon Staff Governor (Nursing & Midwifery) (to 80/18[b]) Dr Mike Jones Staff Governor (Medical) Mr David Lindsay Public Governor (Derwentside) (to 80/18[a]) Dr Carmen Martin-Ruiz Public Governor (Chester le Street) (to 80/18[a]) Mr Gordon Mitchell Appointed Governor (Local Universities) (to 80/18[a]) Dr Lakkur Murthy Appointed Governor (Healthwatch Durham) (Shared Post) Dr Richard Scothon Public Governor (Durham City) Cllr Andy Scott Appointed Governor (Darlington Borough Council) Dr John Sloss Public Governor (Darlington) Dr David Smart Appointed Governor (North Durham CCG) Mr David Taylor Public Governor (Sedgefield) Rev Kevin Tromans Staff Governor ((AHPs, Professional and Technical & Pharmacists) Mr Neil Williams Staff Governor (Admin, Clerical & Management) Mr Colin Wills Public Governor (Wear Valley & Teesdale)

In Attendance:

Mr Michael Bretherick Non-Executive Director Ms Jenny Flynn MBE Non-Executive Director Ms Sue Jacques Chief Executive Mr Jeremy Cundall Executive Medical Director (to 80/18[a]) Mr David Brown Executive Director of Finance Ms Carole Langrick Executive Director of Operations Mr Warren Edge Senior Associate Director of Assurance & Compliance (Trust Secretary) Ms Morven Smith Director of HR & Workforce Ms Lesley Roe Associate Director of HR & Workforce (to 77/18) Mr Craig Holden Associate Director of Service Transformation (to 73/18) Ms Suzanne Jarvis Minute Taker

Observer: Mr Mark Price NHS Provider Governor Support

The Trust Chairman gave a warm welcome to all those present. Although Ms Ethel Armstrong had submitted her apologies for absence, the Chair did, however, wish to formally acknowledge that Ms Armstrong had received an MBE in the 2018 New Year’s Honours List. He extended his warmest congratulations to Ms Armstrong who had worked for the NHS for 70 years.


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The Chair then went on to highlight that, in the coming months, CDDFT was to celebrate the 70 year history of the NHS.

In terms of the conduct of meetings, Mr Edge made reference to that note which he had distributed in connection with Item 74/18 - Governor Questions from the Minutes of Trust Board Meetings. Essentially, he asked that Governors be mindful of the very long agenda for this evening and he went on to ask that the business of this meeting be addressed as effectively as possible. Whilst the Trust looked to give every opportunity for Governors’ queries, Mr Edge requested that any questions raised be relevant to holding the Trust Board to account, through the Non-Executive Directors, for the overall performance of the organisation and did not focus on specific elements of operational detail. He was to attempt to cater for any questions outside that remit in another form.

70/18 Apologies for Absence

Cllr Joy Allen Appointed Governor (Durham County Council) Ms Ethel Armstrong MBE Public Governor (Derwentside) Mr Henry Ballantyne Public Governor (Sedgefield) Mr Chris Boyd Public Governor (Easington) Mr Joseph Chandy Appointed Governor (DDES CCG) Ms Andrea Herkes Staff Governor (Nursing & Midwifery) Dr Alison MacNaughton-Jones Appointed Governor (Darlington CCG) Ms Carole Reeves Public Governor (Durham City) Ms Borsha Sarker Public Governor (Darlington) Mr Patrick Scott Appointed Governor (Tees, Esk & Wear

Valley NHS Trust) Mr Paul Forster-Jones Non-Executive Director

71/18 Declarations of Interest

Any Governor who was aware of a conflict of interest relating to any matter on the agenda was required to disclose it at this stage or when the conflict arose during consideration of a particular item.

No declarations of interest were made.

72/18

(a)

(b)

Minutes and Matters Arising from the Previous Meeting held on Wednesday 11 October 2017

Accuracy The Minutes of this meeting were accepted as an accurate record.

Updates from the Minutes of the Previous Meeting Item 47/18(b) Matters Arising from the Minutes of the Meeting held on 5 July 2017 The Trust Chair advised that Mr Cundall was to provide the latest information

with regard to vulnerable services under Item 78/18 - Service Developments. In terms of Teams Around Patients (TAPs) the Chairman reported that, having

made a visit to some TAPs, he had received some very positive feedback from those staff. He was, however, concerned to put on record that, following those visits, he had been contacted by a Governor whose view of TAPs had not


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been consistent with his own. He had spoken with that Governor and had undertaken to acknowledge that different perspective during the course of this meeting. A presentation on TAPs was to be organised for a future meeting of the Council of Governors. The Chair then invited Ms Jacques to comment upon the TAPs scheme. Ms Jacques confirmed that she and the Chairman had recently visited two TAPs which were at different stages of development. She went on to advise that the Trust actually had some very good evidence of the improvements made for patients by working in this manner. Nevertheless there had also been some examples of problems in relation to a number of pieces of equipment with an increasing workload for TAPs. As a result, the organisation had given some practical support in order to manage those issues. As a result of one team raising a question about professional support, CDDFT’s Executive Director of Nursing had made a separate visit to that team. Specifically, as community services were currently out to tender, this uncertainty for staff was causing a level of anxiety. Ms Jacques assured Governors that the organisation would be through that tendering process by the end of this financial year. As a further point of note Ms Jacques reported that, earlier in the day, at a meeting of the Integration Board with Durham County Council and Durham commissioners, feedback had been received about the work of TAPs – with a general consensus that the teams were serving to look after people in their homes without the need for hospital admission. Given that the teams were in the very early stages of development Ms Jacques voiced her view that this was very encouraging. Whilst the Trust was aware of some difficulties, those issues were being addressed by the entire healthcare system which was beginning to observe some results. Nevertheless, staff uncertainty could not be resolved until just into 2018-19.

Item 48/18 Northern Cancer Alliance (NCA) – Patient Engagement (page 5) With the NCA having cited interaction with patients in the UHND chemotherapy unit as an example of working with CDDFT, Ms Jacques advised that the organisation was collaborating with Macmillan to consider proposals for the extension of the chemotherapy unit - which was currently very small for the number of patients treated. From demographic information, it was also known that the utilisation of chemotherapy was to significantly expand over the next decade or so. Work was ongoing to raise charitable funds, to be invested alongside Macmillan monies, with charitable campaigns being conducted in each of CDDFT’s main constituencies. Item 49/18 Electronic Patient Record (EPR) The Chair put on record that EPR staff workshops were being delivered throughout the Trust and, having attended one of those sessions himself on 12 February, he had been very impressed with what he had seen. He added that, in the interests of relating this initiative to the best patient experience, he had been able to provide his own feedback. Item 52/18 Quality, Performance & Strategy Update Finance As a Governor had raised a question at the October meeting of Governors in connection with the level of funds raised by the ongoing Trust MRI Scanner’s Appeal, Ms Jacques reported that this fund stood at £639,717 as of 13 February. This included funding released from the William Drysdale Endowment and accommodated within this funding arrangement. Item 52/18 Quality, Performance & Strategy Update (b) Operational Performance Ms Jacques reported that, to date, the organisation had reported 18

occurrences of C.diff – all of which had been subject to a full root cause


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(c)

analysis in order to consider any themes or specific actions required. Of those 18 cases, CDDFT had successfully appealed against two. Essentially, whilst those particular cases would still count against the Trust’s total, it had been recognised that there was nothing that the organisation might have done to avoid those two cases. A theme had been identified in relation to the way in which stools were sampled in six of those incidents and, as a consequence, action had been undertaken to reinforce some of the practicalities of that sampling as well as infection control protocols. Those 18 cases of C.diff stood against an annual target of 19. Ms Jacques was, however, concerned to flag that CDDFT had last year been the fifth best performer in the country in this regard and she estimated that it was, currently, in a similar very good relative position. It was also of note that the organisation scored very highly in the North East. Mr Taylor asked why it had been necessary to lodge those 2 appeals and what, if any, were the cost implications. In response, Ms Jacques advised that the root cause analysis investigative work and the making of appeals were actually the same. There was, therefore, no extra cost attached. Two helpful issues had, however, been teased out. Specifically, from the commissioners’ perspective, there was nothing that the organisation could have done to prevent those cases. Secondly, this was a national system, applied locally, under which the Trust might be fined by its commissioners in respect of C.diff cases. Having successfully appealed, it was not possible for commissioners to impose a fine. As a result it was worth appealing.

Noting that Rev Tromans had raised a question at the October meeting about the possibility of that cohort of Italian nurses leaving the organisation as a result of Brexit the Chairman reported that, having recruited 87, only 4 had returned to Italy: 1 had been homesick; 1 had returned for personal reasons and 2 had obtained permanent jobs at home.

Item 58/18 Trust Secretary’s Update As Ms Woolley-Brown had resigned as a Public Governor to focus on her role as CDDFT’s Freedom to Speak Up Guardian, it was put on record that Ms Boyle had been elected as Chair of the Governors’ Quality & Healthcare Governance Committee.

No other comments were made.

Action Log

Those actions ‘greyed out’ on the Log were accepted as complete. Item 47/18(c): Vote on the Constitution With insufficient Governors present to take a vote, this action was again carried forward. Item 47/18(c): Amendment to Terms of Reference of the Strategy & Planning Committee Mr Edge reported that, although this amendment had been made, these Terms of Reference were to be submitted to the March committee for approval. Action carried on to April. Item 47/18(c): Presentation on the work of Teams Around the Patient (TAPs) The Chairman advised that this presentation was to have been scheduled for this meeting. However, the team was currently very heavily involved in the community services tender process - which was at a critical stage. Deferred until April. Item 47/18(a): Amendment to Minute 23/18


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This amendment had been made. Action complete. Item 51/18: Update on the number of vacancies and the whole time equivalent (WTE) posts in vulnerable service areas Mr Edge explained that he was to have asked Mr Cundall for this information but, on reflection and because the figures changed frequently, he had not been certain that this would provide the data requested. He suggested that a broader update on recruitment would give a better answer. Action deferred until April.

No further observations were made.

73/18

(a)

Update on Operational Planning 2018-19/UHND Emergency Care Centre

Draft Annual Plan Mr Holden delivered a presentation on the draft Annual Plan for 2018-19 when it was noted that external drivers and key dates were: the submission of the draft Plan to NHS Improvement (NHSI) on 8 March; with a final Operational Plan deadline of 30 April 2018. Questions were invited.

Mr Taylor asked if this was a one-year plan. In response, Mr Holden advised that this document represented the second year of a two-year plan and, in essence, was a one-year plan. Mr Taylor went on query if the organisation always worked to a one-year plan. Acknowledging the need to look further ahead, Mr Holden reported that the Trust would very much like to change this process. Ms Jacques added that CDDFT did have a Strategy, formed from three component parts, which typically ran over three to four years. Within that Strategy the organisation set out detailed plans in a prescribed format - which was required to be submitted to the centre. Essentially, there was a one year plan which served to describe the Trust’s improvements and meet the requirements of the Regulator. Governors would all have had sight of CDDFT’s Strategy Handbook which was where everything was collated. Pursuing his point, Mr Taylor suggested that, to look at a one-year plan in February, to commence in April, was too short a timescale and he queried if this was a typical timeline. Ms Jacques advised that the organisation started its planning for the following year in September. Ordinarily, within the NHS, guidelines were due to be issued on Christmas Eve and that had happened over the previous five to six years. Unfortunately, guidance in respect of 2018-19 had only been distributed two weeks ago. Ms Jacques highlighted that, until those business rules were issued, along with the level of funding to be made available, the Trust was only able to plan using assumptions. It was then necessary to quickly retrofit that guidance to the plans. Mr Taylor made reference to a Government statement which had advised that it was to give NHS organisations two to three years’ guidance. Ms Jacques confirmed that this was indeed the case. However, as a consequence of those recent pressures experienced across the country, the Government had issued its new guidance for one year only. She made the point that those local authorities, with which CDDFT worked very closely, were in a similar position. As a consequence, all organisations had made their own assumptions and, having worked in collaboration with commissioners to agree those expectations, this was all fitted together in final plans.

If this Plan was to be presented to an average staff member on CDDFT’s frontline, Dr Jones raised a question around the likelihood of that member of staff recognising the document. Mr Holden advised that he would like to think that staff


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(b)

had contributed to the construction of this Plan as it was built up from plans for each service. Nevertheless it was impossible to engage all 8,000 Trust staff in this process. It was put on record that there had been a good turn-out to planning sessions on the part of each of the care groups – with every effort having been made to ensure that all staff members were aware of their input. Dr Jones went on to ask if it was intended to survey staff once the document was published. Mr Holden assured Governors that there was to be a de-briefing process which, in his view, would provide the Trust with valuable information from all staff groups as to whether they had had an opportunity to contribute to CDDFT’s plans.

The Trust Chair was concerned to emphasise the importance of the council of governors understanding and endorsing this Plan – particularly Members of the Governors’ Strategy & Planning Committee. He put on record that, should any other Governor wish to attend a meeting of that Committee, Ms Featherstone as Committee Chair, would extend them a warm welcome.

UHND Emergency Care Centre Governors were advised that Dr Paul Peter, Clinical Director for the Acute & Emergency Care Group, was to attend a future meeting of the Council of Governors in order to share more detail of these plans. On his behalf, Ms Jacques delivered a verbal update on that agreement reached by the Trust Board two weeks ago. She explained that, for any major capital case, there were rules under which to properly govern the making of changes and how those changes were to be implemented. This was a £25m scheme – with a number of stages for formal approval by Board Members. Within its strategy the Trust Board had committed to a new Emergency Care Centre at UHND as, currently, the department had been designed for about half the attendances that it actually received. Specifically, it was planned to build on to the front of the existing building where, at the present time, there stood a listed building. The organisation had already had that listing removed - contingent upon gaining approval for its plans. The Trust Board had approved the Outline Business Case (OBC) which had summarised the clinical model and the way that it was believed that this scheme could be affordable as well as, operationally, how it would allow the organisation to deliver the various targets in respect of A&E. Obviously the OBC was a commercial document at this stage and the Board had been able to support the move forward to the development of a Full Business Case (FBC) by Autumn 2018. Ms Jacques went on to report that, originally, this was to have been a two-storey structure but, with the team having reflected upon how to make the best use of space, along with cost efficiencies, this was now planned to be a single storey building which facility could be expanded as necessary. Governors were advised that there were times of the day when A&E was quieter and, instead of having several pieces of work taking place in different locations, it would be possible to flex staff. It was envisaged that this would be much more efficient and effective for patients. Obviously consideration was to be given to the entire flow of the hospital as well as the operation of Rapid Assessment & Treatment Teams (RATTs) which sought to get patients to the right person as soon as possible.

In terms of the financials, the team was required to secure a source of funding – with four possibilities. Governors would recall from previous meetings that the Sustainability & Transformation Partnership (STP), working across boundaries and planning together to make a collective sense, had identified an amount of money


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for the south of the North East patch – with £30m in that pot. Ms Jacques highlighted that, unfortunately, the sourcing of funds was not always straightforward. As a result, should no funding be forthcoming from the NHS, the Trust was currently considering three commercial funding routes.

Ms Jacques assured Governors that the clinical benefits of this initiative were to be quantified in more detail – along with the way in which it was intended to work over the anticipated 25 year period of the life of the building. It would also be necessary to somewhat refine assumptions around activity. To reach that point, Ms Jacques put on record that the organisation must spend just over £1m. Although cash was tight, the Trust Board had agreed to commit to that £1m of expenditure. However, on a month by month basis, between the stages of OBC and FBC, CDDFT’s Executives had been asked to facilitate the project team and to ensure that the appropriate legal advice was obtained. Ms Jacques very much looked forward to the completion of the FBC.

Ms Jacques reiterated that the clinical team was to make a further presentation to Governors on this scheme.

With reference to the building work ongoing at DMH around outpatients, Ms Jacques advised that the organisation had secured just under £2m to improve its A&E departments and to allow the Trust to undertake Primary Care Streaming (PCS). It was expected that those building works at DMH would be complete before the end of March when it was anticipated that PCS would assist with patient flow. Again, this was a visible sign for the public about ongoing commitment to an A&E service at DMH.

In light of recent rumours, Mr Cartwright suggested that the organisation should reinforce these messages about A&E.

Having used the Trust’s A&E facilities on three occasions since Christmas, Dr Davison took this opportunity to put on record that the DMH A&E Department was immaculate – with systems working well and never too many patients waiting.

Dr Sloss asked if imaging was to be intrinsic to the UHND project. In response, Ms Jacques advised that there was a large space in the design to facilitate a CT scanner. However, the Trust had not yet determined whether there was sufficient work for this, if it should seek to have all imaging together, or if all patients should be sent to a department close by for a scan. In terms of DMH, whilst there were no plans to change the physical location of radiology, it was intended to upgrade all of the imaging equipment - with CDDFT’s Radiology Equipment Procurement Programme (REPP) looking at replacement and additions in respect of the existing radiology kit. Ms Jacques acknowledged that the Trust was very reliant on radiology for clinical diagnoses.

Noting that a paper had been submitted to the Trust Board in relation to the UHND A&E clinical model, Dr Jones expressed some concerns that clinicians out-with ED had no idea about these proposals. In his opinion there was a significant disconnect here. Ms Jacques put on record that that presentation made to Board Members had been delivered by a clinical team which had included matrons, doctors and physicians. Mr Cundall added that the A&E Clinical Lead, although not


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at that meeting of the Board, had been involved in planning.

The Trust Chairman was concerned to note that, as a result of questions raised Mr Cartwright in advance of this meeting, it would be crucial to address further communications with the public - along with photographs of the works undertaken.

74/18 Governor Questions from the Redacted Minutes of Trust Board Meetings

No questions were raised.

75/18 Trust Constitution/Standing Orders

As had already been highlighted under Item 72/18(b), Updates from Previous Meetings, Mr Edge confirmed that two-thirds of the Council of Governors must be present before a vote could be taken. With only 22 of the full complement of 35 Governors in attendance, this vote was deferred until the following meeting – scheduled for April.

76/18 Update on Regulation

(a)

(b)

Well-Led Report Mr Edge outlined the contents of this report. For the benefit of new Governors, he explained that the Well Led Report was in relation to a piece of best practice work recommended by both the Care Quality Commission (CQC) and NHSI and, essentially, asked that the Trust Board reviewed its leadership and governance process, prior to commissioning as independent, external review of that assessment. It was noted that CDDFT’s Board had been through that process at the end of 2016-17. KPMG had then undertaken the independent review, with the completion of a report, which had made a number of low priority developmental recommendations, and more important recommendation re strategy resulting in the Trust’s Strategy Handbook. Since July 2017 the Board had been tracking the implementation of all of those actions advocated – with the organisation now at the point of having 83% of those fully implemented. Mr Edge was mindful that there were a handful of iterative developments to be addressed over the following years, for example, incremental improvements in performance reporting as well as the automation of key datasets. However, all other actions would be implemented by 31 March. Essentially, then, substantial progress had been made.

(c)

NHSI Having held a Quarterly Review Meeting (QRM) with NHSI in December, Mr Edge referred Governors to the NHSI letter of 19 December 2017, included in the agenda papers, which summarised all of the key points and actions as a result of that discussion. Mr Edge advised that NHSI measured the organisation against a range of indicators and had categorised CDDFT as being in Segment 2 of the Single Oversight Framework – reflecting the view that the Trust did not require mandated support in any area. It had also been noted that good progress had been made in a number of areas.

Care Quality Commission

Mr Edge advised that the CQC had completed their well-led review in October 2017 and had issued their draft reports to the Trust in December 2017. Trust officers had


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completed an extensive factual accuracy check of those reports and provided a detailed response to the CQC at the end of December 2017. Having reviewed that response, the CQC had then held a meeting with its Deputy Chief Inspector in order to finalise the Trust’s ratings. The inspection team was scheduled to hold a pre- publication meeting with CDDFT’s Chief Executive on 15 February 2018.

Mr Edge was content to take any questions or comments. None were raised.

77/18 Staff Listening, Retention & Engagement

Ms Roe and Ms Smith delivered a presentation which focused upon CDDFT’s approach to staff engagement - based upon the work of Prof Michael West and the King’s Fund which had concluded that a fully engaged workforce was key to the delivery of excellent patient care.

Ms Smith then went on to advise that she had been made aware of queries raised in connection with staff stress levels when working under extreme pressure over Christmas. She reported that, as part of those staff roadshows prepared in respect of winter pressures, leaflets had been distributed which contained advice on the management of stress as well as in respect of physical health. A further employee assistance programme having been in place for some time and Ms Smith highlighted that the organisation had been very successful in respect of the number of influenza vaccines administered to its staff this winter.

Ms Featherstone sought more detail about the employee assistance programme. In response, Ms Smith advised that there was a telephone helpline which staff members were able to contact anonymously in order to discuss any work or personal problems – with access to a number of sessions for monitoring and support. If more specific help was required, there was also the opportunity for staff members to be signposted to other agencies. In addition the Trust had a clinical psychologist who worked with Occupational Health and who had developed various support programmes. There were also training sessions for managers to alert them to stress indicators on the part of their staff. The organisation provided resilience training for all CDDFT staff and, if they required support to manage their work, specific courses could be laid on. Clearly, then, there was a plethora of opportunities to provide staff with proactive support in a timely manner. Nevertheless, Ms Smith acknowledged that there was not one solution which would fit all situations. All of this information was disseminated via computer screen savers and various leaflets. Whilst it might well prove necessary to follow up concerns raised in respect of a particular area of work, Ms Smith took this opportunity to assure Governors that the content of any survey was anonymous. She put on record that she had never had any feedback to suggest that staff anonymity had been compromised.

In terms of retention activity, Mr Taylor asked if it was possible to break down that 7% voluntary turnover by profession. He specifically questioned if nursing turnover was higher than average when compared to other staff groups. Ms Smith reported that, in total, CDDFT was very low in terms of voluntary turnover. Whilst this was measured against departments, she made the point that this Trust did not have a bigger problem than any other trust in the area – with others standing at circa 9% in terms of voluntary turnover. Obviously, this varied by staff group.


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Turning to exit interviews, Ms Featherstone reported that concerns had been raised at the January meeting of the Governors’ Strategy & Planning Committee. Specifically, the question had been raised around whether staff members were able to give true reasons when leaving the organisation and how anonymous those exit interviews were. Ms Smith made the point that, if staff chose to believe that nothing else was anonymous, this should not matter. Essentially, exit interviews tried to establish what might be improved within CDDFT in order to make this organisation more preferential and open than other trusts. Whilst exit interviews were very much up to the individual, Ms Smith assured Governors that everyone was approached to undertake an exit interview – with an on-line system in place with a focus on ‘stay and starter’ interviews. Ultimately, however, once a member of staff had joined the Trust every effort was made to maintain dialogue about what had attracted them to the organisation. Ms Featherstone suggested that there might be problems within a team with a particular line manager. Ms Roe put on record that, in such a case, there was the opportunity for a staff member to request an exit interview with a neutral individual.

Thanking Ms Roe and Ms Smith for their presentation, Dr Jones advised that he had been aware of Prof West’s research for some time. Whilst Dr Jones recognised that this work was really critical, he made the point that 40% of staff would not recommend their own Trust and some 39% were not given the care that they would want. He asked how data from exit interviews compared with those views. In response, Ms Smith advised that the organisation was at a very early stage completed focussed work with staff groups on retention with high impact task forces covering all staff groups but having only addressed nursing groups to date. The Trust was now at the point of turning its attention to Allied Health Professional workers. Although more people were engaged in this process, and with staff members becoming increasingly confident about sharing their views, Ms Smith accepted that, inevitably, the organisation would never get 100% of staff to provide their reasons for leaving CDDFT. The views provided would include those points referred to by Mr Jones and hopefully provide further richness as to the reasons for those views

As part of the planning behind CDDFT’s Diversity Matters: Equality, Diversity & Inclusion Strategy, Ms Roe put on record that Prof West had voiced his own view that this would be a 5-year journey for the organisation. Nevertheless, some real changes and shifts in thinking were being observed across the Trust – with line managers beginning to think differently about how best to manage their staff. Whilst a great deal of work remained to be addressed, Ms Roe believed that green shoots were starting to emerge. In particular, individuals were more willing to tell the organisation where they worked and the details of their role – with some positives coming out of this. For Ms Roe this strategy was moving in the right direction.

Ms Smith took this opportunity to advise that she would welcome Governors’ support in this connection.

In terms of CDDFT’s excellence reporting system, the Trust Chair was pleased to inform Governors that, during the course of visiting the Neonatal Unit, he had met a cleaner who had recently received an excellence report who had expressed the


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view that this was an absolutely wonderful example of him being valued and recognised.

Mr Wills sought the main reason why nurses left the organisation. In response, Ms Roe reported that, often, this was to seek career progression in another organisation. As a result, CDDFT was looking to make it easier for nursing staff to be able to progress internally. It was undoubtedly the fact that the Trust had an ageing workforce – with a great many individuals looking to reduce their hours. It was often the case, however, that people retired and then returned to work on the Staff Bank. Recognising that nursing could be a very intense role, this was partly about a work/life balance.

Mr Colling voiced his view that this had been a very impressive presentation – with a great deal of work ongoing. Reverting to that research cited on the part of Prof West and the King’s Fund, he asked if it was possible to make a link between staff engagement and excellent patient care. Ms Roe advised that the Trust’s communications team had carried out a great deal of work on patient experience feedback – with lot of compliments having been received. The outcome of that research had been there were many positives in respect of managers who cared about the development of their staff members. Fundamentally, some stresses were externally driven and these were very difficult to ameliorate for staff. Efforts continued to assist Trust staff to cope better in such circumstances. Ms Smith highlighted that Prof West had carried out a lot of research around good quality appraisals. Obviously there was a link with good engagement and the organisation looked to develop that work as much as possible.

Mr Williams advised that, at the January Governors’ Strategy & Planning Committee, there had been a debate about that turbulence in community care services -with uncertainty being experienced by community staff. He made the point that this affected line managers as well as their staff. Ms Roe advised that a member of her team sat on the project team for the community services tender and was working to support those staff.

For Mr Taylor, the management of change was key. It would be crucial to bring staff on side or they would be lost to the organisation. Mr Taylor observed that the health service was evolutionary and in development. It was, therefore, necessary to communicate the direction of travel to staff – both in the one-year plan and five years on.

Mr Taylor went on to query the level of staff sickness within the Trust. In response, Ms Smith reported that sickness amongst staff currently stood at 4.8%. Mr Taylor acknowledged that this was comparatively good.

In conclusion, the Trust Chair hoped that Governors were reassured about all of the measures in place, not only to recruit, but also to retain staff. Trust staff was the organisation’s most valuable asset.

78/18 Service Developments

Ms Jacques introduced this item by stating that, at the request of Governors, service developments were to be routinely reported to the Council of Governors.


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It was put on record that paediatrics was one of the Trust’s most vulnerable services in terms of staff numbers. As a consequence the Board had considered contingency plans. Ms Jacques was sure that Governors were aware that, due to staff shortages, South Tyneside NHS FT had had to close down its paediatric services at extremely short notice. Clearly, CDDFT must prepare itself for the possibility that there could, at some future point, be insufficient staff to run a service safely – with a need for some innovation. One of the actions taken by the Trust had been to invite the Royal College of Paediatrics to review CDDFT’s proposed paediatric model of care. Their representatives were to visit the organisation in March.

Ms Jacques alerted Governors to a recent regional review of vascular services across the North East. The outcome of that review had been a recommendation to consolidate vascular services on three sites - rather than four. Having agreed that two of those sites must be Newcastle NHS Trust and South Tees NHS Trust that left a decision to be made about CDDFT and Sunderland City Hospitals NHS Trust. With the review having been concluded, those recommendations were under consideration by the local and regional Health Overview & Scrutiny Committees, by which scrutiny process local authorities collectively considered change. Ms Jacques had envisaged that, probably by the end of the financial year 2017-18, vascular services would move to Sunderland. It was, however, unlikely that that change would be effected until just before Christmas 2018. Finally, she assured Governors that that the organisation had very good clinical results in vascular services and no retention problems.

In terms of urology, Ms Jacques advised that a high quality service was delivered at UHND. She put on record that urology services in the south of the patch were provided by South Tees NHS Trust, on a hub and spoke arrangement. South Tees was fully responsible for the DMH collaborative model.

With reference to the paper in the agenda pack, Ms Jacques asked Governors to note that CDDFT had been very successful in recruiting consultant staff to every specialty. Mr Cundall added that the medical staff recruitment strategy had been implemented from August 2016. With 60 consultants having been appointed, the consultant workforce had increased by 5%.

Turning to ophthalmology, Mr Cundall acknowledged that there had been ongoing service difficulties over a number of years. As of two weeks ago, the department had five substantive consultants and one internal locum consultant and, with support from the RVI, was essentially quorate. This was great news.

Ms Featherstone sought the difference between a Trust locum and an external locum. Mr Cundall explained that a Trust locum was paid by the organisation and external locums were paid locum rates via an agency.

The Trust Chairman highlighted that the organisation had recently appointed another stroke consultant.

Dr Jones was surprised that there was no mention of the general medicine rota within this paper. Accepting that his point was well made, Mr Cundall was pleased to advise Dr Jones that gastroenterologists had agreed to act as Physician of the


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Day (POD) 3. Stroke physicians were to join the general medical rota.

The Chairman made reference to the December Joint Meeting of the Trust Board and Council of Governors when a question had been raised about whether the organisation was up to establishment in terms of the number of paediatric nurses employed. Ms Jacques reported that CDDFT’s Executive Director of Nursing had been looking sequentially at all nurse staffing levels. The initial results of that work had shown that there were sufficient nurses in post. Ms Jacques put on record that the Trust had recruited very successfully into the paediatric nurse complement. She went on to advise that, after a recent visit, the CQC had suggested that paediatric nurses be deployed in both A&E departments on a 24-hour basis. Having considered all of the advantages and disadvantages to this proposal, and based upon the number of children presenting at different times of the day, the Trust had opted to provide paediatric nurses in A&E for 12 hours. This was now well embedded.

In terms of paediatrics, and in view of that constant churn of paediatricians looking for better offers across the region, Dr Sloss asked if the Trust was to give consideration to collaborative working with other trusts. Mr Cundall advised that, in terms of collaboration, the Better Health Programme (BHP) had turned its focus to ‘out of hospital care’. For ‘in hospital care’ there were two vehicles. In the south there were meetings of the provider Committees in Common of CDDFT, North and South Tees and, the north, the Sustainability & Transformation Partnership (STP) was working across boundaries to consider all of the issues in paediatrics.

79/18

(a)

(b)

Quality, Performance & Strategy Update

Trust performance was highlighted in the following areas.

Influenza Mr Cundall delivered a brief presentation on the impact of influenza on the Trust. He put on record that, having noted that the national prevalence data did not accord with the incidence of influenza experienced on the ground by CDDFT, it had been established that Public Health North East did not collect hospital data and relied purely upon a sample of GP information.

Governors were advised that, since New Year, on average, the organisation had had 45 inpatients with influenza – with 2-4 in intensive care. As of today, there were 50 in patients who were suffering from ‘flu.

Mr Cundall was pleased to report that 76.5% of Trust staff had received a ‘flu vaccination. He went on to highlight that 90% of doctors had been vaccinated. CDDFT was the third best performer in the region in terms of its staff vaccination performance and had made the greatest improvement in the number of vaccines administered.

Questions were invited. None were raised.

Infection Control Ms Jacques advised that, to date, the organisation had reported 18 cases of C.diff.


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(c)

(d)

(e)

(f)

(g)

It was put on record that the Trust had experienced a period of increased incidence of Vancomycin Resistant Enterococcus (VRE) on some UHND wards. As a consequence, all of those patients who had a confirmed positive urine sample were isolated - with strict infection control measures in place. As Ward 12 appeared to be common to many of those confirmed patients, environmental screening was carried out which had identified colonies of VRE on some equipment and shelving. Following advice from Public Health England, Ward 12 was deep-cleaned and decontaminated. It was important to note that no patient had come to harm as a result of this VRE outbreak. Ms Jacques went on to make the point that, as Chief Executive, when such issues arose these were invariably reported to her immediately – with advice from the infection control team on a range of actions that might be taken to balance the risk across the Trust. This was a testament to the infection control team.

Falls With reference to the latest set of data produced in the North East, Ms Jacques reported that the DMH and UHND sites had been the top and second top performers in the region in terms of their work to prevent falls – with validation of that performance. From the latest audit data, it was also known that the North East was performing well when compared across the country.

Pressure Ulcers Ms Jacques flagged that the Trust had had no high grade pressure ulcers in its acute hospitals for more than 17 months. Cases in the community continued be infrequent. It was of further note that the work of one of the Trust’s community nurses around fractured neck of femur had been adopted as a National Institute for Health & Clinical Excellence (NICE) guideline.

Care Quality Commission (CQC) It was noted that the organisation awaited the outcome of the CQC’s 2017 inspection.

Incidents & Never Events Ms Jacques was disappointed to report that three Never Events had occurred between October 2017 and January 2018. With root cause analyses having been carried out in respect of all cases, Governors were referred to those actions set out in the table on page 3 of the paper in the agenda pack.

Mortality Mr Cundall put on record that the key mortality ratios: the Summary Hospital Mortality Index (SHMI) and the Hospital Standardised Mortality Ratio (HSMR) were well within expected statistical parameters.

He went on to advise that the Trust also monitored its surgical mortality data which indicated that CDDFT was a positive outlier and in the top 25% of trusts throughout the country.

An NHS England (NHSE) review of mortality statistics was well under way – a new core team was being trained to use recently introduced software for mortality reviews within the Trust.


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(h)

(i)

Patient Experience Ms Jacques reported that the number of complaints received were down when compared to the previous year. In addition, patients who would recommend this Trust to others had increased. This was very positive news – with a need to ensure that this trend continued.

Turning to those graphs showing the Trust’s performance in terms of the Friends & Family Test (FFT) included in this report, Dr Jones observed that there appeared to have been a significant shift in performance from March 2017. Ms Jacques advised that some of those processes put in place, as had been explained by Ms Roe and Ms Smith, would not have come into effect at that time. She made the point that this was not an exact science. Essentially, the organisation had changed the way in which it collated that information. The Trust Chairman added that this must be viewed against an increased level of activity.

Reverting to the report on Never events, delivered under Item 79/18(f) above, Dr Murthy commented that there was no mention of communication of those events to patients. Ms Jacques reported that, if anything was to go wrong with any patient’s care, the organisation operated under the tenets of the Duty of Candour. This meant that the patient and their family must be formally advised of all of the circumstances as soon as possible. It was essential that the Trust Board complied with the Duty of Candour regulations. These declarations were monitored and Ms Jacques put on record that CDDFT’s compliance was very good. Specifically, within the latest Board report, it had been recognised that the Trust was performing very well. Ms Jacques offered to bring more information on this requirement to the April meeting of the Council of Governors.

Finance Mr Brown outlined the contents of his report. It was highlighted that the Trust had lost national Sustainability & Transformation Funding (STF) in the sum of £1.158m due to the fact that the organisation had failed to achieve agreed performance levels with respect to the percentage of A&E patients seen, treated, or admitted, within four hours in Quarter 3. This left the Trust £1.1m behind plan overall. Whilst the Trust did expect to recover the position in Quarter 4, it was anticipated that cash would be tight at the end of 2017-18.

Questions were invited.

Ms Featherstone sought progress in respect of budget negotiations with Clinical Care Groups (CCGs). Mr Brown advised that, in terms of the contracting round and the management of risk, the Trust was meeting with CCGs on a weekly basis. He added that winter pressures had led to increased expenditure and different case mixes.

Dr Murthy asked for clarification about the amount of outsourcing to the independent sector in respect of endoscopy, ophthalmology and radiology work. Ms Jacques made the point that outsourcing was commonly utilised by all NHS organisations. Clearly, it was the Trust’s objective to reduce the amount of outsourcing. However, where there were significant gaps in, say, ophthalmology, in order to deliver NHS Constitution standards, it was necessary to allow Trust work to


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(j)

(i)

(ii)

(iii)

be undertaken in other sectors. Mr Cundall highlighted that locum costs had decreased quite substantially. Ms Jacques undertook to provide some detailed figures on how these costs had changed over time.

In terms of income, Mr Taylor questioned how money actually flowed into the Trust every month. In response, Mr Brown reported that contractual payments were received on the 15th of every month. He flagged that significant capital programmes radically impacted upon levels of cash.

Operational Performance Targets Ms Langrick referred Governors to the paper included in the agenda pack. She went on to highlight the salient points in her report.

A&E In terms of the Quarter 3 position and 4-hour waits, Ms Langrick put on record that the Trust had been in a good position in October and November 2017 in relation to its STF trajectory agreed with NHSI. However, at the beginning of December 2017, winter pressures had struck. On the back of that rise in demand, the organisation had still managed to hold its trajectory position under increasingly difficult circumstances for its staff, right up to 29 December 2017 with the consequence that, against the Quarter 3 STF improvement trajectory of 91.94%, it had achieved 91.29%. Although there was no mechanism for appeal, it had then been decided to lodge a formal appeal with NHSI – based upon those high activity figures. Unfortunately, that appeal had been rejected and, as a consequence, that funding of £1.158m, as had been reported by Mr Brown under Item 79/18(i) above, had been lost to the Trust. Ms Jacques was concerned to put on record that the Local A&E Delivery Board (LADB), comprised of local authorities and commissioners, had supported CDDFT’s appeal. Whilst this appeal had also had the backing of NHSE, and the reasons widely accepted by a number of different bodies, this had been turned down at national level. Ms Langrick was sure that Governors were aware that these significant winter pressures had been experienced across the country and she made the point that, if NHSI had accepted CDDFT’s appeal, many other trusts would have made similar claims.

Moving on to Quarter 4, Ms Langrick reported that those pressures had continued into January 2018 – driven partly by the number of admissions related to influenza, the time of the year and levels of sickness absence. This had had the effect of delaying the Trust’s elective activity programme well into January. Obviously this would have further implications for the organisation. Nevertheless A&E was starting to observe some more positive performance days than had been the case at the beginning of January. Ms Langrick was mindful, however, that some catching up would be required. It was noted that the next key stage was March 2018, when there was a target for the organisation to deliver 95% in terms of A&E 4-hour waiting times. She voiced her view that this would prove challenging.

18-Week Referral to Treatment (RTT) This target had been comfortably achieved.

Cancer: 2-Week Wait and 62-Day Again, the organisation had been successful in achieving these targets.


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In terms of those Trust Board Minutes which had referred to CDDFT’s new A&E facilities being planned to accommodate a 3% increase in activity, Mr Cartwright asked if the organisation ought to be planning for greater activity levels. Ms Langrick replied that, for a number of years, the average growth rate had been at that level - which would seem to be reasonable. The quandary was whether that increase in activity experienced over the previous two months was the beginning of a new trend.

Dr Jones highlighted that the A&E 4-hour waiting target had actually been introduced as a quality target when measures had been brought in to ensure that patients did not come to harm. Ms Langrick made the point that there were a number of other indicators of heat within the system. For example, the number of ambulances waiting at A&E, the Operational Pressures Escalation Levels Framework (OPEL) as well as the intervention of the NHSI Emergency Care Intensive Support Team (ECIST) – all of which would lead the organisation to instigate well-rehearsed action cards. Pursing his point, Dr Jones suggested that specific indicators for acuity were required to ensure that patients came to no harm. It was finally decided that Mr Cundall, Dr Jones and Ms Langrick were to address this issue out-with the meeting.

Ms Langrick advised that ECIST representatives had been invited to return to the Trust, in the week commencing 19 February, to consider if there were any further actions which the organisation might take to improve upon its A&E performance.

For the information of Dr Jones, Ms Jacques took this opportunity to put on record that Ian Dalton, who was very familiar with the North East healthcare systems, had been appointed as NHSI Chief Executive from 4 December 2017. She was pleased to advise that CDDFT was the first organisation in the region which he was to visit and that that visits was to encompass A&E. She recommended that Dr Jones seek to hold an informal dialogue with him.

In terms of elective postponements over the winter period, Dr Sloss sought actual numbers. Ms Langrick reported that she did not have that information to hand. She assured Dr Sloss that the Trust had been able to maintain its day case performance unless it had been obliged to use a day case areas as bedded units. The organisation had also been successful in maintaining its list of longer waiting patients at a reasonable level. Obviously those patients who had been postponed would receive alternative dates. She highlighted that, if a planned procedure had been delayed, the organisation was obliged to provide another date for that procedure within 28 days of postponement.

With reference to those winter pressures experienced by the Trust, Rev Tromans asked if there was any evidence as to how many patients were actually readmitted. Ms Langrick assured Rev Tromans that readmissions were monitored on an ongoing basis and not only when the organisation was under pressure. She shared her view that there did not tend to be any pattern in respect of the number of patient readmissions. Ms Jacques added that the number of readmissions were slightly down. By way of explanation, Rev Tromans went on to report that, in the previous


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(k)

month, he had had a couple of conversations with patients who had presented at A&E, who had returned home but who had then been subsequently admitted to hospital. Ms Langrick offered to look into these cases.

Noting that NHSI had turned down CDDFT’s appeal in respect of its A&E performance, Dr Murthy asked if any explanation had been provided in this connection. Ms Jacques advised that, to be fair, there was no right of appeal. Nevertheless, the Executive Team had felt very strongly that all staff had worked incredibly hard – not only within the Trust but across the entire healthcare system.

For a more meaningful assessment of the position, Mr Taylor asked if actual numbers might be made available in future – rather than percentages. Ms Langrick referred Mr Taylor to the papers of the public meeting of the Trust Board which set out a full performance report – with that level of detail in terms of A&E, RTT etc. shared with the public.

In concluding the debate on performance, Ms Jacques highlighted that between 600-700 patients a day presented at each CDDFT acute hospital every day.

Workforce/Bank & Agency Staff Ms Smith reported that good progress had been made in terms of recruitment. She highlighted those key metrics set out in her report.


80/18

(a)

Non-Executive Directors’ Update

Ms Jenny Flynn Ms Flynn introduced herself to the governing body. She explained that she also acted as CDDFT’s Senior Independent Director - a regulatory role on the Trust Board. This entailed carrying out the Trust Chairman’s appraisal along with two Governors who sat on the Governors’ Nomination & Remuneration Committee. It was noted that, for 2017-18, those Governors would be Ms Gordon and Dr Scothon. In terms of the practical aspects of the Chair’s appraisal, Ms Flynn advised that all Governors were to receive a questionnaire on the Chairman’s performance and she urged that everyone completed that survey. She added that the Non-Executive Directors were also to be surveyed and she anticipated that the Executive Team would receive the same questionnaire.

It was put on record that a similar approach to appraisals was to be rolled out to Non-Executive Directors. .

Ms Flynn advised that, with Ms Gordon, she was CDDFT’s mental health link with Tees, Esk & Wear Valley NHS FT (TEWV) contract in respect of patients with mental health problems who presented at the Trust.

Ms Flynn went on to report that her other main role in addition to her general NED role was to Chair the Trust Board’s Charitable Funds Committee which belonged to the Association of NHS Charities. Currently there was a total of £3.9m in CDDFT’s Charitable Funds pot – with the Committee looking to secure a regular annual income of £300k. This income was becoming increasingly important to the NHS


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Charities sector – with those extra funds to be utilised for the benefit of patients. Ms Flynn was pleased to announce that a large amount of Charitable Funds had recently been used for special mattresses to be supplied to both acute and community hospitals across the Trust so that wards did not fail in terms of their excellent performance with regard to the incidence of pressure ulcers. In addition, Ms Flynn reported that the Charity had bought 700 chairs for patients’ and visitors’ use across the Trust – with different specifications as appropriate for each ward. Acknowledging that Charitable Funds were primarily for patients’ benefit, Ms Flynn was keen to put on record that that funding could also be used for Trust staff. Crucially, if the staff of the organisation were content, this was ultimately to the benefit of patients. As a result, with the aim of raising staff morale, the Charitable Funds Committee had undertaken to provide funding for the staff Christmas Lunch as well as providing financial support for the annual International Nurses’ Day. Ms Flynn highlighted that, historically, the Fund had been fairly dormant. Considerable efforts were being made to re-energise the fundraising, with the appointment of a Charity Development Officer, who was working extremely hard to raise the profile of the CDDFT Charitable Fund – via the orchestration of various charitable events. In particular, Ms Flynn was concerned to make Governors aware that the organisation had embarked upon two major charitable appeals. The first was the MRI Scanners’ Appeal - with the objective of raising £2.5m.

Governors were advised that the Trust had received great support from local Rotary Clubs as well as from the public. Ms Flynn shared her view that the CDDFT Charitable Fund was becoming the charity of choice for the local population. This fund currently stood at almost £640k – as had been reported by Ms Jacques under Item 72/18(b) above. This included the William Drysdale Endowment Fund, released with the permission of the Charity Commission, and which was to be used for the purchase of the Bishop Auckland Hospital (BAH) MRI scanner. Consideration was currently being given contingency planning to fund the DMH MRI scanner should donations fall short of the target.

The second major appeal was in collaboration with Macmillan in relation to the expansion of the UHND Chemotherapy Unit, with CDDFT and Macmillan hoping to raise £850k each.

The next phase of work for the Charity was the recruitment of more fund-raisers.


Mr Wills asked if any indication had been attached to those chairs purchased for patients and visitors that they had, in fact, been provided by the Charity. In response, Ms Flynn reported that there had been some publicity in the Northern Echo as well as in the Trust Bulletin. Appropriate certificates had also been displayed in the wards. Ms Flynn looked to obtain labels to be fixed to the chairs themselves.

Ms Fawcett made the point that a great many wards held their own charitable funds. Ms Flynn assured Governors that this had been made clear on those certificates posted on wards. She highlighted that there were actually 147 separate ward funds – with some of that funding either restricted, or designated to, particular wards which meant that they could not be utilised for other areas or departments – and with a great many smaller funds not having been touched for some time. Essentially the only fund which could be drawn upon for whatever purpose was the


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(b)

General Fund. It was, therefore, necessary to take a strategic view of what was best for the Trust and its patients.

Mr Michael Bretherick Mr Bretherick advised that his principal role, in addition to his general Non- Executive Director role, was to Chair the Integrated Quality & Assurance Committee (IQAC), an amalgamation of CDDFT’s previous Planning & Workforce Committee and the Trust Board’s Quality & Healthcare Governance Committee, which re-formed structure had not yet gone through a full annual review cycle. Essentially IQAC was a senior Committee of the Board. With a large Committee attendance to monitor performance, there were also two observers from the Governors’ Quality & Healthcare Governance Committee. IQAC met every month for a three to four hour session - with a great deal of preparation involved in reading through all of the papers under consideration. To ensure that no issues were allowed to fall between the gaps, it was of further note that IQAC had an annual plan dovetailed with other committees. As a further source of assurance, it was noted that committee chairs met together on an annual basis to ensure that no issues were omitted. With a work cycle of a three month rotation, frequent, consideration was given to the Board Assurance Framework (BAF) – 80% of which was owned by IQAC and with other matters to be considered by finance, audit and risk committees. Essentially IQAC looked to verify and triangulate the picture preserved in the BAF with the other reports and information scrutinised to determine whether it was an accurate representation of the position on the ground. Every effort was made to implement learning from patients’ stories, whether positive or negative, and to establish what had gone well and what had gone badly. Essentially IQAC operated as a delegated arm of the Trust Board.

Mr Bretherick then explained that he made visits to all Trust sites in an effort to follow up the Board Assurance Framework on the ground. As an example, he sought to ensure that the falls strategy was followed through. In this endeavour he had made visits to theatres as well as to A&E to establish that Local Safety Standards for Invasive Procedures (LocSSIPs) were being implemented.

It was put on record that IQAC studied performance reports in quite minute detail – with any risks to be addressed considered by the Committee. Specifically, Committee Members had given their attention to patients’ nutrition, going home transfers, patients’ falls and Never events.

Finally, Mr Bretherick took this opportunity to commend the massive commitment of Trust staff in giving up their time to leave their jobs on the ground to attend IQAC.

Ms Featherstone commented that these reports had provided assurance to Governors that Non-Executive Directors were effectively fulfilling their roles.

Looking back at the previous five agenda items this evening, the Trust Chair was acutely aware that CDDFT had always taken very seriously the outcome of those reports made in respect of troubled NHS organisations, such as the Morecambe Bay Inquiry. He voiced his view that this Trust was particularly mindful of its duty to consider whether lessons could be learned from those reports. The Chairman put on record that the Trust had recently received a report in relation to that independent review of the failings of the Liverpool Community Health NHS Trust


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and was to study that report very carefully to establish if there was any learning to be obtained. It was crucially important that the organisation continued to learn.

81/18 Update from Sub-Committee Chairs

(a) Audit & Governance Due to illness over the previous month, Dr Davison trusted that Governors would accept all of that information with regard to the business of this Committee under the Trust Secretary’s Update - to be delivered under Item 82/18 below.

(b)

Strategy & Planning Committee As Committee Chair, Ms Featherstone referred Governors to her summary of the proceedings of the Committee meeting held on 22 January 2018 – contained in the agenda pack.

(c) Quality & Healthcare Governance Ms Boyle, Committee Chair, reported that the Committee had last met on 6 February 2018 when she had welcomed a number of new Governors. The following items had been on the agenda: A very informative presentation on the Acute Intervention Team. A comprehensive update on the first year of the Quality Matters Strategy. The Committee had also received an update on the Quality Accounts – with a

draft document to be available in April. There had been a detailed discussion around how Governors could be

assured about data quality and the selection of patients for those audits. No areas RAG rated as ‘red’ were highlighted to the Committee.


82/18 Trust Secretary’s Update

Mr Edge outlined the details of his report contained in the agenda pack when it was noted that Trust Membership currently stood at 11,420 – with further recruitment initiatives planned. In terms of Membership engagement the following events were scheduled, to commence in the main outpatients areas, and to be promoted in the Your Trust magazine: 23 March 2018 UHND 12 April 2018 BAH 20 April 2018 DMH The Audit and Governance Committee had requested, and Mr Edge had agreed to support, at least one recruitment and engagement event in each major constituency in 2018/19, and governors were invited to suggest existing community events from their own knowledge, where a Governor presence to engage members would be helpful. Subject to evaluation of the first events, more constituency events might be supported.

With the sub-committee allocation process having been completed, Mr Edge flagged that, in the previous year, with those committees having been under- subscribed, it had been agreed that Governors might sit on a third committee if they so wished. A number of Governors had taken up that offer and the Audit and


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Governance Committee had questioned whether the arrangement could be made permanent. Currently, with the majority of Governors opting to sit on two committees and with those committees no longer under-subscribed, Mr Edge recommended adherence to the rule that Governors were limited to a maximum of two committees. It was important to preserve some vacancies for Governors to be elected from the May by-election. No objections were raised.

Mr Edge advised that the Council of Governors was due to complete its annual effectiveness self-assessment. If Governors were content with this survey process, as had been set out in the paper attached to the agenda pack – along with draft questions, this process was to commence on 26 February. No changes were requested.

The Council of Governors noted this update.

83/18

(a)

(b)

Any Other Business

Ian Dalton The Chairman put on record that Ian Dalton, newly appointed NHSI Chief Executive, was to visit UHND on 16 February.

Apprenticeships’ Awards Ceremony The Trust Chair advised that the Trust was to hold its awards ceremony in respect of its apprenticeships on 9 March.

84/18 Future Meetings

Council of Governors Wednesday 11 April 2018 17:00hrs to 20:00hrs

Executive Board Room, DMH

85/18 Motion to Exclude Press & Public

The Trust Chairman moved the following motion.

Those representatives of the press and other members of the public be excluded from the remainder of this meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest.

There were no objections.

86/18 Close

With no further questions or comments raised, the public section of the meeting was formally declared closed at 20:00hrs. The Chairman thanked all Governors for their contributions and observations.


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Chair – Prof Paul Keane ……………………… Date ……………………..

Action Log

Item Action Responsible

63/17 05/18 24/18(c) 47/18(c)

72/18(c)

Carry forward the vote on the Constitution to July 2017. Carry forward to a short meeting prior to the September AGM. With two-thirds of Governors required to be present, this vote was again carried forward. With insufficient Governors present, this vote was carried forward to April 2018.

WE

13/18

47/18(c) 72/18(c)

Amend Section 4.3 of the ToR of the Strategy & Planning Committee. Noted as updated but not yet approved by the Committee as Mr Edge was on annual leave. Carried forward to the next meeting of the Committee scheduled for 4 December 2017. With the amendment having been made, a further review was required. Action carried forward.

WE

29/18(g) 47/18(c) 72/18(c)

Once TAPs fully established ask a representative to share the details of their work with the CoG. To be diaried. Action to be carried forward to a future CoG. With the team currently very heavily involved in the tender process for the community services contract, this action was carried forward to April.

WE

47/18(a) Amend Minute 23/18 as had been noted. FTO

51/18 Update on the number of vacancies and whole time equivalent (WTE) posts in vulnerable service areas. Broader presentation on recruitment to be delivered in April.

JeC WE

53/18 72/18(c)

Circulate podcast if possible. Distribute CQC Welcome Packs to Governors. Noted as complete.

WE

55/18 The handling of employment cases deferred to the next Joint meeting of the Trust Board and CoG in December.

WE


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79/18(h) Bring more information about Duty of Candour to the April CoG. SJ/WE

79/18(i) Obtain details/figures on how outsourcing/locum costs have decreased over time.

SJ

79/18(i) (iii)

Out-with the meeting, address the issue of other indicators to ensure that patients came to no harm in A&E.

JeC/MJ CL

79/18(i) (iii)

Look into the circumstances of those patients who had presented at A&E, been returned home but subsequently admitted.

CL

SEVENTH MEETING OF THE GOVERNING COUNCIL minutes cog... · 2018. 6. 20. · Ms Tricia Gordon Staff...

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