Frank Collins  4358 Chairman BBOOAARRDD OOFF DDIIRREECCTTOORRSS 2266TTHH MMAARRCCHH 22001155 AATT 99..3300 AA..MM.. TTHHEE BBOOAARRDD RROOOOMM AAGGEENNDDAA PPAARRTT OONNEE -- PPUUBBLLIICC MMEEEETTIINNGG 1.0 Apologies: 2.0 Minutes of the previous meeting held on 26th February 2015 Paper 1 3.0 Matters Arising 4.0 Declarations of Interest SSTTRRAATTEEGGYY 5.0 Getting It Right First Time: National report by Professor Tim Briggs Paper 02/ Presentation RJAH report Paper 03 6.0 2014 Inpatient Survey Paper 04 7.0 2014 Staff Opinion Survey Paper 05 8.0 Policy Framework Strategy Paper 06 9.0 Foundation Trust Membership Update Paper 07 PPEERRFFOORRMMAANNCCEE 10.0 Month 11 Integrated Performance Report Paper 08 GGOOVVEERRNNAANNCCEE,, QQUUAALLIITTYY AANNDD SSAAFFEETTYY 11.0 Monitor Quarter 3 Feedback Paper 09 12.0 Use of Trust Seal 2014-15 Paper 10 13.0 2015-16 Clinical Audit Plan Paper 11 14.0 Any Other Business: None notified 15.0 Questions from the Public 16.0 Date and time of next meeting: 9.30 a.m. on 30th April 2015, The Board Room, RJAH Orthopaedic Hospital NHS Foundation Trust, Oswestry Questions from the Public on Agenda items – time limit of 15 minutes There will be an opportunity for the public to ask questions on agenda items. These should be limited to two questions per person and the time in total for each person should be limited to five minutes. If topics are likely to exceed this, they should be the subject of discussions between the hospital management and the individual concerned or there should be a formal request agreed by the Trust Board for the item to be included on the next agenda. If questions are detailed and require information that is not instantly available, the hospital will respond to the question within ten working days. To resolve, in accordance with Trust Standing Orders, that 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. (Section 1(2) Public Bodies (Admission to Meeting) Act 1960) U:\Trust Board & Committees\Public Trust Board\2014-2015\March 2015\2015_03_26_Board_of_Directors_Agenda.doc AAGGEENNDDAA PPAARRTT TTWWOO –– PPRRIIVVAATTEE CCLLOOSSEEDD SSEESSSSIIOONN 17.0 Minutes of the previous meeting held on 26th February 2015 Paper 12 18.0 Matters Arising 19.0 Chief Executive’s Update Verbal 20.0 2015-16 Draft Financial Plan Paper 13 21.0 Any Other Business 22.0 Date and Time of Next Meeting: 30th April 2015 following the Public Board of Directors meeting U:\Trust Board & Committees\Public Trust Board\2014-2015\March 2015\2015_03_26_Board_of_Directors_Agenda.doc Paper 1 Frank Collins  4358 Chairman BBOOAARRDD OOFF DDIIRREECCTTOORRSS 2266TTHH FFEEBBRRUUAARRYY 22001155 MMIINNUUTTEESS OOFF MMEEEETTIINNGG PPRREESSEENNTT:: Frank Collins, Chairman Wendy Farrington Chadd, Chief Executive John Grinnell, Director of Finance Jayne Downey, Director of Nursing and Service Delivery Steve White, Medical Director Richard Clarke, Non-Executive Director Ian Davis, Non-Executive Director Alastair Findlay, Non-Executive Director Hilary Pepler, Non-Executive Director IINN AATTTTEENNDDAANNCCEE:: Ruth Tyrrell, Associate Director of HR Margaret Surrage, Head of Board Governance (Trust Secretary) Ann Ashworth, Trust Secretary Designate Janet Cox, Minutes Secretary PPAARRTT OONNEE –– PPUUBBLLIICC MMEEEETTIINNGG The Chairman welcomed everyone to the meeting and said that he felt immense pride in being invited to take on the Chairman’s role at the hospital. He thanked the Executive Directors for their help in guiding him through his first few weeks in post and asked for patience from colleagues whilst he familiarises himself with the organisation’s protocols and processes. He also thanked the previous Chairman, Russell Hardy, for his great contribution to the Trust. MMIINNUUTTEE NNOO TTIITTLLEE AACCTTIIOONN 26/02/1.0 AAPPOOLLOOGGIIEESS There were no apologies. 26/02/2.0 MMIINNUUTTEESS OOFF TTHHEE PPRREEVVIIOOUUSS MMEEEETTIINNGG 29/01/8.0 Month 09 Integrated Performance Report Domain 1 Patient Safety The Director of Nursing and Service Delivery confirmed that all patients are risk assessed for pressure ulcers and MMIINNUUTTEESS requested that the word ‘elective’ be removed from the 7th SSEECCRREETTAARRYY bullet point on page 3 of the minutes. Following this amendment the minutes were approved as an accurate record. 26/02/3.0 MMAATTTTEERRSS AARRIISSIINNGG The Chairman went through the actions which had all been completed or diaried for future agendas. Investment Decision Making Policy The Director of Finance confirmed that the Policy had been updated and that the Business Risk and Investment Committee would have further discussion around the investment metrics. U:\Trust Board & Committees\Public Trust Board\2014-2015\March 1 2015\2015_03_26_Board_of_Directors_Paper_01_Minutes_of_the_Meeting_held_on_26_February_2015.doc Paper 1 26/02/4.0 DDEECCLLAARRAATTIIOONNSS OOFF IINNTTEERREESSTT The Head of Board Governance (Trust Secretary) confirmed that the Chairman’s declarations had been added to the website. There were no additional new declarations of interest to record. SSTTRRAATTEEGGYY 26/02/5.0 RESEARCH STRATEGY The Medical Director presented the Research Strategy which had been designed to ensure a robust programme of research to support improvement in patient outcomes at the hospital and in the wider community. He explained that it will ensure appropriate Clinical Governance arrangements are in place to safeguard patients, staff and the Trust. He gave thanks to Mr Andrew Roberts, Research Director and Consultant Orthopaedic Surgeon for his leadership and help in developing the Strategy. A discussion took place on the promotion of research within the Trust and whether this was ‘visible’. It was acknowledged that there is a lot of surgeon and physician involvement and that more could be done to encourage the nursing and allied health professional staff to participate in research, not just as support to clinicians but in their own right. The Board of Directors welcomed the Strategy and requested HHEEAADD OOFF that an update be provided in 6 months’ time when funding BBOOAARRDD streams and the themes identified in the document have been GGOOVVEERRNNAANNCCEE progressed. It also supported and encouraged the links with ((TTRRUUSSTT academic institutions – suggesting that this include Glyndŵr SSEECCRREETTAARRYY))// University as they have technical areas of expertise which MMEEDDIICCAALL may be useful. In addition, it was felt that the Director of DDIIRREECCTTOORR Nursing and Service Delivery should be the co-Responsible Director to reflect the need for research to include the nursing DDIIRREECCTTOORR OOFF and allied health professional body. This was agreed. NNUURRSSIINNGG && SSEERRVVIICCEE An explanation of what CRN means was requested and the DDEELLIIVVEERRYY Medical Director confirmed that this means Clinical Research Network which is part of the National Institute of Health Research. The RJAH comes under the Birmingham and Black Country office which provides support to the organisation such as measuring outcomes. If the organisation performs well, more money is potentially available to support research. A discussion then took place on the Institute of Orthopaedics and its link to the Board of Directors and it was noted that this link is at Executive-level and will continue as the direction of travel for Research evolves. The Board of Directors noted that research is viewed and run as a trading arm within the organisation and welcomed this approach. It agreed that this approach emphasises how critical it is to ensure that there is a mix of work to make research sustainable as it is not just about the awarding of grants. The Board of Directors discussed and approved the draft Research Strategy. U:\Trust Board & Committees\Public Trust Board\2014-2015\March 2 2015\2015_03_26_Board_of_Directors_Paper_01_Minutes_of_the_Meeting_held_on_26_February_2015.doc Paper 1 26/02/6.0 TTHHEE DDAALLTTOONN RREEVVIIEEWW The Chief Executive presented the executive summary of the Dalton Review ‘Examining new options and opportunities for providers of NHS care’ which had identified five key themes: One size does not fit all. Quicker transformational and transactional change is required. Ambitious organisations with a proven track record should be encouraged to expand their reach and have greater impact. Overall sustainability of the provider sector is a priority. A dedicated implementation programme is needed to make change happen. She then gave a presentation which is available here. She explained that a number of recommendations had been identified under these themes and gave a brief explanation of what these were: A new ‘kitemark’ of success should be developed for ambitious organisations to aspire to A credentialing process to be developed which looks at things which are done well at organisations and then transfers these to other parts of the sector. From this, new partner organisations to be identified. A procurement framework to then be developed which allows credentialed organisations to register for management contract and/or development opportunities. Leadership capacity and capability Leadership Academy to take a more proactive role which is co-ordinated at a national level. Monitor and TDA need more options to prevent deterioration in quality of care Buddying system to be expanded. Monitor to have more intervention powers. She concluded that it is likely that this comprehensive piece of work will be further developed post-Election but that the Board needs to be thinking about the impact of these recommendations as we progress our planning process into 2015-16. The Board of Directors welcomed the themes identified and the opportunities that this may present for the Trust. In particular it noted that the organisation has good quality templates of care which could be transferred to enhance its own reputation as well as benefiting the wider health economy. It noted that these themes will be addressed as the 2015-16 operational plan is finalised. The Board of Directors noted the report. PPEERRFFOORRMMAANNCCEE 26/02/7.0 MONTH 10 INTEGRATED PERFORMANCE REPORT The Chief Executive introduced the Month 10 integrated performance report which demonstrated strong performance U:\Trust Board & Committees\Public Trust Board\2014-2015\March 3 2015\2015_03_26_Board_of_Directors_Paper_01_Minutes_of_the_Meeting_held_on_26_February_2015.doc Paper 1 in the key metrics across all five domains. She confirmed that the quality and patient experience metrics had continued their strong performance throughout the year and improvements in the efficiency domain were now showing progress. She added that continued improvement in this area is key in supporting the Trust in delivering its efficiency targets. She concluded that the financial performance in January was very positive. Domain 1 Patient Safety The Medical Director reported that strong performance in this domain had continued. He highlighted that: There were no hospital acquired infections in month. One serious incident was recorded in month. Full investigation would be undertaken and the results presented to the next Quality and Safety Committee. There were no patient deaths. There were two instances of hospital acquired venous thromboembolism in month. Both patients had been risk assessed. There were 17 medication incidents with no harm recorded. Four patients were readmitted as an emergency within 28 days of discharge. The Director of Nursing and Service Delivery reported that: There were 13 patient falls in month - seven patients were not complying with medical advice at the time of their fall. Two minor harms were experienced. Work is continuing to understand the reasons behind this and to analyse the data. Work has also been undertaken around medical advice given and to check patients understanding. The Trust scored 99.36% in providing harm-free care using the safety thermometer tool which is above the national twelve month average of 97.53%. There were no hospital acquired pressure ulcers (of any grade) in month. The Board of Directors noted that the Quality and Safety Committee would be reviewing the serious incidents in more detail and that an audit was currently being undertaken. MMEEDDIICCAALL A question was asked about the readmission rate of 0.69% DDIIRREECCTTOORR and whether this was accurate and it was agreed that this would be reviewed. Domain 2 Patient Experience The Director of Nursing and Service Delivery reported that all metrics were forecast green at year-end with the exception of Welsh access times. She highlighted that: The net promoter score was 88.80 which was above the target of 71. The Trust remains within the top 10 acute trusts with regards to satisfaction rates. During December this was 98.1% against the national target of 94.5%. 111 formal compliments were received with no additional feedback on the NHS Choices website. Six complaints had been received which is within tolerance levels. All have been investigated within the U:\Trust Board & Committees\Public Trust Board\2014-2015\March 4 2015\2015_03_26_Board_of_Directors_Paper_01_Minutes_of_the_Meeting_held_on_26_February_2015.doc Paper 1 required timescales. There were three delayed discharges (on the Spinal Injuries Unit). The delays were measured in days rather than in months as had previously been the situation. Access targets relating to bone tumour, diagnostics and English Referral to Treatment targets had been maintained. Work is continuing with Welsh Commissioners to meet their access targets with 85.23% of patients completing their pathways within 36 weeks. The NHS England RTT validation team are due to finish on 27th February 2015. A question was asked regarding the delayed discharges on the Spinal Injuries Unit and whether this had caused delays in admitting new patients. The Director of Nursing and Service Delivery confirmed that no delays had been caused in admitting new patients to the Unit. A question was then asked about the suggestion that Trusts write to all patients who are waiting over 12 weeks to check whether they should still be on the waiting list. It was noted that the validation work being undertaken by NHS England would address this. A discussion then took place on the open pathway target which in the past has had more headroom and was there anything which could be done to improve this. It was noted that whilst this is challenging to meet every month, there is a robust patient tracking system in place and there are no underlying issues that needed addressing. Domain 3 Efficiency The Director of Nursing and Service Delivery reported that 8 of the 10 metrics were rated green in month as a result of improvements in efficiency. She highlighted that: Demand for services had decreased in line with seasonal variation during December 2014, although referrals had continued to increase during the year. Commissioners have acknowledged this increase and discussions are ongoing with regards to the pressures on resources and the need for pathway review and achievement of QIPP schemes to reduce demand. Activity was marginally behind plan in the Surgical Division. Daycase performance increased in month and was above the 50.5% target at 52.92%. The BADS rate remained below the target of 87% at 83.85% in month. Theatre efficiency was above target at 96.88%. Cases per session remained on target at 2.2. Average length of stay decreased to 3.58 days which was reflective of casemix. A significant increase in the number of patients discharged within 3 days of their operation was achieved in month as a result of progress with the enhanced recovery programme. Bed occupancy on adult orthopaedic wards was behind the target range at 77.69%. Outpatient productivity: Did Not Attend rates increased slightly but the rate remains below the quarter 1 baseline performance that is being used to U:\Trust Board & Committees\Public Trust Board\2014-2015\March 5 2015\2015_03_26_Board_of_Directors_Paper_01_Minutes_of_the_Meeting_held_on_26_February_2015.doc Paper 1 benchmark the success of the text reminder system which will be rolled out to all services by the end of the financial year. A discussion took place on the reduction in the surgical activity and it was noted that further review was required although it was not thought that there was any underlying reason for this. This then led to a discussion on the increase in the number of referrals and whether there had been any change in approach from Commissioners. It was noted that there had been increases in certain sub-specialties and discussions were continuing with Commissioners to understand the reasons for this. HHEEAADD OOFF BBOOAARRDD A suggestion was made for an update to be provided to the GGOOVVEERRNNAANNCCEE Board of Directors on the progress made with the Enhanced ((TTRRUUSSTT Recovery Programme and it was agreed that this would be SSEECCRREETTAARRYY)) included in the Board Business Programme. DDIIRREECCTTOORR OOFF NNUURRSSIINNGG && A question was asked regarding Outpatient activity and what SSEERRVVIICCEE plans were in place to bring this to target. The Director of DDEELLIIVVEERRYY Nursing and Service Delivery explained that work was ongoing in a number of areas to support achievement of this metric. Domain 4 Resources The Director of Finance reported that: A £180k surplus had been delivered against a plan of £80k. Cumulatively the surplus is £880k which is £40k ahead of plan. In month, the EBITDA margin was 6% and cumulatively is 5%. Income levels were over plan by £110k predominantly as a result of increased activity in the medicine division. Pay costs were underspent by £60k. Non-pay costs were overspent by £130k reflecting consumable costs and over-performance on pathology costs which is linked to activity. Cost improvements of £324k were realised in month. Year to date savings are ahead of plan and full achievement of the £3m programme is forecast. Cash balances increased in month to £4.5m as a result of an interim cash settlement from Shropshire CCG. Settlements regarding year-end positions have been agreed with most Commissioners. Capital expenditure was £304k in month. To achieve the year-end financial surplus target of £1m, £120k needs to be delivered in the remaining two months of the financial year. A question was asked regarding the Cost Improvement Programme and what schemes were included in the Corporate Division. It was agreed that the Director of Finance would respond outside of the meeting. HHEEAADD OOFF A discussion then took place on the underspend on pay costs BBOOAARRDD and the reasons for this. It was noted that there were two key GGOOVVEERRNNAANNCCEE elements – reduced out of job plan spend and the proactive ((TTRRUUSSTT U:\Trust Board & Committees\Public Trust Board\2014-2015\March 6 2015\2015_03_26_Board_of_Directors_Paper_01_Minutes_of_the_Meeting_held_on_26_February_2015.doc Paper 1 management of nursing staff linked to capacity and flexibility. SSEECCRREETTAARRYY)) It was suggested that the Spinal Injuries Ward Manager DDIIRREECCTTOORR OOFF provide an update to the Board of Directors on the work that is NNUURRSSIINNGG && being done around acuity and staffing levels. This was SSEERRVVIICCEE agreed. DDEELLIIVVEERRYY Domain 5 External Perception The Trust maintained its ‘green’ governance rating and level 4 continuity of services risk rating. The Board of Directors noted the Month 10 Integrated Performance Report. GGOOVVEERRNNAANNCCEE,, QQUUAALLIITTYY AANNDD SSAAFFEETTYY 26/02/8.0 REVISED STANDING FINANCIAL INSTRUCTIONS AND SCHEME OF DELEGATION The Director of Finance presented the Standing Financial Instructions and Detailed Scheme of Delegation which had been reviewed and recommended for approval by the Audit Committee. He explained that there was a proposed change in the Significant and Material Transactions wording to align with the Trust’s Constitution; changes to the wording in the Scheme of Delegation relating to the practicalities of delegating budgetary control and capital expenditure and how this is managed once signed off by the Board of Directors and quotation and tender limits have been updated. The Audit Committee Chairman confirmed that the Audit Committee had discussed the changes in detail and had approved the changes proposed. The Board of Directors approved the revised Standing Financial Instructions and Detailed Scheme of Delegation. 26/02/9.0 FREEDOM TO SPEAK UP – REVIEW BY SIR ROBERT FRANCIS The Chief Executive presented the correspondence received from the Secretary of State for Health and Monitor Chief Executive following the publication of the Freedom to Speak Up Review by Sir Robert Francis. She confirmed that the correspondence had been disseminated throughout the HHEEAADD OOFF organisation as requested and suggested that this is BBOOAARRDD discussed further at the April Board of Directors meeting with GGOOVVEERRNNAANNCCEE regards to any ongoing impact on the organisation. She ((TTRRUUSSTT confirmed that the lead executive is the Director of Nursing SSEECCRREETTAARRYY))// and Service Delivery. DDIIRREECCTTOORR OOFF NNUURRSSIINNGG && The Board of Directors agreed that it was important that SSEERRVVIICCEE whistleblowers were treated fairly and agreed to discuss this DDEELLIIVVEERRYY at the Board meeting in April. 26/02/10.0 BOARD GOVERNANCE PACK INCLUDING MATTERS RESERVED TO THE BOARD The Head of Board Governance (Trust Secretary) presented the Board Governance Pack which had been updated to confirm the change in Director responsibilities approved by the Board in January 2015 and reflect the new regulations on the Fit and Proper Person Test. She added that no changes were proposed to the Matters Reserved to the Board. It was noted that the documents made reference to ‘Vice HHEEAADD OOFF Chair’ and it was agreed that this would be changed to read BBOOAARRDD ‘Deputy Chair’. GGOOVVEERRNNAANNCCEE U:\Trust Board & Committees\Public Trust Board\2014-2015\March 7 2015\2015_03_26_Board_of_Directors_Paper_01_Minutes_of_the_Meeting_held_on_26_February_2015.doc Paper 1 ((TTRRUUSSTT The Board of Directors approved the proposed changes to SSEECCRREETTAARRYY)) the Board Governance Pack and confirmed that the Matters Reserved to the Board remain unchanged. 26/02/11.0 NON-EXECUTIVE DIRECTOR BOARD AND COMMITTEE ROLES The Chairman presented the paper which proposed changes to the Non-Executive Director Board and Committee Roles following the departure of Peter Jones, Non-Executive Director. He explained that it was his intention to defer discussion around individual roles to the closed private session with the role of the Senior Independent Director/Deputy Chairman to be discussed in the public session. He reminded the Board that it is the Council of Governors role to appoint the Deputy Chairman whilst the Senior Independent Director was a Board appointment to be made in consultation with the Council of Governors. He described how he had spoken to Board colleagues regarding this appointment. He confirmed that his recommendation was for Alastair Findlay, Non-Executive Director to be appointed to the role of Senior Independent Director as it was his view that he had the necessary experience, competence and professionalism to fulfil the role. He added that he would recommend to the Council of Governors that the Senior Independent Director would also assume the role of Deputy Chairman. He concluded that if the Board of Directors were in agreement with his recommendation, he would discuss this at the Council of Governors meeting later in the day. The Board of Directors approved the recommendation for Alastair Findlay to become the Senior Independent Director and to recommend to the Council of Governors that he should be appointed as Deputy Chairman. 26/02/12.0 BOARD DECLARATIONS 2014-15 The Head of Board Governance (Trust Secretary) presented the statements which are required to be included in the organisation’s annual report concerning the independence of the Non-Executive Directors and the balance and completeness of the Trust Board as required by the NHS Foundation Trust Code of Governance. She explained that there were a number of assurances to support these statements, namely the fit and proper person test for the new Chairman, whose leadership skills and experience will strengthen the Board, the refresh of the Directors declarations of interest and the balance of the Board which was discussed at the meeting in January 2015. The Board of Directors approved the statements as presented for inclusion in the Trust’s annual report. 26/02/13.0 RREEPPOORRTTSS FFRROOMM BBOOAARRDD CCOOMMMMIITTTTEEEESS:: AAUUDDIITT CCOOMMMMIITTTTEEEE –– 1133TTHH JJAANNUUAARRYY 22001155 Richard Clarke, Non-Executive Director and Chairman of the Audit Committee presented his report of the Audit Committee held on 13th January 2015. He explained that the Committee had received its usual reports relating to finance, governance, counter fraud and risk management. The Committee had also discussed and recommended a 2 year extension to the external audit contract. The Board agreed with the rationale for extending the external audit contract and noted that this U:\Trust Board & Committees\Public Trust Board\2014-2015\March 8 2015\2015_03_26_Board_of_Directors_Paper_01_Minutes_of_the_Meeting_held_on_26_February_2015.doc