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TRUST BOARD MEETING in PUBLIC Thursday 6 October 2016 at 10 TRUST BOARD MEETING IN PUBLIC Thursday 6 October 2016 At 10:00am VENUE: Oasis Centre Queen Alexandra Hospital COSHAM Trust Board Meeting in Public Held on Thursday 1 September 2016 at 10:00am Lecture Theatre Queen Alexandra Hospital MINUTES Present: Sir Ian Carruthers Chairman Steve Erskine Non-Executive Director Liz Conway Non-Executive Director Mike Attenborough-Cox Non-Executive Director Mark Nellthorp Non-Executive Director Tim Powell Interim Chief Executive Cathy Stone Director of Nursing Chris Adcock Director of Finance Simon Holmes Medical Director Ed Donald Chief Operating Officer Rebecca Kopecek Interim Director of Workforce Simon Jupp Director of Strategy In Attendance: Simon Hunter Chief of Service, Emergency Medicine Rosemary Brownbridge Head of Nursing, Emergency Medicine Ali Bartens Chief of Service, AMU Peter Mellor Director of Corporate Affairs Michelle Andrews PA to Trust Board (Minutes) Item Minute No 109/16 Apologies: John Smith, Non-Executive Director Rob Haigh, Director for Emergency Care Declaration of Interests: There were no declarations of interest. 110/16 Patient Story Simon Hunter, Chief of Service, and Rosemary Brownbridge, Head of Nursing, were in attendance for this item and delivered the following presentation which summarised the general patient experience across the Emergency Medicine CSC: Trust Board EM CSC re patient story Sept Liz Conway asked about staff morale within the department. Rosemary advised that due to the never ending pressures staff morale had been very low, particularly after the publication of the CQC report, even though staff had been prepared for the likelihood of a negative report. However, the positive response from the public following the publication of the report has been a real morale boost. Simon Hunter explained that the on-going improvement 1 projects within the department were keeping the staff morale high as these were projects that staff had contributed to via the various focus groups. Steve Erskine asked whether the department felt part of the wider team across the organisation and whether any collaboration from the rest of the organisation was needed. Simon Hunter felt that there had been a real shift change throughout the organisation in recognising the pressure within the Emergency Department. Professional standards had been introduced which have made a positive impact. Mark Nellthorp referred to the number of patients who were inappropriately brought to the Emergency Department via ambulance. He asked whether there is was any way that the Trust could have a service which enabled those patients to be triaged in the community before coming to hospital. The Medical Director advised that it was only a small group of patients and they usually come from nursing homes. Dr Jim Hogan, Portsmouth CCG, has taken responsibility for reporting back any inappropriate attendances. There is a now a ‘silver phone’ process in place which enables nursing homes to phone directly to a Geriatrician for advice and this is expected to reduce the number of inappropriate attendances. The Chairman thanked all members of staff for their continued hard work during this difficult time. He was pleased to hear of the positive improvements being made and the recognition that urgent care was the responsibility of everyone within the organisation and not just those within the Emergency Department. 111/16 Minutes of the Last Meeting – 7 July 2016 The minutes were agreed as a true and accurate record. 112/16 Matters Arising/Summary of Agreed Actions All complete. 113/16 Notification of Any Other Business None. 114/16 Chairman’s Opening Remarks The Chairman reminded that the NHS was facing a challenging time, both nationally and locally. There were challenges nationally, in particular, with both urgent care and financial health. He drew attention to a number of closures of Emergency Departments across the country but confirmed that this would not affect us locally. He drew attention to the Sustainability and Transformation plans being developed across the country. For services to be truly sustainable in the future, some difficult choices would need to be made. There was currently a most significant savings requirement from the healthcare sector in Hampshire and the Isle of Wight. A further Junior Doctors dispute is being planned for mid-September. How this would affect the Trust was unknown but, historically, Junior Doctors working at Portsmouth had always acted responsibly with only a minimal impact on services. The search process for a substantive Chief Executive was now underway. It was not likely to be concluded until early November. It could then be a considerable period of time before the successful individual would be in post because of the possible need to serve a period of notice. The Chairman thanked all staff, Governors and Volunteers for their invaluable contribution to the organisation. 115/16 Chief Executive’s Report 2 The Interim Chief Executive drew attention to key areas of his report: · Supporting Providers to improve A&E performance - Plans are underway to help NHS providers find ways to meet and sustain A&E performance. · Strengthening Trusts' Financial and Operational Performance for 2016/17 - NHS Improvement unveiled a suite of new measures for providers and commissioners to restore financial discipline and help ensure on-going financial sustainability for the NHS. They have placed five challenged NHS providers in financial special measures in order to bring about swift improvement and, as part of this, each Trust will undergo a rapid review and agree a financial recovery plan. · Mental Health Risk Summit – National issues around the provision of care. The mental health service is at crisis point in Hampshire with provision of care deemed inadequate. A summit will help to identify the most pressing risks currently facing the care system and how organisations might best work together to mitigate them. 116/16 Integrated Performance Report Quality The Director of Nursing drew attention to the following areas, with supporting comment from the Medical Director: · Tissue viability – a continued improvement was being seen by ensuring that the right supplies are in the right place at the right time. One of the elective orthopaedic wards had recently been given an award for being ‘incident free’ for 7 years. · Patient moves after 12am – a decrease in the number of non-clinical moves has been seen. · ED Friends and Family Test – there has been a reduction in the response. The reasons for this are multifactorial. There has also been a slight decrease in the reported satisfaction rate. · Falls – there were 3 falls reported in July, however, this was adjusted to 4 following 1 historical case which was confirmed as a severe harm incident during July. · PLACE audit – the Trust scored above the national average in 7 of the 8 domains, with food scoring slightly lower. · Healthcare Acquired Infections – There were zero incidents of MRSA reported in July. There were 3 reported cases of C.Difficile in the month with a year to date position of 9 cases against an objective of 13. There were 4 reported cases of MSSA in July, which compared favourably nationally. · Mortality – There has been a sudden rise in the Trusts HSMR score. Whilst it is ‘within expected range’ it was now above the national average. The position has been reviewed by Dr Foster and internally by the Clinical Effectiveness Steering Group and there are 3 clear themes: o The figures include those deaths which happen in Jubilee House, despite the patients being the responsibility of Solent NHS Trust. There was a ‘batch’ of 6 months’ worth of data reported in one month. o The coding for palliative care had fallen off. o There has been a rise in the number of patients recorded in a ‘residual code’ rather than the correct code for their morbidities. · Stroke – a continued improved performance with a trajectory to move to rating ‘B’ by the end of the year which would be earlier than planned. Liz Conway was concerned at the HSMR rate and particularly the on-going issue of coding. The Medical Director agreed that coding was an issue and that the Trust was currently looking at how others have overcome the issue. It was agreed that a paper should be brought to the next meeting outlining the reasons for the sudden increase in the HSMR. The paper also needs to include the independent assurance from Dr Foster. Action: Medical Director Steve Erskine referred to the Quality Care Review and asked what the reason was for the variation in standards between the different maternity wards. The Director of Nursing 3 explained that the reviews imitate that of the CQC and this particular case of variation was due to a small cohort of new Midwives who were unaware of some of the Trusts internal processes. Operations The Chief Operating Officer drew attention to the following areas of the report: · A&E service standard – performance was 80.25% against the 95% standard. Whilst this was below the improvement trajectory of 85%, performance was improving. The number of ambulances being held was lower and the percentage of patients being triaged within 15 minutes remained high. · Continued improvement seen in the identification and treatment of sepsis. · Good progress with the implementation of the Frailty Improvement Team. · Delayed transfers of care are currently at an all-time high and patients are being reviewed on a daily basis so that any issues can be escalated. · RTT – 91.21% achievement against the 92% standard and improvement trajectory. The number of long waiting patients has reduced and recovery plans have been developed for those areas of concern. · Cancer – a consistent improvement seen with 7 of the 8 standard achieved. A slight dip in performance is possible for August because of patient choice over the holiday period. · Diagnostics – performance of 99.4% against a trajectory of 99%.
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