Present: Andy Windross Chairman

ANNUAL MEMBERS’ MEETING Minutes of the meeting held on Wednesday 14th September 2005

Assembly Rooms, Hackney Town Hall

Present: Andy Windross Chairman Nancy Hallett Chief Executive Pauline Brown Hospital Secretary / Director of Corp. Development John Coakley Medical Director Sue Acott Director of Redesign Andrew Panniker Director of Estates & Facilities Guy Young Director of Nursing and Quality Kate Costeloe Non Executive Director Jessica Crowe Non Executive Director Ian Luder Non Executive Director Irving Mellor Non Executive Director Gillian Borrie Public Governor - Hackney John Donaghy Public Governor - Hackney Ken Hanson Public Governor - Hackney Wayne Hoban Public Governor - Hackney Eli Kernkraut Public Governor - Hackney Faizullah Khan Public Governor - Hackney Joe Lobenstein Public Governor - Hackney Helen Scher Public Governor - Hackney Muttalip Unluer Public Governor - Hackney Steve Stephenson Public Governor - City Geoffrey Rivett Public Governor - City Dr Mary Britton Staff Governor Paul Eastwood Staff Governor Mark Edwards Staff Governor Dr Peter Freedman Staff Governor Chipo Takavarasha Staff Governor Ken Ayers Appointed Governor Professor Chris Fowler Appointed Governor Professor Sally Glen Appointed Governor Marian Goodrich Appointed Governor Janet McMillian Appointed Governor Councillor Fran Pearson Appointed Governor Laura Sharpe Appointed Governor

In attendance: Dr Micheal Craft Public Governor - Hackney Katie Lloyd-Thomas Public Governor - Hackney Sarah Weiss Public Governor - Hackney Tanya Reynolds Staff Governor

Minutes: Kim Hutchings Trust Board Secretary 1. CHAIRMAN’S WELCOME & INTRODUCTIONS - 2 -

The Chairman welcomed the attendees to the 2nd Annual Members Meeting of Homerton University Hospital NHS Foundation Trust.

He outlined the purpose of the meeting and thanked the members in attendance (approximately 300) for their interest in the meeting.

2. APOLOGIES FOR ABSENCE

Apologies were received from: Caroline Clarke, Director of Finance and Information, Sophie Fagan, Staff Governor, Carol Bailey, Appointed Governor, Jane Winder and Kate Green, members.

3. DECLARATIONS ON INTERESTS

There were no declarations of interest by governors and directors regarding matters on the agenda.

4. MINUTES OF THE PREVIOUS AMM HELD ON 28TH SEPTEMBER 2004 AND MATTERS ARISING

The minutes of the previous Annual Members Meeting were approved and signed as a true record of the meeting with the following amendments:

 Mr Eric Cato reminded the meeting that he had commented on the use of the park adjacent to the hospital.  Mrs Musgrave commented that she had questioned the use of mixed sex wards in the hospital and the use of contracted out domestic staff.

5. CHAIRMAN’S REFLECTION ON THE YEAR

Mr Windross reported on the major themes of the work of the Trust throughout 2004/5. He commented on the following:

 Increasing patient numbers and increasing services  Staffing - currently 2,200 employees  The involvement of governors and members in the work of the hospital  Performance ratings 2004/5  The success of the first Open Day  The move to hospital becoming a No Smoking hospital; and

He also reported on the implementation of the Electronic Patient Record (EPR) system within the year which had caused some administrative issues noted by members and patients.

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He highlighted the success of the Members’ Forums, three of which had taken place immediately before the AMM on the themes of Hygiene, Patient and Staff Communication, and No Smoking. He reported that these focus groups would continue to address specific issues of concern and he thanked members for their active interest in this work.

Lastly, Mr Windross thanked the staff for their hard work throughout the year in maintaining and improving services and maintaining, for the fourth year running, the three Star performance rating.

6. FINANCE AND PERFORMANCE REPORT 2004/5

Peter Walsh, Deputy Director of Finance, presented the Finance and Performance Report for 2004/5 in the absence of Miss Clarke, Director of Finance and Information.

He highlighted that this was the accounts of the first year of the Trust as a Foundation Hospital with a new financial regime and a new Independent Regulator, explaining, that income is now based on a system known as Payment by Results (PbR) in which the Trust is paid for activity at a national tariff. He also commented on the nature of these legally binding contracts with PCTs.

He highlighted the benefits of foundation trust status to the Trust in its greater financial freedoms and its ability to borrow money to fund development which had resulted in increased capital investment and the ability to re-invest surpluses in patient care, which had not been possible before the advent of foundation trust status.

He outlined the Trust’s income and expenditure for 2004/5 and reported that both income and expenditure had amounted to £126.8m with an overall income and expenditure surplus of £13,000 being achieved.

He commented on capital investment explaining that the fixed asset base at year end was £210.5m, an increase of £11.4m since March 2004. He highlighted the main developments:  a new operating theatre,  a primary and urgent care centre (in conjunction with City and Hackney PCT)  a new academic centre, and  investment in the Electronic Patient Record system

Mr Walsh concluded that accounts had been subject to a rigorous external audit review by the Trust’s new external auditors, KPMG who had been appointed by the Council of Governors in 2004. He reported that the Trust had been issued with an Unqualified Audit Opinion and summarised this as follows:  a successful transition to the new foundation trust financial regime  an income and expenditure surplus achieved  borrowing within limits  capital developments completed within planned funding, and

 accounts given unqualified audit opinion.

He however highlighted that there will be challenging targets and pressures for the forthcoming year.

6. ANNUAL AUDIT MANAGEMENT LETTER

Neil Thomas, external Audit Manager from KPMG, presented the Annual Audit letter. He highlighted the role of the external auditors in assessing:  use of resources,  financial accounts.

In relation to use of resources he highlighted as positive aspects:  the transition to foundation trust status,  the implementation of a new EPR patient information system and financial ledger system,  investment in systems to support data quality, and  the organisational and financial governance arrangements.

He did however comment on some challenges:

o realising the full potential of the new systems, o budgets risks and management, and o momentum on the National Workforce agenda.

In relation to the finances and accounts he reported that this audit had been completed on time. Some adjustments had been needed however, this was not unusual in any audit.

He highlighted the key issues to consider for the future as:  maintaining financial balance,  ensuring maintenance of liquidity,  responding to Monitor guidance and  responding to the challenging accounts timetable.

He highlighted the workplan for year 2005/6, including the audit plan, the national benchmarking work for the Healthcare Commission, a programme of Benefits Realisation with regard to new IT systems, new workforce contracts, and financial position.

Members posed the following questions to Mr Thomas and Mr Walsh:

Q: What was the level of expenditure on Human Resources? A: Approximately 70% of the budget is spent on Human Resources. Q: Does the Trust has concerns about the National Tariff? A: This is a new system implemented nationally, costs must remain below the

National Tariff, and the Trust’s costs are overall within the tariff. Therefore the Trust has enough funding to meet its targets in this and next year, although cost pressures cannot be disregarded.

Q: How is the level of liquidity? A: The Trust has a healthy cash balance.

Q: What are reserves? A: Reserves are contingencies in revenue which it had not been necessary to use within 2004/5.

Q: Why is foundation trust status better? A: It gives the hospital the ability to borrow money in order to develop new services. This is new and is a distinct advantage as is the development of members and the ability to have a membership actively involved in decision- making. Also, the Trust has more control of itself and its decisions through the governors.

Q: Does the Trust get income from private patients? A: The Trust has little income from private patients, the amounts specified within the annual report are for paying patients rather than private patients, ie those patients not eligible for NHS treatment.

Q: How is the borrowed money paid back? A: This type of loan is repaid over several years out of the income that the Trust has each year.

8. CHIEF EXECUTIVE‘S REPORT

Nancy Hallett, Chief Executive addressed the members. She presented the Annual Report and highlighted the extent of the work undertaken by the hospital on the Homerton site, at Mary Seacole nursing home, and within the community of Hackney and the City.

She highlighted the following areas:

 the work of the staff  the 24 hour nature of the organisation  the changes to information technology and implementation of the EPR system  the number of patients seen as in-patients, out-patients and A&E attendances  the number of babies born at the Homerton and  the 3 star performance rating of the Trust for the fourth successive year.

In relation to technological developments, Ms Hallett highlighted the opening of the new Centre for Laproscopic surgery as one example of state-of-the-art technology and medical care undertaken at the hospital. Looking to the future, she reported on the building works and capital plans for the hospital.

`She highlighted the challenges and changes for the forthcoming year as:

 finance and efficiency  Healthcare Commission standards  NHS changes, and  Preparation for the 2012 London Olympics

Ms Hallett took the following questions:

Q: What is the Trust doing regarding car parking on site and locally around the hospital? A: The Trust has little flexibility in car parking due to the land locked nature of the hospital site. However, the Trust is working actively with the local authority transport plans and a new configuration of the front driveway of the hospital should increase safety for pedestrians, create a one way system for traffic, improve bicycle parking and provide extra seating. The hospital is working closely with the local authority on an integrated travel plan.

Q: Are services still contracted-out? A: The catering, domestic, and portering services were recently tendered and the catering and domestic services remain contacted out services. The terms and conditions for contracted out staff were negotiated to be in line with directly employed staff. The Trust had worked closely with North East London Strategic Health Authority (NELSHA) on developing this.

Q: What is the difference between an NHS Trust and a Foundation Trust? A: The hospital as a foundation trust still remains fully part of the NHS. The benefits of being a foundation trust were given in a previous reply.

Q: Why had some patients experienced difficulties with the IT system and appointment booking? A: A new EPR record system had been implemented last September and had involved the transfer of all patient records to a new electronic system. This had caused some problems initially in relation to patients receiving appointments and it was regretted that this had happened.

Q: What is the hospital going to do about payment tariff if this National Tariff was not working? A: Miss Hallett reported that she and her colleagues in other foundation Trusts agreed that the National Tariff was sensible as the hospitals were now paid for the activity they performed.

Q: Does the hospital still have mixed sex wards? A: The wards at the Homerton are divided into bays and there are no mixed sexes within these bays. All bays are segregated and bathrooms on wards are distinctly male or female. The receiving ward still remains a mixed sex ward although wherever possible sexes were not mixed within bay areas.

Q: Do patients wait less time and is treatment better? A: Yes to both parts of the question, patients are waiting shorter times and the treatment and the facilities continue to approve.

Q: Are there initiatives for employment for local people? A: The Trust is the second biggest employer in Hackney. Examples of schemes designed for local people were given such as:  cadet nurses scheme,  Groundwork placements schemes for adults  Hackney schools mentoring scheme, and work experience placements.

Q: Will the Trust be doing anymore specialist services? A: The services that the hospital provides are increasingly relevant to the Hackney population. There will always be some specialist services which need to be provided in specialist centres and Hackney patients would be sent to these.

Q: How much choice is available when making hospital appointments, particularly with regard to different faiths? A: The Government had just implemented a new Choose and Book system whereby patients have more choice over the time of appointment and the hospital they wish to attend and therefore increase choice for the patient.

Q: What chaplaincy services does the hospital have? A: The hospital has a multi faith team of Chaplains working on a full-time, part- time and sessional basis.

Q: What will be the impact of the Olympics on waiting at the hospital? A: The Olympic games will have a health centre on site and therefore experience from previous Olympic games (i.e. Athens) suggests that the increase in patients at nearby hospitals is minimal. However, the opportunities for regeneration and transport remain paramount.

Several members commented on the successes of the hospital and offered their ongoing support.

9. MEMBERSHIP DEVELOPMENT REPORT

Mark Edwards, Governor and Chair of the Membership Development Committee presented the Membership Development Report. He highlighted the total number of members and commented on the increase of 38% in membership since April 2004 when the Trust became a foundation trust, set against a target figure of 25%. He compared the ethnic breakdown of membership to the Hackney Census data and commented on the Trust’s ability to plot membership to geographical area. He highlighted the usefulness of this as a means to focus on particular areas or communities for membership.

In terms of membership activity throughout the year, he reported on the following:

 Governors surgery  Members Forums  Members health awareness talks  Trust Open Day  Nurse training  Readers groups  Patient Environment Action Team (PEAT) visits  Involvement in patient and public involvement forum  Committee representation (PPI, Research and Development, Clinical Practice Ethics).

10. KEYNOTE SPEECH BY RICHARD LEWIS, RESEARCHER, KING’S FUND

Richard Lewis, from the King’s Fund outlined the research project he had undertaken with governors at Homerton over the previous 18 months. He reported that the project was to assess the development of new forms of democratic accountability and the influence that governors and members have over foundation trust decision making.

He highlighted the reasons that governors had stood for election - commenting on the opportunity to make a difference; dissatisfaction with public involvement mechanisms; and how governors, concerned about the notion of foundation trust status, felt that it would be better to be included.

He highlighted the national guidance and ongoing confusion over the role of the governor and the relationship between the governor and the Board, but commented that this confusion had abated at the Homerton though still remains to a lesser degree.

He commented on the governors’ perceptions of representing the community and working with the community and posed the question “Have governors made a difference?” In conclusion he reported:  a successful development of new structures,  low expectations among governors and directors in relation to tangible change in year 1,  national and local confusion over the role of the governor, although some consensus was emerging,  community engagement increased,  more clarity over longer term roles of governors and Board / Council relationships was needed, and lastly  Government rhetoric that governors should be ‘the voice of the community’ had not yet been achieved.

Mr Edwards and Mr Lewis took the following questions:

Q: Who paid for the research undertaken by the King’s Fund?

A: The King’s Fund is a charity and the research was paid for by the charity.

Q: Will there be copies of the report available? A: Copies will be forwarded to the Trust and will be available to members upon request.

Q: What other surveys of a similar nature have been carried out? A: Others have been done nationally, for example by the Healthcare Commission. However the King’s Fund survey was undertaken purely for and at Homerton.

11. RESULTS OF THE ELECTION TO THE COUNCIL OF GOVERNORS FROM SEPTEMBER 2005

Mr Windross reported on the results of the recent election to the Council of Governors, replacing three Public governors and one Staff governor. He reported that the following Public governors had been elected by the members:

Dr Michael Craft Katie Lloyd-Thomas Sarah Weiss

He reported that Tanya Reynolds had been appointed as Staff governor in an uncontested election.

12. ANY OTHER BUSINESS

Q: Are bicycles allowed in the hospital? Members have seen people taking them into the hospital on more than one occasion. A: The security team try to monitor and stop any persons trying to cycle inside the hospital.

Q: Why don’t the nurses where aprons and hats anymore? A: These accessories have been abandoned because of infection control considerations.

Q: Why have no ethnic minority been elected to the Board as non executive directors? A: Non executive directors have been appointed to the Board in the first year of foundation trust status. The appointments are now made by the Council of Governors and although active steps were taken to encourage ethnic minority uptake, the governors appointed the candidate with the best skills for the role. It was noted that there had been over 70 applicants for the post.

DATE OF THE NEXT MEETING: TO BE CONFIRMED

MEETING CLOSED.

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