PRESENT: Mrs S Asghar, Public Governor, Barrow and Copeland

Minutes of the Council of Governors meeting held on Monday 31 October 2011 at 10am, Banqueting Suite, Lancaster Town Hall.

PRESENT: Mrs S Asghar, Public Governor, Barrow and Copeland Mrs B Adams, Public Governor, South Lakes and Eden Professor P Brown, Public Governor, South Lakes and Eden. Councillor A Burns, Partner Governor, Cumbria County Council Mr G Davies, Staff Governor, Estates and Ancillary Councillor S Fishwick, Partner Governor, Lancashire County Council Mr John Goodacre, Partner Governor, Liverpool University Mrs S Granville, Staff Governor, Management and Admin Mrs K Halbert, Staff Governor, Nurses, Midwives and Operating Department Practitioners Mrs J Hamid, Public Governor, Lancaster, Craven and Wyre Mr S Hill, Public Governor, Barrow and Copeland Mr P Hodge, Public Governor, Lancaster, Craven and Wyre Mr M Holder, Partner Governor, NHS North Lancashire Mrs K Hyland, Staff Governor, AHPs Mr J Hunter, Public Governor, Lancaster, Craven and Wyre Professor E Kane, Chairman Mr J Kaye, Public Governor, South Lakes and Eden Mrs K Knipe, Public Governor, Lancaster, Craven and Wyre Mr G Ozuzu, Staff Governor, Medical and Dental Mr M Porter, Public Governor, Lancaster, Craven and Wyre Mrs M Radice, Public Governor, South Lakes and Eden Mr R Short, Public Governor, Barrow and Copeland Mr R Slack, Public Governor, South Lakes and Eden Mr I Soane, Partner Governor, Voluntary Sector, Cumbria Ms L Stafford, Public Governor, Lancaster, Craven and Wyre Mr J Wood, Public Governor, Lancaster, Craven and Wyre

IN ATTENDANCE: Mr T Bennett, Director of Finance and Information Mr P Dyer, Medical Director Mr T Halsall, Chief Executive Ms J Holt, Director of Nursing and Modernisation Mrs J Stanley, Head of Financial Services Miss R Whitaker, FT Membership Services Officer Mr R Wilson, Director of Human Resources and Organisational Development Mr S Vaughan, Director of Operations and Performance Mrs C Alexander, Head of Clinical Services

1. APOLOGIES FOR ABSENCE Apologies for absence received from Dr D Earnshaw, Public Governor, South Lakes and Eden, Mr P Clarke, Partner Governor, NHS Cumbria, Mr Graeme Nicholson, Staff Governor, Nursing, Midwifery and AHPs, Mr P McGahon, Director of Service and Commercial Development

2. ELIGIBILITY TO VOTE DECLARATION 1 All elected Governors present had confirmed their eligibility to vote.

3. MINUTES OF THE MEETING HELD ON 26 JULY 2011 Cllr Fishwick raised a question regarding the potential threats and risks involved of opting out of the North Cumbria acquisition process. Mr Halsall informed Cllr Fishwick that although there would have been a number of benefits for the Trust moving to a larger organisation, work will now be undertaken to review the effect of no longer being part of the acquisition process.

Following Mr Halsall’s response, Mr Soane suggested the voluntary sector become involved as part of the review to be undertaken.

4. MATTERS ARISING Mr Kaye raised an issue regarding item 11.1 of the 26 July minutes, which relate to procedures for handling issues related to patient care. Mr Kaye was concerned this item should not have been put before the full council as approval was not sought from the Patient Experience sub group. Mr Kaye mentioned that Mrs Wright had subsequently informed him by e-mail that she had decided to put the issue before the full council which was against his judgement as Chair of the Patient Experience sub group.

Ms Holt commented that this particular system was put in place for patients to raise concerns via the Governors and if it is feel the current system needs to be reviewed, then it should be done.

With regards to item 11.7 of the 26 July minutes, Mr Ozuzu suggested a sub group be established including people with a suitable finance background that would further advise the full Council on matters, including the annual accounts. Professor Kane agreed this could be explored as a possibility.

Mr Ozuzu asked if this could progress and Professor Kane suggested those interested contact Mr Bennett who would facilitate the group.

5. CHAIRS ITEMS a) North Cumbria acquisition process update Professor Kane confirmed there had been no announcements regarding the next part of the acquisition process. b) Constitution Professor Kane confirmed Monitors approval to widen the boundaries and informed the Governors the revised constitution is available via the Governors portal and on Monitors website. c) Council of Governors Nominations Committee Professor Kane mentioned there is a vacancy on the Nominations Committee, due to Mr Boddy not being re-elected. Professor Kane proposed to await the outcome of the lead governor process and agree a way forward after that.

Mr Ozuzu commented that he felt one year was too short for the Lead Governor position and Cllr Burns agreed that the lead Governor would just be feeling comfortable with the role after one year.

Professor Kane agreed to speak to Mrs Rowan and ask her to refer to the constitution regarding extending the time period for a lead Governor.

2 d) Company Secretary As per constitutional requirement, Professor Kane confirmed that Emma Wright, Company Secretary has now left the Trust. Day to day Governor queries will be dealt with by Mr Woodford and Miss Whitaker and Company Secretary issues will go through Mrs Rowan. e) Notice of Annual Members Meeting Professor Kane formally recorded that the Council of Governors received notification about the annual members meeting on 28 September 2011. f) Council of Governors elections Professor Kane confirmed the outcome of the election process was distributed to the Council of Governors on 16 September 2011. g) NED appointment Professor Kane formally recorded that relevant declarations relating to the reappointment to Mr Smith and Dr Greenwell had been forwarded to the Governors outside the meeting cycle on 26 September 2011.

6. CURRENT ISSUES/GOVERNOR ISSUES Chief Executive’s presentation Mr Halsall’s presentation covered a number of current issues including an update on the recent CQC report relating to maternity services. Mr Halsall informed the Governors that it is important to remember the CQC have not said the Trusts Maternity units are not safe. He confirmed the Trust has been working with the CQC and are on target to achieve compliance by the CQCs deadline of 21 November 2011.

Mr Halsall mentioned that Monitor are due to undertake a diagnostic review and this will form part of a process used to strengthen risk management and find solutions to any issues. In relation to problems with Outpatients, Mr Halsall confirmed that additional clinics have been put in place and extra staff are being used to review any cases that are required and used to work through a backlog of patients.

In relation to mortality rates, Mr Halsall informed the Governors that the Dr Foster report has not yet been published however the Trust has not seen an increase in deaths since last year. He informed the Governors that the Trusts death rates are reported on each month as part of the Board reports. He confirmed that the Medical Director was correct to be in consultation with clinicians regarding Dr Foster and mentioned that there are issues regarding data collection.

Cllr Fishwick raised a number of queries following Mr Halsalls presentation including the issue raised around culture. Mr Halsall confirmed that the CQC criticised interaction between medics and midwives and improvements are now being made to strengthen work between clinical groups. Mr Halsall also mentioned there is now an Outpatients steering group in place to look at the way in which Outpatient appointments are booked and staff are working with the local health community to investigate what has gone wrong.

Mr Soane mentioned that there are a number of governance issues and questions that need to be asked regarding the way strategies are implemented. Mr Soane suggested a group should be formalised to improve interaction and involvement and help with the operational versus strategic discussions.

3 Mr Wood mentioned this is something all Governors would like to be a part of and suggested an away day may be beneficial. Mr Kaye mentioned the meeting agendas are to packed and there is often too much to discuss for only four to five meetings a year.

Cllr Burns asked Mr Halsall if the Trust feeds back to a local authority safeguarding board. Mr Halsall confirmed that there is an active process in place and mentioned that an agreement has been reached with NHS Cumbria and NHS North Lancashire to review safeguarding.

In relation to Mr Kaye’s comments about full agendas, Mr Halsall mentioned that he welcomed comments and thoughts on how to continue to build relationships and suggested more informal meetings may be beneficial.

Mrs Adams mentioned that the Trust Board need to find a mechanism when it comes to governance and queried if Monitors Quality Governance framework is used. Professor Kane mentioned that the Trust went through Monitors quality assessment process prior to becoming a Foundation trust and a review of systems and governance was undertaken and received positive reports. Professor Kane agreed with Mrs Adams that a mechanism to keep this under constant review is a good idea and any suggestions the Governors may have can be brought forward. He suggested that to ensure everyone gets the chance to input, Governors should contact Mr Woodford with their suggestions.

Mr Kaye commented that people have been making mistakes for years and he felt it is the Governors responsibility to look into the way in which the Board have been and are currently running the Trust. Mr Kaye mentioned that he did not want to get involved in management issues however he felt the Governors need to be more involved.

Professor Goodacre suggested it would be beneficial to draw on the experience of external partners to improve things such as staff development.

Mr Ozuzu mentioned that the Council of Governors have a duty to ensure there is a strong Board to Board and due to the collective nature of the challenge he mentioned that a Non-Executive Director with a Medical background would be beneficial.

Mr Slack raised his concerns regarding medical records and mentioned that this is an issue he has been raising for two years. Mr Slack asked for an update regarding Mr Flynn’s report.

Mr Halsall mentioned that the Governors were provided with an update regarding Mr Flyn’s report at the last Governors meeting and explained that a steering group has now been in place for 8 months and includes GPs and clinicians. He mentioned that new Clinical hubs are working well and work is being undertaken not only do deal with the backlog but to turn the system around.

Mrs Alexander, Head of Clinical Services, gave the Governors a more detailed overview and explained that the Trust makes approximately 1000 appointments per day and stores approximately 1 million records. Mrs Alexander said that they are using patient perspective along with the findings from Mr Flyn’s report as a way to redesign the outpatient system moving forward.

Mr Slack queried if a tracer system was in place for the patient records and Mrs Alexander confirmed that there was. She explained that capacity is a big issue and notes are stored across the organisation. She mentioned that work is being undertaken to

4 support staff and review competencies and in the longer term an electronic document management system is being looked into.

Mr Ozuzu mentioned that he is familiar with the problems and mentioned that he was aware there was a business case on-going regarding the scanning of patient records.

Mrs Alexander explained that she has visited other Trusts who have been doing this, the business case has been revisited and her team plans to use the best points learnt from other organisations.

7. PERFORMANCE REPORTS Mr Bennett and Mr Vaughan presented the report and Mr Bennett explained that the Trusts financial risk rating remains at three, non-elective activity was lower than planned, but a better than planned elective and day case activity partly offset the shortfall. He confirmed that the Trust is anticipating delivering its activity plan in full by the end of the financial year. Mr Holder queried if the financial impact of the Outpatient review is yet apparent. Mr Bennett confirmed that this is still being worked through.

Mr Vaughan explained that activity targets in quarter two were achieved in all areas bar one. He mentioned that performance for October was back on track and the overall governance risk rating was red due to the CQC findings.

Ms Holt mentioned that following the CQC visit, concerns relating to nutrition, staffing levels and complaints have now been actioned. She explained that a protected mealtime policy is now in place across all three sites.

Mrs Radice queried if staff are competent to assist with protected meal times and Ms Holt explained that staff have undertaken additional diet training and lessons have been learned from other Trusts nationally.

8. LEAD GOVERNOR REPORT AND COUNCIL OF GOVERNORS REVIEW Ms Stafford presented her report which included an update regarding Monitors concerns. Ms Stafford mentioned that the Monitor team has requested to meet with a Governor when they are next at the Trust.

Ms Stafford mentioned that a review of the membership strategy and sub groups was to be undertaken.

A discussion took place in which an agreement was made that Governors would be consulted on how to undertake a review of Governor roles and sub groups.

The Governors noted the content of the report and agreed to the Governors review.

9. ANNUAL REPORTS OF COUNCIL OF GOVERNOR SUB GROUPS The Governors received and noted the content of the sub group reports.

10. LEAD GOVERNOR ROLE

5 The Governors received information about the lead Governor role and were asked to submit their expressions of interest by 5pm on Thursday 10 November 2011. A closed ballot process will then be held between 11 and 18 November, the outcome of which will be announced on Monday 21 November 2011.

Mr Soane thanked Ms Stafford for her work as Lead Governor.

11. GOVERNOR EXPENSES POLICY AND ANNUAL REVIEW The Governors received the expenses policy which sets out the guidelines under which Governors and prospective Governors may be reimbursed for legitimate expenses incurred in the course of their duties as a Governor.

The Governors reviewed the document.

12. STANDING ORDERS FOR THE COUNCIL OF GOVERNORS Mrs Stanley presented the standing orders and explained that they form part of the Trust’s Corporate Governance Manual along with Standing Orders for the Board of Directors, Standing Financial Instructions, Codes of Conduct and the Treasury Management policy. Mrs Stanley mentioned that the standing orders are a statutory requirement that were decided at the Governors inaugural meeting.

The Governors noted the content of the report.

13. FOR INFORMATION a) Register of members of the Council of Governors b) Council of Governors declaration of interest post election process c) Minutes of the Trust Board meeting 20 July 2011 d) Minutes of the Council of Governor Patient Experience group meeting 2 September 2011 e) Minutes of the Council of Governors FT Membership and Communications group meeting 9 September 2011 f) Minutes of the Strategy group meeting 13 September 2011 g) Draft schedule of Council of Governor meetings 2012/12

14. MOTIONS OR QUESTIONS ON NOTICE None received.

15. URGENT MOTIONS OR QUESTIONS None received.

16. DATE & TIME OF NEXT MEETING 2 February 2012, 10am, Forum 28, Barrow-in-Furness

17. EXCLUSION OF THE PRESS AND MEMBERS OF THE PUBLIC