North Bristol NHS Trust Trust Board Meeting in Public Thursday 31 March 2016 12.30pm, Seminar Room 5, Learning and Research Centre, Southmead Hospital Agenda 1. Apologies and Declarations of Interest: Harry Hayer, Catherine Phillips 2. Questions from Members of the Public 3. Minutes of the Trust Board meeting held on 28 January 2016 Enc 4. Action Log AY/Enc 5. Chairman’s Business PR/Verbal 6. Chief Executive’s Report AY/Enc Quality & Performance 7. Patient Story SJ/Verbal 8. Board Member Walkround Programme SJ/Enc 9. Monthly Integrated Performance Report AY/Execs/Enc 10. Equality Annual Report 2014/15 PJ/Enc 11. National Staff Survey PJ/Enc Strategy and Development 12. Trust Strategy 2016/17 – 2020/21 CB/Enc 13. Cellular Pathology Service Transfer CB/Enc 14. Capital Planning Update SW/Enc Governance & Regulation 15. Partnership Programme Board and Agreement AY/Enc 16. Workforce Committee Terms of Reference PJ/Enc 17. Annual Declaration of Interests Review PR/Enc 18. Cycle of Business 2016/17 PR/Enc 19. Trust Management Team Report AY/Enc 20. Finance & Performance Committee Report AW/Verbal 21. Charitable Funds Committee KG/Enc 22. Quality & Risk Management Committee Report RM/Enc 23. Remuneration and Nominations Committee AW/Enc 24. Any Other Business 25. Date of Next Meeting Thursday 2 June 2016, 12.30pm, Learning and Research Centre, Southmead Hospital. North Bristol NHS Trust Minutes of the Trust Board Meeting held in public on 28 January 2016 in Seminar Room 4, Learning and Research Building, Southmead Hospital Present: Mr P Rilett Chairman Ms A Young Chief Executive Mr J Everitt Non-Executive Director Dr C Burton Medical Director Mr K Guy Non-Executive Director Mr N Darvill Director of Informatics Mr R Mould Non-Executive Director Ms K Hannam Director of Operations Ms E Redfern Non-Executive Director Mr P Jones Interim Director of People and Organisation Health Mr A Willis Non-Executive Director Mrs S Jones Director of Nursing Mrs C Phillips Director of Finance Mr S Wood Director of Facilities In Attendance: Dr M Baird Deputy Medical Mr E Sanders Trust Secretary Director Ms S Cownie Alcohol Nurse Mr N Stibbs Corporate Services Specialist (until item Manager 01/04 Mrs C Lang Acting Head of Dr T Valliani Consultant Marketing and Gastroenterologist (until Communications item 01/04) Mr R Quinn Alcohol Nurse Specialist (until item 01/04) Observers: Mr Colin Puckett, Staffside Chairman Action TB/16/01/01 Apologies and Declarations of Interest Apologies were received from Prof Nishan Canagarajah, Non-Executive Director and Mr Harry Hayer, Director of People and Organisation Health No interests were declared in the papers presented. TB/16/01/02 Questions from Members of the Public There were no questions from the public. TB/16/01/03 Patient Story Sue Jones, Director of Nursing, introduced to the Board, Dr Talal Valliani, consultant gastroenterologist, Ms Sally Cownie and Mr Ryan Quinn, alcohol specialist nurses. Mr Quinn’s post was funded by the Bristol and South Gloucestershire Councils. Ms Cownie, reported that a 48 year old man presented himself to the Emergency Department and was admitted a week before Christmas, 1 | Page vomiting blood. He had presented on a number of other occasions and endoscopy had identified varices. He had previously not engaged in any therapy or treatment and professed to staff that he would probably discharge himself. He was seen on the ward by the specialist staff with his partner of long standing and was provided with a clear explanation, in understandable language, of his long term health, what he could do and withdrawal symptoms. This had been easier to do by being in a single room. A view of what could happen in six months if he stayed as an inpatient for a while and what might happen if he continued to drink was explained. He stayed in hospital that weekend and complied with all the nursing guidance with positive help from his partner. He had been seen that day and appeared to be relaxed. He had engaged well with services outside the hospital and was getting support. Knowledge that additional help was available over the phone was helpful and she had been able to link him with a dietician. Sue Jones said that alcohol dependent patients could be very disruptive and be inpatients for long periods and Dr Valliani said that the Trust was lucky to have the expertise of Sally and Ryan. CQUIN funding had been helpful in providing the service and the Trust’s liver clinic was working with primary care and focussing on earlier identification of issues. Liz Redfern, Non-Executive Director, questioned the long term benefits for the patient and Dr Valliani said that he was quite young and if he remained compliant would be a potential recipient for a liver transplant. Robert Mould, Non-Executive Director asked about links with other organisations and Sally Cownie said that she and Ryan bridged the hospital service with community services and arranged packages of care to fit the individual depending on physical, psychological and fitness attributes. Dr Valliani said that he would like to offer screening for alcohol in endoscopy and outpatients. Andrew Willis, Non-Executive Director, questioned whether the Trust was looking at cases or models that looked at the whole pathway and was advised that South Gloucestershire CCG was investigating the latter aspect. The Board thanked the three clinicians for presenting the patient story. TB/16/01/04 Minutes of the Trust Board meeting held on 26 November 2015 The minutes were approved as a true and correct record of the meeting. TB/16/01/05 Action Log The Trust Board approved the closure of actions as noted on the action log and noted progress as follows: Action 25 – a risk summit was being held the following day and the action was considered closed. Andrew Willis questioned how the Board could improve its links with CCGs and it was agreed to discuss this after the summit. Actions 57 and 58 – To be considered at the March 2016 meeting. 2 | Page Action 11 – To be considered at the March 2016 meeting. Action 23 – ongoing action Action 24 – will be reported through Workforce Committee and, therefore, the Board agreed to close the action. PJ Action 28 – The Board agreed that this should be reported through Quality and Risk Management Committee (Q&RMC). TB/16/01/06 Chairman’s Report Peter Rilett reported that he had no issues to discuss other than those on the agenda. TB/16/01/07 Chief Executive’s Report Andrea Young, Chief Executive, presented her report on the external environment impacting on the Trust. She highlighted the recognition of the Trust’s catering department as a national leader in hospital and staff food, for its Soil Association Food for Life catering mark (for patients) and Bronze mark for staff. In addition there were a considerable number of events and actions being undertaken for staff health and well-being. The Board noted the report and the appointment of five new consultants. TB/16/01/08 Emergency Department CQC Inspection Report Sue Jones presented the report from the Care Quality Commission from its visit to the Emergency Department on 27 November 2015. It confirmed that a number of improvements had been made since the hospital’s inspection in 2014, in particular that the Warning Notice conditions had been fully met. Eric Sanders, Trust Secretary, noted that South Gloucestershire Council had been pleased to view the report and the Board agreed that the action plan should be considered by the Q&RMC. RM TB/16/01/09 Integrated Performance Report Andrea Young presented the Integrated Performance Report (IPR) with data to the end of December 2015. She highlighted the failure in December to achieve the A&E four hour target with bed pressures remaining the main source of breaches and some impact from the switch of patient administration systems. Waiting times for minor injuries had been included in a small number of breaches and many actions had been put in place. Much escalation capacity in the hospital was being utilised. The Trust’s performance to reduce over 18 week waiters was better than projected and it was expected that six out of the eight cancer targets would be achieved. The Trust’s ‘’harm free’ rate was above the national average and there had been no grade 4 pressure ulcers in the year and no grade 3’s since September 2015. There had, however, been some mixed sex breaches as a consequence of using escalation capacity. 54 new staff had joined the Trust and 41 offers had been made to nurses following an open day in January. On finance the Trust was £16 million adverse to plan mainly 3 | Page due to lower than planned income and pay overspends. Kate Hannam, Director of Operations, said that the source of breaches in ED was roughly split 75/25 bed pressures/PAS switch. Four internal critical incidents had been called and black escalation covered most of January. 33 extra beds were open every day but evidence showed that quality had been unaffected. Andrew Willis said that it appeared that the performance of ED had stabilised but was not improving and Kate Hannam said that a trajectory had been agreed to achieve 95% by July, with February and March unlikely to show great improvements. Breaches were now happening in the morning instead of the evening and the discharge lounge was being opened at 08:00 each day. Liz Redfern questioned whether there had been progress on the Discharge to Assess (D2A) project and Kate Hannam reported that for South Gloucestershire patients Sirona was delivering the Pathway 1 target but a 75% increase in productivity for Pathway 2 patients was required.