MINUTES OF THE THIRTY FIRST MEETING OF THE COUNCIL OF GOVERNORS OF PORTSMOUTH HOSPITALS NHS TRUST
Held on Friday 28 September 2012 – 09:30am to 12:30pm
Lecture Theatre, Education Centre, Queen Alexandra Hospital, Cosham, Portsmouth, PO6 3LY
PRESENT:
David Rhind (Chair)
Public – Fareham & Gosport: Public – Portsmouth City: Richard Mackay Dr Isabel Pine David Gattrell Sarah Edmonds Mary Sheppard Syd Rapson
Public – Havant & East Hampshire: Staff: Kate Bowskill Nicholas Courtneidge Jocelyn Wace
Appointed Governors: Patient/Carer: Norman Robson – West Sussex Dr Robin Marsh Stephen Arkle – University of Portsmouth Pepe Chisenga Jackie Powell – Portsmouth City CCG Cllr Gwen Blackett – Havant Borough Council Cllr Will Purvis – Portsmouth City Council
IN ATTENDANCE:
Peter Mellor – Company Secretary Michelle Marriner (Minutes) Dr Mark Roland – for agenda item Dr Ian Cairns – for agenda item
APOLOGIES:
Ursula Ward – Chief Executive Surg Cdre Andrew Hughes – Ministry of Defence Jocelyn Booth – Havant & East Hampshire Roland Howes – Havant & East Hampshire Cllr Peter Edgar – Hampshire County Council Les Jones - Staff Lucy Docherty - Fareham & Gosport
1 45/12 APOLOGIES
The Company Secretary announced those apologies that had been received in advance of the meeting.
Pepe Chisenga, Jos Wace & Gwen Blackett all advised that they would need to leave the meeting early.
DECLARATION OF ANY CONFLICT OF INTERESTS
Syd Rapson declared that his son was an employee of Carillion Services Limited.
46/12 MINUTES OF THE PREVIOUS MEETING
The minutes were approved as a true and accurate record of the meeting, although Jos Wace felt that there was a lack of clarity regarding certain issues: Discussion around the removal of the cost of living allowance Concerns raised about 5% wage cuts Concerns around staff redundancies
The Director of Strategy had stated at the last meeting that the Cost Improvement Plan (CIP) was on track. Jos Wace thought this not to be the case. He was concerned that the level of openness shown to the Council of Governors was less than that to the Trust Board. He also asked for some explanation regarding the sudden departure of the Director of Finance amidst the Trusts current financial crisis. He said that there were lots of rumours around the organisation regarding the reason for his departure.
The Chairman advised that the Trust was currently experiencing some significant financial problems which were a significant challenge to the organisation. He admitted that the CIP’s had not progressed as well as had been expected.
He advised that with regards to the Director of Finance, it had been his personal decision to leave the Trust. Whilst here, he commuted each week from Yorkshire and this had a significant impact on his family. He had therefore taken the decision to move back closer to home. Jos Wace said that there were rumours outside of the Trust that he had resigned as a consequence of mistakes that he had made. Jos Wace said that the reason he had raised the issue was due to a level of uncertainty amongst the staff. He thanked the Chairman and Company Secretary for clarifying the situation.
The Company Secretary confirmed that the discussion about the removal of cost of living allowance and 5% wage cuts, although not explicit, was summarised on page 6 of the minutes.
47/12 MATTERS ARISING
ACTION GRID
The Company Secretary advised that he had been reassured that the signs within the north car park had been erected. He said that he would need to check that they were clear and easy to understand.
48/12 CHAIR’S REPORT
The Chairman advised that as part of the Foundation Trust (FT) Process, the Board had recently been assessed by a number of external companies: KPMG had conducted interviews with each Board member regarding the Board Governance Assurance Framework (BGAF).
2 PWC had conducted their Historical Due Diligence during September. RSM Tenon had conducted a Quality Governance Review during September
Each company had recently submitted their reports. The findings within the report were not a surprise and matched the findings of our own self assessments. Actions plans have been developed based on the recommendations within the reports. For example, a point was raised about the Board committee structure. Therefore a review has been undertaken and appropriate changes made.
Pepe Chisenga asked if the report from the staff focus group could be shared with those Governors who had taken part. The Company Secretary advised that the report was to be sent to the Strategic Health Authority (SHA) from KPMG and felt that it would not be appropriate to share in full. He confirmed that parts of the report would be shared publicly. The Chairman committed to creating a short summary of the report for those Governors who were involved. Action: Chairman
Stephen Arkle asked if there were any consistent themes in the feedback on committee structures. The Company Secretary said that reviews had suggested that the Governance & Quality Committee should be a committee of the Trust Board. All of the committees will be reviewed, including the membership of them.
Norman Robson felt that sometimes it was easy not to recognise the good things happening within the organisation for example the recent television programme which had highlighted the issues with alcoholism and the impact on the organisation. The Chairman agreed.
David Gattrell enquired whether there was any opportunity to gain more business overseas. The Chairman said that we had a clear business plan but the focus would be on issues which could be resolved locally. Our primary focus is to provide an excellent service to the local 650,000 population.
Syd Rapson said that the Government had announced 30 Trusts who might be taken over by a private company. He sought reassurance that the Council of Governors would be informed should something similar occur locally. The Chairman confirmed that PHT was absolutely not one of those Trusts under threat and promised that the Council of Governors would be immediately informed if that position was to change.
49/12 DIRECTOR/GOVERNOR INTERACTION IN NHS FOUNDATION TRUSTS
The Company Secretary delivered the following presentation:
The Role of Governors in NHS Foundation Trusts.ppt
Richard Mackay asked whether the ‘private’ Trust Board agenda would be shared with the Council of Governors. The Company Secretary said that it would require some careful consideration and would depend on the content of the agenda. Pepe Chisenga said that if the Council of Governors was responsible for the management of the Non Executive Directors, how they could do so if they were not able to attend the private meeting. The Company Secretary agreed that it was not ideal but the Council of Governors would have many other opportunities to monitor the performance of the Non Executive Directors.
50/12 END OF LIFE CARE
Dr Mark Roland and Dr Ian Cairns were in attendance for this item. Dr Roland advised
3 that Dr Cairns was new in post and had previously worked as the Medical Director for a Hospice on the Isle of Wight.
He provided some background information regarding the medicine for older people End of Life Care support team. He explained that they receive approximately 90 new referrals per month. A Liverpool Care of the Dying Pathway (LCDP) facilitator had taken up post in early 2012 and was working to improve education throughout the Trust to encourage the uptake of the LCDP on all of our adult inpatient wards.
He advised that in the current financial year, 52% of adult ward deaths had occurred on the LCDP, which was much better than the national average of 26%.
He explained about the Locality Support register where GP’s, Community Nurses and hospitals could register patients who were due to die in the next 3 months and register their preference of where they would like to die. He advised that there was a system being rolled out during November to compile all of the data into one central list.
He advised that Portsmouth Hospitals NHS Trust and Southern Health had piloted a project for fast track discharge for patients who wished to go home to die. He said that project was extremely successful and that they would be going to NHS Hampshire on 11 October to seek support to continue with the pilot.
Syd Rapson asked whether the End of Life Care Support Group report would be available shortly. Dr Roland advised that the final draft of the report was almost complete. It would be shared with the Chief Executive in the coming weeks.
Syd Rapson reminded that the support group had been established in response to the protests against closing G5. He asked for reassurance that the end of life care provided within the hospital was as good as that provided when in G5. Dr Roland confirmed that the care provided was equally as good as it was in G5. He said it would be difficult to measure whether it was ‘better’ care as it was a different type of care. There had been a reduction in the number of complaints received. A review of feedback from families had been conducted and the report was very positive. Dr Cairns said that due to the nature of the business, people will always die in hospital; therefore it is vital that the care provided is of the highest quality.
Kate Bowskill asked where the funding came from. Dr Cairns advised that the core funding was received from Southern Health but the staff were PHT employees. He explained that 40% of his post was funded by the Rowans Hospice as he participates in their out of hours rota.
Robin Marsh asked whether there was a specific End of Life Care team. Dr Cairns said that there was although their role was unclear. Should they provide a one to one service with the patient or should they be supporting the wards in doing so. Robin Marsh asked why there was no end of life care support on wards F5, F6 or F7. Dr Cairns explained that the team do go to those wards. Moving forward, there is a clear need for equality across the hospital.
Robin Marsh asked who decides that the patient is going to die. Dr Cairns said nobody decided that they would die but that it was about assessing the patient’s health status.
Cllr Will Purvis said engaging with the families was an important part of end of life care. Dr Cairns agreed. He said that talking and consulting with families was crucial.
51/12 FEEDBACK FROM TRUST ADVISORY GROUPS
Planning and Performance TAG
4 Richard Mackay advised that the Planning & Performance TAG had recently met and that the following subject had been discussed: Private Patient Unit
The group had considered the answers to their questions regarding the Integrated Performance Report and would like to emphasise the following points to the Full Council of Governors: Capital expenditure – lack of planning or inability to stick to plan Workforce – lack of management of process
The Chairman offered to provide a brief summary explaining the process and rationale of the Capital expenditure process. Action: Chairman
The Chairman did not agree that there had been a management failure regarding workforce. He explained that a number of changes had been implemented on top of the existing plan. Richard Mackay agreed that there had been some changes but felt that the Integrated Performance Report needed to be clearer in detailing that. The Chairman felt that it would be useful to share the process of reviews/decision making with the Council of Governors. Action: Chairman
Best People and Care TAG
Richard Mackay presented in Lucy Docherty’s absence.
He advised that a small group of Governors from the Best People & Care TAG had visited 3 outpatient reception areas over the past year to obtain views of both patients and staff on the service and facilities provided. There were a number of consistent themes which had arisen from those visits: Doctors arriving late for the start of clinics. There seemed to be a lack of management of the issue. Lack of information on delays within clinics Signage Patient flow – some days were busier than other. Suggestion that clinics should be scheduled to ensure even flow of patients throughout the week.
The Chairman advised that the issue of Doctors arriving late for the start of clinics would be raised at the next Trust Board meeting. Action: Chairman
The Company Secretary advised that he and the Chairman had recently seen a presentation of a few shortlisted companies who had been selected to possibly provide the self check in system across the Trust. He advised that the system was very intelligent and would resolve some of the issues. It would also provide analysis including what time the Doctor had arrived for the start of each clinic.
Richard Mackay advised that the Best People & Care had also discussed the following topics: Complaints – the definition of complaints and plaudits seemed to be contradictory and inconsistently applied across the Hospital. Reported numbers for the same period were not the same in different reports. Strategic aims – The Strategic Aim ‘To be in the top 20% quartile’ was discussed. The explanation of how it was being measured seemed confusing.
The Company Secretary advised that the Director of Strategy would be attending the next Planning & Performance TAG to explain how we measure against that Strategic Aim. 5 Best Hospital TAG
Mary Sheppard advised that the Best Hospital TAG had recently met and that the following subjects had been discussed: Patient letters – By the end of October, all of the new standard patient letters would be rolled out across the Trust with the exception of Dermatology, Oncology and Gynaecology. Pharmacy
52/12 AGENDA ITEMS FOR NEXT MEETING
Norman Robson suggested an item on Finances. He felt that it might be useful to get a view of the Non Executive Directors. This would enable the Council of Governors to understand a set of principals on how to operate in the future. The Company Secretary advised that there was a joint Board/Governors meeting on 6 December which might be a useful opportunity to hold discussions on how the Council of Governors might hold the Non Executive Director’s to account.
The Chairman suggested an item on workforce resourcing and how decisions were made.
Richard Mackay suggested a discussion on the Trusts Hospital Standardised Mortality Rate (HSMR) which had recently increased. The Chairman explained that the reason the figure had changed was in part due to the change in methodology. He advised that the Medical Director was currently looking into this and would report to Trust Board with his findings. The Company Secretary advised that the Clinical Effectiveness Steering Group looked at this in detail on a monthly basis.
The Company Secretary suggested that Paul Morgan, Head of Fundraising could be invited to the next meeting to share his initial thoughts and plans. He explained that he was recently new in post.
53/12 ANY OTHER BUSINESS
Syd Rapson raised a concern about staff sitting in their uniform smoking on the road side in Cavell Drive. The public were nervous that germs and infection could be brought back into the hospital. He understood that it was outside of the hospital grounds and therefore the Trust might not be able to discipline them. The Company Secretary said that the Trust needed to accept that staff members would always smoke. He said that a possible solution which would need to be considered might be to provide a staff smoking shelter for them.
Jackie Powell advised the Council of Governors that Portsmouth CCG was progressing well in its process to become authorised as a CCG.
Kate Bowskill asked about the date and subject of the next round of public constituency meetings. The Company Secretary advised that dates would be agreed shortly. He suggested that the meetings be used to discuss the Foundation Trust application with members of the public. The Council of Governors agreed
The Company Secretary reminded the Council of Governors of the Trust Open Day on asked that the event be advertised as widely as possible.
There being no further business, the meeting closed at 12:40pm.
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