5.30-7.30pm, 13TH AUGUST 2014 IN THE EDUCATION CENTRE ... · To approve the revised Membership & Engagement Strategy ENC 9 – Ms D Myers, Membership & Communications Officer

CoG Aug 2014: 00_Agenda August 2014 (Govs)

GENERAL MEETING OF THE COUNCIL OF GOVERNORS OF BARNSLEY HOSPITAL NHS FOUNDATION TRUST

5.30-7.30pm, 13TH AUGUST 2014 IN THE EDUCATION CENTRE, BARNSLEY HOSPITAL

AGENDA Part 1: in public

1. Apologies & Welcome 2. To invite comments from members of the public 3. To receive any declaration of interests 4. To approve the Minutes of the Meeting held on 11th June 2014 ENC 4 5. To consider any matters arising from the Minutes of the last meeting 6. To receive and consider the External Auditor’s report on the ENC 6

Quality Account for 2013/14 and consider planning for 2014/15 – Mr James Findlay, PricewaterhouseCoopers

7. To receive an overview on Barnsley Hospital Support Services Limited (BHSS) Presentation – Mr Francis Patton, Chair, BHSS

8. To review and endorse latest report of the Nominations Committee ENC 8 9. To approve the revised Membership & Engagement Strategy ENC 9

– Ms D Myers, Membership & Communications Officer 10. To receive a report from the Trust’s Chairman, Mr S Wragg ENC 10 11. To receive a report from the Lead Governor, Mr J Unsworth ENC 11 12. To receive update report from the Trust’s Chief Executive, Ms D Wake ENC 12 13. To review and endorse the report of the Council of Governors’ sub-groups ENC 13

– Mr D Brannan (Strategy & Performance), Mr J Ramsey (Patients’ Experience), and Mr A Conway (Staff & Environment)

14. To receive and note reports from the Board of Directors ENC 14 – latest Board Agenda and Minutes (meetings held in public) – latest integrated monthly performance report

15. To consider issues raised by Governors: ENC 15 – Report from Ms Sanderson on Governwell – Response to question from Mr Kerr, regarding security of mobile devices

16. Any other business, including: – matters raised by the public – date of next meetings: Annual General & Public Members Meeting, 11th September (1pm) General Meeting, 8th October 2014 (5.30-7.30pm)

17. To resolve that representatives of the press and other members of the public be excluded from the final part of this meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest in accordance with 8.13.2 and 8.13.3 of the Trust’s Constitution.

Signed: ……………….….. Chairman

COUNCIL OF GOVERNORS – AUGUST 2014 REF: CG/14/08/04

04

MINUTES OF A GENERAL MEETING OF THE COUNCIL OF GOVERNORS

HELD ON 11TH JUNE 2014, 5.30PM IN THE EDUCATION CENTRE, BARNSLEY HOSPITAL

Present: Mr P Ardron Partner Governor, Sheffield Universities

Mr D Brannan Partner Governor, Voluntary Action Barnsley Mrs P Buttling Public Governor, Barnsley Public Constituency Mrs J Gaines Public Governor, Barnsley Public Constituency Mr A Grierson Public Governor, Barnsley Public Constituency Ms R Hewitt Staff Governor, Clinical Support Services Mr M Jackson Partner Governor, Joint Trade Unions Committee Mr W Kerr Public Governor, Barnsley Public Constituency Mr B F Leabeater Public Governor, Barnsley Public Constituency Mr P Lleshi Partner Governor, Barnsley Together Ms G Morritt Staff Governor, Nursing & Midwifery Mrs L Neasmith Partner Governor, Barnsley College Mrs J O’Brien Public Governor, Barnsley Public Constituency Mr R Raychaudhuri Staff Governor, Medical & Dental Mrs M Richardson Public Governor, Barnsley Public Constituency Mrs C Robb Public Governor, Barnsley Public Constituency Mrs L Sanderson Staff Governor, Nursing & Midwifery Mr T Smith Public Governor, Barnsley Public Constituency Mr H Spence Public Governor, Barnsley Public Constituency Mr D Sykes Public Governor, Barnsley Public Constituency Mr L Steenson Public Governor, Public Constituency O (out of area) Mr D Thomas Public Governor, Barnsley Public Constituency Mr J Unsworth Lead Governor & Public Governor, Constituency A Mr S Wragg Trust Chairman

In attendance: Ms C Dudley Secretary to the Board Mr R Kirton Director of Strategy & Business Development

Mrs H McNair Director of Nursing & Quality Mrs D Myers Membership & Communications Officer

Apologies: Mr A Conway Staff Governor, Volunteers

Mr A Dobell Public Governor, Barnsley Public Constituency Cllr J Platts Partner Governor, Barnsley MBC Mr J Ramsey Staff Governor, Non Clinical Support Staff

CG/14 34 APOLOGIES & WELCOME The Chairman welcomed Governors and Directors to the meeting. He also welcomed Ms Hewitt to her first meeting since being appointed as Staff Governor for Clinical Support Staff, and Ms Myers, attending to provide an update on membership matters.

Action

CoG Aug 2014:04_CoG June 2014 (pum) page 2 of 8

Apologies were noted as above. The Chairman reminded Governors that Mr Patton, Non Executive Director, had been scheduled to attend the meeting to report on the work and plans of Barnsley Hospital Support Services Limited. Unfortunately Mr Patton had had to submit apologies but would be attending in August.

CG/14 35 COMMENTS FROM THE PUBLIC Mrs Bevis reported on the escalator in outpatients, one side of which was not working; she had observed an elderly patient trying to go up the down escalator on his own. Several members of staff and the public had tried to assist the gentleman and no-one had been hurt, nevertheless the Chairman would pass on the report. He had reported similar incidents to Estates previously when facilities had been out of action and alternative arrangements had not been signed clearly enough. It was agreed that there needed to be better signage and guidance regarding the alternatives available for patients and visitors. Mrs Bevis was thanked for raising her concerns with the Governors.

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CG/14 36 DECLARATIONS OF INTEREST It was noted that the Lead Governor, Mr Unsworth, had been elected as Councillor for Penistone West Ward in the latest local elections. The Chairman confirmed that the Register of Interests had been amended accordingly. No other declarations were received.

CG/14 37 MINUTES OF LAST MEETING (Enc 4) The Minutes of the General Meeting held in public on 9th April 2014 were received and accepted as a true record.

CG/14 38 MATTERS ARISING • CG 14/24 – Quality Account

It was confirmed that the Governors’ response to the Trust’s Quality Account had been drafted, completed and submitted on behalf of the Council of Governors. The work had been led by the Strategy & Performance sub-group (agenda item 11 refers).

• CG 14/25 – Chairman’s report As requested at the last meeting, the Strategy & Performance sub-group had completed a review of the terms of reference for the sub-groups and the role of the Lead Governor. No significant changes were found to be required. Details had now been received for the first local Governwell training event, as set out in the Chairman’s report (agenda item 8). Anyone wishing to register for this training on 22nd July, should contact the Secretary to the Board.

• Policy on Governors’ Expenses Work on the requested policy was nearing completion Copies of the draft policy were available at the meeting or on request and comments from Governors would be welcomed before the final draft were due to be presented for the Board’s approval in July.

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CG/14 39 MEMBERSHIP – UPDATE REPORT (Enc 6) Mrs Myers expanded on her report on the work of the Membership Office since she was appointed in February 2014. The report had been reviewed previously with the Lead Governor and Deputy Lead Governor. It provided an overview of the Trust’s membership, summarised work to ensure public was representative of the people eligible for membership within the two public and six staff constituencies, and highlighted work progressed since February and ongoing work planned for July-September. The report identified a number of areas within the Barnsley Public Constituency that were currently under represented, including young people (aged 16-21), males, ethnic groups and some Barnsley wards. Mrs Myers highlighted some of the work proposed to address this, much of which would require support from Governors over the coming months. She thanked Governors for their support in recent events, such as Mrs O’Brien’s involvement with visits at the Sugar Cube Café on ward 19 and a local event held in her local community. At the latter, Mrs Myers and Mrs O’Brien had signed up over 25 new members. Mrs O’Brien affirmed that she had enjoyed being involved with both events and had greatly valued the engagement opportunity. Mrs Myers advised that she had started work to revise the Membership and Engagement Strategy, which she hoped to develop further in liaison with the Governors’ Strategy & Performance Sub-group. This approach was welcomed and agreed. She was also drafting an action plan to support her personal objectives plan for the year and would be pleased to share it with the Council of Governors when finalised as many of the objectives would support the work outlined in the report. The presented report was appreciated by the meeting; it provided a wealth of information not previously shown in such a comprehensive format. It was acknowledged that the report largely focused on the Barnsley Public Constituency and Mr Steenson asked if similar data was available for his Constituency (out of area - rest of England & Wales). Mrs Myers undertook to provide this to him outside the meeting. Governors were keen to support the work going forward: • several volunteered to attend forthcoming Equality Celebration event; • Mr Grierson requested more membership forms; • Mr Brannan had been in contact with another organisation recently

regarding youth engagement and would discuss that further with Mrs Myers outside the meeting

• the Chairman encouraged Mrs Myers to liaise further with Barnsley Together (represented by Mr Lleshi as their nominated Partner Governor) to develop more links with minority groups across the region – they could also help with review of the membership form to encourage completion (declaration was not mandatory on the membership forms thus was likely to be under reported)

• Mr Unsworth invited Mrs Myers to prepare a bid for the Governors Funding & Finance Committee’s consideration, which, if supported, might be able to fund the membership banners mentioned in the report.

Mrs Myers appreciated the Governors’ support and undertook to action the points above. On behalf of the Council of Governors, the Chairman thanked Mrs Myers for the informative overview on membership and

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engagement to date. It was agreed that further updates should be presented at least quarterly.

CG/14 40 PATIENT FLOW PATHWAY ACTION PLAN Presentation Mrs McNair and Mr Kirton presented the patient flow pathway action plan, developed in response to the Bed Utilisation review undertaken in January 2014. Mrs McNair highlighted key findings from the review, which had shown that the Trust could work differently with some patients, such as those with substance abuse, long term conditions and the frail and elderly, to help avoid inappropriate admissions and reducing lengths of stay – ensuring that patients had the right care in the right place, not necessarily in an acute hospital. Mr Kirton advised that the findings would be used as a community-wide resource, recognising the need to work together across a range of partner organisations to avoid inappropriate admission and enable faster discharge, with robust care support at or nearer to patients’ homes, supported by 7-day working at the hospital. The report was welcomed and Governors’ widely supported the action plan. In discussion several aspects were explored further. Mrs O’Brien had recently attended a community event, which had highlighted the growing use of a telehealth café. This was well utilised by GPs but to date there seemed to be a low level of referrals from the hospital. Mrs McNair acknowledged that it sometimes takes time to gain confidence in new systems but advised that the Trust’s virtual hospital system was working well and would be developed further. The Chairman advised that the telehealth programme had been launched on a trial basis with GPs but was expected to be rolled out more widely as it became established. Mr Raychaudhuri queried the role of community matrons in the decision making process to avoid hospital admissions as well as that of GPs, which was not made clear in the plan. Mrs McNair agreed that the impact of both roles could and undoubtedly would be increased as the plan developed and funding became available to support this. As the plan grew it was envisaged that the decision making process would grow too, taking account of input from all care providers, including end of life pathways, nursing homes and ambulance services as well as GPs. Mr Smith sought more information on the planned closure of several wards and the related staffing implications. Mrs McNair advised that one of the wards (ward 29) had been closed since April; the issue was not about ward closures but bed reductions, reflecting the increasing use of day surgery, the benefits of patients being able to go home more quickly, the current level of nurse vacancies and the need to retain a good staff to beds or patients ratio. Mr Brannan enquired if the closures/bed reductions would be deferred pending establishment of a proper admissions avoidance scheme (to be led by the Clinical Commissioning Group/CCG) and “step down” facilities. Mr Kirton emphasised the phased approach behind the plan, which would ensure that each stage included clinical input from the hospital, GPs and the CCG. Some elements were not yet in place but were being pursued in discussion with partners and with consideration of other options such as providing step down facilities on site if funding could be available from winter pressure monies. It was acknowledged that close working with community partners was essential to every aspect of the plan


and that some current arrangements within the community may be restrictive initially (eg existing community care arrangements, GP contracts, differing GP opening hours, the commissioning structure) – none of which could be changed overnight. There was, however, a strong commitment to supporting this work in partnership, which would be invaluable. To illustrate this, the Chairman referred to earlier comments regarding drug and alcohol abuse. The Board of Directors had recently received information on a high number of deaths in young people attributable to alcohol; this data had been shared with the Health & Wellbeing Board and Public Health. Additionally local community teams were looking for information from the hospital to help support and inform messages to schools etc in terms of preventative work. Mrs McNair emphasised the whole system requirement in terms of providing the best care for patients and best value for money as a community too.

CG/14 41 CHAIRMAN’S REPORT (Enc 8) The Chairman’s report was received and noted. It provided commentary and updates on a range of activities, items of interest and Board discussions since the last General Meeting. The Chairman also reported on the resignation of Mr Woodcock, due to business commitments which precluded him from giving sufficient time to the role of Governor. The implications of the vacancy arising from this resignation were being considered and would be reported further at the next meeting. The Chairman drew attention to a number of items from his report, including:

• The views of the new Chief Executive for NHS England, shared at the NHS Confederation’s Annual Conference; he had made it clear that he had a high regard for district general hospitals, which he sees to have a valued place in the system.

• The successful HEART Awards event held on 6th June. The staff who won awards had been delighted and others had already declared their determination to win next year. One Award had been presented in memory of the late Mr Bob Ramsay, in tribute to his contribution as a governor since 2005. The evening had been very well attended by Staff, Governors and Directors. Although it was acknowledged that the event had been a great success overall, Mr Unsworth and some other Governors were very dissatisfied with the food, although others had fared better and had praised it. It was disappointing that the standard had not been consistent and had fallen below expectations for several diners; this had been compounded by the waiting staff failing to act on concerns raised on the evening. It was agreed that these concerns should be reported to the venue. They did not, however, detract from an otherwise very good event, enabling the Trust to celebrate with and acknowledge its excellent staff.

• The Barnsley Birthing Centre would be opened formally on 25th June; there was an open invitation for all Governors to attend.

• Governors supported the suggestion to defer the annual review of the Trust’s Constitution in view of the current position, the ongoing investigations and the work underway on the Trust’s governance systems.

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• A focus group was being arranged with Governors as part of the ongoing governance review, led by Deloitte. This was originally mooted for 24th June but it was agreed that the date should be changed to enable more Governors to be involved; an alternative date would be circulated shortly.

• Training opportunity: one of the Sheffield Trusts was hosting a local Governwell training event (full day) on 22nd July. Governors interested were asked to register via the Secretary to the Board.

• The update on the work of the Barnsley Hospital charity was noted. Governors were pleased to see the increasing support for the Trust’s Charity, which included a collection point at every branch of Sainsburys across Barnsley (there were a number of “local” outlets within the borough).

Mr Kerr enquired about the Trust’s approach to procurement. He had questioned this time some ago regarding supplies such as needles etc and had been assured of a robust approach to contracts, all of which were reviewed regularly. He asked if this approach was being continued and if it applied to utilities too, such as the telephone service. He also queried repayments of foreign nationals receiving treatment on the NHS. The Chairman assured the Council that the Trust maintained a robust approach to procurement of all supplies and complied with requirements for tendering in accordance with European Directives. Its phone bills had been reviewed recently and changes made around mobile phones; he assured the meeting that these kinds of things were continually reviewed to ensure best value for money. With regard to the repayment of foreign nationals, there was a prescribed procedure for reimbursement, which was followed. However, as Governors would expect, the Trust retained its approach of responding to patients’ needs first, looking at payment second. Mr Kerr’s questions had been timely: the Chairman was the Trust’s nominated champion for procurement and as such he had recently attended a national seminar on procurement. The Department of Health was concerned that the NHS did not buy well enough as a whole and had urged all Trusts to ensure they were vigilant on procurement, using government contracts where it would be beneficial to do so.

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CG/14 42 LEAD GOVERNOR’S REPORT (Enc 9) The Lead Governor’s report on activities since the last meeting and items of interest for the Council was received and noted. He endorsed the Chairman’s comments regarding this year’s HEART Awards as a great way to acknowledge staff’s continuing commitment and support for the Trust. He also reiterated the value of the Foundation Trust Governors’ Association (FTGA) national meetings. Unfortunately no-one had been able to attend the recent event aimed at newer governors but details on the FTGA’s next development day were due shortly and he urged Governors to attend. Referring to his recent election as a local Councillor, Mr Unsworth assured the meeting that he did not foresee this giving rise to any issues of conflict of interest. He had been appointed to the Council’s Overview Scrutiny Committee, which could overlap with the hospital’s work in some areas but, if so, he would not take part in those discussions. Mr Unsworth was congratulated on his success in the elections.


CG/14 43 CHIEF EXECUTIVE’S REPORT (Enc 10)

Mrs McNair presented the Chief Executive’s report on behalf of Ms Wake. The following points were highlighted in discussion:

• The business plan would not be affected by the proposed turnaround plan due to be submitted to Monitor by 30th June. The turnaround plan would be closely aligned with the tenets and objectives set out in the agreed business plan.

• It was noted that as well as achieving JAG (Joint Advisory Group) Accreditation, the Endoscopy team had also received the latest BRILLIANT Award, in recognition of its achievement.

• The A&E <4 hours performance target continued to perform to high standards. It had dipped on 10th June due to high demand on that day but the improved performance generally had enabled the Trust to maintain target levels overall. Mrs McNair outlined some of the key factors within the Emergency Department and across the Trust that had contributed to this improvement and the work ahead to ensure that the better performance was embedded and maintained on a consistent basis.

• The Chairman and Mrs McNair provided more information on the Better Care Fund Allocation, which was intended to drive greater integration of services in the community. It needed a clear financial strategy to underpin this work, which was currently being developed. The work was at an early stage and the Barnsley Health & Wellbeing Board had recently determined that the Directors of Finance and Chief Executives from all partner organisations should work together to lead this.

CG/14 44 SUB-GROUP REPORTS (Enc 11) The draft minutes and reports from the latest meetings of the Strategy & Performance and Staff & Environment sub-group meetings chaired by Mr Brannan and Mrs Robb (in Mr Ramsey’s absence) respectively, were received and noted. Mrs Robb and Mr Brannan expanded on the minutes and key issues discussed. Mrs Robb highlighted the training provided on Infection Prevention & Control and Safeguarding, the 2013/14 year end reports on quality issues and Governors’ continuing involvement in the Quality & Safety visits. She also reported on the group’s discussions on interpreter services and the importance of treating people with the same respect whether in or outside of the hospital. Mr Brannan referred to the Strategy & Performance sub-group’s continuing discussions on mortality ratios. He also drew attention to the group’s recommendation for monitoring the key objectives for the Trust’s business plan for 2014/15; this was considered and accepted by the wider Council of Governors. The Council also ratified the response submitted on its behalf for the 2013/14 Quality Account and approved the Terms of Reference for the sub-groups and role of the Lead Governor without change. Minutes were not yet available from the latest Staff & Environment sub-group meeting. In Mr Conway’s absence, Mr Raychaudhuri reported on some of the issues discussed, which had included the current financial position and Governors’ concerns about the likely harm that could be caused by rumours and how these could/should be quashed and better


managed in future. The group had also provided some useful feedback on the new appraisals system. Mr Patton, the Non Executive Director present at the meeting, had undertaken to feedback the group’s comments to the Board and the Chairman affirmed that this had been actioned.

CG/14 45 BOARD OF DIRECTORS (Enc 12) The agenda (June), approved Minutes (May) and latest integrated performance report as presented to the Board of Directors meeting held in public in June 2014 were received and noted.

CG/14 46 ISSUES RAISED BY GOVERNORS WiFi Charges for Patients Mr Sykes had submitted a question to the Chairman on this issue and it had been agreed to respond via the General meeting rather than to Mr Sykes in private. This approach was appreciated and could be adopted more widely for future questions from Governors, provided any such issues were formally submitted to the Chairman in good time. Mr Sykes had reported a question brought to him from a patient, who had been surprised to be charged for use of the internet whilst in hospital. The Chairman advised that currently the Trust did not currently have publically available WiFi on site and the internet services accessible for patients were provided via Hospicom, to whom the Trust was contracted. The Trust was looking at options for the provision of WiFi in future but this may be restricted by the current contract. In terms of funding support for such services, the Chairman also advised that the Trust would be bidding into the second round of the national programme for Electronic Patients Records (EPR) as part of its work to develop its EPR and move towards paperless working.

CG/14 47 ANY OTHER BUSINESS a) A&E

Mrs Bevis, member of the public, advised that she had recently had to attend A&E as a patient. Despite the circumstances, she had considered it a pleasant experience overall and had been treated and discharged in good time. Her feedback was appreciated.

b) Annual General & Public Members Meeting (AGM/APMM) It was confirmed that the AGM/APMM would be held on 11th September 2014 – timings would be announced shortly.

c) Head and Neck Cancer Awareness At the close of the meeting, Ms Sanderson advised that the Trust had recently launched a Head and Neck Cancer Awareness Campaign. Posters were available for Governors to display in their community and business areas.

It was resolved that representatives of the press and other members of the public be excluded from the final part of the meeting having regard to the confidential nature of the business to be transacted.

COUNCIL OF GOVERNORS – AUGUST 2014

REF: CG/14/08/06

CoG August 2014: 06_2013 14 QA report

06

QUALITY REPORT 2013/14

1. INTRODUCTION

1.1. In accordance with Department of Health requirements and Monitor’s Foundation Trust Annual Reporting Manual for 2013/14 (the “ARM”), all Trusts are required to provide a report on the quality of care they provide within their annual report.

1.2. Monitor’s guidance also requires Foundation Trusts (FTs) to include a limited assurance report from the external auditors on the content of the quality report and certain mandated indicators. The limited assurance report gives the auditor’s view on whether anything has come to their attention that leads them to believe that the content of the quality report has not been prepared in line with the guidance or is consistent with other referenced information sources.

2. OUTCOMES

2.1. Barnsley Hospital’s latest quality report and the auditor’s limited assurance report are both included within the Annual Report & Accounts 2013/14, copies of which have been provided to Governors under separate cover and are available on the Trust’s website (www.barnsleyhospital.nhs.uk). The Annual Report & Accounts will be presented formally to Governors and members at the Trust’s Annual General & Annual Public Members meeting to be held on 11th September 2014.

2.2. As usual our auditors, Pricewaterhouse Coopers (PWC), have also prepared a fuller report (copies attached for Governors). Additionally, senior representation from PWC will be attending our General Meeting to expand on the report, provide further information and welcome any questions or comments from Governors.

3. RECOMMENDATION

The Council of Governors is asked to receive the attached report and further information to be provided by Pricewaterhouse Coopers at the meeting.

Stephen Wragg CHAIRMAN August 2014


REF: CG/14/08/08

08

REPORT OF THE NOMINATIONS COMMITTEE

1. INTRODUCTION 1.1. At the latest meeting of the Nominations Committee, it was intended to (a) complete

the 2013/14 year end performance review of the Chairman and Non Executive Directors (NEDs) in order to present recommendations to the wider Council of Governors for approval, and (b) carry out the annual review of the Terms & Conditions of Service of the Chairman and NEDs, for implementation from 1st January 2015.

1.2. Both reviews would, as usual, be carried out as mandated by the wider Council of Governors and in accordance with Monitor’s guidance.

1.3. Governors will, however, be aware of the other review work ongoing, in particular an independent review on the Board’s systems and processes. This has impacted on this year’s plans as reported below.

2. PERFORMANCE REVIEWS 2.1. Chairman’s review:

This has been carried out in accordance with published guidance and the requirements agreed by the Council of Governors. It is jointly led by the Senior Independent Director (SID) and the Lead Governor, with the support of the Nominations Committee. As in previous years, a wide range of feedback has been collated to ensure a comprehensive review. Additionally a 360o review was commissioned this year for the first time, stipulated by the Council of Governors in February 2014 at the time of the Chairman’s re-appointment.

2.2. NEDs’ review: The Chairman leads the review of the NEDs each year. He has met with each of the NEDs to review their performance for 2013/14 and will report and discuss outcomes with the Nominations Committee.

2.3. Independent reviews: Two independent reviews have been commissioned this year and will have a bearing on the performance reviews – (i) the 360 review for the Chairman, and (ii) the independent review of the Trust’s systems and processes. The Nominations Committee extended the year end review process for 2013/14 to enable it to take these into account.

2.4. The 360 review for the Chairman has involved input from the Board of Directors, senior management, representatives from Governors, and key stakeholders. Whilst the review has recently been completed, it needs further consideration and analysis before being presented to the Nominations Committee. Unfortunately the SID became indisposed at the time that he and the Lead Governor would have carried out this work and presented it to the Nominations Committee.

2.5. The second independent review has focussed on systems across the Trust and has also included input from the people involved with the Chairman’s 360 – plus other staff from across the Trust, more Governors, a wide range of partner organisations and a number of service users. This work will not now be fully completed until late August.

CoG Aug 2014: 08_Nominations Committee

2.6. Whilst much of the data for the review processes for both the Chairman and the NEDs has been collated, the Nominations Committee believes it would be sensible to defer final considerations until the findings of the independent reviews are also available. The Committee therefore plans to meet again in September to complete the final stages of the year end reviews for the Chairman and the NEDs, by which time information from both of the independent reviews will be available.

3. ANNUAL REVIEW OF TERMS AND CONDITIONS OF SERVICE

3.1. In accordance with the Chairman and Non Executive Directors’ service agreements, the Council of Governors is required to undertake an annual review of their Terms and Conditions of Service. This work is led by the Nominations Committee on behalf of the Governors.

3.2. With reference to Monitor’s guidance, market testing of pay levels needs only to be carried out “at least once every three years” (Your statutory duties: a reference guide for NHS foundation trust governors – Monitor, August 2013, updated). This was carried out comprehensively last year, at which time an uplift was agreed to bring their remuneration more in line with the median for smaller FTs, nationally and locally.

3.3. Monitor’s guidance also requires that any considerations must take account of a range of factors beyond comparable rates, for example economic climate, market conditions, changes in roles and responsibilities.

3.4. For this year’s review the Committee took account of the latest reports available from the Foundation Trust Network, Capita’s ‘NHS Foundation Trust Board Remuneration Report’, and national pay awards within the NHS. The Committee also considered the Trust’s current position, the pace of the economic recovery in England, and the challenging environment that continues to face the NHS generally.

3.5. Taking all factors into account, the Committee did not feel it appropriate to recommend any changes to the Chairman and Non Executive Directors’ terms and conditions of service for 2015.

4. RECOMMENDATION The Council of Governors is asked to: a) consider the information provided above b) note and support the deferral of completion of the Chairman and Non

Executive Directors’ annual performance reviews, to be presented to the Council of Governors in October 2014, and

c) approve the recommendation not to make any uplift for the Non Executive Directors and Chairman’s remuneration or other changes to their Terms and Conditions of Service for 2015.

Joe Unsworth LEAD GOVERNOR For and on behalf of the Nominations Committee, August 2014

CoG Aug 2014: 09_(i) Cover Report re Membership Engagement Strategy

COUNCIL OF GOVERNORS – AUGUST 2014 REF: CG/14/08/09

MEMBERSHIP OFFICE – MEMBERSHIP AND ENGAGEMENT STRATEGY

2014 - 2016

1 INTRODUCTION 1.1 Since achieving authorisation as a Foundation Trust in January 2005, Barnsley Hospital

NHS Foundation Trust has made considerable efforts to build a membership that is vibrant and representative. The Trust has a duty to engage with our local communities and encourages local people to become members of our organisation.

1.2 Barnsley Hospital NHS Foundation Trust is committed to being a successful NHS membership organisation and strengthening its links with the local communities. To be truly successful, we must maintain an active membership that involves and reflects a wide representation of our local community by positively engaging with the members, staff, public/patients and our key stakeholders about our services.

2 MEMBERSHIP AND ENGAGEMENT STRATEGY 2.1 In addition to updating the formal objectives, the current Membership & Engagement

Strategy has been reviewed and revised. 2.2 The Strategy is built around the vision for membership and the Trust’s duty to recruit and

engage with members. 2.3 The Strategy was submitted to the Council of Governors’ Strategy & Performance Sub-

group meeting held on 8 July 2014 seeking Governors’ input and support. 2.4 Governors’ comments on the Strategy were noted and incorporated into the final version

of the Strategy to be presented to the wider Council of Governors (attached).

3 RECOMMENDATIONS Governors are asked to receive and approve the Membership and Engagement Strategy 2014 - 2016

Debbie Myers Membership & Communications Officer August 2014

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Barnsley Hospital NHS Foundation Trust

Membership and Engagement Strategy

2014 - 2016

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Contents page: Title Page 1.0 Introduction 3

1.1 Scope of Strategy 3 1.2 Vision for Membership 3

2.0 The Membership Scheme 3 2.1 Becoming a member 4 2.2 Exclusions to Membership 5 2.3 Defining our Membership Community 5 2.3.1 Public Governors 5 2.3.2 Staff Governors 5 2.3.3 Partners Governors 6 3.0 The Membership Register 6 4.0 Recruitment of Members 6 4.1 Recruitment Methods 6 4.2 Who is responsible for Recruiting Members? 7 4.3 Recruitment Plan 7 4.3.1 Recruitment Approach 7 4.3.2 Media Coverage 8 4.3.3 Staff 8 5.0 Engaging with Members 8 5.1 Methods of Engagement 8 5.2 Engagement Plan 9 6.0 Working with Internal Departments and External Organisations 9 7.0 Monitoring Success 10 7.1 How Will Success Be Measured? 10

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1.0 Introduction

Since achieving authorisation as a Foundation Trust in January 2005, Barnsley Hospital NHS Foundation Trust has made considerable efforts to build a membership that is vibrant and representative. The Trust has a duty to engage with our local communities and encourage local people to become members of our organisation. Barnsley Hospital NHS Foundation Trust is committed to being a successful NHS membership organisation and strengthening its links with the local communities. To be truly successful, we must maintain an active membership that involves and reflects a wide representation of our local community by positively engaging with the members, staff, public/patients and our key stakeholders about our services. The diagram below shows the relationship between our Foundation Trust and its serving public community:

1.1 Scope of Strategy This strategy outlines the Trust’s vision for membership and the methods we intend to use to identify and build an effective, responsive and representative membership body. It also outlines our future plans in terms of recruitment and engagement and how we will measure the success of our membership. The strategy will be delivered within the wider framework of Trust strategies that address the matters of equality, diversity, public/patient involvement, user engagement and communications. 1.2 Vision for Membership We want our membership to be active, engaged and representative of local communities, staff, and the wider population that the Trust serves.

2.0 The Membership Scheme The Membership Scheme allows Barnsley Hospital NHS Foundation Trust to build on the sense of ownership that many people feel towards our Trust. An effective membership scheme has been shown to be valuable in improving patient experience by providing

BARNSLEY HOSPITAL NHS FOUNDATION

TRUST

“Partnership will be our strength”

Investing in relationships will

improve the quality of care and

wider health

PUBLIC COMMUNITY

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Barnsley Hospital with an opportunity to communicate with our members on issues of importance around our services and their developments and also providing our local communities with a way of expressing their loyalty and support for us.

We recognise that for the Membership Scheme to be effective and successful, we must be representative of all people in the nationally recognised protected nine characteristic groups (i.e. sex (gender), age, race, disability, religion and belief, sexual orientation, pregnancy and maternity, marriage and civil partnership, gender reassignment) and provide benefits and reasons for people to join us.

The Membership Scheme is free and members can:

• Receive ‘Barnsley Hospital News’ magazine and up to date information about the hospital and its work (Level One – see table below).

• Be given the opportunity to have a say and be heard in setting the future of their local Trust (Level’s One & Two – see table below).

• Receive invitations to special events, meetings and enrich their understanding of health issues, and the organisation depending on their level membership level (Levels One, Two & Three – see table below).

• Have the opportunity to join the NHS discount scheme and save money on a range of goods and services (Levels One, Two & Three – see table below).

• Receive a vote for electing a representative to serve on the Council of Governors, and if over 16, they can chose to stand for election to the Council of Governors (Levels One, Two & Three – see table below).

• Engage with other members (Level’s Two & Three – see table below).

We have developed a range of tiered membership levels which will lead to a better informed membership: Membership Level Membership Requirement Level One I would like to receive the Barnsley Hospital Newsletter and voting

information only. Level Two As Level One, plus invitation to members’ only events and the

opportunity to join discussion groups. Level Three As Levels One and Two, plus information about involvement

opportunities, developments in the hospital and the opportunity to stand as a Governor.

2.1 Becoming a Member Membership is open to all residents of Barnsley over the age of 14 years (exclusions apply see 2.2), this also extends to people who live outside of Barnsley along with members of staff, including volunteers. Members will be eligible to join one of two Constituencies:

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• The public constituency (two classifications) which is representative of our local community (this extends to people who live outside of Barnsley but are interested in the Hospital’s services).

• The staff constituency (see 2.3.2) which is representative of staff employed in the Trust.

An individual cannot be a member of more than one membership constituency and a person who satisfies the criteria of the staff membership constituency may not become or continue as a member of the public constituency group. An individual can become a member by one of four ways:

• Completion of a membership application form. • Joining online via the Trust’s website at www.barnsleyhospital.nhs.uk • Calling the Membership Office on 01226 434530. • Emailing [email protected]

2.2 Exclusion to Membership

There are some exclusion to membership, as follows:

• Any individual who does not accept or does not abide by the Trust’s values. • Any individual under the age of 14 years old.

2.3 Defining our Membership Community

2.3.1 Public Governors

We have sixteen Public Governors (fifteen across Barnsley; one for the rest of England and Wales). The Trust’s population is approximately 222,861 and at present we have 9,064 Public Members (4% of the population). We have 773 ‘out of area’ members accounting for almost 8% of our public members.

As a Foundation Trust there is no set target for the numbers of members we should have but our aim remains to steadily recruit and increase representative membership in comparison with the population, we have a significantly lower representation of young people (16-20years), lower representation of all BME groups and certain geographical areas.

2.3.2 Staff Governors

The Trust has over 3,452 staff members (number refers to part and full time staff). Staff automatically become staff members, however, are free to ‘opt out’ if they prefer. The Trust has five staff constituencies and staff members elect a total of six staff Governors, term of office is three years within these:

Staff Constituencies Number of Staff Governors Clinical Support One

http://www.barnsleyhospital.nhs.uk/

mailto:[email protected]

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Medical & Dental One Non Clinical Support One Nursing & Midwifery Two

Volunteers One 2.3.3 Partner Governors

We have seven Partner Governors who have been nominated by:

• Barnsley College • Barnsley Metropolitan Borough Council (BMBC) • Barnsley Together • Joint Trade Union (JTIC) • NHS Barnsley Clinical Commissioning Group (CCG) • Sheffield Universities (joint seat) • Voluntary Action Barnsley (VAB)

3.0 The Membership Register

A professional, external database management company ensures that our membership database is accurate, secure, reflects our constitution, and is resilient enough to support our governance arrangements and elections. All members are made aware of the existence of the members database via the membership registration form and have the right to refuse to have their details disclosed (Data Protection Act). 4.0 Recruitment of Members

We wish to encourage and develop a strong sense of community involvement with the membership scheme. Therefore, we will continue our efforts to actively recruit new members in all categories. The Trust’s membership target is to be reviewed each year as part of the annual plan submission to Monitor. Our aim is to identify under-represented groups within the wider community and develop a targeted approach for proactive recruitment to each. 4.1 Recruitment Methods

We undertake a range of activities to raise awareness and promote the benefits of membership through a variety of communications channels, including its website, using local newspapers, hosting and attending local events/meetings, membership materials and targeted recruitment. Communications Method Frequency Attendance at Local Community events (i.e. Health Fayre, LGBT Forum, St Helen Community Event, Equality Forum Celebration)

Monthly/Quarterly

Creation of an events pack to enable the Membership & Communications Officer to rotate around the various hospital entrances through the Trust to recruit and engage with new members

Quarterly

A rolling article within the Barnsley Hospital News Magazine Quarterly Creation of [email protected] email address to enable Ongoing

mailto:[email protected]

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two-way communication Run two Health Talks/events to interact and engage with members Six monthly Attendance at local and regional events to map engagement/consultation forums to develop a co-ordinated approach

Monthly

Internal meetings to consider additional methods of membership recruitment, communications and engagement across the borough of Barnsley

Monthly

Website to be refreshed to ensure increased visibility and more inactivity users.

Quarterly

4.2 Who is Responsible for Recruiting Members?

The Director of Marketing and Communications leads on the strategic direction for membership but the Membership and Communications Officer will be responsible for recruiting members. Governors also have an important role to play by building and encouraging membership recruitment. This provides a real opportunity for Governors to influence the work of the Trust and the wider healthcare landscape. 4.3 Recruitment Plan

The Trust’s membership target is to be reviewed each year as part of the annual plan submission to Monitor. Our aim is to identify under-represented groups within the wider community and develop a targeted approach for proactive recruitment to each. We aim to achieve continual year on year growth for our public membership and to ensure that staff membership is maintained at an appropriately high level (e.g. going along to events, talking to members and telling them about the services we provide in their area and our plans for the future). The Director of Marketing and Communications along with the Council of Governors has overall responsibility for ensuring the Membership and Communications Officer will focus on issues of recruitment and membership engagement. 4.3.1 Recruitment Approach

Our recruitment approach is to seek out other like-minded organisations and key stakeholders within the borough of Barnsley to raise the profile of community activity, to share best practice with such partners on membership, co-operation and community relations in order to:

• maximise opportunities for positive public relations in the local community; • continue to use membership champions and governors to recruit at local community

events; • link with the activities of local authorities exploring whether joint projects are feasible; • ensure regular contact with under-represented groups.

We will also promote the aims and principles of becoming a Foundation Trust member across the Trust by:

• ensuring the Trust’s members/Governors webpage is visual with opportunities to interact with members and provide opinions and feedback; video-casts etc.

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• establishing a “Become a Foundation Trust Member” events stand for rotation around the various hospital entrances throughout the Trust

• promoting “Become a Foundation Trust Member” materials established and made available at events and available to distribute regularly

• organising a series of events to visit local communities to recruit new members • utilising the Trust’s internal communications – weekly e-Newsletter, Barnsley

Hospital News, Intranet/Internet site, CEO Communications, global emails, staff communications events, staff notice boards/display boards etc.

4.3.2 Media Coverage

Good media coverage is fundamental as it strengthens community information and has the ability to improve public perceptions and awareness of the Trust. Barnsley Hospital will maximise opportunities for positive public relations in:

• local newspaper coverage e.g. Barnsley Chronicle, The Star, Independent, We are Barnsley

• local radio e.g. Dearne FM, Barnsley Hospital Broadcasting • local TV news e.g. Calendar, Look North • Social Media e.g. Facebook, twitter, mobile phone facilities, telecommunications

(e.g. Telehealth, hospital at home etc.).

4.3.3 Staff

New staff are automatically made a member and are given an overview of membership, which forms part of the induction training for all new starters (see section 2.3.2). New employees are made aware that their interests are represented by the appropriate Barnsley Hospital Staff Governor(s). Where a member of staff leaves the organisation the Trust will remove them from the staff membership and proactively ask if they wish to become a Public Member. 5.0 Engaging with Members

The Trust is committed to maintaining a two-way dialogue to enable us to have an effective and active membership. In order to involve the membership fully, members are asked to confirm their interests (via the membership registration form) so that a programme of events can be tailored to meet these preferences. The Trust will consider the needs of its diverse membership when assessing its methods of communication and aim to prove material in appropriate and accessible formats. 5.1 Methods of Engagement

Community engagement activity takes place in many different ways. It can involve asking an individual to complete a survey, or participate in a focus group. With engagement there is never a “one size fits all” approach and it is important for us to develop and tailor ours for each individual. This will provide the opportunity for a stronger partnership both with our members, staff, patients and the wider community. The tiered membership levels will enable better targeting of key messages and activity.

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5.2 Engagement Plan

We aim to ensure members have an opportunity to get involved with the Trust and through this engagement, help shape the services that we provide. Positive engagement with our members is extremely important and we are constantly seeking ways of improving and increasing the level of this. Engagement with our members includes:

• A welcome letter from the Chief Executive Officer and Chairman will be issued to all members when they initially join.

• An invitation to the Annual Meeting to hear more about the Trust’s achievement and have the opportunity to ask questions.

• A copy of the Barnsley Hospital News Magazine with a membership survey via the newsletter to:

• involve members in making decisions about the Trusts current and future services;

• gauge membership satisfaction levels, quality and quantity of involvement; and

• understand the types of events/activities they would like to participate in. • An invitation to Health Talk events throughout the year; each focusing on a different

clinical and non-clinical theme. • An invitation to ‘Listening Events’ for members to get together and during this time

members will be given the opportunity to engage with their elected Governors in: • What they think we are doing well and not doing well. • What they think we should be doing, but are currently not doing adequately, or

at all. • An events calendar designed to target specific community groups and increase

membership and awareness of the Trust activities utilising Governor support and leading to increased community activity and stronger partnerships.

6.0 Working with Internal Departments and External Organisations

We will maximise our efficiencies by linking closely with the following departments/organisations to enable more effective engagement and understanding of key issues: (please note that the list is not exhaustive) Internal

• Human Resources • Equality & Diversity Advisory • Learning & Development • Head of Patient Experience • Complaints and Patient Advice Liaison Services (PALS)

Internal meetings are to consider additional methods of recruitment, communication and engagement across the borough of Barnsley.

External

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• South West Yorkshire Foundation Trust • Health Watch • Partner Organisations (i.e. VAB, BMBC) • Community Forums

It is important to attend local organisations to represent the Trust to map engagement/consultation forums to develop a co-ordinated approach. This will ensure continual learning of innovative approaches to membership and ensure best practice is adopted wherever possible.

7.0 Monitoring Success

The Membership and Communications Officer will lead and manage the implementation of this strategy and its future development and submit a progress report on a quarterly basis to the Council of Governors meetings, inviting feedback and challenge to ensure objectives are being met. 7.1 How Will Success Be Measured?

The success of membership recruitment will be measured by the following criteria:

• a membership that is representative of the population, leading to better engagement on service developments

• achievement of the recruitment target (500 new members per annum )

The success of engaging with members will be measured by the following criteria:

• attendance at events and meetings organised by the Trust (i.e. Health talks, service redesign etc.)

• returned interest survey rate (reputation and general feedback is positive) • increase in engagement at local communities/forums (BME Women & Children’s,

Barnsley African Together Association, Together for Mental Health etc.) • anecdotal feedback from members.

Committee of the Board

Groups (direct reports to Board Committees)

Working Groups/Task & Finish Groups

(not exhaustive)

RemunerationCommittee

Corporate OperationsGroup

AuditCommittee

Finance & Performance Committee

Capital OperationsGroup

WorkforceGroup

Quality & Governance Committee

Patient Safety & QualityGroup

Patient ExperienceGroup

Health & SafetyGroup

Research & Development Group

Infection Prevention & Control Group

Learning from ExperienceFrients & Family TestPatient Information

RadiationMedical DevicesDecontaminationsMedical GasesMoving & Handling

Estates & ProcurementGroup

CIP SteeringGroup

Risk ManagementGroup

SustainabilityProcurementSpace UtilisationCateringCleaning

Data security / CyberFOI

Board of Directors

Equality & DiversityEducation / Mandatory training

FireSharpsWaste MgmtTheatre User group

MortalityQuality PolicyRecord managementMedicines Mgm'tCQC

ResusSI ReviewsDementiaVTESafeguarding

Litigation review groupConsentRisk registersResilience & Emergency Planning

Organ DonationGroup

Information GovernanceGroup


REF: CG/14/08/11

CoG June 2014: 11(i) Lead Governor report Aug 2014 Page 1 of 3

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LEAD GOVERNOR’S REPORT

1. INTRODUCTION 1.1. Since the last Council of Governors’ meeting in June, I was away on a holiday for two

and a half weeks, and accordingly missed two sub-group meetings and the opportunity to observe the July Board meeting. As usual this report highlights my activities as Lead Governor since the last Council of Governors and some important developments.

2. EVENTS AND ACTIVITIES

2.1. Sub-groups and committees The Trust had a stand at the Equality Forum Celebration held in Barnsley Town Hall on 21st June, organised by our Membership Officer, Debbie Myers. From the governors, Pauline Buttling and I helped out at the Trust stand.

2.2. I missed the Patient Experience sub-group on 24 June, and the Strategy & Performance sub-group on 8th July, but was at the Staff & Environment sub-group on 22nd July.

2.3. The Nominations Committee met on 5th August, and there is a report of this meeting on the Council of Governor’s agenda.

2.4. Deloitte As part of the external review of the Trust’s governance by Deloitte, a focus group of Governors was arranged for Wednesday 16th July. Despite some confusion over the start time, this was well attended. I counted 15 governors present, including myself, and all the governors contributed to the discussion. Additionally, as Lead Governor, I had a one-to-one session with one of the Deloitte team the following day, 17th July.

2.5. These sessions were, of course, on a non-attributable basis, so Governors could speak quite frankly. The report from Deloitte was expected to be available in August, but not until after the Council of Governors’ meeting.

2.6. GovernWell training Disappointingly, places were very limited on the GovernWell training event in Sheffield on 22nd July, and only one governor, Lisa Sanderson, was able to attend. Lisa has kindly provided a report on the event under a separate agenda item. I understand the Chairman is looking at organising some in-house GovernWell training.

2.7. Barnsley Hospital News A meeting of the editorial group was held on Tuesday 5th August. We are always looking for items about governors and their activities, so if you have an item of news, however small, please contact one of the editorial team. The editorial team comprises the sub-group chairs, myself, Debbie Myers (membership officer) and Phil Wainwright (Comms Team).

CoG August 2014:11(i) Lead Governor report Aug 2014 Page 2 of 2

2.8. We would also welcome more governors responding to the “two minute interview” feature, for the magazine. If you would be willing to answer a few quick questions for a future issue to tell others why you became a governor, what you like (or dislike!) about the role, how important it is etc - please contact Debbie Myers, Membership & Communications Officer, or Carol Dudley, Secretary to the Board.

2.9. While writing this report I received, by email, the first edition of a new Trust newsletter, “Quality Matters”, which is to come out bi-monthly. This newsletter is targeted at stakeholders and I am impressed by its quality. I am assured that this newsletter is in addition to Barnsley Hospital News, which is aimed at our members.

3. FOUNDATION TRUST GOVERNORS’ ASSOCIATION (FTGA)

3.1. At the end of July I realised that the last communication I had received from the FTGA was the May newsletter. The FTGA newsletter is (or rather was) sent on a monthly basis by email to governors of member Trusts. I found that the FTGA website had not been updated and showed no information about the expected FTGA autumn development day and AGM.

3.2. Upon enquiry I found that the FTGA had been in discussion with the Foundation Trust Network on a merger (or more accurately assimilation by the FTN) and had gone to ballot on this proposal. A letter from the FTN and a ballot letter from the FTGA had been sent to Trust Secretaries. Carol Dudley, Secretary to the Board, had received this correspondence, but naturally assumed that I had been informed of this directly. Copies of the FTN letter and the FTGA ballot letter are included in your packs.

3.3. The letter from the FTGA points out that a dozen Trusts have cancelled their subscriptions to the FTGA in the last year. Given that the FTGA subscription at £3,300 per annum is a small fraction of the subscription that FTs pay to the FTN, and given the key governance role of FT governors, this is disappointing. Since the only alternative option given by FTGA Directors is dissolution I have reluctantly concluded that we must agree to this merger.

3.4. The decision on the FTGA ballot is one for the Board of Directors. I understand that the closing date for the ballot is 14th August and accordingly the Board will have cast their vote before our Council of Governors’ meeting. I would request, however, that the Board communicate to the FTGA our disappointment at the lack of direct communication of the proposal to governors via the FTGA newsletter.

3.5. The FTN letter does indicate an intention to offer governor development days and networking opportunities to governors, and I very much hope that this will be the case. With the loss of the FTGA and our regional meetings this may be the only opportunity for governors to meet governors from other Foundation Trusts.

4. RECOMMENDATIONS

It is recommended that; • the Council of Governors receive this report • the Council of Governors notes the decision by the Board of Directors to vote

in the FTGA ballot for a merger of the FTGA with the FTN, but also requests that the Board communicate our deep disquiet at the lack of direct communication and consultation with governors of member Trusts.

J Unsworth LEAD GOVERNOR, August 2014

To: Company Secretaries, FTN members July 2014 Dear Colleagues, The FTN and the FTGA Those of you who are FTGA members will know that it is balloting its members on a proposal to become part of the FTN. The proposal is the culmination of detailed discussions to secure a strong independent representation and a comprehensive networking and development offer for governors that is sustainable in the medium to long term. The FTN initiated discussions with the FTGA earlier this year because we saw the need to add to our governance offer to FTs to make it comprehensive, in the context of the implementation of the 2012 Act. Our approach was welcomed by the FTGA because it shares the aspiration to support foundation trusts in delivering high quality services for patients, service users and the public. Furthermore, by working with us, the FTGA would be able to secure a sustainable future for strong governor representation as well as enhanced development and networking opportunities. Our negotiations over the last few months have been based on our shared values and objectives and we are confident that this outcome is the right one. I hope those of you who are FTGA members will vote in favour of the proposal so that together we can deliver for governors. Subscriptions The intention is that the transaction will be cost neutral and that operational costs for the rest of the FTN’s financial year 2014/15 will be met from existing resources. This means that those trusts that are existing FTGA members will not be invoiced in the autumn of 2014 and there will be no other costs passed on to members in respect of the governor offer in 2014/15. We have not yet started to work on subscriptions for future years, but as always there will be a frank and open dialogue with members via the FTN board. Membership The services offered to governors under the new arrangements will be part and parcel of FTN membership. Existing FTN members will therefore be entitled to the services for governors as part of their overall membership. There will not be an option available to buy into a ‘governors only’ service. The initial offer In continuing with much of the work of the FTGA, our intention is to offer governors developments days and networking opportunities along with enhanced policy support including the provision of written advice and publications, as well as high quality member communications. A new governor policy board, with a majority governor membership will be formed to feed governor policy issues into the FTN board to assure and promote the governor voice. The service will be delivered by existing FTN staff alongside a staff member transferring from the FTGA.

GovernWell It makes sense to consider how GovernWell fits into the picture and to examine the potential benefits of integrating GovernWell into our broader governor support. However our broader offer needs to be considered in the context of our evolving policy regarding which services form part of our core services to members and which are optional and therefore subject to a separate fee. This work is likely to be carried out later this financial year after which the way forward will be clearer. Implementation and the future If the FTGA ballot produces a positive result, the new arrangements will begin on 1 September 2014. The outgoing FTGA board will provide a steer through the implementation period and the first 6 months of operation. Some FTGA directors may stay on for longer as part of the governor policy board. The FTGA website, will be relocated, but will continue until the FTN rebrands in the autumn after which there will be a dedicated governor section on the new website. We expect our offer for governors to be reviewed and developed over time, but our approach will be incremental and we will consult foundation trusts and their governors as part of the evolutionary process. We hope that those of you who are FTGA members will vote and vote in favour of the proposal. If you have any queries or concerns, please do not hesitate to contact me on 020 7304 6875 or at [email protected]. Yours faithfully, John Coutts Governance Advisor FTN


REF: CG/14/08/12

CoG Aug 2014: 12_CEO Report Page 1 of 6

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CHIEF EXECUTIVE’S REPORT

1. INTRODUCTION

1.1 This report is intended to give a brief outline of some of the key activities undertaken

as Chief Executive since the last Council of Governors meeting and highlight a number of items of interest.

1.2 The items below are not reported in any order of priority.

2. LEADING DEEP CULTURAL CHANGE MASTERCLASS – 20 MAY 2014

2.1 The Chief Executive attended a Leading Deep Cultural Change Masterclass on 20 May 2014.

2.2 The Masterclass launched Advancing Quality Alliance’s (AQuA) 2014/15 programme for Board, Governing Body and Senior Leader Development. The aim of the programme was to support members in the improvement, oversight and governance of quality and patient safety and was led by James Reinertsen M.D.

3. PRACTICAL ASSESSMENT OF CLINICAL EXAMINATION SKILLS (PACES) COURSE – 16 AND 17 MAY 3.1 Dr Eltrafi and the Medical Education team hosted a PACES exam preparation course

for 20 delegates from the Yorkshire region. The PACES exam is designed to test the clinical knowledge and skills of trainee doctors who hope to enter higher specialist training.

3.2 Over 30 patients were used across the weekend with real clinical conditions to test the participants’ communication, history, examination and clinical judgement skills.

3.3 The patients were all previous and current patients of Barnsley Hospital and are all part of the “Patients as Educators” bank which was set up by the Medical Education team to enable the Trust to use patients to enhance the teaching experience of both undergraduate and postgraduate doctors on placement at the Trust. It promotes an active role for patients in the process of medical education and allows the doctor to gain a patient’s perspective on the management and treatment of their condition.

3.4 One patient who was involved in the course this weekend said “Enjoyed the session immensely. Very polite doctors who were very easy to talk to. Good to feel I can ‘give something back’ for the help and treatment I have received.”

3.5 The exams were held in June 2014.


4. STRATEGIC SERVICES DEVELOPMENT GROUP (SSDG) MEETING – 19 MAY 2014

4.1 The Chief Operating Officer attended the SSDG meeting on 19 May 2014 on behalf of the Chief Executive. Finances for the Better Care Fund Allocation were briefly discussed and a further meeting was being arranged to discuss the financial strategic direction in June. This will include consideration of a “refresh” of the SSDG strategy, to which the Trust is a contributor as a full participating member of the SSDG. The Trust’s Business Plan will also be referenced to the strategy to show alignment and support to delivering the overall strategy.

4.2 The Strategy also links with the “One Barnsley” programme and the “Pioneer Status” accorded to the Barnsley Community in recognition of its integrated working arrangements.

4.3 Underpinning the strategy is the requirement to consider the Medium Term Financial Strategy which, linked to the Better Care Fund, will potentially drive service changes across the Health Community over the next 1- 3 years. The Better Care Fund is a national requirement to transfer resources from the acute sector via the CCG and the SSDG to support Local Authority Social Services, in particular to ensure the provision of services in the community to either prevent or reduce admissions and attendances at Hospitals, a target of 15% reduction being required over the next three years.

5. SUPERVISOR OF MIDWIVES ANNUAL LOCAL SUPERVISORY AUDIT (LSA) VISIT 22 MAY 2014

5.1 The Chief Executive was invited to meet with the LSA Audit Team over lunch

5.2 The audit is undertaken annually and the context of the audit was: • Priorities of headlines from regional/national prospective • Presentation by the team including last year’s audit recommendations and action

plan • Success and challenges in supervision (local contest) • LSA audit team verbal feedback session to the Supervisor of Midwives team and

invited guests including the Chief Executive.

6. JOINT ADVISORY GROUP (JAG) ACCREDITATION

6.1 Following the JAG re-visit to the Endoscopy Unit at the Trust on 8 May 2014, I am pleased to advise that the Endoscopy Unit at Barnsley Hospital NHS Foundation Trust met all the required JAG Accreditation standards.

7. PERSONAL, FAIR AND DIVERSE AWARDS 2014

7.1 The work of Diversity Champions has resulted in the Trust winning a national award by NHS Employers. The awarded is ‘Highly Commended Winner’ in their Personal, Fair and Diverse Awards for 2014.

7.2 The Trust has won this accolade because it has demonstrated an on-going commitment to personalised care through inclusive behaviour which has helped to improve patient outcomes and create a more inclusive workplace. The Trust has been seen as going the extra mile to engage and encourage staff in the organisation to promote the work of Diversity Champions and in turn help further embed the organisation’s values. The Trust has been invited to attend a Personal, Fair and Diverse Champion award ceremony along with other winners


8. PASSION FOR COMPASSION CONFERENCE – HEALTHCARE ASSISTANTS 28 MAY 2014

8.1 The Chief Executive and Chairman were invited to attend a Passion for Compassion Conference at the Trust to celebrate the hard work and dedication of the Health Care Assistants (HCAs)

8.2 HCAs form a huge part of the nursing team and are often referred to as the bedrock of the nursing services and provide invaluable support and care to our patients.

8.3 There were a number of presentations including Dementia Care in Hospitals, Safeguarding and Continence Support, along with facilitated group work.

9. NHS NATIONAL CONFERENCE LIVERPOOL JUNE 2014

9.1 This year’s Confederation was attended by Stephen Wragg, Chairman; Diane Wake, Chief Executive; David Peverelle, Chief Operating Officer and Karen Kelly, Director of Operations. The key speakers for the Conference including representatives from all the main political parties, speaking particularly in anticipation of the election next year. This included the Secretary of State, Mr Jeremy Hunt; the Shadow Health Secretary, Andy Burnham and for the Liberal Democrats, Norman Lamb.

9.2 In addition, the Conference also heard the inaugural speech from the new Chief Executive of the NHS, Simon Stevens who gave a wide ranging review of the challenges facing the NHS.

9.3 Also the Confederation heard from the new NHS Confederation Chief Executive Rob Webster who outlined a challenge for all the political in relation to a plea for all political parties to settle on a “10 year NHS funding settlement” with real terms of growth of the budget over that period with a £2 billion annual transition pot to pay for service change. Also he sought parity of esteem between physical and mental health services and also specifically for mental health patients to be given new rights to access services in a set time limit regards to their choice of service with similar targets being set to those found in the acute sector.

10. MEDIA COVERAGE

10.1 As expected, the Trust saw a significant amount of media coverage following Monitor’s announcement. This was mainly in the local and regional media on Friday 6 and Saturday 7 June, with BBC Look North, ITV Calendar, BBC Radio Sheffield, Hallam FM, Yorkshire Post and Sheffield Star all picking up the story.

10.2 On a national level, the Health Service Journal also ran the story. Nearly all publications included the Trust’s statement in response to Monitor’s concerns.

11. BARNSLEY HOSPITAL CHARITY HEART AWARDS 2014

11.1 As previously reported in the Chairman’s report, the fifth annual Barnsley Hospital HEART Awards were held at the Holiday Inn on Friday 6 June 2014. The event was a great success and was attended by almost 300 guests. This year the Chief Executive’s Award was introduced and was won by the Critical Care Team.


12. WORKING TOGETHER RADIOLOGY PROGRAMME

12.1 A Working Together Radiology Workshop was held on 18 June 2014. There was very impressive level of engagement, useful discussion and clear will to work collaboratively. Workstreams with task and finish groups have been identified and further meetings are being arranged for August, September and October.

13. NICE CLINICAL GUIDANCE DEVELOPMENT GROUP – SEPSIS

13.1 NICE are currently undertaking a nationwide study on Sepsis; the aim of the study is to identify and explore avoidable and remediable factors in the process of care for patients with known or suspected sepsis. The study’s objective is to examine organisational structures, processes, protocols and care pathways for sepsis recognition and management in hospitals from admission through to discharge or death, and to identify avoidable and remediable factors in the management of the care for a sample of adult patients with sepsis. In the study, a sample of patients identified as having sepsis in the two week data collection period; will be identified for an in-depth case review by a multidisciplinary group of Advisors. The Trust’s Corporate Matron, Julian Newell, has been appointed as one of the Advisors on the study, due for publication in 2015.

13.2 NICE have been asked to develop a clinical practice guideline on Sepsis - the recognition, diagnosis and management of Severe Sepsis (due to be published 2016) for use in the NHS in England, Wales and Northern Ireland. NICE has commissioned the National Clinical Guideline Centre (NCGC), hosted by the Royal College of Physicians, to produce a clinical guideline on Sepsis: the recognition, diagnosis and management of severe sepsis. Healthcare professionals were invited to apply to be considered for membership of Sepsis Guideline Development Group (GDG). The GDG members will work closely with the NCGC technical team, who will be responsible for reviewing and presenting the evidence to the GDG. Julian Newell has been successful in applying for membership of the Sepsis Guideline Development Group

14. CLINICAL TEACHING AWARD 2014

14.1 Dr Eltrafi has been awarded a Clinical Teaching Award by the Medical School, University of Sheffield Medical students were asked to nominate individuals who fulfil the following criteria: • has provided teaching of the highest quality within a clinical setting over a

sustained period • inspires and supports students through close engagement with them and by

being and excellent role model • enables students to feel part of their clinical team and enables other members of

their team to help with their development • creates an environment in which students feel empowered to engage with clinical

medicine.

14.2 Awards were made to NHS staff in General Practice, Psychiatry, each of the four Associate Teaching Hospitals and Sheffield Teaching Hospitals.

14.3 Congratulations go to Dr Eltrafi on this award.


15. NATIONAL ACUTE MEDICINE AWARENESS WEEK

15.1 The staff on the Acute Medical Unit (AMU) undertook a virtual marathon on 16 July 2014 as part of the National Acute Medicine Awareness Week initiative.

15.2 The first mile was undertaken by Lead Nurse, Louise Sharp and throughout the day medical and nursing staff, managers and governors as well as the Chairman added to the mileage following a virtual route around the borough. The final 2.5 miles was completed by AMU Lead Consultant Dr Rana by 18:00. This was a great achievement by all concerned.

15.3 The virtual marathon raised £128.00 which will be used towards further enhancing the ‘Dignity Room’ on AMU for patients and their families.

15.4 Pictures and a report will be sent to the National Society for Acute Medicine (SAM) and will be published via the network along with news letters from across the country.

16. HOSPITAL ATTACHMENT FOR MA STUDENTS IN HOSPITAL MANAGEMENT

16.1 The Trust has received a certificate and a letter of thanks from the University of Leeds, Nuffield Centre, following the three-week attachment of one of their international students.

16.2 Over the years, students who have been placed in the Trust have repeatedly stated how valuable and educationally beneficial their experience has been to them.

17. SIGN UP TO SAFETY

17.1 The Trust has signed up to “Sign up to Safety” campaign with Julian Newell, Corporate Matron – Patient Safety leading the campaign. The “Sign up to Safety” campaign’s key elements are: • put Safety First. Commit to reduce avoidable harm in the NHS by half and

make public the goals and plans developed locally. • place patent safety at the heart of the Trust’s Quality Strategy. With the

setting of goals on patient safety issues such as National Early Warning Scores (NEWs) and sepsis.

• continually learn. Make the organisation more resilient to risks, by acting on the feedback from patients and by constantly measuring and monitoring how safe the services are

• complaints. Actively investigate and respond to all complaints and concerns in a timely manner

• deaths. Review all deaths in the Trust in a uniform and systematic way • patient safety. Monitoring patient safety through traingulation of information

(Quality Impact Monitoring, Clinical Audit) in order to analyse, improve and learn • honesty. Be transparent with people about progress to tackle patient safety

issues and support staff to be candid with patients and their families if something goes wrong. Actively pursue a policy of candour in the circumstances of something going wrong.

• collaborate. Take a leading role in supporting local collaborative learning, so that improvements are made across all of the local services that patients use.


• support. Help understand why things go wrong and how to put them right. Give

staff the time and support to improve and celebrate the progress. Ensure staff is informed about patient safety issues and support staff so that changes and improvements are made in ways which are effective and sustainable.

Diane Wake Chief Executive August 2014


REF: CG/14/08/13

CoG June 2014: 13_(i) Sub-groups report

13

STRATEGIC SUB-GROUPS

1 INTRODUCTION

1.1 The sub-groups continue to meet regularly:

– Patients’ Experience Chair: Jordan Ramsey Vice Chair: Carol Robb

– Staff & Environment Chair: Tony Conway Vice Chair: Trevor Smith

– Strategy & Performance Chair: David Brannan Vice Chair: Pauline Buttling

The latest draft minutes from the sub-groups are attached for information. These are presented prior to approval by the groups at their next meeting but have been reviewed by the sub-group Chairs.

1.2 Sub-group meetings are open to all Governors and are intended to supplement and support the work of the wider Council of Governors. If there is an issue you would like any of the sub-groups to address, please liaise with the relevant sub-group Chair or come along and raise it at the next sub-group meeting.

2 WORK OF THE SUB-GROUPS 2.1 One of the primary objectives of the sub-groups is to support the Governors’ role of

holding the Non Executive Directors (NEDs) – and through them, the Board – to account for the Trust’s performance. As part of this, and as shown in the attached minutes, the sub-groups continue to review progress against the strategic aims and objectives underpinning the Trust’s business plan.

2.2 The 2014/15 strategic aims are monitored throughout the year, as follows:

Strategic Aim Sub-group Aim 1: Patients will experience safe care Patients’ Experience Aim 2: Partnership will be our strength Strategy & Performance Aim 3: People will be proud to work for us Staff & Environment Aim 4: Performance matters Strategy & Performance

2.3 Board reports on a range of issues are regularly shared with Governors for review at sub-groups and others can be presented on request. Directors and managers’ attendance at sub-group meetings gives Governors the opportunity to raise questions directly about the reports. Recently Governors have requested and appreciated increased NED attendance at sub-group meetings too.

2.4 Further information is also obtained via formal and informal updates from the Chairman and Chief Executive, Governor attendance at Board meetings held in

CoG Aug 2014: 13_(i) Sub-groups report (2)

public, the annual joint meeting of the Governors and Board, briefings received at Council of Governors’ meetings and the Board’s responses to any questions.

2.5 The meetings provide a valuable opportunity for Governors to share reports from their constituencies (public, partners and staff) as well as their own experiences and observations of the hospital’s services.

2.6 Governors are referred to the attached draft minutes on the full range of topics discussed in the most recent meetings of the sub-groups. Items of particular note since the last General Meeting have included:

• Discussions and comment on the updated Membership & Engagement Strategy, prior to its formal presentation to the wider Council;

• Review of the latest performance report and thinking about how data should/could best be presented to Governors;

• Plans to focus this year’s Annual Development Strategy session (ADS) on “holding the Non Executive Directors to account”: what information and mechanisms do Governors need or want to help them do this effectively? Can the current system be changed? improved? Proposed date for this year’s ADS is Tuesday, 14th October, 5.30-7.30pm. The central topic and date are both subject to agreement by the wider Council of Governors;

• Update on the Electronic Patients Records project – going live on 6th September;

• Briefing and useful discussion on current staffing issues, including appraisals and plans to streamline the recruitment process;

• Annual report on the Trust’s handling of complaints, concerns and compliments, and sharing lessons learned and good practice;

• Recommendations to share learning from regional and national events (see separate agenda item for feedback from the recent regional Governwell event, attended by Lisa Sanderson);

• Continued monitoring of the Trust’s actions on pressure ulcers, mortality ratios and other performance targets and quality matters;

• Proposals for distribution of sub-group meeting papers electronically – to be trialled for 3-4 months. Meeting papers will be distributed electronically to regular members of respective sub-groups and agendas will be emailed to all governors too. Full printed packs will be available at the meetings.

3 TRAINING 3.1 Governors value the training provided at the sub-group meetings but have discussed

timings. Often it has proved difficult to do full justice to both a training session and the sub-group’s usual agenda items in one meeting.

3.2 Several options have been considered, including extending the timings for these dual-purpose meetings (as trialled with Patients & Experience) or running them on separate dates to the sub-group meetings, as we have done in the past – but both routes would put more demand on Governors’ already busy diaries.

3.3 It was agreed to trial a different way of delivering the six annual training sessions:

• staggering the training across the year, alternate months • keeping to the agreed timings for these sessions, aligned with sub-group

meetings (ie 1 hour for training, 1 hour for usual business of the meeting) • Sub-group Chairs to review their meeting agendas and, if necessary, refer

pressing issues to the next sub-group meeting (not necessarily the same sub-group).

CoG Aug 2014: 13_(i) Sub-groups report (3)

3.4 With the Council’s agreement, this approach will be trialled for the next three training sessions. Revised dates and timings will be issued as the training sessions approach. Feedback on the trial as it progresses would be welcomed.

3.5 Governors are asked to let the Trust’s Chairman, Lead Governor, sub-group Chairs or Secretary to the Board know if there are any particular areas they would like to see included in the in-house programme.

4 RECOMMENDATIONS Governors are asked to: a) consider this report and the attached Minutes, and receive further updates

from the sub-group meeting Chairs at the General Meeting b) note and support the system being trialled for electronic distribution of sub-

group meeting papers c) approve the proposals for the Annual Development Strategy session – to be

held on 14th October, 5.30-7.30pm, focusing on “Holding the NEDs to Account” d) note and support proposals to reschedule the in-house training sessions on a

trial basis.

David Brannan, Tony Conway and Jordan Ramsey SUB-GROUP MEETING CHAIRS/VICE-CHAIR August 2014 Appendices: 1 – Draft Minutes for Patients Experience sub-group, June 2014 2 – Draft Minutes for Strategy & Performance sub-group, July 2014 3 – Draft Minutes for Staff & Environment sub-group, July 2014

COUNCIL OF GOVERNORS PATIENTS’ EXPERIENCE SUB-GROUP MEETING

Draft Notes from meeting held 29th April 2014

PRESENT: David Brannan (DB) Partner Governor Pauline Buttling (PB) Public Governor Tony Conway (TC) Public Governor Tony Grierson (TG) Public Governor Bruce Leabeater Public Governor, Barnsley Jacky O’Brien (JOB) Public Governor Cllr Janet Platt (JP) Partner Governor, BMBC Jordan Ramsey (JR) Staff Governor, Sub-group Chair Margaret Richardson (MR) Public Governor Lisa Sanderson (LS) Staff Governor Carol Robb (CR) Sub-group Vice Chair & Public Governor Trevor Smith (TS) Public & Deputy Lead Governor Stephen Wragg (SW) Trust Chairman

IN ATTENDANCE: Linda Christon (LC) Non Executive Director Carol Dudley (CED) Secretary to the Board Jill Pell (JP) Head of Patient Experience *

* in attendance as noted

APOLOGIES: Tony Dobell (TD) Public Governor Rachel Hewitt (RH) Staff Governor Gwyn Morritt (GM) Staff Governor Cllr Jenny Platts (JP) Partner Governor Luke Steenson (LS) Public Governor, Out of Area Joe Unsworth (JU) Public & Lead Governor, Public Governor

PE 14/17 APOLOGIES & WELCOME JR welcomed Governors and attendees to the meeting. Apologies were noted as above. JR advised that the agenda order would be revised to enable the guest speaker to address the meeting first.

PE 14/18 LEARNING FROM EXPERIENCE (LFE) JP presented an overview on the Trust’s handling of complaints, compliments and concerns (similar presentation shared with Board of Directors recently) - copy attached. Governors were reminded of the implementation of the new system, Datix, which had supported easier reporting and enabled the team to develop a more triangulated reporting system. It also supported wider information sharing across the clinical business units, further developments for which were ongoing. The presentation highlighted that key issues raised via complaints/concerns had been:

• Timeliness of response to investigations - the Trust was working hard to improve this whilst importantly still protecting the quality of the response

• Communications - training continued to support this • Lack of treatment – which on investigation often linked back to communications

where treatment might be planned or underway but not clearly communicated to

the patient/family and thus not recognised; it was essential to ensure information had been understood

• Discharge – which included a number of factors, eg discharge protocols, medications, final tests, care packages (often multidisciplinary and co-ordinated by social care workers), etc

The annual report on LFE was due shortly and could be made available to Governors on request. JP outlined the action plan for the year ahead, which was intended to build on last year’s progress and continue to improve from the learning. Shared learning across the Trust had got better and the tem would be looking to develop this further with the newly established clinical business units (CBUs), identifying trends in their areas and sharing learning and good practice across the CBUs. The Patient Advice Liaison (PALS) and volunteer’s team had handled over 2500 requests for assistance - ranging from directions, to advice and support. The presentation outlined just some of the areas the team had been involved with. The PALS team aimed to help resolve patients’ (or the families) concerns quickly; it was not intended to ‘avoid’ complaints. The Trust was keen to address concerns as quickly as possible for the benefit of the patient, by whatever route – formal (complaints) or informal (PALS) – was most suitable for the person(s) involved and to learn from the process in order to make improvements and/or avoid repetition for future patients. The Trust also received a lot of compliments formally, every one of which was acknowledged by the Chief Executive or Chairman, as were all of the formal complaints. Many more compliments were received at ward and clinic level too and an e-site was being set up to enable staff to record these too, to make the reporting more comprehensive. The action plan for 2014/15 would continue to drive improvements in the system and thus in services to patients, supported by the complaints and PALS teams and the Trust’s 250+ volunteers. This would be supported by the new governance structure coming into place, which would help ensure learning and issues were cascaded and escalated appropriately. Governors were interested to learn more about interpreter services. JP advised that these were always available at key stages, with no restriction on telephone support although some patients were reluctant to use phone services. Support was also available for patients with hearing difficulties. It was acknowledged, however, that it could still be challenging for staff to provide optimum support to patients where there were language barriers. Arrangements were more simple when the need had been identified as part of a GP referral and would become easier when the new electronic patient records services were in place. Interpreter services were focussed on ensuring patients understood their treatment plan and knew what would be happening next. LS flagged that it was often difficult to support patients moving between consultation and tests (eg from clinic to audio or for blood tests) as interpreter services were sometimes limited to the consultation itself; JOB wondered if it would be possible to develop a series of cards for “standard” patient pathways such as to/from blood tests, to assist patients. JP asked that any gaps such as this were reported to her team so that they could explore options and continue to make the best use of the available interpreter services. Before leaving the meeting, JP was thanked for an informative presentation and for answering Governors’ questions.

PE 14/19 MINUTES OF LAST MEETING The notes of the meeting held on 29th April were reviewed and accepted as a true record.

PE 14/20 MATTERS ARISING • SI (serious incident) report

LC provided further information on the reported “failure to act – harm”. As with all SIs, the case had been fully investigated. The failure and potential harm was linked to a delayed x-ray in a complex case and subsequent delays in diagnosis and treatment. It had been found, however, that treatment and outcome would not have differed had the x-ray and diagnosis been available sooner but it did identify lessons to be learned in terms of improve radiography cover at holiday periods.

• TB TG referred to another death locally due to TB. SW and LC had received further information following discussions at the last meeting and at Board. TB was rising nationally, particularly in the more crowded cities. It was confirmed that although TB was a reportable disease, it was not something hospitals were required to screen for automatically. LC advised that whilst incidence remained low in Barnsley, the Trust was going to be part of a public health review of TB services which would look at incidences and prevention and controls.

• Outpatient Kiosks LC and SW reported on a recent benefits review on the outpatient kiosks, it had shown that the kiosks had improved patient flow in the outpatients reception area; a cost savings of £18,000 pa had been identified and the kiosks had also reduced booking times and increased nurses’ time for treatments/observations (spending less time collecting patients from reception). A further service (ENT outpatients) was now using the system.

• CNST (initially raised at an earlier meeting) JR had copy handouts available to provide an overview of the CNST scheme and the different levels therein. In essence it was an insurance scheme available for certain clinical services, which trusts were required to have. The Trust was currently at level 1 for its maternity services and was looking at the Working Together programme to explore if this could be addressed differently in partnership with other hospitals as it was a significant cost to trusts.

• CQUIN (raised at an earlier meeting) JR had the required 2012/13 data available and would be happy to share it and take questions on request at or outside the meeting.

PE 14/21 REGULAR REPORTS

The report of the Assistant Directors of Nurses was noted for information (distributed via the Governors’ private website and still under development) as were the Minutes of the latest Patients Experience Group (issues largely covered in other discussions). The Clinical Governance Committee’s (CGC) assurance report, as presented to the Board recently, was received and reviewed. LC highlighted some key points, including the CGC’s request for further information regarding the national audit on increased risk of post-operative complications for emergency laparotomy and a view on the Trust’s position on this; performance against stroke indicators (improvement in performance generally, slight issues on TIAs/minor strokes and further information requested) and the assurance gained from the recent independent review of the reported peaks in mortality ratios for December 2012 and April 2013 (no issues identified) albeit a trend had been noted in relation to an increase in alcohol related deaths in young people. This information had been shared with the Health & Wellbeing Board and Public Health. A copy of the dashboard reviewed by the CGC had been included for information; it showed some of the areas for improvement (and progress to date), which the Committee continued to focus on. Governors reviewed the report and queried several items:

Pressure ulcers: TC had recently attended a demonstration using wool mattress toppers rather than plastic mattress covers and wondered if that had been considered at Barnsley. LS and SW affirmed that the Trust’s approach was based on best practice and NICE guidance. It was also acknowledged that some ulcers were unavoidable due to co-morbidities. The Trust’s increased focus on pressure ulcers was acknowledged and supported; the group also supported PB’s suggestion that it would be useful to see an annual review of progress later in the year. Action: add to work programme

Complaints: TS queried the difference in the reported number of complaints under sections 2 (21) and 4.1 (52). It was clarified that section 2 referred to complaints reported in the month; 4.1 was an accrued figure, showing all ongoing investigations to date. LC undertook to feedback the confusion in the current style of reporting. TG enquired how many of the reported complaints were from MPs/Councillors; it was noted that these were not recorded separately but all complaints would be acknowledged. It was also noted that whilst support for patients was appreciated, the Trust still needed to seek consent from the patients/families involved to pursue the concerns, often resulting in the Trust’s response being sent to the complainant direct.

Pressures on radiology services: SW acknowledged that some services were facing increased pressures, particularly in ultrasound due to a lack of sonographers nationally. The Trust’s performance had returned to “green” but work was ongoing to ensure more support going forwards.

Governors noted that as part of the Trust-wide governance review, the CGC would become the Quality & Performance Committee in future, with a wider remit and revised mechanisms for cascade to CBUs/departments and escalation to the Board. LC emphasised that the business of the CGC would be carried over into the new Committee as would the CGC’s consistent focus on patients. TG reported a situation whereby a member of staff had got something in her foot and had attended the GP, who had tried to remove the object. The staff member subsequently found part left in her foot and her line manager had referred her to A&E to have the object removed. The clinician in A&E had taken it out but had commented that she should have gone back to her GP rather than A&E. It was acknowledged that there could be two schools of thought: one that it had been right to attend A&E as the member of staff had subsequently resumed her shift, and the other that it was still an inappropriate attendance at A&E. It was stressed that staff did not get preferential treatment from the hospital albeit they were able to refer themselves direct to occupational health when appropriate. TS highlighted the Governors’ role of holding the Non Executive Directors to account and queried if future reports on performance etc should be presented in a different form for Governors to help them fulfil this requirement. It was however noted that the Trust tried to be as open with Governors as possible by sharing the reports presented to its operational teams, committees and to the Board and responding to any questions therein. To create a separate report for each issue reported to the Governors would give rise to a huge demand on management and scope for some issues to be overlooked. Equally, the Board remained happy to provide further information on any matter of interest or concern. BFL suggested an overview of the recent and impending structural and governance changes would be useful. SW affirmed that a report on this was going to the Board shortly and could be shared with the sub-group at the next meeting. Action: agenda item for next meeting

PE 14/22 KEY OBJECTIVES The objectives assigned to the Patient Experience sub-group for in-year monitoring, were reviewed and accepted. SW reminded the meeting that the Trust was currently finalising the two year turnaround plan, which might require some changes to the agreed objectives to ensure its delivery. The quality section of the latest performance report was received and reviewed. PB enquired about the reported SI involving potassium. LC outlined the basis of the incident, which was currently subject to a root cause analysis. She had been advised that the reported error had not impacted on the outcomes for the patient but had highlighted issues around recording of patient’s data, which were being pursued to prevent repetition in future.

PE 14/23 WORK PROGRAMME The work programme was noted. TS repeated his interest in the national Panel for Governors, which had been mentioned briefly as a national training event. It was agreed that this should be added to the programme for the October meeting. Action: add to work programme

PE 14/16 ANY OTHER BUSINESS AND DATE OF NEXT MEETING • Training

PB had appreciated TS’s reference to national training. She asked how feedback from training and network events could be shared more widely and it was agreed that it would be useful if those who attended would share some feedback at General Meetings, providing a brief update to the rest of the Council. Further information on the Governwell training event being hosted by Sheffield Children’s Hospital had been received. Places were now restricted to one per neighbouring Trust. Post meeting note: delegate confirmed as LS.

• Date of Next Meeting There being no further business, the meeting closed at 7pm. The date of the next meeting was confirmed for 19th August 2014, 5.30-7.30pm (including training).

Draft mins –S&P July

COUNCIL OF GOVERNORS

STRATEGY & PERFORMANCE SUB-GROUP MEETING DRAFT Notes from meeting held 8th July 2014

PRESENT: David Brannan (DB) Partner Governor (sub-group Chair)

Tony Conway (TC) Staff Governor Tony Dobell (TD) Public Governor Tony Grierson (TG) Public Governor Bruce Leabeater (BFL) Public Governor Gwyn Morritt (GM) Staff Governor Jordan Ramsey (JR) Staff Governor Margaret Richardson (MR) Public Governor Carol Robb (CR) Public Governor Trevor Smith (TS) Public & Deputy Lead Governor Stephen Wragg (SW) Trust Chairman

IN ATTENDANCE: Carol Dudley (CED) Secretary to the Board Debbie Myers (DM) Membership & Comms Officer

APOLOGIES: Pauline Buttling (PB) Public Governor

Joan Gaines (JG) Public Governor Rachel Hewitt (RH) Staff Governor Jacky O’Brien (JOB) Public Governor Mr Ray Raychaudhuri (RR) Staff Governor Lisa Sanderson (LS) Staff Governor Harry Spence (HS) Public Governor Luke Steenson (LS) Public Governor Joe Unsworth (JU) Public & Lead Governor

SP/14 27 APOLOGIES & WELCOME

DB welcomed Governors and attendees to the meeting. Apologies were received as noted above.

SP/14 28 MINUTES OF LAST MEETING Notes from the meeting held on 13th May 2014 were reviewed and accepted as accurate.

SP/14 29 MATTERS ARISING • Timings of meetings.

Extended timings had been trialled for the latest Patient Experience Sub-group meeting: 1 hour for training and 1.5 hours for business. It had worked well on that occasion but it was doubted whether it would be practicable as a regular arrangement, being mindful of Governors’ work and other commitments outside the Trust. Several alternatives were considered and in conclusion it was agreed to trial a system of:

− staggering the Governors’ six training sessions across the year, alternate months

− keeping timings of meetings with training included to 2 hours (as currently)


− sub-group Chairs would manage their meeting’s agendas to allow 1 hour business and 1 hour training when required. Any items deferred from the business part of a sub-group/training meeting, should be referred to the next (any) sub-group’s meeting if necessary or held over until the next meeting of the sub-group in question.

• Receipt of papers The meeting’s papers had fallen foul of the mailout. This was not the first time and the group agreed that sub-groups should trial an alternative system: packs would be emailed in advance to all attendees with internet access and printed copies provided at the meetings. The trial should run for 3-4 months across all sub-groups, subject to the agreement of the wider Council (to be sought by email).

SP/14 30 MEMBERSHIP & ENGAGEMENT STRATEGY DM presented a draft strategy, intended to update and refresh the existing version. The draft was built around the scope of the strategy, the vision for membership and the Trust’s duty to recruit and engage with members. DM was also drafting a supporting membership and engagement action plan, which she would present to a future meeting. Governors’ comments on the strategy were noted: • membership recruitment and engagement were equally important and were a

challenge to all FTs. • the staffing numbers referred to part and full time staff, not whole time equivalent • the constituencies should be defined more clearly - restructured in 2013 to two

Constituencies: Staff (with six classifications) and Public (with two classifications) • it should include reference to all people in the nationally recognised protected nine

characteristic groups (to be listed) • Council of Governors’ General Meetings should not be included in the list of

engagement events, although members were always welcome to attend. The wide range of other events listed was appreciated and Governors were keen to support these as much as possible. It was noted that some events were being revisited (eg “surgeries”) with better support now available through a dedicated Membership Officer, as well as new opportunities such as talks on health issues, which had proven successful in other FTs

• the vision should be shorter: first bullet point only (second bullet point could be moved to the introduction of section 2.2)

• reference to eligibility and disqualifications should be checked to ensure it matches the Trust’s Constitution

• media coverage was important in terms of engagement, Governors appreciated the avenues outlined by DM including links with “We are Barnsley” through the hospital’s charity and review of membership information on the Trust’s web site – in addition to the members’ magazine. DM was also working towards developing a 3 tier membership for future registration to encourage greater participation and support more focussed engagement and more e-communications. Additionally she was working closely with community groups and minority groups. The Chairman recommended discussing this further with Barnsley Together too, as they had a number of links already established across the community.

• any further comments from Governors should be sent to DM before 18th July, to enable a revised version to be prepared Action: Governors to submit comments to DM


• a final, version of the Strategy would be presented to the wider Council of Governors at its next general meeting, having been re-issued to sub-group members in advance. Action: DM to co-ordinate

DM was thanked for her work and an excellent draft.

SP/14 31 REGULAR BOARD REPORTS & REVIEW OF KEY OBJECTIVES

a) Mortality Ratios Deferred, pending receipt of the new style report expected shortly following the recent review with the Advanced Quality Alliance (AQuA) and an in-house workshop, intended to refresh the action plan and reporting mechanisms. It was acknowledged that a lot of work was continuing around this important subject, and TS referred back to the sub-group’s last meeting (Minute SP 14/23) to illustrate this further.

b) Performance report The integrated performance report for month 2 (as presented to the Board of Directors in July) was reviewed. It was noted that the format had been revised in some parts, making the report even more comprehensive, and further work was ongoing. As the report was in a development phase, SW advised that all targets and indicators would become colour coded in future (red/amber/green) to show the position more clearly; “crosses” indicated data not available or not applicable. Several aspects of the report were highlighted in discussion, including: • SIs (serious incidents) had increased; GM and SW explained that in part this

was due to the higher number of issues now counted as SIs, including pressure sores. The meeting agreed that it was good to see more issues reportable/ reported albeit trends and exceptions must continue to be scrutinised closely.

• Most indicators used only red or green ratings, which could lead to some data being open to misinterpretation; amber could be used for some issues to denote progress. Whilst Governors agreed with this, it was requested that any system changes (eg criteria/ratings system) be explained so that they were aware of changes and the implications. TS also suggested it would be useful for mini reports, with further explanation, to be available for Governors on issues flagged as red as part of holding NEDs to account (see also Minute SP 32 re development session).

• The Trust was currently underperforming against elective activity and work was ongoing to identify the rationale behind this.

• GP referrals were high and work was ongoing across the community to review this, ensuring patients were referred appropriately to the right services in or outside or the hospital. TS and DB referred to recent national reporting on GP referrals (sometimes too late to enable effective treatment) and the impact of national awareness campaigns (increases in referrals), which were also acknowledged as important factors.

It was agreed that all “red” issues should continue to be challenged and assurance sought on robust actions to address these; DB assured the meeting that this approach was followed by the Non Executive Directors (NEDs) at every Board meeting. There was considerable discussion around Governors’ attendance at Board meetings, with several Governors suggesting that all members of the Council of Governors should attend at least one Board meeting per annum, enabling them to see the Board in action and be assured on its approach. It would also be a useful


tool in terms of holding the NEDs to account, which is one of the Governors’ key statutory responsibilities. Whilst the Board’s meetings were technically restricted for observation, the Chairman always made time to receive questions at the end of each meeting; Governors also had opportunity to submit questions directly to the Chairman after the meetings and to raise issues at sub-group and general meetings. It was not, however practicable for everyone to do so and there were diverse views on the benefits. It was, however, agreed that it was equally important that NEDs should attend Governors’ meetings more frequently, including the sub-groups, as these provided opportunity for Governors to ask direct questions of the NEDs. It was greatly appreciated that the Chairman attended nearly every sub-group meeting and that Mrs Christon attended the Patient Experience Sub-group meetings regularly but it would be good to see other NEDs at meetings too. Mr Patton’s contribution at the latest Staff & Environment meeting had been very useful. JR reminded Governors that they had the right to request Directors to attend meetings to provide information on identified issues. This could be particularly useful in terms of finance, if one of the NEDs could talk it through albeit it was emphasised that no single NED was responsible for any one issue: the Trust operated a unitary Board, with all Directors holding equal responsibility for every area. Governors were mindful of the detailed confidential briefing provided by Mr Diggles recently on the current financial position; this had been both useful and comprehensive. The session had answered many of their questions on the current and future financial position albeit there were still some queries about how the situation had arisen. It was anticipated this would be answered when the investigation outcomes were known. The Chairman advised that the two year turnaround plan had been submitted to Monitor on 30th June, further details on which would be cascaded widely once approved by Monitor. Monitor had queried one aspect already – sign off of contract with the commissioners. The Board had confirmed that it would continue to defer sign off until the contract met the Trust’s needs, which was now very close. The Governors welcomed and supported this approach.

SP/14 32 ANNUAL DEVELOPMENT SESSION (ADS) It was agreed that the 2014 annual development sessions should focus on holding the NEDs to account. Whilst this had worked well to date, things were changing (including performance reporting formats) as discussed earlier and the environment and challenges were tougher. It was therefore timely to review the current system: what did Governors need in order to be able to hold the NEDs to account? How was or could this be delivered? Options for the date and time of the ADS were also discussed. Previously it had been held in the afternoon immediately before the October General Meeting but this had made it a long day and attendance had suffered consequently. It was suggested that a separate evening meeting should be scheduled: 14th October, 5.30-7.30pm. This would be proposed to the wider Council for agreement at the next General Meeting.

SP/14 33 2014 WORK PROGRAMME Noted – further comments welcomed outside the meeting.

SP/14 34 ANY OTHER BUSINESS & DATE OF NEXT MEETING i) Emergency Department

SW advised that the outcomes of the Research & Development team’s work on the Emergency Department were now available. These would be presented to the Governors’ via a sub-group meeting shortly.


ii) Review of Meeting It was agreed that it had been another good meeting with lively discussion and valuable input from everyone present.

iii) Date of Next meeting There being no further business, the meeting closed at 7.25pm. The date of the next meeting was confirmed for 16th September at 5.30pm.

13_(iv) SE July 2014 (DRAFT) p1 of 5

COUNCIL OF GOVERNORS STAFF & ENVIRONMENT SUB-GROUP MEETING

Notes from meeting held 22 July 2014 PRESENT: David Brannan (DB) Partner Governor

Tony Conway (TC) Staff Governor (Volunteers), Chair Tony Dobell (TD) Public Governor Tony Grierson (TG) Public Governor Jacky O’Brien (JOB) Public Governor Mr Ray Raychaudhuri (RR) Staff Governor Margaret Richardson (MR) Public Governor Joe Unsworth (JU) Public & Lead Governor Stephen Wragg (SW) Trust Chairman

IN ATTENDANCE: Jason Bradley (JB) Director of ICT * Suzy Brain England (SBE) Non Executive Director Hilary Brearley (HB) Director of HR & OD * Carol Dudley (CED) Secretary to the Board Rema McKend (RMcK) EPR Communications Lead * Francis Patton (FP) Non Executive Director Michelle Sheppard (MS) HR Resourcing Manager * Llinos Williams (LW) Lorenzo Programme Manager * (* attended as minuted below)

APOLOGIES: Pauline Buttling (PB) Public Governor

Joan Gaines (JG) Public Governor Bruce Leabeater (BFL) Public Governor

Gwyn Morritt (GM) Staff Governor (Nursing & Midwifery) Jordan Ramsey (JR) Staff Governor (Non Clinical Support) Carol Robb (CR) Public Governor Lisa Sanderson (LS) Staff Governor (Nursing & Midwifery) Trevor Smith (TS) Public & Deputy Lead Governor Harry Spence (HS) Public Governor

SE/14 23 APOLOGIES & WELCOME

TC welcomed governors and attendees to the meeting and noted apologies as listed above. It was agreed that the meeting would move directly to the briefing with HB, before reverting to the main order of the agenda.

SE/14 24 STAFF ISSUES HB provided more information on several of the issues raised at the last meeting:

• Recruitment: Staff governors had commented on the length of time taken to recruit new staff, particularly nurses, following receipt of a resignation. HB advised that a number of factors impacted on this – internal and external, as shown in the report by MS (copies tabled). It was acknowledged that the vacancy control panel also impacted


on the time taken for recruitment but the meeting agreed it was right to ensure that the need to fill every vacancy was challenged. The report from MS outlined current practice across the Trust and plans to reduce recruitment times. An agreed standard for recruitment timings would be established; it would be monitored, analysed and reported differently in order for the new target of 56 days to be met (30 days, discounting statutory checks, which were outside of the Trust’s remit), albeit SW pointed out that the timeline started from receipt of notice at HR, not from actual date of resignation. MS and HB expanded on some of the actions that would support the new approach It was acknowledged that the recently reported ward closures would have a short term impact on recruitment. HB confirmed that all of the qualified nurses affected would be reassigned within the hospital. Most of the unqualified staff would also be reassigned immediately and the employment of the remaining staff would be protected for 12 months, within which time it was anticipated the majority would be able to find other roles in the hospital. TG complimented the Trust on being able to make the changes without creating any redundancies. MR queried why the Trust had needed to close wards at all and it was explained that this action had been agreed as part of the work on better utilisation of beds (reduction in bed numbers, not necessarily wards) and improved patient flow. Changes to the Trust’s bed base was just one element of a wider action plan built on the findings of the bed utilisation review undertaken in January 2014. A closed ward would be “mothballed” so that it could be put back into use quickly if needed for an emergency or winter pressures. The reduction in beds did mean that bed occupancy was over optimum, as JU had surmised, and this was being monitored carefully. RR also asked if information could be provided on other aspects that might also be affected, such as incidence of infection and cancelled operations. HB affirmed that performance data was monitored weekly and had not shown any adverse impact following the bed reduction. High quality and safe services patient continued to be of paramount importance to the Trust and the Executive Team would take action if these were jeopardised by any of the changes made.

• Appraisals HB confirmed that the low level of appraisals reported at the last meeting had improved to 86.5% by the end of June. This was a great achievement, particularly in view of the new system introduced from 1st April, which required appraisals to be completed in Q1 and linked to Agenda for Change increments and Trust values and behaviours, rather than the national key competency framework. It was now equally important to ensure that the appraisals were meaningful, and HB outlined steps in place to support this. She also confirmed that refresher training was available for staff. FP advised that on a recent quality & safety visit, several ward staff had offered to let him see their appraisals. Whilst the staff had appreciated the changes made to the appraisal system, FP welcomed plans to build stronger links with the Trust’s business plan and develop more evidenced-based assessments too.

• Staff motivation and engagement This was always important and never more so than in the current situation. Staff were a key asset to the Trust and it was vital that they felt supported, engaged and motivate. Recent improvements in internal communications were proving effective and had been appreciated, alongside greater visibility and access of the Board and executives. Building on this, the Board would shortly issue a summary of the turnaround plan to all staff (and external partners). The Trust’s approach to


engagement, data sharing and introduction of change had been revised with the establishment of the CBU, introducing better ways to share information (from Board to ward and vice versa) – and further work on this was continuing.

Before they left the meeting, HB and MS were thanked for an informative update. FP assured the meeting that all of the issues raised above would also be closely monitored by the Board’s Finance & Performance Committee regularly.

SE/14 25 MINUTES OF LAST MEETING

The notes of the meeting held on 22nd June were received and reviewed. Contrary to the attendance shown, both TG and RR had been at the meeting. Subject to this correction, the notes were accepted as accurate.

SE/14 26 MATTERS ARISING • Safeguarding

TG reported on an incident in which a child attending the Emergency Department (ED) had been in the same area as patients under the influence of drugs or alcohol in the ED. SW acknowledged that the Trust did not direct addicts away from A&E (to another unit), as was the practice in some larger hospitals, but believed this had been an unfortunate occurrence as there was a separate area for children attending the ED.

• TC commented on an increase in the number of patients being accompanied by the Police. This had not, however, been reported as a concern to staff and it was acknowledged that all patients attending ED should receive the same level of care and treatment.

SE/14 27 ELECTRONIC PATIENT RECORDS (EPR) / LORENZO JB joined the meeting and introduced LW and RMcK, and their roles in the team. JB outlined the progress to date, with six weeks to go to “go live” for the Lorenzo system. Lorenzo would enable the Trust to retire the existing PAS (patient administration system) and use more electronic documentation, including nursing plans. A trial exercise had been carried out to ensure switchover would work and a number of staff training sessions had taken place, with more scheduled (including training for new junior doctors working in the Trust on rotation). The system would be introduced initially in ED and inpatients, then outpatients. The next stages would explore options for midwifery and theatres, subject to approval of business cases. The Trust intended to move towards increasingly paperless working. Governors were assured that existing paper records (patients notes) would be retained in line with national guidance for data retention but would be called upon less frequently as the Lorenzo system became more established. Links for information sharing locally – with GPs and neighbouring trusts and hospitals – would also be explored if beneficial to patients (and still protecting confidentiality of patients’ data), as well as alignment with national systems if/when implemented. SBE and SW asked the team if the changeover would present any risks to patients or delivery of key targets. LW acknowledged that there could be delays on some aspects of services but the preparatory work and training carried out to date should ensure these were kept to a minimum, with the Trust expected to resume normal activities within 2-3 weeks rather than the 4-5 months experienced by earlier implementers. The key differences introduced with Lorenzo would be in the working environment not care plans, so there should be no risks to patient care. Nonetheless,


the system would be monitored very closely from the start to ensure that patient care and safe services were not put at risk and any technical issues identified and addressed as quickly as possible. All of this work would be supported by the engagement work led by RM. JB and the team also confirmed that the project would “go live” on the planned date of 6th September. JB, LW and RMcK were thanked for providing an informative update, and left the meeting at this juncture.

SE/14 28 KEY OBJECTIVES The latest Board reports on the business plan objectives monitored by the staff & Environment sub-group were received and reviewed. FP reminded the meeting that the data was historic (May), as illustrated by the 30% compliance for appraisals, which had in fact increased to over 85% as reported at the meeting (see above). He also confirmed that whilst the NHS did not have a national target for appraisal uptake, the average was 30% and the Trust compared well with peers. JOB sought more detail on the data for sickness absence. FP advised that this would be reported into and closely monitored by the Finance & Performance Committee, alongside the other issues already flagged. The latest position was below target but was a marked improvement on historic problems of, say 5-6 years ago. D&V, stress and musculo-skeletal related ailments were among the highest illnesses reported but there were other multi-factorial issues to be taken into account and work was continuing to drive further improvements and more support to staff. The ability to self-refer to occupational health was well used and the recent initiative of enabling staff to take on a different role within the Trust to help them get back to work was proving effective. SBE advised that staff were encouraged to make good use of the fairly new “wellbeing” app too. Governors noted and welcomed the support provided to staff. The Trust would continue to look at other initiatives to support staff and reduce absence, including options around pay for the first day(s) of absence. The Board did not, however, wish to reduce the internal target as sickness absence put additional pressures (workload) on other staff and was a financial pressure. The new CBU structure allowed closer scrutiny and more support to be offered to those areas identified with higher levels of sickness absence.

SE/14 29 WORK PROGRAMME The programme was reviewed and noted. JOB highlighted the update on Estates, which had been scheduled for the July meeting. This had been deferred to allow sufficient time for the reports from HR and IT (as above). The work programme was flexible and this approach seemed to work well. Action: Update on estates to be scheduled As usual, suggestions for further items to add to the programme were welcome and should be addressed to the sub-group Chair or CED outside the meeting.

SE/14 30 ANY OTHER BUSINESS i) Smoking on site

MR had noticed a number of patients smoking on site, near the Pogmoor Road side door entrance. SW confirmed that anyone reported smoking on site would be moved on by the security team. Everyone was encouraged to let security know when they saw people smoking on site. so that action could be taken swiftly.


ii) Drinking water dispensers MR had been approached by a member who had reported concerns regarding staff using the water dispensers on site inappropriately to refill water bottles, giving rise to poor hygiene and infection risks. The Trust would like to progress this issue through its reporting system with the member’s agreement (which MR was able to confirm), in order to reinforce good practice and refresh signage. Action: email and contact details to be passed on to PALS/complaints team

iii) Review of meeting It was agreed that it had been a good meeting overall, with some useful briefings and interesting discussion.

There being no further business, the meeting closed at 5.35pm; the date of the next meeting was confirmed for 30th September 4-6pm (to include training).

COUNCIL OF GOVERNORS – AUGUST 2014 REF: COG/14/08/14

CoG Aug 2014/14_(i) Board of Directors

14

BOARD OF DIRECTORS

1 MEETING PAPERS & AGENDA

1.1 The Agenda for the meeting of the Board of Directors held in public on 7th August 2014, is attached for information. The minutes of the previous meeting, held in July are also attached (subject to approval at the August meeting).

1.2 The performance report for month 3, is enclosed too. Progress against delivery of the strategic objectives for the 2014/15 business plan will continue to be monitored through the sub-groups (please see sub-group report for more detail – agenda item 13) and the full performance report is reviewed regularly at the Strategy & Performance sub-group. Any questions or comments on the report would also be welcomed at the General Meeting.

1.3 Copies of the full reports from all Board meetings held in public are available on the Trust’s website (www.barnsleyhospital.nhs.uk) or on request from the Secretary to the Board (Carol Dudley, 01226 431818 or email [email protected]).

2 FUTURE MEETINGS 2.1 Governors, staff and members of the public are welcome to come along to any

meetings of the Board held in public. Meeting papers will be provided on the Trust’s website and at the meeting.

2.2 Under the 2014 meeting schedule for the Board of Directors, their meetings are generally held on the first Thursday of every month. The timings and venue are unchanged (ie 9am, in the Education Centre).

2.3 The next meeting of the Board of Directors to be held in public is scheduled for 9am on Thursday 4th September 2014.

3. RECOMMENDATION Governors are asked to receive and note this report.

Stephen Wragg CHAIRMAN August 2014

A MEETING OF THE BOARD OF DIRECTORS

WILL TAKE PLACE ON THURSDAY 7TH AUGUST 2014, 9AM IN THE EDUCATION CENTRE, BARNSLEY HOSPITAL

AGENDA

No Item Sponsor Ref

1. Apologies and Welcome

S Wragg, Chairman

2. To receive any further declarations of interests 14/08/P-02

3. To approve the Minutes of the meeting of the Board of Directors held in public on 2nd July 2014 14/08/P-03

4. To approve the Action Log in relation to progress to date and review any outstanding actions

14/08/P-04

Strategic Aim 1: Patients will experience safe care

5. To receive and consider a Patient’s Story L Christon Non Executive Director

6. To receive and endorse the Medical Director’s quarterly update report. Dr J Mahajan

Medical Director

14/08/P-06

7. To receive and approve the report on Doctors’ revalidation 14/08/P-07

8. To receive and endorse the monthly update on Nursing & Midwifery staffing

A Bielby Deputy Dir of Nursing 14/08/P-08

9. To approve the annual report on Infection Prevention & Control

Dr J Rao Director of Infection

Prevention & Control 14/08/P-09 Presentation

10. To note and support progress on the Hospital @ Night programme

A Bielby Deputy Dir of Nursing 14/08/P-10

11.

For the Trust’s Mortality Ratios: a) To review progress on the Trust’s Mortality Ratios b) to note the review outcomes and approve the action plan c) to note audit status for Sepsis Six and NEWS programmes

Dr J Mahajan Medical Director

14/08/P-11 (a-c)

12. To receive and endorse assurance report from the Clinical Governance Committee

L Christon Committee Chair 14/08/P-12

13. To receive and endorse assurance report from the Finance & Performance Committee

F Patton Committee Chair 14/08/P-13

14. To receive and endorse assurance report from the Audit Committee

P Spinks Committee Chair 14/08/P-14

15. To approve the Terms or Reference for the Governance Committees A Keeney

Assoc Director of Corporate Affairs

14/08/P-15

16. To review and endorse the Board Assurance Framework (month 3 report)

14/08/P-16

Cont/…

No Item Sponsor Ref

Strategic Aim 2: Partnership will be our strength

17. To note and endorse the monthly report from the Chairman S Wragg Chairman 14/08/P-17

18. To note the monthly report from Chief Executive D Wake, Chief Executive 14/08/P-18

19. To receive and endorse the quarterly marketing and communications report

E Parkes Director of Marketing &

Communications 14/08/P-19

Strategic Aim 3: People will be proud to work for us Strategic Aim 4: Performance matters

20. To review the integrated performance report (month 3) Executive Team 14/08/P-20

21. In accordance with the Trust’s Standing Orders and Constitution, to resolve that representatives of the press and other members of the public be excluded from the remainder of the meeting, having regard to the confidential nature of the business to be transacted. Date of next meeting: - 4th September 2014, 9am, at Education Centre, Barnsley Hospital

Signed: ………………………….. Chairman

Please see reference section at back of papers for key to business plan and glossary of terms/acronyms

REF: 14/08/P/03

REPORT TO THE BOARD OF BARNSLEY HOSPITAL NHSFT

MINUTES OF A MEETING OF THE BOARD OF DIRECTORS HELD ON 2ND JULY 2014

IN THE EDUCATION CENTRE, BARNSLEY HOSPITAL NHSFT

PRESENT: Mrs S Brain England OBE Non Executive Director Mrs L Christon Non Executive Director Mr S Diggles Interim Director of Finance Mrs K Kelly Director of Operations Dr J Mahajan Medical Director Mrs H McNair Director of Nursing & Quality Mr P Spinks Non Executive Director Ms D Wake Chief Executive Mr S Wragg Chairman

IN ATTENDANCE: Ms L Bamford Lead Nurse, Clinical Business Unit 4 * Dr A Bowry Clinical Director, Clinical Business Unit 5 Mr J Bradley Director of ICT Ms H Brearley Director of HR & Organisational Development (OD) Mrs L Christopher Associate Director of Estates & Facilities Ms C E Dudley Secretary to the Board Ms E Foreman Clinical Nurse Lead, Deloitte (Observer) Dr K Kapur Clinical Director, Clinical Business Unit 3 Ms A Keeney Interim Assoc Director of Corporate Affairs Mr R Kirton Director of Strategy & Business Development Ms E Parkes Director of Communications & Marketing Mr M Shiwani Clinical Director, Clinical Business Unit 4 Ms A Trainer Head of Nursing, Clinical Business Unit 4 * Mr M H Wickham Clinical Director, Clinical Business Unit 5 (* attending for Minute ref 14/115)

APOLOGIES: Sir Stephen Houghton CBE Non Executive Director Mr F Patton Non Executive Director

14/111 APOLOGIES & WELCOME

Members and attendees as noted above were welcomed and apologies were noted from Sir Stephen and Mr Patton. Particular welcomes were extended to Ms Foreman, attending to observe as part of the Deloitte review of the Trust’s governance arrangements, and three Clinical Directors (CDs) – Dr Bowry, Mr Shiwani and Mr Wickham. The Chairman affirmed that, following establishment of the new Clinical Business Units (CBUs), invitations had been extended to all of the CDs to attend Board meetings to provide advice directly to the Board, share updates from their CBUs and ensure timely feedback to their teams.

BoD August 2014: 14_(ii) Board Mins July 2014 Page 2 of 14

14/112 REGISTER OF INTERESTS AND (14/07/P-02) DECLARATION OF INTERESTS The latest Registers of Interests for the Board of Directors, the Executive Team and Clinical Directors were received and noted. Members were reminded that any changes to their entries on the Registers should be declared as soon as possible. No declarations of interest were received for any agenda items.

14/113 MINUTES OF LAST MEETING (14/07/P-03) The Minutes of the meeting of the Board of Directors held in public on 3rd June 2014 were received and approved as a true record.

14/114 ACTION LOG (14/07/P-04) The action log showing progress on matters arising from the last and previous meetings held in public was reviewed and noted. Two of the older entries on the log were queried:

• 14/10 (January 2014) – inreach model for AMU to be refined The log showed that the review had been completed but further progress would be “subject to funding”. Mrs Kelly advised that this related to funding sought as part of the 7-days working business case, a decision on which was due from the Clinical Commissioning Group (CCG) shortly.

• 13/182 (July 2013) – HSMR The log showed that the strategy would be developed after the review led by AQuA (Advanced Quality Alliance) had been completed. Dr Mahajan confirmed that the review work had now been progressed with AQuA, feedback from which had been shared at a recent workshop held with attendees from key areas across the Trust – see latest report on Mortality Ratios for more information. The action plan on mortality ratios was currently being revised building on the AQuA review and outcomes from the workshop and would be presented to the Board as soon as possible.

14/115 PATIENT’S STORY Mrs McNair introduced Ms Trainer, one of the new Heads of Nursing, and Ms Bamford, a Lead Nurse in CBU 4, to present this month’s Patient’s Story. It comprised three accounts recently published by patients, relating to treatment received in May or June: two on the NHS Choices website and one in the Barnsley Chronicle. Each of the stories was very positive: • one from a patient who had previously used private healthcare and had

been wary of using an NHS hospital. Their experience had been a positive one overall and they had appreciated the support and clear explanations given by the hospital’s caring staff;

• the other case posted on NHS Choices related to a patient who had received treatment under anaesthetic for the first time in their life. They had been put at ease throughout their treatment and able to go home on the same day. They had been very impressed by both the staff, particularly those on the Surgical Admissions Unit (SAU), and the brilliant care they received pre- and post-operatively;

• the third case was similarly positive and again related to the SAU.


Ms Trainer and Ms Bamford emphasised the value of positive feedback like this being shared with the teams involved to ensure learning and further improvements. It was also a boost to staff morale. The Board agreed that the reports were a positive acknowledgement of the high standards of care provided on the SAU. Mrs Kelly endorsed this and advised that the unit worked extremely well, particularly around escalation needs with a flexible approach between day cases and in-patients, ensuring that all patients received the right care at the right time. It was recognised that the unit operated differently to other areas, with a different mix of patients and their corresponding needs. Nevertheless the unit clearly benefited from the strong clinical leadership provided by Ms Bamford and the Board suggested that it would be useful to identify learning points and good practice to be shared with other teams. Mrs Brain England also asked if some form of “buddy” mentoring could be provided so that newer lead staff could benefit from the experience of more experienced nurses such as Ms Bamford. Ms Trainer advised that she had been looking to develop this with the band 6 and 7 staff she had worked with previously and intended to revisit the possibilities in the new CBU. She would also explore other opportunities to share learning, as outlined by the Board. Dr Mahajan further commended the team and reported that junior doctors and medical trainees often commented on the learning and good experience they had benefited from when working with the SAU team. The Board appreciated the work of everyone on the SAU team and thanked Ms Trainer and Ms Bamford for their leadership and for attending the meeting as part of the Board’s approach to Patients’ Stories. The Chairman reminded members that Patients’ Stories were taken as an early agenda item to reinforce the purpose of the meeting – to support the Trust’s intention to provide top class services for patients.

14/116 NURSING & MIDWIFERY STAFFING (14/07/P-06) Mrs McNair presented the second report on monthly nursing and midwifery staffing levels against plan. The report differed slightly to the version presented last month, reflecting changes required by the Department of Health/NHS England (NHSE). The data presented in appendix 1 to the report would be posted on the national system; it now included “harm” data, as shown in the final columns. It was anticipated the published data would be accompanied by RAG (red/amber/green) ratings at some point as reporting developed further. The latest data showed that the Trust was meeting its requirement for staffing numbers, with appropriate mitigation in place where required. The accompanying report expanded on the core data required by NHSE for publication. The additional information provided for the Board highlighted areas of shortfalls and overstaffing and the mitigating actions taken. Mrs McNair advised that one incident of harm potentially could be linked to staffing levels albeit this was a subjective assessment presently; the incident was being reviewed in more detail to identify any learning. It was acknowledged that the reported shortfalls were largely due to vacancies, maternity leave and sickness absence. A reduction in sickness absence would make an impact, as would improvements in recruitment; the latter was particularly challenging with over 500 nurse vacancies currently across the region. Work was ongoing to support recruitment and Mrs McNair outlined some initiatives being explored with the Universities to attract interest into specialist areas in particular, as these were often harder to recruit to in smaller


general hospitals. The Board was mindful of proposals to reduce the headroom currently embedded in nurse staffing levels, from 22% to 18%. Mrs McNair also reminded the Board of the staffing ratios of registered nurses to patients applied at Barnsley (1:7 compared to the national average of 1:8), giving further support to safe care. The data return showed the Trust at 9.1% of shifts uncovered against planned rotas, which compared well with the national benchmark for staffing levels deemed unsafe (80% cover). Mrs McNair anticipated being able to provide more detailed and comparative information after a full quarter’s data had been published. Mrs Brain England welcomed the data and the extended report which, collectively, gave the Board good assurance on safe staffing levels. However, she did ask if the presentation of the report – and the data displayed on every ward – could be revised to ensure that same level of assurance was also provided for members of the public. Mr Spinks referred to previous discussions in which the Board had requested more information on the mitigating actions and emphasised that, even if national reporting was against planned staffing, the Board needed assurance on actual staffing levels on wards. Mrs McNair affirmed that a lot more data was available in detail for each ward but was difficult to present in a cohesive report format due to the volume of data available and, for accuracy, the need to take account of the acuity mix each day (one ward could be “short” of staff but with only 70% of its beds occupied, thus having more than sufficient staff to care for its patients at that time). Mrs Kelly reported on a system used in a trust she had worked with previously, which provided a report that in effect showed the staffing position 30 minutes into each shift, presented 24 hours retrospectively, reflecting actual staffing rather levels against plan at the start of shifts. It was agreed that this could be useful and should be pursued. As indicated above, it was agreed that, whilst the report met NHSE requirements, for the Board’s purpose it would be useful to revise it in terms of both format and content in order to give better assurance. This would be referred to the Quality & Governance Committee for action.

HM

LC/HM Q&G

14/117 HOSPITAL STANDARDISED MORTALITY RATIO (HSMR) (14/07/P-07) & SUMMARY HOSPITAL MORALITY INIDCATORS (SHMI) Dr Mahajan presented and expanded on the latest report to May 2014, which showed progress on the agreed action plan, including the productive workshop on mortality rates held in June and continuing work to increase awareness of the Sepsis Six initiative. The report did not, however, provide an update on the Trust’s HSMR and SHMI position as no new statistics had been issued since last month: there had been a delay in issue of HSMR data nationally and SHMI statistics were only released quarterly. In terms of crude mortality rates, Dr Mahajan affirmed that the Trust had remained below mean since May 2013 and the position for May 2014 was at its lowest (best) since recording of this indicator had begun. Dr Mahajan also drew attention to the potential impact of the clinical decision unit (CDU) on mortality rates. The CDU provided a better service for patients – and their families – for end of life care but it also meant that more deaths were counted in the Trust’s mortality rates. The Executive Team were looking at the implications of this more closely. Several members commented that, whilst it was disappointing the latest report did not provide an update on the Trust’s HSMR or SHMI positions, it would be useful if other elements of the report could also be reviewed to ensure information was current and relevant. It seemed to be growing in size but was not matched by a greater understanding of the issue. Dr Mahajan advised that


a review of the report’s format, together with the action plan, was already in progress as mentioned earlier, linked to work progressed with the Allied Quality Alliance (AQuA). Mr Spinks also queried the SHMI position, which was reported to be within expectations but continued to show the Trust to be high compared to others, particularly against similarly sized trusts. It was clarified that (a) the statistics available to date still included the anomalous months reported previously - December 2012 and April 2013 - the impact of which was expected to lessen in future reporting, and (b) the data could not reflect the differences between the varying trusts, some of which had a very different patient and acuity mix (for instance, Airedale, which had no trauma department). It was agreed that it would be useful to include a brief explanation of such key factors where possible. Dr Mahajan affirmed that reportable progress towards the agreed reduced target for HSMR would remain slow throughout 2014/15, with a greater impact showing towards the year end, as set out in the Trust’s Quality Strategy. It was agreed that it would be useful if the report demonstrated what was and was not working, to give assurance that the Trust continued to minimise avoidable deaths and to illustrate progress of each of the agreed actions. Ms Wake recommended that future reports should include a schedule of audits and milestones too. The need to restructure the report was acknowledged but did not undermine the work and progress ongoing:

• Ms Wake commended the work and progress to date

• Dr Mahajan and Ms Wake advised that review work on all deaths had developed over the past six months. This had led to a number of mortality and morbidity reviews being undertaken to help the Trust identify any issues within each CBU. The reviews were scrutinised via the Patient Safety Steering Group. It was agreed that a succinct overview of this work would be useful to share with the Board, on a quarterly basis.

• Mrs McNair referred to ward by ward quality indicators, which were regularly monitored and provided more detail on issues such as compliance with the NEWS (national early warning signs) training. A ‘heat map’ was available for the latter; if required this could be reviewed at the Quality & Governance Committee, which in turn could provide assurance to the Board. This offer was accepted.

• Dr Mahajan advised that key actions were reviewed via weekly reports at operational meetings.

• As Chair of the Clinical Governance Committee (CGC), Mrs Christon assured the Board that the CGC had spent a lot of time reviewing reports relating to mortality and would continue to do so under the new form of the Quality & Governance Committee.

Dr Mahajan reconfirmed that the format report was under review. A revised version, taking account of AQuA’s recommendations and updated action plan, would be presented for the Board’s consideration shortly. Once approved by the Board, the new report and refreshed plan would be managed through the Trust’s Mortality Steering Group and monitored via the Quality & Governance Committee.

JM/JB

JM

HM

JM

14/118 NON CLINICAL GOVERNANCE & RISK COMMITTEE (14/07/P-08) (NCGRC) - ASSURANCE REPORT Mrs McNair presented the assurance report on behalf of Mr Patton, NCGRC Chair, following the latest (last) meeting of the Committee held in June. She


drew attention to the Committee’s suggested allocation of ongoing issues to the new Quality & Governance and Finance & Performance Committees, to ensure that nothing was overlooked in the transition, including: • further work required on DNAs (did not attends), assurance on which was

still outstanding despite two reports commissioned by the committee, neither of which had proved satisfactory. NCGRC recommended that this be pursued through the Quality & Governance Committee. – Mrs McNair advised that the Executive Team was leading some work to

take this forward. Mr Bradley and Mrs Kelly outlined key aspects being progressed with the CBUs to prevent DNAs. The links with the Trust’s work on space utilisation were also highlighted. Mrs Kelly advised that Children’s service and Hepatology services remained the highest areas for DNAs. The former was not unexpected and needed to be managed with care. Plans were being considered for the latter services, to develop a different approach to better fit with patients’ needs;

• risks associated with the pathology systems when the current support contract expired in November (a joint risk shared with Rotherham FT). The Committee recommended that this be referred to the Finance & Performance Committee for close monitoring. – Mr Bradley confirmed that work was ongoing; his team would be

meeting with the current providers shortly to discuss options for support after December 2014 but the risk would remain until the situation had been fully addressed. Ms Wake advised that the issue had been discussed at the recent performance review with pathology and the CBU had been requested to provide more detail at the next meeting with a view to taking it to the CCG for support or, if necessary, looking to the small financial contingency held in the Trust’s capital programme. Mrs Christopher advised that overall costs to secure the extended support needed were estimated at £400,000 (to be shared across both trusts).

• Appraisals - to be monitored via the Finance & Performance Committee. Mrs Brain England emphasised Mr Patton’s view that work now needed to focus on quality not just quantity and ensure staff’s objectives were more clearly linked to the Trust’s business plan. – Ms Brearley reminded the meeting of the new appraisal programme for

all staff (other than medics) launched recently to fit better with the Trust’s business plan process and agreed values and behaviours and to enable introduction of robust performance measures as required under Agenda for Change. Whilst compliance levels stated in the report only showed 30%, the position at end of June had improved to 85.6%. This turnaround was commendable, reflecting a huge level of commitment across the Trust. In addition, a new step had been instigated through the Together We Will Make It Better initiative, learning from last year’s staff survey and the Trust now issued a personal questionnaire to all staff on completion of their appraisal. This would enable the Trust to collate more feedback on the quality of appraisals and develop further improvements.

– Ms Wake advised it had been recognised that the changed process was not perfect, particularly in relation to the expectation for appraisals to be completed in the first three months of the financial year and alignment with strategic objectives. She had discussed these aspects with many staff at local level and appreciated their comments. The process was a work in progress and there were improvements to be made but the

LC/ Q&G

FP/ F&P

FP/ F&P


attainment of 85.6% – which would put the Trust in the top 20% nationally for compliance – was commendable. It was affirmed that further work on the appraisal process would be linked to the turnaround plan and Ms Parkes also advised that the communications plan would ensure continued cascade of the Trust’s objectives throughout the year.

The Chairman requested further information on two other points featured in the report: • E-prescribing

– it was confirmed that this had been withdrawn from the Trust’s work on its new electronic patient reporting (EPR) programme, however, the Trust continued to keep a watching brief on developments via Lorenzo, and

• Re-siting of the Clinical Coding team – Mrs Christopher advised that a temporary space had been identified within O Block, so that the team could be located more centrally. The move would be completed shortly.

The Board noted the Committee’s concerns, supported the processes proposed to address them and endorsed the Committee’s suggested re-allocation of identified issues for future monitoring. The Board also endorsed the NCGRC’s request that the new governance structure must be fully implemented with appropriate and robust terms of reference (next agenda item referred). As part of its usual business, the Committee had reviewed and recommended one new policy: • Governor and Members expenses policy It has also approved three amended/updated policies: • Supporting Staff involved in an accident, complaint or claim • Stress Policy • Contamination Incident Policy All of the above policies were approved and/or ratified by the Board accordingly.

14/119 GOVERNANCE RESTRUCTURE (14/07/P-09) The Board considered the proposed new governance structure presented by Ms Keeney. The new approach was intended to be more streamlined and to reflect a two-way approach with the Board and Trust being assured upwards through the organisation’s structure and also ensuring cascade back down. Ms Keeney explained that the structure had several main parts: the new committee structure – Quality & Governance, Finance & Performance and Audit – processes for reporting and assurance (using the escalation framework), a robust Board Assurance Framework and clear links to the Risk Registers. The structure overall was welcomed and widely supported. There was a consensus that it would be simpler and would help to ensure a more comprehensive approach to governance within the Trust. It was acknowledged that there could be some overlap between the committees and it was important that the lead director for each issue was clearly identified and assigned to the right committee in the first instance. It was agreed that some further revisions would be useful for the Terms of Reference (TOR) for the three main committees to support this. Ms Keeney planned to meet with each of the committee Chairs to review the TOR (she had already commenced

AK


these discussions) to ensure they met with each committee’s needs before presenting final drafts at the Board’s next meeting, for approval. Mrs Brain England had noted in another report that it was proposed some delegated authority be given to the Finance & Performance sub-group, to facilitate approval of business cases. It was agreed that this seemed a sensible approach and, when approved, should be reflected in the TOR. Other delegated authorities would remain with the Executive Team, in accordance with the Trust’s Standing Orders and Scheme of Delegations. It was not anticipated that the committees would assume any other decision-making responsibilities and their main purpose would still be to provide assurance - or escalate risks – to the Board. This was agreed. It was also agreed that the outcomes of the governance review being led by Deloitte should be taken into account in the TOR when known. In relation to more general points, it was agreed that (i) the TOR needed to be reviewed to eliminate any typing and grammar errors and to ensure a uniform style to the TOR and (ii) as Committees of the Board, only Executive and Non Executive Directors could be full members, with voting rights. The Chairman reported that, following discussion with the Non Executive Directors and to ensure an equitable allocation of responsibilities, the Non Executive assignments within the new structure would be:

• Audit – Mr Spinks (Chair), Mrs Brain England and Sir Stephen • Finance & Performance – Mr Patton (Chair) and Mr Spinks • Quality & Governance – Mrs Christon (Chair) and Mr Wragg Referring to the operational groups reporting into the three committees, Ms Keeney advised that she would also be meeting with the executive leads of the groups to clarify membership and reporting systems and ensure that all groups had been identified and tied into the new structure. Mrs McNair welcomed the executive leadership at this level and emphasised the importance of ensuring that a clear focus on clinical and quality issues was maintained. The TOR for any task and finish groups would also be important and would be closely aligned to the overall structure. It was agreed that a Board workshop should be held to provide a refresher to risk assessment and risk management.

HM

14/120 CHAIRMAN’S REPORT (14/07/P-10) The Chairman’s report, which provided an overview of a range of activities since the last Board meeting and reported on items of interest, was received and noted. The Chairman drew attention to the attached presentation, from the Foundation Trust Network’s (FTN) recent meeting for Chairs and Chief Executives. It outlined the FTN’s perspective of the challenging future facing the NHS and needed to be considered in the context of the Trust’s future too. The Chairman also referred to a letter from Monitor, following the latest monthly performance review meeting, copies of which would be distributed to Board members shortly. No further reports were received from other members of the Non Executive team.

SW

14/121 CHIEF EXECUTIVE’S REPORT (14/07/P-11) The Chief Executive’s report on a range of activities and issues of interest arising since the last Board meeting was received and noted. Ms Wake was also pleased to report that the Trust had been highly commended for its work


on diversity and had received an Award from NHS Employers for demonstrating ongoing commitment to personalised care and an inclusive workplace. Ms Brearley advised that the Award recognised the work of the Trust’s diversity champions, which the staff involved undertook over and above their core duties. Dr Mahajan highlighted the Clinical Teaching Award presented to Dr Eltrafi. This was an excellent recognition of his work and it was agreed that a letter of congratulations should be send on behalf of the Board to Dr Eltrafi.

SW

14/122 COUNCIL OF GOVERNORS (14/07/P-12) The latest agenda (June) and approved minutes (April) from the Council of Governors’ General Meetings were received and noted. More information on the work of the Governors had also been included in the Chairman’s report.

14/123 FINANCE & PERFORMANCE COMMITTEE (14/07/P-13) The exception report from the first meeting of the Finance & Performance Committee was received and noted. The Chairman commended the Committee on being able to present the report so quickly, which was appreciated. In the absence of the Committee’s Chair (Mr Patton), Mr Diggles expanded on the report. He explained that it had been a transitional meeting. It had therefore focussed on the usual business of the Finance Committee and started to look at the new agenda of the Finance & Performance Committee. Some of the transition requirements had been progressed further outside the meeting to ensure that all aspects were addressed. Mr Spinks advised that other key issues discussed at the meeting had included consideration of how the CBUs would report in to the Committee (further work was required on this) and the proposed delegated levels of authority for approval of business cases, with the current thresholds recognised as being too low, hence the proposal to uplift these to £50,001 to £150,000 for the Committee. Mr Diggles confirmed that business cases below £50,000 would still be presented to the Committee for completeness. Ms Wake emphasised the importance of ensuring that all approved business cases approved were linked to requirements for a report on benefits realisation being presented to the Committee within six months; this was fully supported. In closing discussions, the Chairman referred to the report’s title as an “exception report”. As highlighted earlier (see new governance structure), the key role of each of the governance committees was to give assurance to the Board, not just report on exceptions, and this should be reflected in future reporting. The report was endorsed and the proposed delegated levels of authority for approval of business cases were approved.

14/124 2014/15 BUDGET REPORT (14/07/P-14) Mr Diggles presented and expanded on the draft budget for 2014/15, which formed a critical element of the two year turnaround plan submitted to Monitor on 30th June. He highlighted a number of key factors, including:

• an overview of the Trust’s underlying baseline position, as shown in the report


• the projected outcome (improvement against baseline) of -£11.9 million for 2014/15, taking account of all potential incomes, costs, assured non-recurrent income and the cost improvement plans (CIP)

• the cash position, which would need careful management and continued support from the Department of Health

• the reduced capital expenditure budget, with a small contingency for further demands in year.

The budget had been presented in full and transparent form. It was acknowledged that any further internal and external reporting on the budget must be managed carefully to ensure that it was read correctly and not misinterpreted. Mr Spinks emphasised that the report reflected the Board’s statement in the annual accounts that it had based its going concern status on the bases outlined in the report and the reasonable assumption that central funding would be available. The Board recognised the risks associated with the budget, as was the case for any organisation at the start of the year. These included the service contract with the Trust’s main commissioners, which Ms Wake advised was still subject to final negotiations. The Board was also conscious of the Trust’s poor record on CIPs and was committed to delivering this year’s programme through close monitoring and continued development of more CIPs to meet, and if possible exceed, the £6 million target (4% of budget, 6.2% full year effect). It was also anticipated that other savings could emerge in year as planned changes progressed and the CBUs developed, which would help to improve the position. It was clarified that approval of the capital programme was integral to approval of the budget, although Mr Diggles emphasised that a prudent spending schedule had been applied. He confirmed that some expenditure on items identified as essential with regard to safety of care or future critical needs had already been progressed; they had not been held back pending finalisation of the budget. It was acknowledged that the budget was not – nor should it be – a static plan. Like the Turnaround Plan, it was a living document and the Board would expect every effort to be made to improve it in year, without putting quality at risk at any time. The Board approved the 2014/15 budget as presented.

14/125 INTEGRATED PERFORMANCE REPORT (14/07/P-15) The month 2 report on performance was received and noted. Lead Directors expanded on their respective sections: Activity Mrs Kelly advised that the Trust had continued to meet the <4 hour A&E target since 15th April. The target for Q1 had also been met. This improvement had been well received by Monitor and the CCG, as well as the Board. The Trust was currently the second best performer in the region. Mrs Kelly believed the improvement reflected how people were working differently in the organisation and the impact of a number of schemes now coming to fruition in the Acute Medicine Unit and Emergency Department, facilitating better patient flow across the Trust. She commended the staff involved and assured the Board that more work was ongoing to ensure the trend continued and improvements were fully embedded. Ms Wake advised that central funding to support winter pressures had been declared recently (£1.8 million allocation to Barnsley community); the Trust would be working with the CCG to seek support for


extra staffing - medical and nursing – as part of the Trust’s greater focus on flows rather than opening extra beds, although the Trust had also been clear that, if funded, it would be prepared to provide sub acute beds on site if these could not be provided in the community. Mrs Kelly reminded the Board that the national team for emergency care (ECIST) had revisited the Trust recently, to help review and refresh the emergency care pathway action plan. She was also mindful of the national proposal to reduce waiting times to 16 weeks, which would be a huge challenge for the NHS and would also need to be factored into future plans. Mr Spinks queried why the report no longer showed a breakdown of the “longest waits”. This information had provided useful indicators as to where the issues lay when delays occurred and whether or not they had been avoidable in terms of action by the Trust. The Chairman had noticed that the single longest waits were shorter than had been reported in previous months and he had taken this as a reflection of the whole system improvement. Mrs McNair and Mrs Kelly assured the Board that any issues that might cause delays would be identified in the daily operative reports reviewed by the Executive Team and would be actioned accordingly. It was agreed that further details were not necessary for the Board. Referring to the report on performance against other national targets, it was clarified that where an ‘x’ was shown on the tables, data was not yet available – it did not imply that targets had not been achieved. Similarly some cells in the table remained blank where no data was applicable. The table would be further refined next month to make this clearer. The performance dashboard reflected a good performance against most indicators. The exceptions related to:

• M120 – diagnostic tests This was due to the continuing national shortage of sonographers. However the position would be supported and improved by the recent appointment of a part-time locum and continuing work with the CCG to limit direct referrals, to enable the department to calibrate back to normal levels of service. Ms Wake advised that the impact of increased referrals to these services was one of the reasons the main service contract had not yet been signed, with a need to try to offset penalties associated with long waits, which seemed unfair when demand levels were outside the Trust’s control. In terms of plans to address the shortage in the longer term, Dr Mahajan referred to work ongoing within the Working Together workstream for radiology, to support a regional approach. Mr Wickham also advised that the Trust had two in-house trainees who would be qualified in September and it was proposed to carry this programme forward to ensure newly trained staff were always coming through. Additionally Mrs McNair reported on plans to assess whether midwives could take on some training too, expanding their work with baby scans.

• M210 – DNA (did not attend) rate As mentioned, work to reduce DNAs was being led by the CBUs and would be reflected in the regular CBU performance reporting. Mrs Kelly also reported on in-depth work around outpatients and clinical utilisation, and working with health visitors and community partners, to identify why patients did not attend and how/if certain services could be changed (e.g. hepatology) to better fit with patients’ needs and lifestyles. Ms Wake advised that the Trust’s approach to access was being updated to ensure it was acting appropriately with follow up ratios


too (the Trust was currently over performing in many clinical areas compared to national benchmarks).

Quality Mrs McNair reminded the Board that most of the reported indicators in this section did not have prescribed targets, however, she had extrapolated some from the Trust’s Quality Strategy in order to give context against monthly performance. She had also applied a 50% improvement criterion across the board for the safety thermometer as a stretch target. It was noted that the report, like the performance section, was in a new format. Any feedback on the style would be appreciated. Some anomalies had been noted (e.g. why some indicators were shown in colour – red/amber/green - but not all) and would be addressed by the next meeting. Ms Wake reiterated her request that thresholds were clearly shown when rating systems were used. Whilst the inclusion of internal targets was appreciated, it was agreed that it would be useful to review these further at the Quality & Governance Committee and also to consider how the Patient Safety Thermometer could be improved. Initial suggestions included adding the date of the survey (it was a point prevalence report) and to add a new column to show the month’s data and/or application of a heat map on this and other indicators. Finance Mr Diggles expanded on the submitted report, which was set against the deficit budget for 2014/15 agreed earlier (see above). Key points included:

• overall performance above plan (albeit still a significant deficit)

• a continuity of service rating of 1, which the Trust was expected to remain at throughout the year

• slightly behind income due to levels of activity (down in months 1 and 2 but some retrieval in month 2) and the assumption of incurring risks and penalties subject to final contract agreement

• CIP at green, having achieved progress against plan for the first two months, although projections in Q1 were lower than later in the year

• a favourable variance against pay costs, reflecting better controls on agency and bank

• higher debtors and creditors/accruals slightly down, largely reflecting a short term planned position. Mr Diggles reported that this was a positive position as it resulted from raising invoices earlier than in the past to ensure cash received earlier. It was also confirmed that the Trust was reducing its creditor balance, which meant that it was catching up with some of last year’s pressures with a controlled and managed process to ensure no adverse impact on the Trust or its suppliers

• capital showing at red (behind plan) – this was, however, a positive position for the Trust reflecting the agreed restrictions on expenditure.

Workforce Ms Brearley drew attention to the sickness absence data. Although the 12 month cumulative had not reduced, the monthly rate had, reflecting the extensive work already progressed, including the impact of an escalated/rapid response programme for any stress related issues and work with the rostering team to help management of sickness. More recently an initiative had been launched to help teams understand the impact of sickness absence in their

Exec Team

LC/ Q&G

HM


areas (supported by a well being programme). All of this work would continue and would be closely monitored. Mandatory training compliance remained constant and was discussed regularly in performance review meetings. The HR team would also be revisiting the corporate training programme shortly to ensure that it was being delivered as effectively as possible. With regard to appraisals, the meeting was referred to earlier discussions (Minute 14/118 refers). Mrs Brain England welcomed the closer scrutiny of the key workforce indicators at CBU level, which would enable any issues to be reported upwards through the relevant committees. Mr Spinks suggested it would be useful and timely for the Trust’s position to be set against benchmarking data where viable - this was agreed for the next report.

HB

14/126 ANY OTHER BUSINESS AND DATE OF NEXT MEETING a) Public Comments

In light of the Trust’s reported deficit position, Mr Millington, member of the public, challenged assurances given by the Board and one of the Non Executive Directors in February that the Trust was a well run organisation. He stated his appreciation regarding the improvements in the A&E led by Mrs Kelly but questioned why this had not happened sooner; he also queried a perceived lack of urgency to address the Trust’s deficit position (which he calculated to be much higher than reported) and acceptance of continuing failings against certain targets, for instance 30% compliance on appraisals. The Chairman noted the points raised. Whilst he and the Chief Executive corrected several of the figures cited by Mr Millington, the Chairman also clarified that the assurances given in February had been based on the information presented to the Board at that time. When a different position had been identified at the end of March, the Board had acted swiftly to start work to address it, investigate reasons, report to Monitor and prepare an action plan, and had made a lot of progress. The Chairman was confident that the Trust would recover its position with the turnaround plan, with the support of the Board and management present at the meeting and staff across the organisation. The Chairman thanked Mr Millington for his questions but suggested it would be inappropriate to respond further as some of them were directed to individuals (the Trust operated a unitary board) and some were inaccurate.

b) Mr Brannan, one of the Trust’s governors, referred to the Register of Interests for the Board of Directors. It was clarified that the Register matched the composition of the Board. One Director was currently off sick and their position was covered by an interim appointment, hence they were not shown on the Register but their declarations were still on record ad readily available.

c) Mr Brannan also relayed a report presented to him by a patient. At a recent consultation, the patient had been told they had a terminal illness. This had been completely unexpected but after the consultation no-one had approached him or his wife to try to offer support or advice, or give them the opportunity to compose themselves before they left the hospital in shock. Mrs McNair asked Mr Brannan to obtain more information if possible as it was a very unusual case and was contrary to the Trust’s practice; she would like to pursue it further. When breaking bad news, patients were normally offered support, indeed another member of the


public present also worked as a volunteer in the Trust and reported that the area she worked in had nurses specially trained to help patients in these sad situations.

d) On behalf of the members he represented, Mr Jackson, a governor of the Trust and representative of the Joint Trade Unions Committee (staff side), expressed concerns regarding the closure of a ward, the potential impact on A&E and plans to reduce beds on another ward. He sought assurance that (a) these actions would not impact on the Trust’s quality of care and (b) such proposals would be better managed in future, with earlier involvement of staff side. Mrs Kelly explained the rationale for the proposed reduction in beds, which had been identified following the bed utilisation review undertaken in January. The review had shown that as many as 45% of the Trust’s patients on any one day did not need acute care. This was borne out on a daily basis by the number of empty beds identified across the site and the Trust had consequently considered changing its bed structure. Mrs Kelly emphasised that it was not just about taking beds out of the system but working differently and improving discharge practices to the advantage of our patients and without adversely affecting quality of care. Clinical teams were now involved in the planning process and a recent trial closure of one ward had demonstrated that it could be done without being detrimental to services or safety. However, it was acknowledged that staff side could and should have been involved sooner and steps had been taken to redress this and ensure co-operative working as the plans progressed. Mrs Kelly also assured Mr Jackson that the impact of any closure would be carefully monitored and actions swiftly taken if any adverse impacts on staff or patients were identified. The proposals were not final and it was more about the bed base rather than ward closures, so could still be addressed differently if it proved a better option to protect safety and quality of services for patients. Ms Wake apologised for not including staff side sooner; the Trust had been working on this and other proposals at a considerable pace but would make every effort to ensure it did not recur in future.

e) Confidential matters In accordance with the Trust’s Constitution and Standing Orders, it was resolved that members of the public be excluded from the remainder of the meeting, having regard to the confidential nature of the business to be transacted. Due to clinical commitments, Mr Shiwani and Dr Kapur also left at this juncture.

f) Date of next meeting Before moving to the business of the remainder of the meeting, the Chairman confirmed the time and date of the next Board meeting: 9am on 7th August.

REPORT TO THE BOARD OF BARNSLEY HOSPITAL NHSFT REF: 14/08/P-20

BoD Aug 2014: P20_Integrated Board Report_1

SUBJECT: MONTHLY INTEGRATED TRUST BOARD REPORT – REPORT PERIOD MONTH 3

DATE: AUGUST 2014

PURPOSE:

Tick as applicable Tick as

applicable For decision/approval Assurance

For review Governance For information Strategy

PREPARED BY:

SPONSORED BY:

Stuart Diggles, Interim Director of Finance David Peverelle, Chief Operating Officer Heather McNair, Director of Nursing & Quality Hilary Brearley, Director of Human Resources & Organisational Development

PRESENTED BY:

Stuart Diggles, Interim Director of Finance Heather McNair, Director of Nursing & Quality David Peverelle, Chief Operating Officer Hilary Brearley, Director of Human Resources & Organisational Development

STRATEGIC CONTEXT 2-3 sentences

To provide an overview of the Trust’s performance in terms of quality, activity, workforce and finance for July 2014. To provide positive assurance against the following Trust business objectives: 1a, 1b, 2c, 3c, 5b. To provide an update on the Trust’s Emergency Care 4 Hour Pathway Action Plan.

QUESTION(S) ADDRESSED IN THIS REPORT

How has the Trust performed in month 3 and year to date? Are sufficient actions in place to address any areas of concern?

CONCLUSION AND RECOMMENDATION(S) The Board of Directors is asked to receive and consider the contents of the report.

BoD Aug 2014: P20_Integrated Board Report_1

REFERENCE/CHECKLIST

• Which business plan objective(s) does this report relate to?

• Has this report considered the following stakeholders?

Patients

BCCG

Other

Staff

BMBC

Please state:

Governors

Monitor

• Has this report reviewed the Trust’s compliance with:

Regulators (eg Monitor / CQC)

Legal requirements (Acts, HSE, NHS Constitution etc)

Equality, Diversity & Human Rights

The Trust's sustainability strategy

• Is this report supported by a communications plan?

Yes

Not applicable

To be developed

• Has this report (in draft or during development) been reviewed and supported by any Board or Executive committee within the Trust?

Quality & Governance

Audit Committee

Finance & Performance

ET

• Where applicable, briefly identify risk issues (including any reputation) and cross reference to risk register and governance committees

Inherent within the report.

• Where applicable, state resource requirements:

Finance: Other:

NHS Constitution: In determining this matter, the Board should have regard to the Core principles contained in the Constitution of:

• Equality of treatment and access to services • High Standards of excellence and professionalism • Service user preferences • Cross community working • Best Value • Accountability through local influence and scrutiny

The Board will also have regard to the Trust’s core vision statement: “Barnsley Hospital: Providing the best healthcare for all”

= target achieved

= target not achived

= target achieved


= target achieved


= target achieved


= target achieved


Summary of Actions by the Imaging Department Reducing the 6 weeks access Waiting Times. Andy

Hardy July 2014

Waiting Times & Actions:

MRI: o currently at around 6.5 weeks wait o Trust approved the use of mobile MRI towards the end of June – sessions booked as

soon as available. o 6 consecutive days of mobile MRI booked from 22nd August 2014 – this should

reduce wait to 5 weeks, potentially less than this dependent on demand. o Future use of mobile MRI does have some funding within budget – however, our own

MRI scanner will be commencing some weekend service from late September/early October and will have some positive impact on weekly elective activity. Therefore no further mobile planned at this stage but finance available to support if required.

o Assessment of the waiting time trajectory is being undertaken , focussing on volume of patients waiting 3-4 weeks and assessing if in-house MRI service has appropriate capacity to maintain sub-6-week wait. If not, then mobile will be booked at an earlier stage to prevent breaches and avoid a backlog.

Ultrasound:

o MSK Ultrasound – locum (private sector) sessions now running – has seen reduction from 13 weeks peak to just over 8 weeks (the latter figure being for patients who are to be booked next from the waiting list). Still tracking to achieve a sub 6 week wait by October. Plan to review MSK position

at end of August to try and gauge on-going requirements for private sector support, or whether demand can be managed with in-house capacity.

o Soft-Tissue, Lumps, Hernias – 9 week wait as these have historically been Radiologist examinations only. 6 locum sessions booked through August with (based on demand up until

July) projection to a 6 week wait in September. As with MSK, the Department will review the position and assess any future support required or whether stable position can be held in-house.

o General Ultrasound – some patients experiencing access time of around 4 weeks at present (range 4-6 weeks) for Sonographer lists.

o Obs/Gynae Ultrasound – 6 week wait at present for routine cases. Fetal Anomaly back within target after lengthy period of breaches following

18hpw locum support from 2nd July .

CT: o Most patients, including routine cases, have access to CT within 2 weeks at present. o 2ww patients well managed (concern with reporting turnaround, but access

generally of no concern at present). o Weekend elective capacity will expand slightly in Autumn – 7 day working agenda.

= target achieved


= target achieved


= target achieved


= target achieved


= target achieved


Green = on target Improvement in performance

Amber = under performance (within 5% of target) Deterioration in performance

Red = fail (>5% target) No change in performance

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EXECUTIVE SUMMARY

Page 20 of 25

Key Issue RAG Trend Financial Performance Summary Appendix

Key to RAG

Rating

The RAG Rating applied to financial commentary is based the on following criteria

• Green equating to on or exceeding plan.

• Amber behind plan by up to 5%.

• Red greater than 5% behind plan.

Financial

Reporting Indices

The Trust’s continuity of service rating exclusive of working capital facility at month 3 is 1. In line with expectations, a number of indicators of forward financial risk have been triggered. Liquidity is -25 days, and the capital servicing capacity defined as revenue available for capital service over annual debt service is -7. The outturn for capital expenditure is 47.6% of plan.

Appendix 1

Statement of

Comprehensive Income

The consolidated overall position for month 3 is a £4.98m deficit, against a plan position of £5.29m deficit, a favourable variance of £0.31m. (A deficit of £3.37m was reported for month 2 against a plan deficit of £3.64m.) EBITDA is -£3.158m against a planned position of -£3.39m, which is favourable.

Appendix 2

Income

Contract income £0.93m behind plan at month 3, of this £0.28m is due to risks and penalties. (Month 2 £0.55m behind). The significant variance relates to CBU 1 (Emergencies, Orthopaedics and Care Services). Other Income £0.63m ahead of plan at month 3, (£0.12m ahead of plan at month 2).

Appendix 2a

Cost

Improvement Programmes

Achievement at month 3 is £0.81m which is £0.05m ahead of plan, although there are variances at scheme level. The current position includes significant achievements, for example, the closure of ward 29.

Appendix 3

Pay

Total pay expense is showing a favourable variance of £0.6m. The agency run rate has increased in month (£0.5m in June, £0.48m in May), with particular pressures in CBU 1 (Emergencies, Orthopaedics and Care Services) and CBU 3 (General & Specialist Medicine).

Amber

Green

Green

Green

Green

Key Issue RAG Trend Financial Performance Summary Appendix

Statement of

Financial Position

The principal variances at month 3 are total debtors, which are higher than plan by £1.43m, Overdue debtors (31- 90 days plus) stand at £1.01m. Total creditors including accruals are lower than plan by £0.77 million. Deferred income is £1.11m ahead of plan due to the receipt of business case income. Overall, total assets employed are £0.12m favourable to plan.

Appendix 4 &

4a

Cash

Cash is £0.68m ahead of plan. Cash flow has been micromanaged over the previous 3 months with particular attention given to the payment of creditors.

Appendix 5

Capital

Capital expenditure is £0.58m year to date, £0.63m behind plan, being principally VDI, O Block and Intelligent drug cabinets.

Appendix 6

Amber

Red

Green

Appendix 1

Indicators of Forward Financial Risk - Consolidated accounts

Risk Actual

Unplanned decrease in EBITDA margin in two consecutive quarters No

Quarterly self-certification by trust that the continuity of service rating (COSR) may be less than 3 in the next 12 months Yes

Working capital facility used in pervious quarter No

Debtors > 90 days past due account for more than 5% of total debtor balances Yes 8.85%

Creditors > 90 days past due account for more than 5% of total creditor balances Yes 9.87%

Two or more changes in Finance Director in a twelve month period No

Interim Finance Director in place over more than one quarter end No

Quarter end cash balance < 10 days of operating expenses No 15

Capital expenditure < 75% of plan for the year to date Yes 47.56% Continuity of Service RatingMetric Weight Definition Rating Categories Score Rating

1 2 3 4Liquidity ratio (days) 50% Working capital balance * 360

Annual operating expenses <- -14 -14 -7 0 -25.0 1

Capital Servicing capacity (times) 50% Revenue available for capital service < 1.25 1.25 1.75 2.5 -7 1Annual debt service

Overall rating 1

Appendix 2

Performance against plan @ Month 3

Statement of Comprehensive Income Draft Month Month Cumulative CumulativePerformance against draft plan/budget at Month 3 FY2014/15 Budget Plan Actual Variance Plan Actual Variance

Full Year Jun-14 Jun-14 YTD YTD YTD YTD£'000 £'000 £'000 £'000 £'000 £'000 £'000

NHS Clinical IncomeElective Long Stay 10,867 901 860 -41 2,621 2,303 -318Non Elective 49,406 4,035 4,141 106 12,209 12,391 182Planned Same Day 14,310 1,184 1,143 -41 3,456 3,414 -42Out-patients 25,748 2,140 2,080 -60 6,210 6,066 -144A & E 7,368 625 613 -12 1,875 1,832 -43Other 35,730 3,246 2,618 -628 8,850 8,537 -313Business Cases 4,818 271 565 294 816 565 -251

Total 148,247 12,403 12,020 -383 36,037 35,108 -929

Non NHS Clinical IncomePrivate patients 13 1 0 -1 3 1 -2Other Non Protected Clinical Income (RTA) 1,088 90 93 3 272 446 174

Total 1,100 91 93 2 275 447 172

Other incomeResearch and development 545 46 56 10 136 141 5Education and Training 4,098 343 372 29 1,029 1,070 41Other income 10,709 521 992 471 2,467 2,879 412PFI specific income 0 7 2 -5 7 7 0

Total 15,351 917 1,422 505 3,639 4,097 458

Total income 164,698 13,411 13,535 125 39,951 39,652 -299

CostsEmployee benefits expenses (Pay) & Agency costs -118,554 -9,900 -9,746 154 -29,800 -29,191 609Drug costs -11,710 -948 -965 -17 -2,900 -2,955 -55Clinical supplies and services -17,548 -1,176 -1,257 -81 -3,542 -3,258 284Misc other operating expenses (excl Dep'n) -20,846 -2,420 -2,571 -151 -7,101 -7,406 -305

Total costs -168,657 -14,443 -14,539 -96 -43,343 -42,810 533

EBITDA -3,959 -1,033 -1,004 29 -3,392 -3,158 234

Depreciation & Amortisation - owned assets -5,723 -436 -452 -16 -1,336 -1,355 -19Depreciation & Amortisation - PFI assets -48 -4 -4 0 -12 -12 0Interest Income 20 2 1 -1 6 7 1Restructuring Costs -350 -29 0 29 -87 0 87PFI Interest Expense 0 -4 -4 0 -12 -12 0PFI Specific Costs 0 -12 -12 0 -34 -34 0PDC Dividend expense -1,884 -141 -139 2 -425 -418 7

Net Surplus/(Deficit) -11,945 -1,657 -1,614 43 -5,292 -4,982 310

Consolidated Statement of Comprehensive Income

Appendix 2a

Activity £'000 Activity £'000Plan Actual Variance Plan Actual Variance Plan Actual Variance Plan Actual Variance

01 - Elective Inpatients 371 342 -29 893 846 -47 1,079 966 -113 2,596 2,273 -323 02 - Elective Daycases 1,906 1,906 -0 1,185 1,124 -61 5,554 5,644 90 3,456 3,414 -43 03 - Non Elective 2,743 2,641 -102 3,715 3,803 88 8,329 8,359 30 11,279 11,635 35603 - Non Elective (CDU) 247 271 24 135 148 13 742 714 -28 404 389 -15 04a - Excess Beddays (Non Elective) 741 279 -462 167 67 -101 2,250 1,646 -604 508 364 -144 04b - Excess Beddays (Elective) 37 32 -5 9 7 -2 107 135 28 25 30 505 - Outpatients New Att. 5,686 5,615 -71 874 843 -32 16,481 16,657 176 2,536 2,499 -37 06 - Outpatients F/up Att 18,265 16,414 -1,851 1,266 1,243 -23 52,988 50,179 -2,809 3,675 3,675 108 - A&E Attendances 6,810 6,876 66 625 614 -11 20,429 20,397 -32 1,875 1,833 -42 09 - Critical Care 641 575 -66 478 427 -51 1,944 2,084 140 1,451 1,516 6510 - Maternity Pathway Tariff 501 450 -51 469 386 -83 1,521 1,417 -104 1,421 1,314 -108 11 - Direct Access Tests 220,163 225,835 5,672 352 350 -2 639,500 653,682 14,182 1,019 1,024 512 - High cost drugs revenue 0 0 0 613 568 -46 0 0 0 1,839 1,719 -121 12a - Unbundled Radiology 1,460 1,372 -88 147 145 -2 4,242 4,301 59 427 443 1613 - Other non-tariff revenue 4,344 3,240 -1,104 333 324 -9 12,627 10,734 -1,893 1,027 1,035 814 - Schedule of Service Fee Items 0 0 0 16 16 0 0 0 0 47 47 015 - Community Paediatrics 0 0 0 88 88 0 0 0 0 263 263 016 - Business Cases 0 0 0 44 44 0 0 0 0 132 132 017 - Therapy Services 2,765 2,439 -326 99 95 -4 8,032 7,256 -776 288 279 -9 18 - Specialist Nursing 952 1,019 67 46 44 -3 2,765 3,014 249 134 126 -8 TOTAL 11,553 11,180 -374 34,403 34,010 -393

Activity £'000 Activity £'000Plan Actual Variance Plan Actual Variance Plan Actual Variance Plan Actual Variance

CBU 1 - Emergencies, Orthopaedics & Care Services 2,336 2,285 -51 6,910 6,502 -407 CBU 2 - Theatres, Anaesthetics & Critical Care 309 307 -1 936 951 14CBU 3 - General & Specialist Medicine 3,655 3,587 -68 10,911 11,111 200CBU 4 - General & Specialist Surgery 1,902 1,878 -24 5,628 5,644 16CBU 5 - Diagnostics & Clinical Support Services 552 551 -1 1,631 1,660 29CBU 6 - Women, Children's & GUM 2,167 1,984 -183 6,492 6,356 -136 CBU 7 - Corporate 632 586 -46 1,896 1,786 -110 TOTAL 11,553 11,180 -374 34,403 34,010 -393

CQUINs (1/12 of total) 267 267 0 802 802 0

Risks & Penalties Current Month Year To DateContract Risks & Adjustments (e.g N:F Ratios) 20 -18 -38 20 -104 -124 Quality Schedule (RTT, Diagnostics & D1) 0 -77 -77 0 -164 -164 2014/15 CQUINs (Dementia - 1/12 of declared risk) 0 0 0 0 0 0TOTAL 20 -95 -115 20 -268 -288 Risk Adjusted Total 11,841 11,352 -489 35,225 34,544 -681

CBU Analysis

Current Month - June-14

Current Month - June-14

Year To Date - June-14

June-14Year To Date -

POD Analysis

Appendix 3 Efficiency Plan 2014-15

CBU summary Full Year Month 3 Month 3 Month 3Target Target Actual Variance

£1000's £1000's £1000's £1000'sEmerency Medicine, Trauma & Orthopaedics, Care of the Elderly, Therapy Services 367 58 66 8Theatres, Anaesthetics and Crtical Care Services 242 27 10 (18)General and Specialist Medicine 260 32 11 (21)General and Specialist Surgery 835 172 155 (17)Diagnostic and Clinical Support Services 782 154 202 47Women's, Children's and GUM Services 279 36 36 (1)Estates & Facilities 84 21 31 10Corporate 3,465 256 302 46Total 6,316 757 812 54

Income, Pay, Non-Pay summary Full Year Month 3 Month 3 Month 3Target Target Actual Variance

£1000's £1000's £1000's £1000'sIncome 310 42 55 12Pay 5,038 495 592 98Drugs 100 25 33 8Clinical Supplies 513 107 71 (35)Non-Clinical Supplies 0 0 0 0Miscellaneous Other Expenses 355 89 61 (28)Total 6,316 757 812 54

Scheme summary Full Year Month 3 Month 3 Month 3Target Target Actual Variance

£1000's £1000's £1000's £1000'sCI001 - Endoscopy Consumable Budget Reduction 15 0 0 0CI002 - 5% Reduction on Printing Budgets 22 5 0 (5)CI003 - 5% Reduction on Travel Budgets 12 3 0 (3)CI004 - Savings on Prosthetics 30 8 0 (8)CI005 - Savings on PACS System Costs 78 20 20 0CI006 - Reduce Computer Maintenance Budgets 162 41 41 1CI007 - Savings Projects Continuing From 13/14 144 48 48 0CI008 - Renewal of Contracts Ending in Year 18 0 0 0CI009 - New Saving Initiatives 150 12 12 0CI010 - Buying Team Transactional Savings 156 39 11 (28)CI011 - Income Generation 32 8 7 (1)CI012 - EPR System Benefits 140 0 0 0CI013 - Reduce Interpreter Budgets 15 4 0 (4)CI014 - Removal of Budget for Counselling Services for the Hospice 16 4 0 (4)CI015 - Medicine Management Savings 100 25 33 8CI016 - Working Together 50 13 0 (13)CI017 - Closure of Ward 29 600 150 150 0CI018 - Closure of 2 Further Wards 702 0 0 0CI019 - 1% Vacancy Factor on all Pay Budgets 1,000 250 248 (2)CI020 - Reduction in 2nd On Call Budgets 25 0 0 0CI021 - Reduction of hours for A&C Staff (37.5 to 35) 58 14 0 (14)CI022 - Reduction of SPAs to 1.5 per Consultant 250 0 0 0CI023 - Capping Maximum number of PAs to 12 250 0 0 0CI024 - Radiology Skill Mix Review 135 26 26 0CI025 - Cardio Respiratory Skill Mix Review 15 4 4 0CI026 - Restructure Bed Management Team 50 0 0 0CI027 - 2.5% Reduction of Back Office Functions 952 0 114 114CI028 - Pathology Partnership Savings 202 50 50 0CI029 - Increase Salary Sacrifice Income 50 12 16 4CI030 - Increase Patient Car Parking Charges 10 2 2 0CI031 - Increase Staff Car Parking Charges 38 10 20 10CI032 - Increase SLA for Telecommunications Services to SWYPT 40 10 10 0CI034 - CBU 1 CIP Target £200K Full Year but not to start until August 133 0 0 0CI035 - CBU 2 CIP Target £200K Full Year but not to start until August 133 0 0 0CI036 - CBU 3 CIP Target £200K Full Year but not to start until August 133 0 0 0CI037 - CBU 4 CIP Target £200K Full Year but not to start until August 133 0 0 0CI038 - CBU 5 CIP Target £200K Full Year but not to start until August 133 0 0 0CI039 - CBU 6 CIP Target £200K Full Year but not to start until August 133 0 0 0

6,316 757 812 54

Appendix 4

2013/14 2013/14Plan Actual VarianceJune June£'000 £'000 £'000

NON CURRENT ASSETS 72,238 71,235 -1,003

CURRENT ASSETSInventories 1,379 1,269 -110NHS Trade Receivables Current 1,367 2,837 1,470Non NHS Receivables Current 550 574 24Other Receivables Current 1,301 975 -326Prepayments Current 1,117 882 -235Cash 6,547 7,223 676Assets Current Total 12,261 13,760 1,499

CURRENT LIABILITIES (< one year)Trade Payables Current -5,571 -4,784 787Other Payables Current -10,116 -6,997 3,119PFI Leases Current -181 -187 -6Social Security Creditors Current -3,644 -3,555 89Accruals Current -3,371 -6,552 -3,181Provisions current -683 -693 -10Deferred Income Current -491 -1,599 -1,108Total Current Liabilities -24,057 -24,367 -310

NET CURRENT ASSETS (LIABILITIES) -11,796 -10,607 1,189

Other Receivables Non current 624 657 33 PFI Leases Non Current -484 -471 13

Other non current -282 -282 0Total Non Current -142 -96 46

TOTAL ASSETS EMPLOYED 60,300 60,532 232

TAXPAYERS' AND OTHERS' EQUITYPublic dividend capital 56,558 56,558 0Retained earnings -529 -297 232Revaluation reserve 4,271 4,271 0

TAXPAYERS EQUITY TOTAL 60,300 60,532 232

Consolidated Statement of Position

Appendix 4a Aged Debt at 30/6/2014 Not due 1-30 31-60 61-90 91+ balanceTotal 13,948,895.28 382,944.56 585,237.52 114,893.37 308,435.46 15,340,406.19Cash received 30/6/2014 (123,181.41)Period 3 invoices raised post 30/6/14 630,188.59Total invoiced position 15,847,413.37Adjusted for Period 4 invoices raised (11,644,725.38)Invoiced Ledger position 4,202,687.99Accrual for advanced invoicing (1,010,898.71)Debtor element of VAT 212,941.24Debtor element of Social Security costs 52,894.05Debtor Charitable Funds 28,807.34Debtor Other (7,188.50)BHSS debtors 549,480.98Consolidation adjustments (249,320.48)Bad Debt Provision (368,243.21)

Trade & Other Debtors at 30/6/14 3,411,160.70 Aged Credit at 30/6/2014 Not due 1-30 31-60 61-90 91+ balanceTotal (511,361.54) (2,226,823.34) (2,118,480.80) (1,510,764.96) (968,942.58) (7,336,373.22)Period 3 invoices posted after 30/6/14 (200,830.04)Total ledger position (7,537,203.26)Invoiced & accrued (10,484,132.20)Creditor element of VAT (33,583.87)PDC Dividend payable (76,500.00)BHSS Creditors (446,277.19)Consolidation adjustments 249,320.48BHSS Corporation tax payable (4,676.00)

Trade & Other Creditors at 30/6/14 (18,333,052.04)

Appendix 5

DRAFT DRAFT DRAFTBudget Budget Actual Variance Budget Actual Variance£'000s £'000s £'000s £'000s £'000s £'000s £'000s

Annual Jun-14 Jun-14 Jun-14 YTD YTD YTDCashflows from Operating Activities

Operating Surplus/(Loss) -11,945 -1,657 -1,614 43 -5,292 -4,982 310

Non-cash Income & Expenses/ movements in Working CapitalDepreciation & Amortisation 5,771 454 456 2 1,362 1,367 5PDC Dividend 1,884 141 139 -2 425 418 -7PFI Interest 0 16 16 0 46 46 0Interest Received -20 -2 -1 1 -6 -7 -1Decrease/(Increase) in Trade & Other Receivables 579 160 1,211 1,051 1,915 1,348 -567Decrease/(Increase) in Inventories 0 0 -84 -84 0 299 299(Decrease)/Increase in Trade & Other Payables -8,325 -1,939 -2,175 -236 -1,726 -4,307 -2,581(Decrease)/Increase in Other Liabilities -4,140 -372 0 372 -991 0 991(Decrease)/Increase in Deferred Income -218 -18 -276 -258 -54 1,054 1,108(Decrease)/Increase in Provisions 0 0 -6 -6 0 10 10Other Movements 424 -122 34 156 -366 -7 359NET CASH INFLOW FROM OPERATING ACTIVITIES -15,988 -3,339 -2,300 1,039 -4,687 -4,761 -74

Cash Flows from Investing Activities

Interest received 20 2 1 -1 6 7 1 Purchase of Property Plant & Equipment -3,476 -301 -186 115 -1,209 -540 669

Net Cash Outflow from Investing Activities -3,456 -299 -185 114 -1,203 -533 670

Cash flows from Financing ActivitiesPDC Received 0 0 0 0 9,955 9,955 0Capital Element of Private Finance Initiative Obligations -180 -15 -20 -5 -45 -58 -13Interest Element of Private Finance Initiative Obligations 0 0 2 2 0 6 6

PDC Dividend Paid -1,884 0 0 0 0 0 0Net Cash Outflow from Financing Activities -2,064 -15 -18 -3 9,910 9,903 -7

Increase/(Decrease) in Cash and Cash Equivalents -21,508 -3,653 -2,503 1,150 4,020 4,609 589

Cash and Cash Equivalents at 1 April 2,527 10,200 9,726 -474 2,527 2,614 87Cash and Cash Equivalents at 30 June -18,981 6,547 7,223 676 6,547 7,223 676

-21,508 -3,653 -2,503 1,150 4,020 4,609 589

Consolidated Statement of Cashflows

Appendix 6

Capital Programme 2014/15 Annual Budget Actual VarianceBudget to date to date£'000s £'000s £'000s £'000s

2013-14 Deferred SchemesElectrical Testing 9 9 0 -9 Maternity Birthing Unit 266 266 291 25Kitchens AB/KL 35 35 31 -4 O Block 613 200 44 -156 Pharmacy Robot - Inpatients 18 18 18 -0 OT Kitchen Refurbishment 5 5 4 -1 Urgent Care 7 7 32 25Hospital Contact Centre 7 7 4 -3 Replace Theatre Chiller Plant 40 40 15 -25 Ceiling Tracking Hoist 2 2 2 1Estates Deferred 2013-14 1,002 589 441 -148 Digital Dictation 6 0 0 0Intelligent Drug Cabinets 6 6 0 -6 Intelligent Drug Cabinets (AMU) 48 48 3 -45 IM&T Deferred 2013-14 60 54 3 -51 Ceiling Tracking Hoist 17 17 0 -17 Winpath POCT Interface Blood Gas Analyser 1 1 0 -1 M&S Equipment Deferred 2012-13 19 19 0 -19 Total Deferred 2013-14 1,081 661 444 -217 Electrical Infrastructure 360 0 0 0Escape Lighting 50 15 0 -15 Security - JAG Accreditation 20 18 15 -3 Air Tube Upgrade 50 0 0 0H&S Barriers 35 10 0 -10 HV Switchgear (Sub 3) 40 0 0 0Asbestos Enabling 30 0 3 3Day Case Chiller 50 0 0 0KL Condensate Tanks 45 0 0 0FRA Upgrades 50 0 0 0ESTATES Backlog Maintenance 2014/15 730 43 18 -25 VDI 445 445 69 -376 Replace Wireless AP's 5 0 0 0Colposcopy Database 40 0 0 0IM&T 2014/15 490 445 69 -376 Medical & Surgical Equipment 0 0 0 0M&S Equipment 2014/15 0 0 0 0EPR 605 60 37 -24 O Block - Neonatal Unit 100 0 0 0Pathology Autoclave 70 0 0 0STRATEGIC SCHEMES 2014/15 775 60 37 -24 Contingency 400 0 8 8TOTAL CAPITAL PROGRAMME 3,476 1,209 575 -634


REF: CG/14/08/15

CoG August 2014:15_Governwell Page 1 of 2

15

GOVERNWELL TRAINING

1. INTRODUCTION

1.1. The Foundation Trust Governors Association (FTGA) introduced a national training programme for Governors in 2013 - Governwell. Initial feedback on some of the early training modules was mixed but more recent modules have been well received and found to be worthwhile.

1.2. Whilst the learning is invaluable, the costs and time implications of attending the individual modules for the Governwell programme has been inhibiting, so the prospect of a full day’s training, more locally, and covering several modules, was very attractive.

1.3. The Sheffield Health & Social Care NHS Foundation Trust hosted the first such event on 22nd July. Whilst wide interest was invited in the first instance, due to high uptake, neighbouring FTs were restricted to one space each. The space allocated to Barnsley Hospital was assigned to me and this report gives an overview of why I wanted to attend and some feedback from the day.

2. FEEDBACK - Why attend?

2.1. People choose to become a governor because they have a desire to make a change and to ensure that the Trust is acting in the best interests of its members and the interests of the public. To be an effective Governor we need to have a clear understanding in how Foundation Trusts operate, our duties and our role in holding the Non Executive Directors into account.

2.2. It was expressed during the day by several attendees that they were unprepared for the expectations of involvement that was required. The hosts responded that the commitments beyond the statutory ones were down to choice and sometimes it was better to remain distant to the trust as increased familiarity sometime can impair a governor’s judgement as they ‘go to the dark side’. This can make them less likely to challenge actions as it can alter their perceptions regarding issues within the Trust.

2.3. GovernWell provides either a firm foundation or a refresher course in the understanding of what our roles are. It was well attended both by newly appointed governors and some more experienced, who had started their third term in office. It provides an understanding of the framework in which Foundation Trusts operate, governors’ statutory and non statutory duties and how to hold the board to account by developing the skills required for effective questioning. It demonstrates the need for clarity regarding the information given to enable informed questions along with the importance of seeking evidence to support the information that is given. There are interactive sessions which challenge your skills in effective questioning and thereby reducing the potential for digression and unnecessary delays within meetings.

CoG August 2014:15_Governwell Page 2 of 2

2.4. Although we may enter the governor’s role with skills, knowledge and experience, which can be transferrable to meetings, we still need to possess the knowledge and skills to be a Governor, to enable us to be capable of making valuable contribution and to be able to act to the best interests of both its members and the public. GovernWell provides us with such tools whether it is a firm foundation on which to build or a refresher to gain our focus back.

3. CONCLUSION

3.1. I have found GovernWell a valuable training resource, which has increased my understanding and confidence. The training pack was of a high standard and has provided some very useful resources and information links. This training resource would be of benefit to any of our Board of Governors to access regardless of their time in post.

4. RECOMMENDATIONS

It is recommended that the Council of Governors receive this report. Lisa Sanderson Staff Governor, Nursing & Midwifery August 2014

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Documents

5.30-7.30pm, 13TH AUGUST 2014 IN THE EDUCATION CENTRE ... · To approve the revised Membership & Engagement Strategy ENC 9 – Ms D Myers, Membership & Communications Officer