MINUTES OF THE TENTH MEETING OF THE COUNCIL OF GOVERNORS OF THE ROYAL DEVON & EXETER NHS FOUNDATION TRUST

Transcription

1 MINUTES OF THE TENTH MEETING OF THE COUNCIL OF GOVERNORS OF THE ROYAL DEVON & EXETER NHS FOUNDATION TRUST Held on Tuesday 11 July 2006 at 1400 in The FlyBe Suite, St James Centre, Exeter City AFC Present: Angela Ballatti (Chairman) Public & Staff Governors East Devon Trish McKenzie Stanley White Margaret Green Linda Fryer Gail Nunan Mid Devon Ivor Watts Roger Smith Exeter Andrew Webber Rachel Jackson Imraan Jhetam Miles Kinchin Terry Roberts Staff Medical & Dental Paul Marshall Nursing & Midwifery - Monica Overy Admin, Clerical & Managers, Sue Greenall Other Regions Brian Perriss Christopher D Oyly Appointed Governors John Shepherd Exeter City Council Marguerite Shapland, North Devon District Council Sally Morgan Devon District Council Alan Griffiths Mid-Devon District Council In Attendance: Chief Executive Angela Pedder Director of Finance - Mike Stevens Director of Operations - Elaine Hobson Foundation Trust Secretary - Tony Taylor Head of Corporate Affairs Pauline McCluskey Apologies Margaret Read (Public - Exeter) David Cox (Appointed East Devon DC) Liz Smith, (Appointed - East Devon PCT) Reuben Miles (Public Mid Devon) Tony Cox (Staff AHP) Brian Croft (Staff Hotel & Estates) Gordon Davies (Public Mid Devon) Victor Bloom (Public Other Parts) John Dowell (Appointed Exeter PCT) Bob Doy (Public East Devon) Janice Kay (Appointed - PMS) * Denotes rest of Devon, Dorset, Somerset, Cornwall, Isles of Scilly APOLOGIES AND QUORUM CHECK Apologies were as noted above. The meeting was confirmed as quorate MINUTES OF PREVIOUS MEETING The previous minutes were agreed to be a true record MATTERS ARISING There were no matters arising 1 of 7

2 NOTIFICATION OF INTERESTS There were no new Notifications of Interest SECRETARY S NOTES Mr Taylor reminded governors of the following: a. Development day on 20 July would be held in the Boardroom, Noy Scott House at b. Copies of the 2006 PPI Forum Annual Report had been tabled for governors information. c. In accordance with the house rule of promulgating CoG dates at least a year in advance, there would be a CoG meeting on Wednesday 10 October 2007 from at St James Park CHAIRMAN S REMARKS Ms Ballatti stated that she was delighted to be chairing her first meeting of the Council of Governors and looked forward to learning more about the function and business of the council in the future. She took the opportunity to welcome two new governors. Councillor Sally Morgan (appointed governor for Devon County Council) has been nominated as the replacement for Mr David Johnstone, and Councillor Marguerite Shapland was attending her first meeting since being nominated as the appointed governor for North Devon District Council. She also bade farewell to Dr Victor Bloom (elected governor for Other Parts) who did not stand for re-election. Had he been able to attend this would have been his last meeting. Presently she was busily engaged in a varied induction programme, which was providing her with much needed information and background about how the Trust works. She had recently attended the Wider Governance conference in Birmingham and found it very useful particularly to hear at first hand the experience of other FTs i. FINANCE UPDATE Mr Stevens reported that the contract discussions with PCTs were still ongoing and were yet to be signed. Although progress was generally satisfactory, there were still some areas to be clarified. At the end of May he reported that there was a surplus of income over expenditure of 0.2m against a planned figure of 0.7m surplus. Progress towards the achievement of CRES targets was satisfactory with 19% of the Current Year target achieved and 34% of the Brought Forward target achieved. He reported this was a good start to the financial year. The Trust is required to achieve a further 5.1m worth of savings in the current year to achieve its overall financial target and has plans to deliver 6m to provide some headroom. The forecast out-turn of income over expenditure surplus for this year is 2.4m and the Trust remained on plan to achieve this. The cash surplus at the year end will be 9.2m. Capital Schemes Mr Stevens reported that there had been a slight delay in the forecast date for completion of Phase IV, which is now planned for February Intensive care Unit (ICU) work commenced in January 2006 and will complete in early Diabetes also commenced in January 2006 and will complete in August The provision of the third linear accelerator is due to commence this month and will complete in July Dr White asked how the Trust had turned the original planned deficit of 2.8m last year into a surplus. Mr Stevens replied that this was due to a provision to write-off of 1.4m from the revaluation of assets no longer being required as a result of negotiations with the District Valuer, a reduction in potential income losses through negotiation with PCTs and a significant boost in patient income received very late in the year that could not have been forecast. 2 of 7

3 In response to a question from Roger Smith about penalties on contractors, Mr Stevens replied that there may well be penalties to be levied for any delays to the Phase IV but this would depend on the reason for the delay. ii. PERFORMANCE UPDATE Miss Hobson gave a report on the Trust s performance so far this year on the key targets, stating that the Trust had met them all except for the 62-day cancer target. Considerable work was being done to try and achieve this, however, delays in the transfer of patients from an outlying organisation to us could mean that the Trust was unavoidably penalised for breaching the 62-day target. Miss Hobson went on to report that achieving efficient pathways of care is absolutely vital towards achieving the 62-day target. There will be a cancer services peer review in September, which will report to the Health Care Commission as part of the Trust Annual Health Check. Some of the important areas they will be looking at will be whether we are meeting NICE guidelines, following good practice and providing a safe service. Booking The Trust was meeting this target satisfactorily. Maximum Six-Month Waiting Lists The Trust had achieved this for some time and was now moving towards achieving a maximum 20 week wait by March MRSA It was still unclear how this would be analysed nationally and it had been accepted by the Health Care Commission that only hospital acquired infections should be counted against the Trust. However, discussions to confirm this are underway with the Department of Health, who set the targets. The Council of Governors noted the quarterly Finance and Performance updates ANNUAL PLAN AND SERVICE DEVELOPMENT STRATEGY UPDATE Mrs Pedder began by giving an overview of the previous year, which had seen the financial risk rating for the Trust improve from 2 to 4 during the year and culminating in a small year end surplus. She also reported that good performance against health care standards and targets had been made, although the thrombolysis target was probably unlikely to be achieved by the Trust owing to its participation in the Primary Angioplasty pilot scheme. She also noted that the MRSA figures showed a 33% reduction for hospital acquired infections over the year. In addition the Trust had dealt with an extremely challenging C.diff outbreak. Mrs Pedder went on to report the achievements made against the Service Development Strategy Improvement Strategies. Strategy 1: Improving access to the RD&E and its services 68% of patients treated in 3 months or less Achievement of all NHS Plan Access targets Eliminated previous year s deficit and generated small surplus Choose and Book system introduced 98% of ED patients treated, admitted or discharged within four hours 100% increase in number of plastic surgery services provided in the community 3 of 7

4 Strategy 2: Achievements Highly commended in the Health Service Journal awards for improving patient access End Of Life Care Pathway developed in partnership with Exeter Hospice Emergency vascular surgery rota developed with South Devon Health Care Improved stroke pathway in partnership with the PCTs Increased use of community hospital facilities for day case surgery and outpatient clinics. In listing these achievements for Strategy 2 she highlighted the fact that the NHS booklet Commissioning a patient-led NHS had not been published 12 months ago when the plan was developed. Strategy 3: Developing new ways of delivering care Reduced average length of stay by 7%. This is a significant reduction and will assist greatly in the move towards maximising the amount of day case surgery. In addition it has a considerable financial benefit for the Trust Introduction of minimally invasive oesophagectomy National pilot site for primary angioplasty Radiofrequency Ablation for urological cancers Business case for PACs Introduction of single assessment process within an acute setting Strategy 4: Responding to staff 12 members of staff received a Chairman s Award. These people were nominated by colleagues New uniforms introduced for nursing staff 90% reduction in agency nursing and midwifery spend New staff newsletter introduced Agenda For Change implemented Improved education and training facilities Key challenges in the forthcoming year would be: Coming to terms with the reconfiguration in commissioning following the new SHA/PCT reorganisation. The overall NHS financial environment, which will be very challenging indeed The introduction of choice Independent sector diagnostic procurement The need for a 5% shift from secondary to primary care in delivery of patient services as outlined in the 2006 white paper Our Health, Our Care, Our Say. Meeting the 62-day cancer and thrombolysis targets. The annual plan for this year plans for the Trust to maintain a financial risk rating of 4 and then aims to move to the lowest level of financial risk rating [5] for the next two years thereafter. Mrs Pedder emphasised the need to generate a surplus in order to be able to invest to achieve the improvements required in the delivery of health care services. In addition there was a need to recover 7.5m in terms of cost savings and service improvement programmes. 31m was earmarked for expenditure on capital programmes in the year. Capital Investments Phase IV is nearing completion. Mrs Pedder specifically noted that this project would complete some 15 years since its first inception. This demonstrated the extremely long periods of time necessary in the era prior to Foundation Trust Status in achieving the completion of major capital schemes. The 4 of 7

5 business case for a treatment centre on the Wonford site was being reviewed and, in the interim, further day case operating facilities would be developed on the Heavitree site. There would be significant investment in more diagnostic facilities, which was extremely good news for patients. In addition, expansion and improvements would commence in diabetes, endoscopy, ITU, provision of a third linear accelerator and improved mortuary provision. The key service improvement aims for the year will be as follows: Achieve all health care standards and targets Further improvement in average length of stay Further reductions in average waiting times Complete development of new model for emergency care Appoint additional staff, reduce overtime and agency staff Expand Park And Ride scheme Fully implement digital radiology system Fully implement Choose and Book system Review strategic direction Dr Marshall asked whether Mrs Pedder foresaw any role for the RD&E in the 10% shift of resource to community care. Mrs Pedder replied that the situation was unclear at present, however, there would appear to be three options: 1. The PCTs could run the facilities 2. The Foundation Trust could run the facilities 3. Either the independent sector or GP surgeries could run the facilities Mr Webber asked whether, given the national financial environment of the NHS, there were any implications for the Trust. Mrs Pedder replied that there would be an impact at strategic level and this would be felt most keenly through the commissioning capacity of the PCTs. Mr Griffiths asked whether there were any implications for staff in the move of resources out to community hospitals. Mrs Pedder replied that it would not be possible to pay for this service twice - by both maintaining it at Wonford and providing it in the community hospitals - and this would have to be looked at carefully. The solution would inevitably have to be trade off. Mr Griffith also asked whether the reduction in agency staff usage would mean more demands on permanent staff. Mrs Pedder replied that this should not be the case providing the rostering of staff was optimised. This would require that the right blend of permanent staff was available at the right times. The governors noted the presentation on the Annual Plan and Service Development Strategy NOMINATIONS COMMITTEE TERMS OF REFERENCE The Council of Governors approved the revised version of the terms of reference for the Nominations Committee and also agreed that the number of public governors on the committee should reduce from 4 to 3 on the 1 st of October 2006, assuming that the constitution changes were approved by Monitor. The governors approved the revised terms of reference for the Nominations Committee NATIONAL GOVERNORS FORUM The Governors considered the briefing pack issued by FTN and whether to join the National Governors Forum. They understood that the question of funding would be a matter for the board of directors to decide upon. Of the 5 question asked in the briefing pack 4 had been considered at the April CoG meeting and the CoG response passed to FTN. Only Q1, whether the CoG wished to participate in the National Governors Forum, remained to be considered at this meeting. The Governors agreed to join the National Governors Forum 5 of 7

6 ELECTION RESULTS Ms McCluskey, Head of Corporate Affairs, reported the election results as follows: Exeter Rachel Jackson and Margaret Reid were re-elected unopposed Mid Devon Roger Smith was re-elected unopposed Staff Brian Croft and Paul Marshall were re-elected unopposed East Devon Margaret Green and Stan White were re-elected. This was a particularly pleasing result as 51% of the membership voted in this election. Other Parts Martin Perry from Okehampton was elected to replace Victor Bloom, who did not stand for re-election. It was agreed in subsequent discussion that there was a need to continue good publicity for members interested in standing as Governors. The CoG noted the election results MEMBERSHIP DEVELOPMENT STRATEGY REVISION Ms McCluskey introduced this item, stating that this was due for review following the experience gained of two years operation as a Foundation Trust. She went on to outline the aims of the strategy, which fundamentally was to develop, build and manage an active membership base. The new policy centred on strategic objectives as follows: Building the membership base Managing active membership Communicating with members Playing a key community role Making NHS Foundation Trust status distinctive Working with other member organisations She also drew attention to the objectives associated with each of these key strategies, and the workplan to support the strategy which had been developed by the Governors. The Governors would receive a six-monthly report, which would specify achievement against the objectives and the strategy itself will be reviewed on a two-yearly basis. The Council of Governors approved the revised Membership Development Strategy PROPOSED CHANGES TO THE CONSTITUTION Miss Margaret Green introduced this item by saying that work had been ongoing over a long period by the Constitution Review Working Group (CRWG) to review the constitution. She asked the Foundation Trust Secretary, Mr Taylor, to elaborate. Mr Taylor reported that the aim of the review had been as follows: To review the current constitution content against the model core constitution issued by Monitor To streamline or simplify the constitution where possible To consider the future of the Other Parts Public Constituency To realign CoG membership with the new PCT reorganisation To remain legal To achieve the changes by the 1 st of October of 7

7 In addition to the CRWG, Directors and Governors had discussed the key issues at a Joint Development Day in March A sanity/legal check had been conducted by a firm of local lawyers and the final version of the proposed changes had been agreed by the Directors at their meeting on the 28 th of June A preliminary check of nearly all the changes now proposed had been cleared by Monitor. Key issues The main issues were as follows: a. The Other Parts Public Constituency would cease to exist and the three Governors would be distributed among the three new public constituencies. The area previously covered by Other Parts would be subsumed within the three new public constituencies. b. There would be a new public constituency of Exeter and South Devon, consisting of seven Governors c. There would be a new public constituency called Mid North West Devon and Cornwall, consisting of five Governors d. There would be a new public constituency of East Devon, Dorset and Somerset, consisting of seven Governors. The total number of public Governors would remain at 19. The Quorum requirements would be set at 12 Governors of any category. There would be a reduction in PCT Governors from 4 to 1 to reflect the introduction of the All Devon PCT. The two voluntary sector Appointed Governor posts, which were currently vacant, have been reviewed and it was considered that they were no longer required. There were no other changes proposed to the number of appointed Governors. The total number of Governors would now stand at 31 against a previous total of 36. The other significant change mentioned was the proposal to devolve the authority for future changes to the constitution from members to the Governors. This has been successfully achieved by other Foundation Trusts, and approved by Monitor, on the grounds that it is the Governors who represent the members. Mr Taylor concluded by saying that, whilst there were a large number of other less significant changes, all but one of these had been approved by the CRWG. The one that had not referred to the addition of a final sentence in Paragraph covering situations when the Deputy Chair of the Council of Governors was not available. This covered a previous loophole in administrative arrangements. All but five of the proposed changes had already been passed to Monitor for preliminary consideration and their comments included in the final draft now presented to Governors. It was not expected that these subsequent five changes would prove contentious. Assuming the Governors agreement to the changes at this meeting, the next step would be for a period of consultation with the members until the end of August 2006 and approval by the members at the annual members meeting on the 7 th September Thereafter, the changes would be passed to Monitor requesting the inclusion in the Terms of Authorisation by the 1 st of October The governors agreed the proposed changes to the Constitution DATE OF NEXT MEETINGS Thursday 7th September 2006 Annual Members Meeting in the St James Centre Tuesday 10th October 2006, Quarterly CoG meeting in the St James Centre. 7 of 7