AGENDA for a meeting of the Board of Directors of Heart of England NHS Foundation Trust

to be held at St Johns Hotel, Warwick Road, Solihull on 3rd June 2014 at 9.30am

PART ONE:

1.

APOLOGIES

2. DECLARATIONS OF INTEREST

(Enclosure)

3. MINUTES – to be considered at next meeting

4. MATTERS ARISING

(Enclosure)

5. CHAIR’S REPORT

(Enclosure)

6. COUNCIL OF GOVERNORS REPORT (Chair)

(Oral)

7. OTHER SOURCES OF INCOME (AQ)

(Enclosure)

8. SURGERY RECONFIGURATION – APPROVAL TO PROCEED (MC)

(Enclosure)

9. ANNUAL PLAN (Years 3-5) – OUTLINE APPROVAL (MC)

(Enclosure)

10.

BOARD COMMITTEE REPORTS 10.1 Audit Committee (27.05.14) (AL) 10.2 Finance & Performance Committee (25.04.14) (Chair) 10.3 Donated Funds Committee (23.05.15), including Terms of Reference (Chair)

(Oral) (Oral & Enclosure) (Oral & Enclosure)

11. ANY OTHER BUSINESS

Date and venue of next meeting – 4th July 2014 – Education Centre, Birmingham Heartlands Hospital

PRESS AND PUBLIC ARE WELCOME TO ATTEND THIS MEETING AS OBSERVERS ONLY

EXCLUSION OF THE PRESS AND PUBLIC

The Board will be asked to resolve “That representatives of the press and other members of the public be excluded from the remainder 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”. PART TWO (PRIVATE)

REGISTER OF DIRECTORS and REGISTER OF DIRECTORS’ INTERESTS

VOTING TRUST BOARD MEMBERS

NAME DATE OF

APPOINTMENT INTEREST (if any)

DATE OF NOTIFICATION

DATE OF TERMINATION OF INTEREST

Dr Patrick Cadigan

01.07.13 1. Consultant cardiologist at Sandwell and West Birmingham Hospital Trust.

2. Registrar of the Royal College of Physicians of London.

3. Member of the clinical advisory group advising the Trust Special Administrators re the future of Mid Staffs NHS Trust

4. Member of the clinical advisory group to NHS England on rare diseases

Mar 2014

31.12.13

Mar 2014

Dr Andrew Catto 01.03.14 Nothing to declare.

Mrs Sam Foster 01.09.13 Nothing to declare.

Mr Les Lawrence 01.04.12 1. Trustee for the National Institute for Conductive Education

2. Governor of City of Birmingham School

3 Director of Lindridge Enterprises Limited

Mar 2013

Mar 2013

Mar 2014

Mr David Lock 01.07.13 1. Practising barrister and a member of Landmark chambers. Providing legal advice and representation to a wide range of individuals, NHS organisations, local authorities, charities and commercial organisations mainly on public law issues. These frequently involve issues concerning the rights of patients to NHS treatment as well as structural and management issues involving NHS bodies

2. Director of No5 Chambers Limited (management company running No5 chambers)

3. Member of Amnesty International 4. Trustee of Brook Young People

Limited, the Sexual Health Charity for young people (unremunerated)

5. Member of the BMA Ethics Committee (unremunerated)

6. Member of the Labour Party and occasional legal advice to Labour Party and elected Members of Parliament on NHS policy issues

7. Chair of the West Midlands Labour Finance and Industry Group

8. Mr Lock’s wife Dr Bernadette Gregory, is a medical doctor employed by Redditch and Bromsgrove Clinical Commissioning

Updated Jan 14

Mar 2014

Group and is Clinical Lead for the Worcestershire Integrated Care Project.

9. Representing an NHS body in relation to Stafford Hospital

10. Chairman ofInnovation Birmingham Limited

11. Representing NHS England in relation to specialised services

10.09.13

05.11.13

06.01.14

Ms Alison Lord 01.05.13 1. CEO and Shareholder of Allegra Ltd.

2. Voluntary role as a business mentor for the Prince's Trust.

3. In her professional capacity as a 'turnaround executive' Ms Lord has relationships from time to time with major accountancy firms, legal firms, banks and venture capital providers.

22.01.14

Dr Mark Newbold 01.08.10

1. Member of Multidisciplinary Professional Advisory Panel of BabyLifeline (Charity)

2. Governor on the Council of Aston University

3. Chair of the NHS Confederation Hospital Forum

4. Member of the BMA Medical Manager Committee

5. Governor of Waverley School 6. Director on the West Midlands

Academic Health Science Network

01.01.12

01.08.12

Oct 2012

Nov 2012

Nov 2012 Sep 2013

Mar 2014

01.04.14 01.04.14

Prof Edward Peck 01.04.12

1. Pro-Vice-Chancellor, Head of College of Social Science, University of Birmingham

2. Wife is the chair designate of the proposed organisation to deliver community health services in Gloucestershire

3. Councillor for Birmingham Chambers of Commerce

4. Vice-Chancellor Designate Nottingham Trent University (appointment effective 01.08.14)

Nov 2012

Mar 2014

Dr Jammi Rao 01.07.13 1. Sole director of Gorway Global Ltd. a private company owning 50% of the share capital. A consulting company offering management support, training and bespoke public health analytical support to public sector organisations involved in health, well-being and health care.

2. Board Director of Welcome CIC - a Community Interest Company supporting minority and disadvantaged communities by working with statutory and other agencies.

3. Shareholder in GSK. 4. Trustee of the Faculty of Public

Health as an elected General Board Member. Term of office from 2010 to July 2013.

5. Visiting Professorship in Public Health in the School of Health, Staffordshire University.

05.11.13

Prof Laura Serrant

01.04.12 1. Director of Research & Enterprise at University of Wolverhampton

2. Board member of MOSAIC – a registered charity.

3. Non-executive director (unremunerated) - National Skills Academy for Health

23.01.14

Mar 2014

Mr Adrian Stokes 01.07.08 1. Director of HECL 2. Pfizer Virtual Customer programme

01.07.08 20.06.11

Ms Lisa Thomson

06.11.12 1. Non-executive Director of Multistory 2. Trustee of a charity - Redditch

United Football In the Community

22.12.08 07.11.11

Dr Sarah Woolley 07.05.07

Energy & Home Condition Surveys Ltd – Company Secretary

16.03.07 Jul 2008

BOARD OF DIRECTORS

Schedule of Matters Brought Forward and Action Points

Date raised

Minute No

Detail Action Due Status Completed

2 July 2013

13.064.02

Transport strategy – alternative methods review. JS May

2014 Agenda item 15 6 May 14

13.067.01 Identify any opportunitiesto increase private patient income. AQ Jun

2014 Agenda item7

10 Sep 2013 13.083.03

Review and report back on improved Board Assurance Framework and Risk Register process.

LT May 2014 Agenda item 14 6 May 14

4 Mar 2014 14.036.01

Give feedback to Alison Lord regarding usefulness of ‘Safety Sitrep’.

All May 2014

Being pursued via Kennedy Task Force

6 May 14

6 May 2014 Report on framework for Recruitment

& Retention Strategy/ Policy HG Jul 2014

CHAIRMAN’S REPORT to the BOARD of DIRECTORS – 3 June 2014

This is my first Board Meeting as Chair and I wanted to put on record my thanks for the support from my colleagues as a Non-executive Director and Chair of the Finance & Performance Committee. I am looking forward to working with you, as Chair, on our agenda which is focused on improving services for our patients; it is both challenging and exciting. At our Council of Governors meeting last Tuesday,proposals were accepted to appoint Alison Lord as Deputy Chair and David Lock as Senior Independent Director. Alison will also continue her important role as Chair of the Audit Committee and David will take up Chair of the Finance & Performance Committee as an interim measure. I can also report that we have completed the interview process for the post of Chief Nurse; I will be able to update you on this appointment at the meeting.

Les Lawrence Chair

OTHER SOURCES OF INCOME

1. INTRODUCTION

The Trust wishes to explore opportunities to increase activity and income from private

patients to contribute to ongoing patient care development and as a source of growth

contribution.

2. APPROACH

A centrally led project will be implemented that will consider the following:

a) Is a PPU viable at HEFT?

b) How can the Trust maximise private patient income through specific directorates?

c) What new services could HEFT package and take to the market e.g. health

screening?

d) What is the overseas potential – either incoming or outgoing?

3. RESOURCES

A number of resources have been identified to complete this work including:

Performance and finance teams to provide the data required

Involvement of the estates team to identify and assess the suitability of proposals

for alternative use of existing facilities

Proactive engagement and time from the directorates

Access to the Trust’s external consultant who negotiates insurer agreements

Completing a full market assessment (15 consultancy days)

4. THREE KEY STAGES

5. RECOMMENDATION

It is recommended the Trust agrees to undertake this work and reports back to Trust

Board at that time. It is estimated that this work will be complete by the end of September

2014.

Aidan Quinn

Acting Director of Finance & Resources, May 2014

1. Undertake desk top background analysis of Trust information, provided by the

relevant functions, in relation to:

Private patient activity, pricing and revenue for the last 3 years by department,

consultant, specialty and payee.

Mapping of referral patterns by post code of existing private activity.

Review of operational policies and processes for managing private patients in

HEFT.

Review of any previous work undertaken on private patient opportunities within

the Trust.

2. Undertake field work to include:

Analyse the market and competitor providers using demographics, market size,

PMI penetration, self-pay opportunities etc.

Interview internal stakeholders to identify potential opportunities, degree of

support, issues to be addressed etc.

Audit HEFT’s current position, against the factors seen as key for a successful

NHS PP service, produce a gap analysis and action plan to close any gaps.

Devise business development opportunities.

SWOT analysis for HEFT private patient services.

Identify target market segments and potential propositions.

Compare the HEFT self-funding pricing structure with local private and NHS

providers.

Financially appraise the opportunities identified.

3. Expected Outcome:

Justification case which describes the findings contains an initial financial

appraisal of the potential revenue opportunities, the recommendations for next

steps and key success factors.

Surgery Reconfiguration at HEFT – Building a Sustainable Future

Paper for the Trust Board, June 2014

Dr Andrew Catto, Executive Medical Director

1. Introduction

Reconfiguring surgery across the HEFT sites is a key element of the Trust’s strategic plan. It has been given extensive consideration over recent years in order to devise a proposal to deliver high quality, sustainable surgical services to our patients in the future. The Board has recently given consideration to the proposed changes at its strategy meetings.

Specific options for reconfiguring have been identified, designed at a high level and appraised by clinically led multidisciplinary teams. External engagement through a diverse stakeholder reference group is contributing to the co-design of the proposals. This will ensure the needs of patients and other service users are properly considered and incorporated into our plans.

Transforming surgical provision will deliver the following benefits:

• The ability to meet current and future clinical standards for surgery

• Better outcomes and experiences for our patients

• Shorter waiting times and more certainty with dates for planned surgery

• Faster access to emergency surgery and reduction in bed days waiting for such surgery

• The ability to create of centres of excellence in a number of surgical specialties

• The capacity to deliver activity internally without the need for premium rate waiting list or private sector work

• The opportunity to grow those specialties where additional revenue could be secured egbariatric surgery

• Gains in efficiency from consolidation and best practice benchmarking eg reduction in LOS and increased theatre utilisation

• Opportunities to release financial benefits by doing things differently

To release these benefits from April 2015, phase 4 of this programme, which will devise the detailed operational and implementation plans and undertake the required external consultation, must commence in May 2014.

This paper provides more detail and an indicative timeline for the public consultation phase anddescribes how the elements of the next phase (phase 4) of this complex, transformationalchange programme will take place in parallel.

2. Surgery Reconfiguration – phase 4

Detailed Design and Implementation Planning

During phase 4 internal teams will continue to co-design the detailed reconfiguration plans withthe Stakeholder Reference Group.

The many interdependencies will require input and full engagement from many functions withinHEFT. A formal programme management and governance framework is being established asdescribed in the decision paper to facilitate this and ensuring there is adequate resource andvisible Board sponsorship are amongst the key success factors identified.

Progressing this part of the programme in parallel to, rather than after, the public consultationwill allow the design of the proposed solution to fully consider feedback from the consultationprocess whilst work up of some of the fundamental building blocks continues thus enablingfaster delivery of patient and organisational benefits once a decision as to how to proceed ismade.

Financial Appraisal

A full financial appraisal cannot be undertaken until the detailed design has been completed. Thiswill therefore be an iterative process working to increase the levels of granularity of theassumptions throughout the next 6 months to produce the financial implications as part of thefinal Board decision paper in December.

Public Consultation

The Trust takes its obligations to involve the users of its services in the in development andconsideration of proposals for changes in the way those services are provided, as contained insection 242 of the NHS Act 2006, very seriously.

A comprehensive suite of consultation documents is currently being prepared as shown in thepre-consultation phase on the attached timeline. An agreed approach will be adopted with ourClinical Commissioners to review the consultation plan with the scrutiny bodies of theappropriate Local Authorities and input will be sought from the various sources of expert adviceand guidance available to NHS organisations .

A 8-10 week period of consultation is planned for the Autumn after which the findings will bereviewed by all parties and will be key to finalising the delivery and implementation plans.

The proposed configuration which consultation will consider is as follows. The implications ofthe “do nothing” alternative will be included in the consultation documentation.

HEFT Surgery reconfiguration- Phase 4 timeline

Pre-consultation Consultation Post Consultation

Proceed to implementation

Decision Paper for Board

Produce “Case for Change”Produce consultation plan

Agree approach with CCGs for OSCs and HWBs liaison

CCG led or joint CCG & HEFT discussions with all OSCs and HWBs

Finalise public consultation documentation

Discuss with West Midlands Clinical Senate

Initiate Gateway Review

Assess against 4 tests Formal public consultation

Formal discussions with OSCs and HWBs

Analysis and review by HEFT, CCGs, OSCs HWBs

June July August September October November December

Detailed design and implementation planning

3. Recommendations

The Board is asked to approve:

1. To make and communicate internally a decision to proceed in principle with surgery reconfiguration, as described in this paper, recognising that further iterations may develop during the detailed implementation planning phase.

2. To approve and support progression to the external consultation process

Annual Plan (Years 3-5)

Commentary & Values

3 June 2014

Board of Directors

Years 1-2 (2014/15-2015/16) submitted to Monitor on

2nd April

Feedback call with Chief Executive on 1st May

Key themes;

∗ Reduced acute footprint through LOS reductions

and increased community care.

∗ Reduce agency usage.

∗ Financials remain with £2m surplus pa, capital

expenditure of £25m pa and £24m CIP pa.

∗ 0.5% clinical income growth.

Progress so far

to provide services that inspire confidence, trust and pride within the communities we serve

Healthcare at the heart of our communities

Working Culture

An outstanding

provider

Future hospitals

AcuteCare

Out of Hospital

Implementing & sustaining best practice

Acute Pathway redesign

Post inspection

Plan

Solihull integrated

hub

New models of integrated

care

Investment in OoH

services

Cultural development

Plan

Surgeryreconfiguration

Improving against

CQC metrics

Improved co-ordination

of health & social care

Investing in research

Supporting specilaised

services

Investing in

informatics

Our strategy on a page

∗ Short stay hospital model, leading to a reduction in the acute

footprint of our hospitals

∗ Centralisation of different specialties at different hospitals (e.g.

Trauma, Orthopaedics, Stroke)

∗ Using our estate differently e.g. ‘convalescence’ or well-being

∗ A new model for Solihull – urgent care, Orthopaedics &

Ophthalmology and a hub for services for the frail elderly

∗ Greater involvement in running services outside of the hospital

e.g. HEFT at home, co-ordinating care in a crisis

∗ Greater use of technology / telehealth especially in people’s

own homes

∗ Different staffing model – more ‘general’ physicians / fewer

specialists; more care co-ordinators / fewer specialist nurses

∗ Payment of a whole year of care, rather than individual

episodes

Strategic themes Years 3-5

High Level Financials

∗ Surplus to remain low at between £0m to £5m.

∗ Low net income growth from existing NHS clinical

services c 0.5% per year (activity growth in the

region of 2% offset by tariff deflator of 1.5%).

∗ £20m per year capital expenditure.

∗ Maintain COSR 3.

∗ Explore all avenues for CIP target of £24m– include

income growth in sexual health services and

pathology services.

* to include potential growth in pathology services, private patient care and other initiatives.

Efficiency Plans

Scheme type

2016

/17

£m

2017

/18

£m

2018

/19

£m

Tot

al

£m

Clinical income

generation3 3 3 9

Trading income/

market penetration6 0 0 6

Transforming

Models of Care4 3 5 12

Service redesign 4 4 4 12

Other schemes,

including

capital charges

2 3 2 7

Procurement 2 2 2 6

Drugs 1 1 1 3

Scheme details still

being worked up *2 8 7 17

Total 24 24 24 72

Spend type £m

Income 15

Pay 19

Drugs 3

Clinical Supplies 6

Non-clinical

supplies2

Miscellaneous other

operating expenses23

Non-operating

expenses4

Total 72

This level of spend is in line with previous planning assumptions and has not been affected by the recent changes

in capital plans in 2014/15 and 2015/16

Capital Plans

2016/17

£m

2017/18

£m

2018/19

£m

Total

£m

Operational Spend 6 6 6 18

Maternity 8 5 0 13

Critical Care/ ITU 0 7 4 11

Solihull Cross Site

Strategy Schemes1 0 8 9

Site Rationalisation 2 1 2 5

Endoscopy 3 0 0 3

Other 0 1 0 1

Total 20 20 20 60

Next Steps

F&PC

COG

Board

Trust Strategy

Monitor Standing

Committee

23 May

• Discuss more detailed financial plans

27 May

• Consideration of assumptions, themes

and financial plans

3 June

• Further consideration of assumptions,

themes and financial plans

June

• Further discussion of strategic themes

and delivery

27 June

• Final templates approved in time for

submission on 30th June – 9am

1

Minutes of the Finance & Performance Committee meeting held on 25th

Present:

April 2014 at 9.30hrs, in the Boardroom, Devon House, Heartlands Hospital

Lord Phillip Hunt Mrs Hazel Gunter Mr Les Lawrence Mr Richard Parker Prof. Edward Peck Mr Aidan Quinn Mrs Lisa Thomson

Chairman Director of Workforce Non Executive Director (Chair) Interim Managing Director - GHH Non Executive Director Acting Finance Director Managing Director – SOL

PH HG LL RP EP AQ LT

In Attendance:

Mr Malcolm Clark Mr Andrew Clements Mrs Sam Foster Mr Jonathan Gould Mr Mark Houghton Mrs Angeline Jones Mrs Sue King Ms Erica Loftus Dr Govindan Raghuraman Miss Louise Jenkins

Business Consultant – C/F/R&D Business Consultant - SOL Acting Head Nurse Finance Operations Director General Manager - BHH Chief Financial Controller Head of Performance Head of Operations - CSS Associate Medical Director - BHH Personal Assistant (Minutes)

MC AC SF JG MH AJ SK EL RG LJ

1. APOLOGIES FOR ABSENCE

Apologies were received for: Dr Andrew Catto and Mr Carl Holland 2. MINUTES OF THE MEETING HELD ON 21ST MARCH 2014

The minutes of the meeting held on 21st

March were accepted as an accurate record.

3. MATTERS ARISING All matters arising were identified for action in either this, or a future meeting agenda

4. FINANCE POSITION UPDATE 4.1 Finance and Performance Directors Report M12

Mr Quinn opened with we ended the year as expected prior to the revaluation and further impact from the Kennedy review. We have consolidated the accounts in line with reporting guidance with the charitable accounts therefore the result for the year is a £6m loss. The Trust’s COSR rating for the end of the year was a 4. We start the new financial year with a underlying £6m loss with the challenge for Q1 being delivery of the new efficiency target and exit from winter.

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Areas of Performance to note are: • red governance risk rating due to A&E • 18 weeks - still an issue and reported to Monitor as failed • Cancer 2 week waits – still issues and unlikely to achieve Q4

Mr Lawrence asked Mr Quinn to explain the year end position to the Governors which details the impairments and losses so they fully understand any adjustments and circulate to Non Executives colleagues. Mr Lawrence stated we understood we were on course for the £2m surplus so how did we arrive at a £6m deficit. Mrs Jones explained that additional costs for the Kennedy provision were higher than had been predicted in the £2m forecast. These costs included a mixture of recalling patients, new medical care and cost of running the Kennedy task force, including legal fees. Some costs were incurred in 2013/14 but this provision means we are covered for future liabilities that we have committed to at the end of the year. Additionally there was also a charge of £4.7m for impairment costs, which is an accounting adjustment only and does not affect the financials in future years but takes the loss for the Trust to £5.3m. On top of this is a loss made by the Charity of £0.7m, which is in line with its plans, and takes the total consolidated loss to £6m. Although the same number this differs from the £6m recurrent loss being taken into the new financial year. Mr Quinn also added we cannot count on non recurrent funding such as winter and the £2m Birmingham City Council benefit moving forward. A level of the non-recurrent income in 13/14 was offset by non-recurrent costs. Mr Lawrence added an excellent job in the last 2 weeks in trying to achieve the A&E 4 hour target. Mrs Foster also wanted to convey her thanks to all and pass on to colleagues.

5. CURRENT MATTERS 5.1 18 Weeks Update

Ms Loftus advised we had a 1,200 patient backlog at the end of March 2014 against a plan of 600. We require a further 3 months to get to a sustainable backlog. New plans have been submitted to Monitor which state where we will be at the end of Q1. However we are still off track and need to have more robustness around delivery of the agreed plans. We plan to complete peer reviews of 18 week processes across the sites and plan for a backlog of 800 by the end of Q1. There are 2 specialties that cannot achieve their targets, T&O and ENT, which will take longer. There was a slight increase in the backlog over Easter but this appears to be reducing at the beginning of May. The CCG are now attending our 18 weeks regular meetings. There is now growing concerns for 52 weeks and we are trying to understand this. There were 21 patients in March for admitted, non admitted and open clocks. Root Causes Analysis is being undertaken for each 52 week breach to try and gain an understanding of the reasons for these. Significant scrutiny is being placed on all

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patients waiting over 40 weeks with a view to taking action to prevent any further 52 week breaches. Work on centralised booking is still progressing and we are working on General Surgery. EL/May 2014 - Include section in 18 weeks report on centralised bookings. Prof. Peck stated for the last 2 years he has attended F&PC there has been discussions on efficiency, A&E performance, and now 18 weeks and 52 weeks added. The last 2 years has seen an increase in the range of issues. As a NED he is committed to understand these issues and questioned whether these are issues for the whole NHS or just HEFT. Mrs King responded that there were problems at a national level with the delivery of 18 weeks and the admitted pathway target had failed at a national level for the first time in February. She also felt however that some of the internal processes and governance arrangements had not been strong enough. Mr Lawrence said that we already provided some information to Monitor showing our A&E performance against other comparable large organisations. She agreed to provides an overview of the national position for the next meeting. Mr Quinn advised efficiency is in a cycle for which we need headroom to clear. Generally it is a struggle if you exit the previous year poorly. We are now planning earlier as delayed planning equals delayed implementation. Prof. Peck continued escalation has slowly eroded and in his role what more can he do to assist Prof. Peck suggested we choose 5 Trust similar to HEFT and compare the top 5 areas for comparison. SK – provide details of comparable data Mr Lawrence advised centralised booking was agreed some time ago but has not been implemented, and would like to gain an understanding of why this has not been delivered. Mrs Loftus continued the discussion by stating that the Trust tried to get consensus from everyone when implementing new schemes, even when they had been agreed at an Executive level and this needs to be better managed. Prof. Peck finalised we need corporate management to back the change and then adhere to the decision once made. EL – Provide LL with update details on centralised booking progress

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5.2 Cancer Update

Mr Houghton advised further detailed plans were requested from the last F&PC meeting. The current report doesn’t reflect the amount of work undertaken. The interim manager has developed plans and trajectories which should achieve by the end of Q1. Mrs King advised the FPC that there was a joint health economy/Trust clinical cancer forum being held on the 15th

5.3

May. Some initial analysis undertaken in preparation for this showed that there has been a 16% increase in referrals to the 2 week wait rapid access service and from last year, and a 4% decrease in conversion to a cancer pathway. There is a significant amount work to be done with the GP referrals. Mr Lawrence felt it would be useful to try and identify some of the costs incurred as a result of the increase in referrals that don’t convert to cancer pathways SK/May 2014 – to provide an update from the Clinical Cancer meeting Mr Houghton continued that March’s 31 and 62 days should be achieved and is monitored weekly. Urology will pull back by Q2 Financial Challenge Update Mr Lawrence advised that going forward this report will be split. Mr Quinn advised the level of CIP’s at low risk is circa £13m, £8m is high risk and a current unidentified GAP of £2m. Plan A and MARS is in progress, with agreements being reached on MARS to realise future benefits. Work is in progress for disinvestments and decisions need to be made. We are asking for reviews not necessarily cessation of services. We are challenging the divisions and there is a local process for the Finance Business Consultants. The winter review will be due later in the year. John Sellars will be sharing proposals regarding the PMO. Work is in progress for gate 1’s in relation to the pay challenge. AQ/May 2014 – Update Disinvestment table with decisions made or dates for completion All/May 2014 – Provide details of gate 1 plans Mrs Foster added Nurse bank is being integrated into E-Rostering. She needs a diagnostic to complete a benefits realisation to identify the 10%. SF/May 2014 – Provide clear integrated plan Mrs Foster advised for supervisory wards sisters, we are starting to see an uplift. We are starting to embed the process and a number of sisters are going down the performance management route. July will see the formal evaluation and a presentation to the Board is scheduled.

5

Mr Quinn added for the next CIP Board meeting – closing the gap should be high on the agenda. Mr Lawrence advised at the next Trust Board meeting he and Mr Quinn will need to report the gap.

5.4 Friends and Family Test

Mrs Thomson gave an update on the FFT for patients, she stated that robust plans are in plan to increase the response rate, which now includes the introduction of the FFT for staff, no target for compliance has currently been set for this element of the FFT but this is expected. We have to prove we have targeted all staff and this will be done via payslips and reported quarterly which will also include staff not traditionally seen as HEFT staff i.e G4S. Inpatients & A&E targets have increased and are now measured as individual targets. Delivery in Q1 for inpatients is likely to be the most difficult to deliver as it relies the use of paper based returns. However BHH was currently tracking at 23% return rate for April. ICT system is being developed for Q2. Mrs King questioned the robustness of the plans as performance in March had dipped significantly to 10% for inpatients and NHS England had questioned the poor response rate. She also stated that she felt that there was some need for investment in the delivery of this CQUIN as it was no longer possible to manage within existing resource and that we need to review our processes. We need an agreed IT solution which will need investment/funding. LT/May 2014 – Provide updated F&FT including solution for staff to complete questionnaire, report on actions

5.5 Winter Update

Mr Clements provided an overview of the report. There has been some slippage versus agreed Site exit plans agreed in recent months. Mr Lawrence advised Deloittes are leading on the winter plan review which will be agreed at Audit Committee. LT/RP/CH May 2014 - to deliver exit plans to revised deadlines and confirm next month. CH May 2014 to confirm final dates against all residual plans.

5.6 Medical Workforce Update

Mr Lawrence asked the committee to note the recommendation but a further report will be required next month as we need a plan so we can plan effectively. Mrs Gunter gave an overview of the locum usage and a number of meetings have

6

been held to identify why we are using locums. Of the 87 vacancies, 67 use locums with 42 having active recruitment plans. Meetings have been held to review all the vacancies and whether we need to recruit to them substantively. 2 are in post which have been incorrectly costed and 12 have future recruitment plans. 7 posts are on hold, 4 are no longer required and 11 are awaiting feedback. Dr Catto and Dr Ryder have also reviewed long term locum bookings. 45 long term locums have recruitment plans. All of these form part of the gate 1 plans. It was recommended to review on a regular basis and look at alternatives to using locums. Mr Lawrence questioned how it relates back to the £3m. Mr Quinn advised if we are using locums in the Trust we are paying enhanced costs. Prof. Peck questioned does extra cover mean unauthorised? Ms Loftus advised these are authorised by the divisions to cover waiting list initiative and become a cost pressure plus we are looking at medium and long term plans. Prof. Peck asked how did we know we had an extra 23 staff and where was the money coming from? Ms Loftus advised it comes from divisional budgets. Prof. Peck continued if we have unauthorised additional spend and we are not managing it, do we need to increase our establishment to meet demand. Mrs Jones explained we know we are over plans for medical staff and the report helps to explain this. The 23 are spread out and are not allin the same area. Mrs Gunter continued agency are expensive and would potentially be better to have established posts which may be cheaper or review as not needed. Mr Lawrence advised we need to understand demand management, establishments and budgets. Using cancer as an example we know a plan is in place for future adverts and campaigns. Mr Lawrence continued Dr Catto is looking at referrals and using advanced practitioners before patients are referred to a Consultant so we can get the correct treatment /path quickly. A discussion followed on job planning, demand management and establishments, including budgets and uplifts. HG/May 2014 – Provide an updated report including locums and recruitment starters and leavers and estimated cost savings.

5.7 Supervisory Ward Sisters Update Mr Lawrence questioned why sickness had reduced but is now back on the increase. Mrs Foster responded there are short and long term plans in place to reduce sickness. Sickness is lower than compared to last year. Mr Lawrence advised after meeting with junior doctors they don’t understand SWS have KPI’s. Mrs Foster added as time progresses integration will happen. It has however taken longer for the team to understand what their roles are and ensure productivity. The discussion then returned back to the FFT including response rates.

5.8 Business Planning Monitoring Dashboard 2013/14 Mr Lawrence provided an overview of the reports including divisions understanding the links to the Corporate Strategy. The report was taken as read.

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5.9 Capital Carry Forwards

Mr Lawrence stated that it appears that over a third of the schemes had not spent their funding and asked that if we have not completed these schemes whether we should cancel them and bring other schemes forward. Mrs Jones stated that the majority of the smaller schemes had spent all of their money and that it was the larger more complicated schemes that had not been completed. She explained that this year because of the reduction in future year capital It was difficult to move money from one year to the next. Mr Lawrence advised there needs to be an understanding that if scheme(s) are not going to be completed in year we bring forward other schemes forward and requested a narrative of how the capital plan development works be included in the paper. Lord Hunt continued with a question on whether the document scanning scheme (worth £3m) was still in progress. Mrs Jones advised the project was on hold while a better referencing system was implemented and feedback was sought from the Consultants. A discussion followed on scanning, archiving and skinny documents. Lord Hunt suggested the committee should continue to monitor the progress of this scheme. A Laverick/May 2014 – Provide a report on digitising records, include where we are

5.10 VAT Update Mrs Jones provided an overview of the report. Option 3 of the recommendations was agreed.

5.11 Annual Plan Update Mr Lawrence advised the paper is split, detailing years 1&2 and then 3, 4 and 5 as requested by Monitor. Mrs Jones advised both halves are detailed and provided an overview of the report and level of detail required, including an overview of CIP and workforce. A discussion followed on headcount, budgets, demand and activity. For the 3-5 year the detailed schemes are still being worked on with assumptions of small level of income growth, static surplus, large CIPs and some headcount changes. Lord Hunt questioned whether we are going to work on the assumption a financial crisis will hit the NHS. Mr Lawrence stated we needed to plan with what we know and to get the site plans in order, we are centring plans around emergency areas and creating specialty centres across the 3 sites. The assumptions were agreed.

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5.12 Contract Update 2014/15

Mr Gould advised that contracts of approximately £600m will be agreed for 14/15. £150m of contracts had been agreed with the largest element being for specialised services. Last year three quarters of the money sat under JMRA (£420m). We are still in the process of agreeing a JMRA. CCGs continue to support a JMRA because it provides transparency and stability, but we need to make sure we are funded correctly. A communication was received yesterday from NHS England about the national deficit relating to specialised services. There is a regional meeting on 29th

5.13

April to find out more. Purchase Orders and Contracts Awards All purchase orders and contracts orders were agreed

6. FOR INFORMATION All items marked for information were noted and no further comments were made. 7 AOB

Mr Lawrence advised this was Lord Hunt’s final Finance and Performance Committee and wanted to pass on his thanks for his support. This was echoed by all committee members

DATE AND TIME OF THE NEXT MEETING The next meeting is scheduled to take place on 2nd

Chairman …………………………..Dated .......................................................

June 2014 at 11.00 am in the Board Room, Devon House, Heartlands Hospital.

Minutes of a meeting of the Donated FundsCommittee of Heart of England NHS Foundation Trust

held in the Boardroom, Devon House, Birmingham Heartlands Hospital on 23rd

PRESENT:

May 2014

Mr P Hensel (Chairman) Mrs A Jones (proxy for Mr Quinn)

Mr L Lawrence

IN ATTENDANCE: Ms A Evans Mrs E Hale Mr K Smith (Secretary)

14.013 APOLOGIES

Apologieshad been received fromMr Fletcher, Mr Quinn and Mrs Thomson. Mr Quinn had nominated Mrs Jones to act as his proxy (and count toward the quorum).

14.014 MINUTES OF PREVIOUS MEETING & MATTERS ARISING

The minutes of the meeting held on 17th

January 2014 were approved as a true record.

The only matter brought forward but not otherwise covered by the agenda was 14.007, in relation to which, Mrs Jones confirmed that she had shared the HEFT capital planning schedule with Mrs Hale to assist in identifying relevant projects for fundraising.

14.015 FUNDRAISING REPORT

Mrs Halepresented the pre-circulated fundraising report and noted that the full 2013/14 year had seen some positive and some negative performance against plan with income from fundraising and legacies ahead of plan but donations and grants below plan. The biggest variance arose from a decision not to proceed with a major lottery grant appeal (£300k), which was beyond the control of the fundraising team. The team was now running with a full complement of experienced, competent staff, so Mrs Hale was confident that the team had begun the new financial year with a team that was capable of achieving plan. Mr Hensel noted that the volatility of staffing and variability of experience had been big issues in terms of the impact on fundraising over the last year. In relation to DBS checks for Charity volunteers, Mrs Jones advised that it was possible for checks to be done for people handling cash. Mrs Hale explained that further security measures were also being investigated with a view to ensuring volunteers couldn’t gain direct access to inpatients (by differentiation of security passes).

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A major capital appeal, for £780k, was anticipated in respect of the proposed Solihull chemotherapy and rheumatology unit, which was subject to final approval by HEFT’s Executive Management Board. Meetings had taken place with the Sharon Fox Cancer Support Centre (SFCSC), Tamworth with a view to establishing a similar centre in Solihull. It was anticipated that the Charity might be asked to assist with start-up funding in the expectation that the new centre would eventually be self-sustaining through direct fundraising.

14.016 FINANCIAL REPORT

Mrs Jones referred to the pre-circulated report and noted that total income of £1,579k for the full year to 31st

March 2014 was £371k behind plan but expenditure of £2,269k was £734k behind plan, therefore the Charity had spent £690k more than income received but this had generated a £363k positive variance against plan.

A gain on the revaluation of investments of £428k had been recorded, resulting in a net deficit o £262k, which was £791k better than plan. As a result of the change in investment managers and resultant sale and re-investment of certain assets by Investec, a gain of £1,178k had crystallised and was now in a holding fund to enable a considered decision to be made about its use at a later date. Committee members had been made aware of this strategy in advance, as it was out with normal process. A further £13k of legacies had been received in the fourth quarter of the year. Mrs Jones referred the Committee to the explanation in the paper regarding the question raised at the previous meeting (minute 14.007) about the salary content and timeline for the Leukaemia & Cancer Research Project. In addition, it was noted that this project would take funding from several small funds first resulting in a reduction of the number of open funds, which was administratively helpful. The 2014/15 Budget was considered with income of £2.2m, expenditure of £2.4m and a deficit of £0.2m with a net loss after revaluation of investments of £0.1m. This was broadly in line with the fundraising plan. Fundholders had been asked to forward their 2014/15 plans and those who hadn’t would be chased shortly.

14.017 INVESTMENT BENCHMARKING RECOMMENDATION

Mr Smith referred to the pre-circulated papers. The benchmarking recommendation had been provided by Investec and reflected its investment strategy, as previously approved by the Committee; it had been reviewed by the Charity’s investment adviser, Marlborough, which had confirmed that it was comfortable with the recommendation. The benchmarking recommendation was approved. The paper from Investec describing its house view of risk was noted.

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The Committee confirmed that future reports on investment returns compared to the benchmark should come from Investec with a commentary on Investec’s performance from Marlborough.

14.018 ANNUAL REPORT & ACCOUNTS 2013/14

Mrs Jones referred to the pre-circulated, substantially final, version of the Charity’s Report & Accounts for 2013/14 and explained the timetable and process to sign off, the following week. It was noted that a more attractive presentational style had been developed for the document this year, which it was felt would be helpful from a fundraising perspective. This had involved considerable effort on the part of Mrs Evans and the HEFT Communications and Medical Illustrations teams. The Committee expressed its satisfaction with the new design and wished to record its thanks and appreciation to all involved. Mr Smith noted that Mr Fletcher had seen a draft of the document and confirmed that he was comfortable with it. The Committee approved the document for onward consideration by the HEFT Audit Committee and Board.

14.019 PwC ISA 260 REPORT 2013/14

Mrs Jones referred to the pre-circulated report from PwC and explained that the year end audit process had been very straightforward and efficient this year. The report identified no uncorrected misstatements nor any significant judgments or accounting estimates nor issues with material disclosures. There were no significant control deficiencies but there were three instances highlighted in testing where PwC felt that controls in place were not operating effectively. The control issues were discussed and the Committee noted that none were significant and one was based on a subjective view of practice that varied between internal and external auditors. The Committee was assured that appropriate and proportionate actions were being taken by management in relation to all three matters.

14.020 MANAGEMENT REPRESENTATION LETTER 2013/14

The Committee noted and approved the content of the proposed letter of representation.

14.021 OPERATIONS COMMITTEE

Mr Smith reported that the Operations Committee had met informally on 14th March, 24th April and 16th

May 2014 and the related Actions Log was noted.

Mr Smith drew the Committee’s attention to the decision to take a 20% share in St

Giles Hospice Lottery takings for facilitating sale of lottery tickets at Good Hope

Hospital and the potential learning benefits to the fundraising team for possible future

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lottery ventures on other HEFT sites.It was agreed that proceeds would be allocated to

the Good Hope general purposes fund.

Mrs Hale confirmed the decision that had been taken to defer a Big Lottery funding application based on advice that success was more likely in the new financial year. Mr Hensel observed that the Operations Committee seemed to be working very well.

14.022 FUNDRAISING PLAN

Mrs Hale referred to the pre-circulated report and explained that it set out to explain how the fundraising team planned to achieve its targets for 2014/15. Its optimism, compared to the 2013/14 outturn was based on its full complement of experienced staff. Mr Hensel noted the inherent difficulty in planning for and estimating a target. The power of social networking and mobile technology in the fundraising arena was noted, together with the efforts that the team were making to leverage this. It was particularly noted that text donations were currently facilitated via ‘Just Giving’ and that this should be kept under review because they do take a level of commission from donations that may be bettered elsewhere or even eliminated through HEFT’s own IT resources (although the it was noted that the power - and ‘comfort’ - of their brand shouldn’t be underestimated).

14.023 FUNDRAISING PROPOSAL

Mrs Hale referred to the pre-circulated papers and reported that she had pre-briefed Committee members over a period on months of the nature of the proposal that was based on the Charity directly funding the fundraising activity. This was common practice for NHS charities and the proposal reflected a ratio of cost to targeted income that was in line with other similar charities, as demonstrated in the appendix to the proposal. The proposal also sat well with the concept of an independent charity that was under consideration.

Mr Hensel commented that he favoured this approach and that it was more appropriate for a charity of this size than directly employing fundraising staff. After due consideration the proposal was approved and any one member of the Committee, or the Secretary, were authorised to sign the Service Agreement (which would be effective from 1st

April 2014).

14.024 COMMITTEE TERMS OF REFERENCE

Mr Smith referred to the mark-up of the existing Terms of Reference and noted that the main change reflected a request from the Director of Finance that he be replaced by the Chief Financial Controller as a member of the Committee. It was noted that certain consistency corrections were required (Chair versus Chairman) and that the membership of ‘One Non-Executive Director’ should be supplemented by ‘or the Chair’ of HEFT.

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Subject to the foregoing, the proposed revised Terms of Reference were approved for onward recommendation to the Board.

14.025 RISK REGISTER

Mrs Jones reported that the Risk Register had been revised, as agreed at the previous meeting, and included in the pack for review. It was noted that contrary to the page numbering, the Register only comprised a single page. The Register was reviewed. It was noted that liquidity would need to be carefully monitored going forward as planned expenditure might exceed income and much of the Charity’s funds was invested but this was not expected to be problematic.

14.026 ANY OTHER BUSINESS

Mr Hensel reported that he and Mrs Evans had recently attended an interesting seminar on independence for NHS charities. The DoH had published its guidance and the NHS Charities Association would be providing support (and a ‘toolkit’) for what might be a very involved and convoluted process. It was now understood that primary legislation would only be required for existing independent NHS charities.It was generally perceived that the main advantage to independence was fundraising. A memorandum of understanding between the new independent charity and HEFT would be of critical importance. The general view was don’t go with the first tranche of charities to ‘convert’; instead, learn from their experience. On this basis it seemed unlikely that the HEFT Charity would ‘convert’ before 1st

April 2016. Mr Hensel confirmed that the Steering Group created by the Chairman of HEFT would meet in the near future to consider the feasibility and practicalities of ‘converting’.

14.027 DATE OF NEXT MEETING

The next meeting was scheduled for 21st

July 2014.

....................................... Chairman

DONATED FUNDS COMMITTEE

TERMS OF REFERENCE

(Approved by the Board on 3 January 2012…………….2014)

All powers and authorities exercisable by the Board, together with any delegation of such powers or authorities to any committee or individual, are subject to any limitations imposed by the Constitution or by Monitor or by the National Health Service Act 2006. Due regard will also be had to any Code of Governance issued from time to time by Monitor. Any reference to “Director” shall be to formally appointed directors of the Trust Board and, unless otherwise specified, not to personnel who carry the word “Director” as part of their title. 1.

• Independent Chair

MEMBERSHIP

1.1 Members of the Committee shall be appointed by the Board and shall be made up of at least two members.

1.2 Only members of the Committee have the right to attend Committee

meetings. However, other individuals, including external advisers, may be invited to attend for all or part of any meeting, as and when appropriate.

1.3 The Board shall appoint the Committee Chairman who should be either the

Chairman of the Board or an independent Non-Executive Directoran independent chair. In the absence of the Committee Chairman or an appointed deputy, the remaining members present shall elect one of their number to chair the meeting.

1.4 The following shall be members of the Committee:

• TwoOne Non-Executive Directors or the Chair of the Trust

• Director of Finance Chief Financial Controller

• Director of Corporate AffairsPatient Experience & External Affairs

• AOne Governor 1.5 The Chairman of the Trust shall nominate a Governor to sit on the Committee

for as long as that person remains a Governor. 1.6 Employees expected to attend each meeting are: Chief Financial ControllerHead of Fundraising & Volunteering 1.7 Members and Attendees may not send deputies unless specifically approved

by the Committee Chairman.

2. SECRETARY

2.1 The Company Secretary or their nominee shall be Secretary to the Committee and shall attend all meetings and provide appropriate support to the Chairman and Committee members.

2.2 The Secretary's duties will include:

2.2.1 agreement of the agenda with the Chairman, collation and circulation of papers;

2.2.2 minuting the proceedings and resolutions of all meetings of the

Committee including recording the names of those present and in attendance. Minutes shall be circulated promptly to all members of the Committee;

2.2.3 keeping a record of matters arising and issues to be carried forward;

and 2.2.4 advising the Committee on pertinent areas.

3. QUORUM

3.1 The quorum necessary for the transaction of business shall be three, one of whom must be a non-executive director or independent chair. A duly convened meeting of the Committee at which a quorum is present shall be competent to exercise all or any of the authorities, powers and discretions vested in or exercisable by the Committee.

4. FREQUENCY OF MEETINGS

4.1 The Committee shall meet quarterly and at such other times as the Committee shall require.

5. NOTICE OF MEETINGS

5.1 Meetings of the Committee shall be summoned by the Secretary of the Committee at the request of any of its members.

5.2 Unless otherwise agreed, notice of each meeting confirming the venue, time

and date together with an agenda of items to be discussed, shall be forwarded to each member of the Committee and any other person required to attend no later than five working days before the date of the meeting. Supporting papers shall be sent to Committee members and to other attendees as appropriate, at the same time.

6. DUTIES In relation only to Donated/Charitable Funds, the Committee shall:

6.1 fulfil the legal responsibilities of the Trust as Corporate Trustee as laid down in the Charities Act 2006 any replacement or amendments thereto and as required by the Charity Commission;

6.2 adhere to best practice with particular reference to any guidance from the

Charity Commission;

6.3 ensure that the Investment Policy approved by the Trust Board is adhered to and that Investment Strategy and Performance are continually reviewed whilst being aware of the ethical considerations;

6.4 ensure that there are adequate risk management processes in place and

regularly undertake risk assessments on all aspects that appear to the Committee to require them;

6.5 ensure the year end reporting activity is performed in a professional manner including;

• Review the annual report and accounts to ensure they reflect the status of the charity,;

• ensure the Aannual Rreport and AaccountsFinancial Statements are audited each year,; and

• review the external audit report to make ensure any control recommendations are implemented.;.

6.6 ensure major items of income and expenditure are reviewed on a regular

basis;

6.7 have a strategy to ensure that income and expenditure reflects the requirements of the bBoard is in balance over the longer term (in balance, building up reserve or utilising reserve) and review the performance against this on a regular basis;

6.8 ensure individual major fund-holders have plans in place to manage their

individual funds in accordance with the wishes of any benefactors and for the appropriate benefit of the Trust;

6.9 regularly review the annual Internal Audit Reports, and ensureing that any

recommendations are implemented in a timely mannerand annually review the external audit report;

6.10 request the presence of any fund-holder or manager to clarify any issues that

arise from information provided to the Committee;

6.11 approve the fundraising strategy, approve the annual fundraising plan and regularly review performance against this plan.

6.12 consider business cases where investment is required or where a decision is

required on significant appeals. 6.13 provide support, guidance and encouragement for all income

generatingraising activities whilst managing and monitoring the receipt of all income; and

6.132 provide information and support developments in the Ccharity arena as

requested by Trust Board. 6.14 keep the Trust Board fully informed on the activity, performance of and risks

to the monies under its control.

7. REPORTING RESPONSIBILITIES

7.1 The Committee ChairmanChair or his representative shall report formally to the Board on its proceedings after each meeting on all matters within its duties and responsibilities.

7.2 The Committee shall make whatever recommendations it deems appropriate

on any area within its remit where action or improvement is needed.

Formatted: Bulleted + Level: 1 +Aligned at: 1.9 cm + Indent at: 2.54 cm

8. OTHER MATTERS

8.1 The Committee shall, at least once a year, review its own performance and Terms of Reference to ensure it is operating at maximum effectiveness and recommend any changes it considers necessary to the Board for approval.

9. AUTHORITY

9.1 The Committee is authorised to seek any information it requires from any employee of the Trust in order to perform its duties.

9.2 The Committee is authorised to obtain, at the Trust's expense, outside legal

or other professional advice on any matters within its Terms of Reference.