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Board meeting in public Item: 185.13 ENC: A

MINUTES OF THE TRUST BOARD MEETING

HELD IN PUBLIC

on Thursday 24 October 2013 at 09.45 to 13.25 in J1 Boardroom, Brighton General Hospital, Elm Grove, Brighton BN2 3EW

Sue Sjuve SS Chair Caroline Becher CB Non-executive director Paula Head PH Chief Executive Sue Johnson SJ Non-executive director Richard Curtin RC Chief Operating Officer Stephen Lightfoot SL Non-executive director Jonathan Reid JR Director of Finance and Estates Martin Sambrook MS Non-executive director Nancy Barber NB Chief Nurse David Standfast DS Non-executive director In attendance

Graham Nice GN Exiting Chief Nurse – items 158.13 to 161.13 only Caroline Fox CF Director of Human Resources and Organisational Development Colin Farmer CFa Foundation Trust Lead Nick Fairclough NF Head of Marketing, Communications & Intelligence Gilbert George GG Interim Director of Corporate Affairs Dr Sian Bennett SB Associate Medical Director/Clinical Director, Brighton and Hove

Children and Family Services – on behalf of Medical Director Debbie McElroy DMcE Corporate Governance & Foundation Trust Membership Manager Andrea Illingworth AI Programme Lead, Releasing Time to Care - items 160.13 and

161.13 only Tony Reynolds TR Central Sussex Independent Patients‟ Forum Lilian Bold LB Patients‟ Forum Heather Duffield HD Patients‟ Forum Ngaire Cox NC Staffside Chair Michelle Wilkins MW Specialist Nursery Nurse – item 160.13 only Lee Foster LF Specialist Nursery Nurse – item 160.13 only

158.13 WELCOME AND APOLOGIES FOR ABSENCE

The Chair welcomed members of staff and the public to the meeting, in particular NB, who took up the role of Chief Nurse on Monday, 21 October 2013, GG, Interim Director of Corporate Affairs and SB, Associate Medical Director/Clinical Director, Brighton and Hove Children and Family Services, attending on behalf of Richard Quirk.

Apologies were received from Richard Quirk , RQ, Medical Director. The Chair announced the winners of the Employee of the Month awards for August and September as follows:

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August winner: Sarah Dobson, Team Leader/Senior Nurse at Chailey Heritage Clinical Services, was nominated by six members of her team. Sarah was praised for her tireless commitment to her patients and the inspirational and supportive way she leads her team. September winners: Sara Barrington, Clinical Services Manager at Crawley Hospital and Philip Tremewan, Safeguarding Adults Lead at Horsham Hospital, were praised for their great professionalism and tenacity over the previous three months in the managed closure of a large nursing home in Crawley. Working with social care colleagues, Sara and Philip demonstrated exemplary commitment to the task while maintaining their individual roles. A farewell gift was presented to GN and each executive director delivered a personal message of praise and thanks to him. The Chair thanked GN for his efforts and commitment on behalf of the whole Board, and wished him every success in the future.

159.13 DISCLOSURES AND DECLARATIONS OF INTEREST

None received.

160.13 A PATIENT’S STORY

The Chair welcomed patient, AH and his Mum and Dad. Mum advised that AH, now two years old, had begun refusing feeds at an early stage. His GP referred him to the Royal Alexander Children‟s Hospital where he received therapy from a Speech and Language Therapist employed by Sussex Community NHS Trust SCT. He had a brief stay in hospital and was also seen by a dietician. At his 10 month check AH‟s Health Visitor referred him to a Paediatrician at the Mid Sussex Child Development Centre. At this point AH began receiving care from the MW and LF, Specialist Nursery Nurses. Referrals were made for physiotherapy, as he was late walking, audiology, speech and language therapy and dietary advice. Michelle and Lee also invited AH and his Mum and Dad to attend Sensory Explorers Messy Play group sessions for children who have feeding and social communication difficulties. Mum and Dad advised that AH is much improved and will now at least try new foods though, as he is currently teething, he is experiencing a slight set back. Mum said she felt the messy play sessions had helped tremendously. He is still lagging behind with speech but it is hoped that this will improve with further therapy. Mum said she had felt “desperate” in the early stages as she didn‟t know who to talk to but since MW and LF had been caring for AH she had felt much better. She explained that at the beginning of AH‟s difficulties there had been little communication and no single point of contact. She had felt frustrated at having to continually respond to questions from each new health professional involved in AH‟s care. CF asked what Mum and Dad thought could be done to enable SCT staff to help patients and their families. Mum said she felt that staff need more time to deliver care.

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Referring to Mum‟s point about the lack of a single point of contact in the early stages of AH‟s care, SJ stressed the need to ensure relevant patient information is shared between professionals as quickly as possible to benefit patients and parents/guardians. Mum thanked MW and LF for their dedicated support and especially for introducing AH to the messy play sessions. During the conversation AH played happily and quietly. The Chair thanked Mum and Dad for coming along with AH and sharing their experiences.

161.13 PRODUCTIVE SERIES – UPDATE ON PROGRESS

AI delivered a presentation to the Board – attached below

Productive Series Board Presentation 24.10.13v2.ppt

PH noted that during a visit to the Neurological Rehabilitation Team in Brighton she had been impressed by the level of enthusiasm and commitment to the productive series. SL said he had been very impressed with the Productive Series Team‟s work so far and suggested that this might be linked with the Quality, Innovation, Productivity and Prevention QIPP Programme in the Adults Coastal Locality. In response to a question from DS regarding capacity within teams to complete modules, AI advised that the Productive Series Team does not put pressure on services to complete modules in one go – services may find they have to disengage for a time due to other priorities but will then be encouraged to re-engage at a later date. AI noted that the benefits realised are often enough in themselves to encourage teams to complete modules. DS questioned the availability of resources in future to continue the Productive Series work and PH advised that funding will run out but the team will be re-focussed on QIPP targets. Productive Series methodology will continue. The Chair thanked AI for her presentation.

JR/RC 29.11.13

162.13 MINUTES OF THE MEETING HELD IN PUBLIC ON 26 SEPTEMBER 2013

Minutes of the board meeting, held in public on 26 September 2013, having been previously circulated, were approved as a true record, for signature by the Chair subject to the following amendments: Item 142.13 – the final paragraph is to be amended to read, „From next month the Integrated Performance Report to the Board is to include updates on progress in increasing use of Bank staff as opposed to agency where and when appropriate.‟

163.13 BOARD ACTION SCHEDULE AND MATTERS ARISING

The Board noted the earlier-circulated action log and that all actions had

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been completed, save for: 150.13 Committee reviews and approval of proposed amended

committee terms Scheme of delegation to be developed and received by the Board on 19.12.13

GG 19.12.13

125.13E Integrated Performance Report – stakeholder engagement Key Performance Indicators KPIs Stakeholder engagement KPIs are to be discussed at the Board seminar on 18.11.13 with regard to management of the SCT brand. Update 09.09.13 This will be discussed at the 18.11.13 Board Seminar with regard to the Management of the SCT brand. Update 11.11.13 The Board Seminar on 18.11.13 is now to be devoted to preparation for the NHS Trust Development Authority TDA readiness review on 28.11.13. The SCT brand will be discussed at the Board Seminar on 12.12.13.

CF 18.11.13 12.12.13

120.13B Healthcare assistants Nursing Advisory Group to consider any further action necessary in view of the Cavendish Review Update 09.09.13 Assistant Practitioner Task & Finish Group (encompassing Healthcare Assistant HCA 'Cavendish‟ Task & Finish group) held 18 Sep 13 (work-plan to be produced at meeting). Deputy Chief Nurse and Head of Professional & Practice Development are engaged with the Royal College of Nursing re HCA induction and advised to wait for the government response to the Cavendish review (policy & practice briefing to be held at Westminster on Nov 12th) before any radical changes are made. A report is to be received by the Board in the Chief Executive‟s update on 19.12.13 Update 24.10.13 SJ advised the Board that the Human Resources & Organisational Development HR&OD Committee had discussed the matter.

CF & PH 26.09.13 PH 19.12.13

164.13 INFORMATICS STRATEGY

The Informatics Strategy was received and noted. In response to a question from SL, JR advised that the strategy will be implemented through structural changes in-house and through the employment of external resources. CF assured the Board that the Organisational Development specialism will underpin any structural changes and employment of new resources. SJ stressed that operational staff should be involved from the beginning and queried lack of reference to budget and costs. JR confirmed that operational staff will be involved and budget and costs will be evaluated, including effect on capital. RC noted that senior operational staff should have involvement with outputs. In response to a question from CB, JR confirmed that training needs will be

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identified before costs are evaluated. It was agreed that the Informatics Programme Board will provide ongoing assurance on progress to the Board via the Chair of the Finance and Investment Committee. The Board approved the Informatics Strategy.

165.13 TRUST OVERSIGHT RETURN – SEPTEMBER 2013

The Board approved the Board statements and compliance declarations for September 2013, noting that full compliance would be declared in October‟s return.

166.13 CHIEF OPERATING OFFICER’S QUARTERLY REPORT JULY TO SEPTEMBER 2013 (QUARTER 2) AND THE 2013/14 WINTER PLAN

The Board noted the Chief Operating Officer‟s quarterly report and 2013/14 Winter Action Plan. RC advised that it is inevitable that there will be a surge this winter due to the older local population and increasing demands on emergency services. He said the Trust is better prepared than last year and everything that can be done is being done. He went on to talk about how the Trust is supporting all three area specific winter plans, referred to in his report, through the development and implementation of a Surge & Escalation Plan with other parties. He confirmed that the combined plans should ensure that the Trust can maintain its services even when all areas are under significant pressure. He described plans to meet expected increases in activity during winter, additional capacity that has been commissioned by the CCGs in each of the areas and contingency should this still not be enough to ensure business continuity. The effectiveness of our plans and the impact that we have in supporting the Local Health Economy LHE will be monitored by us and shared with the commissioners and the NHS Trust Development Authority TDA. Referring to the lack of operational performance Key Performance Indicators KPIs and targets specifically designed for community services, SJ asked whether the Trust feels able to challenge non relevant targets. PH assured the Board that the Trust will confidently challenge where appropriate. She cited, as an example, a recent debate with the TDA on the use of activity data drawn from national reporting module UNIFY, which does not capture community services activity and therefore gives a skewed view of our performance if taken out of context. In response to a question from SJ, RC advised that where performance or continuity of small services is affected by staff sickness or annual leave, discussions are taking place with commissioners to consider whether they might be better placed with another provider, eg the headache clinic. This clinic is run by a single GP and sees around eight patients each month. CB suggested that the Trust will be well placed to inform the views of commissioners this year as a result of the major role SCT played last year in supporting acute providers during the winter pressures. PH noted that SCT regard the pressure on primary care and community services as an important part of the whole system response to winter pressures; that often increased activity in these services heralded pressure in

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acute services and so it is incredibly important that the whole system works together to manage through the winter. SCT plays a pivotal role in being able to support both primary care and acute services in keeping people out of hospital in winter. Responding to a question form the chair, on Delayed Transfers of Care DToC, RC advised that, community trusts are not able to raise fines for delays in social care. . The Trust is working with colleagues to reduce delayed transfers and is considering carrying out some of the Continuing Healthcare Assessments regarding eligibility for ongoing NHS funded care thus expediting transfers which follow these assessmnets. . PH advised that the winter Surge & Escalation Plan, as well as the DToC action plan, will be sent to the TDA in response to their request for information on managing winter pressures.

167.13 ANNUAL OPERATING PLAN – UPDATE QUARTER 2 2013/14

The Board noted, with assurance, the Annual Operating Plan update for quarter 2. SL expressed his view that the Plan includes too many objectives and that some of the targets appear “hopeful” rather than planned for. JR responded that the executive team plan to reduce and sharpen objectives in the next iteration. Following a question from SJ, CF advised that she and NB would agree a proposal for structure and lines of responsibility in connection with statutory training. The proposal will then be submitted to the Human Resources and Organisational Development HR&OD Committee. SJ questioned whether the 100% target for statutory training is too ambitious. CF advised that 5,300 statutory training days had been made available to staff for 2013/14, thereby ensuring more than adequate opportunity for all staff to access training. All efforts will be made to highlight the importance to staff of attending training days. RC noted that he and NB would analyse service level data indicating which staff have attended. CF confirmed that assessment of competence will become part of the statutory training programme. CB requested that pace be increased on corporate objective CO12 regarding review and assessment of nursing levels on community bedded units. PH advised that the targets for quarter 3 and quarter 4 were set at the beginning of the year and while it would be unwise to change these, she assured the Board that the Trust is working closely with commissioners to ensure clarity regarding what has been commissioned for which patients, in which beds. With higher levels of patient acuity and dependency in community beds, the Trust will ensure that at quarters 3 and 4 appropriate nursing levels have been assessed and are in place to meet need next year. In the short term action has been taken to ensure patient safety and managers within teams have been given sufficient responsibility to enable them to measure nursing levels against dependency and close beds as a last resort if necessary. However, the situation would be escalated if the beds needed to remain closed for more than two shifts. At CB’s suggestion this information to be included in the relevant section of the Board Assurance Framework BAF. In response to a point raised by SL, JR advised that the nationally reported harm free care metric (CO6), used by the TDA captures all incidences

GG 29.11.13

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irrespective of source. While the Trust is working closely with partner organisations to ensure a reduction in pressure damage, it will continue to report against the internal metric as well.

168.13 INTEGRATED PERFORMANCE REPORT

The Board noted, with assurance, the Integrated Performance Report for Month 6. The Chair noted that much of the commentary repeated figures in the various dashboards. She requested that commentary cover the reasons for deviation from target performance and the actions in train to address this, to allow the board to focus on assurance rather than clarification questions. She also asked that acronyms and jargon be avoided or at least explained. In response to a question from SJ, JR confirmed that a revised, shortened format for the Integrated Performance Report IPR would be presented to the Board in December 2013, alongside the current format. The new report will be more outcome focussed and exception reporting will be retained. PH added that at the TDA‟s suggestion, locality focus will be included in the new format. At MS’s suggestion, JR explained that impairment referred to in the third paragraph on page 14 is a technical transaction resulting from the reduction in value of buildings in Brighton in which the Trust has invested. In response to a question from MS, JR advised that Bank and agency spend remains high due to a number of factors including the introduction of new services at pace and high staff turnover. Agency staff are being encouraged to join the staff Bank. CF noted that a new manager for the staff Bank is now in place and work is underway to strengthen and centralise the service provided. She advised that over the next 12 months full staff establishment will be assessed. Following reference from DS, PH advised that there will be no time for the Integrated Workforce Strategy to be fully reviewed again by Non-executive directors (NEDs) before it is submitted to the TDA on 4 November 2013. However, she assured the Board that it will be thoroughly checked before submission and will be emailed to NEDs. The emphasis and direction of the Strategy will be discussed at Board meetings in future while operational issues will be discussed at meetings of the executive team. DS queried the level at which expenditure of charitable funds requires approval by the Board. It was agreed that GG, JR and DS as the new chair of the charitable funds committee would agree a revised sum. The Board approved the £3m capital investment loan application for development of the Trust‟s estate and also the charitable funds expenditure exceeding £10k for each item set out on page 27 of the report.

CF 29.10.13 GG, JR, DS 29.11.13

169.13 FOUNDATION TRUST PROGRESS REPORT

The Board noted, with assurance, the progress achieved in the Trust‟s application to become an NHS Foundation Trust. PH advised that the document submission to the TDA on 4 November 2013 will inform the readiness review which is to take place on 28 November 2013. All areas of work are on track.

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170.13 BOARD GOVERNANCE MEMORANDUM

The Board noted, with assurance, the refreshed Board Governance Memorandum.

171.13 STRATEGIES FOR SUBMISSION TO THE NHS TRUST DEVELOPMENT AUTHORITY

The Board noted, with assurance, the summary of changes to the following documents:

Foundation Trust FT Governance Rationale;

FT Constitution;

FT Membership Strategy;

Clinical Care Strategy;

Estates Strategy. SJ questioned whether the report provides meaningful information to members of the public. It was agreed that full versions of the refreshed strategies would be added to the Trust‟s website. PH highlighted the merging of the Quality Strategy and the Clinical Care Strategy following advice from the TDA. The Quality Committee have ensured the essence of quality has not been lost through this change. The Chair noted that two of the changes to the Council of Governors were agreed following a proposal from the executive team, ie to include a governor from the higher education sector and a governor to represent the views of young people. By increasing the number of appointed governors, the number of elected governors is required to increase by one and this is reflected in the additional public elected governor to represent the Arun area.

GG 29.10.13

172.13 BOARD ASSURANCE FRAMEWORK

The Board noted, with assurance, the Board Assurance Framework BAF. SJ noted that the Care Quality Commission CQC outcomes listed on the cover sheet to the BAF did not include narrative explanation. It was agreed that from next month a sheet of CQC outcomes will be included in packs of Board meeting papers and, at SJ‟s suggestion, patient outcomes will also be included. SL suggested that consistency in scoring be reviewed and risks be ranked against each other once scored. MS highlighted errors in target dates which will be amended. As she has significant experience in the area, the Chair agreed to work with the executive team and advise how to improve the framework, taking into account the issues raised, prior to submission to the TDA on 4 November 2013. The NEDs agreed the Chair‟s involvement in an advisory capacity.

GG 29.11.13 GG 29.11.13

173.13 SCHEDULE OF BOARD AND COMMITTEE MEETINGS 2014

The Board noted, with assurance, a schedule of dates for Board, Board

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seminar and committee meetings in 2014. The Chair advised that the annual work plan will be received by the Board at the next meeting on 29 November 2013.

174.13 CHAIR’S REPORT

The Board noted, with assurance, the Chair‟s report. It was noted that Professor Raj Rajkumar will join the Trust as NED designate with effect from 1 November 2013. The Chair advised that the following NEDs will now chair the various board committees

Audit Committee – MS

Quality Committee – CB

HR & OD Committee – SJ

Finance and Investment Committee – SL

Charitable Funds Committee – DS Further responsibilities:

Deputy Chair – CB

Senior Independent Director SJ

Raising Concerns (whistleblowing) lead – SJ

Advisory Committee on Clinical Excellence Awards ACCEA representative – MS

The Chair noted that she had attended the Foundation Trust Network FTN annual conference earlier in the week and would include feedback in her next report to the Board. The Chair advised that while on visits to services some staff had raised concern regarding staffing levels. She questioned this in light of earlier discussion at item 167.13 when the Board was informed that frontline managers are able to take immediate action without further approval and ultimately close beds if necessary. PH assured the Board that patients are never exposed to risk. She explained that some isolated units experience difficulties in securing agency support and rely on the goodwill of permanent staff who are already under pressure. She cited this as a good example of the need to continue working closely with commissioners. PH advised that a risk assessment has been completed and a skill mix review is required but must be done with commissioners, since to do so without their input would result in establishment to an uncommissioned level. CF assured the Board that staffing levels are constantly being reviewed. RC noted that the Trust has benchmarked current staffing levels with data produced by the Royal College of Nursing RSN for care of the elderly wards. This data is based on acute care wards but comparison suggests that the Trust‟s early shifts are within benchmark. Late shifts differ in terms of skill mix but this would be appropriate for the Trust‟s cohort of patients. The Chair was reassured following discussion regarding staffing levels but requested a report be submitted to the Quality Committee, looking into the staffing concerns raised during NED service visits. SJ is to

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input to the report and attend the Quality Committee meeting at which the report is to be discussed. In response to a question from SL, PH advised that aspiring community NHS FTs, the NHS Confederation and the FTN are lobbying on behalf of community NHS trusts to input into development of the new CQC inspection process and ensure they are not left until the end of the process. PH has volunteered to contribute staffing to aspiring community NHS FT proposals for inspections in community hospitals. The Chair advised that Monitor has also requested input.

RC Jan 2014

175.13 CHIEF EXECUTIVE’S REPORT

The Board noted, with assurance, the Chief Executive‟s report. The Board extended congratulations to Healthwatch West Sussex following their formal launch on 11 October 2013. PH expressed congratulations to all those who achieved the Institute of Learning & Management ILM Level 5 award and received their certificates at an event at Brighton General Hospital in August 2013. In response to a question from CB, PH advised that the Communications team is promoting the annual staff survey via a variety of channels and she, herself, has sent a message to staff encouraging them to take part. CB praised publicity regarding the Trust‟s decision to adopt the Living Wage on the BBC1 Sunday Politics television programme aired on 20 October 2013. Remaining on the subject of publicity: SJ suggested a link to the NHS England pressure ulcer campaign be included in Team Talk. In response to the Chair‟s suggestion, NB advised that she will review the Trust‟s work in connection with the Nursing Times Speak Out Safely campaign.

176.13 FINANCE & INVESTMENT COMMITTEE MEETINGS: - 5 September 2013 - minutes - 15 October 2013 - chair’s update

The Board noted, with assurance, the minutes of the Finance & Investment Committee meeting held on 5 September 2013 and the committee chair‟s update following the meeting held on 15 October 2013.

177.13 AUDIT COMMITTEE MEETINGS: - 5 September 2013 – minutes - 15 October 2013 – chair’s update -

The Board noted, with assurance, the minutes of the Audit Committee meeting held on 5 September 2013 and the committee chair‟s update following the meeting held on 15 October 2013.

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178.13 QUALITY COMMITTEE MEETINGS - 5 September 2013 – minutes - 9 October 2013 – chair’s update

The Board noted, with assurance, the minutes of the Quality Committee meeting held on 5 September 2013 and the committee chair‟s update following the meeting held on 9 October 2013. Referring to the meeting held on 5th September 2013, DS advised that though not minuted, he had asked which healthcare agency should lead when several are involved in a patient‟s care. PH advised that this is the purpose of the integration agenda and that, ideally, one person would lead throughout a patient‟s healthcare journey. However, governance arrangements prevent this at present. RC advised that Proactive Care is addressing this issue in the meantime, particularly in the case of multidisciplinary teams where a care worker will coordinate care across agencies. Patient satisfaction surveys will monitor success and a fundamental part of the Trust‟s strategic objectives concerns achievement of patient care goals.

179.13 HUMAN RESOURCES AND ORGANISATIONAL DEVELOPMENT COMMITTEE MEETING - 15 October 2013 – chair’s verbal update

SJ highlighted the following areas of discussion:

Cavendish review and how the Trust will respond to recommendations regarding healthcare assistants.

SCT Workforce Plan and what staffing levels are appropriate.

Cultural enquiry – it was felt that broad discussion was required to ensure a unified and positive culture across the Trust and also to define what is meant by „culture‟. This subject is to be discussed at the Board seminar on 12 December 2013.

180.13 WRITTEN AND VERBAL QUESTIONS FROM THE PUBLIC

In response to comments and questions from Lilian Bold:

the Chair confirmed that consideration will be given to any impact on equality and diversity for staff and patients when service changes are planned.

A link to the UN Convention on the rights of people with disabilities is to be uploaded to the Trust website.

CF advised that clarification of roles for frontline staff ensures patients are not put at risk.

Tony Reynolds asked how the Local Health Economy will cope with winter pressures following near failure to cope with the surge escalation during the summer when other factors such as staff sickness were not so prevalent. RC advised that the Trust has rolled out a major flu vaccination programme for staff and uptake so far has been good. A Flu Pandemic Plan is in place. The Trust is better prepared to cope with winter pressures this year than in previous years. In response to a question from Ngaire Cox , PH confirmed that the Trust is reconsidering allowing staff access to social media websites and will report back to the board within the next few months. In response to a question from Heather Duffield, RC advised that staff and funding for Proactive Care are in place. Additional staff are currently being recruited.

CF/NF 29.11.13

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Heather said she had heard reports that acute hospitals in the area were discharging patients too early. RC assured Heather that no patients would be discharged until they were medically fit. He explained that all evidence suggests early rehabilitation provides the best outcome for patients who can otherwise decompensate if they remain in acute settings for too long. Heather asked whether the 20 community beds in the Coastal Locality at Southlands Hospital, deployed last winter, could be re-commissioned. Heather agreed to accept a written response to this question. In response to a request from Tony Reynolds acronyms are to be explained in all reports to the Board and jargon is to be avoided. Tony congratulated the Communications team and especially Paul Somerville on excellent publicity materials across the Trust.

SS 29.11.13

181.13 PUBLIC BODIES (ADMISISON TO MEETINGS) ACT 1960

The Board resolved that in accordance with the public bodies (Admission to Meetings) Act 1960 s1(2) members of the public would be excluded from the remainder of the meeting, having regard to the confidential nature of the business to be transacted, publicity of which would be prejudicial to the public interest.

NEXT MEETING: Friday, 29 November 2013 Billingshurst Community and Conference Centre, Roman Way, Billingshurst, West Sussex RH14 9QW