Council of Governors · 2014. 1. 13. · Chairman's Report Chief Executive's Report Performance year to date Matters Arising Transform-ing Patient Experience Conference Flow and 4-hour

Declaration of Interests

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Minutes of Meetings

ApologiesAny

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Chairman'sReport

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Performanceyear to date

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Transform-ing Patient Experience Conference

Flow and 4-hour target

RecruitingChairman'sSuccessor

BHH Main EntranceUpdate

Agenda

Council of Governors20 January 2014

4.00pm

Education Centre, Heartlands Hospital

January 2014

Council of Governors

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Notice is hereby given that a meeting of theCouncil of Governors

of Heart of England NHS Foundation Trust will be held at Rooms 2 & 3, Education Centre, Birmingham Heartlands Hospital

on 20 January 2014 at 4.00pm

A G E N D A1. Welcome

2. Apologies

3. Declarations of Interest (Enclosure)

4. Minutes of meeting held on 18 November 2013 (Enclosure)

5. Matters Arising (Enclosure)

6. Chairman’s Report, including:• Kennedy Report • Governor volunteer for Task Force

Lord Philip Hunt (Enclosure)

7. Chief Executive’s Report, including:• CQC Inspection

Dr Mark Newbold (Enclosure)

8. Performance year to date Mr Aidan Quinn (Enclosure)

9. Flow and 4-hour target Mr Adrian Stokes (Enclosure)

10. Recruitment of Chairman’s Successor Mr Richard Hughes (Oral)

11. BHH Main Entrance - update Mr John Sellars (Oral)

12. Reports from Committees:12.1 Finance & Strategic Planning Report (9/12/13 & 13/01/14)12.2 Finance & Strategic Planning Minutes (12/11/13)12.3 Hospital Environment Committee Report (6/01/14)12.4 Hospital Environment Committee Minutes (7/11/13)12.5 Membership & Community Engagement Minutes (29/11/13)12.6 Patient Experience Committee Minutes (29/11/13)12.7 Quality & Safety Committee Minutes (06/11/13 & 4/12/13)12.8 Remuneration Committee Minutes (18/11/13)

Mr Barry Orriss

Mrs Elaine Coulthard

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

13. Transforming Patient Experience Conference Mrs Susan Hutchings (Enclosure)

14. Any Other Business

15. Date of Next Meeting

17 March 2014 – St Johns Hotel, Solihull.

Refreshments will be available from 3.30pm

Kevin SmithCompany Secretary13 January 2014

January 2014


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Apologies

January 2014


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Declarations ofInterests

Council of GovernorsJanuary 2014

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COUNCIL OF GOVERNORS

REGISTER OF INTERESTS NAME INTEREST DECLARED DATE

DECLARED DATE CEASED

Cllr Mohammed Aikhlaq

Awaiting information

Arshad Begum Nothing to declare 21 Nov 2011

Kath Bell Company Secretary - Succeed Services Ltd 21 Nov 2011

Barry Clewer, MBE

1. Sandwell & West Birmingham Hospital NHS Trust - Patient & Public Involvement (PPI) member

2. Sandwell & West Birmingham Hospital NHS Trust - Patient Led Assessment of the Care Environment (PLACE) member.

3. Royal College of Nursing - ACTION ON HEARING LOSS - Nursing Practice Steering Group member.

4. Birmingham Healthwatch - Enter & View Representative.

16 Sep 2013

7 Jan 2014

Elaine Coulthard Nothing to declare 21 Nov 2011

Dr Olivia Craig No declaration received

Carol Doyle Awaiting information

Emma Hale Awaiting information

Ron Handsaker Shareholder – Santander 2000

Albert Fletcher Director - Aquarius (unpaid). A charity that specialises in helping and treating those with drink and/or drug issues.

28 May 2013

Richard Hughes 1.Chairman - Homestart (Tamworth) 2.Chairman - Tamworth Credit Union Ltd 3.Director - The Pathway Project 4.Director - Tamworth Community Advice Network CIC 5.Chairman - Tamworth Talking Newspaper Ltd 6.TrusteeChairman - The Rawlett Trust 7.Vice Chairman - Standards Committee, Tamworth Borough Council 8.Divisional President - St John’s Ambulance 9.Member - Appeal Committee, St Giles Hospice 10.Retired CEO & President Secretary, Tamworth Cooperative Society 11.Mr Hughes’ son holds a very senior managerial position with Barclays Bank 12.Chairman - Tamworth Community Advice Network CIC 13. Independent Member - Tamworth

21 Nov 2011

Amended 1 Sep 2013 Amended 23 Oct 2012 6 Feb 2012 23 Oct 2012

23 Oct 2012 23 Oct 2012 23 Oct 2012 23 Oct 2012


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Borough Council Nominations Committee 14. Member - Conservation Advisory Committee, Tamworth Borough Council 15. President - Tamworth Male Voice Choir 16. Treasurer - St Andrew’s Methodist Church, Tamworth 17. Shareholder - BP 18. Shareholder - Santander

23 Oct 2012

23 Oct 2012

23 Oct 2012 23 Oct 2012 23 Oct 2012 23 Oct 2012 23 Oct 2012

Michael Hutchby Nothing to declare 16 Aug 2013

Sue Hutchings Shareholder in Lloyds TSB 19 Sept 2013

Phillip Johnson Nothing to declare 21 Nov 2011

Michael Kelly Nothing to declare 21 Nov 2011

Attiqa Khan Nothing to declare 16 Aug 2013

Heidi Lane 1. Member of Church - Renewal Christian Centre

2. Husband is an Elder of the Church. 3. Trust uses Christian Renewal Centre for

conferences & meetings

21 Nov 2011

Andrew Lydon Nothing to declare 16 Aug 2013

Anne McGeever Nothing to declare 17 Sep 2013

Margaret Meixner Awaiting information

David O’Leary Awaiting information

Barry Orriss Nothing to declare 21 Nov 2011

Mark Pearson Nothing to declare

16 Aug 2013

Cllr Jim Ryan Archway Academy Ltd – Owner/MD Archway Community College - Owner/MD Archway Brimstone Security – Owner/MD Archway Renaissance LLP – Owner/MD Robert Ryan Housing Investments - Owner /MD

15 July 2013

Liz Steventon Friends of Solihull Hospital 21 Nov 2011

Joy Townsend Awaiting information

David Treadwell 1. Shareholder - Lloyds TSB 2. Shareholder - STW 3. Shareholder - National Grid

21 Nov 2011

Matthew Trotter

1. HEFT Employee 2. Director - Specialist Health Partnership

12 Sep 13

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Minutes of Meetingheld on 18 November 2013


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Minutes of meeting18 November 2013


Minutes of a meeting of theCouncil of Governors of Heart of England NHS Foundation Trust

held at St Johns Hotel, Solihullon 18th November 2013

PRESENT:

Lord Philip Hunt (Chairman)

Cllr Mohammed Aikhlaq Ms Heidi LaneMrs Kath Bell Mr Andrew LydonMrs Elaine Coulthard Ms Margaret MeixnerMr Albert Fletcher Mr David O’LearyMr Ron Handsaker Mr Barry OrrissMr Richard Hughes Mr Mark PearsonMr Michael Hutchby Cllr Jim RyanMs Sue Hutchings Mrs Liz SteventonMr Philip Johnson Ms Joy TownsendMr Mike Kelly Mr David TreadwellMs Attiqa Khan Mr Matthew Trotter

IN ATTENDANCE

Dr Aresh Anwar Dr Mark NewboldMs Hazel Gunter Prof Edward PeckMr Simon Hackwell Dr Jammi RaoMr Les Lawrence Mrs Lisa ThomsonMs Alison Lord Dr Sarah Woolley

Mrs Bev Bellerby (minutes)Jonathan Gould (for Adrian Stokes)Prof Don MilliganMr Malcolm PyeMr Kevin Smith (Company Secretary)

PUBLIC IN ATTENDANCE

Mr Steve CoathupMr M HutchinsonMr W Naylor

The Chairman opened the meeting by thanking everyone for attending. He advised that he had come to the meeting from Mr Gerry Robinson’s funeral and wanted to


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record a vote of thanks to Mr Robinson for the work that he and the CHC had done for the Trust. The meeting held a minute’s silence to honour Mr Robinson.

13.073 APOLOGIES

Apologies had been received from Governors: Mrs A Begum, Mr B Clewer, Dr O Craig, Mrs C Doyle and Mrs E Hale.

Apologies were also received on behalf of Mrs S Foster, Mrs S Moore, Mr J Sellars and Mr A Stokes.

The Chairman asked that if anyone was unable to attend future meetings they sendapologies, to allow for accurate reporting of attendance.

Mr Orriss noted that the meeting was the last one that Dr Anwar would attend, before leaving to take up a new post in Australia. The Chairman thanked Dr Anwar for the excellent work he had done as Medical Director and wished him well for the future.

13.074 DECLARATION OF INTEREST

There were no new declarations of interest. The Chairman reminded everyone of the need to notify the Company Secretary of any new declarations.

13.075 MINUTES OF MEETING

The minutes of the Annual Meeting of Members and Council of Governors held on 17th September 2013 were approved by the meeting as an accurate record.

13.076 MATTERS ARISING

13.039.2 The issue around patients that did not attend appointments (DNAs) wasbeing picked up in the CoG Patient Experience Committee meetings.

Ms Hutchings asked about training events for new Governors, especially regardingpatient safety and quality care. The Secretary advised that he circulated details ofany relevant training that he became aware of and also asked the Governors to contact him regarding their specific training needs; in addition the Chairman and Secretary undertook to consider the matter further.

13.077 CHAIRMAN’S REPORT

The Chairman advised that the Staff Recognition Awards had been held in September and had been a resounding success.

Board members had undertaken patient safety visits, which had been noted by theCQC during the recent inspection; the Chairman felt that Directors’ visits were a good way of picking up safety issues, internally.



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13.078 CHIEF EXECUTIVE’S REPORT

MonitorDr Newbold advised that the Trust was in breach of its licence with Monitor, as it hadnot met its 4-hour A&E target for more than a year. The Trust had been asked to provide an undertaking to deliver a recovery plan, of which there were three parts:

Existing winter plans and Gold Command – Gold Command was a crisis intervention approach that commenced on 18th November and was chaired by an Executive Director with site offices at Birmingham Heartlands Hospital (BHH) andGood Hope Hospital (GHH), initially seven days a week. Emergency Care Intensive Support Team (ECIST) would also be spending a week at BHH and GHH during December.

Allocation of winter monies to the Birmingham health economy that would beadministered by a joint working group.

Re-modelling the emergency care pathway based on other successful ED models.Expert clinicians would be working with John Drew from McKinsey over the following 4-6 weeks to develop sustainable solutions.

Sir Ian Kennedy’s ReportDr Newbold advised that Sir Ian Kennedy’s report was commissioned at the beginning of the year; once action had been taken regarding Mr Ian Paterson, the surgeon, and the patient recall process had taken place. The report was almost complete and would be published shortly.

Dispatches broadcast a programme regarding the surgical practices of Mr Paterson on Channel 4 on 11th November 2013; the programme revealed no new information.Sir Ian Kennedy’s report was expected to attract much media attention; Dr Newbold and Mrs Thomson were working on a plan to deal with this.

Chief Inspector’s Visit (CQC)Dr Newbold advised that it had been a tiring week for all involved in the CQC visit.The inspection team comprised 45 staff that attended all of the Trust’s hospitals andhad open access; some visits were unannounced. There had been good staff interaction and the inspection team had been impressed by the staff. The public meetings had low turnouts with only 10-15 at each meeting. The Trust had provided a large volume of documentation to the CQC.

The CQC had given positive initial feedback; noting the open and honest approach of the Trust; staff had been described as caring and committed. No critical safety issues were identified during the inspection. The draft report would be available in around 4-6 weeks to enable a review of factual accuracy by the Trust. A Quality Summit was scheduled for 9th January 2014 to review the findings in full.



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18 trusts would be inspected before Christmas and 3 would have their ratings published, HEFT being one of the three. The rating categories being: outstanding, good, requires improvement and poor.

Mr Hughes asked about staffing at GHH as he had been advised of difficulties in A&Eand ITU. Dr Newbold had not been aware of a specific problem and explained that ITU beds were not always fully open as only half of them were required, but sometimes beds were ‘flexed’; he would look into this. Staff numbers across the Trust were steadily increasing and recruitment was going well.

Mr Lydon mentioned his two recent visits to A&E at BHH and asked about ambulance queues, PIN codes, 15 minute releases and conflicting information about when the 4-hour A&E target period commenced. Dr Newbold declined to talk about individual cases but advised that more was done in A&E at HEFT than at many other hospitals, which was seen to be a safe way of working. However, this inevitably had an impact on the 4-hour target. Ambulance handovers were sometimes contentious but work was being done around the relationship between the Trust and the ambulance service. Patients were not accepted until there was a cubicle ready for them to go into and new arrangements were in place to keep ambulance turnarounds to 30 minutes. New triage arrangements were working well. Dr Newbold added that Gold Command would manage patient flow using the e-Jonah patient tracking system, to ensure everything was reviewed in a timely manner.

Cllr Ryan asked for a report from the Dr Newbold regarding what information wastaken in A&E when non-European patients received treatment, because of the need to recharge the cost of that treatment. Dr Newbold advised that overseas patients were charged appropriately and the information regarding the amounts recouped was recorded.

Mrs Steventon asked how Dr Newbold would gain assurance that the new A&E process would be sustainable, given past experience; he advised that the processhad worked for five quarters in a row but, once the Trust had failed to meet thetarget, it had been unable to recover its position. Many trusts were re-thinking how their A&E departments worked. The key was now thought to be shorter stays, particularly for frail, elderly patients; this may lead to fewer wards for the elderly and increased acute assessment capacity.

Mr Lydon asked if Sir Ian Kennedy’s report recommended change. The Chairman advised that there were likely to be recommendations for change.

Mr Treadwell asked if there was a record of spending on ‘out of hours’ services, such as paying for extra capacity. Dr Newbold advised that £5m of growth money was to be spent on extra capacity and staff for this winter.

13.079 PERFORMANCE YEAR-TO-DATE



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Mr Gould advised that the Trust had spent more than planned, year-to-date, but had received additional income, so was slightly ahead of plan with a £3.7m surplus year-to-date, and a forecast £2m surplus for the full year.

From 1st October, Monitor had introduced a new Risk Assurance Framework. Under the new framework, the Trust would be measured in the top ranking for the financemeasure because of the surplus that it had built up over time; this was good but therating would go down if the Trust spent too much money.

Cost savings, year-to-date, were slightly behind plan but this had been built into the full year forecast. The escalation table demonstrated how issues were raised to improve focus. £41m had been invested in operational cap ex, other large schemes and cross site strategy schemes. Provisions would be reviewed again for the year end.

The Monitor targets for A&E 4-hour wait, C diff and MRSA were currently rated red.The C diff and MRSA targets were particularly difficult to achieve as they were tougher in each successive year.

Cllr Ryan asked why Solihull Hospital’s (SoH) A&E performance was so good in comparison to BHH and GHH. Mrs Thomson advised that the number of emergency patients going to SoH was small compared to BHH and GHH. Cllr Ryan asked why SoH didn’t take pressure off BHH by diverting ambulances to SoH. Mrs Thomson explained that SoH could not take major trauma patients but was changing some wards so that more patients could be treated there. Mr Johnson asked if ambulanceshad discretion around where to take patients. Dr Newbold advised that heart attacks and trauma cases automatically went to BHH and general patients were taken tohospitals within the ambulance’s catchment area, to keep ambulances in ‘zones’, but diversions could be requested if needed, using a system called ‘intelligent conveyancing’. Mr Orriss asked why ambulances from Staffordshire were going to GHH rather than Burton. Dr Newbold was not aware of this but noted that that GHHdid take emergency patients from South Staffordshire. In response to a comment from Cllr Aikhlaq about the number of patients who travel to A&E by car, Dr Newbold explained that around 300 patients per day attend A&E by car, taxi or on foot and a further 90 by ambulance.

Mr Gould advised that the Trust was considering its five year strategy and would be required to share this with Monitor, including the next two years in some detail.

The Chairman added that it had been a real challenge to try to meet the overall Cost Improvement Programme (CIP) of £22m in the current financial year. Mr Gould explained that 68% of CIP savings had been achieved by November 2013. The Trust needed to decide what services it proposed to provide in the future. Frail, elderly patients were staying in hospital for too long which was not beneficial to their health or financially for the Trust. The Jointly Managed Risk Agreement (JMRA) gave the Trust and Commissioners greater financial certainty as it was a form ofblock contract whereby the Trust was paid a lump sum rather than a rate per patient


18 trusts would be inspected before Christmas and 3 would have their ratings published, HEFT being one of the three. The rating categories being: outstanding, good, requires improvement and poor.

Mr Hughes asked about staffing at GHH as he had been advised of difficulties in A&Eand ITU. Dr Newbold had not been aware of a specific problem and explained that ITU beds were not always fully open as only half of them were required, but sometimes beds were ‘flexed’; he would look into this. Staff numbers across the Trust were steadily increasing and recruitment was going well.

Mr Lydon mentioned his two recent visits to A&E at BHH and asked about ambulance queues, PIN codes, 15 minute releases and conflicting information about when the 4-hour A&E target period commenced. Dr Newbold declined to talk about individual cases but advised that more was done in A&E at HEFT than at many other hospitals, which was seen to be a safe way of working. However, this inevitably had an impact on the 4-hour target. Ambulance handovers were sometimes contentious but work was being done around the relationship between the Trust and the ambulance service. Patients were not accepted until there was a cubicle ready for them to go into and new arrangements were in place to keep ambulance turnarounds to 30 minutes. New triage arrangements were working well. Dr Newbold added that Gold Command would manage patient flow using the e-Jonah patient tracking system, to ensure everything was reviewed in a timely manner.

Cllr Ryan asked for a report from the Dr Newbold regarding what information wastaken in A&E when non-European patients received treatment, because of the need to recharge the cost of that treatment. Dr Newbold advised that overseas patients were charged appropriately and the information regarding the amounts recouped was recorded.

Mrs Steventon asked how Dr Newbold would gain assurance that the new A&E process would be sustainable, given past experience; he advised that the processhad worked for five quarters in a row but, once the Trust had failed to meet thetarget, it had been unable to recover its position. Many trusts were re-thinking how their A&E departments worked. The key was now thought to be shorter stays, particularly for frail, elderly patients; this may lead to fewer wards for the elderly and increased acute assessment capacity.

Mr Lydon asked if Sir Ian Kennedy’s report recommended change. The Chairman advised that there were likely to be recommendations for change.

Mr Treadwell asked if there was a record of spending on ‘out of hours’ services, such as paying for extra capacity. Dr Newbold advised that £5m of growth money was to be spent on extra capacity and staff for this winter.

13.079 PERFORMANCE YEAR-TO-DATE


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treated; however a £4m risk pool was available to adjust for treatment of patients above or below plan.

13.080 RECRUITMENT OF CHAIRMAN’S SUCCESSOR

Mr Hughes advised that the Appointments Committee had begun the recruitment process for a new chairman and that Remuneration Committee had met directly before the Council of Governors meeting, to decide on the level of salary required to enable the Trust to recruit the right sort of candidate to the role. By majority decision, the Remuneration Committee had resolved to increase the salary from £50k to £55kto £60k. An exact salary would not be disclosed in the advertisement.

In response to a question from Mr Lydon, Mr Hughes explained that theAppointments Committee would shortlist the applicants and conduct interviews. TheJanuary Council of Governors meeting would be updated with details of the shortlisted applicants with interviews following in February.

Cllr Ryan explained that he had voted against the salary increase in the Remuneration Committee meeting, as he thought the public and staff would be unhappy to hear of the post being given a pay rise when many people had not had pay rises for some time. Mr Hughes voiced concern that the right candidate could be difficult to find at the current salary level. After a protracted and frank discussion the decision was put to the vote and, on a show of hands, a clear majority voted in favour of holding the current salary level of £50k.

Mr Fletcher and Mr Orriss endorsed the process and thanked the committees for the work they had done so far regarding the recruitment of the new chairman.

13.081 SOLIHULL URGENT CARE REVIEW

Mr Hackwell told the meeting that Solihull CCG was doing some work around urgent care in Solihull which was spread across several providers but mainly based on the SoH site:

• A&E at Solihull (which was actually a Minor Injuries Unit)• AMU and MAU were staffed by consultants 24-hours a day• BaDGER Clinic was manned 17:00 to 22:00hrs• Birmingham managed BaDGER Clinic after 22:00hrs (not at SoH)• Walk-in Centre run by CCG – 08:00-20:00hrs

The Walk-in Centre was in a temporary building and HEFT was working with the CCGs to look for alternatives. Patients found it confusing to know where to go for treatment and services were often duplicated.

A clinical reference group and a patient reference group had been established to review the position for the CCG which would take the final decision and make a proposal to Solihull Borough Council before being put to consultation. Overall



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services would be enhanced. In any event A&E would need to be re-named tosomething more appropriate but this would not change the service it offered.

Cllr Ryan was keen to see SoH take extra patients from central Birmingham, which he felt would help to keep services at Solihull. He was concerned that changing the name from A&E would take away the ‘brand’.

Mr Hackwell advised that SoH didn’t have a paediatrics service which was needed to provide a full A&E service. A&E patient numbers between 12:00 midnight and08:00hrs at SoH were modest and didn’t justify the full complement of staff needed to run a full service.

13.082 SURGICAL RECONFIGURATION

Mr Hackwell informed the meeting that surgical services were being reviewed acrossthe Trust with a view to having specialist surgery at BHH and emergency surgery at BHH and GHH. Planned surgery and emergency surgery needed to be reviewed as clinical standards were going up but 20-25% less doctors were training for surgery year-on-year. There were both operational and financial challenges and there may be a more effective way of organising surgery and improving productivity. By restricting certain specialties to specific sites, better outcomes would be expected for patients too. One option was for SoH to become a centre of excellence for orthopaedics with other services transferring to GHH. Another would be for orthopaedics to be at Solihull but trauma to be at BHH. A business case would be developed that would include details around numbers of beds required, theatre times,etc.

In response to a question from Mr Fletcher, Mr Hackwell confirmed that the financial implications hadn’t been worked through yet, this would follow as the business case was developed; the work done so far had been clinically led

Mr Orriss observed that the Trust shouldn’t lose sight of the impact on patients who may be asked to travel further afield for particular specialities. Mr Hackwell acknowledged that something might need to be done to facilitate transport.

13.083 BETTER CARE THROUGH RESEARCH

Prof Milligan, Director of Research, referred to the pre-circulated paper that had been presented to the Board in July 2013; the recommendations of which were approved by the Board.

Prof Milligan explained that it was necessary to undertake research to drive better care and to recruit better staff. MIDRU had been built on the BHH site but the Trust invested relatively little on research on an ongoing basis. The report had asked for money to be invested in:

• More academic appointments from the universities of Birmingham and Warwick;



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• Nursing staff;• Developing a specialism and working closely in Healthcare Safety (working

with Warwick University) and Public Health (working with University of Birmingham); and

• Establishing 4-5 consultant research posts which would attract research funding and kudos.

Dr Newbold confirmed that he was fully supportive of this initiative, which was based on clinical research that offered patients treatment to which they might not otherwise have had access. The Trust was the largest recruiter of clinical trials in 2012; larger even than University Hospital Birmingham. Prof Milligan added that he was keen to expand clinical research into obstetrics, paediatrics, dementia and other areas.

13.084 REPORTS FROM COMMITTEES

Appointments Committee and Remuneration Committee - Both had been addressed earlier in the meeting.

Finance & Strategic Planning Committee - Mr Orriss noted Mr Gould’s report on the financial position. The ability of the Trust to break even in future years was a major concern, particularly when taking into account a number of one-off contributors to income in the current year. Business transformation had been considered and would be on the agenda for a future meeting.

Hospital Environment Committee – The Committee had met once since the Governor elections but only four of the eight members were in attendance. The next meeting was planned for 6th January 2014 at SoH when and the Committee would be touring the catering facility. Mrs Coulthard asked for all Committee members to let her know whether or not they would be at the meeting.

Membership and Community Engagement Committee – The Committee met on 4th October. Mr Fletcher advised that the main issue at the meeting was that there were over 100,000 members but 90,000 of those were not actively engaged. The objective was to try to get the replace some of the 90,000 inactive members with active members. The Committee would need some resource for postage, etc. Mr Lydon added that he had attended UHB’s AGM and felt that they had a very active membership; however, it was probably because everything was on one site andmaybe the Trust could learn from other multi-site Trusts. Mrs Thomson undertook to take Mr Lydon’s observation back to the Committee.

Patient Experience Committee – The Committee met on 4th October and Mr Kelly advised that there had been a good attendance. Di Eltringham, Head Nurse at BHH,had spoken at the meeting about nursing across the three sites and how they would be working to a model of eight patients to one nurse. The title of ‘Matron’ had been reintroduced instead of ‘Lead Nurse’ as that had led to confusion with staff and patients, alike. Ms Theresa Price had attended to talk about DNAs (Did Not Attend) and how the Trust had reduced DNAs from 12.7% to 9.9% of appointments. Posters



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had been put up in Outpatients departments to advise of the cost of not attending. At a recent Kings Fund meeting, they had quoted that Leeds only had 4% DNAs and Mr Kelly had suggested liaising with them to find out what they did differently.Discharges had improved at GHH and closing their discharge lounge had saved money.

Four complaints had been sent to the Parliamentary Ombudsman in the year which was a massive improvement on the year before. HEFT had gone from being 1st, withthe highest number of complaints sent to the Ombudsman, to 20th.

Quality and Safety Committee – The Committee met on 6th November when the Terms of Reference were discussed. Mrs Steventon reported that there were plans for the Committee to review mortality monitoring.

13.085 REPORTS FROM FTGA EVENTS

The pre-circulated reports were taken as read.

13.086 ANY OTHER BUSINESS

Mr Fletcher gave an update on the Donated Funds Committee of the Board (DFC). The Committee acted as the trustee of a HEFT’s registered charity. Mr Paul Hensel, a former Non-executive Director, used to chair the Committee and had agreed to continue in that role. Both Charities Commission and Department of Health regulations applied to the charity but the rules were changing. Mr Hensel had also agreed to chair a working party to look into the possibility of running the charity independently from the Trust. Mr Fletcher had offered to represent the Governors on the working party. Budget holders had been asked to develop and present plans to spend the money donated to the charity, as patients and relatives wanted to see things being bought with the money they had given to the hospital.

Mr Kelly mentioned that two shops next door in the New Main Entrance at BHH were still closed and looked unsightly for visitors walking through the area. The Secretary explained that Mr Sellars would be in attendance at the next meeting, so would be able to provide an update on this.

Mr Kelly commented that crutches were not being handed back to clinics and there must be a cost associated with this. A conversation followed regarding other items that were not returned, such as wheelchairs and heart monitors and it was agreed that a policy was required to hold people to account who did not return hospital property.

Mr Orriss asked why Board minutes were not sent out to the Governors (although Agendas were). The Secretary agreed they would be sent out once they had been approved at the following Board meeting.

The next Council of Governors meeting was scheduled for 20th January 2013.



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The next Breakfast Meeting was scheduled for 6th December, in CR 3, Devon House,BHH, when Dr Anwar would be address the meeting.

………………………Chairman


January 2014


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SCHEDULE OF MATTERS BROUGHT FORWARD

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21 Nov 2012 12.74 Governor podcast

updateCo Sec

Mar2014

21 Mar 2013 13.039.2 DNA missed

appointments review LT Nov 2013

Being pursued by Patient Experience Cttee.

18.11.13

15 Jul 2013 13.053.2

Discussion on vendors at BHH main entrance –vacant spaces and opening hours.

JS Jan 2014 Agenda item 11

18 Nov 2013 13.076 Consider Governors’

training needs.

Chair/ Co Sec

Mar 2014

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CHAIRMAN’S REPORT to the Council of Governors – January 2014

Sir Ian Kennedy’s ReviewIn my report to January’s Board meeting (included below) I detailed proposed actions which were agreed. To ensure that we are progressing all of the elements of Sir Ian Kennedy’s Review I am setting up a Task Force which will meet monthly and I would like a Governor representative to join us on that group. I am suggesting that we ask for nominations and that a vote then takes place to elect the Governor representative. As we need to commence this work as soon as possible we will need to deal with this at our meeting on 20 January.

In addition, I have offered to consider, should the Governors’ request it, to stay on as Chair for an extended four month period to drive forward these changes. However, I hope to be able to confirm this proposal at our meeting as the Trust is currently under discussions with Monitor, the Regulator, about Sir Ian Kennedy’s Review. Also it is dependent on the Governors agreeing this proposal.

The following are the work streams we committed to as the response of our Board to the Kennedy Review. Each will have a Director lead supported by a Project Manager (Richard Brown) to support the work and ensure proper documentation and progress monitoring. Alex Covey, as Head of Organisational Development, will also take a supporting role.

The Task Force will be supported by Kevin as Board Secretary.

The next stage will be to draw up a detailed plan for each action. This should be outlined by the Director lead and then drawn up by the Project Manager.

1. To strengthen the Trust Whistleblowing Policy – to ensure all staff are aware of how to raise concerns and to be clear about the actions that will follow, including proper feedback.Hazel Gunter, supported by Alex Covey

2. Further development of a Patient-Centred approach in the Trust - culture work with Sir Muir Gray.Mark Newbold, supported by Lisa Thomson and Alex Covey

3. Quality and Safety Committee – review of Terms of Reference and working arrangements for this committee of the Trust Board.Jammi Rao, supported by Kevin Smith

4. Improving our consent process – to ensure that the proper principles of agreeing consent for treatment are uniformly followed.David Lock, supported by Matthew Cooke

5. Reviewing the flow of information to Trust Board – to ensure the Board is fully appraised of issues arising, and actions being taken, that could impact on service quality and safety.Alison Lord, supported by Kevin Smith

6. Improving patient information and the patient environment – responding to concerns raised by patients about the handling of initial information-giving, and patient-centred follow up arrangements.Les Lawrence, supported by Lisa Thomson

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7. Review of Trust Disciplinary policies - to ensure timely investigation of concerns about patient care, and sharing of learning with relevant staff, is balanced with fairness to employees.Hazel Gunter, supported by Rachael Blackburn

8. Development of a clinical leader support and development programme – to help clinicians who take on these challenging roles.Mark Newbold, supported by Andrew Catto

9. Implementation of ‘values-based’ consultant recruitment – to ensure values, team working skills and behaviours are assessed, and to implement a ‘compact’ to describe expected behaviours.Hazel Gunter, supported by Alex Covey

10. Development of a protocol for patient recall – a standardised process that will ensure a patient-centred recall.Lisa Thomson, supported by Richard Brown

CQC InspectionOn the 9th January we met with the Care Quality Commission (CQC) and discussed their report following over 400 hours of inspection by 45 people across all of our sites. Our Commissioners, NHS England, Monitor and the Denary were also represented at this meeting where they highlighted the caring nature of our staff as well as some of the challenges we are facing.

A full action plan and response is being made to all of the issues (both large and small) and I have asked Dr Mark Newbold, through his reports to the Council, to keep the Governors fully updated on the actions taken.

I have also asked for the reports to be sent to the Governors as soon as they are published and you should have these before we meet for our Council meeting.

CHAIRMAN’S REPORT to the BOARD of DIRECTORS – January 2014

Sir Ian Kennedy’s ReviewIn my Board Report this month I felt it critical that I focus on Sir Ian Kennedy’s Review of the Breast Care services at Solihull Hospital. Commissioned by the Trust on behalf of patients, I would like to take the opportunity to officially thank Sir Ian for his detailed and exhaustive investigations. Sir Ian’s Report was published on 19th December 2013.

Sir Ian’s Report describes the failings by the Trust’s previous management team in the handling of the issues that arose from the surgical and behavioural practices of Mr Ian Paterson, a surgeon who operated in the Breast Care unit at Solihull Hospital. At the launch I offered a full and unreserved apology to both patients and staff and this is something I would like to reaffirm today.

Sir Ian’s Report makes a series of recommendations that include changing the culture, practices and processes within the Trust so that it is fully aligned with the aims of the Francis Report and ensures that patients are at the heart of every decision taken by Trust employees. As the Board will be aware, we have accepted all the recommendations in full.

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The following are the Board’s specific responses to Sir Ian’s recommendations and were made available as part of the Trust’s response given at the launch:

1. In 2011 the Trust strengthened its approach to whistleblowing with a new policy. This allows staff to report concerns externally, to Public Concern at Work. We will now sign up to the new PCAW Code of Practice, remind all staff members of this facility and ensure they are aware of how to make contact. This includes the ability of Public Concern at Work to have direct access to the Trust Board to raise any issues it feels require immediate action.

In addition, we will develop a process for ensuring that all staff feel able to raise concerns and that these are responded to and fed back with actions taken.

2. The recent Chief Inspector of Hospitals inspection commended the organisation for its clear commitment to openness and transparency. We will take this even further and have already commissioned Professor Sir Muir Gray, Chief Knowledge Officer to the NHS, to work with us to develop an open and patient-centred culture much further. This is something Mark Newbold and the executive will take forward and report back on plans and progress.

3. We have appointed a new, clinically qualified, Chair of the Board Quality and Safety Committee, Dr Jammi Rao. He is reviewing the Terms of Reference in light of the recommendations in the Kennedy Review, including the information used by the Committee; reporting to the full Board; and consideration of disciplinary and other staff issues that may impact on quality and safety.

4. The Non-Executive Directors (NEDs) will take an active role in implementing the recommendations:

a. David Lock QC, NED, will lead on work to review and improve our procedures for agreeing consent with patients.

b. Alison Lord, NED and Chair of Audit Committee, will lead a piece of work to look at information flows to the Trust Board.

c. Former Birmingham City Councillor, Les Lawrence, NED and Deputy Chair, will conduct a review into the patient environment and the information we provide to them.

d. The Chair and the NEDs will meet regularly with clinician groups to ‘take the temperature’ of the clinical body, to build dialogue and engagement, and to provide a safe environment for direct feedback by front line staff. I have asked Lisa Thomson to set these up using the same methodology as used by the CQC and these are to commence later this month.

5. Trust Disciplinary and investigatory processes will be reviewed, to ensure that concerns about safety and quality of care can be investigated speedily and independently, and learning shared openly with employees. The new arrangements will be explicit that, whilst fairness to employees is essential, the need to prevent detriment to patients will be paramount. This will also require a further review of

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grievance and disciplinary policies and processes to ensure that all professions are treated equally and that patient safety becomes the overriding principle.

6. A formal programme of clinical leadership development and support will be implemented, to help clinicians who take on these challenging roles. The focus of theroles will be on measuring, monitoring and improving clinical quality as well as developing and delivering high effective team working.

7. Formal values-based recruitment for medical staff will be implemented. This is to be supported by assessment that includes personality profile and team working ability, and a formal ‘compact’ that describes expected values and behaviours of all appointees. In future this approach will be used for all clinical staff.

8. Advice will be sought to draw up a ‘recall protocol’ which details how any future patient recall processes will be implemented, managed and reported. The focus will be on putting the patient at the centre of everything we do with openness as the core principle. All of this activity will be reported to the Board for assurance.

This month I will set up a task force, which will be established as a Committee of the Board, and will ask David Lock, Alison Lord and Les Lawrence to join me as members. All NEDs are welcome to attend these meetings. I will also be asking for representation form the executive, including Mark Newbold, Clive Ryder, Hazel Gunter and Lisa Thomson. I have also invited the chair of the patient group set up as a result of Mr Paterson’s practice who will be joining us at these meetings. In addition, I will be asking the governors to elect a representative to support the work we are undertaking. This group will oversee the actions being taken to address the recommendations in Sir Ian’s Report and it will publish progress on implementing the recommendations within six months. Sir Ian has kindly offered to meet with us after six months to hear progress and comment on the actions we are taking.

The Board will be aware that we have recalled all of Mr. Paterson’s mastectomy patients and are continuing to follow-up those requiring additional review. This will be for a longer period than normally anticipated, of at least 15 years. In addition, the Trust has commenced a wider review of all of Mr. Paterson’s patients. A review of 60 sets of notes, along with all of the tests including the histopathology and the treatment requested and delivered, and shows no evidence of any issues for these patients. A team of 12 external experts (consultants and breast care nurses) are now reviewing all patient notes and their results and care received.Should they find any discrepancies or issues these patients will be immediately be invited into a clinic to have their care reviewed. I have asked for updates to be brought to the Board.

Also as the Board will be aware, I will be asking the Governors at their January meeting to consider enabling me to stay on as chair for an extended three to six month period to drive forward these changes.

CQC UpdateAs you will see from the Chief Executive’s report we are expecting the official feedback following the first round of the new CQC inspection process, for which we volunteered. I have had an opportunity to review the draft reports which are currently being checked for accuracy. There are no surprises with the Inspection Team highlighting areas for improvement including:

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• The care provided in the all of the A&E departments, particularly around the timing and type of initial assessment.

• Clarification with regards to the services provided by the A&E department at Solihull.

• Ensuring patients are cared for on appropriate wards and clinical areas.

• Reduction of the use of agency and bank staff through continued recruitment of permanent staff.

• Documentation relating to patient care.

• Clarification with regards to the services provided in the Critical Care Unit at Solihull and whether the staff are appropriately trained to look after the type of patients who could be admitted there.

They also highlight the following other areas for improvement: • Sharing information to monitor performance and quality of care.

• Services for children and young people with physical and mental health needs.

• The efficient running of operating lists to reduce the number of cancelled operations.

In addition they highlight the following as good practice:

• The E-JONAH system that highlights patients who are medically fit for discharge and promotes multidisciplinary working to discharge patients effectively.

• The work carried out by the end of life care team in ensuring that relatives were involved and continued to feel cared for after the death of their loved one.

• The support of the critical care outreach team to other hospital staff while patients were waiting for a critical care bed.

The Board will be able to review the full reports and the Trust’s reposes following a quality summit taking place on the 9th January.

Lord Philip HuntChairmanJanuary 2014

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Chief Executive's Report - Council of Governors - January 2014

PerformanceIn my report to January’s Board (included below) I highlighted the challenges we are facingboth in terms of quality, performance and finance. We are making progress with regard to the Trust’s A&E performance. The Governor's will be aware that the Trust has been escalated to the first stage of Monitor's new enforcement process and is being monitored under a series of enforcement undertakings. The current A&E position following a detailed action plan and close involvement of the executive is showing improvement. However, Good Hope Hospital’s performance remains a concern and I have asked Sam Foster to take on executive lead for the site to implement the learning for the 'perfect week' where actions have resulted in sustained Improvements at Birmingham Heartlands Hospital.

Regarding finance, in November the Trust delivered a loss in line with expectations. Importantly underlying rectification/CIP delivery remains unchanged, signalling a continued stalling position as stated last month.

November saw a significant release of funding to Division’s including the remaining Operational Board monies, Trust Wide Winter and National monies to manage pressures over the remaining months. We will need to contain costs to avoid a difficult last quarter and ensure exit strategies are in place to mitigate risk for the new financial year.

There are other ongoing issues that we are managing extremely closely:• failure of the 62 day cancer target in September and October, with initial November

data showing an ongoing failure; and• the backlog of 18 week is now in excess of 1,300 patients.

CHIEF EXECUTIVE’S REPORT to the BOARD of DIRECTORS – January 2014

OverviewThere is no doubt that 2014 will be a challenging year for the NHS, and certainly as a Trust we face a number of challenges and I think it is appropriate to outline these for the Board. We have plans in place to address these but it will be important for the Board to closely monitor our progress and to hold firm to the courses of action we have agreed and are implementing.

CQC inspectors VisitThe reports from the recent Care Quality Commission (CQC) Inspector visits will be made public in January and whilst there is nothing in the draft reports that we are not already aware of, and working to improve, they will highlight the emergency pathway issues we are facing. It is fair to say that most of our current performance challenges relate to the difficulties with managing the ‘front door’ pressures. Further on in my report I have highlighted that in addition to the publication of these reports the CQC will be making it public that it served the Trust with a notice under Section 29 of the Health and Social Care Act 2008 with regard to the Emergency Department (A&E), Medical Assessment Unit (MAU) and Acute Medical Unit (AMU) at Good Hope Hospital. I have included information on this in my report along with a copy of the letter from the CQC.

A&E 4 hour performance

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We remain under close scrutiny from Monitor and commissioners for our performance against the 4 hour access target.

The on-going performance in Quarter 3 of A&E is 90.02% as at 12 December. The Trust has now signed the Enforcement Undertaking and is reporting weekly against this. Monitor is now also responsible for the performance of the FT sector against this target, and we are reporting separately each week in respect of this new approach.

A great deal of work and focus from the executive working closely with the operational teams has taken place in the run-up to Christmas. This has had a positive impact, in particular the ‘Breaking the Cycle’ initiative which we ran in the week commencing 16 December. However, the real test of progress will certainly be in January when we see our busiest time of the year.

18 weeks and 62 Day Access TargetsAs a result of the system pressures we have built up a considerable 18 week backlog and we need to tackle this. Maintaining the 18 week target means that some people will face much extended waits and we do not feel this is acceptable. Accordingly, we are proposing to rectify this in Q4, which will mean a ‘planned failure’ of this target for the quarter. We are discussing this course of action with the commissioners and with Monitor currently. We are also likely to miss the 62 day cancer target in September and October; this is a target in which very small numbers have a large impact. We are currently making significant changes to our booking and theatre scheduling processes to rectify this.

The financial challenge At the December Finance and Performance Committee colleagues were informed thatNovember delivered a loss in line with expectations. Underlying CIP delivery remains a concern, and there is a shortfall currently in plans for the next financial year. Divisions have been asked to address the current shortfall in plans prior to the start of the next financial year in order to stabilise the position with immediate effect. As an Executive we are looking at overarching schemes to support the Directorate-based approach.

Chief Inspector’s VisitJust before Christmas the Trust received the draft reports for each site following the CQC Inspection Team visit in November. These were provided for accuracy checks only, with changes to be provided before the 9th January when the CQC will hold a Quality Summit.

Overall the CQC are reporting that whilst most services were delivered safely, the safety of patients in A&E at all sites, the Acute Medical Unit (Ward 20) at Good Hope Hospital and the Critical Care Unit at Solihull must be improved. The lack of initial assessment of patients in A&E at Birmingham Heartlands and Good Hope hospitals led to some patients not receiving treatment in a timely manner. This has already been picked up with the work on improving flow resulting in patients being seen and treated faster across all sites.

The CQC’s note that clarity about the scope of services is needed in the A&E and critical care services offered at Solihull are also being picked up with the recent reviewing being led by the commissioners on emergency care across the local health economy.



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The CQC has recognised the work the Trust has done to improve staffing levels, noting that the Trust had an active recruitment programme and could demonstrate that significant numbers of staff were due to start work in early 2014.

One area requiring immediate action concerns the Emergency Department (A&E), Medical Assessment Unit (MAU) and Acute Medical Unit (AMU) at Good Hope Hospital. With regard to these areas the CQC has served the Trust with a notice under Section 29 of the Health and Social Care Act 2008. The CQC letter is attached for reference.

The Trust must address these concerns and become compliant by 21 February 2013 and these are already being actioned by the local site team.

Sir Ian Kennedy’s ReportIn addition to the Chairman’s update on the actions being taken as a result of Sir Ian Kennedy’s report I can confirm that I will be leading a team which is focused on delivering the cultural changes required. Professor Sir Muir Gray will be working with us over a six month period to assist in driving the change programme and his expertise is to be welcomed. This group will report back through the Chairman’s Taskforce and update the Board on progress against the actions agreed.

The Board should be aware that the Trust’s HR process remains ongoing and that the GMC is continuing to review the matter from a professional disciplinary perspective. In addition, the private sector’s (Spire) independent review of its aspects is to be published in early 2014. The police investigation remains ongoing into issues relating to the private sector.

The Trust is continuing its review of both the patients of Mr Paterson who have undergone a mastectomy, and a review of the notes, results and treatment for those undergoing other breast surgery.

We will continue to keep the Board updated on progress.

Executive UpdateThe Board will be aware that Aresh Anwar has now left the organisation to develop his career in Perth, Australia. Following an external recruitment process we will be welcoming Dr Andrew Catto as our new Medical Director in April. To ensure continuing professional leadership, Dr Clive Ryder had been appointed as Interim Medical Director. The Board will also be aware that Sue Moore is leaving us at the end of January to take up a Chief Operating Officer post at Lancashire Care Foundation Trust. Richard Parker will take over the Managing Director role, for six months in the first instance, on an interim basis. Richard is an experienced Board-level Operations Director. He is currently working at University Hospitals Coventry and Warwickshire NHS Trust as Emergency Care Recovery Programme Lead and is looking forward to joining us on Monday 3rd February.



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Medical Imaging Data IncidentThe company (Medical Imaging UK Ltd.) who provide the administration for the Birmingham and Black Country Diabetic Eye Screening Programme recently experienced a data breach that resulted in 55 patients receiving letters with another patient’s letter and personal details on the reverse of their letter. The letters were incorrectly printed on 14th December 2013. The sensitive data that would have been included on the letter are:

• Patient Name;

• Patient date of birth;

• Patient Address;

• Patient NHS number; and

• Patient GP practice code.

We were alerted to this issue by a small number of patients who called the administration office on 18th and 19th December on receipt of their letters that had been posted out on Monday 16th December 2013.

Our initial investigation has identified the main cause of this incident as being human error when printing invitation to screening letters and some “normal” results letters. Whilst we have a number of processes and protocols that were followed on this occasion as evidenced by the audit trail, there was evidently a miscalculation of the number of letters going through the printing process. This resulted in some letters being left in the printer that were subsequently “overwritten” when reprinted to attach additional information regarding screening venues.

Medical Imaging UK Ltd has processed over three million letters in the past few years and this is the first incident of its type. They are nevertheless reviewing their print processes and have already introduced additional visual quality checks for each print run.

A letter of apology and notification of what has happened has been sent to all of those patients affected.

WMQRS Review of the Care of Critically Ill & Critically Injured Children: Heart of England NHS Foundation Trust - 3rd & 4th October 2013The Trust has now received the final report of the review of the care of critically ill and critically injured children in the Trust which took place on 3rd and 4th October 2013. The purpose of the report is to help in improving the quality of these services across the Trust.

The report will be made publicly available by the West Midlands Quality Review Service (WMQRS) through its website in February 2014.

This review looked at the care of critically ill and critically injured children in the Emergency Departments at Good Hope Hospital, Birmingham Heartlands Hospital and Solihull Hospital. These departments saw approximately 14,000, 28,000 and 10,000 children per annum respectively. Children’s assessment services at both Good Hope and Birmingham Heartlands Hospitals were reviewed which had observation beds for patients to stay for up to



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24 hours.

The report highlights areas of good practice including:

1. Information leaflets were clear, comprehensive and available on-line. This meant that they were tailored to the patients’ needs, individually named for them, and the patients’ notes recorded what information had been given to them.

2. All drugs and equipment on the resuscitation trolleys were well-organised and bar-coded. Resuscitation officers could therefore monitor electronically when drugs and equipment were approaching their ‘use by’ date.

3. Paediatric guidelines were clear, well organised and easy to use. An Emergency Department version of the guidelines included relevant information, for example, about minor injuries.

The review showed that no immediate risks were identified.

The review did highlight areas for improvement including:

1. Training Records - During the course of the review it was not clear whether medical staff in the Emergency Department, paediatric service and anaesthesia had appropriate competences in resuscitation and stabilisation of critically ill children or in child safeguarding. It was also not clear whether adult nurses in the Emergency Department had appropriate competences in the care of children. (Training records for children’s trained nurses in the Emergency Departments were seen but a children’s trained nurse was not always on duty.) Staff tried hard to find this information but with patchy results.

Reviewers concluded that service managers did not have the access to update information about training and competences which they needed to manage the services for which they were responsible.

2. Transfers - Several aspects of the transfer of children were of concern to reviewers:

Transfer bags were not sealed and reviewers were given inconsistent information as to whether they were checked weekly or monthly. Reviewers were given examples of equipment not being available when required. Different drugs and equipment were in the transfer bags in each area.

The Trust Transfer Policy did not specify the drugs and equipment which should be taken on a transfer.

Reviewers were told of delays in ambulance transfers of children from Good Hope and Solihull Hospitals to Birmingham Heartlands Hospital, because the ambulance service considered the child was in a ‘place of safety’. A monitoring protocol was in place with clear criteria for



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escalation if necessary. Reviewers were concerned that a child’s condition could deteriorate while waiting and difficulties may occur which could have been prevented by an earlier transfer. The number of children affected would be likely to increase during winter months. The Trust was aware of this problem and was considering possible options.

3. Trust-wide Group - The Trust did not have a Trust-wide group looking at the care of children in all settings. There was a ‘Women’s and Children’s Directorate’ as part of the management structure but no forum which brought paediatric services together with, for example, anaesthetists, surgeons, imaging and resuscitation officers. Such a group could also be used to bring together staff working on different hospital sites.

All of these issues are being picked up in the Women’s and Children’s Division with actions and progress reported back through the quality and safety Committee.

Visits and MeetingSince the last Board Meeting I have limited my external work a little in order to stay close to our local challenges. I have given several talks, listed below:

• Current NHS challenges, Health Services Management Centre, Nov 19

• Navigating the NHS, National Prostate Cancer Charity, Birmingham, Nov 19

• Whistleblowing, Health Education West Midlands Conference, Nov 21

• Hospital Reconfiguration, Health Services Management Centre, Nov 26

• Clinical Engagement and Leadership, Hospital Directions Conference, Nov 28

• Why doctors should get involved in management, Birmingham Medical School, Dec 5

Dr Mark NewboldChief ExecutiveJanuary 2014



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Chief Executive's Report - Council of Governors - January 2014

PerformanceIn my report to January’s Board (included below) I highlighted the challenges we are facingboth in terms of quality, performance and finance. We are making progress with regard to the Trust’s A&E performance. The Governor's will be aware that the Trust has been escalated to the first stage of Monitor's new enforcement process and is being monitored under a series of enforcement undertakings. The current A&E position following a detailed action plan and close involvement of the executive is showing improvement. However, Good Hope Hospital’s performance remains a concern and I have asked Sam Foster to take on executive lead for the site to implement the learning for the 'perfect week' where actions have resulted in sustained Improvements at Birmingham Heartlands Hospital.

Regarding finance, in November the Trust delivered a loss in line with expectations. Importantly underlying rectification/CIP delivery remains unchanged, signalling a continued stalling position as stated last month.

November saw a significant release of funding to Division’s including the remaining Operational Board monies, Trust Wide Winter and National monies to manage pressures over the remaining months. We will need to contain costs to avoid a difficult last quarter and ensure exit strategies are in place to mitigate risk for the new financial year.

There are other ongoing issues that we are managing extremely closely:• failure of the 62 day cancer target in September and October, with initial November

data showing an ongoing failure; and• the backlog of 18 week is now in excess of 1,300 patients.

CHIEF EXECUTIVE’S REPORT to the BOARD of DIRECTORS – January 2014

OverviewThere is no doubt that 2014 will be a challenging year for the NHS, and certainly as a Trust we face a number of challenges and I think it is appropriate to outline these for the Board. We have plans in place to address these but it will be important for the Board to closely monitor our progress and to hold firm to the courses of action we have agreed and are implementing.

CQC inspectors VisitThe reports from the recent Care Quality Commission (CQC) Inspector visits will be made public in January and whilst there is nothing in the draft reports that we are not already aware of, and working to improve, they will highlight the emergency pathway issues we are facing. It is fair to say that most of our current performance challenges relate to the difficulties with managing the ‘front door’ pressures. Further on in my report I have highlighted that in addition to the publication of these reports the CQC will be making it public that it served the Trust with a notice under Section 29 of the Health and Social Care Act 2008 with regard to the Emergency Department (A&E), Medical Assessment Unit (MAU) and Acute Medical Unit (AMU) at Good Hope Hospital. I have included information on this in my report along with a copy of the letter from the CQC.


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A&E 4 hour performanceWe remain under close scrutiny from Monitor and commissioners for our performance against the 4 hour access target.

The on-going performance in Quarter 3 of A&E is 90.02% as at 12 December. The Trust has now signed the Enforcement Undertaking and is reporting weekly against this. Monitor is now also responsible for the performance of the FT sector against this target, and we are reporting separately each week in respect of this new approach.

A great deal of work and focus from the executive working closely with the operational teams has taken place in the run-up to Christmas. This has had a positive impact, in particular the ‘Breaking the Cycle’ initiative which we ran in the week commencing 16 December. However, the real test of progress will certainly be in January when we see our busiest time of the year.

18 weeks and 62 Day Access TargetsAs a result of the system pressures we have built up a considerable 18 week backlog and we need to tackle this. Maintaining the 18 week target means that some people will face much extended waits and we do not feel this is acceptable. Accordingly, we are proposing to rectify this in Q4, which will mean a ‘planned failure’ of this target for the quarter. We are discussing this course of action with the commissioners and with Monitor currently. We are also likely to miss the 62 day cancer target in September and October; this is a target in which very small numbers have a large impact. We are currently making significant changes to our booking and theatre scheduling processes to rectify this.

The financial challenge At the December Finance and Performance Committee colleagues were informed thatNovember delivered a loss in line with expectations. Underlying CIP delivery remains a concern, and there is a shortfall currently in plans for the next financial year. Divisions have been asked to address the current shortfall in plans prior to the start of the next financial year in order to stabilise the position with immediate effect. As an Executive we are looking at overarching schemes to support the Directorate-based approach.

Chief Inspector’s VisitJust before Christmas the Trust received the draft reports for each site following the CQC Inspection Team visit in November. These were provided for accuracy checks only, with changes to be provided before the 9th January when the CQC will hold a Quality Summit.

Overall the CQC are reporting that whilst most services were delivered safely, the safety of patients in A&E at all sites, the Acute Medical Unit (Ward 20) at Good Hope Hospital and the Critical Care Unit at Solihull must be improved. The lack of initial assessment of patients in A&E at Birmingham Heartlands and Good Hope hospitals led to some patients not receiving treatment in a timely manner. This has already been picked up with the work on improving flow resulting in patients being seen and treated faster across all sites.

The CQC’s note that clarity about the scope of services is needed in the A&E and critical care services offered at Solihull are also being picked up with the recent reviewing being led


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by the commissioners on emergency care across the local health economy.

The CQC has recognised the work the Trust has done to improve staffing levels, noting that the Trust had an active recruitment programme and could demonstrate that significant numbers of staff were due to start work in early 2014.

One area requiring immediate action concerns the Emergency Department (A&E), Medical Assessment Unit (MAU) and Acute Medical Unit (AMU) at Good Hope Hospital. With regard to these areas the CQC has served the Trust with a notice under Section 29 of the Health and Social Care Act 2008. The CQC letter is attached for reference.

The Trust must address these concerns and become compliant by 21 February 2013 and these are already being actioned by the local site team.

Sir Ian Kennedy’s ReportIn addition to the Chairman’s update on the actions being taken as a result of Sir Ian Kennedy’s report I can confirm that I will be leading a team which is focused on delivering the cultural changes required. Professor Sir Muir Gray will be working with us over a six month period to assist in driving the change programme and his expertise is to be welcomed. This group will report back through the Chairman’s Taskforce and update the Board on progress against the actions agreed.

The Board should be aware that the Trust’s HR process remains ongoing and that the GMC is continuing to review the matter from a professional disciplinary perspective. In addition, the private sector’s (Spire) independent review of its aspects is to be published in early 2014. The police investigation remains ongoing into issues relating to the private sector.

The Trust is continuing its review of both the patients of Mr Paterson who have undergone a mastectomy, and a review of the notes, results and treatment for those undergoing other breast surgery.

We will continue to keep the Board updated on progress.

Executive UpdateThe Board will be aware that Aresh Anwar has now left the organisation to develop his career in Perth, Australia. Following an external recruitment process we will be welcoming Dr Andrew Catto as our new Medical Director in April. To ensure continuing professional leadership, Dr Clive Ryder had been appointed as Interim Medical Director. The Board will also be aware that Sue Moore is leaving us at the end of January to take up a Chief Operating Officer post at Lancashire Care Foundation Trust. Richard Parker will take over the Managing Director role, for six months in the first instance, on an interim basis. Richard is an experienced Board-level Operations Director. He is currently working at University Hospitals Coventry and Warwickshire NHS Trust as Emergency Care Recovery Programme Lead and is looking forward to joining us on Monday 3rd February.



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Medical Imaging Data IncidentThe company (Medical Imaging UK Ltd.) who provide the administration for the Birmingham and Black Country Diabetic Eye Screening Programme recently experienced a data breach that resulted in 55 patients receiving letters with another patient’s letter and personal details on the reverse of their letter. The letters were incorrectly printed on 14th December 2013. The sensitive data that would have been included on the letter are:

• Patient Name;

• Patient date of birth;

• Patient Address;

• Patient NHS number; and

• Patient GP practice code.

We were alerted to this issue by a small number of patients who called the administration office on 18th and 19th December on receipt of their letters that had been posted out on Monday 16th December 2013.

Our initial investigation has identified the main cause of this incident as being human error when printing invitation to screening letters and some “normal” results letters. Whilst we have a number of processes and protocols that were followed on this occasion as evidenced by the audit trail, there was evidently a miscalculation of the number of letters going through the printing process. This resulted in some letters being left in the printer that were subsequently “overwritten” when reprinted to attach additional information regarding screening venues.

Medical Imaging UK Ltd has processed over three million letters in the past few years and this is the first incident of its type. They are nevertheless reviewing their print processes and have already introduced additional visual quality checks for each print run.

A letter of apology and notification of what has happened has been sent to all of those patients affected.

WMQRS Review of the Care of Critically Ill & Critically Injured Children: Heart of England NHS Foundation Trust - 3rd & 4th October 2013The Trust has now received the final report of the review of the care of critically ill and critically injured children in the Trust which took place on 3rd and 4th October 2013. The purpose of the report is to help in improving the quality of these services across the Trust.

The report will be made publicly available by the West Midlands Quality Review Service (WMQRS) through its website in February 2014.

This review looked at the care of critically ill and critically injured children in the Emergency Departments at Good Hope Hospital, Birmingham Heartlands Hospital and Solihull Hospital. These departments saw approximately 14,000, 28,000 and 10,000 children per annum respectively. Children’s assessment services at both Good Hope and Birmingham Heartlands Hospitals were reviewed which had observation beds for patients to stay for up to



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24 hours.

The report highlights areas of good practice including:

1. Information leaflets were clear, comprehensive and available on-line. This meant that they were tailored to the patients’ needs, individually named for them, and the patients’ notes recorded what information had been given to them.

2. All drugs and equipment on the resuscitation trolleys were well-organised and bar-coded. Resuscitation officers could therefore monitor electronically when drugs and equipment were approaching their ‘use by’ date.

3. Paediatric guidelines were clear, well organised and easy to use. An Emergency Department version of the guidelines included relevant information, for example, about minor injuries.

The review showed that no immediate risks were identified.

The review did highlight areas for improvement including:

1. Training Records - During the course of the review it was not clear whether medical staff in the Emergency Department, paediatric service and anaesthesia had appropriate competences in resuscitation and stabilisation of critically ill children or in child safeguarding. It was also not clear whether adult nurses in the Emergency Department had appropriate competences in the care of children. (Training records for children’s trained nurses in the Emergency Departments were seen but a children’s trained nurse was not always on duty.) Staff tried hard to find this information but with patchy results.

Reviewers concluded that service managers did not have the access to update information about training and competences which they needed to manage the services for which they were responsible.

2. Transfers - Several aspects of the transfer of children were of concern to reviewers:

Transfer bags were not sealed and reviewers were given inconsistent information as to whether they were checked weekly or monthly. Reviewers were given examples of equipment not being available when required. Different drugs and equipment were in the transfer bags in each area.

The Trust Transfer Policy did not specify the drugs and equipment which should be taken on a transfer.

Reviewers were told of delays in ambulance transfers of children from Good Hope and Solihull Hospitals to Birmingham Heartlands Hospital, because the ambulance service considered the child was in a ‘place of safety’. A monitoring protocol was in place with clear criteria for escalation if necessary. Reviewers were concerned that a child’s condition could deteriorate while waiting and difficulties may occur which could



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have been prevented by an earlier transfer. The number of children affected would be likely to increase during winter months. The Trust was aware of this problem and was considering possible options.

3. Trust-wide Group - The Trust did not have a Trust-wide group looking at the care of children in all settings. There was a ‘Women’s and Children’s Directorate’ as part of the management structure but no forum which brought paediatric services together with, for example, anaesthetists, surgeons, imaging and resuscitation officers. Such a group could also be used to bring together staff working on different hospital sites.

All of these issues are being picked up in the Women’s and Children’s Division with actions and progress reported back through the quality and safety Committee.

Visits and MeetingSince the last Board Meeting I have limited my external work a little in order to stay close to our local challenges. I have given several talks, listed below:

• Current NHS challenges, Health Services Management Centre, Nov 19

• Navigating the NHS, National Prostate Cancer Charity, Birmingham, Nov 19

• Whistleblowing, Health Education West Midlands Conference, Nov 21

• Hospital Reconfiguration, Health Services Management Centre, Nov 26

• Clinical Engagement and Leadership, Hospital Directions Conference, Nov 28

• Why doctors should get involved in management, Birmingham Medical School, Dec 5

Dr Mark NewboldChief ExecutiveJanuary 2014



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20131219 Good Hope Warning Notice Regulation 10 1

By Email and Recorded Delivery

Mr Mark NewboldHeart of England NHS Foundation TrustBordesley Green EastBirminghamWest MidlandsB9 5SS

20 December 2013

The Care Quality CommissionThe Health and Social Care Act 2008WARNING NOTICE:Heart of England NHS Foundation TrustRegulated Activity: Treatment of Disease, Disorder or Injury

Our reference: RGP1-1144748531.Account number: RR1

Dear Mr Newbold,

This notice is served under Section 29 of the Health and Social Care Act 2008.

This warning notice relates to your registration to carry on the aboveregulated activity at or from the following location:

Good Hope Hospital,Rectory Road,Sutton Coldfield,Birmingham,B75 7RR

We are notifying you that you are failing to comply with the relevant requirementsof the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010(the Regulated Activities Regulations 2010).

The Regulated Activities Regulations 2010

You are failing to comply with Regulation 10(1)(a)(b) and (2)(b)(iii)(iv) whichstates:

10.—(1) The registered person must protect service users, and others who maybe at risk, against the risks of inappropriate or unsafe care and treatment, by

CQC RepresentationsCitygateGallowgateNewcastle upon TyneNE1 4PA

Telephone: 03000 616161Fax: 03000 616171


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means of the effective operation of systems designed to enable the registeredperson to—(a) regularly assess and monitor the quality of the services provided in thecarrying on of the regulated activity against the requirements set out in this Partof these Regulations; and

(b) identify, assess and manage risks relating to the health, welfare and safety ofservice users and others who may be at risk from the carrying on of the regulatedactivity.

(2) For the purposes of paragraph (1), the registered person must—(b) have regard to—

(iii) the information contained in the records referred to in regulation 20,(iv) appropriate professional and expert advice (including any advice obtainedpursuant to sub-paragraph (a)),

Why you are failing to comply with this regulation:

1. On 11, 13 and14 November 2013 the Care Quality Commission inspectionteam led by Fiona Allinson (see appendix A) visited Good Hope Hospital,Rectory Road, Sutton Coldfield, Birmingham, B75 7RR. On 23 November2013 Fiona Allinson Head of Hospital Inspection led a team consisting ofAndrea Gordon, Regional Director Operations, Bethan Graf, Clinical Fellow toSir Mike Richards, Amanda Hennessy and Debbie Williams, ComplianceInspectors to inspect AMU, MAU, critical care services and the A&E unit.

2. During the inspection we inspected the accident and emergency department(A&E) and the ward area known as Ward 20/AMU. In both areas we foundbreaches of Regulation 10.

3. As the registered provider for the regulated activity of treatment of disease,disorder or injury at the Good Hope Hospital location of Heart of England NHSFoundation Trust, you have a legal duty to ensure that service users areprotected against the risks of inappropriate or unsafe care and treatment. Youare required by Regulation 10 of the Regulated Activities Regulations 2010 toprotect service users against the above risk by means of the effectiveoperation of systems designed to enable you to regularly assess and monitorthe quality of the services provided in the carrying on of the regulated activityof treatment of disease, disorder or injury against the requirements set out inthe relevant Part of the Regulated Activities Regulations 2010 and identify,assess and manage risks relating to the health, welfare and safety of serviceusers who may be at risk from the carrying on of the regulated activity oftreatment of disease, disorder or injury . You are failing to comply with thisregulatory requirement.

4. This Notice sets out the detailed grounds upon which you are in breach of thisRegulation.



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Regard to appropriate professional and expert advice3. The current guidance about triage within the A&E department from the

College of Emergency Medicine position statement on triage 2011 states that“Well defined red flag presentations, for example crushing chest pain orprofuse bleeding may be recognised by non–registered health care workerssuch as Emergency Department (ED) reception staff who should seek theimmediate assistance of a registered clinician. Assessing urgency in otherpresentations is a more complex process, and requires the skills of a trainedhealth care professional.” This process is known as streaming. Furthermorethis guidance goes on to define “Triage” as “a face to face encounter whichshould occur within 15 minutes of arrival or registration and should normallyrequire less than 5 minutes contact. Triage should be viewed as a briefintervention - it is not a consultation.” We spoke to staff and patients at GoodHope Hospital and found that whilst you currently employ “streaming “ by thereceptionists who are non-registered healthcare workers i.e. an initialassessment of needs, this is not followed up within the recommended 15minutes by a trained health care professional.

4. Your own patient pathway in the emergency department states that yournursing team will triage designated major patients within 15 minutes of beingnotified of their arrival. It also states that “On occasions due to the volume ofcritically ill/ life threatening patients attending we may not be able to do theinitial nurse assessment in this timeframe.” The pathway does not give alength of time that patients categorised as minors by the receptionist shouldwait. This means that someone miscategorised by the receptionist may notreceive timely treatment and may suffer harm as a result of the delay.

5. We spoke with a patient in the waiting room who had chest pain. The guidancereferred to above indicates such a presentation should be trigger theimmediate request for assistance of a registered healthcare worker. However,the patient explained to us they were surprised they had not been seen by ahealth care professional quickly because they had chest pain. They were toldto wait in the waiting room to be seen. We also found that other patients in thewaiting room were waiting as long as two hours before being seen by a healthcare professional. One patient who had been waiting for two hours told us theyhad not been asked any questions about their condition when they booked inat reception. In the absence of such questioning, reception staff may miss thered flag presentations described in the guidance referred to above. It wastherefore unclear as to whether this person had been designated a “minor” or“major” and consequently how long they could expect to wait to be seen by atrained healthcare professional.

6. We saw that because A & E cubicles were occupied during our visit,additional patients brought in by ambulance were waiting in the corridor on


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trollies. We spoke with a relative of one patient who told us their relative hadbeen waiting in the corridor on a trolley for one hour and 20 minutes. Theytold us that none of the A&E staff had assessed them or spoken to them anddid not seem to be aware that they were there. The patient commented thattheir bottom was becoming sore. Another patient waiting on a trolley in thecorridor had been waiting in excess of two hours. On reviewing their carerecords it was clear that they had not been assessed nor had anyphysiological observations checked during this period.

7. We asked the nurse in charge to explain who was responsible for the patientswaiting on trolleys or in chairs on the corridor. They told us that at the time thehospital and ambulance liaison officer was responsible. However, we thendiscovered that that this member of staff had left the department and had notinformed the nurse in charge. One patient had been left on an ambulancetrolley. Nursing staff in the A&E department were not trained to useambulance trollies. Staff had to ask another paramedic crew to assist them tomove the patient.

8. The national guidance entitled Standards for clinical practice and training,June 2008, from the Resuscitation Council states that staff should check theemergency equipment every day to ensure that it is ready in case of anemergency. However we found that both on A&E and on Ward 20/AMU thesechecks were not taking place. We looked at the resuscitation trolley in theminor injury department. We saw that staff were required to check this trolleyevery day. We looked at records of signatures to demonstrate that the trolleyhad been checked for the last three months and saw that the defibrillator hadnot been checked every day. On ward 20/AMU there was an emergencytrolley which had only been checked on 7 November after the ward openedand not again up to the date of our inspection. We saw this through checkingthe log on the trolley where staff sign to state that they have checked thetrolley. On this check it had been identified that there was no A4 mask orspare roll for the ECG on 7 November 2013. The senior nurse checked thetrolley during our inspection and found a mask and spare roll. This indicatesthe check is not being performed correctly or with the required frequency asthe check log did not accurately record the current condition of the equipmenton the trolley on the date of our inspection. .

9. The patient pathway in the emergency department also states that “We alsohave an overnight stay called the Clinical Decisions Unit [“CDU”] wherepatients are kept in overnight for observation.” However we observed onepatient we spoke with had been delayed in the A&E department and waswaiting within the CDU for a medical bed to become available. This patienthad been in CDU for 26 hours.

10. There is evidence that a systematic approach to rounding can improvepatients’ experience of care and build their trust, ensure that care is safe and


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reliable, and alleviate pressure on nurses. Intentional rounding involves healthcare professionals carrying out regular checks with individual patients at setintervals and is described by a number of authors including Firth-Cozens J,Cornwell J (2009) Enabling Compassionate Care in Acute Hospital Settings.London: The King’s Fund. It is accepted practice at a number of NHS Trusts.

11. Whilst in the A&E department we observed two patients calling for help ina distressed manner, both of whom were disorientated to time and place. Wesaw that two staff walked past and did not respond to their calls. We spokewith staff about how they met patients’ needs. The staff we spoke withdemonstrated a good understanding of patients’ basic needs but told us theywere too busy to always meet them. We asked if comfort or intentionalrounding was carried out. We were told that this would happen if patients werein the department for a long time. We were told staff were too busy to do thisat the time of our visit. We visited the A&E department at Good Hope Hospitalon three occasions on three different days and could not find any evidence ofcomfort rounds or intentional rounding being carried out.

12. The best practice guidance the Safe and secure handling of medicines: ateam approach, March 2005, includes guidance on the safe storage ofmedicines. This also includes the physical security of medication withinhospital settings. This guidance state that the cupboards should be lockedwhen not in use and Conform to BS2881:1989 and BS 3621:2007 and thatthe medicine trolley should be immobilised when not in use .

13. We visited ward 20/AMU on 13 November 2013 and saw that medicineswere not stored securely in that they were stored within the clean utility room.There was a keypad on the door to the clean utility room. We saw the keynumber was written on the whiteboard in the office and when questionedabout this the band 7 nurse said the number was there so all staff couldaccess the room. She said this had been done because of the changes in staffas there was no regular ward staff. In the store room there were two drugtrolleys, but only one in use. This was not secured to the wall, as required bythe Medicines Act 1968, and there was no way to do this. There weremedicines in cupboards which were not locked. They had been locked butbecause the latch was short of the locking pin the lock was ineffective as thedoors could be pulled open. The fridge was not locked and containedmedicines. We asked staff to lock the fridge: they explained that they wereunable to do so as there was no key. There were three bags of medicines lefton the cupboard. The drug trolley was very full with bags of patients’ ownmedicines in it. We spoke with the operations manager who assured us thatthese issues would be addressed. However on our visit of 23 November 2013we found that these issues were still present and that the fridge, despitehaving a notice on it stating do not use was in fact being used to store fourinsulin products.



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14. Therefore our evidence demonstrates that you are in breach of Regulation10(1)(a)(b) and (10 (2)(b)(iv) in that there are not systems operating effectivelyas required by Regulation 10(1) so as to protect patients against the risks ofinappropriate or unsafe care and treatment and for the purposes of Regulation10(1) you are failing to have regard to professional and expert advice in thatpatients are not assessed nor are they seen by the appropriate personnel inA&E: you are not checking resuscitation equipment to ensure that it is readyfor use: you are not undertaking intentional rounding or similar processes:your audit processes have not identified that you are storing medicines whichare not secured.

Managing the risk.

15. We asked to see a risk assessment on the reopening of Ward 20/AMUwhich supported information given to us by the operations manager, howeverthis was not presented to us. We were supplied with two emails detailing thedeficiencies on ward 20/AMU dated 7 and 8 November 2013. These emailssuggest that the management team was aware of the issues on ward 20/AMUat that time and was working to put systems in place to address these issuesand manage the risks. It states “ I am sure that most of these issues you arealready aware of and as I write you would be working on these issues to beresolved asap. You would however agree that as move of AMU Female ShortStay to ward 20 was planned in advance therefore one would have thoughtthat most of these issues should have been ironed out in advance avoiding un-necessary stress for the staff.” It lists the issues which include: only one drugtrolley, one notes trolley, no bedside lockers, and tables amongst the issues.This highlights that the issues in respect of medicines management are notbeing addressed which is a risk to patient safety.

16.We visited the ward on 13 November 2013 and checked the ward to seewhether patients had all the equipment they needed. There were two patientswithout lockers. One patient’s belongings were in a hospital plastic bag on thefloor behind their chair (Bed 7). The patient in Bed 10 which was a side roomhad their belongings in a cardboard box on a chair in their room. The patientin Bed 12 had no easy chair to sit out in. Unoccupied beds also had nolockers: beds 5, 6 and 14. There was no bed for the space marked bed 17.We also saw that patient notes were not stored in a notes trolley. You arefailing to have regard to the information contained in the records that youmaintain in relation to the management of the regulated activity in the AMUunder Regulation 20 in this respect.

17.Therefore our evidence demonstrates that you are in breach of Regulation 10(1)(b) and 10(2)(b)(iii) in that you are not managing the risks relating to thehealth, welfare and safety of service users and others who may be at riskfrom the carrying on of the regulated activity, in that you are failing to manage


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the risks identified to you in an email of 7 and 8 November 2013 in relation tothe management of the regulated activity in the AMU and that you are notfollowing your own policies and guidance.

You are required to become compliant with Regulation 10(1)(a)(b) and(2)(b(iii))(iv) by 21 February 2013.

Please note: If you fail to achieve compliance with the relevant requirementwithin the given timescale, we may take further action to make sure thatyou achieve compliance.

We will notify the public that you have been served with this warning notice byincluding a reference to it in the inspection report. We may also publish asummary more widely, but will not do so if there is a good reason not to.

If you think that the notice has been wrongly served on you, you may makerepresentations to us. This could be because you think the notice contains anerror, is based on facts you consider to be inaccurate, that it should not havebeen served, or is an unreasonable response to the situation it describes. Youmay also make representations if you consider that for these or any other reason,the notice should not be more widely published.

Any representations should be made to us in writing within 10 working days ofthe date this notice was served on you. To do this, please complete the form onour website at: www.cqc.org.uk/warningnoticerepresentations and email it to:[email protected]

If you are unable to send us your representations by email, please send them inwriting to the address below. Please make it clear that you are makingrepresentations and make sure that you include the reference number <CRMprocess ID >.

If you have any questions about this notice, you can contact our NationalCustomer Service Centre using the details below:

Telephone: 03000 616161

Email: [email protected]

Write to: CQC RepresentationsCitygateGallowgateNewcastle upon TyneNE1 4PA


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If you do get in touch, please make sure you quote our reference number (<CRMprocess ID >) as it may cause delay if you are not able to give it to us.

Dr Andrea GordonRegional Director Operations (Central Region)

January 2014


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Performance Year to Date


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Performance year to date


Finance and Performance Update Month 8


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Continuity of Services Rating (COSR) of 4 at month 8.

• £4.2m YTD surplus at the end of October (month 8).

£0.9m better than plan. £7.4m overspend against operational budgets.

Remaining winter monies released by HOMB (£5.3m total)

Medical and nursing staffing overspends. CIP non-delivery Slow delivery against rectification reports. Difficult discussion at December Finance and

Performance Committee on next steps

• One off benefits in position include; HPA contribution £4m JMRA Contingency £2m and BCC resolution £2m,

Forecast of £2m subject to;• Winter costs• No unexpected income• Provisions reviews.

Current and forecast financial performance



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COSR

From 1 October 2013 move from Compliance Framework to Risk Assurance Framework (RAF).

New finance measure is Continuity of Services rating (COSR) with 4 rankings – 4 is the best ranking. Ranking a combination of level of surplus compared to interest paid and liquidity.

At month 8 the Trust scores 4.

Monitor Calculations



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CIP

Focus on Pay control and CIP delivery

Plan is for £22.2m CIP. YTD delivery is £10.3m,70% of YTD plan. Forecasting has reduced slightly to £15.9m (previously £16.2m).

Continued focus on pay control and CIP delivery.

Escalation meetings are being held on non-delivery

Level 5 Delivered

Level 4 Planned with expected delivery

Level Planned with likely delivery



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Balance sheet

• Strong balance sheet.• Cash balance £112m.• Debtors remain below £15m but with a persistent £1m of

over 1 year old.

• Capital– Capital underspends against plans; money not allocated

to schemes and delays in site strategy schemes.

– Not expecting to hit Monitor 85% target for quarter 3 (month 9) so will submit re-forecast to Monitor in February, anticipated forecast to be £29.6m

– Small revaluation required in year for new build schemes (GHH CHP, Solihull generator, Yardley Green car Park, Chest Clinic refurbishment, pathology refurbishment, Cederwood refurbishment and energy sustainability).

FullYear

budget£m

Month 6 YTD £m

Operational Capex 9.6 4.8

Other Large Schemes 14.0 5.8

Cross site strategy Schemes

17.2 5.0

Total 40.8 15.6



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Performance – Monitor Standards

Nov 2013 Performance Information

KPI Month Target

In Month position

YTD target

YTD position

A&E 4 hour wait 95% 89.69% 95% 92.96%

C Difficile 6 8 45 61

MRSA 0 0 0 6

18 weeks admitted

90% 90.93% 90% 92.02%

18 weeks non-admitted

95% 96.24% 95% 96.48%

18 weeks incomplete pathway

92% 94.07% 92% 94.48%


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A&E Performance

The failure to meet the target in Q3 relates to 6,360 breaches out of a total of 72,385 patients attending the

Trust A&E departments (including Solihull Walk-In Centre)


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A&E Performance

The table above shows the number of breaches in Quarter 3 by reason of delay.


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Performance – Monitor Standards

Cancer Performance Information –October 2013 position reported one month in arrears

KPI MTH Oct-13 YTDtarget

YTD position

Target position

Cancer 2 week wait

> 93% 93.04% > 93% 93.72%

2 week wait-breast symptoms

> 93% 93.48% > 93% 94.61%

Cancer 31 day > 96% 96.21% > 96% 98.25%

Cancer 31 day -surgery

> 94% 96.61% > 94% 98.06%

Cancer 31 day –drug treatment

> 98% 100.00% > 98% 100.00%

Cancer 62 day - GP referral

> 85% 78.48% > 85% 87.43%(A breach of 1% =4 patients)

Cancer 62 day -national screening service

> 90% 100% > 90% 97.30%


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Looking ForwardsMonitor Annual Plan

Two phased submission process;

4 April Submission

• 2 year detailed financial plans an Operational Plan Document

• Set out “how the Trust intends to deliver high quality and cost effective services for their patients over the next 2 years, with particular emphasis on the specific challenges posed in 2015-16.”

30 June Submission

• 5 year financial return and Strategic Plan.

• Set out “how the Trust intends to deliver appropriate, high quality and cost-effective services for their patients on a sustainable basis.”

Detailed guidance set out at; http://www.monitor-nhsft.gov.uk/sites/default/files/publications/Guidance%20for%20the%20Annual%20Planning%20Review%202014-15.pdf


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Looking ForwardsMonitor Annual Plan

Indicative modelling has begun on the financials. Until a plan has been agreed in principle with the commissioners some of the values cannot be confirmed. The table below summarises the assumptions that were agreed in outline at the December Finance and Performance Committee.

2014/15 2015/16 2016/17 2017/18 2018/19

Surplus c£2m throughout plan period

CIP C£24m pa throughout the plan period, dependent on income plans with commissioners

Capital £40m £40m £20m £20m £20m

Cash Decreasing across plan period but not to go below £40m

COSR Not to drop below level 3 across plan period

January 2014


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Urgent Care Update to Trust Board – January 2014 Adrian Stokes, Deputy Chief Executive

Context

The Trust approach of having Gold Command operating on two separate site, the length of time this has been running and the variation in approach to the four hour challenge means this report is more Heartlands centric at present but will need to become Trust Wide in order to tackle the issues that exist on both sites and are arguably more of an issue on the Good Hope site.

Introduction

The report is broken in to two distinct sections;

• What interventions have been put in place over the last four weeks and early results, and;

• What will it take to sustain momentum?

The report is supported by two appendices which have been discussion papers circulated widely throughout Heartlands.

Interventions

The following is a list of actions taken and an assessment of when this impacted on performance.

Triumvirate led PODs – This is a process where Heartlands is broken up into three distinct areas and each assigned an Operational lead, a nurse lead and a Medic lead who visit their wards to challenge delays in care/discharge and to promote earlier and quicker discharges as well as relaying any blockages back to the site team. This started on 25th November but took until 9th December to get consistent Medical presence. When it occurred there was a marked improvement in the number of discharges on those days leading to a lower occupancy in the run up to “Breaking the Cycle” week.

Discharge Hub – This is an internal process of identifying available external capacity and supporting wards to access this capacity. This became effective around 9th December as we became clearer on the varying access criteria for additional beds and as the winter funding provided to CCGs became available as additional capacity. This supported the POD process as there were now more options available to discharge patients medically suitable for discharge who still required sub acute care.

Breaking the Cycle – This is an intensive week of intervention to demonstrate that flow can be achieved. This involved every single ward being allocated Ward Liaison officers (and creating a ward level triumvirate) to support the wards, introduction of the SAFER bundle approach to ward management and a greatly enhanced site office to respond to all escalations that impeded on discharge blockages. It utilised a major incident type of command and control structure of Gold (Executives), Silver (Site Office) and Bronze (Ward). This led to a significant increase in flow from A&E to AMU to base wards and had a significant impact on safety, morale and performance. This commenced 16th December.



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6.30pm Site Integrity Meeting – Started 16th December and has become a key point of the day to assess any issues that have an opportunity to be resolved before the handover period which had previously caused poor performance and safety concerns. It is difficult to assess the impact of this yet as our greatly reduced occupancy meant that flow issues were less of a problem although it has identified issues around emergency surgery which will need tackling in the New Year.

The graph below highlights the daily performance across December compared to the average for last years Quarter 3 and October and November this year on the Heartlands site. Appendix 3 contains the same graph for Good Hope and Trust wide performance as recognised by Monitor.

Maintaining Momentum

Delivering short term improvements in performance has been a success but the key for the organisation is to understand what factors could stop this becoming embedded in the organisation and the way we do business going forward.

The following are, I believe, eight key issues that need resolving if flow and performance are to be sustained for the future. Some of these issues may well explain why we have had periods of delivery in the past but have failed to sustain performance.

1. External Capacity – The greatest single risk to continued delivery. The discharge improvement has been supported by the £9.3m investment in additional capacity. If this capacity is constrained again then the hospital occupancy rising to unmanageable levels very quickly seems inevitable. The money is only provided until March 31st this year.

2. Trust wide implementation of schemes – There is a lack of a coordinated approach across the whole Trust to solve the challenge. Whilst recognising that in some instances this might be beneficial there are others where we should have a consistency of approach (IMAS pointed out that the two sites approached “Breaking the Cycle” differently). The SAFER bundle, the 6.30pm site integrity meeting and the structures supporting the process of discharge should be the same across all three sites as an absolute minimum.

3. Medical Leadership – Breaking the Cycle required intensive medical leadership. Heartlands have a vacancy for the Associate Medical Director, there is a vacancy for the clinical lead for



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Acute Medicine and there is no lead for General Internal Medicine (a cross directorate responsibility). The implementation of the SAFER bundle will require significant Medical input and challenge which at present does not exist. Several poor performing Directorates were highlighted in the “Breaking the Cycle” week and need this input to effectively challenge and promote changes. This is exacerbated by not having a permanent Medical Director in the short term. Good Hope also has its challenges in this regard.

4. Managerial Grip – Heartlands has significant senior managerial input and yet has failed to implement simple standard operating procedures systematically. Achieving consistently will require a greater rigour and standardisation of key processes which need to apply regardless of current performance or who is on call for that period of time. A lot of the interventions that have been applied over the last four weeks are not new but have lapsed over time. The SAFER bundle is something which needs to be applied consistently across all wards and performance management of areas that do not comply.

5. Supervisory Ward Sisters – The SAFER bundle requires full MDT approach to solving the issues around progressing discharges at ward level. The senior nursing on those wards are the most constant and should be the eyes and ears of care delivery and should be actively challenging any delays in care. The “Breaking the Cycle” week evidenced some poor practises that you would have expected to have been flagged up through this route given the investment made.

6. AMU staffing/capacity/process across the week – By creating capacity on our base beds we have exposed another bottleneck which needs resolving. With the majority of emergency admissions going through our AMU facility and direct admissions from GPs to AMU this “funnel” can become blocked easily and across key times of early evenings and weekends this happens with some regularity. This results in a backlog arising in A&E and poor performance despite having a lower overall occupancy. This is exacerbated by poor early discharge performance which we have not yet resolved.

7. SAFER Bundle – We have not yet identified a solution for Early in the Day discharge and our performance here is poor. In the weeks where we have had good performance we have managed to create flow out of AMU because of the much lower occupancy, where we start days nearer full occupancy then we have a full AMU and very limited movement out of AMU until mid afternoon (and the knock on consequences as highlighted in “Breaking the Cycle” appendix). We also have days where our discharge numbers are low (weekends, bank holidays and annual leave hot spots), the period of December 20th until 6th January is particularly challenging because of this.

8. Staffing Levels – Despite reassurances around winter recruitment it has proven impossible to guarantee additional nursing support to enable opening of flex capacity. There are unresolved issues around our actual staffing numbers on the ground on any given day. There are also issues around rostering of medics which are unresolved.



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Conclusion

Whilst the early performance improvements are encouraging and has seen the Trust achieve in excess of 95% over a very difficult time of the year there are some underlying issues that could prevent this being sustained once a “Gold Command” infrastructure is removed (The intensity required to achieve Gold Command is also unsustainable over a protracted period of time). Some of the issues, if unresolved, have wider consequences than just the Four Hour standard.

Recommendation

That Finance and Performance Committee and Trust Board receive monthly updates detailing progress against the eight underlying issues that will impede more long term delivery of the Four Hour standard.

The Board discusses the role of Governance and Risk Committee given that the potential safety consequences of poor flow are as significant, if not more so, than the impact on the four hour standard.



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Appendix 1

Breaking the Cycle

This paper aims to describe the current position of the Heartlands site and ultimately lay out a few simple things we need to all do to change the current position we are in.

It is interesting seeing the perspectives of how different groups see the problem and worrying how the one issue of flow impacts so heavily on all groups of patients and staff. It is in all our interests to solve this major issue of flow.

A Typical day at Heartlands for staff

The site office meeting at 8am is always a difficult start to the day, they normally have a list of about ten patients who arrived in A&E at 8pm the night before, a decision to admit was made at midnight and these patients need to be found a bed, but there are none. The desperate chase for beds start.

By 9am the next set of patients start arriving at A&E, with ten ahead of them in the queue for beds A&E already know that the day will not be a good one. Needing to ask our A&E staff to go above and beyond again has become the norm.

By 10am the site office is getting increasingly worried, the day looks like it might collapse, it starts to phone around wards pushing for discharges (and by doing it taking valuable ward time away from the actual process of progressing discharges). As the day progresses and things look worse then the wards will be chased, chased and chased again. It is certainly not the best use of their time. If you are in the site office and see the queue in A&E you have no choice but to chase!

By 11.00 am we might start to think some beds will become available and therefore we bring some patients into theatres, the theatre staff are already frustrated because they’ve waited so long and already had to cancel patients and pre-warn other patients they may be cancelled later that day.

By midday the first arrivals in A&E are reaching the four hour target, because of the immense pressure from CCGs, Area team, Monitor, Ambulances and even the Secretary of State the site office are worried and phone A&E to see what the plan is to avoid the next breach (a difficult call which will get repeated throughout the day). The A&E staff are working in a hospital with no beds, we have only just cleared the patients we decided to admit last night and being phoned to point this out does not help.

By 1pm the ambulance phone the Executive team and demand a response to how we are going to handle ambulances today as the waits are starting to grow. Getting a response involves phoning the site office, who phone A&E and the wards to push discharges a little harder.

By 2pm, despite all the effort and pushing on discharges we have only had about a dozen discharges out of the hospital (even though we’re likely to achieve 85 by the end of the day).

Between 3pm and 6pm – The site office try very hard to push flow by creating one bed at a time (by chasing the wards again) and taking patients from A&E one at a time (by chasing A&E again). The surgeons go and inform the patients that despite waiting all day their surgery is unlikely to happen today.



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By 7pm the majority of the beds start to become available to the site office, we start to clear A&E (who are in the middle of changing shifts). We fill these beds with patients that arrived in A&E much earlier in the afternoon and everybody has waited more than four hours by now. The consultant on call is phoned to see whether they can help with an incredibly busy A&E but some, not all, say their job is not to “Breach Bust”. A&E is verging on unsafe but it’s been like this for so long we no longer see it. The four hour standard is now impossible.

By 8pm patients continue to arrive at A&E (but the rate picks up, sometimes we get 15 ambulances in an hour to an already full A&E). These patients will eventually get seen and need admitting, their bed will come up tomorrow morning and are added to the list for the tomorrows 8am site meeting.

At 10pm the theatre staff finally clear their recovery area (the patients were waiting for a bed) and are allowed home after an incredibly long shift watching patients cancelled and waiting too long and doing more hours than they were set to do at the start of the day (We will ask these staff to do this every day, it has become the norm).

From 10pm to 8am – The day shift from the site office tend to leave having often done a 16 hour day and we leave a hospital on the verge of being unsafe to the night team who fight ambulance delays and pateint moves into the early hours before writing their handover to the site office team to start again.

The site office meeting at 8am is another difficult start to the day, they have a list of twelve patients who arrived in A&E at 8pm the night before, a decision to admit was made at midnight and these patients need to be found a bed, but there are none. The desperate chase for beds start. Groundhog day!

This is not fair on the A&E staff, it is not fair on theatre staff, it is not fair on the wards and it is not fair on the site office. It is even worse for the patient.

The view of the patient

Attached to this document is a copy of a complaint we received this week, please read it.

This type of letter is, unfortunately, not uncommon. There are similar levels of distress for the patient spending 16 hours in A&E whilst surgery and medicine argue what type of bed they require or the patient on the ward that repeatedly acquires infections and has a potential 3 day stay turn into 57 day stay and is worse off as a result.

What is the cause?

There are only two real fundamental issues that sit behind this distressing chain of events;

1. We do not progress a patient through their pathway as quickly as we could. Some spend a day or two longer than they should, many stay weeks longer than necessary.

2. When we do discharge patients we do it very, very late in the day. We are like a hotel that says you can arrive at ten in the morning but tells their current guests that checkout time is seven at night.



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Can it be solved?

It is only small changes that make the difference. If every ward had discharged an additional 3 patients last week we would have started last Monday with two empty wards and the patient complaint letter would not have arrived.

We need to do a few things;

1. Have a concentrated effort on discharging patients for a few weeks so we discharge more than we admit and come into the hospital with some empty beds every day as a norm.

2. Plan our ward rounds and pathways so people spend less time in hospital 3. Have an easy way to escalate and resolve the complex discharges (those needing support

from other organisations) 4. For each ward to have a couple of their discharges managed in the morning. 5. Stop patients unnecessarily getting into our hospital by better decision making as close to

A&E as possible.

Breaking the cycle

We are going to have a week where we ask everyone to focus on discharging patients and raising any concern about any delay and resolve as many of them as we can. We are going to make sure that A&E and AMU are staffed to make sure we only admit those that are absolutely necessary. We are going to ask you to go above and beyond for this week to avoid having to work this way continuously.

We are getting some support in from an organisation that has run these events before and it has worked. We will give you more detail over the next week and start 16th December.

Maintaining Momentum

Once we have created some breathing space it is important we do not slip back to where we find ourselves now. We need to ensure we do the following all the time as the new norm.

1. Each ward to discharge a couple of extra patients a week 2. For two of the discharges to have happened in the morning

Final Thoughts

We have normalised the unacceptable, we have become an outlier on our mortality rates, we have become the worst performing Trust in the country when it comes to the four hour standard, we are the worst performing Trust in the country for ambulance waits, we cancel patients as routine and we ask our staff to work in difficult conditions every single day.

I know asking for a week of additional effort is a big ask but given where we are it would be wrong not to.

Adrian Stokes

Director of Emergency Pathway Transformation and Deputy Chief Executive



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The Patient Story

This is a copy of a complaint received this week; It is not unusual;

To Whom it may concern

i am writing this e-mail well knowing that i am wasting my time because of the hundreds faceless numbers that sit in the back ground of our hospitals, I entered Heartlands Hospital at 7.30 am on Monday 2nd December under the threat of being 15 minutes late and having my intended operation cancelled, i made my way to ward 5 as per my instructions.

On arrival at ward 5 I was greeted very nicely by the ward staff and to my surprise I was was number one on the intake board, I was processed and shown to the lounge, after 5 minute s i was taken to an interview room were the relevant paper work was completed , blood pressure and pulse taken, so far so good, whilst this was being done the consultant arrived and proceeded to scan my left leg and mark the intended procedures route, (nothing but praise so far).

Sadly from here this is where every thing went wrong , we were told informally that I would be the first one into theatre , but this may change, AND CHANGE IT DID, together with my wife we sat in the lounge watching more and more patients arrive, so many so that we at one stage we were compelled to sit in the corridors outside of the ward as all the seats were taken.

we sat there letting the hours roll by , i was trying to reassure my wife that all would be fine as she by her very nature was very stressed with concern for my wellbeing.

the hours came and the hours went i occasionally asked at the desk was there a problem? why is it taking so long?, to be told it is always like this on a Monday as a result of the weekend, after 5 and half hours of sitting there i eventually convinced my wife that it would be best for her to return home and telephone to find out if all had gone well.(we knew the telephone number as we were told a bed was allocated for me in WARD 4 this was duly marked on the admissions board).

my wife left at 1300 hours and made the 1 hour drive home, at 1600 hours my wife called ward 4 to ascertain my condition and to find out visiting times, but alas i still had not had the operation, her telephone call was transferred to ward 5 what is the reason for the delay in the operation she asks again it is the Monday syndrome she is told (by now my wife is in a terrible state worrying about me sitting in the very uncomfortable waiting area) it is now 4 pm and i have sat walked and moved around all areas of ward 5 occasionally questioning why so long is there a problem? am i going to have the operation today? , it was at this point when I really started to get concerned as majority of the other patients had had there operations and being dispatched to their respective ward I had been here 8 and a half hours now my mouth by now was dry as my last intake of any liquid had 5.45am.

WE were now down to three people myself a west Indian gentleman and one other , at last the other man was called into an interview room where alas he was told that he would not be operated on today after sitting there for 9 hours.

another hour passed and another telephone call was received from by now my totally distressed wife to ward 4 only to be told that no operation had be been performed and that I was not there,



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she was transferred to ward 5 , surely my husband is not still sitting around in his dressing gown not have eaten or drank anything since 0600 this morning, yes was the reply, can you explain why was the question it is the Monday syndrome (the old get out of jail free card)

She ask to speak with me, why are you still there? why have not had the operation? have you questioned why? my reply was i do not - i do not know- and yes only to told the same as you, sweetheart please ring off and try to relax i am alright, I will now put my mobile phone on as it is very quiet and there is no risk of it ringing and annoying staff or patients, i will ring you as soon as i am called to go down to the theatre, 10 hours have now passed and say the least i getting annoyed i keep asking is this going to happen?, can i speak with someone in authority ? no sorry everyone is scrubbed up (please do not treat me as an idiot the MANAGEMENT COMMITTEE are not scrubbed up) can you please ring ward 4 to confirm that they have a bed allotted for me i asked , this the nurse did after sitting on the telephone for along while she was told that they would call her back, needless to say the phone call was never received.

it is now 5.30 pm another phone call from my wife who now is in tears Colin this is stupidity you cannot be expected to wait this amount of time with nothing to eat or drink, i have had Ben our son in America on the phone he cannot believe you are being treated this way , also Nicky our daughter in Australia has phoned exactly the same comments, and our daughter Vicky from New Zealand what is going on is the place run by professionals or ametures .

again i asked my wife to put the phone down an i will call here back as i am going to get some sort of answer.

back to desk bidding the nursing staff good night as they were now going home, can you please get some one to come and talk to me and explain what is going on, Back to the waiting room, eventually the west India gentleman was called to theatre , i am now sitting like an idiot alone in the waiting room , as each member of the staff come in and out red faced and most apologetic about the ridiculous situation.

I am now fuming I have stood around the ward for 11 hours and been treated like a mushroom, eventually the nurse from the desk came and said she had received a phone call telling her to offer me something to eat!!!!!!!!!!!!!!!!

alarm bells ring, if you are offering me food this means i am not having the operation is this correct, yes i am sorry was the reply, some one will come and see you in 1 hour, sorry i said i am not prepared to stand around here for another hour .

I got dressed and left to face the one and three quarter hour journey home through rush hour traffic, as it was my son was on his way to visit me thinking i had the operation by now, so he was able to take me home to my distraught wife, who also was given no consideration, just a mere 14 hours of my life wasted along with god knows how much personal expence.

where as the nursing staff were exemplary , I feel that the faceless, heartless,feeling less management that run the hospital have completely lost track of what an hospital is, patients are sick people not lumps of meat or numbers on a budget sheet, do they not realise the stress and worry that a patience and their family go through prior to going into hospital.



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I fully appreciate that there are circumstances beyond control of the Surgeons and nursing staff, but i cannot and will not accept that the illustrious faceless management that control everything cannot have the COMMON DECENCY TO REMEMBER THEY ARE DEALING WITH SICK PEOPLE NOT NUMBERS OR LUMPS OF MEAT who incidentally pay their salary.

Why must some one like my self be treated in this manner , we do not expect to treat like private care patients but simply as human beings with feelings, is it right that some faceless creature thinks it is fitting to keep a person standing around in a hospital ward for 12 hours without so much as sorry or an explanation , regardless of the stress and trauma that one has gone through, does a patients wellbeing mean nothing, you go through the process of taking ones blood pressure at 7.30 am I wonder what the reading was twelve hour later when I left.

I entered the into this operation with not a very high opinion of the NHS only to have my every concern confirmed , it is no longer a NATIONAL HEALTH SERVICE but a business where budget sheets mean far more than patients, it is no wonder that it is in such a pitiful state when you watch the thousands of pounds it wasted on a daily basis.



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Appendix 2

Breaking the Cycle 2 – Maintaining Flow and Momentum

Running at 102% occupancy is clinically unsafe in the long run.

On Saturday 14th December, before “Breaking the Cycle” we started the day with 65 empty beds. Capacity is an issue we can sort.

Capacity is not the same as flow, we have much more work to do to understand how we move patients through our hospital to avoid unnecessary waits or crowding in various parts of the hospital. (We had long waits in ED and assessment units on the evening of Saturday 14th December even with empty beds on nearly all wards). Creating capacity gives us the time to explore these issues more fully.

The question I’ve been getting is “How do we maintain momentum after Breaking the Cycle?” The question should be “What have we done differently in the run up to Breaking the Cycle”.

The answer is fairly simple. It is not new either.

The HEFT Patient Flow Bundle SAFER – Breaking the Cycle

S - Senior Review, all patients will have a Consultant Review before 10am followed by a Ward or Board Round.

A - All patients will have a Planned Discharge Date (that patients are made aware of) based on the medically suitable for discharge status agreed by the clinical teams

F - Flow of patients will commence at the earlier opportunity from assessment units (AMU & SAU) to inpatient wards. Receiving wards from assessment unites will commence before 10am daily

E – Early discharge, 50% of our patients will be discharged from base inpatient wards before midday. TTO’s for planned discharges should be prescribed and with pharmacy by 3pm the day prior to discharge

R – Review, a weekly systematic review of patients with extended lengths of stay >14 days to identify the issues and actions required to facilitate discharge. This will be led by senior leaders within the Trust.

From now we will be monitoring these five things every day across every ward.

It works best when the triumvirate of Doctor, Nurse and manager work together towards the same goal.



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Why do we keep getting into this position?

“How are you going to ensure that ALL wards deliver on a DAILY consultant ward round starting at 0800 – we are consistently told that this is already happening however ringing around the wards at 0800 several weeks ago, experience when doing POD rounds and the improvements in flow this w eek (w hen wards ARE actually having a daily 0800 consultant ward round) suggests that this is only routinely happening on a minority of medical wards” – AMU DoctorWe slowly slip back to crisis because we start to feel comfortable with delays or small changes that start to occur. The missing social worker is not escalated, we accept the nursing home not taking until the following week, the TTO’s are done a little later, the site office don’t push as hard, the ward round starts a little later, some days we go without ward rounds, we admit a few more patients through A&E, the JONAH board is not as up to date as it could be, we don’t cover a weekend absence, we let them have another couple of nights with us, we accept a 7 day turnaround for equipment, we don’t raise a physio delay, we wait a bit longer for the scans or the bloods. The feedback from PODs and the first days of “Breaking the Cycle” is that these examples exist on almost every ward.

“Any good w ork and capacity that is created during the w eek is currently being completely undone at the w eekends – having a single medical consultant on AMU at the weekend who is expected to go round 44 patients before even beginning to review new admissions for that day is unsafe and w ill not generate the flow required on AMU at the weekend – the trust should make it an urgent priority to restructure on-call rotas for GiM at the weekend so that at least 2 consultants are present on AMU on Saturday and Sunday“ – AMU DoctorIt is only the pressure of near full occupancy that drives this out of the system, the key is maintaining this momentum when there are beds in the system. Are you prepared to push for a 9am discharge when you have a few empty beds already? Would you chase down the nursing home if you know you have some spare beds anyway? Are you willing to challenge every admission in A&E when a bed is available? Are you prepared to be intolerant of any delays when we have beds? Will you challenge someone who doesn’t come in when they should? Are you prepared to escalate poor performance? If we are to stay on top of flow you have to.

“Having carried out a surgical "POD" round today I was surprised at what levels of poor advanced planning w ith regards to discharge and lack of awareness of the various options available to help patient leave the hospital is evident on many wards” CD

Eventually we get to the point where keeping the patient in front of you on your ward means that a sicker and frailer person will spend the night on the A&E corridor.

“95 year old lady due to go home to residential home on the 5th December. Residential home delay neither challenged or escalated and w ill now spend Christmas at Heartlands w ith hospital acquired pneumonia.” Chief Nurse

Directorate Plans

Every directorate needs a plan to consistently apply the SAFER flow bundle. This should be visible and shared with all staff.



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Escalation

Consistent application of SAFER flow bundle should avoid us being in constant escalation, but we will require escalation at times.

For the next 3 weeks over the Christmas/New Year period we are going to continue with the POD infrastructure with a Op/Doc/Nurse triumvirate. We need time to collate feedback from “Breaking the Cycle” and introduce changes to enable wards to manage the site.

After these three weeks I am going to suggest the following;

Site is Green

If we have 30 or more beds free Monday morning the discharge process will be left to the wards.

The site office is there to resolve any issues that are impeding your ability to progress safe discharges. Be intolerant of delays and don’t be afraid to escalate.

In addition the site team will also;

1. Publish adherence to the agreed Flow Bundle for all wards 2. Discuss any patient individually who has waited over 14 days to see what obstacles can be

removed 3. JONAH escalation meetings with individual wards to promote best practise. These will be

with the Clinical Director, Matron and Directorate manager.

Site is amber

There are more than 10 beds empty morning, but less than 30 and no capacity in AMU/SAU

We will reintroduce the POD infrastructure of Operations/Doctor/Nurse for that week. I know it is not popular, but it does work. We will operate this until we get the site back to green again. The incentive is, of course, to not get into this state by doing the basics right every single day.

Site is Red

We maintain PODs for that week and plan another emergency intervention remembering that 102% occupancy is unsafe for patients and unfair for staff.

Additional Site Safety and Integrity Meeting

We will also introduce a key clinically led meeting at 6.30pm each day to assess safety going into the evening with clinicians from all key areas.

Adrian Stokes

Director of Emergency Pathway Transformation



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Appendix 3

75%

80%

85%

90%

95%

100%

4 Hour Peformance at Good Hope A&E

75%

80%

85%

90%

95%

100%

4 Hour Peformance at HEFT A&E Departments (inc WIs)


January 2014


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Recruitment ofChairman's Successor

January 2014


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BHH Main Entrance - Update

January 2014


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Reports fromCommittees

12.2 Finance & Strategic Planning Minutes (12.11.13)

12.3 Hospital Environment Committee Report (6.1.14)

12.5 Membership & Community Engagement Minutes (29.11.13)

12.6 Patient Experience Committee Minutes (29.11.13)

12.8 Remuneration Committee Minutes (18.11.13)

12.7 Quality & Safety Committee Minutes (6.11.13 & 4.12.13) (Encl.)

12.4 Hospital Environment Committee Minutes (7.11.13) (Encl.)

(Oral)

(Oral)12.1 Finance & Strategic Planning Report (9.12.13 & 13.1.14)

(Encl.)

(Encl.)

(Encl.)

(Encl.)


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Finance and Strategic Planning Minutes(12.11.13)

COUNCIL OF GOVERNORSFINANCE & STRATEGIC PLANNING COMMITTEE

Minutes of a meeting of the FINANCE & STRATEGIC PLANNING COMMITTEE

of the Council of Governors of Heart of England NHS Foundation Trust

held in Education Centre, Good Hope Hospital

on 12 November2013

Present: Barry Orriss (Committee Chairman)Albert FletcherRichard HughesPhillip JohnsonMichael HutchbyOlivia Craig

In attendance: Joanna HodgkissAngeline JonesClaire Walker

Phillip Lyddon (for item 13.10)

Head of Planning & DevelopmentChief Financial ControllerExecutive Assistant (minutes)

13.01 APOLOGIES

Apologies were received for Les Lawrence, Attiqa Khan, Matthew Trotter and Simon Hackwell.

As the CQC inspection was underway at the Trust Adrian Stokes was required to remain on the Heartlands site in case he was called upon last minute. His apologies were therefore noted.

13.02 APPOINTMENT OF CHAIRMAN

It was agreed that Mr Barry Orriss would continue to serve as Chair to this Committee and that Mr Albert Fletcher would act as Deputy Chair as required.

13.03 MINUTES OF MEEETING – 10 JULY 2013

The minutes of the meeting held on 10 July 2013 were discussed and the following points were noted.

• Miss Hodgkiss informed that item 12.98 AHSN was now up and running and that Dr Mark Newbold has a seat on the formal Board. HEFT are leading on this and the conditions of the licence are now acceptable.

• Miss Hodgkiss also reported that all Pathology tenders have all been pulled but that the Trust are approaching Wolverhampton independently to discuss possibilities.

• Under the Any Other Business section of the minutes the Chair wished that thanks to the officers supporting the meeting be added.

With the above points taken into account the minutes from 10th July were accepted as a true and correct record.

CW (Nov)

13.04 MATTERS ARISING / ACTION LOG

All items noted on the action log were featured on either this or planned for future agendas.


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13.05 REVIEW OF TERMS OF REFERENCE

The Committee were informed that Kevin Smith the Company Secretary is looking at the Terms of Reference for various Committees and it is anticipated that amendments and additions will be made to the current documents. The following points were made regarding the current document:

Section 1 – Membership• It was believed that the agenda for every Governor meeting should be sent to ALL

Governors. Should a featured item be of particular interest to an individual they may contact the relevant Chair and request permission to attend the meeting. If permission is granted the Executive Support for that Committee would need to informed for venue size, refreshment purposes and document circulation.

• Appointment to the Committee should be extended from two years to three years in line with the appointment period of governors.

Section 5 – Notice of Meetings• The summoning of meetings by the secretary should be in consultation with the

Committee Chair.Section 7 – Duties• The Committees overarching aim should include performance.

These points will be passed onto the Company Secretary for consideration when reviewing the Terms of Reference documentation.

AJ(Nov)

13.06 FINANCE & PERFORMANCE UPDATE MONTH 6

Mrs Jones presented the pre-circulated paper and summarised that at the end of September, Quarter 2, the Trust are at a financial risk rating of 4. With a year to date surplus of £3.7m which is £1.4m better than plan. Mr Orriss felt the term ‘better than plan’ to be misleading as it had taken into account the £2m received from BCC. Mrs Jones informed that the main financial pressures are overspend against budgets and non delivery of CIP. She went on to assure the Committee that the Finance & Performance Committee see divisions that are not delivering to ensure robust plans are in place and actioned. Mrs Jones reported that there had been a big recruitment drive in the Trust to deal with nurse staffing, we have recruited many nurses over the summer so a reduction in the use of agency should be seen.

A question was raised asking why, if we know we are going to overspend, do we not budget for it? It was explained that the budget had been set at a level that delivered the level of surpluses required by the Trust, the budget had been signed off at Finance & Performance Committee and the allocations to the divisions had been agreed by their senior managers. It was felt that there is always a demand for more funding and no matter how much budget you allocate to divisions they will still overspend against it. In addition, some savings (CIP) have not been delivered that expected to be delivered by this point and this had caused some of the overspend. It was felt that it would be useful to invite Mr Aidan Quinn to this Committee to present the budget setting paper that will be presented at Finance & Performance Committee.

Mrs Jones stated that from October the Trust will be monitored against the Risk Assurance Framework (RAF) applied by Monitor who have changed how they measure us. COSR (continuity of services rating) which ranks a combination of level of surplus compared to interest paid and liquidity. The Trust, very comfortably ranks a 4 and Mrs Jones assured that as a Foundation Trust the money is ours and cannot be taken off uswithout a change in legislation.

It was reported that CIP is managed by HOMB (HEFT Operations Management Board) which then sends a report on CIP performance into the Finance & PerformanceCommittee.

AJ(Nov)



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The following points were also noted:

• In relation to Capital a small revaluation will be needed for some of our specific schemes.

• Car parking at Good Hope is currently going through business case process.• Performance monitor standards, A&E continues to be very difficult and the Trust has

missed this target for the 5th Quarter in a row.

13.07 MONITOR ANNUAL PLAN

Mrs Jones informed the Committee that the Annual Plan is a document that goes to Monitor which covers three areas, finance, governance and strategy.

The plan now needs to look at 5 years instead of 3 with the first 2 years in detail. Mrs Jones stated that she had received some further details stating that the first 2 years of the plan will need to be submitted in March with the remaining 3 years submitted in June.

This Committee can expect to see an update on the requirements at January’s meetingand a version of the document for comment at March’s meeting.

AJ(Jan)

13.08 CORPORATE STRATEGY

Ms Hodgkiss requested that an extra meeting be held during December which Mr Simon Hackwell, Commercial & Strategy Director can attend to look at this item in further detail.

Members of the Committee agreed to the additional meeting. Mrs Walker will look at possible dates and availability of key attendees and circulate some date options.

SH(Dec)

CW(Nov)

13.09 BUSINESS PLANNING / RESHAPING HEFT UPDATE

It was agreed that this item would be deferred to the additional meeting in Decemberwhere Mr Hackwell and Mr Lawrence, Non-Executive Director would be present and the item could be discussed in detail.

Ms Hodgkiss however, wished to highlight that plans are progressing around the changes to Solihull A&E and it is anticipated that the full business case will be presented here in December.

JH/SH(Dec)

JH(Dec)

13.10 BUSINESS TRANSFORMATION

Mr Phil Lyddon, Operations Lead attended the meeting (this item only) and introduced his presentation. He informed that the Business Process Board was set up to ensure delivery of a number of existing projects. He gave a summary of these projects and the following points were noted:

• Jonah - The project ensures clinical staff have access to an IT system that tells them at a glance where patients are in their pathway. The project has now been handed to the site teams to ensure the system is being used.

• E-letters to patients - The project enables the sending of OPD letters electronically to GP’s, rather than via post, enabling faster more secure communication with GP’s and saving on postal costs. Many GP’s have signed up to the scheme with more work ongoing to engage with CCG’s and with individual practices, to bring more on line.

• Digital Dictation - Phase 1 will convert all analogue dictation devises to digital and install all relevant software on hospital PC’s. This gives additional information on



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dictation requirements that will enable a better identification of benefits possible and Phase 2 will aim to reduce operational costs. The Business case for Phase 1 willbe submitted to EMB in December 2013.

• Centralisation of Booking – This is a new project that aims to centralise the booking of all outpatient appointments. Currently in the process of creating a project brief and developing the project plan. A timeline will be established as part of this process.

• Paperless Outpatients - This is about ceasing the use of paper within outpatient departments, this includes referrals into the department, documentation within outpatients and information leaving the departments. This is a large and complex project, the brief is currently being constructed.

A lengthy discussion arouse around some of the projects and certain elements and what consideration should be given around patients. It was felt that some of the issues raised should be discussed during the Patient Experience Committee which was thought to be the most appropriate forum for this type of discussion. In addition, Mr Orriss agreed to bring this to the attention of the full Council of Governors meeting due to be held next week.

No further questions were asked and Mr Orriss thanked Mr Lyddon for attending the meeting.

BO(Nov)

13.11 FUTURE PAPER CIRCULATION

As the meeting had run over its scheduled time, this item was not discussed.


No further items were discussed under any other business.

13.13 DATES OF FUTURE MEETINGS

13th January 2014 at 10.00 at Heartlands Hospital.10th March 2014 at 10.00 at Solihull Hospital.

.....................................Committee Chairman



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Hospital Environment Committee Minutes(7.11.13)

COUNCIL OF GOVERNORSHOSPITAL ENVIRONMENT COMMITTEE

Minutes of a meeting of the Hospital Environment Committee of the Council of Governorsheld in Meeting Room 1, Estates Offices, Heartlands Hospital, on 7 November 2013

PRESENT: Barry ClewerDavid O’LearyElaine CoulthardSue Hutchings

IN ATTENDANCE: John Sellars, Director of Asset ManagementAnn Harwood, Executive Assistant to Director of Asset Management (minutes)

13.26 APOLOGIES

Apologies for absence were received from David Treadwell

13.27 INTRODUCTION

John Sellars welcomed members to the first meeting of the newly formed Hospital Environment Committee, following the Governors elections. Members introduced themselves and John Sellars explained the background to and the purpose of the Hospital Environment Committee.

The following points were noted: The purpose of the committee is to look at any issues relating to the infrastructure of all the HEFT

sites. Members can raise/ discuss any areas of concern relating to the infrastructure, particularly in relation to how patients/ visitors may view the sites.

Meetings are held alternately on the three main sites i.e. Heartlands, Good Hope and Solihull hospitals.

Each meeting normally begins with a walk round an area/ department which members have asked to visit. Following which the meeting is normally held in the Education Centre on whichever site the meeting is being held. The current meeting had been arranged to take place in the Estates/ Workshops building as it had been planned to take members on a tour of the new building. John Sellars explained the reason for the new build was due to the old workshops building being condemned and requiring demolition.

Members were concerned that there is no signage to the Estates building from the visitors’ car park. John Sellars stated that the Estates building is located in the industrial zone of the Heartlands Hospital site, signage in the visitors car park purposely only refers to patient/ visitor areas.

A site map showing the location of the Estates building had been included with the meeting papers together with an explanation of where the building is located. It was agreed that site maps will be included with future meeting papers.

David O’Leary queried what the parking arrangements are for Committee members. John Sellars advised that members should park in the visitors’ car park and claim the money back via the Governors’ expenses route.

At the last meeting concern had been expressed regarding the poor attendance at previous Hospital Environment Committee meetings.

13.27 APPOINTMENT OF A CHAIR

Elaine Coulthard nominated herself for the position of Chair, this was seconded by Barry Clewer and Sue Hutchings, Elaine Coulthard was therefore duly voted in as Chair of the Hospital Environment Committee.


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13.28 MINUTES OF THE MEETING HELD ON 15 JULY 2013

The minutes of the meeting held on 15 July 2013 were approved as an accurate record.

It was agreed that going forward Ann Harwood will forward a hard copy of the meeting papers to Barry Clewer and David O’Leary.

Barry Clewer queried the third bullet point in the minutes relating to the PLACE and CHC inspection reports, where John Sellars had advised that within Estates and Facilities the actions from the PLACE inspections will take precedence over the actions from the CHC inspection reports. John Sellars explained that the PLACE inspections are an annual external mandatory requirement and as such all actions from these inspections have to be resolved. Any urgent works from the CHC inspections will also be addressed and any remaining actions will be monitored. David O’Leary agreed to ensure that members receive a copy of the CHC reports.

John Sellars confirmed that the Hospital Environment Committee’s role is to pick up infrastructure/ environment issues not relating to ward areas on all Trust sites, including Birmingham Chest Clinic and the satellite renal units. It was agreed that one of the future meetings will be arranged to take place at the Chest Clinic with a tour of the building. It was noted that currently work is underway at the Chest Clinic to replace windows and carry out refurbishment works. As the Chest Clinic building is owned by Birmingham City Council, the Trust is pushing for the City Council to carry out all the works they are responsible for.

David O’Leary was concerned about the state of the ceiling in the renal unit on ward 3 at BHH which he felt was a disgrace. John Sellars explained that there is an issue with being able to gain access to the wards in the Tower Block at BHH to carry out refurbishment works. Ward 3 had been available for 2 weeks and during that time urgent works were undertaken, however there was not sufficient time to replace the ceiling tiles as this was not a priority. When a full ward refurbishment is being carried out a vacant ward is required for the ward to decant to.

It was agreed that the Terms of Reference will be discussed as an agenda item at the next meeting.

Barry Clewer and Sue Hutchings queried some of the abbreviations in the minutes and the following was noted:ROH: Royal Orthopaedic HospitalRSU: Richard Salt UnitCCU: Critical Care Unit

13.29 ACTION SHEET FROM MEETING HELD ON 15 JULY 2013

13.29.1 Day Case Theatres at Good Hope Hospital The brass plaque has been removed and replaced with a new plaque with the correct spelling. The issues around the temperature in the kitchen and the fire damper have now been resolved, a

new fire rated grille has been fitted into the floor which increases the air flow.

13.29.2 A&E Walkabout Funding has been approved to address the pedestrian and ambulance zoning issues and works

should be complete before March 2014. Ann Harwood to check with Dave Smith, Estates Manager at Good Hope Hospital, that the works

to the entrance doors in the A&E waiting area have been completed. It was agreed to leave this action on the action sheet until the next meeting.

Sue Hutchings queried whether the sensitivity of the opening and closing of doors can be adjusted so that they close more quickly. John Sellars confirmed that this can’t be done as there



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would be a danger that people could walk into the doors. This is the reason for looking at revolving entrance doors to the A&E waiting area.

13.29.3 Food Quality IssuesJohn Sellars confirmed that DNA testing carried out by the Trust’s meat suppliers has not shown any horse meat contamination.

13.29.4 Food Waste Disposal At the last meeting John Roberts had passed information to John Sellars on a food waste disposal

system for consideration re introducing a similar system in the Trust. However, John Sellars advised that this system is designed for small catering establishments and would not be appropriate for the Trust’s large scale catering department.

Mike Towler, Catering Manager, is looking at alternative systems including an anaerobic digester system which breaks food down so that all that goes down the drain is ‘grey’ water.

13.29.5 Movement of BedsBattery operated bed movers are being trialed at Good Hope Hospital. A decision on whether to purchase them has not yet been made.

13.29.6 Richard Salt Unit (RSU)The car parking signage outside the RSU entrance has been amended so that it now includes information on the 15-minute drop-off criteria and entitlements for people in receipt of benefits.

13.29.7 Parking Meter and Signage Issues at GHH

John Sellars reported that the parking meter adjacent to the car park for people with a disability has been repaired. However Elaine Coulthard advised that this parking meter had not been working the previous Friday as it would not accept cards. John Sellars agreed to e-mail Dave Smith, Estates Manager at GHH to check that this has been picked up.

Elaine Coulthard queried whether Security check that people parking in a disabled bay are showing their blue badges. John Sellars confirmed that regular checks are made and Civil Penalty Notices (CPNs) are issued where these are not displayed.

John Sellars agreed to find out how often Security are monitoring staff and visitor car parking at Good Hope Hospital and confirm this at the next meeting in January.

13.29.8 SignageAt the last meeting it had been reported that the signage by the Richard Salt Unit (RSU) directing patients/ visitors to the Critical Care Unit (CCU), was pointing in the wrong direction. This signage has now been removed.


13.30.1 Food Quality Members were concerned about the quality of patient food and queried what the result of the

PLACE inspections had shown with regard to food. John Sellars agreed to confirm these results at the next meeting. It was noted that issues relating to the quality of food should be raised at the Patient Experience Committee.

A new menu is being introduced across the Trust in March 2014. All patient food is cooked at the Central Processing Unit (CPU) at Solihull Hospital and re-heated

in re-generation ovens on the wards. It was agreed that a tour of the CPU and food tasting session would be arranged for the January

meeting which is being held at Solihull Hospital. David O’Leary stated that the CHC look at the quality of food and how patients are fed as part of

their ward inspections.



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13.30.2 Action on Hearing LossBarry Clewer advised that Action on Hearing Loss are running a pilot on wards 21, 27 and 30 at Heartlands Hospital, whereby inpatients who wear a hearing aid will be given a hygienic box to store their hearing aid, to prevent them being lost. He queried who would be monitoring and evaluating this pilot. John Sellars felt that this is probably Simon Jarvis and agreed to confirm this at the next meeting in January 2014.

13.30.3 Future Meetings Meetings have been arranged to alternate between the Trust’s sites and it was agreed that an A3

plan of the relevant site will be circulated with the meeting papers and will be marked up with the meeting venue and the areas to be visited.

It was also agreed to include the address and post code for the relevant site on the agenda for each meeting.

13.30.4 A&E Waiting Area at Good Hope Hospital Elaine Coulthard advised that there is no information on current waiting times displayed in the

A&E waiting area. John Sellars stated that it is not possible to display this information as waiting times depend on the severity and type of injury or illness that a patient presents with.

Previously there was a TV on the wall in the waiting area which has been removed, Elaine Coulthard queried whether a replacement TV could be installed. John Sellars agreed to write to Sue Moore regarding this issue.

Complaints have been received from patients/ relatives regarding the lack of privacy when they speak to the A&E receptionists. Elaine Coulthard queried whether it would be possible to install perspex domes or shields to allow for confidentiality. John Sellars agreed to include this issue in his e-mail to Sue Moore.

13.30.5 Internal Website for GovernorsBarry Clewer queried whether an internal website could be set up for Governors which would include information, minutes etc from all the Council of Governors (CoG) meetings. He agreed to raise this issue at the next CoG meeting on 18th November 2013.

13.31 DATE OF NEXT MEETING

1.00 p.m. on Monday, 6 January 2014, in Room 6, the Education Centre, Solihull Hospital.

The meeting will commence with a tour of the Central Processing Unit (CPU) and a food tasting session. Details will be confirmed when the meeting papers are circulated.

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



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Membership and Community Engagement Minutes (29.11.13)

MINUTESfor a meeting of the

MEMBERSHIP AND COMMUNITY ENGAGEMENT COMMITTEEof the

COUNCIL OF GOVERNORSof Heart of England NHS Foundation Trust

to be held in the Board Room, Devon House, Heartlands Hospital29 November 2013 at 10:00

Present: Albert Fletcher (Chair)– Governor Mohammed Aikhlaq – GovernorArshad Begum – GovernorBarry Clewer, MBE – GovernorPeter Colledge – VolunteerElaine Coulthard – GovernorHeidi Lane – GovernorAnne McGeever – GovernorDavid O’Leary – GovernorDavid Treadwell – Governor

In Attendance Simon Jarvis – Head of Patient EngagementSandra White – Membership ManagerAngie Hudson – Minutes

1. Introductions and Apologies

Apologies from Mrs Thomson were received.

The Chair welcomed everyone to the meeting.

Chair

2. Minutes of the Previous Meeting

The minutes were agreed as a true representation of the previous meeting and signed as a correct record.

Chair

3. Matters Arising

Terms of Reference. Mr Clewer noted that in the Terms of Reference it was noted that the term of office for committee members was 2 years rather than 3. Mr Fletcher advised that the ToR’s were in the process of being updated by the Company Secretary’s office and these would be circulated in due course.

There were no other matters arising.


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4. Dates for next year’s meetings

The dates were agreed other than the 29 August which needed to be rescheduled.

5. Perry Barr update

Mr Jarvis and Mr Clewer gave a brief overview on the current membership format and how it could be improved to get more involvement from our members. They had met to discuss how the Trust could improve constituency member input and it had been agreed that Perry Barr would be used as trial constituency for improving membership engagement as it had the smallest number of constituents. It was intended that the draft letter, as circulated, from Mr Clewer would be sent to every member within the Perry Barr constituency giving them information about the role of members and encouraging them to take a more active role in the Trust as well as the opportunity to opt out being a member. The mailing would cost approximately £2,300, including a freepost reply. The meeting discussed the letter and itwas agreed that that reference to removal from the membership list if no response was received would be removed, following this amendment the content of the letter was approved. Action

Mr Jarvis would circulate the final version of the letter. SJ

6. Engaging with members - Links with Governors

Mr Jarvis gave an overview of the circulated setting out how the Trust currently engaged with its members as well as working with Governor to support them in engaging with constituents. Work had also included updating the Governor Handbook. Further feedback and suggestions were required in order to drive this forward. The meeting discussed ideas how it could improve engagement including:• More opportunities for members to meet with Governors.• Utilising and circulating additional copies of the Heart & Soul newsletter:• Picture Boards showing Governors and contact details on each of the 3 sites and in GP

Surgeries however it was noted that this would incur additional funding. • Mr Treadwell advised that the Trust could write to the Council Ward Support Office and

get membership engagement on the agenda for discussion. Action :

Potential costs for additional copies of Heart & Soul MagazineDraft designs for Governor photo boards. SW

SJ

7. Overview of membership breakdown and areas for improvement

Mr Jarvis circulated a paper showing membership breakdown and advised that the Trust membership now stood at 109,266 and no recruitment was underway, however anyone who asked to become a member was accepted. It was noted that the Membership Seminars were an excellent way for Governors to meet and engage with members. The dates for 2014 Health seminars was circulated at the meeting.

8. Corporate Citizenship



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Mr Jarvis gave a verbal update on the work the Trust is undertaking in the local community. Progress has been made to build relationships with the Somali community including filming for the local TV channels focusing on health education. Mr Lawrence, NED is the executive lead for who will be leading the project. The project will need funding and Mr Jarvis was in the process of sourcing funding opportunities, Mr Treadwell suggested approaching local government for contribution. The committee were invited to take an active role in project going forward to be involved going forward.

ActionProgress reports to be bought back to future meetings.


Mr Treadwell asked what the Trust position was on the ensuring the confidentiality of patient information in particular the issue of selling information to organisations. Mr Fletcher advised that this was not an issue for this committee.

Mr Clewer asked whether this committee would be given an update on the Reshaping HEFT surgical reconfiguration. Mr Fletcher believed this was a matter for the Council of Governors and not this committee.

Following a question from Cllr Aikhlaq Mrs White agreed to send the dates of the Community Health Seminars for circulation in order to encourage more members of the general public to attend.

Mr Jarvis advised that he was leaving the Trust at the end of December. Mr Fletcher wished him all the best and thanked him for the enormous amount of work and dedication he had shown to this committee and the Trust.

10. Dates of Future Meetings

Friday 17 January 2014 – 12:00-13:30pm. Boardroom, Devon House, BHH



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Patient Experience Committee Minutes (29.11.13)

MINUTES for the meeting of the

PATIENT EXPERIENCE COMMITTEEof the COUNCIL OF GOVERNORS

of Heart of England NHS Foundation Trust Boardroom, Devon House, Heartlands Hospital,

Friday 29 November 2013

Present: Michael Kelly (Chair) – Governor Arshad Begum – GovernorKath Bell – GovernorSheila Blomer – CHCPeter Colledge – VolunteerElaine Coulthard – GovernorSue Hutchings – GovernorFrancis Linn – CHCDavid O’Leary – GovernorDavid Treadwell – Governor

In Attendance Simon Jarvis – Head of Patient EngagementMargaret Mitchell – Deputy Head, Patient EngagementSandra White – Membership ManagerAngie Hudson – Minutes

1. Welcome and Apologies

The Chair welcomed Mr O’Leary to the meeting.

Apologies were received from Mrs Meixner.

2. Minutes of the meeting on the 12th July 2013

The minutes were agreed as a true representation of the previous meeting and signed as a correct record

3. Matters Arising/Action Log

There were no matters arising.

4. CQC Update

As Mrs Thomson had sent apologies the report was deferred.


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5. Living Well for longer

Mr Kelly gave an update on the recent conference he had attended in Birmingham. He advised that the key message had been around prevention and lifestyle changes required by individuals and the impact that living longer would have on future funding budgets. He had been disappointed that there had been no opportunity for ask the presenters questions. Action

The slides would be circulated.

6. CHC reports

Mr Kelly advised the meeting of the sad new that Gerry Robinson had passed away at the start of December and his and the committees’ thoughts and sympathies were with his family at this very sad time. He also paid tribute to the enormous contribution Gerry had made to the Trust.

The reports were taken as read.

7. Friends and Family Update

Complaints Update

Mrs Mitchell gave an overview of the patient services function at the Trust, explaining the differences formal and informal complaints and the different avenues that facilitate patients and public contacting the Trust. Any complaints resulting in compensation and staff disciplinary were dealt with through different channels eg. the claims department handle all compensation claims. Customer services try to resolves as many complaints as possible at source. In instances where complaints are raised by a third party, including Governors, the Trust always contacts the patient concerned for their consent. All lessons learned from complaints was valuable and feedback into the trust by means of videoing patient stories, development of on-line training via ‘Moodle’ and goldfish bowl feedback sessions etc. Apilot study was underway at Solihull Hospital looking at a new process for handling complaints and it was anticipated that this would be rolled out to all sites following evaluation of the pilot study. The meeting discussed the process by which Governors raise complaints on behalf of their constituencies and it was agreed that going forward all queries should be directed though the company secretaries office who would then pass these onto Customer Relations for dealing with. Mr Kelly asked what the process was for rewarding individual staff/wards where compliments were received. Mr Jarvis advised that staff received a letter of congratulations and this was added to their personnel records. Concern was raised about the mediums of Facebook and Twitter and the corrosive effect these could have on the reputation and how the Trust could manage these. Mrs Linn shared a story of a patient who had received better care following cross departmental working.

The role of the Customers Services department was noted and the Chair thanked Mrs Mitchell for her presentation.



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Action Governors would refer any complaints received on behalf of constituents through the Company Secretaries office.


Hysterectomy claim. Mr Jarvis gave a brief update at a request of Mrs Hutching for clarity on the recommendations on the recent media attention related to Mrs Sanders, who had required a hysterectomy at the aged 19. The Trust had settled the claim and compensation agreed. Mrs Sanders complaint had followed the formal complaints processand had been a complex claim. A review of the records showed her care was completed appropriately. Mrs Bell had noted that the media story had been explicit that Mrs Sandershad never received an apology and asked why it had not given one. Mr Jarvis responded that previous the NHS, as a whole, had been reluctant to offer an apology, however our Trust did not consider this to be right and therefore all complaints now offered an apology to complainant.

DBS Forms. Mr Jarvis advised that the DBS rules had changed and the Trust needed to ensure that anyone who undertook inspections or had patient contact was required to complete a DBS form.

Sir Ian Kennedy – Independent Review. Mr Roberts asked if there was any update on the Sir Ian Kennedy review, Mr Jarvis advised that the Trust had as yet not received the report. Once it had been received the Governors would be advised.

Medical Records. Mr Treadwell asked what the Trust position was on the ensuring the confidentiality of patient information in particular the issue of selling information to organisations. Mr Jarvis advised that the Trust had very strict rules on access to medical records including electronic logging of access.

Cedarwood. Mrs Coulthard advised that she had recently visited the newly opened ward which was run by Healthcare at Home, Midland Heart and St Giles Hospice. The facility was for use by patients who were medical fit to go home, but required some assistant in order to do so.

Kings Fund Conference. Mrs Hutchings had recently attended a conference on transforming the patient experience which had looked at how improvements could be made. Mrs Hutchings would report fully to the next Council of Governors meeting.

Patient DNA Letter. Mrs Linn advised that she had a copy of a letter sent out to a patient saying they had not attended an appointment and advised that the patient in question had advised that she had not in fact received notification of the appointment having been told by the hospital that the appointment date would be sent to their GP. The Trust needed to ensure that it was communicating the right information to patients. Mr Jarvis took on board the comment.

Mr Jarvis advised that he was leaving the Trust at the end of December. Mr Kelly wished him all the best and thanked him for the enormous amount of work and dedication he had shown to this committee and the Trust.



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9. Date of Next Meeting

Friday 17 January 2014 –-13:30 – 15.30pm. Boardroom, Devon House, BHH



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Quality and Safety Committee Minutes (6.11.13 and 4.12.13)

FINAL

Minutes of a meeting of the

COUNCIL OF GOVERNORS QUALITY AND SAFETY COMMITTEE

Heart of England NHS Foundation Trust, Education Centre, Solihull Hospital6 November 2013 10.00

Present Title InitialsSTEVENTON, Liz CHAIR (Public Governor) LSLYDON, Andrew Public Governor ALKELLY, Mike Head of Patient Experience Group MKLANE, Heidi Staff Governor HLKHAN, Attiqa Public Governor AKhORRIS, Barry Public Governor BOTREADWELL, David Public Governor DT

In attendanceKEOGH, Ann Director of Medical Safety AKBRADSHAW, Siân Executive Assistant to Sarah Woolley (minutes) ARWOOLLEY, Sarah Director of Safety and Organisational Development, HEFT SW

1. Apologies for absence

Apologies were received from Mrs Kath Bell.Liz Steventon was re-elected as Chair and Kath Bell as Deputy Chair. Two new members were welcomed; Attiqa Khan and Andrew Lydon. The work of previous Committee members was acknowledged; namely Elaine Coultard, Kevin Daly, Veronica Morgan, John Roberts, David Roy and Tom Webster.Domestic arrangements were discussed; Papers are to be sent two weeks in advance and attendees to email Siân Bradshaw to say how they would like their papers delivered.

2. Minutes of the previous meeting

Matters arising from the minutes

Review of Actions

• Ann Keogh circulated ‘SUI at a glance’ reports for the two maternity SUIs (Serious Untoward Incidents). Carry forward in actions.

Actions relating to the Patient Experience Committee will be forwarded to Mike Kelly and Lisa Thomson for review.

Actions relating to incident reporting will be incorporated into the new Committee activities following review of the Terms of Reference.

3. Overlap of the Patient Experience Committee and the Quality and Safety Committee

There was a discussion relating to the division of activities between Patient Experience and the Quality and Safety Governor’s Committee.


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SW outlined the history of Quality and Safety. Several years ago when the first Council of Governors first came into being, they felt they did not have enough opportunity to scrutinise the work of the hospital. These working groups were set up to address this.

Executive changes led to better clarity between the Corporate and Clinical Governance agendas.Information Governance, Corporate Risk and the Quality account moved into the Corporate Governance Directorate. SW had picked up Staff Engagement and Organisational Development. LT has Patient Experience and Complaints. The Board has its own committee for dealing with Quality. This is the Quality and Risk Committee (formerly Governance and Risk Committee) which oversees patient experience, clinical safety and clinical effectiveness.

AL suggested we divide complaints into clinical and non-clinical and that clinical complaints could come to this Committee.

HL felt that complaints were a separate issue and were not part of this Committee.

MK agreed that Patient Experience is the right place to deal with complaints agenda.

HL, SW, LS and MK confirmed that complaints will remain with the Patient Experience Committee.

BO The best way for all of the Committees is to mirror the portfolios of the Directors so the purpose of this Committee should be to scrutinise the activities which take place in your Directorate. I would like the TORs drawn up to reflect that.

KS commented that the TORs could also include promoting positive messages about patient services.

LS pointed out that this requirement was one for Governors generally.

DT asked whether lack of staff and recognition would be covered by this committee?

SW said that it would.

Following discussion it was agreed that SW and KS would draw up a revised Terms of Reference to reflect the discussions with a clearer focus on safety and clinical effectiveness. These will be circulated at the next Council of Governors safety meeting and will be submitted to Council of Governors Safety meeting for finalapproval. SW also agreed to draft some proposals around how Governors could practically scrutinise the safety and effectiveness agenda.

Future Work

Developing a scrutiny model.

DT asked for clarity on where the issue of primary and secondary care in relieving pressure on A and E could be discussed. SW said it was an issue for the Council of Governors generally, and for the Chairman and the Chief Executive to pick up more generally.

4. Updating the TORs

Liz Steventon, Mike Kelly, Sarah Woolley, Lisa Thomson and Kevin Smith to met after the meeting to develop draft terms of reference to be circulated to both the Patient Experience and Quality and SafetyCommittees.



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5. Date of next meeting

The date of the next meeting is 4 December in Room 9 of the Education Centre, at 09.00 at Heartlands Hospital. Breakfast, tea and coffee will be provided on arrival. Please send any apologies and dietary requirements to Siân Bradshaw – [email protected] or call 0121 424 1325.

Parking is booked at Devon House on a first come, first served basis and 6 spaces have been reserved.Please let Siân Bradshaw know if you require a parking space.



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DRAFT (until approved at 6 February meeting)

Minutes of a meeting of the

COUNCIL OF GOVERNORS QUALITY AND SAFETY COMMITTEE

Heart of England NHS Foundation Trust, Education Centre, Solihull Hospital4 December 2013 09.30

Present Title InitialsSTEVENTON, Liz CHAIR (Public Governor) LSBELL, Kath LYDON, Andrew

Public GovernorPublic Governor

KBAL

PEARSON, Mark Public Governor MPLANE, Heidi Staff Governor HLORRIS, Barry Public Governor BOTREADWELL, David Public Governor DT

In attendanceKEOGH, AnnRUDD, Louise

Director of Medical SafetyHead of Clinical Governance

AKLR

BRADSHAW, Siân EA/Minutes SB

1. Apologies for absence

Apologies were received from Sarah Woolley.

2. Minutes of the previous meeting

The Chair said that going forward, unless notified prior to the meeting, the minutes will be taken as read and agreed. Any issues are to be notified to Siân Bradshaw beforehand as the minutes will have been sent out two weeks beforehand. The minutes of 6th November 2013 were approved as an accurate record.

3. Discussion of the draft TORs

There was a discussion of the draft TORs and several changes were agreed:

Paragraph 3 – There was to be an addition that ‘Governors are welcome at any meeting by prior agreement with the Chair’.

Paragraph 7 - Duties - The Chair asked that a third bullet be added.

• ‘To receive from the patient experience committee concerns regarding patient safety on an “as and when” basis and to be notified to the Chair.’

End of document ‘Review date of TORS to be to Aug 2014.’

Amended TORs to be sent to the Chair (Action SB)

AK asked that we formally request to be notified by the Patient Experience Committee of any safety trends.There was discussion of how issues raised would come to this Committee. There was a re-discussion of where complaints should sit and MP asked that a list of complaint categories/subcategories should come to this Committee but only to observe particular trends/peaks but not to discuss each individual complaint.


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MP felt that the Committee split patient and staff complaints and did not get a full picture of potential safety issues. There was discussion that the TORS should be amended to allow reciprocal information flows between this Committee and Patient Experience.

Chair to approach Mike Kelly, Chair of the Patient Experience Committee to discuss reciprocal information flows (Action LS)

4. Basic introduction to Patient Safety (Incident Reporting and Risk Management)

Incident Reporting

LR gave a presentation on incident reporting.

KB asked what would happen if an incident was not investigated by a senior manager and the incident reported still had safety concerns.

AK said that this was recognised and is being picked up by the new Raising Concerns policy.

MP asked for an organisational structure and raised the issue of the independence of investigations.AK explained the process for complaints and investigations and the use of staff from different sites and departments and occasionally external investigators, where appropriate.

BO asked about the process of learning from mistakes. AK and LR explained the different methods for learning and dissemination and where the subjects for ‘Lesson of the month’ come from.

AL raised the issue of staff changeover and his experience of a lack of continuity of care.

AK raised the possibility of involving the Governors in a project but that this would be Spring 2014 at the earliest.

A copy of the Incident Reporting presentation to be sent with the draft minutes (Action SB)

Risk Management

LR went on to present on Risk Management.

DT asked what happens when a risk can’t be managed.

LR outlined the process of understanding the risk, understanding the future of the risk, the symptoms of the risk and the management of the symptoms.

5. The Safety Sitrep

The Safety Sitrep was handed out to the Committee and AK took the Committee through it.

AK explained that the report has a very wide distribution and went through the report page by page with the Committee.

BO asked whether Concerto (electronic patient records system) had been rolled out to the entire Trust.

LR confirmed that it had but some glitches were being worked out where Concerto was having trouble communicating with certain stand alone IT packages.

AK said that for future meetings there will be an opportunity to involve specialists from other areas as the



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Committee develops interests in particular areas.

KB voiced concern about what the Committee actually does and what impact their work does.

MP said he would prefer that they could take the Sitrep away. AK said that for the next meeting the Sitrep would be sent in advance.

DT said that he felt that the Committee had progressed a long way since it was established.

KB said she felt that other than one report on the Prince of Wales maternity unit, that the Committee had no impact.

LR outlined examples of where the Governors had historically been involved in reporting and made a real contribution.

BO suggested that Dr Jammi Rao (Chair of Quality and Risk) be invited to the Committee once a year and the Chair asked that it be arranged.

The Chair asked that areas of concern to be addressed at future meetings to be sent to her.

AK to circulate a Sitrep glossary (Action AK)AK agreed to re-circulate the SUIs with the dates removed (Action AK)

Dr Jammi Rao (Chair or Quality and Risk) to be invited to the next meeting (Action SB)

6. Date of next meeting

The date of the next meeting is 6 February in Room 2 of the Education Centre, at 10.00 at Heartlands Hospital. Tea and coffee will be provided on arrival as will lunch. Please send any apologies and dietary requirements to Siân Bradshaw – [email protected] or call 0121 424 1325.

Parking is booked at Devon House on a first come, first served basis and 6 spaces have been reserved.Please let Siân Bradshaw know if you require a parking space.

Date of Meeting

Action/Person responsible Due

December 2013

Amended TORs to be sent to the Chair/SB Before February meeting

December 2013

Chair to approach MK, chair of the Patient Experience Committee to discuss reciprocal information flows/Chair

Before February meeting

December 2013

A copy of the Incident Reporting presentation to be sent with the draft minutes/SB

To be sent with papers for February meeting (despatched 23rd Jan

December 2013

AK to circulate a Sitrep glossary/AK To be sent with papers for February meeting (despatched 23rd Jan

December 2013

AK agreed to re-circulate the SUIs with the dates removed/AK


December 2013

Dr Jammi Rao (Chair or Quality and Risk) to be invited to the next meeting/SB




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Remuneration Committee Minutes(18.11.13)

Minutes of a meeting of the REMUNERATION COMMITTEEof the COUNCIL OF GOVERNORS of Heart of England NHS Foundation Trust

held St John’s Hotel, Solihull on 18 November 2013

PRESENT: Richard Hughes (Chairman) Ron Handsaker

Michael HutchbySue HutchingsMark PearsonJim Ryan

IN ATTENDANCE: Malcolm Pye

13.05 APOLOGIES

Apologies were received from Carol Doyle.

13.06 MINUTES

The minutes of the Committee meeting held on 10 May 2013 were approved.

13.07 REVIEW OF REMUNERATION AND OTHER TERMS AND CONDITIONS OF CHAIRMAN

The Chairman outlined the process undertaken so far by the Council of Governors (“CoG”) Appointments Committee in reaching a recommendation to the CoG about the process and timings relevant to the appointment of a new Chairman but there remained a requirement on this Committee to consider the remuneration and other terms and conditions applicable to the position shortly to be advertised. The Chairman reminded the meeting that the incumbent’s pay was £50,000pa for the equivalent of an average of two days per week. In order to ensure a good flow of quality applicants it was thought necessary to consider an increase in the pay, especially because it was believed that any new appointee would be required to work more than two days per week.

The meeting considered a detailed comparator schedule produced by the Foundation Trust Network showing the pay for chairmen of similar sized FTs.

It was suggested that given the size of HEFT (both as to turnover and employee numbers) an appropriate increase in pay could be seen as justifiable, and that, if approved and notwithstanding the current financial constraints of the trust, the money was available to support this.

Cllr Ryan countered by suggesting that in the current financial circumstances, it was inappropriate to award any increase in pay, especially as he believed it would be seen externally as inappropriate and unnecessary. There was also a need to consider the impact on executive pay of any increase for the Chairman.


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The meeting then went on to consider if some form of banding or range may be appropriate such that the CoG Appointments Committee might be given an element of discretion dependent upon the quality of any individual applicant. On this basis, the advert would need to indicate pay to be “….in accordance with experience… “ or similar wording.It was suggested that given the strong likelihood that the new Chairman would need to give more than two days each week, some recognition of this ought to be made in the pay and that, perhaps, a range of £50,000 to £60,000 might be recommended. Mr Ryan said that he could only support a range of £50,000 to £55,000 and that anything more stood the prospect of being ridiculed. The Chairman was especially concerned that to advertise the role at £50,000 would not bring in enough quality applicants and believed that it was unlikely that anyone of quality would take up such an onerous role for £50,000. Mr Ryan indicated that it would be acceptable to indicate that more pay might be available following a performance review after the successful applicant had been in post for a period of time.The Chairman was particularly concerned to emphasise to the Committee that getting this appointment wrong would be a real problem for the Trust and must be avoided by appointing only the strongest available candidate. The Trust could not afford to be without a strong Chairman if the CoG failed to appoint as part of this current process not least of which that Monitor might intervene.

Following further detailed discussion two possible outcomes appeared to have support. The first was to offer the role with a range of £60,000 to £66,000 and the second with a range of £50,000 to £55,000 but with the prospect of a performance review. Following a show of hands, each proposal had three votes.

Following further discussion, it was agreed by a five to one majority (Mr Ryan dissenting) that a recommendation should be put to the CoG to offer the role at £55,000 to £60,000.


There was none.

13.09 DATE OF NEXT MEETING

TBA

...........................................

Chairman

Remuneration Committee Minutes(18.11.13)

January 2014


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Transforming Patient Experience Conference


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I attended a conference at The Kings Fund on 6 November 2013 entitled ‘Transforming Patient Experience’. There were a number of speakers both patients and NHS member contributions.

Key themes were:

• How patient knowledge is improving care – Hearing the patient voice Speaker – Anya de longh, Expert Patient

o Patient experience is the totality of living with health, illness and treatment whether it be long term or one off health issues

o Involvement is an ongoing process o To have a complete patient pathway, you need clinicians’ and patients’ knowledge.

Clinical pathways need to encompass the patient experience each step of the way for example taking medication, anxiety over test results, how it is affecting family life and work......

• Putting patient experience at the centre of clinical practice Speaker – Hiro Tanaka, Consultant Orthopaedic Surgeon, Aneurin Bevan Local Health Board

o Patient satisfaction survey carried asking the question ‘who do you believe gave you the best care during your stay in hospital’ 7 out of 10 patients voted the cleaner as the one who cared for them the most. One to one interviews were carried out with patients and 3 reasons became clear: 1. The cleaner was always happy and smiled whilst she was working; 2. She chatted with everyone, both patients and staff, about work or trivial things like the weather, and the things that patients cared about the most, family and their homes; 3. She was the one constant, she was the person they saw most often, it’s about familiarity. Should clinicians and staff inspire to be more like the cleaner? The speaker gave 3 other examples: The first was about his mother who was taken ill and rushed to his hospitals A&E with a heart condition and because her son was a doctor there, within 20 mins of arrival she had an ECG/chest x-ray/blood tests/she had amazing care. She was in hospital for 2 days, her son, the doctor, thought her care was amazing. After she was discharged he asked her what she thought of his hospital, she said the 2 days she spent in hospital was the worst experience of her life, she had spent 2 days petrified not knowing what was happening to her, what was about to happen, as far as she was concerned she was going to die. He was shocked that he had not understood his own mothers fears so what chance did his patients have. It taught him 2 things: 1. Pride stopped him seeing what his mother was feeling; 2. Even though everything was done right that does not mean that the patient has a positive experience. It’s about how a patient feels about what is happening to them and how they feel about what didn’t happen.


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The second was about trust, in particular the trust a patient puts in the clinician who is treating them. There is a difference between consent and trust. Consent is the rational action based on a logical analysis - risk v benefit. Trust is important, and there is a need to gain more trust from patients, by doing more for patients. Give more appointments, offer the best medical technologies, and offer more information. There is a need to consider how we make clinicians more trustworthy. He stated 3 things to achieve this; 1. Competence and patient safety; 2. Ability by delivering what we promise to deliver; 3. Honesty by being vulnerable – For instance, buying a TV from John Lewis, they give a 5 yr money back guarantee. He sees 500+ patients per year, he now gives each patient a business card with his contact details, it’s not the card, it’s in its meaning by saying thank you to his patients for giving him their trust, by making himself available to his patients makes them feel he truly cares. The third was about an elderly patient who required an operation otherwise if the condition was left untreated she would die. She was admitted in a great deal of pain. She had a severe form of Aortic Stenosis where the heart did not pump blood round the body and it was a miracle she was still alive. There was nearly a 100% chance she would die if she had the operation. She was told this and she said she did not want to die, she was in a lot of pain and insisted on having the operation. She wanted him to trust her that she would make it through the operation. He was dammed if he did and dammed if he didn’t do the operation. He liaised with a number of clinical colleagues informing them that whatever the outcome he would ultimately be responsible for the decision and outcome. So the decision was to do the operation because the patient wanted it. Every safety measure possible was taken and she survived the operation against all the odds. She inspired everyone at the hospital and he was getting loads of calls asking how the patient was. She inspired them to do their work at their very best. It gave them fulfilment in their work. A reminder of why they do what they do.

• Patients at the heart of the agenda Speaker – Neil Churchill, Director for Patient Experience, NHS England

o 5 themes for improvement Seeing care from patients perspective

• Friends and family test

• Patient stories

• Meaningful patient and public engagement

• Observations Creating a climate for improvement

• Partnership not consultation

• Open and responsive

• Culture of values, caring, learning Tackling very poor care



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• Robust complaints process to enable good response, learning, improving

• Marginalised and vulnerable patients

• Equality assessments Co-creating improvement

• Engaging with patients Measurement and feedback

• You said we did approach

• Continuous improvement o Macmillan based standards

Co-created with patients, carers, family members, staff Based on 8 areas most important to patients and staff

• I am the expert on me

• My business is my business

• I am more than my condition

• I’d like to understand what will happen to me

• I’d like not to be ignored

• I’d like to feel comfortable

• I don’t want to feel alone in this

• My concerns can be acted upon o Value based assessment for recruitment

A questionnaire based on values required Role play exercises Re-assessment after probation to ensure values are still being practiced

• How patient feedback and involvement will help ensure quality and safety Speaker – Professor Sir Mike Richards, Chief Inspector of Hospitals, Care Quality Commission Measuring for improvement – The new hospital programme

o Purpose – To make sure health and social care services are safe, effective, compassionate and high-quality and encourage improvement;

o Role – To monitor, inspect and regulate services to meet good standards of quality and safety. Publish findings from inspections to inform the public;

The inspection process has 5 main areas o Safe, effective, caring, responsive to people’s needs and well-led o Asking the right questions about quality and safety to gather evidence o Being robust, fair, transparent and helpful

Then talked about the inspection process.

• Putting the patient first: Reflections and personal experience from a patient Speaker – Charles Ellis, patient and Non-Executive Director, East Sussex Healthcare NHS Trust

o His career background has been in the NHS



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o His medical history goes back to 1996 when he was diagnosed with MS and has been in and out of hospitals after a number of relapses.

o 2007 he had a mega relapse and spent 6 months in hospital and has more recently had major surgery.

o Due to surgery he had to have 14 days bed rest then transferred to a ‘Rehab’ unit where the average age of the other patients was 75 He received very little rehab Told legs would not work again and told to ‘get on with it’ There was an outbreak of CDiff and winter vomiting in the ward He wasn’t listened to Offered 2 showers in 6 weeks Very aware of low morale amongst staff Had lots of conflicting and different advice Discharge arrangements were totally inadequate as they had not taken his

home arrangements into account regarding his needs He lost a lot of weight

Due to the ‘service and lack of care he received’ He felt totally dis-empowered.

o He had friends who he had worked with in the NHS who got him into a specialist Neuro Rehab Unit The experience was totally different to the other rehab unit Staff were happy Ward rounds took place where patients needs were identified The discharge process was well managed and safe

2 very different experiences

o He became a patient advisor and Non-Executive Director of a NHS Trust Challenges decisions to ensure they will improve patient care Spends time listening and talking to staff and patients Views complaints as jewels of knowledge that tell you about your

organisation Encourages Senior Executives to visit departments Sometimes staff and patients tell you what you want to hear – look beyond

the obvious (look at the bathrooms, do they look like they have been used?)

• Creating a culture to ensure good patient safety, quality and patient experience Speaker – Julie Hendry, Director of Quality and Patient Experience, Mid Staffordshire NHS Foundation Trust

o Some reasons for the failings Run based on finance No patient input No focus on patients Staff not listened to Board inaccessible



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Nursing posts taken out to balance the books o New philosophy

Care for people Listen to improve Work together Do the right thing Get the community involved Board to Ward/Ward to Board communication Public Board meetings Be honest and transparent Complaints focus group Ask public if any questions for the Board Press table at Board meetings PALS based in main reception Real time patient feedback from bedside Happy staff/Happy patients Staff thanked for raising concerns Zero tolerance of poor staff attitude

Experience-Based Co-Design (EBCD)

This was a theme throughout the conference used by a number of NHS Trusts.

EBCD involves gathering experiences from patients and staff through in-depth interviewing, observations and group discussions, identifying key 'touch points' and assigning positive or negative feelings. A short edited film is created from the patient interviews. This is shown to staff and patients, highlighting how patients experience the service. Staff and patients are then brought together to explore the findings and to work in small groups to identify and implement activities that will improve the service or the care pathway.

A standout comment made by one of the speakers

Patients see and hear what is going on, Staff don’t.

The gist of the conference was about listening to and working with patients, family and carers to improve patient experience. All the sessions were about how different Healthcare service providers are working in different ways to improve patient experience.

Sue Hutchings Governor – Hall Green


January 2014


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Dates of Future Meetings

17 March 2014, St Johns Hotel, Warwick Road, Solihull

Agenda

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Council of Governors · 2014. 1. 13. · Chairman's Report Chief Executive's Report Performance year to date Matters Arising Transform-ing Patient Experience Conference Flow and 4-hour