Annual Board Meeting

SolviTech Systems Inc.

Minutes of a Meeting of SolviTech Systems Inc.Board of Directors held on Friday 14 December

2011 in the Committee Room, Royal Bournemouth Place

Present: Jane Stichbury (JS) Chairman (in the chair)

Tony Spotswood (TS) Chief Executive
Karen Allman (KA) Director of Human Resources
Mary Armitage (MA) Medical Director
David Bennett (DB) Non-Executive Director
Pankaj Davé (PD) Non-Executive Director
Brian Ford (BF) Non-Executive Director
Stuart Hunter (SH) Director of Finance and IT
Helen Lingham (HL) Chief Operating Officer
Steven Peacock (SP) Non-Executive Director
Alex Pike (AP) Non-Executive Director
Richard Renaut (RR) Director of Service Development
Paula Shobbrook (PS) Director of Nursing and Midwifery
In attendance: Karen Flaherty (KF) Trust Secretary
Peter Gill (PG) Director of Informatics
Dily Ruffer (DR) Governor Co-ordinator
Tracey Hall (TH) Head of Communications
Judith Adda (JA) Public Governor
Mike Allen (MAll) Public Governor
David Bellamy (DBe) Public Governor
Glenys Brown (GB) Public Governor
Sharon Carr-Brown (SCB) Public Governor
Derek Dundas (DD) Public Governor
Lee Foord (LF) Appointed Governor
Alf Hall (AH) Public Governor
Doreen Holford (DH) Public Governor
Keith Mitchell (KM) Public Governor
Graham Swetman (GS) Public Governor
David Triplow (DT) Public Governor
Margaret Neville (MN) Member of the Public
Apologies: Ken Tullett (KT) Non-Executive Director

JS welcomed PG, the recently appointed Director of Informatics, to the

meeting.

122/12 MINUTES OF MEETING HELD ON 9 NOVEMBER 2012 (Appendix A)

The minutes of the meeting held on 9 November 2012 were received and
accepted as a true record of the meeting.

_______________________________________________________________________________________
BOD/PT 1 MINS 14.12.2012 PAGE 1 OF 12
123/12 ACTIONS LOG (Appendix B)

(a) Performance Report – Liverpool Care Pathway

PS reported that there had been a very good discussion at the Healthcare
Assurance Committee (HAC) meeting on 29 November 2012 which had
been attended by Ros Pugh, a Consultant in the Macmillan Unit, Brian
Williams, the Lead Co-ordinating Chaplain, and Ellen Bull, the Deputy
Director of Nursing and Midwifery. She noted that the HAC had
commissioned some additional work given that there had recently been an
appointment to a short-term post of an End of Life Care facilitator funded by
the Strategic health Authority.

In relation to the financial incentives which had been raised in the media
coverage, PS confirmed that there was a CQUIN marker relating to End of
Life Care which but this was a quality initiative and there was no financial
incentive. PD added that at the HAC the Chaplain had noted that the
Liverpool Care Pathway was also the right thing to do spiritually as it helped
the patient and their family prepare for death. He further added that the
communication with the patient in terms of getting their consent was the
primary focus for staff and communication with the family was sometimes
secondary. He concluded by sharing some data from the HAC: that out of
the 529 patients on the Liverpool Care Pathway, there were only 1-2
complaints, neither of which were related to Liverpool Care Pathway itself.

BF noted that the focus in the media reports had been on consent and
patients not being aware that they were on the Liverpool Care Pathway and
he would appreciate further assurance for the Board around the process for
consent. PS agreed, noting that this was an area of focus in the action plan. PS
MA added that the Liverpool Care Pathway was a process and, like all
processes, there were occasions when it did not work properly but in most
cases it worked well.

124/12 MATTERS ARISING

(a) Cancer Performance Measures (Verbal)

HL reported that she would be bringing this item back to the Board HL
with Tamas Hickish, the Trust’s Cancer Lead, most likely in
February but she would confirm the date.

125/12 QUALITY

(a) Patient Story (Verbal)

PS read a letter from the family of a patient whose father had died
having been a patient on Ward 25 and the AMU; they had been
impressed by the care and compassion shown by staff and the
way in which staff had communicated with the family. PS noted
how this demonstrated how well the Liverpool Care Pathway
could work in practice when done properly.
_______________________________________________________________________________________
BOD/PT 1 MINS 14.12.2012 PAGE 2 OF 12
 JS thanked PS for highlighting this issue in the Patient Story given
the discussion earlier in the meeting, noting the positive
comments about Trust staff.

(b) CQC Quality and Risk Profile (Appendix C)

PS presented the report and noted that the Trust was rated low
risk by the Care Quality Commission (CQC).

PS updated the Board on the CQC unannounced inspection which

occurred on 22 and 23 November 2012. She reported that they
had visited ED, Ward 4, Ward 23, Outpatients and the Eye Unit.
PS noted that she had received the draft report which was very
favourable and the Trust was compliant with all the essential
standards which were inspected: outcome 2 (Consent to care and
treatment), outcome 4 (Care and welfare of people who use
services), outcome 10 (Safety and suitability of premises),
outcome 12 (Requirements relating to workers) and outcome 21
(Records).

She noted :
• that the patients who had been interviewed by the CQC
had all commented very favourably about their experience;
• the positive comments from the CQC about the Estates
Department and the processes they had developed around
Legionella, which had been the focus for the CQC; and
• that DNAR (Do Not Attempt Resuscitation) forms and the
quality of documentation had improved since the CQC’s
last visit.

PS thanked all the staff who had been involved. The Board
agreed that the feedback from the inspection including the positive
comments which had been made by the CQC should be
distributed as part of the key communication points following the PS
Board meeting. In response to a request from SP, PS agreed to
circulate a copy of the final report to the Board of Directors and PS
the Council of Governors once it was issued.

TS highlighted that the visit had taken place at a time of increased

activity and commended the work of PS and HL in maintaining the
high quality of the service and patient experience in these
circumstances. JS added that as this was an unannounced visit
there was a high level of assurance to be gained from the CQC’s
feedback and report.

(c) Update on Nursing Staff Recruitment (Appendix D)

PS noted that the Board had requested a report to provide an

update on the recruitment process and further assurance. She
presented the report, noting the recommendations from the review
_______________________________________________________________________________________
BOD/PT 1 MINS 14.12.2012 PAGE 3 OF 12
 and the aims in terms of recruitment. She reported that there were
50 vacancies, which would reduce to 19 in January with further
interviews scheduled in early January. She added that bank and
agency staff had been used where there were vacancies.

DB and PD questioned what assurance the Board should gain

and what improvements the Board should expect to see as a
result of the Ward staffing review. PS responded that:
• the assurance was that the Trust nurse staffing levels in
line with the latest Royal College of Nursing guidance on
nursing staff to patient ratios produced in 2012;
• improvements would be monitored through the Nursing
Quality Indicators around pressure ulcers, falls, infection
control and complaints which would be reviewed at Ward
level every six months; and
• improvements were also tied into leadership on the Wards
and the “Time to Lead” programme which was discussed at
the Board meeting last month.

SP asked how the Trust was managing the integration of the new
members of staff and the impact on the organisation. PS noted
that the electronic rostering system which can be used as a tool to
ensure correct levels of staffing. PS noted the challenges
particularly with newly qualified nurses but commended the quality
of the Trust’s preceptorship programme in their first year to
provide mentoring, support, training and study.

HL added that there was clear evidence that if an organisation

invests in the right level of staffing then it should see
improvements in quality but also in efficiency. She noted that it
should therefore have a positive impact on discharge planning
and overall efficiency.

KA reiterated the quality of the preceptorship programme and

added that the Trust had a very low turnover of nursing staff and
identifying vacancies had been the bigger issue in the past as
opposed to attracting applicants. In response to a comment from
SP, PS and KA agreed to consider a more formal way of capturing KA/PS
the views and ideas of new staff to support the encouragement
that they had already provided when they had attended induction
training. They also agreed to provide an update if any of those KA/PS
recently recruited had left the Trust.

JS commented that she had heard positive comments from staff

on the Wards about these changes releasing more time to care for
patients.

_______________________________________________________________________________________
BOD/PT 1 MINS 14.12.2012 PAGE 4 OF 12
126/12 PERFORMANCE

(a) Performance Report (Appendix E)

HL gave an update on performance. She highlighted that:

• there had been good progress against the action plan to
address emergency pressures to date with a few things in
progress to provide Directorate support which she expected
to be in place post-Christmas;
• despite the challenges around activity in ED, the quality
metrics remained strong in October;
• there was a single C Difficile case in October and the Trust
benchmarked well regionally with 8.2 cases of C Difficile per
100,000 bed days against an average of 8.9;
• the Trust benchmarked well on MRSA, with no cases, and
MSSA, where there was no national target;
• the Trust was an outlier for cases of E Coli but the vast
majority were community acquired although the Trust’s
position as the hub for Urology and complex biliary care did
increase the risk of infection;
• there was a very positive performance on cancer although
there were still high levels of fast track referrals;
• the demand for bowel cancer screening was higher than the
previous two years and the Trust was putting in extra
capacity in response;
• the JAG accreditation for Endoscopy services was due to be
reviewed in February with waiting times one of the 262
metrics used in the accreditation process;
• the performance on Stroke in November was disappointing;
• the PCT had approved a joint approach to a 7 day TIA
service and the Trust was working with its partners to
implement this;
• capacity rather than patient choice was the main reason for
patients not spending time on the Stroke Unit or being
directly admitted to the Stroke Unit;
• the Stroke pathway was due to change in January with
patients directly admitted to Stroke Unit following GP triage
rather than going through the AMU unless appropriate and
outreach teams would also be strengthened.
• she was meeting with the Director of Acute and Primary
Care Service Improvement at the PCT about activity levels
as the Trust had been in a negative position on bed status
consistently for six weeks;
• the Trust was struggling to manage emergency demand and
this could have a knock-on effect on the overall performance
of the organisation;
• Delayed Transfers of Care were still an issue with delays
with social services and community hospitals;
• the Trust was working with the PCT and other providers to
understand the flexibility around bed capacity in local
_______________________________________________________________________________________
BOD/PT 1 MINS 14.12.2012 PAGE 5 OF 12
 community hospitals and to ensure transparency around this
as there was in the acute trusts;
• the Trust and other local acute trusts had not yet signed off
the local Winter Plan due to the issues around capacity but
there was a need to resolve this before January;
• the Trust was getting support from GPs and those GPs who
were working in ED will be supporting the Trust over
Christmas and was appreciative of their support and their
knowledge in helping with the discharge of patients;
• there was a strong performance on staff sickness given the
number of short periods of sickness at the moment; and
• the Trust was maintaining a stable position on appraisals
and she was not singling out Directorates at present given
the other pressures.

JS stressed that the Board needed to note the strong statement

from HL on activity levels and provide support.

The Board discussed the issues around capacity and DB

questioned whether there was anything else that could be done
given the Trust was running ahead of plan financially.

TS added that the Trust had taken action to address the capacity
issues and there was a need for the Trust to focus on the wider
local issues, working with its local health partners which he and TS/SH
SH would take forward. HL added that it would be helpful if a letter
to the PCT came from JS to follow up on the promised actions. TS HL/JS
also suggested that a conversation between MA and Forbes
Watson would be helpful and MA agreed, noting that she would MA
involve the Medical Directors from Dorchester County Hospital
and Poole Hospital NHS Foundation Trusts and the GPs who
were working in the ED too.

HL noted that there was very positive dialogue with GPs about
trying to manage the level of admissions as they understood that
this needed to be addressed before the patients turned up at the
Hospital. She highlighted that the GPs were going to take the
ambulance calls from nursing homes.

DB noted that the Trust did not appear to be able to achieve the
metrics for the Stroke Unit. PD supported this, adding that the
Trust was able to demonstrate activity but not able to demonstrate
progress. HL responded that there was not a single problem to fix
and the Trust had worked on creating a sustainable performance
even if it was taking slightly longer but that capacity issues were
now having an impact. She added that he Trust was not an outlier
locally or nationally.

AP asked that the progress on the Stroke Unit and 7 day TIA was
acknowledged. With the issues around capacity she felt it was
important for the Trust to educate patients and their families
_______________________________________________________________________________________
BOD/PT 1 MINS 14.12.2012 PAGE 6 OF 12
 around the discharge process so they feel supported and
understand why this was the right thing for them rather than feel
they were being pushed out of the Trust too soon. She also asked
why brain imaging, which was not related to capacity, was still not
improving. HL replied that the referral to imaging was the cause of
the delay even though radiologists were working extra hours. PS
added that the early supported discharge teams collected data
from patients and there were fantastic examples of patients who
wanted to be discharged and the discharge process was very well
evaluated by patients

SP noted the comments in the recent Dr Foster report about the

impact of hospitals operating at above 85% occupancy. HL noted
that the Trust was looking at metrics such as occupancy and
readmissions but these needed to be broken down by areas as
elective can operate above 85% occupancy but other areas need
to be below this. HL agreed to provide an update in January on HL
the metrics on occupancy and productivity measures.

PG recognised the consistent dedication required to keep the

infection control levels down particularly in the context of the
activity. BF asked that the report refer to a trajectory rather than a HL
target on the infection control measures.

JS noted that the Board could discuss these issues for longer but
highlighted the actions which had been agreed. She added that it
was important that the Board heard frankly about the pressures
and difficulties being experienced by the Trust.

(b) Financial Performance (Appendix F)

SH reported that:
• the Trust was ahead of plan due to the delivery of efficiency
savings and stressed that these were not affecting quality
as the impact on quality was assessed as part of the
transformation programme and quality had to be
maintained at the same level or improved;
• the Trust has invested money to address the activity
pressures which was the right thing to do and would fund
other ways to treat patients where these were identified but
there was a limit to the beds which the Trust could make
available;
• if the Trust had to go back on the cost improvement plans
from previous years and open more beds this would create
recurrent costs and 2013/14 would be likely to be a very
difficult year for the Trust;
• there was a need to assess the impact of the levels of
activity on future cost improvement plans which were based
on a further reduction of beds;
• the PCT had recognised that this was a local and national
issue and had confirmed that money would be made
_______________________________________________________________________________________
BOD/PT 1 MINS 14.12.2012 PAGE 7 OF 12
 available to support the increased activity and the Trust had
submitted bids for funding; and
• the FTN was making representations to the Department of
Health about the marginal rate tariff for emergency activity
which had been discredited by the levels of activity.

In response to a question from SP about what had happened to

create the increase in activity and the pressure on quality, MA
noted that much of this was about social services as there are
patients who should not be in hospital. HL cited an example from
the previous day when 61 patients, the equivalent of two wards,
who did not need to be in the Trust as they were medically stable,
could not be discharged.

DB asked what the FTN and other organisations were doing to

align the funding structures and performance metrics. TS replied
that the FTN had been discussing this with the Head of National
Commissioning Board and with Secretary of State of Health in
order to be able to pursue the agenda of reducing the size of the
acute sector and transforming these services. He added that there
was a need to focus on community healthcare which has not been
transformed. He noted that what there was a risk that what was in
the best interest of the patients could get lost in this debate.

127/12 STRATEGY

(a) Proposed Merger between Poole Hospital and RCBH

(Appendix G)

TS provided an update on the process with the Office of Fair

Trading (OFT), describing the OFT’s position that the incentive to
drive up quality in the specialities and sub-specialties in which the
OFT believed that the Trusts were competitors would disappear if
the Trusts were to merge.

He noted that the Trusts had provided a robust and effective

response and demonstrated that the Trusts provided
complementary rather than competitive services. He also added
that Tim Goodson, the Accountable Officer at the Dorset CCG,
had stated that the CCG did not want the Trusts to compete on
non-elective services.

He described the process within the OFT to present the case to

internal decision makers and added that the merger was still likely
to be referred to the Competition Commission. He noted that the
referral to the Competition Commission would provide an
opportunity to engage with the CCG on the benefits case for
merger. He confirmed that the impact on the merger timetable
which would mean the Trusts were unlikely to merge until the end
of 2013.

_______________________________________________________________________________________
BOD/PT 1 MINS 14.12.2012 PAGE 8 OF 12
 JS noted that there had been a series of very positive meetings
that week between the Boards of the two Trusts and the Proposed
Board with both Trusts showing tremendous leadership and
resilience.

128/12 DISCUSSION

(a) Monitor Consultation on Guidance for Commissioners

(Commissioner Requested Services and Protected Services)
(Appendix H)

RR presented the report, noting that all mandatory services are

likely to be designated as Commissioner Requested or Protected
Services with the level of contributions to a risk pool used to
incentivise a reduction in those services over time. He added that
funding from the risk pool would be used to support the services in
a failing trust.

In response to a question from TS, RR confirmed that from April

2013 all mandatory services would transfer and from April 2014
the Trust and commissioners would start discussions around de-
designation.

DB asked whether there were implications for any reconfiguration

post-merger to which RR responded that this would involve
discussion with the local commissioners.

(b) Prescribed Specialist Services (Appendix I)

RR highlighted that:
• these proposals would affect which services stayed in
Dorset;
• there was a risk that specialist services being de-
designated;
• there was a much broader definition of prescribed specialist
services which meant this would have a much wider impact;
• there was the potential for penalties and ultimately the loss
of services;
• this was a continuation of the move to larger centres which
demonstrated the need to get to a critical mass in order to
maintain services;
• the time and resource which would be required to respond
to these changes and measure and evidence the metrics
which would be required;
• the consultation on the draft specifications would run until
January and the Clinical Leads were reviewing the
specifications with support from the Information Team on
the algorithms; and
• the Trust could apply for derogations from 1 April 2013 and
agree a timetable to meet the specifications.

_______________________________________________________________________________________
BOD/PT 1 MINS 14.12.2012 PAGE 9 OF 12
 PD asked how this linked to the Any Qualified Provider process,
with RR confirming that this would lead to the reverse and greater
consolidation of services.

PG noted that this would present the opportunity in some areas to

move to IT systems rather than paper systems.

The Board was very supportive of the emphasis on this work as a

significant issue for this Trust and the proposed merged trust.

129/12 INFORMATION

(a) Jigsaw 2 – Open Letter (Appendix J)

The letter was noted for information.

(b) Government Mandate to NHS Commissioning Board

(Appendix K)

The report was noted for information. RR confirmed that this was
the final version and the indicators in the report would need to be
reflected in the Trust’s performance measures. He added that
there would be a direct link between the services that would be
commissioned by the Clinical Commissioning Groups and these
performance measures.

(c) Dr Foster Hospital Guide 2012 (Appendix L)

The report was noted for information. RR highlighted the Trust’s

performance in the three other methods used by Dr Foster
alongside the Hospital Standardised Mortality Ratio (HSMR): the
Summary Hospital-level Mortality Indicator (SHMI), deaths after
surgery and deaths in low risk conditions.

(d) Department of Health Consultation on Local Authority Health

Overview and Scrutiny (Appendix M)

The report was noted for information.

(e) Emergency Preparedness Report (Appendix N)

The report was noted for information. JS thanked HL for such a

thorough report.

(f) Core Brief (November) (Appendix O)

The report was noted for information.

_______________________________________________________________________________________
BOD/PT 1 MINS 14.12.2012 PAGE 10 OF 12
 (g) Communications Update (Appendix P)

The report was noted for information. JS thanked the

Communications team for all the work on the merger and
responding to the issues which had been raised in the press and
their other activities.

(h) Board of Directors Forward Programme (Appendix Q)

The report was noted for information.

130/12 DATE OF NEXT MEETING

Friday 11 January 2013 at 8.30am, Committee Room, Royal Bournemouth

Hospital

131/12 ANY OTHER BUSINESS

HL noted that Trust had been working with Dorchester and Salisbury
Hospitals on a bid for the local vascular service using a hub and spoke
model and following the issue of the national specification they would be
bidding to provide this service, with this Trust as the vascular hub.

132/12 Key Communications points for staff

1. Performance and activity.

2. Merger activity.
3. CQC unannounced inspection.

133/12 QUESTIONS FROM GOVERNORS

1. JA asked how seriously the Hospital was tackling the increase in late
onset type 2 diabetes, particularly given the age profile of the local
population. She noted the effect of diabetes on other long-term,
chronic conditions. MA noted that diabetes was not usually managed
by an acute hospital but she noted that this Hospital has taken a lead
in delivering education sessions to help patients understand how to
manage their diabetes and Peter Kavanagh goes out to GPs and
specialist nurses.
2. DB asked whether there had been any increase in readmissions
given the increased pressure on admission and discharge in order to
respond to the current levels of activity. HL responded that the
overall readmission rate was declining and added that from the
review of the data on readmissions patients discharged at weekends
were less likely to be readmitted. She noted that the Trust had
undertaken an audit on readmissions with GPs and she was waiting
for the final report.
3. DT asked whether the deadline for merger vote had changed given
the change in the overall timetable due to the OFT’s likely referral of
the merger to the Competition Commission. TS replied that the
Trusts were likely to get a provisional view from the Competition
_______________________________________________________________________________________
BOD/PT 1 MINS 14.12.2012 PAGE 11 OF 12
 Commission after 15 weeks and it was unlikely that Monitor would
want to invest much time in its review prior to that. He added that in
his view the vote would be more likely to take place in the summer
rather than spring but an update on the timetable would be provided
after the OFT’s decision in early January.

JS wished the Governors a good Christmas and New Year and looked
forward to working with them in what promised to be a challenging year
ahead.

There being no further business the meeting was declared closed.

_______________________________________________________________________________________
BOD/PT 1 MINS 14.12.2012 PAGE 12 OF 12