2018/2019 from august 2018 name position held interests declared first appointed acott, susa

280 Pages·2017·11.58 MB·English

REGISTER OF DIRECTOR INTERESTS – 2018/2019 FROM AUGUST 2018

FIRST APPOINTED
NAME POSITION HELD INTERESTS DECLARED

ACOTT, SUSAN Chief Executive Advisory Council of The Staff College (leadership Appointed 1 April 2018
development body for the NHS/Military) (4)
Substantive Chief Executive at Dartford and
Gravesham NHS Trust (DGT). A memorandum of
understanding has been signed to mitigate the risks
with the substantive role and the interim role. No
longer a Board member at DGT. Discussed and
accepted at the Board meeting held on 6 October
2017 (5)

ADEUSI, SUNNY Non Executive Director None 1 November 2015
(First term)

CAVE, PHILIP Director of Finance and Wife works as a Senior Manager for Optum, who run Appointed 9 October
Performance Management the Commissioning Support Unit (CSU) in Kent, which 2017
supports the Clinical Commissioning Group’s (CCG’s)
of East Kent in their contracting (5)
Non Executive Director of Beautiful Information
Limited (1)

COOKSON, WENDY Non Executive Director Managing Director of IdeasFourHealth Ltd, a 6 January 2017
consultancy for the healthcare industry (2) (First Term)
Sole Shareholder for IdeasFourHealth Ltd (3)
Trustee of Bede House Charity, a local community
charity in Bermondsey, London, from January 2017 (4)
Member of Health Advisory Board for OCS Group UK
(5)
Non Executive Director of Medway Community
Healthcare (1)

LE BLANC, SANDRA Director of HR Justice of Peace (East Kent) and I am a specialist 1 September 2014
advisor for the CQC (4)
Member – Scheme Advisory Board for the NHS
Pension Scheme (4)

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REGISTER OF DIRECTOR INTERESTS – 2018/2019 FROM AUGUST 2018

FIRST APPOINTED
NAME POSITION HELD INTERESTS DECLARED

MANSLEY, NIGEL Non Executive Director Jeris Associates Ltd (1) (2) (3) (First term)
Chair, Diocesan Board of Finance (Diocese of 1 July 2017
Canterbury) (1)

MARTIN, LEE Chief Operating Officer None Interim from May 2018
Substantive from August
2018

OLLIS, JANE Non Executive Director Quvium UK (1) 8 May 2017
The Heating Hub (1) (First term)
Board Member of the Kent Surrey Sussex Academic
Health Science Network (AHSN) (1)

PALMER, KEITH Non Executive Director Managing Director of Silverfox Consultancy Ltd (1) 1 January 2017
Sole shareholder of Silverfox Consultancy Ltd (3) (First term)
Non Executive Director of EKMS (1)
Non Executive Director of 2Gether Support Solutions
(1)

REYNOLDS, SEAN Non Executive Director Trustee of Building Heroes (1) 20 August 2018
(First term)

SHUTLER, LIZ Director of Strategic Nil January 2004
Development and Capital
Planning/Deputy Chief
Executive

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REGISTER OF DIRECTOR INTERESTS – 2018/2019 FROM AUGUST 2018

FIRST APPOINTED
NAME POSITION HELD INTERESTS DECLARED

SMITH, SALLY Chief Nurse and Director of Nil Interim from 1 April 2015
Quality Substantive from 28 July
2015

SMITH, STEPHEN Chair Non Executive Director of NetScientific Plc (1) 1 March 2018
Chairman of Biotechspert Ltd (1)
Non Executive Director of uMed Ltd (1)
Non Executive Director of Draper and Dash (1)
Chairman of Signum Health Ltd (1)
Trustee of Pancreatic Cancer UK (1)
Stephen Smith Ltd (1)
Chair of Scientific Advisory Board (4)
Pancreatic Cancer UK (4)
Non Executive Director of Great Ormond Street
Hospital (1) (overlap agreed by NHS Improvement
until the end of May 2018)

STEVENS, PAUL Medical Director CQC Adviser (4) June 2013
NICE Chair, Chair of the Kidney Disease Guideline
and Quality Standards Groups (4)
Executive Member of Kidney Disease Improving
Global Outcomes (4)
Non Executive Director of Beautiful Information
Limited (1)

WILDING, BARRY Senior Independent Director Trustee of CXK, a Charity in Ashford inspiring people 11 May 2015
to thrive (4) (First term)

Footnote: All members of the Board of Directors are Trustees of East Kent Hospitals Charity
Categories:

1 Directorships
2 Ownership or part-ownership of private companies, businesses or consultancies likely or possibly seeking to do business with the NHS
3 Majority or controlling shareholding
4 Position(s) of authority in a charity or voluntary body
5 Any connection with a voluntary or other body contracting for NHS services
6 Membership of a political party

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EAST KENT HOSPITALS UNIVERSITY NHS FOUNDATION TRUST
Board of Directors
10 August 2018

UNCONFIRMED MINUTES OF THE EIGHTY-SIXTH MEETING OF THE
BOARD OF DIRECTORS
FRIDAY 10 AUGUST 2018 AT 9.45 AM
IN SEMINAR ROOMS 1 & 2, BUCKLAND HOSPITAL, DOVER

PRESENT:
Professor S Smith Chair StS
Mr S Adeusi Non-Executive Director SA
Mr P Cave Director of Finance and Performance Management PC
Ms W Cookson Non-Executive Director WC
Ms S Le Blanc Director of Human Resources SLB
Mr N Mansley Non-Executive Director NM
Mr L Martin Chief Operating Officer LM
Ms J Ollis Non-Executive Director JO
Ms L Shutler Director of Strategic Development
and Capital Planning/Deputy Chief Executive LS
Dr S Smith Chief Nurse and Director of Quality SSm
Dr P Stevens Medical Director PS
Mr C Tomson Non-Executive Director (joined at 10.15 am) CT
Mr B Wilding Non-Executive Director BW

IN ATTENDANCE:
Mrs A Fox Trust Secretary AF
Ms C Hardwick Head of Speech and Language Therapy
(for minute number 63/18) CH
Ms A Price Workforce Programme Director (for minute number 66/18) AP
Ms S Robson Board Support Secretary (Minutes) SR
Ms S Stevens Speech and Language Therapist (for minute number 63/18) SaSt
Ms N Yost Director of Communications NY

MEMBERS OF THE PUBLIC AND STAFF OBSERVING:
Ms D Gordon
Mr C Morley
Mr K Rogers
Dr J Sewell
Mrs M Smith
Mr S Stevens
Mrs J Whorwell

MINUTE
ACTION
NO.
56/18 CHAIRMAN’S WELCOME

The Chair welcomed attendees to the meeting.

57/18 APOLOGIES FOR ABSENCE

Apologies were noted from Ms Susan Acott (SAc), Chief Executive Officer and
Mr Keith Palmer (KP), Non-Executive Director.

CHAIR’S INITIALS ……………
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EAST KENT HOSPITALS UNIVERSITY NHS FOUNDATION TRUST
Board of Directors
10 August 2018

58/18 DECLARATION OF INTERESTS

It was noted that there were no changes to the declaration of interests.

59/18 MINUTES OF THE PREVIOUS MEETING HELD ON 8 JUNE 2018

The minutes of the previous meeting were APPROVED as an accurate record of
the meeting.

60/18 MATTERS ARISING FROM THE MINUTES ON 8 JUNE 2018

The quarterly quality strategy update was noted.

The presentation of health and safety reports on a quarterly basis to the Board
related to actions for future Board meetings.

Confirmation of the number of staff employed in the Emergency Department (ED) at
Queen Elizabeth the Queen Mother (QEQM) Hospital had been provided in the
actions table, this was noted and the action was closed.

61/18 CHAIR’S REPORT

The Chair reported that the Trust had been part of the BBC’s celebration of
70 years of the NHS.

The Chair provided an update from the Council of Governors. There would be
continued evolution and modernisation of interactions with Governors. There had
been six Governor, Executive Director and Non-Executive Director joint visits to
various areas across the hospital sites. There had been concerns regarding
underutilisation of the Buckland Hospital, and that utilisation of capacity needed to
remain a matter for discussion. In addition to these visits, the Executive Directors
had a full plan of engagement and buddying visits.

Implementation of services provided by the wholly owned subsidiary company,
2gether Support Solutions (2SS), had ran smoothly. AF noted that positive
feedback had been received from staff and engagement had been good. LS added
that 2SS had announced a pay increase for the lowest paid Serco staff.

The Chair noted that changes to the Trust’s Constitution were outlined in the
appendix attached with the Chair’s report, which had been approved by the
Governors. These were presented to the Board for approval.

It was noted that the Trust was reviewing the use of single-use plastics.

The Board NOTED the Chair’s report and APPROVED the changes to the Trust’s
Constitution.

62/18 CHIEF EXECUTIVE’S REPORT

LS noted successes in the Emergency Department (ED) performance
improvements. The results of the Care Quality Commission (CQC) visit were
awaited. There had been a review of reporting by subsidiaries and a strategy for
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EAST KENT HOSPITALS UNIVERSITY NHS FOUNDATION TRUST
Board of Directors
10 August 2018

East Kent Medical Services (EKMS) requested. Accreditation for haematology and
blood transfusion had been retained.

‘Listening into Action’ (LiA) had been launched and the points raised included the
provision of drinking water fountains, air conditioning and other temperature-related
issues. There would be further discussions held at the staff forums.

JO recommended that the Board remained sighted on LiA projects taken forward.
SLB advised that she would be updating the Strategic Workforce Committee (SWC)
at each meeting and that updates would be reported back to the Board within the
SWC Chair’s report. LS commented that it would be valuable for the Board to have
sight of staff comments from LiA.

SA enquired whether any ideas from the LiA programme could be included in the
transformation agenda. LS replied that 10 service areas would be chosen, with a
doctor, nurse and senior manager responsible for a transformation project in each
area.

NM advised it was important that suggestions received through LiA should be
acknowledged and responded to. LS indicated that a blog from SAc
acknowledging issues would be disseminated to staff. NY added that a LiA
communications plan had been developed.

The Board NOTED the Chief Executive’s Report.

63/18 PATIENT AND STAFF EXPERIENCE STORY `

CH explained that speech and language therapists worked with patients with
communication difficulties and swallowing difficulties. SaSt added that swallowing
difficulties could have potentially life-threatening consequences and could also
impact negatively on patients’ quality of life. Patients were initially assessed with a
clinical bedside examination of the swallow, leading to recommendations for the
team caring for the patient.

The clinical bedside examination was limited as some patients did not show any
obvious signs of problems. Research suggested that up to 40% of people with
dysphagia were aspirating silently. In others, aspiration risk could be
overestimated, leading to unnecessary restrictions or tube feeding. Therefore,
instrumental assessment was required. Video fluoroscopy but was not available to
all patients as patients needed to be well enough to be able to go to the X-ray
department and be positioned correctly.

Fibreoptic endoscopic evaluation of swallowing (FEES) was not yet widely available
in the Trust. A video was played to demonstrate the ease of use at a patient’s
bedside.

CH outlined a case study of a stroke patient. Bedside assessment indicated
difficulties with swallowing but a FEES examination demonstrated that the issues
were not as bad as expected. The patient was started on a modified diet and did
not require a feeding tube. FEES equipment would benefit patients, save time for
the speech and language therapy department and reduce costs for the Trust.

CHAIR’S INITIALS ……………
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EAST KENT HOSPITALS UNIVERSITY NHS FOUNDATION TRUST
Board of Directors
10 August 2018

A question was raised regarding whether FEES could be used for patients with
oesophageal cancers. CH replied that in oesophageal cancer patients food was
often stuck further down the oesophagus, although there could be discomfort
higher up.

It was enquired if transient ischaemic attack patients were screened for swallowing
difficulties. CH replied that if a swallowing screen for nurses was available on all
wards, any problems would result in a referral to speech and language therapy.

WC asked for an update on the progress of the business case. SaSt replied that
there had been an invitation to present this at the Charitable Funds Committee on 6
September to request funding.

SSm noted that the speech and language therapy team had won an accreditation,
and extended congratulations to the team.

The Board NOTED the report.

64/18 QUALITY COMMITTEE – CHAIR REPORT

BW highlighted that the Quality Committee continued to closely monitor the
situation around performance in the ED. Learning from serious incidents was also
a focus of the Committee.

The Board NOTED the report.

65/18 MEDICAL DIRECTOR’S REPORT

PS reported that an IT issue at Public Health England had led to a number of
people not being called forward for breast screening. The local service had been
working hard to rectify this.

The MBRRACE report on perinatal mortality indicated that the Trust’s stillbirth and
neonatal mortality rate was above the national average. Indication had revealed
that most of the local variation related to congenital non-survivable conditions.

Healthcare associated infection, particularly C. diff, was an area of concern. An
independent external visit to examine the infection prevention and control action
plan was planned.

The General Medical Council (GMC) training survey had demonstrated small
improvements for the Trust, it was noted that burn out was an issue nationally.

SA noted 18 never events over the past three years and enquired if underlying
causes would be addressed in the planned workshop. PS replied that never events
could never be completely eradicated and that these typically had multiple causes.

CT noted a slight deterioration on mortality indices. PS commented that the
hospital standardised mortality ratio (HSMR) was more meaningful than the crude
mortality rate and remained low. The mortality index demonstrated possible
problem areas in acute myocardial infarction and stroke. Randomly selected cases
would be assessed in detail and presented to the mortality steering committee. BW
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EAST KENT HOSPITALS UNIVERSITY NHS FOUNDATION TRUST
Board of Directors
10 August 2018

added that the Quality Committee looked for assurance that thorough and detailed
analysis was being undertaken.

NM expressed concern over the amount of red and pink on the training survey,
particularly around gastroenterology. PS replied that this related to the balance
between acute medicine and gastroenterology. Recruitment and retention of staff
would help to address that.

JO asked what training around resilience and mindfulness was provided to junior
doctors. PS replied that there was not enough, and that aspects of MediLead,
which had been developed in Medway NHS Foundation Trust, would be adopted.

SLB noted that the Trust had implemented mindfulness and resilience training in
the previous year and it was provided particularly in areas where demand for
services was high. However, demand was not yet being met. WC commented
measurement of impact would be helpful.

PS commented that Schwartz Rounds had been running for around two years and
were very well attended.

The Chair noted that stroke mortality was high. The introduction of hyperacute
stroke units would reduce this. Internal investigation around the MBRRACE report
was linked to national criteria.

The Chair extended sympathy to those patients that had been missed from the
breast screening programme.

The Board NOTED the report.

66/18 URGENT CARE AND LONG TERM CONDITIONS WORKFORCE
DEVELOPMENT PROGRAMME – REPORT AND FORWARD PLAN

SLB noted that urgent care accounted for 25% of the Trust’s workforce. The
previous winter had been challenging. AP had joined the Trust to support the
leadership team in developing a long-term sustainable workforce plan.

AP explained that the paper summarised progress across the six workstreams.
Attracting local populations to consider working in the heath service at an early
stage in their education was a key opportunity.

The Chair commented that the Board were concerned by the level of agency
overspend and required assurance that this was under control and being
monitored. SLB replied that the main issue was the recruitment to vacant posts.
Agreement of a number of additional business cases meant that the vacancy gap
had now increased. SLB would present a paper on addressing this at the next
Board meeting.

It was noted that operational pressures had impacted on the reporting of the
appraisal process in the Urgent Care & Long Term Division (UC&LTC). Staff were
being encouraged to take ownership of appraisals. WC commented that there was
possibly a larger Trust-wide issue around manual processes. SLB indicated that
appraisal reporting was not an issue in other Divisions.
CHAIR’S INITIALS ……………
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EAST KENT HOSPITALS UNIVERSITY NHS FOUNDATION TRUST
Board of Directors
10 August 2018

It was noted that junior doctors in training would be removed from joiners and
leavers figures.

BW queried how agency spend would impact on the Cost Improvement Programme
(CIP). PC replied that there was a risk around CIP delivery. Activity
overperformance and underspending in other areas had mitigated agency spend to
some extent. SLB observed that work around retention was being carried out.
Some agency spend represented staff required above establishment for patient
safety reasons. There were business cases around changing these posts to
substantive, which would further reduce agency spend.

LS noted that there were difficult recruitment challenges in areas of primary care
and joint working between providers could provide a solution to many issues. AP
agreed that the programme of work should be system-wide. Band 4 was a level of
staffing that was underutilised in the NHS but could play an important role. LM
indicated that providers had agreed not to compete against each other around the
recruitment of staff.

The Board NOTED the report.

67/18 STRATEGIC WORKFORCE COMMITTEE – CHAIR REPORT

CT noted concerns that a number of indicators were moving negatively. However,
there had been a significant reduction in staff leaving the Trust in the first year, with
a net gain of just under 400 people. Flu vaccination uptake was amongst the most
improved in the UK.

Recruitment was significantly up on the previous year, including a substantial
number of consultants recruited. Turnover and recruitment was similar to the
national average. CT commented that nursing turnover and the age profile of
nurses were areas of concern. PS observed that finalising the clinical strategy was
important so that potential staff could make long-term plans. LS commented that a
medium-term vision was also important, particularly in areas such as ITU. PS
added that certainty was needed on the strategy.

SLB reported that just over 60 new consultants had been recruited in a year. The
Trust had an aging workforce profile, and a ‘working longer’ group was considering
more flexible options for staff who were considering retirement.

NM asked how the pilot on attracting staff back into the workforce was measured.
SLB replied that this was on staff feedback. NM asked if commission was offered
to staff introducing new people to the Trust. SLB answered that this was one of the
additional measures that was being considered.

The Board APPROVED the report.

68/18 NOMINATIONS COMMITTEE – CHAIR REPORT

JO reported that the Committee reviewed and took assurance around succession
planning, the fit and proper persons test and updating the register of interests.

CHAIR’S INITIALS ……………
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EAST KENT HOSPITALS UNIVERSITY NHS FOUNDATION TRUST
Board of Directors
10 August 2018

The Board APPROVED the report.

69/18 REMUNERATION COMMITTEE – CHAIR REPORT

WC reported that the Committee had discussed a review of pay policy and
remuneration of Executive Directors. The salary and terms and conditions of Board
Directors of 2gether Support Solutions (2SS) had also been discussed.

The Board APPROVED the report.

70/18 INTEGRATED AUDIT AND GOVERNANCE COMMITTEE (IAGC) – CHAIR
REPORT

BW reported that the Committee recommended for Board approval to remove the
annual priority in relation to delivery of the Leadership Programme, as the provision
of funding had not been supported by NHS Improvement (NHSI).

WC asked for further detail around constitutional standards and system risks on the
risk register. BW replied that there were 33 items on the strategic risk register,
which was too many. Some would be amalgamated, some recommended for
closure and some transferred to the Divisional risk registers.

AF commented that there would be consideration of a risk around pathways and
mitigation of system-wide risk.

CT observed that the NHS was moving towards becoming an Accountable Care
Organisations. There was encouragement for local bodies to work together to form
a plan, but very little governance and that considering system risks collaboratively
could be a way to move towards this. It was noted that conversations around how
to include governance had commenced. The Chair noted that the health service
needed to function within the legal framework of the 2012 NHS Act, but there were
many opportunities for providers to work collaboratively. The Trust would need to
proactively consider differences in the new environment.

PC noted that the Trust was working together with Clinical Commissioning Groups
(CCGs) around an aligned incentive contract.

DECISION: The Board APPROVED the report and the removal of the annual
priority in relation to delivery of the Leadership Programme.

71/18 FINANCE AND PERFORMANCE COMMITTEE – CHAIR REPORT

SA reported that an encouraging meeting had been held with NHSI regarding the
Trust’s Financial Special Measures (FSM) status. NHSI had requested a three-
year operational plan.

There was a cap of £19m agency spend for the year and £9.9m had been spent in
the first quarter, mostly in urgent care. There was a need to ensure recovery of the
elective activity underperformance and achieve the level of planned income.

The Trust had a £30m Cost Improvement Programme (CIP), of which around
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