Hertfordshire Community NHS Trust Board Meeting in Public Thursday 28 January 2016 10.00am

225 Pages·2016·2.6 MB·English

by  Authorised User

Hertfordshire Community NHS Trust Board Meeting in Public

th
Thursday 28 January 2016

10.00am – 1.00pm

St. Albans City & District Council
Civic Centre
St Peters Street
St Albans
Hertfordshire
AL1 3JE

For map and directions please see:
http://www.stalbans.gov.uk/contact-us/how-to-find-us.aspx
(For Sat Nav users, please use AL1 3LD to locate the Council Offices)

Wifi Code: St4Lb&nsD(

AGENDA

Lead For Attachment Allocated Approx
Time Timing
(0) Patient / Learning Story 30 mins 10.00-10.30

A Carer’s story – Experiences of post-discharge N/A
arrangements from a community hospital.

Ruth Bradford
Clinical Quality Manager – Patient Experience

(A) Preliminaries 10 mins 10.30-10.40

DO’F 1. Welcomes, Introductions and Apologies for
Absence
DO’F 2. Chair’s Announcements / Notice of Urgent To note
Business (to include confirmation of Board
appointments and leavers):
DO’F 3. Members’ Declarations of Interest To note
(Members to declare any interests material
to items on the agenda)
Board 4. Ratification of items of Chair’s and Chief To ratify
Executive’s Action taken since the last
meeting under Standing Order 5.2
1
DO’F 5. To approve the Minutes of the meeting held To approve (A1)
on 12th November 2015
DO’F 6. Matters Arising from the Minutes of the To note
meeting held on 12th November September (A2)
2015. (Tracker).
(B) Clinical Services & Healthcare Governance 20 mins 10.40-11.00

CH 1. Director of Quality & Governance / Chief To note & (B1) 5 mins
Nurse’s Report discuss

1.1 Serious Incident Report (B2) 3 mins
1.2 Complaints Report (Oct – Nov 2015) (B3) 3 mins
1.3 Quality Improvement Plan (B4) 3 mins
1.4 Safe Staffing Report (B5) 3 mins

AM 2. Chair of Healthcare Governance To note for (B6) 3 mins
Committee’s Assurance Report assurance
(Operational Review: End of Life Care)

(C) Operations & Performance 20 mins 11.00-11.20

JH 1. Director of Operations’ Report To note & (C1) 5 mins
discuss

1.1 Emergency Planning and Resilience: To approve (C2) 3 mins
Statement of Readiness

PB 2. Summary Integrated Board Performance To note (C3) 3 mins
Report (Dec 2015)

PB 3. Business Unit Assurance Reports To note (C4) 4 mins

CH 4. High Level Risk Register To note & (C5) 5 mins
discuss
Break 10 mins 11.20-11.30
(D) Strategy, Resources & Engagement 30 mins 11.30-12.00

DL 1. CEO’s Report, Strategy Update and To note & (D1) 8 mins
Strategic Framework discuss

PB 2. Director of Finance’s Report To note & (D2) 5 mins
discuss
AS 4. Director of HR and OD’s Report To note & (D3) 5 mins
discuss
4.1 Public Sector Equality Duty (PSED) To approve (D4) 3 mins
Report

LS 5. Strategy & Resources Committee Chair’s To note for (D5) 3 mins
Assurance Report assurance

2
JP 6. Audit Committee Chair’s Assurance To note for (D6) 3 mins
Report assurance

DL 7. Board Assurance Framework: To approve (D7) 3 mins
Revision to format and process of review of
strategic risks.

(E) Board Governance & Leadership 3 mins 12.00-12.00

PB 1. Amendment to Operational Scheme of To approve (E1) 3 mins
Reservation and Delegation

(F) Healthwatch 5 mins 12.10-12.15

MC A verbal report from Meg Carter, Healthwatch To note (verbal)
observer, on Healthwatch news and issues
pertinent to the Trust.

(G) Urgent Business 5 mins 12.15-12.20
(As notified under Item (A) 2 above)
(H) Risks Arising / Observations 3 mins 12.20-12.23
DO’F 1. Summary of Risks Arising (Verbal) 3 mins
(J) Supporting Papers / Items for Receipt and Noting Only 2 mins 12.23-12.25
Clinical Services & Healthcare Governance To receive
and note
B1 (i) Log of Complaints Received (J1)
CH
B2 (ii) Professional Clinical Leads Group (J2)
CH
B2 (iii) Notes of Operational Review Meeting (J3)
AM
(End of Life Care) held on 10th

December 2015

Operations & Performance

PB
C2 (i) Integrated Board Performance Report
(J4)
(December 2015)

Strategy, Resources & Engagement
(J5)
PB D2 (i) Month 9 Finance Report (Dec 2015)
(J6)
PB D4 (i) TDA Return (December 2015)

(K) Date, Time & Venue of Next Meeting(s) 1 min 12.25-12.26
DO’F Thursday 24th March 2016
1.30- 4.00pm

Board meeting in public:
3
Venue (Central) TBA
(L) Questions from the Public 4 mins 12.26-12.30
DO’F The Chair will take questions from members of
the public.
Questions which cannot be addressed at the
meeting or in the time allocated will be noted.
Replies will be communicated to questioners
following the meeting and reported to the next
Board meeting in public.

(M) Informal Review of Meeting 4 mins 12.30-12.34
(All)

Please note that Board papers and Trust papers referenced in Reports are available on the
Trust’s Website at:

http://www.hertschs.nhs.uk/about-us/our-board/meeting-papers

Hard copies, or copies in large size font or in translation can be provided on application to:

The Company Secretary
Hertfordshire Community NHS Trust
Unit 1A Howard Court
14 Tewin Road
Welwyn Garden City
Hertfordshire
AL7 1BW
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Board: 28th January 2016 Attachment A1

HERTFORDSHIRE COMMUNITY NHS TRUST

Minutes of the Hertfordshire Community NHS Trust Board Meeting
th
Held in Public on Thursday 12 November 2015 at

East Herts Council Chambers
Wallfields, Hertford

Key Points from the Meeting for the Board to note:

* The following were approved / ratified:

(i) Temporary cover arrangements for statutory/regulatory roles of the Medical Director
(ii) Chair’s approval made under Standing Order 5.2 to enter a contract made following a full
tender process, with Abbott Laboratories for provision of enteral feeds was ratified.
(iii) The Strategic Outline Case (SOC) for “Your Care Your Future”
(iv) TDA Return (Oct 15)
(v) Communications and Engagement Strategy 2015-2020
(vi) Influencing the Influencers Strategy 2015 - 2020
(vii) Programme of Board and Board Committee meetings April 2016 – March 2017

* The following were received and considered:

(i) Minutes and Action Trackers from the Board meeting held on 17th September 2015
(ii) CEO’s Report and Strategy Update
(iii) Standing Reports from Executive Directors
(iv) Assurance Reports from NED Committee Chairs
(v) Safe Staffing Report (Sept 15)
(i) Serious Incident Report (Aug/Sept 15)
(i) Complaints Report Qtr 2 2015/16
(vi) PLACE 2015 Report and action plan
(vii) Summary Integrated Board Performance Report (Nov 15)
(viii) Annual Audit Letter 2014/15
(ix) Business Unit Assurance Reports (Oct 15)
(x) High Level Risk Register (Nov 15)
(xi) Foundation Trust Progress Report (Nov 15)
(xii) Report on the “Well Led Framework”
(xiii) Record of Remuneration Committee Meeting held on 27th October 2015

* Kim Bilsby, Locality Manager, East & South and Elaine Smith, infant Feeding Co-ordinator,
presented on UNICEF Accreditation: “The Baby Friendly Initiative
* Additional supporting papers were received. (See min:210/15 for list)
* The meeting concluded with a review of risks arising
* Questions and observations were invited from the public, staff and informal observers present.

Present: * = Voting Board member

Declan O’Farrell (DOF) Chair *
Anne McPherson (AM) Non-Executive Director *
Jeff Phillips (JP) Non-Executive Director *
Alan Russell (AR) Non-Executive Director (Vice Chair) *
Dr Linda Sheridan (LS) Non-Executive Director *
David Law (DL) Chief Executive *
Phil Bradley (PB) Director of Finance*
Clare Hawkins (CH) Director of Quality & Governance /Chief Nurse *
Julie Hoare (JH) Director of Operations
Alison Shelley (AS) Director of HR & OD

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Board: 28th January 2016 Attachment A1

In Attendance:

Meg Carter (MC) Healthwatch Observer
Clive Appleby (CApp) Company Secretary

For item 177/15 – UNICEF Accreditation Presentation:

Kim Bilsby (KB) Locality Manager, East & South
Elaine Smith (ES) Infant Feeding Co-ordinator

(0) Learning Presentation
177/15 UNICEF Accreditation: “The Baby Friendly Initiative – Action
Promoting Health and Wellbeing for All Babies”

Kim Bilsby, Locality Manager, East & South and Elaine Smith,
Infant Feeding Co-ordinator, presented on the above
accreditation programme for which HCT had completed stage
one of three (of a three year programme) in July 2015.

The presentation covered:

• Breastfeeding – Reducing the Risks and cost savings
for the NHS
• Breastfeeding and Parenting
• Breastfeeding rates
• National Drivers
• The Baby Friendly Initiative Standards and Health

Visiting Standards

• Key Themes

• The Assessment Process

• Where are we now and what are we doing

• Integrated Working

It was noted that:

(i) There is a lot of additional information on the UNICEF
website
(ii) Stage 1 is “Building a Firm Foundation”, Stage 2 is
“An Educated Workforce and Stage 3 is “Parent
Experience”.
(iii) HCT is aiming to complete Stage 2 by July 2016
and the work required to train both professional and
non-clinical support staff is well on track
(iv) The programme is high profile nationally for health
visitors and is also an HCT quality priority

Observations and Questions from the Board:

(a) The national breastfeeding rate drops off at 6 months
after birth to only 1%. It is difficult to identify reasons
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Board: 28th January 2016 Attachment A1

for the low rate, but contributory factors would include
extensive marketing of breast milk substitutes and
discomfort / inconvenience factors associated with
breast feeding/return to work.

(b) The same parental ethos is applied for those who
can’t or prefer not to breastfeed as for those who do,
eg the importance of bonding and touch.

(c) The health visiting service works widely with many
other NHS and non NHS organisations in taking
forward the programme. This includes the County
Council, children’s centres, GPs, midwives /
community midwives and The National Childbirth
Trust

(d) Giving messages “early” about the advantages of
breast feeding is advantageous in improving rates. For
example, through ante-natal clinics.

(e) A key part of the programme is standardising
messages and information, which is variable across
organisations and the County.

(f) Efforts are made to reach families in deprived areas
and younger mothers, where rates of breast feeding
tend to be lower.

(g) Desired goals and outcomes are identified as part of
the quality priority, but more can be done to promote
outcomes achieved.

The Chair thanked KB and ES for the informative
presentation and expressed appreciation for all the good
work that has been put in to date.

(A) Preliminaries & Board Governance Action
178/15 Welcome, Introductions and Apologies

DO’F welcomed those present.

Apologies were received from Brenda Griffiths, Non-
Executive Director (Designate) and Caroline Allum, Medical
Director.

179/15 Chair’s / CEO’s Announcements & Notice of Urgent
Business

Temporary Cover Arrangements for Caroline Allum,
Medical Director.
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Board: 28th January 2016 Attachment A1

It was reported that Caroline Allum (CA), Medical Director,
was on long term sickness absence and that cover
arrangements had been identified pending her return. This
included cover for core statutory /regulatory functions such
as Caldicott Guardian and Responsible Officer.

It was noted that:

(i) Some of these roles had required notification of the
acting officer’s details to external bodies.
(ii) The TDA had approved the interim arrangements, but
if CA’s absence proved to be longer than currently
anticipated, then the Trust may need to revisit the
arrangements.

Decision(s), Outcome(s) and Actions:

(1) The Board ratified the temporary cover arrangements
for Caroline Allum’s statutory / regulatory roles.

180/15 Members’ Declarations of Interest Relating to Business
on the Agenda / For the Register of Interests
No declarations.
181/15 Ratification of items of Chair’s and Chief Executive’s
Action taken since the last meeting under Standing
Order 5.2

The Board ratified the Chair’s approval on behalf of the
Board made under Standing Order 5.2 to enter a contract
made following a full tender process, with Abbott
Laboratories, for provision of enteral feeds. This contract had
been reported and discussed previously at SRC.

182/15 Minutes of the Meeting held on 17th September 2015

The minutes of the meeting held on 17th September 2015
were agreed as a correct record subject to:

p.9 (a) Delete: “eluded to”; Insert “alluded to”.

183/15 Matters Arising from the Minutes of the Meeting Held on
th
17 September 2015 (Board Tracker)

It was noted that:

81/15: Looking at “wider impacts” as factors contributing to
pressure ulcers was a work in progress using root
cause analysis (RCA) tools and, to allow time for
enough data to be collected, will be considered by
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Board: 28th January 2016 Attachment A1

HGC in March 2016.

There were no matters arising not otherwise included on the
Tracker.

(B) Clinical Services & Healthcare Governance
184/15 Director of Quality & Governance / Chief Nurse’s Report
(CH)

The Director of Quality & Governance / Chief Nurse’s Report
for November 2015 was received and discussed.

Items reported on were:

(1) Executive Summary

• Limited assurance on delivery of the CQC quality
improvement plan with progress update due for
completion by November 20th.
• Internal quality assurance visit planned for The Mount
on November 11th. Following this assessment of
progress against delivery of the CQC action plan will
be made.
• HCT continues to work to the Board agreed staffing
ratios in its inpatient units
• Implementation of nurse revalidation on track.
• Improvements noted at Herts and Essex hospital

inpatient unit.
• PLACE action plan underway and planning for the

next assessment is in hand.

• Risk remains in relation to the impact of the LMC

recommendation that GPs do not authorise HCT

medicines administration charts.

• Friends and family test results are at 97% against a

target of 90%. All school health programme

measures were achieved in the 2014/15 school year.

• As of November children’s safeguarding training

(levels 1, 2 and 3) are achieving the revised target of

95%.

(2) Current Performance:

• Friends and family test results are at 97% against a

target of 90%. All school health programme measures

were achieved in the 2014/15 school year. As of

November children’s safeguarding training (levels 1, 2

and 3) are achieving the revised target of 95%

• One C Difficile case was reported in September. Root

cause analysis is underway.

• A slight deterioration in harm free care relates to nine
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Board: 28th January 2016 Attachment A1

patients affected by catheter associated urinary tract
infection.

(3) Risks and Challenges

• Limited current assurance on delivery of the CQC
quality improvement plan with progress update due for
completion by November 20th.
• Internal quality assurance visit planned for The Mount
on November 11th. Following this assessment of
progress against delivery of the CQC action plan will
be made. A long term solution for GP service into The
Mount has not yet been found. This is escalated to the
Associate Director of Operations.
• Risk remains in relation to the impact of the LMC
recommendation that GPs do not authorise HCT
medicines administration charts.

(4) Supporting Papers

The following papers relevant to the DQ&G’s report
are in the supporting papers:

(i) Safe Staffing and Efficiency National Policy (letter
dated 13th October 2015)
(ii) Log of Complaints Received Qtr 2 2015/16

Challenge and Response to Board Questions

(a) Obtaining advice from the RCN, rather than the NMC
in respect of medicines administration in general
practice is relevant, as the RCN offers professional
advice to its members. However, the risk continues
and HCT is working with the LMC to try and find a
solution.

(b) At the HGC meeting this week there was discussion
about triangulating safe staffing data with other
metrics, to give a clearer picture of patient safety.
Work will be undertaken to evolve robust triangulation
by April 2016. The information as currently reported
in the IBPR will also need to be updated to reflect this.
(See also min 185/15 below).

(c) Good progress is being made with the numbers of CH
independent prescribers in the Trust, but CH will (Jan 16)
check whether (i) There is a target number and (ii)
There is a reasonable geographical spread of
providers.

(a) Major elements of concern at the Herts & Essex CH
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