A G E N D A - RBCH: The Royal Bournemouth and … · Eric Fisher Member of East Dorset Locality Health Network Group ... Dr Gail Thomas Bournemouth University ... Chris Ar David B

Council of Governors Meeting Agenda - Part 1 January 2015 Page 1 of 2

Meeting Name:

COUNCIL OF GOVERNORS

Chair:

JANE STICHBURY

Date: Thursday 22 January 2015

Time: 08:30

Venue: Conference Room

A G E N D A Item Item description Item presenter Appendix

1 Welcome Chair

2 Apologies for Absence Chair

3 Declaration of Interests Chair A

4 Approval of the Minutes of the Meeting held on 28 October 2014

Chair B

5 MATTERS ARISING 08:35 - 08:45

5.1 Actions Log from Minutes of the Meeting held on 28 October 2014

Chair C

6 STRATEGY 08:45 – 09:15

6.1 Developing the Trust’s Annual Plan 2015/16

Sandy Edington

Oral

6.2 Patient and Public Engagement Group (PPEG)

Eric Fisher D

7 PERFORMANCE 09:15 – 10:05

7.1 Workforce Report Karen Allman E

7.2 Quality Performance Report

Jo Sims F

BREAK 10:05 – 10:15

PERFORMANCE continue 10:15 – 11:05

7.3 Performance Report Richard Renaut

G

7.4 Financial Performance Pete

Papworth H

8 FOR INFORMATION 11:05 – 11:30

8.1 Events for Membership

David Triplow Oral

8.2 Website Task and Finish Group Bob Gee I

Council of Governors Meeting Agenda - Part 1 January 2015 Page 2 of 2

Item Item description Item presenter Appendix

8.3 Forward Planner Sarah Anderson

J

8.4 Governor Sub-Committee Meeting Reports Reporting Governors

K

8.4.1 Membership Development Committee (MDC) David Triplow

8.4.2 Governor Training Committee (GTC) David Bellamy (Interim)

8.4.3 Governor Involvement with Patient and Public Engagement Committee (GIPPE)

Glenys Brown

8.4.4 Governor Scrutiny Committee Part 2 item

8.5 Trust Sub-Committee Reports Reporting Governors

L

8.5.1 Carbon Management Committee Mike Allen 8.5.2 Charitable Funds Committee Graham

Swetman 8.5.3 Diversity Committee Vacancy 8.5.4 Editorial Group Various 8.5.5 End of Life Strategy Glenys

Brown 8.5.6 Governor Finance Briefing Group Graham

Swetman Eric Fisher

8.5.7 Healthcare Assurance Committee (HAC) Vacancies 8.5.8 Infection Prevention and Control Committee

(IPCC) Keith Mitchell

8.5.8 Organ Transplant Committee Dexter Perry 8.5.10 Patient Experience and Communications

Committee (PECC) Glenys Brown (GIPPE Chair) David Triplow (MDC Chair) Eric Fisher

8.5.11 Patient Information Group (PIG)

Keith Mitchell

8.5.12 Valuing Staff and Wellbeing Group

Keith Mitchell

8.6 Reports from Governors 8.6.1 Reports from Appointed Governors Appointed

Governors M

8.6.2 Report from Staff Governors

Staff Governors

N

8.6.3 Governor reports of activities outside the Trust All Governors O

9 DATE OF THE NEXT COUNCIL OF GOVERNORS MEETING

Tuesday 28 April 2015 08:30 Conference Room, Education Centre Royal Bournemouth Hospital

To resolve that under the provision of Section 1, Sub-Section 2, of the Public Bodies Admission to Meetings Act 1940, representatives of the press, members of the public and others not invited to attend be excluded on the grounds that publicity would prove prejudicial to the public interest by reason of the confidential nature of the business to be transacted.

Council of Governors Meeting

COG/Register of Governors Interests Page 1 of 2

THE ROYAL BOURNEMOUTH AND CHRISTCHURCH HOSPITALS NHS FOUNDATION TRUST

REGISTER OF GOVERNORS’ INTERESTS

as at 14 January 2015 The following Governors of The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust have declared interests as listed below: NAME/CONSTITUENCY

DECLARED INTEREST

ELECTED GOVERNORS Public: Bournemouth and Poole David Bellamy The Chairman of the Patient Panel of a local GP Group Glenys Brown None Carole Deas Partner – Roger Parsons, Public Governor Paul Higgs None Colin Pipe None Roger Parsons Partner – Carole Deas, Public Governor Keith Mitchell None David Triplow None Monika Whitmarsh None Public: Christchurch and Dorset County Chris Archibold Wife is a member of staff employed in the Orthopaedic

Department, based at the Royal Bournemouth Hospital Paul McMillan None Derek Chaffey Member of the Stanpit and Mudeford Residents’

Association Eric Fisher Member of East Dorset Locality Health Network Group (in a

personal capacity) which is arranged through the Dorset CCG

Member of the Patient and Public Engagement Group (PPEG) with Dorset CCG as part of the Clinical Services Review

Doreen Holford None Brian Young Consultant (salaried) for Immunotec Public: New Forest, Hampshire and Salisbury Mike Allen None Bob Gee None Graham Swetman Member of the Conservative Party

Director, Family Property Investment Companies Staff Medical and Dental Vacancy Dean Feegrade Administration, Clerical and Management

None

Ian Knox None

Council of Governors Meeting

COG/Register of Governors Interests Page 2 of 2

Allied Healthcare Professionals, Scientific and Technicians Nursing, Midwifery and Healthcare Assistants

Vacancy

Richard Owen Hotel Services and Estates

None

NOMINATED GOVERNORS Local Authority Governors John Adams Bournemouth Borough Council

Councillor Bournemouth Borough Council Member of the Conservative Party Chairman of the Dorset Police and Crime Panel

Colin Jamieson Dorset County Council

Elected member of Christchurch Borough Council Elected member of Dorset County Council Chairman of the Christchurch Planning Committee Chairman of the Dorset Health Scrutiny Committee Member of the Dorset Health and Wellbeing Board Member of the Cabinet of Dorset County Council (Public

Health and Communities Portfolio) Wife is a Constituency Agent for the Conservative Party Member of the Cabinet of Dorset County Council, with the

Public Health and Communities portfolio, as such I will have a seat on the Dorset Health and Wellbeing Board.

Phil Goodall Poole Borough Council

Councillor Poole Borough Council Member of Dorset Police and Crime Panel Director of Streetwise (West Howe)

Partnership Governors The Royal Bournemouth and Christchurch Hospitals Volunteers

Vacancy

Dr Gail Thomas Bournemouth University

None

Primary Care Trust Governors Dr Tom Knight CCG Dorset

General Practitioner Board Member of Dorset Clinical Commissioning Group (CCG)

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2

Mike Richardson, Facilities Manager Derek Dundas, Non- Executive Director Ian Metcalfe, Non-Executive Director Steven Peacock, Non- Executive Director Paul Stanley-Watts, Councillor, Bournemouth Borough Council Sue Bungey, Member of Public Sharon Carr-Brown, Public Member

MINUTES Action The meeting commenced: 10:00 14/57 Welcome JS welcomed everyone attending the meeting of the Council of

Governors.

14/58 Apologies for absence As listed above. 14/59 Declarations of interest None. 14/60 Approval of the minutes of the Meeting held 22 July 2014 The minutes were confirmed as an accurate record.

MATTERS ARISING 14/61 Actions Log from Minutes of the Meeting held on 22 July 2014 (14/49) Performance report- DB queried the readmission data that was

discussed by HL during the September Governor training and requested this was re-circulated. (14/49) Communication- KM noted the follow up regarding telephones on wards and requested a response to his query about communicating with relatives when patients are moved between wards on AMU.

DR

DP

QUALITY

14/62 CQC Visit Report- current position JS confirmed that the Trust had received the CQC report and were

providing feedback to the CQC therefore the report was not available to the public but would be circulated within the next few weeks. Further details would be provided once publicised but there were no new issues and no changes to the Trust’s position with the CQC. A more focused inspection would be due by August 2015.

PERFORMANCE 14/63 Quality Performance Report Harm free care- scoring had slightly decreased in month but the safety

thermometer tools were being used to focus on pressure damage and a steering group were managing actions around this. It was emphasised that the Trust was managing performance around key pressures and safety thermometer performance. Never events- one event was noted within minor surgery although the patient was not harmed. A full investigation was completed and the team presented follow up actions to the Board. Friends and Family Test- performance was maintained and there had


3

been an increase in compliance. The Emergency Department results were improving from the token system and within outpatient areas. New methodology and further guidance is to be introduced to obtain more narrative and qualitative data. Complaints- response times had improved and there is more focus on the quality of complaints handling and taking greater acknowledgement of what people are asking. Key areas of complaints were Medicine, Elderly care, Orthopaedics and some Surgery. The Trust was managing this and identifying any themes. Patients Association- working with focus groups to support and try and answer patient queries and concerns. Feedback from this is to be provided to PECC and monitored through HAC. DP queried why it had been defined as a never event if no harm had been sustained. EB responded that following discussions with the Governance Team, HAC, the CCG and Medical Director it agreed that the incident satisfied the definition. Further information to be provided on Serious Incidents to Governors. EF commended the use of the care campaign audit in driving actions through. He queried whether the Trust had implemented the Francis report requirement that the responsible clinician and lead nurse were shown for each patient as he noted that the patient boards were not always consistent. EB responded that there was still work to do as it was a new process but that the Trust were looking to rationalise whiteboards and the criteria to ensure the same structure is used throughout the Trust. CJ requested further information about patient opinions and complaints. EB responded that the data collected from patient choice and NHS England was reported into the Governance process although there is often no detail to identify specific areas. The Trust is ensuring that a response is provided and people are invited to contact the Trust/PALS to discuss and resolve any issues. Emails and electronic communications are also increasing to improve communication.

DR/EB

14/64 Performance Report RR reported on the Trust’s performance against the national

requirements for August:

62 day wait (predominantly for urology cancers)- an improved performance was sustained although this will remain at risk due to impact from national campaigns, patient choice and potential transfers from Dorchester;

Improvements had been made and there had been an increase in slots for 2 week Cancer waits;

Due to potential risks it is likely that the Trust will not reach the 62 day target for this quarter although it is planned to be back on track from January to March;

Robotic surgery operating has increased to aid with the volume of patients waiting and discussions are taking place with


4

Commissioners about template biopsies as a more efficient and less painful form of diagnostic test;

The Trust achieved 95% and narrowly missed compliance for the 4 hour target. Performance reflects the increased ambulance conveyances and other organisations are also struggling with this indicator;

Work is underway to alleviate some of the pressure within ED to improve patient flow and best practice for rapid assessment on arrival. There will be an increase in ambulatory clinics with some being GP lead;

Building work will be taking place where the discharge areas are situated to form an ED clinical area where patients will be fast tracked. Emergency trolley admissions can be transferred to a clinical setting earlier on with quicker access to pathways. There will also be a close easy drop off and pick up area for the discharge lounge.

BG queried the current numbers for robotic surgery. RR responded that specific numbers could be provided but these would be increasing due to additional patient transfers from Dorchester which will also increase year on year. EF queried the winter pressures plan and how it would be providing for the increase in capacity of respiratory and thoracic issues and the resources. Further he questioned whether the CCG rewarded the Trust for working with the community to reduce admissions. RR responded that the plan provided capacity for 12-15 additional beds and that over the next week the additional numbers would be confirmed. He emphasised that the Trust were conducting proactive work and education outside of Trust for respiratory conditions. He confirmed that the CCG do not reward the Trust for this work however it provides for a better service. CJ queried the cost associated with the Robot and the relationship with the CCG. RR responded that the robot was donated by charity and the cost paid by Commissioners was the same as traditional treatment although it is more beneficial to patients. CJ further questioned the 4 hour target and the definition of admissions and attendances. RR explained that an attendance concerned public arriving by foot and they should then be seen within 4 hours of attending and a decision made as to whether they are admitted. He added that by improving other services it would allow for alternatives for the ambulance services to use. JA queried the strategic alliance with Poole going forward due to patient treatment commencing at Bournemouth and continuing at Poole. RR confirmed that Radiotherapy treatments take place at Poole and operations at the Trust. The cancer target culminates breaches from both sites and is shared. GS queried the figures for the 62 day cancer target and the profiles behind the breakdown of the data. RR advised that the numbers were small but that it was often those patients on pathways within the diagnostic phase where breaches often occurred. RR added that he would be able to provide specific examples of the pathways and stages

RR


5

in order to understand the targets. It was emphasised that a large amount of patients require operations and the Trust aims to treat patients as soon as possible but a system needed to be created for speed of treatment taking into consideration the convenience of the patient.

18 week RTT target- working to clear the back log of patients already waiting and the Trust is making progress but concerns have been highlighted between January and March for in patients while dealing with emergency patients. There was a planned miss for this quarter as nationally all Trusts are working to clear inherent backlogs;

Non admitted outpatients were under considerable pressure with follow ups and there was a risk of missing the target from December to March and there are due to be monthly updates to the Board.

RR

14/65 Financial Performance PP outlined the report to 31 August 2014 highlighting that the increased

pressures had impacted upon the financial position. The planned deficit for month five was £600,000 which formed part of the full year deficit of £1.9 million. This was the first year that the Trust had set a deficit plan and was in line with many other Foundation Trusts. For the five month position the Trust delivered £2.3 million which was significantly away from the plan however has resulted from the increase in activity and reflects the national shortage for medical and nursing staff. The Trust did not deliver the cost improvement programme and as such a financial recovery plan has been put in place with weekly meetings to ensure directorates have support in delivering the improvement programme. The forecast will not be achieved in full but it will be a greatly improved position in light of the increased pressures and activity. Work is currently underway to explore why staff are leaving to aid with further recruitment. The junior doctor rotation has improved the position in elderly care. It was noted that not all plans were backed by the CCG and the new winter ward would therefore add to the Trust’s deficit position but will ensure the hospital is safe. The CCG have highlighted that national funding may be available although confirmation is yet to be received. There is also a draft tariff package which will be received soon but the Trust will need to save 4% per year. National variances will continue and there is a possibility that organisations will be penalised for emergency readmissions. Subject to the final package there is an open door for moving away from nationally funded packages and this will be considered over the next few weeks. The Council discussed the sharing of risk between commissioners and providers and raised concerns that this will de -incentivise Trusts. It was also noted that moving away from Tariffs for elderly patients would be beneficial. RP commented on the Tariff system and penalisation for readmissions.


6

He raised concerns that the CCG give undue favouritism to Trusts in deficit rather than those in surplus. PP advised that there was no additional funding and Trusts were bound by the national tariff and that it was not in the Trusts’ favour and this highlighted concerns. DB queried the use of locums and the impact upon the deficit and whether now that the Trust had employed more staff it had improved the position. PP responded that agency reliance continues but winter pressures would require more staff which would be at a premium. The Junior doctor rotation had reduced reliance on locums and was encouraged that the trend would move in the right direction once the winter pressures had been dealt with. TK suggested that Dorset needed to have a better healthcare position and wanted Governors to be aware of the Clinical Service Review and the impact this would have upon the Trust. PP advised that in terms of the overall approach of the review that the implications would be significant. It was proposed that a briefing was held for Governors on the purpose and impact of the Clinical Service Review.

RR

14/66 Workforce Report KA advised the Council of Governors that the position remained

challenging although the Trust had recruited a large number of staff particular within overseas nursing. The Trust are looking at other campaigns to further increase recruitment such as overseas Consultants who are NHS trained and returning to the United Kingdom. The figures reflected the position for August and the data for the next few months was being processed and would include starters and leavers. The Trust is currently following up with staff who are leaving with EXIT questionnaires and a piece of work will be brought to the Board in order to understand the reasons. Mandatory training and the assessment of competency levels are to become an individual electronic process. The new education and training structure is hoped to be more positive and increase clinical education amongst staff. The use of the simulation suite has increased with more staff engagement and within ward areas. The Trust is working to improve the development of staff, their progression and introducing new leaders through the ‘Time to lead’ programme, which has received good feedback. There has also been an increase in the ways in which the Trust recognises staff and their hard work as it is important to engage, listen and communicate. The recent tea party for staff and for volunteers was highlighted and the staff awards that took place in November. It was emphasised that different ways to recruit are being identified to fulfil the vacant roles and those that will be required for the future. It was noted that it will be important to redesign the strategy in light of the impact upon finances.

GB queried the recruitment from Bournemouth University. KA advised


7

that applications were being made across the country and that the Trust may not have been the preferred choice. The Trust is ensuring that they are providing good support and giving the best experience while students were training at the Trust. KA commented on upcoming recruitment events and stands at careers events across the country. There is also work underway to develop a role for apprentices by joining up locally with other organisations and to structure a training. EF welcomed the report and was encouraged by the development in encouraging people to stay and work at the Trust by developing roles. He queried the comparison of turnover with other trusts. KA responded that it was lower but that the template change had masked turnover. DT advised that the Trust was developing plans to encourage younger people in careers with the NHS and queried why the Trust had not attended the recent Poole Careers event. KA added that she would look into this as an option in the future and emphasised that work experience was occurring although it had not been coordinated at present. JA commented on Ward 26 and queried the previous issue with staffing. KA advised that the figures for the elderly care wards were challenging and remained difficult to retain staff in this area. The Trust is considering incentives and training with a rotation to improve retention. JS confirmed mitigation was completed to ensure all wards were up to template. CA commented on appraisal compliance being below target and queried whether there were regular meetings with managers to pick up on themes. KA advised that a recent audit had been completed and a system was being developed to ensure appraisals are more meaningful and this to be implemented in April. It was acknowledged that feedback was fundamental and that performance is discussed with staff. The Annual staff survey reflected that the value of appraisals were low and this is what the Trust is also focused on improving. JS added that this was an issue that has featured amongst staff governor’s feedback and will be discussed at Board. CJ commended queried the ramifications for mandatory training non compliance. KA responded that there are a variety of areas of compliance and the new approach would feature core skills with a new platform which will be implemented in March and it is hoped the new programme will have a positive impact on compliance. DP added highlighted the importance of a balance between training and compliance. KA outlined that under the new programme competency would be assessed and would require less time and training would be flagged accordingly. JS suggested that a seminar session was held for Governors regarding staff training, the appraisal process and the Trusts’ workforce strategy going forward.

DR/KA

14/67 PLACE Report MR advised that the report reflected an audit that focused on the hospital

and the environment and the data was collected during February and


8

March 2014. In general the results were better compared to last year and every area audited had improved with the exception of the condition of Christchurch hospital and the food at Bournemouth. The report highlighted some issues within Medicine for the elderly and dusting which reflected difficulties with resourcing and accessing wards for deep cleaning. This was reported to BCC and a bid was placed this month for frequent public toilet cleaning which has been recognised as an area to improve upon. The food results at Bournemouth had not been positive and were low compared to the national average. It was noted that the Hostess on the particular ward was new and had not been provided with adequate support. KM queried whether water coolers would be more feasible for elderly wards. MR added that this was dependent upon individual ward budgets and maybe something the Board should discuss. JS encouraged that this should be actioned and prioritised. EF questioned whether there were any themes identified from the walk- arounds and audits as a form of independent evidence supporting the targets going forward. MR confirmed that this occurs and that the Trust constantly audit information which is also fed back to the IPCC. It was acknowledged that external consultants were looking at cost and quality and where savings could be made to redirect funds into clinical areas. JS added that Executives and management had been very responsive on this point as it is representative of the Trust. PG commented that disabled toilets needed to be made bigger for scooter access and MR noted this for future reference. GB commented on a particular ward that scored low for appearance, maintenance and privacy and dignity. She requested assurance whether this had been dealt with. MR advised that this concerned flooring and RR added that the difficult areas to reach have been a priority and the next areas for refurbishment would be ward 4 and 5 next year. MR added that the data was old but that the actions had been completed. A final report would be provided highlighting any outstanding actions and it was noted that the information is reviewed through the committees.

MR

FOR DECISION 14/68 Council of Governors Meetings and Training dates of 2015

JS requested the Council response to support for the proposed dates. The Council agreed the dates.

14/69 Council of Governor 2015 meetings time of day EF outlined the paper highlighting that meetings were interactive and

constructive however were too long. He requested the Councils thoughts as to adapting the times in light of Governors’ commitments. DB highlighted that many Governors were able to attend Board meetings


9

at 8:30am and suggested meetings should encompass two short breaks in the morning terminating at lunch time. Governors discussed that Poole meetings were often held in the evenings and would be an option for one meeting although it was noted that Executive attendance may be difficult. In contrast it was highlighted that this may attract more public and younger members. The Council of Governors confirmed that it was not favourable for the meetings to begin at 4pm. It was agreed by consensus of a mandate to change the meeting times to 8:30am.

14/70 Governor Involvement with Patient and Public Engagement (GIPPE) Terms of Reference

GB commented that the terms of reference had been changed 12 months ago when the group was altered to encompass public engagement. One of the changes included the frequency of meetings to quarterly under the rationale that this would enable the group to complete surveys. The reports would then be fed to the Patient Engagement and Communications Committee whereas previously they took place before PECC verbally and this reporting will give opportunity to present a paper. GB added that additional paper discussed progress made in the last year and it was discussed that a review would be provided. There has been a lot of engagement from the public through many of the methods and the paper highlights the triangulation of these surveys. JS requested the Councils agreement of the changes to the terms of reference and the Council agreed.

14/71 Governor Scrutiny Committee update from previous reports including:

Discharge Letters Hospital at Night Food and Nutrition

EB summarised the update noting that the scrutiny outcomes were not available but progress was being made.

Food and nutrition: out of 8 points raised these have all been achieved;

Education and support for the MUST score is being managed and is reported through the Healthcare assurance committee. The Trust has significantly improved upon compliance in the completion of risk assessment and food ordered on same day/ hot food with a changeover to tray delivery system also;

Patients who require help are assessed and are monitored through a steering group. Audits had been conducted and the Trust achieved 100% but this must remain consistent;

Meal times- dedicated members of staff with ward hostesses and ward sisters work together to ensure meals are delivered;

Hand cleaning- wipes are available before and after meals and work is underway to ensure that these are offered and monitored


10

through observational audits and patient engagement; Urine bottles and commodes to be cleaned more regularly- bottle

holders have been ordered to fit on the side of beds and distributed accordingly. Commodes now have a clear structure for cleaning;

Better communication around food nutrition and abbreviations have now been rationalised and are available on patient television with hostess support with choices;

Nutrition and patient meals- reported through nutrition steering group. Actions have been achieved and some have been closed and some will continue to be monitored.

SE presented to the Council on the topic of discharges: The Trust had reviewed the content of letters and are sending

more electronically to GP practices within 24 hours of discharge. This will then be followed up with paper copies but the Trust is pushing towards a 100% electronic process;

Issue with acronyms by junior medical staff and the Trust is working to educate upon induction and will continue to work with Juniors on this point;

Acronyms between specialities are not understood and a glossary is being considered to be published on the website;

Patient notification of death- a structure is being put in place electronically to be followed up with GPs by telephone to speed up the process. The Trust is also developing a system to notify GPs of cancellations so that another appointment can be made;

Best practice and content of acronyms- tests are often undertaken and commenced in hospital with results being received after discharge and the Trust is working to ensure that these are managed internally with GPs being notified of results;

Letters have been more defined with better content and receiving feedback from GPs about fit notes to be issued as part of the discharge summary;

Electronic discharge summaries are to also include pharmacy information with a list of drugs and whether the GP should continue to prescribe particular drugs/the rationale for changing any medication;

More changes are to be made and the process is under continual development such as DNRs and elevating communications to GPS which will be available in April.

DB commented that it was reassuring that the scrutiny recommendations were impacting upon changes within the Trust. Further he added that subsequent surveys about food after surgery remained difficult and helping patients to order food on screen needed to be considered. DB queried the hospital at night survey and that staff weren’t able to access food at night and result. EB added that night shifts begin at 7pm and catering have engaged arrangements for restaurant to stay open until 8pm and orders could be made to access food but it will not be open through the night. TK commented that electronic summaries and paper information did not coincide with electronic information and this was not completely reliable. He was encouraged by further GP involvement and emphasised that


11

senior clinicians should be more involved if there are difficulties engaging junior doctors. He suggested that the prescribing of drugs could be improved by ambulatory care plans. SE commented that this was an IT issue and had been noted. KM added proposed extending ward hostesses in the evenings to help with meal times. He questioned whether enough was done to encourage people to eat and whether this was being monitored. EB advised that ward hostesses and the staffing review on the acuity wards was being reviewed. In terms of monitoring the food that patients eat and this is monitored through intervention and prescribed charts are completed with clear guidance on process. Relatives ordering food is something that is being implemented within the culture of the Trust and work with ward sisters and hostesses is being supported to ensure needs are met. A drinks availability list has been issued with times for up to 7 drink rounds a day along with the availability of water. An audit is due to be completed on this area. PH questioned the discharge of patients and whether anything could be done to expedite discharge and when patients are aware of this. EB advised a project was underway concerning the structure of the day and the completion of paperwork. DC questioned whether there was a facility for a GP to advise about transport and if it is required within discharge letters. EB responded that these issues are picked up on separately. JS added that the items outstanding should be identified and that a paper had not been provided for decision. The slides from the presentation were to be attached to outstanding points and identified from the update. RR added that the water coolers had been offered to every ward 2 years ago and will write to every ward to request whether each sister required these on their wards. The Council of Governors received the update.

EB

FOR INFORMATION 14/72 Clinical Service Review and Better Together RR outlined the Clinical Services Review and its aim to consider the

healthcare across Dorset making in sustainable for the future. The company Mckinseys had been appointed by the CCG to implement the review and it was confirmed that there was widespread patient engagement and the Trust will encourage the team to engage with Governors and voluntary groups. Initial reviews will be due by next summer following the election for a blueprint model for healthcare services. TK added that the review was looking to the future and highlighted the website ‘Dorset Vision’. It was highlighted that the CCG budget was being used for the review in order to consider how the remaining budget should be used. DT proposed that this should be a training item for

DR


12

Governors.

14/73 Trust Secretary Appointment The item was noted for information. 14/74 Forward Planner The item was noted for information. 14/75 Governor Sub- Committee Meeting Reports

Membership Development Committee (MDC)

Governor Training Committee (GTC)

Governor Involvement with Patient and Public Engagement Committee (GIPPE)

Governor Scrutiny Committee

The reports were taken as read.

Trust Sub- Committee Reports GT suggested an update at the next meeting from Bournemouth

University and graduate recruitment. CJ added that that appointed governors as DCC had provided a public health paper for Governors information.

GT

Reports from Governors 14/76 Reports from Appointed Governors The reports were noted. 14/77 Report from Staff Governors The reports were noted. 14/78 Governor reports of activities outside the Trust The reports were noted. 14/79 Date of the next Council of Governors Meeting

Next meeting to be held on 22 January 2015 at 08:30am Conference Room, Education Centre Royal Bournemouth Hospital

Concluded at 13:17

To resolve that under the provision of Section 1, Sub-Section 2, of the Public Bodies Admission to Meetings Act 1940, representatives of the press, members of the public and others not invited to attend be excluded on the grounds that publicity would prove prejudicial to the public interest by reason of the confidential nature of the business to be transacted.

Council of Governors Meeting – Part 1 22 January 2015

__________________________________________________________________________________________________________________ PAGE 1 OF 2


Actions carried forward from a meeting of the Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust Council of Governors Part 1 held on 28 October 2014.

14/61 Actions Log from Minutes of the Meeting held on 28 October 2014

(14/49) Performance report- DB queried the data that was presented by HL during the September Governor training and requested this was circulated. (14/49) Communication- KM noted the follow up regarding telephones on wards and requested a response to his query about communicating with relatives when patients are moved between wards on AMU.

DP

DP

Completed

Completed

PERFORMANCE

14/63 Quality Performance Report

Further information would be provided on Serious Incidents to Governors.

EB/DR

Training given to Governors on 4 December 2014

14/64 Performance Report

BG queried the current numbers for the robotic surgery. RR added that he would provide specific numbers but would be increasing numbers and patients from Dorchester will have impact and year on year will increase and trajectory.

RR 110 in last 12 months. Predicted to be more than 150 in next 12 months, which would comply with minimum numbers

14/65 Financial Performance

It was proposed that a briefing was held for Governors on the purpose and impact of the Clinical Service Review.

RR Tony Spotswood has provided the briefing and this will be on-going


__________________________________________________________________________________________________________________ PAGE 2 OF 2

14/66 Workforce Report

JS suggested that a seminar session was held for Governors regarding staff training, the appraisal process and the Trusts’ workforce strategy going forward.

KA Been added to the Governor training schedule

14/67 PLACE Report

DH added that the results had been disappointing concerning food on Ward 17 and everything else was of a good standard. She highlighted one member of staff who was not given sufficient support or training. JS confirmed that comments would be obtained from the Director of Nursing and reassurance provided that this had been addressed.

PS/JS Completed

14/71 Governor Scrutiny Committee update from previous reports including: Discharge Letters, Hospital at Night, Food and Nutrition

JS added that the items outstanding should be identified and that a paper had not been provided for decision. The slides from the presentation were to be attached to outstanding points and identified from the update.

Slides were circulated to Governors following the meeting

14/72 Clinical Services Review

DT proposed that the CSR should be a training item for Governors. DR See 14/65 comment

14/73 Trust Sub- Committee Reports

GT suggested an update at the next meeting from Bournemouth University and graduate recruitment.

GT Completed - see Appendix N


Meeting Date and Part:

22 January 2015 – Part 1

Subject:

Clinical Services Review (CSR) - Public Engagement Process

Section:

Strategy

Author of Paper:

Eric Fisher

Details of previous discussion and/or dissemination:

Dorset Clinical Commissioning Group

Key Purpose: Patient Engagement

Governance Performance Strategy

X X

Action Required by Council of Governors:

For information

Summary:

Key Decisions/Discussions/Actions

Strategic Goals & Objectives:

Links to CQC Registration: (Outcome reference)

N/A


CLINICAL SERVICES REVIEW (CSR) - PUBLIC ENGAGEMENT PROCESS Governor: Eric Fisher (and member of the CCG CSR Patient & Public Engagement Group - PPEG) Meeting Dates: December and January 2015 Key Decisions/Discussions/Actions

1. The Dorset Clinical Commissioning Group (CCG), which is the organisation responsible for commissioning most NHS services in Dorset, is undertaking a review of health care in Dorset with the aim to ensure that everybody in the county has access to safe, high-quality, effective and affordable health services now and into the long-term.

2. The evidence shows that most patients currently receive good care in Dorset, but there is too much variation, both against national (and international) standards and within Dorset itself. In addition, our population is changing and getting older, bringing new health demands which need to be met. And the money to secure healthcare for local people isn’t increasing at the same rate as rising costs and demand.

3. Over 120 people attended public engagement events in December 2014 and three have been planned in January 2015 in Sherborne, Weymouth and Poole.

4. Those taking place in January 2015 are to consider the Need for Change – a document which can be accessed on the www.dorsetsvision.nhs.uk. This summarises the current picture of healthcare in Dorset based on the evidence gathered as part of the Clinical Services Review (CSR). The evidence has been reviewed by over 100 doctors, nurses, other clinicians and health leaders. This material has been drawn from published sources, and insight from provider organisations (including the Royal Bournemouth & Christchurch Hospitals NHS Foundation Trust), other key stakeholders and patients and the public.

5. The first stage of the review was to look at all the evidence about NHS health care in Dorset giving a detailed picture of what is working well and where performance needs to be improved. Now the clinicians have started the task of coming up with models of good clinical care. What does good care look like? What would need to happen to ensure that it is delivered consistently across Dorset? They are basing their discussions on the evidence gathered, including UK and international comparisons, and a wealth of patient and public insight and feedback. They will work on developing a set of options to be tested out with local people in a public consultation next summer.

6. The Dorset CCG has stressed their keenness for the Need for Change document to be seen by as many people as possible so please share it widely through your organisation or network. The views of patients, carers and the public are vital to the success of the review. At each stage of the CSR process clinicians, patients, the public and key stakeholders are being given


the opportunity to review and comment on the evidence which has been gathered and the developing thinking.

7. More public events are planned each month to provide the basis for options on differing models of care to be developed and further consulted upon before decisions can be made in Autumn2015.

8. Governors are encouraged to play their part in engaging in the CSR process and to use it as an opportunity to meet with public and organisations in our catchment area. It would be useful to share any feedback with Eric Fisher as a member of PPEG.




Subject: Workforce Report

Section: Performance

Author of Paper: Karen Allman


Board of Directors and Workforce Committee

Key Purpose:

Patient Engagement


X


For Noting.

Summary:

This report is a slight variation on that tabled at Board and shows Trust-wide figures for a range of workforce metrics. The report includes updates on recruitment, the staff retention project, together with detail around mandatory training compliance rates within the Trust.


To listen to, support, motivate and develop our staff


Outcomes 12, 13 & 14 - Staffing

Council of Governors: 22nd January 2015 – Workforce Report Page 1

WORKFORCE REPORT This report contains information concerning the progress with recruitment and gives some more context and detail around compliance regarding mandatory training in particular and the steps being taken to improve these areas. 1. Workforce Data as at 31 October 2014

The monthly workforce data is shown below, both by care group and category of staff. Trust targets of 90% appraisal compliance and 3% sickness absence have been set and performance has been RAG rated against these targets.

Care Group

Appraisal Compliance

Mandatory Training

Compliance

Sickness Absence

Joining Rate

Turnover Vacancy Rate (from ESR)

At 31 Oct Rolling 12 months to 31 Oct At 31 Oct

Surgical 68.5% 77.2% 4.23% 12.0% 10.8% 4.3%

Medical 73.0% 78.7% 3.41% 18.8% 11.5% 3.4%

Specialities 72.1% 77.4% 3.80% 10.3% 10.1% 2.1%

Corporate 76.3% 83.5% 4.08% 13.5% 13.1% 5.2%

Trustwide 72.4% 78.9% 3.83% 14.1% 11.3% 3.7%

Staff Group

Appraisal Compliance

Mandatory Training

Compliance

Sickness Absence

Joining Rate

Turnover Vacancy Rate (from ESR)

At 31 Oct Rolling 12 months to 31 Oct At 31 Oct

Add Prof Scientific and Technical

70.1% 83.8% 4.18% 8.8% 14.7% 5.4%

Additional Clinical Services

73.2% 79.5% 5.73% 21.4% 10.8% 6.4%

Administrative and Clerical

74.5% 81.9% 3.42% 15.0% 12.6% 4.3%

Allied Health Professionals

69.3% 84.6% 1.72% 13.9% 12.8% 1.3%

Estates and Ancillary 80.1% 85.0% 6.20% 10.1% 14.6% 4.3%

Healthcare Scientists 62.9% 87.5% 3.71% 9.7% 12.9% 5.9%

Medical and Dental 66.9% 51.6% 1.05% 8.1% 7.2% 0.1%

Nursing and Midwifery Registered

71.5% 83.0% 3.85% 12.6% 9.7% 3.1%

Trustwide 72.4% 78.9% 3.83% 14.1% 11.3% 3.7%


The charts show that Trust-wide appraisal compliance, mandatory training and sickness absence have been fairly static since last month. Reports to directorates and care groups highlighting areas of poor compliance have already been sent. The vacancy rate fell again during October from 4.4% in September to 3.7%. The joining rate continues to exceeds or match the turnover percentage across the Care Groups and corporate areas demonstrating the considerable work undertaken to recruit staff.

2. Medical Staff Recruitment

The overseas recruitment of consultants continues; two doctors from Singapore who had previously been interviewed via video link for posts in E.D. and Orthopaedics visited the hospital on 3 & 4 November. They met some of the Executive team, spent time in the respective departments and visited in and around Bournemouth to look at housing and schools. Unfortunately they have now decided that the time is not right for them to relocate their family at this time. A candidate from Australia was also interviewed via video link and visited the Trust on 19 December. This applicant was also planning to move to Bournemouth; however for family reasons they have also decided to stay where they are. Another doctor from Australia, who is interested in Emergency Medicine, visited the hospital on 29/30 December and again it is hoped this candidate will take up a consultant post in 2015. Whilst it is disappointing that we have yet to formally recruit consultant staff from overseas we continue with our programme to secure appropriate medical staff for the Trust. We have been successful in appointing a consultant in Acute Medicine and a further AAC (Consultant Appointment process) is scheduled for the 5th February with a strong field of applicants for an additional post.

3. Recruitment and Retention

The campaigns for recruiting qualified nursing staff and Health Care Assistants (HCAs) continue. A schedule of HCA recruitment events has been drawn up and these will be continuing in 2015. Due to the success of such events Nurse Recruitment days are also being considered. There are plans for the Trust to be represented at a number of recruitment events during 2015 which includes University and Healthcare fares, conferences etc. This will involve attending events around the country and supporting information marketing opportunities at the Trust and providing comprehensive information. There is a recruitment fair at the Westfield Shopping centre in London on 6th / 7th February which the Trust will attend and has wide representation, and hopes to recruit qualified nurses, therapy staff and other staff groups.


Accommodation and car parking is being reviewed as part of the strategy to attract and retain staff. An incentive payment is to be trialled to the nursing staff who work on older people’s wards. This incentive aims to attract and retain staff on the wards where there are the highest numbers of vacancies. A “refer a friend” incentive scheme is also being considered and relocation expenses are being reviewed as well. An overseas task and finish group has been set up to make proposals for any future overseas recruitment campaigns. A collaborative working group with local recruitment leads from other Trusts has been set up to discuss joint overseas recruitment initiatives and other careers and recruitment events. Additional task and finish groups on retention, work experience and car parking have also been established.

Staff Retention Project A specific project to identify reasons for staff leaving the Trust between August and October was established. 98 staff were identified as potential interviewees and were contacted initially by telephone. 32 leavers were interviewed in the end and they came from a mixture of clinical and non-clinical backgrounds. Of these - 9 people left to move to further education and they gave mainly positive comments about the Trust: “My team encouraged me to complete further education” and “I was supported and grew in confidence whilst working at RBH” In addition there were some concerns expressed about staff car parking and poor staffing levels. 4 people moved for promotion and these all said that they has experienced a positive working environment although one Occupational Therapist said that beds were an “on-going challenge”. A radiographer left citing lack of career progression, and a Personal Assistant left for a higher salary and a less pressurised role from this group. 7 people left citing personal reasons and all 7 gave positive feedback 10 people gave negative reasons for leaving the Trust. These include:

Poor communication and teamwork Inflexibility regarding hours of work Lack of training and development opportunities

3 members of staff have since returned to the Trust and all unsurprisingly speak positively about the organisation.


The workforce committee will be reviewing the detailed outputs from the project at the meeting on the 8th December. Information will also be shared as appropriate ensuring confidentiality with care groups and individual directorates and a similar independent review will take place again in the spring. Data from all available sources of information regarding staff views and concerns will also be triangulated and inform our future work plans. 4. Update on staff survey

The staff survey closed on the 1 December 2014 and the Trust final response rate was 48.5%.The national range as at 25 November was 24.3% to 60% and two reminders were sent by the Picker Institute directly to employees who received the questionnaire. Regular e-mails were also been sent to senior managers, detailing response rates for their area and requesting that they remind staff to complete questionnaires. A number of reminders to staff also appeared in the weekly communications round-up and a “have your say” screensaver was produced and displayed. Nationally there is a trend for lower response rates and this has been suggested that this is because of the number of other staff surveys that have taken place this year including the Friends and Family Test for staff. The national staff survey results will not be available until February/ March 2015.

5. Safe Staffing

The final Safe Staffing Unify return for October 2014 showed a total Trust aggregate fill rate of registered nurses in the day of 93.8% and at night a 101.1%. The aggregate fill rate of healthcare assistants is 94.8% in the day and 112.9% at night.

RN Actual HCA Actual

Day 93.8% 94.8%

Night 101.1% 112.9%

Areas which were below 90% for registered nurse fill rate on day duty were;

AMU, Stroke ward, Surgical Admissions Unit, ward 1, ward 21 and ward 24. These areas were only just below 90% and were all mitigated at a local level.

Ward 9 (Orthopaedics): the template requires refinement. The position is much

more favourable than reported from e-roster as the actual number of patients is lower than the number of patients the staffing template is set for.

No areas were below 90% for the registered nurse fill rate on night duty.

There were 5 wards across care groups where the HCA fill rate was lower than

90% in the day. These ward areas had RN fill rate higher than 90% with the exception of SAU.


There are 7 ward areas across surgery and the older people’s wards where over 100% usage of HCAs existed during the night shifts. This is due to clinical acuity, falls prevention and specials. This is being reviewed within the Care Group and has elevated the overall aggregate to 112.9%.

All areas were appropriately risk mitigated. Staffing is reviewed daily by the

Matron workforce with localised assessment and decisions on use of temporary workforce, skill sets required and staff

Staffing for the additional bed capacity A structured procurement process has succeeded in the Trust proceeding with a block booking contract and the block booked agency nurses received induction with the Trust on 1st December 2014. They have been allocated to the workplace and have had a tour and introduction with the Matron or Sister of the area. Some of the individuals have worked in the Trust before, and all commented on how welcome they have felt at the induction session on the 2nd December.

6. Mandatory Training – Essential Core Skills and Appraisal Compliance

The current Trust target for Mandatory Training is 95%. This is historic and was set based on NHSLA (NHS Litigation Authority) recommendations. A recent study by Skills for Health, reports that the best performing Trusts consistently achieve above 80% compliance rates and are working towards 90% compliance. Our overall Trust compliance rate was 78.6% in November 2014. This compliance is split into two categories - Trust and National Core skills . The subjects listed under National Core Skills are all part of the UK Core Skills Training Framework (UKCSTF).

Competency x Month Apr‐14

May‐14

Jun‐14 Jul‐14 Aug‐14

Sep‐14

Oct‐14 Nov‐14

National Core Skills 76.4% 76.3% 76.4% 76.8% 77.1% 76.6% 76.1% 75.7%

Conflict Resolution 48.0% 48.3% 49.9% 51.2% 53.7% 57.0% 57.1% 58.7%

Diversity 48.2% 49.5% 51.4% 55.1% 54.2% 53.3% 54.8% 54.4%

Fire Safety 83.8% 83.9% 84.7% 84.9% 85.6% 84.9% 84.5% 84.3%

Health and Safety 84.6% 84.6% 84.2% 84.6% 85.5% 84.9% 84.3% 83.7%

Infection Control 83.5% 83.3% 82.9% 83.2% 84.2% 83.7% 84.9% 85.5%

Information Governance 72.7% 70.5% 67.6% 66.2% 64.8% 62.0% 58.5% 55.6%

Manual Handling 81.1% 80.5% 81.1% 81.8% 83.4% 83.3% 83.6% 82.6%

Resus (BLS/ILS) 70.8% 70.5% 71.1% 72.1% 70.8% 71.0% 71.9% 71.6%

Safeguarding Adults 86.4% 86.1% 86.2% 86.2% 87.2% 87.1% 86.3% 86.3%

Safeguarding Children 85.5% 85.9% 85.8% 85.4% 84.9% 83.9% 82.1% 82.4%

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86.8% 8

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83.8% 8

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88.4% 8

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2.8% 60.4%

7.0% 87.9%

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0.0% 81.9%

4.3% 85.6%

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8.8% 78.6%

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Page 6

83.2% 83.

64.6% 66

86.6% 86

84.3% 84

82.0% 81

85.1% 85

83.6% 83

77.6% 78

81.2% 81

89.0% 88

78.9% 78

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Competency by Staff Group

Add Prof Scientific and

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Additional Clinical Services

Administrative and Clerical

Allied

Health Professionals

Estates and Ancillary

Healthcare Scien

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Med

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Nursing and M

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for the period: Nov ‐14

National Core Skills 78% 78% 78% 85% 81% 82% 47% 79% Conflict Resolution 28% 52% 68% 76% 68% n/a n/a 58% Diversity 61% 53% 58% 67% 63% 66% 49% 48% Fire Safety 94% 89% 84% 94% 90% 84% 44% 92% Health and Safety 90% 87% 85% 91% 90% 88% 43% 92% Infection Control 90% 89% 84% 94% 90% 89% 55% 92% Information Governance 46% 58% 59% 62% 55% 68% 25% 62% Manual Handling 87% 83% 83% 86% 91% 81% 64% 85% Resus (BLS/ILS) 84% 85% 0% 87% 100% n/a 25% 76% Safeguarding Adults 90% 86% 84% 92% 90% 88% 68% 91% Safeguarding Children 86% 86% 86% 93% 90% 89% 46% 89%

Trust Mandatory Training 88% 85% 87% 83% 92% 90% 55% 89%

Blood Transfusion 58% 64% n/a 50% 76% n/a 61% 70% Bullying & Harassment 93% 91% 90% 90% 94% 92% 44% 93% Falls Awareness n/a 85% n/a 77% n/a n/a n/a 85% Medicine Management 100% n/a n/a n/a n/a n/a 67% 87% Security & Counter Fraud 90% 86% 85% 84% 92% 89% 58% 91% Sharps 90% 87% 84% 85% 90% 89% 43% 92% Tissue Viability 100% 87% n/a 80% n/a n/a 34% 91% Venous Thromboembolism 81% 83% n/a 59% n/a n/a 62% 90% Violence & Aggression 93% 89% 87% 91% 94% 89% 68% 94%

Overall Compliance 82% 80% 81% 84% 85% 84% 50% 83%


Medical and Dental staff compliance remain low and have a detrimental effect on overall staff compliance. The Board will be aware that the a new Virtual Learning Environment is currently being developed and is due to go live in March and this will support the delivery of essential core skills training and assessment at a time that suits the individual. This training can be accessed off site through a tablet, PC or other mobile device and should have a significant impact on the levels of compliance. Doctor revalidation and appraisal also support the need to be up to date with mandatory training. The revised process will also ensure that competency and knowledge is assessed rather than an individual receiving a credit for attending a training session.

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20%

30%

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Current Overall Competency by Staff Group


Meeting Date and Part: 22 January 2015 Part 1

Subject: Quality Report – October 14


Executive Director with overall responsibility

Paula Shobbrook, Director of Nursing and Midwifery

Author(s): Ellen Bull, Deputy Director of Nursing and Midwifery Joanne Sims, Associate Director Quality & Risk

Action required: The CoG is asked to note the report which is provided for information. Summary: This report provides a summary of information on patient safety and patient experience indicators for October 2014 including: Patient safety incidents

4 Serious incidents were reported on STEIS in October 2014,

Safety thermometer The ST data is 89.05% harm free care. This represents a slight decrease from last month. Patient experience Trust wide FFT remains consistent. The Trust FFT is 76 and the response rate is 18.7%, a reduction on last month. This is due to the implementation of the new system in the emergency department and AMU. Related Strategic Goals/ Objectives:

All

Relevant CQC Outcome: All Risk Profile:

i. Have any risks been reduced? No

ii. Have any risks been created? No

Reason paper is in Part 2 Not applicable

Quality & Patient Safety Performance Exception Report October 2014

1. Purpose of the Report This report accompanies the Quality/Patient Performance Dashboard and outlines the Trust’s performance exceptions against key quality indicators for patient safety and patient experience for the month of October 2014. This was presented to the Trust Board in December 2. Serious Incidents Four Serious Incidents were confirmed and reported on STEIS in October 2014. 3. Safety Thermometer All inpatient wards collect the monthly Safety Thermometer “Harm Free Care” data. The survey, undertaken for all inpatients the first Wednesday of the month, records whether patients have had an inpatient fall within the last 72 hours, a hospital acquired category 2-4 pressure ulcer, a catheter related urinary tract infection and/or, a hospital acquired VTE. If a patient has not had any of these events they are determined to have had “harm free care”. The results for the October 2014 data collection are as follows:

NHS SAFETY THERMOMETER

13/14 Average

14/15 Target

May 2014

June 2014

July 2014

Aug 2014

Sept 14

Oct 14

Safety Thermometer %Harm Free Care

89.0% 95% 90.95%91.11%90.02%89.76% 92.15%89.05%

Safety Thermometer % Harm Free Care (New Harms only)

97.84%97.58% 97.6% 97.19% 96.9% 95.79%

Monthly survey using Safety Thermometer (Number of patients with Harm Free Care)

480 NA 421 451 450 445 444 420

Results are as follows: RBCH (%)

Sept 14 RBCH (%)

Oct 14 National Average

All Acute Hospital Wards ( Oct14)

Harm Free Care 92.15% 89.05% 93.87%

Pressure Ulcers – All 6.82% 9.47% 4.44%

Pressure Ulcers – New 2.27% 2.74% 1.03%

Falls with Harm 0.62% 0.42% 0.63%

Catheters and new UTIs 0.21% 0.84% 0.36%

New VTEs 0% 0.42% 0.44%

April 2014

May 2014

June 2014

July 2014

Aug 2014

Sep 2014

Oct 14

Number of patients surveyed

490 464 495 501 498 484 475

Falls with Harm

2 0 3 4 0 3 2

New Pressure Ulcers

11 8 4 6 9 11 13

New VTE

1 1 2 0 1 0 2

New Catheter UTI

2 1 3 2 4 1 3

4. Risk Assessment Compliance Compliance continues to be reviewed by ward sisters and matrons and formally audited monthly. May

2014 June 2014

July 2014

Aug 14 Sep 14 Oct 2014

Risk assessment compliance Falls 92% 91% 91% 88% 91% 91% Waterlow 96% 95% 96% 94% 96% 96% MUST 88% 88% 89% 90% 91% 87% Mobility 91% 91% 93% 87% 90% 93% Bedrails 95% 93% 94% 90% 93% 95%

5. Patient Experience

FFT scores

FFT Score October (Sept) Compliance Rate October (Sept)

Trust wide (Inc. OPD) 76 (75) NA

All FFT Areas 75 (77) 19% (23%)

In- patient 81 (75) 43% (47%)

ED 66 (80) 8% (14%)

Maternity 68 (82) 17% (13%)

Having complied with the original NHS England directive and a CCG requirement, the refined methodology was implemented. Discussions with NHS England have confirmed that the directive to remove the tokens will not be withdrawn. The methodology replaces tokens with paper ‘bookmarks’. The ED areas that have struggled with the new methodology are now taking forward actions led by the Matrons (Claire Liggins and Alison Pressage) which also include additional volunteer support.

Staff have initiated action plans to improve the FFT compliance rates which in AMU has evidenced an increase in compliance from 23% (September) to 40% (October). Main ED reported challenges with staffing, number of patients admitted and the environmental changes taking place.

FFT themes

A total of 3,277 Patient Experience Cards have been returned this month, with total of 1797 (55%) having also completed written comments. Overall, comments are much improved and more positive about the hospital experience. Main themes for negative comments are poor communication especially with medics, waiting (for appointments, TTA`s, discharge) and perceived staff attitudes and availability. Ward moves at night resulting in disruption and lost property continue to feature. The table below evidences the breakdown of comments themes.

Positive Negative Mixed NA

1491 120 161 29

83% 7% 9% 2%

Extremely Unlikely results from FFT – October data

There have been 18 “extremely unlikely” to recommend from areas which are included in the FFT national submission. We collate all ‘extremely unlikely’ responses so that we can review the trend across the entire Trust. Extremely Unlikely Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14

Total Extremely Unlikely to recommend

40 19 30 40 44 32 25

No of returns 2547 2441 2299 2527 3278 3188 3277

% Extremely Unlikely to recommend

1.57% 0.78% 1.30% 1.58% 1.34% 1.00% 0.76%

The table provides a comparison using NHS England’s reporting system which has changed to using percentage of patients who would not recommend the Trust. The result is in line with our CQUIN target of 1.5% and evidences that there is consistent improvement.

6. Recommendation The Council of Governors is requested to receive the report which is provided for information.


Meeting Date and Part: 22 January 2015 - Part 1

Subject: Performance Report


Executive Director with overall responsibility Richard Renaut

Author(s): Donna Parker/David Mills

Previous discussion and/or dissemination: PMG & Board of Directors in December 2014

Action required: The Council of Governors is asked to consider the information provided and support any actions highlighted in relation to non-compliant or ‘at risk’ indicators.

Summary: The attached Performance Indicator Matrix and Exception Report outline the Trust’s performance exceptions against key access and performance targets for the month of October 2014.

It also incorporates an indicative RAG rating for expected performance in the following month based on internal monitoring to date, as well as an indication of Trust level risk in relation to the metrics over the quarter.

Key non compliances in October were:

Cancer 2 week wait for September performance including for breast symptomatic patients

62 and 31 day cancer targets in September, however, these are compliant for the full Q2

A&E 4 hour target, but in line with our trajectory agreed with the CCG

Admitted RTT at aggregate level and in General Surgery, Orthopaedics, Ophthalmology, Cardiology and Gynaecology – in line with planned breach to remove longer waiters

Non admitted RTT speciality level in ENT, Oral Surgery, General Surgery and General Medicine, though aggregate was maintained.

52 week waits (x1) on incomplete (unadjusted) pathways – patient treated in November and will unfortunately be reported as a 52 week waiter in November.

VTE slightly under threshold at 94.2%

Performance risks for the forthcoming month are:

C Difficile, we are within our Monitor trajectory year to date, but below our stretch target

Cancer 2ww (October reporting), however, our weekly run rate is on track for compliance

A&E 4 hour target

RTT admitted, non-admitted and incomplete pathways targets as per national RTT recovery plan

52 week waits due to increased RTT pathway pressures and patient choice

6 week wait to diagnostics due to endoscopy capacity

For Quarter 3 the key risks to the Trust remain:

Cancer 2ww including breast symptomatic, predominantly due to patient choice and capacity issues in specific specialities.

Cancer 31 and 62 day due to Urology treatments being carried out

A&E 4 hour wait - the higher level of ambulance conveyances has continued

RTT admitted, non admitted and incomplete pathway targets as per national RTT recovery plan of reducing long waiters and potential impact on 52 week waiters

These remain under close review and management.

Related Strategic Goals/ Objectives: Performance

Relevant CQC Outcome: Section 2 – Outcome 4: Care and welfare of people who use services. Outcome - 6 Co-operating with others.

Risk Profile: i. Risk assessments for the cancer 62 day wait non-compliance and potential risk to the trust’s

authorisation remains on the risk register despite Q1 and Q2 compliance, due to ongoing risks. ii. Risk assessment against the 4 hour target has been reviewed to reflect the increase in

ambulance conveyances and attendances and our continued non-compliance. iii. RTT speciality performance continues on the risk register with aggregate performance non-

compliance also now added, though this position is expected as part of the national RTT recovery plans.

iv. The urgent care impact risk assessment remains on the Trust Risk Register given the increased activity pressures, 4 hour non-compliance and other indicators such as the increase in outliers.

v. A risk assessment for the cancer two week wait target is being completed. vi. A risk assessment has been completed in relation to the RTT non admitted target compliance.

Council of Governors – Part 1 22 January 2015

Performance Monitoring Page 1 of 4 For Information

Performance Exception Report 2014/15 - December

1 Purpose of the Report This report accompanies the Performance Indicator Matrix and outlines the Trust’s performance exceptions against key access and performance targets for the month of October 2014, as set out in Everyone counts: Planning for Patients 2014/15, the Monitor Risk Assessment Framework and in our contracts. 2 Infection Control

Number of Hospital acquired C. Difficile and MRSA cases

For October, three cases of C. Difficile were reported on the Wards, bringing the financial year total to 10. Whilst this total is over the local cumulative target, we are still below the Monitor cumulative target (15). There have been no reported cases of MRSA. 3 Cancer Performance against Cancer Targets

Current indicative performance (unvalidated)

Key Performance Indicators Threshold Q2 14‐15 Sep‐14 Oct‐14 Nov‐14

2 weeks ‐ Maximum wait from GP 93% 78.2% 73.7% 80.6% 87.0%

2 week wait for symptomatic breast patients 93% 68.8% 61.5% 86.7% 88.5%

31 Day – 1st treatment 96% 96.1% 94.7% 96.5% 87.8%

31 Day – subsequent treatment ‐ Surgery 94% 95.5% 100.0% ‐ ‐

31 Day – subsequent treatment ‐ Others 98% 100.0% 100.0% 96.6% 95.0%

62 Day – 1st treatment 85% 87.1% 84.1% 83.9% 77.2%

62 day – Consultant upgrade (local target) 90% 50% 100% 100% 50%

62 day – screening patients 90% 96.4% 100.0% 92.3% 91.7%



As expected we continued to remain below the threshold against the overall and breast symptomatic Two Week Wait target for September and for Q2, predominantly as a result of patient choice. Previously reported capacity related breaches especially in Dermatology have now improved however, Quarter 3 performance remains challenging. Compliance was maintained against the 62 and 31 Day targets for Q2, although September performance was below threshold due to a number of Urology treatments being carried out. Current projections for Q3 do show a risk against the 62 Day and 31 Day targets due to Urology treatments. The 62 Day Screening to Treatment target continues to be monitored as there is a potential risk due to a late referral from another provider, patient choice and complex pathways. 4 A&E Performance 4 hour maximum waiting time – 95%

Whilst a very slight improvement was seen against the 4 hour target in October to 92.9% we remained below the 95% threshold. The on-going significant increase in ambulance conveyances continued: up 9% compared to the same period last year (August to October), with a 16.8% increase in non-elective admissions. Monthly performance for November is currently also at risk, as there has been a 10.1% increase in ED attendances for November (1st - 23rd) compared to the same period last year. Performance month to date is 93.78% and is in line with the trajectory indicated to commissioners. Task and Finish groups to review implementation of best practice have been established. Specific focus is on initial assessment (‘pit stop’ protocols) targeted to start in January, ‘see and treat’ for minors (start December), improved Resus capacity and flow, and faster diagnostics. We are currently in the process of recruiting middle grade doctors and consultants; it is hoped that these may be in post in January. We have trained a number of Majors Assisting Practitioners in ED to support the implementation of rapid assessment and further practitioners are commencing training. In addition, an ambulatory area is also being established within the department to improve patient flow. 5 VTE Risk assessment of hospital-related venous thromboembolism

For October, the VTE return was 94.2%, narrowly missing the target of 95%. Unfortunately staff absence did result in a slight reduction in monitoring of data inputting and outcomes in October and early November, however this has now been addressed



with medical staff, Matrons and Ward Leaders. An IT issue has been raised with regard to VTE input on Ward 1 which is also being addressed. 6 Cancelled Operations

Number of patients not offered a binding date within 28 days of cancellation

Unfortunately one patient was not given an operation date within 28 days during October. This patients’ procedure was originally cancelled on the 1st September as there was no bed available, and rebooked on the 4th September for an appointment on 3rd October. 7 52 Week Waiter (Incomplete Pathways) Zero tolerance of over 52 week waiters (Incomplete Pathways)

Unfortunately the General Surgery patient reported in September continued to be reportable in October as their treatment was carried out in November. 8 Admitted RTT – Aggregate and Specialty Level 90% of patients on an admitted pathway treated within 18 weeks

In line with the national requirement to work towards the reduction of waiting lists and long waiters, we were non-compliant on a planned basis with the Referral to Treatment Admitted aggregate target in October. In line with Monitors’ expectations for implementing the national plan, we reported a non-compliant position against the target for Quarter 2. Increased capacity both internally and outsourced has been funded nationally allowing us to work towards bringing down both our outpatient and surgical treatment times. The particular specialities which were below threshold in October were: General Surgery, Orthopaedics, Ophthalmology, Cardiology and Gynaecology. A focus on continuing to reduce long waiters continues in November in line with national guidance. We plan to return to aggregate compliance for Jan-Mar 2015. 9 Non-Admitted RTT - Specialty Level

95% of patients on a non-admitted pathway treated within 18 weeks



For October, whilst aggregate performance was compliant, a number of specialities were non-compliant and further work is underway to reduce outpatient waiting times. Oral Surgery improved to 91.0% though remained below threshold along with ENT, General Medicine and General Surgery. Work to move to the new recording system (PPW) is progressing. Pressure upon first outpatient appointment waiting times is being responded to by targeted extra clinics. 10 Recommendation

The Council of Governors is requested to note the performance exceptions to the Trust’s compliance with the 2014/15 Monitor Framework and ‘Everyone Counts’ planning guidance requirements.

2014/15 PERFORMANCE INDICATOR MATRIX FOR BOARD OF DIRECTORS

Area Indicator Measure Target Monitor Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14Forecast -

Next Month

Forecast -

Quarter

Monitor Governance Targets & Indicators

Infection Control Clostridium difficile Number of hospital acquired C. Difficile cases (25 2.1

pcm)2.1 0 1 2 2 3 1 3 > trajectory <= trajectory

RTT Admitted 18 weeks from GP referral to 1st

treatment – aggregate 90% 1.0 90.1% 90.1% 90.2% 88.7% 86.8% 86.2% 89.3% <90% >90%

RTT Non Admitted 18 weeks from GP referral to 1st treatment – aggregate 95% 1.0 98.1% 98.0% 98.7% 98.2% 97.4% 97.1% 96.4% <95% >95%

RTT Incomplete pathway Patients on an 18 week pathway awaiting treatment – aggregate 92% 1.0 95.1% 95.1% 94.9% 93.9% 94.1% 94.9% 95.1% <92% >92%

2 week wait From referral to to date first seen - all urgent referrals 93% 1.0 93.6% 95.7% 95.9% 88.7% 70.1% 73.7% <93% >93%

2 week wait From referral to to date first seen - for symptomatic breast patients 93% 1.0 100.0% 100.0% 100.0% 92.9% 20.0% 61.5% <93% >93%

31 day wait From diagnosis to first treatment 96% 1.0 95.4% 94.5% 91.6% 97.0% 96.7% 94.7% <96% >96%

31 day wait For second or subsequent treatment - Surgery 94% 1.0 94.4% 100.0% 93.8% 84.4% 100.0% 100.0% <94% >94%

31 day wait For second or subsequent treatment - anti cancer drug treatments 98% 1.0 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% <98% >98%

62 day wait For first treatment from urgent GP referral for suspected cancer 85% 1.0 80.7% 76.6% 81.7% 91.7% 84.6% 84.1% <85% >85%

62 day wait For first treatment from NHS cancer screening service referral 90% 1.0 86.4% 100.0% 94.4% 100.0% 90.5% 100.0% <90% >90%

A&E 4 hr maximum waiting time From arrival to admission / transfer / discharge (Type 1 & 2) 95% 1.0 94.4% 95.8% 95.8% 93.1% 95.9% 92.6% 92.9% <95% >95%

LD Patients with a learning disability Compliance with requirements regarding access to healthcare n/a 1.0 No Yes

Indicators within the Everyone Counts: Planning Guidance/ Key Contractual Priorities

MSA Mixed Sex Accommodation Minimise no. of patients breaching the mixed sex accommodation requirement n/a 0 0 0 0 0 0 0 0 0 0 > 0 0

Infection Control MRSA Bacteraemias Number of hospital acquired MRSA cases 0 0 0 0 0 0 0 0 1 0 0 >1 0

Cancer 62 day – Consultant upgrade Following a consultant’s decision to upgrade the patient priority * 90% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 50.0% 0.0% 100.0% < 90% >90%

VTE Venous Thromboembolism Risk assessment of hospital-related venous thromboembolism 95% 93.5% 95.3% 95.0% 95.3% 95.3% 95.0% 95.8% 95.0% 95.1% 94.2% <95% >95%

Diagnostics Six week diagnostic tests More than 99% of patients to wait less than 6 wks for a diagnostic test >99% 96.30% 99.00% 96.50% 99.4% 97.0% 99.30% 99.8% 99.8% 99.8% 99.8% <99% >99%

Admission via A&E No. of waits from decision to admit to admission over 12 hours 0 0 0 0 0 0 0 0 0 0 0 >1 0

Ambulance Handovers No. of breaches of the 30 minute handover standard tbc 19 17 24 15 46 25 52 37 33 75 tbc

Ambulance Handovers No. of breaches of the 60 minute handover standard tbc 13 4 11 13 14 9 4 9 9 13 tbc

28 day standard No. of patients not offered a binding date within 28 days of cancellation 0 2 0 1 0 0 0 1 0 0 1 >1 0

Urgent ops Cancelled for 2nd time No. of urgent operations cancelled for a second time 0 1 0 0 0 0 0 0 0 0 0 >1 0

Referral to Treatment 52 week waiters Zero tolerance of over 52 week waiters (Incomplete Pathways) 0 3 1 1 0 0 0 1 3 3 1 >1 0

RTT Admitted 100 - General Surgery 90% 85.1% 84.9% 85.8% 89.3% 86.9% 88.5% 80.7% 81.7% 81.8% 84.7% <90% >90%

RTT Admitted 101 - Urology 90% 91.8% 90.0% 91.8% 94.8% 92.0% 90.3% 87.0% 86.0% 91.4% 92.5% <90% >90%

RTT Admitted 110 - Orthopaedics 90% 89.6% 89.0% 90.3% 89.5% 89.9% 89.1% 89.8% 80.0% 76.9% 84.0% <90% >90%

RTT Admitted 130 - Ophthalmology 90% 85.4% 86.3% 83.9% 81.4% 84.2% 86.0% 84.7% 82.9% 84.6% 83.2% <90% >90%

RTT Admitted 300 - General medicine 90% 99.7% 99.7% 99.7% 99.7% 98.7% 99.1% 98.7% 98.3% 99.7% 99.4% <90% >90%

RTT Admitted 320 - Cardiology 90% 93.8% 91.3% 92.0% 91.0% 92.1% 91.4% 93.3% 92.3% 91.0% 89.3% <90% >90%

RTT Admitted 330 - Dermatology 90% 90.2% 91.2% 93.4% 95.9% 91.5% 91.9% 95.6% 94.9% 87.7% 91.7% <90% >90%

RTT Admitted 410 - Rheumatology 90% 96.9% 100.0% 100.0% 97.4% 95.1% 97.7% 97.1% 90.9% 88.9% 98.1% <90% >90%

RTT Admitted 502 - Gynaecology 90% 91.3% 88.7% 88.4% 80.7% 93.0% 86.7% 89.9% 84.9% 79.5% 85.7% <90% >90%

RTT Admitted Other 90% 97.3% 98.6% 99.3% 98.1% 98.1% 97.4% 100.0% 98.8% 98.7% 99.4% <90% >90%

RTT Non admitted 100 - General Surgery 95% 95.3% 95.0% 99.3% 96.5% 98.5% 96.6% 96.4% 95.2% 95.7% 90.9% <95% >95%

RTT Non admitted 101 - Urology 95% 99.2% 99.1% 99.6% 98.1% 99.1% 98.7% 99.1% 99.5% 97.4% 99.5% <95% >95%

RTT Non admitted 110 - Orthopaedics 95% 98.8% 97.6% 98.7% 99.4% 99.2% 97.8% 100.0% 97.8% 97.8% 96.7% <95% >95%

RTT Non admitted 120 - ENT 95% 95.2% 95.4% 95.1% 95.2% 95.8% 95.0% 95.2% 91.9% 93.0% 92.6% <95% >95%

RTT Non admitted 130 - Ophthalmology 95% 100.0% 99.4% 99.6% 99.5% 100.0% 100.0% 99.7% 99.7% 99.7% 100.0% <95% >95%

RTT Non admitted 140 - Oral surgery 95% 96.2% 97.4% 97.3% 97.4% 95.6% 96.8% 92.1% 86.4% 86.6% 91.0% <95% >95%

RTT Non admitted 300 - General medicine 95% 95.3% 95.2% 97.6% 97.6% 98.6% 95.9% 96.9% 96.3% 95.1% 93.3% <95% >95%

RTT Non admitted 320 - Cardiology 95% 98.2% 97.8% 97.0% 98.3% 97.8% 100.0% 99.5% 97.3% 97.8% 95.8% <95% >95%

RTT Non admitted 330 - Dermatology 95% 100.0% 99.6% 99.7% 100.0% 100.0% 97.9% 99.4% 100.0% 100.0% 100.0% <95% >95%

RTT Non admitted 340 - Thoracic medicine 95% 100.0% 100.0% 100.0% 100.0% 100.0% 99.0% 100.0% 100.0% 98.7% 97.5% <95% >95%

RTT Non admitted 400 - Neurology 95% 100.0% 100.0% 100.0% 98.5% 100.0% 96.5% 100.0% 97.9% 98.5% 97.4% <95% >95%

RTT Non admitted 410 - Rheumatology 95% 99.0% 98.4% 97.2% 97.7% 98.3% 99.0% 97.7% 96.6% 97.5% 95.9% <95% >95%

RTT Non admitted 502 - Gynaecology 95% 99.0% 98.9% 98.5% 99.4% 99.4% 98.6% 99.1% 100.0% 97.7% 98.3% <95% >95%

RTT Non admitted Other 95% 98.0% 97.1% 100.0% 99.6% 99.3% 98.0% 98.9% 97.8% 98.5% 98.8% <95% >95%

NHS Number Compliance Completion of NHS Numbers in SUS Submission (IPS/OPS) 99% N/A N/A N/A 100% 100% 100% 100% 99.8% tbc <99% >99%

NHS Number Compliance Completion of NHS Numbers in SUS A&E Submissions 95% N/A N/A N/A 98% 98% 97% 97% 96.8% tbc <95% >95%

* Local standard of 90% with a de minimis of 2 breaches per month or 6 per quarter

100.0%

94.5%

95.0%

98.5%

97.6%

90.1%

SUS Submissions

RAG Thresholds

Referral to Treatment

Cancer

A&E

Cancelled Operations

RTT Specialty

1

90.4%

90.5%

82.4%

100.0%

96.3%


Meeting Date and Part: 22 January 2015 – Part 1

Subject: Financial Performance


Executive Director with overall responsibility

Stuart Hunter, Director of Finance

Author(s): Pete Papworth, Deputy Director of Finance

Previous discussion and/or dissemination:

Finance Committee, Trust Management Board and Board of Directors

Members are asked to note the report for information. Summary: The activity and demand pressures faced by the trust continued during October, with non- elective activity 16% above planned levels and emergency department attendances 5% above planned levels. This continues the pressures seen in previous years and this year to date, and brings the year to date activity increases to 13% for non-elective activity and 7% for emergency department attendances. This level of additional demand continues to have a significant impact on the financial performance of the Trust. At 31 October, the year to date budget was for a net surplus of £0.4 million, against which the Trust has reported an actual deficit of £1.9 million. This represents an adverse variance of £2.4 million. Income has overachieved by £1.1 million year to date, driven by additional cost and volume drugs, aseptic drug issues recharged to Poole Hospital, and additional CCG income in recognition of the premium agency pressures the Trust is facing due to the national shortage of trained medical and nursing professionals. Expenditure reported an over spend of £727,000 during October, bringing the year to date over spend to £3.5 million. This has been driven by:

Activity pressures, particularly in relation to emergency activity for which the Trust only receives 30% of the national tariff price;

Significant additional pay costs as a result of continued reliance upon locum and agency staff;

Additional cost and volume drugs, most notably within oncology and which are recharged directly to Commissioners;

Drug issues in relation to the Aseptic unit, which have been recharged to Poole Hospital.

The Trusts’ variance to budget is illustrated at Care Group level below, which highlights the

impact of the demand and recruitment pressures within the Medical Care Group particularly.

(3,000)(2,500)(2,000)(1,500)(1,000) (500) 0 500 1,000 1,500

Corporate Services

Specialties Care Group

Medical Care Group

Surgical Care Group

TOTAL TRUST WIDE

The adverse expenditure position has reduced the Trust Continuity of Services Risk Rating to a rating of 3. Given the considerable adverse variance reported to date; a financial recovery plan has been developed and approved by the Board. In addition to targeting further Improvement Programme Savings; this focuses on reducing the Trusts expenditure on expensive medical and nursing agency staff. A re-forecast position has been requested by Monitor, given the predicted £5.2 million deficit, which exceeds the planned deficit for the year originally of £1.9 million. The Trust is currently working towards securing 2015-16 Improvement programme savings and identifying further sustainable delivery plans. Related Strategic Goals/ Objectives:

Goal 7 – Financial Stability

Relevant CQC Outcome: Outcome 26 – Financial Position Risk Profile: No new risks have been added to the Trust risk register, and none have been removed or reduced.

ANNEX A

2013/14YTD ACTUAL PLAN ACTUAL VARIANCE VARIANCE PLAN ACTUAL VARIANCE VARIANCE

£'000 £'000 £'000 £'000 % £'000 £'000 £'000 %

NET SURPLUS/ (DEFICIT) 2,136 424 (1,934) (2,358) (556%) 997 564 (434) (43%)

EBITDA 9,326 8,392 6,185 (2,207) (26%) 2,069 1,677 (392) (19%)

TRANSFORMATION PROGRAMME 4,784 4,055 3,370 (685) (17%) 461 461 0 0%

CAPITAL EXPENDITURE 4,027 8,545 9,004 459 5% 1,048 1,507 459 44%


NUMBER NUMBER NUMBER NUMBER % NUMBER NUMBER NUMBER %

Elective 39,122 39,388 40,048 660 2% 6,082 6,105 23 0% Outpatients 166,282 198,907 196,227 (2,680) (1%) 30,703 29,945 (758) (2%)Non Elective 16,393 17,012 19,238 2,226 13% 2,442 2,832 390 16% Emergency Department Attendances 50,333 49,299 52,932 3,633 7% 7,061 7,415 354 5% TOTAL PbR ACTIVITY 272,130 304,606 308,445 3,839 1% 46,288 46,297 9 0%


£'000 £'000 £'000 £'000 % £'000 £'000 £'000 %

Elective 42,553 40,869 41,357 488 1% 6,309 6,415 106 2% Outpatients 18,461 18,871 18,842 (29) (0%) 2,913 2,907 (7) (0%)Non Elective 30,119 31,829 32,173 344 1% 4,611 4,621 11 0% Emergency Department Attendances 4,584 4,979 5,058 79 2% 713 726 13 2% Non PbR 39,628 40,815 39,844 (970) (2%) 6,249 6,128 (121) (2%)Non Contracted 14,054 14,464 15,599 1,135 8% 2,138 2,422 283 13% Research 1,131 1,070 1,131 61 6% 153 162 9 6% Interest 87 88 87 (2) (2%) 14 12 (2) (12%)TOTAL INCOME 150,617 152,985 154,091 1,105 1% 23,100 23,393 293 1%


£'000 £'000 £'000 £'000 % £'000 £'000 £'000 %

Pay 88,344 92,760 94,552 (1,792) (2%) 13,205 13,586 (381) (3%)Clinical Supplies 19,981 20,331 20,742 (411) (2%) 3,035 3,082 (46) (2%)Drugs 14,965 16,266 16,743 (476) (3%) 2,468 2,394 74 3% Other Non Pay Expenditure 16,734 13,596 14,306 (710) (5%) 2,058 2,429 (371) (18%)Research 970 1,074 1,134 (61) (6%) 156 165 (9) (6%)Depreciation 4,849 5,513 5,497 16 0% 788 772 16 2% PDC Dividends Payable 2,639 3,022 3,051 (29) (1%) 393 403 (10) (3%)TOTAL EXPENDITURE 148,481 152,562 156,025 (3,463) (2%) 22,102 22,829 (727) (3%)

2013/14YTD ACTUAL PLAN ACTUAL VARIANCE VARIANCE

£'000 £'000 £'000 £'000 %

Non Current Assets 144,431 163,430 163,241 (189) (0%)Current Assets 70,345 70,437 70,227 (210) (0%)Current Liabilities (26,519) (27,679) (27,952) (273) 1% Non Current Liabilities (2,563) (11,710) (11,888) (178) 2% TOTAL ASSETS EMPLOYED 185,694 194,478 193,628 (850) (0%)

Public Dividend Capital 78,674 78,674 79,063 389 0% Revaluation Reserve 64,485 72,999 72,999 0 0% Income and Expenditure Reserve 42,535 42,805 41,566 (1,239) (3%)TOTAL TAXPAYERS EQUITY 185,694 194,478 193,628 (850) (0%)

2013/14YTD ACTUAL PLAN ACTUAL RISK WEIGHTED

METRIC METRIC METRIC RATING RATING

Debt Service Cover 3.30x 2.72x 1.91x 3 1Liquidity 58.5 52.2 52.3 4 2CONTINUITY OF SERVICE RISK RATING 4 3

CONTINUITY OF SERVICE RISK RATINGCURRENT YEAR TO DATE

ACTIVITYCURRENT YEAR TO DATE

INCOMECURRENT YEAR TO DATE

EXPENDITURECURRENT YEAR TO DATE IN MONTH

CURRENT YEAR TO DATEKEY FINANCIALS

STATEMENT OF FINANCIAL POSITIONCURRENT YEAR TO DATE


FINANCIAL PERFORMANCE FOR THE PERIOD TO 31 OCTOBER 2014

IN MONTH

IN MONTH

IN MONTH




Subject:

Web Development

Section:

For Information

Author of Paper:

Bob Gee and Eric Fisher


Web Development Task and Finish Group



X X X X


Note for information

Summary:

Key Decisions/Discussions/Actions


WEB DEVELOPMENT TASK & FINISH GOUP Meeting Date: 8 January 2015 Governors: Bob Gee & Eric Fisher Key Decisions/Discussions/Actions

1. Set up by the Trust last Summer to revamp the RBCH web site with two governors included via Membership development committee

2. The new homepage is now quicker and visual with FAQs, videos, links, thank you options and updating of Departments information with gaps filled in as part of a Trust wide programme. A slides presentation which goes into this in more detail will be sent to Governors separately.

3. This has been achieved in house by an innovative, enthusiastic and expert ICT group – well overseen by a proactive Communications and input from governors providing the means for easier updating for the future.

4. We have seen increased hits on the web site and improved

5. This was the last meeting of the Task & Finish Group but plans are in place to continue the improvements to the site and especially to a Patient & Visitors Section

6. Bob Gee will continue to act as the Governor link if anyone spots any area needing correction/updating and he will then pass this on to enable an updates in a joined up way rather a more disruptive piecemeal approach

7. A short video is to be prepared for the web site on the importance of membership to the Foundation Trust with an interview with a couple of Governors building upon a “storyboard” which is being developed by Bob Gee. Another on the role of governors will then be produced.

8. Governors are encouraged to ensure that their profile statements are complete and kept up to date and to let BG know of any suggested changes to the web site.




Subject:

Forward Planner

Section:

For Information

Author of Paper:

Sarah Anderson


None



X X


Note for information

Summary:

Copy of the Council of Governors Forward Programme



N/A

Council of Governors Forward Programme 2015

What Who Where Before Jan Apr May Jul Sept Nov Where After

Annual Plan

Annual Plan - Draft for Public Consultation RR TMB Part 2 BoD

Annual Plan - Feedback from Consultation to COG RR TMB Part 2 BoD

Annual Report & Accounts

Annual Report & Accounts First Draft SH BoD Part 2 BoD

Annual Report & Accounts - Final draft presented SH BoD & Audit Cttee Part 2 Monitor/Parliament

Quality

Inpatient Survey Results PS BoD N/A

Outpatient Survey Results PS BoD N/A

Quality Performance Report PS BoD

Significant Risk Report PS BoD Part 2 Part 2 Part 2 Part 2 N/A

PLACE Inspection PS HAC N/A

Quality Accounts - First Draft PS Clinical Governance Part 2 N/A

Quality Accounts - Final Draft presented PS Clinical Governance Part 2 Publication

Election Results

Deputy Chair Election DR N/A N/A

Public Governor Election DR N/A AMM

Infection Control

Infection Control - Annual Report PS BoD N/A

Constitutional Documents

Constitution Trust Sec Constitution Grp/BoD Monitor

Standing Orders Trust Sec Constitution Grp/BoD Monitor

Membership Development Strategy DT MDC BoD

Policy on Composition of COG Trust Sec N/A N/A

Policy on NED Composition Trust Sec NED RemCo BoD

Governance

Register of Interests Trust Sec Trust Secretary File

Meeting Dates for Next Year Trust Sec Trust Secretary N/A

Forward Programme Trust Sec Trust Secretary N/A

Actions Matrix Trust Sec Trust Secretary N/A

Annual Members' Meeting Trust Sec MDC 23 N/A

Governor Attendance Trust Sec NED RemCom Part 2 Part 2 Part 2 Part 2 N/A

Governor Budget Trust Sec Trust Secretary Part 2 Part 2 Part 2 Part 2 N/A

Reports from COG Committees/Groups

Constitution Joint Working Group Trust Sec N/A N/A

Governor Induction and Training Committee SB N/A N/A

Governor Involvement with Patient and Public Engagement Committee GB N/A N/A

Membership Development Committee DT N/A N/A

Nomination Committee JS N/A N/A

Non-Executive Director Remuneration Committee DD N/A Part 2 Part 2 Part 2 Part 2 N/A

Governor Scrutiny Committee SCB N/A N/A

Reports from Trust-led Committees/Groups

Carbon Management Committee MAll N/A N/A

Charitable Funds Committee GS N/A N/A

Diversity Committee Vacancy N/A N/A

Editorial Group Various N/A N/A

End of Life Strategy Group GB N/A N/A

Finance Briefing Group GS/EF/Vac N/A N/A

Healthcare Assurance Committee Vacancy N/A N/A

Infection Control KM N/A N/A

Organ Transplant Committee DP N/A N/A

Patient Engagement and Communications Committee EF/GB/DT N/A N/A

Patient Information Group (PIG) KM N/A N/A

Valuing Staff and Wellbeing KM N/A N/A

Performance Reporting

Financial Reporting SH BoD N/A

Performance Reporting RR BoD N/A

Governors' Work Programme Chairs Relevant Committees BoD

Non-Executive Director Role NEDs N/A Part 2 Part 2 Part 2 Part 2 N/A

Review Performance & Terms of Reference of Subordinate Committees

and Groups

Constitution Joint Working Group Trust Sec N/A N/A

Governor Training Committee Vacancy N/A N/A

Governor Involvement and Patient and Public Engagement Committee GB N/A N/A

Membership Development Committee DT N/A N/A

Nomination Committee JS N/A N/A

Non-Executive Director Remuneration Committee Vacancy N/A N/A

Governor Scrutiny Committee Vacancy N/A N/A

General Reports

SWGEN All N/A N/A

Outside the Trust engagements All N/A N/A

Staff

Staff Survey KA BoD N/A




Subject:

Governor Sub-Committee Meetings Report

Section:

For Information

Author of Paper:

Representatives of the Trust Committees/Groups


None


Patient Engagement

Patient Engagement

Patient Engagement

X X X X


To note

Summary:

Key Decisions/Discussions/Actions from committee meetings held during the past quarter


N/A


N/A

Council of Governors Meeting Part 1 22 January 2015

Governor Sub-Committee Meeting Reports Page 1 of 4

GOVERNOR SUB-COMMITTEE MEETINGS REPORTS

October 2014 – January 2015

MEMBERSHIP DEVELOPMENT COMMITTEE (MDC) Chair: David Triplow Meeting Dates: 5 November 2014 and 7 January 2015 Key Committee Decisions/Discussions

1. Various talks have been organised in constituencies for 2015. Full details later. 2. We need to gain more21to 60 year olds, Dave to talk to all governors about getting us to local events. 3. An e mail about careers to be sent to under21 year olds on a monthly basis. We need to update governors video on

recruitment 4. We updated terms of reference, had feedback from Web development group and Equality and Diversity meting

Activities and Events in Previous Quarter Description Date Attendance and Outcome Many careers conventions , October/November Including Avonbourne, Harewood, Bournemouth Boys and Girls, Talbot Heath, Ringwood and Purbeck

Encouraging young people to aim for a career in the NHS and also gaining new members. Thanks for the help of governors

Careers in schools day 10th November Nearly 100 students and many representatives from parts of the hospital. Brilliantly organised by Dily and thanks for help from governors.

Talk in West Hants Club 22 October Over 50 people attended Future Activities and Events Description Date Location Opportunities for Governors to be Involved* Parkstone Careers Convention 4 March 2015 Parkstone

Grammar School Yes

*Please contact Governor Co-ordinator if you are interested in getting involved in a particular event



GOVERNOR TRAINING COMMITTEE (GTC) Interim Chair: David Bellamy Meeting Date[s]: [DATE] Key Committee Decisions/Discussions

1. Arrange programmes for future Governor training and education. Teaching sessions will take place two monthly. Departmental tours are also to be arranged.

2. Discuss the format for the next Board / Governor Away day

3. Assess feedback from Governors of previous educational sessions and consider suggestions made by them for future topics of learning.

4. The committee agreed to meet every two months. The election of a new chair will take place at the next committee meeting once new Governors have been appointed with the current elections.

Activities and Events in Previous Quarter Description Date Attendance and Outcome Training October 22nd 2013

Alison Ashmore gave a very good overview of the out patient department. Dr Krishnan provided a stimulating presentation of aspects of the gastroenterology department which received the high acclaim of 100% excellent in Governor assessments. Finally Richard Ford gave us an update of what was happening to car parking. Overall the meeting was very well received.

Training December 4th 2013 Kelly Spaven Matron for acute medicine, gave an inspirational talk about AMU and ambulatory care in the ED. .Joanne Sims gave us a clear presentation on what serious incidents are and Vanessa Mason talked about the Working Together programme.

Away Day November 20th The day was centred on Strategy both from the CCG – the Clinical Services Review- and the forward plan from the Trust. Future plans are far reaching and likely to incur major changes to the local Health service. Small group sessions allowed everyone to express some viewpoints.



Future Activities and Events Description Date Location Opportunities for Governors to be

Involved* Building Professional Relations January 14th and 15th Post Grad Centre This is a very interactive course to help

Governors with communication with the public, patients and staff.

*Please contact Governor Co-ordinator if you are interested in getting involved in a particular event



GOVERNOR INVOLVEMENT with PATIENT and PUBLIC ENGAGEMENT (GIPPE) Chair: Glenys Brown Meeting Date: 7 November 2014 Key Committee Decisions/Discussions

1. Key messages from the patients surveys taken to PECC 2. Forward Plan of the Committee

Activities and Events in Previous Quarter Description Date Attendance and Outcome Stakeholder event November 2014 See separate report Future Activities and Events Description Date Location Opportunities for Governors to be

Involved* Relative and Carers Audit TBC Christchurch Hospital Yes *Please contact Governor Co-ordinator if you are interested in getting involved in a particular event




Subject:

Trust Committee / Group reports

Section:

For Information

Author of Paper:

Representatives of the Trust Committees/Groups


Trust Committee / Group reports


Patient Engagement

Patient Engagement

Patient Engagement

X X X X


To note

Summary:

Key Decisions/Discussions/Actions points from committee meetings held during the past quarter


N/A


N/A


Trust Committee Meeting Reports Page 1 of 5

TRUST COMMITTEE MEETING REPORTS October 2014 – January 2015

CARBON MANAGEMENT COMMITTEE Governor Representatives: Mike Allen Meeting Dates: 25 November 2014 Key Decisions/Discussions/Actions

1. Consideration of updating Terms of Reference 2. Future activities that could be included 3. Green Impact progressing 1 Silver, 4 Bronze and more departments 4. Degree days to be considered

CHARITABLE FUNDS COMMITTEE Governor Representatives: Graham Swetman Meeting Dates: 21 November 2014 Key Decisions/Discussions/Actions

1. The draft Charity Strategy was discussed prior to presentation to the December Board of Directors

2. Of the total funds of £5.1million, it was noted that about £2.4 million had already been committed for Jigsaw Building running costs.

3. Approvals were given for the Alter G treadmill machine, and the use of £290K of Christchurch charitable funds for equipment for the development.

4. Plans to rationalise the various charitable funds were discussed, largely to bring the funds into line with organisation changes.

DIVERSITY COMMITTEE Governor Representative: Vacancy Meeting Dates: No Governor attended, therefore no report this quarter



EDITORIAL GROUP Governor Representative: Mike Allen, Dean Feegrade, Bob Gee, David Bellamy, Doreen Holford and Vacancy Meeting Dates: 7 January 2015 Key Decisions/Discussions/Actions

1. Theme – Life in the Hospital 2. JS introduction

Dates for your diary News stories and news in brief You said, We did Focus on feature – Pain management A day in the life – Bob Gee, Governor Day in the life – Career path Governor page

END OF LIFE STRATEGY GROUP Governor Representatives: Glenys Brown Meeting Dates: 14 November, 27 November, 12 December 2014 Key Decisions/Discussions/Actions

1. A review of the Bereavement Service at Christchurch Hospital has taken place. Report with recommendations is included with the COG papers

2. Discharging of End of Life patients to a setting outside an acute hospital continues to be a problem given the shortage of appropriate beds in the community.

3. The implementation of an electronic palliative care co-ordination system continues to be an IT challenge, meanwhile this poses a risk for effective service delivery.

4. All consultants are expected to take part in the advanced communication programme as part of compassionate care training. All remaining staff will have this aspect of care delivery as part of mandatory training. Funding of this remains an issue.



GOVERNOR FINANCE BRIEFING GROUP Governors: Graham Swetman; Eric Fisher, Vacancy Paul McMillan (as observer) Meeting Date: 25 November 2014 Key Decisions/Discussions/Actions

1. The underlying financial performance against the revised forecast deficit of £5.2m was discussed. The month on month position continues to stabilise.

2. The two main drivers of the adverse variances continue to be the additional emergency activity and the continued requirement to cover vacant shifts through the use of expensive agency staff and locums.

3. Progress was being made to address the slippage on the approved cost improvement programme and to commence plans to meet the continuing 4% requirement (equivalent to £8.5m) in improvements per annum into 2015/16 and 2016/17.

4. The Trust’s Continuity of Services Risk Rating is now a robust 3 and this is likely to remain for the remainder of 2014/15 due to the strong liquidity position of the Trust. The liquidity measure (EBITDA) of 4% represented a better position than most acute Trusts.

5. Next Meeting 2 February 2015 INFECTION PREVENTION AND CONTROL COMMITTEE Governor Representative: Keith Mitchell Meeting Dates: 23 October 2014 Key Decisions/Discussions/Actions

1. Hand washing at meal times - patients are being offered the ability to wash hands but in addition hand-wash wipes to be purchased and circulated to cover any gaps from patients who are unable to use the current methods

2. No hospital acquired MRSA Infections in the reporting period. CDiff below trajectory.

3. The Trust has produce plans and procedures to manage the unlikely event of an Ebola case within the Trust. Numerous meetings had taken place with working document now available.

4. PLACE Report -All areas improved and above national average other than condition and appearance at Christchurch. Food and hydration at Bournemouth not scoring well but this was due to one ward where there was a Ward Hostess on her first day, scoring 36%. Scores would still have been marginally under national average.



HEALTHCARE ASSURANCE COMMITTEE Governor Representatives: Vacancies x 2 – David Bellamy in attendance Meeting Dates: 30 October 2014, 27 November, 16 December 2014 No report received ORGAN TRANSPLANT COMMITTEE Governor Representative: Dexter Perry Meeting Dates: No meeting held PATIENT ENGAGEMENT AND COMMUNICATIONS COMMITTEE Governor Representatives: Eric Fisher / David Triplow / Glenys Brown Meeting Dates: 7 November 2014 Key Decisions/Discussions/Actions

1. Discussion on using e mails to connect patients. 2. Discussion on models for the future in the local Health service 3. Decisions on format for new patient experience cards. 4. Glenys briefly fed back from GIPPE. No time for Dave T item.

PATIENT INFORMATION GROUP (PIG) Governor Representative: Keith Mitchell Meeting Dates: Monthly Key Decisions/Discussions/Actions

1. See approved information leaflets following this report



VALUING STAFF AND WELLBEING Governor Representative: Keith Mitchell and vacancy Meeting Dates: 14 November 2014 Key Decisions/Discussions/Actions

1. LH (Active Dorset) and TH (Bournemouth Borough Council) outlined a project proposal for partnership, namely Living Well Active Workplaces (LWAW). The project aims to promote active travel and physical activity at the workplace in order to improve sustainable travel choices and employee health in the long term.

2. Employer Assistance Programme quarterly report for the period 1st June 2014 to 31tst August 2014. During this time a total of 110 staff members made a contact of which 60 have been to the telephone counsellors, 37 have received face to face counselling, 12 were advised by information specialists and 1 through the online counselling service. This is one of the highest usage since the contract commenced, marking a 34% increase from the same quarter last year.

3. Flu vaccination - It was the stage of submitting the interim data to the DH – and over 2500 people were vaccinated, among which approximately 50% of all patient facing staff

4. Staff Physiotherapy was briefly reviewed: the number of referrals is currently 49 per month with the average waiting times increased to 7 (from 3) days for urgent referrals and 26 days for routine appointments (up from 9 days) due to staff shortages over the last few months.

Department of Clinical Nutrition & DieteticsRe-introduction of higher fibre foods after a low residue diet

Your Dietitian is:The Royal Bournemouth Hospital: 01202 704732

Your doctor or dietitian has advised you to start re-introducing fibre in your diet. You should build up the amount of fibre gradually. Use the guidelines below:

These re-introductions give a gradual build up of fibre in your diet. The aim is to determine the level of fibre that you can tolerate before provoking symptoms again. Once you find the level of fibre that suits you, try to stick to it. Use the guidelines below.

Week oneIntroduce one extra portion of fruit or vegetables per day up to a maximum of five portions per day:Remember that some fruits and vegetables can be very hard to digest and you should continue to avoid these eg sweetcorn, nuts, dried fruits, peas, string beans, broad beans, oranges and tomatoes.An example of one portion is -one medium piece of fruit e.g. banana/apple/pear (fits into the palm of your hand)two plums/kiwi fruit/other small fruitone cupful of grapes/cherriesthree tbsp vegetablessmall glass of fruit juice

Week twoTry replacing your normal portion of white bread with wholemeal bread. Remember that granary bread should still be avoided.

Week threeTry a higher fibre breakfast cereal e.g. Weetabix, Shredded Wheat, Bran Flakes.

Week fourIf you are still symptom free, you may like to introduce further portions of fruits and vegetables.You may find that you can eat high fibre vegetables on days when you do not have wholemeal bread and high fibre breakfast cereals. If this is the case, try varying the sources of your fibre intake on a daily basis to achieve a balanced diet.

Vitamin and mineral supplementsFive portions of fruit and vegetables per day (not including potatoes) are recommended long-term for a healthy diet.

If you are unable to tolerate the recommended five portions of fruits and vegetables per day you may require a multivitamin supplement to ensure an adequate intake of vitamin C and folic acid. Please consult your dietitian for advice.

FluidFibre adds bulk to your diet by absorbing fluid and making stools easier to pass. It is, therefore, important to increase your fluid intake. Aim to drink at least eight cups (approximately 200ml) every day this can include water, squash, decaffeinated tea/coffee or fruit teas.

cs/ljs/sharedfile/dietsheets/low residuereintro of higher fibre foods/Feb2014

Website: www.rbch.nhs.uk n Tel: 01202 303626

Our VisionPutting patients first while striving to deliver the best quality healthcare.

The Royal Bournemouth Hospital Castle Lane East, Bournemouth, Dorset, BH7 7DW

Please contact the author if you would like details of the evidence in the production of this leaflet.We can supply this information in other formats, in larger print, on audiotape, or have it translated for you.

Please call the Patient Advice and Liaison Service (PALS) on 01202 704886, text or email [email protected] for further advice.

Author: Dael Hartley Date: October 2014 Version: Two Review date: October 2017 Ref: 021/14

We are committed to providing excellent care for every patient, every day, everywhere and our dedicated staff are here to care for you and then support you to leave hospital to recover. It is essential that we discharge patients when they are medically fit to ensure we have enough beds for those requiring operations and those who come to us through our Emergency Department to prevent them from having long, uncomfortable waits.

Choice process - Factsheet 1Planning your discharge from hospital

This factsheet is to explain the social assessment and discharge process for all patients.

The ward will be requesting a social care and/or therapy assessment for you, to find out which services you might require to support your safe discharge from hospital. A therapist, social care professional or member of the community mental health team will discuss your needs with you and any family/friends/carers you would like involved. The aim is to find out whether, with the right help and support, you can return to home after your assessment and treatment or whether care elsewhere might be needed.

The team looking after you at the hospital, will do all that they can to help you and give you the information you need to make a decision.

If it is agreed you need carers at home or to move to a care home, you will be offered help to arrange this via our learning hospital support service (BCHA), or Social Services. If there is little availability in the community, or your preferred choice has no current vacancies/availability, you will need to accept a temporary option, sometimes called ‘interim care’ while you wait or search for your first choice.

It is not possible for you to remain in this hospital when you are ready for discharge or transfer, as this puts you at increased risk of hospital acquired illnesses or infections. This will also help us ensure we have beds available for those who are critically ill. The hospital team will help you to make arrangements for discharge within the next few days.

If patients/their carers do not accept the options offered to support discharge, the Trust may charge £100 per day for any days spent in hospital longer than is deemed appropriate by the hospital team.

If you would like a copy of this factsheet to be given to someone else please speak to one of the nurses on your ward. Please ask a member of the multidisciplinary team if you have any questions.


Our VisionExcellent care for every patient, every day, everywhere.

The Discharge Coordination Team, The Royal Bournemouth Hospital Castle Lane East, Bournemouth, Dorset, BH7 7DW

Please contact the author if you would like details of the evidence in the production of this leaflet.We can supply this information in other formats, in larger print, on audiotape, or have it translated for you.

Please call the Patient Advice and Liaison Service (PALS) on 01202 704886, text or email [email protected] for further advice.

Author: Kt Whiteside Date: October 2014 Version: Two Review date: October 2017 Ref: 130/14


The Royal Bournemouth Hospital, Castle Lane East, Bournemouth, Dorset, BH7 7DW

Please contact the author if you would like details of the evidence in the production of this leaflet.We can supply this information in other formats,

in larger print, on audiotape, or have it translated for you.Please call the Patient Advice and Liaison Service (PALS)

on 01202 704886, text or email [email protected] for further advice.

Our VisionPutting patients first while striving to deliver

the best quality healthcare.

Author: Lucy Chaldecott Date: May 2014 Version: Four Review date: May 2017 Ref: 169/14

Trapeziectomy

08

Endoscopic Clips


Move to improve exercise class

What do others say about the group?There is a lot of positive feedback from recent participants in the group, such as:l “Staff very kind, helpful and professional”l “A leisurely atmosphere giving you confidence to join in with all the equipment and enjoy with everyone”l “I was really encouraged as it gave me motivation to come out and join in”l “[I gained] Control - belief that I can do more without pain.”l “[I gained] Confidence and hope that exercise will improve my condition.”

Statistics from questionnaires also demonstrate that many participants experience increased ability to manage their condition and perform daily activities after the programme.

How can I get involved?To find out more information and how to get involved, it is a good idea to ask your therapist (if you are already visiting a physiotherapist or occupational therapist at Christchurch Hospital) or your rheumatology practitioner. They will be able to discuss with you whether the class may be suitable, and then refer you into the group.

Do you find it hard to maintain activity due to a condition such as

Rheumatoid Arthritis, Lupus or Fibromyalgia? Would you like to safely increase your activity

in a supportive environment?

Endoscopic Clips

What is the Move to Improve Exercise Group?It is a gentle movement class which meets at Christchurch Hospital once a week for people who have conditions such as Rheumatoid Arthritis, Lupus or Fibromyalgia. It aims to illustrate the benefits of regular physical activity by introducing safe and appropriate activities for people with long-term conditions who currently find exercise painful, difficult or frightening.

How may I benefit from attending?There are several benefits from attending this group, such as:l Improving your overall fitness and activity levelsl Finding new, suitable ways to exercisel Developing your confidence to exercisel Meeting like-minded peoplel Discovering further support available to you, such as schemes to maintain exercise and support networks

So why not come and try it out for yourself?Why should I attend?There are numerous benefits of regular physical activity. For example, it can:l Increase the strength of your muscles and bonesl Improve your function in day to day livingl Reduce your risk of developing conditions such as type II diabetes and osteoporosis

You may find your condition limits what you can do due to pain or fatigue, or you may feel scared to exercise. However, research demonstrates that exercise for people with conditions like RA not only has these normal benefits but may also:l Ease your painl Reduce fatiguel Improve your quality of lifel Reduce the progression of your diseasel Reduce your need for so much medication

Not only is exercise safe for you, it is extremely beneficial. This group can help to introduce, or re-introduce, suitable activities to start producing these positive effects.

Endoscopic Clips

What are the practicalities of the group?l The group meets once a week in the therapy gym at Christchurch Hospital and lasts approximately an hour.l It is a 6-week programme which 5-10 participants attendl It is led by 2 or 3 therapists who can tailor the exercises to your needs and talk to you about any concerns or goals you may have.l Therapists will also discuss what support networks are available to you and the opportunities to continue activities and exercise after the programme.

What does a typical session look like?Each week the group involves a gentle warm-up, graded circuit exercises, a group activity and then a cool-down. This is tailored to the group as a whole and also to you individually depending on your own needs and wishes.

1 Warm-up - simple movements to gently move your muscles and joints and gradually increase your heart rate and breathing rate. 2 Graded circuit exercises - aerobic and strengthening exercise stations to do individually. These include: - gym equipment, like the static bike - gym balls - therapeutic hand equipment, like hand putty - shoulder pulleys and resistance bands 3 Group activity - a short activity led by the therapists for the group to do together. This may include: - tai chi - gym balls - pilates - short tennis or badminton - relaxation methods 4 Cool down - simple movements to gently stretch and cool down your muscles and reduce your heart rate and breathing rate.

Food and drink


Food and drink

Nutrition and Dietetics

Additional Notes


The Royal Bournemouth Hospital, Castle Lane East, Bournemouth, Dorset, BH7 7DW

Please contact the author if you would like details of the evidence in the production of this leaflet.We can supply this information in other formats,

in larger print, on audiotape, or have it translated for you.Please call the Patient Advice and Liaison Service (PALS)

on 01202 704886, text or email [email protected] for further advice.

Our VisionPutting patients first while striving to deliver

the best quality healthcare.

Author: Dieticians DepartmentDate: July 2014 Version: One Review date: July 2017 Ref: 178/14

Additional Notes

Food and drink

This leaflet aims to tell you why food and drink are important If you do not eat or drink enough your recovery from illness and length of stay in hospital may be prolonged. You could also be at risk of complications. It is important that you know what the problems are if you do not eat or drink enough and to report any concerns to your nursing and medical team looking after you. If you are hungry or thirsty at anytime, please inform a member of staff.

Lack of food - malnutrition can cause:l increased risk of illness and infectionl slower wound healingl increased risk of fallsl difficulty keeping warml low moodl reduced energy levelsl reduced muscle strengthl weight loss

How will my food and fluid needs be assessed?Both nurses and doctors will assess your needs and ask about your preferences during your hospital stay. You may be referred to a specialist team or dietitian.

02

Food and drink

07

ReferencesBritish Association of UK Dietitians Malnutrition - May 2012 Overcoming the Problem Food Fact Sheet

National Collaboration Center for Acute care, NICE CG 32 February 2006. Nutrition Support in Adults. Oral nutrition support, enteral tube feeding and parenteral nutrition. Methods evidence and guidance 2006/2012

Nutrition and Hydration Council. Hydration in Hospital. June 2011. Fact Sheet

Water UK (2011) Hydration Toolkit for Hospitals and Healthcare.

The League of Friends at The Royal B

ournemouth H

ospital

Food and drink

04

Food and drink

05

How do I keep hydrated?

You can check the colour of your urine using the chart below; if you are unsure please check with a member of staff

“Healthy pee is 1-3, 4-8 you must hydrate!”

Eat well, get betterYou should aim to eat three meals a day and two snacks

l If you do not manage all your meal, additional snacks are available.

l Food can be brought in from home, please check with ward staff to ensure its suitability.

l Please note there are no facilities on the ward to heat food.

l Foods can be fortified at ward level e.g. made richer in calories

l We protect our mealtimes from interruption

l Family and visitors are welcome to help you at mealtimes.

Aim to drink 8-10 cups of fluid a day unless instructed otherwise by your doctor. We have modified drinking cups / mugs which you may find more comforta

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5

6

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Food and drink

03

Food and drink

06

How do I order my meals?We use an electronic system to order food / meals, through using a bedside TV. You will be shown how to use this and assisted throughout your stay.

There are seven hot drink rounds every day and fresh water is available throughout the day. Please ask if you would like a hot drink at other times.

Lack of fluid/drinks - dehydration can cause:l weight lossl thirst/ Extreme thirstl feeling dizzy/light headednessl risk of fallsl sleepiness/tirednessl sunken eyesl dry, sticky mouth and skinl headachel rapid heartbeatl passing small amounts of dark, concentrated urinel urine infectionsl kidney damage

Snack boxes are available if you miss a meal / or you are admitted late e.g. between 8pm and 8am when the kitchens are closed and a hot meal cannot be given.

We use a red crockery system for people who need assistance or feeding. Modified eating/drinking aids are available.

We have specials menus available. These includeHalal, kosher, vegan, gluten free, fork mashable, puree, finger foods and vegetarian.

Our gluten free products include:Bread, cereals, cake, biscuits and all hospital made soups. If you have any concerns ask the nurses to call the Catering Department.




Subject:

Appointed Governor Reports

Section:

For Information

Author of Paper:

Appointed Governors


None


Patient Engagement

Patient Engagement

Patient Engagement

X X X X


To note

Summary:

Reports of activity from Appointed Governors:

Bournemouth University Clinical Commissioning Group Dorset County Council


N/A


N/A


Update from Bournemouth University

and the Faculty of Health & Social Sciences January 2015

Bournemouth University (BU)

BU is in the middle of its 6 year strategic plan, BU 2018. Significant progress has been achieved since the inception of the plan which is based on the concept of fusion- the integration of research and professional practice into an excellent student experience. There has recently been a restructure from the pre-existing 6 schools into 4 faculties:

Health & Social Sciences Science & Technology Media & Communications Management

Student recruitment at undergraduate levels is buoyant, there is considerable building taking place (International College in Holdenhurst Road, Student Centre and new teaching block at Talbot Campus) with plans for a new building for Health & Social Sciences at the Lansdowne moving forward. The Research Excellence Framework recently reported that the proportion of world recognised and world leading research at BU is increasing very positively and generally our student evaluations are very good. The last audit undertaken by the Quality Assurance Agency for Higher Education commended BU for the quality of its student learning opportunities. In summation, BU is developing in strength and reputation.

Faculty of Health & Social Sciences (FHSS)

The mission of FHSS is to ‘help to make peoples’ lives better’ through academic endeavour. All of our work aims to touch people’s lives, directly or indirectly. This includes preparing students to have the theoretical knowledge, the skills and the compassion to support individuals in challenging life situations; offering opportunities for continued learning beyond graduation/ registration to ensure practice is well informed, up-to-date and of the highest quality; engaging in practice development work that leads to improved service delivery; and by conducting and publishing high quality research in areas of health and social sciences, that provides insights, understanding and sound evidence to increase knowledge and enhance practice. Academic areas include nursing, midwifery, health professions, social work, sociology, public health and health sciences.

Our undergraduate courses are approved by professional bodies, feature placements / fieldwork opportunities, and are geared to ensuring graduates are well equipped for their chosen careers. Post-registration and postgraduate students


benefit from opportunities that allow them to focus their studies on specialist areas of knowledge and / or advanced practice, providing pathways for lifelong learning and growth. Our student numbers total 4300 (mix of full and part time), supported by approximately 160 academic (as well as some lecturer practitioners from local NHS Trusts) and 60 administrative staff.

Our contracts with the NHS are with Health Education Wessex and we work with acute and community Trusts in Dorset, Somerset, Hampshire and south Wiltshire (acute Trusts include Yeovil, Dorset County, Poole, RBCH, Salisbury, Portsmouth, Basingstoke, Winchester, Isle of Wight). We have a University Centre in Yeovil where we deliver adult nursing and a sub campus in Portsmouth where we deliver midwifery. The number of commissioned places in adult nursing is increasing in order to meet the workforce demands of the Trusts, other numbers are remaining fairly static.

In addition to pre-registration education, we have a highly regarded Masters course for nurse practitioners which recruits well as well as post graduate degrees in public health, leadership and management and other areas of advanced practice. We have approximately 100 doctoral level students, mainly from health and social care backgrounds, undertaking research projects that will make a positive impact on the quality of care. Areas of current growth include the BU Dementia Institute (BUDI) which was established two years ago and has become known as an important centre for research and development work to support people with dementia and their carers. The University is planning to invest significantly with the support of the Wessex AHSN to create an Orthopaedic Research Institute, working with colleagues from RBCH to establish a centre of excellence. In addition we are launching a Centre for Leadership, Impact and Management in Bournemouth (CLIMB) to work with health and social service colleagues to build leadership capacity and effectiveness in services. One unique aspect of the work in CLIMB stems from earlier programmes in social care where evaluating the impact of educational interventions is a key feature. These research centres complement our existing expertise in humanisation, maternal health, social work and social science research. Next Steps This note is the first of planned updates for the Governors at RBCH to provide information on BU that may be of interest and useful for considering potential collaborations. As it is the first, it provides some general background as well as a few current developments; feedback is welcome on its helpfulness and any other particular aspect Governors would find useful. Professor B. Gail Thomas Dean of Health & Social Sciences RBCH Appointed Governor – Bournemouth University


Dorset Clinical Commissioning Group

Report from the Dorset Clinical Commissioning Group January 2015

The CCG is currently allocating most of its time and resource to the CSR. I would like to thank all RBH members of staff who have been involved and encourage them to continue their involvement. The highlight has been getting lots of different primary and secondary care clinicians in the same room. We all have the same ideas of what the problems are and what needs to change. Tom Knight Appointed Governor – Clinical Commissioning Group


Report from Dorset County Council January 2015

Health Improvement Hub procurement The Joint Public Health Board in July approved plans to develop a pan-Dorset health improvement hub. This will bring access to all existing health improvement services such as smoke stop and weight loss services into a single hub. This means that we will be able to offer a holistic approach to health improvement, as people often have multiple lifestyle factors that could contribute to ill health. This will also mean that there is a clear offer to support those who are identified as being at risk of cardiovascular disease through Health Checks. The service will offer signposting to locality based options such as sports and leisure activities, as well as motivational interviewing and referral to specific health improvement services as appropriate. A provider has been identified through the procurement process and will be announced week commencing 19th January, with the service due to commence April 2015. Sexual health Currently sexual health services in Dorset are based in a range of settings, over the last two years commissioners and providers of current services have been working together to coordinate development of some initial improvement plans. The vision for sexual health service is to procure a comprehensive, integrated service that enables transformation to a single managed system providing the right intervention, by the most appropriate professional, at the right time and place to meet population needs. The focus of the commissioning intentions will be to focus on open access provision of most contraceptive services, specialist services including young peoples sexual health. Outreach, HIV prevention, Sexual health promotion, STI testing and HIV testing. The scope of this commissioning exercise currently excludes GP and Pharmacy contracts; there will be future opportunities for further integration with primary care as services evolve. A procurement process has commenced for the development of an integrated open access sexual health service for our local population and will continue during 2015. Supplier engagement events and online e-procurement tools, to support the process, have successfully engaged providers in this vision for a more effective way of working. Teenage pregnancy pilot in Weymouth and Portland Smoking during pregnancy causes significant harms to both mothers and the babies and reducing the incidence of smoking during this time is critical if we are to improve maternal and longer-term public health outcomes. There is a growing evidence base nationally to show that the additional use of incentives during pregnancy can improve


outcomes, and this has been acknowledged in NICE guidance and through subsequent national guidance. The pilot project which will last for a 12 month period and will be evaluated to test a) the viability of the approach b) the effectiveness and cost effectiveness of the use of incentives in this context should be going live in early February 2015. Cllr. Colin Jamieson Dorset County Council




Subject:

Staff Governor Reports

Section:

For Information

Author of Paper:

Staff Governors


None


Patient Engagement

Patient Engagement

Patient Engagement

X X X X


To note

Summary:

Reports of activity from Staff Governors


N/A


N/A


Overview of AHPST Staff Governors Activities 2014 – 2015

No. Overview 1. AHPST Forum

Agreed to formulate and set up a Strategic AHPST Forum to initially meet 6 weekly with AHPST Staff representatives and the Trusts Directors (Terms of reference available). Work with the Director of Nursing and Lead for AHPST Staff ref: AHPST Issues.

2. Trust Theatres Visited Theatres with Helen Lingham and agreed to highlight 5 key points of concern in mini report with AHPST team.

3. Cost Savings Met with Stuart Hunter following COG Meeting ref: cost savings: Items discussed:

1. Lease/ Rental Contracts 2. Out- sourcing services 3. Current ordering process 4. Manager to be provided with Debit Cards 5. Income generation 6. Electronic ordering of Drugs 7. Electronic booking of next appointment for & with Patients 8. Reduce Agency expenditure

4. Ward Three

Concern raised reference Ward Three to IK by Senior staff in the Trust. Followed this up with PS and agreed to meet Ward Three team and report on findings to management team and directors/JS.

This visit took place: Report compiled and delivered: good management and patient care noted and discussed improvements to consider.

5. Pathology Department

Visited Pathology AHPST Staff Issues highlighted:

Staffing and workforce planning Increased demand for their services year on year Trust training being appropriate for AHPST staff needs An urgent need to improve their rest facilities (improvements in progress post meeting

and assistance with JS/TS) 6. Information Technology in the Trust

IK raised concern ref: Information Technology services with JS & TP at monthly meeting (TS suggested to meet with PG): Many concerns discussed with PG and further meeting to explore solutions:

IT Help Line & frustration with IT equipment clinical teams Many systems labour intensive Frustrations with systems:- eCamis, eIDF etc. Benefits of other options explored, do systems meet end-users needs and an

evaluation process for the future. IK & PG AHPST staff to be invited and attend IT Meetings Work on-going

7. Trusts modernisation event

IK & RO attended and supported the Modernisation event run by Debora Matthews 8. HR Workforce planning

Mini report produced highlighting: HR Strategy, workforce development, training concerns and workforce planning - major concerns from AHPST Forum also mentioning nursing workforce


planning issues. Attend: Trusts Workforce planning session for the Trust.

9. FFT London Visit Attended FFT Forum and followed up with briefing from meeting.

10. Cardiac Physiology visit Met the Cardiac Physiology AHPST team and their unit; Mini report delivered ref: concerns and highlighted good care.

11. Attend: Governor Training events GOG Meetings

Ian Knox Staff AHPST Staff Governor




Subject:

Governor Additional Activity Report

Section:

For Information

Author of Paper:

Written by Governors Compiled by Dily Ruffer


None


Patient Engagement

Patient Engagement

Patient Engagement

X X X X


To note

Summary:

Additional activities undertaken by Governors since the last Council of Governors meeting held in October 2014 over and above their general commitments on meetings and training


N/A


N/A

Bereavement service provision at Christchurch Hospital

Background

The only in -patient facility at Christchurch Hospital is the Macmillan Unit.

Approximately 5 years ago the Macmillan Init was accredited by Bournemouth University as a Practice Development Unit . As part of this review a decision was made that the death certificate would be collected from the Macmillan Unit rather than the General Office.

Current practice

Following a death relatives are advised to contact the Macmillan Unit by phone on the next working day and are given an appointment time to come in to collect the death certificate. Three appointment times per day are identified for this purpose. At the same time any property is returned to the relatives. Plastic carrier bags are still being used for the return of property and valuables are in a wooden box.

On average the mortality rate is one per day.

Advantages

There is a dedicated quiet room to receive relatives which is pleasant and reasonably quiet.

Where possible one of the nurses who has cared for the deceased will be the person meeting with the relatives. This means that if there are any areas which they wish to address this can be facilitated.

There is normally a doctor available if any further explanation of the death certificate is required.

Advice is given about the process for registering the death.

It gives closure to staff who have often been caring for the patient and family for an extended period of time.

Disadvantages

The nurse is part of the ward team and if relatives require more time this can be to the detriment of patients on the ward.

Relatives are coming back to the ward area where their loved one was dying.

Recommendations

A sign could be placed on the quiet room door so that those in the corridor are aware and can respect the need to lower their voices.

Consideration could be given to whether there needs to be some adjustment to staffing levels or rotas to accommodate time spent with relatives of the deceased.

The same property bags which have been introduced at Bournemouth Hospital should be made available to the Macmillan Unit.

Consideration could be given to the suitability of the box used for valuables.

Viewing area

Current situation

The viewing area is immediately adjacent to the mortuary and very close to the Macmillan Unit.

Viewings are rare, on average about one a month. This may be because provision is made to allow relatives to say goodbye to their loved one in the Macmillan Unit for up to several hours if required.

There are no capacity issues in the mortuary.

The viewing room is rather tired looking and not a welcoming area.

There is recognition that the future provision of a mortuary at Christchurch is under discussion however in the short term some minor changes could be made which would have a minimal cost impact yet improve the service.

Recommendations

The metal cabinet in the corner of the room could be removed and shelves set into the recess with doors to match the rest of the facia.

The walls could be repainted with a warmer colour.

The carpet could be given a deep clean

Dried flower arrangement could be replaced (This action has been completed by Duncan)

Glenys Brown Public Governor

Patient and Public Stakeholder Event

28 November 2014

This was held on 28 November and was attended by around 45 people which included representatives from the voluntary sector, public sector, governors, patients and staff from the Trust.

110 invitations had been sent out.

Glenys Brown had been invited to give the key note address and presented the progress made since the CQC report of 2013 and the revisit in 2014. Consideration was given to themes which had emerged from Governor survey work and where this chimed with other audit work carried out by the Trust. Areas where improvement was required were identified.

Sue Mellor, Head of Patient Engagement, gave a brief update on the outcomes from the previous stakeholder event and explained that the breakaway groups for the afternoon would each have one of the problem areas to consider and to identify ways for improvement.

There was considerable energy in the room with participants fully engaged with the process. The feedback session which followed demonstrated that there were many positive suggestions for improvement and these were captured on flipcharts.

Sue Mellor will be working with the ward sisters and department leaders to take these suggestions for improvement forward.

Glenys Brown Public Governor

Additional Activity Conducted by Keith Mitchell

October 2014 – January 2015

Date Activity/Event/Meeting

28/10/14 Flu champion

30/10/14 AMU visit

5/11/14 Matrons talk – elderly care

20/11/14 PRIDE Awards

1/12/14 Understanding Health

1/12/14 Hospital charity tea

1/12/14 Trust values

2/13/14 Ward 3 workshop

4/12/14 Housekeeping thank you



10/12/14 Volunteer coffee morning


11/12/14 Christchurch Hospital Tea Dance

17/12/14 Stroke Unit Fair

18/12/14 Hospital Christmas Lights

21/12/14 Hospital Carol Service


25/12/14 Elderly wards

6/1/15 Mealtime training

8/1/15 iPad training

9/1/15 Focus group

12/1/15 Governor Talk – St Barnabas

15/1/15 CCG Consultation

21/1/15 Sisters talk – elderly care