Board minutes 19th May 2014

Minutes from May 2014 Board meeting
Derbyshire Health United Ltd,
Derbyshire Healthcare Ltd; Derbyshire Medical Services (1995) Ltd
Combined Board meetings
Monday 19th May 2014
19:00 – 22:00 Board Room, DHU, Mallard House, Stanier Way,
Wyvern Business Park, Chaddesden, Derby, DE21 6BF
Attendees:
Dr David Disney
Dr Phil Cox
Dr Melvyn Heappey
Dr John Blissett
Jenny Doxey
Glyn Rees-Jones
David Walsh
Lindsey Wallis
Dr Aqib Bhatti
Stephen Bateman
Willie Wardrop
Dr Anthony Gould
Carly Gray
Jenny Tilson
Chair
Vice-Chair
Director of Education
Director of Clinical Staffing
Deputy Clinical Director
Director of Finance & Strategy, and Company Secretary
Director of HR and Organisational Design
Chief Executive
Clinical Director
Chief Operating Officer
Non-Executive Director
Medical Director
Executive Assistant to the Board (minutes)
Director of Nursing and Quality
Apologies:
Pauline Hand
111 Programme and Operations Director
Did not attend: Dr Ian Anderson
Clinical Director (Derbyshire)
Minutes
1.
Arrival and Dinner
2.
Apologies and Director’s Interests
Apologies were received from PH, and there were no changes to Directors interests.
3.
Minutes of last meeting
The minutes were passed and approved as a true and accurate reflection of the previous meeting.
Matters arising
LW provided an update regarding EMAS contingency status, informing that EMAS had taken aggressive
steps to improve performance and therefore avoid entering into contingency. However DHU were still
experiencing additional call volumes and the auto-alert e-mail system which EMAS had proposed they
set up was not yet working, so DHU were not being informed when EMAS went into CNP3 status and
couldn’t react accordingly. LW had been informed that EMAS had fixed the e-mail alert and that DHU
should be informed of future instances, and that a dialogue was continuing with EMAS on a monthly
meeting basis.
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4.
Actions from previous Board meetings
All actions were either completed or on the agenda, with the following exceptions/updates:
Timing as in week day in hours and frequency of DHU Board meetings to be added to future agenda
once DHU’s financial position is further clarified. On-going, since January. The Board decided to review
in future whilst DHU finances required more frequent scrutiny. CG to add to future agenda. ACTION: CG
Budget 2014/2015: confirm whether 1% pay increase would be awarded to consulted staff.
LW and GRJ updated that discussions were still in progress and the action would be completed outside
of the Board meeting. CLOSED.
5.
For Decision
5.1 Risk Register
SB circulated the risk register and highlighted the various aspects it covered.
SB informed that the actions from the register formed part of the Executive/SMT’s annual objectives
and that he had their commitment that this was to be a live document. Development was underway for
a register for each contract and issues would be escalated appropriately from these. LW noted that the
register improved process controls for the IG and Audit committees.
WW presented a risk register using a heatmap format which the Board agreed could be useful to
incorporate for future versions of the register.
SB reiterated from last meeting that it would be reviewed monthly by the Executive/Senior
Management teams and quarterly by the Board.
The Board APPROVED the risk register.
Risk register to be added to July’s Board meeting agenda and then quarterly moving forwards. ACTION:
CG
6.
For Discussion
6.1 OOH Service Delivery Review
AB presented performance and productivity data. Methods to ensure the data was as accurate as
possible were debated, as were systems to address productivity and ensure workloads were spread
fairly i.e. allocating lists to single clinicians. AB informed that the productivity data would be released to
clinical staff. LW highlighted the importance that all of the GPs on the Board support this process and
help with communications to ensure that this is understood as a service improvement action, focusing
on patient waiting times and patient safety to gain acceptance from clinical staff. AB to circulate draft
letter to the clinicians on the board for review. ACTION: AB
AB provided an overview of the performance data and it was noted that whilst day time GPs were able
to turn patients away or book appointments for later in the week the OOH contract was a block contract
requiring that all patients were seen. Analysis of volumes/performance against contract clearly
illustrated increased demand being met with increased staffing. JB queried the statistic that the number
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Minutes from May 2014 Board meeting
of calls resulting in home visits was 27% versus the expected ~19%. Post meeting note: AB worked with
data analyst and confirmed the integrity of this statistic.
6.2 UXL Update
SB presented the NHS111 UXL performance improvement program information and provided an
overview of the actions taken within the programme.
SB fed back that overall staff felt more supported as a result of the programme, and that it would
continue past the end of May for this reason. However SB also noted that those nurse advisors
struggling to cut call lengths were experienced and long-serving staff, and were mainly also challenging
the consultation.
SB highlighted the improvement in statistics for both call handler and nurse advisors and believed that
there were approximately 5% outliers.
LW informed that patient quality was a strong focus, particularly ambulance dispatch/inappropriate use
of 111. LW mentioned that DHU had a slight underperformance regarding percentage of calls answered
within 60 seconds compared to other 111 providers, but that admissions/ED usage was significantly less.
SB referenced Injixo, the workforce management tool, and listed the service and performance
improvements this micromanagement would bring once in place. SB also informed that UXL was being
used to aid recruitment, identifying the personality traits of those achieving success.
LW informed that three of the CCG’s provided DHU with small sums of money totalling £63k in
recognition that the return to bid case action plan was not going to be completed until end May 2014.
LW commented on a Nottingham led review of complaints management. DHU’s standard for time lines
of responding to complaints was generally shorter than the NHS. Ways to simplify the complaints
management were under consideration. NHS111 complaint ratio of ~0.06% against annualised call
volumes of 1m will generate roughly 600 complaints. Complaint handling could be simplified e.g. a
standard template for initial responses rather than tailoring each response. SB and JT were also working
on a change in process whereby shift managers would deal with complaints on shift. MH and JB
suggested that every complainant be asked to complete a formal, written complaint as a way of
reducing the work load. The Board however identified that access and simplicity of complaining via
calling NHS111 was important so this proposal was not supported.
SB also informed the Board that DHU’s NHS111 performance was benchmarked against all other
providers, by contract and as a whole, on a monthly basis for the national Minimum data set reporting.
Ordinarily DHU did quite well and LW noted that DHU ambulance dispatch stats were better than the
national average, identifying the benefit of clinical focus in the service.
JD announced that an intelligent data tool was being developed by Pathways, which would also
demonstrate local and national benchmarking. The tool was due to be in place by the end of June 2014.
This data to be provided in the monthly Board report. ACTION: JD/SB
6.3 NHS111 Consultation Update
DW provided an update on the consultation for NHS111 staff:
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130 staff had accepted the new terms and conditions; 20 staff had declined to sign the contract. 100
staff had not responded but were working the new shift patterns.
The 100 staff undecided were written to asking for a decision given that plenty of time and opportunity
had been provided to make a decision, and that if no response was received by the end of the month
that this would be taken as acceptance of the terms and conditions. The 20 staff who declined to sign to
accept the new terms and conditions would be met with, dismissed and re-engaged on a new contract.
DW listed the steps taken to ensure the consultation was fair and risk for litigation was as slight as
possible.
6.4 Board to Board meeting 22nd May – Planning
DD outlined the plans for the Board to Board meeting with North Derbyshire Clinical Commissioning
Group. A broad agenda had been sent by chair Ben Milton, and DD listed those attending from NDCCG.
The Board to Board would also review the PriceWaterhouseCooper (PwC) report. The PwC report had
not been received from NDCCG despite their promise to circulate to DHU on day of this meeting (19th
May 2014). CG to circulate as soon as report is received. DD reminded the Board that a pre-meeting was
organised at Ashgate Manor at 12.30pm so possibly the PWC report could be looked at then. AB and
MH offered apologies.
JT presented a terms of reference document from commissioner Jane Stringfellow who had received
word from anonymous sources anecdotally that there were concerns regarding DHU, referencing
staffing in particular. JT informed that Judy Derricott, deputy quality manager, would be meeting with
relevant staff over next few weeks for fact finding sessions. A joint report would then be produced with
input from DHU. SB listed staff whom Judy needed to meet with. DD queried why this method was
chosen to investigate rather than via the Contract Management Board but was informed that this was
the preferred working practice of the CCG.
LW noted that DHU had increased staffing over the past three years to support its commitment to
patient safety and tight clinical standards. The same analysis showed that revenues did not meet the
increased demand or staffing. It was noted that the CCG’s would not pay for some of this additional
staffing e.g. the CRH co-location increased staffing, for which DHU had taken a cost hit during 2013/14.
The Board noted this type of DHU willingness to ‘help’ had to cease, especially as the company no longer
had ample reserves to draw on.
The Board reviewed the issue of out of hour staffing. It was noted that there were some shifts on Rota
Master that were for additional staffing to give flex to the cover. The GPs who did clinical lead shifts
commented they could not see those additional sessions and they noted that there were pressures on
staffing. PH to confirm what view of staffing the CLs had. ACTION: PH. The Board were advised that the
service routinely was back filling NP shifts with GPs which was cost unsustainable. LW noted that in
reporting to QAG the staffing report provided by Paul Tilson had identified 2.5% of sessional OoH shifts
for the month of April were unfilled. AB and DW updated on current GP recruitment that there were 30
GP applications going through the system. It was previously identified that new GPs were recruited to
work in the OOH service but sometimes failed to book into a session once recruited; AB to focus on new
GPs to ensure that sessions are being booked.
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6.5 Offender Health
Update that the offender health contracts were nominally over budgets due to agency costs. There was
one nurse progressing through ill health retirement which was increasing the necessity for agency
nurses.
6.6 Finance April 2014
DD introduced this additional agenda item and GRJ referenced the end of year financial report which
was circulated since the last meeting, and asked for any queries. No queries received.
GRJ presented April’s financial Board report, apologising that due to deadlines it was not published prior
to the meeting. The Board interrogated the profit and loss sheet and discussed the variance between
budgets and future predictions.
The overdraft facility GRJ had been negotiating with RBS for since February remained outstanding; GRJ
reported that in April DHU’s outgoings exceeded funds in account due to cash flow and had written
confirmation from the bank that DHU would be charged interest, but not charged for the unauthorised
borrowing. Discussions with bank were on-going.
To aid cash flow, CCG payments were scheduled for the 1st of each month, and Derbyshire CCG’s were
paying an extra £330k to offset professional indemnity fee rises. Additional payment was also received
of £115k for CRH streaming nurses.
DD and AB questioned the adequacy of the annual budget in view of extra costs incurred during the first
month of the financial year. LW mentioned that DHU were on block contracts so that extra OoH demand
doesn’t generate extra money. Additionally the GP DES for 2.5% of patients on a care plan will likely
drive up the number of RightCare© plans which were nominally capped in the new contract at 6000 and
had already reached 8000. LW noted she and GRJ were working to negotiate additional funding from
the Derbyshire commissioners for the care of patients on these additional plans.
AB suggested that we survey patients to ask why they are accessing primary care through DHU as often
anecdotal feedback revealed that patients could not access a suitable appointment with their own GP.
SB to feedback trim plan to return to contract costs and budgets to make efficiencies, and liaise with GRJ
to present at a future Board meeting. ACTION: SB
7. Any Other Business
DHU annual strategy event
DD requested feedback from the Board regarding the DHU annual strategy event held on 15th May.
GRJ, SB and WW provided observations that the session was positive, objectives were focussed,
attendance was appreciated at 100%, attendees expressed pride to work for DHU and that the forum to
openly express frank viewpoints was deemed beneficial. LW to circulate notes from the meeting once
produced, and a formal DHU strategy paper would be presented at the July Board meeting.
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Calls being closed in error
AG informed the Board that he was receiving weekly data from CQI lead Lynn Charlesworth regarding
decreasing the number of times that calls are inadvertently closed and that the matter was in hand.
Derbyshire LMC
DD informed the Board that he had received a letter expressing thanks to the Board for their
contribution towards a retirement gift for Kate Lawrence.
Management Structure
LW stated that, in agreement with GRJ and SB, going forward SB would lead the Information
Management and Technology (IM&T) team as the final structure change to place Performance and
IM&T alongside operations.
8. Close
The meeting closed at 22:00
9. Board Report
9.1
NHS111 Performance
As report
9.2
HR Report
As report
9.3
Offender Health Report
As report
9.4
Safeguarding Report
As report
9.5
Quality Standards Report
As report
9.6
Clinical Governance Report
As report
10.
Date and time of next meeting
Monday 16th June 2014, 19:00 – 22:00 Third Floor Meeting Room, Ashgate Manor, Ashgate Road,
Chesterfield, S40 4A
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