JOINT MEETING IN PUBLIC OF THE BOARD OF DIRECTORS OF THE ROYAL DEVON AND EXETER NHS TRUST AND THE TRUST BOARD OF NORTHERN DEVON HEALTHCARE NHS ...
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JOINT MEETING IN PUBLIC OF THE BOARD OF DIRECTORS OF THE ROYAL
DEVON AND EXETER NHS TRUST AND THE TRUST BOARD
OF NORTHERN DEVON HEALTHCARE NHS TRUST
Wednesday 28 April 2021
Via MS Teams
MINUTES
PRESENT RD&E: Mr J Brent Chairman
Mr P Dillon RD&E Vice Chair
Mrs H Foster Chief People Officer
Professor A Harris Chief Medical Officer
Mrs A Hibbard Chief Finance Officer
Professor J Kay Senior Independent Director
Professor H Khalil Non-Executive Director (from 58.21)
Mr S Kirby Non-Executive Director
Mr A Matthews Non-Executive Director
Mr K Orford Non-Executive Director, NDHT and RD&E
Mr J Palmer Interim Chief Operating Officer
Mr C Tidman Deputy Chief Executive
Mrs S Tracey Chief Executive Officer
PRESENT NDHT: Mr J Brent Chairman
Dr T Douglas-Riley Senior Independent Director
Mr R Down Non-Executive Director
Mrs H Foster Chief People Officer
Mrs P Geen Vice Chair
Professor A Harris Chief Medical Officer
Mrs A Hibbard Chief Finance Officer
Mr S Kirby Associate Non-Executive Director (non-voting NDHT
Board member)
Mr T Neal Non-Executive Director
Mr K Orford Non-Executive Director, NDHT and RD&E
Mr J Palmer Interim Chief Operating Officer
Mr C Tidman Deputy Chief Executive (non-voting NDHT Board
member)
Mrs S Tracey Chief Executive Officer
APOLOGIES: Professor C Bones Non-Executive Director, RD&E
Mrs C Mills Chief Nursing Officer (Joint)
IN ATTENDANCE: Mrs M Holley Director of Governance (Joint)
Miss Tracey Reeves Director of Nursing, RD&E
Miss Louise Vine Executive Support Officer, RD&E (minute taker)
ACTION
52.21 CHAIRMAN’S OPENING REMARKS
Mr Brent welcomed everyone to the meeting, including Governors and members
Board Minutes Public 28 April 2021
Page 1 of 13of the public. He particularly welcomed Mr Palmer as it was his first Board
meeting, and he noted that Miss Reeves was deputising for Mrs Mills.
Mr Brent reminded those attending that it was a meeting in public not a public
meeting, with questions on the agenda from the public to be taken at the end.
He noted the meeting was being recorded in MS Teams and if anyone objected
to this, they were asked to leave the meeting. Mr Brent reminded all of the
etiquette for the meeting, advising members of the public that there would be an
opportunity to ask questions relating to the agenda at the end of the meeting,
although one question had been received in advance.
Mr Brent acknowledged that this was the first time the two Boards had held a
joint Board meeting, explaining that both Boards remained independent in their
functions and fiduciary responsibilities. He stressed that this did not mean any
decision had been made as to whether or not the two organisations would be
joined; this decision was not due to be taken for several months. Mr Brent
encouraged Board members to highlight any additional conflicts of interests that
might arise, further to those already routinely declared. He noted that whilst a
number of agenda items included reports for both Trusts, some were also
individual, however engagement was welcomed from any Director on any
matter. Mr Brent clarified that one overall set of minutes would be produced
which would be approved by both Boards. He added that the usual approach to
decisions was to build a consensus, but if necessary a separate vote could take
place by the respective Board.
The Board noted the Chairman’s Remarks.
53.21 APOLOGIES
It was noted that apologies had been received from Professor Bones and Mrs
Mills (with Miss Reeves deputising for Mrs Mills).
54.21 ANNUAL REVIEW OF THE RD&E BOARD’S REGISTER OF INTERESTS
Mrs Holley said that the interests were as outlined within the report with one
further addition:
Mr Palmer – Owner and Director of JC Palmer Ltd
The following updated were also noted:
Mrs Foster – Church Warden of the Church of St Lawrence, Clyst St Lawrence.
Mr Dillon – no longer a Director of Phoenix Venture Holdings Limited.
Professor Harris – Director of Menegai Medical Limited.
The Board noted the annual review of the RD&E Board’s Declarations of
Interest.
55.21 MATTERS TO BE DISCUSSED IN THE CONFIDENTIAL MEETING
Mr Brent informed the meeting that the Board would be discussing in its
Confidential meeting the routine quarterly review of the Board Assurance
Frameworks, the RD&E Draft Annual Accounts, an update on both the NDHT
and RD&E Draft Annual Reports, an update on the Operational and Financial
Plan 2021/22, an update from the Integration Programme Board, a MY CARE
Board Minutes Public 28 April 2021
Page 2 of 13update, and an update from the Our Future Hospitals Programme Board. Mr
Tidman requested that an update in relation to the Nightingale Hospital also be
added; this was noted.
MINUTES OF THE MEETING OF THE RD&E BOARD HELD ON 31 MARCH
56.21
2021
The minutes of the meeting held on 31 March 2021 were approved as an
accurate record subject to the following amendments:
Minute 50.21, page 9, third paragraph should read: “Mrs Kay Foster, a Public
Governor, noted…”
57.21 MATTERS ARISING AND BOARD ACTION SUMMARY CHECK
Action check
The actions were noted as per the tracker with the following additions:
26.21 (2) Mrs Mills to provide an update to the April 2021 Board meeting on the
reporting of safe clinical staffing fill rates. Miss Reeves drew the Board’s
attention to the graphs on page 26 of the Integrated Performance Report (IPR)
and acknowledged that concern had arisen due to the apparent reduction in the
fill rate. She clarified that the graph showed the proportion of rostered staff
against actual staff numbers, which was informed by the establishment review
and was dependent on the type of ward, bed numbers and complexity in terms
of care needed. Miss Reeves explained that a temporary change of use of ward
(for example due to COVID-19) would impact on the fill rate as the e-roster may
not have been updated retrospectively, therefore the incorrect number of
required staff would be displayed within the data provided. She added that if a
decision had been made to cohort particular patients, the actual staffing levels
would be adjusted to ensure safe staffing levels, but again the e-roster itself
may not always be updated. Miss Reeves recognised that it was not acceptable
to have variation between the actual and planned fill rates but assured the
Board that there was a very robust process for ensuring safe staffing levels.
She added that the Safe Care Rostering Group across both Trusts would carry
out detailed analysis to ensure there was greater scrutiny throughout the
process and that the data was correlating correctly, and would report back to the
Joint People, Workforce Planning & Wellbeing Committee. In addition, roster
surgeries would continue to be held to highlight the importance of updating e-
rosters following any changes as described. Mr Matthews asked whether the
data presented could be adjusted dynamically or whether there should be a
level of acceptance that there would continue to be slight variances due to the
reasons already outlined. Miss Reeves said that although it probably would not
match exactly, there should be a greater alignment in future between planned
and actual, with exemptions highlighted each month. Mr Brent commented that
where there were known data errors similar to this within reports, this should be
clearly noted rather than exerting a disproportionate amount of effort in trying to
correct such errors.
45.21 (1) A case study to be developed with the Nightingale Team drawing on
their experiences and learning from setting up, staffing and running the
Nightingale to be used with other staff to encourage innovation. Mrs Tracey
said that the Executive team had discussed how best to disseminate the
learning whilst balancing this with the importance of encouraging empowerment.
Board Minutes Public 28 April 2021
Page 3 of 13She said that this would be developed later in the year through the work she
and Mrs Foster were due to carry out with middle management. The Board
agreed that this action be closed, and that Mrs Tracey and Mrs Foster would
provide the Board with an oral update once this further work was complete.
ACTION: Mrs Tracey and Mrs Foster to provide an oral update to the
ST / HF
Board, in relation to the learning available from the Nightingale, once the
development work with middle management was complete
There were no further questions or matters arising.
58.21 CHIEF EXECUTIVE OFFICER’S REPORT
Mrs Tracey reminded the Board that the submission date for the system plan
was 6 May 2021. She said there was a particular focus on the wellbeing of
staff, and the impact of COVID-19 on waiting lists over the last 12 months and
what this meant for the community.
Mrs Tracey was pleased to note that real milestones had been achieved both
locally and nationally in terms of the number of COVID-19 vaccinations to date
with half the population having already received their first vaccination. She
acknowledged the significant challenges faced in other countries and said that a
national group, of which she was a member, was looking at what could be done
to assist various countries overseas whilst balancing this with the national need.
Mrs Tracey informed the Board that a shadow Integrated Care System had
been formed, with particular focus on how to progress the Local Care
Partnerships, and recovery of the elective position. Mrs Tracey said that she
was leading the elective recovery work on behalf of the system over the next 12
months; there were six workstreams looking at demand and how capacity could
be increased to 100% of pre COVID-19 levels by July 2021; this would be
discussed in greater detail in the Confidential meeting of the Board.
In relation to the financial position of the system, Mrs Tracey was pleased to
note that partner organisations had agreed a balanced position could be
achieved for the system.
Mrs Tracey reported that the Trusts hoped to hold a Board to Board meeting
with Torbay & South Devon NHS Foundation Trust on 10 May 2021 to progress
the strategic alliance. The already established Partnership Board had a meeting
scheduled for the following day to look at the governance arrangements of the
alliance.
Operationally, Mrs Tracey said that workload had been returning to more pre-
COVID-19 levels which was putting pressure on both Trusts with an increase in
elective and cancer care. She said that the RD&E in particular had experienced
a number of flow issues, due to an increase in referrals to the Acute Medical
Unit and Same Day Unit from GPs as well as there being a higher acuity of
patients, which in turn was impacting on emergency activity.
Mrs Tracey was pleased to report that 16,000 vaccinations had been achieved
at NDHT and a total of 102,000 at the RD&E; 42,000 at the RILD building and
60,000 at the Westpoint site on behalf of the wider population. She added that
the Westpoint site would soon close down as originally planned, and an
alternative arrangement had been made at Greendale which was due to open
towards the beginning of May2021.
Mrs Tracey said that approximately 1200 responses had been received from the
staff survey relating to the Integration work, proportionately from each Trust
Board Minutes Public 28 April 2021
Page 4 of 13relative to the staff population sizes. She said that key messages included that
staff believed this would be a key factor in terms of improving patient care, as
well as better education and training opportunities, although understandably
there were also concerns in relation to job security and the culture of the two
organisations. Mrs Tracey said that work would continue through staff
conversations (anonymously), in addition to work to understand the views of the
wider population.
Mrs Tracey reported that the Devon Wellbeing Hub, led by the Devon
Partnership Trust, was now live. This was a fantastic resource for staff both
individually and as part of a team, which complemented the resources already
available internally at both Trusts.
There being no questions from the Board, the Chief Executive’s Report
was noted.
59.21 A NDHT PATIENT STORY
Mr Brent reminded the Board that the patient story alternated between the two
Trusts and welcomed Sarah Delbridge, Communications Officer – NDHT, to the
meeting.
Miss Reeves presented the story of a patient who was diagnosed with breast
cancer and underwent a mastectomy and four months of radiotherapy during
the COVID-19 pandemic, surgery (mastectomy).
Miss Reeves said it was a powerful example of the two Trusts working
collaboratively to deliver excellent care, and how successfully a pathway can be
completed. She said it also highlighted areas in which the Trusts would hope to
improve further, and confirmed that Jason Lugg, Director of Nursing – NDHT,
was already progressing a number of these. Miss Reeves invited questions
from the Board.
Mr Neal was pleased to note that, for this particular patient, facilitating trust in
people was of the utmost importance.
Professor Kay commented on the patient’s pleasant surprise at having the
surgical procedure carried out as a day case and the assumption that this was
attributed with cost savings. She suggested that further engagement would be
of benefit to highlight the advances in care and for this to be applied to any and
all conversations in relation to surgical procedure.
Mr Palmer agreed that this was a very encouraging story with areas to develop
further, though he acknowledged that the Trusts were likely to see an increase
in the number of late stage cancer presentations due to COVID-19. He added
that work on one stop pathways was on-going.
On behalf of the Boards, Mr Brent expressed his sincere thanks to the patient
and the teams involved.
The Board noted the Patient Story.
60.21 RD&E TOWARDS INCLUSION UPDATE
Mrs Tracey reminded the Board that she was the Chair of the RD&E Inclusion
Group and she stressed that although each Trust had taken a slightly different
approach in relation in Inclusion, this did not mean there was a difference in
importance for either Trust and, during the course of the next year, the aim was
to align the work of both Trusts. She presented a brief set of slides which had
Board Minutes Public 28 April 2021
Page 5 of 13been circulated to the Board in advance,
Mrs Tracey recapped the approach of the 2020/21 Towards Inclusion Plan,
against which solid progress had been made. She said that although there had
been a slight reduction in the measures used for inclusivity, it was widely
understood that this was to be expected at the start as people felt more
confident in raising issues knowing it would result in action being taken. Mrs
Tracey said it was further expected to see imminent improvement again in these
measures as work progressed.
Mrs Tracey highlighted that one of the most significant achievements was the
establishment of the BAME, LGBTQ+ and staff disability networks, all of which
had Executive sponsors who acted as mentors to the network chairs. She said
that it was important for the work to be driven by these networks.
Mrs Tracey said that the key focuses for 2021/22 were the engagement of
frontline groups, the review of three key policies which tied in with the
presentation from Mrs Foster previously regarding the shifting of culture of both
Trusts, and training/raising awareness. Although the primary focus was in
relation to staff, Mrs Tracey said that this was not exclusive and the staff focus
was also expected to positively impact on patients and the public. Another
priority for 2021/22 was to develop the partnership with the University of Exeter,
in particular through the joint recruitment process to replace Rohan Chauhan as
Trust Inclusion Lead. She invited questions from the Board.
Professor Kay was pleased to note the fantastic progress and she commented
that it was clear to see the positive effect of the systematic way this had been
pursued. She said it was important for the networks to develop allies in tandem
so that those involved did not feel overwhelmed by the work. Professor Kay felt
that the term “BAME” was a marginalised term and she suggested a
conversation with this particular network would be beneficial to develop a more
person centric term. Mrs Tracey acknowledged the importance of this and
confirmed she would discuss directly with the network how it should be referred
to within the organisation. She also commented that the teams were very
conscious of not creating exclusivity within these networks, highlighting that
anyone could contribute to them. Mrs Tracey said it was worth noting however
that feedback received from members of this network was that sometimes they
wanted a safe space to talk freely with those sharing similar characteristics.
ACTION: Mrs Tracey to discuss a more appropriate term for what is
currently referred to as the “BAME” network ST
Mr Orford praised the Trust for the enthusiastic and energised commitment
being given to Inclusion, particularly with Mrs Tracey as CEO leading the work.
He asked whether the actions for 2021/22 were too specific in terms of the focus
on certain characteristics. Mrs Tracey said that this was possibly true of the
focus on career progression for BAME staff, but noted this was proportionate to
its significance. She added that the other four objectives were broader and
more focussed on inclusivity; awareness raising, understanding and valuing
difference and being respectful. Mrs Tracey said this would also link into the
just and learning culture work.
Mr Brent highlighted the need to continue the work across the system to also
understand which areas of the communities served by the Trusts felt excluded
by virtue of their socio-economic situation.
The Board noted the update.
61.21 NDHT & RD&E INTEGRATED PERFORMANCE REPORTS
Board Minutes Public 28 April 2021
Page 6 of 13Mr Tidman informed the Board that patient demand was all almost back to that
of pre COVID-19; whilst this was logistically challenging for the Trusts (infection
control/social distancing etc), it was reassuring to know patients were seeking
the appropriate care. He added that the RD&E in particular had seen a
reduction in Emergency Department (ED) 4-hour and ambulance handover
performance linked to high demand and issues with patient flow, but that a
recently initiated Patient Flow Gold Command approach was already getting
good engagement across both Trusts and with external partners.
In relation to elective recovery, Mr Tidman said that NDHT delivered a notably
higher level of outpatient activity than at any time over the last two years; work
was on-going to try to replicate this at the RD&E. Mr Tidman said there was a
vast amount of planning at both system and Trust level, with guidance being
worked through to ensure the full benefit of the financial incentives are realised
within the system.
Mr Tidman said that staff continued to be supported to take annual leave and
that encouragingly, staff sickness and turnover rates continued to decrease.
Mr Tidman commented that one of the primary concerns was the increasing
volume of long waiting patients, but that a significant amount of resource was
being spent stratifying the risk and ensuring that patients were being seen
according to clinical prioritisation. He added that MY CARE continued to be an
excellent tool to support staff in risk stratification.
Whilst both Trusts achieved a broadly breakeven position at the end of the year,
Mr Tidman said there were still uncertainties beyond the end of September
2021, but this was being highlighted at both regional and national levels. He
invited questions from the Board.
Mr Kirby commented that the report gave an excellent overview and said that it
was especially valuable to see the similarities and differences across both
Trusts. He further acknowledged that whilst MY CARE was a huge advantage,
he was growing increasingly worried in relation to the process and data issues,
and asked whether this was due to distraction and/or an adverse effect.
Professor Harris assured the Board that the teams were utterly focussed on this
and that the issues were being adequately resourced. He praised the work of
both the Divisional and MY CARE teams which was expected to resolve many
of the issues.
Referring to the pressure within the system in relation to nursing and care home
provision, Mr Kirby asked whether the local authorities were providing support to
address this. Mr Palmer confirmed that there was a good level of support
throughout the system and that at the Local Authority and Chief Officer meeting
the previous week, it had been acknowledged that the incentive funding
available for achieving certain targets should also be available to primary and
social care partners.
Mrs Geen enquired as to how the quality of and impact of non-face-to-face
outpatient activity could be measured. She noted that national guidance
suggested a minimum of 25% face to face but added that some specialities lent
themselves more to non-face-to-face than others. Mrs Geen asked how the
Trusts would balance this correctly. Professor Harris said the Trusts had
achieved funding to appoint a Clinical Lead across both Trusts to drive this
work. He added that the 25% noted within the guidance was an aggregate and
that in reality it was very much speciality driven. Given the appropriate focus
this was given by the Non-Executive Directors, Professor Harris suggested that
Mike Browning (JOB TITLE) and Stuart Kyle attend the May 2021 Board
Board Minutes Public 28 April 2021
Page 7 of 13meeting to provide a brief presentation; the Board agreed.
ACTION: Mike Browning and Stuart Kyle to be invited to attend the June AHa/
2021 Board meeting to provide a brief presentation in relation to face to MB/SKy
face versus non-face-to-face outpatient activity
Mr Brent noted that the Emergency Department was not the most appropriate
place for mental health patients to be treated and he acknowledged the distress
this often caused these patients. He asked what system work was underway to
address this. Mr Tidman said that Mrs Tracey was a member of an on-going
steering group with Devon Partnership Trust (ST) where this was being looked
at further, likewise for CAMHS patients.
Referring to the recent public health campaigns relating to, for example, cancer
and stroke awareness, Mr Brent asked whether organisations were given prior
warning of these campaigns in order to respond appropriately. Mr Tidman said
that the Trusts often received notification of these campaigns, but he
commented that it was not always straightforward to react to the increase as a
result, and then step this back down again afterwards.
Mr Brent recognised the challenging diagnostic position and asked how the
Trusts would develop a roadmap to ensure a return to a more robust position.
Mr Palmer said that by moving the cystoscopy service, and with the additional
capacity the Nightingale hospital would provide, it was anticipated that this
would begin to improve within the next 12 months. He added that effective
discussions were taking place around improving pathways and ensuring as
many one stop pathways as possible were in place, as well as highlighting the
importance of early cancer diagnosis.
Mr Neal noted the volume of data relating to patient experience and
acknowledged the reassurance provided as to the process but commented that
the data did not provide much insight as to what this actually meant for patients.
He asked how behaviours and improvement work, such as the achievements in
relation to pressure damage, could be embedded widely and throughout. Miss
Reeves acknowledged this and commented that Mrs Mills was leading a review
of the key metrics to ensure good progress was sustained. She added that the
patient experience was much broader than complaints data, and as part of the
wider work underway the teams would be identifying what could meaningfully be
measured in order to broaden the metrics reported to the Board. Miss Reeves
further commented that the just and learning culture work, and learning from
excellence, would also help reinforce good practice.
Professor Kay asked whether more could be done, possibly in collaboration with
the National Institute for Health Research (NIHR), to increase the research and
training programme places available as this would most likely improve the on-
going recruitment issues in relation to medical staffing. Professor Harris
concurred and added that there was a vast imbalance of training numbers, both
at the previous SHO grade and registrar grade, in the spine of the country. He
added that the South West peninsula was particularly disadvantaged in this
respect and that the national acceptance of this was being addressed.
Professor Harris confirmed that the numbers were gradually increasing, with
efforts to ensure this was also equitable across the Trusts in the peninsula.
Referring to the role of MY CARE in the stratification of risk, Professor Khalil
asked what data was available to provide assurance that the process was
robust, for example when the wait and acuity increased. Professor Harris said
that clinicians were able to see all the relevant information with diagnostic
results and notes more readily and immediately available. This allowed them to
make secondary and even tertiary risk judgements.
Board Minutes Public 28 April 2021
Page 8 of 13Mr Matthews noted that there was not a clear date for resolution of the issues
relating to MY CARE and Venous Thromboembolism (VTE) data and he queried
whether this could be masking potential patient safety issues. Professor Harris
assured the Board that substantial efforts were being made to address this and
he highlighted to the Board that these were best practice advisories which
reminded staff to complete assessments. Compliance had already increased
from 50% to 79% since these were switched back on, having been inadvertently
temporarily switched off. Professor Harris confirmed that there was no evidence
of increased harm as a result of this, the assessments had been taking place
but had not been recorded, and there had been no increase of Pulmonary
Embolisms or VTE’s as a consequence.
The Board noted the Integrated Performance Reports.
62.21 RD&E & NDHT STAFF SURVEY RESULTS
Mrs Foster reported that although NDHT had seen an increase in the response
rate, and the RD&E a slight decrease, this was due to the difference in
approach to engagement. She added that work was underway to align this.
Mrs Foster highlighted that this was the first year that both acute and community
were benchmarked together as one group; as a result of this both Trusts were
benchmarked against the same group.
Mrs Foster said that of the ten key themes, the RD&E performed below average
against similar Trusts on four of these themes; quality of care, immediate
managers, safety culture, and team working. She added that immediate
managers and quality of care had also declined since 2019 and work was on-
going to address this.
Mrs Foster was pleased to report that despite a slight decline for the immediate
managers theme, NDHT still achieved the highest score across the
benchmarking group.
Mrs Foster commented that, at first glance, it appeared that work relating to
annual leave had had a positive impact on staff sickness but further analysis
would be undertaken to substantiate this. She invited questions from the Board.
Noting the slightly better performance at NDHT than the RD&E, Dr Douglas-
Riley acknowledged the huge cultural shift that had occurred at NDHT as a
result of the Collaborative Agreement, and he asked whether this could have
negatively impacted on the RD&E due to a possible perceived reduction in
leadership. Mrs Foster said that the external company that undertook the
survey on behalf of NDHT had reflected on some of the leadership changes
over the last few years. She added that the rise could sometimes be slightly
artificial but that the best of both Trusts would be fed into the cultural
development work.
Mr Down asked whether there were any lessons to be learnt in a more
systematic way as to why there were such differences between the best and
worst nationally for staff sentiment. Mrs Foster confirmed that work was
underway nationally to look into this, with much more intelligent thinking as to
what was being measured and how; this would be linked to the STP best place
to work programme, which in turn would better inform plans.
Mr Matthews expressed concern that the quality of care theme had declined for
the third consecutive year at the RD&E and he asked whether there were any
early indications as to whether this was localised to a specific Division or
department. Mrs Foster reminded the Board that a deep dive had been carried
Board Minutes Public 28 April 2021
Page 9 of 13out into this within the last few years which showed it was much less of a
concern amongst clinical staff, and so a great deal of work had taken place as a
result of this with non-clinical staff. Mrs Foster stressed the need to understand
whether this was still the case; if found to be so, it could be linked to
misconceptions similar to that highlighted within the patient story around day
cases being a cost saving. Mrs Foster said that as part of the engagement
strategy being developed, further work was planned to help managers have
more holistic management conversations. She said that confirmation of
completed actions would be reported to the People, Workforce Planning and
Wellbeing (PWPW) Committee.
Mr Orford noted that despite benchmarking ‘above the average’ 4% of staff
reported to have experienced discrimination and he said it was important to
acknowledge this was still not acceptable. Mrs Foster concurred and reiterated
the importance of the inclusion work and obtaining qualitative data.
Mrs Tracey reminded the Board that this was but one of the tools available to
the Trusts. She added that teams with over 11 responses were able to receive
their collective team responses.
Mrs Foster said that an improvement in the immediate manager score was
expected to positively affect a number of others as well.
Referring to integration, Mr Brent asked what the Trusts were going to do to get
smarter. Mrs Foster said that the cultural plan was due to be discussed and
developed at the joint Board and Council of Governors Development day on 12
July 2021. In addition to this, she suggested that a further update be provided
at the June 2021 Board meeting in relation to the quality of care theme and
management development.
ACTION: Mrs Foster to provide a further update to the June 2021 Board
meeting in relation to the Staff Survey, specifically the quality of care HF
theme and management development
There being no further questions, the Board noted the report.
63.21 NDHT GUARDIAN OF SAFE WORKING REPORT Q4 2020-21
Professor Harris reported that there were eight exceptions in Q4 2020-21, all of
which were F1’s who had been asked to work additional hours. He confirmed
that all of these had been resolved.
Mr Brent said it was important to keep promoting the value of exception
reporting.
The Board noted the report.
64.21 RD&E & NDHT AUDIT COMMITTEE REPORTS
Mr Matthews informed the Board that the RD&E Audit Committee (AC) had
received an update from Internal Audit which included minor amendments to the
Audit Plan for 2020/21, confirmation that three further reports had been finalised
and all provided significant or satisfactory ratings, and they also provided
assurance that although there was still a substantial amount of work outstanding
before the end of the year, this would be finalised in time for the May 2021 AC
meeting. Referring to the recommendations where due dates had been
extended, Mr Matthews reported that the Audit Committee (AC) had received
Board Minutes Public 28 April 2021
Page 10 of 13some assurance that the new process required a higher level of approval,
therefore there continued to be a reduction in the overall number of those with
extended dates for actions. He commented that, where appropriate, further
action was planned to incorporate the actions that were still unclear into the due
diligence process for the proposed integration.
Mr Matthews reported that the AC had received and reviewed the final
Pricewaterhouse Coopers (PwC) report on the fair value valuation for
accounting purposes in respect of the MY CARE programme, and the AC was
assured that reasonable judgements had been applied.
Mr Matthews commented that an update from KPMG had been received, which
indicated that good progress had been made with one relatively minor
recommendation which had arisen from the interim audit visit.
Mr Matthews highlighted to the Board that a significant amount of additional
work had been required of the external auditors under new auditing guidelines
this year in respect of the Value for Money (VfM) opinion. The new requirement
would result in a more extensive narrative relating to VfM within the Annual
Report.
Mr Matthews reported that KPMG had highlighted a heightened risk in relation
to financial sustainability, as a result of which they would be carrying out
additional work as the audit was progressed through to final opinion.; this would
be explained in further detail in the confidential meeting of the Board.
On behalf of the NDHT AC, Mr Orford reported that in addition to the
consideration of a number of Internal Audit reports, a review of the Standing
Order/Standing Financial Instructions had been completed and the proposed
amendments would be presented to the Board for approval in May 2021.
Mr Orford informed the Board that the External Auditors were likely to report in
their VfM opinion that they had identified a significant risk to financial
sustainability and that whilst the outturn deficit of the Trust had been recovered
in year, there remained a risk to the medium-term sustainability given the
underlying deficit across the Integrated Care System (ICS). Mr Orford said that
reducing the deficit would require close working with the wider ICS and
successful implementation of a longer-term strategy.
Mr Orford commented that the main item of business had been the Draft
Accounting Statements for 2020/21 and he confirmed that the Going Concern
opinion on the draft accounts was that ‘there are no material uncertainties that
may cause significant doubt about the Trust’s ability to continue as a Going
Concern.’ The AC noted the achievement of performance against the Capital
Resource Limit, and a proposed disclosure to the accounts relating to the
proposal for NDHT and the RD&E to ‘merge their operations, asset and
liabilities into one single new Trust subject to review and approval by the NDHT
Trust Board, RD&E Board of Directors, RD&E Council of Governors, and
NHSE/I.
Mr Matthews and Mr Orford invited questions from the Board.
Mr Down asked whether the External Auditors had commented on the Going
Concern opinion and whether this was reflected in the notes of the accounts.
Mr Orford confirmed that the External auditors were satisfied with the Going
Concern opinion. Mrs Hibbard added that there was very clear national
guidance in relation to the Going Concern opinion which was to do with the
likelihood of continuation of services rather than the legal form of a Trust in its
own regard.
Board Minutes Public 28 April 2021
Page 11 of 13There being no further questions, the Board noted the reports.
65.21 REVIEW OF THE RD&E BOARD SCHEDULE OF REPORTS
Mrs Holley said she would take the report as read, inviting questions from the
Board.
Mr Neal noted that although the schedule included MY CARE updates, it did not
contain anything in relation to digital in the wider context. Mrs Holley confirmed
that the new Digital Committee would report to the Board after each meeting
and this would be reflected in the report schedule.
Mr Down queried the removal of the key strategic issues discussion. Mrs Holley
clarified that this would no longer be a standing item but would remain on the
schedule with a frequency of “as and when required”.
As part of the Trusts’ net zero obligations, Mr Tidman suggested that an Annual
Sustainability & Development plan should be added. Mrs Holley noted this.
The Board noted the report.
ITEMS FOR ESCALATION TO THE NDHT & RD&E BOARD ASSURANCE
66.21
FRAMEWORKS
The Board agreed that there were no items requiring escalation to the Board
Assurance Framework, noting that this was also due to be reviewed in full
during the Confidential Board meeting.
67.21 ANY OTHER BUSINESS
There was no other business.
68.21 PUBLIC QUESTIONS
Mr Brent invited questions from the public. 3.29
Tim Bolot, a member of the public, asked whether there were any specific
factors that indicated why the positions relating to Hospital Acquired COVID
Infections were so different in terms of the infection prevention controls,
assurance practices and ward accreditation. If so, he asked whether there were
any practices that could be spread from the RD&E to NDHT to improve quality.
Miss Reeves confirmed there was already a good process in place for the
sharing of practice in general across the two Trusts. In relation to this specific
point, she said work was on-going to understand the detail and a more
comprehensive response to this question would be provided on both Trust
websites, and emailed to Mr Bolot once the work was complete. Mr Bolot
further asked whether it was an accurate reflection that one Trust experienced
more than the other. Professor Harris said that further work was required to
analyse the data in greater detail as it was not believed to be quite as the data
appeared. He added that small variations in data had a big impact on the
overall position at NDHT due to the fact it was a smaller organisation.
ACTION: Miss Reeves/Mr Lugg to provide a more comprehensive
response (via email and on the Trust websites) to the question raised by a TR/JL
member of the public (Tim Bolot) relating to the differing positions across
Board Minutes Public 28 April 2021
Page 12 of 13the two Trusts with regard to Hospital Acquired COVID Infections
Michael James, a public governor, was pleased to note the excellent
communication between both Trusts, particularly for the patient in the patient
story. He commented that the appointments telephone system needed further
adjustments however and said he would contact Mrs Holley with further detail.
Sue Matthews, a member of the public, commented that similarly to the patient
in the patient story, a high number of patients had been asked to attend the
RD&E for both MRI scans and ECGs rather than NDHT, reportedly due to the
quality, and she asked whether there were any clinical concerns. Professor
Harris confirmed that there were no clinical concerns at either Trust in regard to
either the MRI or ECG scanners, nor the individuals operating them. He added
that it was likely the reason was due to the fact there was a higher resolution
MRI scanner at the RD&E.
Sue Matthews further asked whether it was possible to see the potential impact
of staff fill rates at ward level, and whether there was likely to be a staffing
review as part of the issues around e-rostering. Mrs Tracey commented that the
Board had made an intentional decision not to report staff rostering at ward level
as it was too operational in nature, and the Board should instead be provided
with assurance that there was a clear and robust process of review. Miss
Reeves confirmed that this was the case, adding that both Trusts carried out
regular establishment reviews. She said that this was a detailed process which
looked at the acuity of patients, national benchmark information and the
correlation with sickness and fill rates. The processes were overseen by Mrs
Mills as Chief Nursing Officer and would be aligned between the two Trusts in
the coming months.
In relation to the patient story, Rosie Howarth-Booth, a member of the public,
commented that overnight stay availability was a very important contribution to
the overall experience. Mr Brent said this was widely acknowledged.
Rosie Howarth-Booth asked, if the input to staff surveys was anonymised, how
would those staff who had responded poorly be identified in order to get them
involved with co-designing improvement. Mrs Foster reiterated that the data
was anonymised, and only the data from teams of 11 or greater could be shared
to ensure no individual could be identified. She added that the free text fields
also provided further detail, this was again anonymised.
There being no further questions from the public, the meeting was closed.
69.21 DATE OF NEXT MEETING
The date of the next meeting was announced as taking place at 9.30am on
Wednesday 26 May 2021 via MS Teams.
Board Minutes Public 28 April 2021
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