Up and running can I ask everyone to go on to mute please are we recording Erica I’m just waiting for a confirmation of the live feed Richard yeah just confirmation of the live feed please Richard can you just bear with me for a minute please while that’s happening I can tell
You that some of the staff at Kint the hospital in great voice in The Carol concert that’s just taking place now wonderful most though most of the staff watched and refused to come down and join him but those of us who did had a a
Very nice time for the last half an now it’s lovely so you s as well Simon sadly yes but I did find out that Melissa who runs the booking um service is a proper performer her stage name is Mitsy and she does musical theater by the sound very impressive just Melissa just
As long as you don’t have a stage name we’re all fine don’t worry there’s no danger that as some Co some colleagues here will know my school name was Smurf but I’m not going to go on the stage as Smurf okay Richard are we up and running
Now okay great can everyone please go on to mute okay well welcome ladies and gentlemen to this the final was acute a public ball before um The Christmas break um and we’ve had a busy morning already we’ve been talking about our work on Flow and finances we had a
Very interesting presentation from the team on Hospital acquired functional decline which is one of our real challenges when we have such a long length of stay and some of the dischar charge challenges we’ve got within the trust which the team are working on uh we then had a presentation from hannen
Lancaster our chief operating officer on our winter plan um lots of good work going on and uh we will cover off a bit later some of the um very small green shoots in terms of the work we’re doing on Ed s De and FY which we think will bear more fruit
In in calendar 24 and then we had a discussion on our financial challenges and the work we need to do to ensure that going forwards our finances are in a healthier State uh we have apologies from Christine Blanchard but welcome to jwes uh we also um I’m delighted to
Announce Michel Lynch will become an associate Ned with us uh from January so really pleased about that Michelle and today is the last Board of Tina rickets who’s been working with with us now for six years as our chief people officer uh Tina we’re very sad to see you go we
Wish you all the best at Dorset you’ve done some wonderful things um with um our vacancy rates for example I think when you arrived we had almost 250 nurse whole time equivalent vacancies and now it’s it’s below 100 uh the well-being work that you’ve done particularly on
The networks has been fantastic so you will be great missed and we wish you well for the future um we have a pretty busy bold so I will keep things uh moving at a pace uh the first is are there any new Declarations of interest uh
Tony CH it’s not a declaration but I think we also have apologies for non-executive director Ken HTH who’s on leave okay thank you um and uh any Declarations of interest and colleagues please raise a digital hand hand can’t see any digital hands raised um so the minutes of the meeting held on
The 19th of October if you weren’t happy with the accuracy of those minutes could you please raise a digital hand I can’t see digital hand rate so I’ll take those as an accurate record and I think we just had one uh matter arising which was with respect to the chart um and
Uh we’re going to continue just with regular updates on that aren’t we Tina okay yes we are yes okay super um so are there any matters arising that colleagues feel I have missed please raise a digital hand okay so we’ll move on then it’s um
Been a a busy week and it is busy obviously with the junior doctor strike and other things are going on um but uh Glenn how are you seeing things the chief Executives report please thank you chairman there’s a few things in my report and obviously we’ll talk about some of those other operational
Challenges later on particularly when we do the performance report I start by talking about the NHS Finance position and the productivity Challenge and and a lot of this stems from a a financial reset process that’s gone on across the NHS as a result of a request for the
Treasury for additional money so two billion was asked for and 200 million was given um so what that led to was a a review of some of the national budgets um the 200 million that had been given in the summer was being held centrally so that’s been allocated out locally so
The combination of all of those things uh has been some additional money for support of the cost of industrial action um and um and a change to the way that the uh elective threshold is calculated both of which bring some addition funding into the organization but um we Face huge cost
Pressures so we I won’t I won’t steal Neil’s thunder in terms of the detail of all of that but the the result of that reset process um and the emerging challenges around delivery of this year’s financial plan have led to us being in a in a certainly in a
Challenged place as an organization and I I’ve had uh meetings with the regional national team to to discuss the consequences of that uh um all of which has led to some of the actions that we pick up in this report so the um the fact that we we we’ve gone into a
Financial turnaround mode uh we have Finance recovery board um we have brought in some of the skills from elsewhere in the group in terms of just helping us to look through the detail of those plans and look for opportunities so uh and we spent some time this morning looking at the initial findings
From that um so that will give us some some actions that we can put in place in the short term but also more importantly develop a longer term financial plan um and and what I want to see with that plan and what we all want to see with
That plan is the connection between the financial recovery but the improvements in flow uh and the improvements in in both uh performance against some of our key standards but also the quality of service and the outcome for patient so I think I think there is a a virtuous
Circle there we can ensure that we stick to um we um though as an NHS will will be challenged on the um the preco and postco um staff headcount numbers um and if you look at most parts of the nhhs there’s been an increase in in headcount um that is not necessarily fully
Explained through uh changes in activity um so I think a focus on productivity is perfectly appropriate bearing in mind we spend a large amount of Public Funding so that’s something that we will certainly be looking at as a board and will feature as part of our objectives for next
Year uh I also talk here about uh a rewrite of the intelligent board um guide um which should be out soon and within that actually we’ll talk about some of the metrics that boards can look at to look at productivity um in a different way um and um and then I move
On to talk about volunteering um we had a great talk at our four boards meeting um from Sir Tom Hughes Hallet who um who has led the um the help Force um movement uh across the NHS and and I know that Sarah our chief nurse has
Connected in with him and we will be um doing some uh lots of interesting work on volunteering across the group and we’ll be sharing the learning from that which um will um help to improve care to our patients it’s probably a good time at this festive period to say thanks to
All our fantastic volunteers that we already have so so so thank you for the work that you do um I then talk about leadership Development Association of groups are doing some work on this um developing a development program that connects some of the individuals working in these various group models across the
NHS but then complementing that with the work we’re doing locally within the organization then also some group level teachings on various subjects which will will get off the ground um uh next calendar year um and then we’re going to hopefully you you’ll get used to the structure of my reports move forward we
Tred to just drill down into one or two areas within the organization just to explain a little bit about what’s going on so we talked here firstly about the staff psychological well-being service which was created during covid but absolutely is needed moving forward and we should have had it before Co actually
As an NHS and it’s great to see that um that’s now now being given permanent funding and is’s making a real difference to the well-being of our Workforce um uh and then a little explanation about py rehab team and the great work that they do um to um support our
Patients um and then I’m happy to take any questions chairman thank you very much Glenn any questions or perspectives to Glenn Simon and you mentioned rack um in the report I’m not aware of that being major issue for us it or if you just clarify
On where we are with rack please yeah so the bigger issue for us will be the impact on the national capital budget for the NHS because there are some sites elsewhere that have serious rack issues we’ve got a small issue on the kidster site but but nothing too material but My
Worry is that without any additional Capital funding being announced in the Autumn statement the priority now will go towards those sites with bigger problems so it’s it’s going to be a challenging Capital position next year for the NHS I think there was one Hospital in the north where the rack uh
Refurbishment costs are running into something like 400 million um any other questions to Glenn okay just two quick things for me Glenn and then we’ll move on to you Stephen the first is just to uh reinforce the thanks you gave Glenn to our volunteers Sarah shinga Simon and
Myself attended the Christmas lunch for our volunteers and again just to further say we can’t thank you enough for the help you give day in day out uh to the well-being of our patients and as Glenn said we do have ambitious plans going ahead uh for even more volunteers so if
Members of the public are wondering maybe when you’ve retired or you’ve got some free time um what to do with that uh we would love to welcome you uh into the fold of the werer um hospitals uh to help us give even better service to our patients the second is just on
Productivity I know everyone focuses on the headcount numbers Glenn when it comes to the increase in the workforce I do think part of the issue is the growth in part-time working across the workful so whilst the headcount is going up the number of hours isn’t and so I think the
More we can get get into hours as our thinking available hours of capacity rather a whole time equivalence rather than just numbers I think it’s helpful but you know that okay we’ll move on then to the integrated performance report uh Stephen do you want to introduce this please yeah I’ll
Introduce and just to just quick couple of lines and introduce myself as a first board so Steven Coleman managing director um really I I won’t dwell on it too long and I won’t steal other people’s Thunder but building on the work that we did at the development
Session and for those uh watching or in person um really the the the main thing that I want to pull out is around the floor that’s the golden thread that you see through all of it which is if we have patients that are attending our emergency department and they can’t move
Out the department in a timely manner that impacts on our ambulance Handover performance it impacts on our Emergency Care standards I think more importantly for me it also impacts on our staff experience and how they’re able to do the job so it’s it’s crucial for that we
Then if we see extended lengths of stay in the hospital we start moving into what we call unfunded capacity so these are probably areas that are not ideal for patients to be in they’re safe but they’re not really where we would want it to be we tend to do that through bank
And agency staff as well so there’s a consequence on the money there’s also a consequence on the quality because we’re we’re looking after so many patients so what we’ve started to detail in this and and Helen will touch on is some of the schemes that we would do traditionally
Through what we would look at as winter I think two bits that I just want to pull out for board on that though that I think are really important we’ve got to move the organization being in that reactive position of doing this as it as
As it kind of escalates up and doing it and you’ll see in some of the schemes that’s the approach that we’re trying to take and and with that it’s schemes that we think will work and will demonstrate improvements in January and we’ll feed that through to board but they’re the
Right things that we should be doing so we had the presentation of around fry so increasing fry in the next year is going to be crucial for us along along with another another other services that we’ve got and the bit that I really want to go through as well and really emphasize to
Board is this is divisionally Led so these are our clinicians that are coming up with these ideas and and are working on them so so there’s there’s a high degree of Buy in from the divisional leadership teams around the success of these and we’ll track it very closely
We’re still in tier two for Urgent and emergency care which is the national kind of escalation so tier one being the most challenged areas we’re in tier two it’s particularly around long ambulance weights and we’re really focused on that uh just the other bit on on um
Performance is around cancer and hen no touching it we’ve got two areas that we’re working really hard on that are causing us the challenge Dermatology and neurology we’ve had a number of visits we’re we’re looking for support from others in terms of how can we improve
What do we need to do to do that so we’re working through detailed plans on that that we’re in tier one for that for those cancer performances and just the other bit I did want to pull out and is really nice in a in a in a way for my first report
So I have absolutely no credit for this but I can see Justin on in terms of the CQC rating good for maternity which came out after the last board um but I’d hand over to Helen if that’s okay Russell it’s that golden thread of floor that we
Just need to keep absolutely focused on and if we drive down that length of stay use our same day emergency care services a lot more we’ll start to turn the dial on all those metrics that we really need to move around quality performance and money so Helen if I hand over to
You uh thank you um Stephen so um just wanted to um for the purposes of board talk through um some of the uh winter plan and and the flow um metrics and the flow program that we are now seeing um come to fruition and because that’s actually real time now whereas we know
That the the board report is actually a look back so I’ll come back to some of the performance issues but really wanted to talk through some of the key things that we have um done um for the winter and are all um all up and running um as
We speak and so the single point of access started on the 1st of December we’ve done some movement around moving our surgical s deck actually our Medical de and our Cardiology s DEC all down into the old Ed footprint which has now almost become a multi-p specialty es DEC
Um area so there’s some real opportunities for us with that to really challenge um some of the pathways through there and push the boundaries a little bit in terms of um not admitting patients and and seeing patients in an ambulatory um way which is which is much
Better for the majority of patients and trying to keep them home for as long as possible possible um our uh our virtual Ward program around um respiratory um hopefully we can start um between January and February so that’s um um a a really really good program in terms of
Getting patients home sooner um we’ve got um a number of additional things we’ve done around supporting weekend working with um Junior doctors to support further discharges and we’ve also opened some additional capacity so we’ve we’ve got um we’ve opened two Wards one here um on
The Worcester site at 22 um beds and 15 beds at the Alex and then an additional beds um uh eight beds um which we had to do when we had a norovirus outbreak on medical EST DEC and then we’ve got 24 Flex capacity beds um open so all of
Those schemes are in place now and and and working now I’m not saying that this it’s all going to this perfect but to day um with everything all um working we have gradually um felt a to be in a in a slightly better position over the last
Two or three um days so we came in this morning to only one ambulance Handover delay over the hour um during the night on the Worcester site and that was um that that could have been avoided that was a bit of a mistake an Neil I think
You were on call last night and you you told us that actually it was a um where the ambulance had parked um and then we’ve only had four at the Alex and so in terms of that performance um and that they were overnight they were from midnight but since um six o’cl this
Morning we’ve had um we’ve had nothing um we have flow in the Ed so we have capacity in the Ed empty cubicles and that’s allowing us to move the long waiters out of Ed into the beds that we have got and we have got um our bed
Occupancy currently at the moment is 95% which means that we have got flow so some real positives um across uh across the organization in terms of supporting that flow it feels better for staff it’s much much safer for patients and actually we’re driving then that ambulance Handover performance um really
Really strongly now in terms of holding uh holding the line on that so this is what having capacity does having good schemes putting things all in the right place it gives us that flow to start to make the difference so um it’s really really imperative now
That we start to drive down the length of stay um across um across the whole organization it’s about um 8.4 at the moment across the non-elective um Pathways it needs to be closer to six and if we can get it to six then we fit in the bed base without boarding without
Corridor care and all of those things and that’s the that’s where we need to be so that we fit into it fit into our bed base so the teams are all um fully engaged um in that sort of small um amount of schemes because we absolutely
Know they work and as Stephen was saying we taking that opportunity um to test all of these things during winter because many of these things really really should be our business as usual but we just need to demonstrate that they uh that they work so that’s really
That first point um Russell that I wanted to um discuss I do have a another slot later on where I’m talking about the performance so shall I finish there um or do you want me to keep going no just keep on going Helen because like you said the performance is historic so
It’s what you’ve just said is more helpful so if there are any people can obviously read the report ladies and gentlemen the report is available for public consumption but if there just any sort of relevant points to today out of the report that would be great but what
You’ve done already has been very helpful yeah thanks um Russell so just um a few key points on the positive um that was met the um the national milestone for the 28 day faster diagnosis standards in cancer so um during um October and November so that’s
Um really positive and we have had um a um intensive support team visit from um the cancer team and we’ve received feedback on that and there is an action plan that’s going through cancer board to address those issues um I just wanted to uh we’ve had um the new theat
Obviously um opened and um we are um improving our elective recovery positions the only thing that we’re slightly under is our impatient and day case um activity and but we’re over plan for um all of our other metrics in terms of our elective recovery so really positive um on that positive position on
DNA rates and um piu I think the challenge for us as Steven said is cancer and we have two particular Specialties um that are causing the majority of our 62 day um backlog and the challenge is um in in our faster diagnosis standard and that’s um Urology which we’re um receiving Mutual Aid
Support um from Northampton and there’s a there’s a a significant plan um around um Urology and we approved a business case in uh trust management board yesterday to um start to improve the diagnostic pathway through Urology and the other one is skin and that’s um I
Think the board fully has been cited on the challenges that we have with our Dermatology and our and our skin service so they still remain our two challenge Specialties and but cancer is recovering across all of the other tumor s sites so if we can make some inrs into Urology
And dermatology then our cancer performance will recover a lot a lot quicker so there are plans in place to do that I’ll just take any questions then Russell thank you Helen very helpful and bold colleagues we’ve been well briefed and versed in a lot of what
Helen’s been briefing us on just now any questions or perspectives to Helen uh Simon Ju Just a couple for me um very pleased that we got the single point of access working now at previous board meetings we would get stats demonstrating how many people didn’t need to be an Rae and they were
Generally over 20% at the Royal and wersan and sometimes over 30% at the Alex so hopefully we’re going to see some real positive impacts through the single point of access I look forward to that data coming out in due course ju just a question on as you go through the
IPR a number of the sections have as a risk clinical engagement and I just wonder if you could describe what that is and what we’re doing about it if it if it is a risk it was in several of the uh the sections thank you yeah thank you Simon
And and this is something that and the exec team have been um we’ve been working on with the divisions particularly through the um the trium so Sarah um myself um and um Christine and also um Steven since he is coming to post is really thinking about how we get the divisions
Really to own some of the challenges but also come up with the plans to make things better because they absolutely do have all of that knowledge all of that experience to be able to think well what would make that make that difference so those are the conversations that we are
Having asking the teams to start coming up with those Solutions and really trying to give them the permission to get on get on and do the things that um need to be uh done we’ve also talked about the potential of what the actual about merging um the ueec division and
The specialty medicine um Division and really work on uh I’ve just met with um uh one of the clinical leads um um in between um the board uh workshop and board now really to talk about so so what would our plan look like moving forward around how we engage a number of
Those clinicians I in in the things that we need to do particularly around um driving down um that length of stay because that’s the key driver for us because if we can drive down the length of stay it makes a makes a difference across everything also talking to the
Surgical division around how we can maximize those opportunities through a number of Specialties and how we right siiz some of the bed base and if we right siiz some of the the bed base for the surgical Specialties there’s are expectations around what is then um delivered but asking them how they think
That should be should be done so they’re the types of conversations that we’re starting to have Simon and and I’m hoping that that will start to pay off because the winter schemes have all come from the divisions in terms of what they think um should be put in place and and
Working so the proof will be in the pudding no thanks Helen um guys we’ve got an awful lot to cover so can we keep um uh um questions and answers as short as possible Richard we do thank you and thanks alen I’m very positive about what you’ve said
And the things that I’ve seen put in place and the first results that you’re seeing um one thing that I didn’t really read is how we kind of bring our outpatient follow-ups further down is there is there anything done on that yeah so so that is a a longer um
Piece of work um due to the fact that we do have um a lot of patients in that follow-up um that backlog um uh section and so working through what the risk is in those patients that have got a uh in the backlog and making sure that we
Understand what the clinical risk is in through there so there’s some validation pieces that the teams are doing looking at those patients looking at um whether the clinical risk and whether they can be discharged when they can be discharged to a pffu or whether they
Need to be seen so that’s going to take us some time to work that um through Richard but hopefully we’ll bring some more detail back on that when the piece of work’s finished thanks Helen thanks Richard and finally nil then we’ll move on H yeah thank you thank you Russ I just wanted
To come back to uh to the winter plan as hen said I was on call last night I can confirm it is brilliant it does work um however as we discussed earlier in the day it’s not currently affordable within the projections that we’ve got and the
Uh the plans that we lay down around winter by about 400,000 we agreed with Helen the mitigation plans very much built on doing the right thing for patients reducing the length stay clearly we don’t achieve that that is a Financial Risk to us we just wanted the board to
Be aware of that yeah no thank you Richard we did discuss that Neil we did discuss that earlier uh Glenn yeah I’m sure we’ll touch on this later as well I think the key for me on this is to if if we manage Urgent Care appropriately in the way that Helen’s
Described with capacity in all the right Specialties for the patients to go into their beds first time that will give us elective capacity also that will ensure that we deliver our income Target so I think whilst there is a cost pressure here um failure in in in in those other
Way as well as being not the right thing for our patients would cost us more money yeah no we definitely with a a length of stay of nine days going back to the hospital acquired functional decline our patients non-elected patients are staying too long in our
Hospitals we need to help them get home faster and that will create flow um thank you very much Helen thanks for your hard work uh great summary we’ll move on then to quality and safety we’ve got some good news on maternity lovely to see Justine on the call as well um
But uh I’ll start off with Sarah Sarah over to you thank you chair um so um we you’ve got a really detailed report on on quality so um I’m I am pleased to see that as you’ll see that the um Hospital acquired harm um is reducing and and I
Think that’s Testament to the staff and the hard work given the challenges that we do have at the front door um and the extra escalation areas that we have got open but there’s nothing chair that I really want to escalate um and happy to take questions um along with
Juls yeah no that’s um uh Jules is there anything you want to add um I know you’re standing in today for for um Christine but anything you want to add on quality of safety no thank you chair I’m happy to take our section as R and have to take any questions else
Necessary okay great any questions or perspectives to Sarah or jwes Richard yeah just one related to this action and that is really the action plan related to Fed neof femur this has been a topic that’s been on on on the agenda for a couple of months already any progress on this
George you taking that yeah happy to um thank you Richard yes it is an ongoing AA of concern for us um there is a plan in place to get back together with the directorate um in the new year there’s been some challenges around Operational Support in that area and I think you’ve
Previously articulated concerns around some of the governance structures in place so we just need to work through that um but that’s all kind of sitting within um the cmo’s uh line of sight so to say so should be fixed for the new year okay thanks Jor Helen is there
Anything you wanted to add to that yes yes and and and some of the challenge that we do have around this is um capacity within um the trauma footprint to bring those patients out of Ed into a bed so they can then go to um theater so
Um obviously flow here again is the key so if we’re not outlining outline from the medical point of view into the um surgical beds then we’ve got surgical beds that are free then um to bring the fractured NECA FEMA patients through so we’ve extended the um SAU footprint so
That there’s the ability to bring more patients through um SAU to be able to support some of that early assessment and see as many patients as we can do to see whether they can go home or not so we’re starting to free that capacity there’s a further stage that we’ll need
To be thinking about the other side of Christmas probably towards the end of January where we potentially right siiz the surgical footprint which puts some additional beds back into trauma which will then allow um all of the um kns to go straight to a bed um in the trauma um
Footprint so they can then go straight to theater so there is a plan there it’s just going to take us a little bit longer to um resize that no great thank you Helen thank you Richard and Tony yeah thank you chair my question is about delivery of performance on sep 66
Bundle cuz we seem to be in a bit of a downward Trend over the last few months and it seems to be a bit of a mixed bag in terms of what we’re delivering better and what what seems to be a struggle for us so I just like to hear the level of
Confidence that we can turn this back into uh an improving performance please thank you and Sam do you want to go on that one or it’s actually sits to the CMO Russell so I’m gonna go back to Jo thank you I’m happy to respond to that chair
Um so Tony we’re just in the process C of of of moving the sepsis screening bundle across from um essentially a paper based kind of audit onto the new epr so that is in progress so we’ve got a double data set running at the moment um which obviously means that neither is
Particularly strong while we’re transitioning from one to the other which is why the screening figures are quite fluctuant we’re confident in the delivery of the actual elements so the anics within an hour which is the key piece is still kind of there or there abouts um as our the other important
Components um and we’re just tracking our mortality indices as well with sepsis and those are still very well within expected range um I’m optimistic so we’re doing quite a lot of work with the clinical epr team just to try and iron out some of the tving problems with
That data transition from one to the other um but it may well be still fluctuant for for a bit until we get that data capture right um so it just to warn the board it may the screening element may still be a little bit unpredictable um for for the next month
Or two until we just iron all those bits out okay thanks Jules keep us briefed because obviously it is a concern okay colleagues we’ll move on then to the workforce part of um the pack uh Tina what would you like to pull out here um just some good news to start off with
We’re still still seeing an improving directory for our staff turnover and our vacancy rates um and we’re on track to deliver our Workforce plan for this year the three areas of concern for me are um a agency spend we’re not seeing any reduction in fact we’re seeing an increase um this month particularly
Around medical um so we are focusing on our medical Recruitment and obviously working with the divisions on plans to swap out the high cost agency where we can part of the agency has been driven by the increase in sickness absence this month we have seen an improvement in the
Long-term sickness absence but we are seeing an increase in short-term sickness absence and we’ve got lots of cold flu and uh Co around um at the moment but people have been more sociable in the festive period so that’s a focus for my team as well and then the
Third area of um concern is the job planning um regards to compliance but quality um and we do need to do a big piece of work about um for that and doing starting with a um demand capacity profiling to make sure the job plans in
Line to what we need to deliver but we made a first step that today by um agreeing the job planning policy through trust management board this week and that gives us a platform then to start um doing that demand capacity modeling so happy to take any questions great
Thank you Tina and and just obviously because we’re now in December um uh this report refers to some time ago so are we seeing any Improvement in those agency spends now no not we’re still seeing the um agency rate slightly deteriorated in um in November and we’re still um we’re
Still seeing they been challenged this month as well due to the sickness absence okay great thank you Tina questions and perspectives to Tina obviously essential we grab and control that agency cost which we’ve talked about um Richard yeah very quickly I I actually think it’s going to go up a little
Further Russell give the the winter but um aside from that I think job planning is the really important topic here Tina and it’s great to have the policy is there any expectation on when you think we’re going to have um improved job planning especially in
Surgery it we we we need to start this is agreed as the executive team as a priority um piece of work and I think it um in the board development session this morning around the demand capacity piece and that’s a bit that we need to do
First to be able then to make sure we’ve got the right um job plans in place so if I can come back outside of the meeting Richard with a timeline for that please okay thank you Tina and Karen thank you chair um Tina just to go back to the agency spending obviously I’m
Aware that there’s been a significant amount of work and um research and understanding our position and and what the drivers are behind that um and I guess I just wanted to test the level of confidence now in relation to the controls that we’ve got in place and
Whether we feel that that has tightened up and that we’re comfortable with the level of controls we’ve got in place for authorizing bank or agency spend so on um for non-medical yes for medical there’s still some um room for improvements we have got a standing operating procedure in place but we’re
Still seeing a number of retrospective approvals coming through the main difference between the two staff groups is we’ve got all of our clinical Workforce on er- rostering where we haven’t we’ve got different ER rostering systems and not the oversight for medical and that’s something that we
Need to to put in place to B to make sure we’ve got better controls so it’s still um work in progress but we have got regular audits being undertaken and we’ve got the internal Auditors doing that review of the medical banking agency in January back but leave Glen yeah GL yes
So this was an area that was reviewed as part of that piece of work I referred to earlier which we we had a little bit of feedback on in workshops so there’s I think the controls around agency and recruitment are are reasonably solid um we’ll look at this in more detail in the
Finance recovery board but I think this for me the separation between the day-to-day use of agency versus the additional areas that we we’ve actually decided that we’re opening up for capacity would be a useful way of separating those two points because some of this we’re planning to do and some of
This needs a bit more grip and control okay thank you K did you want to come back no that’s fine Glenn’s covered it thank you Russell okay super okay we’ll move on then to the finances things still very tough Neil but we’re sticking with our forecast um uh anything you
Particularly want to pull out not really Russell as you rightly say the challenged areas are those that we well we’ve already discussed those really haven’t we in terms of agency High Cost of end sourcing in order toh to support delivery the uh the key targets but we got some um exceptional
Unplanned items as well um in there uh we’re still projecting 34.9 million deficit as Glenn identified in his report earlier we have um invoked a turnaround approach a different approach with the divisions now on targeting some improvement in the Run rate for the uh the end of the financial year and
Started next year if I could just touch chair if you wouldn’t mind on Capital um so uh Capital nhhs England is lagging behind somewhat in issuing memorandums of understanding for additional public dividend Capital um one of those areas in particular Frontline digitalization we’re continuing with the spend um ahead
Of the M coming through which does present a potential risk that I need the board to be cited on um but I’m continuing or we took the decision at the capital planning delivery group that we should continue as normal the business case has been signed off at the
Start of the year but there is a potential risk um as we’re not getting traction with the money coming through at this point just want the board to be cited on that um but we are we are proposing that we continue as is otherwise we’ll lose the opportunity to
Spend uh the allocation in this year um and from a cash perspective um and the impact of our financial position on uh the requirements for cash and indeed the better payment practice code um is having a slight impact uh we will try and pay on time but we are somewhat uh
Challenged with getting cash support out of NHS England in a timely manner um and I would like to ask the board to formally minute their support for the additional cash that we have applied for in quarter for1 million it’s a requirement generally they want a board minute attached to that uh we did
Discuss it in the private session last last month but hold it minuted formally in public thanks happy to take any questions thank you Neil my video is frozen which I will sort out but any questions to Neil okay thanks um Neil so lots of challenges ahead and as Neil indicated
We have put in place the necessary processes to assure ourselves um that we have the level of control we need to deliver that 34.9 million and we’ll move on then to um uh the um uh perinatal safety report and over to you Justine and for just again congratulations on
The CQC report for you and all your team I know it’s the result of an enormous amount of hard work um uh Sue and I and Michelle had a really good visit um a few weeks ago to the team and we’re delighted to sharing um the the the
Success so Justine the peronal safety report please thank you chair for your comments we’re absolutely thrilled as you can imagine so this is the perinatal safety report for October with insurance level of five you’ll note that this is the first time the reports uh come to board
In this format and this is a combination of the previous maternity safety report and the neonatal safety report um and if I may I will give an update on the Midwifery staff as part of this report rather than repeat it as a separate agenda item if that’s okay chair so as I
Say this is the first report of of in this format you’ll know are just a few escalations I just want to point out the perinatal mortality rate remains below the national average which is a really good place to be and we’re currently on trajectory to reduce our still burst in
Month by in Year sorry by 40% um and again that is you know a reflection of all the hard work and the the clear implementation of the saving baby lives care bundle um you see the incidents that outlined in there but nothing specific to say about those uh
At this point um I’d also obviously we were going to highlight the the um the achievement around CQC um we will be bringing a new action plan um in subsequent perinatal reports now um of the most new must dos and should dos that are outlined in that report but
Also a number of actions that we have um taken on board from feedback that CQC gave us during the visit um where there are always areas to improve and that will be included in in future reports um I’m not going to steal Jan under Jane our compliance Insurance Midwife is with
Us today and she will take you through the cnst paper um but just to note that the um the status that’s reported in this paper obviously is now uh almost eight weeks out of date and you’ll hear a different um narrative shortly um other than that um there isn’t anything
Other than in terms of Workforce um I’ll just cover off you you will see we have reduced our vacancy and turnover that continues with midwives um and although we are seeing an increase in short-term sickness in month and that has in in continued through November and December um predominantly shortterm I
Have to say um and sees to be very seasonal um msws is still an area of concern ER and we have gone out to advert and shortlisted a large number uh of Ms well MCAS to be recruited so we feel that we’ll be successful in um reducing that um vacancy rate
Considerably um sickness rate and turnover rate is on it on its way down in that group as well uh although I have now seen the the sickness absence rates for December uh for November sorry and um the MSW uh sickness absence rate is starting to creep up as well with the
Usual coughs colds and seasonal Pro seasonal issues um so that’s all I’m going to say um but happy to take any questions that’s great Justine and thank you for your hard work on a week in week out basis I mean one of the things that we can be really proud of with our
Midwifery Services is our continuative care um uh service which is quite exceptional and I think for mothers to Avail themselves of it is very assuring so for me um it’s always been the case the two most important things we do as a trust is to bring life safely into the
World and allow life to leave this world with dignity and Justine you and your team are doing a great job on that first absolute priority any questions to Justine okay um keep up the great work Justine and team we’ll come on to um the cnst Declarations just a we while so
Hold your horses J thank you CH we’ll move on then to some items for approval the first is effectively the reforecast U Neil um addressing the significant financial challenges following industrial action um Neil over to you uh yes thank you thank you Russell um so as Glen mentioned in his report we were
Asked to do a rapid exercise so this uh this paper is here for ratification uh the board needed to approve within a twoe timeline a revised projection to the end of the financial year around the finances and around some of our key operational standards and targets um this paper is what was
Presented to the board outside a formal committee meeting and there under the uh the regulations in the standing orders we uh we took the decision the board approved this and it was um it was sent up centrally you can see within the paper from a financial perspective we’re
Tracking the 34.9 key drivers of that are those that we’ve previously disc G there is the additional 4.2 million in for uh for for winter as Glenn mentioned the additional uh funding centrally around supporting the costs of industrial action and the reduction in the expectations around elective activity targets that are within there
Um is there anything you wanted to pull out in respect of um the performance Helen before I ask for the board to uh to ratify uh Helen saying no um so I think it’s um any quick questions or perspectives we’ve talked about this a lot team um and we’ve discussed it
Outside of this meeting um Glenn yeah just to emphasize the support to cover industrial action costs and indeed this forecast was based on Industrial action that happened prior to this week so obviously we’ve got industrial action happening now and in January which will add extra cost that we need
To uh ideally seek addition funding for from the center but but but but try and manage within our forecast yeah no well said Glenn okay so this is just for ratifying we’ve previously approved it um any uh issues with ratification please raise a digital hand okay super Julie noted thank you
Neil for all the hard work you and your team put in um doing that intense period now we then move on to the patient safety instant response plan Sarah what would you to pull out of this so we have got Alan um with us Russell but if I just briefly um
Introduce and and then we can answer Alan can answer any detailed question is needed so this instant response plan um will replace our serious instant framework as part of the national patient safety strategy published in 2019 um as we can see it’s been through every committee within the trust um so
Hopefully the board will be able to approve today um now in agree ment with the IC we have been running the new framework in Shadow form since since October 22 and we’ll be formally adopting the new approach on the 1 of January 24 um final approval is with the IC so
I’m looking for two things from the board um one is to approve um the new uh framework and the new way of working and two to submit our framework to the ICB for approval and I’ll stop there perfect thank you so and um Alan can I just
Thank you for all the hard work that’s gone on behind the scenes this is an immense piece of work and um we’re very grateful for everything you’ve done in sort of making it happen any questions or perspectives to Alan or if you’re not happy to approve this new um patient safety incident response
Plan could you please raise a digital hand blimy Allen you got us easy there thank you very much for your hard work have a lovely Christmas thank you we then move on to the cnst Declarations and um I think are we with you Jane yes good afternoon everyone um
You’ve already introduced me but my name is Jane wardor I am the assurance and compliance Midwife for maternity I am attending today to present a summary to the board of our year five cnst submission the clinical negligence schemes for trusts cnst a maternity incentive scheme is a scheme operated by
NHS resolutions in order to support the delivery of safe and maternity care this applies to all acute trusts that deliver maternity Services across the country the scheme incentivizes 10 maternity safety actions with minimum requirements within the following areas and I’ll explain those quite briefly for you um
Initially there is the use of the national perinatal mortality review tool there is the completion of the maternity Services data set there is providing Transitional Care Services to minimize separations of our moms and our babies there is the demonstration of effective systems of clinical Workforce and also Midwifery Workforce achieving 70% of the
Saving babies lives care bundle version three which actually was um was brought out in just in May this year right at the end of May to engage with patient feedback and co-production we use our maternity and neonatal voices partnership for this achieving set standards and compliance levels of maternity training ensuring a working
Cohort of maternity and neonatal safety Champions that aligned with the perinatal safety surveillance tool and also reporting a 100 cases um 100% of cases to HB that meet the the um eligibility for that and HS is the healthc care safety investigation Branch I would like to bring to the
Attention of the board that in M year four as I’ve stated before we are in mure 5 now our compliance status was actually two out of 10 we have made significant progress in this year that is to do with the appointment of an assurance and compliance Midwife in
April of this year and I have been assigned to be dedicated to the cnst scheme it has allowed me time to have action plans put in place to monitor them to have the collation of the evidence from these and providing Assurance of the outcomes you have all the relevant
Evidence um shared with you within the report today and it is in full with this embedded this has been reviewed by the director of Midwifery and the chief nursing officer who have both agreed that the evidence meets the requirement to recommend that we declare nine out of
10 this year the chief nursing officer recommends that the board to approve recommended level of compliance we aren’t declaring compliance with Safety Action five Safety Action five is around Midwifery Workforce across the summer you will recall our director of mid Midwifery reported via the Safety Action safety
Report safe Staffing report that she did not achieve um super numy status on seven delivery Suite coordinators in four months of the reporting period in the majority of the these cases and the explanation for this is because band sevens were needed to cover clinical care for midwives attending theaters to
Provide scrub cover you will recall that there has been a business case to employ 10 whole-time equivalent nurses to undertake the scrub role that has been approved we expect this then to improve the position for next year scheme we have also had our local maternity and the innatal system our
Lmns program lead uh review this report um and that was taken place on the 18th of December there was three inquiries raised and we’ve successfully responded to all three of those there is one in particular though that I would like to discuss with you today and that is around um maternity mandatory training
We have needed to change our trajectory that you will have seen on Justine’s perinatal safety report um in months before we need to change that from 4% per month to 6% of Staff allocation per month this is this amendment’s being put in place in order to ensure that we meet
Cnst guidance of 90% compliance by July 24 there were also um an additional pieces of evidence that will be embedded into November’s perinatal safety report of which you will receive next month um that is the summary of consultant attendant throughout the year the action plan for fetal monitoring is saving
Babies lives training to raise from 80 to 90% within a 12we period and the summary of gtf kandor for all of our H cases on completion of these queries the lmns program lead also agreed that as with our local assessment that we should declare nine out of 10 the final stage
Of the scheme is for the board to review the evidence presented to you in this report agree the evidence and for the CEO to be requested to submit the board declaration to NHS resolutions by the 4th of February at 12 noon trusts that do not meet 10 out of 10 that’s us um
May be eligible for for a small discretionary payment from the scream to help to make progress against actions that have not been achieved we will be presenting an action plan against Safety Action five as part of the board declaration um I will pause there and if anybody has any questions I’m happy to
Take them very comprehensive thank you Justin and thank sorry Jan and every thank you for all of the hard workor that’s G on in the background on it um questions or perspectives uh Neil thank you thank you Russell so recognizing um recognizing Jane that um we’re not comping currently but this is
A retrospective review that we’re being asked to to look at are we compliant what’s the deadline by which we will need to be compliant to be able to ensure that we take the box next year for 10 out of 10 if that makes sense and when do we need this in place
From to sure we get next year’s unfortunately the scheme um standards within it don’t stay exactly the same every year um and they also don’t give us a date that the um scheme is released um this year it came out in May um and the turnaround was obviously because of
The way that we work for today to bring this report to you um we’re hoping that it will be earlier in the spring and then we will have the detail of what that needs to look like um but quite often it is the reporting cycle from
When the actual cnst put out the actual um the actual ask but but but recognizing this one may still feature going forward when will we have this in place from to ensure when will we needed to have have it in place from if this one was to feature next year in order to
Stick that box when does it need to be in place I shall I cut I come in and answer that okay so um as you know the business case was approved some some months ago and the recruitment of the new ban five nurses to take over the
Scrub cover is underway we think that probably by the the 1 of April we will have the that cohort of Staff in place and trained uh in to such a skill to work effectively in obstetric theaters um the scheme will probably come out in February um and we need we’ always got
To recognize that our vacancies in our midwy Workforce are also dropping so we need the two things to come together for us to achieve Safety Action 5 next year um we’re confident Neil that what we’ve put in place will get us across the line next year thank you Justin and
Ken thank you chair just a keep on um Jane I think what you said just going picking up on mandatory training was that in order to meet the compliance Target you’ve moved the trajectory from 4% a month to 6% is that right yes it is
And I just wanted to test the level of confidence in terms of staff’s capacity to actually do that to achieve that you do you feel confident that we can do that so again I’ll let Justine answer for that as the Director okay so um it’s
Going to be a challenge Karen and and it will be for the first six months of the year it won’t be for the entire year because once we’ve met the trajectory the training then needs to be um completed every two years so we’ll be able to pull back then for the latter
Half of the year it may have a uh an impact on our on other areas of training but then we will be able to um increase the number of of other days that we put on to compensate in the second half of the year when we pull back massively on
This requirement it’s just because of the date of the end of July to get us up to the 90% um and once we’ve achieved it then we can focus put our focus and efforts elsewhere thank you Justine thank you K so if you’re not happy to support this
Cnst declaration could you please raise a digital hand okay Julie um approved for declaration thank you um J for your hard work and Justine um for for your oversight and leading it uh we then move on to the and we need to pick up the
Pace of bit GL if we can the maternity safety Support Program Justine I back with you yes chair thank you so this is the request to exit the NHS support program and the we’re offering an assurance level of six for this paper so the paper outlines our current position
Against all of the that we aligned to the 2020 CQC visit the recommendations from oern and cnst that you’ve just heard um that um the Mia and myself pulled together into a plan um all of this is included in the exit criteria um we have met the majority of the actions
That were out you know that were outlined in that um original action plan and you’ll notice that what’s left is Amber so we’re either working towards it or it’s the kind of business as usual types of actions that you would expect a service to be focusing on on a on a
Month by month basis so the recommendation is that as we’ve met um an agreed level of uh achievement the chief midrif officer and the maternity Improvement advisor have recommended that we make a formal request now to exit the program um and a sustainability plan agreed which you can see outlined
In the report um it’s there in a appendix to and as I say it’s predominantly business as usual type actions um so we would therefore like the board’s agreement that we proceed with a request to exit um exit the the program um obviously we’ve also now got
Our CQC um good uh following our inspection so that further adds you know weight to this report um so I’ll leave it there and take any questions thank you Justine would seem of getting a CQC good and then still being in um any questions or perspectives to uh
Justine really delighted for you and the team Justine on on the CQC work and the evidence that um that shows for our families in Wester um if you’re not happy to approve this um exiting of the mmsp please raise a digital hand Julie approved let’s exit thank you
Um Justine and we then move on to some items for noting and information the first is the communication and engagement report uh Richard anything you’d like to highlight um thank you chair given given the time and my inability to talk very long without coughing I’ll keep this
Brief um I’d like to say a big thank you to the comms and charity teams uh for all the work they’ve done over the year I’ve obviously a lot of work to to support things that we’ve already covered uh today along the 10-point plan the epr uh
Flow winter I’ve tried for for this report to to cover a different cross-section of the work that we’ve done and particularly tried to tease out uh where we have looked at demonstrating the value of uh the work that the teams do to the organization in terms of benefits realization return on
Investment and some tangible metrics which hopefully are uh useful couple of things that aren’t in the report but I would like to mention given that they are likely to featureing future board discussions one is the start of a discussion with the organization that I’m working with Stephen and the rest of
The executive team on around reshaping The Narrative about what kind of organization our people want this trust to be what our strategic direction of travel would be and that picks up on some of the diversity and inclusion issues that we talked about earlier as well as um Quality in general working
Environment so that will gather Pace in the new calendar year um and also our continued focus on building on the progress we’ve already made to work collectively at a place and a system level uh ongoing campaigns will include winter and home before lunch and also across group and some work is is
Gathering Pace on on uh aligning approaches across the group to things like staff reward and recognition uh we’ll have an improvement month coming up in May which uh more to follow and also some developmental work to to help skill up noncoms colleagues across the group on things like most effective use
Of social media um how to drive effective Communications campaigns and um other issues happy to leave it there chair and answer any questions thank you Richard and thank you for your hard work um and un your team uh a number of us attended the staff Awards recently and it was
Extremely professionally um done well done you um questions or perspectives to Richard Simon uh it’s SP Old Chestnut Richard when too surprised to hear me ask you mentioned find out resources uh again in the report and then obviously you have to concentrate priorities is is there anything that you’re not able to
Actually do justice to that you’d be concerned about or that we ought to be aware of um we we keep it under constant review Simon as you’re aware clearly uh my teams as as the rest of the corporate teams are going to have to make a contribution to bringing the Run rate
Back down as we’ve discussed uh in the the varied Financial uh discussions that have taken place so far today so we’re constantly reviewing the priorities obviously we’re going to focus on those things that are in the 10 the 10-point plan and the four immediate priorities particularly overflow and um home first
But also looking at recruitment to help teams who are looking to to swap out Reliance on bank and agency for permanent staff while also focusing on our kind of must do and the big one for the next quarter is going to be the move to internet to thanks Simon thanks Richard and Glenn
Then we’ll move on Glenn yeah just thank you for Richard and his team for the work they’ve been doing particularly getting the rumor mill up and running so quickly and and the way they’re connecting into other parts of the group um where you know I think I think the
The the combin might to the comms teams across the group really helping to get some of these important messages over so thanks yeah absolutely okay Richard thank you I hope you feel better soon we’ll move on then to some committee terms of reference um uh the financial recovery Bard terms of reference um
Erica I know this has been through various different machinations anything particularly like to emphasize only to say chair that uh it’s due further revision so since we’ve published the board pack uh the financial recovery board have sat and made further recommendations so um whilst this provides a sort of
Foundation from where we are there will be a further revision chair okay can I suggest we bring it back to the next board for final uh conclusion um Richard particularly Richard is when you’re um happy with it as well and it’s been through that process and so we’ll come
Back to this shall we Erica yes please chair okay super thank you we’ll move on then to um some um uh of our subcommittee um um uh minutes the first is the foundation Group B uh minutes of the last meeting held on the 1st of November I’ll take these as red but are
There any questions on them in terms of accuracy I would say to members of the public there are very interesting meetings to try and get to they are different from the normal meetings because there’s so much uh comparison work that goes on um and that sort of uh
Feeds through to the um action points update which is on page 244 of our pack um which are ongoing but I would strongly encourage members of the public to um join us whenever they can to those meetings and that why I find them interesting and I think you might uh the
Quality um governance committee um from October Julia I know you’re under the weather as well um anything you wanted to pull out on this I don’t think so thank you we’ve covered all the M midy stuff already and I think just take the reporters ready if you don’t mind mind
Okay great any questions um on those minutes of the quality governance committee okay thank you very much and then the audit and Assurance committee um in Collin’s absence I’ll take these as um R but any questions on those okay thank you everyone who’s involved in that meeting and then we’ve
Got the people and culture committee um from October Karen anything you wanted to pull out on those minutes just one brief thing chair um and simply because um these are the minutes from October we had another meeting on the 5th of December and we discussed again
The um the issue of freedom to speak up and how we might um become which we have a very good process for in the organization but we wanted to impove some of the transparency around how we share some of the themes and outcomes in an appropriate way across the
Organization so it was just to to State and confirm that that’s a piece of work that we’re taking forward as as it’s a recurring thing no super thank you k um I would just sorry I forgot to mention we had a very interesting session led by
Tina and Rich this morning on EDI um but on the subject of freedom to speak up I’d just like to make a general point to uh colleagues you absolutely have the right and you’re encouraged by me the chairman and I’m sure all of the board to speak
Up on any issue which causes you anxiety obviously ideally you do that through your management line but if for some reason you f unable to do that there is a freedom to speak up Guardian um the reality is the best organizations in healthc care are those where freedom to
Speak up is just part of the way we do things and that we are encouragers of people to be able to speak up on areas of concern so i’ just like to emphasize that to support what Karen’s just said any other questions to Karen so I think we on to any other
Business board colleagues any other business please raise a digital hand uh Richard uh thank you chair um you mentioned earlier the importance of um supporting patients at the start of life and at the end of their life and if I could just give a very brief plug uh to
Our Christmas appeal which is why uh I’ve got this I’ve deviated from the corporate backdrop um we’re trying to raise 20,000 to provide 20 additional day beds so that our paliative and end of Life Care team uh can provide a better experience for families who are
Spending um the last few hours at the bedside of a loved one uh it can be donated by the web link behind me or by texting daybed uh to 70460 to donate 5 text will cost the donation amount plus one standard Network great message and we are very grateful for the support
We’ve received so far thank you Richard um can’t see any other business from colleagues um the only other business for me is to wish every one um a very happy Christmas stay safe hopefully it won’t be too icy so for members of the public um look after yourself stay warm
Stay mobile um this is a very lonely time of year for many members of our community so if you know someone who’s on their own or you think someone may have lost a loved one during the last year a friendly smile a knock on the door can make all the difference to
Someone’s feeling of Lon this um so any questions from members of the public have we been notified of any Erica I haven’t been notified of any no chair okay and for members of the public on the line is there any question you’d like to ask ask ask us as a board please
Either raise a digital or physical hand okay can’t see any hands raised so I wish you well look forward to seeing you soon uh for Bard colleagues um we need to St on the line I think for the trustee meeting is that right Erica or is it another
Darling uh Joe can confirm I think it we stay on okay stay on please yeah okay thank you Joe Merry Christmas everyone take care thanks Al Vicki you must be cold every time I’m looking at youc your um hood is no it’s not it’s it’s the
Back of the chair Russ and it’s my my hair’s got bigger as the day’s gone on I was trying to work out whether you had a sort of a Canadian goose very expensive hoodie no what going on no no and the hair just cuz it’s curlier and
It’s like a bit a bit cold today it’s going really really coolly so there we go and it’s very windy out there very that’s the next thing okay so the trustees meeting I’m not used to doing this so apologies I Cally forget it so um we got the same
Apologies of absence from Colin and Christine um earlier um any Declarations of interest for this meeting please raise a digital hand okay the minut of the trust board meeting of the corporate truste held on the 19th of October if you weren’t happy with those please raise a digital
Hand then got the charitable funds report um Simon anything you wanted to particularly pull out here not especially other than to say that we have had a meeting with the um person who has donated money towards the helipad which should address the audit queries that are mentioned in the report
Okay great thank you Simon any questions to Simon just remind me Simon how much maybe you don’t know the answer so to director to you if you know great how much money we got in the Bank of the charity uh it’s about 4.3 million I
Think off the top of my head I might be wrong on that um lipping hell how much of that is um uh unallocated I know you’re going to ask me that how much is restricted I think there is a fair amount restricted um we’re going through a process with um divisions and with
Different parts of the trust uh where money has been allocated to them uh to ensure they do spend it uh it is a little bit of a contact sport at the moment um but we are getting there and we will get there because the whole point of having charitable funds is to
Do charitable things with that money and we will and and we are as you can see from the report okay I mean that to be honest every trust I’ve been involved in in the last 15 years always has a problem on spending the money so if if
You’re doing it better than others well done um any questions to Simon any other business okay team um thank you for Expediting the meeting I I do try and um keep things going because I know how busy this time of year in particular is for can I suggest we all have a 15minute
Comfort break get back together again at 2:30 and um do the confidential board okay thank you very much team e for e e