minutes of the meeting of the trust board of northern

Trust Board 26 May 2021

Minutes of the Meeting held on 4 March 2021

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Minutes of the Meeting of the Trust Board of Northern Devon Healthcare NHS Trust

Held on Thursday 4 March 2021. The meeting was held via MS Teams and was recorded.

PRESENT

Mr Pete Adey Chief Operating Officer Ms Andrea Bell Interim Director of Nursing Mr James Brent Chair Dr Tim Douglas-Riley Non-Executive Director Mr Robert Down Non-Executive Director Ms Hannah Foster Director of People (Non-Voting) Mrs Pauline Geen Non-Executive Director and Vice Chair Mrs Angela Hibbard Chief Finance Officer Mr Stephen Kirby Associate Non-Executive Director (Non-Voting) Ms Carolyn Mills Chief Nursing Officer Mr Tony Neal Non-Executive Director Mr Kevin Orford Non-Executive Director Mr Chris Tidman Deputy Chief Executive (Non-Voting) Mrs Suzanne Tracey Chief Executive

IN ATTENDANCE

Ms Geraldine Garnett-Frizelle PA to the Chairman/Non-Executive Directors (for minutes) Mr Will Griffiths-Jones Guardian of Safe Working (for item 032/21) Mrs Mel Holley Acting Trust Secretary Ms Jess Newton Head of Communications and Engagement Ms Angela Walter Admiral Nurse (for item 027/21) Members of the Public and Observers Included: James Bradley (Governor, RD&E) Rosemary Howarth-Booth Sue Matthews Dr Elizabeth McElderry Monika Herpoldt-Bright (Governor, RD&E)

020/21 Chair’s Remarks

The Chair welcomed the Board, members of the public and observers to the meeting. In addition, he welcomed Carolyn Mills and Steve Kirby to their first meeting as members of the Board.

021/21 Apologies

Apologies were noted for Adrian Harris.

022/21 Register of Interests

James reminded the Board of the proposal previously discussed at Board that a Non-Executive Director from NDHT should join the RD&E Board and vice versa. He advised that Kevin Orford had now joined the RD&E Board of Directors and Steve Kirby had joined the NDHT Trust Board as an Associate Non-Executive Director. Kevin informed the Board that he would become the Interim Chair of the Intellectual Property Office with effect from 1 April 2021. The updates for the Register of Interest were noted.




023/21 Minutes of the last meeting

The minutes of the meeting held on 7 January 2021 were approved subject to the following amendments: Page 7, minute 010/21 Integrated Performance report, last bullet - change “next October” to “this calendar year”. Page 9, minute 013/21 Ockenden Report - sentence to be amended to read “A second action for which the Trust is partially compliant relates to having a consultant presence on the morning and evening Labour Ward rounds; this is the case on weekends weekdays but not on Bank Holidays and at weekends.”

024/21 Matters Arising

The Board noted the updates to the action log.

025/21 Chairman’s Report March 2021

The following items were noted on the agenda for discussion in the confidential Board meeting – updates from the Digital Programme Board, Finance Committee, Our Future Hospitals Board and Integration Programme Board, as well as the Terms of Reference from the Remuneration Committee and a Planning Update. James advised the Board of the following national updates:

A White Paper was published on 11 February 2021 focussed on prevention and joined up working with local authorities to look at health inequalities as the next step in the move to Integrated Care Systems. The complex architecture is set against the ambition to reduce bureaucracy. There was also assurance that social care reforms would come back to parliament later this year. There will be changes to fiduciary responsibilities of directors; the roles of Trusts and Foundation Trusts will continue largely as before, but with a statutory obligation to collaborate as well as their responsibility to their local population.

The Board noted the update.

026/21 Chief Executive’s Report March 2021

Suzanne advised the Board of the following updates locally and regionally:

Covid – there continued to be an improving picture, with decreasing rates of transmission and very good uptake of vaccinations. There is a plan between the SEND hospitals to continue to have a ward allocated to deal with Covid patients should it be needed and the ability to use the RD&E as a “blue” site should significant numbers of beds be needed. The Nightingale Hospital remains in a state of operational readiness should it be needed.

Vaccination – more than 80% of staff had received the first dose vaccination by the end of February 2021. The Trust has also provided support to other vaccination sites, such as care homes. Staff will start to receive their second dose from 15 March 2021.

With regard to the integration programme, an important element will be submission of the business case in November 2021. The roll out of the electronic patient record will be an important aspect of the integration and formal approval for roll-out of EPIC has now been received. A clear programme for the roll-out of MyCare will be developed, taking learning from the RD&E roll-out at the end of last year.

It will be important to get engagement from staff and the public to help the Trust understand what future healthcare looks like to the local community and there are a number of staff and public surveys available. There are also a number of internal engagement events planned internally, including looking at clinical pathways.




Work is continuing on the Our Future Hospitals programme with other Trusts in Devon with the aim of submitting the Strategic Outline Case in July 2021.

The recruitment process for a substantive Chief Operating Officer (COO) is underway and an experienced Interim COO has been recruited to cover the role until an appointment has been made. In addition, Jason Lugg has started as Director of Nursing for NDHT.

The Associate Director of Nursing for Surgery, Donna Knight, has announced her retirement; however she will be continuing to work on the bank.

James asked for best wishes to be passed on to Donna on behalf of the Board. In addition, he extended the thanks of the Board to Pete Adey for the positive impact he had made, particularly in terms of quality and safety. The Board also recognised the significant work undertaken by Angela Hibbard and the team in securing the EPIC funding, and the commitment of the Chief Executive. The Board noted the updates.

[Angela Walter joined the meeting]

027/21 Patient Story

Jess Newton informed the Board that the patient story was a video which related to the role of the Admiral Nurse and the continuity of care provided to the family. Tony asked how people are supported prior to a diagnosis of dementia and Angela responded that there were challenges with patients getting a diagnosis, but the Team were looking at whether they could make direct referrals to the memory clinic for assessment and the older person’s mental health team to speed up the diagnosis process. Kevin said that the voices of carers of people with dementia are not heard enough in society and asked how the Trust could make sure they are heard in planning services in Devon. Angela advised that Dementia UK are advocates for carers; there are also a number of groups which hospitals affiliate to both nationally and locally, including Devon Carers which has representation on the Trust’s Involving People Steering Group. It was noted that there is currently no Admiral Nurse at the RD&E and Carolyn agreed to look at the equity of provision across NDHT and the RD&E and report back to the Governance Committee. Action. CM

Tim commented that the Organ Donation Committee received funding for organs donated which it had used in the past to run a who cares for carers day in the Emergency Department which had been very successful and suggested that a similar event could be planned in the future for carers of those with dementia. He agreed to discuss further with Carolyn outside the meeting. Action. TDR The Board noted the presentation and asked for thanks to be extended to the team.

[Angela Walter left the meeting]

028/21 Audit Committee Report

Kevin provided an update on issues discussed at the Audit Committee meeting held on 11 February 2021 and highlighted the following key points for the Board’s attention:

No new internal audit reports were presented, however actions from two limited assurance reports were reviewed and assurance provided that they were on track to be completed by their due dates at the end of March 2021.




The focus of the meeting was largely on year end planning for the accounts and the internal audit and counter fraud workplans.

The timetable and approach for auditing the accounts was agreed with the external auditors.

The Committee has worked with the RD&E Audit Committee in developing risk based plan for internal audit and counter fraud which covers both Trusts as far as possible. Both plans were approved.

Robert asked whether there was a plan to look at a higher degree of internal control and audit scrutiny in the future and it was agreed that Kevin and Robert would discuss this outside the meeting. Action. RD/KO

The Board noted the update.

029/21 Integrated Performance Report

Pete presented the following key issues from the performance section of the Integrated Performance Report (IPR):

There were currently no inpatients in the Trust with Covid. NDHT had offered mutual support to other organisations taking patients other areas of Devon, the Midlands, London and Kent.

Elective activity had decreased and referrals were down.

Overall waiting list size had increased although not at the pace expected and RTT had remained static.

Emergency admissions had increased marginally, and there had strong performance on ambulance handover times.

Two-week wait breast cancer referrals had increased significantly and a plan is in place to manage this with mutual support from Exeter to support the service.

Focus is on restoration of services and planning for 2021-22. Hannah brought the following points to the Board’s attention:

Sickness absences rates were low for the time of year.

As far as possible staff had been enabled to take leave before the end of the financial year, but carry over has been managed where necessary.

Vaccination uptake amongst BAME colleagues has been better than elsewhere in the country, but work continues to improve this further.

There has been a delay nationally on the annual submission of the gender pay gap report and a narrative report will be prepared for the Board in due course.

Similarly, there had been a delay in public release of the annual staff survey results but once released the report will be presented to a future public Board meeting.

Carolyn presented the quality and safety section and advised that there had been a significant deterioration in complaints being responded to within an agreed timeframe and this will be looked at in more detail through the Governance Committee to establish the reasons. CM

Angela Hibbard presented the finance section of the report highlighting the following:

Performance has continued to be better than plan with a £626k surplus against a deficit plan.

The forecast shows a worsening position due to the inclusion of the annual leave accrual, however this will improve in Month 11.

The Trust has been awarded funding to purchase off-site accommodation which must be achieved before year end, together with the final payments of the ED scheme. Risk of non-delivery against these was, however, judged to be minimal.




Kevin asked when it was expected the Trust would have a plan in place to reduce long waits and how long it was estimated it would take to reduce the waiting list to levels pre-Covid. Pete responded that work on the 2021-22 plan was already underway with guidance expected soon. All waiting lists are stratified Kevin noted that stroke performance had deteriorated and asked if there was assurance on care provided and outcomes for patients. Pete responded that the target for stroke was not being met because of Covid restrictions meaning some stroke patients were not able to be admitted to the stroke ward. However, he provided assurance that the clinical nurse specialist had oversight of all stroke outliers and each had also been reviewed by the stroke multi-disciplinary team. It was noted that outcomes data relating to this would be discussed through the Governance Committee. Action. TN

Tony asked if the impact of the staff wellness campaign was being captured and Hannah responded that although this was difficult to measure, it was being discussed through the People, Workforce, Planning and Wellbeing Group. Steve noted that the 52 week waits graph appeared to be below forecast and asked if there was confidence this was correct. Pete advised that this related to NDHT carrying on activity slightly longer at the start of the Covid incident than other organisations. Steve further noted that the number of virtual appointments achieved at NDHT was much higher than at the RD&E and asked what feedback from patients had been received. Jess Newton responded that the Board had previously received patient stories relating to this outlining the positive experiences of many patients. Feedback generally had been very good from both staff and patients regarding the remote appointments. Learning from the Trust’s experience is being considered in particular how best to share it across the system. Pauline asked if there was equipment, funding and trained staff available at the Nightingale to enable it to be used for diagnostics. Pete said that there is equipment, a number of trained staff and funding to support activity available at the Nightingale. Short term use is being considered to increase CT scanning, Echo and ultrasound. The longer term future of the building and the future requirements of the service are being discussed. Robert asked if there was experience of dealing with significant numbers of long waiters, some of whom may require more treatment due to their long wait. Pete responded that very productive discussions with the primary care networks in East Devon regarding how risk for long waiters was being managed and how those patients were being communicated were ongoing. The Board received the report.

030/21 Governance Committee Report

Tony Neal informed the Board of the following key issues discussed at the Governance Committee meeting held on 26 February 2021:

Assurance was provided to the Committee on progress regarding the peri-articular plates process and the communications to patients potentially impacted, notifying them of the issue. Not all patients have been contacted yet and a further update will be provided to the Committee once this has been completed.

Learning from Deaths reports were presented from both Trusts and it was noted that there were some data discrepancies in the Structured Judgement Reviews between the organisations which was discussed. The discrepancies related to the judgements made




about standards of care provided and the Committee requested that this be looked at in more detail. In addition, it was noted that there had been an issue regarding provision of office accommodation for the Medical Examiners in Northern Devon which were being addressed. Issues relating to weekend cover in Northern Devon were noted. The Committee noted that further work was needed at the RD&E to link PALs and patient experience processes back to learning from deaths which was being picked up.

An update was received from the PWPW Group. The revised Terms of Reference were presented and some further work has been requested before they are re-presented at the next Governance Committee. In addition, the Committee was advised that PWPW had discussed the Baroness Harding letter sent to all Trusts earlier in the year relating learning from an investigation into the suicide of a nurse in London following a disciplinary process. A number of recommendations had been made on how Trusts support staff in the disciplinary process. It was noted that this work will be ongoing during the coming months and Governance Committee will receive progress reports. Finally, the appraisal compliance extension period was approved.

It was noted that work is underway to resolve the workforce resource issues in the Integrated Safeguarding Team at the RD&E, with some cover continuing to be provided from Northern Devon in the interim. No significant risks relating to this had been identified.

All sub-committees provided details of their workplans for Quarter 4 2020-21.

An update on the mass Covid vaccination programme was provided and assurance was provided that the Trust was compliant with the Care Quality Commission key lines of enquiry. No significant issues or concerns were identified and it was noted that the Safety and Risk Committee would continue to monitor. Following discussion it was agreed that this had flagged up that the Committee wanted further assurance regarding the governance of the Nightingale Hospital and this would be provided at a future meeting.

The annual serious incident and Never Event reports were received and approved.

The Committee noted the plan to have an interim restart of Patient Experience Committee meetings whilst future strategy to take this forward is planned.

The infection control risk score was increased for Northern Devon following recent outbreaks and the risk of the Trust being unable to submit monthly outcome data was closed. In addition, closure of a risk of secondary fracture was approved as it had been amalgamated into another risk relating to Care of the Elderly.

Two updates on whistleblowing were received; the first related to a specific whistleblowing case and the second was an update on an action and the Committee agreed it was assured on progress of both.

Suzanne advised that the issue of weekend cover noted in the Learning from Deaths report had been discussed at the most recent Safety and Risk Committee meeting and a connection had been noted with the key risk regarding medical workforce and locums. Further work is being undertaken on this. Tim advised that the future direction for the Patient Experience Groups is still under discussion. The Board noted the report.

031/21 Maternity Services Assessment – Ockenden Report

Carolyn presented an update on the maternity services assessment with the following points highlighted to the Board:

The report contains the Trust’s final self-assessment position against the 7 immediate and essential actions and the 10 safety actions that were part of the Ockenden Report.




One area was rated amber; this related primarily to assurance that risk assessments were being completed for every face to face appointment. Mitigations are in place.

Midwifery leadership had also been rated amber pending a planned review in line with national guidance and also as part of the integration work between the Trust and the RD&E.

A zip file of evidence is available to review.

An action plan will be developed for those actions rated amber which will be monitored through the Safety and Risk Committee.

There is Non-Executive Director oversight of this work with regular updates being provided by the maternity team.

James asked if the team had thought of any actions or learning from the report not contained within the recommendations. Suzanne responded that there had been a longstanding piece of work to support the development of the maternity team and the Ockenden Report and recommendations should be viewed in the context of that wider piece of work. Tony noted that many of the actions had short timeframes for completion and asked if there was confidence that there was capacity to achieve this and ensure that outcomes were embedded. Carolyn responded that she had discussed this with the team and they were committed to using this as part of a wider tool to look at practice and governance and were confident on the timescales. The Board noted the update.

032/21 Guardian of Safe Working Report

Dr Will Griffiths-Jones attended to present the Guardian of Safe Working Report. He advised the Board that there had been 14 exception reports during quarter 3, none of which related to immediate safety concerns and all had been resolved satisfactorily. The Junior Doctors Forum had met twice during quarter 3 and are submitting a request to the Space Utilisation Committee a request to look at the space available for the Junior Doctors Mess. There had already been an issue identified prior to Covid restrictions with there not being enough space available to fulfil the Fatigue and Facilities Charter and the position has worsened with social distancing requirements. It is hoped that additional space can be identified to extend the Mess. It was agreed that Will would invite a Junior Doctor to attend a future Board meeting with him. Action. WGJ The Board noted the report.

033/21 Learning from Deaths Report

Carolyn presented the report on behalf of the Medical Director, noting that it had been previously presented to the Governance Committee. It was noted that the high level mortality benchmarking data was within the expected range. A review of weekend emergency admissions and mortality reviews which had found that the outcomes and standard of care for these patients was comparable to patients received on weekdays.

James asked if there was an update on office space availability for the Medical Examiners and Angela responded that purchasing of off-site accommodation is underway which will facilitate moving as much non-clinical work off site as possible, to free up space on site for clinical use and this will be reviewed as part of that work.




James asked whether there was assurance that issues with weekend working had stabilised and Carolyn responded that in Governance Committee it had been agreed that some of the workforce challenges remain and there is therefore still a risk.

It was noted that there had been discussion at Governance Committee regarding the differences between the RD&E and NDHT reports and a peer review was going to be undertaken.

Pauline asked if there was a process in place for patients who did not attend appointments or discontinued treatment and Carolyn agreed that she would email Board members after the meeting regarding this. Action. CM

The Board noted the report.

034/21 One Northern Devon Fuel Poverty Strategy

Suzanne presented the One Northern Fuel Poverty Strategy to the Board for consideration. The key headlines were noted as:

It helps with understanding at a more granular level the position for the local population, highlighting areas where there are significant poverty issues in Ilfracombe and Bideford.

The wider determinants of health, such as this, have a significant impact on patients’ health and thereby the system.

The Trust has signed up to play its part in delivering this strategy as a member of One Northern Devon.

Work is being undertaken to scope KPIs to measure impacts from implementation of the strategy.

One of the next steps could be to look at frequent attenders at the hospital with a view to undertaking some targeted work with partners.

There are opportunities within this to possibly drive efficiencies.

There are also opportunities to be explored at STP level to look at this more widely across the system.

The Board noted the report and agreed its strong support for the One Northern Devon Fuel

Poverty Strategy.

035/21 Emerging Issues / Raising with other Committees / Adding to the Board Assurance Framework

There were none noted.

036/21 Any Other Business

James reminded the Board that they had previously discussed maintaining separate statutory Boards whilst the work continues on the proposed integration of the Trust and the RD&E but recognising that there were benefits for both organisations of the two Boards working together, both in terms of efficiency and for the added richness it would be bring to debate. He advised that it had been agreed that the Board meetings would be brought together with the aim of starting at the end of April. Dates would be circulated for the Board’s consideration.

037/21 Questions from Members of the Public

The Chair invited questions from members of the public. Question 1 – Sue Matthews – Will the contract for the Nightingale Hospital be extended and if so, who will staff it.




Suzanne responded that the Nightingale remained in operational readiness should it be needed. The site was currently staffed by existing staff from across the Devon system and Somerset and had recently also had support from the military. With regard to the future to what will happen after the end of March no decision has yet been reached. In the medium term consideration is being given to what is needed, but the diagnostic facility is being stood back up for the time being. There will be a wider options appraisal across the system to look at how it could be used, perhaps as part of the further recovery plans for Devon.

038/21 Impact for Population from Board Today

The Board agreed that the Patient Story had been very powerful illustrating the very positive impact of the service for the family of the patient.

039/21 Date of the Next Meeting

The next meeting of the Trust Board will take place at 10.00 a.m. on Thursday 6 May 2021 via MS Teams.

040/20 Exclusion of Press / Public

It was formally MOVED by James Brent, and unanimously RESOLVED that under the

provision of Section 1, sub-section 2, of the Public Bodies (Admission to Meetings) Act 1960, that the public be excluded from the confidential section of the meeting on the grounds that publicity would be prejudicial to the public interest by reason of the confidential nature of the business to be transacted.

Trust Board 7 January 2021

Draft Minutes of the Meeting held on 5 November 2020


ACTION LOG AS AT 20 MAY 2021 No Minute Item Action Comments Lead Outcome

7 January 2021

3 010/21 Integrated Performance Report

Governance Committee to look at mortality indices in SHMI in more detail regarding whether there was a data quality or other issue and report back to Board.

Update 21.01.21 – SHMI diarised for discussion at GC on 26.02.21 and update will provided in GC report to March Board. Update 04.03.21 – TN advised that this had been followed up with AHa who had discussed with Tom Martin. TM had responded as follows: “The period of elevated SHMI occurred in June/July/August 2020 when activity was depressed owing to Covid and advice coming back is that mortality indices during that time should be interpreted with caution because activity and the profile of the hospital patient population will have changed significantly and there are regional differences, so looking at national comparators is not always as useful.” A specific investigation has not been undertaken but Mortality Review Group continue to monitor metrics that feed into calculations with a focus on ensuring that coding completion accuracy, weekday/weekend differences and palliative care records are correct. The conclusion was that for this specific period of time there is assurance about the indicator going out of the expected range and noting that it has subsequently moved back in to expected range. Agreed to close this action.

TN Closed




No Minute Item Action Comments Lead Outcome

4 013/21 Ockenden Report Confirmation to be circulated to the Board at the end of January 2021 that full compliance with recommendations of the report had been achieved as required.

04.03.21 – Update on the agenda for March Board.

JH Closed

4 March 2021

6 027/21 Patient Story CM agreed to look at equity of provision as there is no Admiral Nurse at RD&E and report back to the Governance Committee.

19.04.21 – Dementia services parity – dementia has been added to the due diligence process for the Corporate Governance workstream. Initial assessment undertaken with relevant personnel led by Tracey Reeves & Jason Lugg. Review date set for 07.05.21. Added to GC agenda for discussion on 30.04.21

CM Complete

7 027/21 Patient Story TDR to discuss the carers day that had been run with the ED using organ donation funding with a view to a similar event being organised for carers of people with dementia.

22.04.21 – TDR emailed details relating to the Carers Day that was funded by organ donation money in ED, ITU and Theatres.

TDR Complete

8 028/21 Audit Committee RD and KO to discuss internal control and audit scrutiny outside the meeting.

22.04.21 – On the agenda for discussion at the Audit Committee meeting.

RD/KO Closed


Significant deterioration in complaints being responded to within an agreed timeframe to be looked at in more detail through GC.

20.04.21 – It was agreed that there is a wider piece of work relating to themes and learning behind both compliments and complaints and this would sit better within the patient experience operational group’s remit and then reported through to GC.

CM Closed


Outcomes data relating to stroke patients who had not spent their stay on a stroke ward to be discussed through Governance Committee.

20.04.21 – agreement that a paper linking the outcome measures will be presented to GC.

CM./TN Complete




No Minute Item Action Comments Lead Outcome

10 032/21 Guardian of Safe Working Report

Arrangement to be made for a Junior Doctor to attend with the Guardian next time the report is presented to the Board.

22.04.21 – WG-J unable to attend the April Board meeting. The Q1 report will be presented to the July meeting and arrangements will be made for a Junior Doctor to attend that meeting if possible.

WG-J Complete

11 033/21 Learning from Deaths Report

CM to look at what processes are in place to follow up with patients who do not attend appointments/ discontinue treatment

18.05.21 – CM confirmed that there are patient access policies in place for NDHT & RD&E which include Do Not Attend (DNA) guidelines, and that both organisations have in addition specific policies relating to children that DNA. Both policies state that for adult patients who DNA on two or more occasions they should be referred back to their GP (this is based on national/system elective care access policies); both local policies state that in specific situations this approach can be flexed and that this decision is informed by the relevant clinician and their assessment of the patient’s condition. Consideration to be given to inclusion of an audit of processes in a future local/internal audit plan.

CM Complete

Chairman’s Signature:

Date: 26 May 2021

minutes of the meeting of the trust board of northern

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