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The Royal Wolverhampton NHS Trust Minutes of the meeting of the Board of Directors held on Monday 30 January 2017 at

10 am in the Boardroom, Corporate Services Centre, Building 12, New Cross Hospital, Wednesfield, Wolverhampton

PRESENT: Mr J Vanes Chairman Dr J Anderson Non-Executive Director

Ms R Edwards Non-Executive Director Ms C Etches OBE Chief Nursing Officer Mr D Loughton CBE Chief Executive Mr R Dunshea Non-Executive Director Mrs M Martin Non-Executive Director Ms G Nuttall Chief Operating Officer Dr J Odum Medical Director Mrs S Rawlings Non-Executive Director

Mr K Stringer Chief Financial Officer Ms L Holland Director of HR and OD

Mr S Mahmud Director of Integration Mr M Sharon Director of Strategic Planning and

Performance

IN ATTENDANCE: Ms R Baker Associate Chief Nurse (pt)

Ms N Mehay Freedom to Speak up Guardian Ms T Palmer Head of Midwifery (part) Mr A Sargent Trust Board Secretary

OBSERVERS: None APOLOGIES:

Mr J Hemans Non-Executive Director Prof Rob Stockley Associate Non-Executive Director

Mr S Marshall Wolverhampton CCG Councillor A Muston Wolverhampton City Council

Part 1 – Open to the public TB.6221: Declarations of Interest from Directors and Officers RESOLVED: That the declarations of interest by Directors and Officers be noted.

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TB.6222: Minutes of the meeting of the Board of Directors held on Monday 28 November 2016 RESOLVED: That the minutes of the meeting of the public session of the Trust Board held on Monday 28 November 2016 be approved as a correct record, subject to the third paragraph of minute TB.6200 being amended to read as follows: “Mrs Martin said that the Finance and Performance Committee had requested that the risk rating around the Staffordshire STP be reconsidered.” TB.6223: Matters arising from the minutes of the meeting of the Board of Directors held on 28 November 2016 The following updates were given orally at the meeting: TB.6184 – Infant Mortality Follow-up letter: Dr Anderson confirmed that the letter would be sent shortly. TB.6191 – Theatre Utilisation Rates: Ms Nuttall said that she would circulate the information requested (GN). TB.6191 – Metrics from general practices: Mr Sharon suggested that this matter was covered by the content of the report on Vertical Integration in the private part of the meeting later today. The Board accepted this. TB.6224: Board Action Points RESOLVED: That the Board Action Points list be noted. TB.6225: Chief Executive’s Report Mr Loughton highlighted the visit to Belfast to view a primary care hub with 25 GPs located in one building along with pharmacy and diagnostics. The challenge of such an arrangement appeared to include the need to integrate fully, thereby removing multiple reception points. Regarding Action on Smoking Rates in the NHS, Mr Loughton commented that any plan to make the Trust a smoking-free environment must include properly thought out and resourced measures to enforce a smoking ban on the sites concerned. It was suggested that further discussion on this matter might be appropriate at a Board Development Session. The Chairman expressed appreciation, on behalf of the Board, for those members of staff who had worked hard to achieve the amendments granted by the CQC in respect of the 2015 hospital inspection judgement. Dr Anderson asked whether there was any patient satisfaction feedback for the integrated GP practices. Mr Mahmud said that of the 21 measures in the GP survey, the RWT VI practices were performing better than the national performance on 16 of them. This was a good platform for further development. Mr Dunshea enquired as to the next steps in the STP process. The Chairman replied that all of the STPs had now been published, and the local Health Scrutiny Panel had held a special meeting recently to discuss the Black Country Plan.

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Mr Vanes referred to recent publication of responses to the death of Connor Sparrowhawk in the care of Southern Healthcare, and asked whether there were any implications for this organisation. Dr Odum responded by talking about rising mortality rates in the Trust, and indicated that internal work was underway to establish what lay behind the data and indicated that RWT would also consider nationally informed changes to the handling of mortality reporting. He agreed to report back to the Board (JO). RESOLVED: That the Chief Executive’s report be received and noted. TB.6226: Patient’s Story The Board watched a DVD recording of Mr Mike Sharon, Executive Director with this Trust, who had received surgery to a broken ankle at the hospital. He said that he had felt safe whilst undergoing the procedure, and had found the majority of staff to be kind, caring and responsive. He noted that a high proportion of staff did not introduce themselves by name, and there were times when he would have welcomed a little more information about what was happening. Ms Etches made the point that the account underlined the need for staff to remember that sometimes patients could not retain everything they were being told by staff. RESOLVED: That the patient story be noted. TB.6227: Safe Hands Ms R Baker gave a short presentation on the background, development and future potential of Safe Hands at the Trust. The Board noted the amount of data which this system could handle. RESOLVED: That the presentation describing the progress made in developing Safe Hands at the Trust be received and noted. TB.6228: Contracting and Commissioning Update Mr Sharon submitted a report on current contracting issues and all commissioning intentions shared with the Trust. The Chairman expressed gratitude to all those who had worked hard to reach the position outlined in the report. RESOLVED: That the Contracting and Commissioning Update report be received and noted. TB.6229: Financial Recovery Board Mr Sharon presented the report on the work of the Financial Recovery Board. Mr Dunshea noted that the Dashboards D1 and D2 showed little progress on the recurrent schemes and Lord Carter Opportunities and enquired whether any other projects were being prepared to make up the shortfall on the savings targets. Mr Sharon said that the Executive Directors were keeping these under review, and confirmed that further PIDs were expected from D1 at the February and March FRB meetings. Ms Nuttall sounded a note of caution, saying that the Lord Carter “deep dives” had not generated the level of savings hoped for in the divisions or corporately.

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In response to Dr Anderson, Mr Sharon confirmed that there was an element of invest to save. Mr Vanes welcomed the report, but asked for the cumulative performance and forecast graph (executive summary, page 5) be updated for the next Board meeting so as to show actual performance since September 2016 (MS). RESOLVED: That the update on the work of the Financial Recovery Board be received and noted. TB.6230: Integrated Quality and Performance report The monthly Quality and Performance report had been circulated prior to the meeting. Mr Vanes noted the small number of cancelled operations due to a shortage of beds. Mr Loughton indicated that Cannock Chase hospital helped in this regard, along with the willingness of local residents to have treatment there. Ms Nuttall said that the Trust’s overall performance against the four hour standard had dropped during January, with some exceptionally challenging days. RWT had agreed to accept some ambulances from Stafford over a ten day period, at the same time as seeing increasing lengths of stay (partly due to increasing acuity), and ongoing challenges within Social Care for discharge arrangements. In reply to a question about the impact of the national campaign to avoid patients going to their local ED, Mr Loughton said that there were several places, besides the ED, to which patients with urgent needs could go in a City such as Wolverhampton. RESOLVED: That the November-December 2016 Integrated Quality and Performance report be received and noted. TB.6231: Chair’s report of the meeting of the Quality Governance Assurance Committee held on 25 January 2017 Ms Edwards presented a report containing the highlights of the meeting of the Quality Governance Assurance Committee held on 25 January 2017. RESOLVED: That the Chair’s report of the Quality Governance Assurance Committee meeting on 23 November 2016 be received and noted. TB.6232: Nursing Workforce report Ms Etches said that the staff numbers had not altered markedly during November and December. There were now 18 registered nurses from the Philippines working for the Trust. Another 18 were expected to arrive in February and March. RESOLVED: That the report on planned versus actual staffing by ward during November and December 2016 be noted. TB.6233: Trainee Nursing Associates – Pilot Project Ms Etches introduced a report on the introduction of the role of trainee nursing associate across the Trust. There were now 19 former health care assistants in this role. Mr Dunshea asked how trainee nursing associates fitted into skill mix reviews. Ms Etches replied that these associates would not be taking over the RN or HCA roles, and therefore skill mix reviews would have to take account of the distinct skills and competencies of this hybrid role. In response to a further question, she said that it seemed unlikely that this role

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would eventually develop into a more academic training route, and to a large extent it was for the Trust to make this a successful initiative. RESOLVED: That the report be received and noted. TB.6234: Finance Board report – Month 9 (December 2016) Mr Stringer introduced the report on the Trust’s financial position at month 9, and highlighted the revised forecast deficit of c£9.7m. The Board would discuss in the private session certain issues raised by NHS Improvement around whether it wished to persist with the previously agreed year end forecast position. Mr Stringer also pointed out that cash balances in month 9 had been stronger than forecast due to a large element of capital expenditure being pushed back into Q4. RESOLVED: That the report on the Trust’s financial position at month 9 (December 2016) be received and noted. TB.6235: Chair’s report of the meeting of the Finance and Performance Committee held on 25 January 2017 Mrs Martin picked out the highlights from her report of last week’s meeting of the Finance and Performance Committee, including the Committee’s assessment of its own performance and setting several actions as a result. RESOLVED: That the Chair’s report of the meeting of the Finance and Performance Committee held on 25 January 2017 be received and noted. TB.6236: Executive Workforce report Ms Holland presented the monthly update on workforce. She reported orally that uptake of the flu vaccination had reached 72% by 31 December and the campaign would remain live until the end of March. A report on lessons learned from this year’s campaign would be submitted to Board in February. Mrs Rawlings asked for an update on the new junior doctor contract. Dr Odum said that the balance of junior doctors would transfer to the new contract in the August changeover. Ms Edwards wanted to know whether clinical areas were committed to taking on apprentices. Ms Holland indicated that more needed to be done to raise awareness of the benefits of taking on apprentices and a report to the next Board meeting would touch on this. Mr Dunshea asked where in the report he could see the numbers of clinical fellows in the Trust. Ms Holland said that the current number of recruited clinical fellows was approximately 35 with on-going recruitment activity. A working group from the Medical Workforce Group, including Dr Odum, Ms Nuttall and HR Resourcing staff were currently working with specialities to define the grades and roles needed in the medical establishment, with the aim of defining the requirements for clinical fellows. Mr Loughton asked for the clinical fellows to be shown in the report as broken down between divisions. Replying to Mr Dunshea, Mr Mahmud said that over time he expected the portfolio careers and the enhanced model of medicine which RWT could offer in the VI programme to appeal to GPs. RESOLVED: That the Executive Workforce report be received and noted.

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TB.6237: Seven Day Services: Progress To Date Dr Odum introduced this item. Mr Dunshea asked for an update on the new junior doctor contract. Dr Odum said that a group was looking at the introduction of this locally and good progress was being made. Most rotas had been reviewed and were either compliant or were being altered to make them so. He told the Board that the main area of dissatisfaction was pay protection, but this could only be resolved at the national level. RESOLVED: That the report on the compliance against the 7 standards by 31 March 2017 be received and noted. TB.6238: Clinical Fellowship Programme (and Academic Institute of Medicine) Introducing this report, Dr Odum said that the Medical Workforce Group had established a good idea of the numbers of clinical fellows required in the Trust. RESOLVED: That the report be received and noted. TB.6239: 100,000 Genomes Project RESOLVED: That the report on the progress of the 100,000 Genomes Project be received and noted. TB.6240: Apprenticeships The Board noted that this report had been held over until the March Board meeting. TB.6241: Reconfiguration of Level 3: Cannock Chase Hospital In response to questions, the Board was reassured that the contractor was ready to start the work, and all consultant cover arrangements were being managed. RESOLVED: That the business case for the reconfiguration of Level 3, Cannock Chase hospital be approved. TB.6242: Business case for PC and Laptop Replacement Introducing this report, Mr Stringer explained that a bid had been made to the centre for funds to assist with digitisation, to be spent by 31 March. It was unclear whether any funds secured in this way could help offset the cost of the programme in this business case. He added that the programme could be flexed across the year end and into the next financial year. RESOLVED: That the business case for the replacement of laptops and PCs be approved. TB.6243: Business case for Theatre 6 Refurbishment Ms Nuttall responded to a question from the Chair by saying that there had been a big impact on capacity while Theatre 6 was down, but it should be in use again by the end of March. RESOLVED: That the business case for Theatre 6 refurbishment be approved.

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TB.6244: Business Case for Reconfiguration of Wards A12 and A14 RESOLVED: That the business case for the reconfiguration of Wards A12 and A14 be approved. TB.6245: Midwifery Ms T Palmer attended for this item and drew out the salient points of her report. She confirmed that the Trust continued to actively recruit to posts in order to safeguard the good birth: midwife ratio. RESOLVED: That the six monthly progress update on Midwifery Services be received and noted. TB.6246: Update on the review of midwifery regulation by the NMC Ms Palmer guided the Board through the salient points in this report. A further report would be presented to the April Board meeting on how this Trust would move forward with the new model. In response to questions, Ms Palmer explained that the removal of certain elements of local supervision represented a significant change, but the elements which would remain would provide adequate checks and professional issues would be picked up quickly. In response to other questions, she confirmed that it was expected that RWT would deliver approx. 4900 babies during 2016/17 and the same number next year. Mr Loughton reminded the Board that if the figure rose above 5000 the service would need to be resourced differently. RESOLVED: That the update on the review of midwifery regulation by the NMC be received and noted. TB.6247: Clinical Audit Month 9 Position Report During discussion of this item, Mrs Martin noted that there were six audits showing significant non-compliance without any assurance of a timescale to action them. Dr Odum replied that the clinical audit programme was constructed to look at compliance and no audit was signed off unless a detailed action plan was in place. He offered to provide further information on the six audits highlighted by Mrs Martin, outside the meeting. Answering a point made by Dr Anderson, Dr Odum said that information about the number of re-audits could be provided in the next report to Board. He added that whilst the report showed a low number of audits in some areas, the programme tended to accelerate and catch up towards the end of the year. RESOLVED: That the report be received and noted. TB.6248: Finance and Performance Committee – Terms of Reference The Board noted that the Terms of Reference had now been approved by the Committee. RESOLVED: That the revised terms of reference for the Finance and Performance Committee be approved.

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TB.6249: Board Assurance Framework/Trust Risk Register Ms Etches presented the Board Assurance Framework and Trust Risk Register report. She invited the Board to give further consideration to whether it wished the BAF to be redesigned. Dr Anderson mentioned that the City was mid-way through an Ofsted inspection of safeguarding. RESOLVED: That the report on the Board Assurance Framework and Trust Risk Register be received and noted. TB.6250: Independent External Review of Governance and Action Plan The Independent External Review of Governance report by Deloittes was submitted, along with the Trust’s action plan. The Chairman reported that he had, with Mr Loughton, attended a recent meeting of the City Council’s Health Scrutiny Committee to discuss this report. The Committee had asked for an update on implementing the action plan later in 2017/18. RESOLVED: That the Independent External Review of Governance be received and

noted, that the outline Action Plan be approved, and that a progress report including a

detailed action plan (with a timetable and delegated responsibility) be submitted to

the March Board meeting.

TB.6251: Freedom to speak up Guardian : The Role of the Guardian – first 90 days Ms N Mehay attended for this item and answered questions about her role in the Trust. She emphasised the need for senior managers to play their part in dealing with any concerns raised. She also spoke of the challenge around changing perceptions and culture to make this happen. RESOLVED: That the report on the work of the Freedom to Speak up Guardian to date be noted. TB.6252: Chair’s report and draft minutes of the meeting of the Trust Management Committee held on 25 November 2016 RESOLVED: That the Chair’s report and minutes of the meeting of the Trust Management Committee held on 25 November 2016 be noted. TB.6253: Chair’s report of the Finance and Performance Committee meeting held on 21 December 2016 RESOLVED: That the Chair’s report of the Finance and Performance Committee meeting held on 21 December 2016 be received and noted. TB.6254: Chair’s report of the meeting of the Audit Committee meeting on 8 December 2016 RESOLVED: That the Chair’s report of the meeting of the Audit Committee meeting on 8 December 2016 be received and noted.

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TB.6255: Minutes from earlier Board meetings The following minutes were received and noted: Quality Governance Assurance Committee, 23 November 2016 Finance and Performance Committee, 23 November and 21 December 2016 Audit Committee, 8 September 2016 TB.6256: Matters raised by members of the press and general public No matters were raised. TB.6257: Any Other Business Ms Nuttall reported that a live major incident simulation test had been undertaken on Sunday 29 January, the first of any significance to be attempted through the new ED. It had involved 60 members of staff and 50 “patients”. Initial feedback from NHS England was positive. TB.6258: Date and time of next meeting It was noted that the next meeting was due to be held on Monday 27 February 2017 at 10 am in the Board Room, Corporate Services Centre, Building 12, New Cross Hospital, Wolverhampton TB.6259: Exclusion of Press and Public RESOLVED: That, pursuant to the provisions of section 1(2) of the Public Bodies (Admission to Meetings) Act 1960, the press and public be excluded from the remainder of the meeting on the grounds that publicity would be prejudicial to the public interest by reason of the confidential nature of the business about to be transacted.

The meeting closed at 1:03 pm.