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TRUST BOARD OF DIRECTORS (PUBLIC)

Minutes of the Public Meeting held on Tuesday 27

th February 2018 at 9.00 am

In the Boardroom, Diana Princess of Wales Hospital

For the purpose of transacting the business set out below

Present: Mrs A Shaw Trust Chair (Chair) Dr P Reading Chief Executive Mr R Sunley Deputy CEO and Director of Operations Dr K Wood Acting Medical Director Mrs T Filby Chief Nurse Mr M Hassall Director of Finance Mr S Shreeve Non-Executive Director Mrs L Jackson Non-Executive Director Mrs S Cousland Non-Executive Director Mr A Bramley Non-Executive Director In Attendance: Mrs W Booth Director of Governance & Assurance & Trust Secretary Mrs J Adamson Director of People and Organisational Effectiveness Mr O Hasan Turnaround Director Ms C Grinhaff Interim Head of Communications & Engagement Mrs J Loughborough For the Patient Story Mrs D Rojahn Secretary to the Chair (for the minutes) Cumulative Record of Board Director’s Attendance (2017/18)

Name Possible Actual Name Possible Actual

Mrs A Shaw 11 11 Mrs S Cousland 11 8

Dr P Reading 7 7 Mrs S Hills 11 10

Mr R Sunley 11 9 Mr A Bramley 11 11

Mrs J Adamson 11 11 Mrs T Filby 11 11

Mr L Roberts 7 5 Mrs W Booth 11 11

Mr S Shreeve 11 11 Mr M Hassall 8 8

Mrs L Jackson 11 9 Dr K Wood 5 5 1. Business Items

1.1 Chairs Opening Remarks Anne Shaw welcomed everyone to the meeting and declared the meeting open at 9.00 am. Anne Shaw took the opportunity to thank Sue Cousland, Non-Executive Director, who will be leaving the Trust at the end of March to take up a new position with EMAS, for all her valued work since joining the Trust.

1.2 Apologies for Absence

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Apologies were noted from Sandra Hills (Holiday), Bryony Simpson for the Guardian of Safe Working Hours Report (adverse weather conditions) and Mr Hemadri for the FTSUG Report (Clinic).

1.3 Declarations of Interest Anne Shaw invited members to draw the Boards’ attention to any conflicts of interest relating to specific agenda items or to any updates to their formal annual declarations. There were none.

1.4 To approve the minutes of the previous Public meeting held on the 28th November 2017 – NLG(18)044 With the exception of two amendments to the names of two Non-Executive Directors, the minutes were approved as a true and accurate record of the meeting and will be duly signed by the Chair.

1.5 1.5.1

Matters Arising Proposed Changes to Meeting Structures – Workforce Wendy Booth referred to the paper and the one outstanding action from the previous meeting which was to provide proposals in respect of the assurance oversight role in respect of workforce & OD. Following a meeting of NED’s and relevant Executive Directors it was agreed that Quality and Safety would have the oversight role for OD and workforce unless there was a financial implication in which case it would be referred to the Finance and Performance Committee. There would also be a standing item on the agendas and within the Terms of Reference for cross referring between the two committees. It was also agreed that the change to the management OD and workforce group would be reviewed in August as part of the routine sub-committee review for added assurance. NED concerns remain related to the strategic delivery of OD and workforce transformation work. The Board agreed the formal implementation date to meeting structures from the 1 April 2018, and to review the effectiveness of the changes made to Board sub-committees in August 2018 as part of the annual review.

1.6 Trust Board Action Log – Public – NLG(18)046 Members received and reviewed the Action Log and updates were provided as required.

1.7 Updated Register of Directors’ Interest – NLG(18)047 Wendy Booth reported that the register had been updated to now include Dr Kate Wood. Dr Kate Wood asked for an amendment to be made in the paper with regards to her title from Interim to Acting.

1.8 Guardian of safer Working Hours Report Quarterly Report – NLG(18)048 As Bryony Simpson was unable to attend the meeting, Peter Reading together with Kate Wood offered to take the Board through the paper and discuss what was being asked of the Board:

1. The Board are asked to read and note the quarterly report from the Guardian of Safe Working Hours

2. The Board needs to decide whether they wish to offer the same conditions to Trust Doctors as those offered to Junior Doctors by the 2016 contract.

On this second point Peter Reading commented that this was the first time he had been made aware of this and that it needed to go through other structures (Trust Management Board - TMB) and a proper process for consideration first before being presented to the Board.

3. The Board are asked to support robustly the encouragement of clinical directors, directorate managers and educational supervisors to be aware of, and fulfil their

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responsibilities within the new contract. On the third point Peter Reading felt that the work which he, Kate Wood, Ian McNeil and Jayne Adamson were doing was supporting the junior doctors now in a way which had not previously been done. Pater Reading also mentioned that there were some changes with college tutors which had not been mentioned in the paper.

4. The Board are asked to promulgate positive messages regarding the 2016 contract and the importance of the ER system as a tool to improve safety and training.

Kate Wood spoke briefly about the fourth point which alluded to exception reporting, with Board level support this reporting was the right thing to do where junior doctors are working past their normal hours. Kate Wood advised that she would be using this report to help develop a case for Band 3 staff, briefly mentioned at the TMB meeting this week. Peter Reading made a request to the Board that although there is a request that this report is made to the Board it did not work in practicalities and asked if the Chair could write to Bryony Simpson saying although it is right that this paper comes to the Board but it should also go through the TMB structure where the people who can actually make this happen attend. It was agreed that Kate Wood would draft a letter to be sent from the Chair. Linda Jackson raised the point that she found this a hard paper to comprehend, there were tables and a number of abbreviations she did not understand, and the paper did not provide assurance at all. Tara Filby reiterated what had already been said and supported the paper going to the TMB. Action: Anne Shaw / Kate Wood to write to Bryony Simpson.

1.9 1.9.1 1.9.2

Non-Executive Director (NED) Role Adjustments: NED Alignment to Divisions – NLG(18)049 The Trust Board has agreed to the alignment of Non-Executive Directors (NEDs) to Clinical Divisions. Wendy Booth explained that the paper provided the key principles and next steps in respect of this approach which would be shared with the rest of the organisation once the Board had approved. The Trust Board agreed the approach outlined in the paper. Review of NED Challenge and Support Roles – NLG(18)050 Anne Shaw referred to the paper explaining that the report provided the updated schedule of NED challenge and support roles and how NED’s link into and support the Improving Together programme as it currently stands. This had also been shared with the Governors. Linda Jackson suggested sharing paper NLG(18)049 with the Governors also.

1.10

Chief Executive’s Briefing – Verbal Peter Reading remarked that the Trust had been working under intense emergency and urgent care pressure over the last month. He wrote to the staff yesterday thanking them especially as it had been a particularly difficult and challenging weekend recently. Peter Reading made reference to Thursday 15

th February when DPoW reached Opel 4 where a

request was made for volunteers from non-medical areas help support the wards. This consequently contracted adverse negative publicity which was very disappointing as neighbouring hospitals who also took this approach got some very positive publicity. Peter Reading spoke about the risks facing the organisation of which there were five:

1. Continuous emergency pressure which had recently affected DPoW much more than SGH

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1.10.1

2. Continuation of suspension of parts of routine planned surgical work. This is done with both CCG and NHSI approval on a weekly basis. The number of operations cancelled on a daily basis is 15 to 20 percent which equates to no more than 7 per day. Peter Reading asked to put on record that the Trust deeply regrets the impact this is having on patients, waiting list positions and also the affect it is also having on respective staff.

3. Sickness Levels – these have risen dramatically recently and are in fact higher than our neighbours. Peter Reading alluded to the usual winter bugs but felt that some of it was attributable to morale issues.

4. Waiting Lists – as a percentage on RTT (Refer to Treatment) the Trust is in the worst position in the country and having to cancel work means progress is not being made on this. The Trust had to concentrate on emergency care and was doing its utmost to concentrate on cancers and the longest waiters. Peter Reading suggested that a plan was needed in regard to the waiting lists and subsequently this should then be put forward to the CCG’s and partners.

5. Finances – The financial position deteriorated in month 10; this was very disappointing and not where NHSI wanted the Trust to be. There was a very constructive meeting with NHSI last week and their feedback was that the Trust was making good progress and are supportive of the financial plans.

Linda Jackson raised a concern on behalf of the Finance and Performance committee regarding the waiting list and stated that they would like to do a deep dive into this; they would like to know what the position is per speciality and what is being done about it. Tony Bramley, with the same concern, wanted to have an understanding of what the Trust is capable of doing; what the capacity is, what the gap is and the ability to deliver. Sue Cousland referred to the negative press and wondered what effect this would have on the staff; she also mentioned that with the winter pressures which the Trust had been under recently the most difficult bit was the recovery. Stan Shreeve commented on the debilitating affect the constant improvement programmes and financial improvement plans have on staff and that there is a need to be more thoughtful about the way the Trust celebrates success. Jayne Adamson remarked; building on what had just been said; that explaining to the staff what was happening had helped them see things differently. Ensuring managers communicate effectively with the teams so that the staff understand the situation can make a big difference. Jayne Adamson and Peter Reading also wanted to take the opportunity to thank the communications team for the fantastic job they had done. Kate Wood spoke about the week when DPOW went into Opel 4 and the importance of executive visibility of walking of the wards, which worked well, the intense focus needed to respond to OPEL 4 was to the detriment of anything else happening within the organisation; crucial meetings which needed to take place had to be cancelled. Anne Shaw commented that she wanted to put on record her thanks to Jayne Adamson and the team for her leadership standing in as Acting CEO for w/c 12

th February. Thanks also to the Non-Execs for

walking the wards during this difficult week. Anne Shaw also remarked that as a Trust Board we should be very clear about the lessons the Trust needs to learn as an organisation coming out of the first experience of Opel 4, and what does it need to change or do differently to manage this intensity going forward. She also reflected on how dreadfully the use of volunteers was reported in the press; when people were volunteering for the right reason – to support clinical colleagues. A further discussion followed about what needed to happen around communication going forward and what would be happening in the future. CQC Update – Verbal Wendy Booth advised the Board that the Trust had received the Provider Information Request (PIR)

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which is effectively the start of the CQC inspection process. This had been completed and submitted by the 21

st February 2018 deadline. The CQC must complete the inspection visit within six months of

the Trust receiving the PIR but they can inspect any time from April. It will be a 3 day visit which will also include Goole and Community. The planning is now underway. Peter Reading advised the Board that Wendy Booth had planned to retire and return at the end of March 2018 but this was now postponed, with agreement for a further six months, and Wendy Booth would be the programme manager for the CQC planning process and visit.

2. Quality & Safety

2.1 2.2 2.2.1

Patient Story & Reflection - Verbal Jo Lougborough presented Joyce’s story to the Board which was an incredibly uplifting story about her experience at SGH. Nothing was too much trouble at all , from her experience through A & E to being admitted for an operation; meeting Mr Kallam, Dr Amwar, Theatre staff, Ward Staff, the HCA’s, the Domestics to recovering on Ward 28. Joyce said that she was treated so well she felt like royalty. Anne Shaw said it was so refreshing to hear the detail of her story and how she included everybody. Tara Filby mentioned Mike Searby who is the charge nurse on Ward 28 and that this was such a testament to him and his team. Sue Cousland wanted to know how the Trust was proposing to bottle the leadership of Mike Searby and how it would translate this example more widely? Jayne Adamson commented on how the Doctor dealt with the discharge and recovering better at home. Jo Loughborough advised that the story was sent to the Ward but it was reliant on the story being played back to the team; Peter Reading thought it should also be sent to Mr Kallam and Dr Amwar. Anne Shaw thanked Jo Loughborough for the story and asked her to pass on the Trust Boards’ thanks also to Joyce for sharing her story. Quality Special Measures Progress Report Quality & Safety: Executive Highlight Report – NLG(18)051 Tara Filby referred to the Highlight Report which brings to the attention of the Trust Board key issues in relation to patient safety and quality, including an updated position on safer staffing. The details are contained within supporting papers submitted for information. Both Tara Filby and Kate Wood spoke about the safer staffing issues as highlighted and before moving on to Quality & Safety asked for any questions. Tony Bramley asked if the Nursing Establishment Review 2018/19 would be in place for April. Tara Filby said that was the intention. Linda Jackson asked what the roster control was like at the present time as the Trust needed to get the basics right, whilst tackling sickness and getting people back to work; Is the Trust using the best agency possible? Tara Filby advised the Board on what was happening with regard to the roster compliance whereby additional duties had reduced; Bank fill was tracked and remained fairly static. In terms of the agency element, Thornbury had come back to the Grimsby site but there had been additional escalation beds open over and above what had been planned which had to be responded to and sickness had compounded this position. Thornbury is used as a last resort as they do tend to fill. Obi Hasan thought that the best view, in terms of the agency, would be to say that Thornbury does not exist anymore and then plan around that. Obi Hasan spoke about the amount of premium that could then be reinvested and where this extra premium could be redeployed and used for appropriate staff and that the Financial Plan was built on certain things happening.

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2.3 2.3.1

Further discussion followed and the fact that it was about balance of risk and how do you get enough headroom so that this agency is no longer used and that a clear target was needed with working everything around that. It was also mentioned that there was also the whole human factor for our staff, which is one of the biggest issues, regarding the use of agency. It was noted that there are some real challenges about doing things differently. Tara Filby referred to the Quality & Safety element of the report and briefed the Board on the items highlighted. Peter Reading wanted to know as meetings had been cancelled as to whether the work had been

done “Unintended Impact of operational pressures ‐ Mortality group and Quality & Safety oversight group stood down; with data unable to be provided to fully complete the Staffing Capacity report”. Tara Filby advised that the work was still ongoing in spite of meetings being cancelled. Anne Shaw commented about the ongoing pressures facing frontline staff and asked what was being done in terms of extra support. Were there any themes or trends emerging as a result of ongoing pressures in relation to the Quality & Safety Dashboard.? Tara Filby advised due to the pressures they chose to use observational audits in place of the nursing documentation dashboard audit; there were no particular themes coming from the observational audits, but acknowledged it does not provide the same robustness of assurance. Tony Bramley referred to the SI reporting and said that Quality & Safety SI reporting seem to be stuck on the same issues now as they were a year ago and it is about how we move these on. Mortality Improvement Plan – NLG(18)052 Kate Wood presented the paper to the board briefing them on the key points. Kate Wood also advised the Board that the inaugural meeting of the new mortality group had been cancelled and therefore the ToR (Terms of Reference) had not, as yet, been agreed. Stan Shreeve queried page 4 and the composition of the mortality group; in the narrative it talked about the CCG partners but then in the attendee list it was not there. Secondly what had been agreed in terms of Healthwatch. Kate Wood advised that the CCG partners would be attending the Mortality group and Healthwatch would be attending the Quality & Safety group. Linda Jackson thought that the paper was good and that a lot of work had gone into it but that it was more of an update and action report and felt that there needed to be a lot more emphasis on progress in the report so as to get it into an assurance format for the next quarter. Sue Cousland felt that there was some limited assurance there and Tony Bramley stated that he could not be assured until he saw what the graphs illustrated. He also spoke about the last Quality & Safety meeting and whether they had a good enough understanding on mortality; Jeremy Daws is going to present a separate briefing so that the NED’s are reassured that they are focusing on the key aspects and asking the right questions. Quarterly Learning from Deaths Progress Report – NLG(18)054 Kate Wood presented the paper to the Board advising that there is a requirement to report on a quarterly basis on any avoidable deaths. It is based on the fact they need to do Structure Judgement reviews which has fallen off quite dramatically over the last couple of months due to operational pressures. The learning comes from identifying themes and then changing practices as a result of the reviews and the Trust is not currently getting the traction to deliver these changes. Anne Shaw observed that the importance of the reviews is critical to enable change to happen. The paper is in development at this stage until the group gets underway. Stan Shreeve had a couple of observations to make, one being how important the groups were

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2.4

beneath the mortality group being effective and being driven and led by the structure judgement reviews. He queried the table on page 5 referring to the 99 definitely not avoidable and no avoidable and stressed that this was counter intuitive to our mortality performance from a SHMI point of view. Kate Wood responded agreeing that it seemed counter intuitive saying that she had looked into this some months ago and that patients had been coming in with low mortality diagnoses but this proved not to be the case when looking further into their conditions. Quality & Safety Committee Highlight Report and Board Challenge – NLG(18)054 Tony Bramley as Chairman of this committee advised that the meeting on the 14

th February was

poorly attended due to the pressures within the organisation and briefed the Board on the contents of the paper presented. The Board noted the report

3. Strategy

3.1 3.2

Service Strategy: Executive Highlight Report – NLG(18)055 Richard Sunley referred to the highlight report noting the key issues would be covered off later on in the briefing sessions. Refreshing NHS Plans: 2018 / 19 Planning Guidance – Presentation Pam Clipson advised that she would be focusing on the non-financial aspects of the planning guidance and Marcus Hassall would speak about the financial aspects. Pam Clipson took the Board through the main headlines advising that the 2018/19 guidance is a refresh of the 2017/2019 plan that was submitted in December 2016. From here she picked up the elements which were changing. The final page of the presentation was a timeline where the two significant dates for the Trust were the 8

th March 2018 for the Organisational Operational Plans to be submitted by and the 30

th April for

the Board or Governing Body approved Organisation Operating plans. .

4. Leadership, OD & Culture

4.1

Workforce, OD and Culture: Executive Highlight Report – NLG(18)055 Jayne Adamson presented the report to the Board. The Allied Health Professional turnover is extremely high running at approximately 20% YTD which is much higher than nursing or consultant / doctor positions. Vacancies overall are at 24%. The HCA (Health Care Assistant) establishment is over 9%, there are some delays in the starting dates; hopefully this number should reduce to 2% by April. PADR compliance was low, usually running at between 85 – 95%; last month it was 68% which is the lowest it has ever been. This is something which the CQC will look at so it would be prudent for all areas to review their compliance rating to get the level up to where it should be. There are now 110 volunteers; spread across all areas; for the PPPR (Promoting Professional Pride and Respect). The Staff Advisory Line was launched that morning which is part of this process; the official launch will be on the 7

th March 2018.

The apprenticeship target for the year had now been achieved. NLaG is the only Trust in the country which has hit the target and NHS Employers will be using this Trust as a case study. Jayne Adamson thanked Rachel Maguire, Head of people Development for all her work with the apprenticeship and pre apprenticeship programme. Jayne Adamson brought to the Board’s attention the remaining points as per the paper, particularly the leave policy and advised that they would be looking further into what had been booked over the next 4 - 5 months concentrating on the Easter period initially.

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4.2 4.3 4.3.1 4.3.2 4.4

Wendy Booth asked if there were any plans to address the low percentage figures on PADR compliance. Jayne Adamson advised that the PADR process had already been simplified and that Harriet Stephens, Head of Education, Training and Development was already going to the different areas where the figures are low to try and understand why and what more could be done to help to achieve higher compliance. Linda Jackson suggested that it would be a good idea to have a board briefing on the emerging new roles, as discussed earlier, and where they would fit in. Draft Board Development Programme – NLG(18)057 Jayne Adamson referred to the paper advising that it was an outline of progress on pulling together a Board Development programme and planned activities over next 3 months, which is linked to the Well Led Framework. There are currently three briefing / workshops booked:

Strategy Session 2 - 27th February 2018

Insights Board Development feedback session - 21st March 2018

NED and Exec Director Development sessions facilitated by Deloittes - 10th April 2018

Freedom to Speak Up: National Guardians Office: Case Review Report and Trust Improvement Plan – NLG(18)058 Anne Shaw advised that the paper could be taken as read and asked if Jayne Adamson and Wendy Booth would like to reflect on some of the content. Wendy Booth advised that the Improvement Plan had been out for comment and was before the Board today for approval; the set of recommendations were very sensible. The paper had to be submitted on the 28

th February 2018.

Jayne Adamson advised that there had been one set of comments from a Non-Executive Director, Sandra Hills, which had not been included as yet and she had wanted to raise it before the Board today. The comment was the report specified that either Wendy Booth or Jayne Adamson was the executive lead for completing nearly all of the actions and Sandra Hills was of the view that it should be a shared executive response and not just linked to Wendy Booth and Jayne Adamson. Anne Shaw commented she had noted this also and felt very much that it should be a collective responsibility. Anne Shaw asked the Board if they were happy to approve the plan but in agreement to have Executive leads for final oversight and that it is a Trustwide collective responsibility. This was agreed The question was how would this be enacted and it was agreed that it would need thinking through and then presented before SMT before being brought back to the Trust Board. The Board approved NLaG Freedom to Speak Up Guardian’s Quarterly Report – NLG(18)059 In the absence of Mr Hemadri, Wendy Booth presented the paper to the Board which could be taken as read. Wendy Booth asked the Board to note that there would be a revision to the format of this report going forward. The themes from reported cases to date were noted. Workforce Committee Highlight report and Board Challenge – NLG(18)060 In the absence of the Chair, Sandra Hills, Sue Cousland agreed to present the paper to the Board and asked the members to take it as read and briefly highlighted the key points.

5. Access & Flow

5.1

Access & Flow: Executive Highlight Report Richard Sunley advised the Board, with agreement from the Chair that he would pick this paper up

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5.1.1 5.1.2

after the next two items on the agenda had been presented. Winter Planning Progress Report – Verbal Sue Barnett recapped, advising NLaG is a category 4 system and that the ask from NHSI and NHSE was to deliver 90% for quarters 3 and 4; this was achieved for quarter 3 (last year 85%) and currently quarter 4 is at 85.1%; for the same period last year it had been 80.3% so a significant improvement. February had been more challenging than January, which was also reflected in last years’ performance. The sites and the Trust continue to be challenged; 15% of elective activity had been cancelled to be able to deliver these figures. More escalation beds had been opened than planned; occupancy is running at 93 to 96% daily across the Trust; the plan was 90%. Compounding this issue there is approximately half a ward out at each site due to flu. Varying degrees of D &V at both sites; last week, 78 beds out at Grimsby and this week 72 beds out at Scunthorpe. This is also compounded by sickness rates, particularly at SGH. Regionally NLaG is sitting at the top in the bottom third of Trusts performance overall. Alert from NHSI this morning; the daily monitoring, winter calls and the view of the country, she advised that this would continue to post Easter. Staff are coping well; there was an Opel 4 at half term and there are lessons to be learnt there particularly around leave. There is a need to look at how to increase the banded people on the ground throughout the whole of the week, more people are required Saturday, Sunday and Bank holidays. Linda Jackson asked what other issues there were other than annual leave and weekend working which the Board should be sighted on. Sue Barnett said that the biggest issue was how do you get the wider clinical leadership at all levels, all areas, all departments. A winter plan for next year had to be produced by March 8

th 2018 and there are 5 things which need to happen:

1. Have an Urgent Care Centre 2. Our own medical model development 3. Doing more for the care of older people (over 75% of patients are over the age of 75) 4. Change the way cardiology operates 5. Have to have correct capacity

Sue Barnett advised that day cases and elective activity would be deferred for a further week at Grimsby. The first review of Winter Pressure for this year would be taking place on Thursday 1

st

March. Anne Shaw thanked Sue Barnett for her update and invited her back to the March meeting. Clinical Harm Review Process Progress Report – Presentation A presentation was made to the Board by Richard Sunley, Louise Glover Project Director and Steven Griffin, AMD for Clinical Support Services. The Board was briefed on:

The purpose of the Clinical Harm Review

The Background

How Had the Trust got to the current position

Progress

Trajectories

Cobra

Risks

Next Steps and Recommendation

Anne Shaw commented that that the Non-Executive Directors had been conscious that this work had been going on but hadn’t necessarily had the full information in terms of timescales as well as the scale of some of the areas of difficulty. The information is very useful and clear and that it was good

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to note that the consultants see COBRA as being very intuitive. Louise Glover added that NHSI had requested that the presentation was presented at their conference in April and that this was very positive as this programme had been developed in house. Anne Shaw added that from a Trust Board point of view and where they needed to focus their attention was the duty of candour, the risks and the next steps and recommendations. Wendy Booth felt that there was something missing from the presentation and the weekly dashboard and that was the length of time some of the patients had been waiting and this needed to be included to ensure complete transparency around this process. Tony Bramley made reference to the comments made on the “Risk” slide and asked if there was another plan. Richard Sunley advised that urgent patients would be seen in a timely manner than they had been and within a six week window. Peter Reading picked up on Colorectal and felt that as this was such a big issue and on that alone there was a need for another approach. He drew the Boards attention to the slide on Duty of Candour and recommended that the Trust does not proactively write to individual patients at this point, SIB supported this approach partly because of having this discussion at the Public meeting and as the reviews were not yet complete and to write to patients now may cause undue concern. The Board supported and approved this recommendation by David Black, NHSE Regional Medical Director. Linda Jackson stated that as yet she was not assured and noted that a lot of work had been done and still a lot more to do. Two key items had been mentioned; the 4000 records having only just gone out and colorectal and the unacceptable timescales; she felt that something needed to be brought back at the next Board meeting to give some assurance as it is too early to tell at the moment. Both the Chair and the CEO agreed that this should be on the agenda. Anne Shaw spoke about the Marsden model re colorectal which is straight to test. Richard Sunley stated that as part of the cancer targets there would be a new approach for next year where 95% top patients would be diagnosed within 28 days. Anne Shaw asked whether enough support had been put in to support the clinical leads and this is something which Kate Wood would be looking at. Kate Wood asked about the November backlog. Steven Griffin advised that this particular cohort goes up to August 2017 and that there would be another one to follow; the CCG’s have asked what could they do to help as this is a recurring problem. Tara Filby asked how they were sighted on the degree of risk building up. Richard Sunley spoke about the RTT over 52 weeks where at 80 the number was unacceptable and that it was now at 148 having almost doubled with the Winter pressure. Anne Shaw summed up as follows:

That the Board is mindful of its Duty of Candour, extremely sighted on the difficulties around this process but also very clear about the work which had taken place between October 2017 to date.

Traction will be monitored carefully and this will be on the Trust Board Agenda going forward.

Mindful that there needs to be wider support not only for the Trust but also GPs

Supportive of Dr David Black’s recommendation in terms of communications at this point in time.

Linda Jackson asked what needed to be done to stop this happening again and did there need to be some focus on forward planning. Sue Cousland asked if it could all be quantified as a whole rather than 2 separate pieces of work. Wendy Booth also reiterated the need to ensure oversight of the ‘live’ position and not just the cohorts referred to above. It was noted that East Riding CCG did not want to take part, there was no reason given by them for

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5.1 5.1.3

this. Access and Flow: Executive Highlight Report – NLG(18)061 Richard Sunley advised the Board that items in this report had been covered earlier. 62 Day Cancer Progress Report – Verbal Richard Sunley briefed the Board on the numbers which were included in the Intergrated Performance Report. They were as follows: patients who had been waiting longer than 62 days should be reached by the end of June and the position for those patients waiting between 42 and 62 days between mid-January and February had now gone down from 207 to 101. Patients who were 63 to 104 days had gone down from 156 to 118, as of mid –January. Anne Shaw commented that it was encouraging to note the progress.

6. Finance

6.1 6.1.1 6.1.2 6.1.3 6.2 6.3

Financial Special Measures Recovery Plan Progress Report: Finance: Executive Highlight Report – NLG(18)062 2018/19 Cost Improvement Programme – Verbal 2018/19 Budget Setting – NLG(18)075B Marcus Hassall advised the Board that he would cover these 3 items altogether. He spoke firstly about the financial position of Month 10 and that there had been a deterioration within this month, and briefed the Board on some of the critical issues regarding this. One of the main areas of concern continues to be the clinical staffing position. He spoke about the deficit and the need to reach the target of £40m. There had been a difficult shift in underlying spend but they had been able to mitigate this, however Month 10 altered the view on the rate of progress. Marcus Hassall briefed the board on Budget setting as per the paper. This report provided an overview and update on the 2018/19 financial planning framework including the Trust’s budget setting principles and basis for setting individual budget allocations. Also included at section 8 is an outline timetable highlighting the key milestones required to ensure appropriate budgets are agreed by the end of March 2018. Obi Hasan advised that the approach they were taking was determining the size of the challenge and what was deliverable and that was a judgement to be made. He then briefed the Board on the details. Marcus Hassall said that NHSI had seen the detail and were quite pleased with the quality of work that underpinned the headline numbers; however it would have to be fully owned by the people expected to deliver it. Tony Bramley raised a query regarding the 2017/18 Forecast Outturn Deficit table, whereby a detailed discussion followed. Peter Reading strongly supported the recommendation Finance & Performance Committee Highlight Report & Board Challenge, January 2018 - NLG(18)063 Linda Jackson as Chair presented her paper to the Board and noted that most of the points had already been covered. She added that with regard to the Budget setting that it was one of the best base lines that the Trust had ever had whilst she had been here. Linda Jackson also spoke about one of the other main points highlighted in more detail which was about the Patient Admin Update. Audit, Risk & Governance Committee Highlight Report, February 2018 – NLG(18)064 Stan Shreeve as Chairman of this committee advised the paper could be taken as read but did want to raise the point around Document Control. They had been deep diving into individual divisions on a

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rotational basis. What they had discovered were documents no longer required and if they are redundant they need to be eliminated and the committee needed to be advised.

Items for Approval

7. 7.1 7.2 7.3 7.4 7.5

Items for Approval Being Open and Duty of Candour Policy – NLG(18)065 Wendy Booth advised the Board that the amendments to the policy were highlighted and included reference to the Freedom to Speak Up Guardian and Associate Guardians as another source of support for staff involved in or who report a patient safety or other incident Stan Shreeve commented that there needed to be two amendments made on this paper; one to include the Trust’s name and clarification on point 3.3 – Divisional Clinical Directors. Subject to these two further amendments the Board was happy to approve Gender Pay Gap Report – NLG(18)066 Jayne Adamson advised that the report provides Trust Board with a highlight report against the Gender Pay Gap reporting standard which legally we must publish each year. The Gender Pay Gap is not the same as Equal Pay. It considers the average salaries and average bonuses for male and female staff. The data headline can be seen in Appendix 1. The Gender Pay Gap data will once published attract a great deal of media attention. Tony Bramley referred to item 5.3 regarding the action plan and that there was no timescale attached to it. The Board was happy to approve. Equality and Diversity Strategy – NLG(18)067 Jayne Adamson presented this paper to the Board advising that as part of the Public Sector Equality General Duty (Equality Act 2010) all Public Sector organisation much:

Eliminate discrimination, harassment and victimisation Advance equality of opportunity amongst protected characteristics

Foster good relations between protected characteristics An effective method to enable the achievement of this is to have an Equality and Diversity Strategy. In addition, as part of the Public Sector Equality Specific Duties Public Sector organisation must have a set of Equality Objective which last for 4 years. The Board was happy to approve Delegated Authority for Accounts – NLG(18)068 Marcus Hassall presented the paper advising that in order to ensure the timely sign off of the Trust’s audited accounts by the Chief Executive and the External Auditor, prior to submission to NHSI on the 29th May 2018, the Trust Board is requested to delegate formal authority to the Audit, Risk and Governance Committee at its meeting on the 17th May 2018 to sign off the accounts and reports on its behalf. The Board was happy to approve DH Loan Agreement – Diagnostic Programme Part 1 Marcus Hassall advised that this paper sets out for formal approval by the Trust Board, the drawdown of £4m of additional capital financing facility to support phase 1 of the Trust’s diagnostic scanner

NLG(18)093

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development programme. The Board was happy to approve

8

Items for Information – (see separate Appendix A) None

9 Matters to be included in the Board briefing for Governors Anne Shaw pointed out as this was a public meeting the governors had sight of all papers but would ensure they were briefed on key items.

10

Any Other Urgent Business None

11 Date and Time of the Next Meeting: Date : Tuesday 27

th March 2018

Time : 9.00 am Venue : Lecture Room, Goole Anne Shaw thanked members and closed the meeting at 1.28pm