Board Matters - May 2014

Board Matters
Welcome to Board Matters
Welcome to the May edition of Board Matters.

This month’s meeting was opened with a thank you to Martin Kuper who was attending his last Board meeting before taking up his new role as medical director at the Homerton University Hospital NHS Foundation Trust. Non-executive director Professor Jane Dacre was congratulated for being elected to the prestigious appointment of president of the Royal College of Physicians (RCP). Unfortunately, this means that Jane will be stepping down from her non-executive director role in July. Jane is a UCL nominated non-executive director and I will be meeting with UCL to discuss her replacement.

We welcomed new non-executive director Anu Singh to the Board who will chair the quality committee for the Trust. Anu, who is head of business improvement for Staffordshire County Council, gave the Board a brief outline of her background, her experience in commissioning and the importance, as a local resident, of putting something back into her local community.

The recruitment process for the new chief executive is underway. We expect this process to be completed in early summer. The new chief executive will play an important role in the recruitment of other substantive staff onto the board. 

Both our chief executive and I have met our counterparts at Camden and Islington NHS Foundation Trust, who provide mental health and social care services. We have agreed to develop a closer partnership building on our shared goal of delivering integrated care to local people.

A number of new apprentices have joined us this month. The scheme provides an opportunity for people to work with the organisation, develop their skills and make a difference to their local community. We have apprentices working in a wide range of areas including procurement and pharmacy.

The Trust celebrated International Day of the Midwife at the beginning of May. The work of a number of our midwives who volunteer to help in maternity units around the world was highlighted. Working in places such as Uganda, Nigeria, Sudan, India and Spain, they care for pregnant women and new mothers, delivering babies and sharing their knowledge.
Steve Hitchins
Chair of Whittington Health
I would like to hear your thoughts
If you have any comments or views on any agenda items, please get in touch by clicking on the ‘email Steve’ button below or give me a ring on 0780 1106860.
Patient story   1
The Board heard moving stories from two patients on how receiving treatment from the Improving Access to Psychological Therapies (IAPT) service in Haringey, Enfield and Barnet had completely changed their lives.

Neo told how he had struggled with obsessive compulsive disorder (OCD) for around 30 years. He described how the disorder affected his life. At its worst, it had prevented him from leaving his bedroom and being unable to eat. He said IAPT was the reason he was here today and described the excellent treatment and support he received from the therapists that worked with him. He said: “I received excellent treatment and support from therapists and I am now able to function again. I can't be more grateful - IAPT saved my life."

Darren performed a rap to the Board that he had written about his experiences. He described what he had been through as a self-harmer who was homeless. He told how he managed to overcome his problems with the treatment and support from IAPT and his therapist. He said: “I owe my life to IAPT. I was cutting myself on a daily basis. If it wasn't for IAPT, I wouldn't be here. I owe them a lot."

IAPT provides psychological therapy to adults across Barnet, Enfield and Haringey. The service is a partnership between Whittington Health and Barnet, Enfield and Haringey Mental Health NHS Trust. 
IAPT patients tell their story
2   Care Quality Commission inspection
Five out of six standards being met
The Care Quality Commission (CQC) published its report into standards of care at The Whittington Hospital following a routine inspection in January. A range of departments were visited including our emergency department, several wards, outpatients, the day treatment centre and the appointments booking team. The CQC found the hospital met five out of six standards inspected, we were not compliant on one. They said many services were delivered well and patients received a high standard of care.

Most patients told the CQC that they were happy with the care and treatment provided by the Trust, felt their dignity was respected and that staff were friendly, polite and knowledgeable. The CQC found the emergency department was extremely busy and patients faced long waits for beds, however, the Trust was putting in measures to manage the delays.

The five standards that the hospital met were:
  • Safeguarding people who use the service from abuse
  • Safety and suitability of premises
  • Staffing
  • Supporting workers
  • Complaints
The Trust didn’t meet the standard around care and welfare of people who use services. The CQC highlighted two areas for improvement, several aspects of care on Meyrick ward and long waiting times in outpatients and not receiving clear communication on the delays. The Board heard how an action plan is now underway to address these concerns and progress is being monitored.
Our financial position   3
The Board heard that at the end of the financial year (2013/14) the Trust has delivered its financial target of break even, recording a technical surplus of £1.1m. This followed good financial results in March. Chief finance officer Simon Wombwell told the Board that the figures were still subject to external audit and that the full financial accounts would be reviewed by the audit and risk committee. They would come back to the Board at its next meeting for adoption.

It was agreed that this was an excellent outcome following a challenging year. However, it has been achieved using a significant amount of reserves. The focus in the coming year was on improving our delivery of savings targets and maintaining control on expenditure. The chair thanked all our staff for their work in meeting the target.
Excellent result for challenging year
4   Performance: theatre use
Improvement in theatre use
The Board heard about two improvements in services which had been shown to improve quality and deliver care more efficiently.

Poor theatre use results in a loss of income each year from cancelled operations and empty theatres. The aim of the programme has been to support theatre teams to work more effectively together to improve the quality of patient experience, the safety and outcomes of surgical services, the effective use of theatre time and staff experience.

A number of changes have been implemented including: agreeing and locking down theatre lists a week in advance, advising those patients who are first on the list for surgery to enable operations to start promptly and bringing forward the first theatre slot. Since its introduction, there has been a seven per cent improvement in theatre use.
Performance: outpatients
The second improvement has been in outpatients. The outpatients service has been working with frontline staff to redesign and improve the appointment system.

Some patients had been experiencing multiple cancellations for appointments and delays getting through to the appointment centre. A review of the booking process has been carried out and a new service for managing appointment booking introduced which has significantly improved the system for patients. The centre now has lengthened opening times, increased staff at peak times and appointments are only being booked six weeks in advance when the training needs and annual leave of staff can be considered. These changes had enhanced both the patient and staff experience, reduced waiting times, improved clinic use, cut the amount of rebooking because of cancellations and improved the time waiting to book or amend an appointment.
Appointment system redesigned
6   Complaints review
Changes to complaints
The Board heard a report on the Trust's complaints process. It was acknowledged that response times were not good enough and the quality of responses needed to be improved. The proposed changes include a restructure of the patient advice and liaison service (PALS) and the complaints team. The Board were also informed of the Trust's response to the national Clywd/Hart Report on the NHS complaints process, the gaps identified and the Trust's action plan. It was noted that the lack of a standard approach has contributed to the delays and resulted in confusion about roles, responsibilities and expectations of what the divisions and the corporate team should be doing in relation to the management of complaints. All complaints are now being signed off by the chief executive.
Working on it!