Board Matters - December 2014

Board Matters
Welcome to Board Matters
Our December Board meeting opened with a patient story from our busy emergency department. We also discussed how we were coping with the pressures faced by our teams over winter, as well as progress on our five-year strategy and our latest financial performance.

We were delighted to have the Minister of State for Care and Support, the Rt Hon Norman Lamb MP, officially open our ambulatory care centre and to welcome centenarian Maud Ford MBE to start our Christmas festivities by switching on our Christmas lights. Maud is a long-serving former employee of Whittington Health who worked in our 'bed bureau' and celebrated her 100th birthday earlier this year.

We thanked our colleagues for their hard work and dedication during the year and gave particular thanks to those working over the Christmas period. Mince pies were also given to all employees due to the generosity of our PFI contractor WFL and catering company Sodexo. Some of the executive team visited wards on Christmas Day to wish people a Happy Christmas.

I would like to take this opportunity to wish everyone a Happy New Year.
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 07801 106860.
Patient story   1
Matthew Pomeroy, matron in our emergency department (ED), introduced this month’s patient story. The board were shown a short video of Pamela’s patient experience in the emergency department in January.

Pamela was woken in the night with a sharp pain in her chest and was taken by ambulance to our emergency department for an ECG. On arrival she was initially taken into the resuscitation area of ED to wait rather than the majors section, because of capacity issues within the department. Pamela said how this was initially confusing for her but that she had preferred the ‘excitement’ of the emergency department to later when she was on a ward. She felt that the ED staff were consistently nice and compassionate in their care but that there was a lack of drinking straws for feeding and there was not a pillow available for her.

Matthew said they had looked into her concerns making more pillows available, finding activities for patients to get them more active and looking at how patients are managed and supported when the emergency department gets really busy.

The Board thanked Matthew and the ED team, noting the pressure they were under, their work and the commitment shown on a daily basis.
ED patient Pamela
tells her story
2   Chief executive's report
Simon Pleydell
Simon Pleydell was pleased to announce to the Board the permanent appointment of Stephen Bloomer as chief finance officer. A start date is being finalised.

The Care Quality Commission (CQC) in its latest intelligent monitoring report had placed Whittington Health in band six, the lowest risk band. It has also been a year since we had any cases of MRSA bacteraemia, Simon thanked our infection control team and colleagues across the organisation for their hard work and this achievement. However, he said we were still fighting the battle against Clostridium difficile (C. diff) which remains a challenge for us. Each infection was one too many.

Simon reported that we were doing well with our flu campaign, which was ahead of our target. Last year we achieved 75 per cent vaccine uptake, this year we are aiming for 80 per cent. We hope again to be the leader in London for vaccination rates.
Winter pressures in emergency department   3
The Board heard that we were experiencing a high level of pressure on our emergency department (ED).

The NHS has changed its normal winter planning, now calling it resilience planning to reflect the pressures throughout the year. We started our planning several months ago and have extensive plans in place. Unfortunately, our ED experienced a large amount of pressure in the first few weeks of winter and this had continued. Whittington Health is not alone in these challenges and this pressure has beenfelt across London and nationally.

More assistance has been given around intermediate care and we have opened our own intermediate care beds. Teamwork in ED has been exceptional. We have now extended our opening hours for our ambulatory care centre and added more senior doctors in the ED. During the past few months, there has also been increased pressure across the organisation, including district nursing and our musculoskeletal (MSK) service.
Resilience planning
4   Seven day working 
Strengthening care
out of hours
In recent years there has been an increasing focus nationally on the need to strengthen emergency and acute care in hospitals in England during evenings, nights and weekends, which is often referred to as seven day working. The NHS is committed to have emergency and acute services out of hours consistent to the service provided during normal working hours.

There are local London commissioning standards as well as national standards for seven day working. Since the first version of the London Commissioning Standards was published in September 2011, Whittington Health has invested in a fundamental reconfiguration of out-of-hours provision of care across all acute services. Following this work, there has been a progressive improvement in the Trust's mortality rate and patients admitted as medical emergencies are spending a shorter amount of time in hospital.

The Board heard that while we have achieved substantial progress on seven day working, there are still improvements to be made including strengthening of senior doctor presence out of hours.
Charity fundraising   5
The Whittington Health charitable funds audited accounts and annual report for the financial year 2013/14 were presented to the Board. The charity had a total value of the fund balance £1,328,000 as of March 2014. In 2013/14 £250,000 was raised.

In the past year, charitable funds money has been used in a variety of ways that supports our patients and colleagues, including the purchasing of equipment for cancer patients on the chemotherapy ward and a new monitor within the neonatal unit. A number of fundraising activities have taken place, among them our marathon runners raising £12,000, an annual Rotary quiz event and a new range of Christmas cards.

Non-executive director Tony Rice told the Board of the opportunities to raise more money for charitable funds and that an investment was needed support this fundraising. 
Making a difference
6   Our financial performance
Finance update
The Board heard how our financial position remains very challenging and at the end of October we had a £982k deficit, bringing our year-to-date position to £6.3m deficit. While we are forecasting a balanced position, this is looking increasing unlikely. Chief executive, Simon Pleydell, said it was important for the Trust to limit the overspend as far as could be managed, understanding the run rate, and to set a robust budget for next year.

We have a back-to-balance plan in place, which includes seeking to secure additional income, and are continuing discussions with commissioners on our contract for 2014/15. The Trust has delivered year-to-date cost improvement savings of £4.2m against a plan of £7.5m. There are plans to deliver £8.7m for the year.

Simon stressed the importance of checking that the financial plan set at the start of next year was appropriate and sustainable.
Working on it!