(i)            Councillor Gibbons disclosed, in the interest of transparency, that he had been appointed by the Council as a Governor of Bradford District Care NHS Foundation Trust.

(ii)          Trevor Ramsay disclosed, in the interest of transparency, that he was standing to be a Governor of Bradford District Care NHS Foundation Trust.

ACTION:       City Solicitor

Recommended –

That the minutes of the meeting held on 8 February 2018 be signed as a correct record (previously circulated).

(Claire Tomenson – 01274 432457)

Resolved –

That the minutes of the meeting held on 8 February 2018 be signed as a correct record.

(Access to Information Procedure Rules – Part 3B of the Constitution)

Reports and background papers for agenda items may be inspected by contacting the person shown after each agenda item.  Certain reports and background papers may be restricted. 

Any request to remove the restriction on a report or background paper should be made to the relevant Strategic Director or Assistant Director whose name is shown on the front page of the report. 

If that request is refused, there is a right of appeal to this meeting. 

Please contact the officer shown below in advance of the meeting if you wish to appeal. 

(Claire Tomenson - 01274 432457)

There were no appeals submitted by the public to review decisions to restrict documents. 

Any referrals that have been made to this Committee up to and including the date of publication of this agenda will be reported at the meeting.

No referrals had been submitted to the Committee.

The Care Quality Commission (CQC) carried out an inspection of Bradford District Care NHS Foundation Trust in October and November 2017.  Nine complete core services were inspected (out of 14 provided by the Trust) and the Trust was rated as Requires Improvement.

The CQC will submit Document “AE” containing the inspection report.

Recommended –

That the report be noted.

(Caroline Coombes – 01274 432313)

The Inspection Manager, Care Quality Commission, introduced Document “AE” which reported that the Care Quality Commission (CQC) had undertaken an inspection of Bradford District Care NHS Foundation Trust in October and November 2017.  Members were informed that a new approach had been undertaken, however, the same five key questions were asked and these were used as the key lines of enquiry.  It was noted that the Trust had been very helpful prior to and during the inspection.  In October 2017 nine out of the fourteen core services had been examined.  In relation to good practice, the Trust was rated as good, however, there were areas that required further work.  The Inspection Manager reported that overall the Trust had been rated as ‘requires improvement’ and would have to submit an Action Plan.  To ensure that the necessary action was undertaken, monthly engagements via the telephone and quarterly meetings were available to the Trust.

Members then made the following comments:

·         With regard to the organisation being well-led, it appeared that leadership and continuing improvement were being measured.  Where had the balance been found in well-led?

·         Surely it was a management matter if staff did not carry out procedures.

·         The recruitment, retention and development of staff was a major issue.  Were there any problems?

·         Mental Health services in Bradford had been transformed.  Just because the overall rating was ‘requires improvement’ did not mean that it was a bad Trust.

·         What was the difference between ‘requires improvement’ and ‘inadequate’?

·         The Trust used to be classed as very good in relation to its different approaches.  Was it responsive?

·         Were policies in place but not leadership?

·         Was the Trust effective in some areas?

·         Governance was an issue for the Trust’s Board.

·         Was the oversight in relation to the operational side?

·         Were there governance and practice issues?

In response Members were informed that:

·         It was a training oversight and process issue.

·         There were some areas where staff were not following set procedures and others where management was not in place.

·         There were areas where robust procedures were not being followed by staff.

·         Well supported and trained staff usually stayed.  People had also come back to work for the Trust, due to a previous good experience.  Management training was in place and it just needed to be made clearer that staff training was too.

·         The inspection of core services had been chosen in order to look at the pathway of the Trust and how it was moving forward.

·         It could be a minor issue that made the overall rating to be ‘requires improvement’.  A breach of legislation would entail a ‘requires improvement’ rating.

·         Descriptions were available to match the ratings and the Trust had not met the ‘inadequate’ description.  Mandatory training was covered by a key question, therefore, the Trust had failed in this area and had to be classed as ‘requires improvement’.

·         The Community Health report outlines the responsiveness and other areas.  It was an innovative Trust that worked with different sectors.

·         Some cases showed  ...  view the full minutes text for item 79.

Bradford District Care NHS Foundation Trust will submit Document “AF” which provides an action plan to address the areas for improvement in response to the Care Quality Commission’s inspection report undertaken in October and November 2017

Recommended –

That the findings of the recent Care Quality Commission inspection and the actions that are being taken by Bradford District Care NHS Foundation Trust to correct all areas of concern, in a timely and sustainable manner, be noted.

(Dr Andy McElligott – 01274 228293)

The Medical Director, Bradford District Care NHS Foundation Trust presented Document “AF” which outlined the outcome and response following the Care Quality Commission (CQC) inspection.  He informed Members that the Trust was disappointed with the outcome, as it had been rated as ‘good’ for a number of years and it had prevalent leadership, values and ethos.  A Regulation had been broken, therefore, the Trust had been rated as ‘requires improvement’.  This was due to some policies and procedures not being followed, however, they could be rectified in a short time period.  The Medical Director explained that a 51 point Action Plan had been developed in response to the CQC report and this was evolving on a daily basis.  A number of actions had already been completed and were to be signed off by the Trust Board, others would be resolved over the next few months.  Members noted that the Trust hoped that all actions would be finalised prior to the CQC revisit.  It was aspiring to be an outstanding organisation and viewed the inspection outcome as an opportunity to put things right.

Members raised the following concerns:

·         What was the Trust doing to improve staff understanding of the Duty of Candour and other policies?  Was language an issue?

·         What was the Trust doing to improve basic life support?

·         What was the reason for the repeated Disclosure and Barring Service (DBS) check?

·         Only three incidents of restraint had been logged but they had not been properly recorded.  Had only three occurred?

·         How much notice was given prior to the inspection taking place?

·         How would the Trust fair if a surprise inspection was undertaken tomorrow?

·         Could bank staff access training?

·         The Trust had been shocked by the rating, but had it been aware that its staff were lacking in training?

·         The Trust was exceptional and there was a great deal of disappointment from all areas at the rating.  The management and staff had not lived up to expectations, but an apology had not been made.

·         The lack of oversight was a leadership issue, which should have been dealt with by the Board and senior managers of the organisation.  Had the lack of oversight been apparent or just not addressed?

·         Why was training a weakness? What were the demands on the staff, as absences were high? 

·         Not all serious incidents had been investigated effectively and within timescales.

·         How was staff training monitored?

It was explained to Members that:

·         There were training issues around Duty of Candour and other policies.  The Trust had a high reporting rate.  Staff needed to be helped to understand the language and a Communications Programme would be established.  The majority of staff were trained in relation to the Mental Capacity Act, however, the Trust was unable to show records of the numbers trained.  A robust process was in place to ensure staff were trained.

·         More training had been facilitated regarding basic life support, which was monitored and the compliance had improved.

·         The Trust’s policy required everyone to be DBS  ...  view the full minutes text for item 80.

On the 25 October 2017 Airedale NHS Foundation Trust Board gave approval to proceed with the formation of a wholly owned subsidiary for Estates, Facilities and Procurement Services. The subsidiary is named AGH Solutions Limited and went live on 1 March 2018 with the transfer of 319 staff.

Airedale NHS Foundation Trust will submit Document “AG” which outlines the reasons for this decision and includes a redacted business case.

Recommended –

(1)       That the reasons why Airedale NHS Foundation Trust agreed to form the wholly owned subsidiary, AGH Solutions, be noted.

(2)       That the ambitions of AGH Solutions, including employing more people from the local community and using more local community businesses in the supply chain, be noted.

(David Moss – 01535 294826)

The Director of Operations, Airedale NHS Foundation Trust, presented a report (Document “AG”) which detailed the reasons for the establishment of a wholly owned subsidiary for Estates, Facilities and Procurement Services, which had come into effect on 1 March 2018.  Members were informed that the Trust had increasingly had to think differently in order to sustain quality within a tight financial environment and to be imaginative in how it delivered savings.  A number of options had been considered, however, the Trust Board had been persuaded to establish a wholly owned subsidiary, which would be owned by the Trust and they would retain the key decision making.

Members then made the following comments:

·         The projected revenue saving was £2.5 million in year 1.  What was the current situation?

·         The procurement aspect seemed sensible and exciting.

·         What was the Trust’s highest risk and what had the Board done to mitigate this?

·         What were the risks in the operating climate?

·         New staff would have different terms and conditions.  Were there any guarantees?

·         Would there be any risks going forward?

·         Why were the new Service Level Agreements (SLAs) more restrictive than previously and why were new ones required?

·         How much work had been put into the potential impact on patients?

·         Had any key staff been lost?

·         The work undertaken by the Director of Operations in respect of the Children’s Cardiac Centre in Leeds was praised.

·         Would the Trust remain responsible for the new company’s debts?

·         Could the commercial focus be increased without taking this course of action?

·         Was there the potential to realise additional income?

·         Had the terms and conditions and pensions been transferred with the staff?

·         Would the new staff have a choice in relation to pensions?

·         What about tax issues?

·         Were conflicts of interest being managed with regards to the TUPE (Transfer of Undertakings (Protection of Employment)) Regulations and pension issues?  How was it being ensured that there would be transparency in the process?

The Director of Operations, Airedale NHS Foundation Trust and the Director, AGH Solutions, reported that:

·         The projected revenue saving was made up of different components.  The NHS had a set of procurement rules, however, the new company could work with other organisations, as it was not restricted in the same way.  It was hoped that opportunities could be given to local people, as the subsidiary had flexibility and freedom.  New staff would be offered different terms and conditions and could not be offered the NHS pension.  Overall the Board could make savings and a reinvestment.

·         The Trade Unions had not agreed with everything and the best compromise had been achieved.  The Trust could now outsource to companies that were not on the NHS register.

·         There had to be a separation between the Trust Board and the subsidiary, however, it had been insisted that the company had a People’s Strategy and was aligned to the Trust’s core values.  The Board also maintained certain rights over key issues.  Sessions had been undertaken with Trade Unions and it had  ...  view the full minutes text for item 81.

Bradford Teaching Hospitals NHS Foundation Trust will submit Document “AH” which informs Members of an evaluation it is undertaking to explore the option to safely create an Alternative Delivery Model (ADM) to deliver Estates and Facilities Services. 

Recommended –

That Bradford Teaching Hospitals NHS Foundation Trust’s intention to complete a full evaluation and present a comprehensive business case to its Board of Directors in July 2018, where a definitive decision will be taken, be noted.

(Donna Thompson – 01274 364841)

The Director of Finance, Bradford Teaching Hospitals NHS Foundation Trust (BTHFT), presented a report (Document “AH”) which outlined the current position as to the creation of an alternative delivery model to provide Estates and Facilities services to the Trust.  He explained that the Trust was in a different position to Airedale NHS Foundation Trust and were still considering the options, taking into account the financial challenge along with the vision and values of the organisation.  It had been agreed that a full business case would be developed in order to review the options and the favoured model was a Wholly Owned Subsidiary.  This would be submitted to the Board of Directors in July 2018 to ensure that the right decision would be taken.

The Chief Executive, BTHFT, confirmed that Airedale NHS Foundation Trust had started work on the matter before BTHFT and had undertaken exemplary work.  He stated that he could not determine what route they would take, however, they were committed to following an extensive process.

Members made the following points:

·         What had made the Trust realise it required more time?

·         Would there be an option to go to other areas and the potential to privatise?

·         Staffs’ feelings towards being part of the NHS was a key issue, as they may work differently if not for the NHS.  Had this been considered?

·         The options had been available for years.  Having lots of companies at arms length trading with each other raised concerns.  Had the Trust looked at the wider picture?

·         A wholly owned company involved risks in relation to the management of provision.

·         Were there Health Trusts that had totally outsourced services?

·         If the project failed would the staff that had been transferred under TUPE return to work for the Trust?    

Members were informed that:

·         The Trust needed further time as the issue had not been progressed and the information required was incomplete.

·         The process would be similar to that operated by Airedale NHS Foundation Trust and cover Estates and Facilities.  Other areas had included Corporate Services.

·         Keeping the NHS logo could be a way forward.  Staff were in crucial and critical roles and both Trusts felt very strongly about this.

·         Wholly Owned Subsidiary companies existed across the country and it was not uncommon for one of the Trust Board Members to sit on the Subsidiary Board.  BTHFT had not determined what action it would take as yet.

·         The Trust Board would bring the services back in house and staff would be transferred in via TUPE Regulations.

Resolved –

That the Committee notes:

(1)       the concerns raised by the Trade Union representative.

(2)       the increasing complexity in the way that public bodies are organised, the delivery of public services and the challenges surrounding accountability and transparency and requests that these issues be taken into consideration during the evaluation and consultation being undertaken by Bradford Teaching Hospitals NHS Foundation Trust.  

ACTION: Chief Executive and Director of Finance, Bradford Teaching Hospitals NHS Foundation Trust