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SOUTH EASTERN HEALTH AND SOCIAL CARE TRUST

Minutes of a Public meeting of the South Eastern Health & Social Care Trust Board held on Wednesday 26 November 2014 at 11.00 am

in the Great Hall, Downshire Estate, Downpatrick PRESENT: Mr C McKenna, Chairman Mr H McCaughey, Chief Executive Miss F Graham, Non-Executive Director Ms D Mann-Kler, Non-Executive Director Mr N Mansley, Non-Executive Director

Mr C Martyn, Medical Director Mr D O’Hara, Non-Executive Director Mr N Guckian, Director of Finance and Estates

Ms N Patterson, Director of Primary Care, Older People & Executive Director of Nursing Mr I Sutherland, Director of Children’s Services & Executive Director of Social Work

Mr J Trethowan, Non-Executive Director IN ATTENDANCE: Ms R Coulter, Director of Planning, Performance & Informatics

Mr S McGoran, Director of Hospital Services Mr E Molloy, Director of Human Resources & Corporate Affairs Mr B Whittle, Director of Adult Services & Prison Healthcare Ms P Glenfield, Senior Manager, Community Stroke Team (For item 128/14) Miss I Low, Board Secretary/Assistant Director, Risk Management & Governance

Miss J Turner, Executive Support Services Manager APOLOGIES: Mr P Davison, Non-Executive Director OPENING REMARKS

At the outset, the Chairman welcomed everyone to the meeting. 121/14 DECLARATION OF POTENTIAL CONFLICT OF INTERESTS WITH ANY

BUSINESS ITEMS ON THE AGENDA

No conflict of interest with any business item on the agenda was declared. 122/14 CHAIRMAN’S BUSINESS

The Chairman informed members that he attended a number of events, on behalf of the Trust, since the last meeting. Mr McKenna stated that Nurse Roisin Dorrian, a cardiac rehabilitation nurse, was invited to attend the meeting, but unfortunately was unable to be present. Her attendance would have afforded Trust Board members the opportunity to thank her for her heroic efforts in saving a local man’s life. Nurse Dorrian, was present at a charity boxing event in Ardglass when one of the competitors collapsed in the ring. She realised he had had a heart attack and called for a defibrillator which was provided by the volunteer first aiders from the Order of Malta, who were

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present at the event. The competitor was unconscious and Roisin carried out CPR immediately. The patient was transferred by ambulance to the Ulster Hospital, where surgery was carried out. By coincidence, following his discharge, the patient will receive cardiac rehabilitation care from Nurse Dorrian. There was positive media coverage of the incident and it attracted widespread publicity on Twitter.

123/14 CHIEF EXECUTIVE’S BUSINESS

(a) Stewart Memorial Home

Mr McCaughey asked Mr Whittle to update members on the recent media publicity surrounding the announcement of the forthcoming closure of the Stewart Memorial Home. Mr Whittle informed members that the Trust received formal notification from the Board of Trustees at the Northern Ireland Institute for the Disabled (NIID) of their decision to close Stewart Memorial Nursing Home in Bangor. The rationale provided was the longstanding unviability of running a small nursing unit (30 beds) functioning at an average of around 50% capacity. Trust staff met with residents’ families in Stewart Memorial Home on Monday 24 November 2014. Assistance will be provided by Trust staff with sourcing alternative accommodation for the residents involved. The Trustees of NIID have indicated they will not exercise the three months’ contract notice period and that they will co-operate with the Trust, for as long as necessary, in order to achieve relocation of the residents. In response to an enquiry from a member, Mr Whittle confirmed that Stewart Memorial Home is not owned by the Trust and the decision to close the facility was not taken by the Trust.

124/14 MINUTES OF THE PREVIOUS TRUST BOARD MEETINGS

The minutes of the Trust Board meeting held on 5 November 2014, having been previously circulated, were taken as read and signed by the Chairman as a true and accurate record.

125/14 MATTERS ARISING FROM THE PREVIOUS MINUTES (a) Update on Transforming Your Care (TYC)

Ms Coulter informed members of a workshop which was held by the HSC Board to consider the way forward in relation to Transforming Your Care (TYC). It was agreed there was a need to continue with the implementation of TYC and that a number of reform initiatives should be taken forward on a system wide basis. It was agreed to consider how this could be applied across acute services, out-patients, pathways and reablement. The Trust continues to be actively involved with in Integrated Care Partnerships (ICPs). Ms Coulter stated that work continues within the Trust to progress the reform agenda through the Reform Board which identifies key projects for 2014/15.

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126/14 REQUEST FOR SPEAKING RIGHTS ON ITEM 7.2

(a) Mr Eamonn McGrady

Mr McGrady thanked the Chairman for the opportunity to address Trust Board members. He conveyed an apology on behalf of Ms Ann Trainor, who applied for speaking rights, but was, unfortunately, unable to attend. He stated that he found attendance at Trust Board meetings useful, informative and, at times, frustrating. For example, he referred to the information the Chairman provided in relation to Nurse Dorrian saving a man’s life, in the community, which emphasised the need for local coronary care services being available quickly and locally. Mr McGrady also stated that it was a folly that services should be provided to the NHS by the private sector. Health care should be provided by the state. Mr McGrady stated there were threats to the £64m Downe Hospital before it even opened – a ward was closed and some areas were never brought into use. Many of those in the audience were involved in the hospital campaign for years. Mr McGrady referred to the Business Case, dated October 2003, which listed the requirements for an enhanced local hospital, which were also included in “Delivering Better Services”. These included 24 hour Emergency Department, consultant led medicine, day care and diagnostic services. Mr McGrady acknowledged that medicine needs to change and progress and in this respect, he thought it would favour small, local hospitals. However, there has been a “salami slicing” of services over the years; there were cuts to A&E earlier this year and now 9 beds are to be cut from the Downe on 1 December 2014. Mr McGrady stated he was informed there were no free beds in the Downe Hospital on the evening of Monday 24 November 2014. There was no consultation on the latest proposals, nor communication with staff. It was “death by 1,000 cuts” and while the building will be called a hospital, with 40 beds it will really be a poly clinic.

Mr McGrady stated he did not believe the cuts would be “temporary” and he enquired when they would become permanent. He enquired about the consultation and the Equality Impact Assessment. As the Minister indicated there had been discussion since April 2014 regarding possible cuts, Mr McGrady stated there was time to plan for the proposals, including consultation. He stated the Trust was pursuing a “centralist” agenda, once again. When the opening hours of the Emergency Department were changed, the Trust stated it was not related to finance and the public believed this information. On this occasion, it is related to finance. Mr McGrady stated community confidence in the Trust has never been lower. There was a perception that the Ulster Hospital was protected from the cuts and that it would also benefit from the skills of staff relocated from the Downe. He stated that the Ulster Hospital site was over-developed and the cuts discriminated against a rural community. The urban community around the Ulster Hospital would benefit again. As 40% of the Belfast population attend at the Ulster Hospital, it is in reality a Belfast hospital. Mr McGrady enquired if the Trust submitted alternative proposals to those now being implemented. As public servants, particularly the Non Executive Directors, Mr McGrady stated they should represent the interests of all of the community, not just those of the population of Belfast. While accepting that reform and restructure was required, Mr McGrady also sought assurance

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from the Trust Board that the cuts would only be temporary and that the beds would re-open in April 2015.

Mr McGrady stated that a number of hospital consultants earn more than the First Minister and the Prime Minister and it was unfortunate that there was much expenditure on large salaries in the NHS. He stated that he did not understand why front line services were not “ring fenced” against cuts and why savings could not have been found elsewhere. The community believed that the Trust would oversee the end of the local hospital. Mr McGrady requested that the implementation of the cuts would be “placed on hold” and reversed. He requested that Trust Board members would have an honest discussion and, in particular, that the Non Executive Directors would make their positions clear. Mr McGrady requested that the front line services, which are needed by the community, would be protected.

(b) Councillor Colin McGrath

In preparing for this presentation to you today I spent some time checking the Oxford English Dictionary to think of the appropriate words to use. I checked – Respect – A feeling of deep admiration for someone or something elicited by their abilities, qualities, or achievements. Certainly not relevant here. Trust – Firm belief in the reliability, truth, or ability of someone or something, also not relevant here. Dignity – The state or quality of being worthy of honour or respect. Again not relevant. Trust Board with this decision I don’t, the council doesn’t and the people of Down District don’t Respect or Trust you and don’t think you are worthy of dignity. Now, why would I say that? Why would I suggest that you don’t deserve such, lets face it, basic polite terms? Because as ever you have had to squeeze your belt a little and you force the notch on Downpatrick, you have had to cut your cloth and you have snipped at the Downe – you have had to tighten the purse strings and you have strangled our local hospital. Because you constantly chip away at the Downe you don’t deserve our trust or our respect or for us to afford you any dignity. Now, things are a little different this time. Many times in the past you have cut just at the Downe but on this occasion you have chosen to cut services on a wider scale – at Lagan Valley, Bangor Hospital and at the Downe. Now let’s deal with them in their proper order, I’m sorry about Bangor – but to be honest I didn’t realize it had a hospital until now and am sure it is really only a glorified nursing home – funny I must check that model – because it sounds like what we will end up with here. But to the Level 2 hospitals that areLagan Valley and the Downe. The Lagan Valley – in its supremely plum position of being but 8 miles from other major acute hospitals by motorway still managed to receive a smaller cut than the Downe – why? Why must we continually ask: ‘why the Downe is dealt more harshly by you, treated worse by your decisions?’ Why? What fight have you put up Trust Board for these cuts? Why with 20 beds at Bangor, 6 at the Lagan Valley and 9 at the Downe – 35 in total out of 100 in NI – why are you as one fifth of NI hospital coverage instigating over one third of the cuts? Why is this fair to the people of our

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Trust area? And to the reductions at the Downe – the loss of specialist Coronary Care at our hospital (and that is what it is). You might have sweetie mice running around in your heads if you think we can accept that the six coronary care beds subsumed into the medical wards of the Downe is acceptable. Let’s be clear – if there are only six beds left in the Downe and they are the coronary care beds and the next seven patients are six medical cases followed by a coronary care patient – we all know the coronary care patient will be moved on because the beds are taken. Coronary Care at the Downe will fail due to bed-blocking by medical cases – you know it, I know it, the staff know it – so don’t sell us that pig in a poke and expect us to be grateful to you. I’m sure you are gathering now why we don’t respect or trust you or afford you dignity. Let’s move on to the savings and the impact on staff. Savings? £350k. Really. Are you so poor at managing your resources that you cannot (out of the millions and millions you spend each week) couldn’t find £350k to maintain services at a hospital you have already ripped the heart out of? Seriously? You cannot manage to find 350k? Well, I may go back and search my dictionary and check for the term ‘poor financial management’. Trust Board – this is just not acceptable. And as for the staff – some who live a decent drive away from the Downe and as a result of your mismanagement get offered jobs in the Ulster? Hardly acceptable asking people to drive a round trip of 90 miles across rural, mountainous County Down to go to work and back. Asking people that have worked a lifetime in one place to move to somewhere else – upsetting lives, upturning family lives and then sneering ‘well, at least you will have a job’. You’ll probably apply for a Charter Mark or an Investors in People award – no hold on you have an Investors in People award – really – its like a comedy gold this. You only think of one thing Trust Board and One Thing only. I was thinking of how best to illustrate this point and had considered going to Belfast zoo to ask for an elephant and locating it in the corner – just over there. Because the elephant in the room, Mr Chairman, is that this time, like every time, to the point of bleeding mercy – each and every one of you is complicit in protecting at all costs the bastion that is Camp Ulster Hospital. Like military precision you move, manoeuvre, cajole and connive to make sure that your empire at Dundonald is maintained. Yes – you’ll be told its safest to move all to the Ulster Yes – you’ll be told its best practice to move all to the Ulster, Yes you’ll be told for clinical standards you must move all to the Ulster Yes – you’ll be told the whole health system you preside over will collapse if you don’t move all to the Ulster The only thing you probably are yet to be told is ‘would it be better to move everyone from Down District to the Ulster’. You wonder I am sure Mr Chairman why we are hurt, sore and angry. Well, like previous meetings I will list it all again:

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- we lost 24 hour consultant led A and E; - we lost our anesthetists; - we’ve lost our intensive area unit; - we have lost non-elective surgery; - we’ve seen elective surgery slashed; - we have wards that were built fitted out but never opened; - Consultants and clinics moved out; - Finance and Administrative staff moved on; - St John’s home shut down; - Our Maternity Ward downgraded; - bed reductions; - staff relocations. How much have we lost? I would ask you to wake up and smell the coffee but you even shut our coffee shop down. We are running on empty Mr Chairman and now you are cutting the engine. It is that which is unfair Mr Chairman. It is that which makes us sore, bruised and angry. In March next year you as a Trust Board will make decisions. You will decide should the decisions you’ve taken be revoked or made permanent. You will get the chance to overturn the decision we think it disastrous for this hospital. I would ask you to do right by the people of Down, do right by the staff at the hospital, do the best for the patients in our area – and overturn these decisions. Give us our hospital back and let us Respect you. Give us our vital health services back and let us Trust you. Give our children, our elderly folk, our sick adults and their families together with your staff team their dignity with you. Council wants it, I want it but most importantly the people of Down District and Mourne deserve it Please revoke this decision before it is too late

(c) Kieran McCarthy MLA

Mr McCarthy stated he was grateful for the opportunity to address Trust Board regarding the savings proposals. Mr McCarthy paid tribute to all of the staff of the Downe Hospital for the work they carry out. He stated that his constituents feel passionate about the services provided in the Downe Hospital. He also paid tribute to the campaign which was successful in ensuring there was a hospital maintained in the area. With the investment of £64m in a new hospital, Mr McCarthy stated that local people may have thought they would have no further worries or concerns – but this was not the case. Recently there were changes to the opening hours of the Emergency Department and now the proposed cuts leading to the amalgamation of beds in the Downe. Mr McCarthy requested that the current proposals, especially in relation to the reduction of beds in the Downe and reduction in domiciliary care packages would be paused. The reductions outlined would affect some of the most vulnerable people in society. Mr McCarthy questioned the

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“temporary” basis of the proposals and cited the example of the “temporary” closure of the Emergency Department at the Belfast City Hospital.

The former Health Minister rejected the content of the June Monitoring round, on the grounds that he would not oversee cuts. Members were reminded that the current Health Minister, Jim Wells, is an MLA in the South Down constituency. Mr McCarthy stated that Mr Wells was obviously prepared to oversee the implementation of cuts, which would have an adverse impact on his constituency. Mr McCarthy stated that he stood “shoulder to shoulder” with Down Community Health Committee and the people of the Down area in opposition to the cuts. At a meeting during the previous week with the Minister, Mr McCarthy stated he left him in no doubt that the proposed cuts were not acceptable. It was suggested to the Minister that savings could be achieved by the Department by a reduction in bureaucracy, duplication and waste. Mr McCarthy stated there was a contingency fund established by the Executive for “indemnity work” and he suggested that this could be used to meet the gap in funding for the Health Service between now and the end of March 2015. He reiterated his concerns about the “temporary” nature of the proposals and, on behalf of the local community, Mr McCarthy made a plea for Trust Board to seek financial assistance from the Department, rather than implement the proposed cuts and reductions. He stated that if such an approach was made, the “damning proposals” may be rescinded by “people at Stormont” and that the people of the area would receive the “health service which they deserve and to which they are entitled”. Mr McCarthy thanked the Chairman for the opportunity to speak.

(d) Ms Margaret Ritchie MP

The people of this community in Down and Mourne fought a long and hard campaign to secure a new hospital in Downpatrick with a range of services, and will not stand idly by and allow the Minister for Health the Health Board, and the Trust to continue to strip our asset - our hospital of services including nine coronary care beds and to decimate our community care provision. Such a move is clearly seen as discriminating against a rural community and will have a disproportionate impact on the elderly. This Ministerial decision by the Department as a result of contingency plans from the Trust represents an assault on our services and will be resisted at the community.

Central to the approval of the Business Case for the new Downe Hospital in 2003 was the recognition of two fundamental principles upon which the hospital was built and opened to the public at the end of June 2009. Those basic principles were local accessibility to services at the point of delivery and equity of access to those services. Those basic principles upon which the new Downe Hospital was approved, built and opened to the public with a range of medical and health services are as valid today as they were in 2003 when the Business Case was approved. What is now happening with the further removal of 9 coronary care beds will not only reduce accessibility, and equity of access to services at the hospital, but will impact on patient recovery levels.

Whilst we have an important medical and health asset in the new Downe Hospital, there has been an agenda to strip services which commenced

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during the design of the service profile for the new hospital. Before the hospital was due to open, the proposal for the Short Stay Unit was withdrawn; one of the 10 bedded medical units was closed around the time of the official opening of the new hospital in June 2010; the profile of services offered by the Accident and Emergency Department changed from Consultant led services at night-time to those offered by the GP Out of Hours service from April 2011 and then in December 2013 the Trust withdrew on a temporary basis the Consultant led Accident and Emergency service to be replaced by the GP Out of Hours service.

This was followed by the seasonal closure of medical beds over the summer period which has happened, according to the Trust during the summer months in previous years. That resulted in a 25% reduction in beds over the summer period when there was a demand for beds in the medical unit with new admissions and with those returning from the Belfast Hospitals for rehabilitation who found themselves having to wait a certain time for beds in the Downe Hospital. That situation is unacceptable.

What is more damning is that the South Eastern Trust as part of their contingency plans for efficiency savings submitted to the Minister in October proposed to continue to strip services and to temporarily remove 9 beds from the Coronary Care Ward and replace some of these beds in one of the existing medical wards. This puts immediate pressure on the medical wards at a time when winter pressures results in increased admissions and over-burdens the Belfast hospitals with admissions who are finding it increasingly difficult to cope with patients lying on trolleys awaiting treatment for long periods of time. Such a management approach is not reasonable, practical or compassionate to either patients or staff.

What makes the decision to temporarily remove beds from the Coronary Care Ward even more ludicrous is that the Downe Hospital is operating at the moment to full capacity. I have been told that during the day patients approved for admissions to the wards have had to wait some time for allocation to a bed.

The Downe Hospital was built to cater for 69 beds. With the removal of the short stay unit and the 10 bedded medical ward in 2010 the number of beds was reduced to 49. The temporary removal of 9 coronary care beds will bring the bed complement down to 40. This means that the Downe Hospital has to operate at 50% of it’s original complement and the capacity at which it could operate and deliver health and medical services for the people of Down and Mourne.

In fact, what is even more unpalatable is that there are 101 beds earmarked for temporary closure over the next few months in hospitals in Northern Ireland, and the Downe Hospital is expected to bear one tenth of those bed closures.

The Trust has already asserted to me in recent correspondence that the decision to undertake such a drastic removal of beds in the Coronary Care ward is due to a drop in admissions to the hospital over the last year. What the Trust fails to point out is that it is their decisions to change the delivery of certain Accident and Emergency services and the Ambulance Service taking

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patients directly to the Ulster Hospital rather than the Downe Hospital where they could be adequately treated has led to this downward trend in numbers. However, the Trust in their massaging of figures has failed to mention that the Downe Hospital is operating at full capacity over the summer and autumn period – demonstrating a clear need for their services from the community in Down and Mourne.

The local population is asking a series of important questions which demand answers from the Minister for Health, Health Board and the Trust. Those questions include the following:-

What has changed to reduce the type of services delivered at the Downe Hospital since the Business Plan was approved in 2003 and the hospital was built and opened it’s doors in June 2009?

Are these decisions to remove the Coronary Care beds and change the delivery mechanism for Accident and Emergency services the result of budgetary constraints; pressure from the Department of Health; the Royal Colleges for the various medical disciplines and the Training Organisation for Medical Consultants and Doctors (NIMIDTA), or a combination of these organisations?

Why will the Trust not protect, safeguard and honour the principles of local accessibility to services at the point of delivery and equity of access to those services? Why will the Trust not protect it’s existing asset at the Downe Hospital rather than pursuing new capital infrastructure at the Ulster Hospital which is an over-restricted site?

Why will the Trust not ensure an equitable and fair distribution of services through the full operation of clinical networking between the Ulster Hospital and the Downe Hospital? Does clinical networking work to it’s optimum potential as it was intended when the idea was first introduced some 12 years ago and described in the Hayes Review into acute services in Northern Ireland?

Why does the Downe Hospital have to suffer at the expense of the Ulster Hospital which is within three miles of the Belfast Hospitals: Royal Victoria, Belfast City and Mater Hospitals? Why does the Downe have to be the victim of over provision of medical and health services in the Belfast Hospitals?

Why does the Department of Health; the Health Board and the Trust persist in providing and wanting to deliver services on a centralist Belfast basis?

Why will the Trust not ensure that if patients are asked to travel from the Downe Hospital to the Ulster Hospital for services that those services could be delivered at the Downe and then patients could either remain in their local area and others could travel to it within the greater catchment area of the South Eastern Trust?

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Why does the South Eastern Trust not defend and stand solidly behind the Downe Hospital; the profile of services that were approved to be provided and those services that currently exist?

Why is the Department of Health, the Health Board and the Trust still persisting with a concentration of services in larger hospitals when in England, the NHS is reverting back to local hospitals for service provision?

Why has there been a growing concentration of managers in the administration of the health service which seems to be at the expense of patient care and the delivery of medical and health services to the wider community within the Trust area?

All these questions demand and require answers from the Trust today. Last week when I and others met with Minister Wells he agreed to have discussions with senior Trust representatives regarding the need to look at other options which would involve a fairer distribution of services and a re-location of services from the Ulster Hospital to the Downe Hospital. Furthermore, it is important for the community to try to assist the process through the provision of solutions to this current problem. In that regard, I would urge the GPs to encourage their patients to use the services at the Downe Hospitals, and for the local community to insist that they are treated on at least an initial basis at the hospital. The Trust needs to point out how they will protect the existing infrastructure and asset that is the Downe Hospital by locating a range of services that could operate at full capacity in a cost effective manner for the local population If the Trust is safeguarding capital investment at the Ulster Hospital which will involve additional revenue expenditure in future years’ budgets - then the Trust has a duty to not only scrutinise the use of that expenditure but also secure the future of previous capital investment at the new Downe Hospital with the retention of existing services and a range of new provision. I believe that a solution could be found in such a medical and health context. I have taken some time to look at the potential of services that could be re-located from the Ulster Hospital to bolster the Downe Hospital and ensure an effective, safe delivery of services for the people of the Down and Mourne areas. Such a range of services could include:- - In Medicine – Day Ward for all cardiac/medical conditions including

investigations and check ups or anyone needing specialist assessment that any GP or A/E could utilise.

- In A/E – many of the South Eastern Trust’s minor injuries ailments including booked attendances for minor operations under Local Anaesthetic.

- In Theatre: As the Downe Hospital is only one of a very few hospitals with a specially equipped theatre for orthopaedics and ophthalmology – this

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could be utilised by bringing in additional orthopaedic work to reduce waiting lists in Carpal Tunnel Elbow/Shoulder minor operation injections into the spine; Sports Injuries. Additional sessions could be held for cataracts as elderly patients will travel to the Downe where parking is available; varicose vein surgery; urology sessions; max-fax sessions; plastics general; minor operations in Gynaecology.

- Consideration should also be given to extending day procedure times as

has been done in many hospitals in England where some DPUs are open 23 hours – as a result more procedures could be carried out.

- Additional radiography services in the form of ultrasound and CT scanning which could extend the GP and X ray service out of hours.

I would urge that the Trust along with the Minister for Health and the Board enters into immediate discussions that ensures that the decision to remove 9 coronary care beds at the Downe Hospital, and the reduction in domiciliary care services is abandoned and new options within the Trust area explored. Concentration of time must now be devoted to the more effective deployment of resources and services, which could be executed through a re-location of some of the services in the Ulster Hospital to the Downe Hospital for effective delivery to all of the people within the South Eastern Trust. This would ensure that the South Eastern Trust could provide for the future use of existing capital investment at the Downe Hospital, for medical and health service delivery for the people of Down and Mourne and the wider South Eastern Trust area, rather than pursuing new capital ventures at the Ulster Hospital on a restricted site. I implore you the Board members here today to ensure that your Trust has acted in a responsible manner, and look at ways in which you can protect and safeguard your greatest asset within your Trust area, that is the £64m Downe Hospital and the first class medical services and staff within that new hospital.

(e) Chris Hazzard MLA

Mr Hazzard thanked the Chairman for the opportunity to address members and stated that he agreed with the views expressed by the previous speakers. He stated there were key issues to be addressed by Trust Board and by the Non-Executive Directors in particular. He concurred with Mr McGrady’s view that there continued to be a centralisation of services, combined with an increase in the use of the private sector to provide services to the NHS. Mr Hazzard stated that Trust Board members should be honest and state the proposals are not temporary and that they are permanent. He stated that they were described as temporary in order to avoid consultation and in doing so, the Trust was deceiving the public. Mr Hazzard stated the Trust should treat the population as “capable individuals” and with respect. He requested that a Forum would be created by the Trust to discuss the proposals with elected representatives and the local community. He stated the onus was on the Trust to communicate with the community and he further alleged that media outlets were briefed prior to elected representatives being informed. Mr Hazzard claimed that nurses in Lagan Valley Hospital were informed before the nursing staff in the Downe Hospital

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were informed of the proposals. Mr Hazzard criticised Mr McCaughey and Ms Patterson for not going to the Downe Hospital to speak to staff.

In relation to the position of staff in the Downe, Mr Hazzard enquired about the flexibility which will be afforded to staff who are asked to travel to a new workplace. He enquired if an Equality Impact Assessment would be carried out. In a recent debate in the Assembly, Mr Hazzard stated the Minister informed members that the Trust had alternative proposals. He requested that these would be outlined by members at the meeting today. He enquired if the Non-Executive Directors would be willing to discuss the alternative proposals at the meeting today. Mr Hazzard stated the 33% reduction in the provision of domiciliary care would have a negative impact on the elderly members of the population. He stated that this would have been identified by equality screening. He also stated there was a rumour that the GP Out of Hours facility was going to be relocated and he sought clarification on this issue.

In relation to the financial position, Mr Hazzard stated the Trust faced challenges for a number of years and for this reason, he did not accept that the proposed cuts had to be implemented at short notice. He stated that the financial management in the Department of Health was not good either, with £13m being returned to the Treasury as it was not utilised. This would have employed 200 nurses, according to Mr Hazzard. There was an unstable process for the management of the finances of the health service and Mr Hazzard enquired if the Trust challenged the Minister and indicated this was not an acceptable way to conduct business. Overall, there needed to be better leadership from both the Department and the Trust. Mr Hazzard stated there was waste in the system, which could be addressed by the Health Minister and he enquired about the levels of fraud within the Trust. He referred to the £250m set aside for Phase B – he suggested the Trust could explore possible investment with the European Investment Bank, in order to protect front line services. Mr Hazzard stated that up to £200m would be saved by the Education Department by reducing expenditure on administration. He enquired if similar savings could be achieved by the Health Department. Mr Hazzard stated the Trust recently used the services of KPMG to compile a report – he enquired if this was true, when the report would be published and how much the exercise cost. He enquired if the Trust had recently purchased 600 new printers. He stated that Directors received an 8% increase in their salary and that a number of members of staff earn over £150 k as a salary. There was a need to discuss revenue properly. Mr Hazzard referred to the directive given by the Health Minister to the Northern Trust to consult on the temporary closure of Dalriada Hospital. He stated there should be a similar consultation exercise in relation to the Downe Hospital. He stated there needed to be discussion on the issue and repeated his request to create a Forum. This would help to build trust with the local community and provide an opportunity for answers to be given to questions posed.

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Trust Response to Speakers Mr McCaughey responded to some of the points raised by the speakers. He noted that everyone felt passionately about Health & Social Care and the discussion today reflected that emotion as the system is under threat. The Assembly had only settled the financial allocation in late October 2014 and the consequence of this delay was that the Trust had to achieve £5m savings in the final five months of the year. If this position had been agreed at the beginning of the financial year the Trust would have been required to save £400k per month but the late notification has resulted in a target of £1.25m per month and this has increased the impact on services. He commented that following the budget settlement every political party has griped about the people left to implement their decisions. He had been speaking to a number of Politicians and Elective Representatives in every area of the Trust and the response regarding cuts is always “not here but somewhere else”. He felt that it would be shallow to avoid the issues being faced by Trusts. All Health Systems across the world are facing the challenge of growth of 3% - 4% per year in demand in addition to inflation costs and new techniques. In order to “stand still” 5% - 6% of growth investment is required each year but in reality the budget has only been increased by 1% (2% in a good year) over the past number of years. This in effect is a 3% - 4% reduction in real terms each year with the expectation that the Trust will absorb these additional costs. Over the past number of years the Trust has been able to increase patient care through fewer beds because it is required, year on year, to work harder and faster. Mr McCaughey believed that society, and Politicians, need to face up to the challenge of addressing the financial allocation for Health & Social Care. In order to increase investment discussion will need to take place regarding the allocation of funding and review the current “free” provisions in order to assess if this would be better allocated in another manner, for example free prescriptions or Domiciliary Care provision – these services all have a cost and if funding allocation should be a choice made by society. Over the past number of years the Health & Social Care has been “ring fenced” with a 1% increase and “muddled” through but the pressure has increased year on year within the system. He noted that the Trade Union representatives present would be able to confirm the increased pressure on staff throughout the Health & Social Care System. In response to comments made by speakers regarding the Downe Hospital, Mr McGoran noted that there had been quotes from the 2002 Developing Better Services report and that the Hospital was a Local Enhanced Hospital. However, he pointed out that at that time it was made clear by the Department of Health that “Enhanced Local Hospitals” was a vulnerable model and the approach would have to be evaluated on a regular basis to ensure its continued viability. Mr McGoran noted that a Judicial Review judgement two years ago supported the Trust’s decision to change services in the Downe Hospital to an urgent care model. The challenges were dismissed and the Trust’s action endorsed 100%. Mr McGoran advised that changes have to be made when circumstances change in order to retain services in the Downe Hospital. He stressed the services which are centralised in the Downe Hospital, for example Sexual Health Services and Bowel Screening. He also advised that many new services had been brought to the Downe Hospital including cataract surgery, fracture surgery, maxilla-facial surgery and the MLU. He commented that whilst it would be great to increase services carried out in the Downe Hospital, as noted by a previous speaker, the financial constraints upon the system currently would prevent these developments being commissioned. The use of Independent Sector providers had also been noted

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and Mr McGoran agreed that the Trust would have preferred to carry out this work in-house but this had been a Commissioner decision by HSCB. Regarding the previous statement about the Downe Hospital being singled out for cuts, Mr McGoran pointed out that 6 beds were being closed in Lagan Valley Hospital based on the evidence of 200 fewer admissions this year compared to last year when projected to the end of the year. Within the Downe Hospital it has been agreed to reprofile the two 20 bedded Wards to 21 beds and therefore reduced by 7 beds. He noted that there have been 300 fewer admissions to the Downe Hospital during the first 6 months of the year. Whilst there may be days when the Downe Hospital may struggle to cope with this reduced bed number the hospital should cope on most days. There were no changes to bed numbers at the Ulster Hospital due to the evidence of 1000 extra admissions during the year. Within Bangor Hospital the 20 beds reduction will have a significant impact on the Ulster. Mr McGoran expressed frustration that some of the earlier speakers appeared to attack the Ulster Hospital and outlined the valuable services provided there for all the people of the catchment area, including the Downpatrick area. He noted the clinical network established between the Ulster and Downe Hospitals and how vital this was to the provision of services, for example it would not be possible to sustain the Emergency Department without the assistance of Consultants at the Ulster Hospital. He believed that Consultants would not be attracted to work solely at the Downe Hospital. A previous speaker had referred to the bed capacity within the Downe Hospital and the potential to be unable to cope with a reduction. Mr McGoran noted that there are currently 49 beds in Downe Hospital of which 9 are nominated as cardiology beds but often these are used for medical patients as there is not usually that number of cardiology patients at one time. Whilst the reduction to 42 beds will have an impact this is necessary in order to realise the savings required as previously highlighted. He shared the concerns expressed and noted that the Trust had written to the Department of Health, Social Services & Public Safety (DHSSPS) and the Health & Social Care Board (HSCB) to place on record the potential for increased risk. Whilst it is not clear that there is an actual risk, the organisation was aware that an increase in demand for services with less capacity is an area for concern, although the productivity and efficiency has resulted in the Trust being able to cope generally with increasing demand. In relation to the savings, Mr McGoran noted that this is the 8th year of reductions and therefore all the actions which would not affect front line services have been taken. It is now necessary to reduce capacity in order to achieve the savings required. He noted that a previous speaker had referred to the capital development at the Ulster Hospital and he advised that this is specific funding in the same manner as that used to fund the new Downe Hospital. Whilst there will be revenue consequences arising from the new development it should not be forgotten that this building will provide a critical service for the people of Downpatrick also. Mr Martyn noted that reference had been made to the heroic actions of the Cardiac Rehabilitation Nurse in saving the life of a person at a charity event. He stressed that this successful outcome had been the result of the Nurse being in the right place at the right time with the correct equipment. Cardiac arrest is a time critical condition and the outcome for the patient would not have been affected by the availability or otherwise of cardiology beds in the Downe Hospital. In fact he

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noted that the surgical interventions required are carried out within the Belfast Trust. Mr McGoran noted that Mr Hazzard had referred to how the Trust had communicated with staff regarding the savings proposals. He noted that the Directors had attempted to notify as many staff as possible at all Trust sites as early as possible. Mr McGoran had given the presentation to the Lagan Valley Hospital at an early stage, ie before the embargo to release plans, and then visited the Downe Hospital before going to the Ulster Hospital. At the Lagan Valley Hospital meeting he had only been able to speak about the plans for that location although the fact that there were other meetings scheduled may have led staff to assume that there would be impacts elsewhere. Any communication between staff from Lagan Valley Hospital to those in the Downe and/or Ulster Hospitals would have been mere speculation. Ms Patterson had met with staff in Bangor Hospital. He stressed that whilst it would have been ideal to tell everyone affected personally it was not feasible or practical to do so. There may have been a better way of advising staff who were directly involved before the public meetings and this would be a piece of learning for the future. Mr McGoran believed that everyone had done the best they could in difficult circumstances. Mr Molloy pointed out that the Trust Board is a meeting in public rather than a public meeting and therefore this is not the appropriate forum to respond to all questions/issues raised. He stressed that the Trust is happy to respond to all questions and, in fact, have done so recently in respect of a large number of Assembly Questions, Freedom of Information requests and ToFs/CoRs. However he felt it incumbent on him to address some of the points raised. In respect of the query regarding fraud within the Health & Social Care System, Mr Molloy advised that since 2007 he was aware of only one case which was referred to the Counter Fraud Unit in respect of £300. Mr Molloy noted that the Health & Social Care System has been the only one subject to the Review of Public Administration which has resulted in 26 organisations reducing to 6. This had a huge impact on the workforce and there was a 25% reduction in Administration and Management costs before budgets were set. He advised that South Eastern Trust has the lowest management costs in the Province, less than 3.5%. He noted that management costs included Nurse Managers, Medical Managers, AHPs and people who run the organisation every day and carry out very valid pieces of work. In respect to the query regarding the engagement of KPMG Consultants, Mr Molloy advised categorically that they were not engaged by this organisation. Mr Hazzard had referred to a “cursory glance” at salaries and Mr Molloy suggested that he review the papers again. As Chairman of the Remuneration Committee he confirmed that no Trust Officers had received a £150k increase in salary. In respect of the establishment of a Forum Mr Molloy noted that this suggestion had been made previously at a Downe Council meeting. The Trust is more than open to engage in a Forum where constructive dialogue on future services in this area could take place. He suggested that this be organised as quickly as possible. Mr Molloy stressed that discussions at the Forum would be at a level expected of any public meeting. He stated that he was grossly offended and found some of

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the language used earlier in the meeting to be completely unacceptable. He asked that the statements made be retracted. In conclusion the Chairman noted that the delay of politicians to notify Trusts of the savings has resulted in the greater impact on services. He noted that a speaker had queried if Trust Board members had been made aware of the options available and confirmed that this had been carried out on 4 – 5 occasions. The primary concern had been to ensure that the actions taken would not compromise patient safety whilst achieving the statutory responsibility to breakeven financially. The decisions taken were those available after the political procrastination which reduced the timescale for achievement. The Chairman also noted that, as a member of the Remuneration Committee, no-one had received more than a 1% pay rise. He also agreed to engage in discussions as there will be further savings required over the next five years. Ms Ritchie requested an opportunity to reply and the Chairman made an exception and granted permission. Ms Ritchie asked Trust Directors to concentrate on the budget they had been allocated as she felt, whilst there had been a delay in confirming the overall financial position, the original funding had not been utilised to maximum benefit. If they concentrated on the allocation given, and the priorities for the service, the Downe Hospital services could be safeguarded. She questioned why the Ulster Hospital always appeared to be viewed as medically critical and therefore received the funding.

127/14 FINANCIAL REPORT FOR THE PERIOD ENDED 31 OCTOBER 2014 (MONTH 7)

Members received, for discussion, Paper No: SET/70/14(a), Financial Report for the period ended 31 October 2014, which had been circulated with papers for the meeting. In relation to the Trust’s savings plans for 2014/15 Mr Guckian noted that there had been three strands to this:- £7.1m was taken off the Trust’s baseline allocation of which £3.5m had been

achieved out of the cost base (non-front line services), and the Trust managed to increase services.

The second strand was £5m which resulted in the Trust being asked to achieve £2.5m without any major impact on services.

The Trust is in effect taking 30% of savings out of the front line (ie £2.5m out of £12.1m, from front line services, which it has been accepted will have an impact on services).

In relation to the Month 7 financial report, Mr Guckian advised that there is currently a £3.1m deficit which would forecast to a year end position, taking into account savings plans, a £2.1m deficit. However Trust staff are working hard towards reducing this amount and getting as close to a breakeven position as possible. He stressed that the late approval of Contingency Plans would only allow this report to the end of October 2014 to show partial implementation of proposals. He assured Trust Board that all Directors are vigorously reviewing areas for savings and are working to finalise Contingency Plan actions.

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Regarding the assumptions with the Finance Report Mr Guckian noted that these have been detailed in line with prior years and will be fully discussed at a meeting with HSCB colleagues on 27 November 2014. He commented that overall the Trust’s performance had been almost identical to the previous month. Progress against the original savings target of £7.1m has remained changed (50% achievement). In relation to the new Contingency Plans the success of general workforce actions, ie 30% reduction in Agency staff in non-acute services, has been actioned and will be reviewed in next month’s information. Mr Guckian noted that it is a difficult time of year, with the onset of winter, to realise savings from Contingency Plans which had been submitted in June; August and September 2014. However the Organisation is fully engaged in the management of temporary measures/plans in order to reduce costs. He reminded Trust Board that the forecast deficit at the beginning of the financial year was £18m and this has now been reduced to £2.1m and every effort is being made to reduce this further. Discussion took place regarding the financial position and a member noted that Trust Board is well aware of the financial position for 2014/15 but asked if appropriate plans were in place for 2015/16, especially with regard to planning cycles for DHSSPS and HSCB agreements. Ms Coulter advised that this issue has been raised on a number of occasions. The process requires the DHSSPS to prepare a Commissioning Direction to which the HSCB, as Commissioner, must respond through a Commissioning Plan and then this document is used by Trusts to develop a Trust Delivery Plan. She noted that as of November 2014 no approved Commissioning Direction Plan has been received for 2014/15 and whilst a Trust Delivery Plan has been designed and submitted it has not yet been agreed. This document is required in order to influence the development of the Commissioning Direction for 2015/16. The Chairman expressed concern about this position and asked Ms Coulter and Mr Guckian to stress to DHSSPS and HSCB colleagues the urgent need for clarity in this regard. A member asked if, in the absence of approved Plans, has the Trust been paid appropriately for all services delivered. Mr Guckian advised that the Trust’s overperformance, eg 3,500 admissions, has been often pointed out to the HSCB but whilst accepted in principle there are no additional resources. He noted that 70% - 80% of the Trust’s deficit is linked to service need. Mr McCaughey believed that the basic answer to the question is that the Trust is not paid for all services provided as the reality of a requirement of 3% - 4% additional funding each year in order to stand still has not been received whilst there has been expectation that the Organisation will continue to absorb this additional activity. He stressed the additional pressure this places on staff across the Organisation and believed that the Trade Union representatives present would be able to testify to this. In response to a query regarding the measurement of Contingency Plan proposals Mr Guckian advised that robust processes are being put in place in order to monitor the achievement of all savings and also the impact on services. He noted that there is recognition that these proposals will have an impact on activity, flow and quality, whilst safety is paramount.

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2015/16 and Beyond Members received, for discussion, Paper No: SET/70/14(b), Contingency Measures – Summary Report, which had been circulated with papers for the meeting. Mr Guckian noted that the Trust is currently £1.5m adrift of the £4.9m Contingency Plan target however some Directors continue to identify Agency staff to be removed and he stated that this figure could reduce down to £800k - £900k if all Directorates deliver further plans. With only five months to deliver savings the main methods are via workforce cost reductions eg vacancy controls and overtime. He noted that the Trust will keep DHSSPS and HSCB colleagues advised of progress and if there is a gap in Contingency Plan savings when all have been implemented then further proposals may be required. During discussion Non-Executive Directors noted that the Trust has a legal duty to achieve financial breakeven and the importance of monitoring for 2014/15 and into the future. It was also pointed out that financial problems within the National Health Service are a United Kingdom wide issue and society must review methods of reducing this increasing burden. This would be a discussion for politicians at both Stormont and Westminster.

128/14 PRESENTATION OF A PATIENT/CLIENT STORY

Ms Patterson reported that unfortunately the patient at the centre the story today, Mr Paddy O’Neill, was unable to attend today due to work commitments but he had asked Ms Glenfield, Senior Manager Community Stroke, to present his experience of the Psychological Therapy Service following a stroke. Ms Glenfield read out Mr O’Neill’s patient experience story which detailed his life prior to having a stroke and impact this illness had on him both physically and mentally. He had previously been a very independent and able person and he had suffered the stroke at a bad time for the family, ie when his father was seriously ill and subsequently died. Whilst the physical problems were overcome he had found it very difficult to deal with the psychological effects which included panic attacks, worry surrounding suffering another stroke and a fear of being left on his own. He had detailed how the Psychologist had discussed all his fears and explained methods to cope with panic attacks and to take steps to deal with challenges. Whilst not easy to achieve initially, Mr O’Neill had felt a great sense of achievement as over a period of weeks he had worked to recognise the signs of panic attacks and how to stop them early. With these achievements he has now been able to return to his outdoor leisure activities, including kayaking, and also to work. In conclusion he noted that whilst he still has some challenges to face he thanked the Psychological Therapy Service for their assistance. During brief discussion Non-Executive Directors and Executive Directors noted the enlightening story which gave a new perception to strokes and the benefits of the Psychological Therapy Service.

129/14 PERFORMANCE MANAGEMENT REPORTS Members received, for discussion, Paper No: SET/71/14, Corporate Scorecard

(October 2014) and Paper No: SET/72/14 Performance Management Dashboard (October 2014), which had been circulated with papers for the meeting.

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Ms Coulter noted that this report is for the period to the end of October 2014 and therefore is prior to the implementation of approved Contingency Plans. Appropriate monitoring arrangements will be established for Contingency Plans across the four main elements of Financial Performance; Activity/Access to Services/Patient Flow; Impact on Workforce and Impact on Safety/Quality. Ms Coulter advised that out of 52 Commissioning Plan and Prison Healthcare targets, 18 were rated green status, 11 amber and 23 red. Compared to the same period in 2013, non-elective demand had increased with an additional 99 ambulance arrivals at the Ulster Hospital; 298 new and unplanned attendances at the Emergency Department; and an increase of 325 outlying patients. Despite this additional activity the Trust had managed to reduce the number of 12 hour breaches from 47 in October 2013 to 22 in October 2014. During November 2014 there have been 3 12 hour breaches to 21 November 2014. She also highlighted that Adult Services have resettled all long-stay patients from Downshire Hospital into the community – the first Trust in Northern Ireland to achieve this target. The resettlement of long stay clients into new accommodation in Downpatrick has been extremely successful. During an overview of activity Ms Coulter noted that there had been an increase of 105 Emergency Admissions at the Ulster Hospital, together with continued increased referrals for Cancer Services. Complex Discharges had increased to 493 in October. The demand for Children’s Services had remained constant and there were 109 referrals for child protection during October with 99% being allocated within 24 hours. She also noted that in the current financial position the HSCB had ceased Independent Sector elective activity and this will have a detrimental effect on in-house waiting times for admission, outpatient appointments and day procedures. Waiting lists are anticipated to increase on a monthly basis and a system is in place to ensure that all urgent patients are treated as a priority with an ongoing review of risks. The HSCB have also “paused” a number of patient (392) treatments in the Independent Sector from the South Eastern Trust are and all of these are identified as non-urgent. During discussion a Non-Executive Director asked if increased waiting times related to bed pressures or Consultant capacity and Mr Martyn advised that all Teams are fully committed and in order to carry out additional work it would be necessary to increase Consultant Programmed Activities (PAs) or appoint additional staff. Also, additional Theatre availability would be required. Mr McGoran highlighted the correlation between the increased emergency admissions to the inability to deal with the number of elective patients. Ms Coulter reported that the Trust’s Length of Stay has remained consistent despite increased demand. Regarding the 12 hour target for Emergency Department patients, she noted that there were 22 breaches in October (half of the number for the same period last year) and, to date, there were 3 in November 2014. Regarding the 4 hour target Ms Coulter noted that there was a 72% performance achievement.

In relation to Cancer Services Ms Coulter noted that, following extensive work with HSCB colleagues, there was an achievement of 100% of Breast Cancer referrals seen within 14 days. Regarding the target for patients referred urgently with a suspected cancer to begin their definitive treatment within 62 days, there

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was a 95% achievement. This slightly deteriorating position was due to a 17% increase in referrals. Due to the increase in demand for these services escalation meetings have been arranged with HSCB to address each pathway. There has been a continued deterioration in the achievement of the target for patients not to wait longer than 13 weeks for a Psychological Assessment to 55.8% due to lack of funded resources; increased demand and a change to service delivery in the Pain Management programme. Ms Coulter advised that there has also been a reduction in the achievement of the Autism target for no child to wait more than 13 weeks for assessment. This performance is now at 44% due to an increase in demand and the Trust’s ability to meet the current demand. There are 154 children waiting for assessment, with 86 waiting over 13 weeks. The Trust will continue to work to address this issue with the HSCB. In response to a query Ms Coulter advised that in relation to waiting lists there is a focus on urgent and cancer patients with regular monitoring of all patients to check if their priority rating has changed. A Non-Executive Director noted that overall there was a very strong performance in the current circumstances. She believed that given the current resource position, it would be appropriate to highlight that achievable targets should be agreed as it is not confidence building for staff to set unachievable performance measures. This view was supported by Trust Board members.

130/14 CONSULTATION EXERCISE – TRAFFIC MANAGEMENT STRATEGY

Members received, for consideration and approval, Paper Nos SET/73/14 (a) Extension of Traffic Management Across South Eastern Trust Hospital Sites – Consultation (September 2014); (b) Public Consultation on the Extension of Traffic Management Proposals (18 November 2014); (c) Press Release – Trust Launches Consultation on Traffic Management Proposals (26 November 2014) and (d) Traffic Management Across South Eastern Trust (Consultation Response Questionnaire), which had been circulated with the papers for the meeting. Mr Molloy advised that this Strategy was presented for approval in order to commence consultation on the provision of a long term car parking solution for the Trust’s facilities and is based on regional guidance. The main aim is to stop inappropriate parking and charge everyone a fair and equitable rate for parking. He noted that any income is utilised to offset car park costs, eg lighting and maintenance, and any surplus is then put towards patient and client care. Mr Molloy noted that four options were considered and Option 4 was the preferred option. Discussion took place regarding the Traffic Management Strategy and, in response to a query, Mr Molloy confirmed that the exceptions detailed are reviewed on a constant basis by the Car Parking Management Group. Requests for discretionary dispensation are reviewed on a case by case basis. The Chairman sought, and received, Trust Board approval to the Traffic Management Strategy and the commencement of the consultation exercise.

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131/14 UPDATE REPORT ON BOARD ASSURANCE FRAMEWORK AND CORPORATE RISK REGISTER

Members received, for information, Paper No. SET/74/14, Update Report on the Board Assurance Framework and the Corporate Risk Register – 2014/2015, which was circulated with the papers for the meeting. Mr Molloy said that the paper provided an update on the Board Assurance Framework, and the Corporate and Directorate Risk Registers for 2014/2015 as at 17 November 2014. It also provided a suite of Datix Reports for the Corporate Risk Register which illustrated progress on the implementation of the action plans (per individual Corporate Risk Register pro formas).

It was noted that both the Corporate and Directorate Risk Registers are currently being reviewed to take account of any changes in terms of action plans and risk scoring due to the recent contingency plans announced by the Trust. The full effect of these plans on the registers will be reported at the Governance Assurance Committee on 17 December 2014 and the Corporate Control Committee on 21 January 2014.

132/14 UPDATE ON THE INDEPENDENT EXPERT-LED INQUIRY INTO CHILD

SEXUAL EXPLOITATION (CSE) IN NORTHERN IRELAND (MARSHALL REPORT)

Mr Sutherland referred to the Briefing Paper issued on 18 November 2014 and advised that the Report laid before the Assembly is a fair and balanced Report. He noted that the issue of child sexual exploitation is consistently raised. The work of front line staff in Residential Care Homes was commended and Mr Sutherland advised that he will be writing to all front line Residential Care Staff advising them of the work undertaken to implement the Report’s recommendations. During discussion Non-Executive Directors noted the excellent Briefing Paper and the tremendous work of staff in Residential Care Homes. In response to a query Mr Sutherland outlined the work undertaken with young people who have gone missing through the Safe Choices Project. He indicated that a brief presentation will be arranged for a future Trust Board Workshop on the Safe Choices Project.

133/14 DRAFT SAFEGUARDING STRATEGY

Members received, for approval, Paper No. SET/75/14, Our Strategy for Safeguarding Children 2014 - 2017, which was circulated with the papers for the meeting. Mr Sutherland outlined the background work which has resulted in the development of the Trust’s own Safeguarding Strategy, which is the first within Northern Ireland. During brief discussion a few minor typographical issues were noted and it was agreed that these would be updated. The Chairman sought, and received, Trust Board approval for the Safeguarding Strategy.

134/14 INTERVAL DELEGATED STATUTORY FUNCTIONS AND CORPORATE

PARENTING REPORT – 1 APRIL 2014 TO 30 SEPTEMBER 2014

Members received, for information, Paper No. SET/76/14, Interval Report on the Delegation of Statutory Personal Social Services Functions and CC302 Corporate Parenting Report, which was circulated with the papers for the meeting. Mr

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Sutherland outlined the background to this interim Report and highlighted the following points:- The integrated Health & Social Care system. The need to continue to develop and extend links with Voluntary

organisations, particularly due to the increasing demand on services. RQIA had raised the issue of the placement of adolescents in Cuan Court

despite them not needing a long term placement and this has now been resolved.

Mr Sutherland confirmed that this Report will be further discussed at the Corporate Parenting Workshop. In response to a query Ms Patterson confirmed that whilst work continues on the Meals tender the current service has been extended and there has been no break in service. The Chairman sought, and received, Trust Board Approval to the Interval Delegated Statutory Functions and Corporate Parenting Report.

135/14 ANNUAL REPORT ON INFORMATION GOVERNANCE 2013/14

Members received, for information, Paper No. SET/77/14, Annual Report on Information Governance as at 31 March 2014, which was circulated with the papers for the meeting. Mr Molloy advised that this report was presented for information.

136/14 MINUTES OF THE ADUIT COMMITTEE MEETING HELD ON 2 OCTOBER 2014

Members received, for information, Paper No. SET/78/14, Minutes of a meeting of the Audit Committee held on 2 October 2014, which was circulated with the papers for the meeting. Mr Trethowan advised that the minutes were presented for information.

137/14 MINUTES OF THE FINANCE COMMITTEE MEETING HELD ON 3 NOVEMBER 2014

Members received, for information, Paper No. SET/79/14, Minutes of the Finance Committee held on 3 November 2014, which was circulated with the papers for the meeting. Miss Graham advised that the minutes were presented for information.

138/14 QUARTERLY REPORT ON UNALLOCATED CASES (JULY – SEPTEMBER 2014)

Members received, for information, Paper No. SET/80/14, Unallocated Cases (July to September 2014) (Gateway, Family Intervention and Disability Teams), which were circulated with the papers for the meeting. Mr Sutherland reported that work is ongoing to address this issue.

139/14 ANY OTHER BUSINESS

There was no business under this item.

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140/14 DATE AND VENUE OF NEXT MEETING

The Chairman confirmed that the next meeting of the Trust Board will be held on Wednesday 28 January 2015 at 11.00 am in the Conference Room, Trinity Conference Centre, Lisburn.

________________________________________ Date: ________________________ Mr Colm McKenna Chairman Public_TBMins_26 November 2014