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Agenda and minutes

Venue: Board Rooms, Trust HQ, Great Western Hospital, Swindon. View directions

Contact: Carole Nicholl  01793 605171

Items
No. Item

38/17

Apologies for Absence and Chairman's Welcome

Minutes:

Apologies for absence were received from Nerissa Vaughan.

39/17

Declarations of Interest

Members are reminded of their obligation to declare any interest they may have in any issue arising at the meeting, which might conflict with the business of the Trust.

Minutes:

There were no declarations of interest.

40/17

Questions from the public to the Board relating to the work of the Trust

Minutes:

There were no questions from members of the public.

41/17

Minutes pdf icon PDF 563 KB

Roger Hill, Chairman

·        6 April 2017 (public and summary of private minutes)

Minutes:

The minutes of the meeting of the Board held on 6 April 2017 were adopted and signed as a correct record, subject to the following amendments: -

 

Minute 7/17 Chief Executive’s Report – The deletion of the last sentence in the paragraph immediately before the resolution.

 

Minute 8/17 Finance Report – The deletion of the sentence reading “KJ advised that the Trust had loans which meant that the cash level must not fall below £7m” in the section headed “Cash” and the substitution thereof with the words “KJ advised that the Trust had loans which meant that the cash level must not fall below £1.7m”.

 

Minute 9/17 Chair of Finance & Investment Committee Overview – The deletion of the words “public finance initiative” in the third paragraph and the substitution thereof with the words “private finance initiative” and the deletion of the words “cash neutral” in the sixth paragraph and the substitution thereof with the words “I&E neutral”.

 

12/17 Quality Report – In the fourth paragraph the deletion of the first sentence and the substitution thereof with the following “NLB questioned whether the Board was reassured that work on Sepsis and Acute Kidney Injury would help keep the Trust’s mortality rate below 100, noting that the Trust had exceeded 100 on one occasion in recent weeks”.

 

In the paragraph titled “National Audits” the deletion of the penultimate sentence and the substitution thereof with “GR commented that the number of national audits had increased, details of which would be reported to the next meeting”.

 

In the second paragraph under the title “Serious Incidents” the deletion of the following words “those with moderate harm to be reviewed within 14 days and some incidents where an investigation was not required”.

 

In the paragraph title “Mandatory Training”, the deletion of the first sentence in the second paragraph and the substitution thereof with the following “JS agreed nothing that mandatory training levels for nursing staff were good but for medical staff levels were very low and she questioned the action being taken to address this”.

 

 

 

42/17

Outstanding actions of the Board (public) pdf icon PDF 432 KB

Minutes:

The Board received and considered the outstanding action list.  The Board noted updates as set out below:-

 

377/16

Freedom to speak up

OF advised that she had yet to confirm the appointment of a representative for Swindon Community Health Staff.  However, notwithstanding this it was noted that Julie Marshman, the Deputy Chief Nurse was a Freedom to Speak Up Champion and she regularly worked with the Swindon Community Staff.

488/16

Quality Report – HSMR Data

GR advised that the HSMR Data related to the hospital only and did not include the community. It was agreed that this action was closed.

 

364/16

Questions – volunteers

OF confirmed that she had included an expanded section in the annual report about volunteers and details would be reported going forward in the monthly workforce report.  It was agreed that this action was closed.

 

454/16

Time To Assess (TTA) Project

It was explained that this would be presented to the next ordinary meeting of the Board.

 

490/16

Operational Performance Report (OPR) – Private Patients

This was included in the report to the Finance & Investment Committee later in the month and it was agreed that this action was closed.

 

08/17

Finance Report – cash position

This action had been was completed.

08/17

Finance Report – amendments

This action had been was completed.

14/17

OPR – Right Patient Right Place Name

AGr reported that the project group had been renamed and going forward references would refer to Right Patient Right Place. It was noted that this action had been completed.

14/17

OPR – Right Patient Right Place Measures

AGr advised that this action was nearing completion with details to be reported to the Performance, People and Place Committee.  It was agreed that this action could be closed on the Board action tracker.

14/17

OPR – Patient Flow Diagram

This action had been was completed.

14/17

Accountable Care System (ACS) Communication to include services and availability

KM confirmed that this would be picked up as part of the Communications Strategy.  It was agreed that this action could be closed on the tracker.

14/17

ACS Communications Strategy

KM reported that this was to be presented to the Performance, People & Place Committee later in the month. It was agreed that this action could be closed on the tracker.

 

The Board agreed that completed actions be removed from the tracker and the updates be noted.

43/17

Chairman's Report, Feedback from the Council of Governors

Roger Hill, Chairman

Minutes:

The Chairman gave a verbal report as follows: -

 

Council of Governors - A meeting of the Council of Governors was held on 20 April 2017.  Governors had discussed finances, quality matters and amendments to the Constitution which were approved.

 

Council of Governors Effectiveness - The Governors also discussed how to improve the effectiveness of the Council of Governors and working groups.  This included the introduction of open discussion time on the Council agenda and the re-establishment of the governor pre-meetings.  Furthermore, the Lead and Deputy Lead Governors would support informing the Council of Governor agendas for each meeting.

 

Re-appointment of Steve Nowell - Furthermore, the Governors had discussed a Non-Executive Director re-appointment.  RH was pleased to report that Steve Nowell had been reappointed as a Non-Executive Director for a further 3 years ending 31 May 2020.

 

Governor working Groups - A meeting of the governor Finance & Staffing Working Group had been held on 3 May. Governors had discussed in detail finances, workforce matters, E-Rostering and Junior Doctor Contracts.

 

Governor retirement - Finally, RH was joined by all members of the Board in recording thanks to Peter Hanson who was retiring from the Trust.  Peter had been a Staff Governor since November 2010 representing doctors and dentists.

            

RESOLVED

 

that the report of the Chairman be received.

44/17

Chief Executive's Report pdf icon PDF 199 KB

Nerissa Vaughan, Chief Executive

Minutes:

The Board received and considered a report from Guy Rooney on behalf of the Chief Executive covering the following issues: -

 

·         Multimedia recruitment campaign launched

·         Staff go extra mile over busy Easter weekend

·         New senior staff nurse role advertised

·         Endoscopy unit awarded JAG accreditation

·         Update on Never OK campaign against staff abuse

·         Surgeon pioneers latest 3D printing technology

·         Annual Staff Excellence Awards finalists announced

 

In presenting the report GR referred to the extra effort made by staff over the busy Easter weekend to ensure patient safety. GR referred to the annual Staff Excellence Awards highlighting the finalist, details of which were included in the report.

 

GR highlighted that surgeons in the Trust had successfully used the latest 3-D printing to help a patient who had suffered with mobility issues for three decades to walk without pain. NLB welcomed the latest 3-D printing technology but questioned the processes in place to ensure on-going funding, skills and competencies and questioned whether these had been considered prior to implementation.  In response GR explained that the policies were still being developed and that there were governance processes in place around the consideration of business cases for investment in new initiatives. The Board agreed that there needed to be a robust governance process around the authorisaiton of innovative ideas and it was agreed that GR would report back to a future meeting of the Board explaining the arrangements in place.

 

JS questioned whether innovative ideas were considered through the Research and Development Team. GR responded that this was not the case as the Research and Development Team was predominantly delivering studies. GR explained that he had contacted both RUH Bath NHS Foundation Trust and Salisbury NHS Foundation Trust to consider whether shared processes could be considered.

 

PH commented that the governance processes need to extend beyond innovation in that staff also came forward with new ideas generally and there needed to be a clear route where these could be considered. NLB commented that it was important what messages the Trust delivered to patients in terms of informing their expectations around what services might be available. GR commented that there was a firm process around businesses cases for investment. JS commented that the governance processes should not stifle innovation.

 

The Board noted that the multimedia recruitment campaign had been launched highlighting the Trust as a great place to work. OF advised that the number of hits to the Trust’s website was being monitored and these had significantly increased post the launch of the campaign.        

 

RESOLVED

 

that the report of the Chief Executive be received.

45/17

Provisional Year End Position 2016/17 pdf icon PDF 186 KB

Karen Johnson, Director of Finance

Minutes:

The Board received and considered a report on the provisional financial year end position for the Trust for the period 1 April 2016 – 31 March 2017. In presenting the report the following points were made:-

 

·         The external auditors were currently auditing the accounts.

·         The year had been particularly challenging and complex from a financial perspective due to the combination of another year of significant savings along with the national requirement to sign up to a control total set by NHS Improvement.  Staff were commended on their effort to drive efficiencies.

·         The true position prior to the receipt of any external funding was a provisional year end deficit of £7.3m.

·         With the additional cash injections from NHS Improvement the Trust’s provisional financial outturn was £600k surplus.

·         The cash injections from NHS Improvement were aimed at enabling the provider sector to move into a surplus position over the next two years although nationally this was proving challenging.    

·         The Trust had received £1.3m Sustainability and Transformation Fund incentive monies which had been calculated at a point in time on a pound to pound basis. The additional funding would be used to pay historical creditors with a focus on those which were in excess of 120 days.

·         It was highlighted that budget pressures through-out the year had been as expected with high agency costs totalling £13.5m and drugs costs above plan, all of which correlated with increased demand. However, savings of £8.2.m were recurring which was very positive.

·         It was commented that cash was above plan due to holding money from Wiltshire Health and Care LLP which had subsequently been transferred back to the LLP and furthermore there had been two payments from Commissioners as normal at this time of year.

·         It was noted that notwithstanding the delivery of savings the quality of care had not been compromised.

 

The Board considered communication of the financial position to members of staff and it was noted that a statement was being pulled together outlining the key messages, noting that it would be difficult for staff to understand the surplus position given the continued pressure to deliver savings throughout the year.  KJ commented that without having achieved the control total the Trust would not have benefitted for additional Sustainability and Transformation Fund monies and therefore the savings delivered were essential.  KJ commented that savings would become increasingly more difficult to achieve in the years ahead.

 

KJ circulated a copy of the draft statement to staff and invited comments from members of the Board. HW suggested that it might be appropriate to explain the financial position to members of staff as part of an open staff forum and this was supported.

 

Reference was made to capital investment and in response to a question from JS, KJ advised that the intention was to develop capital schemes ready for submission should any capital funding become available noting that previously the turnaround time for applications had been short.

 

RESOLVED

 

that the report be received.

46/17

Chair of Finance & Investment Committee Overview pdf icon PDF 165 KB

Steve Nowell, Non-Executive Director

Minutes:

The Board considered a report which summarised the key issues from a meeting of the Finance and Investment Committee held on 24 April 2017 which it was considered should be drawn to the attention of the Board covering the following: -

 

·         Overall financial performance

·         Cost Improvement Programme 2017/18 Overview

·         Swindon Community

·         Reset 5 year Forward View

·         Board Assurance Framework

 

SN highlighted that whilst £8.8m Cost Improvement Programme Schemes had been identified for 2017/18 there remained a £2.5 m gap which was an area for focus. KJ advised that at the next meeting of the Finance & Investment Committee the detail around the CIP Schemes would be presented, together with consideration of the wider financial risks.

 

SN highlighted that the Committee had considered the strategic risks aligned to the Finance & Investment Committee and the sources of assurance around the mitigation of those risks and had flagged that a further strategic risk around the establishment of an Accountable Care System should be flagged to the Board to consider as part of its discussion on strategy.      

 

RESOLVED

 

that the report be received.

47/17

Quality Report pdf icon PDF 114 KB

Hilary Walker, Chief Nurse

Additional documents:

Minutes:

The Board received and considered a report which provided commentary and progress on activity associated with key safety and quality indicators. The key points to note for March were as follows: -

 

  • The twelve month period January 2016 to December 2016 provided the Trust with a Hospital Standard Mortality Rate (HSMR) of 98.28.
  • There was 1 case of Clostridium difficile during March 2017.  The Trust had reported 21 cases during 2016/17.
  • 3 Serious Incidents had been reported during March 2017.
  • There are no (0) overdue Serious Incident action plans reported in March 2017.

 

In presenting the report the following comments were made: -

 

National audits - In comparison to March 2016 the number of overdue items was less in that in March 2016 there were 144 National Audits with a total of 29 (21%) overdue items whilst this year in March 2017 there were a total of 203 National Audits currently registered on the programme with only 19 (9%) items overdue.  

 

Clostridium Difficile – There had been 21 cases exceeding the Trust’s trajectory of 20 cases for 2016/17.  Of those 21 cases, to date there had been only one case assigned as “avoidable”. GR commended that given the increased activity and winter pressures this was good performance. 

 

Serious incidents - HW advised that the Trust had in place a Patient Quality Committee and a Patient Safety Panel each scrutinising incidents and ensuring learning was implemented. It was noted that new guidance had been issued by the Care Quality Commission (CQC) and the Ombudsman and a multi-disciplinary meeting had been held in February to consider whether the Trust was as effective as it could be in considering incidents and embedding learning. A number of cases had been reviewed with a focus on recognising the decorating patient.  Consideration had also been given to the NEWS score and the analysis showed that there were two areas of concern namely around escalation and where there had been escalation, it had not always been clear what the medical plan was as a result. HW advised that this was not considered to be a training issue but rather staff taking an active decision not to follow process, but the reason for this was not understood. It was not known how many patients there were in the organisation at any one time that would trigger an escalation and it might be that there were too many for staff to respond to. It was known that there was a significant amount of discussion about incidents, but it was not known whether there was sufficient sharing from serious incidents across the organisation. As such it was planned that the Trust would hold events every three months where serious incidents would be presented and shared and the learning from them discussed and reviewed with an open audience in an attempt to learn how to respond.        

 

JS questioned what mechanisms had been considered to ensure any learning was disseminated between the three monthly meetings to ensure timely improvements. HW advised that  ...  view the full minutes text for item 47/17

48/17

Chair of Quality & Governance Committee Overview pdf icon PDF 222 KB

Nick Bishop, Non-Executive Director

Minutes:

The Board received a report from NLB the Chair of the Quality & Governance Committee which summarised key issues considered by that Committee at its meeting held on 19 April 2017 covering the following: -

 

·         Improvement Plan Update

·         Quality Strategy Update

·         Quality Report

·         Safer Staffing Monthly Exception Report

·         Swindon Community Health Services

·         Well Led Governance Review

·         Board Assurance Framework – Strategic risks aligned to this Committee

·         Constitution Review

 

NLB highlighted that the Improvement Committee was being disbanded noting that it has previously been agreed that any remaining actions would be passed to Divisions for completion.

 

NLB reported that on considering the Quality Report the Committee had discussed the Friends and Family benchmark figures and had agreed that the total eligible numbers should be reviewed.

 

NLB highlighted that the Committee had considered an overview of the roll out of milestone actions arising from the Well Led Governance Review and was assured that satisfactory arrangements were in place to progress the actions.  However, the Committee had agreed that a further report on completion of those actions and there imbeddedness in the organisation be reported to the meeting of the Committee in September.

 

NLB highlighted that the Committee had considered the strategic risks aligned to the Committee and the sources of assurance around the mitigation of those risks and had confirmed that assurance could be provided to the Board that strategic risks associated with quality were being managed effectively.

 

Finally, NLB reported that the Committee had considered an amendment to the Constitution which was referred to elsewhere on the agenda. 

     

RESOLVED

 

that the report be received and it be noted that the Quality & Governance Committee will continue to scrutinise and challenge the delivery of actions to drive improvements.

49/17

Briefing paper on National Guidance on Learning from Deaths pdf icon PDF 90 KB

Guy Rooney, Medical Director

Additional documents:

Minutes:

The Board received and considered a report which provided a summary of the National Quality Board framework for NHS Trusts to identify, report, investigate and learn from deaths in care. 

 

GR highlighted that no Trusts had been able to demonstrate best practice for reviewing deaths and it was noted that consideration of this was to be included in the Quality Accounts for next year. GR highlighted that the Trust had a Mortality Group and was taking part in a pilot to implement the national guidance on learning from deaths.

 

AC questioned the involvement of families in the review of deaths to which GR responded that the Duty of Candour applied and that families would be informed. GR also highlighted that feedback from family members was extremely important.     

 

RESOLVED

 

that the report be noted.

50/17

Operational Performance Report pdf icon PDF 190 KB

Adrian Griffiths, Interim Chief Operating Officer

Additional documents:

Minutes:

The Board considered the Operational Performance Report which provided an update on performance against key national and local performance standards in addition to progress against key work streams and remedial recovery plans with headlines as follows: -

 

Standard                 

Standard required

Performance

Target

Trust 4 Hour Performance

95%

March - 83.7 %

Not achieved

Referral to Treatment (RTT)

92%

February - 91.14%

Not achieved

Diagnostic Waiting Times

99%

February - 99.1%

Achieved

Cancer

2 Week Wait

31 Day

62 Day

 

93%

96%

85%

February

83.5 %

96.6 %

83.9 %

 

Not achieved Achieved

Achieved

 

Emergency Department (ED) 4 hour access target – AGr reported that the Trust had achieved 83.7% against the 95% ED 4 hour patient access standard in March. It was noted that the position had been extremely challenging due to the acuity of patients, the Easter holiday and very little or no discharges over the Bank Holiday period. AGr outlined the main Emergency Department Improvement Plan actions as set out the report   

 

The 4 hour ED trajectory was discussed and it was noted that regulators had indicated that the currently submitted trajectory was not ambitious enough.  The Board noted that AGr was reviewing the performance trajectory, but expressed serious concern at the ability of the Trust to secure over 90% in the month of March 2018.  The Board formally stated its intention to support the Operational Team in presenting a revised trajectory in which they had confidence.  This might therefore mean that the resubmitted trajectory would not meet the national expectations.  This was accepted by the Board.

 

Building Grant - AGr highlighted that the Trust had been successful in its bid for £800k towards building works to physically integrate the Urgent Care Centre with the Emergency Department. In response to a question from RH, AGr advised that the majority of work would take place to the Clover Building. In response to a further question from JS, KM advised that the majority of work fell outside of the PFI and that a project Board was in place to look at all matters associated with the project, including architects fees and drawings. KJ highlighted that criteria of the award of funding was that the work needed to be completed by October. In response to a question from PH it was confirmed that clinicians had been involved in working up the proposals.

 

JS questioned whether the building works would incur VAT which could be recovered and SN asked that this be explained in the trajectory of costs.

 

AGr reported that in being awarded the grant funding there was an expectation there would be growth in Primary Care and GP workforce however this scheme did not commit to significant growth of GPs at this stage.

 

Older people’s pathway - AGr highlighted that meetings were taken place to develop the Older Peoples Pathway in agreement with the consultant geriatricians, the GPs supporting SWICC and the wider multi-disciplinary teams to enable patient exit routes for the elderly care bed base. KM explained that a  ...  view the full minutes text for item 50/17

51/17

Chair of Performance, People & Place Committee Overview pdf icon PDF 166 KB

Steve Nowell, Non-Executive Director

Additional documents:

Minutes:

The Board received a report from the Chair of the Performance, People & Place Committee which summarised key issues considered by that Committee at its meeting held on 26 April 2017 covering the following: -

 

·         Operational Performance Report

·         Emergency Department Improvement Plan - Update

·         Home to Assess

·         Allocate – eRoster Presentation

·         Workforce Report

·         GWH Estates & Facilities Management Team

·         Board Assurance Framework

·         Forward agenda

 

SN highlighted that a report would be presented to the next meeting looking at stroke services and theatre efficiency.

 

OF highlighted the key workforce measures commenting that turnover had gone up with 12 Band 5 nurses leaving the organisation. OF advised that the numbers of whole time equivalent staff continued to rise with vacancies reducing.  It was noted that there were significant workforce challenges and that further work was being undertaken to better understand staff absence.

 

OF explained that overseas recruitment had been stopped due to costs and length of time to recruit and she reported that 36 members of staff were currently going through the IELTS English language test.

 

RESOLVED

 

that the report be noted.

52/17

Nursing and Midwifery Care Framework - a response to Leading Changing, Adding Value pdf icon PDF 476 KB

Hilary Walker, Chief Nurse

Minutes:

The Board received and considered a report which provided a six monthly progress report relating to the nursing and midwifery response to Leading Change, Adding Value, a framework for nurses, midwives and care staff.

 

The paper summarised the achievements over the last six months and described the remaining actions which focused on patient quality, workforce development, utilisation of technology to reduce unwarranted variation and building research capability to improve evidence based practice.

 

In considering Commitment 4 (focus on individuals experiencing high value care), it was noted that implementation of the Ward Assessment and Accreditation Framework was in line with agreed timeframes and that progress made to date had already seen some positive impact. This would be assessed going forward with further updates provided.

 

With reference to Commitment 8 (right education, training and development to enhance skills, knowledge and standing) it was noted that this was designed around supporting career progression and initiatives in place would be expanded to Allied Health Professionals.          

 

RESOLVED

 

that the Patient Care Strategy be supported to proceed across clinical areas and Divisions.

53/17

Changes to regulation of Midwives and fitness to practice arrangements pdf icon PDF 120 KB

Hilary Walker, Chief Nurse

Minutes:

The Board received and considered a report which provided details of national changes to remove statutory Midwifery Supervision from legislation which had led to a redesign of the approach to upholding practice standards in midwifery.

 

It was noted that whist a national pilot of a new model was underway, midwives at Great Western Hospital would be supported by appropriately skilled and knowledgeable supervisors and their access to senior decision making 24 hours a day would be maintained.  As the evaluation of the national pilot was made available on-going plans for the clinical supervision of midwives would be developed.

 

In presenting the report, HW advised that the Morecombe Bay Report had found that the midwifery supervision concept was flawed which had resulted in recommendations to make changes which had come into force from 1 April 2017. The local supervisory establishment had been abolished with the responsibility for regulatory functions returned to the National Midwifery Council. HW explained that nationally there was a pilot to replace the model with the introduction of Midwifery Advocates. HW highlighted that the report outlined the arrangements agreed for this Trust pending any new model, noting that the Trust would maintain oversight of the pilot to ensure implementation of any changes needed.

 

In response to a question from AGr, HW confirmed that there was a distinction between the delivery function and the management function and that any conduct issues would now go through a formal process and would not be dealt with under supervisory rules.         

 

RESOLVED

 

that the interim arrangements be endorsed.

54/17

Chair of Mental Health Governance Committee Overview pdf icon PDF 209 KB

Nick Bishop, Non-Executive Director

Minutes:

The Board received a report from the Chair of the Mental Health Governance Committee which summarised key issues considered by that Committee at its meeting held on 7 April 2017 covering the following: -

 

·         Repeat attenders CQUIN

·         Acute Behaviour Disturbance (ABD)

·         Ligature risk case in Trust

·         Metric Mental Health Dashboard

·         Mental Health Work plan

·         Training: Mental Health training programme

·         Mental Health Policies

·         Mental Health Act Protocols

·         24/7 Mental Health Liaison Service to GWH

 

In presenting the report NLB commented on the work undertaken to progress the mental health work plan highlighting that Avon and Wiltshire Mental Health Partnership had agreed under a Service Level Agreement to provide managers for a managers hearing panel for the Trust, should a patient detained under the Mental Health Act appeal against the decision of their detention. Furthermore, the Trust had agreed a Service Level Agreement Responsible Clinician for children and young people detained under the Mental Health Act which included medical scrutiny of legal documents by a consultant psychiatrist at Oxford Health NHS Foundation Trust.

 

NLB commented that work continued around how to manage acute behaviour disturbance noting that a number of individuals who were not necessarily ill or require acute treatment had been brought to the hospital in the absence of any other suitable location. This presented difficulties for members of staff around decision making regarding best practice, treatment and location. Discussion would continue with partners to resolve the matter.      

 

Finally, NLB highlighted that the Trust had developed a Level 1 Mental Health training module for all staff which had been ratified and was in use and it was suggested that the module would benefit other acute organisations. GR suggested that the Allied Health Science Network might be able to support promotion of the training module.

 

RESOLVED

 

that the report be noted.

55/17

Safer Staffing Monthly Exception Report pdf icon PDF 437 KB

Hilary Walker, Chief Nurse

Additional documents:

Minutes:

The Board considered a report which provided the monthly exception reporting on actual nursing and midwifery staffing compared to that planned, together with associated quality impacts. In March the position was as follows: -

 

Proportion of actual versus planned nursing hours (fill rate):

 

Registered Nurses

Auxiliary Nurses

Day Shift

91.2%

103.8%

Night Shift

101.2%

104.9%

 

Average skill mix ratio (day): -

RN

61.7%

Care staff

38.3%

 

HW highlighted that whilst overall fill rates were satisfactory there were wards where the fill rate fell well below expected levels although there were no wards which stood out more than any other in terms of their quality measures.

  

RESOLVED

 

that the report be received.

56/17

Analysis of the 2016 Staff Survey Results & Next Steps pdf icon PDF 2 MB

Oonagh Fitzgerald, Director of Human Resources

Minutes:

The Board received and considered a report which provided an overview of the 2016 Staff Survey results.  The paper outlined the Trust’s results in comparison to national and regional results and therefore provided a gap analysis that determined the Trust’s focus for 2017. In addition to the report, the Board considered a presentation from OF covering culture, objectives, staff engagement and benchmarking against “outstanding” Trusts.

 

OF advised that staff engagement was better than average but the score was a reduction on last year. OF highlighted that there would be an Away Day with the Executive Team to consider ways of improving this.

 

In response to a question from JS, OF advised that the staff survey was issued to a randomly selected group of staff covering a cross section of staff groups.

 

OF highlighted that the Trust’s staff survey scoring was better than a number of Trusts with “outstanding” performance. OF advised that whilst the Trust’s response rate remained one of the highest in the region the Trust’s overall position had declined slightly compared to last year with this Trust being ranked twelfth when benchmarked with organisations across the South West and third when benchmarked against neighbouring Trusts which was important given that those Trusts would be seeking to recruit from the same cohort of potential applicants in the local geographical area. KM suggested that it might be beneficial for the Board to have sight of a list of other organisations in the area that the Trust was competing with to attract staff.

 

OF advised that 2016 had been a stabilising year following a significant improvement in 2015. Notwithstanding this the Trust needed to do more around learning. OF highlighted:-

·         stress at work was better than national average which needed to be explained as part of the recruitment campaign;

·         with an 8% vacancy rate, every team in the Trust was affected;

·         staff were dissatisfied at the level of agency staff working on the wards;

·         effective team working was worse than average and there was a need to focus on this; and

·         appraisal rates were improved but this still remained an area for focus.

NLB questioned why staff felt that they had to work even when they were unwell, OF responded that she had asked this question and the response had been that staff continued to work despite being poorly because they knew that their absence would have an impact on their colleague workers.

 

In response to a question from JS around support for corporate teams, OF referred to staff open forums and discussion of staff survey results at team meetings. In response to a question from JS about the Estates Team specifically, KM advised that an away day for the Estates Team was scheduled and there would be a focus on some aspects of the survey results. Furthermore, it was noted that the Corporate Directors would support the Corporate Teams.

 

PH referred to the key highlights from the staff survey results commenting that it would be good to see a reversal  ...  view the full minutes text for item 56/17

57/17

Ratification of Decisions made via Board Circular/Board Workshop

Carole Nicholl, Director of Governance & Assurance

Minutes:

None.

58/17

Board and Committee Effectiveness Review pdf icon PDF 137 KB

Carole Nicholl, Director of Governance & Assurance

Minutes:

The Board received and considered a report which summarised the actions arising out of the Board & Committee Effectiveness Review workshop which took place in April 2017. 

 

RESOLVED

 

that the report and outcomes set out in the report be noted.

59/17

Constitution Review pdf icon PDF 210 KB

Carole Nicholl, Director of Governance & Assurance

Minutes:

The Board received and considered a report which sought approval for an amendment to the Constitution.

 

RESOLVED

 

(a)   that the following amendment to the Constitution be approved: -

Constitutional Provision

Proposed Change

Reason

Annex 3 – Composition of the Council of Governors

The removal of “1.1.2.1 1 being elected by the Hospital Nursing and Therapy Staff Class”

 

and the substitution thereof with

 

“1.2.1 1 being elected by the Nursing and Therapy Staff Class”

 

To ensure that the staff sub-classes reflect the Trust’s staff base.

 

(b)    that the Company Secretary be delegated authority to finalise the exact wording in the Constitutional documents and thereafter submit to NHS Improvement within 28 days.     

60/17

Board Declarations - Licence Condition Compliance pdf icon PDF 213 KB

Carole Nicholl, Director of Governance & Assurance

Karen Johnson, Director of Finance

·        Any annual self certifications requiring Board approval will be reported at the meeting.

Additional documents:

Minutes:

The Board received and considered a report which sought approval of the annual certifications to NHS Improvement for sign off by the Chief Executive and Director of Finance on behalf of the Board.

 

RESOLVED

 

Certification on Corporate Governance

 

that the Board approves that the Chief Executive and Director of Finance sign the governance statement on behalf of the Board of Directors confirming:-

 

1.     The Board is satisfied that the Trust applies those principles, systems and standards of good corporate governance which reasonably would be regarded as appropriate for a supplier of health care services to the NHS.

 

2.     The Board has regard to such guidance on good corporate governance as may be issued by Monitor from time to time

 

3.     The Board is satisfied that the Trust implements:

(a) Effective board and committee structures;

(b) Clear responsibilities for its Board, for committees reporting to the Board and for staff reporting to the Board and those committees; and

(c) Clear reporting lines and accountabilities throughout its organisation.

 

4.     The Board is satisfied that the Trust effectively implements systems and/or processes:

(a) To ensure compliance with the Licensee’s duty to operate efficiently, economically and effectively;

(b) For timely and effective scrutiny and oversight by the Board of the Licensee’s operations;

(c) To ensure compliance with health care standards binding on the Licensee including but not restricted to standards specified by the Secretary of State, the Care Quality Commission, the NHS Commissioning Board and statutory regulators of health care professions;

(d) For effective financial decision-making, management and control (including but not restricted to appropriate systems and/or processes to ensure the Licensee’s ability to continue as a going concern);

(e) To obtain and disseminate accurate, comprehensive, timely and up to date information for Board and Committee decision-making;

(f) To identify and manage (including but not restricted to manage through forward plans) material risks to compliance with the Conditions of its Licence;

(g) To generate and monitor delivery of business plans (including any changes to such plans) and to receive internal and where appropriate external assurance on such plans and their delivery; and

(h) To ensure compliance with all applicable legal requirements.

 

5.     The Board is satisfied that the systems and/or processes referred to in paragraph 4 should include but not be restricted to systems and/or processes to ensure:

(a) That there is sufficient capability at Board level to provide effective organisational leadership on the quality of care provided;  

(b) That the Board’s planning and decision-making processes take timely and appropriate account of quality of care considerations;

(c) The collection of accurate, comprehensive, timely and up to date information on quality of care;

(d) That the Board receives and takes into account accurate, comprehensive, timely and up to date information on quality of care;

(e) That the Trust, including its Board, actively engages on quality of care with patients, staff and other relevant stakeholders and takes into account as appropriate views and information from these sources; and

(f) That there is clear accountability for quality  ...  view the full minutes text for item 60/17

61/17

Urgent Public Business (if any)

To consider any business which the Chairman has agreed should be considered as an item of urgent business and to note the reasons for the urgency.

Minutes:

None.

62/17

Date and Time of next meeting

Date: 4 May 2017

Time: 9:30am

Venue: Trust Management Boardrooms, Trust HQ, 2nd Floor, Great Western Hospital

Minutes:

It was noted that the next meeting of the Board would be held on 1 June 2017 at 9:30am in Trust Boardrooms, Trust HQ, Great Western Hospital, Swindon.

63/17

Exclusion of the Public and Press

The Board is asked to resolve:-

 

that representatives of the press and other members of the public be excluded from the remainder of this meeting having regard to the confidential nature of the business to be transacted, publicity of which would be prejudicial to the public interest” when the following items are considered: -

·        Minutes (Private)

·        Outstanding Actions of the Board (Private)

·        Final Swindon Community Health Services contract position

·        PFI

·        Board Assurance Framework

·        Well Led Governance Review

·        New models of care in Swindon update

·        Wiltshire Health & Care update

·        Executive Committee verbal report

·        Finance & Investment Committee Minutes

·        Performance, People & Place Committee Minutes

·        Quality & Governance Committee Minutes

·        Senior Independent Director Appointment

·        Urgent Private Business (if any)

Minutes:

RESOLVED

 

that representatives of the press and other members of the public be excluded from the remainder of this meeting having regard to the confidential nature of the business to be transacted, publicity of which would be prejudicial to the public interest when the following items are considered: -

 

·         Minutes

·         Outstanding Actions of the Board (private)

·         Final Swindon Community Health Services agreed contract position – verbal

·         PFI update

·         GWH PFI Benchmarking Exercise

·         Board Assurance Framework

·         Well Led Governance Review

·         New models of care in Swindon – update

·         Wiltshire Health & Care – update

·         Ratification of Decisions made via Board Circular/Board workshop

·         Executive Committee Minutes

·         Finance and Investment Committee Minutes

·         Performance, People & Place Committee

·         Quality & Governance Committee

·         Senior Independent Director Appointment

·         Urgent Private Business – media issue

64/17

Minutes

Roger Hill, Chairman

·        6 April 2017 (private)

Minutes:

The minutes of the meeting of the Board held in private on 6 April 2017 were adopted and signed as a correct record subject to amendments.

65/17

Outstanding Actions of the Board (Private)

Minutes:

The Board received and considered the outstanding actions list. 

 

66/17

Swindon Community Health Services

Karen Johnson, Director of Finance

Minutes:

The Board received a verbal report providing an update regarding the final contract position for Swindon Community Services. 

67/17

PFI

Kevin McNamara, Director of Strategy

Minutes:

The Board received and considered a report on the PFI.

68/17

PFI Benchmarking Exercise

Kevin McNamara, Director of Strategy

Minutes:

The Board received a paper regarding a benchmarking exercise of the Private Finance Initiative (PFI).

69/17

Board Assurance Framework

Carole Nicholl, Director of Governance & Assurance

Minutes:

The Board received and considered a report which set out a summary of the Board Assurance Framework (BAF).  The Board noted the Board Assurance Framework dashboard setting out strategic risks scores and sources of assurance; took assurance from the framework dashboard and committees that strategic risks were being appropriately managed; and agreed that two strategic risks be removed as no longer relevant.

70/17

Well Led Governance Review

Carole Nicholl, Director of Governance & Assurance

Minutes:

The Board received and considered a report which provided an overview of the roll out of milestone actions arising from the Well Led Governance Review as at the end of quarter 4.

71/17

New models of care in Swindon

Kevin McNamara, Director of Strategy

Minutes:

The Board received a paper which provided an update on the development of an Accountable Care System in Swindon.

72/17

Wiltshire Health & Care - update

Hilary Walker, Chief Nurse

Minutes:

The Board received and considered a report which provided an update from Wiltshire Health and Care (WH&C) on matters of relevance to the Trust.

73/17

Ratification of Decisions made via Board Circular/Board Workshop - Wiltshire Community Estate

Carole Nicholl, Director of Governance & Assurance

·        Wiltshire community estate – ratification of approval of proposals agreed via Board Circular dated 10 April 2017 which reflect the discussion at the Board (minute 37/17 refers)

Minutes:

The Board was asked to ratify a decision made via Board Circular dated 10 April 2017. 

74/17

Executive Committee

Nerissa Vaughan – Committee Chair

·        18 April 2017 (verbal report)

·        March meeting cancelled

Minutes:

It was noted that a meeting of the Executive Committee had been held on 18 April 2017.

75/17

Finance and Investment Committee

Steve Nowell – Committee Chair

·        24 April 2017 (written report)

·        27 March 2017 (enclosure)

Minutes:

The minutes of the meeting of the Finance and Investment Committee held on 27 March 2017 were received.  Furthermore, it was noted that a meeting of the Finance and Investment Committee had been held on 24 April 2017.

76/17

Performance, People & Place Committee

Steve Nowell – Committee Chair

·        26 April 2017 (written report)

·        29 March 2017 (enclosure)

Minutes:

The minutes of the meeting of the Performance, People & Place Committee held on 29 March 2017 were received.  Furthermore, it was noted that a meeting of the Performance, People & Place Committee had been held on 26 April 2017.

77/17

Quality & Governance Committee

Nick Bishop - Committee Chair

·        19 April 2017 (written report)

·        23 March 2017 (enclosure)

Minutes:

The minutes of the meeting of the Quality & Governance Committee held on 23 March 2017 were received.  Furthermore, it was noted that a meeting of the Quality & Governance Committee had been held on 19 April 2017.

78/17

Senior Independent Director Appointment

Carole Nicholl, Director of Governance & Assurance

Minutes:

The Board received a paper which sought approval for the appointment of a Senior Independent Director.

79/17

Urgent Business (Private) - Media Issue

To consider any business which the Chairman has agreed should be considered as an item of urgent business.

Minutes:

The Board discussed a recent media issue which the Chairman had accepted as an item of urgent business in view of the need for Directors to be aware of the matter.