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Agenda and draft minutes

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

Contact: Carole Nicholl  01793 605171

Items
No. Item

80.

Apologies for Absence and Chairman's Welcome

Minutes:

Apologies for absence were received from Peter Hill and Adrian Griffiths.  RH welcomed Linda Power, the Deputy Chief Operating Officer to the meeting.

81.

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.

82.

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

Minutes:

There were no questions from members of the public.

83.

Minutes pdf icon PDF 604 KB

Roger Hill, Chairman

·        4 May 2017 (public and summary of private minutes)

Minutes:

The minutes of the meeting of the Board held on 4 May 2017 were adopted and signed as a correct record, subject to the following amendments: -

 

Minute 41/17 Minutes – In the last sentence, the deletion of the words “JS agreed nothing” and the substitution thereof with the words “JS agreed noting”.

 

Minute 47/47 Quality Report

 

In the paragraph headed “serious incidents”, the deletion of the sentence “A number of cases had been reviewed with a focus on recognising the decorating patient.” and the substitution thereof with “A number of cases had been reviewed with a focus on recognising the deteriorating patient”.   

 

In the paragraph headed “serious incidents”, the deletion of the last sentence and the substitution thereof with “Furthermore, additional work was in the pipeline associated with “Sign up to Safety” and the Academic Health Science Network which all needed focus time and effort from the Divisions. HW advised that she was pulling together a proposal for additional resource to support this”.            

 

In the paragraph headed “Reporting”, the deletion of the word “medium” and the substitution thereof with the word “median”.

84.

Outstanding actions of the Board (public) pdf icon PDF 435 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

The Board noted that a Freedom to Speak up Representative for Swindon Community Health Services Staff had now been appointed, namely Caroline Davies.

 

485/16

Finance Report - Capital

It was noted that this action was complete in that a report on the Estates Strategy had been presented to the Performance, People and Place Committee which included capital schemes.

08/17

Agency Spend reporting

It was noted that this action had been completed.

12/17

National quality metrics

It was noted that the Executive Directors would continue to consider the resource implications of additional reporting on the organisation.  It was agreed that this action could be closed on the action tracker.

14/17

Job Plans

OF reported that the outcome of job planning would be discussed at the Executive away day later in the month.  It was agreed that this action could be closed on the action tracker.

 

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

85.

Finance Report pdf icon PDF 172 KB

Karen Johnson, Director of Finance

Additional documents:

Minutes:

The Board received and considered a report on finance for month 1, together with a presentation as follows: -

 

Actual Operating costs

In month deficit of £264k compared to a planned surplus of £160k (variance of £424k worse than plan). Underlying deficit excluding Sustainability & Transformation Fund (S&TF) of £602k.

Contractual Income

£21.3m in month (£0.15m above budget).

Total Income

£27m in month (variance of £0.3m below budget).

Income Activity highlights

·         Elective inpatients below plan

·         Day case activity below plan

·         Non-elective above plan

·         Outpatient appointments below plan

·         A&E below plan

Total Expenditure

 

£25m in month (variance of £0.09m above budget).

Expenditure highlights in month:

·         Drugs £0.1m above budget

·         Pay £0.5m above budget

·         Supplies £0.1m below budget

·         Other Costs £0.1m below budget

EBITDA

6.4% for month 1

Savings

Savings plan of £14.052m

£0.284m Cost Improvement Programme Schemes (CIPS) delivered in month against a plan of £0.717m.

Debtors

£38.4m debtors and stock

£7.5 above plan

Creditors

£61.6m creditors

£5.9m above plan

Cash

£4.4m (£0.1m below plan)

Loan

£2.4m of Working Capital Facility repaid following receipt of part of Q3 S&TF cash.

Finance Risk Ratings

Use of Resources (UoR) 3

(rating 1 – top, rating 4 - bottom).

 

The Board considered the report and comments were made as follows: -

 

Financial position – KJ highlighted that month 1 had been challenging.  Activity had decreased in April compared to March in all areas and work was underway to better understand this although this was most likely related to the Easter holiday period.  KJ explained that activity had increased in May.

 

KJ reported that Swindon community data was now being included in the report and therefore comparisons with the previous year would be difficult. KJ advised that she was looking to revise the monthly monitoring report.

 

Pay spend – KJ reported that within the Divisions pay spend had increased in month and that this would need to be monitored closely.

 

Non-pay expenditure­ – KJ highlighted that expenditure on drugs was less than for the same period last year.  KJ reported that high level costings varied around Delayed Transfers of Care (DTOCs) and that a high level overview was underway to explore this. 

 

Private patient income – This was slightly below plan but it was clarified that this was not due to cancellations as a result of NHS activity.

 

Cost Improvement Plan Schemes (CIPS) – It was noted that CIPS had been discussed at the Transformation Board earlier in the week and that there was a concern around closing the £2.5m gap.  Divisions had been asked to think about what services they could stop providing.

 

Cash – KJ explained that cash was in line with plan.

 

Sustainability & Transformation Fund (S&TF) - It was noted that the Trust had yet to receive S&TF and that interest was now being incurred on the working capital facility.  It was highlighted that interest charges had not been factored into the accounts which amounted to £3.5m full year effect.  KJ advised that a  ...  view the full minutes text for item 85.

86.

Quality Report pdf icon PDF 113 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 April were as follows: -

 

·         HSMR remained better than expected at 98.32.

·         The Trust had received a mortality alert from Dr Foster for septicaemia. Alongside the normal investigatory process of coding and case note review work was underway to cross reference the cases identified by Dr Foster to see whether the GWH Sepsis Team had reviewed any of the same cases and if so, whether there were discrepancies in their findings.

·         A ‘Never Event’ was reported during April that was now under investigation.

·         A serious incident was reported in the Children’s Unit and an investigation was underway in partnership with another healthcare provider.

·         28 mixed sex accommodation breaches were reported due to the use of Day Surgery Unit during periods of escalation

·         3 ‘Freedom to speak up’ alerts were raised in April. All had investigations underway.

·         An integrated operational performance and quality report has been developed for the Emergency Department enabling more sophisticated analysis and triangulation of information and delivering a more granular understanding of the issues, presented in one report. This would be reviewed at the Unscheduled Care Divisional Performance meeting monthly until standards were consistently delivered. It was suggested this was received at Quality & Governance Committee monthly for a period of time to provide more in depth assurance to Trust Board. The report would then go forward to provide assurance to commissioners and others through the Emergency Department Delivery Board.

 

In presenting the report GR highlighted the detail around missed medicines doses and the work underway within Pharmacy.

 

In response to a question from JS, it was noted that at the time of writing the Quality report not all reports of patient safety visits by Non-Executive and Executive Directors had been finalised and therefore details would be included in the next report.

 

RESOLVED

 

(a)     that the report be noted; and

 

(b)    that plans for the Quality and Governance Committee to receive the integrated operational and quality performance report for the Emergency Department monthly be endorsed.

87.

Operational Performance Report pdf icon PDF 322 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%

April – 86.7%

Not achieved

Referral to Treatment (RTT)

92%

April - 91.1%

Not achieved

Diagnostic Waiting Times

99%

April - 99%

Achieved

Cancer

2 Week Wait

31 Day

62 Day

 

93%

96%

85%

March

82.2%

100%

88.3%

 

Not achieved Achieved

Achieved

 

Emergency Department (ED) 4 hour access target

LP advised that the main challenge was achieving the 4 hour access target.  However sustained improvement was being seen in performance with a stepped improvement expected in May.  Admissions and acute attendances had reduced.  Streaming patients was continuing and hot clinics were in place.  NV commented on the need for commissioners to understand the current position and work underway.

 

LP advised that the Trust had submitted a trajectory around performance which showed that the Trust would not meet 95% for March 2018. NV commented on the need for a realistic 4 hour access trajectory.

 

RH referred to delayed transfer of care (DTOCs) questioning impact on ED performance.  LP advised that the Trust was not seeing the level of social services support needed. Reference was made to investment in social care by the local authorities noting that Wiltshire Council had a transparent process, but in Swindon the process was less clear. NV commented that both Wiltshire Council and Swindon Borough Council had stated at the A&E Delivery Board that the additional cash would not help this winter.  It was noted that NHS Improvement understood the position, but they had no jurisdiction over the councils and their priorities for spending.

 

It was noted that Wiltshire Council was trying to establish re-enablement, but there was no certainty around Swindon Borough Council's plan.  JM commented that health was not their only issue.  NV referred to improvements the Trust could make around staffing and discharging.

 

In response to a question from JS, LP advised that the Home to Assess business case had not yet been signed off and that this was currently being funded on a month by month basis. NV stated that until social care provision in Swindon was addressed, Home to Assess would not work with big numbers. NV had raised this with the Clinical Commissioning Group (CCG).

 

Urgent Care Centre

LP reported that plans were being finalised around streaming.

 

Referral to Treatment Times (RTT)

It was noted that there was a marginal under achievement of the RTT incomplete standard in April.  However, management processes for RTT remained robust.

 

Cancer

It was highlighted that the two week cancer standard was again failed in March despite considerable additional capacity added for breast services and colorectal cancer.  Work was underway to improve performance but sourcing clinical capacity was challenging.

 

Delayed Transfers of Care (DTOC)

Concern was expressed around the DTOC position.  In response to a comment from JM  ...  view the full minutes text for item 87.

88.

Ratification of Decisions made via Board Circular/Board Workshop

Carole Nicholl, Director of Governance & Assurance

Minutes:

None.

89.

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.

90.

Date and Time of next meeting

Date: 6 July 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 6 July 2017 at 9:30am in Trust Boardrooms, Trust HQ, Great Western Hospital, Swindon.

91.

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

·        Outstanding Actions of the Board (Private)

·        Annual Report & Accounts 2016/17

·        Swindon Walk-In Centre (Carfax Street)

·        eObservations – Proposed Expansion of Scope

·        Wiltshire Health & Care – update

·        Wiltshire Health & Care Board Representative

·        Audit, Risk and Assurance Committee Minutes

·        Executive Committee Minutes

·        Finance & Investment Committee Minutes

·        Joint Nominations Committee Minutes

·        Mental Health Governance Committee Minutes

·        Performance, People & Place Committee Minutes

·        Quality & Governance Committee Minutes

·        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)

·        Annual Report & Accounts 2016/17

·        Swindon Walk-In Centre (Carfax Street)

·        eObservations – Proposed Expansion of Scope

·        Wiltshire Health & Care – update

·        Wiltshire Health & Care LLP – Member Representative

·        Audit, Risk and Assurance Committee Minutes

·        Charitable Funds Committee Minutes

·        Executive Committee Minutes

·        Finance & Investment Committee Minutes

·        Joint Nominations Committee Minutes

·        Mental Health Governance Committee Minutes

·        Quality & Governance Committee Minutes

·        Remuneration Committee Minutes

·        Urgent Private Business (if any)

92.

Minutes

Roger Hill, Chairman

·        4 May 2017 (private)

Minutes:

The minutes of the meeting of the Board held in private on 4 May 2017 were adopted and signed as a correct record.

93.

Outstanding Actions of the Board (Private)

Minutes:

The Board received and considered the outstanding actions list. 

94.

Annual Report & Accounts 2016/17

Carole Nicholl, Director of Governance & Assurance

Minutes:

The Board ratified the Annual Report and Accounts 2016/17, including the Quality Accounts which it was noted would remain confidential until such time as they were presented to Parliament in July 2017.

95.

Swindon Walk-In Centre (Carfax Street)

Kevin McNamara, Director of Strategy

Minutes:

The Board received and considered a report which provided details of the future provision of the Swindon Walk-In Centre.

96.

eObservations - Proposed Expansion of Scope

Hilary Walker, Chief Nurse

Minutes:

The Board received and considered a report which provided details of the eObservation project being delivered by clinical and IT staff and outlined the financial investment required to expand the initiative.

97.

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.

98.

Wiltshire Health & Care LLP - Member Representative

Carole Nicholl, Director of Governance & Assurance

Minutes:

The Board received and considered a paper which invited the Board to formally appoint a member as the Trust’s representative on the Wiltshire Health & Care LLP.

99.

Audit, Risk and Assurance Committee

Julie Soutter – Committee Chair

·        25 May 2017 (verbal report)

·        16 March 2017 (enclosure)

Minutes:

The minutes of the meeting of the Audit, Risk and Assurance Committee held on 16 March 2017 were received.  Furthermore, it was noted that a meeting of the Audit, Risk and Assurance Committee had been held on 25 May 2017.

100.

Charitable Funds Committee

Jemima Milton – Committee Chair

·        3 May 2017 (verbal report)

Minutes:

It was noted that a meeting of the Charitable Funds Committee had been held on 3 May 2017.

101.

Executive Committee

Nerissa Vaughan – Committee Chair

·        16 May 2017 (verbal report)

·        18 April 2017 (enclosure)

Minutes:

The minutes of the meeting of the Executive Committee held on 18 April 2017 were received.  Furthermore, it was noted that a meeting of the Executive Committee had been held on 16 May 2017.

102.

Finance and Investment Committee

Steve Nowell – Committee Chair

·        22 May 2017 (verbal report)

·        24 April 2017 (enclosure)

Minutes:

The minutes of the meeting of the Finance and Investment Committee held on 24 April 2017 were received.  Furthermore, it was noted that a meeting of the Finance and Investment Committee had been held on 22 May 2017.

103.

Joint Nominations Committee

Roger Hill – Committee Chair

·        20 April 2017 (verbal report)

Minutes:

It was noted that a meeting of the Joint Nominations Committee had been held on 20 April 2017.

104.

Mental Health Governance Committee

Nick Bishop – Committee Chair

·        7 April 2017 (enclosure)

Minutes:

The minutes of the meeting of the Mental Health Governance Committee held on 7 April 2017 were received. 

105.

Performance, People & Place Committee

Steve Nowell – Committee Chair

·        24 May 2017 (verbal report)

·        26 April 2017 (enclosure)

Minutes:

The minutes of the meeting of the Performance, People & Place Committee held on 26 April 2017 were received.  Furthermore, it was noted that a meeting of the Performance, People & Place Committee had been held on 24 May 2017.

106.

Quality & Governance Committee

Nick Bishop - Committee Chair

·        18 May 2017 (verbal report)

·        20 April 2017 (enclosure)

Minutes:

The minutes of the meeting of the Quality & Governance Committee held on 20 April 2017 were received.  Furthermore, it was noted that a meeting of the Quality & Governance Committee had been held on 18 May 2017.

107.

Remuneration Committee

Steve Nowell, Committee Chair

·        24 May 2017 (verbal report)

Minutes:

It was noted that a meeting of the Remuneration Committee had been held on 24 May 2017.

108.

Urgent Business (Private) - Community Estate

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

Minutes:

The Chairman had agreed to accept this item as a matter of urgent business in view of a decision being required before the next meeting of the Board.

 

The Board considered a verbal report from KM on the community estate.