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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

144.

Apologies for Absence and Chairman's Welcome

Minutes:

Apologies for absence were received from Jemima Milton and Guy Rooney.  The Chairman welcomed Tobenna Onyirioha, Associate Medical Director to the meeting who was representing the Medical Director in his absence.

145.

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.

146.

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

Minutes:

There was one question from Rosemarie Phillips, Governor as follows: -

 

“So all GWH staff know that Wiltshire and Swindon have superseded Advance Directives with Treatment, Escalation Plans (TEPs)?  If not, is there a mechanism that can inform staff as soon as possible.

 

HW, Chief Nurse undertook to provide a response to the question for report back to the next meeting of the Board.

147.

Minutes pdf icon PDF 528 KB

Roger Hill, Chairman

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

·        29 June 2017 – Joint Board & Council of Governors’ Meeting (public minutes)

Additional documents:

Minutes:

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

 

Minute 116/17 Finance Report – In the last paragraph the deletion of the words “detail in the report on S&T funding which was incomplete” and the substitution thereof with the words “ detail in the balance sheet classification”.

 

Furthermore, the minutes of the meeting of the Joint Board and Council of Governors held in public on 29 June 2017 were adopted and signed as a correct record.

 

148.

Outstanding actions of the Board (public) pdf icon PDF 378 KB

Minutes:

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

 

445/16

Finance Report – cost base

It was noted that the cost base was included in the Finance Report.  The Finance Team was undertaking work to understand the recurring position which would be reported to the Finance and Investment Committee in August.

50/17

Operational Performance Report – Home to Assess

It was reported that the Home to Assess statistical data was now included in the Operational Performance report.  It was explained that Home to Assess would not be funded by the Clinical Commissioning Group going forward.

 

85/17

Finance Report – Rolling Cash Position

It was noted that this would be updated in the Finance Report for August.

 

116/17

Finance Report – pay profile

AC reported that he had discussed the detail with the Deputy Director of Finance and that he had no concerns to raise regarding the pay profile.  It was noted that the profiling of pay had been submitted to NHS Improvement as part of budget setting.

 

121/17

Operational Performance Report – Delayed Transfers of Care (DTOCs)

 

The Board noted that a briefing note on DTOC definitions would be circulated and discussed later in the meeting.

 

121/17

Operational Performance Report – Representative on DTOC Board

 

It was noted that the Chief Operating Officer would be the Trust’s representative on the Delayed Transfers of Care Board.

 

121/17

Operational Performance Report  - Stroke

AGr reported that there had been progress on rolling out the stroke action plan which had been considered by NV and AGr with the Divisional Director.  Actions were progressing with the detail explained in the Operational Performance Report.

121/17

Operational Performance Report – Theatres

AGR advised that there were protected theatre slots. There was a dedicated emergency theatre and Neurology made their own emergency slots.

 

121/17

Operational Performance Report – Cancer 2 week waits

AGr reported that a risk stratification process was in place.

 

Updates would continue to be reported in the Operational Performance Report.

 

 

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

149.

Finance Report pdf icon PDF 118 KB

Karen Johnson, Director of Finance

Additional documents:

Minutes:

The Board received and considered a report on finance for June 2017 together with a presentation as follows: -

 

Actual Operating costs

In month surplus of £546k including Sustainability & Transformation Funding (S&TF), (surplus of £209k excluding S&TF). Year to date surplus of £487k compared to target surplus of £483k including S&TF (£526k deficit compared to a £530k target deficit excluding S&TF)

NHS Clinical Income

£23.4m in month and £67.6m year to date (£1.4m above plan year to date)

Total Income

£29m in month and £84.1m year to date (£0.4m above plan year to date)

Income Activity highlights for the month

·         Elective inpatients above plan

·         Day case activity above plan

·         Non-elective below plan

·         Outpatient appointments

·         A&E below plan

Total Expenditure

 

£26.5m in month and £77.8m year to date (£0.4m below plan year to date)

Expenditure highlights in month:

·         Drugs £0.2m above plan (£0.3m above plan year to date )

·         Pay £0.42m above plan (£1.6m above plan year to date)

·         Supplies £0.26m below plan (£0.3m below plan year to date)

·         Other Costs £0.3m below plan (£1.2m below plan year to date)

EBITDA

7.5% year to date

Savings

Savings plan of £14.052m of which £11.687m identified

£0.712m Cost Improvement Schemes (CIPS) delivered in month against a plan of £1.008m.

£1.649m delivered against a plan of £2.573m year to date (£0.924m below plan)

Debtors

£38.8m debtors and stock

£8.1m above plan

Creditors

£55.7m creditors

£1.9m below plan

Cash

£4.4m (£2.6m above plan)

Loan

No draw down in month

Finance Risk Ratings

Use of Resources (UoR) 3 (Rating 1 now top and 4 bottom).

 

Release of provisions

KJ reported that in month provisions had been released.

 

Cash

KJ reported that cash was above plan; the main reason for this related to additional cash receipts relating to Swindon Community prior year contract.  The Finance Team was undertaking a piece of work around the longer term cash position noting that the Trust would need additional borrowing in October.  Discussions on cash flow were ongoing with NHS Improvement because they did not look at the longer term cash position as a rule.  Discussions had commences around supported borrowing going forward.

 

Reserves

It was noted that the reserve balance at month 3 was £11.9m. KJ advised that a review of all schemes reported through the Business Improvement Group (BIG) process was underway to ensure that schemes were delivering as planned.  It was possible that some investments would be stopped.

 

Private Patient Income

It was reported that private patient income was below plan due to lower private patient activity linked in part to theatre capacity.  Work was underway to address this   .  KJ expressed some concern about private patient income which could potentially cause a year end pressure.

 

Pay expenditure

KJ highlighted that pay spend had decreased.  It was commented that processes in place around agency approval were robust. KJ advised that the Finance Team was formulating detailed projections around agency usage.  KJ advised that although the in-month agency spend  ...  view the full minutes text for item 149.

150.

Quality Report pdf icon PDF 113 KB

Hilary Walker, Chief Nurse

Additional documents:

Minutes:

The Board received and considered a monthly report which provided commentary and progress on activity associated with key safety and quality indicators. The key points to note for June 2017 were as follows: -

 

·         Most recent Hospital Standard Mortality Rate (HSMR) was 96.62 (12 month period April 2016 – March 2017)

·         There was 1 case of Clostridium difficile during June 2017, the current rate is 5.95 per 100,000 bed days.

·         4 Serious Incidents were reported during June 2017.

·         There were 12 Mixed Sex Accommodation breaches in June 2017.

·         There were three 12 hour Decision to Admit breaches reported in June 2017.

 

The following points were highlighted in the report.

 

MRSA

HW advised that a MRSA bacteraemia identified during June had been assigned to the Clinical Commissioning Group.

 

Incidents

Divisions were working hard to learn from incidents early; however Divisions were struggling to respond to patient complaints in a timely way.  A quality role was being established within each division to support this work.

 

Family & Friends

It was noted that many texts were being sent out to patients but not many text were being received which was disappointing. It was explained that it was not possible to recruit volunteers to support family and friends.

 

Serious Incidents

The report identified two action plans which were overdue; however one was now resolved.  HW flagged that five maternal internal root cause analyses were reported in June of which one was reported under the Each Baby Counts National Quality Improvement Programme.  Initial reviewed suggested that the cases were not related.

 

Incidents

In response to a question from RH it was noted that of the 796 clinical incidents reported in June, 84 were reported by Swindon Community Health Services.  It was explained that a culture of reporting was not embedded in the community and the previous incident reporting system was not user friendly.  There was more work to do to embed a strong incident reporting culture in the community and it was likely that an increase in reporting would be seen over time.

 

JS questioned how new processes made a difference to patient experience on the wards in terms of a huddle versus a team meeting.  HW responded that a huddle was an update opportunity which provided time to talk about things which would impact on how staff might work that day.  In response to a further question from JS, it was noted that most wards had huddles but there was a need for consistency.

 

Infection control

In response to a question from PH regarding cases of Trust attributable E Coli bacteraemia it was explained that there was not a target limit for these. HW reported that most cases were in the community.  The Medical Director chaired the Infection Prevention and Control Committee where there was challenge and discussion of these cases.

 

Sign up to safety

HW flagged that there had been continued strong performance to prevent pressure ulcers.  There had been significant improvement with no pressure ulcer in May and June.

 

RESOLVED

 

(a)   that the  ...  view the full minutes text for item 150.

151.

Operational Performance Report pdf icon PDF 270 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: -

 

Emergency Department (ED) 4 hour standard (95%)  (combined – Emergency Department, Minor Injuries Unit (MIU) & Urgent Care Centre (UCC)) 

 

June - 87.8% (not achieved)

12 hour reportable Decision to Admit breaches

June - 4

Referral to Treatment Incomplete standard (92%)

June – 92.09% (achieved)

6 Week Diagnostic Wait (99%)

June – 98.7% (not achieved)

Cancer Targets

2 Week Waits (93%)

2 Week Wait Breast Symptomatic (93%)

31 Day Surgery (94%)

62 Day Surgery (85%)

May -

81.8% (not achieved)

42.6% (not achieved)

100% (achieved)

79.1% (not achieved)

 

In presenting the report, the following points were highlighted: -

 

ED 4 Hour Access Target

AGr drew the Board’s attention to the Executive overview which provided further detail around performance to accompany the data appended to the report.  AGr highlighted that the main area of concern remained ED 4 Hour Access Target performance.

 

AGr flagged that during June there had been many partner delays and many patients had waited longer in ED.  July performance was improving.  The main concern was the flow of patients in and out of ED.  A consultation was currently underway around new working patterns for acute physicians to be in place by late October.

 

With a stronger Consultant presence, the Unscheduled Care Division proposed to convert the Linnet assessment area into a trolley unit to allow for active patient assessment and turnaround.

 

AC questioned the length of the consultation period, which OF responded that this reflected contract terms.  OF advised that if agreement could be reached quicker, changed rotas would be implemented sooner.

 

TO advised that the point of the working pattern changes was to map staff more to demand particularly the GP medically expected patients.   TO commented that streaming remained a challenge due to loss of skilled practitioners and experienced personnel in the Urgent Care Centre.

 

Streaming

JS referred to streaming which had featured heavily in the press recently in terms of the effectiveness of front door streaming being dependent on who was doing it.  JS questioned who undertook front door streaming at GWH and the confidence around effectiveness.

 

AGr responded that there were a number of pathways which were appropriate for streaming away from ED to the Urgent Care Centre, and were directed by ED triage.  TO advised that the Emergency Department was investigating different ways of working which would improve over the next few months. It was commented that up-skilling would be required.

 

Delayed Transfers of Care

In addition to the report, AGr circulated a paper titled “Delayed Transfers” which provided an explanation of what was a delayed transfer of care (DTOC), timeframes to be a true DTOC and a definition of “green to go” / medically fit list.  AGR highlighted that DTOCs remained a major issue for the Trust.  It was reported  ...  view the full minutes text for item 151.

152.

Ratification of Decisions made via Board Circular/Board Workshop

Carole Nicholl, Director of Governance & Assurance

Minutes:

None.

153.

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.

154.

Date and Time of next meeting

Date: 7 September 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 Thursday 7 September 2017 at 9:30am in Trust Management Boardrooms, Trust HQ, 2nd Floor, Great Western Hospital.

155.

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)

·        Enforcement Undertakings – Update

·        Carbon & Energy Fund Project

·        Fire Security

·        Audit, Risk and Assurance Committee Minutes

·        Charitable Funds Committee Minutes

·        Executive Committee Minutes

·        Finance & Investment 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)

·         Enforcement Undertakings Update

·         Carbon & Energy Fund Project

·         Fire Security

·         Audit, Risk and Assurance Committee Minutes

·         Charitable Funds Committee Minutes

·         Executive Committee Minutes

·         Finance and Investment Committee Minutes

·         Mental Health Governance Committee Minutes

·         Performance, People and Place Committee Minutes

·         Quality & Governance Committee Minutes

·         Urgent Private Business (if any)

156.

Minutes

Roger Hill, Chairman

·        6 July 2017 (private)

·        29 June 2017 – Joint Board & Council of Governors’ Meeting (private minutes)

Minutes:

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

 

Furthermore, the minutes of the meeting of the Joint Board and Council of Governors held in private on 29 June 2017 were adopted and signed as a correct record.

157.

Outstanding Actions of the Board (Private)

Minutes:

The Board received and considered the outstanding actions list.  The Board noted progress against the actions and agreed that completed actions be removed.

158.

Enforcement Undertakings - Update

Nerissa Vaughan, Chief Executive

Minutes:

The Board had before it a letter from NHS Improvement setting out Emergency Department investigations and findings dated 25 July 2017.

 

The letter confirmed the outcome of NHS Improvement’s Regional Provider Support Group South which had considered the findings from NHS Improvements investigation of Emergency Department quality, safety and 4 hour performance, opened in January 2016 in response to a Care Quality Commissioning warning notice in respect of Emergency Department staffing, training, record keeping and use of the Trust’s observation ward. 

 

The Board noted the letter and the action underway to address the recommendations proposed.

159.

NHS Carbon & Energy Fund Project

Kevin McNamara, Director of Strategy

Rupert Turk, Deputy Director of Estates

Minutes:

The Chairman welcomed Rupert Turk, the Deputy Director of Estates & Facilities to the meeting for this item.

 

The Board considered a paper which sought approval of a full business case for the appointment of a Preferred Bidder under the NHS Carbon & Energy Framework (CEF). The Board approved an appointment.

160.

Fire Security pdf icon PDF 129 KB

Kevin McNamara, Director of Strategy

Minutes:

This paper was considered in the public part of the Board meeting.

 

The Board received and considered a paper which provided an update on what actions were being taken following the Grenfell Fire which had highlighted significant problems with building cladding.

 

It was explained that cladding for SWICC (owned by PropCo) had been sent off for testing, together with cladding from the hospital building.  It was explained that the timeframes for this were uncertain given that the fire service was prioritising testing of materials on residential buildings.  It was explained that the Board would be kept up to date of testing results when received.

 

The consequences of cladding failure were set out in the report.

 

SN reported that a report on health and safety which included fire had been considered through the Performance, People and Place Committee.  In response to a question from SN and the need for the Board to be assured that its liabilities associated with fire were mitigated, it was noted that the Trust operated from a small part of the Carfax building only.

 

SN reported that Oxford Universities Hospitals had closed one of its buildings due to concern around fire safety and he questions the reasons for this.  KM advised that Oxford had closed a trauma unit of 68 beds for one year.  KM was not aware of the specific data relating to fire security of the premises.

 

KM reported that Savernake Hospital had steel cladding which was not deemed a risk.  In response to a further question, KM advised that buildings with cladding were listed in the report.

 

RESOLVED

 

that the Board notes the actions being taken in relation to cladding and progress with planned inspections by the Fire Service.

161.

Audit, Risk and Assurance Committee

Julie Soutter – Committee Chair

·        13th July 2017 (verbal report)

·        25th May 2017 (enclosure)

Minutes:

The minutes of the meeting of the Audit, Risk and Assurance Committee held on 25 May 2017 were received.  Furthermore, it was noted that a meeting of the Audit, Risk and Assurance Committee had been held on 13 July 2017.

162.

Charitable Funds Committee

Steve Nowell – Committee Chair

·        2 August 2017 (verbal report)

Minutes:

It was noted that a meeting of the Charitable Funds Committee had been held on 2 August 2017.

163.

Executive Committee

Nerissa Vaughan – Committee Chair

·        18 July 2017 (verbal report)

·        20 June 2017 (enclosure)

Minutes:

The minutes of the meeting of the Executive Committee held on 20 June 2017 were received.  Furthermore, it was noted that a meeting of the Executive Committee had been held on 18 July 2017.

164.

Finance & Investment Committee

Steve Nowell – Committee Chair

·        24 July 2017 (verbal report)

·        26 June 2017 (enclosure)

Minutes:

The minutes of the meeting of the Finance and Investment Committee held on 26 June 2017 were received.  Furthermore, it was noted that a meeting of the Finance and Investment Committee had been held on 24 July 2017.

165.

Mental Health Governance Committee

Nick Bishop – Committee Chair

·        7 July 2017 (verbal report)

Minutes:

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

166.

Performance, People & Place Committee

Steve Nowell – Committee Chair

·        26 July 2017 (verbal report)

·        28 June 2017 (enclosure)

Minutes:

The minutes of the meeting of the Performance, People & Place Committee held on 28 June 2017 were received.  Furthermore, it was noted that a meeting of the Performance, People & Place Committee had been held on 26 July 2017.

167.

Quality & Governance Committee

Nick Bishop - Committee Chair

·        20 July 2017 (verbal report)

·        22 June 2017 (enclosure)

Minutes:

The minutes of the meeting of the Quality & Governance Committee held on 22 June 2017 were received.  Furthermore, it was noted that a meeting of the Quality & Governance Committee had been held on 20 July 2017.

168.

Urgent Business (Private) - 999 What's your emergency

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

Minutes:

The Chairman had agreed to consideration of this item as a matter of urgent business in view of the need for members of the Board to briefed on the matter at the earliest opportunity.

 

The Board considered a paper circulated at the meeting regarding the latest series of a national channel 4 programme call “999 what’s your emergency?”.  The Board noted the paper.