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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

169.

Apologies for Absence and Chairman's Welcome

Minutes:

Apologies for absence were received from Kevin McNamara and Nerissa Vaughan.

170.

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.

171.

Questions from the public to the Board relating to the work of the Trust pdf icon PDF 63 KB

Attached for information is a response to a question asked at the last meeting of the Board regarding Treatment Escalation Plans.

 

Furthermore, a question has been received from a member regarding the Pharmacy provision.  The question and response is attached.

Additional documents:

Minutes:

The Board noted questions and answers relating to the following, details of which had been circulated with the agenda: -

 

1.     Treatment Escalation Plans

2.     Pharmacy and dispensing drugs

 

In addition the Board noted the following question from Kevin Parry, Governor which it was agreed should be referred to the Clinical Commissioning Group for response.

 

“There are many drug users that are supplied needles to help to prevent the risk of aids and other drug related diseases.  There is a need to improve the safety from needles being discarded in parks and public places to ensure that children and members of the public are safe.  Is there a possibility of looking at secure deposit boxes on Doctors Surgeries/Pharmacies?”

 

172.

Minutes pdf icon PDF 362 KB

Roger Hill, Chairman

·        3 August 2017 (public and summary of private minutes)

Minutes:

The minutes of the meeting of the Board held on 3 August 2017 were adopted and signed as a correct record, subject to the following amendments: -

 

Minute 149/17 Finance Report Forecast Outturn Position - The deletion of “report on this through the Finance and Investment Committee in October” in the last sentence and the substitution thereof with “report on this through the Finance and Investment Committee in December”.

 

Minute 150/17 Quality Report Incidents – The deletion of the sentence ”A quality role was being established within each Division to support this work”.

 

Minute 150/17 Quality Report Family & Friends - The deletion of the words ”not many texts were being received” and the substitution thereof with “not many texts were being replied to”.

173.

Outstanding actions of the Board (public) pdf icon PDF 382 KB

Minutes:

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

 

50/17

Operational Performance Report – Home to Assess

In response to a question from RH, AGr confirmed that  Home to Assess would not be funded by the Clinical Commissioning Group going forward but that financial support for an alternative home enablement system was likely.

54/17

Mental Health Training Module

The Board noted that the mental health training modules had been developed and had been in use for less than 6 months. Evaluation of the modules was required before potential engagement with external partners.

 

The Board agreed that the Mental Health Governance Committee could receive a progress report in 6 months’ time and that this action could be removed from the Board tracker.

 

87/17

Operational Performance Report – Delayed Transfers of Care

 

It was noted that this action had been superseded by events and could be removed from the tracker.

 

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

174.

Chairman's Report, Feedback from the Council of Governors

Roger Hill, Chairman

Minutes:

The Chairman gave a verbal report as follows: -

 

Annual Members Meeting – RH reminded Directors that the Joint Annual Members and Council of Governors Meeting would take place on Thursday 28 September 2017 in the Academy at 6.00pm to which all members of the Board were invited, highlighting that as in previous years there would be health workshops beforehand.

 

Governor Elections – RH advised that governor elections were underway for the following seats: -

 

§  Hospital Nursing & Therapy Staff Constituency Governor

§  Southern Wiltshire Public Constituency Governor

§  Gloucestershire & Bath and Northeast Somerset Public Constituency Governor

 

In addition the term of office of the nominated governor representing Prospect House was due to end and Prospect House had been asked to confirm their nomination going forward.

 

Urgent Business – RH reported that he had agreed to accept an item of urgent business relating to estates matters which would be considered in the private part of the meeting.

 

RESOLVED

 

that the report of the Chairman be received.

175.

Chief Executive's Report pdf icon PDF 205 KB

Nerissa Vaughan, Chief Executive

Minutes:

The Board received and considered a report from the Chief Executive presented by GR covering the following issues: -

 

·         Latest rating by the Care Quality Commission (CQC)

·         Shalbourne Private Health Care open event

·         New provider of Swindon Walk-In Centre

·         Leaving hospital campaign continues

·         New Integrated Discharge Service

·         Celebrating our staff at our annual awards ceremony

·         Revolutionary genomic project

·         Transfer of property to NHS Property Services

·         Proposals for investment in Wiltshire community healthcare services 

·         Local STP chosen for national diabetes prevention programme

·         STP ratings published for the first time

·         New CCG ratings shared

·         Chairman of Wiltshire Clinical Commissioning Group to step down.

 

In presenting the report, the following comments were made: -

 

Care Quality Commission (CQC)

GR highlighted that whilst the Trust retained the same overall rating of “requires improvement” there had been considerable service improvements across the Trust and notably in the Emergency Department which had achieved an “outstanding” rating for quality of care which was commendable.  GR referred to the many positive comments in the report about innovations and kind, compassionate and caring staff.

 

Shalbourne Private Health Care open event

GR highlighted that staff and the public had been invited to learn about the benefits to the Trust and to the wider community of offering a private healthcare option which like many NHS trusts across the country, was about giving local people who choose to pay for healthcare, an alternative to private companies but with the benefit that all profits were invested back into NHS services at the Great Western Hospital and in the Swindon community.

 

Leaving hospital campaign

GR advised that delayed transfers of care were increasing which was a concern nationally. The Trust continued to promote the “Leaving Hospital” campaign which encouraged staff, families and carers to have open discussions about leaving hospital earlier on and provided a reminder of the practical things everyone could do to help, such as being available to collect the patient from hospital, arranging help around the home and bringing clothes for them to leave in.

 

Celebrating our staff at our annual awards ceremony

A staff awards evening had been held to recognise and celebrate success.

 

Revolutionary genomic project

GR reported that the Trust had been named as the first trust in the region to join Oxford's NHS Genomic Medicine Centre, which was part of the national 100,000 Genomes Project.  

 

The innovative project was working to establish a world class genomic medicine service in the NHS, which would give scientists and doctors a better understanding of the complete genetic coding of an individual. This would help the NHS to better understand the DNA which caused rare diseases and certain cancers, develop more personalised treatment options and prevent and treat diseases that were passed from one generation to another.

 

As an official partner, the Trust was inviting patients with certain rare diseases and their family members to take part in whole genome sequencing.

 

AC questioned why the Trust was involved and whether there were resource implications.  GR responded that there were two halves  ...  view the full minutes text for item 175.

176.

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 month 4, together with a presentation as follows: -

 

Actual Operating costs

In month deficit of £13k incl. STF (deficit of £463k excluding Sustainability& Transformation Funding (S&TF)). Year to date surplus of £475k compared to target surplus of £641k incl. S&TF (£988k deficit compared to a £822k target deficit excluding S&TF)

NHS Clinical Income

£22.7m in month and £90.3m year to date (£1.2m above plan year to date)

Total Income

£28m in month and £112.1m year to date (£0.09m below plan year to date)

Income Activity highlights for the month

·         Elective inpatients below plan

·         Day case activity below plan

·         Non-elective above plan

·         Outpatient appointments below plan

A&E below plan

Total Operating Expenditure

 

£26.1m in month and £103.9m year to date (on plan year to date)

Expenditure highlights in month:

·         Drugs £0.29m above plan (£0.55m above plan year to date)

·         Pay £0.11m above plan (£1.75m above plan year to date)

·         Supplies on plan (£0.29m below plan year to date)

Other Costs £0.81m below plan (£2.0m below plan year to date)

EBITDA

7.4% YTD

Savings

Savings plan of £14.052m of which £11.309m identified

£0.861m CIPS delivered in month against a plan of £1.048m.

£2.510m delivered against a plan of £3.622m YTD (£1.112m below plan)

Debtors

£39.7m debtors and stock

£9m above plan

Creditors

£57.4m creditors

£2.8m below plan

Cash

£5.4m (£0.9m above plan)

Loan

£2.597m drawn down in month

Finance Risk Ratings

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

Actual Operating costs

In month deficit of £13k incl. STF (deficit of £463k excluding S&TF). Year to date surplus of £475k compared to target surplus of £641k including S&TF (£988k deficit compared to a £822k target deficit excluding S&TF)

NHS Clinical Income

£22.7m in month and £90.3m year to date (£1.2m above plan year to date)

 

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

 

National overview

KJ commented that she thought it would be beneficial for the members of the Board to understand the national budget picture regarding NHS finances. KJ explained that the national picture for quarter one was a deficit of £735m for 2017-18 compared to a deficit of £461m in 2016-17. The revised year end forecast deficit was now £530m from £496m. 67 providers were reporting adverse variances to plan and overall there was a national slippage on Cost Improvement Programmes of 10% totalling £102m behind plan.

Agency spend had fallen to 4.6% compared to 6.5% in 2016 -17 but there was therefore an increase in bank usage. 68% (162 of 238) providers were reporting a deficit compared to 64% in 2016-17.     206 Trusts had accepted a control total.

 

KJ advised that nationally was as follows:-

·         A&E attendance 2.9% increase in activity

·         4 hour access target 90.29% achievement

·         RTT 89.96 % achievement

In terms of an  ...  view the full minutes text for item 176.

177.

Chair of Finance & Investment Committee Overview pdf icon PDF 173 KB

Steve Nowell, Non-Executive Director

Minutes:

The Board considered a report which summarised the key issues from meetings of the Finance & Investment Committee held on 24 July and 21 August 2017 which it was considered should be drawn to the attention of the Board covering the following: -

 

·         Overall financial performance

·         Unscheduled Care Division

·         Diagnostics and Outpatients Division

·         Cost Improvement Plans

·         Carter Review

·         BAF Strategic Risks

·         Policies

·         Procurement Transformation Plan and Update

·         Unplanned Nursing Costs

·         Capital Schemes

·         Asset Register

 

RESOLVED

 

that the report be received.

178.

Chair of Audit, Risk & Assurance Committee Overview pdf icon PDF 168 KB

Julie Soutter, Non-Executive Director

Minutes:

The Board considered a report which summarised the key issues from a meeting of the Audit, Risk & Assurance Committee held on 13 July 2017 which it was considered should be drawn to the attention of the Board covering the following: -

 

·         15+ Risk Register / Board Assurance Framework

·         External audit progress report

·         Internal audit progress report

·         Counter Fraud / Counter Fraud Self-Assessment

·         Freedom to Speak Up

·         Conflicts of Interest

·         Contract Extensions and Waivers

·         Losses and Compensation Payments

 

RESOLVED

 

that the report be received.

 

179.

Quality Report pdf icon PDF 139 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 July were as follows: -

 

·         Most recent HSMR = 95.24 (12 month period April 2016 to March 2017)

·         4 cases of Clostridium difficile during July

  • 1 Serious Incident was reported during July 2017.
  • 4 Maternity incidents requiring RCA’s were reported during July
  • 34 Mixed Sex Accommodation breaches occurred during July 2017
  • 5 - 12 hour Decision to Admit (DTA) breaches reported in July 2017
  • 10 complaint cases were re-opened during July due to failure to answer concerns and family or patients being dissatisfied with responses

 

Hospital Standardised Mortality Rate (HSMR)

GR reported that the Hospital Standard Mortality Rate (HSMR) figure for April 2016 to March 2017 was 95.51.  GR explained that HSMR was the observed number of deaths and expected deaths based on population and geographical area.   AC referred to the week day and weekend mortality by day of admission table set out in the report and GR undertook to talk to AC outside of the meeting to explain the detail.

 

Mortality Reviews

GR highlighted that the national Quality Board had published guidance on learning from deaths in March 2017. A new mortality review process had been introduced as a result of this guidance. GR explained that the Trust was looking to formalise its processes around mortality reviews.  More structured reviews would be detailed and measure different themes and the Trust was aiming to increase the number completed.

 

National Audits

GR highlighted that progress was being made with completion of National Audits with a number in progress and a number not applicable to the Trust. Locally the number of awaited national summaries had continued to rise during the last three months.

 

 

Infection Prevention and Control

GR reported that there were 3 cases of Clostridium difficile reported in July for Acute Services and 1 case reported in Swindon Community Health Services. However, the Trust remained under trajectory. GR highlighted that there was a world-wide shortage of a particular antibiotic and therefore it was expected that the number of Clostridium difficile cases would increase.

 

E coli bacteraemia

GR highlighted that there were 2 cases of e coli bacteraemia attributed to Acute Services during July. GR explained that e coli bacteraemia was not in the hospital but the measurement of e coli bacteraemia was captured by the hospital. There were plans in place to address this across the system.

 

Blood Culture Contamination Rate

KJ noted that the Blood Culture Contamination Rate had increased over the last four months and she questioned whether there was a need to be concerned. GR responded that an intensive piece of work was under way working through a QI process which included additional training to look to address this. HW commented that this was about members of staff doing what they needed to do every time and that it would be more helpful to the Board if a  ...  view the full minutes text for item 179.

180.

Chair of Quality & Governance Committee Overview pdf icon PDF 221 KB

Nick Bishop, Non-Executive Director

Minutes:

The Committee received a report from the Chair of the Quality & Governance Committee which summarised key issues considered by that Committee at its meetings held on 20 July and 17 August 2017 covering the following: -

 

·         Quality Report

·         Emergency Department Dashboard

·         Overdue Outpatient Follow Ups

·         Annual Clinical Audit and Effectiveness Report 2016/17 and 2017/18 Audit Programme

·         Safer Staffing Monthly Exception Report

·         Swindon Community Health Services clinical governance and quality oversight

·         Board Assurance Framework – Strategic risks aligned to this Committee

·         Corporate Governance Report

·         Equality & Diversity Update

·         Trust response to CQC Consultation on Fit and Proper Persons Test

 

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.

181.

Operational Performance Report pdf icon PDF 273 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)) 

 

July - 87.4% (not achieved)

12 hour reportable Decision to Admit breaches

July – 5

Referral to Treatment Incomplete standard (92%)

July – 91.06% (achieved)

6 Week Diagnostic Wait (99%)

July – 98.8% (not achieved)

Cancer Targets

2 Week Waits (93%)

2 Week Wait Breast Symptomatic (93%)

31 Day Surgery (94%)

62 Day Surgery (85%)

June -

90.1% (not achieved)

66.4% (not achieved)

96.2% (achieved)

81.3% (not achieved)

 

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

 

Emergency Department 4 Hours Access Target / 12 hour Breaches

The Trust had achieved 87.4% against the 95% ED four hour patient access standard in July. The Trust had five breaches of the 12 hour Decision to Admit (DTA) standard at the beginning of July but AGr was pleased to report that there had been no further breaches of the 12 DTA standard in August. AGr referred to the high numbers of admissions in month and the high level of delayed transfer of care (DTOC) patients totalling 80. It was explained that in July there had been considerable focus on improving delayed transfers of care in Wiltshire but this could not be sustained.  AGr reported that the ED 4 hour access target for August was 88.8%.

 

The report summarised progress with the ED Improvement Plan with specific areas highlighted for the attention of the Board. AGr referred to the changes to the work patterns of the acute physicians which had been developed to secure improved consultant coverage of the Acute Medical Unit (AMU) and for an increased period of the day.  A formal consultation was underway with a planned implementation date of 23 October 2017. AGr advised that at the same time there would be a reorganisation of the Linnet Assessment Area which would provide more capacity. More space (approximately 70 places) would be created which would enable the movement of patients away from the Emergency Department which would mitigate crowding.

 

In response to a question from CN, AGr explained that the conversion of the Linnet Assessment Area into a trollied unit to allow for active patient assessment and turnaround with a size and through put large enough to accommodate the medical take within the 4 hour standard could not be implemented sooner than 23 October 2017 because the staffing element was subject to the acute physician consultation.

 

AGr referred to challenges in the Unscheduled Care Centre reporting that a triage system had been introduced. AGr mentioned first assessment breaches advising that a twilight Registrar was proposed which it was hoped would be supported outside of the formal acute physician consultation. The twilight Registrar would aid the reduction of first assessment breaches. AGr explained that breach  ...  view the full minutes text for item 181.

182.

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

Steve Nowell, Non-Executive Director

Minutes:

The Committee 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 July and 23 August 2017 covering the following: -

 

·         Operational performance

·         Baseline Emergency Staffing Tool Audit

·         Workforce

·         Electronic roster implementation

·         Fire risk

·         Digital and IT Strategy

·         Information Governance

·         Managed Equipment Services

 

 

It was noted that there needed to be a refresh of the ED improvement plan to include points from NHS Improvement letter received in July.

 

The Committee still had some concerns around data quality noting that there was a need to have an effective validation process in place connecting pathways and identifying potential breaches.

 

The Committee had noted that testing of cladding was underway and that the report on this had not yet been received from the Fire Officer.

 

The Committee had welcomed a progress report on the Digital and IT Strategy for the next five years.

 

The Committee had noted the workforce vacancy rate noting that staff recruitment continued to be a major challenge for the Trust.

 

RESOLVED

 

that the report be received and it be noted that the Performance, People & Place Committee will continue to scrutinise and challenge the delivery of actions to drive improvements.

183.

Mental Health Act and Mental Capacity Act Committee Annual Report 2016/17 pdf icon PDF 170 KB

Hilary Walker, Chief Nurse

Additional documents:

Minutes:

The Board received and considered a report that advised that under the requirements of the Mental Health Act 1983, (MHA) and the Mental Capacity Act 2005, (MCA) the Trust had a key responsibility for ensuring that patients with mental health issues were assessed, treated, monitored and discharged/transferred under the requirements of the Acts as follows: -

 

“The Trust must:

  • Ensure that patients who require detaining are done so under the correct legal framework i.e. MHA and MCA and DoLS.
  • Ensure that patients’ treatment and care accords fully with the provision of the Acts;
  • Patients are fully informed of, and supported in, exercising their rights;
  • Patients’ cases are dealt with in line with other relevant statutory legislation including Human Rights Act 1998, Mental Health Act 1983, Mental Capacity Act (including Deprivation of Liberty Safeguards) 2005, The Equality Act 2010, The Race Relations Act, Disability Discrimination Act 1995 or Data Protection Act 1998.”

 

The Five Year forward view for Mental Health (FYFV MH) priority areas for action 2016 – 2021 were set out in the report.

 

It was noted that a significant point to highlight from the report was the establishment of a mental health liaison service 24/7 which was a significant improvement.

 

The Board recorded its thanks to Wendy Johnson, Head of Safeguarding Adults at Risk, MCA and DoLS Compliance and Health for her hard work in this area.

 

RESOLVED

 

that the report be received.

184.

Safer Staffing Monthly Exception Report pdf icon PDF 439 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 June the position was as follows: -

 

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

 

Registered Nurses

Auxiliary Nurses

Day Shift

86.6%

104%

Night Shift

100.5%        

117.5%

 

In July the position was as follows: -

 

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

 

Registered Nurses

Auxiliary Nurses

Day Shift

84.9%

100.3%

Night Shift

97.6%        

112.9%

 

Average skill mix ratio (day): -

 

June

July

Registered Nurse Staff

61.6%

61.9%

Care staff

38.4%

31.8%

 

RESOLVED

 

that the report be received

185.

Safer Staffing - Six monthly skill mix review pdf icon PDF 190 KB

Hilary Walker, Chief Nurse

Minutes:

The Board received a paper that advises the Board, by exception, of the nursing and midwifery 6 monthly skill mix review undertaken against the current establishments.

 

In response to a question raised, it was explained that the Out-patient modernisation groups reported into the Transformation Board as part of the Productive People Workstream.

 

It was reported that the Divisional Directors of Nursing had determined that an annual review was more helpful with a focused response.  It was noted that the information in the report had already gone through internal reporting processes.

 

HW drew attention to the work on Saturn Ward to support a large number of acutely unwell patients requiring high dependency support advising that a business case was being developed.

 

HW reported that in December 2015 the Government launched plans for a new nursing role, expected to work alongside care assistants and registered nurses to deliver hands-on care. The “Shape of Caring” review recommended developing this role because of a need in the NHS.   Eleven sites were chosen to deliver pilots of 2 year programmes from January 2017; with a further 24 test sites from April 2017. There is no formal evaluation information from pilots yet. The Chief Nurse and senior team would be watching, with interest, to decide how this role could support GWH nurse staffing. HW commented that it had only been two years since the Trust had undertaken a large piece of work around associate Practioners and it might be concluded that the current arrangements remain appropriate.

 

RESOLVED

 

that the report be received. 

186.

People Strategy 2014-2019 - Six month progress report (October 2016 to March 2017) pdf icon PDF 711 KB

Oonagh Fitzgerald, Director of Human Resources

Minutes:

The Board received and considered a report which provided an update on the progress of the roll-out of the People Strategy 2014-19.  An assessment against milestone actions and identified associated risks was included. It was flagged that recruiting to vacant posts continued to be the highest risk and the focus was on Recruitment and Retention Plans with a need to ensure the Trust had safe staffing levels supported by temporary staff.

 

In presenting the report OF highlighted that the number of staff had increased by 55 whole time equivalents; there was a downward trend on turnover and the bank fill rate was increasing. Reference was made to the use of volunteers many of whom were students. 26 volunteers had subsequently secured employment with the Trust. OF explained that she was working to recruit students at Swindon College studying health to support growth of the future work force.

 

KJ commented on all the movement on Sustainable Transformation Programmes and Accountable Care Systems questioning if there was a need to include any reference to this in the People Strategy. OF responded that she was planning to undertake a refresh of the Strategy next year which would include this.

 

JS referred to international recruitment commenting on the 33 members of staff working below level until they obtained their registration questioning what was their expected profile and cost. OF responded that she had had a meeting to assess each individual and advised that some of these staff were unlikely to pass the English language test and might be able to stay as part of the workforce but on a lower grade.  It was commented that some individuals had taken the English language test four times and were therefore unlikely to pass.  RH asked for an update to the Board on the financial and operational implications of this.

 

JM commented on the need to take a system wide approach to recruitment to include key worker accommodation.  KJ responded that this was being addressed through the work of the Sustainable Transformation Programme.  In addition OF advised that she was a member of the Swindon Employment Board looking at this point. Furthermore, KJ advised that Health Education England had allocated some money across the system and one of the bids being submitted was to do with work around initial costings of key worker accommodation and how this could look for the region.

 

RESOLVED

 

(a)   that it be agreed the progress made against each of the six commitments set out in the report is in line with expectations and

 

(b)   that the risk with the current vacancy position and the work underway to reduce both vacancies and turnover be recognised.

187.

Guardian of Safe Working - Six monthly update pdf icon PDF 166 KB

Guy Rooney, Medical Director

Additional documents:

Minutes:

The Board considered a report which provided assurance that following the introduction of the new Junior Doctors Contracts, the Trust had the processes in place for the monitoring of junior doctors’ working hours and that this was in accordance with the Terms and Conditions of Service for NHS Doctors and Dentists in Training in England (July 2016), Schedule 06 Guardian of Safe Working Hours.  The report included data on all rota gaps on all shifts.

 

GR reported that Dr Neil Campbell was the Guardian of Safe Working.

 

GR highlighted that a junior doctor forum had been established. GR advised that the monitoring required new doctors filling in lots of forms but that the number of exception reports was low.  PH referred to the issues arising set out in the report around reluctance to complete exceptions report due to the perception around lack of resultant change and GR advised that he would support Dr Campbell with future reporting.

 

RESOLVED

 

that the report be noted.

188.

Responsible Officer's Annual Board Report on Appraisal and Revalidation pdf icon PDF 111 KB

Guy Rooney, Medical Director

Additional documents:

Minutes:

The Board received and considered a report from the Medical Director explaining that medical revalidation had been launched in 2012 to strengthen the way that Doctors were regulated with the aim of improving the quality of care provided to patients, improving patient safety and increasing public trust and confidence in the medical systems.

 

The statutory duties of the responsible officers in discharging their duties under the Responsible Officers Regulations were set out in the report including the expectation of provider Boards to oversee compliance.

 

In presenting the report GR highlighted that the Trust had 360 prescribed connections (Doctors whose Responsible Officer was the Medical Director at Great Western Hospital) as at 31 March 2017. There had been a significant increase in Doctors compared to previous years. Whilst there had been growth in all staff groups the main growth had been in Junior Doctors that were not Deanery trainees. As a proportion they currently represented 29% of the medical workforce compared to the 18% nationally.

 

GR referred to appraisal completion explaining that for Consultants the Trust had seen an improvement that matched the national comparison. Likewise the Trust matched national comparison at FSA level. Overall the figures were reduced by “other” Doctors of which very few had had an unapproved delay. GR highlighted that “others” included Clinical Fellows and the main reason was that they were included in other systems. GR highlighted that there were only 7 unapproved delays which was very low and that all appraisal were completed within 15 months.

 

GR commented that an electronic system was used to support revalidation.

 

JS questioned what was the link between Mandatory Training through the appraisal process. GR responded that medics were being told of their training and the timescales for completion. SN welcomed the improvement in the appraisal completion rate.                                        

 

RESOLVED

 

(a)   that the report be noted and the summary accepted; and

 

(b)   that the Chief Executive Officer be authorised to sign the Statement of Compliance on behalf of the Board.

 

189.

Ratification of Decisions made via Board Circular/Board Workshop

Carole Nicholl, Director of Governance & Assurance

Minutes:

None.

190.

Equality & Diversity Update pdf icon PDF 448 KB

Carole Nicholl, Director of Governance & Assurance

Additional documents:

Minutes:

The Board received and considered a report that provided a summary of the work underway to provide assurance on how the Trust was working towards meeting its public sector duty in relation to Equality and Diversity.

 

The headlines in the report were as follows: -

 

·       Equality & Diversity 2014-18 Vision agreed by the Board

·       Objectives agreed to meet Equality & Diversity objective outcome

·       Milestone actions underpinning objectives identified with continued annual refresh and prioritisation

·       E&D Steering Group established – quarterly meetings booked

·       Governance in place - E&D Minutes presented to Executive Committee / reporting to Quality & Governance Committee and annual reporting to Board

·       Forward Plan 2017/18 in place

·       National Reporting Requirements being met

-       Equality Delivery System for the NHS – EDS2 completed Apr-17

-       Workforce Race Equality Standard (WRES) 2016/17 approved Jul-17

-       Workforce Disability Equality Standard 2017/18 due Apr-18

·       Information on Trust’s website

·       E&D included as mandatory training module

·       Networking groups joined to ensure sharing of best practice

 

Appended to the report was a Workforce Race Equality Standard (WRES) action plan which the Board considered and approved.

 

RESOLVED

 

(a)   that the report be received and that the Board be assured that processes are in place to ensure on-going governance arrangements to support the Trust in delivering milestone actions to support achievement of the Trust’s equality and diversity objectives; and

 

(b)   that the Workforce Race Equality Standard Action Plan appended to this report be approved.

191.

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.

192.

Date and Time of next meeting

Date: 5 October 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 5 October 2017 at 9:30am in Trust Management Boardrooms, Trust HQ, 2nd Floor, Great Western Hospital

193.

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)

·        ID Medical Master Vendor Agreement Review

·        Swindon Community Services

·        Emergency Department Performance

·        Charitable Funds Committee Minutes

·        Executive Committee Minutes

·        Finance & Investment 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

·         ID Medical Master Vendor Agreement Review

·         Swindon Community Services

·         Emergency Department Performance

·         Charitable Funds Committee Minutes

·         Executive Committee Minutes

·         Finance & Investment Committee Minutes

·         Performance, People & Place Committee Minutes

·         Quality & Governance Committee Minutes

·         Urgent Private Business – Estates Matter

 

194.

Minutes

Roger Hill, Chairman

·        3 August 2017 (private)

Minutes:

The minutes of the meeting of the Board held in private on 3 August 2017 were adopted and signed as a correct record subject to amendment.

195.

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.

196.

ID Medical Master Vendor Agreement Review

Oonagh Fitzgerald, Director of Human Resources

Minutes:

The Board considered a report which explained that the Trust had entered a Master Vendor contract with ID Medical (IDM) from 1 June 2017 in order to reduce agency spend and ensure the Trust had a good supply of agency workers when needed.  The Board noted implementation of the new arrangement to date.

 

197.

Swindon Community Services

Kevin McNamara, Director of Strategy

Presentation by Lorraine Austen, Associate Director & Caroline Davies, Head of Community Nursing

Minutes:

 

The Board received and considered a report that advised that Swindon Community Services had undergone significant changes since the Trust took over the services last Autumn.  Accompany the report was a presentation which provided some key highlights since transition in particular focusing in depth on the work that had been done to improve community nursing.

 

The presentation included:-

 

·         Key priorities

·         Structure

·         Current community nursing provision

·         Current situation

·         Vision

·         Potential model community services access

·         Future access to community services

·         Potential model community nursing working practices

·         Replacement for the virtual ward

·         Community nursing the wider team vision

·         Relationships with the acute setting

·         Potential outcome of the changes

The Board noted the report.

 

198.

Emergency Department Performance - verbal discussion

Adrian Griffiths, Interim Chief Operating Officer

Minutes:

The Chairman explained that in addition to the Operational Performance Report discussed earlier in the public part of the meeting it was essential that the Board had the opportunity to discuss matters associated with ED performance, the nature of which would be prejudicial to the public interest and therefore should be consider the private part of the Board.  The Board had a brief discussion which included staffing matters.

 

199.

Charitable Funds Committee

Steve Nowell – Committee Chair

·        2 August 2017 (enclosure)

Minutes:

The minutes of the meeting of the Charitable Funds Committee held on 2 August 2017 were received. 

200.

Executive Committee

Nerissa Vaughan – Committee Chair

·        15 August 2017 (verbal report)

·        18 July 2017 (enclosure)

Minutes:

The minutes of the meeting of the Executive Committee held on 18 July 2017 were received.  Furthermore, it was noted that a meeting of the Executive Committee had been held on 15 August 2017.

201.

Finance and Investment Committee

Steve Nowell – Committee Chair

·        21 August 2017 (written report & enclosure)

·        24 July 2017 (enclosure)

Minutes:

The minutes of the meeting of the Finance and Investment Committee held on 24 July 2017 were received.  Furthermore, it was noted that a meeting of the Finance and Investment Committee had been held on 21 August 2017.

202.

Performance, People & Place Committee

Steve Nowell – Committee Chair

·        23 August 2017 (written report)

·        26 July 2017 (enclosure)

Minutes:

The minutes of the meeting of the Performance, People & Place Committee held on 26 July 2017 were received.  Furthermore, it was noted that a meeting of the Performance, People & Place Committee had been held on 23 August 2017.

 

203.

Quality & Governance Committee

Nick Bishop - Committee Chair

·        17 August 2017 (written report)

·        20 July 2017 (enclosure)

Minutes:

The minutes of the meeting of the Quality & Governance Committee held on 20 July 2017were received.  Furthermore, it was noted that a meeting of the Quality & Governance Committee had been held on 17 August 2017.

204.

Urgent Business (Private) - Estates

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 of urgent business in view of the Board needing to be advised of the issue as soon as possible.

 

The Board received a verbal report on estate matters.