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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

205.

Apologies for Absence and Chairman's Welcome

Hilary Walker, Chief Nurse

Minutes:

Apologies for absence were received from Julie Soutter and Hilary Walker.

206.

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.

207.

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

Minutes:

There were no questions from members of the public.

208.

Minutes pdf icon PDF 571 KB

Roger Hill, Chairman

·        7 September 2017 (public and summary of private minutes)

Minutes:

The minutes of the meeting of the Board held on 7 September 2017 were adopted and signed as a correct record, subject to the following amendments: -

 

Minute 183/17 Operational Performance Report - In the first paragraph under the sub-heading Stroke, the deletion of the words “two key points in the data” and the substitution thereof with “two key points in the day”.

 

Minute 188/17 Responsible Officer’s Annual Report on Appraisal and Revalidation – the deletion of the reference “FSA” and the substitution thereof with “SAS”.

209.

Outstanding actions of the Board (public) pdf icon PDF 433 KB

Minutes:

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

 

44/17

CE Report- innovative ideas

GR reported that an element of the Sustainability & Transformation Programme (STP) was the alignment of procurement around consumables, which would involve clinical engagement. 

 

The intention was not to set up another group to consider innovative ideas but instead to incorporate this into the work of the STP.  Consumables, (such as surgical gloves) would be reviewed first.  A policy had been drafted around innovative practices and products and meetings set up.

 

It was agreed that this action be closed on the tracker.

 

119/17

Mortality alert relating to complications of surgical / medical care

GR explained that the Trust considered the Doctor Foster alerts and it was flagged that many alerts resulted as a result of practice in other hospitals.  The Trust was seeking to understand why information was coming through to this Trust.

 

 

176/17

Finance Report – forecast

AC confirmed that he had had a further discussion with KJ and therefore this action was now complete.

176/17

Finance Report – cash

KJ advised that this would be reported through the Finance and Investment Committee later in the month as planned.  A report had been received from pwc indicating the likely costs of the pfi premium.  The report was currently being validated.  It was agreed that this action could be closed on this tracker.

 

179/17

Quality report – HMSR

It was confirmed that GR had discussed this with AC and therefore this action was now complete.

181/17

 

OPR – Brain imaging 

AGr commented that there were vulnerabilities around performance associated with times of day.  Further work was underway to understand this and information would be included in a future operational performance report to the Board.

 

186/17

People Strategy – additional staff

OF reported that there had been some movement from the Nursing Medical Council (NMC) around the English Language Test which would be reported through the Performance, People and Place Committee.

 

 

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

 

 

 

 

210.

Finance Report pdf icon PDF 120 KB

Karen Johnson, Director of Finance

Additional documents:

Minutes:

The Board received and considered a report on finance for month 5, together with a presentation as follows: -

 

Actual Operating costs

In month deficit of £743k including Sustainability & Transformation Funding (S&TF) (deficit of £1.041m excluding S&TF). Year to date deficit of £268k compared to a target surplus of £797k including S&TF (£2.029m deficit compared to a £1.116m target deficit excluding S&TF)

NHS Clinical Income

£22.6m in month and £112.9m year to date (£1.5m above plan year to date)

Total Income

£27.8m in month and £139.9m year to date (£0..23m below plan year to date)

Income Activity highlights for the month (based on estimated activity)

·         Elective inpatients above plan

·         Day case activity above plan

·         Non-elective above plan

·         Outpatient appointments below plan

·         A&E below plan

Total Operating Expenditure

 

£26.6m in month and £130.5m year to date (£0.7m above plan year to date)

Expenditure highlights in month:

·         Drugs £0.2m above plan (£0.7m above plan year to date)

·         Pay £1.2m above plan (£2.9m above plan year to date)

·         Supplies £0.1m above plan (£0.4m below plan year to date)

·         Other Costs £0.6m below plan (£2.6m below plan year to date)

EBITDA

6.7% year to date

Savings

Savings plan of £14.052m of which £11.442m identified

£0.778m Cost Improvement Programmes (CIPS) delivered in month against a plan of £1.117m.

£3.289m delivered against a plan of £4.739m year to date (£1.45m below plan)

Forecast

Forecast had deteriorated in month and was now £0.862m deficit (including S&TF) after identified mitigations, which was £1.8m below control total.

Debtors

£35.8m debtors and stock

£5.2m above plan

Creditors

£62.3m creditors and borrowings

£0.8m above plan

Cash

£6.6m (£1.1m above plan)

Loan

£0.6m repaid in month

Finance Risk Ratings

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

 

The Board discussed the report, noting the Executive Director summary and comments were made as follows: -

 

Financial performance

KJ highlighted that CIPs and agency spend were causing significant pressure on the financial position.  A financial recovery plan had been initiated and options for driving out costs would be considered with Executive Director challenge on 23 October. NHS Improvement, the Regulator of NHS Foundation Trust had been informed of the worsening position.

 

It was noted that reviews into pay as a total had been launched. OF and KJ had met with internal auditors to start working up an audit scope that would test the adequacy of controls in place around agency usage. In addition a full review of all non-clinical vacancies was taking place.

 

KJ reported that discussions were ongoing with commissioners around year-end financial deals.

 

It was noted that messaging the whole organisation about the financial position would be a priority with a view to a trust wide effort to reduce costs as far as possible.

 

KJ advised that triangulation of data was underway to understand spend and how this correlated or otherwise to activity.   The Finance Team was challenging why spend had gone up in  ...  view the full minutes text for item 210.

211.

Quality Report pdf icon PDF 112 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 September were as follows: -

 

·         Most recent Hospital Standardised Mortality Rate (HSMR) = 94.75 (12 month period June 2016 to May 2017)

·         National audits were continuing to progress, but challenges around completion of reports and documenting evidence.

·         There were 2 cases of Clostridium difficile during August 2017.

·         Progress had been made around visibility of key safety and quality indicators for patient in ED with an integrated performance dashboard now available and reported through the Board Committees.

 

Hospital Standardised Mortality Rate (HSMR)

GR draw attention to the HMSR which showed that the rolling 12 month period was below 90 which meant that less people were dying in the Hospital than were expected to die given the population served.  This was commendable given the operational performance pressures on the organisation.

 

National Clinical Audits

NLB questioned whether the Trust was making sufficient progress with clinical audits noting that a number of reports were overdue and had been for some time. GR commented on the work involved around some of the audits which was challenging.  He explained that good progress had been made on informed consent.

 

Infection Prevention and Control

GR advised that the Trust had ended quarter 2 with 10 cases year to date.  GR reminded the Board that the year-end trajectory was 21 cases.  GR advised that he had no issues of concern to flag at this stage.

 

Still births cluster

It was noted that the external review had concluded that the Trust had not needed to report the still births as a cluster serious incident.  It was felt that there was natural variation and it was noted that two of the still births had occurred in other organisations with the mums choosing to give birth at this Trust.  The external review had concluded that only one should have been reported as a serious incident and a full investigation was currently underway.

 

PH commented that the report from the external review was reassuring in that it provided confidence around the robustness and rigour of internal investigation processes.  It was commented that the deaths were inter uterine deaths, rather than deaths during delivery and it was important for the public to understand this.

 

Serious incidents and complaints

As set out in the report, the number of overdue investigations into serious incidents and overdue complaint responses was noted.  It was explained that this was being challenged through the Patient Quality Committee.

 

JMa explained that she would discuss closure of serious investigations with the Divisional Directors of Nursing.  There was a monthly Serious Incident Panel to review the serious incident investigations as well as to offer support to the investigator and consider lessons learnt.  Going forward it was proposed that there would be a six week plan of the Serious incident investigations due to be completed to enable early oversight of what was coming up and  ...  view the full minutes text for item 211.

212.

Operational Performance Report pdf icon PDF 273 KB

Adrian Griffiths, Interim Chief Operating Officer

·        Including Winter Plan

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: -

 

ED 4 hour standard (95%)

(combined – Emergency Department, Minor Injury Unit & Urgent Care Centre)

 

August 90.5%

Not Achieved

12 Hour Reportable Decision to Admit Breaches (DTA) Breaches

 

August - Nil

Achieved

Referral to Treatment (RTT) Incomplete standard (92%)

 

August 90.94%

Not Achieved

6 Week Diagnostic Wait (99%)

 

August 97.8%

Not Achieved

Cancer Targets

2 Week Waits (93%)

2 Week Wait Breast Symptomatic (93%)

31 Day Treatment (96%)

62 Day Treatment (85%)

July

95.1%

92.9%

96.6%

75.6%

 

Achieved

Not achieved

Achieved

Not achieved

 

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

 

Emergency Department 4 hour Access Target

Whilst August had seen an improved position, performance had been worse in September with the month ending at 87.3%.  A number of actions were ongoing as previously reported and discussed at the Board and through the Performance, People and Place Committee and these actions were reflected in the Winter Plan.

 

It was noted that the changes to Acute Physicians work patterns were still on track to commence in October.   A clinical lead post had yet to be filled and discussions were underway about that.

 

It was highlighted that breach analysis was flagging first assessment breaches which remained concerning.  The ED consultants had agreed to change work patterns from November which would help improve this.  It was explained that consultants were introducing SLAM (a senior assessment review) which was a version of “ratting” (a rapid assessment and treatment model for patients in ED).  In terms of establishing a trajectory of improvement, it was noted that first assessment breaches could be monitored.

 

In response to a question from AC, it was noted that better performance around first assessments would support improved performance and flow in ED but more importantly would improve patient care.  Working practices were being changed to address this and completion of first assessments was a continued area for focus.

 

AGr reported that streaming was improving and that consideration was being given as to how the patients streamed to Ambulatory Care could be shown statistically in the Trust’s performance.  In response to a question from JM it was reported that discussions around 7 day streaming were ongoing, including consideration of nurse led options.

 

It was explained that there was a need to establish metrics for the integrated discharge service, but that this would take longer to embed because of training requirements, culture and granularity in terms of looking at the detail to drive improvement.

 

It was reported that the Delayed Transfers of Care (DTOC) and Urgent Care Working Group had been comprehensively reviewed and were amalgamating.  Swindon Clinical Commissioning Group was working on a capacity map across the patch with a view to a system wide approach to resolving DTOC issues.

 

The Older People Pathway would be launched later in the month, details of  ...  view the full minutes text for item 212.

213.

Ratification of Decisions made via Board Circular/Board Workshop

Carole Nicholl, Director of Governance & Assurance

Minutes:

None.

214.

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.

215.

Date and Time of next meeting

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

216.

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)

·        STP Update

·        Scoping the future for service provision

·        Pathology Network

·        Rightsizing hospital capacity: planning for the future – Strategic Outline Case

·        Audit, Risk and Assurance 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

·         Outstanding Actions of the Board

·         STP Update

·         Scoping the future of service provisions

·         Pathology Network

·         Rightsizing hospital capacity: planning for the future – strategic outline Case

·         Audit, Risk and Assurance Committee Minutes

·         Executive Committee Minutes

·         Finance and Investment Committee Minutes

·         Performance, People and Place Committee

·         Urgent Private Business (if any)

 

217.

Minutes

Roger Hill, Chairman

·        7 September 2017 (private)

Minutes:

The minutes of the meeting of the Board held in private on 7 September 2017 were adopted and signed as a correct record.

218.

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.

219.

STP Update

Kevin McNamara, Director of Strategy

Minutes:

The Board received and considered a paper which provided an update on the progress of the BaNES Swindon and Wiltshire STP following a refresh session held in September.  Priorities for each workstream in the next phase were described in the report.

 

The Board noted the report.

220.

Scoping the future for service provision

Kevin McNamara, Director of Strategy

Minutes:

The Board received and considered a paper on work carried out to scope the potential for future services.

 

The Board noted the report and the work now taking place.

221.

Pathology Network

Kevin McNamara, Director of Strategy

Minutes:

The Board received and considered a report on changes in pathology.  The Board agreed the recommendation in the report.

222.

Rightsizing hospital capacity: planning for the future - Strategic Outline Case

Kevin McNamara, Director of Strategy

Minutes:

The Board had before it a detailed report on rightsizing the hospital the content of which was reviewed in detail at a Board workshop later in the day.

223.

Audit, Risk and Assurance Committee

Julie Soutter – Committee Chair

·        14 September 2017 (verbal report)

·        13 July 2017 (enclosure)

Minutes:

The minutes of the meeting of the Audit, Risk and Assurance Committee held on 13 July 2017 were received.  Furthermore, it was noted that a meeting of the Audit, Risk and Assurance Committee had been held on 14 September 2017.

224.

Executive Committee

Nerissa Vaughan – Committee Chair

·        19 September 2017 (verbal report)

·        15 August 2017 (enclosure)

Minutes:

The minutes of the meeting of the Executive Committee held on 15 August 2017 were received.  Furthermore, it was noted that a meeting of the Executive Committee had been held on 19 September 2017.

225.

Finance and Investment Committee

Steve Nowell – Committee Chair

·        25 September 2017 (verbal report)

·        21 August 2017 (enclosure)

Minutes:

The minutes of the meeting of the Finance and Investment Committee held on 21 August 2107 were received.  Furthermore, it was noted that a meeting of the Finance and Investment Committee had been held on 25 September 2017.

226.

Performance, People & Place Committee

Steve Nowell – Committee Chair

·        27 September 2017 (verbal report)

·        23 August 2017 (enclosure)

Minutes:

The minutes of the meeting of the Performance, People & Place Committee held on 23 August 2017 were received.  Furthermore, it was noted that a meeting of the Performance, People & Place Committee had been held on 27 September 2017.

227.

Quality & Governance Committee

Nick Bishop - Committee Chair

·        21 September 2017 (verbal report)

·        17 August 2017 (enclosure)

Minutes:

The minutes of the meeting of the Quality & Governance Committee held on 17 August 2017 were received.  Furthermore, it was noted that a meeting of the Quality & Governance Committee had been held on 21 September 2017.

228.

Urgent Business - 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 as an item of urgent business in view of the need for the Board to be advised of the matter at the earliest opportunity.

 

The Board received and considered a verbal report from KM on an estates matter.  The Board noted the report.