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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

229.

Apologies for Absence and Chairman's Welcome

Minutes:

There were no apologies for absence.

230.

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:

Jim O’Connell the Chief Operating Officer declared a personal interest in the report of the meeting of the Remuneration Committee in so far as a recommendation to the Board related to his recent appointment (minute 268/17 refers).

231.

Questions from the public to the Board relating to the work of the Trust pdf icon PDF 107 KB

Carole Nicholl, Director of Governance & Assurance

 

Minutes:

The Board had before it a paper listing five questions from members of the public and governors together with responses to those questions received in advance of the meeting.  Two further responses were provided at the meeting as follows: -

 

S106 money

“There is a group which includes representatives from Swindon Borough Council which specifically looks at housing development and S106 money.  Legal advice to support is being sourced.”

 

Weekly parking rate

 

“Visitors and carers of patients that fall under the concessionary pass would receive a £1 a ticket a day so technically this will work out cheaper than a weekly pass (£7 for the week). Clearly however, we try to restrict to one card a patient (partner, carer, family member who is visiting everyday) as sometimes you can have multiple visitors a day with 5 cars to one patient.”

 

The Board agreed that there were no further actions which should be taken in response to the questions raised and answered.

 

RESOLVED

 

that the report be received.

 

232.

Minutes pdf icon PDF 453 KB

Roger Hill, Chairman

·        5 October 2017 (public and summary of private minutes)

Minutes:

The minutes of the meeting of the Board held on 5 October 2017 were adopted and signed as a correct record, subject to the following amendments: -

 

Minute 209/17 Outstanding actions of the Board (public)

The deletion of the words “Nursing Medical Council” and the substitution thereof with the words “Nursing and Midwifery Council”.

 

Minute 211/17 Quality Report

The deletion of “the year-end trajectory was 21 cases” in the paragraph about infection control and the substitution thereof with the words “the year-end trajectory was 20 cases”.

 

The deletion of the words “uterine deaths” in the still births section of the minute and the substitution thereof with the words “intrauterine deaths”.

 

Minute 212/17 Operational Performance Report

The deletion of the word “Neurology” in the cancer section of the minute and the substitution thereof with the word “Urology”.

 

233.

Outstanding actions of the Board (public) pdf icon PDF 422 KB

Minutes:

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

 

119/17

Mortality alert relating to complications of surgical / medical care

GR explained that the alerts related to all of a patients’ care in hospital and the Trust had been advised to disregard the alert as not relevant.

 

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

234.

Chairman's Report, Feedback from the Council of Governors

Roger Hill, Chairman

Minutes:

The Chairman gave a verbal report as follows: -

 

Governor Elections & changes

Karen Hawkins had been elected as the staff governor of the Nursing & Therapist Staff Constituency.  Karen was a Superintendent Physiotherapist.  CN and RH had met with her earlier in the week and she was very keen to represent the views of nurses through the Council of Governors.

 

A vacancy remained for the Southern Wiltshire Constituency as no candidates had stood for election.  The Board was reminded that there was only a small membership for this constituency.

 

A vacancy now existed for the Gloucester & Bath and North East Somerset Constituency.  Martin Rawlinson’s terms of office had ended and no candidates had stood in the recent election.  RH expressed his thanks to Martin for his support over the past three years. 

 

A vacancy remained for the nominated governor position representing the Academy.  One last effort would be made to secure an appointment and thereafter consideration would be given to an alternative organisation.

 

Dr Anna Collings had resigned as the nominated governor representing Wiltshire Clinical Commissioning Group on 30 September 2017.  A replacement governor had been sought.

 

Annual Members Meeting

The Annual Members Meeting and Council of Governors had been a well-attended event again this year with a number of questions asked and views expressed by members and the public.  There was an informative presentation from Cardiology which was excellent.  RH expressed thanks to everyone who had attended and made presentations and he also thanked CN for organising the event. 

 

Public Lectures

For the benefit of members of the public, RH explained that the governors hosted regular public lectures which provided an opportunity for engagement and feedback from the public, as well as recruiting new members.

 

In October the governors had hosted a public lecture on breast health for men and women.  This had been well received, so much so that the lecture would be hosted again next year. 

 

The next governor hosted public lecture would be on dizziness. 

 

Governor hospital walk about

Again for the benefit of members of the public, RH explained that governors undertook monthly walkabouts of the hospital and community areas.  This allowed governors an opportunity to see care being delivered, understand the hospital better and to seek feedback from patients and staff on any matters.

 

Governors had made a walk about on Neptune Ward, (gastro) in October.  Governors provided some immediate feedback from patients they had talked to and on their observations generally which was then shared with the ward sister. There were no issues which governors had asked be referred to the Board. 

 

This month the governor walk about would be on Orchard Ward (short stay rehab).

 

Council of Governors

RH reminded Directors that the next Council meeting would be held on Thursday at 4.30pm in the Academy.  The agenda and papers had been circulated earlier in the week.

 

 

Governor Effectiveness Day

Finally, RH reminded the Non-Executive Directors (NEDs) that the joint governor and NED's effectiveness review day would be held on 12 December.  The  ...  view the full minutes text for item 234.

235.

Chief Executive's Report pdf icon PDF 196 KB

Nerissa Vaughan, Chief Executive

Minutes:

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

 

·         Annual staff flu vaccination campaign launched

·         Red2Green initiative helps patients get home quicker

·         Recovery plan introduced to support financial position

·         Health secretary sends personal letter of congratulations

·         Preparations for winter at GWH and in the community

·         GWH hosts event for vulnerable teenagers moving into adult care

·         Tea parties aid trauma patients’ recovery

·         Week dedicated to quality and safety

 

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

 

Flu vaccination - NV reported that there had been a successful launch of the annual staff flu vaccination campaign and it was hoped that the number of staff receiving the vaccination would be greater than in previous years. 

 

Red2Green initiative – This had been rolling out across a number of wards and departments since the summer and was focussed on timely ways of working to prevent patients waiting.

 

Vulnerable teenagers moving into adult care – A special event had been held to offer support to families whose children were approaching the age of 18 when their care would transfer from children to adult services.  In response to a question raised by JM it was noted that the event was the benefit of Wiltshire and Swindon families.  It was noted that transitional arrangements could be unsettling for some patients and carers and that the event provided an opportunity for families to speak with staff.

 

RESOLVED

 

that the report of the Chief Executive be received.

236.

Finance Report pdf icon PDF 121 KB

Karen Johnson, Director of Finance

Additional documents:

Minutes:

The Board received and considered a report on finance for month 6, together with a presentation as follows: -

 

Actual Operating costs

The report excludes Sustainability & Transformation Funding (S&TF) and represented the Trust Control Total only.

In month deficit of £892k. Year to date (YTD) deficit of £2,921k compared to target deficit of £1,411k.

NHS Clinical Income

£22.4m in month and £135.3m YTD (£1.2m above plan YTD)

Total Income

£27.2m in month and £165.3m YTD (£0.83m below plan YTD)

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

·         Elective inpatients below plan

·         Day case activity below plan

·         Non-elective below plan

·         Outpatient appointments below plan

·         A&E below plan

Total Operating Expenditure

 

£26.1m in month and £156.6m YTD (£0.5m above plan YTD)

Expenditure highlights in month:

·         Drugs £0.05m above plan (£0.8m above plan YTD)

·         Pay £0.5m above plan (£3.4m above plan YTD)

·         Supplies £0.02m above plan (£0.3m below plan YTD)

·         Other Costs £0.8m below plan (£3.3m below plan YTD)

EBITDA

5.3% YTD

Savings

Savings plan of £14.052m of which £12.213m identified

£1.664m CIPS delivered in month against a plan of £1.258m.

£4.953m delivered against a plan of £5.997m YTD (£1.04m below plan)

Forecast

The forecast had deteriorated in month and was now £7.363m deficit after identified mitigations, which was £2.403m below control total. A Financial Recovery Plan had commenced to recover this position by the end of Q3.

Debtors

£33.1m debtors and stock

£2.6m above plan

Creditors

£60.8m creditors and borrowings

£0.9m above plan

Cash

£7.5m (£3.5m above plan)

Loan

No repayment made in month

Finance Risk Ratings

Use of Resources (UoR) 4 (Rating 1 was top and 4 was bottom). The UoR had deteriorated from the prior month rating of 3, due to failure to achieve Q2 Financial Control total. The current forecast was to recover the position by Q3 and therefore the forecast UoR was 3.

 

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

 

Financial Recovery Plan

KJ highlighted that the Trust was behind plan by £1.8m.  A Recovery Plan had been launched with a target of £2,500k which, in conjunction with the forecast and mitigations, would deliver the plan deficit of £4,960k. However this left little contingency for any further slippage in the Trust’s position or forecast. 

 

KJ highlighted the areas of concern notably the need for greater agency reduction; stock controls within theatres; activity and NHS clinical income delivery below plan and non-achievement of cost improvement plans.

 

Pay spend

Whilst pay costs had decreased in month this was not sufficient.  The internal auditors had been commissioned to undertake a review of internal controls and processes.  Furthermore, a review of close support was also underway.

 

Cost Improvement Programmes (CIPs)

In month had seen an improvement in CIPs delivery but the forecast outturn remained below plan.  Divisional managers continued to look for additional CIP schemes but closing the financial gap was becoming increasingly more challenging.

 

KJ advised that there had been a focus on the year end forecast which without mitigation was £9.6m  ...  view the full minutes text for item 236.

237.

Chair of Finance & Investment Committee Overview pdf icon PDF 172 KB

Steve Nowell, Non-Executive Director

Minutes:

The Board considered a report which summarised the key issues from a meeting of the Finance & Investment Committee held on 23 October 2017 which it was considered should be drawn to the attention of the Board covering the following: -

 

·         Overall financial performance

·         Women’s, Children’s and Sexual Health Division overview

·         Planned Care Division overview

·         Cost Improvement Programme (CIP) overview

·         BAF Strategic Risk

 

In presenting the report, SN advised that the Committee had considered CIPS for next year but the reality was that given that the ability to achieve CIPS this year was challenging, next year’s CIPs would be even more difficult to achieve and that a £12.7m CIPs was ambitious.  It was commented that Trust wide schemes totalled £5m and therefore the remainder would need to come from the Divisions.

 

SN commended the amount of work undertaken by the Finance Team to support the Recovery Plan and to support Divisions.

 

RESOLVED

 

that the report be received.

238.

Chair of Audit, Risk & Assurance Committee Overview pdf icon PDF 171 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 14 September 2017 which it was considered should be drawn to the attention of the Board covering the following: -

 

·         15+ Risk Register

·         External auditor progress report and technical update

·         Internal auditor progress report

·         Estates compliance audit updates

·         Counter Fraud / self-review tool process

·         Mitigation to Synergy 4

·         Fixed Asset Register

 

In presenting the report, JS referred to the continuous good work going on to support risk management throughout the organisation and that the Committee had welcomed the Executive Directors’ narrative against the 15+ risks.

 

JS advised that the internal auditors had offered to host a workshop on risk management which would be arranged in discussion with the Audit Committee.  It was noted that the internal auditors had undertaken an advisory review of the Trust’s risk maturity and had concluded that the Trust was performing very well.  The good work around the Board Assurance Framework and the governance arrangement in place were noted.

 

Finally, JS explained that work was continuing on the asset register to ensure that problems experienced last year were not repeated in the future.

 

RESOLVED

 

that the report be received.

 

 

239.

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 September were as follows: -

 

·         Most recent HSMR = 95.3 (12 month period June 2016 to June 2017)

·         There were 2 cases of Clostridium difficile during September, the current rate was 11.09 per 100,000 bed days year to date

·         3 Serious Incidents were reported during September

·         There were 54 clinical incident investigations overdue more than 90 days

·         There were 21 mixed sex accommodation breaches in September

 

Hospital Standardised Mortality Rate (HSMR)

GR explained that HMSR was the expected death rate versus the observed death rate and the Trust was performing well.

 

National Audits

GR highlighted that the number of audits had increased from previous years and this resulted in additional work for already busy teams.  Notwithstanding this, progress was being made to participate in audits and data submission remained at 100%.  Additional staff had been engaged to support continuous data analysis.

 

Infection Prevention and Control

The Trust was 1 over trajectory which had been set prior to the Trust taking on Swindon Community Services. There had been 1 case of MRSA and it was probable that the patient had MRSA before being admitted to hospital. PH suggested that staff should be commended for their efforts towards infection prevention and control.

 

Quality Indicators

HW commented that the Trust was mostly performing well against the quality indicators although there had been a disappointing number of pressure ulcers in SwICC.  A robust action plan was in place with support being provided to drive forward actions. There were a number of staff vacancies in SwICC but an additional matron had been engaged to strengthen leadership further.

 

It was noted that the ED dashboard had been reviewed by the Quality and Governance Committee.  Whilst there had been no Decision to Admit (DTA) 12 hour breaches, there were patients in the Emergency Department for more than 12 hours but there was confidence that their care was safe. 

 

The Clinical Lead had briefed the Quality & Governance Committee on areas of concern.  Reference was made to SHINE and it was noted that consideration was being given around how use could be audited differently.  The Quality & Governance Committee had also received a presentation about pharmacy missed doses with assurance provided around actions in place.

 

HW commented that overdue action plans were frustrating but since writing the report these were now all complete.  Additional steps were being added to the investigation process to include flags to ensure actions were being picked up in a timely way.

 

HW commented that unfortunately there had been an increase in the number of overdue incident investigation.  However, those with harm were being investigated first with learning shared with support from the Clinical Risk Team.  HW commented that the Trust was experiencing pressure.

 

Patient Feedback

HW highlighted the feedback from patients which was both complimentary and negative.  One patient had raised concerns about poor care and a  ...  view the full minutes text for item 239.

240.

Chair of Quality & Governance Committee Overview pdf icon PDF 229 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 21 September and 19 October as follows: -

 

·         Quality Report

·         Emergency Department Dashboard

·         Maternity and Neonatal Services Transformation Plan and Quality Improvement Overview

·         Safeguarding Children Annual Report 2017/18

·         Omitted Dose Update

·         Clinical Audit and Effectiveness Q2 Report

·         Safer Staffing Monthly Exception Report

·         Swindon Community Health Services clinical governance and quality oversight

·         Quality Governance Framework

·         Well Led Governance Review

·         KLOE Compliance Assurance Framework

·         Board Assurance Framework – Strategic risks aligned to this Committee

·         Corporate Governance Report

 

NLB commented that the Committee had discussed the Emergency Department Dashboard in detail and had heard about alternative options for testing SHINE performance.   NLB clarified that the missed doses information referred to doses missed and not numbers of patients.  It was commented that the Trust benchmarked favourably with other Trusts around missed doses.

 

The Committee had discussed the sources of assurances aligned to strategic risks and had challenged risk scoring.

 

NLB advised that there was now clarity regarding which Committee was responsible for oversight of maternity with management and leadership, plus performance falling under the Performance People and Place Committee and quality falling under the Quality and Governance Committee.

 

Reference was made to new measures around ambulance handover times and JS commented that the Trust had good ambulance handover performance which should be noted.

 

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.

241.

Operational Performance Report pdf icon PDF 274 KB

Jim O’Connell, 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: -

 

ED 4 hour standard (95%)                     September 87.3%           Not Achieved

(combined - ED, MIU & UCC)                 Q2 87.7%

 

12 Hour Reportable DTA Breaches         September                      Nil

 

RTT Incomplete standard (92%)             September 90.02%          Not Achieved

 

6 Week Diagnostic Wait (99%)               September 98.5%           Not Achieved

 

Cancer Targets:                                     August

2 Week Waits (93%)                              92.8%                             Not Achieved

2 Week Wait Breast Symptomatic(93%)95.1%                              Achieved

31 Day Treatment (96%)                        96.7%                             Achieved

62 Day Treatment (85%)                        78.7%                             Not Achieved

 

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

 

ED 4 hour standard

It was noted that towards the end of the month ED attendances had increased with greater acuity of patients.  The Board was asked to be mindful of the performance of the Walk in Centre and the Urgent Care Centre (UCC) in contributing to the overall performance.

 

Reference was made to the quality of care and patient safety and it was noted that whilst there had been no 12 hour Decision to Admit breaches, 195 patients had waited over 12 hours in the Emergency Department.  These patients were being managed.

 

Ambulance Arrivals

It was noted that from March 2018 there would be a requirement to record performance against 15 minute handovers.

 

Right Patient Right Place (RPRP) indicators

The performance against the indicators in the report was noted.  It was commented that there needed to be a stronger focus on patient discharges. 

 

In response to a question from JS, LP reported that from November the Trust would move to rapid assessment and treatment of patients known as RATTING or SLAM which were the same thing. This was good national practice but once ED became overcrowded it was not possible to do this.

 

In response to a question from AC, LP undertook to provide information on the number of first assessment breaches in the next report.  AC questioned the correlation with patients admitted.  NV responded that breaches were not good and that there was a need to make sure flow was as good as possible.  NV confirmed that there was a correlation between longer waits and admissions.

 

AC questioned this Trust’s first assessment breaches compared to other hospitals and LP undertook to report benchmark data on this in future reporting. It was commented that completion of timely first assessments would not necessarily improve ED performance but they were a safety measure.

 

JO explained that what caused ED to become overcrowded was unclear and that the data needed to be available and understood.  The number of partner discharges was a contributory factor and that there was a need to be having patient by patient discussions.  There were a number of processes in the system which slowed things down.  Delayed Transfers of Care (DTOCs) were concerning. 

 

JS commented that the staff consultation around revised working patterns had ended and she sought an update  ...  view the full minutes text for item 241.

242.

Chair of Performance, People & Place Committee Overview pdf icon PDF 167 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 27 September and 25 October 2017 covering the following: -

 

·         Operational Performance Report

·         Monthly Workforce Report

·         Board Assurance Framework (BAF) – strategic risks

·         Winter Planning

·         IT

 

The Committee had focussed primarily on the Operational Performance Report (OPR) at its September and October meetings.  At both meetings there was a detailed review of performance against Emergency Department and Cancer targets.  

 

SN highlighted that there remained significant challenges around achieving the 4 hour ED access standard, cancer performance and Referral to Treatment Times (RTT). The Committee had been assured that there was focussed attention in the right areas to drive improvements and SN expressed his thanks to LP for all her hard work around this over recent months.

 

SN highlighted that the Committee had looked at winter planning and IT, notably IT requirements for the next five years and that a view on this from the Finance and Investment Committee had been sought.

 

Finally, SN advised that the Committee had looked at fire cladding and additional assurance was being sought.

 

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.

243.

Safer Staffing Monthly Exception Report pdf icon PDF 203 KB

Hilary Walker, Chief Nurse

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 September the position was as follows: -

 

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

 

Registered Nurses

Care staff

Day Shift

84.6%

103%

Night Shift

94.8%        

109%

 

Average skill mix ratio (day): -

Registered Nurse Staff

62%

Care staff

38%

 

HW advised that the fill rate for Registered Nurses was low because there were band 4 staff who were qualified but had not yet obtained their pin, details of which were explained in the report. 

 

HW reported that a review of close support was underway and would be reported through the Board Committees next month.

 

HW highlighted that there had been changes nationally to the English language test requirements with staff booked on the first new testing sessions in December. RH asked if this would be monitored and it was noted that this would form part of the Productive People Workstream.  OF reported that Teams were drafting recruitment trajectories.

 

RESOLVED

 

that the report be received.

244.

Ratification of Decisions made via Board Circular/Board Workshop

Carole Nicholl, Director of Governance & Assurance

Minutes:

None.

245.

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.

246.

Date and Time of next meeting

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

247.

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)

·        NHS Enforcement Undertakings

·        Recovery Plan

·        Cash and Borrowing 2017/18 – 2019/20

·        PFI Benchmarking Options Appraisal

·        Team Swindon/Accountable Care System (ACS)

·        Brighter Futures Strategy Report

·        15+ Risk Register

·        Board Assurance Framework

·        ED Performance

·        Well Led Governance Review

·        Wiltshire Health & Care Update

·        Charitable Funds 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

·        Remuneration 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)

·         NHS Enforcement Undertakings

·         Recovery Plan

·         Cash and Borrowing 2017/18 – 2019/20

·         PFI Benchmarking Options Appraisal

·         Team Swindon/Accountable Care System (ACS)

·         Brighter Futures Strategy Report

·         15+ Risk Register

·         Board Assurance Framework

·         ED Performance

·         Well Led Governance Review

·         Wiltshire Health & Care Update

·         Charitable Funds 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

·         Remuneration Committee Minutes

·         Urgent Private Business (if any)

248.

Minutes

Roger Hill, Chairman

·        5 October 2017 (private)

Minutes:

The minutes of the meeting of the Board held in private on 5 October 2017 were adopted and signed as a correct record.

249.

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.

250.

NHS Enforcement Undertakings

Nerissa Vaughan, Chief Executive

Minutes:

The Board had before it a letter from NHS Improvement advising that the outcome of the Regional Provider Resource Group (South) was that a compliance certificate in respect of the Trust’s 2015 financial undertakings should be issued and that the Trust should move from segment 3 to segment 2 under the Single Oversight Framework.  A set of informal actions to support continued financial performance throughout the remainder of 2017/18 had been stipulated.  The Regional Group had also considered that the Trust had made sufficient progress in improving flow and 4 hour performance that formal regulatory action at this stage would not be appropriate.  However, the Trust was required to deliver a refreshed set of informal actions to deliver continued performance improvement.

 

The Board received the letter.

 

251.

Recovery Plan - verbal update

Karen Johnson, Director of Finance

Minutes:

The Board received and consider a verbal update from KJ together with a briefing paper circulated at the meeting covering the Financial Recovery Plan 2017/18.  The briefing covered the following: -

·         Summary of further identified opportunities as at 18 October 2017 showing a remaining gap of £1.04m against £2.5m target

·         Overview of Divisional Recovery Schemes

·         Further opportunities with no financial values identified

·         Reserves position as at 20 October 2017

 

The Board received the verbal report and briefing paper.

 

252.

Cash and Borrowing 2017/18 - 2019/20

Karen Johnson, Director of Finance

Minutes:

The Board received and considered a report which provided an update on the potential borrowing requirements for the Trust over the next 3 years and the possible options on how to address this.

 

Having discussed the cash position, the most likely scenario was supported as the basis for a full business case.

253.

PFI Benchmarking Options Appraisal

Kevin McNamara, Director of Strategy

Minutes:

The Board considered a paper which provided an update on the PFI Benchmarking exercise.  The Board received the report.

 

254.

Team Swindon/Accountable Care System (ACS) - progress update

Kevin McNamara, Director of Strategy

Minutes:

The Board received and considered an update on the Team Swindon programme and progress to deliver a new model of care in Swindon. The Board received the report and noted progress.

 

 

255.

Brighter Futures Strategy Report

Kevin McNamara, Director of Strategy

Minutes:

The Board received and considered a report together with a presentation which provided an overview of the fundraising strategy.  The Board received the report and presentation.

 

256.

15+ Risk Register

Carole Nicholl, Director of Governance & Assurance

Minutes:

The Board received and considered a report which set out brief details of the risks scoring 15+ (extreme risks) together with an Executive Director comment against each.

 

It was noted that there were 55 high / extreme risks which the Board was mostly well sighted on through Board and Committee reporting, details of which were listed in the report.  Those risks where the Board was not so well sighted included additional information.

 

The Board received the report, noted the 15+ risks, agreed that there were no further actions required and also agreed that the systems and processes in place for the management of risk remained effective.

257.

Board Assurance Framework

Carole Nicholl, Director of Governance & Assurance

Minutes:

The Board received and considered a report which presented the Board Assurance Framework (BAF) as at the end of quarter 2.  The BAF showed that the scoring of the 18 strategic risks was as follows: -

·         1 moderate risk

·         4 high risks and

·         13 extreme risks

 

The report included a covering dashboard setting out the sources of assurance against the indicators aligned to the strategic risks.  The Board noted the areas that were flagging for attention as set out in the paper recognising that the issues identified were being considered through the Board Committees.

 

The Board received the report.

258.

Emergency Department Performance - verbal update

Jim O’Connell, Chief Operating Officer

Minutes:

The Board considered a verbal update from the new Chief Operating Officer in terms of his initial views on ED improvements.  The Board noted the update.

259.

Well Led Governance Review

Carole Nicholl, Director of Governance & Assurance

Minutes:

The Board considered a report that provided an update on the roll out of milestone actions arising from the well led governance review.  The Board was invited to consider if the recommendations in the report had been addressed and agree that the action plan be closed down.

 

The Board agreed that the action plan from the Well Led Governance Review undertaken in 2016 should be closed down and confirmed that the recommendations in the review had been sufficiently addressed, with the overall rating of “GOOD” for the well led domain by the Care Quality Commission in its recent inspection report providing sufficient assurance around improvements made to well led governance.

260.

Wiltshire Health & Care Board Meeting Update

Nerissa Vaughan, Chief Executive

Minutes:

The Board received and considered a report which provided an update on key topics discussed at the recent Wiltshire Health & Care Board.  The Board noted the report.

 

261.

Charitable Funds Committee

Jemima Milton – Committee Chair

·        1 November 2017 (verbal report)

Minutes:

It was noted that a meeting of the Charitable Funds Committee had been held on 1 November 2017. 

262.

Executive Committee

Nerissa Vaughan – Committee Chair

·        17 October 2017 (verbal report)

·        19 September 2017 (enclosure)

Minutes:

The minutes of the meeting of the Executive Committee held on 19 September 2017 were received.  Furthermore, it was noted that a meeting of the Executive Committee had been held on 17 October 2017.

263.

Finance and Investment Committee

Steve Nowell – Committee Chair

·        23 October 2017 (verbal report)

·        25 September 2017 (enclosure)

Minutes:

The minutes of the meeting of the Finance and Investment Committee held on 25 September 2017 were received.  Furthermore, it was noted that a meeting of the Finance and Investment Committee had been held on 23 October 2017.

264.

Joint Nominations Committee

Roger Hill – Committee Chair

·        12 October 2017 (verbal report)

Minutes:

It was noted that a meeting of the Joint Nominations Committee had been held on 12 October 2017.

265.

Mental Health Governance Committee

Nick Bishop – Committee Chair

·        6 October 2017 (enclosure)

Minutes:

The minutes of the meeting of the Mental Health Governance Committee held on 6 October 2017 were received. 

266.

Performance, People & Place Committee

Steve Nowell – Committee Chair

·        25 October 2017 (verbal report)

·        27 September 2017 (enclosure)

Minutes:

The minutes of the meeting of the Performance, People & Place Committee held on 27 September 2017 were received.  Furthermore, it was noted that a meeting of the Performance, People & Place Committee had been held on 25 October 2017.

267.

Quality & Governance Committee

Nick Bishop - Committee Chair

·        19 October 2017 (verbal report)

·        21 September 2017 (enclosure)

Minutes:

The minutes of the meeting of the Quality & Governance Committee held on 21 September 2017 were received.  Furthermore, it was noted that a meeting of the Quality & Governance Committee had been held on 19 October 2017.

268.

Remuneration Committee

Steve Nowell – Committee Chair

·        19 October 2017 (verbal report and recommendation)

Minutes:

Jim O’Connell the Chief Operating Officer had declared a personal interest in this item in so far as a recommendation to the Board related to his recent appointment and he left the meeting during its consideration.

 

The Board received a verbal report of the meeting of the Remuneration Committee held on 19 October 2017 and agreed a recommendation in relation to the appointment of the appointment of the new Chief Operating Officer.

269.

Urgent Business (Private) (if any)

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

Minutes:

None.