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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

270.

Apologies for Absence and Chairman's Welcome

Minutes:

There were no apologies for absence as everyone expected was present.

271.

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.

272.

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

Minutes:

There were no questions from members of the public.

273.

Minutes pdf icon PDF 523 KB

Roger Hill, Chairman

·        2 November 2017 (public and summary of private minutes)

Minutes:

The minutes of the meeting of the Board held on 2 November 2017 were adopted and signed as a correct record.

274.

Outstanding actions of the Board (public) pdf icon PDF 407 KB

Minutes:

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

 

181/17

OPR – Brain imaging

It was explained that not all stroke patients accessed the hospital via the Emergency Department (ED).  There were some patients who had strokes whilst on the wards.  There was sufficient scanning capacity; the issue was around recognition of stroke and assessment periods.

 

It was noted that work was underway around improvement to stroke performance and that brain imaging performance would be included as part of that.  It was therefore agreed that this action could be removed from the tracker.

 

212/17

OPR – Older Peoples Pathway

It was reported that a business case had been developed with funding sought towards an older person scheme which included specialist nursing.  This action was therefore closed.

 

212/17

OPR Capacity SWICC

SWICC and ED were working closely together and therefore the role of SWICC was becoming clearer.  The number of discharges per day was improving.  ECIP was on site working with the Trust around improvements to patient flow and this would include use of SWICC.  It was therefore agreed that this action be closed on the tracker.

 

212/17

OPR – Patient length of stay

Length of stay was being considered as part of the patient flow improvement plans.  Improved flow would lead to reduced length of stay.  Improvements had been seen with a reduction in the number of bed days lost.  It was agreed that this action be closed as the matter was being picked up as part of winter planning.

 

239/17

Quality Report – patient stories

It was noted that HW had shared patient feedback stories and therefore this action had been completed.

 

239/17

Quality Report – patient stories

It was noted that HW had provided additional information around lessons learnt and therefore this action had been completed.

 

239/17

Quality Report – patient stories

It was noted that KM had discussed support from Brighter Futures towards gaining patient feedback and therefore this action was closed.

 

241/17

OPR – Right Person Right Place

It was noted that a review of first assessment breaches was underway.  It was known that a number of breaches should not be classified as true breaches but related to the availability of beds.  Therefore an additional assessment category was to be introduced to identify these.  It was agreed that the action be closed.

 

241/17

OPR – Right Person Right Place

It was reported that the Trust benchmarked higher than other Trusts for first assessments.  It was therefore agreed that the action to provide benchmark information could be closed.

 

241/17

OPR – Acuity of patients

In response to a request for insightful analysis of ED acuity levels, JO had advised that he was unaware of an acuity model which would provide this information.  It was therefore agreed that this action be closed noting that this information might not necessarily have been beneficial in supporting performance improvements.

 

 

The Board agreed that completed actions be removed from  ...  view the full minutes text for item 274.

275.

Finance Report pdf icon PDF 168 KB

Karen Johnson, Director of Finance

Additional documents:

Minutes:

The Board received and considered a report on finance for month 7, together with a presentation as follows: -

 

Actual Operating costs

The report did not contain any data relating to Sustainability and Transformation Funding (STF) and represented the Trust Control Total only.

 

In month deficit was £391k.  Year to date (ytd) deficit of £3,312k compared to a target deficit of £1,933k.

 

NHS Clinical Income

£23.1m in month and £158.4m ytd (£1.0m above plan ytd)

Total Income

£28.3m in month and £193.7m ytd (£1.2m below plan ytd)

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

·         Elective inpatients below plan

·         Day case activity above plan

·         Non-elective above plan

·         Outpatient appointments below plan

·         A&E below plan

Total Operating Expenditure

 

£26.8m in month and £183.4m ytd (£0.021m above plan ytd)

Expenditure highlights in month:

·         Drugs £0.259m above plan (£1.05m above plan ytd)

·         Pay £0.544m above plan (£3.952m above plan ytd)

·         Supplies £0.315m above plan (£0.031m below plan ytd)

·         Other Costs £1.645m below plan (£4.993m below plan ytd)

EBITDA

5.3% YTD

Savings

Savings plan of £14.052m of which £12.454m identified

 

£1.278m Cost Improvement Plans (CIPS) delivered in month against a plan of £1.289m

 

£6.231m delivered against a plan of £7.286m ytd (£1.055m below plan)

 

Forecast

Forecast had deteriorated in month prior to any recovery or mitigation actions. After the application of £1.27m recovery actions and £1.9m of mitigations and recovery actions, the forecast was a £6,824k deficit which was £1.864m below the plan deficit of £4.96m. In addition there were approximately £700k risks to the forecast that could result in a £7,460k deficit which was £2,500 worse than the Control Total

Debtors

£37.5m debtors and stock

£7.0m above plan

Creditors

£61.8m creditors and borrowings

£4.3m above plan

Cash

£2.9m

£1.1m above plan

Loan

No repayment made in month

Finance Risk Ratings

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

 

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

 

National overview

KJ commented that the NHS as a whole was struggling financially.  KJ reported that the national financial position which included acute, specialist and community was forecasting a large deficit with many Trusts swinging out on their forecast position. Nationally there was £2.2billion overspend against a planned deficit of £1billion.

 

Financial position

KJ reported that as at month 7 there was a slightly improved financial position.  However, pay costs had increased.  A shift between permanent and agency spend was being seen but not at the right level.

 

It was noted that the financial impact of the junior doctor contracts negotiated earlier in the year was now being seen.  OF highlighted that the Trust had not been awarded any extra funding as the view was that the new contracts would be cost neutral but this was not the case.

 

Cost Improvement Plans (CIPs)

It was noted that the fortnightly Transformation Board meetings continued where CIP identification and delivery was scrutinised and challenged.

 

Cash

KJ emphasised that cash was the main concern.  KJ was  ...  view the full minutes text for item 275.

276.

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 were as follows: -

 

·         Most recent Hospital Standardised Mortality Rate (HSMR) - 96.67 (12 month period July 2016 to June 2017)

·         There was 1 case of Clostridium difficile during October, the current rate was 11.49 per 100,000 bed days year to date.

·         3 Serious Incidents were reported during October 2017.

·         There were 550 overdue investigations into incidents (by more than 14 days).

·         No Freedom to speak up alerts were received during October.

 

Hospital Standardised Mortality Rate (HSMR)

GR reported that the HSMR was being maintained below 100 which was good.

 

Infection Prevention and Control

GR advised that the Trust had one Clostridium Difficile case above trajectory. 11 cases had been reported to date, with 6 of those being deemed unavoidable, 1 avoidable and the others awaiting decision.

 

Patient safety indicators

AC sought clarification around the RAG rating of the patient safety indicators. GR responded that for some indicators the number observed was very low and that the Trust was not an outlier.  In response to a question on what would lead to a Red RAG rating it was commented that usually this would be more than two standard deviations and the Trust would receive an alert.

 

AC questioned whether there could be concerns which might not flag. GR responded that this was why Dr Foster’s independent alerts had been introduced. A national methodology applied.  AC commented that he would like to understand this better and GR undertook to talk to AC outside of the meeting to provide further information on the trigger of alerts.

 

Clinical Audits

AC questioned the reason why a number of clinical audits were delayed commenting that it was important to participate in the national audits highlighting the falls and fragility audit as important.

 

HW advised that for some audits listed, the start might have been delayed due to capacity or competing priorities but that the audit was underway.  GR advised that the Trust had a track record of compliance with national audits and that each year there were a number with delayed starts but they were completed. 

 

Quality considerations

HW highlighted that the report set out details of where quality of care was being compromised, notably care was being provided for some patients in an environment not designed for care. Cleaning was an area for close attention to ensure that standards were maintained.  HW advised that one ward had been closed due to norovirus.

 

It was noted that clinical teams were spending more time on direct clinical care because of the additional patients and therefore staff were choosing to prioritise their work with a focus on patient safety and care.  As such some administrative duties were being delayed such as responding to complaints and carry out incident investigations in a timely way.  Focus was on those incidents which had resulted in harm. HW highlighted that over the last  ...  view the full minutes text for item 276.

277.

Operational Performance Report pdf icon PDF 273 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: -

 

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

 

October 88.1% (not achieved)

Referral to Treatment +Incomplete standard (92%)

October 90.2% (not achieved)

6 Week Diagnostic Wait

October 96.8% (not achieved)

Cancer Targets

2 week waits (93%)

2 week wait breast symptomatic (93%)

31 day treatment (96%)

62 day treatment (85%)

October Achieved

95.8%

97.3%

98.3%

85.7%

 

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

 

Emergency Department (ED) performance

JO advised that performance against the 4 hour access target was not achieved due to first assessment breaches and bed availability.  The availability of beds was the key issue to address and there was a focus on medically fit for discharge (MFFD) patients.  JO advised that data suggested that approximately 90 MFFD patients occupied acute beds at any given time and these patients accounted for approximately 600 lost bed days.  Meetings between partners were taking place three times a week to ensure movement of these patients.  There were some improvements with the position at 69 MFFD patients equating to 359 lost bed days last week.  

 

JO advised that ECIP was supporting ED.  ECIP had undertaken a two day walk through of ED and had provided feedback on the tightening up of processes.  The Trust would continue to work with ECIP to deliver improvements.  In response to a question about the scope of ECIPs work, NV advised that ECIP would be supporting the Trust throughout the winter, focussing on length of stay, rehabilitation and best use of SWICC.   ECIP was providing targeted intervention to support ED with a lot of focus on frailty and elderly care.

 

JO advised that there was additional national funding for the NHS and the Trust had submitted a bid for a range of options focussed on liberating beds and finding solutions for those patients blocking beds.  In response to a question from JM, it was noted that the outcome of the bid application would be known in mid-December at which point detail would be shared with the wider Board.

 

Referral to Treatment Times (RTT)

JO advised that performance remained above 90% which whilst below the standard, was at a level deemed acceptable by the Trust given the need to balance priorities namely cancer performance, ED performance and financial control.  Recovery proposals were being developed and in response to a comment from JS around Non-Executive Director oversight, it was noted that these would be reported through the Performance, People and Place Committee.

 

Cancer

JO reminded the Board that there were improved processes and systems in place.  Performance had continued to recover but remained challenged due to reliance on tertiary centres and volumes and complexity of patients.   A comprehensive plan was being developed which would show pinch points in the  ...  view the full minutes text for item 277.

278.

Ratification of Decisions made via Board Circular/Board Workshop

Carole Nicholl, Director of Governance & Assurance

Minutes:

None.

279.

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.

280.

Date and Time of next meeting

Date: 4 January 2018

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 4 January 2018 at 9:30am in Trust Management Boardrooms, Trust HQ, 2nd Floor, Great Western Hospital.

281.

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)

·        Forecast Outturn

·        NHSI Cash Drawdown Request

·        PFI – Deloitte Review

·        Emergency Department Performance update

·        Wiltshire Health & Care update

·        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 (Private)

·         Forecast Outturn

·         NHSI Cash Drawdown Request

·         PFI – Deloitte Review

·         Emergency Department Performance update

·         Wiltshire Health & Care update

·         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)

282.

Minutes

Roger Hill, Chairman

·        2 November 2017 (private)

Minutes:

The minutes of the meeting of the Board held in private on 2 November 2017 were adopted and signed as a correct record subject to amendments.

283.

Outstanding Actions of the Board (Private)

Minutes:

The Board received and considered the outstanding actions list. 

284.

Forecast Outturn

Karen Johnson, Director of Finance

Minutes:

The Board received and considered a report which provided an explanation of the month 7 financial position and the movement in year-end forecast between month 6 and month 7.

285.

Cash Drawdown

Karen Johnson, Director of Finance

Minutes:

This Board considered a report that provided an overview of a submission to NHS Improvement.  The Board noted the report.

286.

PFI

Karen Johnson, Director of Finance

Minutes:

The Board considered a report on the PFI.

287.

Emergency Department Performance

Jim O’Connell, Chief Operating Officer

Minutes:

The Board received a verbal update on ED performance.

288.

Wiltshire Health & Care - update

Carole Nicholl, Director of Governance & Assurance

Minutes:

The Board received and considered a report which provided an update on key topics discussed at the recent Wiltshire Health and Care (WH&C) Board meeting.

289.

Audit, Risk and Assurance Committee

Julie Soutter – Committee Chair

·        16 November 2017 (verbal report)

·        14 September 2017 (enclosure)

Minutes:

The minutes of the meeting of the Audit, Risk and Assurance Committee held on 14 September 2017 were received.  Furthermore, it was noted that a meeting of the Audit, Risk and Assurance Committee had been held on 16 November 2017.

290.

Executive Committee

Nerissa Vaughan – Committee Chair

·        21 November 2017 (verbal report)

·        17 October 2017 (enclosure)

Minutes:

The minutes of the meeting of the Executive Committee held on 17 October 2017 were received.  Furthermore, it was noted that a meeting of the Executive Committee had been held on 21 November 2017.

291.

Finance and Investment Committee

Steve Nowell – Committee Chair

·        27 November 2017 (verbal report)

·        23 October 2017 (enclosure)

Minutes:

The minutes of the meeting of the Finance and Investment Committee held on 23 October 2017 were received.  Furthermore, it was noted that a meeting of the Finance and Investment Committee had been held on 27 November 2017.

292.

Performance, People & Place Committee

Steve Nowell – Committee Chair

·        29 November 2017 (verbal report)

·        25 October 2017 (enclosure)

Minutes:

The minutes of the meeting of the Performance, People & Place Committee held on 25 October 2017 were received.  Furthermore, it was noted that a meeting of the Performance, People & Place Committee had been held on 29 November 2017.

293.

Quality and Governance Committee

Nick Bishop - Committee Chair

·        23 November 2017 (verbal report)

·        19 October 2017 (enclosure)

Minutes:

The minutes of the meeting of the Quality & Governance Committee held on 19 October 2017 were received.  Furthermore, it was noted that a meeting of the Quality & Governance Committee had been held on 23 November 2017.

294.

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.