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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

295.

Apologies for Absence and Chairman's Welcome

Minutes:

Apologies for absence were received from Steve Nowell.

296.

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.

297.

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

Minutes:

There were no questions from members of the public.

298.

Minutes pdf icon PDF 402 KB

Roger Hill, Chairman

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

Minutes:

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

 

The deletion of Adrian Griffiths (AG) in the list of members present and the substitution thereof with Jim O’Connell (JO).

299.

Outstanding actions of the Board (public) pdf icon PDF 420 KB

Minutes:

The Board received and considered the outstanding actions list.  The Board noted updates as recorded on the tracker and agreed that completed actions be removed.

300.

Chairman's Report, Feedback from the Council of Governors

Roger Hill, Chairman

Minutes:

The Chairman gave a verbal report as follows: -

 

Non-Executive Director Re-appointment - The Chairman was pleased to advise that Julie Soutter had been re-appointed as a Non-Executive Director and the Deputy Chair for a further 3 year term.

 

Reference to the Board from Governors - At the Governors’ Patient Quality and Operational Performance Working Group governors had received the answer to a question around bedside notifications and had asked that further information be sought.  The Chairman invited the Quality and Governance Committee to consider this matter on behalf of the Board and report back to the governors.

 

Lead Governors - The Chairman was delighted to advise that Roger Stroud and Pauline Cooke had been appointed Lead and Deputy Lead Governors respectively.  The Chairman was joined by all members of the Board in expressing thanks to Margaret White for her hard work as Lead Governor over the last couple of years.

 

RESOLVED

 

that the report of the Chairman be received.

301.

Chief Executive's Report pdf icon PDF 183 KB

Nerissa Vaughan, Chief Executive

Minutes:

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

 

1.     Brighter Futures’ Radiotherapy Appeal had reached £2 million milestone

2.     Secretary of State visited GWH

3.     Staff showed commitment during adverse weather

4.     Care for hip fracture patients improved

5.     New senior responsible officer for STP

6.     Norovirus at GWH

 

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

 

Radiotherapy Appeal – NV was delighted to report that more than £2 million had been raised for the appeal which was a fantastic achievement.  NV expressed her gratitude to the people of Swindon who had contributed towards the funds, noting that the £2 million was from local people and not major donors.  NV referred to the media coverage for the appeal from The Advertiser which had raised local awareness and support.  NV was joined by members of the Board in expressing gratitude for the support.

 

Secretary of State Visit – It was noted that the Secretary of State for Health had visited the Trust.  NV thanked Guy Rooney, the Medical Director for his excellent presentation on patient safety.

 

Staffing commitment during adverse weather – It was noted that during the recent bad weather staff had shown their commitment to providing care and there were many instances of staff covering shifts, offering lifts and providing overnight beds for colleagues.  NV was joined by members of the Board in thanking staff generally and especially those staff who had worked over Christmas.

 

Additional Winter Money - Further to the report, NV advised that the Trust had received confirmation of additional money for winter pressures totalling £1.4m split into 3 categories namely buying nursing home beds; additional staff to support the front door; and increased resilience 7 days per week, the details of which were being worked through.  It was noted that there would be additional expenditure on agency and that the Trust was already an outlier for agency spend.  OF commented that the agency spend for escalation would be separated out to allow clear oversight of agency spend.

 

In response to a question from RH, NV confirmed that the £1.4m was short term money for the winter.  PH commented that the biggest concern was expenditure on nursing home beds as any costs associated after 1 April 2018 would need to be met.

 

NV responded that Swindon Clinical Commissioning Group had commissioned beds until the end of April, but agreed that ongoing costs would need to be looked at.  NV explained that the criteria of patients to go into nursing home beds was being carefully considered to ensure that long term patient stays were avoided.

 

Norovirus – NV reported that norovirus was present in the hospital and that it was possible to isolate patients into side rooms.  However, members of the public, family and friends of patients were being encouraged not to visit the hospital if they had norovirus to avoid further infections.

 

RESOLVED

 

that the report of the Chief Executive be received.

302.

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 8, together with a presentation.

 

The report did not contain any data relating to Sustainability & Transformation Funding (STF) and represented the Trust Control Total only.  Furthermore, the report did not include any winter funds which needed to be added.

 

Actual Operating costs

In month deficit of £702k. Year to date (YTD) deficit of £4,014k compared to target deficit of £2,457k.

NHS Clinical Income

£23.4m in month and £181.8m YTD (£1.6m above plan YTD)

Total Income

£28.3m in month and £222.0m YTD (£1.0m below plan YTD)

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

·         Elective inpatients below plan

·         Day case activity below plan

·         Non-elective above plan

·         Outpatient appointments below plan

·         A&E below plan

Total Operating Expenditure

 

£27.1m in month and £210.5m YTD (£0.24m above plan YTD)

Expenditure highlights in month:

·         Drugs £0.439m above plan (£1.49m above plan YTD)

·         Pay £0.640m above plan (£4.592m above plan YTD)

·         Supplies £0.458m above plan (£0.428m above plan YTD)

·         Other Costs £1.284m below plan (£6.329m below plan YTD)

EBITDA

5.2% YTD against a plan of 5.7%

Savings

Savings plan of £14.052m of which £12.491m identified

£0.887m Cost Improvement Plans (CIPS) delivered in month against a plan of £1.309m.

£7.117m delivered against a plan of £8.595m YTD (£1.478m below plan)

Forecast

The forecast had deteriorated in month prior to any mitigation actions. After the application of £1.6m of mitigations, the forecast was a £7.784m deficit which was £2.824m below the plan deficit of £4.96m. In addition there were additional risks to the forecast that could result in a £8.460m to £8.960m deficit which was £3.5m - £4m worse than the Control Total. 

Since closing the month end position a further risk of up to £1.8m income could have a direct impact on the Trust’s year end position resulting in the worst case scenario of £1.8m variance from plan (£10.76m deficit).

Debtors

£32.7m debtors and stock

£2.3m above plan

Creditors

£61.2m creditors and borrowings

£2.1m above plan

Cash

£6.9m

£3.4m above plan

Loan

Loan repayment of £99k in month

Finance Risk Ratings

YTD Use of Resources (UoR) 4 (Rating 1- top and 4 - bottom).

 

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

 

Forecast

The Trust’s income had been reduced by about £1m mostly because of patient streaming.  KJ reported that she was having discussions with Swindon Clinical Commissioning Group (CCG) around an end of year block payment.  However, the CCG was seeing pressures within primary care and therefore a block payment was unlikely which was reflected in the forecast.  AC questioned whether there was anything that the Board could do to strengthen discussions with the CCG commenting that the revised streaming arrangements were right for patients.  AC questioned whether a Chair to Chair discussion might be helpful.  KJ advised that this was the way the national funding worked but that she would continue the discussions with the CCG as it was not unreasonable to seek financial support.

 

KJ explained  ...  view the full minutes text for item 302.

303.

Chair of Finance & Investment Committee Overview pdf icon PDF 163 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 27 November and 22 December 2017 which it was considered should be drawn to the attention of the Board covering the following: -

 

·         Overall financial performance

·         Cost Improvement Programme (CIP) overview

·         Draft budget

·         Divisional updates

·         Business planning

·         Managed services

 

RESOLVED

 

that the report be received.

304.

Risk Tolerance Statement - Annual Refresh pdf icon PDF 291 KB

Carole Nicholl, Director of Governance & Assurance

Minutes:

The Board considered a report that set out proposed changes to the Trust’s Risk Tolerance Statement. The revised statement reflected feedback from the Audit, Risk and Assurance Committee from its meeting held in November. The change proposed related to organisation risk in that the Trust now had a low risk appetite and a minimal tolerance for organisational risk and would only be prepared to accept the possibility of very limited financial loss if essential.  Value for money was a primary concern.

 

The Board discussed the rationale behind proposed levels of tolerance for risk relating to patients, the organisation, opportunities, compliance including legal requirements and reputation and agreed the change proposed.

 

RESOLVED

 

that the Risk Tolerance Statement be agreed as set out in the report.

 

305.

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 November 2017 were as follows: -

 

·         Most recent Hospital Standardised Mortality Rate (HSMR) was 98.9 (12 month period September 2016 to August 2017)

·         There were no cases of Clostridium difficile during November 2017 with a current rate of 9.4 per 100,000 bed days.

·         1 Serious Incident was reported during November 2017.

·         There had been a decrease in overdue clinical incident investigations during November 2017.

·         There was a slight increase in complaints in November 2017.

 

Hospital Standardised Mortality Rate (HSMR) 

HSMR remained below 100 but was expected to change when the data was next rebased. 

 

It was highlighted that the septicaemia diagnosis group was alerting again which was being investigated.  Previously coding and reporting as well as the way Dr Foster captured data had been the issue.  GR commented on the recording being undertaken by junior doctors which was being reviewed with Dr Foster.

 

GR reported that there was new guidance on learning from deaths which included publication requirements.  GR advised that the Trust’s focus was on the quality of mortality reviews with an emphasis on learning.   There was an aim to achieve 50% reviews.  GR reported that the good news was that the Trust was not reporting more than 50% avoidable deaths.   GR highlighted that the Trust would always be reporting a quarter late.

 

Infection Prevention and Control

GR was pleased to advise that there had been no cases of C.diff in November. GR advised that cases of norovirus, flu and influenza were being seen.

 

GR advised that the flu vaccination campaign had been successful but there were variations in the strain of flu and outbreaks had been seen nationally.

 

Operational pressures

HW referred to the operational pressures advising that the Patient Quality Committee had been cancelled in November due to the Trust’s OPEL 4 escalation status, which was the highest level that could be declared.  Membership of the Committee was comprised of senior clinical staff who were needed to provide direct patient care.  Cancellation had been mitigated by making sure key messages were sent via email.  HW anticipated that the meeting of the Committee next week would proceed.

 

Complaints, Concerns and Compliments

HW reported that the Patient Advice Liaison Service (PALS) and the Clinical Risk Team were supporting Divisions to continue investigation and learning from incidents and complaints. Complaint responses were being prioritised, such as those in maternity.

 

Safeguarding

The report included the 6 monthly update for adult safeguarding.  There was an increasing understanding of safeguarding requirements.  HW commented that there was variable compliance with mandatory training, but good compliance with level 2 adult safeguarding training.

 

National Audit of Inpatient Falls 2017

HW highlighted that there had been considerable improvement in results noting that the Trust was the only hospital in the South West to achieve 80-100% compliance in 4 key areas and the Trust had achieved above national average in  ...  view the full minutes text for item 305.

306.

Chair of Quality & Governance Committee Overview pdf icon PDF 186 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 23 November and 21 December 2017 covering the following: -

                                 

·         Quality Report

·         Emergency Department Quality Dashboard

·         Quality Strategy update

·         National Mortality Reviews and 500 Lives

·         Overdue follow up update

·         Stroke nation audit

·         Safeguarding adults update

·         Safer staffing monthly report

·         Swindon Community Health Services

·         Well Led Assurance Framework

·         Code of Governance overview

·         Provider Licence update

·         Corporate Governance Report

 

NLB highlighted the encouraging results from the National Audit of Inpatient Falls 2017 noting that the Trust was the only hospital in the South West to achieve 80-100% compliance in 4 key areas and the Trust had achieved above national average in 5 out of 7 key areas.

 

NLB also highlighted the campaign to save 500 lives and noted that observed mortality rates were better than the national average.

 

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.

307.

Quality Strategy Update pdf icon PDF 840 KB

Hilary Walker, Chief Nurse

Minutes:

The Board considered a report which provided an update on the progress over the past six months on the delivery of the key performance indicators of the Quality Strategy since April 2017.

 

Included in the report was detailed progress against key performance indicators (22 achieved, 8 partially achieved and 12 not achieved as intended).

 

In response to a question from RH, HW advised that given the site pressures, progress was satisfactory but it was disappointing that some indicators were not achieved.

 

RESOLVED

 

that the report be received and progress noted.

308.

Operational Performance Report pdf icon PDF 271 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))        

 

November 86.1% (not achieved)

Referral to Treatment Incomplete standard (92%)

November 90.2% (not achieved)

6 Week Diagnostic Wait

November 96.6% (not achieved)

Cancer Targets

2 week waits (93%)

2 week wait breast symptomatic (93%)

31 day treatment (96%)

62 day treatment (85%)

October Achieved

95.7%

97.3%

98.2%

85.8%

 

In advance of presenting the report, JO advised that the format and content of the report would be reviewed in consultation with CN, SN and PH.

 

Emergency Department (ED) Performance

JO reported that performance was above 80% which was in line with the region.  JO referred to the significant operational pressures each day commenting on the excellent work being undertaken by the staff teams to maintain patient safety.

 

JO reported that all escalation areas were open and the site pressures were being managed on a day to day basis.

 

JO reported that the ability to achieve the 4 hour performance standard was dependent on bed availability and that bed occupancy was an issue. 

 

JO referred to the volume of patients noting that it was challenging to cope with over 90 attendances in the Urgent Care Centre and yet there had been 120 plus patients. It had not been possible to get all the staff needed.  Notwithstanding this and the site pressures, performance was satisfactory compared to the national picture.

 

Referral to Treatment Times (RTT)

JO reminded the Board that RTT was not one of the three priorities set by NHS Improvement (NHSI) and as such there had been informal agreement that circa 90% performance would be acceptable.   JO highlighted that this would be challenging going forward dueto a recent direction from NHSI that routine elective cases should be cancelled during January. 

 

JO advised that day surgery would continue as far as possible, however the Recovery 2 area was being used as an escalation area and this could impact the Trust’ ability to carry out day cases.

 

JM advised that it was across the national papers that operations were cancelled.  NV explained that there were instructions issued nationally to cease elective cases during January and that it was important for the Trust to comply with the directive. NV commented that it was also critical to ensure that urgent, essential or cancer cases were treated.  HW advised that the reason for cancellation of routine elective work was to free up staff to support the winter pressures.

 

RH questioned communication to the public around cancellations.  NV responded that the message given was that if a patient did not hear from the Trust then they should attend as planned.   In response to a comment from JM, it was noted that further communication was being worked through.  

 

NLB commented that he  ...  view the full minutes text for item 308.

309.

Chair of Performance, People & Place Committee Overview pdf icon PDF 161 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 meetings held on 29 November and 20 December 2017 covering the following: -

 

·         Emergency Department Performance

·         Recovery Plans and reporting

·         Additional funding

·         Quality

·         Stroke performance

·         Referral to Treatment Times (RTT)

·         Theatre activity and utilisation performance

·         Cancer performance

·         Diagnostic Tests

·         Pharmacy

·         Swindon Community Services

·         Communications Strategy

·         Workforce

 

At this point in the meeting it was noted that Steve Nowell had stood down as Chair of this Committee and PH was joined by all Directors in commending Steve for his hard work in the role.

 

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.

310.

Nursing, Midwifery and Allied Health Professional - response to the Five Year Forward View pdf icon PDF 217 KB

Hilary Walker, Chief Nurse

Minutes:

The Board received and considered a paper which described the Nursing, Midwifery and Allied Health Professionals’ response to the five year forward view (NHSE 2014), Leading Change, Adding Value, a framework for nurses, midwives and care staff (NHSE 2016), Better Births, A Five Year Forward View for Maternity Services (2016) and the Trust Strategic Objectives.

 

HW reported that there had been focus on three key principles namely health and wellbeing; care and quality; and funding and efficiency, with some attention to some of the wider national workstreams. 

 

HW reminded Directors that the Quality and Governance Committee had received a detailed presentation from Maternity about their response to the guidance.  HW highlighted that there was scope for additional benefits for patients plus career development through workforce redesign, notably around the nursing associate role and the introduction of assistant practitioner posts.

 

In response to a question from RH, OF confirmed that the Trust had experienced difficulties in recruitment to Allied Health Professional posts.  Pay premium had been introduced, noting that neighbouring trusts paid at a higher rate. It was noted that a Head of Podiatry had been recruited into the community and that this appointment would attract more staff.

 

JS questioned how staff feedback had fed into the recruitment process.  OF confirmed that staff feedback had been captured and considered and that NHS Improvement had offered lots of support around recruitment and retention.  HW advised that the Nursing Together Strategy was formulated with what staff had said.  HW commented that staff welcomed development opportunities and that the Allied Health Professionals had advised that they wanted a modular development approach.

 

RESOLVED

 

that the Strategy as set out in the report be supported for roll out across clinical areas and Divisions.

311.

Safer Staffing Bi-Monthly Exception Report pdf icon PDF 454 KB

Hilary Walker, Chief Nurse

Additional documents:

Minutes:

The Board received and considered the safer staffing bi-monthly exception report and noted that the actual versus planned nursing hours (fill rate) was as follows: -

 

November

Dayshift

Registered Nurses

91.2%

Care Staff

107.9%

Night shift

Registered Nurses

96.3%

Care Staff

112%

 

October

Dayshift

Registered Nurses

87.7%

Care Staff

105%

Night shift

Registered Nurses

95.6%

Care Staff

109.8%

 

HW advised that fill rates had improved, there was less reliance on closer support and that there were additional nursing staff in the organisation.  HW commented that there was a lack of clarity in terms of the overall denominator as this would go up if there were staff in areas where the Trust would not normally have patients.

 

The key nursing quality indicators were noted in the report, namely that whilst an increase in falls and hospital acquired pressure ulcers had been seen, average call bell response times had improved and there were no cases of acquired category 3 pressure ulcers and only one case of C.diff in October and none in November.

 

RESOLVED

 

that the report be noted.

312.

Membership of Committees pdf icon PDF 102 KB

Carole Nicholl, Director of Governance & Assurance

Additional documents:

Minutes:

The Board received a report which invited Directors to approve the membership of Committees and Non-Executive Director appointments, details of which were in a schedule appended to the report.

 

An amendment was noted to the schedule in that Peter Hill was to be a member of the Quality and Governance Committee but not a member of the Audit, Risk and Assurance Committee.

 

CN advised that she would ask the policy leads to contact the relevant Non-Executive Directors about the roles associated with the Non-Executive Director appointments referred to in the report.

 

RESOLVED

 

that the membership of meetings as set out in the appendix to the report as now amended be approved from 1 January 2018.

313.

Ratification of Decisions made via Board Circular/Board Workshop

Carole Nicholl, Director of Governance & Assurance

Minutes:

None.

314.

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.

315.

Date and Time of next meeting

Date: 1 February 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 1 February 2018 at 9:30am in Trust Management Boardrooms, Trust HQ, 2nd Floor, Great Western Hospital

316.

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)

·        Managed Equipment Service

·        Carillion

·        500 Lives

·        Guardian of Safe Working

·        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.

317.

Minutes

Roger Hill, Chairman

·        7 December 2017 (private)

318.

Outstanding Actions of the Board (Private)

319.

Managed Equipment Service - Imaging (MES)

Karen Johnson, Director of Finance

320.

Carillion Update - verbal

Kevin McNamara, Director of Strategy

321.

500 Lives Update

Guy Rooney, Medical Director

Mark Juniper, Quality Lead to present

322.

Guardian of Safe Working - 6 monthly update

Guy Rooney, Medical Director

323.

Emergency Department Performance - verbal

Jim O’Connell, Chief Operating Officer

324.

Charitable Funds Committee

Jemima Milton – Committee Chair

·        1 November 2017 (enclosure)

325.

Executive Committee

Nerissa Vaughan – Committee Chair

·        19 December 2017 (verbal report)

·        21 November 2017 (enclosure)

326.

Finance & Investment Committee

Steve Nowell – Committee Chair

·        22 December 2017 (written report)

·        27 November 2017 (enclosure)

327.

Performance, People & Place Committee

Steve Nowell – Committee Chair

·        20 December 2017 (written report)

·        29 November 2017 (enclosure)

328.

Quality & Governance Committee

Nick Bishop - Committee Chair

·        21 December 2017 (written report)

·        23 November 2017 (enclosure)

329.

Urgent Business (Private) (if any)

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

330.

Chair of Audit, Risk & Assurance Committee Overview pdf icon PDF 176 KB

Julie Soutter, Non-Executive Director

Minutes:

The Committee received a report from the Chair of the Audit, Risk & Assurance Committee which summarised key issues considered by that Committee at its meeting held on 16 November covering the following: -

                                 

·         Divisional risk register

·         15+ risk register / Board Assurance Framework

·         Risk Tolerance Statement

·         External Audit progress report

·         Internal Audit progress report

·         Counter Fraud

·         Combined costs collections

·         Budget setting process

·         Conflicts of interest

·         Losses and compensations

 

RESOLVED

 

that the report be received.