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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

331.

Apologies for Absence and Chairman's Welcome

Minutes:

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

332.

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.

333.

Minutes pdf icon PDF 369 KB

Roger Hill, Chairman

·         4 January 2018 (public)

Minutes:

The minutes of the meeting of the Board held on 4 January 2018 were adopted and signed as a correct record subject to the following amendment

 

Minute 308/17 Operational Performance Report – Deletion of the words “ it was across the national papers that operations were cancelled” and the substitution thereof with the words “operations were being cancelled nationally”.

334.

Outstanding actions of the Board (public) pdf icon PDF 361 KB

Minutes:

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

 

119/17

Quality Report – Mortality alerts

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

 

241/17

OPR – DNA Community Services

It was reported that a Head of Podiatry had now been appointed and this would be an area for attention.  It was agreed that this action be removed from the tracker noting that this would be covered off in the Operational Report.

276/17

Quality Indicators

 

It was noted that GR and AC had discussed the quality indicators and AC had been invited to attend the Mortality Group to observe Dr Foster in practice.

It was agreed that this action had been completed.

 

277/17

Theatres – oral surgery presentation

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

 

277/17

Theatres – productivity

OF reported that the staffing costs were correct and that the reason why the Trust’s cost were less per session against peer group and nationally was because the Trust had a leaner skills mix.  It was agreed that the action had been completed.

 

277/17

SWICC – visit by Non-Executive Directors

It was noted that there was a site visit to SWICC for Non-Executive Directors after the Board meeting and therefore this action had been completed.

 

308/17

OPR – DNAs public communication

It was reported that there had been additional public communication about attending appointments and therefore this action had been completed.

 

308/17

Staff hard work

It was reported that JO had passed on the Board’s thanks to staff for their hard work and therefore this action had been completed.

 

 

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

335.

Finance Report pdf icon PDF 242 KB

Karen Johnson, Director of Finance

Additional documents:

Minutes:

The Board received and considered a report on finance for month 9, together with a presentation as follows: -

 

Actual Operating costs

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

There was an in month deficit of £3,548k (year to date (ytd) deficit of £7,562k compared to target deficit of £2,984k).

NHS Clinical Income

£20.3m in month and £202m ytd (£0.08m below plan YTD)

Total Income

£25.2m in month and £247.1m ytd (£3.1m 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

 

£26.8m in month and £237.3m ytd (£1.2m above plan ytd)

Expenditure highlights in month:

·         Drugs £0.423m above plan (£1.9m above plan ytd)

·         Pay £0.519m above plan (£5.1m above plan ytd)

·         Supplies £0.437m above plan (£0.9m above plan ytd)

·         Other Costs £0.466m below plan (£6.7m below plan ytd)

EBITDA

4% ytd against a plan of 5.6%

Savings

Savings plan of £14.052m of which £12.75m identified

£1.082m Cost Improvement Plans (CIPS) delivered in month against a plan of £1.29m.

£8.3m delivered against a plan of £9.9m ytd (£1.6m below plan)

Forecast

Forecast had deteriorated in month prior to any mitigation actions. After the application of £0.4m of mitigations, the forecast was a £11.416m deficit which was £6.456m below the plan deficit of £4.96m.

Debtors

£30.8m debtors and stock

£0.4m above plan

Creditors

£55.4m creditors and borrowings

£5.6m below plan

Cash

£6.1m

£1.1m below plan

Loan

No Loan repayment in month

Finance Risk Ratings

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

 

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

 

KJ highlighted that there had been a significant swing in month with the financial position deteriorating.  A number of risks had materialised including additional costs associated with extreme escalation and a reduction in income due to the cancellation of elective activity. Activity was considerably lower in elective due to the cancellation of non-urgent appointment as per Regulator instructions.  KJ reported that the year-end end forecast had swung out against plan by £6.5m.

 

KJ reported that she was having contractual discussions with commissioners around a year end settlement.  The year to date position had been adjusted to assume the contract for Swindon reverted back to PbR which had had a £1.125k impact on income.

 

KJ advised that she had been in discussion with NHSI regarding the forecast outturn and the Trust had advised NHSI that the control total would not be achieved.  KJ advised that it the Trust failed to hit the control total, funding expected for this would be returned to a national pool which would be distributed to those Trusts which had achieved their control total.

 

It was noted that NHSI had concerns regarding the Trust’s financial position but that there were many Trusts nationally in a similar or worse  ...  view the full minutes text for item 335.

336.

Quality Report pdf icon PDF 230 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 December 2017 were as follows: -

 

  • The Hospital Standardised Mortality Rate (HSMR)HSMR figure for September 2016 to August 2017 was 98.9
  • 3 cases of Clostridium difficile were reported during December 2017, the CDI rate year to date was 9.19 per 100,000 bed days against a target of 9.4 per 100,000 bed days.
  • 1 Serious Incident was reported during December 2017.
  • There had been an increase in overdue clinical incident investigations during December 2017.
  • A decrease in complaints was seen during December 2017

 

Hospital Standardised Mortality Rate (HSMR) – GR reported that the mortality figures were the same as previously reported as an updated from Dr Foster had yet to be received.

 

Infection Prevention and Control – The Trust was broadly within Clostridium difficile levels and the majority of cases were not avoidable or attributable to the Trust.

 

GR referred to influenza, commenting that the Trust was still seeing steady numbers of cases.  GR referred to the fantastic Team efforts to manage cases by both front line and back line staff.  GR reported that there were many staff working extra shifts to ensure cover and to carry out tests.  The Trust was providing more rapid testing than some of the teaching hospitals in London.  This had contributed to the prompt isolation of patients.  GR recorded his thanks to everyone concerned for their hard work.

 

Cleaning Standards – HW advised that matrons were focused on the cleanliness of wards. The nurse cared for patient equipment audit showed improvement except on Jupiter Ward.  A matron had been tasked with looking at this to consider improvements, noting that for three months the audit scores had been below where they should be.  Notwithstanding this, there had been no cases of infection within that ward.

 

Serious Incicents – HW reported that there was a hospital acquired Category IV pressure ulcer in SwICC.  This was a disappointing dip in an otherwise good track record around preventing pressure ulcers.  The case was being investigated.

 

HW referred to the delays in investigations into clinical incidents commenting that priority was being given to those where there had been harm.  HW reported that Teams were advising that they were prioritising patient care and therefore were not able to investigate cases in a timely way.

 

HW reported that within Maternity Services there had been 8 incidents, 3 of which fell within national reporting requirments to “Mbrace” and “Each Baby Counts”.  Appropriate investigations were underway but to date there were no indications of poor practice.

 

Complaints – HW reported that there had been one complaint response which the complainant had felt was insulting.  This case served to illustrate the importance of contacting the complainant to avoid misinterpretation. HW advised that the complaint was being addressed and she was confident that it would be resolved.

 

The Board noted the innovative method to seek patient feedback  ...  view the full minutes text for item 336.

337.

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: -

 

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

 

December 81.5% (Not Achieved)

Referral to Treatment +Incomplete standard (92%)

November 90.2% (Not Achieved)

6 Week Diagnostic Wait (99%)

November 96.5% (Not Achieved)

Cancer Targets

2 Week Waits (93%)

2 Week Waits Breast Symptomatic (83%)

31 Day Treatment (96%)

62 Day Treatment (85%)

November

94.7% Achieved

91.7% Not Achieved

99.2% Achieved

83.8% Achieved

 

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

 

Referral to Treatment Times (RTT) - JO advised that since writing the report there had been deterioration in RTT as a result of responding to dictat to cancel elective activity.  AN RTT Recovery Plan was in place.

 

6 Week Diagnostic Wait - JO advised that NHSI had indicated that it was acceptable to maintain performance around 95%.

 

Cancer - JO commented that the 2 week wait (breast symptomatic) performance was disappointing but this had been due to patient choice.  A piece of work was underway to look at the pathway and patient choice options at points in that pathway.

 

JO referred to the significant amount of work undertaken to improve cancer performance. The Trust had some tertiary referrals and therefore achieving percentage targets was challenging.

 

Emergency Department 4 Hour Access Target – JO advised that the Trust was failing the ED 4 hour target.  JO acknowledged the amount of additional work around flu and commended the Teams for their hard work around additional testing and isolation of patients. JO advised that there was relatively little impact on flow but side rooms were needed for isolating patients.

 

Stroke Performance – JO reported that stroke performance was below required levels. A report was due to be considered by the Performance, People and Place Committee in February to understand the issues and planned actions for improvement. It was noted that a performance notice had been received from the Clinical Commissioning Group.

 

JO advised that there were about 45 strokes cases per month but that these were often in surges rather than spread across the period. It was noted that a representative of the Stroke Team attended the site meeting each day and that there was a focus on individual cases.  Data was being collected each week which would inform improved decision making around stroke patients.

 

NLB commented that there was national evidence which suggest that patient on a stroke unit were more likely to have a better outcome because of the concentration of the right expertise in one place. NLB referred to ring fencing bed and question whether the Trust had looked at using the Outreach Team.  JO commented that looking at rising fencing beds would form part of the improvement plan. JO advised that stroke patients came from all areas of the hospital  ...  view the full minutes text for item 337.

338.

Membership of Committees pdf icon PDF 100 KB

Carole Nicholl, Director of Governance & Assurance

Additional documents:

Minutes:

The Board considered a report which sought amendment to the membership of Board Committees.

 

RESOLVED

 

that the amended membership of Committees be approved as appended to the report.

339.

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.

340.

Date and Time of next meeting

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

341.

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.”

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.

342.

Minutes

Roger Hill, Chairman

·        4 January 2018 (private)

343.

Outstanding Actions of the Board (Private)

344.

Monthly Review

Roger Hill, Chairman to lead discussion

345.

Carillion Update

Kevin McNamara, Director of Strategy

346.

Ratification of Decisions made via Board Circular/Board Workshop

Carole Nicholl, Director of Governance & Assurance

 

The Board is asked to ratify decisions made via Board Circulars attached relating to

1.      Loan Agreement

2.      Board Assurance Statement

347.

Audit, Risk and Assurance Committee

Julie Soutter – Committee Chair

·        18 January 2018 (verbal report)

·        16 November 2017 (enclosure)

348.

Executive Committee

Nerissa Vaughan – Committee Chair

·        16 January 2018 (verbal report)

·        19 December 2017 (enclosure)

349.

Finance and Investment Committee

Steve Nowell – Committee Chair

·        22 January 2018 (verbal report)

·        22 December 2017 (enclosure)

350.

Mental Health Governance Committee

Nick Bishop – Committee Chair

·        5 January 2018 (enclosure)

351.

Performance, People & Place Committee

Peter Hill – Committee Chair

·        24 January 2018 (verbal report)

·        20 December 2017 (enclosure)

352.

Quality & Governance Committee

Nick Bishop - Committee Chair

·        18 January 2018 (verbal paper)

·        21 December 2017 (enclosure)

353.

Urgent Business (Private) (if any)

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