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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

1.

Apologies for Absence and Chairman's Welcome

Minutes:

Apologies for absence were received from Paul Lewis.

2.

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.

3.

Questions from the public to the Board relating to the work of the Trust pdf icon PDF 130 KB

Minutes:

The Board noted eleven questions from members of the public as set out in the report relating to the following matters: -

·         Carillions workers

·         Zimmer frames

·         External consultancy spend

·         Hearing loops

·         Smoking at GWH

·         Fees from non-EU migrants

·         Continuation of services during adverse weather

·         Nerve gas plans

·         Discrimination of women notably in relation to pay

·         GIRFT Ophthalmology

·         Hold File Ophthalmology

 

Responses where available were noted.  Directors commented on the timeliness of responding to questions and CN agreed to chase these with the relevant leads.

 

RESOLVED

 

that the questions and responses be received noting that these would be reported to the Council of Governors later in the month.

4.

Minutes pdf icon PDF 426 KB

Roger Hill, Chairman

·        1 March 2018 (public and summary of private minutes)

Minutes:

The minutes of the meeting of the Board held on 1 March 2018 were adopted and signed as a correct record, subject to the following amendments: -

 

Minute 360/17 Chief Executives Report - the deletion of the words “core clamping” in the fourth paragraph and the substitution thereof with the word “cord clamping”.

 

Minute 364/17 Quality Report - the deletion of the words “any new processed” in the penultimate paragraph and the substitution thereof with the words “any new processes”.

 

Minute 367/17 Chair of Performance, People & Place Committee Overview - the deletion of the ultimate paragraph before the resolution.

5.

Outstanding actions of the Board (public) pdf icon PDF 339 KB

Minutes:

The Board received and considered the outstanding action list. 

6.

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 11 together with a presentation as follows: -

 

Actual Operating costs

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

In month deficit of £1,099k. Year to date (YTD) deficit of £10,282k compared to target deficit of £4,272k.

NHS Clinical Income

£22.6m in month and £247.2m YTD (£1.9m above plan YTD)

Total Income

£27.7m in month and £303.0m 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

£26.9m in month and £292.1m YTD (£4.6m above plan YTD)

Expenditure highlights in month:

·         Drugs £0.26m above plan (£2.83m above plan YTD)

·         Pay £1.32m above plan (£7.89m above plan YTD)

·         Supplies £0.03m above plan (£1.1m above plan YTD)

·         Other Costs £0.29m above plan (£7.20m below plan YTD)

EBITDA

3.6% YTD against a plan of 5.4%

Savings

Savings plan of £14.052m of which £12.891m identified

£0.906m CIPS delivered in month against a plan of £1.390m.

£9.935m delivered against a plan of £12.661m YTD (£2.726m below plan)

Forecast

Forecast had not changed in month and was a £11.416m deficit which is £6.456m below the plan deficit of £4.96m.

Debtors

£31.1m debtors and stock

£0.9m above plan

Creditors

£54.8m creditors and borrowings

£4.4m below plan

Cash

£7.1m

£3.6m above plan

Loan

No loan finance received in month

Finance Risk Ratings

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

 

The Board noted that the Finance report has been considered in detail at the Finance and Investment Committee.

 

KJ reported that negotiations with commissioners had now been concluded.  The closing down of accounts was underway and the outturn position was forecast at £11.4m deficit.

KJ advised that the pressure to drive savings and keep down expenditure continued and site communication had been issued to all staff about the financial position.  KJ emphasised that is was essential that financial controls remained in place.

 

KJ reminded the Board that it had been necessary to borrow £6m to ensure cash flow.  Funds had now been received ensure creditors and staff would be paid.

 

RH asked what had been the impact from the decision nationally to cancel all non-urgent elective operations.  KJ responded this was circa £800k, but the Trust had gained in non-elective activity income albeit this was at 70% of tariff.  KJ commented that those non-urgent patients were now delayed in the system and would still require their treatment.  KJ advised that the cost of escalation during the winter months was significantly higher.

 

JO advised that a recovery plan for elective work was in place but there was now a national drive to keep referral to treatment times at the same rate as the end of March position.

 

RESOLVED

 

(a)   that it be agreed that the Month 11 financial position is a  ...  view the full minutes text for item 6.

7.

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. Key quality issues for February 2018 were as follows:

 

·         The rolling 12 month Hospital Standardised Mortality Rate (HSMR) for December 2016 to November 2017 was 96.94.

·         3 cases of Clostridium difficile (CDI) were reported during February 2018, the CDI rate year to date was 11.82 per 100,000 bed days against a target of 9.4 per 100,000 bed days.

·         2 Serious Incidents were reported during February 2018.

·         Quarter 3 update for Safeguarding Adults at Risk had identified that a total of 74 alerts were raised by the Trust, a total of 9 alerts were raised by the Trust against other providers and a total of 6 alerts were raised against the Trust from external agencies.

·         Quarter 3 update for Safeguarding Children showed a level of 78% Trust wide compliance with Level 3 against a target of 80%.  Further work was being done by the Safeguarding children’s lead to identify the areas of lower compliance and to actively work with the Divisional Directors of Nursing and Associate Medical Directors to ensure all staff had been correctly allocated the right level of training required.

 

Hospital Standardised Mortality Rate (HSMR) – It was noted that the HSMR remained below 100 which was good.

 

Mortality Reviews

A copy of an additional paper was circulated at the meeting which showed the

Learning from death, mortality reviews for quarter 3 (October – December 2017) as follows: -

 

Number of deaths in their care

332

Number of those deaths subject to case record review

71

Number of deaths investigated under the serious incident framework and declared as serious incidents

1

Number of deaths that were reviewed and considered more likely than not to be due to problems in care

0 (none)

Number of deaths of people with learning disabilities

0 (none)

Number of deaths of people with learning disabilities that have been reviewed

n/a

Number of deaths of people with learning disabilities considered more likely than not to be due to problems in care

0 (none)

 

Infection Prevention and Control – GR advised that cases of Clostridium difficile had been reported in February which was most likely associated with the greater use of antibiotics.

PH was joined by other members of the Board in congratulating staff for the low infection rates which given the site pressures was commendable.

 

Medicines incidents – It was noted that the Trust was performing very well for the percentage of patients experiencing omissions of critical medicines.

 

Cleaning Standards – HW advised that the overall cleaning score for the Trust during February was 99%.  There would be a close watch on this with the handover of soft facilities management to a new service provider.

 

Overdue Incident investigations – HW advised that there was work underway to look at how managers could be better supported to close down cases which did not require investigation.  It was commented that an IT solution was being  ...  view the full minutes text for item 7.

8.

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: -

 

Achieved

Cancer Targets

·         2WW (all cancer) 93.6% (Jan) against 93% target

·         31 day (Decision To Treat to Treatment).   Wait for first treatment: All Cancers 98.2% (Jan) against 96% target

·         31 Day Wait for Second Or Subsequent Treatment: Anti-Cancer Drug Treatments 100% (Jan) against 98% target

·         31 Day Wait for Second Or Subsequent Treatment: Surgery 100% (Jan) against 94% target

·         62 Day Wait for First Treatment From Consultant Screening Service Referral: All Cancers 100% (Jan) against 90% target

Stroke

·         Stroke: Brain Imaging 53.06% (Feb) against 50% target

 

Under achieving

·         Emergency Department D 4-hours 88.9% (Feb) (85% trajectory agreed with NHSI)

·         62 day (Urgent GP Referral to Treatment) Wait for First Treatment: All Cancers 83.8% (Jan) against 85% target to patient choice & clinic capacity.

 

Failing

·         2WW Breast Symptomatic 84.2% (Jan) (93% target ) – 23 breast symptomatic breaches due to post Christmas Out Patient Clinic capacity and patient availability issues

·         18-week Referral to Treatment Time (RTT) 87.53% Jan (below 90% trajectory agreed with NHSI)

·         Stroke: Direct Admission 75% (Feb) against 90% target.  Direct Admission within 4 hours 39.6% (Feb) against 90% target. Stroke Unit – Length of spell 56% (Feb) against 90% target.  Stroke Unit – Length of spell (GWH + rehab) 65.85% (Feb) against 80% target, Thrombolysis 83.02 (Feb) against 90% target.

·         6 Week Diagnostics (DM01) – 92.3% (Jan) (95% Trajectory agreed with NHSI)

·         Last-minute Cancelled Operations 1.1% against 0.8% target

 

 

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

 

Emergency Department 4 hour access performance

JO commented that overall performance was satisfactory.

 

Referral to Treatment Times (RTT)

Performance has seen deterioration due to the cancellation of non-urgent electives. It was noted that a RTT Recovery Plan had been considered by the Executive Committee and discussed at the Performance, People and Place Committee in March.  The intention was to achieve recovery to 90% in the first instance with waiting list initiatives and outsourcing agreed. JO advised that further demand and capacity planning was needed.

 

DM01 Diagnostic Waits

JO advised that this was challenging and that further discussions were needed with commissioners about this.  Breaches had occurred due to lack of capacity, notably in Radiology.

 

Cancer performance

JO commented that overall progress had been made to recover performance.  JO advised that there were very small numbers of patients which therefore had a significant impact of performance reporting in percentages.

 

Stroke

JO reported that there were some early signs of improvement.  New measures had put in place notably around recording patients and ensuring they were located on the stroke ward. 

 

In response to a question from NLB about confidence in achieving the stroke performance trajectories, JO explained that at this stage the trajectories were estimates and that performance would be monitored each month.  However, JO advised that processes were being put in place to support  ...  view the full minutes text for item 8.

9.

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.

10.

Date and Time of next meeting

Date: 3 May 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 3 May 2018 at 9:30am in Trust Management Boardrooms, Trust HQ, 2nd Floor, Great Western Hospital

11.

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.

12.

Minutes

Roger Hill, Chairman

·        1 March 2018 (private)

13.

Outstanding Actions of the Board (Private)

14.

Monthly review of issues - Chairman to lead discussion

15.

Operational Plan Refresh 2018/19

Kevin McNamara, Director of Strategy

16.

Final Budget 2018/19

Karen Johnson, Director of Finance

17.

Emergency Department Performance - verbal

Jim O’Connell, Chief Operating Officer

18.

Wiltshire Health & Care - verbal update

Kevin McNamara, Director of Strategy and Community Services

19.

Ratification of Decisions made via Board Circular/Board Workshop

Carole Nicholl, Director of Governance & Assurance

20.

Audit, Risk and Assurance Committee

Andy Copestake – Committee Chair (in Julie Soutter’s absence at the March meeting)

·        15 March 2018 (verbal report)

·        18 January 2018 (enclosure)

21.

Charitable Funds Committee

Jemima Milton – Committee Chair

·        8 February 2018 (enclosure)

22.

Executive Committee

Nerissa Vaughan – Committee Chair

·        20 March 2018 (verbal report)

·        13 February 2018 (enclosure)

23.

Finance and Investment Committee

Steve Nowell – Committee Chair

·        26 March 2018 (verbal report)

·        19 February 2018 (enclosure)

24.

Performance, People & Place Committee

Peter Hill – Committee Chair

·        28 March 2018 (verbal report)

·        21 February 2018 (enclosure)

25.

Quality & Governance Committee

Nick Bishop - Committee Chair

·        22 March 2018 (verbal report)

·        15 February 2018 (enclosure)

26.

Urgent Business (Private) (if any)

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