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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

64.

Apologies for Absence and Chairman's Welcome

Minutes:

Apologies for absence were received from Oonagh Fitzgerald.

65.

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.

66.

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

Minutes:

It was reported that there were two questions from members of the public received during May, details of which, including responses would be reported to the next meeting.

67.

Minutes pdf icon PDF 347 KB

Roger Hill, Chairman

·        3 May 2018 (public and summary of private minutes)

Minutes:

The minutes of the meeting of the Board held on 3 May 2018 were adopted and signed as a correct record.

 

68.

Outstanding actions of the Board (public) (to follow) pdf icon PDF 340 KB

Minutes:

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

 

366/17

Waiting Lists

It was noted that this information was included in the Operational Report and therefore this action was closed.

8/18

Patient Discharges

It was agreed that it was no longer relevant to receive an update on “5 days no delays” and therefore this action was closed.

 

8/18

CT scanning demand and capacity

JO reported that a deep dive was underway looking at CT scanning demand and capacity and this would be reported through the Performance, People and Place Committee.  It was agreed that this action be closed on the Board tracker.

 

 

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

69.

Finance Report pdf icon PDF 114 KB

Karen Johnson, Director of Finance

Additional documents:

Minutes:

The Board received and considered a report on finance for month 1, together with a presentation as follows: -

 

Actual Operating costs

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

In month deficit of £1,942k compared to a target deficit of £1,677k.

NHS Clinical Income

£22.2m in month (£0.1m below plan)

Total Income

£24.6m in month  (£0.007m below plan)

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 above plan

Total Operating Expenditure

 

£24.6m in month  (£0.3m above plan)

Expenditure highlights in month:

·         Drugs £0.06m above plan.

·         Pay £0.3m above plan

·         Supplies £0.07m above plan

·         Other Costs £0.2m below plan

EBITDA

-0.1% year to date (YTD) against a plan of 0.9%

Savings

Savings plan of £11.611m of which £9.1m identified

£0.2m CIPS delivered in month against a plan of £0.7m.

 

Debtors

£42.6m debtors and stock

£2.4m above plan

Creditors

£59.1m creditors and borrowings

£2.4 below plan

Cash

£4.2m

£0.3m below plan

Loan

No loan drawdown in month

Finance Risk Ratings

YTD Use of Resources (UoR) 3 (Rating 1 is now top and 4 is bottom).

 

In addition to the report, KJ outlined the national financial headlines for quarter 4 for the NHS.  It was noted that of the 234 Providers, 102 (44%) had ended the year in a deficit position.  65% of all acute Providers had ended the year in a deficit position.

 

Reasons for adverse variance in month

KJ drew attention to the Executive summary in the report which set out the main reasons for the £239k adverse variance to plan. 

 

Reference was made to the LAMU use of corridor during extreme escalation costing £26k in month.  It was noted that the intention was to convert a bay to a seating area.

 

Cost Improvement Plans (CIPs)

KJ advised that a main area for focus was the delivery of cost improvement plans (CIPs), noting that these were currently behind schedule.  KJ reported that the non-delivery of CIPs was the main contributor to the financial position in month with a shortfall of £562k.

 

NV reported that a lag was to be expected as the Trust had accepted a higher than desired Control Total.  There was a need to identify additional CIP schemes.  PH commented that it was worth noting that tactically Trusts had agreed higher Control Totals to enable access to other funds.

 

CQUIN

AC questioned whether the financial plan had included CQUIN penalties.  KJ responded that it was not permissible to assume penalties.  KJ advised that some CQUINs were set nationally and would be difficult to achieve.

 

National funding

AC commented on the adequacy of funding within the NHS questioning whether funding was allocated in the right areas within the health system.  KJ responded that NHS Improvement and NHS England were looking at the balancing of funding. 

 

It was noted that whilst there appeared to be adequate  ...  view the full minutes text for item 69.

70.

Quality Report pdf icon PDF 111 KB

Julie Marshman, 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 April were as follows: -

 

·         Swindon Community Health Services had reported a significant number of pressure ulcers

·         1 Serious Incident was reported during April

·         Incident closures remained high

 

Hospital Standardised Mortality Rate (HSMR) – Despite a busy winter the HSMR remained satisfactory with the rolling 12 month HSMR for February 2017 to January 2018 at 98.54.

 

 

National audits – The audit plan was on track.

 

 

Infection Prevention and Control – GR commented that the cases of flu were reducing.

 

Blood Culture Contamination Rate – JM referred to spikes in contamination rates but it was noted that overall the rates were reducing.  GR explained that there had been a quality improvement project focussed on this.

 

Never Event – JMa reported that there had been a never event in May.  The Trust was dedicated to establishing appropriate practices and improving systems and behaviours to minimise the incidences of never events.

 

Overdue Incident Investigations – JMa reported that there were a number of overdue incident investigations which meant that the opportunity for learning was reduced.  JMa explained that a full review of investigation processes was underway to consider the most efficient and effective mechanisms for learning from incidents and implementing change.  Details were being reported through the Patient Quality Committee.

 

Serious incidents – JMa reported that there had been a cluster of pressure ulcers in the community.  This had prompted a swift response from the community teams to embrace learning with quality improvements being implemented.  It was explained that the incidents arose mainly in relation to patients in care or nursing homes and working arrangements with agencies for a collaborative approach was important.

 

JMa reported that there had been a serious incident reported in April relating to the appropriateness of a treatment plan.

 

Care Quality Commission (CQC) – It was noted that the Trust was to be inspected by the CQC as part of its normal programme of inspections.  The Trust had submitted a number of documents by the required deadline.  The Board commended the Compliance Team for their hard work in co-ordinating the submission within the tight deadline.

 

Well Led – The Board noted that as part of the new style inspection, there would be a well led review looking at the 8 key lines of enquiry under the NHS Improvement Guidance issued in 2017.  It was noted that CN had worked with the Executive Directors to self-assess compliance against a number of indicators under the key lines of enquiry to inform shared understanding of compliance and identify gaps for actions, details of which would be shared with the wider Board.  An initial report on the developing framework was presented to the Quality and Governance Committee some months ago.

 

Complaints, Concerns and Compliments – Details of high level summary complaints, concerns and compliments were set out in the report and it was noted that  ...  view the full minutes text for item 70.

71.

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%) 

March 90.9% (not achieved)

Referral to Treatment +Incomplete standard (92%)

March 86.7% (not achieved)

6 Week Diagnostic Wait

March 90.1% (not achieved)

Cancer Targets

2 Week Waits

2 Week Breast Symptomatic

31 Day Treatment

62 Day Treatment

March Achieved

 

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

 

Emergency Department (ED) 4 hour standard – JO advised that performance was much improved particularly given that the Trust no longer included performance from Trowbridge and Chippenham urgent care centres.  JO commented that flow within the hospital was critical and significantly impacted on ED performance.

 

JO advised that Acute Medicine was critical to support 4 hour performance, but that it was difficult to recruit consultants.  The Acute Medical consultant rotas had been changed which had had a positive impact on performance.

 

JO reported that there continued to be focus on the numbers of medically fit for discharge patients. JO advised that unfortunately two wards had been closed recently due to norovirus and this had impacted on performance with beds remaining empty. Finally, JO advised that performance continued to improve and he recognised the hard work of teams to maintain a constant focus on driving improvements.

 

AC commented on the significant improvement in ED 4 hour performance and he sought clarification around activity levels.  JO responded that attendances were about the same overall and that real improvements had been made around processes and systems.  GR commented that ED had seen 600 more patients in January 2018 compared to the same month last year.

 

Cancer

 

It was noted that the weekly Cancer Recovery Group continued to meet to oversee the roll out of actions in the Cancer Recovery Plan.  JO reported that the Urology cancer pathway was complex and Urology was the area most challenged due in part to capacity issues, but also due to the reliance of tertiary centres.  It was flagged that there were known breaches going forward and that the focus on driving improvements would continue.

 

Referral to Treatment Times (RTT)

 

It was noted that a Trust wide RTT recovery plan had begun as well as an RTT trajectory for the year agreed with regulators.  Details of the speciality waiting list size trajectory were set out in the report, totalling 20,790 patients. The waiting list would continue to be monitored and reported. 

 

Stroke performance

 

It was noted that there was a general upward trend in performance, but that performance was behind the recovery trajectory.  Actions taken were having a positive impact but new processes were not embedded.  A Matron for stroke was being recruited to support improvement.  The Performance, People and Place Committee had received a full update on stroke at its meeting in May and was satisfied with the improvement plans in place but welcomed  ...  view the full minutes text for item 71.

72.

The Winter Plan 2018/19 pdf icon PDF 264 KB

Jim O’Connell, Chief Operating Officer

Additional documents:

Minutes:

The Board considered a Winter Plan 2018/19 which had been developed in consultation with staff and partners and took into account lessons learnt from the last winter period.  JO advised that the Plan had been developed further since writing the report, with additional elements included to reflect further feedback.  JO explained that the intention was that the Plan would be overseen by the Right Patient Right Place Group.  JO reported that there would be workstreams to support the Plan.

 

JS drew attention to the high level timeline set out in the Plan, questioning the timing for recruitment and suggesting this should be brought forward to July which was agreed.

 

KM referred to funding and suggested that early discussions should take place with the clinical commissioning groups.

 

KJ referred to the costs associated the Plan stating that these needed to be detailed and finalised and without this detail the Board was not in a position to sign off the Plan. JO advised that he would commence discussions at the A&E Delivery Board later in June.  JO commented that Swindon CCG was supportive in principle but the detail of this needed to be agreed.

 

RH questioned when the Plan would be reviewed.  JO explained that he would provide an update in the monthly Operational Performance Report and there would be a final formal review in August, to include costings.

 

NLB questioned how elective cancellations could be avoided during escalation.  JO responded that this would be mitigated through a more planned approach.  There would be limited use of Daisy and Recovery 2 with additional day cases.  Better planning would mitigate a reduction in elective activity, such as through the use of community nursing beds.

 

PL commended the plan and welcomed the level of engagement in its formulation.

 

RESOLVED

 

(a)   that the Winter Plan be accepted, acknowledged and supported noting that updates will be included in the monthly Operational Performance Report; and

 

(b)   that a formal review of the Plan to include costings be presented to the meeting of the Board in August.

73.

Ratification of Decisions made via Board Circular/Board Workshop pdf icon PDF 193 KB

Carole Nicholl, Director of Governance & Assurance

·        Self Certifications: General Condition 6 and Continuity of Service Condition 7 of the NHS Provider Licence – to ratify the decisions

·        2017/18 Data Security Protection Requirements – Board response

Minutes:

The Board was asked to ratify decisions made via Board circular as follows: -

 

(1)   2017/18 Data Security Protection Requirements: Guidance

 

It was noted that NHS Improvement required the Trust and other organisations to submit a Data and Cyber Security Assurance Statement, with a requirement that Board approval was sought prior to submission.

 

RESOLVED

 

that the Data and Cyber Security Assurance Statement approved via Board circular dated 25 May 2018 be ratified.

 

 

(2)   Declaration required by General Condition 6 and Continuity of Service Condition 7 of the NHS Provider Licence

 

It was noted that the Board was required to submit self-certifications to NHS Improvement as part of the end of year reporting and in doing so was required to demonstrate Board approval of those certifications.

 

RESOLVED

 

that the declarations as set out in the appendix to the Board circular dated 25 May 2018 and as attached to these minutes be ratified.

74.

Board Self Certifications - Governor Training pdf icon PDF 187 KB

Carole Nicholl, Director of Governance & Assurance

Minutes:

The Board received and considered a report which explained that S151(5) of the Health and Social Care Act Health 2012 required NHS Trusts to provide training for governors to ensure they were equipped with the skills and knowledge they needed to undertake their role.

 

An overview of the training to governors was provided and the Board was invited to approve a self-certification of compliance with training requirements.

 

It was noted that in addition to the training and development opportunities detailed in the report, governors had access to the Board reports and had been provided with a very detailed welcome pack about governor specific roles and duties.

 

The Council of Governors in April had confirmed that it was satisfied with training requirements.

 

RESOLVED

 

that it be agreed that the Board is satisfied that during the financial year most recently ended the Licensee has provided the necessary training to its Governors, as required in s151(5) of the Health and Social Care Act, to ensure they are equipped with the skills and knowledge they need to undertake their role.

75.

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.

 

At this point in the meeting, JM advised that she had represented the Board at a Volunteers Awards event.  JM commended the work of the volunteers and the huge contribution they made to support the work of the Trust.

76.

Date and Time of next meeting

Date: 5 July 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 5 July 2018 at 9:30am in Trust Management Boardrooms, Trust HQ, 2nd Floor, Great Western Hospital.

 

It was also noted that there would be a joint meeting of the Board and Council of Governors on Thursday 28 June 2018 at 5.00pm in Lecture Hall 1, The Academy, Great Western Hospital.

77.

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.

 

78.

Minutes

Roger Hill, Chairman

·        3 May 2018 (private)

79.

Outstanding Actions of the Board (Private) (to follow)

80.

Monthly review of issues - Chairman to lead discussion

81.

Annual Report & Accounts 2017/18

Carole Nicholl, Director of Governance & Assurance

82.

Carillion transition update

Kevin McNamara, Director of Strategy & Community Services

83.

Safer Maternity Strategy - NHS Resolution Incentive Scheme

Julie Marshman, Chief Nurse

84.

Emergency Department Performance - verbal

Jim O’Connell, Chief Operating Officer

85.

Wiltshire Health & Care Board Meeting Update

Carole Nicholl, Director of Governance & Assurance

86.

Terms of Reference for BANES, Swindon and Wiltshire Sustainability & Transformation Partnership (STP) Acute Hospitals Alliance

Carole Nicholl, Director of Governance & Assurance and Company Secretary

·        For Board approval

87.

Audit, Risk and Assurance Committee

Julie Soutter – Committee Chair

·        24 May 2018 (verbal report)

·        15 March 2018 (enclosure)

88.

Executive Committee

Nerissa Vaughan – Committee Chair

·        22 May 2018 (verbal report)

·        17 April 2018 (enclosure)

89.

Finance and Investment Committee

Steve Nowell – Committee Chair

·        29 May 2018 (verbal report)

·        23 April 2018 (enclosure)

90.

Mental Health Governance Committee

Nick Bishop – Committee Chair

·        6 April 2018 (enclosure)

91.

Performance, People & Place Committee

Peter Hill – Committee Chair

·        30th May 2018 (verbal report)

·        25th April 2018 (enclosure)

92.

Quality & Governance Committee

Nick Bishop - Committee Chair

·        17 May 2018 (verbal report)

·        19 April 2018 (enclosure)

93.

Urgent Business (Private) (if any)

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