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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

94.

Apologies for Absence and Chairman's Welcome

Julie Marshman, Chief Nurse

Peter Hill, Non-Executive Director

Julie Soutter, Non-Executive Director

Minutes:

The Chair welcomed all to the Great Western Hospitals Foundation Trust (GWHFT) Board meeting held in public, particularly members of the public.   The Chair reflected on the importance of the day in the context of the NHS 70th birthday and described the initial NHS model development in Swindon.

 

Apologies were received as outlined above.

95.

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 received on any issues arising at the meeting which might conflict with the business of GWHFT in addition to those already declared on the Declaration of Interests register.

 

The meeting was declared as quorate.

96.

Questions from the public to the Board relating to the work of the Trust pdf icon PDF 102 KB

Additional documents:

Minutes:

The Board had received four questions from the public which covered:-

 

·        Hearing Loop

·        Walk-in Centre

·        Building Cladding

·        Gender Pay Gap

With regard to the hearing loop question, this was being investigated by a member of staff to clarify the position however it was noted that the Trust were not the owners of the premises and therefore could not make installations or changes.  A further update would be given at the next Board meeting.

Action :  Director of Governance & Assurance

 

Nick Bishop, Non-Executive Director commented that question 64 was more around equal pay as opposed to the gender pay gap and there was a crucial difference.  Carole Nicholl, Director of Governance & Assurance agreed to expand the response to cover equal pay.

Action :  Director of Governance & Assurance

97.

Minutes pdf icon PDF 510 KB

Roger Hill, Chairman

·        7 June 2018 (public and summary of private minutes)

Minutes:

The minutes of the meeting of 7 June 2018 were adopted and signed as a correct record.

98.

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

Minutes:

The action list was noted with the following comment:-

 

71/18  /  Operational Report /  Swindon Community Health Service (SCHS) :  It was noted that the action was for discussion on further integration opportunities at the next workshop not as recorded in the action list.

Action  :  Director of Governance & Assurance

99.

Chairman's Report, Feedback from the Council of Governors

Roger Hill, Chairman

Minutes:

Roger Hill, Chair presented a verbal report which included the following:-

 

·        A welcome to the new Deputy Company Secretary, Caroline Coles.

·        The resignation in June 2018 of Kevin Parry, the public governor for Swindon Constituency due to demands on time.   Dr Balber Virik had been appointed to fill this vacancy.

·        The Joint Board and Council of Governors meeting held on 28 June 2018 which discussed strategy formulation.  The Chair reminded Directors and Governors to feed their views to the Director of Strategy who would arrange a further strategy meeting later in the summer

The Board noted the update.

100.

Chief Executive's Report pdf icon PDF 185 KB

Nerissa Vaughan, Chief Executive

Minutes:

Nerissa Vaughan, Chief Executive presented the report and highlighted:-

 

·        The successful transfer of the Facilities service from Carillion to Serco and thanked all staff involved who kept the service running smoothly during uncertain times.

·        The levels of Medically Fit for Discharge (MFFD) numbers which were fluctuating however the figure was decreasing due to the system working well together. 

·        The new e-observations system, Nervecentre, an electronic system that helped staff manage patient observations electronically, and thanked all staff concerned for the smooth implementation.

Andrew Copestake, Non-Executive Director asked for clarification on how PIFU worked. Jim O’Connell, Chief Operating Officer replied that PIFU was the Patient Initiated Follow-Up Service which was specifically designed for patients with stable long-term conditions to allow direct access to clinical teams as and when a flare up of their conditions occurred rather than waiting for an appointment in several weeks or months.

 

The Board noted the report.

101.

Finance Report pdf icon PDF 115 KB

Karen Johnson, Director of Finance

Additional documents:

Minutes:

Karen Johnson, Director of Finance presented the Finance Report for month 2 (ending 31 May 2018) and highlighted:-

 

·        In month deficit of £1.3m compared to a target deficit of £191k.

·        Year to date deficit of £3.2m compared to planned deficit of £1.9m (variance £1.3m).

·        The planned end of year position of £12.4m deficit was an area of concern and therefore a deep dive on costs would be undertaken. 

·        Private Patient (PP) income was below plan and discussions were underway to understand and explore opportunities to mitigate this risk.

·        The run rate income and expenditure improved largely through levels of activity; however there was a significant increase in A&E activity.  A review was underway to confirm whether this was an area of concern.

·        Drugs spend had increased and there was a correlation between drugs and non-pay and increase in activity.

·        Overall the financial position was challenging and a number of controls were being put into place to help mitigate pressures within the system.

·        The Trust had the opportunity to resubmit the Operational Plan and to re-profile the budgets, as long as the year end value remained the same.  This could result in achieving the Provider Sustainability Funding (PSF) in Q1.  However, the Trust needed to continue to manage costs and explore further transformational changes.

 

Roger Hill, the Chair asked if the revised Operational Plan had been reviewed at the Finance & Investment Committee.  Karen Johnson, Director of Finance replied that due to timing issues this had not been possible however would present the document at the next meeting.

Action  :  Director of Finance

 

Jemima Milton, Non-Executive Director asked what the confidence rate was on achieving the Cost Improvement Plans (CIPs).  Karen Johnson, Director of Finance responded that confidence rate was around 60-70% and the Trust continued to look at transformation of services to drive further efficiencies.  Nerissa Vaughan, Chief Executive added that the Trust achieved a lot of transformation particularly around pathway development but it took time and measuring financial benefit was difficult.

 

A discussion followed on the developments within the Sustainability & Transformation Partnership (STP) of moving away from PbR to a block contracting arrangement.  The focus was on exploring a cost not income based contract in some form for the next financial year.

 

Resolved

 

(a)   that it agreed the month 2 financial position was a year to date deficit of £2,503k (including PSF);

(b)   that it agreed the month 2 financial position was a year to date deficit of £3,215K (excluding PSF); and

(c)   that it agreed that the year-end Use of Resources Rating was 4.

102.

Chair of Finance & Investment Committee Overview pdf icon PDF 171 KB

Steve Nowell, Non-Executive Director

Minutes:

The Board received a report from the Chair of the Finance & Investment Committee which summarised the key issues considered by the Committee at its meeting held on 29 May and 25 June 2018.

 

The Board noted the report.

103.

Chair of Audit, Risk & Assurance Committee Overview pdf icon PDF 170 KB

Julie Soutter, Non-Executive Director

Minutes:

The Board received a report from the Chair of the Audit, Risk & Assurance Committee which summarised the key issues considered by the Committee at its meeting held on 24 May 2018.

 

The Board noted the report.

104.

Quality Report pdf icon PDF 111 KB

Toni Lynch, Deputy Chief Nurse

Dr Guy Rooney, Medical Director

Additional documents:

Minutes:

Dr Guy Rooney, Medical Director and Toni Lynch, Deputy Chief Nurse presented the Quality report and highlighted the following:-

 

Hospital Standard Mortality Rate (HSMR)

Both the HSMR and Summary Hospital-level Mortality Indicator (SHMI) scores reflected a consistent picture of a level below 100.  The themes from the published quarterly report on deaths highlighted learning from management of end of life care packages and massive transfusions.

 

National Audits

The audit programme remained on schedule. It was noted that the concern around the Stroke audit had been resolved.

 

Infection Control 

There were 4 cases of C diff reported in May 2018 which had placed the Trust over trajectory.  It was noted that Swindon Community Health Services was now incorporated in the Trust’s reporting with no increase in the annual trajectory target.  Investigations were in process however the emerging cause was the increase in the use of antibiotics for more at risk patients.

 

There were no cases of E.coli reported during May 2018.  This was due to the extensive programme of work put in place covering the whole system.

 

Never Event

There was 1 never event reported in May 2018 with no harm to the patient.  Full duty of candour was followed with the patient involved together with recommendations and trust wide lessons learnt.  

 

Serious Incidents

There were a further 8 serious incidents during May 2018; 7 of these were category 4 pressure ulcers in Swindon Community Health Services.  Improvement plans had been developed to raise awareness and identify patients with deteriorating skin integrity.

 

NHS Improvement (NHSI) and National Reporting & Learning System (NRLS) had revised their incident summary report and showed that for April to September 2017 GWHFT had a good culture of reporting.

 

Safety Alerts 

Trusts had been requested by NHSI to review their implementation of patient safety alerts.  This had demonstrated that the Trust had a robust process in place.

 

Safeguarding Adults

The number of alerts raised in Q4 had seen a marginal drop from Q3. Training compliance was mixed however overall an improving picture.

 

Safeguarding Children

Training showed some improvement in all levels however level 3 compliance remained below target.  Measures to enable maximum compliance had been taken.

 

Andrew Copestake, Non-Executive Director firstly congratulated the team on achieving zero reported cases in MRSA and E coli and secondly asked when the causes of the increase in serious incidences would be known.  Toni Lynch, Deputy Chief Nurse replied that internal action plans had been instigated and would be reviewed at the next Patient Quality meeting and then to Board thereafter.  In terms of the pressure ulcers the large scale training package implemented had helped with tissue integrity.

 

Resolved

 

(a)   that it agreed that the Quality Report provided assurance of progress towards quality improvements and quality indicators; and

 

(b)   that the report be noted.

105.

Chair of Quality & Governance Committee Overview pdf icon PDF 187 KB

Nick Bishop, Non-Executive Director

Minutes:

The Board received a report from the Chair of the Quality & Governance Committeewhich summarised the key issues considered by the Committee at its meeting held on 17 May and 21 June 2018.

 

Nick Bishop, Non-Executive Director and Chair of Quality & Governance Committeereported that there were no issues to draw to the Board’s attention and thanked Jemima Milton for chairing.

 

Carole Nicholl, Director of Governance & Assurance added that the amendments to the Constitution had been agreed to reflect:-

 

·        the increased number of Swindon governors from 5 to 7;

·        that Oxford Brooks was now the partnership organisation not the Academy

 

The Board noted the report.

106.

Operational Performance Report pdf icon PDF 273 KB

Jim O’Connell, Chief Operating Officer

Kevin McNamara, Director of Strategy & Community Services

Additional documents:

Minutes:

Jim O’Connell, Chief Operating Officer presented the report and highlighted:-

 

National Targets June 2018­

Although there was a dip in A&E 4 hr performance in May 2018 the figure still continued to be ahead of last year.  It was noted that a revised trajectory figure had been agreed with NHSI.

 

Cancer

There was a potential risk of a breach in waiting times in Urology due to external issues; however it was noted that there were a few internal issues also to be addressed.   Both the CCG and the regulators had been kept informed. This was a national issue with enormous pressures across the country. 

 

RTT 

The size of waiting list was being managed and it was anticipated the service would be back on track in June/July 2018.

 

Stroke 

Improvement in performance continued but was variable.  Significant actions had been taken to improve performance and although these were having a positive impact they needed to be embedded in a sustainable way.

 

Diagnostics

Performance was low at 78% and was anticipated to decrease further before the actions put in place would impact and improve performance.  There continued to be capacity issues within MRI even though 10 Radiographers were recruited in September 2017, this was due to the backlog.  Steps were in place to resolve this in the form of portable scanners and more clinics; however it had also been noticed that urgent referrals were going up disproportionately.  

 

Medically Fit for Discharge (MFFD)

While the number of MFFD was falling the number of lost bed days remained high due to a couple of complex patients. 

 

Dr Guy Rooney, Medical Director highlighted the significant improvement in turnaround times in Pharmacy following the investment approved by the Board.

 

Roger Hill, Chair asked what the actual numbers were that represented the 59% figure of patients directly admitted to the stroke unit.  Jim O’Connell, Chief Operating Officer replied that the numbers were very variable but small.  The average was 2 patients per day but there were lots of peaks and troughs and therefore challenging to manage.

 

Jemima Milton, Non-Executive Director asked whether the Trust benchmarked with other Trusts in the sudden spikes in services and whether a deep dive into this area was required to understand the reasons these occurred.  Karen Johnson, Director of Finance replied that discussions within the STP were already taking place and the CCG were undertaking a deep dive as the other acute trusts have had a similar increase.  A more detailed report on spikes would come back to the Board in due course.

Action  :  Chief Operating Officer

 

Jemima Milton, Non-Executive Director highlighted the significant increase in one month for ultrasounds, along with MRIs.  Jim O’Connell, Chief Operating Officer responded that this spike was picked up in the analysis and had been discussed in detail at the Performance, People & Place Committee as there were a limited number of Radiologists.  A significant amount of capacity had now been put in place and the impact of this should show an improvement in performance  ...  view the full minutes text for item 106.

107.

Chair of Performance, People & Place Committee Overview pdf icon PDF 166 KB

Peter Hill, Non-Executive Director

Minutes:

The Board received a report from the Chair of the Performance, People and Place Committee which summarised the key issues considered by the Committee at its meeting held on 30 May and 27 June 2018.

 

The Board noted the report.

108.

Safer Staffing Bi-Monthly Exception Report pdf icon PDF 492 KB

Toni Lynch, Deputy Chief Nurse

Additional documents:

Minutes:

Toni Lynch, Deputy Chief Nurse presented the Safer Staffing Bi-Monthly Exception Report which provided an exception report on Registered Nurse, Midwifery and Care Staff fill rates compared to that planned.  The following was highlighted:-

 

·        There was little variance in the Trust’s fill rate compared to last year.

·        There was an increase of 3% in Registered Nurse over the year.

·        Controls for the use of temporary staff continued with new meetings put in place to review levels to ensure robustness.

·        The care hours per patient day had increased however this corresponded with the introduction of beds on Dorcan Ward.

·        The national hospital model had not yet been updated therefore it was not possible to give a national benchmarked position for the Trust.

 

Nick Bishop, Non-Executive Director queried the reason for the significant increase in total care hours per patient as Dorcan Ward and asked for clarification.  Toni Lynch, Deputy Chief Nurse replied that staff fluctuated according to activity however as the model hospital data had not been updated no comparison against standards could be undertaken. 

 

A discussion followed on the source of the data in terms of comparing year on year as more data was now coming from Ledger.  Toni Lynch, Deputy Chief Nurse added that more work was required to understand the position and a further update would be provided at the September 2018 Board.

Action  :  Chief Nurse

 

The Board noted the update.

109.

Ratification of Decisions made via Board Circular/Board Workshop

Carole Nicholl, Director of Governance & Assurance

Minutes:

The Board were asked to ratify:-

 

(i)       the certificate of compliance for the Trust’s provider licence to be submitted to NHSI.

 

Resolved

 

(a)   The Board ratified the certificate of compliance for submission to NHSI.

110.

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:

There were no further items of business for discussion.

111.

Date and Time of next meeting

Date: 2 August 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 in public would be held on 2 August 2018 at 0930 hrs in Trust Management Boardrooms, Trust HQ 2nd Floor, Great Western Hospital.

112.

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:

The Board were 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.’