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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

126/18

Apologies for Absence and Chairman's Welcome

Minutes:

The Chair welcomed all to the Great Western Hospitals Foundation Trust (GWHFT) Board meeting held in public, particularly members of the public and governors. 

 

Apologies for absence were received as outlined above.

127/18

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.

128/18

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

Minutes:

There were no questions from members of the public.

129/18

Minutes pdf icon PDF 451 KB

Roger Hill, Chairman

·        5 July 2018 (public and summary of private minutes)

Minutes:

The minutes of the meeting of the Board held on 5 July 2018 were adopted and signed as a correct record.

130/18

Outstanding actions of the Board (public) pdf icon PDF 317 KB

Minutes:

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

 

·        The actions 88/18 (both) and 85/18 would be on the September 2018 Board meeting agenda.

·        Action 90/18  :  It was noted that this would be covered in the routine Operational Report and would not be a separate report.

 

Jemima Milton, Non-Executive Director asked if the governors’ questions could be viewed every month.  Carole Nicholl, Director of Governance & Assurance replied that it was a decision of the Board to keep the agenda to a bare minimum for the shortened Board meetings every other month.  Following further discussion it was agreed to view the governors’ questions on a monthly basis.

131/18

Finance Report pdf icon PDF 115 KB

Karen Johnson, Director of Finance

Additional documents:

Minutes:

The Board received and considered a report on finance for month 3, together with a presentation as follows: -

 

Actual Operating costs

In month deficit of £517k compared to a target deficit of £1,873k.Year to date deficit of £3,732k compared to

planned deficit of £3,741k. Year to date variance £9k.

 

Contractual Income

 

£23.6m in month and £69.2m year to date (variance of

£0.09m below plan)

 

Total Income

£26.2m in month and £76.5m year to date (variance of

£0.41m below plan)

 

Income Activity highlights: -

·        Elective inpatients below plan

·        Day case activity below plan

·        Non-elective above plan

·        Outpatient appointments below plan

·        A&E above plan

 

Expenditure

 

£24.9m in month and £74.6m year to date (positive variance of £0.4m below plan year to date)

 

Expenditure highlights in month:

·        Drugs £0.2m below plan (£0.3m above plan ytd)

·        Pay is £0.2m above plan (£0.5m above plan ytd)

·        Supplies £0.1m below plan (£0.2m above plan ytd)

Other Costs £0.7m below plan (£0.5m below plan ytd)

EBITDA

32.6% YTD which is on plan

 

Savings

Savings plan of £11.611m of which £7.936m identified

£0.306m CIPS delivered in month against a plan of £0.528m.

Debtors

£37m debtors and stock

£4m above plan

Creditors

£56.5m creditors and borrowings

£6.1m above plan

Cash

£7.5m

£1.1m above plan

Loan

No Loan Drawdown in Month

Continuity of Service Risk Rating (CoSRR)

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

 

The report was reviewed and the following highlighted:-

 

·        In month deficit £517k was a significant reduction to the previous month.  This favourable position was mainly due to the re-profiling of reserves and CIPs as part of the Annual Plan resubmission and one off adjustments. 

·        The Trust achieved its Provider Sustainability Funding (PSF) performance for Q1.

·        In line with other Trusts GWHFT had the opportunity to resubmit the Operational Plan and to re-profile CIP targets.

·        There had been an improvement in the run rate primarily due to a significant improvement in income activity although down in some areas it still remained above in non-elective.  Elective activity was below plan however was starting to pick up due to improved theatre utilisation.

·        The pay bill was in line with the previous month, after the favourable variance on reserves and the adverse variance of CIPs not delivering.  There was a reduction in agency costs due to Close Support however this remained a major cost pressure.

·        Cost pressures were consistent with months 1 & 2 and a recovery plan had been introduced.

·        The level of reserves to support the position was high and meant that funding for new investments was significantly reduced.  The key focus would be to continue to control vacancies and sickness levels and strengthen plans to deliver CIP schemes.

 

Jemima Milton, Non-Executive Director was concerned that the waiting list size was not reducing.  Nerissa Vaughan, Chief Executive replied that the waiting list target was not to be any higher in March 2019 than in March 2018.

 

Roger Hill, Chair asked if there was a greater risk in re-phasing the  ...  view the full minutes text for item 131/18

132/18

Quality Report pdf icon PDF 112 KB

Julie Marshman, Chief Nurse

Dr Guy Rooney, Medical Director

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 June 2018 were as follows: -

 

·        Provisional HSMR 99.5 for April 17 – March 18

·        2 c-diff cases attributed to GWH in June 2018

·        2 Serious Incidents reported

·        Incident closure >90 days still remains high

·        Number of overdue complaint cases remains high

 

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

 

Hospital Standardised Mortality Rate (HSMR) – The figure for April 2017 – March 2018 was below the 100 level as expected.  It was noted that figures in previous months would have been lower however this was due to Dr Foster rebasing.  The SHMI figure reflected a broader picture of hospital mortality as it included all deaths in all settings.

 

National Audit – The audit programme was on schedule except for the National Diabetes Audit as this was reliant on an external IT package in order to collect the data.  The Division were reviewing the options.

 

Infection Prevention and Control – There were two cases of C-diff in June 2018.  Regional data showed that the Trust was not an outlier in the southwest. 

 

Nick Bishop, Non-Executive Director asked that as SHMI figures were published quarterly how did the Trust know if mortality had taken a sudden dip.  Guy Rooney, Medical Director confirmed that actual mortality figures were published and scrutinised closely.  Kevin McNamara, Director of Strategy & Community Services added that national alerts are received should there be an anomaly throughout the year.

 

Serious Incidents – Two serious incidents were reported in June 2018; one was a category IV ulcer pressure in the community.  The pressure ulcer improvement programme was continuing with thorough oversight through the appropriate committees.  The other incident involved a patient with learning disabilities.  This was under investigation for lessons learnt, together with a review of past experiences for further assurance.

 

Overdue Incidences – There were 4 overdue serious incident actions plans.  There was full oversight with regards to these actions plans with assurance that all had been actioned and it was a delay in closing down.  As a point of learning more realistic deadline dates needed to be set which were agreed with all parties concerned beforehand.

 

Complaints, Concerns and Compliments  -  The biggest number of complaint cases over the due timeframe was in the Unscheduled Care Division however these mainly involved highly complex cases.  The Divisions were managing complaints much better and had strengthened processes to improve.   A review of the Patient Advice and Liaison Service (PALS) service was being undertaken and an initial report would be presented to the relevant Committees during August 2018.

 

Roger Hill, Chair asked if there were any major complaints.  Julie Marshman, Chief Nurse replied that the Trust benchmarked well with regards to complaints.  Some complaints were more difficult to respond to due to the many elements to investigate (such as where patients had co-morbitites) and time was  ...  view the full minutes text for item 132/18

133/18

Operational Performance Report pdf icon PDF 272 KB

Jim O’Connell, Chief Operating Officer

Kevin McNamara, Director of Strategy & Community Services

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: -

 

 

ED 4 hour standard (95%)                     June 91.7%              Under Achieving

(combined - ED, MIU & UCC)                

 

 

RTT Incomplete standard (92%)          May 87.1%               Not Achieved*

 

*NHS central guidance has changed to size of waiting list at year end rather than

% delivery.

 

 

6 Week Diagnostic Wait (99%)              May 74.8%               Not Achieved

 

 

Cancer Targets:                                     May

 

2 Week Waits (93%)                                95.9%                       Achieved

2 Week Wait Breast

Symptomatic (93%)                                 91.9%                       Not Achieved

31 Day Treatment (96%)                         100%                        Achieved

62 Day Treatment (85%)                         87%                          Achieved

 

 

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

 

Emergency Department (ED) 4 hour standard­ – ED performance was below the national target but ahead of trajectory agreed with NHSI.  There had been a significant improvement in performance over the past year thanks to the hard work of the ED Team.  There was still more work to do, however performance was consistently above 90% which was good news.

 

There were no 12 hour wait breaches and as this had been a significant issue last year this was a significant achievement.

 

Cancer – The Trust was achieving all key cancer targets.  However a dip in performance in Q2 was expected due to a batch of urology breaches.  It was anticipated to be back on trajectory by Q3.  This was a national picture due to a shortage of urology slots. 

 

Diagnostics – Performance continued to be low at 74.7% however a comprehensive recovery plan was in place.  Portable scanners were in use to clear the backlog.  At the beginning of September 2018 there would be an increase in capacity due to recruitment of Radiographers.

 

Stroke – Although performance was behind the trajectory there had been significant improvement however, this needed to be sustained.

 

RTT – Performance in May 2018 was above trajectory as agreed with NHSI but was below the national standard.  A recovery plan was in place however a further  deep dive had been undertaken into the specialties whose lists had increased significantly to understand the reason for this and for any remedial actions to be put in place if required.

 

Corneal graft surgery contributed significantly to the 52 wk breaches.  The Trust was working in conjunction with Salisbury hospital to clear this backlog.   However due to the lead time in tissue sourcing this could be as late as November 2018, and was being closely monitored.

 

Jemima Milton, Non-Executive Director asked if there was any harm to patients in terms of the delay in corneal graft surgery.  Jim O’Connell, Chief Operating Director replied that each case was being reviewed by a clinician and monitored closely.

 

Overdue Fall Ups (Hold File) – The mitigating actions to address the high number of overdue follow ups had demonstrated good development over the past month.

 

Roger Hill, Chair asked if the deep dive report with regard to the RTT  ...  view the full minutes text for item 133/18

134/18

Workforce Race Equality Standards Report 2018 pdf icon PDF 390 KB

Sally Fox, Deputy Director of Human Resources

Additional documents:

Minutes:

The Board considered a short summary of last year’s National and this year’s Trust results for the Workforce Race Equality Standards (WRES) reporting together with a draft action plan.  The following was highlighted:-

 

·      All 2017/18 WRES actions were completed

·      Improvement had been seen in BME representation at higher bands, access to non-mandatory training and CPD had increased for BME staff and was slightly higher than access for white staff and an improvement in the number of BME candidates who had been appointed following shortlisting.

·      Deterioration was seen in BME staff experiencing harassment, bullying or abuse from staff, for BME staff experiencing discrimination from staff and managers and in the results of BME staff feeling that the Trust provided equal opportunities for career progression or promotion

·      A BME Speak Up Guardian was in place

·      The 2018/19 WRES Action Plan would focus on actions to improve career progression and reduce harassment and discrimination for BME staff.   It was noted that there was no BME representative on the Board however when an NED opportunity arose links into the community to encourage applications would be undertaken.

 

RESOLVED

 

(a)   that this year’s WRES results are noted

(b)   that the proposed action plan is approved subject to any additions or amendments from the Equality and Diversity Group  (if any these will be reported at the meeting)

135/18

Ratification of Decisions made via Board Circular/Board Workshop

Carole Nicholl, Director of Governance & Assurance

Minutes:

It was noted that the information circulated was for information only not for approval.

136/18

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.

137/18

Date and Time of next meeting

Date: 6 September 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 6 September 2018 at 9:30am in Trust Management Boardrooms, Trust HQ, 2nd Floor, Great Western Hospital

138/18

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.

139/18

Minutes

Roger Hill, Chairman

·        5 July 2018 (private)

140/18

Outstanding Actions of the Board (Private)

141/18

Monthly Review

Roger Hill, Chairman

142/18

Entonox briefing

Dr Guy Rooney, Medical Director

143/18

Radiotherapy - verbal update

Kevin McNamara, Director of Strategy & Community Services

144/18

Wiltshire Health & Care - verbal update

Kevin McNamara, Director of Strategy & Community Services

145/18

Audit, Risk and Assurance Committee

Julie Soutter – Committee Chair

·        12 July 2018 (verbal report)

·        24 May 2018 (enclosure)

146/18

Charitable Funds Committee

Jemima Milton – Committee Chair

·        2 May 2018 (enclosure)

147/18

Executive Committee

Nerissa Vaughan – Committee Chair

·        17 July 2018 (verbal report)

·        19 June 2018 (enclosure)

Minutes:

.

148/18

Finance and Investment Committee

Steve Nowell – Committee Chair

·        23 July 2018 (verbal report)

·        25 June 2018 (enclosure)

149/18

Mental Health Governance Committee

Nick Bishop – Committee Chair

·        6 July 2018 (enclosure)

Minutes:

The minutes of the meeting of the Mental Health Governance Committee held on 6 July 2018 were received and the following covered:-

 

·       The terms of reference. 

·       Legislation on absconders

·       A case review

 

The Board noted the report.

150/18

Performance, People & Place Committee

Peter Hill – Committee Chair

·        25 July 2018 (verbal report)

·        27 June 2018 (enclosure)

151/18

Quality & Governance Committee

Nick Bishop - Committee Chair

·        19 July 2018 (verbal report)

·        21 June 2018 (enclosure)

152/18

Remuneration Committee

Steve Nowell – Committee Chair

·        25 July 2018 (verbal report)

153/18

Urgent Business (Private) (if any)

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