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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

154/18

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.

155/18

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.

156/18

Questions from the public to the Board relating to the work of the Trust pdf icon PDF 143 KB

Minutes:

The Board received questions from the public and noted the responses as detailed in the report.  With regard to the question concerning the commencement of Patient Initiated Follow-Up Service (PIFU) Guy Rooney, Medical Director advised that the service was anticipated to start in 3 to 4 months’ time.

 

RESOLVED

 

that the questions and responses be noted and it be agreed that no further action is required to address the issues raised.

157/18

Minutes pdf icon PDF 366 KB

Roger Hill, Chairman

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

·        28 June 2018 – Joint Board & Council of Governors’ Meeting (public minutes)

Additional documents:

Minutes:

The minutes of the meeting of the Board held on 2 August 2018 were adopted and signed as a correct record, subject to the following amendments: -

 

133/18 / Operation Report – Swindon Community Health Services:  Change the wording in the 5th paragraph to:-

 

·         “Kevin McNamara, Director of Strategy & Community Services replied that although there was still some work to be completed within the larger areas, focus had turned to the smaller areas.”

·         “Nerissa Vaughan, Chief Executive added that feedback received from staff was that some integration benefits had been lost.  It was the intention of the Trust to find ways to address this.”

 

134/18 / Workforce Race Equality Standards Report 2018:  Last bullet point change ‘representative’ to ‘Non-Executive Director (NED)’.

 

The minutes of the meeting of the Joint Board of Directors and Council of Governors held on 28 June 2018 were adopted and signed as a correct record.

158/18

Outstanding actions of the Board (public) pdf icon PDF 310 KB

Minutes:

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

 

131/16 – Finance Report / National Pay Reviews:  It was noted that it was not possible to split out the costs of the pay award as requested by the Board, however more detailed information would be presented at the next Finance & Investment Committee.  This action was closed. 

 

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

159/18

Chairman's Report, Feedback from the Council of Governors

Roger Hill, Chairman

Minutes:

Roger Hill, Chairman gave a verbal report as follows: -

 

Council of Governors Meeting – 26 July 2018

A Council of Governors meeting had taken place on 26 July 2018 where reports on finance, operational performance and quality were considered, together with a briefing on the Accessible Information Standard and a presentation from the Unscheduled Care Division.  The Governors had no issues of concern to draw to the attention of the Board.

 

Governor Representatives

The Trust noted the resignation of David Barrand, Appointed Governor for Prospect House.  Names of trustees who might be interested were being sought from Prospect House.  Carole Nicholl, Director of Governance & Assurance advised that a tentative nomination had now been received.

 

RESOLVED

 

that the report of the Chairman be received.

160/18

Chief Executive's Report pdf icon PDF 187 KB

Nerissa Vaughan, Chief Executive

Minutes:

The Board received and considered a report from Guy Rooney, Deputy Chief Executive on behalf of Nerissa Vaughan covering the following issues: -

 

·         The Trust had celebrated the NHS 70th birthday on 5 July 2018 and of particular note was the specially commissioned artwork which had been unveiled in the Hospital Atrium.

·         The appointment of a new Deputy Chief Nurse, Tania Currie who would take up post from September 2018.

·         The CQC visit which would take place from 14 August until mid-September 2018.

·         The Staff Excellence Awards ceremony that had taken place on 22 June 2018 to honour staff that go above and beyond their duties for patient care.

·         The successful bid to take part in a national Quality Improvement collaborative on patient flow.

·         The development of an educational video to support care of patients with learning disabilities and particularly the involvement of Wendy Johnson, Head of Safeguarding Adults and Mental Health and Lead Nurse for Learning Disabilities.

 

RESOLVED

 

that the report of the Chief Executive be received.

161/18

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 4, together with a presentation as follows: -

 

Actual Operating costs

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

There was an in month deficit of £955k compared to a target deficit of £878k.  Year to date (YTD) deficit of £4,687k compared to planned deficit of £4,619k. Year to date variance £68k.

NHS Clinical Income

£23.6m in month and £92.8m YTD (£0.15m below plan YTD)

 

Total Income

£26.4m in month and £102.9m YTD (£0.61m above plan YTD)

 

Income Activity highlights for the month (based on estimated activity):

·         Elective inpatients above plan

·         Day case activity below plan

·         Non-elective above plan

·         Outpatient appointments below plan

·         A&E above plan

 

Total Operating Expenditure

 

£25.4m in month and £99.9m YTD (£0.7m above plan YTD)

Expenditure highlights in month:

 

·         Drugs £0.4m above plan (£0.7m above plan ytd)

·         Pay was £0.2m above plan (£0.6m above plan ytd)

·         Supplies £0.2m above plan (£0.4m above plan ytd)

·         Other Costs £0.5m below plan (£1.0m below plan ytd)

 

EBITDA

2.9% YTD which 0.1% below plan

 

Savings

Savings plan of £11.611m of which £8.163m identified.

£0.663m Cost Improvement Plans (CIPs) delivered in month against a plan of £0.619m.

 

Debtors

£44.3m debtors and stock

£4.9m above plan

 

Creditors

£61m creditors and borrowings

£9m above plan

Cash

£4.6m

£2.8m above plan

 

Loan

No loan drawdown in month

 

Finance Risk Ratings

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

 

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

 

·         The year to date position was above plan by £68k however the run rate had deteriorated due to a few one-off benefits in month 3 which had not reoccurred in month 4.

 

·         Staff had received a national increase in salary and during month 5 back pay had been incurred which had been reflected in the increased pay costs.  Although funding had been received from the Department of Health there was still a cost pressure on the Trust of £10k.  The pay bill had improved but was still not within budget.

 

·         Agency costs had improved slightly due to decreased costs for the level of close support.  This was monitored closely on a weekly basis.

 

Julie Souter, Non-Executive Director asked if over a period of time close support would increase.  Julie Marshman, Chief Nurse replied that yes it would however some changes had come into effect which supported better oversight and scrutiny.

 

·         Reserves were supporting the shortfall in the delivery of savings which still had a gap of £3.6m.  A recovery plan had been implemented to consider specific areas, in particular outpatient productivity, admissions levels and the successful delivery of the Commissioning for Quality and Innovation framework (CQUIN).

 

Andy Copestake, Non-Executive Director asked if the CQUINs were monitored closely at the Finance & Investment Committee.  It was noted that there had been a robust discussion at the recent meeting however achievement of CQUIN was  ...  view the full minutes text for item 161/18

162/18

Chair of Finance & Investment Committee Overview pdf icon PDF 191 KB

Steve Nowell, Non-Executive Director

Minutes:

The Board considered a report which summarised the key issues from meetings of the Finance & Investment Committee held on 23 July and 28 August 2018 and noted in particular the completion of the long term financial model for the Trust.

 

RESOLVED

 

that the report be received.

163/18

Chair of Audit, Risk & Assurance Committee Overview pdf icon PDF 173 KB

Julie Soutter, Non-Executive Director

Minutes:

The Board considered a report which summarised the key issues from a meeting of the Audit, Risk and Assurance Committee held on 12 July 2018.

 

RESOLVED

 

that the report be received.

164/18

Quality Report pdf icon PDF 111 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 July 2018 were as follows: -

 

·         Provisional HSMR 99.4 for April 17 – March 18

·         2 clostridium difficile cases attributed to GWH in July 2018

·         1 Serious Incident reported

·         Incident closure >90 days gradually decreasing.

 

In presenting the report the following was highlighted:-

 

Hospital Standardised Mortality Rate (HSMR) – The data was the same as last month due to no available update from Dr Foster. The figure was in the expected range however factors had come to light that would affect the figure notably around palliative coding and once adopted would have a positive effect.  Also the current data included Wiltshire Community Care data which could not be removed.  The introduction of recent quality measures, such as the Nerve Centre, would have a positive impact on the Trust’s overall mortality rate

 

Nick Bishop, Non-Executive Director commented that the Trust was in a good position, however the Standardised Hospital Mortality Indicator (SHMI) data was 12 months old.  Guy Rooney, Medical Director replied that mortality was closely monitored on a regular basis and at 95% agreed was in a good position.

 

Clinical Audits – Progress with national audits remained on schedule except for the National Diabetes audit.  This was due to a reliance on the sourcing of an IT package.  Options were being considered carefully to ensure the ability to collect data in the prescribed format going forward.

 

Infection Prevention and Control – Two further cases of clostridium difficile had been reported in July 2018.  The common theme continued to be patients exposed to broad spectrum antibiotics and alternative regimes were being explored, however this was complicated and required careful monitoring. 

 

With regard to E.coli the Trust was performing well and working with the community, in particular around catheter treatment, to ensure this was maintained. 

 

Serious Incidents    In July 2018 there was one serious incident which was a further category IV pressure ulcer in the community.  Peter Hill Non-Executive Director added that a deep dive into pressure ulcers in the community had been undertaken, the results of which were considered at the Quality & Governance Committee.  He reassured the Board that the Quality Improvement Programme had been implemented and was progressing well with a focus on the root cause analysis, raising awareness and accountability.   Pressure ulcers and falls in the acute setting remained low.

 

Nerve Centre - The roll out of the Nerve Centre programme had been successful and very well received with staff seeing real patient safety benefits.

 

Julie Soutter, Non-Executive Director enquired about the status on rolling out whiteboards.  Julie Marshman, Chief Nurse replied that these had been fully implemented and whiteboard were in use.  Guy Rooney, Medical Director added that with the introduction of Nerve Centre the use of these would change. 

 

Nick Bishop, Non-Executive Director asked why escalation with the Nerve Centre did not include the Consultant body.  Guy Rooney,  ...  view the full minutes text for item 164/18

165/18

Chair of Quality & Governance Committee Overview pdf icon PDF 188 KB

Nick Bishop, Non-Executive Director

Minutes:

The Committee received a report from the Chair of the Quality & Governance Committee which summarised key issues considered by that Committee at meetings held on 19 July and 23 August 2018.  In particular to note was the quality and service improvements for dementia with the recruitment of 134 dementia champions within the Trust, the funding secured for a two year pilot for a specialist nurse, and the results of a bed audit.  Guy Rooney, Medical Director added that with the introduction of the Nerve Centre updating of bed boards would be instantaneous.

 

Roger Hill, Chairman asked about the Freedom to Speak Up initiative.  Carole Nicholl, Director of Governance & Assurance replied that new guidance had been received in May and July 2018 introducing a self-assessment tool to be completed by end August 2018 and reviewed by NHS Improvement in September 2018.  The Quality & Governance Committee had had oversight of the self-assessment and had concluded that although there was a robust system some further strengthening was welcomed.  There would be a further update in October 2018 with a refreshed policy.  A half yearly report would be presented to the Board in November or December 2018.

 

RESOLVED

 

that the report be received and it be noted that the Quality & Governance Committee will continue to scrutinise and challenge the delivery of actions to drive improvements.

166/18

Operational Performance Report pdf icon PDF 273 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%)                         July 91.8%                 Under achieved

(combined - ED, MIU & UCC)                     

 

RTT Incomplete standard (92%)                June 86.82%              Under achieved*

 

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

% delivery.

 

6 Week Diagnostic Wait (99%)                   June 78.9%                Under achieved

 

Cancer Targets:                                        June

 

2 Week Waits (93%)                                   94.9%                        Achieved

2 Week Wait Breast Symptomatic (93%)     98.6%                        Achieved

31 Day Treatment (96%)                             100%                         Achieved

62 Day Treatment (85%)                             93.6%                        Achieved

 

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

 

ED 4 Hour Performance – Overall number of attendances for July 2018 was high and a deep dive to understand why was being undertaken with commissioners.  Figures for August 2018 showed a dip back to normal anticipated activity. 

 

Cancer Performance - All targets had been met however it was noted that the 62 day standard would take an anticipated significant dip in due to the urology roll over of patients and would be back on track in Q3.  It was noted that a 70 day review marker for longer waiters had been introduced and this was monitored on a weekly basis. 

 

Stroke Performance - A recovery plan was in place and actions were progressing to drive improvements. 

 

Referral to Treatment Time (RTT) - Performance in July 2018 was above trajectory as agreed with NHS Improvement (NHSI) but was below the national standard.  The two areas not achieving were admitted and non-admitted.  Non-admitted was largely due to dermatology seasonal issues and was anticipated to be back on track by October 2018.  However admitted remained a challenge going into the winter period.  A recovery plan was in place.

 

Julie Soutter, Non-Executive Director acknowledged that dermatology was a national issue as skin problems were on the increase and there was a shortage of staff, however she asked how the Trust benchmarked nationally.  Jim O’Connell, Chief Operating Officer did not have this information to hand and undertook to report this detail to the Performance, People & Place Committee.  There followed a discussion on creating a single service and building on the community services  linking in with partners to help manage the pressures.  Nick Bishop, Non-Executive Director asked if the pressures came from the RUH, Bath not accepting certain dermatology referrals.  Jim O’Connell, Chief Operating Officer responded that he would explore this further and report back.

 

Medically Fit for Discharge Patients - The figure remained at 50 patients.  Work was underway to review the integrated discharge service to ensure it was fit for purpose to manage capacity and demand.  It was noted that the Performance, People & Place Committee had requested a detailed report on night moves for assurance that late transfers were appropriate.  Julie Marshman, Chief Nurse added that there was strict national standard operating procedures for transferring patients after  ...  view the full minutes text for item 166/18

167/18

The Winter Plan 2018/19 pdf icon PDF 264 KB

Jim O’Connell, Chief Operating Officer

Additional documents:

Minutes:

The Board considered the Winter Plan for 2018/19.  The Plan had been developed early this year to give as much time as possible to design and implement changes to cope with the anticipated increases in patient acuity associated with the winter period.   There were10 key work streams to support the plan; 5 Business as Usual, 5 Winter Impact. 

 

Jim O’Connell, Chief Operating Officer described each work stream and the actions in place in detail.  It was noted that, in discussions with Karen Johnson, Director of Finance, the funding set aside had been increased to £1.455m, although it was acknowledged that this would not cover all the schemes proposed. 

 

Roger Hill, Chairman asked if the extra funding had been within the forecast.  Karen Johnson, Director of Finance replied that the winter cost contingency had been set at £1m therefore forecast was being remodelled to support the extra funding.  Andy Copestake, Non-Executive Director added that the Trust could not afford this extra funding and he questioned whether there was any potential for further monies from the commissioners.  Karen Johnson, Director of Finance replied that this was not likely as this was classed as internal investment, however she would report to NHS Improvement the additional cost pressure.

 

Julie Soutter, Non-Executive Director noticed the comment under IT enabler that the key was to replace old hardware and asked was there any funding.  Jim O’Connell, Chief Operating Officer replied that there was a small amount in the plan however this had focussed on the introduction of the Nerve Centre project planned to go live in October 2018.  Karen Johnson, Director of Finance added that there was a replacement programme in place.  Julie Soutter, Non-Executive Director asked if there were any capital bids.  Kevin McNamara, Director of Strategy and Community Services replied yes and that there were plans to submit bids.

 

Nick Bishop, Non-Executive Director was pleased to see the plans earlier and that these were good however he did not see primary care referenced and the link to reducing admissions.  Kevin McNamara, Director of Strategy and Community Services responded that the outcomes of the End of Life care would pick up stranded patients and Medically Fit for Discharge patients.  However he would raise this at the next A&E Delivery Board, together with ensuring primary care were involved in the frailty pathway at the front door scheme.  Paul Lewis, Non-Executive Director suggested determining a critical path for additional assurance of successful delivery.  Jim O’Connell, Chief Operating Officer said that any critical deviation would be reported to the Performance, People and Place Committee.

 

Peter Hill, Non-Executive Director commended this piece of work as it demonstrated great engagement both internally and externally.

 

Julie Soutter, Non-Executive Director asked about the timescales around the flu vaccinations campaign.  Julie Marshman, Chief Nurse replied that this commenced when the vaccine was received.  Guy Rooney, Medical Director added that this year the vaccine would cover both A&B flu virus strains and that an early turnaround of testing by Pathology would be  ...  view the full minutes text for item 167/18

168/18

Nursing, Midwifery and Allied Health Professional - response to the Five Year Forward View pdf icon PDF 286 KB

Julie Marshman, Chief Nurse

Minutes:

The Board considered a paper which described the nursing, midwifery and allied health professional response to the Five Year Forward View, Leading Change, Adding Value, and Better Births.  The paper summarised five commitments on which the professional groups would deliver.  The work streams focussed on improving patient safety and experience whilst also investing in and developing the workforce.

 

Paul Lewis, Non-Executive Director welcomed the models which included NHS patient experience and asked if there were any plans to use the framework to collate more information on patient experience.  Julie Marshman, Chief Nurse replied that this focussed mainly on patients with learning disabilities; however a broader agenda would take forward a broader patient experience.

 

RESOLVED

 

that the strategy be supported to proceed across clinical areas and Divisions.

169/18

Safer Staffing - 6 monthly skill mix review pdf icon PDF 398 KB

Julie Marshman, Chief Nurse

Minutes:

The Board considered a paper that advised by exception of potential changes required following the nursing and midwifery 6 monthly skill mix review.  The key items to note were:-

 

·         A number of proposals were being worked up for the Business Investment Group (BIG)

·         A number of minor changes were being managed within Divisional budgets

·         Other proposals were being scoped.

 

RESOLVED

 

that the Board noted the contents of the report.

170/18

Safer Staffing Bi-Monthly Exception Report pdf icon PDF 447 KB

Julie Marshman, Chief Nurse

Minutes:

The Board considered a report which provided the bi-monthly exception reporting of the Care Hours per Patient Day (CHPPD) in line with NHS Improvement’s requirements for reporting from July 2018.  As CHPPD would vary from month to month this would be shown in trend charts.  As this was the first month that CHPPD had been the primary reporting matrix, a trend chart for fill rate had been included. 

 

The key highlights were:-

 

·         In July 2018 the Trust reported CHPPD of 7.5 hours.

·         The fill rate for care staff numbers overnight remained above 100% due to care staff role gaps. 

·         Fill rates had remained stable.  However in July there was a sharp fall in the day fill rate for care staff due to new NHSI guidelines.

·         The quality indicators have remained stable with a slight increase in call bell response time

 

RESOLVED

 

that the report be noted.

171/18

Mental Health Governance Committee Annual Report 2017/18 pdf icon PDF 171 KB

Julie Marshman, Chief Nurse

Additional documents:

Minutes:

Julie Marshman, Chief Nurse presented the Mental Health Governance Committee Annual Report for 2017/18 and highlighted:-

 

·         The list of key achievements in 2017/18 notably staff training and education,

·         The award for Psychiatric Liaison Accreditation Network,

·         The development of a dashboard demonstrating good assurance against the matrix,

·         Established  formal Mental Health work plans,

·         The good working relationship between the Trust and Avon & Wiltshire Mental Health Partnership (AWP).

 

Julie Soutter, Non-Executive Director asked about the timing of the report in relation to the Quality Account in the Annual Report. Julie Marshman, Chief Nurse replied that this was produced at the same time and delay was due to the report going through the correct governance process.

 

Nick Bishop, Non-Executive Director wished to thank the Mental Health Team, particularly Wendy Johnson and commended the high achievement of staff around their mandatory training.

 

Jim O’Connell, Chief Operating Officer asked about Children and Adolescent Mental Health Service (CAMHS) in relation to an overnight service and the Trust’s flow.   Julie Marshman, Chief Nurse replied that Oxford Health Trust had been awarded the contract for Swindon, Wiltshire and BaNES and they were doing excellent work.  However there was a limited out of hours service and acute trusts’ were deemed as a safe place.

 

RESOLVED

 

that the report be noted.

172/18

Responsible Officer's Annual Board Report on Appraisal and Revalidation pdf icon PDF 111 KB

Guy Rooney, Medical Director

Additional documents:

Minutes:

Guy Rooney, Medical Director presented the report which provided an overview of the Trust’s revalidation and assurance that all the statutory duties had been met.  Highlights were as follows:-

 

·         There had been a growth to the number of doctors attached to the hospital.

·         Consultants continued to meet the national completion rate, however there had been a significant improvement for both SAS doctors and other doctor groups.

·         There had been an increase in unapproved delays however this was a small number and would be completed within 15 months.

·         Public attendance had been strengthened by regular attendance of governors to committee meetings.

·         Quality assurance had been maintained by the reading of every appraisal as opposed to other Trusts who do a sample.

·         An action plan was being developed for further improvement.

 

Carole Nicholl, Director of Governance & Assurance was pleased to see that mandatory training had been included in the check list as well conflicts of interest registration.

 

RESOLVED

 

(a)           that the Board note and accept the summary;

 

(b)           that it be agreed that the Chairman or the Chief Executive be authorised to sign the statement of compliance on behalf of the Board.

173/18

Ratification of Decisions made via Board Circular/Board Workshop

Carole Nicholl, Director of Governance & Assurance

Minutes:

It was noted that the Policy on Policies circulated via Board circular in August had been approved by the Board and Directors were asked to ratify this decision.

 

RESOLVED

 

that approval of the Policy on Policies be ratified.

174/18

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.

175/18

Date and Time of next meeting

Date: 4 October 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 4 October 2018 at 9:30am in Trust Management Boardrooms, Trust HQ, 2nd Floor, Great Western Hospital, Swindon.

176/18

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.

 

177/18

Minutes

Roger Hill, Chairman

·        5 July 2018 (private)

·        28 June 2018 – Joint Board & Council of Governors’ Meeting (private minutes)

178/18

Outstanding Actions of the Board (Private)

179/18

Monthly Review

Roger Hill, Chairman

180/18

Entonox briefing

Dr Guy Rooney, Medical Director

Kevin McNamara, Director of Strategy & Community Services

181/18

Executive Committee

Nerissa Vaughan – Committee Chair

·        21 August 2018 (verbal)

·        17 July 2018 (enclosure)

182/18

Finance and Investment Committee

Steve Nowell – Committee Chair

·        28 August 2018 (written report)

·        23 July 2018 (enclosure)

183/18

Joint Nominations Committee

Carole Nicholl, Director of Governance & Assurance

·        20 August 2018 (verbal)

184/18

Performance, People & Place Committee

Peter Hill – Committee Chair

·        29 August 2018 (written report)

·        25 July 2018 (enclosure)

185/18

Quality & Governance Committee

Nick Bishop - Committee Chair

·        23 August 2018 (written report)

·        19 July 2018 (enclosure)

186/18

Urgent Business (Private) - Tribunal

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