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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

187/18

Apologies for Absence and Chairman's Welcome

Roger Hill, Jim O’Connell

Minutes:

The Chair welcomed all to the Great Western Hospitals Foundation Trust (GWHFT) Board meeting held in public, particularly members of the public, which included 2 Chief Registrars observing a Board meeting, and, governors. It was noted that Simon Barson, Divisional Director was deputising for Jim O’Connell, Chief Operating Officer. 

 

Apologies for absence were received as outlined above.

 

188/18

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.

189/18

Questions from the public to the Board relating to the work of the Trust pdf icon PDF 308 KB

Minutes:

The Board received questions from the public and noted the responses. 

 

Jemima Milton, Non-Executive Director raised a concern with regard to the timing in answering the Caesarean Section question which was raised 6 weeks ago.   Guy Rooney, Medical Director gave a verbal response and confirmed that all maternity services were available whether emergency or elected and followed NICE guidelines.  On average 20-25 C-sections were performed every year which were in line with national figures.

 

RESOLVED

 

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

190/18

Minutes pdf icon PDF 434 KB

Peter Hill, Deputy Chairman

·        6 September 2018 (public and summary of private minutes)

Minutes:

The minutes of the meeting of the Board held on 6 September 2018 were adopted and signed as a correct record, subject to the following amendment:-

 

161/18  :  Finance Report  :  Page 10 :  4th bullet point  :  change the word ‘asked’ to ‘informed the Board that CQUINs….’.

 

191/18

Outstanding actions of the Board (public) pdf icon PDF 255 KB

Minutes:

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

 

131/18 – Finance Report / Control Target  :  It was noted that the Regional Director of Finance, NHS Improvement (NHSI) had acknowledged receipt of the letter sent with regard to The Trust’s PFI (Private Finance Initiative) /control target and would arrange a time to discuss this further at a later stage.

 

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

 

192/18

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 5, 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 represents the Trust Control Total only.

In month deficit of £1,356k compared to a target deficit of £1,274k. Year to date (YTD) deficit of £6,043k compared to planned deficit of £5,894k. Year to date variance £150k.

NHS Clinical Income

£23.3m in month and £116.1m YTD (£0.321m above plan YTD)

 

Total Income

£26.6m in month and £129.6m YTD (£1.2m above plan YTD)

 

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

·         Elective inpatients above plan

·         Day case activity above plan

·         Non-elective above plan

·         Outpatient appointments on plan

·         A&E above plan

 

Total Operating Expenditure

 

£26.1m in month and £126.1m YTD (£1.4m above plan YTD)

Expenditure highlights in month:

·         Drugs £0.1m above plan (£0.8m above plan ytd)

·         Pay is £0.2m above plan (£0.8m above plan ytd)

·         Supplies £0.2m above plan (£0.6m above plan ytd)

·         Other Costs £0.2m above plan (£0.9m below plan ytd)

 

EBITDA

2.7% YTD which 0.2% below plan

 

Savings

Savings plan of £11.611m of which £8.1m forecast to be delivered

£0.553m CIPS delivered in month against a plan of £0.925m.

 

Debtors

£41.1m debtors and stock

£5.3m above plan

 

Creditors

£59.8m creditors and borrowings

£9m above plan

Cash

£5.8m

£1.7m above 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).

 

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

 

·         Month 5 closed £149k behind plan; however the Q2 Provider Sustainability Fund (PSF) was on track to be delivered.  The main change in the pay bill was the payment of Agenda for Change back pay and there was a small reduction in agency costs.  Cost Improvement Programmes (CIPs) had improved marginally but year to date continued to be off plan.  Activity performance was also over plan.

 

·         The pressures were consistent with those that had been present throughout the financial year and the national finances showed a similar picture, with the main drivers also being pressures relating to costs of temporary staffing to cover vacancies and slippage on savings.

 

·         Overall the Trust’s financial position had not improved in August 2018.  With a £3m gap on the savings programme and without any significant change to business as usual, this position was expected to continue and the financial pressure would continue to grow.  The regulators were aware of the position although a deviation from target had not been reported formally as the Trust was looking to mitigate through an internal Financial Recovery Plan.

 

Jemima Milton, Non-Executive Director asked why Waiting List Initiative (WLI) spend was lower than run rate in July.  It was clarified that the WLI had not been undertaken due to Consultant leave and therefore no overtime payments applied.

 

Nick Bishop, Non-Executive Director asked for clarification on achieving the Provider Sustainability Fund (PSF).  Karen Johnson,  ...  view the full minutes text for item 192/18

193/18

Quality Report pdf icon PDF 112 KB

Julie Marshman, Chief Nurse

Dr Guy Rooney, Medical Director

·        Mortality Statistics Reporting

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 August 2018 were as follows: -

 

·         Provisional HSMR for June 17 – May 18 is 99.7

·         5 cdiff cases attributed to GWH in August 2018

·         1 Never Event has been reported during August 2018

·         A further 2 Serious Incidents have been reported

·         Clinical Incident overdue >90 days is gradually decreasing

·         There is a total of 51 overdue complaints responses as of the end of August 2018

·         There were 9 low/medium reopened complaint cases during August 2018

 

In presenting the report the following were highlighted:-

 

Hospital Standardised Mortality Rate (HSMR) – The HSMR looked at the average figure which remained running at 100 even though this figure had been better since April 2018.  The Trust was in the mid-range of the region.

 

The Trust’s SHMI looked at a different set of data and reflected a broader picture, and gave the Trust a ‘Better than Expected’ rating. 

 

Learning from Deaths Mortality Review - There were no unavoidable deaths reported during Q1.  The main lesson learnt in all hospitals across the West of England had been the need to introduce end of life care sooner and a focussed piece of work has been started by the West of England Academic Health Science Network (AHSN).

 

National Clinical Audits –. The audit programme had remained on schedule with the national projects, with the exception of the National Diabetes Audits. These had a delayed status due to the methodology of the data collection and the requirement to purchase new IT equipment. 

 

Infection Prevention and Control  There were 5 cases of Clostridium Difficile during August 2018.  An intensive investigation had been undertaken with an action plan developed by the new lead for infection control.

 

Never Event / Serious Incidents    A surgical Never Event was reported during August 2018 by using a wrong prosthesis for fractures.  A full investigation was underway and would be shared once completed.

 

There were 2 further serious incidents reported which were both category IV Pressure Ulcers and although a good emerging picture of improvements and strengthened awareness was taking hold through the Quality Improvements Regime this was hidden by continuous incidents.

 

Safeguarding  The quarterly report for safeguarding adults which detailed the alerts raised.  All alerts were fully investigated and quality improvement programmes put in place.

 

There was an improvement seen for level 1, 2 and 3 for Quarter 1 in the safeguarding children mandatory training; however it was disappointing to see a decline in compliance for June 2018 for levels 2, 3 and specialist training level 3. Assurance had been sought from the safeguarding and divisional teams to ensure this was actioned appropriately and improvement sustained, particularly in respect of identifying appropriate staff to complete level 3 training rather than a blanket approach.

 

Peter Hill, Deputy Chair asked for confirmation of which groups of staff would not undertake level 3 training.  Julie  ...  view the full minutes text for item 193/18

194/18

Operational Performance Report pdf icon PDF 273 KB

Simon Barson, Divisional Director Unscheduled Care

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%)                         August 93.6%             Under achieved*

(combined - ED, MIU & UCC)                                

 

 

RTT Incomplete standard (92%)                August 87.2%             Under achieved*

                                                                                                          

 

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

% delivery.

 

 

6 Week Diagnostic Wait (99%)                   July 83.62%               Under achieved*

 

Cancer Targets:                                        July

 

2 Week Waits (93%)                                   93.6%                        Achieved

2 Week Wait Breast Symptomatic (93%)     94%                           Achieved

31 Day Treatment (96%)                             98%                           Achieved

62 Day Treatment (85%)                             76.7%                        Under achieved*

 

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

 

ED 4 Hour Performance – The Trust met its trajectory target as agreed with NHSI for July 2018.  August 2018 was a challenging month due to the increase in attendance, primarily due to injuries.  September’s position showed an improvement and therefore the ED would hit its trajectory for the quarter.

 

Referral to Treatment Time (RTT) -  RTT had not meet its trajectory. The 52 WW breach related to corneal graft surgery.  The Trust was working in conjunction with Salisbury hospital and all patients now had a time and date for operations with a reduction anticipated by the year end.  The 6 WW under performance concerned ultrasound, MRI and CT scans and a recovery plan was in place to achieve trajectory by March 2019. 

 

Cancer Performance  -  All targets had been met however the concern remained around urology, colorectal and gynaecology.  In-house improvement plans were in place.  It was noted that the regional picture was also one of challenge to deliver targets.

 

Stroke Performance  -  The Trust had improved its SSNAP from level E to D.  It was recognised that this was the first time in 2 years and the Trust was now working towards an action plan to move to level C.

 

Diagnostics    -  Karen Johnson, Director of Finance advised the Board that a formal contract notice had been issued by the CCG around DM01 performance.  An action plan was in place.

 

Swindon Community Health Services  -  As there was a Board workshop following this meeting focussing on community there were no further comments to add to the report.

 

RESOLVED

 

that the report be received and the on-going plans to maintain and improve performance be accepted, acknowledged and supported.

195/18

Chair of Performance, People & Place Committee Overview pdf icon PDF 201 KB

Peter Hill, Non-Executive Director

Minutes:

The Board considered a report which summarised the key issues from the Performance, People & Place (PPP) Committee meeting hold on 25 July and 29 August 2018.

 

The Chair of PPP Committee commended the improvement in stroke performance and congratulated the team on their efforts and looked forward to seeing further improvements.

196/18

Gosport Inquiry - impact for this Trust pdf icon PDF 279 KB

Dr Guy Rooney, Medical Director

Minutes:

The Board considered a paper which provided an overview of the Gosport Inquiry along with an overview of the key processes in place at the Trust to provide oversight and assurance. 

 

The Gosport Independent Inquiry was published into the Gosport War Memorial Hospital in which a Doctor continually prescribed drugs without medical justification above the recommended levels for patients. This led to 456 patients having an early death between 1989 and 2000. The report stated that there was institutionalised practice of shortening of lives taking place within the hospital. Although staff reported this practice it did not lead to a review or monitoring of practice in an open and transparent way.

 

There were no recommendations for other NHS organisations however the Trust undertook a self-assessment which covered the present and previous years and nothing had been highlighted as a concern, however an action plan to further strengthen processes going forward had been put in place.

 

Peter Hill, Deputy Chair commented that this was a helpful briefing and would be reviewed in more detail at the Quality & Governance Committee. 

 

Andy Copestake, Non-Executive Director commented that there had been a thorough investigation and robust processes were in place however asked what would stop this in the first place.   Dr Guy Rooney, Medical Director said there were some patients who required opiates particular at end of life and it was a case of empowering the use of rules as well as relying on staff to know what appropriate and inappropriate dosage was.  It was noted that with the introduction of electronic prescribing (EPMA) it would be more prescriptive on what was written.

 

Below is the link to access the full report.

https://www.gosportpanel.independent.gov.uk/media/documents/070618_CCS207_CCS03183220761_Gosport_Inquiry_Whole_Document.pdf

 

RESOLVED

 

(a)        that the Board notes and accepts the summary; and

 

(b)        that the Board notes the recommendations being taken forward.

197/18

Ratification of Decisions made via Board Circular/Board Workshop

Carole Nicholl, Director of Governance & Assurance

Minutes:

None.

198/18

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.

199/18

Date and Time of next meeting

Date: 1 November 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 1 November 2018 at 9:30am in Trust Management Boardrooms, Trust HQ, 2nd Floor, Great Western Hospital.

 

200/18

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.

 

201/18

Minutes

Peter Hill, Deputy Chairman

·        6 September 2018 (private)

202/18

Outstanding Actions of the Board (Private)

203/18

Rightsizing hospital capacity: planning for the future

Kevin McNamara, Director of Strategy & Community Services

204/18

Audit, Risk and Assurance Committee

Julie Soutter – Committee Chair

·        13 September 2018 (verbal report)

·        12 July 2018 (enclosure)

205/18

Charitable Funds Committee

Jemima Milton – Committee Chair

·        26 July 2018 (enclosure)

206/18

Executive Committee

Nerissa Vaughan – Committee Chair

·        (meeting on 18 September cancelled)

·        21 August 2018 (enclosure)

207/18

Finance and Investment Committee

Steve Nowell – Committee Chair

·        24 September 2018 (verbal report)

·        28 August 2018 (enclosure)

208/18

Performance, People & Place Committee

Peter Hill – Committee Chair

·        26 September 2018 (verbal report)

·        29 August 2018 (enclosure)

209/18

Quality & Governance Committee

Nick Bishop - Committee Chair

·        20 September 2018 (verbal report)

·        23 August 2018 (enclosure)

210/18

Urgent Business (Private) (if any)

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