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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

211/18

Apologies for Absence and Chairman's Welcome

Karen Johnson, Caroline Coles

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.  It was noted that Anne-Marie Howroyd, Deputy Director of Finance was representing Karen Johnson, Director of Finance.

 

Apologies for absence were received as outlined above.

212/18

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.

213/18

Questions from the public to the Board relating to the work of the Trust pdf icon PDF 292 KB

Minutes:

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

 

RESOLVED

 

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

 

214/18

Minutes

Roger Hill, Chairman

·        4 October 2018 (public minutes)

Minutes:

The minutes of the meeting of the Board held on 4 October 2018 were adopted and signed as a correct record, subject to the following amendment:-

 

193/18  :  Quality Report – Safeguarding  : 3rd paragraph / 1st line amend “would not undertake” to “ did not require”.

215/18

Outstanding actions of the Board (public) pdf icon PDF 244 KB

Minutes:

The Board received and considered the outstanding action list. 

 

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

216/18

Chairman's Report, Feedback from the Council of Governors

Roger Hill, Chairman

Minutes:

The Chairman gave a verbal report as follows: -

 

Annual Members Meeting – This was held on 24 September 2018 reporting on past performance, looking forward and celebrating achievements in 2018/19, which included a presentation from Dr Sarah Bates, Consultant Paediatrician & Neonatologist.

 

Governor Elections  -  Elections had taken place in October 2018 and the results were confirmed.  It was noted that two public governors’ terms of office had come to an end and thanks and best wishes were extended to Margaret White and Penny Bowen for their support over their time as governors.  The Board noted the new governor appointments and re-appointments as follows:-

 

Jane Turner - West Berkshire and Oxfordshire Public Constituency,  new appointment

Janet Jarmin - Wiltshire Central Public Constituency, re-appointment

EnamChowdhury - Wiltshire Northern Public Constituency, new appointment

Pauline Cooke - Wiltshire Northern Public Constituency – re-appointment

 

RESOLVED

 

that the report of the Chairman be received.

217/18

Chief Executive's Report pdf icon PDF 174 KB

Nerissa Vaughan, Chief Executive

Minutes:

The Board received and considered a report from the Chief Executive and the following was highlighted:-

 

·        The 23 new trainee Nursing Associates who joined the Trust recently.

·        The older patients’ pathway, following a successful pilot, would now be shared with care homes and in the community over the coming months.

·        An Allied Health Professionals (AHPs) event was held on 15 October 2018 to celebrate  AHPs.

·        The introduction of new Cooling Caps for chemotherapy patients.

·        The procurement collaboration between the Trust and Salisbury Hospital as part of the Sustainability and Transformation Partnership.

·        The commencement of the 2018 flu vaccination programme.

 

Nick Bishop, Non-Executive Director noted that Radiographers and Optometrist were not mentioned in ‘celebrating national AHPs day’.  Julie Marshman, Chief Nurse confirmed that they were included in the day, together with the other professional groups.  Jim O’Connell, Chief Operating Director added that later in the year there was a National Radiologists Day and this would be also be celebrated.

 

RESOLVED

 

that the report of the Chief Executive be received.

218/18

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 6, 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 £1,436k compared to a target deficit of £1,629k.Year to date deficit of £7,479k compared to planned deficit of £7,523k. Year to date variance £44k surplus.

NHS Clinical Income

£22.9m in month and £139m YTD (£0.269m below plan YTD)

Total Income

£25.8m in month and £155.4m YTD (£0.95m above plan YTD)

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

·        Elective inpatients above plan

·        Day case activity on plan

·        Non-elective below plan

·        Outpatient appointments below plan

·        A&E above plan

Total Operating Expenditure

 

£25.3m in month and £151.4m YTD (£0.916m above plan YTD)

Expenditure highlights in month:

·        Drugs £0.2m above plan (£1.1m above plan ytd)

·        Pay is £0.8m below plan (on plan ytd)

·        Supplies £0.4m above plan (£1m above plan ytd)

·        Other Costs £0.3m below plan (£1.1m below plan ytd)

EBITDA

2.6% YTD which is on plan

Savings

Savings plan of £11.611m of which £7.4m forecast to be delivered

£0.878m CIPS delivered in month against a plan of £0.990m.

Debtors

£38.2m debtors and stock

£3.8m above plan

Creditors

£57m creditors and borrowings

£6.9m above plan

Cash

£5.5m

£1.2m 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).

 

Anne-Marie Howroyd, Deputy Director of Finance highlighted the following:-

 

·        The financial position at the end of month 6 was slightly better than planned and therefore the Trust had achieved PSF for Quarter 2 (Q2).

·        The forecast had deteriorated by £1m which was £3.6m worse than plan this was mainly due to pressures on delivery of CIPs.

·        Although the underlying key variances remained consistent with previous months contract,

income had reduced in month and was also below the expected level. This variance mainly related to Non Elective Activity and the likely reasons due to September having fewer weekends and the month end falling on a Sunday.

·        Expenditure in some areas had reduced in month and along with the release of a central provision had off set the under performance.

·        The pay bill had reduced from August as payment of Agenda for Change back pay was in the prior month position.  Agency had increased slightly. Although pay spend was within budget, pressures continued due to the winter period

·        CIP delivery in month had improved but still presented a challenge.

 

It was noted that although the Q2 financial control total had been achieved the overall financial position had not changed.

 

Roger Hill, Chair asked for a view on the cash flow forecast.  Anne-Marie Howroyd, Deputy Director of Finance replied that currently this was in line with plan however the challenge was the assumption of achieving the Sustainability and Transformation Fund (STF) in  ...  view the full minutes text for item 218/18

219/18

Chair of Finance & Investment Committee Overview pdf icon PDF 198 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 24 September and 22 October 2018 which it was considered should be drawn to the attention of the Board and highlighted the following:-

 

·        A deep dive had been undertaken on each Cost Improvement Programme (CIP) which had resulted in a reduction against some of the schemes.

·        The Long Term Financial Model (LTFM) was discussed which would be updated on a monthly basis.

·        Agency spend performance, which was positive in that it had decreased significantly since last year.  However, the second half of the year would see continued pressures particularly during the winter period.

·        The Ophthalmology project which would be reviewed again particularly around sustainability and the outcome of the external review.

·        The 5 year capital plan which particularly focussed on the challenges and risks around the capital programme and concluded that a further review of the allocation  £3m capital budget would be undertaken.

 

RESOLVED

 

that the report be received.

220/18

Chair of Audit, Risk & Assurance Committee Overview pdf icon PDF 175 KB

Julie Soutter, Non-Executive Director

Minutes:

The Board considered a report which summarised the key issues from a meeting of the Audit, Risk & Assurance Committee held on 13 September 2018, and highlighted that the internal auditors were currently refreshing the audit plan.

 

RESOLVED

 

that the report be received.

221/18

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 November were as follows: -

 

Hospital Standardised Mortality Rate (HSMR) / Summary Hospital-level Mortality Indicator (SHMI) – It was noted that the SHMI better reflected the overall mortality rates of the Trust.  It was noted that the National Confidential Enquiry into Patient Outcome and Death (NCPOD) Non-invasive ventilation was the first report and the author was Dr Mark Juniper, Consultant in Respiratory and Critical Care Medicine at GWH FT which highlighted the great work accomplished at the Trust. 

 

Andy Copestake, Non-Executive Director observed that the Standardised Hospital Mortality Indicator (SHMI) had been referred as an “experimental” official statistic.  Guy Rooney, Medical Director clarified that both HSMR and SHMI indicators were still used and that the data was continually improving.

 

Infection Prevention and Control – There was 1 Clostridium Difficile reported in September however there were no cases reported in October and therefore the initiatives that had been put in place were now showing a positive impact but this would be an area to watch.

 

The Trust-wide flu vaccination campaign had commenced in September 2018 and the aim was to achieve 95% uptake.

 

Complaints, Concerns  and Compliments -  Concerns had increased slightly but complaints had decreased which was where the Trust wanted to be as concerns were resolved much quicker and did not lead to more formal complaints.

 

The number of overdue complaints was being monitored carefully, however it was recognised that the Trust’s deadline was 25 days, which was a much quicker turnaround than other trusts normally 40 days.

 

Julie Marshman, Chief Nurse advised that there had been further incident following the Never Event.  Julie Marshman explained that following the Never Event a complete review of past forearm fracture plates had been undertaken and as a result no further incidents were now expected.   Full Duty of Candour with all patients affected had taken place and a root cause analysis investigation underway.  Roger Hill, Chair asked what this procedure was.  Julie Marshman, Chief Nurse replied that the plate secured a fracture while it healed.  Findings from investigations to date had been shared with national bodies and suppliers of the plates who were supportive of the Trust’s thorough and robust review.  Paul Lewis, Non-Executive Director asked what the feedback from patients and families had been.  Julie Marshman, Chief Nurse responded that this process was still on-going and therefore she could not comment at this stage.

 

RESOLVED

 

(a)   that the quality matters and exceptions contained within the report be noted;

 

(b)   that it be agreed that the Quality Report provides assurance of progress towards quality improvements and quality indicators; and

 

(c) that the report be noted.

222/18

Chair of Quality & Governance Committee Overview pdf icon PDF 187 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 its meetings held on 20 September and 18 October 2018 and highlighted the excellent training video developed by GWH FT staff about care and communication needs of learning disability patients, which would also be shared nationally. 

 

 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.

223/18

Operational Performance Report pdf icon PDF 270 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%)                        September 92.7%      Under achieved*

 

RTT Waiting List Size 21,256 against a 21,063

Trajectory (August)                                                                         Failing*

 

                                                                                                          

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

% delivery.

 

 

6 Week Diagnostic Wait DM01 (99%)       August 75.13%         Under achieved*

 

Cancer Targets:                                            August

 

2 Week Waits (93%)                                        94.8%                 Achieved

2 Week Wait Breast Symptomatic (93%)           96.7%                 Achieved

31 Day Treatment (96%)                                  92.6%                 Failing*

62 Day Treatment (85%)                                  84%                   Failing*

 

Stroke Direct Admissions(90%)                           81%                     Failing*

Stroke Direct Admissions within 4 hours (90%)   53%                     Failing*

 

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

 

A&E  -  Performance had continued the trend of being circa 5% better than the position last year in September 2018.  However October’s performance was lower due to the closure of Dorcan ward, increased attendances and many days of Operational Pressures Escalation Levels (OPEL) 4 with increased conversion to admissions. Also discharges were down due mostly to capacity issues with partners.  Although work streams were in place for stranded patients these had not had the impact as expected and therefore some aspects of the winter plan would be brought forward.

 

DM01  -   Performance was not where it needed to be, however there were good robust recovery plans in place and it was expected that performance improvement would be seen next month.

 

Cancer  -  Sustainable recovery for 62 day performance had yet to be achieved as there were 12 breaches reported, however it was noted that there had been more treatments so a larger denominator.

 

Stroke  -  Performance continued to improve.  The service was still scoring D on the SNAPP data however a robust action plan was in place to increase the level to C.

 

Referral to Treatment Time (RTT) – Reporting had now shifted to waiting list size and performance was improving.  Issues were mostly in non-admitted however this was expected to get back on track.

 

Nick Bishop, Non-Executive Director asked that with the mobile CT and MRI contract ending in October 2018 was there confidence that the request rate was achievable with the existing resources.  Jim O’Connell, Chief Operating Officer replied that pathways were changing constantly and therefore the Trust could revert back if necessary, however for now it was safe to take out this additional capacity.

 

Julie Soutter, Non-Executive Director asked what the definition of winter period was as the Trust was hitting OPEL 4 in October, and how this was aligned to predictions and planning.   Nick Bishop, Non-Executive Director added that the Trust saw more patients in July than in February.   Jim O’Connell, Chief Operating Officer replied that the Trust was not in winter all year round however in terms of July the peak was due to fractures in young people.  Nerissa Vaughan, Chief Executive added that capacity modelling  ...  view the full minutes text for item 223/18

224/18

Chair of Performance, People & Place Committee Overview pdf icon PDF 186 KB

Peter Hill, Non-Executive Director

Minutes:

The Committee received a report from the Chair of the Performance, People & Place Committee which summarised key issues considered by that Committee at its meeting held on 26 September 2018 and particularly highlighted the improvement in stroke performance and waiting list size.

 

RESOLVED

 

that the report be received and it be noted that the Performance, People & Place Committee will continue to scrutinise and challenge the delivery of actions to drive improvements.

225/18

Safer Staffing Bi-Monthly Exception Report pdf icon PDF 509 KB

Julie Marshman, Chief Nurse

Additional documents:

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.  In August and September 2018 the Trust reported CHPPD of 7.6 and 7.6 hours respectively.  The following was highlighted:-

 

·        Overall fill rate increased by 7%  which was the highest increase in last 12 months. This was due to a slight increase in September in most wards.

·        The Trust was in the lowest quartile in the National distribution report of CHPPD.

·        The paper provided assurance of safe staffing at a ward-base level and met the national reporting requirements.

 

Julie Soutter, Non-Executive Director asked about the slight increase in wards and if there were any themes.  Julie Marshman, Chief Nurse replied that this was total reporting (open areas) and could be due to the requirement for close support.  This figure was expected to move up and down.

 

Steve Nowell, Non-Executive Director asked about day rate fill for care staff.  Julie Marshman, Chief Nurse acknowledged that this was one to watch and to understand more.

 

Steve Nowell, Non-Executive Director asked why a few wards were raising incidents for staff shortages.  Julie Marshman, Chief Nurse indicated that these were red flags and as this was an exception report were highlighted.  It was recognised that Ambulatory Care Unit (ACU) had a slightly higher level of nurses than a ward area and this might triangulate with acuity, however this was carefully monitored and investigated to ensure shifts were run safe.

 

Peter Hill, Non-Executive Director congratulated staff on the improvement in responding to  call bells at 93%.  Julie Marshman, Chief Nurse agreed there was an overall improvement however this had recently deteriorated and was a constant challenge to achieve the internal target of 95%.

 

RESOLVED

 

that the report be noted.

226/18

Equality & Human Rights Annual Report 2018 pdf icon PDF 202 KB

Carole Nicholl, Director of Governance & Assurance

Additional documents:

Minutes:

The Board considered the Equality & Human Rights Annual Report for 2018 which set out the Trust’s response to the Public Sector Equality Duty (PSED) and Equality Act 2010.  It detailed equality information and workforce information, highlighting progress and key achievements the Trust had made in 218, along with objectives for 2019 – 2022.

 

Nick Bishop, Non-Executive Director praised the report, however thought the strap line could be improved.  

Action  :  Director of Governance & Assurance

 

The Board congratulated Carole Nicholl, Director of Governance & Assurance for a very informative report and all the work being progressed.

 

RESOLVED

 

(a)   that the report be received;

 

(b)   that the Board is assured that processes are in place to ensure on-going governance arrangements to support the Trust in achievement of the Trust’s equality and human rights objectives; and

(c) the Board approves the Equality and Human Rights Objectives for 2018-2011 as      set out in the report.

 

 (d)  that the strap line be revised to “Great Western Hospitals NHS Foundation Trusts expects its services and opportunities to be equally accessible to all irrespective of any protected characteristics”.

227/18

Freedom to Speak Up Bi-Annual Report pdf icon PDF 90 KB

Carole Nicholl, Director of Governance & Assurance

Additional documents:

Minutes:

The Board considered the Bi-Annual Freedom to Speak Up report from Carole Nicholl, Director of Governance & Assurance on behalf of the Freedom to Speak Up Guardians.  The report provided assurance that concerns were robustly managed in line with current best practice.  The following was highlighted:-

 

·        A new Executive Lead had been appointed

·        A number of new Guardians had been appointed

·        A recruitment campaign was underway for additional Guardians

·        A communications plan was being developed

·        The learning and improvements for 2018/19

 

Andy Copestake, Non-Executive Director commended the report which was acknowledged by other Non-Executive Directors. 

 

Steve Novell, Non-Executive Director asked if BME statistics for Serco were included in the report.  Carole Nicholl, Director of Governance & Assurance replied that she would need to check tthis with HR. 

Action  :  Director of Governance & Assurance

 

Guy Rooney, Medical Director added that there were other mechanisms to speak up within the Trust.

 

RESOLVED

 

(a)        that the report be received,

 

(b)        to check whether SERCO staff were included in the report.

228/18

CQC Registration Annual Update pdf icon PDF 96 KB

Carole Nicholl, Director of Governance & Assurance

Minutes:

The Board considered a report providing an annual update on CQC registration and the following was highlighted:-

 

·        Following a regular quarterly review of GWH sites and services one possible registration of a Trust internal vehicle had been identified.  However on further investigation application was not required due to the use of the vehicle.

·        The Trust purpose of statement would be updated to list the vehicle as provision only.

·        The Trust remained fully compliant with its CQC registration without conditions.

 

RESOLVED

 

(a)      that the CQC registration update be acknowledged and agreed; and

(b)   that the update to the Trust  statement of purpose be acknowledged and agreed.

229/18

Report from West of England Health Science Network Board Meeting - September 2018 (to note) pdf icon PDF 156 KB

Dr Guy Rooney, Medical Director

Minutes:

The West of England AHSN Board report was presented to the Board for noting only.

230/18

Ratification of Decisions made via Board Circular/Board Workshop

Carole Nicholl, Director of Governance & Assurance

·        Approval of BUZ No. 7

Minutes:

The Board was requested to ratify the decision made via Board Circular for a loan agreement from the Department of Health as identified in the Trust’s annual plan for 2018/19.

 

RESOLVED

 

(a)   that the Board approves the terms of, and the transactions contemplated by, the Finance Documents to which the Trust is a party and resolves that the Finance Documents to which it is a party be executed;

 

(b)   that the Chief Executive or Director of Finance be authorised to execute the Finance Documents to which the Trust is a party on its behalf;

 

(c)   that the Director of Finance or the Deputy Director of Finance on the Trust’s behalf, be authorised to sign and/or despatch all documents and notices (including, if relevant, any Utilisation Request) and to be signed and/or despatched by the Trust under or in connection with the Finance Documents to which the Trust is a party, and;

 

(d)  the Trust will comply with the additional Terms and Conditions of the Loan as set out in Schedule 8.

231/18

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.

232/18

Date and Time of next meeting

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

233/18

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.

 

234/18

Minutes

Roger Hill, Chairman

·        4 October 2018 (private minutes)

235/18

Outstanding Actions of the Board (Private)

236/18

Monthly Review

Roger Hill, Chairman

237/18

STP Maternity Transformation Update

To be presented by Lucy Baker, Acting Director of Acute Commissioning, Wiltshire CCG and Sandra Richards, LMS Midwife, Wiltshire CCG (12.30pm)

238/18

15+ Risk Register / Management of Risk

Carole Nicholl, Director of Governance & Assurance

239/18

Board Assurance Framework

Carole Nicholl, Director of Governance & Assurance

240/18

IT & Digital Roadmap

Jim O’Connell, Chief Operating Officer

Manni Imiavan, Director of IT to attend (1.00pm)

241/18

Serco Hard FM Compliance

Kevin McNamara, Director of Strategy & Community Services

Rupert Turk, Director of Estates & Facilities to attend (1.15pm)

242/18

Guardian of Safe Working - 6 monthly update

Dr Guy Rooney, Medical Director

243/18

Executive Committee

Nerissa Vaughan – Committee Chair

·        16 October 2018 (verbal report)

244/18

Finance and Investment Committee

Steve Nowell – Committee Chair

·        22 October 2018 (written report)

·        24 September 2018 (enclosure)

245/18

Mental Health Governance Committee

Nick Bishop – Committee Chair

·        5 October 2018 (verbal report)

246/18

Performance, People & Place Committee

Peter Hill – Committee Chair

·        24 October 2018 (written report)

·        26 September 2018 (enclosure)

247/18

Quality & Governance Committee

Nick Bishop - Committee Chair

·        18 October 2018 (written report)

·        20 September 2018 (enclosure)

248/18

Remuneration Committee

Steve Nowell – Committee Chair

·        30 October 2018 (verbal report)

·        26 September 2018 (verbal report)

249/18

Urgent Business (Private) (if any)

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