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Agenda and draft minutes

Venue: Board Rooms, Trust HQ, Great Western Hospital, Swindon. View directions

Contact: Carole Nicholl  01793 605171

Items
No. Item

250/18

Apologies for Absence and Chairman's Welcome

Paul Lewis & Kevin McNamara

Minutes:

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

 

Apologies for absence were received as outlined above.

251/18

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.

252/18

Questions from the public to the Board relating to the work of the Trust pdf icon PDF 256 KB

Caroline Coles, Deputy Company Secretary

Minutes:

The Board received questions from the public which included a late submission as follows:-

 

“What progress has been made on commissioning an intensive rehabilitation service at GWH? Has a successful applicant been found (if so who)? And what will the service mean for the facilities at GWH (e.g. more building work)? “

 

A response was read out as below:-

 

“We have submitted a bid for national funding that would enable us to expand our Emergency Department and bed capacity, and to introduce an intensive rehabilitation facility– a facility that would be subject to a competitive procurement process.

 

We are hopeful that we will hear the outcome of this bid shortly and we can then move onto developing the case for how we will expand capacity.

 

In line with a transparent and full procurement process, GWH NHS FT held a pre-procurement supplier engagement event at GWH on Friday 28 September 2018.”

 

RESOLVED

 

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

253/18

Minutes pdf icon PDF 345 KB

Roger Hill, Chairman

·        1 November 2018 (public)

Minutes:

The minutes of the meeting of the Board held on 1 November 2018 were adopted and signed as a correct record.

254/18

Outstanding actions of the Board (public) pdf icon PDF 247 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.

255/18

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 7 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.

In month deficit of £1,005k compared to a target surplus of £382k.Year to date deficit of £8,484k compared to planned deficit of £7,141k. Year to date variance £1,343k deficit.

NHS Clinical Income

£24m in month and £163m YTD (£0.6m below plan YTD)

Total Income

£26.8m in month and £182.1m YTD (£0.8m above plan YTD)

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

·        Elective inpatients above plan

·        Day case activity above plan

·        Non-elective below plan

·        Outpatient appointments below plan

·        A&E above plan

Total Operating Expenditure

 

£25.8m in month and £177.2m YTD (£2.1m above plan YTD)

Expenditure highlights in month:

·        Drugs £0.3m above plan (£1.4m above plan ytd)

·        Pay is £0.1m above plan (£0.1m above plan ytd)

·        Supplies £0.3m above plan (£1.3m above plan ytd)

·        Other Costs £0.4m above plan (£0.7m below plan ytd)

EBITDA

2.7% YTD which was 0.8% below plan

Savings

Savings plan of £11.611m of which £7.7m forecast to be delivered

£0.6m CIPS delivered in month against a plan of £1.2m and forecast of £0.5m

Debtors

£39.1m debtors and stock

£3.8m above plan

Creditors

£55.9m creditors and borrowings

£7.8m above plan

Cash

£1.9m

£0.9m above plan

Loan

Loan drawdown of £4.171m in month in line with plan

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:-

 

·        The year to date position as month 7 was a deficit of £8,484k which was £1,343k above plan.

·        The in-month position for October was a deficit of £1,005k compared to £1,436k in the previous month.  The two drivers were income and non-pay; however this was subject to further investigation as the expectation was for non-pay to slow down as activity slowed down.  However staff reported that the hospital continued to be busy therefore length of stay could be a factor. 

·        Forecast was slightly behind due to income.  Detailed work was being carried out with Divisions to scrutinise the position and to clarify the level of risk.

·        In order to help protect from these fluctuations discussions were underway across the Sustainability and Transformation Partnership (STP) to agree a year end position.

·        There was still a small amount of reserves that had not been committed however the Trust was due to enter its busiest time which could put additional pressure on the system.

·        The cash position was being monitored carefully and the Trust continued to anticipate further borrowing in line with the Trust’s annual plan.

·        Regulators were aware of the deviation from the control target and were assured that the Trust were doing all to mitigate its position but recognised the challenges.  An internal financial recovery plan was being finalised, together with  ...  view the full minutes text for item 255/18

256/18

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) – The HSMR 12 month rolling figure for July 2018 was 99.85 which indicated a figure to end of the financial year of 101.23, which was in line with the expected national range.  The SHMI, which better reflected the overall mortality rates of the Trust, was 90.84% giving the Trust ‘Better than Expected’ rating. 

 

Nick Bishop, Non-Executive Director asked if there was any data later than March 2018 published in respect of the SHMI.  Dr Guy Rooney, Medical Director replied that SHMI was always 6-9 months in arrears.

 

National Audits  -  A solution to the data collection for the National Diabetes Audit had been resolved and an IT solution secured which would work across both secondary and primary sectors.

 

Infection Prevention and Control – A new dashboard had been launched by NHS Improvement (NHSI) for sepsis reporting across the NHS which would allow better benchmarking data.

 

There was one case of Clostridium Difficile reported in October 2018 which put the Trust above the trajectory for 2018/19.  An action plan was in place.  However it was noted that the Trust was not an outlier amongst other trusts in the SW. 

 

The staff flu vaccinations rate was at 78% which was excellent however the local target was to achieve 95%.  Roger Hill, Chair asked if SERCO were included in this figure.  Sally Fox, acting Director of HR replied that there were sufficient supplies to support SERCO staff but would check the detail on up take.

Action  :  Acting Director of HR

 

Cleaning Standards – Following implementation of weekly monitoring in ED and the Special Care Baby Unit (SCBU) significant improvement in their cleanliness scores had been achieved.

 

Serious Incidents/Never Events – Four Never Events had been reported which completed the cluster of seven previously reported.

 

Roger Hill, Chair asked for clarification on the Never Events.  Julie Marshman, Chief Nurse explained that a cluster of 7 surgical Never Events had been reported in connection with a wrong plate used for fractures.  Two Never Events had come to light due to patients presenting as the weaker plate had bent slightly.  Immediate actions had been put in place to reduce the risk of further re-occurrence, and a historical case review undertaken over a 12 year period.  Following the full investigation 5 previous occurrences had been found, therefore the Trust reported 7 Never Events, with 2 patients classified as coming to harm as further surgery was required. No other incidents were anticipated as most factures had healed. 

 

An update on the four long overdue serious incident actions was given which confirmed that they were all progressing and the reason they were overdue was due to unrealistic deadlines set at the outset.  A lesson learnt for future action plans.

 

Andy Copestake, Non-Executive  ...  view the full minutes text for item 256/18

257/18

Operational Performance Report pdf icon PDF 350 KB

Jim O’Connell, Chief Operating Officer

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: -

 

A&E  -  There had been significant improvement in performance however winter had started early this year (October) and although November had pulled back December would prove to be tricky, however the winter plan was being worked through with the Acute Care Unit opening on 10 December 2018.

 

Guy Rooney, Medical Director added for context 800 extra patients had attended A&E in October 2018, a 10% increase on the previous October which was a regional trend.

 

Cancer – The Trust continued to deliver on cancer standards except 62 day wait for treatment partly due to Urology, this was also a national issue, mainly due to a significant increase in referrals following Stephen Fry’s prostate cancer diagnosis.   The impact on the Trust was an increase from 40 referrals per month to 70.  Lots of controls had been put in place and referrals were moving back down to 40.

 

Stroke -  Direct admissions performance for October 2018 had improved although below the 90% standard.  Admissions within 4 hours had declined slightly however this was anticipated to improve significantly as the stroke management process had been amended.

 

The Sentinel Stroke National Audit Programme (SSNAP) in Q1 had improved from level E to D and although Q2 had remained at D there was an overall improvement however it was recognised that this was a complex service to deliver with an ambition to achieve level C.

 

Carole Nicholls, Director of Governance & Assurance asked how frequently SSNAP was assessed.  Jim O’Connell, Chief Operational Officer replied that this was quarterly.

 

Referral to Treatment Time (RTT)  -  The RTT programme of work continued to be on track and was close to its trajectory.

 

Diagnostics  - The 6 week diagnostics was in line with trajectory and recovery continued.

 

Roger Hill, Chair asked if the planned 10 new radiologists had started.  Jim O’Connell, Chief Operational Officer confirmed that they had.

 

Julie Soutter, Non-Executive Director asked about the reporting of 12 hour breaches.  Jim O’Connell, Chief Operational Officer replied that none had been reported in October or November 2018 and added that future reporting would be added to the Operational Performance Report.

 

RESOLVED

 

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

258/18

Update on the Winter Plan 2018/19 pdf icon PDF 254 KB

Jim O’Connell, Chief Operating Officer

Additional documents:

Minutes:

The Board received an update on the Winter Plan.  Overall there was a good level of confidence and assurance that the plans identified were in place and ready to support the enhanced pressures.

 

Steve Nowell, Non-Executive Director asked if the winter cost contingency of £1.5m was within the reserves budget.  Karen Johnson, Director of Finance replied that this remained the case. 

 

Jemima Milton, Non-Executive Director asked that future developments would be reported through the relevant Committee.  Jim O’Connell, Chief Operating Officer confirmed that progress and lessons learnt would be reported through Performance, People & Place Committee.

 

Karen Johnson, Director of Finance added that success was dependent on partners.   Jim O’Connell, Chief Operating Officer assured that rigorous tracking and monitoring was in place to ensure a right patient to right bed. 

 

RESOLVED

 

that the Board accept, acknowledge and support the on-going winter plans to maintain and improve performance

259/18

Ratification of Decisions made via Board Circular/Board Workshop

Carole Nicholl, Director of Governance & Assurance

Minutes:

None.

260/18

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.

261/18

Date and Time of next meeting

Date: 10 January 2019

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 10 January 2019 at 9:30am in Trust Management Boardrooms, Trust HQ, 2nd Floor, Great Western Hospital

262/18

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.

 

263/18

Minutes

Roger Hill, Chairman

·        1 November 2018 (private)

264/18

Outstanding Actions of the Board (Private)

265/18

Radiology Equipment Replacement - Outline Business Case

Sarah Balchin, Head of Imaging, Dr Sarah Taylor, Clinical Lead, Adam Dougherty, Head of Transformation, and Anne-Marie Howroyd, Deputy Director of Finance, to present (10.45am)

266/18

Trustees' Responsibilities and Funds Classification

Carole Nicholl, Director of Governance & Assurance

267/18

Chair of Charitable Funds Committee Overview

Jemima Milton, Non-Executive Director

268/18

Wiltshire Health & Care - update (to note)

Kevin McNamara, Director of Strategy & Community Services

269/18

Audit, Risk and Assurance Committee

Julie Soutter – Committee Chair

·        15 November 2018 (verbal report)

·        13 September 2018 (enclosure)

270/18

Executive Committee

Nerissa Vaughan – Committee Chair

·        20 November 2018 (verbal report)

·        16 October 2018 (enclosure)

271/18

Finance and Investment Committee

Steve Nowell – Committee Chair

·        26 November 2018 (verbal report)

·        22 October 2018 (enclosure)

272/18

Mental Health Governance Committee

Nick Bishop – Committee Chair

·        5 October 2018 (enclosure)

273/18

Performance, People & Place Committee

Peter Hill – Committee Chair

·        28 November 2018 (verbal report)

·        24 October 2018 (enclosure)

274/18

Quality & Governance Committee

Nick Bishop - Committee Chair

·        20 November 2018 (verbal report)

·        18 October 2018 (enclosure)

275/18

Urgent Business (Private) (if any)

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