• Home
  • Agenda and minutes

Agenda and minutes

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

Contact: Carole Nicholl  01793 605171

Items
No. Item

276/18

Apologies for Absence and Chairman's Welcome

Carole Nicholl

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.

277/18

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.

278/18

Minutes pdf icon PDF 232 KB

Roger Hill, Chairman

·        6 December 2018 (public minutes)

Minutes:

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

 

257/18 / Operational Report / A&E  :  Change title of Acute Care Unit to Ambulatory Care & Triage Unit.

 

257/18 / Operational Report / Cancer  :  Rephrase last sentence to read “Lots of controls had been put in place ensuring all referrals were appropriate……”.

 

257/18 / Operational Report / Diagnostics  :  Change Radiologists to Radiographers.

279/18

Outstanding actions of the Board (public) pdf icon PDF 253 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.

280/18

Questions from the public to the Board relating to the work of the Trust pdf icon PDF 281 KB

Minutes:

The Board received and considered the questions and responses from members of the public and noted the following:-

 

·        Question 87 relating to the Bank Register - a verbal response was given.  

 

·        A late question had been received with regard to smoking on Trust premises and a response would be sought following the meeting.

 

RESOLVED

 

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

281/18

Chairman's Report, Feedback from the Council of Governors

Roger Hill, Chairman

Minutes:

The Chairman gave a verbal report as follows: -

 

Council of Governors Effectiveness Review – The Council of Governors annual Effectiveness Review took place on 4 December 2018.  There was attendance from 4 Non-Executive Directors plus Liam Coleman Chair Designate.  A number of recommendations were identified particularly in further developing the responsibility of holding the Non-Executives to account for the Board performance and would be considered further at a working group before being formalised.

 

Nominations & Remuneration Committee - A Nominations & Remuneration Committee was held on 6 December 2018 to agree the outcomes of the review process of the Non-Executive Directors and Chair, together with a review of Non-Executive allowances.

 

Non-Executive Director Vacancy - The process to fill the Non-Executive Director vacancy was underway. Shortlisting had been completed and interviews would take place on Friday 1 February 2019 followed by a Joint Nominations Committee and Council of Governors meeting on 7 February 2019 to complete the process.

 

 RESOLVED

 

that the report of the Chairman be received.

282/18

Chief Executive's Report pdf icon PDF 180 KB

Nerissa Vaughan, Chief Executive

Minutes:

The Board received and considered a report from the Chief Executive covering the following issues: -

 

CQC Inspection Results – The Trust’s CQC inspection report had been published with a rating of ‘requires improvement’ however it was noted that the vast majority (80%) of its services had been rated ‘good’ demonstrating significant improvement across the core services since the last inspection.

 

Successful Bid for National Funding  -  The Trust had successfully bid for £30m of national funding to expand the Emergency Department, purchase land for potential expansion and to help develop a model of intensive rehabilitation. 

 

Incubator Appeal – Brighter Futures had successfully achieved its target in raising funds of £175,000 to purchase neonatal incubators for the Special Care Baby Unit.

 

Radiotherapy Appeal – The Radiotherapy Appeal had successfully reached its target in December 2018 and confirmation had been received that the Secretary of State had approved the loan to Oxford University Hospitals NHS FT to build and operate the unit.

 

New Ambulatory Care and Triage (ACAT) Service Launched – The Trust opened a new Ambulatory Care and Triage Service as an expansion of the former Ambulatory Care Service.

 

New Medical Day Unit Opened and new Head and Neck Cancer Care ‘Closer to Home’ – A new Medical Day Unit was opened in December 2018 to enhance cancer service for existing medical patients, together with a new Head and Neck Cancer clinic so that patients in the local area can get specialised care closer to where they live.

 

Smoke Free Zone – The Trust became a smoke free zone from 1 January 2019.

 

RESOLVED

 

            that the report of the Chief Executive be received.

283/18

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 08 (ending 30 November 2018), 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 represents the Trust Control Total only.

In month deficit of £463k compared to a target deficit of £222k.Year to date deficit of £8,947k compared to planned deficit of £7,364k. Year to date variance £1,583k deficit.

NHS Clinical Income

£24.5m in month and £187.6m YTD (£0.1m above plan YTD)

Total Income

£27.3m in month and £209.4m YTD (£1.6m above plan YTD)

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

·        Elective inpatients above plan

·        Day case activity on plan

·        Non-elective on plan

·        Outpatient appointments below plan

·        A&E above plan

Total Operating Expenditure

 

£25.8m in month and £203.1m YTD (£3.1m above plan YTD)

Expenditure highlights in month:

·        Drugs £0.1m below plan (£1.3m above plan ytd)

·        Pay is £0.1m above plan (£0.2m above plan ytd)

·        Supplies £0.4m above plan (£1.7m above plan ytd)

·        Other Costs £0.6m above plan (£0.1m below plan ytd)

EBITDA

3% YTD which was 0.8% below plan

Savings

Savings plan of £11.611m of which £7.5m forecast to be delivered

£0.7m CIPS delivered in month against a plan of £1.2m

Debtors

£39.1m debtors and stock

£7.7m above plan

Creditors

£56m creditors and borrowings

£11.6m above plan

Cash

£2.9m

£0.6m 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 report was reviewed and the following highlighted:-

 

·        The run rate movement from month 7 to month 8 was an improvement due to finalising the year end position with commissioners.

·        The pay bill had slightly reduced with a reduction in agency costs in line with the Trust’s target for November 2018.

·        Non-elective activity and A&E were above planned levels in month.

·        There was a reduction in in-patient activity which was in line with plan.

·        Day case and outpatients were behind plan due to the transformation programme in utilisation of clinic space.

·        It was unlikely that the Trust would achieve its Q3 Provider Sustainability Funding (PSF) target and therefore would have to borrow further from the Department of Health.

·        The end of year forecast had not changed at £3.7m deviation from plan.

·        New risks had emerged that could impact on year end position which included overseas recruitment, as well as continuing to mitigate agency costs.

 

Roger Hill, Chair asked what the carry over for next year was in terms of the cost improvement programme.  Karen Johnson, Director of Finance explained that any cost improvement programme initiatives that started after April 2019 would roll into 2019/20.  This currently equated to £1.2m and the plan was to achieve an efficiency of 3% for next year, even though the national target was 1.1%, as the Divisions had already identified a number of significant cost improvement programmes.  It was noted  ...  view the full minutes text for item 283/18

284/18

Chair of Finance & Investment Committee Overview pdf icon PDF 197 KB

Andy Copestake, Non-Executive Director

Minutes:

The Board considered a report which summarised the key issues from a meeting of the Finance & Investment Committee held on 26 November and 21 December 2018. 

 

RESOLVED

 

that the report be received.

285/18

Chair of Audit, Risk & Assurance Committee Overview pdf icon PDF 174 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 15 November 2018.

 

RESOLVED

 

            that the report be received.

286/18

Risk Tolerance Statement - Annual Refresh pdf icon PDF 270 KB

Carole Nicholl, Director of Governance & Assurance

Minutes:

The Board considered a paper that set out the Trust’s Risk Tolerance Statement for annual review. The revised statement had been considered at the Audit, Risk and Assurance Committee held in November 2018, where it was recommended that the statement remained fit for purpose and therefore no changes were required. 

 

Andy Copestake, Non-Executive Director agreed that the statement was fit for purpose however would like to understand  other Trust’s risk appetite.

Action  :  Director of Governance & Assurance

 

RESOLVED

 

(a)        that the Board agrees the recommendation of the Audit, Risk and Assurance          Committee and approves the  Risk Tolerance Statement without amendment,   and;

 

(b)        obtain an understanding of other Trust’s risk appetite.

287/18

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 showed improvement at 93%, 7% better than national statistics. This was also reflected in the SHMI at 91% over a rolling 12 month period.

 

There were 2 mortality alerts which had undergone the usual investigation and there were no concerns highlighted.  The Week Day and Weekend Mortality by Day of Admission data also showed no concerns.

 

The mortality review which had been running over the year had highlighted key learning as better identifying those patients at end of life, especially as a significant number of Swindon people died in hospital.  As a result the Trust was working closely with partners to devise a new end of life pathway.  It was noted that this was around choice of location for end of life patients and part of the work with partners was to roll out a system for shared records which would then become a blueprint to benefit other patients.   Peter Hill, Non-Executive asked what the timescale was for this pilot.  Kevin McNamara, Director of Strategy and Community Services replied that roll out to the initial three GP practices would be in April 2019.

 

National Audits – National audits remained on track except for 5 projects that had been reported as either a delayed start or where progress was reduced mainly due to the holiday period.

 

Infection Prevention and Control – There was a significant increase in the blood culture contamination rate and robust investigations were underway. 

 

There were 4 cases of Clostridium difficile infection in November 2018.  Although the Trust had exceeded its Public Health annual target it was noted that this had been set lower than last year and had not taken into account the significant higher number of patients attending the hospital.  A robust review, supported by NHS Improvement (NHSI), and an action plan had been completed. 

 

Andy Copestake, Non-Executive Director asked if it was normal for the blood culture contamination rate to be higher in the Emergency Department (ED).  Guy Rooney, Medical Director replied that this reflected the increase in workload and that systems and processes, supported by training, had been put into place to stop the spikes.  Jemima Milton, Non-Executive Director asked how we compared to other EDs.  Julie Marshman, Chief Nurse said that it was difficult to benchmark as this indicator was not in all Quality contracts.

 

Cleaning Standards – A lot of work had been undertaken within the Equipment Self Audits by staff to ensure those areas scoring below 90% were highlighted.  There were some areas of concern which reflected how busy the organisation was and these were being closely monitored.  Different options were being considered to relieve the nursing staff of this task. 

 

Julie Soutter, Non-Executive Director asked if this happened within other  ...  view the full minutes text for item 287/18

288/18

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 meeting held on 20 November and 20 December 2018 and highlighted the discussion on the Committee’s effectiveness review and  the assurance in compliance with regard to the provide licence.

 

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.

289/18

Operational Performance Report pdf icon PDF 349 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: -

 

Summary of Standards:

 

ED 4 hour standard (95%)                        November 90.3%      Under Achieving

(combined - ED, MIU & UCC)                               

 

RTT Waiting List Size                              October 20,582 against 20,929

                                                                      trajectory (-347)                                                                  

 

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

% delivery.

 

6 Week Diagnostic Wait (99%)                 October 95.87%        Not Achieved

 

Cancer Targets:                                       October

 

2 Week Waits (93%)                                 96.7%                        Achieved

2 Week Wait Breast Symptomatic (93%)    99.1%                        Achieved

31 Day Treatment (96%)                           98%                          Achieved

62 Day Treatment (85%)                           90.9%                        Achieved

 

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

 

Emergency Department  -  Performance was 7% ahead of November last year and reflects the good work that continued in terms of improvements against previous year.  It was noted that Christmas and New Year were fairly quiet however the start of January had seen a significant increase of pressure in terms of dealing with the number of patients.  The winter plan was firmly in place and progressing with provision of extra capacity internally and externally.  The current concern was out of area patients and systems were being reviewed to address this area.

 

There were 3 reportable discharge to assess 12 hr breaches in November 2018.   Deep dive investigations had been undertaken and revealed that a combination of a number of pressures had contributed to these breaches including two major traffic accidents however this would continue to be closely monitored.

 

Julie Soutter, Non-Executive Director noted the great performance in terms of ambulance handover and commended the ED team in achieving this.  Jemima Milton, Non-Executive Director added that it was right to recognise this achievement as it was right for the patient however it had implications on the Trust’s performance.   

 

Stroke  -  There was an  improvement in performance in terms of direct admissions in 4 hours however this remained a challenge due to the fact they came in small numbers and in batches.  However despite the pressures the next reported figure continued to show improvements.

 

In terms of the SSNAP data the Trust had maintained level D status although the overall score had increased.  The team were undertaking further work to re-energise and push hard to attain level C.

 

Outpatients  -  There remained a concern around the holding file albeit a reduction of overdue patients had been achieved.  A task and finish group had been established to commence with 4 key specialities to focus on managing the overdue follow up position.

 

Referral to Treatment Tim (RTT)  -  There was an overall reduction in waiting list size in month, however close monitoring was still required to ensure this standard continued to improve.

 

Cancer  -  Cancer performance continued to improve and the Trust now ranked 7th in the country however Urology remained an issue which reflected the national picture and was one  ...  view the full minutes text for item 289/18

290/18

Chair of Performance, People & Place Committee Overview pdf icon PDF 353 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 24 October and 28 November 2018 and highlighted the discussions which covered succession planning and cyber security.

 

Roger Hill, Chair asked if the cyber security had gone through the organisation.  It was noted that the Board and Executive Committee members had completed the training and Jim O’Connor, Chief Operating Officer took the action to find out what other areas had completed the training. 

Action  : Chief Operating Officer

 

RESOLVED

 

(a)        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, and;

 

(b)        check who had completed cyber security training within the organisation.

291/18

Care Quality Commission (CQC) Inspection Report 2018 pdf icon PDF 90 KB

Julie Marshman, Chief Nurse

Additional documents:

Minutes:

The Board received a report that presented the mapping of CQC ratings over time which showed that whilst the Trust rating remained at “requires improvement” overall there had been a significant improvement across the core services. 

 

It was noted that the areas that ‘required improvement’ were those areas that were most challenged in terms of capacity issues including the need to address overcrowding in the Emergency Department which had recently been recognised by the successful bid for national funding to resolve this issue.

 

It was clear where the focus of work for improvement was and robust action plans would be produced to support those Divisions to turn around their outcome next time to good/outstanding.

 

Of particular note were the significant improvements across the board in Community Services and the Board commended the Community team for their hard work.

 

Roger Hill, Chair added that a Board workshop would be arranged in early February 2019 to discuss the findings and quality improvement plans in more detail.

Action  :  Chief Nurse

 

RESOLVED

 

(a)        the Board is asked to note the report, and;

 

(b)        a Board workshop to be arranged early February 2019 to discuss CQC findings.

292/18

People Strategy: 12 Month Progress Report (October 2017 - September 2018) pdf icon PDF 2 MB

Sally Fox, Interim Director of Human Resources

Minutes:

The Board considered a paper which outlined the progress against the 6 commitments in the People Strategy 2014-2019.  The key highlights were:-

 

·        The Trust’s overall vacancy rate had fluctuated over the period.

·        There was a 4% increase in staff who recommended the place to work.

·        Staff engagement was stable; however this was an area to focus on in the future.

·        Executive Directors had been working on the frontline with staff as a result of staff feedback.

·        The Trust’s sickness rate was reasonable and benchmarked well with a high uptake in the number of initiatives offered around Health & Wellbeing.

·        Mandatory training compliance had increased and the appraisal rate was steady.

·        There were a number of new in-house leadership and development courses in place however this would also be a development area for the future.

·        The strategy would be refreshed during 2019 following the development of the Trust’s Strategy.

 

Julie Soutter, Non-Executive Director noted that the number of volunteers had increased which was good, however asked if there was a limit to the number of volunteers.  Sally Fox, Director of HR replied that due to the requirements to give meaningful tasks and supervision there was a natural limit.  Julie Marshman, Chief Nurse added that volunteers should not replace paid work.  It was noted that all the Trust’s volunteers were active and engaged with a spread of ages.

 

RESOVLED

 

(a)        that the Board notes the progress against the strategy;

 

(b)        that the Board notes the plan to develop a new People Strategy in 2019       following the new Trust Strategy.

 

293/18

Directors' Code of Conduct pdf icon PDF 91 KB

Caroline Coles, Deputy Company Secretary

Additional documents:

Minutes:

The Board received a paper that contained a revised Directors Code of Conduct, which was due for its three year review.

 

There were only minor changes which reflected revised practices such as managing conflicts of interest, duty of candour and freedom to speak up.

 

RESOLVED

 

that the Board of Directors adopt the Directors Code of Conduct 2019-2021.

294/18

Membership of Committees

Caroline Coles, Deputy Company Secretary

·        Directors are asked to note that the annual refresh of membership of Committees will be presented in March 2019.  However, in the interim, the Board is asked to approve the appointment of Andy Copestake as the Chair of the Finance and Investment Committee.

Minutes:

The Board noted that the annual refresh of membership of Committees would be presented in March 2019.  However in the interim, due to the vacancy of the Chair of the Finance & Investment Committee it was proposed that Andy Copestake would fill this role until the refresh.

 

RESOLVED

 

            that the Board approve the interim appointment of Andy Copestake as Chair of       the Finance & Investment Committee until the review of membership of            committees in March 2019.

295/18

Ratification of Decisions made via Board Circular/Board Workshop

Caroline Coles, Deputy Company Secretary

Minutes:

The Board had received, prior to the meeting, Board Circulate No 8 which outlined the terms of the planned loan from the Department of Health in January 2019.  The Finance team had reviewed the terms of the loan documentation and confirmed that this was consistent in all material respects with previous loan documentation.  This had also been discussed at the Finance & Investment Committee on 21 December 2018.

 

It was noted that the loan had been reduced by the Department of Health from a request of £5m to £3.7m due to receipt of PSF funding in December 2018.  Active discussions were underway with the Department of Health to resolve the issue as the loan agreed over the course of 12  months was £15m prior to any provider sustainability funding.  In the meantime cash flow would be managed robustly to address the shortfall with the planned loan request in March 2019 adjusted to include the January 2019 shortfall.

 

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; and

 

(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.

 

 

296/18

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.

297/18

Date and Time of next meeting

Date: 7 February 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 7 February 2019 at 9:30am in Trust Management Boardrooms, Trust HQ, 2nd Floor, Great Western Hospital

298/18

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.