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Agenda and minutes

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

Contact: Carole Nicholl  01793 605171

No. Item


Apologies for Absence and Chairman's Welcome

Julie Marshman


The Chair welcomed all to his first meeting as Great Western Hospitals Foundation (GWHFT) Trust Chair. 


The Chair recognised the significant challenge placed on the Trust due to the recent adverse weather conditions and wished to formally record the Board’s thanks for the efforts staff had gone to in keeping services running both in the hospital and in the community. 


Apologies for absence were received as outlined above.


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.


There were no declarations of interest.


Minutes pdf icon PDF 478 KB

Liam Coleman, Chairman

·        10 January 2019 (public minutes)


The minutes of the meeting of the Board held on 10 January 2019 were adopted and signed as a correct record.


Outstanding actions of the Board (public) pdf icon PDF 256 KB


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.


Questions from the public to the Board relating to the work of the Trust pdf icon PDF 357 KB


The Board received and considered the questions and responses from members of the public.


Julie Soutter, Non-Executive Director highlighted that fax machines were mentioned in the NHS Long Term Plan in terms of removing usage.  Nerissa Vaughan, Chief Executive confirmed that the Trust was working towards moving to digital services.




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


Finance Report pdf icon PDF 116 KB

Karen Johnson, Director of Finance

Additional documents:


The Board received and considered a report on finance for month 09, 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 £833k compared to a target deficit of £2,472k.Year to date deficit of £9,830k compared to planned deficit of £9,836k. Year to date variance £6k favourable.


NHS Clinical Income

£23.8m in month and £211.3m YTD (£1.3m above plan YTD)


Total Income

£26.7m in month and £236.1m YTD (£3.1m above plan YTD)


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

·        Elective inpatients above plan

·        Day case activity in line with plan

·        Non-elective activity below plan

·        Outpatient appointments below plan

·        A&E above plan


Total Operating Expenditure


£25.6m in month and £228.7m YTD (£3.1m above plan YTD)


Expenditure highlights in month:

·        Drugs £0.3m above plan (£1.6m above plan ytd)

·        Pay is £2m below plan (£1.8m below plan ytd)

·        Supplies £0.7m above plan (£2.4m above plan ytd)

·        Other Costs £0.9m above plan (£0.6m above plan ytd)



3.1% YTD which is 0.0% below plan



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

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



£37.2m debtors and stock

£1.4m above plan



£51m creditors and borrowings

£4.4m above plan



£2.1m above plan



No Loan drawdown in month


Finance Risk Ratings

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


The report was reviewed and the following highlighted:-


·        The year to date position at month 9 was a deficit of £9,830k which was £6k below plan.

·        The in-month position for December was a deficit of £883k compared to £463k in November.  This meant the Trust had achieved Q3 financial control total and had received £1.5m PSF associated with this. The Trust had achieved Q3 A&E Provider Sustainability Fund (PSF) as this was linked to cumulative performance Q1-Q3.  It was noted that GWHFT was the only Trust to achieve this within the Sustainability and Transformation Partnership (STP) footprint.  However the Trust was not likely to achieve its control total in Q4.

·        The Trust had been in discussions with the commissioners to mitigate over performance in terms of the financial position.  As a result the Clinical Care Group (CCG) had acknowledged winter resilience support during the winter period and therefore the Trust’s deficit had been reduced from £3.7m to £1.1m.

·        Reserves had been utilised to fund year end position which assumed delivery of Cost Improvement Plans (CIPs).

·        There had been further borrowing in January 2019 as planned.  However 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.  Detailed discussions had taken place at the Finance & Investment Committee and a formal letter had been sent to NHS Improvement  ...  view the full minutes text for item 313/18


Quality Report pdf icon PDF 112 KB

Julie Marshman, Chief Nurse

Dr Guy Rooney, Medical Director

Additional documents:


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 December 2018 were as follows: -


Hospital Standardised Mortality Rate (HSMR) / Summary Hospital Mortality Indicator (SHMI) – A consistent picture overall in terms of the HSMR figure at 95% with a 12 month rolling figure of 97%; all below the 100% national target.  This triangulated with the SHMI figure in June 2018 of 88.9% which was significantly lower than expected. 


One alert had been received which had been discussed in detail at the Quality & Governance Committee.  A summary of the last 6-12 months alerts, once closed off, would be incorporated in a future report.


National Audit – There had been a dip in closing down some audits in December due to holidays and catch up would be required this year.


Infection Prevention and Control  There had been no reported cases of clostridium difficile infection in December.


The Trust continued to see flu cases (type A) and would continue to encourage people to get vaccinated.  Julie Soutter, Non-Executive Director asked if there was any data for the Swindon area for take-up of the flu vaccination.  Dr Guy Rooney, Medical Director replied that the CCG held this data and highlighted that there were two big cohorts who were more at risk; children and the elderly especially those with chronic illness.  Julie Soutter further asked whether there were any parts of the population who would not vaccinate due to past media discreditation of other vaccinations.  Dr Rooney replied that generally the UK was still good at vaccinating.


Cleaning Standards – Areas with low scores in the Patient Care Equipment audit were the Paediatrics and Adult Emergency Department.  Weekly audits had taken place by senior staff and as a result the scores had improved.  This was a priority and now under control in these highly busy departments.


Serious Incidents – There were 3 overdue serious incidents.  However, it was noted that one was now closed and with another shortly to close once off line approval of a policy had taken place which had been delayed due to operational pressures and issues with IT.


Overdue clinical incidence had increased over last month; however the trend line remained flat.  This continued to be an area of focus in all divisions to ensure these were reduced.


National Report and Learning System  -  There was no evidence of potential under reporting by the Trust.


Complaints, Concerns and Compliments – A full report on patient experience had been considered at the Quality & Governance Committee and it had noted the work that had been undertaken to improve patient experience and complaint management.  The 25 day timeframe for a response to complaints was a local target and some cases were outside this due to complexity.    The current total of 27 was much lower than in previous times.  Liam Coleman, Chair asked if the data could be split to show  ...  view the full minutes text for item 314/18


Operational Performance Report pdf icon PDF 349 KB

Jim O’Connell, Chief Operating Officer

Kevin McNamara, Director of Strategy & Community Services

Additional documents:


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: -


6 Week Diagnosis Performance -  Radiology showed progress in performance with an achievement of 99% due to clearing the backlog, however the issue was now in Cardiology as Physiologist capacity was a significant issue, which was reflected nationally. There was no easy solution however the Trust would continue to work to contain the issue. 


ED Performance  -  Performance compared to last year had overall maintained a 7% improvement however ED had been pressured during December and this had continued into January.


RTT Performance  -  Focus now was on waiting list size and the Trust was doing well, however there was concern going into the winter period due to bed occupancy in switching surgical beds into medical beds.


Cancer Performance  -  Good progress had been made on key standard targets and the Trust had remained in the top 10 in the country.  There were a few challenges in that as breach numbers were fairly small this was reflected in the percentage.


Stroke  - Direct admissions performance reflected the bed pressures during the winter period.  The Performance, People and Place Committee had received a full update and seen the progress that had been made.


Appointment Slots  -  An issue had recently been highlighted around the national electronic referral system (eRS) which had been configured in a way that meant any patient who was on the system more than six months was automatically deleted from the system.  Usually this was not an issue as patients were transferred to the Trust’s local electronic referring system well within this time period.  However, there had been an issue over a year ago when there was long waiting times for patients due to capacity issues which meant that some patients had been deleted from the system.  A full investigation had been undertaken to ensure all patients concerned were contacted and allocated appointment slots in January and February.  Actions had been put in place to ensure this error was not replicated in future. 


Julie Soutter, Non-Executive Director asked if this had been referred up nationally.  Jim O’Connell, Chief Operating Officer replied that NHS Improvement (NHSI) had been notified and where currently processing the information.


Liam Coleman, Chair highlighted the importance that whilst the Trust regretted the inconvenience to patients of the potential impact of such delays, the Medical team had not identified at this point any harm to patients from this issue.


Paul Lewis, Non-Executive Director asked, in relation to achieving the ED 4 hour wait target, what the increase in number of patients attending A&E during the winter period.  Jim O’Connell, Chief Operating Officer replied that in December 2018 there were 6,000 compared to 6,800 in December 2019, an increase of over 10% during the winter period.


Swindon Community Health Services


End of Life Rapid Response  ...  view the full minutes text for item 315/18


Ratification of Decisions made via Board Circular/Board Workshop

Carole Nicholl, Director of Governance & Assurance




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.




Date and Time of next meeting

Date: 7 March 2019

Time: 9:30am

Venue: Trust Management Boardrooms, Trust HQ, 2nd Floor, Great Western Hospital


It was noted that the next meeting of the Board would be held on 7 March 2019 at 9:30am in Trust Management Boardrooms, Trust HQ, 2nd Floor, Great Western Hospital


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”




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.