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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

1/19

Apologies for Absence and Chairman's Welcome

Minutes:

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

 

It was noted that following a robust recruitment process the Trust had been successful in recruiting two new Board members; a new Director of HR and Medical Director.  In the meantime Guy Rooney, current Medical Director would continue in his role until end of June 2019.

 

Apologies for absence were received as outlined above.

 

2/19

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.

3/19

Minutes pdf icon PDF 436 KB

Liam Coleman, Chairman

·        7 March 2019 (public minutes)

·        25 March 2019 (public minutes)

Additional documents:

Minutes:

The minutes of the meeting of the Board held on 7 March 2019 were adopted and signed as a correct record, subject to the following amendments: -

 

345/18  :  Chair of Finance & Investment Committee Overview  - 5th paragraph change end of sentence to “…….confirmed that the contract position would be agreed by the deadline”.

4/19

Outstanding actions of the Board (public) pdf icon PDF 303 KB

Minutes:

The Board received and considered the outstanding action list. 

5/19

Questions from the public to the Board relating to the work of the Trust

Minutes:

There were no questions from members of the public.

6/19

Finance Report pdf icon PDF 118 KB

Karen Johnson, Director of Finance

Additional documents:

Minutes:

The Board received and considered a report on finance for month 11, 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 £2,144k compared to a target deficit of £1,162k.Year to date deficit of £12,438k compared to planned deficit of £11,112k. Year to date variance £1,327k adverse.

NHS Clinical Income

£23.7m in month and £260m YTD (£3.9m above plan YTD)

Total Income

£26.6m in month and £290.2m YTD (£6.3m above plan YTD)

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

Elective inpatients below plan

·        Day case activity above plan

·        Outpatient appointments below plan

·        Non-elective activity above plan

·        A&E above plan

Total Operating Expenditure

 

£26.8m in month and £281.5m YTD (£7.5m above plan YTD)

Expenditure highlights in month:

·        Drugs £0.3m above plan (£2.0m above plan ytd)

·        Pay is £1.1m above plan (£0.3m below plan ytd)

·        Supplies £0.6m above plan (£3.2m above plan ytd)

·        Other Costs £0.9m above plan (£2.4m above plan ytd)

EBITDA

3.0% YTD which is 0.5% below plan

Savings

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

£1.1m CIPS delivered in month against a plan of £1.2m

Debtors

£41.8m debtors and stock

£4.4m above plan

Creditors

£52.7m creditors and borrowings

£7.3m above plan

Cash

£4.3m

£1.5m below plan

Loan

Nil 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 11 was above plan and still on plan to forecast a year end deviation of £1.1m

·        The month’s actual from month 10 to month 11 was a deterioration however the month was shorter resulting in less income.  This was in line with forecast.

·        A&E continued to be under significant pressure due to a 6% increase in attendance.  This resulted in pressure on agency spend.

·        Planned Care activity was down due to the pressures resulting in escalation.

·        Discussions continued with commissioners and the health system to achieve the control total for year end as a result of ED pressures however it was noted that any funding would be non-recurring and therefore the Trust would still have an underlying financial issue.

·        As planned the Trust had received £7.9m from Department of Health to support the IE position.

 

Julie Soutter, Non-Executive Director sought clarification on late invoicing, for example agency, in terms of closing down month 12 as this had been an issue in previous years.  Karen Johnson, Director of Finance agreed that there was always a challenge in terms of agency staff invoicing however confirmed that with a solid process in place  with ID Medical, and, working closely with HR there was minimal risk.

 

Paul Lewis, Non-Executive Director asked what impact winter had and whether there was any learning from a financial point of  ...  view the full minutes text for item 6/19

7/19

Quality Report (including Mortality Statistics Reporting Q3) pdf icon PDF 112 KB

Julie Marsham Walker, Chief Nurse

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 February 2019 were as follows: -

 

Hospital Standardised Mortality Rate (HSMR) / Summary Hospital Mortality Indictor (SHMI) – There continued a downward trend in the HSMR and the SHMI which placed the Trust in the top 10% in the country. 

 

Andy Copestake, Non-Executive Director sought clarification on the correlation between the  near perfect SHMI score and the graph on page 6 that showed the trust nationally in the mid- range.  Guy Rooney, Medical Director replied that 500 lives supported this picture, which would be part of next month’s report. 

 

Mortality Reviews   :  The data for Q3 for learning from deaths & mortality reported 2 deaths identified for full investigation; one case was not considered to be avoidable, the other was still under investigation.  The main lesson from mortality reviews remained the need to introduce end of life care sooner which focussed on the use of ReSPECT Forms and working closer with community services.

 

National Audit  -  The focus had been on completion of audits and this would be reflected in next month’s report.

 

Infection Control  -  There was 1 case of Clostridium difficile infection (CDI)  reported in February and no cases in March 2019. It was noted that the Trust had joined a national research project on the use of antibiotics.

 

Andy Copestake, Non-Executive Director asked about the blood culture contamination rate rolling average which had dropped in February 2019 and whether there were any underlying issue.  Guy Rooney, Medical Director responded that a review of practices was underway to ensure that following the Quality Initiative a year ago on root causes practices remained the same.  Part of the issue would also be taking blood cultures in an overcrowded environment.

 

Paul Lewis, Non-Executive Director commented on the positive progress made with regard to the patient equipment cleaning score, however asked if there were action plans in place for the remaining areas below the 90% score.  Julie Marshman, Chief Nurse confirmed that plans were in place with marked improvements coming through.

 

Serious Incidents  -  There was a robust governance structure in place with regard to the management of patient safety incidents. The number of overdue actions were due to individual actions rather than action plans  as a result of this robust scrutiny.  The Divisions were working hard to reduce the numbers however it was important to note that there was nothing of any harm within the numbers reported.  The Model Hospital of medicines safety benchmarking data demonstrated the Trust in an excellent position and well below the national average for missed doses and medicines incidents causing harm.

 

Mixed Sex Breaches  -  There was a significant increase in reported mix sex breaches this was as a consequence of a busy site in full escalation.

 

Safeguarding Adults & Children   -  There was an increase in adult safeguarding alerts related to poorly completed documentation at  ...  view the full minutes text for item 7/19

8/19

Operational Performance Report pdf icon PDF 273 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%)                   January 84.9%                         Failing

(combined - ED, MIU & UCC)

 

RTT Waiting List Size                                     Waiting list size (January)      Achieving

19,076 against 20,974 trajectory

 

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

% delivery.

 

6 Week Diagnostic Wait (99%)            January 91.70%                       Failing

 

Cancer Targets:                                  January

 

2 Week Waits (All cancer 93%)             92.4%                                       Failing

2 Week Wait Breast Symptomatic (93%) 90.1%                                                 Failing

31 Day Treatment (96%)                       100%                                        Achieved

62 Day Treatment (85%)                       78.6%                                       Failing

 

The report was reviewed and the following highlighted:-

 

Cancer Performance  -  The performance on 31 days had met the standard targets.  The two issues were 62 wait for first treatment which fluctuated due to the small number of breaches and tolerance level; January was at 78%, February had hit the standard but March was in the low 80s.  There was a significant amount of oversight on this standard and it was anticipated would be back on track in Q1.

 

It was noted that the spike in breast cancer referrals was significant which was linked to a TV drama story line.  This was being closely monitored to ensure it was not a trend.

 

Referral to Treatment Time (RTT  -  It was noted that due to a review in reporting and revalidating of data reporting was late this month.  A full detailed report would be presented to Performance, People and Place Committee in due course.

 

Diagnostics Performance  -  Pressures continued in Cardiology Physiology with regard to demand and capacity due to workforce constraints, and although there was no long term solution as yet the Trust were using the workforce flexibly.  There were plans were in place for Gastroenterology and Endoscopy with a locum starting in April 2019 to add capacity with other options being explored including outsourcing.  These areas would remain a challenge throughout the year due to the shortage of workforce and the challenges in recruiting staff.

 

Strokes  -  There was a disappointing ‘blip’ in data due to staff absence which  would be back on trace next month.  The SSNAP score remained at D.  Although a robust recovery plan was in place to attain level C it was recognised that significant financial investment to address the issues would be required to achieve level C.

 

Julie Soutter, Non-Executive Director commented that there was a lot of focus on recruiting staff what actions were in place to retain a flexible workforce.  Kevin McNamera, Director of Strategy and Community responded that the biggest issues were physiotherapists and occupational therapists, other groups of staff were flexible.  Julie Marshman, Chief Nurse added that the Trust had a recruitment and retention programme but recognised that this could be strengthened further.

 

A&E Performance  - This continued to be under pressure.  It  ...  view the full minutes text for item 8/19

9/19

Staff Survey 2018 Report pdf icon PDF 173 KB

Sheridan Flavin, Interim Director of Human Resources

Additional documents:

Minutes:

The Board received a paper that summarised the staff survey results for 2018.  The key points to note were:-

 

·        There was a 44% response rate which was slightly decreased from last year but was based on a different sample size.  It was above the national average response rate at 40%.

·        Reporting had changed this year as the key findings had been replaced by 10 themes which were driven by the questions in the survey.

·        The results for GWH indicated 2 areas where the Trust scored below the national average and these would be priority areas for 2019; quality of appraisal and quality of care.

·        In addition two further themes in the action plan for 2019/20 would be health and wellbeing and staff engagement.

The Chair recognised that the outcomes of the staff survey had been discussed in detail at the Executive Committee and in Board sub committees.  The Board noted and supported  the action plan in place to address areas of concern and recognised that this was an important  survey as it reflected staff satisfaction.

 

RESOLVED

 

the Board notes the report.

10/19

Gender Pay Gap Reporting - Results for 2017/18 pdf icon PDF 421 KB

Sheridan Flavin, Interim Director of Human Resources

Minutes:

The Board received a paper that summarised the results of the Gender Pay Gap analysis.  The key points to note were:-

 

·        The Trust had met its obligations under the Equality Act to publish gender pay gap information.

·        The information was a snap shot on 31 March 2018 and covered 6 standards.

·        The mean gap had improved slightly (excluding medical and dental)

·        Medical and dental professionals significantly impacted the results due to consultant salaries and the current split of 66% male to 35% female, this was also reflected nationally.  However it was noted that in terms of junior doctors the split had changed to 53% female which over time would reduce the pay gap.  In attempt to redress the male/female split the Trust would ensure there were at least two female applicants for consultant roles shortlisted for interview; however the Trust would only appoint the best candidate for the position.

Liam Coleman, Chair asked if the Interim Director of HR was comfortable with the trust’s activity and recruitment process and whilst the current picture showed a gap it was moving towards a more balanced position.  Sheridan Flavin, Interim Director of HR confirmed her confidence in the process and that to further strengthen the process would ensure that the makeup of the interview panel was a balanced male/female split and that all protected characteristics were also included.

 

Nick Bishop, Non-Executive Director acknowledged that it would be easy to misinterpret the information and pointed out that the Trust paid women the same as men to do the same job.  Nerissa Vaughan, Chief Executive added that the Trust was in the top 1 or 2 in the South West as the best performing in terms of discrimination in the staff survey.

 

RESOLVED

 

(a)        that the paper is noted; and,

 

(b)        that any further actions are agreed and documented.

11/19

Ratification of Decisions made via Board Circular/Board Workshop

Carole Nicholl, Director of Governance & Assurance

Minutes:

The Board was requested to ratify the decision made via Board Circular on 21 March 2019 to finalise the 2019/20 contract position.

 

RESOLVED

 

that the Board ratified the 2019/20 Contract be signed noting the statement from commissioners with regard to additional activity.

12/19

Register of Interests and Declaration of Interests at Meetings pdf icon PDF 172 KB

Carole Nicholl, Director of Governance & Assurance

Additional documents:

Minutes:

The Board received a paper that provided a copy of the Register of Interests of the Board of Directors for annual review.  It also reminded members of their obligation to register any interest and material interests as soon as they arose or within 7 clear days of becoming aware of the existence of the interest and to also make amendment to the register as appropriate.

 

RESOLVED

 

(a)   that the requirement of directors to register their relevant and material

interests as they arise or within 7 clear days of becoming aware of the

existence of an interest be noted;

 

(b)   that the requirement to keep the register up to date by making

amendments to any registered interests as appropriate be noted;

 

(c)   that the requirement to declare the existence of registered interests or

any other relevant and material interests at meetings be noted including

the requirement to leave the meeting room whilst the matter is discussed;

and,

 

(d)   that the Director’s Register of Interests be received and it be agreed that

the Board is assured that the requirements of the Constitution to

maintain a register of interest of Board Directors are being met.

13/19

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.

14/19

Date and Time of next meeting

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

15/19

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.