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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

33/19

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 members of the public and governors.

 

The Chair welcomed Lizzie Abderrahim to her first Board meeting as the Trust’s new Non-Executive Director.  There followed a short introduction from Lizzie which highlighted her previous experience.

 

Apologies were received as outlined above.

 

34/19

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:

A declaration of interest was received for an agenda item, Senior Independent Director Appointment, for ratification in the private session of the Board by Nick Bishop, Non-Executive Director and he would not participate in the decision making in this matter.

 

There were no other declarations of interest.

35/19

Minutes pdf icon PDF 385 KB

Liam Coleman, Chairman

·        4 April 2019 (public minutes)

Minutes:

The minutes of the meeting of the Board held on 4 April 2019 were adopted and signed as a correct record, subject to the following amendments: -

 

7/19 : Quality Report : Infection Control  - Change ‘dropped’ to ‘risen’ in 2nd line.

 

8/19  :  Operational Performance Report  : Resolved  - Change action (c) to Director of Strategy & Community Services (KM).

 

10/19 : Gender Pay Gap Report 2017/18 – Add “provided the applicant met with the job and person specification” in 4th bullet point 6th line down.

 

10/9 : Gender Pay Gay – Add “managing” before discrimination in last paragraph.

 

36/19

Outstanding actions of the Board (public) pdf icon PDF 305 KB

Minutes:

The Board received and considered the action list.

37/19

Questions from the public to the Board relating to the work of the Trust pdf icon PDF 327 KB

Minutes:

The Board received and considered the questions from the public. 

 

RESOLVED

 

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

38/19

Chairman's Report, Feedback from the Council of Governors

Liam Coleman, Chairman

Minutes:

The Chair gave a verbal report as follows:-

 

·        The Council of Governors formally approved the re-appointments of Nick Bishop and Andy Copestake as Non-Executive Directors.

·        The Council of Governors met on 11 April 2019.  This was the first meeting to trial an amended agenda moving to a more Non-Executive Director (NED) led reporting which would strengthen the governor’s role in holding the NEDs to account for the performance of the Board of Directors.  The Chair expressed thanks to Andy Copestake, Non-Executive Director who covered Finance and other areas.  It was felt that the change was an improvement and a good opportunity to strengthen the relationship between the governors and NEDs.

Key topics discussed included the way forward plan in developing the hospital; the annual review of the Governors’ Register of Interests and ratification of the appointment and reappointments of the NEDs.  It was noted that the Council of Governors requested more assurance with regard to the capacity to deliver the 62 week cancer particularly around upper GI activity. Assurance would be covered in the next NED report to the Council of Governors.

·        A reminder of the charitable funds fun run event on Sunday 5 May 2019.  Super Heroes was the theme and all were welcome.

 RESOLVED

 

that the report of the Chairman be received.

39/19

Chief Executive's Report pdf icon PDF 189 KB

Nerissa Vaughan, Chief Executive

Minutes:

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

 

·        The Trust had been awarded a green rating from Public Health for its commitment to becoming a smoke free site.

·        The successful fund raising by Brighter Futures to acquire 5 state of the art incubators for the Special Care Baby Unit (SCBU) which had now been installed and in use.

·        The submission of 13 nominations for the 2019 NHS Parliamentary Awards.  These staff members would also be recognised locally and be provided with a certificate for the nomination.

Jemima Milton, Non-Executive Director and Chair of the Charitable Funds Committee gave an update on the incubators position as the number had increased to 10 due to the generosity of the manufacturers and members of public raising more than the target of £175,000.

 

RESOLVED

 

that the report of the Chief Executive be received.

40/19

Finance Report pdf icon PDF 137 KB

Karen Johnson, Director of Finance

Additional documents:

Minutes:

The Board received and considered a report on finance for month 12 (ending 31 March 2019), 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 £48k compared to a target deficit of £1,314k.Year to date (YTD) deficit of £12,390k compared to planned deficit of £12,426k. Year to date variance £36k favourable.

NHS Clinical Income

£29.6m in month and £289m YTD (£9.7m above plan YTD)

Total Income

£33m in month and £323.2m YTD (£12.8m above plan YTD)

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

·        Elective inpatients below plan

·        Day case activity in line with plan

·        Outpatient appointments below plan

·        Non-elective activity below plan

·        A&E above plan

Total Operating Expenditure

 

£31.2m in month and £312.7m YTD (£13m above plan YTD)

Expenditure highlights in month:

·        Drugs £0.6m above plan (£2.6m above plan ytd)

·        Pay is £0.4m above plan (£0.1m above plan ytd)

·        Supplies £0.6m above plan (£3.7m above plan ytd)

·        Other Costs £3.9m above plan (£6.5m above plan ytd)

 

EBITDA

3.2% YTD which was 0.2% below plan

Savings

Savings plan of £11.611m of which £7.5m had been delivered

£1m CIPS delivered in month against a plan of £1.2m

Debtors

£35.9m debtors and stock

£3.6m above plan

Creditors

£49.2m creditors and borrowings

£3.2m above plan

Cash

£5.2m

£4.2m above plan

Loan

£8.8m loan drawdown in month, up on plan of £6.1m

Finance Risk Ratings

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

 

The report was reviewed and the following highlighted:-

 

·        The financial position outturn as at March 2019 was provisional as the external auditors were still undertaking their year-end audit which would be presented to Audit, Risk and Assurance Committee on 23 May 2019.  There was currently no indication of any changes.

·        The financial position had improved against February 2019 due predominantly to additional income for winter pressures from the Health System which resulted in a favourable movement of £1.1m to the year-end position.

·        It was noted that this additional income was non-recurring and therefore the underlying financial deficit would be greater than the reported end of year deficit.

·        The pressures continued to be activity, which was extreme in March 2019 which in turn put pressure on agency costs.

·        The Cost Improvement Programmes (CIPs) had not deviated significantly from plan and therefore achieved £7.5m against a target of £11.6m.  The target for 2019/20 was £9.1m.

·        The cash balance at year end was £5.2m due to the additional income received from  commissioners.  Although the cash risk had gone for the foreseeable future this would continue to be closely monitored due to the Trust running at a financial deficit position.

·        The PSF for Q4 had not been met due to the pressures on the hospital and therefore inability to achieve the A&E 4 hour target which represented 30% of the  ...  view the full minutes text for item 40/19

41/19

Chair of Finance & Investment Committee Overview pdf icon PDF 182 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 25 March and 23 April 2019 covering:-

 

·        The year end financial position.

·        The underlying financial deficit.

·        Pay costs particularly as these were already under pressure going into the new financial year.  It was noted that the end of year position was slightly over budget due to robust controls on pay and agency costs.  The Committee congratulated all those involved.

RESOLVED

 

that the report be received.

 

42/19

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 and Assurance Committee held on 14 March 2019.

 

RESOLVED

 

that the report be received.

43/19

Quality Report pdf icon PDF 112 KB

Julie Marshman, 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 following key points to note for March 2019 were as follows: -

 

·        12 month rolling Hospital Standard Mortality Rate (HSMR) for January 18 – December 18 is 92.71

·        1 case of Cdiff reported during March 2019. The Trust has exceeded the Clostridium difficile (Cdiff) case trajectory of 19 cases with a total of 27 cases year to date.

·        1 Never Event and a further 5 Serious Incidents reported during March 2019.

 

The report was reviewed and the following highlighted:-

 

Hospital Standardised Mortality Rate (HSMR) / Summary Hospital Mortality Indictor (SHMI)  -  The HSMR figures were lower than expected and investigations found that this was due to  issues with Coding outside the control of the department.  This had now been resolved, therefore the figures would change when the data was next updated.

 

The Trust’s SHMI at 92.71 for the period January 2018 to December 2018 was a good position particularly going through escalation was demonstrated how well the Trust was performing in terms of mortality rates.

 

Andy Copestake, Non-Executive Director asked what ‘coding outside the department’s control’ meant.   Julie Marshman, Chief Nurse replied that it was the supply data provided to Dr Foster and confirmed that the Trust’s data was correct. 

 

Mortablity Alerts  - There was one alert reported in March 2019; ‘Aortic and peripheral arterial embolism or thrombosis’, and although very low patient numbers the usual patient-level report had been provided for auditing/investigation purposes.  In terms of the outcomes of the closed mortality alerts it was noted that there were no issues identified.

 

National Audits – There was a significant reduction in overdue items however it was noted that there were more projects carried forward to 2019/20 than in the previous 2 years.

 

Infection Prevention & Control  -  There was 1 case of Clostridium Difficile (Cdiff) infection reported in March 2019.  At year end 2018/19 the Trust had reported a total of 27 cases which had exceeded the year end trajectory of no more than 19 cases set by NHS England.  Following an investigation by a Clinical Commissioning Group (CCG) Expert Panel there were 11 cases deemed to be avoidable to date. This was possibly a reflection of the pressures on the hospital under constant escalation and the inability to isolate patients.  This was being closely monitored through the Infection Prevention & Control Committee.

 

Liam Coleman, Chair added that when discussing the fullness of the hospital there would inevitably be a correlation in some way with the outcomes of the various measures on the Trust however he asked for further explanation on the inability to isolate patients.  Julie Marshman, Chief Nurse explained that there were other areas of the Trust that required priority for  isolation for example critically ill or end of life patients and each requirement would be risk assessed.  Julie Soutter, Non-Executive Director asked if there was any  ...  view the full minutes text for item 43/19

44/19

Chair of Quality & Governance Committee Overview pdf icon PDF 228 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 21 March and 18 April 2019 which covered:- 

 

·        The Patience Experience Report for Q4 which highlighted telecommunications as the biggest Quality Improvement initiative underway to improve patient experience.

·        The Emergency Department (ED) Quality Dashboard which highlighted the significant increase in ED attendance.

·        A review of the Care Quality Commission (CQC) report Opening the door to change which analysed factors which had influenced the continued prevalence of Never Events in the NHS.

·        The Board Assurance Framework for Q4 relating to Strategic objective 1 – To deliver consistently high quality, safe services which deliver desired patient outcomes was discussed in detail with assurance that actions were in place to mitigate the risks.

·        An Equality & Diversity report which provided a summary of the achievements and continuing work to ensure that the Trust delivers its Vision of ensuring services and opportunities are equally accessible to all irrespective of any protected characteristics. 

 

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.

45/19

Operational Performance Report pdf icon PDF 329 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%)                        March 83.7%                        Failing

(combined - ED, MIU & UCC)                               

 

 

RTT Waiting List Size                              RTT – Waiting list size        Achieving

                                                               (February) 20,113

                                                               against 20801 trajectory

 

 

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

% delivery.

 

 

6 Week Diagnostic Wait (99%)                 March 92.77%                                   Failing

 

Cancer Targets:                                       February

 

2 Week Waits (All cancer 93%)                 95.7%                                  Achieving

2 Week Wait Breast Symptomatic (93%)    94.1%                                  Achieving

31 Day Treatment (96%)                           100%                                   Achieving

62 Day Treatment (85%)                           86.6%                                  Achieving

 

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

 

Referral to Treatment (RTT)_  -  Although RTT had met its standard target in February, it was noted that due to reporting issues this would not be achieved March 2019.    An internal review had been undertaken to understand the deterioration in the size of the waiting list and the Trust was in the process of commissioning an independent review to ascertain what lessons can be learnt.

 

Diagnostics  -  Performance had reduced in March 2019 due to continued pressures in capacity. The recovery plans that were in place were progressing with additional sessions to support performance and on-going recruitment however this area would remain a challenge throughout the year.

 

Emergency Department (ED) – Performance was at 93.7% in March 2019 in line with last year and given the level of pressure in patient attendances in ED, which was up 13.4%, this was testament to the staff who had delivered the same level of performance as last year.  However due to the sustained pressure of attendances April had been a difficult month.  Significant analysis was being undertaken locally and system wide to reduce numbers in the short term and a range of activities were underway to improve flow of patients.  The longer term plan was to expand the hospital with the investment recently pledged for a new ED build.

 

There followed a robust discussion regarding patient flow in particular the number of beds required to ensure flow was maintained.  It was noted that although this would be a relatively small number it was the time of turnaround that was more important.  Other drivers managing patient flow were discussed which included increase in demand in both winter and summer months, length of stay, out of hospital provision, delayed transfers and referrals.

 

Julie Soutter, Non-Executive Director asked how the Trust would manage demand until the new ED facility was available considering the continuing increase in attendances.  Nerissa Vaughan, Chief Executive replied that a number of options were being explored however these were in the early stages of appraisal and would be shared in due course.

 

Stroke  -  The main reason for the poor performance for direct admissions was because stroke beds were compromised by flow.  Robust monitoring continued to  ...  view the full minutes text for item 45/19

46/19

Chair of Performance, People & Place Committee Overview pdf icon PDF 242 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 meetings held on 27 February and 27 March 2019 and highlighted the following: -

 

·        Operational Performance Report

·        Board Assurance Framework (BAF) – strategic risks

·        IT update

·        Deep dive on mandatory training

·        Workforce Report.

 

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.

47/19

Safer Staffing Monthly Exception Report pdf icon PDF 650 KB

Julie Marshman, Chief Nurse

Minutes:

The Board received and considered a report which provided the bi-monthly exception reporting for safer staffing within the inpatient ward areas.

 

In February and March 2019 the Care Hours per Patient Day (CHPPD) were 7.1 and 7.6 hours respectively.

 

The report was reviewed and the following highlighted:-

 

Fill Rate  -  Overall night fill rates remained the same and day fill rates increased.  The fill rate for Registered Nurses (RN) was doing well however if the Assistant Practitioners, who also fill RN gaps, were included the score would be 96%.

 

Triangulation of Data  -  Data was triangulated with key quality performance indicators to ensure there were no adverse effects.  Benchmarking was undertaken using Model Hospital data.  The quality data did not indicate any concerns about the care provided on the ward, and professional judgment reviews indicated the ward was safe.

 

Julie Soutter, Non-Executive Director asked what the Trust was doing to address the change in workforce expectations in terms of flexible working, age profile and bank working.  Julie Marshman, Chief Nurse replied in terms of nursing a multifaceted approach was being adopted particularly around looking at the different entry routes into nursing, this included the new Nursing Associate role and Nursing Apprenticeships.  The Trust was working with the Sustainability and Transformation Partnership (STP) and nationally to work towards delivering a sustainable workforce for the future.  Sheridan Flavin, Interim Director of HR added that it was clear that a more flexible workforce was required and the Trust was developing mechanisms and opportunities for flexibility.

 

RESOLVED

 

that the report be received.

48/19

Ratification of Decisions made via Board Circular/Board Workshop

Carole Nicholl, Director of Governance & Assurance

Minutes:

None.

49/19

Self Certificate - Governor Training pdf icon PDF 125 KB

Carole Nicholl, Director of Governance & Assurance

Minutes:

The Board received and considered a paper that provided an overview of the training to governors and invited the Board to approve a self-certification of compliance with training requirements.

 

It was noted that in addition to the training and development opportunities in this report, governors had access to the Board reports and had been provided with a very detailed welcome pack about governor specific roles and duties.

 

The Council of Governors in February 2019 had confirmed that it was satisfied with training requirements for 2018/19.

 

RESOLVED

 

that it be agreed that the Board is satisfied that during the financial year most recently ended the Licensee has provided the necessary training to its Governors, as required in s151(5) of the Health and Social Care Act, to ensure they are equipped with the skills and knowledge they need to undertake their role.

 

50/19

Self Certifications pdf icon PDF 94 KB

Carole Nicholl, Director of Governance & Assurance

Additional documents:

Minutes:

The Board received and considered a number of self-certifications for Board approval prior to submission to NHS Improvement.  The self-certifications were:-

 

·        G6(3) – Systems or compliance with licence conditions (31-May)

·        G6(4) – Publication of condition self-certification (30-Jun)

·        FT4(8) – Compliance with required governance arrangements - training of Governors (30-Jun)

·        CoS7(3) – Availability of resources & accompanying statement (31-May)

 

RESOLUTION

 

that the annual self-certifications be approved.

51/19

Committee Membership pdf icon PDF 107 KB

Carole Nicholl, Director of Governance & Assurance

Additional documents:

Minutes:

The Board received and considered a paper that outlined amendments to the membership of the Board Committees, the appointment of Non-Executive Directors to supporting roles and the establishment of a new committee to seek assurance around the progress with the Way Forward Project (new ED build).

 

In consideration the following was noted:-

 

·        The Director of Strategy & Communications to be added to the membership of the newly established Way Forward Board committee.

·        The Non-Executive Director membership of the Joint Nominations Committee would rotate on an annual basis.

·        Further clarification on the role of NED champions/lead to be provided on an individual basis.

·        Add Peter Hill as nominated NED lead for Falls.

·        The Way Forward Committee to take place after the Board (short) meetings but with a separate agenda for a trial period.  The Board workshops would follow.

·        The Director of Strategy & Communications to be added to the Performance, People & Place Committee as a member.

·        A review to take place in 6 months’ time.

 

RESOLVED

 

(a)   that it be agreed that an additional Board Committee be established to seek assurance on behalf of the Board around progress with the Way Forward Project (new ED build) with terms of reference to be formally approved when drafted;

 

(b)   that the membership of Committees be approved as set out in appendix 1 to the report from 2 May 2019, subject to the amendments as outlined above;

(c)  that the appointment of non-executive directors to the supporting roles set out in Appendix 2 be approved, subject to the amendments as outlined above; and,

 

(d)  a review in 6 months’ time.

52/19

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.

53/19

Date and Time of next meeting

Date: 6 June 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 6 June 2019 at 9:30am in Trust Management Boardrooms, Trust HQ, 2nd Floor, Great Western Hospital

54/19

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.