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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

71/19

Apologies for Absence and Chairman's Welcome

Minutes:

The  Chair welcomed all to the Great Western Hospitals NHS Foundation Trust Board meeting held in public and acknowledged that this was Guy Rooney’s last Board meeting as Medical Director and formally thanked him for all his hard work and effort during his time on the Board.

 

Apologies were received as outlined above.

72/19

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.

73/19

Minutes pdf icon PDF 542 KB

Liam Coleman, Chairman

·        2 May 2109 (public minutes)

Minutes:

The minutes of the meeting of the Board held on 2 May 2019 were adopted and signed as a correct record, subject to the following amendments: -

 

43/19 / Quality Report / Concerns and Complaints ­   :  Add “in particular whether the agreed revised timescales were being met” to the end of the first sentence.

74/19

Outstanding actions of the Board (public) pdf icon PDF 301 KB

Minutes:

The Board received and considered the outstanding action list. 

75/19

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.

76/19

Finance Report pdf icon PDF 117 KB

Karen Johnson, Director of Finance

Additional documents:

Minutes:

The Board received and considered a report on finance for month 1 (ending 30 April 2019), together with a presentation as follows: -

 

Actual Operating costs

The report did not contain any data relating to Provider Sustainability Funding (PSF), Marginal Rate Emergency Tariff (MRET) and Financial Recovery Fund (FRF) and represents the Trust Control Total only.

In month deficit of £2,792k compared to a target deficit of £2,439k.

NHS Clinical Income

£23.7m in month (£124k below plan)

Total Income

£26.2m in month (£72k below plan)

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

·        ED over plan

·        Non elective below plan

·        Day Case ahead of plan

·        Elective behind plan

·        Outpatient (OP) follow ups and procedures close to plan but OP firsts behind plan.

Total Operating Expenditure

 

£27m in month (£271k above plan)

Expenditure highlights in month:

·        Pay below plan by £166k year to date (YTD).

·        Supplies below plan by £251k YTD.

·        Drugs above plan by £164k YTD.

·        Other costs above plan by £492k YTD.

EBITDA

3.1% YTD which was 1.3% below plan

Savings

Savings plan of £9.105m of which £6.4m has been identified.

£291k CIPS delivered in month against a plan of £549k

Debtors

£48.3m debtors and stock

£0.8m below plan

Creditors

£63m creditors and borrowings

£2.2m above plan

Cash

£7m on plan

Loan

No loan drawdown in month as per plan

Finance Risk Ratings

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

Actual Operating costs

The report did not contain any data relating to Provider Sustainability Funding (PSF), Marginal Rate Emergency Tariff (MRET) and Financial Recovery Fund (FRF) and represents the Trust Control Total only.

In month deficit of £2,792k compared to a target deficit of £2,439k.

NHS Clinical Income

£23.7m in month (£124k below plan)

Total Income

£26.2m in month (£72k below plan)

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

·        ED over plan

·        Non elective below plan

·        Day Case ahead of plan

·        Elective behind plan

·        Outpatient follow ups and procedures close to plan but OP firsts behind plan.

Total Operating Expenditure

 

£27m in month (£271k above plan)

Expenditure highlights in month:

·        Pay below plan by £166k YTD.

·        Supplies below plan by £251k YTD.

·        Drugs above plan by £164k YTD.

·        Other costs above plan by £492k YTD.

EBITDA

3.1% YTD which was 1.3% below plan

Savings

Savings plan of £9.105m of which £6.4m has been identified.

£291k CIPS delivered in month against a plan of £549k

Debtors

£48.3m debtors and stock

£0.8m below plan

Creditors

£63m creditors and borrowings

£2.2m above plan

Cash

£7m on plan

Loan

No loan drawdown in month as per plan

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 for month 1 was a deficit of £2,792 which was £353k above plan.  It was noted that this included an element of reserves funding of £818k to support  ...  view the full minutes text for item 76/19

77/19

500 Lives and mortality review update pdf icon PDF 184 KB

Guy Rooney, Medical Director

Minutes:

The Board received and considered a paper that provided an interim update on the Save 500 Lives Campaign, together with a progress report on mortality reviews.  The following was highlighted:-

 

·        The main focus of work to reduce mortality rates was on sepsis, acute kidney injury and deteriorating patients.

·        The introduction of Nervecentre, a mobile clinical workflow platform which identified deteriorating patients and improved performance against mortality indicators.

·        Saving Lives was one of three indicators in measuring mortality.  It was agreed at the Quality & Governance Committee to continue to report all three indicators.

·        Mortality rates had improved within the Trust.

 

There followed a discussion around the use of the three indicators and although there was some degree of delay in reporting in each, fundamentally all were below the national 100 index and provided triangulated assurance that the Trust was performing well in this area. 

 

It was noted that the main lesson learnt from the mortality reviews remained the introduction of end of life care earlier.

 

RESOLVED

 

(a)    to note this update and the associated risks, and;

 

(b)    to note the current status of mortality reviews.

78/19

Quality Report pdf icon PDF 111 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 key points to note for April 2019 were as follows: -

 

·        12 month rolling Hospital Standardised Mortality Rate (HSMR) for February 18 – January 19 was 95.50.

·        4 cases of Cdiff reported during April 2019.

·        4 Serious Incidents reported during April 2019.

 

The report was reviewed and the following highlighted:-

 

Hospital Standardised Mortality Rate (HSMR) – The final HSMR figure for the financial year 2018/19 was 95.50.

 

Summary Hospital Mortality Indicator (SHMI) - The SHMI for the rolling 12 month period of October 2017 to September 2018 was 85.56 giving the Trust a ‘Better than Expected’ rating. The SHMI for this period was lower (better) than the nationally expected value of 100, and was similar to the previous 12 month period.

 

Mortality Alerts – Two alerts were received with the normal patient-level report provided for auditing/investigation purposes.

 

National Audits – The number of outstanding audits was 13 which were all being actively chased for completion.  It was noted the Laparotomy Audit had reported some good figures and had contributed to the lower SHMI and HSMR rates.

 

Paul Lewis, Non-Executive Director was pleased to see further improvements in overdue reports however requested that a revised target date be included in future reporting.  Lizzie Abderrahim, Non-Executive Director added that the reason for delay would also be helpful to understand the pressures on individuals which made it difficult to complete the audit.

Action  :  Medical Director

 

Infection Prevention & Control  -  It was noted that the trajectory for Clostrium difficile infection (CDI) for 2019-20 had been set and must not exceed 47 cases.  This number had increased from last year this was due to the inclusion of community services.

 

Safety Incidents  -  There were 4 Serious Incidents reported during April 2019 with 2 of these being Category 4 Pressure Ulcers identified within the community. The Trust continued to work closely with community services to put the right measures in places to reduce the risks.

 

All overdue actions were monitored closely at the Quality & Governance Committee.  It was noted that there were one or two overdue actions involving IT and competencies. Appropriate target dates had been negotiated with IT and the training was about to be signed off, however this had been particularly difficult to release staff due to low numbers of staff.

 

Lizzie Abderrahim, Non-Executive Director commented that there were 808 clinical incidents reported during 2019 but no detailed information on how many were outside or within the set timescale.  Julie Marshman, Chief Nurse agreed to add this detail to future reports.

Action :  Chief Nurse

 

Mixed Sex Breaches­  -  There had been a significant rise in reportable mixed sex breaches which were all linked to escalation, notably the use of Recovery 2 area.

 

Liam Coleman, Chair highlighted that this was a consequential outcome due to the number of patients and should be reflected in the comments within  ...  view the full minutes text for item 78/19

79/19

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%)                        April  82.8%                          Failing

(combined - ED, MIU & UCC)                               

 

 

RTT Waiting List Size                              RTT – Waiting list size        Failing

                                                               (March ) 21,558 against

                                                               20,790 trajectory*

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

% delivery.

 

 

6 Week Diagnostic Wait (99%)                 April  94.16%                       Failing

 

Cancer Targets:                                       March

 

2 Week Waits (All cancer 93%)                 93.4%                                   Achieving

2 Week Wait Breast Symptomatic (93%)    86%                                      Failing

31 Day Treatment (96%)                           100%                                    Achieving

62 Day Treatment (85%)                           88.7%                                   Achieving

 

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

 

Cancer Performance  -  Cancer was performing well and the team were commended for their hard work.  The one area that was failing was 2 Week Wait Breast referrals and related to abnormality not a cancer diagnosis.

 

Stroke Performance  -  The two key matrics for stroke performance relating to direct admissions had slipped significantly and correlated with the pressures in the Emergency Department (ED).  A deep dive would be undertaken at the next Performance, People and Place Committee to understand actions.

 

Diagnostics Performance  -  There had been a significant improvement in performance and this was slowly increasing back to 99% target.  Pressure continued with the Cardiology Physiology however an appointment had been made to help address the demand issue.

 

ED Performance-  The 4 hour performance had remained a challenge over the last 6 weeks within the south west region with only one trust achieving the standard.  The Trust was rated 26 out of 35 trusts.  The challenges were known particularly with the increase in major attendances at ED.  The number of breaches increased significantly in April which also correlated with the mix sex breaches reported in the Quality Report.

 

It was noted that May performance had improved slightly but not as last year.  The pressure over the last few months was similar to winter and as a result the Executive Team was refreshing the ED plan to tackle specific issues which included stranded patients, reconfigure beds, and address breaches.  Furthermore there was an indication that NHS England was changing the current A&E measures to new standards.

 

Karen Johnson, Director of Finance commented that there was a real concern with regard to the increased attendance of patients in majors in ED and asked for clarification on what involvement the System had to address this issue.   It was noted that the system-wide A&E Board had commissioned a review to understand the flow of demand in particular the route of referrals within the system, plus the Clinical Leadership Group’s remit had been extended and its first task was to resolve this issue.  

 

Referral to Treatment Time (RTT)  -  The Trust failed to meet the Waiting List size trajectory in March and  ...  view the full minutes text for item 79/19

80/19

Generator Incident (electrical interruption) 1 February 2019 pdf icon PDF 168 KB

Julie Marshman, Chief Nurse

Kevin McNamara, Director of Strategy & Community Services

Minutes:

The Board received and considered a report that provided a review of the generator incident that occurred on 1 February 2019 and the following highlighted:-

 

·        On 1 February 2019 the Trust had experienced a complete loss of electrical power for 42 minutes and a major incident was called. 

·        A number of IT systems were affected and it was several days before full recovery was achieved.

·        No incidents of moderate or severe harm to patients had been identified.

·        Since the incident SERCO, the Trust’s facilities management company, had introduced a range of interim measures to ensure this type of incident did not happen again.  A wider range of permanent solutions continued to be introduced.

·        The Trust’s major incident response across the entire organisation had worked effectively with huge efforts from staff who were also contending with adverse weather conditions.  Both these factors helped to ensure that there was no harm to patients.

 

Liam Coleman, Chair asked about the learning from an IT perspective in terms of battery power and repowering the system.  Kevin McNamara, Director of Strategy and Community services replied that a whole range of learning had taken place which included a clearer understanding of order, protection and toleration levels within the system.

Nick Bishop, Non-Executive Director asked how this had been logged to ensure corporate memory was sustainable.  Rupert Turk, Director of Estates and Facilities replied that the Trust’s resilience process, Irespond, had been strengthened and there was a clear process to follow.

 

Paul Lewis, Non-Executive Director asked what the on-going confidence, oversight and assurance was over key third parties to ensure that similar issues did not happen again.  Rupert Turk, Director of Estates and Facilities responded that a significant amount of work had taken place and action plans underpinned this and there were no known gaps with third parties to highlight.

 

RESOLVED

 

(a)     that Board note the content of the report, and;

 

(b)     that Board specifically note that a range of interim measures have been introduced to ensure this incident cannot re-occur and further permanent measures are also underway.

81/19

Ratification of Decisions made via Board Circular/Board Workshop

Carole Nicholl, Director of Governance & Assurance

Minutes:

None.

82/19

Freedom to Speak Up bi-annual report pdf icon PDF 117 KB

Carole Nicholl, Director of Governance & Assurance

Additional documents:

Minutes:

The Board received and reviewed a report that provided bi-annual report on Freedom to Speak Up.  The key headlines were:-

 

·        Freedom to Speak Up mechanisms were in place to support an open and supportive culture that encouraged staff to speak up about any issues of patient care, quality and safety.

·        There were 7 guardians now appointed and representative of staff groups.

·        All the actions from the national template self-assessment were completed.

·        Learning outcomes had been captured and shared.

·        One indicator of an open culture was the staff survey which was worse than last year, however the timing of the survey was before the refreshed approach adopted by the new Executive Lead and therefore all the achievements reported in the paper were not in place at the time.

 

Nick Bishop, Non-Executive Director commented that the Quality & Governance Committee was content with progress to date and commended the Executive Lead and Guardians for their hard work.

 

Jemima Milton, Non-Executive Director asked if the guardian names could be added to the next report. Carole Nicholl, Director of Governance & Assurance said she would include this.

Action   :  Director of Governance & Assurance

 

RESOLVED

 

that the half year report on Freedom to Speak Up be received and the Board be asked to confirm that it is assured that actions are ongoing to support the Freedom to Speak Up mechanisms in place.

83/19

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.

84/19

Date and Time of next meeting

Date: 4 July 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 4 July 2019 at 9:30am in Trust Management Boardrooms, Trust HQ, 2nd Floor, Great Western Hospital.

85/19

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.