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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

99/19

Apologies for Absence and Chairman's Welcome

Nick Bishop

Minutes:

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

 

The Chair acknowledged that Kevin McNamara was acting as Deputy Chief Executive in the absence of the Chief Executive.

A representative from CHKS, a healthcare improvement specialist, was present as a member of the public to present a prestigious award to the Trust as one of the CHKS Top Hospitals for 2019.

Apologies were received as outlined above.

100/19

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.

101/19

Minutes pdf icon PDF 364 KB

Liam Coleman, Chairman

·         6 June 2019 (public minutes)

Minutes:

The minutes of the meeting of the Board held on 6 June 2019 were adopted and signed as a correct record.

102/19

Outstanding actions of the Board (public) pdf icon PDF 297 KB

Minutes:

The Board received and considered the outstanding action list and the following comment noted:-

 

348/18  /  Quality Report / National Audits  / QI Projects Board Workshop  :  It was noted that a specific date had not been set as the Chair was currently reviewing the topics for future meetings.

103/19

Questions from the public to the Board relating to the work of the Trust pdf icon PDF 193 KB

Minutes:

The Board received and considered the questions from the public.

 

Jemima Milton, Non-Executive Director expressed her disappointment that the portable hearing loop did not work at the recent Joint Board and Council of Governor meeting.  It was confirmed that there would be staff present at the next Council of Governor’s meeting to ensure that the equipment worked. 

 

RESOLVED

 

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

 

104/19

Chairman's Report, Feedback from the Council of Governors

Liam Coleman, Chairman

Minutes:

The Chairman gave a verbal report as follows: -

 

·        The annual Joint Board of Directors and Council of Governors meeting was held on 4 July 2019 where the governors were presented with and had opportunity to input into the Trust’s Master Planning which set out the future options for the hospital site.  There was an active discussion which covered infrastructure particularly access, staffing, ophthalmology department and mental health facilities. 

 

·        An introduction and welcome to the Trust’s new Director of HR, Jude Gray and a thank you to Sheridan Flavin for her work whilst stepping into the leadership role.

 

·        There had been two very successful and well attended Health Talks in May and June 2019.  The next talk would be on 25 July 2019 and would cover Tobacco Control and Alcohol Misuse.

 

RESOLVED

 

that the report of the Chairman be received.

105/19

Chief Executive's Report pdf icon PDF 262 KB

Nerissa Vaughan, Chief Executive

Minutes:

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

 

·        The successful 10th Staff Excellence Awards held on 21 June 2019 to celebrate staff that had gone above and beyond for patients.  A list of winners was included in the report.

 

Peter Hill, Non-Executive Director asked for the job title of the Patient’s Choice Award.  Julie Marshman, Chief Nurse replied it was Admiral Nurse who looked after patients with dementia.  Liam Coleman expressed thanks, on behalf of the Board, to all members of staff involved in making the event so successful. 

 

·        The British Empire Medal in the Queen’s Birthday Honours list had been awarded to Wendy Johnson, Head of Adult Safeguarding and Mental Health, Lead Nurse Learning Disabilities for transforming care of vulnerable people.    The Board conveyed their congratulations to Wendy.

 

·        The Trust’s refreshed Strategy had been rolled out to staff which outlined the Trust’s ambitions over the next 5 years, and could be accessed via the Trust’s website.

 

RESOLVED

 

that the report of the Chief Executive be received.

106/19

Finance Report pdf icon PDF 185 KB

Karen Johnson, Director of Finance

Additional documents:

Minutes:

The Board received and considered a report on finance for month 02 (ending 31 May 2019), together with a presentation as follows: -

 

NHS Clinical Income

£25.3m in month (£369k below plan) £493k below plan ytd

Total Income

£28m in month (£160k below plan) ££231k below plan ytd

 

Non elective income activity and income is behind plan but this is mitigated by the blended payment where the floor on the contract means the trust retains £316K that would otherwise have been lost under full PbR.

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

·        Elective inpatients below plan

·        Day case activity below plan

·        Outpatient appointments below plan

·        Non-elective activity below plan

·        A&E above plan

 

Total Operating Expenditure

£27m in month (£1m above plan) £1,359k above plan ytd

 

Expenditure highlights in month:

·        Pay is above plan by £201k, (£34kYTD).

·        Supplies are below plan by £128k, (£379k YTD).

·        Drugs are above plan by £753k (£917k YTD).

·        Other costs are above plan by 262k (£787k YTD).

 

EBITDA

0.3% YTD which is 2.9% below plan

 

Savings

Savings plan of £9.105m of which £6.5m has been identified.

£598k CIPS delivered in month against a plan of £549k

 

Debtors

£48m debtors and stock

£5m above plan

 

Creditors

£67m creditors and borrowings

£6m above plan

 

Cash

£12m, £3m below plan

Loan

No loan drawdown in month as per plan

 

Finance Risk Ratings

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

 

The report was reviewed and the following highlighted:-

 

·        The year to date position at month 2 was a deficit of £3,802k, which was a deviation to plan of £1,636k.

 

·        The main drivers for the deviation were predominantly the shortfall in delivery of Cost Improvement Programmes (CIPS), drug costs, and clinical income specifically elective and same day activity.

 

·        As part of the NHS financial reforms for 2019/20 the Trust had signed up to a blended payment approach for A&E and non-elective admissions, this involved a fixed payment agreed with commissioners linked to expected levels of activity.   However the actual activity in Wiltshire had been significantly different from the planned level agreed and therefore there was a risk of a repayment to Swindon Commissioners. 

 

Lizzie Abderrahim, Non-Executive Director asked for further clarity on how the expected levels of growth activity had been agreed.  Karen Johnson, Director of Finance replied that the agreed forecast levels had been reached based on a 3 year trend profile over all commissioners.   However external factors had influenced activity levels which could not have been predicted, such as issues within primary care, and had resulted in a 4% increase in activity levels within the Swindon area.

 

Julie Soutter, Non-Executive Director asked for clarification on the financial overview which showed that the plan and forecast for some months this year as significantly more than last year.  Karen Johnson, Director of Finance replied that this related to pay back on block contract and the forecast which was based on Operation Pressures Escalation  ...  view the full minutes text for item 106/19

107/19

Chair of Finance & Investment Committee Overview pdf icon PDF 225 KB

Andy Copestake, Non-Executive Director

Minutes:

The Board considered a report which summarised the key issues from meetings of the Finance & Investment Committee held on 28 May and 24 June 2019.

 

A discussion followed on identifying opportunities and developing income and generating business developments.  Although there were routes within the Trust to discuss opportunities to generate income a further review would be undertaken by the Executive Directors in relation to the refreshed Trust Strategy.

 

RESOLVED

 

that the report be received.

108/19

Chair of Audit, Risk & Assurance Committee Overview pdf icon PDF 249 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 23 May 2019.

 

RESOLVED

 

that the report be received.

109/19

Chair of Charitable Funds Committee Overview pdf icon PDF 239 KB

Jemima Milton, Non-Executive Director

Minutes:

The Board considered a report which summarised the key issues from a meeting of the Charitable Funds Committee held on 1 May 2019.  In addition it was noted that the loan had now been agreed between Oxford University Hospitals NHS Foundation Trust and the Department of Health & Social Care towards the development of the Radiotherapy Facility on site.  Now that all funding had been secured work would commence in Spring 2020.

 

RESOLVED

 

that the report be received.

 

110/19

Quality Report pdf icon PDF 175 KB

Julie Marshman, Chief Nurse

Charlotte Forsyth, 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.  Key points to note for May 2019 were as follows:-

 

·        12 month rolling Hospital Standard Mortality Rate (HSMR) for March 2018 – February 2019 was 95.74.

 

·        2 cases of Clostridium difficile (C.diff) reported during May 2019.

·        2 Serious Incidents reported during May 2019.

The report was reviewed and the following highlighted:-

 

Infection Prevention & Control - It was noted that Julie Marshman, the Chief Nurse had taken on the role of Director of Infection Prevention and Control (DIPC) and would undertake a review of governance within this area.

 

Serious Incidents (SI) - There were 3 Serious Incidents reported in May 2019.  It was noted that in terms of overdue action plans; one had recently been completed and the other one would follow shortly.  These had been connected to IT and training.

 

Andy Copestake, Non-Executive Director highlighted that Sepsis had been in the media recently and asked how the Trust was managing sepsis.  Julie Marshman, Chief Nurse responded that the Trust was one of the leaders across the South West and with the introduction of Nervecentre software had further improved early detection of sepsis.

 

Lizzie Abderrahim, Non-Executive Director commented that the overdue actions for national audits still did not show revised deadline targets or clear statements on the reason they were not completed.  Charlotte Forysth, Medical Director responded that a review of the audit process was being undertaken to look at this and to improve visibility of learning which would include the process around action plans.

 

RESOLVED

 

(a)   that the quality matters and exceptions contained within the report be noted;

 

(b)   that it be agreed that the Quality Report provides assurance of progress towards quality improvements and quality indicators;

 

(c)   that the report be noted.

 

111/19

Chair of Quality & Governance Committee Overview pdf icon PDF 249 KB

Nick Bishop, Non-Executive Director

Minutes:

The Board received and considered a report that summarised the key issues from a meeting of the Quality & Governance Committee held on16 May and 20 June 2019.  In the absence of the Chair of the Quality & Governance Committee any questions should be directed through the Company Secretary.

Action  :   Director of Governance & Assurance

 

RESOLVED

 

(a)        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, and;

 

(b)        any further questions be directed to the Director of Governance &   Assurance.

 

112/19

Operational Performance Report pdf icon PDF 180 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: -

 

ED 4 hours                                              85.0% (May) below its 95%                                

(combined – ED, MIU & UCC)

 

RTT Waiting List Size                            (April) 21,558 against a trajectory of

                                                    21,969 (+411)                                                       

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

 

6 Week Diagnostic Wait                       94.16% (April) against 99% target                             

 

Cancer Targets                                    

2WW (all cancer)                                  88% (April) against 93% target    

2 Week Wait Breast Symptomatic         65.1% (April) against 93% target                              

31 Day Treatment                                 97.9% (April) against 96% target 

62 Day Treatment                                 89.1% (April) against 85% target 

 

The report was reviewed and the following highlighted:-

 

Emergency Department Performance - May this year compared to May last year demonstrated the continued theme of increased attendances month on month.   The Trust’s performance placed it 20th out of 31 for the regional 6 week average performance. The top breach reasons remained bed availability and first assessment capacity.

 

Stroke Performance - All performance indicators in May 2019 were worse than the same period as last year.  However it was noted that there had been an improvement over the last few weeks.  Stroke performance would always be impacted by site pressures however a great deal of work had been put in place to improve performance.

 

Outpatients - The overall volume of patients currently on the hold file had decreased.  All however all specialities had individual recovery plans in place to reduce the hold file further which consisted of administrative and clinical validation, virtual clinic capacity and options to add additional face to face capacity.

 

Theatre Utilisation - Theatre utilisation had deteriorated in month.  Analysis of performance and trend lines had been undertaken which showed a number of reasons for the deteriorated performance. While a number of them are associated with operational pressures and the knock on impact of unavailability of beds and use of Theatre Recovery for escalation, there were a number of other reasons identified which required speciality level recovery plans to be implemented.

 

Referral to Treatment Time (RTT)/Waiting List Size - Performance continued to be behind trajectory in May with growth in the waiting list size.

 

A discussion followed on the impact to the Trust’s financial position on the performance of RTT.  It was noted that a robust deep dive had been undertaken locally and with commissioners/regulators.  Also the RTT governance structure had been revised together with operational processes.  Full speciality recovery plans were developing.

 

Community

Swindon Intermediary Care Patient flow and Discharge - Flow continued to be slow with a significant drop in the week day average transfers from 4 to 2.5. Overall there was a decent level of flow with the challenges from the acute side with stranded patients.  The other impacting factor was that the Swindon Clinical Commissioning Group (CCG) had opened up this service to Wiltshire and Oxfordshire patients.  The  ...  view the full minutes text for item 112/19

113/19

Chair of Performance, People & Place Committee Overview pdf icon PDF 227 KB

Peter Hill, Non-Executive Director

Minutes:

The Board received and considered a report that summarised the key issues from a meeting of the Performance, People and Place Committee held on 24 April and 29 May 2019. 

 

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.

114/19

Safer Staffing Monthly Exception Report pdf icon PDF 764 KB

Julie Marshman, Chief Nurse

Minutes:

The Board considered a report which provided assurance of safe staffing processes across the Trust; and the on-going work to ensure the Trust clearly reflected the monthly nurse staffing position, in line with National Quality Board (2013) requirements.  The following was highlighted:-

 

·        The April 2019 average fill rate had increased due to the increase in patient close support.

 

·        In April 2019, due to increased demand on trauma capacity, the Trauma Unit and Aldbourne Ward underwent bed reconfiguration.  A deep dive was undertaken to triangulate data in order to provide assurance that safety was being monitored and maintained.

 

·        Although staff ratio was slightly below the optimum of 65:35 Registered Nursing/Care Staff, the Trust had met national guidance and was working towards the introduction of new roles such as Nursing Associates.

 

Andy Copestake, Non-Executive Director asked if there was any theme behind the increase in incident reporting (IR1s) associated with staffing levels.  Julie Marshman, Chief Nurse replied that an increase in incident reporting was not out of place during high escalation periods and that staffing levels were monitored through the Performance, People & Place Committee to ensure there were no trends emerging.

 

Julie Soutter, Non-Executive Director asked if a rolling 12 month average could be added to the fill rates data.  Julie Marshman, Chief Nurse agreed to include this in the next report.

Action  :  Chief Nurse

 

RESOLVED

 

(a)        that the report be received, and;

 

(b)        additional data would be included in the report in terms of fill rates.

 

115/19

Ratification of Decisions made via Board Circular/Board Workshop

Carole Nicholl, Director of Governance & Assurance

Minutes:

None.

116/19

To approve Way Forward Committee Terms of Reference pdf icon PDF 196 KB

Carole Nicholl, Director of Governance & Assurance

Minutes:

The Board received the revised terms of reference for the newly established Way Forward Committee which reflected feedback from Board members. 

 

A query was raised with regarding the quorum and voting requirements.  It was agreed that clarification would be sought and the Terms of Reference amended accordingly.

Action  :  Director of Governance & Assurance

 

RESOLVED

 

to approve the terms of reference for the Way Forward Committee subject to clarification requirements for quorum / voting requirements.

117/19

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.

118/19

Date and Time of next meeting

Date: 1 August 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 1 August 2019 at 9:30am in Trust Management Boardrooms, Trust HQ, 2nd Floor, Great Western Hospital

119/19

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.