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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

131/19

Apologies for Absence and Chairman's Welcome

Liam Coleman, Karen Johnson

Minutes:

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

 

It was noted that as part of their routine service a CQC representative was present to observe how the Board was run and also an opportunity to meet its members.

 

The Chair reminded all that the Trust held full Board meetings every other month with alternate meetings being much shorter in length as the main reports were fully scrutinised by the Board sub committees.  This meeting was a shorter meeting, however it was noted that the Operational Report, which had not been scrutinised beforehand due to timing, would be considered in full.

 

Apologies were received as outlined above.

132/19

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.

133/19

Minutes pdf icon PDF 334 KB

Peter Hill, Deputy Chairman

·         4 July 2019 (public)

Minutes:

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

 

Attendance List  -  Add Charlotte Forysth and Lizzie Abderrahim.

 

106/19 / Finance Report / Blended payments   :  Amend wording in 3rd bullet – to

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  fixed and variable elements of payment which were agreed with commissioners and linked to expected levels of activity.   However the actual activity in Swindon had been significantly different from the planned level agreed and therefore there was a risk that the payment agreed would be lower than anticipated from Swindon Clinical Commissioning Group (CCG).

 

106/19 / Finance Report / Capital Spend – Add to last paragraph the following as a second sentence “it was noted that the Board had considered a request earlier in the year and the situation had changed.:

 

110/19 / Quality Report / Serious Incidents-  Amend wording in 3rd paragraph to

Lizzie Abderrahim, Non-Executive Director was concerned that the overdue actions for national audits still did not show revised deadline targets or clear statements on the reason they were not completed and belied the statement in the report that the Trust “gave due consideration to the clinical guidelines, interventional procedures, quality standards and other best practice guidelines issued by NICE.  Charlotte Forysth, Medical Director responded that a review of the audit process was being undertaken to improve visibility of learning which would include the process around action plans.

 

 112/19 / Operational Performance Report / Community Services – change title from ‘intermediary’ to ‘intermediate’.

 

112/19 / Operational Performance Report / Community Services  - revise wording in first paragraph to “It was noted that the commissioners had opened up the SwICC service to Wiltshire and Gloucestershire patients.  This would have an impact on length of stay as patients out of area would stay longer due to the challenges Oxford Hospital had with their heart service.”

134/19

Outstanding actions of the Board (public) pdf icon PDF 511 KB

Minutes:

The Board received and considered the outstanding action list.

135/19

Questions from the public to the Board relating to the work of the Trust pdf icon PDF 251 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.

 

136/19

Finance Report pdf icon PDF 228 KB

Anne-Marie Howroyd, Deputy Director of Finance

Additional documents:

Minutes:

The Board received and considered a report on finance for month 03 (ending 30  June 2019) and the following was highlighted:-

 

·        The year to date position was a deficit of £5,981k which was £2,484k above plan.  The main drivers for the variance were clinical income, cost improvement programme (CIP) shortfall, drug costs and pay.

 

·        The Control Total would not be met for Q1.

 

·        The year end forecast showed a deficit of £20m which was £8m worse than plan. 

 

·        A financial recovery plan was in place and work continued with Divisions to ensure budgets were back on track.  The focus of the financial recovery plan was to increase income, close CIP gap and reduce expenditure.

 

·        Capital expenditure had started slower than expected and had been reduced by 20% as instructed by NHS Improvement capital this had been determined by slippage of schemes.

 

Peter Hill, Deputy Chair commented that the financial recovery plan had undergone significant scrutiny at Finance & Investment Committee last week.

 

Jemima Milton, Non-Executive Director commented that the wording on page 20 around reserves required revision.

Action  :  Deputy Director of Finance

 

Jemima Milton, Non-Executive Director commented that one focus of the financial recovery plan was a vacancy freeze however this would result in higher agency costs and compound the statement in the report “”additional agency costs due to high vacancies”.  Kevin McNamara, Interim Deputy Chief Executive replied that the Executive team had re-evaluated the approach to a total freeze and instead had  strengthened the Vacancy Review Panel process with more Executive oversight.  A further in-depth report with a finalised financial recovery plan would be produced for review by the Board in September 2019.

Action  :  Interim Deputy Chief Executive

 

Julie Soutter, Non-Executive Director asked for the top 5 adjustments associated with the non-pay variance across the Divisions in the revision of the forecast position for the next meeting.

Action  :  Deputy Director of Finance

 

Lizzie Abderrahim, Non-Executive Director questioned whether the risk score for the financial position was adequate.  Carole Nicholls, Director of Governance & Assurance replied that the risk score had been increased recently to reflect the financial position.

 

 

RESOLVED

 

(a)     the Month 03 financial position is a year to date deficit of £4.476m, £3.173m worse than plan, including PSF, MRET & FRF, all currently forecast to plan;

 

(b)     the Month 03 financial position excluding PSF, MRET & FRF is a year to date deficit of £5.981m, £2.484m worse than plan;

 

(c)   that the Use of Resources Rating is a 4;

 

(d)   revise wording around reserves;

 

(e)   to present the top 5 adjustments associated with the non-pay variance across the Divisions in the revision of the forecast position, and;

 

(f)   finalised Financial Recovery Plan to September 2019 Board meeting.

 

 

137/19

Quality Report pdf icon PDF 216 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.  The key quality issues covering June 2019 were as follows:

 

·        The 12 month rolling HSMR for April 2018 to March 201 was 96.51.

·        There were 3 cases of cdiff reported during June 2019.

  • There was 1 Serious Incident reported during June 2019.
  • The report had been considered in detail at the recent Quality & Governance Committee

 

The report was reviewed and the following highlighted

 

Infection Prevention & Control  -  The Trust was best in the south west in the C-diff Public Health data, however it was noted that Public Health had not yet changed its mechanism for new accounting and therefore this result may look slightly different against other trusts in the future.

 

Safety Incidents  -  There was one overdue serious incident action reported in June 2019.  It was confirmed that the related training would be completed by end July 2019.

 

Good News -  There were many nominees for ‘placement of the year’ which was a sign of good mentoring and experience in ward areas.

 

Paul Lewis, Non-Executive Director pointed out that although the number of outstanding audit actions had reduced there were still several with no revised date or had passed the revised date for completion and asked for assurance that this was being addressed.  Charlotte Forsyth, Medical Director reassured the Board that she had direct contact with all the overdue audit leads and that there was nothing of concern and was purely down to process and area that required review.  Nick Bishop, Non-Executive Director and Chair of the Quality & Governance Committee added that the Committee had been assured that the quality of care was satisfactory and within guidelines and confirmed that it was purely an administrative delay in reports and sign off.

 

There followed a robust discussion with regard to the quality of the information presented in the report and how it could be perceived as misleading in the quality of care provided by the Trust.   Julie Marshman, Chief Nurse, replied that all the data in the report was accurate and agreed that some of the wording was repetitive, however added that the Quality Report was under review and a new format and style would be presented at the next meeting which would reflect all the comments and concerns expressed . The discussion broadened to the governance of all Board reports in terms of the number of times they were reviewed and whether this was efficient use of time.  Carole Nicholl, Director of Governance & Assurance responded that the reason for repetitive reviewing was an opportunity to deep dive and challenge in committees however noted the comments and would undertake a full review.

Action;  Director of Governance & Assurance

 

Andy Copestake, Non-Executive Director noted that the blood culture contamination rate was on the increase and in the narrative said that ‘the trust was focussed on sustaining the reduction in blood contamination’ and asked for the actions  ...  view the full minutes text for item 137/19

138/19

Use of Perinatal Mortality reporting tool within Maternity Services Q4 2018-19 & Q1 2019-20 pdf icon PDF 614 KB

Julie Marshman, Chief Nurse

Minutes:

The Board considered a report which outlined the quarterly data to demonstrate compliance with the safety action 1 in the NHS Resolution Maternity Incentive Scheme.  It was noted that the full report had been discussed at the Quality & Governance Committee with the Head of Maternity.

 

The standard was met with the exception of the completion of uploading.  This was due to technical issues in accessing the national MBRACE website and out of the Trust’s control.

 

Andy Copestake, Non-Executive Director was assured with the process however was surprised at the number of deaths in one quarter and asked if this percentage was consistent with other trusts.  Julie Marshman, Chief Nurse replied that the Trust was not an outlier and added that all cases were investigated and learning taken on board.

 

RESOLVED

 

to note the report.

139/19

Maternity Incentive Scheme - NHS Resolution 10 Criteria pdf icon PDF 555 KB

Julie Marshman, Chief Nurse

Minutes:

The Board considered a report which provided assurance that there was sufficient evidence to demonstrate the achievement of all 10 criteria in the Maternity Incentive Scheme.

 

Nick Bishop, Non-Executive Director and Chair of the Quality & Governance Committee confirmed that the Committee had reviewed all 10 standards and were assured that they had been met with hard evidence and congratulated the staff concerned for their hard work.

 

Andy Copestake, Non-Executive Director and Chair of the Finance & Investment Committee added that this was an important scheme and excellent progress had been made and this had also been discussed at the Finance & Investment Committee.

 

Jemima Milton, Non-Executive Director asked if the amber  rating on the action plan would be an issue in terms of compliance.  Julie Marshman, Chief Nurse replied that this was over and above the evidence required and therefore was not an issue.

 

RESOLVED

 

the report and evidence provided is noted particularly the requirements for the ‘Board Declaration Form’ sign off process and the for the information to be shared with the local Commissioners as required by  NHS Resolution.

140/19

Operational Performance Report pdf icon PDF 223 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 hour standard (95%)                               87.4% June

(combined - ED, MIU & UCC)   

 

RTT Waiting List Size                                    22,854 against a trajectory of                                                                21,558 (+1296) May

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

 

6 Week Diagnostic Wait (99%)            92.34%  June          

 

Cancer Targets:         

2 Week Waits (All cancer 93%)            90%      May

2 Week Wait Breast Symptomatic (93%)           72.5%   May

31 Day Treatment (96%)                                   98.1%   May

62 Day Treatment (85%)                                   82.7%   May

 

The report was reviewed and the following highlighted:-

 

Cancer Performance – The 2 week wait breast target had not been met due to a spike in demand, however this was back in control in July 2019.  The 62 day treatment standard continued to be a challenge despite the tremendous level of improvement in the timed pathway and the weekly review of each breach; however these were small numbers and very complex cases.

 

Peter Hill, Deputy Chair asked how the trust benchmarked with other trusts in terms of cancer referrals and treatment.  Jim O’Connell, Chief Operating Officer replied that all trusts were finding it challenging to hit the cancer targets however the Trust was performing well as indicated in the latest available data.

 

Stroke  - Stroke performance was still challenging in terms of direct admissions within 4 hrs.  Stroke performance would always be impacted by site pressures.  It was noted that the benefits from the approved Business Case to improve the Sentinel Stroke National Audit Programme (SNNAP) performance would be realised in the Autumn 2019. 

 

Jemima Milton, Non-Executive Director expressed concern around the direct admissions within 4 hrs performance as timing was everything in terms of a stroke, and the importance of keeping the ring fenced stroke bed.  Charlotte Forsyth, Medical Director responded that a stroke nurse would go down to the ED department and there would always be stroke input on such occurrences.  Julie Marshman, Chief Nurse added that the stroke ward was predominantly full with stroke patients and that the ring fenced bed would only be used in escalation and when absolutely necessary.

 

Lizzie Abderrahim, Non-Executive Director expressed concern with regard to the phrase ‘will always be impacted by site pressures’ as it implied that no improvement was ever going to be achieved in stoke performance.  Jim O’Connell, Chief Operating Officer agreed to reword however explained that in reality the Trust was short of 60-80 beds and there would always be a challenge.  Peter Hill, Deputy Chair added that correct messaging within the organisation was essential and that it was never acceptable not to improve. 

 

It was noted that acute stroke was under review by the Sustainability and Transformation Partnership (STP) with a report due late August 2019 which the Board would consider in due course. 

 

Diagnostics and Outpatients (D&O  ...  view the full minutes text for item 140/19

141/19

Ratification of Decisions made via Board Circular/Board Workshop

Carole Nicholl, Director of Governance & Assurance

Minutes:

None.

142/19

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.

143/19

Date and Time of next meeting

Date: 5 September 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 5 September 2019 at 9:30am in Trust Management Boardrooms, Trust HQ, 2nd Floor, Great Western Hospital.

 

144/19

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.