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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

193/19

Apologies for Absence and Chairman's Welcome

Jemima Milton, Julie Soutter

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 also thanked the governor group and all those who attended the successful Annual Members Meeting held on 26 September 2019, with a special mention to Rosemarie Phillips who brought to life the role of the governors and what they can do for the Trust.

 

Apologies were received as outlined above.

194/19

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.

195/19

Minutes pdf icon PDF 444 KB

Liam Coleman, Chairman

·         5 September 2019 (public)

Minutes:

The minutes of the meeting of the Board held on 5 September 2019 were adopted and signed as a correct record.

196/19

Outstanding actions of the Board (public) pdf icon PDF 512 KB

Minutes:

The Board received and considered the outstanding action list with the following comments:-

 

165/19 : Safer Staffing : Staff Survey  :  It was noted that as the staff survey was completed by a cross section of staff it was not possible to pull out staffing sections. Closed. 

 

166/19  :  Safer Staffing  :  Apprenticeship Levy  :  It was noted that Nursing Associates were not classed as apprenticeships.  Closed.

 

169/19  : Workforce Disability Equality Standard  -  The deadline for submission was 30 September 2019 however greater measures would be added for the next submission.  Closed

 

171/19  :  Appraisal and Revalidation   :  External Review  - A note would be circulated to advise on position with regard to external reviews for the medical revalidation and appraisal process.

Action :  Director of Governance & Assurance

 

173/19  :  Operational Performance Report  :  Delayed Transfer of Care Review NHS Outcomes Framework  :  This was discussed at Performance, People and Place Committee.  Closed.

 

197/19

Questions from the public to the Board relating to the work of the Trust pdf icon PDF 267 KB

Minutes:

There was one question from members of the public based on visually impaired patients which was noted with no further action required.

 

198/19

Brexit preparedness pdf icon PDF 200 KB

Additional documents:

Minutes:

Leighton Day, Associate Director of Operational Performance joined the meeting for this item.

 

The Board received and considered a paper that provided an update on the Trust’s preparations undertaken in relation to the UK’s exit from the EU on 31 October 2019.  The following was highlighted:-

 

·         There were comprehensive national guidelines and national reporting on assurance and compliance.

·         Key work streams had been established that covered medicines/ vaccines/clinical trials, medical equipment/clinical consumables, non-clinical consumables/goods/services, workforce and data sharing/access.

·         Medicines supplies had been nationally co-ordinated and protocols produced for serious shortages.  A minimum of 6 weeks additional supply of medication would be stockpiled by pharmaceutical companies. There was no requirement for health providers to locally stockpile medication beyond business as usual stocks

·         EU nationals had been written to offer support with registration.

·         National assurances in relation to suppliers who are part of the NHS Supply Chain had been gained nationally as contingency arrangements had been  developed centrally.

·         The procurement team with service managers had developed and reviewed a comprehensive database of over 50,000 lines.  High risk items had been identified.

·         An irespond team were in place to manage any impact post Brexit.

 

Andy Copestake, Non-Executive Director asked about the form of assurance from major suppliers.  Leighton Day, Associate Director of Operational Performance replied that notwithstanding national guidance, the Trust had sensed checked in discussions with suppliers to seek assurances about continuity of supply.

 

Paul Lewis, Non-Executive Director asked if there was any risk to the hospital from other Trusts that may not be in the same position.  Leighton Day, Associate Director of Operational Performance responded that there was a potential risk particularly around procurement however there was a robust local contingency/business continuity plan in place to manage any impact.

 

The Board thanked Leighton and his team for a good presentation which outlined the breadth of risks the Trust had considered and its approach to the management of each risk in conjunction with the national framework for the NHS

 

RESOLVED

 

to note the current preparedness of the Trust in relation to the UK exiting the EU on 31 October 2019.

199/19

Quality Report pdf icon PDF 217 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 and the following was highlighted:-

 

·         The report had been robustly scrutinised by the Quality & Governance Committee.

·         The external report commissioned  to review how the Trust managed patient safety, clinical risk and clinical governance.  This described a blueprint to move from Requires Improvement to Good to Outstanding in terms of the Trust’s Care Quality Commission (CQC) rating which included the Serious Incident Review which was currently being undertaken. 

·         Work had been undertaken to improve the response rate for the Family & Friends Test (FFT).  

 

Liam Coleman, Chair commented that although there was a national framework to engage with patients it was important to recognise that there were different approaches to gaining feedback which maybe outside the framework.  Peter Hill, Non-Executive Director added that NHS England had recently carried out a project to improve some areas of the Friend and Family Test which had resulted in a revised FFT Guidance to be implemented next year.  Kevin McNamara, Acting Chief Executive further added that this was only one element of patient feedback and another rich source was through the complaints procedure.  It was noted that an audit was currently underway related to the quality of responses and a new escalation process had been put in place to address overdue complaints.

 

·         New guidance on Mix Sex Breaches which would potentially mean a significant rise in reporting for GWH.  However it was noted that  due to significant variation in reporting in the southwest NHS England (NHSE) were undertaking a review to understand this variance in reporting.

·         The good work happening in the Quality Improvement (QI) area with nearly 60 projects underway.

·         To improve Electronic Discharge Summaries (EDS) the Medical Director had introduced a standard that no patient leaves the hospital without a EDS .  It was noted that this would take a while to embed and may have a potential impact on flow.

 

Andy Copestake, Non-Executive Director commented that he liked the new reporting format however asked for clarification on the risk rag status.  Julie Marshman, Chief Nurse replied that the rag rating responded to meeting the national standard targets. Lizzie Abderrahim, Non-Executive Director proposed that the rag rating was applied to the top of each page under the ‘safe, effective, care, responsive and well-led’ banners.  Kevin McNamara, Acting Chief Executive added that a balance scorecard was in development which would improve oversight.

 

Andy Copestake, Non-Executive Director highlighted that only half of the matron audits had been completed and was disappointed to see this.  Julie Marshman, Chief Nurse acknowledged this and was due to the fact that these audits had only recently been introduced to outpatient areas and this figure would improve significantly next month.

 

Lizzie Abderrahim, Non-Executive Director expressed concern with regard to the phrase ‘…and at present no solution have been found’ within the Mixed Sex Breaches narrative as it implied that nothing would be done  ...  view the full minutes text for item 199/19

200/19

Workforce Report pdf icon PDF 359 KB

Jude Gray, Director of Human Resources & Organisational Development

Minutes:

The Board received and considered the Workforce Report for month 5 which outlined the key issues and risks identified in August 2019.  The following was highlighted:-

 

·         The report had been robustly scrutinised by the Performance, People & Place Committee.

·         The number of vacancies had improved however it was still a challenging environment.

·         Sickness absence rate was up slightly.

·         The overall voluntary turnover remained below target however there were some divisional challenges in community and planned care which were being addressed.

·         Appraisals were in line with the compliance rate.  The Trust were currently reviewing the appraisal policy.

·         In month agency spend achieved target however failed to meet the year to date target.  Improvements in nursing agency spend continued to be closely monitored.

·         Recruitment volumes were high however there were still areas that were difficult to fill and further work was underway to address these issues.

·         The Trust continued to invest in the development of a proactive health and wellbeing strategy for staff.

·         Mandatory training remained above target however hot spot areas remained and further work was on-going to find the most effective ways of managing these to achieve compliance.

·         October 2019 was Freedom to Speak Up (F2SU) month and an event was held to raise awareness with follow up activities planned.

 

Liam Coleman, Chair commented that feedback was very positive and well received both internally and externally with the initiatives and learning that was taking place with regard to the F2SU and thanked all those involved for their hard work and effort.

 

Nick Bishop, Non-Executive Director asked if the turnover figure included trainees as during the months of September and February there would be a massive spike due to the changeover.  Jude Grey, Director of HR responded that they were.

 

Paul Lewis, Non-Executive Director asked about the sickness absence rate as the national standard was 4% and the position reported was positive.  Jude Grey, Director of HR responded that the 3.5% was an internal target and would ensure in future that staff understood this positive position.

 

Lizzie Abderrahim, Non-Executive Director asked about any recruitment campaigns that the Trust were undertaking to encourage more substantive recruitment.  Jude Grey, Director of HR responded that there were a range of initiatives being reviewed which included recruitment nursing events and tailored recruitment packages.  Liam Coleman, Chair added that ultimately the best route was to ‘grow your own’ which required an innovative approach. 

 

RESOLVED

 

that the report is noted.

 

201/19

Operational Performance Report pdf icon PDF 223 KB

Jim O’Connell, Chief Operating Officer

Kevin McNamara, Acting Chief Executive

Additional documents:

Minutes:

The Board received and considered the Operational Performance Report for July/August 2019 and highlighted the following:-

 

Cancer -  Overall performance continued to achieve the standard, however it was noted that the 62 week standard dipped in July.

 

Stroke -  Performance had moved to SNNAP level E for Q1 due to submission of incomplete data and the Trust were not able to resubmit the correct data.

 

Diagnostics  -  Progress on performance continued and was on plan.

 

Emergency Department (ED) - Performance had decreased and showed an earlier drop off in the overall performance  for the year compared to last year.  August had showed a marked increase in attendances.   A GIRTH review had identified efficiency in both front and back door for discharge of patients and highlighted that the focus should be on delayed patients and that the Trust was one of only 3 trusts in the country that had a bed capacity issue.

 

Nick Bishop, Non-Executive Director commented that according to the report on delayed transfer of care there appeared to be a high proportion of patients from outside Swindon experiencing delays.  Jim O’Connell, Chief Operating Officer replied that arranging a patient’s on-going care to leave hospital in a timely, safe and supported way relied not only on our own hospital processes but a system wide response from other health and social care. 

 

There followed a discussion on the relationship between the public and private sector in relation to availability of beds and home care support.  It was noted that the Trust were currently using Princess Lodge whilst essential renovation work was carried out in wards in the Swindon Intensive Care Centre (SwICC) with the potential of usage spilling over to the winter period as escalation beds.

 

Paul Lewis, Non-Executive Director noted that in relation to the 4 hr breach the biggest breach was in first assessment and asked whether this was linked to bed capacity.  Jim O’Connell, Chief Operating Officer responded that first assessment breaches could be associated with bed capacity however there were many factors that influenced and impacted on ED flow. 

 

Referral to Treatment Time (RTT)  -  Performance continued to be significantly off trajectory.  Recovery actions were in place to ensure delivery of a stable waiting list by the end of the year. 

 

Nick Bishop, Non-Executive Director asked, to put the numbers in context, what time would it take to clear the waiting list in weeks.  Jim O’Connell, Chief Operating Officer replied it would take less than a month’s activity to clear the waiting list.

 

Community

COPD Service  -  There had been an increase in average length of stay patients admitted to acute and a review was underway to explore whether the end of life rapid response service could support in future.

 

Community Matron Service  -  Work was underway to embed the Community Matrons into each Locality Nursing team to provide clinical leadership for patients with complex needs on the community nursing case load.

 

Swindon Intermediate Care Centre (SwICC)  -  Orchard Ward had  ...  view the full minutes text for item 201/19

202/19

Finance Report pdf icon PDF 229 KB

Karen Johnson, Director of Finance

Additional documents:

Minutes:

The Board received and considered the Finance Report for month 5 (August 2019) and the following highlighted:-

 

·         The year to date position at month 5 was a deficit of £4.3m above plan

and the cause of the deterioration remained consistent with previous months. 

·         Additional pressures related to the doctor’s pay and the achievement of the waiting lists which had not been included previously. 

·         Discussions with commissioners on the blocked contract for the remainder of the year were nearing completion.

·         In terms of divisional performance the biggest financial risk areas were Planned and Unscheduled Care due to a combination of CIP delivery, pay and escalation.

·         The forecast outturn position had deteriorated to previous month by £10.5m however the block contract, if agreed, would reduce this variance by £3m.

·         The Financial Recovery Plan was well underway with Divisional oversight by the Finance & Investment Committee.

·         There were several key risks that could impact the Trust achieving its Control Total.   It was noted that any deviation from Control Target was now a STP issue and NHSE were producing a protocol for such occurances.

 

Nick Bishop, Non-Executive Director asked why the drug costs were significantly above plan.  Karen Johnson, Director of Finance replied that Pharmacy were working hard to manage costs but was primarily due to high volume of patients and different case mix.

 

Paul Lewis, Non-Executive Director commented that there was a need for accountability at all levels with regard to financial recovery and asked if there was also a requirement to train and up-skill managers in financial skills.   Karen Johnson, Director of Finance responded that finance training was available however improvements in this area were under review.  In terms of wider accountability this would be part of the Organisational Development Plan currently being produced.

 

RESOLVED

 

(a)     that the Month 05 financial position is a year to date deficit of £7.267m including PSF, MRET & FRF, all currently forecast to plan;

 

(b)    that the Month 05 financial position excluding PSF, MRET & FRF is a year to date deficit of £9.558m, and;

 

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

203/19

Ratification of Decisions made via Board Circular/Board Workshop

Carole Nicholl, Director of Governance & Assurance

Minutes:

None.

204/19

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.

205/19

Date and Time of next meeting

Date: 7 November 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 7 November 2019 at 9:30am in Trust Management Boardrooms, Trust HQ, 2nd Floor, Great Western Hospital.

206/19

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.