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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

221/19

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, particularly members of the public and governors. 

 

Apologies were received as outlined above.

 

222/19

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.

223/19

Minutes pdf icon PDF 337 KB

Liam Coleman, Chairman

·         3 October 2019 (public minutes)

Minutes:

The minutes of the meeting of the Board held on 3 October 2019 were adopted and signed as a correct record subject to the following amendements:-

 

200/19 / Workforce Report-  Last paragraph, first line add ‘innovative’ before recruitment.  Change ‘Grey’ to ‘Gray

 

201/19 / Operational Performance Report  -  Change GIRTH to ‘GIRFT’.

224/19

Outstanding actions of the Board (public) pdf icon PDF 500 KB

Minutes:

The Board received and considered the outstanding action list. 

225/19

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.

226/19

Chairman's Report, Feedback from the Council of Governors

Liam Coleman, Chairman

Minutes:

The Board received a verbal report from the Chair which included:-

 

Annual Members Meeting – This was held on 26 September 2019 and included a presentation on the Way Forward Programe which was the project to right size the hospital.

 

Health Talks  -  The public health talks continued to be well attended with one in August 2019 on Pain Management.  The next would be in November on Functional Disorders.

 

Governor Elections  -  Governor elections were currently underway with results for Swindon Constituency and staff groups governors due on 8 November 2019.

 

Board Development  -  Two Board Workshops were held during the period which focused on ‘Primary Care and the opportunity to acquire two GP practices’, and ‘how the Trust will approach transformation and how to achieve a step change in our performance’.

 

NED Appraisals  -  NED appraisals had been completed this year with the outcomes reported at a recent Nominations and Remuneration Working Group.  For next year reviews for 2019/20 will be completed by June 2020 with reports to the Nominations and Remuneration Working Group in July 2020.

 

RESOLVED

 

to note the update.

227/19

Chief Executive's Report pdf icon PDF 332 KB

Kevin McNamara, Acting Chief Executive

Minutes:

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

 

Merger of Clinical Commissioning Groups (CCGs)  -  NHS England and NHS Improvement had formally approved the merger of the three CCGs across the Sustainability and Transformation Partnership (STP).  As a result the CCGs would formally become NHS B&NES, Swindon and Wiltshire Clinical Commissioning Group on 1 April 2020.

 

Jemima Milton, Non-Executive Director asked if Swindon CCG would keep Shrivenham in its boundaries.  It was confirmed that at this stage there would be no boundary changes.

 

Demand  -  A Winter Risk Summit had been held across the STP to reflect the concerns with the current pressures and to discuss collaboration plans during the winter period.  As part of the Trust’s winter plans it was planned to commission extra beds at Princess Lodge and a reset of the system processes within the hospital with a particular emphasis on early discharges each day.

 

Primary Care  -  The preparations to take over the provision of services at two GP services in Swindon; Abbey Meads Medical Group and Moredon Medical Centre on 27 November 2019. 

 

Flu Campaign  -  The launch of the annual flu campaign in October 2019 to encourage staff to have influenza vaccinations.

 

Freedom to Speak Up  -  October 2019 was Freedom to Speak Up month which was marked with a launch event to promote the initiative to staff together with hosting a regional event attended by the National Guardian.

 

Purdah

The Board were reminded that the country was in a period of purdah and that certain rules, which had been circulated, applied to the NHS. 

 

Peter Hill, Non-Executive Director wished to highlight the significant achievement of the Endoscopy service who had achieved the JAG accreditation and congratulated the team.

 

Lizzie Abderrahim, Non-Executive Director added that the Black, Asian and Minority Ethnic (BAME) Diversity Day had been incredibly successful and looked forward to see how the group developed.

 

RESOLVED

 

to note the report.

228/19

Patient Story

Tania Currie, Deputy Chief Nurse to present

Minutes:

The Board watched a video of a family member who shared their experience of their mother’s stay in hospital with dementia.  The video highlighted areas where the hospital could improve on care particularly around recognising family members as expert carers and the importance of signposting to access resources. The video would be used as training for staff to learn from and continue to improve the quality of care.

 

Liam Coleman, Chair thanked all those concerned and welcomed other patient stories as it was important for the Board to see a variety of patient experiences.

229/19

Chair of Quality & Governance Committee Overview pdf icon PDF 329 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 on 19 September and 24 October 2019 with the following highlighted:-

 

·         There was a change in the meeting structure so that the meeting started with the Board Assurance Framework (BAF).  This would help inform and  encourage further challenge on agenda items.

·         The challenges around Electronic Discharge Summaries (EDS) were discussed.

·         The Infection Prevention & Control Annual Report was considered however the Committee requested a revised version for further review.

·         Clinical audits had improved although further work was required.

 

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.

230/19

Quality Report pdf icon PDF 221 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:-

 

Quality Risks  -  The list of 15+ risks on the risk register with a quality theme.  All risks had actions and mitigations in place.

 

Serious Incidents (SI)  -  There was an increase in the  number of SI’s reported.  This was a reflection of the changes that had been made to the incident management process at the beginning of September 2019.   In addition the Trust was now reporting fractured neck of femurs (NoF’S) and Hospital Acquired DKA (Diabetic ketoacidosis) as SI’s, which had not previously been reported.  It was noted that there had been 10 reported fractured neck of femurs (NoFs) in the past 6 months and although there was no known cluster or continued trend an investigation would be undertaken and reported through the relevant governance committees.  Initial investigation revealed the removal of shoes by patients was a potential cause.

 

Nick Bishop, Non-Executive Director was concerned to hear about the occurrence of DKAs and linked this to the patient story in that expert knowledge of care was the patient/families particularly when it came to managing diabetes.

 

Infection Prevention & Control  -  The Trust continued to be slightly under trajectory for the diagnosis of C.difficle.  Each case was thoroughly investigated and enhanced cleaning implemented to prevent spread.  

 

Patient Advice and Liaison (PALS)  -  The Divisions were working hard to reduce the number of overdue complaints.  It was noted that since the report Unscheduled Care had reduced their overdue complaints from 16 to 4.

 

Patient Moves and Night Moves  -  There had been no significant change to the percentage of night moves and continued to be an on-going quality concern.  This was caused by the need to move patients to support the management of demand and capacity.  The Quality & Governance Committee had asked for additional reporting for further review.

 

Andy Copestake, Non-Executive Director commented that the format of the report had been changed again.  Julie Marshman, Chief Nurse explained that the rag ratings had been removed and aligned to the workforce and finance reports  and would remain this way until a balance score card had been finalised.

 

Andy Copestake, Non-Executive Director commented that the matron audits had improved slightly however the percentage was still low and asked whether this was an optional audit.  Julie Marshman, Chief Nurse replied that this was best practice and that current data reflected further improvement.  It was noted that a successful trial using a handheld device to undertake audits had been undertaken which cut down the time to perform these audits from 2 hours to 15 minute. In discussion it was considered beneficial to introduce these devices for such a small cost.

 

Liam Coleman, Chair asked in connection to mixed sex breaches if it was possible to identify the breaches caused by escalation and those not.  Julie Marshman,  ...  view the full minutes text for item 230/19

231/19

Safer Staffing Monthly Exception Report pdf icon PDF 198 KB

Julie Marshman, Chief Nurse

Additional documents:

Minutes:

The Board received and considered a report providing a summary overview of save staffing processes across the Trust.  The report had been scrutinised by the Quality & Governance Committee.  The following was highlighted:-

 

Fill Rate  -  Fill rate remained good compared to the current agreed establishment.  Additional care staff above establishment was due to close support requirement and escalation areas.

 

Care Hours Per Patient Day (CHPPD)  - 

·         A deep dive on Saturn Ward had been undertaken.

·         Model Hospital showed the Trust was in the lower quartile despite using additional staff due to escalation in certain areas.  Overall CHPPD had remained stable, within 0.5 hour over the past six months. Bed occupancy and staffing resource would impact this data.

 

It was noted that each ward establishment was under review to ensure it was fit for future with the outcome to be presented to Performance, People & Place Committee and Quality & Governance Committee. 

 

Andy Copestake, Non-Executive Director asked if there was an overall measure to assure the Committee that a ward was doing well in terms of outcomes.  Julie Marshman, Chief Nurse responded that not all the measures were currently in one place however the Trust were developing a scorecard which once in place would resolve this, also ward accreditation was another good indicator.

 

Nick Bishop, Non-Executive Director asked for clarification on what staff were used to calculate the CHPPD. Julie Marshman, Chief Nurse replied that only the staff on ward rosters were included which meant that those staff covering several wards were not included.

 

There followed a discussion on productivity and efficiency which included staff ideas, IT systems and organisational development.

 

RESOLVED

 

the report is noted.

232/19

Mental Health Governance Committee Annual Report 2018/19 pdf icon PDF 313 KB

Nick Bishop, Non Executive Director and Chair of Mental Health Governance Committee

Additional documents:

Minutes:

The Board received and considered the Mental Health Governance Committee Annual report for 2018/19 and the following was highlighted:-

 

·         The report referenced the work undertaken with external organisations which demonstrated partnership working.

·         The Trust benchmarked well in terms of managing mental health in an ever increasing mental health agenda in an acute trust.

·         There were many successes and thanked Wendy Johnson and the team for their commitment and hard work.

 

Julie Soutter, Non-Executive Director asked whether the Trust’s duties and obligations would change when we took over the GP practices.  Kevin McNamara, Acting Chief Executive replied that same duties would apply.  Liam Coleman, Chair added that this would be part of the due diligence with GPs to understand over the next year in terms of practices and duties.

 

Andy Copestake, Non-Executive Director asked if there was any succession planning within mental Health.  Julie Marshman, Chief Nurse replied that this was currently being addressed to strengthen resilience within the team.

 

RESOLVED

 

the report is noted.

 

233/19

Workforce Report: Key Performance Indicators (Month 6) pdf icon PDF 380 KB

Jude Gray, Director of Human Resources & Organisational Development

Minutes:

The Board received and considered a paper providing a summary of the key workforce issues and risks identified from the month 6 workforce report.  The following was highlighted:-

 

·         The report was still in development.

·         Overall most of the indicators were above or within their targets.

·         Recruitment and retention were doing well except for Allied Health Professionals who tended to move more than other professions.

·         Although mandatory training was achieving its target one persistent area of challenge was safeguarding.  Actions were in place to resolve this issue.

·         A revised appraisal policy was currently going through the governance process.

·         Watch points were sickness rates, staff survey and diversity and human rights

·         The current concern was the pay bill although there were good controls in place for agency costs.

·         Emerging concerns were the formal dispute in theatres around changing shift patterns, and taking over the GP practices.

 

There was a discussion with regard to the format of the report particularly around terminology.

 

Lizzie Abderrahim, Non-Executive Director commented that the Non-Executive Directors had not been asked if they wished to have a flu jab and believed that this was a missed opportunity in relation to the wider point of NED visibility and as an integrated part of the Board.  Julie Marshman, Chief Nurse agreed to organise vaccinations around the next committee meetings.

Action  :  Chief Nurse

 

RESOLVED

 

(a)   the report is noted, and;

 

(b)   arrange Non-Executive Director flu jabs.

234/19

Freedom to Speak Up pdf icon PDF 804 KB

Carole Nicholl, Director of Governance & Assurance

Additional documents:

Minutes:

The Board received and considered a paper providing an update on the ongoing actions to support the mechanisms in place to promote an open and supportive culture that encouraged staff to speak up.

 

There followed a robust discussion around a continuous improvement culture and generating a sustainable environment whereby staff felt confident to speak up outside any formal processes.  However, it was recognised that this was one mechanism to embed an open and honest culture.

 

Nick Bishop, Non-Executive Director commented that it would be helpful to use stories of those who had gone through the experience.  Carole Nicholl, Director of Governance & Assurance agreed that it was important to hear the stories not only from the staff reporting their experiences but also from the recipient in lessons learnt. 

 

Lizzie Abderrahim, Non=Executive Director asked what support the guardians were offered particularly in terms of wellbeing as this role was an add on to their current role.    Carole Nicholl, Director of Governance & Assurance replied that a great deal of discussion had taken place to determine the best model to adopt in terms of guardians.   The current practice worked well with lots of interaction and support given to the guardians; however this would be continuously reviewed to ensure it remained fit for purpose. 

 

The Chair thanked all those concerned for their commitment and hard work and this was one indication of the type of culture the Trust was trying to build.

 

RESOVLED

 

that the report is noted.

235/19

Chair of Performance, People & Place Committee Overview pdf icon PDF 295 KB

Peter Hill, Non-Executive Director

Minutes:

The Board received and considered a paper providing a summary of the key issues from meetings of the Performance, People and Place Committee held on 25 September and 30 October 2019.   The following was highlighted:-

 

·         The Board Assurance Framework (BAF) was reviewed.  The Committee gained assurance that all issues had either been discussed or were future agenda items.

·         The Committee received a presentation on GIRFT and was keen to maximise on any recommended benefits.

·         The Committee had undertaken a deep dive into the stroke service in terms of performance and acknowledged that it had been hampered by an error in data submission.

·         The Committee had also undertaken a deep dive on theatre utilisation and were assured that there was an action plan in place to improve utilisation.

 

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.

236/19

Operational Performance Report pdf icon PDF 223 KB

Jim O’Connell, Chief Operating Officer

Kevin McNamara, Acting Chief Executive

Additional documents:

Minutes:

The Board considered the operational performance report which provided an update on performance during August/Septmber 2019 against key national and local performance standards in addition to progress against key work streams and remedial recovery plans with headlines as follows: -

 

Cancer Service – Performance was doing well on the majority of cancer targets with the 2 week wait primarily failing due to the seasonal increase in activity in dermatology.

 

Nick Bishop, Non-Executive Director asked in terms of the 2 week referral what was the number of patients referred that turned out to have cancer.  Jim O’Connell, Chief Operating Officer agreed to find the figure for further discussion at the next Performance, People & Place Committee.

Action  :  Chief Operating Officer

 

Stroke Service – Issues regarding the wrongly submitted data was still under review. 

 

Diagnostics Service-  Diagnostics performance was in line with trajectory although sleep studies was an issue due to the use of inpatient beds however this should improve as some of the studies move into the community.

 

ED – There had been a deterioration in ED performance partly due to increased pressure and partly due to accounting changes.  Although October figures were showing a slight dip in attendance this was due to the introduction of the new initiative Reverse Streamlining which would have a positive impact on patient experience.

 

Referral to Treatment Time (RTT) - This remained a concern with regard to the level of variance from trajectory however there was a comprehensive recovery plan in place to improve the position by year end.

 

Hold File-  The overall reduction in overdue follow ups had remained stable and continued to show improvement since April 2019.  However a slight deterioration in August was due to recruitment vacancies.

 

Theatre Utilisation  -  A new theatre management structure had been implemented with a newly recruited Divisional Director with theatre background to drive improvements in performance.

 

Community Services

Rapid Response Service  -  The 4 hr rapid response service had met its target however the future challenge would be the national move to a 2 hr rapid response service.  The B&NES, Swindon and Wiltshire (BSW) Sustainability and Transformation Partnership (STP) had signed up as an early adopter.

Community Nursing - Despite workforce issues community nursing had performed well.  Discussions with the commissioners were taking place to discuss the future of community services and their commissioning intentions.

Swindon Intermediate Care Centre  -  During September 2019 Orchard Ward reduced its bed base to 26 pending its move to Princess Lodge.

 

RESOLVED

 

(a)   that the report be received and the ongoing plans to maintain and improve performance be accepted, acknowledged and supported, and;

 

(b)     obtain data in terms of the 2 week referral for cancer for patients referred that turned out to have cancer.

237/19

Chair of Finance & Investment Committee Overview pdf icon PDF 314 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 23 September and 29 October 2019 and highlighted the following:-

 

·         Tracey Cotterill had been appointed as Interim Director of Finance starting in January, with a handover during November 2019.

·         The month 5/6 financial position was against a backdrop of a hospital under pressure with significantly increased activity.

·         Block contracts for the remainder of the year had been agreed with Swindon and Wiltshire commissioners which had improved the forecast

·         There was more grip and control in some areas particularly agency costs and close support.

·         There had been a robust discussion in terms of cash and borrowing particularly around a the requirement for a loan in January 2020.

·         The Committee received presentations from each Division on delivering Financial Recovery Plans.  Although some progress had been made the Divisions were finding it a challenge to deliver the £8.3m recovery target.

·         Progress had been made on the PWC financial recovery report.

·         The 5 yr plan submission as part of the overall STP submission had been reviewed and agreed with caveats, which had been shared with the Board.

·         The budget setting process for 2020/21 had been noted with the focus on ensuring budget holders understood and took responsibility for their budgets.

·         The Outline Business Case for the land purchase under the Way Forward Programme was supported for submission to the Board for approval.

 

RESOLVED

 

that the report be received.

 

238/19

Finance Report pdf icon PDF 227 KB

Karen Johnson, Director of Finance

Additional documents:

Minutes:

 

The Board received and considered a report on finance for month 6 (ending 30  September 2019) and the following was highlighted:-

 

·         The month 6 position was discussed in detail at the Finance & Investment Committee

·         The financial position in September 2019 was a deficit of £88k, which was £1,160k better than plan due to the agreement of blocked contracts with Swindon and Wiltshire commissioners.

·         The year to date position was a deficit of £9,646k which was above plan.

·         The main variances for the month remained the shortfall in Cost Improvement Plans (CIPS) and pressures of a full hospital.

There followed a discussion on CIPs and the challenges around delivering year on year.  However, the PWC report had identified that there were still opportunities around transactional CIP. 

·         Non-Elective and Elective activity were below plan.

·         Discussions with NHSI around the Trust’s Financial Recovery Plans and deviation from the Control Total as at Q3 continued.  It was noted that the Get It Right First Time (GIRFT) programme had identified that the Trust was only one of 3 in the country where bed capacity and ED as too small were issues.

·         Cash at month 6 was above plan with the current financial position having had an adverse effect on cash forecast and the Trust was in discussion with NHSI about additional borrowing in January 2020. 

There followed a discussion on borrowing which included the national NHS borrowing, purdah implications and risks.  

 

Nick Bishop, Non-Executive Director asked how the Trust benchmarked in terms of their financial position.    Karen Johnson, Director of Finance replied that in the south west the Trust was an outlier.  

 

RESOLVED

 

(a)     the Month 06 financial position is a year to date deficit of £6.963m including PSF, MRET & FRF, all currently forecast to plan.

(b)    The Month 06 financial position excluding PSF, MRET & FRF is a year to date deficit of £9.646m. 

 

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

 

239/19

Chair of Audit, Risk & Assurance Committee Overview pdf icon PDF 324 KB

Julie Soutter, Non-Executive Director

Minutes:

The Board received and considered a paper that summarised the key issues discussed by the Audit, Risk and Assurance Committee at the meeting held on 12 September 2019.

 

RESOLVED

 

that the report be received.

 

240/19

CQC Registration Update pdf icon PDF 285 KB

Carole Nicholl, Director of Governance & Assurance

Additional documents:

Minutes:

The Board received and considered a paper that provided an update to the CQC registration and the following was highlighted:-

 

·         The statement of purpose was attached for approval.

·         The statement reflected the changes in registration for the Princess Care Home, and the Primary Care Network together with the de-registration of the Swindon walk-in centre.

 

In review it was noted that historical services were still included in the report and a question raised on whether a review on rationalisation of services was due in view of the significant number of GP practices used by the Trust. 

 

RESOLVED

 

(a)   that the committee acknowledges the CQC registration update, and;

that the statement of purpose is approved subject to comments above.

241/19

Membership of Committees pdf icon PDF 129 KB

Director of Governance & Assurance

Additional documents:

Minutes:

The Board received and considered a paper that invited the Board members to consider whether the current membership of Board Committees, as agreed in May 2019, continued to be fit for purpose.

 

There followed a discussion around membership, champion roles and objectives and it was agreed to bring back a revised version in January 2020.

Action  :  Director of Governance & Assurance

 

RESOLVED

 

the revised Board Committee membership to be reviewed again in January 2020.

 

242/19

Ratification of Decisions made via Board Circular/Board Workshop

Carole Nicholl, Director of Governance & Assurance

Minutes:

A Board circular had been circulated in November 2019 with regard to the 5 yr plan submission as part of the overall STP submission which would be discussed further in the confidential part of the Board meeting.

 

243/19

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.

244/19

Date and Time of next meeting

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

 

245/19

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.