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Agenda and minutes

Venue: Board Rooms, Trust HQ, Great Western Hospital, Swindon. View directions

Contact: Carole Nicholl  01793 605171

No. Item


Apologies for Absence and Chairman's Welcome


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.


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.


There were no declarations of interest.


Minutes pdf icon PDF 418 KB

Liam Coleman, Chairman

·         7 November 2019 (public minutes)


The minutes of the meeting of the Board held on 7 November 2019 were adopted and signed as a correct record, subject to the following amendments: -


227/19  /  Chief Executive’s Report  :  Add “and congratulated the effort of those who arranged it”  after ‘successful’.


230/19  /  Quality Report  :  Add “Outpatients” in 9th paragraph before ‘matron’.


Outstanding actions of the Board (public) pdf icon PDF 494 KB


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


236/19  /  Operational Performance Report  /  2 Week Wait  :  The number of patients referred that turned out to be cancer was an average figure of  8.5%.  Closed.



Questions from the public to the Board relating to the work of the Trust pdf icon PDF 269 KB


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



Patient Story


The Board watched a video of a husband who shared their experience of his wife’s stay in hospital.  The video highlighted areas where the hospital could improve on hygiene in ward areas and the bereavement process.  The video would be used as training for staff to learn from and continue to improve the quality of care.


There was a robust discussion which included the importance of matron audits, the complaints and bereavement processes, and the Medical Examiner role which would strengthen the bereavement process.


It was noted that since this event improvements had been implemented including executive directors joining SERCO audits weekly together with matrons and ward managers attending on an ad hoc basis, plus matrons completing their own audits.  In addition bereavement support has been made available earlier.  It was noted that the advert for the role of Medical Examiner would be published in January 2020.


Liam Coleman, Chair emphasised the importance that all teams worked as one no matter who they worked for and that the Board supported plain, clear and understandable communication to patients, family and carers.


The Board thanked the family member for his courage in coming forward at such a difficult time.


Quality Report pdf icon PDF 221 KB

Julie Marshman, Chief Nurse

Charlotte Forsyth, Medical Director

Additional documents:


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 October 2019 were as follows: -


Serious Incidents – There continued to be a rise in Serious Incident reporting due to the changes that had been made in the incident management process at the beginning of September to strengthen the process.


Infection Prevention and Control  -  A total of 29 C. Difficile infections had been diagnosed so far in 2019-20 (Apr-Oct). For the first time this year the number had gone above the Trust’s nationally set cumulative year to date upper limit.  Each case was thoroughly investigated and enhanced cleaning was implemented to prevent spread.


It was also noted that two hospital acquired MSRA had been identified in October 2019. 


Electronic Discharges-  The completion of Electronic Discharge Summaries remained  a challenge, with a reduction in compliance in October.


Patient Moves  -  The Trust continued to report a high number of additional patient moves and a high percentage occurred at night which was mainly due to reporting issues as in periods of high demand the actual time of the move was not entered on Medway (the patient system)  and when entered the time was not backdated.  New initiatives were being introduced to address this issue.


Complaints, Concerns and Compliments – Work continued on reducing overdue complaints, with a reduction in October.


Andy Copestake, Non-Executive Director asked for clarification on the quality risk theme for ‘funding all PFI equipment’ and what this actually covered.  Kevin McNamara, Acting Chief Executive explained that this covered a significant number of areas and equipment (not medical equipment) which was too vast to report on, however acknowledged that the top 20 should be more visible.  An audit had been carried out 12-18 months ago to ensure that all obligations were being fulfilled and added that there were different funding sources for PFI and the Trust equipment.


Andy Copestake, Non-Executive Director asked about the differing views amongst anaesthetists regarding skin marking.  Jim O’Connell, Chief Operating Officer replied that there had been some concerns raised around skin marking for all invasive procedures however the Trust had concluded that this would be included in the policy.


Paul Lewis, Non-Executive Director was encouraged that overall the number of overdue complaints had reduced however one Division, Unscheduled Care, stood out at 35% which was disproportionate to the rest of the hospital and asked for assurance that the right focus and action was in place to address this.  Julie Marshman, Chief Nurse responded that it had been identified that a greater amount of time and personnel were required to address the issues in Unscheduled Care and due to the pressures the Deputy Director of Nursing would focus on this going forward.  Kevin McNamara, Acting Chief Executive added that complaints were reviewed on a weekly basis and the numbers constantly fluctuated within each area.


Andy Copestake, Non-Executive Director asked about the  ...  view the full minutes text for item 267/19


Operational Performance Report pdf icon PDF 292 KB

Jim O’Connell, Chief Operating Officer

Kevin McNamara, Acting Chief Executive

Additional documents:


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.  The following was highlighted:-


Cancer  -  The majority of cancer standards had been met except for 2-week Wait which was predominantly due to dermatology and colorectal services.  Dermatology tended to spike post summer holidays and the Trust would try to address this spike in future years, however locum workforce gaps added further pressures to this pathway delivery.


Stroke   Stroke performance continued to rate at Sentinel Stroke National Audit Programme (SSNAP) level E due to a data submission error, however the Trust predicated recovery in Q3 back to level D.


Referral to Treatment Time (RTT) – The waiting list size had slightly deteriorated in month however further improvement was expected in November 2019.


Diagnostics and Outpatients (D&O)  :  D&O performance had improved in October however there continued to be concerns with regard to the volume of diagnostic tests and additional support for Radiology from a mobile unit for the remainder of the year would therefore be progressed. 


Emergency Department (ED)  -  The ED’s October’s performance improved marginally against September performance however as anticipated type 1 patients (those in need of immediate treatment) performance worsened due to the introduction of reverse streaming.


Length of Stay (LOS)  -  The LOS position remained a concern and a full review would take place at the beginning of December. As part of the Fit 4 Winter initiative the plan was to continue with the  Medical Director, Chief Nurse and Chief Operating Officer reviewing all Stranded Patients with a LOS of over 14 days.


Julie Soutter, Non-Executive Director asked how the Trust was going to make the length of stay process sustainable and whether ‘champions’ would be required to take this forward and keep the momentum.   Charlotte Forsyth, Medical Director replied that the process was still going through a learning period to understand where the blockages were.


Community Services

It was noted that the Performance, People and Place Committee had considered in detail the Community Wheelchair Service as performance had deteriorated due to the increase in the number and complexity of referrals.  Actions were in place to address the issue.


Nick Bishop, Non-Executive Director was pleased to see a slight improvement in theatre utilisation and was encouraged to see a new management system/team in place that showed a grasp of the problems and the ability to turnaround performance as demonstrated at a recent Quality & Governance Committee presentation.


Paul Lewis, Non-Executive Director commented that within the public view data the Trust scored in the highest quartile for some treatments and asked if this could be considered for inclusion in the reporting pack in future.   It was noted that the Performance, People and Place Committee had also requested more trends and data within the Operational Performance Report.

Action  :  Chief Operating Officer




(a)   that the report be received and  ...  view the full minutes text for item 268/19


Workforce Report pdf icon PDF 328 KB

Jude Gray, Director of Human Resources & Organisational Development


The Board received and considered a paper providing a summary of the key workforce issues and risks identified from the month 7 (October 2019) workforce report.  The following was highlighted:-


·         The Trust had achieved the majority of workforce indicators.

·         The overall statutory mandatory training compliance rate remained above target, however a review was underway on how to report this in a more meaningful way.

·         Agency spend within month was underspent however the overall pay bill was overspent.

·         Watch points were sick absence levels, staff survey 2019 and staff friends and family test

·         The emerging issue was the collective dispute in theatres.


Paul Lewis, Non-Executive Director asked how information was shared with staff with regard to trends and position on workforce.  Jude Gray, Director of HR replied that information was currently shared on the Trust’s intranet and would include staff survey results and actions together with information to support wards and the demands within the hospital.  The Trust was also piloting an App to try and improve communications to staff.  Julie Soutter, Non-Executive asked if other options had been explored particularly around using face to face communications and ward handovers.  Julie Marshman, Chief Nurse replied that communication of safety messages were well embedded within the Trust and options to extend this could be considered.

Action :  Director of HR / Chief Nurse


Jemima Milton, Non-Executive Director was concerned to see the high level of administration and clerical vacancies and recognised that the introduction of IT systems may result in less roles required however this had the potential to impact on medical and nursing staff time.  Kevin McNamara, Acting Chief Executive responded that Thoughtonomy, a system that automated a wide range of processes, had been rolled out in  Gastroenterology but was not about taking away jobs but to complement human skills and talent. Carole Nicholl, Director of Governance & Assurance added that as part of financial recovery vacancies were managed through a Vacancy Review Panel and some of these vacancies maybe on hold due to this process.


Lizzie Abderrahim, Non-Executive Director commented that the equality and diversity element within the report did not have any measurement for achievement which would also cover both staff and patients and asked how all the information would be collated to assure the Board that our services were provided across our communities equally.  Jude Gray, Director of HR replied that data was captured in many forms and how this was to be presented was in development.

Action :  Director of HR




(a)   that the Board notes the report;


(b)   to consider other options to communicate with staff, and;


(c)   to note that the workforce report was in development.



Finance Report pdf icon PDF 229 KB

Karen Johnson, Director of Finance

Additional documents:


The Board received and considered a report on finance for month 7 (ending 31 October 2019), and the following was highlighted:-


Month 7 Position  -  The month 7 position was worse than plan and forecast. This was due to higher costs of clinical supplies predominantly in Planned Care, which was under investigation.


The main year to date variances were similar to previous months; Cost Improvement Plans (CIPs) delivery, non-pay costs, income and pay costs.


Nick Bishop, Non-Executive Director asked if the target for CIPs for this year had been set unrealistically as the Trust had been commended in the past for achieving its CIP targets, and also asked about next year’s CIP’s target.   Kevin McNamara, Acting Chief Executive replied that the Trust had achieved £29m over 3 years however this had been below the national average in for the past 2 years.  As for 2020 CIPs PWC’s report had identified that there were still transactional CIP opportunities.  As for next year the recommendation was that CIPs would be 1.6% lower however this would have to feed into the STP’s position to secure financial recovery.


Lizzie Abderrahim, Non-Executive Director was concerned that there was a confused message within the report in terms of the delivery of CIPs and wished clarification on whether CIPs would be achieved or not.  Karen Johnson, Director of Finance replied that there was currently a £4m gap, but recognised the reality that this would not be achieved in the next 3-4 months.  However the organisation still needed to attempt to achieve its target.  There are recovery plans in place within divisions which supported CIP, however the focus was on financial recovery. 


Paul Lewis, Non-Executive Director asked whether the review around CIPs at divisional level had included an analysis breakdown on where the CIPs came from, for example staff, income, procurement.  Karen Johnson, Director of Finance replied that each division created a workbook to monitor against but did not think that this analysis occurred and could feed into plans for next year.


Control Total  -  The Trust was required to apply formally to NHS Improvement (NHSI) to deviate from the control total at the end of quarter 3.  Based on this month’s movement an Executive decision, which was supported by the Finance & Investment Committee, had been made to formally report a deviation of £10m against the control total – a deficit of £21.5m. This would now require agreement with the Sustainability and Transformation Partnership (STP), before formal submission to NHSI. 


Andy Copestake, Chair of the Finance & Investment Committee confirmed the robust discussion that had taken place around the issues and reasons for the deviation with the conclusion to recommend that the Board support the deviation from control target.  There was also a detailed discussion on productivity however there was concern that the data used was two years out of date therefore there would be further discussion in January 2020 when refreshed data was available.  Karen Johnson, Director of Finance added that timing may slip as it  ...  view the full minutes text for item 270/19


Ratification of Decisions made via Board Circular/Board Workshop

Carole Nicholl, Director of Governance & Assurance




Standing Financial Instructions Policy - for ratification pdf icon PDF 610 KB

Carole Nicholl, Director of Governance & Assurance


The Board received and considered revised Standing Financial Instructions (SFIs) Policy which had been amended to reflect organisational changes and improved clarity around controls where weaknesses had been identified.  The SFIs had been considered and agreed at the November 2019 Audit, Risk and Assurance Committee with a recommendation for the Board to approve.




that the Board ratifies the Standing Financial Instructions Policy.


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.


During the meeting the Acting Chief Executive gave a verbal update on the following:-


·         A successful Patient and Carer Involvement Strategy Engagement Event was held in November 2019 to engage with the public on the Trust’s Quality Strategy. 

·         A second Leadership Forum was held with two of the Trusts Non-Executive Directors discussing their leadership experience in the NHS.  This was a developing forum with an increasing membership and the aim was to host a Leadership Conference in the next 12 months.

·         The Trust took over 2 GP surgeries on  27 November 2019 which marked an important step in system leadership responsibility.  A Clinical Lead had been appointed to ensure safe transition of the service.

·         As part of winter planning the Executives were buddying up with wards to enable a connection across the organisation and to strengthen the process of the identification of any quality issues promptly

·         The Trust had put in a bid for additional funds from the STP for winter.  A few investments had already been implemented to support corridor care and relieve pressure which included the additional beds in Princess Lodge.


Jemima Milton, Non-Executive Director asked if the STP had agreed any criteria for allocating the winter monies.  It was noted that a Winter Summit was to be held this week to set indicators.


Date and Time of next meeting

Date: 9 January 2020

Time: 9:30am

Venue: Trust Management Boardrooms, Trust HQ, 2nd Floor, Great Western Hospital


It was noted that the next meeting of the Board would be held on 9 January 2020 at 9:30am in Trust Management Boardrooms, Trust HQ, 2nd Floor, Great Western Hospital


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”




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.