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Agenda and minutes

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

Contact: Deborah Rawlings  01793 604179

Items
No. Item

155/19

Apologies for Absence and Chairman's Welcome

Nick Bishop, Andy Copestake

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.

 

The Chair invited Rosemarie Phillips, Governor to brief the Board on an initiative governors had been involved in to improve patient experience.  New whiteboards, ‘name above the bed’, would shortly be launched which featured four symbols to ensure staff were aware of patients’ varying needs so necessary adjustments could be made or provide additional support.  On behalf of the Trust the Board thanked Rosemarie and the governors for leading on this improvement.  Carole Nicholl, Director of Governance & Assurance requested that this was presented to the Trust’s Annual Members Day on 26 September 2019.

Action  :  Deputy Company Secretary

 

Apologies were received as outlined above.

156/19

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.

157/19

Minutes pdf icon PDF 468 KB

Liam Coleman, Chairman

·         1 August 2019 (public minutes)

Minutes:

The minutes of the meeting of the Board held on 1 August 2019 were adopted and signed as a correct record, subject to the following amendment: -

 

137/19  :  Quality Report   -  Add to last paragraph on page 4/3rd sentence “…efficient use of time and what the function of the Board was when reports had been discussed before”.

158/19

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

Minutes:

The Board received and considered the outstanding action list. 

159/19

Questions from the public to the Board relating to the work of the Trust

Minutes:

There were no questions from members of the public.

160/19

Chairman's Report, Feedback from the Council of Governors

Liam Coleman, Chairman

Minutes:

There had been no Council of Governors meeting held and therefore no update to note.

161/19

Chief Executive's Report pdf icon PDF 327 KB

Nerissa Vaughan, Chief Executive

Minutes:

The Board received and considered a report from the Chief Executive covering the following issues: -

 

·         Sustainabilty and Transformation Partnerships (STP)s.  The Trust had made positive progress in some areas, specifically collaborating with Salisbury NHS Foundation Trust on procurement and payroll.  There was also an appetite among the three Trusts to move to a single financial ledger.   Next steps was the requirement to submit a 5 year plan by end of November 2019

·         The Trust was piloting a new approach to managing the increase in demand in the Emergency Department by using a new method called ‘reverse streaming’. 

·         From August Executive Directors had joined the Trust’s Estates and Facilities team weekly walkabouts to review the environment, cleanliness and facilities of the hospital.

·         New Leadership forums would be introduced from October 2019 for an opportunity for leaders across the organisation to hear the latest updates, share learning and generally improve communications.

·         Oxford University Hospitals FT announced that final funding had been confirmed from the Department of Health for the Radiotherapy Centre.  Building work would commence in Spring 2020.

·         A new online appointment service for patients, DrDoctor, was introduced this month which would give patients the option of receiving digital appointment letters and text reminders.

Jemima Milton, Non-Executive Director asked when the Board would be able to consider the Sustainable and Transformation Partnership (STP) 5 Year Plan and also what were the benefits of the STP.   Kevin McNamara, Interim Deputy Chief Executive replied that the final Plan was due for submission in November 2019 and as soon as the Trust received a copy it would be shared with the Board.  In terms of benefits this was more around improving care in specific services for example stroke and cardiology, as well as developing the health and care workforce.  Jemima Milton, Non-Executive Director proposed that the Trust write to the STP to convey the Board’s concern around not receiving this document in a timely manner.  Liam Coleman, Chair responded that all the organisations were in the same position and that this view had been expressed through the appropriate channels.

Lizzie Abderrahim, Non-Executive Director asked for more explicit detail with regard to timeframes and criteria for all the patient safety visits.  Julie Marshman, Chief Nurse replied that a review of the quality visits would take place through the Quality & Governance Committee.  Kevin McNamara, Interim Deputy Chief Executive added that the Patient Environment walkabouts had been introduced in response to long standing unresolved environmental issues around the hospital estate.

RESOLVED

 

that the report of the Chief Executive be received.

162/19

Patient Story pdf icon PDF 223 KB

Julie Marshman, Chief Nurse

Sue Day, Quality Improvement Lead to present

Minutes:

Sarah Fallon, Deputy Divisional Director of Nursing joined the meeting for this agenda item.

 

A patient story was shared with the Board that highlighted how a pathway change could positively affect patient experience.  This involved a point of care testing trial for sepsis patients which meant that the testing pathway dramatically decreased from 12 hours to 30 minutes wait.

 

A discussion followed on the length of time the organisation adopted good practice post a successful trial.  Currently there was a gap and this story highlighted the need to improve the process within the organisation to turnaround successful trials much quicker.  The Executive team would determine an appropriate process within the context of financial recovery, organisational development and culture improvements.

 

There was also a discussion on further pathways that required an urgent review.  It was noted that another four were in the pipeline.

 

The Board welcomed the patient story and as a regular feature at future meetings, recognising that these would come in different formats.

 

RESOLVED

 

that the Board receive the patient story.

 

163/19

Chair of Quality & Governance Committee Overview pdf icon PDF 321 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 18 July and 22 August 2019. 

 

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.

164/19

Quality Report pdf icon PDF 215 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. 

 

It was noted that two reports had been presented as the new style report was still being finalised through discussions and comments at the various meetings including Quality & Governance Committee and Executive Committee.  There was also a Quality data oversight review being undertaken with informatics to ensure that all data was in one place.

 

As the report had been through a thorough review at the Quality & Governance Committee no further comment was made.

 

Julie Soutter, Non-Executive Director was pleased to see the new format and helpful to understand the development however asked what assurance was there that the committee scrutinised the report thoroughly.  Julie Marshman, Chief Nurse replied that this was achieved through robust discussions of both local and national data which were reflected in the minutes for openness and transparency.

 

Liam Coleman, Chair asked about the coding errors in mortality reviews and whether there was an escalation process.  Charlotte Forsyth, Medical Director replied that there was a lot of discussion around coding as a whole within the Trust and processes were part of these discussions and reviews.

 

Peter Hill, Non-Executive Director commented on the number of complaint cases that had been re-opened and was aware that a review into the complaints process was being undertaken however at some stage it would be helpful to have a patient story based on the  complaint process.  Carole Nicholl, Director of Governance & Assurance added that in the Freedom to Speak Up section of the report it pointed out about a short video on the experience of NHS staff speaking about their Freedom to Speak Up experiences and that next month, October 2019, was Freedom to Speak Up month.

Action  :  Deputy Company Secretary

 

A discussion followed around the new style report which included looking into an integrated approach of reporting quality and performance and the use of national benchmarking data.

 

RESOLVED

 

(a)   that the Board notes the quality matters and exceptions contained within the report, and;

 

(b)   add to the forward agenda a patient story on the complaints process.

165/19

Safer Staffing - 6 monthly skill mix review pdf icon PDF 643 KB

Julie Marshman, Chief Nurse

Additional documents:

Minutes:

The Board received and considered a paper providing a six monthly update on the nursing and midwifery staffing.  The following was highlighted:-

 

·         The Nursing Associates update, particularly the number of trainees.   – 21 trainees started in September 2018, 19 will start their 2nd year.  These Nursing Associates would become an essential  part of the workforce skill mix.

Liam Coleman, Chair asked if this cohort of staff’s responses could be separated out of the next staff survey to see if this recruitment process was working well.  Jude Gray, Director of HR agreed to check whether this was possible.

Action  :  Director of HR

·         The next step was for the senior nursing team, liaising with HR, to design a workforce fit for the future across the organisatioin.

Peter Hill, Non-Executive Director asked if consideration had been made with regard to other types of workforce for example the Big Hospital Experiment in Derby hospital where they are hiring young volunteers to care for patients.  Julie Marshman, Non-Executive Director recognised that all options would need to be explored to replace  high cost agency spend and that all of the nursing team where engaged and recognised the need to find different ways.

·         Intensive Care Unit (ITU) shift times had been changed to meet European Working Time Directive and highlighted the need to increase the workforce to support the change.  In the meantime temporary staff would cover the shortfall.

·         Due to increased demand and acuity in the surgery admissions unit an additional trained nurse coordinator was required to improve flow and patient outcomes.

 

RESOLVED

 

(a)   to note the actions being taken to ensure nurse staffing levels are safe;

 

(b)   to note this as assurance of compliance against the expectations of the National Quality Board 2016, and:

 

(c)   check to see if the Nursing Associate cohort can be separated out in the next staff survey.

166/19

Safer Staffing Bi-Monthly Exception Report pdf icon PDF 1 MB

Julie Marshman, Chief Nurse

Minutes:

The Board received and considered a report providing a summary overview of staff staffing processes across the Trust.  The following was highlighted:-

 

·         Deep dives had been undertaken in Forrest and Orchard wards.

The care hours per patient day (CHPPD) in Forrest Ward had shown that it was on par with STP footprint partners however was below the national medium.  Orchard ward showed that it was significantly below both local and national averages, however patient acuity data was not being consistently recorded and had now been addressed.  Both wards had additional Health Care Assistants (HCA) to support the risk identified.

·         It was also noted that Beech ward was  significantly below the national average however this was due to the ward being used as part medical ward in escalation and therefore difficult to compare with national data.

 

Julie Soutter, Non-Executive Director pointed out that at a previous Board meeting she had asked for a 12 month rolling average on the fill rates, this was indicated under the graph on page 94 however the graph did not show this data.  Julie Marshman, Chief Nurse agreed that this had not been amended and would ensure this was corrected for the next report.

Action  :  Chief Nurse

 

Liam Coleman, Chair asked if the environment to recruit nursing staff was still difficult.  Julie Marshman, Chief Nurse replied that the national picture to recruit was very tough and locally could be even tougher as nearby cities and London areas are more attractive, however our fill rates were good but this then had cost implications in order not to affect quality of care.   Jude Gray, Director of HR added that currently there were 5 different entry levels to recruit nursing staff however the Trust continually looked at what else could be done.

 

Liam Coleman, Chair asked if the level of bank staff was realistic full of available people when required or was it limited availability due to our own staff seeking extra work.  Julie Marshman, Chief Nurse replied that a high percentage was the Trust’s substantive staff.  Julie Soutter, Non-Executive Director asked if this caused an issue with regard to the European Working Hours breach.  Julie Marshman, Chief Nurse responded that whether bank or staff  on the roster hours of work were very closely monitored.

 

A discussion followed on funding Nursing Associates and apprenticeship levy and whether there was a way of tapping into this funding stream.

Action  :  Director of HR

 

RESOLVED

 

the report is noted.

167/19

Brexit update

Leighton Day, Associate Director of Operational Performance

·         Presentation to be received at the meeting

Minutes:

This item was deferred as on this date the political situation was changing at a pace.

168/19

Workforce Report: Key Performance Indicators (Month 4) pdf icon PDF 351 KB

Jude Gray, Director of Human Resources

Additional documents:

Minutes:

The Board received and considered a paper providing a summary of the key workforce issues and risks identified from the month 4 workforce report.  The following was highlighted:-

 

·         The vacancy rate had decreased by 16.5 WTE

·         There was a slight deterioration in the sickness absence rate compared to month 3  however there were no underlying trends identified.

·         Mandatory statutory training met the KPIs.  Hot spot areas remained a focus and a nominated single point of contact within each Division would be appointed to maintain the required level of training.

·         Appraisal rates had decreased slightly.

·         Recruitment time to hire standard had increased but fell below the south west streamlining target.  The Trust was placed in the first quartile  of the Model Hospital average.

 

The appraisal target was discussed as it indicated that 20% of the Trust had not had appraisals.  It was noted that this figure would include delays in appraisals, and those staff on maternity, long term sickness and new starters therefore a Trust never reached 100%.  A key action from the staff survey results was to improve the quality of appraisals and this continued to be a priority area and would be linked to the total review of performance management and succession planning.

 

RESOLVED

 

that the Board notes the report.

169/19

Workforce Disability Equality Standards pdf icon PDF 900 KB

Jude Gray, Director of Human Resources

Minutes:

The Board received and considered a paper that provided a short summary of the Trust’s WDES 2018 results together with a draft action plan.  The following was highlighted:-

 

·         The highest numbers of staff with disabilities were in bands 2 and 6.  There were no staff who declared a disability in bands 8-9.

·         Disabled staff are far more likely to enter a formal capability process.

 

There followed a discussion about the definition of a disability and declaring a disability during your working life.  It was noted that there had been a recent campaign to staff to raise awareness and encourage updating personal records on the NHS Electronic Staff Record (ERS) system.

 

Lizzie Abderrahim, Non-Executive Director requested that measures were added to the action plan, together with an analysis undertaken to understand why disabled people were less likely to be shortlisted.

Action  :  Director of HR

 

Lizzie Abderrahim, Non-Executive Director asked for clarification on the governance arrangements for this report.  Carole Nicholl, Director of Governance & Assurance replied that normally this report would be reviewed by the Equality & Diversity Group then through the Quality & Governance Committee and then to Board.  However due to a timing issue this year the report had been presented direct to Board.

 

RESOLVED

 

(a)   that the 2018 WDES results are noted;

 

(b)   that the draft action plan agreed, and;

 

(c)   add measures to the action plan and undertake analysis to understand why disabled people were less likely to be shortlisted.

 

170/19

Workforce Race Equality Standards Report 2019 pdf icon PDF 945 KB

Jude Gray, Director of Human Resources

Minutes:

The Board received and considered a report that provided a summary of the Trust’s 2018 Workforce Race Equality Standards (WRES) together with a draft action plan.  The following was highlighted:-

 

·         All 2018/19 WRES actions were completed.

·         Access to non-mandatory training for BME staff remained higher than for white staff.

·         BME staff was less likely to enter a formal disciplinary process than white staff.

·         There had been a reduction in the number of BME candidates who had been appointed following shortlisting.

·         BME staff continued experiencing harassment, bullying or abuse from staff.

·         There had been a deterioration in the results of BME staff feeling that the Trust provided equal opportunities for career progression or promotion.

·         The 2019/20 WRES Action Plan was in development.

 

Lizzie Abderrahim, Non-Executive Director observed that neither the WRES nor this paper had recognised or mentioned any risks associated by not achieving these standards.  Carole Nicholl, Director of Governance & Assurance agreed however confirmed there was a risk on the register around non-compliance.

 

RESOLVED

 

(a)   that the results for 2018 were noted, and:

 

(b)   that the draft action plan is discussed and agreed.

171/19

Responsible Officer's Annual Board Report on Appraisal and Revalidation pdf icon PDF 300 KB

Charlotte Forsyth, Medical Director

Additional documents:

Minutes:

The Board received and considered the annual report on the revalidation of medical staff and the activities undertaken by the Responsible Officer (RO).  This report also contained the statement of compliance which would be submitted to NHS.

 

Julie Soutter, Non-Executive Director asked how, as Chair of Audit, Risk and Assurance Committee, could she be assured that there was a robust process in place, and was there an independent review that was undertaken.  Charlotte Forsyth, Medical Director replied that all appraisals are signed off by the Medical Director/Responsible Officer and an audit was undertaken on a random selection of appraisals together with a peer review.  Carole Nicholl, Director of Governance & Assurance agreed to take the task of checking whether an external review had taken place in the last three years.

Action  :  Director of Governance & Assurance

 

RESOLVED

 

(a)   that the Board note and accept this summary;

 

(b)   that the Board approve the statement of compliance, and:

 

(c)   check whether an external review of revalidation had been undertaken in last 3 years.

172/19

Chair of Performance, People & Place Committee Overview pdf icon PDF 294 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 26 June 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.

173/19

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: -

 

The NHS Outcomes Framework Indicator  -  data on Delayed Transfer of Care for this Trust was under review and the outcome would be presented through the Performance, People and Place Committee.

Action  :  Chief Operating Officer

 

Cancer Performance  -  Q1 performance had been achieved.   The 62 day standard was at 5/6th in the country.  The 2 week wait dipped slightly however this was due to seasonal increase in dermatology referrals. 

 

Stroke Performance  -  There continued to be no change in performance.  It was anticipated that achievement of SSNAP score level C would be maintained in Q3.

 

Diagnostics Performance  -  This continued in line with the recovery trajectory.

 

Referral to Treatment Time (RTT)  -  The overall position was a deterioration on the forecast position however the position was stabilising with an action plan to address the deficit.

 

Outpatients - Hold File Overdue Follow Ups  -  A substantial improvement had been achieved by admin validation and some services increasing capacity due to recent recruitment.

 

Julie Soutter, Non-Executive Director had asked at a previous Board meeting for a 12 month rolling data for attendance in ED which had been not been included.  Jim O’Connell, Chief Operating Officer apologised for the error and would be added for the next report.

Action  :  Chief Operating Officer

 

There followed a discussion on the increase in A&E attendance and noted that there were no one or two major themes for the increase and that Swindon were not an outlier in terms of the STP footprint.  It was also noted that the number of stranded patients had increase significantly which was also a national trend.  Actions to improve this situation included a review to the length of stay process and the recruitment of a new Head of Patient Flow who had recently started.

 

Community Services

Wheelchair Service  - Performance had dipped within month however a new member of staff had been recruited to target outstanding assessments.

 

Podiatry Service  -  The service had seen some challenges for a period of time and although the target had not been achieved there was an upward trend with confidence to sustain this position.

 

Swindon Intermediate Care Centre (SwICC)  -  The length of stay targets for both Orchard and Forrest ward had been achieved.  It was noted that due to essential refurbishment work required on the wards a temporary decant of patients to a registered care home in Swindon would be happening from the end of September 2019.  This would also test a potential winter bed escalation pathway using a nursing home.

 

A discussion followed on the process of determining length of stay, and the nursing issues as reported in the safer staffing bi-monthly report.

 

RESOLVED

 

(a)   that the report be received and the ongoing plans to maintain and improve  ...  view the full minutes text for item 173/19

174/19

Chair of Finance & Investment Committee Overview pdf icon PDF 310 KB

Andy Copestake, Non-Executive Director

Minutes:

The Board considered a report which summarised the key issues from a meeting of the Finance & Investment Committee held on 22 July and 27 August 2019 and highlighted that Divisions had now been invited, when appropriate, to the Finance & Investment Committee meetings in order to seek assurance on their financial recovery action plans.

 

RESOLVED

 

that the report be received.

175/19

Finance Report pdf icon PDF 228 KB

Karen Johnson, Director of Finance

Additional documents:

Minutes:

The Board received and considered a report on finance for month 4 (July 209), and highlighted the following:-

 

·         The format of the report had changed slightly to give further detailed breakdown on divisional variance.

·         The overall financial position was significantly adverse and recovery planning was underway.

·         The year to date position was a deficit of £7,296k which was above plan with the main drivers non-pay and high drugs. 

·         The pressure within drugs was due to gastro outsourcing which had not been budgeted for.  This would continue due to the waiting list size.

·         Identified CIPs were below the required level by £1m.

·         There were on-going discussions with the commissioners to move towards a block contract.

·         The Trust had sought external assurance that the areas of focus for financial recovery were the right ones.  A draft report had been received and was undergoing accuracy.

 

Julie Soutter, Non-Executive Director asked about the timetable and process for revising our financial position.  Karen Johnson, Director of Finance replied that should the Trust deviate the first step was to go to the STP Board and collectively discuss how the system could support this, followed by discussions with NHS Improvement.  There was potential of a £13m deviation from our control total if a block contract was not agreed.

 

LizieAbderrahim, Non-Executive Director commented that the risk around financial recovery was at a score of 12 which appeared low.  Karen Johnson, Director of Finance agreed however there was a time lag and hence the low score in the report.

 

Jemima Milton, Non-Executive Director commented that one of the areas recommended in the external report was coding  which had been reviewed in the past.  Karen Johnson, Director of Finance replied that this had been reviewed 3-4 years ago there was a massive opportunity to refresh training and embed the importance of coding within the organisation.

 

Jemima Milton, Non-Executive Director asked if true transformation was being looked at as achieving CIPs targets would continue to be a risk going into next year.  Kevin McNamara, Acting Chief Executive replied this would be one area to discuss when considering the PWC report. 

 

RESOLVED

 

(a)     the Month 04 financial position is a year to date deficit of £5.399m including PSF, MRET & FRF, all currently forecast to plan;

 

(b)    the Month 04 financial position excluding PSF, MRET & FRF is a year to date deficit of £7.296m, and:

 

(c)     that the use of resources rating is 4.

176/19

Chair of Audit, Risk & Assurance Committee Overview pdf icon PDF 304 KB

Julie Soutter, Non-Executive Director

Minutes:

The Board received and considered a paper the summarised the key issues discussed by the Audit, Risk and Assurance Committee at the meeting held on 11 July 2019.

 

RESOLVED

 

that the report be received.

177/19

Chair of Charitable Funds Overview pdf icon PDF 318 KB

Jemima Milton, Non-Executive Director

Minutes:

The Board received and considered a report that summarised the key issues discussed by the Charitable Funds Committee at its meeting on 30 July 2019.

 

It was noted that there was a minor error in the finance report and that “£2.5m raised” should read “£2.5m of investment….”

 

RESOLVED

 

the report be received.

178/19

Ratification of Decisions made via Board Circular/Board Workshop

Carole Nicholl, Director of Governance & Assurance

Minutes:

None.

179/19

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.

180/19

Date and Time of next meeting

Date: 3 October 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 3 October 2019 at 9:30am in Trust Management Boardrooms, Trust HQ, 2nd Floor, Great Western Hospital

181/19

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.