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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

Jim O’Connell


The Chair welcomed all to the Great Western Hospitals NHS Foundation Trust Board meeting held in public. 


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 391 KB

Liam Coleman, Chairman

·         6 February 2020 (public minutes)


The minutes of the meeting of the Board held on 6 February 2020 were adopted and signed as a correct record, subject to the following amendments: -


343/19  :  CQC Registration Update  -  Change last paragraph to  “Lizzie Abderrahim, Non-Executive Director expressed concern that the general description of the Trust’s structure in the GWH Statement of Purpose document did not reflect the Trust’s current structure. This was acknowledged by Carole Nicholl and it was agreed that this description needed to be reviewed. Lizzie Abderrahim was also concerned about some of the wording in the Primary Care Network Statement and offered to review the document for the next submission.”



Outstanding actions of the Board (public) pdf icon PDF 506 KB


The Board received and considered the outstanding action list.  



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


There were no questions from the public for the Board.



Chairman's Report, Feedback from the Council of Governors

Liam Coleman, Chairman


There were no material issues to report.



Chief Executive's Report pdf icon PDF 320 KB

Kevin McNamara, Acting Chief Executive


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


Coronavirus  -  Guidance from Public Health England continued to be closely followed.  It was a fluid situation and would require stronger governance and more resilience over the longer term.  Staff were thanked for maintaining a calm and professional approach to care at this challenging time for the NHS.


Staff Survey  -  The national staff survey results for 2019 had been published and showed some positive progress as well as highlighting areas to improve working life.  A number of actions would be arranged which included a workshop focussed on wellbeing, an Executive Away day on patient experience plus a membership patient participation group in the GP Network.


Flu Update  -  The Trust had achieved 86% of staff vaccinated, with community areas with the best uptake. 


Pro-bikers Visit GWH  -  Three pro-bikers from Italy had visited the Trust on 18 February 2020 bringing ‘bike therapy’ to the UK for the first time. This was an initiative led by Charlotte Forsyth, Medical Director and was well received by staff, visitors and patients.  The Communications team had shared the experience on social media.


Jemima Milton, Non-Executive Director congratulated and thanked those staff that actually made this happen from a health & safety perspective, however expressed her disappointment in the communications as it had not been picked up nationally.  Kevin McNamara, Acting Chief Executive replied that a huge amount of publicity had been undertaken and it had been picked up by a national paper.


NHS Opearational Planning and Contracting Guidance  -  NHS England and NHS Improvement had published the Operational Planning and Contracting Guidance for 2020/21 on 30 January 2020.  The guidance sets out a number of expectations including a ‘System by Default’ model as all systems prepare to become an Integrated Care System by April 2021.




(a)   that the report of the Chief Executive be received.



CQC - verbal update

Kevin McNamara, Acting Chief Executive


A verbal update was given on the recent CQC inspection visit which included a summary of the initial CQC feedback.  The Trust awaits the final report.



Patient Story

Julie Marshman, Chief Nurse


The Board watched a video of a patient who shared their experience to demonstrate where the hospital could improve on its care, and, around the complaints process.  Particular areas highlighted were the length of time and quality of a complaint responses, delay in issuing a death certificate together with the lack of full explanations during the journey of this patient.  It was noted that lots of improvements had been implemented since this feedback particularly around overdue complaints and a workshop had been undertaken to take on the learning to make improvements.


There followed a robust and lengthy discussion which included medical documentation, the challenges around medical outliers and resourcing, death certificates, end of life care and the complaints process. 


It was acknowledged that there remained challenges around medical outliers, which would continue until the hospital right sized its bed base, however all mitigating actions had been put in place in the current constraints, and that this was captured on the Trust’s risk register. 


The complaints process had improved significantly.  In discussion it was considered that there was also a role for the internal auditors and this would be discussed further at the Audit, Risk and Assurance Committee in planning for the programme of audits.

Action :  Interim Director of Finance


Death certificates were monitored regularly by the End of Life Committee with oversight by the Quality & Governance Committee.  A Medical Examiner had recently been appointed.  It was considered that further assurance on end of life medication was required and this would be picked up as a future agenda item by the Quality & Governance Committee.

Action  :  Medical Director


Liam Coleman, Chair summarised the discussion and proposed that the actions would be reviewed in 9 months’ time to ensure that all learning was embedded within the organisation.  Julie Marshman, Chief Nurse agreed and that this would be completed as part of the Quality Improvement.

Action  :  Chief Nurse


The Board were thankful to the patient and family who had permitted their experiences and stories to be shared with the Board.





(a)   complaints process to be reviewed in the context of the internal auditors programme at Audit, Risk and Assurance Committee;


(b)   review of end of life medication to be added a future Quality & Governance Committee; and


(c)   actions and lessons learnt from patient stories to be reviewed in 9 months’ time.



Chair of Quality & Governance Committee Overview pdf icon PDF 328 KB

Nick Bishop, Non-Executive Director


The Board received and considered a report that summarised key issues considered by the Quality & Governance Committee at meetings held on 23 January and 20 February 2020  and the following was highlighted:-


Serious Incidents  -  A Serious Incident Review and Learning Group had been established to focus on serious incidents and the Committee would monitor their output.  There was also further training in investigations of serious incidents which were planned over the next quarter. 


Mortality  -  Although there was no concern with regard to the mortality rate, which was stable and within the expected range, the mortality report had reverted to monthly reporting for better governance.


Dementia Report  -  Benchmarking data highlighted some areas for improvement however further resource was required which was currently going through the relevant process.  The Committee also noted the future focus for dementia work in 2020 and requested Key Performance Indictors to be added to the Dementia Strategy.


Diabetes Quality Report  -  There were still challenges around issuing data to the national diabetes audit due to not having the IT software. 


Lizzie Abderrahim, Non-Executive Director asked for clarity on the purpose of the Board sub-committee reports, whether for noting or for comments even though they may have been made at the meeting.  Liam Coleman, Chair confirmed that the report would be accepted unless a member of the committee did not accept that it was a true and fair representation of the meeting, or, there were any further questions, clarity or assurance on any of the items contained within the document required.




that the report be received.



Quality Report pdf icon PDF 222 KB

Julie Marshman, Chief Nurse

Charlotte Forsyth, Medical Director

·         Stranded Patient Review

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 November 2019 were as follows: -


Serious Incidents  -  There had been 11 serious incidents that had failed to be completed within the required 60 days due to availability of trained investigation leads. Bespoke investigation training was underway together with a clear process to ensure shared learning.  


Liam Coleman, Chair asked if there was sufficient visibility to see any patterns or trends coming through. Julie Marshman, Chief Nurse replied that an aggregated approach was being strengthened for shared learning with input from both legal and complaints.  Charlotte Forsyth, Medical Director added that the actions put in place in ED around pressure ulcers was a triggered response from this process.


Complaints  -  A considerable amount of work had taken place to actively manage overdue complaints and since writing the report this figure had decreased from 17 to 0.


Infection Prevention and Control  -  The number of C.diff cases reported was just over the trajectory line set and remained an area of concern.  Each case was thoroughly investigated; however the Trust continued to be in escalation.


Pressure Ulcers  -  There were 9 acute pressure ulcers acquired in January 2020.  The Trust performed well nationally as demonstrated in Model Hospital however the aim was not to have any.  Due to the concern with longer waits in ED actions had been put in place to support assessment in this area to prevent further developments of pressure ulcers. 


Andy Copestake, Non-Executive Director asked whether there was a target for patient moves and was there a process to track patients to monitor these moves.  Julie Marshman, Chief Nurse replied that patients were tracked and that it was expected there would be a certain amount of moves however not more than 3.  Kevin McNamara, Acting Chief Executive took an action to discuss with the Chief Operating Officer for further detail on the where and how many times.

Action  :  Acting Chief Executive  / Chief Operating Officer.


Liam Coleman, Chair highlighted that the Coronavirus Pandemic would impact on performance and reporting and therefore any variance should be reported in real time not retrospectively. 


Stranded Patient Review

The Board received a paper that outlined the work flow for reducing stranded patients.  This had been reviewed by Performance, People and Place Committee.


Tracey Cotterill, Interim Director of Finance highlighted that this would inform the contract negotiations for 2020/21 with the commissioners as there were financial implications for each patient.  Kevin McNamara, Acting Chief Executive added that the patient flow and order diagram showed the lead names for each part of the process to ensure that this would not spill back to the Medical Director as previously.




(a)   that the report and quality matters and exceptions contained within the report be noted;


(b)   that the work flow for reducing stranded patients be noted; and


(c)   further review and  ...  view the full minutes text for item 372/19


Safer Staffing 6 monthly skill mix report pdf icon PDF 635 KB

Julie Marshman, Chief Nurse


The Board received and considered a paper that provided a comprehensive review of the nursing and health care worker skill mix and workforce profile for all wards and departments that provided clinical services to patients.


The review looked at what was currently spent to deliver safe care against what is spent over establishment.  There was a notable increase in the need for 1:1 care, and the regular use of Registered Mental health Nurses.


There followed a robust discussion on the contents of the report in particular reference to a request for a significant amount of investment.  It was clarified that this paper was purely a quality paper that quantified the financial impact for additional staff.  Any investment request and approval would go through the normal budget setting process and the appropriate governance routes.


Andy Copestake, Non-Executive Director commented that the Trust appeared to be rebasing before looking at efficiencies and this was a stepping stone to eventual establishment.  Julie Marshman, Chief Nurse replied that the Trust was currently recruiting and training Nursing Assistants however currently there were insufficient numbers to change the skill mix or ward staffing to make the big step towards transformation. Andy Copestake added that he would like to see the ‘end game’ and how far away the Trust was from it.  Julie Marshman replied that more work was required to get to this stage with workshops planned to establish this


There followed a discussion around the approach in creating a properly funded establishment which would go hand in hand with accountability of budgets in each division.  It was noted that further discussions would be on-going through the relevant governance routes.




that the review be noted.


Workforce Report: Key Performance Indicators (Month 10) pdf icon PDF 252 KB

Jude Gray, Director of Human Resources & Organisational Development


The Board received and considered a paper that summarised the key workforce issues and risks identified from the workforce report in January 2020 (month 10).  The following was highlighted:-


·         Recruitment and retention was very similar to last month with no noticeable variance.

·         A Menopausal Talk was well attended and well received.  

·         Occupational Health had obtained a free upgrade to their IT system.

·         The Trust had achieved its flu vaccination target at 80.15%.  The target for 2020/21 had been confirmed as 90% by the Clinical Commissioning Group (CCG).

·         A paper had been developed as part of a well led initiative to learn from best practice with an update on progress presented to the May 2020 Executive Committee.

·         The pay bill was an on-going issue. A number of actions had been introduced which included the launch of the Spring Save Scheme to help increase bank fill rate, a new reporting system to strengthen reporting and proactive usage of the e-roster.

·         Modelling had been undertaken with regard to loss of staff due to the Coronavirus and there was clear guidance for staff on the intranet with regard to self isolation.


Peter Hill, Non-Executive Director and Chair of the Performance, People & Place Committee (PPPC) confirmed that a robust discussion had been undertaken on the workforce report at the PPPC.


Paul Lewis, Non-Executive Director highlighted that there were no references to the top HR risks in the report.  Jude Gray, Director of HR was aware of the 15+ HR risks and there were actions in place to mitigate, however acknowledged that these could be referenced in future.


There followed a discussion on the impact of the Coronavirus on staffing which included retired doctors and nurses, volunteers, staff with children, home working. 




that the report be noted. 



Gender Pay Gap Reporting - Results for 2018/19 pdf icon PDF 1 MB

Jude Gray, Director of Human Resources & Organisational Development


The Board received and considered a paper that summarised the results of the Gender Pay Gap analysis for 2018/19.  The following was highlighted:-


·         The total workforce showed a gap of 4.5%.  A typical gap expected was 5% therefore there were no concerns to raise.

·         There was one cohort disparity between male and female which was the medical cohort.

·         One area that showed a significant difference between male and female was in the bonus element mainly due to consultants receiving Clinical Excellence Awards, some of which were for life (now not available) and more likely to be paid to men than women.  However a better understanding of why males were earning more than female in incentive payments would be an area of focus.


The action plan was attached as appendix 1 and would focus on the medical workforce including a deeper dive into incentive payments.



Lizzie Abderrahim, Non-Executive Director pointed out that Non-Executive Directors do not get paid a salary but a remuneration.


Andy Copestake, Non-Executive Director asked what was to be done to achieve a non-gender bias recruitment process.  Jude Gray, Director of HR acknowledged that this was not practical on an interview panel and would delete this action.


Julie Soutter, Non-Executive Director asked if we could not use the word bonus but additional payments.  Jude Gray, Director of HR replied that this was a national standard template.




(a)   that the paper is noted; and


(b)   that the information is agreed to be published subject to any amendments as outlined above.



Chair of Performance, People & Place Committee Overview pdf icon PDF 290 KB

Peter Hill, Non-Executive Director


The Board received and considered a report that summarised key issues considered by the Performance, People and Place Committee at meetings held on 29 January and 27 February 2020.  The following was highlighted:-


Stroke Performance  - An update was received with excellence performance in moving from scoring E to D to C.


Sustainability  -  An update was received on the Sustainability Development Plan which provided assurance that work had been undertaken in this area as well as highlighted projects that the Trust was committed to for the future.  This included the Sustainability Day on 19 March 2020 which Board members were encouraged to attend.


52 Week Waiters -  Due to concerns around patients waiting in Gastroenterology, which was linked to the data quality issues within the organisation, a paper was presented regarding the over 52 week waiters.  The Committee were satisfied that patients had been identified and an action plan produced with clinical input however this would be closely monitored by the Committee as was concerning.




that the paper be noted.



Operational Performance Report pdf icon PDF 291 KB

Leighton Day, Deputy Chief Operating Officer

Lorraine Austen, Associate Director, Swindon Community Health Services

Additional documents:


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


ED Performance  -  The various initiatives recently introduced within the ED had started to show a positive impact on performance.  There continued to be bed issues due to flow impacted by various factors which included stranded patients and  noravirus.  Corridor care was still prevalent with ambulance handover significantly worse for the first time in 13 months.


Stroke Performance  -  The SSNAP tool predictor had predicted a score at the top end of B which was encouraging.  The official Q3 result was expected by Mid March 2020.


Referral to Treatment Times (RTT)  -  The waiting list improved in January 2020 with 158 away from year end target.  The movement in month was related to live Patient Tracking List (PTL) clock stops through validation and reduced referrals.


Theatres  -  The overall theatre utilisation had decreased in month which was primarily driven by the number of cancellations due to escalation and use of Recovery 2.


Cancer  -  Overall performance was maintained, except for two Week Wait (2ww) national standard which was not achieved predominantly due to capacity.


Diagnostics & Outpatients  -  Performance was good, however there were a number of breaches within CT due to technical issues.


Liam Coleman, Chair acknowledged the turnaround in the stroke performance but also recognised the commitment in the ED for introducing initiatives that had only just started to see improvements, and congratulated all the teams for their commitment and achievements.  Paul Lewis, Non-Executive Director asked how the organisation was going to recognise and celebrate this fantastic progress.  Kevin McNamara, Acting Chief Executive replied that all celebrations/successes would be made public every quarter.


Julie Soutter, Non-Executive Director asked if moving to a SNNAP C rating would benefit the Trust financially.  Tracey Cotterill, Interim Director of Finance replied that there would only be a financial benefit if the Trust achieved Best Practice Tariff outside the block contract.




that the report be received and the ongoing plans to maintain and improve performance be accepted, acknowledged and supported.



Chair of Finance & Investment Committee Overview pdf icon PDF 297 KB

Andy Copestake, Non-Executive Director

Additional documents:


Chair of Finance & Investment Committee Overview


The Board received and considered a report that summarised key issues considered by the Finance & Investment Committee at meetings on 27 January and 24 February 2020.  It was noted there were two different formats of report, with February the new one.  The following was highlighted:-


·         There was a sense that the financial position had stabilized.  The Trust continued to be on tract to deliver a result that was £8.8m worse than control total.

·         A presentation on Cost Improvement Programmes (CIPs) for 2020/21 was received and although the Committee was pleased to see a much more controlled approach to identification, monitoring and delivery there were concerns that only £2.7m of £9m had been identified to date.

·         Transformation would not be delivered in 2020/21 but would be set up for delivery for the following year with more robust and cross-cut CIPs.

·         The progress on the Coding project was frustrating and remained a concern.  




that the report is received.



Finance Report pdf icon PDF 229 KB

Tracey Cotterill, Interim Director of Finance

Additional documents:


The Board received and considered a report on finance for month 10 (ending 31 January 2020)  and the following was highlighted: -


·         M10 in month and forecast was reported in line with the trajectory.

·         The focus had been on establishing a credible baseline run rate for the latter months which would inform the April 20 position.

·         The Divisions were working on the new style variance report that documented key drivers and remedial actions.

·         The CIP report now included a number of items not previously reported.  The forecast outturn had therefore improved compared to numbers previously reported, however did not affect the bottom line.

·         Risks remained similar to previously reported, with a new risk captured in relation to costs for Coronavirus.

·         The Urgent Treatment Centre (UTC) activity was now reported, and the reverse streaming could be seen being captured in this new group.

·         Contract negotiation for 2020/21 had commenced with an indicative activity plan (IAP) shared with the CCG for review.

·         Financial Plans at system level had been submitted.

·         Cash remained a challenge and loan applications submitted in February and March 2020.

·         Capital forecast remained the same as reported at M09 – underspend against plan related to the delay on the Way Forward Programme, partially offset by additional capital funding for MRI and IT.


Lizzie Abderrahim, Non-Executive Director raised a question on the risks schedule, noting that the likelihood percentage on the CIPs delivery at 30% likely was misleading.  Tracey Cotterill, Director of Finance acknowledged this and took the action to reword the description of the risk.

Action  :  Director of Finance




(a)   the Month 10 financial position is a year to date deficit of £12.229m including PSF, MRET & FRF. FRF and PSF not forecast to achieve.


(b)   The Month 10 financial position excluding PSF, MRET & FRF is a year to date deficit of £16.483m.


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


(d)   reword on description of risk schedule with regard to likelihood of delivery of CIPs.


Chair of Audit, Risk & Assurance Committee Overview pdf icon PDF 329 KB

Julie Soutter, Non-Executive Director


The Board received and considered a report that summarised key issues considered by the Audit, Risk & Assurance Committee at the meeting held on 16 January 2020.  There were no further comments as a verbal update was given at the last Board meeting.




that the report is received.



Chair of Charitable Funds Committee Overview pdf icon PDF 309 KB

Jemima Milton, Non-Executive Director


The Board received and considered a report that summarised key issues considered by the Charitable Funds Committee at the meeting held on 5 February 2020 with the following comments:-


·         The general election purdah had been the biggest challenge as there was no fundraising undertaken during this period.

·         Since the meeting it had been confirmed that a Pam Ayres concert would take place on 1 October 2020 for Better Births.




that the report is received.



Constitution Review pdf icon PDF 351 KB

Carole Nicholl, Director of Governance & Assurance


The Board received and considered a paper outlining the proposed amendment to the Trust’s Constitution which was in connection with the appointment of members to the Council of Governors from the two CCG partnership organisations, Swindon CCG and Wiltshire CCG.  These CCGs would cease to exist from 1 April 2020 and be replaced with the newly created Bath and North East Somerset, Swindon and Wiltshire (BSW) Clinical Commissioning Group (CCG). 


Lizzie Abderahim, Non-Executive Director asked how the reason for change for 2.2 was ‘remained the same’.  Carole Nicholl, Director of Governance & Assurance clarified that there would no change to the number of appointed governor representative as this remained as two (2) however recognised that it would be over a wider geographical area.




(a)   that the Board approves the amendments of the Constitution as set out above and for recommendation to the Council of Governors for approval; and


(b)   delegates authority to the Director of Governance & Assurance to finalise the exact wording in the Constitutional documents and thereafter submit to the NHS Improvement within 28 days.



Register of Interests and Declaration of Interests at Meetings pdf icon PDF 291 KB

Carole Nicholl, Director of Governance & Assurance

Additional documents:


The Board considered a report that provided an annual reminder to Directors of their obligation to register any relevant and material interests as soon as they arise or within 7 clear days of becoming aware of the existence of the interest and to also make amendments to their registered interests as appropriate. 


The report also reminded of the requirement to declare interests at meetings when matters in which there was an interest were being considered and the requirement to withdraw from the meeting during their consideration.


Furthermore, the report asked the Board to receive a copy of the Register of Interests of the Board of Directors for review, which best practice suggested, should be undertaken on at least an annual basis.




(a)   that the requirement of directors to register their relevant and material interests as they arise or within 7 clear days of becoming aware of the existence of an interest be noted;


(b)   that the requirement to keep the register up to date by making amendments to any registered interests as appropriate be noted;


(c)   that the requirement to declare the existence of registered interests or any other relevant and material interests at meetings be noted including the requirement to leave the meeting room whilst the matter is discussed; and


(d)    that the Director’s Register of Interests be received and it be agreed that the Board is assured that the requirements of the Constitution to maintain a register of interest of Board Directors are being met.



Ratification of Decisions made via Board Circular/Board Workshop

Carole Nicholl, Director of Governance & Assurance




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.



There was a verbal update on the Coronavirus situation which highlighted:-


·         The numbers of cases in the UK and within the local area.

·         Trusts were requested to look at expanding ICU facilities.

·         Community testing had worked well and prevented people visiting ED.

·         Escalation plans for ICU and theatre had been reviewed.

·         Daily Incident Control meetings were up and running.

·         Fit test continued with the extra supplies ordered delivered.


There followed a discussion which included stranded patients, cross system working, supplies, and ICU facilities.


The Board would be kept up to date by weekly emails/conference calls.



Date and Time of next meeting

Date: 9 April 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 April 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.