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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

1/20

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 and explained this meeting was being held virtually by teleconference due to the Coronavirus Pandemic. Whilst under normal circumstances the public were able to attend the Trust’s Board meeting held in public Government social isolation requirements constituted ‘special reasons’ to avoid face to face gatherings as permitted by legislation, therefore under these circumstances the public were unable to attend. 

 

Roger Stroud, Lead Governor, had been invited as an observer in order to retain the effective relationship between the Board and Council of Governors during these unprecedented times.  Roger assured the Trust Board that the Council of Governors were pragmatic and accepted the Trust’s approach to meetings in these challenging times.

 

Apologies were received as outlined above.

 

2/20

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.

3/20

Minutes pdf icon PDF 529 KB

Liam Coleman, Chairman

·         5 March 2020 (public minutes)

Minutes:

The minutes of the meeting of the Board held on 5 March 2020 were adopted and signed as a correct record, subject to the following amendments: -

 

Attendance List  -  Add Tracey Cotterill, Interim Director of Finance. 

 

371/Chair of Quality & Governance Committee Overview  - Last paragraph amend to “Lizzie Abderrahim, Non-Executive Director asked for confirmation that reports that had previously been the subject of robust discussion at Board sub-committees (for example the Quality Report, the Operational Performance Report and the Workforce Report) were for Noting at Board Meetings.  Liam Coleman, Chair confirmed that this was the case: reports that had been through a Board sub-committee were for Noting at the Board and did not invite detailed discussion.

 

375/Gender Pay Gap Report  -  4th paragraph amend to “Lizzie Abderrahim, Non-Executive Director requested that a distinction be drawn in the report between salaried employees of the Trust and Non-Executive Directors who, as  Office Holders, are not employed by the Trust and whilst remunerated are not salaried.

 

4/20

Outstanding actions of the Board (public) pdf icon PDF 592 KB

Minutes:

The Board received and considered the outstanding action list.  

 

5/20

Questions from the public to the Board relating to the work of the Trust pdf icon PDF 349 KB

Minutes:

The Board received and considered one question in relation to timeliness of consultant’s reports particularly in the cancer service.  It was noted that on review there were no letters that were over 7 day and due to the personal nature of exploring this further this question was closed down and would be investigated outside this forum.

 

6/20

Chairman's Report, Feedback from the Council of Governors

Liam Coleman, Chairman

Minutes:

There were no material issues to report.

 

7/20

Chief Executive's Report pdf icon PDF 295 KB

Kevin McNamara, Chief Executive

·         Coronavirus update

Minutes:

Firstly the Chief Executive formally announced with great sadness the death of one of our colleagues, Dr Edmond Adedeji (Locum ED Registrar) who had died from Covid-19.  A statement from Dr Adedeji's family was received and read out on their behalf:-

 

"We as a family are grateful to God for the life of Dr Edmond Adefolu Adedeji.

"He died doing a job he loved, serving others before himself.

"We would like to thank the staff and his colleagues for looking after him during his final days.

"He leaves behind a wife, three children and three grandchildren."

 

Liam Coleman, Chair expressed, on behalf of the Board, the Trust’s deepest thanks and gratitude to Dr Adedeji for his dedication, commitment and courage in these challenging circumstances and also condolences to his family at this most difficult and emotional time.

 

There was a moment of silence to pay tribute to Dr Adedeji.

The Board received and considered a report from the Chief Executive which focussed on the Coronavirus. 

 

The managing of the Coronavirus Pandemic remained the Trust’s number one priority.  There had been a number of changes to the way the Trust normally operated these included configuring wards and beds within the hospital, working with the independent sector, up-skilling staff and cancelling non-essential appointments and routine activity.  The current focus was on managing Personal Protective Equipment (PPE) and staff testing, together with putting in place a wide range of health and well-being packages to support staff. 

 

Andy Copestake, Non-Executive Director asked how frequently were staff being retested.  Julie Marshman, Chief Nurse replied that it was important that testing was completed in the first couple of days of being symptomatic.  If the results came back undetected and there was still clinically strong signs of the virus there would be a retest but only in these circumstances. 

 

Jemima Milton, Non-Executive Director asked how were relationships with the independent section.  Jim O’Connell, Chief Operating Officer replied that there was a work stream overseeing this and that co-operation had been excellent.  The Trust was redirecting patients to The Ridgeway Hospital for some outpatient activity and selected surgery.

 

Peter Hill, Non-Executive Director commented that there would be some positives that would come out of this Pandemic in relation to ways of working and lessons learnt and asked if these were being captured.  Kevin McNamara, Chief Executive replied that key work streams had been established to manage our response to COVID-19 and one was to manage ‘Reset and Recovery’ and this group would be responsible to retain any beneficial elements of our response to the coronavirus, this would also include at a system-wide level.

 

Jemima Milton, Non-Executive Director asked had the Trust seen or been offered any help in connection with the national recruitment of volunteers to support the NHS.  Jude Gray, Director of HR replied that as well as the national campaign there had been a local process to bring back staff.  This had been successful with 500 responses, of which 223 already  ...  view the full minutes text for item 7/20

8/20

Quality Report pdf icon PDF 222 KB

Julie Marshman, Chief Nurse

Additional documents:

Minutes:

The Board received a verbal update on the Quality Report from the Chair of the Quality & Governance Committee’s perspective and the following noted:- 

 

·         The Quality Report had been discussed in detail however it was recognised that this report had been superseded by events due to the situation regarding the Coronavirus. 

·         One area of focus was around mortality figures which had increased month on month for the past 8 months.  Although the Committee had no concerns, as SHMI figures were below the nationally expected value of 100, it wanted to be reassured that all criteria around mortality were being monitored robustly.

 

 

The Board received and considered the Quality Report for February 2020 which was noted.   However as result of the Coronavirus the Chief Nurse gave a verbal update on the current position for March 2020 and highlighted the following:-

 

Mixed Sex Breaches  - There had been no mixed sex breaches as Recovery 2 had been utilised in a different way due to surgery not taking place. 

 

Care Hours Per Patient Day  (CHPPD) -  Although this was still being recorded it was in a totally different way as a different staffing model was required to support management of the coronavirus.

 

Incident Reporting  -  There had been 24 incidents reported to date related to COVID-19.  Two were due to medication delays and some due to transfers to community which occurred at the beginning when processes were still being bedded in.  None were of a significant level.  There was one RIDDOR, (the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations) reported which related to a staff fracture in Sunflower Lodge. Liam Coleman, Chair asked for assurance that RIDDOR reporting was not being overlooked.  Julie Marshman, Chief Nurse confirmed that robust scrutiny was undertaken on all incidents raised and there were no other incidents that constituted a RIDDOR at this time.

 

Returning Nursing Workforce  - The returning nursing workforce included returners, international and student nurses.

 

Liam Coleman, Chair asked how the morale and resilience was within the nursing group in these challenging and stressful circumstances.  Julie Marshman, Chief Nurse replied that the nursing team were working incredibly well as a team.   Some areas had felt slightly confused and frustrated with the ever changing PHE guidance however the Trust had put in the effort to ensure that staff had the knowledge, resources and support particularly around PPE.

 

RESOLVED

 

to note the quality matters and exceptions contained within the report.

 

9/20

Workforce Report: Key Performance Indicators (Month 11) pdf icon PDF 246 KB

Jude Gray, Director of Human Resources

Minutes:

The Board received a verbal update on the Workforce and Operational Performance Reports from the Chair of the Performance, People and Place Committee’s perspective and the following noted:- 

 

·         The Workforce and Operational Performance Reports had both been discussed in detail however it was recognised that these reports had been superseded by events due to the situation regarding the Coronavirus.

·         The ED 4 hour performance had been around 80%, which was mid- pack nationally however since the pandemic this had improved significantly.

·         Stroke performance had significantly improved.

·         There had been a robust discussion around the 52 week waiters (52ww) however as this had now been superseded by events further review would be undertaken when normal business had been resumed.

 

The Board received and considered a paper that summarised the key workforce issues and risks identified for month 11 (February 2020) which was noted.  Jude Gray, Director of HR commented that the current focus within HR was on the right configuration of staff and the support staff health and well-being in response to the Pandemic.

 

RESOLVED

 

the report be noted.

 

10/20

Operational Performance Report pdf icon PDF 292 KB

Jim O’Connell, Chief Operating Officer

Lorraine Austen, Associate Director for Swindon Community Health Services

Additional documents:

Minutes:

The Board received and considered the Operational Performance Report for month 11 which was noted.  Jim O’Connell, Chief Operating Officer gave a verbal update on the current position:-

 

Cancer  -  The Board were assured that cancer work had continued as the service had moved to The Ridgeway Hospital. 

 

Referral to Treatment Time (RTT)  -  To reduce the footfall in the hospital all routine activity had been stopped.  Some virtual outpatient clinics had been undertaken and some urgent endoscopies which had gone through a rigorous triage process.  This would result in a significant impact on RTT performance and therefore a separate work stream had been created to manage the recovery plan.

 

Diagnostic and Outpatients  -  Diagnostics tests within 6 weeks would also be significantly impacted.

 

ED Performance  -  The ED had been split into 2 areas; blue (non-COVID) and red (COVID) patient assessment areas.  There was currently significant capacity within the hospital which had been created for CORVID-19 patients.

 

Stranded Patients – This had reduced significantly due to creating the maximum possible inpatient and critical care capacity for COVID-19 and working with organisations to ensure the peak requirements were met. 

 

Andy Copestake, Non-Executive Director asked what the format of the Operational Performance Report would be like in the next few months.  Peter Hill, Non-Executive Director and Chair of PPP Committee replied that in response to the changes made operationally and the day to day impacts on all staff and patients the Committee, in liaison with the Chief Operating Officer, had agreed that the next reports would be more COVID focussed and that the changes would focus on the most important metrics and to reduce the amount of time in the collection and provision of information and data.

 

Paul Lewis, Non-Executive Director asked what the demographics of the COVID patients were and if there were any outside the Trust’s catchment area.  Jim O’Connell, Chief Operating Officer replied that he did not have this data currently and would report this in the next Operational Performance Report.

Action  :  Chief Operating Officer

 

RESOLVED

 

(a)   to accept, acknowledge and support the on-going plans to maintain and improve performance; and

 

(b)   to provide data in next report on demographics of COVID patients.

 

11/20

Finance Report pdf icon PDF 236 KB

Tracey Cotterill, Interim Director of Finance

Additional documents:

Minutes:

The Board received a verbal update on the Finance Report from the Chair of the Finance & Investment Committee’s perspective and the following noted:- 

·         As a result of the Coronavirus Pandemic there was a totally different financial regime in place over the next few months.  The existing plans and contracting were on hold with the focus to identify COVID-19 costs. 

·         There was evidence within the Trust that solid protocols and controls were in place to capture the expenditure (revenue and capital) and ensure it had been through the appropriate approval process.

·         The year-end position was on track to meet the £8.8m over the control total.

·         Good progress had been made on CIPs/transformation although it was recognised that with the different financial regime this would now be more a challenge in some areas.

·         The Committee had also requested for a register of contracts and licences to be established and monitored with expiry dates.

 

The Board received and considered the Finance Report for month 11 (February 2020) and the following highlighted:-

 

2019/20 Financial Position

 

The year end position was still achievable but with pressure from COVID-19.  National guidance had been issued to inform that all revenue costs would be refunded, however under the current guidance there was no provision to reimburse Trusts for a number of items including the loss of private patient income, loss of car parking income, accrued costs for cancelled leave and loss of NHS income for non-contracted activity.  Further consideration was being given to the first 3 of these items.  Although there was some underspend in non-COVID-19 areas to off-set these costs there could still be a cost pressure to year end.

 

Financial Year 2020/21

 

From 1 April 2020 the national planning exercise was suspended and a new financial regime would be introduced from 1 April to 31 July 2020.  Under the interim arrangements all NHS contracts were suspended with an immediate move to block contracts with both NHS England (NHSE) and host Clinical Commissioning Groups (CCGs).   The contract values would be based on M09 submissions to NHSI and an internal review was underway to ensure the figures calculated by NHSI were aligned to 2019/20 runrate.

 

There was a national procurement policy to support critical suppliers for on-going services to protect the NHS supply chain.  The Trust was working with suppliers and NHSI to seek support where necessary.  The Trust had met all creditor requirements and ensured prompt payment.

 

Julie Soutter, Non-Executive Director was concerned for the finance team and the number of calls from creditors due to cash pressures.  Tracey Cotterill, Interim Director of Finance replied that a lot of work had been undertaken with Divisions to ensure invoices were approved in a timely manner together with the introduction of an escalation process.

 

Julie Soutter, Non-Executive Director asked if any extra audit work was required in relation to COVID-19 costs, both nationally and locally.  Tracey Cotterill, Interim Director of Finance responded that although no official notification had been received it was anticipated there  ...  view the full minutes text for item 11/20

12/20

Ratification of Decisions made via Board Circular/Board Workshop

Carole Nicholl, Director of Governance & Assurance

Minutes:

The Board was asked to ratify the following which had been approved via Board Circular.  Details of the amendments to each had been included in the respective circulars. 

 

No 24 / 7-Feb-20           Revenue Loan of £2.7m

No 26 / 11-Mar-20          Capital Loan £422k

No27 / 16-Mar-20           Capital Loan £4.8m

No 28 / 20-Mar-20          Temporary adjustment to SFIs - procurement due to                                           COVID-19

 

No 1 / 01-Apr-20            Membership of Committees

No 2 / 01/Apr-20            Terms of Reference of Board Committees

N0 3 / 01/Apr-20            Powers Reserved to the Board and Scheme of Delegation*

No 4 / 01-Apr-20            Risk Management Strategy

No 5 / 01-Apr-20            Standing Financial Instructions

 

*It was noted one recommendation for amendment from the Director of Finance to the Powers Reserved to the Board was to include approval of any applications for public dividend capital.

 

RESOLVED

 

that 9 Board Circulars as outlined above where approved.

 

13/20

Changes to CQC Statement of Purpose pdf icon PDF 447 KB

Carole Nicholl, Director of Governance & Assurance

Minutes:

The Board received and considered a paper that outlined the application to submit to CQC for the following:-

 

  • To register the new Chief Executive as the Trust’s Register Manager
  • To change the Trust’s Statement of Purpose to reflect the changes put in place due to the COVID-19 Pandemic

 

Due to the speed at which decisions are made the Board were requested to delegate authority to the Director of Governance and Assurance to make any further applications.

 

RESOLVED

 

(a)   that an application be made to the Care Quality Commission to register Kevin McNamara, Chief Executive as this Trust’s Registered Manager under the Health & Social Care Act 2008 for the purpose of enabling and monitoring compliance with the Fundamental Standards across regulated activities and sharing legal responsibilities in relation to that position with the provider; and

 

(b)   that the Director of Governance & Assurance be delegated authority to submit statutory notifications and revised Statement(s) of Purpose on behalf of the Trust to the CQC to reflect the delivery of services which provide additional health and social care capacity in an area and / or contribute to the control of the outbreak of coronavirus or the treatment of people who have contracted the illness.

14/20

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.

15/20

Date and Time of next meeting

Date: 7 May 2020

Time: 9:30am

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

Minutes:

It was noted that the next meeting of the Board would be held on 7 May 2020 at 9:30am in Trust Management Boardrooms, Trust HQ, 2nd Floor, Great Western Hospital

 

16/20

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.