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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

135.

Apologies for Absence and Chairman's Welcome

Minutes:

Apologies for absence were received from Hilary Walker, Chief Nurse.

136.

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.

137.

Questions from the public to the Board relating to the work of the Trust - Oonagh Fitzgerald, Director of Human Resources to provide a verbal response

'In the light of the recent referendum result what is being done to reassure those employees of the Trust who are citizens of other EU states that their continuing work for the Trust is essential and highly valued'.  Given the present situation of overwhelming uncertainty for such employees there is a likely adverse consequence for morale which if not addressed will impact on the Trust's commitment to high quality patient care. 

 

Peter Pettit

Public Governor

Minutes:

A question on behalf of the public had been received by Peter Pettit, public governor as follows:-

 

“In the light of the recent referendum result what is being done to reassure those employees of the Trust who are citizens of other EU states that their continuing work for the Trust is essential and highly valued. Given the present situation of overwhelming uncertainty for such employees there is a likely adverse consequence for morale which if not addressed will impact on the Trust's commitment to high quality patient care.”

 

OF responded that firstly she had sought to ensure that a message was communicated to staff from the Medical Director explaining that the Trust continued to recruit from the EU and support staff from abroad.  A copy of the message had been sent to Peter Pettit. OF explained that she had met with unions earlier in the week and they wished to send out a further message to staff advising of their continued support for all staff.

 

 

138.

Minutes pdf icon PDF 448 KB

Roger Hill, Chairman

·        2 June 2016 (public and summary of private minutes)

·        9 June 2016 (public and summary of private minutes)

Additional documents:

Minutes:

The minutes of the meetings of the Board held in public on 2 and 9 June 2016 were adopted and signed as correct records.

 

CN advised that the minutes of the meeting of the Board held on 23 May 2016 would be presented to the next ordinary meeting, together with the minutes of the Joint Board and Council of Governors held on 9 June 2016.

139.

Outstanding actions of the Board (public) pdf icon PDF 376 KB

Minutes:

The Board received and considered the outstanding action lists and an update to the tracker was provided as follows: -

 

102/16 Reasons for loss of bank staff – OF provided a verbal update explaining that there had been an analysis of this which had identified that some bank staff had joined payroll and some had the joined agencies because they were paid more by those agencies.  The fill rate had improved for bank shifts.

 

The Board agreed that completed actions be removed from the tracker.

140.

Chairman's Report, Feedback from the Council of Governors

Roger Hill, Chairman

Minutes:

The Chairman gave a verbal report as follows: -

 

1.     RH was joined by all members of the Board in welcoming Andy Copestake to his first meeting as a Non-Executive Director.

 

2.     RH asked the Board to formally record that Angela Gillibrand had ceased to be a Non-Executive Director on 30 June 2016 and that Julie Soutter had become the Deputy Chairman of the Trust.

 

3.     RH asked the Board to formally record that Douglas Blair had ceased to be a Non-Voting Board member on 30 June 2016.

 

4.     A By-Election was underway for the vacant Governor seat in the Northern Wiltshire Constituency.  The nomination period would be open between 12 and 27 July 2016.

 

5.     There had been a Joint meeting of the Board and Council of Governors on 9 June 2016. This meeting had approved amendments to the Constitution and received updates regarding the Sustainability and Transformation Plan and the mobilisation of Wiltshire Health & Care.

 

6.     There had been a public health lecture on obesity in June. Coverage had been very popular with the Community Dietician Fiona Dickens having been interviewed by the Swindon Advertiser (online and paper), Swindon Link and Index Wiltshire.

 

RESOLVED

 

(a)   that the report of the Chairman be received; and

 

(b)   that the following be formally recorded: -

-       Angela Gillibrand ceased to be a Non-Executive Director on 30 June 2016 following the expiry of her term of office;

-       Douglas Blair ceased to be a Non-Voting Board Member on 30 June 2016;

-       Andy Copestake became a Non-Executive Director on 1 July 2016 for a three year term; and

-       Julie Soutter became the Deputy Chairman of the Trust for the remainder of her term of office.

141.

Chief Executive's Report pdf icon PDF 255 KB

Nerissa Vaughan, Chief Executive

Minutes:

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

 

·         Community healthcare services for adults in Wiltshire transfer to new

·         partnership Wiltshire Health and Care

·         Staff Excellence Awards

·         Claim up to 30 hours of free childcare a week

·         Oxford Brookes University Placement of the Year Award 2016

·         Waiting times for planned procedures

·         NHS Improvement new single oversight framework

·         Radiotherapy Appeal one year anniversary

 

In presenting the report, the following comments were made: -

 

·         Community services for adults in Wiltshire had transferred to Wiltshire Health and Care from 1 July 2016.  This was a new partnership organisation formed between this Trust, Royal United Hospitals Bath NHS Foundation Trust and Salisbury NHS Foundation Trust.

·         Staff excellence awards had been celebrated at an event in June.

·         NHS Improvement was consulting on a new single oversight framework which aimed to provide an integrated approach for both NHS foundation trusts and NHS trusts, across regulation and performance management and to emphasise NHS Improvements renewed offer of support to the sector.  The Trust would be submitting a formal response which would be considered at the next meeting of the Board.

 

Arising upon consideration of this report JS referred to the latest junior doctor contract discussions noting that there had been a vote by the junior doctors against the latest proposed contract.  It was reported that the government would impose the new contract.  OF explained that the contract which went to final vote had less favourable pay elements than an earlier version and it was therefore not surprising that the junior doctors had objected. In response to a further question around financial risk, OF responded that once the pay calculator was uploaded, financial analysis would be undertaken.   OF explained that raw data would be used to enable calculations for different rotas. GR commented that the software to support pay would not be re-designed until final package details were released.

 

OF commented that this would be a challenging period for all trusts in that a contract was being introduced which the junior doctors did not want. NV commented on the need for the Trust to expect and prepare for further industrial action.

 

RESOLVED

 

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

 

(b)   that it be noted that the Trust will be submitting a formal response to the Single Oversight Framework consultation which will be considered at the next meeting of the Board; and

 

(c)   that it be noted that the Trust should continue to prepare for further industrial action associated with national negotiations around the new junior doctor contracts.

142.

Finance Report pdf icon PDF 109 KB

Karen Johnson, Director of Finance

Additional documents:

Minutes:

The Board received and considered a report on finance for month 2, together with a presentation as follows: -

 

Actual Operating costs

In month surplus of £150k. Total surplus of £104k compared to a target surplus of £113k. Year to date (YTD) (variance of £9k worse than plan).

Contractual Income

£24.2m in month and £47.5m YTD (variance of £0.6m above budget YTD). Forecast £259.5m for the year (on budget).

Total Income

£26.9m in month and £53.1m YTD (variance of £0.7m above budget YTD). Forecast £318.9m for the year (on budget).

Income Activity highlights

·         Elective inpatients above plan (YTD Elective inpatients above plan).

·         Day case activity above plan (YTD Day case activity below plan).

·         Non-elective above plan (YTD Non-elective above plan).

·         Outpatient appointments above plan (YTD Outpatient appointments above plan).

·         A&E is above plan (YTD A&E was above plan).

Total Expenditure

 

£26.8m in month and £53.0m YTD (variance of £0.7m above budget YTD). Forecast £318.3m for the year (on budget).

Expenditure highlights in month:

·         Drugs £0.2m above budget (£0.2m above budget YTD).

·         Pay £0.1m above budget (£0.3m above budget YTD).

·         Supplies £0.03m below budget (£0.1m above budget YTD).

EBITDA

7.9% YTD

Savings

Savings plan of £14.2m of which £10.1m has been identified.

£1.0m CIPS delivered in month against a budget of £1.1m.

£1.8m delivered against a budget of £2.1m YTD (£0.3m below budget).

Debtors

£51.2m debtors and stock

£12.0m above plan

Creditors

£62.5m creditors

£5.3m above plan

Cash

£7.4m (£0.2m above plan)

Loan

No Further Loans Agreed

Reserves

£13.6m

Forecast

£0.6m surplus for the year (on plan).

Finance Risk Ratings

FSRR 2 (Material level of risk)

 

The Board discussed the report and comments were made as follows: -

 

Financial performance

KJ explained that even though the budget position was showing a surplus there was an underlying deficit in that the surplus position assumed payment from the Sustainability and Transformation Fund (S&TF).  It was noted that guidance on the S&TF was awaited which would clarify conditions and payment arrangements.

 

KJ reported that there were a number of trusts which had not signed up to the control total attached to the S&TF and this had been the reason for the delay in the issue of guidance.  KJ explained that without S&TF the Trust would have cash difficulties in October.

 

NV advised that the need for clarity on S&TF had been raised with NHS Improvement (NHSI) and it was agreed that KJ should highlight to NHSI in writing that this Trust had not had a drawdown of money and remind them of this Trust’s difficult cash position in October and the need for clarity on the S&TF.

 

Agency spend

KJ reported that a deep dive was being undertaken to better map agency spend.  KJ commented on the importance of mapping all pay costs, including overtime costs which were increasing and these areas would be included in the deep dive also.  KJ had asked the Finance Team to develop a dashboard to enable oversight of all  ...  view the full minutes text for item 142.

143.

Chair of Finance, Investment & Performance Committee Overview pdf icon PDF 169 KB

Liam Coleman, Non-Executive Director

Minutes:

The Board received a paper from SN on behalf of the Chair of the Finance, Investment and Performance Committee which summarised key financial issues considered by that Committee at its meeting held on 27 June 2016, which it was considered should be drawn to the attention of the Board in public covering: -

 

·         Financial position

·         Cash position

·         Sustainability and Transformation Fund (S&TF)

·         Income

·         Pay costs

·         Non-Pay Expenditure

·         Aged creditors

·         Planned Care Divisional Performance

·         Cost Improvement Programme workstreams

·         Reference costs 2015-16

·         Informatics update

·         Improvement investment

·         Service line reporting / management

·         Operational performance

 

In presenting the report, the following items were discussed: -

 

Reference costs

SN explained that the Committee had considered a report which summarised the Trust’s controls in relation to the production of a reference costs submission which was recommended to the Board for approval.  JS asked that consideration be given to how controls around reference costs could be overseen by the Audit, Risk and Assurance Committee.

 

Improvement investment

SN reported that the Committee had reviewed the investment committed to date to drive improvements identified in the Care Quality Commission report. 

 

Service line reporting

SN explained that the Committee had considered a detailed paper on service line reporting and had challenged implementation and whether to pilot service line reporting in some areas.  It was noted that the Executive Team had undertaken to consider whether a phased approach to implementation was appropriate for some areas which had a higher appetite or capability than others to progress service line reporting.

 

RESOLVED

 

(a)   that the report on behalf of the Chair of the Finance, Investment and Performance Committee be received; and

 

(b)   that consideration be given to how controls around reference costs could be overseen by the Audit, Risk and Assurance Committee.

144.

15+ Risk Register pdf icon PDF 155 KB

Carole Nicholl, Company Secretary & Head of Corporate Governance

Additional documents:

Minutes:

The Board received and considered a report which set out a summary of the risks scoring 15+ (extreme risks) as at 26 June 2016.  It was noted that there were 22 extreme risks with the highest risk area being safety. 

 

The Board was advised that an Executive Committee workshop had been held in June 2016 where the stages of risk management from risk identifier through to Executive Committee had been reviewed and barriers and benefits discussed.  Feedback had been shared with Deloitte who were supporting the Trust in formulating improvement in risk management throughout the organisation.  It was noted that risk management within the Trust was comparable with other Trusts and that risk management was reasonable.  However, improvements could be made to ensure consistency in all areas and a more structured approach to reporting and escalation.

 

The Board noted that for 15 risks there had been no movement in risk score, however 4 had reduced and 3 had increased.

 

NV commented that divisional managers were being challenged on their management of risk at the Divisional Performance Meetings with high risks driving the agendas for those meetings.  A risk management culture was developing with some divisions further ahead in terms of embedded systems than others.

 

JS advised that timeliness and consistency in approach were important and the Audit, Risk and Assurance Committee was overseeing improvements.  It was noted that a shift in culture would take time. 

 

NV explained that she had spoken to NHS Improvement around consistency in practice and whilst risk management systems were in place and the Trust was not an outlier in terms of risk management generally, there was scope to strengthen the governance arrangements within divisions and across Board committees.  

 

RB questioned whether improvement in risk management should be included as a transformation project in terms of gaining pace in driving improvements.  However, NV explained that risk management was now being picked up through monthly performance review meetings.  It was not agreed that risk management should be a transformational project given that improvement work was already underway and Deloitte had been commissioned to support this. 

 

AGr reported that he had discussed risk management with divisional managers and the need for controls and actions. NV explained that risks were being entered onto the risk system but that keeping the register up to date and used for driving agendas were areas for focus.  The risk register needed to be used as an active risk management tool. 

 

RB commented on the need for pace in driving improvements generally and that there was a need to change the focus of the organisation so that managers considered the inhibitors to resolving issues. 

 

AC sought further information on risk 1033 - inability to fund replacement equipment and risk to patient safety.  It was explained that the Trust had old equipment in some areas and a lack of capital funds for its replacement.  There was a limited budget, which included a contingency element which was used for replacement of equipment deemed a priority  ...  view the full minutes text for item 144.

145.

Improvement Plan Update pdf icon PDF 401 KB

Hilary Walker, Chief Nurse

Minutes:

The Board received and considered a paper which provided an update on actions and progress in place to address the findings of the Care Quality Commission (CQC) Inspection Report covering the following: -

 

·         Milestones

·         Assurance

·         Improvement plans

·         Emergency Department Steering Group

 

In presenting the report the following comments were made: -

 

·         It was noted that milestone actions were progressing and consideration was being given as to how to report this in a meaningful way to enable understanding of the milestones linked back to the actions.

·         For May, 4 out of 5 actions had been completed, namely 80%.  It was noted that because of the low number, there was a large drop in the percentage of compliance.

·         Testing of achievement was ongoing.  There were peer reviews and the Trust had included additional days in the internal audit plan for testing and review.

 

Arising upon consideration of this report, JMa advised that a report had been received from the Care Quality Commission (CQC) outlining its findings from its follow up unannounced visit in April.  JMa advised that the CQC had recognised that there had been good changes and improvements.  However, the warning notice would remain in place until the Trust had addressed all aspects of the notice and these were embedded, namely around patient observations, documentation and the ED Obs Unit redesign.

 

It was noted that redesign of the ED Obs Unit would include building work predominantly to address the environmental changes needed for the care of mental health patients.  It was explained that the Trust had sought to restrict elderly frail patients being treated in ED Obs.  However in times of escalation this had not always been possible.

 

JMa explained that the CQC had recognised the addition of a mental health nurse on every shift but considered that more mental health needs risk assessments were necessary.  JMa advised that she believed that since the time of the unannounced visit in April, there had been improvements in this.

 

AGr commented that significant efforts had been made to prevent elderly patients being cared for in the ED Obs unit. AGr commented that mental health provision was a system wide issue and that the Trust was accommodating mental health patients for days longer than planned because there was a lack of mental health accommodation elsewhere.  AGR commented on the need for a proper pathway for these patients.

 

NV explained that at the last Strategic Resilience Group a paper had been presented on this. NV reported that she was pushing negotiations with Avon and Wiltshire Mental Health Partnership to review mental health provision locally and in the meantime, there was a need to progress the environmental changes to the ED Obs unit.

 

JS referred to pace of compliance and commented that some milestone actions had slipped in other areas and not just the Emergency Department, notably the provision of whiteboards. JMa responded that actions were progressing with any areas of slippage challenged through the Improvement Committee.    However, pace was not matching the drive required in  ...  view the full minutes text for item 145.

146.

Quality Report pdf icon PDF 148 KB

Hilary Walker, Chief Nurse

Additional documents:

Minutes:

The Board received and considered a report which provided commentary and progress on activity associated with key safety and quality indicators. The key points to note were as follows: -

 

·         Hospital Standard Mortality Rate (HSMR) - 92.0 at February 2016 which was a slight increase compared to the previous month. However the rate remained within the expected range.

 

·         5 reported cases of Clostridium difficile during May.

 

·         4 Serious Incidents reported during May.

 

·         Overdue investigations into incidents (by more than 14 days) had reduced slightly to 435.  However the average number of days that IR1s were overdue had increased from 62.9 days to 82.3 days in April.

 

·         1 incident of mixed sex accommodation breach within the Day Surgery Unit in April.

 

·         Response rate to complaints during April for ‘high – extreme’ complaints had reduced to 69% within 25 days. The response rate for ‘low–medium’ complaints was at 50% against a target of 80%.

 

·         There was a significant backlog of complaints outstanding which were over timeframe; a total of 58 open cases had gone over the 25 working day timeframe.

 

·         2 ‘low-medium’ complaints and 1 ‘high- extreme’ complaint were reopened during April for further review.

 

·         2 cases were closed by the Parliamentary Health Service Ombudsman (PHSO) during April.  There remained a total of 5 cases open with the PHSO at the end of April.

 

·         Friends and Family response rate was well below target at 7.81% for inpatients and 1.79% for Emergency Department (ED).

 

 

The Board discussed the report and comments were made as set out below.

 

Clostridium difficile - GR explained that the trajectory was to have no more than 5 cases at the end of the quarter.  However, it was reported that there had been a further case since writing the report and therefore the Trust had exceeded the target with a total of six cases at quarter end.  It was noted that each case would be reviewed to understand whether the case had been avoidable or not.

 

Patient story – A film was shown at the meeting which was a series of short interviews with patients to gain feedback on their experience whilst being cared for by the Trust.  It was noted that the patients filmed had each provided consent for their story to be shared and each had been picked at random from different areas across the hospital.

 

AC welcomed the patient stories which he considered were informative.  AC questioned if there was any merit in filming patients at home after their hospital visit as reflection on their experience and feedback might be different afterwards outside of the hospital setting.  KM responded that patients had been interviewed post their hospital visit previously and it was agreed that this be considered again.

 

GR advised that as part of end of life care, the Trust participated in the “CODE” project which included contacting families to get feedback on care.

 

JM referred to the feedback on moving patients during the night which was not a good experience. AGr suggested that there was  ...  view the full minutes text for item 146.

147.

Chair of Governance Committee Report - 27 June 2016 pdf icon PDF 170 KB

Steve Nowell, Non-Executive Director

Minutes:

The Board received a paper which summarised key governance issues considered by a meeting of the Committee held on 27 June 2016, which it was considered should be drawn to the attention of the Board in public covering: -

 

·         CQC Improvement Plan Update

·         Quarterly Quality Report – ‘Deep Dive’ Data

·         Shaping the Future: CQC’s Strategy 2016-20

·         Quarterly report on Clinical Audits

·         Director Fit and Proper Person Requirements

·         Staff Code of Conduct

·         Safeguarding Children six monthly update

·         Health & Safety, Fire and Security Annual Report and Statement of Commitment

 

SN presented the report explaining that the internal auditor would be undertaking service reviews against the Care Quality Commission’s key lines of enquiry in targeted areas where it was considered that the most benefit could be gained.

 

SN explained that the Committee would retain a focus of driving improvements and sustainability and that there had been a deep dive into the Emergency Department to support this approach.

 

SN explained that the Committee had considered a presentation which set out headlines of the Care Quality Commission’s future approach to assessment of Trusts which it was agreed would be shared with the Board. 

 

In response to a question from JS, it was noted that priority areas identified in the Improvement Plan did not map across to Sustainability and Transformation Funding priorities.

 

SN reported that the Committee had noted that there were some delays in completing clinical audits in terms of developing and delivering action plans.

 

Finally, SN referred to the Committees consideration of the work of the Trust’s Safeguarding Children’s Forum which was seeking to ensure compliance with new standards. 

 

Arising upon consideration of this report, it was noted that the report on the Well Led Governance Review was awaited and once received a report thereon would be presented to the Board.

 

RESOLVED

 

(a)   that the report of the Chair of the Governance Committee be received;

 

(b)   that it be noted that the Governance Committee will continue to scrutinise and challenge the delivery of actions to drive improvement;

 

(c)   that the presentation which set out headlines of the Care Quality Commission’s “Shaping the Future: CQC Strategy 2016-20” be shared with the Board;  and

 

(d)   that it be noted that the report on the Well Led Governance Review is awaited and once received a report thereon will be presented to the Board.

148.

Operational Performance Report pdf icon PDF 246 KB

Adrian Griffiths, Interim Chief Operating Officer

Additional documents:

Minutes:

The Board considered a 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.  A summary of the Trust’s performance against key patient safety, quality and operational performance indicators for May was included and highlighted as follows: -

 

Emergency Department (ED) 4 hour standard (95%) - (combined - ED, MIU & UCC)    

May  93.4% (Not Achieved)

Referral to Treatment (RTT) - Incomplete standard (92%) 

May   92.2 % ( Achieved)

6 Week Diagnostic Wait

May  96.1% (Not Achieved)

Cancer Targets - 2 Week Waits, 31 Day & 62 Day

April-16  (All Achieved)

 

Emergency Department (ED) 4 hour access standard

The Board noted that there were no trusts across the southwest region which had met the 4 hour standard in June.  It was noted that the Trust had achieved 91.2% for the quarter which was below the Recovery Action Plan (RAP) locally agreed target of 92%.

 

In response to a question from RH, it was explained that a percentage equalled between 13-17 breaches.

 

JS referred to a previous discussion around time recording which could impact on the overall percentage and it was noted that an IT solution to resolve this was being pursued.

 

The Board performance against this standard would impact on the achievement of Sustainability and Transformation Funding and it was commented that it was possible that an element would be deducted for this. KJ reported that the guidance on S&TF had been published during the course of this meeting.

 

RB questioned the reason for the increase in the number of patients in the emergency department asking whether there had been any research to determine if this was related to seasonal factors.  AGr responded that this type of review was needed nationally.

 

AGr advised that there was a tolerance level against the standard in quarters 1 and 2, but that the position needed to continue to improve.

 

Right patient right bed

The Board noted that there had been a slight deterioration in May and a number of key performance indicators (KPIs) had not been met.  However, there had been progress since last year, but overall the 30% reduction in delayed transfers of care and general delays had not been achieved for quarter 1.

 

In response to a question from JS, AGr commented that some processes were not being applied consistently.  AGr explained that the Project Management Office was supporting a review of ward and board round practice. Options to fund Allied Health Professional support for weekend ward rounds under the 7 day working initiative were being explored with Wiltshire Clinical Commissioning Group

 

Stroke performance

AGr reported that stroke performance was missed in May.  It was noted that it was likely that an opportunity would arise to integrate the Acute Stroke and Stroke Rehabilitation Units, enabling the development of an improved stroke pathway, which would improve performance against the length of stay on a stroke unit target and provide an opportunity to improve the performance against the  ...  view the full minutes text for item 148.

149.

The Carter Review: Hospital pharmacy and medicines optimisation pdf icon PDF 92 KB

Guy Rooney, Medical Director

Minutes:

The Board received and considered a report which provided a summary of the key recommendations of the Carter Review that related to pharmacy and medicine optimisation.

 

It was noted that as part of the recommendations, the Medcial Director had been named as the nominated Executive Director with responsibility for overseeing the development and delivery of the Hospital Pharmacy Transformation Programme (HPTP) and the Board was asked to endorse this.

 

JS noted that each Trust’s Finance Director working with their Chief Pharmacists would ensure that coding of medicines, particularly high cost drugs, were accurately recorded with NHS reference costs and JS questioned if this had been highlighted in the end of year audit of accounts.  KJ could not recall specifically but advised that it was likely that there had been some comment because reference costs for drugs was improving.

 

RESOLVED

 

(a)   that the summary findings and recommendations contained within the report be noted; and

 

(b)   that it be agreed that Guy Rooney be the named Executive Lead with responsibility for overseeing the development and delivery of the Hospital Pharmacy Transformation Programme (HPTP).

150.

Safer Staffing Monthly Exception Report pdf icon PDF 379 KB

Hilary Walker, Chief Nurse

Additional documents:

Minutes:

The Board considered a report which provided the monthly exception reporting on actual nursing and midwifery staffing compared to that planned, together with associated quality impacts.

 

In May the proportion of actual versus planned nursing hours (fill rate) was as follows: -

 

 

Registered Nurses

Auxiliary Nurses

Day Shift

88.7%

96.8%

Night Shift

101.7%

101.2%

 

The report covered the following: -

 

  • Publication of data
  • Division fill rate narrative
  • Skill mix ratio
  • Care hours per patient per day
  • Divisional quality reports
  • The national agenda

 

It was reported that the fill rate had improved, although it was explained that the Trust had a low fill rate when benchmarked with other Trusts.  OF commented that the bank fill rate had increased and this was due to the ability of bank staff to book shifts from home and a shift from monthly wages to weekly payments.

 

RESOLVED

 

that the report be received.

151.

Harnessing the full potential of electronic rostering pdf icon PDF 463 KB

Oonagh Fitzgerald, Director of Human Resources

Minutes:

The Board received a status report as to how effective the Trust was at utilising its e-rostering system compared to best practice sites.

 

It was reported that electronic rostering had been challenging for the NHS and this Trust to implement, however the benefits of the effective and efficient deployment of the workforce was a vital part of the Trust’s People Strategy. Furthermore, the effective implementation of electronic rostering supported patient safety and the effective management of the pay bill.

 

The Trust had been implementing e-rostering as a wide scale workforce change since 2010 with the first rosters going live in January 2011. The Trust now rostered 1,491 staff via a web based system developed to improve speed and functionality. E-rostering worked at its optimum level in wards with standardised shift patterns and low vacancies. However, in the rostered areas there were 133.96 vacancies (nurses and health care assistants). This together with varying shift patterns, hampered effective rostering.

 

Post implementation challenges were explained including lack of user confidence, the ongoing challenge of building capability of rostering managers, system speed, software concerns and compliance with the rostering policy. Details of action to address these challenges and constraints were set out in the report, together with information on those challenges which remained for roster managers and the senior team.

 

OF reported that e rostering had been introduced to improve the productivity of the workforce.  Best practice had been applied and a scoping exercise completed, followed by a business case had resulted in £112K to kick start the project.  However, the project was under resourced, with only one member of staff to support and roll out limited to only a couple of areas.  OF explained the historical position in terms of paper records still being used alongside the e rostering system and concerns regarding the suitability of the system. It was explained that the system was more effective when standardised shift patterns applied.

 

OF reported that a team was established to rebuild the system to ensure it aligned to patterns of work.  The web based system was introduced last year to improve the speed of rostering.  OF commented that there was inconsistency of use of the system as a business tool across all wards.  OF commented that there were late shift requests because of matron delays in signing them off; shift patterns were not built into the e-rostering system or staff were not available.

 

OF commented on the need to do more work on standardising shift patterns, explaining that the Trust had resisted this because of the level of vacancies.  Furthermore, there were system issues which needed to be resolved to enable management reports to be produced as a cost of £13k.  OF explained that this had not been pursued as alternative replacement systems were being explored.

 

JS noted this cost and asked whether the efficiency gains outweighed this in the short term pending a business case for an alternative e-rostering system.  In response to a question raised KJ commented that a request for  ...  view the full minutes text for item 151.

152.

Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 - Regulation 5 - Director Fit and Proper Person requirements pdf icon PDF 325 KB

Carole Nicholl, Company Secretary & Head of Corporate Governance

Minutes:

The Board received a report which sought to address feedback from the Care Quality Commission (CQC) Inspection which stated that the Trust did not have a clear and transparent process in respect of Regulation 5 – Director Fit and Proper Person Requirements.

 

This report explained that the regulations placed a requirement on provider organisations to ensure director level appointments and continuing appointments met a “fit and proper person requirement”.  A more robust test relating to good character was included. 

 

This was now integrated into the CQC’s registration requirements and fell within the CQC’s regulatory and inspection approach. Furthermore, requirements for fit and proper directors was a condition of our provider licence and a requirement under NHS Improvement’s Code of Governance. 

 

The Board had before it a practical toolkit to support the Trust in assuring itself that the Trust had followed a robust and due process with regards to the fit and proper person requirements.  The toolkit had been developed by NHS Providers working with the NHS Confederation and NHS Employers and had been circulated by the former Foundation Trust Network.  It had been amended to reflect this Trust’s policies, processes and procedures and included explanatory text.

 

The Board was asked to approve the use of a toolkit to ensure ongoing compliance.  The Governance Committee had recommended approval of the recommendations in the report.

 

KM sought to understand how far back the test would apply.  CN responded that in respect of serious misconduct or responsibility for failure in a previous role there was no time limit. NV referred to the CQC guidance commenting that regard would be given to an individual’s full employment history. 

 

NV referred to recent cases nationally, notably Southern Health NHS Trust commenting that it was important for the Trust to demonstrate a robust process in testing the requirements around Fit and Proper Persons.   NV commented that meeting the requirements was very high profile with the CQC and that the CQC would investigate any allegations of directors which did not meet the requirements and failure to follow a through process could lead to conditions attached to registration.   NV commented on the need to ensure a through process, particularly having regard to the comments of the CQC in its inspection report earlier in the year.

 

NV reiterated the national high profile cases reported in the media recently commenting that she wanted to ensure this Trust had robust processes.  NV stated that all Board members needed to be mindful of the requirements as breach could lead to disqualification from the Board.  NV commented that whilst she did not  envisaged any concerns regarding directors of this Trust, it was important that this could be clearly evidenced particularly in light of the recent employment tribunal and that processes needed to be thorough and correct. 

 

It was noted that the Chairman needed to sign and return a declaration to the CQC. It was anticipated that this would be completed by the end of July.

 

RESOLVED

 

(a)   that the report be received;

 

(b)   that  ...  view the full minutes text for item 152.

153.

Ratification of Decisions made via Board Circular/Board Workshop

Carole Nicholl, Company Secretary & Head of Corporate Governance

Minutes:

None.

154.

Membership of Board Sub-Committee Meetings pdf icon PDF 145 KB

Carole Nicholl, Company Secretary & Head of Corporate Governance

Minutes:

The Board received and considered the proposed membership of Board Committee from 1 July 2016 onwards.

 

RESOLVED

 

that the Board Committee Membership 2016/17 be approved.

155.

Report from West of England Health Science Network Board Meeting - 13 June 2016 (to note) pdf icon PDF 105 KB

Carole Nicholl, Company Secretary & Head of Corporate Governance

Additional documents:

Minutes:

The Board considered a report of the Board meeting of the West of England Academic Health Science Network (AHSN) held in June covering the following: -

 

·         Highlights of our work in Quarter 1 2016/17

·         Sustainability and transformation plans

·         Annual Report 2015/16

·         Stakeholder survey

·         West of England Local Clinical Research Network

 

JS noted that there were 52 improvement coaches currently in training from member organisations.  OF commented that there were individuals within this organisation who had the skills in improvement science to lead quality improvement work. 

 

RESOLVED

 

that the report from the West of England Academic Health Science Network Board be received.

156.

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.

157.

Date and Time of next meeting

Date: 25 July 2016

Time: 12.00pm

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

Minutes:

It was noted that the next ordinary meeting of the Board would be held on 4 August 2016 at 9:30am in Trust Boardrooms, Trust HQ, Great Western Hospital, Swindon.  An additional meeting would be held on Monday 25 July 2016 at 12.00noon or immediately upon the rising of the Finance, Investment and Performance Committee whichever was the latter.

158.

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” when the following items are considered: -

·        Minutes

·        Service Line Management

·        Transformation Board Update

·        Community Estate

·        Update on Sustainability and Transformation Plan

·        Charitable Funds Committee verbal report

·        Executive Committee Minutes

·        Finance, Investment and Performance Committee Minutes

·        Governance Committee Minutes

·        Mental Health Act and Mental Capacity Act Committee verbal report

·        People Strategy Minutes Minutes

·        Urgent Private Business (if any)

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 when the following items are considered: -

·         Minutes

·         Outstanding Actions of the Board (Private)

·         Service Line Management

·         Transformation/Savings Programme 2016/17

·         Update on Sustainability and Transformation Plan (STP)

·         Community Estate

·         7 day working: an overview and proposed plan

·         Charitable Funds Committee

·         Executive Committee

·         Finance, Investment and Performance Committee

·         Governance Committee

·         Mental Health Act and Mental Capacity Act Committee

·         People Strategy

·         Urgent Private Business – Legal Matter

159.

Minutes

Roger Hill, Chairman

·        2 June 2016 (private)

·        9 June 2016 (private)

Minutes:

The minutes of the meeting of the Board held in public on 2 June and the reconvened meeting held on 9 June 2016 were adopted and signed as a correct record, subject to amendments.

160.

Outstanding Actions of the Board (Private)

Minutes:

The Board received and considered the outstanding actions list.  The Board noted progress against the actions and agreed that completed actions be removed.

161.

Service Line Management

Jan Bergman, Interim Director of Transformation

Minutes:

The Board received and considered a report which provided an update following the introduction of Service Line Reporting.

162.

Transformation/Savings Programme 2016/17

Jan Bergman, Interim Director of Transformation

Minutes:

The Board received and considered a report which provided an overview of the Transformation Programme 2016/17.

163.

Update on Sustainability and Transformation Plan (STP) - verbal report

Kevin McNamara, Director of Strategy

Minutes:

The Board received and considered a verbal report which provided an update to the Sustainability & Transformation Plan (STP).

164.

Community Estate

Kevin McNamara, Director of Strategy

Minutes:

The Board received and considered a report which provided an update on the community estate.

165.

7 day working: an overview and proposed plan

Guy Rooney, Medical Director

Minutes:

The Board received a report which outlined the proposed implementation of a 7 day working model for the Trust.  It was explained that 7 day working was needed to maintain patient flow over the weekend and to meet the four prioritised Keogh standards.

166.

Charitable Funds Committee

Steve Nowell – Committee Chair

·        30 June 2016 (verbal report)

Minutes:

It was noted that a meeting of the Charitable Funds Committee was held on 30 June 2016.

 

167.

Executive Committee

Nerissa Vaughan – Committee Chair

·        21 June 2016 (verbal report)

·        17 May 2016 (enclosure)

Minutes:

The minutes of the meeting of the Executive Committee held on 17 May 2016 were received.  Furthermore, it was noted that a meeting of the Executive Committee had been held on 21 June 2016.

168.

Finance, Investment and Performance Committee

Liam Coleman – Committee Chair

·        27 June 2016 (verbal report)

·        23 May 2016 (enclosure)

Minutes:

The minutes of the meeting of the Finance, Investment and Performance Committee held on 23 May 2016 were received.  Furthermore, it was noted that a meeting of the Finance, Investment and Performance Committee had been held on 27 June 2016.

169.

Governance Committee

Steve Nowell - Committee Chair

·        27 June 2016 (verbal report)

·        17 May 2016 (enclosure)

Minutes:

The minutes of the meeting of the Governance Committee held on 17 May 2016 were received.  Furthermore, it was noted that a meeting of the Governance Committee had been held on 27 June 2016.

170.

Mental Health Act and Mental Capacity Act Committee

Robert Burns – Committee Member

·        3 June 2016 (verbal report)

Minutes:

It was noted that a meeting of the Mental Health Act and Mental Capacity Act Committee had been held on 3 June 2016.

171.

People Strategy Committee

Jemima Milton – Committee Chair

·        12 May 2016 (enclosure)

Minutes:

The minutes of the meeting of the People Strategy Committee held on 12 May 2016 were received.

 

172.

Urgent Business (Private) - Court of Protection

To consider any business which the Chairman has agreed should be considered as an item of urgent business.

Minutes:

The Chairman had agreed to consider this as an item of urgent business in view of the need to update the Board on an issue in advance of the next meeting. 

 

GR gave a verbal report on the need for a Court of Protection Order.  The Board noted the report.