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Agenda and minutes
Venue: Board Rooms, Trust HQ, Great Western Hospital, Swindon. View directions
Contact: Carole Nicholl 01793 605171
Apologies for Absence and Chairman's Welcome
Apologies for absence were received from Liam Coleman and Steve Nowell.
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.
Questions from the public to the Board relating to the work of the Trust
There were no questions from members of the public.
Karen Johnson, Director of Finance
The Board received and consider the in year declarations certifying on-going compliance with the Trust’s provider licence covering finance, governance other exceptional matters.
This paper provides an overview of performance against these requirements for quarter 1: -
a. The Financial Service Risk Rating was 2 and was forecast to remain at 2.
b. The Trust had not achieved performance target for A & E in Quarter 1.
c. The Trust had achieved performance target for Referral to Treatment (RTT) standard in Quarter 1.
d. The Trust was compliant with all 6 indicators for: Access to Healthcare for people with a Learning Disability
e. There was 1 Never Event reported in Quarter 1
f. There were 6 exceptional matters that had occurred in Quarter 1.
In considering the declarations the Board had regard to the views of the Finance, Investment and Performance Committee which had met earlier in the day.
(a) that it be approved that the Chief Executive and Director of Finance sign the in year governance statement on behalf of the Board of Directors confirming:-
1. The Board is unable to confirm that it anticipates that the trust will continue to maintain a financial sustainability risk rating of at least 3 over the next 12 months.
2. The Board anticipates that the trust's capital expenditure for the remainder of the financial year will not materially differ from the amended forecast in this financial return”
3. The Board is able to confirm that there are no matters arising in the quarter requiring an exception report to NHS Improvement (per the Risk Assessment Framework page 22 Table 3) which have not already been reported or are not included in this report.
(b) that it be agreed that having discussed performance against the A & E performance target and the actions being taken to recover the position the following statement can be confirmed: -
1. The Board is not satisfied that plans in place are sufficient to ensure ongoing compliance with all existing targets (after the application of thresholds) as set out in Appendix A of the Risk Assessment Framework; and a commitment to comply with all known targets going forwards.
Carole Nicholl, Company Secretary & Head of Corporate Governance
The Board had before it a paper which advised that NHS Improvement (NHSI) had published its new ‘single oversight framework’ for consultation. The framework aimed to provide an integrated approach for both NHS foundation trusts and trusts, across regulation and performance management and to emphasise its renewed offer of support to the sector.
Under the proposals, all trusts would be placed in one of four segments depending on their performance. The five domains within the framework were:
- Quality of care (using ratings in four of the five Care Quality Commission (CQC) domains plus progress against standards for implementing seven day services)
- Finance and use of resources (being developed with the CQC and including progress against control totals and efficiencies)
- Operational performance (largely reflecting existing national targets and based on a trust’s agreed performance trajectory)
- Strategic change (a domain yet to be fleshed out in detail. This section would focus on ‘progress in implementing Sustainability and Transformation Plans, and where applicable devo deals)
- Leadership and improvement capability (building on the existing well led framework to capture good governance and leadership and to introduce a focus on capacity for improvement).
NHS Providers would be making a formal response on behalf of NHS foundation trusts. The consultation period closed on 4 August and directors were asked to inform the response.
The Board discussed the proposed framework which was broadly welcomed with comments made relating to the following: -
· Consistency in approach in terms of priorities, with the views of NHSI and the CQC complementing each other.
· The Trust welcomed a single sight framework but noted that the distinction between Foundation Trusts and NHS trusts was reduced.
· There should be a distinction between monitoring and micro managing.
· Reporting on a monthly basis would be reasonable, provided there was sufficient time for validation.
· There seemed to be limited flexibility in the monitoring methodology in terms of having regard to the reality of a local situation or an understanding of contributory factors to performance. For example where the achievement of a metric was outside of the trust’s control due to partner pressures, lack of primary care, demographics etc. There was concern that information would be judged without quantification or explanation.
· There needed to be a sharing of data, noting that data could be analysed and cut in various ways at different times.
· The burden of inspection and reporting was too onerous and significantly impacted operational needs. There should be regulatory reporting, but this should focus on key indicators or strategic issues. Unannounced inspections of areas of regulatory concerns were supported as a way to review issues and support sustainability of remedial actions. Planned inspections required too much effort by already busy people, or dedicated resources which were unaffordable.
· Clarity on regulatory approach which recognised the reality of operational constraints / financial position / increasing activity levels / local environment was needed.
· Consideration for reporting on cost improvement programme and transformation plans linked to the Sustainability Transformation Plan should be given, together ... view the full minutes text for item 177.
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.
Date and Time of next meeting
Date: 4 August 2016
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 Thursday 4 August 2016, at 9.30am in the Boardrooms, Trust HQ, Great Western Hospital, Swindon.