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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

180.

Apologies for Absence and Chairman's Welcome

Minutes:

Apologies for absence were received from Liam Coleman, Non-Executive Director.

181.

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.

182.

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

Following the publication of "Learning from mistakes: An investigation report by the Parliamentary and Health Service Ombudsman into how the NHS failed to properly investigate the death of a three-year old child", I would like to ask what action the Trust is taking with respect to this report and its recommendations.

 

Peter Pettit

Public Governor

Minutes:

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

 

“Following the publication of "Learning from mistakes: An investigation report by the Parliamentary and Health Service Ombudsman into how the NHS failed to properly investigate the death of a three-year old child", I would like to ask what action the Trust is taking with respect to this report and its recommendations.”

 

HW explained that the report set out an investigation following the death of a child.  Failures were identified on the part of every organisation involved the child’s care and the report considered why the failures had occurred. HW commented that the findings in the report were very broad. Weaknesses identified reflected those of many NHS trusts including this trust. 

 

HW reported that she had asked the Deputy Director of Quality to review the report with a view to developing proposals. It was likely that this would include the development of an investigating team to make sure the quality of reporting was good and that opportunity for learning resulted in really learning.  HW reported that it was likely that this would be reported through the Patient Quality Committee to the Governance Committee in September.

183.

Minutes pdf icon PDF 303 KB

Roger Hill, Chairman

·        23 May 2016 (public and summary of private minutes)

·        9 June 2016 – Joint Board and Council of Govenors’ Meeting (public and summary of private minutes)

·        7 July 2016 (public and summary of private minutes)

Additional documents:

Minutes:

The minutes of the meetings of the Board held in public on 23 May and 7 July  2016 were adopted and signed as correct records, subject to the following amendments:-

 

1.      Minute 37/16 Apologies for Absence - The inclusion of Hilary Walker in the list of apologies.

 

2.      Minute 140/16 Chairman’s Report – The addition of the following sentence at the end of paragraph 2 “The Chairman was joined by all members of the Board in expressing thanks to Angela Gillibrand for her commitment to the Trust over a number of years”.

 

3.      Minute 142/16 Finance Report – The deletion of the sentence “OF reported that there was a paper being presented to the next Finance, Investment and Performance Committee on the pipeline of agency” and the substitution thereof with the sentence “OF reported that there was a paper being presented to the next Finance, Investment and Performance Committee on the recruitment pipeline and the impact on agency”.  Also under this minute, the deletion of the words “Mutually Agreed Redundancy Scheme (MARS)” and the substitution thereof with the words “Mutually Agreed Resignation Scheme (MARS)”.

 

4.      Minute 151/16 Harnessing the full potential of electronic rostering – The deletion of the sentence “KJ commented that the system was not being support” and the substitution thereof with the words “KJ commented that the system was not being support by the current supplier”.

 

The minutes of the meeting of the Joint Board and Council of Governors held in public on 9 June 2016 were received. It was noted that Julie Soutter was present at this meeting.

184.

Outstanding actions of the Board (public) pdf icon PDF 218 KB

Minutes:

The Board received and considered the outstanding action list.  The Board agreed that completed actions be removed from the tracker.

185.

Chairman's Report, Feedback from the Council of Governors

Roger Hill, Chairman

Minutes:

The Chairman gave a verbal report as follows: -

 

1.      RH welcome Nick Bishop (NB) the recently appointed Non-Executive Director to his first meeting of the Board.  It was noted that NB had been appointed for a three year term from 1 August 2016 until 31 July 2019.  RH explained that NB had extensive clinical and NHS experience having been a medical director and former deputy Chief Executive.

 

2.      RH asked the Board to formally record that Robert Burns (RB) had been appointed for a further term of 6 months until 31 January 2017

 

3.      RH reported that Brian Ford had been appointed as new governor representing Swindon Borough Council from 1 August 2016.

 

4.      RH reported that there was a contested by-election underway for the public governor seat in the Northern Wiltshire Constituency.

 

5.      RH advised that there had been a meeting of the Governor’s Patient Quality and Operational Performance Working Group in July which had considered operational performance, patient experience, complaints and concerns, cross border care and delayed transfers of care.  There were no issues of concern to flag for the Board’s attention.

 

Reference from the Council of Governors to the Board

 

RH reported that at the meeting of the Council of Governors held on 7 July 2016, concerns were raised by the Governors regarding the clinical risk associated with EPMA (electronic prescribing) with clinicians facing difficulties accessing hardware in order to treat patients, especially in large numbers, in a timely manner. Guy Rooney and Richard Musk (Lead Pharmacist EPMA) were preparing a paper for the Board to provide an update on how this concern was being addressed.

 

RESOLVED

 

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

 

(b)   that it be noted that a report on electronic prescribing will be presented to the Board in October.

186.

Chief Executive's Report pdf icon PDF 177 KB

Nerissa Vaughan, Chief Executive

Minutes:

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

 

·        Latest Care Quality Commission report published

·        Junior doctors’ contract

·        Recruitment update

·        Waiting times for planned procedures

·        Emergency Department waiting times

·        Ministerial changes

·        Award nominated video takes you through having an MRI scan

 

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

 

Junior doctors’ contract – NV advised the Board that during July the British Medical Association (BMA) had announced that their members had voted against the proposed new junior doctors’ contact.  It was commented that this had not impacted on the August in-take of junior doctors.

 

Ministerial changes – NV highlighted ministerial changes as set out in the report.

 

Recruitment update – JS referred to the update on recruitment set out in the report and in response to a question raised, OF advised that the “Glass Door Agency” was the sources of the ranking of Swindon as one of the top 10 places to work.  OF commented that this statement had been used as part of the media coverage to support recruitment. 

 

AC referred to the risk issues at the start of the report, which it was noted needed updating, particularly in respect of risk 1345 – risks associated with the financial recovery plan 2015/16.

 

RESOLVED

 

that the report of the Chief Executive be received.

187.

Finance Report pdf icon PDF 110 KB

Karen Johnson, Director of Finance

Additional documents:

Minutes:

The Board received and considered a report on finance for month 3, together with a presentation as follows: -

 

Actual Operating costs

In month surplus of £90k. Total surplus of £193k compared to a target surplus of £164k. Year to date (variance of £29k better than plan).

Contractual Income

£24.2m in month and £71.7m year to date (on budget year to date). Forecast £257.8m for the year (on budget).

Total Income

£27.1m in month and £80.2m.  Year to date (variance of £0.22m above budget year to date). Forecast £316.9m for the year (£0.6m below budget).

Income activity highlights: -

·        Elective inpatients below plan (year to date Elective inpatients below plan).

·        Day case activity below plan (year to date Day case activity below plan).

·        Non-elective above plan (year to date Non-elective above plan).

·        Outpatient appointments above plan (year to date Outpatient appointments above plan).

A&E is above plan (year to date A&E was above plan).

Total Expenditure

 

£27.0m in month and £80.0m year to date (variance of £0.2m above budget year to date). Forecast £316.3m for the year (£0.6m below budget).

Expenditure highlights in month:

·        Drugs £0.2m above budget (£0.4m above budget year to date).

·        Pay £0.2m below budget (£0.1m above budget year to date).

Supplies £0.25m above budget (£0.36m above budget year to date).

EBITDA

7.9% year to date

Savings

Savings plan of £14.2m of which £14.1m had been identified.

£1.3m CIPS delivered in month against a budget of £1.1m.

£3.1m delivered against a budget of £3.2m year to date (£0.1m below budget).

Debtors

£51.3m debtors and stock

£2.7m above plan

Creditors

£58.5m creditors

£2.0m above plan

Cash

£4.1m (£6.4m under plan)

Loan

No further loans agreed

Reserves

£11.6m

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 position / Sustainability and Transformation Funding (S&TF)

KJ reported that the financial position included £2,225k of Sustainability and Transformation Funding (S&TF) and therefore there was an underlying deficit position of £2,032k.

 

In response to a question around receipt of S&TF, KJ explained that the Trust had achieved the control total and had signed off trajectories for A&E access standards; Referral to Treatment standards and cancer performance.  As these had been achieved in quarter one, it was anticipated the S&TF for the quarter would be received.  KJ reported that as requested at the last meeting of the Board, she had written to NHS Improvement asking when the Trust could reasonable expect to receive payment, which was not likely to be September.

 

Activity

KJ reported that activity rose in June compare to May in all areas except A&E and GP referrals.  Activity in all areas except elective day case admissions and elective inpatient admissions was above plan in month.  Elective day case admissions, elective inpatient admissions and outpatient appointments in month were lower than in June 2015.

 

Agency spend

KJ reported that there  ...  view the full minutes text for item 187.

188.

Chair of Finance, Investment & Performance Committee Overview pdf icon PDF 157 KB

Liam Coleman, Non-Executive Director

Minutes:

The Board received a paper from JS who had chaired the last meeting of the Finance, Investment and Performance Committee which summarised key financial issues considered by that Committee at its meeting held on 25 July 2016, which it was considered should be drawn to the attention of the Board in public covering: -

 

·        Financial Position

·        Activity

·        Income

·        Sustainability and Transformation Funding (S&TF)

·        Pay costs

·        Non-pay expenditure

·        Stock

·        Aged Creditors

·        Cost Improvement Plans (CIPS)

·        Agency Review

·        Unscheduled Care Divisional Performance

·        Operational Performance

 

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

 

JS advised that the Finance, Investment and Performance Committee would also focus on capital reporting going forward.

 

It was reported that reportsfrom chairs of committees would precede relevant reports for future Board agendas.

 

RESOLVED

 

(a)   that the report be received; and

 

(b)   that it be noted that reports from chairs of committees will precede any relevant report.

189.

15+ Risk Register pdf icon PDF 1 MB

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 July 2016.  It was noted that there were 25 extreme risks, with the highest risk area being safety; 1 risk had been mitigated and 7 risks had increased to 15+.

 

Risk management

CN reported that the report showed that the risk system was not being used effectively (mainly planned care and unscheduled care with some corporate areas).  However, since publishing the report the position was much improved with many risks updated.  It was noted that whilst it had been explained to Divisional Managers that as part of the outcome of the well led review, support would be sought to improve reporting, there remained a requirement to use the risk management system which was fit for purpose.

 

CN highlighted that going forward the intention was for the development of a risk escalation framework. This would include additional Executive challenge at monthly extended meetings of the Transformation Board.

 

Updates reported at the meeting

 

As referred to above, CN reported a number of updates to the report as follows: -

 

1471 Patients with mental health needs presenting challenge in ED Obs Unit - The business case had now been signed off and work to progress was awaited which it was hoped would be before winter, depending on agreement, but if not early spring.  This was a warning notice action.

 

1464 Rising risk was timely observations in ED - improvements had been made but more was needed.  Patient flow and movement in ED was to be mapped to reduce handovers / improve processes which it was thought would improve timely observations of patients.

 

1482 JAG accreditation – Actions were on track but the risk score remained the same.

 

823 Risk to patient safety due to bed capacity and admissions – the timescales for some actions were not realistic and therefore these had been refreshed with leads identified.  The risk was being monitored by Site Management.

 

1294 Day Surgery Unit (DSU) - capital funding approval for the provision of showers was awaited.  In the meantime a 23 hour care model was being trialled with some success.

 

1332 Critical Care Outreach – funding had now been approved at the Business Improvement Committee to support an additional position 24/7.  An advertisement for the post was to be published seeking recruitment as soon as possible.

 

1071 Agency spend – the risk score remained the same because of the national shortage in nursing.  A retention plan was being submitted to the Executive Committee in August.

 

1232 General surgery / urology hold file – Validation of the hold file continued alongside increased virtual reviews of patients. The number of patients at risk was reducing.

 

1235 Clinical capacity in Orthodontics – It had not been possible to appoint substantive staff and therefore patients were being sent elsewhere for treatment.

 

1545 Respiratory patients bookings – The booking centre had now allocated resources for respiratory bookings.  The situation would be  ...  view the full minutes text for item 189.

190.

Quality Report pdf icon PDF 145 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: -

 

·        Most recent Hospital Standardised Mortality Rate (HSMR) (March 2016) = 92.91, a slight increase compared to the previous month however the rate remained within the expected range.

 

·        There had been 1 reported case of Clostridium Difficile during June 2016.

 

·        1 reported case of MRSA Bacteraemia was reported and allocated to the Trust in June 2016.

 

·        4 Serious Incidents and 5 internal Root Cause Analyses (RCA’s) have been reported during June.

 

·        There were a total of 30 open complaint cases, which had gone over the agreed timeframe, this was a significant, continued improvement since April 2016.

 

·        6 low /medium complaints had been reopened during June for further review.

 

·        Friends and Family response rate was well below target at 16.6% for inpatients and 2.10% for the Emergency Department.

 

 

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

 

Hospital Standardised Mortality Rate (HSMR)

GR reported that the HMSR included expected deaths.  GR suggested that the Board should look at sepsis deaths which reflected HSMR better.  This was an indicator which showed those patients which were expected to die, but had not died.  GR explained that this indicator provided a strong source of assurance. The Trust had agreed investment to Acute Kidney Injury (AKI) in a similar method to Sepsis, and this would benefit the HSMR.

 

Clostridium Difficile

GR reported that whilst there had only been 1 case in June, the trajectory for the quarter had been exceeded.  However, there had been no cases in July.

 

MRSA

There had been one case of MRSA year to date which was attributable to the Trust.  This was being investigated to establish any learning.

 

Serious incidents /incidents

HW advised that after every serious incident a “swarm” meeting took place to review the incident.  These meetings had proved beneficial in helping whole teams understand that an incident had occurred and were an effective mechanism to identify changes immediately.

 

HW reported that there were a further 5 incidents where the Trust had carried out a root cause analysis.  HW flagged that 4 cases were about failing to recognise a deteriorating patient. HW advised that in these incidents the patients had not come to significant harm. Reference was made to the NEWS score (methodology to calculate a patients deterioration) and it was noted that work was continuing to drive improvements around this. HW advised an that most likely positive impact would be an electronic observation system. In response to a question from JS, HW explained that the 5 incidents were spread across the Trust.  HW reported that since writing the report, the outstanding actions had been completed.  In response to a question from RH, HW advised that overdue IR1s provided an indicator of how busy staff were.

 

HW advised that not all IR1s related to patient safety.  HW reported that the Patient Quality Committee had  ...  view the full minutes text for item 190.

191.

Chair of Governance Committee Overview 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 22 July 2016, which it was considered should be drawn to the attention of the Board in public covering: -

 

·        Improvement Plan Update        

·        Follow up by the CQC on their inspection in April

·        Planning for Improvement – Picker Inpatient Survey 2015 – Divisional update on progress

·        National Maternity Review – Better Births – Gap Analysis

·        Deprivation of Liberty Safeguards (DoLS)

·        Water Management

·        Corporate Governance Q4 2015/16 and Q1 2016/17 Report

 

SN reported that there were only 9 milestone actions not delivered in accordance with agreed timescales, the reasons for which had been scrutinised and challenged by the Improvement Committee and overseen by the Governance Committee.  93% of milestones actions had been delivered at end the end of quarter 1.  SN commented that the Committee had welcomed an informative update on testing and challenging of how whether improvement delivered was being sustained. The Committee had been assured that robust systems were in place and monitoring was continuing.

 

SN highlighted that the Committee had considered the report from the Care Quality Commission on their follow up visit in April.  The Committee had noted that improvements had been made but that there was further work to do. SN advised that the Executive Team was aware of the gaps and had dedicated resource to address these.   SN suggested that issues in the latest CQC letter needed to be considered in a similar way to those identified in the warning notice and CQC inspection report.  The Board was advised that this would be picked up through the Improvement Committee.

 

SN highlighted that the Committee had received a report on areas for improvement relating to maternity which had been identified as part of a maternity gap analysis.  It was noted that there were no significant areas of concern identified. The Board formally recorded that HW was the Board lead for maternity.

 

SN reported that the Trust was compliant with its obligations relating to Deprivation of Liberty requirements; however the local authorities were not complying with their obligations.  Discussion had taken place on this and HW advised that the consequence of this was that the Trust might care for patients outside of the legal framework.

 

SN reported that the Committee had received a report on estates, notably water management and a report on this would be presented to the Audit, Risk and Assurance Committee.  The Board was informed of details of water testing, results and action.

 

SN explained that the Committee had considered a Corporate Governance Report setting out performance in relation to policies and procedural documents management, legal claims inquests and disclosures; consent and membership and engagement. It was flagged that an area of concern was the degree of non-compliance with updating policies and procedural documents.  It was noted that a trajectory of improvement in updating documents was to be agreed with Divisional Managers. 

 

With reference to consent, it was noted that a new consent form was  ...  view the full minutes text for item 191.

192.

Operational Performance Report pdf icon PDF 321 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 June was included and highlighted as follows: -

 

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

June 92.2% (Not Achieved)

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

June 92.02 % ( Achieved)

6 Week Diagnostic Wait

June 94.7% (Not Achieved)

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

May-16  (All Achieved)

 

AGr presented the report as set out in the Chief Operating Officer’s overview, with a detailed explanation of actions being taken. 

 

Emergency Department (ED) 4 Hour Access Target

AGr reported that July had been challenging in terms of levels of activity. ED co-ordination, which was not as consistent as it should be, and ED communication were areas which needed improving and the Minor Assessment Unit (MAU) needed improvement to generate sufficient beds.  At speciality wards, clinical engagement needed addressing.  AGr reported that a Right Patient, Right Bed full delivery meeting was scheduled later in the week which would discuss the clinical aspects of improvement.  AGr reassured the Board that there was a real refresh and focus on targeted areas.

 

Delayed transfers of care (DTOC)

AGR explained that delayed transfers of care (DTOC) remained at circa 60 patients due to how domiciliary care worked.  This needed to be addressed.  NV commented that a risk summit was scheduled later in the month with ongoing discussions with NHS Improvement.  JM suggested that the Trust should approach the Council with a view to setting up a meeting to discuss DTOCs to address situation as soon as possible. 

 

Mental health provision

AGr commented on the level of acute mental health care being provided and explained that Avon and Wiltshire Mental Health Partnership Trust was working towards picking this up.  AGr commented that many factors contributed to the ability to achieve the 4 hour target.

 

Swindon Intermediate Care Centre (SWICC)

AGr reported that he had commenced discussions with SEQOL around SWICC and an active project had been set up to create a frailty pathway with an opportunity for an integrated stroke unit too.

 

Ambulance handover

AGr reported that  performance against ambulance handover standard was good, which was an achievement given to increase in ambulance conveyance rate increase in July. 

 

Length of Stay

AGr reported that the Trust was in the top quartile for length of stay.

 

Referral to treatment (RTT) Standards

AGr reported that standards were not achieved in June. However, the internal processes and systems were improved.  AGr reported that the margin of validation was too high. 

 

Theatres

In response to a question from JS around the percentage of operating efficiency, AGr commented on the need to look at bookings, but also there was a workforce deficit.  The Trust had previously been successful in recruitment of anaesthetists.  Another issue to  ...  view the full minutes text for item 192.

193.

Safer Staffing Monthly Exception Report pdf icon PDF 243 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 June the proportion of actual versus planned nursing hours (fill rate) was as follows: -

 

 

Registered Nurses

Auxiliary Nurses

Day Shift

87.8%        

97.7%

Night Shift

101.9%      

103.4%

 

The report covered the following: -

 

  • Publication of data
  • Divisional fill rate
  • Average skill mix ratio
  • Care hours per patient per day
  • Divisional quality reports
  • The national agenda

 

HW reported that while the fill rate from temporary staffing was increasing, the overall number of Registered Nurse hours available during the day was largely unchanged. Many areas were understaffed on a daily basis. HW expressed concern regarding the skill mix which was finely balanced and was now getting to a tipping point. HW commented that a 60-40 percent ratio of registered nurses to care staff was considered a minimum for safe care in acute settings.  HW advised that the Trusts ratio was 60.03% to 39.97% and therefore there were days and wards where the ratio was below the minimum desired.

 

Following the publication of the first Model Hospital data for nurse staffing, HW advised that the Trust had had fewer than the average number of care hours per patient per day, but that the cost of staffing was more due to high agency costs.  In response to a question from JM, HW advised that the skill mix ratio included community hospitals staff but that below the minimum ratio affected hospital wards and not only those in the community.

 

Reference was made to the inability to fill all shifts requested, notably is some areas such as LAMU and the Emergency Department. 

 

OF reported that three Portuguese nurses had resigned recently stating concern over future employment associated with the implication of Britain pulling out of the European Union.  OF advised that she was monitoring the situation carefully.  HW commented that the reasons for staff leaving were broader.

 

JS asked whether the Trust tracked staff that left the Trust to understand whether they returned to their home countries or whether they went on to work somewhere else.  OF advised that staff had told the Trust that they were returning to their home country. 

 

SN expressed concern at the vacancy levels in the Unscheduled Care Division.  HW commented that she had asked the senior nursing team to consider what other action they wanted to take and what could be done differently during the winter on the assumption that none of the non EU recruits would join the workforce.

 

RESOLVED

 

that the report be received.

194.

Well Led Governance Review - Verbal update

Carole Nicholl, Company Secretary & Head of Corporate Governance

Minutes:

The Board reminded Directors that the draft report of the Well-Led Governance Review had been circulated to all members of the Board for information.  The findings in the report reflected the initial feedback from Deloitte at a Board workshop in May.

 

CN reported that an action plan had been drawn up, with leads identified for each.  Milestone actions were being developed to ensure achievement of each action within a reasonable timescale.  CN explained that notwithstanding agreement of the action plan, milestones actions were already underway, notably to refresh the Board Committee terms of reference and actions to improve risk management across the organisation.

 

CN commented that in the first instance the action plan to address the findings would be reported through the Governance Committee in September, with progress of milestones and exception reporting through to the Board.  SN, as Chair of the Governance Committee welcomed this approach, agreeing that in the first instance it was appropriate for the Governance Committee to consider the report of the Well Led Governance Review, but that the report should receive exception reports.

 

RESOLVED

 

that the update be received.

195.

Ratification of Decisions made via Board Circular/Board Workshop

Carole Nicholl, Company Secretary & Head of Corporate Governance

·        Single Oversight Framework Consultation Response

Minutes:

The Board was asked to ratify a decision made by Board circular dated 1 August 2016.

 

RESOLVED

 

that the response to the Single Oversight Framework Consultation made via Board circular dated 1 August 2016 be ratified.

196.

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.

197.

Date and Time of next meeting

Date: 1 September 2016

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 1 September 2016 in the Trust Boardrooms, Trust HQ, Great Western Hospital, Swindon at a time to be confirmed, noting that a later start time had been agreed earlier in the year.

198.

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

·        Update on Sustainability and Transformation Plan

·        Assessment of 'Provider to Provider' arrangements

·        Board Assurance Framework

·        Improvement Plan Update

·        Winter Capacity Proposal

·        Wiltshire Health & Care Transfer Arrangements

·        Wiltshire Health & Care Update

·        Audit, Risk and Assurance Committee Minutes

·        Charitable Funds Committee Minutes

·        Executive Committee Minutes

·        Finance, Investment and Performance Committee Minutes

·        Governance Committee Minutes

·        Remuneration Committee verbal report

·        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

·         Update on Sustainability and Transformation Plan

·         Assessment of 'Provider to Provider' arrangements

·         Board Assurance Framework

·         Improvement Plan Update

·         Winter Capacity Proposal

·         Wiltshire Health & Care Transfer Arrangements

·         Wiltshire Health & Care Update

·         Audit, Risk and Assurance Committee Minutes

·         Charitable Funds Committee Minutes

·         Executive Committee Minutes

·         Finance, Investment and Performance Committee Minutes

·         Governance Committee Minutes

·         Remuneration Committee verbal report

·         Urgent Private Business – serious incident

199.

Minutes

Roger Hill, Chairman

·        23 May 2016 (private minutes)

·        9 June 2016 – Joint Board and Council of Govenors’ Meeting (private minutes)

·        7 July 2016 (private minutes)

Minutes:

The minutes of the meetings of the Board held in private on 23 May and 7 July 2016 were adopted and signed as a correct record subject to amendments.

 

The minutes of the meeting of the Joint Board and Council of Governors held in private on 9 June 2016 were received. It was noted that JS was present at this meeting.

200.

Outstanding Actions of the Board (Private)

Minutes:

The Board received and considered the outstanding action lists and agreed that completed actions be removed from the tracker. 

201.

Sustainability and Transformation Plan Progress Update

Kevin McNamara, Director of Strategy

Minutes:

The Board received and considered a report which provided an update on the Sustainability & Transformation Plan.

202.

Assessment of 'Provider to Provider' arrangements

Kevin McNamara, Director of Strategy

Minutes:

The Board received and considered a report which provided details of the contract for services.

203.

Board Assurance Framework

Carole Nicholl, Company Secretary & Head of Corporate Governance

Minutes:

The Board received and considered a report which provided an update to the recently updated Board Assurance Framework. 

204.

Improvement Plan Update

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.

205.

Winter Capacity Proposal: Discharge to Assess

Adrian Griffiths, Interim Chief Operating Officer

Minutes:

The Board received and considered a report which provided summary of a proposal to establish a comprehensive Discharge To Assess service.

206.

Wiltshire Health & Care Transfer Arrangements - Verbal update

Oonagh Fitzgerald, Director of Human Resources

Minutes:

The Board received a verbal update regarding the Wiltshire Health & Care transfer arrangements.

207.

Wiltshire Health & Care - Update

Hilary Walker, Chief Nurse

Minutes:

The Board received and considered a report which provided an update from Wiltshire Health and Care’s first Board meeting held on 21 July 2016.

208.

Audit, Risk and Assurance Committee

Julie Soutter – Committee Chair

·        20 July 2016 (verbal report)

·        19 May 2016 (enclosure)

Minutes:

The minutes of the meeting of the Audit, Risk and Assurance Committee held on 19 May 2016 were received.  Furthermore, it was noted that a meeting of the Audit, Risk and Assurance Committee had been held on 20 July 2016.

209.

Charitable Funds Committee

Steve Nowell – Committee Chair

·        30 June 2016 (enclosure)

Minutes:

The minutes of the meeting of the Charitable Funds Committee held on 30 June 2016 were received.

210.

Executive Committee

Nerissa Vaughan – Committee Chair

·        19 July 2016 (verbal report)

·        21 June 2016 (enclosure)

Minutes:

The minutes of the meeting of the Executive Committee held on 21 June 2016 were received.  Furthermore, it was noted that a meeting of the Executive Committee had been held on 19 July 2016.

211.

Finance, Investment and Performance Committee

Liam Coleman – Committee Chair

·        25 July 2016 (verbal report)

·        27 June 2016 (enclosure)

Minutes:

The minutes of the meeting of the Finance, Investment and Performance Committee held on 27 June 2016 were received.  Furthermore, it was noted that a meeting of the Finance, Investment and Performance Committee had been held on 25 July 2016.

212.

Governance Committee

Steve Nowell - Committee Chair

·        22 July 2016 (verbal report)

·        27 June 2016 (enclosure)

Minutes:

The minutes of the meeting of the Governance Committee held on 27 June 2016 were received.  Furthermore, it was noted that a meeting of the Governance Committee had been held on 22 July 2016.

213.

Remuneration Committee

Liam Coleman – Committee Chair

·        20 July 2016 (verbal report)

Minutes:

The Board received a verbal report of the meeting of the Remuneration Committee held on 20 July 2016.

 

214.

Urgent Business (Private) - Serious Incident

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

Minutes:

The Chairman had agreed to accept this as an item of urgent business in view of the need for members of the Board to be advised of the matter as soon as possible.

 

HW made a verbal report of a serious incident and the action being taken to address learning.  The Board received the report.