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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

215.

Apologies for Absence and Chairman's Welcome

Minutes:

Apologies for absence were received from Nerissa Vaughan.

216.

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.

217.

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

Minutes:

There were no questions from members of the public.

218.

Minutes pdf icon PDF 390 KB

Roger Hill, Chairman

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

·        4 August 2016 (public and summary of private minutes)

Additional documents:

Minutes:

The minutes of the meeting of the Board held on 25 July 2016 and 4 August 2016 were adopted and signed as correct records, subject to the following amendments:-

 

Minute 187/16 Finance Report – The addition of the following sentence immediately before the income heading “ it was noted that if the delta between recruitment and retention increased and staff were then hired, this would have a financial impact which would affect the Trust’s financial forecast.”

219.

Outstanding actions of the Board (public) pdf icon PDF 207 KB

Minutes:

The Board received and considered the outstanding action list.  The Board noted updates as follows: -

 

187/16

Finance Report - private patient (PP) income

It was noted that private patient income had been reported through the Finance, Investment and Performance Committee meeting in August.

187/16

Finance Report - forecast

It was noted that the forecast outturn position was being reported through the Finance, Investment and Performance Committee with the worst case scenario now amended to assume non-achievement of Sustainability and Transformation Funding.

 

187/16

Finance Report – Cost Improvement Plans (CIPs) reporting

It was noted that further detailed reporting of CIPs was now included in reporting through the Finance, Investment and Performance Committee meeting. 

 

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

220.

Chairman's Report, Feedback from the Council of Governors

Roger Hill, Chairman

Minutes:

The Chairman gave a verbal report as follows: -

 

1.      The Board was asked to formally record that Guy Rooney had been appointed Deputy Chief Executive from 1 August 2016.

 

2.      The Annual Members meeting would take place on 22 September 2016 in the Academy. Workshops and health checks would be held from 5pm. The meeting would start at 6pm which would include a clinical presentation on radiotherapy from Dr Claire Blesing (Consultant Clinical Oncologist).

 

3.      Voting was currently underway for the North Wiltshire Constituency Governor vacancy.  There were 5 candidates. Completed ballot papers must be received by the Independent Scrutineer by 5pm on Tuesday 4 September 2016.

 

4.      Elections would open on 19 September and continue until 4 October for following Governor seats in the following constituencies:

§  Swindon (5 seats)

§  South Wiltshire (1 seat)

§  West Berkshire & Oxfordshire (1 seat)

§  Staff (4 seats)

 

5.      A meeting of the Governor Finance and Staffing Working Group had been held on 10 August 2016. The following subjects were discussed:-

·        Financial Performance

·        Workforce vacancy levels

·        International Recruitment Campaigns

 

RESOLVED

 

that the report of the Chairman be received.  

221.

Chief Executive's Report pdf icon PDF 181 KB

Guy Rooney, Deputy Chief Executive

Minutes:

The Board received and considered a report from the Chief Executive, presented by GR in NV’s absence, covering the following issues: -

 

·        Trust chosen as new provider for Swindon adult community services

·        Maintaining a strong staffing level

·        Working towards saving an extra 500 lives by 2020

·        Never OK

·        Exemplary care given to cardiac patients

·        Emergency Department improvements 

 

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

 

Swindon Adult Community Services – GR explained that the Trust was the preferred bidder for this contract due to start in February 2017.  GR highlighted that this would provide a great opportunity to enable a more joined up service.  GR was joined by all members of the Board in welcoming the community staff that would be coming to work for the Trust as a result of the new arrangements. 

 

Saving an extra 500 lives – GR reported that the Trust continued to work towards saving extra lives.  GR referred to a presentation given earlier in the day at the annual safety conference.  The external speaker, Martin Bromley, founder of the Clinical Human Factors Group had talked about how mistakes could save lives in terms of learning and changing practice.  GR reported on the number of people trying to change practice and procedures and that there was a culture in the UK of safety.

 

Never OK campaign – It was recorded that the Never OK campaign had been launched which was aimed at sending a clear message that abuse of staff was never ok and that action would be taken against anyone who verbally or physically abused Trust staff.

 

Exemplary care given to cardiac patients

It was highlighted that it had been revealed that patients needing treatment for a slow heart beat were more likely to receive the pacemaker most appropriate for their condition at the Great Western Hospital in Swindon, than anywhere else in the country.  This was an excellent achievement.

 

National strike action

Arising upon consideration of this report, GR advised that further junior doctors’ strike action was planned for 5 days and that the Trust needed to prepare a plan on how to manage this.  GR commented that the planned strike action would present enormous challenges around achievement of performance standards and would impact on patient care.

 

RESOLVED

 

that the report of the Chief Executive be received.

222.

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 4, together with a presentation as follows: -

 

Actual Operating costs

In month surplus of £99k. Total surplus of £293k compared to a target surplus of £257k. Year to date variance of £36k better than plan.

Contractual Income

£20.7m in month and £92.5m year to date (£0.2m above budget year to date). Forecast £257.7m for the year (on budget).

Total Income

£26.3m in month and £106.5m year to date (variance of £0.1m above budget year to date). Forecast £316.2m for the year (£1.3m below budget).

Income Activity highlights

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

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

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

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

·        A&E above plan (year to date A&E above plan).

Total Expenditure

 

£26.2m in month and £106.2m year to date (variance of £0.1m above budget year to date). Forecast £315.6m for the year (£1.3m below budget).

Expenditure highlights in month:

·        Drugs £0.05m above budget (£0.45m above budget year to date).

·        Pay £0.3m above budget (£0.4m above budget year to date).

·        Supplies £0.21m above budget (£0.57m above budget year to date).

EBITDA

8.0% YTD

Savings

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

£1.2m Cost Improvement Plans delivered in month against a budget of £1.2m.

£4.3m delivered against a budget of £4.7m year to date (£0.4m below budget).

Debtors

£54.0m debtors and stock

£6.7m above plan

Creditors

£56.6m creditors

£0.2m under plan

Cash

£1.6m (£3.4m under plan)

Loan

No further loans agreed

Reserves

£11.3m

Forecast

£0.6m surplus for the year (on plan).

Finance Risk Ratings (FSRR)

 

FSRR 2 (Material level of risk)

 

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

 

Sustainability & Transformation Funding

At month 4 the overall financial performance had improved resulting in a year to date surplus of £293k, which was £36k better than plan. It was explained that this included Sustainability and Transformation Funding (STF) which had been received for the first quarter.  KJ highlighted that there were risks around ability to achieve the full amount of STF going forward, notably around the percentage of STF attached to Emergency Department 4 hour wait performance.  It was reported that discussions were on going and it was flagged that achievement of some standards was impacted on by health wide issues, outside of the Trust’s control. KJ advised that a business case around this was being developed for submission to NHS England. 

 

Activity

It was noted that activity had risen in July compared to June in A&E and elective inpatient admissions.  GP referrals had dropped but these were still higher than this time last year.

 

Junior Doctor Strike

KJ flagged that any industrial action would put financial pressure on the Trust.  There would be a need to cancel elective appointments which would impact on the Trust’s Referral to  ...  view the full minutes text for item 222.

223.

Chair of Finance, Investment & Performance Committee Overview pdf icon PDF 154 KB

Liam Coleman, Non-Executive Director

Minutes:

The Board received a paper from LC Chair of the Finance, Investment and Performance Committee which summarised key financial issues considered by that Committee at its meeting held on 22 August 2016, which it was considered should be drawn to the attention of the Board in public covering: -

 

·        Financial Position

·        Activity

·        Income

·        Pay costs

·        Non-pay expenditure

·        Cost Improvement Plans (CIPS)

·        Sustainability and Transformation Funding (S&TF)

·        Aged Creditors

·        Cash Flow Forecast

·        Overtime Review

·        Nursing Recruitment

·        Diagnostic and Outpatients Review

·        Capital Expenditure

·        Operational Performance

 

In presenting the report, LC advised that there had been significant challenge around agency costs, which it was noted would be discussed further at the next meeting.

 

The Committee had received a high level review of cost improvement plans (CIPs) and had challenged the gap with further opportunities for savings considered.  The Committee had asked for greater clarity and risk profiling of those CIPs not being achieved. It was noted that new schemes had yet to be assessed (“RAG” rated), but that this would be done in conjunction with building up the schemes.

 

LC advised that the Committee had discussed cash flow in detail and had sought further information around Sustainability and Transformation Funding (STF). KJ reported that £2.2m had been received in respect of quarter 1.

 

LC commented that what the Trust knew as an institution was less than should be known around STF, in terms of how much funding would be received, when funding would be paid, what the requirements were for eligibility and impact.  This information was needed to enable the Trust to model through its cash position. LC advised that the position was unsatisfactory because the Trust was forced to look at a position which could not be modelled.

 

LC reported that the Committee had received an interesting presentation from the Diagnostic and Outpatients Division on their divisional plans.  There were challenges around workforce and agency spend, with significant detail provided to enable the Committee to understand the impact of that and what they were doing to mitigate associated risks.

 

LC advised that there would be more reporting around capital through the Finance, Investment and Performance Committee but also through the Executive Committee.

 

Finally, LC explained that discussion on operational performance had focussed on the continued and increase pressure being faced and how this would add more financial risk to the Trust.

 

RESOLVED

 

that the report be received and that it be noted that the Finance, Investment and Performance committee continues to challenge the financial recovery and the processes and controls in place to improve the position.

224.

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 22 August 2016.  It was noted that there were 25 extreme risks, with the highest risk area being Staffing Levels for Unscheduled Care, design and layout of the Emergency Department Observation Unit and Patient Safety on Linnet Ward.  Two risks had increased to 15+.

 

In response to a question from NB, it was explained that risks scoring 15+ should be reviewed monthly.  JS reported that the Audit, Risk and Assurance Committee had concerns regarding the number of overdue risk reviews and actions.

 

The Board was advised that work continued with Deloitte to develop a risk escalation framework which would be introduced during September.

 

RESOLVED

 

that the report of the 15+ Risk Register be received.

225.

Improvement Plan Update pdf icon PDF 388 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, HW advised that the focus was now on outcomes.  One action had been changed from completed to requires further action.  Reference was made to improvements and it was noted that it had been hoped that greater consistency would have been achieved.  SN referred to a “tipping point” in terms of deciding when or what was reasonable and it was agreed that this would be discussed at the Governance Committee later in the month.

 

In response to a question from JM, HW advised that the Emergency Department Steering Group had not yet merged into the Improvement Committee, pending further review of action progress.

 

RESOLVED

 

(a)   that the report be received; and

 

(b)   that a tipping point” in terms of deciding when or what is reasonable be discussed at the Governance Committee later in the month.

226.

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: -

 

·        Most recent Hospital Standardised Mortality Rate (March 2016) remained better than expected at 89.62.

 

·        There were no reported cases of Clostridium difficile during July 2016.

 

·        There were no Serious Incidents during July.  1 internal root cause analysis and 1 maternity internal root cause analysis were reported in July 2016.

 

·        Overdue investigations into incidents (by more than 14 days) had decreased to 424 from 502 reported the previous month.

 

·        Response rate to complaints during July for ‘high – extreme’ complaints had increased slightly to 75% within 25 days. The response rate for ‘low–medium’ complaints was at 74% against a target of 80%.

 

·        A total of 27 open cases had gone over the 25 working day timeframe which continued to reduce and had done since April 2016.

 

·        There were no cases opened by the Parliamentary Health Service Ombudsman during July 2016.

 

 

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

 

Audits Board members were asked to note the National Audit findings of vital signs in children. Data collection was for the period January to December 2015 and the results were very poor. It was explained that the findings reflected the concerns raised by the Care Quality Commission (CQC) in relation to safety in the Emergency Department (ED).  It was explained that improvement plans were being progressed and that there would be a re-audit.

 

NB questioned what had been done to make sure that progress was being made around the observation of children.  HW responded that there had been two audits in August.  The results of one were not positive, whereas the results of the second audit were better.  HW advised that she had asked if the audits going forward could be split out to differentiate between children and adults. 

 

Serious incidents – It was noted that there were no serious incidents in July and this was unusual.  The proper reporting of serious incidents had been tested with the clinical leadership teams and confidence was high that incidents were being discussed and reported.

 

Serious Incidents overdue action plans – It was explained that within the report reference was made to two overdue incident action plans.  However, one was now closed and the other had an action with IG Team which would be completed in early September.  HW reported that a breakdown of clinical and non-clinical overdue incident investigations was included in the report and it was noted that the majority (circa 70%) related to clinical matters.

 

Complaints – It was highlighted that the Unscheduled Care Division had continued their efforts to reduce their complaints backlog.  It was reported that the Deputy Director of Quality Governance had been asked to consider different measures for quality and complaint responses.

 

It was flagged that the report contained a number of patient experience comments and feedback this month which was a balance  ...  view the full minutes text for item 226.

227.

Chair of Governance Committee Overview pdf icon PDF 166 KB

Jemima Milton, Non-Executive Director (substituting for Steve Nowell)

Minutes:

The Board received a paper presented by JM who chaired the last meeting of the Governance Committee, which summarised key issues considered at the meeting held on 23 August 2016, which it was considered should be drawn to the attention of the Board in public covering: -

 

·        Improvement Plan Update

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

·        Root Cause Analysis Report

·        Hambleton Medical Medicines Management Report – Action plan progress update

·        Falls – reducing the rate and level of harm

·        Annual Clinical Audit & Effectiveness Report 2015/16

 

The Board’s attention was drawn to the work of the Improvement Committee on monitoring the roll out of actions identified to address the warning notice and findings in the Care Quality Commission’s report received earlier in the year.  It was noted that the Governance Committee had discussed exceptions which included delays with the installation of a shower in the Day Surgery Unit and training on the use of whiteboards which had now been installed.

 

It was explained that the Governance Committee had also considered a presentation which outlined the root cause analysis investigation relating to the care and management of a patient admitted to the Emergency Department.  The Committee had noted the actions in place, but had agreed that additional assurance be sought.

 

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; and

 

(c)   that it be formally recorded that HW is the Board lead for maternity.

228.

Operational Performance Report pdf icon PDF 246 KB

Linda Power, Acting 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 July was included and highlighted as follows: -

 

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

July 87.4% (Not Achieved)

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

July 91.60% (Not Achieved)

6 Week Diagnostic Wait

July 93.3% (Not Achieved)

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

June -16  (All Achieved)

 

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

 

Emergency Department (ED) 4 Hour Access Target - LP highlighted that ED performance continued to be impacted by demand, with July seeing an increase in attendances compared to June.  76 patients had endured stays of more than 12 hours with 1 reportable breach.   The reasons for this included timely flow out of ED and bed blocking.  LP reported that no patients had come to any harm.

 

LP flagged that given the volume of major activity, it had not been possible to protect the Minors Department.

 

Referral to treatment (RTT) Standards

The RTT 92% incomplete standard was not achieved in July, with the main reason being the impact of pressures in ED which had led to procedures and clinics being cancelled.  LP advised that doctor strike action would impact further on RTT, ED performance and cancer performance.

 

The Board noted that a national doctors’ strike was planned for the following week.  In response to a request from RH, OF undertook to circulate a note to the Board as soon as possible on the mitigation plan and implications of strike action, with a copy to governors for their information also.

 

Hospital moves over night

NB referred to the number of hospital moves over night and sought further information to better understand the types of patients involved.

 

LP reported that there was a CQUIN target around moves over night and action underway to limit these.  LP advised that the data available needed cleansing as she believed some moves were recorded more than once. LP explained that   moves over night were required to manage 4 hour targets and 12 hour pressures to prevent breaches.

 

NB sought to understand why space had to be made as most patients came into the hospital before 8pm.  It was explained that moves at night were related to the level of bed occupancy and that the 111% occupancy rate was difficult to manage. It was noted that every possible bed space was open and that the Trust had not come out of escalation during the summer.

 

In response to a question from JS, HW advised that the work planned for ED by Deloitte was process mapping and would specifically look at patient management in ED.  The flow of patients in the  ...  view the full minutes text for item 228.

229.

Winter Capacity Proposal - Discharge to Assess pdf icon PDF 220 KB

Linda Power, Acting Chief Operating Officer

Additional documents:

Minutes:

The Board received a paper which provided an update on a proposal to establish a comprehensive Discharge To Assess (D2A) service, supporting and complementary to additional enhanced nursing care bed provision in Swindon between November 2016 and April 2017 inclusive.  The paper covered: -

·        Context summary

·        Proposal

·        Costing assumptions

·        Sources of funding

·        Update

 

LP advised that since writing the report, the position was now changed and there was no funding within Swindon Clinical Commissioning Group (CCG) or SEQOL which could be diverted towards discharge to assess.

 

LP reported that another option was around nursing home beds.  The intention was to renegotiate the cost of weekly beds to less than £1,200 per week. Another possibility around those beds was that the Trust had significant numbers of out of area patients and therefore discussions would be opened with surrounding CCGs about bridging services or spot services.

 

LP advised that there were a number of other workstreams being progressed to improve capacity which would be reported back next month.

 

KJ noted that as part of the contractual sign off this year, the CCG had reduced the Trust’s contract down by £600k which was about bed days reducing. KJ advised that the CCG would have to pay anyway and it would cost more, with a worse outcome for patients.   LP advised that the biggest risk was 500 hours care which needed to be funded. This was currently unresolved.

 

JM commented on the need for a firm approach with the Borough Council commenting that they should be providing social care and funding it.

 

LC referred to the discussion earlier in the meeting on the level of bed occupancy at 111%.  LC suggested that by adding winter pressures to this level, the gap was more than 60 beds.  LC commented on continually solving a small problem, when actually the problem was bigger and growing.

 

NB commented on the backlog of patients needing to exit the hospital. NB commented on the need to get patients out of the hospital to where they needed to be and suggested that extra beds would provide a short term solution as they would soon become full and the underlying problem of not exiting patients would remain.

 

LC commented that he was concerned to understanding the size of the problem, noting that the Trust was currently at 111% bed occupancy because there were circa 80 patients who did not need to be in the hospital.

 

HW questioned whether there was an increased appetite to issue financial penalties in respect of delayed transfers of care.  It was noted that this amounted to £125 a day per patient.  KJ responded that she had written to the outlying CCGs on this point.

 

KJ commented on the financial pressures on all parties, explaining that discussion would be continuing. It was agreed that the costs burdens associated with social care should be discussed at the Finance, Investment and Performance Committee later in the month.

 

RESOLVED

 

(a)   that the report be noted;

 

(b)   that it be noted that  ...  view the full minutes text for item 229.

230.

Responsible Officer's Annual Board Report on Appraisal and Revalidation pdf icon PDF 102 KB

Guy Rooney, Medical Director

Additional documents:

Minutes:

The Board received a paper which provided assurance that the Trust had fulfilled its statutory duties relating to medical revalidation following its launch in 2012.

 

GR advised that there were 304 doctors of whom there were 227 completed appraisals, 61 approved but incomplete appraisals and 16 unapproved incomplete appraisals.  It was explained that there were legitimate reasons why some doctors had not had appraisals and examples were mentioned. GR advised that the Trust was performing well and that the overall appraisal and revalidation process had been reviewed by internal auditors, with a substantial opinion given around the processes in place. 

 

In response to a question raised, it was confirmed that all consultants received a copy of any incidents or complaints they were named in and this had been positively received.

 

The Board discussed the number of doctors who had not had appraisals due to lack of engagement which it was suggested was not a legitimate reason for non-completion of an appraisal. It was noted that nationally doctors had been struck off the General Medical Council for failing to engage in the appraisals process.  GR advised that doctors at this Trust had and would be referred to the GMC as necessary. 

 

The reasons for the unapproved incomplete appraisals were discussed and it was commented that lack of doctor engagement, lack of doctor time and appraisal outputs not being signed off (accounting for 35 doctors) was not acceptable.  The Board noted that whilst performance benchmarked well with other Trusts, it was requested that compliance needed to be improved.  GR undertook to consider this.

 

RESOLVED

 

(a)   that the report be noted; and

 

(b)   that GR be requested to consider how compliance with appraisals and doctor revalidation could be improved further.

231.

Nursing and Midwifery Care Framework - a response to Leading Change, Adding Value pdf icon PDF 225 KB

Hilary Walker, Chief Nurse

Minutes:

The Board received a paper which described the nursing and midwifery response to “Leading Change, Adding Value”, a framework for nurses, midwives and care staff (NHS England 2016).   Six commitments were summarised on which the profession would deliver, focussed on patient quality, workforce development, utilisation of technology to reduce unwarranted variation and building research capability to improve the care given.

 

It was noted that the Trust’s strategy 2014-19 was aligned with the Transformation and Sustainability Plan across Bath, Swindon and Wiltshire and included a focus for a patient care framework for nurses, midwives and care staff centred on delivering quality care, developing new approaches, workforce redesign and use of technology.

 

Following publication of the new framework, workstreams had been developed to support the delivery of care locally linked into the overall Trust strategy. Ambitions for this year had been set, details of which were set out in the report.  HW explained that the intention was that progress reports would be submitted to the Board bi-annually.

 

RESOLVED

 

that the patient care strategy be supported for roll out across clinical areas and Divisions.

232.

Safer Staffing Monthly Exception Report pdf icon PDF 374 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 July the position was as follows: -

 

Proportion of actual versus planned nursing hours (fill rate):

 

Registered Nurses

Auxiliary Nurses

Day Shift

87.8%        

102.3%

Night Shift

100.6%      

103.0%

 

Temporary staff fill rate:

Shifts

Care staff

Registered Nurse Staff

Requested

1631

2851

Covered

1200

2411

Not covered

431

440

Fill rate %

74%

85%

 

Average skill mix ratio (day): -

Registered Nurse Staff

58.4%

Care staff

41.6%

 

The report covered the following: -

 

  • Publication of data
  • Divisional Director of Nursing Quality Reports
  • The national agenda

 

It was highlighted that there large numbers of staff who had join the Trust from Oxford Brookes as Band 3 staff until they got their pins.  Therefore it was hoped that an increase in registered nurses would be seen in September.

 

There had been a significant increase in requests for temporary staffing which reflected the vacancy situation.  It was noted that the average skill mix ratio had worsened. 

 

HW drew attention to the care hours per patient per day set out in the report, explaining that from September onwards data would be available which would allow the Trust to benchmark with peer organisations.  At present the information available showed that the Trust had fewer nursing days per patient but that this was more expensive (because of the level of vacancies).

 

 

RESOLVED

 

(a)   that the report be received; and

 

(b)   that it be noted that work is underway to look at skills mix to include financial and HR implications and that this will be included in a future report.

233.

Safer Staffing - 6 monthly skill mix review pdf icon PDF 421 KB

Hilary Walker, Chief Nurse

Minutes:

The Board considered a report which provided details of the nursing and midwifery 6 monthly skill mix review undertaken against the current establishments.  It was highlighted that due to unforeseen circumstances, the Unscheduled Care Division had not completed its review in full and therefore this would be included in future reporting.

 

RESOLVED

 

that the report be noted.

234.

Ratification of Decisions made via Board Circular/Board Workshop

Carole Nicholl, Company Secretary & Head of Corporate Governance

Minutes:

None.

235.

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.

236.

Date and Time of next meeting

Date: 6 October 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 6 October 2016 at 9:30am in the Trust Boardrooms, Trust HQ, Great Western Hospital, Swindon.

237.

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

·        Sustainability and Transformation Plan update

·        Swindon Community Care

·        Wiltshire Health & Care update

·        Audit, Risk and Assurance Committee Minutes

·        Executive Committee Minutes

·        Finance, Investment and Performance Committee Minutes

·        Governance Committee 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)

·        Update on Sustainability and Transformation Plan

·        Status of Swindon Community Care Services

·        Wiltshire Health & Care - update

·        Executive Committee Minutes

·        Finance, Investment and Performance Committee Minutes

·        Governance Committee Minutes

·        Urgent Private Business (none)

238.

Minutes

Roger Hill, Chairman

·        4 August 2016 (private minutes)

Minutes:

The minutes of the meeting of the Board held in private on 25 July 2016 and 4 August 2016 were adopted and signed as a correct record, subject to amendments.

239.

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. 

240.

Update on Sustainability and Transformation Plan (verbal report)

Kevin McNamara, Director of Strategy

Minutes:

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

241.

Status of Swindon Community Care Acquisition

Kevin McNamara, Director of Strategy

Minutes:

The Board received a report which provided an update to Swindon Adult Community Services.

242.

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 11 August 2016.

243.

Executive Committee

Nerissa Vaughan – Committee Chair

·        16 August 2016 (verbal report)

·        19 July 2016 (enclosure)

Minutes:

The minutes of the meeting of the Executive Committee held on 19 July 2016 were received.  Furthermore, it was noted that a meeting of the Executive Committee had been held on 16 August 2016.

244.

Finance, Investment and Performance Committee

Liam Coleman – Committee Chair

·        22 August 2016 (verbal report)

·        25 July 2016 (enclosure)

Minutes:

The minutes of the meeting of the Finance, Investment and Performance Committee held on 25 July 2016 were received.  Furthermore, it was noted that a meeting of the Finance, Investment and Performance Committee had been held on 22 August 2016.

245.

Governance Committee

Steve Nowell - Committee Chair

·        23 August 2016 (verbal report)

·        22 July 2016 (enclosure)

Minutes:

The minutes of the meeting of the Governance Committee held on 22 July 2016 were received. Furthermore, it was noted that a meeting of the Governance Committee had been held on 23 August 2016.

246.

Urgent Business (Private) (if any)

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

Minutes:

None.