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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

247.

Apologies for Absence and Chairman's Welcome

Minutes:

Apologies for absence were received from Roger Hill.  Julie Soutter the Deputy Chairman, chaired the meeting.

248.

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.

249.

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

In the light of the recent announcement of the calling off of the Junior Doctors proposed strikes what action will the Trust be taking to monitor the impact of the implementation of the new contract to ensure that there are no adverse outcomes for the Trust’s hardworking junior doctors?

 

Peter Pettit

Public Governor

Minutes:

Peter Pettit, a Public Governor asked what action would the Trust be taking to monitor the impact of the implementation of the new contract to ensure that there were no adverse outcomes for the Trust’s hardworking junior doctors in the light of the recent announcement of the calling off of the Junior Doctors proposed strikes?

 

OF responded that there were a number of actions underway regarding the junior doctor contracts notably the appointment of a guardian of safe working hours; the establishment of a junior doctors’ forum; the establishment of a system for exception reporting with supporting technology and a local equalities impact assessment.  OF explained that together with GR, she was attending ongoing meetings to consider appropriate actions around the junior doctors.

 

Peter Pettit, who was present at the meeting commented that he would be interested to understand the junior doctors’ forum and OF undertook to provide details outside of the meeting.

250.

Minutes pdf icon PDF 575 KB

Roger Hill, Chairman

·        1 September 2016 (public and summary of private minutes)

Minutes:

The minutes of the meeting of the Board held on 1 September 2016 were adopted and signed as a correct record, subject to the following amendments: -

 

Minute 222/16 Finance Report

Deletion of the word “slightly” in the paragraph titled “Cost Improvement Plans (CIPs)” and deletion of the sentence “JS commented that agency retention needed to be looked at” and the substitution thereof with the words “JS commented that staff retention needed to be looked at”..

251.

Outstanding actions of the Board (public) pdf icon PDF 220 KB

Minutes:

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

 

407/15

8/16

IPR format and content

The Board noted that there had been some further thought to the IPR having regard to feedback from the Well Led Governance Review.  CN had met with the Chair of the Audit, Risk and Assurance Committee and the Chair of the Governance Committee to consider approach, which had been reviewed by the Chief Executive.  Plans were in hand to develop a simple concise dashboard of key metrics which would form part of the Chief Executives report. 

 

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

252.

Chairman's Report, Feedback from the Council of Governors

Roger Hill, Chairman

Minutes:

The Deputy Chairman reported the following: -

 

1.     The Board was asked to note that Phil Prentice a former public governor of the Swindon Constituency had sadly died on 31 August.  Condolences had been sent to Phil’s family on behalf of the Board and Council of Governors.

 

2.     The Board was asked to note that Dr Peter Crouch, the Chairman of Swindon Clinical Commissioning Group had passed away during September.  Condolences had been sent to Peter's family at this sad time.

 

3.     The joint Annual Members Meeting and Council of Governors had taken place on 22 September. The meeting included a summary of Trust business for 2015/16 from Nerissa Vaughan, Chief Executive; a presentation of the audited accounts from Karen Johnson, Director of Finance and activities of the governors from Margaret White, Lead Governor.    In addition amendments to the Constitution had been approved and a clinical presentation on radiotherapy had been given by Dr Claire Blesing, Consultant Clinical Oncologist.  There were several questions from members and a good dialogue of current issues.

 

4.     There had been a meeting of the governors’ Nomination and Remuneration Working Group on 26 September which had considered benchmark Chair and Non-Executive Director allowances.

 

5.     There had been a meeting of the governors’ Membership & Governor Training Working Group on 5 September which considered progress on delivery of the Membership Strategy and governor mandatory training plans.

 

6.     A governor contested by-election had been held in September for the Northern Wiltshire Constituency. Penny Bowen had been elected as a public governor for the remainder of a 2 year term ending in November 2018.

 

7.     Elections were underway for governor seats in the Swindon, West Berkshire & Oxfordshire, South Wiltshire and Staff constituencies.  These had been widely advertised.  Close of nominations was earlier in the week.

 

8.     There had been a meeting of the Joint Nominations Committee on 1 September followed by a Council of Governors on 12 September 2016 which had considered Non-Executive Director appointments and JS was delighted to ask the Board to formally record that Roger Hill had been re-appointed as Chairman for a 2 year term from 1 February 2017 and Jemima Milton had been re-appointed as a Non-Executive Director by the Council of Governors for a 3 year term from 1 January 2017.

 

9.     Finally, the Board was asked to record that Liam Coleman had tendered his resignation as a Non-Executive Director with effect from 31 December 2016 due to work commitments.  Therefore recruitment was currently underway for two new Non-Executive Directors noting that Robert Burns’ term of office would end in January.

 

RESOLVED

 

that the report made on behalf of the Chairman be received.

 

253.

Chief Executive's Report pdf icon PDF 192 KB

Nerissa Vaughan, Chief Executive

Minutes:

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

 

1.     Trust asked to become caretaker for adult community healthcare in Swindon

2.     Junior doctors’ contract update

3.     Developing our Sustainability and Transformation Plan

4.     Endoscopy Unit recognised for high quality 

5.     Celebrating achievements on World Sepsis Day

6.     Speak Out on Safety event

7.     Dr Peter Crouch

8.     New Accountable Officer to join Wiltshire Clinical Commissioning Group

 

In presenting the report, NV asked the Board to note that the Trust had become the caretaker for adult community healthcare services in Swindon from 1 October. 

 

NV highlighted that the Endoscopy Unit had been recognised for high care of the highest quality.  NV commented on the excellent feedback from a recent inspection and advised that the Joint Advisory Group (JAG) accreditation was subject to the planned capital development of the Endoscopy Unit being completed within three months.  Actions were underway to progress the work required.

 

Finally, NV referred to the sad death of Dr Peter Crouch advising that his funeral was on 7 October 2016 and that the family had welcomed the attendance of members from this Board.

 

RESOLVED

 

that the report of the Chief Executive be received.

254.

Chair of Finance, Investment & Performance Committee Overview pdf icon PDF 166 KB

Liam Coleman, Non-Executive Director

Minutes:

The Board considered a report from the Chair of the Finance, Investment and Performance Committee which summarised the key issues from a meeting of that committee earlier in the month which it was considered should be drawn to the attention of the Board covering the following: -

 

·         Agency spend and controls service review

·         Timelines for submission of plans to regulators

·         Overall financial performance

·         Activity

·         Non-pay expenditure

·         Working capital ratios

·         Balance sheet – life cycle works variance to date

·         Rolling cash flow forecast

·         Forecast

·         Risks likelihood and value

·         Data Quality

·         Board Assurance Framework (BAF) – strategic risks

·         Private patients update

·         Cost Improvement Programme (CIP) overview

·         Service Line Reporting

·         Recruitment and retention plans

·         International recruitment

·         E-Rostering Business Case

·         Operational Performance report

 

RB commented that he had concerns regarding cash flow and the impact on creditors. RB stated that the Trust was operating in a changing environment with increased demands and many decisions were being made to respond to external pressures. RB commented on the need to take a holistic view of whether the Trust would be able to deliver on everything.  JS advised that the issue of multiple demands would be discussed later in the meeting.

 

In response to a question from AC, it was noted that the e-rostering business case would be considered later in the meeting and in response to a comment from RB about errors in the cash flow forecasts, it was noted that this would be discussed under the Finance report.

 

RESOLVED

 

that the report be received.

 

255.

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 5, together with a presentation as follows: -

 

Actual Operating costs

In month surplus of £23k. Total surplus of £316k compared to a target surplus of £286k. Year to date (YTD) (variance of £30k better than plan).

 

Contractual Income

£20.2m in month and £112.8m YTD (£0.6m below budget YTD). Forecast £258m for the year (on budget).

 

Total Income

£26m in month and £132.5m YTD (variance of £0.7m below budget YTD). Forecast £317.8m for the year (£0.3m above budget).

 

Income Activity highlights

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

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

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

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

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

Total Expenditure

 

£26m in month and £132.2m YTD (variance of £0.7m below budget YTD). Forecast £318.1m for the year (£1.2m above budget).

 

Expenditure highlights in month:

·         Drugs £0.2m above budget (£0.7m above budget YTD).

·         Pay £0.5m below budget (£0.1m below budget YTD).

·         Supplies £0.1m above budget (£0.7m above budget YTD).

 

EBITDA

7.7% YTD

Savings

Savings plan of £14.24m of which £14.21m had been identified.

£1.1m CIPS delivered in month against a budget of £1.4m.

£5.4m delivered against a budget of £6.0m YTD (£0.6m below budget).

Debtors

£50.1m debtors and stock

£10.8m above plan

Creditors

£56.6m creditors

£1m under plan

Cash

£4.8m (£2.6m under plan)

Loan

No Further Loans Agreed

Reserves

£1.9m balance available

Forecast

£0.2m deficit for the year (£0.8m below plan).

Finance Risk Ratings

FSRR 2 (Material level of risk)

 

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

 

Financial performance

KJ reported that financial performance was still ahead of plan but the in-month position had deteriorated. 

 

Outturn

It was noted that the full year effect of reduced Sustainability and Transformation Funding (S&TF) relating to non-achievement of A&E performance had now been recognised in the outturn position which meant the Trust was forecasting £234k deficit.

 

It was explained that the Trust had been in dialogue with NHS Improvement and would be submitting an exceptional circumstances case around non-achievement of A&E performance being a system wide issue. 

 

Creditors / cash flow

KJ highlighted that the cash flow position was concerning in that at March 2017 the Trust would deviate from the £1.7m cash target position.  This was because of the commitment to spend £1m on creditors each month.  KJ commented on the need to maintain the creditor position and that more suppliers were having stronger conversations with the Trust seeking payment.

 

Capital schemes

Reference was made to investments and it was noted that a review was currently underway and any schemes which could be delayed would be put on hold.  This would support the cash position.   Reference was made to the review of back office functions currently underway which included a focus on how to make savings this financial year.

 

Reference was made to  ...  view the full minutes text for item 255.

256.

Risk Management / 15+ Risk Register pdf icon PDF 251 KB

Carole Nicholl, Company Secretary & Head of Corporate Governance

Additional documents:

Minutes:

The Board considered a report which provided an update on the development of a risk escalation framework and introduced the new reporting format to support the management of risk.  It was agreed that the risk escalation

 

The risks scoring 15+ (extreme risks) to the organisation together with dashboards providing an analysis of all Trust risks as at 26 September 2016 was presented.

 

The Board was reminded that its role was to receive the 15+ Risk Register (and the Board Assurance Framework) and seek assurance through committees that risk was being managed effectively.

 

In response to a question from RB, it was noted that Wiltshire Health & Care (WH&C) was managing its risks.  However, those relevant to the Trust would be captured and considered through the Executive Committee and reported to the Board if necessary. It was noted that WH&C risks would be reported to this Board as part of the WC&H reporting arrangements.

 

It was noted that at the meeting of the Transformation Board in September the 15+ risks had been considered in detail by the Executive Directors and it had been recognised that there was work to do in tidying up the risk register in terms of reviewing the relevance of older risks, updating controls and reflecting on appropriateness of actions.  This work had commenced and would continue over coming months.

 

JS thanked CN for her work towards improving risk management which it was noted would take time to embed.

 

RESOLVED

 

(a)   that it be noted that a new risk escalation framework has been developed;

 

(b)   that it be noted that the Audit, Risk and Assurance Committee has recommended approval of a revised Risk Management Strategy which incorporates the new risk escalation framework and that this is being finalised for approval at a future meeting of the Board;

 

(c)   that it be noted that that improvements in consistent risk management are expected over the coming months, noting that the new risk framework will require some time to become embedded;

 

(d)   that it be noted that the approach to considering the Board Assurance Framework (BAF), which forms part of the Risk Escalation Framework, is developing and that the BAF will be reported to a future meeting of the Board;

 

(e)   that it be noted that the alignment of strategic risks to Committees having regard to the remit of Committees is included in the minute on Committee Structure;  

 

(f)    that the 15+ risk register be received with assurance taken from the Executive Committee (and Transformation Board) and the Audit, Risk and Assurance Committee that the systems and processes for managing risk are effective; and

 

(g)   that the presentation made to the Audit, Risk and Assurance Committee setting out the new risk escalation framework be circulated for information to all members of the Board.

257.

Improvement Plan Update pdf icon PDF 379 KB

Hilary Walker, Chief Nurse

Minutes:

The Board considered a report which provided an update on progress of “must do” milestone actions since the last meeting to deliver the required improvements in response to the Care Quality Commission (CQC) Inspection report received in January 2016.

 

Warning Notice

It was highlighted that in respect of the actions required to address the warning notice, Deloitte had been commissioned to undertake a review of the flow of patients within the Emergency Department.  This work was now underway.

 

Follow up CQC Visit

HW reported that there had been a further follow up visit from the CQC of the Emergency Department earlier in the week.  The verbal feedback had been predominately positive, although a written report was awaited.

 

Effectiveness of the Improvement Committee

It was commented that the Improvement Committee was effective and as such it was considered that the governance set up would be replicated to consider Swindon adult community services. 

 

Incomplete milestones

In response to a question from SN about nursing documentation, it was explained that there had been a move to a paper based system from an electronic system which had been rolled out and tested.  HW advised that the milestone action remained open in part to address the document not being easy to use and also to address the culture around consistent use and completion of the documentation.

 

In response to a question from JM around whiteboard implementation, HW advised that she would seek an update from the new Director of IT and report thereon to the next meeting.

 

RESOLVED

 

that the report be received.

258.

Chair of Governance Committee Overview pdf icon PDF 169 KB

Steve Nowell, Non-Executive Director

Minutes:

The Committee received a report from the Chair of the Governance Committee which summarised key issues considered by that Committee at its meeting held on 22 September 2016 covering the following: -

 

·         Gastroenterology and Endoscopy Update

·         Improvement Plan Update

·         Quality Report

·         Swindon Community Services

·         Safer Staffing monthly exception report

·         Quarterly Report on Clinical Audits

·         Safeguarding, Mental Capacity/Deprivation of Liberty Safeguards (Adults), Acute Trust Strategy 2016-2021

·         Review of Board Committees

·         Well Led Governance Review – Action Plan

 

SN explained that the focus of the Committee was changing and what that meant in practice was that there would be monthly consideration of quality report and the safer staffing report as time allowed.

 

SN reported that there had been positive feedback from the Joint Advisory Group (JAG) review of Gastroenterology and Endoscopy.  The Improvement Committee continued to test and challenge actions and that the areas remaining for focus included sustained consistent use of the nursing documentation and learning from serious incidents.  SN reported that HW was focussing on these areas and that there was a real focus and determination by management to address outstanding issues.  SN reported that action progress had been RAG (red, amber, green) rated with managers changing some actions back from red to green as they had not been satisfied with evidence to show that actions were complete.

 

SN reported that the Committee had discussed the results of an audit report on Vital Signs in Children which showed that the Trust was in the lower quartile for a number of standards relating to recording vital signs in children attending the Paediatrics Emergency Department.  The Committee was due to consider a further report on this at the next meeting.

 

RESOLVED

 

that the report be received and it be noted that the Governance Committee will continue to scrutinise and challenge the delivery of actions to drive improvements.

259.

Quality Report pdf icon PDF 106 KB

Hilary Walker, Chief Nurse

Additional documents:

Minutes:

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

 

·         There had been an increase in the Hospital Standard Mortality Rate which was 97.4 for the 12 month period June 2015 to May 2016.

 

GR reported that there had been a strong focus on sepsis and going forward the same approach would be adopted for acute kidney injury with work coordinated for both.  GR reported that it was known that poor flow through the organisation could affect mortality and therefore work on winter planning would support saving lives.  GR reported that the Trust had reviewed its coding which was now satisfactory in terms of coding patient deaths.  However, there was improvement to be done around coding for patients who lived.

 

·         There had been 2 reported cases of Clostridium difficile during August 2016 with a current rate of 8.77 per 100,000 bed days.

 

GR reported that the Trust had received a mortality alert for influenza but there were no concerns regarding this.  GR highlighted that the Trust had been commended in the national Cardiac Rhythm Management audit report for fulfilling NICE guidance. 

 

·         No serious Incidents were reported during August 2016, however there were 5 internal Route Cause Analysis (RCA’s) reported.

 

HW reported that within medicines safety the number of “missed doses” had been steadily improving due to the work undertaken by the Pharmacy.  Benchmark data showed that the Trust was doing well compared to others.

 

HW reported that there were no avoidable pressure ulcers during June and July which was excellent.

 

·         There were 443 overdue investigations into incidents (by more than 14 days, 316 of these related to clinical incidents).

·         There were a total of 20 mixed sex accommodation breaches reported during August; these breaches had been due to extreme escalation and the continued use of the Day Surgery Unit (DSU) as an inpatient area.

 

HW referred to patient experience which was directly impacted by work pressures.

 

·         There was 1 Serious Hazard of Transfusion (SHOT) reportable incident during August 2016

·         1 complaint case had been opened by the Parliamentary Health Service Ombudsman (PHSO) during August 2016.

 

HW reported that Friends and Family response rates were very low.  A new provider had started in September.  HW had asked for a briefing during October so that she could understand the drivers for improvement.

 

JS referred to the safeguarding mandatory training levels of clinical staff which were below 80%.  GR undertook to send a reminder to medical staff of their need to complete mandatory training generally.

 

NB referred to the local assessment against national reports noting that the Trust was amber for the consent rate (89%) for the percentage of records submitted with confirmed patient consent to storage of patient identifiable National Joint Registry data. GR undertook to remind staff of the need to take consent and record this accordingly.

 

The Board listened to a number of patient stories providing examples  ...  view the full minutes text for item 259.

260.

Operational Performance Report pdf icon PDF 170 KB

Linda Power, Deputy Chief Operating Officer

Additional documents:

Minutes:

The Board considered the Operational Performance 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 with headlines as follows: -

 

Emergency Department (ED) 4 hour standard (95%)  (combined – Emergency Department, Minor Injuries Unit (MIU) & Urgent Care Centre (UCC)) 

 

August 90.1% (not achieved)

Referral to Treatment +Incomplete standard (92%)

August 92.1%      (achieved)

6 Week Diagnostic Wait

August 91.7%   (not achieved)

Cancer Targets

2 Week Waits, 31 Day & 62 Day

July (achieved)

 

In presenting the report, the following points were highlighted: -

 

Joint Advisory Group (JAG) Accreditation - The JAG accreditation assessment team had described the unit as providing care of the highest quality and genuinely put the patient at the centre of the service aims.  Accreditation would be would be automatic pending the completion of the building works within a three month deadline.  Work was due to start at the end of October.  Discussions were underway with Carillion to resolve deed issues and the pace of progress around estates issues.  KM advised that lender approval was required for any changes to the estate.

 

ED attendances

It was noted that these fell in August compared to July by 7.8% (585 attendances).  However, activity was 3.1% above the same period last year. The month end performance was 90.1% against the 95% standard.  In response to a question from SN, LP confirmed that MIU data was included in the performance percentage.

 

Stroke Performance - This remained a concern in particular performance against Direct Admission and length of stay on the Stroke Unit.  This was now being addressed through a system-wide focused piece of work looking at the End to End Pathway. 

 

Referral to Treatment (RTT) – The 92% Incomplete Standard was achieved in August with a verified month end position of 92.1%.  A major concern for sustainable delivery of this target was the pressure and impact of the increasing Non-elective admissions.  

 

Diagnostic Performance – This continued to be a concern.  A recovery plan was in place and the Trust was on track to recover diagnostic performance in October.

 

Cancer Performance - LP advised that whilst the report stated that cancer performance continued to be maintained in July the position had deteriorated in August with the 2 week wait not being achieved.  This related mostly to dermatology and patient choice.  There would be a review to understand this.

 

Maternity – The numbers of births in-month had increased.

 

12 hour breaches- In response to a question raised LP explained that the start time for a breach was the point at which a decision to admit was made and that there were patient in the Emergency Department for longer than 12 hours.  NB commented that keeping patients under observation was important and that doing this in ED was not poor treatment.

 

Vacancies - JS referred to the number of vacancies notably in the anaesthetic teams.  Reference was made to the need to fill vacancies as soon as possible  ...  view the full minutes text for item 260.

261.

E-Prescribing & Medicines Administration (EPMA) pdf icon PDF 282 KB

Guy Rooney, Medical Director

Additional documents:

Minutes:

The Board considered a report from the Medical Director which sought to address concerns raised by governors regarding the introduction of E-Prescribing and Medicines Administration (EPMA).

 

The Board noted the concerns raised by governors as follows: -

 

·         The lack of hardware/log-in details meant that Doctors were unable to access EMPA for long periods of time.

·         Clinicians were becoming increasingly frustrated with the ability to manage patients.

·         Drug charts were difficult to access and consequently represent clinical risk.

 

The report set out the background around the introduction of EPMA, the assessment of the system, governance around ongoing review which included training, review of risks and clinical engagement, together with recommendations going forward.

 

RB referred to hardware commenting on the economies which could be made through bulk purchase, restricted choice and lease options with planned upgrades.  GR responded that technology needs were different for different areas.

 

GR advised that the Trust was an exemplar site for implementation of EPMA.  GR reported that he had met with the staff governor to discuss concerns and noted that no incidents had been raised specifically relating to Endoscopy services.

 

RESOLVED

 

that the report be noted.

 

262.

Safer Staffing Monthly Exception Report pdf icon PDF 364 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 August the position was as follows: -

 

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

 

Registered Nurses

Auxiliary Nurses

Day Shift

86.5%

101.3%

Night Shift

99.4%

101.9%

 

Temporary staff fill rate:

Shifts

Care staff

Registered Nurse Staff

Requested

1397

2989

Covered

994

1779

Not covered

403

1210

Fill rate %

71%

60%

 

Average skill mix ratio (day): -

Registered Nurse Staff

60.2%

Care staff

39.8%

 

The report covered the following: -

 

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

 

RESOLVED

 

that the report be received.

263.

Chair of People Strategy Committee Overview pdf icon PDF 162 KB

Jemima Milton, Non-Executive Director

Minutes:

The Board received a report which summarised the key issues considered by the People Strategy Committee at its meeting held on 16 September 2016 covering the following:

·         Recruitment and retention

·         Medical education

·         Leadership development

 

In presenting the report, JM explained that the Committee had also considered the strategic risks aligned to the strategic objective around ensuring the Trust was a place where people wanted to work and it was noted that after the meeting OF and CN had met to consider risk scoring and sources of assurance.

 

RESOLVED

 

that the report be received and it be noted that the People Strategy Committee will continue to scrutinise and challenge the delivery of actions to drive improvements relating to workforce issues.

264.

Recruitment and Retention Plan pdf icon PDF 1 MB

Oonagh Fitzgerald, Director of Human Resources

Minutes:

The Board considered a report which advised that there was a need to increase substantive staff numbers in some areas in order to ensure that safer staffing standards were met and to reduce pressure on individuals and teams.  Recruitment and retention of good staff remained a key challenge and as such the Trust could not rely on traditional methods but had to think and act creatively.

 

The report set out approach and plans; provided an update on the current vacancy position, reported on turnover by professional group, explained contributing factors and outlined actions being taken to ensure staffing levels were increased. It was noted that as there were many reasons why staff joined and left the organisation there were wide ranging actions needed to recruit and retain staff.

 

In order to increase substantive staff numbers there were corporate actions that needed to take place as well as profession specific actions. The Optimising Nursing and Midwifery Programme Board had been overseeing the Nurse Recruitment and Retention Plan since May 2016 and this was being monitored monthly.

 

OF reported that a weekly task force had been set up to progress the plan.  It was explained that for quarter 1, the staff survey results had shown a deteriorating position in culture in that there were less staff recommending the Trust as a place to work.  Staff were leaving because of the pressures at work.   Whilst the vacancy position had improved, the level of vacancies remained too high.

 

OF reported that a number of initiatives were in place many of which had been quantified in terms of return on effort.  These included a job shop; career clinics; liaison work with the armed forces; return to work programmes; UK based overseas nurse seeker campaign; maintaining ongoing international recruitment and redesign of the band 5 recruitment process. Local plans were being developed for any area where turnover was higher than 13%.

 

JM reported that the People Strategy Committee had welcomed the plan emphasising a need to concentrate efforts on retention as well as recruitment.   JM questioned whether working for this Trust was more pressurised than working for any other major hospital. OF responded that the intensity of the work at this Trust was higher for medical staff who rotated between hospitals.  It was further noted that the Trust had seen a 9% rise in attendances and this added to the pressure.

 

In response to a question from SN, OF reported that there was a target of 13% turnover which equated to a maximum of 32 staff leaving every month.

 

SN commented that notwithstanding all the effort underway, it was unlikely that the Trust would recruit and retain staff to the optimum levels and he asked for clarity on the gap in terms of the remaining vacancy levels, phasing and impact. NV agreed on the need for further clarity and the need for further quantification of effort.  NV commented on the need to understand indicators which explained what success looked like.  NV stated that numbers  ...  view the full minutes text for item 264.

265.

Chair of Audit, Risk & Assurance Committee Overview pdf icon PDF 157 KB

Julie Soutter, Non-Executive Director

Minutes:

The Board considered a report from the Chair of the Audit, Risk and Assurance Committee which summarised the key issues considered at a meeting of that committee held on 15 September 2016. 

 

The report included a summary of the discussion on the following: -

-       Risk escalation framework / risk management strategy / Board Assurance Framework

-       Information Governance Annual report 2015-16

-       External Audit progress report and technical update

-       Internal Audit progress report 2016-17

-       IT infrastructure and security

-       Counter Fraud report

-       E-Rostering

-       Contract extensions

-       Terms of Reference

 

JS highlighted the increasing pressure on the Information Governance Team in terms of the increased number of freedom of information requests.  JS also highlighted that a number of matters had been noted in the External Auditor’s technical update and a position statement on these had been requested for report back to the next meeting.

 

It was noted that an exercise had commenced to appoint internal auditors noting that the current contract was due to expire. A tender specification was being drawn up and a panel was being established to consider applications which would include Board representatives.

 

RESOLVED

 

that the report be received.

266.

Well Led Governance Review pdf icon PDF 121 KB

Carole Nicholl, Company Secretary & Head of Corporate Governance

Minutes:

The Board was reminded that there had been a well led governance review earlier in the year using NHS Improvement Well Led Governance Review Framework.  A final report was received and circulated to all Directors in August 2016.  In response to a request received, CN undertook to re-circulate the final report.

 

The report covered the reasons and scope of the Well Led Governance Review Framework and summarised the headlines in the report received.  In addition, the report outlined progress in the development of an action plan to address the recommendations and the governance arrangements in place to ensure oversight and scrutiny of delivery.

 

In summary the key findings were as follows: -

 

Areas of strength included: -

·       an improved business planning process that engaged with the divisional leadership teams;

·       a Board which was demonstrating the ability to work collaboratively across the local health economy; and

·       a strong Non-Executive Director cohort, with an Executive team for whom there were high levels of confidence from internal and external stakeholders.

 

Key areas for further development and enhancements included: -

·       further development of the risk management framework, from identification and escalation of risks to formation of the Corporate Risk Register and use of the Board Assurance Framework;

·       inconsistencies across the divisional governance arrangements impacting on the ability to provide assurances to the Board; and

·       data quality.

 

It was noted that the review did not highlight any areas which the Trust was not already aware of.  On consideration of this report, LC referred to the internal audit of data quality which provided substantial assurance (as referred to in the Chair of the Audit, Risk and Assurance Committee’s report) and asked that the findings of that audit be crossed referenced to the findings of the well led governance review noting that the latter review identified data quality as an area for improvement which was at odds with an audit opinion providing substantial assurance.

 

RESOLVED

 

(a)   that the report be received;

 

(b)   that the final report of the well led review be re-circulated to all members of the Board; and

 

(c)   that the internal audit of data quality which provides substantial assurance be crossed referenced to the findings of the well led governance review.

267.

Review of Board Committees pdf icon PDF 702 KB

Carole Nicholl, Company Secretary & Head of Corporate Governance

Additional documents:

Minutes:

The Board considered a report which invited Directors to approve the Board Committees and their remit effective from 1 January 2017.  Detailed terms of reference had not been finalised pending agreement of the new committees.  However, the remit for each was summarised in this report. The proposed structure was considered as attached as an appendix to these minutes.

 

The Governance Committee had discussed in detail a report on Board Committees at its meeting held on 22 September 2016 and views expressed had been incorporated into the report.

 

The intended outcome of the review was to ensure that all areas of Trust business received oversight and scrutiny at a Board committee; to reduce duplication of reporting as far as possible; to ensure that there was a logical spread of responsibility and fair workload across committees; and to ensure appropriate membership / invitees.

 

The Board discussed the report as set out below.

 

Non-Executive attendance at Board Committees - It was recorded that Non-Executive Directors could attend any Board Committee and that this should be made explicit in the Terms of Reference.

 

Invitees to Finance and Investment Committee - It was considered that whilst the Trust remained under enforcement undertakings all members of the Board should continue to be invited to the Finance and Investment Committee.

 

Performance, People and Place Committee – It was clarified that this committee would have oversight, scrutinise and challenge on all matters relating to IT and not just IT infrastructure.

 

There was concern that this committee might be overloaded, however it was noted that there was no appetite amongst directors to create a further committee.  It was recognised that there were additional areas which needed to report into the Board through the committees and this was the most appropriate committee for the additional areas at this time.  Furthermore, the intention was that the Performance, People and Place Committee would meet monthly, whereas the existing People Strategy Committee (considering workforce matters) only met quarterly.

 

On consideration of this RB expressed concern regarding IT generally, commenting that the savings targets which Trusts were facing as part of the Sustainability and Transformation Plan would inevitably result in plans requiring IT support and he suggested that there was a need to scrutinise the IT strategy. It was noted that the interim Director of IT was currently reviewing this.

 

RB commented that the Trust looked at investment in terms of costs rather than qualitative benefits and that more effort should be made to assess the potential benefits and payback period.  It was clarified that the relevant Board committee would view strategies within their remit, which would then be ratified by the Board. 

 

Reference was made to an Integrated Performance Report (IPR) and CN explained that she had met with the Chief Executive and the Chair of Audit, Risk and Assurance Committee to consider this and the intention now was that a simple IPR would be appended to the report of the Chief Executive.  Work continued on this and the IPR would be finalised  ...  view the full minutes text for item 267.

268.

Ratification of Decisions made via Board Circular/Board Workshop

Carole Nicholl, Company Secretary & Head of Corporate Governance

Minutes:

None.

269.

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.

270.

Date and Time of next meeting

Date: 24 October 2016

Time: 12.00pm

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

Minutes:

It was noted that a meeting of the Board was scheduled to take place on 24 October 2016.

271.

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 & Transformation Plan and Annual Planning Update

·        Swindon Adult Community Services

·        Winter Capacity Proposal – Discharge to Assess

·        Briefing update on 7-day working

·        Business Case for E-Rostering System

·        Developing Leadership Capability of GWH

·        Wiltshire Health & Care - Update

·        Audit, Risk and Assurance Committee Minutes

·        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 Minutes

·        People Strategy 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

·         Outstanding Actions of the Board (Private)

·         Sustainability and Transformation Plan and Annual Planning Update

·         Swindon Adult Community Services

·         Winter Capacity Proposal – Discharge to Assess

·         Briefing Update on 7 Day Working

·         Business Case: Changing our E-Rostering System

·         Developing Leadership Capability at GWH

·         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

·         Mental Health Act and Mental Capacity Act Committee Minutes

·         People Strategy Minutes

·         Urgent Private Business (if any)

 

272.

Minutes

Roger Hill, Chairman

·        1 September 2016 (private minutes)

Minutes:

The minutes of the meeting of the Board held in private on 1 September 2016 were adopted and signed as a correct record.

273.

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.

274.

Sustainability & Transformation Plan and Annual Planning update

Kevin McNamara, Director of Strategy

Minutes:

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

275.

Swindon Adult Community Services

·        Assurance on process in providing a caretaking role – Kevin McNamara, Director of Strategy

·        Workforce Issues – Oonagh Fitzgerald, Director of Human Resources

Minutes:

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

276.

Winter Capacity Proposal - Discharge to Assess

Linda Power, Deputy Chief Operating Officer

Minutes:

The Board considered a report which provided an update on a proposal to establish a discharge to assess service.

277.

Briefing update on 7-day working

Guy Rooney, Medical Director

Minutes:

The Board received and considered a paper which provided an update on 7 day working covering the current situation; background; an update on progress; key risks and next steps.

 

It was noted that the project team had identified the core services that needed addressing, prioritising and phasing of delivery together with indicative costs. 

278.

Business Case: Changing our E-Rostering System

Oonagh Fitzgerald, Director of Human Resources

Minutes:

The Board received and considered a business case for a replacement e-rostering system.

279.

Developing Leadership Capability at GWH

Oonagh Fitzgerald, Director of Human Resources

Minutes:

The Board received and consider a report which described an assessment of leadership capability within the organisation and recommended plans to develop this further.

280.

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.

281.

Audit, Risk and Assurance Committee

Julie Soutter – Committee Chair

·        15 September 2016 (verbal report)

·        13 July 2016 (enclosure)

Minutes:

The minutes of the meeting of the Audit, Risk and Assurance Committee held on 13 July 2016 were received.  Furthermore, it was noted that a meeting of the Audit, Risk and Assurance Committee had been held on 15 September 2016.

282.

Charitable Funds Committee

Steve Nowell – Committee Chair

·        21 September 2016 (verbal report)

Minutes:

It was noted that a meeting of the Charitable Funds Committee had been held on 21 September 2016. 

283.

Executive Committee

Nerissa Vaughan – Committee Chair

·        20 September 2016 (verbal report)

·        16 August 2016 (enclosure)

Minutes:

The minutes of the meeting of the Executive Committee held on 16 August 2016 were received.  Furthermore, it was noted that a meeting of the Executive Committee had been held on 20 September 2016.

284.

Finance, Investment and Performance Committee

Liam Coleman – Committee Chair

·        26 September 2016 (verbal report)

·        22 August 2016 (enclosure)

Minutes:

The minutes of the meeting of the Finance, Investment and Performance Committee held on 22 August 2016 were received.  Furthermore, it was noted that a meeting of the Finance, Investment and Performance Committee had been held on 26 September 2016.

285.

Governance Committee

Steve Nowell - Committee Chair

·        22 September 2016 (verbal report)

·        23 August 2016 (enclosure)

Minutes:

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

286.

Mental Health Act and Mental Capacity Act Committee

Nick Bishop – Committee Chair

·        2 September 2016 (verbal report)

·        3 June 2016 (enclosure)

Minutes:

The minutes of the meeting of the Mental Health Act and Mental Capacity Act Committee held on 3 June 2016 were received.  Furthermore, it was noted that a meeting of the Mental Health Act and Mental Capacity Act Committee had been held on 2 September 2016.

287.

People Strategy Committee

Jemima Milton – Committee Chair

·        16 September 2016 (verbal report)

Minutes:

It was noted that a meeting of the People Strategy Committee had been held on 16 September 2016.

288.

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.