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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

321.

Apologies for Absence and Chairman's Welcome

Minutes:

There were no apologies for absence.

322.

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:

Steve Nowell had declared a personal interest in the report on the appointment of a Senior Independent Director in so far as he was being recommended for the appointment (minute 354/16 refers). 

323.

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

What does the Trust envisage will be the impact on its drugs procurement, equipment replacement and staff recruitment costs of the recent and possibly on-going fall in the value of sterling? 

 

Peter Pettit

Public Governor

Minutes:

Peter Pettit, a Public Governor asked “what did the Trust envisage would be the impact on its drugs procurement, equipment replacement and staff recruitment costs of the recent and possibly on-going fall in the value of sterling”.

 

In response it was reported that there would be minimal impact because the Trust did not have material procurement directly from overseas but what was less clear was those suppliers who subcontracted to overseas companies which the Trust did not know of.

 

RB commented that whilst the impact was minimal at present the Trust had equipment due for replacement, some of which would come from abroad and therefore there might be an impact at that stage.

 

LC referred to the cost of non-EU drugs and GR suggested that thought should be given to other issues such as petrol prices. KJ responded that in answering the question she had considered revenue expenditure and not capital and that the Trust did not have direct supplies from overseas which were material.  However, KJ agreed that wider consideration of the implications of the on-going fall in the value of Stirling was needed and that this would be picked up through the Finance Team.

324.

Minutes pdf icon PDF 708 KB

Roger Hill, Chairman

·        6 October 2016 (public and summary of private minutes)

Minutes:

The minutes of the meeting of the Board held on 6 October 2016 were adopted and signed as a correct record.

325.

Outstanding actions of the Board (public) pdf icon PDF 289 KB

Minutes:

The Board received and considered the outstanding action list.  The Board noted updates as set out below: -

 

255/16

Finance Report S&TF

KJ had raised again the timing of the S&TF payments with NHS Improvement but a definitive response had yet to be received. 

249/16

Question form public re Junior Doctors strike

It was noted that OF had provided details of the Junior Doctors Forum to Peter Pettit outside of the meeting.

 

255/16

Improvement Committee whiteboard

The Executive Committee at its meeting in October has discussed the delay in the implementation of the whiteboards across the organisation and had requested that actions be taken to ensure the whiteboards were up and running as soon as possible.   It was noted that the Improvement Committee continued to oversee the actions arising out of the CQC report.

255/16

Finance Report – Pay Forecast

It was noted that a report on Pay Forecast would be presented to the next Finance, Investment and Performance Committee.

255/16

Finance Report – IT Schemes

It was noted that the presentation has been delayed until the next meeting of the Board due to the recent appointment an Interim Director of IT. NV reported that a high level overview of priorities had been presented to the Executive Committee in October.

 

Arising upon consideration of the report on IT Schemes, RB highlighted that changes in data legislation were due to come into force in May 2017 relating to cyber security and he asked whether the Interim Director of IT would have regard to this also. NV responded that points of best practice around Cyber Risk had been issued which the Director of IT would consider.    

 

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

326.

Chairman's Report, Feedback from the Council of Governors

Roger Hill, Chairman

Minutes:

The Chairman gave a verbal report as follows: -

 

Non-Executive Director Recruitment

Recruitment was currently underway for two new Non-Executive Directors with interviews now scheduled for December.  Nominations would be considered at the Council of Governors in February with the expectation that new Non-Executive Directors would take up post in March.

 

Elections

Voting was currently underway for five governor seats in the Swindon Constituency and one governor seat in the West Berkshire & Oxfordshire Constituency. Full election results would be announced on 14 November 2016.

 

The Chairman highlighted that there were uncontested elections for two Staff Governor positions namely the Allied Health Professionals staff governor and the Doctors/Dentists staff governor.  However, there had been not candidates for two staff constituencies and therefore there would be two staff governor vacancies representing Administrators and Nursing Staff. By-elections would be held for vacant posts in 2017/18.

 

Finally, the Chairman report that no candidates had stood for the Southern Wiltshire governor seat.  This was not surprising given the low numbers of members in that constituency. 

 

Arising upon the consideration of elections it was suggested that the sub classes of the staff constituency be amended to reflect the addition of staff in the community. CN undertook to consider this should the Trust take on Community Services permanently.

 

Governor Meetings

The Chairman reported that there were no meetings of the Governor Working Groups during October 2016.  However a full meeting of the Council of Governors was to take place on 24 November 2016 at 4:30pm.  Immediately following this there would be a presentation by the Planned Care Division.

 

Public Lecture

A public lecture was scheduled for 7 December 2016 on learning and disabilities.

 

Non-Voting Board Director Appointment

The Board was asked to formally record that Carole Nicholl had been appointed as a Non-Voting Director of the Board from 1 November 2016.  The role was Director of Governance & Assurance and Company Secretary.  The Chairman was joined by all members of the Board in congratulating Carole on this appointment which reflected her expanded role over many months.

 

Linda Power, Acting Chief Operating Officer

Finally, the Board joined the Chairman in thanking Linda Power for her work in the role of Acting Chief Operating Officer over recent weeks.  Linda had been covering the position in the absence of Adrian Griffiths who was due to return to the Trust next week. 

 

RESOLVED

 

that the report of the Chairman be received.

327.

Chief Executive's Report pdf icon PDF 180 KB

Nerissa Vaughan, Chief Executive

Minutes:

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

 

1.       Flu vaccination campaign progressing well

2.       New bereavement suite offers quiet space for families

3.       Encouraging students to think about a career in healthcare

4.       Health Secretary announces increase in medical training places from September 2018

5.       Help to live well with and beyond a cancer diagnosis

6.       Emergency Department waiting times

7.       Waiting times for planned procedures

8.       Radiotherapy Appeal total tops £1 million

9.       Celebrating World Mental Health Day

10.     New Chief Executive for Salisbury NHS Foundation Trust.

 

In presenting the report NV highlighted that the Brighter Futures Radiotherapy Appeal had reached the £1m mark. An event hosted by the Mayor of Swindon to recognise the efforts of local people in achieving the fund raising level had been held on 20 October 2016.  NV reported that the construction work on the Radiotherapy Centre was due to start on site next week.

 

NV highlighted that Cara Charles-Barks had been appointed as the Chief Executive for Salisbury NHS Foundation Trust and would be taking up the position in January 2017. Cara was a nurse by background and had held a variety of management roles in the NHS and the Australian healthcare system.

 

JM referred to the update on encouraging students to think about a career in healthcare and questioned how the Trust kept in touch with young people who wanted to work for the organisation. OF responded that the Trust had links with colleges and universities, including Oxford Brookes and local school visits were regularly undertaken.

 

RESOLVED

 

that the report of the Chief Executive be received.

328.

Finance Report pdf icon PDF 111 KB

Karen Johnson, Director of Finance

Additional documents:

Minutes:

The Board received and considered a report on finance for month 6, together with a presentation as follows: -

 

Actual Operating costs

In month deficit of £205k. Total surplus of £111k compared to a target surplus of £379k. YTD (variance of £268k worse than plan).

Contractual Income

£21.1m in month and £133.9m YTD (£0.3m below budget YTD). Forecast £258m for the year (on budget).

Total Income

£26.1m in month and £158.7m YTD (variance of £1m 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 above plan (YTD Non-elective above plan).

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

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

Total Expenditure

 

£26.3 in month and £158.6m YTD (variance of £0.8m below budget YTD). Forecast £318.1m for the year (£1.2m above budget).

Expenditure highlights in month:

·         Drugs £0.2m above budget (£0.8m above budget YTD).

·         Pay £0.4m above budget (£0.3m above budget YTD).

·         Supplies £0.2m above budget (£0.9m above budget YTD).

EBITDA

7.8% YTD

Savings

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

£1.1m CIPS delivered in month against a budget of £1.2m.

£6.5m delivered against a budget of £6.8m YTD (£0.3m below budget).

Debtors

£49.1m debtors and stock

£13.3m above plan

Creditors

£56.3m creditors

£1.9m under plan

Cash

£5.8m (£4.5m under plan)

Loan

No Further Loans Agreed

Reserves

£1.7m 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 at month 6 the overall financial position was behind plan by £268k following deterioration in month.  This included £4,172k of Sustainability and Transformation funding (S&TF) and therefore there was an underlying position £4,061k deficit.  The reduction in performance was partly due to recognition in the financial position of S&TF not being achieved for A&E performance in July, August and September amounting to £278k. The full year effect of this has been included in the forecast position which was why the Trust had moved from a planned surplus of £600k to a deficit of £234k. The Trust needed to continue to work to improve the monthly operating run rate to meet the planned year end surplus of £600k as 70% of the S&TF was dependant on achieving the financial trajectory.

 

KJ reported that a business case for funding had been submitted to NHS England regarding the non- achievement of A&E performance being a system wide problem. The Trust had emphasised that non-achievement had been due to wider health economy pressures outside of the Trust’s control and therefore payment should be made to the Trust. KJ reported that she had sought advice from NHS Improvement around the process for appeal, but currently there was no process in place and therefore there was  ...  view the full minutes text for item 328.

329.

Chair of Finance, Investment & Performance Committee Overview pdf icon PDF 192 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 held on 24 October 2016 which it was considered should be drawn to the attention of the Board covering the following: -

 

·         Procurement review

·         Board Assurance Framework (BAF) – strategic risks

·         Overall financial performance

·         Agency spend

·         Sustainability & Transformation Funding

·         Activity / Risks

·         Contracts

·         Balance sheet and cash

·         Capital spend

·         Rolling Cash forecast

·         Run rate / factors

·         Cost Improvement Programme (CIP) overview

·         2 Year Plan

·         Women’s, Children and Sexual Health

·         Budget Holder Review

·         Agency spend

·         Operational Performance report

 

In presenting the report LC drew attention to the strategic risks aligned to the Finance Investment and Performance Committee explaining that these had been discussed in detail at the meeting and that the risk of the inability to manage demand creating significant pressure and cost had been scored at 20 (extreme risk).

 

LC advised of an amendment to the report in that non-elective in-patient activity had reduced and was above plan.

 

LC referred to the factors impacting on the run-rate, explaining that the Committee had recognised that the Trust was running above the planned run-rate which was largely driven by agency over-spend and fill rate. LC commended KJ and NV around their engagement with the Clinical Commissioning Groups to reduce patient risk and cash risk in terms of the proactive negotiations around the year end position. LC commented that agreement of the year-end financial settlement was beneficial in that this materially reduced the Trust’s volatility risks.

 

The Committee discussed the deteriorating position in agency spend which was due to increased costs in pay. The Committee had welcomed a review of agency and locum spends but accepted that because of the difficulties in recruitment there was not a simple solution to address this.

 

LC highlighted that the Committee had discussed the impact of elective activity versus non-elective activity which had a significant impact on the Trust’s financial position, noting that the Trust was paid 30% less for non-elective activity and that this was the majority of the Trust’s work. LC commented that this significantly impacted on the Trust’s reserve position, noting that £1.4m reserves were insufficient going into winter.

 

Finally, LC reported that the Committee had considered that there was now sufficient focus on Cost Improvement Plans which were regarded as a continuous process and imbedded within the organisation.

 

RESOLVED

 

that the report be received.

330.

Reducing Agency Spend - Board Self Certification Checklist pdf icon PDF 85 KB

Oonagh Fitzgerald, Director of Human Resources

Additional documents:

Minutes:

The Board considered a report that provided assurance that processes were in place to control and reduce excessive costs of agency spend.

 

In presenting the report OF explained that appended to the report was a self-certification check list which Directors were asked to review, which set out assurance that sufficient focus and pace had been made regarding the Agency Reduction Plan. With reference to check point 1, relating to the Chief Executive’s strong grip on agency spend, OF clarified that the response was positive with a number of examples sighted such as NV chaired the Transformation Board looking at agency spend and NV had initiated a number of activities to support agency reduction which it was agreed would be reflected in the return. NV commented that there was a need to put more focus on workforce transformation.

 

The Board considered the self-certification check list and JS sought clarification on the process for filling vacancies within 21 days. OF responded that best practice was forty days which the Trust was working too and that 21 days was not achievable. However, NV stated that from the point of resignation to interview and offer should be 21 days and this was supported.

 

Reference was made to the processes for approving agency usage in terms of a centralised Agency Staff Booking Team and the actions to reducing demand for agency staffing and it was agreed that further work was required to respond to Questions 6, 7 and 8.

 

JS referred to questions 13 and 14 suggesting that instead of reference to the Board reference should be made to the People Strategy Committee of the Board and this was agreed.   

 

RESOLVED

 

that the Director of HR be delegated authority to amend the Self-Certification Check List to strengthen the wording around steps taken for sign off by the Chief Executive and Trust Chairman for submission to NHS improvement by 30 November 2016 having regard to the comments made at this meeting as set out above.

331.

Improvement Plan Update pdf icon PDF 381 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.

 

HW highlighted that following a second un-announced CQC visit, which had taken place on 5 October 2016, the Trust had now received confirmation that the Warning Notice relating to improvement within the Emergency Department had been lifted. HW advised that the CQC was planning a further inspection in the week commencing 22 March 2017.

 

HW advised that the Emergency Department (ED) Steering Group continued to meet regularly.  However, it was now proposed that the work of the ED Steering Group would be subsumed into the work of the Improvement Committee.    

 

HW advised that the Governance Committee had considered an Improvement Plan update and had expressed concerns around the lack of progress around 11 milestone actions. HW advised that detail of progress on those 11 actions was included in the report before the Board, commenting that the checking and challenging of work was continuing together with a programme of mini-visits to check compliance and embeddedness.

 

In response to a question by RH, HW advised that she was confident that the Improvement Committee would continue to oversee the checking and challenging of improvements within ED. However, it was explained that the intention remained that the Improvement Committee would be timed limited specifically to oversee the roll out of CQC milestones, with any on-going matters handed over to Divisions for their management as business as usual.

 

On consideration of a further planned inspection in March 2017, NB suggested that the Trust should discuss with the CQC that the visit should be site specific and HW undertook to raise this with the CQC at the next quarterly meeting.

 

The Board discussed the outstanding milestone actions and in a response to question from JS regarding the showers in the Day Surgery Unit, NV responded that there were concerns regarding delays in progressing improvement works within the hospital site and the associated costs. NV commented that Carillion did not have a list of preferred tenderers to draw down from to undertake works and this had been a matter for discussion with Carillion. KM referred to the costs involved and challenged whether £10k for drawings was value for money. NV agreed that the costs were high but commented that this was a mechanism for making profits on PFIs and that in this instance it was appropriate to proceed with the showers due to the benefit which would be realised through improved patient experience.  There was no objection to this suggestion.

 

RESOLVED

 

that the report be received.

332.

Quality Report pdf icon PDF 147 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 September were as follows: -

 

·         The most recent hospital standardised mortality rate was 92.24 (April 2016-June 2016).

·         There were two reported cases of clostridium difficile during September 2016 with a current rate of 9.39 per 100,000 bed days.

·         Three serious incidents were reported during September.

·         There were 489 overdue investigations into incidents (by more than 14 days, 333 of which related to clinic incidents).

·         There had been a total of 32 mixed-sex accommodation breaches reported during September. These had been due to extreme escalation and the use of the Day Surgery Unit as an in-patient area.

·         One Freedom to Speak Up alert had been received.

 

Serious incidents – Investigations were underway in respect of the three serious incidents reported during September. Some immediate changes had been put into practice.

 

Overdue incident investigations - The Trust’s position was not improving and therefore the Head of Clinical Risk had been asked to formulate proposals on how the Trust could better learn from incidents with a view that it might be appropriate to determine that not all incidents were worthy of investigation, but instead themes be considered.

 

Falls - HW highlighted that there was a lower rate of falls due to the on-going activities to reduce the rate of falls and their avoidable harm.

 

PALS/patient experience – HW reminded the Board of the need to learn from patient feedback on their experience to inform learning and on-going improvements. HW drew attention to the quality measures set out as Appendix A to the report which provided proposals to measure the quality of complaints management to give a more rounded view on Trust services. It was explained that the proposed quality matrix would allow for more detailed monitoring of the Trust’s complaint handling process with an emphasis on ensuring that patients were regularly kept informed, improvements in the quality of the response letters sent out were made and there was a reduction in re-opened complaints. It was explained that learning from complaints would be consistent throughout the organisation with reviews of actions built into an audit process which would allow for a more meaningful lessons learnt and changes made, to avoid additional complaints received relating to similar issues.

 

HW advised that feedback collected from the Friends and Family responses would be reported. HW explained that “word clouds” of positive and negative comments, including quotes from Friends and Family, NHS Choices and complaints would be reported monthly as a standing item. HW explained that there was a desire to increase the Friends and Family response rate with the introduction of static touch screen boxes and text messaging.

 

JM referred to a patient safety visit she had attended commenting that feedback from the PALS Team was that they had difficulties in consistency of senior staff providing responses to complaints. OF explained that since the patient safety visit, a workshop  ...  view the full minutes text for item 332.

333.

Chair of Governance Committee Overview pdf icon PDF 247 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 20 October 2016 covering the following: -

 

·         Improvement Plan Update

·         Quality Report

·         Quality Strategy Update

·         Divisional Quality Governance Workshop

·         Swindon Community Services

·         Well Led Governance Review

·         Board Assurance Framework

·         External/Peer Reviews and Accreditation Mapping

·         Corporate Governance Q2 2016/17 Report

 

In presenting the report SN highlighted that the Committee had discussed in detail the progress of the milestone actions to deliver improvements following the CQC inspection in 2015. The Committee had noted that eleven “must do” milestone actions had yet to be completed as well as “should do” actions and other milestone actions. The Committee had questioned how the eleven “must do” issues were being tracked, whether there were any “should do” or other milestone actions that would give cause for concern and whether the Internal Auditor service review report had focused on testing whether the CQC actions were embedded and if this report should be considered by the Governance Committee or the Audit, Risk and Assurance Committee or both.

 

SN suggested that the Governance Committee should look in detail at the eleven remaining “must do” milestone actions and progress made to date at the next meeting of the Governance Committee and this was supported.  SN welcomed the update in the Quality Report considered earlier in the meeting.

 

SN advised that the Governance Committee had received and endorsed a report which set out an addendum to the Trust’s Quality Strategy to address the recommendation from the Well Led Governance Review to ensure that key strategies clearly demonstrated links between the Trusts’ strategic objectives priorities and values. SN advised that the addendum was recommended to the Board for endorsement.

 

SN reported that the Committee had received a report on Divisional Quality Governance which set out a number of milestone actions around improvements to divisional governance. The Committee had welcomed the report and requested that an update be reported to a future meeting.

 

SN reported that the Committee had discussed how the Board would be assured on the due diligence process in providing a caretaker role for Swindon Community Health Services. NV commented that this was to be discussed at an Executive Away Day the following week in terms of understanding the risks, the governance and initial findings from the service reviews.  NV explained that the Executive Directors would highlight the key risk areas and issues as part of the due diligence exercise.

 

SN reported that the Governance Committee had received a report on how the Trust would have oversight of external review peer visits and how accreditations across the organisation were being mapped. It was noted that details of accreditations would be covered in the Quality Report to the Board.

 

Finally, SN explained that the Committee had considered a report on the performance of the Corporate Governance Team for Quarter 2 which had flagged that there were a number of policies and procedures which were overdue review.  ...  view the full minutes text for item 333.

334.

Quality Strategy pdf icon PDF 178 KB

Hilary Walker, Chief Nurse

Additional documents:

Minutes:

The Board considered a report that outlined an addendum to the Trust’s Quality Strategy to address the recommendations contained within the Well Led Governance Review regarding the alignment of key strategies to the Trust’s strategic objectives, priorities and values, while also using the opportunity to refresh the priorities and objectives in line with the changing context within which the Trust was now working.

 

RESOLVED

 

(a)   that the Quality Improvement Strategy addendum be endorsed; and

 

(b)   that it be agreed that progress updates shall be reported to the Board on a 6 monthly basis.

335.

Operational Performance Report pdf icon PDF 259 KB

Adrian Griffiths, Interim 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)) 

 

September 89.5% (not achieved)

Referral to Treatment +Incomplete standard (92%)

September 92.0% (achieved)

6 Week Diagnostic Wait

September 95.6% (not achieved)

Cancer Targets

2 Week Waits, 31 Day & 62 Day

August  Achieved except  2 week waits – 83.9%

 

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

 

LP highlighted that the “Right Patient Right Bed”(RPRB) performance was variable in month but the main areas of concerns were the number of patients streamed to the Urgent Care Centre and the number of medical patients admitted to the Ambulatory Care Unit as both these key performance indicators (kpi’s) supported flow and safety in the Emergency Department. LP explained that consideration was being given to escalation processes and a report on a Discharge to Assess model was to be presented later in the meeting.  

 

LP highlighted that the Delayed Transfer of Care (DTOC) position continued to deteriorate with a 4% rise in month and a 33.5% increase on this time last year; this equated to the loss of 920 bed days in month.

 

NV noted that for both Wiltshire and “Out of Area” patients the main reason for delay had been the lack of further acute care such as rehabilitation. Reference was made to the purchase of additional social care provision and an extension to the contract for therapies to support improvement in the delayed transfer of care (DTOC) position this winter, noting that GP practices had difficulty in recruiting staff.

 

LP highlighted that the Referral to Treatment (RTT) targets of 92% had been achieved in September. However to maintain the performance it had been necessary to outsource activity and to run additional weekend activity.

 

LP highlighted that 52 week waits continued to cause concern, noting that patients were being offered a choice too late in their pathway.  In response to a question by RH it was explained that the Trust was now aware where patients were on the pathway and offering options at 35 weeks.  LP explained that there would be a focus on improving the position.

 

LP highlighted that Theatre KPI performance had dipped in month.  However, future sessions were already booked. In response to a question from RH regarding the theatre start time, LP explained that theatre sessions would not commence unless a bed was available for the patient.

 

NV referred to theatre utilisation noting that a number of patients had not turned up for their surgery, some theatres had run out of time and other reasons contributing to the theatre utilisation level commenting that this should be an area for focus.  NV suggested that there should be a “deep dive” analysis into the 50 patients referred to in the report to understand  ...  view the full minutes text for item 335.

336.

Safer Staffing Monthly Exception Report pdf icon PDF 350 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 September the position was as follows: -

 

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

 

Registered Nurses

Auxiliary Nurses

Day Shift

88.8%

101.6%

Night Shift

99.2%        

103.3%

 

Temporary staff fill rate:

Shifts

Care staff

Registered Nurse Staff

Requested

1350

2949

Covered

940

2665

Not covered

410

284

Fill rate %

70%

90%

 

Average skill mix ratio (day): -

Registered Nurse Staff

61.6%

Care staff

38.4%

 

The report covered the following: -

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

 

HW commented that she was pleased to note that the registered nurse staff to care staff ratio was above 60%.  However this was still well below the national average. HW commented that the Divisional Directors of Nursing were concerned about the day to day adjustments to staffing on the wards noting that “one to one” close support was not always available. HW flagged to the Board that this would impact on Performance Indicators such as falls.

 

In response to a question from RH, HW responded that the critical point at which the staffing levels became unsafe was a professional judgement and would be different in each case.

 

In response to a question from JS, HW confirmed that the graph setting out the care hours per patient day related to Acute Trusts only which incorporated specialist Acute Trusts.

 

RESOLVED

 

that the report be received.

337.

Well Led Governance Review pdf icon PDF 297 KB

Carole Nicholl, Company Secretary & Head of Corporate Governance

Additional documents:

Minutes:

The Board was reminded that there had been a well led governance review earlier in the year using NHS Improvement’s Well Led Governance Review Framework.  A final report had been received and circulated to all Directors in August 2016. 

 

The Board received a report which provided details of the action plan which had been developed to address the findings of the review. This has been considered by the Governance Committee.

 

RESOLVED

 

(a)   that the Action Plan to address the findings of the Well Led Review be received;

 

(b)   that the Board agrees that it is assured by the Governance Committee that satisfactory arrangements are in place to address the findings of the Well Led Review; and

 

(c)   that it be agreed that appropriate governance arrangement are in place to ensure oversight and scrutiny of progress, it being noted that the Action Plan will be monitored through the Governance Committee with an Exceptions Report to the Board on a quarterly basis.

338.

Risk Management Strategy pdf icon PDF 100 KB

Carole Nicholl, Company Secretary & Head of Corporate Governance

Additional documents:

Minutes:

The Board received and considered a report which recommended amendments to the Risk Management Strategy.

 

CN explained that the main changes in the Strategy were as follows:-

·         an update to reflect a new Risk Escalation Framework,

·         an update to reflect risk accountabilities,

·         an update to reflect new Board Committees,

·         Clarification of use of paper based systems in community sites only when access to Safeguard was not available; and

·         an update to reflect NHS Improvement, not Monitor and job titles.

 

The Committee noted that the Risk Management Strategy has been considered by the Audit, Risk and Assurance Committee in September and recommended to the Board for approval.

 

RESOLVED

 

that the Risk Management Strategy be approved.

339.

Membership of Committees pdf icon PDF 152 KB

Carole Nicholl, Company Secretary & Head of Corporate Governance

Additional documents:

Minutes:

The Board considered a report which invited Directors to approve the Non-Executive Director membership of Board Committees and Non-Executive Director membership and invitees effective from 1 January 2017.  Detailed terms of reference were being finalised for approval via Board circular before 31 December.

 

The Board noted an amendment to the membership of Board Committees in that the Director of Strategy would be an attendee of the Charitable Funds Committee (it was not possible for the Director of Strategy to be a member of the Committee due to the need to maintain a majority of Non-Executive Directors and the Chief Executive was a member).  

 

RESOLVED

 

that the proposed membership of committees as set out in the report be approved with effect from 1 January 2017.

340.

Ratification of Decisions made via Board Circular/Board Workshop

Carole Nicholl, Company Secretary & Head of Corporate Governance

Minutes:

None.

341.

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.

342.

Date and Time of next meeting

Date: 1 December 2016

Time: 9:30am

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

Minutes:

It was noted that the next ordinary meeting of the Board would be held on 1 December 2016 at 9:30am in Trust Management Boardrooms, Trust HQ, 2nd Floor, Great Western Hospital, Swindon. However, it was noted that an additional meeting of the Board would be held on Thursday 17 November 2016.

343.

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 Community Health Services

·        PFI update

·        Discharge to Assess Resilience Model 2016-2017

·        Additional Resilience Capacity and operational changes to support GWHFT 2016/17

·        Wiltshire Health & Care Update

·        Consultant Issues

·        Board Assurance Framework

·        Senior Independent Director Appointment

·        Executive Committee Minutes

·        Finance, Investment and Performance Committee Minutes

·        Governance Committee Minutes

·        Mental Health Act and Mental Capacity Act Committee Minutes

·        People Strategy Minutes

·        Remuneration 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)

·         Sustainability & Transformation Plan and Annual Planning Update

·         Swindon Community Health Services

·         PFI – verbal update

·         Discharge to Assess Resilience Model 2016-17

·         Additional Resilience Capacity and operational changes to support GWHFT 2016-17

·         Wiltshire Health & Care – update

·         Consultant Issue

·         Board Assurance Framework

·         Appointment of Senior Independent Director

·         Executive Committee Minutes

·         Finance, Investment and Performance Committee Minutes

·         Governance Committee Minutes

·         Mental Health Act and Mental Capacity Act Committee Minutes

·         People Strategy Minutes

·         Remuneration Committee Minutes

·         Urgent Private Business (if any)

344.

Minutes

Roger Hill, Chairman

·        6 October 2016 (private minutes)

Minutes:

The minutes of the meeting of the Board held in private on 6 October 2016 were adopted and signed as a correct record subject to amendment.

345.

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. 

346.

Sustainability & Transformation Plan and Annual Planning Update

Kevin McNamara, Director of Strategy

Karen Johnson, Director of Finance

Minutes:

The Board received and considered a report together with a presentation which provided an update on the development of the Sustainability & Transformation Plan (STP), since the June 2016 submission and the July Board Paper, as part of the BaNES, Swindon and Wiltshire footprint. 

347.

Swindon Community Health Services

Kevin McNamara, Director of Strategy

Minutes:

The Board received and considered a report which provided an update on Swindon Community Health Services.

348.

PFI - verbal update

Kevin McNamara, Director of Strategy

Minutes:

The Board received a verbal update regarding the Private Finance Initiative (PFI) agreement.

349.

Discharge to Assess Resilience Model 2016-2017

Linda Power, Deputy Chief Operating Officer

Minutes:

The Chairman welcomed Tom Kearney (TK) to the meeting who presented this item.

 

The Board considered a report which provided details of an additional supported discharge resource, namely a 20 week pilot throughout Q3 and Q4 2016-17.  It was explained that the Discharge to Assess Resilience Model would provide additional hours of care, nursing and therapy assessments and support in the Community post admission to the hospital where normally patients would have remained in the hospital awaiting therapy assessment and/or package of care.  The Board supported the model.

350.

Additional Resilience Capacity and operational changes to support GWHFT 2016/17

Linda Power, Deputy Chief Operating Officer

Minutes:

The Board received a paper which outlined the additional demand which was is projected for Great Western Hospital NHS Foundation Trust throughout Quarter 3 and Quarter 4 of 2016 -2017 and a summary outline of system wide resilience and mitigation to support demand management and acute care. The paper focussed on acute attendance and admission management measures.

351.

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 (WH&C) on matters of relevance to the Trust and set out the routine performance report.

352.

Consultant Issue

Oonagh Fitzgerald, Director of Human Resources

Minutes:

The Board received a report which provided details of a consultant issue.

353.

Board Assurance Framework

Carole Nicholl, Company Secretary & Head of Corporate Governance

Minutes:

The Board received and considered a report which set out the Board Assurance Framework (BAF).  This had been updated to include gaps in controls, actions and sources of assurances.  It was noted that in addition a dashboard had been included which mapped the metrics being considered to provide assurance against each strategic risk.  The Board received the Board Assurance Framework.

354.

Appointment of Senior Independent Director

Carole Nicholl, Company Secretary & Head of Corporate Governance

Minutes:

Steve Nowell had declared a personal interest in this item and left the meeting during its consideration.

 

The Board noted that at the meeting of the Council of Governors held in September Governors had been consulted on the Senior Independent Director (SID) appointment and had supported the proposal that Steve Nowell be appointed into the role.   Steve Nowell was appointed to the position for the remainder of his term of office ending 31 May 2017.

355.

Executive Committee

Nerissa Vaughan – Committee Chair

·        18 October 2016 (verbal report)

·        20 September 2016 (enclosure)

Minutes:

The minutes of the meeting of the Executive Committee held on 20 September 2016 were received.  Furthermore, it was noted that a meeting of the Executive Committee had been held on 18 October 2016.

356.

Finance, Investment and Performance Committee

Liam Coleman – Committee Chair

·        24 October 2016 (writtent report)

·        26 September 2016 (enclosure)

Minutes:

The minutes of the meeting of the Finance, Investment and Performance Committee held on 26 September 2016 were received.  Furthermore, it was noted that a meeting of the Finance, Investment and Performance Committee had been held on 24 October 2016.

357.

Governance Committee

Steve Nowell – Committee Chair

·        20 October 2016 (written report)

·        22 September 2016 (enclosure)

Minutes:

The minutes of the meeting of the Governance Committee held on 22 September 2016 were received.  Furthermore, it was noted that a meeting of the Governance Committee had been held on 20 October 2016.

358.

Mental Health Act and Mental Capacity Act Committee

Nick Bishop – Committee Chair

·        2 September 2016 (enclosure)

Minutes:

The minutes of the meeting of the Mental Health Act and Mental Capacity Act Committee held on 2 September 2016 were received. 

359.

People Strategy Committee

Jemima Milton – Committee Chair

·        16 September 2016 (enclosure)

Minutes:

The minutes of the meeting of the People Strategy Committee held on 16 September 2016 were received. 

360.

Remuneration Committee

Liam Coleman – Committee Chair

·        24 October 2016 (verbal report)

Minutes:

The Board received a verbal report of the meeting of the Remuneration Committee held on 24 October 2016.

361.

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.