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Agenda and draft minutes

Venue: Board Rooms, Trust HQ, Great Western Hospital, Swindon. View directions

Contact: Carole Nicholl  01793 605171

Items
No. Item

362.

Apologies for Absence and Chairman's Welcome

Minutes:

There were no apologies for absence from members of the Board.  However, the Board noted that Peter Pettit had intended to be present at the meeting to receive an answer to a question he had raised.  However he was unable to attend as planned and had submitted his apologies for absence..

363.

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.

364.

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

Minutes:

Peter Pettit, a Public Governor asked “would it be appropriate for the Trust Board to receive an annual report of the work being undertaken by Trust volunteers, an assessment of its value to the Trust and future plans for sustaining and developing this work”.

 

OF responded that she was responsible for the volunteer strategy including supporting the volunteering community in the Trust. The contribution of the Trust’s 307 volunteers including the monthly hours contribution (2,532 hours per month) and 55 areas of the Trust where there were fantastic volunteers was reported to the Board, through the annual report.  

 

OF reported that the Trust’s strategy since 2014 had been to extend the volunteering offer. In 2014, the Trust had secured funding through NESTA (£100k for 18months) to establish the home from hospital service with WRVS which was still in operation and the roles and contribution of volunteers was extended to include, for example musical therapy for patients. The service offer still included patient befriending, supporting patients with mealtimes, way-finding, patient information and support with administration. The Trust had many long serving volunteers and each year an event was hosted to celebrate the contribution of volunteers.

 

OF explained that importantly, the Trust also had 78 students who were volunteers.  Many former student volunteers had subsequently pursued careers in health or had joined the bank of temporary workers or a substantive job.

 

Finally, OF undertook to expand this the annual report and agreed to provide further updates on the work of volunteers every six months through the Performance, People and Place Committee.

365.

Minutes pdf icon PDF 555 KB

Roger Hill, Chairman

·        3 November 2016 (public and summary of private minutes)

Minutes:

The minutes of the meeting of the Board held on 3 November 2016 were adopted and signed as a correct record, subject to the following amendment: -

 

Minute 328/16 - Finance Report

Deletion of the sentence “KM advised that he was now in receipt of a report from CIPFA about potential savings on the PFI which he would discuss with KJ and report to the Board” and the substitution thereof with the words “KM advised that he was now in receipt of a report from CIPFA and business case about potential savings on the PFI which he would discuss with KJ and report to the Board”.

 

Arising upon consideration of this item, KJ updated the Board explaining that the Trust had been due to receive a Sustainability and Transformation Funding (S&TF) payment on 22 November.  However on that day, the Trust instead received notification from NHS Improvement that payment would not be made and as such the Trust had been required to draw down £1.5m loan, which was subsequently repaid on receipt of the S&TF.  KJ advised that she had again made representations to NHS Improvement around the unfairness of this and the impact of the Trust’s ability to manage its cash position.  Other members of the Board agreed that this was unreasonable.

 

In response to a question from JS, KJ explained that a further payment was due in September but there was no guarantee it would be received as expected.  However, KJ commended the speed at which NHS Improvement had responded to the Trust’s need for cash.

 

In response to a question from RB, KJ explained that interest payments applied for the loan period which in this case was for one week.

 

AC referred to prioritising the payments to debtors and KJ confirmed that she was considering this for report back through the Finance, Investment and Performance Committee.  KJ explained that she had informed NHS Improvement of the Trust’s need to manage its creditor position. KJ commented that she would be meeting with NHS Improvement next week to discuss the creditor position and to review cash flow.

 

Arising upon this RB asked that the Finance, Investment and Performance Committee should looked at aged debtors and opportunities to net those off.

 

 

 

366.

Outstanding actions of the Board (public) pdf icon PDF 201 KB

Minutes:

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

 

264/16

Recruitment & Retention Reporting

OF reported that the People Strategy Committee had confirmed the launching of the new recruitment campaign with the support of the Communications Team.

 

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

367.

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 scheduled for 5 December 2016. Any 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.

 

Governor Elections

 

Public Constituencies - A Contested Election was held for five governor seats to serve for a three year term in the Swindon Constituency and one governor seat in the West Berkshire & Oxfordshire Constituency. It was reported that Ros Thomson, Louise Hill and Kevin Parry and been successfully re-elected while Roger Stroud and Rosemarie Phillips had also been elected to represent the Swindon Constituency. The Chairman highlighted that Peter Pettit had been re-elected to represent the West Berkshire & Oxfordshire Constituency.

 

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

 

Staff Constituency - An uncontested election was held for four seats to serve for a three year term in the Staff Constituency. Peter Hanson was duly re-elected for the Doctors and Dentists Sub-Class and Claire Brooks was elected to the Allied Health Professionals Sub Class. It was reported that two governor vacancies remained, one in the Hospital Nursing & Therapy and Administrators sub-class and one in the Maintenance, Auxiliary and Volunteers Sub Class.

 

Nominated governors - RH reported that Phrynette Morrison had resigned as a Governor representing the Swindon & North Wiltshire Health & Social Care Academy as she no longer met the eligibility criteria. It was noted that a replacement governor had been invited.

 

Lead & Deputy Lead Governors

The Chairman reported that Margaret White and Peter Pettit had been re-elected as Lead & Deputy Lead Governor respectively for a one year term ending November 2017.

 

RESOLVED

 

that the report of the Chairman be received.

368.

Chief Executive's Report pdf icon PDF 182 KB

Nerissa Vaughan, Chief Executive

Additional documents:

Minutes:

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

 

·         Improvements recognised in the Emergency Department

·         Providing healthcare in the Swindon community

·         Groundwork begins on new radiotherapy unit

·         Sustainability and Transformation Plan

·         Delayed discharges

·         Trust joins forces with national colleagues to improve hip fracture care

·         Celebrating 25 years of breast screening in Wiltshire

·         World Antibiotic Awareness Week.

 

Warning notice lifted - In presenting the report NV highlighted that the warning notice, previously imposed on the Emergency Department had been lifted following an unannounced inspection by the Care Quality Commission (CQC) in October. It was explained that the inspectors had seen improvements which were sufficient to result in the warning notice being lifted.

 

Swindon community healthcare services - NV reported that work to manage Swindon community healthcare services continued.  The Trust had now received a copy of the report from the CQC on their inspection of services in September 2016 when services were under the management of SEQOL. Arising upon consideration of this, NB commented that the wording within the report should be clarified to highlight that the CQC had not given a rating to SEQOL services as opposed to the CQC “did not rate the service” and this was noted.

 

Radiotherapy centre - NV explained that the construction work on the Radiotherapy Centre had begun in November 2016. Fund-raising was progressing.

 

Sustainability & Transformation Plan - It was reported that a draft summary of the local Sustainability & Transformation Plan (STP) had been published on the Trust’s website in November. The full publication of the STP was due in January 2017. NV advised that public engagement within the area would commence in the New Year.

 

Breast Centre - NV reported that a special tea party had been held in the Breast Centre to celebrate 25 years of Wiltshire’s Breast Screen service.  This was a remarkable achievement.  In response to a question from NB, GR explained that the Breast Centre’s target to see 93% of patients referred only to symptomatic treatment of patients. 

 

Integrated performance information – NV introduced an integrated performance page of her report which would be included as appendix to future reports.  The page was split into quadrants covering quality service, performance, our people and financial health.  The intention of the page was to provide headlines under each which should be drawn to the attention of the Board, with detail covered off in the Executive summary sheets elsewhere on the agenda.  NV invited comments on the report. 

 

JS welcomed the page commenting that some brief detail on trends would be helpful and an indication if the situation was deteriorating or improving.   AC suggested that it would be beneficial to understand what good looked like and as such brief details of percentages or targets would be helpful.

 

An amendment to the report was noted in the ED performance year to day was 89.4% and not 93.3% as set out in the report.

 

RESOLVED

 

that the report of the Chief Executive be received.

369.

Finance Report pdf icon PDF 112 KB

Karen Johnson, Director of Finance

Additional documents:

Minutes:

The Board received and considered a report on finance for month 7, together with a presentation as follows: -

 

Actual Operating costs

In month surplus of £615.00. Total surplus of £111k compared to a target surplus of £478k year to date (variance of £367k worse than plan).

Contractual Income

£21.1m in month and £155.0m year to date (£0.3m below budget year to date).

Total Income

£26.6m in month and £185.3m year to date (variance of £1.3m below budget Year to date).

Income Activity highlights

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

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

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

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

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

Total Expenditure

 

£26.6 in month and £185.2m year to date (variance of £0.9m below budget year to date).

Expenditure highlights in month:

·         Drugs £0.2m above budget (£1.1m above budget year to date).

·         Pay £0.4m above budget (£0.6m above budget Year to date).

·         Supplies £0.3m above budget (£1.2m above budget year to date).

EBITDA

7.8% Year to date

Savings

Savings plan of £14.24m of which all had now been identified.

£1.0m Cost Improvement Plans (CIPs) delivered in month against a budget of £1.1m.

£7.6m delivered against a budget of £8.3m year to date (£0.8m below budget).

Debtors

£56.5m debtors and stock

£14.2m above plan

Creditors

£57.7m creditors

£3.1m under plan

Cash

£1.8m (£3.0m under plan)

Loan

No Further Loans Agreed

Reserves

TBC

Forecast

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

Finance Risk Ratings

Use of Resources (UoR) 3 (Rating 1 is now top and 4 is bottom).

 

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

 

Financial performance - KJ reported that the Trust had recorded an in month surplus of £615.00 which had been £367k behind plan due to delayed payments of Sustainability and Transformation Funding (S&TF). KJ informed the Board that concerns regarding the timely payments of the S&TF had been raised with NHS Improvement (NHSI).

 

KJ advised that the year-end position was being closed down with each Division finalising their annual budgets. Discussions continued to take place to agree levels of activity due to be outsourced and levels of reserves required to be released. KJ highlighted that the Finance, Investment & Performance Committee had discussed the recovery plan as reserve cash levels had reduced to £1m with further cost pressures expected with winter activity pressures.

 

Activity - Patient activity levels continued to rise in October 2016 particularly around elective inpatient and non-elective admissions. KJ expressed concern that the Trust was operating at over 100% capacity and if this continued then patients would require treatment at premium rates through outsourcing or by paying staff to work overtime.

 

KJ advised that the discussions continued to close down the commissioning year end position with Swindon Clinical Commissioning Group (CCG). Agreement of a year-end position  ...  view the full minutes text for item 369.

370.

Chair of Finance, Investment & Performance Committee Overview pdf icon PDF 155 KB

Liam Coleman, Non-Executive Director

Minutes:

The Board considered a report which summarised the key issues from a meeting of the Finance, Investment and Performance Committee held on 21 November 2016 which it was considered should be drawn to the attention of the Board covering the following: -

 

·         Overall financial performance

·         Income and activity

·         Year end forecast

·         Debtors and creditors

·         Balance sheet and cash

·         Capital spend

·         Rolling cash forecast

·         Cost Improvement Programme (CIP) overview

·         Agency spend progress report

·         Operational Performance Report

·         Swindon Community Healthcare Services

 

SN presented the paper highlighting that the Trust’s forecast outturn position remained a deficit of £234k and that the cash position remained challenging.  It was noted that the Committee had asked the Director of Finance to ensure greater scrutiny of capital expenditure with a focus on review and prioritisation of schemes.

 

The Committee had received a summary of the top ten debtors and creditors and had discussed trends over the past six months.  SN reported that the Council of Governors had questioned whether there were any smaller creditors who might be at risk of going out of business should the Trust fail to make prompt payment.  KJ noted this and undertook to raise this with the Finance Team.

 

The Committee had received a report detailing agency spend and reasons for this over the past two years.  Additional information had been sought by the Committee and a further paper would be presented to the Committee in January 2017.

 

Finally it was explained that the Committee had discussed the operational performance report and had noted actions underway to improve performance in the Emergency Department.

 

RESOLVED

 

that the report be received.

371.

Risk Management - Risk Tolerance Statement pdf icon PDF 164 KB

Carole Nicholl, Director of Governance & Assurance / Company Secretary

Additional documents:

Minutes:

The Board considered a report that set out proposed changes to the Trust’s Risk Tolerance Statement. The revised statement reflected feedback from the Audit, Risk and Assurance Committee from its meeting held in November.

 

The Board discussed the rationale behind proposed levels of tolerance for risk relating to patients, the organisation, opportunities, compliance including legal requirements and reputation.     It was commented that whilst a risk tolerance statement could be set, it would be acceptable to move outside the tolerance levels if appropriate mitigation measures were in place.

 

In response to a question from RH, JS commented that the Audit, Risk & Assurance Committee had discussed risk scenarios and what the appetite might be.  Whilst it was considered that there could be a greater appetite for organisational risk, appetite for reputational risk was less.  In addition risks to patients should be avoided.    It was noted that the statement was a tool for management for them to use to inform their decision making around risk.  LC suggested that it would be useful to include assessment of risk in business cases against the appetitive statement.

 

The Board supported the statement but concluded that the chart should be removed to avoid any confusion noting that the matrix appended to the statement was sufficiently informative.

 

RESOLVED

 

that the Risk Tolerance Statement be agreed as set out in the report subject to the chart being removed.

372.

Improvement Plan Update pdf icon PDF 397 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 advised that the Improvement Committee continued to meet on a monthly basis to monitor outstanding actions and to test embeddedness of improvement.  It was flagged that the Emergency Department Steering Group had now concluded with roll out of remaining actions being overseen by the Divisional management and the Improvement Committee

 

It was flagged that the Improvement Committee had discussed its future role, noting that it had originally been intended that the Committee would be time limited to oversee the roll out of the improvement plans arising from the CQC inspection report.  However, as a further inspection was planned for March 2017, it was proposed that changes be made to the Committee’s Terms of Reference to allow monitoring of progress against outstanding actions, but also to provide an additional focus on preparation for the next inspection.

 

Following a question from RH, HW explained that the Trust would be required to provide a self-assessment of its services, but the approach to informing this had yet to be agreed.  In response to a further question raised it was reported that it was likely that the CQC would focus on improvements made to address concerns in the previous inspection.

 

In response to a question from NV, HW confirmed that Non-Executive Directors would continue to be informed of improvements and updates to action plans through the Governance Committee.

 

JS highlighted that internal audits had also provided additional areas of focus ahead of the next inspection.

 

Reference was made to the outstanding actions, notably the implementation of electronic white boards.  HW clarified that the use of whiteboards had been proposed by the Trust as a tool for tracking and reviewing Deprivation of Liberty (DoLS) applications and it was noted that all wards would be using white boards by the end of December 2016. In the meantime, a safe manual system was in place to monitor DoLS applications until they could be electronically managed. In response to a further comment made around CQC requirements, it was explained that the CQC had raised concerns regarding that need for timely DoLS applications and that white boards were proposed by the Trust.

 

RESOLVED

 

that the report be received.

373.

Quality Report pdf icon PDF 145 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 October were as follows: -

 

·         The provisional Hospital Standardised Mortality Rate (HSMR) for April 2016 to July 2016 was 93.25.

·         There had been 2 reported cases of Clostridium difficile during October 2016 with a current rate of 9.8 per 100,000 bed days.

·         2 Serious Incidents had been reported during October.

·         There were 396 overdue investigations into incidents (by more than 14 days, 333 of which related to clinical incidents).

 

Hospital Standard Mortality Rate (HSMR) - GR reported that the Trust’s HSMR was at 98.4 which was better than expected nationally.

 

Local Assessments against National Reports - GR advised that the National Paediatric Diabetes Audit had highlighted that the Trust had made significant improvements to HcA1c level monitoring.

 

Clinical Incidents - HW highlighted that two serious incidents had been reported in October 2016 relating to paediatric care. HW explained that both incidents had been investigated however no commonalities had been found between the two cases.

 

Serious incidents - HW advised that there were five outstanding overdue serious incident action plans.  However the Patient Quality Committee continued to scrutinise progress of actions by Divisional management. In response to a question from NB, HW advised that all serious incidents were reviewed to ensured that they were not classified as a never event.

 

Complaints, Concerns & Compliments - HW reported that overcrowding in the Emergency Department (ED) continued and therefore this was the service area which received the highest number of complaints. It was highlighted that this would be a continuing concern due to increasing activity levels and attendance in ED. It was noted that the continued activity pressures was having a negative impact on staff morale in the Emergency Department. HW highlighted that projects including Discharge to Assess and Right Patient, Right Bed would help to relieve some pressure within ED. NV commented that discussions with other specialities had taken place to raise awareness of the pressures in the hospital and encourage all areas to help where possible. It was noted that an additional meeting with the consultant body had taken place with 70 consultants attending.  NV commented on a willingness throughout the hospital to support each other in providing safe care and improving patient flow.

 

Close patient support - HW expressed concern that despite an increase in agency spend there had been poor levels of close patient support. HW commented that incidents regarding falls prevention and mental health were being raised.

 

Patient feedback - In response to a concern raised by JS, HW advised that the Governance Committee had already highlighted the need to review the Trust’s response to patient feedback which it was suggested could be different, including more sensitive to the patients concerns.    

 

Friends and Family (F&F) response rates - The Board recognised the need to improve Friends and Family (F&F) response rates. HW advised that technological solutions were being sought,  ...  view the full minutes text for item 373.

374.

Chair of Governance Committee Overview pdf icon PDF 165 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 17 November 2016 covering the following: -

 

·         Improvement Plan Update

·         Quality Report

·         Quality Impact Assessments Review

·         Safer Staffing Monthly Exception Report

·         Swindon Community Services

·         Equality & Diversity Update

·         Staff Code of Conduct

 

Improvement - In presenting the paper SN reported that the Committee had considered an update on the progress of milestone actions to deliver improvement in response to the Care Quality Commission (CQC) inspection report.

 

Cleanliness - SN explained that the Committee had scrutinised the Quality report and had focused on cleanliness standards due to performance dipping below the 95% standard. SN advised that improvements were expected to be reported in the December 2016 Quality Report.

 

Quality Impact Assessments - The Committee had received a report which provided an update on the review of Quality Impact Assessments and assurances were received that appropriate scrutiny was placed on cost improvement plans with robust processes in place to ensure high standards of quality. 

 

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.

375.

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)) 

 

October 85.3% (not achieved)

Referral to Treatment +Incomplete standard (92%)

October 92.0% (achieved)

6 Week Diagnostic Wait

October 99.07% (achieved)

Cancer Targets

2 Week Waits, 31 Day & 62 Day

September Achieved except  2 week waits – 75.5%

 

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

 

Emergency Department (ED) 4 hour wait access standard

AGr reported that the Trust had achieved 85.3% against the 95% standard.  AGr explained that this had been due to the continuance of high numbers of attendance and admissions throughout the summer and a large increase in the numbers of patients being admitted to hospital in October.  AG highlighted that acute admissions had increased in October by 8.7% (272 patients) compared to October 2015.   NV commented on the need to drive improvement in performance which was dropping.

 

AG commented that the Urgent Care Strategy had been produced on the assumption that Delayed Transfers of Care (DToC) would reduce but these had increased by 33.5% compared to October 2015. However, it was noted that average length of stays had reduced in October to circa 4 days.

 

Reference was made to winter mitigation plans and it was reported that from December 2016 8 beds would be ring-fenced on Shalbourne for NHS patients. AGr reported that Ambulatory Care would be relocated to the Clover building in January 2017 where the service would be able to fully operate, resulting in reduced length of stay.   There would be a further 11 in-patient beds which amounted to an additional 19 beds in total. KM advised that there were also a further 4 beds in SWICC.  In response to a question from HW around staffing the additional beds, AGr reported that the Teams had been asked to consider alternative staffing options.

 

Discharge to Assess

The Board discussed performance of the Discharge to Assess model which had been introduced on 16 November.  Early data up to 25 November showed that the initiative had generated the equivalent of 2 beds per day.  16 patients had benefits from the model with 12 patients going back to the same level of independence they had prior to their hospital stay. AGr advised that the model was still in the early stages of roll out.  However progress was being made and the number of patients waiting discharge had reduced.

 

7 day working

Reference was made to 7 day working and it was explained that weekend working was being explored with pharmacy support.  It was thought that this might result in increased discharges and less pressures during the week.  

 

Occupancy

In response to a question raised by RB and JS, the Board discussed recent correspondence from NHS England on bed occupancy percentages.  It  ...  view the full minutes text for item 375.

376.

Emergency Preparedness Resilience & Response (EPRR) Assurance Report pdf icon PDF 85 KB

Adrian Griffiths, Interim Chief Operating Officer

Additional documents:

Minutes:

The Board received and considered a report which outlined the Trust’s assurance return against the NHS Core Standards for Emergency Preparedness, Resilience and Response (EPRR).  It was noted that the core standards set out the minimum standards which must be met by NHS organisations and providers of NHS funded care.  Each year NHS England conducted an assurance process in line with the core standards giving a rated assessment.  Of the 51 core standard, 47 were applicable to acute trusts of which there were 5 against which the Trust was not compliant, but there was evidence of progress in the work plan.

 

In addition the paper provided a summary of iRespond: modular planning and response system, which was the system used to drive the resilience agenda.

 

In presenting the report AG explained that the Great Western Hospital was not a mass casualties hospital and therefore major trauma patients would be diverted to Oxford.

 

AG commented that iRespond had been developed by the Resilience Team and was a well-managed platform which was being adopted by the majority of NHS organisations within Swindon and Wiltshire.

 

RESOLVED

 

(a)   that NHS England’s Core Standards for Emergency Preparedness, Resilience and Response 2016 be noted; and

 

(b)   that the assurance return against the core standards be confirmed.

377.

Freedom to Speak Up - Update pdf icon PDF 397 KB

Oonagh Fitzgerald, Director of Human Resources

Minutes:

The Board received and considered a report which provided assurance that the Trust was taking steps to create an effective culture whereby staff felt safe and confident in their ability to raise concerns.

 

In presenting the report OF explained that there had been a focus on creating a culture of safety and the Trust was already ahead of other organisations by adopting Guardians.

 

OF highlighted that the Care Quality Commission (CQC) had felt that the Trust was open and had a good culture for reporting. It was reported that the ‘Freedom to Speak Up’ culture had resulted in concerns being raised by staff and addressed with reporting through to the Board.  OF advised that the Trust remained within normal benchmarking levels for reporting concerns (as identified through the staff survey results).

 

OF explained that there was a need to appoint a new Guardian, to replace Liam Coleman whose term of office as Non-Executive Director ended on 31 December 2016. It was noted that a replacement for Douglas Blair, former Director of Community Services was also required.

 

In response to a question from JS, OF reported that she had not tested whether staff perceived “Freedom to Speak Up” as a positive tool or a barrier to escalation. OF explained that initial feedback had been positive, however further work was required to assess the full impact of the framework.

 

In response to a question from JM, OF confirmed that a freedom to speak up guardian would be identified to representative Swindon Community Healthcare Services staff.

 

In response to a question from SN, OF highlighted that benchmarking data on freedom to speak up had yet to be published as this was new national policy.  

 

RESOLVED

 

(a)   that the report be received;

 

(b)   that the role models, of a ‘Freedom to Speak Up’ culture be supported; and

 

(c)   that it be noted that guardians have yet to be identified to replace Liam Coleman, Non-Executive Director and Douglas Blair, former Director of Community Services and to ensure a representative for Swindon Community Healthcare Services staff.

378.

Safer Staffing Monthly Exception Report pdf icon PDF 362 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 October the position was as follows: -

 

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

 

Registered Nurses

Auxiliary Nurses

Day Shift

89.58%

100.4%

Night Shift

102.8%        

101.9%

 

Average skill mix ratio (day): -

Registered Nurse Staff

62.1%

Care staff

37.9%

 

HW reported that there had been an increase in the fill rate for registered nurses however there had been a decrease in the fill rate for unregistered nurses.

 

HW reported that there remained a national focus to improve the size of the nursing workforce and she undertook to report to the Performance, People and Place Committee on emerging legislation, an explanation of the register nurse role versus all other roles and an outline of the national picture.  

 

RESOLVED

 

(a)   that the report be received;

 

(b)   that it be noted that the Chief Nurse will report to the Performance, People and Place Committee on emerging legislation, an explanation of the register nurse role versus all other roles and an outline of the national picture.

 

379.

Briefing paper on actions being undertaken following the GMC survey on medical trainees pdf icon PDF 83 KB

Guy Rooney, Medical Director

Additional documents:

Minutes:

The Board received and considered a report which provided a summary of feedback from the from the National Annual General Medical Council (GMC) Medical Trainee Survey.

 

In presenting the report GR explained that the annual survey had shown that the scores had declined when compared to 2015 results. GR commented that the Trust had performed worse than neighbouring Trusts with concerns raised regarding workload, workforce and levels of supervision.  Action plans were in place to address areas of concern with a focus on improving teaching.  GR expressed concern that additional resources were not available across the NHS to support improvement.

 

In response to a question from SN, GR explained that the responsibility for training and supervision lay with Clinical leads and Associate Medical Directors.  GR highlighted that the Trust employed a low number of junior doctors and was not a teaching hospital.

 

In response to a question from AC, GR advised that the Trust remained in the bottom third of national rankings following publication of the survey results. 

 

RESOLVED

 

that the report be received.

380.

People Strategy 2014-2019 - six month progress report (April to September 2016) pdf icon PDF 689 KB

Oonagh Fitzgerald, Director of Human Resources

Minutes:

The Board considered a report which provided details of the nursing and midwifery 6 monthly skill mix review undertaken against the current establishments.

 

In presenting the report OF explained that the Trust had 347 vacancies which resulted in increased pressure on substantive staff and increased the reliance on agency staff.

 

OF reported that overseas recruitment of nurses had been successful however many candidates had struggled to pass the ILS English Language assessment. OF commented that the assessment was set at a very high academic level and included some unusual and difficult subject areas.

 

OF highlighted that staff turnover rates remained higher than expected however a retention plan was being rolled out across the Trust.

 

The People Strategy Committee had continued to support staffing to enable them to continue to provide effective levels of care. This included monitoring sickness rates and physical activity.  OF reported that the Trust benchmarked well for sickness absence.Also,despite high workloads the Trust continued to reward the efforts of staff through various recognition schemes. 

 

OF reported that the Trust had been visited by the Early Years Minister, Caroline Dinenage as the Trust had been part of a pilot of providers offering 15 hours of free childcare a week for 3 to 4 year olds. It was noted that this had been received positively by staff with100 staff benefiting from the scheme.

 

In response to a question from RH, OF undertook to bring a paper to the next Board meeting to report on the range of issues surrounding the relaxation of nurse apprentice schemes.

 

In response to a question from AC, OF explained that each Division had a recruitment panel which assessed the service need for all non-clinical vacancies. It was noted that Executive scrutiny was provided at Vacancy Review Panel (VRP) meetings.

 

RESOLVED

 

a)    that the report be noted

 

b)    that OF present a paper to the next Board meeting regarding nurse apprentice schemes

381.

Chair of Audit, Risk & Assurance Committee Overview pdf icon PDF 160 KB

Julie Soutter, Non-Executive Director

Minutes:

The Board received a report from the Chair of the Audit, Risk & Assurance Committee which  summarised key issues considered by that Committee at its meeting held on 17 November 2016 covering the following: -

 

·         15+ Risk Register / Board Assurance Framework – Strategic Risks / Risk Tolerance Statement

·         External Audit progress report and technical update

·         PwC Audit – Reference Costs

·         Internal audit progress report 2016-17

·         IT Infrastructure and Security

·         Referral to Treatment (RTT) Informatics Turnaround Update

·         Client Briefings

·         Audit Reporting Protocol

·         Counter Fraud Report

·         E-Rostering

·         Staff Code of Conduct

·         Audit Committee Effectiveness Plan 2016/17 – update on actions/annual effectiveness review

·         Contracts Waivers and Extensions

·         Losses and Compensations

 

Risk management - JS commended the work to date in developing the Board Assurance Framework (BAF) and roll out of the refreshed risk management processes commenting that risks to delivery of strategic objectives were being flagged and considered with areas for focus or further scrutiny were being identified, notably around staff recruitment and retention;  IT system, equipment and capacity.  The Committee had considered the Board’s appetitie for risk and had suggested amendments to the Risk Tolerance Statement as discussed earlier in the meeting.

 

­Declarations of Interest - The Committee had received a report on the roll out of the Staff Code of Conduct – Declarations of Interest Policy which had been approved earlier in the year.  The Committee had noted that new guidance on gifts and hospitality was expected from NHS England in the New Year and this would provide an opportunity to consider a combined approach for declaring interests and declaring gifts and hospitality, possibly with a link to the annual appraisal process.

 

Reference costs - JS explained that the Committee had considered the PwC Audit of reference costs reference costs and actions arising.

 

Internal audit progress report 2016-17 – JS commented that the internal audit progress report had been considered which set out audit findings in relation to service reviews, listing actions completed to date to improve systems and process and actions pending completions. JS highlighted that weaknesses had been identified in systems relating to waiting list initiatives and actions would be taken to address this.  

 

Committee effectiveness – JS advised that the Committee had proposed amendments to the Committee Effectiveness review questionnaire noting that each Committee required a core set of questions in addition to questions specific to each committee.

 

Audit reporting protocol - It was noted that the Committee had agreed that all internal audit reports would be first reviewed by the Audit, Risk and Assurance Committee and then the report would be coped to the chair of the relevant Board committee for review.

 

Contract waivers and extensions - JS explained that revised internal actions relating to contract waivers and extensions had proved beneficial with improved systems and reporting.

In response to a request from RB, NV confirmed that the Board would receive a presentation on the IT Strategy at its meeting in January.

 

RESOLVED

 

that the report be received.

382.

Ratification of Decisions made via Board Circular/Board Workshop

Carole Nicholl, Director of Governance & Assurance / Company Secretary

Minutes:

None.

383.

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.

384.

Date and Time of next meeting

Date: 5 January 2017

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 5 January 2017 at 9:30am in Trust Management Boardrooms, Trust HQ, 2nd Floor, Great Western Hospital, although an additional meeting of the Board would be held on 15 December 2016.

385.

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

·        Swindon Community Health Services – Board Update

·        Community Estates Update

·        Clinical Strategy Update

·        Wiltshire Health & Care Update

·        Audit, Risk and Assurance Committee Minutes

·        Executive Committee Minutes

·        Finance, Investment and Performance Committee Minutes

·        Governance Committee Minutes

·        People Strategy 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)

·        Swindon Community Health Services – Board update

·        Community Estates – Update

·        Update of Clinical Strategy

·        Wiltshire Health & Care – Update

·        Audit, Risk and Assurance Committee Minutes

·        Executive Committee Minutes

·        Finance, Investment and Performance Committee Minutes

·        Governance Committee Minutes

·        People Strategy Minutes

·        Remuneration Committee Minutes

·        Urgent Private Business (if any)

386.

Minutes

Roger Hill, Chairman

·        3 November 2016 (private)

Minutes:

The minutes of the meeting of the Board held in private on 3 November 2016 were adopted and signed as a correct record.

387.

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. 

388.

Swindon Community Health Services - Board update

Kevin McNamara, Director of Strategy

Minutes:

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

389.

Community Estates - Update

Kevin McNamara, Director of Strategy

Minutes:

The Board received and considered a report which provided an update on the community estate.

390.

Update of Clinical Strategy

Guy Rooney, Medical Director

Minutes:

The Board received and considered a report which provided a summary of the current outputs against the markers within the Trust’s Clinical Strategy.

391.

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 which included a performance report.

392.

Audit, Risk and Assurance Committee

Julie Soutter – Committee Chair

·        17 November 2016 (written report)

·        15 September 2016 (enclosure)

Minutes:

The minutes of the meeting of the Audit, Risk and Assurance Committee held on 15 September 2016 were received.  Furthermore, it was noted that a meeting of the Audit, Risk and Assurance Committee had been held on 17 November 2016.

393.

Executive Committee

Nerissa Vaughan – Committee Chair

·        15 November 2016 (verbal report)

·        18 October 2016 (enclosure)

Minutes:

The minutes of the meeting of the Executive Committee held on 18 October 2016 were received.  Furthermore, it was noted that a meeting of the Executive Committee had been held on 15 November 2016.

394.

Finance, Investment and Performance Committee

Liam Coleman – Committee Chair

·        21 November 2016 (written report)

·        24 October 2016 (enclosure)

Minutes:

The minutes of the meeting of the Finance, Investment and Performance Committee held on 24 October 2016 were received.  Furthermore, it was noted that a meeting of the Finance, Investment and Performance Committee had been held on 21 November 2016.

395.

Governance Committee

Steve Nowell - Committee Chair

·        17 November 2016 (written report)

·        20 October 2016 (enclosure)

Minutes:

The minutes of the meeting of the Governance Committee held on 20 October 2016 were received.  Furthermore, it was noted that a meeting of the Governance Committee had been held on 17 November 2016.

396.

People Strategy Committee

Jemima Milton – Committee Chair

·        18 November 2016 (verbal report)

Minutes:

It was noted that a meeting of the People Strategy Committee had been held on 18 November 2016.

397.

Urgent Private Business (if any)

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

Minutes:

None.