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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

438.

Apologies for Absence and Chairman's Welcome

Guy Rooney, Medical Director

Minutes:

Apologies for absence were received from Kevin McNamara, Guy Rooney and Nerissa Vaughan.

439.

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.

440.

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

Peter Pettit, Public Governor has asked: “In a recent article in the Health Services Journal, Chris Ham (5 January 2017) notes: “Sustainability and transformation plans must be backed up by resources, time and leadership and not become lost in the huge drive to get performance back on track.”  What risks does the Trust face in trying to deliver the BSW STP and whilst endeavouring to maintain service quality?”  Karen Johnson, Director of Finance, to respond.

Minutes:

Peter Pettit, a Public Governor had asked “In a recent article in the Health Services Journal, Chris Ham (5 January 2017) notes: “Sustainability and transformation plans must be backed up by resources, time and leadership and not become lost in the huge drive to get performance back on track.” What risks does the Trust face in trying to deliver the BSW STP and whilst endeavouring to maintain service quality?

 

In response it was explained that currently the Sustainability and Transformation Plan was progressing with limited resource. This had been discussed at a Leadership Group and whilst it was understood that that resources were very tight during the normal contracting round a decision was made to prioritise business as usual.  Now that the contracting round had been concluded resources would be re-prioritised to support the Sustainability and Transformation Plan. The Trust was committed to the plan and was actively progressing discussions around further integration with Swindon Clinical Commissioning Group. The Trust currently led on two of the seven Sustainability and Transformation Plan workstreams namely Finance and Acute Sustainability. The remaining five workstreams were Prevention, Planned Care, Urgent Care, IT and Estates. The Sustainability and Transformation Plan and business as usual would eventually become one of the same thing so in terms of the risks the Trust was taking on performance and then changing the quality of service it was considered that this was minimal at the moment.

441.

Minutes pdf icon PDF 284 KB

Roger Hill, Chairman

·        15 December 2016 (public and summary of private minutes)

·        5 January 2017 (public and summary of private minutes)

Additional documents:

Minutes:

The minutes of the meetings of the Board held on 15 December 2016 and 5 January 2017 were adopted and signed as correct records, subject to the following amendments: -

 

Minute 416/16 Quality Report - The deletion of the title “patient stories” and the substitution thereof with the title “Well Led”.

 

Minute 419/16 Safer Staffing – The deletion of the sentence “In response to a question from RH, HW advised that acuity and dependency were factors which had been built in to the national nurse to patient ratio” and the substitution thereof with the words “In response to a question from RH, HW advised that acuity and dependency were factors which had been built in to the new Allocate Safer Staffing (e-roster) system.”

 

Minute 420/16 Nursing Workforce Future

 

In the first sentence the deletion of the words “next two years” and the substitution thereof with “coming years”.

 

In the third paragraph the deletion of the words “HW highlighted that registered nurses had increased” and the substitution thereof with the words “HW highlighted that at Great Western Hospital registered nurses had increased”.

 

In the third paragraph the deletion of the last sentence and the substitution thereof with “HW advised that the Senior Team at this Trust believed that level seven was not appropriate in that it was too difficult and this view had been shared via Ruth May, NHS Improvement Director of Nursing.

 

The deletion of the last three paragraphs and the substitution thereof with the following: -

 

“The report set out retention efforts and training for registered nurses. HW flagged that the demand for nurses outstripped supply nationally. In the Comprehensive Spending Review last year a change to nursing bursaries was announced with the introduction of student loans from September 2017. It was flagged that applications to date showed a 20% reduction from the previous year for the take up of training places. It was highlighted that the Secretary of State had referred to an opportunity for people to take up an apprenticeship to obtain a nursing degree but as yet it was unclear how the funding available would support both the academic and employment costs.

 

The report set out enhancing the roles of Health Care Support Workers, in particular the development of the Nursing Associate role, and HW advised that a curriculum had been developed to understand what this role would look like. It was highlighted that there was professional disagreement around the role in that there was little difference in the curriculum between Registered Nursing and the Nursing Associate role. HW commented that the registered nursing workforce needed to look very different in the future. In response to a question from RH, HW advised that newly registered nurses might be better equipped to make changes to those who had been registered for some time. In response to a further question from NLB around offers of conversion courses, HW responded that there was no need for a conversion course as the new qualifications would lead into nursing  ...  view the full minutes text for item 441.

442.

Outstanding actions of the Board (public) pdf icon PDF 304 KB

Minutes:

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

 

416/16

Quality Report – blood culture hound badges used by others

OF reported that she had looked into this and had agreed that training was the appropriate response to address this matter. It was agreed that the action be removed from the tracker.

416/16

Quality Report – Stock Levels

OF reported that she had looked into this matter and there were no issues of concern regarding stock levels on Teal Ward. It was agreed that the action be closed on the Action Tracker.

418/16

Operational Report – Discharge/Prescriptions

AGr reported that this action would be discussed under the Operational Report to be considered later in the meeting.

419/16

Safer Staffing Report - data

HW advised that the data source included overtime. It was agreed that the action be closed.

412/16

CE Report – Integrated Performance Report

The Board noted that the Chief Executive and Chairman had met on 26 January 2017 and had concluded that a dashboard would not be in the Chief Executive’s report as this would be a duplication of information provided elsewhere.  The Executive summaries provided a comprehensive overview of the main issues with the detailed data and information contained within the accompanying reports.  Furthermore, the Board Assurance Framework provided detail of key metrics with quarterly comparisons which were being reporting through the Board Committees.  Also the production of a separate dashboard added another task to an already very busy Executive Team.  It was agreed that the action be closed.

 

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

443.

Chairman's Report, Feedback from the Council of Governors

Roger Hill, Chairman

Minutes:

The Chairman gave a verbal report as follows: -

 

Governor Effective Day – The Chairman reported that a Review Day had taken place in January looking at the effectiveness of the Council of Governors.  RH expressed thanks to the Non-Executive Directors who were able to attend. RH reported that the day was a well-received event and the feedback had been excellent.  RH thanked CN for her work in organising this event.

 

RH explained that Governors had considered a presentation on what it meant to be foundation trust and a refresh about their role.  A number of topics for focus over the next year were highlighted and there was a good discussion on how the governor working groups feeding into the Council of Governors could work differently to improve dialogue and involvement. The next steps included developing practical steps to deliver some change which would be worked through over coming weeks with governors involved. 

 

Council of Governors – RH highlighted that there was a meeting of the Council of Governors at 4:30pm in Lecture Hall 1 later today.  The Governors would be asked to agree local quality indicators and would have a briefing on the forthcoming Care Quality Commission inspection.  In addition Governors would be considering the recommendations of a Joint Nominations Committee on the appointment of a new Non-Executive Director.

 

RESOLVED

 

that the report of the Chairman be received.

444.

Chief Executive's Report pdf icon PDF 178 KB

Nerissa Vaughan, Chief Executive

Minutes:

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

 

·         Operational pressures since the beginning of the year

·         UK’s first four-lead pacemaker fitted at Great Western Hospital

·         Trust joins new mortality collaborative to improve hospital safety 

·         Critical Care Outreach Team available 24/7

·         Recruitment event for Swindon community staff

·         Maternity support worker receives national award nomination

·         Highlighting local healthcare options

·         More than 50 per cent of staff protected against flu

 

KJ highlighted the operational pressures since the beginning of the year commenting that during the first two weeks of January there had been an average of 220 people visiting the Emergency Department each day with around one third needing hospital admission.

 

KJ was pleased to report that the Cardiology Team at the Great Western Hospital had shown they were leading the way in their field after implementing the UK’s first four lead pacemaker. NLB commented that he was in support of innovation but questioned whether policies and procedures were in place around introducing new techniques. In response it was explained that innovations came through the Divisional Governance arrangements and any new ideas needed to be declared at Doctor’s appraisals. HW explained that the suggestion of a committee to consider innovation had been discussed and she undertook to raise this again with the Medical Director. However, it was confirmed that there were systems in place.  

 

KJ reported that the Trust had joined a new mortality collaborative with two other Trusts in the West of England to take part in a new initiative to better understand and review the factors that contributed towards unnecessary deaths. In response to a question raised by NLB it was agreed that Board Members be advised of the other two Trusts outside of the meeting.

 

KJ highlighted that a recruitment event for Swindon Community Staff had been held in Swindon at the end of January. OF commented that the event had been successful with 24 candidate nurses and therapists attending. At the event services had been show cased and the benefits of working for this trust had been highlighted.  In response to a question raised OF highlighted that some of those candidates were existing members of staff working for Wiltshire Health and Care who lived in Swindon and wished to work locally. OF commented that more recruitment events were planned throughout the year.

 

KJ highlighted that Kerry Wheeler, a Maternity Support Worker at the Great Western Hospital had been nominated for a national award by the Royal College of Midwives. In response to a question from JS, OF replied that there were plans in place to support Kerry Wheeler as an ambassador to promote recruitment and that OF had already made an initial approach to progress this.  The Board commended Kerry Wheeler on the nomination.

 

RESOLVED

 

that the report of the Chief Executive be received.

445.

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 9, together with a presentation as follows: -

 

Actual Operating costs

In month surplus of £132k. Total surplus of £238k compared to a target surplus of £467k. Year to Date (YTD) (variance of £229k worse than plan).

Contractual Income

£21.4m in month and £197.2m YTD (£1.6m above budget YTD).

Total Income

£26.8m in month and £238.7m YTD (variance of £0.3m above budget YTD).

Income Activity highlights

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

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

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

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

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

Total Expenditure

 

£26.6 in month and £238.4m YTD (variance of £0.5m above budget YTD).

Expenditure highlights in month:

·         Drugs £0.3m above budget (£1.5m above budget YTD).

·         Pay £0.2m above budget (£1.2m above budget YTD).

·         Supplies £0.3m above budget (£1.7m above budget YTD).

EBITDA

8.1% YTD

Savings

Savings plan of £14.24m of which £13m was in the forecast outturn position.

£1.0m CIPS delivered in month against a budget of £1.3m.

£9.6m delivered against a budget of £10.8m YTD (£1.1m below budget).

Debtors

£55.8m debtors and stock

£19.9m above plan

Creditors

£62.8m creditors

£9.4m above plan

Cash

£8.6m (£2.2m under plan)

Loan

No Further Loans Agreed

Reserves

-

Forecast

£44k surplus for the year (£556k 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 advised that the overall financial performance was behind plan by £229k including Sustainability and Transformation Funding (S&TF) of £6,397k and therefore there was an underlying position of £6,265k deficit. KJ highlighted that the Trust had been successful in its appeal over the loss of S&TF due to the non-achievement of A&E standards in Quarter 2. KJ highlighted that the year-end position had improved with a projected surplus of £44k.  

 

Reserves – KJ highlighted that reserves had reduced slightly from £1.2m to £1.14m but this did not take account of the full known pressures the Trust had experienced during January. KJ advised that reserves and the financial position generally had been discussed with NHS Improvement at a monitoring meeting held last week. The Trust was still in a vulnerable position but was in a better position than many Trusts nationally. January had been challenging and the decision made to invest in the relocated Ambulatory Care Centre had impacted further on the financial position.

 

Activity – KJ highlighted that activity had fallen in December compared to November in all areas. It was explained that although over the month in total activity was lower than planned, activity had been exceptionally high on a number of single days in December and this was reflected in income for A&E which was higher than planned. It was commented that  ...  view the full minutes text for item 445.

446.

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

Steve Nowell, 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 23 January 2017 which it was considered should be drawn to the attention of the Board covering the following: -

 

·         PFI Business Case

·         Overall financial performance

·         Income and Activity

·         Year End Forecast

·         Creditors

·         Rolling Cash forecast

·         Cost Improvement Programme (CIP) overview

·         Operational Performance report

·         Swindon Community Services

 

In presenting the report SN highlighted that the outcome overview of reference costs was encouraging in that the Trust’s cost base was lower than benchmark apart from some outliers which would be reviewed.

 

SN reported that a Service Review of Agency Spend and Controls had been undertaken resulting in a number of recommendations. It was flagged that Agency Spend was an area of concern in that the Trust benchmarked poorly in this area. OF continued to work on reducing Agency Spend across the organisation and a commitment had been made for a further £2m agency spend reduction next year.

 

Finally, SN highlighted that a training session was being organised for Non-Executive Directors on Trust finances and all members of the Board were invited to attend should they need training on Trust finances.

 

RESOLVED

 

that the report be received.

447.

Board Assurance Framework and 15+ Risk Register pdf icon PDF 403 KB

Carole Nicholl, Company Secretary & Head of Corporate Governance

Additional documents:

Minutes:

The Board received and considered a report which set out a summary of the Board Assurance Framework (BAF) in addition to risks scoring 15+ (extreme risks) as at 1 January 2017.  It was noted that there were 31 extreme risks, with the highest risk area being safety.

 

In presenting the report it was noted that whilst the Board Assurance Framework was aimed at seeking assurance to mitigate strategic risks it also provided assurances relating to matters within the remit of each Committee which enabled a way of understanding the current position and “predicting” the future. It was explained that the BAF was showing areas of warning/caution in relation to waiting time standards, environment, equipment, medicine safety, safe processes, patient safety, staff capacity, governance, IT, staffing levels (recruitment and retention) and staff wellbeing.

 

On consideration of the 15+ Risk Register, CN highlighted that whilst there had been improvement in the management of risk there was further work to do to embed consistent processes across all departments and all divisions. It was flagged that the Executive Committee at its meeting in January had discussed in detail the need to ensure that the Risk Register remained up to date and refreshed but that there was further work to do with divisions encouraged to ensure that their registers were maintained. Notwithstanding this the Committee noted that part of risk management was the consideration of risks and the Committee was assured through the reports from the divisions that this was happening.  It was noted that at its meeting in January the Executive Committee had cross referenced discussions of reports with the 15+ Risk Register, which would be reflected in the minutes.

 

It was noted that the Audit, Risk and Assurance Committee in January had considered a detailed report providing analysis of the full Risk Register and an overview of risk management within the divisions. That Committees view that whilst it was assured that satisfactory processes and systems were in place for the systematic management of risk within the organisation, compliance was inconsistent across all departments in all divisions all of the time with further attention particularly needed in the Planned Care Division and the Corporate Division. JS as Chair of the Audit Risk and Assurance Committee confirmed that the two divisions for focus were Planned Care and Corporate and that there was further work to do to embed risk management by all divisions. In response to a question raised regarding the newly added 15+ risk relating to a retiring member of staff, it was noted that the Risk Register was a live document and that any member of staff who had received training could place an item on the Register but that it was for the departments/divisions to review whether they were satisfied with the risk scoring, controls and mitigating actions.  This risk had yet to be reviewed.

 

AGr commented that he did not favour a system whereby individuals could place an item on the Risk Register without an initial consideration of that risk.  ...  view the full minutes text for item 447.

448.

Chair of Audit, Risk & Assurance Committee Overview pdf icon PDF 156 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

·         External Audit progress report and technical update / External Audit Plan 2016/17

·         Internal Audit Progress Report 2016-17

·         Counter Fraud Progress Report 2016/17

·         Year end audit and reporting timetable

 

In presenting the report JS highlighted the discussion on the 15+ Risk Register and the Board Assurance Framework reiterating that the Planned Care Division and Corporate Division had the most overdue risk reviews and outstanding actions.

 

JS highlighted that an External Audit Progress Report and technical update had been received and the impact on the new policy on Off Payroll Working (IR35) Rules for Public Sector Contractors would come into effect in April 2017. The Committee had noted that the Deputy Director of Finance was able to confirm that information on the IR35 Rules had already been received and that this had been shared with the Trust’s HR Department. A short report on the impact on this and the mitigation of any risks was to be presented to the next meeting.

 

JS highlighted that the Internal Audit Progress Report had set out the internal service reviews finalised in relation to financial accounting which had received reasonable assurance and payroll which had received substantial assurance.

 

JS reported that the Counter Fraud Progress Report had been received which included a summary of reactive work and the progress against the Local Counter Fraud Service Work Plan. JS highlighted that the Committee had requested early notification of possible significant alleged frauds being investigated elsewhere in order that the Trust might be able to learn from experiences nationally, particularly relating to cyber fraud.

 

Finally, JS highlighted that the Committee had reviewed the timetable for the Year End Audit and Annual Reporting. It was explained that in order to reduce the burden of producing a number of drafts of the Annual Report, CN was considering how information could be provided in as finalised form as possible.

 

RESOLVED

 

that the report be received.

449.

Improvement Plan Update pdf icon PDF 190 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.

 

In presenting the report HW explained that the Terms of Reference of the Improvement Committee had been changed to include Care Quality Commission (CQC) Inspection preparedness. The Committee was forward looking to assess the readiness of the organisation for a follow-up CQC inspection in March 2017. HW highlighted that presentations had been received from each of the Divisions which were encouraging and it was apparent that CQC inspection preparedness was being considered and prioritised across the organisation.

 

On a less positive note HW explained that the Internal Audit Advisory Review looking at some of the actions since the last inspection had been received. The Trust had performed well in communicating to front line teams but it was frustrating that all improvements were not embedded. Measuring and consistent reminders continued but it might be that the Trust might need to consider more inventive ideas on how to ensure improvement all of the time, on all of the requirements.

 

RESOLVED

 

that the report be received.

450.

Quality Report pdf icon PDF 144 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 December were as follows: -

 

·         Most recent Hospital Standard Mortality Rate (HSMR)was 99.56 (12 month period October 2015 to September 2016);

·         There were 3 cases of Clostridium difficile during December 2016;

·         There were 4 Serious Incidents and 2 internal Route Cause Analyses (RCA) were reported during December 2016;

·         There were 392 overdue investigations into incidents (by more than 14 days), 319 of which related to clinical incidents;

·         1 Freedom to speak up alert had been received during December 2016.

 

Hospital Standard Mortality Rate (HSMR) - In presenting the report HW advised that the Hospital Standard Mortality Rate (HSMR) for the Trust was 99.56 which was in the mid-range of the region containing 34 Acute Trusts in the former South West Strategic Health Authority area. HW explained that work continued to focus on sepsis performance, acute kidney injury and other initiatives to reduce hospital mortality rates.  Furthermore an electronic observation scheme was planned for next year which would support this.

 

Clostridium difficile - HW highlighted that Quarter 3 had ended with 16 Clostridium difficile cases against a trajectory of 15 but of those reviewed only one had been deemed avoidable. Given the activity of the Trust, this was an excellent achievement. HW explained that recently there had been a number of flu cases with the detail to be reported next month.

 

Patient safety - HW reported that in terms of patient safety, the Trust was maintaining high level clinical indicators despite the activity pressures being faced by the organisation. Most of the wards and departments were providing good caring for patients and quality standards were being delivered.

 

Cleaning standards - HW highlighted that there had been a small dip in cleaning standard. HW was due to meet with the new Carillion Housekeeping Manager later in February.

 

Serious incidents - HW highlighted that there had been no “never events” in December. There had been four serious incidents reported and two internal route cause analyses reported. HW explained that the Clinical Risk Team was to report back to a future meeting of the Patient Quality Committee on more timely learning. HW commented that disappointingly there were outstanding actions relating to Serious Incidents. The actions were more complex than had originally been anticipated but it was hoped that they would be completed during February.

 

RH questioned whether the level of incident reports would impact on the Trust’s rating as part of the CQC inspection. HW advised that the CQC would be keen to understand the Trust’s reporting rate and more importantly learning from incidents. It was explained that the Clinical Risk Team had produced a video with a view to encouraging staff to look differently at reporting, to ensure a culture whereby staff saw incident reporting as a positive thing and an opportunity for learning. HW advised that consideration of incidents and  ...  view the full minutes text for item 450.

451.

Chair of Quality & Governance Committee Overview pdf icon PDF 214 KB

Nick Bishop, Non-Executive Director

Minutes:

The Board received a report from the Chair of the Quality & Governance Committee which summarised key issues considered by that Committee at its meeting held on 20 January 2017 covering the following: -

 

·        Improvement Plan Update

·        Great Western Hospital Ophthalmology Department Options Paper – Hold File Management

·        Preparation for the CQC visit in March

·        Quality Report

·        Safer Staffing Monthly Exception Report

·        Board Assurance Framework – Strategic Risks aligned to this Committee

·        CQC and NHS Improvement Consultations

·        Well Led Governance Review

·        Corporate Governance Q3 2016/17 Report

·        Terms of Reference for Quality & Governance Committee

 

NLB highlighted that the Committee had considered a paper on hold file management in the Ophthalmology Department which detailed a requirement to align demand and capacity whilst implementing changes in service delivery to sustain the reduction in the hold file. The Committee had agreed that further monitoring and assurance should be undertaken by the Executive Committee with follow-up through the Divisional Performance meeting and had requested an update report on progress in six months’ time.

 

The Committee had received a report on the work of the Improvement Committee noting that there was further work to do around embedding improvements. In addition the Committee had noted that there was to be a refresh of the way the Trust looked at mortality with each Division asked to nominate a representative for a reinvigorated Mortality Group. However, there were no issues of concern to highlight on this issue.

 

RESOLVED

 

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

452.

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)) 

 

December 82% (not achieved)

Referral to Treatment + Incomplete standard (92%)

December 92.1% (achieved)

6 Week Diagnostic Wait

December 98.7% (not achieved)

Cancer Targets

2 Week Waits, 31 Day & 62 Day

November Achieved

 

Emergency Department (ED) 4 hour standard

 

AGr highlighted that although there had been less activity and fewer admissions, December had been challenging due to the large surges in activity. January had been as equally challenging with the hospital completely full and community capacity compromised. 

 

AGr explained that there were a number of actions which it was hoped would both reduce ED congestion and improve 4 hour performance, details of which were set out in the Chief Operating Officers overview, notably:

 

·         The transfer of Ambulatory Care from the Acute Medical Unit to the Clover Building;

·         Reorganisation of the medical take;

·         Conversion of 11 beds vacated by Ambulatory Care to an Acute Triage area;

·         Introduction of consultant “in-reach” and “hot clinics” in Urology, Respiratory Medicine and Cardiology;

·         Work to develop the frailty pathway;

·         Home to Assess;

·         Use of the Shalbourne Ward;

·         New Improvement Team.

In response to a question by JS regarding the possibility of patients being left in the Admissions Lounge it was explained that there were a number of cultural and process issues to work through and that it was anticipated that a dedicated Admission Lounge would speed up patient flow through ED.

 

In response to a further question from JS it was explained that patients would be discharged from the wards instead of a Discharge Lounge. AC questioned why this had not been instigated in the first instance rather than the creation of a Discharge Lounge. HJ responded that previously there had been a focus on the back end of a patient’s pathway.  However, there was now attention on the admission part of the patient pathway with a focus on identifying those most sick patients.   In response to a request made it was agreed that AGr present a report to the next meeting of the Performance, People and Place Committee outlining the proposed use of the Admissions Lounge to include diagrammatical information on patient flow.

 

In response to a comment from JM around the length of time a patient might be waiting on a ward to go home, it was commented that this would be no different to the patient waiting in a Discharge Lounge. However, the added benefit would be that by remaining on the ward the staff in the area would know of the patient’s care plan and would therefore be better placed to observe the patient prior to their discharge. 

 

In response to a question from SN, AGr explained that the gain from partners around improvement in  ...  view the full minutes text for item 452.

453.

Chair of Performance, People & Place Committee Overview pdf icon PDF 153 KB

Steve Nowell, Non-Executive Director

Minutes:

The Board received a report from the Chair of the Performance, People & Place Committee which summarised key issues considered by that Committee at its meeting held on 25 January 2017 covering the following: -

 

·        Terms of Reference / Forward Planning

·        Operational Performance Report

·        IT Projects Portfolio

·        Recruitment and Retention Plan

·        Monthly Workforce Report

·        Board Assurance Framework (BAF) – strategic risks

·        Internal Audit Reports

 

In presenting the report SN highlighted that the Committee had received a high level overview of IT projects which included a brief summary of the work being undertaken within IT. The Committee sought additional information on those projects with a priority score and requested that further information be provided post the arrival of the recently appointed head of I.T. in April on operational projects, clinical, corporate and IT infrastructure, IT disaster recovery, an outline of the staffing structure within the IT Department and relationships with partners, key strategic relationships and details of suppliers from a clinical and technological aspect.

 

SN highlighted that the Committee had before it the monthly Workforce Report and commented that this would be considered in more detail next month.

 

Finally, SN highlighted that the Committee received two Internal Audit reports, one on Waiting List Initiatives and one on Referral to Treatment operational practices.

 

RESOLVED

 

that the report be noted.

454.

Clinician-led Ward Improvement Presentation (SORT and TTA Project)

Helen Jones, Deputy Medical Director

Dr Anthony Kerry, Consultant Physician, Respiratory Medicine and

Dr Beas Bhattacharya, Consultant in Diabetes & Endocrinology and Clinical Lead Outpatients Specialties to present

Minutes:

The Chairman welcomed Beas Bhattacharya, Consultant Physician to the meeting who gave a presentation on the Trust’s To Take Away (TTA) project which covered the following:-

 

·         Aims of Project

·         Bed Utilisation

·         Patient Journeys

·         Challenges

·         TTA project

·         Challenges and action plans

 

In making the presentation the following points were made:-

 

  • There was an aim to increase patient discharges before noon each day.
  • There was a need for a line of communication between wards and the site to speed up processes.
  • The number of total hours that beds were empty needed to be read in the context of 80 outliers.
  • The information presented in the slides related to a two week period.
  • The challenges identified and solved could be rolled out to other areas.
  • Pharmacy presence had made a significant difference in focusing earlier discharge.
  • The ability to print from  a lap top had reduced wasted time.
  • There was a need to focus on a change in culture which in included nurses as well as clinicians.
  • The morning ward round was vital to speed up discharges.
  • There was a need to have enough Junior Doctors available and free to complete TTA’s.
  • Training was essential.

 

In a response to a question raised by KJ, AGr responded that the ideal period of time for a bed to be empty was the time it took from notification to the time the patient arrived. In response to a question raised by OF regarding prescriptions at the bedside, it was explained that Pharmacist support on the ward was required to allow for a quicker discharge. Doctors were writing prescriptions at the end of the ward round rather than at the bedside which resulted in patients staying longer.  It was suggested that Junior Doctors prioritising discharges was essential. TTA’s needed to be brought forward and to facilitate this, a change in culture and working practice was required.

 

NLB commented that most patients went home with the drugs they came in with and that discussion about drugs should take place as part of the ward round. TTA’s would be about a patient’s existing drugs unless a ward round identified other requirements. AGr advised that discussions were underway around the need for prescriptions to be pulled together on the basis of a patient’s existing prescription. Doctor Bhattacharya commented that delayed discharges were due to a number of factors and processes, each of which needed to be considered and reviewed.

 

In response to a question from AH, AGr reported that discussion were underway about a pharmacy workforce plan with a focus on ward pharmacists to facilitate prescribing and discharge.

 

In response to a question raised around the pilot study, HJ advised that the Pharmacists had been able to shift their priorities for the period of the trial and that in her view a Pharmacist Discharge Team was essential. The Hospital Pharmacy Transformation Board was considering this matter and whilst there was a good Pharmacy Service, prescribing needed to be extended to support earlier discharge.

 

In response to a question from AGr,  ...  view the full minutes text for item 454.

455.

Chair of Mental Health Governance Committee Overview pdf icon PDF 168 KB

Nick Bishop, Non-Executive Director

Minutes:

The Board received a report from the Chair of the Mental Health Governance Committee which summarised key issues considered by that Committee at its meeting held on 6 January 2017 covering the following: -

 

·         Deprivation of Liberty Safeguards (DoLS) Joint Quality Improvement Project – Woodpecker Ward GWH with Swindon Supervisory Body.

·         Mental Health Clinical Noting

·         Police notification to Darren Hiller ED Consultant re new category of people to ED

·         ED Workstream

·         Mental Health Act Policy

·         Use of Mental Capacity Act 16 – 17 year olds    

 

In presenting the report NLB commented that the Committee had received a report on Depravation of Liberty Safeguards Joint Quality Improvement Project which was working to ensuring patients under a DoLS at Great Western Hospital were being assessed in a timely manner. Details of the project were outlined in the report and it was noted that the project was progressing well. Issues for further development were outlined in the report which included the need for an increased number of assessments by the Swindon Supervisory Body.

 

JM commented that changing the dates of the meetings of the Committee had resulted in better attendance and this was noted.

 

RESOLVED

 

that the report be noted.

456.

Safer Staffing Monthly Exception Report pdf icon PDF 340 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 December the position was as follows: -

 

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

 

Registered Nurses

Auxiliary Nurses

Day Shift

89.4%

105.5%

Night Shift

103.1%

99.8%

 

Average skill mix ratio (day): -

RN

60.9%

Care staff

39.1%

 

HW reminded the Board that as reported at the last meeting, the Trust had accepted that it would not be able to fill to normal staffing levels so minimum numbers had been identified.  Therefore the Trust was reporting against those minimum numbers and not what had been agreed. HW advised that the shift fill rate remained at an acceptable level due to the use of temporary staff.  

 

RESOLVED

 

that the report be received.

457.

Calendar of Meetings 2017 pdf icon PDF 146 KB

Carole Nicholl, Director of Governance & Assurance / Company Secretary

Minutes:

The Board considered a draft calendar of meetings for 2017/18.  It was noted that it was not planned to have a meeting of the Performance, People and Place Committee in December due to the Christmas holiday period, but should it be considered necessary, a meeting would be arranged.

 

RESOLVED

 

that the calendar of meetings 2017/18 be agreed with the Director of Governance and Assurance delegated authority to make any amendments to the calendar throughout the year as required.

458.

Ratification of Decisions made via Board Circular/Board Workshop

Carole Nicholl, Company Secretary & Head of Corporate Governance

Minutes:

None.

459.

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.

460.

Date and Time of next meeting

Date: 2 March 2017

Time: 9:30am

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

Minutes:

It was noted that the next meeting of the Board would be held on 3 March 2017 at 9:30am in Trust Boardrooms, Trust HQ, Great Western Hospital, Swindon.

461.

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 Update

·        Wiltshire Community Estate Transfer Update

·        IT Projects Portfolio

·        CQC Self Assessment

·        Well Led Governance Review

·        Wiltshire Health & Care update

·        Audit, Risk & Assurance Committee Minutes

·        Charitable Funds Committee Minutes

·        Executive Committee Minutes

·        Finance & Investment Committee Minutes

·        Quality & Governance Committee Minutes

·        Mental Health Governance Committee Minutes

·        Performance, People & Place Committee

·        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 Update

·         Wiltshire Community Estate Transfer

·         IT Projects Portfolio

·         CQC Self-Assessment

·         Well-Led Governance Review

·         Wiltshire Health & Care

·         Audit, Risk and Assurance Committee Minutes

·         Charitable Funds Committee Minutes

·         Executive Committee Minutes

·         Finance and Investment Committee Minutes

·         Quality & Governance Committee Minutes

·         Mental Health Governance Committee Minutes

·         Performance, People & Place Committee Minutes

·         Urgent Private Business (if any)

462.

Minutes

Roger Hill, Chairman

·        15 December 2016 (private)

·        5 January 2017 (private)

Minutes:

The minutes of the meetings of the Board held in private on 15 December 2016 and 5 January 2017 were adopted and signed as correct records.

463.

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. 

464.

Sustainability & Transformation Plan Update (verbal report)

Kevin McNamara, Director of Strategy

Minutes:

The Board received a verbal update regarding the Sustainability & Transformation Plan.

465.

Wiltshire Community Estate Transfer - update

Kevin McNamara, Director of Strategy

Rupert Turk, Deputy Director of Estates & Facilities to present

Minutes:

The Board received and considered a paper which provided an update on progress with the Community Estates transfer.

 

466.

IT Projects Portfolio

Adrian Griffiths, Interim Chief Operating Officer

Minutes:

Consideration of this item was deferred pending prior discussion by the Performance, People and Place Committee.

467.

CQC Self Assessment (verbal report)

Hilary Walker, Chief Nurse

Carole Nicholl, Director of Governance & Assurance / Company Secretary

Minutes:

The Board received a verbal update together with slides presented at the meeting regarding the Trust’s self-assessment against the Care Quality Commission’s (CQC’s) key lines of enquiry.

468.

Well Led Governance Review

Carole Nicholl, Director of Governance & Assurance / Company Secretary

Minutes:

The Board received and considered a report which provided an overview of progress against milestone actions following a Well-Led Governance review conducted by Deloitte. It was flagged that the report had been considered by the Quality and Governance Committee but since that update, further actions had progressed, details of which were set out in the report.  The Board noted the report.

469.

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.

470.

Audit, Risk and Assurance Committee

Julie Soutter – Committee Chair

·        19 January 2017 (written report)

·        17 November 2016 (enclosure)

Minutes:

The minutes of the meeting of the Audit, Risk and Assurance Committee held on 17 November 2016 were received.  Furthermore, it was noted that a meeting of the Audit, Risk and Assurance Committee had been held on 19 January 2017.

471.

Charitable Funds Committee

Jemima Milton – Committee Chair

·        15 December 2016 (enclosure)

Minutes:

The minutes of the meeting of the Charitable Funds Committee held on 15 December 2016 were received.

472.

Executive Committee

Nerissa Vaughan – Committee Chair

·        17 January 2017 (verbal report)

·        20 December 2016 (enclosure)

Minutes:

The minutes of the meeting of the Executive Committee held on 20 December 2016 were received.  Furthermore, it was noted that a meeting of the Executive Committee had been held on 17 January 2017.

473.

Finance & Investment Committee

Steve Nowell – Committee Chair

·        23 January 2017 (written report)

·        23 December 2016 (enclosure)

Minutes:

The minutes of the meeting of the Finance & Investment Committee held on 23 December 2016 were received.  Furthermore, it was noted that a meeting of the Finance & Investment Committee had been held on 23 January 2017.

474.

Quality & Governance Committee

Nick Bishop - Committee Chair

·        20 January 2017 (written report)

·        22 December 2016 (enclosure)

Minutes:

The minutes of the meeting of the Quality & Governance Committee held on 22 December 2016 were received.  Furthermore, it was noted that a meeting of the Quality & Governance Committee had been held on 20 January 2017.

475.

Mental Health Governance Committee

Nick Bishop – Committee Chair

·        6 January 2017 (written report & enclosure)

Minutes:

The minutes of the meeting of the Mental Health Governance Committee held on 6 January 2017 were received. 

476.

Performance, People & Place Committee

Steve Nowell – Committee Chair

·        People Strategy Committee Minutes – 18 November 2016 (enclosure)

Minutes:

The minutes of the meeting of the People Strategy Committee held on 18 November 2016 were received. 

477.

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.